BP7584BUILDING PERMIT APPLICATION
Permit Fee: ~a - OCR Jurisdiction of City of Blair, Nebraska
218 South 16th Street
Issuance Fee: Blair, Nebraska 68008 7 5 8 4
Deposit Receipt #: (402) 426-4191 • Fax (402) 426-4195 Permit
Application Date: ~'Z~"~ / Issue Date: 3` Z~' cl
JOB ADDRESS 1 ~ ( S ~ V ~ I ,~T7 S / `
LEGAL
1 . DESCR. LOT No. BLK. TRACT
^ SEE ATTACHED SHEET
OWNER MAIL ADDRESS
2. N Gtn C ~ ~ aY,n ct~ ; ,~^ ZIP PHONE
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3. CONTRACTOR ~ "/ I + mil f RMAILADDRE~ /~~
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~ . / ~~~~ZIP/. ~MG(.~ PHONE O /~
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4. Class of Work: NEW
0 ADD
IT
I
O
N O REMODEL
5. Describe Work: ~~ - ~ ~ 1 O Finished Basement O Unfinished Basement
6. Total Sq. Footage (IncludlRg Basement and Garagel: Total Finished Area:
7. Valuation of Work: $ 31:010- d~
Floodway O Yes O No
8. Floodplaln: Fringe O Yes O No Dev. Permil
BFE
Elev. Cert.
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
O No
O No
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.
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 ofNebrask .I understandthatthispermitisvoidifworkisnotcommencedwlthin
180 ays or i n c mpl ed wit ' 2 years of date of issue.
IGNATURE OF OWNER/CONTRACTOR ATE
Comment:
Site Plan Attached ~ Q Corr~plg 5 PI~ ~ ~tf~ched
Approximate Completion Date N~-11'l.~.f I -,- /
Inspections Required and Fees
Utilities
Sewer Water Service
Septic Remote
Stop Box Card
Buildina
Footings Drywall
(before finish)
~J ~ ~ ~ ~ ~
Framing Final
Electrical
Rough-in Fixtures
Final Permanent Service
Temporary Service
Mechanical
Rough-in A1C
Final
Plumbina
Ground Work
Rough-in Final
WHEN PROPERLY VALIDATE (IN THIS SPACE) THIS IS YOUR PERMIT
Approved By: ,.p
POUNDS PRTG: Blair, NE ~ Rev. 6/96
~~~"~ "BUILDING INSPECTION REPORT
~_ _ _~
~_- -
"CITY OF BL;AIR ~ WASHINGTON COUNTY ~ OTHER
r71-- ~r
LOCATION OF INSPECTION: ~-~ : f 7 ~~ ~ r r-~r'r-3 ~-,~ sj ~{~
~` - , ~,J~~/jam r ,~ ~i
f. NAME OF bWIVER: ~~'`~tr~~~~~; CONTRACTOR:~~%f~{ 7~'~>J~i ~'~~-, "-~~ ~
DATE INSPECTION REQUESTED:. ~7 ` ~ ` ` ~/~p~~qT N0: f ~~~~,.
[ °~ ' . f.
t TIME INSPECTION REQUESTED: " .~ r~ -
~-
TYPE OF INSPECTION REQUESTED: ~
.. _ ! > ~ ~~ irk
~ BUILDING:
FOOTING ^ FRAMING. ^ DRYWALL .-FINAL
UT]LITIES:
SEWER TAP ~ SEWER ~ SEPTIC ^ WATER TAP
REMOTE Q WATER SERVICE
ELECTRICAL:
ROUGH'IN ^ FIXTURES - ~ FINAL ^ MOTORS
^ PERMANENTSERVICE " ~ TEMPORARY SERVICE
MECHANICAL:
~ ^ ROUGH-W ~ A/C 0 FINAI,
~'
PLUMBING:
^ GROUNDWORK ^ ROUGH-IIY.FINAL
-RESULTS OF THE INSPECTION: • PASSED ~s~xorEsi Q FAILED ~s~ NorFS>
~_
~~ NOTES/REMARKS:
F;:
~"
( I -
F.,. f ~`
F.: ~ ¢€~I/~~
~' INSPECTOR: ~~i`f ~ ~ F 1 ~,/t-,5~-~"~ -
~- ~^-~
DATE OF INSPECTION MADE: ~~
k
.CALLEDOPPD\ ^ YES N0 '.
TO CONNECT' SERVICE:
r`
r,
f ~, WANT OFFICE STAFF TO CALL OPPD\
~ ^ YES ~'NO' BLR-1