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<br /> { *�'°�� `"' WOOD BURNING EOUIPMENT
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<br /> � .f- Wood stove with flue
<br /> � ���'rx�'� Wood combination or add-on �:���
<br /> �� Factory fireplace with flue o_ "� ;
<br />� _� Factory Fireplace (s) Freestanding Masonry -��� ;�.'-
<br />� Wood Stove (s) Franklin, other �
<br />��"�:, Brand Name � � Model No. �
<br />� C� Q�?�' �;;:
<br /> ��-,g���-`� :.:�.,�: Mfgr's Min., �Clear ces, side , rear , min. flue dia. ;;�
<br />� T"ak�.�-L3y' ,,,�t
<br /> ; 4 ,� ` i
<br /> , ,��" VENTILATION ;
<br /> � � 5�' `•` No. Kitchen Exhaust ducted recirculating cfm i;
<br />� � f No. Bath Exhaust must be ducted outside cfm , -��
<br />�+ �� : �� .�. -;�� � )
<br /> No. Other Fans: Locations _�_ � �_�__ __ cfm . f ,�`'
<br />�a«-+�� � K
<br />��" ��°�' FUEL STORAGE (MUST BE APPROVED BY FIRE MARSHAL) ' y
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<br />�;-�i�,,�'" Installation Removal F°� `�'
<br /> 1 � y� �}"Y� IY>�: ',
<br /> � -��=•� Fuel oil: gallons underground inside outside � ' ��
<br />��' �riJ� "� . L P G a s: g a l l o n s a� � Y�:
<br />��h<�� '�. } _ Other -- --- -- Gas opening °;
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<br />��, PERMIT FEE CALCULATION 7
<br />��; 1. 1.25% of Contract Price* or Minimum Fee 35.00
<br /> �
<br /> �-��-�-�<' ���� X .oi2s $ .�.D� � ���
<br />���'���'' (contract price) -
<br /> ` ' 2. State Surcharge. XX Add the State Building Code Division
<br />�` '�
<br /> ^f Surcharge to each permit. �z7,";'�U-� x .0005 $ %, (J �
<br /> :�� �:: or $.50, whichever is greater (concract price)
<br /> �_
<br />����` �7��, 3. Posta�e and Handlin� (Only mail-in applications) �� $ 1.50 �� �
<br />���>� ;;� 4. TOTAL PERMIT FEE (Add lines 1-3 above) $ � ) � �j � :;,:
<br /> rt��7 x:�.�'
<br /> � �h ,�
<br />�"' x� � * CONTRACT PRICE or JOB COST means the actual or estimated dollar amount charged for the permitted
<br />,���a'��'� �"� ,� work including materials, labor, profit, and other fixed costs. It is the amount to be chareed to the
<br />��-� � - cu.sivmer ior the �;�ark cor e. If ar,y ir�teri�, equiprnent, Iaut3I', ar installat'ron are furnisned by the owner,
<br />�'�,�r ':, tenant or any other party the reasonable market value of such items must be added to the estimated cost �,
<br /> or contract price for pernut fee purposes. In the event that there is a dispute on the amount of the job cost, _
<br /> x � ^�� the City may request the submission of a signed copy of the actual contract.
<br />�` �
<br />�ri�, �� ` ** The STATE 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 /> �`"�' ��n=` The undersigned hereby applies to the City for issuance of a Mechanical Permit, agrees to do
<br /> ,
<br />>� �>,:" all work in strict accordance with the ordinances of the City and the regulations of the Minnesota
<br /> �Ix k '•- s�
<br /> ,T �.�:` State Building Code, and certifies that all statements made on this application are complete, true
<br /> , , ,: :
<br /> ,r, and correct. �
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<br /> Applicant's Signature: ' �� � Date• LP � �� .
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<br /> y Approved By: _ Date:
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