BP7264I ~ 1_. I~
~ ~ Jurisdiction of City of flair, Nebraska
Permit Fee: 218 South 16th street
Issuance Fee: Slair, Nebraska 68008
Deposit Receipt #: (402) 420®4191 ®Fax (4.02) 426®4195 Permit-
Application Date: ~"~ ~ ~ (' ~.) ~~
Issue Date: ~~~ ~ ~ ~ - ~j
JO iADDRESS ~ ~ ~ ~ ~~(
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LEGAL LOT No.
1 . DESCR. BLK. TRACT
~ SEE ATTACHED SHEET
OWNER
2.
~ ~ MAIL.,g6 RESS
r ZIP PHONE
~ ~ ~~,~'-
CONTRA T R
3
~ MAIL ADDRESS ~
L ~ ~ ZIP ~ ~ ~~ PHONE T
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4. Class of Work: ®NEW ®ADDITION ®REMODEL
5. Describe Work: ® Finished Basement ®Unfinished Basement
1 /
6. Total Sq. Footage (Including Basement and Garage}: Total Finished Area:
7. Valuation of Work: $ ~ ~
Floodway O Yes O No Dev. Permit
Elev. Cert.
FIOOdplain:
~
O
O
.
Yes
No BFE
Fringe
9. Current Zoning: ®Site Plan Attached ®Complet Plans Attached
Approximate Completion Date `~ ~ '- ~
10. State Fire Marshall Re wired: ®Yes ®No
q
Inspects®ns Required and Fees
11. Special Use Permit Required: ®Yes ®No Utilities
12. Variance Required: ®Yes ®No Sewer Water Service
13. Minimum Setbacks: Front Side Rear
Septic
Remote
14. Sidewalk Required: ®Yes ®No Waiver Approved Stop Box Card
NTICE
Separate permits are required for electrical, plumbing, heating, ventilating and air
conditioning, and septic systems. By my signature below, I acknowledge that payment
Building
Footings
of the building permit applicatton fee does not constitute Issuance of this building Framing
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 Electrical
Inspector.
I hereby agree to perform the proposed work in accordance with the specifications set Rough-in
forth above and in accordance with the codes/ordinances of the City of Blair and the
State of Nebraska. I understa th this permit isvoid if wor 'snot commenced within Final
1 ~0'd'ays~r ~ not completit 2 years of,d~te of iss~,
Comment:
OF
c
DATE
Temporary Service
Mechanical _
Rough-in
Final
Plumbing .
Ground Work
Rough-in _
A\C
Final
WHEN PROPERLY VALIDATED (IN THIS SPACE) THIS IS YOUR PERMIT
Approved By:
Drywall
(before finish)
Final f `~' ~ ~
Fixtures
Permanent Service
POUNDS PRTG.-Blair, NE Rev. B/96
~__:~ y~J
' ' ~~~'`CTTY OF BLAIR ^ WASHINGTON COUNTY ^ OTHER
4- ~ r,
- LOCATION OF INSPECTION: ~~~=•~~~ ~ ~~~`~.Fl~~
NAME OF OWNER~~r.:.` ?' %~,~,'~- :r~-7 =`i~~'~ CONTRACTOR ;I/?- ~,•, i.?r t°
DATE INSPECTION REQUESTED: ~ ~~°`°°' f~'rPERMITNO: ~~°~~''--r.
.` I
,~'''r f,-- ~
TIME INSPECTION REQUESTED:
~'
TYPE OF INSPECTION REQUESTED:
_~
BUILDING: 1 E j'~ 1
^ FOOTING ^ FRAMING ^ DRYWALL FINAL , ~~~ I
UTILITIES:
I
^ SEWER TAP ^ SEWER ^ SEPTIC ^ WATER TAP
^ REMOTE ^ WATER SERVICE j ,
ELECTRICAL: ~
^ ROUGH IN ^ FIXTURES ^ FINAL ^ MOTORS ~ ~j
^ PERMANINT SERVICE ^ TEMPORARY SERVICE
MECHANICAL:
^ ROUGH-IN ^ A/C ^ FINAL
PLUMBING:
I
. ~ ^ GROUNDWORK ^ ROUGH-W ^ FINAL ~~,
RESULTS OF THE INSPECTION:"PASSED (sESxoTas> ^FAILED (s~rroTES) ~
I
NOTES/REMARKS:
~~ z ',
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INSPECTOR: ~-~ - ~ ~- r. ~'
i. ~. I~
• DATE OF INSPECTION MADE: - ' ~ ~ TIME: i ~ ~ '
i CALLED.OPPD\ TO CONNECT SERVICE: ^ YES ^ N0.
WANT OFFICE STAFF TO CALL OPPD\ ^ YES ^ NO BLR t
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