BP7405BUILDING PERMIT APPLICATION
Permit Fee: ~~ Jurisdiction of City of Blair, Nebraska
218 South 16th Street
Issuance Fee: Blair, Nebraska 68008 7 4 0 5
Deposit Receipt #: (402) 426-4191 • Fax (402) 426-4195 Permit
1
Application Date: a~ 1 ~ % Issue Date: ~
JOB ~DDRESS .~,
JJ1 4 i r
C~
LEGAL
1 . DESCR. LOT ND. BLK. TRACT
^ SEE ATTACHED SHEET
OWE r _ ~1 MAIL ADDRESS -Eh
2. ~ l-e.~ ~ f r I C~ U ZIP
U d~ / PH
u Z b "~ 7 7 7
CO TRACTOR j~ ~1 MAIL ADDRESS r 1
3. ~ h r` Kov7 i r1 ~~~rf~r ~ ~ u r 1`V'c~~t t-S~ , ZIP
(~ g PHONE
~-( 2,(c~ ~ 2~
4. Class of Work: NEW O ADDITION O REMODEL
5. Describe Work: O Finished Basement O Unfinished Basement
O i Vl S ~a ~ ~ . ~ ~ d~ C
6. Total Sq. Footage tln~mding Ba6emenr and Garage>: Total Finished Area:
7. Valuation of Work: $ ~ ~ ~ , (~
Floodway O Yes O No Dev. Permit
8. Floodplain: Fringe O Yes O No BFE
Elev. Cen.
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 codes/ordinances of the City of Blair and the
State of Nebraska. I understand thatihis permit is void if work is not commenced within
1 a or i not completed hin 2 year of dat of issue.
-/3 -~
IG TURE OF 0 ER/CONTRACTOR DATE
Comment:
O Site Plan Attached O om lete Plans Attached
Approximate Completion Date ~ "G
Inspections Required and Fees
Utilities
Sewer Water Service
Septic Remote
Stop Box Card
Building
Footings Drywall
(before finish)
Framin ~7 O,
Final r " _ `~
g
Electrical
Rough-in Fixtures
Final Permanent Service
Temporary Service
Mechanical
Rough-in A\C
Final
Plumbin
Ground Work
Rough-in Final
WHEN PROPERLY VALIDATED THIS ACE) THIS IS YOUR PERMIT
Approved By: „, _ p,
POUNDS PRTG: Blair, NE Rev. 6796
BLTLI:..I~.ING INSPECTION.
~._ . - REPORT
ITY OF BIAIR ~ WAS~GTON COUNTY ~ 0~~
i
LOCATION OF INSPECTION: ~> ~ ~`! ~' ~~~/
~-r
-NAME OF OWNER: ~. ~~
DATE INSPECTIONREQUESTED: .~'`~",,'"`- ~~
PERI6IIT N0: ~~~~~
TIME INSPECITON REQUESTED: j~
~ TYPE OF,INSPECTION REQUESTED:
~,
BUILDING:
~ ". .
FOOTING ~ .r`~ '~- ?'
FRAMING ^ DRYWALL -~
'~ A1.
UTILITIES:
i
` CI s.EwER TAP ~ SEWER
^ SEPTIC ~] WATER TAP
~ > , ^ REMOTE ~ WATER SERVICE
~ ,ELECTRICAL:
ROUGI~ IN ^ FIXTURES ~ FINAL ~ MOTORS
I. __
PERMAIVINT SERVICE
^ TEMPORARY SERVICE -
MECHANICAL:-
OROUGH=IN
j ^ A/C ~-FINAL
PLUMBING:
- -------- - - -^GROUNDWORK ------_ ....--
ROUGH=~-~ ~~
RESULTS OF THE INSPECTION: ~
ASSED ls~xo~s~ ^FAILED (s~xo~s>
NOTESfREMARKS:
.-
,~~ -
i
INSPECTOR: ~ -
. DATE OF INSPECTION MADE: .~' ` ~`~` `~ ~ r
,~~~" TIME: ~ ;
CALLED OPPD\ TO CONNECT SERVICE:
i _ ^ YES ~NO
WANT OFFICE STAFF TO CALL OPPD\
' ^ YES " . ~ Np
BLR_ 1