BP4950~~BUILDING PERMITAPPLICATIO~N
Jurisdiction of City of Blair, Nebraska
218 South 16th Street
~P
ANrlication Date:
Blair, Nebraska 68008
(402) 426-419/1
Issue Date: if
Site Plan Attached ~ Compl~ lans ttached~
Approximate Completion Date
Inspections Required and Fees
"'7S~ Utilities
Sewer Tap ~ _ ~~ ~ ~ .~; Water Tap
~ r C - L O.
Sewer /'~~ 6~L~/,~r. Water Service /~ ee ~. L~
JOB ADDRESS
LEGAL
1 ' DESCR. LOT NO. ~ BLK. TRA T
^ SEE ATTACHED SHEET
2. OWNER ~ MAILADDRE
1r- ZI ~ - PHO E
3. CONT CTO AILADDRESS /P"HO E /~ CENSENO.
USE OF BUILDING
4.
5. Class of Work: N W ^ ADDITION ^ALTERATION ^ REPAIR ^ MOVE ^ REMOVE
6. Describe Work:
]. Sq. FOOtage Of StrUCtUre (Including Basement and Garage): ~~~ ~ `
l.J
8, Change of Use From: Change of Use To:
g, Valuation of Work• ~ 0(~ U
10. Floodplain: Floodway Yes^
Fringe Yes^ No ^ Dev. Permit
No ^ BFE Elev. Cerl.
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 ~s
16. Sidewalk Required: Yes No ^ Waiver Approved
ACCEPTEQ 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 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 codes~ordinances of the City of Blair and the State of
Nebraska. Iyy++~rtQ~Jstand that this perm t is void if work is not commenced within 180 days
or is not ~birtbJatsQd wlf~yete of issue.
OR AUTHORIZED AGENT DATE
Septic
Remote
~l7-QS- l.?1 ~s d
Building U~.P t..I1~ robJGY`
Footings' ~"~ ~y~ Drywall ~~ ~
(before finish) ~ ~ _
Framing ~ Final "~ ~ ' ~ ~ Cf~
Electrical
Rough-in '~ 1 7, ~•,~ 'c '(o~Cx7
Final ~/ ~-7. ~,~'S -(o-c~
Temporary Service
Permit ~~ _ _ 4950
a~
Permit Fee: $
Fixtures
Permanent Service ~
~ Mechanical ~ ~j
Rough-in~,.l~,~~--~,~.~ q~C /~'~ ~,-,/2,z-~~~'~~.~ ~
Final ~~ ~ -~• •
~,. "Plumbing r
_~ ,!~ I Ground V
SIGNATURE OF 0 (IF OWNER BUILDER) DATE Rough-in
Final
WHEN PROPERLY VALIDATED (IN THIS SPACE) THIS IS YOUR PERMIT
Comment: Appro d ~ ~~ n ~
______ _.. -._ ~/ Rev-1019'
' ~ CI~IFCK LIST FOR ISSUING RCSIDCN7IAL QUILDING PCRMI7S
Site
1. ?.oning _ '~.(_ , Flood Plain: Yes
__ No
2. Permitted Use ~~~, ~.
3. Special Use Special Use Permit Issued
e. .
4. Location. on Lot (Setbacks)
a. Front Yd, Required ~ 5~ Shown ~
~
,
b. Rear Yd. Required 2S~
`~ ,.
, Shown
c. Side Yd. Required ~ Shown o `~
5. Variance. Required; YCS
NO ~
G • Lot Area Required l 20 o G ,
, Actual / ~ 1.;; ~~
7. Lot. Coverage Al )owed ~f'o ~~ Actual ~~ °`
o~,
a. Other Structures on Lot ~ ,
Adjacent Lot
9•
a p9
Utilities ,,~~~.}~,~ ,) ~~ ~-
,41
building Plans
1. Floor Plan
a. Room Sizes / -
b• Cmergency Egress
2 Foundation Plan ` ~ ~ .
a. Framing Plan r
a. Cross Sections ~
b. Stairs
~• Clevations and Grading '
a. Clectrical .
~• Mechanical
7• Plurnbing ,
BUILDING PERMITAPPLI
- Jurisdiction of City of Blair, Nebraska
218 South 16th Street
Blair, Nebraska 68008
402 426-4191
CATION
No 4998
~ )
~1~-= Issue Date: Permit Fee: $ ~S
Application Date: ~ ~ "oC7 "'7 Z ~ ~
JOBADDRESS
LEGAL
1 ' DESCR. LOT N0. ~
~ BLK. TRACT ~"
_ _ 2~,~ ~
^ SEE ATTACHED SHEET
2. OWNEf;~~ // MAILADD~iE ~ ZIP PHONE
3. CON RA TO ~ MAILADDRESS ~ PHONFi ~ LI ENSENO.
USE OF BUILDING
4. r
5. Class of Work: ^ NEW ^ ADDITION ^ALTERATION ^ REPAIR ^ MOVE ^ REMOVE
6. Describe Work:
7. Sq, FOOtage Of StrUCtUre (Including Basement and Garage):
8, Change of Use From: Change of Use To:
g, Valuation of Work: $
10. Floodplain: FI°Dawey Yes^ No ^
Fringe Yes^ No ^ Dev. Permit
BFE Elev. Cert.
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 NY 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 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 codes/ordinances of the City of Blair and the Siate of
Nebraska. I understand that this permit is void if work is not commenced within 180 days
or is not completed wilhi~ 2 years of date of is~t{e.
OR
DATE
Site Plan Attached ^ Complete Plans Attached ^
Approximate Completion Date
Inspections Required and Fees
~; ~: Utilities
Sewer Tap '~ ~ Water Tap
G~% p cr
Sewer ~~ Water Service /~'
Septic Remote
Footings
Framing
Rough-in
Final
Temporary Service
Fixtures _
Permanent Service
~<, Mechanical ~ j ~~
Rough-in ~ ABC /~)
G, C{ r_~
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: Approve By: ~ ~~
Building
Permit
Drywall
(before finish)
Final
Electrical
POUNDS PRTG: Blalr, NE nev. i~iei
CITY INSPECTION SLIPS
Inspection has been requested for ~.y.~~ ~- ~ ~`~~.-'L,~ ~, y ,~
~. Location of Building
~~
By ~' ~~'~
Name of Company
On ~r5'h - ~
Type of Inspection
~--~.-
At ~ ~- 1 ~,
Date Time
Results of the Inspection are:
_ ~-~~}c~
Cit3~ Representative
`\
• 1
1
BUILDING PERMITAPPLI
Jurisdiction of City of Blair, Nebraska
218 South 16th Street
Blair, Nebraska 68008
CATION
(402) 426-4191
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)
i
F Final
ram
ng
Electrical
D~
Rough-in ~ Fixtures
N~ 5037
C~ ~ Q a
Application Date: ~ Issue Date: 1 `J~ ~ ~ermtt Fee: ~
JOBADDRESS "
l ~~ ~
-
LEGAL
1 ' DESCR. LOT N
~ BLK. TRACT
~7 ^ SEE ATTACHED SHEET
2. OWNER
~[.tl`"~ MAIL ADDRESS Z PHONE
3. CO TRACTOR /)_ ~ /J
/E//nom MAILADDRE~S~ •~ PHON LICENSE NO.
C/e_J~ ~ ~C)
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. FIOOdplaln: Floodway Yes^ No ^
Fringe Yes^ No ^ Dev. Permit Elev. Cert.
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 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 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 setforth
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 i~ comp e d withi yegr~of dat ' f iss e
(,- ~~-~~
SIGNATURE OF OWNERJCONTRACTOR OR AUTHORIZED AGENT DATE
SIGNATURE OF OWNER (IF OWNER BUILDER)
DATE
Final ~ - Permanent Service
Temporary Service
Mechanical
Rough-in ABC
Final
Plumbing
Ground Work
Rough-in _
Permit
Final
WHEN PROPERLY VALIDATED (IN THIS SPACE) THIS IS YOUR PERMIT
Comment: Approv d'By:
.".............t,...~_._ .~~ Rev. 10/9
CITY INSPECTION SLIPS
Inspection has been requested for ~ ~ Location of Building
~y
Name of Company
On ~: gar f
Type of Inspection
At ~ ~~
llate Time
Results of the Inspection are: ~f€~- ~~-~"
A
~~" ~ ~- ~ moo- ~~~._dtl"4 f ~`,
y ~~.
City Rep
tive
T.
CITY INSPECTION SLIPS
~ ~
Inspection has been requested for ::~ ~~ (1 %' z'~-~"
Location of
., f ,r ,
By ,~~ /., r ,;.f~ ,~.
Name of Company
J-
`Type of Inspection
lding
At e~ ~~~-
Date Time
Results of the Inspection are: ~~~r~
_,
~.s
City Representative
CITY INSPECTION SLIPS
Inspection has been requested for ~ ~w~~---,_~~ - :' `'
Location of Buil~''ing
Name of "Company
(Typeaaof Inspection) _
S I ~ ~-.
/! ~ i.-r1
At
Date Time ~-r'~
Results of the inspection are: ~~~
n
City Representative
CITY INSPECTION SLIPS
Inspection has been requested for_-, y~ ~ '=J~ ~
Location of Building
c./ ~~
By G'~ ~J ~ ~~~~-
~~~~ JName of C pany '
On yy~~~ ~~~~
Type of Inspection
At ~- z r ~z ~~ ~)
Date Time
Results of the Inspection are: ~ ~~
~/ y~
City presentative