BP7826~.~~ s~~~~ ~ ~~~
~UIL®II~G PEF~MIT ~4PPL1~~41"ION
~~ ~J ~' Jurisdiction of City of Blair, Nebraska
Permit Fern: 218 South 16th Street
Issuance Fee: Blair, Nebraska 68008
D R ' t #• (402) 426-4191 ~ Fax (402) 426-4195 Permit
7826
eposit ecetp '~Q~) /~
Application Date:_T~" `~
Issue Date: ~ ~ ~ 9
JOB ADDRESS `)
~~~(/
LEGAL
1. DESCR. LOT NO. BL TRACT
^ SEE ATTACHED SHEET
OWNER MAIL ADDRESS
2. ~ ZIP PHONE
C TOR ~ AIL AD ESS ~ ~`~~~ - „ PHONE
4. Class of Work: O NEW O ADDITION EMODEL
5. Describe Work: ~ O Finished Basement O Unfinished Basement
6. Total Sq. Footage (Including Rosemont and Garage>: Total Finished Area:
G~
7. Valuation of Work: $ ~~j(~
Floodway O Yes O No Dev. Permit
8. FIOOdplain: Fringe O Yes 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
O No
O No
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 of Nebraska. I understand that this permit is void if work is not commenced within
180 days or is not~pleted within 2 ye~ys of date of issue.
SIGNATURE OF
Comment:
~-~U~
DATE
O Site Plan Attached .~/ ~m~lete Plans Attached
Approximate Completion Date ~/
Inspections Required and Fees
Utilities
Sewer Water Service
Septic Remote
Stop Box Card
Building
Footings Drywall
Framing (before fin' h
Final
Electrical
Rough-in Fixtures
Final Permanent Service
Temporary Service
Mechanical
Rough-in _
Final
Plumbing _
Ground Work
Rough-in _
Final
r
WHEN PROPERLY VAL TED (IN THIS SPACE) THIS IS YOUR PERMIT
Approved By: ~,,
A\C
POUNDS PRTG: Blair, NE Rev. 8198
BUILD-ING INSPECTION REPORT
p~p., OF BLA1"IZ ^ WASHINGTON COUNTY . ^ OTHER
P; _
LOCATION~OF INSPECTION: ~C~.3 J~t'i~'~-~ ~'~
~! P
NAME OF OWNER::d~-• ~'~ ~1~ i1..r.y ~,_ CONTRACTOR• ~~r ~y .~ fr i ~:,;
•;
DATEINSPECTION REQUESTED:, f~ ~ ~ ~ ~ PERMIT NO: ~~-
~; , - -
TIMEINSPECTIONREQUESTED: .
~,- TYPE OF INSPECTION REQUESTED: ,
BUILDING:
~ r ~`
l i `~': ~~
^ FOOTING ^ FRAMING ^ DRYWALL AL
kk UTILITIES:
I~' ^`SEWER-TAP ^ SEWER', ^ SEPTIC ^ WATER TAP
• ~;
` ^ REMOTE ^ WATERSERVICE
h
ELECTRICAL: .
^-ROUGH IN ^ FDCI'URES -^ FINAL ^ MOTORS
^ PERMANENT SERVICE ^ TEMPORARY SERVICE
MECHAMCAL:
^ROUGH-W ^ A/C ^ FINAL
PLUMBING:
- ...~
^`GROUNDWORK ^ ROUGH- ^ FINAL
RESULTS OF THE INSPECTION: ASSED (s~xoTES) ^ FAILED (sEa xo~rES)
- NOTES/REMARKS: