BP7276~UIL
Permit Fee: ~ /
Issuance Fee:
Deposit Receipt #:
DING PERMIT e4PPLICATION
Jurisdiction of City of Blair, Nebraska
218 South 16th Street
Blair, Nebraska 68008
(402) 426-4191 ~ Fax (402) 426-4195
Application Date: ~' Z-~- ~
Issue Date: W ,ZI
Permit
7276
JOB ADDRESS
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LEGAL
1. DESCR. LOT ND. BLK. TRACT
^ SEE ATTACHED SHEET
Q ER t
2. ~ ~r ~ ~ ~ r~~o n MAIL ADDRESS // ~
4~ n IP
to ~~ PHONE
2 b 2~
CONTRAC 0 1
3. ~'1~ 1 r1 V1nS 1 /l S
rb rt'1 AIL ADDRESS
1 ~. l~ (Z ~I~ i ZIP
1906~ti PHONE
`[ 2~ r~~
4. Class of Work: NEW ADDITION O REMODEL
5. Describe
Work: O Finished Basement O Unfinished Basement
~
d~"i n ~1 ~ c) b ~~-e
6. Total Sq. Footage pRCluding Basemem and Garage): Total Finished Area:
7. Valuation of Work: $ ~ ~ ~ a ~ ~ Q C>
Floodway O Yes O No
8. Floodplain: Fringe O Yes O No Dev. Permit
BFE
Elev. Ced.
9. Current Zoning:
10. State Fire Marshall Required: O Yes
11. Special Use Permit Required: O Yes
12. Variance Required: O Yes O No
O No
O No
13. Minimum Setbacks: Front Side Rear
14. Sidewalk Required: O Yes O No Waiver Approved ,
NOTICE
Separate permits are required for electrical, plumbing, heating, ventilating and air
conditioning, 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.
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 ebraska.lunderstandthatthispermitisvoidifworkisnotcommencedwlthin
18 avs r ~ not comDleted~rithin 2 vr~rs of,date of issue.
~~~
SIGNATURE OF
Comment:
DATE
O Site Plan Attached O Complete Plans Attached
Approximate Completion Date 1 6" 3 p^ t
Inspections Required and Fees
Utilities
Sewer Water Service
Septic Remote
Stop Box Card
Buildin
Footings Drywall
(before finish) ~ ' ~7 ~~
Framing Final
Electrical
Rough-in Fixtures
Final Permanent Service
Temporary Service
Mechanical
Rough-in A\C
Final
Plumbin _
Ground Work
Rough-in _
Final
WHEN PROPERLY VALIDATED (IN THIS SPACE) THIS IS YOUR PERMIT
Approved By:
POUNDS PRTG: Blair, NE Rev. 8196
'. i r „ - --
. ;,.;:; .,BUILDING INSPECTION REPOII,T! ~ T
~TT'Y OF BLAIIt ~ WASHINGTON COUNTY ~ p~pt
IACATION, O~F.~+INSPECTION: ~ ~ ~~ ~ ` ~. ~ ..../
NAME OF OWNER: ~~l~c~/~' ~-i ~ > /~
CONTRACTOR: ~~1 ~/u, ~ ~i°,~/ r ~;,,~"
~ DA-TE INSPECTTONREQUESTED: ~S- ~ ~ ~,~ ~ ~ .
PERMIT NO: ~~.
TIME INSPECTION REQUESTED: _ .~
TYPE OF INSPECTION REQUESTED: -
~, ~ . ~ .
BUILDING:
^ FOOTING ~ FRAMING ,..~- .~l e ~~~ ~F; ' -
j ^ DRYWALL [FINAL •
UTILITIES:
SEWER TAP ^ SEWER ^ SEPTIC ^ WATER TAP
^ REMOTE ^ WATER SERVICE
ELECTRICAL:
^ ROUGH IN ^ FIXTURES ^ FINAL 0 MOTORS
^ PERMANENT SERVICE ~ `I`EMpORARY SERVICE .
MECHANICAL:
`. O ROUGH-IN ^ A/C ~ FINAL
PLUMBING:
^ GROUNDWORK ~ ROUGH-IN ~] FINAL:
RESULTS OF THEINSPECTIO ~ '
~°R,~SSED (s~xo~s~ ~ FAILED (sue rro~rESI
NOTES/RFMARKS:
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