BP13262
CITY OF BLAIR - APPLICATION FOR BUILDING PERMIT '""I""
/' ~~.. ~'"'"iT . Permit # I :::;> ;U:~ c)
u' c c u (' {~ 1/) C 'f J,'. ...1.- C~ (hi S., -+ Y lie. ~ ~ A '
Date: '7 ~ ( 3 _0c) Approximate Completion Date: 7..- 1"3 ;)0 ( 0
Site Plan Attached: ,/ REScheck Attached: Complete Plans Attached
Application for: Residential Commercial/Industrial _
New Construction Manufactured Home Modular
Move-on: Homr-,-- 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 _
g. ,t' .', I UJ fl h J ~ ~. -f-1
R./ /::7 J 0 u Ct - "~ ?/~~rtA, u~ /./\ . .
A{iditionaJ Description of project if neces.sary: c
1::", ; K ~AL ' '-<: .
Proiect Information:
Job Address:
JJ
Be IltCif::>/f-a /atJt.,. ~4dcl ,Par?
~Description (if applicable) tJ c..c (/ f II iVC:Y --,:..;~
Owner:fN\,l'~. C~. t~l1jj1Address:
I /;3L1L- / Ill! Per I
c?,-l.;e{', -rr ~ A
Phone#:
Contractor:
Address: r, 0 '(><J~ C) u"J.lr \ W::t;A,;/~ CJ Cell #:
1'1 (f'"
o 1't'N5)j..~~ l". 8-1 \)0
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/ordin~nces 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 IS not completed within two (2) years of date of issue.
, .~
Signature of wner/c ontractv
Phone #: ~bO
..f~ ~ ,""" ..-,..;;'~
/" -/c::1 .~v f
Date
ZONING REVIEW:
Zonin1VFlood Plain/Utilities:
Current Zoning: R mG=
State Fire Marshal Required:
Minimum Setbacks: Front
Conditional Use Permit Required: Yes _ No ~
Date CUP Approved:
Yes No Variance Required: Yes _ No_
Second Front Side Side Rear_
lot Sauare Footage: ~
length x Width: lot Coverage % /
Drivewavs/Sidewalks:
Sidewalk required: Yes_ No ~ I~ ""Sidewalk Waiver: Yes _ No
iT Date Waiver Approved:
Preexisting Garage requires drive ay to be less than 3' from property line: Yes_
Approved by:
Flood Plain: Yes No
If yes, specify special requirements:
BUilDING INSPECTOR REVIEW:
Number of Stories
One Two
Three
Four
>Four
High Rise (>75 ft)_
Type 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 Footage:
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
Occupancy 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 building reauired to be protected bv automatic fire sprinkler system?"
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 Deoosit 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 sqfft area
(not including finished basement area)
Finished basement sqfft area
Unfinished basement sqfft area
Garage sqfft 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
CITY OF BLAIR - APPLICATION FOR BUILDING PERMIT -; .
.tJ CCUf{q<JCY :]:.<1- CQ.~S'-t. +Yf't:.- U-A 'Permit# I . )G:,")
Date: 7- f 3 -()1
Site Plan Attached: /
Approximate Completion Date:
REScheck Attached: Complete Plans Attached
/"
Application for: Residential Commercial/Industrial _
New Construction Manufactured Home _ Modular_
Move-on: Homr_ Accessory Bui)ding 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: Blqir _ Kennard _
County Road Permit Required: Yes_ No _ Submitted: Yes _ No _
Apditionalpescription of project if necessa.ry: J.J ~
~ JYr0.i~ 6- ~ 0,((.. ~
.Jt. .5-G'Ju 00" ':'; -- {~ ~~.
~-tJ2 6.fl.
Proiect Information:
\.
.J
Job Address: g 1 0
N. J).\~
JYr'
/
I
I
t ./
f', (\ \ :~v
1 ./
~~~UJ'
~,/'
Legal Description (if applicable)
Owner:M~. c,~- ~Address:
Contractor: ~ (~~~""'...
Address: p.lJ. f>0-.J.. '7 0 ~ 8', W~ C Cell #:
ON\." iL". t. ~I u( ,
Separate permits ~;e~;;;r 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
codesjordin ces of the City of Biair and the State of Nebraska. I understand that this permit is void if work is not commenced within
180 days IS not completed within two (2) years of date of issue.
