BP12960
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CITY OF BLAIR - APPLICATION FOR BUILDING PERMIT
Permit # i l.. q&U
Date: L} 12-31 8<i'S, Approximate Completion Date: i-2.. ~i J o~
Site Plan Attached:
REScheck Attached:
Complete Plans Attached
Application for: ResidentialX Commercial/Industrial
New Construction Manufactured Home Modular
Move-on: Home Accessory Building Other
Remodel L - Addition
Accessory Bui lCIi rig: Garage ~ Pole Barn_ Other
Floor Type: Dirt Concrete Electricity: Yes _ No
Other
Utilities: Public Water: Yes_ No Private Well
If yes, responsible entity: Blair OPPD Line Kennard
Agreement-need~d: _ 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 _
A<fd;tional Descqption .Of project 'f necessarx.:bc~ rh.CLi\J- Re\rl....... ckJ . updaleol
Old 6D cd t beCLIn W W{-' LaC(" O\US cV d ~ d eclY'<:S,S
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Proiect Information:
Job Address:
\~53
b (c3X\.* 04-
Pc cdt- L/
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Legal Description (if applicable)
Owner: ~blf(~OvY\ lq nl~
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Contractor: t\\Y\L\\ l~<O-\\'\lL\lO'1
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Address:
f3 roo 1.f5:51<;;/
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2rcl)'l'l.\!- Phone#~?itJ -lS3(5
Address:
Phone #:
Cell #: >< ~ -J5acf
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 shail not be commenced until) have received a copy of a permit signed by the Building
Inspector. ) 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. ) understand that this permit is void if work is not commenced within
180 da or is not completed within two (2) years of date of issue.
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ZONING REVIEW:
ZonimVFlood Plain/Utilities:
Current Zoning: fl'riL---- Conditional Use Permit Required: Yes _ No_
Date CUP Approved:
State Fire Marshal Required: Yes No Variance Required: Yes _ No_
Minimum Setbacks: Front.;;1JJ.. Second Front Side 17 Side _ Rear.....4;)
lot SQuare Footage:
length x Width:
lot Coverage %
~DrivewavsLSjdftWalks:____....
Sidewalk required: Yes_ No-A-
NoXU
Sidewalk Waiver: Yes
Date Waiver Approved:
Flood Plain: Yes__ No
If yes, specify special requirements:
N/~
BUilDING INSPECTOR REVIEW:
Number of Stories
One Two
Th ree
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
SQuare Footage:
Main level:
Basement: (Unfinished)
Garage:
Detached Garage:
Addition:
Porch: Front
Deck that affect setbacks:
Second level: Third level
(Finished)
2 bay_ 3 bay_ 4 bay_ 5+ bay
Pole Barn:
Remodel:
Side
Front Side
Rear
Rear
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, IibrClries, museums_
Business Educational Factory and industrial, moderate hazard _
Factory and industrial, low hazard _ High Hazard, explosives_
High Hazard HPM Institutional, supervised environment _
Institutional, incapacitated _ Institutional, restrained _
Institutional, day care facilities _ Mercantile Residential, hotels _
Residential, multiple family _ Residential, one- and two-family
Residential, care/assisted living facilities
Storage, moderate hazard _ Storage, low hazard _ Utility, miscellaneous_
Is buildinli! reauired to be protected bv automatic fire sprinkler svstem?"
