BP13178
Permit #: 13178 Issued:
Completed:
Location: 1060 Colfax St
Owner: David Heer
Address: 8837 Co Rd 37
Blair, NE 68008
Phone: 426 0425
Section:
Subdivision:
Township:
1 4
Blair Building Permit Detail
04/17/2009
10/09/2009
Type: Residential Remodeling
Valuation: 121796
Permit Fee:
Issue Fee:
Deposit Amt.:
Receipt #:
730.78
25
500
24484
Range:
Lot:
Block:
2 bedroom 1 bath house to be moved on to property. will have a basement underneath. Basement will not be
finished. RI bath in basement. 1 car garage -existing attached.
Contractors
Heer Remodeling
Beebe Refrigeration, Htg. & AlC, Inc.
Commonwealth Electric
Henton Trenching, Inc.
Plumbing Works, Inc.
Remarks
04/20/2009 BMP
04/21/2009 KAR
04/21/2009 KAR
06/08/2009 KAR
07/24/2009 HOW
07/28/2009 HOW
09/22/2009 HOW
09/18/2009 KAR
General Contractor
Heating Subcontractor
Electrical Subcontractor
Plumbing Subcontractor
Plumbing Subcontractor
Permit #
M1894
E3115
P2028
P2010
Issued
07/28/2009
06/16/2009
07/14/2009
06/03/2009
House move permit must be obtained.
outlets required for wall space as per code. Same for kitchen and GFCI protected and
bath rom and garage. one window in bedroom and garage to be removed. closet lights to
meet code. Stairs to basement 6'8" clearance. Egress for basement to R 10 Minimum.
Smoke detectors as per code.
Air test 10:35 a.m. to 10:50 a.m.
Scope: partial rough in for stairwell. Smoke detector and other work will come later
1. Scope: Building sewer -ok-hw.
1.final bldg.-Provide s.d.s,
Outlet required for front of house and back. Several places require outlets hallway west
bedroom, kitchen, all kitchen counter outlets to be GFCI protected. Arc Fault protection for al
branch circuits to bedrooms. 20 amp dedicated to bathroom outlet.
Blair Building Permit Detail
09/18/2009 KAR Protect romex in basemetn up to 8' off of floor. Maximum breaker for hewat pump AC 20 amp.
Bond to gas line #6 becsue of csst.
Inspections Date By
04/20/2009 MARH Footings Pass
04/21/2009 KAR Conference Pass
06/08/2009 KAR Plumbing Groundwork Pass
06/08/2009 KAR Plumbing Pressure Test Pass
06/22/2009 KAR Electrical Permanent Service Pass
07/14/2009 HOW Conference Pass
07/24/2009 HOW Electrical Rough-ins Pass Partial
07/27/2009 HOW Sewer Lines Pass
07/28/2009 HOW Plumbing Rough-ins Pass
08/03/2009 SAJ Stop Box Card Pass
09/18/2009 HOW Final Inspection of Project Fail Partial
09/18/2009 KAR Electrical Final Fail
1 0/07/2009 KAR Electrical Final Pass
1 0/09/2009 HOW Plumbing Final Pass
1 0/09/2009 HOW Final Inspection of Project Pass
1 0/09/2009 HOW Mechanical Final Pass
BUILDING INSPECTION REPORT
, []c' CITY OF BLAIR
D W ASHlNGTON COUNTY
LOCATION OF INSPECTION'
/'/) l/ <:')
D OTHER
,; /f
(' '~)- i~:(~.;~,/ }(..
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("'i ,/
L,,,.,,)(/ ~
\,.i~S~~: \I:~l
NAME OF OWNER' ...i../,/li'/
.l;,l1,1
/"/
CONTRACTOR'
(' :~.~),.,,,;'lli lil(,.
f"i.? {;~,;_;,L/J c;<lp (~';:.,~:?E',j
l/" :>() ',/~:,~;:;?,;; "j .
DATE INSPECTION REQUESTED' ..
(r/ . c;',.! l:~':(
. ,/',
~ 8 .' "J"\ f"\ .f" f "
'/ TIME INSPECTION REQUESTED' //If l..)(.">cf lil.)', PERMIT
TYPE OF INSPECTION
D CONFERENCE
D STATUS CHECK
BUILDING: D FOOTING D DECK FOOTING D FRAMING D DRYWALL D FINAL D PARTIAL
PASSED FAILED
D D
COMMENTS:
UTILITIES: D SEWER TAP D SEWER D SEPTIC D WATER TAP D REMOTE D WATER SERVICE
D PARTIAL
PASSED FAILED
D D
COMMENTS:
ELECTRICAL: D ROUGH IN D
D PARTIAL
RECONNECT
P~~ED
COMMENTS:
MECHANICAL:D ROUGH-IN D AlC D FURNACE D RADIANTHEAT D FINAL D PARTIAL
PASSED FAILED
D D
COMMENTS:
PLUMBING: D GROUNDWORK D ROUGH-IN D FINAL D WATERMETERINSTALLED D PARTIAL
D PRESSURE TEST
PASSED FAILED
D D
COMMENTS:
D OCCUPANCY GRANTED D CONDITIONAL OCCUPANCY GRANTED
NOTES/REMARKS' f+tf/'O~.r 6oer' fet:c,d !;;enJke
INSPECTO~ ~
DATE OF INSPECTION MADE: C6-- a.;2-~9 TIMF' )d,,'()S
FAXED OPPD\BURT REA
TO CONNECT SERVICE: ON
BY
CITY OF BLAIR - APPLICATION FOR BUILDING PERMIT
Permit #
Date:
Approximate Completion Date: Lv-
/3/78
C1
Site Plan Attached: 'f.
