BPM1994TYPE OF INSPECTION REQUESTED: _ _ _ ❑ CONFERENCE
❑ STATUS CHECK
BUILDING: ❑
FOOTING ❑ DECK FOOTING ❑ FRAMING ❑ DRYWALL ❑ FINAL ❑ PARTIAL
FAILED
❑
❑
COMMENTS:
UTILITIES: ❑
SEWER TAP ❑ SEWER ❑ SEPTIC ❑ WATER TAP ❑ REMOTE ❑ WATER SERVICE
PASSED
FAILED
❑
PARTIAL
El
El
ELECTRICAL: ❑
ROUGH IN ❑ FINAL ❑ PERMANENT SERVICE ❑ TEMPORARY SERVICE �❑ PRECONNECT
PASSED
FAILED
F
PARTIAL
❑
❑
COMMENTS:
MECHANICAL: ❑
ROUGH-IN ', D A/C, 171, FURNACE ❑ RADIANT HEAT �❑ FINAL ❑ PARTIAL b�ffi
PASSED
FAILED
❑
COMMENTS:
PLUMBING: ❑
GROUNDWORK ❑ ROUGH -IN ❑ FINAL ❑ WATER METER INSTALLED ❑ PARTIAL N
_ PASSED
FAILED
El
PRESSURE TEST
❑
❑
COMMENTS:
❑ OCCUPANCY GRANTED ❑ CONDITIONAL OCCUPANCY GRANTED
(N_ cces5 ! z,�) ve
INSPECTO DATE OF INSPECTION MADE: 6 - 1 1 f t T iMF
FAXED OPPDIBURT REA TO CONNECT SERVICE: ON BY
MECHANICAL PERMIT APPLICATION
Jurisdiction of City of Blair, Nebraska
218 South 16 th Street
Blair, Nebraska 68008
Fax (402) 426-4195 M 1994
(402) 426-4191
Application Date*- B Pen Fee:
'A A AL iZ1 li ey C/
WHEN PROPERLY VALIDA'I'El) (IN I HIN NFAUL) I HIN 1N _Y UUK -rhKIVII I
Approved By:
Rev. 2008-10
I , -1 ---- -- - - — I-- -- -
Job Address z r
Owner ai Address Zip Phone
1. /\Jj lle'z' C ;62
Contractor ail ddre§s Zip Phone
2. X2 '6 _
3. Class of Work: [I COMMEPCIA1 0 lk5tIDENTIAL C1 New 13 Addition 0 Alteration 0 Repair 0 Replacement
Describe Work:
4. (1 4�7z� A�
eZ Li"
MECHANICAL PEPMIT FEES
Heat Pump Tons
Central A/C Tons
Furnace/Heat Pump/Air Conditioner (Per Unit) X
Furnace BTUiH
Up to and including 100,000 BTU / 3Ton ... .........................
4 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
(Per Unit)
(No w or Rep
Boiler Chart
BTU Fee
. . . .. . .... . . ... . .... . . . ..... . . ..... ...................................... $15.00
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
Boiler (itse BTU Chart to left) ....................
Appliance Vent/Fans ........................$10.00
Notice
Duct System ......... .........................
1 hereby certify that I have read and examined this
application and know the same to be true and correct. All
Gas/Air Outlets 5 x $6.00
provisions of laws and ordinances governing this type o f
.................
work will be complied with whether specified herein or
not. The granting of a pen 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
Radiant Heat System s/Gas/Water
performance of construction.
Piping System ....... .........................
Modular Home ................. $ 50.00
A
Si.-nature of Contractor or Authorized Agent
Permit Issuance Fee .......................... $25.00
Total 0 C;
Current License on File A 13 No 0 N/A
Date
Comment:
n u ILDING INSPECTION
❑;, CITY OFBUIR ❑ WASHINGTON COUNTY ❑ OTHE
LOCATION OF INSPECTION
f
NAME OF OWNER F f t r..` r. �r r CONTRACTO
DATE INSPECTION REQUESTED " REQUESTED - '
Q � � TIME INSPECTION � � �' PERMIT NO
TYPE OF INSPECTION REQUESTED: ❑ CONFERENCE
❑ ST ATUS CHECK
BUILDING: ❑
FOOTING ❑ DECKFOOTING ❑ 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 w❑ A/C ,❑'FURNACE ❑ RADIANT HEAT ❑ FINAL . ❑ PARTIAL
PASSED
FAILED
El
COMMENTS
PLUMBING: ❑
GROUNDWORK ❑ ROUGH -IN ❑� FINAL ❑ WATER METER INSTALLED ❑ PARTIAL
PASSED
FAILED
❑
PRESSURE TEST
❑
❑
COMMENTS:
❑ OCCUPANCY GRANTED ❑ CONDITIONAL OCCUPANCY GRANTED
NOTES/REMARKS
I yzS1t A cc es s a✓L- iJ® Atie-
t4 e--
INSPECTO 7 �IXi DATE OF INSPECTION MADE: 6 - t t ° 1 TIM • SJ A "'� ,
FAXED OPPD\BURT REA TO CONNECT SERVICE: