BP6847__
- - ~ BUILDING PER IT APPLICATI®N
Jurisdiction of City of Blair, Nebraska
218 South 16th Street
Z~. ~~~
~i~~z
Blair, Nebraska 68008 ~ ~ ~ 7
(402) 426-4191 Permit
Application Date: ~ ~" ~ ` C(~ Issue Date: ~ ~ ~-~ ~ Cl ~ Permit Fee: $ (oC) • ~(1
JOB ADDRESS
2110
/~e~ ~~
LEGAL
1 ' DESCR. LOT NO.
` BLK.
~ TRAC
~(~C~= ~'~ ~ ~'
^ SEE ATTACHED SHEET
2. OWNER Lj1Q ~~
! `~ ~ C ~M91yADDgESS ZIP
~~/
~~
11((
,,
1 PHONE
CONTR OR DRESS PHONE
A
1L
A
D
~ -` M LICENSE NO.
USE OF BUILDING
4.
5. Class of Work: C~NEW ^ ADDITION ^ ALTERATION ^ REPAIR ^ MOVE ^ REMOVE
6. Describe Work: ~ - ~l~`~{ ~ ' ,(,l'Q.C ~i~ I~cj [ l (~ l ll ~~~~ C.~'1~'
7, Sq. Footage of Structur (Including Bas ment end Garage): ~^,~ (' a a~Y.~ ~~G ~-~~
c)'~-
8. Change of Use From: Change of Use To:
g, Valuation of Work: $ Z~ I ~~1C1. ~~
10. Floodplain; Floodwey Yes^
Fringe Yes^ No ^ Dev. Permit Elev. Cert.
No ^ BFE
11. Current Zoning:
12. State Fire Marshall Required: Yes ^ Nod
13. Special Use Permit Required: Yes ^ No [~
14. Variance Required: Yes ^ No [,]'~ ~
15. Minimum Setbacks: Front Side ~ Rear_
16. Sidewalk Required: Yes^ No^ W~~Ver~Approved
L~
BY I PLANS CHECKED BY
d(~t~1~1
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 acopy of this application form signed by the Building Inspectorand stamped
'APPROVED'.
I hereby agree to perform the proposed work in accordance with the specifications set forth
above and in accordance with ihecodes/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,
is not completed within 2 years of the date of issuance; or if work is abandoned for six (6)
months or longer, whichever is earliest.
/SIGNA URE OF OWNETOR OR AUTHORIZEDT DATE
OWNER (IF OWNER
Site Plan Attached ~ Complete Plans Attached ^
Approximate Completion Date r
Inspections Required nd Fees
Utilities
Sewer Tap Water Tap
Sewer Water Service
Septic Remote
Building
Footings f Drywall
(before finish)
Framing Final r~'~-~~
Electrical
Rough-in f/~~~~ Permanent Service
Final i/~-,~-~' Temporary Service
Mechanical
Rough-in ~ ABC
Final ~
Plumbing _ -~2~~. ~~_~~-~-~~:
Ground Work
Rough-in / Final i~
WHEN PRO,~ERtY VALIDATED (IN THIS SPACE) THIS IS YOUR PERMIT
Comment:
Approved By:
PRTO -Bleb, NE Rev' Oflr95
~#- ~'
r-
....
d
7 v
3 ~
v ~~
0
PLUMBING PERMIT APPLICATION
Jurisdiction of City of Blair, Nebraska
218 South 16th Street
Blair, Nebraska 68008
(402) 426-4191
Application Date: ~ ~ ~ q
Permit Fee: $
JOB ADDRESS
(~11,~~
LEGAL
1 • LOT NO. ~ BLK. ~ TRACT 'I '
~
~h
O SEE ATTACHED SHEET
DESCR. ~
t5 ,
2. OWNER e n MAILADDRESS
~~~-C1(. ZIP PHONE
CONTRACT MAIL ADDRESS
3. ~ ~t b 3y PHONE
. ~~~'-"~- X26 -s~~r LICENSE NO.
4. Class of Work: O NEW RESIDENTIAL O NEW COMMERCIAL O REMODELING/ADDITIONS O REPLACEMENTS
5. Describe Work:
Comments:
PLUMBING PERMIT FEES
Type of Fixture No.
Kitchen .................................. $8.00 x
8 p0
Bath ....................................... $8.00 x ~
Rough-In Bath ....................... $4.00 x
Utility .....................................
