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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. -�
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<br /> VENTILATION �
<br /> No. Kitchen Exhaust ducted recirculating cfm
<br /> No. Bath Exhaust (must be ducted outside) cfm ':�
<br /> T�T� Qther Fans: Lc.atic:�s �fn'- '
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<br /> FUEL STORAGE (MUST 3E APPROVED BY FIRE MARSHAL)
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<br /> Installation Removal
<br /> Fuel oil: gallons underground inside outside ;:,�
<br /> LP Gas: gallons �
<br /> Other Gas opening ,;�
<br /> PERI�TIT FEE CALCULATION
<br /> 1. 1.25% of Contract Price* or l�iinimum Fee ($35.00) ,
<br /> /���,;> , ? � x .0125 $ -� 5 � �� �-' �
<br /> (contract price) - • - p� �- �
<br /> 2. State Surchar�e. ** Add the State Building Code Division �, ,�
<br /> Surcharge to each permit. / ���� < c �1 x .0005 $ �lJ �
<br /> or $.50, whichever is greater (concract 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) $ � 7. � v '��
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<br /> * CONTRACT PRICE or JOB COST means the actual or estimated dollar amount charged for the permitted
<br /> ;vor'.: incl>?din� material�, labnr, 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 furnished by the owner,
<br /> tenant or any other party the reasonable market value of such items must be added to the estimated cost
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<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. �t�
<br /> ** T'he 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. `;;
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<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 conect. �, '�
<br /> Applicant's Signature: u� �-
<br /> Date:� � � �� �
<br /> Approved By: Date: "�
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