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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 .
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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 />�`` FUEL STORAGE (MUST BE APPROVED BY FIRE MARSHAL)
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<br /> Installation Removal , ,;�
<br />, �; Fuel oil: gallons underground inside outside � _�
<br /> r ` LP Gas: gallons
<br /> f Other Gas opening
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<br />''�=x PERMIT FEE CALCULATION
<br />�J 1. 1.25% of Contract Price* or inimum 'ee 35.00
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<br /> `�y � x .0125 $
<br /> (contract price)
<br /> pr�,: 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. PostaQe and Handlin� (Only mail-in applicafions) $ 1.50 P
<br /> 4. TOTAL PERMIT FEE (Add lines 1-3 above) $
<br /> * CONTRACT PRICE or JOB COST means the actual or estimated dollar amount charged for the pernutted
<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 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 /> 1 or contract price for pemut fee purposes. In the event that there is a dispute on the amount of the job cost, ;
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<br />�' the City may request the submission of a signed copy of the actual contract.
<br /> � � ** The STATE SURCHARGE is .0005 of the contract price under $1,000,000 or $.50 - whichever is
<br />'i` 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 statements made on this application are complete, true
<br />:F'' and correct. �'�,� �
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<br />�� � � Applicant's Signature: " 'U C� �" � Date:C� � '7- �
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<br />�., Approved By: Date:
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