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<br /> WOOD BURNING EQUIPMENT
<br /> Wood stove with flue
<br /> Wood combination or add-on �°`
<br /> ' Factory fireplace with flue �`�
<br /> F';
<br /> _ Factory Fireplace (s) Freestanding Masonry : �.
<br /> r- Wood Stove (s) Franklin, other
<br /> r Brand Name Model No.
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<br />�� �-�� Mfgr's Min., Clearances, side , rear , min. flue dia. ;
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<br /> � ',:: F.;. VENTILATION ��;� F� y�
<br />_ ;��' ` No. Kitchen E�aust ducted recirculating cfm � �°
<br /> No. Bath Exhaust (must be ducted outside) cfm
<br /> y�, �V No. Other Fans: Locations cfm `"'
<br /> FUEL STORAGE (MUST BE APPROVED BY FIRE MARSHAL) '"
<br /> ;,; : �H.�
<br /> �,: Installation Removal
<br />� ' Fuel oil: gallons underground inside outside ��' '�r�
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<br /> LP Gas: gallons ,k �
<br /> ` Other Gas opening r � ��f �"�
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<br /> ,y �� PERMIT FEE CALCULATION .-�' �
<br />��. 1. 1.25% of Contract Price* or Minimum Fee ($35.00) �
<br /> � (�So.� x .0125 $ k
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<br />�_ �' (contract price) ��'
<br />�� �� 2. State Surcharge. ** Add the State Building Code Division �
<br />� Surcharge to each permit. x .0005 $ �
<br /> �' 'j � ` 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) $ �,�
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<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 are furnished by the owner,
<br /> t z ' ' ' tenant or any other party the reasonable market value of such items must be added to the estimated cost �r;
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<br />��' or contract price for pernut 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 /> F �' �f,�. ' ** 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 City for issuance of a Mechanical Permit, agrees to do :
<br /> , �.�; `` , n °� all work in strict accordance with the ordinances of the City and the regulations of the Minnesota � `�
<br /> �, State Building Code, and certifies that alT statements made on this application are complete, true g Y�
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<br /> and correct.
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<br />�; Applicant's Signature: r � � � � Date: � / C/ �
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<br />`` � Approved By: �
<br />� Date:
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