BP6757m ®®
Jurisdiction of City of Blair, Nebraska
218 South 16th Street
Blair, Nebraska 68008
(402) 426-4191 Permit
~~y-
. ~-
Application Date: ~ ~ ,~~ ~/ ~ Issue Date: /' ~° ~ '~ " ~~ ~ ___ Permit Fee: $ ~k~`_s, i ~~~'~
JOB ADDRESS ~.
I ~? _ ='
LEGAL
1 ' DESCR. LOT NO. BLK.
TRACT ®SEE ATTACHED SHEET
OWNER ~tt) -Y' , { MAILADD ESS ZIP PHONE
3. CONTRACTOR ~ MAILADD ESS PHONE LICENSE NO.
USE OF BUILDING
4.
5. Class of Work: NEW ^ ADDITION ^ ALTERATION ^ REPAIR ^ MOVE ^ REMOVE
6. Describe Work: ~ t
7. Sq. FOOtage Of StrUCtUre (Including Basement and Garage):
$. Change of Use From: Change of Use To:
g, Valuation of Work: $ ~`> ~;~} ~;C~j ~~'~~
10. FIOOdplaln: Floodway
Fringe Yes ^ No ^ Dev. Permit Elev. Cert.
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 ^ Wairoved _
AP_ PLI1OATION ACCEPTED BY I PLANS CHECKED BY IRO i~ 0~ ~At~~
~ 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 copy of this application form signed by the Building Inspectorand stamped
'APPROVED'.
Iherebyagreetoperfo~ heproposedworkinaccordancewiththespecificationssetforth
above and in accggrd~gth the codeslord' a ces of the City of Blair and the State of
Nebraska. I u,,~~d~rs fi at thi~perr~~rit's`~ I ' work is not commenced within 180 days,
is not com ate n 2 ye ~f ttf~~ issuance, or if work is aban ned for ix (8)
mo r' ~irhichzv~r Is earlie .,, _. ~ ~'
OR AUTHORIZED AGENT " e~ DA
SIGNATURE OF OWNER (IF OWNER BUILDER)
DATE
Site Plan Attached ^ Complete Plans Attached
Approximate Completion Date
Inspections Required and Fees
Utilities
Sewer Tap ~~r~f~- Water Tap
Sewer ,~~-~~-~~"`~ t ~ `~ ~ f~~'. Water Service
Septic
Remote
Euilding
Footings
Framing
Drywall
(before finish)~.~°
Final ~° ~-'~S"~~o
Electrical
Rough-in ~ ~- !~ ~ ~`~~~'~r~-~~~ permanent Service
Final • 9'°~`~''~ ~=.Gt ~`~-r" ~' Temporary Service
Mechanical ~
Rough-in >(~~~~t:r~~~ -~..~. ABC
Final ,,~'"e`}~" ~;rr ~.~,;.-~.
Plumbing
Ground Work
- ,
Rough-in ~,~;'-, ~,~~f'~hz~, Final .~' ~I ~' = ~ '
WHEN PROPERLY VALIDATED (IN THIS SPACE) THIS, IS YOUR PERMIT
Comment: Approved By:
~m~~~~~
POUNDS PRTG: BIeIr, NE Rev. 08/95
,~ ~ ~
C,
Jurisdiction of City of Blair, Nebraska
218 South 16th Street
Blair, Nebraska 68008
(402) 426-4191 Permit ~ i ~~~
Application Date: ~ ~ m ((~ s ~ ~~ ~ Issue Date: I ~ ~ ~' ~~ ~~ Permit Fee: $ <~--- '
JOB ADDRESS ~ ~ ~ ~ ~ ~ ~ (~j ~_ ~ (
LEGAL
1 ' DESCR. LOT NO. BLK. TRACT
^ SEE ATTACHED SHEET
OWNER - ~ AILADDR S ~ --~- ZIP PHONE
3, CONTRACTOR - . ~
~~~\,~"`~,~~4~5_~~ 4 I~.,.t.1.~~t~ MAILARDRESS PHQ E LIC 0.
~ ~-~,. r° ~-(y- r..._ ~
,~ < ~f*~ -~P ~ ~ i `. ire i ~~.~ 1~ l t ~~ i ~~tf'/~~f~7r~
4, USE OF BUILDING
5. Class of Work: NEW ®ADDITION ^ALTERATION ^ REPAIR ^ MOVE ®REMOVE
6. Describe Work: C~`l. '~ ~ ~~.~E w~ r~y', t~,ur ~ . ~ ~ ~~~~`,~ _~-a-~. ~`~1 ~ C ~~~. f ~_ ~ '~~ r
f ~'~.~~.~" ~ ~,
], Sq. FOOtage Of StrUCtUre (Including Basement and Garage):
8, Change of Use From: Change of Use To:
g, Valuation of Work: $
Floodway Yes ^ No ^
10. Floodplain:
Fringe Yes^ No ^ Dev. Permit
EI9v. cert.
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
APPLIC~A'rION ACCEPTED BY I PLANS CHECKED BY I APPROVED FOR ISSUANCE BY
,_ i t ., i ~ - .,.~-
NOTICE
Separate pefmits are required for electrical, plumbing, heating, ventilating and air condi•
tinning, and septic systems, By my signature below,) 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 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 not complete in years of the date o 's ance, off work is abandoned for six (8)
months or Ion er, whic eve3 iS arligst.
~.
~~i
SIGNATURE OF OWNE{7h ONTRACTOR ~ R ACTH RIZED AGENT DATE
SIGNATURE OF OWNER (IF OWNER BUILDER) DATE
Site Plan Attached ^ Complete Plans Attached ^
Approximate Completion Date
Inspections Required and Fees
Utilities
Sewer Tap Water Tap
Sewer Water Service
Septic Remote
Building
Footings Drywall
(before finish)
Framing Final
Electrical
Rough-in Permanent Service
Final Temporary Service
Mechanical
Rough In ~'~; C`~ t ABC ~ C~ ~ ~ ~ ~ (~ s
Final ~1` ~'~'
Plumbing
Ground Work
Rough-in Final
WHEN PROPERLY VALIDATED (IN THIS SPACE) THIS IS YOUR PERMIT
Comment: Approved By: ~;/ ;'
~~
POUNDS PRTG: Blelr, NE ~~ Rev. 08/95
ADDRESS
t LEGAL I LOT NO. I d~• I I HAS I ®SEE ATTACHED SHEET
1. DESCR.
~ ennaGe A 71 . t PHONE
2 ~,., , ~ ... _..--- ~- ~
,3 CON OR MAILADDRESS / ~ PHONE UCENSENO.
f ~
USE OF BUILDING
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: $
10 Floodplain: Floodway Yes^ No ® Dev.Permit EIev.Cert.
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 _
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 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 not comple d within 2 years of the at~uance, or if work is abandoned for six (6)
enfor ~ er, w ichev rise hest. ~~ ~
SIGNA RE F ' WNE (CONTRACTOR OR AUTHOgI ED AGENT DATE
SIGNATURE OF OWNER (IF OWNER BUILDER) DATE
Site Plan Attached ^ Complete Plans Attached ^
Approximate Completion Date
Inspections Required and Fees
Utilities
Sewer Tap Water Tap
Sewer Water Service
Septic Remote
Building
Footings Drywall
(before finish)
Framing Final
Electrical
Rough-in Permanent Service
Final Temporary Service
Mechanical
Rough-in ABC _
Final
Plumbing
Ground Work .~ t
Rough-in ~ ~'°` Final
WHEN PROPERLY VALIDATED (IN THIS SPACE) THIS YOUR PERMIT
Comment: Approved By:
Rev. 08185
POUNDS PRTG: Blelr, NE
Jurisdiction of City of Blair, Nebraska
218 South 16th Street
Application Date: ~~
Blair, Nebraska 68008
(402) 426-41 1
l' i~' 9
Issue Date:
Permit
~~~
Permit Fee: $
JOB ADDRESS
LEGAL
1 LOT N0. BLK. TRACT
^ SEE ATTACHED SHEET
' DESCR.
2.ON(NE MA RESS ~ T ZIP PHONE
3 CO ACTOR ~-'-° MAILADDRES PHONE LICENSE NO.
USE OF BUILDING
4.
5. Class of Work: ^ NEW ^ ADDITION ^ALTERATION ^ REPAIR ^ MOVE ^ REMOVE
6. Describe Work:
7. Sq. Footage Of StrUCtUre (Including Basement and Garage):
8, Change of Use From: Change of Use To:
g, Valuation of Work: $
Floodway Yes^ No ® Dev. Permit
10
Floodplain:
EIev
Cerl.
.
Fring9 Yes^ No ^ BFE .
11. Current Zoning: Site Plan Attached ^ Complete Plans Attached ^
12. State Fire Marshall Required: Yes ^ No^ Approximate Completion Date
Inspections Required and Fees
13. Special Use Permit Required: Yes ^ No ^ ~-°°~ Utilities
~
Sewer Tap
Water Tap
14. Variance Required: Yes® No® .Sewer ~~ ~~ Water Service
15. Minimum Setbacks: Front Side Rear septic Remote
16. Sidewalk Required: Yes ^ No ^ Waiver Approved Building
A PLICATION ACCEPTED BY PLANS CHECKED BY APPROVED FOR ISSUANCE BY Footings Drywall
p ~ (before finish)
NOTICE Framing -Final
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 Electrical
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 receivedacopyofthisapplicationformsignedbytheBuildinglnspectorandstamped ROUgh•in Permanent Service
'APPROVED'.
I hereby agree to perform the proposed work in accordance with the specifications set forth Final Tem ora Service
p ry
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 not completed within 2 years of the date of issuance, or' work is abandoned for six ((i) Mechanical
nths ® er, w he e i arlies
~' ,.- c =
Rough-in ABC
S E OF 0 ~NER/CO TRACTOR R THORIZED AG DATE Final
Plumbing
Ground Work
SIGNATURE OF OWNER (IF OWNER BUILDER) DATE Rough-in Final
WHEN PROPERLY VALIDATED (IN THIS SPACE) THIS IS YOUR PERMIT
Comment:
Approved
POUNDS PRTO: Bleb, NE Rev. 09./85
Jurisdiction of City of Blair, Nebraska
218 South 16th Street
Blair, Nebraska 68008
(402) 426-4191 Permit.
