BPM1847
MECHANICAL PERMIT APPLICATION
Jurisdiction of City of Blair, Nebrask~~'~' ~"- - -
218 South 16th Street ,,'" K\;J
Blair, Nebraska 68008
Fax (402) 426-4195
(402) 426-4191
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Application Date:
Job Address
OwneF--;) //
1. '~I;i (:{ [;
Contractor
2. "
3. Class of Work:
Describe Work:
4.
Heat Pump
Central A/C
Tons
Tons
BTU/H
AlC
Furnace
# 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 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.
4- 2 ~ -9
Date
:~.:..; ,~
M/l's47
Permit Fee:
Furnace/Heat Pump/Air Conditioner (Per Unit) X" d (' '~(J, (:\ 0
Up to and including 100,000 BTU / 3Ton............................$15.00
FurnacelHeat 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
Total
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Current License on File )EJ Yes 0 No
Comment:
o NjA
WHEN PROPERLY V ALIDA TED (IN THIS SPACE) THIS IS YOUR PERMIT
I Approved By: ,') (7).' / I' ,
( 15 /, y J u:l;J/r)
Rev. 2008-10
BUILDING INSPECTION REPORT
,~ITY OF BLAIR
D WASHINGTON COUNTY
D OTHER
LOCATION OF
" (') (~l TIME INSPECTION REQUESTED- I' ,;'1
NAME OF
DATE INSPECTION REQUESTED-, i1"
TYPE OF INSPECTION REQUESTED: D CONFERENCE
BUILDING: D FOOTING D DECK FOOTING D FRAMING D DRYWALL "B,':FINAL D PARTIAL
D STATUS CHECK
~ F~ED
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 D FINAL D PERMANENT SERVICE D TEMPORARY SERVICE D PRECONNECT
D PARTIAL
PASSED FAILED
D D
COMMENTS:
MECHANICAL:D ROUGH-IN D A/C '~:' FURNACE D RADIANT HEAT )f2j:FINAL D PARTIAL
COMMENTS:
PLUMBING: D GROUNDWORK D ROUGH-IN D FINAL D WATERMETERINSTALLED D PARTIAL
D PRESSURE TEST
~ED
PASSED FAILED
D D
COMMENTS:
D OCCUPANCY GRANTED D CONDITIONAL OCCUPANCY GRANTED
NOTES/REMARKS-
INSPECTOR - K.Jzzid
FAXED OPPD\BURT REA
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DATE OF INSPECTION MADE:
o5,oI-~teF( TIMR-JO-~
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TO CONNECT SERVICE: ON
BY