BP7856-2~~ ~ BUILDING PERIVI~T APPLICATION
~ Jurisdiction of City of Blair, Nebraska
Permit Fee: ~~ 218 South 16th Street
Issuance Fee: ~ Blair, Nebraska 68008
Deposit Receipt #: (402) 426-4191 • Fax (402) 426-4195 Permit 7 ~ Jc 6
Application Date: ~ ~ / `~ ~ Issue Date: ~ ~ ~ `~ -"l
JOB ADDRESS
~Q 7 ( ~~
/00~ V'~~
LEGAL
1 . DESCR. LOT NO. ~
~~ G 7~ BLK.
~f ~ TRACT
~~„ ^ SEE ATTACHED SHEET
OWNER
2. J~~ MAIL ADDRESS Zlp PHONE
r
RACTOR MAI DDRESS ZIP PHONE
4. Class of Work: ~ NEW O ADDITION O REMODEL
5. Describe Work: ~(x~~- - ~ ' ~ ~~ O Finished Basement O Unfinished Basement
6. Total Sq. FOOtage (Including Basement and Garage): Total FInlShed Area:
7. Valuation of Work: $ ~ J (~ . 0~
Floodway O Yes O No
8. FIOOdplain: Fringe O Yes O No Dev. Permit
BFE Elev. Cert.
9. Current Zoning:
10. State Fire Marshall Required: O Yes O No
11. Special Use Permit Required: O Yes O No
12. Variance Required: O Yes
13. Minimum Setbacks: Front
14. Sidewalk Required: O Yes
O No
Side Rear
O 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 covered by this permit application shall not be
commenced until I have received a copyof 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 with the codeslordinances of the Ciry of Blair and the
State of Nebraska. I understand that this permit is void if work is not commenced within
180 days or is not completed within 2 years of date of issue.
SIGNATURE OF OWNER/CONTRACTO DATE
Comment:
O Site Plan Attached ~~ / .Complete Plans Attached
Approximate Completion Date ~
Inspections Required and Fees
Utilities
Sewer Water Service
Septic Remote
Stop Box Card
Buildin
Footings Drywall
(before finish) ~
Framing Final O r~ ?' -r
Electrical
Rough-in Fixtures
Final Permanent Service
Temporary Service
Mechanical
Rough-in A1C
Final
Plumbina
Ground Work
Rough-in Final
WHEN PROPERLY VALIDBgTED (IN THIS SPACE) THIS IS YOUR PERMIT
Approved By: v /~ /~
POUNDS PRTG: Blair, NE // Rev. B/96
• ~ ~; ~IJIL_ DING INSPECTION REPORT
E 1 ~ -
~; [CITY OF BLAIR 0 WASHINGTON COUNTY ~ OTHER
~ ~ f.. ~
~`
L. LOCATION OF INSPECTION:. _._/~~~ ~' f r'1~~4/; ~ ~~,-
~ ~~~ ~~~; ,~ J ~ ~
NAME OF OWNER:. _ ~~~~ CONTRACTOR: I~/~~2t~C-~_L'.~rf"~~
DATE INSPECTION~REQUESTED: ~ - ' ~~ ~-~ u
PERMITNO; ,~ t~
1TME INSPECTION REQUESTED ~ _---
~. ,
~. TYPE QF INSPECTION REQUESTED:
BUILDING: `
- ~ _. fy
~ ^ FOOTING
~• . ^ FRAMING ^ DRYWALL FINAL
,. ~ .
. UTILITIES.
~:..' .... 4. -. .. ".
^ SEWER TAP ^ SEWER . - ^ SEPTIC ^ WATER TAP, _.
~: ^ REIGIOTE ^ WATER SERVICE
ELECTRICAL:
^ ROUGH IN ^ FIXTURES ~ FINAL; ~ MOTORS
• f; ^ PERMANENT SERVICE ^ TEMPORARY SERVICE
MECHANICAL:
f°:_
^ ROUGH-IN ^ A/C ~ FIN;
k.,
E
-- ._
k -_PLUMBING:. - -- -- - -- -
--- -
--
^ GROUNDWORK ~ ^ ROUGH-IN ~ FINAL
. ~ RESULTS OF THE INSPECTION: SSED ~s~rroTES~ Q FAILED cs~ xo~sl
~`' NOTFS/RE[yIARKS: