BP4836~~ BUILDING PERMIT APPLI
Jurisdiction of City of Blair, Nebraska
218 South 16th Street
Blair, Nebraska 68008
(402) 426-4191
Application Date:
Issue Date
~--i? ~~
CATION
N~ 4836
Permit
#~ 31~~:3
Permit Fee: $ ~ D .DC>
JOB ADD SS
LEGAL
1 ' DESCR. LOT N0. BLK. TRACT
^ SEE ATTACHED SHEET
2, 0 NER ~ MAILADDRESS ~ ZIP PHONE
ONTRACTOR/1
3. 'VVl ~C~ MAILAD RESS PHONE LICENSE NO.
USE OF BUIL ING
4.
5. Class of Work: ^ NEW ^ ADDITION ALTERATION ^ REPAIR ^ MOVE ^ REMOVE
6. Describe Work: ~ u` ~ G~-~~'
7. Sq. Footage of Structure (chiding Basement an arage):
8, Change of Use From: ~ C ~. Change of Use To:
g, Valuation of Work: $ a G ~, , ~
10. Floodplain: FI°cdway Yes No ^
Fringe Yes^ No ^ Dev. Permil Elev. Cert.
BFE
11. Current Zoning: ~ Wl
12. State Fire Marshall Required: Yes ~' No^
13. Special Use Permit Required: Yes ^ ~ No ^
14. Variance Required: Yes ^ No ~]
15. Minimum Setbacks: Front Side Rear
16. Sidewalk Required: Yes ^ No ^ Waiver Approved _
APPLICATION ACCEPTED BY I PLANS CHECKED BY I APPRgV~ OR ISSUANCE BY
NOTICE
Separate permits are required for electrical, plumbing, heating, ventilating and air condi-
tioning, and septic systems. By my signature below, I achnowledge that payment of the
building permit application fee does not constitute issuance of this building permit. I further
agree that construction covered by this permit application shall not be commenced until I
have received a copy of this application form signed bythe Building Inspector and stamped
'APPROVED'.
I herebyagree to perform the proposed work in accordance with the specifications setforth
above and in accordance with the codesJordinances of the City of Blair and the State of
Nebraska. I understand that this permit is void if work is not commenced within 180 days
or is not ~pleted it 'n 2 years f date of issue.
>< ~- r , ~~
SIGNATURE OF 0 NERt NT ACTOR OR AUTHORIZED AGENT DATE
Site Plan Attached ^ Complete Plans Attached
Approximate Completion Date 5 -~~" ~'
Inspections Required and Fees
Utilities
Sewer Tap Water Tap
Sewer Water Service
Septic Remote
Building
Footings Drywall
(before finish)
Framing 'S Final ~~~~
ElectriCa~ ,
Rough-in ~Ic • ~`~'' °~~~~ ~ 3 Fixf"tireJs 4 ~
Final .~ ~=~t~~~ ~ 7 w ~~ Permanent Service
Temporary Service
Mechanical
Rough-in ~ ABC _
Final ;~
Plumbing
Ground Work '
l SIGNATURE OF OWNER (IF OWNER BUILDER) DATE I Rough-in Final
WHEN PROPERLY VALIDATED (IN THIS SPACE) THIS IS YOUR PERMIT
Comment: Approv d ~~~ ~ ~~~
_....------ -.. .._ /vim/ °r~, aa~ tmo
53521
_.. _=1l81I a I1.'QII
No~~
Project Title Laeelion
~~ ou'fpAT11=NT SPECIALIg'(5 CLIIJIC
E9A5~MENY I`;~MaC~t;L-9C41~MQ'(IC PLAN
MEMO~IIAI- COMMUNITY WoSPITAL
~LAlri , I,JE~t~ASKA
Henntne~on, ourhsm
6 Nfchsrd~on, Inc. D I O "~ ~ I sY fJUl3A5 02000-09
DD I
BUILDING PERMIT APPLICATION
Jurisdiction of City of Blair, Nebraska
218 South 16th Street _ -
Blair, Nebraska 68008 ~.:_~° _ _ 483
(402) 426-4191 Permit
Application Date: ~ ~ ~ ~(Z Issue Date: ~'~ ~ ~ ~~~z° Permit Fee: $
JOB ADDRESS
~
~ - Z 2 r1 c~
LEGAL
1 LOT NO. BLK. TRACT
^ SEE ATTACHED SHEET
' DESCFt.
2. OWNER _
~~ C-~,~~~ ,lC. MAI ADDRESS
~~ - t ~ ZIP PHONE
3. CONTRACTOR ~ `~ I „ ~N1AI ~ DRESS _(~ /~ ~ ~~ `ONE LICENSE N0.
USE OF BUILDING
4.
5. Class of Work: ^ NEW ^ ADDITION ^ ALTERATION REPAIR ^ MOVE ^ REMOVE
6. Describe Work: _; , , ~ 0~ ~C~I ~C:~ ~' • ~~r r,
7. Sq. FOOtage Of StrUCture (Including Basement and Garage):
$, Change of Use From: Change of Use To:
g, Valuation of Work: $
10. Floodplaln; Floodway Yes^
Frin
e Y
^ No ^ Dev. Permit
N
^ Elev. Cert.
g
es o
BFE
11. Current Zoning:
12. State Fire Marshall Required: Yes ^ No^
13. Special Use Permit Required: Yes ^ No ^
14. Variance Required: Yes ^ No ^
15. Minimum Setbacks: Front Side Rear
16. Sidewalk Required: Yes^ No ^ Waiver Approved _
PLANS CHECKED BY I APPROVED FOB.ISSUANCE BY
NOTICE
Separate permits a required for electrical, plumbing, heating, ventilating and air condi-
tioning, and septic systems. By my signature below, I achnowledge that payment of the
building permit application fee does not constitute issuance of this building permit. I further
agree that construction covered by this permit application shall not be commenced until I
have received a copyof this application form signed bythe Building Inspectorand stamped
'APPROVED'.
I hereby agree to perform the proposed work in accordance with the specifications set forth
above and in accordance with the codes~ordinances of the City of Blair and the State of
Nebraska. I understand that this permit is void if work is not commenced within 180 days
or is not~ompleted within 2 years of die of issue.
SIGNA OF OWNER)CONTRACTO~W AUTHORIZED AGENT DATE
Site Plan Attached ^ Complete Plans Attached ^
Approximate Completion Date ~~" ~~--
Inspections Required and Fees
Utilities
Sewer Tap Water Tap
Sewer Water Service _
Septic Remote
Building
Footings Drywall
(before finish)
Framing Final
Electrical
/
Rough-in (_~ ~.~r~ Fixtures
Final ~~- ~-~ Permanent Service
Temporary Service
Mechanical
Rough-in ABC
Final
Plumbing
Ground Work
SIGNATURE OF OWNER (IF OWNER BUILDER) DATE ~ Rough-in Final
WHEN PROPERLY VALIDATED (IN THIS SPACE) THIS IS YOUR PERMIT
Comment: Approved By.~-+-V
POUNDS PRTG: Blelr, NE ne.. ~o~e~
` CITY INSPECTION SLIPS
Inspection has been requested for /
~ Location of Building
By
fame of Company
On '
Type of nspection
At ~ ~~~
D to ime
Results of the Inspection are: ~ C~
Cit epresentative
" ~~ ~ CITY INSPECTION SLIPS
Inspection has been requested for z `'-'-
Location o Building
By ,~
Name of Co any
On _
(Type of Inspection)
At ~9 ~, n. ao~ _
Date Time
Results of the inspection are: ~.~`" ~~ ~ ~~L.~~ ,g,,_ ~.,c~t ,. <,. ,~ ~,,,
C ty Representative