1992, 01-13 Permit App: 92000209 Pellet Stove MECHANICAL PERMIT APPLICATION FORM
Information Worksheet
STREET ADDRESS: 1 51 0 C - S 1/1-'-,1D
CITY/STATE/ZIP: Sp DK_ t.(,4 oC/6 PARCEL NUMBER:
OWNER: DY\ I 0CIA t.0 PHONE NUMBER: .j to Yoc.
MAILING ADDRESS:
Ea
(Street) (City/State) (Zip)
CONTRACTOR: f a )cx C 4r2DEiJ CEiJJ f►2 LICENSE NUMBER: F-4lCD &C.I'73 t U
PHONE NUMBER: (SD(4) q'a?(o-e9)I
MAILING ADDRESS: E • CI D 5p2A91ce_, S,QO .AAJe_ LJA 992 Deo
(Street) (City/State) (Zip)
MECHANICAL WORKSHEET/FEE SCHEDULE
NUMBER X EACH
DESCRIPTION OF UNITS UNIT =AMOUNT
ELECTRIC/DUCTWORK(SEPARATE SYSTEMS) x 10.00 =
OS7. ST�7V>=?tNSER�' ..r x 25.00 —
-GAS WATER HEATER x 10.00
} .A -PQUIPMFnig,I 0 T PUJ.D = ` ince _ x 12.00 �t
GAS EQUIPMENT+1.00,000 BTU DUCTWORK)
x 15.00 ,,.. �.r , , •
p,vuM'Mfnw.y:.w .:JCl::.•}}v_y.;}}v.}:__ }.,
I 1 .v ;.; y w = x
� i .l.;.v.;.
a-:K'�c.:,�- uvrdra•>:c;.:.c :.c:,s.-:a�.;;a:;ny�..,'y,'�.H�'..�iNR`,T�x: ,:: N.v-vawu�` >.c,h = =c A
BOILER/REFRIG 1-100M BTU .:),(1?-09:74•1'4,!; ]
a1 '4
.� J hex+'
::11,]=1771;11111
BOILER/REFRIG 501-1,000M BTU
6 = < "BF# ..G,.'yiAn' I:. . +•!mX K _ •` .)\11''';..
4yy 3500:_ _
BOILER/REFRIG+1,750M
BTU ' ' `*; x
< ,. LIMP ==Atl LflNDI'1 }.[ree>F- : fl[ pt= 3 x 12.00` p'
HEAT PUMP&AIR CONDITIONER 3-15 TONS '--- - x 20.00
I.E.atittAi.KVAR:1070:401LimplimitvglapKvA x
HEAT PUMP&AIR CONDITIONER 30-50 TONS x 35.00
r-PU:MP •t> GOND 1' 1 +t To 9 x 60.00 :
VENTILATING FANS :'` "-- , x 10.00 y n f:
W '-3RLire t L :.. '. 11-44: .a .r' t•,<` �''� . r. x 10.00 7-•
-
.. x..w,awc...d .dtt�.,, .ccww::•..rar`.3..0.:.` .� �
TYPE I HOOD(PER 12' OR 12' PTN.OF HOOD) x 50.00 ._ .
x 10.00 = .
CLOTHES DRYER x 10.00 =
10.00 =
GAS_LOG x 10.00 =
,...,:. G ..:.;.. .EMUS{NOTCOVhREI�ELSEWHI_RE'�=���� _.,: - x 10.00
UNLISTED GAS APPLIANCE<400,000 BTU x 50.00 =
UUNSTED GAS APPLIANCE>400,000 BTU : :< :';`:<': ' x100.00=
USED APPLIANCE<400,000 BTU x 50.00 =
U E:. PC AN S
x100.00-
=DA ..PLt E.�4
AIR HANDLER<10,000 CFM x 12.00 =
AILERR
x 15.00 =
. .:: x:.00 C ......... ........... . . :.........._. : .....:
SUBTOTAL $ a 5 Da
PLUS: PROCESSING FEE +$ 25.00
NOTE: MINIMUM PERMIT FEE IS$35.00 EQUALS: TOTAL PERMIT 5b6D
FEE DUE =$
SV3NATURE