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<br /> WOOD BURNING EQUIPMENT 1'
<br /> Wood stove with flue
<br /> Wood combination or add-on
<br /> r; '��� Factary fireplace with flue ��� � �.��
<br /> ' Factory Fireplace (s) Freestanding Masonry
<br />'+'�' Wood Stove (s) Franklin, other �
<br />,� :
<br /> Brand Name Model No.
<br /> <`_� :' Mfgr's Min., Clearances, side , rear , min. flue dia.
<br /> �
<br /> � �,_".�' �,� - `�:� VENTILATION
<br /> No. _� Kitchen Exhaust ducted _� recirculating � cfm �
<br /> No. � Bath Exhaust (must be ducted outside) .-'o cfm �`A
<br /> No. Other Fans: Locations cfm
<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 �q
<br /> � 1. 1.25% of Contract Price* or Minimum Fee ($35.00) �
<br /> Yy�;l�o "` x .0125 $ � �
<br />�' (contract price)
<br /> 2. State Surcharge. ** Add the State Building Code Division
<br /> t�� Surcharge to each permit. x .0005 $ ;
<br />_�: or $.50, whichever is greater (contract price) '
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<br /> 3. Postage and Handlin� (Only mail-in applications) $ 1.50
<br /> 4. TOTAL PERMIT FEE (Add lines 1-3 above) $ �(.,� '�(�_ ��
<br /> * CONTRACT PRICE or JOB COST means the actual or estimated dollar amount charged for the pernutted
<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, 7�
<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 pernut 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 /> ��
<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 /> Applicant's Signature: � � Date: 8"v1d -��
<br /> Approved By: � Date: �
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