2004, 01-23 Permit App BLD-04-03444 FurnaceMECHANICAL PERMIT APPLICATION
PROJECT j( ,/ p PERMI -
iADDRESS: S / `� (�} 2 ! ` fUSE: G'C.Q. �r f aC.E
OWNER:
J 2. JJ _
PHONE (Olaylime Contact):
MAILING ADDRESS:
/v
/^
W
X
(street)
(city/state) (zip)
CONTRACTOR,:'1af�-
c t ' 4 '�
C`Yt
X
$19 =
LICENSE
'S/IECC#:Q-/[�
' c I`I Pf .`� Y✓ �3CF"�.rG f7 Sg '
MAILING ADDRESS:
tljL(cZE—
-OR<400,000
PHONE#:
$50
Street)
(C t&tate) (zip)
DESMPTION OF WORK
# OF VMM
I X I
COST I ISQUALS
I AMOUNT
1 IFUEL BURNING APPLIANCE
= OR -4100,000
X
$15
p�
2 FUEL BURNING APPLIANCE
>100,000
X
$19 =
31 UNLISTED APPLIANCE (ADDITIONAL FEE)
-OR<400,000
X
$50
.41 UNLISTED APPLIANCE ADDITIONAL FEE)
>400,000
X
$100
51 USED APPUANCE(WSEC min. AFUE rating)
=0R-4400,000 I
X
$501-
61 USED APPUANCE(WSEC min. AFUE rang)
>400,000 1
X
$100
7 BOILER/REFMGERATION
1-1 DOM BTU
X
$151-
8 BOILER/REFRIGERATION
101-500M BTU
X
$28
9 BOtLER/REFRIGERATION
501-1,OOOM BTU
X 1
$39 =
10 BOILERIREFRIGERATION
1001-1,750M BTU
X
$671-
11 BOILERAEFRIGERATiON
+1750MBTU
X
$95 =
12 GAS LOG, GAS INSERT, GAS FIREPLACE
.,
X
$90 =
13 RANGE
-
X
$10
14 DRYER
-
X
$10
1S FUEL BURNING WATER HEATER
X
$10 =
1S MISCELLANEOUS FUEL BURNING APPL
-
X
$10
17 GAS PIPING ea. Outlet)
_
X
$1 -
18 DUCT SYSTEMS
X
$10 -
19 VENTILATING FANS
X
$10 -
20 AIR HANDLER (DOES NOT include ducting)
=0R<1 QDODCFM
X
$12
21 IAIR HANDLER (DOES NOT Include due5ng
>10,000CFM
X
$19 =
22 EVAPORATIVE COOLERS
_
X
$10
.
23 TYPE I HOOD
-
X-
24 TYPE II HOOD
X
S10
25 HEAT PUMPlAIR CONDITIONER
03 TO
X
2S AIR CONDITIONER
3-15 TON
X
$20 =
27 AIR CONDITIONER
15-30 TON
X
$25 =
28 AIR CONDITIONER
30,553 TO
X
$35 =
29 AIR CONDITIONER
.+50TON
x
$60 =
30 LPG STORAGE TANK
31 WOOD OR PELLET STOVEINSERT
32 WOOD STOVE - FREE STANDfNG
-
-
-
X
X
X
$10 a
$10 >
$25 =
Maw
Q CASH ❑ =CK [� ❑ ,
?A= ?W= VMI OMYBE ACCEPTED PRH PAYIiXIij
W A MAroB. a=rr CARD
DATE: ExpME.S.
SUBTOTAL
PLUS PROCESSING
FEE
TOTAL PERMIT FEE
DUE
l�� (70
SSa_UC f
9ANKCARD NUMBER:
At=C=ED SIGNATURE: