BP9060City of Blair Building Permit Detail
Permit #: 9060 Issued: 11/16/2000 Type: Residential Additions
Completed: 3/24/2006 Valuation: 5000
Location: 1169 South Street
Owner: Heath Cornett Permit Fee: 50
Address: 1169 South Street Issue Fee: 15
Deposit Amt.:
Blair, NE 68008 Receipt #:
Phone: 402 426 2972
Section: Township: Range:
Subdivision: Lot: Block:
13 1/2 X 13 1/2 room addition. 2 story with walk out basement. Main level extension of bedroom. Basement used
for mudroom. Extended competion date from 11-30-2001 to 2002 -Extension to 5/31/2003 -RENEWED BY PERMIT
Contractors
SELF
SELF
SELF
Remarks
General Contractor
Plumbing Subcontractor
Electrical Subcontractor
Permit # Issued
P0622 10/29/2001
E1441 10/29/2001
Inspections
2/28/2006 BMS Brenda spoke with Heath, and we will final out what he has done on March 3rd 2006. If he
decides to finish this project, he will need to come in to pull a new permit. As the project sits
now, it is not a safety issued and can be finaled for now.
3/13/2006 BM5 Changed completion date to 3/24/2006. Dale was not in the office on 3/10/2006, so it was not
finaled.
3/27/2006 DEM Dale finaled what Heath had finished. Heath did come in and pull a whole new permit to finish
this project.
Date By
8/8/2001 DEM Footings Pass
11/7/2001 DEM Plumbing Groundwork Pass
6/9/2003 DEM Status check Fail
2/15/2005 DEM Status check Fail
3/24/2006 DEM Electrical Final Pass
3/24/2006 DEM Final Inspection of Project Pass
BUIL®ING PERMIT APPLICATION
Permit Fee: JSO , O y ~ Jurisdiction of City of Blair, Nebraska
~ ~ o .~, pc7 .218 South 16th Street
Issuance Fee: Blair, Nebraska 68008
Receipt #: (402) 426-4191 • Fax (402) 426-4195 Permit
9060
Deposit Receipt #:
Issue Date:. ~ " ~~ "~ ~ Type: ~ b 6 ~ /~ C~ ~l i nn1
JOB ADDRESS
S~ ~~
5
LEGAL
1. DESCR.
^ SEE ATTACHED SHEET
OWNE
2. ~ -~
~~~[ MAILADDRESS
S9 ~ ..~ ZIP HOME PHONE G
WORK/CELL PHONE u -- Z !
CONTRACTO
3. ~~ L
- MAILADDRESS ZIP WORKICEOLNPHONE
4. Class of Work: ^ NEW ~ ADDITION Q REMODEL ^ OTHER ^ FINISHED BASEMENT ^ UNFINISHED BASEMENT
5. Describe Work: ~ C~t , 3 %Z t j `Z oh L
~
~-
~-~ ~~
~rstL y ~.
-~ ~ ~ ~
(fie ~ ~
6. Valuation of Work: $ ~ d0 - Total Sq. Footage Qncluding Basement and Garage): Total Finished Area:
Floodway
7. Flood lain:
p Fringe Yes
Q Yes o No ~E%'-~'-~h r~'~~e~ Dev. Permit
~-~~ ~~ °
~~~ ~ ~u E BFE
Elev. Cert
8. Current Zoning:
«t~l L.1 '4 ~ ~~u ~., c~ ~L. ~~.~ ,
9. State Fire Marshall Required: Q Yes ~ No
10. Special Use Permit Required: ^ Yes [o
11. Variance. Required: Q Yes O No ~ C_;
~°." ~
12. Minimum Setbacks: Front ~ -? Sid 1 U Rear
13. Sidewalk Required: O Yes ~S pproved
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 bythis permit application shall not be
commenced until I have received a copy ofthis application form signed bythe 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.
SIGNATURE OFOWNER/CONTRACTOR DATE
Comment:
~~ A~ ~~~~
~5~~~~ ~R~QI~
F ;:STQRY~AI~~N.BASEM~NTS ASE"`
..~~QUiR~~zo~.:~Gas wi~oow-.