REScheck Attached:
Complete Plans Attached
Application for: Residential ~ Commercial/Industrial _
New Construction Manufactured Home Modular
~
Move-on: HDme...lS.- Accessory Building Other
Remodel ,,~ Addition
Accessory Building: Garage _ Pole Barn_ Other
Floor Type: Dirt _ Concrete _ Electricity: Yes x No
Sign Erecting, Awnings _ Decks/Handicap Ramps (plot plan required) _
Satellite Dishes/Radio Antenna/Cell Towers (plot plan required) _
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 _
;7()
Utilities:
Additional Description of project if necessary:
'It) !J.fJ J.1~r7 d/,Jl C/
'1~
Job Address:
[t6'-f;~Y/}i ,J/j. 8qc;o '-I-&80q
Legal Description (If applicable) :Be ;:;t~f ;i i PI?f i/Ae JH 1fJf: t.5 a /(1 Pt! 'I
Owner: ,,})cu . //;:LL. Address: tfEL~) Phone#: ll2L:
Contractor: /lel1 ~;Ync) c:b.!ti; C?.)
!J
)2c/ ,j-J'
/0 t:J t5
Phone #:
Address:
C;Y8.! ;1' '7
/ .' ; ! '
~ '-,.... I
,;P,!
j',,)J/cU-l
6/ti'ul;6
Cell #:
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. I further agree that
construction covered by this permit application shall not be commenced until I 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. I understand that this permit is void if work is not commenced within
180 days or is n~~ completed within two (Q) years of date of issue. , ~ t'
.LY0A<--1( ~ MC'~ '! _-:1 _C'(
Signature of Owner/Co tractor Date
ZONING REVIEW:
ZoninJVFlood Plain/Utilities: . .
Current Zoning: p)'Y) 1_ Conditional Use Permit Required: Yes _ No ~
Date cu.>!pproved: r
State Fire Marshal Required: J-es _ No Variance Required: Yes _ No, fl--
Minimum Setbacks: Front..1.S- Second Front f D Side 1 Side ~ Rear~ (I
lot Sauare Footal:!e:
length x Width:
lot Coverage % elL --
Drivewavs/Sidewalks: X
Sidewalk required: Yes No _ Sidewalk Waiver: Yes
Date Waiver Approved:
Preexisting Garage requires driveway to be less than 3' from property line: Yes_
Approved by: .
Flood Plain: Yes No \./
If yes, specify special r~ents:
NO-X
BUilDING INSPECTOR REVIEW:
Number of Stories
One ~ Two _ Three
Four
>Four
High Rise (>75 ft)_
Tvpe 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 Footal:!e: ()f:;f<?
Main level: r 1:> ,lj
Basement: (Unfinished)
Garage: ]vJ?
Detached Garage:
Addition:
Porch: Front Rear
Deck that affect setbacks: Rear
Second level:
?fco i- ~~ (Finished)
2 bay_ 3 bay_ 4 bay_ 5+ bay
Pole Barn:
Remodel:
Side
Front
Third level
Side
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, libraries, museums _
Business Educational Factory and industrial, moderate hazard _
Factory and industrial, low hazard _ High Hazard, explosives _
(section continued on next page)
High Hazard HPM
Institutional, incapacitated _
Institutional, day care facilities_
Residential, multiple family _
Residential, care/assisted living facilities
Storage, moderate hazard _ Storage, low hazard _ Utility, miscellaneous _
Institutional, supervised environment _
Institutional, restrained _
Mercantile Residential, hotels _
Residential, one- and two-family
Is buildint:! reauired 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: 20% grade or less? Yes _ No
(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:
Buildint:! Permit Deposit Fee:
Commercial, new homes and residential
additions/remodels/accessory buildings valued $10,000 or greater $
Fee - $500.00
Residential additions/remodels/accessory buildings valued under $10,000 $
Fee = $200.00
All other permits Fee = $50.00 $
RESIDENTIAL - NEW CONSTRUCTION:
Permit fee is: ,'0(/
Finished sqjft area 1 t;l L}
(not including finished basement area)
Finished basement sqjft area
Unfinished basement sqjft area Rot
Garage sqjft area 3e)~'
Total Valuation:
X$92
X $56
X $29
X $25
$
<10 8'1l..P. tJO
I
$
$ ;}B I ,J.oo. ()()
$ 17, 1 ()O. ()()
$ I d I . '1,//.J. () ()
,
$ 730.78
Total Valuation I:J I: 1 rtl < pO Multiplied by 0.006 =
Issuance Fee:
$ 25.00 = 755,78.,.. 5DO,()t!)
$ II :;55.78
.
Total Permit Fee = Deposit + Permit Fee + Issuance Fee
^tR\
\4;). "\
'\ . "
eN"I'ln (, t~ ...... f)' 4' 2.000
L U ~') I:: P. . _.. ,.8
MECHANICAL PERMIT APPLICATION
Jurisdiction of City of Blair, Nebraska J" ^ :tt II 3 I '78
218 South 16th Street ()JVI ().JU'
Blair, Nebraska 68008
Fax (402) 426-4195 M 1894
(402) 426-4191
Application Date: 7- 2-11--01
Job Address
Owner
1.
Heat Pump Tons
Central AlC Tons
Furnace BTUIH
# of Units AlC
Furnace
Completion Date:
Boiler Chart
BTU Fee
Up to 100,000.............................. ..$15.00
100,000-500,000.................. .......... ..$30.00
500,000-1,000,000... ... ... ....... .......... .$40.00
1,000,000-1,750,000.................... .. ..$60.00
Over 1,750,000........................... ...$100.00
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
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.
C'
d~ z 7'~()9
Date
/ ill, 00
Permit Fee: $ ':[!I
Zip
Phone
Zip
Phone
o Addition 0 Alteration 0 Repair 0 Replacement
VtYJ i
FurnacelHeat Pump/Air Conditioner (Per Unit)
Up to and including 100,000 BTU / 3Ton............................$15.00
FurnacelHeat Pump/Air Conditioner (Per Unit)
Over 100,000 BTU / 3 Ton......................................... ....$25.00
Refrigeration Units/Coolers/Lines/Compressor - Commercial
(New or Replacement) (Per Unit)
. . . .. . . .. .. . .. . .. . .. . . .. . .. .. . .. . . .. . .. . .. . .. .. . .. . . .. .. . . .. . .. . .. . . . . .. . . . . .. $15.00
Boiler (use BTU Chart to left)............ ........
Appliance Vent/Fans. .. .. . .. . .. . . . . . .. . .... .$10 .00
Duct System}. ~!?'f.l.1?~J~f':10~.... ..$15.00
U~
Gas/Air Outlets.................First 5 x $6.00
/5'.oc)
. . . . . . .. .Additional
x $1.00
Radiant Heat Systems/Gas/Water
Piping System........................ ...... ..$50.00
Modular Home...... ... ...... ... ... .......... $50.00
Permit Issuance Fee........................ ..$25.00
Total
c!2 5.00
0.00
Current License on File fiYes 0 No 0 N/A
Comment:
WHEN PROPERLY VALIDATED (IN THIS SPACE) THIS IS YOUR PERMIT
I Approved By:
I
Rev. 2008-10
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:
Job Address
Owner
1. ,
2.
3. Class of Work:
Describe Work:
4.
Comments:
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.
~X:~
ignature of Contractor or Authorized Agent
. 1
J~?
Date
\,~\1B
\,.-'"
P 2028
. 5-5 0
PermIt Fee: $ ".... .
o Alteration 0 Repair 0 Replacement
PLUMBING PERMIT FEES
Modular Home... ... ... ...... ... ....$50.00
Type of Fixture No.
Kitchen............................. .$12.00 x
Bath... ..Residential/Single Stall $12.00 x_
...... .. .... ... ... ..Multi-Stall $25.00 x
Rough-In Bath....................... .$8.00 x_
Additional Sinks....... ... .......... .$6.00 x
Slop Sink/Laundry Tray/Drain.....$6.00 x_
Water Heater.................... .....$10.00 x
Outside Water Faucet...................$6.00 x
Drinking Fountain........................$6.00 x
Backflow/Grease Trap............. $15.00
Water Service. . . . . . . . . . .. . .. . .. .. . .. $15.00
Sewer............................... ..$15.00
Groundwork..................... ....$15.00
Septic Tank & Laterals............ $15.00
Lawn Sprinkler System......... ...$10.00
Sprinkler System (Commercial)..$30.00
Gas/Water Piping System
(Commercial)...................... ..$50.00
~
---L-
Permit Issuance Fee......... ... .....$25.00
Current License on File ~es 0 No
Comment:
Total
o NjA
WHEN PROPERLY V ALIDA TED (IN THIS SPACE) THIS IS YOUR PERMIT
I Approved By: ~~6. P-I/ ~v~
Rev. 2008-10
vt
ELECTRICAL PERMIT APPLICATION
Jurisdiction of City of Blair, Nebraska :# /3/78
218 South 16th Street
Blair, Nebraska 68008
Fax (402) 426-4195 E 3115
(402) 426-4191
Application Date:
&-/v~o9
Job Address
I t:J /;J 0
Owner
1
Service Fee = (Amp Fee + $5.00 per branch circuit)
1-100 Amp Fee... ... ... ...... ..... ...$25.00
101-200 Amp Fee...... ... ..............$35.00
201-300 Amp Fee...... ............... ..$55.00
301-400 Amp Fee................... ....$75.00
401-500 Amp Fee......... ... ......... ..$95.00
501-600 Amp Fec.................... .$115.00
601-700 Amp Fee.................... .$135.00
701-800 Amp Fee.................... .$155.00
801-900 Amp Fee................... ..$175.00
901-1000 Amp........................ .$195.00
IF OVER 1000 Amp
1 st 1000 Amp Fee............... ...$195.00
Each additiona1100 Amps...... ...$20.00
Notice
I hereby certify that I have read and examined this
application and know the same to be true and conect. All
provisions of laws and ordinances governing this type of
work wiI! 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.
