440_0001.tif i
ME CHANIC AL
E P ICATI N.
jurisdiction o f City of Blair, Nebraska
218 South I6 Street
6$008
' Nebraska
Blair,
Pa( 02) 45
426-4191
Permit Fee: $
ApplicationD'ate:
Job Address F
Zip
Owner Mail Address Phone
Address -
1. zip r
• _ _Mail �
- Contractor
2. ❑New d Addition O Alteration 'O Repair d Replacemen
3. Class of Work: 0 COMMERCIAL O RESIDENTIAL
Describe Work:
4 MECHANICAL PERMIT FEES
Tons
Heat Pump Tons Furnace/ Conditioner (Per Unit)
HeatP ump /Air
•Central .A/C d including 100,000 BTU 13Ton .................... • • • .... 15.00
$
BTU/I� UP to an •
Furnace /Aix Conditioner (Per Unit)
A/C Fumace/HeatPump ...,..25.00
#of Units Over 100,000 BTU / 3 Ton .. .............•..••••••
Furnace
Refrigeration Units /Co olers/UneslCompres sor — Commercial
Completion Date: (N or Replacement) (Pet' Unit) ..
Fee $15,00
Boiler Chart ....................... •.. ........................,....
BTU
Up to 100, 000 ....... .........................$ 12 t a ��?t'.� tr•►ci b �..
100,000 -500, 000 ..... ......:..................$30.00
.
500, 000 -1 ,000, ......... • ........ ,.•. ,,$ 40.00 ,
1,000 1,7 000 ........................ $60-00 Boiler (use, BTU Chart to left).................
...............$ i
Over 1,750,00 .............. r
10.00
.Appliance Ven ans. $
Notice Duct System ..............I ..................
I hereby certify that I have read and examined this -x$6.00
application andknow the same to be true and correct. All Gas/A Outlets .................First 5
provisions of laws and ordinances governing this type of al x$1.00
work will be complied '013,whetller specified herein or addition
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 $50.00
performance of construction.
Pl ing em, .......
Syst................ ..
Modular Home ..........................
50.00
Signature of Contractor or Authorized Agent . '
Permit Issuance Fee . ........................$
• Total
Date
Current License on File ® Yes CI No Li N/A
Comments : R, F pin
THIS IS YOUR PERMIT
IN THIS SPA )
Y VALIDATED ( CE
OPERT � � �•�-��
V�rI -TEN PR
Approved By: � •� �����- �� -•�'�
i