Get KY FMB39-3 2005-2024

FMB39-3 Rev. 9-1-05 Submit to Department. of Housing Boiler Section 101 Sea Hero Road Suite 100 Frankfort KY. 40601- 5405 Phone 502 573-1708 Permit Application For the installation of boilers pressure vessels and related pressure piping in the Commonwealth of Kentucky. FMB39-3 Rev* 9-1-05 Submit to Department. of Housing Boiler Section 101 Sea Hero Road Suite 100 Frankfort KY. 40601- 5405 Phone 502 573-1708 Permit Application For the installation of boilers pressure vessels and related pressure piping in the Commonwealth of Kentucky. Name of contractor license holder Complete mailing address Zip 2. Boiler contractor license number Name of owner user Specific location of installation County 5. Give description of unit s to be installed 5A. Type of pipe joints Range Fee Check Appropriate or less - 10 000 10 001 - 25 000 25 001 - 50 000 75 001 - 100 000 300 001 - 400 000 700 001 and over Box 70. 00 130. 00 200. 00 850. 00 960. 00 1 500. 00 6. Approximate start date Make check payable to Kentucky Treasurer Approximate completion date APPROVED Notify this office 7 days in advance of final Inspection* For office use only YES NO Chief Boiler Inspector Date. 40601- 5405 Phone 502 573-1708 Permit Application For the installation of boilers pressure vessels and related pressure piping in the Commonwealth of Kentucky. Name of contractor license holder Complete mailing address Zip 2. Boiler contractor license number Name of owner user Specific location of installation County 5. Name of contractor license holder Complete mailing address Zip 2. Boiler contractor license number Name of owner user Specific location of installation County 5. Give description of unit s to be installed 5A. Type of pipe joints Range Fee Check Appropriate or less - 10 000 10 001 - 25 000 25 001 - 50 000 75 001 - 100 000 300 001 - 400 000 700 001 and over Box 70. Give description of unit s to be installed 5A. Type of pipe joints Range Fee Check Appropriate or less - 10 000 10 001 - 25 000 25 001 - 50 000 75 001 - 100 000 300 001 - 400 000 700 001 and over Box 70. 00 130. 00 200. 00 850. 00 960. 00 1 500. 00 6. Approximate start date Make check payable to Kentucky Treasurer Approximate completion date APPROVED Notify this office 7 days in advance of final Inspection* For office use only YES NO Chief Boiler Inspector Date. 40601- 5405 Phone 502 573-1708 Permit Application For the installation of boilers pressure vessels and related pressure piping in the Commonwealth of Kentucky. Name of contractor license holder Complete mailing address Zip 2. Boiler contractor license number Name of owner user Specific location of installation County 5. Give description of unit s to be installed 5A. Type of pipe joints Range Fee Check Appropriate or less - 10 000 10 001 - 25 000 25 001 - 50 000 75 001 - 100 000 300 001 - 400 000 700 001 and over Box 70. Name of contractor license holder Complete mailing address Zip 2. Boiler contractor license number Name of owner user Specific location of installation County 5. Give description of unit s to be installed 5A. Type of pipe joints Range Fee Check Appropriate or less - 10 000 10 001 - 25 000 25 001 - 50 000 75 001 - 100 000 300 001 - 400 000 700 001 and over Box 70. 00 130. 00 200. 00 850. 00 960. 00 1 500. 00 6. Approximate start date Make check payable to Kentucky Treasurer Approximate completion date APPROVED Notify this office 7 days in advance of final Inspection* For office use only YES NO Chief Boiler Inspector Date. .