BP7272~~ BUILDING PERMIT APPLICATI®N
Permit Fee: ,~0 ~C~~ Jurisdiction of City of Blair, Nebraska
218 South 16th Street
Issuance Fee: Blair, Nebraska 68008 7 2 7 2
Deposit Receipt #: (402) 428-4191 ~ Fax (402) 426-4195 Permit
Application Date: ~~ ~7- c~~ Issue Date: ~` ~7~
JOB ADDRESS
~
~ ~
LEGAL
1. DESCR. LOT NO. BLK. TRACT
^ SEE ATTACHED SHEET
OWN MAILADDRESS -~, J ZI PHONE
CONTRAC,Tp R
3
~~ M LADDRESS ZIP
~
g PHONE
-
. L
~o ; arm ~ 7 a ~
4. Class of Work: 'KNEW O ADDITION O REMODEL
5. Describe Work: O Finished Basement O Unfinished Basement
6. TOtal Sq. FOOtage (Including Basement and Garage): Total Finished Area:
7. Valuation of Work: $ o~, ~ 0 O . C~ ~
Floodway O Yes O No
Floodplain:
8 Dev. Permil Elev. Cert.
.
Fringe O Yes O No BFE
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 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~f~Iebraska. l understand that this permit is void if work is not commenced within
18 da~ or ~ not completed wjtgin 2 year, of date,of issue.
O Site Plan Attached O Complete Plans Attached
Approximate Completion Date lam"-`- m~'~ ~
Inspections Required and Fees
Utilities
Sewer
Septic
Buildin
Footings
Framing
Electrical
Rough-in
Final
Temporary Service
P
SIGNATURE F 0 N CONTRACTOR DATE Mechanical
Rough-in _
Final
Comment:
Plumbin _
Ground Work
Rough-in _
WHEN PROPERLY VALIDA
Approved By:
Water Service
Remote
Stop Box Card
Drywall
(before finish)
Final ~ ~~~ 9
Fixtures
Permanent Service
A\C
Final
THIS SPACE) THIS IS YOUR PERMIT
POUNDS PRTG: Blair, NE j Rev. 8196
_, BUILDING INSPECTION REPORT' T
~~ ~<_
~. CITY OF BLAIR [~ WASHINGTON COUNTY ~ O'I'gpt
~.:, .
LOCATION~~O~~F?,INSPECTION: ~~~T ~ c~ ~~ ~tG~*
~ _ . ~"t~,1~ t~~ ~I ,t
~. NAME OF OWNER:. ~ c? u ~~P~sS'~'I.
CONTRACTOR: ~~~~,~-%~~.~,
DATE INSPECTIONREQUESTED:_ ~ ~~` ERMITNO: ~, ~,
TIME INSPECTION REQUESTED: .~'`
-_,---
-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
MECHAMCAL:
ROUGH-IN ^ A/C ~ FINAL
PLUMBING:
!~;
GROUNDWORK ^ ROUGH-W ~ FINAL
RESULTS OF THE INSPECTION: PASSED ~s~xoTEs
^FAILED~sEaxoTES) ,
' NaTES/REMARKS:
i
.~ J
DATE OF INSPECTION MADE: '~ `~ E ~ ~
~:.• ~- ~ ~ .TIME:
CALLED OPPD\ TO CONNECT SERVICE:
^ YES ^ NO
. WANT OFFICE STAFF T0. CALL OPPD\ __
- -- ~ ~-.YES `ENO BLR 1-