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<br /> WOOD BURNING EOUIPMENT ��
<br /> Wood stove with flue --
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<br /> Wood combination or add-on �
<br /> Factory fireplace with flue ��
<br /> Factory Fireplace (s) Freestanding Masonry :"�
<br /> Wood Stove (s) Franklin, other t
<br /> - Brand Name Model No. '
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<br />��' Mfgr's Min., Clearances, side , rear , min. flue dia. E;�
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<br /> VENTILATION
<br /> No. Kitchen Exhaust ducted recirculating cfm �;
<br />��� No. Bath Exhaust (must be ducted outside) cfm ��
<br /> No. Other Fans: Locations cfm ;
<br /> FUEL STORAGE (MUST BE APPROVED BY FIRE MARSHAL) �
<br />;.-�: Installation Removal '`'�
<br /> ~� Fuel oil: gallons underground inside outside �
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<br />° ;� LP Gas: gallons . �
<br />� Other Gas opening r
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<br />� �'�� PERMIT FEE CALCULATION �
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<br /> � 1 1. 1.25% of Contract Price* or Minimum Fee ($35.00) � ;
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<br /> f -� „ ��v�c�� x .0125 $ ��o. �� A
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<br />, ` (contract price) •x
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<br /> � 2. State Surchar�e. ** Add the State Building Code Division � �
<br /> Surcharge to each permit. �-/��'- ��� x .0005 $ /, � j ;,,�
<br /> k '"' r `� or $.50, whichever is greater (contract price) '`�
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<br /> ` t 3. Postage and Handlin� (Only mail-in applications) $ --�.39--
<br />' { 4. TOTAL PERMIT FEE (Add lines 1-3 above) $ ,�? �, :�� �: �
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<br />� .r, * CONTRACT PRICE or JOB COST means the actual or estimated dollar amount charged for the pemutted �
<br />�� `'"� �" �� work including materials, labor, profit, and other fixed costs. It is the amount to be charged to the `�
<br /> k �,j r ' � customer for the work done. If any material, equipment, labor, or installation are furnished by the owner, a4
<br /> ; # '` 5�y ! 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 />�� .;'�.� �;;
<br />� { ; ** The STATE SURCHARGE is .0005 of the contract price under $1,000,000 or $.50 - whichever is
<br />� .i' greater. For valuations over $1,000,000 call the Department of Inspectional Services for the price.
<br />� r The undersigned hereby applies to the City for issuance of a Mechanical Permit, agrees to do
<br /> r z:. all work in strict accordance with the ordinances of the City and the regulations of the Minnesota
<br />�' � d`. 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: �--3-T�
<br /> ��,���'� ' Approved By: Date:
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