BPM1836
Permit #: M1836 Issued:
Completed:
Location: 1081 N 28th St
Owner: Richard Lorenzen
Address: 1081 N 28th St
Blair, NE 68008
Phone:
Section:
Subdivision:
Replacing Furnace.
Township:
Contractors
Beebe Refrigeration, Htg. & NC, Inc.
Remarks
Inspections Date
03/20/2009
03/20/2009
By
OEM
OEM
Blair Building Permit Detail
03/20/2009
03/20/2009
Range:
Lot:
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Type: Mechanical Miscellaneous
Valuation:
General Contractor
Final Inspection of Project
Mechanical Furnace
Permit Fee: 15
Issue Fee: 25
Deposit Amt.:
Receipt #:
Block:
Permit #
Issued
Pass
Pass
o . LAIR
l '
LOCATION OF INSPECTION-
BUILDING INSPECTION REPORT
o WASHINGTON COUNTY
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D.. 9THER
L....::;.)J~~? 'i.::,L'
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NAME OF OWNER-
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,t/-~> (,~___ ,',;~;j?li:;z:r! ,/, (~"'6"~':~{lt/~~,'~:~_:<./(ll'
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CONTRACTOR-
DATE INSPECTION REQUESTED- <.",,/, '.
,<' '/~~!
TIME INSPECTION REQUESTED-
PERMIT
TYPE 0.11' INSPECTION REQUESTED: 0 CONFERENCE
BUILDING: 0 FOOTING 0 DECK FOOTING 0 FRAMING 0 DRYWALL 0 FINAL 0 PARTIAL
COMMENTS:
MECHANICAL: 0 ROUGH-IN 0 AlC
FURNACE 0 RADIANT HEAT 0 FINAL 0 PARTIAL
o STATUS CHECK
PASSED FAILED
0 0
PASSED FAILED
0 0
PASSED FAILED
0 0
FAILED
0
PASSED FAILED
0 0
COMMENTS:
UTILITIES: 0 SEWER TAP 0 SEWER 0 SEPTIC 0 WATER TAP 0 REMOTE 0 WATER SERVICE
o PARTIAL
COMMENTS:
ELECTRICAL: 0 ROUGH IN 0 FINAL 0 PERMANENT SERVICE 0 TEMPORARY SERVICE 0 PRECONNECT
o PARTIAL
COMMENTS:
PLUMBING: 0 GROUNDWORK 0 ROUGH-IN 0 FINAL 0 WATER METER INSTALLED 0 PARTIAL
o PRESSURE TEST
COMMENTS:
o OCCUPANCY GRANTED 0 CONDITIONAL OCCUPANCY GRANTED
NOTESIREMARKS-
:<
DATE OF INSPECTION MADE: J
TIMK- ( I f~ 3 J
INSPECTO -
FAXED OPPD\BURT REA
TO CONNECT SERVICE: ON
BY
'<i
MECHANICAL PERMIT APPLICATION
Jurisdiction of City of Blair, Nebraska
218 South 16th Street
Blair, Nebraska 68008
Fax (402) 426-4195 M 1836
(402) 426-4191
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''7> ' , Permit Fee: $ 7Y
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owner'i'J, ' . J..../ ,Mail Address
1. J<. ( t! h tki tJ( l;X trUl1 ~
Contractp;;, I _ 'V . Mail Address.
2. ,-.U Q.,i" (.? 11 aZl t"rv
3. Class of Work: 0 COMMERCIAL 0 RESIDENTIAL
Describe Work:
4.
