BP6557~~ c,k- /~d z~~3 !r ~0~3~~~
BUILDING PERMIT APPLICATION
Jurisdiction of City of Blair, Nebraska
218 South 16th Street
Blair, Nebraska 68008
(402) 426-4191 Permit_
Application Date: ~ (~~ ~S Issue Date:
(p`3~~CrS
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Permit Fee: $ ~~
JOB ADDRESS ~ ~ ~ ~~~~~_ ~~
LEGAL
1. DESCR. LO
~ BLK. TRACT ~j / ') i ^ SEE ATTACHED SHEET
~~ ' ~ J ~
2. OWNF~-- MAILADDRESS ZIP PHONE
3. CONT \1 n
'~!/„l.- M ADDRESS PHONE LICENSE NO.
USE OF BUILDING
4.
(ec `
~ "
5. Class of Work: ^ NEW ^ ADDITION ^ALTERATION ^ REPAIR ^ MOVE ^ REMOVE
6. Describe Work:
7. Sq. Footage Of StrUCtUre (Including Basement and Garage): ~ ~ ~ a
8. Change of Use From: Change of Use To:
g, Valuation of Work: $
I ~-
~ C~ ~~
10. Flood lain: Flooaway Yes ^
p Fringe Yes^ No _
No ~~ Dev. Permit Elev. Ced.
BFE
11. Current Zoning;
~ L
12. State Fire Marshall Required: Yes ^ No0-
13. Special Use Permit Required: Yes ^ No [~-'
14. Variance Required: Yes^ No[~-
15. Minimum Setbacks: Front~Side ~ Rear '
16. Sidewalk Required: Yes^ No O'Waiver Approved
ACCEPTED B~l PLANS CHECKED BY I APPROVED FOR ISSUANCE BY
" L 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 commenced within 180 days
or is nod mpleted w' in 2 year~f d~ issue.
iL ~~t' a~~_~~+'.~~~.(~ ~' '
SIGNATURE OF OWNER~CONTRACTOR OR AUTHORIZED AGENT DATE
Site Plan Attached ^ Com t Plan ttached ^
Approximate Completion Date ~ 3a ~
Inspections Required and ees
Utilities
Sewer Tap Water Tap
Sewer Water Service
Septic Remote
_ Building
Footings ~'~~ ~~ Drywall
(before finish)
Framing >/ Final's ~ U ~I ~ ~~
Electrical
Rough-in ~ Fixtures
Final ~ ~- Permanent Service ~l~'~~`~?~
Temporary 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) THIS IS YOUR PERMIT
~~
~aas.~-
6557
Comment: Appro y „~.
~"'~
viuuns aam .aiotr NF Rev. 108
~ s ~ s 7/
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BUILi~ING PERMITAPPLI
Jurisdiction of City of Blair, Nebraska
218 South 16th Street
Blair, Nebraska 68008
(402) 426-4191
Site Plan Attached ^ Complete Plans Attached ^
Approximate Completion Date
Inspections Required and Fees
Utilities
Sewer Tap Water Tap
Sewer Water Service
Septic Remote
Application Date: p ' Z- e -~ ~ Issue Date: 0 ~~ ~ ~~~ Permit Fee: $ ~ G~
JOB ADDRESS
LEGAL
1 ' DESCR. LOT N0. BLK. TRACT
^ SEE ATTACHED SHEET
2, OWNER MAILADDRESS ZIP PHONE
~~ ~ ~-
r3 CONTRACTOR ~~ c~~ M 14A TRESS ,,7 PHONE LICENSE NO.
r ~~ - ~r ~- ~ ~X Ufa 0
USE OF BUILDING
4.
5. Class of Work: NEW ^ ADDITION ^ ALTERATION ^ REPAIR ^ MOVE ^ REMOVE
6. Describe Work: ~ ~`~ ~ ~~[/"/~~ ~i~ Gt-I`t~ 1~ `_~C~(./ ~ ~C~ C -- ~U ~ c~ ~ ~ U tip
], Sq. FOOtage of StrUCtUre (Including Basement and Garage):
8, Change of Use From: Change of Use To:
g, Valuation of Work: $
10. Floodplain• FlDOdwey Yes^ No ^ Dev.Permil EIev.Cen.
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
'~~/1~~~
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 Inspectorand stamped
'APPROVED'.
I hereby agree to perform the proposed work in accordance with the specifications setforth
above and in accord ce with the codesJordinances of the City of Blair and the State of
Nebraska. I u nd that this permit' d if work is not commenced within 180 days
or is ed within 2 years
~ 6 ~~~. ~.
IGNATURE OF OWN (CONTRACTOR OR AUTHORIZED AGENT DATE
Footings
Framing
CATION
Building
6691
Permit
Drywall
(before finish)
Final
Electrical
Rough-in Fixtures
Final • ~ ~ Permanent Service
Temporary 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) THIS OUR PERMIT
Comment: Approved By: ,(~/' .
(~~ ~/.!
POUNDS PRTG: Blelr, NE
Rev. 1091
°t
TIME INSPECTION REQUESTED: ~ ~~'
TYPE OF INSPECTION.REQUESTED:
P, - \~~'
BUILDING:
3;' [] FOOTING ~ FRAIvIING `DRYWALL INAL ~%
~3',
a UmILITIESr .
~~ ^ SEWER TAP ^ SEWER., :~ SEPTIC ' ' ~ WATER TAP
~r
~~ '; •
't' ~ REMOTE D WATER SERVICE
rR, .
Er
,<
(
ELFC.TRICAL;
z:
~~,. ^ ROUGH W ~~ FIXTURES ~ FINAL ~ MOTORS
' 'PERMANENT SERVICE . _ . ~ [] TEMPORARY SERVICE
{ra
~~: 1}~IECHANICAL:
~` ~ ROUGH-IN D A/C D FINAL
~. ,
r~ .
~~,~,; ,PLUMBING:
~.
~:' Q ROUGH-IN. ~ FINAL
. ^"GROUNDWORK
~; RESiJLTS 0E TH&INSPECTION:,PASSED (sEENoTES> '" D FAILED (sBaxoTES)
~, ~.. ~ -
NOTES/REMARICS: _
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