BP5325BUILDING PERMIT APPLICATION
Jurisdiction of City of Blair, Nebraska
218 South 16th Street
Blair, Nebraska 68008 5 3 2 5
(402) 426-4191 Permit
Application Date: .~ '- Z ~ ~~~~ Issue Date: .S ~~-`I' ~~ Permit Fee: $ ~ ~ < ~~
JOB ADDRESS 5 r'
LEGAL
1. DESCR. LOT NO. BLK. TRACT
^ SEEATTACHEDSHEET
OWNER ~ MAIL ADDRESS ~ ZIP PHONE
3. CONTRACTOR __ ~ MAILADDRESS PHONE LICENSE NO.
USE OF BUILDING
4.
5. Class of Work: ^ NEW ^ ADDITION ^ ALTERATION ^ REPAIR ^ MOVE ^ REMOVE
6. Describe Work: ~.~`_.~c~ ~ ~ (~ t- ~ S'~ ~1 ~ - ~'_(,tJ CJ/~C'L ~ ~~'i!1 ~ 7U ~ `~l/I~~ Lr~
7. Sq. Footage of Structure (Inducing Basement ana Garage):
8. Change of Use From: Change of Use To:
g, Valuation of Work: $
Floodway Yes^ No ^
10. Floodplain: Fringe Yes^ No ^ Dev.Permit
BFE Elev.cen.
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 Requilred and Fees
Utilities
Sewer Tap Water Tap
Sewer
15. Minimum Setbacks: Front Side Rear
16. Sidewalk Required: Yes^ No ^ Waiver Approved _
PLANS CHECKED BY I APPROVED FOR ISSUANCE 8Y
` ~' NOTICE
Separate per its 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 rdance with the codes~ordinances of the City of Blair and the State of
Nebraska. I d rstand that this per i 's void if work is not commenced within 180 days
or is not p ted within 2 years f d e of ' 'sue.
SI~NATUR 0 WNERJCO ACTOR OR HORIZED AGENT DATE
SIGNATURE OF OWNER (IF OWNER BUILDER) DATE
Water Service
Septic Remote
Building
Footings Drywall
(before finish)
Framing Final
Electrical
Rough-in Fixtures
Final Permanent Service
Temporary Service
Mechanical
Rough-in ABC _
Final
Plumbing
Ground Work
Rough-in G-~ CSC Final,
/,2_ CU~I
WHEN PROPERLY VALIDATED (IN THIS SPACE) THIS IS YOUR PERMIT
Comment: Approved
..,. w.,~ ooT~ _o~-~, uo Rev. 10/9
.BUILDING PERMITAPPLICATION
Jurisdiction of City of Blair, Nebraska
218 South 16th Street
Blair, Nebraska 68008 5 3 2 7
(402) 426-4191 Permit
Application Date: ~ = 2- ~ " ~~~ Issue Date: ~~ '~ ~ `~~•~ Permit Fee: $ ~~ - ~
JOB ADDRESS ~~
I~9 /~~ . ~i~ S~.
LEGAL
1 ' DESCR. LOT NO. BLK. TRACT
^ SEE ATTACHED SHEET
OWNER MAILADDRESS ~~, ZIP PHONE
CONTRACTOR ~ MAILADDRESS PHONE LICENSE NO.
USE OF BUILDING
4.
5. Class of Work: NEW ^ ADDITION ^ ALTERATION ^ REPAIR ^ MOVE ^ REMOVE
6. Describe Work: \~ ~C~~-l.C_~,1 ~~~~~~~ ~~
], Sq. FOOtage Of StrUCtUre (Including Basement and Garage):
$, Change of Use From: Change of Use To:
g, Valuation of Work: $
Floodway Yes^ No ^ Dev.Permit
10. Floodplain: 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 _
APFC,CA~~~~hE~~~1BY I PLANS CHECKED 8Y I APPROVED FOR ISSUANCE BY I
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 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 completed within 2 years of date of issue.
GNATURE OF OWNER~CONTRACTOR OR AUTHORIZED AGENT DATE
SIGNATURE OF OWNER (IF OWNER BUILDER)
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 ~ nn Fixtures
Final ~~ - ~~ ~- Permanent Service
Temporary Service
Mechanical
Rough-in ABC _
Final
Plumbing
Ground Work
Rough-in Final ,
WHEN PROPERLY VALIDATED (IN THIS SPACE) THIS IS YOUR PERMIT
Comment:
Approved By:
POUNDS PRTG: Blelr, NE ~ flBV• ~~~
BUILDING INSPECTION REPOR'
CITY OF BLAIR WASHINGTON COUNTY
LOCATION OF INSPECTION : ~ ~G~ ~ ~ Z-~ S~ S
NAME OF OWNER: ~IYI(Y1C'~~ ~OC-IC'.~ CONTRACTOR
DATE INSPECTION REQUESTED: ~ ~ ~~ I"~~ PER
TIME INSPECTION REQUESTED: IO~:OC) c~~
TYPE OF INSPECTION REQUESTED:
BUILDING:
FOOTING FRAMING DRYWAL
FRAMING FINAL ~~
UTILITIES:
SEWER TAP SEWER SEPTI
WATER TAP WATER SERVICE REMO
ELECTRICAL:
ROUGH IN: FIXTURES FINAL
PERMANENT SERVICE TEMPORARY SERVI
MECHANICAL: ROUGH-IN A\C FINAL
PLUMBING: GROUNDWORK ROUGH-IN FI
RESULTS OF THE INSPECTION: PASSED V (SEE NOTES)
NOTES\REMARKS:
INSPECTOR:
l
DATE INSPECTION MADE: ~~~~.J TIME:_~
CALLED OPPD\ TO CONNECT SERVICE: YES
WANT OFFICE STAFF TO CALL OPPD\ YES
CITY INSPECTION SLIPS
J n ~ / ~7 J
Inspection has been requested for /~ / N ' G/ s
g-y~ Location of Building
By ~/~LI~7~"'/ ~0 ~(~~
Name of Compan~~
~ ~~CJ ~~ f ~' ~ ~~~
• On c.- ~
Type of Inspection
Date
me
Results of the Inspection are:
City Representative
~/
.~~
Inspection has been
CITY INSPECTION SLIPS
requested for ~e ~ ~ ~ '
Location of luilding
~~
\~
l
Y
Na-n~ of Company
t~~ ~,
`type of Inspection
~~
Date Time
Results of the Inspection are:
~,~
Ci~ Representative