BP7423
JOB ADDRESS ~ ~''} ` _
LEGAL
1 . DESCR. LOT NO. BLK. TRACT
®SEE ATTACHED SHEET
OWNER.-~ °`" ~f ~ ~ ~ MAIL ADDRESS ZIP PHONE
2 ~ %~~'~ =, ~ _ ~ '
CONTRACTOR ~1 MAIL ADDRESS ZIP PHONE
3.
4. Class of Work: ®N~W ®ADDITION ®REMODEL
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r ®Finished
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5. Describe Work: ~-~' ~~ Basement ®Unfinished Basement
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6. Total Sq. FOOtage (Including Basement and Garage): TOtal FInlShed Area:
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Valuation of Work: $
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Floodway O Yes O No Dev. Permit
Floodplain:
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Elev. Cert.
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Fringe O Yes ®No BFE
9. Current Zoning: O Site Plan Attached ,~. ~~ ,O Complete Plans Attached
Approximate Completion Date ~ ,
10. State Fire Marshall Required: ®Yes ®No
Inspections Required and Fees
11. Special Use Permit Required: ®Yes ®No Utilities
12. Variance Required: ®Yes O No Sewer Water Service
13. Minimum Setbacks: Front Side Rear
Septic
Remote
14. Sidewalk Required: ®Yes ®No Waiver Approved Stop Box Card
Building
N1°ICE Footings Drywall
Separate permits are required for electrical, plumbing, heating, ventilating and air (before finish)
conditioning, and septic systems. By my signature below, l acknowledge that payment
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of the building permit application fee does not constitute issuance of this building Framing ~ l~
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. I understand thatthis permit is void ifwork is not commenced within Final Permanent Service
180 days or is not completed within 2 years of date of issue.
~ Temporary Service
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Mechanical
SIGNATURE OF OWNER/CONTRACTOR DATE
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Rough-in
ABC
Comment:
Final
Plumbing _
Ground Work
Rough-in
Final
WHEN P PERLY.VQLIDATED (IN THIS SPACE) THIS IS YOUR PERMIT
Approved By ~ ,
POUNDS PRTG: Blair, NE Rev. B/96
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°CTI'Y OF BLAIR ^ WASHINGTON COUNTY ^ O'T'HER
LOCATION OF INSPECTION: U :f ~ -`'f'f (.'.~.~~.t ~
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NAME OF OWNER: .i ~"~'' ~f~f ' e ~ ~~ CONTRACTOR: -~ ``~ ~~" ~~
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DATE INSPECTION REQUESTED: PERMIT N0: ~ ' r `a
TIME INSPECTION REQUESTED:
TYPE OF INSPECTION REQUESTED:
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` BUILDING: V'"'"
^ FOOTING ^ FRAMING ^ DRYWALL ^-FINAL ~~ r'
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UTILITIES:
SEWER TAP ^ SEWER ^ SEPTIC ^ WATER TAP i
^ REMOTE ^ WATER SERVICE I
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ELECTRICAL: ~
ROUGH IN ^ FIXTURES ^ FINAL ^ MOTORS
^ PERMANENT SERVICE ^ TEMPORARY SERVICE
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MECHANICAL: ~
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^ ROUGH-IN ^ AJC ^ FINAL ~
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PLUMBING: ~ ~!
^ GROUNDWORK ^ ROUGH-IN ^ FINAL
RESULTS OF THE INSPECTION: PASSED (saErroTES) ^ FAILED (sue rroTas>
NOTES/REMARKS:
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INSPECTOR; ~ Ef ~~ 'i
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DATE OF INSPECTION MADE: ~~ ~~~ ~~ TIME: ~
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CALLED OPPD\ TO CONNECT-SERVICE: ^ YES ^ NO i
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^ YE.S ^,NO BLR f
~ WANT OFFICE STAFF TO CALL OPPD\ _ . ~__ _ -- - -
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