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CITY OF BLAIR - MISCELLANEOUS BUILDING PERMIT, ,/j 11 -:::; --J
Permit# / / 'to ~
Date: If ,- :;J~"'... tJ EAPproximate Completion Date: f3 "$l.t) 13 Site Plan Attached:
Estimated Valuation of Project: ;;!tN) (), 00
Sign Erecting, Awnings (Per Sign)
Roofing/Siding/Soffit and/or Eave Repair/Gutters
Window/Door Replacement (Size Change Only)
Egress Window (floor plan drawing required)
Swimming Pools with Fence (plot plan required)
Fences (plot plan required)
Decks/Handicap Ramps (plot plan required) Y
Satellite Dishes/Radio Antenna/Cell Towers (plot plan required)
Gazebos (plot plan required)
Miscellaneous Building Permits (items not covered by one of the above)
Other
Application for:
Permit Fee $20/lssuance Fee $20
Patios/Driveway Permits/Utility Excavation and Curb Grinding Fee $35
Curb Grind
Length
Utility Excavation
Length Un. Ft.; Width
Type: Water ; Sewer ; Other
Fee: $40.00
Un. Ft
Amount of Bond Posted: Bond Check #
(Curb grind - $9.00 per Un. Ft.; Utility Excavation - $6.00 per Sq. Ft.)
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 permit fee of $0-$50,000 $100.00 $
Original permit fee of $50,000 - $100,000 $150.00 $
Original permit fee of $100,000 - $500,000 $250.00 $
Original permit fee of $500,000 or more $400.00 $
Issuance Fee:
Total Renewal Remit Fee = Permit Fee/Issuance Fee
$ 20.00
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$ ':[!!' {Jor .
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cfye,t 0:4 cP c#d
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PROJECT INFORMATION:
Job Address:
II /7 tI j? tU1J /:;j; JUclfl
Address: <J1tU1L,P t/!d ohcn/-f Phone#: L/~;!d? ~gt/;;J8
Phone #:
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 not completed within two (2) years of date of issue.
Y~dj-oF
Date
For Office Use Only
WHEN PROPERLY VALIDATED (BELOW) THIS IS YOUR PERMIT
< . af3 ?;f <"") (1)
Date Permit Paid: L/,~ ;J3 Receipt # SJ P ;JtJ/i.pproved by: d. jr vI;- ~~
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~TY OF BLAIR
BUILDING INSRECl'ION\REPORT
LOCATION OF INSPECTION'
D OTHER
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CONTRACTOR' ~. .1
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TIME INSPECTION REQUESTED' A j-
PERMIT NO'
/ ;;Y.3;?
TYPE OF INSPECTION REQUESTED: 0 CONFERENCE
BUILDING: 0 FOOTING 0 DECK FOOTING 0 FRAMING 0 DRYWALL 0 FINAL 0 PARTIAL
ATUSCHECK
COMMENTS:
PASSED FAILED
o 0
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UTILITIES: 0 SEWER TAP 0 SEWER 0 SEPTIC 0 WATER TAP 0 REMOTE 0 WATER SERVICE
o PARTIAL
PASSED FAILED
o 0
COMMENTS:
----w-T- -,,~a'.::z.~'T~ ~
ELECTRICAL: D ROUGH IN 0 FINAL 0 PERMANENT SERVICE 0 TEMPORARY SERVICE 0 PRECONNECT
o PARTIAL
COMMENTS:
PASSED FAILED
o 0
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MECHANICAL:D ROUGH-IN 0 AlC 0 FURNACE 0 RADIANTHEAT 0 FINAL 0 PARTIAL
COMMENTS:
PLUMBING: 0 GROUNDWORK D ROUGH-IN D FINAL 0 WATERMETERINSTALLED 0 PARTIAL
o PRESSURE TEST
PASSED FAILED
OJ 0
PASSED FAILED
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OCCUPANCY GRANTED 0 CONDITIONAL OCCUPANCY GRANTED
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NOTESIREMARKS'
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BUILDING INSPECTION'REPORT '
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,~~CITY OF BLAIR
D WASHINGTON COUNTY
LOCATION OF INSPECTION'
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NAME OF OWNE~>f~t.'i.A,1,A } 1'7 (i I '-{J>n
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DATE INSPECTION REQUESTED' d - 8- () "~I
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D OTHER
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CONTRACTOR'
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TIME INSPECTION REQUESTED' /'7 I
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PERMIT NO' 0-1 "r::~,) dPi
,!~EOFINSPECTI~NREQUESTED: ~~_ ~._~~~~~_~E~~~E~!!!~_
BUILDING: D FOOTING D DECK FOOTING D FRAMING D DRYWALL D FINAL D PARTIAL PASSED FAILED
COMMENTS: i)j(!i----, D D
UTILITIES: D SEWERTAf D SEWER D SEPTIC D WATERTAP 0 REMOTE D WATER SERVICE
D PARTIAL'
PASSED FAILED
D D
k""'~~~__~""""""",~"""",,,,_
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ELECTRICAL: D ROUGH IN D FINAL D PERMANENT SERVICE
D PARTIAL
TEMPORARY SERVICE D PRECONNECT
PASSED FAILED
D D
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COMMENTS: '
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MECHANICAL:D ROUGH.IN 0 AlC D FURNACE D RADIANTHEAT D FINAL D PARTIAL
PASSED FAILED
D D'
COMMENTS: "
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PLUMBING:;, 'D GROUNDWORK D ROUGH-IN D FINAL WWATERMETERINSTA,LLED D PARTIAL
D PRESSURE TEST
COMMENTS:,' , . ". " . .' ,'. " ,c, ,.,..'.
tl occ~~~ti;T~~~cc~&d[ARtiK;~--~
PASSED FAILED .
D D
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NOTESIREMARKS' .
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BUILDING INSPECTION REPORT
rz(~ITY OF BLAIR
D WASHINGTON COUNTY D OTHER
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LOCATION OF INSPECTION' //~./ '7'- /~ /1//:7 /5/ ~ if., /.:I)(~::~t: ...,/ .' r::::....
NAME OF OWNER:=4:se:e(;/ ./-1.jl?~:Zt:It/' CONTRACTOR'
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DATE INSPECTION REQUESTED' <,_.:1/~:3 /{) c;? TIME INSPECTION REQUESTED' ;1 T'--
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TYPE OF INSPECTION REQUESTED: D CONFERENCE
.
BUILDING: D FOOTING D DECK FOOTING D FRAMING D DRYWALL D FINAL D PARTIAL
/_P7,//'7..F<
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PERMIT NO' / .;7) "'7~ .,. (...~"
. '^...~ "''-J>
IZr-S;ATUS CHECK
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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
D PARTIAL
PASSED FAILED
D D
COMMENTS:
~~
Ill! - """""""':am:!. ,."
MECHANICAL:D ROUGH-IN D AlC D FURNACE D RADIANTHEAT D FINAL D PARTIAL
PASSED FAILED
D D
COMMENTS:
PLUMBING:
--------~~"P""""""""""~"""...".,.
COMMENTS:
D GROUNDWORK D ROUGH-IN D FINAL D WATER METER INSTALLED D PARTIAL
D PRESSURE TEST
PASSED FAILED
D D
-........_.....,.,-~
D OCCUPANCY GRANTED D CONDITIONAL OCCUPANCY GRANTED
NOTESIREMARKS'
DATE OF INSPECTION MADE:
TIMK' /~.13 j
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FAXED OPPD\BURT REA
TO CONNECT SERVICE: ON
BY
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