BP7963Jurisdiction of City of Blair, Nebraska
Permit Fee: ~~~-=-~~"`~~ 218 South 16th Street
Issuance Fee: t'I~ Blair, Nebraska 68008
Deposit Receipt #: ~ (402) 426-4191 ®Fax (402) 426-4195
Application Date: ~ ~ 7 ~ ~' ~ Issue Date: '~` ~~`~'~,/
JOB ADDRESS
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LEGAL
1. DESCR. LOT NC. BLK. TRACT
^ SEE ATTACHED SHEET
OWNER .~~" } ? MAIL ADDRESS ZIP PHONE
2. ;fit ,. ~) tt~' °`" ~~
CONTRACTOR ~ ~~~ ~., MAILADDRE S. ~
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3 _~~ ,4~ ` `~` - /~ ZIP PHONE
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4. Class of Work: NEW O ADDITION O REMODEL
5. Describe Work: ~'~~~~~ ~ ~ , s,Y ~ O Finished Basement O Unfinished Basement
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6. Total Sq. Footage (Including Basement and Garage): Total Finished Area:
7. Valuation of Work: $ i ~' ~ °~ o°` ~~~~
Floodway O Yes O No
Floodplain:
8 Dev. Permit
Elev. Cert.
.
Fringe O Yes O No BFE
9. Current Zoning:
10. State Fire Marshall Required: O Yes
11. Special Use Permit Required: O Yes
12. Variance Required: O Yes O No
13. Minimum Setbacks: Front
14. Sidewalk Required: O Yes O Nc
® No
O No
Side Rear
Waiver Approved
NOTICE
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.within 2 years of date of issue.
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SIGNATURE O~OWNER/CONTRACTOR BATE
Comment:
O Site Plan Attached O Complete Plans Attached
Approximate Completion Date
Inspections Required and Fees
Utilities
Sewer _
Septic _
Buildina
Footings
Framing
Electrical
Rough-in
Final
Temporary Service
Mechanical
Rough-in _
Final -
Fixtures
Permanent Service
Plumbina .
Ground Work
Rough-in
A\C
Final
POUNDS PRTG: Blair, NE
WHEN PROPERLY VALIDATFh?'(IN THIS SPACE) THIS IS YOUR PERMIT
Approved 6y: ~~
~ '~ ~~_, i __~-
Rev. 6196
Permit
Water Service
Remote
Stop Box Card
Drywall
(before finish)
Final ~°~` ` )
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~CTI'Y OF BI;AIR ^ WASHINGTON COUNTY ^ OTHER
LOCATION OF INSPECTION: ' ~~~~~ f`~~ ~'l// ~'~~
NAME OF OWNER:~~"/ ~L~'`r~~~-~ CONTRACTOR: %~~~~ ,
DATE INSPECTION REQUESTED: ~~ ~~ ~ PERMIT N0: ~ f
TIME INSPECTION REQUESTED: ~ ~ ~° d``
TYPE OF INSPECTION REQUESTED:
BUILDING: ~
J~t`' .~°
^ FOOTWG ^ FRAMING ^ DRYWALL`FINAL
UTILITIES:
^ SEWER TAP ^ SEWER ^ SEPTIC ^ WATER TAP
^ REMOTE ^ 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 (s~xo~s) ^ FAILED (sue xo~res)
NOTES/REMARKS:
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CALLED OPPD\ TO CONNECT SERVICE: ^ YES . ^ N0
WANT OFFICESTAFF TO CALL OPPD\ ~ ^ BLR 1
• .:~_ -AYES ___-~ NO - _ - - _
DATE OF INSPECTION MADE: ~~ ~~ ~ ~ TIME: ~~ ' `-~