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<br /> WOOD BURNING EQUIPMENT � ,�;� J F. .
<br /> Wood stove with flue � i ' �
<br /> Wood combination or add-on '� `
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<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., Cleazances, side , reaz , min. flue dia. ��
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<br /> VENTILATION
<br /> No. Kitchen E�chaust ducted recirculating cfm
<br /> No. Bath Exhaust (must be ducted outside) cfm
<br /> No. Other Fans: Locations cfin
<br /> FUEL STORAGE (MUST BE APPROVED BY FIRE MARSHAL)
<br /> Installation X Removal .�
<br /> T Fuel oil: ,�O gallons X underground inside � outside �y
<br /> LP Gas: gallons -?+
<br /> Other Gas opening ;'.
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<br /> PERMIT FEE CALCULATION
<br />, s 1. 1.25% of Contract Price* or Minimum Fee ($35.00) �
<br /> yc�C� X .O12S $ "l !�• G� �
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<br /> (contract price)
<br /> 2. State SurcharL�e. ** Add the State Building Code Division
<br /> Surcharge to each permit. x .0005 $ ,�. �rz% `�
<br /> or $.50, whichever is greater (contract price)
<br />��`` 3. Postage and Handling (Only mail-in applications) $ 1.50
<br /> 4. TOTAL PERMIT FEE (Add lines 1-3 above) $ J � . ��- '�`
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<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 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, �
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<br /> the City may request the submission of a signed copy of the acival contract. ' j �f
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<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 'x
<br /> State Building Code, and certifies that all statements made on this application are complete, true
<br /> � and conect.
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<br /> Applicant's Signature: ��--- Date: %� - 1
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<br /> ��` Approved By: Date: a.
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