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BP8127�N The City of Blair Building Permit Detail Permit #: 8127 Issued: 05/07/1998 Completed: 01/04/1999 Owner: Jim Sandvold Address: 1103 S. 16th Street Blair, NE 68008 Phone: 402-533-2577 Type: Residential Additions Valuation: $16,000.00 Permit Fee: $80.00 Issue Fee: $15.00 Deposit Amt.: $200.00 Receipt #: 7261 Section: Township: Range: Subdivision: Lot: Block: 24x20 Addition w/ basement - walk out basement, master bed & bath, closet - 960 total sq. ft. 480 total finished sq. ft. Inspections Date 05/14/1998 05/14/1998 11/13/1998 11/13/1998 11/13/1998 11/13/1998 11/23/1998 12/22/1998 01/04/1999 Remarks By KAR KAR DEM DEM DEM DEM DEM KAR DEM Contractors SELF Beebe Refrigeration, Htg. & A/C, Inc. SELF SELF Plumbing Groundwork Footings Mechanical Rough -ins Plumbing Rough -ins Electrical Rough -ins Framing Drywall Final Inspection of Project Final Inspection of Project General Contractor Heating Subcontractor Plumbing Subcontractor Electrical Subcontractor Pass Pass Pass Pass Pass Pass Pass Fail Pass Permit # 0282 0037 0977 Issued 11/12/1998 05/13/1998 05/13/1998 BUILDING PERMIT APPLICATION Jurisdiction of City of Blair, Nebraska Permit Fee: 218 South 16th Street Issuance Fee: Blair, Nebraska 68008 812 7 Deposit Receipt #: 2� I (402) 426-4191 • Fax (402) 426-4195 Permit Application Date: c, e Issue Date: JOB ADDRESS LEGAL 1. DESCR.,St LOT NO. ' BLK. TRACT 2 C , ❑ SEE ATTACHED SHEET E. OWNER 1 ` MAIL ADDRESS ZIpPF�QNE L I CONTRACTA. 3. MAIL ADDRESS ZIP PHONE 4. Class of Work: O NEW ADDITION O REMODEL 5. Describe Work: 2LA ')( ZA66 j b.o n O Finished Basement Unfinished Basement © �►� 4. 6. Total Sq. Footage (Including Basement and Garage): Ci LD C)- Total Finished Area: L4 CSD 7. Valuation of Work: $ Floodway O Yes O No 8. Floodplain: Fringe O Yes No Dev. Permit BFE Elev. Cert. 9. Current Zoning: � Site Plan Attached O Complete Plans Attached 10. State Fire Marshall Required: O Yes O No Approximate Completion Date Inspections Required and Fees 11. Special Use Permit Required: O Yes O No Utilities 12. Variance Required: O Yes O No Sewer Water Service 13. Minimum Setbacks: From Side Rea Septic Remote 14. Sidewalk Required: Yes O No Waiver Approved Stop Box Card Building NOTICE Footing Separate permits are required for electrical, plumbing, heating, ventilating and air Dryw conditioning, and septic systems. Byrrysignature below, I acknowledge that payment (bef ref'nish) of the building permit application fee does not constitute issuance of this building Framing' Fin 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 Electrical Inspector. /l hereby agree to perform the proposed work in accordance with the specifications set Roughki Fixture forth above and in accordance with the codes/ordinances of the City of Blair and the State of Nebraska. Iunderstand thatthispermit isvoid ifworkisnotcommencedwithinFir�af' Permanent Service 180 days r is not completed wit in 2 years of date of issue. Temporary Service SIG }URE OF OWNER/CONTRACTOR DATE VFin AComment: 0►W%Aft Plumbing Ground Wope WEN PROPERLY VALIDATED IN THIS SPACg THIS IS YOUR PERMIT POUNDS PRTG: Blair, NE Rev. 6/96 ELECTRICAL PERMIT APPLICATION Jurisdiction of City of Blair, Nebraska 218 South 16th Street Blair, Nebraska 68008 (402) 426-4191 Permit. 0977 Application Date: 5 ` (3-0r�) o Permit Fee: $ 50-60 JOB ADDRESS LEGAL LOT NO. BLK. TRACT 1 DESCR. O SEE ATTACHED SHEET 2. OWNER J(M s _ 1 V6 1(2-( / MAILADDRESS _S�Y ZIP �� PHONE r3 . CONTRACTOR (� �i MAILADDRESS PHONE LICENSEN . scl .� 14. Class of Work: O NEW RESIDENTIAL O NEW COMMERCIAL REMODELING/ADDITIONS O UPGRADE SERVICE 5. Describe Work: 6. Current License on File V3 Yes O No New Service Fee = (Amp Fee + $2.00 per branch circuit) 1-100 Amp Fee ............................ $ 13.00 101-200 Am a ............................ �18.. 201-30u Amp ........................ 301-400 Amp Fee ............................ $ 42.00 401-500 Amp Fee ............................ $ 55.00 501-600 Amp Fee ............................ $ 67.00 601-700 Amp Fee ............................ $ 80.00 701-800 Amp Fee ............................ $ 92.00 801-900 Amp Fee ........................ I... $105.00 901-1000 Amp ................................. $117.00 IF OVER 1000 Amp 1st 1000 Amp Fee ....................... $117.00 Each additional 100 Amps ........... $ 13.00 NOTICE I hereby certify that I have read and examined this application and know the same to be true and correct. All provisions of laws and ordinances governing this type of work will be complied with whether specified herein or not. The granting of a permit does not presume to give authority to violate or cancel the provisions of any other state or local law regulating construction or the performance of construction. SIGNATURE OF CONTRACTOR OR AUTHORIZED AGENT �0 DATE S -O 2 Ob ELECTRICAL PERMIT FEES Upgrade Existing Service ...... $10.00 Temporary Service................$10.00 Fire Alarm System ................. $10.00 Signs .....................................$15.00 Miscellaneous Apparatus ......$11.00 AC/DC Circuit ........................ $5.00 Commercial/Multi-Family and All Upgrades: # of Circuits x $2.00 60 Amp Fee //''� Amp Fee + Circuit Total `T Uig New Residential: (Finished Area) Single/Two Family Dwellings 4 20 sq. ft. x .045 Modular/Manufactured Homes ....... $30.00 Receptacle/Switch Outlets Fixtures -x $.75 Smoke Detectors x $3.00 Residential/Commercial Appliance # Fixed Outlets x $3.00 Motor(s) x $3.00 Power Apparatus (220 Volts) # Apparatus x $3.00 Permit Issuance Fee .............$15.00 TOTAL WHEN PROPERLY VALIDATED (IN THIS SPACE) THIS IS YgJR PERMIT (S . d0 56- (0c) Comment: Approved By: POUNDS PRTG: Blair, NE Rev. 8197 PLUMBING PERMIT APPLICATION Jurisdiction of City of Blair, Nebraska 218 South 16th Street Blair, Nebraska 68008 Fax (402) 426-4195 P 0037 (402) 426-4191 Application Date: 5-13-99 Permit Fee: $ - P 0 JOB ADDRESS I /( Y-/' S-/ 1 . OWNER MAIL ADDRESS ZIP -5 33 rpk TO 2 CONTRACTOR MAIL ADDRESS PHONE LICENSE NO. 3. Class of Work: O COMMERCIAL WRESIDENTIAL O NEW ADDITION O ALTERATION EPAIR O REPLACEMENT 4• Describe Work: Comments: PLUMBING PERMIT FEES Modular Home ...................... $15.00 Type of Fixture No. Kitchen .................................. $8.00 x Bath ....................................... $8.00 x �_ `5- 00 Rough -In Bath .......................$4.00 x Slop Sink/Laundry Tray ......... $5.00 x Water Heater ......................... $3.00 x Outside Water Faucet ........... $3.00 x Drinking Fountain .................. $3.00 x Water Service ........................ Sewer .................................... $10.00 $10.00 NOTICE I hereby certify that I have read and examined this Groundwork...........................$10.00 application and know the same to be true and correct. All provisions of laws and ordinances governing this type of Septic Tank & Laterals .......... $10.00 work will be complied with whether specified herein or not. The granting of a permit does not presume to give authority Lawn Sprinkler System ......... $10.00 to violate or cancel the provisions of any other state or local Sprinkler System ................... $30.00 law regulating construction or the performance of (Commercial) construction. Gas/Water Piping System (Commercial) ............................$30.00 Permit Issuance Fee $15.00 ) �� �I NATURE OF CONTRACTOR OR AUTHORIZED AGENT TOTAL. J / Current License on File OYes O No VNA DATE WHEN PROPERLY VALIDATED (IN THIS SPACE) THIS IS YOUR PERMIT Comment: I Approved By: 6 POUNDS PRTG: Blair, NE // Rev. 4/98 Application Date: MECHANICAL PERMIT APPLICATION Jurisdiction of City of Blair, Nebraska 218 South 16th Street Blair, Nebraska 68008 0282 Fax (402) 426-4195 M (402) 426-4191 Permit Fee: $ �' b v JOB ADDRESS 1 OWN� �^ O MAIL ADDRESS ZIP � 2 3 PHO 2. CONT ITOR MAIL ADDRESS � • PHONE LICENSE N0. 3. Class of Work: O COMMERCIAL RESIDENTIAL O NEW O ADDITION O ALTERATION O REPAIR REPLACEMENT 4• Describe Work: MECHANICAL PERMIT FEES Central A/C Tons Furnace BTU/H Forced Air/Heat Pump Systems - Per Unit Commercial/Residential (New) .................................................... $25.00 # of Units A/C Air -Conditioner Unit - Per Unit Furnace Commercial/Residential (New) .................................................... $10.00 Forced Air Systems/Air Conditioner Unit Replacement Per Unit Commercial/Residential ................... $10.00 Completion Date: Refrigeration Units/Coolers/Lines/Compressor - Per Unit Commercial (New or Replacement) ...... ..................... $10.00 Comments: Appliance Vent/Fans ............................... $10.00 Boiler .......................................................$15.00 //11 Duct System ............................................ $10.00 Gas/Air Outlets .................. x $2.00 Radiant Heat Systems ............................ $25.00 NOTICE 1 hereby certify that I have read and examined this application and know the same to be true and correct. All provisions of laws and ordinances governing this type of Modular Home $15.00 work will be complied with whether specified herein or not. ......................................... The granting of a permit does not presume to give authority to violate or cancel the provisions of any other state or local /�� O law regulating construction or the performance of Permit Issuance Fee ............................... $15.00 construction. � 0 L2�!� '�� ---I S' SIGNATUR OF CONTRACTOR OR AUTHORIZED AGENT TOTAL ° 12,/��c�� Current License on File Yes O No O NA DATE/ Comment: WHEN PROPERLY VALIDATED (IN THIS SPACE) Approved S IS YOUR PERMIT POUNDS PRTG -Blair, NES / Rev. 4/98 N O I I HO 9:25 0 6,6E - / oNnHHONMIJ L WO' S lou,L�ES I5 O rau-r I/Lit ��F St�EA-'C•1�I�1� -/ caps �-So r-114 Cea-106 IOCZOL, T-DtiA �xc� �v�• ��cla• aS IZc-G�t(LEtJ - 2x�g-�V fig e Ilo" oc. — 13 M10. 104zoL-a-r�o�1 0- L- L-(.apC- kI(,4-F VJILL\/,NiN ELOPe AWNIf r�,g ,F 4 oNipframr SIZi: Au- �ooTl►�(�� PEIZ SOIL g�P.t=' 1►1(a . Iof vers la3 (��ulw`Ep -z-A-0 r %DL e Zx 4 cOLL.P-�Z- T,Et e �b'I o,-. 2 x PU R.La Go. x 2x� $ 4e eS e. 'oc If2�' (JfZYkl� c GEtL��l.o WALL - /A.P.(L (3 �1�>� Q k1AUr�• fLz"2 • (ewe=D 4 IlaAisp IN, to FI,�2 To I ST" Q I L2 oG . 12 n °o SILL PI.p.Tr= o�l EZ Silt. g�n.LEQ.. �o p 1<t LLS � A 11L�io12 f'�t-TS PI:I� Cocom. PEI? C�(r�.PE HEt�I�}'f' i��oiz FOUIZE, L'arJC 13�ouR�� S' -o" r3�z Som P Pi r. I �- 60�-I c- �Lcn 2 �811 pi d.r, L, W�LLSSC iot� . CITY OF BLAIR Application for Building Permit PLOT PLAN Address 1103 -5-9 � Date 7- / U Legal Description: Lot 1 Block Addition Please show all measurements of existing and contemplated structures, also show distances between structures, etc., and property lines. /� Is this a corner lot? /"41 Property Line �l -- 30 16 C 13-=7 3 " _ _Center Line of _ _ _ Street_ _ Applicant �,,�. s-ndv� 14 Indicate North I promise - City of Blair 218 South 16th Blair, Nebraska 68008 402-426-4191 Fax - 402-426-4195 BUILDING PERMIT DEPOSIT AGREEMENT A $200.00 refundable deposit is being collected at the time of your building permit application for all permits in excess of $10,000.00. However, the City reserves the right to not refund this deposit if any of the following conditions occur during the construction period: 1) water is connected without a meter by either the plumber, owner or general contractor, 2) all required inspections have not been obtained (this includes drywall prior to taping) as per attached checklists (Both Rough -In and Final), 3) occupancy or utilization occurs prior to a final inspection, and 4) all permits have not been obtained. If any or all of these situations occur during construction, you may forfeit your deposit. I, hereby agree to the above conditions, and understand that should any or all of the above situations occur, the building permit deposit may be forfeited or discounted upon the discretion of the City of Blair, Building and Inspections Department. C tractor/Owner �,-7— Date Contractor/Owner City of Blair 11211 EOUALNOUSING OPPORTUNITY -' promise City of Blair 218 South 16th Blair, Nebraska 68008 402-426-4191 Fax - 402-426-4195 HOMEOWNER VERIFICATION FOR ELECTRICAL WIRING PERMITS states the following: print your full name on line above: 1. I am the owner of the single family dwelling for which I am applying for an electrical permit. ll / C Address: ll03 -5-/� 51 �! , % ✓v!� C� ��00 2. 1 am applying for an electrical permit for a single family dwelling and it is or will be my principal residence. 3. 1 will install and connect the electrical wiring for myself, without compensation or pay from or to, any other person. 4. 1 have sufficent knowledge of the 1996 National Electrical Code requirements to make an electically safe and mechanically secure installation which will meet the minimum standards referenced in 81-2104. 5. 1 am aware of all inspections required prior to a final. 6. 1 will call twenty-four ( 24 ) hours in advance for an inspection. I am also aware that it is not the inspector's job or duty to be my instructor in electrical wiring. 7. 1 am aware that Nebr. Rev. Stat. 81-2143 makes it a Class 1 misdemeanor to make a false statement on a request for inspection. 8. By signing this form I am stating the above information is true and correct. Homeowner / Ap licant Signature Date 12t EWIILHWSW/3 OPPOHTUNRY 0 1 promise City of Blair 218 South 16th Blair, Nebraska 68008 402-426-4191 Fax - 402-426-4195 HOMEOWNER VERIFICATION FOR A PLUMBING AND/OR MECHANICAL PERMITS �l S l/ JG M �� 5� G 1 �y�-' , states the following: print your full name on line above: 1. I am the owner of the single family dwelling for which I am applying for a plumbing and/or mechanical permit. Address: 2. 1 am applying for a plumbing and/or mechanical permit for a single family dwelling and it is or will be my principal residence. 3. 1 will install and connect the plumbing and/or mechanical for myself, without compensation or pay from or to any other person. 4. 1 have sufficent knowledge of the 1994 UNIFORM PLUMBING and/or MECHANICAL code requirements to make a safe and mechanically secure installation which will meet the minimum standards referenced in the 1994 UNIFORM CODES. 5 L-. 7. A am aware of all inspections required prior to a final. I will call twenty-four ( 24 ) hours in advance for an inspection. I am also aware that it is not the inspector's job or duty to be my instructor in plumbing and/or mechanical. I am aware that violation of the codes make it a Class 1 misdemeanor to make a false statement on a request for inspection. By signing this form I am stating the above information is true and correct. Hom 'vvner / Applicant Signature Date i. 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