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<br />;�` WOOD BURNING EQUIPMENT �, � .'- ;:' . , ., � �,:�
<br /> Wood stove with flue `�
<br /> ,�:
<br /> r; Wood combination or add-on
<br /> �� � � � � � Factory fireplace with flue �'
<br /> �l Factory Fireplace (s) Freestanding Masonry �
<br /> t, ��'' Wood Stove (s) Franklin, other =
<br /> � :
<br /> _.,, Brand Name Model No. t
<br /> �' `���"`' Mfgr's Min., Clearances, side , rear , min. flue dia. ,'
<br />� �
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<br />��; VENTILATION
<br /> r� No. Kitchen Exhaust ducted recirculating cfm . y
<br /> `� No. Bath E�aust (must be ducted outside) cfm
<br /> No. Other Fans: Locations cfm
<br />�. FUEL STORAGE (MUST BE APPROVED BY FIRE MARSHAL) ���
<br /> �,
<br />� �' )( Installation Removal '�
<br />#":ry
<br />�:, Fuel oil: gallons underground inside outside
<br /> � LP Gas: gallons �
<br /> Other ,n��-����� -�'� (L�� C����� ���1 � Gas opening
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<br /> PERMIT FEE CALCULATION
<br /> 1. 1.25% of Contract Price* or Minimum Fee ($35.00) �j`.'� �
<br /> ,-
<br /> '"' � ���! x .0125 $
<br /> (contract price)
<br />` 2. State Surchar�e. ** Add the State Building Code Division % �
<br />� Surcharge to each permit. x .0005 $ � t�'
<br /> or $.50, whichever is greater (contract price)
<br /> 3. Posta�e and Handling (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 chazged 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 work done. If any material, equipment, labor, or installation are furnished by the owner,
<br />��:;� tenant or any other party the reasonabie market value oi sucii iterris n,ust �e auded to the es,:m.ated c�st
<br />`'` or contract price for pernut 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 /> i, .
<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 Ciry and the regulations of the Minnesota
<br /> State Building Code, and certifies that all statements made on this application are complete, true
<br /> and correct.
<br /> �
<br /> Applicant's Signature: '� � '�;�. Date:
<br /> Approved By: � `' Date: ..5 0� Q
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