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BP1243511 �ze t6-1 V-7_� Blair Building Permit Detail Permit #: 12435 Issued: 4/17/2006 Completed: 6/27/2007 Location: 9505 Co. Rd. 29 Owner: John Henton Address: 9505 Co. Rd. 29 Blair, NE 68008 Phone: 402 426 5356 Type: Residential Additions Valuation: 40000 Permit Fee: 200 Issue Fee: 15 Deposit Amt.: 200 Receipt #: 16620 Section: Township: Range: Subdivision: Lot: Block: 16x27 one story w/full basement under. Addition will be for a master bedroom w/master bathroom -basement will be a bedroom with one egress window and bathroom too. Contractors SELF General Contractor Permit # Issued C.N.J. Plumbing Inc Plumbing Subcontractor P1544 7/5/2006 Reed Electric and Plumbing Heating Subcontractor M1466 11/20/2006 SELF Electrical Subcontractor E2591 11/17/2006 Remarks 4/25/2006 BMS Sent copy of permit. 2/8/2007 BMP Spoke to John and he said he was not done quite yet. Changed completion date to 4/1/2007. Inspections Date By 6/9/2006 DEM Footings Pass 7/7/2006 DEM Plumbing Groundwork Pass 11/20/2006 DEM Plumbing Rough -ins Pass 11/20/2006 DEM Mechanical Rough -ins Pass 11/20/2006 DEM Electrical Rough -ins Pass 11/20/2006 DEM Framing Pass 6/27/2007 DEM Plumbing Final Pass 6/27/2007 DEM Mechanical Final Pass 6/27/2007 DEM Electrical Final Pass 6/27/2007 DEM Final Inspection of Project Pass BUILDING PERMIT APPLICATION -200 � jurisdiction of City of Blair, Nebraska Permit Fee: A 218 South 16th Street Issuance Fee: �� Blair, Nebraska 68008 12435 Receipt #; �'�(402) 426-4191 •Fax (402) 426-4195 Permit Deposit Receipt #: % U o� � ' I Issue Date: `c�11rtk' Type: JOB ADDRESS 150 Cz _ r rU��`ii� LEGAL 1. DESCR. ❑ SEE ATTACHED SHEET OWI MAIL ADDRESSHOME 2 '-�Vwy -b� , ZIP PHONE WORKICELL PHONE 4a(-5 is s( CONTRACT 3. :St MAILADDRESS ZIP t 1 HOME PHONE WORKICELL PHONE 4. Class of Work: ❑ NEW peDDITION ❑ REMODEL `OTHER ❑ FINISHED BASEMENT ❑ UNFINISHED BASEMENT 5. Describe Work: r Wt Ak ( ed mIy - �-oNlaslitk- vuy)-i ast mo��—1 UJ%A Uo 'O, IgeA a nm - ki 6. Valuation of Work: $ L�-D D� Total Sq. Footage (including Basement and Garage): Total Finished Area: Floodway Q Yes O No Dev. Permit 7. Floodplain: Fringe Q Yes Q No BFE Elev. Cert. 8. Current Zoning: 9. State Fire Marshall Required: ❑ Yes ONo 10. Special Use Permit Required: ❑ Yes -KNo 11. Variance Required: ❑ Yes ❑ No 12. Minimum Setbacks: Front ` Side 50 Rear 13. Sidewalk Required: ❑ 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 acknowledge that payment of the building permit application fee does not constitute issuance of this building permit. I further agree that construction over d by this permit application shall not be commenceduntil averec i dacop ofthi application form signed by the Building Inspector. I agree t pe orm t e op se or in a ordance with the specifications set orth'2b ve and n ccord it th o s/o i nces of the City of Blair and the Stateof ebras .I rider d mtcommencedwithin 180 day or is n t roDle it ' so e f issue, f ❑ Site Plan Attached nICpmp�lete Plans Attached Approximate Completion Date I11 Inspections Required and Fees Utilities Sewer Water Service Septic Remote Stop Box Card Buildin Fob ' "gs Drywall /al 0 TAPING) Fr ing EI c ri I Rot -in Fixtures FiI Permanent Service W Temporary Service h�icl Al Fi Plumbing Rou -In Fiilai/ WHEN PROPERLY VALIDATED (IN THIS SPACEII-T iIS IS YOUR PERMIT