BP5592-" ~U-~LCING~~PERMITAPPLICAT~O~V
Jurisdiction of City of Blair, Nebraska
218 South 16th Street
Blair, Nebraska 68008
(402) 426-4191
Permit
Application Date: ~~ '/ ~' ' ~ '~ Issue Date: I l.J ~C~'~~ Permit Fee: $ t~ (JQ" (~~
JOB ADDRESS
%~l7 ~I ~ S~C`~ fie. <
S~
LEGAL
1 • DESCR. LOT NO. BLK. TRACT
^ SEE ATTACHED SHEET
2. OWNER n .~ 1
/~I ~C' 1 ~/ I /lX MAILADDRESS
S~~~ks. ZIP PHONE
3. CONTRACTOR
_ ~C~I"~'1-~f MAILADDRESS PHONE LICENSE NO.
4. USE OF BUILDING
5. Class of Work: N
EW ^ ADDITION ^ALTERATION ^ REPAIR ^ MOVE ^ REMOVE
nn
6. Describe Work: 1~~~~~r '_ C(iC~~,vC~ CC?~~/~/~ .(CZ/'t~ ~ l'zC, (_/7S/~~.(,(.!f'/~
7. Sq. Footage of Structure pnduding Besememandcarage): ~~~ X c~
8, Change of Use From: Change of Use To:
g, Valuation of Work: $ ~ ~U G, ~~ ~, ~ 0 C~ ~C~ ~~~~ c'>,~ c11.:.~r~~~. 122~~
10. Floodplain: Floodway Yes^ No ®~
Fringe Yes^ No ^/ Dev. Permit
BFE Elev. Cen.
11. Current Zoning: ~1 U
12. State Fire Marshall Required: Yes ~ No^
13. Special Use Permit Required: Yes ^ No
14. Variance Required: Yes^ Nom
15. Minimum Setbacks: Front Side ~ Rear ~
16. Sidewalk Required: Yes^ No~ Waiver Approved
I APPLIC~T~~~ C~ D BY I PLANS CHECKED BY I APPROVED FOR ISSUANCE BY I
' 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 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 not co/rg~leted within 2 years of of issue.
SIGNATURE OF OWNERICONTRACTOR OR AUTHORIZED AGENT DATE
SIGNATURE OF OWNER (IF OWNER BUILDER) DATE
Site Plan Attached ^ Complete-Plans Attached ^
Approximate Completion Date 1~G !~-~ ~~~ ~':~~~ ~(i,. ~ ~~~
Inspections Required and Fees
Utilities
Sewer Tap Water Tap
Sewer
Water Service
Septic Remote
~2.2~j `1"~ Building ~/c~~~ ,~~~~i'L~1~75_ ~ -=z`l-l~
Footings ~~ l - ~ ~~_~ S Drywall
~' ~J ~I ~ (before finish) c~
Framing Final ~Z JI L~
~ Electrical
Rough-in "!~!(,~S Fixtures
Final /~ c',~ Permanent Service -S'"2~" Q~
Temporary Service
Mechanical
Rough-in ~~-~r k .~ 3~~~~~ ABC
Final '~~
Plumbing
Ground Work'`
Rough-in rr Final ~~
WHEN PROPERLY VALIDATED (IN THIS SPACE) THIS IS YOUR PERMIT
Rai.
BUILDING INSPECTION REPOR'.
CITY OF BLAIR WASHINGTON COUNTY
LOCATION OF INSPECTION:_ I~~7 ~ ~~-C~~,.~ ~~~-.
NAME OF OWNER : ~~5 ~c~~ - ~~'~.,c~% CONTRACTOR
DATE INSPECTION REQUESTED: (Z~ZI- ~ ~ PER;
TIME INSPECTION REQUESTED: `~'.~3(~ ~,~ ~~~
TYPE OF INSPECTION REQUESTED:
BUILDING:
FOOTING ~~ FRAMING DRYWAL:
FINAL
UTILITIES:
SEWER TAP SEWER SEPTII
WATER TAP WATER SERVICE REMO'.
