BP73531
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ca Jurisdiction of City of Blair, Nebraska
Permit Fee: ~` ~~ ~ 218 South 16th Street
Issuance Fee: Blair, Nebraska 68008
Deposit Receipt #: (402) 426-4191 ®Fax (402) 426-4195 Permit
~,-
Application Date: Issue Date:
9. Current Zoning:
10. State Fire Marshall Required: ®Yes
11. Special Use Permit Required: ®Yes
12. Variance Required: ®Yes O No
13. Minimum Setbacks: Front
14. Sidewalk Required: O Yes O N
O No
O No
Side Rear
o Waiver Approved .
NOTICE
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. l further agree that construction covered by this permit application shall not be
commenced until I have received acopy of this application form signed by the Building
Inspector.
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 or is not completed w' in 2 years of date of issue.
~ ~,.
GNATURE OF OWNER/CONTRACTOR DATE
Comment:
POUNDS PRTG: Blair, NE
® Site Plan Attached or~pp~t Plans Attached
Approximate Completion Date -~ ~``
Inspections Required and Fees
Utilities
Sewer _
Septic _
13uildina
Footings
Framing
Electrical
Rough-in
Final
Temporary Service
Mechanical
Rough-in _
Final -
Fixtures
Permanent Service
A\C
Plumbing _
Ground Work
Rough-in _
Final
WHEN PROPERL-Y°V ATED (IN THIS SPACE) THIS IS YOUR PERMIT
Approved By-~~°~ jJ
Rev. 6/96
Water Service
Remote
Stop Box Card
Drywall
(before finish)
Final '~~ ~ ~3
~_i
r = • ^ IJ I
\ CITY OF BLAIR ^ WASHINGTON COUNTY ^ OTgER
~ ~
- OCATION OF INSPECTOO :°`~ ?~~ ~ ~-- ~t.:~~° _--~~,.~ t
• ~,
NAME OF OWNER: °'~ CONTRACTOR: ~~.'
DATE INSPECTION REQUESTED: ~ `~~Z ~ pF~~T N0: < ~~~ +
TIME INSPECTION REQUESTED:
TYPE'OF INSPECTION REQUESTED: ~ !
I
BUILDING:
' ^ FOOTING ^FRAMING ^ DRYWALL ~ ~
UTILITIES:
,.
^ SEWER TAP ^ SEWER ^ SEPTIC ^ WATER TAP
I
^ REMOTE ^ WATER SERVICE
.ELECTRICAL:
I
ROUE
H
^ IN
^ FIXTURES ^ FINAL ^ MOTORS
. ~ ^ PERMANINT SERVICE ^ TEMPORARY SERVICE
~,
MECHANICAL:
+ ^ ROUGH-IN ^ A/C ^ FINAL j
I
. PLUMBING: ~~ i
• ^ GROUNDWORK
^ ROUGH-W ^ FINAL '
RESULTS OF THEINSPECTION:~ASSED ~sESrroTES~ ^ FAILED ~s~NOTES~
/ I
NOTES/REMARKS:
'~ ~~ ~ I
.INSPECTOR: ~ ~ { i
i
't. DATE OF INSPECTION MADE: i ~ /~~
. - TIME: !
CALLED OPPD\ ~ I
~~ TO CONNECT SERVICE: ^ YES' ^ Nrp
WANT OFFICE STAFF TO CALL OPPD\ ~ ^)'ES- ^ NO BLR 1
- -.-_ _ _ _ - - - - _ _ __; i