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<br /> WOOD BURNING EQUIPMENT �`� , ' z
<br /> Wood stove with flue ��r
<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. �
<br /> �.
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<br /> VENTILATION
<br /> No. Kitchen Exhaust ducted recirculating cfm
<br /> No. l�. _ Bath Exhaust (must be ducted outside) �_ cfm �.
<br /> No, Other Fans: Locations cin�
<br /> �'���'
<br /> FUEL STORAGE (MUST BE APPROVED BY FIRE MARSHAL) � ,+y
<br /> Installation Removal �:;
<br /> Fuel oil: gallons underground inside outside ;4:
<br /> LP Gas: gallons
<br /> Other Gas opening y`
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<br /> PERMIT F'EE CALCULATION � �rr
<br /> � r.
<br /> 1. 1.25% of Contract Price* o�Minimum Fee ($35.00) / �?
<br /> /��, 7�5 } x .0125 $ / � � � � �. s
<br /> (contract price)
<br /> .
<br /> 2. State Surcharge. "" Add the State Building Code Division
<br /> Surcharge to each permit. x .0005 $ � 3g
<br /> or $.50, whichever is greater (contract price)
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<br /> 3. Postage and Handling (Only mail-in applications) $ 1.SO '.
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<br /> 4. TOTAL PERMIT FEE (Add lines 1-3 above) $ ��� . =�.1_ __
<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 materiai, equipment, labor, or instailation are furnished by the owner,
<br /> tenant or any other party the reasonable mazket 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, ,-.-,F:,
<br /> the City may request the submission of a signed copy of the actual contract. -:`';3-;
<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: S — � �
<br /> Approved By: Date: �;;
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