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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.
<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) cfm
<br /> G� 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 �
<br /> �R�
<br />�,�; LP Gas: gallons `;�
<br />�'' Other Gas opening ��;�
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<br /> *.,; �,
<br />��: PERMIT FEE CALCULATION :F
<br /> - 1. 1.25% of Contract Price* or Minimum Fee ($35.00)
<br /> /�, 9v� : .�� x .0125 � Z 3 6 . � �
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<br /> (contract price)
<br /> 2. State Surcharge. ** Add the State Building Code Division �
<br /> Surcharge to each permit. �$,yo�.c� x .0005 $ �. �-S #
<br /> or $.50, whichever is greater (contract price) '��
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<br /> 3. Posta�e and Handlin� (Only mail-in applications) $ 1.50 ,�
<br />� 4. TOTAL PERMIT FEE (Add lines 1-3 above) $ Ly�. Z,v �°�'
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<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 fumished 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 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 $1,000,000 call the Department of Inspectional Services for the price.
<br /> The undersigned hereby applies to the City for issuance of a Mechanical Permit, agrees to do
<br /> all work in strict accordance with the ordinances of the City and the regulations of the Minnesota �s':'LL
<br /> 4`< State Building Code, and certifies that all statements made on this application are complete, true
<br /> �`-"' and correct. �
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<br /> £�; Applicant's Signature: ,� Date: �� /z$���
<br /> Approved By: Date:
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