BP4989~BI~ILDING PERMIT APPLICATIO`iV
Jurisdiction of-City of Blair, Nebraska
218 South 16th Street _ _
Blair, Nebraska 68008 ~p 4989
(402) 426-4191 Permit ° - ~ -
Application Date: ~~ ~~.. ~~ ~~~~~' Issue Date: ~ -Z~~ ~2- Permit Fee: $
JOBADDRESS' ~ ~ ~
L~ ,`~ V1
T' J ~ n
(v
LEGAL
1 ' LOT NO. BLK. TRACT , •--~
~) ~ ~ ^ SEE ATTACHED SHEET
DESCR. _
OWNER ~l MAILADDR ~ _ '~ ' , HO t__~
,ZIP-
3. CONTRACTOR~~ v ' ~ MAILADD ES ~_ - I/` r ~ON~, ~~~~CENSENO.
4. USE OF BUILDING ` /
I .~ ' ~ / \ /~
5. Class of Work:/ ®•NEW ^ ADDITION ^ALTERATION ^ REPAIR ^ MOVE ^ REMOVE
~ ~
6. Describe Work: ~ ~~) ~ ~~'
l
]. Sq. FOOtage Of StrUCtUre (Including Basement and Garage) : ) ~
i~
$, Change of Use From: Change of Use To:
g, Valuation of Work: $ l ~ ~~
10. Floodplain: FI°°away Yes^
Fringe Yes^ o ~~
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^ N~
15. Minimum Setbacks: Front •Z~ Slde ~_ 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 a copy of 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 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 OWNERfCONTRACTOR OR AUTHORIZED AGENT DATE
~,
,{~/
RE OF OWNER (IF OWNER BUILDER)
Site Plan Attached ~( __ Complete PI s Attache~d)~/
Approximate Completion Date ~ _ - ~
Inspections Require and Fees
Utilities ~
Sewer Tap //~•~ .~ Water Tap
Sewer ~/c~a~z 75%0~ ~ ° I S'`'Water Service rl~o•-~•?~ lc~~~~ •,SdU'
Septic Remote
Building
Footings / ~' Zo ~'Z._- Drywall '~
(before finish) . ~ ,~.,
Framing `~ FinalT=,~~~-~~"1~
Electrical
Rough-in'l ~~ •~~ // 3'~/LFixtures
Temporary rnce ~ ~+.~~
Mechanical
Final -(,'c~~ Permanent Service
~ - -3 qZ
Rough-in /~a•U~ler~hGvuc~S'q~C r/ l0.0®~~eGri~
Final / ~ - OCa ~ ~
r/16-11~ ~.Z Plumbing
Ground Work ~, ,~,~~~~J11 /
Rough-in r/ 12. Uo f~le(~~Final / ~• UC? ~yIZ~L
WHEN PROPERLY VALIDATED (IN THIS SPACE) THIS IS YOUR PERMIT
Comment: Approve ~~~~
._....__ ...._.. .... - ..~ Rev. 1 °191
CFICCK LIST FOR ISSUING RGSIQCNTIAL DUILOING PCRMITS
Site
1. 1.oning ~ ~ flood Plain: Yes No ~
~_ .
2. Permitted Use ,2i~ •
3. Special Use _ Special Use Permit Issued
4. Location on Lot (Setbacks)
a. Front Yd. Required ~-~ Shown ~.
b. Rear Yd. Required _ ~~~ Shown ~`
c. Side Yd. Required ~ _ , Shown _ 13 , ~'
5. Variance Required: YCS ~
NO
G. Lot Area Required _ ~ 2000. I
~ ACtua~ ~ ~~Z~ ~ nJi2•~~~'~ate-~ ~ ,
7. Lot Coverage Allowed ~'~"~~~ Actual Zo o
a. Other Structures on Lot ~ ,Adjacent Lot
9. Utilities `
-r------
Ruildin9 Plans
1, Floor Plan
a. Room Sizes ~'
b. Cmergency Ogress ~ ~~.,~,,
2. Foundation Plan ~'°
~. Framing Plan may'
a. Cross Sections °'°"
b. Stairs r'-
~l. Clevations and Grading ,~-
r,. Clectrical ,.
