BP7473T ~ ~ BUILDING PERMIT APPLICATION
~~~ ~ ~ Jurisdiction of City of Blair, Nebraska
Permit Fee: 218 South 16th Street
/~°~
Issuance Fee: Blair, Nebraska 68008 7 4 7 3
Deposit Receipt #: (402) 426-4191 • Fax (402) 426-4195 PermiQQt
Application Date: ~~ ~/~~ Issue Date: ld ~ 7ts~
JOB ADDRESS~~ ~ J~
/A`'
LEGAL
1. DESCR. LOT NO. BLK. TRACT
^ SEE ATTACHED SHEET
OWNER
2. MAIL ADDRE ZIP PHONE
CONTR R MAILA,.g~RfcSS J ZP PHO
4. Class of Work; O NEW O ADDITION O REMODEL
5. Describe Work: ~ ~,.yv O Finished Basement O Unfinished Basement
6. Total Sq. Footage (IRal~ding easement and Garage): Total Finished Area:
d~
7. Valuation of Work: $ (~('~
Floodway O Yes O No
8. Floodplain: Fringe O Yes O No Dev. Permit
BFE
Elev. Cerf.
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
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. 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 bythis permit application shall not be
commenced until I have received a copy of this application form signed by the Building
Inspector.
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 o 's not com ed within 2 years of date of issue.
SIGNATURE OF OWNERICONTRACTOR DATE
Comment:
O Site Plan Attached ~~ O 9b~plete Plans Attached
Approximate Completion Date ~ ~ {@
Inspections Required and Fees
Utilities
Sewer
Septic _
Buildin
Footings
Framing
Electrical
Rough-in
Final
Temporary Service
Mechanical
Rough-in _
Final -
Plumbin9 -
Ground Work
Rough-in
WHEN PROPERLY VALIDATED
Water Service
Remote
Stop Box Card
Drywall
(before finish)
Final f ~ ~-~~~
Fixtures
Permanent Service
A\C
Final
THIS SPACE) J.bi
YOUR PERMIT
POUNDS PRTG: Blair, NE Rev. B/96
CITY OF BLAIR
Application for Building Permit
PLOT PLAN
Address Date
Legal Description: Lot Block Addition
Please show all measurements of existing and contemplated structures,
also show distances between structures, etc., and property lines.
Is this a corner lot?
Pr
v
.,~
a
I~
0
a
_ _Center Line_of _ _ _
Street_ _
Indicate North
Applicant
BUILDING INSPECTION REPORT
_,
CITY OF BLAIR ~ ^ WASHINGTON COUNTY ^ .OTHER
LOCATION OF INSPECTION: ~ ~ ~ ~ `~ ~ ~~~~
NAME OF OWNER: ~~--~ ~ -~-~ CONTRACTOR: ~~~
I DATE INSPECTION REQUESTED: ~~'" ~ ~ ` ~ ~ PERMIT N0: ~ ~ ~~
TIME INSPECTION REQUESTED: ~", ~ti ~ ~r~"~ _
i
TYPE OF INSPECTION RgEQ~UESTED: ~ _ - , ~
BUILDING: -
FOOTING ^ FRAMING ^ DRYWALL ~~FINAL
UTILITIES: '
~I ^ SEWER TAP ^ SEWER ^ SEPTIC ^ WATER TAP
' ^ REMOTE ^ WATER SERVICE
ELECTRICAL:
^ ROUGH IN [^ FIXTURES ^ FINAL ^ MOTORS
^ PERMANENT SERVICE :^ TEMPORARYSERVICE
-MECHANICAL:
^ ROUGH-W ^ A/C ^ ~~-
PLUMBING:
^ GROUNDWORK ^ ROUGH-IN ^ FINAL
~~ RESULTS.OF THE INSPECTION: PASSED (s~xoTES) ^FAILED (s~xoTES)
-
NOTESlREMARKS:
IN _/ /
' SPECTION MADE: ~` TIME:. F C s~~ _
DATE OF IN
CALLED OPPD\ TO CONNECT SERVICE: ^ YES ^ NO
VdANT OFFICE STAFF TO CALL OPPD\ ^ YES ^ NO BLR 1