BP7350'~ ~ BUILDING PERMIT APPLICATION
~~`I Jurisdiction of City of Blair, Nebraska
Permit Fee: ~ ,C~ D 218 South 16th Street
Issuance Fee: Blair, Nebraska 68008 7 3 5 0
Deposit Receipt #: (402) 426-4191 • Fax (402) 426-4195 Permit
Application Date: ~ ~~" ~~° Issue Date:
JOB ADDRESS ~ ~~ ~ /7
(.J`"
LEGAL
1. DESCR. LOT ND. BLK. TRACT
^ SEE ATTACHED SHEET
2.OWNER _ n /
~`/ jAIL~DD~~ ~ ZIP ~~~ , ~H~ON~
CONTRACTOR
3. ~ ~ 3~ ~ MAIL ADDRESS
z 75~~- IP
~ 2 va ~ ~D ~ s~ PHCNE
r3 5 ~= ~8d''
4. Class of Work: O NEW O ADDITION O REMODEL ~ ~~,~ ~~~ - ~ ~
5. Describe Work: ~ O Finished Basement O Unfinished Basement
6. Total Sq. Footage (including Ba6emeRt ana Garage): Total Finished Area:
7. Valuation of Work: $ ~~ ~ ~~ D
Floodway O Yes O No
8. Floodplain: Fringe O Yes O No Dev. Permit
BFE
Elev. Cerl.
9. Current Zoning:
10. State Fire Marshall Required: O Yes
11. Special Use Permit Required: O Yes
12. Variance Required: O Yes ~ No
O No
O No
Rear
13. Minimum Setbacks: Front Side
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 copy of 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
180 days or is not completed within 2 years of date of issue.
~c ~~~L~~l~ 9~~'° ~ ~
SIGNATURE OF OWNER/CDNTRACTO DATE
Comment:
O Site Plan Attached O~Comple~~ ns Attached
Approximate Completion Date //
Inspections Required and Fees
Utilities
Sewer Water Service
Septic Remote
` ~ o (Std Box Card -
Buildin ~9-~ ~- -~~
Footings /~~ ~~ Drywall ~~v
_~~~~~
Framing \ `~
Electrical VV 1 ~ `
Rough-in ___s
Final
Temporary Service
Mechanical
Rough-in _
Final
Plumbtna -
Ground Work
Rough-in
- Final
WHEN PROPERLY VALIDATED (IN THIS SPACE) THIS IS YOUR PERMIT
Approved\By~ .
'\ ~ (befor nish) ~
-~" ina r ' ~
~~
xt
anent Service
A\C
POUNDS PRTG: Blair, NE Rev. 8196
BUILDING .INSPECTION REPORT _,.
_ o ~~
^ CITY O~~ELP;~ ^ WASHINGTON COUNTY ^ :OTHER
l
• LOCATION OF INSPECTION: ~ ~ ~~ ~~'~~--
NAME 01? OWNER.. ~`~?' ~.~- CONTRACTOR: ~ ~ ~ ~ ~ ct~
F • PATE INSPECTION REQ TED: , PERMIT N0: -~' 4~
•• -TIME INSPECTION REQUESTED;
~r
TYPE QF INSPECTION REQUESTED:
BUILDING:
-- ~~~-
FOOTING -, . ^ FRAMING ^ DRYWALL FINAL
iI'F~LITIES: •
~~ ,
^~EWER TAP , ^ SEWER , ^ SEPTIC -^ WATER TAP
r[F REMOTE ^ WATER SERVICE -
[ ~ ~ L ...:
EL~C'1'RICAL:
I
i
i
f~
7
`~
', fi
~`
i
it
- §~ _
- ^ ROUGH IN , ^ FIXTURES ^ FINAZ ^ MOTORS ~ ~
s,. , '~ ~ I
E .' ^ PERMANENT SERVICE ^ TEMPORARY SERVICE ~' ',
~ - MECII=~YIVICAL: ~ }~ ~ •
_ ~-
ROkJG~I-IN ^ A/C ^ FINAL
~- ~
~, PLUMBIIV"G J~ ~~
~'~ F
~r I
^ GROTJNDWORK ^ ROUGH-W - ^ AL ; I
;_
RESULT~(~~THEINSEECTION: ^PASSED(s~rroTES> ED(s~rroTES>
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k NOTES/ARKS: ~ 1 6
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INSPECT6& ~
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~I?ECTION MADE:;I~ ~ TIME:
~
DATE OF
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tip, ~ \~
•
IN
+'r_ ~ ,
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• ~, CALLED D\ TO CONNECT SERVICE:.. ^ YES - ^ NO ~~ ~ I
~ :WANT OFIfI~~ STAFF TO CALL OPPD\ ^ YES_ ^ NO BLR 1
,:
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