BP4925- ,BUILDING PERMIT APPLICATIO~fiV
Jurisdiction of City of Blair, Nebraska
218 South 16th Street _ _
Blair, Nebraska 68008 ~~ 495
(402) 426-4191 Permit - - ~- -
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Application Date: ~ l / o~ Issue Date: Permit Fee: $ ~5
J08ADDRESS ~ /
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LEGAL
1 ' DESCR. `~
LOT N0. r U
~ ~ o! ~ /~~ TRACT
^ SEE ATTACHED SHEET
2, OWNER ~~~ ~I~ADDRES ~ ZIP ~ PHONE, /~~ _ ~c,~
J
r3. CONTRACTOR MAIL ADDRESS PHONE LICENSE NO.
USE OF BUILDING
4.
5. Class of Work: ^ NEW ADDITION ^ALTERATION ^ REPAIR ^ MOVE ^ REMOVE
6. Describe Work:
], Sq. FOOtage Of StfUC1Ure (Including Basement and Garage): ~ / r ~ ~' ~
(.~
Change of Use To:
8, Change of Use From:
g, Valuation of Work: $ -~~~ ~ C~ c~ ° a
10. FIOOdplaln; Floodway Yes ^ No ^ Dev. Permit Elev. Cert.
Fringe Yes^ No ^ BFE
11. Current Zoning: ~ ~ L Site Plan Attached ^ Complete Plans Attached ^
12. State Fire Marshall Required: Yes ^ No[`~ Approximate Completion Date ~~~3~ ~~°~-
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
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CA
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ON
ACCEPTED BY
~PLI PLANS CHECKED BY APPROVED FOR ISSUANCE BY (-~ • IS •~~
Footings Drywall ~
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C (before finish)
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NOTICE Framing Final ~
Separate permits are required for electrical, plumbing, heating, ventilating and air condi- /~~
tinning, 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. (further
agree that construction covered by this permit application shall not be commenced until I / `I - ~-~12 rz,. -
Rough-In G' ~~• ~ '~! Z- L c~K
. bi) Fixtures
have received a copyof this application form signed bythe Building Inspector and stamped
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APPROVED
. .
Final / Permanent Service
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
Temporary Service
Nebraska. I understand that this permit is void if work is not commenced within 180 days
o ' no~ completed within 2 years of date of issue.
~~~ J ~ ~ ~ ~~
~
~ Mechanical
U---~.
~ ~ Rough-ir ABC
SIGNATURE OF OWNER~CONTRACTOR OR AUTHORIZED AGENT DATE Final.
Ground Work ~ Plumbing
/
SIGNATURE OF OWNER (IF OWNER BUILDER) DATE Rough-in +~ ~~
Final/
WHEN PROPERLY VALIDATED (IN THIS SPACE) THIS IS YOUR PERMIT
Comment: Approve ~y ~
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Carl Scott
1101 State St.
Blair, NE 68008
Dear Mr. Scott,
City of flair
218 South 1 bth
Blair, Nebraska 68008
402-426-4191
September 11, 19.92
Bill Wilson, City Building Inspector, has informed me that
he did a rough-in electrical inspection for you on September 9,
1992. According to our records, no electrical permit has been
obtained.
Enclosed please find the electrical permit, which you need
to sign by the highlighted area, and return to us along with the
512.00 permit fee.
Thank you in advance for your cooperation. If you have any
questions, feel free to contact either Bill or myself.
Sincerely,
Brenda Taylor
City of Blair
Enc
BUILDING PERIVIITAPPLI
Jurisdiction of City of Blair, Nebraska
218 South 16th Street
Blair, Nebraska 68008
(402) 426-4191
CATION
Permit N° 5 0 5 3
Application Date: ~ "~ ~ ' ~ ~ Issue Date: ~ _ ~ S - ~ I ~ Permit Fee: $
JOB ADDRESS ~ ~ Q 1 ~~~ ~ ~~~~
LEGAL
1 ' DESCR. LOT NO. BLK. TRACT
^ SEE ATTACHED SHEET
2. OWNER ~r ~ ~ r ~
1 MAIL~A/DD~RESS ZIP PHONE
3, CONTRAC]~OR
1~0~ ( SC MAILADDRESS PHONE LICENSE NO.
CJ~XY1~ '?~~yS
USE OF BUILDING
4.
5. Class of Work: ^ NEW [ADDITION ^ALTERATION ^ REPAIR ^ MOVE ^ REMOVE
6. Describe Work: ~x ~~ KI °tu l~f'1 ~ L ~el~N 'l Co`l~
], Sq. FOOtage Of Structure (Including Basement and Garage):
8. Change of Use From: Change of Use To:
g, Valuation of Work: $
10. Floodplain: FI°odway Yes^ No ^
Fringe Yes^ No ^ Dev. Permit Elev. Cert.
BFE
11. Current Zoning: Site Plan Attached ^ Complete Plans Attached ^
12. State Fire Marshall Required: Yes ^ No^ Approximate Completion Date t2 3 ~ -9'Z
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 BY Footings Drywall
~~ ~ d~~ (before finish)
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 Co ~ OCR Fixtures
have received a copy of this application form signed bythe Building Inspector and stamped
'
'
`U~
APPROVED
. Final Permanent Service
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
Temporary Service
Nebraska. I - der t d tha perm' 'syoi r is menced within 180 days
or is not I d ith' ear d issu Mechanical
Rough-in ABC
GN R F 0 (CONTRACTOR OR AUTHORIZED NT DATE 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: Approve
Rnv 1f11G
CITY INSPECTION SLIPS
ir'--
Inspection has been requested for ~ ~ ~ ~ ~' '~" `'~`
Location of Building
,~ f
Name of Company
On ~ ~ ~ -
Type of Inspection
At ~' ! ~'
Time ~
Date
Results of the Inspection are:
City Representative
CITY INSPECTION SLIPS
Inspection has been requested for ~~d ~- ~'~`~
Location of Building
Name of Company
~` ~
(Type of Inspecticx~)
At .~~.~ "
Da~te~ Time
Results of the inspection are: ~(.~~
x1: G} y~~._~ L
City Representative