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BP7484
BUILDING PERMIT APPLICATION Permit Fee: ~ ~C> - O U Jurisdiction of City of Blair, Nebraska 218 South 16th Street Issuance Fee: Blair, Nebraska 68008 Deposit Receipt #: (402) 426-4191 • Fax (402) 426-4195 7484 Application Date: ~ ` ~' ~ ~ Issue Date: ~`l - l7 JOB 1 I DDRES~ ~ 55 ~ ~ ~ LE GAL 1. DESCR. LOT ND. BLK. TRACT ^ SEE ATTACHED SHEET 2 0 ER ~ MAIL ADDRES~ ~ ~j' \ PONE . f ~ I f~ ~ C V ONTR s C OR ` -~ ' S MAIL AD ESS ` ZIP f ~~avg PHONE ~ -2~ ~ r I ~ ~ o~c ~ ~ ~ ~ 4. Class of Work: O NEW O DDITION O REMODEL 5. Describe Work: O Finished Basement O Unfinished Basement ,. ~ _ ~ f t? S ~ U ~ C~ U ~ I~ CP ~ 6. Total Sq. Footage (IRCluding Basement and Garagey: Total Finished Area: 7. Valuation of Work: $ ~ 7t`,~ ©P © o Floodway (~ Yes O No 8. Floodplain: Fringe O Yes O No Dev. Permit BFE Elev. Cert. 9. Current Zoning: 10. State Fire Marshall Required: O Yes 11. Special Use Permit Required: O Yes 12. Variance Required: O Yes O No O No 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 mysignature 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 Sta ebraska•lunderstan thatthispermitisvoidifworkisnotcommencedwithin 1 days r i not comp i~d ithin 2 y rs ofd a of issue. Comment: OF DATE O Site Plan Attached ~--0 om a Plans Attached Approximate Completion Date ~~~ Inspections Required and Fees Utilities Sewer _ Septic _ Buildina Footings Framing Electrical Rough-in Final Temporary Service Mechanical Rough-in _ Final Plumbina - Ground Work Rough-in Final WHEN PROPERLY VALIDATED (I HIS SPACE) THIS IS YOUR PERMIT Approved By: ~ ,j Permit Water Service Remote Stop Box Card Drywall (before finish) Final 5U Fixtures Permanent Service A\C POUNDS PRTG: Blair, NE // Rev. 9/96 :y .,B`~ILDING INSPECTION REPORT ~- ~, _ :. :.. CITY OF BI;AIR : ~ WASHINGTON COUNTY . ~ OTHER - `_ I .LOCATION OF INSPECTION: -_ ~z~' ~~:a bra ~~~;~ ` NAME OF OWNER~~ ~ ~ ~1 g~ ~ vaGy t ~ - CONTRACTOR: ~~~ f-e ~.~'.~ c :.5 DATE INSPECTION REQUESTED: ~~°~~` `~ /~ pERMITNO: ~v~~~~ _ , ` TTMEINSPECTTONREQUESTED: '~~ ~ ~ APE OF INSPECTION REQUESTED: :_;: -., BUILDING: f ' ~ ~ ~.~~ f (] FOOTING ^ IaRRANID~IG QDRYWALL AL ,',~ ' E UTILITIES: ^ SEWER TAP ~ SEWER ~ SEPTIC ^ WATER TAP ^ REMOTE ^ WATER SERVICE ;. ELECTRICAL: ^ ROUGH IN ^ FIXTURES ~ ~~ []MOTORS PERMANENT SERVICE ^ TEMPORARY SERVICE MECHANICAL; _0-ROUGH W ~ ^ AlC :.^ FINAL PLUMBING:. ' - -- ~` [] GROUNDWORK ^ ROUGH-IN ^ FINAL j - RESULTS OF THE INSPECTION: ASSED (s~xoTes~ ^ FAILED cs~ xo~rFS> • - .. ~ . NOTES/REMARKS: ~ ~} ~' ~ ~, ' INSPECTOR: ~~"~• ~... - ! ~~'~~'" DATE OF INSPECTION MADE: --~ ~ ~ ~ , r TIME: _ ~ CALLED OPPD\ TO CONNECT SERVICE: ^ YES ~ NO WANT OFFICE STAFF TO CALL OPPD\ __ - - ^ YES ~ NO BLR 1 .