BP12233~~ ~l 3 ~ il~ ~~ i- ~ z
`' Blair Building Permit Detail
Permit #: 12233 Issued: 8/26/2005 Type: Residential Remodeling
Completed: 10/12/2006 Valuation: 25000
Location: 214 Jackson Street
Owner: Chris Cozad Permit Fee: 125
Address: 214 Jackson Street Issue Fee: 15
Deposit Amt.: 200
Blair, NE 68008 Receipt #: 15106
Phone: 402 990 4696
Section: Township: Range:
Subdivision: WEIMERS1 Lot: 34 Block:
Approx. 600sq ft. addition to North side of house. Addition will have 2 bedrooms with one bedroom having a W/I
closet and possible bathroom.
Contractors
SELF General Contractor Permit # Issued
SELF Electrical Subcontractor E2325 10/12/2005
SELF Plumbing Subcontractor P1395 10/12/2005
SELF Heating Subcontractor M1315 10/12/2005
Remarks
10/10/2005 BMS sent copy of permit.
3/8/2006 BMS Spoke to Chris Cozad, and he said he would be working on this until the end of summer.
Extended completion date to 10/01!2006.
10/9/2006 BMP Called and Left message about status of this proje ct.
10/10/2006 BMP Spoke to Chris and set up inspection 10/12/2006.
Inspections Date By
9/23/2005 DEM Footings Pass
10!31/2005 DEM Mechanical Rough-ins Pass
10/31/2005 DEM Framing Pass Partial
11/3/2005 DEM Plumbing Groundwork Pass
11/3/2005 DEM Framing Pass Partial
3/21/2006 DEM Plumbing Rough-ins Pass
3/21/2006 DEM Electrical Rough-ins Pass
3/21/2006 DEM Framing Pass
10/12/2006 DEM Plumbing Final Pass
10/12/2006 DEM Mechanical Final Pass
10/12/2006 DEM Electrical Final Pass
10/12/2006 DEM Final Inspection of Project Pass
BUILDING PERMIT APPLICATION
~ ~~^~, Jurisdiction of City of Blair, Nebraska
Permit Fee: ~yU ~~~ 218 South 16th Street
Issuance Fee: ~~'~~ -~ Blair, Nebraska 68008 12 2 3 3
Receipt #: ~,3 y'0 `"Z (402) 426-4191 • Fax (402) 426-4195 Permit
Deposit Receipt #: I ~ t ~
Issue Date: g ~ ~' b -off Type: ~ r
JOB ADDRESS
alb
LEGAL
1 . DESCR. ~
Q,t~Vv~tM I~ -~
3 ~
^ SEE ATTACHED SHEET
OWNER ~
2. ~ ~ U MAIL ADDRESS Zlp HOME PHONE Q, (~ ~`
WORIVCELL PHONE /~ ~ 7~ /
CONTRAC R
3. MAIL ADDRESS ZIP HOME PHONE
WORIVCELL PHONE
4. Class of Work: ^ NEW Q ADDITION Q REMODEL ^ OTHER ^ FINISHED BASEMENT ^ UNFINISHED BA
S
EMENT
5.
Descri
be Work: ~, Q () .S ~ ~ .
~~~~.~w~. ~u- f r~
n
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^^
jj~~ (
,n. ,
n3
6. Valuation of Work: $ ~~ ~,t) (~ Total Sq. Footage pocluding Basementana Garage): 7,~
Total Finished Area: o
Floodway Q Yes Q No
7. Floodplain: Fringe Q Yes Q No Dev. Permit
BFE Elev. Cert.
8. Current Zoning:
9. State Fire Marshall Required: ^ Yes (~'No
10. Special Use Permit Required: Q Yes '~'No
11. Variance Required: ^ Yes '~lo
t
12. Minimum Setbacks: Front o~0 t Side ~ Rear
13. Sidewalk Required: j~Yes ~ No Waiver Approved .
NOTICE
Separate permits are required for electrical, plumbing, heating, ventilating and air
conditioning, and septic systems. By mysignature 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 codes/ordinances of the City of Blair and the
State ofNe ska,lunder d tthispermitisvoidifworkisnotcommencedwithin
180 day s c ete ithin 2 years of date of issue.
