1991, 11-18 Permit App: 91008042 Woodstove(,5 �wECHANICAL PERMIT APPLICATION FORM
F151`) Sub Q � ��
b a Information Worksheet I
JOB STREET ADDRESS: ,U (e I -7 rv-\ t AA_
kecL No , Saar!
CITY/STATE/ZIP: U eAU 2 I e.. `'T C)3'7 PARCEL NUMBER:
OWNER: Ur\ VI 6LA9 PHONE NUMBER: 9028 - y (p5J
MAILING ADDRESS:
(Street) (City/State) (Zip)
CONTRACTOR: E I C(1 & 4rrtEiJ CEi.I i~ F►2 LICENSE NUMBER: 1- ►4 I CD &C. I %3 b lel
PHONE NUMBER: (SOA) cJ)(o-e9I I
MAILING ADDRESS: E . q31 D _.Q eR3ix e S KAA1 e- 4>a 992 Deo
(City/State) (Zip)
MECHANICAL WOR
DESCRIPTION
(Street)
ELECTRIC/DUCTWORK (SEPARATE SYSTEMS)
GAS WATER HEATER
Gli*Q31PME<1QQ�00017vI`,»n... rr.
GAS EOUiPMENT+100,000 BTU DUCTWORK)
r>,,,,, : ,.,..,.�....k •.�,.,b,..r,;-;.:- :tea,.;.:,,>:;;;,};.:
jfEis
BOILER/REFRIG .1-100M BTU
BOILERIREFRIG 501-1,000M BTU.' .i `."� 4:._ .r.. -rte
BOILER/REFRIG +1,750M
UM fitR.00t d - eFRI ` flNS
�.vur' QmviiNMwGvmM4w....xnv++wrwLG.,rv+..nv,..wwwrKMeWif//iGvwiwwr { _»"nnu,
-r HEAT PUMP & AIR CONDITIONER 3-15 TONS-"
HEAT PUMP & AIR CONDITIONER 30-50 TONS"
Ammoomien
VENTILATING FANS
.;±«.. ,.,.w.......w,•.:..w.�•r .:•,, yw.- .. ..:;;:y�ra+Sr"'°'v1r:;7.
Y1
...iuFi0fw9F.wvw /.rAv+iwiwK:wl. wvnlQpCtt4+�4.'ri}:'iJw:�kt4-(r:L"L:v-ttrwv.:vf ,vwii ••. __r:
TYPE I HOOD (PER 12' OR 12' FTN. OF HOOD
YP .0 =1OOD'.
CLOTHES DRYER
GAS LOG
MISCELLANEOUS (NOT COVERED ELSEWHERE
UNLISTED GAS APPLIANCE <400,000 BTU
ULINSTED GAS:'APPLIANCE>400000 BTU
USED APPLIANCE <400,000 BTU
USED APPLIANCE>400,000>BTU
AIR HANDLER <10,000 CFM
AIR:; f-IANDLER>10,000 C
ro.
N 0 V 1 1991
NOTE: MINIMUM PERMIT FEE IS 2335.00
SIGNATURE
NUMBER
OF UNITS
X EACH
UNIT
= AMOUNT
x10.00 =
25.00 =
x 10.00=
x12.00
x 15.00 ==.
x,1.00
x 12.00
x 20.00
.mr`
, x 25.007
X 35.00 ,, _
x 60.00 �';"
x12.00
x20.00 =`:
x 25.00
x35.00
x 60.00-1-'4=
x-
x10.00
x 10.00
x50.00=
x10.00=
x10.00 =
x10.00 =
x 10.00 =
x 10.00 =
x 50.00 =
x100.00 =
x 50.00 =
x100.00 =
x 12.00 =
x 15.00 =
-
. -
,: -
s�«z..k,.•1:
.;,.44:,
I a, .47.17.r . .r.,
y .,=.' ,L �-4f
..._ � . , .. ,_e• a ..
t i.4 f" . :=
I 7.-:.,---,-,-- til:;:'
,:-•r,., t��- „„4:,..x�
-
•; r'°-..'
. �.
*- � :`
_ .te.7.-..i•,'-.,-,-.
i : I.; _
:m'.?E.44'-
t
z,; ; .�..
. _.-f -
:' -
.1 .4',4;4.``-
-- :•
i'r✓:
1
_ .:.�....= _
_.-.
I
SUBTOTAL
$ as -
PLUS: PROCESSING FEE
+ $ 25.00
EQUALS: TOTAL PERMIT
FEE DUE
-,S
?rift/ Divis