BP12835
CITY OF BLAIR - MISCELLANEOUS BUILDING PERMIT
Permit # 1;11355'
Date: q../ /J "" () 1 Approximate Completion Date: q J ;21 ~ tJ 1 Site Plan Attached:
.
Aoplication for:
Permit Fee $20jlssuance Fee $20
Fee: $40.00
Sign Erecting, Awnings (Per Sign)
Roofing/Siding/Soffit and/or Eave Repair/Gutters Y
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)
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
Patios/Driveway Permits/Utility Excavation and Curb Grinding Fee $35
Curb Grind
Length
Utility Excavation
Length Un. Ft.; Width
Type: Water ; Sewer ; Other
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 only 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:
$
20.00
'1tJ. CU)
Total Renewal Remit Fee = Permit Fee/Issuance Fee
PROJECT INFORMATION:
Job Address:
d((~13 J: 13)1~ Sf.
Legal Description (if applicable)
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Owner: /itljd./JMf ~c(!tJ:J.U Address: 0<,3, . I .
Contractor: '7?J:ti~ 2~j)
Address: I ~ If ,,51 t: / s.;- JI,h
-.S/a# bgotJt]
Phone#: L/C1~ "07tJ3 tJ ~
5cW4""
Phone #:
Cell #:
t!C21iJ -
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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.
""
<Ute
q!'7/07
, I
For Office Use Only
WHEN PROPERLY VALIDATED (BELOW) THIS IS YOUR PERMIT
Date Permit Paid: q "'11 .;" (/1 Receipt #
Approvedby: c~ ~~~
PROJECT INFORMATION:
Job Address:
d((~13 J: 13)1~ Sf.
Legal Description (if applicable)
/}</-' /1" ~,.l, I'J aJ '3'~J~
Owner: /itljd./JMf ~c(!tJ:J.U Address: 0<,3, . I .
Contractor: '7?J:ti~ 2~j)
Address: I ~ If ,,51 t: / s.;- JI,h
-.S/a# bgotJt]
Phone#: L/C1~ "07tJ3 tJ ~
5cW4""
Phone #:
Cell #:
t!C21iJ -
.~ ~3ifl/
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.
""
<Ute
q!'7/07
, I
For Office Use Only
WHEN PROPERLY VALIDATED (BELOW) THIS IS YOUR PERMIT
Date Permit Paid: q "'11 .;" (/1 Receipt #
Approvedby: c~ ~~~
BUILDING INSPECTION REPORT
CITY OF BLAIR ^ WASHINGTON COUNTY ^ OTHER
LOCATION OF INSP ECTION ~--~` ~ ~ ~ ~ ~L'~- L "
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NAME OF OWNER . ,.
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CONTRACTOR
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DATE INSPECTION PERMI
REQUESTED = t ~ - TIME INSPECTION REQUESTED ' T NO'
TYPE OF INSPECTION REQUESTED: ^ CONFERENCE ^"STATUS CHECK
BUILDING: ^ FOOTING ^ DECK FOOTING ^ FRAMING ^ DRYWALL p 'FINAL ^ PARTIAL PASSED FAILED
^ ^
COMMENTS:
UTILITIES: ^ SEWER TAP ^ SEWER ^ SEPTIC ^ WATER TAP ^ REMOTE ^ WATER SERVICE PASSED FAILED
^ PARTIAL ^ ^ 7
COMMENTS:
ELECTRICAL: ^ ROUGH IN ^ FINAL ^ PERMANENT SERVICE ^ TEMPORARY SERVICE ^ PRECONNECT PASSED FAILED
^ PARTIAL ^ ^
COMMENTS:
MECHANICAL: ^ ROUGH-IN ^ A1C ^ FURNACE ^ RADIANT HEAT ^ FINAL ^ PARTIAL PASSED FAILED
^ ^
COMMENTS:
PLUMBING: ^ GROUNDWORK ^ ROUGH-IN ^ FINAL ^ WATER METER INSTALLED ^ PARTIAL PASSED FAILED
^ PRESSURE TEST ^ ^
COMMENTS:
^ OCCUPANCY GRANTED ^ CONDITIONAL OCCUPANCY GRANTED
NOTES/REMARKS
£ ^- /" ~.
,, "
DATE OF INSPECTION MADE: TID4F~ %~~~ ' -'"~` -~'
FAXED OPPD\BURT REA TO CONNECT SERVICE: