BP5406r
BUILDING PERMIT APPLI
Jurisdiction of City of Blair, Nebraska
218 South 16th Street
Blair, Nebraska 68008
(402) 426-4191
AGENT DATE
Application Date: C' , C~ -C(.~ Issue Date: ~ ° ~ - ~ •~ Permit Fee: $ ~0-U ~~
JOB ADDRESS
1 ' DESCR, LOT NO. ~ ~ / ~ BLK. TRACT ~f` ~ ` (~ j
( l Q" / /
^BEEATTACHEDSHEET
2. OWNER MAILADDRESS
'~a--h ~-~ 1'~~ CI c~ ~,C ZIP PHONE
3. CONTRACTOR , b •^ MAILADDRE ~ L X~ ~~• `x. /c_!'1'1L'~~~~ ~~~' ~ 7~ LICENSE NO.
USE OF BUILDING
4.
5. Class of Work: ^ NEW ^ ADDITION ^ALTERATION ^ REPAIR ^ MOVE ^ REMOVE
6. Describe Work: C ~~ `~ i~QCyYI f~ CJC~.~ C, ~ ~-C'`--° ~Cl /i ~~ ~~Cf~
7. Sq. Footage of Structure (I~duding Basement and Garage):
8, Change of Use From: Change of Use To:
g, Valuation of Work: $ ~ 3 C3 CCU • CC
Floodway Yes ^ No ^
10. Floodplain: 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. Minimum Setbacks: Front Side Rear
16. Sidewalk Required: Yes^ No ^ Waiver Approved _
APpLICATI\~ON ~~ ~,ED BY I PLANS CHECKED BY I APPROV~ ISSUANCE BY I
' 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 not completed within 2 years of date of issyg,,,
~ `-~~
OR
SIGNATURE OF OWNER (IF OWNER BUILDER)
Site Plan Attached ^ Complete Plans Attached ^
Approximate Completion Date ~~,~3C~- ~_3
Inspections Required and Fees
Utilities
Sewer Tap Water Tap
Sewer
5406
Permit
Water Service
Septic Remote
Building ~-ZN`r13~ Sell Actk~ve
Footings Drywall
(before finish) '/ ~Q,~~
Framing' Final r~1-Z(o~ y,~~
Electrical
~ aLJ
Rough-in Fixtures
Final Permanent Service
Temporary Service
Mechanical
Rough-in ABC
Final
Ground Work ~ Plumbing
DATE Rough-in ,~/ ' 12 •v ~ P~c,v~l, Final
WHEN PROPERLY VALIDATED (IN THIS SPACE) THIS ISYOUR-PERMIT
CATI®N
Comment: Approved ~
- ~ BUILDING P~RMITAPPLICATION
Jurisdiction of City of Blair, Nebraska
218 South 16th Street
Blair, Nebraska 68008 5 4 41
r~ _ (402) 426-4191 Permit
Application Date: / ~ Issue Date: ~ ~ ~ 1' ~~~ Permit Fee: $
JOB ADDRESS
LEGAL
1 ' DESCR. LOT NO ~ J~
( BLK• TRACT ~ ~ ~ (~ /J
/ ^ SEE ATTACHED SHEET
2, NER ~' MAILADDRESS ZIP PHONE
3. CO ACT MAILADDRESS ^ ~ HONE-) LICENSE NO. ` _
!/ (/~Q[/~
USE OF BUILDING
4.
5. Class of Work: ^ NEW ^ ADDITION ^ALTERATION ^ REPAIR ^ MOVE ^ REMOVE
6. Describe Work: ~[
], Sq. FOOtage of StrUCture (Including Basement end Garage):
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 _
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 bythe Building Inspector and stamped
'APPROVED'.
thereby 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 1 SO days
or is np~orgpleted within ?„year~f date of issue. t
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
. ~.o Electrical
Rough-in Fixtures
Final ~~ ~ Permanent Service
Temporary Service
Mechanical
Rough-in ABC
SIGNATURE OF OWNER/CONTRACTOR OR AUTHORIZED AGENT DATE
Final
Plumbing
Ground Work
SIGNATURE OF OWNER (IF OWNER BUILDER) DATE Rough~in Final
WHEN PROPERLY VALIDATED (IN THIS SPACE) THIS IS YOUR PERMIT
Comment: Approve
,.
OUNOS PRTG -fllelr. NE flev. 1019
BUILDING P~RMITAPPLI
Jurisdiction of City of Blair, Nebraska
218 South 16th Street
Blair, Nebraska 68008
CATIO N
5441.
Permit
_ (402) 426-4191
r~ c
Application Date: ~ 'Issue Date: ~ - ~ 1 ~ ~-~ Permit Fee: $
JOB ADDRESS
1 ' DESCR. LOT NO ~ ~~ BLK. TRACT ~ G
/ ~ r~ //
/ ^ SEE ATTACHED SHEET
NER ~' MAILADDRESS
2. ZIP PHONE
3. CO ACT MAILADDRESS _ ~ HONE LICENSE NO. ` _
(/!d7[IvJ)
USE OF BUILDING
4.
5. Class of Work: ^ NEW ^ ADDITION ^ ALTERATION ^ REPAIR ^ MOVE ^ REMOVE
6. Describe Work: ~[
], Sq. FOOtage Of StrUCtUre (Including Basement and Garage):
8, Change of Use From: Change of Use To:
g, Valuation of Work: $
10. Floodplain: Flooaway Yes^ No ^ Dev. Permit
Fringe Yes^ No ^ 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. Minimum Setbacks: Front Side Rear
16. Sidewalk Required: Yes ^ No ^ Waiver Approved _
ACCEPTED B'~.I PLANS CHECKED 8Y 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 riot 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 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 np~orgpleted within 2„year~f date of issue, t
SIGNATURE OF OWNER~CONTRACTOR OR AUTHORIZED AGENT 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 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 IS YOUR PERMIT
Comment: Approve
A ~
OUNDS PRTG: Blelr, NE Rev. 1018
BUILDING PERMIT APPLI
Jurisdiction of City of Blair, Nebraska
218 South 16th Street
Blair, Nebraska 68008
(402) 426-4191
Application Date:
n
~ -`~1- .~
Issue Date:
~ - ~~n'
CATION
Permit 5 4 51
Permit Fee: $ - ~ V
JOB ADDRESS
1 . LEGAL
DESCR. LOT N!
I L BLK.
TRACT C ~, I ~- ~ ^ SEE ATTACHED SHEET
J
2 OWNER ,-~~~~ ~~ r'` j ^' `
~ ZIP PHONE
MAILADDRESS
~~ ~
CONTRACTOR
3. ~~ V' ; ~ f~C:~..t. MAIL/1DDRESS / PHONE ~~~ ~ ~~ ~ / LICENSE No.
N ' `-l ~~
USE OF BUILDING
4.
5. Class of Work: ^ NEW ^ ADDITION ^ ALTERATION ^ REPAIR ^ MOVE ^ REMOVE
6. Describe Work: ~~ ~~ ~ ~ {~~~ ~-~~~,1,~
7. Sq. FOOtage Of StrUCtur@ (Including Basement and Garage):
8, Change of Use From: Change of Use To:
g, Valuation of Work: $
Floodway Yes^ No Q
10. Floodplaln: Fringe Yes^ No ^ Dev.Permit
BFE EIev.Cert.
11. Current Zoning: Site Plan Attached ^ Complete Plans Attached ^
^
^ Approximate Completion Date
No
12. State Fire Marshall Required: Yes
Inspections Required and Fees
13. Special Use Permit Required: Yes ^ No ^ Utilities
Sewer Tap Water Tap
14. Variance Required: Yes ^ No ^ sewer Water service
15. Minimum Setbacks: Front Side Rear Septic Remote
16. Sidewalk Required: Yes^ No ^ Waiver Approved Building
APPLICATION ACCEPTED BY PLANS CHECKED BY APPROV D FOR ISSUAN C BY Footings Drywall
,, ~ ~ (before finish)
NOTICE Framing Final
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 EleCtriCel
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 Rough-in Fixtures
have received a copyof this application form signed bythe Building Inspector and stamped
'APPROVED'. Final Permanent Service
I hereby agree to perform the proposed work in accordance with the specifications setforth
above and in accordance with the codes~ardinances of the City of Blair and the State of
Temporary Service
Nebras a. I understand that this per ' ' void if ork is not commenced within 180 days
or is t compl within 2 year d of i ue. McChaniCel
Rough-in ABC
SI NATURE NER~C ACTOR 0 A HORIZED AGENT DATE Final
Plumbing
Ground Work
(
SIGNATURE OF OWNER (IF OWNER BUILDER) DATE Rough-in 12 -C~c~ °` yC~
Final
WHEN PROPERLY VALIDATED (IN THIS SPACE) THIS IS YOUR PERMIT
Comment: Approved y:
.~~LG-a-..,.. ,
()1INnC PRTfl _Rlnlr. NF RBY. ~~
;.i
I
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