BP6807JOB ADDRESS
11
LEGAL LOTNO. °L'' In~~ ^ SEEATTACHEDSHEET
1 ' DESCR. ~~"
pyy r~ MAILADDRESS ZIP PHONE
2 ~ ~~ r , _ a ~-~
3 CO TOR ~ ~ ~ "MAILADDRESS ~ ~ ~ PHONE LICENSE NO.
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4. USE 0 BUILDI G .
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5. Class of Work: ^ NEW ^ ADDITION ^ALTERATION ^ REPAIR OVE ^ REMOVE
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6. Describe Work: ~° ~ ` "
7. Sq. FOOtage Of StrUCtUre (Including Basement and Garage): ~
~. ,
$, Change of Use From: Change of Use To:
g, Valuation of Work: $ ~'y'~~y !,~ ~.P N~.~ ,_,
lain: Flooaway Yes^ No ^
10
Flood Dev.Permit
.
p
Fringe Yes^ No ^ gFE
11. Current Zoning:
12. State Fire Marshall Required: Yes ^ Nd
13. Special Use Permit Required: Yes ^ Na
14. Variance Required: Yes® N
15. Minimum Setbacks: Front ~ Side '~ Rear 1~~
16 Id wa~C Required: Yes No ^ Waiver Approved
Elev. Cen,
Site Plan Attached ^ Complete Plans Attached ^
Approximate Completion Date
Inspections Required and Fees
Utilities
ewer Tap • '. .~ ~ Water Tap
_ t , . ,„~
Sewer ~ F j Water Service . ~~ ~ ~='
Septic Remote
Budding
AP~PLICATiON"ACCEPTED BY ~ PLANS CHECKED BY ~PR ®D~~ IS~UAN~~I
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'.
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 (ti)
months or longer, whichever is earliest.
R OF OWNER/CONTFTOR R AUTHORIZED AGENT DATE
SIGNATURE OF OWNER (IF OWNER BUILDER) DATE
WHEN PROPERLY VALIDATED (IN TH
Drywall
(before finish)
~~,. I
Final ~~
Electrical
rin ~~ ~~° _ ~' ~' k ~~~' ~~"~r~ermanent Service ~'~~ ~
~°" ~ Temporary Service
Mechanical
ough-in r` ' E ~ ABC ~`~~° ~ %~
Final ~°` ~f;~~%!~,`~.',~.~
Ground Work ~~-~ .~~.~~~ .~~r ,. Pl„r bing
Rough-in ~~ ~_ °~~' `°"' Final ~'°`-
SPACE) THIS IS YOUR PERMIT
Comment: Approved By: ,°~) ~`
/~~ ~~/ fe°~,
OUNOS PRTG: BIaIr,NE / Rev. 08/9
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f RED'®RT B'UILI)ING INSPECTION REPORT EtJILI9ING INSPECTION REPORT
~
n ~ ^CTTYOFBLAIlj ^ WASHINGTONCOUNTY ^OTHER ~ ^ WASHINGTON COUNTY ^ OTHER
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ACATIONOFINSPECfION:
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c CATION OF INSPECTIO
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~ ~C\Y~IIL
)R _- CONTRACTOR
-' NAME OF
WNER -- .
CONTRACTOR:
1\AMEOFOWNER:
Q0: p
- DATE INSPECTIONREQUESTED: ~ ~~~/~ PERMTT.NO: ~~, f "' DATEINSPECTIONREQUESTED: ?~~~1~~ PERMIT NO:
/~ ';
TIME INSPECTION REQUESTED: tt~/./77-/7'11
TIMEINSPECTIONREQUESTED: 3..~C~~L~~O~
- -; TYPE OF INSPECTION REQUESTED: ~
~ TYPE OF INSPECTION REQUESTED:
_ - t. .BUILDING: BUILDING:
- ^ FOOTING ^ FRAMING ^ DRYWALL ^ FINAL
,.
~c ^ FOOTING ^ FRAMING ^ DRYWALL ^ FINAL
_
_
' UTILITIES:
~ ~ UTILITIES:
(sp ( ^6EWER TAP ^ SEWER ^ SEPTIC ^ WATER TAP ~ ~~ ^ SEWER TAP ^ SEWER ^ SEPTIC ^ WATER TAP
REMOTE ^ WATER SERVICE ^ REMOTE ~ ^ WATER SERVICE '
ELECTRICAL:
l ~,^/ROUGH IN ^ FLYTURES ^ FINAL ^ MOTORS
- .: L•1~ PERMANENT SERVICE ^ TEMPORARY SERVICE
4
r .MECHANICAL:
- ~ ~. ^ ROUGH-IN ^ A/C ^ PINAL
PLUMBING:
^ GROUNDWORK ^ ROUGH-IN ^ FINAL
i
r
7LED trer ~,~~iFS> / /~ t RESULTS OF THE INSPECTION: ~ASSED (s~xorES> ^FAII.ED. (s~xolFS~ -
~~ti~ Lt~`^-~- _ NQTES/REMARKS: ,
~- k
~ INSPECTOR: Gt'U~"~~'
I~
DATE OFINSPECTIONMADE• ~ ` ~~ '~~=° TTME: ~~~
~ ' ~
/02~~ i/IDpj~t~
^ YNS ^ NO - CALLED OPPR\ TO CONNECT SERVICE: - ~~ ES - ^ NO
^YES ^NO ELR1 - AVA.V'C OPFICF?STAPF TQ CALL OPQD\ - ^YES. ^NO BLR1
ELECTRICAL:
^ ROUGH IN ^ FIXTURES ^ FINAL ^ MOTORS
^PERMANENTSERyICE ^TEMPORARYSERVICE
t MECHANICAL:
f_ _ ^ ROUGH-IN . ^ A/C ^ FINAL
-,~~ ~ P~L.,UMBING:
~F;,_-~ L~;JGROUNDWORK ^ROUGH-IN ^FINAL
F '\
E... RESULTS OF THE INSPECTION: '.~ PASSED(s~xorasl ^FAILED(sEExorFSl
~_ ` ~ INSPECTOR: I
f DATE OF INSPECTION MADE: ~'~ ~ ~" / J TLVtE: ~.-r=20
I~ CALLEDOPPD\ TO CONNECTSERVICL: ^YES ^NO
1VAL~°"'FT~"' ~""~P""~"'CALLf)PPL`._ ~ ^YH§ ^<v0 BtR1
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