(.,.0
Date
Permit Fee: $
8(, 00
Zip
Phone
'-AJ t/.;l.;?.s~ c:f. tJ 9#.Z~/. c:)4nah a tR :;/:; 7 g.3/~ I
NEW COMMERCIAL' REMODELINGjADDillONS 0 UPGRADE SERVICE
fJ al- /dad /J11dt/..i'd 7d /I.J!W Jt1{Jail;
Completion Date
ELECTRICAL PERMIT FEES
Upgrade Existing Service... .. . ... .. . .$25 .00
Temporary Service.................... $15.00
Fire Alarm System.................. ...$15.00
Signs (each)........................ ......$25.00
Miscellaneous Apparatus......... .....$15.00
CommerciallMuIti Family and All Upgrades:
# of Circuits x $5.00
Amp Fee ~ 'j5: t/()
Amp Fee + Circuit Total
New Residential: (Finished Area)
Single/Two Family Dwellings
sq. ft. x .063
Modular/Manufactured Homes...... .$50.00
Other: (alterations, additions and modifications)
ReceptaclesjSwitches!Lightin~ Fixtures (110 volt o~ly)
# of Apparatus.......... I r2{ x $1.00 / r.J . I/O
35. 0 ()
Power Apparatus (220 Volt or higher)
# of Apparatus....... x $8.00
Smoke Detectors. . . ..
o
x $3.00
tf. ~ ()
"'7 r, () ()
Permit Issuance Fee.................. .$25.00 P""c.J.
Total . /. tJ ()
Comment:
WHEN PROPERLY VALIDATED (IN THIS SPACE) THIS IS YOUR PERMIT
I Approved By: c 1; ?.t f ~
I
Rev. 2008-10
ELECTRICAL PERMIT APPLICATION
#- ;3/7/3
Jurisdiction of City of Blair, Nebraska
218 South 16th Street
Blair, Nebraska 68008
Fax (402) 426-4195
(402) 426-4191
Application Date:
1ff-/If-o'1
Job Address
Permit Fee: $
E 3115
I}(. tJo~
~~,
/tJ /c/O
Phone
Service Fee = (Amp Fee + $5.00 per branch circuit)
1-100 Amp Fee......... ......... .....$25.00
101-200 Amp Fee......... ......... .....$35.00
201-300 Amp Fee.......................$55.00
301-400 Amp Fee..................... ..$75.00
401-500 Amp Fee.......................$95.00
501-600 Amp Fee......... .. .. .. .. . .. . $115.00
601-700 Amp Fee.....................$135.00
701-800 Amp Fee.................. ...$155.00
801-900 Amp Fee...... ............ ...$175.00
901-1000 Amp........................ .$195.00
IF OVER 1000 Amp
151 1000 Amp Fee............... ...$195.00
Each additional 100 Amps..... ....$20.00
Notice
I hereby certify that I have read and examined this
application and know the same to be true and correct. AU
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.
Signature of Contractor or Authorized Agent
Date
Zip
ZIp Phone
t/,,;1d-5-J", 09#' J-?fl. c)4rlcd1C:" /i',c'JIc2 '1 33/-/
NEW COMMERCIAL REMODELING/ADDITIONS 0 UPGRADE SERVICE
If{ al- tV 0'4 )171dt/ J! c/ i~ /1.1 tV Jtt {'Jab;
Completion Date
ELECTRICAL PERMIT FEES
Upgrade Existing Service............ .$25.00
Temporary Service.................... $15.00
Fire Alarm System.................. ...$15.00
Signs (each)......................... .....$25.00
Miscellaneous Apparatus......... .....$15.00
CommerciaIIMulti Family and All Upgrades:
# of Circuits x $5.00
Amp Fee c 'i',), IJO
Amp Fee + Circuit Total ,35. 0 ()
New Residential: (Finished Area)
Single/Two Family Dwellings
sq. ft. x .063
Modular/Manufactured Homes...... .$50.00
Other: (alterations, additions and modifications)
Receptacles/Switches!Lightin~ Fixtures (110 volt only);
# of Apparatus .......... / .,ji{ x $1. 00 / ,;? , t ()
Power Apparatus (220 Volt or higher)
# of Apparatus....... x $8.00
Smoke Detectors.....
2
"-.J
x $3.00
'1. tJO
Permit Issuance Fee......... ......... .$25.00
2/,c-, ,'J tJ
~;; u '
/ tJ()
Total
Comment:
WHEN PRO PERL Y VALIDATED (IN THIS SPACE) THIS IS YOUR PERMIT
I Approved By' 1);2 I'
. c1).' ,~. ~!~
Rev. 2008-10
RESIDENTIAL - ADDITIONS / REMODELS and
COMMERCIAL - NEW CONSTRUCTION / ADDITIONS / REMODELS:
Business/I ndustrial/Ed ucational/ Assembly/Factory/Storage/Utility
*Porches with roofs/screened patios are considered additions
Construction valuation computation: Sqjft area X $63
Except for the following:
Accessory Buildings & Interior Remodeling Projects: sqjft area X $43
Pole barns with no hard surface floor: sqjft area X $25
Sign Erecting/Awnings and Decks/Handicap Ramps: sqjft area X $25 (Minimum
valuation of $2000)
Construction valuation computation:
Finished sqjft area
X$
$
Construction valuation is ...................................Permit fee is:
$0 TO $50.......................................................... $0
$51 TO $500........................................................$25
$501 TO $2,000........................................................$25 + $3 per additional $100
$2,001 TO $25,000........................................................$70 + $13 per additional $1,000
$25,001 TO $50,000..................................................... $370 + $10 per additional $1,000
$50,001 TO $100,000..................................................... $620 + $7 per additional $1,000
$100,001 TO $500,000..................................................... $970 + $5 per additional $1,000
$500,001 TO$1,OOO,OOO ..................................................$2,970 + $4 per additional $1,000
$1,000,001 AND OVER ..................................................$4,970 + $3 per additional $1,000
Permit Fee calculated from chart above
$
$
$
25.00
Issuance Fee:
Total Permit Fee = Deposit + Permit Fee + Issuance Fee
Additional Comments:
Approved by:
f
'.~1.
