BP13222
CITY OF BLAIR - APPLICATION FOR BUilDING PERMIT
Permit # 13
Date: tp--, .- cP\
. /) :2\' ".r-r II
Approximate Completion Date: It- OJ 'u""'l
Site Plan Attached:
REScheck Attached:
Complete Plans Attached
ADDlication for: Residential/< Commercial/Industrial _
New Construction Manufactured Home Modular
Move-on: Home _ Accessory, Building Other
Remodel _ Addition L
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 _
(\ I, VfJ'
Proiect Information:
Job Address:
I43S .Scu.Jh 0-!- B9ot:? tl79CJ~
Legal Description (if applicable) 15 t! ,;to! I( ~ tJ ~ (51 ~ f t/ "l pi of 1/// If S>;A .ifIJ/t II I
J . \... I ' ODt V1 ".. ] I " eDit
Owner. ,. 0 e l"t COi nCje V fv(? c e v \ Address: Sd I}LL Phone#: '-1dLi> .." 1
"
Contractor: Se l (::
//1 Pt '7
Phone #:
Address: )\Sa nUL-
Cell #: 533- '-/CIDb
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 day} or is ~ot c:rleted Wrhin ~wo 2) years of date of issue.
;\." ::...... I., /~ y
(l '.;/\,;:'~' J
Sigpature of Owner/Contractor
~( (cl - 1- rff/
I Date
ZONING REVIEW:
Conditional Use Permit Required: Yes _ No ~
Date CU~ 7'pproved: ~
State Fire Marshal Required: Yes _ No -f::...- Variance Required: Yes No . .
Minimum Setbacks: Front ~ Second Front Side.;; Side gear /)
ZonimVFlood Plain/Utilities:
Current Zoning: if? A II rf-
'V v l
lot Sauare Foota~e:
Length x Width: ~t Coverage %
Drivewavs/Sidewalks:
Sidewalk required: Yes_ No_
())L--
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 Storie~
One _ Two Three _ Four _ >Four _ High Rise (>75 ft)_
T e of Residential Structure: Gc\.VC(~ McP..(\i.~
Ranch _ Two Story Split Entt9 _ Raised Ranch _ Other
Rooms _ Bedrooms _ Bathrooms _ Fireplaces _ Gas_ Electric _
Egress in Basement: Required: Yes tV rr No _ Provided on Plans: Yes No
Sleeping Rooms Living Area Other Egress
Sauare Foota~e:
Main Level:
Basement: (Unfinished)
Garage: /3';)-0
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
Occuoancv 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, supervised environment _
Institutional, incapacitated _ Institutional, restrained _
Institutional, day care facilities _ Mercantile Residential, hotels _
Residential, multiple family _ Residential, one- and two-family (CJ
Residential, care/assisted living facilities
Storage, moderate hazard _ Storage, low hazard _ Utility, miscellaneous _
Is buildi
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 X 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:
Buildin~ Permit Deoosit Fee:
Commercial, new homes and residential
additions/remodels/accessory buildings valued $10,000 or greater $ DO!), cO
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:
Business/I ndustrial/Ed ucational/ Assembly/Factory /Storage/Utility
*Porches with roofs/screened patios are considered additions
/-'\
Construction valuation computation: Sqjft area X ~)
Except for the following:
Accessory Buildings & Interior Remodeling Projects: sqjft area X $43
Pole barns with no hard surface floor: sqjft area X $25
Sign Erecting/Awnings and Decks/Handicap Ramps: sqjft area X $25 (Minimum
valuation of $2000)
/J;
Construction valuation comoutation: /. '2 :;LO
