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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 '
<br /> Wood Stove (s) Franklin, other
<br /> Brand Name Model No.
<br /> Mfgr's Min., Clearances, side , rear , min. flue dia.
<br /> VENTILATION
<br /> No. Kitchen Exhaust ducted recirculating cfm
<br /> No. Bath Exhaust (must be ducted outside) cfm
<br /> No. 3 Other � Locations � p�lG a.�r-�e�-�'�
<br /> .5(D�A ���►loirc huvhid�fiexl 155 /�'l�t� Li�'e/jt'�afh �1I
<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
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<br /> PERMIT FEE CALCULATION
<br /> 1. 1.25% of Contract Price* or Minimum Fee ($35.00) �;
<br /> 500�.0o x .0125 $ � �2•�
<br /> (contract price) �
<br /> 2. State Surcharge. "" Add the State Building Code Division
<br /> Surcharge to each permit. �j pao.cs� x .0005 $ �. S� ;, -y
<br /> or $.50, whichever is greater (contract price)
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<br /> 3. Posta�e and Handling (Only mail-in applications) $ 1.50 `� �
<br /> 4. TOTAL PERMIT FEE (Add lines 1-3 above) $ �9 , p�
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<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 r
<br /> customer for the work done. If any material, equipment, labor, or installation are fumished 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,
<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 zf
<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 y_�
<br /> State Building Code, and certifies that all statements made on this application are complete, true
<br /> and correct.
<br /> Applicant's Signature: �(�, �, Date: -(�-
<br /> Approved By: , Date:
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