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MECHANICAL PERMIT APPLICATION
Jurisdiction of City of Blair, Nebraska
218 South 16th Street
Blair, Nebraska 68008
Fax (402) 426-4195
(402) 426-4191
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033 iJ.
Application Date:
Job Address
ownero \ I'
1. -cbI01e'
Cont ctor A. _ ().
2. L-t..U/l.A.J.K.OLc
3. Class of Work:
Describe Work:
4.
Heat Pump
Central AlC
Tons
Tons
Furnace
9D 10 lJ'J
.
BTUIH
AlC
# of Units
Completion Date:
Furnace
11- U"U~
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.
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Date
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M 1941
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MECHANICAL PERMIT FEES
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FumacelHeat Pump/Air Conditioner (Per Unit) l )--
Up to and including 100,000 BTU / 3Ton............................$15.00
FumacelHeat 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/GaslWater
Piping System... ... .................. ..... ...$50.00
Modular Home...... ......... ... ... .......... $50.00
Permit Issuance Fee......................... .$25.00
Total
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Current License on File
o No 0 NjA
Comment:
WHEN PRO PERL Y VALIDATED (IN THIS SPACE) THIS IS YOUR PERMIT
I Approved By: (J Q \)/0;;>
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I
Rev. 2008-10