BPP2049
:iN
PLUMBING PERMIT APPLICATION
Jurisdiction of City of Blair, Nebraska
218 South 16th Street
Blair, Nebraska 68008
Fax (402) 426-4195
(402) 426-4191
Application Date: c; - r - 0 9'
P 2049
17" h -- () ()
Permit Fee: $ LJ
/T 07
. (/. 0
Mail Address // -"" .',
l/1'n C(,r1/1V LcrJ7..J -Pu:I CZ1 cnV
::S:COMMERCIAL 0 RESIDENTIAL e8'New 0 Addition
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Job Address
Owner 7
1. C't 1 C
Contractor
2.
3. Class of Work:
Describe Work:
4.
Mail Address
Comments:
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.
o Alteration
o Repair 0 Replacement
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IT FEES
!--
PLUMBING PE
Modular Home... ... ... ... ... ... ....$50.00
Type of Fixture
No.
Kitchen... ... ... ... ...... ... ... ... ...$12.00 x
Bath... ..Residential/Single Stall $12.00 x_
................. ...Multi-Stall $25.00 x
Rough-In Bath....................... .$8.00 x_
Additional Sinks............... ..... .$6.00 x
Slop Sink/Laundry Tray/Drain.....$6.00 x_
Water Heater..................... ....$10.00 x
Outside Water Faucet...................$6.00 x
Drinking Fountain........................$6.00 x_
Backflow/Grease Trap........... ..$15.00
Water Service..................... ..$15.00
Sewer............................... ..$15.00
Groundwork...................... ...$15.00
Septic Tank & Laterals............ $15.00
Lawn Sprinkler System... ....... ..$10.00
Sprinkler Sys~el11. (C;9illmercial)..$30.00
"..~" <~ .--".. ", "-~'''.-"
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Gas(Water PipingSysltlUl/
(Comllercial)... ................... ..$50.00
x
c....5l), iJ t/
Permit Issuance Fee... ... ... ...... ..$25.00
Current License on File
Comment:
Total
Yes 0 No 0 NjA
WHEN PRO PERL Y VALIDATED (IN THIS SPACE) THIS IS YOUR PERMIT
I Approved By: J! j'O, / .
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Rev. 2008-10
BUILDING INSPECTION REPORT
OF BLAIR
o WASHINGTON COUNTY
o OTHER
LOCATION OF INSPECTION'
NAME OF OWNER' ("'~'?'IJ:Zl:,I:~;> '
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DATE INSPECTION REQUESTED- ,
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TIME INSPECTION REQUESTED'
TYPE OF INSPECTION REQUESTED: 0 CONFERENCE
BUILDING: 0 FOOTING 0 DECK FOOTING 0 FRAMING 0 DRYWALL 0 FINAL 0 PARTIAL
o STATUS CHECK
COMMENTS:
UTILITIES: 0 SEWER TAP 0 SEWER 0 SEPTIC 0 WATER TAP 0 REMOTE 0 WATER SERVICE
o PARTIAL
PASSED FAILED
o 0
COMMENTS:
ELECTRICAL: 0 ROUGH IN 0 FINAL 0 PERMANENT SERVICE 0 TEMPORARY SERVICE 0 PRECONNECT
o PARTIAL
PASSED FAILED
o 0
COMMENTS:
MECHANICAL:O ROUGH-IN 0 A/C 0 FURNACE 0 RADIANTHEAT 0 FINAL 0 PARTIAL
PASSED FAILED
o 0
COMMENTS:
PLUMBING: 0 GROUNDWORK 0 ROUGH-IN 0 FINAL 0 WATER METER INSTALLED ~RTIAL
o PRESSURE TEST
PASSED FAILED
o 0
COMMENTS:
~ED F~LED
o OCCUPANCY GRANTED 0 CONDITIONAL OCCUPANCY GRANTED
NOTES/REMARKS'
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INSPECTOR'
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DATE OF INSPECTION MADE: ~.J- ,jl!1 'J
TIME' I a ~ 3 (I A. ~'^'"
FAXED OPPD\BURT REA
TO CONNECT SERVICE: ON
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CITY OF BLAIR
BUILDING INSPECTION REPORT
o WASHINGTON COUNTY
D OTHER
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LOCATION OF INSPECTION'
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DATE INSPECTION REQUESTED- ,I
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NAME OF OWNER-
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TYPE OF INSPECTION REQUESTED: D CONFERENCE
BUILDING: 0 FOOTING 0 DECK FOOTING D FRAMING D DRYWALL 0 FINAL D PARTIAL
COMMENTS:
PLUMBING: 0 GROUNDWORK D ROUGH-IN:~ .FINAL 0 WATER METER INSTALLED
D PRESSURE TEST
D STATUS CHECK
PASSED FAILED
0 D
PASSED FAILED
D 0
PASSED FAILED
D 0
PASSED FAILED
D 0
PASSED FAILED
~ 0
COMMENTS:
UTILITIES: D SEWER TAP D SEWER 0 SEPTIC D WATER TAP 0 REMOTE 0 WATER SERVICE
D PARTIAL
