BP13063
CITY OF BLAIR - APPLICATION FOR BUILDING PERMIT
Permit #
/1. 'J
7 0 fc ./
(-06
Date:
Approximate Completion Date:
J) -
Site Plan Attached:
REScheck Attached:
Complete Plans Attached
Application for: Residential Commercial/Industrial
New Construction Manufactured Home Modular
Move-on: Home Accessory Building Other
Remodel Addition
Accessory Building: 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:
, . "f}) ti'
t [U AA'l(. It_CAJ<- , j
Proiect Information:
Job Address:
1 S S~)
~J0t
\it
fjq 00 Lf-s-~:;tf~
'-.~ /;!:.- z:; 0 /13
Phone#:)JY
Legal Description (if applicable)
if) f1 C}\ n
Owner: CJLu'i ,; ,JA.Aj~"I-
Contractor: .~
,!iJ{! (~~ 9 i pt ctf' ?&t! ,5?/
Address: ICJ:5-; ~~ !r
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
codesjordinanc s of the Ci yof Blair and the State of Nebraska. I understand that this permit is void if work is not commenced within
180 da d~ is ot compled ithin two (2) years of date of issue.
r j7
Date
ZONING REVIEW:
Zonin Flood Plain U i1ities:
Current Zoning: L Conditional Use Permit Required: Yes _ No X-
Date CUP Approved:
State Fire Marshal Required: Yes _ No ~ Variance R~..9!1Jred: Yes _ No ~
Minimum Setbacks: Front _ Second Front Side S Side _ Rear~
Lot SQuare Foota~e:
Length x Width:
Lot Coverage %
Drivewavs/Sidewalks:
Sidewalk required: Yes_ No_
Sidewalk Waiver: Yes
Date Waiver Approved:
No
Flood Plain: Yes No
If yes, specify special requirements:
BUILDING INSPECTOR REVIEW:
Number of Stories
One Two
Th ree
Four
>Four
High Rise (>75ft)_
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 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
Occu pancv Classification:
Assembly, theaters, with stage Assembly, theater, without stage _
Assembly, nightclubs _ Assembly, restaurants, bars, banquet halls _
Assembly, churches _ Assembly, arenas _
Assembly, general, community halls, librClries, 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 buildinz:! 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:
Buildinz:! 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
Perm it 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:
Busi ness/I nd ustria I/Ed ucationa 1/ Assem bly/Factory/Storage/Util ity
*Porches with roofs/screened patios are considered additions
Buildinl! 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
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 sqfft area
Finished sqfft area
#.~
X$60
X$40
$
$ 3 tf i _5'tv t) . C5()
,
$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
$ /e;'
$ 20.00 -:: I
$ 11'7
Issuance Fee:
Total Permit Fee = Deposit/Permit Fee/Issuance Fee
Additional Comments:
Approved by; ~d ClIfZ Date: ~~
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: ' fJ -;:? /:3'- () f3--~
Permit Fee: .2 I '7. -." (p
Deposit Amount ~-50() - (' {..7 7
;:::~ftt :aid by for return to: {~t!~1 (;/J5tr11
/ f:-.i);2 &;4(/141 f
Building Inspection Pouch given: Yes _ No
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10
BUILDING INSPECTION REPORT
~, CITY OF BLAIR '\~)' ~ AS)HINGTON COUNTY
I LOCATION OF INSPECTION' .' \ ,_) C._ C<) j!"..(
,
NAME OF OWNER' C. ho () (C, l b~() (\
o OTHER
~'\ ? ./
n.l \ ,Ql~..,
.- fl.--IO'
tI
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\....~ /
CONTRACTOR'
~ l fl
~~ f\
1/1 ",.,
"7,00
.--'-
....
DATE INSPECTION REQUESTED'
el{1 t I 0';:
TIME INSPECTION REQUESTED'
PERMITNO.130(O ~
TYPE OF INSPECTION 0 CONFERENCE
BUILDING: FOOTING 0 DECK FOOTING 0 FRAMING 0 DRYWALL 0 FINAL 0 PARTIAL
COMMENTS:
UTILITIES:
SEWER 0 SEPTIC 0 WATER TAP 0 REMOTE 0 WATER SERVICE
o STATUS CHECK
;ErD F~ED
PASSED FAILED
o 0
COMMENTS:
~ ~__~~.-='Z2""""",",~"",,",,_~~~~~~~'~~~~~~
ELECTRICAL: 0 ROUGH IN 0 FINAL 0 PERMANENT SERVICE 0 TEMPORARY SERVICE' 0 PRECONNECT
o PARTIAL
PASSED FAILED
o 0
COMMENTS:
"''"'= ~~_.- -' ._",.~"""""""'~~~
MECHANICi\L:O ROUGH-IN 0 A/C 0 FURNACE 0 RADIANTHEAT 0 FINAL 0 PARTIAL
PASSED FAILED
o 0
COMMENTS:
PLUMBING: 0 GROUNDWORK 0 ROUGH-IN 0 FINAL 0 WATERMETERINSTALLED 0 PARTIAL
o PRESSURE TEST
_..--0'.-:'"'
PASSED FAILED
D 0
o OCCUPANCY GRANTED
CONDITIONAL OCCUPANCY GRANTED
NOTESIREMARKS'
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BUIL:t)ING INSPECTION REPORT
r:z{ CITY OF BLAIR
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D WASHINGTON COUNTY
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LOCATION OF INSPECTION' /;/ ,.Jr'/) (::;'7/,--../ "V /
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NAME OF OWNER' C'-:?/ ,Z)~! /j
DATE INSPECTION REQUESTED' / C),/(q'j /l,1!3 TIME INSPECTION REQUESTED'
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D OTHER
CONTRACTOR'
/1 J ._~"- ~-::....
/1 T PERMIT NO' / -.:j'[) /:7 ~j
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TYPE OF INSPECTION REQUESTED: D CONFERENCE IL]'STATUS 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 SEWER TAP D SEWER D SEPTIC D WATER TAP D REMOTE D WATER SERVICE
D PARTIAL
PASSED FAILED
D D
ELECTRICAL:, D ROUGH IN D FINAL D PERMANENT SERVICE D TEMPORARY SERVICE D PRECONNECT
D PARTIAL
COMMENTS:
PASSED FAILED
D D
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MECHANICAL:D ROUGH=IN D AlC cD FURNACE D RADIANT HEAT D FINAL D PARTIAL
PASSED FAILED
D D
COMMENTS:
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PLUMBING: D GROUNDWORK D ROtJGH~iN b FINAL D WATERMETERINSTALLED D PARTIAL
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. DPRESSURE TEST
COMMENTS: c
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PASSED FAILED
D D
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D occuPANCY GRANTED oJ c()NJ?#iQ~~;~~~DP~pY:q~~])
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