;,
^ Site Plan Attached Q Complet,Z Ivans ttached
Approximate Completion Date L
R~ c~ ~o -
Inspections equire and ees
Utilities
Sewer _
Septic
B it in
Footin -
Fr g -
Electri a `` __ /
R~o~ -In ~e [_.-~
J„"'
Temporary Service
Mechanical
RoygM~irf~
Plumbing .
Ground Work
Rough-in
Water Service
Remote
Stop Box Card
D
(PRIOR TO TAPING)
Fin
Fixtures
Permanent Service
A\C ,
Final
WHEN PROPERLY VALIDATEDLN THIS SP
f J Rev. B/96
POUNDS PRTG: Blair, NE
BUILDING PERMIT APPLICATION ;~
~o ~~ Jurisdiction of City of Blair, Nebraska ~U~
Permit Fee: 218 South 16th Street
Issuance Fee: OS`~c.~ ' ' Blair, Nebraska 68008 ~ ~~ 6
Receipt #: (402) 426-4191 • Fax (402) 426-4195 Permit
Deposit Receipt #: !
Issue Date: (C~ / ~7 ~ .~ Type: ~G~S~-i ~-I 0 +~ I' `~ ~ (/J Cam.
JOB ADDRESS I I ~ ( S Q ~~ ~~.
LEGAL
1 . DESCR.
^ SEE ATTACHED SHEET
OWNER
2. ~'-~,~ MAIL ADDRESS
~( ~~' Zlp HOME PHONE / / /
WORK/CELL PHONE ~7 Ztp~ Z~/ 7
CONTRACTOR MAIL ADDRESS
3. S'~ ~ ~' ZIP HOME PHONE
WORK/CELL PHONE
4. Class of Work: Q NEW ADDITION ^ REMODEL Q OTHER N
I
SHED BASEMENT Q UNFINISHED BAS
E
ENT
M
O FI
5. Describe Work: ~~,j ~~ ~®~ ~ - Z ,~6r'~ -~
//
~
"
.~
[
W Lv-/) w~,t_,~-fL (~ t~ ~~~"lQ-l1/ -
~ .S~(a1 ~ ~ /YI ~ r
6. Valuation of Work: $ ~~d() • ~ Total Sq. Footage QncluaingBasementanaGaragej: Total Finished Area:
Floodway
7. FlOOdplain: Fringe Q Yes Q No Dev. Permit
^ Yes ^ No BFE Elev. Cert.
8. Current Zoning:
9. State Fire Marshall Required: Q Yes
Q No
Q Site Plan Attached Com~lete Plans Attached
Approximate Completion Date ~' ~~~ c?~
Inspections Required and Fees
10. Special Us ~~_ ~,~J ~~
2I2•I (Ole`
11. Variance R~
12. Minimum S. ~`~ ~ ~r .~,~~~~~~~°- _
13. Sidewalk RE
~~ - ~or(L - 533-1 Sam -
Separate permi 2 ~~~ it
conditioning,arn ~' ~~ J It
of the building f
permit. I further a
commenced unti ~
Inspector.
I herebyagreeto I
forth above and it
State of Nebraska
180 days or is no'
SIGNATU OF OWN~rv~UNTRACTOR
Comment:
Utilities
Sewer _
Septic _
Building
Footings
Framing
EI c rical
Rough-in
Final
Temporary Service
°'' ~ Mechanical
DATE
Rough-in _
Final
PI i_-t mbin~ -
Ground Work
Rough-in _
Water Service
Remote
Stop Box Card
Drywall
(PRIOR TO TAPING)
Final
Fixtures
Permanent Service
A\C
Final
WHEN PROPERLY VALIDA~
Approved By: ~'
S SPACE) THIS IS YOUR PERMIT
POUNDS PRTG.~Blair, NE [/ Rev. B/96
PLUMBING PERMIT APPLICATION
%r~
Jurisdiction of City of Blair, Nebraska
218 South 16th Street
Blair, Nebraska 68008
Fax (402) 426-4195 P 0 6 2 2
(402) 426-4191
Application Date: I~ I ` ~~~ I
Permit Fee: $ '
JOB ADDRESS
I ~,~~
1 . OWNER ~'-)
ZIP
I MAIL ADDRESS _
~ Y ~ ')P/HO,NE /'~~ I~
L
I
6 ~ -
UJ
C
MAIL ADDRESS PHONE
2 CONTRACTOR LICE
NSE NO
.