Finished sqjft area :.J ~
X$
$ ;o,I!;J(). o()
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
$ 85~.(.'j(/
Issuance Fee:
$ 25.00":: 9 7'" 00
Total Permit Fee = Deposit + Permit Fee + Issuance Fee
$ i 1) 7 7. 00
Additional Comments:
rp~:(JGtvu~
Date:
6(7,/0 r
Approved by:
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:
Permit Fee:
Deposit Amount
Receipt #
Deposit Paid by for return to:
Building Inspection Pouch given: Yes _ No
WHEN PROPERLY VALIDATED (IN THIS SPACE) THIS IS YOUR PEKM1T
Approved By: � 'j ,
Job Address �y
Owner // Mail Address Zip Phone
2ontractor �7 , �� ail Address p � / zip 7' AV, 1
3. Class of Work: In NEW RESIDENTIAL O NEW COMMERCIAL 10 REMODELING /ADDITIONS O UPGRADE SERVICE
Describe Work: j 1 r
�/ :i� a � � � C%� � iGb %1
4. �%� � ®
5.Current License on File 4-j: O No O NfA Completion Date
ELECTRICAL PERMIT FEES
Service Fee = (Amp Fee + $5.00 per branch circuit)
Upgrade Existing Service .............$25.00 �23 CC U
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
901 Amp
# of Circuits x $5.00
o
-1000 . ........................$195.00
IF OVER 1000 Amp
Amp Fee '�
ls 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
I hereby certify that I have read and examined this
application and know the same to be true and correct. All
Modular /Manufactured Homes..... , 350.00
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 (I 10 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)
f,
# of Apparatus....... x $8.00
Smoke Detectors..... x $3.00
Signature of Contractor or orized Agent
r�
Permit Issuance Fee ...................$25.00
Total
— /
Date
Comment:
Rev. 2008 -10
2461
CITY OF BLAIR, 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, 8+air. NE 68008
~
~
.:JO
~
'..<1 0\
Promise
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.
Contractor/Owner
City of Blair
{v-if-Oj
Date
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BUILDING INSPECTION REPORT
CITY OF BLAIR
D WASHINGTON COUNTY
LOCATION OF
TIME INSPECTION
NAME OF
DATE INSPECTION
TYPE OF INSPECTION REQUESTED: D CONFERENCE
BUILDING: FOOTING D DECK FOOTING D FRAMING D DRYWALL D FINAL D PARTIAL
D STATUS CHECK
COMMENTS:
UTILITIES: D
D
D WATER TAP D REMOTE D WATER SERVICE
PASSED FAILED
D D
COMMENTS:
ELECTRICAL: D ROUGH IN D FINAL D PERMANENT SERVICE D TEMPORARY SERVICE D PRECONNECT
D PARTIAL
PASSED FAILED
D D
COMMENTS:
MECHANICAL:D ROUGH-IN D AlC D FURNACE D RADIANT HEAT 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 D
COMMENTS:
~='.ll::Br.L.IT.1"",^!;'ID'0';"m::Z;;]!2"'''~!::.~~~rr&''ff~=,2X.l,,,:?&=;;m;.~d/'"",^''&1';''!Z!J7J:l!?,&;;i:,illi21SZi;H'$2=="&.'D;i=-',.i3;';::,~1!1ZJZMlj:m'W:Zlli!4~~,7f&I&U'l$1!;laj2'J;13.'1'i;iJW&&JZ!ZlJ'i,;z!il!1'?lMlR!ti';~iJi.'3J2J7jS{!3;Z;:;~~#S7f!i'1ii'Z:'iZlfN1!!1;:81&!!!f;;Zi'2i/~=~0'1ZZ;==f!'l3f1t5W
o OCCUPANCY GRANT~NDTONAL OCCUPANCY GRJ!: tJ c51' /30 <'<7' ~
NOTES/REMARKS . r:,. C:errre- ere: ( e{. f -.m Iptyec:-/
Be ~V\. ptv7 Fkcrv.
DATEOFINSPECTIONMADE:Ob '7i(K~ . TIME' to.' /(/
INSPECTO .
FAXED OPPD\BURT REA
TO CONNECT SERVICE: ON
BY
BUILDING INSPECTION k.t.a
DeITY OF BLAIR
D WASHINGTON COUNTY
D OTHER
NAME OF OWNER" .', ."'
". -/"1,
/ '- ,.
