BP13361
Date:
Itl2L{j OC1
Site Plan Attached: REScheck Attached: Complete Plans Attached
Application for: Residenti,vV Commercialjlndustrial_
New Construction ~ Manufactured Home _ Modular_
Move-on: ~o/I1e _ Accessory Building Other
Remodel N Addition
Accessor/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 _
~ddit7ional Description of project,;f necessary:frA.?emeAJ. ~ Fam ( I Y ~()VV1.
V\j _ baY' n. 'r R c..... - Bcd.A.J'Lvl-'VI - ~ StDr1Cl ~ O-t---e.-L
I
Proiect Information:
Job Address:
3YD E .1:?CLV 0 Vl LlCJt-- 1) fZ &' 9 (} () if 175' k/
Legal Description (if applicable) (,.:&3 "/;~Mt5'7Jc? 0::1 I,{zMit:l ,;;;r; t
(j /1
Owner: KeJJ\ (,1 lAClAJ~ Address~ '
C.J L' (-
Contractor: ol
7 1/5' j'7c~
Phone#: Lf~,-LJq 1;)-
Phone #:
Cell #:S\s ~~'!-3L{
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/ordinanc~ of the Cit}1of Blair and the State of Nebraska. I understand that this permit is void if work is not commenced within
,.0 d"Y"i!~tio' ~pl" ; with!" ,t (2) ye,~ of d,'oo",,",. . L ~
. . ~ .. ) /'~ 2~nJ-,)'
ature of Owner Contractor D~e /
/
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:
Zonim!/Flood Plain/Utilities: \ '
Current Zoning: a]J Conditional Use Permit Required: Yes _ No,4
~ ,~/ Date CU~ Al?proved: \
State Fire Marshal Required: Yes _ No * Variance Required: Yes _ No_
Minimum Setbacks: Front _ Second Front " Side Side Rear_
Lot Square Footage:
Length x Width:
1\ ,i
~-".
Drivewavs/Sidewalks:
Sidewalk required: Yes_ No_
Lot Coverage %
f,J
Sidewalk Waiver: Yes
Date Waiver Approved:
Preexisting Garage requires driveway to be less than 3' from property line: Yes_
Approved by:
! 'f\~"
No
Flood Plain: Yes No "'j-,,--
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
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 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:
Busi ness/I nd ustrialjEd ucationalj Assem bly/Factory /Storage/Utility
*Porches with roofs/screened patios are considered additions
Construction valuation computation: Sqjft area X $63
Except for the following:
Accessory Buildings & Interior Remodeling Projects: sqjft area X $43
Pole barns with no hard surface floor: sqjft area X $25
Sign ErectimUAwnings and Decks/Handicap Ramps: sqjft area X $25 (Minimum
valuation of $2000)
Construction valuation computation:
Finished sqjft area
2-
X $ l{:J
$ ~3(1,i !~i!1L{.
--~\ '
!ii It
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
$
$
$
t~)" I' 6
<- ,-
Issuance Fee:
25.00
Total Permit Fee = Deposit + Permit Fee + Issuance Fee
~ I' ')
. ,,{lLt) (~('
LI q
f. I
Additional Comments:
Approved by:
~1/' /' ,ii
/'. ," )?I,'''f.,;..
I
Date:
II ( ,:' I
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
T f 2 2
ELECTRICAL PERMIT APPLICATION
Jurisdiction of City of Blair, Nebraska
218 South 16th Street
Blair, Nebraska 68008
Fax (402) 426-4195
(402) 426-4191
~
Application Date:
r /- 01
Job Address
Owner
1.
Service Fee = (Amp Fee + $5.00 per branch circuit)
1-100 Amp Fee...... ......... ...... ..$25.00
101-200 Amp Fee......... ... ...... ... ..$35.00
201-300 Amp Fee... ... ...... ... ..... ...$55.00
301-400 Amp Fee............ ......... ..$75.00
401-500 Amp Fee.......................$95.00
501-600 Amp Fee...... ...... ... ...... $115.00
601-700 Amp Fee................... ..$135.00
701-800 Amp Fee.................... .$155.00
801-900 Amp Fee................... ..$175.00
901-1000 Amp....................... ..$195.00
IF OVER 1000 Amp
1st 1000 Amp Fee..................$195.00
Each additional 1 00 Amps..... ....$20.00
Notice
I hereby certify that I have read and examined this
application and know the same to be true and correct. All
provisions oflaws 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.
Agent
- IA - j(J
Date
'<7 V <tic.. e = ""'" ~
1;/
J
E 3171
Permit Fee: $
(yti,
bJ'
Phone
I Zip
c)t7t:) p/./
Zi12, _;;;? /J . , / Phone.
