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CITY OF BLAIR - APPLICATION FOR BUILDING PERMIT
Permit # j:3 33 cf
Date:
'0 I?:>o 10<1
Approximate Completion Date: -1-' - 30- 0 q
Site Plan Attached:
REScheck Attached:
Complete Plans Attached
Application for: Residential 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 _ No _
Sign Erecting, Awnings ~ Decks/Handicap Ramps (plot plan required) _
Satellite Dishes/Radio ~na/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: St 'j nS- ~(ec f-flJ(o.v/ wJtl
be Qddu~
Proiect Information:
Job Address:
'2-\ r s' ~ 1- "" 3)~ZI/i ;21 P Z o~
Legal Description (if applicable)
j 1Le
Owner: ~ 0, ~
81cJ{)3C1830
Address:
~
Phone#:
Contractor: CD;:) Sigil lfJ '
Address: '2\ q 2...a P{ (JI.-Hevu.-v1 eel
C~'f..{v:),
lo $502.~ ~ \ Cell #:
Phone #:
2-00
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.
Signature of Owner/Contractor
Date
For Building Permits other than One & Two Family Residential Structures:
~I e e y cknowledge and agree that ave/will submit a set of plans for this project to the Nebraska State Fire Marshal's Office for
Review.')
l'
'V:~ (tJ (':SC) 0 CI
t' of Own r/Contractor Date . '
ZONING REVIEW:
Zonim!/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 Square Footage:
length x Width:
lot Coverage %
Driveways/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
Th ree
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 by automatic fire sprinkler 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. AI will review all second access requests and industrial and
commercial driveway requests)
Required Off Street Parking:
Permit Fee Calculation:
Suildim! 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:
Businessjl nd ustrial/Ed ucationa 1/ Assem blyjF actoryjStoragejUtility
*Porches with roofs/screened patios are considered additions
Construction valuation computation: Sqjft area X $63
Except for the followin~:
Accessory Buildings & Interior Remodeling Proiects: sqjft area X $43
Pole barns with no hard surface floor: sqjft area X $25
Si~n Erecting/Awnings and Decks/Handicap Ramps: sqjft area X $25 (Minimum
valuation of $2000)
- '6/0 ,~,ft.
. . . 1 s( (J \1\
Construction valuation computation:
Finished sqjft area Z,^c:I S/91\ ::.- 3S~ 2,%
-::.. 2- L{ - <;{~ '7 ~o ,llf
X$ ~,S- $
) :'>-03_ S~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
$ B 5'. CO
Issuance Fee:
$ 25.00
50,CU
$ / ex),- ()()
Total Permit Fee = Deposit + Permit Fee + Issuance Fee
Additional Comments:
Approved by:
I)
<~).... I
,> < iA
.1,. j"
'If f, j,;,',,/Kf
>"', ii/V'" 1 "',~"
I
Date:
II ? ()'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
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
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Howard Wolfe
From:
Sent:
To:
Subject:
Attachments:
Jay Muller [JayMuller@cbssigns.com]
Friday, November 06, 2009 8:40 AM
Howard Wolfe
Installation information on signs for Blair Plaza
Blank Bkgrd.gif; CBS 123131.jpg; 101_0187,JPG; 101_0188,JPG
Howard Let me know if you need anything else
Jay Muller
CBS Sign Co
Office: 402 332-0080
Cell: 402740-1784
1
BUILDING INSPECTION REPORT
, E]'- -' CITY OF BLAIR ❑ WASHINGTON COUNTY ❑ OTHER
LOCATION OF INSPECTION -
NAME OF OWNER J� CONTRACTOR Ko% - my r.
DATE INSPECTION REQUESTED TIME INSPECTION REQUESTED: A PERMIT NO:
TYPE OF INSPECTION REQUESTED: ❑ CONFERENCE
❑ STATUS CHECK
BUILDING: F FOOTING ❑ DECK FOOTING E:l FRAMING E:l DRYWALL F INAL ❑ PARTIAL
R4SSED
FAILED
F-I
COMMENTS:
UTILITIES: F SEWER TAP ❑ SEWER ❑ SEPTIC WATER TAP ❑ REMOTE ❑ WATER SERVICE
PASSED
FAILED
[_1 PARTIAL
F
❑
COMMENTS:
ELECTRICAL: F ROUGH INF FINAL F PERMANENT SERVICE ❑ TEMPORARY SERVICE ❑ PRECONNECT
PASSED
FAILED
❑ PARTIAL
1
F
COMMENTS:
MECHANICAL: ❑ ROUGH-IN ❑ A/C ❑ FURNACE ❑ RADIANT HEAT ❑ FINAL ❑ PARTIAL
PASSED
FAILED
COMMENTS:
PLUMBING: F GROUNDWORK F ROUGH-IN ❑ FINAL ❑ WATER METER INSTALLED ❑ PARTIAL
PASSED
FAILED
❑ PRESSURE TEST
❑
❑
COMMENTS:
❑ OCCUPANCY GRANTED ❑ CONDITIONAL OCCUPANCY GRANTED
NOTES/REMARKS -
n
INSPECTOR DATE OF INSPECTION MAD
TI F.
FAXED OPPD\BURT REA TO CONNECT SERVICE: ON By