BP6042BUILDING PERMIT APPLICATION ~~m ~~~'
Jurisdiction of City of Blair, Nebraska~~n~ C~~~bZ'7~ ~' x(0`9
218 South 16th Street
Blair, Nebraska 68008 6 0 4 2
(402) 426-4191 Permit
Application Date: D-~~ ~~~ Issue Date: ~;-~~"`~`~ Permit Fee: $ ~~•
JOB ADDRESS
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DESCR, LOT NO. I BLK. ~ TRACT
~~ ef- ~,~~ ~/~'~~ ^ SEEATTACHEDSHEET
OWNER (~~~r, ,~I~., MAILADDRESS
2. L ~f I ~_~ ZIP PHONE
r3. CONTRACTOR ~ ~ ~~ ~ ~ I 1 ~M\AIL A ~DR)ES~
~~1~-, J /~ .~ ~~~ r ~ P L/~~' ~ ~ ~ LICENSE No.
U
USE OF BUILDING
4.
5. Class of Work: ~ NEW ^ ADDITION ^ALTERATION ^ REPAIR ^ MOVE ^ REMOVE
6. Describe Work: ~() ~~~~ ~~~ ~•~ ,
], Sq. FOOtage Of StrUCtUre (Including Basement and Garage):
8. Change of Use From: Change of Use To:
g, Valuation of Work: $ `7S ~~
10. FIOOd laln: Floodway Yes ^ No [~~ Dev. Permil
p Fringe Yes^ No ^~ BFE Elev. Cert.
11. Current Zoning: ~ ~
12. State Fire Marshall Required: Yes ^ NoO~
13. Special Use Permit Required: Yes ^ No []~
14. Variance Required: Yes ^ No ~®
15. Minimum Setbacks: Front 25~ Side ~ Rear
16. Sidewalk Required: Yes No ^ Waiver Approved _
APPL~ON~~ PT~ Y ~ PLANS CHECKED BY ~ 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 copyof this application form signed bythe Building Inspector and 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
Nebraska. I understand that this permit is void if work is not commenced within 180 days
or i wit ' ate of issue.
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IGNATURE RJCONTRACTOR OR AUTHORIZED AGE DATE
SIGNATURE OF OWNER (IF OWNER BUILDER)
DATE
Site Plan Attached ^ Complete Plans Attacl ed-~_~
Approximate Completion Date ~./~G~-r1 / , / g ~s
Inspections Required and Fees
f ~-Z~-9 ` yc~ Utilities ~ ~ Z~,-`~~
Sewer Ta /~~ ,I Water Tap
o.~-~~/y~~~,~,~
Sewer y/ Water Service ~"~
Septic Remote
C-~It
Building
Footings '~~~'~~/ ~ Drywall '~
(before finish) I-2~'~l S~~ ~in~/
Framing -/11~7~5-w~i Final ~ ~ "ZS ~~
I } JZ~,cI~, Electrical
Rough-in a/ ~ ~ Fixtures
Final:// ~ Permanent Service '~ ~- '- r
Temporary Service
>>: ~'cl~I /~ Mechanical
Rough-in C'l.l(~%L~ , j/ Zy~Y y A1C ~ ~~~~~//
Final CC/ ~'L`
~ • Plumbing
Ground Work`~l -3. ~ ~/~,f~,^,,, //
Rough-in ~ ~I"2bFinal /~^'L~~~.g~L~
WHEN PROPERLY VALIDATED (IN THIS SPACE) THIS IS YO~JR PERMIT ~
Comment: Approve ~
SOUNDS PRTG: Blelr, NE Rev. 1019
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W
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CITY OF BLAIR ^ WASHINGTON COUNTY . ^ OTHER
• r' r
_ I:OCATIONOFINSPECTION: ~~-~ C"~ ~' ~ ~
NAME OF OWNER:. ~ ~ CONTRACTOR: ~
' DATE INSPECTION REQUESTED: PERMIT NO:
TIME INSPECTIQN REQUESTED: ~~
-TYPE OF INSPECTION REQUESTED:
`i
• BUILDING:
'FOOTING ^ FRAMING ^ DRYWALL ^ FINAL
UTILITIES:
^ SEWER TAP ^ SEWER ` ' ^ SEPTdC ^ WATER TAP -
^ REMOTE ^ WATER SERVICE
ELECTRICAL:
^ ROUGH IN ^ FIXTURES ^ FINAL ^ MOTORS
^ PERMANINT SERVICE *^ TEMPORARY SERVICE
MECHANICAL:
^ ROUGH-W ^ A/C ^ FINAL
PLUMBING:
^ GROUNDWORK . ^ ROUGH-IN ^ FINAL
RESULTS OF THE INSPECTION:PASSED (s~xoTES> . ^ FAILED (sEaxo~rFS)
' NOTES/REMARKS:
'DATE OF INSPECTION MADE: TIME: /u`~
CALLED OPPD\ TO CONNECT SERVICE: ^ YES ^ NO
WANT OFFICE STAFF TO CALL OPPD\ ^ YES ^:NO BLR 1