BP12926
Blair Building Permit Detail
Permit #: 12926 Issued: 3/4/2008
Completed:
Location: 1575 Oak Dr
Owner: Rick Ruhge
Address: 1575 Oak Dr
Type: Residential Remodeling
Valuation: 42160
Blair, NE 68008
Permit Fee:
Issue Fee:
Deposit Amt.:
Receipt #:
122
20
500
21894
Phone:
Section:
Subdivision:
Township:
Range:
Lot:
Block:
Tearing out walls to create open area. adding wet bar and adding walls over existing patio to create a laundry room.
Will have electric, plumbing, and heating.
Contractors
D.A. Boswell Company
Apollo Refrig. & Heating Sys., Inc.
Hipnar Electric
Jeller's Plumbing, Inc.
Remarks
General Contractor Permit # Issued
Heating Subcontractor M1631 4/2/2008
Electrical Subcontractor E2868 3/26/2008
Plumbing Subcontractor P1811 4/2/2008
3/13/2008
OEM
Failed in the am and went back at 2:21pm and it passed.
6/23/2008
OEM
Ceiling fan not installed.
6/24/2008 OEM Occupancy granted
Inspections Date By
3/13/2008 OEM Footings Pass
3/13/2008 OEM Footings Fail
4/2/2008 OEM Plumbing Rough-ins Pass
4/2/2008 OEM Mechanical Rough-ins Pass
4/2/2008 OEM Electrical Rough-ins Pass
4/2/2008 OEM Framing Pass
6/23/2008 OEM Plumbing Final Pass
6/23/2008 OEM Mechanical Final Pass
6/23/2008 OEM Electrical Final Fail
6/23/2008 OEM Final Inspection of Project Pass
6/24/2008 OEM Electrical Final Pass
'1 ; r I')
CITY OF BLAIR - APPLICATION FOR BUILDING PERMIT
Permit # 1.;<' 'J 2ft;
Date: 3-Lf-ot:)
Site Plan Attached:
REScheck Attached:
Approximate Completion Date: 7'" /- [) 13
Complete Plans Attached ~
Application for: Residential X Commercialjlndustrial
New Construction Manufactured Home Modular
Move-on: Home Accessory Building Other
Remodel ~ - Addition
Accessory Building: Garage _ Pole Barn_ Other
Floor Type: Dirt Concrete Electricity: Yes _ No
Other
Public Water: Yes_ No Private Well
If yes, responsible entity: Blair OPPD Line Kennard
Agreement needed: _ Date Agreement Received: _
Public Sewer: Yes_ No Septic Drawing Provided: _
If yes, responsible entity: Blair _ Kennard_
County Road Permit Required: Yes_ No _ Submitted: Yes _ No _
Additional Description of p'roj~ct if necessary: ~4Ai;,t2 oJ t-Ja.I~
cv' od dt-n~, ,1 WJ f /:;~ rf041d .
t/.$I o'er' ~ tJ1.v7 cd:/ a (/
A d t/~ c.dP (! '.A/ t! ,,-y! tvm w;" a 8 /uJ a.:th-, C1. -
Project Information: / I~ ?-' If'
00 L <-Lk t/h
Utilities:
Job Address:
1<..')'75'
f3<t 665& 5'81
Legal Description (if applicable) ~ 1\{~{~0Il Arid % t /
Owner: j3cJf. 'EAf'-:.. Address: c'VtlA1V M tJ/J~IIJ
^ '"J .1/1
Contractor: <...,LJ. A" d>tJJI u) .af
II ~ 0/ ~ IIw'j dO
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Phone#:
Phone #:
Address:
~a1
(/80CJ!3
Cell #: 533-3878
Separate permits are required for electrical, plumbing, hearting, ventilating and air conditioning, and septic systems. By my signature
below, I acknowledge this building permit application does not constitute issuance of this building permit. ) further agree that
construction covered by this permit application shall not be commenced until) have received a copy of a permit 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, ) understand that this permit is void if work is not commenced within
180 days or is not com d within two (2) years 0 ate of issue,
S'-<-j-o~
Date
RESIDENTIAL - ADDITIONS / REMODELS and
COMMERCIAL - NEW CONSTRUCTION / ADDITIONS / REMODELS:
Business/I n d ustrialjEd ucationalj Assem bly/F acto ry /Storage/Utility
*Porches with roofs/screened patios are considered additions
BuildinJ:! Permit Deposit Fee:
Residential additions/remodels/accessory buildings valued under $10,000 $
Fee = $200.00
Commercial, new homes and residential
additions/remodels/accessory buildings valued $10,000 or greater $ S60, c?(J
Fee - $500.00
