BPM1993ME CHANICAL PERMIT APPLICATION
Jurisdiction of City of Blair, Nebraska
218 South 16 Street
Blair, Nebraska 68008
Fax (402) 426 -4195 M 1993
(402) 426 -4191
0 Permit Fee: $
Application Date: /� r /�
f /f
Job Address
"
Owner 6i re s Zip Phone
1. f
Contractor Mail dress , Zip Phone
2. ea
3. Class of Work: O ` COMMERCIAL ESIDE TIAL M New O Addition O Alteration O Repair eplacemenk
Describe Work: 4
MECHANICAL PERMIT FEES
Heat Pump Tons
Central A/C Tons
Furnace/Heat Pump /Air Conditioner (Per Unit) IC 5
Furnace BTUM
Up to and including 100,000 BTU / 3Ton ... .........................$15.00
# of Units A/C
Furnace /Heat Pump /Air Conditioner (Per Unit)
Furnace
Over 100,000 BTU/ 3 Ton .................... .........................$25.00
Completion Date:
Refrigeration Units /Coolers /Lines /Compressor— Commercial
(New or Replacement) (Per Unit)
Boiler Chart
BTU Fee
.............. ............................... .........................$15.00
Up to 100, 000 ...... .........................$15.00
100,000- 500,000.:..
500, 000 -1, 000, 000 .. .........................$40.00
1, 000, 000 -1, 750, 000 ........................$60.00
Over 1, 750, 000 ....... .......................$100.00
Boiler (use BTU Chart to left)...................
Appliance Vent /Fans . .......................$10.00
Notice
Duct System... .$15.00
" " " " " "' "" "
I hereby certify that I have read and examined this
application and know the same to be true and correct. All
Gas /Air Outlets 5 x $6.00
provisions of laws and ordinances governing this type of
.................First
work will be complied with whether specified herein or
not. The granting of a permit does not presume to give
.........Additional x $1.00
authority to violate or cancel the provisions of any other
state or local law regulating construction or the
Radiant Heat Systems /Gas /Water
performance of construction.
Piping System ....... .........................$50.00
r
Modular Home ............................... $50.00
° Signature of Contractor or Authorized Agent
49
Permit Issuance Fee . ......................... �
0
Total
Current License on File tes O No O N/A
Date
Comment:
WHEN PROPERLY V ALWA 1 Ell (IN 1111 a NYALr,) I Jtill Ta I U U It i
Approved By:
Rev. 2008 -10
MECHANICAL PERMIT APPLICATION
Jurisdiction of City of Blair, Nebraska
218 South 16 Street
Blair, Nebraska 68008
Fax (402) 426 -4195 M 1993
I (402) 426 -4191
Application Date: Y�
Permit Fee: $
Job Address a C � °
fJ r�i �.
Owner - c Mdii Add re s Zip Phone
c
Contractor / ,b Mail dress,. ,,r Zip Phone
2.
3. Class of Work: O COMMERCIAL ESIDE TIAL O New O Addition O Alteration O Repair eplacement
Describe Work: 4
°]
4.
4
MECHANICAL PERMIT FEES
Heat Pump Tons
Central A/C Tons
Furnace /Heat Pump /Air Conditioner (Per Unit)
Furnace BTU/H
Up to and including 100,000 BTU / 3Ton ... .........................$15.00
# of Units A/C
Furnace /Heat Pump /Air Conditioner (Per Unit)
Furnace
Over 100,000 BTU / 3 Ton .................... .........................$25.00
Completion Date:
Refrigeration Units /Coolers /Lines /Compressor — Commercial
(New or Replacement) (Per Unit)
Boiler Chart
BTUFee
...................... ............................... .........................$15.00
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
Boiler (use BTU Chart to left)....................
Appliance Vent / Fans ........................$10.00
Notice
Duct System ......... .........................$15.00
I hereby certify that I have read and examined this
application and know the same to be true and correct. All
Gas /Air Outlets 5 x $6.00
provisions of laws and ordinances governing this type of
.................First
work will be complied with whether specified herein or
not. The granting of a permit does not presume to give
.........Additional x $1.00
authority to violate or cancel the provisions of any other
state or local law regulating construction or the
Radiant Heat Systems /Gas /Water
performance of construction.
Piping System ....... .........................$50.00
f
Modular Home ............................... $50.00
i
signature of Contractor or Authorized Agent
Permit Issuance Fee . .........................$25.00 : q'a
Total
Current License on File _ es O No O N/A
Date
Comment:
WHEN PROPERLY VALlDA'1'Ell (1N 'l'H1S �WAUE) llilN 1a YUUK FhK1V111
Approved By:
Rev. 2008 -10