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�i i r �r vxvivv HrrLi�H�ivi� r utc ivi��r�uvic;x�r�tuvu t Yage 2 oi�� . � <br /> , t <br /> COOLING SYSTEMS <br /> @uantity: <br /> Make: � <br /> ��\_ <br /> Model: � <br /> Tons: �'- <br /> H.Power <br /> FIREPLACES <br /> Gas faetory fireplace <br /> - ��d barning factory fireplace with flue <br /> Wood Stove�_ <br /> Wood stove with flue `� <br /> � �e Model No. <br /> VENTILATION <br /> Kitchen E�cllaust duct recalculating cfm <br /> No. diaust(mu-st iave duct outside) cfm , <br /> No. Other Fans. tions ��► <br /> FUEL STORAGE(MUST BE APPROVED BY FIRE MARSHAL) <br /> Insta�Ta�'tiss. r Removal <br /> Fuel oil: ns underground inside outside <br /> LP Gas: gallons <br /> Other Gas opening <br /> �ERMTT FEE CALCULATION(S) <br /> 2002 State Statute Yes This Section App6es <br /> The replacement of a Residential fixture or appliance that meets atl tlu-ee of the following requirements: <br /> l) 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 fi�cture 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 Surcl�arge$ .50 <br /> Mail-In Fee $ 1.50 <br /> I��ov-e�oes-not app y, �o ow gui e �nes e ow: <br /> 1 <br /> 1. Contract Price* is .O l25%of joU with a Minimum Fee of($35.00) -�� <br /> —----- � <br /> .___����� � x A 125 $ ��� ��� � <br /> (contraci price)---- (minimum$35.00) - — <br /> 2. State Surchargc. ** Add the State Building Code Division a Miniruum Fee of($.50) � <br /> -- -------------�� , <br /> __.. x.0005 $ ,� / <br />