'~/-L
Signature ~;b:"er/contractor
Phone#:
Phone #: 'h 0 ~ 3JS:::>
'7-13~D "I
Date
MECHANICAL PE~tfj:f~iPFmcA TION
Jurisdiction of City of Blair, Nebraska
218 South 16th Street
Blair, Nebraska 68008
Fax (402) 426-4195
(402) 426-4191
~
Application Date: D (f f ( () 7
Job Address
?/O
Owner (' ~p ~~d'ress J~ ^
1. fV\.)..~ ~. r"<\J \A{\.A/\4..{
ConKa~tori\ 1\' i'\ ,~^ ~ilAddr\:ss _.\) .'-
2. 1 V\~'J VV' kJL...-, '6~I) ~
3. Class of Work: -crtOMMERCIAL 0 RESIDENTIAL
Describe Work: r( / "
4. "C. e c ,'ILl c t-\eLc tell... ~
Heat Pump Tons
Central AlC Tons
Furnace BTU/H
# of Units A/C
Furnace
Completion Date:
Boiler Chart
BTU Fee
Up to 100,000....................... ....... ..$15.00
100,000-500,000...... ... ... ... .. .......... ...$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 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.
.' ~7
_....~.;;:;//<'/ . .:Z ........ .://
. /Z/7C2:</~ .-............... ..............
/ Signature of'tontractor or Authorized Agent
J~ I~J~vr
I Date
fJ
M 1904
u Q..9..-
Permit Fee: $ {O
N ')Ir~u
Zip
Phone
GJ:::t)J ()~l.~ &?I)V Phone57J_Lj;S1'
:;E(-;o.rew 0 Addition 0 Alteration 0 Repair 0 Replacement
Al( ClAvctCtln
MECHANICAL PERMIT FEES
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 to left)............ ..... ...
Appliance Vent/Fans..................... ...$10.00
Duct System................................ ..$15.00
IS-OO
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
Permit Issuance Fee... ... ... ... ...... ....... .$25.00
Total
s;< s CxJ
Yo (J~
Current License on File
DYes 0 No 0 NjA
Comment:
WHEN PROPERL Y VALIDATED (IN THIS SPACE) THIS IS YOUR PERMIT
I Approved By: '~<\ (:::"
.b 'r~
Rev. 2008-10
RESIDENTIAL - ADDITIONS / REMODELS and
COMMERCIAL - NEW CONSTRUCTION / ADDITIONS / REMODELS:
Businessjl nd ustrialjEd ucationalj AssemblyjFactoryjStoragejUtility
*Porches with roofs/screened patios are considered additions
Construction valuation computation: Sqjft area X $63
Except for the following:
Accessory Buildin~s & 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)
Construction valuation computation:
Finished sqjft area <t? J (J
X $ lo5
$ 50) t/ Ob. 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
$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
$ &'18. ()()
Issuance Fee:
$ 25.00:;; t.fJ 73. 'x.!
$ lil?3.po
Total Permit Fee = Deposit + Permit Fee + Issuance Fee
Additional Comments:
Approved by:
74h/~
Date:
gc--&-~o'1
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
-0
"
E
Vi
w
b
z
...J
<t
U
Z
<t
:r:
u
w
::;;
..c:
,,~
:3 "j:
e~
:) r=
"'~
t;::0l
g~
00.
0.
~ii:
0_
~ 0 "
H ~ ]
r---L-g -8 .s-
a:: .g ..Q .~ "0
~;og a. 5
] a: ~ .~ ~ t
ID2>-E ]g<e
> uL~ ~ >..2 10
.sN~ :3~~c
.......00 O~ .-
-*.~U~ ~a2=
.L~.E 8-~ 1- ~
...c: c u CI) Ul 0 ::J
;<.::.Bo -+-,~""'...Q
~U>O~ o.......,...E
] Ol 0 .~ S ~ B
]-g: ~~~;g
Ell) ~e~.
.g"CL e..o ~ ~
]52 =a~~g
III ~(j)..c -
L-> ::~t=
~6~ __.a L- tD
::J- 0 '*-.,....
00'02 .g~-E;
Oc3= a.CI)C~
~:8<E -ot:~.-
;:g'6t15E?;~
~~ ~~~.~.Q ~
.~ .~ ~:: g g-.~ .~
li: ~.s g,~ ~ & p:
I I I I I I
o
"
'e-
o.
"
05
e
.a
o
2
;;
Q) J1'
(; ....... ~~ 53
~ ~ ~ ~i: .~
~ ~ .~ ] :S -S CI):a e
..a~:a.~o ~~~.....
