1989, 09-14 Permit App: 89003386 Water Heater iq MECHANICAL PERMIT APPLICATION FORM
Information Worksheet ,
it JOB STREET ADDRESS: S - l O OS- ,
CITY/STATE/ZIP: PARCEL NUMBER:
OW1�ER. ��.,, '� �'Z,o-C.
NAILING ADDRESS=
(Street) (City/State) (Zip)
ct L. CENSE NRMBER: ,,m - 1 c 0 g►
- A_Le_ PHONE NUMBER 7 2,2„-615,6,-‘,..1
MAILING ADDRESS: e t 0 j vZ ,--, .- Q-',, S ;/;tate) (Zip)
a ?MECHANICAL WORKSHEET/FEE SCHEDULE
,: rt: NUMBER X EACH
k DESCRIPTION OF UNITS UNIT = AMOUNT
DUCTWORK SYSTEM _ x$10.00 =
WOODSTOVE/INSERT X 2 ' S =
GAS WATER HEATER x 0. •0 l Off,
HEATING EQUIPMENT <100,000 BTU _ _ _ _ _ x 12.00 =
HEATING EQUIPMENT +100,000 BTU x 15.00 =
t GAS PIPING (3. - 4 OUTLETS) x 4.00 =
x;
GAS PSPING (5 OR.MORE. "EACH:) x 1.00 =
REBRIG 1-100M BTT 6 OT A/C OR HEAT PUMP) x 12.00 =
REFRIG 101-500M ::� x 20.00 =
REF..RIG 501-1,000/4 Wie x 25.00
t, REPRIG 1,001-1,750MT _ x 35.00 =
" REFRIG +1,750M BTU -, _ x 60.00.=
HEAT PUMP & AIR 64 "664. 6k,. ER 0-3 TONS _ x 12.00 =
HEAT PUMP & AIR w 11 • ~' 3-15 TONS x 20.00 =
Ma? PUMP & AIR COM i 4- 15-30'TONE x 25.00 =`
'1MT POMP &"AIR CORDY � 30-50 'ONS x.s3 5.00 =
HEAT & AIR `� EONER +50 TONS x 0.00
FANS 4 �.. ..... -' x 10.00
L+'VA " �
°� x 10.00 =
TYPE Z. i ,( R 12' OR 12' PTN. OF HOOD) x 50.00 =
TYPE II Boor _.. - x 10.00 =
ESg DRYER '
RANGE.. .: ' .:� .., - - - x 10.00 =
GI Loa , ° x 10.00
MISCELLA iEO (NOYC D ELSEWHERE)_; x 10.00 =
UNLISTED GAS'.APPLIANCE; <400,,000 BTU x 50.00 =
',,' 'UNLISTED GAS APPLIANt 5400;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
aL` AIR HAND r.r& , -VA :: _ - - - x 15.00 =
SUBTOTAL $ t o"Q,.
PLUS: PROCESSING FEE + $ 25.00
EQUALS: TOTAL PERMIT
NOTE: MINIMUM PERMIT FEE IS $35.00 FEE DUE = $ SS"lr__.
SIGNATURE