BP5253~~ . BPJILDING PERMIT APPLICATION
Jurisdiction of City of Blair, Nebraska
~~~. 218 South 16th Street
Blair, Nebraska 68008 J 2
-, U~~ (402) 426-4191 Permit
1"
Application Date. ~ J .~C~ ~-~'~ ,~ ~ Issue Date: -~ ~ ~~ hermit Fee: ~ lC~). ~~~
JOB ADDRESS
CSZ~~ ~C~-'~ ~~ .
LEGAL
1 ' DESCR. LOT NO. i
I BLK• ~ C'~ TRACT ~ /'
~- ^ SEE ATTACHED SHEET
2 OWNER
L MAILADDRESS ZIP
~ l~~ ~~°~--~ PHONE
3. CONTRACTOR MAIL ADDRESS PHONE LICENSE NO.
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):
$. Change of Use From: Change of Use To:
g, Valuation of Work: $ "7 ~, ~ ~~
10. Floodplain: FI°odway Yes ^
Fringe Yes^ No 0~ Dev. Permit
No ~~ BFE Elev. Cert.
11. Current Zoning: Q ~ )~
12. State Fire Marshall Required: Yes ^ No^'
13. Special Use Permit Required: Yes ^ No [~
14. Variance Required: Yes ^ No [~
15. Minimum Setbacks: Front L~ Side ~ Rear
16. Sidewalk Required: Yes No ^ Waiver Approved
BY I 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 accorda~nce with the codes/ordinances of the City of Blair and the State of
Nebraska. I and~rsfand that this permit is void if work is not commenced within 180 days
or is not co pl'e d'~iithin 2 years of date of i slie.
C- ~ ~ ~ e
NATURE OF OWNERfCONTR~ TOR OR AUTHORIZED AGENT DATE
SIGNATURE OF OWNER (IF OWNER BUILDER) DATE
Site Plan Attached ^ Complete Plans Attach~d~~
Approximate Completion Date w /~C/YIiL/~~
Inspections Required and Fees
Utilities
Se er Tap 75 •~O °~br~lsca~W/ater Tap
.~iue3 1 U ~ Oct ~5 ~3 Water Serv~ I C~ , c>y - >gr<5~r~.~r
Septic
Remote
Building
Footings ~ ~ Drywall '~
(before finish)
`c'
Framing '~ Final ~ " ~ ~
Electrical
Rough-in ~~-~~~/ ~1'cS~,ny~~ Fixtures
Final y ~, Cx.t - Permanent Service /
Temporary Service ~ Z-~`~3
Mechanical
Rough-in 1/ ,(.~.~~ ~~(cfh,,r>~~ ABC / L~ .~)(~l ~~~L
Final / s-CSQ c.~
Plumbing
Ground Work ~
Rough-in / i 2-~ ~~F ni al~~ ~) "Rc~'`'r`3".
WHEN PROPERLY VALIDATED (IN THIS SPACE) THIS IS YOUR PERMIT t
Comment: Approv ~~ y!~
~~
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CHECK LIST FOR ISSUING RESIDENTIAL BUILDING PERMITS
SITE
1) Zoning ~ i~'l N Flood Plain : Yes
2) Permitted Use V~,~
No's
3) Special Use ~)a Special Use Permit Issued,
4) Location on Lot (Setbacks)
a. Front Yard Required l~ ,Shown,
b. Rear Yard Required ,Shown ~t
c . Side Yard Required ~ ,Shown ~ G
5) Variance Required: Yes No '~
6) Lot Area Required l.~ ~~ ~ ,Actual ~' ~~'~ ~
7) Lot Coverage Allowed ~Q~~~ ,Actual ~ ° ~o
8) Other Structures on Lot ~ ,Adjacent Lot ~
9) Utilities ~j ®~~D, ~( e r~va ~~
BUILDING PLANS
1) Floor Plan
a. Room Sizes V
b. Emergency Egress
2) Foundation Plan v
3) Framing Plan '~
a. Cross Sections "~
b. Stairs '`~-
4) Elevations and Grading ``
5) Electrical ~
6) Mechanical '~
7) Plumbing
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BUILDING PERMITAPPLI
Jurisdiction of City of Blair, Nebraska
218 South 16th Street
Blair, Nebraska 68008
(402) 426-4191
CATION
Permit
5287
Application Date: ~ _Z~~c~ Issue Date: ~-Z~"`~~°~ Permit Fee: $
JOB ADDRESS ~ ~ } ~ ~ I Z I ~~ C Cl~-~-~ ~-~~ _Sf'
