BP7330BUILDING PERMIT APPLICATION
~® pU Jurisdiction of City of Blair, Nebraska
Permit Fee: 218 South 16th Street
Issuance Fee: Blair, Nebraska 68008 7 3 3 0
Deposit Receipt #: (402) 426-4191 ~ Fax (402) 426-4195 ~ Perm"
~~
Application Date: ~~~/~~ Issue Date:
JOBADDRESS~~~ /U
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LEGAL
1. DESCR. LOT N0. BLK. TRACT
^ SEE ATTACHED SHEET
2.OWN MAIL ADDRESS ZIP ~~ PHO~ J
CONT CT
3. AIL ADDRESS -~~ ~ ZIP PHONE
4. Class of Work: O NEW O ADDITION O REMODEL '~7~~'T"~7
5. Describe Work: ~~ -. O Finished Basement O Unfinished Basement
6. Total Sq. Footage (Including Basement and Garage): Total Finished Area:
~~3 / ~
7. Valuation of Work: $
Floodway O Yes O No
8. Floodplain: Fringe O Yes O No Dev. Permit
BFE
Elev. Cert.
9. Current Zoning:
10. State Fire Marshall Required: O Yes O No
11. Special Use Permit Required: O Yes O No
12. Variance Required: O Yes O No
13. Minimum Setbacks: Front
14. Sidewalk Required: O Yes
Side Rear
O No 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 copy of 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 codeslordinances of the City of Blair and the
State of Nebraska. I understand that this permit is void if work is not commenced within
180 s or is not completed within 2 years of date of issue.
U~ -
SIGNATURE OF OWNER/CONTRACTOR DATE
Comment:
O Site Plan Attached ~~ mp~~ ans Attached
Approximate Completion Date
Inspections Required and Fees
Utilities
Sewer Water Service
Septic -
Buildina
Footings
Framing
Electrical
Rough-in
Final
Remote
Stop Box Card
Drywall -
(beforefinish)
Final ~~~~~
Temporary Service
Mechanical
Rough-in _
Final
Plumbin _
Ground Work
Rough-in
Fixtures
Permanent Service
A\C
Final
WHEN P LIDATED (IN THIS SPACE) THIS IS YOUR PERMIT
Approved By; _ O
POUNDS PRTG: Blair, NE Rev. 6/96
• 1 ELECTRICAL:
^ ROUGH IN ^ FIXTURES
^-FINAL ^ MOTORS
~.PERMANENTSERVICE ~TEMPORARYSERVICE
` 1VIECHANICAL: - .
~ ^ ROUGH-IN ^ AJC
,. ~ FINAL
_
PLUMBING;
I '-
i;..: ' _
^ GROUNDWORK .
Q ROUGH-IN ^ FINAL ; -
- --- ------ - -----' - ---- ~ RESULTS OF THE INSPECTION:: _ ~PA$SED ~s~.xoTES -_ - ---- _._- - ----
FAILED (sue rroTFS~
I NOTES(REMARKS:
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DATE OF WSPECTION'MADE: ~
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TQ CONNECT SERVI~E• [~ YFS
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° ~ANT`OFFICE STAFF T~ CALL OPPD\ , t0 YE5 '_` ^ N0
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