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<br /> WOOD BURNING EQUIPMENT
<br /> Wood stove with flue
<br /> Wood combination or add-on �`��
<br /> , t, } Factory fireplace with flue
<br /> �: � - �-�� Factory Fireplace (s) Freestanding Masonry
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<br /> �. � Wood Stove (s) Franklin, other
<br />, `� � Brand Name Model No.
<br /> t`�r`,` r` Mfgr's Min., Clearances, side , rear , min. flue dia.
<br />�~ VENTILATION
<br />```'"' No. Kitchen E�aust ducted recirculating cfm
<br /> � No. G� �ath E�haust (must be c�ucted outside� cf_m
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<br /> No. Other Fans: Locations cfm
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<br /> FUEL STORAGE (MUST BE APPROVED BY FI MARSHAL)
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<br /> Installation Removal
<br /> Fuel oil: gallons underground inside outside
<br /> LP Gas: gallons
<br /> � '' Other �_ Gas opening
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<br /> �` PERMIT FEE CALCULATION
<br /> '` l. 1.25% of Contract Price* or Mini um Fee 35.00
<br />�� � ('��)t�� x .0125 $ �
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<br />'k� (contract price) `
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<br />��;. 2. State Surchar�e. ** Add the State Building Code Division
<br />��s Surcharge to each permit. x .0005 $
<br /> or $.50, whichever is greater (contract price)
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<br />�,�� 3. Posta�e and Handlin� (Only mail-in applications) $ 1.50
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<br /> ���-� 4. TOTAL PERMIT FEE (Add lines 1-3 above) $
<br /> * CONTRACT PRICE or JOB COST means the actual or estunated dollar amount charged for the permitted
<br /> work including materials, labor, profit, and other fixed costs. It is the amount to be charged to the
<br /> customer far the work done. 1:any maierial, equipmerri, tabor, �n-ir�stat2atiar, are fun�ishe�l by the owner,
<br /> `� = tenant or any other party the reasonable market value of such items must be added to the estimated cost
<br /> �� ' � �`� . or contract price for pernut fee purposes. In the event that there is a dispute on the amount of the job cost,
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<br /> k < �f��` the City may request the submission of a signed copy of the actual contract.
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<br /> � � �� * `�' ** The STATE SURCHARGE is .0005 of the contract price under $1,000,000 or $.50 - whichever is
<br />"y ' � '�' greater. For valuations over $1,000,000 call the Department of Inspectional Services for the price.
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<br /> The undersigned hereby applies to the City for issuance of a Mechanical Permit, agrees to do
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<br /> b�. .�z � �:` all work in strict accordance with the ordinances of the City and the regulations of the Minnesota
<br /> '' State Building Code, and certifies that all statements made on this application are complete, true
<br /> �'�} and correct.
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<br /> �- Applicant's Signature: Date:
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<br /> Approved By: Date:
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