' Fy
(y,\ ie/J-'
Date:
if1r7/0r
Contingent On Approval by Fire Marshall
Meet IBC, IPC, IMC and NEC Code Requirements L/
Sleeping Rooms below Story and in Basement required to have egress
For Office Use Only
Date Permit Paid: ~~.~
Permit Fee: 755" ."18
Deposit Amount 5tJO' 00
Receipt # ~4l\ <'64
Deposit Paid by for return to:
[XNI" cl W-ee{"
Z~.'~'l rC) h6 ~'1_
Building Inspection Pouch given: Yes -4- No
%R
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:
Job Address
Permit Fee: $
IO~
Owner 0 : f)
1. OJULt{
CO antor '-^ J "-
2. ~~~
3. Class of Work:
Descril'F Work:
4. f
Mail 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 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.
Ie
~
Signature of Contractor or Authorized Agent
Date
Zip Phone
\~\1f:)
P 2010
00
/Ob^~
Phone
o Repair 0 Replacement
~
PLUMBING PERMIT FEES
Modular Home.................... ..$50.00
Type of Fixture No.
Kitchen............................. .$12.00 x
Bath... ..Residential/Single Stall $12.00 x_
... ... ... ... ... .... .Multi-Stall $25.00 x
Rough-In Bath...................... ..$8.00 x_
Additional Sinks....... ... ... ....... .$6.00 x
Slop Sink/Laundry Tray/Drain.....$6.00 x
Water Heater.................... .....$10.00 x
Outside Water Faucet...................$6.00 x
Drinking Fountain........................$6.00 x_
Backflow/Grease Trap............ .$15.00
Water Service...................... .$15.00
Sewer............................... ..$15.00
Groundwork... ... ... ... . .. ...... ....$15 .00
Septic Tank & Laterals..... ... .... $15.00
Lawn Sprinkler System......... ...$1 0.00
Sprinkler System (Commercial)..$30.00
Gas/Water Piping System
(Commercial)................. ... ....$50.00
Permit Issuance Fee................ .$25.00
Current License on File
Comment:
Total
es 0 No 0 Nj A
If
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WHEN PRO PERL Y VALIDA TED (IN THIS SPACE) THIS IS YOUR PERMIT
I Approved By: c%. ?JI ~-...-/
Rev. 2008-10
CITY OF LAIR, NEBRASt<A
Phone 402-426-4191
RECEIVED OF:
ADDRESS
CI1Y. STATE. ZIP CODE
THANK YOU
KEEP THIS COPY FOR YOUR RECORDS.
NO
RECEIVED BY
Pounds Prinling, Blair, NE 68008
CITY OF BLAIR
Application for Building Permit
PLOT PLAN
Address /(} (; [) Co {F= "-)(
,
Legal Description: Lot
Date
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Please show all measurements of existing and contemplated structures,
also show distances between structures, etc., and property lines.
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Is this a corner lot?
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Indicate North
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BUILDING PERMIT DEPOSIT AGREEMENT
A $500.00 refundable deposit is being collected for any new commercial, new
residential, and any additions, remodels and accessory building valued $10,000 or
greater at the time of your building permit application.
A $200.00 refundable deposit is being collected for any residential remodel,
addition or accessory building valued under $10,000.
A $50.00 refundable deposit is being collected for all misc. permits.
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 the plumber, owner or general contractor.
2) All permits have not been obtained.
3) All required inspections have not been obtained.
4) Occupancy occurs prior to a final inspection.
5) The project is completed without a final inspection being done.
6) Storm Water Management Plan inspection not obtained. (If Required)
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.
tJ~~/!~
Contractor/Owner
Contractor/Owner
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City~ of Blair '
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.{h-016~
Date
CITY or 5L1\I12
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 2006 International Buildina
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.
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( ..,-,
Owner/Occupant
~
Contractor
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Date
~QUAlHOUsrN~
218 South 16th Street. Blair, Nebraska 68008 . 402-426-4191 . Fax 402-426-4195 . E-mail cityofblair@ci.blair,ne,us "''''"''''
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BUILDING INSPECTION REPORT
CITY OF BLAIR
o WASHINGTON COUNTY
o OTHER
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LOCATION OF INSPECTION'
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NAME OF OWNER: ,i \<i i/j (:Y . 'c/.
