BP5298=BUILDING PERMIT APPLICATION.
Jurisdiction of City of Blair, Nebraska
218 South 16th Street
Blair, Nebraska 68008
(402) 426-4191 Permit 5 2 9 ~
Application Date: of ~ ~ - Issue Date: ~ ~'~~~ Permit Fee: $ ~S ~~ C,
JOB ADDRESS ~~
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LEGAL
1 ' DESCR. LOT NO. BLK. TRACT ~
~~_("~
^ SEE ATTACHED SHEET
OWNER MA)LADDRESS ZIP P 0 E
3. CONTRACTOR MAILADDRESS
~~.~~ PHONE LICENSE NO.
USE OF BUILDING
4.
5. Class of Work: NEW ^ ADDITION ^ALTERATION ^ REPAIR ^ MOVE ^ REMOVE
6. Describe Work: ~~ ~ O - ~, d ~ - ~ ~ ~ ~ ,~
7. Sq. Footage of Structure pDdudlRg BassmaRt and Garaga):
8. Change of Use From: Change of Use To:
g, Valuation of Work: $ ~,~~~~, ~~
Floodway Yes^ No O Dev.Permit
10 FIOOdplaln: Fringe Yes^ No ^ BFE
EIev.Cen.
11. Current Zoning: ~ r"L
12. State Fire Marshall Required: Yes ^ No[~
13. Special Use Permit Required: Yes ^ No [~
14. Variance Required: Yes ^ No 0--
15. Minimum Setbacks: Front Side Rear
16. Sidewalk Required: Yes ^ No 0-GVaiver Approved _
BY I PLANS CHECKED 8Y
8Y
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 copyof this application form signed bythe Building Inspectorand stamped
'APPROVED'.
I hereby agree to perform the proposed work in accordance with the spedfications 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~not completed wit~h~n 2 years of d~te of ~ssuel I
OF OWNEP{fCONjfRACTOR OR AUTHORIZED AGENT DATE
SIGNATURE OF OWNER (IF OWNER BUILDER)
DATE
Site Plan Attached Complete Plans Attached ^
Approximate Com etion 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
Ground Work Plumbing
Rough-in Final ,
WHEN PROPERLY VALIDATED (IN THIS SPACE) THIS IS YOUR PERMIT
Comment: Approv'~ ~~
POUNDS PRTG: BIeIr, NE nev. luryl
r
CITY OF BLAIR
Application for Building Permit
PLOT PLAN
Address ~ ~ 3 ~.dr~ Z~~~ ~~~ Date ~ ~ ~~'
Legal Description: Lot ~ Block Addition ~~'~ v° ~S
Please show all measurements of existing and contemplated structures,
also show distances between structures, etc,, and property lines,
Is this a corner lot? _~
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Applicant ~~''~~-
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BUILDING INSPECTION - -~---:--_-.
~- REPORT
>, - CTI'Y OF BLAIR [WASHINGTON COUNTY ~ 0~~ _
LOCATION OFINSPECTION: ~p~°j ~~ , may`; ~\ ~-
NAME OF OWNER: f~l r" ; I ~~ ~'"/ I ; r !-~ .~~~ `~ .
~~1~-eoNTRACTOR: ,~G~,!~~fL~
DATE INSPECTIONREQUESTED: ~"~~' `~~-, `_
PERMIT N0: ~ `~?
TIME INSPECTION REQUESTED: ~ 2 , C~~ /~~~~
TYPE OF INSPECTION REQUESTED; ` `
BUILDING: -
^ FOOTING ^ FRAMING ~ DRYWALL ,
~~
UTILITIES;
~'
I ^ SEWER TAP [~ SEWER ~ SEpHC ~ WAS TAP
^ REMOTE ^ WAR SERVICE __
ELECTRICAL:
^ RO UGH IN ^ F~~ES ~ ~~ ~ MOTORS o
P~MANENT SERVICE ~ TEMpORARY SERVICE
MECHAMCAL:
^ ROUGH IN ~ A/C ~ ~~
-' -PLUIIIBING:
__
GROUNDWORK ROUGH IN ~ FINAL
RESULTS OF THEINSPECTlON: ~pASSED (s~xorES)
^ FAILED Ism Nom)
NOTES/RFMARKS: ~ ~,~ / _ `\
CPECTOR: .
'E OFINSPECTIONMADE: ~ (~
TIME: ~2- DO
~D OPPD\
TO CONNECT SERVICE:
^ YES
`FFICE STAFF TO CALL OPPD\ ~
~FICE~1t~rr ~~....__
^NO
^ YES ^NO BLR1 :R1
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