ELECTRICAL:
ROUGH IN: FIXTURES FINAL
PERMANENT SERVICE TEMPORARY SERVI(
MECHANICAL: ROUGH-IN A\C FINAL
PLUMBING: GROUNDWORK ROUGH-IN FI11
RESULTS OF THE INSPECTION: PASSED (SEE NOTES)
NOTES\REMARKS:
INSPECTOR:
--
DATE INSPECTION MADE: 2 Z rJ'3
CALLED OPPD\ TO CONNECT SERVICE:
WANT OFFICE STAFF TO CALL OPPD\
TIME:
YES
YES
~D~;~ ~ _-
,~ ~
' -~~ ~ ~U=ILDING~ PERMIT APPLI
.~ Jurisdiction of City of Blair, Nebraska
218 South 16th Street
Blair, Nebraska 68008
(402) 426-4191
Site Plan Attached ^ Complete Plans Attached ^
Approximate Completion Date
Inspections Required and Fees
Utilities
Sewer Tap Water Tap
5670
Application Date: I Z - (~ ° ~ Issue Date: ~ 2 ~ ~~ "I J~ Permit Fee: $ ~L
JOB ADDRESS
~(~ 9
S-~c~` ~e ~~-
LEGAL
1 ' DESCR. LOT NO. BLK. TRACT
^ SEE ATTACHED SHEET
2 OWNER (~ ~ P~ (~~' ~(_,{ r
j't f~ f J L^' MAILADDRE$S ZIP PHONE
3. CONTRACT ~~ m~~ `MAI_LADDRESS n ~/- ~
((//((~~T cs~C,~V l0 P NE ~ ~L~ NSENO~a J
/J ~
4. USE OF BUILDING
5. Class of Work: [NEW ^ ADDITION ^ALTERATION ^ REPAIR ^ MOVE ^ REMOVE
6. Describe Work: ~.~~-~ ~~ ~~ i !`~-l/+'l.l
7. Sq. FOOtage Of StrUCture (Including Basement and Garage):
8, Change of Use From: Change of Use To:
g, Valuation of Work: $
10. Floodplain: 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 _
APPLICATION ACCEPTED BY PLANS CHECKED BY APPROVED FOR ISSUANCE BY
NOTICE
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
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 and in accordance with thecodes/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 SO days
or is not completed within 2 years 4f date of issue.
OF
DATE
Sewer
Septic
Footings
Framing
CATION
Permit
Water Service
Remote
Building
Drywall
(before finish)
Final
Electrical
Rough-in Fixtures
Final Permanent Service
Temporary Service
Mechanical
Rough-in ~ - ~ ABC _
Final ~~ • ~ ( ~
Ground Work Plumbing
SIGNATURE OF OWNER (IF OWNER BUILDER) DATE Rough-in Final
WHEN PROPERLY VALIDATED (IN THIS SPACE) THIS YOUR PERMIT
Comment: Approved By: /~
POUNDS PRTG: Blelr, NE ,~ Rev. 10r91
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~~UILDING P~RMITAPPLICATIO~V
:~~-- SSc~ ~: Jurisdiction of City of Blair, Nebraska
218 South 16th Street
Blair, Nebraska 68008
(402) 426-4191
c
Application Date: 1'.3 ' ~~~ Issue Date: 1 ~ ~ ~ Permit Fee: $ ~-~
JOB ADDRESS
~Lj ~ G~ cS' ~'l
LEGAL
1 ' DESCR. LOT NO. BLK• TRACT
^ SEE ATTACHED SHEET
2. OWNER J . /
~~ l MAILADDRESS ZIP PHONE
3. CONTRACTOR MAILADDRESS PHONE LICENSE NO.
4. USE OF BUILDING
5, Class of Work: [NEW ^ ADDITION ^ ALTERATION ^ REPAIR ^ MOVE ^ REMOVE
6. Describe Work: ~~~ ~~, ICS -
7. Sq. Footage of Structure (Including Basement ana Garage):
8, Change of Use From: Change of Use To:
g, Valuation of Work: $
Floodway Yes^ No ^
10. Floodplain: Fringe Yes^ No ^ Dev.Permit
BFE Elev. Cert.
11. Cuf•rent 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
I APP~~ /A/ ~~~ Y I PLANS CHECKED BY I APPROVED FOR ISSUANCE BY I
/ 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 City of Blair and the State of
Nebr~~s a I understand that this permit is void if work is not commenced within 1 SO days
~is~no mpleted wi in 2 years of date of issue.
-~ `~
$ ATURE OF OWNERfCONTRACTOR 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)
Framing Final
Electrical
Rough-in ~o - U ~~ Fixtures
Final ~ `~ Permanent Service
Temporary Service
Mechanical
Rough-in ABC _
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: Approved By:
OUNDa PRTG: Blelr, NE Rev.10/9
5684
Permit
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