BP7861
Application Date
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Permit
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Issue Date: ~ l 5~° ~ ~
JOB ADDRESS ~ ~ ~ ~ F J ~~
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LEGAL
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CONTR fS MAIL ADDRESS `~ ZIP
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4. Class of Work: ®NEW O DDITION ®REMODEL
5. Describe Work: .~ „ ~~ ®Finished Basement ®Unfinished Basement
6. Total Sq. Footage (Including Basement and Garage}: Total FInlShed Area:
7. Valuation of Work: $ ~, ®n a ,~
Floodway O Yes O No Dev. Permit
8. Floodplain: Fringe O Yes O No BFE
Elev. Cert.
9. Current Zoning: ®Site Plan Attached ~ Complete Plans Attached
Approximate Completion Date ~ ®f `~ ~
10. State Fire Marshall Required: O Yes ®No
Inspections Required and Fees
11. Special Use Permit Required: O Yes O No Utilities
12. Variance Required: ®Yes ®No Sewer Water Service
13. Minimum Setbacks: Front Side Rear
Septic
Remote
14. Sidewalk Required: O Yes O No Waiver Approved Stop Box Card
Buildina
~®~'~ 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
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of the building permit application fee does not constitute issuance of this building Framin Final
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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 bythe 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 ofNebraska.lunderstandthatthispermitisvoidifworkisnotcommencedwithin Final Permanent Service
180 days or is not ompleted within 2 years of_date of issue.
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Temporary Service
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Mechanical
SIGNATURE OF OWNER/CONTRACTOR ~ DATE Rouah-in air.
Comment:
Final
Plumbing -
Ground Work
Rough-in _
Final
WHEN PROPERLY VALIDATED (IN THIS SPACE) THIS IS YOUR PERMIT
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POUNDS PRTG: Blair, NE Rev. B/96
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~C~iTl' OF BI:AiRyr- ^ WASHINGTON COUNTY ^ OTHER
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LOCATION OF INSPECTION: ~~ ~ ~ ~ ' " / "~
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NAME OF OWNER: ~~~ ~-n~~~' ~ ~ CONTRACTOR:
DATE INSPECTION REQUESTED: ~ ~-~ ~~ , ~ PERMIT NO: ~ ~~~
TIME INSPECTION REQUESTED:
TYPE OF INSPECTION REQUESTED:
s'
BUILDING: ~ ,.~~~
^ FOOTING ^ FRAMING ^ DRYWALL [FINAL
P
UTILITIES:
^ SEWER TAP ^ SEWER ^ SEPTIC ^ WATER TAP
^ REMOTE ^ WATER SERVICE
ELECTRICAL:
^ ROUGH IN ^ FA I'URES ^ FINAL ^ MOTORS
^ PERMANINT SERVICE ^ TEMPORARY SERVICE
MECHANICAL:
^ ROUGH-IN ^ A/C ^ FINAL
PLUMBING:
^ GROUNDWORK ^ ROUGH-IN ^ FINAL
RESULTS OF THE INSPECTION. SSED (sEE rroTES> ^ FAILED (sES rro~rES)
NOTES/REMARKS:
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DATE OF INSPECTION MADE: / ~` ~ / ~ TIME: ~ _r~
CALLED OPPD\ TO CONNECT SERVICE: ^ YES ^ NO
WANT OFFICE STAFF TO CALL OPPD\ ^ YES ^ NO BLR 1 ~ ~ l