BP7591l ~ ®„ ~
~ ~~I~® I ~' L ~~1~-s l~ ~) ~ ®Y ~ 1'~'~i r~I'' i ~I I~ ®L'i .~I ~' '~i
~, ~~ ~ Jurisdiction of City of flair, Nebraska
Permit Fee: 210 youth 16th Street
Issuance Fee: Slair, Nebraska 6ROOR
Deposit Receipt #: (402) 420®4191 ®Fax (402) 426®4195 Permit
Application Date: " ~ ~ A ~~ k Issue Date: °`~' ~ ~/~~ ,~
9. Current Zoning:
10. State Fire Marshall Required: ®Yes
11. Special Use Permit Required:, ®Yes
12. Variance Required: ®Yes ®No
® No
® No
13. Minimum Setbacks: Front Side Rear
14. Sidewalk Required: ®Yes ®No Waiver Approved
NTICE
Separate permits are required for electrical, plumbing, heating, ventilating and air
conditioning, and septic systems. By mysignature below, I acknowledgethat payment
of the building permit application fee does not constitute issuance of this building
permit. I further agree that construction covered by this permit application shall not be
commenced until 1 have received a copy of this application form signed by the Building
Inspector.
I hereby agree to perform the proposed work in accordance with the specifications set
forth above and in accordance with the codes/ordinances of the City of Blair and the
State of Nebraska. I understand that this permit is void if work is not commenced within
180 days or is not completed within 2 years of date of issue,
f . I
SIGNATURE OF OWNER/ OR DATE
Comment:
®Site Plan Attached ®Complete Plans Attached
Approximate Completion Date <°~A ~ ~ ~ ~
Inspecti®ns Required and Fees
Utilities
Sewer
Septic
Buildin
Footings
Framing
Electrical
Rough-in
Final
Temporary Service
Mechanical
Rough-in _
Final
Plumbing _
Ground Work
Rough-in
Final
WHEN PROPERLY VALIDATED (IN THIS SPACE) THIS IS YOUR PERMIT
Approved By:
Water Service
Remote
Stop Box Card
Drywall
(before finish)
Final '3` ~ (~~
Fixtures
Permanent Service
A\C
POUNDS PRTG: Blair, NE Rev. 6/96
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[~~CITY OF BI:AIR ^ WASHINGTON COUNTY ^ OTHER §
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LOCATION OF INSPECTION: i ~°- ~ ~
NAME OF OWNER: ~y ''` '"~ ~~ ` ~~Fv'~ , CONTRACTOR: . ~ ?~d ~'`-;''S ~~'
DATE INSPECTION REQUESTED: M- ~" (~' ~! PERMIT N0: --~ `~ Fi
j.. `'
TIME INSPECTION REQUESTED: ~ s ''\ ~ i°~ ^;• `` ~ ' $ff
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TYPE OF INSPECTION REQUESTED: " ',
'r a1 I
BUILDING: ~7 r ~_> ~
r~ a ~ r '-
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^ FOOTING ^ FRAMING ^ DRYWALL ~ ~ FINAL -
~,;
UTILITIES:
^ SEWER TAP ^ SEWER ^ SEPTIC ^ WATER TAP 1;
^ REMOTE: ^ WATER SERVICE
ELECTRICAL:
^ ROUGH IN ^ FIXTURES ^ FINAL ^ MOTORS
^ PERMANENT SERVICE ^ TEMPORARY SERVICE
MECHANICAL: '~
!` I
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^ ROUGH-IN ^ A/C -^ FINAL .-~ .~~ ` t
PLUMBING: l'
~,
^ GROUNDWORK ^ ROUGH-IN ^ FINAL
RESULTS OF THE INSPECTION: • SED (sEENO~rES) ^ FAILED (sEE xoTES)
NOTES/REMARKS: ;
~,
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INSPECTOR: ~
_ ] _ i
I' DATE OF INSPECTION MADE: ~ '` ~/ TIME: ~ '~
CALLED OPPD\ TO CONNECTSERVICE: ^ YES ^ NO 1
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f WANT OFFICE STAFF TO CALL OPPD\ ~^ YES ^ NO _ BLR 1 =~
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