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<br />�°�� WOOD BURNING EOUIPMENT �'�
<br />�� Wood stove with flue �
<br />�r' Wood combination or add-on ry�'
<br />�.,
<br />, Factory fireplace with flue t
<br /> Factory Fireplace (s) Freestanding Masonry `'
<br />�r� �
<br /> Wood ve (s) Franklin, other �
<br /> Brand Name �,� � � Model� �`
<br /> ��
<br /> � � �Mfgr's 'n., Clearances, side , rear , min. flue dia. �
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<br />�`` VENTILATION � �
<br />�, , �
<br />,�,> No. Kitchen Exhaust ducted recirculating cfm
<br />'"�' r1o. Bath Exhaust (must be ducted outside) cfm ��
<br /> 1� No. Other Fans: Locations cfm ry�
<br /> � FUEL STO�AGE (MUST �E APPROVED BY FIRE MARSHAL) �a
<br />�:� _,
<br />%��� Installation Removal � -�
<br />�,� Fuel oil: gallons underground inside outside �:
<br />�a' LP Gas: gallons ��
<br /> ' Other - Gas opening �
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<br /> PERMIT FEE CALCULATION ���
<br /> ' 1. 1.25% of Contract Price* or Minimum Fee ($35.00) Q t:a
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<br /> i � -� x .0125 $ • �
<br /> (co tract price) ''��
<br />�' 2. State Surcharge. ** Add the State Building Code Division ! r�
<br />��<' Surcharge to each permit. x .0005 $ �
<br /> �' �
<br /> or $.50, which�ver is greater (contract price) '
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<br /> 3. Postage and Handlin� (Only mail-in applications) $ 1.50 �'�
<br /> 4. TOTAL PERMIT PEE (Add lines 1-3 above) $ , � �
<br /> =j * 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 /> y 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 mazket value of such items must be added to the estimated cost ��
<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 /> .;.� �
<br /> :,�: ** The S"IATE 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 /> r�` The undersigned hereby app]i�� to the City for issuance of a Mechanical Permit, agrees to do �
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<br /> all work in strict accure�ance with the ordinances of the City and the regulations of the Minnesota
<br /> ,4
<br /> State Building Code, and certifies that all statements made on this application are complete, true ;�
<br /> F`:'::
<br /> and correct.
<br /> � � �� � � �
<br /> Arrlicant's Si�nature: Date:
<br /> :�
<br /> Approved By: Date: "'�'
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