All other permits valued under $10,000 No Deposit Fee
Construction Valuation will be computed by SQ/ft area X $60
Accessory Buildings & Interior Remodeling Projects will be computed bv SQ/ft
area X $40
Permit fee is:
Finished sqjft area
Finished sqjft area
/o.s-~
X$60
X $40
$
$ tf.;l.1 IlYO. 00
$0 TO $49.............................................................................................. $0 (plus Permit Issuance Fee)
$50 TO $9,999............................................................................................$50
$10,000 TO $99,999............................................................................................$50 + $6 per additional $1,000
$100,000 TO $249,999......................................................................................... $590 + $4 per additional $1,000
$250,000 TO $499,999......................................................................................$1,190 + $3 per additional $1,000
$500,000 TO $999,999......................................................................................$1,940 + $2 per additional $1,000
$1,000,000 AND OVER ......................................................................................$2,940 + $1 per additional $1,000
Permit Fee calculated from chart above
$ /61/).00
o
$ 20.00 ~ t '-f~' ()
$ lP E{ J, ()o
Issuance Fee:
Total Permit Fee = Deposit/Permit Fee/Issuance Fee
Additional Comments:
Approved'bj(: 7~ C~,
Date:
gls/~
I ,
X
f "
Contingent On Approval by Fire Marshall . .
Meet IBC, IPC, IMC and NEC Code Requirements )(
Sleeping Rooms below Story and in Basement required to ~ave egress
For Office Use Only
Date Permit Paid:
Permit Fee:
Deposit Amount
Receipt #
Deposit Paid by for return to:
Building Inspection Pouch given: Yes _ No
ZONING REVIEW:
ZoninWFlood Plain/Utilities: (',"
Current Zoning: ~ 01\ Conditional Use Permit Required: Yes No --X-
, r \ Date CUP Approved: - I
State Fire Marshal Required: Yes _ No + Variance Required: Yes _ No_
Minimum Setbacks: Front _ seco.ncl Front Side -;- Side _ Rear~
,;/'" .:'5-
c"-
~ '
Lot Sauare FootaJ:!e: ^ A
Length x Width: Lot Coverage % ^ j ~v\
,\, r
Driveways/Sidewalks: 1\ \ L '\ IY/
Sidewalk required: Yes--1-\Jr 4 Sidewalk Waiver: Yes __ No
~ A-Date Waiver Approved:
Flood Plain: Yes No I " \
If yes, specify special req ire ents:
BUILDING INSPECTOR REVIEW:
Number of Stories
One Two
Three
Four
>Four
High Rise (> 75 ft) _
Type of Residential Structure:
Ranch _ Two Story _ Split Entry _ Raised Ranch _ Other
Rooms _ Bedrooms _ Bathrooms _ Fireplaces _ Gas_ Electric _
Egress in Basement: Required: Yes _ No _ Provided on Plans: Yes No
Sleeping Rooms Living Area Other Egress
Sauare FootaJ:!e:
Main Level:
Basement: (Unfinished)
Garage:
Detached Garage:
Addition:
Porch: Front
Deck that affect setbacks:
Second Level: Third Level
(Finished)
2 bay_ 3 bay_ 4 bay_ 5+ bay
Pole Barn:
Remodel:
Side
Front Side
Rear
Rear
Occupancy Classification:
Assembly, theaters, with stage Assembly, theater, without stage _
Assembly, nightclubs _ Assembly, restaurants, bars, banquet halls _
Assembly, churches _ Assembly, arenas _
Assembly, general, community halls, librClries, museums _
Business Educational Factory and industrial, moderate hazard _
Factory and industrial, low hazard _ High Hazard, explosives _
High Hazard HPM Institutional, supervised environment_
Institutional, incapacitated _ Institutional, restrained_
Institutional, day care facilities _ Mercantile Residential, hotels _
Residential, multiple family _ Residential, one- and two-family
Residential, care/assisted living facilities
Storage, moderate hazard _ Storage, low hazard _ Utility, miscellaneous _
Is buildinJ:! required to be protected by automatic fire sprinkler system?"
No
Only partially in some areas or rooms Please Specify
Yes _ If yes, the standard to which the sprinkler system will be designed:
NFPA 13 NFPS 13R NFPA 13D
Driveway Grade: (percentage) (Dale will review new residential construction) (AI
will review all second access requests and industrial and commercial driveway requests)
Required Off Street Parking:
Permit Fee Calculation:
RESIDENTIAL - NEW CONSTRUCTION:
BuildinJ:! Permit Deposit Fee:
Residential additions/remodels/accessory buildings valued under $10,000 $
Fee = $200.00
Commercial, new homes and residential
additions/remodels/accessory buildings valued $10,000 or greater $
Fee - $500.00
All other permits valued under $10,000 No Deposit Fee
Permit fee is:
Finished sqjft area
(not including finished basement area)
Finished basement sqjft area
Unfinished basement sqjft area
Garage sqjft area
Total Valuation:
X$88
$
$
$
$
$
$
$
$
X$53
X$26
X$20
Total Valuation
Multiplied by 0.0056 =
Issuance Fee:
20.00
Total Permit Fee = Deposit/Permit Fee/Issuance Fee
PLUMBING PERMIT APPLICATION '
Jurisdiction of City of Blair, Nebraska ; '1 Cj' J. {j
218 South 16th Street I d
Blair, Nebraska 68008
Fax (402) 426-4195 P 1811
(402) 426-4191
~
Application Date:
tf'/~'o8
Job Address
Comments:
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.
cluj C/
Permit Fee: $
.CJfb ,>0 A
o r. ~o>
tJaf.: k.
Zip
Phone
Phone
'..1JI11(p11.f b!foZ5
o Repair 0 Replacement
{r1 Ra,110 dd
PLUMB I G RMIT FEES
Modular Home...... ......... ... ....$50.00
Type of Fixture No.
Kitchen............................. .$8.00 x
Bath... ... ... ...... ... ......... ... ....$8.00 x
Rough-In Bath....... ............ ... $4.00 x
Additional Sinks.................. ..$3.00 x 3
Laundry/Drain.................... ..$5.00 x l
Water Heater.................... ....$3.00 x
Outside Water Faucet..................$3.00 x
Drinking Fountain.......................$3.00 x
q,t;O
F'j,OO
Backtlow/Grease Trap........... .$10.00
Water Service. . . .. . .. . . .. .. . . .. .. . . $1 0.00
Sewer........................... .....$10.00
Groundwork..................... ...$10.00
Septic Tank & Laterals........... $10.00
Lawn SprillIder System... ...... ...$10.00
Sprinkler System (Commercial). $30.00
Gas/Water Piping System
(Commercial)..................... ..$30.00
Permit Issuance Fee............... .$20.00
Current License on File
Comment:
Total
es 0 No 0 N/ A
WHEN PROPERL Y VALIDATED (IN THIS SPACE) THIS IS YOUR PERMIT
I Approved By: ;j{, 1?Jf~
~
MECHANICAL PERMIT APPLICATION
Jurisdiction of City of Blair, Nebraska. 0.'1 (;
218 South 16th Street { :J -( t7
Blair, Nebraska 68008
Fax (402) 426-4195 M 1631
(402) 426-4191
Application Date:
Ij,~ ;1-0B
Permit Fee: $.:: 10,00 ~.
Job Address
Central A/C
Tons
Furnace
BTU/H
A/C
# of Units
Furnace
Completion Date:
Comments:
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.
