BP7824JOB ADDRESS ~- _ ~ ~ '
",~ ~-, P
LEGAL
1. DESC LOT ND. BLK. TRACT
®SEE ATTACHED SHEET
pyy MAIL ADDRESS ZIP PHONE
2.
CO 0 MAIL AD RESS ZIP PHONE -.,
4. Class of Work: ®NEW ®ADDITION ®REMODEL
5. Describe Work: ,~ ~.; ..~= „_ ~ ~;_-.- ~ .,.,~ ®Finished Basement ®Unfinished Basement
6. Total Sq. FOOtage (Including Basement and Garage): Total Finished Area:
C>.~
7. Valuation of Work: $ ~~ ---~
Floodway O Yes O No Dev. Permit Elev. Cert.
8. Floodplain: Fringe O Yes O No BFE
9. Current Zoning: ®Site Plan Attached Complete Plans Attached
Approximate Completion Date -
10. State Fire Marshall Required: ®Yes ®No
Inspections Required and Fees
11. Special Use Permit Required: ®Yes ®No Utilities
12. Variance Required: ®Yes ~ No Sewer Water Service
Septic Remote
13. Minimum Setbacks: Front Side Rear
14. Sidewalk Required: ®Yes ®No Waiver Approved Stop Box Card
NTICE
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 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 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 withjri°~ye~ , ate of issue.
Comment:
DATE
13uildin
Footings
Framing
Electrical
Rough-in
Final
Temporary Service
Mechanical _
Rough-in
Final
Plumbin _
Ground Work
Final
WHE r ROPERLY V~LIDATED (IN THIS SPACE) THIS IS YOUR PERMIT
l -~ ~ Rev. e/96
POUNDS PRTG: Blair, NE
Drywall
(before finish) /
Final ~~~( ~
Fixtures
Permanent Service
A\C
_ -~ -
t. }
`- ~_ `, GLAIR ^ WASHING/ETON COUNTY ^/ OTHER
LOCATION OF INSPECTION: ~ /~4~ ~~' ' r %'~ ~~
`~ c~ .~1
NAME OF OWNER: ';~.~~"~ f~~71 C_L~~;~c= CONTRACTOR:/'"'~U'?~"~'~ ~~'S F
,_ ~ ~ ~'. ~
DATE INSPECTION REQUESTED: ~ ..- '' f~ `7s'PERMIT NO: ''a
TIME INSPECTION REQUESTED: .~~..-~`
r'
TYPE OF INSPECTION REQUESTED:: ~'
f`a
BUH.DING: ,~-
^ FOOTING ^ FRAMING ^ DRYWALL -::~ 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: ASSED (sue rro~s) ^ FAILED (sue rro~s)
DATE OF INSPECTION MADE: _t~1 ~! ~ TIME: ~ ~ ` •-~
..,
CALLED OPPD\ TO CONNECT SERVICE: ^ YES ^ NO
WANT OFFICE STAFF TO CALL OPPD\ ^ YES ^ NO BLR 1
NOTES/REMARKS: