BP6010BUILDING PERMIT APPLICATIO~IV
Jurisdiction of City of Blair, Nebraska
218 South 16th Street 6 010
Blair, Nebraska 68008
(402) 426-4191 Permit
Application Date: g' ~ "~~7 Issue Date: ~ ~ ~~/ Permit Fee: $ '~
JOB ADDRESS
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LEGAL
1 ' DESCR. LOT NO. BLK. TRACT
^ SEE ATTACHED SHEET
2 OWNER CQr ~/ ~~ AYC.C.~RES ZIP PHONE
`
MAILADDRESS PHONE LICENSE NO.
,3. CONTRACTOR
USE OF BUILDING
4.
5. Class of Work: NEW ^ ADDITION ^ALTERATION ^ REPAIR ^ MOVE ^ REMOVE
6. Describe Work: ~ ~~
]. Sq. FOOtage Of StrUCture (Includi g Basement and Garage):
8, Change of Use From: Change of Use To:
g, Valuation of Work: $ 5()~ ,
10. Floodplain: Floodwey 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 Required: Yes^ No^
15. Minimum Setbacks: Front Side Rear_
16. Sidewalk Required: Yes^ No ^ Waiver Approved
Site Plan Attached Complete Plans Attached ^
Approximate Co pletion Date
Inspections Required and Fees
Utilities
Sewer Tap Water Tap
Sewer Water Service
Septic Remote -
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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 a copyof this application form signed bythe Building Inspector and stamped
'APPROVED'.
I her y ree to perform the proposed work in accordance with the specifications set forth
ab a an in accordance with the codes~ordin es of the City of Blair and the State of
Ne rask I understand that this permit is voi If ork is not commenced within 180 days
of mpleted within ears o s e.
~.~-~'
S A RE _- WNER~CONTRACTO OR AUT ORIZED AGENT DATE
Footings
Framing
Rough-in
Final
Temporary Service
Permanent Service
Mechanical
Rough-in ABC _
Final
Plumbing
Ground Work
SIGNATURE OF OWNER (IF OWNER BUILDER) DATE Rough-in final
WHEN PROPERLY VALIDATED (IN THIS SPACE) TH IS YO P MIT
Comment: Approved By:
POUNDS PRTG: Blelr, NE ~ [ / Rev. 10)91
THIS AGREEMENT EXISTS BETWEEN CARGILL AND RON HANSEN, OWNER AND OPERATOR
OF HANSEN TREE FARM. IT ALLOWS FOR THE PLACEMENT OF A 4'X 8' SIGN ON
HANSEN TREE FARM DIRECTLY BELOW THE EXISTING HANSEN TREE FARM SIGN.
PAYMENT FOR SIGN RENTAL SHALL BE $240 PER YEAR PAYABLE IN ADVANCE,
EFFECTIVE ON COMPLETION OF SIGN CONSTRUCTION.
THIS CONTRACT MAY BE CANCELED AT ANY TIME BY EITHER PARTY PROVIDING
THREE MONTHS NOTICE IS GIVEN.
HANSEN TREE FARM
~ ~l~ ~4
CARGILL
DATE
A lication for Outdoor Advertising Permit
EBRASKA pp
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THE FOLLOWING MUST BE ATTACHED TO THIS APPLICATION •
copy of the lease with the landowner for all signs erected after March 27,1972, as per the Rules & Regulations. •
,
A copy of the sketch showing the location of the sign. (Sketch may be drawn on the back of this application.)
of the Permit from the Local Permit Authority or a copy of a written approval from the Local Permit
A cop z -o
y
,.
will issue a permit contingent upon the Department of Roads issuing a permit.
that the
it
th
A ~
y
or
y
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DATE OF APPLICATION: EXISTING SIGN -GATE ERECTED: • • • 6137 -{
TYPE OF SIGN ••
NAME OF SIGN OWNER: SINGLE FACE POSTER PANEL (Pa er Faced
~~/L(~~j~1 ~ - DOUBLE FACE WOOD SUPPORTS
BOX/STRE T oR ou- T~r3-o.: BACK-TO-BACK STEEL SUPPORTS
SIDE BY SIDE PAINTED BULLETIN (Painted Fgcs)
ctr ,STATE !. Z c V-TYPE WOOD SUPPORTS
STACKED Sl EEL SUPPORTS
TELEPHONE NUMBER: TOTAL NUMBER OF FACES: Z,
NAME OF LANDOWNER: OTHER: (Speci/y)
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~~~1~'~ SG r v
BOX/STREET OR ROUTE NO.: '
~~~ .~~ ~QX ~Q Z Wood O plastic
CIT^~ STATE 6 Z~IP(CGO7~DpE
:d~ Metal O Other (Spec!/Y! --------------•----------------°°-
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• • • e • e
' LENGTH ~ HEIGHT AREA SQ. FT.
ncies
bli
A
P LENGTH HEIGHT AREA SQ. FT.
ge
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Owned and maintained by Public Offices or F
Ip within territorial jurisdiction. LENGTH HEIGHT AREA T.
SQ.
IE School Bus Shelter LENGTH HEIGHT AREA ~ SQ. FT.
II/fj For Sale (INTERSTATE) • ~ • •
E
(f
l
R: (Spec
y
a YES SCOTCHLITE OTH
~ (C "On-Premise" (INTERSTATEI
Distance Iron building or main activity:-__--___-_-__ FEET
NO REFLECTIVE PAINT
~ • •
III Advertising Sign (BILLBOARDI
owned and
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bli ~ YES MERCURY VAPOR FLUORESCENT
aces
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Informational Sign pertaining to pu
IVA operated by governmental entity (Federal, State or Locall ~ NO QUARTZ INCANDESCENT
Local Government or Civic Organization, Churches, Public
OTHER: (SpeclfY)
IV Institutions, Service Clubs, Schools
ATTACH A PICTURE OR MAKE A DRAWING OF THE SIGN IN THIS SPACE:
Farm or Ranch Directional -Miles to farm or ranch from
V highway
• • • •
CITY: ( Name o/ Town) COUNTY:
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ZONED UNZON6D OTHER: (SpeclfY) r
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Cf1MME RC_IAL. COMMERCIAI
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