BP11105City of Blair Building Permit Detail
Permit #: 11105 Issued: 7/23/2004
Completed: 8/26/2004
Location: 11178 Bridgeview Drive
Owner: Jeff Novotny
Address: 11178 Bridgeview Drive
P.O. Box 189
Blair, NE 68008
Type: Residential Additions
Valuation: 4000
Permit Fee: 25
Issue Fee: 15
Deposit Amt.:
Receipt #:
Phone: 426-0308
Section: Township: Range:
Subdivision: Lot: Block:
12' x 12' sun room addition; deck is existing; covering deck at this time; electricity and one heat run
Contractors
SELF
SELF
Remarks
Inspections Date
8/11 /2004
8/11 /2004
8/26/2004
8/26/2004
General Contractor Permit # Issued
Electrical Subcontractor E1993 7/23/2004
By
DEM Electrical Rough-ins Pass
DEM Framing Pass
DEM Electrical Final Pass
DEM Final Inspection of Project Pass
BUILDING PERMIT APPLICATION
Permit Fee: 2 Jurisdiction of City of Blair, Nebraska
~ ,~~ , 218 South 16th Street
Issuance Fee: Blair, Nebraska 68008 1110 5
Receipt #: (402) 426-4191 • Fax (402) 426-4195 Permit
Deposit Receipt #. n -I ~I
Issue Date: ~'~ ~~ Type; 1"~eSr C!~(\'t~7C~/~ ~~~`~-(d}~
JOB ADDRESS
1 ,
I I~ ~ ~'rr~ ~V~"~~ 'J~•
LEGAL
1 . DESCR.
^ SEE ATTACHED SHEET
2.OWNER ~e ~\ \ O ~ O~~\
v MAILADDRESS' ~~- ~0 ~~~IP' ~~ yyORKICEOLLPHONE ~~~ ~®~Q
S 1
`
CONTRACTOR
3. ~~~ •'~' MAIL ADDRES
Z
IP HOME PHONE
WORK/CELL PHONE
4. Class of Work: NEW Q ADDITION Q REMODEL ^ OTHER [~ FINISHED BASEMENT ~ UNF
IN
ISHED BASEMENT
5. Describe Work: Q ~~~ ~(~~ ~Z X~ C ~ •- ,,
//
~ C~` l S /S ~1n
~QU~ 2-c ~t`l~ c~C C.~- `-n ~~S ~/l~kj - ~~~ C~ Cl c I f~,(~ ~Gcn
6. Valuation of Work: $ y()Q(~ ~ ~~ Total Sq. Footage (Including Basement ana Garage): Total Finished Area:
Floodway
7. Floodplain: Fringe Q Yes ^ No
Q Yes ^ No Dev. Permit
BFE Elev. Cert.
8. Current Zoning: ~, ~--
9. State Fire Marshall Required: Q Yes ~No
10. Special Use Permit Required: Q Yes ~o.
11. Variance Required: ^ Yes ~lo
12. Minimum Setbacks: Front ~ Side ~_ Rear
13. Sidewalk Required: Q 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 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. I understand thatthis permit is void if work is not commenced within
180 days or is not completed within 2 years of date of issue.
>>
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SI A F WNERICONTRACTOR DATE
Comment:
IVI~i IBC, IRC, IPC,IMC aN a N ~C COpE RLQUIREMEIV't~
O Site Plan Attached ^ Com lete Plans Attached
Approximate Completion Date ~/~C~~
Inspections Required and Fees
Final
iii i
Sewer
Septic
Buil in
F ngs
Fr ing
EI c ric I
Rot-in
F' al
Temporary Service_
M h ni
Rough-in
Final
Plumbing
Ground Work
Rough-in
WHEN PROPERLY
Water Service
Remote
Stop Box Card
Drywall
(PRIOR TO TAPING)
F' I
Fixtures
Permanent Service
A1C ,
THIS SPACEI THISJS YOJ.1Ft PERMIT
POUNDS PRIG: Blair, NE R~• ~G
ELECTRICAL PERMIT APPLICATION
Jurisdiction of City of Blair, Nebraska
218 South 16th Street
Blair, Nebraska 68008
(402) 426-4191 Permit E 19 9 3
~f a r ~~
Application Date: 2~ 6 / Permit Fee: $ ~` -
JOB ADDRESS ~ I I ~ ~ ~` / / ' ~I D~ ~ .
