M2000_0004.tif MECHANICAL PERMIT APPLICATION
Jurisdiction of City of Blair, Nebraska
218 South 16 th Street
Blair, Nebraska 68008
Fax (402) 426-4195 M'2000
(402) 426-4191
Application Date: Permit Fee:
Re 3-1-2
Job Address 1�
Owner yy Mail Address zip Phone
ur �"w rud"A 1 , VA n h'�
Contractor Mail Address zip Phone
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2.
3. Class of Work: 2rCOMMERCIAL C3 RESIDENTIAL C3 New C3 Addition 13 Alteration 173 Repair Replacement
Describe Work:
0
4.
MECHANICAL PERMIT FEES
Heat Pump Tons
Central A/C Tons Fumace/Heat Pump/Air Conditioner (Per Unit)
Furnace BTU/H Up to and including 100,000 BTU/ 3Ton ... .........................
# of Units A/C Fumace/Heat Pump/Air Conditioner (Per Unit) '50.0a
Furnace Over 100,000 BTU / 3 Ton .................... .........................$25.00
Completion Dater 1, 1 °' ")
Refrigeration Units /Coolers /Lines /Compressor — Commercial
Boiler Chart (New or Replacement) (Per Unit)
BTU Fee .............................................................................. $15.00
Up to 100,000 ....... .........................
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
I hereby certify that I have read and examined this Duct System ......... .........................
application and know the same to be true and correct. All
provisions of laws and ordinances governing this type o f Gas/Air Outlets ................. 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 ....... .........................
Modular Home ............................... $50.00
Signature of Contractor or AuthoriE5Agent Permit Issuance Fee .......................... $25.00 6o
/0 Total
Date Current License on File 'or. 0 No 173 N/A
Comment:
WHEN PROPERLY VALIDATED (IN THIS SPACE) THIS IS YOUR PERMIT
Approved By:
Ke
Rev. 2008-10