BP6334N(P
BUILDING PERMITAPPLI
Jurisdiction of City of Blair, Nebraska
218 South 16th Street
Blair, Nebraska 68008
(402) 426-4191
Application Date: ~ / ~ ~ 1 I~ Issue Date:
Permit
6334
00
Permit Fee: $
JOB ADDRESS
LEGAL
1 ' DESCR. LOT NO. BLK. TRACT
^ SEE ATTACHED SHEET
2. OWNER ~ C~tJ~ MAILADDRESS ~~ c •ZIP Z' I~ ~C'CI~ONE
3, CONTRFjCrT
U R ~ LADDCRESS ~ I ~ ~ HONE s ({ S 3 ~ 77 ~ 1LIC~EN~ N~
1 ..~ C-
BUILDING
4. USE OF
5. Class of Work: ^ NEW ^ ADDITION ^ALTERATION ^ REPAIR ^ MOVE ^ REMOVE
6, Describe Work: ~~ l~ Q-~~ ~ ti ~~~~ !
7. Sq. Footage of Structure (Including Basement and arage):
$, Change of Use From: Change of Use To:
g, Valuation of Work: $
10. Floodplain: Flooaway Yes ^ No Q 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 _
APPLICATION ACCEPTED BY f 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 set forth
above and in accordance with the crodes/ordinances of the Ciry of Blair and the State of
Nebraska. I understand that this permit is void if work is not commenced within 180 days
or is n completed i In 2 years of date of issue.
' ~ ~ i anti- z -~~ -~ y
SIGNATURE 0 NERJCONTRACTOR 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)
~
~G~~y~'
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: Approved
CATION
POUNDS PRTG: Blelr, NE Rev. 70/91
r
' ~ ~ LDIN~ INSPECTION REPORT.
i
CITY OF BLAIR ^: WASHINGTON COUNTY ^ OTHER
~
~
~ ' LOCATION OF INSPECTION: I ~ c~ o: ~Q (1~'~ S-~ '-' _
~ rU~ ~~1 ~ -CONTRACTOR;-
NAME QF OWNER
T ~ ~
.
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MIT N0:
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~ . =DATE INSPECTION REQUESTED:,
TIME INSPECTION REQUESTED: I ~ ^~ ~ J
._
.TYPE OF INSPECTION REQUESTED
~ ~~~
'.BUILDING
rj JJ
1 n
^ FOOTING ^ FRAMING ..^ DRYWALL ~ . FINAL .
;. ,: . ~ ,
UTILITIES:
. : ^ SEWER TAP ^ SEWER ^ SEPTIC "^ WATER TAP
• ^ REMOTE., ' ^ WATER SERVICE
i
:ELECTRICAL: -.
,.
i ~ ^ ROUGH IN ^ FIXTURES ^ FINAL 1 ^ MOTORS _
~ -
^ PERMANENT SERVICE , ^ TEMPORARYSERVICE
MECHANICAL:;:
'--,^ ROUGH-IN ^ A/C ^ FINAL
PLUMBING:.
1