BP7876BUILDINCa PERIVIII'`APPLICATION
Jurisdiction of City .of Blair, Nebraska
`Permit Fee: ~ ~ -C~~ 218 South 16th Street
Issuance Fee: Blair, Nebraska 68008 7 $ 7 6
Deposit Receipt #: (402) 426-4191 • Fax (402) 426-4195 Permit
Application Date: ~ ~~-R ~ Issue Date: ~ r Z Y
JOB ADDRESS 4-~ O~ ~ n 1 „ / _ r~ ~Gl ~~
~
r ~ ~J,
LEGAL
1 . DESCR. LOT NO. B
LK. TRACT
^ SEE ATTACHED SHEET
/ J ,~ , ~/ ~ /!e
2.OWNER ~~l~L1cX~" ~~ Y Vll ~~L~9 ESS c 1~~~- / oMZIP ~ - /_~~~ PHONE
(o 'J'_. ' r `(Jl,/ ~f//l~ lL/
PHONE
CONTRACTOR ~~ ~~ ~ ~ MAIJ.-ADDRESS ` ZIP
3. ~~.11 `Vr(~.~
4. Class of Work: O NEW O ADDITION O REMODEL
5. Describe Work: ~~ ~(~~~{(~ ~/'~ O Finished Basement O Unfinished Basement
6. Total Sq. Footage (InDluding easement and Garage): Total Finished Area:
7. Valuation of Work: $ ~ c( ~~~~
Floodway O Yes O No Dev. Permit
8. Floodplain: 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 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.
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,
SIGNATURE OF OWNERICONTRACTOR DATE
Comment:
O Site Plan Attached frfpl tie Plans Attached
~,~e0
Approximate Completion Date ~
~ it Lc~I-Q-~
Inspections Required and Fees
Utilities
Sewer Water Service
Septic Remote
Stop Box Card
Building
Footings Drywall
(before finish)
l ~r L/~~
Framing Fina
Electrical
Rough-in Fixtures
Final Permanent Service
Temporary Service
Mechanical
Rough-in _
Final
Plumbing .
Ground Work
Rough-in
Final
WHEN PROPERLY VALIDA
Approved By: ~'
A\C
THIS SPACE) THIS IS YOUR PERMIT
POUNDS PRTG: Blair, NE / / Rev. Bleb
~9 ~~1~ILDING INSPECTION REPORT
s, ~~,
~Tl'Y OF BLAIR ~ WASHINGTON COUNTY, ~ OTHER
. LOCATION OFINSPECTION: -_ c~ ~ ~ ~ ~l ~,~~Y cr ~ ~~( ~„ f
NAME OFOWNER: - Ir~ l ' ~ ~ I I/ f) I' CONTRACTOR: _ ~ ~ 1 ° ~ •)1 [!C) ~/ /
_ `~
DATE INSPECTION REQUESTED: ' 'I '" ~~ •~ `l p~ P~JyIIT N0: ~~
TIME INSPECTION REQUESTED: I`~ ~ /
';
TYPE OF INSPECTION REQUESTED:
BUILDING: If''~ ~~ ~
((~~
~ FOOTING Q FRAMING ^ DRYWALL [~ INAL ~ (` t t)-'`~
%.k~
.UTILITIES:
SEWER TAP ^ SEWER ^ SEPTIC ^ WATER TAP
^ REMOTE ^ WATER SERVICE
ELECTRICAL: •
ROUGH IN ~ FIXTURES ^ FINAL ~ MOTORS
PERMANENT SERVICE ~ TEMPORARY SERVICE
MECHANICAL:
[] ROUGH-IIY ^ A/C ~ FINAL
PLUMBING:
GROUNDWORK ^ ROUGH-IN ~ ^ FINAL
• RESULTS OF THE INSPECTION:SED (S~xoTFS~ ^ FAILED ~s~ rioTES>
' NOTES/REMARKS: