BP7865BUILDING PERMIT APPLICATION
Jurisdiction of City of Blair, Nebraska
Permit Fee: 218 South 16th Street
t~ S~~ ~
Issuance Fee: ~ Blair, Nebraska 68008 7 ~ 6 5
Deposit Receipt #: (402) 426-4191 ~ Fax (402) 426-4195 Permit
Application Date: ~"~~ ~ ~ Issue Date:
JOBADDRES~~~ ~ ~~
LEGAL
1 . DESCR. LOT ND. BLK. TRACT
^ SEE ATTACHED SHEET
0 E MAIL ADDRESS ZIP PHONE
CO CTOR
3. MAIL ADDRESS ZIP PHONE
4. Class o ork: O NEW O ADDITION O REMODEL
5. Describe Work: A ! O Finished Basement O Unfinished Basement
d~
6. Total Sq. Footage (Includlrlg Basement aDd Garage): Total Finished Area:
7. Valuation of Work: $ ~QQ ~ LO Q
Floodway O Yes O No
8. FIOOdplain: 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, healing, ventilating and air
conditioning, and septicsystems: Bymysignature below, I acknowledgethat 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 that this permit is void if work is not commenced within
180 days his not completed within rears of~e of issue.
OF
P~ ~ / ~~ 2
DATE
Comment:
O Site Plan Attached O Complete 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
Fixtures
Permanent Service
A\C
Final
WHEN PROPERLY VALIDATED (IN THIS SPACE) THIS IS YOUR PERMIT
Approved B~
Water Service
Remote
Stop Box Card
Drywall
(before finish)
~~ ~` ~
Final / ~ ' ~ ~
POUNDS PRTG: Blair, NE Rev. 8196
G- -~ ~-_
,~
~- ~-:=~~UILDING INSPECTION REPORT ~
f
f °~ -r - ~
E:-
f CITY ORBL;AIR ^ WASHINGTON COUNTY ^ OTHER
1 ~
LOCATION OFINSPECTION:. 1 ~ ~ ~~ ~~~c"!G-•r-~ ,.j ; ; ~~
NAME OF OWNER: ~.~ r~ ~~i;~ t ~'~.~~ ,~~ ~ ~r
CONTRACTOR:
DATE INSPECTION REQUESTED:
E- E~MITNO: 1.~~
~~ ~ ` -~
~ ~~~l~t
~;- TIME INSPECTION REQUESTED: ~ : ~~
/~
TYPE OF INSPECTION REQUESTED:- ``~~ ~ ~ '~ ` ~ ~Prr "~ ,
BUILDING:
~~ ~ ~--~-
FOOTING ^ FRAMIIdG ^ DRYWALL ;
( _ 'FINAL , ' r ~=
f:~. _
~. UfILITIESe
~' ^SEWERTAP ^SEWER SEPTIC
^ ^ WATER TAP
^ REMOTE ^ WATER SERVICE
ELECTRICAL:
~:
~_" ^ ROUGH IN ^ FD(TURES ^ FINAL ^ MOTORS
a
^'PERMANENT SERVICE ^ TEMPORARY SERVICE
- MECHANICAL:
,_.
l- ^ ROUGH-IN ^ A/C ^-FINAL
PLUMBING:
~ ^ GROUNDWORK ^ ROUGH-IN .^ FINAL - .
f.
! RESULTS OF THE INSPECTION:. SASSED ~s~rro~s> ^ FAILED ~s~ rro~s>
l~ ~- _
~ " NQTES/REMARKS: ~ .`~ ' ~:L / t~ ~ • ~'~ r ~~,
E. ! _~; _
INSPECTOR:. X"~~;,._~ ~ ~ I iafrir-t~f.=r-t..Pr~
• ~
~, DATE OFINSPECTION-MADE; fL. ~S'- ~ % TIME; v : ~Q~•: .
CALLED OPPD\ ` TO CONNECT SERVICE: .
