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<br />� WOOD BURNING EOUIPMENT � � � �
<br /> `� Wood stove with flue � :_ ` i
<br /> � , .
<br /> { t , � , _ Wood combination or add-on � � � � ;; „ '
<br /> � '
<br /> f�' Factory fireplace with flue �;�;�:f � 'a�;
<br />�;� Factory Fireplace (s) Freestanding Masonry
<br /> E��-' Wood Stove (s) Franklin, other
<br /> i Brand Name Model No.
<br /> � ,-: �r Mfgr's Min., Clearances, side , rear , min. flue dia.
<br /> �_ ,;
<br /> ,; .
<br /> .,s
<br /> ,�.� '��; VENTILATION �,�� � '
<br />'� �� No. � Kitchen Exhaust ' ducted recirculating cfm � � - ��
<br />�' r,TM .` `"- ;i_;: No. Bath Exhaust (must b ducted outside) cfm �� � ��' � r
<br />���Er�r_�" No. _ - Other Fans: Locations _ cfm ,�����,. `'„ �
<br /> � �
<br />� � , 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 /> _ ,•,. -. , _; ����
<br />�'��'� PERMIT FEE CALCULATION � r �
<br /> � ��:'.
<br /> � 1. 1.25% of Contract Price* or Minimum Fee ($35.00) �
<br />.._..__ � ���00 .`� x .0125 $ �jj� � �`° �
<br /> (contract price) ��
<br /> , - 2. State Surcharge. ** Add the State Building Code Division ` `� �
<br />' � i :: Surcharge to each permit. x .0005 $ �, 2� -� ��� °
<br />�� ;� �° �� � or $.50, whichever is greater (con�ract price) �� "''"�� '
<br /> �t
<br /> �-. �
<br /> � � '�` : ,
<br /> ��
<br />��`�;'' 3. Posta�e and Handling (Only mail-in applications) $ 1.50 '"'
<br /> ��° �' 4. TOTAL PERMIT FEE (Add lines 1-3 above) $ �7?� � � �'
<br /> `� ����� ^( �J 4
<br /> � ���.;x �4 � * CONTRACT PRICE or JOB COST means the actual or estimated dollar amount charged for the permitted �,! ��
<br /> ; ,.
<br /> �:s� .Y�rk incliiriin�a materials, 1?.hpr, nrofr, and other fized costs. It is the amount to be chazged to the �
<br /> �� �'* , . 'r :' customer for the work done. If any material, equipment, labor, or installation aze fumished by the owner, f� ��
<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 /> �,,t�,
<br /> T rf�' the Ciry may request the submission of a signed copy of the actual contract. ,� �<:
<br /> ,�
<br /> �t�' ' ** The STATE SURCHARGE is .0005 of the contract price under $1,000,000 or $.50 - whichever is ��_
<br /> �F .•J f. . � :
<br />�' i°#' greater. For valuations over $1,000,000 call the Department of Inspectional Services for the price. ;
<br /> ,,.7'7 ��.;..��. �� •'.
<br />� , The undersigned hereby applies to the City for issuance of a Mechanical Permit, agrees to do ,��.,�Y�
<br />� *.'= all work in strict accordance with the ordinances of the City and the regulations of the Minnesota t.�;. �,� t
<br /> State Building Code, and certifies that all statements made on this application are complete, true ��; ��`
<br />�, �
<br />� and correct. ='�'��'
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<br /> Applicant's Signature: � Date: �oz�1� N' � �
<br />�,; �
<br />�s Approved By: Date: '��
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<br /> M',Y
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