DATE INSPECTION REQUESTEDfcC[
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TIME INSPECTION REQUESTED' / / ,',:) () /j ',iLl, PERMIT
TYPE OF INSPECTION REQUESTED: 0 CONFERENCE
BUILDING: FOOTING 0 DECK FOOTING 0 FRAMING 0 DRYWALL 0 FINAL 0 PARTIAL
o STATUS CHECK
P~ED FAILED
/~ 0
COMMENTS:
UTILITIES: 0 SEWER TAP 0 SEWER 0 SEPTIC 0 WATER TAP 0 REMOTE 0 WATER SERVICE
o PARTIAL
PASSED FAILED
o 0
COMMENTS:
ELECTRICAL: 0 ROUGH IN 0 FINAL 0 PERMANENT SERVICE 0 TEMPORARY SERVICE 0 PRECONNECT
o PARTIAL
PASSED FAILED
o 0
COMMENTS:
MECHANICAL:D ROUGH-IN 0 AlC 0 FURNACE 0 RADIANT HEAT 0 FINAL 0 PARTIAL
PASSED FAILED
o 0
COMMENTS:
PLUMBING: 0 GROUNDWORK 0 ROUGH-IN 0 FINAL 0 WATERMETERINSTALLED 0 PARTIAL
o PRESSURE TEST
PASSED FAILED
o 0
COMMENTS:
o OCCUPANCY GRANTED 0 CONDITIONAL OCCUPANCY GRANTED
NOTES/REMARKS'
INSPECTOR'
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DATE OF INSPECTION MADE:
(,~ ~
TIME' .) 2--
FAXED OPPD\BURT REA
TO CONNECT SERVICE: ON
BUILDING INSPECTION REPORT
CITY OF BLAIR 0
LOCATION OF INSPECTION'
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NAME OF OWNER'"L",'/A II ',,'
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DATE INSPECTION REQUESTED' LI~ ~ ,.,,~( ! - (,J!}
TIME INSPECTION REQUESTED'
ti
TYPE OF INSPECTION REQUESTED:' :l2}~1~ONFERENCE
BUILDING: FOOTING 0 DECK FOOTING 0 FRAMING 0 DRYWALL 0 FINAL 0 PARTIAL
o STATUS CHECK
COMMENTS:
UTILITIES: 0 SEWER TAP 0 SEWER 0 SEPTIC 0 WATER TAP 0 REMOTE 0 WATER SERVICE
o PARTIAL
PASSED FAILED
o 0
COMMENTS:
ELECTRICAL: 0 ROUGH IN 0 FINAL 0 PERMANENT SERVICE 0 TEMPORARY SERVICE 0 PRECONNECT
o PARTIAL
PASSED FAILED
o 0
COMMENTS:
MECHANICAL:D ROUGH-IN 0 AlC 0 FURNACE 0 RADIANTHEAT 0 FINAL 0 PARTIAL
PASSED FAILED
o 0
COMMENTS:
PLUMBING: 0 GROUNDWORK 0 ROUGH-IN 0 FINAL 0 WATERMETERINSTALLED 0 PARTIAL
o PRESSURE TEST
PASSED FAILED
o 0
COMMENTS:
PASSED FAILED
o 0
DATE OF INSPECTION MADE:
'(~;< I~;;!tdl TIME' /O.tx)
FAXED OPPD\BURT REA
TO CONNECT SERVICE: ON
BY
BUILDING INSPECTION REPORT
OF BLAIR
o WASHINGTON COUNTY
DATE INSPECTION REQUESTED'
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LOCATION OF
NAME OF
TIME INSPECTION REQUESTED'
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,i UL/ji 'I 'I ' PERMIT NO'
TYPE OF INSPECTION REQUESTED: 0 CONFERENCE
BUILDING: 0 FOOTING 0 DECK FOOTING 0 FRAMING 0 DRYWALL 0 FINAL 0 PARTIAL
o STATUS CHECK
PASSED FAILED
o 0
COMMENTS:
UTILITIES: 0 SEWER TAP 0 SEWER 0 SEPTIC 0 WATER TAP 0 REMOTE 0 WATER SERVICE
o PARTIAL
PASSED FAILED
o 0
COMMENTS:
ELECTRICAL: 0 ROUGH IN 0 FINAL 0 PERMANENT SERVICE 0 TEMPORARY SERVICE 0 PRECONNECT
o PARTIAL
PASSED FAILED
o 0
COMMENTS:
MECHANICAL:D ROUGH-IN 0 AlC 0 FURNACE 0 RADIANTHEAT 0 FINAL 0 PARTIAL
PASSED FAILED
o 0
COMMENTS:
PLUMBING:
o ROUGH-IN 0 FINAL 0 WATERMETERINSTALLED 0 PARTIAL
PRESSURE TEST
COMMENTS:
o OCCUPANCY GRANTED D CONDITIONAL OCCUPANCY GRANTED
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NOTES/REMARKS'
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DATE OF INSPECTION MADE: 66 - C)f!- ,-~g~, 1 c) :;5'
INSPECTO '
FAXED OPPD\BURT REA
TO CONNECT SERVICE: ON
BY
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J~;;:P;'EmY OF BLAIR
BUILDING INSPECTION REPORT
D WASHINGTON COUNTY
D OTHER
LOCATION OF INSPECTION-
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DATE INSPECTION REQUESTED' f7~' / l.;/" (~) C?
CONTRACTOR'
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TIME INSPECTION REQUESTED' /,/ ",) (i/l, f''l 'PERMIT NO'i' 'oS l ';' /)
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TYPE OF INSPECTION REQUESTED: ',:< CONFERENCE
BUILDING: D FOOTING D DECK FOOTING D FRAMING D DRYWALL D FINAL D PARTIAL
D STATUS CHECK
PASSED FAILED
D D
COMMENTS:
UTILITIES: D SEWER TAP D SEWER D SEPTIC D WATER TAP D REMOTE D WATER SERVICE
D PARTIAL
PASSED FAILED
D D
COMMENTS:
ELECTRICAL: D ROUGH IN D FINAL D PERMANENT SERVICE D TEMPORARY SERVICE D PRECONNECT
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PASSED FAILED
D D
COMMENTS:
MECHANICAL:D ROUGH-IN D AlC D FURNACE D RADIANTHEAT D FINAL D PARTIAL
PASSED FAILED
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COMMENTS:
PLUMBING: D GROUNDWORK D ROUGH-IN D FINAL D WATERMETERINSTALLED D PARTIAL
D PRESSURE TEST
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COMMENTS:
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INSPECTOR' 7; V +
DATE OF INSPECTION MADE: 7-- ("-0 "'7
TIMF'
II: J S ,(\W\.
