BP7493
Application Dater ~ ~~ Issue Date: ~~~ ~~ ,_ '
JOB ADDRESS ~~'~ ~ ~ ~ ~ ~'
LEGAL
1. DESCR. LOT ND. ,~ ~ BLK. TRACT
O SEE ATTACHED SHEET
% DRESS ZIP
OWNE ~ M AD
~` PHONE
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2.
CO sC R e ~ MA(L"~1DDRESS a ZIP
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4, Class of Work: O NEW O ADDITION O REMODEL
5. Describe Work: ,__ ~~ y- ~ .-y~ /~, ~-~ - ~ O Finished Basement ®Unfinished Basement
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,
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~ Total Finished Area:
6. Total Sq. Footage (Including Basement and Garage):
~' ~~
7. Valuation of Work: $ ¢~ ®-~ -
Floodway O Yes O No Dev. Permit Elev, Cert.
Flood
8
lain:
.
p
Fringe O Yes O No BFE
9. Current Zoning: O Site Plan Attached to Plans Attached
~
Approximate Completion Date ~
10. State Fire Marshall Required: O Yes O No
Inspections Required and Fees
11. Special Use Permit Required: O Yes O No Utilities
12. Variance Required: O Yes O No Sewer Water Service
13. Minimum Setbacks: Front Side Rear
Septic
Remote
14. Sidewalk Required: O Yes O 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 septicsystems. Bymysignature below, I acknowledge that payment .~ ,-\~
of the building permit application fee does not constitute issuance of this building Framing ~
Final ~ (~'
permit, I further agree that construction covered by this permit application shall not be
commenced until I have received a copyof this application form signed bythe 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.lunderstandthatthispermitisvoidifworkisnotcommencedwithin Final Permanent Service
180 days or is o't completed within 2 years of date of issue.
f/` ..
,, Temporary Service
~
Mechanical
OF OWNEWCONTRACTOR DATE
SIGNATU Rouah-in a~C
IJ CTI T -
_ `~.~
tip; CITY OF BLAIR ^ WASHINGTON COUNTY ^ OTHER
LOCATION OF INSPECTION: ~ - - -~~' `¢~
NAME OF OWNER ;` v, ~-° , ~ ~ ` '+'~? ~ f=-~ ~ CONTRACTOR = ~`', ~' _`
_ k: t.r`
DATE INSPECTION REQUESTED: ~'~ j'~ .~ ~ `" ~'~,-~ PERMIT N0: ~ rA-9?
-~
TIME INSPECTION REQUESTED: -~~,> ``~` ~~"'(=
~~~
TYPE OF INSPECTION REQUESTED:
BUILDING: , -
.i ~,~.
^ FOOTING ^ FRAMING ^ DRYWALL ] FINAL
.UTILITIES:
^ SEWER TAP -;^ SEWER ^ SEPTIC ^ WATER TAP
^ REMOTE ^ WATER SERVICE
. ELECTRICAL:
^ ROUGH IN ^ FIXTURES ^ FINAL ^ MOTORS
^ PERMANENT SERVICE ^ TEMPORARY SERVICE
MECHANICAL:
^ ROUGH-IN ^ A/C ^ FINAL
PLUMBLNG:
^ GROUNDWORK ^ ROUGH-IN ^ FINAL
' RESULTS OF THE INSPECTION: ASSED (s~xoTas~ ^ FAILED (s~xoTES~
NOTES/REMARKS:
1
DATE OF INSPECTION MADE: ~~ `C7~ TIME:
CALLED OPPD\ TO CONNECT SERVICE:
. WANT OFFICE STAFF TO CALL OPPD\
_. - _.,
-- __
n n
- ,
'~~
^ YES ^ NO
^ YES s ^ NO BLR 1