3. Class of Work: COMMERCIAL RESIDENTIAL O NEW ADDITION O ALTERATION O REPAIR O REPLACEMENT
4• Describe Work: Q~~l ~ ~~~
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
~ ~' ~~
Slo Sink/Laund Tra
p rY Y ......... $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
Permit Issuance Fee ............. $15.00 ~ ~ ' ~~)l J
SIGNATURE OF CON RACTOR OR AUTHORIZED AGENT
TOTAL
~-~ • ~3~
DATE Current License on File OYes ~o O NA
WHEN PROPERLY VALIDATED (IN THIS SPACE) THIS IS YOUR PERMIT
Comment: Approved By:
Rev. M98
POUNDS PRTG: Blair. NE
.~ rr~~ i~~" `~ac¢b
ELECTRICAL PERMIT APPLICATION
Jurisdiction of City of Blair, Nebraska
218 South 16th Street
Blair, Nebraska 68008
(402) 426-4191 Permit E 14 41
Application Date: I ~ _ ~~ _ ~~~
Permit Fee: $ ~ ~ C~
JOB ADDRESS
~~~
LEGAL
1 • DESCR. D SEE ATTACHED SHEET
2 OWNER ~ ~ „ r MAIL ADDRESS ZIP
~G ~z
O
~
U
WORK/C
1 -
ELL PHONE
/
3 CONTRACTOR
MAIL ADDRESS PHONE HOME PHONE
WDRKICELL PHONE
4. Class of Work: p NEW RESIDENTIAL D NEW COMMERCIAL REMODELING/ADDITIONS D UPGRADE SERVICE
5. Describe Work: C7k~ ~ ; ~~ ~ ~ ~ °j1~C Qf.4.. IE~f ~~ '/
6. Current License on File D Yes No DNA Completion Date ~/~,: ~~- ~C~C)2
New Service Fee = (Amp Fee + $2.00 per branch circuit) ELECTRICAL PERMIT FEES
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 Am Fee $ 42.00
p ............................ Signs
•••••••••••••••••••••••••••••••••••••$15.00
401-500 Amp Fee $ 55.00
501 -600 Am Fee 67.00
p ............................ Miscellaneous Apparatus ......$11.00
601-700 Amp Fee ............................ $ 80.00 AC/DC Circuit ........................ $5.00
701-800 Amp Fee ............................ $ 92.00
801-900 Am Fee $105.00
p ............................ 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 SinglelTwo 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
k
ill b
li
d
ith
h
th
ifi
d h
i
t
wor
e comp
w
e
e
er spec
e
ere
n or no
w
w
.
The granting of a permit does not presume to give authority
to violate or cancel the provisions of any other state or local Receptacle/Switch Outlets / )
Fixtures ~ x $.75 (~
law regulating construction or the performance of Smoke Detectors ~
x $3.00 ~ • ~J
construction. _
Residential/Commercial Appliance
# Fixed Outlets x $3.00
Motor(s) x $3.00
!~ Power Apparatus (220 Volts)
SIGNATURE 0 CONTRACTOR OR AUTHORIZED AGENT # Apparatus x $3.00
Permit Issuance Fee $15.00 ~ ~ ~~
DATE
TOTAL ,
WHEN PROPERLY VALIDATED (IN THIS SP.
Comment:
POUNDS PRTG: Blair, NE
Approved
THIS IS YOUR PERMIT
Rev. 11/99
BUILDING INSPECTION REPORT
^ CITY OF BLAIR ^ WASHINGTON COUNTY ^ OTHER
LOCATION OF INSPECTI N: / / lL C/ ~-%v~.~ ~`' ~~
~, ~
NAME OF OWNER: _ ~ ~~~~~~-C.- L l CONTRACTOR:
DATE INSPECTION REQUESTED: /'J / ~ <l / TIME INSPECTION REQUESTED: / /~ PERMIT N0:
TYPE OF INSPECTION REQUESTED:
^ CONFERENCE ^STATUSCHECK
BUILDING: ^ FOOTING ^ DECKFOOTING ^ 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: ^ ^
e ~'
PLUMBING: ~ GROUNDWO~ ^ FINAL ^ WATER METER INSTALLED ^ PARTIAL PASS FAILED
COMMENTS: ^
^ OCCUPANCY GRANTED ^ CONDITIONAL OCCUPANCY GRANTED-
NOTES/REMARKS:
OF INSPECTION MADE: Y ~ ~~~/ TIME:~~ C~
FAXED OPPD~BURT REA TO CONNECT SERVICE: ON By
BUILDING INSPECTION REPORT
~.
