BP6576C
BUILDING PERMIT APPLICATION
Jurisdiction of City of Blair, Nebraska
218 South 16th Street
Blair, Nebraska 68008 . ~ 6 5 ~ 6
(402) 426-4191 Permit
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Application Date: (y / ~ !~ Issue Date: ~~ Permit Fee: $
~. ,. J /~ ,
JOB ADDRESS ~ ',n^
1 ~~ `~
LEGAL
1 LOT N0. BLK. TRACT ^ SEE ATTACHED SHEET
' DESCR.
2. OWNER f~^ ~ MAILADDRESS r~~ ZIP
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' r l PHONE
MAILADDRESS
3. CONTRACTOR PHONE LICENSE NO.
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): I
8. Change of Use From: Change of Use To:
g, Valuation of Work: $
10. Floodplain: Floodway Yes^ No ^ Dev.Permit
Fringe Yes^ No ^ BFE EIev.Cert.
11. Current Zoning: ~C'~ Site Plan Attached ^ Complete Plans Attached ^
12. State Fire Marshall Required: Yes ^ Nom Approximate Completion Date
Inspections Required and Fees
13. Special Use Permit Required: Yes ^ No ~ utilities
Sewer Tap Water Tap
14. Variance Required: Yes ^ Nom 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 condi-
tioning, and septic systems. By my signature below, I acknowledge that payment of the Electrical
building permit application fee does not constitute issuance of this building permit. (further
shall not be commenced until I
ti
li
it
i / p0
~
ca
on
s perm
app
agree that cronstruction covered by th Rough-in Fixtures
have received a copy of this application form signed bythe Building Inspector and stamped
' p
Fi
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.
'APPROVED na erv
ce
Permanent
I hereby agree to perform the proposed work in aa:ordance with the specifications setforth
f
d
h
S
Temporary Service
tate o
t
e
above and in accordance with the codes~ordinances of the City of Blair an
Nebraska. I understand that this permit is void if work is not commenced within 180 days
or is not completed within 2 years of date of issue. Mechanical
Rough-in ABC
SIGNATURE OFOWNER/CONTRA TOR 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: Approved By:
POUNDS PRTG: Blair, NE
City of Blair
218 South 16th
Blair, Nebraska 68008
402-426-4191
Fax - 402-426-4195
~~~
_suly 6.,.1995
. .!like ..Davis...:. .
_ 1333. Lincoln.
Blair, NE 680Q8 y.
__ Dear Mr. Davis.r
Oa June- 30 ,. 199.5.,. you applied for. a ht~ild**+g_ permit aad_ an.
electrical permit fcr a,she~d on your property. _W:e havee been unable
to issue this permit as a. plot plan. drawing was not submitted.. at
the time of application..
Please drop off a plat plan.drawing as soon as._possible._ We.
will also need the sire of the proposed boil ding .
Also, enclosed is a refund of $12...00 fnr the electrical-.p.ermi.t.
you applied for....We .are .unable to issue this permit.:as ..you are not.
the property owner. A licensed eleatriciaa.wil.l need, to obtain_a
permit and hook-up the electricity t.o the shed. _ Y.a~t~.:must...._ ,-.
disconnect the electricity- immediately. An inspection. of the ._
property wi 11 be made on. Zul y 14, . 1995... to make sure. you. have.
complied with this request.
We would appreciate your prompt =expanse t.a the. above
_. reques is . Thank . you in advance ..for your . cooperation, , ..Shaul d yosi
have an.y questions. feel free to contact either myself.. or Rodney
Storm,-.City Adminis.tratox. _
Sincerely,
Brenda Taylor
City of Blair
-' promises
f ~~
-~ ~ BUILDING PERMIT APPLICAT O ~ ,~~~
Jurisdiction of Cfty of Blair, Nebraska „~!~~
218 South 16th Street v 6 5 ~ ~
Blair, Nebraska 68008 permit
(402) 426-4191
no
Issue Date: Permit Fee: $ 1 ~ -~
ApNlication Date:
JOB ADDRESS ~ I .L
BLK. ~/y-\ I TRACT ^ SEE ATTACHED SHEET
LEGAL LOT NO.
1. DESCR. ZIP PHONE
~ MAIL ADDRESS
2. OWNER LICENSE NO.
MAILAD RESS PHONE
3 CONTRACTOR
4. USE OF BUILDING
ADDITION ALT TION REPAIR ^ MOVE ^
5. Class of Work: NEW ^
6. Describe Work:
7, Sq. Footage of Structure,. (locluaiog Basement aRa Garage):
$, Change of Use From:
g, Valuation of Work: $
Floodway Yes ^ N ^
10. FIOOdplaln: Fringe Yes^ No Dev. Pe mit._
BFE
11. Current Zoning:
State Fire Marshall Required: s ^
12 ~^
.
13. Special Use Permit Required: Ye ^ N ^
14. Variance Required: Yes^ o^
15. Minimum Setbacks: Front Side Rear_
16. Sidewalk Required: Yes^ No ^ Waiv r Appro ed
APPLICATION ACCEPTED BY PLANS CHECKED BY APPRO D FOR IS ANCE BY
NOTICE
Separate permits are required for electrical, plumbing, heating, ventilatin nd 'r condi-
tioning, and septic systems. By my signature below, I achnowledge that pa a of the
building permit applicatlon fee does not constitute issuance of this building perm urther
agree that construction covered by this permit application shall not be commenced until I
have received acopy of this applicationform 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 th 180 daos
Change of Ube To:
Elev. Cert.
Site Plan A ched ^ Complete Plans Attached ^
Approxim Completion Date
Inspections Required and Fees
Utilities
Sewer Tap Water Tap
Sewer Water Service
Septic Remote
Building
Footings Drywall
(before finish)
Framing Final
Electrical
° a Fixtures
Rough-in
Final ~ ' Permanent Service
Temporary Service
Nebraska. I understand that this permit is void if work Is not commenced wlthln Y Mechanical
or is not completed within 2 years of date of issue.
Rough-in ABC
SIGNATURE OF OWNERfCONTR CTOR OR AUTHORIZED AGENT DATE Final plumbing
' ~ Ground Work
A DATE Rough-in Final
SIGNATURE OF OWNER (IF OWNER BUILDER)
WHEN PROPERLY VALIDATED (IN THIS SPACE) THIS IS YOUR PERMIT
Comment: Approved By:
Rev. 1081