|
�� ,��,���,".,�'.P,*r.`-.� '�3�', � -'"�r^rs ...s�;•—v 4. . �'-�r'� . � �
<br /> �-
<br /> � � ' €.
<br /> y;
<br /> WOOD BURNING EQUIPMEN'I'
<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 , inin. flue dia.
<br /> VL+'NTILATION
<br /> No. Kitchen Exhaust ducted recirculating cfm
<br /> No. Bath Exhaust (must be ducted outside) cfm
<br /> No. Other Fans: Locations cfm
<br /> rUI:L 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 /> P�RMIT F�� CALCULATION
<br /> l. 1.25% of Contract Price* or Minimum ree ($35.00)
<br /> 7� oo � E�� x .0125 $
<br /> (contract price)
<br /> 2. State Surchar�e. ** Add the State Building Code Division
<br /> Surcharge to eacli permit. x .0005 $ �
<br /> or $.50, whichever is greater (contract price)
<br /> 3. Posta�e and Handlin� (Only mail-in applications) $ 1.50 _
<br /> 4. TOTAL P�RMIT FEE (Add lines 1-3 above) $
<br /> * CONTRACT PRICE or JOB COST means the actual or estimated dollar amount chargcd for the permitted
<br /> work including materials, labor, profit, and other Cixcd costs. It is the amount to be charged to the
<br /> customer for the work done. If any material, equipmcnt, labor, or installation are furnished by the owner,
<br /> tcnant or any other party the reasonable market value of such items must be added to the estimated cost
<br /> or contract pricc for permit fee purposes. In the event tliat there is a dispute on the amount of the job cost,
<br /> the City may request the submission of a signcd copy of the actual contract.
<br /> ** '('he STA`I'E SURCHARGE is .0005 of the contract pricc under $I,000,000 or $.50 - whichcver 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 th all stateme � m e on this application are complete, true
<br /> and correct. � ; �
<br /> � _ /�
<br /> Applicant'sSignattire. � Date: lD S��
<br /> ,
<br /> Approved By: '� Date:
<br />�� ,: ,,
<br />��:�� ��,�,��_.,.�:,..��,._,.:_�_,�..,y�_��:�.,��r�,�,;�_,.�__.. , .� .Y_�_..... , . .�.__ . .._,�.. ....�.�,�__.....�_�....__
<br />
|