BP5396BUILDING PERMIT APPLICATION
Jurisdiction of City of Blair, Nebraska
218 South 16th Street
Blair, Nebraska 68008
(402) 426-4191 Permit
5396
~~
c= C_^
Application Date: ~~ Issue Date: _ ~ J ~ ~ Permit Fee: $ (-~~
JOB ADDRESS
~
_
%~~-I V y'
I I
1 LEGAL LOT NO. ~ B
L
K TR 1i l~
/ ~ SEE ATTACHED SHEET
DESCR. (
~
2, OWNE .htAll DDRESS / ~-
~j ~ ~ Zl~f ~ J~~PWONE
J
3. CONTRA 0 MAILADDRESS PHONE LICENSE NO.
USE F BUILDING
4.
~ ~~,
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: $ ~ ~ ~~ ~ ~~
Floodway Yes ^
10
Flood
lain: No ^ Dev. Permit
EIev
Cert.
.
p
FrlRge Yes^ No ^ BFE .
11. Current Zoning: ~ (--
12. State Fire Marshall Required: Yes ^ Nom
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 _
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 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 spe~I ' lions set forth
above and in accordance with the codes~ordinances of the City of fair a d the State of
Nebrask~l understand that this permit is void if work is not com ence ithin 180 days
or is nok mpleted within 2N~;irs..n~date of issue.
OF OWNERICONTRAC70R OR AUTHORIZED AGENT DATE
SIGNATURE OF OWNER (IF OWNER BUILDER)
Site Plan Attached Comple~ PI ns ~a~ d~
Approximate Com letion Date
Inspections Required and Fees
Utilities ~
Sewer Tap Water Tap
Sewer Water Service '~ 1 ~ •~~ ~"~-~
Septic / I ~ ~ ~~ ' I'~m,~ Remote
G,,,~~3
Building
Footings '~~° (~'~ ' C~ Drywall °~
(before finish)
Framing ~ Final ~~."~~~ ~~
Electri ~ li "~~
/a ~u -~~
Rough-in ~Fixtu s
Final r/ ~ ~ ° ~~ Permanent Service
Temporary Service
Mechanical
Rough-in /L~.CY~ - (~'~ S ABC / /O C~C~- ~~S
Final ~ Lo . c`~~ `~
Plumbing
Ground Worker +
Rough-in ~ 12--y0 ` ~1~ Final +~ lo• nC~ - Lin .s
DATE
WHEN PROPERLY VALIDATED (IN THIS SPACE) THIS IS YOUR PERMIT
Comment: Approv ~~%~~ ~.
'OUNOS PRTG: Blelr, NE Rev. 10/B
BUILDING PERMIT APPLICATION
Jurisdiction of City of Blair, Nebraska.
219 South 16th Street
Blair, Nebraska 68008 5 4 2
(402) 426-4191 Permit
Application Date:
a~(~ r~
Issue Date: ~ _ ~ ~ Permit Fee: $ ~~~V
JOB ADDRESS
LEGAL
1 ' DESCR. LOT NO. g
f BLK. TRACT
~,R~~ ('~~ ^ SEE ATTACHED SHEET
2. OWNER C~~ Z~ CM/A¢ADDRESS ZIP PHONE
3 CONTRACTOR ,r~ I / ~ MAIL ADDRESS
IJl C~r~ ~1'PC~21 ~ HONE LICENSE NO.
~ ~J~ ~ '~
USE OF BUILDING
4.
5. Class of Work: NEW ^ ADDITION ^ ALTERATION ^ REPAIR ^ MOVE ^ REMOVE
6. Describe Work: ~.~ -e
7. Sq. Footage of Structure (IRdudiRg BasamaRt and Garaga):
8, Change of Use From: Change of Use To:
g, Valuation of Work: $
Floodway Yes ^ No ^ Dev. Permit
10. Floodplain: Fringe Yes^ No ^ BFE
EIev.Cert.
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 _
BY I PLANS CHECKED BY I APPROVED FOR ISSUANCE BY
NOTICE
Separate per is 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 not completed within 2 years of date of issue.
