1993, 01-27 Permit App: 93000398 Wood Stove114EOPPWICAL PERMIT APPLICATION FORM
I p inforjnation Worksheet
JOB STREET ADDRESS: IV • 50I 0 C EI CLLCX
CITY/STATEtIP�J�
:�p:
(D4 • [5_Z/(o PARCEL NUMBER:
OWNER: I JL(Q_ 410f1rin PHONE NUMBER:
MAILING ADDRESS:
R12a- 4430
En-
(Street) (City/State) (Zip)
CONTRACTOR: i t? I C 1‘ Gla le nE; J CE,J f Fp? LICENSE NUMBER: R.'i ;co &C- I -73 b L(
PHONE NUMBER: (SOP) 67.-2(y, -&' % / I
MAILING ADDRESS: I (-1.31 P _:331C.,; (R.(E _ r,^.k.-1 , 1 J.✓ R cl 9 2 Eve -
(Street)
(City/State)
MECHANICAL WORKSHEET/FEE SCHEDULE
DESCRIPTION
ELECTRIC/DUCTWORK (SEPARATE SYSTEMS)
WOODSTOVE/INSERr
GAS WATER HEATER
GAS EQUIPMENT<100 000:$TU,(INCLUDES--------------
GAS EQUIPMENT+100,000 BTU DUCTWORK)
•GAS PIPING.(EA OUTL
BOILER/REFRIG 1-100M BTU
BC1L=R/AEFRIG 101-5006i3TU.
BOILER/REFRIG 501-1,000M BTU
BOILEt?/RSFRIG .1,0001.41,750M_ ------.--
Bili.
BOILER/REFRIG +1,750M BTU --
HEAT PUMP'&"AIR'CONDITIONER-0
HEAT PUMP & AIR CONDITIONER 3-15 TONS.- -- -
:HEAT :PUMP::&jAIR,CONDITIONER:1530TONS
HEAT PUMP & AIR CONDITIONER 30-50 TONS -
H AT PUMP & AIR: CONDITIONER -r50 TONS
VENTILATING FANS .. •
TYPE I HOOD (PER 12' OR 12' PTN. OF HOOD)
CLOTHES DRYER
GAS LOG
MISCELLANEOUS. (NOT COVERED ELSEWHERE
UNLISTED GAS APPLIANCE <400,000 BTU
ULINSTED GAS APPLIANCE>400;000 BTU
USED APPLIANCE <400,000 BTU
USED APPCIANCE)400;000BTU _
AIR HANDLER <10,000 CFM
AIR HANDLER,>10;000 CFM' :
ATE: MINIMUM PERMIT FEE IS $35.00
(Zip)
NUMBER
OF UNITS
X EACH
UNIT
= AMOUNT
x 10.00 =
x 25.00 =
x 10.00 =
x 12.00 =
x 15.00 =
x 1.00 =,
x 12.00 =
x20.00=
x 25.00 =
x 35.00 =
x 60.00 =
x 12.00 =:
x20.00 =
x 25.00 =
x35.00 =
x60.00 =
x 10.00 =
x10.00 =
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 =
r
r2
, 06
'
SUBTOTAL
$
5,CD
!PLUS: PROCESSING FEE
+5
25.00
EQUALS: TOTAL PERMIT
FEE DUE
=S
50.00