BP8758The City of Blair Building Permit Detail
Permit #: 8758 Issued: 01/20/2000
Completed: 04/07/2000
Owner: Jorgensen Contracting
Address: 628 Front St
Blair, NE 68008
Phone: 402-426-4440
Type: Industrial/Commercial -New Const.
Valuation: $21,000.00
Section: Township: Range:
Subdivision: K-SPAN Lot: 9
Wick Bldg 40x80, equipment storage, no electrical
Inspections Date By
04/07/2000 DEM
Final Inspection of Project
Permit Fee: $105.00
Issue Fee: $15.00
Deposit Amt.: $200.00
Receipt #: 1690
Block:
Pass
Remarks
Contractors
Jorgensen Contracting, Inc.
General Contractor
Permit # Issued
BUILDING PERMIT APPLI
p~j pp I~U,Oh Jurisdiction of City of Blair, Nebraska
Permit Fee: ~dddd~~+ 218 South 16th Street
Issuance Fee: ~S' ~~ Blair, Nebraska 68008
Deposit Receipt #: l~°~C (402) 426-4191 • Fax (402) 426-4195
~~~~ C~~
Application Date: /~ ~~ ~ W Issue Date: ~ ~ ~ "tea
JOB ADDRESS /~ o~
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LEGAL
1. DESCR. LOT NO.
~ BLK. TRACT
- ~
~/1 ^ SEE ATTACHED SHEET
OWNER 1~-}-~MA~IL ADDR SS
2. ~ ~~ 1 ~ 1 \ \ V ~ r l..
ZIP ~~ , ° ~ V
CONTRA TOR MAIL CRESS
3. ~ ~J~ ~Y
C~~ ZIP PHONE
Sfi~.>~.e--
4. Class of Work: NEW O ADDITION O REMODEL
5. Describe Work: ~l ~~ bl X O ~ O Finished Basement O Unfinished Basement
~ u ~ ~V I
6. TOta Sq. FOOtage (Including Basement and Garage): 3 Z Total Finished Area:
7. Valuation of Work: $ Z
Floodway O Yes No
8. Floodplain: Fringe O Yes No Dev. Permit
BFE Elev. Cert.
9. Current Zoning: ~~ Cl'l ~
10. State Fire Marshall Required Yes ,,~?I' No
11. Special Use Permit Required: D Yes ..•••~~~~~1111! ~~~~~o
12. Variance Required: O Yes ~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 copyof 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 days or is not completed within 2 years of date of issue.
Comment:
MEET UBC, UPC, UMC AND
NEC CODE REQUIREMENTS
Q~~
~~~
O Site Plan Attached ' O Co~mple~ t~Je P~lalts Attached
Approximate Completion Date ,`
Inspections Required and Fees
Utilities
Sewer
Septic
Building
Footi
Fran~igg''f
Electrical
Rough-in
Final
Temporary Service
Permit a 7 5
Water Service
Remote
Stop Box Card _
Drywall
(~be-forme finish)
~~
Fixtures
Permanent Service
A\C
DATE Mechanical
Rough-in _
Final
Plu- mbina -
GroyAd~/ork
WHEN PROPERLY VALIDATED (IN THIS SP~CCF~-TH1S-1S YOUR PERMIT
CATION
POUNDS PRTG: Blair, NE Rev. B/96
NEBRASKA STATE FIRE MARSHAL
- -- - - •
ode eview -- - --
~,~ GIJ Plans Division ^ District "B" ^ District "C"
02-18-2000 102055-00
JERRY
JORGENSEN CONTRACTING INC
530 FRONT ST
BLAIR, NE 68008 .
EQUIPMENT STORAGE
JFS
628 FRONT ST
BLAIR, NE 68008
~ Mq
Q. 9
'~ ND
NFBRAS~P
*Review and approval is conditional upon conformance with comments listed in remarks.
O Preliminary Plans and O Reviewed for compliance ~ Resubmit for Approval*
Specifications Reviewed" with State Accessibility
Guidelines`
O Final Plans and
Specifications and Approved* ~ Shop Drawings Approved* ~ Materials Reviewed"
REMARKS:
This code review does not include a determination of compliance with State of Nebraska
Accessibility Guidelines. This compliance must be determined by the local jurisdiction in which
the project is located.
1. Exit sign shall be provided. LSC, 29-2.10
^ Plans Division ^ District "A"
246 S. 14 246 S. 14
Lincoln, NE 68508-1804 Lincoln, NE 68508-1804
(402) 471-2027 (402) 471-2590
SFM-75a (Rev. 2/99)
Copies lo: Recipient, Fire Chiel, Deputy, OKce File, Extra
e.r re.r~r ~ nrr~ucrf
® District "B" ^ District "C"
438 West Market 200 South Silber
Albion, NE 68620-1241 North Platte, NE 69101-4200
(402) 395-2164 (308) 535-8181
Printed with soy ink on recycled paper
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Blair
BUILDING PERMIT DEPOSIT AGREEMENT
A $200.00 refundable deposit is being collected at the time of your building permit
application for all permits in excess of $10,000.00. However, the City reserves the
right to not refund this deposit if any of the following conditions occur during the
construction period: 1) theft of water service by either the plumber, owner or general
contractor, 2) all required inspections have not been obtained (this includes drywall
prior to taping), 3) occupancy occurs prior to a final inspection, 4) all permits have
not been obtained, and 5) the project. is completed without a final inspection being
done. If any or all of these situations occur during construction, you may forfeit your
deposit.
I, hereby agree to the above conditions, and understand that should any or all of the
above situations occur, the building permit deposit-may be forfeited or discounted
upon the discretion of the City of Blair, Building and Inspections Department.
City of Blair
~ ~d -~ G
Date
city of
218 3.16TII 3~'REET, RLAIR, NE 60008.2010. (402) 426.4191 • (402) 426.4195 FAX ®E-MAIL: cityofblair@huntel.net ~on~x~
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Blair
BUILDING PERMIT SUPPORTING DOCUMENTS
This building permit packet includes various items dealing with particular code
requirements and/or building permit requirements. It in no way includes ALL particular
code items. Also, it is your- .responsibility to know the Uniform Building Code
requirements that apply to your project. Please understand this packet is only designed
and distributed to aid you in your building permit process. The Uniform Building Code is
available for your use at the Blair Public Library.
I have read the above disclosure and accept this building permit documentation on my
own behalf assuming full responsibility as the owner/contractor for this project.
Owner/Occupant
~~~~~~
City of Blair
Date
e~~y of
~-
21II ~. l~~li[ S~'R~~~', ~LAttt, l~l; 6000.2010 ~ (402) 426-4191 ~ (402) 420-4195 ~'A~ a li;~V1AI1,: cityofblair@huntel.net ~~A~~a~u~
OPPOgNNRY
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BUILDING INSPECTION REPORT
.,~.: ~,
CITY OF BLAIR ^ WASHINGTON COUNTY ^ OTHER
LOCATION OF INSPECTION: --~ ~~ ~~~'
NAME OF OWNER;_~~~~I/'~rG ~t~- ~~f ~?l- ~ CONTRACTOR: ~ ~ +
DATE INSPECTION REQUESTED: ~ `~ _ ~°-~ TIME INSPECTION REQUESTED: tJ ~. PERMIT N0: ~ ! ~ ll
TYPE OF INSPECTION REQUESTED: ~ ,~f ~~ ^ CONFERENCE ^ STATUS CHECK.
BUILDING: ^ FOOTING ^ FRAMING ^ DRYWALL FINAL ^ PARTIAL PASS FAILED
COMMENTS: ^
UTILITIES: ^ SEWER TAP ^ SEWER ^ SEPTIC ^ WATER TAP ^ REMOTE ^ WATER SERVICE PASSED FAILED
^ PARTIAL ^ ^
COMMENTS:
ELECTRICAL: ^ ROUGH IN ^ FDCTURES ^ FINAL ^ MOTORS ^ PERMANENT, SERVICE ^ TEMPORARY SERVICE PASSED FAILED
^ PARTIAL ^ ^
COMMENTS:
MECHANICAL: ^ ROUGH-IN ^ A/C ^ FURNACE ^ FINAL ^ PARTIAL PASSED FAILED
COMMENTS: ~ ^
PLUMBING: ^ GROUNDWORK ^ ROUGH-IN ^ FINAL ^ WATER METER INSTALLED ^ PARTIAL PASSED FAILED
COMMENTS: ^ ^
^ OCCUPANCY GRANTED ^ CONDITIONAL OCCUPANCY GRANTED
NOTES/REMARKS:
FAXED OPPD1
e:~-r/ DATE OF INSPECTION MADE: ~ ~ ~U TIME: C/ ~G~1
TO CONNECT SERVICE: ^ YES ^ NO