BP6839i
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Application Date: ~` ~ - ~~~
Jurisdiction of City of Blair, Nebraska
218 South 16th Street _
Blair, Nebraska 68008 5
(402) 426-4191 Permit
Issue Date: ~ ~ ~ ~~ ~~-=~ Permit Fee: $ ~~P~~~'~
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JOB ADDRESS
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LEGAL
1 ' ~~~'~- ~ V
L07 NO, r BLK. / TRACT ®SEE ATTACHED SHEET
DESCR. ~
2. OHI g ~ MAILADDRESS ~ ~~ ~, ,ZIP
r CP ' ~/ ~ ~i~ NE
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3. CONTRAC 0 ~M/AILADDRESS
,9/t-~ / ~~~, PHONE
Lam' LICENSE NO.
.Z ~ ~~~
USE OF BUILDING
4.
5. Class of Work: ^ NE ~ ADDITION ^ALTERATION ^ REPAIR ^ MOVE ^ REMOVE
6. Describe Work:
~ ~ ~ ~ ~ ~,
c
7, Sq. Footage of Structure (Including Basement ana Garage):
$, Change of Use From: Change of Use To:
g, Valuation of Work: $ ~~`~ ~ ~ ~ ~~
10. Floodplain: Floodway Yes^ No ^ Dev.Permit
^
Elev. Cert.
Fringe Yes
No ^ BFE
11. Current Zoning: Site Plan Attached ~ Complete Plans Attached ^
12. State Fire Marshall Required: Yes ^ No^ Approximate Completion Date
Inspectio ns Required and Fees
Special Use Permit Required: Yes ^ No ^
13 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
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APPLICATION ACCEPTED BY PLANS CHECKED BY APPROVED ISSUANCE BY Footings I
"
~) Drywall
(before finish)
NOTICE Framing Final ) 6'~~`~~
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 notconstitute issuance of this building permit. I further EleCtriCal ~-
~'w ,~ n , a ~ , ~ r €~~~~ ~~
t°
agree that construction covered by this permit application shall not be commenced until 1
have receivedacopyofthisapplicationformsignedbytheBuildinglnspectorandstamped Rough-in Permanent Service
'APPROVED'.
I hereby agree to perform the proposed work in accordance with the specifications set forth Final Temporary Service
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 1 SO days,
is not complet d within 2 years of at issuance, or if work is abandoned for six (6) Mechanical
onths er, w h r is s -- ~. ~
11~~ ~i ~
Rough-in
ABC
SIGNATURE 0 OWNER)CONTR~ CTOR OR AUTHORIZED AGENT 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 By: ~,/
POUNDS PRTG: Blalr, NE
Rev. Oel85
Jurisdiction of City of Blair, Nebraska
218 South 16th Street
Blair, Nebraska 68008
(402) 426-4191 Permit
A lication Date:
-~ <-w~-.
