BP7820v BUILDING PERMIT APPLIC~4T1®N
Jurisdiction of City of Blair, Nebraska
Permit Fee: -~~ (~~ 218 South 16th Street
Issuance Fee: V` Blair, Nebraska 68008
402 426-4191 • Fax 402 426-4195
Deposit Receipt #: ( ) ( )
Permit ~ 8 ~ O
Application Date: ~" ~ " ~ I Issue Date: ~" I "
JOB ADDRESS I~ 1/~
LEGAL
1. DESCR. LOT NO. BLK. TRACT
^ SEE ATTACHED SHEET
2.OWNER ~r \ ~n ~ ~ ~,~, ^
V MAIL ADDRESS ZIP ~,~ , PH N~
/1~` ~~
3. CONTRACT MAIL ADDRESS ~ ~~~ ~ ZI/ E W /u U /~~ vPH'/ G~~
1
4. Class of Work: ~ NEW O ADDITION O REMODEL
5. Describe Work: ~ ~ -~~(~ ~ O Finished Basement O Unfinished Basement
(~~
6. Total Sq. Footage (IRCIudIRg Basement aRd Garage): Total Finished Area:
7. Valuation of Work: $ ~ ~l-(-~ ~ ~~
Floodway O Yes O No
8. Floodplain: Fringe fJ Yes O No Dev. Permit
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, 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
1,r}0 days or is not comple~gd within 2 year~jof date of issue.
SIGNATURE OF OWNER/CONTRACTO.
Comment:
DATE
O Site Plan Attached Complete 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
Plumbina .
Ground Work
Rough-in _
WHEN PROPERLY V
Approved By /
Water Service
Remote
Stop Box Card
Drywall
(before finish)
Final ~ ~~~~~
Fixtures
Permanent Service
A\C
Final
THIS SPACE) THIS IS YOUR PERMIT
POUNDS PRTG: Blair, NE // Rev. B/96
~ ~ I
C. . ~ _- - -.. _..
- ~B~~TILDING INSPECTION REPORT
~_~TfY OF BLAIR ~ ~ WASHINGTON COUNTY ~ '~~
~~~~~ ~^
LOCATION OF INSPECTION: ~ fI
G `~
~T" '~
NAME OF OWNER `` ~`~ ~ /L:.~~~~~{ ..r - CONTRACTOR: _~" ! ~'"~'`~'~ ~~ `.~'
` DATE INSPECTION RE UESTED: ~ ~',.~ ' ~ ~ `~ ~~
~ Q ~' PERMIT N0; 4
~_ TIME INSPECTION REQUESTED: IJ~/~ -.~ -
~,
r'
~ TYPE OF INSPECTION REQUESTED; _
~ ~
BUILDING: ~~~~
~ ~
~ ^ FOOTING - ~ FRAMING,;:, ~ DRYWALL r FINAL
~,, ;.
e' UTILITIES:
s
f. ~ SEWER TAF ~ SEVy~ Q SEPTIC - [)WATER TAP
^ REMOTE
WATER SERVICE
_-
ELECTRICAL: .
'A OROUGHIN.
~ ~ FIXTURES ^ FINAL ~ MOTORS
i
! ~ PERMANENT SERVICE ^ TEMPORARY SERVICE
f
F ~ MECHAMCAL: i~ .~~~7~°-,~r
~ ~~~ ~
I! ~ ROUGH-IN Q A/C [~ FINAL
PLUMBING: ~/~~~~~/~iY,~S
l~
t- GROUNDWORK Q ROUGH IN I
~? ~ FINAL' 1
.RESULTS OF THE INSPECTION:
D (SEE NOTES) AII.ED (SEE NOTES) I
NOTES/REMARKS: ~i~~. _ `~ I
~ _ ~~ I
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