BP7553~~~ ~ ~ ~~d Y , I ~ { ~~V~~L ~~~ L.\\iY,~' i~ -1~\ U~~\•<S 11 ~1,_\''611\~
~C1 O y Jurisdiction of City of Blair, Nebraska
Permit Fee: 218 South 16th Street
Issuance Fee: Blair, Nebraska 68008
Dep®sit Receipt #: (402) 426-4191 ®Fax (402) 426-4195 Permit
` t!®- l 7 Issue Date: ~" ~ ° ~ ~
Application Date:
JOB ADDRESS
~~o~ ~ ~ii7-"~ 1 ~~-
LEGAL
1. DESCR. LOT N0. BLK. TRACT
®SEE ATTACHED SHEET
2.OWNER !'~ I/ C ~e! ~~ f1e , n~~ MAIL ADDRESS
U ZIP PHONE
rn ~_ ~MAILA~RESS
3 CONTRACTOR ~ `
1 ~~t7'r~ L_
7~V Z~f ~CCi~' ~C~.~~- ~~II~VHU`. Cp0~Z3
O ADDITION ®REMODEL
4. Class of Work: NEW
5. Describe Work: t~v p .~ _ ~ ~ ~ 2 r ~~, ~ O Finished Basement ®Unfinished Basement
~c~ w/ ~ how
6. Total Sq. Footage (Including Basement and Garage): Total FInlShed Area:
7. Valuation of Work: $ 3 ~j(o,3~ U ~
Floodway O Yes O No Dev. Permit
Flood
lain:
8
Elev. Cert.
p
.
Fringe O Yes O No BFE
9. Current Zoning: ~ Co~nple~ Plans Attached
®Site Plan Attached
`
Approximate Com -~
pletion Date-~
~
10. State Fire Marshall Required: O Yes ®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, andsepticsystems.Bymysignaturebelow,lacknowledgethatpayment <~ ,- ._ ~;.
-~ ` ~`'~ ~
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 copy of 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.lunderstandthatthispermitisvoidifworkisnotcommencedwlthin Final Permanent Service
180 days or is not completed within 2 years of date of issue. Temporary Service
~F9
`'~°~' ' °'°"° ~
Mechanical
SIGNATURE OF NER/C RACTOR DATE
Rouoh-in
A\C
Comment:
Final
Plumbin _
Ground Work
Rough-in
Final
WHEN PROPERLY VALIDAT (IN THIS SPACE) THIS IS YOUR PERMIT
Approved By;
/i, e
POUNDS PRTG: Blair, NE // Rev. B/96
I
- - - I
- • ~JI.I, I C I
~TY OF BLAIR ~] WASHINGTON COUNTY [] pTg~ ~
LOCATION OF INSPECTION: ~ ~~ ~'-> IIi i
_ f
NAME OF OWNER:,: ~' z~=,-,~~~ r'~~~ .~r~,~~ ,E ~ ~',-' s=~?'~ ~
CONTRACTOR: {a~'~
>> ~,
' DATE INSPECTION REQUESTED: " ~. ~;~` pERMIT N0: e ~~ ~~°.
- I
TIME INSPECTION REQUESTED: -~~r2e~' ; ; ,~ ~-~ I
~~
i TYPE OF.INSPECTION REQUESTED:
"~
BUILDING: _
~ , a
c'~.~ " '
^ FooTING ^ FRAMING ^ DRYWALL ~~~ ~
UTILITIES:
~,
^ SEWER TAP [] SEWER [] SEPTIC ~ WATER TAP ' I
1 I
^ REMOTE ^ WATER SERVICE ~ ~,~
i
ELECTRICAL: _ ~ I
. - - i
i
[] ROUGH IN ^ FIXTURES ^ FINAL ~ MOTORS
PERMANENT SERVICE { ~i
^ TEMPORARY SERVICE
MECHANICAL:
'~
^ ROUGH-IN ^ A/C ^ FINAL
~.
PLUMBING: ',
^ GROUNDWORK ~
^ ROUGH-W ^ FINAL
~. i
RESULTS OF THEINSPECTION:ASSED ts~xo~rFS~ ^FAILED (s~xoTES>
-€
NOTES/REMARKS:
~,°--~
INSPECTOR:- ;- ~€s~:~ ~.~.I- s j"~~3~-~°~~ ~..,~`,~" `
~ { r
,DATE OF INSPECTION MADE: y ~ .~= ~ ,r` •~qE: c~...•~'" ~ ,~ j
CALLED OPPD\ TO CONNECT SERVICE:
^ YES !
[] NO ti
WANT OFFICE STAFF TO CALL OPPD\
[] YES [] N0 BLR 1