allo tJv d
re of Contractor or Authorized Agent
Date
ad
/ Zip
tJ1rUl tUJ e.:t aJ l/....i
/I'd" -4'A/1, Zip /f ~ # Phone
/i~ //'1' t(). //!--k141cnv /1/1..#. cZ.UlJ!.iIl/iLI U1g(~5' -Z3''1
o New 0 Addition 0 Repair 0 Replacement
--/r1 I ~'11 () d.d
MECHANICAL PERMIT FEES
Phone
Forced Air/Heat Pump Systems - Per Unit
Commercial/Residential (New)....................................... ..$25.00
Air-Conditioner Unit - Per Unit
Commercial/Residential (New).................................... ......$10.00
Forced Air Systems/Air Conditioner
Unit Replacement Per Unit Commercial/ResidentiaL.. ... ... ...... ..$1 0.00
Refrigeration Units/Coolers/Lines/Compressor -
Per Unit Commercial (New or Replacement)....................... ...$10.00
Appliance Vent/Fans..................... ..$10.00
Boiler...................................... ...$15.00
Duct System... ...... ... ... ... ... ... ......... $1 0.00
00
,/ll.
Gas/Air Outlets.......................
x $2.00
Radiant Heat Systems/Gas/Water
Piping System..................... ... ..... ..$25.00
Modular Home...... ...... ... ... ... ......... $50.00
f") 00
Permit Issuance Fee... ......... ......... ... $20.00 c>('tJ.
Total . 00
Current License on File ~s 0 No 0 N/ A
Comment:
WHEN PROPERLY VALIDATED (IN THIS SPACE) THIS IS YOUR PERMIT
I Approved By: 3. 131 ~
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:
If ",~,tJ8
Job Address
COlllinents:
Notice
I hereby certify that I have read and examined this
application and know the same to be tme and correct. All
provisions oflaws 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 01' cancel the provisions of any other
state 01' local law regulating construction or the
performance of construction.
P 1811
8fb,' (.i 0
Permit Fee: $ "
cJai.
Zip
Phone
Phone
'wU?lfP11 f tf; 8 tlZ,5
o Repair 0 Replacement
Rf2fll () eft!
No.
Kitchen............................. .$8.00 x
Bath................................ ..$8.00 x
Rough-In Bath..................... .$4.00 x
Additional Sinks.... ... ......... ....$3.00 x B
Laundry/Drain... ...... ... ..........$5.00 x I
Water Heater.................... ....$3.00 x
Outside Water Faucet..................$3.00 x
Drinking Fountain.......................$3.00 x
q.OO
/5 ,00
Backflow/Grease Trap........... .$10.00
Water Service.................. ....$10.00
Sewer.............................. ..$10.00
Groundwork.................. ......$10.00
Septic Tank & Laterals........... $10.00
Lawn SpriiiIder System....... .....$10.00
Sprinkler System (Commercial). $30.00
Gas/Water Piping System
(Commercial)..................... ..$30.00
Permit Issuance Fee......... ...... .$20.00
Current License on File
Comment:
Total
es 0 No 0 N/A
WHEN PROPERLY VALIDATED (IN THIS SPACE) THIS IS YOUR PERMIT
I Approved By: 3 \ 1!J f J/~
"
\
Apr 03 08 09:08a
Apollo Heating & Ale
#
402-291-5821
p.2
MECHANICAL PERMIT APPLICATION
Jurisdiction of City of Blair, Nebraska
218 South 16th Street
Blair, Nebraska 68008
Fax (402) 426A195 M 1631
(402) 426-4191
Application Date: t/_~i!:f) S
J oil Ad dress
Central Ale
Tons
BTUIH
Ale
Furnace
# of Units
Furnace
Completion Date:
Comments:
Notice
1 hereby certifY that I haw read and examined this
application and know the same t(} 1>c true and correct. AU
provisions of laws and ordinances governing this type of
work win be complied with whether specified herein or
not. The grallting of a pClnlit does not presmne to give
authority to violate or cancel the provisions of any other
state or local law regulating construction or the
performance of construction.
Permit Fee: $ c -:gO. 0 0
Phone
... ~ .t!.dtL_.
