BP13322
_, ._ ",..oJ ""."
(,
~''''
~ ~
; ~-.
v
FILE COpy
Date:
, O{ ~10Cl
CITY OF BLAIR - APPLICATION FOR BUILDING PERMIT
Permit # I 33 .) ),
10 l<l{ (0
\.d Approximate Completion Date:
e rAu- \I{-\O~CJ.-<. 0-
Site Plan Attached: RESche6k Attached: Complete Plans Attached
Application for: Residential 'X. Commercial/Industrial _
New Construction...lS2- Manufactured Home _ Modular_
Move-on: Home _ Accessory Building Other
Remodel Addition
Accessory Building: Garage _ Pole Barn_ Other
Floor Type: Dirt _ Concrete _ Electricity: Yes _ No
Sign Erecting, Awnings _ Decks/Handicap Ramps (plot plan required) _
Satellite Dishes/Radio Antenna/Cell Towers (plot plan required) _
Other
RECE
OCT - 8 2009
GlfY OF BLAIR
NEBRASK#\
Utilities: Public Water: Yes_ No Private Well
If yes, responsible entity: Blair OPPD Line Kennard
Agreement needed: _ Date Agreement Received: _
Public Sewer: Yes_ No Septic Drawing Provided: _
If yes, responsible entity: Blair _ Kennard
County Road Permit Required: Yes_ No _ Submitted: Yes _ No _
Additional Description of project if necessary:.A S~ . 3'e::t2- - u n~ hlsl<.eJJ
~VV\Jl..--n t 3 ~~)Y' 1CLV~tl at- ~- Rill &).:H-, LVI (Qo-~~ vnz/~
Job Address:
l-o{- \ 18
89' 6CJ 82ZCfZ
'be:=rl1 e t cL Y.iuJ-+ 4ddai~
F, el c\ ( (e ~+ D y
CD C I' Iff s+
Address:cpZ'l ..::> \[J
(;)010
Proiect Information:
Legal Description (if applicable)
owne,Nak +K. \et../ 1-tvJ.>e- V
Contractor: S-c l..(;
1-{2' " 3l(q a,'
Phone#: lO
Phone #:
Cell #: .3:f)S ~ 535-S k
Address:
Separate permits are required for electrical, plumbing, hearting, ventilating and air conditioning, and septic systems. By my signature
below, I acknowledge this building permit application does not constitute issuance of this building permit. I further agree that
construction covered by this permit application shall not be commenced until) have received a copy of a permit signed by the Building
Inspector I hereby agree to perf rm t ~proposed work in accordance with the specifications set forth above and in accordance with the
codes/? dinanc~Hhe~ity of: I . ~d the State of Nebraska. ) understand that this permit is void if work is not commenced within
0.. 'l"'m~~I:tW (2),.""""",",",. .; o/,~ L01
s ~ aM . of Ow erj ont eto, ~I.
For Buildin Per its other than One & Two Family Residential Structures:
I hereby ack'i1owledge and agree that I have/will submit a set of plans for this project to the Nebraska State Fire Marshal's Office for
Review.
Signature of Owner/Contractor
Date
ZONING REVIEW:
Zonin Flood Plain
Current Zoning: Conditional Use Permit Required: Yes _ No ~
Date c~)(pproved:
,St.".!eFire Marshal Required: Y!7- No Vari~nce Require.d: Yes _ No
:l\1,mlJ:llum Setbacks: Front....a-s. Second Front SIde -+- SIde 4- Rear
LotSauare Foot~g~f\ {'J
Length x Width: -----6UL=- Lot Coverage %
D~
. Driveways/Sidewalks:
Sidewalk required: Yes
Sidewalk Waiver: Yes
Date Waiver Approved:
Preexisting Garage requi es driveway to be less than 3' from property line: Yes_
Approved by:
No
NO~
Flood Plain: Yes No
If yes, specify special req
BUILDING INSPECTOR REVIEW:
Number of Stories
One Two
Th ree
Four
>Four
High Rise (> 75 ft) _
T e of Residential Structure:
Ranch _ Two Story Split Entry _ Raised Ranch _ Other
Rooms _ Bedrooms _ Bathrooms _ Fireplaces _ Gas_ Electric _
Egress in Basement: Required: Yes....L No _ Provided on Plans: Yes V No
Sleeping Rooms 's Living Area Other Egress
Square Footage:
Main Level: r:+4- i
Basement: (Unfinished) j l f. ~
Garage: '1],)'
Detached Garage:
Addition:
Porch: Front Rear
Deck that affect setbacks: Rear
Second Level: 1/)'5' Lf Third Level
(Finished)
2 bay_ 3 bay_ 4 bay_ 5+ bay
Pole Barn:
Remodel:
Side
Front Side
Occupancy Classification: ~,3
Assembly, theaters, with stage Assembly, theater, without stage _
Assembly, nightclubs _ Assembly, restaurants, bars, banquet halls _
Assembly, churches _ Assembly, arenas _
Assembly, general, community halls, libraries, museums _
Business Educational Factory and industrial, moderate hazard _
Factory and industrial, low hazard _ High Hazard, explosives _
(section continued on next page)
High Hazard HPM
Institutional, incapacitated _
Institutional, day care facilities_
Residential, multiple family _
Residential, care/assisted living facilities
Storage, moderate hazard _ Storage, low hazard _ Utility, miscellaneous _
Institutional, supervised environment_
Institutional, restrained _
Mercantile Residential, hotels_
Residential, one- and two-family
Is building reauired to be protected by automatic fire sprinkler svstem?"
