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l-13-1 9y7 1 :24P�-1 FRDPA F I RES I DE COR'VER 6'2 633 6432 ��_ :3
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<br /> � '�k� WOOD BU�'�IG EOUIPI'�NT��"�°`R x,_: A k,_:, � :� .� ���'
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<br /> �,� . � . .... Wood stove w�th flue�� ' � 1 ° � ��
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<br /> � ,:; .W'ood combina.tion or'add-on:: _ ', � ,_ ° , '� ;�.� � �.:
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<br /> 1 �,-_, . .. ., _ a
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<br /> �, s� _ Factory fir�place with flue , - � . .. ; ~, ' "." r x:,
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<br /> V..�_� Factory �xrepIace (s) •�", �, _'Frcestanding Ivlasanry � ,�;�
<br /> , . . ''Wood Stove (s) . Frank2ia, ocher . • �' . .
<br /> , BrandNan�e � �- c7t��=��jn MadelNo._- �
<br /> Mfgr's Min., Clearances, si e , reas , min.flue dia. �
<br /> ,�.r.. .�� Total '
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<br /> � _ �.:'-:VENTII.A'I'IaN _ _ - ' , s . � . .�
<br /> ,�� •No. Kitchen �c�aust r d�tete� recircu2ating _ , cfm ' �-
<br /> ''»',f" Nv. � Bath Exhaust {must be �ucted outside) Cfm f .�
<br /> _�f� No. Other Fans Lacations �� .
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<br /> �r.:.41��. , . � . . -� . . ., . . � ' .. .. , .. _�.'�.,�
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<br /> . `"`FU�L STt�RAGE {MUST BE APPROVED BY FTRE N�hSHAL)'' . -�_ ,
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<br /> InsLaliatiou. Reawval �. ' .�. � , .
<br /> � ' �'uel oi�: gall�as f undergro�nd imsideu ` .:" 'outside '�` y �-
<br /> LP Cas: gallons _ �
<br /> Otber Gas opening
<br /> PE�tMIT FEE C.�;,Y.CULATION. ,
<br /> , 1. 1.25% vf Cout,ract Prica* or Minim Fee ( 5� ��
<br /> , a�� x .0125 $ ..��� 00
<br /> � . (cau�act prica)
<br /> 2 State Surc��e. ** Add the State Bnilding Gode Division
<br /> � 'Surc�arge to each permit. ��OC.) x .4005 $ � 1 (� ,
<br /> . . (ca,atzact price) _
<br /> . vr $.50, wbic.�zever is greater . � `` ,
<br /> 3. Postaae and Handling (�aly mai�-in applzcations) $ , .50
<br /> 4. TC�TAL PERMIT FEE ` (Add iines 1-3 above) $ k�• '� ~ ,
<br /> * CONTRA.GT PRTCF or JOB COST means the acresal or escimated dollar araount c.�axgad foz t�e pe�miaaE
<br /> work iacluding maserials, l�.bor, pro�Zc, and ot6er fual costs. It is the amauut to be chargcd ta ihc
<br /> custozaer for tk�e work dax. I�aay m�aceriai, equipmeut, labo:,ar inssa:latiou aro fizmished by the owner,
<br /> - tenaat ar auy ot�er party the reasonabEc markei valuc of such items saust be added to the estimated cost
<br /> or coa�*�„-t pricc Por permit fce pnrposes.�In ih�eveus rhu ctxcre is a dispute on the azuount of the job cast.
<br /> r�Ze Ciry may request the submiss�on of a sig�ed coPY of the actuat coatracz. . - :
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<br /> , '� •"' The STATE SURCHAI2GE is .ObOS o#the eontr.�t price uader S1.000,Q00 0: SSO - whichever u - .
<br /> greater: For valua�ioas over S�,OOO,OOC1 caii the DePar�n�Bt vf Inspeational Sezt►ices for the�sica. �
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<br /> T�ie undersigned hereby appIies to the City for issuaace of a Mec�cal Permit; agrees to dn
<br /> all work in strict accord,ance with the ordi�uances af the Cxty a�d sIze regulations of tha Minnesvia
<br /> SLate Bt�ilding Code, �nd cer�tifie's that all statemeuLs made an this agplicatiou ar�complete, tn�
<br /> and cQrreCt. � -- - ., .
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<br /> - Applicani's Sigaature: Dars
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<br /> �Approved By:-; _ ' Date: __
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