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�i i r ur vxvlvv KrrLi�H 1 iviv r vx rvt�t;t�viLai.r r��civtt 1 Yage 2 of 3 ,,,� <br /> � <br /> COOLING SYSTEMS ' <br /> Quantity: � <br /> Make: ��11� �„��w.:; ,� <br /> � � <br /> Model: "-%� T �� � � <br /> >--� <br /> Tons: � <br /> H.Power <br /> FIREPLACES <br /> Gas factory fireplace <br /> Woo�l burning factory fireplace with flue <br /> Wood Stove <br /> Wood stove with flue <br /> Brand Name Model No. <br /> VENTILATION <br /> Na ---.Kits�ten Exhaust duct recalculating cfm <br /> No. Bath Exhaust(must- ►ave duct outs�de) cfm <br /> No. Other Fans: Locations �� � <br /> FUEL STORAGE(MUST BE APPROVED BY FIRE MARSHAL) <br /> Installatior�or Removal <br /> Fuel oil: `ga ons --inside outside <br /> LP Gas: gallons <br /> Other Gas opening <br /> PERMTT FEE CALCULATION(S) <br /> 3002 State Statute Yes This Section Applies <br /> fihe replacement of a Residential fixture or appliance that meets all tlu�ee of the following requirements: <br /> 1) Does not require modification to electrical or gas service. <br /> 2) as a total cost of$500.00 or less;excluding the cost of the fixture or appliance: <br /> and <br /> 3) Is improved, instailed or replaced by the homeawner or licensed contractor. <br /> Skip next section; Cost of Permit $ 15.00 <br /> State Surcharge$ <br /> Mail-In Fee $ <br /> a ove oes not app y, o ow gui e �nes e ow: > � ; <br /> . �� ;� � - <br /> 1. Contract Price* is .O l25%of job with a Minimum Fee of��.35.00) �,�j <br /> ------ �.. —,��" ._�`-- � <br /> =>� i � X.0�25 $ ��� <br /> (contract price) — - (minimum 535.00) ---- <br /> 2. State Surcharge. ** Add the State Building Code Divi�;�on a Minimum Fee of($.50) <br /> _ . _.___....__`._ / ,,-� . . <br /> ���� �^ <br /> <t� <br /> .�i. � f x.0005 $ � ��� <br />