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<br /> WOOD BURNING EQUIPMENT �,�
<br /> Wood stove with flue `:�
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<br /> Wood combination or add-on
<br /> Factory fireplace with flue "�$
<br /> Factory Fireplace (s) Freestanding Masonry `"�
<br /> Franklin, other �
<br /> Wood Stove (s) �
<br /> Brand Name Model No. ��
<br /> Mfgr's Min., Clearances, side , rear , min. flue dia. �
<br /> X.;
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<br /> VENTII.ATION ,(o�:r-� ��
<br /> No, i �Kitchen E�aust �_ ducted recirculating cfm s
<br /> No. Bath E�aust (must be ducted outside) cfm =i
<br /> No. Other Fans: Locations cfm �
<br /> FUEL STORAGE (MUST BE APPROVED BY FIRE MARSHAL)
<br /> Installation Removal
<br /> Fuel oil: gallons underground inside outside ;�
<br /> LP Gas: gallons `_
<br /> �a
<br /> Other Gas opening ;;�
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<br /> PERMIT FEE CALCULATION �b
<br /> 1. 1.25% of Contract Price* or Minimum Fee ($35.00) '�
<br /> z<.
<br /> 'z 77j`� x .0125 $ �
<br /> (contract pr:ce)
<br /> 2. State Surcharge. ** Add the State Building Code Division "'
<br /> Surcharge to each permit. x .0005 $
<br /> or $.50, whichever is greater (contract price) �
<br /> 3. Posta�e and Handlin� (Only mail-in applications) $ 1.50
<br /> 4. TOTAL PERMIT FEE (Add lines 1-3 above) $ y
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<br /> * CONTRACT PRICE or JOB COST means the actual or estimated dollar amount charged for the pemutted :�
<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 party the reasonable market value of such items must be added to the estimated cost
<br /> or contract price for pemut fee purposes. In the event that there is a dispute on the amount of the job cost, _q
<br /> the City may request the submission of a signed copy of the actual contract. �
<br /> under �1 000,000 or $.50 - whichever is ��
<br />�' ** The STATE SURCHARGE is .0005 of the contract pnce , �
<br /> ;- greater. For valuations over $1,000,000 call the Department of Inspectional Services for the price. tt
<br /> k,. as
<br />�j: The undersigned hereby a�plies 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 x
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<br /> and conect. �
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<br /> Applicant's Signature: �v; Date: f/ 3 d�
<br /> � � Date:
<br /> Approved By:
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