^ YES QNO
WANT OFFICE STAFF TO CALL OPPD\ •
;::.
^ YES ^ NO _ BER 1 ~
BUILDING PERMIT APPLICATION
~'" Jurisdiction of City of Blair, Nebraska
Permit Fee: 218 South 16th Street
Issuance Fee: Blair, Nebraska 68008 7 7 ~ 2
Deposit Receipt #: (402) 426-4191 • Fax (402) 426-4195 Permit
~~~> ~ `"1
ApNllcatl~n fJate:
r~
Issue date: ~, ~~ r
JOB ADDRESS / N -~
LEGAL
1. DESCR. LOT NO. 6LK.
~ TRACT
^ SEE ATTACHED SHEET
2.OVYN~R~ ~ MAILADDRESS ZIP PHONE
CON ~
3. MAIL AD SS
~~-Or-1 l~ ~ IP PHONE
~' ° ~ L,.~~
4. Class of Work: O NEW O ADDITION O REMODEL
5. Describe Work: ~ ~ ~ ~~ ...~~ O Finished Basement O Unfinished Basement
~.
6. Total Sq. Footage (IROIuaiRg BasemeRr 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
11. Special Use Permit Required: O Yes
12. Variance Required: O Yes O No
13. Minimum Setbacks: Front
14. Sidewalk Required: O Yes O Nc
O No
O No
Side Rear
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 thatthis permit is void if work is not commenced within
180 days or is no ompleted within 2~~rs~ate of issue,
SIGNATURE OF
Comment:
~ ~V
DATE
O Site Plan Atiached ~/O~or}tSlpte~Plans Attached
Approximate Completion Date ~/~~ ~~ JJ ,
Inspections Required and Fees
Utilities
Sewer Water Service
Septic Remote
Stop Box Card
Buildin
Footings Drywall
(before finish) _
Framing Final ~ r S ~~
Electrical
Rough-in Fixtures
Final Permanent Service
Temporary Service
Mechanical
Rough-in _
Final
Plumbing _
Ground Work
Rough-in
Final
WHEN PRO Y VALIDATED (IN THIS SPACE) THIS IS YOUR PERMIT
Approved By; Z, /J
A\C
POUNDS PRTG: Blair, NE Rev. B/96
~BUILDING:INSPECTION REPORT
rt-o s-.- _ _ -
€ ~ CITY OF BLAIR ^ WASHWGTONCOUNTY _ OTHER
_- p ~'P ~_
-~C~TION-OF INSPECTION:/'? / ~ i (~ ~~-*~i ~
N OF OWNER: ~` f"~1 ~ ~~_ CONTRACTOR: -
DATEINSPECTIONREQUESTED: PERMIT NO: ~~ ~ ~~°~
TIME INSPECTION REQUESTED:
~ TYPE OF INSPECTIONREQUESTED: ` ~ -
BUILDING: -
`~~~
FOOTING ^ FRAMING ^.DRYWALL ~ ~ AL .
iTl'ILITIES:
SEWER TAP ^ SEWER ^ SEPTIC ^ WATER TAP
^ REMOTE ^. WATER SERVICE
ELECTRICAL:
^ ROUGH IN ^ FIXTURES ^ FINAL ^ MOTORS
^ PERMANEN.T SERVICE ^ TEMPORARY SERVICE
MECHANICAL:
^ ROUGH-IN ^ A/C ^ FINAL •-
~- 1
i
PLUMBING: ~~'
^ GROUNDWORK ^ ROUGH-IN ^ FINAL _
RESULTS OF THE INSPECTION: ASSED ~s~xoTES~ ^ FAILED ~s~ xo~r~s>
NOTES/REMARKS:
f CALLED OPPD\ TO CONNECT SERVICE: , ^ YES ^ NO
- .WANT-OFFICE STAFF TO CALL:OPPB\_
f ^ YES. ^ NO BtR t
r/
DATE OF INSPECTION MADE: ~ ~ '~: ~/ c /