BP5369,r1
BUILDING PERMIT APPLICATION
Jurisdiction of City of Blair, Nebraska
218 South 16th Street
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Blair, Nebraska 68008 5 3 6 9
(402) 426-4191 Permit
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Application Date: lr1 -~ ~' /~ Issue Date: Permit Fee: $
JOB ADDRESS - f
~la~ ~~ l~ ~Uh~x~-/
LEGAL
1 LOT N0. BLK. TRACT
^ SEE ATTACHED SHEET
' DESCR.
OWNER MAILADDRESS
2 ZIP PHONE
.
3. CONTRACTOR ~ --, MAIL ADDRESS . PHONE ,,~ ,1 ~ ,~ LICENSE N0. L.
USE OF BUILDING
4.
5. Class of Work: ^ NEW ^ ADDITION ALTERATION ^ REPAIR ^ MOVE ^ REMOVE
6. Describe Work: C I-I ~ ~ ~C~,'~f~ ~ ~2C~~. _' ~ ~!-~r7~ ~-~ (S~ ~~ c
7. Sq. Footage of Structure pncluding BaSameRtaodGarage): F'
,~/X- ~. ~~~
~ C~~'~~ J
$, Change of Use From: Change of Use To:
g, Valuation of Work: $
Floodway Yes ^ No ^ Dev. Permit
10. Floodplain: F
in
e Y
^ N
^
EIev.Cert.
r
g
es
o
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
BY I PLANS CHECKED BY I APPROVED FOR ISSUANCE BY
U 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 Ciry of Blair and the State of
Nebraska. I understand that this permit is void if work is not com~~d within 180 d s
or is n t compl ed ' hin 2 ars f date f issue. l/
C/i~ ~ ~ ~
SIGNATURE OF OWNER~CONT CTOR OR AUTHORIZED AGENT DATE
SIGNATURE OF OWNER (IF OWNER BUILDER) 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 ~" ~~ c~~~
Electrical
Rough-in
Final _
Temporary Service
Fixtures
Permanent Service
Mechanical
Rough-in ~.C'~ q~C /~~ C)Cl
Final ~'-~'~~
Plumbing
Ground Work
Rough-in Final
WHEN PROPERLY VALIDATED (IN THIS SPACE) THIS IS YOUR PERMIT
Comment: Approved By: ~ -
~OUNGS PRTG: BIeIr. NE ~ Re~• ~~
~I
~~~~ BUILDING PERMIT APPLICATIO~IV
Jurisdiction of City of Blair, Nebraska
218 South 16th Street
Blair, Nebraska 68008
(402) 426-4191 Permit_
d~°.
Application Date: 2 - ~ ~ -~ ~`~ Issue Date: ~ - ~ ~-"c~~~ Permit Fee: $
JOB ADDRESS
A
{
/ (~/
`~' LJ /
LEGAL
1 ' LOT NO. B
LK
. TRACT
^ SEE ATTACHED SHEET
DESCR.
2 OWN ~
~
~
' MAI~1`tDCRE S S - / ,~ ~
C~•U
~ ylp ~G~ ~ PHO E
t
m h
~ ~ v
---
C TR R
3.
~ AI ADDRESS
~ ~
~
~ HONE
~ LICENSE N .
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o
~ 7
7
4. USE OF ILDING
5. Class of Work: ^ NEW ^ ADDITION ^ALTERATION ^ REPAIR ^ MOVE ^ REMOVE
6. Describe Work: -~~l`
7. Sq. Footage of Structure (IRdodiRgBasamsntandcaraga):
8. Change of Use From: Change of Use To:
g, Valuation of Work: $
Floodway Yes ^ No ^
1Q. Floodplain: F
in
e Y
^ N
^ Dev. Permit
Elev. Cert.
r
g
es
o 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 by the Building Inspector and stamped
'APPROVED'.
I hereby agree to perform the proposed work in accordance with the specifications set forth
above and inaccord;~nce with the codes~ordinances of the City of Blair and the State of
Nebraska.~f understand t~.atthis permit is void if work is not commenced within 180 days
or is not mpleted w l 2 vea ofl ate of issue. I I
OF OWNERfCONTRACTOR qR AUTHORIZ€D AGENT
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
Rough-in Fixtures
Final Permanent Service
Temporary Service
v° 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: Approve _
,~ s,! 'tom,
5709
POUNDS PRTd: &alr, NE Rev. 10/91
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_ _ _ _.BUILDING INSPEC'~ION REPORT
_ „ '^rCITY OF BLAIR =^ W9SHINGTON COUNTY ^ OTHER !
- :"
~ LOCATION OF INSPECTION. ` , ~ ~!
f j~ OC~~S CON'T`RACTOR: ~~~'`-'' ;--5 ~-'~~ ~'}'~GU}'~ {~
!= NAME OFOWNER: -=~J ~~ ~ r ~ ~ f
L ~ Z~' ~ ! PERMIT N0: ~~ (~'~ ` 5 7d~
DATE INSPECTION REQUESTED:
4:: TIME INSPECTIOI~REQUESTED: #-~rr1 ~ ! `~-~
1
TYPE OF INSPECTION REQUESTED:
~ -. - -_
! BUILDING:
~; ^ FOOTING ^ FRAMING ^ DRYWALL ^ FINAL -
UTILITIES:
1~ ^ SEWER TAPr'_^ SEWER - ' ^ SEPTIC ^ WATER TAP
`' ^ REMOTE ^ WA'D'ER SERVICE„
r::
~,` ELECTRICAL:
~;~ _
-- --
^ ROUGH IN ^ FIXTURES ^ FINA3-~ > : ~ ' ^ MOTORS
~_ ~^ PERMANINT SERVICE ^ TEMPORARY SERVICE
` MECHANICAL: -
`,
_- _
r
^_ROUGH-IN ^ A/C =_ ,, _
. ^ FINAL ° _..
,PLUMBING:., ---
,~ ^~GROUNDWORK
t ^ ROUGH-IN ^ FINAL- _ _
- RESULTS OF THEINSPECTION _
: - PASSED (s~Nm'ES) ^FAII.ED (s~NOTES)
NOTES/REMARKS:
.- INSPECTOR: " ~
g ~: /l/5
-DATE OF INSPECTION MADE: 3
CALLED OPPD\ _ TO CONNECT SERVICE: ^ YFS ^ NO
^ YES ^ NO BLR t
WANT OFFICE STAFF TO CALL OPPD\ _-
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