No
Only partially in some areas or rooms Please Specify
Yes _ If yes, the standard to which the sprinkler system will be designed:
NFPA 13 NFPS 13R NFPA 13D
Driveway Grade: 20% grade or less? Yes _ No_
(Dale will review new residential construction. AI will review all second access requests and industrial and
commercial driveway requests)
Required Off Street Parking:
Permit Fee Calculation:
Building Permit Deposit Fee:
Commercial, new homes and residential
additions/remodels/accessory buildings valued $10,000 or greater $ 500.06
Fee - $500.00
Residential additions/remodels/accessory buildings valued under $10,000 $
Fee = $200.00
All other permits Fee = $50.00 $
RESIDENTIAL - NEW CONSTRUCTION:
Permit fee is:
Finished sqjft area ~) '7 '1.1:;
(not including finished basement area)
Finished basement sqjft area
Unfinished basement sqjft area I i I ~.
Garage sqjft area 9 '3 S
Total Valuation:
X $92
d57) I L/tJ, 00
$
$
$ .,"'] ;2 Il22. 6()
-~ , ~.
$ 02::f, Q"15:bi)
$ ~ I Z I ~j31. 00
t
X $56
X$29
X$25
Issuance Fee:
$ / 677. ~;!.;
25.00 ',z /9 f);2, ~~
.:(1L/ ();;<. b~
$
Total Valuation ;3 / :2., 9'37 (,Ii) Multiplied by 0.006 =
Total Permit Fee = Deposit + Permit Fee + Issuance Fee
$
RESIDENTIAL - ADDITIONS / REMODELS and
COMMERCIAL - NEW CONSTRUCTION / ADDITIONS / REMODELS:
Business/I nd ustrial/Educationa 1/ Assem bly/Factory/Storage/Utility
*Porches with roofs/screened patios are considered additions
Construction valuation computation: Sqjft area X $63
Except for the following:
Accessory Buildim!s & Interior Remodeling Proiects: sqjft area X $43
Pole barns with no hard surface floor: sqjft area X $25
Sign Erecting/Awnings and Decks/Handicap Ramps: sqjft area X $25 (Minimum
valuation of $2000)
Construction valuation computation:
Finished sqjft area
X$
$
Construction valuation is ...................................Permit fee is:
$0 TO $50...........................................................$0
$51 TO $500........................................................ $25
$501 TO $2,000........................................................ $25 + $3 per additional $100
$2,001 TO $25,000........................................................ $70 + $13 per additional $1,000
$25,001 TO $50,000......................................................$370 + $10 per additional $1,000
$50,001 TO $100,000......................................................$620 + $7 per additional $1,000
$100,001 TO $500,000......................................................$970 + $5 per additional $1,000
$500,001 TO$1,OOO,OOO.................................................. $2,970 + $4 per additional $1,000
$1,000,001 AND OVER.................................................. $4,970 + $3 per additional $1,000
Permit Fee calculated from chart above
$
$
$
25.00
Issuance Fee:
Total Permit Fee = Deposit + Permit Fee + Issuance Fee
Additional Comments:
Approved by:
->1 ;Zv~k
,
Date:
/ tJ -{/,f-, 09
.
Contingent On Approval by Fire Marshall
Meet IBC, IPC, IMC and NEC Code Requirements
Sleeping Rooms below Story and in Basement required to have egress
For Office Use Only
Date Permit Paid:
Permit Fee:
Deposit Amount
Receipt #
Deposit Paid by for return to:
Building Inspection Pouch given: Yes _ No
~
p t;p.. 1<' <>"" ~ ~ "= _.
MECHANI~A~ PE~'Fl'PPLICATION
Jurisdiction of City of Blair, Nebraska {'
218 South 16th Street
Blair, Nebraska 68008
Fax (402) 426-4195 M 1949
(402) 426-4191
Application Date:
/ "'1 #
,ot.
/ftl~C:' r
Job Address
Owner ~_j
1. <-/-. tT1/ tuooor-
3. Class of Work:
Describe Work:
4.
Heat Pump
Central AlC
Furnace / d2 LJ, () t:' {!
v
Tons
Tons
BTU!H
AlC
# 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.
If-/O
Date
Permit Fee: $ /IJ(J,
~.
Phone
ZJv '
'i7 ./'/""1-->
o Alteration 0 Repair
Phone
o Replacement
47lzf
MECHANICAL' PERMIT FEES
Furnace/Heat Pump/Air Conditioner (Per Unit)
Up to and including 100,000 BTU 13Ton............................$15.00
Furnace/Heat Pump/Air Conditioner (Per Unit) ",,5 0 ' 00
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
/6. CJ{)
/,5~, {)
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
Current License on File ~ es 0 No 0 Nj A
Comment:
WHEN PROPERL Y VALIDATED (IN THIS SPACE) THIS IS YOUR PERMIT
I Approved By: :::i? ':;?,' /, '
-:z_) " / <=jl r ..IVf4,.tr-J
Rev. 2008-10
~~.'"
'..... ..
'J
-..."""".....-
1
PLUMBING PERMIT APPLICATION
Jurisdiction of City of Blair, Nebraska '.3 ~ d ()
218 South 16th Street l, lj
Blair, Nebraska 68008
Fax (402) 426-4195 P 2080
(402) 426-4191
Application Date: / d- ./(3"1 - cJ r
Job Address
Owner
1.
Contrac
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,
,?1 J -- CJ C
Date
'F.--' .,
""
')
'vi
FIl- ,06
V. d CJ;IA cZ' ChnaAa ~~ //0
o Alteration 0 Repair 0 Replacement
/~,oo
(!J Li 00
8. 00
b,tJo '7 ,00
'-"
/fI)UtP{(fJ ~
/ tJ. 00
If!;. 00
/ (5'.00
WHEN PROPERL Y VALIDATED (IN THIS SPACE) THIS IS YOUR PERMIT
I Approved By: - ...CiJ, . 7)
. ~, rd/~u
Permit Fee: $
Zip Phone
jl uJ tJ lit! uM
PLUMBING PERMIT FEES
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 J!!t.1
Water Heater.................. .......$10.00 x I
Outside Water Faucet...................$6.00 i3 I/I)J
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............$1O.00
Sprinkler System (Commercial)..$30.00
Gas/Water Piping System
(Commercial)................. .......$50.00
Permit Issuance Fee................ .$25.00
Current License on File ~s
Comment:
Total
o No 0 NjA
Rev. 2008-10
."
PLUMBING PERMIT APPLICATION
I Jurisd!~t16n,Qf""Ci~~t'~fBlai.r;t~raska J 33 d';;)
~ " 1'r '2 rs South 16th Street
Blair, Nebraska 68008
Fax (402) 426-4195 P 2065
(402) 426-4191
~
Application Date: \ I - ~ '- D7
Job Address
. ~()J
Permit Fee: $ /;;,s-
DI
Jo)~ ~etJ.0-{c,rt
l \ Mail Address
I'll.\, e (
T N[ail Address
r C"V\lh ,(\"
o COMMERCIAL ESIDENTIAL
cj ~~ (\slfv\)~
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,
.iU
/ i~/
: __ --,J../t,,-:: ( /. L.y ,,';Y0
@jgnatureofContractor or Au~th9 ized Agent
II //.:;
. '")!? /67
Date
Zip
Phone
Zip
Phone
o Repair 0 Replacement
PLUMBING PERMIT FEES
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 System (Commercial)..$30.00
Gas/Water Piping System
(Commercial)...................... ..$50.00
15--00
I S- 'u0
Permit Issuance Fee... ...... ...... ..$25.00
Current License on File
Comment:
DYes 0 No
Total
o NjA
SPACE) THIS IS YOUR PERMIT
Rev. 2008-10
~
l
f'
'f '11(' r" "'" ..,.
fiFe ,., f'l
I 33;J02.
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: J J ..::;3-' 0)
Job Address
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 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.
'1/ './ "
C ~.~. /~
>'Signature of Contractor ort;tjrized::;t
. lyS /rJ7
Date
T 1362
d 00
Permit Fee: $ bO ,-,
/u MeIJ<l'cs'f- Dr.
Zip
Phone
Zip
Phone
New 0 Addition 0 Alteration 0 Repair 0 Replacement
PLUMBING PERMIT FEES
Water Tap Fee - %"
$150.00
Water Tap Fee -I"
$200.00 X-
Water Tap Fee - 1~" $250.00
Water Tap Fee - 2"
$300.00
Current License on File
Comment:
Total ;>-00
DYes 0 No 0 NjA
HIS SPACE) THIS IS YOUR PERMIT
Rev. 2008-10
ELECTRICAL PERMIT APPLICATION
.' ~rl;?
4f I 3<./1'~'~
E 3160
~J)(r
~
Jurisdiction of City of Blair, Nebraska
218 South 16th Street
Blair, Nebraska 68008
Fax (402) 426-4195
(402) 426-4191
Application Date:
/0,,/11 - 09
Job Address
Owner, I. .' // ..o/lail Addre}S / /, _ ,
1. a T J 1 ^- '"" /-jt/ .t::Vf./V
Contract , . 1" (t // AM il Addre~s
2. JLUJOQ/ CLP er.:/U e
3. Class of Work: ~ NEW RESIDENTIAL 0
Describe Work: (Y //" .~ I." ,
4. eyJ {! cA/ e
5.Current License on File Yes 0 No
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
1st 1000 Amp Fee..................$195.00
Each additional 100 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.
/- (1//7
!'t. L(t'1J(
Signature of Contractor or Authorized Agent
Z(.-o
Date
Permit Fee: $
Phone
Zip
C} 0 g V cu/; 1/';; t-U Jlf~iP I '.~ I/tu t.9 /
NEW COMMERCIAL 0 REMODELING/ADDITIONS 0 UPGRADE SERVICE
~tu . 'tJ~
ELECTRICAL PERMIT FEES
Upgrade Existing Service............ .$25.00
Temporary Service.................... $15.00 ! !} I 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
Amp Fee + Circuit Total
New Residential: (Finished Area)
Single/Two Family Dwellings
'79~ sq.ft.x.063
Modular/Manufactured Homes...... .$50.00
Other: (alterations, additions and modifications)
i?I.t,PC(
Receptacles/Switches/Lighting Fixtures (110 volt only)
# of Apparatus .......... x $1. 00
Power Apparatus (220 Volt or higher)
# of Apparatus....... x $8.00
Smoke Detectors.....
x $3.00
Permit Issuance Fee................. ..$25.00
Total
Comment:
WHEN PRO PERL Y VALIDATED (IN THIS SPACE) THIS IS YOUR PERMIT
I Approved By: 2. ?J f ~
Rev. 2008-10
CITY OF BLAIR, NEBRASKA
Phone 402-426-4191
RECEIVED OF:
ADDRESS
CITY, STATE. ZIP CODE
THANK YOU
KEEP THIS COPY FOR YOUR RECORDS.
