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BP5664QU~LDING PERMIT APPLICATIO~iV Jurisdiction of City of Blair, Nebraska 218 South 16th Street Blair, Nebraska 68008 5 6 6 4 (402) 426-4191 Permit Application Date: ~-`.3~ `~3 Issue Date: 12-" ~ 5 `~ ~ Permit Fee: $ ~6~ a O .~ ~S~_~ JOB~~E~ ~~~ LEGAL 1 LOT NO. BLK. TRACT ^ SEE ATTACHED SHEET ' DESCR. 2 0 ER MAILADDRESS Zlp ~~ PHONE 3c~~/ ~ .. r3. CONTRACTOR MAILADDRESS PHONE 8 LICENSE NO. ~ ~ 30 ~i~ 4. USE OF IL 5. Class of Work: ^ NEW ^ ADDITION ^ALTERATION ~ REPAIR ^ MOVE ^ REMOVE 6. Describe Work: 7. Sq. FOOtage Of Str CtUre (Including asament end Garage): 8, Change of Use From: Change of Use To: g, Valuation of Work: $ ~5 ~~ ~m 10 Floodplain: Floodway Yes^ No ~ Dev. Permit Elev Cert Fringe Yes^ No ^ . . 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 [,~~laiver Approved _ I AP~ ~ I C~CCEPTED BY I PLANS CHECKED BY I APPROVED FOR ISSUANCE BY I 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 completed within 2 years of date of issue. SI ATURE OF OWNERS TRACTOR 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 ~2~(~` ~~ Final ~ ~J c~~ /2,f~,~3 ~ Electrical ~ ou`50 • Rough-in r/ ~~ ~ ~ b C?~ ~~ ~ ~~Fixtures _ Final / ~°~ ° g5~>~ permanent Service Temporary Service Rough-in Final - Plumbing Ground Work Rough-in Final WHEN PROPERLY VALIDATED (IN THIS SPACE) THIS IS YOUR PERMIT Mechanical - ABC _ POUNDS PRTG: Blelr, NE / Rev. 10/91 QUi~.DING P~RMITAPPLI Jurisdiction of City of Blair, Nebraska 218 South 16th Street Blair, Nebraska 68008 (402) 426-4191 CATION Permit 5 6 6 ~ Application Date: ~ IS~~i3 Issue Date: Permit Fee: $ JOB ADDRESS LEGAL 1 ' DESCR. LOT NO. BLK. TRACT ^ SEE ATTACHED SHEET 2 OWNER MAILADDRESS ZIP PHONE 3. CONTRACTOR MAILAQp)3~SS_ PHONE OO/i11~ 66 ``,UU(( ((``77CC l~U LICENSE NO. ~ F ~~ 4. USE OF BUILDING 5. Class of Work: ^ NEW ^ ADDITION ^ALTERATION ^ REPAIR ^ MOVE ^ REMOVE 6. Describe Work: 7, Sq. Footage of Structure (Indoding Besement end Gerege): 8. Change of Use From: Change of Use To: g, Valuation of Work: $ 10 Floodplain: FI° g wey Yes ^ No ^ Frin a Yes^ No ^ Dev. Permit BFE Elev. Cert. 11. Current Zoning: Site Plan Attached ^ Complete Plans Attached ^ 12. State Fire Marshall Required: Yes ^ No^ Approximate Completion Date 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 (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. (further th t t i / a; agree a cons ruct on covered by this permit applicetion shall not be commenced until I have received a copy of this application form signed by the Building Inspector and stamped Rough-in (D Fixtures 'APPROVED'. I hereby agree to perform the proposed work in accordance with the specifications set forth Final ~~ a© 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 permit is void if work is not commenced within 180 days or is not com leted within 2 years f d~te-ofi sue. Mechanical ~ ~ ~ ~ ~ Rough-in ABC SIGNATU FOWNERICONTRACTOROR HORIZEDAGENT DAT 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: Approved y: Rev. 1Of91 ' BUILDING INSPECTION REPOR' CITY OF BLAIR WASHINGTON COUNTY LOCATION OF INSPECTION: rl~l,~ NAME OF OWNER : ~I I K~ ~~ CONTRACTOR.~k DATE INSPECTION REQUESTED: J~ - I ~ ` Cam? PER TIME INSPECTION REQUESTED: ~ M TYPE OF INSPECTION REQUESTED: (n ~~G~I~ BUILDING: ,f~L~~ FOOTING FRAMING ~ DRYWAL FINAL UTILITIES: SEWER TAP SEWER SEPTI WATER TAP WATER SERVICE REMO ELECTRICAL: / ~~ ROUGH IN: V FIXTURES FINAL PERMANENT SERVICE TEMPORARY SERVI MECHANICAL: ROUGH-IN A\C _ PLUMBING: GROUNDWORK ROUGH-IN RESULTS OF THE INSPECTION: PASSED NOTES\REMARKS: INSPECTOR : __~~sy~~-~L DATE INSPECTION MADE: 3 TIME:_,,,~ CALLED OPPD\ TO CONNECT SERVICE: YES WANT OFFICE STAFF TO CALL OPPD\ YES FINAL FI (SEE NOTES) ~,- 9 d o d ~ ~, y o ~ ~o ~ b \ ~ \ I i tr1 ~Y e n h h 0 n ~ ^ y ~ D o y z° . e ~~ ~ ~ l+1 ~" ~ C7 ~. 0 ~ : b ~. ~ ~ n z ~ ~ 7 ` O o N. ~ ~. . ~ w cn ~ .. ° ~ d ~ o 0 _ _ ~ .,= . _ C o ~ ~, ~ b x, _~, ~ r ~ r t7 ~ ~ y ca ~. o d o ~ ~ ~ ~ ,tom,- ~' ~ _ ~ ~' ~ o ~ ~ ra'- ,~~ . ~ ~ ~ a ~ z ~ p ~;;~~ o x ~ ~ ~ ~ ~ J~ ~ o b ~ ° a ~ ~ o ,~ y _~ ~ Z ~ ~ o z ~. o ~ ~ ~...M~-~ ~ S O~ ~ ~ ~ y ~ r ~ r x y ~ ~ y ~ ~ G~ ~. ~: ~ b °z ~ O ~ C n o x 0 ~ ~ d z y^ r ~ x 0 b ^ O r '.'A ' H ; 1D ,~ ^ , ,~ ~' ,'' ` ~ ~ C ~ y t" ~, a ~ . „~ ~ 0 . ~ c ~ .; 'y ~. 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