ME-2010-00012.tif MECH A PP L I CA TION
Jurisdiction of City of Blair, Nebraska
218 South 16 Street
Blair, Nebraska 68008
Fax (402) 426 -4195 M 2016
(402) 426 -4191
Application Date: Permit Fee: $ t, C
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Job Address
Owner t 4 Mail Address �� Zip Phone
Cont rac or I Mail A flre�ss Zip , Phone
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1, T t a t
3. Class of Work: O COMME CIAL O RESIDENTIAL O New O Addition O Alteration O Repair O Replacement
Describe W
4. -'r� IT l
1 () MECHANICAL PERMIT FEES
Heat Pump �' r Tons
Central A/C Tons Furnace /Heat Pump /Air Conditioner (Per Unit) ( 0 0
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 Da Refrigeration Units /Coolers /Lines /Compressor — Commercial
Boiler Chart (New or Replacement) (Per Unit) 15
$ BTU Fee ............................................... ............................... . 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 (arse 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
provisions of laws and ordinances governing this type of Gas /Air Outlets .................First 5 x $6.00
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
X ' — � Modular Home ............................... $50.00
Signature of Contractor or Authorized Agent
Permit Issuance Fee .......................... $25.00 Y d
Total
(� 7F Date Current License on File Yes O No O N/A
Comment:
WHEN PROPERLY VALIDATED (IN THIS SPACE) THIS IS YOUR PERMIT
Approved By:
Rev. 2008 -10