BPM1664
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MECHANICAL PERMIT APPLICATION
Jurisdiction of City of Blair, Nebraska
218 South 16th Street
Blair, Nebraska 68008
Fax (402) 426-4195 M 1664
(402) 426-4191
Application Date: f3." 8 c_ 08
Job Address
,4c!
Central A/C
/d
Tons
Furnace
BTU/H
AlC
# of Units
Furnace
Completion Date:
8~ 11~()8
Comments: . ro e., ~/
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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.
9~/tr--'?J:/
Date
Permit Fee: $
)i/f]
I
$c 7'-' /J! r /'( -i8 ~(J.
/ L ... PhO,ne . / /5 fY! I/E
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Phone
o Alteration 0 Repair 0 Replacement
MECHANICAL PERMIT FEES
Forced Air/Heat Pump Systems - Per Unit
CommerciaVResidential (New)....................................... ..$25.00
~oo
Air-Conditioner Unit - Per Unit -tV .
CommerciaVResidential (New)....................................... ...$10.00
Forced Air Systems/Air Conditioner
Unit Replacement Per Unit Commercial/ResidentiaL.............. ..$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
Current License on File ~s 0 No 0 Nj A
Comment:
WHEN PROPERL Y VALIDATED (IN THIS SPACE) THIS IS YOUR PERMIT
I Approved By: ,.---=::> ..0 I
o . rJr~
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8;:::6TY OF BLAIR
D WASHINGTON COUNTY D P, THER
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LOCATION OF INSPECTION' 711;;2 y t.-'Z..14 tJ-.4/ U) -.If. /1 ,
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NAME OF OWNER~,.nlo.-b1 /UCt fJ~j 1?la17 t CONTRACTOR' Q;!j/U bj ;!::r4.lt,;c::liZ'I a]11:r~'0
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DATE INSPECTION REQUESTED' ('I ~ /9-C)f3 TIME INSPECTION REQUESTED' ~1, M. 1,..../ PERMIT NO' /v'[ / [vlc; if
TYPE OF INSPECTION REQUESTED: D CONFERENCE DSTATUS CHECK
-~~~~~~~~-====~~~~~'llm;:Il;.:":<:<:;mm:.1=z:!:!UI_'IIilRW;;l:lli"it!:atz;=~~
BUILDING: D FOOTING D DECK FOOTING D FRAMING D DRYWALL c:r-.J:'ilNAL D PARTIAL PASSED FAILED
D D
COMMENTS:
UTILITIES: D SEWER TAP, D SEWER D SEPTIC D WATER TAP D REMOTE D WATERSERVICE
D PARTIAL "
PASSED FAILED
D D
COMMENTS:
ELECTRICAL: D ROUGH IN D FINAL D PERMANENT SERVICE D TEMPORARY SERVICE D PRECONNECT
D PARTIAL
PASSED FAILED
D D
COMMENTS:
....~,_.._~~..."".......~
CT'!~"."'''..'''r''''''''''''''--~~~"",~=~~'~~~~~
MECHANICAL:D ROUGH-IN D AlC D FURNACE D RADIANTHEAT D FINAL D PARTIAL
PLUMBING:' D GROUNDWORK D
D PRESSURE TEST
COMMENTS:;
~" ,.""';"- '~- '" ~"'^"""'-~~ ~~~"''''~-~~~..~
o OCCUP ,we\, GItANTED m CONDITIONAL OCCUPANCY GRANTED
NOTES/REMARKS'
PASSED FAil;ED '
DO
PASSED FAILED
D D
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