G. t4echanical
7. Plurnbing .~
BI~ILDING PERMIT APPLICATION
Jurisdiction of City of Blair, Nebraska
218 South 16th Street
Blair, Nebraska 68008 0 - -
(402) 426-4191 Permit ~= 5 0 4 5
r oc~
Application Date: ~ Issue Date: ~~$ ~~ ~ Permit Fee: $
JOB ADDRESS
~ U SCf GC~7 ~~
LEGAL
1 ' DESCR. LOT NO. ~~ BLK. TRACT y,
^ SEE ATTACHED SHEET
2. OWNER ,_- MAI `
1 U ~~-~~7'l DRESS ~ t
~-- ~ ~ ~~ ~` l _ PHON
y(Q ~J ~d~
3. CONTRACTOR ~f
/x_ MAILADDRESS PHONE LICENSE NO.
US 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; Flooawey Yes ^
Fringe Yes^ No (]
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 acopyof this application form signed bythe 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 under land that this permit is void if work is not commenced within 1 SO days
or is not ce I ~ 2.y f date of issue.
~~
IGNATURE OF OWNER~CONTRACTOR OR AUTHORIZED AGENT DATE
Site Plan Attached ^ Complete Plans Attached ^
Approximate Completion Date
Inspections Required and Fees
Utilities
Sewer Tap Water Tap
Sewer
Septic
Water Service
Remote
Building
Footings Drywall
(before finish)
Framing Final
Electrical
O ~~
Rough-in Fixtures
Final
Permanent Service
Temporary Service
Rough-in
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:
Mechanical
- ABC _
irn iunc Darr. -amo- NF / flev. 1019
BUILDING PERMITAPPLI
Jurisdiction of City of Blair, Nebraska
218 South 16th Street
Blair, Nebraska 68008
(402) 426-4191
CATION
Permit N°
5106
pp /v- ~ ~- ~ Z Issue Date: / ~ ~~ t ~ Permit Fee: $ . G~
A lication Date:
JOB ADDRESS
1 ' DESCR, LOT NO. ~ ~ BLK. TRACT ~ N
~-~ l f~~ n ~~ ^ SEE ATTACHED SHEET
2, OWNEfl ~ MILADDRE
J~. C. I horscx~ ~o~ ~~! ~lcur' ZIP PHONE
3, CONTRACTOR MAILADDRESS
,J"~ec~~.tru~~~ Svcs. 71m~ ~i~ PHONE LICENSE NO.
,fox ~ ~f ~3.3~~
USE OF BUILDING
4.
5. Class of Work: .NEW ^ ADDITION ^ALTERATION ^ REPAIR ^ MOVE ^ REMOVE
6. pescribe Work: ' ~~ , ~~ c ~ C~~-f'(, ` I U ~ ~t_) h PLC,
], Sq. Footage Of S1rUCture (Including Basement and Garage):
$, Change of Use From: Change of Use To:
g, Valuation of Work: $
1f) FIOOdplaln; Floodway Yes^ No ^ Dev. Permit
Fringe Yes^ No ^ BFE Elev. Cert.
11. Current Zoning: Site Plan Attached ^ Complete Plans Atta hed ^
12. State Fire Marshall Required: Yes ^ No^ Approximate Completion Date 7- /~/-~~
Inspections Required and Fees
13. Special Use Permit Required: Yes ^ No ^ utilities
Sewer Tap Water Tap
14. Variance Required: Yes^ No^
sewer Water service
15. Minimum Setbacks: Front Side Rear septic Remote
16. Sidewalk Required: Yes^ No ^ Waiver Approved Building
AP LIGATION ACCEPTED BY
r~ PLANS CHECKED BY APPROVED FOR ISSUANCE BY Footings Drywall
b
f
fi
i
h
>
l 1~/' (
e
ore
s
n
)
NOTICE Framing Final
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 EleCtrlCal
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 Rough-ln Fixtures
have received a copy of 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 Final Permanent Service
above and in accordance with the codes~ordinances of the City of Blair and the State of Temporary Service
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. Mechanical
Rough-in ,O ABC ~Q `~~
I NATURE OF OWNERJCONTRACTOR OR AUTHORIZED AGENT DATE Final - U ~
Plumbing
~~ Ground Work
~
U ~
~ 7
~
S NATURE OF OWNER (IF OWNE BUILDER) DATE Rough-in -
Final
~
WHEN PROPERLY VALIDATED (IN THIS SPACE) THIS IS YOUR PERMIT
Comment: Annrnl/7orf Rv _ ~-. s ~
POUNDS PRTG: Blelr, NE Rev. 10/B1
- CITY INSPECTION SLIPS `~/~jy
Inspection has been requested for 170 .S' l~ ~~ ~-~ /~~"`~~~
Location of Building
/'~ ,N,,ame o/"f" ,C~o,~m{pany -
Type of Inspection
At to i6-yz fl.rn.