C( (
1 LEGAL
p SEE ATTACHED SHEET
DESCR.
MAIL ADDRES~ r ~~ ~ j-ir~ ZIP
2 OWNER ~
E ~~to V ~~U
a a~
~
y~ORKICELL PHON
(
CONTRACTOR MAILADDRESS PHONE HOME PHONE
,3
.
~~'y`f~ WORK/CELL PHONE
EW COMMERCIAL O REMODELING/ADDITIONS O UPGRADE SERVICE
4• Class of Work: EW RESIDENTIAL O N
l
5• Describe Work: ~ (,L/~ /~~yJ'1 a~C/' ~/~f --
6. Current License on File O Yes O No Q NA Completion Date
ELECTRICAL PERMIT FEES
New Service Fee = (Amp Fee + $2.00 per branch circuit)
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 S stem $10.00
y .................
301-400 Amp Fee ............................ $ 42.00 Si ns $15.00
g ~~~~~~~•~~~~~~~~~~~~~~~~~~~•~~~~•~~~~
p ............................
401-500 Am Fee $ 55.00
501-600 Amp Fee ............................ $ 67,00
Miscellaneous Ap ratus ......$11.00 nr~_
P~ _ , ~ _ _ Q,~ -~°~
~ - C~C~
~1
~
601-700 Amp Fee ............................ $ 80.00 cttit-.......•........
. $5.00
n
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 a •UC7
IF OVER 1000 Amp Amp Fee
1st 1000 Amp Fee ....................... $117.00 a ~ ~
Each additional 100 Amps ........... $ 13.00 Amp Fee + Circuit Total
New Residential: (Finished Area)
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 complied with whether specified herein or not.
The granting of a permit does not presume to give authority
l
l
h Receptacle/Switch Outlets
3 ` U~
~
er state or
oca
to violate or cancel the provisions of any ot x $.75
Fixtures
law regulating construction or the performance of Smoke Detectors x $3.00
construction. Residential/Commercial Appliance
# Fixed Outlets x $3.00
Motor(s) x $3.00
;~ Power Apparatus (220 Volts)
NATURE OF CONTRACTOR OR AUTHORIZED AGENT # Apparatus x $3.00
Permit Issuance Fee ............. $15.00 ~ 5 'C~ ~
DATE
TOTAL ~~
WHEN PROPERLY VALIDATED (IN THIS SPACE) THIS IS YOUR PERMIT
Comment: Approved By:
~,
POUNDS PRTG: Blair, NE Rev. 11/99
^ CITY OF BLAIR
LOCATION OF INSPECTION•
NAME OF OWNER• ~}
DATE INSPECTION REQUESTED• ~ TIME INSPECTION
TYPE OF INSPECTION REQUESTED;
PERMIT NO• ~ ~ / o
^ CONFERENCE ^ STATUS CHECK
BUILDING: ^ FOOTING ^ DECK FOOTING ^ FRAMING ^ DRYWALL FINAL ^ PARTIAL PASS D FAILED
^
COMMENTS:
UTILTTIES: ^ SEWER TAP ^ SEWER ^ SEPTIC ^ WATER TAP ^ REMOTE ^ WATER SERVICE PASSED FAILED
' ^ PARTIAL ^ ^
`COMMENTS: -
~ibECTRICAL:- ^-"ROUGH IN FINAL ^ PERMANENT SERVICE ^ TEMPORARY SERVICE ^ PRECONNECT PASS D FAILED
^
>~ COMMENTS: PARTIA ^
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 MADE: ~ = TiMR~ / O .
BUILDING INSPECTION REPORT
^ WASHINGTON COUNTY ^ -OTHER
FAXED OPPDIBURT REA TO CONNECT SERVICE:
-O _i R.: p
CTI'Y OF BLAIR
LOCATION OF INS]
BUILDING INSPECTION REPORT
^ WASHINGTON COUNTY ^
V.~Y l..'
