BP7919BUILDING PERMIT APPLICATION
`~~ o~ ,Jurisdiction of City of Blair, Nebraska
Permit Fee: 218 South 16th Street
Issuance Fee: Blair, Nebraska 68008
Deposit Receipt #: (402) 426-4191 • Fax (402) 426-4195 Permit-
Application Date: ~ ~ ~~ Issue Date:
~o l 3 2 ~ -~ ~s ec~ - Inc i r ~ ~ ~ C5 C~
LEGAL
1. DESCR. LOT No. BLK. TRACT
^ SEE ATTACHED SHEET
0 N AIL
2. ev a ~ i l ~-~-~ ESS
ro
s ~~ IP PHONE
~ ~S ~~ - 6 Z
^
a7. C ~cC(_ \ h 1~, ~ I ~ MAIL ADDS (~ ~ ~~ O-YL\ S~ - ZI l~ ~ U V O PH-.L.E L ~C
4. Class of Work: NEW O ADDITION O REMODEL
5. Describe Work: O Finished Basement O Unfinished Basement
-r ~ co,. r ~ 0 ~~~ ~ C, ~ ~ ~ o - n
6. Total Sq. Footage (Including easement and Garage): Total FInlShed Area:
7. Valuation of Work: $ ~ ~ ~ (~ ~ 6 (~
Floodway O Yes O No
8. FIOOdplain: Fringe O Yes O No Dev. Permil
BFE
Elev. Cert.
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, healing, 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.
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 braska.lunderstan thatthispermitisvoidifworkisnotcommencedwithin
180 ys r i not comp a ithin 2 ye of da of issue.
ATURE OF NER/CONTRACTDR DATE
Comment:
O Site Plan Attached ~ _O~ mp~~lans Attached
Approximate Completion Date /
Inspections Required and Fees
Utilities
Sewer Water Service
Septic
Buildin
Footings .
Framing
Electrical
Rough-in
Final
Temporary Service
Mechanical
Rough-in _
Final
Plumbin -
Ground Work
Rough-in
Remote
Stop Box Card
Drywall
(betorefinish)~i' ~~~~
Final V
Fixtures
Permanent Service
A\C
Final
WHEN PROPER Y VALI ED (IN THIS SPACE) THIS IS YOUR PERMIT
Approved By:
7919
POUNDS PRTG: Blair, NE Rev. 8196
t ~ - BUILDING INSPECTION REPORT
~ ~ ~
~, TfY OF BL;AIR ^ WASHINGTONgCOUNTY;~~ ^ OTHER ~~
f
LOCATION OF WSPECTION: ~. ~~~ ~_ d~~~'~=
NAME OFOWNER:,=~-~~' ~~~' ~`'`~''~~-j ~ CONTRACTOR~~'/~ ~ ~ ~~'L'-..S ~ f ° ` ~ ~Il
~,_ ~' ,,;
' -_DATE INSPECTION REQUESTEII: ~t'.~ `~~%'-~~PERMIT N0: ~ ~ ;~
~~ -
TIMEINSPECTION REQUESTED:
.TYPE OF INSPECTION REQUESTED:
BUILDING:
"d -~
^FOOTING ^ FRAMING ^ DRYWALL AL
{ _ _ UTILITIES:
. ~`
^`SEWER TAP ^ SEWER - .^ SEPTIC ^ WATER TAP
E~E ^ REMOTE ^ WATER SERVICE
f-
F' ELECTRICAL:
^ ROUGH IN ^ FIXTURES ^ FINAL ^ MOTORS
^ PERMANINT SERVICE ^ TEMPORARY SERVICE
' MECHAMCAL:
ROUGH-IN ^ A/C ^ FINAL
PLUMBING:
^ GROUNDWORK ^ ROUGH.W ^ FINAL
~.` : •
RESULTS DF THEINSRECTION: ASSED ~s~xoTFS> ^ FAILED ~s~xo~rES)
~:
E ' .. NOTES/REMARKS:
• ~~ - ~
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