BP12955
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CITY OF BLAIR - MISCELLANEOUS BUILDING PERMIT" / r')qK2::
Permit # C7 t'--^-J
Date: Lj, //1-08 Approximate Completion Date: (;-30- vt>"5ite Plan Attached: L
Estimated Valuation of Project: (), 6 (/
Application for:
Permit Fee $2Ojlssuance Fee $20
Fee: $40.00
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) X'
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 onlv be allowed with the
stipulation that all exterior site work and outside finish work is completed and interior life-
safety issues have been properly address. Permit renewals are for one (1) year, with a
maximum of two (2) renewals fora 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
Additional Description of project if necessary:
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PROJECT INFORMATION:
Job Address:
J!J3tJ ~crnt JIJ< 8'c160 C{7383
3e ,:;tdt/'f .8ft 95 1/4 PeS
,
Address: c203tJ 'j(;OI'-1/ JY/ Phone#: i/;tf; -l/t!5d
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.
~/-2!-oY
Date
For Office Use Only
WHEN PROPERLY VALIDATED (BELOW) THIS IS YOUR PERMIT
Date Permit paid:--;;',;; /-{)[j Receipt #P;;J d /;& Approved by{ g hi ~
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BUILDING INSPECTION REPORT
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S"::CITY OF BLAIR
D WASHINGTON COUNTY
D OTHER
NAME OF OWNER' (
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PERMIT NO- /2 9 /5~':')
DATE INSPECTION REQUESTED' I'}.. ( Lt.. D /5 TIME INSPECTION REQUESTED'
TYPE OF INSPECTION
BUILDING: D FOOTING D DECK FOOTING D FRAMING D DRYWALL
D CONFERENCE
D PARTIAL
D STATUS CHECK
PASSED
D
COMMENTS:
UTILITIES: D SEWER TAP D SEWER D SEPTIC D WATER TAP D REMOTE D WATER SERVICE
D PARTIAL
COMMENTS:
PASSED FAILED
D D
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ELECTRICAL: D ROUGH IN D FINAL D PERMANENT SERVICE D TEMPORARY SERVICE D PRECONNECT
D PARTIAL
PASSED FAILED
o D
COMMENTS:
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MECHANICAL:D ROUGH-IN D AlC D FURNACE D RADIANTHEAT D FINAL D PARTIAL
PASSED FAILED
o D
COMMENTS:
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PLUMBING: D GROUNDWORK D ROUGH-IN D FINAL D WATER METER INSTALLED D PARTIAL
D PRESSURE TEST
PASSED FAILED
D D
COMMENTS:
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D OCCUPANCY GRANTED 0 CONDITIONAL OCCUPANCY GRANTED
NOTES/REMARKS-
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BUILDING INSPECTION REPORT
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'0" CITY OF BLAIR
D WASHINGTON COUNTY
D OTHER
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- 0;:; TIME INSPECTION REQUESTED' l+ 7'>
LOCATION OF INSPECTION'
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NAME OF OWNER' (,-./ ~1 u?)
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DATE INSPECTION REQUESTED' .. ( ",
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PERMIT NO' .I'~ I '-J..._J
TYPE OF INSPECTION
BUILDING: D FOOTING D DECK FOOTING D FRAMING D DRYWALL
D CONFERENCE
FINAL D PARTIAL
D STATUS CHECK
PASSED FAILED
D D
COMMENTS:
UTILITIES: D SEWER T~ D SEWER D SEPTIC D WATER TAP D REMOTE D WATER SERVICE
D PARTIAL
PASSED FAILED
D D
COMMENTS:
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ELECTRICAL: D ROUGH IN D FINAL D PERMANENT SERVICE D TEMPORARY SERVICE D PRECONNECT
D' PARTIAL
PASSED FAILED
D D
COMMENTS:
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MECHANICAL: D ROUGH-IN D A1C D FURNACE D RADIANT HEAT D FINAL D PARTIAL
PASSED FAILED
D D
PLUMBING: D GROUNDWORK D ROUGH-IN D FINAL D WATERMETERINSTALLED D PARTIAL
D PRESSURE TEST
PASSED FAILED
D tJ
D
COI'IDITIONAL OCCUPANCY GRANTEP
NOTESiREMARkS' ,
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BUILDING INSPECTION REPORT
~€ITY OF BLAIR
o WASHINGTON COUNTY
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NAME OF OWNER' 1__ ~ (1() (.~}1
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DATE INSPECTION REQUESTED' i v .-
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- &/ TIME INSPECTION REQUESTED'
LOCATION OF INSPECTION'
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PERMIT NO' ~"- /\.55
TYPE OF INSPECTION REQUESTED: 0 CONFERENCE 0 STATUS CHECK
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BUILDING: 0 FOOTING 0 DECK FOOTING 0 FRAMING 0 DRYWALL tsl"",YmAL 0 PARTIAL
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COMMENTS: U' lJ./t; t/ d' C~..! ./
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UTILITIES: 0 SEWER TAP 0 SEWER 0 SEPTIC 0 WATER TAP 0 REMOTE 0 WATER ERVICE
o PARTIAL
COMMENTS:
ELECTRICAL: 0 ROUGH IN 0 FINAL 0 PERMANENT SERVICE 0 TEMPORARY SERVICE 0 PRECONNECT
o PARTIAL
PASSED FAILED
o 0
Cm,1MENTS:
MECHANICAL: 0 ROUGH-IN 0 AlC 0 FURNACE 0 RADIANT HEAT 0 FINAL 0 PARTIAL
PASSED FAILED
D 0
FAILED \
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COMMENTS:
PLUMBING: 0 GROUNDWORK 0 ROUGH-IN 0 FINAL 0 WATERMETERINSTALLED 0 PARTIAL
o PRESSURE TEST
PASSED FAILED
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COMMENTS:
NOTES/REMARKS'
o OCCUPANCY GRANTED
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JZI CITY OF BLAIR D WASHINGTON COUNTY
LOCATION OF INSPECTION- {-;JU..:-5 () ;:: ;El-; ,,/ T-'
NAME OF OWNER' Ii A S(:>/,J'~'Jli c;.l
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DATE INSPECTION REQUESTED' / C?' /.:f/ t1---;; TIME INSPECTION REQUESTED' // / PERMIT NO- (--y.. I ..'::)
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TYPE OF INSPECTION REQUESTED: D CONFERENCE caiTATUS CHECK
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BUILDING: D FOOTING D DECK FOOTING D FRAMING D DRYWALL D FINAL D PARTIAL
COMMENTS: /;" /~jJL€.
D OTHER
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BUILDING INSPECTION REPORT
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CONTRACTOR'
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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:
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MECHANICAL:D ROUGH-IN D AlC D FURNACE D RADIANTHEAT D FINAL D PARTIAL
PASSED FAIL)jD
D D
PLUMBING: 0 GROUNDWORK D ROUGH,IN D FINAL 0 WATERMETERINSTALLED D PARTIAL
D PRESSURE TEST
COWvlENTS:
PASSED FAILED
D D
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D OCCuPANCY GRANTED 0 CONolifo~AEOCCUPANQY GRi\NrED
NOTESIREMARKS'
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BUILDING INSPECTION REPORT
[L(' CITY OF BLAIR D WASHINGTON COUNTY D OTHER
r LOCATION OF INSPECTION' at?.,&) pl3;~
NAME OF OWNER'~~ -::\ D ~) --t=< C) f~ CJI CONTRACTOR'
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DATE INSPECTION REQUESTED' ....J /1'r':J /0 /' TIME INSPECTION REQUESTED'
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PERMIT NO' / (':;' /~S '~~
COMMENTS:
D CONFERENCE
D DRYWALL C:(FINAL D PARTIAL
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D STATUS CHECK
PASSED FA
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TYPE OF INSPECTION REQUESTED:
BUILDING: D FOOTING D DECK FOOTING D FRAMING
UTILITIES: D SEWER TAP D SEWER D SEPTIC D WATERTAP 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:
--
:MECHANICAL:D ROUGH-IN D NC D FURNACE D RADIANT HEAT 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
NOTESIREMARKS'
INSPEC
DATE OF INSPECTION MADE:
FAXED OPPD\BURTREA
TO CONNECT SER~CE: ON
BY
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