BP57117
` BUILDING PERMIT APPLICATION
Jurisdiction of City of Blair, Nebraska
218 South 16th Street
Blair, Nebraska 68008 5 711
(402) 426-4191 Permit
A lication Date: ~ ~~ ~ Issue Date: Z " ~ ~ " ~~ Permit Fee: l~~
PP ~
JOB ADDRESS 1
1 • D SCR. L ~'~ ~.. ~ BLK ~ ~ ~ " ~ TRACT ^ SEE ATTACHED SHEET
2 OWNER MAI ADb ESS ZIP PHONE
~
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3. NTRAC MAIL D ESS PHONE LIC 0.
~~'
USE 0 LDI
4.
5. Class of Work: ^ NEW ADDITION ^ALTERATION ^ REPAIR ^ MOVE ^ REMOVE
6. Describe Work:
7. sq. FOOtag@ Of StfUCtUre (Including Basement end Garage):
8. Change of Use From: Change of Use To:
g, Valuation of Work: $ ' ~~~ ~~
Floodway Yes^ No ^
10
Floodplain: Dev.Permit
EIev
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 Waiver Approved
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 permitapplication 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 acopyof this application form signed bythe Building Inspectorand stamped
'APPROVED'.
I hereby agree to perform the proposed work in accordance with the specifications setforth
above and in accordance with the codes/ordinances of the City of Blair and the State of
ka. I understand that this permit is void if work is not commenced within 180 days
or Is t comoleted~ldthirs 2 years of date of issue. /) it
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)
Z~-9y
Framing Final
Electrical
Rough-in Fixtures
Final Permanent Service
Temporary Service
Mechanical
Rough-in ABC
OF OWNERICONk1r(ACTOR OR AUTHORIZEp,/fG~T 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
°OUNDS PRT6: Blalr, NE ",,"""_`~_ _` - Rev. 1010
_ BUILDING INSPECTION REPORT
_ .~, ~ _ -
. CITY OF BLAIIt ~ WASHINGTON COUNTY
/ _ ^ gTxER
' LOCATION OF INSPECTION: ~,~1 ~~~ S ~ ~~` ~~
~£ NAME OF OWNER: ~~n / ~ .~{to~ ~J~~Qf CO c f
- NTRACTOR: ;1G~tyC~S~~ L~cib~~~-•
0
DATE INSPECTIONREQUESTED: 7 -~5' l~ p~MITNO: S7f
TIMEINSPECTIONREQUESTED: i-tr"~C.~~L/Y~_G'
,TYPE OF INSPECTION REQUESTED: - -
' BUILDING:..
^ FOOTIIdG ,~ ~ /
FRAMING ~ DRYWALL I-~t'FiNAi. ~l~l;~..
e
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5'
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fR) ~ 190.
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T L. 200
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75'-~
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TAX LOT 150 AND TAX LOT 200 LYING IN THE
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.1'r7y ~L. ~- ~i ~1~.,1 i ViV i. `1 ''il~l~•,'Cj71~ IL1 !~~l~i~'-~~i r
RANGE 11 EAST OF THE~6th P.M., WASHINGTON
COUNTY, NEBRASKA.
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SURVEYOR'S CERTIFICATION:
1 ~; ~'.i 268.79 {m) .
~a'~ 265.82 (R)
~ r I N 89° 55 2fi ~ W
~ ~~' . N3 322'' 4 T L. 150: i
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261.38~(Rl
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~ Q i 264,10 (m)
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SC4~E IN FEET
(R) Distance on Records
(m) Meosured Cis!once
0 Found 5/8"Iron
0 Found 5/8`~Pinched-top Pipe
~ Set I/2~~x 20~~ Rebor
- I HEREBY CERTIFY THAT THE SURVEY
SHOWN AND DESCRIBED HEREON WAS MADE UNDER
ao' MY DIRECT SUPERVISION AND THAT I AM A DULY
S to°34'w REGISTERED LAND SURVEYOR UNDER THE LAWS OF
35.15 (R) THE STATE OF NEBRASKA.
35.23 {m)
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I :`" ~' '; RICHARD L, HAPdSEN
~ ,f ,~ ' E REGISTERED LAND SURVEYOR
''" 3~ ,~' ,` REGISTRATION N0. LS-382
`~.~ ~~ DATE: FEBRUARY 14, 1992
tj.i CLIENT: CENTURY 21/ STERNBERG
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0 75'
LEGAL
DESCRIPTION:
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B GLAIR ENGINEERING ~
E SURVEYING CO., INC.
S 1570 W~hhpbn St., P.O. Box 100
C Bldr, N.brak+ eeooa-0100
O {102) 126-9414