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BP12506I Z J3 010 \)-Y 1 0 a_ Blair Building Permit Detail Permit #: 12506 Issued: 6/26/2006 Type: Residential - New Construction Completed: 12/11/2006 Valuation: 165937 Location: 1404 Voss Dr. Owner: John & Jackie Ambroz Address: 1268 Deerfield Blvd #302 Blair, NE 68008 Phone: Permit Fee: 739 Issue Fee: 15 Deposit Amt.: 200 Receipt #: 17013 Section: Township: Range: Subdivision: DEERFIELD Lot: 69 Block: Ranch style home. 3br, 1 RI bath in basement 2 full bath. Attached 2 car garage off of kitchen area. Unfinished basement with 1 egress for potential bedrm. Not a walk out basement. TSF: 5325 TFA: 2352 Contractors Melvin Sudbeck Homes, Inc Century Electric, Inc. L.A. & Sons Heating & A/C Inc. Mike Plambeck Plumbing, LLC Mike Plambeck Plumbing, LLC Walz Plumbing Remarks General Contractor Permit # Issued Electrical Subcontractor E2508 7/10/2006 Heating Subcontractor M1462 10/25/2006 Plumbing Subcontractor T1233 9/15/2006 Plumbing Subcontractor P1581 9/15/2006 Plumbing Subcontractor P1586 9/25/2006 6/28/2006 BMS Sent copy of permit. Inspections Date By 7/11/2006 DEM Electrical Temporary Service Pass 8/3/2006 DEM Footings Pass 9/25/2006 DEM Plumbing Groundwork Pass 10/6/2006 DEM Sewer Tap Pass 10/6/2006 DEM Sewer Lines Pass 10/6/2006 DEM Water Tap Pass 10/6/2006 DEM Water Service Pass 10/11/2006 DEM Plumbing Pressure Test Pass 10/11/2006 DEM Plumbing Rough -ins Pass Partial 10/13/2006 DEM Electrical Rough -ins Pass 10/13/2006 DEM Mechanical Rough -ins Pass 10/13/2006 DEM Plumbing Rough -ins Pass 10/13/2006 DEM Framing Pass 10/26/2006 DEM Electrical Permanent Service Pass 12/7/2006 DEM Stop Box Card Pass 12/11/2006 DEM Plumbing Final Pass 12/11/2006 DEM Final Inspection of Project Pass 12/11/2006 DEM Electrical Final Pass 12/11/2006 DEM Mechanical Final Pass I.& I', PERMIT BUILDING o Jurisdiction of City of Blair, Nebraska PerrrGt Fee: 7S-Y-oD 218 South 16th Street Issuance Fee: Uj Blair Nebraska 68008 Receipt #: r 9E -Y- 0-0(402) 426-4191 • Fax (402) 426-4195 Permit ` Deposit Receipt #: 1-2 b 1.3 Issue Date: 0� 6 ,.-0 b Type: I � 12506 JOB ADDRESS v C7 "J LEGAL 1 . DESCR. ` ;e A— 6 ❑ SEE ATTACHED SHEET OW MAIL ADDRES 2. A-. � � �j� J HOME PHONE �yLQ � � 0 A WORK/CELL PHONE 3. CONT TOR c P 1 ��DRESS D� l tin D �y�'�Ct h ZIP del 36 WORIWELLHOMEPHOLIPHONE , 4. Class of Work: NEW ❑ ADDITION ❑ REMODEL ❑ OTHER [3 FINISHED BASEMENT ❑ UNFINISHED BASEMENT 5. Describe Work: 2 I a 64, U� 6. Valuation of Work: 4165, 93� Total Sq. Footage (including Basement and Garage): Total Finished Area: FloWway C] Yes 0 No Dev. Permit 7. Floodplain: Fringe 0 Yes ❑ No BFE Elev. Cert. 8. Current Zoning: 9. State Fire Marshall Required: ❑ Yes [X110 10. Special Use Permit Required: ❑ Yes M. -No. 11. Variance Required: ❑ Yes �o 12. Minimum Setbacks: Front: ��S Side Rear 13. Sidewalk Required: �es ❑ No Waiver Approved NOTICE Separate permits are required for electrical, plumbing, heating, ventilating and air conditioning, and septicsystems. 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 that this permit isvoid if work is not commenced within 80 daysor is not completed within 2 ye rs of date of issue. bA i� —� SIGNATURE OF OWNER/CONTRACTOR DATE Comment:. . WET 18 ' .14d, IPC, IMC AND NEC CODE REQUIR MENTS- SLEEPING ROOMS BELOW THE FOURTH STORY AND IN BASEMENTS ARE \`1IRED TO HAVE AN EGRESS'WINDOW.