|
bs ,�� K� � i j A " ,� � �; �.
<br /> � � � . .,, n •� . . � ... . `
<br /> .
<br /> �
<br /> ,�; w,.. . .- ,z. , -- �� " .'�"�' . . _._.. . '.
<br /> i.$_.
<br /> ,.,' ` J ` - .
<br />�. � ay,r� �./ . - . .
<br /> „�
<br /> 5, -
<br /> WOOD BURNING EOiTIPMENT �` ` .
<br /> d'' �. I
<br /> 4����;; Wood stove with flue -� � r;
<br /> Wood combination or add-on � - -� � - ` . �
<br /> �. _ _
<br /> _ _ .._. ,
<br /> .
<br /> ,
<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 /> ;w: x =: VENTILATION .
<br /> No. Kitchen Exhaust ducted recirculating cfm `�
<br /> No. Bath Exhaust (must be ducted outside) cfm
<br /> No. Other Fans: Locations �� � �
<br /> 1.
<br /> - - +
<br /> ;-, { ;` FUEL STORAGE (MUST BE APPROVED BY FIRE MARSHAL) ��
<br /> 4rt#'�� � ` - Installation �C Removal
<br /> � .` F r '': Fuel oil: j �� o gallons �X underground inside outside
<br /> ;y .
<br /> LP Gas: gallons -
<br /> j Other Gas opening a:.
<br /> � 1 ° �
<br /> _ ti_
<br /> _ PERMIT FEE CALCULATION "' '�
<br /> 1. 1.25% of Contract Price* or Minimum Fee ($35.00) '
<br /> �/S's D, x .0125 $
<br /> (contract price) , �
<br /> � 2. State Surchar� ** 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 Handling (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 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 /> _ customer for the work done. If any material, equipment, labor, or installation aze furnished by the owner,
<br /> ,
<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 pemut 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 /> 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 that all statements made on this application are complete, true
<br /> ,
<br /> ����z �,�,. and correct. '
<br /> - -� �- Applicant's Signature: . Date: � /-5 ��
<br /> s{.y
<br /> � � �- -- -
<br /> h � �� Approved By: Date:
<br /> .. ,. _
<br /> . �, ..;
<br /> � ; � •
<br /> %9 � e .
<br /> S +f': F _ ..; § . �. .
<br /> � _ � _.� � 1�' _ � __ • � — �t..
<br /> r — � ° f � ,' a
<br /> ;. :: _^� -:..
<br /> > ;.
<br /> . z.,. �.. -_ _�. . � ,
<br /> . . , „
<br /> , . :,. . .. . . ., ,_.-
<br /> _
<br /> . : , — . .
<br /> . � .. , � _ .
<br /> . � , :
<br />
|