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<br /> WOOD BURNING EOUIPMENT -'------= --�-- . ,_,--._ __
<br /> Wood stove with flue � � " "
<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 />��s'' Mfgr's Min., Clearances, side , rear , min. flue dia.
<br /> Fr .
<br /> VENTILATION • �
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<br /> No. Kitchen E�chaust ducted recirculating cfin �
<br /> { No. Bath Exhaust (must be ducted outside) cfm ��'
<br /> r`���' � No. Other Fans: Locations cfm
<br /> FUEL STORAC'TE (MZJST BE APPRGVED BY rIRE MARSHAL)
<br /> Installation Removal
<br /> Fuel oil: gallons underground inside outside �.�, Y�`�
<br /> LP Gas: gallons _
<br /> Other Gas opening
<br /> PERMIT FEE CALCULATION
<br /> � 1. 1.25% of Contract Price* or Mini �m Fee ($35.00) ` `�' �
<br /> � � C7,� X .oizs $ , L �
<br /> (contract price)
<br /> 2. State Surcharge. ** Add the State �uilding Code Division ��
<br /> Surcharge to each permit. �� �� x .0005 $ ,�.
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<br /> �� : or $.50, whichever is greater (contract price)
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<br /> k��' � ;� 3. Posta�e and Handling (Only mail-in applications) $ 1.50
<br /> _ ��, - '� 4. TOTAL PERMIT FEE (Add lines 1-3 above) $ • �
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<br /> k ` Y * CONTRACT PRICE or JOB COST means the actual or estimated dollar amount charged for the permitted '
<br /> `�' ��,�;r " ' -` ' work including materials, labor, profit, and other fixed costs. It is the amount to be charged to the
<br /> a�.���� � custoiner for the work done. If any material, equipment, labor, or u�stallation are fumished by the owner,
<br /> "" ��': ��� ; tenant or any other party the reasonable mazket value of such items must be added to the estimated cost
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<br /> � Y or contract price for permit fee purposes. In the event that thera is a dispute on the ar.iount of the jab cost,
<br /> '�'' the City may request the submission of a signed copy of the actual contract.
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<br /> k" ** The STATE SURCHARGE is .0005 of the contract price under $1,000,000 or $.50 - whichever is
<br />:y� 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. 'l
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<br /> �� Applicant's Sianature: �� ��� Date: � �� �
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<br /> �� Approved By: Date: l5 3" l �
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