BP4917BUILDING PERMIT APPLICATIO`IV
' Jurisdiction of City of Blair, Nebraska
218 South 16th Street _ _
Blair, Nebraska 68008 ~~ 49 ~ ~
(402) 426-4191 Permit - - - - -
Application Date: ~ J 1 $ I~ ~ Issue Date: `~r~ ~/~-~- Permit Fee: $ 6
JOB ADDRESS
I~
1 . LEGAL
DESCR. LOT NO. BLK. TRACT ^ SEE ATTACHED SHEET
2. OWNER ~ MAILADpRESS ~ ZIP PHONE
,3. CONTRA~i~pR ~
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) MAILADDRESS~ I ~~PHONE
,/°~C ~~~ . ~~ LICENSE NO.
USE OF
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4.
5. Class of Work: ~EW ^ ADDITION ^ ALTERATION ^ REPAIR ^ MOVE ^ REMOVE
6. Describe Work: ~, ~ 2 Goa s
]. Sq. FOOtage Of StfUCture (Including Basement and Garage):
8. Change of Use From: Change of Use To:
g, Valuation of Work: $ ~ °O
10. FIOOd laln; Floodway Yes I] No ^
p Fringe Yes^ No ^ Dev. Permit
BFE Elev. Cert.
11. Current Zoning: ~~ ~~
12. State Fire Marshall Required: Yes ^ NoL~
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
r NOTICE ~ A.
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 accordance 'th the codes~ordinances of the Ciry of Blair and the State of
Ne as a. I nderst this permit is void if w 's not commenced within 180 days
or is hi ears of datebf is /~
OF WNERICONTRACTOR ORAUTHORIZED AGENT DATE
SIGNATURE OF OWNER (IF OWNER BUILDER) DATE
Site Plan Attached ^ Complete Plans Attached ^
Approximate Completion Date ~ ~ 1 ~q' Z
Inspections Required and Fees
Utilities
Sewer Tap Water Tap
Sewer Water Service
Septic Remote
~ - i r3°- ~
Bulldtng
Footings ~~3"9~- Drywall
(before finish)
Framing Final ~ 12'ZU~~-3
Electrical
Rough-in l ~ . U0 ~ t-l~ 5 Fixtures
Final ~/~ _ck~ ~-~~'~ permanent Service '~
Temporary Service
Mechanical
Rough-in ABC
Final
Ground Work Plumbing
Rough-in Final
WHEN PROPERLY VALIDATED (IN THIS SPACE) THIS IS YOUR PERMIT
Comment: Approve y'
~~
'OUNDS PRTG: Blelr. NE Rev. 10/9
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HLN~ ~1Xis
- BUILDING PERMITAPPLI
Jurisdiction of City of Blair, Nebraska
218 South 16th Street
Blair, Nebraska 68008
(402) 426-4191
Permit
~® _ - 5~0~
Application Date: ~ ~ ~ I~7 -~2 Issue Date: 1 U"~ ~o -~ ~-- Permit Fee: $ f2 -o~
JOB ADDRESS
LEGAL
1 ' DESCR. LOT NO. BLK. TRACT
^ SEE ATTACHED SHEET
2. OWNER ~ - MAILADDRESS ZIP PHONE
3. CONTRACTOR ^ ~ ~~c ~~$C~ J MAJL AD6DRk S ~ ~ ~ PHONE ,~~ I ~/ ~~ LICENSE N0.
df~ t /1 CO
USE OF BUILDING
4.
5. Class of Work: NEW ^ ADDITION ^ALTERATION ^ REPAIR ^ MOVE ^ REMOVE
6. Describe Work: ~~(~ ~S - ~~~C~Y J C. ~ ~r
7. Sq. Footage of Structure (momding Basemem and Garage):
8. Change of Use From: Change of Use To:
g, Valuation of Work: $
10. Floodplain: Flooaway Yes^ No ^
Fringe Yes^ 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 _
APPLICATION ACCEPTED BY PLANS CHECKED BY 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 accordancewith the specifications setforth
above and in acwrdance 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 n t com~leted within. years f da of issue.
r ~,~
SIGNA RE OF OWNERJCONTRACTOR OR AUTHO ED 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)
Framing Final
Electrical
l
Rough-in („. ~U Fixtures
Final ~~- C~C1 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
Comment: Appr red By: ~_
CATION
POUNDS PRTG: Bleb, NE
CITY INSPECTION SLIPS
Inspec 'on has been requested for
Location of B 'lding
B f~.~
y
Name of Company
^(Typ o Inspection)
At ~ ! D ~~
Da e Time
Results of the inspection are:
~~
City Representative
CITY INSPECTION SLIPS
.~
~~.
Inspection has been requested fo
(~, ocation of Buil ng
Dame of Company
On
yp of Inspect on)
At ~ ~ ~-
~~
Date Time
Results of the inspection are:
~~~'
City Rep sentative
BUILDING INSPECTION R1
I/ CITY OF BLAIR WASHINGTON COUNTY
LOCATION OF I NSPE~CT I ON : I ~ ~ ~ ~C, CI.~fY1.
NAME OF OWNER : _~[a r I J c~-~ hy~ CONTRACTOR
DATE INSPECTION REQUESTED: 1Z -~
TIME INSPECTION REQUESTED: ~ol~
TYPE OF INSPECTION REQUESTED:
BUILDING:
FOOTING FRAMING DR
FINAL ~~ ~ ~~~-~`~
UTILITIES:
SEWER TAP SEWER S
WATER TAP WATER SERVICE
ELECTRICAL:
ROUGH IN: FIXTURES FINAL
PERMANENT SERVICE TEMPORARY S
MECHANICAL: ROUGH-IN A\C F
PLUMBING: GROUNDWORK ROUGH-IN
RESULTS OF THE INSPECTION: PASSED ~ (SEE NOT
NOTES\REMARKS:
INSPECTOR:
i„
DATE INSPECTION MADE: ~ TIME
CALLED OPPD\ TO CONNECT SERVICE: YES
WANT OFFICE STAFF TO CALL OPPD\ YES