P1043City of Blair Building Permit Detail
Permit #: P1043 Issued: 12/9/2003
Completed: 12/9/2003
Location: 1453 Grant Street
Owner: Daryl Paulsen
Address: 1453 Grant Street
Blair, NE 68008
Phone: 402 533 2572
Section: Township:
Subdivision:
Replace old water lines with new.
Contractors
Henton Trenching, Inc.
Remarks
Type: Plumbing Miscellaneous
Valuation:
Range:
Lot:
General Contractor
Permit Fee: 10
Issue Fee: 15
Deposit Amt.:
Receipt #:
Block:
Permit # Issued
Inspections Date By
12/9!2003 DEM Water Service Pass
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PLUMBING PERMIT APPLICATION
Jurisdiction of City of Blair, Nebraska
218 South 16th Street
Blair, Nebraska 68008
Fax (402) 426-4195 P 10 4 3
(402) 426-4191
Application Date:
~1 ~ ~ ~
Permit Fee: $ ~ ~~
JOB ADDRESS - /' ~~
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1 OWNER ~~~~'^ J~ MAILiDD ES
~ ZIP PHONE~~~~S7~
2 COtpT ACTOR I MAILADDRESS1C ~~ PHONE ~ICENSE ~~~~
3• Class of Work: O COMMERCIAL I~IESIDENTIAL ^ NEW O ADDITION O ALTERATION C~REPAIR O REPLACEMENT
4• Describe Work: ~j ~ ~
Comments: PLUMBING PERMIT FEES
Modular Home ...................... $15.00
Type of Fixture No.
Kitchen .................................. $8.00 x
Bath ....................................... $8.00 x
Rough-In Bath ....................... $4.00 x
Slop Sink/Laundry Tray ......... $5.00 x
Water Heater ......................... $3.00 x
Outside Water Faucet ........... $3.00 x
Drinking Fountain .................. $3.00 x
Water Service ........................ $10.00 ~ fib- ~~
NOTICE Sewer .................................... $10.00
I hereby certify that I have read and examined this Groundwork ........................... $10.00
application and know the same to be true and correct. All
provisions of laws and ordinances governing this type of Septic Tank & Laterals .......... $10.00
work will be complied with whether specified herein or not. Lawn Sprinkler System ......... $10.00
The granting of a permit does not presume to give authority
to violate or cancel the provisions of any other state or local Sprinkler System ................... $30.00
law regulating construction or the performance of (Commercial)
construction.
Gas/Water Piping System
(Commercial) ............................ $30.00
_~~
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Permit Issuance Fee .............
$15.00
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SIGNATURE F CONTRACTOR 0 AUTHORIZED A E !~ ` ~
TOTAL ~f ~~ C~`1
DATE Current License on File Yes O No O NA
WHEN PROPERLY VALIDATED (IN THIS SPACE) THIS IS YOUR PERMIT
Comment: Approved By:
~~~
POUNDS PRTG.~Blair, NE Rev. 4/9B
^ CTTY OF BLAIR
LOCATION OF INSPECTIO(N~:
NAME OF OWNER: ~"~~ ~S'Q ~
CONTRSCTOR: r ~-- ~ n
DATE INSPECTION REQUESTED: '1 '~~ TIME INSPECTION REQUESTED: ' 2-./ ~ PERMIT N0: 0 3
TYPE OF INSPECTION REQUESTED: ^ CONFERENCE ^ STATUS CHECK
BUILDING: ^ FOOTING ^ DECK FOOTING ^ FRAMING ^ DRYWALL ^ FINAL ^ PARTIAL PASSED FAILED
^ ^
COMMENTS:
UTILITIES: ^ SEWER TAP ^ SEWER ^ SEPTIC ^ WATER TAP ^ REMOTE WATER SERVICE PASS FAILED
^ PARTIAL ^
COMMENTS:
ELECTRICAL:... ^ RO~JGH~N ^ FINAL ^PERMANENT SERVICE ^ TEMPORARYSERVICE ^ PRECONNECT PASSED FAILED
~~ PARTIAL ^ ^
COMMENTS:
t .. ~:
MECHANICAL:, ^ ROUGH ~ ;' ^ A/C ^ FURNACE ^ RADIANT HEAT ^ FINAL ^ PARTIAL PASSED FATTED
^ ^
COMMENTS
PLUMBING: ^ GROUNDWORK ^ ROUGH-IN ^ FINAL ^ WATER METER INSTALLED ^ PARTIAL PASSED FAII,ED
COMMENTS:
^ OCCUPANCY GRANTED ^ CONDITIONAL OCCUPANCY GRANTED
NOTES/REMARKS:
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BUILDING INSPECTION REPORT
^ WASHINGTON COUNTY ^ OTHER
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FAXED OPPD~BURT REA TO CONNECT SERVICE: ON BY