BP5693~- ~~ ~~ BUILDING PERMIT APPLI
Jurisdiction of City of Blair, Nebraska
218 South 16th Street
Blair, Nebraska 68008
(402) 426-4191
5693
Permit
Application Date: ~ _ ~ I -~ ~~ Issue Date: ~' ~ `c~ ~T Permit Fee: $ ~ ~
JOB ADDRESS
LEGAL
1 ' DESCR. LOT NO.
/ /
~ BLK. TRACT
^ SEE ATTACHED SHEET
2. OWNER MAILADDRESS ZIP PHONE
C~__
,3. CONTRACTOR -II~ .
l~~l ~ .S• / T~ ~f l S MAILADDRESS l PHONE ~, 1 LICENSE NO.
Q~c.. ~ • •~LL a'~ ~l ~ - 1~,2.~1~ • l UL. (r'~ ~~,G~
4. USE OF BUILDING
5. Class of Work: NEW ^ ADDITION ^ALTERATION ^ REPAIR ^ MOVE ^ REMOVE
6. Describe Work: C ~~ ~~~~ -- ~ ~,~' /S r~,~ ~~.~LU (~f,
7. Sq. Footage of Structure (IndDding BesemBnt end Gerage):
8, Change of Use From: Change of Use To:
g, Valuation of Work: $
10 Floodplain; Floodway Yes^ No ^
Fringe Yes^ No ^ Dev. Permit Elev. Cert.
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 _
APPLICATION ACCEPTED 8Y I PLANS CHECKED BY f 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 acknowledge 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 thecodes/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 c:o~leted w~thin years of da of issue. ~ /
SIGNATURE OF OWNERfCONTR CTOR OR AUTHORIZED AGENT .~ DATE
SIGNATURE OF OWNER (IF OWNER BUILDER) 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 '~ ' ~ ~~c~ Lf
Electrical
Rough-in Fixtures
Final Permanent Service
Temporary Service
Mechanical
Rough-in ABC
Final fie, - ~~~~
Plumbing
Ground Work
Rough-in _
Final
WHEN PROPERLY VALIDATED (IN THIS SPACE) T~y~' IS YOUR PERMIT
Comment:
Approved By:
CATION
POUNDS PRTG: Blelr, NE ~ Rev. 10/01
,-
- _ _ ..
- - "-"BUILDING INSPECTION REPORT
TI'Y OF ggAIR ^ WASHINGTON COUNTY ^ OTHER
`-':7- ~,
''' - LOCATION-OFINSPECTION: ~~ ~l^-~ '- ~~~
NAME OF OWNER: if ~ `~ CONTRACTOR:
,DATE INSPECTION REQUESTED; Z ~/ ! / PERMIT N0:
i
TIME INSPECTION REQUESTED: ~ ~ ~ r.
I
• TYPE OF INSPECTION REQUESTEDc
BUILDING: _
^ FOOTING. ^ FRAMING ^ DRYWALL ^ FINAL...
• UTILITIES:
SEWER TAP . ^ SEWER ^ SEPTIC ^ WATER. TAP
I .
^ REMOTE - ^ WATER SERVICE
ELECTRICAL: ~~
^ ROUGH IN ~ FIX'T'URES ~• FINAL ^ MOTORS
~ ^ PERMANENT'SERVICE '~ ~ ^ TEMPORARY SERVICE
MECHANICAL:
^ ROUGH-W ^ A/C' ^ FINAL ,i
.PLUMBING:
^ GROUNDWORK. ^ ROUGH=IN ' ^ FINAL
RESULTS OFTHEINSPECTION: ASSET) ~sEExoTES> ^ FAILED ~s~xoTEST
NOTES/REMARKS:
INSPECTOR: ~i~' i . /
%~