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<br />� WOOD BURNING EOUIPMENT
<br /> j. Wood stove with flue
<br />� Wood combination or add-on
<br /> Factory fireplace with flue
<br /> � Factory Fireplace (s) Freestanding Masonry
<br /> Wood Stove (s) Franklin, other
<br /> Brand Name Model No.
<br /> Mfgr's Min., Clearances, side , rea.r , min. flue dia..
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<br /> e VENTILATION
<br />� No. Kitchen Exhaust ducted recirculating cfm
<br />� No. Bath Exhaust (must be ducted outside) cfm
<br />� No. Other Fans: Locations cfm
<br /> FUEL STORAGE (MUST BE APPROVED BY FIRE MARSHAL)
<br /> Installation Removal
<br /> Fuel oil: gallons underground . inside outside
<br /> LP Gas: gallons
<br /> Other Gas opening
<br /> PERMIT FEE CALCULATION
<br />' 1. 1.25% of Contract Price* or Minimum F�e ($35.00�
<br /> f 1 c� ��� � � x .0125 $ �-��j ��
<br /> C - - - - - - - - - (contract price)� - - - -a - - - � � - -- - - -
<br /> � 2. Sta.te Surcharge. ** Add the Sta.te Building Code Division
<br />' Surcharge to each permit. � ��`'�, �� x .OQOS $ ��C'�
<br />�, or $.50, whichever is greater (contract price)
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<br />� 3. Postage and Handlin� (Only mail-in applications) $ 1.50
<br />` 4. TOTAL PERNIIT FEE (Add lines 1-3 above) $ � '� � �.�
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<br /> * CONTRACT PRICE or JOB COST means the actual or estimated dollar amount charged for the permitted
<br />�► - _ tu4rk in�]udine materials, labor, profit, and other fixed costs. It is the amount to be charged to the
<br />' customer for the work done. If any material, equipment, labor, or installation aze fumished 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 permit fee purposes. In the event that there is a dispute on the amount of the job cost,
<br />' the City may request the submission of a signed copy of the actual contract.
<br />. ** The STATE SURCHARGE is .0005 of the contract price under $1,000,000 or $.50 - whichever is
<br />; greater. For valuations over $1,000,000 call the Department of Inspectional Services for the price.
<br />' The undersigned hereby applies to the City for issuance of a Mechanical Permit, agrees to do
<br />� 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 sta.tements made on this application are complete, true .
<br />, and correct. , �
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<br />`r APPlicant's Signature: ���� Date: �� �
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<br />� Approved By: Date: �- � � �
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