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v <br /> � ' <br /> t.i i r vr �xvlvv HrrLi�H i ivi� r vtc tvtr,Ltit�vlL�r�tttvlt t Y�e 2 oi'3 <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 /> VENFJLATION <br /> Na Kitchen Exhaust duct recalculating cfm <br /> Na Bath E�aust(must�ve duct outside) cfm <br /> �filo. Other Fans: Locations cfm � <br /> FUEL STORAGE(MUST 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 /> 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 etectrical 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 /> It Ta —ove oes not app y, fo low gui e ines e ow: <br /> 1. Contract Price* is .0125%of job with a Minimum Fee of($35.00) � <br /> ------------ �/�_-. <br /> �:��'c_� � x .0125 $ �� <br /> --- --- _ ------------.._. <br /> (contract price) (minimum$35.00) <br /> 2. State Surcharge. ** Add ti�e State Building Code Divisio��inimum Fee of($.50) <br /> __._. <br /> � �X.000s � <br /> 3 <br />