1993, 01-12 Permit App: 93000162 Woodstove-1 t, U L-3 I 5u 7
NI (ga.evl mi3 i' _ FORM
B-2. i4:EC-1-1 NiCA pERK•^i"'�L i:.l.TION Z.--
- - Information Worksheet
JOB STREET ADDRESS: 61 U Li1 o„Sinf-D --1.56'q
CITY/STATE/71P: TE�O vie c1 °/ PARCEL NUMBER:
OWNER: J I •l. VQ fr1 V r e ( PHONE NUMBER: q 2P.-- 7 7L/
MAILING ADDRESS:
(Street)
(City/State) (Zip)
CONTRACTOR: f } ) C C, CFtiI f F,2 LICENSE NUMBER: r4 IC -O 61e.1-73 b l i
MAILING ADDRESS: t- • 233 r'r rrt,c
(Street)
DESCRIPTION
PHONE NUMBER: (`"C'ql //i 1 1
(City/State)
MECHANICAL WORKSHEET/FEE SCHEDULE
ELECTRIC/DUCTWORK (SEPARATE SYSTEMS)
GAS WATER HEATER
GAS EQUIPMENT<100,000 BTU INCLUD S
GAS EQUIPMENT +100,000 BTU DUCTWORK)
GAS FIRING EA OUTL
BOILER/REFRIG 1-100M BTU
BOIL} �IF1EFRIG X01 ;500M BTU
BOILER/REFRIG 501-1,000M BTU
BOIL _R/R-FRIG 1,0001 1,75OMBTU-
BOILEFUREFRIG +1,750M BTU
HST P0.1cw & AtR CQNDtT)ONER .7 T
HEAT�P„UMP & AIR CONDITIONER 3-i5 TONS -j
�i AT PUMP &AIR CONDITIONERS 30 TONS. <
HEAT PUMP & AIR CONDITIONER 30-50 TONS
-TEAT PUMP &AIR CONDmm10NER 450 TONS;
VENTILATING FANS..::._:---------------------------.:..:.......:......:....-.
VENTILATING...............
VAPORATIVE GOOLE
TYPE I HOOD (PER 12' OR 12' PTN. OF HOOD)
CLOTHES DRYER.........:..:.:.... -----.....................---..-...---
^-^,NCS
GAS LOG
MISCELLANEOUS (NOT COVERED ELS�IIVHER
UNLISTED GAS APPLIANCE <400,000 BTU
ULINSTED GAS:APPLIANCE:>400 000 BTU
USED APPLIANCE <400,000 BTU
USED APPLIANCE>400,000;8TU
AIR HANDLER <10,000 CFM
AIR HANDLER>10,000CFM
:'CTE: MINIMUM PER? I T FEE IS 535.00
. ,TITRE
PP)
NUMBER
OF UNITS
ELECTRIC/DUCTWORK
X EACH
UNIT
= AMOUNT
x 10.00 =
x 25.00 =
x 10.00 =
x 12.00 =
x 15.00 =
x 1.00 =
x12.00 =
x 20.00
x25.00=
x 35.00 =
x 60.00 =
x 12.00 =.
x 2o.og=
x25.00 =
x35.00 =
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 =
x100.00 =
x 12.00 =
x 15.00 =
1
e2. ----°----
_ -
_.--
_x20.00
-
SUBTOTAL
S ,--
PLUS: PROCESSING FEE
+S 25.00
EQUALL TOTAL PERMIT
FEE DUE
= S ,S7)--
S7)'