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<br /> �-��' WOOD BURNING EOUIPMENT �
<br /> � Wood stove with flue ,y.�, ,;�;� �'
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<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. `::,. ,�� ;�
<br /> �;� Mfgr's Min., Clearances, side , rear , min. flue dia. f, �N� ;
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<br /> ���� �` VENTILATION ��
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<br /> No. Kitchen Exhaust ducted recirculating cfm `�
<br /> Y F No. Bath Exhaust (must be ducted outside) cfrn
<br />�� t No. Other Fans: Locations cfm -
<br /> FUEL STORAGE (MUST BE APPROVED BY FIRE MARSHAL) � t '
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<br /> Installation Removal `� ''`;�'
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<br /> Fuel oil: gallons underground inside outside �� �` �
<br /> LP Gas: gallons '"
<br /> �'` Other Gas opening _��, � "��r
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<br /> PERMIT FEE CALCULATION .
<br /> 1. 1.25% of Contract Price* or Minimu Fee 35.00 ��
<br /> � � � — X .oi2s $ �5 C�C� � ,.
<br /> `� (contract price) -"'�''""'
<br /> 2. State Surchar� ** Add the State Bui ' g Code'Division �� '"
<br /> Surcharge to each permit. � �� �� x .0005 $
<br /> ,'. s �� or $.50, whichever is greater (contract price)
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<br /> �-°��` 3. Posta�e and Handling (Only mail-in applications) $ 1.50
<br /> - 4. T�TAL PEkMIT FEE (Add iines i-3 above) $ 3 7• �C�
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<br /> * CONTRACT PRICE or JOB COST means the actual or estimated dollar amount charged for the pemutted �
<br /> work including materials, labor, profit, and other fixed costs. It is the amount to be charged to the -�
<br /> c,ist:,:r�er far ttie �Ncrk doiie. Ii any ir,aterial, equipment, labo., or u��allation 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, ''''
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<br /> 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 correct.
<br /> � �Applicant's Signature: k � �(�p Date: —� �
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<br /> �pproved By: � ! t,w�..._ Date: I 31 -��
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