BP12967
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CITY OF BLAIR - MISCELLANEOUS BUILDING PERMIT
Permit # /J C?iY '7
Date: ij/(g(), 0 ~pproximate Completion Date: (5- -,)1- O&ite Plan Attached:
Estimated Valuation of Project: hOOO . ov
Application for:
Permit Fee $2Oj/ssuance Fee $20
Fee: $40.00
Sign Erecting, Awnings (Per Sign)
Roofing/Siding/Soffit and/or Eave Repair/Gutters Y
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
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 =
$ tIt/
vJ.4v
oc,;
PROJECT INFORMATION:
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Legal Description (if applicable) die! C;t,t':;~ L1"k.. 38 /1 Lf pc;: 1
I) (I ;]//// /J .~" '1--0...0 sp~
Owner: [. . cJ ' CJ&j' vuJ ~ . Address:
Contractor: ;(t /; a t/ ?L 7:>n (! ,
Address: ~ or c/"" ~ /ltJJ Sw
~yY7 aM .J J+ (:;)/ t:J ,3 I
Job Address:
Phone#:
Phone #:
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.
~C;1ZL
S~nature fOwnerjConrracror
LI~30/61
Date
For Office Use Only
WHEN PROPERLY VALIDATED (BELOW) THIS IS YOUR PERMIT
Date Permit Paid: if,] ()-o 4eceiPt # {},l315 3 APp~oved by: (?jJ 0/d~
BUILDING INSPECTION REPORT
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~,-....CITY OF BLAIR D WASHINGTON COUNTY D OTHER
It'-iLl-C") 'I " .I
LOCATION OF INSPECTION' I" 11/C0h-.t-?lqrtrl',..j
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NAME OF OWNER' L/. J, (~wtdti( -- -i1'C -0 CONTiicTOR' lIOI1t20:.u
DATE INSPECTION REQUESTED' 11-- I 0 - 08 TIME INSPECTION REQUESTED' j-'? 1'-'1
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PERMIT NO'
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TYPE OF INSPECTION REQUESTED: D CONFERENCE D STATUSCHl):CK
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BUILDING: D FOOTING 0 DECK FOOTING D FRAMING D DRYWALL ~.p;AL P PARTIAL / P~lID l;.AIL..'-.I!
COMMENTS: f=- O'1)' --' .!.~fC'L ~t(] r- ..' ," " ..~.:
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UTILITIES: D SEWER TAP D SEWER D SEPTIC D WATER TAP D REMOTE D WATER SERVICE PA$SED.F~~b ~'.'
D PARTIAL D-'" [J ,
COMMENTS:
ELECTRICAL: D ROUGH IN 0 FINAL D PERMANENT SERVICE D TEMPORARY SERVICE D PRECONNECT
o PARTIAL
COMMENTS:
MECHANICAL:D ROUGH-IN D A/C D FURNACE D RADIANTHEAT D FINAL D PARTIAL
COMMENTS:
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PLUMBING: D GROUNDWORK D ROUGH-IN D FINAL D WATERMETERINSTALLED D PARTIAL PASSEDfA,ILE,D
D PRESSURE TEST [1' .'&1-.-.
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COMMENTS:
~~~~~=:~~~"
D OCCUPANCY GRANTED D CONDITIONAL OCCUPANCY GRANTED
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NOTES/REMARKS'
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o CITY OF BLAIR
BUILDING INSPECTION REPORT
o WASHINGTON COUNTY
o OTHER
LOCATION OF INSPECTION'
NAME OF OWNER'
f'J c t' N tb--
DATE INSPECTIONREQUESTEDi"
/' " '
CONTRACTOR'
"i' ; ;.' i
TIME INSPECTION REQUESTED'
:/
PERMIT NO' L.' /
TYPE OF INSPECTION REQUESTED:
BUILDING: 0 FOOTING 0 DECK FOOTING 0 FRAMING 0 DRYWAW'
o CONFERENCE
FINAL 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 F~SD
o ~.
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 NC 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
PASSED FAILED
o 0
NOTES/RI'MARK([, ,
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INSPECTOR'
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DATE OF INSPECTION MADE: ~ (f -/ ((-.-.0 9 TIMF' ,it) ~ ceJAl.t/\
FAXED OPPD\BURTREA
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CITY OF BLAIR
BUILDING INSPECTION REPORT
o WASHINGTON COUNTY
o OTHER
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LOCATION OF INSPECTION' 17 !"~l () V.l it S I~ .I "_:~ .+ 0 ,j 5'-{ ,
NAME OF OWNER' tiS
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CONTRACTOR'
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DATE INSPECTION REQUESTED' (;~ i k- c '/
TIME INSPECTION REQUESTED'
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PERMIT NO' i ,~~:' (f ~. 7
TYPE OF INSPECTION REQUESTED: 0 CONFERENCE
BUILDING: 0 FOOTING 0 DECK FOOTING 0 FRAMING 0 DRYWALL 0 FINAL PARTIAL
o STATUS CHECK
COMMENTS:
UTILITIES: 0 SEWER TAP 0 SEWER 0
o PARTIAL
PASSED FAILED
o
o WATER TAP 0 REMOTE 0 WATER SERVICE
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:O ROUGH~IN 0 AlC 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
PASSED FAILED
o 0
COMMENTS:
o OCCUPANCY GRANTED 0 CONDITIONAL OCCUPANCY GRANTED
NOTES/REMARKS'
INSPECTOR'
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DATE OF INSPECTION MADE:
L:I) , ;1 r:'< ," () 1
FAXED OPPD\BURTREA
TO CONNECT SERVICE: ON
BY
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GlCITY OF BLAIR
BUILDING INSPECTION REPORT
LOCATION OF
TIME INSPECTION REQUESTED'
D WASHINGTON COUNTY
NAME OF
DATE INSPECTION
TYPE OF INSPECTION REQUESTED: D CONFERENCE
BUILDING: D FOOTING D DECK FOOTING D FRAMING D DRYW ALL,~"l'INAL ARTIAL
D STATUS CHECK
COMMENTS:
/'
UTILITIES: D SEWER TAP D SEWER D SEPTIC D WATER TAP 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
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
COMMENTS:
D OCCUPANCY GRANTED D CONDITIONAL OCCUPANCY GRANTED
NOTES/REMARKS'
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INSPECTOR'
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DATE OF INSPECTION
FAXED OPPD\BURT REA
TO CONNECT SERVICE: ON
BY