- J: a Plan Attached Complete Pla Attached Approximate Completion Date %!� ' a �� Inspections Required and Fees Utilities 7eptic rWater eivice Ree Stop/x Card B it in Footi s pryw (PRIER TO TAPING) FrarOi(Ig F LElectrical uol ^� Rou in Fixt/s Fi Perman Service Tempora ervice M ha is I . Rou -in Fir Plumbing p GrouZin' k Rou Fir WHEN PROPERLY VALIDATED (IN THIS SPACE) THIS.ISXGUR PERMIT er, NE Rev. 8/96 ELECTRICAL PERMIT APPLICATION Jurisdiction of City of Blair, Nebraska 218 South 16th Street Blair, Nebraska 68008 (402) 426-4191 Permit E 2508 Application Date: `'-, J Permit Fee: $ /3M -V_ JOB ADDRESS V 1 LEGAL DESCR. D SEE ATTACHED SHEET 2. OWNE MADDRESS ZIP HOME / ELLAIL WORK PHONE CONTRA OR MAILADDRESS PHONE HOME PHONE 3 f USU .. ,3 WORKICELL PHONE 4. Class of Work: D NEW RESIDENTIAL D NEW COMMERCIAL D REMODELING/ADDITIONS D UPGRADE SERVICE 5. Describe Work:ut�&J 6. Current License on File 4Yes D No D 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 UJ 201-300 Amp Fee ............................ $ 30.00 Fire Alarm System $10.00 y 301-400 Am 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 Amp Fee 1st 1000 Amp Fee ....................... $117.00 Each additional 100 Amps ........... $ 13.00 Amp Fee +Circuit Total New Residential: (Finished Area) NOTICE Single/Two Family Dwellings _ 3 U5 �y 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 Receptacle/Switch Outlets to violate or cancel the provisions of any other state or local Fixtures -x $.75 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) # Apparatus x $3.00 SI ATU OF CONTRACTOR OR AUTHORIZED AGENT 7- Permit Issuance Fee ............. $15.00 • L)j DATE TOTAL 3 V ° F y WHEN PROPERLY VALIDATED (IN THIS SPACE) THIS IS YOUR PERMIT Comment: Approved By: POUNDS PRTG: Blair. NE Rev. 11/99 MECHANICAL PERMIT APPLICATION Jurisdiction of City of Blair, Nebraska 218 South 16th Street Blair, Nebraska 68008 1462 Fax (402) 426-4195 M (402) 426-4191 Application Date: 1441 —021 `0 44 Permit Fee: $ `D JOB ADDRESS / 611 ' 1 OWNER. '"n / LADD ��, ZI PHONE 2• ccNTRAC OR �j MAIL RESS �) HONE LICENSE NO. r� / 3• Class of Work: O COMMERCIAL RESIDENTIAL W O ADDITION O ALTERATION O REPAIR O REPLACEMENT 4• Describe Work: lehalnj eaJ �*7 &&) Central A/C Tons MECHANICAL PERMIT FEES Furnace BTU/H rced ' /Heat Pump Systems - Per Unit �Oa � ............. ............. mercial/Residential (New) ......y ..�......�. $25.00 # of Units A/C _ Air ie -Gond' er Unit -Per Unit �� Furnace Commercial/Residential (New) ............................................... . $10.00 Forced Air Systems/Air Conditioner Unit Replacement Per Unit Commercial/Residential ................... $10.00 Completion Date: Refrigeration Units/Coolers/Lines/Compressor - Per Unit Commercial (New or Replacement) ...... ..................... $10.00 Comments: Appliance Vent/Fans $10.00 Boiler.......................................................$15.00 Duct System $10.00 Gas/Air Outlets .................. x $2.00 Radiant Heat Systems ............................ $25.00 NOTICE 1 hereby certify that I have read and examined this application and know the same to be true and correct. All provisions of laws and ordinances governing this type of Modular Home $15.00 work will be complied with whether specified herein or not. ......................................... The granting of a permit does not presume to give authority to violate or cancel the provisions of any other state or local law regulating construction or the performance of Permit Issuance Fee ............................... $15.00 I" construction. TOTAL �� r 0 t) SIGNATURE CO TOR 0 tl ORIZED AGENT Current License on File >ees O No O NA DATE - WHEN PROPERLY VALIDATED (IN THIS SPACE) THIS IS YOUR PERMIT Comment: Approved By:S z ���¢ POUNDS PRTG: Blair, NE Rev. 4/98 PLUMBING PERMIT APPLI Jurisdiction of City of Blair, Nebraska 218 South 16th Street Blair, Nebraska 68008 Fax (402) 426-4195 (402) 426-4191 Application Date:—9 115 l C(=:, CATION T 1233 Permit Fee: $ 2M'10 JOB ADDRESS VL4 \ O SJ ER 1 LSMAILADDRESS NMZIP 1. PHONE 2 CIIZACROR lof �M /�� MAILADDRESS �3 /� PHONE 1 LICENSE NO. �aZ 3. Class Work: O COMMERCIAL RESIDENTIAL NEW O ADDITION/1 O ALTERATION O REPAIR O REPLACEMENT 4. Describe Work: I ( Oa— j \ V �c Comments: PLUMBING PERMIT FEES Modular Home ........................ $15.00 Water Tap Fee - 3/4" $150.00 Water Tap Fee - 1 " $200.00 Water Tap Fee - 1 1/2" $250.00 NOTICE I hereby certify that I have read and examined this application and know the same to be true and correct. All provisions of laws and ordinances governing this type of Water Tap Fee - 2 $300.00 work will be complied with whether specified herein or not. The granting of a permit does not presume to give authority to violate or cancel the provisions of any other state or local law regulating construction or the performance of construction. SIGNATURE OF CONTRACTOR OR AUTHORIZED AGENT o6 TOTAL DATE Current License on File des Cl No O NA WHEN PROPERLY VALIDATED (IN THIS SPACE) THIS IS YOUR PERMIT TI: I Approved By: 4 � j v n I `� l� uG air, NE Rev. 10/05 PLUMBING PERMIT APPLI Jurisdiction of City of Blair, Nebraska 218 South 16th Street Blair, Nebraska 68008 Fax (402) 426-4195 (402) 426-4191 Application Date: v1 (� IOC CATION P 1581 Permit Fee: $ JOB ADDRESS $8.00 x Bath ....................................... 1 O4 V oS-& 1✓" W ER $4.00 x / MAIL ADDRESS ZIP PHONE 2. C FACTOR $5.00 x Water Heater .......................... MAILADDRESS PHONE LICENSE NO. Vy 3• Class of Work: O COMMERCIAL O'RESIDENTIAL ff.ONEW O ADDITION O ALTERATION O REPAIR O REPLACEMENT 4• Describe Work: (Commercial) ....................... $30.00 r-- maAA Comments: PLUMBING PERMIT FEES ModularHome ........................ $15.00 NOTICE I hereby certify that I have read and examined this application and know the same to be true and correct. All provisions of laws and ordinances governing this type of work will be complied with whether specified herein or not. The granting of a permit does not presume to give authority to violate or cancel the provisions of any other state or local law regulating construction or the performance of construction. SIGNATURE OF CONTRACTOR OR AUTHORIZED AGENT l.5 -6:)�) DATE Type of Fixture Kitchen .................................. $8.00 x Bath ....................................... $8.00 x Rough -In Bath ........................ $4.00 x Additional Sinks ..................... $3.00 x Laundry .................................. $5.00 x Water Heater .......................... $3.00 x Outside Water Faucet ............ $3.00 x Drinking Fountain ................... $3.00 x Back Flow/Grease Trap .......... $10.00 Water Service ........................$10.00 Sewer .................................... $10.00 Groundwork ............................ $10.00 Septic Tank & Laterals ........... $10.00 Lawn Sprinkler System .......... $10.00 Sprinkler System ................... $30.00 (Commercial) Gas/Water Piping System (Commercial) ....................... $30.00 Permit Issuance Fee ............. $15.00 Current License on File No. I a o0 �O CDD TOTAL 11 No 13 NA WHEN PROPERLY VALIDATED (IN THIS SPACE) THIS IS YOUR PERMIT :,omment::::Approved By: L POUNDS PRIG. -Blair, NE Rev. 10105 PLUMBING PERMIT APPLICATION Jurisdiction of City of Blair, Nebraska 218 South 16th Street Blair, Nebraska 68008 Fax (402) 426-4195 P 1586 (402) 426-4191 Application Date: q l 2-c�' 1 Permit Fee. $ JOB ADDRESS y VossbrL- 1 • W ER 3 ` -C-O _ 4,61(b2- MA21L'ADDRE el Vd 4302 V' l.( b�„14ZIPPHONE WLICENS C %MR�C� OR I b AIL ADDoo ESS � l r i PHONE O-1 1 NO. � . &I-P-62- [(L� 3. Class of Work: COMMERCIAL Q -RESIDENTIAL Iff NEW I ADDITION Cl ALTERATION O REPAIR O REPLACEMENT 4• Describe Work: I i� rit Y� L Comments: PLUMBING PERMIT FEES ModularHome ........................ $15.00 o Tyf Fixture pe No. I U Kitchen........... ....................... $8.00 x . Bath ....................................... $8.00 x_ (�� oo Rough -In Bath ........................ $4.00 x Additional Sinks ..................... $3.00 x S C� .................................. Laundry$5.00 x T 3'W WaterHeater ..........................$3.00 x ' Outside Water Faucet ............ $3.00 x — Drinking Fountain ................... $3.00 x Back Flow/Grease Trap .......... $10.00 NOTICE Water Seryice ........................$10.00 I hereby certify that I have read and examined this application and know the same to be true and correct. All Sewer ...:................................ $10.00 provisions of laws and ordinances governing this type of work will be complied with whether specified herein or not. Groundwork ............................ $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 Septic Tank & Laterals ........... $10.00 law regulating construction or the performance of construction. Lawn Sprinkler System .......... $10.00 6. 00 Sprinkler System ................... $30.00 (Commercial) ✓� , . Gas/Water Piping System (Commercial) ....................... $30.00 SIGNATURE OF CON ACTOR OR AUTH IZED AGENT Permit Issuance Fee ............. $15.00 / `" z�---O.1- TOTAL ­7-1,co � DATE Current License on File Oyes O No O NA WHEN PROPERLY VALIDATED (IN THIS SPACE) THIS IS YOUR PERMIT Comment: Approved By: )� L& p POUNDS PRIG: Blair, NE Rev. 10105 BUILDING INSPECTION REPORT >;:�iI'Y OF BLAIR ❑ WASHINGTON LOCATION OF INSPECTION NAME OF OWNERla /M ,L&42 A#d& Z CONTRACTOR - DATE INSPECTION REQUESTED• J (/ W TIME INSPECTION REQUESTED: A 4 • M ' PERMIT N;Z50 Cl' TYPE OF INSPECTION REQUESTED: ❑ CONFERENCE ❑ STATUS CHECK BUILDING: ❑ FOOTING ❑ DECK FOOTING ❑ FRAMING ❑ DRYWALL FINAL ❑ PARTIAL PAS D FAILED COMMENTS: ll UTILTPIES: ❑ SEWER TAP. ❑ SEWER ❑ SEPTIC ❑ WATER TAP ❑ REMOTE El WATERSERVICE PASSED FAILED ❑ PARTIAL ❑ ❑ COMMENTS: ELECTRICAL:. ❑ ROUGH INFINAL ❑ PERMANENT SERVICE ❑ TEMPORARY SERVICE ❑ PRECONNECT PASSPD FAILED ❑ ❑ COMMENTS: PARTIAL MECHANICAL: ❑ ROUGH -IN ❑ A/C ❑ FURNACE ❑ RADIANT HEAT AL ❑ PARTIAL P SSSS FAILED COMMENTS: T ❑ PLUMBING: ❑ GROUNDWORK ❑ ROUGH -IN FINAL ❑ WATER METER INSTALLED ❑ PARTIAL PAS D FAILED COMMENTS: ❑ PRESSURE TEST ❑ OCCUPANCY GRANTED ❑ CONDITIONAL OCCUPANCY GRANTED NOTES/REMARKS: DATE OF INSPECTION FAXED OPPD\BURT REA TO CONNECT SERVICE: ON 15( MECHANICAL: ❑ BUILDING INSPECTION REPORT PASSED ❑ CITY 0BLAIR ❑ WASHINGTON COUNTY ❑ OTHER ❑ U _ COMMENTS: LOCATION OF INSPECTION• v V PLUMBING: ❑ GROUNDWORK ❑ ROUGH -IN ❑ FINAL ❑ WATER METER INSTALLED ❑ PARTIAL PASSED NAME OF OWNER• 1 CONTRACTOR- ONTRACTO -DATE PRESSURE TEST ❑ _ DATEINSPECTION REQUESTED- TIME INSPECTION REQUESTED. PERMIT NO - 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 PASSED FAILED ❑ PARTIAL ❑ ❑ COMMENTS: ELECTRICAL: ❑ ROUGH IN ❑ FINAL ❑ PERMANENT SERVICE TEMPORARY SERVICE ❑ PRECONNECT PASS FAILED PARTIAL F1 PARTIAL / - � n D r} � E] COMMENTS: V 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- INSPECTION MADE: TO CONNECT SERVICE: ON BY 7//l 7/1r /o BUILDING INSPECTION REPORT XCITYO AIR ❑ WASHINGTON COUNTY ❑ OTHER LOCATION OF INSPECTION_ /A0 0 `T NAME OF OWNERC / ( ��'p���Z ILA ONTRACTOR CONTRACTOR- DATE DATE INSPECTION REQUESTED- t6 - �� �LY TIME INSPECTION REQUESTED./.,L,)Iom • PERMIT NO - TYPE OF INSPECTION REQUESTED: ❑ CONFERENCE ❑ STATUS CHECK BUILDING: XFOOTING ❑ DECK FOOTING ❑ FRAMING ❑ DRYWALL ❑ FINAL ❑ PARTIALPASS FAILED F-1 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 F1 PARTIAL El❑ 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- FAXED OPPD\BURT REA TO CONNECT SERVICE: ON BY T t' :�S BUILDING INSPECTION REPORT I C B AIR ❑ WASHINGTON COUNTY\\ ElOTHER LOCATION OF INSPECTION- V Voss oss 01 NAME OF OWNER Y l U O E Qb'bZ- CONTRACTOR J DATE INSPECTION REQUESTED- T13 TIME INSPECTION REQUESTED• ��� PERMIT NO 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 PASSED FAILED Fl PARTIAL F-1 ElCOMMENTS: ELECTRICAL: ❑ ROUGH IN ❑ FINAL ❑ PERMANENT SERVICE ❑ TEMPORARY SERVICE ❑ PRECONNECT PASSED FAILED ❑ PARTIAL ❑ F-1COMMENTS: MECHANICAL: ❑ ROUGH -IN ❑ A/C ❑ FURNACE ❑ RADIANT HEAT ❑ FINAL ❑ PARTIAL PASSED FAILED ❑ ❑ COMMENTS: -4 PLUMBING: AGROUNDWORK ❑ ROUGH -IN ❑ FINAL ❑ WATER METER INSTALLED ❑ PARTIAL COMMENTS: FlPRESSURE TEST ❑ OCCUPANCY GRANTED ❑ CONDITIONAL OCCUPANCY GRANTED FAILED FAXED OPPD\BURT REA TO CONNECT SERVICE: ON BY BUILDING INSPECTION REPORT ❑ CITY OF BLAIR ❑ WASHINGTON COUNTYI ❑ OT\H,ER LOCATION OF INSPECTION• ` y V � 0-14 f %) j� ` NAME OF OWNER- CONTRACTOR- P DATE INSPECTION REQUESTED / _ v TIME INSPECTION REQUESTED- 30 PERMIT N0A �sy 6 TYPE OF INSPECTION REQUESTED: ❑ CONFERENCE ❑ STATUS CHECK BUILDING: ❑ FOOTING ❑ DECK FOOTING ❑ FRAMING ❑ DRYWALL ❑ FINAL ❑ PARTIAL PASSED FAILED ❑ ❑ COMMENTS: UTILITIES: f e SEWER TAP : SEWER ❑ SEPTIC / WATER TAP ❑ REMOTE WATER SERVICE PASS FAILED !❑ PARTIAL ❑ COMMENTS: TTT ELECTRICAL: ❑ ROUGH IN ❑ FINAL ❑ PERMANENT SERVICE --❑j TEMPORARY SERVICE ❑ PRECONNECT PASSED FAILED ❑ PARTIAL -E. ❑ ❑ COMMENTS: d 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- INSPECTO • DATE OF INSPECTION MADE: ©^ TIME FAXED OPPD\BURT REA TO CONNECT SERVICE: ON BY e S BUILDING INSPECTION REPORT ❑ WASHINGTON COUNTY ❑ LOCATION OF INSPECTION: "-f U 14 U v ----g. 11 �YJ--,v 1 NAME OF OWNER: CONTRACTOR: W DATE INSPECTION REQUESTED- r u ` TIME INSPECTION REQUESTED: 0 PERMIT TYPE OF INSPECTION REQUESTED: - 6-76- 0) y,V )dS-o� ❑ CONFERENCE ❑ STATUS CHECK BUILDING:. ❑ FOOTING ❑ 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 t- ❑ PARTIAL ❑ ❑ COMMENTS: MECHANICAL: ❑ ROUGH -IN ❑ A/C ❑ FURNACE ❑ RADIANT BEAT ❑ FINAL ❑ PARTIAL PASSED FAILED El F1 COMMENTS: PLUMBING: ❑ GROUNDWORK [/ ROUGH -IN ❑ FINAL ❑ WATER METER INSTALLED Z' PARTIAL PASS FAILED [PRESSURE TEST ❑ COMMENTS: / ❑ OCCUPANCY GRANTED ❑ CONDITIONAL OCCUPANCY GRANTED NOTES/REMARKS- FAXED OPPD\BURT REA DATE OF INSPECTION MADE: 0 L [ ; TO CONNECT SERVICE: ON BY �99 BUILDING INSPECTION REPORT -,KLcTTY OI` LAIR ❑ WASHINGTON COUNTY 'p OTHER LOCATION OF / a NAME OF OWNERL / k CONTRACTOR: O DATE INSPECTION REQUESTED- /D ��/ TIME INSPECTION REQUESTED-// �v "� ' PERMIT N0: TYPE OF INSPECTION REQUESTED: ❑ CONFERENCE ❑ STATUS CHECK BUILDING: ❑ FOOTING ❑ DECK FOOTING FRAMING ❑ DRYWALL ❑ FINAL ❑ PARTIALPAS FAILED COMMENTS: UTILITIES: ❑ SEWER TAP ❑ SEWER ❑ SEPTIC ❑ WATER TAP ❑ REMOTE ❑ WATER SERVICE PASSED FAILED ❑ PARTIAL ❑ ❑ COMMENTS: ELECTRICAL: OUGH IN ❑ FINAL ❑ PERMANENT SERVICE ❑ TEMPORARY SERVICE ❑ PRECONNECT PASS FAILED ❑ PARTIAL ❑ COMMENTS: MECHANICAL: OUGH-IN ❑ A/C ❑ FURNACE ❑ RADIANT HEAT ❑ FINAL ❑ PARTIAL PASSFjP FAILED COMMENTS: PLUMBING: ❑ GROUNDWORK ROUGH -IN ❑ FINAL ❑ WATER METER INSTALLED ❑ PARTIALPASS FAILED ❑ PRESSURE TEST ❑ COMMENTS: ❑ OCCUPANCY GRANTED ❑ CONDITIONAL OCCUPANCY GRANTED NOTES/REMARKS: 6' DATE OF INSPECTION MADE: b � _' TIME - FAXED OPPMBURT REA TO CONNECT SERVICE: ON /B l BUILDING INSPECTION REPORT TTY OF BLAIR ❑ WASHINGTON COUNTY UNTY ' Q LOCATION OF INSPECTION• % A NAME OF OWNER ❑ OT R CONTRACTOR DATE INSPECTION REQUESTED TIME INSPECTION REQUESTED- �U,�' M' PERMIT NO- / a�06C TYPE OF INSPECTION REQUESTED: ❑ CONFERENCE ❑ STATUS CLIECK BUILDING: ❑ FOOTING ❑ DECK FOOTING ❑ FRAMING ❑ DRYWALL ❑ FINAL ❑ PARTIAL PASSED FAILED COMMENTS: F-1 F-1 UTILITIES: ❑ SEWER TAP ❑ SEWER ❑ SEPTIC ❑ WATER TAP ❑ REMOTE ❑ WATER SERVICE PASSED FAILED ❑ PARTIAL El ElCOMMENTS: ELECTRICAL: ❑ ROUGH IN ❑ FINALSE VICE ❑ TEMPORARY SERVICE ❑ PRECONNECT D FAILED ENT COMMENTS: ❑ PARTIAL D ` p � PASS /) - � ❑ , MECHANICAL: ❑ ROUGH -IN ❑ A/C ❑ FURNACE ❑ RADIANT HEAT ❑ FINAL ❑ PARTIAL COMMENTS: PASSED FAILED F-1 n PLUMBING: ❑ GROUNDWORK ❑ ROUGH -IN ❑ FINAL ❑ WATER METER INSTALLED ❑ PARTIAL PASSED FAILED COMMENTS: ❑ PRESSURE TEST ❑ ❑ ❑ OCCUPANCY GRANTED ❑ CONDITIONAL OCCUPANCY GRANTED ,T�E)D OP URT REA p !U 2'7 -66 DATE OF INSPECTION MADE: TO CONNECT SERVICE: T � prom/se of ave\\ CITY OF I)LAIQ_ BUILDING PERMIT DEPOSIT AGREEMENT A $200.00 refundable deposit is being collected at the time of your building permit application for