BPM2000M
Application Date:
MECHANICAL PERMIT APPLICATION
Jurisdiction of City of Blair, Nebraska
218 South 16 Street
Blair, Nebraska 68008
Fax (402) 426-4195 M 2000
(402) 426-4191
M
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Permit Fee: $ ' Is'o
11LI P6 --I
Job Address
Owner Mail Address Zip Phone
Contrac Mail Address Zip Phone
2.
3. Class of Work: COMMERCIAL 13 RESIDENTIAL O New C3 Addition C3 Alteration C3 Repair )7f Replacement
Describe Work:
4. MAL
MECHANICAL PERMIT FEES
Heat Pump - ey - k Tons
Central A/C Tons
Furnace/Heat Pump/Air Conditioner (Per Unit)
Furnace BTU/H
Up to and including 100,000 BTU / 3Ton ... .........................
of Units A/C
Furnace/Heat Pump/Air Conditioner (Per Unit) 50.ca
Furnace
Over 100,000 BTU / 3 Ton .................... .........................$25.00
Completion Dat
Refrigeration Units/Coolers/Lines/Compressor — Commercial
(New or Rep (Per Unit)
Boiler Chart
BTU Fee
.... . .. . .. . .... . . ........ . . . ..... . . ..... ...................................... $15.00
Up to 100,000 ....... .........................
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 (use BTU Chart to left) ....................
Appliance Vent/Fans ........................$10.00
Notice
Duct System .................................. $15.00
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 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
Radiant Heat Systems/Gas/Water
performance of construction.
Piping System ....... .........................
Modular Home ............................... $50.00
Pen Issuance Fee ............ $25.00
Signature of Contractor or Authorie)Agent
'/ ---�' S /0—
Total
Current License on File M�Yes 0 No C3 N/A
Date
Comment:
� I - I --,I
1 ')
WHEN PROPERLY VALWAIJ--0(11V 1"UrrM 'Will
Approved By:
Rev. 2008-10
"BUILDING INSPECTION REPORT
❑` CITY OF BLAIR
LOCATION OF INSPECTI
❑ WASHINGTON COUNTY ❑ OTHE
t
NAME OF OWNER CONTRACTO f s
DATE INSPECTION REQUESTED a TIME INSPECTION REQUESTED i PERMIT NO P
TYPE OF INSPECTION REQ UESTED : ❑ CONFE ❑ STATUS CHECK
BUILDING: ❑ FOOTING ❑ DECK FOOTING ❑ FRAMING ❑ DRYWALL n MNAL 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 B FINAL ❑ PARTIAL
PASSED
FAILED
COMMENTS:
PLUMBING: F
GROUNDWORK Fl ROUGH -IN F FINAL ❑ WATER METER INSTALLED El PARTIAL
PASSED
FAILED
❑
PRESSURE TEST
❑
❑
COMMENTS:
❑ OCCUPANCY GRANTED
❑ CONDI� OCCUPANCY GRANTED
NOTES/REMARKS
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INSPECTO ° /��a.%f`
DATE OF INSPECTION MADE:
._ l `
T IME•
FAXED OPPDIBURT REA
TO CONNECT SERVICE: ON
BY
>CITY OF BLAIR
LOCATION OF INSPECTION:.
❑ WASHINGTON COUNTY
❑ t OTHE R
r`
NAME OF OWNER Q a 4..._•�� < ,f i
CONTRACTO
DATE INSPECTION REQUESTED TIME INSPECTION
REQUESTED-PERMIT NO I' °
T YPE OF INSPECTION REQUEST _ _ ❑ C
❑ STATUS CHECK
BUILDING: ❑
FOOTING ❑ DECK FOOTING ❑ FRAMING ❑ DRYWALL ❑kft_NAL PARTIAL
PASSED
FAILED
❑
COMMENTS:
UTILITIES: ❑
SEWER TAP ❑ SEWER ❑ SEPTIC ❑ WATER TAP ❑ REMOTE ❑ WATER SERVICE
PASSED
FAILED
❑
PARTIAL
❑
❑
COMM
ELECTRICAL: ❑
ROUGH IN ❑ FINAL ❑ PERMANENT SERVICE ❑ TEMPORARY SERVICE ❑ PRECONNECT
PASSED
FAILED
❑
PARTIAL
❑
❑
COMMEN
MECHANICAL: ❑
ROUGH -IN ❑ A/C ❑ FURNACE El RADIANT HEAT Q FINAL ❑ PARTIAL `
� � PASSED
FAILED
❑
❑
COMMENTS: s r
PLUMBING: ❑ GROUNDWORK ❑ ROUGH -IN ❑ FINAL ❑ WATER METER INSTALLED ❑ PARTIAL PASSED FAILED
❑ PRESSURE TEST ❑ ❑
COMMEN
❑ OCCUPANCY GRANTED ❑ CONDITIONAL OCCUPANCY GRANTED��
S 6 /'A,ro0- Al2 L-A� �c
ieeo e, am i'� D✓ti/ Wr�`� tldc► u ' 6 E /�
INSPECTO DATE OF INSPECTION MADE: t6
FAXED OPPD\BURT REA TO CONNECT SERVICE:
BUILDING INSPECTION REPORT
❑ .,,CITY OF BLAIR ❑
WASHINGTON COUNTY
❑ OTHE
FOOTING ❑ DECK FOOTING ❑ FRAMING ❑ DRYWALL ,❑ FINAL ❑ PARTIAL
LOCATION OF INSPECTION
FAILED
�
NAME OF OWNER- ���.�� r�r:r/ �P�
��
F •
CONTRACTO -
DATE INSPECTION REQUESTED
° F' TIME INSPECTION
REQUESTED
Y 7 PERMIT NO
TYPE OF INS PECTI O N REQUESTED: ❑ C ONFERENCE
❑ STATUS CHECK
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
❑
❑
COM MENTS:
MECHANICAL: ❑
ROUGH -IN ❑ A/C ❑ FURNACE ❑ RADIANT HEAT Eh ❑ PARTIAL "
ASSED
FAILED
COMMENTS:
f
PLUMBING: ❑
GROUNDWORK ❑ ROUGH -IN ❑ FINAL ❑ WATER METER INSTALLED ❑ PARTIAL
PASSED
FAILED
❑
PRESSURE TEST
❑
❑
COMMENTS:
❑ OCCUPANCY GRANTED
❑ CONDITIONAL OCCUPANCY GRANTED��
NOTES/REMARKS
INSPECTO '�di DATE OF INSPECTION MADE ® TIME` ° o P
FAXED OPPD \BURT REA TO CONNECT SERVICE: