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UI 1 r yr UKU1vv HYrL1l.H I1OIN rvK Mt✓c;tiA'11UAL Y.C.KM11 Page 2 of 3 _ <br /> COOLING SYSTEMS • <br /> Quantity: I <br /> Make: 4-7.t Orley( <br /> Model: • C - 0 SO <br /> Tons: , <br /> H.Power <br /> FIREPLACES <br /> Gas factory fireplace <br /> Wood burning factory fireplace with flue <br /> Wood St ' e- ., <br /> Wood stove with flue <br /> Brand Name Model No. <br /> VENTILATION <br /> No. Kitchen Exhaust duct recalculatin cfm <br /> No. �,$Bath Exhaust(must have duct outside) cfm <br /> No. i Other Fans: Locations y' - cfm <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 /> PERMIT FEE CALCULATION(S) <br /> 2002 State Statute Yes This Section Applies <br /> The 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) Has 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 /> I above oes not app y, o ow gui clines below: <br /> 1. Contract Price* is .0125%of job with a Minimum Fee of($35.00) `� / <br /> ----- <br /> } D x.0125 $ _ _ <br /> (co .ct price) _ (minimum$35.00) <br /> 2. State Surcharge. ** Add the State Building Code Divisiom Minimum Fee of($.50) <br /> ��. x.0005 <br />