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<br /> WOOD BURNING EQUIPMENT
<br /> Wood stove with flue `�
<br /> Wood combination or add-on ':�u�
<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.
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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 /> p^� FUEL STORAGE (MUST BE APPROVED BY FIRE MARSHAL)
<br /> ��� Installation Removal
<br /> Fuel oil: gallons underground inside outside
<br /> LP Gas: gallons
<br />�r Other Gas opening
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<br /> PERMIT FEE CALCULATION
<br /> l. 1.25% of Contract Price* or Minimum Fee 35.00 J J � � � �
<br /> , .�;. . ,.l x .0125 $ � I
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<br /> �conuact price) -
<br /> 2. State Surchar�e. ** Add the State Buildin Code Division �. ��; �
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<br /> Surcharge to each permit. � ������ •� �-� x .0005 $
<br /> 4< or $.50, whichever is greater (contract price)
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<br />� 3. Posta�e and Handlin� (Only mail-in applications) $ 1.50
<br />�=< 4. TOTAL PERMIT FEE (Add lines 1-3 above) $ • • C
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<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
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<br />�� customer for the work done. If any material, equipment, labor, or installation are furnished by the owner,
<br /> r� 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 />�'��� 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.
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<br />�,`: The undersigned hereby applies to the City for issuance of a Mechanical Permit, agrees to do
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<br />�< all work in strict accordance with the ordinances of the City and the regulations of the Minnesota
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<br /> :; State Building Code, and certifies that all statements made on this application are complete, true
<br /> and correct. ; a
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<br /> t'sSi nature:C� � Date:
<br />�; Applican g
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<br /> � Approved By: Date: �.b
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