HomeMy WebLinkAbout1600 (5)MECHANICAL PERMIT (HVAC) APPLICATION
City of Hermosa Beach - Community Development Department
Forced -Air or Gravity -Type Fumace, Includes
Ducts and Vents:
1. Up to 100,000 S.T.U.
2. Over 100,000 B.T.U.
$ 43
Floor Furnace, Including Vent
Heater -Suspended, Recessed Wall or Floor
Mounted
$ 43
$ 54
$ 43
QTY.
AMOUNT
Gas Piping System (Enter No. of Outlets);
a. 1-5 Outlets (Inclusive), Total Fee
b. 6 or More Outlets (Per Outlet)
Appliance Vent Only
$ 33
$ 7
Boiler/Compressor.
a. Up to 3 HP or 100,000 BTU
b. 3 to 15 HP or 100,001 to 500,000 BTU
Absorption System:
1. 15 to 30 HP or 500,001 to 1,000,000 BTU
2. 30 to 50 HP or 1,000,001 to1,750,000 BTU
3. Over 50 HP or Over 1,750,000 BTU
$ 33
$ 43
$ 43
JOB ADDRESS:
/600 ARD/ wR6- '102.2V
JOB DESCRIPTION:
V.E.r + iCA N /.sf 7
"DLL ��
PROPERTY OWNER(S) NAME:
e>1 t -e zv - SM
ADDRESS:
/Gco /e1.4 Gz 4/
Air Handling Unit/Air Conditioner (Including
Ducts)
1. Under 10,000 C.F.M.
2. Over 10,000 C.F.M.
Evaporative Cooler (Non -Portable)
Vent Fan/Single Duct
$ 43
$ 98
$ 98
$ 54
$ 54
$ 43
$ 33
Mechanical Vent
$ 33
Mechanical Suppression System and Exhaust
Hood
Repair, Alteration, Addition to Each Heating
Appliance, Refrigerator Unit, Comfort Cooling
Unit or System (includes Controls)
$ 33
CITY, STATE, ZIP:
/ aYA 314C.h, c, 9Z102.cy'
PHONE:
3/6-gg•2179v
MECHANICAL CONTRACTOR:
--est,D,f cans i .cT/v„)
EMAIL ADDRESS:
bgAGlyComc@yk1p' /COI--
ADDRESS:
"ADDRESS:
%L732 in 7 Pib 4/
$ 43
Any Equipment Regulated but not Included
Above (Includes Factory Fireplace)
$110
MISCELLANEOUS
CITY, STATE, ZIP:
:1 ca `%,26
PHONE:
'5(2-cC77- //o)
BUSINESS LICENSE NO.:
STATE LICENSE NO.: q5- 3 /s-/
SUPPLEMENTAL PERMIT FEE
$ 17
ISSUANCE FEE
$ 59
TOTAL FEE
TYPE OF BUILDING:
CdhDD
NO. OF STORIES:
*Please contact Public Works Department at (310) 318-0214
if work is going to be done in the public right of wav
(sidewalk or street).
NO. OF METERS:
NO. OF FAMILIES:
u�-r/lh��h
DATE ISSUED:
ISSUED BY:
PERMIT NO.:
�ie1;0111)T3
I hereby certify that I have read and examined this application and know the same to be true and correct. All
provisions of laws and ordinances goveming this type of work will be complied with whether specified herein or not.
No person shall be allowed to perform work under this permit in violation of the labor code of the State of California.
1 further state that I am properly licensed as required by Section 7031.5 of the State License Business and
Professional Code (or claim exemption under Section 7044).
Signature of Contractor Signature of Owner (If Owner/Builder)
F:b951cd\forms-handoutslapplication\mechanic 9/1111 Revised 10-3-11