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<br /> � WOOD BURNING EOUIPMENT , � ��
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<br /> Wood stove with flue r,�; ��
<br /> Wood combination or add-on ��' � t � �
<br /> Factory fireplace with flue � "���F �
<br /> Factory Fireplace (s) Freestanding Masonry ���`��
<br /> � ' ' Wood Stove (s) Franklin, other ���f`
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<br /> `" ��� Brand Name Model No. �`'� '�
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<br /> '�.� Mfgr's Min., Clearances, side , rear , min. flue dia. � � y
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<br /> VENTILATION `� ��.
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<br /> No. Kitchen Exhaust ducted recirculating cfm ;���.
<br /> : ,� No. Bath Exhaust (must be ducted outside) cfm ;���
<br /> No. � Other Fans: Locations cfm �
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<br /> z,„�� FUEL STORAGE (MUST BE APPROVED BY FIRE MARSHAL) ,w,.:��
<br /> Installation Removal
<br />`}1 Fuel oil: gallons underground inside outside
<br />�" LP Gas: gallons :s;
<br /> ��' Other Gas opening
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<br /> r PERMIT FEE CALCULATION ,-
<br />�: 1. 1.25% of Contract Price* or Minimum Fee ($35.00) €�d
<br /> � x .0125 $ _ _3S 7� '��
<br /> � (contract price) �'�
<br />-� 'Y 2. State Surchar� ** Add the State Building, Code Division '
<br /> ��'�� , Surcharge to each permit. �-�(�c� ��`� x .0005 $ /. �.� �
<br /> �f ; or $.50, whichever is greater (contract price) j
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<br /> �"y��Yr� T 3. Postage and Handling (Only mail-in applications) , $ -�-56
<br /> �k�.,�,: 4. TOTAL PERMIT FEE (Add lines 1-3 above) $ 37•d�
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<br /> �` CONTRACT PRICE or JOB COST means the actual or estimated dollar amount char ed for the ermitted �
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<br /> � `� r 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 insiallation are furnished by the owner, ;�;
<br /> � tenant or any other party the reasonable mazket value of such items must be added fo 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, �l
<br /> "� �� x ` the City may request the submission of a signed copy of the actual contract. �'�
<br /> � � :;�
<br /> ** The STATE SURCHARGE is .0005 of the contract price under $1,000,000 or $.50 - whichever is
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<br /> _ greater. For valuations over $1,000,000 call the Department of Inspectional Services for the price.
<br /> The undersigned hereby applies to the City for issuance of a Mechanical Permit, agrees to do 1
<br /> all work in strict accordance with the or ' _ ces of the City and the regulations of the Minnesota
<br /> State Building Code, d certifies that a statements made on this application are complete, true '��
<br /> ��� and correct. ' �'
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<br /> '��� - Applicant's Signature: �li'� "� Date: � -- 7 �� r��.
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<br /> Approved By: G� Date: �,, �
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