BP4887BUILDING PERMIT APPLICATI0IV
' Jurisdiction of City of Blair, Nebraska
218 South 16th Street
Blair, Nebraska 68008
(402) 426-4191
N~ _48_x_7
Permit ' ' -
Application Date: ~~ ~~ % L' Issue Date: ~~ Z ~~` l ~ Permit Fee: $ ~U-~
JOB ADDRESS 1 ~,\ I ~ f,~ ~~ L~
LEGAL
1 ' DESCR. LOT NO. ~ BLK. TRACT ~~
^ SEE ATTACHED SHEET
2. OWNER
2/1,12 S MAIL ADDRESS ZIP
s PHONE
3. CONTRACTOR ,//,^, r
1~ ~ ~n S M DDRESS PHONE
6 c~ LICENSE NO.
USE OF BUILDING
4.
5. Class of Work: ^ NEW ^ ADDITION ^ALTERATION REPAIR ^ MOVE ^ REMOVE
6. Describe Work: G~~ ~~~ c ~~G ~ ~ S
], Sq. Footage Of StrUCture (Including Basement and Garage):
$, Change of Use From: Change of Use To:
g, Valuation of Work: $ ~ ~Q: ~~
10. Floodplain: FI°Dawey Yes ^ No ^
Fringe Yes^ No ^ Dev. Permit Elev. Cert.
BFE
11. Current Zoning: ~- n^
12. State Fire Marshall Required: Yes ^ No[~'
13. Special Use Permit Required: Yes ^ No
14. Variance Required: Yes^ Nod
15. Minimum Setbacks: Front Side Rear_
16. Sidewalk Required: Yes^ No ^ Waiver Approved
TION ACCEPTED BY PLANS CHECKED BY APPROVED FOR ISSUANCE BY Footings
~l.(,n r~a~ /1~
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 acopy 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 accord with the codesJordinances of the City of Blair and the State of
Ne~ska. I t~ stand t t this permit is void if work is not mmenced within 1 t30 days
pr' not pleted n 2 years of date gam' ue
OF OWNERJCONTRACTOR OR AUTHORIZED AGENT DATE
Site Plan Attached Complete Plans Attached ^
Approximate Co pletlon Date ~a~~`~Z
Inspections Required and Fees
Utilities
Sewer Tap Water Tap
Sewer Water Service
Septic Remote
Building
Framing '~
Drywall '~
(before finish) c~ G
Final ~G~ ~Z~~ l ~`'
Electrical ~- , ~-~-
Rough-in ~ -~ 2~ Fixtures
Final / Permanent Service
Temporary Service
Mechanical
Rough-in ~ ABC
Final ~
~ 2tl •~t Z oJ~ Plumbing EJ
Ground Work Ir r Fin f
I SIGNATUREOFOWNER(IFOWNERBUILDER) DATE I Rough-in /~..GO l ` / ~'C_~~
WHEN PROPERLY VALIDATED (IN THIS SPACE) THIS IS YOUR PERMIT
Comment: Approv d B • ~ s
OUNDS PRTG: Blelr, NE Rev. 1019
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BUILDING PERMIT APPLICATIO~1
Jurisdiction of City of Blair, Nebraska
218 South 16th Street _ _
Blair, Nebraska 68008 ~~ 4890
(402) 426-4191 Permit - ' - -
Application Date: `--/ ~3I~1~ Issue Date:
z~~zy. ~
oa
Permit Fee: $
JOB ADDRESS h I O II ~G ~t~
LEGAL
1
LOT NO.
BLK. ,
TRACT
^ SEE ATTACHED SHEET
' DESCR.
2. OWNER ~~ S I ~ I MAIL ADDRESS ZIP PHONE
MAILADDRESS PHONE LICENSE NO.
,3. CONTRACT
` ~
~
I ~
l.V
USE OF BUILDING
4.
5. Class of Work: ^ NEW ^ ADDITION ~1LTERATION ^ REPAIR ^ MOVE ^ REMOVE
6. Describe Work:
~-~'}
'F
'
n bS
v`
.
~ YO O rn 1
Y
t rZ
]. Sq. FOOtage Of StrUCture (Including Basement and Garage):
8. Change of Use From: Change of Use To:
g, Valuation of Work: $
laln: Floodway Yes^ No ~ Dev. Permit Elev
Cert
10
FIOOd
.
.
.
p
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
APPLICATION 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 bythe Building Inspectorand 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'~bt compJrted within 2 year$ gf date of issue.
SIGNATURE OF OWNERfCONTRACTOR OfT7~1THORIZED AGENT DATE
Site Plan Attached ^ Complete Plans Attached ^
Approximate Completion Date S ~ ~ ~ ~
Inspections Required and Fees
Utilities
Sewer Tap Water Tap
Sewer Water Service
Septic Remote -
Building
Footings Drywall -
(beforefinish)
Framing Final -
Electrical
Rough-in
Final
Temporary Service
Rough-in
Final
Ground Work_
SIGNATURE OF OWNER (IF OWNER BUILDER) DATE ~ Rough-in Final
WHEN PROPERLY VALIDATED (IN THIS SPACE) THIS IS YOUR PERMIT
Fixtures
Permanent Service
Mechanical
- ABC
Plumbing
Comment: Approved B : \ ~
~ .W`
,.,. ~.~~~.,.,r.. o~_~. ..~ Rev. 101:
CITY INSPECTION SLIPS
Inspection has been requested for I ~ / ~ ~~ ~J(9-4~ ~/~--
Location of Building
By ~.~ ~~
Name of Company
c
On ~•~--
Type of Inspection
At ~l ~~~
Date Time
Results of the Inspection are:
w .-d - .
CITY INSPECTION SLIPS
Inspection has been requested for
BY_ d ~ / ~ /[./
Name of Company
_ Type o nspection ~/
At ,~L/~~ . •~~ v
-ate Time
Location of Bui
~-,-~,
~• ~~..
~~,CJ ~.~~.L,I.
Results of the Inspection are: (~(~
City Re~ -- presentative
E
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c~ . ~ ,rte ~.~~,., ~~.
City R~pr'esentative
-~~-~Z.~
~~ ~ ~