RN-2012-00352_0007.tif MECHANICA PERMIT APPLIC
jurisdiction of City of Blair, Nebraska
218 South le Street
Blair, Nebraska 68008 �,• ;1,03 � 1
Fax (402) 426 -4195 :.,.,:;,, ,�,,.••.
402) 426 -4191
Permit Fee: $
Application Date:
Job Address Phone
Zip
Qwner Mail Address
1.1 Zip Phone
Contractor Mail Address i
3. Class of Work: O COMMERCIAL ® RESIDENTIAL O New O Addition O Alteration O Repair O placemen
2.
Describe Work:
4. MECHANICAL PERMIT FEES
Heat Pump Tons
Central A/C
Tons Furnace/Heat Pump /Air Conditioner (Per Unit)
BTU/H Up t° and including 100,000 BTU / 3Ton.
$15.0
Furnace � • (Per Unit)
# of Units A/C Furnace/Heat Pump /Air Conditioner $2500
Furnace
Over 100,000 BTU / 3 Ton ...
. .............. • • .
Completion Date: Refrigeration Units /Coolers/Lines /Compressor — Commercial
(New or Replacement) (Per Unit) $15 00
BoilerChart ................................................ I .............. ..........
Up to 00, 000 ...... .....................:....$15 00
...$30.00
100,000- 500,00 ...........:........
G �3 l {�
500, 000 -1, 000 ,000 ....................•.••.. •$40.00
60.00
1,000;000- 1,750,000 .................. • • • • • •$ Boiler (use BTU Chart to left)....................
Over 1, 750, 000 ...... .......................$
Appliance Vent / Fans ........................$
Notice Duct System ......... ........................$
Fapp2a,� ertify that I have read and examined this
Gas /Air Outlets :................First 5 —- - X $6.00
d know the same to be true and correct. All
laws and ordinances governing this type of worv� complied ed with whether specified herein or A dditi °real x $1.00
not. The granting of a permit does not presume to give
authority to violate or cancel the provisions of any other
state or local law regulating construction or the Radiant Heat Systems /Gas/Water $50.00
performance of construction. Piping System .......................
.......... $50.00
Modular Home ...................I.
• I
' I
Signature of Contractor or Authorized Agent .. • . $25
Permit Issuance Fee. ,00
....................
Total �
Date Current License on File O Yes ❑ No O N/A
Comment:
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PROPERLY V THIS IS YOUR PERMIT `: .o
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Approved By:z1.o�=
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