BP7362Permit Fee: ~~; ~¢~r~~ Jurisdiction of City of Slair, Nebraska
218 South 16th Street
Issuance Fee:~~ Slair, Nebraska 68008
Deposit Receipt #: ~ (402) 425-4191 ®Fax (402) 426-4195 Permit
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Application Date: ~ ~ .~ ~ -~` r Issue Date: ~ f ~ t,~"~
JOB ADDRESS I
LEGAL
. DESCR. LOT NO. BLK. TRACT _
^ SEE ATTACHED SHEET
OWNER _ ~ ~; f ~' MAIL ADDRESS ZIP PHONE
CONTRACTOR MAIL ADDRESS ZIP PHONE
4. Class of Work: NEW O ADDITION ®REMODEL
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®Finished Basement ®Unfinished Basement
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Describe Work: ' ~~~
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6. Total Sq. FOOtage (Including Basement and Garage): Total Finished Area:
7. Valuation of Work: $ ~~ ;~ r,
Floodway O Yes O No Dev. Permit
Flood
lain:
8
Elev. Cert.
.
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Fringe O Yes O No BFE
9. Current Zoning: Site Plan Attached ®Complete Plans Attached
Approximate Completion Date ~ ~~-~~~'~°~~
10. State Fire Marshall Required: ®Yes O No
Inspections Required and Fees
11. Special Use Permit Required: ®Yes O No Utilities
12. Variance Required: ®Yes O No Sewer water Service
13. Minimum Setbacks: Front Side Rear
Septic
Remote
14. Sidewalk Required: O Yes ®No Waiver Approved Stop Box Card
Buildina
NOTICE Footings Drywall
Separate permits are required for electrical, plumbing, heating, ventilating and air (before finish)
conditioning, and septic systems. By my signature below, I acknowledge that payment
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of the building permit application fee does not constitute issuance of this building Framing Final
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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 Fixtures
forth above and in accordance with the codes/ordinances of the City of Blair and the
State of Nebraska.lunderstandthatthispermitisvoidifworkisnotcommencedwlthin Final Permanent Service
~ 80 days or is not comFeted within 2 years of date of issue, Temporary Service
Mechanical
SIGNATURE OFOWNER/CONTRACTOR DATE Rouah-in ABC
Comment:
Final
Plumbin
Ground Work
Rough-in
WHEN PROPERLY VALIDA'
Approved By: _
~°
Final
THIS
THIS IS YOUR PERMIT
POUNDS PRTG: Blair, NE Rev. B/96
IJIL I DTI ~'
~~ CITY OF BLAIIt ^ WASHINGTON COUNTY ^ OTHER
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LOCATION OF INSPECTION: ` ~ ``~ ~ 'i`L1~~L ~ ~ 1i ~ i _r~i ~
NAME OF O WNER: f-' { . ~';.._ ~ _'; - ; ~ CONTRACTOR: ~ ~ ' , ;~ ;'' , ~'
r ~I
_
~ DATE INSPECTION REQUESTED: ~ f t ` `' ~ PERMIT NO: # --~4~ ~--°
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I TIME INSPECTION REQUESTED: ~ ~a" ~;' k--~ ~`t't ~
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TYPE OF INSPECTION REQUESTED: ~'
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.BUILDING: ~~
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^ FOOTING ^ FRAMING ^ DRYWALL `
' FINAL ~ " "'~ ~~
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UTILITIES:
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~~ ^ SEWER TAP ^ SEWER ~
^ SEPTIC ^ WATER TAP i!
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^ REMOTE ^ WATER SERVICE
ELECTRICAL: i
^ ROUGH IN ^ FIXTURES ^ FINAL ^ MOTORS ,i
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^ PERMANENT SERVICE ^ TEMPORARY SERVICE:;
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MECHANICAL: ~
^ ROUGH-W ^ A/C ^ FINAL ~,
PLUMBING:
^ GROUNDWORK ^ ROUGH-IN ^ FINAL
~, RESULTS OF THE INSPECTION: ~ASSED ~s~NOTES> ^ FAILED (sESrroTES~ '
NOTES/REMARKS: ~ '
~F
INS - ~/+ ~
~
~
DATE OF INSPECTION MADE: ~
'HME; / : l
CALLED OPPD\ TO CONNECT SERVICE: ^ YES ^ NO
WANT OFFICE STAFF TO CALL OPPD\ ^ YES ^ NO BLR 1
CITY OF BLAIR
Application for Building Permit
PLOT PLAN
Address Date
Legal Description: Lot _ Block Addition
Please show all measurements of existing and contemplated structures,
also show distances between structures, etc., and property lines,
Is this a corner lot?
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Indicate North
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Cr ~y ~f ~ ~~'S . F 8 ~;
_ _Center Line_of _ _ _ Street_ _
Applicant