BP7497;'; ,, ~,' LEI ;.~ l1'1.~' h;~y'' !~ ~-~'/'~'~ 1i \r
JOB ADDRESS
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LEGAL
1. DESCR. LOT N0. e'
~ . ~ ~ BLK. ~/ ~'
~ `~' TRACT % ,~, j~'
~~ `~.
D SEE ATTACHED SHEET
OWNER ~°°"° MAI ADDRESS
2. _ ~,~ _' ZIP PHONE
CON R / MAIL ADDRESS
3 ~- _ ZIP ~JH~O~NE / ~~
C
~-
4. Class o ork: D NEW D ADDITION °~tEMODEL
5. Describe Work: ~-- ~..~.~~ ,~.w.~ r~~ ~ D Finished Basement D Unfinished Basement
6. Total Sq. Footage pnoluding Basement aRd Garage): Total Finished Area:
g~;~a
7. Valuation of Work: $ ~.~~.~~>
Floodway O Yes O No Dev. Permit
8. Floodplain: Fringe O Yes O No BFE
Elev. Cert.
9. Current Zoning: D Site Plan Attached Com lete Plans Attached
/~ ~
10. State Fire Marshall Required: ~ Yes D No ~
Approximate Completion Date
Inspections Required and Fees
11. Special Use Permit Required: D Yes D No Utilities
12. Variance Required: D Yes D No Sewer Water Service
13. Minimum Setbacks: Front Side Rear
Septic
Remote
14. Sidewalk Required: D Yes D No Waiver Approved Stop Box Card
Buildina
NOTICE Footings Drywall
Separate permits are required for electrical, plumbing, heating, ventilating and air (before finish)
conditioning,andsepticsystems.Bymysignaturebelow,lacknowledgethatpayment ~ ~~ ~
of the building permit application fee does not constitute issuance of this building
Framin ~
Final
permit. I further agree that construction covered by this permit application shall not be g
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.lunderstandthatthispermitisvoidifworkisnotcommencedwithin Final Permanent Service
180 days or is not completed within 2 years of date of issue.
~ ~
~~ ~
~ ~
~ ~ Temporary Service
'
`
`
~
Mechanical
SIGNATURE OF OWNER/CONTRAC OR DATE
Rouah-in
a~C
Comment: /~/~~,~ ~ L.~.~~~j ~- rf//~C
POUNDS PRTG: Blair, NE Rev. 6196
A lication Date: / ~ ~ "
Pp
~~~
Permit Fee: $
LEGAL LOT N0. ~~K• TfiAGT
~ • oESCR. O SEE ATTACHED SHEET
0 "` IL ADDRESS ZIP PHONE
3.
4. Class of Work: O NEON RESIDENTIAL
5. Describe Work:
Comments:
MAIL
O NEW COMMERCIAL
O REMODELING/ADDITIONS
O REPLACEMENTS
PLUMBING PERMIT FEES
Type of Fixture No.
Kitchen .................................. $8.00 x
Bath ....................................... $8.00 x ~ ~~~
Rough-tn Bath ....................... $4.00 x
Utility ..................................... $5.00 x
Water Heater ......................... $3.00 x
Outside Water Faucet ........... $3.00 x
Water Service ........................ $10.00
NOTICE Sewer .................................... $10.00
I hereby certify that I have read and examined this Groundwork ........................... $10.00
application and know the same to be true and correct. All
provisions of laws and ordinances governing this type of Septic Tank & Laterals .......... $10.00
work will be complied with whether specified herein or not.
The granting of a permit does not presume to give authority
Lawn Sprinkler System ..........
$10.00
to violate or cancel the provisions of any other state or local
Sprinkler System ...................
$30.00
law regulating construction or the performance of (Commercial)
construction.
Rev.1Z95
POUNDS PRTG: Blair, NE
JOB ADDRES~
'~,,.-
LEGAL
1 • DESCR. LOT NO.
", ~-~° BLK. ~/ TRACT
®SEE ATTACHED SHEET
2 OWN MAIL DRESS ZIP PHONE
CTOR MAIL ADDRESS n E ICENSE NO.
~ ~
3.
~~ D
~ ~ ~ ~
4• Cla of Work: ®NEW RESIDENTIAL ®NEW COMMERCIAL EMODELING/ADDITIONS ®UPGRADE SERVICE
5• Describe Work: -
6• Current License on File O Yes ®No ®NA
EL TICL NIIT FEES
New Service Fee = (Amp Fee + $2.00 per branch circuit)
1-100 Amp Fee ..................•......... $ 13.00 Upgrade Existing Service ...... $10.00
101-200 Amp Fee ...................•...•.... $ 18.00
p ry .............•..
Tem ora Service $10.00
201-300 Amp Fee ............• ............... $ 30.00
Fire Alarm System ................. $10.00
301-400 Am Fee $ 42.00
p •.• ..............•........,.
401-500 Amp Fee ..•.•........•...........•.• $ 55.00 Signs ..................................... $15.00
501-600 Amp Fee ..........................•• $ 67.00 Miscellaneous Apparatus ...... $11.00
601-700 Amp Fee .......................•...• $ 80,00
701-800 Amp Fee ............................ $ 92.00
801-900 Amp Fee ............................ $105.00 Commercial/Multi-Family and All ~Up~grades:
901-1000 Am $117.00
P •••~••••••••••••••••••••••••••••• ~ ~~
# of Circuits x $2.00
IF OVER 1000 Amp
1st 1000 Amp Fee ....................... $117.00
Amp Fee
Each additional 100 Amps .........•. $ 13.00 Amp Fee + Circuit Total
N®TIC New Residential: (Finished Area)
1 hereby certify that I have read and examined this SinglelTwo Family Dwellings
application and know the same to be true and correct. All sq. ft. x .045
provisions of laws and ordinances governing this type of
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wor
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e comp
ed w
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et
er spec
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n or not.
The granting of a permit does not presume to give authority
to violate or cancel the provisions of any other state or local Receptacle/S ' ch Outlets ~'
~
Fixtures x $.75
iaw regulating construction or the performance of
construction. Residential/Commercial Appliance
# Fixed Outlets x $3.00
~---- Power Apparatus (220 Volts)
~`` # A
aratus x $3
00
pp
.
SIGNA RE OF CONTRACTOR OR AUTHORIZED AGENT
y ~,~`
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C ~~
/ Permit Issuance Fee $15.00 .
DATE •T1°!4L / p
WWEN PR®PERLY VALIDATED (IN THIS SPA THIS IS Y®UR PERMIT
Comment: Approved Sy:
POUNDS PRTG.-Blair, NE Rev. 12/95
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