NO
RECEIVED BY
Pounds Printing, Blair. NE 68008
CITY OF 5L^Il~
BUILDING PERMIT SUPPORTING DOCUMENTS
This building permit packet includes various items dealing with particular code
requirements and/or building permit requirements. It in no way includes ALL particular
code items. Also, it is your responsibility to know the 2006 International Buildina
Code requirements that apply to your project. Please understand this packet is only
designed and distributed to aid you in your building permit process. A copy of the
International Building Code is available for your use at the Blair Public Library.
I have read the above disclosure and accept this building permit documentation on my
own behalf assuming full responsibility as the owner/contractor for this project.
~~
Owner/Occupan
Contractor
City of Blair
/Dfs:b?
Date f I
G)-
EQlJALIIOIJ$lNQ
218 South 16th Street. Blair, Nebraska 68008 . 402-426-4191 . Fax 402-426-4195 . E-mail ciiyofblair@ci.blair.ne.us "",,,"'n
BUILDING PERMIT DEPOSIT AGREEMENT
-----; .
~OO.OO r,efundable deposit is being collected for any new commercial, new
~~defltiat,43nd any additions, remodels and accessory building valued $10,000 or
greater at the time of your building permit application.
A $200.00 refundable deposit is being collected for any residential remodel,
addition or accessory building valued under $10,000.
A $50.00 refundable deposit is being collected for all misc. permits.
The City reserves the right to not refund this deposit if any of the following
conditions occur during the construction period:
1) Theft of water service by the plumber, owner or general contractor.
2) All permits have not been obtained.
3) All required inspections have not been obtained.
4) Occupancy occurs prior to a final inspection.
5) The project is completed without a final inspection being done.
6) Storm Water Management Plan inspection not obtained. (If Required)
If any or all of these situations occur during construction, you may forfeit your
deposit.
I hereby agree to the above conditions, and understand that should any or
all of the above situations occur, the building permit deposit SHALL be forfeited or
discounted upon the discretion of the City of Blair, Building and Inspections
Department.
,~
~or/owner Contractor/Owner
City of Blair
!Q t~~2
Date /
10/08/2009 08:05 4024269415
BESCO
PAGE 01
- PLOT PLAN -
N
FILE COpy
~
~
:(<b
~~
APPROVED
BUIL.OING
PLANNING
PUBLIC WORKS
FIRE OEPT
FOR PROPOSED HOUSE
ON LOT 118,
DEERFIELD FIRST ADDITION
TO THE CITY OF BLAIR
RMIT NO.' 1'~) ~J;)
if ) 0<
o
I
20
.
LEGEND
SCALE: 1 INCH = 20 FEET
40 Feet
~
117
119
ADDRESS JO 10 F~cU~.~!.t i)(
,'.l €.
O~
/'
/'
<:)
~~ ~
~ ",/
\/
\
/
~<(,.~
'00
\
\
BE BlAIR ENGINEERING 8.
SURVEYING CO. INC.
S \l3C GroIn! St. P.O. !lox 100
Co- B~r, Ntb~, llSOOlHJ100
(402142$-0414
Qb NQ,; (l9.064IC:\Carl$Qn2006\wQr1I2009\09004'CJ9.004.dwg
Cllant: Ironwood CUBlomHomoJj)or.mBr. KSPIO.te: 10107/M
FILE COpy
REScheck Software Version 4.3.0
Compliance Certificate
ADDRESS ). D J {)
ke1cl.:rcs.t \)r
Project Title: Huber Residence
Energy Code:
Location:
Construction Type:
Conditioned Floor Area:
Glazing Area Percentage:
Heating Degree Days:
Climate Zone:
2006 IECC
Blair, Nebraska
Single Family
2795 ft2
13%
6506
5
I }'J2'))
~~T NO: :;JJr;A.<"'-
Construction Site:
Lot #118 Deerfield
Blair, NE 68008
Owner/Agent:
Designer/Contractor:
Compliance: Maximum UA: 585
Your UA: 548
Gross Cavity Cant. Glazing UA
Assembly Area or R-Value R-Value or Door
Perimeter U-Factor
0.310
101
147
123
Ceiling 1: Flat Ceiling or SCissor Truss
Wall 1: Wood Frame, 16" o.c.
Window 1: Wood Frame:Double Pane with Low-E
SHGC: 0.27
Door 1: Solid
Basement Wall 1: Solid Concrete or Masonry
Wall height: 9.0'
Depth below grade: 8.0'
Insulation depth: 9.0'
Floor 1: All-Wood JoistlTruss:Over Unconditioned Space
Floor 2: All-Wood JoistlTruss:Over Unconditioned Space
Furnace 1: Forced Hot Air 92 AFUE
Heat Pump 1: Air Source 7.7 HSPF, 15 SEER
3900
3135
397
49.0
23.0
0.0
0.0
68
1485
0.310
21
99
10.0
0.0
1241
476
30.0
30.0
0.0
0.0
41
16
Compliance Statement: The proposed building design described here is consistent with the building plans, specifications, and other
calculations submitted with the permit application. The proposed building has been designed to meet the 2006 IECC requirements in
REScheck Version 4.3.0 and to comply with the mandatory requirements listed in the REScheck Inspection Checklist.
