BP7267f'
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Permit Fee: ~`~
Issuance Fee:
Deposit Receipt #:_
Application
Issue Date:
7267
JOB ADDRES -~-`
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LEGAL
1. DESCR. LOT N0. BLK. TRACT
^ SEE ATTACHED SHEET
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4. Class of Work: NEW O ADDITION O REMODEL
5. Describe Work: O Finished Basement O Unfinished Basement
n ~- s - O c
6. Total Sq. Footage (IRCIudiRg Basement and Garage): Total Finished Area:
7. Valuation of Work: $ ~ ~ Q ~ ~ ~~ ~
Floodway O Yes
Floodplain:
8 O No Dev. Permit
Elev. Cert.
.
Fringe O Yes O No BFE
9. Current Zoning:
10. State Fire Marshall Required: O Yes
11. Special Use Permit Required: O Yes
12. Variance Required: O Yes O No
13. Minimum Setbacks: Front
14. Sidewalk Required: O Yes O Nc
Jurisdiction of City of Blair, Nebraska
218 South 16th Street
Blair, Nebraska 68008
(402) 426-4191 • Fax (402) 426-4195 Permit
O No
O No
Side Rear
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 furtheragree 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
18 day orris not completed within 2 wars of date of issue.
SIGNATURE
Comment:
- ~~
DATE
O Site Plan Attached O Complete PI Attached
Approximate Completion Date ~ _ ~ ~ _c~
Inspections Required and Fees
Utilities
Sewer
Septic
Building
Footings
Framing
Electrical
Rough-in
Final
Temporary Service
Mechanical _
Rough-in
Final
Plumbing
Ground Work
Rough-in
Final
WHEN PROPERLY VALIDATED (IN THIS SPACE) THIS IS YOUR PERMIT
A~D~~ By' n ~ /
BUILDING PERMIT APPLICATION
Water Service
Remote
Stop Box Card
Drywall
(before finish)
Final ~~~~"~"~7
Fixtures
Permanent Service
A\C
Rev. 8796
POUNDS PRTG: Blair, NE C „
- _~----,
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€Fi " ~ ^ . B~JILDING INSPECTION. REPORT
F ~ 5 ~
~, ~-,CITY OF BL;AIR ^ WASHINGTON COUNTY ^ OTHER-
'r. L_OCATIONOFINSPECT!ION: _ t '~' l~
-`"~ G-C~flla9 ~ tom. r~ ~ CONTRACTOR:
NAME OF OWNER
~ ~ ~r~~ ~~
DATE INSPECTION REQUESTED: d ~ ° '~ ~~"' 4 ~ ~ PERMIT N0:
~:
~. TIME-INSPECTION REQUESTED: ~'"'~'~-
k _ TY$E OF INSPECTION REQUESTED: ~
' ~ BUILDING: ~
- ^_FOOTING ^ FRAMING ^ DRYWALL ~ FINAL .
s:. ~' `
,,
k_ UTILITIES:
~._
^ SEWER TAF ^SEWER ^ SEPTIC ^ WATER TAP
~-
^ REMOTE -^ WATER SERVICE.
ELECTRICAL:
~ ' ^ ROUGH IN ^ FIXTURES ^ FINAL ^ MOTORS
[ ^ PERMANENT SERVICE ^ TEMPORARY SERVICE
MECHANICAL: '
~:
F: [] ROUGH-IN ^ AIC ^ FINAL
~; --
- PLUMBING:
P
^ GROUNDWORK ^ ROUGH-IN ^ FINS-
L
F' RESULTS OF THEINSPECTION: ~ PASSED (sEErro~rES) ^FAILED (s~rro~s)
• .. ~ NOTES/REMARKS:
INSPECT /'~
DATE OF INSPECTION M?~DEr ~ ~ ' TIME: ~y o
CALLED"OPPD\ TO CONNECT SERVICE: ^ YES ^ NO
L-
k _ YES ^ NO BLR i
' t WANT OFFICE STAFF TO GALL OPPD\. ~ ^ , _
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