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Location Of Project Number Street City Zip Geocode Assessment Code 1 15.00 $ 11 33.50 $ 2 9.00 $ 12 56.00 $ 3 11.00 $ 13 6.50 $ 4 9.00 $ 14 11.00 $ 5 9.00 $ 15 6.50 $ 16 4.50 $ 17 6.50 $ 6 4.50 $ 18 6.50 $ 7 $ 9.00 19 11.00 $ 20 45.00 $ 21 6.50 $ 8 9.00 $ 22 3.00 $ 23 0.75 $ Totals 9 $ 16.50 10 $ 22.50 Date Date Description of Work Contractor Business License Number Contractor Email Address Butte - Silver Bow Required Owner Contact Date Name (print) Building Code Department 155 West Granite Street Room 108, Butte, MT 59701 Mechanical Permit Application I hereby make application for a permit to do mechanical work in accordance with International Mechanical Code & Administrative Code in a building as hereinafter described. Address,City, State, Zip Telephone Number Each gas piping system of 1 to 4 outlets Installation or relocation of each forced-air gravity-type furnace or burner, including ducts and vents attached to such appliances over 100,000 Btu/h Installation, relocation or replacement of each appliance vent installed and not included in an appliance permit Appliance or equipment regulated by this Code but not classified in other appliance categories, or for which no other fee is listed in this code Installation or relocation of each commercial or industrial type incinerator Each ventalation system which is not part of any heating or air conditioning system authorized by permit Installation of each hood which is served by mechanical exhaust, including the ducts for such hood Each ventalation fan connected to single duct Installation or relocation of each boiler or compressor over 30 horsepower to and including 50 horsepower, or each absorption system over 1,000,00 Btu/h to and including 1,750,000 Btu/h Installation or relocation of each boiler or refrigeration compressor over 50 horsepower, or each absorption system over 1,750,000 Btu/h Each air handling unit to and including 10,000 cfm, including ducts attached. Note: This fee shall not apply to an air handling unit which is a portion of a factory assembled appliance, cooling unit, evaporative cooler or absorption unit for which a permit is required elswhere in this Code Issuance of permit Installation or relocation of each forced-air gravity-type furnace or burner, including ducts and vents attached to such appliances, up to and including 100,000 Btu/h Installation or relocation of each suspended heater, recessed wall heater or floor mounted unit heater including vent Installation or relocation of each domestic type incinerator Each air Handling Unit over 10,000 cfm Each evaporative cooler other than portable type Repair, alteration or addition to each heating appliance, refrigeration unit, cooling unit, absorption unit, each heating cooling, absorption, or evaporative cooling system, including installation of controls regulated by this Code Installation or relocation of each boiler or compressor to and including three horsepower, or each absorption system to and including 100,00 Btu/h Received By Each gas piping system of 5 or more outlets, per outlet Installation or relocation of each floor furnace, including vent Type of Building Occupancy Single Family / Multiple Family / Commercial / Accessory Building / Public Building / Factory Building /Warehouse Building / New / Alterations / Additions Installation or relocation of each boiler or compressor over 3 horsepower to and including 15 horsepower, or each absorption system over 100,000 Btu/h and including 500,00 Btu/h Installation or relocation of each boiler or compressor over 15 horsepower to and including 30 horsepower, or each absorption system over 500,00 Btu/h to and including 1,000,000 Btu/h Total Job Cost Signature of Applicant