BP7729BUILDING PERMIT APPLICATION
Permit Fee: ~5~ ~~
Issuance Fee:
Deposit Receipt #:
Jurisdiction of City of Blair, Nebraska
218 South 16th Street
Blair, Nebraska 68008
(402) 426-4191 • Fax (402) 426-4195
Permit 7 7 2 9
Application Date: ~ •27! ~ ~ Issue Date: S '~~
JOB ADDRESS ~ ~ ~ ` ('+~
l~ ° t ~~ Cif ~ t f 1 ~~~
LEGAL
1. DESCR. LOT NO. BLK. TRACT
^ SEE ATTACHED SHEET
2.OWNER ~ (' ~ _ _ MAIL ADDRESS ZIP PHONE
3. CONTRACTOR ~ ~~ - lJ~-~ '• / 1~1AIL ADDRESS n ~
/~~ /!9~- f ~ ZIP ~~~A `. / ~~ ~ ~~ ~/
c'J, C~
4. Class of Work: NEW O REMODEL
O ADDITION
5. Describe Work: ~ ~ O Finished Basement O Unfinished Basement
1 Cl~ _ l~ C:(
6. Total Sq. FOOtage (Including Basement and Garage}: Total FInlShed Area:
7. Valuation of Work: $ ~ O OU . Q C~
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
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 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. l understand thatthis permit is void if work is not commenced within
180 day o~r i epmple~dyaithin 2~ars of date of issue ` ~
Comment:
:OF
O Site Plan Attached O Complete Plans Attached
Approximate Completion Date Lam' ~ C~-~,
Inspections Required and Fees
Utilities
Sewer
Septic
Buildina
Footings
Framing
Electrical
Rough-in
Final
Temporary Service
Mechanical
Rough•in _
Final
Plumbfna -
Ground Work
Rough•in
Final
WHEN PROPERLY V
Approved By:
POUNDS PRTG: Blair, NE
Water Service
Remote
Stop Box Card
Drywall
(before finish)
Final ~ ` ~ 3~~
Fixtures
Permanent Service
A\C
THIS SPACE) THIS IS YOUR PERMIT
Rev. 9l9fi
k-.. ~. - _
` ~-: ~~ ~T~~LDING INSPECTION REPORT
~~
~; `~- -
~. [t CPTY OF BI;AIR ^ WASHINGTON COUNTY ^ OTHER
~ . f
~ ~ LOCATION OF INSPECTION: ~~ ~ f ~ ~~--%`""~"' ~ ~~`~'
~ _, ~~ ~ ~ ~
NAME OF OWNER: ~"~'"'~ ~ CONTRA-~. ~ -• -~
;:
DATE INSPECTION REQUESTED: PERMIT N0: ~ ~~`"~
TIME INSPECTION REQUESTED:
TYPE OF INSPECTION REQUESTED:- -
BUILDING -
. ^ FOOTII~IG ^ FRAMING ^ DRYWALL FINAL
UTILITIES: -
^ SEWER TAP ^,SEWER ^ SEPTIC ^ WATER TAP
~: ^ REMOTE ^-WATER SERVICE .
~.
~, , ELECTRICAL: ~ .
~, ^ ROUGH W ^ FIXTURES. ^ FINAL ^ MOTORS
^ PERMANENT SERVICE ^ TEIvIPORARY SERVICE
MECHANICAL:
^ ROUGH-IN ^ A/C ^ FINAL
PLUMBING:
^ GROUNDWORK ^ ROUGH-IN ^ FINAL
RESULTSOFTHEINSPECTION: '` PASSED~s~rrorES~ ^FAILED~s~rro~rES~
t= -
E . NOTES[REMARKS:
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~'
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INSPECTOR:
.~ 1
MATE OF INSPECTION MADE: ~ ~ 17 ~~I7.ME: ~ '
CALLED OPPD\ TO CONNECT SERVICE: ^ YES ^ NO
f
WANT OFFICE STAFF TO- CALL GPPD\ : _ _ ^ YES__ ^ NO BLR 1 _~