BP7765~u~~~ ~- ~ I, ~ NIA ~_ti1 ~ ~ . , .~~L'=,',
JOB ADDRESS ~ ~~
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LEGAL
1. DESCR. LOT N0. BLK. TRACT
^ SEE ATTACHED SHEET
OWNE MAIL ADDRESS ZIP ~ PHONE r
~>-
CO FACT R ~ MAIL ADDRESS ~, ZIP PHDNEti
4. Class of Work: O NEW O ADDITION ®REMODEL
5. Describe Work: ~ ~, - O Finished Basement O Unfinished Basement
G `"
6. Total Sq. Footage (Including Basement and Garage>: Total Finished Area:
ca
7. Valuation of Work: $
Floodway O Yes O No Dev. Permit
Flood
8
lain: Elev. Cert.
.
p
Fringe O Yes O No BFE
9. Current Zoning: ®Site Plan Attached .~~ O~~mlete Plans Attached
i
D
C
10. State Fire Marshall Required: O Yes ®No ate
Approximate
omplet
on
Inspections Required and Fees
11. Special Use Permit Required: O Yes ®No Utilities
12. Variance Required: ®Yes ®No Sewer Water Service
13. Minimum Setbacks: Front Side Rear
Septic
Remote
14. Sidewalk Required: O Yes ®No Waiver Approved
Buildin Stop Box Card
f~C~r~e "` 7~~ ~1 '~
N®TIC 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
of the building permit application fee does not constitute issuance of this building Framin Final
permit. I further agree that construction covered by this permit application shall not be g
commenced until I have received a copy of this application form signed by the Building
I
t Electrical
nspec
or.
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.luntlerstandthatthispermitisvoidifworkisnotcommencedwithin Final PermanentSe~vice
180 days or is not completed within 2 ears of date of issue. Temporary Service
,~
Mechanical
SIGNATURE OF OWNER/CONTRACTOR DATE Rouah-in air,
Comment:
Final
Plumbing
Ground Work
Rough-in
Final
WHEN PROPE Y VALIDATED (IN THIS SPACE) THIS IS YOUR PERMIT
Approved By:---~ j
~I
POUNDS PRTG.-Blair, NE Rev. el96
__ ~Ayf_'j1 ~: ~.
TI'Y OF BL;AIR ^ WASHINGTON COUNTY ^ OTHER
LOCATION'OFINSPECTION: ~~~ ~~~~`~~°~
NAME OFOWNER: / ~i ' ~ ~~c:~ ~~ r°P' CONTRACTOR: ~~r /f,/: d~
DATE INSPECTION REQUESTED: ~'~ ~ ~ ~ PERMIT N0: ~, ~~ . `~~
TIME INSPECTION REQUESTED: ~`~' r~
TYPE OF INSPECTION REQUESTED:
BUILDING: ~~
^ FOOTING ^ FRAMING ^ DRYWALL ~H`INAL
UTILITIES:
^ SEWER TAP ^ SEWER ^ SEPTIC ^ WATER TAP
^ REMOTE
i ^ WATER SERVICE
ELECTRICAL:
^ ROUGH IN ^ FIXTURES ^ FINAL ^ MOTORS
^ PERMANENT SERVICE ^ TEMPORARY SERVICE
MECHANICAL:
^ ROUGH-IN ^ A/C ^ FINAL
PLUMBING:
^ GROUNDWORK ^ ROUGH-IN ^ FINAL
RESULTS OF THE INSPECTION: ~`^ PASSED (saexo~rFS~ AILED (s~xoTSS~
NOTES/REMARKS: °i~~'` P`;~~`~"' ~~ ° sf~~r'c~' ~P~C/~;`~'--'~'./!
INSPECTOR:
DATE OF INSPECTION MADE: .~~ ~ TIME: _~
CALLED OPPD\ TO CONNECT SERVICE: ^ YES ^ NO
WANT OFFICE STAFF TO CALL OPPD\ ^ YES ^ NO BLR 1 .