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Li i r yr UKUNU H tTLK, i ivty r UK 1vrbl;11AIN1CAL Yt.KMl t Page 2 of 3 <br /> COOLING SYSTEMS <br /> Quantity: / <br /> Make: L- e Y1 t t <br /> Model: 1� $ 6/5-- 23 <br /> Tons: <br /> H.Power <br /> FIREPLACES <br /> Gas factory fireplace <br /> Wood burning factory fireplace with flue <br /> Wood Stove <br /> Wow stov—`e ittrflue <br /> Brand Name Model No. <br /> VENTILATION <br /> No. Kitehea.�x aaust duct recalculating cfm <br /> No. _ _ Bath Exhaust(must have duct outside) cfm <br /> No. - Other Fans: Locations 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 /> If above does not apply,follow guidelines below: <br /> 1. Contract Price* is .0125%of job with a Minimum Fee of($35.00) <br /> e „7,-/q <br /> 1 i 7 J x.0125 — <br /> (contract price) (minimum$35.00) <br /> 2. State Surcharge. ** Add the State Building Code Division a Minimum Fee of($.50)5� <br /> _ — �•E -- — <br /> j I ! 7 __x.0005 <br />