Name - Title
Signature
Date
Project Notes:
Permit not issued currently
Project Title: Huber Residence
Data filename: C:\Program Files\Check\REScheck\c1aire grey res check.rck
Report date: 10/22/09
Page 1 of 3
RES check Software Version 4.3.0
Inspection Checklist
Ceilings:
o Ceiling 1: Flat Ceiling or Scissor Truss, R-49.0 cavity insulation
Comments:
Above-Grade Walls:
o Wall 1: Wood Frame, 16" O.c., R-23.0 cavity insulation
Comments:
Basement Walls:
o Basement Wall 1: Solid Concrete or Masonry, 9.0' ht 18.0' bg 19.0' insul, R-10.0 cavity insulation
Comments:
Windows:
o Window 1: Wood Frame:Double Pane with Low-E, U-factor: 0.310
For windows without labeled U-factors, describe features:
#Panes _ Frame Type Thermal Break? _ Yes _ No
Comments:
Note: Up to 15 sq.ft. of glazed fenestration per dwelling is exempt from U-factor and SHGC requirements.
Doors:
o Door 1: Solid, U-factor: 0.310
Comments:
Floors:
o Floor 1: All-Wood JoistfTruss:Over Unconditioned Space, R-30.0 cavity insulation
Comments:
Floor insulation is installed in permanent contact with the underside of the subfloor decking.
o Floor 2: All-Wood JoistfTruss:Over Unconditioned Space, R-30.0 cavity insulation
Comments:
Floor insulation is installed in permanent contact with the underside of the subfloor decking.
Heating and Cooling Equipment:
o Furnace 1: Forced Hot Air: 92 AFUE or higher
Make and Model Number:
o Heat Pump 1: Air Source: 7.7 HSPF, 15 SEER or higher
Make and Model Number:
Air Leakage:
o Joints, penetrations, and all other such openings in the building envelope that are sources of air leakage are sealed.
o Recessed lights are either 1) Type IC rated with enclosures sealedlgasketed against leaks to the ceiling, or 2) Type IC rated and ASTM
E283 labeled, or 3) installed inside an air-tight assembly with a 0.5" clearance from combustible materials and a 3" clearance from
insulation.
Sunrooms:
o Sunrooms that are thermally isolated from the building envelope have a maximum fenestration U-factor of 0.50 and the maximum
skylight U-factor of 0.75. New windows and doors separating the sunroom from conditioned space meet the building thermal envelope
requirements.
Vapor Retarder:
Project Title: Huber Residence
Data filename: C:\Program Files\Check\REScheck\c1aire grey res check.rck
Report date: 10/22/09
Page 2 of 3
o Vapor retarder is installed on the warm-in-winter side of all non-vented framed ceilings, walls, and floors; or it has been determined that
moisture or its freezing will not damage the materials; or other approved means to avoid condensation are provided.
Comments:
Materials Identification and Installation:
o Materials and equipment are installed in accordance with the manufacturer's installation instructions.
o Insulatiqn is installed in substantial contact with the surface being insulated and in a manner that achieves the rated R-value.
o Materials and equipment are identified so that compliance can be determined.
o Manufacturer manuals for all installed heating and cooling equipment and service water heating equipment have been provided.
o Insulation R-values, glazing U-factors, and heating and cooling equipment efficiency are clearly marked on the building plans or
specifications.
Duct Insulation:
o Ducts in unconditioned spaces or outside the building are insulated to at least R-8.
o Ducts in floor trusses above unconditioned spaces or above the outdoors are insulated to at least R-6.
Duct Construction:
o Air handlers, filter boxes, and duct connections to flanges of air distribution system equipment or sheet metal fittings are sealed and
mechanically fastened.
o All joints, seams, and connections are made substantially airtight with tapes, gasketing, mastics (adhesives) or other approved closure
systems. Tapes and mastics are rated UL 181A or UL 181 B.
o Building framing cavities are not used as supply ducts.
o Automatic or gravity dampers are instalied on all outdoor air intakes and exhausts.
o Additional requirements for tape sealing and metal duct crimping are included by an inspection for compliance with the International
Mechanical Code.
Temperature Controls:
o Thermostats exist for each separate HV AC system. A manual or automatic means to partially restrict or shut off the heating and/or
cooling input to each zone or floor is provided.
Heating and Cooling Equipment Sizing:
o Additional requirements for equipment sizing are included by an inspection for compliance with the International Residential Code.
Circulating Service Hot Water Systems:
o Circulating service hot water pipes are insulated to R-2.
o Circulating service hot water systems include an automatic or accessible manual switch to turn off the circulating pump when the
system Is not In use.
Heating and Cooling Piping Insulation:
o HVAC piping conveying fluids above 105 degrees F or chilled fluids below 55 degrees F are insulated to R-2.
Certificate:
o A permanent certificate is provided on or in the electrical distribution panel listing the predominant insulation R-vaiues; window
U-factors; type and efficiency of space-cDnditioning and water heating equipment.
NOTES TO FIELD: (Building Department Use Only)
Project Title: Huber Residence
Data filename: C:\Program Files\Check\REScheck\c1aire grey res check.rck
Report date: 10/22/09
Page 3 of 3
006 IECC nergy
Efficiency Certificate
Insulation Rating R-Value
Ceiling I Roof
Wall
Floor I Foundation
Ductwork (unconditioned spaces):
49.00
23.00
10.00
Glass & Door Rating U-Factor SHGC
Window
Door
0.31
0.31
0.27
NA
Heating & Cooling Equipment Efficil:lncy
Forced Hot Air Furnace
Air Source Heat pump
Water Heater:
92 AFUE
7.7 HSPF, 15 SEER
Name:
Comments:
Date:
#w
BUILDING INSPECTION REPORT
~r CITY OF BLAIR
D WASHINGTON COUNTY
D OTHER
, ;~,
LOCATION OF INSPECTION'
I
'" .
