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<br /> WOOD BURNING EOUIPMENT
<br /> Wood stove with flue
<br /> Wood combination or add-on
<br /> Factory fireplace with flue �°
<br /> � Factory Fireplace (s) Freestanding Masonry - t� s
<br /> Woai Stove (s) Franklin, other '�
<br /> Brand Name Model No. *;
<br /> 3;; Mfgr's Min., Clearances, side , rear , min. flue dia.
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<br /> VENTILATION
<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 /> � FUEL STORAGE (MUST BE APPROVED BY FIRE MARSHAL)
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<br /> Installation Removal a�
<br /> Fuel oil: gallons underground inside outside .�
<br /> LP Gas: gallons �"''
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<br /> - Other Gas opening
<br /> PERMIT FEE CALCULATION
<br />" 1. 1.25% of Contract Price* or Minimum Fee ($35.00)
<br /> ��/JO . °° x .0125 $ .
<br /> " (contract price) "
<br />}� 2. State Surchar�e. ** Add the State Building Code Division j
<br /> � Surcharge to each permit. �/(,��. 6d x .0005 $ ff , ��
<br />�� or $.50, whichever is greater (contract price) `}
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<br /> 3. Postage and Handlin� (Only mail-in applications) $ 1.50 �
<br /> J` 4. TOTAL PERMIT FEE (Add lines 1-3 above) $ ,a� . _SS �
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<br /> * CONTRACT PRICE or JOB COST means the actual or estimated dollar amount chazged for the permitted
<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 aze furnished by the owner,
<br /> tenant or any other party ihe reasonable market value of such items must be addeci 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, x;.�
<br /> ` the City may request the submission of a signed copy of the actual contract.
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<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
<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 statem�ts made on this application are complete, true ��: � �
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<br /> and conect. '�' � ��`
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<br /> Applicant's Signatur Date: /Q -��-ot�
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<br />{�, Approved By: `�� Date: :�
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