1991, 07-31 Permit App: 91004656 Furnace, Piping-1
JOB STREET ADDRES
/ CITY/TAT;/ZIP:
MAILING ADDRESS:
(Street) r (City/State) (Zip)
CONTRACTOR ` 64K Q LICENSE NUMBER: Ito n 4-4- l L q
PHONE NUMBER: q 2 2 -SSD c)
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Information Worksheet
•4'
PAROlgit NUMBER,,
y,iir
PHOME, )NUMBER:
MAALINa
k-- (Street)
(City/State)
(Zip)
MECHANICAL WORKSHEET/FEE SCHEDULE
DESCRIPTION
NUMBER
OF UNITS
X EACH
UNIT
= AMOUNT
DUCTWORK SYSTEM
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'
TYPE II HOOD
CLOTHES DRYER
RANGE
PTN. OF HOOD)
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 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 . pi
x 12.94 _
x, 15..=
)TOTE:.
SIGNATURE
•
ti:1dFY
$35.00
ka
ne ./...w.i- 111461101114111
SUBTOTAL
$ 3"1
PLUS: PROC49 aU
EQUALS: TOT
FES:
111
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