.,c :. 'i .,~~ ;t'
i,:~i~/,~~;,jL.}(t:., f)'(~./~{~;'~,<,-,~t i:'~:'" '~,","f< t."l
d
/<I:;'<(:~>i'..
CONTRACTOR'
i: /,' j
\: l,l/<"'l~"~;I"-
(f/
" .
,i' /",,;;' ""/^"
NAME OF OWNER' / \i/;' i .
TIME INSPECTION REQUESTED'
:!,,"""'l,
l '> ':.'5l,)
PERMIT NO'
_J ,,)
j
DATE INSPECTION REQUESTED' /
/,~~ " ,,;"
i'~';' /~ l
'f (;,:;/
TYPEOFINSPECTIO REQUESTED: D CONFERENCE
BUILDING: FOOTING D DECK FOOTING D FRAMING D DRYWALL D FINAL D PARTIAL
D STATUS CHECK
~D 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 AfC D FURNACE D RADIANTHEAT D FINAL D PARTIAL
PASSED FAILED
D D
COMMENTS:
PLUMBING: D GROUNDWORK D ROUGH-IN D FINAL D WATER METER INSTALLED D PARTIAL
D PRESSURE TEST
PASSED FAILED
D D
COMMENTS:
D OCCUPANCY GRANTED D CONDITIONAL OCCUPANCY GRANTED
NOTES/REMARKS'
INSPECTOR'
/41#+
DATE OF INSPECTION MADE: I () ..../ 9,' f) 9
TIME' J ~':)6P,,~
FAXED OPPD\BURT REA
TO CONNECT SERVICE: ON
BY
BUILDING INSPECTION REPORT
CITY OF BLAIR
D WASHINGTON COUNTY
D OTHER
<"'I,
{" ,;,
LOCATION OF INSPECTION:
,/" ",;,.,.
)'<" ,,/{'jic~.-j~:: {'";:'
:~),,/{ ,?,'---"
l.:),"i,
NAME OF OWNER'
~/\</~~i t'<'''(';';
,if( {,,-L:,/~:,,:{<
~ / /
r",,:/i {~/ /l2,l,-,,(o:')
CONTRACTOR'
^.
(/ ~,i 1:::1 (J i;
//~~~f Ci'/// ~i
Ift/::; ~ 9&0/- 2?>'J..
DATE INSPECTION REQUESTED' I ()^ ;;:/:.?'~. r::) (1
TIME INSPECTION REQUESTED'
//;,~:)"
\i_,,:~/l<),~/(i1.l~;l,-
PERMIT NO'
it' :~J~':"::i~,,,:~.;?'
l~:-:' ~~',:? t:(l t~f)
STATUS CHECK
TYPE OF INSPECTION
D CONFERENCE
BUILDING: D FOOTING D DECK FOOTING D FRAMING D DRYWALL D FINAL D PARTIAL
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 D FINAL D PERMANENT SERVICE:"tQ:TEMPORARY SERVICE D PRECONNECT
D PARTIAL
~ F~ED
COMMENTS:
MECHANICAL:D ROUGH-IN D AlC D FURNACE D RADIANTHEAT D FINAL D PARTIAL
PASSED FAILED
D D
COMMENTS:
COMMENTS:
D GROUNDWORK D ROUGH-IN D FINAL D WATERMETERINSTALLED D PARTIAL
D PRESSURE TEST
PASSED FAILED
D D
D OCCUPANCY GRANTED D CONDITIONAL OCCUPANCY GRANTED
NOTES/REMARKS'
DATE OF INSPECTION MADE: 16 ~ 2,;( ...c>{
TIME jiJ.' 10
INSPECTO '
FAXED OPPD\BURT REA
TO CONNECT SERVICE: ON
BY
,-.
_.
'..
~
.~
.~
. .
-'"
I<!'ttd r-r
kCITYOFBLAIR
BUILDING INSPECTION REPORT
o WASHINGTON COUNTY
o OTHER
LOCATION OF INSPECT!ON'
f\., il
NAME OF OWNER' rJL,(. jiJt.,.-
f,,\;;P/~(k," ;'
,/It
\ . ;/'"
CONTRACTOR'...'! <, '
/ '''.J I,.,'~,
~^\ ,,'''' 't,~,:} < !3'
,
; ) \/ <-'-
i ,." I ,..Jc
DATE INSPECTION REQUESTED'
10 ,<If I'
:,:
TIME INSPECTION REQUESTED'
"",,' ~...
i
//"
1 '<~
: J !J
PERMIT
TYPE OF INSPECTION REQUESTED: 0 CONFERENCE
BUILDING: FOOTING 0 DECK FOOTING 0 FRAMING 0 DRYWALL 0 PINAL 0 PARTIAL
o STATUS CHECK
COMMENTS:
UTILITIES: 0 SEWER TAP 0 SEWER 0 SEPTIC 0 WATERTAP 0 REMOTE 0 WATER SERVICE
o PARTIAL
FAILED
o
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 NC 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:
PASSED FAILED
o 0
o OCCUPANCY GRANTED 0 CONDITIONAL OCCUPANCY GRANTED
NOTES/REMARKS'
INSPECTOR'
::j(; VUJf-
DATE OF INSPECTION MADE:
/ () ~")-7,.poD 9
TIMF'
FAXED OPPD\BURT REA
TO CONNECT SERVICE: ON
BY
N1A!
~-6
BUILDING INSPECTION REPORT
D CITY OF BLAIR
D WASHINGTON COUNTY
D OTHER
DATE INSPECTION REQUESTED'
1:\ d
1"'1
" I .
J",
\ "f~ I \ . I ' \
(~/ C) j t) (" \ c~ ~ ~J (. l t"~""J i (,'~~; '/~
,I I
J'. ",.,>
CONTRACTOR- tICi\' '.\ )\
I....
TIME INSPECTION REQUESTED' I.
LOCATION OF INSPECTION'
'\ I
1. I"
NAME OF OWNER f 'I C... () (:~ /
PERMIT NO'
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: SEWER TAP)E] SEWER D SEPTIC>tq WATER TAP D REMOTE';t2~r'WATERSERVICE
, ,. , .- .
D PARTIAL .
COMM~~~~ ____~_ ~ .fuL-12i~_~.~
ELECTRICAL: D ROUGH IN D FINAL D PERMANENT SERVICE D TEMPORARY SERVICE D PRECONNECT
D PARTIAL
PASSED FAILED
..ptD
PASSED FAILED
D D
COMMENTS:
MECHANICAL:D ROUGH-IN D AlC D FURNACE D RADIANTHEAT 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
NOTESfREMARKS-
INSPECTOR-
11 ~/1I/~
DATE OF INSPECTION MADE:
JI-If-09
TIME'
j..' l/:) 0 fu/"l
FAXED OPPD\BURT REA
TO CONNECT SERVICE: ON
BY
?:t~
[;jfCITY OF BLAIR
BUILDING INSPECTION REPORT
D WASHINGTON COUNTY
D OTHER
.~,
//'\, /
,~ }-",/!,
LOCATION OF INSPECTION'
./ i/ i
NAMEOFOWNER./\jO ,i,,/
,~-_;:~,(~~~,::) I /~-,~,.~:.J
;/~(~,(Z./~;;::;?;~,I'1::,:i, V,iL
/ // /
/' ~-~;/.~<<,(;:~~/.~~..t.r'-
/;"}~, ,-'}.--;)'
DATE INSPECTION REQUESTED- ./ [;' . ,:/ .~) .'
~:~~~" (;/
" II" t ,""";'" .,,' ,/_/ 1'". "'.~ ,"..' /:~_;
CONTRACTOR' \. -' ,,{//il,i (,?'.~" /'/;;:;i, ; .<I_i.'I/l ,r"
TIME INSPECTION REQUESTEIl' ,~.yt'3o"~~' ~
D CONFERENCE D STATUS CHECK
FINAL D PARTIAL PASSED FAILED
D D
TYPE OF INSPECTION REQUESTED:
BUILDING: 0 FOOTING 0 DECK FOOTING D FRAMING D DRYWALL D
COMMENTS:
UTILITIES: 0 SEWER TAP D SEWER D SEPTIC D WATER TAP D REMOTE D WATER SERVICE
o PARTIAL
COMMENTS:
PLUMBING:
GROUNDWORK 0 ROUGH-IN D FINAL D WATERMETERINSTALLED D PARTIAL
PRESSURE TEST
PASSED FAILED
D 0
PASSED FAILED
D D
PASSED FAILED
D D
PASSED FAILED
~ D
COMMENTS:
ELECTRICAL: D ROUGH IN 0 FINAL D PERMANENT SERVICE D TEMPORARY SERVICE D PRECONNECT
o PARTIAL
COMMENTS:
MECHANICAL:D ROUGH-IN D NC D FURNACE D RADIANTHEAT D FINAL D PARTIAL
COMMENTS:
D OCCUPANCY GRANTED D CONDITIONAL OCCUPANCY GRANTED
NOTES/REMARKS-
INSPECTOR'
111f1 ~i-ej
DATE OF INSPECTION MADE: I d- ::l.5 ~ tl 9
TIME- {~ 0 fc.U
FAXED OPPD\BURT REA
TO CONNECT SERVICE: ON
BY
1J~'
D CITY OF BLAIR
BUILDING INSPECTION REPORT
D W ASHlNGTON COUNTY
D
LOCATION OF
NAME OF OWNER'
CONTRACTOR'
DATE INSPECTION REQUESTED' l ')
, h.~
It",
TIME INSPECTION REQUESTED'
i\/'T
PERMIT NO' /33 J..- '---
. :if"
TYPE OF INSPECTION REQUESTED: ,:jgf: CONFERENCE
BUILDING: D FOOTING D DECK FOOTING 'Iil:; FRAMING D DRYWALL D FINAL "[SJcP ARTIAL
D STATUS CHECK
J;>ASSED FAILED
",'.~," D
.1,...,....;;
~.^.., ':,::"'{\
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 D FURNACE D RADIANTHEAT D FINAL D PARTIAL
PASSED FAILED
D D
COMMENTS:
PLUMBING: D GROUNDWORK D ROUGH-IN D FINAL D WATER METER INSTALLED D PARTIAL
D PRESSURE TEST
PASSED FAILED
D D
COMMENTS:
o OCCUPANCY GRANTED D CONDITIONAL OCCUPANCY GRANTED
,'I I !
