BP5520BUILDING PERMIT APPLI
Jurisdiction of City of Blair, Nebraska
218 South 16th Street
Blair, Nebraska 68008
(402) 426-4191
t~ rne55 - ~(- i2"~ 7
CATION
Permit
I'
~52~
Application Date: I ` ~ ' C~ ~ Issue Date: ~J~ U ~~ Permit Fee: $ ~~(~ • (~ C~
JOB ADDRESS I I Z5
`~ `5 (~y~ .!-~
I ~ / J
LEGAL
1 ' DESCR. LOT N0. BLK. TRACT
^ SEE ATTACHED SHEET
2. OWNER
Lc~ n _
c MAIL ADDRESS ZIP PHONE
3 CONTRACTOR ~~ ~ '\ ~ ~
U ~ AI~~DDRES_ ^ S ~ ~ HONE ~ ~~
V ~ "~-- 2 ~ rn~ S NS_ E No.
"~
USE OF BUILDING
4.
5. Class of Work: NEW ^ ADDITION ^ ALTERATION ^ REPAIR ^ MOVE ^ REMOVE
6. Describe Work; C' ~ CSC ~ ~~ k ~~
]. Sq. Footage Of StrUCtU a (Including Basement end Garage):
8. Change of Use From: Change of Use To:
g, Valuation of Work: $ '"~ ~~ ~)Cj , ~ ~
10. Floodplain: Floodway Yes^
Fringe Yes^ No ^
No ^ Dev.Permit EIev.Cert.
BFE
11. Current Zoning: I~ ~
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 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 specifications set forth
above and in accordance with the codes~ordinances of the City of Blair and the State of
Nebraska. I nderstand that this permit is vppid if work{snot commenced within 1 BO days
or is,not co~p(eted;within 2 vsbrs oGtl~tebf issue/
Site Plan Attached ^ Complete Plans Attached ^
Approximate Completion Date
Inspections Required and Fees
Utilities
Sewer Tap Water Tap
Sewer Water Service
Septic Remote
-I-12-9~I-s~~rlvv~>~l tl~I%,
•"
"~
~
Building ~'~ ~ ~`~
-
"
Footings ~ Drywall
(before finish) ` `
/ ~ ~ Z~ ~~ `~
Framing Final
Electrical
Rough-in Fixtures
Final Permanent Service
Temporary Service
Mechanical
Rough-in ABC
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 Bey„ „
'()I INnC PRT(i .Rlnlr. NF ~/yay~ HBV.1U/8
Kirk Survey, lnc.
LEGAL DESCRIPTION:
Phons 402-426-8765
Box 264
BI°ir, Nebraska 68008
T11X LOT 191 LYING IN THE SOUTHEAST QUARTER OF THE NORTHWEST f,~UARTER OI'
SECTI:>N 13, TOGdNSHIT' 18 NORTH, RANGE 11. EAST OF TIIE 6TH P.1'R. , WASHINGTON COUNTY,
NEBi't11..'l:~\, CO[JTE1iNING 0.37 ACRES , MORE OR LESS . "40RE PARTICULARLYDESCRIBED AS
E'OLLOi~dS
BEGINIING AT THE NORTHWEST CORNER OF TAX LOT 191 AND ASSUPIIN~ THE WEST LINE
OF TAX LOT 191 TU BEAR SOUTIi 0° 05' 02" VJEST; THENCE SOUTH 89° 54' S8" EAST, A
DISTANCE OI' 147.05 FEET TO THE WESTERLY RIGI-IT-OF-WAY OF U.S. HI':;HWAY NO. 75,
BEIN~~ ON A 2341.83 I•'OOT RADIUS CURVE; THENCE SOUTHEASTERLY ALONG SAID CURVE, A
DISTANCE OF 103.77 1'EET (HAVING A CHORD DISTANCE OF 103.76 FEET AND A CHORD
BEARINt~ OF SOUTH 23° 35' 29" EAST) TO THE SOUTHFrzST CORNER OF Tr.X LOT 191;
THENCE NORTH 89° 54' 58" 6'dEST, A DISTAi~ICE OF 188.72 FEET TO THE SOUTHWEST CORNER
OF TAX LOT 191; TIiENCE NORTH 0° 05' 02" EAST, A DISTANCE OI~' 95.03 FEET TO THE
POINT OI' BEGINNING.
I
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S 89°-54~-58'~E
!47.05 '(M )
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~ 100.0 ' R)
~ S 188.72 ~(M) Tofal
~ 100.07 (M) _
a 's/e"o.r. P.
I o.14 'Easr
OF ACTUAL CORNER
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i SW Corner
d T.L. III
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N 89 °- 54 '- 5 8 '~ W
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\ 9.58'
~ ~ WITNESS G
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Rodius 2341..83
~ Chd . Disl . 103.76 '
`.'' Chd~. ~Brg. S 23°-35'-29'~E
a
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~ y0 s \ SCALE I"=50~
~ 0 60
\ 25 100
~ CORNERS FOUND
~ CORNERS SET - 5/8 ~~ Irons
(R) RECORD DISTANCE
(M) MEASURED DISTANCE
1 "P.7. P.
BUILDING PERMITApPLICATIO~IV
Jurisdiction of City of Blair, Nebraska
218 South 16th Street
Blair, Nebraska 68008 5 9 7 4
,~
(402) 426-4191 Permit
CU`
/ i-
Application Date: / ~ ~ Issue Date: Permit Fee: $
JOB ADDRESS .. ~ ~ ~~ S ~ ~ ~~
LEGAL
1 • LOT NO. BLK. TRACT ^ SEE ATTACHEQ SHEET
D scR.
2. OWE MAILADDRESS Zip NE \ ,.,~~
~
,3 CONTR MAILADp~iI~ L~''~ PHO
)) EN~O`
•
~/ `.XX
4. USE OF BUILDING
5. Class of Work: ^ NEW ^ ADDITION ^ ALTERATION ^ REPAIR ^ MOVE ^ REMOVE
6. Describe Work: -
], Sq. Footage Of StrUC1Ure (Including Basement and Garage):
8. Change of Use From: Change of Use To:
g, Valuation of Work: $
Floodway Yes ^ No ^
10. Floodplain: Frin
e Y
^ N
^ Dev. Permit
EIev.Cert.
g
es
o BFE
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'.
I hereby agree to perform the proposed work in accordance with the specifications set forth
above and in accordance with the codesJordinances 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
oJs rat-completed within 2 years of dat~c f.is~sue. r~
OF OWNERfCONTRACTOR
' /~
DATE
Site Plan Attached ^ Com~le Plan Att~hed ^
Approximate Completion Date ~~
Inspections Required and Fees
Utilities
Sewer Tap Water Tap
Sewer
Septic
Water Service
Remote
Building
Footings Drywall
(before finish)
Framing Final
Electrical
Rou ,-In - Fixtures
Finl~ " - ~ Permanent Service
Temporary Service
Rough-in
Final -
I Ground Work
SIGNATURE OF OWNER (IF OWNER BUILDER) DATE Rough-in _
Final
WHEN PROPERLY VALIDATED (IN THIS SPACE) THIS IS YOUR PERMIT
Mechanical
- ABC _
Plumbing
POUNDS PRTG: elel~, NE Rev. 10191
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