~~~. ~~
SIGNATURE OF OWNERICONTRACTOR DATE
Comment:
MEET IBC, IRC, IPC, IMC AND NEC CODE REQUIREMENTS
SLEEPING ROOMS BELOW THE FOURTH
STORY AND IN BASEMENTS ARE
`~1~QUIRED TO HAVE AN EGRES ,WINDOW.
Site Plan Attached 0 Com lete Plans Attached
Approximate Completion Date ~ ~~ _ ~~
Inspections Required and Fees
Sewer
Septic
Water Service
Remote
Stop Box Card
it in _
F s _
Drywall
(PRIOR TO TAPING)
EI c ri I
R~c ~ - n~ F~es~
Jam' Permanent Service
Temporary Service
h ni ~~
-In ,{~-
F'
Gr Work
Ro~ugH~i ~ s,Ein~
WHEN PROPERLY VALIDAkED (IN THIS SP{~,EEI_J.k11S IS YOUR PERMIT
By:
Rev. 8/98
POUNDS PRTG.-Bleir, NE
ELECTRICAL PERMIT APPLICATION
Jurisdiction of City of Blair, Nebraska
218 South 16th Street
Blair, Nebraska 68008 2 3 2 5
(402) 426-4191 Permit E
A lication Date: j' U~ ~ ~ ~ ~~ Permit Fee: $ ~ ~~ `~
PP
JOB ADDRESS ~ ~ ~ \ '-
,J'1/f~
1 LEGAL
~ SEE ATTACHED SHEET
DESCR.
p . MAILADDRESS ZIP HOME PHONE Q ~~~
2• WORKICELL PHONE / U'
,3
C R T R MAIL ADDRESS PHONE HOME PHONE
. WORKICELL PHONE
4. Class of Work: p NEW RESIDENTIAL O NEW COMMERCIAL EMODELING/ADDITIONS O UPGRADE SERVICE
5• Describe Work: ~~
6. Current License on File O Yes O No O 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
y ................
Fire Alarm S stem $10.00
301-400 Amp Fee ............................ $ 42.00
g .....................................
Si ns $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
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 (~, ~-
~
~
toviolate orcancel the provisions of a er state or local r!s
x $.75
Fixtures ~~~
law regulating constructio the rformance of Smoke Detectors x $3.00
construction.
Residential/Commercial Appliance
# Fixed Outlets x $3.00
Motor(s) x $3.00
f ~ ~ Power Apparatus (220 Volts)
SIGNAT E OF RACTOR OR AUTHORIZED AGENT # Apparatus x $3.00
~Z G3'- Permit Issuance Fee .............$15.00 ~~^` ~`~
DATE ~ '~~
TOTAL
Comment:
WHEN PROPERLY VALIDATED (IN THIS SPACE) THIS IS YOUR PERMIT
Approved By:~ n
POUNDS PRTG: Blair, NE // Rev. 11/99
PLUMBING PERMIT APPLICATION
Jurisdiction of City of Blair, Nebraska
218 South 16th Street
Blair, Nebraska 68008
Fax (402) 426-4195
(402) 426-4191
Application Date: ~ ~ ~ ~ ~" ~ 5~
P 1395
Permit Fee: $
a3.uJ
JOB ADDRESS
1. O ~ MAIL ADDRESS
ZIP
PHONl~~1o_ (/l C J
`` l 6 / (o
2. CON AC R MAIL ADDRESS PHONE LICENSE NO
3• Class of Work: O COMMERCIAL ~1 RESIDENTIAL O NEW ADDITION O ALTERATION O REPAIR O REPLACEMENT
4• Describe Work: ~ ~
Comments: PLUMBING PERMIT FEES
Modular Home ...................... $15.00
Type of Fixture No.
Kitchen ..................................
Bath ....................................... $>3.00 x
$8.00 x
~'~ vJ
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
work will be complied with whether specified herein or not.
The granting of a permit does not presu a authority
to violate or cancel the provisio any others to or local
law regulating construc 'nor the per rmance of
construction.
Septic Tank & Laterals ..........
Lawn Sprinkler System .........
Sprinkler System ...................
(Commercial)
$10.00
$10.00
$30.00
Gas/Water Piping System
(Commercial) ............................ $30.00
Permit Issuance Fee .............
$15.00 ~,~ vv
-
SIGNATUR OF ONT ACTOR OR AUTHORIZED AGENT
Z
TOTAL ~ ~- yJ
(15
DATE Current License on File OYes O No O NA
. WHEN PROPERLY VALIDATED (IN THIS SPACE) THIS IS YOUR PERMIT
Comment:
Approved By:
POUNDS PRTG: Blair, NE ~ Rev. 4/98
MECHANICAL PERMIT APPLICATION
Jurisdiction of City of Blair, Nebraska
' 218 South 16th Street
Blair, Nebraska 68008 1315
Fax (402) 426-4195 M
(402) 426-4191
Application Date:
Permit Fee: $ /~ ` ~~
JOB ADDRESS ~ ~~
1.OWNEg~n ~ MAIL ADDRESS ZIP PHONE
~
2 C TR O
R MAIL ADDRESS PHONE LICENSE NO.
3• Class of Work: O COMMERCIAL RESIDENTIAL O NEW ADDITION O ALTERATION O REPAIR O REPLACEMENT
4• Describe Work: ~~ ~.
~
Central A/C Tons MECHANICAL PERMIT FEES
Furnace ~ \ UJ BTU/H Forced Air/Heat Pump Systems -Per Unit
Commercial/Residential (New) .................................... ................ $25.00
# of Units 'vC
Air-Conditioner Unit -Per Unit
Furnace Commercial/Residential (New) .................................... ................ $10.00
Forced Air Systems/Air Conditioner ~~ ' y`~
Completion Date:
Unit Replacement Per Unit Commercial/Residential ...
................ $10.00
Refrigeration Units/Coolers/Lines/Compressor -
Comments:
Per Unit Commercial (New or Replacement) ...... .....
................ $10.00
Appliance Vent/Fans ............................... $10.00
Boiler ....................................................... $15.00
Duct System ............................................ $10.00 ~~ _ JJ
Gas/Air Outlets .................. x $2.00
NOTICE Radiant Heat Systems ............................$25.00
I hereby certify that I have read and examined this
a
lication and know th
t
b
pp
e same
o
e true orrect. All
provisions of laws and ordinance verning t s type of
work will be complied with w er specified h ein or not.
Modular Home ......................................... $15.00
The grantin
of a
ermit snot
t
h
i
g
p
sume
o ve aut
or
ty
to violate or ca el the rovis' s any of r state or local
law regul n c str Ion or th performance of
construc ' n
Permit Issuance Fee ............................... $15.00 l'S~
.
- ,~
~S
r
C. TOTAL
SIGNATUR OF CON ACTOR OR AUTHORIZED AGENT
~(~ ~~ ~~ Current License on File O Yes O No ~NA
DATE
WHEN PROPERLY VALIDATED (IN THIS SPACE) THIS IS YOUR PERMIT
Comment:. Approved By:
'OUNDS PRTG: Blair, NE Rav nrae
__
BUII.DING INSPECTION REPORT
J ~IT'Y OF AIR ^ WASHINGTON COUNTY ,` J ^ OTHER l
LOCATION OF INSPECTION: C~~I "I ~ /~ ~;~~ ~5~~~ (~/ '
NAME OF OWNER~~/~{~! , /' Z/J~ ~ 9a ~ ~~ ONTRACTO
DATE INSPECTION REQUESTED: ( ~~~ ~ ~~ TIME INSPECTION REQUESTED• ~• ~ PERMIT NO: ~ ~a ~~
TYPE OF INSPECTION REQUESTED: ^ CONFERENCE ^ STATUS CHECK
BUILDING: ~ FOOTING ^ DECK FOOTING ^ FRAMING ^ DRYWALL ^ FINAL ^ .PARTIAL PASS FAILED
COMMENTS: ^
UTILTTIES: ^ 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
^ PRESSURE TEST ^ ^
COMMENTS:
.M~~
^ OCCUPANCY GRANTED ^ CONDITIONAL OCCUPANCY GRANTED
