BP13358h
DEC MI
CITY OF BLAIR - APPLICATION FOR BUILDING PERMIT
Pom,e Permit #
Date: � 1 I .90
Approximate Completion Date:
1 3s--,�
111 ( (c)
Site Plan Attached: RESche k 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
Sign Erecting, Awnings Decks/Handicap Ramps (plot pian required)
Satellite Dishes/Radio Antenna/Cell Towers (plot pian required)
Other
M
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
dditlonai Description of project if necessary: � sf
&m VVA
1_ �
® i
Project Information:
Job Address: -cutu--6)
Legal Description (if applicable)
Owner: La&c Address: Phone#:�o�'1
Contractor: a W Phone #:
Address: Cell #: 0- ' l
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 spe'pifications set forth above and in accordance with the
codes/ordinances of the City of Blair and the State of Nebraska. I understand tha this permit is void if work is not commenced within
3 0 or is not completed within two (2)—yeaysof date of issue.
nature Own Contr for 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/Uti ities:
Current Zoning: Conditional Use Permit Required: Yes No
' Date CUP Approved:
State Fire Marshal Required: Yes No Variance Required: Yes No
Minimum Setbacks: Front Sego, d_Front Side Side Rear
Lot Square Footage:i,
Length x Width: Lot Coverage % '
Driveways/Sidewalks:
Sidewalk required: Yes No Sidewalk Waiver: Yes N
Date Waiver Approved:
Preexisting Garage requires driveway to be less than 3' from property line:
Approved by:
Flood Plain: Yes No
If yes, specify special requirements:
BUILDING INSPECTOR REVIEW:
Yes
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: Second Level: Third Level
Basement: (Unfinished) (Finished)
Garage: 2 bay 3 bay 4 bay 5+ bay
Detached Garage: Pole Barn:
Addition: Remodel:
Porch: Front Rear Side
Deck that affect setbacks: Rear Front Side
Occur)ancv 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
Residential, care/assisted living facilities
Storage, moderate hazard Storage, low hazard Utility, miscellaneous
Is building rewired 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. Al 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 sq/ft area X $92
(not including finished basement area)
Finished basement sq/ft area X$56
Unfinished basement sq/ft area X $29
Garage sq/ft area X $25
Total Valuation:
Total Valuation
Issuance Fee:
Multiplied by 0.006 =
R
R
$ 25.00
Total Permit Fee = Deposit + Permit Fee + Issuance Fee $
i%jimi-- ItlGYY liVItlJIRIJVIIVItl z YIVVIIIVItlJ/ RGIYIVVGLJ.
Business/Industrial/Educational/Assembly/Factory/Storage/Utility
*Porches with roofs/screened patios are considered additions
Construction valuation computation: Sq/ft area X $63
Except for the following
Accessory Buildings & Interior Remodeling Projects: sq/ft area X $43
Pole barns with no hard surface floor: sq/ft area X $25
Sign Erecting/Awnings and Decks/Handicap Ramps: sq/ft area X $25 (Minimum
valuation of $2000)
Construction valuation computation:;
Finished
sq/ft area
—X$
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$1,000,000..................................................$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
0C,
$
Issuance Fee:
$ 25.00
Total Permit Fee = Deposit + Permit Fee +
Issuance Fee
$
Additional Comments:
Approved by: 1_, ' Date:I % e%
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
ED
PLUMBING A'PhiCATION
Jurisdiction of City of Blair, Nebraska
218 South 16th Street
Blair, Nebraska 68008
Fax (402) 426-4195
(402) 426-4191 /
Permit Fee: $ '—i . 0
Application Date: (—I /2—I I CD
P 2101
WIIEN PROPERLY VALIDATED (IN THIS SPACE) THIS IS YUUR PERMIT
Approved By:
Rev. 2008-10
Job Address
l2 Z i PL>1e �,x rI
Owner ' Mail Addres Zip Phone
1. `jc5oc' ZiO-cttfL
Contractor r Mail Address Zip Phone
2. ' P 10
3. Class of Work: O COMMERCIALESIDEN AL O New O Addition O Alteration O Repair O Replacement
Describe Work: II J
4.
PLUMBING PERMIT FEES
Comments:
Modular Home ......................$50.00
Type of Fixture No.
Kitchen .............................. $12.00 x
Bath.....Residential/Single Stall $12.00 x I Z
....................Multi -Stall $25.00 x
Rough -In Bath ........................$8.00 x
Additional Sinks.....................$6.00 x
Slop Sink/Laundry Tray/Drain ..... $6.00 x
Water Heater .........................$10.00 x
Notice
Outside Water Faucet...................$6.00 x
I hereby certify that I have read and examined this
Drinking Fountain ........................$6.00 x
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
Backflow/Grease Trap$15.00
not. The granting of a permit does not presume to give
authority to violate or cancel the provisions of any other
Water Service .......................$15.00
state or local law regulating construction or the
Sewer
performance of construction.
