1991, 09-19 Permit App: 91006067 Furnace, Piping q I --,. .p.� MtbI MNIbMLL itn:vflM
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Information Worksheet 7.
JOB STREET ADDRESS: 1 `-F S 1 Ct 1 ---- . C910t.14__
CITY/STATF�/ZIPS SQ - - PAR ER•. - ' /
O : ` f.,,,_-
: ...,,_..,._,c,,,, PHONE )IUMBER:r 4' 2_51 _ i ->_ 3; 4
MAILING ADDRESS: T Sem--4-2
(Street) i . (City/State) (Zip)
CONTRACTOR: P L ` c1- 4-�t LICENSE NUMBER: 2r4r L'R, 4- -wt l LO i17_
PHONE NUMBER: q2_2_-Sia c)
MAILING ADDRESS: l l S ((, 4' „moi CI q ID
t_ ' ,(Street) ,(City/state) (Zip)
{ ' MECHANICAL WORKSHEET/FEE SCHEDULE
NUMBER X EACH
DESCRIPTION OF UNITS UNIT = AMOUNT
DUCTWORK SYSTEM x$10.00 =
WOODSTOVE/INSERT x 25.00 =
GAS WATER HEATER x 10.00 =
HEATING EQUIPMENT <100,000 BTU ( x 12.00 = 1 "2...9-e
HEATING EQUIPMENT +100,000 BTU x 15.00 =
GAS PIPING (1 - 4 OUTLETS) x 4.00 =
GAS PIING (5 OR MORE. EACH: ) t x 1.00 = I,.
REFRIG 1-100M BTU (NOT A/C OR HEAT PUMP) x 12.00 =
• REFRIG 101-500M BTU x 20.00 =
REFRIG 501-1,000M BTU x 25.00 =
• REFRIG 1,001-1,750M BTU x 35.00 =
REFRIG +1,750M BTU x 60.00 =
HEAT PUMP & AIR CONDITIONER 0-3 TONS _ _ x 12.00 =
HEAT PUMP & AIR CONDITIONER 3-15 TONS _ x 20.00 =
HEAT PUMP & AIR CONDITIONER 15-30 TONS _ x 25.00 =
HEAT PUMP & AIR CONDITIONER 30-50 TONS _ x 35.00 =
HEAT PUMP & AIR CONDITIONER +50 TONS _ _ x 60.00 =
VENTILATING FANS x 10.00 =
EVAPORATIVE COOLERS x 10.00 =
TYPE I HOOD (PER 12 ' OR 12 ' PTN. OF HOOD) x 50.00 =
TYPE II HOOD x 10.00 =
CLOTHES DRYER x 10.00
RANGE x 10.00 =
GAS LOG x 10.00 =
MISCELLANEOUS (NOT COVERED ELSEWHERE)_ _ x 10.00 =
UNLISTED GAS APPLIANCE <400,000 BTU _ _ x 50.00 = 4
UNLISTED GAS APPLIANCE >400,000 BTU_ _ x100.00.=
USED APPLIANCE <400,000 BTU _ _ _ _ _ x 50.00 _
f USED APPLIANCE >400,000 BTU_ _ x100.00 4-' 1
AIR HANDLER <10,000 CFM x 12. .;
AIR HANDLER >10,000CFM _ - x 1500`=
- SUBTOTAL w. , ,. .-_,. 4
s,,PL S t PROCESS 2 5.E
� PR �10 ��� S
.„ , EQUALS: •TOTAL; f • :4 t .`,
NOTE: .Ar` T r $35.00 . LrEE- " 1 i i s uj1* - .. - am)• 4 , �a
• 2;
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