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BP8626City of Blair Building Permit Detail Permit #: 8626 Issued: 09/03/1999 Type: Residential Remodeling Completed: 12/09/2003 Valuation: 6800 Location: 849 S 16th Street Owner: Mike Prochaska Permit Fee: 50 Address: 849 S 16th Street Issue Fee: 15 Deposit Amt.: Blair, NE 68008 Receipt #: Phone: 402 533 4467 Section: Township: Range: Subdivision: Lot: Block: Remodel upstairs - adding a bathroom, moving and adding closets. New windows and electrical work -Renewed by Permit #9321 Contractors SELF General Contractor Permit # Issued SELF Plumbing Subcontractor P0678 02/05/2002 SELF Electrical Subcontractor E0778 09/03/1999 Remarks Inspections Date By 02/09/2000 DEM Electrical Rough-ins Pass 04/11/2000 DEM Electrical Permanent Service Pass 02/19/2001 DEM Status check Fail 08/27/2001 DEM Status check Fail 12/09/2003 DEM Plumbing Final Pass 12/09/2003 DEM Electrical Final Pass 12/09/2003 DEM Final Inspection of Project Pass ~~s BUILDING PERMIT APPLICATION ~~ Jurisdiction of City of Blair, Nebraska Permit Fee: 21$ South 16th Street Issuance Fee: `~'~ Blair, Nebraska 68008 Deposit Receipt #: .` (402) 426-4191 ~ Fax (402) 426-4195 Permit 8 6 2 6 Application Date:. ' ~/" % ~ Issue Date: / / ~ f JOB ADDRESS ~ , /~ ~ ~ ~--~ ~ ~ '''~~~LLL LEGAL 1. DESCR. LOT NO. BLK. TRACT ^ SEE ATTACHED SHEET OWNER / 2. /"6 S MAIL ADDRESS ZIP ~a PHONE .J J oC, ~ . CONTRACTOR 3. ~, MAIL ADDRESS ZIP PHONE 4. Class of Work: O NEW O ADDITION O REMODEL 5. Describe Work: ~ , .~ O Finished Basement O Unfinished Basement l~ ~ ~ ~ /!/ ~ ! _ 6. Total Sq. Footage (Including easement and Garage>: Total Finished Area: o~ 7. Valuation of Work: $ ~ ~(b Floodway, O Yes No 8. Floodplain: Fringe O Yes No Dev. Permit BFE Elev. Cert. 9. Current Zoning: 10. State Fire Marshall Required: O Yes ~Q No 11. Special Use Permit Required: O Yes ~No 12. Variance Required: O Yes ~No 13. Minimum Setbacks: Front ~ Side _~ Rear 14. Sidewalk Required: O Yes ~ 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 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. I understand that this permit is void if work is not commenced within 180 d ysor is not completed within 2 years of date of issue. ~~ f/// ~ 3 V SIGNATURE OFOWNER/CONTRACTOR DATE Comment: ~~ve~ul~t~cr NEC AEQU~~ ®f~- A L-L ~'~~! ~ ~~ ~~~~~~ ~~ ~~ a /YES O Site Plan Attached p O Complete Plans Attached Approximate Completion Date 9- I ~ UCC~T Inspections Required and Fees Utilities Sewer Septic Building Footings _ Frar~g ~- Electrical _~~~,~ Rou Fi emporary Service Mechanical Rough•in _ Final Plumbing - Ground Work Rough-in Water Service Remote Stop Box Card D ( efore finish Fixtures Permanent Service A\C Final WHEN PROPERLY VALI~'ATED PERMIT Rev. flr96 POUNDS PRTG: Blair, NE BUILDING PERMIT APPLICATION Jurisdiction of City of Blair, Nebraska / Permit Fee: ~ ~ ~ ~J~",~ 218 South 16th Street ~loZ Issuance Fee: I ~ ~ ~« Blair, Nebraska 68008 Receipt #: (402) 426-4191 • Fax (402) 426-4195 Permit ~• Deposif Receipt #: Issue Date: ~ r c~ ~' a-U~ ~ TYPe: r~1('~~TlnC4' ` I~P_~~,~,J JOB ADDRESS y ~Sa~,~-~ I ~- ~!-. LEGAL 1 . DESCR. ^ SEE ATTACHED SHEET 2.OWNER ~~ 11 t~ C~n ~S~t~~ILADDRESS • I l c ~ ZIP , I WORK/CEOLLPHONE ~~~`"Y~CQ~ CONTRACTOR '3, n fT\ IL ADDRESS M A ZIP HOME PHONE WORK/CELLPHONE SQ~~ 4. Class of Work: ^ NEW O ADDITION REMODEL ^ OTHER Q FINISHED BASEMENT O UNFINISHED BASEMENT 5. Describe Work: 5~~.-Y5 _ L~ - ~ ~ Q ~ S 6. Valuation of Work: $ Total Sq. Footage QRCIudiRg Ba9emeRt and Garage: Total Finished Area: Floodway 7. Floodplaln: Fringe ^ Yes ^ Yes ~ No Dev. Permit No BFE Elev. Cert. 8. Current Zoning: ~m 9. State Fire Marshall Required: Q Yes ,~ No 10. Special Use Permit Required: Q Yes ~ No 11. Variance Required: ^ Yes [~lo 12. Minimum Setbacks: Front ~,~ Side 7 Rear z~ 13. Sidewalk Required: Q Yes ~ff 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 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. I understand thatthis permit is void if work is not commenced within 180 days o'r is not completed within 2 years of date f issue. X ~~-~ SIGNAT RE OF OWNER/CONTRACTOR DATE Comment: QrQ~i r'1G~.Q ~~I~i~~ gI,QZ(p ~ (/~ 0~ ~/LQ-~0~.~ -- 1,~X7rk C~bo~ ME~IB AND~/e~AOE car I `R'EN~~i'~ ' ~0~ ~E~OW ~E f oU~ STORY AND IN ~~-SEMENTS ARE REQUIRED TO HAVE AN EGRESS WINDOW. ^ Site Plan Attached Complete Plans Attached Approximate Completion Date ~" ~r o~~03 Inspections Required and Fees Utilities Sewer Water Service Septic Remote Stop Box Card Building Footings D all (~PIRI~OR TO TAPING) !.^~ Frarrylfg Electrical Rough-in Final Temporary Service Mechanical Fixtures Permanent Service Rough-in A\C Final Plumbing ~sC~ l t° Ground Work Rou -In F~ WHEN.PROPERLY VALIDATED (IN THIS SPACE) THIS IS YOUR PERMIT Approved By: POUNDS PRTG.~Blair, NE Rev. 9/96 ~~/ ELECTRICAL PERMIT APPLICATION Jurisdiction of City of Blair, Nebraska 218 South 16th Street Blair, Nebraska 68008 (402) 426-4191 Permit. Application Date:~= .~~-99 ~~~~ Permit Fee: $ ~ ~ ~ JOB ADDRESS ~ ~ ~ / ~~ ~ ~ LEGAL ~ • DescR. LOT NO. BLK. TRACT O SEE ATTACHED SHEET 2. OWNER ~ MAILADDRESS ZIP i U/' PHONE ~ ~ r3• CONTRACTOR MAILADDRESS PHONE LICENSE NO. 4. Class of Work; O NEW RESIDENTIAL O NEW COMMERCIAL O REMODELING/ADDITIONS O UPGRADE SERVICE 5• Describe Work: , , ` ~ ~ 6• Current License on File O Yes O No O NA New Service Fee = (Amp Fee + $2.00 per branch circuit) ELECTRICAL PERMIT FEES o~ 1-100 Amp Fee ............................ $ 13.00 Upgrade Existing Service ...... $10.00 ,~~ 101-200 Amp Fee ..........:................. $ 18.00 Temporary Service ..............., $10.00 201-300 Amp Fee ............................ $ 30.00 Fire Alarm System ................. $10.00 301-400 Amp Fee ............................ $ 42.00 Signs .....................................$15.00 401-500 Amp Fee $ 55.00 ............................ 501-600 Amp Fee ............................ $ 67.00 Miscellaneous Apparatus ...... $11.00 601-700 Amp Fee ............................ $ 80.00 AC/DC Circuit ........................ $5.00 701-800 Amp Fee ............................ $ 92.00 801-900 Amp Fee $105.00 Commercial/Multi-Family and All Upgrades: 901-1000 Amp ................................. $117.00 # of Circuits x $2.00 IF OVER 1000 Amp 1 t 1000 A F 11 Amp Fee ~ s mp ee . $ ...................... 7.00 ~ Each additional 100 Amps ........... $ 13.00 p Am Fee + Circuit Total N R id ti l Fi i h d A ew es en a : ( n s e rea) NOTICE Single/Two Family Dwellings I hereby certify that I have read and examined this sq. ft. x .045 application and know the same to be true and correct. All provisions of laws and ordinances governing this type of Modular/Manufactured Homes ....... $30.00 work will be com lied with h th ifi d h i t p w e er spec e ere n or no . The granting of a permit does not presume to give authority Receptacle/Switch Outlets 6U to violate or cancel the provisions of any other state or local Fixtures x $.75 ~6 ~ law regulating construction or the performance of Smoke Detectors ~ x $3.00 ~S~ construction. Residential/Commercial Appliance _ # Fixed Outlets ~ x $3.00 Motor(s) x $3.00 .[~ Power Apparatus (220 Volts) SIGNATURE OF CONTRACTOR OR AUTHORIZED AGENT # Apparatus x $3.00 3~ _ y~ Permit Issuance Fee .............$15.00 DATE TOTAL ~~~~ WHEN PROPERLY VALIDATED (IN THIS SPACE) THIS IS YO - Comment: A ~~~ - POUNDS PRIG: BIaIr, NE qe~, g~gT PLUMBING PERMIT APPLICATION G~'~~ Jurisdiction of City of Blair, Nebraska 218 South 16th Street Blair, Nebraska 68008 Fax (402) 426-4195 P 0 6 ~ 8 (402) 426-4191 Application Date: ~' ~' ~` Permit Fee: $ ~ ~ W JOB ADDRESS ~- ~ ~ q ~~y ~ h ~~ ~~ MAIL ADDRESS OWNER ,. m ~~ ~ ZIP ~-~T PHONE ,- ,~ CONTRACTOR MAIL ADDRESS PHONE LICENSE NO. 3. Class of Work: O COMMERCIAL RESIDENTIAL O NEW O ADDITION O ALTERATION O REPAIR O REPLACEMENT 4. Describe Work: ~ r ~ ~~ Comments: PLUMBING PERMIT FEES Modular Home ...................... $15.00 Type of Fixture No. ~ 1ti1 ~ Kitchen .................................. B h $8.00 x 8 00 . -e, ....................................... at $ . 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 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 ` I~,~ Permit Issuance Fee ............. $15.00 SIGNATURE OF CONTRACTOR OR AUTHORIZED AGENT 7 TOTAL ~ ~~ ~ g2 2~, DATE Current License on File OYes O No 'A WHEN PROPERLY VALIDATED (IN THIS SPACE) THIS IS YOUR PERMIT ~ V Comment: Approved B POUNDS PRTG.