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BP12654Blair Building Permit Detail Permit #: 12654 Issued: 3/5/2007 Type: Residential Remodeling Completed: 12/18/2007 Valuation: 13600 Location: 2354 Jackson St Owner: Ed Rhodes Permit Fee: 68 Address: 2354 Jackson St Issue Fee: 20 Deposit Amt.: 500 Blair, NE 68008 Receipt #: 18489 Phone: 402 533 3758 Section: Township: Range: Subdivision: Lot: Block: Basement remodel -Tear out all carpet -frame walls 2x4 -tear old paneling off -electric to code -paint and stain -new carpet. Will have plumbing and electric. Contractors Bart Moore Subcontracting, Inc Chapman Mechanical Services, Inc. SELF Remarks 3/8/2007 BMP 3/8/2007 DEM Inspections Date 3/8/2007 3/22/2007 3/22/2007 3/22/2007 3/22/2007 12/18/2007 12/18/2007 12/18/2007 By DEM DEM DEM DEM DEM DEM DEM DEM General Contractor Plumbing Subcontractor Electrical Subcontractor Paid for and took permit. Egress window is required. Conference Mechanical Rough -ins Plumbing Rough -ins Electrical Rough -ins Framing Mechanical Final Electrical Final Final Inspection of Project Permit # P1651 E2635 Pass Pass Pass Pass Pass Pass Pass Pass Issued 3/22/2007 3/8/2007 G�foml5epJC CITY OF BLAIR - APPLICATION FOR BUILDING PERMIT Permit # Xo2 Date: .6 —5 -G/ 7 Approximate Completion Date: _U Site Plan Attached: REScheck Attached: Complete Plans Attached Application for: Residential :>� Commercial/Industrial New Construction Manufactured Home Modular Move-on:Ho a Accessory Building Other Remodel Addition Accessory Building: Garage Pole Barn Other Floor Type: Dirt Concrete Electricity: Yes No Other Utilities: Public Water: Yes No 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 rroiect inrormarion7 Job Address: Legal Description (if applicable) Owner: i4 Contractor: Address: �, 1G 4W' Gtbdl�-{� Phone#: c' �'�& C' Phone #: --533 -3 75& Address: e441 IV. ?4//-/' Cell #: Separate permits are required for electrical, plumbing, hearting, 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_gompleted within two (2) years of date of issue. Signature of Owner/Contractor Date ZONING REVIEW: Zoning/Flood Plain Ut' 'ties: Current Zoning: Conditional Use Permit Required: Yes No Date CUP Approved: State Fire Marshal Required: Yes No Variance Required: Yes No Minimum Setbacks: Front Second Front Side Side Rear Lot Square Footage: Length x Width: Lot Coverage % �J Driveways/Sidewalks: Sidewalk required: Yes No Sidewalk Waiver: Yes _ Date Waiver Approved: Flood Plain: Yes No If yes, specify special requirements: BUILDING INSPECTOR REVIEW: Number of Stories One Two Three Four Type of Residential Structure: Ranch Two Story Split Entry _ Rooms Bedrooms Bathrooms No >Four High Rise (>75 ft) Raised Ranch Other Fireplaces Gas Electric Egress in Basement: Required: Yes No Provided on Plans: Yes Sleeping Rooms Living Area Other Egress Square Footage: Main Level: Basement: (Unfinished) _ Garage: Detached Garage: Addition: Porch: Front Deck that affect setbacks: Occupancv Classification: No _ Second Level: Third Level (Finished) 2 bay 3 bay 4 bay 5+ bay Pole Barn: Remodel: Rear Side Rear Front Side Assembly, theaters, with stage Assembly, theater, without stage Assembly, nightclubs Assembly, restaurants, bars, banquet halls Assembly, churches Assembly, arenas Assembly, general, community halls, libraries, museums Business Educational Factory and industrial, moderate hazard Factory and industrial, low hazard High Hazard, explosives High Hazard HPM Institutional, supervised environment Institutional, incapacitated Institutional, restrained Institutional, day care facilities Mercantile Residential, hotels Residential, multiple family Residential, one- and two-family Residential, care/assisted living facilities Storage, moderate hazard Storage, low hazard Utility, miscellaneous Is building required to be protected by automatic fire sprinkler system?" No Only partially in some areas or rooms Please Specify Yes If yes, the standard to which the sprinkler system will be designed: NFPA 13 NFPS 13R NFPA 13D Driveway Grade: (percentage) (Dale will review new residential construction) (AI will review all second access requests and industrial and commercial driveway requests) Required Off Street Parking: Permit Fee Calculation: RESIDENTIAL - NEW CONSTRUCTION: Building Permit Deposit Fee: Residential additions/remodels/accessory buildings valued under $10,000 Fee = $200.00 Commercial, new homes and residential additions/remodels/accessory buildings valued $10,000 or greater Fee - $500.00 All other permits valued under $10,000 Permit fee is: Finished sq/ft area X$88 (not including finished basement area) Finished basement sq/ft area I X $53 Unfinished basement sq/ft area Garage sq/ft area Total Valuation: Total Valuation Issuance Fee: X $26 X $20 Multiplied by 0.0056 = $ No Deposit Fee $ 20.00 Total Permit Fee = Deposit/Permit Fee/Issuance Fee $ RESIDENTIAL - ADDITIONS/ REMODELS and COMMERCIAL - NEW CONSTRUCTION / ADDITIONS / REMODELS: Business/Industrial/Educational/Assembly/Factory/Storage/Utility *Porches with roofs/screened patios are considered additions Building Permit Deposit Fee: Residential additions/remodels/accessory buildings valued under $10,000 $ Fee = $200.00 Commercial, new homes and residential additions/remodels/accessory buildings valued $10,000 or greater $ Fee - $500.00 All other permits valued under $10,000 No Deposit Fee Permit fee is: Finished sq/ft area �� X$60 $ Finished sq/ft area U X $40 $ i 3: i,o0. $0 TO$49..............................................................................................$0 (plus Permit Issuance Fee) $50 TO $9,999........................................................................................... $50 $10,000 TO $99,999........................................................................................... $50 + $6 per additional $1,000 $100,000 TO $249,999...............................................I.........................................$590 + $4 per additional $1,000 $250,000 TO $499,999..................................................................................... $1,190 + $3 per additional $1,000 $500,000 TO $999,999..................................................................................... $1,940 + $2 per additional $1,000 $1,000,000 AND OVER..................................................................................... $2,940 + $1 per additional $1,000 Permit Fee calculated from chart above $ bg k 1)0 Issuance Fee: $ 20.00 00,00-e'5Qd•vv Total Permit Fee = Deposit/Permit Fee/Issuance Fee $ 6)'9'6 •0U Additional Comments: A roved l� / '2i Date: pp Contingent On Approval by Fire Marshall Meet IBC, IPC, IMC and NEC Code Requirements Sleeping Rooms below Story and in Basement required to have egress </ For Office Use Only Date Permit Paid: Permit Fee: Deposit Amount Receipt # Deposit Paid by for return to: Building Inspection Pouch given: Yes No PLUMBING PERMIT APPLICATION Jurisdiction of City of Blair, Nebraska 218 South 16th Street Blair, Nebraska 68008 Fax (402) 426-4195 (402) 426-4191 �a- o Application Date: � r P 1651 v Permit Fee: $ Job Address Owner ,Y Address Zip Phone D 6&OMMail Contractor Mail Add re`%c Zip 2. Phone 3. Class of Wor O COMMERCIAL ESIDENTIAL O New O Addition O Alteration O Repair O Replacement Describe Work: j �� c�l� 4 `�'� �C��!�ti�� / PLUMBING PERMIT FEES Comments: Modular Home ......................$50.00 Type of Fixture No. Kitchen..............................$8.00 x Bath..................................$8.00 x U lJ Rough -In Bath......................$4.00 x Additional Sinks....................$3.00 x Laundry/Drain ......................$5.00 x Water Heater ........................$3.00 x Outside Water Faucet..................$3.00 x Notice Drinking Fountain .......................$3.00 x I hereby certify that I have read and examined this application and know the same to be true and correct. All provisions of laws and ordinances governing this type of Backflow/Grease Trap............ $10.00 work will be complied with whether specified herein or not. The granting of a permit does not presume to give Water Service ......................$10.00 authority to violate or cancel the provisions of any other Sewer................................$10.00 state or local law regulating construction or the performance of construction. Groundwork ........................$10.00 Septic Tank & Laterals........... $10.00 Lawn Sprinkler System ............ $10.00 Sprinkler System (Commercial). $30.00 Gas/Water Piping System � -�V \G (Commercial).......................$30.00 S gna r of Contractor or Auth rized Agent Permit Issuance Fee................$20.00 O C' Total ! v Current License on File es O No O N/A Date Comment: WHEN PROPERLY VALIDATED (IN THIS SPACE) THIS IS YOUR PERMIT Approved By: ELECTRICAL PERMIT APPLICATION Jurisdiction of City of Blair, Nebraska 218 South 16" Street Blair, Nebraska 68008 Fax (402) 426-4195 (402) 426-4191 Application Date: C� E 2635 Permit Fee: $� Job Address ?_35L4 j CL �r L� rl c L 41 1 �U N 1 Owner 1. EcI 1 ail Address Zip zw�- Phone 210 S-7 S'q 2gntr�ctor Mail Address Zip Phone 3.. Class of Work: O NEW RESIDENTIAL O NEW COMMERCIAL a'REMODELING/ADDITIONS O UPGRADE SERVICE Describe Work: gern e— I 4. loll 5.Current License on File O Yes O No 0 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 301-400 Amp Fee......... $42.00 ......................................$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 IF OVER 1000 Amp 15i 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 work will be complied with whether specified herein or Receptacle/Switch Out is Fixtures $.75 �� not. The granting of a permit does not presume to give x •�� authority to violate or cancel the provisions of any other Smoke Detectors a x $3.00 0.6 state or local law regulating construction or the Residential/Commercial Appliance of constructio # Fixed Outlets x $3.00 Motor(s) x $3.00 4perfoance Power Apparatus (220 Volts # Apparatus x $5.00 si a o Contractor or Authorized Agent Permit Issuance Fee....................$20.00 ac). 00 qq t Total / Date Comment: WHEN PROPERLY VALIDNIED (INTHIS SPACE) THIS 1S YOURPEKMfl Approved By: � W \ h ' r— CITY OF t)LAIQ_ Aro��se of aJa\` BUILDING PERMIT DEPOSIT AGREEMENT A $500.00refundable deposit is being collected at the time of your building permit application for all commercial, new homes and residential additions/remodels/accessory buildings valued $10,000 or greater. However, the City reserves the right to not refund this deposit if any of the following conditions occur during the construction period: 1?91) 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, S) 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. Contractor/Owner Contractor/Owner Date City of Blair 1_=.1- 218 South 16th Street • Blair, Nebraska 68008 • 402-426-4191 • Fax 402-426-4195 • E-mail cityofblair@ci,blair,ne.us 10" of a HOMEOWNER VERIFICATION FOR ELECTRICAL WIRING PERMITS [_:�d R ��d_c S print your full name on line above: states the following: 1. I am the owner of the single family dwelling for which I am applying for an electrical permit. I - Address: � J't J 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. 