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<br /> WOOD BURNING EOIT�MENT �`'
<br />� -- Wood stove with flue ��� ^ - - - - - - - --.�- -n
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<br /> � Wood combination or add-on - � ' ;�, ��� i
<br /> ` Factory fireplace with flue ��.
<br /> � t • 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 Exhaust ducted recirculating cfm ,*^.
<br /> - -- - No. Bath Exhaust (must be ducted outside) cfm
<br /> No. Other Fans: Locations cfm R ' '
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<br /> - FUEL STORAGE (MUST BE APPROVED BY FIRE MARSHAL) =r;
<br /> Installation Removal .
<br /> - -, Fuel oiL• gallons underground inside outside >R
<br /> LP Gas: gallons �
<br /> Other Gas opening
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<br /> PERMIT FEE CALCULATION
<br /> 1. 1.25% of Contract Price* or Minimum Fee ($35.00)
<br /> �' 1300.DD x .0125 $
<br /> (contract price) �
<br /> � 2. State Surchar�e. ** Add the State Building Code Division `
<br /> Surcharge to each permit. x .0005 $ �
<br /> or $.50, whichever is greater (contract price)
<br /> 3. Posta�e and Handlin� (Only mail-in applicafions) $ 1.50 � '
<br /> 4. TOTAL PERMIT FEE (Add lines 1-3 above) $ �
<br /> * CONTRACT PRICE or JOB COST means the actual or estimated dollaz amount chazged 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 aze furnished 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 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 contract.
<br /> ** The STATE SURCHARGE is .0005 of the contract price under $1,000,000 or $.50 - whichever is r�
<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 fo 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 /> - A licant's Si ature: r ���� , Date: � �� ��
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<br /> Approved By: � Date:
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