BP5568-' ~ BUILDING PERMITAPPLI
Jurisdiction of City of Blair, Nebraska
218 South 16th Street
Blair, Nebraska 68008
CAT101V
5568
(402) 426-4191 Permit
Application Date: ~- 2 C`~~-~I 3 Issue Date: ~ U 'y' ~~ Permit Fee: $
JOB ADDRESS ''
LEGAL
1 LOT NO. BLK. TRACT
^ SEE ATTACHED SHEET
' DESCR.
OWNER
2 ~ MAILADDRESS ZIP PHONE
~~
. ~
3. CONTRACTOR MAILADDRESS PHONE LICENSE NO.
4. USE OF BUILDING
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: $ ~~ ~~
Floodplain: Flooawey
10 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 ~r Rear ~
16. Sidewalk Required: Yes^ No aiver Approved
8Y 1 PLANS CHECKED BY I APPROVED FOR ISSUANCE BY
Site Plan Attached ^ Complete Plans Attached ^
Approximate Completion Date / ~ - `l` ~ ~
Inspections Required and Fees
Utilities
Sewer Tap Water Tap
Sewer Water Service
Septic Remote -
Building
Footings Drywall
(before finish)
~ 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 applicetion•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 nd in accordance with the codes~ordinances of the Ciry of Blair and the State of
Nebka. I understand that this permit is void if work is not commenced within 180 days
Apr j not completed within 2 years of date of issue?
SIGNATURE OF OWNERfCONTRACTOR OR AUTHORIZED AGENT DATE
SIGNATURE OF OWNER (IF OWNER BUILDER) DATE
Framing Final ~~2' 17'~~
Electrical
Rough-in 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: Appr v@d y: ~
ruunus rniu: clan, ne
CITY OP BLAIR
Application for Building Permit
PLOT PLAN
Address _1"~ ~~ ~•, ~n Cp ~h Date
Legal Description: Lot Block Addition
Please show all measurements of existing and contemplated structures,
also show distances between structures, etc., and property lines.
Is this a corner lot? ~_
J
v
~~
s'
w
0
a
0
~'6'~ ~ Q~~i~
\ S
~,s ~
~G
II
~- 3~ -I
r
Center .Line of
Street_ _
ndica~t e~"North
Applicant
BUILDING INSPECTION REPOR'
CITY OF BLAIR WASHINGTON COUNTY
LOCATION OF I NSPECT I ON : ( y ~ ~ ~ (~ C C~ ~-(rl
NAME OF OWNER : ~SC4~+ ~C~ I ~~ aY1 CONTRACTOR
DATE INSPECTION REQUESTED : ~i Z- I ~' ~3 PER
TIME INSPECTION REQUESTED:
TYPE OF INSPECTION REQUESTED:
BUILDING:
FOOTING FRAMING DRYWAL
FINAL ~ c~Ct ~~1 /~ ~~~~
UTILITIES:
SEWER TAP
SEWER
SEPTI
WATER TAP
ELECTRICAL:
ROUGH IN:
PERMANENT SERVICE
WATER SERVICE
REMO
FIXTURES FINAL
TEMPORARY SERVI
MECHANICAL: ROUGH-IN A\C FINAL
PLUMBING: GROUNDWORK ROUGH-IN FI
RESULTS OF THE INSPECTION: PASSED SEE NOTES)
NOTES\REMARKS:
INSPECTOR: ~~J~ ~~~
~~
DATE INSPECTION MADE: )~ `I ~
CALLED OPPD\ TO CONNECT SERVICE:
WANT OFFICE STAFF TO CALL OPPD\
TIME•
YES
YES