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<br />`�'� WOOD BURNING EOUIPMENT ��� � �
<br /> . � �,� �,_ �,
<br />�' Wood stove with flue ��� �F�{"�'�" �
<br /> �
<br /> "�. Wood combination or add-on
<br /> Factory fireplace with flue '
<br /> � :
<br /> • Factory Fireplace (s) Freestanding Masonry ;�;;`
<br /> 5 Wood Stove (s) Franklin, other
<br /> r � ..�.�- � . . .
<br /> Brand Name Model Na
<br /> Mfgr's Min., Clearances, side , rear , min. flue dia. t
<br /> VENTILATION � .
<br /> � No. Kitchen Exhaust ducted recirculating cfm
<br />�r"�: No. Bath Exhaust (must be ducted outside) cfm
<br /> � " �� � No. Other Fans: Locations cfm
<br /> ry" FUEL STORAGE (MUST BE APPROVED BY FIRE MARSHAL) ?
<br />��
<br /> Installation Removal
<br /> `� v,� Fuel oil: gallons underground inside outside �'�
<br />� �' LP Gas: gallons
<br />'" ` � Other Gas opening
<br /> F�,
<br /> '
<br /> PERMIT FEE CALCULATION
<br /> �� 1. 1.25% of Contract Price* or Minimum Fee ($35.00) ,
<br /> � „� G����`-" x .0125 $ ��'� `�r ;�„
<br />,� � (contract price)
<br /> � 2. State Surchar�e. ** Add the State Building Code Division
<br /> � � Surcharge to each permit. x .0005 $
<br /> };
<br /> , , ` or $.50, whichever is greater (contract price)
<br /> � �f 3. Postage and Handlin� (Only mail-in applications) $ 1.50
<br /> 4
<br /> `"` 4. TOTAL PERMIT FEE (Add lines 1-3 above) $ _�� - ��.� `` , _;
<br /> F ' ��s
<br /> :.:�^ ' * �.i�i
<br /> CONTRACT PRICE or JOB COST means the actual or estimated dollar amount charged for the permitted
<br /> �� - _ work including materials, labor, profit, and other fixed costs. It is the amount to be charged to the
<br /> 1 � � �M customer for the work done. If any material, equipment, labor, or installation aze fumished by the owner,
<br /> �. p tenant or any other party the reasonable market value of such items must be added to the estimated cost
<br /> ; = a�a,,:-: , � or contract price for permit fee purposes. In the event that there is a dispute on the amount of the job cost,
<br /> � �•r s � the City may request the submission of a signed copy of the actual contract: <<
<br /> � � « �
<br /> <.� t,r;,�� �"`;�..�;
<br /> � : � � ** The STATE SURCHARGE is .0005 of the contract price under $1,000,000 or $.50 - whichever is � �
<br /> ,t��'' " ~ 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 r�vith the ordinances of the City and the regulations of the Minnesota
<br />�,,, °` State Building Code, and ce�tifies that all statemen made on this application are complete, true
<br /> �� and correct. � ���'
<br /> ,,
<br /> A licant's Si atur ��� 1� � ��� Date: �f �'
<br /> PP �
<br /> 1.
<br /> Approved By: Date:
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