-Blair, NE Rev. M98 ._ 4 BUILDING- INSPECTION REPORT o- CITY OF BLAIR ^ WASHINGTON COUNTY ^ OTHER LOCATION OF INSPECTION: ~ ~ - VJ ' ' ~~ U~-~~" " NAMP OF OWNER~~~ - ' `" I ~" l~V I~'yl"~ CONTRACTOR: ~~a~ DATE INSPECTION REQUESTED: TIME INSPECTION REQUESTED: PERMIT N0: TYPE OF INSPECTION REQUESTED: ^ CONFERENCE STATUS -CHECK BUILDING: ^ FOOTING ^ DECK 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 FINAL ^ PERMANENT SERVICE ^ TEMPORARY SERVICE ^ PRECONNECT -PASS 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 PAS 'FAILED `- ^ COMMENTS: ^ OCCUPANCY GRANTED ^ CONDITIONAL OCCUPANCY GRANTED NOTES/REMARKS: , DATE OF INSPECTION MADE: i TO CONNECT SERVICE: ON - TIME: FAXED OPPDIBURT REA 1 BY r ~~ BUILDING INSPECTION REPORT ^ CITY OF BLAIR ^ WA,SlH~IN TON COUNTY OTHER LOCATION OF INSPEQT'ION• ~~~~ ~~ NAME OF OWNER: ..-~ CONTRACTOR: DATE INSPECTION REQUESTED: TIME INSPECTION REQUESTED: PERMIT N0: ~~Ct°~-~C~~ TYPE OF INSPECTION REQUESTED: ^ CONFERENCE ~/ STATUS CHECK BUILDING: ^ FOOTING ^ FRAMING ^ DRYWALL FINAL ^ PARTIAL PASSED FAILED ^ ^ COMMENTS: UTILITIES: ^ SEWER TAP ^ SEWER ^ SEPTIC ^ WATER TAP ^ REMOTE ^ WATER SERVICE PASSED FAILED ^ PARTIAL ^ ^ COMMENTS: ELECTRICAL: ^ ROUGH IN ^ FIXTURES 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: ~`` f 4 '~'" INSPECTOR:. ~ PATE OF INSPECTION MADE: ~ ~ ~~/ TIME: FAXED OPPD\ TO CONNECT SERVICE: ^ YES ^ NO ~~ ~.~~~~~/~i~ ~~~~ ~ ~~~~ ~ BUILDING INSPECTION REPORT -~~CITY OF BLAIR ^ WASHINGTON COUNTY OTHER LOCATION OF INSPECTION: ~ ~t ~ ` ~t ~ ~ ` NAME OF OWNER: ~~ ~~ ~'~1~~~~ CONTRACTOR: DATE INSPECTION REQUESTED: i ~' ~ ~ ~ `~' TIME BSPECTION REQUESTED: ~~' ~ ~ ~l`~ PERMIT N0: 9 ~~ TYPE OF INSPECTION REQUESTED: ^ CONFERENCE ^ STATUS CHECK BUILDING: ^ FOOTING ^ FRAMING ^ DRYWALL ^ FINAL ^ PARTIAL PASSED FAILED COMMENTS: ^ ^ UTILITIES: ^ -SEWER TAP ^ SEWER ^ SEPTIC ^ WATER TAP ^ REMOTE ^ WATER SERVICE PASSED FAILED ^ PARTIAL ^ ^ COMMENTS: ELECTRICAL: ^ ROUGH IN ^ FIXTURES ^ FINAL ^ MOTORS PERMANENT SERVICE ^ TEMPORARY SERVICE PASS FAILED ^ PARTIAL /'^~~~j~ ^ COMMENTS: (,~J} ~' 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: INSP ~ ~ I~ aTE OF INSPECTION MADE: "~! DO G TIME: O~c ~~ FAXED OPPD\ ~~~ ~~ DU ~ TO CONNECT SERVICE: ~ES ^. NO ~~ BUILDING INSPECTION REPORT ^ CITY OF BLAIR ^ WASHIN~/GTON-C~-OUNTYJ ^ OTHER LOCATION OF INSPE!GTION: _ ~~/ `~`{ NAME OF OWNER: [ ~~L~~(/e~S~/y ~~ `CONTRACTOR: DATE INSPECTION REQUESTED: ~- ~ U`~`'~:; ~. TTMF, rNSPFC'TrnN uFnrrFCTFn TYPE OF INSPECTIOI~I'REQUESTED: PERMIT N0: ~~~~ ^ CONFERENCE `STATUS CHECK SU1LUllVli: U FOOTING U DECK FOOTING ^ FRAMING ^ DRYWALL ^ FINAL ^ PARTIAL PASSED FAILED COMMENTS: ^ ^ UTILITIES: ^ SEWER TAP ^ SEWER ^ SEPTIC ^ WATER TAP ^ REMOTE ^ WATER SERVICE 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 COMMENTS: ^ ^ ^ OCCUPANCY GRANTED ^ CONDITIONAL OCCUPANCY GRANTED g NOTES/REMARKS: C ~~.~~i 9 ~a ~~ _ ~- ~~ OF INSPECTION MADE: _ /~~. ! ° r FAXED OPPD\BURT REA TO CONNECT SERVICE: ON By BUILDING INSPECTION REPORT f _ ~ ~ CITY OF BLAIIt ^ WASHINGTON COUNTY ^ OTHER. • LOCATION OF INSPECTION: `"~;~ i f NAME OF OWNER: Y•~l ~,~ ~ ` ',`~ Y~'' ` ~ ~~ ~ CONTRACTOR: - ~ DATE INSPECTION REQUESTED: ~~ -~ -~~t~ PERMIT NO: ~ 4~~ `'~ ~ ~~~ ,''` 1. r`? ! i J TIME INSPECTION REQUESTED: ~~~"~ '°- ~~ TYPE OF INSPECTION REQUESTED: r [~ BUILDING: E, ^ FOOTING ^ FRAMING ~^ DRYWALL ^ FINAL UTILITIES: f ^ SEWER TAP ^ SEWER ^ SEPTIC ^ WATER TAP f ^ REMOTE ^ WATER SERVICE i ELECTRICAL: ~ ~ s--;-.c cC~ 4l ~ : ~ tj;i Ste, r S - ~cr;~ ~ i r,,'~,~~i ~ `-C~'Fl Y ovr-~ ~ ~ ~ ' k'~~ G~3i~/- '4' ~c~~--~ ~ ~`~,e1 ~ ~J~r ~-~~ ~ ; ].ROUGH IN ^ FIXTURES ^ FINAL ^ MOTORS ~ ~ I ^ PERMANENT SERVICE ^ TEMPORARY SEP.VICE MECHANICAL: ~ ^ ROUGH-IN ^ A/C ^ FINAL PLUMBING: ^ GROUNDWORK ^ ROUGH-IN ^ FINAL RESULTS OF THE INSPECTION: ~ASSED ~s~xo~rES) ^ FAILED cs~xo~rFS> NO ES/R ARKS: ~ - • / r `C~ ~ ~ ~~ ~ I~• I~ ~AL~ ~~~~i~ - o ~ ~~~. ~-~ _ .DATE OFINSPECTION MADE: / ~ Q ~ 'FIIv1E: ~ G ~~ ' ~ CALLED OPPD\ TO CONNECT SERVICE: ^ YES NO f • 1~VANT OFFICE STAFF TO CALL OPPD\ ^ YES ^ NO BLR 1 A°:,^°;~°°° ~au•Ia~unUro7AblgloN!a I!a~-3 • 96l b-9Zb-ZOb Xp~ • L6 Lb-9Zb-ZOb • 80089 q~sp~gaN '~Ipl9 • ~aai1S u~9 L u~~oS 8 LZ ~U'~ ao!~tel epuaas --.- 9j~'' ~~ ~ `~(!aaaou!g ~aa}}aua s!y} u! uo!}saadooo ano~(ao} aouanpe u! no~(~ueul ~aua }oa}uoo o} aaa~ !aa~ 'anss! s!y} 6u!paa6aa suo!}sanb ~(ua ansy nol~ }! ~aouaaa}aa anon( ao} }!uaaad 6u!p!!nq au} ~o ~(doo a pub asaa!d `paso!ou3 ~po!aad aaa~ (Z)-onn} !auo!}!ppa ua ~o} }!uaaad s!y} nnauaa o} }sanbaa ~o }!uaaad ay} uo uo!}oadsu! !au!} a ao} 600Z `~ sago}op `~(epuoW uay} as}a! ou ao~o mo }oa}uoo o} paau !!!nn nog( }ay} pas!nprz aq asaa~d ' 6002 '0£ aaquaa}daS uo aa!dxa !!!nn }!uaaad anoga au} nog( uaao}u! o} s! as}}a! s!yl 'a~seuooad ~aW aaaa 9298 }!uaaad Gu!p!!n8 :a~ 80089 3N `a!al9 }aaa}S uLg 6 'S 6ti8 e~{sayoo,~d a~!W a ~~~j ~- ~~~~ ~o gala 6002 `5 aunt 6o asfwo~ a ~~.' c,^ o . o~ OJ ,9 ~`ty°fBlair promise 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. ~c.G o ner/Occupant City of Bla' Contractor ~- 3j-5~ Date 218 S.16TH STREET, BLAIR, NE 68008.2010 • (402) 426-0191 ~ (402) 426.4195 FAX • E-MAIL: cityofblair@huntel.net CITY OF BI,L~II~ p~ o~~se of August 12, 2003 Mike Prochaska 849 S. 16t" Street Blair, NE 68008 Re: Building Permit 8626 Dear Mr. Prochaska, This letter is to inform you the above permit will expire on September 30, 2003. Please be advised that you will need to contact our office no -later Tuesday, September 30, 2003 to request a final inspection of this project, asix-month extension or renew this permit for an additional two-(2) year period. If an extension is granted and the project is not complete at the end Of the extension period, you ~,~ri!! be re~u~red to renew this permit at the cost of the original permit. Enclosed, please find a copy of the building permit for your reference. If you have any questions regarding this issue, feel free to contact me. Thank you in advance for your codperation in this matter. Sincerely, ~~~ Brenda Taylor City Clerk Enc ~_ s r 218 South 1 bth Street • Blair, Nebraska 68008 • 402-426-4191 • Fax 402-426-4195 • E-mail cityofblair@huntel.net o ~° City of Blair 218 South 16th Blair, Nebraska 68008 402-426-4191 Fax - 402-426-4195 ~:' ,,~ - ~. >F __-~~ ~ .. ~@ _. A ~0. O ~ promise HOMEOWNER VERIFICATION FOR ELECTRICAL WIRING PERMITS IC fC.4l: ~- ~ .. I ~10~'l~5 ~,~- ,states the following: print your full name on line above: 1. 1 am the owner of the single family dwelling for which I am applying far an electrical permit. Address:_ ~ ~~ ~ S , /~ 7h ~ / 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 sufficent knowledge of the 1996 National Electrical Code requirements to make an electically 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.. 8. By signing this form I am stating the above .information is true and correct. Home ner l Applicant Signat a Date EOUAL HOUSING OPPORTUNITY R~S Mo~~ PI,Qs~~.~ `- /-I-(J~ ~~osal-`T5 S n S w ~~ o, i c3 .AA~.- ~ rt l/ t-Ll-/c1, L, ~ N~Yw wcw~p-t,c' S ~ 'y vb SSA. L~ {~ U 2Y. 4G c~ V ~ 5 / A ~ 12.5 rir; (.cJ L LPL , rJ u'~2V ~ LE3' p A, /b ~ ~. c;~ 57 s ~- W Iw aw ~ .~; ~ ~j Oc3 . LyL~s7"C.`r2lu~l~ ' ~ U ~.5 0 Qn.~~w~..LL o~ l~~ao, - P C.u w.. ~ ,~ o o , ~_. rv~~~~ a, b©o . ~ ~~ ~~~ °v CITY OF BI,t~IR ~Oro~, HOMEOWNER VERIFICATION FOR PLUMBING AND/OR MECHANICAL PERMITS ~ ~- ~~'~ ~ ~- ~ I'2 o G~-~ ~~- ,states the following; Pnnt yow full name online above: i. I am the owner of the single family dwelling for which I am applying for a plumbing and/or mechanical permit. Address: ~`~ ~ S . l ~ T~ s j 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 Plumbing and/or Mechanical Code requirements to make an electrically safe and mechanically secure installation, which will meet the minimum standards referenced in the 2000 Uniform Codes. 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 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. ~. By signing this form I am stating the above information is true an correct. .J~ , Signatwe ~ ~6 ~ Date ~~ ® ~- 218South 16th Street • Blair, Nebraska 68008 • 402-426-4191 • Fax 402-426-4195 • E-mail cityofblair@huntel.net ~~,~