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�i i r ur �xviv� ArrLIUA 1 WIN r vtc 1v1t;1 t1A1Vil AL rLiclvu 1 Page 2 of <br /> COOLING SYSTEMS ' <br /> Quantity: <br /> Make: <br /> Model: <br /> Tons: <br /> H.Power <br /> FIREPLACES <br /> Gas factory fireplace <br /> Wood burning 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 Exhaust(must ave duct outside) cfin <br /> No. Other Fans: Locations efm <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 /> TPERNIIT FEE CALCULATIONS) <br /> 2002 State Statute Yes This Section Applies <br /> 111ie replacement of a Residential fixture or appliance that meets all three of the following requirements: <br /> 1) Does not require modification to electrical or gas service. <br /> 2) Hii a total 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 Surcharge$ .50 <br /> Mail-In Fee $ 1.50 <br /> If ab oes not app y, o ow guy a ones-below: <br /> 1. Contract Price* is .0125%of job with a Minimum Fee of($35.00) ) <br /> x.0125 $ <br /> (contract price) (minimum$35.00) <br /> 2. State Surcharge. * Add the State Building Code Division aMinimum Fee of($.50) <br /> 7 X.0005 $ <br />