.................................$15.00
Groundwork .........................$15.00
Septic Tank & Laterals............ $15.00
Lawn Sprinkler System ............ $10.00
Sprinkler System (Commercial)..$30.00
Gas/Water Piping System
(Commercial)........................$50.00
A
i nature Contractor or Authorized Agent
Permit Issuance Fee.................$25.00Y .per
r
cJ /)
b ��✓
Total (_ , O6
Z5
Current License on File Yes O No O N/A
Date
Comment:
WIIEN PROPERLY VALIDATED (IN THIS SPACE) THIS IS YUUR PERMIT
Approved By:
Rev. 2008-10
ELECTRICAL C
Jurisdiction of City of Blair, Nebraska
218 South 16"' Street ,1k
Blair, Nebraska 68008
Fax (402) 426-4195 E 3197
(402) 426-4191
j00
Application Date: �I 2- O Permit Fee: $ 010
Job Address
2 � —P(Y1c wcC of
Owner Addre s Zip Phone
,Mail
Contractor Mail Address Zip Phone
2.
3. Class of Work: NEW RESIDENTIAL O NEW COMMERCIAL O REMODELING/ADDITIONS O UPGRADE SERVICE
Describe Work:4. Cf�fc3c)4,`
V"1 j
,ktn
5.Current License on File O Yes O No O N/A Completion Date
ELECTRICAL PERMIT FEES
Service Fee = (Amp Fee + $5.00 per branch circuit)
Upgrade Existing Service.............$25.00
1-100 Amp Fee .......................$25.00
Temporary Service............ ..... $15.00
101-200 Amp Fee .......................$35.00
Fire Alarm Sy stem ............ • • • • • • •••$15.00
201-300 Amp Fee .......................$55.00
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
# of Circuits x $5.00
901-1000 Amp.........................$195.00
Amp Fee
IF OVER 1000 Amp
15t 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 ....... $50.00
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
Rec ptacles/Switches/Lighing Fixtures (110 volt only)
authority to violate or cancel the provisions of any other
# of Apparatus �' x $1.00 6 00
state or local law regulating construction or the
..........
performance of construction.
Power Apparatus (220 Volt or higher)
# of Apparatus....... x $8.00
Smoke Detectors..... x $3.00
igna of Co or nth ized Agent
_
Permit Issuance Fee.. ..$25.00
o�
Total
Date
Comment:
WHEN PRO ERLY VALIDATED (IN THIS SPACE) THIS IS YOUR PERMIT
Approved By:
Rev. 2008-10
CITY OF
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, Bleu, NE 68008
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.
IIJJ
Contractor/Ow rF
Date
Contractor/Owner
City of Blair
-'Rise 01 a"
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 Building
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
City of Blair
Contractor
Date
218 South 16th Street • Blair, Nebraska 68008 • 402-426-4191 • Fax 402-426-4195 a E-mail cityofblair@ci,blair,ne.us
BUILDING INSPECTION REPORTF
❑ CITY OF BLAIR ❑ WASHINGTON COUNTY ❑ OTHER E
LOCATION OF INSPECTIONS �,•' °' -
NAME OF OWNERS 4 CONTRACTOR-' a
DATE INSPECTION REQUESTED- TIME INSPECTION REQUESTED- PERMIT NO -
TYPE OF INSPECTION REQUESTED: ❑ CONFERENCE
❑ STATUS CHECK
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-10"ROUGH
IN ❑ FINAL ❑ PERMANENT SERVICE ❑ TEMPORARY SERVICE ❑ PRECONNECT�PASSED
FAILED
❑
COMMENTS:
MECHANICAL: ❑
ROUGH -IN ❑ A/C ❑ FURNACE ❑ RADIANT HEAT ❑ FINAL ❑ PARTIAL
PASSED
FAILED
❑
❑
COMMENTS:
PLUMBING: ❑
GROUNDWORK ❑ ROUGH -IN ❑ FINAL ❑ WATER METER INSTALLED kPARTIAL
PASSED
FAILED
❑
PRESSURE TESTSe� 1
ElCOMMENTS:
_
_ ®V qi,cy
❑ OCCUPANCY GRANTED ❑ CONDITIONAL OCCUPANCY GRANTED
NOTES/REMARKS-
1! I r12th J i J e ilk 16, L 6L,_4- C i GL's, 10_ 2 k
, f 4 i A
�r
INSPECTOR- DATE OF INSPECTION MADE: (7 TIME: l
FAXED OPPD\BURT REA TO CONNECT SERVICE: ON BY
1-3 3 - F
jdgG2010 09:53 AM - - �