BP13160
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CITY OF BLAIR - APPLICATION FOR BUILDING PERMIT
Permit # 13 I iJJ ()
'1 J
Date:<-..j -/8 -0 q
Site Plan Attached:
REScheck Attached:
Approximate Completion Date: 5'.,~?!" (19
Complete Plans Attached ')(
ADDlication for: Residential ~ Commercial/Industrial _
New Construction Manufactured Home Modular
Move-on: Home _ Accessory Building Other
Remodel -X- 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 project if necessary: C7kWfMJ1 i: )3/l/f?cJLlc./ ~
~'V ()lftrJa CJ-.P . o1'a..Lt11/:t~ C?/r1c:l ",?fa rAAt'Jc:rJJI'L..;.,
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Proiect Information:
Job Address:
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c.J.-) C,,\
(J, 1ft;) 'I (3 ()
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89tPd'itJCJ/P I
Legal Description (if applicable) <....1JG?- -rL J?S'U/ 1'1-//1-11 lie! Fe? / tI/ 2. 05~A~
Owner!" ~.t11 tf /J7d..,})tJ1falcl Address: (\' cUJV C'0 a/';CtU Phone#:
Contractor: 6~~ Phone#:c-733'" c;oat!
Address:
Cell #: ",?:::Fd - 7 'I f3 ''/
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 d r is not completed within two (2) years of date of issue.
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Signature of Owner/Contractor
Y.~;J-dl
.
Date
ZONING REVIEW:
ZoninlVFlood Plain/Utilities:
Current Zoning: Kty\
Conditional Use Permit Required: Yes _ No )('
Date CUP Approved:
Yes _ No ~ Variance R~quired: Yes,_ No ~
Second Front iJ( 11' Side!J I r1' Side ~ Rear.1.:(!d.
State Fire Marshal Required:
Minimum Setbacks: Front
Lot Sauare Foota1'!e:
Length x Width: (€i~'
Lot Coverage % /J I Ii'
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 X~'
,
If yes, specify special requirements:
BUILDING INSPECTOR REVIEW:
Number of Stories
One Two
Th ree
Four
>Four
High Rise (>75 ft)_
TVDe 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 Foota1'!e:
Main Level:
Basement: (Unfinished)
Garage:
Detached Garage:
Addition:
Porch: Front Rear
Deck that affect setbacks: Rear
Second Level: Third Level
(Finished)
2 bay_ 3 bay_ 4 bay_ 5+ bay
Pole Barn:
Remodel:
Side
Front Side
OccuDancv 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)
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 buildin~ reauired to be Drotected bv automatic fire sDrinkler 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. Al will review all second access requests and industrial and
commercial driveway requests)
Required Off Street Parking:
Permit Fee Calculation:
Buildin~ Permit DeDosit 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 $
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:
B usiness/lnd ustria IjEd ucational/ Assem bly/Factory /Storage/Utility
*Porches with roofslscreened patios are considered additions
Construction valuation computation: Sqjft area X $63
Exceot for the following:
Accessory Buildings & Interior Remodeling Projects: sqjft area X $43
Pole barns with no hard surface floor: sqjft area X $25
Sign Erectin~AwninJ:!s and Decks/Handicao Ramos: sqjft area X $25 (Minimum
valuation of $2000)
Construction valuation comoutation: /. ~) /7' ,c:""~
Finished sqjft area L",;?) "J X $
$ ~5L~ 8 z5. uO
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
$25,001 TO $50,000..................................................... $370 + $10 per additional $1,000
$50,001 TO $100,000..................................................... $620 + $7 per additional $1,000
$100,001 TO $500,000..................................................... $970 + $5 per additional $1,000
$500,001 TO$1,OOO,OOO ..................................................$2,970 + $4 per additional $1,000
$1,000,001 AND OVER ..................................................$4,970 + $3 per additional $1,000
Permit Fee calculated from chart above
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Issuance Fee:
$
$
25.00;::: Co I-I
OD
Total Permit Fee = Deposit + Permit Fee + Issuance Fee
$ i,l1 cr ' 00
Additional Comments:
Approved bY~
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
x
x
For Office Use Only
Date Permit Paid:
Permit Fee:
Deposit Amount
Receipt #
Deposit Paid by for return to:
Building Inspection Pouch given: Yes _ No
MECHANICAL PERMIT APPLICATION
1:3I/ftO
M 1841
~
Jurisdiction of City of Blair, Nebraska
218 South 16th Street
Blair, Nebraska 68008
Fax (402) 426-4195
(402) 426-4191
Application Date: '1- /5'-- 0 <1
Job Address
JA eM tUn!
Heat Pump
Central AlC
Tons
Tons
Furnace
BTU/H
AlC
# of Units
Furnace
Completion Date:
Boiler Chart
BTU Fee
Up to 100,000......... ............. ....... ...$15.00
1 00,000-500,000...... ......... ... .......... ..$30.00
500,000-1,000,000... ... ... ... ... .. .......... $40.00
1,000,000-1,750,000...... .............. .. ..$60.00
Over 1,750,000..................... ..... ....$100.00
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
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Permit Fee: $_35',
85 ~ ~~.
Phone
30
Zip
Zip
Phone
o New 0 Addition
Iteration 0 Repair 0 Replacement
Furnace/Heat Pump/Air Conditioner (Per Unit)
Up to and including 100,000 BTU / 3Ton.......................... ..$15.00
Furnace/Heat Pump/Air Conditioner (Per Unit)
Over 100,000 BTU / 3 Ton....................................... .. ....$25.00
Refrigeration Units/Coolers/Lines/Compressor - Commercial
(New or Replacement) (Per Unit)
.. . . .. . . . . . . . . . .. . . . . . . . . . . . . . .. . .. . . .. . .. . . . . . . . . . .. .. .. . . . . . .. . .. .. . . . . .. ... $15.00
Boiler (use BTU Chart toleft)~.........,......... .
~~-~I
Appliance Vent/Ffms..................... :'..$10.00
Ib,OO
Duct System................................ ..$15.00
Gas/Air Outlets.................First 5
x $6.00
. . . . . .. ..Additional
x $1.00
Radiant Heat Systems/Gas/Water
Piping System........................ ..... ...$50.00
Modular Home... ... ......... ... ... .......... $50.00
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ELECTRICAL PERMIT APPLICATION .
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Jurisdiction of City of Blair, Nebraska
218 South 16th Street
Blair, Nebraska 68008
Fax (402) 426-4195
(402) 426-4191
3 "/1 ,. q
Application Date: rL)- 0 I
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 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.
~
ignature of Contractor or Authorized Agent
'3 - 31 - 0 -
Date
U'! O() , h.
Permit Fee: $ . W
\
30
Zip
k" );hone.~ ?) / /
J 3J -7;1V<r
Phone
Zip
o UPGRADE SERVICE
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
CommerciaIIMulti 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
Modu1ar/Manufactured Homes...... .$50.00
Other: (alterations, additions and modifications)
Receptacles/Switches/Lighting Fixtures (110 volt only)
__ '2.. - c>(.::>
# of Apparatus .......... -z.... S- x $1. 00 .)-
Power Apparatus (220 Volt or higher)
# of Apparatus....... I x $8.00
~
.~
Smoke Detectors. . . ..
/
;;>
:::>
0'0
x $3.00
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Permit Issuance Fee... ......... ... ....$25.00 0J'
Total /
C'.G-
Comment:
WHEN PROPERL Y VALIDATED (IN THIS SPACE) THIS IS YOUR PERMIT
I Approved By: :is. ;?JI f- ~~
I
Rev. 2008-10
C 1 ;;) '; ~ ~ ~ .; - - - --
PLUMBING PERMIT APPLICATib~ 0 1 fNPD
Jurisdiction of City of Blair, Nebraska / J ~ C)
218 South 16th Street 1:3 UJ
Blair, Nebraska 68008
Fax (402) 426-4195 P 1994
(402) 426-4191
C;;;;;;;:/~My
I Date
J-Zr:~OI
WHEN PROPERL Y VALIDATED (IN THIS SPACE) THIS IS YOUR PERMIT
I Approved By: $.;?.t;~
~.
',..
'..... .'"
Application Date: <-3 - ;;1 & - () 1
Contractor
2.
3. Class ofWo
Describe Work:
4.
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.
I' fa. eJlJ
Permit Fee: $ I {
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30
Zip
Phone
Zip
Phone
o Addition 0 Repair 0 Replacement
Cl.<2.-Mtvvn I- ()~
PLUMBING PERMIT FEES
Modular Home.................... ..$50.00
Type of Fixture No.