/ ;; ~ /,"0< -,/,>c~ :"
, . t
.. f_, __
t ,'~- ;
'--l(
<:' )'J;
-- !;_::', ,',
-- ","
CONTRACTOR'
',L..) "
(','
/,1
DATE INSPECTION REQUESTED' it' '-'<J;'t~E INSPEC.!~ON REqVESTE,P;: ., i PERMIT NO'
- , ,::-'1 ,,':T' , " "1"" .--~'
TYPEOFINSPECTIONREQUESTED:,."' I ';" iD CONFERENCE 0 STATUS CHECK
.-~..-""...' . .,-_.. ",,, ..,", "..-..... '-'." ............ ...~. ..."" ..,-..~""."'.. ...... '.",' .. '....c. ,.'y". '.... . ..."...""".'"...'....,,......."" ....~" "'"".="'"_",''' ","" ..,.. ". .. '_.~._"."'.........~;.
~tii~~;~~'-"-..:M -~~~~~~-D-;~~~(;;;T.~~." D-'~~~ --D-~~;:;~~~-D..,-~.;~~.--~~TIA~._....~._..'--~~~iLED
. .,', d:> 0
COMMENTS: ',' " ,>, "" '.' " .
UTILITIES:
TAP D SEWER D SEPTIC D WATERTAP D REMOTE D WATER SERVICE
P ARTlAL
P ASSED FAILED
D 0
COMMENTS:
~.1,:7..;1."~::",_"_-~ :::::.-.:::::..::::..-~~'...::.;;::"'::;;_....::::s::.:::.-;::.;;;:.: ,,;;"::;;.:::..:=..::.::.::::::::;::;t'=.;:. .:::L.-:::..;:-.":...k.:::::::::.::=L.::;:-:::=":::.:z/:.::;;..J... -;::_'_;:;-':::;=.-~'.2\.""':;:';;'.T':;=---'::'::":.:~':' ;::.;":::''':;;:':::;;'"~:':;''':';..',,:: ~-2:::::_~::::'-:;':=_=::-::.[l..:::'-',::'-c:="',:: -=='='::-=:;",=~-='7',.",-" ;;::.=~:::..::::::..:..:;:.:.-,:..--:::-t::;;;.:.:::.z::.::;;:''::.;::C:'::;:'::_-':::-=-~,:::,'~:::.-:;.c;:;;;::::,'='':':'::::'::'''T=::'''''':'';.:;:::4
ELECTRICAL: 0 ROUGH IN D FINAL 0 PERMANENT SERVICE D TEMPORARY SERVICE 0 PRECONNECT
o PARTIAL
PASSED FAILED
o 0
COMMENTS:
C:''::_7=-~,-='-=:'=:':'::'':'1::'''=''::::::';:;::'--:''::::'::''::...:::,:::'-.:;;,:.-:;:;'.-.:':::::=:::':::"='':::/.. 2-:::~Y:;:'l~.~ ';;":'==~::':;:;::::-::::;,-';:::;:".':"":'::_7=':;::I!:..";::_:::~::: ;:..:..-:;;., ::-"::~;;:L:':"~'::;:J.~:::.==';.';.::::;:::;:;=':::'-:;::.c;..~:::;J=::::,:..-:::.:-;::::::::::. =:::-z..-:;'.:;::::!:-.'::;.=.:.x.=::'~;:;.::::!;::..-:::':;::Z"::;;::...<.:~:::::::"-::.::.;:::::2:-..::;;::!.::O;:.::::;":::-:'J.~=::.:::;:.~::~-.-::.:..::.:;:..::.::..:.c::J.:;'::,::.-:::;;;;;':::'=:L::..:c:2
MECHANICAL:D ROUGH-IN 0 A/C D FURNACE 0 RADIANT HEAT D FINAL 0 PARTIAL PASSED FAILED
D 0
COMMENTS:
...'::::'''::::"Z'_~-:'';':::'::::':;:_::,-~~'''::::~'':::: _::'':''.~':::'::;:'.::'::-..-=:..--:...:.:.t...::::'.:'''':'_:::::::',~::::::::;':::;;;:::';::::''''';;:.::;:'''-:::':~=::':~.:-.z:L'~,,,::,::;;::::: ::::.:'::::;c:.r::;:;':E:::'=':::':"~_-"7V-.,-n~":.!:::.:.'::..=,::',:'=~::~.:.c:.::"~:::;:":.:.r,:;::::':::::J:J"':";':'::=~;:':;:;':.'..)::;'::;'-=:"'--C;.J:"'.....'!:,:::;::::::J;.-'U;;;;:;'z;;::;.:;::::::s.::,.";..::;::.~~."Z=:.=:.::;':::;.:::!,::::-.!.:.:2=';;C:';;:;:::":::,..::.:..:-=~,,;;:t;:.-:z.:..:.:-.,.';;;
PLUMBING: D GROUNDWORK 0 ROUGH-IN 0 FINAL 0 WATERMETERINSTALLED 0 PARTIAL
D PRESSURE TEST
COMMENTS:
PASSED FAILED
o 0
;=.;z;.",-,;:~:::'.r::':.::..::.:;'~:':::;:;"::::==i::.;;::':"~~::<.,,,.:i:::..:z,:::;:::r.:J,=-;;;:::x.:::.;::.,;=,;-;;;;;=,;;.:::.~:'.:-::::::.:O:C:=--:L-.-z:::::::;;';:'~::J:'J:,:'--;;;'-';;~'=~.i.:::'1:::;;c.;z:.:;;:.=~;::::::L';;:";:":;;"~==::::~;::.~::::.~:-:;;s,.,~1:X.;;'T.1'::::::';;::~~:'~~ur:-=o::;z::~~~~.m:.:::::::::L~
o OCCUPANCY GRANTED D CONDITIONAL OCCUPANCY GRANTED
NOTES/REMARKS'
--.....-
.. -
INSPECTO '
DATE OF INSPECTION MADE: ~......DLt::t~. TIME- 9 v' 55
FAXED OPPD\BURTREA
TO CONNECT SERVICE: ON
BY
B
9,, CITY OF BLAIR ❑ WASHINGTON COUNTY ❑ OTHE j
LOCATION OF INSPECTION•
NAME OF OWNER �,. �� L �� ° CONTRACTO #
DATE INSPECTION REQUESTED r ` TIME INSPECTION REQUF.STFD r x - PERMIT NO d � ` .2
TYPE OF INSPECTION REQUESTED: ❑ CONFERENCE ❑ STATUS CHECK j
BUILDING: ❑ FOOTING ❑ DECK FOOTING ❑ FRAMING ❑ DRYWALL ❑ FINAL ❑ PARTIAL PASSED FAILED
❑ ❑
COMMENTS:
- - -- - - -- - - - -- - - - -- - - — ----- - - - - --
UTILITIES: ❑ SEWER TAP ❑ SEWER ❑ SEPTIC ❑ WATER TAP ❑ REMOTE ❑ WATER SERVICE PASSED FAILED
❑ PARTIAL ❑ ❑
COMMENTS:
ELECTRICAL [],' 'ROUGH IN ❑ FINAL F PERMANENT SERVICE ❑TEMPORARY SERVICE ❑ PRECONNECT PASSED FAILE
❑ PARTIAL ❑
COMMENTS:
MECHANICAL: ❑
ROUGH -IN ❑ A/C ❑ FURNACE ❑ RADIANT HEAT ❑ FINAL ❑ PARTIAL
PASSED
FAILED
COMMENTS:
PLUMBING: ❑
GROUNDWORK ❑ ROUGH -IN ❑ FINAL ❑ WATER METER INSTALLED ❑ PARTIAL
PASSED
FAILED
❑
PRESSURE TEST
❑
❑
COMMENTS:
❑ OCCUPANCY GRANTED ❑ CONDITIONAL OCCUPANCY GRANTED
NOTES/REMARKS: t'?r``,J r f '''7 >> `¢ ✓," f} < < !`
C ` /0
INSPECTO DATE OF INSPECTION MADE: °' t � � ` T 1MF /6
