2003, 05-29 Permit 03000479 Plumbing FixturesSiblane MrY
,.Hey
PLUMBING PERMIT APPLICATION
gD o3 - ((77
PROJECT
ADDRESS: )• 15-3CD S , —fif2NCO
alai
PERMIT
USE:
OWNER:
PHONE (Daytime Contact):
MAILING ADDRESS:
(street)
(city/state) (zip)
CONTRACTOR:
D W11
ULck�Y\ tii�Q� `--�
C'
� �1
LICENSE #: �1\/� ( Q
W�( \ \
MAILING ADDRESS:
19.►$L-_._, Spy uQ---
GkopIR
PHONE #:
,5 a9 4QL\-s `i 0 _ •
yes L( a Tgol&
(street)
(city/state) (zip)
PLUMBINGFIXTURES
DESCRIPTION
DETAILS
# OF UNITS
X
COST,
EQUALS
AMOUNT
1
TOILETS
WATER CLOSET, BIDETS
X
$6
=
2
URINALS
-
X
$6
=
3
TUBS
X
$6
=
4
SHOWERS (PER TRAP)
BATH, STALL, ON -SITE BUILT
X
56
=
5
SINKS
LAVS/BASINS, BAR, FLOOR,
KITCHEN, LAUNDRY, UTILITY,
JANITOR, PHOTO, X-RAY, FOOD,
PREP/CULINARY/MEAT
X
$6
=
6
DISHWASHER
X
$6
=
7
CLOTHES WASHER
X
$6
=
8
GARBAGE DISPOSAL
-
X
$6
=
9
WATER SOFTENER
X
$6
=
10
ELEC HOT WATER TANK
NOTE: IF GAS SEE MECHANICAL
X
$6
=
11
FLOOR DRAINS
AREA, CASE, COIL, TRENCH,
CONDENSATE
X
$6
=
12
FOUNTAINS, DRINKING
X
56
=
13
WATER PIPING/DRAIN-IN
WASTE, VENT,
PLUMBING REVERSAL
INSTALLATION, ALTERATION,
REPAIR, REVERSALS
X
$6
=
14
SEWAGE EJECTOR
GRINDER, SUMP PUMP
X
$6
=
15
WATER USING DEVICE
ICE AND/OR COFFEE MAKER,
HOSE BIB, STEAMER, PROOFER,
CARBONATOR, SWAMP COOLER
X
$6
16
CROSS CONNECTION
DEVICE
VACUUM BREAKER, CHECK
VALVE, AND R.P.B.P.D. FOR:
VATS, SUMPS, TANKS, BOILERS
X
$6
=
17
SPRINKLER SYSTEM
X
$25
18
INTERCEPTORS
GREASE TRAP, SAND TRAP,
CHEMICAL HOLDING TANK
X
$6
=
19
MEDICAL GAS per outlet
NITROUS, OXYGEN
X
$6
=
20
MISC PLUMBING FIXTURE
X
$6
=
- _.
v r m-. "
f'�
•
SUBTOTAL
y1
II
CASH ■ CHECK • . ■ _;?.:
PLUS PROCESSING
F E E
$35.00
FAXED PERIN.ITS WILL ONLY BE ACCEPTED WITH PAYloLzNT
OF A MAJOR CREDIT CARD
TOTAL PERMIT FEE
DUE
` r 1.06
`�
EXPIRES:
BANKCARD NUMBER:
AUTHORIZED SIGNATURE:
.•• Val ley
MECHANICAL PERMIT
PROJECT
ADDRESS:
PERMIT
USE:
OWNER:
PHON (Daytime Contact):
MAILING ADDRESS:
(stree
CONTRACTOR:#:
Coug-&
k(c,
Slla
frSEI
RI
MAILING ADDRESS:
GM,er\P
S W
. ciotu ,
PHONE
(street) (city/state)
(zip)
N.
DESCRIPTION OF WORK
# of am
X
COST
EQUALS
AMOUNT
1
FUEL BURNING APPLIANCE
= OR<100,000
X
$15
=
2
FUEL BURNING APPLIANCE
>100,000
X
$19
=
3
UNLISTED APPLIANCE (ADDITIONAL FEE)
=ORe.400,000
X
$50
_
4
UNLISTED APPLIANCE (ADDITIONAL FEE)
>400,000
X
$100
=
5
USED APPLIANCE(WSEC min. AFUE rating)
=0R<400,000
X
$50
=.
6
USED APPLIANCE(WSEC min. AFUE rating)
>400,000
X
- $100
=
7
BOILER/REFRIGERATION
1-100M BTU
-
X
- $15
=
8
BOILER/REFRIGERATION
101-500M BTU
X
$28
=
9
BOILER/REFRIGERATION
501-1,000M BTU
X
$39
=
10
BOILER/REFRIGERATION
1001-1,750M BTU
X
$57
=
11
BOILER/REFRIGERATION
+1750M BTU
X
$95
=
12
GAS LOG, GAS INSERT, GAS FIREPLACE
-
.,
X
$10
=
13
RANGE
-
X
$10
=
14
DRYER
-
X
$10
=
15
FUEL BURNING WATER HEATER
-
X
$10
=
16
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)
=OR<10,000CFM
X
$12
=
21
AIR HANDLER (DOES NOT include ducting)
>10,000CFM
X
$19
=
22
EVAPORATIVE COOLERS
-
X
$10
=
23
TYPE I HOOD
- _
X
$50
=
24
TYPE II HOOD
-
X
$10
=
25
HEAT PUMP/AIR CONDITIONER
0-3 TON
X
. $12
=
26
AIR CONDITIONER
3-15 TON
X
$20
=
27
AIR CONDITIONER
15-30 TON
X
$25
=
28
AIR CONDITIONER
30-50 TON
X
$35
=
29
AIR CONDITIONER
+50TON
X
$60
=
30
LPG STORAGE TANK
-
X
$10
=
31
WOOD OR PELLET STOVE/INSERT
-
X
$10
=
32
WOOD STOVE - FREE STANDING
-
X
$25
=
el
.j..
IT
WITH PAYMEM
CARD
=
CASH ❑ CHECK • ..
SUBTOTAL
•
PLUS PROCESSING
FEE
.�3S.00
DATE:
FAQ PERMITS WILL ADoi NOR
BE ACCEPTEDITCA
oFAMA7oR CREDIT
- FSrPTRFC.
TOTAL PERMIT FEE
DUE
BANKCARD NUMBER:
AUTHORIZED SIGNATURE: