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~ //~ MAJ:I~J~)I~:~UNTY BUILDING INSPECTION <br />Received By: /~;~-~- ~ <br /> <br />Date: <br /> <br /> MECHANICAL PERM~ APPLICATION <br /> <br />Pre~Ownen j... f~. " photo: Mailir~g Address: <br />Job ~mss: ~ ~ . Site No.; Cross Street; <br />~h~ni~a[ In~a~er: ~ ~ - Phone; Address; <br /> <br />H~ BdHder~ Registra{ion NO.: ~ ~ <br /> <br />Resldential:~ Commemiah Use of Building; <br />~w; ~ Alteration: ~ Addition: ~ Relocation: ~ OccupancyChange; ~ <br /> <br /> NO. FEE AMOUNT <br />I~ase Price 10,00 <br />Forced air furnace 100,000 BTU or loss 6.00 <br />_Forced air furnace over 100,000 BTU 7,50 <br />Floor Furnace 6.00 <br />_~, ~spended Heater 6.00 <br />Wall Heater 6,00 <br />Floor Mounted Unit Heater 6,00 <br />Heat Pump I 6,00 ~,. 0 (~ <br />A Jr Ha?dling Unit to 10,000 cu. fl. 4,50 <br />Air,Haedlln~ Ual! over 10,000 au, ft. 7.60 <br />Evaporative Cooler 4,50 <br />Exhaur~t Sys!em Commercial 4,50 <br />Hood and Exhaust Commercial 4,50 <br />Domestic Range Hoods 4.50 <br />Domestic Exhaust Fans & Drye~ Vents 3.00 <br />For pre-installation or installation <br />of each wood stove 7.50 <br /> <br />Commercial or Industrial Incinerator <br />Fire Damper <br />Gas Water Heater <br />For each gas piping system of up to <br /> 4 outlets, minimum fee <br />For each gas piping system of 5 or more <br /> outlets, per outlet <br />For the installation, relocation or <br /> replacement of each appliance vent <br />not included in an appliance permit <br />Appliance or accessory to any heating or <br /> Comfort cooling system not covered <br />Other {as per Mechanical <br />On-Site Technical Review <br /> (Apply at Madon Co. only) <br /> <br />STATE SURCHARGE ..~C) <br /> PLAN REVIEW FEE ~ <br />~NVEST~AT~ON F~E $ <br />FLEETSURCHARGE "~,~ ~ <br /> <br /> TOTAL ~l. Vd <br /> <br /> Please return COMPLETE APPLICATION with the indicated fee. <br /> <br />(L,,-) Jcmar#gi~teredbuilderOR( )theauthorizedrepm*enaslveof SIGNATUREOFAPPLICAN --_ <br /> <br />Rev, 3/87 <br /> <br /> <br />