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<br />�� WOOD B ING E UIPMENT
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<br /> Wood stove with flue � G��S �p� ��!�-�C `v �� - � r `
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<br /> Wood combination or add-on" � '=-�Y;�r' �¢,r�2Y` q
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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. '"�.j
<br />��; Mfgr's Min., Clearances, side , rear , min. flue dia. '�;;
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<br />,� a;�, VENTILATION ?�
<br />��N ��� 1"• No. Kitchen Exhaust ducted recirculating cfm
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<br /> ,, }a' . ,y;; No. Bath Exhaust (must be ducted outside) cfm �;
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<br />� � r" , FUEL STORAGE (MUST BE APPROVED BY FIRE MARSHAL) ��
<br /> �'^ Installation Removal
<br /> � � Fuel oil: gallons underground inside outside �
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<br /> LP Gas: gallons �
<br /> �� ' ' Other Gas opening
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<br /> f'�- �� � PERMIT FEE CALCULATION
<br /> � �' �r�= 1. 1.25% of Contract Price* or Minimum Fee ($35.00) - �-� �� v�
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<br /> -; -'�'��� x .0125 $ ��
<br /> � ' � - (contract price)
<br /> � ' 2. State Surchar�e. ** Add the State Building Code Division ,��y �
<br /> ' r- Surcharge to each permit. x .0045 $ ;�" �� �
<br /> �, ,. �� or $.50, whichever is greater (contract price) � �
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<br /> t 3. Postage and Handlin� (Only mail-in applications) $ 1.50
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<br /> � ���R� ' 4. TOTAL PERMIT FEE (Add lines 1-3 above) $ ,-�?,�' ..��� :�7r��
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<br /> � � �;��_, * CONTRACT PRICE or JOB COST means the actual or estimated dollar amount charged for the permitted �j
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<br /> j work including materials, labor, profit, and other fixed costs. It is the amount to be charged to the �,��/
<br /> g1M�., ,. � !��rSto:^er fcr?H� v�.�ork do.^.�. ii cSl j i 1uii.^.ia:� �'.'�uiYlliL'aii� i3�v:� �^•t il�ii:liia�:Cii1 aZI'�. ��iaTtiStlGu riy lliG O w ii�i� �
<br /> - tenant or any other party the reasonable market value of such items must be added to the estimated cost
<br /> ,, r _ or contract price for pernut 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. �t,
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<br /> 4 � �.- ** The STATE SURCHARGE is .0005 of the contract price under $1,000,000 or $.50 - whichever is �
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<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 statements made on this application are complete, true t
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<br /> and correct. '� " j
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<br /> �'�� Apphcant's Signature: � _�=�' C;��� � '�� s Date: -7 OC� �:9°'
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<br /> a,=;;' Approved By: Date:
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