FAXED OPPD\BURT REA
TO CONNECT SERVICE: ON
BY
BUILDING INSPECTION REPORT
B," CITY OF BLAIR
D WASHINGTON COUNTY
D OTHER
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LOCATION OF INSPECTION'
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DATE INSPECTION REQUESTED'
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TIME INSPECTION REQUESTED',) , '()t.::>7' f 17 '
TYPE OF INSPECTION REQUESTED: D CONFERENCE
BUILDING: D FOOTING D DECK FOOTING D FRAMING D DRYWALL D FINAL D PARTIAL
COMMENTS:
UTILITIES: D SEWER TAP
D PARTIAL
SEWER D SEPTIC D WATERTAP D REMOTE~;"'WATERSERVICE
1: 0 1< 7-'16-0 ~~ .)t.w.
COMMENTS:
D STATUS CHECK
PASSED FAILED
D D
PASSED FAILED
D D
ELECTRICAL: D ROUGHIN D FINAL D PERMANENT SERVICE D TEMPORARY SERVICE D PRECONNECT
D PARTIAL
COMMENTS:
MECHANICAL: D ROUGH-IN D AJC D FURNACE D RADIANT HEAT D FINAL D PARTIAL
COMMENTS:
PLUMBING: D GROUNDWORK D ROUGH-IN D FINAL D WATERMETERINSTALLED D PARTIAL
D PRESSURE TEST
COMMENTS:
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D OCCUPANCY GRANTED D CONDITIONAL OCCUPANCY G
NOTES/REMARKS'
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INSPECTOR'
DATE OF INSPECTION MADE:
FAXED OPPD\BURT REA
TO CONNECT SERVICE: ON
BY
PASSED FAILED
D D
PASSED FAILED
D D
PASSED FAILED
D D
TIME'
?/:tJ .
CITY OF BLAIR
BUILDING INSPECTION REPORT
D WASHINGTON COUNTY
LOCATION OF INSPECTION'
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D OTHER
Cl () \({~;:~'k' "
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NAME OF OWNER' ,tJtX. \J 1(,. !.
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CONTRACTOR'
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DATE INSPECTION REQUESTED'
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TIME INSPECTION REQUESTED' \, .()
PERMIT
TYPE OF INSPECTION REQUESTED: D CONFERENCE
BUILDING: D FOOTING D DECK FOOTING D FRAMING D DRYWALL D FINAL D PARTIAL
D STATUS CHECK
COMMENTS:
UTILITIES: D SEWER TAP /".,SEWER D SEPTIC D WATER TAP D REMOTE D WATER SERVICE
4' 'r,
D PARTIAL I .
PASSED FAILED
D D
COMMENTS:
ELECTRICAL: D ROUGH IN D FINAL D PERMANENT SERVICE D TEMPORARY SERVICE D PRECONNECT
D PARTIAL
FAILED
D
COMMENTS:
MECHANICAL:D ROUGH-IN D AlC D FURNACE D RADIANTHEAT D FINAL D PARTIAL
D
FAILED
D
COMMENTS:
PLUMBING: D GROUNDWORK D ROUGH-IN D FINAL D WATERMETERINSTALLED D PARTIAL
D PRESSURE TEST
PASSED FAILED
D D
COMMENTS:
D OCCUPANCY GRANTED D CONDITIONAL OCCUPANCY GRANTED
PASSED FAILED
D D
NOTES/REMARKS'
INSPECTOR'
~-
DATE OF INSPECTION MADE: 7....-":)..:.7. 0 't
TIME' ~f1"),V\
FAXED OPPD\BURT REA
TO CONNECT SERVICE: ON
BY
BUILDING INSPECTION REPu.l"..L
[SjCITY OF BLAIR
~"." ... ."",.~
o WASHINGTON COUNTY
o OTHER
LOCATION OF INSPECTION'
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NAME OF
CONTRACTOR'
DATE INSPECTION REQUESTED' '/<'// ,~.)." l) /' TIME INSPECTION REQUESTED' />/,J '/;i/)~/,/f4 < PERMIT
TYPE OF INSPECTION REQUESTED: 0 CONFERENCE
BUILDING: 0 FOOTING 0 DECK FOOTING 0 FRAMING 0 DRYWALL 0 FINAL 0 PARTIAL
o STATUS CHECK
PASSED FAILED
o 0
COMMENTS:
UTILITIES: 0 SEWER TAP 0 SEWER 0 SEPTIC 0 WATER TAP 0 REMOTE 0 WATER SERVICE
o PARTIAL
PASSED FAILED
o 0
COMMENTS:
ELECTRICAL: 0 ROUGH IN'rs;J(FINAL 0 PERMANENT SERVICE 0 TEMPORARY SERVICE 0 PRECONNECT
o PARTIAL
P~ED F~
COMMENTS:
MECHANICAL:D ROUGH-IN 0 NC 0 FURNACE 0 RADIANTHEAT 0 FINAL 0 PARTIAL
PASSED FAILED
o 0
COMMENTS:
PLUMBING: 0 GROUNDWORK 0 ROUGH-IN 0 FINAL 0 WATERMETERINSTALLED 0 PARTIAL
o PRESSURE TEST
PASSED FAILED
o 0
COMMENTS:
TED 0 CONDITIONAL OCCUPANCY GRANTED
DATE OF INSPECTION MADE:
7- /fJ-;;?tt?- TIME-!CJ; ~
FAXED OPPD\BURTREA
TO CONNECT SERVICE: ON
BY
~J~
o 'GITY OF BLAIR
LOCATION OF
NAME OF
BUILDING INSPECTION REPORT
o WASHINGTON COUNTY
( "->
DATE INSPECTION REQUESTED' ";' .'
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PERMIT NO' f..J I : f "
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o STATUS CHECK
TYPE OF INSPECTION REQUESTED:
BUILDING: 0 FOOTING 0 DECK FOOTING 0 FRAMING 0 DRYWALL
PASSED FAILED
o ~.
COMMENTS:
UTILITIES: 0 SEWER TAP 0 SEWER 0 SEPTIC 0 WATER TAP 0 REMOTE 0 WATER SERVICE
o PARTIAL
PASSED FAILED
o 0
COMMENTS:
ELECTRICAL: 0 ROUGH IN 0 FINAL 0 PERMANENT SERVICE 0 TEMPORARY SERVICE 0 PRECONNECT
o PARTIAL
COMMENTS:
PASSED FAILED
o 0
MECHANICAL: 0 ROUGH-IN 0 NC 0 FURNACE 0 RADIANT HEAT '[:;;](FINAL ~ARTIAL
COMMENTS:
PASSED FAILED
~ 0
FINAL 0 WATER METER INSTALLED
~SED FAILED
A 0
COMMENTS:
PLUMBING: 0 GROUNDWORK 0 ROUGH-IN
o PRESSURE TEST
o OCCUPANCY GRANTED 0 CONDITIONAL OCCUPANCY GRANTED
NOTES/REMARKS'
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INSPECTOR'
FAXED OPPD\BURT REA
#'7/Jr.~/
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TIME'
IO;~
,
DATE OF INSPECTION MADE:
TO CONNECT SERVICE: ON
BY
BUILDING INSPECTION REPORT
CITY OF BLAIR
o WASHINGTON COUNTY
o OTHER
LOCATION OF INSPECTION'
i' .l' j
NAME OF OWNER'" l::')</ /;'{4>:i /ir;;::,c!!: ,let ,,'
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DATE INSPECTION REQUESTED'
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TIME INSPECTION REQUESTED'
'",' ,:".,::"q
'/' < ;11', PERMIT NO'
TYPE OF INSPECTION REQUESTED: 0 CONFERENCE
BUILDING: 0 FOOTING 0 DECK FOOTING 0 FRAMING 0 DRYWALL 0 FINAL 0 PARTIAL
o STATUS CHECK
COMMENTS:
UTILITIES: 0 SEWER TAP 0 SEWER 0 SEPTIC 0 WATERTAP 0 REMOTE 0 WATER SERVICE
o PARTIAL
PASSED FAILED
o 0
COMMENTS:
PASSED FAILED
o 0
ELECTRICAL: 0 ROUGH IN,:;eJ;~FINAL 0 PERMANENT SERVICE 0 TEMPORARY SERVICE 0 PRECONNECT
o PARTIAL
P5~ FAILED
~ 0
COMMENTS:
MECHANICAL:D ROUGH-IN 0 A/C 0 FURNACE 0 RADIANTHEAT 0 FINAL 0 PARTIAL
COMMENTS:
PLUMBING: 0 GROUNDWORK 0 ROUGH-IN 0 FINAL 0 WATERMETERINSTALLED 0 PARTIAL
o PRESSURE TEST
PASSED FAILED
o 0
COMMENTS:
o OCCUPANCY GRANTED 0 CONDITIONAL OCCUPANCY GRANTED
PASSED FAILED
o 0
NOTES/REMARKS'
DATE OF INSPECTION MADE: /0'" 07 TIMF,!6 ~ be)
INSPECTO .
FAXED OPPD\BURT REA
TO CONNECT SERVICE: ON BY
BUILDING INSPECTION REPORT
o CITY OF BLAIR
o WASHINGTON COUNTY
o OTHER
LOCATION OF INSPECTION'
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DATE INSPECTION REQUESTED'
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TIME INSPECTION REQUESTED'
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PERMIT
TYPE OF INSPECTION REQUESTED: 0 CONFERENCE
BUILDING: 0 FOOTING 0 DECK FOOTING 0 FRAMING 0 DRYWALc.(2j'FINAL 0 PARTIAL
;"
COMMENTS:
o STATUS CHECK
~D F~ED
. !
UTILITIES: 0 SEWER TAP 0 SEWER 0 SEPTIC 0 WATER TAP 0 REMOTE 0 WATER SERVICE
o PARTIAL
PASSED FAILED
o 0
COMMENTS:
ELECTRICAL: 0 ROUGH IN 0 FINAL 0 PERMANENT SERVICE 0 TEMPORARY SERVICE 0 PRECONNECT
o PARTIAL
PASSED FAILED
o 0
COMMENTS:
MECHANICAL:D ROUGH-IN 0 AlC 0 FURNACE 0 RADIANT HEAT ~FINAL 0 PARTIAL
COMMENTS:
PASSED FAILED
Y 0
COMMENTS:
PLUMBING: 0 GROUNDWORK 0
o PRESSURE TEST
FINAL 0 WATERMETERINSTALLED 0 PARTIAL
PASSED FAILED
~ 0
o OCCUPANCY GRANTED 0 CONDITIONAL OCCUPANCY GRANTED
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DATE OF INSPECTION MADE: I 0 - 9 .., () 9 TIME- I 0 ~ AW1
FAXED OPPD\BURT REA
TO CONNECT SERVICE: ON
BY