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�. <br /> l,l l Y Vt' VKVIVV HYYL1l.H11V1V t'VK N1�t�tiANlI;AL Y�KMll `1��8 2 0f� � <br /> � � <br /> �� � 1 <br /> /,., �,'�;�ly''�(�L ���` ` } <br /> f�- � `--� � ��� <br /> COOLING SYSTEMS � - - <br /> Quantity: <br /> Make: -e- ti"�' 7� <br /> � . � <br /> Model: .y'7 ��� =� <br /> � <br /> Tons: � <br /> H.Power <br /> FIREPLACES <br /> Gas factory fireplace <br /> Wood burning factory fireplace with flue <br /> Wood Stove <br /> Wood stove v��ith flue <br /> Brand Name Model No. <br /> VEN'TILATION <br /> No. Kitchen Exhaust duet recalculating cfm <br /> No. Bath Exhaust(must iave duct outs�de) cfin <br /> No. Other Fans: Locations �� <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 /> �'ERM�T FEE CALCULATION(5) <br /> �002 State Statute Yes This Section Applies <br /> fihe replacem�nt of a Res:dential fixture or applia.nce that meets all tlzree 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, insta.11ed or replaced by the homeawner 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. Contract Price* is .0]25%of job with a Minimum Fee of($35.00) ��.__ <br /> ----- � �.! <br /> x.0125 $ �� <br /> (wntract price) ` (minimum$35.00) ---- <br /> 2. State Surcharge. ** Add the State Building Code Division aMinimum Fec of($SO) <br /> . __.__._....---- <br /> f=; <br /> x.0005 $ I �- <br />