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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 /> �_
<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. �;�
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<br />� � _ ` VENTILATION .
<br />� ;��'' . �� No. Kitchen Exhaust ducted recirculating cfm
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<br /> - ` No. � Bath Exhaust (must be ducted outside) cfm
<br />�,�f�' No. Other Fans: Locations cfm 4 �
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<br />� ��� FUEL STORAGE (MUST BE APPROVED BY FIRE MARSHAL) � �.�
<br />�� ;�` Installation Removal E� ` �`
<br /> �; Fuel oil: gallons underground inside outside �
<br /> �� LP Gas: gallons ,�
<br />�LL Other Gas opening
<br />�`; �
<br />��� PERMIT FEE CALCULATION ,�
<br />;* 1. 1.25% of Contract Price* or Minimum Fee ($35.00) °
<br /> j� " ;,-� I�C�`;� t'.��: x .0125 $ � Lj� ,� �� �
<br /> �� ( ntract price) �
<br /> -,�
<br />`� � 2. State Surchar� ** Add the State Building Code Division
<br />�'�'��� ' Surcharge to each permit. j:�';;; '�; x .0005 $ �4 .��
<br />�'� r;;,�,: or $.50, whichever is greater (contract price)
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<br />� 3. Postage and Handling (Only mail-in applications) $ 1.50
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<br />� = 4. TOTAL PERMIT FEE (Add lines 1-3 above) $ i��} - l.�� '. ,;
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<br /> CONTRACT PRICE or JOB COST means the actual or estimated dollar amount charged for the permitted �-�
<br /> �a � � work including materials, labor, profit, and other fixed costs. It is the amount to be charged to the ;
<br /> 4�� �.:;. ' � .- 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 /> a�`f`'` 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.
<br />��
<br /> `' ** The STATE SURCHARGE is .0005 of the contract price under $1,000,000 or $.50 - whichever is Y
<br /> greater. For valuations over $1,000,000 call the Department of Inspectional Services for the price. �y
<br />� The undersigned hereby applies to the City for issuance of a Mechanical Permit, agrees to do `;`
<br /> ��
<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 /> �:v
<br /> and correct.
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<br /> ^t Applicant's Si�nature: ' - �' Date: � �- v `
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<br /> } Approved By: � Date: ;
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