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<br />�}``��� ��� WOOD BURNING EQUIPMENT "
<br /> a;
<br />�, � Wood stove with flue #�
<br /> ry. { Wood combination or add-on �.x `: �
<br /> Factory fireplace with flue
<br /> t . Factory Fireplace (s) Freestanding Masonry
<br />° Wood Stove (s) Franklin, other ��
<br /> s ��
<br /> Brand Name Model No. ` `-
<br />� �' Mfgr's Min., Clearances, side_ , rear , min. flue dia. �;
<br /> Total
<br />� ti VENTILATION
<br /> No. �_ Kitchen Exhaust � ducted �recirculating � cfin
<br /> No. �L Bath Eachaust (must be ducted outside) S� ���cfm
<br /> No. Other Fans: Location.s cfm
<br /> Total
<br />�
<br /> r ' 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) �,U_
<br />� �' �`-/.��� x 1.25 $ �
<br /> y�
<br /> —�(contract price) _
<br /> °�:
<br /> 2. State Surcharge. ** Add the State Building Code Division
<br /> Surcharge to each permit. ��f�' x .0005 $ .3,,�
<br /> ✓ (contract price)
<br /> 3. Posta�e and Handlin� (Only mail-in applications) $ 1.50
<br /> � 4. TOTAL PERMIT FEE (Add lines 1-3 above) $ �}'/,J,��
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<br /> * CONTRACT PRICE or JOB COST means the actual or estimated dollaz amount chazged for the pernutted
<br /> wort; inciuding maceriais, labor, prot2t, and other nxed costs. it is tlie amount io 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 party the reasonable market 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 />�' : the City may request the submission of a signed copy of the actuai contract.
<br />�.:,
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<br />"'` ** The STATE SURCHARGE is .0005 of the contract price under $1,000,000 or $.50 - whichever is
<br /> �
<br />�`` greater. For valuations over $1,000,000 call the Department of Inspectional Services for the price.
<br /> E.°r;
<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 />�
<br /> and correct. �
<br /> � , � - Date: J_� ��
<br /> ' Applicant's Signature: < <
<br />�;: ;�';
<br />�,
<br /> T' Approved By: Date:
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