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: (percentage) (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:
RESIDENTIAL - NEW CONSTRUCTION:
Buildinli! Permit Deposit Fee:
Residential additions/remodels/accessory buildings valued under $10,000 $
Fee = $200.00
Commercial, new homes and residential
additions/remodels/accessory buildings valued $10,000 or greater $
Fee - $500.00
All other permits valued under $10,000 No Deposit Fee
Permit fee is:
Finished sqjft area
(not including finished basement area)
Finished basement sqjft area
Unfinished basement sqjft area
Garage sqjft area
Total Valuation:
X $88
X $53
X$26
X$20
$
$
$
$
$
$
$
$
Total Valuation
Multiplied by 0.0056 =
Issuance Fee:
20.00
Total Permit Fee = DepositjPermit Fee/Issuance Fee
RESIDENTIAL - ADDITIONS / REMODELS and
COMMERCIAL - NEW CONSTRUCTION / ADDITIONS / REMODELS:
Business/I ndustrialjEd ucational/ Assembly/Factory/Storage/Utility
*Porches with roofs/screened patios are considered additions
Building Permit Deposit Fee:
Residential additions/remodels/accessory buildings valued under $10,000 $
Fee = $200.00
Commercial, new homes and residential
additions/remodels/accessory buildings valued $10,000 or greater $ nOD. cO
Fee - $500.00
All other permits valued under $10,000 No Deposit Fee
Construction Valuation will be computed by Sq/ft area X $60
Accessory Buildings & Interior Remodeling Proiects will be computed by Sq/ft
area X $40
Permit fee is:
Finished sqjft area
Finished sqjft area
3'17
X $60
X $40
$
$ 15 I B80
$0 TO $49.............................................................................................. $0 (plus Permit Issuance Fee)
$50 TO $9,999............................................................................................$50
$10,000 TO $99,999............................................................................................$50 + $6 per additional $1,000
$100,000 TO $249,999......................................................................................... $590 + $4 per additional $1,000
$250,000 TO $499,999............,..........................................................................$1,190 + $3 per additional $1,000
$500,000 TO $999,999......................................................................................$1,940 + $2 per additional $1,000
$1,000,000 AND OVER ...................................................................................... $2,940 + $1 per additional $1,000
Permit Fee calculated from chart above
$
BO.OO
of)
20.00 ::: I fJlP'
~ 00 . 00
Issuance Fee:
$
$
Total Permit Fee = Deposit/Permit Fee/Issuance Fee
Approved bY>-/)c2~~~bate: fL?~
Contingent On Approval by Fire Marshall
Meet IBC, IPC, IMC and NEC Code Requirements X
Sleeping Rooms below Story and in Basement required to have egress ~
For Office Use Only
Date Permit Paid:
Permit Fee:
Deposit Amount
Receipt #
Deposit Paid by for return to:
Building Inspection Pouch given: Yes _ No
ELECTRICAL PERMIT APPLICATION
Jurisdiction of City of Blair, Nebraska
218 South 16th Street
Blair, Nebraska 68008
Fax (402) 426-4195
(402) 426-4191
Application Date: Lj /23 t o<;s
Job Address
E 2882
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Permit Fee: $
1<6'-- (tULf&
Mail Address
S(YfrY!e-.
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3. Class of Work:
Describe 'X ~rl~\ ,
4. \AL\.~\
5.Current License on File 0 Yes
Mail Address
6R-\- ~b.J- LA c
o No 0
Service Fee = (Amp Fee + 2.00 per branch circuit)
1-100 Amp Fee.......................$13.00
101-200 Amp Fee.......................$18.00
201-300 Amp Fee...... ...... ...... .. ...$30.00
301-400 Amp Fee......... ... ...... .....$42.00
401-500 Amp Fee...... ... ... ...... .....$55.00
501-600 Amp Fee...... ... ... ...... .. ...$67.00
601-700 Amp Fee... ...... ............ ..$80.00
701-800 Amp Fee...... ............ .. ...$92.00
801-900 Amp Fee.................... .$105.00
901-1000 Amp..................... ...$117.00
IF OVER 1000 Amp
1st 1000 Amp Fee..................$117.00
Each additional 100 Amps.........$13.00
Notice
I hereby celiify that I have read and examined this
application and know the same to be true and correct. All
provisions ofIaws and ordinances governing this type of
work will be complied with whether specified herein or
not. The granting of a permit does not presume to give
authority to violate or cancel the provisions of any other
state or local law regulating construction or the
performance of construction.
4 ?L--
Zip
t8&1~~$
Phone
Zip
REMODELING/ADDITIONS 0 UPGRADE SERVICE
Completion Date
ELECTRICAL PERMIT FEES
Upgrade Existing Service............ .$10.00
Temporary Service.................... $10.00
Fire Alarm System................. ....$10.00
Signs. .. . . . . . . . . . . . . . . . .. . . .. . . . .. . . . .. .... $15.00
Miscellaneous Apparatus......... .....$11.00
AC/DC Circuit... .................... ....$5.00
Commercial/Multi Family and All Upgrades:
# of Circuits x $2.00
Amp Fee
Amp Fee + Circuit Total
New Residential: (Finished Area)
Single/Two Family Dwellings
sq.ft.x.045
Modular/Manufactured Homes... ...$50.00
Receptacle/Switch Outlets '1
Fixtq:res \ ~ x $.75
Smoke Detectors x $3.00
Residential/Commercial Appliance
# Fixed Outlets x $3.00
Motor(s) x $3.00
Power Apparatus (220 V oIts)
# Apparatus x $5.00
0/00
Permit Issuance Fee.................. ..$20.00
01 0 lJO
~W
Total
Comment:
WHEN PROPERL Y VALIDATED (IN THIS SPACE) THIS IS YOUR PERMIT
I Approved By: K \ {\\J & Ub:
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, -Elair,,_ NE 68008
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, . , BUILDING INSPECTION REPORT .
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[LJ/CITY OF BLAIR
D WASHINGTON COUNTY., D OTHER
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LOCATION OF INSPECTION' I O'~:?.) '.0 V arc- ,S'r
NAME OF OWNER' "J DY d.ent L LI n U/\ CONTRACTOR,-:?;:f t P
DATE INSPECfION REQUESlED- r-i~- (l) 3 TIME INSPECTION REQUESTED- \0', mJl,M PERMIT NO- f 'LX j( z...
TYPE OF INSPECTION REQUESTED: D CONFERE~TATUS CHECK
~~;G:- ~D-;~~;;G D DECK FOOTING ~RAMING D DRYWA~;;AL D P~Z ~. --;~~.~~~:;
COMMENTS: Y U
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UTILITIES:
D SEWER TAP D SEWER D SEPTIC D WATER TAP D REMOTE D WATER SERVICE
D_p ARTIAL . _____ _ ____ .
PASSED FAILED
D D
COMMENTS:
ELJWTRICAL!' ROUGH IN ,~~INAL D PERMANENT SERVICE D
D PARTIAL (
SERWCE Q,:lRECONNECT
COMMENTS:
MECHANICAL:D ROUGH-IN D A/C D FURNACE D RADIANTHEAT D FINAL D PARTIAL
PASSED FAILED
D D
PLUMBING: D GROUNDWORK D ROUGH-IN 0 FINAL D WATERMETERINSTALLED D PARTIAL
D PRESSURE TEST
FAILED
D
" OC~:{JPANCY GRANTED D CONDITIONAL OCCUPANCY GRANTED _ _ ,./ __ ;_, _ '
NQl'ESIREMARKS 5v'nt'J;::;e: ifm-~J Jill ~1{1(!-lt- filUA (t;
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LOCATION OF INSPECTION'
NAME OF OWNER' citY! j am c..~11 ell
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DATE INSPECTION REQUESTED'C':-- I
"'Bifi]jbING'INi~PEeiU~~REp:ORT~~'~====-=C=-='~'
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D W ASHINGTON COUNTY~,~~~iIffiR
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~::: CITY OF BLAIR
CONTRACTOR' c.-;;r;'n e.h (!cI)7c.J1IALJ cd:t ~~
TIME INSPECTION REQUESTED'
PERMIT NO' /,;? i tfl 0
TYPE OF INSPECTION REQUESTED: D CONFERENCE '~STATUS CHECK
- ......,.....;; _.<l.&.- .~..,...,...._.- ~
BUILDING: D FOOTING ~'7JDECKFO,OT~G D F~~ D DR~~ALL ~ FINAL D PART~L , P~ED F~
COMMENTS: ~C2~'J0~7 C A~!::'!!d!~ .-- tJ..J~d-~~~:..!::!:!:::.:. q~~_-=- ~
UTILITIES: D SEWERTAP D SEWER D SEPTIC D WATERTA.P D REMOTE D WATERSERVICE
D PARTIAL
PASSED FAILED
D D
COMMENTS:
ELECTRICAL: D ROUGH IN D FINAL D PERMANENT SERVICE D TEMPORARY SERVICE D PRECONNEGT"
D PARTIAL
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COMMENTS:
MECHANICAL:D ROUGH-lN D AlC D FURNACE D RADIANTHEAT D FINAL
PASSED FAILED
D D
PARTIAL
PASSED FAILED
D D
COMMENTS:,
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PLUMBING:D GROUNDWORK D ROUGH-IN D FINAL D WATERMETERINSTALLED D PARTIAL '_,
, " D PRESSURE TEST
, COMMENTS:".,
PASSED ,FAILED
D CT.
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D OCCUP~C~GRANrED 0 CO~tfIONALOCClJPANCYGR.ANt]!;P.
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