Date Time ~-
Results of the Inspection are: ~(/(
~~
Ci Representative
--^ ---
- CITY INSPECTION SLIPS
Inspection has been requested for ~D ~ ~e ~'° ='~``:
Location of Building
Name of Company1
On a.. n,~,.,-~.r"!~ ~ C.tJ~ xaszl ~-~...~a_.
(Type of Inspection)
At r (J 130
Date Time
Results of the inspection are: (/
.C~ R~
Cit~epresentative
` CITY INSPECTION SLIPS
Inspection has been requested for ~ D ~ ~a y - _"mil
Location of Building
gym ~ " "' " " Clk /~~C-2-~O _~
Name of Compa y
r
OR ~d tl lw... 1
(Type of Inspection)
Da e Time ~.
Results of the inspection are: ~!F(
~f
City Representative
r
CITY INSPECTION SLIPS
Inspection has been requested for ~~ ~~ ~S//),,~ /~
Pte' Location of Building
~~~ ~ ~ r-
Name of Company
On ~~~ -1~ C~ ~~
Ty e o Ins ect-ion
At ~ ~~~ ~ ~~~~
Date ~ Time // ~/G
Results of the Inspection are : ~~-~'cL--L..~ ~ ~"?~,_, ~. -, ~ ~` r - ~~ =,~;~ a IX\
,~
o ~ C~`
~ lz tt 1 ~;( r~~~ ~
°~ ,. l
City Representative
,,~ _:_.
CITY INSPECTION SLIPS
Inspection has been requested for ~~?~ ~. / ~~`~
Location of Building
By ~~br`So~ , ~~,
Name of Company
Type of Inspection
Date Time
Results of the Inspection are:
~:y,.~
City Representative
City of Blair
218 5 16th 5t.
Blair, Nebras4;a 680c18
Mechanical Services
P ~ Box 468
Blair, NE 63008
STATEMENT
Page 1
Close 01/31/93
---------
Date ------------
Invoice # --------
Due Date --------------------
CD Description --------------
Ref. # ---------------------
Debits Credits
---------------
-
- ------------
Amount Due
------------ -----------
Past Due
----------- -------
Days
-------
---------
11/30/92 ------------
19921130 --------
11/30/92 --------------------
I INVOICE --------------
BALFDRWARD --
-
-
95.00 95.00 95.00 62
0~~~112 ~'~~`
~' ' ,'
' '3
~~ :, .:+
J
c, ~dN i ,
~ ~~ ~ •~ ~ ~ r ~ a+~~~
~~
Tat al PastDue
Balance Balance Days
------------------------------------------------------------------------------------------------------------------
95.00 95.00 62
------------------------------------------------------------------------------------------------------------------
Current Past Due 1-30 Past Due 31-60 Past Due `~ 60
0.00 0.00 0.00 35.00
Your account will be turned over to our
legal department if not paid immediately
City of B1 air
218 5 16th 5t.
81 air, Nehraska 68008
Mechanical Services
P D Aox 468
B1 air, NE fi8008
5TATENENT
Page 1
Clare 01/01/93
---------
Date ----------
Invoice ----------
# Due Date --------------------
CD Description --------------
Ref. # --------------------
Debits Credits -------------
Amount Due -----------
Past Due -------
Days
11/30/92 19921130 11/30/92 I INVOICE BALFDRWARD 95.00 95.00 95.00 32
-----------------------------------------------------
Curr-ent Past Due 1-30 Past Due 31-60
0.00 0.00 95.OG
-------------------------------------------------------------
Total PastDue
Balance Balance Days
-------------------------------------------------------------
95.00 95.OG 32
-------------------------------------------------------------
Past Due : 60
0.00
Your account will be turned over to our
legal department if not paid immediately
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