1992, 01-30 Permit App: 92000543 Mechanical Fixtures•
MECHANICAL PERMIT APPLICATION FORM
Information Worksheet
JOB STREET ADDRESS: So
CITY/STATE/ZIP:
C4NER:
MAIT 'G ADDRESS:
(Street)
Swirw-TATING
CONTRACTOR:
MAILING ADDRESS:
- 5LP
PARCEL NUMBER:
PHONE NUMBER:
s.,Dc . 99207
(5;;,..)328-4431
WAYNESH258NJ
(Street)
(City/State) (Zip)
LICENSE NUMBER:
PHONE NUMBER:
(City/State)
(Zip)
MECHANICAL WORKSHEET/FEE
DESCRIPTION
SCHEDULE.
NUMBER
OF UNITS
X EACH
UNIT
DUCTWORK SYSTEM
WOODSTOVE/INSERT
GAS WATER HEATER
HEATING EQUIPMENT <100,000 BTU
HEATING EQUIPMENT +100,000 BTU
GAS PIPING (I - 4 OUTLETS)
GAS PIING (5 OR MORE. EACH:)
REFRIG 1-100M BTU (NOT A/C OR HEAT PUMP)
REFRIG 101-500M BTU
REFRIG 501-1,000M BTU_
REFRIG 1,001-1,750M BTU
REFRIG +1,750M BTU
HEAT PUMP & AIR CONDITIONER 0-3 TONS
HEAT PUMP & AIR CONDITIONER 3-15 TONS
_EAT PUMP & AIR CONDITIONER 15-30 TONS
dEAT PUMP & AIR CONDITIONER 30-50 TONS
HEAT PUMP & AIR CONDITIONER +50 TONS _
VENTILATING FANS
EVAPORATIVE COOLERS_
TYPE I HOOD (PER 12' 3R 12' PTN. OF HOOD)
TYPE II HOOD _
CLOTHES DRYEI-
RANGE
GAS LOG
MISCELLANEOUS (NOT COVERED ELSEWHERE)
UNLISTED GAS APPLIANCE <400,000 BTU
UNLISTED GAS APPLIANCE >400,000 BTU_
USED APPLIANCE <400,000 BTU
USED APPLIANCE >400,000 BTU
AIR HANDLER <10,000 CFM
AIR HANDLER >10,000 CFM
x$10.00 =
x 2.00 =
x CO =
x 12.00 =
x 15.00 =
x 4.00 =
x 1.00 =
x 12.00 =
x 20.00 =
x 25.00 =
x 35.00 =
x 60.00 =
x 12.00 =
x 20.00 =
x 25.00 =
x 35.00 =
x 60.00 =
x 10.00 =
x 10.00 =
x 50.00 =
x 10.00 =
x 10.00 =
x 10.00 =
x 10.00 =
x 10.00 =
x 50.00 =
x100.00 =
x 50.00 =
x100.00 =
x 12.00 =
x 15.00 =
= AMOUNT
/6e/
‘-)
SUBTOTAL
PLUS: PROCESSING FEE + $ 25.00