BPM1541
MECHANICAL PERMIT APPLICATION
Jurisdiction of City of Blair, Nebraska
218 South 16th Street
Blair, Nebraska 68008
Fax (402) 426-4195
(402) 426-4191
(:
~
Application Date: ~ Irol61
Job Address
llotol{
~~
Mail Address
Me
CentralAlC
Tons
Furnace
BTU/H
AlC
# of Units
Furnace
Completion Date: ~LlJ ~~ \
Comments:
Notice
I hereby certify that I have read and examined this
application and know the same to be true and correct. All
provisions oflaws and ordinances governing this type of
work will be complied with whether specified herein or
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
erformance of construction.
.~ --ts- -"7
Date
Permit Fee: $
M1541
ffJ?9
-P@K1L ~
S~VYLL
Zip
Phone
Zip
Phone
o New 0 Addition 0 Alteration 0 Repair 0 Replacement
MECHANICAL PERMIT FEES
Forced Air/Heat Pump Systems - Per Unit
Commercial/Residential (New)........................... ... ...... .....$25.00
Air-Conditioner Unit - Per Unit
Commercial/Residential (New)....................................... ...$10.00
Forced Air Systems/Air Conditioner 10 Do
Unit Replacement Per Unit Commercial/Residential... ... ... ... ... ..$10.00
Refrigeration Units/CoolerslLines/Compressor -
Per Unit Commercial (New or Replacement)... ... ... ...... ... ...... ..$10.00
Appliance Vent/Fans..................... ..$10.00
Boiler....................................... ..$15.00
Duct System... ...... ...... ... ... ...... ... .. .$10.00
Gas/Air Outlets.......................
x $2.00
Radiant Heat Systems/Gas/Water
Piping System............................. ..$25.00
Modular Home... ... ...... ... ... ...... ... ...$50.00
Permit Issuance Fee....................... .$20.00
Total
Current License on File
~/A
DYes 0 No
Comment:
WHEN PROPERLY VALIDATED (IN THIS SPACE) THIS IS YOUR PERMIT
[ Approved By: /~ It d)1Ld~
I
CITY or BLNQ
HOMEOWNER VERIFICATION FOR PLUMBING AND/OR
MECHANICAL PERMITS
GdY'rd+ P~t-ifse-n
, states the following:
Print your full name on line above:
1. I am the owner of the single family dwelling for which I am applying for a
plumbing and/or mechanical permit.
Address:
[ &,(0 <-I
fQ)(LL s1-
2. I am applying for a plumbing and/or mechanical permit for a single family
dwelling and it is or will be my principal residence.
3. I will install and connect the plumbing and/or mechanical by myself, without
compensation or pay from or to, any other person.
4. I have sufficient knowledge of the 2006 International Code requirements to make
an electrically safe and mechanically secure installation, which will meet the
minimum standards referenced in the 2006 International Code.
5. I am aware of all inspections required prior to a final.
6. I will call twenty-four (24) hours in advance for an inspection. I am also aware
that it is not the inspector's job or duty to be my instructor in plumbing and/or
mechanical.
7. I am aware that violation of the code makes it a Class 1 misdemeanor to make a
false statement on a request for inspection.
8. g the above information is true an correct.
B~Jr-07
Date
@-
218 South 16th street. Blair, Nebraska 68008.402-426-4191 . Fax 402-426-4195 . E-mail cltyofblalr@cl.blalr,ne,us .",,,,,,.n
BUILDING INSPECTION REPORT
OF BLAIR
D WASHINGTON COUNTY
LOCATION OF
CONTRACTOR'
,l'~;(~;'~J'J/
NAME OF
DATE INSPECTION REQUESTED' ,:Y)
TIME INSPECTION REQUESTED'
~:;t "''df~
.0"...< ,f
PERMIT
TYPE OF INSPECTION REQUESTED:
BUILDING: D FOOTING D DECK FOOTING D FRAMING D DRYWALL
D CONFERENCE
D PARTIAL
D STATUS CHECK
)1D F~ED
PASSED FAILED
D D
COMMENTS:
UTILITIES: D SEWER TAP D SEWER D SEPTIC D WATER TAP D REMOTE D WATER SERVICE
D PARTIAL
COMMENTS:
ELECTRICAL: D ROUGHIN D FINAL D PERMANENT SERVICE D TEMPORARY SERVICE D PRECONNECT
D PARTIAL
PASSED FAILED
D D
COMMENTS:
MECHANICAL:D ROUGH-IN ~AlC".,~Jll,\CE D RADIANTHEAT
FINAL D PARTIAL
pD F~ED
COMMENTS:
PLUMBING: D GROUNDWORK D ROUGH-IN D FINAL D WATER METER INSTALLED D PARTIAL
D PRESSURE TEST
COMMENTS:
PASSED
D
D OCCUPANCY GRANTED D CONDITIONAL OCCUPANCY GRANTED
NOTES/REMARKS'
-
-
.
.
-
r
.
-
-
---~f
"
-
~
.~.~
. - -
-
-
.
--
-