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<br /> WOOD BURNING EOUIPMENT ��_�' . ������ �`>_._' -. �
<br /> �'� �
<br />��� Wood stove with flue - - - �. -� � �.r�-� �'
<br /> `-:��'� .�,� . ,
<br /> Wood combination or add-on � * �-�=�Y�- _
<br />�;; Factory fireplace with flue � `� � � ���
<br /> f' • 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.
<br /> � :��,�:-
<br /> ' '`"` '�� VENTII�ATION � -
<br />.� ..�� -��,Y
<br /> ak } i - No. Kitchen Exhaust ducted recirculating cfm
<br /> F _; �; — -:
<br /> � :� -- No. Bath Exhaust (must be ducted outside) cfm - 4:�
<br /> Y-��,�. �,_ . cfm
<br /> �
<br /> � No. Other Fans: Locations
<br /> ' �v j
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<br /> � 1 �-` FUEL STORAGE (MUST BE APPROVED �S Y r1TcE MARSHAL)
<br /> � � ` �',` Installation Removal
<br />° �.������,�.� ;
<br /> �.�:; �. Fuel oiL• gallons underground inside outside
<br />����` LP Gas: gallons �
<br /> T'� �� Other Gas opening
<br /> � �� �
<br /> :s�. � .
<br /> PERMIT FEE CALCULATION
<br /> 1. 1.25% of Contract Price* or Minimum Fee ($35.00) '
<br /> 3��0 x .o12s $ ���'75
<br />�,� . (contract price) , �
<br />���; ' 2. State Surcharge. ** Add the State Building Code Division �
<br /> ' :� � : Surcharge to each permit. x .0005 $ ���J ,
<br /> or $.50, whichever is greater (contract price) x�
<br /> �� r , , ��
<br /> ' 3. Posta�e and Handling (Only mail-in applicafions) $ 1.50 '
<br /> `' ,. ,.�� 4. TOTAL PERMIT FEE (Add lines 1-3 above) $ So�•o�� ?
<br /> * CONTRACT PRICE or JOB COST means the actual or estimated dollar amount charged for the pernutted
<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, equipment, labor, or installation are fumished by the owner, ��
<br /> - tenant or any other party the reasonable mazkec 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 /> k ,„� � . the Ciry may request the submission of a signed copy of the actual contract.
<br /> ��a,. .
<br /> " �" ** The STATE SURCHARGE is .0005 of the contract price under $1,000,000 or $.50 - whichever is
<br /> �r •
<br /> d:.' greater. For valuations over $1,000,000 call the Department of Inspectional Services for the price. 1
<br /> The undersigned hereby applies to the Ciry 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 Muinesota �
<br /> State Building Code, and certifies that all statements made on this application are complete, true �
<br /> X and correct. �
<br /> , �
<br /> - - Applicant's Signature: �,�- . Date: ��/-qy
<br /> .:�,
<br /> �
<br /> �,� -�-�� _� . � ;
<br /> r �" ,. "��` APProved By: Date: /Z � �
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