BP7375BUILDING PERMIT APPLICATION
Jurisdiction of Cit of Blair Nebraska
Permit Fee: L~ • DO Y
218 South 16th Street
issuance Fee: Blair, Nebraska 68008
Deposit Receipt #: (402) 426-4191 • Fax (402) 426-4195 Permit-
Application Date: I J ~ ~ ' '"- ~ Issue Date: 1-l ~-~
JOB ADDRESS
I ~{IoS ~on-1'
LEGAL
1. DESCR. LOT NO. BLK. TRACT
^ SEE ATTACHED SHEET
2.OWNER ~~`'` ~ ~ I f 1 1C MAILADDRESS ZIP PHONE
Y 1 1
MAILADDRESS ZIP PHONE
CONTRACTOR
3. same
4. Class of Work: NEW ~ ADDITION O REMODEL
5. Describe Work: ~ ~Q ~~ ~rC~ . ,~ IC1C~ Wt~ O Finished Basement O Unfinished Basement
-~ - ~.. Ia c~ sus ~ec~rn - ~ cm l --
6. Total Sq. Footage (IRCluaing Ba6emeRr and Garage): Total Finished Area:
7. Valuation of Work: $ ~ ~~ ~ - (~~
Floadway O Yes O No
8. Floodplain: Fringe O Yes 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 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 bythe 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
180 day r not completed within years of date of issue.
SIGNATURE OF OWNER/CONTRACTOR DATE
Comment:
O Site Plan Attached O Complete Plans Attached
Approximate Completion Date
Inspections Required and Fees
Utilities
Sewer
Septic
Buildin
Footings
Framing
Electrical
Rough-in
Final
Temporary Service
Mechanical _
Rough-in
Final
Plumbina
Ground Work
Rough-in
Fixtures
Permanent Service
A1C
Final
WHEN PROPERLY VALIDATED (IN THIS
Approved By:
Water Service
Remote
Stop Box Card
Drywall
(before finish)
Final ~~~~~~/
7375
THIS IS YOUR PERMIT
POUNDS PRTG: Blair. NE ~ Rev. 8196
_,
. ~~~DING -INSPECTION REPORT
_ ~-.
^ CITY OF BLAIIZ: ~ WASHINGTON COUNTY ~ 0'~QZ
f LOCATION OF INSPECTION: ~~~ ~ „r"";f~nt ~ -~ - '' ~'
f ~ ~ ;.
NAME. OF OWNER: c~~,~LJ~' ~'~ l~~ ~ 1 ~~~; ~~, I
-- y- CONTRACTOR: ~`. ~ fi--- 1'
~ +';
~ DATEINSPECTIONREQUESTED: PERMITNO: ~ ~:
~_
TIME INSPECTION REQUESTED:
TYPE OF INSPECTION REQUESTED: ~
~: 1
• f BUILDING:: ~ i
r =°'t~~ `~--
- 1
^.FOOTING ^FRAMING ODRYWALL 'F`INAL n~ f~ `~~~' ~r~L,°~~
r- .~ ,
UTILITIES: f ~~t ~ r ~r',r " j ~,~~ ~ JH l~ i~
f~
l'"
L, SEWER TAP SEWER ^ SEPTIC ^ WATER TAP
4~ i
~ ~ REMOTE ^ WATER SERVICE
I
f: I
~' ELECTRICAL:
~' ~-ROUGH IN [] FIXTURES ~ FINAL ~ MOTORS
t _ ~ PERMANENT SERVICE ~ TEMPORARY SERVICE
-.
MECHANICAL:
~•:' -
G': ^ ROUGH W [] A/C
- ^ FINAL
a
E PLUMBING: ' •