all permits $10,0000 and above. However, the City reserves the right to not refund this deposit if any of the following conditions occur during the construction period: 1) theft of water service by either the plumber, owner or general contractor, 2) all required inspections have not been obtained, 3) occupancy occurs prior to a final inspection, 4) all permits have not been obtained, and 5) the project is completed without a final inspection being done. If any or all of these situations occur during construction, you may forfeit your deposit. I, hereby agree to the above conditions, and understand that should any or all of the above situations occur, the building permit deposit SHALL be forfeited or discounted upon the discretion of the City of Blair, Building and Inspections Department. Contractor/Owner Date Contractor/Owner City of Blair 218 South 16th Street • Blair, Nebraska 68008 • 402-426-4191 • Fax 402-426-4195 • E-mail cityofblair@huntel.net ,,. IV ,Or0�/se TO CITY OF t)tAIQ 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 designed and distributed to aid you in your building permit process. A copy of the International Building Code is available for your use at the Blair Public Library. 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. Owner/Occupant City of Blair Contractor Date 218 South 16th Street • Blair, Nebraska 68008 • 402-426-4191 • Fax 402-426-4195 • E-mail cityofblair@huntel.net * * * * * * * * * * * * * * * * * * * * * * * BLAIR • All material must be HAND DELIVERED to Blair Office o One set of plans o One plot plan o One surveyors certificate o Res check o Business check (fill out at Blair office) • Complete application at desk o Cost of project(___� =�' :�, excludes lot cost) o Completion date b moo o Name of electrical G,yrtyrq Oct- (- • Name of HVAC sub t- IV -- Sot) L, o Name of plumbing sub Inst � P?wMb)'" fa,rmory0+VZ 6t, IIaS, q� S:VDESIGNITW_ EXCEL_WORDIPROCEDUREIPROCESS PERMIT 0 REScheck Software Version 3,7.3 N/'Compliance Certificate Project Title: HJ -245 Report Date: 05/25/06 Data filename: S:\Design\CUSTOMS\JOB_HJ2451RESHJ245_DF069.rek Energy Code: 2003 IECC Location: Blair, Nebraska Construction Type: Single Family Glazing Area Percentage: 13% Heating Degree Days: 6506 Construction Site: 1404 VOSS DRIVE BLAIR, NE Permit # Permit Date Owner/Agent: Designer/Contractor: JOHN & JACKIE AMBROZ MELVIN SUDBECK HOMES, INC. Compliance: Passes Maximum JA: 368 Your Home UA: 356 --> 3.3% Better Than Code (UA) Ceiling 1: Flat Ceiling or Scissor Truss: 1463 38.0 0.0 44 Wall 1: Wood Frame, 16" o.c.: 1493 30.0 0.0 63 Window: 5460 (RO) Glider Low -E: Vinyl Frame, Double Pane 45 0.340 15 with Low -E: Window: 8" Sidelight: Wood Frame, Double Pane: 11 0.490 6 Window: 3042 (RO) Glider Low -E: Vinyl Frame, Double Pane 18 0.340 6 with Low -E: Window: 4242 (RO) Glider Low -E: Vinyl Frame, Double Pane 12 0.340 4 with Low -E: Window: 27 3/4 X 75 3/4 (RO) Direct Set Low -E: Vinyl Frame, 30 0.300 9 Double Pane with Low -E: Window: 5454 (RO) Glider Low -E: Vinyl Frame, Double Pane 20 0.340 7 with Low -E: 3'0" Front Door: Solid: 20 0.360 7 Door: 2'8" Garage: Solid: 18 0.400 7 Door: 6'0"Slider Timeline Low -E: Glass: 40 0.310 12 Basement Wall 1: Masonry Block with Empty Cells: 535 0.0 0.0 116 Basement Wall 2: Masonry Block with Empty Cells: 303 0.0 10.0 17 Window: 3219 Vinyl: Vinyl Frame, Double Pane: 4 0.500 2 Window: 5454 (RO) Glider Low -E: Vinyl Frame, Double Pane 20 0.340 7 with Low -E: Basement Wall 3: Masonry Block with Empty Cells: 396 0.0 10.0 24 Basement Wall 4: Masonry Block with Empty Cells: 133 0.0 10.0 8 Window: 3219 Vinyl: Vinyl Frame, Double Pane: 4 0.500 2 Furnace 1: Forced Hot Air: 92 AFUE Air Conditioner 1: Electric Central Air: 13 SEER Compliance Statement., The proposed building design described here is consistent with the building plans, specifications, and other calculations submitted with the permit application. The proposed building has been designed to meet the 2003 IECC requirements in REScheck Version 3.7.3 and to comply with the mandatory requirements listed in the REScheck Inspection Checklist. Melvin Sudden %/ornes, Ioc, HJ -245 Page 1 of 2 Builder/Designer Company Name Date Project Notes: LOT 69 DEERFIELD HJ -245 Page 2 of 2 r--� I ----------J I I L------------------ I--------- 1 I1/2"fH MAX I I I I I I x I I 1 I I I I 11/ 21' ME�MAX 1 1/ 211 Vrm AX I I I I 1 OLME J015f UNPR I I I MWING WU5 I 2 x 10 016° O.c. 1 2 x 10 016" O,C, I I 1 FEM PIR 5MP #2 I I I I I I 6A5EM�Nf I A/C I I 1 I '1/12,101151 1icO I I I----- �Ji L---------------- I ---------------------- I L , 36" %36" X e. I I OMNNMWW GONG 'C' IWAC I CPxP6f L —'—\,J I I uNMAVASP I I I l a x I �� III I � 3 L----- ISI I I I I � III I I I- I I I I I u 6uravann I IVIL III AITW c 120 X 12'8" I I I I I I = I I I I I I I I I r I IIII \ � PorENna. aoSEruP %"W I - _ ( ) r -- SII UM55'WNnOWIN I I I I I-Pox5roor I -- I( 1 I I'M WOM) II FWLW I xrPww L— — — — — — — — — — — — — — — — — — — — — — — — - L- — — L — — — — L \ / 4 — — — — — — — — — — J I 8'3" M.O. 1613" M.O. L= — — — — — — — — — — — — -- — — — — — — — — — — — — — — — —4 — — — — — — — — — — — — — — — — — — — — — — — wOxf POx 5sr 0 0 0 I Of - 901150 Ff NOUS - 1438 50 Ff 6AMA d 61150 Ff CONCITt- 858 50 Ff PLOT PLAN SCALA I'' - - - - 201011 LO'69 n PFELP 1404 V055 RK REQUEST FOR SEWER STUB OUT LOCATIONS 'T- Address \� b-�--S Dr, Lot #(Must Have) (09 Subdivision eey--1 elo l Sewer Stub Out Name WL Phone number(s)J3�` r `I Date q � is 6 Ztn SVL,2— 0 LAND SURVEYOR'S CERTIFICATE _1 hereby certify that this plot, map, survey or report was made by me or under my direct supervision and that I am a duly Registered Land Surveyor under the laws of the State of Nebraska. LEGAL DESCRIPTION: Cot �` DEERFIELO, o subdivision as surveyed, platted and recorded in Washington County, Nebraska 14V\14A%; 65 15A 16B _16A 16B 17A'\ .4 7B 64 CENTERLINE CUM DATA CNRVE IEIICIII a1pID 9FMN0 0 TA 1 1.39 AI64.1 E 10� JS.] 1 19 . 92 2 9 019 50000 L695s M �' 30'f 3A 93 Gt7. 1 901. 7 5 10266 NOTE$ 1.ALL 09 ANM ARE OHM N OEWAL FEET. 1. DWW= MYN Y *fpm = MMO � ARE ARC A. ALL M= ANE WfIK= OWW"SE N07E9. 1 AML UNEls1 OOnOMMM NoTla N.R ` S OMTANSES AND ANDlr.6 SMWN W FMWHM EASEMENTL A ALL a9. -DE -WC NAW AAE OLM RET VH= N= OMMMZ 7. ALL CLPDL-M TWO" RIM ARE 25 FLET LW L NM OFdtbt t. A LOTS 1 ANO 2 VO -4 NNE; 11D OWO Access 5. 1O HOMY 79. 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