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'<
M PERMIT A
Jurisdiction of City of Blair, Nebraska 2' U
218 South 16 Street J
Blair, Nebraska 68008
Fax (402) 426 -4195 M 1984
(402) 426 -4191
Application Date:
5 - ( 1 4 - (C)
Job Address I i
O `� n � er
1..) _
Contractor
2.
3. Class of Work:
Describe Work:
4.
Mail Add ess
bCA �� 7. if C�
Mail Address
O COMMERCIAL
Permit Fee: $ S 5
rnonc
O New O Addition O Alteration O Repair O
MECHANICAL PERMIT FEES
Heat Pump ..,._) Tons
Central A/C Tons
Furnace (A) BTU/H
# of Units A/C
Furnace
Completion Date: ._J' _ 1 q — 1 b
Boiler Chart
BTU
Fee
Up to 100, 000 ....... .........................$
100,000 - 500, 000 ..... .........................$30.
500,000 -1, 000 ,000 ...........................
$40.00
1,000,000 -1, 750, 000 ........................$60.00
Over 1, 750, 000 ...... ........................$
Notice
I hereby certify that I have read and examined this
application and know the same to be true and correct. All
provisions of laws 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.
f n
Signature of �ontracfor or Authorized Agent
�I1 S �fG
Date
Furnace/Heat Pump /Air Conditioner (Per Unit)
Up to and including 100,000 BTU / 3Ton ... .........................$15.00
Fumace/Heat Pump /Air Conditioner (Per Unit)
Over 100,000 BTU / 3 Ton .................... .........................$
Refrigeration Units /Coolers /Lines /Compressor — Commercial
(New or Replacement) (Per Unit)
.... .........................$15.00
..................
Boiler (use BTU Chart to left) ....................
Appliance Vent/Fans ........................$10.00
Duct System ......... .........................$
Gas /Air Outlets .................First 5 x $6.00
.........Additional x $1.00
Radiant Heat Systems /Gas /Water
Piping System ....... .........................$5
Modular Home ............................... $50.00
Permit Issuance Fee .. ........................$25.0
Total
Current License on File O Yes O No O N/A
Comment:
WHEN PROPERLY VALID
Approved By:
TED (IN THIS SPA
LW c
THIS IS YOUR PERMIT
Rev. 2008 -10
CITY or I)LAIQ
11 je oT
HOMEOWNER VERIFICATION FOR PLUMBING AND /OR
MECHANICAL PERMITS
C Lit
Print your full name online above:
states the following:
1. I am the owner of the single family dwelling for which I am applying for a
plumbing and/or mechanical permit.
Address:
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. By signing this form I am stating the above information is true an correct.
Signature
5-,) -- 16)
Date
218 South 16th Street • Blair, Nebraska 68008 • 402 - 426 -4191 • Fax 402 - 426 -4195 • E -mail cityofblalr @ci,blair.ne.us oPPOa',r.
ELECTRI~r~~i!~~~Iir~~!s~ICATION\ tl \ \g 0-
218 South 16th Street J
Blair, Nebraska 68008
Fax (402) 426-4195 E 3109
(402) 426-4191
Application Date:
5' - / f) "-01
Job Address
Owner
1.
Contractor
Service Fee = (Amp Fee + $5.00 per branch circuit)
1-100 Amp Fee..................... ..$25.00
101-200 Amp Fee.......................$35.00
201-300 Amp Fee...... ... ............ ..$55.00
301-400 Amp Fee.................... ...$75.00
401-500 Amp Fee...... ............... ..$95.00
501-600 Amp Fee................... ..$115.00
601-700 Amp Fee...... ... ... ...... ...$135.00
701-800 Amp Fee...... ...... ......... $155.00
801-900 Amp Fee................... ..$175.00
901-1000 Amp....................... ..$195.00
IF OVER 1000 Amp
1 st 1000 Amp Fee.............. ....$195.00
Each additiona1100 Amps.........$20.00
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.
5-)'6- (:)'-
Date
fA{).OC)
Permit Fee: $ lJI
Q~k-SffY'-./
Zip
Phone
Zip
Phone
o UPGRADE SERVICE
ELECTRICAL PERMIT FEES
Upgrade Existing Service............ .$25.00
Temporary Service.................... $15.00
Fire Alarm System...... ........... ....$15.00
Signs (each)......................... .....$25.00
Miscellaneous Apparatus......... .....$15.00
CommerciallMulti Family and All Upgrades:
# of Circuits x $5.00
Amp Fee 05.00
Amp Fee + Circuit Total
New Residential: (Finished Area)
Single/Two Family Dwellings
sq.ft.x.063
Modular/Manufactured Homes...... .$50.00
Other: (alterations, additions and modifications)
Receptacles/Switches/Lighting Fixtures (110 volt only)
# of Apparatus .......... x $1. 00
c35', 00
Power Apparatus (220 Volt or higher)
# of Apparatus....... x $8.00
Smoke Detectors.....
