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BUILDING PERMIT APPLICATION
Jurisdiction of City of Blair, Nebraska
218 South 16th Street
~~ ~ ~ q~
Application Date:
Blair, Nebraska 68008
(402) 426-4191
Permit
~c~~®
Issue Date: ~ ~ ~ ~ ~' ~~ Permit Fee: $ o~~O ~~
JOB ADDRESS ~ I I ~ ~ ~~ ~ n (~ f~ U~
V V ~~,
LEGAL
1 ' DESCR. LOT NO. ~ BLK. TRACT ^ SEE ATTACHED SHEET
r
2. OWNER
I MAI DDRESS IP PHONE
3. CONTR CT R MAILADDRESS~ ~ P LICENSE NO.
4. USED BUILDING
5. Class of Work: ^ NEW ADDITION ^ALTERATION ^ REPAIR ^ MOVE ^ REMOVE
6. Describe Work: ` ~p tt~
7. Sq. Footage of Structure (mdDding BBSemem rind Garage): ~~G~C> ~ ~ ~~ a
8, Change of Use From: C f Use To: ~p • ~ ~
g, Valuation of Work: $ /~ ~ ~l~ ~ ~
10. Floodplain: Flooaway Yes ^ No ^
Fringe Yes^ No ^ Dev. Permit
BFE Elev. Cert.
11. Current Zoning:
12. State Fire Marshall Required: Yes ^ No
13. Special Use Permit Required: Yes ^ No [~
14. Variance Required: Yes^ No[~
1~~ • ~
15. Minimum Setbacks: Front ~S.-Side ~ Rear~~~
16. Sidewalk Required: YesQ No ^ Waiver Approved
PPLICATION ACCEPTED I PLANS CHECKED BY ( APP VE r/ I~r'~C~ I
NOTICE '"
Separate permits are required for electrical, plumbing, heating, ventilating and aircondi-
tinning, 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.turther
agree that construction covered by this permit application shall not be commenced until I
have received acopyof this application form signed by the Bui-ding Inspectorand stamped
'APPROVED'.
hereby agree to perform the proposed work In accordance with the specifications set forth
above and in accordance with the codes/ordinances ofthe City of Blair and the State of
Nebraska. I understand that this permit is vol f work is not commenced within 180 days,
is not completed within 2 years of the date Issuance, or if work is abandoned for six (ti)
onths r Ion er, whichever is arli st.
SI NATURE OF OWNER~CONTRACTOR OR AUTHORIZED DATE
SIGNATURE OF OWNER (IF OWNER BUILDER) DATE
Site Plan Attache Compl~ Ian Attached
Approximate Completion Date
Inspectio s Required an Fees
tilities
Sewer T /J Water Tap
Sewer Water Service ~
Septic`, ~ Remote
~U--`~l ' l1 Building
Footings ~ Drywall
(before finish) ~~////
Framing ~ Final t ~7~~~~(o ,` ~7~~~
Electrical ' ~c CJ~ ~
Rough-in / Permanent Service
Final ~~ Temporary Service
Mechanical -~~-~~~~~-I"'`°'`~~-"~
Rough-in ~ ~~ `~c~~.~>_~:,~- . ABC
Finally ~
Plumbing
Ground Wok!
Rough-in Final
WHEN PROPERLY VALIDATED (IN THIS SPACE) TICS IS YOUR PERMIT U
Comment: Approved By:
POUNDS PRTG: Blelr, NE Rev' ~~'
BUIL®ING PERMITAPPLI
Jurisdiction of City of Blair, Nebraska
218 South 16th Street
Blair, Nebraska 68008
(402) 426-4191
CATION
Permit ~ `~ ~" ~
i~/~~~q~~ ~~~~/~s
A lication Date: ` Issue Date:
pp
~~
Permit Fee: $
JOB ADDRESS
LEGAL
1, DESCR. LOT NO. BLK. TRAC
-
~
^ SEEATTACHEDSHEET
2, Oyy MAILAD ESS IP PHONE / ~j
3, C OR MAI~ D~ ~ ~f~ONE ^„
(T/ /~'(/ ~ LICENSE No.
USE OF BU ING
4.
5. Class of Work: ^ NEW ^ ADDITION ^ ALTERATION ^ REPAIR ^ MOVE ^ REMOVE
6. Describe Work:
], Sq. FOOtage Of StrUCtUre (Including Basement and Garage):
$, Change of Use From: Change of Use To:
g, Valuation of Work: $
iQ Floodplain: Floodway Yes ^ No ^
Fringe Yes^ No ^ Dev. Permit
BFE Elev. Cert.
11. Current Zoning:
12. State Fire Marshall Required: Yes ^ No^
13. Special Use Permit Required: Yes ^ No ^
14. Variance Required: Yes^ No^
15. Minimum Setbacks: Front Side Rear
16. Sidewalk Required: Yes^ No ^ Waiver Approved _
ACCEPTED BY I PLANS CHECKED BY I APPROVED FOR ISSUANCE BY
NOTICE
Separate permits are required for electrical, plumbing, heating, ventilating and air condi-
tioning, 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 copyof this application form signed by the Building Inspectorand stamped
'APPROVED'.
herebyagree to perform the proposed work in accordance with the specifications set forth
above and i with th _. es/ordinances of the City of Blair and the State of
Ne s I understa d tha is rmit I oid if work is not commenced within 180 days,
' t c m eted wi ars of t dat of issuance, or if work is abandoned for six (fi)
o hs or I aer.~bi hever is earlie .
OR
SIGNATURE OF OWNER (IF OWNER BUILDER)
AGENT DATE
Site Plan Attached ^ Complete Plans Attached ^
Approximate Completion Date
Inspections Required and Fees
zx~ Utilities
Sewer Tap ~~ Water Tap
cy~ ~~ arr
Sewer ~~ Water Service
Septic Remote
Building
Footings Drywall
(before finish)
Framing
Rough-in Permanent Service
Final Temporary Service
Rough-in
Final _
Plumbing
Ground Work ~~'
DATE Rough-in /.-~ ~ Final
WHEN PROPERLY VALIDATED (IN THIS SPACE) THIS IS YOUR PERMIT
Comment: Approved
POUNDS PRTG: Btalr, NE ~~'~
Final
Electrical
Mechanical
- ABC
Application Date:
BUILDING PERMITAPPLI
Jurisdiction of City of Blair, Nebraska
218 South 16th Street
Blair, Nebraska 68008
(402) 426-4191
JOB ADDRESS ~~~[_- ~I ~ ~ ~ L~~~ \
~
+
~ ~'~(/~/1 LJ1° ~L~ VL ~,~
cr
_ ,
LEGAL
1 LOT NO. BLK. TRACT
^ SEE ATTACHED SHEET
' DESCR.
2. OWNER ',f ~ - MAILADDRESS ZIP PHONE
3. CONTRA T R
' MAILADDRESS
1~
~
~
l ~-~-
~
U PHONE LICENSE NO.
~
- ~ ~~~:+..~~
~~~~
~ ~~_
-mil ~~
~ ~
~ ~
USE OFBUILDING
4.
5. Class of Work: NEW ^ ADDITION ^ ALTERATION ^ REPAIR ^ MOVE ^ REMOVE
6. Describe Work: ~ Cyr } ~}
--
~~ j (, c
7. Sq. Footage of Structure pndudingBesementandcerage): ~> `~7 ~~;y.--~ ,~ ~ %~~-~~ _ ~'-~~~
$, Change of Use From: Change of Use To:
g, Valuation of Work: $
lain: Floodway Yes^ No ^
10 Flood Dev.Permit EIev.Cert.
p
Fringe Yes^ No ^ BFE
11. Current Zoning:
12. State Fire Marshall Required: Yes ^ No^
13. Special Use Permit Required: Yes ^ No ^
14. Variance Required: Yes ^ No ^
15. Minimum Setbacks: Front Side Rear_
16. Sidewalk Required: Yes^ No ^ Waiver Approved
~l GL~~ l~~>'~-
Site Plan Attached ^ Complete Plans Attached ^
Approximate Completion Date
Inspections Required and Fees
Utilities
Sewer Tap Water Tap
~ ~ `" ` l ~ ~~ ~ Issue Date: ~ ~ ; ~ ~`~~~~ Permit Fee: $ ~~~ C=~~~
BY I PLANS CHECKED BY I APPROVED FOR ISSUANCE BY
/ NOTICE
Separate permits are required for electrical, plumbing, heating, ventilating and air condi-
tioning, and septic systems. By my signature below, I acknowledge that payment of the
building permit application fee does notconstitute issuance of this building permit. I further
agree that construction covered by this permit app-ication shall not be commenced until
have received a copy of this application form signed by the Building Inspectorand stamped
'APPROVED'.
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,
Is ~gQco leted within 2 years of the date of is~c~z~ce, of if work i~Jabandoned for six (6)
. milt onger, w}~hever is earliest7,~/Jy`~ /, _ V _ ~ -~ ~p~ ,
DATE
SIGNATURE OF OWNER (IF OWNER BUILDER) DATE
Sewer Water Service
Septic Remote
Building
Footings Drywall
(before finish)
Framing
Permit ~ ~
Final
Electrical
Rough-in Permanent Service
Final Temporary Service
i Mechanical
Rough-in (~~D(~~ ~-~.~rl~fA~C ~ .z=~~, _ ~ u_m.~~
Final /~ ~~'` '
Plumbing
Ground Work
Rough-in Final
WHEN PROPERLY VALIDATED (IN THIS SPACE) THIS IS YOUR PERMIT
Comment: Approved By: ~
~_ ./
a. C~~,
SOUNDS PRTG: Blelr, NE Rev.08/8:
CATION
ELECTRICAL PERMIT APPLICATION
Jurisdiction of City of Blair, Nebraska
218 South 16th Street
Blair, Nebraska 68008 0 2 61
(402) 426-4191 Permit
Application Date: ~ `- f
Permit Fee: $ ~ ~ ~` ~0
JOB ADDRESS ! ~ I ~~ ~~,y, ~ ~~~ U~
I I ' , /~ ~~
u
LEGAL
1 • DESCR. LOT NO. BLK. TRACT
O SEE ATTACHED SHEET
2 OWNER ,rte (~ ~ •1' , d ~ ~e MAIL ADDRESS ZIP
fJ U ll
` ~(J
11 PHONE
'
MAIL ADDRESS PHONE
R _
CONTRAC LICENSE NO.
4• Class of Work: EW RESIDENTIAL O NEW COMMERCIAL
O REMODELING/ADDITIONS O UPGRADE SERVICE
5• Describe Work: ~pQQ ~c _ .~-~. - I
(Gl She-G`) C~ ~~=~`
6• Current License on File Yes O No O NA
New Service Fee = (Amp Fee + $2.00 per branch circuit) ELECTRICAL PERMIT FEES
1-100 Amp Fee ............................ $ 13,00 Upgrade Existing Service .,.... $10.00
101-200 Amp Fee ............................ $ 18.00 Temporary Service $10.00
................
201-300 Amp Fee ............................ $ 30.00
301-400 Amp Fee $ 42,00
............................
Fire Alarm System ................. $10.00
401-500 Amp Fee ............................ $ 55.00 Signs ..................................... $15.00
501-600 Amp Fee ............................ $ 67.00 Miscellaneous Apparatus ...... $11.00
601-700 Amp Fee ............................ $ 80.00
701-800 Amp Fee ............................ $ 92,00
801-900 Amp Fee ............................ $105.00 Commercial/Multi-Family and All Upgrades:
901-1000 Amp ................................. $117.00 # of Circuits x $2.00
IF OVER 1000 Amp Amp Fee
1st 1000 Amp Fee ....................... $117.00
Each additional 100 Amps ........... $ 13.00 Amp Fee + Circuit Total
NOTICE New Residential: (Finished Area)
I hereby certify that I have read and examined this Single/Two Family Dwellings
application and know the same to be true and correct. All 3C~C~ sq. ft. x .045 ~J J . Q ~
provisions of laws and ordinances governing this type of
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n or not.
The granting of a permit does not presume to give authority Receptacle/Switch Outlets
to violate or cancel the provisions of any other state or local Fixtures x $.75
law regulating construction or the performance of
construction. Residential/Commercial Appliance
# Fixed Outlets x $3.00
Power Apparatus (220 Volts)
# A
arat
$3
00
pp
us x
.
SIGNATURE OF CONTRACTOR OR AUTHORIZED AGENT
o Permit Issuance Fee ............. $15.00 ~° ~
DATE
--
TOTAL J c~* L
J V b
WHEN PROPERLY VALIDATED (IN THIS SPACE) THIS IS~OUR PERMIT
Comment:
Approved By:
POUNDS PRTG.-Blalr, NE `" Rev. t?l95
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