POUNDS PRIG: Blair, NE Rw. 9/96 �s PLUMBING PERMIT APPLICATION Jurisdiction of City of Blair, Nebraska 218 South 16th Street Blair, Nebraska 68008 1544 Fax (402) 426-4195 P (402) 426-4191 Application Date: –3 —G _v L Od Permit Fee: $'� 3 JOB ADDRESS i 1 OwNalt� MAIL ADDRESS ZIP PHONE 2 CONTR TOR MAIL ADDRESS PHONE G� .5 LICENSE No. 3. Class of Work: O COMMERCIAL RESIDENTIAL O NEW XADDITION O ALTERATION O REPAIR O REPLACEMENT 4• Describe Work: Comments: PLUMBING PERMIT FEES Modular Home ...................... $15.00 Type of Fixture No. Kitchen .................................. $8.00 x Bath l tJrJ ....................................... $8.00 x 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 ........................ Sewer .................................... $10.00 $10.00 NOTICE 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. The granting of a permit does not presume to give authority Lawn Sprinkler System ......... $10.00 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 SIGNATURE OF C TRACT R OR AUTHORIZED AGENT TOTAL 3' 0) Current License on File /Yes O No O NA DATE WHEN PROPERLY VALIDATED (IN THIS SPACE) THIS IS YOUR PERMIT Comment: Approved By: 'OUNDS PRTG: Blair, NE Rev.4/98 MECHANICAL PERMIT APPLICATION Jurisdiction of City of Blair, Nebraska 218 South 16th Street Blair, Nebraska 68008 1466 Fax (402) 426-4195 M (402) 426-4191 Application Date: [ I _ d L)—L) � Permit Fee: $ /(�) JOB ADDRESS i�' ' - (: , Il a5 1 OWN11AIL ADDRESS ,A ZIP PHONE 2 CO TRA MADppESS PHONE h)) LICENSE 0.^ Y3 _l 3• Class of O COMMERCIAL RESIDENTIAL O NEW ADDITION O ALTERATION O REPAIR 0 REPLACEMENT 4. Describe Work: Central A/C ' MECHANICAL PERMIT FEES Tons Furnace BTU/H Forced Air/Heat Pump Systems - Per Unit �— # Units A/C Commercial/Residential (New) 5.00 of Air -Conditioner Unit - Per Unit Furnace Commercial/Residential (New) .................................................... $10.00 Forced Air Systems/Air Conditioner Id- A 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 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 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 s^• J� law regulating construction the performance of Permit Issuance Fee ............................... $15.00 construction. TOTAL O U-) 'SIONATUFAOF CONTRACTOR OR AUTHORIZED AGENT Current License on File /Yes O No O NA DATE WHEN PROPERLY VALIDATED (IN THIS SPACE) THIS IS YOUR PERMIT Comment: Approved By: g , (4j POUNDS PRTG -Blair, NE Rev. 4/98 ELECTRICAL PERMIT APP Jurisdiction of City of Blair, Nebraska 218 South 16th Street Blair, Nebraska 68008 (402) 426-4191 Application Date: �/✓QTY LICATION Permit E Permit Fee 2591 8 3' JOB ADDRESS 4d F, LEGAL 1 DESCR. p SEE ATTACHED SHEET 2.OWNER�A MAILADDRESS y� Q ZIP HOME PHONE c Lh��Y//% a,y`^ WORKICELLPHONE 30& "af2 0'� 3• CONTRACTOR MAILADDRESS PHONE HOMEPHONE WORK/CELL PHONE 4• Class of Work: O NEW RESIDENTIAL O NEW COMMERCIAL MODELING/ADDITIONS O UPGRADE SERVICE / - L 5• Describe Work: C p✓j Q Cj%G�% d%r 6. Current License on File 0 Yes O No p A Completion Date 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 System ................. $10.00 301-400 Amp 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 1 st 1000 Amp Fee ....................... $117.00 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 �q sq. ft. x .045 ;t 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 a other state or local Fixtures—x $.75 law regulating constructio or e p rformance of Smoke Detectors x $3.00 constructio . Residential/Commercial Appliance # Fixed Outlets is—$3.00 Motors) x $3.00 \ Power Apparatus (220 Volts) SIGNA URE OF N R ORA HORIZED AGENT # Apparatus x $3.00 111-7 6 Permit Issuance Fee .............