BP5236~~JIL~ING PERMITAPPLICAT10~1V
Jurisdiction of City of Blair, Nebraska
218 South 16th Street
Blair, Nebraska 68008 N~ 5236
(402) 426-4191 Permit a
~~
~ ~l ~9~3
Application Date: Issue Date: ~- , ~ "~~ Permit Fee: $
JOB ADDRESS
_~ ~~ 2 ~ ~~,. l Esc-~
1 . LEGAL
DESCR. LOT
~ ~~ ~ BLK. TRACT
~~~~ ~ ~,~/
^ SEE ATTACHED SHEET
2, OWNER MAI ADDRE;iS
~~~1/7 ZIP l J
-12 a _ ~j PHONE
~JS ~/
3, CONTRACTOR MAILADD~ES ~ PHONE ~. IC NSENQ.
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):
$, Change of Use From: Change of Use To:
g, Valuation of Work: $ O~
10. Floodplain: Flooawey Yes^ No ^ Dev.Permit
Fringe Yes^ No ^ 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 _
LICATI~~ ~~~ 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 Ci of Blair and the State of
Nebras I understand that this permit is void if work is not mence ithin 180 days
or i of c mpleted within to of issue.
__ ~ ~/ rye
ATUR OWNERfCONTRACTOR ORAUTHORIZED DATE
SIGNATURE OF OWNER (IF OWNER BUILDER) DATE
Site Plan Attached ^ Complete. Plans Attached ^
Approximate Completion Date ~~i~ ~~`~
Inspections Required and Fees
Utilities
Sewer Tap Water Tap
Sewer Water Service
Septic Remote -
Building
Footings Drywall
(before finish) C /r~`
Framing Final ~ ~'~ ~
Electrical ~~ Z~~
Rough-in w~ C)b ~•3u~~ Fixtures
Final w- Uv ~' Z` X1_3 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: Approu _
~--
__. ---__ ____ _. - .._ Rev. 10/91
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~UILCING PERMIT APPLICATION
Jurisdiction of City of Blair, Nebraska
218 South 16th Street
Blair, Nebraska 68008 ~®
(402) 426-4191 Permit
Application Date: ~~ ~ `~ ~ ~ Issue Date: > yea ~' ~ Permit Fee: $ / Z - U~~1
JOB ADDRESS
1 ' DESCR, LOT N0: ~ ~ / ~ ~' BLK. TRACT ~- i ~ i ~ ®SEE ATTACHED SHEET
2, OWNER ~ 1 MAILADDRESS
f ~:,-, ~S ~rt~~n~' ZIP PHONE
CONTRACTOR ~~' MAIL ADDRESS
3. ~C ~,~ f- E~e C.~rr~c; 2 ~~ PHONE LICENSE NO.
CG~~%C.. f.~~- `f~'S"770
USE OF BUILDING
4.
5. Class of Work: ^ NEW ^ ADDITION ^ALTERATION ^ REPAIR ^ MOVE ^ REMOVE
6. Describe Work: ~. ~ ~ ~' CS~-
], 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
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 _
APP~ATIO~'C,C`IT~D BY 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 applicatign 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 1 f30 days
or is not c leted withi 2 years f date of issue.
li 3 - ~~r -9,~
GNATURE OWNERS NTRACTOR OR AUTHORIZED AGENT 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)
i
F Final
ram
ng
Electrical
Rough-in ~o ~ U~ Fixtures
Final ~~~ Uo Permanent Service
Temporary Service
Mechanical
Rough-in ABC
Final
(/ " Plumbing
Ground Work
SIGNATURE OF OWNER (IF OWNER BUILDER) DATE Rough-in Final
WHEN PROPERLY VALIDATED (IN THIS SPACE) THIS IS YOUR PERMIT
~ment:
i
5245
Rev. 1091
BUILDING PERMITAPPLI
Jurisdiction of City of Blair, Nebraska
218 South 16th Street
Blair, Nebraska 68008
(402) 426-4191
CATION
Permit 5 2 5 4
Application Date: ~ ~'~~ ~~~~ Issue Date: ~~~ ~~ - ~ Permit Fee: $ ~° (~~
JOB ADDRESS
~~7Z ~ ~? cKs
LEGAL
1 ' DESCR. LOT NO. BLK. TRACT
^ SEE ATTACHED SHEET
2. OWNER
~~ c.~.r'~ MAIL ADDRESS ZIP
~ i 'n ~ r7 PHONE
7 zi
.~. CONTRACTOR - C~ \ ~/1 M~ A~~S~ ~~1,, ~ ~~r_ (10NE~_
~ 1~ `~ ~~ LI ~~~Q~~
USE OF BUILDING
4.
5. Class of Work: ^ NEW ^ ADDITION ^ ALTERATION REPAIR ^ MOVE ^ REMOVE
6. Describe Work: ~~~~~ ~
7. Sq. Footage of Structure (IROluding BasameRl and arage):
8, Change of Use From: Change of Use To:
g, Valuation of Work: $
Floodway Yes ^ No ^ Dev. Permit
10. Floodplaln: Fringe Yesl~ No ^ BFE
EIev.Cert.
11. Current Zoning: Site Plan Attached ^ Complete Plans Attached ^
12. State Fire Marshall Required: Yes ^ No^ Approximate Completion Date ~-1~~- ~~
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
APPLICATION ACCEPTED BY
~~ PLANS CHECKED BY APPROVED FOR ISSUANCE eY Footings Drywall
(before finish)
6 ~
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 Electrical
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-In FlXtureS
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 setforth 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 p mit is void if work is not commence within 80 days
or is not ompleted within 2 ye of da of.issp~ , __
~/ MechanlCal
~ ~
'~/ Rough-in ABC
''. SIGNATURE:OFOWNERJCONTRACTOR RAUTHORIZEDAGENT ATE FInaI ~• ~~~~
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~~
POUNDS PRTG: Blalr, NE Rev. 10J81
CITY INSPECTION SLIPS
Inspection has been requested for
By f.c~1C1~S r` C.%1 ~2./1
Name of Company
On ~./n Q ~ y 1~"~
Type of Inspection
c
Date Time
3~ Z J ~ci~~~~t
Location of Building
Results of the Inspection are: (~
C
ity Representative
~~'~
~,,
CITY INSPECTION SLIPS
~r u J` F ,.
Inspection has been requested for f»'~C
/~ Locatio of Building
L~~/C
Name of Company
On (/~~
(Type.of nspection
At
Date Time
Results of the inspection are:_ ~/ (/!
_ ~~
City Representative