Loading...
BP7793Permit Fee: _ Issuance Fee: BUILDING PERMIT APPLICATION ~~ ~ ~ Jurisdiction of City of Blair, Nebraska ~ J ~ ~, 218 South 16th Street Blair, Nebraska 68008 7 7 9 3 Permit Deposit Receipt #• (402) 426-4191 • Fax (402) 426-4195 A lication Date: ~ ~~ !~ 7 Pp Issue Date: ~ JOB ADDRESS ,, U LEGAL 1. DESCR. BLK. LOT No. TRACT ^ SEE ATTACHED SHEET OW ER - ~ 2. MAILA RESS ~• ZIP j~~~ PHONE ~~ '7" CONTRAC 3. MAIL ADDRESS ZIP PHONE 4. Class of Work: O W O ADDITION O REMODEL 5. Describe Work: ~ O Finished Basement O Unfinished Basement 6. Total Sq. Footage (Incl~ding easement ana Garage): Total Finished Area: ~~ 7. Valuation of Work: $ ~J~ Floodway O Yes D No 8. Floodplain: Fringe O Yes D 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 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 copyof 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 days or is not completed within 2 years of date of issue. ~ OF OWNER/CDNTRACTDR DATE Comment: /yl~~/ ~~~ G~©~~ .rlc1 ~/1.~C~f7`-~~5~lrll~~.s O Site Plan Attached ~ O Cgm~,pl~e Plans Attached Approximate Completion Date ~ /Y Inspections Required and Fees Utilities Sewer Septic Building Footings Framing Electrical Rough•in Final Temporary Service Mechanical Rough-in _ Final Plumbin _ Grountl Work Rough-in WHEN PROPERLY VALIDATE ~ ve By; /~ Water Service Remote Stop Box Card Drywall (before finish) ~'~ ~~ Fixtures Permanent Service A\C Final THIS SPACE) TH IS YOUR PERMIT POUNDS PRTG: Blair, NE Rev. 8196 r~ ~GCf~.,~ F~6L5 ~J-~fY~~ I' i/~ ~AE ~C~~~ ~_ ..-~ ~_ r BUILDING INSPECTION REPORT CITY OF BLAIR ^ WASHINGTON COUNTY ^ OTHER LOCATION OF INSPECTION: NAME OF OWNER' r L~' 'J CONTRACTOR: DATE INSPECTION REQUESTED: / ~~ ~ 7 PERMIT N0: TIME INSPECTION REQUESTED: TYPE OF INSPECTION REQUESTED: BUILDING: ^ FOOTING ^ FRAMING ^ DRYWALL FINAL UTILITIES: ^ SEWER TAP ^ SEWER ^ SEPTIC ^ WATE/R TAP / ^ REMOTE ^ WATER SERVICE ` L ~~ ~/n~.~~~ ELECTRICAL: ~ ~~~ ^ ROUGH IN ^ FD~'TURES ^ FINAL ^ MOTORS /~. ^ PERMANENT SERVICE ^ TEMPORARY SERVICE MECHANICAL: ^ ROUGH-IN ^ A/C ^ FINAL PLUMBING: ^ GROUNDWORK ^ ROUGH-IN AL .,` RESULTS OF THE CTION: PASSED (s~xo~s> ^ FAILED (s~xo~s> NOT/REMARKS: l ~~~~ ~~ ~~ "` /1~ ~ LG-- X17 d~ /Q iNCDR!`TYIA • /J ~L