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BP6145. c,l~ v ~ OZ~Sy3 /Z ~`~.rf ~~lGyz~j BUILDING PERMIT APPLICATION Jurisdiction of City of Blair, Nebraska 218 South 16th Street Blair, Nebraska 68008 614 5 (402) 426-4191 Permit Application Date: ~ - 2 C~ _9 ~~ Issue Date: C~ " ~ U ~ ~ Permit Fee: $ ~' . CIC JOB ADDRESS i ' S • f~l~ ~~ ~~~ ~~ LEGAL 1. DescR. LOT NO. .~ (L 15 ' ~ ` BL . , I L ZU~ /V Iv ~y TRAC ~ ~ E ~y .5 I'-~ - //fit/- IZ I l ^ SEE ATTACHED SHEET OWNER MAILA 2. } C~i ~' ~~T~~ ~~.+'~}2a' ~ . RESS ZIP ~_u2~~'~,h0i.(~2. Q~ (,~~ ~~X 2~3 PHONE 5"3,3 ~-~~Q 3. CONTRACTOR FAAILADDRESS PHONE vrc~~~n.s~ C~n~a~n ~~ct ~~~~- LICENSE NO. z~ "~~ ~c~ USE OF BUILDING 4. ,~~ 5. Class of Work: NEW ^ ADDITION ^ ALTERATION ~~ ^ REPAIR ^ MOVE ^ REMOVE 6. Describe Work: '7 .~ f~ ICU ~~ h 0u S~ , ~ ~ yZ / 7. Sq. FOOtage of StrUCture (Including Basement and Garage): 8, Change of Use From: Change of Use To: g, Valuation of Work: $ ~ ~ UL; ~~ , ~ )~~ 10. Floodplain: Floodway Yes ^ No [~' Fringe Yes^ No (~' Dev. Permit Elev. Cen. BFE 11. Current Zoning: ~ }-~ 12. State Fire Marshall Required: Yes ~I No^ 13. Special Use Permit Required: Yes ^ No ~' Site Plan Attached, Complete Plans Attached ^ Approximate Completion Date Inspections Required and Fees Utilities Sewer Tap Water Tap No~j 14. Variance Required: Yes^ Sewer Water service 6a~~ 15. Minimum Setbacks: Front ,, °~Side Rear ~ septic Remote 16. Sidewalk Re uired: Yes No pp q ^ [Waiver A roved s- -~~ts -~s~~ I~yVo~9 o ~ `~ y~`= Building ~ ~ APPLICATION ACCEPTED BY PLANS CHECKED BY APPROVED FOR ISSUANCE BY Footings ' Drywall ~~ /~ (before finish) ~ - ~ '~ ~ z., ~ 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. I further agree that construction covered by this permit application shall not be commenced until I Rough-In '~~~ ~S FlXtures have received a copy of this application form signed by the Building Inspector and stamped 'APPROVED' LILS l /' C) Fi . L na Permanent Service I hereby agree to perform the proposed work in accordance with the specifications setforth S i T abov and in accordance with the codes/ordinances of the City of Blair and the State of emporary erv ce e ras . I understand that this permit is void if work is commenced w' hin 180 days or is n comple 'hin 2 ears of date of iss a Mechanical a9-9 Rough-in ~ ABC IG TURF OF OWNER~CON CTOR OR AUTHORI AGE DATE Final a~ Plumbing ? Ground Work SIGNATURE OF OWNER (IF OWNER BUILDER) DATE Rough-in Final WHEN PROPERLY VALIDATED (IN THIS SPACE) THIS IS YOUR PERMIT Comment: Appro B OUNDS PRTG: Blelr, NE Rev. f0~9 ~~ . ~~ s ~ ~ ~~ a 0 ~~~~lli I i I e i ~l ~'~~/ ~, d~ ~o- / p° ,~ x a`li. r ~ ~ ~ii~ h 3 . a o ~ ~ ~ ~ u : ~ N o 0 ~1 W~ J v . cn 3 q =o to J x rro/ y ~ 2 ~' O a J v C ~ l7 z h 03 y ~~ ~ n~i g V A 2' ~ ~ o ~' lp a w ~ 5 c y 7 Q ~, ~ ~, ~~` P w . ~ v ~ Q ~ 3 ~ ~ . w ~.' J ~~ o c ~o~ ~ °° r x r ~. ~, ~, 3 ~ ~ _ N s~ / / v ~~ /~ / i ~~ `N ~~ ~~ } J ~ a ~o ~~ e V J 3w a~ N w ~i s BUILDING PERMIT APPLICATION Jurisdiction of City of Blair, Nebraska 218 South 16th Street Blair, Nebraska 68008 6 4 6 0 (402) 426-4191 Permit Application Date: ~-- ~ (- ~~ S Issue Date: ~- < < ~~ 5 Permit Fee: $ ~ • ~~ JOB ADDRESS ~. ~ ~ t~ 3~ LEGAL 1' DESCR. LOT N0. BLK. TRACT ^ SEE ATTACHED SHEET OWNER MA DDRESS ZIP PHONE 3. CONTRACTOR _ k r MAILADDRESS PHONE LICENSE NO. ~IL~~ G~~C~I USE OF BUILDING 4. 5. Class of Work: NEW ^ ADDITION ^ ALTERATION ^ REPAIR ^ MOVE ^ REMOVE 6. Describe Work: .I~j)~ E(t°C'~i'r C_u_~ 7. Sq. Footage of Structure (IDCl~ding easement and Garage): 8. Change of Use From: Change of Use To: g, Valuation of Work: $ 10. Floodplain; Floodway Yes ^ No ~ Dev. Permil Elev. Cert. Fringe Yes^ No ^ BFE 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 crondi- 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. I further agree that construction covered by this permit application shall not be commenced until I Rough-In FlXtures have received a copy of this application form signed by the Building Inspector and stamped 'APPROVED'. Final Permanent Service 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 Temporary Service Nebraska. I understand that this permit is void if work is not commenced within 1 SO days or is t completed within 2 e s of date of issue. Mechanical ~~11 -~.~ Rough-in ABC I AT RE OF OWNERfC NTRACTOR 0 AUTHORIZED AGENT DATE Final Plumbing J Ground Work S ATURE OF OWNER (IF OWNER BUILDER) DATE Rough-in Final WHEN PROPERLY VALIDATED (IN THIS SPACE) THIS I YOUR PERMIT Comment: Approved By: POUNDS PRTG: Bleb, NE 'f~ ' ~ ~~ - BUIIJI~I\TG INSPECTION REPORT :_- - ~CITYOF_BLAIIL ^ WASHINGTONCOUNTY .^ -OTHER ~~ ,. LOCATION OF INSPECTION: s - ~ ~~'~ ~~ i _ ~, _ /' . . '' NAME OF OWNER: ~ ~~ r U ~-~~'~~'~~" CONTRACTOR: ~ ~~~c1'C-~~~=rte DATE INSPECTION REQUESTED: ~ ~ `I ~~ yr ~ PERMIT NO: i TIME INSPECTION REQUESTED: - TYPE OF INSPECTION REQUESTED: ., j BUILDING:: (2 ~'~~~1 ~/~ `~ ^ FOOTING , ^ FRAMING ' ^ DRYWALL .FINAL _.C9 ~. • i UTILITIES: - SEWER TAP ^ SEWER-_ _. ^ SEPTIC ^ WATER TAP ~, t ^ REMOTE ^ WATER SERVICE • f ELECTRICAL: `' `~ - ^ ROUGH IN ^ FIXTURES ^ FINAL. ^ MOTORS i, ^ PERMANENTSERVICE ^•TEMPORARY SERVICE ~~ MECHANICAL: ^ ROUGH-IN ~ A/C ' „ ^ FINAL ~. ~! I' PLUMBING: • ~ ^ GROUNDWORK ^ ROUGH-IN ~ ^ FINAL ,~ - • RESULTS OF THE INSPECTION: PASS)JD (s~xoTES> ^ FAILED (sue Notes) NOTES/REMARKS: ~~ i . 4 ~'. l . INSPECTOR: JJ qq /' r~ ~ . ~ ~ DATE OF INSPECTION MADE:~~~ ~ TIME: ~~ ~` ~ I ~' - i E '. CALLED OPPD\ TO CONNECT SERVICE: -^ YES ^ NO i WANT' OFFICE STAFF TO CALL OPPD\:_ ~ ^ YES QNO BLR 1 _~~