SIGNATURE OF OWNER~CONTRACTOR 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
Electrical
Rough-in ~ CXl Fixtures
Final ~ Ck) Permanent Service
Temporary Service
Mechanical
Rough-in ABC
Final
Ground Work Plumbing
Rough-in Final
WHEN PROPERLY VALIDATED (IN THIS SPACE) THIS IS YOUR PERMIT
Comment: Approved y:
SOUNDS PRTG: Blelr, NE R~Y• ~~~
BUILDING PERMIT APPLI
Jurisdiction of City of Blair, Nebraska
218 South 16th Street
Blair, Nebraska 68008
(402) 426-4191
Septic 14 ~ ~~ Remote
Application Date: g'2~~ ` 1.> Issue Date: ~ ~~~ Permit Fee: $ ~p~ ~~>
JOB ADDRESS
~~'0~1 ~~ay~S
1 . LEGAL
DESCR. LOT NO. BLK. TRACT ^ SEE ATTACHED SHEET
OWNER MAIL ADDRESS ZIP
2. ~ ~~ e,rJ cJL PHONE
3. CONTRACTOR ~a ~ ~ ~ 1eC~(C ~ ~~~ LADDRESS ~ ~` ~Q X /r PHONE)
V 1`~ ~~~L /~ ~j~~ / ~jLICENSE N0. 7 [~
i '"'' ~ f~ O U~~ z ~l ~~ /~
USE OF BUILDING
4.
5. Class of Work: NEW ^ ADDITION ^ALTERATION ^ REPAIR ^ MOVE ^ REMOVE
6. Describe Work: ~ ~~
7. Sq. FOOtage Of StrUCture (Including Basement and Gerage):
$, Change of Use From: Change of Use To:
g, Valuation of Work: $
10. Floodplain: FIDDaway Yes^ No ^ Dev.Permit
Fringe Yes^ No ^ BFE EIev.Cert.
11. Current Zoning:
12. State Fire Marshall Required: Yes ^ No^
13. Special Use Permit Required: Yes ^ No ^
14. Variance Required: Yes ^ No ^
Site Plan Attached ^ Complete Plans Attached ^
Approximate Completion Date
Inspections Required and Fees
Utilities
Sewer Tap Water Tap
Sewer Water Service ~ ~ . C~~
15. Minimum Setbacks: Front Side Rear
16. Sidewalk Required: Yes^ No ^ Waiver Approved _
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 copy of this application form 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 the State of
Nebraska. I understand that this permit is void if work is not commenced within 180 days
or is of cb leted within 2 y~rs of date of issue.
E ~~...-
G ATURE OF OWNERJCONTRACTOR OR AUTHORIZED AGENT DATE
Building
Footings Drywall -
(before finish)
Framing
5505
Permit
Final
Electrical
Rough-in Fixtures
Final Permanent Service
Temporary Service
Mechanical
Rough-in G~•C~O ABC ~4.CX~
Final ~- ~~ ~
Plumbing
Ground Work
SIGNATURE OF OWNER (IF OWNER BUILDER) DATE Rough-in I ~ • CSC) Final ~ `~
WHEN PROPERLY VALIDATED (IN THIS SPACE) THIS IS YOUR PERMIT
CATION
POUNDS PRTG: Blalr, NE ~ Rev. 10/81
CITY INSPECTION SLIPS i": J7 JO ~~~~5 j~~
Inspection has been requested for~U~ `
Location of Building
y //`lt. ~
N of Comp~a~nyT7
" On l ~ ~it~l {~ •
' y e of In pection
At ~~~,~ ~ ~~ ~ .
Da a Time
Results of the Inspection are: ~/ /~
Ci y Representative '
CITY INSPECTION SLIPS
Inspection -has been requesCed for '--~JQ~
Location of Building •
By u!~~~2.u.~ ~
' ,,N/ame/ o,.f C~omp~,any
Type of Inspection
~t G ~ l~ ~l3
Date - Time
Results of the Inspection are: ~~~
/ +! 1~1--
y Representative
CITY INSPECTION SLIPS
Inspection has been requested for ~~-~~-¢. ~~
Location of Building
By~ ~_t.
Name of C mpany
r
On _ ~a t-~-t
Type of Inspection '
nt ~) ~/ ~
ate Time /
Results of the Inspection are: ~ !/1
Cit ~Rep~ ntative
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