TY~OF BLAIR ^ WASHINGTON COUNTY ^ OTHER
LOCATION OF INSPECTI N: % ~ C~ C( ~~.~ ' =~~~~ ~,
-NAME OF OWNER: ~)br ~ _, CONTRACTOR:
.DATE INSPECTION REQUESTED: ~ (.~ °~_~~ / TIME INSPECTION REQUESTED: ~`/ ~~ PERMIT N0: ~~
TYPE OF INSPECTION REQUESTED: ^ CONFERENCE
BUILDING: FOOTING ^ DECK FOOTING ^ FRAMING ^ DRYWALL ^ FINAL ^ PARTIAL ^ STATUS CHECK
PASSE FAILED
COMMENTS: ~ ^
UTILITIES:
COMMENTS: ^ SEWER TAP ^ SEWER ^ SEPTIC ^ WATER TAP ^ REMOTE ^ WATER SERVICE
^ PARTIAL PASSED
^ FAILED
^
ELECTRICAL:
COMMENTS: ^ ROUGH IN ^ FINAL ^PERMANENT SERVICE ^ TEMPORARY SERVICE ^ PRECONNECT
^ PARTIAL PASSED
^ FAILED
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
NOTES/REMARKS:
DATE OF INSPECTION MADE: v / ~ ~ Tom: C~ Ol/
FAXED OPPD~BURT REA TO CONNECT SERVICE: ON By
BUILDING INSPECTION REPORT
^CITY OF BLAIR ^ WASHINGTON COUNTY ^ OTHER ~~~ 7 ~~~---'
LOC~ITION OF INSPECTION: ~~~ / JO~~~'`~' Jf~
,~/l:.. -
NAME OF OWNER: C~~~~ ~/ ~ /~~~~ CONTRACTOR:
DATE INSPECTION REQUESTED: C~/ ~ ~~ TIME INSPECTION REQUESTED: PERMTI' N0: ~`' ~ ~'')
TYPE OF INSPECTION REQUESTED: ^ CONFERENCE ^ STATUS CHECK
BUILDING: ^ FOOTING ^ DECK FOOTING ^ FRAMING ^ DRYWALL ~INAL ^ PARTIAL PASSED FAILED
COMMENTS: ^ ^
UTILTPIES: ^ 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 O ^
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
NOTES/REMARKS:
u
i,
INSP E OF INSPECTION MADE: ClG ~ ~ TAE; ~/ 6 ~~
FAXED OPPD\BURT REA TO CONNECT SERVICE: _ ON BY
BUILDING INSPECTION REPORT
n;
CITY OF BLAIR
LOG.MTION OF INSl
^ WASHINGTON COUNTY ^
NAME OF OWNER~~i.I~ ~ ~! CONTRALTO v
DATE INSPECTION REQUESTED: ~ /~ ~~ TIME INSPECTION REQUESTED• PERMTI' 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
^ PARTIAL
COMMENTS: PASSED FAILED
^ ^
ELECTRICAL: ^ ROUGH IN ^ FINAL ^ PERMANENT SERVICE ^ TEMPORARY SERVICE ^ PRECONNECT
^ PARTIAL
COMMENTS: PASSED FAILED
^ ^
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
i ~~,
FAXED OPPD~BURT REA TO CONNECT SERVICE: ON By
BUILDING INSPECTION REPORT
~,
+ CITY OF BLAIR ^ WASHIIVGTON COUNTY ^ OTHER
LOC~kTION OF INSPECTIONS /~~p J ,~j~,~ ,s`~ ~ ~'
NAME OF OWNER• CONTRACTOR: ~ /~ ~~~ '~ ~ ~~
DATE INSPECTION REQUESTED• TIME INSPECTION REQUESTED• ~U ~~ G/
PERMIT NO• / 6
~/a~~~~~
TYPE OF INSPECTION REQUESTED: CONFERENCE STATUS CHECK
BUILDING: ^ FOOTING ^ DECK FOOTING ^ FRAMII~TG ^ DRY WALL FINAL
COMMENTS: ^
UTII,TTIES: ^ SEWER TAP ^ SEWER ^ SEPTIC ^ WATER TAP ^ REMOTE ^ WATER SERVICE PASSED FAILED
^
C PARTIAL ^ ^
OMMENTS:
ELECTRICAL: ^ ROUGH IN~ FINAL ^ PF~R~'ANENT SERVICE ^ TEMPORARY SERVICE ^ PRECONNECT
^
PARTIAL PASS FAILED
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:
NOTES/REMARKS;
~~~
PARTIAL ~ ~ PAS~AILED
FAXED OPPD~BURT REA
OF INSPECTION
/!/. ~~
TIMF.•
TO CONNECT SERVICE:
c ~;
CITY Off' BI,t\II~
a,.
