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Blair Building Permit Detail
Permit #: 13337 Issued: 10/28/2009 Type: Patios /Driveways /Excavation & Curb Grind
Completed: 6/16/2010 Valuation: 2000
Location: 2263 Washington St
Owner: Richard Jensen (Holding a 50.00 deposit and 54.0 Permit Fee: 40
Address: 2263 Washington St Issue Fee: 25
Deposit Amt.: 50
Blair, NE 68008 Receipt M 25513
Phone: 402 426 8213
Section: Township: Range:
Subdivision: Lot: 5 Block:
Extending existing driveway by 6' and extending it to the back accessory building. Will have a concrete pad from
house to accessory building 18.5 x25. HOLDING A 50.00 DEPOSIT UNTIL 1/29/2009
Contractors
SELF General Contractor Permit # Issued
Remarks
10/29/2009 BMP Holding a 50.00 and 54.00 bond check on same check. #3840
11/6/2009
HOW
1. footings- driveway and patio -note: do not pour concrete within 3' of the property line.
11/10/2009
HOW
1. forms incomplete. complete and call for re- inspect.
11/19/2009
HOW
1.footings- driveway forms -ok
Inspections Date
By
11/5/2009
HOW
Footings Pass
11/10/2009
HOW
Framing Fail
11/19/2009
HOW
Footings Pass
6/16/2010
HOW
Final Inspection of Project Pass
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CITY OF BLAIR - MISCELLANEOUS BUILDING PERMIT
Permit #
/3337
V
Date: (a ~lB~oq Approximate Completion Date: iZ-31-D9 Site Plan Attached:
Estimated Valuation of Project: ",;J006 ,00
Application for:
/'
Permit F,~e $40 + Issuance Fee $25 +)$50 Deposit
Fee: $115.00
Egress Window (floor plan drawing reqUired)'"
Fences (plot plan required)
Gazebos (plot plan required)
Patios/Driveways/Sidewalks (new or replacement) :;;x-
Roofing/Siding/Soffit and/or Eave Repair/Gutters
Swimming Pools with Fence (plot plan required)
Window/Door Replacement (size change only)
Miscellaneous Building Permits (items not covered by one of the above)
Description:
Utility Excavation and Curb Grinding
Curb Grind
Length L> I
Utility Excavation
Length
Type: Water
Fjee: $75 plus bond
Un. Ft.; Width
; Sewer
Un. Ft
; Other
00 .
Amount of Bond Posted: 5 t/. Bond Check # ,gBL( 0
(Curb grind - $9.00 per Un. Ft.; Utility Excavation - $6.00 per Sq. Ft.)
PROJECT INFORMATION:
Job Address:
L;! ;;u,'3 (J aoA<-I/h c/J-o-z..-)
v
8100 Sil?O 7 '7
Legal Description (if applicable) $ e (:;tLb~' (l~v .AM (~'e: 5~ i /3 JJ~_5
Owner: ;Gtilt:blcL U...Jt1/lV?1 Address: \3 C?11V as c;.iot/JJ Phone#: L( 26-8 Z /3
Contractor: d'/4
//
Phone #:
Address:
Cell #:
PERMIT RENEWAL FEE:
This fee is based on the amount of the original permit fee and is charged when work is not
completed within two years and the permit expires. Renewals will onlv be allowed with the
stipulation that all exterior site work and outside finish work is completed and interior Iife-
safety issues have been properly address. Permit renewals are for one (1) year, with a
maximum of two (2) renewals for a maximum permit span of four (4) years.
Original valuation of $0-$50,000 $150.00 $
Original valuation of $50,000 - $100,000 $200.00 $
Original valuation of $100,000 - $500,000 $300.00 $
Original valuation of $500,000 or more $400.00 $
Issuance Fee:
$
25.00
Deposit:
$
50.00
Total Renewal Remit Fee = Permit Fee + Deposit + Issuance Fee $
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 not completed within two (2) years of date of issue.
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Signature of Ow' rjContractor
10- '2-);" 0 '7
Date
For Office Use Only
Date Permit Paid: /J - 28-0'7 Receipt # ,;255/3 Approved by:
CITY OF BLAIR, NEBRASKA
Phone 402-426-4191
RECEIVED OF:
ADDRESS
CITY, STATE, ZIP CODE
THANK YOU
KEEP THIS COPY FOR YOUR RECORDS.
NO
RECEIVED BY
Pounds Printing, Blair, NE 68008
".
CITY or BL1\IQ
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 BuildinQ
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.
(M ;Z~j, ~
Owner/Oc u nt
Contractor
fill(Jr-- :2 %" OC7
Date
City of Blair
G)-
EQUAI.-II0USIJIO
218 South 16th Street. Blair, Nebraska 68008 . 402-426-4191 . Fax 402,426,4195 . E-maii cityofblair@cLblair,ne,us "'''''''''
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,
c;t~99jti.QQ()r accessory building valued under $10,000.
