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<br /> 4 ' WOOD BURNING EOUIPMENT ,;
<br /> £: � Wood stove with flue ,. :
<br /> -�' Wood combination or add-on �
<br /> �:; Factory fireplace with flue ';:M
<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.
<br /> VENTILATION
<br /> ,., No. Kitchen E�aust ducted recirculating cfm
<br /> No. Bath Exhaust (must be ducted outside) cfm '� �
<br /> No. Other Fans: Locations cfm
<br /> �; — _ �--- - —
<br /> FUEL STORAGE (MUST BE APPROVED BY FIRE MARSHAL)
<br /> - Installation Removal '��
<br /> ,,; Fuel oil: gallons underground inside outside �X'
<br /> LP Gas: gallons
<br /> Other Gas opening ,;�
<br /> ��
<br /> �� PERMIT FEE CALCULATION ,�� ��� '
<br /> �-X` 1. 1.25% of ontract Price* or Minimum Fee ($35.00) L"�� � ;�
<br /> C���a�i�� , ��:i-,� �.���� _.-�_� ,� .��- _�T._ � X .0�25 � �t �c� �-�y,a� ��£
<br /> �� �
<br /> - (contract price) .-.-�
<br /> y 2. State Surcharge. XX Add the State Building Code Division >> ,��� F
<br /> Surcharge to each permit:}�/������,�J—;�-�'°� x .0005 $ _ �, C'�T-F—,5� ;
<br /> ', or $.50, whichever is greater (contract price) ��
<br /> �:` ��
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<br /> �� 3w; 3. Posta�e and Handling (Only mail-in applications) $ 1.50 �
<br /> 4. TOTAL PERMIT FEE (Add lines 1-3 above) $ (��i�L� ''�
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<br /> � y� * CONTRACT PRICE or JOB COST means the actual or estimated dollar amount charged for the permitted
<br /> �
<br /> work including materials, labor, profit, and other fixed costs. It is the amount to be charged to the :�;
<br /> c�stumcr ior �i�c �ork cluac. ii�uiy m<;teriai, ei�ui�mcnt, l�ror, or installa[ion are rurn;shed 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 pemut 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 /> �'�~',
<br /> -S<, ** 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 /> ',r;`; 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�.1�fi�����(��� / Date: � ����_ � ,
<br /> , �
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<br /> Approved By: Date: ��''
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