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<br /> , . WOOD BURNING EOUIPMENT ' �
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<br /> = Wood stove with flue �
<br /> ,: � Wood combination or add-on r ��
<br /> Factory fireplace with flue � � �' * ��`'y �
<br /> a � Factory Fireplace (s) Freestanding Masonry '� �, �
<br />, Wood Stove (s} Franklin, other -; �� ��
<br />�t�- j: Brand Name Model No. >;; , '�;
<br />�#- Mfgr's Min., Clearances, side , rear , min. flue dia. '� �'3,`�
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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 �3`
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<br />"`"` � FUEL STORAGE (MUST BE APPROVED BY FIRE MARSHAL)
<br />�;� Installation Removal
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<br /> Fuel oil: gallons underground inside outside
<br />� LP Gas: gallons
<br /> � Other Gas opening
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<br />��.�r ''. PERMIT FEE CALCULATION
<br />��'w, 1. 1.25% of Contract Price* or Minimum Fee ($35.00)
<br /> �-�,��7�, x .0125 $ /�o.� ��' ;
<br />� -�ontract price) °
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<br />, :� 2. State Surchar� ** Add the State Building Code Division �:�
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<br /> Surcharge to each permit. x .0005 $ (�.� L1
<br />��` or $.50, whichever is greater (contract price) �°
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<br />��' 3. Postage and Handling (Only mail-in applications) $ 1.50
<br />��� 4. TOTAL PERMIT FEE (Add lines 1-3 above) $ ���. �/� �;� k �����
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<br />�4 * CONTRACT PRICE or JOB COST means the actual or estimated dollar amount charged for the pernutted
<br />� f ' " �' �' . 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 are furnished by the owner,
<br /> tenant or any other party the reasonable market value of such items must be added to the e�timated cos!
<br /> j,;,, or contract price for permit 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 •'°
<br /> ' � ` greater. For valuations over $1,000,000 call the Department of Inspectional Services for the price.
<br /> �, - , �� The undersigned hereby applies to the Ciry 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
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<br /> State Building Code, and certifies that all statements made on this application are complete, true
<br /> and conect.
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<br />� Applicant's Si�nature� / Date: `J-o{���-
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<br /> Approved By: Date: �.
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