BP13112
NOV 6EMrn
CITY OF BLAIR - APPLICATION FOR BUILDING PERMIT
Permit #
T
~
Date:
I 0 -- tJ ,3 --0 !(
Approximate Completion Date:
13/IJ
j)-3/-u?
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
Sign Erecting, Awnings _ Decks/Handicap Ramps (plot plan required) _
Satellite Dishes/Radio Antenna/Cell Towers (plot plan required) _
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 projectif necessary: ~f'DffeJ fhe c~;), Y\5 'j'\. t1-c. J: V\ h 5 (u~ on,
. even /) Ge.1.'! 1'1 '11:) q(Lo~ i>cl,;"j-r1-.-.e.. hc,J j,iJ1'.tC,J sn....o)<:,(, cAetct:.'tu'(",
W S)fI tilld rJe..J ~lo'\)c'lV\ L9q ~ (j.t""" w \J\YI \;)~r\". Ld ;~, ~'^IvJdl
lA-P'11\ \IJ\"') (JU"M
Prolect Information:
Job Address:
l 'I I~-
Pafk.sf 89volf;/a5~9
Ee tY&l' c2 i pi ct I/A(~ Jii Dt.. 8//1/ Pc;?
Phone#: ~)b- r7Y?
Address:
Legal Description (if applicable)
Owner: Kelt ~ fY\cJ Z e h
Contractor: 5e If
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.
S;gg;;,~:!t;6~~ctor D:'etJ - ,) 3 - 0 y
ELECTRICAL PERMIT APPLICATION
Jurisdiction of City of Blair, Nebraska
218 South 16th Street
Blair, Nebraska 68008
Fax (402) 426-4195 E 3028
(402) 426-4191
Application Date: /(J .-;;23 - 08
Pennit Fee: $ 37. 0 0
~~nerf Jd/u
~~ntractor 1-.1
3. Class of Work:
Describe Work:
4.
5.Current License on File
Job Address
Service Fee = (Amp Fee + $5.00 per branch circuit)
1-100 Amp Fee...... ... ............ ..$25.00
101-200 Amp Fee...... ...... ...... .. ...$35.00
201-300 Amp Fee...... ...... ...... .. ...$55.00
301-400 Amp Fee...... ... ............ ..$75.00
401-500 Amp Fee...... ... ............ ..$95.00
501-600 Amp Fee......... ............$115.00
601-700 Amp Fee......... ............$135.00
701-800 Amp Fee...... ...... ......... $155 .00
801-900 Amp Fee...... ...... ......... $175 .00
901-1000 Amp........................ .$195.00
IF OVER 1000 Amp
151 1000 Amp Fee...... ...... .. ....$195.00
Each additiona1100 Amps.... .....$20.00
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.
Zip
y;; & !:hoi ?L/E;
Phone
o UPGRADE SERVICE
(! tJuV
ELECTRICAL PERMIT FEES
Upgrade Existing Service............ .$25.00
Temporary Service.................... $15.00
Fire Alarm System......... ......... ...$15.00
Signs (each)......................... .....$25.00
Miscellaneous Apparatus......... .....$15.00
CommerciaI/Multi Family and All Upgrades:
# of Circuits x $5.00
Amp Fee
Amp Fee + Circuit Total
New Residential: (Finished Area)
Single/Two Family Dwellings
sq. ft. x .063
ModularlManufactured Homes...... .$50.00
Other: (alterations, additions and modifications)
Receptacles/Switches/Lighting Fixtures (110 volt only)
# of Apparatus.... .. .. .. x $1.00
Power Apparatus (220 Volt or higher)
# of Apparatus....... x $8.00
Smoke Detectors.....
cf
x $3.00
/ c:2. 0 0
Permit Issuance Fee................. ..$25.00
."'7.c- (5 0
c.<,J
.'7/"'1 60
Total ,---) . / .
Comment:
WHEN PROPERL Y VALIDATED (IN THIS SPACE) THIS IS YOUR PERMIT
I Approved By: 3. .>0f~~
Rev. 2008-10
High Hazard HPM
Institutional, incapacitated_
Institutional, day care facilities _
Residential, multiple family _
Residential, care/assisted living facilities
Storage, moderate hazard _ Storage, low hazard _ Utility, miscellaneous_
Institutional, supervised environment _
Institutional, restrained _
Mercantile Residential, hotels_
Residential, one- and two-family
Is building reauired to be protected bv automatic fire sprinkler svstem?"
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: 20% grade or less? Yes _ No_
(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:
Building Permit Deposit Fee:
Commercial, new homes and residential
additions/remodels/accessory buildings valued $10,000 or greater
Fee - $500.00
Residential additions/remodels/accessory buildings valued under $10,000
Fee = $200.00
All other permits Fee = $50.00
$~~
,
$
$ 5"'0.60
RESIDENTIAL - NEW CONSTRUCTION:
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$92
$
$
$
$
$
$
$
$
X $56
X$29
X$25
Total Valuation
Multiplied by 0.006 =
Issuance Fee:
25.00
Total Permit Fee = Deposit + Permit Fee + Issuance Fee
RESIDENTIAL - ADDITIONS / REMODELS and
COMMERCIAL - NEW CONSTRUCTION / ADDITIONS / REMODELS:
Business/I ndustrialjEd ucationa Ij Assem bly/Factory/Storage/Utility
*Porches with roofs/screened patios are considered additions
Construction valuation computation: Sqjft area X $63
Except for the following:
Accessory Buildings & Interior Remodeling Proiects: sqjft area X $43
Pole barns with no hard surface floor: sqjft area X $25
Si~n ErectingjAwnin~s and Decks/Handicap Ramps: sqjft area X $25 (Minimum
valuation of $2000)
Construction valuation computation: - D
Finished sqjft area (!:'21' 0
X$
L/3
$ I'cl, L/7CJ ,00
/
Construction valuation is ...................................Permit fee is:
$0 TO $50.......................................................... $0
$51 TO $500........................................................$25
$501 TO $2,000........................................................$25 + $3 per additional $100._ {/
$2,001 TO $25,000........................................................$70 + $13 per additional $1,000 (b . 1-/
$25,001 TO $50,000..................................................... $370 + $10 per additional $1,000 I q 6
$50,001 TO $100,000..................................................... $620 + $7 per additional $1,000 / 35. . 0 tJ
$100,001 TO $500,000..................................................... $970 + $5 per additional $1,000 ~
$500,001 TO$1,OOO,OOO ..................................................$2,970 + $4 per additional $1,000 <.~ () 6 q
$1,000,001 AND OVER ..................................................$4,970 + $3 per additional $1,000
Not rtt';'~ $ ~tr:~~\
~( ~! ~\fO~~c""
( $
Permit Fee calculated from chart above
Issuance Fee:
25.00 ::; ~
!~7S
Total Permit Fee = Deposit + Permit Fee + Issuance Fee
$
Additional Comments:
Approved
.'
,
Date:
Contingent On Approval by Fire Marshall X
Meet IBC, IPC, IMC and NEC Code Requirements, v
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:
Building Inspection Pouch given: Yes _ No
Job Address
G4U
Owner Ma 1 Address zi p Phone
1. �' 2k " o'
Contractor Ma' dress zip Phone �1
2. C`' 2,16 - 40 � i
3. Class of Mrk: tLITEW RESIDENTIAL O NEW COMMERCIAL O REMODELING /ADDITIONS O UPGRADE SERVICE
Describe Work: / a
4. G /
5.Current License on File , es O No O N/A Completion Date
ELECTRICAL PERMIT FEES
Service Fee = (Amp Fee + $5.00 per branch circuit)
Upgrade Existing Service .............$25.00
1 -100 Amp Fee .......................$25.00
Temporary Service .................... $15.00
101 -200 Amp Fee .......................$35.00
201 -300 Amp Fee .......................$55.00
Fire Alarm System ..................... $15.00
301 -400 Amp Fee .......................$75.00
Signs ( each) .............................. $25.00
401 -500 Amp Fee .......................$95.00
Miscellaneous Apparatus .............. $15.00
501 -600 Amp Fee .....................$115.00
601 -700 Amp Fee .....................$135.00
Commercial/Multi Family and All Upgrades:
701 -800 Amp Fee .....................$155.00
801 -900 Amp Fee .....................$175.00
# of Circuits x $5.00
901 -1000 Amp . ........................$195.00
Amp Fee
IF OVER 1000 Amp
1" 1000 Amp Fee ..................$195.00
Amp Fee + Circuit Total
Each additional 100 Amps ......... $20.00
New Residential: (Finished Area)
Single /Two Family Dwellings
Notice
sq. ft. x .063 lell
I hereby certify that I have read and examined this
application and know the same to be true and correct. All
Modular /Manufactured Homes ....... $50.00
provisions of laws and ordinances governing this type of
work will be complied with whether specified herein or
Other: (alterations, additions and modifications)
not. The granting of a permit does not presume to give
Receptacles /Switches/Lighting Fixtures (110 volt only)
authority to violate or cancel the provisions of any other
# of Apparatus x $1.00
state or local law regulating construction or the
..........
