BP5808BUILDING PERMITAPPLI
Jurisdiction of-City of Blair, Nebraska
218 South 16th Street
Blair, Nebraska 68008
(402) 426-4191
`j ~- I Z,~ ~ P o"
Application Date: `/ J Issue Date: Permit Fee: $ ~
JOBADDRESS ~1 p ~
~Gr/ /`~O D
~7 2~-
1
LEGAL LOT NO. BLK. TRACT ^ SEE ATTACHED SHEET
,
DESCR.
2. OW ~ fbi D 0,7 y7 ~ O MAIL~o Eg NCB' 2 (' [~~.t-~ ZIP
``77 ~- l n NE
/
CONTRACTOR
3 ADDRESS PHONE
MAIL LICENSE NO.
,
~ ~/,=
4, USE OF BUILDING
5. Class of Work: NEW ^ ADDITION ^ALTERATION ^ REPAIR ^ MOVE ^ REMOVE
6, Describe Work: ,~. f ~ ~ ,
], Sq. Footage of Structure (InclDaing Ba ment and Garage):
8, Change of Use From: Change of Use To:
g, Valuation of Work: $
Floodplain; FI°odway Yes ^
10 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 ^ Waiver Approved _
APPLICATION ACCEPfiEB~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 bythe 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 ofthe 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 OWNERiCONTRACTOR OR AUTHORIZED AGENT DATE
Site Plan Attached ~ Complete Plans Attached ^
Approximate Compl tion Date
Inspections Required and Fees
Utilities
Sewer Tap Water Tap
Sewer Water Service
Septic Remote
Building
Footings Drywall
(before finish)
Framing Final r 7 ~ 9 ~~
Electrical
Rough-in Fixtures
Final Permanent Service
Temporary Service
Rough-in
Final -
Plumbing
Ground Work
SIGNATURE OF OWNER(IFOWNERBUILDER) DATE Rough-in Final
WHEN PROPERLY VALIDATED (IN THIS SPACE) THIS IS YOUR PERMIT
CATI~V
Permit
Mechanical
- ABC _
" Comment: Approve B • ~ n~
POUNDS PRTG: Blelr. NE ~~'/,-~~_~°`- Rev. 10J9
CITY OF BLAIR
Application for Building Permit
PLOT PLAN
Address f l ~ f 1'~' ~ f~ ~ ~ Date
~ ~, ~, ~~ ;
~., ~
Legal Description: Lot ;,t w~ `s Block ~' Addition J ~~''ix'"" ~ r~ "
Please show all measurements of existing and contemplated structures,
also show distances between structures, etc., and property lines.
Is this a corner lot?
v
.,~
a
+~
v
R:
O
w
~ r'
0
~~~
~~" •,
- -.. ,~.,.~~F~7'F~
Center Line of
Street_ _
y
Indicate North
Applicant ~~.~ :•~,.,~-~.~ ,~`,~ ~"°,.-~.F
~_ '
~~ -
- ~'- ~~ ~EUILDING INSPECTION REPORT ~'
CITY OF BLAIR ^ WASHINGTON COUNTY ,; ^ OTHER
- - LOCATION OF INSPECTION: ~ ~ ~ N ' ~~ `~~ ~'
OF OWNER: ~C'.-~ IY?~•~C~ ~~~ CONTRACTOR: ~~'~~,~
~ NAME i _• -
DATE INSPECTION REQUESTED: ~ ~ ~~ ~~ ' PERMIT NO: " ~~
~` -
TIME WSPECTIONREQUESTED:
TYPE OF INSPECTION REQUESTED:
BUILDING: ~ (J"
^ FOOTING ^ FRAMING ^ DRYWALL FINAL
UTILITIES:
f~ ` ^ SEWER TAP ^ SEWER ^ SEPTZC ^ WATER TAP
t.
~„ ^ REMOTE ^ WATER SERVICE
_.
ELECTRICAL:
~~-
u.` ^ ROUGH IN ^ FIXTURES ^ FINAL ^ MOTORS
F:
~~'
^ PEEtMANENT SERVICE ^ TEMPORARY SERVICE
MECHANICAL: _
- ^ ROUGH IN ^ A/C ^ FINAL
PLUMBING:
~'. ^ GROUNDWORK ^ ROUGH-IN ^ FINAL
RESULTS OF THE INSPECTION: _ASSED (s~xoTES) ^ FAILED (s~xorES)
1V V 1 D.l/1~P~lYlf]LV». -
11\Ji l:.t+i vim. -
DATE OF INSPECTION MADE: ~ 1 TIME:
CALLED OPPD\ TO CONNECT SERVICE:
WANT OFFICE STAFF TO CALL OPPD\
A t
f ~~
^ YES ^ NO
^-YES ^ NO BI:R_ 1
s