BP7178BUILDING PERMIT APPLICATION
Jurisdiction of City of Blair, Nebraska
218 South 16th Street
Blair, Nebraska 68008 7
(402) 426-4191 Permit
Application Date:
(~~3-~~
Issue Date: (~i • ~ -~ ~ ~ Permit Fee: $ 3 O- ®O
JOB ADDRESS
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LEGAL
1 ' DESCR. LOT NO. BLK. TRACT
^ SEE ATTACHED SHEET
2. OWNER MAIL ADDRESS
Sc~rne~ ZIP PHONE
3 CONTRACTOR h ` ~ ~ ~ l ~ MAI~ ADDRESS ~ ~ ~ /~ ~ (
I~ `~L Y~ PHON~ ~ ~// U LICEN ~ NO. ~G~^ iL<
L- LJ ~J
4. USE OF BUILDING
5. Class of Work: NEW ^ ADDITION ^ ALTERATION ^ REPAIR ^ MOVE ^ REMOVE
6. Describe Work: ~ ~ ' x ~ - -~ 5,` fCll. ~- ~U ~ l '~(1
7. Sq. Footage of Structure (Inducing easement ana Garage>: I 1 I
8, Change of Use From: Change of Use To:
9, Valuation of Work: $ ~ ~ 6 O (~ , ~~
Floodway Yes^ No ^ Dev. Permit
10 Floodplain:
Fringe Yes^ No ^ BFE
Elev. Gen.
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 _
BY I PLANS CHECKED BY I APPROVED FOR ISSUANCE BY
NOTICE
Separate ermits 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 tee does not constitute issuance of this building permit, I further
agree chat construction covered by this permit application shall not be commenced until I
have received a copyof 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 the codes/ordinances of the City of Blair and the State of
Nebrask . nderstand that this permit is void if work is not commenced within 180 days,
is not co le within years of the dat f i sue ce, or if work is abandoned for six (8)
months or ong hicheve i e r ies _ ~~
SIGNATURE NER/CONTRACTOR OR AUTHORIZED AGENT 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 ~o'~'~~
Rough-in
Final _
Permanel~t Service
Temporary Service
Mechanical
Rough-in ABC
Final
Plumbing
Ground Work
SIGNATURE OF OWNER(IFOWNERBUILDER) DATE Rough-in Final
WHEN PROPERLY VALIDATED (IN THIS SPACE) THIS IS Y~R PERMIT
Comment: Approved By: ~' ~
POUNDS PRTO: Blalr, NE ~ Rev.OBI85
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SIOU3C CITY IA 51I03 -
FEE 51.0[3 SAID
In accordance with 39-1320 R.R.S. 1943 et Seq, and the Rul ~s and Regulations on advertising promulgated by the State of Nebraska, permission is
hereby granted to erect or maintain one ~ CLASS
Sign with': panel(s) totaling = square feet within the advertising control along the Interstate
or Federal-Aid Primary highway system. All nonconforming signs erected prior to Mazch 27, 1972 are subject to removal under the Beautification Laws.
This permit is subject to the applicable sections of the Rules and Regulations of the State of Nebraska, Depaztment of Roads and 39-1320 R.R.S. 1943 et
Seq• The permit is valid for 2 years, however, it may be revoked by the Department of Roads if necessary prior to the end of the 2 yeaz term. The
applicant shall have 30 days in which to remove the sign after the permit has been revoked. A permit is not transferrable from the original permittee.
The sign advertising
will be located on the side of Highway No." at Mile Post ` in i~~ County
he corporate limits of ~ • on
the property of.~~,~~a~nr~ ~~~~ ^~~ ~ f• ~ as shown on the attached sketch.
Theapplicant shall notify the District Special Permits Technician of the Depaztment of Roads,:' _s~l~>~~~i~,' -~ `~, at
at least 48 hours in advance of the time the applicant expects to begin work within the advertising control limits.
The sign shall be erected as prescribed by the Nebraska Depaztment of Roads and shall comply with each of the following requirements:
/T SHALL NOT.•
A, be placed on the Right of Way.
B. overhang the Right of Way.
C. obstruct [he view of official signs.
D. obstruct the visibility at driveways and in[ersections.
E, be constructed, repaired or maintained Crom the Right of Way.
JT SHALL:
A. have the permit number attached to the sign at a conspicuous
location which makes it visible from both directions of travel
immediately upon receipt of the permit.
B. be placed at the location staked by the applicant.
C, be kept in good repair.
THIS CCIN~=r~ttA~ING CLASS III SIGN MUST C~31hPLY WITH THE ~1INit7U~ SII, ~ TI~HTING
AND SPACING R~I~UIREt~t~N7S ~t3R Ct_ASS III SIGNS AS ~3UT~INt=D ltd
:3~t'ART~IEVT >~F RtIAI~S 't•ITt_L ~r1tl! CHAt'TER 3.
Lighting must be shielded to prevent interference with operation of motor vehicles. No flashing, intermittent or moving lights or parrs shall be permitted on this sign.
ATTENTION: It is understood that any violations of the State of Nebraska Department of Road's Rules and Regulations pertaining to advertising or the
existing laws as set forth in 39-1320 R.R.S. 1943 et Seq. will be cause to revoke this permit and-the State of Nebraska, Department of Roads, shall have
the right after 30 days to enter upon the premises of the landowner and remove the sign in violation, i
Additional information can be obtained from our District Engineer, ~ , or our District Special Permits E
Technician, , at r
Approved for
(Dote)
DISTRIBUTION OF COPIES
1•PERMITTEE
2 -ISSUING OFFICE
3 -SPECIAL PERMITS SIGN TECHNICIAN
State of Nebraska, Department of Roads
(SlBnature)
DR Form 122, May 75 ~ ~ panted on recycled paper
PHONE 71 2-252-4595. • ~ FAX~# 712-252-263.3 • ' TOLL FREE # 800-369-SIGN
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ROUGH IN : ~ FIXTURES ~ FINAL ~ MOTORS
~_, ,
~PERMANENTSERVICE ~TEMPORARYSERVICE' '