$5.00 x .~ ~Ga
Water Heater ......................... $3.00 x
Outside Water Faucet ........... $3.00 x
Water Service ........................ $10.00
NOTICE Sewer .................................... $10.00
hereby certify that I have read and examined this Groundwork ........................... $10.00
1Qao
application and know the same to be true and correct. All
provisions of laws and ordinances governing this type of Septic Tank & Laterals .......... $10.00
work will be complied with whether specified herein or not.
The granting of a permit does not presume to give authority
Lawn Sprinkler System ..........
$10.00
to violate or cancel the provisions of any other state or local
Sprinkler System ...................
$30.00
law regulating construction or the performance of (Commercial)
construction.
0
ISM'
Permit Issuance Fee ............. $15.00
SIGNATUR CONTRACT OR AUTHORIZED AGENT
TOTAL ~
J~
~
~
.. ~
DATE Current License on File OYes O No O NA
WHEN PROPERLY VALIDATED (IN THIS SPACE) THIS IS YOUR PERMIT
Comment: Approved By:
POUNDS PRTG: Blair, NE Rev. 12/95
ELECTRICAL PERMIT APPLICATION
Jurisdiction of City of Blair, Nebraska
218 South 16th Street
Blair, Nebraska 68008
(402) 426-4191 Permit 0 2 2 7
Application Date: I I
Permit Fee: $ ~~7' ~
JOB ADDRESS
~ I U (
G~ r" ~E~ ~ ~ ~
_
LEGAL
1 • DESCR. LOT NO. BLK. TRACT
O SEE ATTACHED SHEET
OWNER ~~ MAIL ADDRESS ZIP PHONE
2. I~~ c 11c~ ~~~~ I~cl~? ~
CONTRACTOR-- MAIL ADDRESS e J \ C ` PHONE ! r` LICENSE NO.
4• Class of Work: O NEW RESIDENTIAL O NEW COMMERCIAL REMODELING/ADDITIONS O UPGRADE SERVICE
5. Describe Work: ~,~ AI ~ t/(1C' ~~r/r ~i ~~I ~C~C~ c ~f~~~ r l~1(,1~~ C~~ ~~xl~~ i~~" ° r~,~
6• Current License on File des O No O I• A
i~c7 ~..~F s~c_ +u I mac;
New Service Fee = (Amp Fee + $2.00 per branch circuit) ELECTRICAL PERMIT FEES
~ ~
~
1-100 Amp Fee ............................ $ 13.00 Upgrade Existing Service ...... $10.00
•
101-200 Amp Fee ............................ $ 18.00 Temporary Service ................ $10.00
201-300 Amp Fee ............................ $ 30.00
p ............................
301-400 Am Fee $ 42.00
Fire Alarm System ................. $10.00
401-500 Amp Fee ............................ $ 55,00 Signs ..................................... $15.00
501-600 Amp Fee ............................ $ 67.00 Miscellaneous Apparatus ...... $11.00
601-700 Amp Fee ............................ $ 80,00
701-800 Amp Fee ............................ $ 92,00
801-900 Amp Fee ............................ $105.00 Commercial/Multi-Family and All Upgrades:
901-1000 Amp ................................. $117.00 # of Circuits x $2.00
IF OVER 1000 Amp Amp Fee
1st 1000 Amp Fee ....................... $117.00
Each additional 100 Amps ..,..,.,... $ 13.00 Amp Fee + Circuit Total
NOTICE New Residential: (Finished Area)
I hereby certify that I have read and examined this Single/Two Family Dwellings
application and know the same to be true and correct. All sq. ft. x .045
provisions of laws and ordinances governing this type of
k
ill b
li
d
i
h
h
h
wor
w
e comp
e
w
t
w
et
er specified herein or not.
The granting of a permit does not presume to give authority
to violate or cancel the
rovisions of an
other state or local Receptacle/Switch Outlets
~ ~ p
.~
~
p
y I x $.75
Fixtures ~
~ ~
law regulating construction or the performance of
construction. Residential/Commercial Appliance
# Fixect Outlets x $3.00
Power Apparatus (220 Volts)
# A
aratus x $3
00
pp
.
SIN RE OF CONT AC R OR AUTHORIZED AGENT
r~~ ~
~~
Permit Issuance Fee ............. $15.00 i S <°~C~
DATE
TOTAL LAC ~ Z--~~
WHEN PROPERLY VALIDATED (IN THIS SPACE) THIS IS YOUR PERMIT
Approved By; ~
POUNDS PRTG: Blair, NE / Rev. 12/95
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