BP7662BUILDING PERMIT APPLICATION
U ° Jurisdiction of City of Blair, Nebraska
Permit Fee: 218 South 16th Street
Issuance Fee: Blair, Nebraska 68008 7 6 6 2
402 426-4191 • Fax 402 426-4195 ~ Permit
Deposit Receipt #: ~ ~
Application Date: '~~ y ~ Issue Date: J ~~
JOB ADDRESS L.,
c-T~J ~
LEGAL LOT N0. BLK. TRACT
^ SEE ATTACHED SHEET
1. DESCR.
OW R DDRESS ZIP PHONE
2
. C CTOR IL ADD SS ~
~ 19 -1 PHONE
~
3.
~
4. Class of Work: O NEW O ADDITION O REMODEL
5. Describe Work:. O Finished Basement O Unfinished Basement
6. Total Sq. Footage tlROii,dlRg easement and Garage>: Total Finished Area:
7. Valuation of Work: $ ~(~ p ~ ~
Floodway O Yes O No Dev. Permit Elev. Cert.
8. Floodplain: Fringe f7 Yes O No BFE
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 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 by the Building
Inspector.
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 thatthis permit is void if work is not commenced within
180 days or iss~r of completed within 2 years of date of issue.
SIGNATURE OF OWNER/CDNTRACTDR ~-- DATE
Comment:
O Site Plan Attached u V le[e clans nuacnCu
Approximate Completion Date ~ 3i
Inspections Required and Fees
Utilities
Sewer Water Service
Septic Remote
Stop Box Card
Buildin
Footings Drywall
(before finish)
-
Framing ~
. ~
Final ~~
Electrical
Rough-in Fixtures
Final Permanent Service
Temporary Service
Mechanical
Rough-in A1C
Final
Plumbin
Ground Work
Rough-in Final
WHE ERLY V ATED (IN THIS SPACE) THIS IS YOUR PERMIT
Approved B ~
~ Rev. flr9fi
-BOUNDS PRTG: Blair, NE
r, ~ o-
~` ~ B~TILDING INSPECTION REP ~____-
~` ORT
CITYOFBLAIIt ~ WASHINGTONCOU
NTY ~ OTxER
€° LOCATIO= r. _
N OF INSPECTION: `~~ L~ / ~
E.
NAD~.OF OWNER ~ ~~~ ~'-.Jr'~ ~''°` / r ,
~~
CONTRACTOR: " ' rte` `
D:ATEINSPEC'ITONREQUESTED: ~~/~/r J~°'~ ~(~
PERMIT N0:
TIMEWSPECTION REQUESTED: ` y ~f ,~-.
~' -
~' `- TYPE OF INSPECTION REQUESTED;
BUILDING:
^ FOOTING Q FRAMING ~ DRYWALL ~ ~ ~ ~~ -
_L--~,FII~TAL
'UTILITIES: .
k-= - Q SEWER TAP ~ SEWER
^ SEPTIC ~ WATER TAP
"REMOTE.
Q WATER SERVICE
ELECT
RICAL:
.ROUGH IN_ ~ FIXTURES ~ ~~ ^ MOTORS
(] PERMANENT SERVICE [] T~PpRARY SERVICE "_
.MECHANICAL:
RO UGH-IN ^ A/C .: 0 FINAL - ' ~' ~-~
PLUMBING:
^GROUNDWORK _._~. --- ---
----- ----- - ---- --- - - ~ ROUGN,~.-- --
FINAL -----
~` RESULTS OE THE INSPECTION: - 0 PASSED. s
.. (EENOTES) v AII.ED'(SEENOTES)
NOTES/REMARKS: ~-~ ~~ _. i