RN-2011-00073-1.tif MECHANICAL PERMIT APPLICATION
Jurisdiction of City of Blair, Nebraska
218 South 16 Street
Blair, Nebraska 68008
Fax (402) 426 -4195 M 2031
(402) 426 -4191
Application Date: Permit Fee: $
Job Address
Owner Mail Address Zip Phone
1. Phone
Contractor Mail Address Zip
2.
3. Class of Work: O COMMERCIAL O RESIDENTIAL O New O Addition O Alteration ®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/H Up to and including 100,000 BTU / 3Ton ... .........................$15.0
# of Units A/C Furnace/Heat Pump /Air Conditioner (Per Unit)
Furnace
Over 100,000 BTU / 3 Ton .................... .........................$
Completion Date: Refrigeration Units /Coolers /Lines /Compressor — Commercial
(New or Replacement) (Per Unit)
Boiler Chart ...........$15.00
BTU Fee .................................... ...............................
Up to 100, 000 ....... .........................$
100, 000 -500, 000 ..... .........................$30.0 Gas Ok2. F4. V) re.r
500,000 -1, 000 ,000 ........................... $40.0
1, 000, 000 -1, 750, 000 ........................$60.00 Boiler (use BTU Chart to left) ....................
Over 1, 750, 000 ...... ........................$10
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 .................First 5 g x $6.00
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 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 ....... .........................$50.0
Modular Home ............................... $50.00
Signature of Contractor or Authorized Agent
Permit Issuance Fee .......................... $25.00
Total
Date Current License on File O Yes 13 No O N/A
Comment:
WHEN PROPERLY VALIDATED (IN THIS SPACE) THIS IS YOUR PERMIT
Approved By:
Rev. 2008 -10
P"LUMBING PERMIT APPLICATION
Jurisdiction of City of Blair, Nebraska
218 South 16 Street
Blair, Nebraska 68008
Fax (402) 426 -4195 P 2146
(402) 426 -4191
Application Date: Permit Fee: $
Job Address
Owner Mail Address Zip Phone
1.
Contractor Mail Address Zip Phone
2.
3. Class of Work: O COMMERCIAL O RESIDENTIAL O New O Addition O Alteration O Repair O Replacement
Describe Work:
4.
PLUMBING PERMIT FEES
Comments: Modular Home ......................$50.00
Type of Fixture No.
Kitchen ..... .........................$12.00 x
Bath.....Residential /Single Stall $12.00 x
............. ....... Multi-Stall $25.00 x
Rough -In Bath ........................ $8.00 x
Additional Sinks .....................$6.00 x
Slop Sink/Laundry Tray/Drain ..... $6.00 x
Water Heater .........................$10.00 x
Notice Outside Water Faucet ...................$6.00 x
I hereby certify that I have read and examined this
application and know the same to be true and correct. All Drinking Fountain ........................$6.00 x
provisions of laws and ordinances governing this type of a,•L „_, ,. ry {
work will be complied with whether specified herein or Backflow /Grease Trap $15.00
not. The granting of a permit does not presume to give p . . . . . . . . . . . . .
authority to violate or cancel the provisions of any other Water Service .......................$15.00
state or local law regulating construction or the
Sewer ........ .........................$15.00
performance of construction.
Groundwork .........................$15.00
Septic Tank & Laterals............ $15.00
Lawn Sprinkler System ............ $10.00
Sprinkler System (Commercial)..$30.00
Gas/Water Piping System
( Commercial ) ........................ $50.00
Signature of Contractor or Authorized Agent Permit Issuance Fee .................$25.00
Total
Current License on File O Yes O No O N/A
Date Comment:
WHEN PROPERLY VALIDATED (IN THIS SPACE) THIS IS YOUR PERMIT
Approved By:
Rev. 2008 -10