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<br /> WOOD BURNING EOUIPMENT ' ' , '''r,, _ °
<br /> Wood stove with flue _ k �`:'''., _ � , �- ° =
<br /> Wood combination or add-on ; ' ' `� ' ��:
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<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 , rear , min. flue dia. � ,��.,`
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<br />� ,�' VENTILATION � ,' .
<br /> No. Kitchen Exhaust ducted recirculating cfm `'`� "�'�
<br />`'"�- ` ;' No. Bath Exhaust (must be ducted outside) cfm
<br /> - No. nther Fans: T ocations 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 Fee ($35.00) � �
<br /> � //�, Cr� x .0125 $ �� , 0
<br /> (contract price)
<br /> 2. State Surchar� ** Add the State Building Code Division �
<br /> Surcharge to each permit. �? !/�, C'�J x .0005 $ l ,
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<br /> or $.50, whichever is greater (contract price)
<br /> 3. Posta�e and Handling (Only mail-in applications) $ 1.50 ' `
<br /> 4. TOTAL PERMIT FEE (Add lines 1-3 above) $ �} 7. .5:� •'�` �
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<br /> * CONTRACT PRICE or JOB COST means the actual or estimated 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 for the work done. If any material, rquiPment, labor, or inst«Ilatior are 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 pemut fee purposes. In the event that there is a dispute on the amount of the job cost,
<br /> the Ciry 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 /> F ' greater. For valuations over $1,000,000 call the Department of Inspectional Services for the price.
<br />�� The undersigned hereby applies to the City for issuance of a Mechanical Permit, agrees to do
<br /> all work in strict accordance with the ordinances of the City and the regulations of the Minnesota
<br />¢ State Building Code, and certifies that all statements made on this application are complete, true � :.,
<br /> r�:�: and correct. , �
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<br /> Applicant's Si�nature: �� ���� � Date:
<br /> � ` 9
<br /> Approved By:
<br /> Date: �/` �$ 'l5
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