,( /1:" L~. ~."V ,I;' F?':> 1
NOTES/REMARKS'
Ii
(f /
.,f
i:)A' I J tlJl t
/1 1 I~ 't'-r,'
~.' .. '."
i } 1
'" if
I
,
\
/1 ,J" ~
, {'
" ,'J i '\
{;.," .;t"
,I r ;.',~ ie' (: ,ffr t{~{-'f) ,f' I"~ r.' 'lJ
l i
i~"",."hJ(l (/ ; /./ C
cft?;;;
''-,j
/, I.,',) e
r (~~'\
r,'~-.;\,) t/t/f (1[ l {[;' ~,(. l " c. I! It'
:,:it"J_ 'i, ' ",r',) \",.' /C:,'f/'-.
f~~. t,~." /~- \ i
,)
~'-~')
Y";,) (l!' iF!
\}\,t. l~ L L_
f'i- -"I. !,'. (....
.~ 0
i,d/,,], j -t i (\
l~>i~ i.),~.-. (..;, ,
(..j -..1 e,,-,,
/ L/) {)II,,:- O;j ',f
l')y~ a 1-' 'j 0:: -I. ,,:;) 01,"\ l\ --( ()fl.~)() l.. ,{- /'; ...l f:~,i.'-,"!<; /'" /j." -{ ~(~ "d'{--f,",,1.\ (') l
:t ' . f '..)
/r( ,
'f /) ie:; A~
I
.c's/t ll~,~,l",~c:,'i
~.'; f,;.' f j'.."
r/:)'t-..,., ,( :''-;
l;..': -" :<,,:;,,-) /-t F {
, 01
I
__,J
"i {
":/ {) lL::,,~' {:~,
,'I ( [
(, C)u l/~;~:> -
.''\
INSPECTOR'
l,;' '/~C'
"? t"
;/ (,
DATE OF INSPECTION MADE: /
i.
/: ( J
TIMF' ':-"j"i~;; ,:(>,~4 ~ji
FAXED OPPD\BURTREA
TO CONNECT SERVICE: ON
BY
#
121" CITY OF BLAIR
BUILDING INSPECTION REPORT
o WASHINGTON COUNTY
o OTHER
I
I
~;~ (:~l::t ftl"
PERMIT NO-
LOCATION OF INSPECTION'
A' /,,; ..l. co' ll>:.~,I.,/ ,'" : ,,/J 1/
NAME OF OWNER- j/ \co't:'l././. '.,
DATE INSPECTION REQUESTED- (:.:;) ,~. <l <1/lJ,/
c~,,~;~{~) lit:::)
.>i
';.\
". "<'4~~~~).~<1
TYPE OF INSPECTION REQUESTED: 0 CONFERENCE
BUILDING: 0 FOOTING 0 DECK FOOTING 0 FRAMING 0 DRYWALL 0 FINAL 0 PARTIAL
o STATUS CHECK
..........
PASSED FAILED
o 0
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.:::E8~:.'ROUGH IN 0 FINAL 0 PERMANENT SERVICE 0 TEMPORARY SERVICR~j~rPRECONNECT
o PARTIAL
COMMENTS:
MECHANICAL:D ROUGH-IN 0 AlC 0 FURNACE 0 RADIANTHEAT 0 FINAL 0 PARTIAL
~ F~ED
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
PASSED FAILED
o 0
NOTES/REMARKS-
DA E OF INSPECTION MADE: O'::Z - () Y-;;l.[Jft) TIME';;;;"'" ~
INSPECTO -
FAXED OPPD\BURT REA
TO CONNECT SERVICE: ON
BY
BUILDING INSPECTIO N REPOR
• r❑ CITY OF BLAIR
LOCATION OF INSPECTION `' °
NAME OF OWNER - - -" CONTRACTOR
DATE INSPECTION REQUESTED • u TIME INSPECTION REQUESTED.P _ �.` `s ° PERMIT NO g
❑ WASHINGTON COUNTY ❑
TYPE OF INSPECTION REQUESTED: ❑ CONFERENCE ❑ STA TUS CHECK
BUILDING: ❑ FOOTING ❑ DECK FOOTING ',Q° FRAMING ❑ DRYWALL ❑ FINAL ❑ PARTIAL P SS D FAILED
COM
❑
UTILITIES: ❑
SEWER TAP ❑ SEWER ❑ SEPTIC ❑ WATER TAP ❑ REMOTE ❑ WATER SERVICE
PASSED
FAILED
❑
PARTIAL
❑
❑
COMMENTS:
❑
ELECTRICAL: ❑
ROUGH IN ❑ FINAL ❑ PERMANENT SERVICE ❑ TEMPORARY SERVICE ❑ PRECONNECT
PASSED
FAILED
❑
PARTIAL
❑
❑
COMMENTS:
PASSED
FAILED
x
ECHANICAL ❑
MECHANICAL:
ROUGH —IN ❑ A/C ❑ FURNACE
❑ RADIANT HEAT ❑ FINAL
❑ PARTIAL
S
FAILED
r
❑
COMMENTS:
PLUMBING: F
W, ROUGH IN ❑
FINAL ❑ WATER METER INSTALLED ❑ PARTIAL
PASSED
FAILED
x
PRESSURE TEST
El
COMMENTS: '
❑ OCCUPANCY GRANTED ❑ CONDITIONAL OCCUPANCY GRANTED
NOTES /REMARKS �"V
Ali) 1 C.Z i P RO
it 4 e1 S
L-a J 5tG
6 F Lx S
INSPECTO & 1IbS DATE OF INSPECTION MADE: �� /�� ° TI c 3'C) Q cm
FAXED OPPDIBURT REA TO CONNECT SERVICE: 0 N BY