BP7237-- ~tt,/~1 d .~03,~ I `~ I 0-1 S- X110 ~ 1 ~ ~ `~
BUILDING PERMIT APPLICATION Z~~.°~~
Jurisdiction of City of Blair, Nebraska
218 South 16th Street
Blair, Nebraska 68008 7 ~ ~ 7
(402) 426-4191 Permit
Application Date: _-~ -° ~ -~ ~ Issue Date: ~~ ~ % (~ Permit Fee: $ r' ~J . ~~'-~
JOB ADDRESS i ~ ~ ~ /~ ~ ~~ I' J
1
D SCR. LOT N0. P
~~ ~ BLK. TRACT ~/,r~~
~ 1C~ ~. LCL~ 1 ~ ^ SEE ATTACHED SHEET
I ~
2 OWNER ~ rr1J 1 ~ mm AAA SS PHONE
ZIP
3, CONTRACTOR MAILADDRESS
1~C~~f~'i~C..K ~~~~~a ~~c a ~ III PHONE LICENSE NO.
.~c~m~ fir. ~[ a~ ~ ,~~P ~-~I ~G
4. USE OF BUILDING ~ %~ 7- ~ `~ Z~
`l
^ REMOVE
5. Class of Work: NEW ^ ADDITION ^ALTERATION ^ REPAIR ^ MOVE
6. Describe Work: ~ ~ ~~
7. Sq. Footage of Structure pe e): ~ ~~
8. Change of Use From: ~n i Shy ~~~ ~~~-f -~ Change of Use To: `~.~L K OTI` ~a~'
g, Valuation of Work: $ ~ (~,C)) C)UG~ • C~C~
Floodway Yes^ No ^ Dev.Permit
1O FIOOdplaln: Fringe Yes^ No ^ BFE
EIev.Cert.
11. Current Zoning:.....
12. State Fire Marshall Required: Yes ^ No^
13. Special Use Permit Required: Yes ^ No ^
14. Variance Required: Yes^ No^
15. Minimum Setbacks; Front Side Rear
16. Sidewalk Required: Yes ^ No ^ Waiver Approved _
I APPLI~~O`N\ ~ CEi~PT~ 8Y I , PLANS C D BY I APPROVED FOR Y I
' NOTICE
Separate permits are required for electrical, plumbing, healing, ventilating and air condi-
tioning, 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 cpvered by this permit application shall not be commenced until I
have received a copyof this application form signed by the Building Inspector and stamped
'APPROVED'.
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 1 SO days,
is not completed within 2 years of the date of issuance, or if work is abandoned for six (6)
months or longer, whichever is earliest.
SIGNAT RE OF OWNERJCONTRACT R OR AUTHORIZE ENT DATE
SIGNATURE OF OWNER (IF OWNER BUILDER) DATE
Site Plan Attached ~ Complete Plans Attached
Approximate Completion Date 1•-I-`~~
Inspections Required and Fees
Utilities
Sewer Tap Water Tap
Sewer Water Service
Septic Remote
~~T-
Ce~Zc~ ~
Building
Footings Drywall
(before finish)
~~ ~,
~ ~~ 1 ' _ ~ ~p
Framing Final
Electrical ~° 1~1 CR`•a E(~C,I-f-, ~--
_
Rough-in Permanent Servicev
Final Temporary Service
Mechanical
~
Rough-in ABC
Final ,(~~
Plumbing -~` ~
t'"
~`~
Ground Work 1
Rough-in Final
WHEN PROPERLY VALIDATED (IN THIS SPACE) THIS IS YOUR PERMIT
Comment:.zyf1G ~ / FJS~6VT Approved By:
/E~,~" ~ic~~ ~~~M ~
POUNDS PRTe: Bleb, NE
,~ _ _
MECHANICAL PERMIT APPLICATION
Jurisdiction of City of Blair, Nebraska
218 South 16th Street
Blair, Nebraska 68008
(402) 426-4191
CI ~ p ° "~
Application Date: ~ Permit Fee: $
JOB ADDRESS ~~~
LEGAL
1 • DESCR. LOT NO.
~ BLK. TRA ~. JiC
Lc..J
O SEE ATTACHED SHEET
2. OWNER MAILADDRESS ZIP PHONE
3• CO RA ~ MAIL ADDRESS ~ / /x PHO~-
f
V
_
~
.
/f LICENSE N ~3 ~~
.7
4• Class of Work: W RESIDENTIAL O NEW COMMERCIAL
DE
LI
NG/ADDITIONS
O R
EM
O O REPLACEMEN
TS
5• Describe Work:
Comments:
MECHANICAL PERMIT FEES
~
d Ai
t
F
S ~~
ems
orce
r
ys
Per Unit Commercial/Residential (New) .............. ........................ $25.00
Air-Conditioner Unit ~~ d v
Per Unit Commercial/Residential (New) .............. ........................ $10.00
Refrigeration Units/Coolers
Per Unit Commercial (New or Replacement) ...... ........................ $10.00
NOTICE
I hereby certify that I have read and examined this Forced Air Systems/Air Conditioner
application and know the same to be true and correct. All Unit Replacement
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 I~~ ~,
TOTAL ~ O . D ~
~`
IG A R /' .F CONTRA TOR OR AUTHORIZED AGENT
C~ ~ ~
ATE
Current License on File Yes O No
O NA
WHEN PROPERLY VALIDATED (IN THIS SPACE) THIS IS YOUR PERMIT
~, Comment: Approved B
i---
POUNDS PRTG: Blair, NE nev. rr~as
PLUMBING PERMIT APPLICATION
Jurisdiction of City of Blair, Nebraska
218 South 16th Street
Blair, Nebraska 68008
(402) 426-4191
~ ~ 9~
Application Date:
~~~
Permit Fee: $
JOB ADDRESS
~~
LEGAL
1 • DESCR LOT NO.
