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<br /> �'" WOOD BURNING EQUIPMENT
<br /> ,.,.�,,,.�...: ., Wood stove with flue
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<br /> �"`�'` k Wood combination or add-on '--�-� � . _ :. :� r_. --- - -_, .�� .
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<br /> _' Factory fireplace wrth flue -
<br /> � Factory Fireplace (s) Freestanding Masonry
<br />_ � f Wood Stove (s) Franklin, other
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<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
<br /> No. Bath Exhaust (must be ducted outside) cfm
<br /> No. Other Fans: Locations cfm
<br /> �`z:
<br /> FUEL STORAGE (MUST BE APPROVED BY FIRE MARSHAL) �
<br /> Installation Removal
<br /> Fuel oil: gallons underground inside outside '
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<br /> l � _ �__� ��; LP Gas: gallons ='°
<br />``� µ Other Gas opening
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<br />�; PERMIT FEE CALCULATION
<br />� 1. 1.25% of Contract Price* or Minimum Fee 35.00 �
<br />�. . _
<br />;� -�,— x .oi2s � 3�-0
<br />` '' (contract price)
<br />�;,` 2. State Surchar�e. ** Add the State B ' ding Code Division
<br /> Surcharge to each permit. �� � x .0005 $ � ` ��J
<br /> or $.50, whichever is greater (concracc price)
<br /> 3. Posta�e and Handlin� (Only mail-in applications) $ 1.50 _
<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 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 /> 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,
<br /> � i . the City may request the submission of a signed copy of the actual contract.
<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.
<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 that all statements made on this application are complete, true
<br /> and conect. �
<br /> Applicant's Signature: � � ��< � �`- Date: l��✓�l��
<br /> Approved By: Date:
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