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<br /> WOOD BURNING EQUIPMENT
<br /> Wood stove with flue
<br /> VJood combination or add-on
<br /> Factory fireplace with flue
<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.
<br /> VENTILATION
<br /> No. Kitchen Exhaust ducted recirculating cfm �
<br /> No. Bath Exhaust (must be ducted outside) �� �
<br /> No. Other Fans: Locations cfm -`'�
<br /> ��
<br /> x�
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<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 F'EE CALCULATION
<br /> 1. 1.25% of Contract Price* or Minimum Fee ($35.00) ��
<br /> ,,.,�,�-; ��_ X .oi2s � 3 �--
<br /> (contract price) '�
<br /> 2. State Surcharge. ** Add the State Building Code Division > _� �
<br /> t
<br /> Surc harge t o e ach permit. �,��(;� �� x .0005 $ "�:
<br />�:. or $.50, whichever is greater (contract price) _�
<br />�,..
<br /> 6� 1.50
<br /> 3. Posta�e and Handlin� (Only mail-in applications) $ �
<br />�' 4. TOTAL PERMIT FEE (Add lines 1-3 above) $ �`�� `�'
<br /> * CONTRACT PRICE or JOB COST means the actual or estimated dollar amount charged for the permitted n;
<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 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 /> t"' or contract price for permit fee purposes. In the event that there is a dispute on the amount of the job cost,
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<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
<br /> f�:
<br />�;�: greater. For valuations over $1,000,000 call the Department of Inspectional Services for the pnce.
<br />�� 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 /> �; State Building Code, and certifies tha all statements made on this application are complete, true „
<br /> `` and correct. �'`
<br /> �- L� Date: �� l�% `�
<br /> fi' Applicant's Signature: -
<br /> �: �
<br /> � Approved By: Date:
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