BP5130BUILDING PERMITAPPLI
' Jurisdiction of City of Blair, Nebraska
218 South 16th Street
Blair, Nebraska 68008
(402) 426-4191
Site Plan Attached ^ Complete Plans Attached ^
Approximate Completion Date
Inspections Required and Fees
Utilities
Sewer Tap Water Tap
N~ 5130
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Application Date: ~ /~ Issue Date: ~~ ~~ ~~~ Permit Fee: $ /
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JOB ADDRESS r ~ ~
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LEGAL
1 LOT NO. BLK. TRACT
^ SEE ATTACHED SHEET
' DESCR.
2. OWNE ~ r ~ A ~ ADD SS l ZIP PHONE
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3. CONTRAC R r ~ ~ PHONE, ICENSE 0.
MAIL D S
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USE OF BUILDING
4.
5. Class of Work: ^ NEW ^ ADDITION ^ALTERATION ^ REPAIR ^ MOVE ^ REMOVE
6. Describe Work: ~ _
]. Sq. FOOtage Of StrUCture (Including Basement and Garage):
8, Change of Use From: Change of Use To:
g, Valuation of Work: $
10. Floodplain: FI°Daway Yes^ No ^ Dev. Permit Elev
Cert
Fringe Yes^ .
.
No ^ 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 _
ACCEPTED BY 1 PLANS CHECKED BY I APPROVED FOR 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 acopyof 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 completed within 2 years of date of issue.
SIGNATURE OF OWNERiCONTRACTOR OR AUTHORIZED AGENT DATE
SIGNATURE OF OWNER (IF OWNER BUILDER)
DATE
Sewer
Permit
Water Service
Septic Remote
Building
Footings Drywall
(before finish)
Framing Final
Electrical
Rough-in Fixtures
Final l~ ~ Permanent Service
Temporary Service
Mechanical
Rough-in ABC
l °-
Final n
Plumbing
Ground Work
Rough-in Final
WHEN PROPERLY VALIDATED (IN THIS SPACE) THIS IS YOUR PERMIT
Comment:
Approved B~: ~~ ~
CATION
POUNDS PRTG: Blelr, NE ~ Rev. 10/81
CITY INSPECTION SLIPS
Inspection has been requested for ~~ ~~.'~; ~'~ ~
Location of Building
~~
Name f Company
On ~ ~- E
Type of Inspection
at ~ I 1 ~ ~
Date Time
Results of the Inspection are:
City Representative
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