|
. ,� �� _ _
<br /> i �� �,
<br /> - _ . . .��e ,:�; " ���I. . - i�ti r� . . . .�i
<br /> � f . . ' i��s,. ' .f,Ni' � f � . . , t.�fi . ,.. . ...I
<br /> ,2. � .. � �, . ., ' �'. 5� .r : '� S . ..- � . .
<br /> �� P 4� T i� �
<br /> ,''f� � � , �� .
<br /> WOOD BURNING EOUIPMENT , -- _�� _ ,•. ..,� ': �
<br /> Wood stove with flue ��` . <k:�� i
<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. �
<br />;�, VENTILATION � �
<br /> -- No. Kitchen Exhaust ducted recirculating cfm
<br /> No. Bath Exhaust (must be ducted outside) cfm
<br /> ;
<br /> No. Other Fans: Locations cfm '
<br />'�'.,�..p�.. .
<br />. ,,
<br /> FUEL S'TORA,GE (MTJST BF APPRC3VED BY FIRE MARSHAL) i,
<br /> Installation Removal ;
<br /> Fuel oil: gallons underground inside outside ���' �
<br /> LP Gas: gallons �
<br /> Other Gas opening '
<br /> I
<br /> PERMIT FEE CALCULATION �
<br /> �� 1. 1.25% of Contract Price* or Minimum Fee ($35.00) �/ i
<br /> ���,'�:� x .0125 $ ��� �''
<br /> ~ (contract price) r i
<br /> * 2. State Surchar�e. ** Add the State Building Code Division I- (
<br /> Surcharge to each permit. � (,,� G'�' x .0005 $ ? �",
<br /> ,-;�� :-: or $.50, whichever is greater (contract price) I
<br /> � �'�� `��� 3. Postage and Handling (Only mail-in applicafions) $ a 1.50
<br /> � � 4. TOTAL PERMIT FEE (Add lines 1-3 above) $ � j �
<br /> '� , I
<br /> ���;-:_�;�
<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 rhe work done. If any material, equipnent, laUor, or instal;at;on aze 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 conuact 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 contraci.
<br />` "�
<br /> � . .•�r:;. . . � . � .
<br /> � �,y � ** 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 />'.��,�, ,
<br /> ;..:;��,: all work in strict accordance with the ordinances of the City and the regulations of the Minnesota
<br /> x`�' � State Building Code, and certifies that all statements made on this application are complete, true
<br /> � .
<br /> �`� and conect.
<br /> ,;' � ,�
<br /> � "f ` �,� �%/ � i
<br /> , �
<br /> �_�,` Applicant's Signature: L� Date:
<br /> ;
<br /> �.�,y:'° G �Y
<br /> Approved By: Date: ('Q -�j�'� 1 �
<br /> ��
<br /> �,
<br /> ;� ! `':
<br /> , .
<br /> �
<br /> � F
<br /> -, . � , .
<br /> ,.
<br /> . - _� ,
<br /> . . _ .
<br /> , ,
<br /> . , �. ,; , .
<br /> , , _
<br />
|