BP7822BUI DII\IC~ PERMIT ~lPPL.ICa4Tl®IV
' Jurisdiction of Cit of Blair, Nebraska
Permit Fee: C .~ •~ Y
218 South 16th Street
Issuance Fee: Blair, Nebraska 68008 7 8 2 2
Deposit Receipt #: (402) 426-4191 • Fax (402) 426-4195 Permit
~'~'~~
Application Date: ~ ° ~ -~ 1 Issue Date:
JOB ADDRESS
V ~ ~~~ ~7 .
LEGAL
1. DESCR. LOT NO. BLK. TRACT
^ SEE ATTACHED SHEET
OWNER MAIL ADDRESS
2. C I ~ rencC- ru-(1C~0~ C. ZIP PHONE
CONTRACTOR MAIL ADDRESS
3. }-~me. t 1c~ 50~ S. 1d~`~ ZIP PHONE
a (~~2~ ~~ -~~~
4. Class of Work: NEW O ADDITION O REMODEL
5. Describe Work: ROC - 2 J Q~ er ~ct.f~ ~ O Finished Basement O Unfinished Basement
P, lac ~c~.l--f-
6. Total Sq. FOOtage (Including Basement and Garage): Total FInlShed Area:
7. Valuation of Work: $ ~ cj~~ ,
Floodway O Yes O No Dev. Permit
8. FIOOdplaln: Fringe O Yes O No 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
iA(~days or is not completed within 2 years of date of issue.
SIGNATURE OF OWNER/CONTRACTOR DATE
Comment:
O Site Plan Attached O Complete Plans Attached
Approximate Completion Date "~ -14-9~
Inspections Required and Fees
Utilities
Sewer_
Septic _
Stop Box Card
Buildin
Footings Drywall
(before finish)
Framing Final 7 ~ ~~ ~7
Electrical
Rough-in Fixtures
Final Permanent Service
Temporary Service
Mechanical
Rough-in _
Final
Final
Plumbin -
Ground Work
Rough-in
WHEN PROPERLY VALIDATED (IN THIS CE) THIS IS YOUR PERMIT
Approved By: ,~ ~
Water Service
Remote
A\C
POUNDS PRTG: Blair, NE U Rav' BleG
----_~ T ^-- --- -_-_ -----------
~` ~- BUILDING INSPECTION REPORT - ~ 'i
_~: ~~ -
f
CITY OF B~LAIR • ^ WASHINGTON COUNTY ^ OTHER
r ~ ~ ~ ~~~
LOCATION OF INSPECTION: ~ ~ ~=~tJ ~ ~ v~ 7`~'~- _
NAME OF OWNER: ~~/°j~~ r ~ ~ CONTRACTOR: ~`~~'~~ -'tf ~rc%~ ~' ,~i
-~ ~
DATE INSPECTION REQUESTED: ~ ~~`'PERMIT NO:
I ;; t _
TIME INSPECTION REQUESTED ~~"~.~~~!
_ f
.TYPE OF INSPECTION REQUESTED:
:.. BUILDING:
i
^ FOOTING ^ FRAMING ^ DRYWALL FINAL ;
f
UTILITIES: .
~ •.
^ SEWER TAP • ^ SEWER . -^ SEPTIC ^ WATER TAP
~.
k ^ REMOTE ^ WATER SERVICE
~'
ELECTRICAL:
~`
~. `'
ROUGH IN ^ FIXTURES ^ FINAL ^ MOTORS
^.PERMANENT SERVICE ^ TEMPORARY SERVICE
MECHANICAL: -
^ ROUGH-W ^ A/C ^ FINAL
PLUMBING:
^ GROUNDWORK ^~ROUGH-IN ^ FINAL _
RESULTS OF THE INSPECTION: SSED ~s~rro~s) ^ FAILED ~s~ rrm~s)
NOTES/REM9RKS: -