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<br /> WOOD BURNING EQUIPMENT
<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. �5
<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 /> No. �_ t��er Fans: Locations � ` cfm
<br /> �(�C-1.S Z:,r�s�:�i r���- v�1tG'�� - �/i2, TJ' r�r'%L .:i�L'Nl���t-�G��-
<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
<br /> 1. 1.25% of Contract Price* or Minimum Fee ($35.00) ��
<br /> �y��� =% x .0125 $ �7�.
<br /> (contract price)
<br /> 2. State Surchar�e. ** Add the State Building Code Division ;,�
<br /> Surcharge to each permit. ly,/?lu� "' x .0005 $
<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) $ ���, j�
<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 /> tena.nt 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 /> ** 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 />;'r- 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. `t
<br />�_, , ,- /� �,, `
<br />� A licant s Signature; � ! ,��� Date: J�'�<</�C�L�
<br />�, PP �
<br />�': Approved By: Date:
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