BP5965a
- BUILDING PERMIT APPLICATION
Jurisdiction of City of Blair, Nebraska
218 South 16th Street
Blair, Nebraska 68008 5 9 6 5
(402) 426-4191 Permit_
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Application Date: Issue Date:
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Permit Fee: $ (~~ -
JOB ADDRESS
LEGAL
1' DESCR. LOT NO. BLK. TRACT ^ SEE ATTACHED SHEET
OWNER AIL ADDRESS ZIP PHONE
3. CONTRAC OR MAI RESS ~ /~ ~. PHON ~
! ~LIC~NSE~~~~
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USE OF BUILDIN
4.
5. Class of Work: ^ NEW ^ ADDITION ^ALTERATION ^ REPAIR ^ MOVE ^ REMOVE
6. Describe Work: ~ ~~~-- ~ ~ ,~ L/
7. Sq. FOOtage Of StrUCtUre (Including Basement and Garage):
8. Change of Use From: Change of Use To:
g, Valuation of Work: $
10. FIOOdplaln: Floodway Yes ^ No ^
Fringe Yes^ No ^ Dev. Permit Elev. Cert.
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 _
Site Plan Attached ^ Complete Plans Attached ^
Approximate Completion Date
Inspections Required and Fees
Utilities
Sewer Tap Water Tap
Sewer
Septic
Footings
Building
ACCEPTEp 8Y 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 set forth
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 comme ced with'n 180 days
or is not complete in 2 ear f date of ' sue.
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SIGNATURE OF OW NTfiQ R 0 AUTHORIZED AGENT DATE
Framing
Water Service
Remote
Drywall
(before finish)
Final ~ Z << I
Electrical
Rough-in Fixtures
Final / _ Permanent Service
Temporary Service
Rough-in_
Final
Ground Work
Mechanical
- ABC
Plumbing
SIGNATURE OF OWNER (IF OWNER BUILDER) DATE Rough-in Final
WHEN PROPERLY VALIDATED ONTHIS SPAG€}~-kIIS IS YOUR PERMIT
POUNDS PRTG: BIeV, NE Rev. 10/91
~ .V~UILDING INSPECTION REPORT
• ~
CTPY OF ~~ AIR ~ . ^ WASHINGTON COUNTY ^ OTHER 7 ~ ~ - ~)C~
Z.
LOCATION OF INSPECTION: ~~ ~ ~ ~~~ ~ ~ ~~ ~~ ~~~- ~
- i ~ n r--'
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. NAME OF OWNER: :.JL~ ~~ ~ CONTRACTOR: `-
DATE INSPECTION REQUESTED: /~' ~ ~~ r PERMIT N0:
TIME INSPECTION REQUESTED: ,, ~ l ~~(;
~V
TYPE OF INSPECTION REQUESTED: l~~f ~ .
k.
BUILDING: ~` ~
/'~
~~ ^ FOOTING ^ FRAMING ^ DRYWALL FINAL ~ G~
Ij UTILITIES: r;~
~ - ~'
^ SEWER TAP ^ SEWER ^ SEPTIC ^ WATER TAP
^ REMOTE ^ WATER SERVICE
~; _
', ELECTRICAL: _ _
..
^ ROUGH III!'` G[~FIXTURES ^ FINAL r., ~ ~~1 ~Ia~oxs ~ ~ ~_)
i
^ PERMANENT SERVICE ^ TEMPORARY SERVICE-
' MECHANICAL: -
^ ROUGH-IN ^ A/C=' _ ^ FINAL .
PLUMBING:
<_ ~
s= - _ _ ;
^ GROUNDWORK ~ ^ ROUGH-IN ^-FINAL ,
RESULTS OF THE WSPECTION:~PASSEl1(s~rio~rES) . ^FAILED.(s~xo~rFS)
NOTES/REMARKS:
INSPECTOR: ~l~"
DATE OF INSPECTION.MADE: ~ ~2/ ~ ~ TIME:. !!d ~`S~ -
/ f
CALLED OPPD\ TO CONNECT SERVICE: ^ YES ^ NO
~ .:. , . WANT OFFICE STAFF TO CALL OPPD\ ^ YES ^ NO BLR 1