BP12983INTERE'D MAY
CITY OF BLAIR — MISCELLANEOUS BUILDING PERMIT
Permit #�
� Promise o �� i
Dat�:`'I� �b Approximate Completion Date:' Site Plan Attached: V/
Estimated Valuation of Project: ]?
Application for: Permit Fee $20/Issuance 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)
Decks/Handicap Ramps (plot plan required)
Satellite Dishes/Radio Antenna/Cell Towers (plot pian required)
Gazebos (plot plan required)
Miscellaneous Building Permits (items npt coveredbyone of the above)
Other X -%r k — e," d t 'f
Patios/Driveway Permits/Utility Excavation and Curb Grinding Fee $35
Curb Grind
Length
Utility Excavation
Length Lin. Ft.; Width Lin. Ft
Type: Water ; Sewer ; Other
Amount of Bond Posted: Bond Check #
(Curb grind - $9.00 per Lin. 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 life -
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
Total Renewal Remit Fee = Permit Fee/Issuance Fee $
ddition I Description of project if necessary: e�11
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PROJECT INFORMATION:
Job Address: (t,92;77 a14-% °+ A c�60 Mo 1
Legal Description (if applicable) 0 S191,
Owner: A�� C Address:-- Phone#:
Contractor: l Phone #:
Address:
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.
Signature of Owner/Contractor Date
For Office Use Only WHEN PROPERLY VALIDATED (BELOW) THIS IS YOUR
Date Permit Paid: �e O Receipt #
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BUILDING INSPECTIONREPORT
e<CITY OF BLAIR ❑ WASHINGTON COUNTY -. ❑ OTHER
,rte
LOCATION OF INSPECTION t' �f �! l f!M t J
( �'%c ' fisc �t
NAME OF OWNER 4 .�"�"- f'i �Jl ,� ��� � �1 •�._ 1 �,
CONTRACTOR • �
DATE INSPECTION RE UESTED i `' Ft=' sa %' / ,fes � �
Q TIME INSPECTION REQUESTED- PERMrr NO• f ,x` � +. 1
TYPE OF INSPECTION REQUESTED: ❑ CONFERENCE 'STATUS CHECK
BUILDING:
COMMENTS
UTILITIES:
❑ FOOTING ❑ DECK FOOTING ❑ FRAMING ❑ DRYWALL ❑ FINAL ❑ PARTIAL
❑ SEWER TAP ❑ SEWER ❑ SEPTIC ❑ WATER TAP ❑ REMOTE ❑ WATER SERVICE P
❑ PARTIAL
u
D 4,AILEI
COMMENTS:
ELECTRICAL: ❑
ROUGH IN ❑ FINAL ❑ PERMANENT SERVICE ❑ TEMPORARY SERVICE ❑ PRECONNECT
PASSED = FAILED
❑
PARTIAL
El
Fl
COMMENTS:
MECHANICAL: ❑
ROUGH -IN El A/C El FURNACE -1 RADIANTHEAT El FINAL ❑ PARTIAL
PASSED'
-FAILED
❑
-11
COMMENTS:
PLUMBING: ❑
GROUNDWORK ❑ ROUGH -IN ❑ FINAL ❑ WATER METER INSTALLED ❑ PARTIAL
PASSED
FAILED
F71
PRESSURF. TF.RT
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BUILDING INSPECTION REPORT
CITY OFBLAIR ❑ WASHINGTON COUNTY ❑ OTHER
LOCATION OF INSPECTION
NAME OF OWNER•/ �`/�./2/1- '/- ``�, -pct_ `�=- CONTRACTOR-
f �
DATE INSPECTION REQUESTED �c�f j TIME INSPECTION REQUESTED- i PERMIT NQ
TYPE OF INSPECTION REQUESTED:
❑ CONFERENCE
ATUSCHECK
BUILDING:
❑
FOOTING ❑ DECK FOOTING ❑
FRAMING ❑ DRYWALL 0 FINAL ❑ PARTIAL
PASSED
FAILED
COMMENTS:
l f
!.L /
❑
y�
UTILITIES:
❑
SEWER TAP ❑ SEWER ❑ SEPTIC
❑ WATER TAP ❑ REMOTE ❑ WATER SERVICE
PASSED
FAILED
❑
PARTIAL `
❑
❑
COMMENTS:
ELECTRICAL:
❑
ROUGH IN ❑ FINAL ❑ PERMANENT SERVICE ❑ TEMPORARY SERVICE ❑ PRECONNECT
PASSED
FAILED
❑
PARTIAL
❑
❑
COMMENTS:
MECHANICAL: ❑
ROUGH -IN ❑ A/C ❑ FURNACE
❑ RADIANT HEAT ❑ FINAL ❑ PARTIAL
PASSED FAILED
❑
❑
COMMENTS:
PLUMBING.'.
❑
GROUNDWORK ❑ ROUGH -IN ❑
FINAL ❑ WATER METER INSTALLED ❑ PARTIAL
PASSED
i
FAILED
El
PRESSURE TEST
❑
❑
COMMENTS::
❑ OCCUPANCY GRANTED ❑ CONDITIONAL OCCUPANCY GRANTED .
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CITY OF BLAIR ❑ WASHINGTON COUNTY ❑ OTHER
LOCATION OF INSPECTION: O .
NAME OF OWNER• " /� /r CONTRACTOR
DATE INSPECTION REQUESTED- TIME INSPECTION REQUESTED* PERMIT N0�s �•' W >
TYPE OF INSPECTION REQUESTED:
❑ CONFERENCE
j2rSTATUS CHECK
BUILDING: ❑
FOOTING ❑ DECK FOOTING ❑
FRAMING ❑ DRYWALL ❑ FINAL ❑ PARTIAL
PASSED
FAILED
❑
❑
COMMENTS:
UTILITIES: ❑
SEWER TAP ❑ SEWER ❑ SEPTIC ❑ WATER TAP ❑ REMOTE ❑ WATER SERVICE
PASSED
FAILED
❑
PARTIAL
❑
❑
COMMENTS:
ELECTRICAL: ❑
ROUGH IN ❑ FINAL ❑ PERMANENT SERVICE ❑ TEMPORARY SERVICE ❑ PRECONNECT
PASSED
FAILED
❑
PARTIAL
❑
❑
COMMENTS:
MECHANICAL: ❑
ROUGH -IN ❑ A/C ❑ 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
DATE OF INSPECTION
FAXED OPPD\BURT REA TO CONNECT SERVICE:
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011'20090315 PM_ .,,.
BUILDING INSPECTION REPORT
CITY OF BLAIR
❑ WASHINGTON COUNTY ❑ OTHER
LOCATION OF INSPECTION -
NAME OFOVY'NER-
_
22 64
CONTRACTOR -
DATE INSPECTION REQUESTED// TIME INSPECTION REQUESTED- PERMIT
NO
TYPE OF INSPECTION REQUESTED: [:1 CONFERENCE
El STATUS CHECK
BUILDING: F -I
FOOTING F -I DECK FOOTING ❑ FRAMING El DRYWALLb4;j4INAL ❑ PARTIAL
PASSED
FAILED
COMMENTS:
UTILITIES: F-1
SEWER TAP D SEWER El SEPTIC R WATER TAP F -I REMOTE R WATER SERVICE
PASSED
FAILED
F]
PARTIAL
1-1
❑
COMMENTS:
ELECTRICAL: F]
ROUGH IN [_1 FINAL F-1 PERMANENT SERVICE F-1 TEMPORARY SERVICE R PRECONNECT
PASSED
FAILED
D
PARTIAL
1-1
❑
COMMENTS:
MECHANICAL: F1
ROUGH -IN El A/C El FURNACE F1 RADIANT HEAT F1 FINAL El PARTIAL
PASSED
FAILED
F -I
F -I
COMMENTS:
PLUMBING: F]
GROUNDWORK R ROUGH -IN El FINAL El WATER METER INSTALLED El PARTIAL
PASSED
FAILED
F-1
PRESSURE TEST
1:1
El
COMMENTS:
F -I OCCUPANCY GRANTED R CONDITIONAL OCCUPANCY GRANTED
INSPECTOR- DATE OF INSPECTION MADE:
3 o T
FAXED OPPD\BURT REA TO CONNECT SERVICE: ON B
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BUILDING INSPECTION REPORT
CJOF OF -1 OTHER WASHINGTON COUNTY F
LOCATION OF INSPECTION -
NAME OF OWNER; -'Y-6/�
-
CONTRACTORzI
mf
DATE INSPECTION REQUESTED
f
_---1,-,'_,-�e 6,,/ 614FIME INSPECTION REQUESTED- PERMIT NO.
TYPE OF INSPECTION REQUESTED: 0 CONFERENCE
F -I STATUS CHECK
BUILDING: F-1
FOOTING F -I DECK FOOTING [:] FRAMING El DRYWALL --!Q,----T4NAL [:1 PARTIAL
PASSED
FAILED
COMMENTS:
ro L A-1 ;N;
❑
UTILITIES: F -I
SEWER TAP F] SEWER F1 SEPTIC F] WATER TAP F -I REMOTE F1 WATER SERVICE
PASSED
FAILED
0
PARTIAL
El
F]
COMMENTS:
ELECTRICAL: F -I
ROUGH IN ❑ FINAL F -I PERMANENT SERVICE F -I TEMPORARY SERVICE F1 PRECONNECT
PASSED
FAILED
El
PARTIAL
El
F1
COMMENTS:
MECHANICAL: n
ROUGH -IN F -I A/C F] FURNACE F1 RADIANT HEAT El FINAL F1 PARTIAL
PASSED
FAILED
El
El
COMMENTS:
PLUMBING: F -I
GROUNDWORK F-1 ROUGH -IN n FINAL El WATER METER INSTALLED El PARTIAL
PASSED
FAILED
0
PRESSURE TEST
El
El
COMMENTS:
n OCCUPANCY GRANTED El CONDITIONAL OCCUPANCY GRANTED
INSPECTOR- DATE OF INSPECTION MADE: G 6 TIME-��
FAXED OPPMBURT REA TO CONNECT SERVICE: ON BY
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CITY OF BLAIR El WASHINGTON COUNTY ❑
LOCATION OF INSPECTION -
NAME OF OWNER-
/Z 6 .6,) k" c 'v/ C CONTRACTOR -
DATE INSPECTION REQUEST TIME INSPECTION REQUESTED- PERMIT NO- x 9
TYPE OF INSPECTION REQUESTED- EICONFERENCE
El STATUS CHECK
BUILDING: F-1
FOOTING E:l DECK FOOTING 'S.,"FRAMING 1-1 DRYWALL El FINAL El PARTIAL
PASSED
FAILED
❑
COMMENTS:
4
UTILITIES: [_1
SEWER TAP [-I SEWER El SEPTIC F] WATER TAP El REMOTE [:1 WATER SERVICE
PASSED
FAILED
F -I
PARTIAL
0
El
COMMENTS:
ELECTRICAL: F]
ROUGH IN ❑ FINAL F] PERMANENT SERVICE F -I TEMPORARY SERVICE El PRECONNECT
PASSED
FAILED
F -I
PARTIAL
1:1
El
COMMENTS:
MECHANICAL: F]
ROUGH -IN F -I A/C F -I FURNACE El RADIANT HEAT F1 FINAL [:1 PARTIAL
PASSED
FAILED
1-1
E]
COMMENTS:
PLUMBING: F -I
GROUNDWORK F ROUGH -IN F] FINAL El WATER METER INSTALLED El PARTIAL
PASSED
FAILED
F1
PRESSURE TEST
El
El
COMMENTS:
F-1 OCCUPANCY GRANTED F -I CONDITIONAL OCCUPANCY GRANTED
NOTES/REMARKSt -
4
INSPECTOR- DATE OF INSPECTION MADE- TIME' (,5 IA,
FAXED OPPD\BURT REA TO CONNECT SERVICE: