BP7275
~~UILDING PERMIT APPLICATION
Jurisdiction of City of Blair, Nebraska
Permit Fee: ~~ 218 South 16th Street
Issuance Fee: Blair, Nebraska 68008 7 2 7 5
Deposit Receipt #: (402) 426-4191 • Fax (402) 426-4195 DPermit
3 ' '7 / Issue Date: '3 ~ 7
Application Date:
JOBADDREIS I ~~ ~ ~ ~ r ~-. ~ ~ ~ Q
LEGAL
1 . DESCR. LOT ND. BLK. TRACT
^ SEE ATTACHED SHEET
0 R I MAIL ADDRESS ~ r~ ZIP PHONE
NTRACT R ` ~
3
~
' MAIL,QQDRESS
~ i ZIC ~ ~ h~
^t
` ~ P•H~ONE
. `
h t od f vt ~r ~
1 u i r~ n
C~
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4. Class of Work: ~IEW O ADDITION O REMODEL
5. Describe Work: O Finished Basement O Unfinished Basement
6. Total Sq. Footage (InI;IBaIRg easement and Garage>: Total Finished Area:
7. Valuation of Work: $ ~ _~ 3 ~ , d O
Floodway O Yes O No
Floodplain:
8 Dev. Permit
Elev. Cert.
.
Fringe O Yes O No eFE
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 septicsystems. By mysignature 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 d~is no~complete~itf~f 2 years of ¢~te of issue/
SIGNATURE OF
Comment:
DATE
O Site Plan Attached O Com let Plans Attached
Approximate Completion Date
Inspections Required and Fees
Utilities
Sewer Water Service
Septic Remote
Stop Box Card
Buildina
Footings Drywall
(before finish)
~ ~~ ~~~
Framing Final
Electrical
Rough-in Fixtures
Final
i Temporary Service Permanent Service
Mechanical
Rough-in _
Final
Plumbing
Ground Work
Rough-in _
A\C
Final
WHEN PROPERLY'VALI
Approved By: „~
POUNDS PRTG: Blair, NE
N THIS SPACE) THIS IS YOUR PERMIT
Rev. 8!96
~ - ~ BYTTLD- ~ -- - - _ ___ . -- -_ ~: -- --- --- -- ~
_ING INSPECTION REPORT
,g CITY OF BLAIIt ^ WASHINGTON COUNTY ^ OTHER
.y LOCATION OF INSPECTION: ~ ~~ ~-'~..~~+ ~ ~ ~~~
NAME OF OWNER:~~"~ dl,~'~G'~- CpNTRACTOR•r'~~G~%~i'd~/yS' 7~°
~, i~
" DATE INSPECTIOTI REQUESTED: `~" ~~` ~~ PERMIT N0: r~~ ~~
TIME INSPECTION REQUESTED: ~y ~ ~°
TYPE OF INSPECTION REQUESTED:
BUILDING: I
^ FOOTING ^ FRAMING ^,DRYWALL [INAL ~ ~~
UTILITIES:
-','
^ SEWER TAP ' ^ SEWER ^ SEPTIC ^ WATER TAP ~I
^ REMOTE ^ WATER SERVICE
`..ELECTRICAL: -
ROUGH W ^ FIXTURES- ^ FINAL ^ MOTORS ~~`
,~F
PERMANENT SERVICE ^ TEMPORARY SERVICE
. MECHANICAL:
ROUGH-IN ^ A/C ^ FINAL
PLUMBING:
GROUNDWORK ^ ROUGH-IN ^ FINAL
RESULTS OF THE INSPECTION: ~SSED (sECrroTFS~ ^FAILED (sEerroTrs~
. NOTES/REMARKS: