BPM1641
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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:
s~ 1)--08
Job Address
Central AlC
Tons
Furnace
BTU/H
AlC
# of Units
Furnace
Completion Date: <--.1:)- /dl - a8
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.
Signature of Contractor or Authorized Agent
Date
M 1641
~ pO
Permit Fee: $ Ct?
8 r co 'f'/ &25 I
Phone
jf~at1? 6
ECHANICAL PERMIT FEES
Forced Air/Heat Pump Systems - Per Unit
CommerciaVResidential (New)............ ... ...... ... ... ... ... ... ;....$25.00
Air-Conditioner Unit - Per Unit
Commercial/Residential (New)... ... ...... ... ......... ... ... ... ... .. ....$10.00
Forced Air Systems/Air Conditioner / tJ. vU
Unit Replacement Per Unit CommerciaVResidential...... .,. ... ... ..$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... ... ... ......... ... ...... ... .., $1 0.00
Gas/Air Outlets.......................
x $2.00
Radiant Heat Systems/Gas/Water
Piping System... ............ ............. ...$25.00
Modular Home... ... ... ... ... ............... $50.00
. ..-10 ob
PermIt Issuance Fee...................... ..$20.00 ~.
Total ..(ti . (10
Current License on File 'bs(es 0 No 0 Nj A
Comment:
WHEN PROPERL Y VALIDATED (IN THIS SPACE) THIS IS YOUR PERMIT
I Approved By: /1/ pI ~J
109 ~~S
MECHANICAL PERMIT APPLICATION
Jurisdiction of City of Blair, Nebraska
218 Soutt: 1 fth Street
Blair, Nebra~: 68008
Fax (402) 426-4195 M 1641
(402) 426-4191
Application Date:
s=- ?--IJfj
Job Address
Central A/C
Tons
Furnace
BTU/H
A/C
# of Units
Furnace
Completion Date: '.-.1)- / d2 - C) 8
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 :, cancel the p visions of any other
stat " r local law gulating 0 truction or the
\ perform ce of IT r 1 tio .
\
\
\
. Signatut.e of Conttllctor or Authorized Agent
,
~)s/o~
.
Date
.:?t I) 0
Permit Fee: $ C. t? .
8 r ct? If'/ ,:/5 I
Phone
~6
ECHANICAL 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 II}. Ob
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/Ail' Outlets.......................
x $2.00
Radiant Heat Systems/Gas/Water
Piping System....,......................... .$25.00
Modular Home... ..................... ......$50.00
Permit Issuance Fee.,. ... ...... ...... ... ...$20.00
Total
Current License on File ~s 0 No 0 Nj A
Comment:
WHEN PROPERL Y VALIDATED (IN THIS SPACE) TIllS IS YOUR PERMIT
I Appro~ed By: ,ii. . pl..6t4PJ
BUILDING INSPECTION REPORT
~dITY OF BLAIR D WASHINGTON COUNTY D OTHER
,- '!'1'
LOCATION OF INSPECTION' 1 d::ftj (;;7 "j I, .// L'.rU ~/ ,,,:j ()
/' i'r) ,,....1;/ ,.'_) 1/";0 l~?/:_':'.,! ,,/~/ c:<~~ t j //
NAME OF OWNER.(,COVC.fI lc.,A,v)..J. 7"t:.:' ! 01 CONTRACTOR' I" )//';tj/7/)/tl/:/"
DATE INSPECTION REQUESTED' (3 --I -' () E> TIME INSPECTION REQUESTEflI17'-
i/( ,."