Heat Pump
Central AlC
Furnace [) t~ () tJ 0
I
Tons
Tons
BTU/H
A/C
# of Units
Furnace
Completion Date:
Boiler Chart
BTU Fee
Up to 100,000............................ ....$15.00
100,000-500,000... ............ .. ........... ..$30.00
500,000-1,000,000................. ........ ..$40.00
1,000,000-1,750,000...................... ..$60.00
Over 1,750,000.................... ...... ....$100.00
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.
lf~/() ~01
Date
Zip
Phone
Zip
Phone
o New 0 Addition 0 Alteration 0 Repair 0 Replacement
yI Wl/tJ.:! ~
MECHANICAL PERMIT FEES
'c ,(;)
Furnace/Heat Pump/Air Conditioner (Per Unit) f-J . P /
Up to and including 100,000 BTU 1 3Ton......................... ...$15.00
Furnace/Heat Pump/Air Conditioner (Per Unit)
Over 100,000 BTU / 3 Ton.......................................... ...$25.00
Refrigeration Units/Coolers/Lines/Compressor - Commercial
(New or Replacement) (Per Unit)
. . . . .. . . . . .. . . . . . . .. . . . . .. . .. . . . . .. . . .. . .. . . . . . . . . . . . . .. .. . . . . .. . .. . . . . . . . . ... $15.00
Boiler (use BTU Chart to left).............. ......
Appliance Vent/Fans.................... ....$10.00
Duct System................................. .$15.00
Gas/Air Outlets.................First 5
x $6.00
... ... ...Additional
x $1.00
Radiant Heat Systems/Gas/Water
Piping System........................ ........$50.00
Modular Home... ... ...... ... ... ... ... ....... $50.00
Permit Issuance Fee......................... .$25.00 ..;J..-J.~ 0(/'
Total ^ t?, c'^JC>
Current License on File f'VYes 0 No 0 NjA
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WHEN PROPERL Y VALIDATED (IN THIS SPACE) THIS IS YOUR PERMIT
I Approved By: '-;')0 /, ,
,]5, r,J r~4'-"
Comment:
Rev. 2008-10
BUILDING INSPECTION REPORT
/
[Z] CITY OF BLAIR 0 WASHINGTON COUNTY / 0 OTHER
( / /, /7 / / _/) /-' t!iD
LOCATIONOFINSPECTIQN' / cl/-) / /1/. L:..-~) --
NAME OF OWNER' Cc.lI7m ia~kM CONTRACTOR'
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DATE INSPECTION REQUESTED' ,-::7,i{34~:::/ U'7 TIME INSPECTION REQUESTED' PERMIT NO' / "I I<!~')' -50.:;
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TYPE OF INSPECTION REQUESTED: 0 CONFERENCE
lllll"l!lll "l"
BUILDING: 0 FOOTING 0 DECK FOOTING 0 FRAMING D DRYWALL 0 FINAL 0 PARTIAL
o STATUS CHECK
PASSED FAILED
o 0
,~
"c""~
"
;',
COMMENTS:
UTILITIES:
<,'J,
~;
o SEWERTAP 0 SEWER 0 SEPTIC 0 WATERTAP 0 REMOTE 0 WATER SERVICE
o PARTIAL
PASSED FAILED
o 0
.'i~:
COMMENTS:
ELECTRICAL: 0 ROUGHIN 0 FINAL D PERMANENT SERVICE 0 TEMPORARY SERVICE 0 PRECONNECT
o PARTIAL
PASSED FAILED
o 0
COMMENTS:
l!Il1lil\!:i:l'l:S ;!,.' ~ "
MECHANICAL:D ROUGH-IN 0 Al~/ FURNACE 0 RADIANTHEAT 0 FINAL 0 PARTIAL
COMMENTS:
PLUMBING: 0 GROUNDWORK 0 ROUGH-IN 0 FINAL 0 WATERMETERINSTALLED 0 PARTIAL
o PRESSURE TEST
FAILED
o
PASSED FAILED
o 0
COMMENTS:
o OCCUPANCY GRANTED D CONDITIONAL OCCUPANCY GRANTED
NOTES/REMARKS'
c
, ~
INSPEc;rO '
DATE OF INSPECTION MADE: 3
TIME' ( I " 3 Je,
,
FAXED OPPD\BURT REA
TO CONNECT SERVICE: ON
BY
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