FAXED OPPD \BURT REA TO CONNECT SERVICE: ON BY I xt,
Ae" Fl-- S?A4 1®,
°CITY OF BLAIR
LOCATION OF INS]
NAME OF OWNER_
B UIL D ING INSPECTI REP
❑ WASHINGTON COUNTY ❑
�M
DATE INSPECT ON R EQUESTE D. a TIME INSPECTION UESTED� " PERMIT NO
r<e��
[r�C
® its ✓,� °
�L"
TYPE OF INSPECTION REQUES
D:
❑ CONFERENCE
❑ ST ATUS C HECK
BUILDING: ❑ FOOTING
❑ DECK FOOTING ❑ FRAMING ❑
DRYWALL ❑ FINAL ❑ PARTIAL
PASSED
FAILED
❑
❑
COMMENTS:
UTILITIES: ❑ SEWER TAP ❑ SEWER ❑ SEPTIC ❑ WATER TAP ❑ REMOTE ❑ WATER SERVICE
PASSED
FAILED
❑ PARTIAL
❑
❑
COMMENTS: 1
ELECTRICAL:' ROUGH IN [:1 FINAL ❑ PERMANENT SERVICE ❑ TEMPORARY SERVICE ❑ PRECONNECT P n Farr FD
❑ PARTIAL ` /- _�/
COMMEN / A /
MECHANICAL. ❑ ROUGH -IN ❑ A/C ❑ FURNACE ❑ RADIANT HEAT ❑ FINAL ❑ PARTIAL 2c ,1 1 al - PASSED FAILED
CO MMENTS: F ❑ ❑
PLUMBING: ❑ GROUNDWORK ❑ ROUGH-IN El FINAL ❑ WATER METER INSTALLED ❑ PARTIAL PASSED FAILED
❑ PRESSURE TEST E] El COMMENTS:
❑ OCCUPANCY GRANTED ❑ CONDITIONAL OCCUPANCY GRANTED
NOTES/REMARKS
DATE OF INSPECTION MADE: � TIM
TO CONNECT SERVICE:
BY l I
`C
�V - �
❑`=,CITY OF BLAIR
LOCATION OF
C 1 l u VIN 9 1 ■1•
❑ WASHINGTON COUNTY ri_ ❑
t i
❑ STATUS CHECK
BUILDING:
❑ FOOTING ❑ DECK FOOTING ❑_'_FRAMING ❑ DRYWALL ❑ FINAL ❑ PARTIAL
NAME OF OWNER r
r
CONTRACTO
l r'
❑ SEWER TAP ❑ SEWER ❑ SEPTIC ❑ WATER TAP ❑ REMOTE ❑ WATER SERVICE
PASSED
FAILED
a
`< `
DATE INSPECTION REQUESTED
❑
❑
TIME INSPECTION REQUESTED I PERMIT NO '
TYPE OF INSPECTION REQ UESTED: ❑ CONFERE
❑ STATUS CHECK
BUILDING:
❑ FOOTING ❑ DECK FOOTING ❑_'_FRAMING ❑ DRYWALL ❑ FINAL ❑ PARTIAL
PASSED
FILED
COMMENTS:
UTILITIES:
❑ SEWER TAP ❑ SEWER ❑ SEPTIC ❑ WATER TAP ❑ REMOTE ❑ WATER SERVICE
PASSED
FAILED
COMM
❑ PARTIAL
❑
❑
COMMENTS:
PLUMBING: ❑
ELECTRICAL: ❑ ROUGH IN ❑ FINAL ❑ PERMANENT SERVICE ❑ TEMPORARY SERVICE ❑ PRECONNECT PASSED FAILED
❑ PARTIAL ❑ ❑
COMMENTS:
MECHANICAL: ❑
ROUGH -IN ❑ A/C
❑ FURNACE
----------
❑ RADIANT HEAT
- - - - --
❑ FINAL ❑ PARTIAL
PASSED
FAILED
❑
❑
COMM
PLUMBING: ❑
GROUNDWORK ❑
ROUGH -IN ❑
FINAL ❑ WATER METER INSTALLED ❑ PARTIAL
PASSED
FAILED
❑
PRESSURE TEST
❑
❑
COMMENTS:
❑ OCCUPANCY GRANTED ❑ CONDITIONAL OCCUPANCY GRANTED
NOTES/REMARKS
l
d
l
• F
a �� «� c�«l�.