performance of construction.
°--°°
Power Apparatus (220 Volt or higher)
# of Apparatus....... x $8.00
f
Smoke Detectors..... x $3.00
,nature of Contractor or Authorized Agent
Permit Issuance Fee.. ..$25.0
- 1
Total
12
Da
Comment:
WHEN PROPERLY VALIDATED (IN THIS SPACE) THIS 1S YOUR PERMIT
Approved By:
Rev. 2008 -10
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:
/ 0 ~ ;)3-0 ~
Job Address
l Y IS
~~ner /(Cith
Contractor
2.
3. Class of Work:
Describe Work:
4.
VI J\ .t... Mail Address
f v let I '2- e V'I
Mail Address
o COMMERCIAL
RESIDENTIAL
0ct 1'\ < t
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.
~ Yl1t11 c
Signature of Contra r or Authorized Agent
~
P 1948
dO
Pennit Fee: $ 37 .-
P cd It.;
Zip
Phone l!J,..I)IIP
Zip
Phone
o New 0 Addition 0 Alteration 0 Repair
Replacement
I""
be, t LrO.)1~
PLUMBING PERMIT FEES
Modular Home...............,.... .,$50.00
Type of Fixture No.
Kitchen.,..,...................,.... .$12.00 x
Bath.....Residential/Sing1e Stall $12.00 x I
................., ..Multi-Stall $25.00 x
Rough-In Bath......,........... ......$8.00 x_
Additional Sinks....... ... ... ....... .$6.00 x
Slop Sink/Laundry Tray/Drain.....$6.00 x_
Water Heater.................... ....,$10.00 x
Outside Water Faucet...................$6.00 x
Drinking Fountain........................$6.00 x_
JJ '"'I
. 'Uv
Backflow/Grease Trap,........... .$15.00
Water Service...........,..,...... ..$15.00
Sewer............................, ....$15.00
Groundwork...................... ...$15.00
Septic Tank & Laterals..... ... .... $15,00
Lawn Sprinkler System.......... ..$10.00
Sprinkler System (Commercial)..$30.00
Gas/Water Piping System
(Commercial)..................... ...$50.00
Pennit Issuance Fee... .., ... ...... ..$25.00
Current License on File
Comment:
Total
Yes 0 No 0 N/ A
WHEN PROPERL Y VALIDATED (IN THIS SPACE) THIS IS YOUR PERMIT
I Approved By: 3.1 JI~
I
Rev. 2008-10
ZONING REVIEW:
Conditional Use Permit Required: Yes - No fr-
~ate CUP Approved:
State Fire Marshal Required: Yes No _ Variance Required: Yes _ No_
Minimum Setbacks: Front _ S cond Front Side Side _ Rear_
lot Sauare Foota~e:
length x Width:
lot Coverage %~
Drivewavs/Sidewalks:
Sidewalk required: Yes_ No_
Sidewalk Waiver: Yes
Date Waiver Approved:
Preexisting Garage requires driveway to be less than 3' from property line: Yes_
Approved by:
No
Flood Plain: Yes No
If yes, specify special requirements:
BUilDING INSPECTOR REVIEW:
Number of Stories
One Two
Three
Four
>Four
High Rise (>75 ft)_
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
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
Occupancv 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 _
(section continued on next page)
CITY OF BLAIR, NEBRASKA
Phone 402-426-4191
RECEIVED 9F:
ADDRESS
CITY. STATE. ZIP CODE
THANK YOU
KEEP THIS COPY FOR YOUR RECORDS.