~~~o: .~Ei g
UOO~1- >......... ~
'6'St;2~ g.1:ID
Q) gU)'S~ ggo ~
~E~~:E: ~e~ ~
ct2 ~~ g .2-g-s .a
.].s~g ~u~ ~
" .Q 0 c ..... """' ~ >.. ~ g
a::~~.sfrlcr:t+=g-8 E
~~g--o g~:E:8. :S
::J U Q.) <..> N.21 OJ .~
:g:E.g --:-g-:!
813=o()....:-fi~bO'" .?:-
~~.g .~ eP.~5 ~
.- '00 .s u:; a... ..0 8."O:g
~J11:[L]-t~~8 ~
~ e ~ 0 =ti g8.e.~ ~ .
o..a %Vi ~ Q)"O &.m :J. CI)
~ '5 0 ~ .S ~ g {5 ~ .~ % ~
0)0"- v 000
"ii'i3~.s e:E ego .s 5-~
.2:E'L.-E ~.B:E~.g 2'OO'-g 8.
C<ll.s.~- Q.I_wo.-........o(l)
:3>(1) oo.....~.... E...... G g Q)+'
~ ~ ~ ~ g] g: ] '6 ~.~.~
g g.s ~N :t='J::S.9:5 g1:: 0-
~ Q.~;::t gP.s-g e 0 ~l)
.~~.8;g ~ ~ 8.e~:"8 ~ E
~g fr.......... 0 Pgd1i):S ~=
"* ~ ~~8-g~,~]g ~ ~~
~1iim:Q);';rnID~:-g~
':; e ~ ~ ~ g ~ ~"5 ~ :Q g a
egee e e e.....:t::"'O f)'-;:
a...ca...a...O"..cQ..~~gct2~
I I I I I
,.
o
-.;
.Q
o
I
";-
Vi
w
b
z
...J
<t
u
12
I-
U
W
...J
W
-0
..s
e
"
E
o
o
'"
"
:Q
.S
.Q
'"
~
U>
.x
"
ADDRESS
c
"
"
};
"
.Q
o
o
o C
" E
"0 ~
CL 8
~b
~~
~ .~
"
,,"'"
.- g'
(/) '2
~ '0
.s E
a "
E ~
o@
~ ~
:E ~
",0
'0) 0
.c: "
o E
~ =>
",0
" 0
U>
a
.Q
e
"
"
,.
o
05
'"
""
'C
"
2-
"
"
E
"
.2'
<5
"
o
"0
"
U>
a
.Q
Vi
w
b
z
e
o.
25-
ern.
.Q 0"
's 05 ~
o e
c mQ..l-"'O
" ~ 0
g ~ci.g1J
:0"'-:" (I} ~ (f) b
o~~e~~
-g ~"S:;: O'l.!:
c 0 [~=s ~
CO _:c
:3>'(I}.~(I.)Q.)
g g E ~~ ~
tJ)85c~]
g~u Q) (/) rn
~~ ~~;::~
o :;:; lo...""-""-
~~(I}a...a....a....
~ ~ '~ ci ti 0
~ K@ ~ c3 ~
~
::>
t
w
l-
I
u
'"
<t
I I
v
"" C')
~ ~ .....
0 u.. ::t
"" i
!B 0 V
m C\J
:i:
'"
..,
lii
~
~~g
~
;;,.'"
oW
'"
'"
=>
Z
<<l
W
"" "";;.:.. ~
t;~cofii w
w::> 2::.::: =:I
~~~~~~
a.ucu(3
C>
C>
C}l
en
:t=2'Q~~
~~~.g
;~;;
'2 cu cr. ffi
~~-g
E <<l '"
8 ~
[ij =a
~"~ ~
tl ~
~
CITY OF BLAIR, NEBRASKA
Phone 402-426-4191
RECEIVED OF:
ADDRESS
CITY. STATE, ZIPCODE
THANK YOU
KEEP THIS cOPy FOR YOUR RECORDS.
NO
RECEIVED BY
Pounds Printing, Blair, NE 68008
Supplemental Instruction
1112 N West Ave
Sioux Falls, SD
phone (605) 336-1160
fax (605) 336-7926
To Solve. To Excel. Together.
Marshalltown - Minneapolis - Rochester - Omaha - Rapid City - Sioux Falls - Sheridan
PROJECT
Addition and Renovation
Memorial Community Hospital & Health System
Blair, Nebraska
SUPPLEMENTAL
INSTRUCTION NO.:
200
DATE OF ISSUANCE:
June 22, 2009
FROM ARClllTECTUE
TSP, Inc.
1112 North West Avenue
Sioux Falls, SD 57104
OWNER
Memorial Community Hospital & Health System
810 North 22ud Street
PO Box 250
Blair, Nebraska
PROJECT NUMBER:
07060136
TO CONTRACTOR (Name and Address)
Hawkins Construction Company
PO Box 9008, Station C
Omaha, NE 68109
CONTRACT FOR:
CM GMP
CONTRACT DATED:
The Work shall be carried out in accordance with the following supplemental instructions issued in accordance with the
Contract Documents. For items described herein that require a change in Contract Sum and Contract Time, please
submit an itemized proposal for the proposed modifications to the Contract Documents. Within 10 days, the Contractor
must submit this proposal or notify the Architect, in writing, of the date on which proposal submission is anticipated.
ITEM NO. 1:
Reference Sheet A-124
1. Plan for changes at Discharge Canopy (former ED canopy).
2. Metal products and detail changes for soffit and fascia are not identified. GC working with
supplier.
a. Soffit panels are recommended to run perpendicular to the building/line of travel as the
vestibule wall is skewed from the outermost column line.
ATTACHMENTS:
. A-124, Sheet 1 of 1
ISSUED BY:
(Signature)
Alison M. Topp, AlA
(Name & Title)
cc: File
G:\2006\07060136 _ Memorial Comm Hospital Addition _ Blair.NE\01_Documents\05_ConstructionAdministration\06-S1\51200\51200 062209.doc
g j D IV, 'J- ';}. foJ & <.) -1: f eri)..;M-.;t> ~ i3.l 6 a..
NEBRASKA STATE FIRE MARSHAL
PLANS DIVISION
Code Review
7/7/2009
I M 07007-09
1
Rex Hambrock
TSP, Inc.
9802 Nicholas Street, Suite 350
Omaha, NE 68814-
Memorial Community Hospital
810 N 22nd Street
Blair 68008-
Your items have been reviewed for compliance with the Nebraska State Fire Marshal Act.
jFinal Architectural Plan
,
REMARKS:
Plan review is for a discharge canopy and vestibule only.
1. If a fire sprinkler system is provided for the existing structure it must be extended to the new vestibule
and canopy.
2. Shop drawings for automatic sprinkler system shall be submitted for separate review and approval.
Title 153 Ch 21,003.01
This code review does not determine compliance with the State of Nebraska Accessibility Guidelines.
This determination shall be done by the local jurisdiction in which the project is
located.
cc. Blair Codes
Page toft
PLEASE CONTACT OFFICE INDICATED BELOW FOR A FINAL INSPECTION.
FINAL APPROVAL IS REQUIRED PRIOR TO OCCUPANCY OR USE
SIGNED:
Jim Kenney
Reviewed By: Main Office
246 South 14th Street
Lincoln, NE 68508-1804
(402) 471-2027
Contact for Inspection: District A
246 South 14th Street
Lincoln NE 68508-1804
(402) 471-2590
CITY or BLAIR
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 Buildinq
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.
Owner/Occupant
/d)~i.LI -i.L rf~j.
Contractor
City of Blair
o "
~ -1/ -() ')
Date
EQUAlHOU5l'1G
218 South 16th Street. Blair, Nebraska 68008 . 402-426-4191 . Fax 402-426-4195 . E-mail cltyofblair@ci.blair.ne.us "'"'""'''
BUILDING PERMIT DEPOSIT AGREEMENT
~~efundable deposit is being collected for any new commercial, new
~sidentia1, and any additions, remodels and accessory building valued $10,000 or
grea"tet 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.
~/4vL~/L ~Ji/"_ r!~cf.
Contractor/Owner
Contractor/Owner
City of Blair
'?-/I-O 7'
Date
L7Lw
':@:'CITY OF BLAIR
BUILDING INSPECTION REPORT
Off
o OTHER
(tIC:7 (((pi 11.'j"""'
o WASHINGTON COUNTY
LOCATION OF INSPECTION' ..):,:>>/,.):;.;,/(;:/ I j</ .
