BP7946BUILDING PERMIT APPLICATION
°~ Jurisdiction of City of Blair, Nebraska
Permit Fee: ~ 218 South 16th Street
Issuance Fee: Blair, Nebraska 68008 7 9 4 6
Deposit Receipt #: (402) 426-4191 • Fax (402) 426-4195 Permit
Application Date: ~/~/f
Issue Date: ~ `~
JOB ADDRESS ~
~~r~~
~~
LEGAL
1 . DESCR. LOT ND. BLK. TRACT
^ SEE ,ACHED SHEET
OWN ~
2. MA A RESS ZIP ONE
CONTRAC
3. MAIL ADDRESS 21P PHONE
4. Class of Work: O EW O ADDITION O REMODEL
5. Describe Work: ~ O Finished Basement O Unfinished Basement
6. Total Sq, Footage (IROIBding easemBRt artd Garage): Total Finished Area:
7. Valuation of Work: $ ~ ~ ~~
Floodway O Yes
8. Floodplain: Fringe O Yes O No
O No Dev. Permit
BFE
Elev. Cert.
9. Current Zoning:
10. State Fire Marshall Required: O Yes O No
11. Special Use Permit Required: O Yes O No
12. Variance Required: O Yes O No
13. Minimum Setbacks: Front
14. Sidewalk Required: O Yes
Side _ Rear
O No Waiver Approved
NOTICE
Separate permits are required for electrical, plumbing, heating, ventilating and air
conditioning, and septicsystems. By mysignature below, I acknowledge thatpayment
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 bythe Building
Inspector.
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 ofNeb ka.lunderstandthatthispermitisvoidifworkisnotcommencedwithin
180 days• r' not completed within 2 years of date # issue.
ATURE OF OWNER/CONTRACTOR DATE ~~~
Comment:
O Site Plan Attached G~' Q C mplete Plans Attached
Approximate Completion Date ~ ~~~9 ~
Inspectio ns Required and Fees
Utilities
Sewer Water Service
Septic Remote
Stop Box Card
Buildina
Footings Drywall
(before finish)
Fi
l ~~~~~
Framing na
Electrical
Rough-in Fixtures
Final Permanent Service
Temporary Service
Mechanical
Rough•in A1C
Final
Plumbin
Ground Work
Rough-in Final
WH ROP D (IN THIS SPACE) THIS IS YOUR PERMIT
Approved B • A ,
POUNDS PRTG: Blair, NE Rev. B!96
i
-~,B,ILDING INSPECTION REPORT
CTfY OF BLAIR _ .^ WASHINGTONCOUNTY ^ OTHER . -
,LOCATION OF INSPECTION: ~~~ ~fr`~I~T `-S~7
NAMEOF'OWNER;~~/a~/f 7~"r ~f~~f 1!~/l CONTRACTOR: -~ ~'/ ~,
DATE`WSPECTIONREQUESTED: ~ PERMITNO: ~~ '
TIMEINSPECTION REQUESTED: ~
TYPE OF INSPECTION'REQUESTED:
BUILDING: 1 ~ ~,~,_._ '
^ FOOTING `^ FRAMING ^ DRYWALL}',FINAL Tj
UTILITIES:.
SEWER TAP ^ SEWER ^'.SEPTIC ^ WATER TAP
^ REMOTE ^ WATER.SERVICE
ELECTRICAL: ;. ,
^ ROUGH IN ^ FIXTURES ^ FINAL ^ MOTORS
^ PERMANENT SERVICE ^ TEMPORARY SERVICE
MECHANICAL:
ROUGH-W ^ A/C ^ FINAL
...PLUMBING.; .- ,
'- ^ GROUNDWORK ^ ROUGH-IN ^ FINAL .
RESULTS OFTHEINSPECTION: ~ ASSED (s~xo~> ^FAILED (sEerroTES)
. NOTES/REMARKS; /
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