BPM1837
~
MECHANICAL PERMIT APPLICATION
Jurisdiction of City of Blair, Nebraska
218 South 16th Street
Blair, Nebraska 68008
Fax (402) 426-4195
(402) 426-4191
Application Date:
3-)
-, 0 C;
Job Address
4.
Heat Pump
Central AlC
Tons
Tons
J
Furnace
BTU/H
AlC
# of Units
Completion Date:
Boiler Chart
BTU Fee
Up to 100,000............................. ...$15 .00
100,000-500,000................. .......... ...$30.00
500,000-1,000,000................. ......... .$40.00
1,000,000-1,750,000....................... .$60.00
Over 1,750,000.......................... ....$100.00
Notice
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 governing this type of
work will be complied with whether specified herein or
not. The granting of a permit does not presume to give
authority to violate or cancel the provisions of any other
state or local law regulating construction or the
performance of construction.
Signature of Contractor or Authorized Agent
Date
M 1837
Permit Fee:
MECHANICAL PERMIT FEES
Furnace/Heat Pump/Air Conditioner (Per Unit)
Up to and including 100,000 BTU / 3 Ton.. ....................... ...$15.00
Furnace/Heat Pump/Air Conditioner (Per Unit)
Over 100,000 BTU / 3 Ton.............................................$25.00
Refrigeration Units/Coolers/Lines/Compressor - Commercial
(New or Replacement) (Per Unit)
............................................................................ ..$15.00
Boiler (use BTU Chart to left)............ ..... ...
Appliance V ent/F ans.. . .. . .. . .. .. .. . .. .. .... $10. 00
Duct System... ... ... ... ... ... ... ... ... ... .. ..$15.00
Gas/Air Outlets.................First 5
x $6.00
. . . . . ." .Additional
x $1.00
Radiant Heat Systems/Gas/Water
Piping System.................. ........ ..... .$50.00
Modular Home... ... ... ... ...... ... ... ... .... $50.00
Permit Issuance Fee........................ ..$25.00
Total
Current License on File
DYes 0 No 0 NjA
Comment: .~., I~- idi \0 0 ~ l'
,. V\ v J-7 ~/ 0-
LJ f t,C' C(; _ o/!'Y' t,
WHEN PROPERLY VALIDATED (IN THIS SPACE) T S IS YOUR PERMIT
I Approved By: c t?, .~f~
Rev. 2008-10
MECHANICAL PERMIT APPLICATION
Jurisdiction of City of Blair, Nebraska
218 South 16th Street
Blair, Nebraska 68008
Fax (402) 426-4195
(402) 426-4191
Application Date:
3-)d,~o1
Job Address
J II ~
Heat Pump Tons
Central AlC J Tons
Furnace BTU/H
# of Units AlC
Furnace
Completion Date:
r" ,.-:) 1- ()~
Boiler Chart
BTU Fee
Up to 100,000....................... ..... ....$15.00
100,000-500,000.................. ........ ....$30.00
500,000-1,000,000.......,......... ......... .$40.00
1,000,000-1,750,000.............. ......... .$60.00
Over 1,750,000.................. ........ ....$100.00
Notice
I hereby certify that I have read and examined this
application and lmow the same to be true and correct. All
provisions of laws and ordinances governing this type of
work will be complied with whether specified herein or
not. The granting of a permit does not presume to give
authority to violate or cancel the provisions of any other
state or local law regulating construction or the
performance of construction.
~L~ &:(ti.f/~7/
Signature of Contractor or Authorized Agent
')
~)- d / C'IG;
Date
M 1837
00
Permit Fee: $~ () ..-r
I/~ M
Zip
Phone
y\) . '71Cl)1- o.~ (,yJ 3\1
o New 0 Addition 0 Alteration 0 Repair
Phone -~ Q I ~ /.
S-s fo - 1701;) -J <.. . if'
Replacement 6tJk<<
MECHANICAL PERMIT FEES
Furnace/Heat Pump/Air Conditioner (Per Unit) I ~-: U)
Up to and including 100,000 BTU / 3 Ton.. ....................... ...$15.00
Furnace/Heat Pump/Air Conditioner (Per Unit)
Over 100,000 BTU / 3 Ton............... .................. ........ ....$25.00
Refrigeration Units/Coolers/Lines/Compressor - Commercial
(New or Replacement) (Per Unit)
.. .. .. .. . . . . .. . .. . .. . . .. . .. .. . .. . .. . .. . . .. .. . .. . .. .. .. ... . . .. . .. . .. .. . .. . .. . ..$15.00
Boiler (use BTU Chart to left)...... ...... ........
Appliance Vent/Fans.................... ....$10.00
Duct System... ............................. ..$15.00
Gas/Air Outlets.................First 5
x $6.00
. . . . . . . ..Additional
x $1.00
Radiant Heat Systems/Gas/Water
Piping System... ......... ......... '" ....... .$50.00
Modular Home......... ...... ...... .......... $50.00
Permit Issuance Fee................... ...... .$25.00
Total
;) 0<--v UJ
'-10<
CU11'ent License on File 0 Yes 0 No 0 NjA
Comment:
WHEN PROPERL Y VALIDATED (IN THIS SPACE) THIS IS YOUR PERMIT
I Approved By: c 15, ;7Z.tf~
I
Rev. 2008-10