BP7605Permit Fee:
Issuance Fee:
~ `~- Jurisdiction of City of Blair, Nebraska
a,. 218 South 16th Street
Blair, Nebraska 68008
Deposit Receipt #: (402) 426-41
Application Date: ~~
91 ®F
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Permit
ax (402) 426-4195
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Issue Date: ~°
J09 ADDRESS _~ ~, ~~ J •~'~
LEGAL
1. DESCR. LOT No. BLK. TRACT
®SEE ATTACHED SHEET
OWN ~'" :. MAIL ADDRESS
2. ~: ZIP PHONE
CONTRACTOR MAIL ADDRESS ZIP PHONE
3.
4. Class of Work: O NEW O ADDITION O REMODEL
5. Describe Work: _~ ~~ ~~ 3 ®Finished Basement O Unfinished Basement
_ .~ ~" "
6. Total Sq. Footage (Including Basement and Garage): Total Finished Area:
~~ c"'~
7. Valuation of Work: $ %~°`~;r~ ~~~
Floodway O Yes O No Dev, Permit
Flood
lain:
8
Elev. Cert.
.
p
Fringe O Yes O No BFE
9. Current Zoning: O Site Plan Attached O Complete 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: ®Yes O No Sewer Water Service
13. Minimum Setbacks: Front Side Rear Septic Remote
Stop Box Card
14. Sidewalk Required: O Yes O No Waiver Approved
Buildin
NOTICE Footings Drywall
Separate permits are required for electrical, plumbing, heating, ventilating and air (before finish)
conditioning, and septic systems. Bymysignaturebelow,lacknowledgethatpayment rJ. ®`c f y~
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 by the Bui-ding 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 isvoid if work is not commenced within Final Permanent Service
ted within 2 years of date of issue.
180 days or is not co
m
p
le' Temporary Service
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Mechanica
SIGNATURE OF OWNER/C NTRACTOR DATE
__ Rouah-in A\C
Comment:
Final
Plumbing _
Ground Work
Rough-in
Final
WHEN PROPERLY,VA TED (IN THIS SPACE) THIS IS YOUR PERMIT
Approved By: ~~
POUNDS PRTG: Blair, NE Rev. 6/96
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III I INS C T
~ - .~~•-
f' -m.=~]:~~TTY OF BLAIR WAS
HWGTON CO ~~I
^ UNTY ^ OTHER
- ~: LOCATION OF INSPECTION: ~'~~' a`f ~ `~'~ .~ ~ ~'/'r ~ ~ '
C - .
(:. ~` ," ~
NAME OF OWNER: CONTRACTOR: ~
E ~ ~, i
DATE INSPECTION REQUESTED: -~ ' %'r~ ~'"' PERMIT NO: .~~`~"- - f `=~.~
I' TIME:INSPECTIONREQUESTED: v~~,~.° ~,^- ', v
,~--
TYPE OF INSPECTION REQUESTED:
BUILDING: `~
^ FOOTING ^ FRAMING ^ DRYWALL ~`FfINAL
'UTILITIES:
. ^ SEWER TAP ^ SEWER ^ SEPTIC WATER TAF '
k; ^ ~
^ REMOTE ^ WATER SERVICE
ELECTRICAL:
^ ROUGH IN ^ FIXTURES ^ FINAL ~ MOTORS
. ~ ^ PERMANENT SERVICE ^ TEMPORARY SERVICE
r: MECHAMCAL:
^ ROUGH-IN ^ A/C ^ FINAL
PLUMBING:
~:
• f; ^ GROUNDWORK ^ ROUGH IN ^ FINAL
~,,.--
k; RESULTS OF THEINSPECTION: -ASSED ~s~rro~rES~ ^ FAILED ~s~xo•rES> ~
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NOTES(REMARKS:
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~ , .INSPECTOR: !~~'/ ~~ `~~~~ ;1: ~ ~ ~'::~~j~ ~,~
r ~, _
• DATE OF INSPECTION MADE: ''~ " ~ ~` ~ TIME: 0 < C,
--~--
• CALLED OPPD\ TO CONNECTSERVICE: ~ YES ^NO
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- " WANT OFFICE STAFF TO CALL OPPD\ ' ^: YES. Q NO BLR 1
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