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1992, 05-08 Permit App: 92003211 Woodstove
ao 5L-13 C1 is 550_.. a T pQ,-2� .w._CHANIC L PERMIT APPLICATION FORM ' V' ,S t 6-- ( information Worksheet JOB STREET ADDRESS: 1..3I2 m CGL PA r1C_ L . CITY/STATE/ZIP: SCOK-4A-v,2 99-2 D(c)PARCEL NUMBER: OWNER: Ri GI\ I.) try -i' SC, le +Cs_ PHONE NUMBER: -2-.� " -7?a.9 MAILING ADDRESS: �ar3at� c0o1S (Street) (City/State).- (Zip) CONTRACTOR: C ICC\ C -/40b iii Fg LICENSE NUMBER: r+4IC-O CSC 1-73 DIA PHONE NUMBER: (SDgI g2c. -d'9 % MAILING ADDRESS: E • q31 p .5p2Ague_ LvA Deo (Street) DESCRIPTION (City/State) (Zip) MECHANICAL WORKSHEET/FEE SCHEDULE ELECTRIC/DUCTWORK (SEPARATE SYSTEMS) GAS WATER HEATER - .c M Ci. 00 ta,.�5 EQ1,:ili' ANT.... �iQi:,............,,.,,...��.. '---------- i....:" vvwwwwvwvww.w rvw.wenr::.v:..: wxrn.wwwiiiw.veie_ :+Lr+.iv h -: GAS EQUIPMENT+100,000 BTU DUCTWORK) . G �o c„u �..,..L.., w..; �a s.�; BOILER/REFRIG 1-100M BTU -.7...'7 .? .: '- BOILER.!REFRIG 501-1,000M BTU.Z .;''' r 'BOB 1J . GR .. 111A.::$7> <:.::.. ::: ,•. BOILER/REFRIG +1,750M B-- - f-;-`�' I_ -.: HEAT PUMP & AIR CONDITIONER 3-15 TONS-_-.4,":7I ZE/lT X I CONN .PITONS 4 HEAT PUMP8 AIR CONDMONER 30-50 TONS `''°"' '"=.= ' lMtE3 CO , VENTILATING FANS 5 i 1.t."`:_'77-f_.,---t.2±--...t.-..f:=.:7-:t _"'77---. - :f .2y'Q'-`-2:r'ic2:'S:f,""'o`xo".:<)?".'??:.:.:c'C^;':!£;->:.:: :':'•x•. r: t - t 'PL'3 T #:.. i0O.LER :.:,::<>::::: <r;<;:>_ >:: >:-µ»::-�:.:::<:-<>:: i' ` TYPE I HOOD (PER 12' OR 12' PTN. OF HOOD) .....................................................x3!N.vv:{-i}inx-n:Y..xy?}iiii:: xmy:ym. CLOTHES DRYER RANGER; GAS LOG MISCELLANEOUS (NOT COVERED ELSEWHERE UNLISTED GAS APPLIANCE <400,000 BTU ULINSTED.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; NOTE: MINIMUM PERMIT FEE IS $35.00 SIGNATURE NUMBER OF UNITS X EACH UNIT = AMOUNT x10.00 =- x2. - _ 500_ -.-- 02_50-0, x10.00 x12.00 :-- , . x 15.00 '.-` .. t i . - _. ... ....___.. .x,1.00. :� r_ .;.-,.. ;:- .:1:; - _ - -- x 12.00s:-----..::-. ' a":;-.4=', -^ �,• -�. �.:. x 20.00'y '1.F::1,7.:. -'4= -;t -'::4;$4e7^; _ .... .. ,x- _.;c2.5..00; ; .; • x 35.OV.-.y , rt v? :, ---77,-1----:-: .. z.. 'i"9a:.-_,-- c.CY4.1er P-,,.---.--:, x 60.00'-=';---7 .... -.ub _ .. �..� x 12.00"-=:.-?. -F..,??.-....L.-1-k44 : l: - x20.00 �• - ;' ._ X25.00 raty .- - .. x 35:00. '=T � � .. c: r . c x 60.00 ff'^: '` • ;• x10-.03-'--:-:'- x10.00'" = - -,.E^. ..E...;'-:;-' _ x 50.00 ------ . ..• . .7-I': - - x x 10.00 = , x 10.00 = x 10.00 = x 10.00 = x10.00 = x 50.00 = , x100.00 = x 50.00 = x100.00 = x12.00 = x15.00 = SUBTOTAL $ X522 PLUS: PROCESSING FEE + $ 25.00 EQUALS: TOTAL PERMIT nob FEE =$ ) DiV!S.-..