BP7836B~UIL.DING PERMIT I~PPLI
~ Jurisdiction of City of Blair, Nebraska
Permit Fee: ~y 218 South 16th Street
Issuance Fee: Blair, Nebraska 68008
Deposit Receipt #: (402) 426-4191 • Fax (402) 426-4195
~ ~' "~ Issue Date:
Application Date:
Permit
7336
JOB ADDRESS
~O ~ _
~~
LEGAL
1. DESC LOT ND. BLK. TRACT
^ SEE ATTACHED SHEET
OWN R
2. MAIL ADD SS ZIP PHONE
,
3. CONT 0 tom-- ~ AIL ADDR ~~. 1 ~ `ZIP__~ `% ~ ONE
C!`' (~`"/
4. Class of Work: O NEW O ADDITION O MODEL
5. Describe Work: y~ ~ O Finished Basement O Unfinished Basement
6. Total Sq. Footage (IRCluaing easement ana Garage): Total Finished Area:
7. Valuation of Work: $ _ ~ ~l ~~
Floodway O Yes
8. Floodplain: Fringe O Yes O No Dev. Permit
O No 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
O No
O No
13. Minimum Selbacks: 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 copyof 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 of Nebraska. I understand that this permit is void if work is not commenced within
180 days or is t completed within years of ate of issue. C
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SIGNATU E OF OWNER/ NTRACTOR DATE ~
Comment:
O Site Plan Attached ~ O C lete Plans Attached
Approximate Completion Date
Inspections Required and Fees
Utilities
Sewer Water Service
Septic Remote
Stop Box Card
Building
Footings Drywall
(before finish)
I U Z3~
Framing Final
Electrical
Rough-in Fixtures
Final Permanent Service
Temporary Service
Mechanical
Rough-in A\C
Final
Plumbing
Ground Work
Rough-in Final
WHEN PROPERLY VALIDA ED (IN THIS SPACE) THIS IS YOUR PERMIT
Approved By:
CATI®N
POUNDS PRTG: Blair, NE Rev. 8196
DATE INSPECTION REQUESTED: .w '~` '' ~ ~ Y~KM1'P NU: ~ ~ ..~ -4-5 -
TIME WSPECTIONREQUESTED: -
TYPE OF INSPECTION REQUESTED:
. BUILDING: _
^ FOOTING ^ FRAMING ^ DRYWALL [INAL
UTILITIES: '
SEWER'TAP' ^ SEWER ^ SEPTIC ^ WATER TAP
REMOTE ^ WATER SERVICE,
ELECTRICAL:
^ ROUGH IN ^ FIXTURES ^ FINAL ^ MOTORS ' ,...%';
PERMANENTSERVICE ^ TEMPORARY SERVICE
MECHANICAL:
ROUGH-W , ^ A/C ^ FWAL
ALUMBING: ~ '
^ GROUNDWORK ^ R~GH-IN -^ FINAL
RESULTS OF THE INSPECTION: ASSED(s~rioTES) ^FAILED{sEExoTES) - .
. ~ NOTES/REMARKS:
+ ~•
.INSPECTOR:
~
v ~~ r
TIME:
@~_'
/ ~~
~ ~ '
OF INSPECTION MADE
A
,~
~
-
~
D
TE
CALLED OPPD\ ~ TO CONNECT SERVICEi ^ YIaS ' ' ^NO
4 WANT OFFICE STAFF,TO CALL ORPD\ ^ YE.S ^ NO . " BLR 1
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