LEGAL
1 ' DESCR. LOT NO. I
~ BLK. ~ ~ TRACT 2~
/`~ ^ SEE ATTACHED SHEET
2. OWNER
~e ~o MAILADDRESS ZIP PHONE
L~;~~s~ n
CONTRACTOR
3. JC~S~ ~ MAILADDRESS PHONE LICENSE NO.
I~U--hir~Sc'~'l z/3>> I/~CiShtl'1G~ ~~
USE OF BUILDING
4.
5. Class of Work: [~r NEW ^ ADDITION ^ALTERATION ^ REPAIR ^ MOVE ^ REMOVE
6. Describe Work: d ~
7. Sq. Footage of Structure (InGuding Basement ana Garage):
8. Change of Use From: Change of Use To:
g, Valuation of Work: $ 1S U C~ ~
10. Floodplain: Fleoaway Yes^
Fringe Yes^ No ^ Dev.Permit EIev.Cert.
No ^ BFE
11. Current Zoning:
12. State Fire Marshall Required: Yes ^ No^
13. Special Use Permit Required: Yes ^ No ^
14. Variance Required: Yes^ No^
Site Plan Attached ^ Complete Plans Attached
Approximate Completion Date ~ /`~~%'~ ~'
Inspections Required and Fees
Utilities
Sewer Tap 75 ' oc~ Water Tap
Sewer ~ ~ • UCH Water Service l CU • ~-~~
15. Minimum Setbacks: Front Side Rear
16. Sidewalk Required: Yes^ No ^ Waiver Approved _
APP ATI~C~t~E~~E~ I PLANS CHECKED 8Y 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 a copy of this application form signed by the Building Inspector and stamped
'APPROVED'.
I hereby agree to perform the proposed work in accordance with the specifications set forth
above and in accordance with the codeslordinances of the City of Blair and the State of
Nebraska. I understand that this permit is void if work is not commenced within 1 SO days
or is n m eted within 2 years ofd of issue.
SI URE OF OWNER~CONTRACTOR OR AUTHORIZED AGENT DATE
SIGNATURE OF OWNER (IF OWNER BUILDER) DATE
Septic Remote
Building
Footings Drywall
(before finish)
Framing Final
Electrical
Rough-in ~ . ~~ Fixtures
Final ~ • ~~ ~~ Permanent Service
Temporary Service
Mechanical ~
Rough-in ~ ~' ~ ABC [ C~ • r'J
Final ~° - ~'~
Ground Work Plumbing
Rough-in 1 ~ ~~~-~ Final ~~ C~
WHEN PROPERLY VALIDATED (IN THIS SPACE) THIS IS YOUR PERMIT
Comment: Appro y ~~ /~ I`
. CITY INSPECTION SLIPS~//,/A/~ ~J ~
Inspection has been requested for ~/~ ~FG'~~GA.G~i/ ~ ~~.
1:
n, ,~~ ~/ Loc ion of -ui d~'
~Name//of .Company ~ /~ ~ ~J
On +~Y~i'~Gtd' ~~~~ 3~- /,O~ u ham" " /
v
(T pe of Inspection)
At '7f le/GJYJ .
Date Time ,-
Results of the inspection are:
ity Represent tive ~ -
~-`~
` CITY INSPECTION SLIPS -
/Z~ ~ ~~
Inspection has been requested for____~ ~,C l- ~: .~ '
Lo ation of building
Name of Company
On ~W lJ~. ~,~G.~-
Type of Inspection
At c~ 3~1~ 3 ;~
Date Time /~
Results of the Inspection are: O"~
~nr L~~i
Cicy Representative
CITY INSPECTION SLIPS
Inspection has been requested for ~ 2 ~~ ~ ~v~
LocaCion of -uild g
-y ~~~ :r^
Name of/C7ompany
On ~4_ ~. 2. ~ `
Type of Inspection
ACJ~2h/
dace Time
Results of the Inspection are:~~
ty Representative