. ,. ) / ;. / I / 'I // __.'j
::~:::::2:~::::tt~ (~~~/~:;~f::~~:::A:::S1":':'~l'; '~i') i~(Pl ';~ERWI' ~(5 ')
r
TYPE OF INSPECTION REQUESTED: 0 CONFERENCE
BUILDING: 0 FOOTING 0 DECK FOOTING .g:;;FRAMING 0 DRYWALL 0 FINAL 0 PARTIAL
COMMENTS: Vt/ A U/:5'
UTILITIES: 0 SEWER TAP 0 SEWER 0 SEPTIC 0 WATER TAP 0 REMOTE 0 WATER SERVICE
o PARTIAL
o STATUS CHECK
PASSED FAILED
~- 0
COMMENTS:
ELECTRICAL: 0 ROUGH IN 0 FINAL 0 PERMANENT SERVICE 0 TEMPORARY SERVICE 0 PRECONNECT
o PARTIAL
PASSED FAILED
o 0
COMMENTS:
PASSED FAILED
o 0
COMMENTS:
PLUMBING:
o AlC 0 FURNACE 0 RADIANT HEAT 0 FINAL 0 PARTIAL
PASSED FAILED
o 0
COMMENTS:
o OCCUPANCY GRANTED 0 CONDITIONAL OCCUPANCY GRANTED
o
o
ROUGH-IN 0 FINAL 0 WATER METER INSTALLED 0 PARTIAL
PASSED FAILED
o 0
NOTES/REMARKS'
INSPECTOR-
/lWd1---- /
DATE OF INSPECTION MADE:
cr - I ~- 09
TIME- I ffMA..
FAXED OPPD\BURT REA
TO CONNECT SERVICE: ON
BY
1Ir""... __ _ ",",'"
~
J JE (DEe 1 '7 fNT'D
J~~
NEBRASKA STATE FIRE MARSHAL
PLANS DIVISION
Code Review
7/7/2009
1M 07007-09
I
/1 ;}-t J-
Rex Hambrock
TSP, Inc.
9802 Nicholas Street, Suite 350
Omaha, NE 68814-
(605) 336-1160
Memorial Community Hospital
810 N 22nd Street
Blair 68008-
Your items have been reviewed for compliance with the Nebraska State Fire Marshal Act.
* Approval is conditional upon conformance with comments listed in remarks.
IFinal Architectural Plan
IIRemodel
I
REMARKS:
Plan review is for a discharge canopy and vestibule only.
1. If a fire sprinkler system is provided for the existing structure it must be extended to the new vestibule
and canopy.
2. Shop drawings for automatic sprinkler system shall be submitted for separate review and approval.
Title 153 Ch 21,003.01
This code review does not determine compliance with the State of Nebraska Accessibility Guidelines.
This determination shall be done by the local jurisdiction in which the project is
located.
cc. Blair Codes
Page 1 of2
PLEASE CONTACT OFFICE INDICATED BELOW FOR A FINAL INSPECTION.
FINAL 0 ITE A PROVAL IS REQUIRED PRIOR TO OCCUPANCY OR USE.
Jim Kennev
SIGNED:
Reviewed By: Main Office
246 South 14th Street
Lincoln, NE 68508-1804
(402) 471-2027
Contact for Inspection: District A
246 South 14th Street
Lincoln NE 68508-1804
(402) 471-2590
7/7/2009
I M 07007-09
I
') d-b d--
Rex Hambrock
TSP, Inc.
9802 Nicholas Street, Suite 350
Omaha, NE 68814-
(605) 336-1160
Memorial Community Hospital
810 N 22nd Street
Blair 68008-
Your items have been reviewed for compliance with the Nebraska State Fire Marshal Act.
* Approval is conditional upon conformance with comments listed in remarks.
IFinal Architectural Plan
IIRemodel
,
Alt Phone:
Occupancy Type: Health Care
Estimated Start Date: 7/1/2009
Fire Protection Features:
Sprinkler Total ~ Spinkler Partial D Range Hood System D Sprinkler Other:
Fire Alarm Manual Sys. D Smoke Detection ~ Heat Detection D Fire Alarm Other:
Email: hambrockra@teamtsp.com
Construction Type: II-A 227 SF
Estimated Completion Date: 10/1/2009
Page 2 of2
PLEASE CONTACT OFFICE INDICATED BELOW FORA FINAL INSPECTION.
FINAL 0 ITE A PROVAL IS REQUIRED PRIOR TO OCCUPANCY OR USE.
SIGNED:
Jim Kennev
Reviewed By: Main Office
246 South 14th Street
Lincoln, NE 68508-1804
(402) 471-2027
Contact for Inspection: District A
246 South 14th Street
Lincoln NE 68508-1804
(402) 471-2590