BPM1509
~
'~
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:
52-, -0 7
Job Address
Owner
1.
Central AlC
Tons
Furnace
BTU/H
A/C
# of Units
Furnace
Completion Date:
:r~bh'(rY1 P
5' --/-0 7
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
performance of construction.
6/I/c;'(
Date
Permit Fee: $
M 1509
c30 . oD
-d /JtIJ
o Repair
U/JU?tr
ECHANICAL PERMIT FEES
~ J'Zne_~;:J~
'-7' Phone L .
'r~d11 r ub'd
o Replacement
Forced Air/Heat Pump Systems - Per Unit
Commercial/Residential (New)........................ ............ .....$25.00
Air-Conditioner Unit - Per Unit I (). tJ 0
Commercial/Residential (New)....................................... ...$10.00
Forced Air Systems/Air Conditioner
Unit Replacement Per Unit CommerciallResidential...... ... ... ... ..$10.00
Refrigeration Units/Coolers/Lines/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... ... ... ... ... ...... ... $20.00
Total
cfl{) I (/0
d.pe)
Current License on File
DYes 0 No 0 N/A
Comment:
WHEN PROPERLY VALIDATED (IN THIS SPACE) THIS IS YOUR PERMIT
I Approved By: 3, 31'~
~BLArn
BUILDING INSPECTION REPORT
o WASHINGTON COUNTY 0 OTHER
LOCATIONOFINSPECfION" /333 IIJlLt4::Jer.2...r J'I.
NAME OF OWNER. iJ,.$.c-~ . ~ a?7 CONTRACTOR. (;JJ'Iz: seh--1JU:L-r-,
DATE INSPECfION REQUESTED' 0 --(--0 7 TIME INSPECTION REQUESTED' /I ( PERMIT NO' 11/5'" tJ 9
TYPE OF INSPECTION REQUESTED:
BUILDING: 0 FOOTING 0 DECK FOOTING 0 FRAMING 0 DRYWALL.-:
o CONFERENCE
INAL 0 PARTIAL
o STATUS CHECK
TF~ED
PASSED FAILED
o 0
COMMENTS:
UTILITIES: 0 SEWER TAP 0 SEWER 0 SEPTIC 0 WATER TAP 0 REMOTE 0 WATER SERVICE
o J~ARTIAL
COMMENTS: / /
, ;. , ~-
ELECTRICAL: [ijU ROUGH IN 0 FINAL 0 PERMANENT SERVICE 0 TEMPORARY SERVICE 0 PRECONNECT
"U PARTIAL
COMMENTS:
MECHANICAL:O ROUGH-IN%NC 0 FURNACE 0 RADIANT HEAT ~AL 0 PARTIAL
COMMENTS: c_/~b ehnJ!--/'7lf c;J tf,n
PLUMBING: 0 GROUNDWORK 0 ROUGH-IN 0 FINAL 0 WATERMETERINSTALLED 0 PARTIAL
o PRESSURE TEST
PASSED FAILED
o 0
COMMENTS:
o OCCUPANCY GJANTED 0 CONDITIONAL OCCUPANCY GRANTED
k,)
NOTESIREMARKS.)~"]'," ""
7->'1../( ..,
(,-LL~/:0)
'/{./
7F~!ED
/
PASSED FAILED
o 0
j
I
J
i i
DATE OF INSPECTION MADE:
TIME" ~ : C)o
FAXED OPPD\BURT REA TO CONNECf SERVICE: ON
BY
- ------- --- - ----'----'--- -'--'-----..'-----'- --~~~.-~'--'----'--- -----~