/~/ t.:~ ~l '
PERMIT ~~,I\jl ) &;i
TYPE OF INSPECTION
BUILDING: D FOOTING D DECK FOOTING D FRAMING D DRYWALL
D CONFERENCE
D PARTIAL
ST ATUS CHECK
PEED FW
COMMENTS:
'G:f'..=z...."'""'C<....~~~~.~..........'-"=~~~~~~~~~~.;~m:a.',$.;;J:::':r"z:::tt=~oz.~~=."',.."+"'''..'''...,'''.~
UTILITIES: D SEWER TAP D SEWER D SEPTIC D WATER TAP D REMOTE D WATER SERVICE
D PARTIAL
PASSED FAILED
D D
COMMENTS:
ELECTRICAL: D ROUGH IN
D PARTIAL
FINAL D PERMANENT SERVICE D TEMPORARY SERVICE D PRECONNECT
PASSED FAILED
D D
COMMENTS:
MECHANICAL: D ROUGH-IN D AlC D FURNACE
D PARTIAL
P~SED F~
COMMENTS:
PLUMBING: D GROUNDWORK D ROUGH-IN D
D PRESSURE TEST
'i: ....J,..
{A/f'(jt/
D PARTIAL
PASSED FAILED
D D
COMMENTS:
~~-P~~;""""'""""","""""""~..$~~,,,,~~~~~~~~~~~~~....~~...,,'J\;.~
D OCCUPANCY GRANTED D CONDITIONAL OCCUPANCY GRANTED
NOTES/REMARKS'
INSPEETO .
~-,,"-- =~.~ -CO"." ~ ~ ---=-=~~~'. -~::-"7"-"""''''=';C""'""''::-:;-"==-_-:,~~-~.,--:'''''''':,"", ~'o."-"--=-~_
BUILDING IN~rElJ'1'lUl" ltE.t'OR1'
"-
-~-
iJ
--..,/~
I~'~V\J....~
D CITY OF BLAIR
D WASHINGTON COUNTY
D OTHER
",-~ J\J !J(Q ("
LOCATION OF INSPECTZON'
I \: ~', I). ,l_~
NAME OF OWNER' (j!,-t..tJ ~ ) Nt) u.s *=-
r&e..tJ CONTRACTOR'
DATE INSPECTION REQUESTED'
TIME INSPECTION REQUESTED'
1 11 / ) II'
PERMIT NO' /. t (O"-;~..
TYPEOFINSPECTIONREQUESTE)): D CONFERENCE D STATUS CHECK
If;j';.~~~~'';"'':'''''''~~~:n-~~'''''''~~~~~-''''''''-~'''''''''~~~~-'::ll:~~~~
BUILDING: D FOOTING D DECK FOOTING D FRAMING D DRYWALL D FINAL D PARTIAL PASSED FAILED
D D
COMMENTS:
Y'l'~"""""""=""""~~r.:::...~..cx="'~~~"=~~~~~~~~~-.::.t~__~~=..s;:~~~~.:;:e;>.::.r.;;~.......,~~".,.."",,=1.~
UTILITIES: D SEWER TAB D SEWER D SEPTIC D WATER TAP D REMOTE D WATER SERVICE
D PARTIAL-
COMMENTS:
PASSED FAILED
D D
foW'>'~~-~~~"""""T-~'/'>"'~""""""'-~~~~uc~~~.z=---a:n..~L=.::;..~""''''''''''''''",^",,_'~=z:::L~~~~'':!....''''l';':!l:'21
ELECTRICAL: D ROUGH IN D . FINAL D PERMANENT SERVICE D TEMPORARY SERVICE D PRECONNECT
D PARTIAL
MECHANIcAL: D ROUGH-IN D AlC D FURNACE D RADIANT
D PARTIAL
PASSED FAILED
D D
PASSED FAILED
D 0
PASSED FAILED -.. :
D [j
COMMENTS:
PLUMBING: . D GROUNDWORK D
_ D PRESSURE~tEST..
~O~~~ITI6tt4M~uT,\Jj~
=::u:::-~.:;~:!:::::n'::l::;m:::;:::;;:;:a::.~""'-"""""-=-=-=~~~
FINAL D WATERMETERINSTALLED D PARTIAL
NOTES/REMARKS: