Loading...
BP5876- BUILDING PERMIT ApPLICATIO~N Jurisdiction of City of Blair, Nebraska 218 South 16th Street Blair, Nebraska 68008 5 8 7 6 (402) 426-4191 Permit Q ~" ~ -~© Apphcatlon Date: ~ r ~ Issue Date: ~ ~ Permit Fee: $~/ JOB ADDRESS / LEGAL 1 ' DESCR. LOT N0. BLK. TRACT ^ SEE ATTACHED SHEET 2, OWNER ~ MAIL AD ~ RESS ZIP PHONE 3, CONTF~AC OR ~ MAILADDRESS ~~~ /LICENSE NO. C/~> C~ USE 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. FIOOdplaln; Floodway Yes ^ No ^ Dev. Permit Elev. Cert. Fringe Yes^ No ^ BFE 11. Current Zoning: Site Plan Attached ^ Comple~Pl~ tt ched ^ 12. State Fire Marshall Required: Yes ^ No^ Approximate Completion D ate , 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 LIC ION ACCEPTED. BY PLANS CHECKED BY APPROVED FOR ISSUANCE 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 Electrical 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 acopy of this application form signed bythe Building Inspector and stamped ' ~APPRDVED~. Final Permanent Service 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 Temporary Service Nebraska. I understand that this permit is void if work is not commenced within 180 days or is not co ted wit ' )years o,d of i stye Mechanical Rough-in ABC S NATURE OF OWNER)CONTRACTOR OR AUTHOgI 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: By: POUNDS PRTG: Bleb, NE Rev. 10191 ~~~~ ~ t -, ~r ` ~'~EIr.a t +~ ~ . ~,y--~z 1 ~~ ;~ CTI'Y~.g1A,IR ~ ' :L CATION OF INSPEC ~~,, ,' NAME OF OWNER, >:. `~r ~, :TIME INSPECTION REQIJESTEG ;. ;"; =,u- ia:~-n, ,g ;r'1 ~' ~ E ~~ ELECTRICAL ~ .~. ~r~~'~~Y ~~~~ ~ ~ ` ' H~-~ ' .`~ ' ~,h [~~tOUGIi FIXTi)RES ~' Ws~~~ L.s ~ ~ ~' ~ } ~ (]MOTOR - ` .~ , 1 . S ~- '~ ,.C]-PERMANENT SERVZCE~' ' [] ~ ~ ; ~ TEMPO ~ ~ °~~,. v ~ , G RARYSERVICE T :- F~ ~ .,~..F ~ ~IGIECHANICA ~~ ~ '~ ~ ~ r s fy.'.1.i f '~ L ;.,:; ~ r =~ r~ ~, ~~'; ~'ROUGII IN ' D A/C i - ^ FINAL, ~ ' , f~ ~ _ ~ _ PLUMBING t , ^ GROUNDv/ORIC? - Q;ROUGH-IN ^ FINAL~r , - ~, ~ _ - 1~ RESULTS OF THE INSPECTION PASSED'~sr.~xoTees) ~~FAILED _ ~ sEr CS ~ xo nz T ~ ~ ~~~ NO~S/REMARKS ~, ~,~~,~ ~~~ ~ ~ ~ •5 INSPECTOR: - .~ `~ ~ - DATE OF INSPECTION MADE ; TIIvIE. ~2~ ~ `d CALLED OPPD\ R TO CONNECT SE VICE: ^ YES ' ~~] NO WANT OFFICE STAFF TO CALL OPPD\ ~, 0 YES ~~~ t x []NO BLR 1 ` .