Application Date: ~ 1 ~ ~~' (~ Issue Date: C ~ ` ~ us /.~ Permit Fee: $ ~%~-
JOBADDRESS
LEGAL
1 ' DESCR. LOT N0. BLK. TRACT
^ SEE ATTACHED SHEET
2 OWNER '`° `~ -mac,` (^ ^~~ _M~4ILADDRESS Zlp PHONE
3. CONTRACTOR , . _
\,~i ttc..°~ ~-- ~-~'~~ ~v~~.._t `~~~., -.:,a MAILADDRESS,_ HOiNE LICENSE NO.
/` i ~
~~ " /1 ; < ~r~~~.~ 1 L )~'y7 ~:C.~ C~~ ~,t~.~ ~~~(~'I' ~ ~/ ~j ~ °- ° ~l, ~ ~-
! `f ,~
USE OF BUILDING
4.
5. Class of Work: ~ °`NEW ^ ADDITION ^ALTERATION ^ REPAIR ^ MOVE ^ REMOVE
-~
6. Describe Work: , -~~, ~~~ ,.
r ~ 6 ~-~ a, i
], Sq. FOOtage Of StrUCtUre (Including Basement and Garage):
$, Change of Use From: Change of Use To:
g, Valuation of Work: $
Floodway Yes^ No ^
10. Floodplaln: 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
Site Plan Attached ^ Complete Plans Attached ^
Approximate Completion Date
Inspections Required and Fees
Utilities
Sewer Tap Water Tap
Sewer
Footings
Septic Remote
Building
BY I PLANS CHECKED BY I APPROVED FOR ISSUANCE BY
~ NOTICE
Separate ermits 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 application shall not be commenced until I
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 not completed within 2 years of the date of issuance, or if work is abandoned for six (8)
months or longer, whichever is earliest.
SIGNATURE OF OWNER~CONTRACTOR OR AUTHORIZED AGENT DATE
SIGNATURE ~F OWNER (IF WNER BUILDER) D TE
Water Service
Drywall
(before finish)
Framing Final
Electrical
Rough-in C~ ~ ~~ Permanent Service
Final ~~~- ~- ~' Temporary Service
Mechanical
Rough-in ABC _
Final
Ground Work
Rough-in
Plumbing
Final
WHEN PROPERLY VALIDATED (IN THIS SPACE) THIS YOUR PERMIT
Comment: Approved By: ~ _ ~~ ~~;
POUNDS PR7G: Blalr, NE Rev. 08/95
'^( CTI'Y OF BLABt ^ WASHIN ~ ON COU~TY ^J~ OTI~ / ~ ~ ~
LOCATION OF INSPECTION: ~-+~~°-l /f-~~i' ~'VC~,.~"\~f,,.
- NAME OF OWNER: ~/' CONTRACTOR: '4'j~^-Q-~
DATE INSPEGTTON~REQUESTED: / ! ERMIT NO:
~ y"/~
-TIME INSPECTION REQUESTED: / + ~~~'
TYPEOFINSPECTIONREQUESTED: Cf ~ ^~
-~-BUILDING: ~ ~f~/[/((//~~JJ
_~ ~ ^:FOOTING ^ FRAMING ^ DRYWALL ~~F'INAL ~ -
.UTILITIES: - ~~``"- //~~~/
:^SEWER TAP ^SEWER ^SEPTIC ^WATER TAP ~~~~G7
'.^REMOTE ^WATER SERVICE
~~ELEGTRICAL:
^ROUGHIN. ^FDCTURES ^FINAL ^MOTORS
PERMANENT SERVICE ^ TEMPORARY SERVICE
:: MECHANICAL:
~.~^ROUGH-IN ^A/C ^FINAL
~.~ PLUMBING: ~ .
~, ^ GROUNDWORK ` ^ ROUGH-IN . ^.FINAL \,
' RESULTS OFTHEINSPECTION: ASSED(sEExoras) ^FAILED(sEExorFS>
- NOTES/RF,MARKS:
-~-INSPECTOR: ~? i)
=.~ DATEOFT~~tiPECTIONMADE: ~ ~ / ~~,' TIME:. /'~Zi~
CALLFU OI'VDC'. TO CONNECTSERVIGH: ^YES ^NO
R ~\NT-OFnICE STAFC TO CALL.OPPD~ ^ YES ^NO BLR;1
~~
IXI CITY OF BLAIR ^ WAS GTO~N COUnNTY ^ OTHEnR -- '
LOCATION OFINSPECTION: SUM I II,cQJ( ~~>~'ll~
NAME OFOWNER: / CONTRACTOR:.
DATE INSPECTIONREQUFSTED: '~ if ~ I C ~ pERMITNO: _ „
~TIMEINSPECiTONREQUESTED: ~.~~ IeJ~
_ TYPE OF INSPECTION REQUESTED:
•-BUILDING:
^ FOOTING ^ FRAMING ^ DRYWALL ^ FINAL
UTILITIES:
,,..^ SEWER TAP ~~ ^ SEPTIC - ^WATER TAP
- ^-REMQTE ___-^ WATERSERVICE -_ _------..-_--.--- --
-`ELECTRICAL: -- ~ ~ ~ ~ ~~
:_ ^ RO UGH IN ^ FIXTURES ^ FINAL ^ MOTORS
^PERMANENTSERVICE
MECHAMCAL:
^ROUGH-IN ^A/C
PLUMBING:
' ^ GROUNDWORK
^ TEMPORARY SERVICE
^ FINAL
^ ROUGH-IN ^ FINAL
,. RESULT50FTHEINSPECTION: ~IPASSED(sr~xorES>. ^FAILED(sEExorFS)~
!,:
`INSPECTOR: ~ {/
~"sFINSPECTIONMADE: y ~ ~ TIME;
TO-CONNECT SERVICE: -^ YES ^N0.
,ALL OPPDA___ ^}'ES ^NO BLR 1'
4-
^ CITYOFBLAEb ^ WASHINGTONrCOUNTY/ -^ OTHER
LOCATIONOFINSPECTION: ~~v "'~~""G ~~~~(~~ry~7(_S1-I~~
NAMEOFOWNER: C~CONTRACTOR: ~`.~ ~e~`L)1`~1~/~.
'I~' DATE INSPECTION REQUffiTED:~~ l~~ `~ PERMIT NO: ~ Z"~
TIMEINSPECTIONREQUESTED:
r ,~0~~'SZt2.E" ~S i s~2
i 'CYPEOFINSPECTIONREQUESTED; s~~~~ ~~- /,9~0~/'~~~~5 .'-
.. ~~/~~
_._ -BUILDING:
^ FOOTING ^ FRAMING ^-DRYWALL ^ FINAL
UTILITIES: ~ ~ ..
' QSEWERTAP.'^SEWER ^SEPTIC ^WATER TAP ._
- ^REMOTE-~~ -^WATER SERVICE ~ - - _
~~ ELECTRICAL:
~ _^ROUGHIN ^FD:TURES ^FINAL '^MOTORS -
^ PERMANENT SERVICE ~ ~ ^:TEMPORARY SERVICE - ~ -
- \1F.CHANICAli: ~ -. - -
^ RQUGH-IN ^A/C, ^ FINAL
_., .,
...~.. ",
PI UMBING:" _ _ -
^ GROUNDWORK : ^ ROUGH-IN ~ ^ PINAL ..
{, RFSUI.TSOFTHEINSEECTION~ASSED(sEexorES) ^FAILED(sEExores)
I ': - NOTES/REMARKS:'
j - -
i - ~', -
,i\SI CIOR ~~~~
r
~ L~ 1IC ()F I~SPECTIONMADF ~. i~' ~~. TIMES--~~~
' GVLLEDOPPD.- _-TOCQN^VECPSERVLCE: ~-^YES ^N0~
'`.Ai•ANTI)fFICk. ST:1 PF'IU CALL OPPDA_ ^Y,ESS ^NO BLE1
' 'i - ~ ~~iLitTlv'ICx 11V~YL+;I~"11UN~~P0RT __ - ---
it ~CTTY OF. BLAIlI ^ WASIIINGTON COUNTY ^ OTHER
F LOCATIONOFINSPEC170N: /~ )"/',I~O~_~I~~ N ~~0~1~ S~ '~ -
-- NAME OP OWNER: R. J ~ lfi{,(.~ ~1p~nn~ CO~NrRACroR:
~ - QATE IN~PECTIONREQUESTED: IZ ~9~ry~PERMITNO: -__
- ' TLNE.INSPECTION REQUESTED:
- :. ~ TYPE OF INSPECTION REQUESTED:
BUILDING:.,
I ~ - ^ FOOTING _ ^ FRAMING ^ DRYWALL ~ ^ FINAL
~ ~.;:., UTILITIES:
C - ~^SEWERTAP -^SEWER, ^SEPTIC ^WATER TAP - -
b
-^ REMOTE. ^WATER SERVICE Q c
~~`"
~
:.ELECTRICAL: ~ ~~
°
~ -~ i ROUGHIN FIXTURES ^ FINAL ^ MOTORS ~~
~
~ '^P-FRMANENT
',,. SERVICE ^;TEMpORARYSERVICE
~~
~.
_ MECHANICAL:
~;
- -
-
^ ROUGH-IN , ^ 6/C ^ PINAL '',
PLUMBING:..
^GROUNDWORK
^ ROUGH•IN ^ FINAL
:RESULTS OR TFIEINSPECTTON: ;PASSED (sEExoTES> ^ FAILED (sr,Bho~rFS)
) .
~_-.. ` NOTES/REMARKS: '
-- INSPECTOR:
DATE OF INSPECTION MADE: ~~J/ ` rnnn• ~.~~
f t.,. CALLEDOPPD\ TO~CONNECTSERVICE: ^-YFS~ ^NO.
~~VVANTUPPICESTAfFTO CALLOVPU\.` -^YES.~.^AO BLRf -~~
v
~v~~ v~vg
~
~I 1Y 4J 1'1l133.ltl LT il'Y A71 L~J 11Vltl 19.~J~7~°.Il.-0..1
~
/¢1TYOFBLAIlt ^ WASHLYGTONC
OUNTY
^ OTHER '~
i ~ OFBL~IIR ^ WASHINGTONCOUNTY ^ OTHER
7
J
~~
LOCATION OF INSPECTION: ~U / -~ ~L~~n "' - ,
~ ~ ~' ~~ ~'-n.f-f C f
LOCATION OF INSPECTION: `7C~.-I S• ~~<' '!\~` -
_
~~ ) i
O
~
~~ ~
%~L~f~'F~ C
N
~~~nCv~
~
L
r~
~
~~ ~
'
NAME
F OWNER:
.
-
O
TRACTOR: ~
-
I O~
l
QL
~
NAME OF OWNER: ~
-~pNTRACTOR:
DATE3NSPECTIONREQUESTED: 12-~-9~ PERMITNO: ` ~„ ~ DATE INSPECTION REQUESTED: ~ ~'SO~IS PERMLTNO: ~n~~
TIME INSPECTION REQUESTED: ~•~1- ~, - i TIMEINSPECITONREQUESTED;_~~,~ _[Z. /,/Tj
- ~ ~~ L~
TYPEOFINSPECTIONRE
UESTED ` ~. ~ ~ ~~-~-
Q
; TYPE.OFINSPECTIONREQUESTED: ~ r ]
~ / /
BUILDING; x211
-
L - L,q. BUILDING: '
^ FOOTING ^ FRAMING ^ DRYWALL ^ FINAL
Z 1 ~1
I ~ ^ FOOTING ^ FRAMING ^ DRYWALL ^ FINAL
'
UTILITIES:
~~~ UTILITIES:
^ SEWER TAP ^ SEWER. : ^ SEPTIC ^ WATER TAP
{ I. ^~SEWER TAP ^ SEWER ^ SEPTIC ^ WATER TAP -
^ REMOTE . ^ WATER SERVICE ~ ~
. ~ - ~ ^.REMOTE ^ WATER SERVICE
.
ELECTRICAL: ~- ~,,': ELECTRICAL:
~ROUGHIN ^~FIXTURES: ^FINAL ^MOTORS - ~ ~ROUGHIN ^FIXTURES ^FINAL. ^MOTORS -
^ PERMANENTSERVIGE ^.TEMPORARYSERVICE - I.~ .. ^PERMANENTSERVICE- ^TEMPORARYSERVICE
MEC
HANICAL: >'. - MECHAMCAL:
ff
Q~kOUGH-IN ^A/C ^FINAL ~ JJ'; \~ROUGH-IN ^A/C ^FINAL.
r
'1~ :
PLUMBING: ~ PLUMBING:
GROUNDWORK ROUGH-IN ^ FINAL .. GROUNDWORK ^.ROUGH-RJ ^ FINAL _
RESULTS OF THE INSPECTION: PAS$ED(sECxor&s): ~-^~FATLED(s~xorns ~• ~
}~ ,`~ ~ ~~~///'''
RESULTSOFTHEINSPECTION: ~`~~~PASSED(sesxolrs) ~^FAILED(sEaxoTFS}
j ~/
/
~N
O
T
~ ~ ~ r~ f ~ /7~~I/CGL'/ Zi.'~~ Y~t-.G~'
ES/REMARKS: ~~ NOTES/REMARKS:
/
~
^
/
u~dG1~~~E~/!~7-zc ~ct4,~ caJ°~ a.~~~~~'iJ~ ~Qf"23~'e/'%i
INSPECTOR
~~~'' ""I
`
LW~
"~~
`
~
-~•~ I( ~~
/
:
?
" INSPECTOR:
~
•,
/
~/
DATE OFINSPECTIONMADE: (~ ~ fl .C.J 7TME: _J J ' / ~ F L
DATE OFINSPECTION
MADE
~~
,..
.
:
TIME:
CALLEDOPPD\ TO CONNECTSERVICE: ^YPS ^NQ. ,I CALLEDOPPD\ --,..T000NNECTSERVICE: ^XES ^N0
WANT 6P~iC'P. ST,hFF TO ('.4LL ~PPDA ~ 1"Lti [.~NO BLR i
- ~ }V 4P, I ~FPiC$STAFF TO C 1LL (lI I D' _ ^ YFS [~NO -.-BLR:
'
-
.lj l.7"1~LYJ'1S'~~0f 11•I:Jl 1+V 11VLr .1.4L'1 11141 __---:. _ i •• .: _.: :_
.••.-. '-~2`~.a~" °"-.ten tom.-.-. _. ~-i-__.~•_-.-.k, k-_. ._ ..:
~''.CTTYOFBLABd ^ WASHING
TONCOUNTY
^ OT
HER - E
R
~ .
~ ` CTl'YOFBLAB2 ^ WASHINGTO COUNTY ^OTH
~/
/
/-
~
~
G7 S
~
~II Sr ~
//~~
~
~
~
LOCATIONOFINSPEC
C
ION:
I
•
V
- CATIONOFINSPECiTON:
~~ ~` '
yR
/
~
`
'
/nj I~`,-,II
IJ~CLLI'Scl)OdI NfO~S
CCjr0(Y~
IJe~IC
NAMEOF
OW
I
~ - ACTOR
_
.
NER: c
.
. CONTRACTOR:
. :
NAMEOF:OWNER: - CONTR
DATE INSPECTIONREQUESTED: /Z-(~'~S PERMLTNO: ' PER
M
ITNO:
~
DATE INSPECTIONREQUFSTED: 3~s
TIME INSPECTION REQUESTED: ~• m • /J~~
/~
~
J
)
TIMEINSPECTiONREQUESTED:-----.;~>~~==v o` ~(JO /,/Yl ',
TYPEOFINSPECTIONREQUESTED: ~~ ~P¢~
BUILDING: ~d,~~~~
^°FOOTING' ^FRAMING ^DRYWALL ^FINAL -~~ b""~'
UTILITIES:
^ S.EWPR TAP ^ SEWER ^ SEPTIC ^ WATER TAP
^ REMOTE ,. ^ WATER SERVICE
ELECTRICAL: -
I~ROUGH IN , ^ FIXTURES ^ FINAL ^ MOTORS
~^ PERMANINT SERVICE ^ TEMPORARY SERVICE
MECHANICAL:
^ ROUGH-IN~ ~4J A(C ^ FINAL
^GROUNDWORK ROUGH-W ^.FINAL
J
"RESULTSOF.THEINSPEC
TION: PASSED(sEExolFS) ^FAIIED(sESxoTES)
~
NOTES/REMARKS: ~+~ ~ ,,// //
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CALLEDOPPD\ TO CONNECT SERVICE: ^YPS ^NO
~\'AIVTQFFiCESTAFFTOCALLOPPQ\ __ ;;^,YFS ,.:^.NO - 8LR1
- TYPEOFINSPECTIONREQUESTED: '
BUILDING: ~
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^POOTING ~.^FRAMING ^DRYWALL ~ F1I~AL d
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UTILITIES: . ~ J
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^SEWERTAP ^:SEWER ^SEPTIC ^WATERTAP' ~,) +~ 1
CT
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^ REMOTE ^ WATER SERVICE , ,v
ELECTRICAL:
dl~
~ ^ ROUGH'IN ^ FIXTURES ^ FINAL ^ MOTORS ~ ";
^ PERMANENT SERVICE ^ TEMPORARY SERVICE
i MECHANICAL:.
^ ROUGH-IN ° ^ A/C ^ FINAL
PLUMBING:
' ^-GROUNDWORK ^ROUGH-IN ^FINAL
RESULTS OF THE INSPECTION: ~ASSED(sflexoTrs) ^ FAILED(s~xoTas) -
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NOTES/12EMARKS: .
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:
I;CTIONMA
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DATE OFIN
', CALLED OPPD\ TO COiVNECTSERVICE : ^ YES ^ NO
:W~INTORF~.CESTAPPTO,CALLOPP,D\, _y_,---J _ ^ Yf:S ^NO BLA 1
City of Blair
218 South 16th
Blair, Nebraska 68008
402-426-4191
Fax - 402-426-4195
0
~~.
September 1, 1995
Robert G. Johnson
RJ Development, Inc.
407 South 16th St.
Blair, NE 68008
Dear Mr. Johnson,
I have reviewed your correspondence dated August 24, 1995
regarding the electrical service for the Phase II design and have
no objections to what you are proposing.
Also, as a reminder, you will need to apply for a new building
permit for Phase II as soon as your design drawings are complete..
Feel free to contact me if I can be of any further assistance.
I look forward to working with you on this project.
Sincerely,
' f "/
~~~
Michael Godfrey '-"`'
City Building Inspector
~ promise '~
August 24, 1995
Dear Mr. Godfrey,
I appreciated the opportunity to meet you and show you our Blair Central
School Aparhnent project. I believe the Blair/Washington County community will
benefit greatly from your experience and insight. This area will experience
tremendous growth in the next few years.
Our Phase II design drawings are being revised to accommodate some
changes to the apartment layouts. We are proposing to install the electrical service
from the mechanical room through the access tunnels per the following design:
1) Two apartment services in one 1-1/2" conduit using #2THHN cable rated
at 11S amps on 7S degree Celsius scale.
2) berating of cable brings it down to 92 amps which we will be installing on
a 100 amp breaker at meter center.
3) Ground wire installed in each conduit sized fora 200 amp service.
4) At the end of each run, a J-box will be installed with a #4~3 conductor
with ground and run to the 100 amp electrical panel in each apartment
unit.
~ ~ ~~~
~ ~ ~- -~~-
~~ .
Trusting this meets your approval.
~ ,
~,~.
,, ,
~- ~~~~
Very True Yo rs, ~ t
Robert G. Johnson
RJ Development, InC.
407 South 16th Street
Blair, NE 68008
42b-3890
,/ ~,
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~C4Lu ~[~ O[~ 4G3LaC~]~G~044Lad
WE ARE SENDING YOU ^ Attached ^ Under separate cover via
^ Shop drawings ^ Prints ^ Plans
(Copy of letter ^ Change order ^
THESE ARE TRANSMITTED as checked below:
^ For approval
1 For your use
/^/ As requested
^ For review and comment
^ FOR BIDS DUE
REMARKS -_ . a
^ Approved as submitted
^ Approved as noted
^ Returned for corrections
19
^ Resubmit copies for approval
^ Submit copies for distribution
^ Return corrected prints
^ PRINTS RETURNED AFTER LOAN TO US
COPY TO
~' RECYCLED PAPER: SIGNED:
g~Contents:40% Pre-Consumer•10% Post-Consumer
if enclosures are not as noted, kindly notify us at once.
the following items:
^ Samples ^ Specifications
JllL "~ ~I'TY £L.~CTf2IC
~tal~ 3, k995
~p ~0 ~~V~Z~pd~abi~a 4P 1du
IdI°es $17.1 ~p~~'~.~~rit~ 5,~1 ~l.d 1~1.g1~ .$~$i[-e~Y
~~r1t~.~~~Yba
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~t~ p~~pos~ t~ iras~al3 ~pea~xi~aY ~eae~~.c~ tee the ~ema~nrrg.
~ra~ 2 ~/2" c~+r~~ta~~, us~e~g ~2~H~~T ~ab1e. ~h~ 2~F~HN as ~~~~d
a~ lid amps Sri ~S c~~gre~ G~1si~u~ ~~~1~.
98~idai,Yt ~~l~.a ~s ~YE~ ~a1~~lC~l~~7LA[! 1rC~u Yae~C~, &7~ e~,Y'2,
1T~~y ~~u1y youx°~
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Fix: (4~2~~~~~~~~
CONTINENTAL FIRE SP.9INKLER CO.
P.O. BOX 37769
4518 SOUTH t33 STREET COP!'TRACTOR'S AAIaTERIAL ~ TEST' CERTIFICATE FOR RO~/E GROUfdD PIPIPIG
OMAHA, NEBRASKA 68137
PROCEDURE
Upon completion of work, inspection and tests shall be made by the contractors representative end witnessed by an owners representative. All defects shall be corrected and
system left in service before contractor's personnel finally leave the job. ,
A certificate shall be filled out and signed by both representatives. Copies shall be prepared for approving authorities, owners, and contractor. It is understood the owner's
representative'ssignature in no way prejudices any claim against contractor for faulty material, poor workmanship, or failure to .comply with approving authority's
requirements or local ordinances:
YF1UYtH I Y NAMt _- I DATE
PROPERTY ADDRESS
ACCEPTED BY APPROVING AUTHORITIES (NAMES)
ADDRESS
PLANS. INSTALLATION CONFORMS TO ACCEPTED PLANS
EOUIPMENT USED IS APPROVED
' IF NO, EXPLAIPJ DEVIATIONS
HAS PERSON IN CHARGE OF FIRE EQUIPMENT BEEN INSTRUCTED AS TO LOCATION
OF CONTROL VALVES AND CARE AND MAINTENANCE OF THIS NEW EQUIPMENT?
IF NO, EXPLAIN ,'~
INSTRUCTIONS ~'~
SIGNATURE ._ - _ _ _ C',?rE
HAVE COPIES OF THE FOLLOWING 6EEN LEFT ON THE PREMISES
1. SYSTEM COMPONENTS INSTRUCTIONS
2 CARE AND MAINTENANCE INSTRUCTIONS
3. NFPA 13A
µ _ LOCATION.
OF SYSTEM SUPPLIES BUILDINGS
IF NO, EXPLAIN
MAKE
MODEL YEAR OF
MANUFACTURE ORIFICE
SIZE
QUANTITY TEMPERATURE
RATING
SPRINKLERS
.:..PIPE AND Type of Pipe
FITTINGS,
Type of Fittings
ALARM
ALARM DEVICE MAXIMUM TIME TO OPERATE ''
THROUGH TEST CONNECTION
VALVE TYPE MAKE n40DEL MIN. SEC.
OR FLOW
INDICATOR
DRY VAWE Q.O.D.
MAKE MODEL SERIAL NO. MAKE MODEL SERIAL NO.
DRY.``
p(PE
OPERATING TIME TO TRIP
THRU TEST
CONNECTION'
WATER
PRESSURE
AIR
PRESSURE
TRIP POINT
AIR PRESSURE TIME WATER
REACHED
TEST OUTLET' ALARM
OPERATED
PROPERLY
LEST MIN. SEC. PSI PSI PSI MIN. SEC. YES NO
- Without
O.O.D.
~ ~~. With
Q.O.D.
'MEASURED FROM TIME INSPECTOR'S TEST CONECTION IS OPENED
BSA (8-89) PRINTED IN U S.A. FORM d 5 Revised 1 '90
U VES U NO
^ YES ^ NO
^ YES ^ NO
^ YES ^ NO
YES ^ NO
^ YES ^ NO
^ YES. ^ NO
OPERATION - ----- _- - ---
sh _ _ __ ^ PNEUMATIC ^ ELECTRIC ^ HYDRAULIC
~° >PIPING SUPERVISED ^ YES ^ NO DETECTING MEDIA SUPERVISED ^ YES ^ NO
DOES VALVE OPERATE FROM THE MANUAI TRIP AND/C7R RFM(1TF C(lNTf7(li STATI(1NR 11 vee 1-I yin
DELUGE & IS THERE AN ACCESSIBLE FACILITY IN EACH CIRCUIT FOR TESTING IF NO EXPLAIN
PREACTION
VALVES ^ YES ^ NO
DOES EACH CIRCUIT OPERATE DOES EACH CIRCUIT MAXIMUM TIME TO
MAKE MODEL SUPERVISION LOSS ALARM OPERATE VALVE RELEASE OPERATE RELEASE
YES NO YES NO MIN. .SEC.
HYDROSTATIC: Hydrostatic tests shall be made at not less than 200 psi (13.6 bars) for two hours or 50 psi (3.4 bars) above static pressure in excess
of 150 psi (10.2 bars) for two hours. Differential dry-pipe valve clappers shall be IeH open during test to prevent damage. All above ground piping
TEST leakage shall be stopped.
DESCRIPTION pNEUMATIC: Establish 40 psi (7_.7 bars) air pressure and measure drop which shall not exceed 1-1/2 psi (0.1 bars) in 24 hours. Test pressuretahks
at normal water level and air pressure and measure air pressure drop which shall not exceed 1-1/2 psi (0.1 bars) in 24 hours.
ALL PIPING HYDROSTATICALLY TESTED AT =___ PSI for - HRS. IF NO. STATE REASON
DRY PIPING PNEUMATICALLY TESTED ^ YES ^ NO
EQUIPMENT OPERATES PROPERLY ^ YES ^ NO
DO YOU CERTIFY AS THE SPRINKLER CONTRACTOR THAT ADDITIVES AND CORROSIVE CHEMICALS, SODIUM SILICATE OR
DERIVATIVES OF SODIUM SILICATE, BRINE, OR OTHER CORROSIVE CHEMICALS WERE NOT USED FOR TESTING SYSTEMS OR
STOPPING LEAKS ^ YES ^ NO
TESTS DRAT READING OF GAC3E LOCATED NEAR WATER RESIDUAL PRESSURE WITH VALVE IN TEST
TEST SUPPLY TEST CONNECTION' PSI CONNECTION OPEN SIDE PSI
UNDERGROUND MAINS AND LEAD IN CONNECTIONS TO SYSTEM RISERS FLUSHED BEFORE CONNECTION MADE TO SPRINKLER
PIPING.
VERIFIED BY COPY CF THE U FORM Nq. 858 ^ YES ^ NO OTHER ~I; EXPLAIN
FLUSHED 8Y INSTALLER OF UNDER-
GROUND SPINKLER PIPING ^ `(ES ^ NO
NUMBER USED LOCATIONS NUMBER REMOVED
BLANK TESTING 1,,,
GASKETS
`'
WELDED PIPING AYES ^ NO
IF YES
DO YOU CERTIFY AS THE SPRINKER CONTRACTOR THAT WELDING PROCEDURE COMPLY
WITH THE REQUIREMENTS OF AT LEAST AWS D10.9, LEVEL AR-3 ^ YES ^ NO
DO YOU CERTIFY THAT THE WELDING WAS PERFORMED BY WELDERS QUALIFIED IN
COMPLIANCE WITH THE REQUIREMENTS OF AT LEAST AWS D10.2, LEVEL AR-3 C] YES ^ NO
WELDING DO YOU CERTIFY THAT WELDING WAS CARRIED OUT IN COMPLIANCE WITH A DOCUMENTED ~
QUALITY CONTROL PROCEDURE TO INSURE THAT ALL DISCS ARE RETRIEVED
THAT
,
OPENINGS IN PIPING ARE SMOOTH, THAT SLAG AND OTHER WELDING RESIDUE ARE
REMOVED, AND THAT THE INTERNAL DIAMETERS OF PIPING ARE NOT PENETRATED YES ^ NO
CUTOUTS DO YOU CERTIFY THAT YOU HAVE A CONTROL FEATURE TO ENSURE THAT ALL
(DISCS) CUTOUTS (DISCS) ARE RETRIEVED? ^ YES ^ NO
HYDRAULIC NAME PLATE PROVIDED IF NO, EXPLAIN
DATA
NA6AEPLATE ^ YES ^ NO
OA1 E LEFT IN SERVICE WITH ALL CONTROL VALVES OPEN:
REASARKS ~~
PROPERTY NAME: °„ ~~__- ,
NAME OF SPRINKLER CONTRACTOR
CONTINENTAL FIRE SPRINICER CO.
TEST WITNESSED BY
SIGNATURES FOR PROPERTY OWNER (SIGNED) TITLE DATE
..:.FOR SPRINKLER CONTRACTOR (SIGNED) TITLE DATE
ADDITIONAL EXPLANATION AND NOTES:
DATE
NOTE THIS SYSTEM HIGH PRESSURE TEST OF WATER@200PSIOR AIR@40 PSI WITNESSED ANDVERTIFIEDBYTHEABOVE,SUBSTANTIATES
THAT THIS PIPING SYSTEM DOES NOT HAVE ANY DEFECTIVE FITTINGS, PIPE OR COUPLING AFTER COMPLETION OF THIS TEST. IF THIS
SYSTEM IS A WET SYSTEM, ADEQUATE HEAT TO PREVENT FREEZING OF WATER IN THE SPRINKLER PIPING IS THE COMPLETE
RESPONSIBILITY OF OTHERS.
LOW AIR ALARM SWITCH INSTALLED YES ^ NO ^
TAMPER SWITCHES INSTALLED YES ^ NO ^
1@89 Edltlon IF NO STATE REASON: