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<br /> _'���`, WOOD BURNING EQUIPMENT ���._�„_�. �. _, � �
<br /> ' ' �� Wood stove with flue �� �°�,�'�� � �
<br /> ' ,.;�Y j,� Wood combination or add-on ���` `�-�'�� � ,
<br /> , �' � � � Factory fireplace with flue �� � i
<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.
<br /> VENTILATION .
<br /> No. ;( Kitchen E�chaust � ducted recirculating cfm
<br /> No. �� Bath Exhaust (must be ducted outside) cfm
<br /> No. Q Other Fans: Locations cfm
<br /> :�
<br /> FUEL STORAGE (MUST BE APPROVED BY FIRE MARSHAL) '� � �'
<br /> Installation Removal ;
<br /> Fuel oil: gallons underground inside outside ��
<br /> LP Gas: gallons , �'
<br /> Other Gas opening
<br /> ; PERMIT FEE CALCULATION �
<br /> : 1. 1.25% of Contract Price* or Minimum Fee ($35.00) j) � ��{
<br /> � Z(--�C�`�! x .0125 $ i��V l.�V �
<br /> ' (contract price) - �
<br /> � 2. State Surchar� ** Add the �ta,t� Buildin,g Code Division ' � �� i�
<br /> � Surcharge to each permit. ��1�41 �(';�,%�.` x .0005 $ v `� t� �
<br />,.=�
<br /> or $.50, whichever is greater (`contract price)
<br />���
<br /> 3. Posta�e and Handlin� (Only mail-in applications) $ 1.50 '; � '.
<br />'' 4. TOTAL PERMIT FEE (Add lines 1-3 above) $ _ � �'
<br />,.:{;.
<br /> * CONTRACT PRICE or JOB COST means the actual or estimated dollar amount charged for the pernutted
<br /> work including materi2ls, labo:, 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 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 /> ** 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 /> �s �� �'��1 r�1
<br /> Applicant's Signature: Date:
<br /> ' 1� g�
<br /> Approved By: � _ Date:
<br />
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