BPP2088P LUMBING PERMIT APPLICATION
Jurisdiction of City of Blair, Nebraska
218 South 16 Street
Blair, Nebraska 68008
Fax (402) 426 -4195 P 2088
(402) 426 -4191
Application Date: _ t � t1 (� U (� Permit Fee: $ 33" �
Job Address ,�i - 9
Owner ail Address Zip Phone
1. ,a ?/I
Contracto V i dress Zip Phone
2. I
3. Class of Work: O COMMERCIAL ESIDENT AL O New O Addition O Alteration O Repair eplacement
Describe Work: v / %�''
4. Gr G�1/yl f �Z;7 G A� t
PLUMBING PERMIT FEES
Modular Home ......................$50.00
Comments:
Type of Fixture No.
Kitchen .............................. $12.00 x
Bath..... Residential /Single Stall $12.00 x
.............Multi -Stall $25.00 x
Rough-la .......................$8.00 x
Additional Sinks .....................$6.00 x
Slop Sink /Laundry Tray/Drain ..... $6.00 x
Water Heater ......................... $10.00 x
Notice
Outside Water Faucet ...................$6.00 x
I hereby certify that I have read and examined this
application and know the same to be true and correct. All
Drinking Fountain ........................$6.00 x
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
Backflow /Grease Trap 15.00
p
Water Service .......................$15.00
state or local law regulating construction or the
performance of construction.
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
Signp re of Contracto or Authorized ent
- - S�
Permit Issuance Fee .................$25.00
Total C>C�
Current License on File Wes O No O N/A
Date
Comment:
WHEN PROPEKLY VALIVAIEL) (IN IHla NrAUL) InIa is YvutcrrLl<tviii
Approved By:
Rev. 2008 -10
CITY OF BLAIR
❑ WASHINGTON COUNTY ❑
r
LOCATION OF INSPECTION
NAME OF OWNER ` ?r k r �' co:
DATE INSPECTION REQUESTED � TIME INSPECTION REQUESTED � A . ��- � " PERMIT
TYPE OF INSPECTION REQUESTED: ❑ CONFERENCE ❑ STATUS CHE
BUILDING: ❑ FOOTING ❑ DECK FOOTING ❑ FRAMING ❑ DRYWALL ❑ FINAL ❑ PARTIAL PASSED FAILED
❑ ❑
COMMENTS:
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:
MECHANICAL: ❑
ROUGH -IN ❑ A/C ❑ FURNACE ❑ RADIANT HEAT ❑ FINAL ❑ PARTIAL
PASSED
FAILED
❑
❑
COMMENTS:
PLUMBING: ❑
GROUNDWOR0 Q ' ROUGH -IN ❑ FINAL ❑ WATER METER INSTALLED ❑ PARTIAL
PASSED
FAILED
COMMENTS: ❑
PRESSURE TEST T L 2 5 M b w e g
El
❑ OCCUPANCY GRANTED ❑ CONDITIONAL OCCUPANCY GRANTED
� f
INSPECTO 'If d¢ DATE OF INSPECTION MADE: _5 ` T TMF `a , A`u' L
FAXED OPPD\BURT REA TO CONNECT SERVICE: 0 N BY