Loading...
1992, 06-09 Permit App: 92004163 Gas Log, Piping " CHANICAL PERMIT APPLICATION FORM �a � e� �w•L= Information Worksheet /^�q�a1 JOB STREET ADDRESS: 1 Q- a • P )�t ss `V u J CITY/STATE/ZIP: \j r , Lt 9'1O3-2 PARCEL NUMBER: OWNER: I l'Wv- C1)-Y-\rJ PHONE NUMBER: 9 a a - -- '1 ) 9 MAILING ADDRESS: Amo . r (Street) _ (City/State).- r- (Zip) CONTRACTOR: C 1a- I Ct1 C 4rrDriJ CE1.1f t�Fv LICENSE NUMBER: +4)C-0 CSC 1-73 DI✓( PHONE NUMBER: (SD9) cfr2(o-S'9/ l MAILING ADDRESS: E • (13 I D .5-p eA91A e, 51 �'4W e- ),JA 99 2 o(° (Street) (City/State) (Zip) • MECHANICAL WORKSHEET/FEE SCHEDULE NUMBER X EACH . DESCRIPTION OF UNITS UNIT =AMOUNT ELECTRIC/DUCTWORK(SEPARATE SYSTEMS) x 10.00 = • • • •nx nw .. -vn-•••• i. WOODSTOVE/INSER'T`:= <;----- >: x 25.00 = _ GAS WATER HEATER=.-- -•� _ '.. --. • ---- _ -- x 10.00 k <:.:..�.. .,...�...�,.,,..�.,,...�.k .....,. .:. ,.?... • _ x 1200 _ IS Q11� M NT 100,EK1E0' 1T 1C DF M ' GAS EQUIPMENT+100,000 BTU DUCTWORK) -'---- x 15.00 7 ='-- : , :..q »,a<=;<{»::-_:_<,:::•�<;•:<. _. .- _:.::_..r .-_.. . x 1.00 =;:4.. :ori:;, .. _ :,r,` +- � _ 80ILER/REFRIG! 100M BTU x 12.00 -.7-'7-'--'2:-.' '-'7.-2-4'7'1:-:-:£ Tt r L - - 1O.,.].".500 F S4 +.. t K <gs _t:. y .7-7:4-:-...-.,'.::.;•.......:.-. 4 .5.:... -x 20.007,7:-..!.3 -`• 1• _ 1 j -c• i a• i� 'S--. „; BOILER/REFRIG 501-1,000M BTU -"- .__.'44.1 }_i. ,,. -- .,X 25.00 Y .K,i".';...,1,i' � .+^ t�-r? yy y}t� '� rorr �' 1' :O0 c' - Q Q,t.- w.�-x...0M B k f;<j o. rr�n 9^'-r a.gµl� 7- c.. .. -. .:•tic• •,x 35.00- .,ifr� i-4.74:-.7Y37t: CX , • 4x ` l. .+ n„ -,.,, - X 60.00.:';',;72: 'F "ez.=: - `. - �� BOILER/REFRIG+1,750M BTUK �-- - --- - �f t - �<• AIR GOND- •oNE-73.4 W§ ,:::5177., . 1z _ x 12.00, ,,E HEAT PUMP&AIR CONDITIONER 3-15 TONS -= -T. - x 20.00 ,..;.;,,,,..,_,L , < �,--i, EAT' M. Ar >'-" I N Ta ":.!A::<<k; : � . _. -... •4_ .x 25.00 .eu. TtA- ',4► ;[2. . -;:•., . HEAT PUMP&'AIR CONDITIONER 30-50 TONS'. " . t 'x 35.00 ',r -`LI`�:,--`Rl`'"'' QE-' i..2:;-- ' R COND (.ON ,+30 TONS s {,� F; ':•1 _ x 60.00 rte:--- .f�- A f VENTILATING FANS-_- ,!' •. """' `r --=-r r"' - . -x 10.00 : °"<°""''-> ,737-"�`:::� `_' -- = _ _ _ '' --. AP 3RA IVI=<GOOt£RS -' >:,,. .: rik-:: - - -4 - .. � x1000 1-: :: TYPE I HOOD(PER 12' OR 12' PTN.OF HOOD)..: " : , x 50.00 = -:-:--:-.. .-77-77--: -..-77.-771.---;'-' TYPE it HOOD -:....,.. :. x 10.00 = . • .-- . CLOTHES DRYER -' x 10.00 = - - - ,..:-µ:?:..•.r.c:v:wvw-_.-yv.�-.wv. _ w1v T.::.::;?.v!}::!.::<.�n_1�:?!1::?N,.-::�:<-::: � �RANGE::: :>:.;;<> ::»»;::: ::::_:::>::::>`»�:<.><:»:.::>�.>:.::::<::::>:�>«:.:::.::.::::>::::::-»>;:-;»»<-:>:=:>:«:::>::;:::. x 10.00 = GAS LOG ( x 10.00 = /0'3E2 MISCELLANEOUS:(NOT COVELS ERED EWHERE x 10.00 = UNLISTED GAS APPLIANCE<400,000 BTU x 50.00 = ULINSTEED GAS'APPL!ANCE>400000 BTU x100.00= USED APPLIANCE<400,000 BTU x 50.00 = USEDAAPPL1ANCE>4.PP. 0O BTU ....:_:: ! • - x100.00= AIR HANDLER<10,000 CFM x 12.00 = AIR HANDLER>'10,000 CFM;: :._ x 15.00 = `"? SUBTOTAL $ /1 �`' v•PLUS: PROCESSING FEE + $ ` 25.00 NOTE: MINIMUM PERMIT FEE IS S35.00 EQUALS: TOTAL PERMITFEE 1 . S `J1/ Go SIGNATURE