1991, 09-19 Permit App: 91006080 Furnace, PipingNWANANIbML rtnaui Mrruwassun rungs
•� • Ipformation Worksheet
OB STREET ADDRESS: t- o o •
f J
CITY/STATE/ZIP:
,z ,
ONER• 241.-"-t.
MAILING ADDRESS ::„fit ,ti.ye
(Street) 1 7 (City/State) - ,(Zip)
CONTRACTOR: ; -I S ct L10ENSE ZAJKBER: v�� 4-4-44t
t-C+ S(1) --S
PARCE NUMBER l s4 I -6 1 7
PHONE. NUMBER:? 6) 2-6 tfCi 5-8
'CLING ADDRESS:
(Street)
MECHANICAL
DESCRIPTION
DUCTWORK SYSTEM
PHONE NUMBER: Q Z2- S -a c7
(City/State) (Zip)
WORKSHEET/FEE SCSEDULE
NUMBER X EACH
OF UNITS UNIT
WOODSTOVE/INSERT
GAS WATER HEATER
HEATING EQUIPMENT <100,000 BTU
HEATING EQUIPMENT +100,000 BTU
GAS PIPING (1 - 4 OUTLETS)
GAS PIVING (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 &
HEAT PUMP &
HEAT PUMP &
HEAT PUMP &
HEAT PUMP &
VENTILATING
AIR CONDITIONER
AIR CONDITIONER
AIR CONDITIONER
AIR CONDITIONER
AIR CONDITIONER
FANS
0-3 TONS _
3-15 TONS
15-30 TONS
30-50 TONS
+50 TONS
EVAPORATIVE COOLERS
TYPE I HOOD (PER 12' OR 12' PTN. OF HOOD)
TYPE II HOOD
CLOTHES DRYER
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 25.00 =
x 10.00 =
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 5000 =
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 12.0 0,,
x 15.0=
=AMOUNT
SUBTOTAL -_ < $
%Rims: PRQC1 #SSI,AT oE .$. , 2
- F "' EQUALS : • TOTA 'i
�►wi ♦ AUMW