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<br /> �,, WOOD BURNING EQUIPMENT . � �=� ��
<br /> - � � . �i -4 ., , .., . . W��
<br /> {�i..��� � $ �. '*1 eV` �.�EJ' [�� . . ;'! ����
<br /> Wood stove with flue
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<br /> . . �f ����. �.. �• . _
<br /> '� Wood combination or add-on �`
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<br />��ty ? � Factory fireplace with flue ;�
<br /> Factory Fireplace (s) Freestanding Masonry "
<br /> Wood Stove (s) Franklin, other
<br /> � Brand Name Model No. �
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<br /> � Mfgr's Min., Clearances, side , rear , min. flue dia. ,�;.
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<br /> � VENTILATION '�'
<br /> �� ' No. Kitchen Exhaust ducted recirculating cfm ,�
<br /> � < <: `
<br /> �•� No. Bath Exhaust (must be ducted outside) cfm
<br /> �' No. Other Fans: Locations cfm
<br /> "x. �
<br /> �`�� FUEL STORAGE (MUST BE APPROVED BY FIRE MARSHAL)
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<br /> ' Installation Removal
<br />�
<br /> ' Fuel oil: gallons underground inside outside � '
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<br /> LP Gas: gallons
<br /> z= Other Gas opening
<br />��$� ��;;
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<br /> PERMIT FEE CALCULATION ��'_
<br /> 1. 1.25% of Contract Price* or Minimum Fee ($35.00)
<br /> x .0125 $
<br /> (contract price) '
<br /> 2. State Surchar�e. ** Add the State Building Code Division ,��
<br /> Surcharge to each permit. �^,�'� °-- x .0005 $
<br /> { or $.50, whichever is greater (contract price)
<br /> 1.50 �
<br /> 3. Postage and Handlin� (Only mail-in applications) $ .�A
<br /> 4. TOTAL PERMIT FEE (Add lines 1-3 above) $ ', ��
<br /> �;
<br /> * CONTRACT PRICE or JOB COST means the actual or estimated dollar amount charged for the permitted s s
<br />}�r' n work including materials, labor, profit, and other fixed costs. It is the amount to be chazged to the � �^
<br /> customer for the work done. If any material, equipment, labor, or installation are furnished by the owner, ;y
<br /> tenant or any other party the reasonable market value of such items must be added to the estimated cost
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<br /> 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. �'
<br /> a;
<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. ;'
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<br />�!x, 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 />�;�,
<br />'�`�` State Building Code, and certifies that all statements made on this application are complete, true
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<br /> and correct. ,;}�
<br />�; � � � � - �`�
<br /> t Date: '�''
<br /> Applicant's Signature: �1x� ,� -� `��' �A'
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<br /> Approved By: Date: _ ��
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