°~~se of
April 2, 2003
Heath Cornett
1169 South Street
Blair, NE 68008
Re: Building Permit 9060
Dear Mr. Cornett:
This letter is to inform you the extension granted on the above permit will expire
on May 31, 2003. Please be advised that you will need to contact our office no later
than Saturday, May 31, 2003 for a final inspection on the 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 cooperation in this matter.
Sincerely,
Brenda Taylor
City Clerk
Enc
218 South 16th Street • Blalr, Nebraska 68008 • 402-426-4191 • Fax 402-426-4195 • ~-mall cilyofblalrC huntel.net
CITY OF BI~~1R
-~ ~~
pro~~se of aJ~``
October 9, 2002
Heath Cornett
1169 South Street
Blair, Nebraska 68008
~5
ym~ 'h` ~ ~a
Re: Building Permit 9060 -Residential Addition
Dear Mr. Cornett, ~~
This letter is to inform you the above permit will expire o~i` November 30, 2002
`` 4
(-~~ ~ ~,
r~
,-,
Please be advised that you will need to contact our office no later Monday,
December 2. 2002 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 will be required 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 cooperation in this matter.
Sincerely,
--`,
Brenda Taylor
City Clerk
Enc
~' ,, , flfl~~"
p i.1~ 1
~,, ~
218 South 1 bth Street • Blalr, Nebraska 68008 • 402-426-4191 • Fax 402-426-4195 • E-mall cliyofblglr@huntel.net
CITY Off' BI,t1IR
~_.~~~,~
r ~ A~\
o~~se of av
HOMEOWNER VERIFICATION FOR ELECTRICAL WIRING PERMITS
~~~~ ~,~)/~~~,Q~ ,states the following:
Print o full name on line above:
i. I am the owner of the single family dwelling for which I am applying for an
electrical permit. -
Address: ~ ~ (~/ ~ CLS~~~-~'~ ~t•
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 sufficient knowledge of the 1999 National Electrical Code requirements to
make an electrically 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 an correct.
~~
Homeowner/Applicant Signature Date
218 South 16th Street • Blair, Nebraska 68008 • 402-426-4191 • Fax 402-426-4195 • E-mail cityofblair@huntel,net
CITY OF 6I,t\II~
-~
~~
o~~se
\~
Jd
of a
HOMEOWNER VERIFICATION FOR PLUIVIBING AND/OR
MECHANICAL PERMITS
~CGC~f'j'I ~~~ /~.~~ ,states the fallowing:
Pruri yo fu name online above:
1. I am the owner of the single family dwelling for which I am ,applying for a
plumbing and/or mechanical permit.
Address: f ~~~ ~ ~ ,'1L-~%~'l1 ~~
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.
8. By signing this form I am stating the above information is true an correct.
Homeowner/Applicant Signattue Date
.~~
~d
218 South 16th Street • Blair, Nebraska 68008 • 402-426-4191 • Fax 402-426-4195 • E-mail cifyofblair@huntel.net ~ ;•~m
o~
promise
,q
~:~
,, JOB
d. i
Blair
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 ~o your project. Please understand this packet is only designed
and distributed to aid yo~;t 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.
O er/Occupant
Contractor
~~ - / -~
Date
218 S.16TH STREET, BLAIR, NE 680,08.2010 • (402) 426.4191 • (402) 426.4195 rAX • E-MAIL; cityofblairC~huntel.net EOUAII,
1 OPPOg7UNITV
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