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�i i r vr vtcvivv HrrLi�ti i ivi� r�x��r�uvl��r�tcNu 1 Yage l of��a \ <br /> �, <br /> �'. <br /> COOLING SYSTEMS � /' <br /> Qu�aty: , � ��'Y'I� ,,� <br /> Make: � � � <br /> ._ <br /> ModeL• � - �f7��� "�� � �•.����.� ����: 19I <br /> _ — <br /> r-- � <br /> Tons: =� � ����� � <br /> H.Power <br /> FIREPLACES . _ _. _ <br /> . � <br /> G ctory�`'ireplace <br /> Wood b ing factory fireplace with flue <br /> Wood Stove�- <br /> Wood stove with flue <br /> Brand Name Model No. <br /> VENTILATION <br /> No. Kitchen Exhaust duct recalculating cfin <br /> No. Bath E�chaust(must�ve duct outside) �� , <br /> Nc�. Other Fans: Locations �� <br /> FUEL STORAGE(MUST BE APPROVED BY FIRE MARSHAL) <br /> Installation or Removal <br /> Fuel oil: gallons underground inside outside <br /> LP Gas: gallons <br /> Other � Gas opening <br /> �'ERNIIT FEE CALCiTLATION(S) <br /> 2002 State Statute Yes This Section App6es <br /> `The replacement of a Residential fixture or appliance that meets all tl�u-ee of the following requirements: <br /> l) Does not require modification to electrical or gas service. <br /> 2) as a totat cost of$500.00 or less;excluding the cost of the fixture or appliance: <br /> and <br /> 3) Is improved, installed or replaced by the homeowner or licensed contractor. <br /> Skip next section; Cost of Permit $ 15.00 <br /> State Surcl�arge$ .50 <br /> Mail-In Fee $ 1.50 <br /> I�ve o�es nat apply, o otiv gui e ines e ow: <br /> 1. Contract Price* is .0125%of job with a Minimum Fee of($35.00) �/� <br /> -------- er .- � <br /> ; � x.0125 $ � <br /> (c tract price) � (minimum$35.00) <br /> 2. State Surcharge. *'` Add ti�e State Building Code Division aMinimum Fee of($.50) —� <br /> _ ----- ------- -- � <br /> . __-_ x.0005 $ � � <br /> � <br />