~ BLK. TRACT
~+ • 1
O SEE ATTACHED SHEET
. ~ ~
2. OWNER IL ADDRESS ZIP PHONE ~
--55~
,3• CONTRACT ~ MAIL ADDRES ~ PHONE
~ LI E SE NO.
~c~
y~ .
4. Class of Work: NEW RESIDENTIAL O NEW COMMERCIAL O REMODELING/ADDITIONS O REPLACEMENTS
5, Describe Work:
Comments:
PL UMBING PERMIT FEES
Type of Fixture No.
~
d
Kitchen ...........................
....... $8.00 x `
Bath ................................
....... $8.00 x ~~UU
'
Rough-In Bath ................ ....... $4.00 x ~ ~
Utility ..............................
....... $5.00 x
/ 0
.~ °_
Water Heater ..................
....... $3.00 x
~_ ~e~
Outside Water Faucet ........... $3.00 x -~
Water Service ................. ....... $10.00
!~ dU
_
NOTICE Sewer ............................. ....... $10.00 ` ~~ ~
hereby certify that I have read and examined this
Groundwork ....................
.......$10.00
~ ~ ~,
/D
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.
Permit Issuance Fee $15.00 /~ a a
G~JATURE OF RACTOR 0 THORIZED AGENT
TOTAL
DATE Current License on File 17Yes O No O NA
WHEN PROPERLY VALIDATED (IN THIS SPACE) THIS YOUR PERMIT
Comment:
Approved By:
POUNDS PRTG -Blalr, NE Rev. 12195
~~ ~~~
~ ELECTRICAL PERMIT APPLI
Jurisdiction of City of Blair, Nebraska
218 South 16th Street
Blair, Nebraska 68008
(402) 426-4191
Application Date: l~' ~ ~ ` ~ ~
CATI O N
0286
Permit
Permit Fee: $ ) ~~ •os
JOB ADDRESS ~ Z~~ Ct~~eL ~(~
,
LEGAL
1 LOT NO. BLK. TRACT
• DescR. O SEE ATTACHED SHEET
,~ OWNER ~U ~ MAIL ADDRESS ZIP
CGtr~c~ l I PHONE
3• CONTRACT,Q~1' G~ • C ~ i~~, C- MAIL A`D~D'~ESS
. ~~ ~ PHONE
J LICENSE NO.
G
4• Class of Work:
EW RESIDENTIAL O NEW COMMERCIAL O REMODELING/ADDITIONS 0 UPGRADE SERVICE
5• Describe Work: ~ e ~ ! ~~_S
6• Current License on File Yes O No O NA
New Service Fee = (Amp Fee + $2.00 per branch circuit) ELECTRICAL PERMIT FEES
1-100 Amp Fee ............................ $ 13,00 Upgrade Existing Service ...... $10.00
101-200 Amp Fee ............................ $ 18.00 Temporary Service $10.00 ((~ ~ C~C'~
-300 Amp Fee ............................ $ 30.00
301-400 Amp Fee $ 42.00
............................ Fire Alarm System ................. $10.00
401-500 Amp Fee ............................ $ 55.00 Signs ..................................... $15.00
501-600 Amp Fee ............................ $ 67.00 Miscellaneous Apparatus ...... $11.00
601-700 Amp Fee ............................ $ 80.00
701-800 Amp Fee ............................ $ 92,00
801-900 Amp Fee ............................ $105.00 Commercial/Multi-Family and All Upgrades:
901-1000 Amp ................................. $117,00 # of Circuits x $2.00
IF OVER 1000 Amp
1st 1000 Amp Fee $117.00 Amp Fee
Each additional 100 Amps ...,....... $ 13,00 Amp Fee + Circuit Total
NOTICE New Residential: (Finished Area)
I hereby certify that t have read and examined this Single/Two Family Dwellings
application and know the same to be true and correct. All
r
i
i
f ~ ~ ~ ~ sq
ft
x
045 ~ ?JO
~ ~
p
ov
s
ons o
laws and ordinances governing this type of .
.
. .
work will be complied with whether specified herein or not
.
The granting of a permit does not presume to give authority
Receptacle/Switch Outlets
to violate or cancel the provisions of any other state or local
l Fixtures x $
75
aw regulating construction or the performance of .
construction.
Residential/Commercial Appliance
# Fixect Outlets x $3.00
Power Apparatus (220 Volts)
SIGNAT OF CONTRACT OR AUTHORIZED AGENT # Apparatus x $3.00
c
Permit Issuance Fee ............. $15.00 I S - C~ C~
DATE
TOTAL 15J, ~~
WHEN PROPERLY VALIDATED (IN THIS SPACEI THIS IS YOUR PERMIT
-----
Comment: Approved By;
Gt, ~~
'OUNDS PRTG: Blair, NE
Rev. 12/95
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