BP7726- BUILDING PERMIT APPLICATION
~ ~ .OCR Jurisdiction of City of Blair, Nebraska
Permit Fee: 218 South 16th Street
Issuance Fee: Blair, Nebraska 68008
Deposit Receipt #: (402) 426-4191 • Fax (402) 426-4195
Application Date: ~ ` ~ ° ~ ~ Issue Date: ~ ' ~~~-~ 7
JOB ADDRESS - ~~ ~ ~ y /
/` 6
LEGAL
1. DESCR. LOT NO. BLK. TRACT
^ SEE ATTACHED SHEET
OWNER Q ~` ~ MAIL ADDRESS ZIP PHONE
CONTRACTOR MAIL ADDRESS
3. ~ ~~~ ZIP PHONE
4. Class of Work: NEW O ADDITION O REMODEL
5. Describe Work: ~~-~ -- ~ ~~ ~ O Finished Basement O Unfinished Basement
!~1 Diu--/
6. Total Sq. FOOtage (Including Basement and Garage}: TOtal FInlShed Area:
7. Valuation of Work: $ `~ ~ °1 ~~
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 mysignature 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 thatthis permit is void if work is not commenced within
180 days or is not completed within 2 years of date of issue.
SIGNATURE OF OWNER/CONTRACTOR
Comment:
O Site Plan Attached ~ C~p~te ~~a~ Attached
Approximate Completion Date ~~ii
Inspections Required and Fees
Utilities
Sewer Water Service
Septic Remote
Stop Box Card
Buildin
Footings Drywall
(before finish)
Framing Final 7~
Electrical
Rough-in Fixtures
Final Permanent Service
Temporary Service
Mechanical
Rough-in _
Final
Plumbin9 -
Ground Work
Rough-in
Final
WHEN PROPERLY VALIDA
Approved By: /
Permit
A\C
THIS SPACE) THIS IS YOUR PERMIT
7-726
POUNDS PRTG.-Blair, NE // Rev. Bl96
-- -------- ____-------- ION REPORT
~_ BUILDIl?~T~ ~~TSPE CT -
,F :~~ .
_._, ;
~ -' ~yt ~'Y OF BLAIR ^ WASHINGTON COUNTY ^ OTHER
~~~ ~, ~
LOCATION OF INSPECTION: r ~ ~ ~ ~~ 9~' f ~~-~c~t~ S
~ ~ ~
NAME OF OWNER: ~~' '~~ ~`f ~` ~~: CONTRACTOR: '°~~~~t `~'
~~ `PERMIT N0: ~ ~rt~ .
DATE INSPECTION REQUESTED:
TIME INSPECTION REQUESTED: ~`~
TYPE OF INSPECTION REQUESTED:
~~ ~~~{
BUILDING: _
^ FOOTING'. ^ FRAMING ^ DRYWALL ~ r~WAL _ ,
UTILITIES:
^ SEWER. TAP ^ SEWER . ^ SEPTIC ~ ^ WATER TAP
REMOTE ^ WATER SERVICE
ELECTRICAL:
^ ROUGH IN ^ FIXTURES ^ FINAL `MOTORS
^ PERMANENT SERVICE ^ TEMPORARY SERVICE
MECHAMCAL: - ~'~ ~ , ~- -
^ ROUGH-W, ^ A/C ~] FINAL
PLUMBING:
•k y
^ GROUNDWORK ^ ROUGH-IN ^ FINAL
! RESULTS OF THEINSPEC OND (s~NO~s) [~] FAILED (sEErro~res)
~~ ! l ~~~
NOTES/REMARKS: _, v ~`~ ~"
. - ~
f ~~~,
~' r -:
- .~.~.`
..INSPECTOR: ~~-f.,~r`~~"~ ~ c~~C`-~~~~`~
DATE OF INSPECTION MADE: ~ ;
i'
~~
:~UILDII~G~-~~~TSPECTION REPORT
. ~~,
QrCITY OF BL;AIIt ^ WASHINGTON COUNTY ^ OTHER
LOC,4TION OF INSPECTION:_ ~
r_ 1
NAME OF OWNER: ~'-d ,~.~ CONTRACTOR:
- f' ! r,,
= DATE INSPECTION REQUESTED: ~`~~ J ~ ~ PERMIT NO:
~, ~
TIME INSPECTION REQ~ESTBD: / ~ I`
TYPE OF INSPECTION.REQUESTED:
BUILDING; i ~,n~~b
^ FOOTING ` ^ FRAMING ^ DRYWALL ~FITtAL
UTILITIES: ((~..
^ SEWER TAP ^ SEWER ^ SEPTIC ^ WATER TAP
^ REMOTE - ^ WATER SERVICE
ELECTRICAL:
ROUGH IN ^ FDCTURE$ ^ FINAL ^ MOTORS
^ PERMANINT SERVICE ^ TEMPORARY SERVICE
MECHANICAL:
^ ROUGH-IN. ^ A/C ^ FINAL
PLUMBING:
~ ,~„~~`
1 ~ i
~~ ~.v~ f~
~~ ~ ~.~
~. f~~ fA
. ~ -~~'
~~~ ~~ ~
~~-~
~~
4
r ^ GROUNDWORK ^ ROUGH-IN ^ FINAL
~.
RESULTS OF THE INSPECTION: -~' ASSED (sue xoiES> - ^ FAILED (sue xoTES>
~.
~` ` NOTES/REMARKS:
~- ` /7
t