BP7471~~ BUILDING PERMIT APPLICATION
~° Jurisdiction of City of Blair, Nebraska
Permit Fee: ~ ~ 218 South 16th Street
Issuance Fee: 15~~ Blair, Nebraska 68008
Deposit Receipt #: (402) 426-4191 • Fax (402) 426-4195
Application Date: f ~~ ~ ~1c1 ~D Issue Date: ~~ ~ ~~~
JOB ADDRESS ~ _` ~ ~ R=~`.""""", ~~-
LEGAL
1. DESCR. LOT NO. BLK. TRACT
^ SEE ATTACHED SHEET
OWNER
2. ~ MIL ADDRESS ~
1 ~ ZIP ~`\~ ~~~ ~~/
V rD
CONTRA T ~R ~
3. ~p ~ ~ iw-.c1 MAIL ADDRESS ,~
J~~~ ~. ~~~° <~"; ZIP PHONE
(,~rw~c~~_~. l~bl ~~ 1 ~rT~ "J~~~
4. Class of Work: ^ NEW O A ITION O REMODEL
5. Describe Work: ~~~ oy~ ~ O Finished Basement O Unfinished Basement
6. Total Sq. Footage (Including easement ana Garage): Total Finished Area:
7. Valuation of Work: $ ,agUt--~ ~
Floodway O Yes O No
8. Floodplain: Fringe O Yes O No Dev. Permit
BFE Elev. Cert.
9. Current Zoning:
10. State Fire Marshall Required: ^ Yes
11. Special Use Permit Required: ^ Yes
12. Variance Required: ^ Yes ^ No
13. Minimum Setbacks: Front
^ No
O No
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 septicsystems. 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
180 day~;br i~Ot ~,yepleted within 2 years of date of issue.
Comment:
DATE
O Site Plan Attached O Complete Plans Attached
Approximate Completion Date ) 2-~) a ~ 9 Co
Inspections Required and Fees
Utilities
Sewer
Septic
i
~ Buildin
Footings
Framing
Electrical
Rough-in
Final
Temporary Service
Mechanical _
Rough-in
Final
Plumbing
Ground Work
Rough-in
Final
WHEN PROPERLY VALIDATED (IN THIS SPACE) THIS IS YOUR PERMIT
Approved ~y:-~ ~ ~~ ,
Permit 7 4 71
Water Service
Remote
Stop Box Card
Drywall
(before finish) ~C,~
Final ~~~ r I
Fixtures
Permanent Service
A1C
POUNDS PRTG: Blair, NE Rev. 8196
BUIL,I)ING INSPECTION REPORT
~~ -_
~~-
ITY OF BLAIR ^ WASHINGTON COUNTY ^ OTHER
LOCATION OF INSPECTION: > , ~ - `~ ~ • •f ~ f~ -~ _' ~
NAME OF OWNER:,%~~fJc~ .~~f`'~e~~? ~1~ E' CONTRACTOR: ~=~cr ~f~ ~'~i~7 !~ '.
DATE INSPECTION REQUESTED: E~ ~'"~ ~~ PERMIT NO: ~ ~~~
~~
TIME INSPECTION REQUESTED:
r-
TYPE OF INSPECTION REQUESTED:
BUILDING: "' ' ~
:~/ ~ ~`
^ FOOTING ^ FRAMING ^ DRYWALL FINAL
UTILITIES:
^ SEWER TAP ^ SEWER ^ SEPTIC ^ WATER TAP
REMOTE ^ WATER SERVICE
ELECTRICAL:
^-ROUGH IN ^ FIXTURES ^ FINAL ^ MOTORS
^ PERMANENT_SERVICE ^ TEMPORARY SERVICE
MECHANICAL:
I ^ ROUGH-IN ^ A/C ^ FINAL'
PLUMBING: -
^ GROUNDWORK ^ ROUGH-IN ^ FINAL
' RESULTS OF THE INSPECTION: SSED (s~rro~s> ^FAILED (s~xoras~
NOTES/REMARKS: -
~ ~,
INSPECTOR: ~'' ~ ~~ ~~~~-~
DATE OF INSPECTION MADE: ~ ,. TIME: ~ ' f ~~~
CALLED OPPD\ TO CONNECT SERVICE: ^ YES ^ NO
WANT OFFICE STAFF TO CALL OPPD\ `^ YES ^,NQ BLR 1
~.