BP6166BUILDING PERMITAPPLI
Jurisdiction of City of Blair, Nebraska
218 South 16th Street
Blair, Nebraska 68008
(402) 426-4191
CATION
Permit 616 6
Application Date: ~ ~ ~ 3--~~ ~~ Issue Date: ~~ ~ > `~~ Permit Fee: $ ~•Z- C\~
JOB ADDRESS
2~ ~ (,~ cz, lam"
LEGAL
1 ' DESCR. LOT N0. BLK. TRACT
^ SEE ATTACHED SHEET
2 OWNER ~ ~- J MAILADDRESS ZIP PHONE
3. CONTRACTOR ~1 MAILADDRESS
ASS ~G'`~~-C/~l -mil X133 L~~l S~ PHONE
~~1 ~~, LICENSE NO.
USE OF BUILDING
4.
5. Class of Work: ^ NEW ^ ADDITION ^ALTERATION ^ REPAIR ^ MOVE ^ REMOVE
6, Describe Work: ~ ~ ~~ C~ ~ ~~ ~~~~~ ~~~~
7. Sq. Footage of StrUC1Ure (Including BasemantandGarage):
8, Change of Use From: Change of Use To:
g, Valuation of Work: $
Floodway Yes^ No ^
10. Floodplain: Fringe Yes^ No ^ Dev.Permit
BFE
EIev.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 _
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 by the 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
Nebras tand that this permits- of If wor is not commenced within 180 days
Is not complete ithin 2 years of date o issue
.~ ~ ~~~ 7y
>~
81GNATURE OF OWNER/CONTRACTOR OR AUTHORIZED AGENT DATE
SIGNATURE OF OWNER (IF OWNER BUILDER) 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
(before finish)
Framing Final ~~ ~~~~~~
Electrical
Rough-in ` Fixtures
Final ~D .C~x~ Permanent Service
Temporary Service
Mechanical
Rough-in ABC ~~ `~~
Final ~-~
Plumbing
Ground Work
Rough-in Final
WHEN PROPERLY VALIDATED (IN THIS SPACE) THIS IS YOUR PERMIT
Comment: Approved By:
POUNDS PRTG: Blalr, NE ~ Rev. 10/91
L~
~-~- ~~-UIIDING INSPECTIO_NRE-PORT.
.CTFY OF B-LAIR ^ WASHINGTON COUNTY ^ OTHER
a
FF\\
LOCATION OF INSPECTION: V
~ _- ~I ~ - ,
NAME OF OWNER: ~-~ ~ ~ CONTRACTOR: ~ J- ~~~~~
_ ~ DATE INSPECTIONREQUESTED: 1 ~~ r ~ ~"l PERMITNO: ~! ~~
~~~
TIME INSPECTION REQUESTED: ;~
_ ~_ v
TYPE OF INSPECTION REQUESTED: ~, ~ ~ - l
_ c~~~ ~ j G
BUILDING: Q.
Uv_ .
^ FOOTING ^`FRAMING ^ DRYWALLFINAL ~~~
` I
I
_- UTILITIES:. ~
F..,, : f l
>_ ,> ,~.
SEWER TAP ^ SEWER . _^ SEPTIC = ~ ^ WATEI~'TAP ~ i
- ^ REMOTE ` ^ WATER SERVICE- - '~ T_
ELECTRICAL: ~'
ROUGH IN ^ FIXTURES ^ FINAL ^ MOTORS
^ PERMANENT SERVICE ^ TEMPORARY SERVICE
MECHANICAL:
^ ROUGH-IN ^ A/C ^ FINAL
,II
„~
PLUMBING:
GROUNDWORK ^ ROUGH-IN ^ FINAL ,.
I
RESULTS OF THE INSPECTION: ASSED (sEExoTES> ^ FAILED (sEENO~rES~ ~
NDTES/REMARKS: