BP13298
CITY OF BLAIR - APPLICATION FOR BUILDING PERMIT
Permit #
Date: R.. ,:q j- () q
Approximate Completion Date: q-j{)- {) 9
Site Plan Attached:
. ,/
1.,/
REScheck Attached:
Complete Plans Attached
Application for: Residential V Commercial/Industrial _
New Construction Manufactured Home Modular
Move-on: Home _ Accessory Building Other
Remodel Addition
Accessory Building: Garage _ Pole Barn ~ Other
Floor Type: Dirt _ Concrete _ Electricity: Yes l~ 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:
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Proiect Information:
Job Address:
l:J 173,5' (~) }2c/ j7/f]
Legal Description (if applicable)
Owner: C~u'i ;(~-! flu
(I..
Contractor: 'Xl.ll.e4 hrn
/.JfcJ 0 (,)' f,t;
TL f)('1
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Phone#: i/tf; 2
Address:
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Phone #: c./CL.;J ,}
,A 01 ~i.
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u;8f',O/Cell #: Lrocr-oLrt
Address:
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.
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Signature of Owner/Contractor
8 -:1/ ..O?:
Date
For Building Permits other than One & Two Family Residential Structures:
I hereby acknowledge and agree that I have/will submit a set of plans for this project to the Nebraska State Fire Marshal's Office for
Review.
Signature of Owner/Contractor
Date
ZONING REVIEW:
Zoning/Flood Plain/Utilities:
Current Zoning:
Conditional Use Permit Required: Yes _ No_
Date CUP Approved:
Yes No Variance Required: Yes _ No_
Second Front Side Side Rear_
State Fire Marshal Required:
Minimum Setbacks: Front
Lot Sauare Footage:
Length x Width:
Lot Coverage %
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
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 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
Occupancv Classification:
Assembly, theaters, with stage Assembly, th.~ater, without ~tage _
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 reQuired to be protected by 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 Deposit 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:
Business/I nd ustrial/Ed ucationa 1/ Assem bly/F actory/Storage/Utility
*Porches with roofs/screened patios are considered additions
Construction valuation computation: Sqjft area X $63
Except for the following:
Accessory Buildim:!:s & Interior Remodeling Proiects: 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 j )~ a 0
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 $1,000
X$ J?5
$ 45; tJt,)c.J, () U
Permit Fee calculated from chart above
$ 5-7tJ... 0 ()
Issuance Fee:
$ 25.00 -:::. 6-15 00
Total Permit Fee = Deposit + Permit Fee + Issuance Fee
$ if) 9,5". tJO
Additional Comments:
Approved by:
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Date:
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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
CITY OF BLAIR - APPLICATION FOR BUILDING PERMIT
Permit #
Date:
R--,:j;-oCf
Approximate Completion Date:
I ", 1'1 q' a
I Jc?- U
q- 36-{) 9
Site Plan Attached: V REScheck Attached:
Complete Plans Attached t--"'"
Application for: Residential V Commercial/lndustrial_
New Construction _ Manufactured Home Modular
Move-on: Home _ Accessory Building Other
Remodel _ Addition
Accessory Building: Garage _ Pole Barn /.,../" Other
Floor Type: Dirt _ Concrete _ Electricity: Yes t/"'" 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: t.jtJ K ~51 ? crb t!o .6P tuU d
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Proiect Information:
Job Address:
/3 735 ('it?..Ed ;0/8
Legal Description (if applicable)
Owner: C~,(;r /.iG
Contractor: YuLlJA hrn
/5tJO Jift1
Address:
Address:
YCU4n r:' J! 0vJ1 du
/5'';' J',L. d'tf../L
Phone#: ~t?:1 -533- ,;;161&
Phone #: tt/~;J-31J/- 22&0
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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.
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Signature of Owner/Contractor
8-3/"0?:
Date
For Building Permits other than One & Two Family Residential Structures:
I hereby acknowledge and agree that I have/will submit a set of plans for this project to the Nebraska State Fire Marshal's Office for
Review.
Signature of Owner/Contractor
Date
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, Blair, NE 68008
APPROVED
BUILDING
PLANNING
PUBLIC WORKS
FIRE DEPT
APPROVAL AS A RESULT OF AN INSPECTION
SHALL NOT BE CONSTRUED TO BE AN APPROVAL
OF A VIOLATION OF THE PROVISIONS OF THE
CODE OR OF OTHER ORDINANCES OF THIS
JURISDICTION,
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LAND, JRVEYOR1S CERT\F1CA1
L.E.GAL~lE.IIQN:..
Part of Tex Lot 80, thet pert lying in the S'Y:l NW'Y4 of Section 3, Tovvnshrp '18
North, Range 11 East of the 6th Principal Meridian, Washington County,
Nebraska and more particularly described as follows:
Beginning at an iron found at the southwest corner of Tax Lot 79 in SectIon
Township 18 North, Range 11 East; thence S 63051'31" E (assumed
bearing) along the southerly line of said Tax Lot 79 and Its southeasterly
projection a distance of 598.04 feet to an iron found on the westerly line of Tax
Lot 77 in said Section 3; thence S 26008'53" W along the westerly line of
said Tax Lot 71 a distance of 515.52 feet to an Iron found on the perimeter of
said Tax Lot 77; thence N 80009'2811 W along the northerly line of said Tax
Lot 77 a distance of 850.79 feet; thence N 42018'16" E a distance of 785,35
feet to the Point of Beginning; and containing '10.01 Acres, more or less.
