Loading...
1991, 12-30 Permit App: 91008824 Gas Log, Piping • :.:ECHANICAL PERMIT APPLICATION FORM - ea,g 221 ( � Information Worksheet �� - JOB STREET ADD ESS:` _ 1 "l --I t ri)bE'(�I G . �Y 1 vE- CITY/STATE/ZIP: �.rc_�d• - ,( \ 6).310rR- PARCEL NUMBER: OWNER: ( ( �� ;)(1.1.0),,k--- PHONE NUMBER: �'I a(A-01 OlO MAILING ADD' ESS: J a P ;l -rt mbe-f---V-0\J('. sb rvve-- F4 (Street) (City/State).- (Zip) CONTRACTOR: r 4 I c C'/her?DEiJ CE.i l 1-F g LICENSE NUMBER: F.4-1C0&C I-73 b Lit PHONE NUMBER: (SDq) q.2(0-&'91 l MAILING ADDRESS: E • (13I D -S-peic)91(e... Sto ) AAie._. Loa 9920e (Street) (City/State) (Zip) _ MECHANICAL WORKSHEET/FEE SCHEDULE NUMBER X EACH DESCRIPTION OF UNITS UNIT =AMOUNT ELECTRIC/DUCTWORK(SEPARATE SYSTEMS) x 10.00 = - • 11• •.w:.v:w.,.v..v.w�,nwwK.�w�i.. ..wwiivvvn:::-:im ',l.0viii.�'.v":___)iti-:Ciiniri4is�� GAS WATER HEATER' . -. .' - _. _' ._-- - x 10.00 =' _ i. ;SA EQUIPMEtT'k100,000 . NGLUDES` -.- ,9 -_,.. x 12.00 -- ,.w......,....i......,......w.w+N..w.,.....v.n....w..�...rx;3. .:.ww,. ..v.rv:,.w,.a,n,;,: - - '. GAS EQUIPMENT-4100,000 BTU DUCTWORK)=-7•;:-.,-,'"-- - '--- x 15.00 '‘ '` s • .GA ��<�I�,4��3-��:,.•.•t QLI�L� :,a6iC,�.i V,,.... 1?j ._.. ' ._.. __.. x,1.QQ e.y.. :':i:;t.c..4.'iltiff) : Erf54 - r. BOILER/REFRIG.1-100M BTU-..':. -: .- - -- -.--- - x12.00 = _::.-. ,.,--2-.=,-` .'� ''" -. 0 .A.4p. , s+F K+iF)4v +x t _ ..iY.<>,i�'r_i ..A:.r.-r..._ . '...i .X 20.00 :'�`t 1..., ti'-i' 4r''1.�... s A, f ic.," ""iT....4cry ...,.,,......,.., w�ba.,......s.�,.v...�.uoeiCoaxi - _ . r "a` I `,fir���,.y. = BOILER/REFRIG 501-1,000M BTU:4- .4 - r47,-- : -z .. :�- _x_25.00 '..K > 4 • r,-�--• ;q�- •4s ',j..'i�:tom♦ :r�;.1 t ^.;}s ! 'S.Q .E `i G 040 0M IBT s<x;---:_ -.-,1_ -x 35.00.-., n=i17&:u rri,sa - a: ; = x .-- . �. ;, t ...�-::ate,.. ;.� ;,� i t;, BOILER/REFRIG+1,750M BTUK='''` ' . -,-`-'' =•�, - x 60.60:j47-: r:n`-1 ? `4` :A-,- i' -- ;M AiF3 C i40 NEfi ff�S�l'ONS ::r: ::� �- � 1 111 ± - _ ' - . ::� �.... ... Q... .. 0 _ -x 12.00 � r. 7, HEAT PUMP&AIR CONDITIONER 3-15 .. , 530T�.•O'-NS-...a . . x 20.00 iry s-'. ,te.: r Tea?• ,• : ATRAIRCON1 5ER> ? sTi§ i j w,. . , - -- 25.00 ,' .,t . wr •'V % 2 x HEAT PUMP&`'AIR CONDITIONER 30.-50 TONS '--'" l x 35.00 �' -- " '., . '�R •;.',•;.,V.::,:;:-,C7;':::1-7....:„.•.:. :_ , •E• tit F Y ONf3):d.R7+ Oi,T NS _ ._ x 60.00 } - r ;. : .:k" r :. VENTILATING FANS_ =• •> " " �'-. ur_.r..• �` 0 F X 0 0..; ...1V ..GOO S. . :. :......... x1Q.00. !r ,_ TYPE I HOOD(PER 12' OR 12' PTN. OF HOOD)... --- . .. • x 50.00 "''• '- PF 11;1-1 <:; :: OOD.. = CLOTHES DRYER -- - x 10.00 = - =.R....A...N;._........... �: ,N :. ... : . . , x 10.00 = ,GAS LOG t x 10.00 = l0- 00 MISCELLANEOUS(NOT COVERED ELSEWHERE x 10.00 = UNLISTED GAS APPLIANCE<400,000 BTU x 50.00 = , ULINSTED GAS APPLIANCE;>400,000 BTU x100.00= USED APPLIANCE<400,000 BTU x 50.00 = USED APPLIANCE>400,000 BTU - x100.00= AIR HANDLER<10,000 CFM x 12.00 = - AIR HANDLER>10,000.CFM. x 15.00 = r~? SUBTOTAL $ \V.00 . -PLUS: PROCESSING FEE + $ 25.00 NOTE MINIMUM PERMIT FEE IS 535.00 EQUALS: TOTAL PERMIT FEE DUE ! , = S -_ I SIGNATURE