BP7189~~~/ ~' Ip3Tlio Z /T~ ~ /~-Qio. -~ 2 coo. a
BUILDING PERMIT APPLICATION ~Z~32
Jurisdiction of City of Blair, Nebraska
218 South 16th Street
Blair, Nebraska 68008
(402) 426-4191 Permit
Application Date: ~' ~ ~ - ~ ~ Issue Date: lD ~~° ~ 4O Permit Fee: $ / U
JOB ADDRESS n ~~ ~O X I I
LEGAL
1. DESCR. LOT NO. BLK. TRACJi
I L ~ I /~ ~
S3 ' 7~~1~1 _ rU ~E SEE ATTACHED SHEET
^
OWNER
2. Dp r~ N e v ct ~ MAIL ADDRESS
~ q 2 ZIP
%'c.(~ PHONE
~/c~ %~'
3. CONTRACTOR
~~~ MAILADD ESS PHONE
Ucz~ ~- ~rC~.m ~` n LICENSE NO.
4. USE OF BUILDING ~
5. Class of Work: [~] NEW ^ ADDITION ^ ALTERATION ^ REPAIR ^ MOVE ^ REMOVE
6. Describe Work: ~~r-a 2 l~/ X 3 (o e.- ~ p 0~ ~ 02P~L ._ 7~~°Gt/c.~'?
7. Sq. Footage of Structu (Induding Basement and Garage): ~ ~ _ ~ ~~~
8. Change of Use From: ~ Change of Use To:
g, Valuation of Work: $ ~ ~ (~(~ ~~~ #. ~~QQ , ~ ~- j, uo~ril
Floodway Yes^ No ^
1U FIOOdplaln: Fringe Yes^ No ^ Dev. Permit
BFE
Elev. Cert.
11. Current Zoning:
12. State Fire Marshall Required: Yes ^ No^
13. Special Use Permit Required: Yes ^ No ^
14. Variance Required: Yes ^ No ^
15. Minimum Setbacks: Front ~ t~Side ~ Rel
16, Sidewalk Required: Yes^ No ^ Waiver Approved
BY I PLANS CHECKED BY
~~ f` /
NOTICE
Separate permits are required for electrical, plumbing, heating, ventilating and air condi-
tioning, 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 by this permit application shall not be commenced until I
have received a copyof this application form signed by the Building Inspectorand stamped
'APPROVED'.
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 is void if work is not commenced within 180 days,
is not completed within 2 years of the date of issuance, or if work is abandoned for six (ti)
months Qr longer, whichever is earliest.
OF OWNEF~CONTRACTOR
a~~~
OF OWNER (IF OWNER BUILDER)
AGENT DATE
,~ ~/i/~
DATE
Site Plan Attached Complete Plans Attached ^
Approximate Co pletion Date
Inspections Required and Fees
Utilities
Sewer Tap Water Tap
Sewer
Water Service
Septic Remote
Building
Footings ~ Drywall
(before finish)
Framing r/ Final ~ rZ ~~"~t~
Electrical - '~~~ ~~~-~~
Rough-in ~ Permanent Service
Final Temporary Service
Mechanical
Rough-in ABC _
Final
Plumbing
Ground Work
Rough-in Final
WHEN PROPERLY VALIDATED (IN THIS SPACE) THIS IS YOUR PERMIT
Comment: Approved By:
POUNDS PRTO: Blslr, NE Rev. Oal85
ELECTRICAL PERMIT APPLICATION
Jurisdiction of City of Blair, Nebraska
218 South 16th Street _
Blair, Nebraska 68008 0 3 9 4
(402) 426-4191 Permit
Application Date: ~ ~ f ~ ~`"I CG Permit Fee: $ ~~`=~
JOB ADDRESS
LEGAL
1 • DescR. LOT NO. BLK. TRACT
O SEE ATTACHED SHEET
2 OWNER MAILADDRESS
~)~ ~C~~~U)~ ZIP PHONE
3• CONTRACT9R-- MAIL ADDRESS PHOy~ LICENSE NO.
4. Class of Work: b NEW RESIDENTIAL O NEW COMMERCIAL O REMODELING/ADDITIONS O UPGRADE SERVICE
5• Describe Work: ~ ~~ ~~ ~ ~
C~ ~~l G ~ ~ .a ~
C-
J
6• Current License on File 'f~ Yes O No O NA
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
301-400 Amp Fee $ 42.00
Fire Alarm System ................. $10.00
401-500 Amp Fee ....•..•.....•.•............ $ 55.00 Signs ..................................... $15.00
501-600 Amp Fee ...............•....•....... $ 67.00 Miscellaneous Apparatus ...... $11.00
601-700 Amp Fee .................•.••....... $ 80.00
701-800 Amp Fee .........................•.. $ 92.00
801-900 Amp Fee ...................•........ $105.00 Commercial/ML~
Iti-Family and All Upg
ades:
901-1000 Amp ....• ..............•....•........ $117.00 $
r
# of Circuits x 2.00 ~ o~
IF OVER 1000 Amp Amp Fee
1st 1000 Amp Fee ..................•.•.. $117.00
A
F
Ci
it T
t
l C-
~ -~Ca
Each additional 100 Amps ........... $ 13.00 mp
ee +
rcu
o
a
NOTICE New Residential: (Finished Area)
I hereby certify that I have read and examined this Single/Two Family Dwellings
application and know the same to be true and correct. All sq. ft. x .045
provisions of laws and ordinances governing this type of
w
rk
ill b
li
d
ith
h
th
ifi
d h
i
o
w
e comp
e
w
w
e
er spec
e
ere
n 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 Receptacle/Switch Outlets
Fixtures ~G7 x $
75
~ ~ • ~~~
law regulating construction or the performance of .
construction. Residential/Commercial Appliance
# Fixect Outlets x $3.00
- Power Apparatus (220 Volts)
r
# A
t
$3
00
ppa
a
us x
.
SIGN RE ONTRA TOR OR AU HORIZ D AGENT
~
~~ Permit Issuance Fee $15.00 ~ ~-~~
DATE
TOTAL
-~~ ~• ~~
WHEN PROPERLY VALIDATED (IN THIS SPACE) THIS IS,yOUR PERMIT
ment:
Approved By:
POUNDS PRTG: Blair, NE // Rev. 12195
~'''
_:;.; ;
Address ~~ ~ F~C~I~ ~ I Date
Legal Description: Lot Block Addition ~~ ~ ~ s ~~ 71~~~ K.l~~
. Please show all measurements of existing and contemplated structures,
also show .distances between structures, etc., and property lines.
Is this a corner lot? ~~~~~~" '
PLOT PLAN
~ J
.CITY OF BLAIR
Application for Building Permit
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