BP7928Permit Fee:
Issuance Fee:
Deposit Receipt
BUILDING PERMIT APPLI
~~ ~ ~ Jurisdiction of City of Blair, Nebraska
218 South 16th Street
Blair, Nebraska 68008
CATION ~ ~~
792
#; (402) 426-4191 • Fax (402) 426-4195 Permit
Application Date:~~ ~7~ Issue Date: /~
J0~ ADDRO~ESS ~ ~ A ~ j ~"
1_
G ~ to ~ D ~ O
LE
AL
1. DESCR. LOT N0. B
LK. TRACT
^ SEE ATTACHED SHEET
0 IL ADD SS p PHONE
2. d a~ ~~ ~~ (~3~ ~o C98 l b~ 30~- 3
CO TRACT MAIL ADDRES ZIP PHONE
4. Class of Work: O I~W O ADDITION O REMODEL
5. Describe Work: -~~~- r~~~ ~ (~ .~ - ~ ~` ~ ~ Inished asement O Unfinished Basement
6. Total Sq. Footage (Including Basement and Garage): Total Finished Area;
7. Valuation of Work; $ `a (a g ~ ~ O b
Floodway f7 Yes O No
8. FIOOdplain: Fringe O Yes O 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
O No
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. Bymysignature 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
18 avs r is not completed w' hin 2 years of date of issue.
r ~ ~~ ~~
DATE
Comment:
O Site Plan Attached O Complete Plans Attached
Approximate Completion Date (~=~
Inspections Required and Fees
Utilities
Sewer Water Service
Septic Remote
Stop Box Card
Building
Footings Drywall
(before finish)
Framing Final
Electrical
Rough-in Fixtures
Final Permanent Service
Temporary Service
Mechanical
Rough-in A\C
Final
Plumbin _
Ground Work
Rough-in _
Final
WHEN PROPERLY VAL TED (IN THIS SPACE) THIS IS YOUR PERMIT
Approved By:
POUNDS PRTG: Blair, NE ~ Rev. 8196
i
- -BUILDING INSPECTION REPORT.
CITY OF BLS ^ WASHINGTON COUNTY ^ OTHER
~ - ~;7 ~
LOCATION OF INSPECTION: ~_~,~ •~- ~ ~--~~~ 17 ~t ~• ~ ~~~~~~ I
/~
NAME OF OWNER: ~I ~.L- CONTRACTOR: /`•''~ :~~~ ~ r)rr ~
DATE INSPECTION REQUESTED: PERMIT N0: ~ ~ ~ ( ~
TIME INSPECTION REQUESTED:
TYPE OF INSPECTION REQUESTED: i
BUILDING: °---~r•-~.~..4~,'(- C)~~~ .,. ~ ~ -If~~ - ~_h}-~~1~_ 1`~"
^ FOOTING ^ FRAMING ^ DRYWALL. ~ FINAL -
UTILITIES:
SEWER TAP ^ SEWER ^ SEPTIC ^ WATER TAP
^ REMOTE`- ^ WATER SERVICE
'`ELECTRICAL:
^ ROUGH W ^ FIXTURES ^ FINAL ^ MOTORS
^ PERMANENT SERVICE ^ TEMPORARY SERVICE
MECHANICAL:
^ ROUGH-IN ^ A/C ^ FINAL
PLUMBINGi
^ GROUNDWORIE ~ ^ ROUGH-IN ^ FINAL
• RESUI:TS OF THE.INSPECTION: ASSED ~s~rrorFSj ^ FAILED'tsasxoTPS)
NOTES/REMARKS:
_: _ ~ .
,: 4 i~ 'z
' ' ''DATE OF INSPECTION MADE:' ~ ~~~/~ TIME: ` v~~
CALLED OPPD\ - TO CONNECT SERVICE: ^ YES - ^ NO
WANT OFFICE STAFF TO GALL OPPD\ ^ YES• ^ NO BLR 1
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