MECHANICAL PERMIT FEES
Forced AirlHeat Pump Systems - Per Unit
CommercialJResidential (New)....,.... .....,... ............ ...... .....S2S.00
Air-Conditioner Unit - Per Unit
Commerc.iaVResidential (New)........ .... 'Ow...... ............ ......$10.00
Forced Air Systems/Air Conditioner
Unit Replacement Per Unit CommerciaJJResidential............ .....$10.00
Refrigeration UnitslCoolerslLinesfCompressor -
Per Unit Commercial (New or Replacement)...... ......... ...... .....$10.00
Appliance Vent/Fans.................... ...$10.00
Boiler.................. ...... ...... ....... ....$15.00
Duct System......... .......,........ ...... ..S10.00
I~. 00
Gas/Air Outlets.......................
x$2.0Q
Radiant Heat SystcmslGas/W ater
Piping System.......,..... ................ ..$25.00
Modular Home,.....,...,........... ........$50.00
Permit Issuance Fee..................... .. .$20,00
'Total
oPt}. 00
,DO
Current License on File ~s 0 No CI N/A
Comment:
WHEN PROPERLY VALIDATED (IN' THIS SPACE TI-IIS IS YOUR PERMIT
Approved By: I
'U-r~
ELECTRICAL PERMIT APPLICATION lP
Jurisdiction of City of Blair, Nebraska \' f) q d--
218 South 16th Street ,;r
Blair, Nebraska 68008
Fax (402) 426-4195 E 2868
(402) 426-4191
NEW COMMERCIAL
(e~<.)Jc l
N/A
rJf!
Application Date:
~.-) 10 --u t
Job Address
I
~~vner .~ ....' c k R l.! ~ Mail Address
Contractor r.-} ...L .Mail Address
2. 14.- Y\c;.,.- t:--CU'"'-'
3. Class fWork: 0 NEW RESIDENTIAL 0
Describe Work: L l' I r'. r
4. (/ CL r r I <-< N~
5.Current License on File 0 Yes 0 No 0
Service Fee = (Amp Fee + 2.00 per branch circuit)
1-100 Amp Fee..................... ..$13.00
101-200 Amp Fee.......................$18.00
201-300 Amp Fee......... ... ... ... .....$30.00
301-400 Amp Fee...... ... ...... ........$42.00
401-500 Amp Fee...... ... ......... ... ..$55.00
501-600 Amp Fee...... ............... ..$67.00
601-700 Amp Fee... ... ... ......... ... ..$80.00
701-800 Amp Fee... ... ......... ...... ..$92.00
801-900 Amp Fee......... ........... .$105.00
901-1000 Amp..................... ...$117.00
IF OVER 1000 Amp
1 st 1000 Amp Fee...... ...... .. ....$117.00
Each additional 100 Amps..... ....$13.00
Notice
I hereby certifY that I have read and examined this
application and know the same to be true and correct. All
provisions oflaws 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.
5 -ZG-O((
Date
Permit Fee: $
Go-w
7~ c)q){ lOr
Zip
Phone
Zip
Phone
REMODELING/ADDITIONS 0 UPGRADE SERVICE
Completion Date
ELECTRICAL PERMIT FEES
Upgrade Existing Service........... ..$10.00
Temporary Service.................... $10.00
Fire Alarm System................. ....$10.00
Signs................................ ......$15.00
Miscellaneous Apparatus......... .....$11.00
AC/DC Circuit... .................. ......$5.00
Commercial/Multi Family and All Upgrades:
# of Circuits x $2.00
Amp Fee
Amp Fee + Circuit Total
New Residential: (Finished Area)
Single/Two Family Dwellings
sq. ft. x .045
Modular/Manufactured Homes... ...$50.00
Receptacle/Switch Outlets
Fixtures :56 - x $.75
Smoke Detectors x $3.00
Residential/Commercial Appliance
# Fixed Outlets' x $3.00
Motor(s) x $3.00
Power Apparatus (220 Volts)
# Apparatus x $5.00
3 7~~"'D
)-00
Permit Issuance Fee.................. ..$20.00
Ju-'w
ho-~v
Total
Comment:
WHEN PROPERL Y VALIDATED (IN THIS SPACE) THIS IS YOUR PERMIT
I Approved B\ cr~
CITY OF BLNQ
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BUILDING PERMIT SUPPOR ING DOCUMENTS
This building permit packet includes various ems 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 ow the 2006 International Buildinq
Code requirements that apply to your projecy 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 fo~.,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 wner/contractor for this project.
Owner/Occupant
..'-1....
City of Blair
o~
(5)-
~(lIJAl.HOUSmG
218 South 16th Street. Blair, Nebraska 68008 . 402.426.4191 . Fax 402-426.4195 . E-mail cityofblair@cLblair,ne,us '"''''"''''
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CITY OF BLNQ
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ILDING PERMIT DEPOSIT AGREEMENT
A $500.00 re ndable deposit is being collected at the time of your building
permit appli ation for all commercial, new homes and residential
'addi1~()Df)lr odels/accessory buildings valued $10,000 or greater. However,
the City'feserves 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)No stop box location card submitted, (with new service only)
3) all required inspections have not been obtained,
4) occupancy occurs prior to a final inspection,
5) all permits have not been obtained,
6) 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
City of Blair
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218 South 16th Street. Blair, Nebraska 68008 . 402-426-4191 . Fax 402-426-4195 . E-mail cityofblair@ci,blair.ne,us "'''''''''
BUILDING INSPECTION REPORT
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D CITY OF BLAIR
D WASHINGTON COUNTY
D OTHER
1S'7 S- 0 '7/(- f) Y'
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LOCATION OF INSPECTION'
NAME OF OWNER') ~
/(l1.1he
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DATE INSPECTION REQUESTED' 3 - ) ~
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CONTRACTOR'
TIME INSPECTION REQUESTED:_J J : '1 0
~33-V73 J
PERMIT NO' I ). C;) ~
TYPE OF INSPECTION REQUESTED:
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BUILDING: --<K(" FOOTING D DECK FOOTING
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COMMENTS:
UTILITIES: D SEWER TAP D SEWER D SEPTIC D WATER TAP D REMOTE D WATER SERVICE
D PARTIAL
D CONFERENCE
___-..... 'l'''+''V~
D FRAMING 0 DRYWALL D FINAL D PARTIAL
D STATUS CHECK
PASSED FAILED
D ;P~
PASSED FAILED
D D
COMMENTS:
ELECIRICA:rt'D ROUGH IN FINAL 0 PERMANENT SERVICE D TEMPORARY SERVICE D PRECONNECT
D FARTIAL
PASSED FAILED
D D
MECHANICAL:D ROUGH-IN D AJC 0 FURNACE 0 RADIANTHEAT D FINAL D PA..RTIA~,
PASSED F"xILED
D D
COMMENTS:
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PLUMBING: D GROUNDWORK D ROUGH-IN 0 FINAL D WATER METER INSTALLED 0 PARTIAL
D PRESSURE TEST
PASSED FAILED
D D
COMMENTS:
o OCCUPANCY GRANTED .0 CONDITIONAL OCCUPANCY GRANTED
NOTES/REMARKS'
IN
DATE OF INSPECTION MADE:
TIMF.' If~' 41
FAXED OPPD\BURT ~A
TO CONNECT SERVICE: ON
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OMAHA HE
342-0040
.
BUILDING INSPECTION REPORT
OF BLAIR
o WASHINGTON COUNTY
LOCATION OF
TIME INSPECTION REQUESTED' ./';c. ,'=},() /1 It}' "
NAME OF
DATE INSPECTION
TYPE OF INSPECTION
BUILDING: 0 FOOTING 0 DECK FOOTING 0 FRAMING D DRYWALL
o CONFERENCE
FlNAL 0 PARTIAL
o STATUS CHECK
COMMENTS:
UTILITIES: 0 SEWER TAP D SEWER 0 SEPTIC 0 WATER TAP 0 REMOTE 0 WATER SERVICE
o PARTIAL
FAILED
o
COMMENTS:
ELECTRICAL: 0 ROUGH IN
o PARTIAL
PASSED FAILED
o D
COMMENTS:
PLUMBING: D GROUNDWORK 0 ROUGH-IN
o PRESSURE TEST
o WATER METER INSTALLED 0 PARTIAL
PASSED
o
o PERMANENT SERVICE 0 TEMPORARY SERVICE 0 PRECONNECT
COMMENTS:
MECHANICAL:D ROUGH-IN 0 A/C 0 FURNACE 0 RADIANTHEAT""8YINAL 0 PARTIAL
NOTES/REMARKS'
ONDlTIONAL OCCUPANCY GRANTEo/
!. " / 7/ A1o"T
o OCCUPANCY GRANTED
IN
DATE OF INSPECTION MADE:
TIMF"/o~50
FAXED OPPD\BURT REA
TO CONNECT SERVICE:
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