P1020City of Blair Building Permit Detail
Permit #: P1020 Issued: 11/13/2003
Completed: 11 !19/2003
Location: 1428 Colfax Street
Owner: Zack Petrick
Address: 1428 Colfax Street
Blair, NE 68008
Phone: 402 426 3925
Section: .Township: Range:
Subdivision: Lot:
Replacing water service from stopbox to meter.
Contractors
SELF
General Contractor
Remarks
Type: Plumbing Miscellaneous
Valuation:
Permit Fee: 10
Issue Fee: 15
Deposit Amt.:
Receipt #:
Block:
Permit # Issued
Inspections Date By
11/19/2003 DEM Water Service Pass
11/19/2003 DEM Plumbing Final Pass
PLUMBING PERMIT APPLICATION
Jurisdiction of City of Blair, Nebraska
218 South 16th Street
Blair, Nebraska 68008
Fax (402) 426-4195 P ~ ~ 2
(402) 426-4191
Application Date: ~ ~ ^ i 3- ~ ~ Permit Fee: $ °~~f Q~
JOB ADDRESS ~ ~~ 1 (,
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MAILA RE S
1. OWNER ~2~1/1~.~..+'li ZIP PHONE,~~~,-35as
2 CONTRACTOR MAIL ADDRESS PHONE LICENSE NO.
3• Class of Work: O COMMERCIAL RESIDENTIAL D NEW O ADDITION O ALTERATION O REPAIR REPLACEMENT
4• Describe Work: ~ °~ ~ ~~~ ~ ~ ~
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 ) O -- U~
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/V1later Piping System
(Commercial) ............................ $30.00
f,
.:
~~ ~ ~
Permit Issuance Fee
$15.00
S' ~~
IGNA RE OF CONTRACTOR OR AUTHORIZED AGENT
TOTAL r~
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_ ~/' ~ .~ ~
DATE Current License on File OYes O No ~NA _
WHEN PROPERLY VALIDATED (IN THIS SPACE) THIS IS YOUR PERMIT
Comment: Approved By~
-- ~.~- a
POUNDS PRTG: Blair, NE Rev. M9B
~.
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® CITY OF BLAIR
,. .
BUILDING INSPECTION REPORT
^ WASHINGTON CO NTY ^ OTHER
LOCATION OF INSPECTION: '~ t ~O 1.~ ~ ~~
NAML OF OWNER: `-° ~v ~ CONTRACTOR: _ ..~fl ~~
/~ ~ I
DATE INSPECTION REQUESTED: ~ , `" 1 O 3 TIME INSPECTION REQUESTED~~~~ PERMIT N0: ~ i
TYPE OF INSPECTION REQUESTED; ^ CONFERENCE ^ STATUS CHECK
BUILDING;' ^ FOOTING ^ DECK FOOTING ^ FRAMING ^ DRYWALL ^ FINAL ^ PARTIAL PASSED FAILED
COMMENTS: _ ^ ^
UTILITIES: ^ ,SEWER TAl? ^ .SEWER ^ SEPTIC ^ WATER TAP ^ REMOTE WATER SERVICE PASSE FAILED
^ PARTIAL, ^ .
COMMENTS:
ELECTRICAL: ^ ROUGI-I~IN ^ FINAL ^ PERMANENT SERVICE ^ TEMPORARY SERVICE ^ PRECONNECT PASSED .FAILED
PARTIAL ^ ^
COMMENTS:
MECHANICALC; ^ ROUGH-IN ^ A/C ^ FURNACE ^ RADIANT HEAT ^ FINAL ^ PARTIAL PASSED FAILED
^ ^
COMMENTS:
PLUMBING: :-Q GROUNDWORK ^ ROUGH-IN ^ FINAL ^ WATER METER INSTALLED ^ PARTIAL PASSED FAILED
^ ^
'-COMMENTS:
^ OCCUPANCY GRANTED ^ CONDITIONAL OCCUPANCY GRANTED
NOTES/REMARKS: __
FAXED OPPD~BURT REA TO CONNECT SERVICE: ON BY
crr~ o~ ~~~~
Ar
o~~se of
HOMEOWNER VERIFICATION FOR PLUMBING AND/OR
MECHANICAL PERMITS
Print your full name on line
states the following:
1. I am the owner of the single family dwelling for which I am applying for a
plumbing and/or mechanical permit.
Address: f ~/~~ ~~ /,~aX Sf.
2. I am applying for a plumbing and/or mechanical permit for a single family
dwelling and it is or will be my principal residence.
3. I will install and connect the plumbing and/or mechanical by myself, without
compensation or pay from or to, any other person.
4. I have sufficient knowledge of the 2000 International Code requirements to make
an electrically safe and mechanically secure installation, which will meet the
minimum standards referenced in the 2000 International Code.
s. I am aware of all inspections required prior to a fmal.
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 plumbing and/or
mechanical.
7. I am aware that violation of the code makes it a Class 1 misdemeanor to make a
false statement on a request for inspection.
s. By signing this form I am stating the above information is true an correct.
Homeowner/
Date
~~
._~
218 South 16th Street • Blair, Nebraska 68008 • 402-426-4191 • Fax 402-426-4195 • E-mail cilyofblair@huntel.net ~ ~°