BP7251.f2~~ ~ ~ a ~ 7~ 4 ~-erg- ~ ~
BUILDING PERMIT APPLICATION
Permit Fee: t-15-1a OO Jurisdiction of City of Blair, Nebraska
e z , oa 218 South 16th Street
Issuance Fee: t ~~ ~~ Blair, Nebraska 68008 7 2 51
Deposit Receipt #: o~~ap2- (402) 426-4191 • Fax (402) 426-4195 Permit
Application Date: ~ ~ ~r~ ~ Issue Date: -
JOB ADDRESS ~~~ ~~~ ~~` ; ~
W ~-- /~ ~, / 2
`7 J
LEGAL
1 . DESCR. LOT No.
~'--~' BLK. /
TRACT~r~~ Ski ~ ~~ea~~J 3 ~ SEEATTACHE~D EET
2.OWNER ~ C CGn n Lv MAIL ADDRESS ZIP PHONE
3. CONTR~~ ~' ~-~ ~I.JU l~rC[ ~l n ADDRE~-L l~ C . ~ ~~ f ~U1t S"~ • "f ~-tr/ ~P`f ~ `f'
4. Class of Work: NEW O ADDITION O REMODEL
5. Describe Work: ~~lS~ - ~~ ~~ ~~ ~ O Finished Basement Unfinished Basement
~Ci~e~~ ~- 13~~
6. Total Sq. FOOtage (Including Basement and Garage): ~~' Total Finished Area: / ~ ~~
7. Valuation of Work: $ ~f ~ (~(~ ~ U ~Yag~ w~-~ ~ GV~~~~7~
Floodway O Yes l7 No Dev. Permit
8. FIOOdplaln: Fringe D Yes O No BFE
Elev. Ced.
9. Current Zoning: ~~~
10. State Fire Marshall Required: O Yes O No
Ite Plan Attached omplete Plans Attached
Approximate Completion Date ~ ~iC~'t~
Inspections Required and Fees
11. Special Use Permit Required: O Yes O No
12. Variance Required: O Yes O No ~ ~
13. Minimum Setbacks: Front ~ Side ~ Ream
14. Sidewalk Required:~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 of Nebraska. I understand that this permit is void if work is not commenced within
0 days or is not comp) d within 2 years of date of i ue.
~-~~ -~,6
S TUBE F OWNER/CONTRACTOR _ DATE ~ ~ ~
Comment: ~",~
~~~.r~~~
Utilities
Sewer
Septic
Water Service
Remote
Stop Box Card
Buildin
Footings Drywall
(before finish) r
l `r Z~~~~
Fi
Framing na
Electrical ~ i ~S " ~Cs1.r
Rough-in Fixtures
Final Permanent Service
Temporary Service
Mechanical (rlallar~l --f~Gtt ~
Rough-in A\C
Final
Plumbin
Ground Work
Rough-in Final
WHEN PROPERLY VALIDATED (IN THIS SPACE) THIS IS YOUR PERMIT
POUNDS PRTG: Blair, NE Rev. B/96
MECHANICAL PERMIT APPLICATION
Jurisdiction of City of Blair, Nebraska
218 South 16th Street
Blair, Nebraska 68008
(402) 426-4191
Application Date: ~ P ~ ~- I ~ Permit Fee: $ ~'~~
JOB ADDRESS ~ ~ ~ ~/~l ~r'
` •^-
=/
`r
/'nwl
1 . LEGAL
DESCR. LOT NO. B
L
K TRACT O SEE ATTACHED SHEET
2. OWNER J Q~ ~V V V ~ ~S MAIL ADDRESS ZIP PHONE
,3, CONTRACTOR I I d~ ~~~~ ~ MAILADDRE~~ ~ ~~ ,. ,~PH~NE~ / ~ ~ LICENSE NO.
4• Class of Work: C~IEW RESIDENTIAL O NEW COMMERCIAL O
REMODELING/ADDITIONS O REPLACEMENTS
/
5• Describe Work: ~ (~ C~UU 'hj ((,, ~Z~l-s~i~ Ct~C~ ~ rl 2 lC~l ~ l
Comments:
MECHANICAL PERMIT FEES
Forced Air Systems 2.00
Per Unit Commercial/Residential (New) .............. ........................ $25.00
Air-Conditioner Unit (O ~ U~
Per Unit Commercial/Residential (New) .............. ........................ $10.00
Refrigeration Units/Coolers
Per Unit Commercial (New or Replacement) ...... ........................ $10.00
NOTICE
I hereby certify that I have read and examined this Forced Air Systems/Air Conditioner
application and know the same to be true and correct. All Unit Replacement
provisions of laws and ordinances governing this type of
work will be complied with whether specified herein or not.
Per Unit Commercial/Residential (Replacement)
........................ $10.00
The granting of a permit does not presume to give authority
to violate or cancel the provisions of any other state or local
law regulating construction or the performance of
construction.
Permit Issuance Fee ............. $15.00 ~ S ~ U
` TOTAL ~U ~~ ~
SIGNATURE OF CONTRACTOR OR AUTHORIZED AGENT
I --~ (P - CC~1
I
Current License on File Yes O No
O NA
DATE
WHEN PROPERLY VALIDATED (IN THIS SPACE) THIS IS YOUR PERMIT
Comment: Approved By: /~
lJ- ~/Y~_
POUNDS PRTG: Blalr, NE Rev. 1219:
ELECTRICAL PERMIT APPLICATION
Jurisdiction of City of Blair, Nebraska
218 South 16th Street
Blair, Nebraska 68008 Permit 0 413
(402) 426-4191
Application Date: ~ ~ ~I~`~ ~ ~~
Permit Fee: $ ~ • ~~
JOB ADDRESS ('~ '
LEGAL
1 • DESCR. LOT NO. BLK. TRACT
O SEE ATTACHED SHEET
OWNER ~ MAIL ADDRESS ZIP
2. .~ Y1/~ f~ PHONE
r3 CONTRA OR // • p ~j /~ ,/MAIL ADDRESS /~ _ PHONE
~f~l'jC r~~~-T~^r~. f'-L~ E~~~~ ~~h ~ 1'~1~U/ ~ LICENSE No.
~~.Lr-~._ "1~
4• Class of Work: NEW RESIDENTIAL O NEW COMMERCIAL O REMODELING/ADDITIONS O UPGRADE SERVICE
b• Describe Work: ~ ~U~ ~~~~~~
6• Current License on File O Yes O No O NA
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 Fire Alarm System $10.00
""""""""'
301-400 Amp Fee $ 42.00
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
1st 1000 Amp Fee ....................... $117.00 Amp Fee
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
') ~{ ~i~ sq. ft. x .045 c~
~~ " ,3~
provisions of laws and ordinances governing this type of
work will b
li
ith
d
h
th
ifi
d h
i
t
e comp
e
w
w
e
er spec
e
ere
n or no
.
The granting of a permit does not presume to give authority Receptacle/Switch Outlets
to violate or cancel the provisions of any other state or local Fixtures x $.75
law regulating construction or the performance of
construction.
Residential/Commercial Appliance
# Fixed Outlets x $3.00
Power Apparatus (220 Volts)
# A
ar
t
$3
00
pp
a
us x
.
R C NTRACTOR OR AUTHORIZ AGENT
~ ~'~~ Permit Issuance Fee $15.00 ~ ~ - ~~
DATE
TOTAL
) ~ - ~ ~-
WHEN PROPERLY VALIDATED (IN THIS SPACE) THIS ~,S YOUR PERMIT
Comment:
Approved By:
POUNDS PRTG: Blair, NE d Rev. 12/95
PLUMB
~/~9~~
Application Date:
CATI O N
~~
Permit Fee: $
JOB ADDRESS
LEGAL
1 • DESCR. LOT NO. BLK. TRACT
O SEE ATTACHED SHEET
OW ~ MAIL ADDRESS
2 ZIP PHONE
.
3• CONTRACT MAI DD SS , PHONE ~ LICENSE NO.
4• Class of Work: ~W RESIDENTIAL O NEW COMMERCIAL O REMODELING/ADDITIONS O REPLACEMENTS
5. Describe Work:
Comments:
PLUM BING PERMIT FEES
Type of Fixture No. ~~v
Kitchen ................................. . $8.00 x ~
/
Bath ....................................... $8.00 x
~ ~
~ ~ a~ o
Rough-In Bath ...................... . $4.00 x
Qu
Utility .................................... . $5.00 x ~
Water Heater ........................
. $3.00 x ~ v
=~ a
~~
Outside Water Faucet ........... $3.00 x /j ~-
L
Water Service .......................
.$10.00 ~ / as
/d
NOTICE Sewer ................................... . $10.00 /d G~
hereby certify that I have read and examined this
Groundwork ..........................
.$10.00 /~Qo
'°
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.
/
~~~
Permit Issuance Fee ............ . $15.00
~
SIGNATURE OF NTRACT OR AUTHORIZED AG T ~~
`/ , ~ ~ /
b TOTAL
•
DATE Current License on File es O No O NA
WHEN PROPERLY VALIDATED (IN THIS SPA E THIS 15 YOUR PERMIT
Comment:
ING PERMIT APPLI
Jurisdiction of City of Blair, Nebraska
218 South 16th Street
Blair, Nebraska 68008
(402) 426-4191
By;
POUNDS PRTG: Blair, NE Rev. 1?l95
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