x $3.00
Permit Issuance Fee.................. .$25.00
,;?5~ t)u
o
Total iItJ (yO. 0 '
Comment:
WHEN PRO PERL Y VALIDATED (IN THIS SPACE) THIS IS YOUR PERMIT
I Approved By: ( 15 . Pc.! fJ~
Rev. 2008-10
C
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BUILDING INSPECTION REPORT
CITY OF BLAIR
o WASHINGTON COUNTY
LOCATION OF
NAME OF
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DATE INSPECTION REQUESTED' l./~. L;/J<' {J 'i TIME INSPECTION REQUESTED'
TYPE OF INSPECTION REQUESTED: 0 CONFERENCE
BUILDING: FOOTING 0 DECKFOOTING 0 FRAMING 0 DRYWALL 0 FINAL 0 PARTIAL
COMMENTS:
UTILITIES: 0 SEWER TAP 0 SEWER 0 SEPTIC 0 WATER TAP 0 REMOTE 0 WATER SERVICE
o PARTIAL
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COMMENTS:
ELECTRICAL: 0 ROUGH IN 0 FINAL 0 PERMANENT SERVICE 0 TEMPORARY SERVICE 0 PRECONNECT
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o 0
COMMENTS:
MECHANICAL:D ROUGH-IN 0 AlC 0 FURNACE 0 RADIANTHEAT 0 FINAL 0 PARTIAL
PASSED FAILED
0 0
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0 0
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0 0
COMMENTS:
PLUMBING: 0 GROUNDWORK 0 ROUGH-IN 0 FINAL 0 WATERMETERINSTALLED 0 PARTIAL
o PRESSURE TEST
COMMENTS:
o OCCUPANCY GRANTED 0 CONDITIONAL OCCUPANCY GRANTED
NOTES/REMARKS'
INSPECTOR' (i\~ -1l~
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DATE INSPECTION REQUESTED' /L3 [.{~ '? J",,~IME ;SP~O~if~~~~:'; ;itl~~(~" PERMIT
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NOTES/REMARKS'
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INSPECTOR'
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DATE OF INSPECTION MADE:
~ ~().iYCJt'
TIMEj",'! 0
FAXED OPPD\BURTREA
T,O CONNEC,T SERVICE: ,ON ~ '
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BY
BUILDING INSPECTION REPORT
CITY OF BLAIR
D WASHINGTON COUNTY
LOCATION OF
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NAME OF
DATE INSPECTION REQUESTED'
/ ' ,::') 0 rei . ,VI, PERMIT
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TYPE OF INSPECTION REQUESTED: D CONFERENCE
BUILDING: D FOOTING D DECK FOOTING D FRAMING D DRYWALL D FINAL D PARTIAL
D STATUS CHECK
PASSED FAILED
D D
COMMENTS:
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'G.;]"'FINAL D PERMANENT SERVICE D TEMPORARY SERVICE D PRECONNECT
D PARTIAL
~~ F~ED
COMMENTS:
MECHANICAL:D ROUGH-IN D AlC D FURNACE D RADIANT HEAT D FINAL D PARTIAL
PASSED FAILED
D D
COMMENTS:
PLUMBING: D GROUNDWORK D ROUGH-IN D FINAL D WATERMETERINSTALLED D PARTIAL
D PRESSURE TEST
PASSED FAILED
D D
COMMENTS:
D OCCUPANCY GRANTED D CONDITIONAL OCCUPANCY GRANTED
NOTES/REMARKS'
JNSPEcrOR"<~~DATEOPINSPECI10NMADE' (jrr-;;C;:07 TIME" /bd
FAXED OPPD\BURT REA
TO CONNECT SERVICE: ON
BY
#v
o CITY OF BLAIR
BUILDING INSPECTION REPORT
o WASHINGTON COUNTY
D OTHER
NAME OF OWNER'
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CONTRACTOR') z i (' V}. \ "'}
DATE INSPECTION REQUESTED'
I
TIME INSPECTION REQUESTED' !
l
PERMIT NO' I
TYPE OF INSPECTION REQUESTED:
o CONFERENCE
o STATUS CHECK
~~D F~ED
BUILDING: DECK FOOTING 0 FRAMING 0 DRYWALL 0 FINAL 0 PARTIAL
COMMENTS:
UTILITIES: 0 S,EWER TAP 0 SEWER 0 SEPTIC D WATER TAP 0 REMOTE 0 WATER SERVICE
o PAlhiAL 0 '"
PASSED FAILED
o 0
COMMENTS:
ELECTRICAL: 0 ROUGH IN 0 FINAL 0 PERMANENT SERVICE D TEMPORARY SERVICE 0 PRECONNECT
o PARTIAL
PASSED FAILED
o 0
COMMENTS:
MECHANICAL:D ROUGH-IN 0 A/C 0 FURNACE 0 RADIANTHEAT '0 FINAL 0 PARTIAL
PASSED FAILED
o 0
COMMENTS:
PLUMBING: 0 GROUND)VQRK 0 ROUGH-IN 0 FINAL 0 WATER METER INSTALLED 0 PARTIAL
o PRESSURE TEST
PASSED FAILED
o 0
COMMENTS:
o OCCUPANCY GRANTED 0 CONDITIONAL OCCUPANCY GRANTED
NOTES/REMARKS'
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INSPECTOR'
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DATE OF INSPECTION MADE:
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FAXED OPPD\BURT REA
TO CONNECT SERVICE: ON
BY
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