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1990, 08-22 Permit App: 90004125 Gas Piping
MtCHANILAL PtHIVIII APPLIUMIUM tUHM Us_A4z'j0_L Information Worksheet 1 JOB STREET ADDRESS:. - ��'r CITY/STATE/ZIP: p1�, _ ��- PARCEL NUMBER: OWNER: [ " -L-dl_•-L PHONE NUMBER: g Ifo�o PJ MAILING ADDRESS: r (Street) SUBTOTAL (City/State) (Zip) Y CONTRACTOR: *LICENSE NUMBER: 0941e p Me}-- -o 0 S Z NOTE: MIN MUM PERMIT FEE IS $ .00 PHONE NUMBER:- 9.2_1- S e•�_ MALING ADDRESS: ''EL18,62 1�.,...a..w►_ - - 0 3 (,�,,�_44� ; (Street) (Cit /State) (Zip) MECHANICAL WORKSHEET/FEE SCHEDULE NUMBER X EACH DESCRIPTION OF UNITS UNIT = AMOUNT _ DUCTWORK SYSTEM_ _ _ _ _ _ _ _ _ _ _ _ _ WOODSTOVE/INSERT - - _ - _ _ _ _ _ _ - _ GAS WATER HEATER ___-__ HEATING EQUIPMENT <100,000 BTU - _ _ _ _ HEATING EQUIPMENT +100,000 BTU _ _ _ _ _ GAS PIPING (1 - 4 OUTLETS) _ _ _ _ _ _ _ GAS PIING (5 OR MORE. EACH:)__ _ - _ _ REFRIG 1-100M BTU (NOT A/C OR HEAT PUMP) REFRIG 101-500M BTU_ _ _ _ _ _ _ _ _ _ REFRIG 501-1,000M BTU_ _ REFRIG 1,001-1,750M BTU _ _ _ _ _ _ _ _ __ _ _ _ _ _ _ _ _ :REFRIG +1,750M BTU_ _ _ _ _ _ _ HEAT PUMP & AIR CONDITIONER_ 0-3 TONS _ _x HEAT PUMP & AIR CONDITIONER 3-15 TONS _ HEAT PUMP & AIR CONDITIONER 15-30 TONS _ HEAT PUMP & AIR CONDITIONER 30-50 TONS _ HEAT PUMP & AIR CONDITIONER +50 TONS _ _ VENTILATING FANS _ EVAPORATIVE COOLERS - -_- -_ -_ -_ _- --_ - TYPE I HOOD (PER 12' OR_ 12' -PT-NT. OF _HOO_D) TYPE II HOOD_ CLO _________ CLOTHES DRYER - _ _ _ RANGE_ -------------- GAS LOG _-__--_-_-_-_-__--_-_-_--_-_ MISCELLANEOUS (NOT COVERED ELSEWHERE)_ _ UNLISTED GAS APPLIANCE <400,000 BTU_ _ _ UNLISTED 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 _ _ _ _ SUBTOTAL x$10.00 = x 25.00 = x 10.00 = x 12.00 = x 15.00 = x 4.00 x 1.00 = x 12.90 = x 20.00 = x 25.00 = x 35.00 = x 60.00= 12.00 = x 20.00 = x 25.00 = x 35.00 = 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 = PLUS: PROCESSING FEE + $ 25.00 NOTE: MIN MUM PERMIT FEE IS $ .00 rofyBuilding and SafeInto inlk fir fj*17c EQUALS: TOTAL PERMIT FEE DUE = $ 3 _ _ SIGNATURE SUBTOTAL $ PLUS: PROCESSING FEE + $ 25.00 NOTE: MIN MUM PERMIT FEE IS $ .00 rofyBuilding and SafeInto inlk fir fj*17c EQUALS: TOTAL PERMIT FEE DUE = $ 3 SIGNATURE Ss pnoikt anondepartment .-- rofyBuilding and SafeInto inlk fir fj*17c