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Building Permit # __________________
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Business License ___________________
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Address of Job ________________________________
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HVAC Permit No. M
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Contract With _________________________________
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Date _______________
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HVAC Contractor _____________________________
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Master's Name______________________
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Company's Address _____________________________
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Master's Signature___________________
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City ______________________ State_______ Zip_______
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State Card #___________________
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Phone # _____________________________________
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Class I ( ) Class II ( )
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Heating System/Furnace
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BTU input, per 50,000 BTU or portion -5.00
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Total BTU input
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No. BTU ______ x
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5.00 = _______
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Air Conditiong
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First 20 tons - 5.00 per ton
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No. ______ x
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5.00 = _______
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20.5 tons and over - 1.25 per ton
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No. ______ x
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1.25 = _______
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Exhaust fan, per 1000 CFM - 5.00
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No. CFM ______ x
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5.00 = _______
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Grease hoods, per 1000 CFM - 5.00
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No. CFM ______ x
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5.00 = _______
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Bath fans, each - 1.25
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No. ______ x
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1.25 = _______
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Incinerator, each - 18.75
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No. ______ x
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18.75 = _______
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Gas line, per linear foot - .125
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No. feet ______ x
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.125 = _______
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TOTAL $ ____________
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