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LI t Y or UKUINU KYrL!LH HUN r UK IvICA.A1 INILAL rt✓KMt I Page 2&3 <br /> COOLING SYSTEMS i <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 _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 /> • <br /> Fuel oil: _ gallons underground inside outside <br /> LP Gas: gallons' ' <br /> Other ' ' Gas opening <br /> — • , 1 . at <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 /> 2(0 � x.0125 $ 3jiw <br /> (contract price) (minimum$35.00) <br /> 2. State Surcharge. ** Add the State Building Code Division a Minimum Fee of($.50) ' <br /> "x.0005 $ / . 5 2– <br />