BP6340BUILDING PERMITAPPLI
Jurisdiction of City of Blair, Nebraska
218 South 16th Street
Blair, Nebraska 68008
(402) 426-4191
6340
Permit
Application Date: _~ ~ --~' ~ Issue Date: ~ " ~' ~ `~ 5~ Permit Fee: $ ~ ~~~
JOB ADDRESS
Z~~~~ ~ I Ion ~~E~~
LEGAL
1 ' DESCR. LOT N0. BLK. TRACT
^ SEE ATTACHED SHEET
OWNER MAIL ADDRESS Zlp PHONE
2• ~(Lr nom V1f ~ti
CONTRACTOR MAILADDRESS PHONE LICENSE NO.
3. l~ ~ c~1 ~~~C~-t~~~C. ~(`"~ i./ ~1~, 27`1 ~~ ,
USE OF BUILDING
4.
5. Class of Work: NEW ^ ADDITION ^ALTERATION ^ REPAIR ^ MOVE ^ REMOVE
6. Describe Work: ~_~ ~ L~r; ~, ~ ~~ ~
7. Sq. FOOtage of StrUCture (Including Basement and Garage):
$. 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 _
TION ACCEPTED BY) 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 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 not complgte~within 2 years of date of issue.
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
(betorefinish) ~
3~l ~~ G S
Framing Final
CATION
Electrical
Rough-in Fixtures
Final ~° ~'~ Permanent Service
Temporary Service
SIGNATURE OF OWNER~CONTRACTOR OR AUTHORIZED AGENT DATE
Rough-in
Final -
Plumbing
Ground Work
SIGNATURE OF OWNER (IF OWNER BUILDER) DATE Rough-in Final
WHEN PROPERLY VALIDATED (IN THIS SPACE) T IS OUR PERMIT
Comment: Approved By: ,~-
Mechanical
ABC
POUNDS PRTG: Bletr, NE // Rev. 10/81
~ _ _. - .
BUILDING INSPECTION REPORT
~ CITY OFBLAIIt ^ WASHINGTON,COUNTY ^ OTHER
~ - LOCAT
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<2 -
I
N OF INSPECTION.
-
~
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~ NAME OF OWNER: ~ ~~ CONTRACTOR:
- ~,
,,
~ `•DATEINSPECTIONREQUESTED: PERMITNO;
. -
~
TIME.INSPECTIONREQUESTED: ~r"
,,
=TYPE OF INSPECTION`REQUESTED:
BUILDING:
~~t
•
^ FOOTING .:? ^
FRAMING _ ^ DRYWALL ` ~ ^ RIVAL
UTILITIES: - -. _
'r^ SEWER TAP'.- ^ SEWER ^SEPTIG ,. ^ WATERTAP -
~= ^ REMOTE , _ .. ^ WATER.SERVICE
ELECTRICAL:..
i
~.. ^ ROUGH IN, :. ^ FIXTURES .^ FINAL -. ^'MOTORS
ERMANENT`SERVICE _ ^ TEMPORARY SERVICE:
~
-
'
:MECHANICAL';
ROUGH-IN ^ A/C ^ FINAL '
PLUMBING: -
^ GROUNDWORK . ^ ROUGH-IN ^ FINAL
RESULTS OF THI~ INSPECTION: PASSED ~sESxoTES> : ^ FAILED ~sEE NoTES~
:NOTES/REMARKS:
.....INSPECTOR: ,
~
/
t ~
DATE OF INSPECTION MADE: ~ a
~ ~
TIME
°':
:
_
~;
CALLED OPPD\ 3~ ~ ~ ~~ TO 00NNECT SERVICE: YES~1u ^ INTO
WANT OFFICE STAFF TO CALL OPPD1.~_ : YES ., ^ NO BLR 1