BPM1992A
1 ,CITY OF BLAIR
LOCATION OF INSPECTION:
❑ WASHINGTON COUNTY
❑ OTHE
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NAME OF
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r CONT12 ACT(1R• !F$�1 ✓, �. A.,
DATE INSPECTION REQUESTED ° �' TIME INSPECTION REQUESTED - ° ks PERMIT NO
TYPE OF INSPECTION REQUESTED: ❑ CONFERENCE ❑ STATUS 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 A/C X FURNACE ❑ RADIANT HEAT �Q PARTIAL
PASSED
FAILED
COMMENT
7 6 o C� U 6 q T ��
El
PLUMBING ❑
GROUNDWORK ❑ ROUGH -IN ❑ ❑ WATER METER INSTALLED S 6ARTIAL
PASSED
FAILED
❑
PRESSURE TEST
❑
COMMENTS:
❑ OCCUPANCY GRANTED ❑ CONDITIONAL OCCUPANCY GRANTED
NOTES/REMARKS:
d to eef Gs -te. v ® e s
FAXED OPPD\BURT REA TO CONNECT SERVICE: ON BY
INSPECTO s DATE OF INSPECTION MADE: ° 1.� - f b T IME 1 e/6 0 ".
Job Address
1136 al q �3
Owner Mail Address Zip Phone
Contractor Mail Phone Address
2.
3. Class of Work: [3 COMMERCIAL -SMS16ENTIAL 0 New 0 Addition .Alteration C3 Repair 0 Replacement
Describe Work:
4.
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 ... .........................
of Units A/C
Fumace/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 Rep (Per Unit)
Boiler Chart
$15.00
BTU Fee
.. .... ........ . ..... . . ..... ......................................
Up to 100,000 ....... .........................
100P0-500,000 .............................. $30.00
500,000-1,000,000 ........................... $40.00
1,000,000-1,750,000 ........................$60.00
Boiler (use BTU Chart to left) ....................
Over 1,750,000 ...... ........................$100.00
Appliance Vent/Fans ........................$10.00
Notice
Duct System .......... ........................
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 o f
.................
work will be complied with whether specified herein or
x $ 1.00
not. The granting of a permit does not presume to give
......... Additional
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 ....... .........................
�Sig.
Modular Home ............................... $50.00
��fCnta,��toroAut�hori7edA�g��nt��
Permit Issuance Fee . .........................$25.00
Total 6LJ
7-
E
Current License on File 0�-Yes C1 No C3 N/A
Date
�
Comment:
WHEN FKUYhKL Y VALAUA I r ViV 1 r Or ` JLL3 JL
Approved By:
Rev. 2008-10