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BP7456BUILDING PERMIT APPLICATION Permit Fee: ~©~ Uv _a° Issuance Fee: Deposit Receipt #: .3 ~~ 7 Jurisdiction of City of Blair, Nebraska 218 South 16th Street Blair, Nebraska 68008 (402) 426-4191 ~ Fax (402) 426-4195 Permit- Application Date: ~D -- J ~~ ~~o Issue Date: I~ ° ~ ~ ~lO JOB ADDRESS I ~ ~ 7 ~v ~. LEGAL 1. DESCR. LOT ND. BLK. TRACT ^ SEE ATTACHED SHEET OWN 2. ~ ~ MAIL ADDRESS ZIP PHONE CONTFlACTOR 3. MAIL ADDRESS a ~ ZIPh~ f~g ~! 2. 7 75CQ 1 YYtc~l. ~'~ ~~-**-t_ ~~3 PHONE 33/-0 ~~~' .(" 4. Class of Work: O NEW O ADDITION O REMODEL 5. Describe Work: ~ O Finished Basement O Unfinished Basement 6. Total Sq. Footage (IRCIudiRg easement and Garage): Total Finished Area: 7. Valuation of Work: $ ~~D©,C~ p 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 11. Special Use Permit Required: O Yes 12. Variance Required: O Yes O No O No O No 13. Minimum Setbacks: Front Side Rear 14. Sidewalk Required: O Yes 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 bythe 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 da s or is not completed within 2 years of date of issue. `~' /D ^ ~.~ !' SIGNATURE OF OWNE ONTRACTOR DATE Comment: O Site Plan Attached O om lete Plans Attached Approximate Completion Date ~a ~~ ~` ~~ Inspections Required and Fees Utilities Sewer Septic _ Buildin Footings Framing Electrical Rough-in Final Temporary Service Mechanical Rough-in _ Final - Plumbina - Ground Work Rough-in Final WHEN PROPERLY VALIDATED (IN THIS SPACE) THIS IS YOUR PERMIT Approved By: ~ _ i Water Service Remote Stop Box Card Drywall (before finish) Final f~~O- Fixtures Permanent Service A\C 7456 POUNDS PRTG: Blair, NE Rev. 8l9fi - ~' ~ BUILDING INSPECTIONREPORT - ~:.,~, CITY OF BI:AIR ^ WASHINGTON COUNTY ^ OTHER ~ ./ ~~ ~ LOCATION OF INSPECTION: ~~~ . ~O ~ C- ~ fi -, -,~~ NAME OF OWNE[~~~.~~f f/-~ CONTRACTOR: _: DATE INSPECTION REQUESTED: PERMIT N0: ~ >~~ ~.: . • TIME INSPECTION REQUESTED: _ r ~ TYPE OR INSPECTION REQUESTED: ~ ~~ ~~~~/ BUILDING: ' ~~: ~, ^•FOOTING ^ FRAMING ^ DRYWALL . f /FINAL [':- ' UTILITIES:: ~! ~' ^ SEWER TAP ^ SEWER ^ SEPTIC ^ WATER TAP - ^ REMOTE . ^ WATER SERVICE ' ELECTRICAL: - ^BOUGH W ^ FIXTURES ^ FINAL ^ MOTORS ^ PERMANENTSERVICE . . ^ TEMPORARY SERVICE ~.. , ~~ MECHAMCAL: , ^ ROUGH-IN ^ A/C ^ FINAL PLUMBING: (( ^ GROUNDWORK ^ ROUGH-IN ^ FINAL t RESULTS OF TI-IE INSPECTION: " PASSED ~s~xm~ES> ^FAILED ~s~xo~rFSI NOTES/REMARKS: = ~~/ / ~ DATE:OF IIYSPECTION MADE: ;'/ /t-~' ~" f~ f 'I~Iy[g; ~ ~f ~ - CALLED OPPD\ TO CONNECT-SERVICE: ^ YES ^NO WANT OFFICE STAFF'I'O CALL OPPD\ ^-.YES ;^ NO BLR_ i