ME-2010-00010.tif i
e l-A ME CHA NI CAL IT APP
Jurisdiction of City of Blair, Nebraska
218 South 16 Street
Blair, Nebraska 68008
Fax (402) 426 -4195 I C' 0 5 i M 2014
(402) 426 -4191
Application Date: Permit Fee: $ 0
Job Address
Owner Ma ddres Zip Phone
1. Contractor Mail Address Zip Phone
2.j1 am
3. Class of Work: O COMMERCIALaKESIDENTIA O New O Addition O Alteration O Repair , lacement
Describe Work: g
ewto
MECHANICAL PERMIT FEES
Heat Pump 3 Tons
Central A/C Tons
Furnace/Heat Pump /Air Conditioner (Per Unit) j
Furnace �, [0 BTU/H Up to and including 100,000 BTU / 3Ton ... .........................$15.00
# of Units A/C Fumace/Heat Pump /Air Conditioner (Per Unit)
Furnace Over 100,000 BTU / 3 Ton .................... .........................$25.00
Completion Date: ,: �f j 0 Refrigeration Units /Coolers /Lines /Compressor — Commercial
Boiler Chart (New or Replacement) (Per Unit)
BTU Fee ......................... I ........................ .........................$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 (arse 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 Radiant Heat Systems /Gas /Water
performance of construction. Piping System ....... .........................$50.00
Modular Home ............................... $50.00
Signature of Contractor or Authorized Agent
Permit Issuance Fee............
..... $25.00
Total
Date Current License on File es O No O N/A
Comment: q ® ' ty �
i
WHEN PROPERLY VALIDATED (IN THIS SPACE) THIS IS YOUR PERMIT
Approved By:
Rev. 2008 -10
BUI LDING INSPEC
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❑, Y F BLAIR ❑ WASHINGTON COUNTY ❑ OTHE �U ;�� 9 ® 7 7 9
LOCATION OF INSPECTION
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NAME OF OWNER .: "3'. , >` _1 CONTRACTO a rr .,'' s? "... ,
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DATE INSPECTION REQUESTED ' TIME INSPECTION REQUESTED r" /2 ' PERMIT NO
TYPE OF INSPECTION REQUESTED ❑ CON ❑ STATUS CHECK
BUILDING: ❑ FOOTING ❑ DECK FOOTING ❑ FRAMING ❑ DRYWALL ❑r FINAL ❑ PARTIAL itPASSED F D
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 b ;A/C , FURNACE ❑ RADIANT HEAT , .Ell- - FINAL ❑ PARTIAL PASSED FAILED
CO MMENTS: GV
PLUMBING: ❑ GROUNDWORK ❑ ROUGH -IN ❑ FINAL ❑ WATER METER INSTALLED ❑ PARTIAL PASSED FAILED j
❑ PRESSURE TEST ❑ ❑
COMMENTS:
❑ OCCUPANCY GRANTED ❑ CONDITIONAL OCCUPANCY GRANTED
NOTES/REMARKS-
INSPECTO DATE OF INSPECTION MADE T IME
FAXED OPPD\BURT REA TO CONNECT SERVICE: ON BY