FAXED OPPD~BURT REA TO CONNECT SERVICE: ON BY
BUILDING INSPECTION REPORT
O LAIR ^ WASHINGTON COUNTY
^ OTHER
/~
~
LOCATION OF INSPECTION: ~` ~ ~ ~ Q ~~ ~~ (~ ~ '
NAME OF OWNER Q~ .~ CONTRACTOR:
/~ ~~11 2
DATE INSPECTION REQUESTED• ~~ ~ ~ TIME INSPECTION REQUESTED: ~• QC/ x~ ' 17) PERMTI' N0: l ~aJ~
TYPE OF INSPECTION REQUESTED: ^ CONFERENCE ^ STATUS CHECK
BUILDING: ^ FOOTING ^ DECK FOOTING FRAMING ^ DRYWALL ^ FINAL PARTIAL PASSED FAILED
^ ^
COMMENTS:
UTILTI'IES: ^ 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 ^ RADIANTHEAT ^ 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•
DATE OF INSPECTION MADE:
T ~ ~~~~~
FAXED OPPD~BURT REA ~ TO CONNECT SERVICE: ON BY
,BUILDING INSPECTION REPORT
'
CITY OF B R ^ WASHINGTON COUNTY ^ OTHER
LOCATION OF INSPECTION• ~/~ ~ C~~ O n V / •
NAME OF OWNER: ~/ ~ ~'/~ ~~ ~~ CONTRACTOR: C `,~-~1/
DATE INSPECTION REQUESTED• / 5 TIME INSPECTION REQUESTED: ~~ • J~a '~ ` PERMTI' N0: /~~ ~~
TYPE OF INSPECTION REQUESTED: ~ ~~ ^ CONFERENCE _^ STATUS CHECK
BUILDING: ^ FOOTING ^ DECK FOOTIN
F
G ^ DRYWALL ^ FINAL PARTIAL PAS FAILED
ff
JJ~~
~ ^
C~Vt
COMMENTS:
UTH.ITIES: ^ SEWER TAP SEWER ^ SEPTIC ^ WATER TAP ^ REMOTE ^ WATER SERVICE PASSED FAILED
^ PARTIAL ^ ^ '?
COMMENTS: '
ELECTRICAL: OUGH IN ^ FINAL ^ PERMANENT SERVICE ^ TEMPORARY SERVICE. ^ PRECONNECT PASSED FAILED
PARTIAL ^ ^ 1
COMMENTS: j
MECHANICAL: ^ ROUGH-IN ^ A/C ^ FURNACE ^ RADIANT HEAT ^ FINAL ^ PARTIAL , - PASSED FAILED
^ ^
COMMENTS: , - - -
))
PLUMBING'/ C~TiOUNDWORK ^ ROUGH-IN ^ FINAL ^ WATER METER INSTALLED ^ PARTIAL
~^ PRESSURE TEST
PAS FAILED
^
COMMENTS:
^ OCCUPANCY GRANTED ^ CONDITIONAL OCCUPANCY GRANTED
NOTES/REMARKS:
INSP / ~ Cs ~
ATE ~F NSrECTI~N MA)E: ~ D t f ~ i
TI
FAXED OPPD~BURT REA TO CONNECT SERVICE: ON . '•. BY
~-
.:. j
J
I
~~ BUILDING INSPECTION REPORT
^ CITY OF BLAIR ^ WASHINGTON COUNTY ^ OTHER
LOCATION OF INSPECTION• )) C a ~ y ~
NAME OF OWNER: ~ ~ ~ ~ U ~ ~ b 7 ~ CONTRALTO
DATE INSPECTION REQUESTED• ~ ~ ~ r TIME INSPECTION REQUESTED: / U ' ~ y PERMIT
TYPE OF INSPECTION REQUESTED: ^ CONFERENCE
~2~33
^ STATUS CIFIECK
BUII,DING: ^
COMMENTS: FOOTING ^ DECK FOOTING FRAMING ^ DRYWALL ^ FINAL ^ PARTIAL
~ ! ~ ~~~ PAS D FAILED
^
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 PAS D FAILED
^
MECHANICAL: ^
COMMENTS: ROUGH-IN ^ A/C ^ FURNACE ^ RADIANT HEAT ^ FINAL ^ PARTIAL PASSED
^ FAILED
^
PLUMBING: ^,
^
COMMENTS: GROUNDWORK ROUGH-IN ^ FINAL ^ WATER METER INSTALLED ^ PARTIAL
PRESSURE ST PA D FAILE>/
^
^ OCCUPANCY GRANTED ^ CONDITIONAL OCCUPANCY GRANTED
NOTES/REMARKS•
FAXED OPPD~BURT REA
'~~~~ATE OF INSPECTION
TO CONNECT SERVICE: ON
B
BUILDING INSPECTION REPORT
TI'Y OF BLAIR ^ WASHINGTON COUNTY / L^ OTHER
LOCATION OF INSPECTION: ~ ~'7 ~~QGI ~~ ~~,
NAME OF OWNER•~/ _ .~~D ~~~ C(~ CONTRALTO
DATE INSPECTION REQUESTED• ! ~ ~ ~~ ~ ~ ~ 'TIME INSPECTION REQUESTED• av •/~1 ' PERMIT N0: ~ ~p~
TYPE OF INSPECTION REQUESTED:' ^ CONFERENCE ^ STATUS CHECK
BUILDING: ^ FOOTING ^ DECK FOOTING ^ FRAMING ^ DRYWALL ~NAL ^ PARTIAL PAS ED FAILED
^
COMMENTS:
UTILTPIES: ^ .SEWER TAP ^ .SEWER '^ SEPTIC ^ WATER TAP ^ REMOTE ^ WATER SERVICE PASSED FAILED
^ PARTIAL ^ ^
COMMENTS:
ELECTRICALS. ^ ROUGH _ FINAL ^ PERMANENT SERVICE ^ TEMPORARY SERVICE ^ PRECONNECT PASS FAILED
^ PARTIAL ~
"` ^
COMMENTS: 777~~~
MECHANICAL: ^ ' ROUGH-IN' ^ A/C ^ _ FURNACE ^ RADIANT HEAT 'IIVAL ^ PARTIAL - PASSED FAILED
COMMENTS: ~ ^
PLUMBING: ^ GROUNDWORK ^ ROUGH-ININAL ^ WATER METER INSTALLED ^ PARTIAL PASSED FAILED:
^ PRESSURE TEST ~ ^
COMMENTS:
OCCUPANCY GRANTED ^ CONDITIONAL OCCUPANCY GRANTED
DATE OF INSPECTION MADE: ~ ~ OC.!' T ~ I v
FAXED OPPD~BURT REA TO CONNECT SERVICE:
CITY OF BL~IR
.or~_
o~~se of
HOMEOWNER VERIFICATION FOR ELECTRICAL WIRING PERMITS
states the following:
print your full name on line above:
1. I am the owner of the single family dwelling for which I am applying for an
electrical permit.
Address: 14' ~~~ ~~ ~~ - ~~~~
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 2002 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 fmal.
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~t for inspection.
8. By sig~g ti's fo~i I am~ating the above information is true an correct.
Homeowner/
/D ~
Date
218 South 16th Street • Blair, Nebraska 68008 • 402-426-4191 • Fax 402-426-4195 • E-mail ciiyofblair@huntel.net
CITY OF BI,~~II~
~_~
~- ~~
a~o~,se t a~~~~
0
HOMEOWNER VERIFICATION FOR PLUMBING AND/OR
MECHANICAL PERMITS
(i~/~~'~d~~IL C.U~ ,states the following:
Print your full name on line above:
1. I am the owner of the single family dwelling for which I am applying for a
plumbing and/or mechanical permit.
Address: ~/¢ .~7~;~SdAJ ~ .~L~~ ~ ~f~DB
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 2003 International Code requirements to make
an electrically safe and mechanically secure installation, which will meet the
minimum standards referenced in the. 2003 International Code.
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 sig~n~tl~ajs foamstating the above information is true an correct.
/~ `z ~.~
Homeowner/Applicant Si Date
218 South 16th Street • Blair, Nebraska 68008 • 402-426-4191 • Fax 402-426-4195 • E-mail c'rfyofblair@huntel.net ~ mm
CITY OF BI,~~IR
-~
a~
o~~se
~,~
of av
HOMEOWNER VERIFICATION FOR PLUMBING AND/OR
MECHANICAL PERMITS
(i~T~/~r~.~'IL ~~~ ,states the following:
Print your full name on line above:
1. I am the owner of the single family dwelling for which I am applyi_n-g for a
plumbing and/or mechanical permit.
Address: ~f ¢ .~~;~ SC~~ ~ .~L~~ ~ ~~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 -fhe 2003 International Code requu-ements to make
an electrically safe and mechanically secure installation, which will meet the
minimum standards referenced in the 2003 International Code.
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.
s. By sig~n~t~,s foamstating the above information is true an correct.
~ /~ l~ ~.~
Homeowner/Applicant Si a Date
218 South 16th Street • Blair, Nebraska 68008 • 402-426-4191 • Fax 402-426-4195 • E-mail cifyofblair@huntel.net
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CITY OF BI,f~IR
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.
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.
Owner/Occupant
City of Blair
Contractor
2~~6~ ~J
Date
218 South 16th Street • Blair, Nebraska 68008 • 402-426-4191 • Fax 402-426-4195 • E-mail ciiyofblair@huntel,net
-'~~se of a~
CITY OF BI,t~IR
~~~
o~~se of
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/ caner
Contractor/Owner
City of Blair
2~~4~~~~~ ~- ~~
Date
218 South 16th Street • Blair, Nebraska 68008 • 402-426-4191 • Fax 402-426-4195 • E-mail ciiyofblair@huntel.net
~c%OS 057G `~
~T~T~ Ot~ NEBRASKA C@l{N1Y 0~ INASHIAlG70N)SS
ENTE~Ea IN NUMERI~AI. INDEX AND IL~~,I+OR RECORD
T~II~ ' s+ . DAY ~~~~.?1?-cv'--~, '~ A,D~ ~D
AT ~-- O'~I~bOK,~,I~ ANp RECORDED IN BOOK
C06fNTY CLERK - ~
OE~U`i~ ~ - -
~ ~ ~~
AGREEMENT
The undersigned being the owners of the fo{lowing described real estate, to-~n+i~:~~~-~7~~ ~, ~r7~,~;~~~
~_~s~it~crou e~ur~~`~ c~:~~~~:
~3LAlR, ~#~Bf~. _ _
Lot 34, Weimers Addition, Blair, Washington County, Nebraska
214 Jackson Street
hereby acknowledge that they have made an application to the City of Blair for the waiver of
the requirement for the construction of sidewalks in conjunction with a residential remodel ofi
greater than 1 ~% of the value of a residence thereon. Said owners further hereby
specifically agree that said waiver is not a permanent waiver, and that at any time the City ofi
Blair requests or requires that a sidewalk be constructed on such real estate, the owners
hereby agree that they will, within a reasonable Mme, construct such sidewalk or participate`
in a sidewalk improvement district if same is created by the City of Blair.
The owners hereby specifically agree that this agreement shall constitute a covenant
which shall run with the land, and that upon the filing of #his agreement against the real
esta#e described hereinabove, all successors, assigns, or #ransferees shall be bound by the
terms and conditions of this agreement as though an original party hereto.
This agreement shall be binding upptl the heirs, personal representatives,
successors, and assigns of the undersigned.
Gated: 2~ ~Uilf~l~i3£~-. , 20 ~ .
Chris Coza ~-
STATE OF NEBRASKA )
ss
WASHINGTON CQUNTY )
The foregoing instrument was acknowledged before me on NOV~~~e~ GI
20 QS by Ch ~i S C_C) ~u
~BLRENpp R~WHEE~~ ~~t/
1 MY Comm. Ems. June 20, 20
NOTARY PUBLIC
~~~
~~n~re~ ~-
I~um~riG~~
B,ASSOCIATES, INC_
LAND SUAYEYORS ~ CONSULTANTS
5pp,t S_ 77pTti STREET
OMAHA_ NEBRASKA 69137
40Z/337-2333
FAX - 4p2/337-Sp77
Imnrovement Location Renort
NAME: Christopher Cozad
ADDRESS: 214 Jackson S4•eet Blair, Washington County
LEGAL: Lot 34, Weimers Addition, ns surveyed, platted, and recorded in Wxshington County, Nebrsslw.
9.2..66 '
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DATE: Saptembm•30, 2003
NOTE: 1. This Repm't is a representation of the conditions that were
found at pte time of the impPOVwnenE location survey and that
. tltc document does not wusfitute a boundary survey and is
subject fo.any inaccuracies that n subsequent boundary survey
nmy disclose. This Report should not be uaeJ to establish any
fence, structure, or other hnprovements. This Report shows
measurements that are based on plat or deed informsfion. and
verified as shown and. this Report represents only visible
' buildingimprovemenfs.
2. Setback and Sideyard measw•emenls are within 0.5 tt+.
3. No blood plain influence ou this lot
FNI3 09079 B-5
Communlly Panel Nuniher
310PPE 0005 B
EIIerIlre Oele:
Julr 16,1981
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