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PLUMBIl'�TTG FIXTURES BETNG INSTALLED <br /> FIXTURE BSMT 1 2 OTHER FIXTURE BSMT 1 2 OTHER <br /> TYPE FL FL TYPE FL FL <br /> � Water Closet Floor Drains <br /> � � � � <br /> Lavatory � t Sewer Ejector <br /> I � <br /> �'' Bathtub p Laundry Tray � � <br /> 1 <br /> �;, Shower W asher <br /> � 6 1 <br /> � Kitchen Sink i Water Heater i <br /> � f t <br /> s.; <br /> � Disposal � Water Softener <br /> � Dishwasher � Wet Bar � <br /> �; Sillcocks � Miscellaneous <br /> �, <br /> � <br /> . ,,� : x�. <br /> . , <br /> � <br /> v �� <br /> . , � , <br /> � . . <br /> �. �- , ,���' �� �..� � <br /> , <br /> , . <br /> �. . ,� .: �. MA <br /> , � . .... . ,a : <br /> r <br /> �" a <br /> �" `''("r� ,. '". F 'dc 3�,�{ �� :'� ° '.�";` '�E . <br /> a <br /> . 4 1. ��w. ' , '� ,. ,`'%1_. ' , . <br /> .. ., .�. ' , .. . . . .�.. . � _ , � ... , :,:. . ... .... ..'... .. .;.. .. . ...... . �..:.�.. . . ......:... . .... � ...,.. ' <br /> � .:.. .. . . , . . .. . . . . . : . <br /> PERMIT FEE CALCULATION(S) <br /> ' BASED 4FF - 2002 STATE STATUE <br /> ❑ Yes,this section applies <br /> � The replacement of a Residential fixture or a plp iance that meets all three of the following requirements: <br /> � <br /> � 1. Does not require modification to electrical or gas service. <br /> �' 2. Has a total cost of$500.00 or less;excludine the cost of the fixture or appliance:and <br /> �; 3. Is improved,installed or replaced by the homeowner or licensed contractor. <br /> �-: <br /> Skip next section,if this applies; Cost of Pernut $ 15.0 � <br /> State Surcharge $ .50 <br /> - - Mail-In Fee(If Applicable) $ 1.50 <br /> Total Permit Fee $ E <br /> �', <br /> ". , ._._ _ . <br /> - ..�x:sr�'���,m�.r�=�e.,., .,��`�:ar;fix���s����^,a�:� <br /> (Permit Fees Continued On Next Page) ' ' <br /> � <br /> , � <br /> 2 � <br /> � � _ <br /> � � <br /> # $ �. + <br /> ... . . � . . . . . . . a: �`€ . . � , :�` i: -�j . <br />