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BP12535Blair Building Permit Detail Permit #: 12695 Issued: 4/10/2007 Type: Accessory Building Completed: 7/6/2007 Valuation: 23040 Location: 14373 Hwy 91 owner: John McClain Permit Fee: 128 Address: 14373 Hwy 91 Issue Fee: 20 Deposit Amt.: 500 Blair, NE 68008 Receipt #: 19143 Phone: Section: Township: Range: Subdivision: Lot: Block: Building a two car garage. Will have electrical. Not attached. Contractors D.A. Boswell Company General Contractor Permit # Issued Dick's Electric Electrical Subcontractor E2686 6/18/2007 Remarks 4/25/2007 DEM Rain footings full of water. Wasted trip. Inspections Date By 4/24/2007 DEM Footings Fail 5/1/2007 DEM Footings Pass 7/6/2007 DEM Electrical Final Pass 7/6/2007 DEM Final Inspection of Project Pass 1Pamsa°s�; CITY OF BLAIR - APPLICATION FOR BUILDING PERMIT Permit # Date: If 0- 07 Approximate Completion Date: C- t -u-7 Site Plan Attached: X REScheck Attached: Complete Plans Attached Application for: Residential X Commercial/Industrial New Construction _ Manufactured Home _ Modular Move -on: Home Accessory Building Other Remodel Addition Accessory Building: Garage >< Pole Barn Other Floor Type: Dirt Concrete Electricity: Yes— No Other Utilities: Public Water: Yes No _X Private Well If yes, responsible entity: Blair OPPD Line Kennard Agreement needed: _ Date Agreement Received: Public Sewer: Yes No >� Septic Drawing Provided: If yes, responsible entity: Blair Kennard County Road Permit Required: Yes_ No _/ Submitted: Yes —No Additional Destct��ription of project if necessary: 6 u.I � � ` n c Ck � c e r ^ q4 lr C . Project Information: Job Address: J4 -73 SJ- 11 wv 1 Legal Description (if applicable) Owner: J��r /111s,"� Address: Phone#: Contractor: b`A, 605we-11 0' Phone #:933--/w0 Address: gs-YL S- Hu -,,t 3o Cell #: Separate permits are required for electrical, plumbing, heading, ventilating and air conditioning, and septic systems. By my signature below, I acknowledge this building permit application 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 a permit 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 that this permit is void if work Is not commenced within 180 days or is not completed within two (2) years of date of issue. Signature of OCvneiltontractor Date ELECTRICAL PERMIT APPLICATION Jurisdiction of City of Blair, Nebraska 218 South 166 Street Blair, Nebraska 68008 Fax (402) 426-4195 E 2686 7 (402) 426-4191 �;,� 1"20 95 Application Date: 6-40 — � / / Permit Fee: $ s8. a 5 Job Address / / ra0 ^`'� �� Phone Owner eess$g ad v� on[rnctor ' p ,L 2 ,g a d� idu li 3. Class of Work: ❑ NEW RESIDENTIAL ❑ NEW COMMERCIAL ❑ REMODELING/ADDITIONS ❑ UPGRADE SERVICE 4escribe Work: ,/? _ /-Q Lf1 5.Current License on File Ye C3(Nom13 /A Completion Date ELECTRICAL PERMIT FEES Service Fee — (Amp Fee + 2.00 per branch circuit) Upgrade Existing Service.............$10.00 I-100 Amp Fee .......................$13.00 Temporary Service.................... $10.00 101-200 Amp Fee .......................$18.00 201-300 Amp Fee .......................$30.00 Fire Alarm System ..................... $10.00 301-400 Amp Fee .......................$42.00 Signs ...................................... $15.00 401-500 Amp Fee .......................$55.00 Miscellaneous Apparatus .............. $11.00 501-600 Amp Fee .......................$67.00 AC/DC Circuit ........................... $5.00 601-700 Amp Fee .......................$80.00 Commercial/Multi Family and All Upgrades: 701-800 Amp Fee .......................$92.00 801-900 Amp Fee.....................$105.00 # of Circuits x $2.00 901-1000 Amp ........................$117.00 Amp Fee d U IF OVER 1000 Amp p v 1"1000 Amp Fee..................$117.00 Amp Fee + Circuit Total Each additional 100 Amps ......... $13.00 New Residential: (Finished Area) Single/Two Family Dwellings Notice sq. ft. x.045 I hereby certify that I have read and examined this application and know the same to be true and correct. All Modular/Manufactured Homes ...... $50.00 provisions of laws and ordinances governing this type of Receptacle/Switch Outlets work will be complied with whether specified herein or not. The granting of a permit does not presume to give Fixtures ! x $.75 5 authority to violate or cancel the provisions of any other Smoke Detectors x $3.00 state or local law regulating construction or the Residential/Commercial Appliance performance of construction. # Fixed Outlets x $3.00 Motor(s) x $3.00 Power Apparatus (220 Volts) XJ S/1 Z Q #Apparatus x $5.00 Signature of Contractor or Authorized Agen Q�-JJ UO Permit Issuance Fee....................$20.00 0�0 Total JG . a5 Date Comment: WHEN PROPERLY VALIDATED (IN THIS SPACE) THIS IS YOUR PERMIT Approved By: I I 4 'e- O O �" 24'-0" -16�7O- 16-0" 24'-0" 4'_0" LEGAL DESCRIPTION: Tract 1: Part of Tax Lot 26, lying in the SW /, of the NE'/, and in the SE'/4 of the NW/4 of Section 9, Township 18 North, Range 11 East of the 6th Principal Meridian, Washington County, Nebraska and more particularly described as follows: From the WY4 Corner of Section 9, Township 18 North, Range 11 East; thence N 89031'48" E (assumed bearing) along the southerly line of the NWY4 of said Section 9 a distance of 1375.25 feet to an iron found on the southerly right-of-way line of State Highway 91, said point lying on a 1996.52 foot radius curve to the left and the Point of Beginning; thence along said southerly highway right-of-way line as follows: northeasterly along said 1996.52 foot radius curve an arc distance of 382.90 feet, said curve having a chord bearing of N 70°02'19" E and a chord distance of 382.32 feet; thence N 58046'47" E a distance of 297.77 feet; thence N 64032'11" E a distance of 275.77 feet to a Point of Curvature along a 1852.84 foot radius curve to the right an arc distance of 169.66 feet; thence N 87030'30" E a distance of 149.87 feet; thence N 5705920" E a distance of 127.02 feet to a point on a 1852.84 foot radius curve to the right; thence along said 1852.84 foot radius curve an arc distance of 128.16 feet to a Point of Tangency, said curve having a chord bearing of N 80°03'02" E and a chord distance of 128.13 feet; thence N 82001'55" E a distance of a distance of 404.08 feet to a Point of Curvature; thence along a 5649.21 foot radius curve to the right an arc distance of 336.13 feet; thence S 82°06'28" E a distance of 201.54 feet; thence N 80°21'23" E a distance of 218.33 feet; thence departing said southerly highway right-of-way line S 3704734" W a distance of 162.16 feet; thence S 13°35'12" W a distance of 184.77 feet to a point in the centerline of a creek; thence westerly along said creek centerline as follows: S 88°10'29" W a distance of 198.64 feet; thence N 35°1520" W a distance of 36.72 feet; thence N 75055'49" W a distance of 77.09 feet; thence S 27037'59" W a distance of 17.03 feet; thence N 88051'10" W a distance of 120.66 feet, thence S 42'14'30" W a distance of 65.40 feet; thence N 79033'41" W a distance of 73.58 feet; thence N 37041'00" W a distance of 136.44 feet; thence N 61°06'05" W a distance of 110.24 feet; thence S 44°30'08" W a distance of 68.10 feet; thence S 79038'58" W a distance of 145.78 feet; thence S 62055'00" W a distance of 151.88 feet; thence N 83058'44" W a distance of 48.25 feet, thence S 69°58'56" W a distance of 270.80 feet; thence S 371650" W a distance of 134.41 feet; thence S 78005'31" W a distance of 63.73 feet, thence N 51019'56" W a distance of 145.92 feet; thence S 77`25'44" W a distance of 50.88 feet;-L'ience S 36'2022' W a distance of 73.83 feet; thence S 24043'38" W a distance of 197.28 feet to a point on the southerly line of the NWY4 of said Section 9; thence departing said creek centerline S 89°31'48" W along said southerly 1/4 section line a distance of 627.25 feet to the Point of Beginning and containing 10.44 acres, more or less. SURVEYOR'S CERTIFICATION: I hereby certify that the survey shown and described hereon was made under my direct supervision and that I am a duly Registered Land Surveyor under the laws of the State of Nebraska. Ij Mit/o, VAND !D✓+� oyc__ fG: Radius -185 Richard L. Hansen ��. I_z: RICHAPD LEE Are Length -1i Registered Land Surveyor _ �:. HAN5EN ,0 Registration No. LS -382 1-5-382 E Date: December 8, 2005 g2 �ytOl Client: Don Boswell RAS ""nnnnnn" y11°�� N; Job No.: 05-147 G � � � y � � e \ )\c- ƒ 2 /00 e 3. p.06 a >61TY OF BLAIR LOCATIOr NAMEOF BUILDING INSPECTION REPORT ❑ WASHINGTON COUNTY" ❑ DATE INSPECTION REQUESTED- '`'-" A; ' /�--1 TIME INSPECTION REQUESTED 1'0:0014' ' PERMIT NO � (0 r 6 �' O TYPE OF INSPECTION REQUESTED: r ❑ CONFERENCE ❑ STATUS CHECK BUILDING: FOOTING ❑ DECKFOO//TING ❑ FRAMING [_1 DRYWALL [71 FINAL Ll PARTIAL PASSFgD FAI OO,4 ❑ COMMENTS: /4'baje"'7 UTILITIES.: ❑ SEWERTAP ❑ SEWER ❑ SEPTIC ❑ WATERTAP ❑ REMOTE ❑ WATERSERVICE PASSED FAILED ❑ PARTIAL ❑ ❑ COMMENTS: ELECTRICAL: ❑ ROUGH IN ❑ FINAL ❑ PERMANENT SERVICE ❑ TEMPORARY SERVICE ❑ PRECONNECT PASSED FAILED ❑ PARTIAL ❑ ❑ COMMENTS: MECHANICAL: ❑ ROUGH -IN ❑ A/C ❑ FURNACE ❑ RADIANT HEAT ❑ FINAL ❑ PARTIAL PASSED FAILED COMMENTS: PLUMBING: ❑ GROUNDWORK ❑ ROUGH -IN ❑ FINAL ❑ WATER METER INSTALLED ❑ PARTIAL PASSED FAILED ❑ PRESSURE TEST ❑ ❑ COMMENTS: ❑ OCCUPANCY GRANTED ❑ CONDITIONAL OCCUPANCY GRANTED It &)A S t� 1 i P DATE OF INSPECTION FAXED OPPD\BURT REA TO CONNECT SERVICE: r LOCATION OF NAME BUILDING INSPECTION REPORT ❑ WASHINGTON COUNTY ❑ OTHER DATE INSPECTION REQUESTED TIME INSPECTION REQUESTED:./ /j'- GD M ' PERMIT NO / I ft TYPE OFINSPECTION REQUESTED: ❑ CONFERENCE [_1 STATUS CHECK BUILDING: FOOTING ❑ DECKFOOTING ❑ FRAMING ❑ DRYWALL ❑ FINAL ❑ PARTIAL PASSPD FAILED ❑ COMMENTS: UTILITIES: ❑ SEWERTAP ❑ SEWER ❑ SEPTIC ❑ WATERTAP ❑ REMOTE ❑ WATERSERVICE PASSED FAILED ❑ PARTIAL ❑ ❑ COMMENTS: ELECTRICAL: ❑ ROUGH IN ❑ FINAL ❑ PERMANENT SERVICE ❑ TEMPORARY SERVICE ❑ PRECONNECT PASSED FAILED ❑ PARTIAL ❑ ❑ COMMENTS: MECHANICAL: ❑ ROUGH -IN ❑ A/C ❑ FURNACE ❑ RADIANT HEAT ❑ FINAL ❑ PARTIAL PASSED FAILED ❑ ❑ COMMENTS: PLUMBING: ❑ GROUNDWORK ❑ ROUGH -IN ❑ FINAL ❑ WATER METER INSTALLED ❑ PARTIAL PASSED FAILED ❑ PRESSURE TEST ❑ ❑ COMMENTS: ❑ OCCUPANCY GRANTED ❑ CONDITIONAL OCCUPANCY GRANTED DATE OF INSPECTION FAXED OPPDIBURT REA TO CONNECT SERVICE: /m� v TIME //-ZS- FAXED I CITY OF BLAIR LOCATION OF INSPECTION' 12,z -Y72 l/u-) tz 5;,/ BUILDING INSPECTION REPORT ❑ WASHINGTON COUNTY ❑ NAME OF OWNER' f��y��/ CONTRACTOR DATE INSPECTION REQUESTED- // TIME INSPECTION REQUESTED- PERMIT TYPE OF INSPECTION REQUESTED: ❑ CONFERENCE ❑ STATUS CHECK BUILDING: ❑ FOOTING ❑ DECK FOOTING ❑ FRAMING ❑ DRYWALL FINAL ❑ PARTIAL COMMENTS: FAILED UTILITIES: ❑ SEWERTAP ❑ SEWER ❑ SEPTIC ❑ WATERTAP ❑ REMOTE ❑ WATERSERVICE PASSED FAILED ❑ PARTIAL ❑ ❑ COMMENTS: ELECTRICAL: ❑ ROUGH IN 0 FINAL ❑ PERMANENT SERVICE ❑ TEMPORARY SERVICE ❑ PRECONNECT PASSED FAILED ❑ PARTIAL Ll MECHANICAL: ❑ ROUGH -IN ❑ AJC ❑ FURNACE ❑ RADIANT HEAT ❑ FINAL ❑ PARTIAL PASSED FAILED ❑ ❑ COMMENTS: PLUMBING: ❑ GROUNDWORK ❑ ROUGH -IN ❑ FINAL ❑ WATER METER INSTALLED ❑ PARTIAL PASSED FAILED ❑ PRESSURE TEST ❑ ❑ COMMENTS: ❑ OCCUPANCY GRANTED ❑ CONDITIONAL OCCUPANCY GRANTED DATE OF INSPECTION FAXED OPPD\BURT REA TO CONNECT SERVICE: C TIME . 3 `` �a pCD�p YDS.: v 4 ._ ♦ .)� 3.Nxy; ` d! � 3 cF 1 p A h d� r.` .y Y N S S�T4 Y ' R� • 4 �ia 5 3 r pCD�p YDS.: v 4 ._ ♦ .)� 3.Nxy; a N S S�T4 Y ' R� • �ia 5 ,CITY OF BLAIR LOCATION OF �/j NAME OF OWNER �� , T `^k r) CONTRACTOR -r DATE INSPECTION REQUESTED -2i TIME INSPECTION REQUESTED, PERMIT NO: BUILDING INSPECTION REPORT ❑ WASHINGTON COUNTY ❑ I-1 J `A1 TYPE OF INSPECTION REQUESTED: ❑ CONFERENCE ❑ STATUS CHECK BUILDING: ❑ FOOTING ❑ DECKFOOTING ❑ FRAMING ❑ DRYWALL FINAL ❑ PARTIAL PAS ED FAILED ��. ❑ COMMENTS: UTILITIES: ❑ SEWERTAP ❑ S ER ❑SEPTIC ❑WATERTAP ❑ REMOTE ❑ WATERSERVICE PASSED FATLED ❑ PARTIAL ❑ ❑ COMMENTS: ELECTRICAL: ❑ ROUGH IN FINAL ❑PERMANENT SERVICE ❑ TEMPORARY SERVICE ❑ PRECONNECT PAS FAILED I❑ PARTIAL ❑ COMMENTS: MECHANICAL:❑ ROUGH -IN ❑ A/C ❑ FURNACE ❑ RADIANTHEAT ❑ FINAL ❑ PARTIAL PASSED FAILED ❑ ❑ COMMENTS: PLUMBING: ❑ GROUNDWORK ❑ ROUGH -IN ❑ FINAL ❑ WATER METER INSTALLED ❑ PARTIAL PASSED FAILED ❑ PRESSURE TEST ❑ ❑ COMMENTS: ❑ OCCUPANCY GRANTED ❑ CONDITIONAL OCCUPANCY GRANTED DATE OF INSPECTION FAXED OPPD\BURT REA TO CONNECT SERVICE: FA TIME .a � N Q o CD a r" Blair Building Permit Detail Permit #: 12535 Issued: 8/9/2006 Type: Residential Additions Completed: 7/19/2007 Valuation: 13821 Pass Location: 1260 Park St DEM Framing Fail Owner: Micky & Lisa Nielsen DEM Permit Fee: 70 Address: 1260 Park St DEM Issue Fee: 15 4/25/2007 DEM Deposit Amt.: 200 Blair, NE 68008 DEM Receipt #: 17259 Phone: 402 426 8961 DEM Electrical Final Pass Section: Township: Range: Subdivision: Lot: Block: 12x16 enclosed sun room off back of house. Will have electric. Will tie into roof. 74' from property line on North side. Will have 42" footings. Contractors Champion Window Co. SELF Remarks 8/14/2006 BMP 10/4/2006 DEM 2/8/2007 BMP 2/8/2007 BMP 2/9/2007 BMP 4/25/2007 DEM 5/30/2007 DEM General Contractor Electrical Subcontractor Sent copy of permit. Permit # Issued E2636 3/8/2007 a contact City Hall note was left. The work is not up to code. Called and spoke to champion. They said it was finished and is ready for a final. I asked if there was any electric done and Champion did not know, they said they would call me back. I then called the Nielsen's and left them a message asking if they may have known if there was any electrical done. Micky called and he will pull the electric permit, but he will not start until the weather warms up. Changed completion date to 5/31/2007. Roof on sunroom is not complete. Roof not complete. 30 days. Inspections Date By 9/5/2006 DEM Footings Pass 10/4/2006 DEM Framing Fail 4/6/2007 DEM Electrical Rough -ins Pass 4/25/2007 DEM Electrical Final Fail 4/25/2007 DEM Final Inspection of Project Fail 5/30/2007 DEM Status check Fail 7/19/2007 DEM Electrical Final Pass Blair Building Permit Detail 7/19/2007 DEM Final Inspection of Project Pass BUILDING PERMIT APPLICATION dd Jurisdiction of City of Blair, Nebraska Permit Fee: �iur, r'o 218 South 16th Street Issuance Fee: Oti d 0"d • d d Blair, Nebraska 68008 12535 Receipt #: �7 r1�)� 402) 426-4191 • Fax (402) 426-4195 Permit Deposit Receipt #: Issue Date: 8 — I J U Type: CU�l o�Y t JOB ADDRESS /3� /L V(}/—, 1.DESCR. EGAL C] SEE ATTACHEDS-H7EET 2 OWN R - Z —� HOME PHONE MAIL ADDRESS ` ZIP WORKICELLPHONE �r�c� _16W 3. CO TOR - MAIL ADDRESS / / / /ZIP :J1- AOME PHONE � J ��lY /�>L4 �'I�G�%J GWORKCELL PHONE �✓ ��OCJ 4. Class of Work: �eEW O ADDITION O REMODEL O OTHER O FINISHED BASEMENT O UNFINISHED BASEMENT 5. Describe Work: /0 '/ 3�1il1 /jdp7y/ vuQP . avl dl � 7z/ ' dm Itla X66. 6. Valuation of Work: $ g, ,9a� D � /, 00 F6ta�FoJo ag^/ae QrICIuding Basemen) and Garage): Total Finished Area: 7. Roadway Floodplain: Fringe O Yes Q Yes O No I] No Dev. Permit Elev. Cert BFE 8. Current Zoning: fy�L. 9. State Fire Marshall Required: O Yes ,r No 10. Special Use Permit Required: O Yees -Q No 11. Variance Required: O Yes 2 No 12. Minimum Setbacks: Frontal Side 7 Rear 13. 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 acknowledgethat 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. lunderstand thatthispee it is void if work is not commenced within 180 days oris not cpmpleteq within 2 y S of date of issue. r , OF OWNERICONTRA( OR / DATE Comment: MEET IBC, IRC, IPC, IMC AND NEC CODE O Site Plan Attached =rl f Complete Plans Attached Approximate Completion Date 4'2�nD�n Inspections Required and Fees Utilities Sewer Water Si Septic Remote Stop Box Card Buildina Fo s Drywall Fr g (PRIOR TO TAPING) �� Temporary Mechanical Rough -in _ Final Plumbina . Ground Work Permanent A)C Final WHEN PROPERLY VALIDATED (IN THIS SPACE) THIS �_JOPERMIT PoNNDS PWG. BL-, NE V R.. 8196 01 ELECTRICAL PERMIT APPLICATION Jurisdiction 0' City of Blair, Nebraska 218 South 16u Street Blair, Nebraska 68008 Fax (402) 426-4195 E Z6 (402) 426-4191 �] Application Date: � � V � Permit Fee: $ Job Address a.cao O1.wn n ` �a}l Ad. dress, v l Zip Pu e � sqw �^( t I Con q /� Mail Address Zip Phone 2. L_� 3. Class of Work: ❑ NEW RESIDENTIAL ❑ NEW COMMERCIAL O REMODELING/ADDITIONS O UPGRADE SERVICE Describe Work: 0 -%r 4. f ctnc— Qswq r v✓1 5.Current License on File ❑ Yes ❑ No ❑ N/A Completion Date ELECTRICAL PERMIT FEES Service Fee = (Amp Fee + 2.00 per branch circuit) Upgrade Existing Service.............$10.00 1-100 Amp Fee .......................$13.00 Temporary Service.................... $10.00 101-200 Amp Fee .......................$18.00 Fire Alarm System.....................$10.00 201-300 Amp Fee .......................$30.00 Signs ............ $15.00 301400 Amp Fee .......................$42.00 .......................... 401-500 Amp Fee .......................$55.00 Miscellaneous Apparatus .............. $11.00 501-600 Amp Fee .......................$67.00 AC/DC Circuit ........................... $5.00 601-700 Amp Fee .......................$80.00 Commercial/Multi Family and All Upgrades: 701-800 Amp Fee .......................$92.00 801-900 Amp Fee.....................$105.00 # of Circuits x $2.00 901-1000 Amp ........................$117.00 Amp Fee IF OVER 1000 Amp V 1000 Amp Fee..................$117.00 Amp Fee + Circuit Total Each additional 100 Amps ......... $13.00 New Residential: (Finished Area) Single/Two Family Dwellings Notice sq. ft. x .045 1 hereby certify that I have read and examined this application and know the same to be true and correct. All Modular/Manufactured Homes..... •$50.00 provisions of laws and ordinances governing this type of Receptacle/Switch Outlets ^^�� work will be complied with whether specified herein or Fixtures 3 x $.75 not. The granting of a permit does not presume to give rte! rr� authority to violate or cancel the provisions of any other Smoke Detectors X $3.00 state or local law regulating construction or the Residential/Commercial Appliance performance of construction. # Fixed Outlets x $3.00 Motor(s) x $3.00 Power Apparatus (220 Volts) # Apparatus x $5.00 Sig azure o Contractor r ut orized Agent �U• �J Permit Issuance Fee....................$20.00 Total 0-7 Date Comment: WHEN PROPERLY VALIDA" ' 'D (1N THl� SPACE) THIS 1S YOUR PERMIT Approved By: Lou -'rise of a� Call Of BtAIQ HOMEOWNER VERIFICATION FOR ELECTRICAL WIRING PERMITS YX/J) J 4 A Jse-h , states the following: print your full name on li a above: 1. I am the owner of the single family dwelling for which I am applying for an electrical permit. Address 1e2l A-0 �aw IC s4 2. I am applying for an electrical permit for a single family dwelling and it is or will be my principal residence. 3. I will install and connect the electrical wiring for myself, without compensation or pay from or to, any other person. 4. I have sufficient knowledge of the 2005 National Electrical Code requirements to make an electrically safe and mechanically secure installation which will meet the minimum standards referenced in 81-2104. 5. I am aware of all inspections required prior to a final. �- I will call twenty-four (24) hours in advance for an inspection. I am also aware that it is not the inspector's job or duty to be my instructor in electrical wiring. 7. I am aware that Nebr. Rev. Stat. 81-2143 makes it a Class 1 misdemeanor to make a false statement on a request for inspection. 8. By signing this form I am stating the above information is true an correct. ( o—) Home caner Appli SignaAde Daze do_o%*� 218 South 16th Sheet • Blair, Nebraska 68008 • 402-426-4191 • Fax 402-426-4195 • E-mail cityofblair@ci.blair.ne.us I p 1-c Icy /l/1 S L S �..� I I , A 11 m Pll-,kj< - 712 �s-7- 7� 40 C'O Prid IInG�> 1/ x 16 1^� u S CITY OF UAIQ BUILDING PERMIT DEPOSIT AGREEMENT A $200.00 refundable deposit is being collected at the time of your building permit application for all permits $10,0000 and above. 