BP6938JOB ADDRESS
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LEGAL
1 LOT NO. ®LK• TRACT
®SEE ATTACHEDSHEET
• DESCR.
OWNE °
2 MAILADDRESS ZIP PHONE
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3. CONTRACTORi ~f ~
FF' MAILADDRESS PHONE LICENSE NO.
USE OF BUILDING
4.
5. Class of Work: ®NEW ^ ADDITION ^ALTERATION REPAIR ^ MOVE ^ REMOVE
6. Describe Work: _~~, ~ - 1 _~~ ~ <-
~~_
7. Sq. FOOtage Of StrUCtUre (Including Basement and Garage):
$, Change of Use From: Change of Use To:
~~
g, Valuation of Work: $
Floodway Yes No ^ Dev. Permit
10. Floodplain: Fringe Yes^ No ^ 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 _
APP ICATION ACCEPTED BY PLANS CHECKED BY APPROVED FOR ISSUANCE BY
NOTICE
Separate permits are required for electrical, plumbing, heating, ventilating and air condi•
tinning, 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 completed within 2 years of the date of issuance, or if work is abandoned for six ((i)
months or longer, whichever is earliest.
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 i ~~ ~ ~ dam`'
Electrical
Rough-in Permanent Service
Final Temporary Service
Mechanical
Rough-in ABC
Plumbing
SIGNATURE OF OWNER~CONTRACTORO ~I~THORIZEDAGENT ,~ DATE Final
~ '~ ~ ~ Ground Work
SIGNA RE OF OWNER (IF OWNER BUILDER) DATE Rough-in Final
WHEN PROPERLY VALIDATED (IN THIS SPACE) THIS IS YOUR PERMIT
Comment: Approved By:~~_ ®~
POUNDS PRTO,•Blalr, NE Rev. 08!85
~,~ ~:~ I ~„i ~.~~ ® ~ I1..~ I ~\ ~ ; 1, '. , tl \"../\±~~~_e d "~'~~ l~~j
~ ~ ~ ~ Jurisdiction of City of Blair, Nebraska
Permit Fee: 218 South 16th Street
Issuance Fee: `~n ~ Blair, Nebraska 68008
~ ~ ~~
Deposit Receipt #: ~ (402) 426-4191 ®Fax (402) 426-4195 Permit
~' _.~ ~'
P,pplication Date: ~° =~® ~~ ~ Issue Date: ~--
5. Describe Work: ~ ~ ~ ~~~ ~~,,~ ,,_ a,~_ ~ /~~,~ ~, „~ ~- ®Finished Basement ®Unfinished Basement
6. Total Sq. Footage (Including Basement and Garage}; Total Finished Area:
7. Valuation of Work: $ ~ ~ c~ c~ , cn c~
Floodway O Yes O No Dev. Permit Elev. Cert.
8. Floodplain: Fringe O Yes O No BFE
9. Current Zoning: .~~~
10. State Fire Marshall Required: ®Yes
11. Special Use Permit Required: O Yes
12. Variance Required: ®Yes ®No
13. Minimum Setbacks: Front ~
14. Sidewalk Required: ®Yes ® P
® No
O No
Side ~ ~ Rear ~~'
~ Waiver Approved
N®'TICE
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.
I hereby agree to perform the proposed work in accordance with the specifications set
folih 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' not completed withi years of date of issue.
Ca-1- ~"/~ 't~ ~
SIGNATU OF OWNER/CONTRACTCR DATE
Comment ~~_~--
=_
®Site Plan Attached ®Complete Plans Attached
Approximate Completion Date ~~'-~°" ~~
Inspections Required and Fees
Utilities
Sewer
Septic
Buildin
Footings
Framing
Electrical
Rough-in
Final
Temporary Service
Mechanical _
Rough-in
',. Final
Plumbin
Ground Work _
Rough-in
Final
WHEN PROPERLY VALIDATED (IN THIS SPACE] THIS IS YOUR PERMIT
APPr~~BY~ ~~ _ , ~ Vii' ~ 3
Water Service
Remote
Stop Box Card
Drywall -
(beforefinish)
Final
Fixtures
Permanent Service
A\C
POUNDS PRTG.-Blair, NE ~~ Rev. a/96
CITY OF BLAIIt ^ WASHINGTON COUNTY ^ OTHER ' j
LOCATION OF INSPECTION: ~ ~ ~-?~ ~- `°~
NAME OF OWNER. ;~ ~- ~.! I,~G CONTRACTOR: ~ ~'~-~
DATE INSPECTION REQUESTED: ~ ~ ~ - ~~ PERIVIIT NO: ~~~ ~ ~ ~ ~ ~6
TIME INSPECTION REQUESTED: '~~~ ~~~~ ~'~ ~~~
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TYPE OF INSPECTION REQUESTED: -
BUILDING: f --~(~,,1~~
, ^ FOOTING ^ FRAMING ^ DRYWALL r~ FINAL ""~~ ~'~~ ~~
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UTILITIES:
^ SEWER TAP ^ SEWF1t ^ SEPTIC ^ WATER TAP
^ REMOTE ^ WATER SERVICE
.ELECTRICAL:
^ ROUGH IN ^ FIXTURES ' ^ FINAL ^ MOTORS
^ PERMANENT SERVICE ^ TEMPORARY SERVICE `?
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' ~ MECHANICAL:
~ -
i ^ ROUGH-IN ^ A/C ^ FINAL
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PLUMBING:
^ GROUNDWORK ^ ROUGH-IN ^ FINAL
' RESULTS OF THE INSPECTION: ^ PASSED ~s~rroTES~ ^ FAILED ~s~ rroTES~
NOTES/REMARKS: ''
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DATE.OF INSPECTION MADE: ~~ ~ TIME: /c _ 1~
•
- f • ;CALLED OPPD\ TO ,CONNECT SERVICEi `^ YES ; ^.N0
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WANT OFFICE STAFF TO CALL OPPD\ ^ YES ^ NO BLR' 1
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