M2009_0002.tif i
ME CHA N ICAL T APPLICATION
Jurisdiction of City of Blair, Nebraska
218 South 16 Street
Blair, Nebraska 68008
Fax (402) 426 -4195 M 2009
(402) 426 -4191
Application Date: �� "� Permit Fee: $
Job Address d ?
OwneY ail ddress Zip Phone
Contract Mail A d` ss Zip Phone
2. t
3. Class of Work: O eOMMERCIAL O RESIDENTIA 1 D fiew O Addition O Alteration O Repair O Replacement
Describe Work:
4.
MECHANICAL PERMIT FEES
Heat Pump Tons
Central A/C Tons Furnace/Heat Pump /Air Conditioner (Per Unit)
Furnace BTU/II 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
Boiler Chart (New or Replacement) (Per Unit)
.................. ............................... .........................$15.00
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 Boiler (use BTU Chart to left)....................
Appliance Vent/Fans ........................$10.00
Notice 15.00
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 of Gas /Air Outlets .................Ftrst 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 constr 1 ion. Piping System ....... .........................$50.00
Modular Home ............................... $50.00
yt /
S' rat re of Loiltrict& or Authorized Agent
Permit Issuance Fee . .........................$25.00 `
Total
6 — — k
ate Current License on File es O No O N/A
Comment: l
WHEN PROPERLY VALIDATED (IN THIS SPACE) THIS IS YOUR PERMIT
Approved By:
Rev. 2008 -10