BP7926a~UILDING PERMIT` APPLICATION
~~ Jurisdiction of City of Blair, Nebraska
Permit Fee: 218 South 16th Street
Issuance Fee: Blair, Nebraska 68008 7 g 2 6
Deposit Receipt #: ~ (402) 426-4191 • Fax (402) 426-4195 Permit
Application Date: ~ ~%~'~~,7 Issue Date: ,~ ~~'~~~~
JOB ADDRESS II
LEGAL LOT NO.
1. DESCR. LK• TRACT
^ SEE ATTACHED SHEET
2.0 NE~~` Q ~ ~ MAILADDF~E$,5 \ yip (j ~~~ , r PHONE ~ ~i~'
o
~
b [,
CON
3. ~ TOR ~
~C_ i \ tv1A ADDRESS
o f PHONE
ZIP
(
~ ~{ ~ _vZ ~ ~
4. Class of Work: NEW O ADDITION O REMODEL
5. Describe Work: O Finished Basement O Unfinished Basement
~ Z°C,t,
6. Total Sq. Footage (Including Basement and Garage): Total Finished Area.
7. Valuation of Work: $ ~ bOb ~ ~~
Floodway O Yes O No
$. Floodplain: Fringe O Yes O No Dev. Permit
BFE
Elev. Cerl.
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.lunderstandt atthispermitisvoidifworkisnotcommencedwithin
18 ays r is~tot complete vin 2 yearsp/1 date ~ issue.
)~
DATE
Comment:
O Site Plan Attached O Complete Plans Attached
Approximate Completion Date ,C-r) ' ~~~ '~~ ~
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
Final
WHE~OPERLX~LALIDATED (IN THIS SPACE) THIS IS YOUR PERMIT
Approved By:
Water
Remote
Stop Box Card
Drywall
(before finish) ~j
Final /0 ~v ' ~~
Fixtures
Permanent Service
A\C
POUNDS PRTO: Blair, NE Rev. e196
- ~~T - - - -=------- -~.~ ~ _ ..-_
. ~` - _ BUILDING INSPECTION REPORT
~,CITYOFBL;AIR ~ WASHINGTONCOUNTY ~ OTHEK
~_
r~ f}
- ` LOCATION OF INSPECTION: .~~~ s' Cc~//,~~~P ~1r` ,
~- :eLV ~ -
NAME OF OWNER: i~r~ r I ~f1~c1 ~ - CONTRACTOR: ~"f qty>t/.y'/
F
DATE INSPECTIONREQUESTED: ~°~ G~i~ °'` ~ p °'" ,^
ERMITNO: s': 7~.~cr
TIME INSPECTION REQUESTED: r~~
' ~`r ~ -
~'< TYPE OF INSPECTION REQUESTED:
{~' BUILDING:
{ ~ _ ~ ~~
mod- ~ ~'1'
^ FOOTING ~ FRAMING QDRYWALL ~~TAL
~Y u'
UTILITIES:
~;
~ ,.
' ~ D SEWER TAP Q SEWER ^ SEPTIC ^ WATER TAP
^ REMOTE -
{ ~ WATER SERVICE .
G
~: ELECTRICAL: 3
f ^ ROUGH IN ^ FINAL
^ FIXTURES ^ MOTORS
F:
I': ~ PERMANENT SERVICE- ~ TEMPORARY SERVICE
~: ,
G': MECHANICAL:
E
K-
t~' ^ ROUGH-IN ^ A/C ~ FINAL
f PLUMBING: JJI
t
^ GROUNDWORK ^ ROUGH-IN ^ FINAL -
.RESULTS OF THEINSPECTION: ~ SED ~s~xo~s~ ^ FAILED ~s~xoTFS~
~ NOTES/REMARKS:.
~~
l:
" : -DATE OF INSPECTION MADE:- , ~i'~ -l?~~~ "~ S ; ' ~
.,--~ TIME• ~ -~
~;. CALLED OPPD\ TO.CONNECTSERVICE: ^ YES QNO
i`
WANT OFFICE STAFF TO CALL OPPD\
~. _ _- 0 YRS - .. Q.NO BLR f