BP5639
Application Date:
BUILDING PERMITAPPLICATIOIV
Jurisdiction of City of Blair, Nebraska
218 South 16th Street
Blair, Nebraska 68008 5 6 3 9
(402) 426-4191 Permit
~ ~,l ~c~
I I ~ `°/ ~ Issue Date: ~ ~ - 2~"~~ ~ Permit Fee: $ ~~
JOB ADDRESS ~ ~ , /~
G~
1 . LEGAL
DESCR. LOT NO. BLK. TRACT ^ SEE ATTACHED SHEET
2. OWNER MAILAD RESS t
=' ~ 2 ~ /~i d 67'1 ZIP ` C. ~. PHONE
~ ~. (r _. _ ~ C,~, ~
3. CONTRACTOR
~- MAILADDRESS PHONE LICENSE NO.
4. USE OF BUILDING
5. Class of Work: ^ NEW ^ ADDITION ^ ALTERATION ^ REPAIR ^ MOVE ^ REMOVE
6. Describe Work: f-; ~ ~ ~ ' ~~ '~~
7. Sq. Footage of Structure pnduaing easement ana Garage): ~, . J ~~
,~
8. Change of Use From: Change of Use To: ~ ~~
g, Valuation of Work: $
10 Floodplain: Flooaway Yes ^ No ^
Fringe Yes^ No ^ Dev. Permit
BFE Elev. Cert.
11. Current Zoning:
12. State Fire Marshall Required: Yes ^ No^
13. Special Use Permit Required: Yes ^ No ^
14. Variance Required: Yes ^ No ^
15. Minim~fm Setbacks: Front Side Rear
16. Sidewalk Required: Yes^ No ^ Waiver Approved _
8Y f PLANS CHECKED BY f 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 permitapplication 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 unde s and that th' a it is void if work is not commenced within 180 days
or is not comple within ears of of•issue.
SIGNATURE OF 0 NERD NTRACTOR 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
G~ Electrical
Rough-in Fixtures
Final Permanent Service
Temporary Service r-
Mechanical
Rough-in ABC
Final
Ground Work Plumbing
Rough-in Final
WHEN PROPERLY VALIDATED (IN THIS SPACE) THIS IS YOUR PERMIT
Comment: Approve
1
~UILDING_.IN~PECTION REPORT
- ~~ ~ _
CCITY~AIR ' ^ WASHINGTON COUNTY ^ -OTHER
-_ .. ~ L ,<
'LOCATION OF INSPECTION: '~ ~ ~~ 't'~-~ ~ I`~ S 1 ' '
' NAME DF OWNER: ` )~ 1 / J~X r I" ~ ~ CONTRACTOR: S C~l~~
~` DATE INSPECTION REQUESTED:. ~ ~^ ~ 1 pERIy1iT NO: ~ ~~~
;~
TIME INSPECTION REQUESTED: ~ ~ ~ UU ' ~~~ - I~-~ ,- -
v. _
TYPE OF INSPECTION REQUESTED:
BUILDING:' t
k.
,~ ^ FOOTING ^ FRAMING ^ DRYWALL ^ FINAL ~~, ~ -
.~
UTILITIES i :, - -
-~F,, ;
r-
^ SEWER TAP ^ SEWER ^ SEPTIC ^ WATER TAP~'~~ -
^ REMOTE ,^ WATER SERVICE ,. 1_ ;,',IIVJJ
C~-~' - '- ° ~ .
ELECTRICAL: ~
''':~ _
- ^ ROUGH IN _ q~^ FIX'T'URES FINAL ^ MOTORS -~ ~ ~
' ^ PI~tMANINT SERVICE ^ TEMPORARY SERVICE t
`:
MECHAMCAL: '
^ ROUGH-IN ^ A/C ^ FINAL
-~ :'• ,
PLUMBING:
^ GROUNDWORK ^ ROUGH-IN ^ FINAL ~ ' ~- ~
- - (
RESULTS OF THE INSPECTION: PASSED (sEExorES) ^FATLED (s~xo~s) 4_ -•' ,
N~,O~T~E~`S/REM S: cr rse~r .t...cl~R _~, ca. !' <<~` C~-'
- '`_ -- /
INSPECTOR: = _ ~ - _ -_
-\~, _ r~
DATE OF INSPECTION MADE: cl TIME; ~ G,-~~~~
. ,f
CALLED OPPD\ ~ ! TO CONNECT SERVICE: ES ^ NO ` `"
WANT OFFICE STAFF TO CALL OI'PD\~
^ YID ^ N0 BLR 1 : ; , _
--- -- ::
-- - ~~