6. 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. �. 4Byng this form tatmg the above inforination is true an correct. o�ppficant Signature Da 218 South 16th Street • Blair, Nebraska 68008 - 402-426-4191 • Fax 402-426-4195 • E-mail cilyofblair@ci.blair.ne.us o.. .,r. Y' V J k+ � s Y' V J k+ r cAi Y' V J k+ r � ` J 12/21/2667 15:39 462-721-4574 GALORD MUSSMAN PAGE 61 STATE FARM [- 4ft INSURANCE O t FAX L"NSMISSION LIRE A GOOD NEIGHBOR STATE FARM IS THERE! We have ROTH IRA's & Long Verna Care? Call for snore information Date: To: (f_ Fax Number: From: Gaylord W. Mussmao Our Phone: (402)727-4861 Our Fax: (402)721-4574 p' se of <J CITY Of I)tAIQ 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 2006 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 Contractor Date 218 South 16th Street • Blair, Nebraska 68008 • 402-426-4191 • Fax 402-426-4195 • E-mail cityofblair@ci,blair.ne.us BUILDING INSPECTION REPORT 4C BLAIR ❑ WASHINGTON COUNTY ❑ OTHER LOCATION OF INSPECTION- NAME NSPECTION NAME OF OWNER - DATE INSPECTION REQUESTED- U TYPE OF INSPECTION REQUESTED: CONTRACTOR `-'�✓� —` TIME INSPECTION REQUESTED- PERMIT �k`-ONFERENCE ❑ STATUS CHECK BUILDING: ❑ FOOTING ❑ DECK FOOTING ❑ FRAMING ❑ DRYWALL ❑ FINAL ❑ PARTIAL PASSED FAILED ❑ ❑ COMMENTS: UTILITIES: ❑ SEWER TAP ❑ SEWER ❑ SEPTIC ❑ WATER TAP ❑ REMOTE ❑ WATER SERVICE PASSED FAILED ❑ PARTIAL El El 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 El PRESSURE TEST El ElCOMMENTS: ❑ OCCUPANCY GRANTED ❑l COONNDITTIIONAL OCCUPANCY GRANTED NOTES/REMARKS• �C9 �� GtC� LL I b O c<�) ( (� I INSPECTO�-4�OF INSPECTION MADE: i FAXED OPPD\BURT REA TO CONNECT SERVICE: ON BY i 1 i BUILDING INSPECTION REPORT CITYOFI� ❑ WASHINGTON COUNTY ❑OTHER LOCATION OF INSPECTION- No c'( s n NAME OF OWNER: �� l� ❑ CONTRALTO DATE INSPECTION RE UESTED� Q� Q TIME INSPECTION REQUESTEDCRMI�TNOL-M&5, TYPE OF INSPECTION REQUESTED: BUILDING: ❑ FOOTING ❑ DECK FOOTING COMMENTS: UTILITIES: ❑ SEWER TAP ❑ PARTIAL J' _- v N / ❑ CONFERENCE FRAMING ❑ DRYWALL ❑ FINAL ❑ PARTIAL ❑ STATUS CHECK PA7 FAILED ❑ SEPTIC ❑ WATER TAP ❑ REMOTE ❑ WATER SERVICE PASSED FAILED COMMENTS: ❑ ❑ ELECTRICAL,JZ ROUGH IN ElFINAL ElPERMANENT SERVICE ❑ TEMPORARY SERVICE ElPRECONNECT PAS D FAILED COMMENTS: ❑ PARTIAL 11 MECHANICAL: ❑ ROUGH -IN ❑ A/C ❑ FURNACE ❑ RADIANT HEAT ❑ FINAL ❑ PARTIAL COMMENTS: PLUMBING: ❑ GROUNDWORKS ROUGH -IN ❑ FINAL ❑ WATER METER INSTALLED ❑ PARTIAL ❑ PRESSURE TEST COMMENTS: ❑ OCCUPANCY GRANTED ❑ CONDITIONAL OCCUPANCY GRANTED FAILED ,OeZ FAILED �7 IN DATE OF INSPECTION MAD TIM FAXED OPPD\BURT REA TO CONNECT SERVICE: ON BY 03/22/2007 VO/ 44 03/22/2007 a 03/22/2007 03/22/2007' 03/22/2007 BUILDING INSPECTION REPORT CITY OF BLAIR ❑ WASHINGTON COUNTY ❑ OTHE LOCATION OF INSPECTION NAME OF OWNER . CONTRACTOR - DATE INSPECTION REQUESTED U TIME INSPECTION REQUESTED: / Lf PERMIT NO• TYPE OF INSPECTION REQUESTED: ❑ CONFERENCE ❑ STATUS CHECK BUILDING: ❑ FOOTING ❑ DECKFOOTING ❑ FRAMING ❑ DRYWALL ❑ FINAL ❑ PARTIALPAS ED FAILED COMMENTS: UTILITIES: ❑ SEWER TAP ❑ SEWER ❑ SEPTIC ❑ WATER TAP ❑ REMOTE ❑ WATER SERVICE PASSED FAILED ❑ PARTIAL ❑ ❑ COMMENTS: ELECTRICAL: ❑ ROUGH IN 0FINAL ❑ PERMANENT SERVICE ❑ TEMPORARY SERVICE ❑ PRECONNECT PAS D 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 NOTES/REMARKS• FAXED OPPD\BURT REA TO CONNECT SERVICE: ON BY ■■ WS ■E1 n no ❑❑ m y a b El a r tai -3 o ro y El a r I 1 06 "S 121181200 1 oy, ( (co ) d i s U C -Y.A * rm i