2005, 07-11 Permit App: 05002332 Gas FurnaceM1=C'_NAN1(1A1 o =oKm-r A001 1e— A'T -1r%kf
PROJECT
ADDRESS: 3 OO L IC2.
USE: 4 '
P
1
OWNER: w e h
PHONE (DayflnLe
Contact): ...
MAILING ADDRESS:
v
c,
street
(city/state)
(zip)
CONTRACTOR:
LICENSE:
=
MAILING ADDRESS:J
PHONE M
FUEL BURNING APPLIANCE
>I00,000
p
(street)
(City/state
(zip)
(C
DESCRIPTION OF WORK
or I/mm
X
COST
EQUALS
AMOUNT
i
FUEL BURNING APPLIANCE
= OR <100,000
X
$15
=
2
FUEL BURNING APPLIANCE
>I00,000
X
$19
=
3
UNLISTED APPLIANCE (ADDITIONAL FEE)
=OR<400,000
X
$50
z
4
UNLISTED APPLIANCE ADDITIONAL FEE)
>400,000
X
$100
=
5
USED APPLIANCE~ SEC min. AFUE ratin)
=OR -400,000
X
1 $50
=
61
USED APPLIANCE(WSEC min. AFUE rating)
>400,000
X
$100
7
BOILER/REFRIGERATION
1 -1 QOM BTU
X
$15
8
BOILER/REFREGERATION
101 -500M STU
X
$28
=
91
BOILERIREFRIGERATION
501- 1,OOOM BTU
x
$39
s
I 0
BOILERIREFRIGERATION
1001- 1,750M BTU
X
$57
11
BOILERIREFRIGERATION
+1750M BTU
X
$95
=
12
GAS LOG, GAS INSERT, GAS FIREPLACE
-
X
$10
=
13
RANGE
-
X
$10
n
14
DRYER
-
X
$10
15
FUEL BURNING WATER HEATER
-
X
$10
-
16
MISCELLANEOUS FUEL BURNING APPL
-
X
$10
17
GAS PIPING ea. Outlet
_
X
$1
IS
DUCT SYSTEMS
X
$10
=
19
VENTILATING FANS
-
X
$10
-
20
AIR HANDLER (DOES NOT include ducting)
=OR <10,00DCFM
X
$12
=
21
AIR HANDLER DOES NOT lnciude ductin)
>10,000CFM
X
$19
-
22
EVAPORATIVE COOLERS
_
X
$10
=
23
TYPE I HOOD
-
X
$50
=
24
TYPE If HOOD
_
X
$10
=
25
HEAT PUMP /AIR CONDITIONER
0 -3 TON
X
$12
-
26
AIR CONDITIONER
3-15 TON
X
$20
=
27
AIR CONDITIONER
15-30 TON
X
$25
s
28
AIR CONDITIONER
30 -50 TON
X
$35
=
29
AIR CONDITIONER
+50TON
X
$60
30
LPG STORAGE TANK
-
X
$10
=
31
WOOD OR PELLET STOVEANSERT
_
X
$10
=
32
WOOD STOVE - FREE STANDING
-
X
$25
SUBTOTAL
MINE S
CASH ® CHFQt ❑ ® '-
PLUS PROCESSING
FAXED PIP.M 7$ VML 01-MY BF. ACCiPTF -t) a7!'P'H PAYi Kt' .'�S. OO
OF A MAJOR CR—rr CARD E
TOTAL PERMIT FEE
BATE: EXPZLES: DUE
BA.*iKCARD NTUMMER.:
A=- TORIZED SIGNATURE:
(C