BPM2011Job Address � n
Owner Mail Address Zip. Phone
1. Coin ld2e
Contract f ) Mail Address Zip Phone
2.
3. Class of Work:.,iFkC O RESIDENTI L O New O Addition O Alteration O Repair eplacement
Describe Work: �
4 d e
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)
Boiler Chart
BTUFee
...................... ............................... .........................$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 (apse BTU Chart to left) ....................
Appliance Vent / Fans ........................$10.00
Notice
Duct System ......... .........................$15.00
I 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 of
.................First
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 ....... .........................$50.00
'
Modular Home............ .... $50.00
Signature of Con ractor or Auth d Agent
�
Permit Issuance Fee .......................... $25.00
qt6 -lo
Total
Current License on File es O No O N/A
Date
Comment: N ,
7 - -
WHEN PROPERLY VALIDATED (1N 'l'HIS SPACE) 1HIS IN YUUK rhKMl1
Approved By:
Rev. 2008 -10
❑ ,CITY OF BLAIR
is .�.
❑ WASHINGTON COUNTY ❑
LOCATION OF INSPECTION f ' r
r
NAME OF OWNER CC
DATE INSPECTION REQUESTED TIME INSPECTION REQUESTED 4 -F` _ _ 'PERMIT NO - 62 Z
TYPE OF INSPECTION REQUESTED: ❑ CONFERENCE
❑ 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
❑
❑
COMME
ELECTRICAL: ❑
ROUGH IN ❑ FINAL ❑ PERMANENT SERVICE ❑ TEMPORARY SERVICE ❑ PRECONNECT
PASSED
FAILED
❑
PARTIAL
❑
❑
COM MENTS:
MECHANICAL: ❑
ROUGH IN ❑ .A/C ❑ FURNACE ❑ RADIANT HEAT [J 3MAL ❑ PARTIAL
PASSED
FAILED
COMMEN
PLUMBING: ❑
GROUNDWORK ❑ ROUGH -IN ❑ FINAL ❑ WATER METER INSTALLED ❑ PARTIAL
PASSED
FAILED
❑
PRESSURE TEST
❑
❑
COMMENTS:
❑ OCCUPANCY GRANTED ❑ CONDITIONAL OCCUPANCY GRANTED
e 1- n,- h� , .) 5 f<Lr .4 A
INSPECTO DATE OF INSPECTION
T IMF
FAXED OPPD\BURT REA TO CONNECT SERVICE:
BUI
❑ .:CITY OF BLAIR ❑ WASHINGTON COUNTY ❑ OTHE
LOCATION OF INSPECTIO
NAME OF OWNER C ONTRACTO R-
` ' `
F
DATE INSPECTION REQUESTED '� TIME IN D
SPECTION REQUESTE °PERMIT N0
TYPE OF INSPECTION REQUESTED: ❑ CONFERENCE ❑ STATUS CHECK
BUILDING:
❑ FOOTING ❑ DECK FOOTING ❑ FRAMING ❑ DRYWALL ❑ FINAL ❑ PARTIAL
PASSED
FAILED
_. ❑
PARTIAL
❑
❑
COMMENTS:
UTILITIES:
❑ SEWER TAP ❑ SEWER ❑ SEPTIC ❑ WATER TAP ❑ REMOTE ❑ WATER SERVICE
PASSED
FAILED
COMMENTS:
❑ PARTIAL
❑
❑
C OMMENTS:
GROUNDWORK ❑ ROUGH -IN ❑ FINAL ❑ WATER METER INSTALLED ❑ PARTIAL
PASSED
FAILED
ELECTRICAL: ❑
ROUGH IN ❑ FINAL ❑ PERMANENT SERVICE ❑ TEMPORARY SERVICE ❑ PRECONNECT
PASSED
FAILED
_. ❑
PARTIAL
❑
❑
COMMENTS:
MECHANICAL: ❑
ROUGH IN ❑ "' A/c ❑ FURNACE ❑ RADIANT HEAT ❑: rNAL ❑ PARTIAL
PASSED
FAILED
COMMENTS:
PLUMBING: ❑
GROUNDWORK ❑ ROUGH -IN ❑ FINAL ❑ WATER METER INSTALLED ❑ PARTIAL
PASSED
FAILED
❑
PRESSURE TEST
❑
❑
COMMENTS:
❑ OCCUPANCY GRANTED ❑ CONDITIONAL OCCUPANCY GRANTED
o LI 1 e) l A 1 4 r .}C_.. C / i,P e sL) e- cV _ I— n C k , A)
INSPECTO - DATE OF INSPECTION MADE: T IMF
FAXED OPPD\BURT REA TO CONNECT SERVICE: ON BY