NO
RECEIVED BY
Pounds Printing, -Blair:, _ NE 68008
Blair Building Permit Detail
Permit#: 13112 Issued: 10/23/2008
Completed:
Location: 1415 Park St
Owner: Keith Matzen
Address: 1415 Park St
Type: Residential Remodeling
Valuation: 12470
Section:
Subdivision:
Township:
Permit Fee: 206
Issue Fee: 25
Deposit Amt.: 500
Receipt #:
Blair, NE 68008
Phone: 426 1748
Block: 8
Dropped the ceiling in the living room to even out ceiling to accomodate the hard wired smoke detectors. New sink
and new flooring in bathroom with vinyl flooring. Putting drywall up in living room.
Contractors
SELF
General Contractor
Electrical Subcontractor
Plumbing Subcontractor
L,rv1 10"-;2,1-- 08
Hipnar Electric
SELF
Remarks
Inspections Date
10/24/2008
By
DEM
Smoke Detectors
?l~
MEET IBC, IRC, IPC, IMC AND NEC CODE REQUIREMENTS
72L~
~~BLAIR
LOCATION OF
BUILDING INSPECTION REPORT
NAME OF
D WASHINGTON COUNTY
- , ~. ~<~"~,) jF,/ ,":." ;:./
.~ > '-_ -,'-Y/l ('<
DATE INSPECTION
, PERMIT NO' C~" )
/ 3 {I Z.
D CONFERENCE D STATu'S CHECK
TYPE OF INSPECTION REQUESTED:
BUILDING: D FOOTING D DECK FOOTING
D DRYWALL 41;J, ~L D PARTIAL
P F~ED
COMMENTS:
UTILITIES: D SEWER TAP 0 SEWER D SEPTIC D WATER TAP D REMOTE D WATER SERVICE
D PARTIAL
COMMENTS:
ELECTRICAL: D ROUGH
D PARTIAL
PASSED FAILED
D 0
COMMENTS:
MECHANICAL:D ROUGH-IN D AlC D FURNACE D RADIANT HEAT D FINAL D PARTIAL
FAILED
D
D PERMANENT SERVICE D TEMPORARY SERVICE D PRECONNECT
COMMENTS:
PLUMBING: D GROUNDWORK D ROUGH-IN D FINAL D WATER METER INSTALLED D PARTIAL
D PRESSURE TEST
PASSED FAILED
D D
COMMENTS:
o OCCUPANCY GRANTED 0 CONDITIONAL OCCUPANCY GRANTED
PASSED FAILED
o D
NOTESIREMARKS'
DATE OF INSPECTION MADE:
TO CONNECT SERVICE:
CITY OF BLAIR
Application for Building Permit
PLOT PLAN
Address
i\.f{5 ~c;ul st
Date
I 0- J 3 --0 \(
Legal Description: Lot
Block
Addition
Please show all measurements of existing and contemplated structures,
also show distances between structures, etc., and property lines.
Is this a corner lot?
k
Line
~
\
"
ClJ
q
'r-!
1-4
h~t L. ," "J "" '"
li't l~(-> ~0
o
Indicate North
i
:>.
t
ClJ
p,
o
H
Pol
)~~ \ttl
Center Line of
Street
Applicant
BUILDING INSPECTION REPORT
:~~ITY OF BLAIR D WASHINGTON COUNTY D OTHER
LOCATION OF INSPECTION' /L/~~:Y f?:JAL Jr/-.
