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BP13230 ~ H o-t c/J, n 'jJ 0 eft SO 00 diftJdI '1lJ d fzw> - :)jdiny, CITY OF BLAIR - MISCELLANEOUS BUILDING PERMIT Permit # /3) 3 () Date: f.o .~:; ~ul Approximate Completion Date: 55 - 3 o~() 7 Site Plan Attached: Estimated Valuation of Project: II 3 I no::;, UJ Application for: Permit Fee $40 + Issuance Fee $25 + $50 Deposit Fee: $115.00 Egress Window (floor plan drawing required) Fences (plot plan required) Gazebos (plot plan required) Patios/Driveways/Sidewalks (new or replacement) Roofing/Siding/Soffit and/or Eave Repair/Gutters Swimming Pools with Fence (plot plan required) Window/Door Replacement (size change only) Miscellaneous Building Permits (items not covered by one of the above) Description: ~ Utility Excavation and Curb Grinding Curb Grind Length Utility Excavation Length Type: Water Fee: $75 plus bond Un. Ft.; Width ; Sewer Un. Ft ; Other Amount of Bond Posted: Bond Check # (Curb grind - $9.00 per Un. Ft.; Utility Excavation - $6.00 per Sq. Ft.) () l-r' ~) 'J Additional Description of project if necessary: f W\.A,v'h-c' /\)\JI"'vl,f _ ,7iJ n -I) I "",,- .AJ'-...\ -I.{ K.~ OJl--(j( 0 t'....A..A..L'~ PROJECT INFORMATION: Job Address: I)Y'i )vti \::( 8 q 00 tf de; t/5' ~. E 'Q 61- <c;?O iV~/9 //<1 pc! I 0 Phone#: If) 7 -:) u } Legal Description (if applicable)~.:le ;;il) f ,,2/ Owner: .CfvtJL J1;1 ~P/'r- Address: \ J QJ Contractor: / .}-"-/-r Phone #: Address: Cell #: 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 valuation of $0-$50,000 $150.00 $ Original valuation of $50,000 - $100,000 $200.00 $ Original valuation of $100,000 - $500,000 $300.00 $ Original valuation of $500,000 or more $400.00 $ Issuance Fee: $ 25.00 Deposit: $ 50.00 Total Renewal Remit Fee = Permit Fee + Deposit + Issuance Fee $ 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. Date Le ~ 5 - OJ For Office Use Only WHEN PROPERLY VALIDATED (BELOW) THIS IS YOUR PERMIT "-""",-~-,,~--,---,-~,,,,."""'.~'-~-- ~"- .c:.~...,-.n"....... ..' ....~~.._._."..~..~_:::-..~_._..~"~._>c..~.... ......,~.-....". ._-~. . --_....._."-~,,.__...._....__....... Date Permit Paid: Jlfl) 3 Receipt # (,,--.::. -0'1 Approved by: - 9 ~ \~ ~hv~ I:i CITY OF BLAIR BUILDING INSPECTION REPORT D WASHINGTON COUNTY LOCATION OF CONTRACTOR- NAME OF J' -""'," /"":'/' /- ,r " ,j PERMIT DATE INSPECTION REQUESTED' J -'.~ 1 ~ I () TIME INSPECTION REQUESTED' TYPE OF INSPECTION REQUESTED: D CONFERENCE BUILDING: D FOOTING D DECK FOOTING D FRAMING D DRYW ALL..\:)G=.3FINAL D PARTIAL COMMENTS: UTILITIES: D SEWER TAP D SEWER D SEPTIC D WATERTAP D REMOTE D WATER SERVICE D PARTIAL CO ENTS: ELECTRICAL: D ROUGH IN D FINAL D PERMANENT SERVICE D TEMPORARY SERVICE D PRECONNECT D PARTIAL COMMENTS: MECHANICAL:D ROUGH-IN D A1C D FURNACE D RADIANT HEAT D FINAL D PARTIAL COMMENTS: PLUMBING: D GROUNDWORK D ROUGH-IN D FINAL D WATER METER INSTALLED D PARTIAL D PRESSURE TEST COMMENTS: D STATUS CHECK PASSED FAILED D D PASSED FAILED D D PASSED FAILED D D PASSED FAILED D D D OCCUPANCY GRANTED D CONDITIONAL OCCUPANCY GRANTED NOTESIREMARKS' N rr-t /0pu' { (' {,(elL , INSPECTOR' 11t1N~ - 1">-9-'b cc-~ DATE OF INSPECTION MADE: FAXED OPPD\BURT REA TO CONNECT SERVICE: ON BY TIME' ~. r~V'"'\.