BP5726~~ BUILDING PERMITAPPLI
Jurisdiction of City of Blair, Nebraska
218 South 16th Street
Blair, Nebraska 68008
(402) 426-4191
Application Date:
G- " ~~~" ~~ ~~
CATION
5726
Permit
Issue Date: ~ . ~~ S~ C~ ~ Permit Fee: $ (C~- ~~
JOB ADDRESS /) r
LEGAL
1 ' DESCR. LOT NO. BLK. TRACT
^ SEE ATTACHED SHEET
MAILADDRESS
OWNER ;v
2. I ~ ( (rLf/ i ~ l!~~~~~y
Zlp
PHONE
3. CONTRACTOR MAI ADDRESS PHONE LICENSE NO.
4. USE OF BUILDING
5. Class of Work: NEW ^ ADDITION ^ ALTERATION ^ REPAIR ^ MOVE ^ REMOVE
6. Describe Work:
~ C C'~~T1 G ~ -~
~ I - ~-
7. Sq. FOOtage Of StrUCtUre (Including Basement and Garage):
8, Change of Use From: Change of Use To:
g, Valuation of Work: $
10. Floodplain: Floodwey 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 _
APP~JC~~~ C~~TED 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 notconstitute issuance of this building permit. I further
agree that construction 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
'APPROVED'.
I hereby agree to perform the proposed work in accordance with the specifications set forth
above and in accordance with the codesJordinances 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.
SIGNATURE OF OWNER/CONTRACTOR OR AUTHORIZED AGENTS 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
i
F (before finish)
l ~! ~ ~ ~ ~ ~~
Fi
ram
ng na
Electrical
Rough-in Fixtures
Final Permanent Service
Temporary Service
Mechanical
Rough-in ABC
Final ~ • ~ ( ~
Plumbing
Ground Work
SIGNATURE OF OWNER (IF OW R B ILDER) DATE Rough-in Final
WHEN PROPERLY VALIDATED (IN THIS SPACE) THIS IS YOUR PERMIT
Comment: Approved By:
POUNDS PRTG: Blair, NE Rev. 10181
'-TYPE OF INSPECTION REQUESTED:
}
BUILDING:. _.
^ FOOTING , ^ FRAIvItrTG ^ DRYWALL ^ FINAL
UTILITIES:
^ SEWER TAP ^ SEWER
~ ^ SEPTIC ^ WATER TAP
' -
^ REMOTE ^ WATER SERVICE
ELECTRICAL:
-, ^ ROUGH IN ^ FIXTURES ^ FINAL ^ MOTORS
^ PERMANENT SERVICE ^ TEMPORARY SERVICE i ~ ,. n /~
MECHAMCAL:
~ ~ ~. " -
/
~
(~
,. ^ ROUGH-IN ^ A/C ~
L}(FINAL ~ ,, ~
,
~ ""• ~ .
- .
PLUMBING:
~;;_ ^ GROUNDWORK ^ ROUGH-IN ^ FINAL
RESULTS OF THE INSPECTION: ^ PASSED (sEExm~s) ^ FAILED (sEE rrorES)
- NOTES/REMARKS:
INSPECTOR ~1 iL
• ~ ~ . DATE OF INSPECTION MADE: TIME: ~FZ ~~
_ ~_-
CALLED OPPD\ TO CONNECT SERVICE: ^ YES ^ NO
~,
• f WANT OFFICE STAFF TO CALL OPPD\ ^ YES ^ NO BLR 1
t
Ir - -- - - - - - ---~--- ~_.~
~ ~ .