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Scale: I"" 200'
o 3!4"Open-lop Plpo Found
o 1/2"Cpen-lop Pipe Found
I'Ii1 1/2" Rebar Found
$ 5/e"x 24" Rebar Set
(r;'I) Measured Distance
[R] Record Distance
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BUILDING PERMIT DEPOSIT AGREEMENT
$500~efundable deposit is being collected for any new commercial, new
,~jde~!Ial, 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 $50.00 refundable deposit is being collected for all misc. permits,
The City reserves the right to not refund this deposit if any of the following
conditions occur during the construction period:
1) Theft of water service by the plumber, owner or general contractor.
2) All permits have not been obtained.
3) All required inspections have not been obtained,
4) Occupancy occurs prior to a final inspection.
5) The project is completed without a final inspection being done.
6) Storm Water Management Plan inspection not obtained. (If Required)
If any or all of these situations occur during construction, you may forfeit your
deposit.
I hereby agree to the above conditions, and understand that should any or
all of the above situations occur, the building permit deposit SHALL be forfeited or
discounted upon the discretion of the City of Blair, Building and Inspections
Department.
Wd/
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Contractor/Owner
Contractor/Owner
City of Blair
9- !O- 0'1
Date
CITY OF BL1\IQ
BUILDING PERMIT SUPPORTING DOCUMENTS
This building permit packet includes various items dealing with particular code
requirements and/or building permit requirements. It in no way includes ALL particular
code items. Also, it is your responsibility to know the 2006 International BuildinQ
Code requirements that apply to your project. Please understand this packet is only
designed and distributed to aid you in your building permit process. A copy of the
International Building Code is available for your use at the Blair Public Library.
I have read the above disclosure and accept this building permit documentation on my
own behalf assuming full responsibility as the owner/contractor for this project.
Owner/Occupant
6)& Ji;tdl/I
. Contractor
City of Blair
~ 9,- 10- O?
Date
EQUAlHOU$INCI
218 South 16th Street. Blair, Nebraska 68008 . 402-426-4191 . Fax 402-426-4195 . E-mail cilyofblalr@ci.blair,ne.us "''''"''''
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BUILDING INSPECTION REPORT
OF BLAIR
D WASHINGTON COUNTY
D OTHER
LOCATION OF INSPECTION'
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NAME OF
DATE INSPECTION
TIME INSPECTION
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'ItPpRMlT NO'
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TYPE OF INSPECTION REQUESTED: D CONFERENCE
BUILDING: ,0:::FOOTING D DECK FOOTING D FRAMING D DRYWALL D FINAL D PARTIAL
D STATUS CHECK
COMMENTS:
UTILITIES: D SEWER TAP D SEWER D SEPTIC D WATER TAP D REMOTE D WATER SERVICE
D PARTIAL
~~ED FAILED
~ 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 RADIANTHEAT D FINAL D PARTIAL
PASSED FAILED
D D
PASSED FAILED
D D
PASSED FAILED
D D
COMMENTS:
PLUMBING: D GROUNDWORK D ROUGH-IN D FINAL D WATER METER INSTALLED D PARTIAL
D PRESSURE TEST
COMMENTS:
D OCCUPANCY GRANTED D CONDITIONAL OCCUPANCY GRANTED
NOTES/REMARKS'
INSPECTOR'
?!~h~
DATE OF INSPECTION MADE:
9 ;-fl"'(J 1
TIME' J 0 r~ D A(/'f'\-.
FAXED OPPD\BURT REA
TO CONNECT SERVICE: ON
BY
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L2}":CITY OF BLAIR
BUILDING INSPECTION REPORT
o WASHINGTON COUNTY
o OTHER
LOCATION OF INSPECTION'
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NAME OF
? TIME INSPECTION REQUESTED' 1,// "c:) l:' 4 l 'J'
PERMIT
DATE INSPECTION REQUESTED'
TYPE OF INSPECTION REQUESTED: 0 CONFERENCE
BUILDING: 0 FOOTING 0 DECK FOOTING 0 FRAMING 0 DRYWALL ,,~,FlNAL J'I PARTIAL
COMMENTS:
UTILITIES: 0 SEWER TAP 0 SEWER 0 SEPTIC 0 WATER TAP 0 REMOTE 0 WATER SERVICE
o PARTIAL
o STATUS CHECK
~D F~ED
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 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:
NOTES/REMARKS'
o OCCUPANCY GRANTED
CONDITIONAL OCCUPANCY GRANTED
INSPECTOR' 7 tV r4- ----
FAXED OPPD\BURT REA
DATE OF INSPECTION MADE:
TIME'
TO CONNECT SERVICE: ON
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