FAXED OPPD\BURT REA TO CONNECT SERVICE: 0 N BY
INSPECTO / / DATE OF INSPECTION MADE:
B UILDING INSPECTION REPORT
❑ ° CITY OF BLAIR ❑ WASHINGTON COUNTY ❑ OTHE
LOCATION OF INSPECTION
NAME OF OWNER t � < -� r" (� �' CONTRACTO
DATE INSPECTION REQUESTED ` "' i TIME INSPECTION REQUESTED " F u 'PERMIT NO
TYPE OF INSPECTION REQUESTED: ❑ CONFERENCE ❑ STATUS CHEC
BUILDING: ❑ FOOTING ❑ U
DECK FOOTING FRAMING ❑ DRYWALL ❑ FINAL ❑PARTIAL PASSED FAILED
COMMENTS: ❑
UTILITIES: ❑
SEWER TAP ❑ SEWER ❑ SEPTIC ❑ WATER TAP ❑ REMOTE ❑ WATER SERVICE
PASSED
FAILED
❑
PARTIAL
❑
❑
COMMENTS
ELECTRICAL: ❑
ROUGH IN ❑ FINAL ❑ PERMANENT SERVICE ❑ TEMPORARY SERVICE ❑ PRECONNECT
PASSED
FAILED
❑
PARTIAL
❑
❑
COMMENTS:
MECHANICAL: ❑
ROUGH -IN ❑ A/C ❑ FURNACE ❑ RADIANT HEAT ❑ FINAL ❑ PARTIAL
PASSED
FAILED
❑
❑
COMMENTS:
PLUMBING: ❑
❑
COMMENTS:
GROUNDWORK ❑
PRESSURE TEST
ROUGH -IN ❑ FINAL ❑
WATER METER INSTALLED
❑ PARTIAL
PASSED FAILED
❑ ❑
❑ OCCUPANCY GRANTED ❑ CONDITIONAL OCCUPANCY GRANTED
r p \ t y
NOTES/REMARKS r' '; r' .1# a r: 'f d € ✓ r
)
f : ! 1
1
'
CtJLjcP- Ll A) ;L
1eo
J� 6f - to i
INSPECTO - !9 DATE OF INSPECTION MADE / i (MF
°� i-�
FAXED OPPD\BURT REA TO CONNECT SERVICE: ON
I l 14 1A U olej I D1 01 t4i
_❑ OF BLAIR ❑ WASHINGTON COUNTY ❑ OTHER
ROUGH -IN F A/C
❑ FURNACE
❑ RADIANT HEAT ❑ FINAL
❑ PARTIAL
PASSED
LOCATION OF INSPECTION
NAME OF OWNER . P .
A
COMMENTS:
DATE INSPECTION REQUESTE D:_
TIME INSPECTION REQUESTED
PERMIT NO
TYPE OF INSPECTION REQUESTED:
EICONFERENCE
F STATUS CHECK
BUILDING: ❑ FOOTING ❑ DECK FOOTING [:1
FRAMING E:l DRYWALL ❑
FINAL ❑ PARTIAL
PASSED FAILED
PASSED
FAILED
F
❑ ❑
COMMENTS:
❑
❑
COMMENTS:
UTILITIES: F SEWER TAP ❑ SEWER ❑ SEPTIC [_1 WATER TAP ❑ REMOTE ❑ WATER SERVICE PASSED FAILED
❑ PARTIAL ❑ F]
COMMENTS:
ELECTRICAL: 'ROUGH IN ❑ FINAL V PERMANENT SERVICE ❑ TEMPORARY SERVIC ONNECT CZASSED-,-PAILED
F PARTIAL / ",%a ;, ��) 5)CPA
Z ',� ❑
COMMENTS: ,
MECHANICAL: F]
ROUGH -IN F A/C
❑ FURNACE
❑ RADIANT HEAT ❑ FINAL
❑ PARTIAL
PASSED
FAILED
COMMENTS:
PLUMBING: ❑
GROUNDWORK ❑
ROUGH-IN ❑
FINAL ❑ WATER METER INSTALLED ❑ PARTIAL
PASSED
FAILED
F
PRESSURE TEST
❑
❑
COMMENTS:
F] OCCUPANCY GRANTED F CONDITIONAL OCCUPANCY GRANTED
NOTESIREMARKS -
mo.
10
m WINA
)0,
DATE OF INSPECTION MADE:
F D OPP \BURT REA TO CONNECT SERVICE: ON BY