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<br /> WOOD BURNING EQUIPMENT � =j; � ` ''
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<br /> Wood stove with flue � �
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<br /> Wood combination or add-on
<br /> � �' �� � Factory fireplace with flue
<br /> '���',�,�-.�� Factory Fireplace (s) Freestanding Masonry
<br /> ` ''�y ; Wood Stove (s) Franklin, other
<br /> , � Brand Name ��'�..Q Model No. 5� �/�
<br /> ivlfgr's Min., �l are�es, si;e , rear . min. flue dia.
<br /> = VENTILATION
<br /> No. Kitchen Exhaust ducted recirculating cfm
<br /> ,,,,,,, ,. No. Bath Exhaust (must be ducted outside) cfm
<br /> No. Other Fans: Locations cfm
<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
<br /> PERMIT FEE CALCULATION
<br /> 1. 1.25% of Contract Price* or Minimum Fee 3 .00
<br /> _ ,�'J�=�',�' � �a�; x .0125 $ �5. C�C�
<br /> (contract price)
<br /> 2. State Surcharge. ** Add the State Building Code Division
<br /> Surcharge to each permit. x .0005 $ j 5�
<br /> or $.50, whichever is greater (contract price)
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<br /> ` '�"`` 3. Posta�e and Handlin� (Only mail-in applications) $ 1.50
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<br /> ��'�'^ 4. TOTAL PERMIT FEE (Add lines 1-3 above) $ ,j� OC%
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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
<br />�:z� cusio��cr ior the wor�4��n�. If ar.y� materi<.1, equip:nent, labor, or installation �se furnished by the ew�ier,
<br />'{y tenant or any other party the reasonable market value of such items must be added to the estimated cost
<br /> ,��<�., . or contract price for pernut fee purposes. In the event that there is a dispute on the amount of the job cost,
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<br /> �� k `� � 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 rice under $1,000,000 or $.50 - whichever is "�' : ��' �'
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<br /> " i` greater. For valuations over $1,000,000 call the Department of Inspectional Services for the price.
<br />� r � The undersigned hereby applies to the City for issuance of a Mechanical Permit, agrees to do
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<br /> � all wark 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 correct.
<br />�'` Applicant's Signature: Date: '
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<br /> Appraved B;: Date:
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