BP7517BUILDING PERMIT APPLICATION
~ ~° Jurisdiction of City of Blair, Nebraska
:permit Fee: ~ J 218 South 16th Street
Issuance Fee: Blair, Nebraska 68008
Deposit Receipt #: (402) 426-4191 ~ Fax (402) 426-4195
Application Date:~~~' ~ C ~ ~ Issue Date: ~~~-
7517
JOB ADDRESS ~ ~ ~ ~ ~~
LEGAL
1. DESCR. LOT NO. BLK. TRACT
^ SEE ATTACHED SHEET
OWNER
2. MAIL ADDRESS
JaQ.a.~ ZIP PHONE
CONTRACTOR
3. ~ IL ADDRESS ZIP $10 Z PHONE
Iwz.~~ ~iZ- ~5d~
4. Class of Work: O NEW O ADDITION O REMODEL
5. Describe Work: 1 O Finished Basement O Unfinished Basement
6. Total Sq. Footage (IRI:IUdiRg Baeemertt and Garage): Total Finished Area:
7. Valuation of Work: $ ~ ~~ ~~-'
Floodway O Yes
8. Floodplain: Fringe O Yes O No Dev. Permit
O No 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 mysignature below, I acknowledgeihat 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.
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 thatthis permit is void if work is not commenced within
180 days or is t- omple 2 years of date of issue.
SIGNATURE OF OWNER/CONT TOR DATE
Comment:
O Site Plan Attached ~/ZGQ~ ~plete Plans Attached
Approximate Completion Date-~/
Inspections Required and Fees
Utilities
Sewer
Septic
Building
Footings
Framing
Electrical
Rough-in
Final
Temporary Service
Mechanical
Rough-in _
Final
Plumbing _
Ground Work
Rough-in _
Permit
Water Service
Remote
Stop Box Card
Drywall
(before finish)
Final ~` 7'`~'~t~
Fixtures
Permanent Service
A\C
Final
WHEN PROPERLY VALIDATED (IN THIS SPACE) THIS IS YOUR PERMIT
Approved B~~ ~
t(~-~
POUNDS PRTG: Blair, NE Rev. 6/96
~~ ~ -~3UILDING INSPECTION REP®RT f~
;..
{
,~'fY OF BLAIR ^ WASHI~N~GTON COUN~~T^-Y^ ^~O°THER
- LOCATION OF INSPECTION; ~ ~~-~~ ~~ f J ~ r
r~" ~~~ e~cls~ ,i~
NAME OF.OWNER:c~~°ty~ ~.'~!~~-~.~~~ .CONTRACTOR: ;.~m~~.~"~'~ .- ~
,• j
DATE INSPECTION REQUESTED: ~-~~-i''/ pERMITNO: ~~
- TIME INSPECTION REQUESTED: Ti ~~
TYPE OF INSPECTION REQUESTED:
BUILDING:
~°~~°
^ FOOTING ^ FRAMING ^ DRYWALL ~'°FWAL
..UTILITIES:
^ SEWER TAP ^ SEWER ^ SEPTIC ^ WATER TAP _
^ REMOTE ^ WATER SERVICE
' ELECTRICAL:
^ ROUGH IN ^ FIXTURES ^ FINAL ^ MOTORS
^ PERMANENT;SERVICE ^ TEMPORARY SERVICE -
MECHANICAL:
^ ROUGH-W ^ A/C ^ FINAL
PLUMBING: -
^ GROUNDWORK ^ ROUGH-IN ^ FINAL
RESULTS OF THE INSPECTION: ASSED ~s~xo~rFS> ^ FAILED (sue rroTFSI
NOTES/REMARKS:
~ .- ~ v _ ~ ~ ,,~
DATE OF INSPECTION MADE: ~ ~ ~ TIME: `'^~ ` G'-.~~
CALLED OPPD\ TO CONNECT SERVICE: ^ YES
WANT OFFICE STAFF T0,CALL OPPD\ - ^ YES
^ N0~
BLR 1