BP7915BUILDING PE~IVIIT APPLICATION
/~ ~ Jurisdiction of City of Blair, Nebraska
Permit Fee: 218 South 16th Street
Issuance Fee: Blair, Nebraska 68008 7 915
Deposit Receipt #: (402) 426-4191 • Fax (402) 426-419 Permit
Application Date: ~ ~ Issue Date: ~ ~ /
JOB ADDRESS
LEGAL
1 . DES LOT ND. BLK. TRACT
^ SEE ATTACHED SHEET
0 ER ~ MAIL ADDRESS
2. ZIP PHONE
NTR R MAIL DRESS
3. ~~ ZIP HONE
4. Class of Work: O NEW O A ITION O REMODEL
5. Describe Work: ~ _ ~ O Finished Basement O Unfinished Basement
r
--P~
6. Total Sq. Footage (Including Basement and Garage): Total Finished Area:
7. Valuation of Work: $
~~~~ G ~
Floodway O Yes O No
8. Floodplain: Fringe O Yes O No Dev. Permit
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 completed within 2 yea date issue. ~j
SIGNATURE OFOWNER/CONTRACTOR ATE
Comment:
O Site Plan Attached ,,0, 9omplete Plans Attached
Approximate Completion Date ~~"/ %;7
Inspections Required and Fees
Utilities
Sewer _
Septic _
Water Service
Remote
Stop Box Card
Building
Footings Drywall
Framin (before finish)
Final b'Z~J~1
g
Electrical
Rough-in Fixtures
Final Permanent Service
Temporary Service
Mechanical
Rough-in _
Final
Plumbin _
Ground Work
Rough-in _
WHEN PROPERLY V,
Approved By:
A\C
Final
(IN THIS SPACE) THIS IS YOUR PERMIT
POUNDS PRTG: Blair, NE Rev. 8196
~, o .BTJILDING INSPECTION REPORT ~
-~
CITY OE BLAIIt ^ WASHINGTON COUNTY ^ OTHER
.~ ~ _
LOCATION OF INSPECTION: ~ ~ ~ ~{ ~ ~ ~~'~ %
NAME OF OWNER: ~~ ~ ~ `x!'~~' ~ ~ CONTRACTOR.
~~~ .
DATE INSPECTION REQUESTED: PERMIT N0:
TIME INSPECTION REQUESTED:
TYPE OF INSPECTION REQUESTED:
g~ ~ ^~BUILDING: ) '
€ 1
FOOTING ^ FRAMING ^ DRYWALL ~ FINAL .
UTILITIES:
~' ^ SEWER TAP ^ SEWER ^ SEPTIC ^ WATER TAP -
" ^.REMOTE ^ WATER SERVICE
. ~ ~~,
ELECTRICAL: ~ {~7~ // rF=~
F l y
ROUGH IN ^ FIXTURES ^ FINAL ^ MOTORS ~ ~ r_
. ^ PERMANINT SERVICE ^ TEMPORARY SERVICE
MECHANICAL:
~" ^ ROUGH-IN ^ A/C ^ FINAL
~~
PLUMBING:
- - - - -_
GROUNDWORK ^ ROUGH-IN ^ FINAL
RESULTS OF THE INSPECTION: PASSED (sESrro~rFS> ^ FAILED (saE No~rES)
NOTES/REMARKS: