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�i i Y vr vxvivv �rrLi�t�i lviv r�tc rn.��t�tvlLaL r�xM11 Yage.�e�f 3 • <br /> � , <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 /> VEI�ITILATION <br /> ——�-- <br /> Na Kitciien Exliaust duct recalculating cfm <br /> Na Bath Exhaust(must iave duct outside) cfrn <br /> No. Other Fans: Locations �� <br /> FUEL STORAGE(MCTST 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 /> �ERMTr FEE CALCULATION(S7 <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 /> l) Does not require modification to electrical or gas service. <br /> 2) as 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$ <br /> Mail-In Fee $ 1.5 <br /> a ove oes not app y, o ow gu� e �nes e ow: <br /> 1. Contract Price* is .O125%of job with a Minimum Fee of($35.00) `1 �� <br /> �z�'. �� <br /> .`� , �`- � <br /> .-. � �•__� x.0125 $ <br /> (con ct price) (minimum 535.00) <br /> 2. State Surcharge. *'� Add the State Building Code Division aMinimum Fee of($SO) <br /> _ . ..._.__..__ �f <br /> x.0005 $ � <br />