NAME OF OWNER: ~ 6 V ~~ n• 7 CONTRACTOR: r ~~ ` ~ ~ ~f y ~ ~~
DATE INSPECTION REQUESTED• t TIME INSPECTION REQUESTED• f ~ ~ V y PERMTI' NO: ~ ~ ~ " ~~
TYPE OF INSPECTION REQUESTED: ^ CONFERENCE ^ STATUS CHECK
BUILDING: ^ .FOOTING ^ DECK FOOTING
FRAMING ^ DRYWALL ^ FINAL ^ PARTIAL PAD FED
COMMENTS:
UTILITIES: ^ SEWER TAP ^ SEWER ^ SEPTIC ^ WATER TAP ^ REMOTE ^ WATER SERVICE PASSED FAILED
^` PARTIAL ^ ^
COMMENTS:
.-
ELECTRICAL;] ROUGH IN ^ FINAL ^ PERMANENT SERVICE ^ TEMPORARY SERVICE ^ PRECONNECT PAS D FAILED
^ PARTIAL ~ ^
COMMENTS:
MECHANi.CAL: ^ ROUGH-IN ^ A/C ^ FURNACE ^ RADIANT HEAT ^ FINAL ^ PARTIAL PASSED FAILED
^ ^
COMMENTS:
1. PLUMBING: ^ GROUNDWORK ^ ROUGH-IN ^ FINAL ^ WATER METER INSTALLED ^ PARTIAL PASSED FAILED
^ PRESSURE TEST ^ ^
COMMENTS:
^ OCCUPANCY GRANTED ^ CONDITIONAL OCCUPANCY GRANTED
NOTES/REMARKS;
DATE OF INSPECTION MA
~ c ~O 1
FAXED OPPD\BURT REA TO CONNECT SERVICE: ON v BY
~ ~~
SCALE-, 1„- 6D~ N~1"~1 L~G7~ l3~)11N~~f~1'Sl~pl/GI'
PHIS IMPROVEMENT LOCATION REPORT IS REPRESENTATION OF
THE CONDNIONS THAT WERE FOUMD AT THE TIME, OF ThIE
IMPROVEMENT LOCATION SURVEY. THIS DOCUIdENT DDES NOT
CONSTITUTE A BOUIJDARY SURVEf AND IS SUBJECT TO ANY
INACCURACIES THAT A SUBSEQUENT BOUNDARY SURVEY MAY
DISCLOSE. THE INFORMATION SIIOWN ON THIS REPORT SHOULD
IJOT BE USED TO ESTABLISH ANY FENCE, STRUCTURE, OTIJER
IMPROVEMENTS, EXISTING BOUNDARY, OR IJEW BOUNDARIES. TFIE
MEASUREMEMS SHOWN ON THIS REPORT ARE BASED ON RIAT OR DEED
INFORMATION NdD VERIFIED AS SHOWN AND THAT THE IMPROVEMENT
LOCATIOIJ REPORT REPRESEPRS ONLY VISIBLE DUILDING IMPROVEMENTS. -.
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LEGAL DESCRIP770N
LOT 31, BLOCK 7, OAK PARK FIRST ADDITION TO BWR, CERTIFICATIDIJ
WASIiINCTON couMY, NEBRnsIN. l HEREBY CERTIFY TI~AT 7NlS SURVEYING DOCUMENT
WAS PREPARED BY ME OR UNDER MY DIRECT PERSONAL
.SUPER</lSION AND THAT l AM A DULY RE6/57ERED LANG
.SUR~fYDR (/NDER 1HE LAWS OF STATE OF NEBRASKA.
5-7-2003 _
DATE OF SIGNATURE- FRED A9. FRANI(LlN 2L.S 525
_ - ~ NOT VALID UNLESS EME30SSED WITH RAISEU SEAL
~~ \~1 ~Iaa r~_..T~~ ~~ DALE: _ S-2 _2003
Lana ,Surveying .. ~ ,,,~
~,.P.O DOX 1 OAKWJD, NEBRASI(A 68045 DRAWN BY: _NNS_____
CNECI(ED BY: F_M[___
2017 DAKOTA(AVE.)SO,BSIOUX CITI', NE. •68716 I ~
(4D2) 494-217.2 PROJECT
,4 REC.' IN SOLIDI DAI(OTA & NEBRASKA ~/: _ZQ~Q~~_
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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
,-~. -.. _ .,.%ciesigt~ed and- di~trib~ated ~ to .aid ~~yot~ -ir°ryour-- buitding~ per-rr~it ~process:~.-~.A~~ copy- of•-tl~te- _ .~... , ....__._.. ~..,
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.
O cupant
Contractor
~z~~
City of Blair Date
218 South 16th Street • Blair, Nebraska 68008 • 402-426-4191 • Fax 402-426-4195 • E-mail cityofblair@huntel,net