BP13039
T
2 9
CITY OF BLAIR - APPLICATION FOR BUILDING PERMIT , /] a
Permit# /,30..J I
Date: r; - 2 ",5--- 0 /3 Approximate Completion Date: //0 ~ \..':]1- 08
Site Plan Attached:~' REScheck Attached: Complete Plans Attached
ADDlication for: Residential ~ Commercial/Industrial
New Construction Manufactured Home Modular
Move-on: ~o e _ Accessory Building Other
Remodel Addition
Accessory uilding: 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 needed: _ 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 _
Additional Description of project if necessarY(~<'l.J~}J'1 ,:),1'1 t ~;@/u
Proiect Information:
Job Address:
Id8t/ /
{f 0 Zd ;ZL;
Be/OG ;/0 /7/3
Legal Description (if applicable) "Tt. 73 ,;;Iv -IB..I/ /4 B 'Pc 2'1
. . (J
Owner: UdC!lL ~t5t)&l feu Address:
U ,) /? /{ '+:.- '
Contractor: 7ui(/U) C; Lt'71 S-fl/ul t'.tut!77 Phone #:
Address: d 06/5 ;(/;{!/;t~~ C~:A~;!P (JI JJ t ~:f(~~ L./ 80 - e 7~ 7
c1j~l1()l/r1 i I F 6160.:9 ;;?
Separate permits are required for electrical, plum6i;:fg,'11earting, 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 b t is permit application shall not be commenced until I have received a copy of a permit signed by the Building
Inspector. I e to perform the proposed work in accordance with the specifications set forth above and in accordance with the
codesjo na t ityof Blair and the State of Nebraska. I understand that this permit is v id if work' not co enced within
180 ys or . pleted wi . rs of date of issue. A '
~ V'
if.{p5 Ae..- 2
Hd
Phone#:
Date
f "'" -f.1 1.
. ':! j
ZONING REVIEW:
ZonimVFlood Plain/Utilities:
Current Zoning: PrG
Conditional Use Permit Required: Yes _ No ~
Date CUP Approved:
Yes _ No -X- Variance Required: Yes _ No;s;:2..
Second Front Side Side Rear_
State Fire Marshal Required:
Minimum Setbacks: Front
Lot Sauare Foota~e:
Length x Width: lfCfO)(<ff4o lot Coverage % IV {fr
Driveways/Sidewalks:
Sidewalk required: Yes_ No --If-. Sidewalk Waiver: Yes
Date Waiver Approved:
Flood Plain: Yes No y
If yes, specify special requirements:
No~
BUILDING INSPECTOR REVIEW:
Number of Stories
One Two
Th ree
Four
>Four
High Rise (>75 ft)_
Type 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
Sauare Foota~e:
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, libraries, 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 buildint:! reauired to be protected by automatic fire sprinkler system?"
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:
Buildint:! Permit Deposit Fee:
Residential additions/remodels/accessory buildings valued under $10,000 $
Fee = $200.00
Commercial, new homes and residential
additions/remodels/accessory b'uildings 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
$
$
$
$
$
$
$ 20.00
$
Total Valuation
Multiplied by 0.0056 =
Issuance Fee:
Total Permit Fee = DepositjPermit Fee/Issuance Fee
RESIDENTIAL - ADDITIONS / REMODELS and
COMMERCIAL - NEW CONSTRUCTION / ADDITIONS / REMODELS:
Business/I ndustria IjEd ucationalj Assembly/Factory /Storage/Utility
*Porches with roofs/screened patios are considered additions
Building Permit Deoosit 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 $.!3J() .IX>
Fee - $500.00
All other permits valued under $10,000 No Deposit Fee
Construction Valuation will be computed bv Sq/ft area X $60
Accessory Buildin2:s & Interior Remodelin2: Proiects will be computed by Sq/ft
area X $40
Permit fee is:
Finished sqjft area
Finished sqjft area
/eJ1.5
X $60
X $40
$
$ '7u1IltJv.w
$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
\
.'76,6
, c/o
4>)
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. \
Permit Fee calculated from chart above
$
tfID,OO
Issuance Fee:
$
20.00 ~ Lf 30 at)
Q30 .00
Total Permit Fee = Deposit/Permit Fee/Issuance Fee
$
Additional Comments:
Approved b~j ~4 ~
Date:
~&tJ/C6'
Contingent On Approval by Fire Marshall
Meet IBC, IPC, IMC and NEC Code Requirements )(
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:
Bui/ding Inspection Pouch given: Yes _ No
9 (f fo" ~p fY~t'"
PLUMBING PERMIT APPLICATION
\ 3D3q
P 1802
Jurisdiction of City of Blair, Nebraska
218 South 16th Street
Blair, Nebraska 68008
Fax (402) 426-4195
(402) 426-4191
Application Date:
3 -/7-0 r
Job Address
J ). pc, l
Permit Fee: $ ;). f,loJ'rA'
(o---lJ
)ro
Zip
Phone
;) 5U W. Gs _ !lJ T
, fOJJ-
o Repair
P;;t-s~ 7.5
o Replacement
\p~O()1'
Comments:
Notice
I hereby certify that I have read and examined this
application and know the same to be true and correct. All
provisions of laws 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.
Signature of Contractor or Authorized Agent
Date
PLUMBING PERMIT FEES
Modular Home... ... ......... ... ....$50.00
Type of Fixture No.
Kitchen.............................. $8.00 x
Bath................................ ..$8.00 x
Rough-In Bath..................... .$4.00 x
Additional Sinks.......... ......... .$3.00 x
Laundry/Drain.................... ..$5.00 x
Water Heater.................... ....$3.00 x
Outside Water Faucet..................$3.00 x
Drinking Fountain.......................$3.00 x
f?', Uu
Backflow/Grease Trap........... .$10.00
Water Service..................... .$1 0.00
Sewer............................. ...$10.00
Groundwork..................... ...$10.00
Septic Tank & Laterals........... $10.00
Lawn Sprinkler System........ ....$10.00
Sprinkler System (Commercial). $30.00
Gas/Water Piping System
(Commercial)..................... ..$30.00
Permit Issuance Fee............... .$20.00
Current License on File
Comment:
Total
Yes 0 No 0 NjA
WHEN PROPERL Y VALIDA TED (IN THIS SPACE) THIS IS YOUR PERMIT
I Approved By: -" 1-; 9. /
~-:s t ,./ r J'v{l~
9 (f fo" ~p fY~t'"
PLUMBING PERMIT APPLICATION
\ 3D3q
P 1802
Jurisdiction of City of Blair, Nebraska
218 South 16th Street
Blair, Nebraska 68008
Fax (402) 426-4195
(402) 426-4191
Application Date:
3 -/7-0 r
Job Address
J ). pc, l
Permit Fee: $ ;). f,loJ'rA'
(o---lJ
)ro
Zip
Phone
;) 5U W. Gs _ !lJ T
, fOJJ-
o Repair
P;;t-s~ 7.5
o Replacement
\p~O()1'
Comments:
Notice
I hereby certify that I have read and examined this
application and know the same to be true and correct. All
provisions of laws 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.
Signature of Contractor or Authorized Agent
Date
PLUMBING PERMIT FEES
Modular Home... ... ......... ... ....$50.00
Type of Fixture No.
Kitchen.............................. $8.00 x
Bath................................ ..$8.00 x
Rough-In Bath..................... .$4.00 x
Additional Sinks.......... ......... .$3.00 x
Laundry/Drain.................... ..$5.00 x
Water Heater.................... ....$3.00 x
Outside Water Faucet..................$3.00 x
Drinking Fountain.......................$3.00 x
f?', Uu
Backflow/Grease Trap........... .$10.00
Water Service..................... .$1 0.00
Sewer............................. ...$10.00
Groundwork..................... ...$10.00
Septic Tank & Laterals........... $10.00
Lawn Sprinkler System........ ....$10.00
Sprinkler System (Commercial). $30.00
Gas/Water Piping System
(Commercial)..................... ..$30.00
Permit Issuance Fee............... .$20.00
Current License on File
Comment:
Total
Yes 0 No 0 NjA
WHEN PROPERL Y VALIDA TED (IN THIS SPACE) THIS IS YOUR PERMIT
I Approved By: -" 1-; 9. /
~-:s t ,./ r J'v{l~
~
Ie
IE
1l~ <:f.l) 0
y v;....i
MECHANICAL PERMIT APPLICATION
Jurisdiction of City of Blair, Nebraska
218 South 16th Street
Blair, Nebraska 68008
Fax (402) 426-4195
(402) 426-4191
( 303 f
M 1669
Application Date:
g"'15 ~-oB
Permit Fee: $
tfo. 00
Job Address
, &/
{}; )2d ~&
Zip
Phone
Zip
Phone
o Replacement
Central A/C
Tons
Furnace
BTU/H
AlC
Forced Air/Heat Pump Systems - Per Unit
CommerciaVResidential (New)............... ........................ ..$25.00
# of Units
Furnace
Air-Conditioner Unit - Per Unit
CommerciaVResidential (New)....................................... ...$10.00
Completion Date:
Forced Air Systems/Air Conditioner
Unit Replacement Per Unit CommerciaVResidential.............. ...$10.00
Comments:
Refrigeration Units/Coolers/Lines/Compressor -
Per Unit Commercial (New or Replacement)...... ...... ...... ...... ..$10.00
Appliance Vent/Fans...... ......... ... .....$10.00
It).OO
Boiler....................................... ..$15.00
Notice
I hereby certify that I have read and examined this
application and know the same to be true and correct. All
provisions oflaws 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.
Duct System................................ .$10.00
) (). oD
Gas/Air Outlets.......................
x $2.00
Radiant Heat Systems/Gas/Water
Piping System............................ ...$25.00
Modular Home............................. .$50.00
-S~ )-~
~L0.
nt Permit Issuance Fee......... ...... ......... $20.00
Total
00
00
Signature of Contractor or Authorized
9 ~3.()~
Current License on File ~es 0 No
o N/A
Date
Comment:
WHEN PROPERL Y VALIDATED (IN THIS SPACE) THIS IS YOUR PERMIT
I Approved By: d)C .) ~i' f-'
'-. /J ,} ;J /J I)ft~
",:J~ ~~..
AUG 2 9
PLUMBING PERMIT APPLICATION
Jurisdiction of City of Blair, Nebraska
218 South 16th Street
Blair, Nebraska 68008
Fax (402) 426-4195
(402) 426-4191
Application Date: g '" f5 ..- of)
Job Address
p
(
r
13 03 9
P 1850
rJCt. 00
Permit Fee: $ ,,?,,-
tJ Zd P(;;
Zip
/ ;28 tt; /
Comments:
Notice
I hereby certify that I have read and examined this
application and know the same to be true and correct. All
provisions oflaws 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.
~-- 021
Phone
Q/ /1 ~ ,1 hone L /,0/1
AD / ;;{JJ411tr?1T U7vv,
o Repair 0 Replacement
....
1U;/V
PLUMBING PERMIT FEES
Modular Home.................... ..$50.00
Type of Fixture No.
Kitchen............................ ..$8.00 x
Bath.............................. ....$8.00 x~
Rough-In Bath....... ...... ........ .$4.00 x
Additional Sinks................... .$3.00 x
Laundry/Drain... ... ......... .... ...$5.00 x
Water Heater..................... ...$3.00 x
Outside Water Faucet..................$3.00 x
Drinking Fountain.......................$3.00 x
13.00
Backtlow/Grease Trap........... .$10.00
Water Service.................... ..$10.00
Sewer............................ ....$10.00
Groundwork.................... ....$10.00
Septic Tank & Laterals........... $10.00
Lawn Sprinlder System...... ... ...$10.00
Sprinkler System (Commercial). $30.00
Gas/Water Piping System
(Commercial).................... ...$30.00
Permit Issuance Fee... .. . ... . . . . . ..$20.00
()
Current License on File
Comment:
es 0 No
WHEN PROPERLY VALIDATED (IN THIS SPACE) THIS IS YOUR PERMIT
I Approved By: 6, J?Jld1AJ~
PLUMBING PERMIT APPLICATION
Jurisdiction of City of Blair, Nebraska
218 South 16th Street
Blair, Nebraska 68008
Fax (402) 426-4195
(402) 426-4191
Application Date:
fj"'I5-08
Job Address
13039
P 1850
Permit Fee: $ 28. CJ 0
~ Zd P(;;
Zip
/ ;2t} tt; /
Comments:
Notice
I hereby certify that I have read and examined this
application and know the same to be true and correct. All
provisions of laws 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.
Signature of Contractor or Authorized Agent
Date
Phone
m /11 II. ~);;~tf711 6th
o Repair 0 Replacement
1U~
PLUMBING PERMIT FEES
Modular Home... ... ... ... ... ... ....$50.00
Type of Fixture No.
Kitchen............................ ..$8.00 x
Bath................................ ..$8.00 x
Rough-In Bath.................... ..$4.00 x
Additional Sinks.......... ... ... .. ..$3.00 x
Laundry/Drain.................... ..$5.00 x
Water Heater... ...... ...... ... ......$3.00 x
Outside Water Faucet..................$3.00 x
Drinking Fountain.......................$3.00 x
8.00
Backflow/Grease Trap......... ... $1 0.00
Water Service.................... ..$10.00
Sewer............................. ...$10.00
Groundwork... ...... ... ... ... ......$10.00
Septic Tam( & Laterals........... $10.00
Lawn Sprinkler System............$lO.OO
Sprinkler System (Commercial). $30.00
Gas/Water Piping System
(Commercial)............... .... ....$30.00
Permit Issuance Fee............... .$20.00
2{). tiC?
Total 2. '. oD
o N/A
Current License on File
Comment:
es 0 No
WHEN PRO PERL Y VALIDATED (IN THIS SPACE) THIS IS YOUR PERMIT
I Approved By: ''"Z> _ ~1) I.
~. /J.~
9j
ELECTRICAL PERMIT APPLICATION
{ 3J::3 q
E 2924
Jurisdiction of City of Blair, Nebraska
218 South 16th Street
Blair, Nebraska 68008
Fax (402) 426-4195
(402) 426-4191
Application Date:
'6/L(-;;?
Job Address
\)f" (
')/o~
Permit Fee: $ 0'
~ . iLd ;; b
b t Mail Address
DG../ r;
Mail Address Zip Phone
Cc y, (; (9 J f-.2 YSs--
o NEW RESIDENTIAL 0 NEW COMMERCIAL 0 REMODELING/ADDITIONS 0 UPGRADE SERVICE
~~s i~e;~r~:c.\ ()f bttS(f21("wt Y00t:j' ~Cf'V\'t. b;2.r- ~b/)-
5.Current License on File Yes 0 No 0 N/A Completion Date 10 ' ~ 1-<.)8'
ELECTRICAL PERMIT FEES
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
1511000 Amp Fee.............. ....$117.00
Each additionall00 Amps..... ....$13.00
Notice
I hereby certify that I have read and examined this
application and know the same to be true and correct. All
provisions oflaws 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 f
authority to violate or cancel the provisions of any other
state or local law regulating construction or the
performance of construction.
Signature of Contractor or Authorized Agent
Date
Zip
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
CommerciallMulti Family and All Upgrades:
"1lJ "'..9
# of Circuits x $2.00 J '1
\/) Q~
Amp Fee "'l_
Amp Fee + Circuit Total
New Residential: (Finished Area)
Single/Two Family Dwellings
sq. ft. x .045
Modular/Manufactured Homes... ...$50.00
Receptacle/Switch Outlets
Fixtures /.!>.....;.. x $.75
Smoke Detectors x $3.00
Residential/Commercial Appliance
# Fixed Outlets x $3.00
Motor(s) x $3.00
Power Apparatus (220 Volts)
# Apparatus x $5.00
Permit Issuance Fee.................. ..$20.00
Phone
)l..
7 L. 00
\ I '1- 00
J (y o.:J
Comment:
Total d- I (y W
WHEN PROPERL Y VALIDATED (IN THIS SPACE) THIS IS YOUR PERMIT
I Approved By: ~, ?.tf~
08/04/2008 15:33 FAX 4026282012 SECO ELECTRIC
Aug. 4, 2008 12:03PM CITY OF BLAIR (402.426.4191)
141 001/001
No. 7566 P. 1
,r?o;~q'
(J '-
ELECTRICAL PERMIT APPLICATION
Jurisdiction of City of Blair) Nebraska
218 South 16111 Street
Blair. Nebraska 68008
Fax (402) 426-4195
(402) 426-4191
App!il;l\tion Pate:
'6..l.J--Z)?
Job Addr\ll;s
\)'k""
E 2924
I 'l:)'Q
Pe.\'nlit :Fee: $ ~ (:)-
~ . rtJ J. 6
Service Fee = (Amp Fee + 2.00 pel' bl'RtlOh oil'cuit)
HOO Amp Fl!:e.....,............ .. ",$13.00
101"200 Amp Feemon... ............ .,$1 8.00
201-300 Amp Fe~.................... ...$30.00
301.400 Amp Fee.....,.............. ...$42.00
401-500 Amp Flle.......................$55.00
501.600 Amp Fee.......................$67.00
601~700 Amp Felil.. d."" ........ ". ...$80.00
701-800 Amp Fee.................... ...$92.00
SOl "900 Atnp Fee............ ........ .$105.00
901-1000 Amp..... ..........;..... ... $117.00
IF OVRR J 000 Amp
)'11000 Amp Fee..................$1l7.00
Each addition~ll 00 Amps..... ....$13 .00
Notiee.
I hereby certify that I ha.ve \'el\(\ l\nd eKlImiD.M this
Il,pplicl'l.tion and know lhe same to be truo and coucct. All
provisions of laws and ordinflucM governing tl1is type of
work \VlU bl! llQl;Ilplilld \'\Iith whclht;r sp~c;Ifl.ed herein or
not. The granting of i'I permit does not presume to give f
!I\llh()tiLy to vioI!\t~ Qr CMC(l) the ]:!fovisions of llny other
state or local law regulating; construction or the
~erformll.nCll of Col\S(rI.lCt\OI\.
1'-.
Zip
Phone
Zip
~ REMODELINGjADOmONS
"&04 b~r-~ol>- )l
CompletIon Date
ELECTRICAL PERMIT FEES
Upgt'ado Existing Service.., ... . . . .. ..$] 0.00
Temporary Service..... ... ... " . . .,... $10.00
Fire Ala1'm System.........""""".."' ...$10.00
Signs....................... ...... .........$15.00
Miscellaneo~\s Apparatus, .. . .. . .. n" ,$11.00
AClDe Ch'ouit... ..........u...... ......$5.00
CommereiallMultl Family and A&UlJCrpdes;
# of,Cu:ouitn $2.00 3 '4 cl
0.11 C.
Amp Fee "1 L.
Amp Fee + Clrouit Total
New Residential: (Finil.lhed Area)
SingleJTwo F'amily Dwellings
_~sq. ft. x .045
Modular/Manufactured Hmnesmm$SO.OO
Receptacle/Switch Outlets
Fb:mres { .!>~;. x $.15
Smoke Deteotors x; $3.00
Residential/Commel'cial AlJpliance
# Fixed Outlets x $3.00
Motol'(s) ~x $3.00
Power Apparatl.l$ (220 Volts)
# Apparatus x: $5.00
7 L. o~__
I' I \f. o~
Pel'mit Issuance Ftlltll....................$20.00 d <::::,- D0
Total J.. I (y ():)
Comment:
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CITY OF BLAIR, NEBRASKA
Phone 402-426-4191
RECEIVED OF:
ADDRESS
CITY; STATE. ZIP CODEf
THANK YOU
KEEP THIS COPY FOR YOUR RECORDS.
NO
Pounds Printing, -Blair., NE 68008
CITY OF BL1\IQ
BUILDING PERMIT DEPOSIT AGREEMENT
A $500.00 refundable deposit is being collected at the time of your building
permit application for all commercial, new homes and residential
additions/remodels/accessory buildings valued $10,000 or greater. However,
the City reserves the right to not refund this deposit if any of the following
conditions occur during the construction period:
1) theft of water service by either the plumber, owner or general
contractor,
2)No stop box location card submitted, (with new service only)
3) all required inspections have not been obtained,
4) occupancy occurs prior to a final inspection,
5) all permits have not been obtained,
6) the project is completed without a final inspection being done.
If any or all of these situations occur during construction, you may forfeit
your deposit.
I, hereby agree to the above conditions, and understand that should any or all
of the above situations occur, the building permit deposit SHALL be
forfeited or discounted upon the discretion of the City of Blair, Building and
Inspections Department.
.......----._~~"~+,.-....>
Contractor/Owner
:J 1/2f/!tf
City of Blair
(5)-
EQUALIIOUSIN~
218 South 16th Street. Blair, Nebraska 68008 . 402-426-4191 . Fax 402-426-4195 . E-mail cityofblair@ci.blair,ne,us """">In
'a~BLA!R
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BUILDING INSPECTION REPORT
D WASHINGTON COUNTY D OTHER
12~ ($ to \ (~j5) ((ell ';2, ~:,
CONTRACTOR' 'S\( I Ie L,e",. C,.. C..C) 'Ii ,",;\ VII I: +1 I)V'!
TIME INSPECTION REQUESTED' ) (): ()()(:,'- ~,,;L PERMIT NO' i~:~~)~':)(::f
LOCATION OF INSPECTION'
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NAME OF OWNER' ....J CO, ,,-.
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DATE INSPECTION
TYPE OF INSPECTION REQUESTED: D CONFERENCE
BUILDING: D FOOTING D DECK FOOTING 5I.. FRAMING D DRYWALL D FINAL D PARTIAL
D STATUS CHECK
FAILED
D
COMMENTS:
UTILITIES: D SEWER TAP D SEWER D SEPTIC D WATER TAP D REMOTE D WATER SERVICE
D PARTIAL
PASSED FAlLED
D D
ROUGH IN D FINAL D PERMANENT SERVICE 0 TEMPORARY SERVICE 0 PRECONNECT
PARTIAL
P~ED FOED
If" F[]""
p~m FAILED
P' 0
COMMENTS:
MECHANICAL:Q ROUGH-IN 0 A/C 0 FURNACE 0 RADIANTHEAT 0 FINAL 0 PARTIAL
COMMENTS:
PLUMBING: 0 GROUNDWORK [\1' ROUGH-IN 0 FINAL 0 WATERMETERINSTALLED 0 PARTIAL
o PRESSURE TEST
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COMMENTS:
o OCCUPANCY GRANTED 0 CONDITIONAL OCCUPANCY GRANTED
NOTES/REMARKS'
DATE OF INSPECTION MAD
INSPE
FAXED OPPD\BURT REA
TO CONNECT SERVICE: ON
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BUILDING INSPECTION REPORT
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o WASHINGTON COUNTY
o OTHER
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CONTRACTOR' \.,.;:,./~
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TIME INSPECTION REQUESTED' " )' ""',
LOCATION OF INSPECTION'
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NAME OF OWNER' IJ~^'
DATE INSPECTION REQUESTED' IV - ;2~
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PERMIT NO'
TYPE OF INSPECTION
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PASSED FAILED
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BUILDING: 0 FOOTING 0 DECK FOOTING 0 FRAMING 0 DRYWALL 0 FINAL 0 PARTIAL
COMMENTS:
UTILITIES: 0 SEWER TAP 0 SEWER 0 SEPTIC 0 WATER TAP 0 REMOTE 0 WATER SERVICE
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ROUGH IN 0 FINAL 0 PERMANENT SERVICE 0 TEMPORARY SERVICE 0 PRECONNECT
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COMMENTS:
o OCClJPANCY GRANTED 0 CONDITIONAL OCCUPANCY GRANTED
NOTES/REMARKS'
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BUILDING INSPECTION REPORT
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LOCATION OF INSPECTION'
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DATE INSPECTION REQUESTED' d - / '1~ eft
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TIME INSPECTION REQUESTED' A I
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PERMIT NO' I 30,3!
TYPE OF INSPECTION REQUESTED: D CONFERENCE
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OCCUPANCY GRANTED D
NOTES/REMARKS'
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