Permit Fee: $ ~ ~~ ~
~ ,- -,
4• Class of Work: O NEW RESIDENTIAL ®NEW COMMERCIAL REMODELING/ADDITIONS ®UPGRADE SERVICE
~ ''
5. Describe Work: ,~ ,~~k ,C` _~~-~ t .~ ~ c%_~~ ~ ~(,Rl ~, {~:f ~ 1',' _ ~z ~ v e ~ .r ~~ ~Yl
~6• Current License on File O Yes ®No NA ~~ ~
New Service Fee = (Amp Fee + $2.00 per branch circuit)
1-100 Amp Fee ............................ $ 13.00
101-200 Amp Fee ............................ $ 18.00
201-300 Amp Fee ............................ $ 30.00
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 ............................ $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 QF CONTRACTOR OR AUTHORIZED AGENT
DATE
L CTICAL PERMIT F
Upgrade Existing Service ...... $10.00
Temporary Service ................ $10.00
Fire Alarm System ................. $10.00
Signs ..................................... $15.00
Miscellaneous Apparatus ......$11.00
Commercial/Multi-Family and All Upgrades:
# of Circuits x $2.00
Amp Fee
Amp Fee + Circuit Total
New Residential: (Finished Area)
Single/Two Family Dwellings
sq. ft. x .045
Receptacle/Switch Outlets ~F
Fixtures I 1 x $.75 ~ ~ ~3
Residential/Commercial Appliance
# Fixed Outlets x $3.00
Power Apparatus (220 Volts)
# Apparatus x $3.00
Permit Issuance Fee ............. $15.00
°TTAL
~~~~~~~~
~ . ~, `.~~
WHEN PR®PERLY VALIDATED (IN THIS SPACE) THIS IS YOUR PERMIT
Comment: Approved Sy: „> ./
POUNDS PRTG: Blair, NE ~ Rev. 12/95
r ~.+~ i a-n ai r o/a ° .• a./ 9- 8iY19 1~.i8JS 77$3r 9-
-:--- •
'~JfITXOFBLkIR" ~O WASHINGTON COUNTY ^ OTHER
0
LOCATION OF INSPECTION: ~~3 /~~
NAME OF OWNER: .~S .L`~=y=.~G~ CONTRACTOR: -~~f~•
DATE INSPECTIONREQUESTED: ~~~~~ PERMIT NO:
TIME INSPECTION REQUESTED: ~/f,Y!/lY/~
TYPE OF INSPECTION REQUESTED;
BUILDING: -
^ FOOTING ^FRAMING ^ DRYWALL ^ FINAL
UTILITIES:
^ SEWER TAP ^ SEWER ^ SEPTIC ^ WATER TAP
^ REMOTE ^:WATER SERVICE
ELECTRICAL:
~ROUGHIN ^FIXTURES ^FINAL ^MOTORS
PERMANINT SERVICE ^ TEMPORARY SERVICE
MECHAMCAL:
^ ROUGH-IN ^ A/C ^ FINAL
PLUMBING: _ -
~^GROUNDWORK ^ROUGH-IN ^FINAL
RESULT$OFTHEINSPECTION: ~ASSED(sEExorES~ ^FAII.ED(saexoTFS>
NOTES/REMARKS: - -
f
I ~/ CITY OFBLABY WASHINGTON COUNTY r
~. LOCATION OF INSPECTION: 3Z3 N I p~'~~ ~rp/
'~ NAMEOF OWNER: ~~m USSR-/~ CC~'1'RACTOR: ~~ "'=3'Y~ s CIO)~~
. DATE INSPECTION REQUESTED: Jc `zL~_c~ PERMIT NO:
I t~S'3~1
TIME INSPECTIONREQUESTED:
TYPE OF INSPECTION REQUESTED; ~q~ ,1
BUILDING: ~ - ~• ~ \~
~. ^ FOOTING FRAMING ^ DRYWALL FINAL
UTILITIES:
^ SEWER TAP ^ SEWER ^ SEPTIC ^ WATER TAP
i~ f
^ REMOTE ^ WATER SERVICE
- ELECTRICAL:
_ ~ ~i, ^ROUGHIN .^.FIXTURES ^FINAL ^MOTORS
~ ^ PERMANINT SERVICE ^ TEMPORARY SERVICE '
~` ~ MECHANICAL:
I ^ ROUGH-IN. ^ A/C ^ FINAL
PLUMBING:
i ^ GROUNDWORK ^ ROUGH-IN ^ FINAL
-,::
{ `RESULTSOFTHEINSPECTION: PAS
S
E
D
(s~xoTes>
LED(sEEnoTesl
9FAI
~ NOT ARKS: //
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lC.J~ iL'h4y~( l ` ~ .
INSPEC - ~ _ ~ -~
.. ~ ~ INSPECT
o
DATE OF INSPECTIONMADE: ~ ~ ~ TIMg; ~ ~~~.~ - ~ ~~ ' DATE.OFINSPECTIONMAD TIME: ~.
I
i
~~~~ i
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CALLED OPPD! TO CQNNECTSERVICE: ^ .YES ^RU :CALLED.OPPD\ PTO WNNECTSERYICEr ^ YES (^N0
W.1B"P OPF[CE STAT'FTO C4LL, UPI'DA [.~YCS [, NU _BCR1 ~A'4NTOFITCF.ST~IFF~TO, GAILNPPDA ^tCS~ ^N0 ~. BLRI -
- ~CITYOFBLraIR-^'"^ WASHINGTON COUNTY ^ OTHER ~ }I
:. ~ # CTTY OP BLAIlt ^ WASHINGTON COUNTY ^ OTHER ..~~
LOCATION OF INSPECTION: ~~ !~ ~ ._ _ ~ ~~ J
- - CATION OF INSPECTION: 3z-3 ~~~ " , ~ ~°~ ':)
NAME OF OWNER: ONTRACTOR: ~~ ~- ~ n J ~ ~ '1
'd'C (E 5 m U ~~LJ\ CONTRACTOR: ~--~~"`- ~~
,~7 - -~ - - - NAME-OF OWNER: 1
DATE INSPECTION REQ. FSTED: I 18.-7f pEILMIT-NO: '~ ~ ~ I - DATE INSPECTION REQUESTED: J •"~'~ PERMTPNO: •I
TLMEINSPECTIONREQUESTEDt~ •~I~-_~U`2'L~~ (,S U~-~~C~Y~C~. I - \ _ I
TIM$INSPECTIONREQUESTED: ~~) ~dV
TYPE OF INSPECTION REQUESTED:
BUILDING: /~ ~ Y
/ }/I,{J~~~~~£LLL
I/
f
'.
~
-^ FOOTING. ^ FRAMING ^ DRYWALL FINAL `•~.
~]
UTILITIES:' - - .. ,
^.SEWER TAP ^ SEWER ^ SEPTIC ^ WATER TAP ~ ~ -~ ~ ~~
^REMOTE -^WATERSERVICE-'~---- -- - ---- ---
ELECTRICAL:
^ROUGHIN~: ^FIXTURES-.^PINAL . ^MOTORS
^;PERMANENTSERVICE ^,TEMPORARYSERVICE
MECHANICAL:. _
^ROUGHIN ~ .^A/C ^FINAL '~ .,-
PLUMBING: -. -
. - - ~ -
.. -
^GROUNDWQRK ^ROUGH-IN ^FINAL - -'
>
RESULTSpRTHEINSPECT'ION:. V}'PASSED(se ExorFSl ~^PAILEDisEExo~rFS
NOTES/REMARKS:.. .. .
DATEOFINSPECTIONMADE:/~ ~~ ~TiME: -~G~~ -
CALLED.OPPD\ ~ ~ _. TO CONNECTSERVTCE:- .^YES ^NO
,;
- _.
WANT OFFICE STAFF TO CALL OPPD\ ~ - ^ AYES ^ NO BLR 1. ~
TYPE OF INSPECTION REQUESTED: -
,,B~~~UIjjjliDlNG: - - `
]FOOTING-, ^.FRAMING; ^-DRYWALL ^FINAL
UTILITIES:
^SEWIIITAP ^SEWER ~- ^SEPTIC ^WATERTAP -
'^REMOTS~ ~^WATERSERVICE ~ --__ __.___-- --__.
ELECTRICAL: -
^ROUGHIN ^FDfTURES ^FINAL ^MOTORS
^ PERMANINT SERVICE. ~ ~ ^ TEMPORARY SERVICE -
MECHANICAL: -
ROUGH-EQ ^ A/C ^ FINAL
PLUMBING: - .-
I ^ GROUNDWORK ^ ROUGH-IN ^ FINAL
RESULTS OE THE INSPECTIONrSSED(sEExoTFS> ^FAH.ED(sEExorFS> -
~. . NOTESJREMARKS:
INSPECTOR: ~
' DATEOFINSPECTIONMADE: (1C.'' TIME: ~~~ J- ~.
CALLED OPPD\ TO CONNECP.SERVICE: ^YES ^NO-
-AV4NT^"Fr~F ~30ALLOPPDV ~]ti'ES ~J NO BLR•1
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