BP6561BUILDING PERMITAPPLICATIOIV
Jurisdiction of City of Blair, Nebraska
218 South 16th Street
Blair, Nebraska 68008
(402) 426-4191 Permit
6561
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Application Date: ~~~ ~~ Issue Date: ~ -3~-`[ S Permit Fee: $
JOB ADDRESS
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1 , LEGAL LOT NO. BLK.
~ TRACT ^ SEE ATTACHED SHEET
DESCR. irk
OWNER
2 MAILADDR ZIP PHONE
~
.
Grl ~ ~~
3. CONTRACTOR MAILADDRESS PHONE LICENSE NO.
USE OF B ILDING
4.
5. Class of Work: ^ NEW ^ ADDITION ^ALTERATION ^ REPAIR ^ MOVE ^ REMOVE
6. Describe Work:
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7. Sq. FOOtage Of StrUCtUre (Including Basement and rage):
8. Change of Use From: Change of Use To:
g, Valuation of Work: $ ~~ °-
iQ Floodplain: Flooaway Yes ^ No Q 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 Re uired• Yes No
Site Plan Attached ^ .Complete Plans Attached ^
Approximate Completion Date
Inspections Required and Fees
Utilities
Sewer Tap Water Tap
' q ^ ~ Sewer Water Service
15. Minimum Setbacks: Front Side Rear Septic Remote
16. Sidewalk Required: Yes ^ No ^ Waiver Approved Building
C IO°~N,A~CCEPTED BY
~ ~~'~~L~~ PLANS CHECKED BY APPROVED FOR ISSUANCE BY Footings Drywall
(before finish)
`
NOTICE Framing Final ~ ~~~
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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 Fixtures
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
T
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above and in accordance with the codes/ordinances of the City of Blair and the State of emporary
erv
ce
Nebr I understand that this permit is void if work is not commenced within 1 SO days
o Is not o leted within 2 years ate of'ssu
y ~~
~ Mechanical
c~,
' ,Q~ Rough-in ABC
SI A R OF OW R~CONTRACTOR OR AUTHORIZED AGENT DATE Final
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 d~
'OUNDS PRTO: Bleb, NE Rev. 109
~ ^ SEWER TAP ^ SEWER ^ SEPTIC - LJ WATER.TAY
-~- ^ REMOTE ^ WATER SERVICE
ELECTRICAL:.
ROUGH IN ^ FI~f"I'URES ^'FINAL " ^ MOTORS.
• ~ ^ PERMANENT SERVICE
~ ^ TEMPORARY SERVICE
~
~ MECHANICAL:
^ ROUGH-IN ^ A/C ^ FINAL
PLUMBING:
•. ^ GROUNDWORK ^ ROUGH-IN ^ FINAL
RESULTS OF THE INSPECTION: SED (s~xoTES) ' ^ FAILED (s~xo~s)
1
REMARKS
:
NOTFS/
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~- :INSPECTOR:.. - -
_
y y~
_ DATE OF INSPECTION MADE: / '~~ / ~ T~?E~ ,/u '~ -
• ~ CALLED OPPD\ TO CONNECT SERVICE: ^ YES ^ NO'
WANT OFFICE STAFF TO CALL OPPD\ ^ .YES ^ NO BLR 1
:..
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