BP13068
CITY OF BLAIR - MISCELLANEOUS BUILDING PERMIT
5' - i - D 2> Permit # / c:JtJ 11/8
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Date: C( - 3 ~ 08 Approximate Completion Date: ~~llrvW Site Plan Attached:
Estimated Valuation of Project: 1:500 ' 00
Application for:
Permit Fee $20/lssuance Fee $20
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 Un. Ft.; Width
Type: Water ; Sewer ; Other
Fee: $40.00
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Un. Ft
Amount of Bond Posted: Bond Check #
(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 $
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PROJECT INFORMATION:
Job Address:
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8100 tf ;;7B5> 7
Owner: cJl1JfA,~/ku
Contractor: J1 ~
Legal Description (if applicable) 15 c do t: :J i' Pf '15 t/Ilt! (.~i f. jjJ L it)
Add ress: /6; ~3 / I~J/{ /~ J'/ Phone#: q ;;l/t1- 8
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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Date
For Office Use Only
WHEN PROPERLY VALIDATED (BELOW) THIS IS YOUR PERMIT
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Date Permit Paid: - c) -UOReceipt #
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&/''.::::1 U Approved by:
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BUILDING INSPECTION REPORT
D W ASHINGT~N coU!jJ:Y
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LOCATION OF INSPECTION- / u2v) i /7 f:..-I..-
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NAME OF OWNER' !.,4~$:)f-/ CJlj,
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DATE INSPECTION REQUESTED' J()//~3/0.!..1 TIME INSPECTION REQUESTED-
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CONTRACTOR'
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PERMIT NO- :/'..5 {J ( ex:.-;
TYPE OF INSPECTION REQUESTED:
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BUILDING: D FOOTING D DECK FOOTING D
COMMENTS:
D CONFERENCE D STATUS CHECK
FRA~GD~~,;Y~AllP."..AL~PAR~ -Fd'E,D F~
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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
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UTILITIES:
COMMENTS:
ELECTRICAL: D ROUGH IN D FINAL D PERMANENT SERVICE D TEMPORARY SERVICE D PRECONNECT
D PARTIAL
FAILED
D
COMMENTS:
MECHANICAL:D 'ROUGH-IN D AlC D FURNACE D RADIANTHEAT D FINAL D pARTIAL
FAILED. '
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COMMENTS:
PLUMBING:
D GROUNDWORK D ROUGH-IN D FINAL D WATERMETERINSTALLED D PARTIAL
D PRESSURE TEST
COMMENTS:
o OCCUPANCY GRANTED D
NOTESIREMARKS'
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E3~:CITY OF BLAIR
BUILDING INSPECTION REPORT
o WASHINGTON COUNTY
o OTHER
LOCATION OF INSPECTION'
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NAME OF OWNER-
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CONTRACTOR-
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DATE INSPECTION
TIME INSPECTION REQUESTED' /,;/)
PERMIT
TYPE OF INSPECTION REQUESTED: 0 CONFERENCE
,
BUILDING: 0 FOOTING 0 DECK FOOTING 0 FRAMING 0 DRYWALL 12l::FlNAL 0 PARTIAL
o STATUS CHECK
COMMENTS:
UTILITIES: 0 SEWER TAP 0 SEWER 0 SEPTIC 0 WATER TAP 0 REMOTE 0 WATER SERVICE
o PARTIAL
PASSED FAILED
o 0
COMMENTS:
ELECTRICAL: 0 ROUGH IN 0 FINAL 0 PERMANENT SERVICE 0 TEMPORARY SERVICE 0 PRECONNECT
o PARTIAL
PASSED FAILED
o 0
COMMENTS:
MECHANICAL:D ROUGH-IN 0 AlC 0 FURNACE 0 RADIANT HEAT 0 FINAL 0 PARTIAL
PASSED FAILED
o 0
COMMENTS:
PLUMBING: 0 GROUNDWORK 0 ROUGH-IN 0 FINAL 0 WATERMETERINSTALLED 0 PARTIAL
o PRESSURE TEST
PASSED FAILED
o 0
COMMENTS:
o OCCUPANCY GRANTED 0 CONDITIONAL OCCUPANCY GRANTED
NOTES/REMARKS'
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DATE OF INSPECTION MADE:
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FAXED OPPD\BURT REA
TO CONNECT SERVICE: ON
BY