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` ,wB~UILDING PERMIT APPLICATION•~~y~~~
Permit Fee: ~4~•w Jurisdiction of City of Blalr, Nebraska
218 South 16th Street
Issuance Fee: Blair, Nebraska 68008 1 12 3 2
Receipt #: (402) 426-4191 • Fax (402) 426-,4195 Permit
Deposit Receipt #:
Issue Date: ~ `~
JOB ADDRESS ~ ~ ~~/~
LEGAL
1 . DESCR.
^ SEE ATTACHED SHEET
OWNER
2. IL ADDRESS ', ,
~CN
• ~n^ n
, r ~ Zlp HOME PHONE
WORWCELL PHONE I ~Q~
i ~. ~~
3 CO C OR ,n^ I ~ „ ~~
_ _ , ~ MA~~ADDRES ~ Zlp yyORKICEOLNPHONE ~~' L~-- ~5~~
4. Class of Work: Q NEW ~ ADDITION Q REMODEL OTHER ^ FINISHED BASEMENT ^ UNFINISHED BASEMENT
5. Describe Work: I I'~ ~ ~ ~j~/~/~ ''1 Gl.~ ~iV~~ 0~ ~als(~-~ 1' uC,(~
6. Valuation of Work: $ ~ ~ ~ ~ _ ~al Sq. Footage (IRCluding Basement and Garage): Total Finished Area:
Floodway ^ Yes Q No Dev. Permit
7. FIOOdplain: Fringe ^ Yes Q No BFE Elev. Cert.
8. Current Zoning:
9. State Fire Marshall Required: ^ Yes ^ No
10. Special Use Permit Required: Q Yes Q No.
11. Variance Required: ^ Yes ^ No
12. Minimum Setbacks: Front Side Rear
13. Sidewalk Required: Q Yes Q 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 herebyagree 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. /~
-/
SIGN TUBE OFOWNER/CONTRACTOR DATE
Comment:
^ Site Plan Attached Comple a Plans Attached
Approximate Completion Date =
Inspections Required and ees
ili i
Sewer _
Septic _
it in
Footings
Water Service
Remote
Stop Box Card
Framing
E c ric I
Rough-in
Final
Temporary Service
Mechanical _
Rough-in
Final
Imin
Ground Work
Rough-in
Fixtures
Permanent Service
A1C
Final
I WHEN PROPERLY VALIDATED (IN THIS SPACE) THIS IS YOUR PERMIT1
Approved Bu: I. !1 _ ,. r .. ~ 1
Drywall
(PRIOR TO TAPING)
Final
POUNDS PRIG: Blalr, NE I ~,f Rev 8/96
T°~~ - ~~ BUILDING INSPECTION REPORT -
;{
CTI'Y OF BLAIR ^ WASHIIVGTON COUNTY ^ OTHER
Q .~ n
LOCATION OF
~~a
NAME OF OWNER• ~ "' -' " CONTRACTOR F~ ~ --" "'
DATE INSPECTION REQUESTED: ~ ~ _ v + TIME INSPECTION REQUESTED• PERMIT N0: ~ ~ ~ '~ °~
TYPE OF INSPECTION REQUESTED: ^ CONFERENCE ^ STATUS CHECK
BUILDING: ^ FOOTING ^ DECK FOOTING ^ FRAMING ^ DRYWALL FINAL ^ PARTIAL
~~
COMMENTS:
PAS~'ED FAILED
~J~j' ^
UTILITIES: ^ SEWER TAP ^ SEWER ^ SEPTIC ^ WATER TAP ^ REMOTE ^ WATER SERVICE PASSED FAILED
^ PARTIAL ^ ^
COMMENTS:
EL_ ECTRICAL: ^ 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
^ PRESSURE TEST ^ ^
COMMENTS:
^ OCCUPANCY GRANTED ^ CONDITIONAL OCCUPANCY GRANTED
NOTES/REMARKS•
,s
FAXEDOPPD~BURTREA TO CONNECT SERVICE: ON BY
r
CI'I'Y OF bI~~~IR
-y ~ - _
- ,~~
~ro~~se 4ot av~\\
ROOFING PERMIT SUPPORTING DOCUMENTS
This supporting document includes information dealing with particular code
requirements and/or roofing 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 document is only
designed ahd distributed to aid you in your roofing permit process. A copy of '.the
International Building Code is available for your use of the Blair Public Library..
:.
-~ ~~ ''
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~- ~ v ~ r"e,Y j ) ~
d
~c~
City of Blair Date
aW°~.Y&~r6 9; act
~ .. 1.-
_ ;~ `°.L =
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~~
218 South 16th Street • Blair, Nebraska 68008 • 402-426-4191 • Fax 402-426-4195 E-mail cifyofblai~@ci,bldir.ne.us o:: ~,•.,..