a~~/;;::~-'";"?')-:t?'i%ir:)r'-l / / . . 0 ;J, 1 I ",
NAME OF OWNER' j4f=~~C;(/b.-~; ~JC.4lae CONTRACTOR' /--1 '-1.;().-11 t:-:u'l, Cu e tyL/ e'
DATE INSPECTION ~~t1is~}r. ~< f,C:O f.<~ f ~~~i?:E~TION REQUESTED' ) () :....i () A, M. PERMIT NO'
r-'
C
~--:1 r/f ""7 (/j
,-IO",",(U
TYPE OF INSPECTION REQUESTED: D CONFERENCE D STATUS CHECK
1'i.oiIi~ . "...~"-"""""""~~"= ~~~~~
BUILDING, D FOOTING D DECK FOOTING P' FRAMING D DRYWAll ~ ...,L D FARTIAL p~ F1"JED"
COMMENTS: jLJ'
UTILITIES: 0 SEWER TAP, D SEWER D SEPTIC D WATER TAP D REMOTE D WATER SERVICE
D PARTIAL
PASSED FAILED
D D
ELECTRICAL: D ROUGH
D PARTIAL
COMMENTS:
D PERMANENT SERVICE D TEMPORARY SERVICE D PRECONNECT PASS.ED FAILED
\"'. li 1/" /'/ t7 l.i if) /jltr1~ /~ D
('-\.""'('/1 tT VI ~ ~.,,~-/ ,/ ~
,- . ..... ' ."" . -- ,,,",,,,, '=z"'~~..u"".'.:lt~-:l.~-:tt:;';..~~~~~
D FURNACE D RADIANT HEAT D FINAL D PARTIAL PASSED FAILED
D D
~~~~
MECHANICAL: D ROUGH-IN D NC
COMMENTS:
D GROUNDWORK D ROUGH-IN D FINAL D WATERMETERINSTALLED D PARTIAL
D PRESSURE TEST
PASSED FAILED
D D
PLUMBING:
~~""~=--i""""""'''''~""~~''''1'~~~'~"""",,,,
[J()'CGUJiANCY GRANTED 0 CONDITIONAL,OCCUPANCY GRANTED
NOTES/REMARKS'
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BUILDING INSPECTION REPORT
d CITY OF BLAIR
D WASHINGTON COUNTY
0/5--' ~u .~j/
LOCATION OF INSPECTION' / // '- / /711::./<-
A./ ~~A ~.~. - (
./ _~I 1// ,.,
NAME OF OWNER' _ - 6//;( ;/-- /,f rb
/~
/)/.-']> ..-
DATE INSPECTION REQUESTED' d./.~/> Dr (.)
I .
D OTHER
~--/-
, .) / /'
CONTRACTOR'
~~
...~.......~~~~~ ~~~~~~=m
L.~1/-- " ? /! .....,..)
TIMEINSPECTIONREQUESTEO' /7 PERMlTNO' /0/, ~----'
____ 0 CON~~~~ATUS CHEC~
o FRAMING 0 DRYWALL D FINAL D PARTIAL PASSED FAILED
4m{)j)~ D 0
TYPE OF INSPECTION REQUESTED:
-"- .V'.
BUILDING: 0 FOOTING D DECK FOOTING
COMMENTS:
UTILITIES: D SmYER T~ 0 SEWER 0 SEPTIC D WATER TAP D REMOTE D WATER SERVICE
o P,ARTIAL
PASSED FAILED
D 0
COMMENTS:
ELECTRICAL: 0 ROUGH IN D FINAL D PERMANENT SERVICE D TEMPORARY SERVICE D PRECONNECT
o PARTIAL
PASSED FAiLED
DO...
COMMENTs:
.~~---,.",.""...,..
~
MECHANICAL:D ROUGH-IN D NC D FURNACE D RADIANTHEAT 0 FINAL 0 PARTIAL
COMMENTS:
PLUMBING:
PASSED FAILED
O D.
-, :"..
COMMENTS:
o GROUNDWORK DROUGH~IN D FINAL D WATERMETERINSTALLED 0 PARTIAL
o PRESSURE TEST
PASSED FAILED
o D
~~....--~"'.~-~. .~ "
D .. OCClJi>~NCY G~ANTED 0;' cO~Iti9NA.LQCC@ANci(GRANTED
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NOTES/REMARKs' .
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