BP7207flair, Nebraska 6SOOS ~' ~-~ ~,yl Q'~
(402) 426-4191 Permit ~ ~
~~
._ %' %~-~~ , Permit Fee: $ _~
Application Date: Issue Date:
JOB ADDRESS ~/ _
LEGAL LOT NO. -` BLK. 1 TR T - R
1 ' DESCR. ~~~~ t~_Z!/~ -~~ , ^ SEE ATTACHED SHEET
OWNER MAIyA~DRESS ~ ZIP PHONE
4 ! MAILA DRESS - PE -~ ~ . LICE N
3 CONTR TO y
USE OFBUILDING - ~~ -° ~~~ _
4.
5. Class of Work: ^ NEW ~ ^ ADDITION ^ALTERATION ^ REPAIR ^ MOVE ^ REMOVE
6. Describe Work: ~~~~~ ~~-
], Sq. Footage Of StrUC a (Including Basement and Garage).
8, Change of Use From: Change of Use To:
g, Valuation of Work: $ ~
~%
10 Floodplain: Floodway Yes No Dev. Permit
Fringe Yes^ No BFE
11. Current Zoning: ~~"~
12. State Fire Marshall Required: Yes ^ Nod,
13. Special Use Permit Required: Yes ® No ~°`
14. Variance Required: Yes ® No ~`
15. Minimum Setbacks: Front Side ~`' Rear
16. Sidewalk Required: Yes^ NoWaiver Approved _
ACCEPTED BY I PLANS CHECKED BY I APPROVED FOR ~~UANCE 8Y
Elev. Cert
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 chat construction covered by this permit application shall not be commenced until I
have received a copyof this application form signed by the Building Inspector and stamped
'APPROVED'.
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 In y f the to of issuance, or if work is abandoned for six ((i)
onths or , whic v 'ear'
.~
IGNATURE OF OWNER/CONTRACTOR OR AUTHORIZED AGENT DATE
SIGNATURE OF OWNER (IF OWNER BUILDER) DATE
Site Plan Attached ^ Comple~~~`~~hed ^
C
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A
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mate
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on
a
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pprox
Inspections Required and Fees
Utilities
Sewer Tap Water Tap
Sewer Water Service
Septic Remote
Euilding
Footings Drywall
(before finish)
Framing ~~ Final
Electrical
h-i
°~ ° ~
R
n
oug Permanent Service
Final `~ ~ ~~ Temporary Service
Mechanical
Rough-in ABC
Final ~°°`r
Plumbing
Ground Work
Rough-in ~-°' Final ~-~-
WHEN PROPERLY VALIDATED (IN THIS SPACE) THIS IS YOUR PERMIT
Comment: Approved By:
POUNDS PRTG: Blatr, NE Rev. 08/95
Application Date: ~-~ ~~ ~ ~='
~~_
Permit Fee: $ ~
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
N®TIC
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. -
NATURE OF CONTRACTOR ~%AUTHORIZED AGENT
°~ ~ ( - ~ ~!
DATE
ELECTRICAL PERMIT FEES
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
Fixtures x $.75 ~~~ ~il ~~
Residential/Commercial Appliance
# Fixect Outlets x $3.00
Power Apparatus (220 Volts)
# Apparatus x $3.00
Permit Issuance Fee ............. $15.00
1~~~~
%~~ C~~
WHEN PROPERLY VALIDATED (IN THIS SPACE) THIS IS YOUR PERMIT
Comment: Approved By:
~..~~~ ~'
POUNDS PRTG.-Blair, NE Rev. 72/95
Application Date: ~a~.-~~/ ~ ' Permit Fee: $
JOB ADDRESS
~~ .
LEGAL
1 ° DESCR. LOT NO. BLK• TRA
~~-~
~ O SEE ATTACHED SHEET
2° OWNER ~ . j~ ~~CG,
~l MAIL ADDRESS ZIP PHONE
CONTRACTOR MAIL ADDRESS PHONE LICENSE NO.
4. Class of Work: O NEW RESIDENTIAL O NEW COMMERCIAL EMODELING/ADDITIONS ®REPLACEMENTS
5° Describe Work:
Comments:
PLUMBING PERMIT FEES
Type of Fixture No.
Kitchen ............................. ..... $8.00 x
Bath .................................. ..... $8.00 x
~ ~~
`~ J
Rough-In Bath .................. ..... $4.00 x _
Utility ................................ ..... $5.00 x
Water Heater .................... ..... $3.00 x
Outside Water Faucet ........... $3.00 x
Water Service ................... ..... $10.00
N®TIC Sewer ............................... ..... $10.00
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.
~
Permit Issuance Fee $15.00
............ ~~ ~~,:~
l ~ `
SIGNATURE OF CON RACTOR OR AUTHORIZED AGENT L+i:-
`
ToTAi_ 1
~
DATE Current License on File OYes O No ®NA
WHEN PROPERLY VALIDATED (IN THIS SPACE) THIS IS YOUR PERMIT
Comment: Approved B
l~
POUNDS PRTG -Blair, NE Rev. 72/95
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