mechanical permit application - waterloo forms/mechanical permit.pdfof waterloo, in its corporate...

MECHANICAL PERMIT APPLICATION Village of Waterloo - 509 S. Front St. - PO Box 127 - Waterloo, NE 68069 - 779-2292 - Fax 779-3387 APPLICANT TO COMPLETE NUMBERED SPACES ONLY PERMIT NO: JOB ADDRESS: 1. LEGAL LOT BLOCK: TRACT: DESC. NO.: D(SEE ATTACHED) 2. OWNER: MAILING ADDRESS ZIP PHONE: 3. CONTRACTOR: MAILING ADDRESS ZIP PHONE: 4. ARCHITECT/DESIGNER: MAILING ADDRESS ZIP PHONE: 5. ENGINEER: MAILING ADDRESS ZIP PHONE: 6. USE OF BUILDING: 7. CLASS OF WORK: Q NEW Q ADDITION Q ALTERATION D REPAIR D MOVE D REMOVE 8. DESCRIBE WORK: 9. CURRENT LICENSE & REGISTRATION ON FILE: DYES DNO JURISDICTION: COMMENTS FOLLOW THE 2006 INTERNATIONAL MECHANICAL CODE AND THE INTERNATIONAL FUEL GAS CODE NOTICE THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION AUTHORIZED IS NOT COMMENCED WITHIN 120 DAYS, OR IF THE WORK DESCRIBED HAS NOT BEEN SUBSTANTIALLY COMPLETED WITHIN ONE YEAR OF THE DATE OF ISSUANCE. I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. I WILL OBEY ALL ORDINANCES OF THE VILLAGE OF WATERLOO, IN ITS CORPORATE LIMITS AND ZONING JURISDICTION. SIGNATURE OF CONTRACTOR DATE SIGNATURE OF OWNER DATE (IF OWNER BUILDER) FEE SCHEDULE ISSUANCE FEE $15.00 $15.00 FORCED AIR FUNACES AND DUCT WORK UP TO 100,000 BTU $ 15.00 S OVER 100,000 $ 18.00 $ RELOCATION OR REPLACEMENT OF ANY APPLIANCE VENT $ 7.25 $ ANY HEATING OR COOLING ADDITION OR CHANGE OUT $ 13.70 $ FOR EACH AIR HANDLING UNIT $10.75 $ BOILERS, COMPRESSORS OR ABSORPTION UP TO 3 HORSEPOWER $ 14.70 $ OVER 3 HP TO 15 HP $ 27.15 $ OVER 15 HP TO 30 HP $ 37.25 $ OVER 30 HP REFER TO 97 UAC EVAPORATIVE COOLERS $10.65 $ EACH VENTILATION FAN $ 7.25 $ MISCELLANEOUS $ 7.50 $ TOTAL PERMIT FEE $ CK# WHEN PROPERLY VALIDATED (BELOW) THIS IS YOUR PERMIT COMMENTS APPROVED BY: DATE:

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Page 1: MECHANICAL PERMIT APPLICATION - Waterloo Forms/Mechanical Permit.pdfof waterloo, in its corporate limits and zoning jurisdiction. signature of contractor date signature of owner date

MECHANICAL PERMIT APPLICATIONVillage of Waterloo - 509 S. Front St. - PO Box 127 - Waterloo, NE 68069 - 779-2292 - Fax 779-3387

APPLICANT TO COMPLETE NUMBERED SPACES ONLY PERMIT NO:JOB ADDRESS:

1. LEGAL LOT BLOCK: TRACT:DESC. NO.: D(SEE ATTACHED)

2. OWNER: MAILING ADDRESS ZIP PHONE:

3. CONTRACTOR: MAILING ADDRESS ZIP PHONE:

4. ARCHITECT/DESIGNER: MAILING ADDRESS ZIP PHONE:

5. ENGINEER: MAILING ADDRESS ZIP PHONE:

6. USE OF BUILDING:

7. CLASS OF WORK: Q NEW Q ADDITION Q ALTERATION D REPAIR D MOVE D REMOVE8. DESCRIBE WORK:

9. CURRENT LICENSE &REGISTRATION ON FILE: DYES DNO JURISDICTION:

COMMENTSFOLLOW THE 2006 INTERNATIONAL MECHANICAL CODE AND THE

INTERNATIONAL FUEL GAS CODE

NOTICE

THIS PERMIT BECOMES NULL AND VOID IF WORK ORCONSTRUCTION AUTHORIZED IS NOT COMMENCED WITHIN120 DAYS, OR IF THE WORK DESCRIBED HAS NOT BEENSUBSTANTIALLY COMPLETED WITHIN ONE YEAR OF THEDATE OF ISSUANCE.I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THISAPPLICATION AND KNOW THE SAME TO BE TRUE ANDCORRECT. I WILL OBEY ALL ORDINANCES OF THE VILLAGEOF WATERLOO, IN ITS CORPORATE LIMITS AND ZONINGJURISDICTION.

SIGNATURE OF CONTRACTOR DATE

SIGNATURE OF OWNER DATE(IF OWNER BUILDER)

FEE SCHEDULE

ISSUANCE FEE $15.00 $15.00

FORCED AIR FUNACES AND DUCT WORKUP TO 100,000 BTU $ 15.00 SOVER 100,000 $ 18.00 $

RELOCATION OR REPLACEMENT OF ANYAPPLIANCE VENT $ 7.25 $

ANY HEATING OR COOLING ADDITION ORCHANGE OUT $ 13.70 $

FOR EACH AIR HANDLING UNIT $10.75 $

BOILERS, COMPRESSORS OR ABSORPTIONUP TO 3 HORSEPOWER $ 14.70 $OVER 3 HP TO 15 HP $ 27.15 $OVER 15 HP TO 30 HP $ 37.25 $OVER 30 HP REFER TO 97 UAC

EVAPORATIVE COOLERS $10.65 $

EACH VENTILATION FAN $ 7.25 $

MISCELLANEOUS $ 7.50 $