BP5801- - BUILDING PERMIT APPLICATION
Jurisdiction of City of Blair, .Nebraska
218 South 16th Street
Blair, Nebraska 68008 5 8 01
(402) 426-4191 Permit
`~~
Application Date: ~ Issue Date: ~ - ~ Z ~~`rt Permit Fee: S
JOBADDRES~ ~,~~ /~ ~-
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LEGAL
1 ' DESCR. LOT NO. BLK. TRACT
^ SEE ATTACHED SHEET
2. OWNER '`MAIL ADDRESS ZIP PHONE
3. CONTRACT - ~ / M IL'A~ ESS ~/~`~ ~ --. ~~ `~~~ ~ LI N '~ ~
USE OF UILDING
4.
5. Class of Work: ^ NEW ^ ADDITION ^ALTERATION ^ REPAIR ^ MOVE ^ REMOVE
6. Describe Work: ~~~~) ~~,
7. Sq. FOOtage Of StrUCture (Including Basement and Gara ):
8. Change of Use From: Change of Use To:
g, Valuation of Work: $ ~ ~~
j ~> ~ C~
Floodway Yes ^ No ^ Dev. Permil
10. Floodplain:
Fringe Yes^ No ^ BFE
Elev. cen.
11. Current Zoning:
12. State Fire Marshall Required: Yes ^ No^
13. Special Use Permit Required: Yes ^ No ^
Site Plan Attached ^ Comple~ ~~~ ~tt~~hed ^
Approximate Completion Date / ~ y
Inspections Required and Fees
Utilities
Sewer Tap Water Tap
14. Variance Required: Yes^ No^
15. Minimum Setbacks: Front Side Rear
16. Sidewalk Required: Yes^ No ^ Waiver Approved _
APPLICATION ACCEPTED 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 acopyof this application form signed bythe 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 Ciry of Blair and the State of
Nebraska. I understand that this permit is void if work is not commenced within 180 days
or is not mpleted within 2 years of date of issue.
y,
SIGNATURES OWNERJCONTRACTOR ORAUTHORIZED AGENT DATE
Sewer
Septic
Footings Drywall
(before finish)
Framing Final ~ ~ Z~1-9 y
Electrical
Rough-in Fixtures
Final Permanent Service
Temporary Service
Rough-in
Final -
Plumbing
Ground Work
SIGNATURE OF OWNER (IF OWNER BUILDER) DATE Rough-in Final
WHEN PROPERLY VALIDATED (IN THIS SPACE) THIS IS YOUR PERMIT
Water Service
Remote
Building
Mechanical
ABC
Comment: Appro By
'OUNDS PRTG: Blelr. NE Rev. 10/9
~~= BUILDING INSPECTION,-.REPORT
- `~T~F'Y OF BLAIR ^ WASHaVGTON COUNTY ^ .OTHER
-~ LOCATION OF INSPECTION: ~~~~ -~
G~ d~
NAME OF OWNER: 7 ~ CONTRACTOR: / '/;
~~ ~ ~~
DATE Pi iSPECTION REQUESTED: PERMIT , f
TIME INSPECTION REQUESTED:
;I ,
TYPE OF INSPECTION REQUESTED:
BUILDING: ':
^ FOOTING ^ FRAMING
^ DRYWALL ~~ , ,,
FINAL ~fL~'d,/
-
_
`. UTILITIES: `
~ ^ SEWER TAP- ^ SEWER ~ _
i _^ SEPTIC. ^ WATER TAP
^ REMOTE ^ WATER SERVICE
'~ -
_
~ ELECTRICAL:
-
'
^ ROUGH IN ^ FIXTURES ^ FINAL ^ MOTORS -
^ PERMANENT SERVICE
i
~ ^ TEMPORARY SERVICE -
--
-
MECHAMCAL:
', ^ ROUGH-IN ^ A/C
~ ^ FINAL
~
PLUMBING:
~
.
^ GROUNDWORK ^ROUGH W ^ FINAL
RESULTS OF THE INSPECTION:. ~J PAS51ED (s~xo~s) ~ ^ FAILED (sue xo~s)
' V
~
NOTES/REMARKS:
~~
INSPECTOR:
/ ..- _
-DATE OF INSPECTION MADE: 2 TIME: ( ~ ~`~
~ CALLEDOPPD\ TO CONNECT SERVICE: ^YES ^NO `''---
I
WANT OFFICE STAFF TO-CALL OPPD\ ^ YES ^ NO BLR 1
9
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