BP7679BUILDING PERMIT APPLICATION
`' ~ Jurisdiction of City of Blair, Nebraska
Permit Fee: ~ _ 218 South 16th Street
Issuance Fee: Blair, Nebraska 68008 7 6 7 9
Deposit Receipt #: (402) 426-4191 • Fax (402) 426-4195 Permit
Application Date:~~ ~ ~ ~ Issue Date: ~h~~
JOB ADDRESS ~ ~ ~ ~ `
LEGAL
1. DESCR. LOT NO. BLK. TRACT
^ SEE ATTACHED SHEET
OWNER
2. MAI DDr~ S
o~ l lo~ ~ ZIP PHO E
bZ ~(~~ - ~l0 Z-(
CONTRACTOR
3. MAIL ADDRESS ZIP PH NE
4. Class of Work: O NEW O ADDITION O REMODEL
5. Describe Work: ~~ ,~ ~ O Finished Basement O Unfinished Basement
6. Total Sq. Footage (IRCIuaIRg easement aRd Garage>: Total Finished Area:
7. Valuation of Work: $ ~ ~(~ b ~
Floodway O Yes O No
8. FIOOdplain: Fringe O Yes O No Dev. Permit
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 (7 No
13. Minimum Setbacks: Front
~ No
O No
Side Rear
O Site Plan Attached .~ / 3 i ~om~let~ ~ ns Attached
Approximate Completion Date l ~
Inspections Required and Fees
Utilities
Sewer _
Septic _
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 copyof 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
180 days or is not completed within 2 years of date of issue.
Comment:
OF OWNER/CONTRACTOR
Buildin
Footings
Framing
Electrical
Rough-in
Final
Temporary Service
~ ~ Mechanical
DATE
Rough-in
_
Final
Plumbin _
Ground Work
Rough-in _
Final
WHEN PROPERLY VALIDATED (IN THIS SPACE) THIS IS YOUR PERMIT
Water Service
Remote
Stop Box Card
Drywall
(before finish)
Final ~~~ ~ 7
Fixtures
Permanent Service
A1C
POUNDS PRTG: Blair, NE Rev. B/96
=BUILDING INSPECTION REPORT =
~'>
_p
~TP Y OF BLAIR ~ ^ WASHINGTON COUNTY ^ OTHER
_ ~~
LOCATION OFINSPE~ON: ~~ ~ `-:~1~ ~~~ ~ ~~ ~~'~
NAME OF OWNER: :~ CONTRACTOR: _
DATE INSPECTION REQUESTED:. :~`~ ~ -~ >^~ PERMIT N0: ,~">~
TIME ]NSPECTION REQUESTED: ~`~`~~
TYPE OFINSPECTION REQUESTEDc
BUILDING: ,~'~ 4~
^ FOOTING ^ FRAMING ^ DRYWALL ,~=FINAL ~ ,
UTILITIES:. '.
^ SEWER TAP . ^SEWIIt ^ SEPTIC ^ WATER TAP -
^ REMOTE ^ :WATER SERVICE ~ -
ELECTRICAL:
^ ROUGH'IN ^ FIXTURES ^ FINAL ^ MOTORS
^ PERMANENTSERVICE ^ TEMPORARY SERVICE
MECHANICAL: ~ - _
ROUGH-IN ^ A/C ^ FINAL
PLUMBINGc
^ GROUNDWORK ^ ROUGH-IN ^ FWAL
~;
RESULTS OF THE INSPECTION: ASSED (s~xo~rES~ ^ FAILED (s~xoi~s~
NOTES/REMARKS:
il ~ ~
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i INSPECTOR:T~ .~j~~~ ~ ~.2~ ~~%'~
a ` ,~ _
.DATE OF INSPECTION MADE: ~ ~ ~~ ~ TIME:. f ~ ~ _
F-~
' _ - ~~.
CALLED OPPD\ TO CONNECT SERVICE: ^ YES ^.NO
WANT OFFICE STAFF TO CALL OPPD\ _ ^ YES ^ NO . _ BLR 1~~
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