COMMENTS:
ELECTRICAL: 0 ROUGH IN 0 FINAL 0 PERMANENT SERVICE D TEMPORARY SERVICE D PRECONNECT
D PARTIAL
COMMENTS:
MECHANICAL:D ROUGH-IN 0 AlC 0 FURNACE 0 RADIANTHEAT D FINAL D PARTIAL
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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TIME- :d- ,O(.,~
FAXED OPPD\BURT REA
TO CONNECT SERVICE: ON
BY
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o 'CITY OF BLAIR
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BUILDING INSPECTION REPORT
LOCATION OF INSPECTION'
o WASHINGTON COUNTY 0 OTHER
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DATE INSPECTION REQUESTED'
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NAME OF OWNER'
TIME INSPECTION
TYPE OF INSPECTION
o CONFERENCE
STATUS CHECK
BUILDING: 0 FOOTING 0 DECK FOOTING 0 FRAMING 0 DRYWALL 0 FINAL 0 PARTIAL
PASSED FAILED
o 0
COMMENTS:
UTILITIES:
o SEWER TAP 0 SEWER 0 SEPTIC 0 WATER TAP 0 REMOTE 0 WATER SERVICE
o PARTIAL
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PASSED FAILED
)Q- 0
COMMENTS:
ELECTRICAL: 0 ROUGH IN 0 FINAL 0 PERMANENT SERVICE 0 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 GROUNDWORK 0 ROUGH-IN 0 FINAL 0 WATERMETERINSTALLED 0 PARTIAL
o PRESSURE TEST
PASSED FAILED
o 0
COMMENTS:
o OCCUPANCY GRANTED 0 CONDITIONAL OCCUPANCY GRANTED
NOTES/REMARKS'
INSPECTOR'
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DATE OF INSPECTION MADE:
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TIME'
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FAXED OPPD\BURT REA
TO CONNECT SERVICE: ON
BY
DATE INSPECTION REQUESTED'
CTION REPORT
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o CITY OF BLAIR
NAME OF OWNER'
TYPE OF INSPECTION REQUESTED:
BUILDING: 0 FOOTING 0 DECK FOOTING 0 FRAMING 0 DRYWALL 0 FINAL 0 PARTIAL
o STATUS CHECK
COMMENTS:
UTILITIES:
PASSED FAILED
o 0
o SEWER TAP 0 SEWER 0 SEPTIC 0 WATER TAP 0 REMOTE 0 WATER SERVICE
o PARTIAL
PASSED FAILED
o
COMMENTS:
ELECTRICAL: 0
o
tC Ii1 t'( ~ L.
ROUGH IN 0 FINAL 0 PERMANENT SERVICE 0 TEMPORARY SERVICE 0 PRECONNECT
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 GROUNDWORK 0 ROUGH-IN 0 FINAL 0 WATERMETERINSTALLED 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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TIMF'
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FAXED OPPD\BURT REA
TO CONNECT SERVICE: ON
BY
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BUILDING INSPECTION REPORT
o WASHINGTON COUNTY
LOCATION OF INSPECTION-
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NAME OF OWNER' ("lll! 't)t~ Aj"
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DATE INSPECTION REQUESTED' f.
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CONTRACTOR'
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TIME INSPECTION REQUESTED' ,~'5: . ,( ') 6)' ,if! '
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PERMIT
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TYPE OF INSPECTION REQUESTED:
BUILDING: 0 FOOTING 0 DECK FOOTING 0 FRAMING 0 DRYWALL
o CONFERENCE
~^RTIAL
o STATUS CHECK
COMMENTS:
UTILITIES: 0 SEWER TAP 0 SEWER 0 SEPTIC 0 WATER TAP 0 REMOTE 0 WATER SERVICE
o PARTIAL
PASSED FAILED
:a- 0
COMMENTS:
ELECTRICAL: 0 ROUGH IN 0 FINAL 0 PERMANENT SERVICE 0 TEMPORARY SERVICE 0 PRECONNECT
o PARTIAL
PASSED FAILED
o 0
COMMENTS:
MECHANICAL: 0 ROUGH-IN 0 NC 0 FURNACE 0 RADIANT HEAT 0 FINAL 0 PARTIAL
PASSED FAILED
o 0
COMMENTS:
PLUMBING: 0 GROUNDWORK 0 ROUGH-IN 0 FINAL 0 WATERMETERINSTALLED 0 PARTIAL
o PRESSURE TEST
PASSED FAILED
o 0
COMMENTS:
o OCCUPANCY GRANTED
NOTES/REMARKS' (j)
(j)
PASSED FAILED
o 0
o CONDITIONAL OCCUPANCY GRANTED
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INSPECTOR'
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DATE OF INSPECTION MADE:
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TIME' :3,' 30 ff/tt/\.,
FAXED OPPD\BURT REA
TO CONNECT SERVICE: ON
BY