BP7929BUILDING PERMIT APPLICATIt~IV
4~~~~ IS fiction of City of Blair, Nebraska
Permit Fee: ~~~'T v""" • 218 South 16th Street
~ ~ ~`,
Issuance Fee: ,f~1 P Blair, Nebraska 68008 7 g 2 g
Deposit Receipt #: ~ (40 426-4191 • Fax (402) 426-4195 Pe mit
Application Date: ~ ~ ~ ~ ~ ssue Date: Q
JOB ADDRESS
~~
1 LEGAL LOT NO. BLK. TRACT
^ SEE ATTACHED SHEET
. MAILADDRES % ZIP PHONE
CONTRA
3. MAIL DDRESS ZIP PHONE
4. Class of Work: O NEW O ADDITION O REMODEL
5. Describe Work: ~~ O Finished Basement O Unfinished Basement
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6. Total Sq. Footage (Including easement ana GaragB): Total Finished Area:
~o~
7. Valuation of Work: $ ~a ~
Floodway O Yes O No
8. Floodplain: Fringe O Yes O No Dev. Permit
BFE
Elev. Carl.
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 ~'j ,
13. Minimum Setbacks: Front ~~ Side / Rear
14. SidewalkRequired:,~Yes O No Waiver Approved
NOTICE
Separate permits are required for electrical, plumbing, heating, ventilating and air
conditioning, and septic systems. lay 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 by the Building
Inspector.
I herebyagree 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 OWNERICONTRACTOR
DATE
Comment:
,~~~G'~~j G'L~~ ~~
~~~~SS ~i~~'`~
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O Site Plan Attached / /J~ Com~l~ Plans Attached
Approximate Completion Date ~~~
Inspections Required and Fees
Utilities
Sewer
Septic _
Building
Footings
Fram~~/
Water Service
Remote
Stop Box Card
prywall -~
(before f/finish)
Fief ..
Electrical /
Rougf>~ Fixtu~
F Permanent Service
Temporary Service
Mechanical
Rough-' A\C
F~
Plumbin _
Ground Work
WHEN PROPERLY VALIDATED (IN THIS SPA THIS IS YOUR PERMIT
BV~ .~ A~
POUNDS PRTG.-Blair, NE Rev. 8198
MECHANICAL PERMIT APPLICATION
Jurisdiction of City of Blair, Nebraska
218 South 16th Street
Blair, Nebraska 68008
(402) 426-4191
Application Date: ~~`~ ~~
r ~~ ~~
Permit Fee: $ y`~
JOB ADDRESS
~~
LEGAL
1 • DESeR. LOT NO. BL TRACT
O SEE ATTACHED SHEET
2. OWN MAIL ADDRESS ZIP PHONE (,T~
•
3• CONTRACT MAIL ADDRESS PHONE LICE E N0.
~ (~
~' ! / !-~~
4. Class of Work: EW RESIDENTIAL O NEW COMMERCIAL O REMODELING/ADDITIONS O REPLACEMENTS
5• Describe Work:
Comments:
v ~~~ MECHANICAL PERMIT FE ES
/~~ ~r~
/ ~
Forced Air Systems
~~ Per Unit Commercial/Residential (New) .............. ........................ $25.00
Air-Conditioner Unit
Per Unit Commercial/Residential (New) .............. ........................ $10.00
Refrigeration Units/Coolers
Per Unit Commercial (New ~ 1 .... ........................ $10.00
NOTICE ~° - <---~~-°~-.~_
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I hereby certify that I have read and examined this oner
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ys
errts ~ on
rce p
application and know the same to be true and correct. All Unit Rep acement \
provisions of laws and ordinances governing this type of
work will be complied with whether specified herein or not.
Per Unit Commercial/Residential (Replacement)
........................ $10.00
The granting of a permit does not presume to give authority
to violate or cancel the provisions of any other state or local
law regulating construction or the performance of
construction.
Permit Issuance Fee ............. $15.00
~~o~~
TOTAL
S NATURE OF CONTRACTOR OR AUTHORIZED AGENT
Current License on File O Yes O No O NA
DATE
WHEN PROPERLY VALIDATED (IN THIS SPACE) T-f#t~l~ YOUR PERMIT
Comment:
Approved By:
d
POUNDS PRTG: Blalr, NE flev. 12!95
PLUMBING PERMIT APPLICATION
Jurisdiction of City of Blair, Nebraska
218 South 16th Street
Blair, Nebraska 68008
(402) 426-4191
Application Date:. ~ d' ~ ~ ~~ ~ Permit Fee: $ ~ ~ '~~
JOB ADDRESS I ~ ,~
C~! , ~~
1 , LEGAL
DESCR. LOT NO. BLK. TRACT O SEE ATTACHED SHEET
2 OWNER .~ ~ILAyDDRESS ZIP
(J"t:_ ~ ~ ~ ~~\ 11..1. PHONE
PHONE ; C
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,3, CONTRACTOR _ MAIL ADDRESS a ~i~~ y~ ~~ LICE~E NO. ' I~/ /~
'
. ~
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4• Class of Work: O NEW RESIDENTIAL O NEW COMMERCIAL EMODELING/ADDITIONS O REPLACEMENTS
5• Describe Work: ~~~~~~~ ~ ~~~(~}}~~
Comments:
PLUMBING PERMIT FEES
Type of Fixture No.
Kitchen .................................. $8.00 x
Bath ....................................... $8.00 x ~ ~- C
Rough-In Bath ....................... $4.00 x
Utility ..................................... $5.00 x
Water Heater ......................... $3.00 x
Outside Water Faucet ........... $3.00 x
Water Service ........................ $10.00
NOTICE Sewer .................................... $10.00
hereby certify that I have read and examined this Groundwork ........................... $10.00
application and know the same to be true and correct. All
provisions of laws and ordinances governing this type of Septic Tank & Laterals .......... $10.00
work will be complied with whether specified herein or not.
The granting of a permit does not presume to give authority
Lawn Sprinkler System ..........
$10.00
to violate or cancel the provisions of any other state or local
Sprinkler System ...................
$30.00
law regulating construction or the performance of (Commercial)
construction.
.t
Permit Issuance Fee .............
$15.00 ~ S., G )
~- G
'' $IGNA~TUR~ O( CONTRACTOR OR AUTHORIZED AGENT ~
~3- UL
TOTAL
DATE Current License on File es O No O NA
WHEN PROPERLY VALIDATED (IN THIS SPACE) THIS IS YOUR PERMIT
Comment: I Approved By: f~ ~~ ~~~
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POUNDS PRTG: Blair. NE ® Rev. 12/95
City of Blair
218 South 1 bth
Blair, Nebraska 68008
402-426-4191
Fax - 402-426-4195
~~~
BUILDING PERMIT DEPOSIT AGREEMENT
A $200.00 refundable deposit is being collected at the time of your building permit
application for all permits in excess of $10,000.00. However, the City reserves the right
to not refund this deposit if any of the following conditions occur during the construction
period: 1) water is connected without a meter by either the plumber, owner or general
contractor, 2) all required inspections have not been obtained (this includes drywall prior
to taping) as per attached checklists (Both Rough-In and Final), 3) occupancy or utilization
occurs prior to a final inspection, and 4) all permits have not been obtained. If any or all
of these situations occur during construction, you may forfeit your deposit.
I, hereby agree to the above conditions, and understand that should any or all of the above
situations occur, the building permit deposit may be forfeited or discounted upon the
discretion of the City of Blair, Building and Inspections Department.
Contract~j/Owner
y0.5 ~/~~~e~
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Date
Contractor/Owner
City of Blair
1
Ed1~L XW SINO
OPPORNRRY
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promise
Jaroct & Sherry Dace
1433 Colfax Street
Blair, NE 68008
OF
BLAIR
June 19, 1998
RE: Final Inspection of Addition --1433 Colfax Street
Dear Mr. & Mrs. Dace,
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On May 15, 1998, Dale Miller did a fmal inspection on the above
residence. At that time, the inspection passed, however, your permit could
not be fmaled because your electrical permit had not been issued.
Please note this permit must be executed before we can refund your
deposit of $200.00 to Bruce Arp. At this time, we are waiting on a permit
from Bender Electric. As soon as we receive the electrical permit, your
building permit can be fmaled.
Since your addition was fmaled on May 15, 1998, please have this
matter taken care of before July 15, 1998.
If you have any questions, feel free to contact either Dale or myself.
Thank you in advance for your cooperation in this matter.
~~~ ~ ~,
CC: Bruce Arp
Sincerely,
Tammy Madsen
~ , Building Department
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218 S. 16TH STREET, BLAIR, NE 68008-2010 (402) 426-4191 • (402) 426-4195 FAX
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