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BPM1974
CITY OF BLAIR LOCATION OF ❑ WASHINGTON COUNTY ❑ OTHE r r , t NAME OF OWNER s tl U" CONTRACTO r i� -. r ,: -? ? "r ✓: ; s r �' r, f d�.-,ri ' ' s , DATE INSPECTION REQUESTED e` �� TIME INSPECTION REQUESTED PERMIT NO TYPE OF INSPEC REQUESTED: ❑ CONFERE ❑ STA TUS CHECK BUILDING: ❑ FOOTING ❑ DECK FOOTING ❑ FRAMING ❑ DRYWALL "-Q ❑' 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 "'El ❑ PARTIAL PASSED FAILED i f ❑ f COMMENTS: PLUMBING: ❑ GROUNDWORK ❑ ROUGH -IN ❑ FINAL ❑ WATER METER INSTALLED ❑ PARTIAL PASSED FAILED ❑ PRESSURE TEST ❑ ❑ COMMENTS: ❑ OCCUPANCY GRANTED ❑ CONDITIONAL OCCUPANCY GRANTED NOTES/REMARKS I mo ! ! �o nJcpc Q Ut I L � � 1 ij EGiIO IJ INSPECTO sf�'�J ��2, DATE OF INSPECTION MADE: 14 —1 q " - T © m FAXED OPPD\BURT REA TO CONNECT SERVICE: ON BY CITY OF BLAIR LOCATION OF ❑ WASHINGTON COUNTY ❑ NAME OF OWNER CONTRACTO `" 6 { 1..:? r i r �'' r <' j ✓F . r r` f; t C> V DATE INSPECTION REQUESTED f � + � '� TIME INSPECTION REQUESTED - t s PERMIT N0 e TYPE OF INSPECTION REQUESTED: ❑ CONFERENCE ❑ S CHECK BUILDING: ❑ FOOTING ❑ DECKFOOTING ❑ FRAMING ❑ DRYWALL ❑FINAL ❑ PARTIAL PASSED FAILED ❑ _:. ❑ ❑ COMMENTS: MECHANICAL: ❑ UTILITIES: ❑ SEWER TAP ❑ SEWER ❑ SEPTIC ❑ WATER TAP ❑ REMOTE ❑ WATER SERVICE PASSED FAILED COMMENTS: ❑ PARTIAL a :• b�•r� i 2 ❑ ❑ COMMENTS: ELECTRICAL: ❑ ROUGH IN ❑ FINAL ❑ PERMANENT SERVICE ❑ TEMPORARY SERVICE ❑ PRECONNECT PASSED FAILED ❑ PARTIAL ❑ ❑ COMMENTS: MECHANICAL: ❑ ROUGH -IN ❑ A/C ❑ FURNACE ❑ RADIANT HEAT ' ❑fie FINAL ❑� PARTIAL PASSED FAILED COMMENTS: a :• b�•r� i 2 ❑ rr.P — _.— --------------- --- PLUMBING: F GROUNDWORK ❑ ROUGH -IN El FINAL El WATER METER INSTALLED El PARTIAL F w PASSED FAILED ❑ PRESSURE TEST ❑ ❑ COM MENTS: ❑ OCCUPANCY GRANTED ❑ CONDITIONAL OCCUPANCY GRANTED NOTES/REMARKS: Li C-a x INSPECTO ®e DATE OF INSPECTION MADE: �^ "� TIME. 4 1 — FAXED OPPD \BURT REA TO CONNECT SERVICE: ON BY / MECHANICAL PERMIT APPLICATION Jurisdiction of City of Blair, Nebraska 218 South 16 Street Blair, Nebraska 68008 Fax (402) 426 -4195 M 1974 f / (402) 426 -4191 89030 ��G Application Date, Permit Fee: $ I/ ,mac? � Job Address 11d 1V a Z 2,1qd 1 eq P. Owner Mail Address Zip Phone 1. Contractor M '1 Address Zip Phone 2. 3. Class of Work: O COMOERCIAL IDENTIAl lb New Addition O Alteration O Repair eplacement Describe Work: 4 Q' MECHANICAL PERMIT FEES Heat Pump Tons Central A/C Tons Furnace/Heat Pump /Air Conditioner (Per Unit) / `® Furnace BTU/H Up to and including 100,000 BTU / 3Ton ... .........................$15.00 # of Units A/C Furnace/Heat Pump /Air Conditioner (Per Unit) Furnace Over 100,000 BTU/ 3 Ton .................... .........................$25.00 Completion Date: Refrigeration Units /Coolers /Lines /Compressor — Commercial (New or Replacement) (Per Unit) ...................... ............................... .........................$15.00 Boiler Chart BTUFee 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 ... ..............$100.00 Boiler (use BTU Chart to left) .................... Appliance Vent / Fans ........................$10.00 Notice I hereby certify that I have read and examined this Duct System......... ................$15.00 "' °' ° " ° application and know the same to be true and correct. All provisions of laws and ordinances governing this type of Gas /Air Outlets .................First 5 x $6.00 work will be complied with whether specified herein or not. The granting of a permit does not presume to give .........Additional x $1.00 authority to violate or cancel the provisions of any other state or local law regulating construction or the performance of construction. Radiant Heat Systems /Gas /Water Piping System ....... .........................$50.00 Modular Home ............................... $50.00 atu Contras or or ut orized Agent Permit Issuance Fee .......................... $25.00 Total ®� Current License on File es O No O N/A Date Comment: I q q WHEN YKUYHKLY VAL1llAlEll (1N 'l'H1S SPACE) 41415 1S YUUK PEKMiT Approved By: Z? � Rev. 2008 -10