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<br />��; �',� �i,P..�//�/ ' C/v�T�/�L �,
<br /> , �OUIPMENT , k,�: '"
<br /> Wood stove with flue ���' ` � � ���
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<br /> Wood combination or add-on
<br /> _� Factory fireplace with flue ��oc.�Cj�d�.Ln/ d�L�(> ' `�
<br /> Factory Fireplace (s) Freestanding Masonry
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<br /> Wood Stove (s) Franklin, other ��
<br /> 5 ,�'����`� BrandName;�U��`'�Z�o/� ModelNo. ,�Y�S f'/�iCIS ���
<br />" � Mfgr's Min., Clearances, side � , rear_�, min. flue dia. g"�' ;k
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<br />�`��� VENTILATION � ''
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<br />'�' No. Kitchen Exhaust ducted recirculating cfm �r
<br /> No. Bath Exhaust (must be ducted outside) cfm
<br /> t No. Other Fans: Locations cfm
<br /> � FUEL STORAGE (MUST RE APPROVED BY FIRE MARSHAL)
<br />��> Installation Removal
<br />�
<br />� Fuel oil: gallons underground inside outside
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<br />� ° � LP Gas: gallons �
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<br />�' Other - Gas opening
<br /> PERMIT FEE CALCULATION �
<br />�� 1. 1.25% of Contract Price* or Minimum Fee ($35.00)
<br />�`�� x .0125 $
<br />�. (contract price)
<br />�.�.,
<br />�� 2. State Surcharge. ** Add the State Building Code Division
<br />��� Surcharge to each permit. x .0005 $
<br />�:� or $.50, which�ver is greater (contrac[ price) >;
<br />�'
<br />� 3. Posta�e and Handlin� (Only mail-in applications) $ 1.50
<br />}�' 4. TOTAL PERMIT rEE (Add lines 1-3 above) $
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<br /> t.�; * 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, equipment, labor, or installation are furnished by the owner, �
<br />��� tenant or any other par[y the reasonable mazket value of such items must be added to the estimated cost
<br /> Y�` or contract price for permit fee purposes. In the event that there is a dispute on the amount of the job cost, �h'
<br />�' the City may request the submission of a signed copy of the actual contract. ft
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<br /> ** The S"IATE 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 /> M::.
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<br /> ` � The undersigned hereby appl i,;� to the City for issuance of a Mechanical Permit, agrees to do
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<br />�;;� all work in strict acc�r�+ance with the ordinances of the City and the regulations of the Minnesota
<br />"�� State Building Code, and certities that all statements made on this application are complete, true
<br />�� and correct. �
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<br />�. Applicant's Signature• � Date: ;
<br />�;°. i;l
<br />'F»'.:
<br />�' Approved By: Date: i
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