(~ $50.00'~fundable 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.
Contractor/Owner
City of Blair
() 10 -2 '6-'.01
Date '
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J?;;],: CITY OF BLAIR D WASHINGTON COUNTY
BUILDING INSPECTION REPORT
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DATE INSPECTION REQUESTED' /
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TIME INSPECTION REQUESTED'
TYPE OF INSPECTION REQUESTED: D CONFERENCE
BUILDING: D FOOTING D DECKFOOTING::;;ErFRAMING D DRYWALL D FINAL D PARTIAL
D STATUS CHECK
COMMENTS:
UTILITIES: D SEWER TAP
D PARTIAL
PASSED FAILED
D~
WATER SERVICE
PASSED FAILED
D D
COMMENTS:
ELECTRICAL: D ROUGH IN D FINAL D PERMANENT SERVICE D TEMPORARY SERVICE D PRECONNECT
D PARTIAL
PASSED FAILED
D D
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 WATER METER INSTALLED D PARTIAL
D PRESSURE TEST
PASSED FAILED
D D
COMMENTS:
D OCCUPANCY GRANTED D CONDITIONAL OCCUPANCY GRANTED
NOTESfREMARKS'
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DATE OF INSPECTION MADE: 1/- I 0 - () j
TIME' 10 -:tfs- Awv~
FAXED OPPD\BURT REA
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D CITY OF BLAIR
BUILDING INSPECTION REPORT
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D OTHER
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PERMIT
DATE INSPECTION REQUESTED'
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TIME INSPECTION REQUESTED' '.'
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TYPE OF INSPECTION REQUESTED: D CONFERENCE
BUILDING: '\l.;2l/FOOTING D DECK FOOTING D FRAMING D DRYWALL D FINAL XPARTIAL
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UTILITIES: D SEWER TAP D SEWER D SEPTIC D WATER TAP D REMOTE D WATER SERVICE
D PARTIAL
D STATUS CHECK
~D F~ED
COMMENTS:
ELECTRICAL: D ROUGH IN D FINAL D PERMANENT SERVICE D TEMPORARY SERVICE D PRECONNECT
D PARTIAL
PASSED FAILED
D D
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:
PASSED FAILED
D D
D OCCUPANCY GRANTED D CONDITIONAL OCCUPANCY GRANTED
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DATE OF INSPECTION MADE:
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FAXED OPPD\BURT REA
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DATE INSPECTION REQUESTED'
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TIME INSPECTIO~ REQ~~STED'""" J 1 .i. :~.' I",," ;~RMIT NO- " .-:;",)'.) l
NAME OF
TYPE OF INSPECTION REQUESTED: 0 CONFERENCE
BUILDING: 0 0 DECK FOOTING 0 FRAMING 0 DRYWALL 0 FINAL 0 PARTIAL
o STATUS CHECK
~ED F3'ED
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 ArC 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:
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LOCATION OF INSPECTION
NAME OF OWNER
DATE INSPECTION REQUESTE "` F� TIME
CONTRACTO
INSPECTION REQUESTED PERMIT
TYP OF INSPECTION R EQUESTED: ❑ CONFERENCE ❑ STATUS CH
BUILDING: ❑ FOOTING ❑ DECK FOOTING ❑ FRAMING ❑ DRYWALL ❑=-FINAL ❑ PARTIAL PASSED FAILED
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COMMENTS: f k -,,� c, A.0 J �Lr_[ c /e� le-ty El
UTILITIES: ❑ SEWER TAP ❑ SEWER
❑ PARTIAL
COMMENTS:
SEPTIC ❑ WATER TAP ❑ REMOTE ❑ WATER SERVICE PASSED FAILED
❑ ❑
ELECTRICAL: ❑
ROUGH M ❑ FINAL ❑ PERMANENT SERVICE ❑ TEMPORARY SERVICE ❑ PRECONNECT
PASSED
FAILED
❑
PARTIAL
❑
❑
COMMENTS
MECHANICAL: ❑
ROUGH -IN ❑ A/C ❑ FURNACE ❑ RADIANT HEAT ❑ FINAL PARTIAL
PASSED
FAILED
❑
❑
COMM ENTS:
PLUMBING: ❑
GROUNDWORK F1 ROUGH -IN ❑ FINAL ❑ WATER METER INSTALLED ❑ PARTIAL
PASSED
FAILED
❑
PRESSURE TEST
❑
❑
COMMENTS:
❑ OCCUPANCY GRANTED ❑ CONDITIONAL OCCUPANCY GRANTED
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INSPECTO ! '/t/� DATE OF INSPECTION MADE: s d TIM
FAXED OPPD\BURT REA TO CONNECT SERVICE: ON BY