Kitchen...... ...... ... ... ... ... ... ... $12.00 x
Bath... ..Residential/Single Stall $12.00 x ~
................. ...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_
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/.;J . 00
Backflow/Grease Trap........... ..$15.00
Water Service..................... ..$15.00
Sewer............................... ..$15.00
Groundwork...................... ...$15.00
Septic Tank & Laterals............ $15.00
Lawn Sprinkler System............$lO.OO
Sprinkler System (Collunercia1)..$30.00
Gas/Water Piping System
(Commercial)......... ........ ... ....$50.00
Permit Issuance Fee................ .$25.00
625- 00
Lie;, 00
Current License on File
Comment:
I'(j Yes
Total
o NjA
o No
I
Rev. 2008-10
CITY OF LAIR, NEBRASKA
Phone 402-426-4191
RECEIVED OF:
ADDRESS
CITY, STATE, ZIP CODE
THANK YOU
KEEP THIS COPY FOR YOUR RECORDS,
NO
RECEIVED BY
Pounds Printing, Blair, NE 68008
CITY OF BLAIR
Application for Building Permit
PLOT PLAN
Address 3)'2 ,:;; /lcc'~l /~t)
I
Legal Description: Lot
Date
;;/,8'" ()'7
Block
Addition
Line
(I
Please'show all measurements of existing and contemplated structures,
also show distances between structures, etc., and property lines.
Is this a corner lot? /~()
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BUILDING PERMIT DEPOSIT AGREEMENT
A $500.00 refundable deposit is being collected for any new commercial, new
residential, and any additions, remodels and accessory building valued $10,000 or
greater at the time of your building permit application.
A $200.00 refundable deposit is being collected for any residential remodel,
addition or accessory building valued under $10,000.
A $50.00 refundable deposit is being collected for all misc. permits.
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 the plumber, owner or general contractor.
2) All permits have not been obtained.
3) All required inspections have not been obtained.
4) Occupancy occurs prior to a final inspection.
5) The project is completed without a final inspection being done.
6) Storm Water Management Plan inspection not obtained. (If Required)
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.
~/d~/
~6ntractor/Owner
Contractor/Owner
City of Blair
J-2cf-C17
Date
CITY or BL1\IQ
BUILDING PERMIT SUPPORTING DOCUMENTS
This building permit packet includes various items dealing with particular code
requirements and/or building permit requirements. It in no way includes ALL particular
code items. Also, it is your responsibility to know the 2006 International Buildina
Code requirements that apply to your project. Please understand this packet is only
designed and distributed to aid you in your building permit process. A copy of the
International Building Code is available for your use at the Blair Public Library.
I have read the above disclosure and accept this building permit documentation on my
own behalf assuming full responsibility as the owner/contractor for this project.
;;?yf~&/J
'Contractor,
Owner/Occupant
City of Blair
Date
(5)-
218 South 16th Street. Blair, Nebraska 68008 . 402-426-4191 . Fax 402..426-4195 . E-mail cityofblair@cLblair,ne,us ,::';-:1J,~:
BUILDING INSPECTION REPORT
o CITY OF BLAIR
o WASHINGTON COUNTY
o OTHER
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NAME OF
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TIME INSPECTION REQUESTED' l' (../ V(j . V! !,
CONTRACTOR'
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DATE INSPECTION REQUESTED'
PERMIT NO'
TYPE OF INSPECTION REQUESTED:
BUILDING: 0 FOOTING 0 DECK FOOTING
o CONFERENCE
FRAMING 0 DRYWALL 0 FINAL 0 PARTIAL
o STATUS CHECK
FAILED
o
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:
/;~~/,;:;)F i"l D
COMMENTS:
ROUGH IN 0 FINAL 0 PERMANENT SERVICE 0 TEMPORARY SERVICE 0 PRECONNECT
PARTIAL
~D
PASSED
~
FAILED
o
FAILED
o
MECHANICAL~E:l ROUGH-IN 0 AlC 0 FURNACE 0 RADIANT HEAT 0 FINAL 0 PARTIAL
~ ~<i~:)~, :~"ll5':t:
COMMENTS:' [/
PLUMBING:
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COMMENTS:
o OCCUPANCY GRANTED 0 CONDITIONAL OCCUPANCY GRANTED
o GROUNDWORK)2( ROUGH-IN o FfNAL 0 WATERMETERINSTALLED 0 PARTIAL
o PRESSURE ntsT
~ED
NOTES/REMARKS'
---
INSPECTO .
DATE OF INSPECTION MADE:
1{~"2f)-~ TIMR' 2:00
FAXED OPPD\BURT REA
TO CONNECT SERVICE: ON
BY