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1991, 09-19 Permit App: 96006066 Furnace, PipingantunwnwAL renom mrruumiun rum", -3, l P P P Information Worksheet �I� Q�A� JOB STREET ADDRESS: ,� -! 3 `f Z! -- / O U CITY/STATF,/ZIP: PARCEL/ Numm. .��"Ll 41 - �S OWNER: PHONE. NUMBER- . Cf;> _e- - 04 a7 - MAILING ADDRESS: (Street) CONTRACTOR: Cd"`"��G�.,._. LICENSE (City/State) NUMBER: Pcbm_-,7n j-" t kO .(Zip) '$ Z PHONE NUMBER: 4 Z2- nO 0 MAILING ADDRESS: r l l S (l, 1M-a-„w_.Q. • 0 (1 �% x �2.r'k;..,-� 4 4ID - (Street) (City/State) (Zip) . MECHANICAL WORKSHEET/FES SCHEDULE ER XONIT DESCRIPTION I OPUU I I =AMOUNT DUCTWORK SYSTEM_ _ _ _ _ _ _ _ _ _ _ _ _ WOODSTOVE/INSERT _ _ _ _ _ _ _ _ _ _ GAS WATER HEATER _ HEATING EQUIPMENT <100,000 BTU _ _ _ _ HEATING EQUIPMENT +100,000 BTU _ _ _ _ _ GAS PIPING (1 - 4 OUTLETS) GAS PILING (5 OR MORE. EACH:)_ _ _ _ _ _ REFRIG 1-100M BTU (NOT A/C OR HEAT PUMP) REFRIG 101-500M BTU_ _ BT REFRIG 501-1,000M U _ _ _ _ _ _ _ _ " REFRIG 1,001-1,750M BTU_ _ _ _ _ _ _ _ _ REFRIG +1,750M BTU_ _ _ _ _ HEAT PUMP 6 AIR CONDITIONER_ 0-3 TON_S _ HEAT PUMP i AIR CONDITIONER 3-15 TONS _ HEAT PUMP 4 AIR CONDITIONER 15-30 TONS _ HEAT PUMP i AIR CONDITIONER 30-50 TONS _ HEAT PUMP i AIR CONDITIONER +50 TONS _ _ VENTILATING FANSx EVAPORATIVE COOLERS _ - - -_ - - - - - _ TYPE I HOOD (PER 12' OR 12' PTN. OF HOOD) TYPE II HOOD CLOTHES DRYER - - - - - - - - -- - -- RANGE -------------- GAS IOG ------ ---------- 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 _ x$10.00 - x 25.00 - X 10.00 = x 12.00 = x 15.00 = x 4.00 = x 1.00 = x 12.00 - x 20.00 = x 25.00 = x 35.00 - x 60.00 - x 12.00 = x 20.00 = x 25.00 = x 35.00 = x 60.00 - 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 = IX 50.00 -- x100.00 = x 12.00 a X 15.00;= -�- SUBTOTAL - • ___ _. $ 3 :.. PIAS. PROC_ESSI.NG-.SEE + $ 25 EQUALS TOTAL BBRIFF}' NOTB:-IQwINUx n T 7192 I $33.00,' - FEE.'bvt;P`A:- r .t 30', SIGNATURE 'E ;- s`r sf m.: 73now.-- s - a--- ------- - _§