BP7672Permit Fee: d~ ~~ Jurisdiction of City of Slair, Nebraska
218 South 16th Street
Issuance Fee: ~~ Slair, Nebraska 68008
Deposit Receipt #: (402) 426®4191 ®FaX (402) 426-4195 Permit-
Application Date: (y Issue Date:
JOB ADDRESS
,,
5. Describe Work: ~ n ~-, ,df~ ®.~ ? „~ .~ ®Finished Basement ®Unfinished Basement
6. Tota) Sq. FOOtage (Including Basement and Garage):
Total Finished Area:
7. Valuation of Work: $ , ~°7
Floodway O Yes O No Dev. Permit
8. Floodplain: Fringe ®Yes O No BFE Elev, Cert.
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 .
iV°TI
Separate permits are required for electrical, plumbing, heating, ventilating and air
conditioning, and septic systems. By my signature below, I acknowledge that payment
of the building permit application fee does not constitute issuance of this building
permit. I fullher agree that construction covered by this permit application shall not be
commenced until I 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.
SIGNATURE OF OWNER/CONTRACTOR DATE
Comment:
® Site Plan Attached ® omplete Plan Attached
Approximate Completion Date -`-~`"
Inspections Required and Fees
Utilities
Sewer
Septic _
Buildin
Footings
Framing
Electrical
Rough-in
Final
Temporary Service
Mechanical
Rough-in
Final -
Plumbin
Ground Work
Rough-in _
Final
WHEN PROPERLY VALIDATED (IN THIS SPACE) TWIS IS YOUR PERMIT
App d :
Water Service
Remote
Stop Box Card
Drywall
(before finish)
Final
Fixtures
Permanent Service
A\C
POUNDS PRTG: Blair, NE Rev. 6/96
® ~, .~ ~IJI I CTI ~ I,
~.~ CITY OF BI:AIR ^ WASHINGTON COUNTY ^ OTHER ',
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LOCATION OF INSPECTION: ~ ~ ~ ~~ ~~`~
NAME OF OWNER: `~ s ~~c`~' U ~ ~C~ ',••r f .~ ~.::--? ~ ~' %~ ~ ~ ~~>`~ =-r =-,
~ " CONTRACTOR: ~ '
- DATE INSPECTION REQUESTED: '°°~ ~' ~'~-'' ~ ~ PERMIT N0: 1'' ~ ~ r
~~ ~----
TIME INSPECTION REQUESTED: -''f "~"
TYPE OF INSPECTION REQUESTED:
BUILDING: ~ ~~ , j
-° ~
^ FOOTING ^ FRAMING ^ DRYWALL -INAL~ ~ ~~~~ ~
I
UTILITIES:
^ SEWER TAP ^ SEWER ^ SEPTIC ^ WATER TAP
^ REMOTE ^ WATER SERVICE ~
i
' ELECTRICAL: -
^ ROUGH IN ^ FIXTURES ^ FINAL ^ MOTORS ':~
^ PERMANINT SERVICE ^ TEMPORARY SERVICE
MECHANICAL: I
I
^ ROUGH-IN ^ A/C ^ FINAL '
PLUMBING: , '
'f ~ '
^ GROUNDWORK ^ ROUGH-IN ^ FINAL ~~
~, RESULTS OF THE INSPECTION: SED ~s~ xo~rES> ^ FAILED ~s~ xo~ras)
NOTES/REMARKS: '
_ '
_ _ r _.__ ____ _._.___ __.__--____._ _ -L
INSPECTOR. ~ _~~ t` ~ i~~~ ^'>i ~ ~~ ~=''`~+.-~ {
r° --
DATE OFINSPECTION MADE: 3 TIME: ~ ~
CALLED OPPD\ , TO CONNECT SERVICE: ^ YES ^ NO
WANT OFFICE STAFF TO CALL OPPD\ ^ YES ^ NO BLR 1
,' L a .