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<br /> � WOOD BURNING EQUIPMENT s�
<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 />_,� Mfgr's Min., Clearances, side , rear , min. flue dia.
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<br /> VENTILATION °
<br /> No. Kitchen Exhaust ducted recirculating cfin ��
<br /> No. Bath E�aust (must be ducted outside) cfm H�
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<br /> No. Other Fans: Locations cfm �
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<br /> FUEL STORAGE (MUST BE APPROVED BY FIRE MARSHAL)
<br />�'�� Installation Removal
<br />�`' Fuel oil: gallons underground inside outside
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<br />�,, LP Gas: gallons `�
<br />�'' Other Gas opening �
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<br /> PERMIT FEE CALCULATION �
<br /> z 3 1. 1.25% of Contract Price* or Minimum Fee ($35.00) ;�
<br />� '?� �DC�. °� _ x .0125 $ �� �S �
<br /> (contract price) ✓ i�`
<br /> 2. State Surchar�e. ** Add the State Building Code Division
<br /> Surcharge to each permit. � �Oa ,`� x .0005 $ � . �S
<br /> �' or $.50, whichever is greater (contract price) �
<br /> 3. Postage and Handlin� (Only mail-in applications) $ 1.50 �:
<br /> 4. TOTAL PERMIT FEE (Add lines 1-3 above) $ �� �� �
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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 t e
<br /> ,. customer for the work done. If any material, equipment, la�or, 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 �
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<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 contraci. b�
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<br />��,� ** The STATE SURCHARGE is .0005 of the contract price under $1,000,000 or $.50 - whichever is
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<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 ardinances of the Ciry 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. :'�
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<br /> Applicant's Signature: Date: a. �
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<br /> Approved By:
<br /> , Date: � ,�'
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