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�i i r vr vxvivv �irrLic,t�i iviv rvx rvt�Lt�uv1L�r�xm11 Yage 2 0£3 -•_ <br /> � <br /> � <br /> COOLING SYSTEMS <br /> Quantity: <br /> Make: `'_� <br /> ,��.. <br /> . _:, <br /> Model: _ <br /> � _.__ __ <br /> Tons: <br /> H.Power -+�� <br /> r�r�cEs <br /> Gas faet�ry fireplace <br /> Wood bu�titig factory firepIace with flue <br /> Wo�Stove <br /> �ood stove with fliie— <br /> Brand Name Model No. <br /> VE <br /> o. Kit�en Exhaust duct recalcvlating cfm <br /> No.�B 'Exhaust(mus-t�iave duct uo—'t.side) /�c� , <br /> No. Ot er Fans: Locations <br /> RAGE(MUST BE APPROVED BY FIRE MARSHAL) <br /> _______ .�_ <br /> Installation or`;—�� Removal <br /> Fuel oil:--�"��� gallons underground inside outside <br /> �,P�t`ras: ---gallons <br /> Other Gas opening <br /> �ERNIIT FEE CALCULATION(S) <br /> 3002 State Statute Yes This Section Appiies <br /> fihe replaceme�t of a Residential fixture or appliance tn�t�r►e�t�ail tIu•ee of►he fall�wing reguiren�ents: <br /> 1) 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 gui e mes e ow: <br /> 1. Coniract Price* is .O125%of job with a Minimum Fee of($35.00) �� <br /> --- �-� _ �� <br /> �^ � .� —" • <br /> `j��(�� ",` �,'��� � x.0125 $ �-� <br /> fJ � (contract price) (minimum$35.00) <br /> 2. State Surcharge. ** Add the State Building Code Division a Minimum Fee of($.50) <br /> . .__-- __ _. <br /> � . <br /> � G� �_� X.00OS $ � <br />