Loading...
1992, 03-24 Permit App: 92001816 Gas Log, Piping a\ 44- [3aa • TSI V ASD 49 :..=CHANICAL PERM APPLICATION FORM o� _ I 44110 I o 8 a Information Worksheet JOB STREET ADDRESS: S • 1 .. l�, l \o t i n(2.. 5C (45c a. CITY/STATE/ZIP: S,f-l1�IC i ,j/i4 I`1 D( PARCEL NUMBER: OWNER: )12,,z1 1-1) e ine-\' PHONE NUMBER: 9.2.ct - "24..05 / MAILING ADDRESS: (Street) (City/State}- (Zip) CONTRACTOR: E }Ci' CI41'21 r-A CE1JfFr2 LICENSE NUMBER: F4ICA&C I-73 bLit PHONE NUMBER: (So c12(o-g91 J MAILING ADDRESS: E • 6131 D SpeA9l.Ce_ 5 ioD AAje_ 1a.)P1 c392o6, (Street) (City/State) (Ziip) • __ MECHANICAL WORKSHEET/FEE SCHEDULE NUMBER X EACH DESCRIPTION OF UNITS UNIT =AMOUNT ELECTRIC/DUCTWORK(SEPARATE SYSTEMS) x 10.00 = WOODSTQVE/INSERT r : .. x 25.00 - ..• ..._ GAS WATER HEATER: - -. _ - ...--- - --- x 10.00 - . -77-:-..-:- GAS 1=4UIPMEhit` 76OS`t'U NCTI3DES 3 x 12.00 i' GAS EQUIPMENT-+100,000 BTU DUCTWORK)-;.--5,-'4',.;--'- . - • ..--- x 15.00 3. " - r = } €G.. ::I G" r �'.' A L1TL � --...:,,:: 'lam ..,�...,::E�,��j.' �M:..::::.:..:::.<:..���>t::;<;;>_-.vn,.vv� ��>>:: _ _.. ._.. _ -. w � �, �, � x:100 f.. BOILER/REFRIG.1-100M BTU b.•;, .p �` 1yt��}�}� �X 12,0 � r . r�..a # _ .� . .f:.; r K _ 4 .1.. •-X 20.0 -� y ,,,r,::,•P aIr^ ,0 rte"" + j .� - .. t N- :idwQ i. %Gf.mi ]Y1. - --... S' l�•(,J: b.!4 :-, BOILER/REFRIG 501-1,000M BTU.. Y rr= :.7i .*. ' _ .. _ . ..X2.5,700.7:1 ,.:. ,.,i.,.... :_;:=5. -f SYe E. - . .y,..-: ... ,�� or..... -�..,:ficy.< ":'m�ewc ;:x-35-06,4- -. 4 st�eT1F ` -0 _ G^I'�flOp � •- t�M$' 3�, : ,� �A:.--�=:� -�, x35.00 � - .���.-:�� t' BOILERIREFAIG+1,750M BTUK'' ' .)4.-`*. xt' -` • - -x60.00r = . i`�- fit.i - D: 'M AiR COND' t3N '0-3' 'ONS "`'- >M'1. _. - ,;:..y.i, ;. . •.n_,>r--F •: '�:. :: E#�:: -x 12.00 s =-� ..3• -�. HEAT PUMP&AIR CONDITIONER_ 3-`15 TONS" - x 20.00 *=•. ry �`' , " : ""...�"" �„�.,�,.�,- ^^^,rte-:,: :?-�;: : a ,,,tiEAT: :IYM #1i AI GONt� .tQN Eli 1 Tt)NS , ti f-,..-,:-.„.i..,__...,..,,-.. x 25.00 . ,J 3 4' :f`1„. :c HEAT PUMP AIR CONDITIONER 30-50 TONS -'"- = t = x 35.00 ='" :x^ ti" x�'T .,� ,;... ` a _ .- t w.. 7f. fax � 'M�, �� {a�� A�! . sV TONS f�$' aiw Fli.:.� - -:-1 X 60.00 f�.'.:.:» '''..t* -,-17,.-744:4 .:., ..t.. VENTILATING FANSY�=a - r""J 7- _.. x 10.00 y-!;::::i.7-7. ` t: :7: WATITorigirVeTd. aac:c.s>ssMo;yrsu .,.:Rs.:.rv:t .. ... --,r - 12 ' TYPE I HOOD(PER 12' OR 12' PTN. OF HOOD).-'7,--:':*-:.:.-- x 50.00 _ ITYP.E I HOOD :.... x 10.00 = . CLOTHES DRYER -- - x 10.00 = - - i9AN x1 = 0. GAS LOGw;...._.,w:..:. a...:.::..:,...._.:...N...�..:..---..,.. ---.,,._,,,,,,,,,,;,,,,,,,,,,,,... 00) x 10.00 = /dao - MISCELLANE US 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 Ai✓PLIANCE>400,OQ0BTU x100.00= AIR HANDLER<10,000 CFM x 12.00 = AIR HANDLER>10,000.:CFM: . .:. ..:: ...: : x15.00 = `2 SUBTOTAL $ I ( 29 . 'PLUS: PROCESSING FEE + $ 25.00 NOTE MINIMUM PERMIT FEE IS 535.00 EQUALS: TOTAL PERMITEEDUE I = --p�p SfGNATURE _ _ ..."tv Divis77