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2004, 08-10 Permit Application: BLD-04-0730 Heat Pump, A/C
c2rue 0 € �ane Valley MECHANICAL D J -23 PROJECT / f i ADDRESS: iI `'t 1(� • _H 1 PERMIT USE; '' C �i41 r t ' OWNER: /�_ �J�VI5� 2 FUEL BURNING APPLIANCE >100,000 ✓j p ( HUN Day Cpniac. t =OR =400;000 $50 MAILING ADDRESS. UNLISTED APPLIANCE (ADDITIONAL FEE) >400,000 8100 © USED APPLIANCE(WSEC min. AFUE rating) = OR <400,000® $50 (street) (city /state) >400,000 X $100 = (zip) CONTRACTOR: 1 -100M BTU 11111111111111113111M03 = LICENSE #: 101 -500M BTU $28 = MAILING ADDRESS: .. , .. / .) .� T PHONE #: 1001- 1,750M BTU X 11 BOILER/REFRIGERATION +1750M BTU g $95 810 =- 12 GAS LOG, GAS INSERT, GAS FIREPLACE - 'EBIMIEIIIII.IIIMIII 13 RANGE (street) (city /state) 14 DRYER - X (zip) DESCRIPTION OF WORN # OF UNITS X COST EQUALS AMOUNT l FUEL BURNING APPLIANCE = OR <100,000 X $15 = 2 FUEL BURNING APPLIANCE >100,000 $19 3 UNLISTED APPLIANCE ( ADDITIONAL FEE) =OR =400;000 $50 UNLISTED APPLIANCE (ADDITIONAL FEE) >400,000 8100 © USED APPLIANCE(WSEC min. AFUE rating) = OR <400,000® $50 6 USED APPLIANCE(WSEC min. AFUE rating) >400,000 X $100 = T BOILER/REFRIGERATION 1 -100M BTU 11111111111111113111M03 = 8 BOILER/REFRIGERATION 101 -500M BTU $28 = 9 BOILER/REFRIGERATION 501- 1,000M BTU 111 $39 10 BOILER/REFRIGERATION 1001- 1,750M BTU X 11 BOILER/REFRIGERATION +1750M BTU g $95 810 =- 12 GAS LOG, GAS INSERT, GAS FIREPLACE - 'EBIMIEIIIII.IIIMIII 13 RANGE Q 14 DRYER - X $10 15 FUEL BURNING WATER HEATER - X $10 16 MISCELLANEOUS FUEL BURNING APPL - X $10 11 GAS-PIPING (ea. Outlet`) - X $1 - 18 DUCT SYSTEMS - X $10 = 19 VENTILATING FANS X $1-01-- _ 20 AIR HANDLER (DOES NOT include ducting) =OR <10,000CFM X $12 = 21 AIR HANDLER (DOES NOT include ducting) >10,000CFM X $19 = 22 EVAPORATIVE COOLERS - X $10 = 23 TYPE I HOOD - X $50 = 24 TYPE 11 HOOD - X $10 = 25 HEAT PUMP /AIR CONDITIONER 0 -3 TON X $12 = 2. l 0 26 AIR CONDITIONER 3 -15 TON X $20 - 27 AIR CONDITIONER 15 -30 TON X $25 28 AIR CONDITIONER 30-50 TON X $35 = 29 AIR CONDITIONER +5OTON X $60 = 30 LPG STORAGE TANK - X $10 WOOD OR PELLET STOVE/INSERT X $10 = WOOD STOVE - FREE STANDING - X 825 = SUBTOTAL [ ? s CP __ .. i�%sa Rae¢ " ❑ CASH • CHECK ❑ : • ___ __::-9-. FAXED PERMITS WILL ONLY BE ACCEPTED a ;TH P A Y.N ENC OF A MAJOR CREDIT CAD TI ATV. t rfl1DL. c- PLUS PROCESSING FEE $35.00 4y�<0 0 TOTAL PERMIT FEE DUE BANKCA.B.L NUMBER: