BP7283
lication Date:
A ~° {-~ - -~ ~ Issue Date: ~ ` ~ '
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JOB ADDRESS
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LEGAL
1 . DESCR. LOT N0. BLK. TRACT
®SEE ATTACHED SHEET
OWNE
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~~~ MAIL ADDRESS
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~ PHONE
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C TRA T R
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IL ADDRESS
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ULJ P/'HONE
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4. Class of Work: NEW ~ ADDITION ®REMODEL
5. Describe Work: ®Finished Basement ®Unfinished Basement
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6. Total Sq. Footage (Including Basement and Garage}: Total FinlShed Area:
7. Valuation of Work: $ ~ ~~ ~ t ~~
Floodway O Yes O No Dev. Permit
8. Floodplain: Fringe O Yes O No BFE Elev. Cert.
9. Current Zoning: ®Site Plan Attached ®Com lete Plans Attached
Approximate Completion Date ~
10. State Fire Marshall Required: ®Yes ®No
Inspecti®ns Required and Fees
11. Special Use Permit Required: ®Yes ®No Utilities
12. Variance Required: ®Yes ®No Sewer Water Service
~ 3. Minimum Setbacks: Front Side Rear
Septic
Remote
14. Sidewalk Required: ®Yes O No Waiver Approved Stop Box Card
Buildin
~®TICE Footings Drywall
Separate permits are required for electrical, plumbing, heating, ventilating and air (before finish)
conditioning, and septic systems. By my signature below, I acknowledge that payment ~e7
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 1 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.lunderstandthatthispermitisvoidifworkisnotcommencedwtthin Final Permanent Service
1 day or is not completed ithin 2 y rs ofd of issue.
C1 ~,
Temporary Service
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Mechanical
SIGNATURE OF WNERICONTRACTOR DATE Rough-in A\C
Final
Comment:
POUNDS PRTG: Blair, NE Rev. 8/96
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,~-:.
ITY OF'~LAIR ^ WASHINGTON COUNTY ^ OTHER
LOCATION OF INSPECTION: ~ ~~ F~~~ ~-~ ~f° `'~ ~~~ ~~
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NAME OF OWNER• ~`~ fl~~~ t~r• ~ aa~, CONTRACTOR: •'=~~~d~/-~ ~
' ~ - - ~; _
DATE INSPECTION REQUESTED: ~ ~~ ~ PERMIT N0: ~~ i
TIME INSPECTION REQUESTED: '~
r . ;;
TYPE OF INSPECTION REQUESTED:
BUILDING: ~ ~~
^ FOOTING ^ FRAMING ^ DRYWALL >Q FINAL
UTILITIES:
^ SEWER TAP ^ SEWER ^ SEPTIC ^ WATER TAP
^ REMOTE ^ WATER SERVICE
ELECTRICAL:
^ ROUGH IN ^ FIXTURES ^ FINAL ^ MOTORS
^ PERMANINT SERVICE ^ TEMPORARY SERVICE
MECHANICAL:
~ ^ ROUGH-IN ^ A/C ^ FINAL
PLUMBING:
^ GROUNDWORK ^ ROUGH-IN ^ FINAL
RESULTS OF THE INSPECTION: .~-
~-PASSED (s~xorES~ ^ FAILED (s~xo~rFS~
NOTES/REMARKS:
DATE OF INSPECTION MADE: `- f ~'~ °~ ~ TIME: ~~ J ~c -~ ,
i
CALLED OPPD\ TO CONNECT SERVICE: ^ YES ^ NO
WANT OFFICE STAFF TO CALL OPPD\ ^ YES ^ NO BLR 1