$15.00 ' Qa DATE ' `� TOTAL ° WHEN PROPERLY VALIDATED (IN THIS SPACE) THIS IS YOUR PERMIT Comment: Approved By:C� 1-2� / POUNDS PRTG.-Blair, NE Rev. 11/99 BUILDING INSPECTION REPORT TY OF BLAI� ❑ LOCATION OF INSPECTIONi WASHINGTON COUNTY ❑ OTHER PASSED FAILED NAME OF OWNER: Jol"Af, � � �' / CONTRACTO t. j DATE INSPECTION REQUESTED %r~A� TIME INSPECTION REQUESTED- �` /� PERMIT NO. 1 TYPE OF INSPECTION REQUESTED: 0 CONFERENCE ❑ STATUS CHECK BUILDING: ❑ FOOTING ❑ DECK FOOTING ❑ FRAMING ❑ DRYWALL�FINAL ❑ PARTIAL PASS D FAILED PARTIAL 1-1COMMENTS: ❑ COMMENTS: 7 UTILITIES: ❑ SEWER TAP ❑ SEWER ❑ SEPTIC ❑ WATER TAP ❑ REMOTE ❑ WATER SERVICE PASSED FAILED ❑ PARTIAL El❑ COMMENTS: ELECTRICAL: ❑ ROUGH IN, FINAL ❑ PERMANENT SERVICE ❑ TEMPORARY SERVICE ❑ PRECONNECT PAS D FAILED F1 PARTIAL 1-1COMMENTS: MECHANICAL: ❑ ROUGH -IN ❑ A/C ❑ FURNACE ❑ RADIANT HEAT '_I;� FINAL ❑ PARTIAL COMMENTS: PLUMBING: ❑ GROUNDWORK ❑ ROUGH -IN - - ❑ PRESSURE TEST COMMENTS: F ❑ OCCUPANCY GRANTED ❑ CONDITIONAL OCCUPANCY GRANTED AL ❑ WATER METER INSTALLED ❑ PARTIAL FAILED FAILED F� i FAXED OPPMBURT REA TO CONNECT SERVICE: ON TIME �� BY ICA= 'b El* �� ` `�'� 4, ;� r :� �.y B 'a I�:ti`-� _ k L I I� .,,._ _� r it ._�_�,_ _...._. _.,.,..,_-,.__.... _ _ �_ —'—_ __ - _- -__-_ �- - _� - - - _ —_ 'IO@ OT "` CITY OF ])LAIQ_ 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 own behalf as,�uming City of Blair isclosure and accept this building permit documentation on my rAsponsibility as the owner/contractor for this project. Contractor 0 to to 218 South 16th Street • Blair, Nebraska 68008 • 402-426-4191 • Fax 402-426-4195 • E-mail cityofblair@huntel.net o� -7 �0seofc CITY Of t)tAIQ 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 tW City of Blair, Building and Inspections Department. Contractor/Owner City of Blair V/11/0 L-0-! Date 218 South 16th Street • Blair, Nebraska 68008 • 402-426-4191 • Fax 402-426-4195 • E-mail cityofblair@huntel.net HOMEOWNER VERIFICATION FOR ELECTRICAL WIRING PERMITS ✓� , states the following: print y50 full name on line above: 1. I am the owner of the single family dwelling for which I am applying for an electrical -Hermit_ Address: Z- 2. I am applying for an electrical permit for a single fa>nily 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 2005 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. S. B signing this m st ng the above information is true an correct. � 4 meowner/App licant igna ue D e 218 South 16th Street • Blair, Nebraska 68008 • 402-426-4191 • Fax 402-426-4195 • E-mail cityofblair@ci.blair.ne.us oP. _,., ... �p jolt y Oil' ifsxw r F U� 07/074.1, z� �F� 910 ,pn fll� t Mo , a f �m� 11/20/,006 '4�* r�:: ,, e: {.: 11/20/2006 r r 11/20/2006 11x'20/2006 x fiv�.a x ,pn fll� t Mo , a f �m� 11/20/,006 '4�* r�:: ,, e: {.: 11/20/2006 r r 11/20/2006 11x'20/2006 4� 41 `rt 11/20/2006 iJ.pO yip I'm mmEwft'*dm 11/20/2006 20/2006 Af P J ` a 11/20/2006 0 =I WPM i 06/27/2 06/27/2007 06/27/2007 p �n 06/27/2007 1 06/27/2007 Ar 06/27/2007 . 06/27/2007 I 06/27/2007 ,y 06/27/200