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, 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 SHALL be forfeited or discounted upon the discretion of the City of Blair, Building and Inspections Department. 5a�&� tractor/Own b 1 Date Contractor/Owner City 218 South 16th Street • Blair, Nebraska 68008 • 402-426-4191 • Fax 402-426-4195 • E-mail cityofblair@huntel. net of QTY OF BLAIQ 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 2003 International 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. A copy of the International 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 218 South 16th Street • Blair, Nebraska 68008 • 402-426-4191 • Fax 402-426-4195 • E-mail cityofblair@huntel.net /rIT, OFR LOCATION OF INSPECTION: NAME OF OWNER CONTRACTOR i/� DATE INSPECTION REQUESTED A _ -5- Q � TIME INSPECTION REQUESTED C/ A M PERMIT NO� TYPE OF INSPECTION REQUESTED: ❑ CONFERENCE ❑ STATUS CHECK BUILDING: FOOTING ❑ DECKFOOTING ❑ FRAMING ❑ DRYWALL ❑ FINAL ❑ PARTIAL PASS.50 FAILED COMMENTS: ❑ BUILDING INSPECTION REPORT ❑ WASHINGTON COUNTY ❑ UTILITIES: ❑ SEWERTAP ❑ SEWER ❑ SEPTIC ❑ WATERTAP ❑ REMOTE ❑ WATERSERVICE PASSED FAILED ❑ PARTIAL ❑ ❑ COMMENTS: ELECTRICAL: ❑ ROUGH IN ❑ FINAL ❑ PERMANENT SERVICE ❑ TEMPORARY SERVICE ❑ PRECONNECT PASSED FAILED ❑ PARTIAL ❑ ❑ COMMENTS: MECHANICAL:❑ ROUGH -IN ❑ A/C ❑ FURNACE ❑ RADIANT HEAT ❑ FINAL ❑ PARTIAL PASSED FAILED ❑ ❑ COMMENTS: PLUMBING: ❑ GROUNDWORK ❑ ROUGH -IN ❑ FINAL ❑ WATER METER INSTALLED ❑ PARTIAL PASSED FAILED ❑ PRESSURE TEST ❑ ❑ COMMENTS: ❑ OCCUPANCY GRANTED ❑ CONDITIONAL OCCUPANCY GRANTED OF INSPECTION MADE: FAXED OPPD\BURT REA TO CONNECT SERVICE: s R r,. � \. s�lj BUILDING INSPECTION REPORT ❑ OCCUPANCY GRANTED ❑ CONDEPIONAL9CCUPANCY GRANTED., NOTES/REMARKS ❑ CITYOF AIR ❑ WASHINGTON COUNTY ❑ OTHER INSPECTO` & DATE OF INSPECTION MADE:-/ LOCATION OF INSPECT'I7O/N/, C %�� I��S�- �� NAME OF OWNER � / /i/ CONTRACTOR, • ��` DATE INSPECTION REQUESTED- 7 TIME INSPECTION REQUESTED PERMIT N0='?5. TYPE OF INSPECTION REQUESTED: ❑ CONFERENCE El STATUS CHECK BUILDING: ❑ FOOTING ❑ DECKFOOTING Q FRAMING ❑ DRYWALL ❑ FINAL ❑ PARTIAL PASSED FABLED ❑ COMMENTS: /0 UTILITIES: ❑ SEWERTAP ❑ SEWER ❑ SEPTIC ❑ WATERTAP ❑ REMOTE ❑ WATERSERVICE PASSED FAILED ❑ PARTIAL ❑ ❑ COMMENTS: ELECTRICAL: ❑ ROUGH IN ❑ FINAL ❑ PERMANENT SERVICE ❑ TEMPORARY SERVICE ❑ PRECONNECT PASSED FAILED ❑ PARTIAL ❑ ❑ COMMENTS: MECHANICAL: E] ROUGH -IN ❑ A/C ❑ FURNACE ❑ RADIANT HEAT ❑ FINAL ❑ PARTIAL PASSED FAILED ❑ ❑ COMMENTS: PLUMBING: ❑ GROUNDWORK ❑ ROUGH -IN ❑ FINAL ❑ WATER METER INSTALLED ❑ PARTIAL PASSED FAILED ❑ PRESSURE TEST ❑ ❑ COMMENTS: ❑ OCCUPANCY GRANTED ❑ CONDEPIONAL9CCUPANCY GRANTED., NOTES/REMARKS FAXED OPPD\BURT REA TO CONNECT SERVICE: INSPECTO` DATE OF INSPECTION MADE:-/ l TIME FAXED OPPD\BURT REA TO CONNECT SERVICE: 0 LOCATION OF INSPECTION NAME OF BUILDING INSPECTION REPORT ❑ WASHINGTON COUNTY ❑ v!- DATE INSPECTION REQUESTED J'�( r -0 7 TIME INSPECTION REQUESTED-- PERMIT NO /�__� TYPE OF INSPECTION REQUESTED: ❑ CONFERENCE ❑ STATUS CHECK BUILDING: ❑ FOOTING ❑ DECKFOOTING ❑ FRAMING ❑ DRYWALL ❑ FINAL ❑ PARTIAL PASSED FAILED COMMENTS: UTILITIES: ❑ SEWERTAP ❑ SEWER ❑ SEPTIC ❑ WATERTAP ❑ REMOTE ❑ WATERSERVICE PASSED FAILED ❑ PARTIAL ❑ ❑ COMMENTS: ELECTRICAL ROUGH IN ❑ F1NAL ❑PERMANENT SERVICE ❑ TEMPORARY SERVICE ❑ PRECONNECT71--1 ASS FAILED ❑ PARTIAL 7 ❑ COMMENTS: MECHANICAL:❑ ROUGH -IN ❑ A/C ❑ FURNACE ❑ RADIANT HEAT ❑ FINAL ❑ PARTIAL PASSED FAILED COMMENTS: PLUMBING: ❑ GROUNDWORK ❑ ROUGH -IN ❑ FINAL ❑ WATER METER INSTALLED ❑ PARTIAL PASSED FAILED ❑ PRESSURE TEST ❑ ❑ COMMENTS: ❑ OCCUPANCY GRANTED ❑ CONDITIONAL OCCUPANCY GRANTED DATE OF INSPECTION FAXED OPPD\BURT REA TO CONNECT SERVICE: 0N BY INSPECTION REPORT T['Y GFBLAIR ❑ BUILDING WASHINGTON OUNTY NG THER LOCATION OF INSPECTION NAME OF OWNER /�� " `�`-y CONTRACTOR�j/ DATE INSPECTION REQUESTED. .Q "7 TIME INSPECTION REQUESTED �' �y'PERMIT NO, /195 TYPE OF INSPECTION BUILDING: ❑ FOOTING ❑ DECKFOOTING ❑ FRAMING ❑ DRYWALL Pj::�INAL ❑ PARTIAL COMMENTS: ❑ STATUS CHECK F,4IL UTILITIES: ❑ SEWERTAP ❑ SEWER ❑ SEPTIC ❑ WATERTAP ❑ REMOTE ❑ WATERSERVICE PASSED FAILED ❑ PARTIAL ❑ ❑ COMMENTS: ELECTRICAL: ❑ ROUGHIN INAL ❑PERMANENT SF,RVICE ❑TEMPORARY SERVICE ❑ PRECONNECT PAS9D F ❑ PARTIAL COMMENTS: MECHANICAL:[-] ROUGH -IN ❑ A/C ❑ FURNACE ❑ RADIANTHEAT ❑ FINAL ❑ PARTIAL \SSED FAILED. ❑ ❑ COMMENTS: PLUMBING: ❑ GROUNDWORK ❑ ROUGH -IN ❑ FINAL ❑ WATER METER INSTALLED ❑ PARTIAL PASSED FAILED ❑ PRESSURE TEST ❑ ❑ COMMENTS: ❑ OCCUPANCY GRANTED ❑ CONDITIONAL OCCUPANCY GRANTED r DATE OF INSPECTION FAXED OPPD\BURT REA TO CONNECT SERVICE: ON BY TINT L D N1O ^C�/ BUILDING INSPECTION REPORT Vf CITY�OF�WASHINGTON COUNTY ❑ OTHER— - LOCATION OF INSPECTION /" �/ 0 NAMEOFOWNER- ��/�c�7 CONTRACTOR - -- DATE INSPECTION REQUESTED Q / TIME INSPECTION REQUESTED. �� -�u PERMIT NO--/,'/ TYPE OF INSPECTION REQUESTED: [_1 CONFERENCE YSTATUS CHECK BUILDING: ❑ FOOTING ❑ DECK FOOTING ❑ FRAMING ❑ DRYWALL FINAL ❑ PARTIAL V PASSED COMMENTS: UTILITIES: ❑ SEWERTAP ❑ SEWER ❑ SEPTIC ❑ WATERTAP ❑ REMOTE ❑ WATERSERVICE PASSED FAILED ❑ ❑ ❑ PARTIAL COMMENTS: ELECTRICAL: ❑ ROUGH IN ❑ FINAL ❑ PERMANENT SERVICE ❑ TEMPORARY SERVICE ❑ PRECONNECT PASSED FAILED ❑ ❑ ❑ PARTIAL COMMENTS: MECHANICAL: El ROUGH -IN ❑ A/C ❑ FURNACE ❑ RADIANT HEAT ❑ FINAL ❑ PARTIAL PASSED FARED COMMENTS: PLUMBING: ❑ GROUNDWORK ❑ ROUGH -IN ❑ FINAL ❑ WATER METER INSTALLED ❑ PARTIAL PASSED FAILED ❑ PRESSURE TEST ❑ ❑ COMMENTS: ❑ OCCUPANCY GRANTED ❑ CONDITIWLOCCUPANCY GRAyFED ., n DATE OF INSPECTION FAXED OPPD\BURT REA TO CONNECT SERVICE: ON BY `-� TIME ./� c'-5–ID s BUILDING INSPECTION REPORT 1. ❑ CITY OF BLAIR ❑ WASHINGTON COUNTY! ❑ OTHER I 0 toe; 1 LOCATION OF INSPECTION �` ��'�n S NAME OF OWNER CONTRALTO • `� Y' w n L� U(� a - I TIME INSPECTION REQUESTED- �- r PERMIT NO, DATE INSPECTION REQUESTED TYPE OF INSPECTION REQUESTED: ❑ CONFERENCE ❑ STATUS CHECK BUILDING: ❑ FOOTING ❑ DECKFOOTING ❑ FRAMING ❑ DRYWALL FINAL ❑ PARTIAL PAS. ILED FAFE COMMENTS: UTILITIES: ❑ SEWERTAP ❑ SEWER ❑ SEPTIC ❑ WATERTAP ❑ REMOTE ❑ WATER SERVICE PASSED FAILED ❑ PARTIAL ❑ ❑ COMMENTS: ELECTRICAL: ❑ ROUGHIN FINAL ❑PERMANENT SERVICE ❑TEMPORARY SERVICE ❑ PRECONNECT PASSED FAILED -- ❑ PARTIAL ❑ ❑ COMMENTS: MECHANICAL:❑ ROUGH -IN ❑ A/C ❑ FURNACE ❑ RADIANTHEAT ❑ FINAL ❑ PARTIAL PASSED FAILED ❑ ❑ COMMENTS: PLUMBING: ❑ GROUNDWORK ❑ ROUGH -IN ❑ FINAL ❑ WATER METER INSTALLED ❑ PARTIAL PASSED FAILED ❑ PRESSURETEST ❑ ❑ COMMENTS: ❑ OCCUPANCY GRANTED ❑ CONDITIONAL OCCUPANCY GRANTED DATE OF INSPECTION FAXED OPPD\BURT REA TO CONNECT SERVICE: ON B TIME ',.,j