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<br /> WOOD BURNING EQUIPMENT
<br /> Wood stove with flue
<br /> Wood 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. a���
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<br />,�. Mfgr s Min., Clearances, side , rear , min. flue dia.
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<br />�''` VENTILATION �
<br />��' No. Kitchen E�aust ducted recirculating cfm �:''
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<br /> ��,;. No. Bath Exhaust (must be ducted outside) cfm !.
<br />� '`� No. Other Fans: Locations cfm -
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<br />�`� FUEL STORAGE (MUST BE APPROVED BY FIRE MARSHAL)
<br /> Installation Removal u�r�
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<br /> Fuel oil: gallons underground inside outside �°;�,, -��
<br /> LP Gas: gallons
<br /> Other Gas opening
<br />�-�
<br />��a:: PERMIT FEE CALCULATION
<br />�`' 1. 1.25% of Contract Price* or Minimum Fee ($35.00)
<br /> � , v� x .0125 $ �
<br />�,, ��� �1
<br />� (contract price)
<br />� 2. State Surcharge. ** Add the State Building Code Division
<br /> �. Surcharge to each permit. ���S, (�Q x .0005 $
<br />��};� or $.50, whichever is greater (contract price)
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<br /> t. 3. Posta�e and Handlin� (Only mail-in applications) $ �
<br />�;-' 4. TOTAL PERMIT FEE (Add lines 1-3 above) $
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<br /> * 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 /> customer for the �vork 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 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 />�:�::
<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 [he Department of Inspectional Services for the price.
<br />�
<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 al ements made on this application are complete, true
<br /> and correct.
<br />� Applicant's Signature: Date: �� �O
<br />_ �
<br />�j Approved By: Date:
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