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CITY OF BLAIR - MISCELLANEOUS BUILDING PERM If. ISl 0 l 1.0'
PermIt # ::::> c-r
Date: 7- J 8~OtApproximate Completion Date: / cP... / ~ 08 Site Plan Attached: ~
Estimated Valuation of Project: /6()() , 6 0
Application for:
Permit Fee $20jlssuance 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 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 t\ Un. Ft.; Width Un. Ft
Type: Water ; Sewer ; Other
Amount of Bond Posted: 414/; , 0 0 Bond Check # c..3 0/ W
(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 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 $
Addit,ional DescriPti~on of projecllf necessary: . S: I ad diilnv tf11 io dv tI..I-
I:;:i) Q/Y/ - . ~~ w It/- I X S I 'S'lab c;vn d 6ltft/ X' 8 / ,j~ak
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PROJECT INFORMATION: 8 q 00 5;;;; /.:5' 7
Job Address: //3 / ~ J/..i/ tV ~ -,
Legal Description (if applicable) ,7fe S/cuAtldtJ ~/:JAls" at ~ //5' pC! / 'f
Owner: !?oM t M~f" Address: 'i ~ u1'<f' tUJ a bt>t'I"Phone#: L/ ;?ir '1W 3
Conlractor: ~/ 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.
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Signature of Owner/Contractor
Date
For Office Use Only
WHEN PROPERLY VALIDATED (BELOW) THIS IS YOUR PERMIT
Date Permit Paid: '7- cJt3' -OZkeceipt # ~;;;fJ3r Approved by:
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BUILDING INSPECTION REPORT
;~cCITY OF BLAIR
D WASHINGTON COUNTY
D OXHER
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LOCATION OF INSPECTION' \ / ,::7'" \ -,/ .
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v' l_"jJ,.'" 'OF '\;J II/f .. _ f'
NAME OF OWNER' /\. t7KJ.,<>-'1 i -L..Jj::,1c..{/J?~t,I-j
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DATE INSPECTION REQUESTED' t...> .. p.,!,l:J -4--:;;
CONTRACTOR' ~--~j~~~'
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TIME INSPECTION REQUESTED' ,/c:...! /
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PERMIT NO' / ,_) f.-</ ( c__
COMMENTS:
DCONFERENCE
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DRYWALL ~::F1NAL D PARTIAL
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D SEWER TAP~ D SEWER D SEPTIC D WATER TAP D REMOTE D WATER SERVICE PASSED FAILED
D PARTIAL D D
D STATUS CHECK
TYPE OF INSPECTION REQUESTED:
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BUILDING: D FOOTING D DECK FOOTING D FRAMING D
P~SED F~D
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UTILITIES:
ELECTRICAL: D ROUGHIN D FINAL D PERMANENT SERVICE D TEMPORARY SERVICE D PRECONNECT
D PARTIAL
CO:MMENTS:
PASSED FAILED
D D
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MECHANICAL:D ROUGH-IN D NC D FURNACE D RADIANTHEAT D FINAL D PARTIAL
PASSED FAILED
D D
D gROUNDWORK D ROUGH-IN D FINAL D WATERMETERINSTALLED D PARTIAL
. ," . D PRESSURE TEST
.. COMMENTS;..~' . '
[}] .....OC6W.~~~;ED cb. CONDITIONAL OCCl]pANCY GRANTED
PASSED FAILED
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BUILDING INSPECTION REPORT
/
I2J CITY OF BLAIR 0 WASHINGTON COUNTY 0 OTHER
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LOCATIONOFINSPECTIQ]}J' /::-!x3/ /-/.I//t?(>?6/.:'cJ L);t:.::
NAME OF OWNER' dZi6l~7--- :l)i.'L/!A/l S/ CONTRACTOR'
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DATE INSPECTION REQUESTED' /01 j/ =-/ VO TIME INSPECTION REQUESTED' PERMIT NO' /:-)7:) -/-C)
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TYPE OF INSPECTION REQUESTED: 0 CONFERENCE ciSTATUS CHECK
~ lG!:lZ:::',J.$,--- ~,.~.\'lC<~~_ ~~,_~~_ >r=w_~=
BUILDING: 0 FOOTING 0 DECK FOOTING 0 FRAMING 0 DRYWALL 0 FINAL 0 PARTIAL PASSED FAILED
o 0
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COMMENTS:
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UTILITIES: 0 SEWER TAP ,0 SEWER 0 SEPTIC 0 WATER TAP 0 REMOTE 0 WATER SERVICE
D PARTIAL
COMMENTS:
PASSED FAILED'
o 0
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ELECTRICAL: 0 ROUGH IN 0 FINAL 0 PERMANENT SERVICE 0 TEMPORARY SERVICE 0 PRECONNECT
o PARTIAL
PASSED FAILED
o 0
MECHANICAL: D ROUGH-IN 0 Ale 0 FURNACE 0 RADIANT HEAT 0 FINAL 0 PARTIAL
COMMENTS:, ..
PA.SSED FAILED
o 0
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PLUMBING:;' o GROUNDWORK 0 ROUGH-IN 0 FINAL 0 WATERMETERINST{\LLED 0 PARTIAL
o PRESSURE TEST
COMMBJ':lTSf~
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NOTES/REMA.RKS'
BUILDING INSPEVTI01"J tt:l!iYUtt.l,
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o W ASHINGTo'N COUNTY
o o'THER
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TIME INSPECTIo'N REQUESTED' /17
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PERMIT No" 1..:5 tJ - ,
LOCATIo'N o'FINSPECTION'
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NAME o'F o'WNER' l!<:obM r; J..JJi.jJC1//'~b]....,
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DATE INSPECTIo'N REQUESTEDcI " ....:.i7 ~- () q
TYPE OF INSP,ECTJ9N REQUESTED: 0 CONFERENCE DSTATUS~CHECK
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BUILDING: 0 Fo'Ol'ING 0 DECKFo'o'TING 0 FRAMING 0 DRYWALL )21<FINAL 0 PARTIAL
COMMENTS:
UTILITIES:' 0 SEWER T~ 0 SEWER 0 SEPTIC 0 WATER TAP 0 REMo'TE 0 WATER SERVICE
o PARTIAL
P~EDFW
COMMENTS:
'PA:SSED FAILED
DO
ELECTRICAL: 0 Ro'UGH IN 0 FINAL 0 PERMANENT SERVICE 0 TEMPo'RARY SERVICE 0 PRECONNECT
o PARTIAL
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COMMENTS: '
MECHANICAL:D Ro'UGH-IN 0 AlC 0 FURNACE 0 RADIANTHEAT 0 FINAL 0 PARTIAL
PASSED FAILED
o 0
COMMENTS:
PASSED FAILED
o 0
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PLUMBING:. D ?R~UNDW0RK'D Ro'UGH-IN 0 FINAL 0 WATERMETERINSTALLED 0 PARTIAL
,0 -:eRESSURBTEST
-CO:r\1MENTS;:, '. ,'-~..
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BUILDING INSPECTION REPORT
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CZJ CITY OF BLAIR D WASHINGTON COUNTY D OTHER
, LOCATIONOFrNSPE~ .~-1/ ';;//.J/;~]) R
NAME OF OWNER' h16uT ~L)::::L/t(/L ~/ CONTRACTOR'
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DATE INSPECTION REQUESTED' ~-j / /~;J/O / TIME INSPECTION REQUESTED' /1 r- PERMIT NO' / ~:).(- ~,()
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TYPE OF INSPECTION REQUESTED: D CONFERENCE ca~ATUS CHECK
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BUILDING: D FOOTING D DECK FOOTING D FRAMING D DRYWALL D FINAL D PARTIAL PASSED FAILED
D D
COMMENTS:
UTILITIES: D SEWERTAP 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 RADIANTHEAT D FINAL D PARTIAL
PASSED FAILED
D D
COMMENTS:
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COMMENTS:
D GROUNDWORK D ROUGH-IN D FINAL D WATER METER INSTALLED D PARTIAL
D PRESSURE TEST
PASSED FAILED
D D
PLUMBING:
D OCCUPANCY GRANTED D CONDITIONAL OCCUPANCY GRANTED
NOTESIREMARKS'
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FAXED OPPD\BURTREA
TO CONNECT SERVICE: ON
/026
INSPECTO '
DATE OF INSPECTION MADE:
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03/18/2009 01:23 PM
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CITY OF BLi\IR
BUILDING INSPECTION REPORT
o WASHINGTON COUNTY
o OTHER
f ~,,- ,it t ff~t \l' I C vJ &_h'r.~,o
CONTRACTOR'
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NAME OF
l+d.-C - '1:1 "t 3
DATE INSPECTION REQUESTED'
";_~'~:z ~.'''.F- '
,: / I'
TIME INSPECTION REQUESTED'
TYPE OF INSPECTION REQUESTED: 0 CONFERENCE
BUILDING: 0 FOOTING 0 DECK FOOTING 0 FRAMING 0 DRYWALL C3i"FINAL 0 PARTIAL
COMMENTS:
UTILITIES: 0 SEWER TAP 0 SEWER 0 SEPTIC 0 WATERTAP 0 REMOTE 0 WATER SERVICE
o PARTIAL
COMMENTS:
ELECTRICAL: 0 ROUGH IN 0 FINAL 0 PERMANENT SERVICE 0 TEMPORARY SERVICE 0 PRECONNECT
o PARTIAL
COMMENTS:
MECHANICAL:D ROUGH-IN 0 NC 0 FURNACE 0 RADIANTHEAT 0 FINAL 0 PARTIAL
COMMENTS:
PLUMBING: 0 GROUNDWORK 0 ROUGH-IN 0 FINAL 0 WATERMETERINSTALLED 0 PARTIAL
o PRESSURE TEST
COMMENTS:
PASSED FAILED
o 0
PASSED FAILED
o 0
PASSED FAILED
o 0
PASSED FAILED
o 0
PASSED FAILED
o 0
o OCCUPANCY GRANTED 0 CONDITIONAL OCCUPANCY GRANTED
NOTES/REMARKS'
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INSPECTOR'
1/ /]';0-r-'
DATE OF INSPECTION MADE:
~;).O~o9
FAXED OPPD\BURT REA
TO CONNECT SERVICE: ON
TIMR ,+: / ) f'~/~
BY
#~
BUILDING INSPECTION REPORT
CITY OF BLAIR D WASHINGTON COUNTY D OTHER
LOCATION OF INSPECTION' t k) l (:z p.f. it \rl';~ fJ ~.
::~:P::::"~=:: /:/tc!t~~f;j TOOE INsp:o:A:~~'TE~I',~~~"
PERMIT
TYPE OF INSPECTION REQUESTED: D CONFERENCE D STATUS CHECK
BUILDING: D FOOTING D DECK FOOTING D FRAMING D DRYWALL FINAL D PARTIAL PASSED FAILED
~~~~q~~-~~~~~~~"u_~,d,!~~~_~k~~_Z_~"_~~~~_'5;';~~
UTILITIES: D SEWER TAP D SEWER D SEPTIC D WATERTAp D REMOTE D WATER SERVICE PASSED FAILED
DU~& 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 AlC D FURNACE D RADIANTHEAT D FINAL D PARTIAL
PASSED FAILED
D D
COMMENTS:
PLUMBING: D GROUNDWORK D ROUGH-IN D FINAL D WATERMETERINSTALLED D PARTIAL
D PRESSURE TEST
PASSED FAILED
D D
COMMENTS:
D OCCUPANCY GRANTED D CONDITIONAL OCCUPANCY GRANTED
....
NOTES/REMARKS' CD cl~ll,..e, Wd-'1 ,.,sa -t' h~ ,~- /{cJ}. PL..ca..fe r?I'i'; Eo( olfLLvewe;;'1
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INSPECTOR-
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DATE OF INSPECTION MADE: 9 ~'t-(J '1
TIMF- II : ;).("A~
FAXED OPPD\BURT REA
TO CONNECT SERVICE: ON
BY