&',_9'~ ~'4?t /'1C: &CtJi1!3
o REMODELING/ADDITIONS 0 UPGRADE SERVICE
Completion Date
ELECTRICAL PERMIT FEES
Upgrade Existing Service............ .$25.00
Temporary Service.................... $15.00
Fire Alarm System................. ....$15.00
Signs (each)........................ ......$25.00
Miscellaneous Apparatus......... .....$15.00
CommerciallMulti Family and All Upgrades:
# of Circuits x $5.00
Amp Fee (~qfr (){}
Amp Fee + Circuit Total
New Residential: (Finished Area)
Single/Two Family Dwellings
sq. ft. x .063
Modular/Manufactured Homes...... .$50.00
Other: (alterations, additions and modifications)
.?~ CJO
U(.J'
Receptacles/Switches/Lighting Fixtures (110 volt only)
# of Apparatus.......... x $1.00
Power Apparatus (220 Volt or higher)
# of Apparatus....... x $8.00
Smoke Detectors.....
x $3.00
Permit Issuance Fee... .............. ..$25.00
<).,t.-"
~'.J'
Total (//
.tY{)
Comment:
WHEN PROPERL Y VALIDATED (IN THIS SPACE) THIS IS YOUR PERMIT
I Approved By: '7) r. / '. -
( 7) , J r -1?Ul40
I
Rev. 2008-10
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
o
~~
'--.-
)
":;Y
a::
g
Cl
::i
o
(/)
\)/'(''-)'J
/1, '::'o~i5
890
. ----J
118-S
~ '-
/'
- -=-----==-- - 119-, t I
o
,....;
I
00
\
\
\
I
/
'V
c
w
>
o
a:
Om
Om
<(
J:
I-
u"'LL
00
~(I)
Z OW
- ~o
Zw(l)z
<m><
LLOO~
OI-OCc
cll.oc
~wwo
=>':I:
=>OCI-OC
(l)I-LLW
W(I)oJ:
OCz I-
<ozo
00 .
(l)w-LL.:z
<m!;!OQ
..Jb..Ja:t;
4: 00_
>z- C
O..J > W(I)
L" ':':! <( 0 a:
:. '~CJ Ii. 0 ::)
t. "":: '0<:> f...
~' tlJ l \",J __
- 1117-ltZ
116-1171
0=
,....;
I
~
118-,6
~-
w
~
rl::
0/",
f-(@
en ~(. 0
'\ (/)
'\,
",
>
/'
/
,/
, '~
I
I
I
,
,
I
I
, I
I:>
: I
,
: I
I
,
I
I
,/
o
-'
,....;
...-l
\
\
\
.:
v
IIV-S
r----------
---
I
T
-----::f------
w
~
z
a::
::l
u.
9-
,/
/'
- ~ -899Z- _
o
Cl
Cl
::i
o
(/)
'-,
I I
I" I
19EzumtI :
I I
I I
I I
I I
I I
I
I
I
I
,~ :9EZUraa
VI?[I (..." i
:;~;;'~:::;;; :~; !
{':"(7i1n:
'. .
"
J\
I
I
.I
I
I
I
I
I
I
I ~
I
I
I
I
I
I
I
I
I
I
I
I
I
.
f(
.
S
~
PLUMBING PERMIT APPLICATION
Jurisdiction of City of Blair, Nebraska
218 South 16th Street
Blair, Nebraska 68008
Fax (402) 426-4195
(402) 426-4191
340 'C 8a.YOh~'
Mail Address
5~
Application Date: ~ :A ~ ( OC1
Job Address
, Cll.J I
Mail Address
Comments:
Notice
I hereby certify that I have read and examined this
application and know the same to be true and correct. All
provisions oflaws 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.
P 2073
J...~oD
Permit Fee: $ _V'"-
rL-
Zip
. Phone
4~0 ~ L{q l;)--
Phone
lip
o Addition 0 Alteration 0 Repair 0 Replacement
VVtCcW
PLUMBING PERMIT FEES
Modular Horne... ... ... ...... ... ....$50.00
Type of Fixture No.
Kitchen...... ... ... ... ... ...... ... ...$12.00 x
Bath... ..Residential/Single Stall $12.00 x' I
.................. ..Multi-Stall $25.00 x
Rough-In Bath....................... .$8.00 x_
Additional Sinks....... ... .......... .$6.00 x I
Slop Sink/Laundry Tray/Drain.....$6.00 x_
Water Heater.................... .....$10.00 x
Outside Water Faucet...................$6.00 x
Drinking Fountain........................$6.00 x
[.;;z;oo
~,oD
Backflow/Grease Trap........... ..$15.00
Water Service.................... ...$15.00
Sewer............................... ..$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
Current License on File
Comment:
Permit Issuance Fee............... ..$25.00
DYes
WHEN PRO PERL Y V ALIDA TED (IN THIS SPACE) THIS IS YOUR PERMIT
I Approved By: ~ Usura i^----
Rev. 2008-10
ELECTRICAL PERMIT APPLICATION
Jurisdiction of City of Blair, Nebraska
218 South 16th Street
Blair, Nebraska 68008
Fax (402) 426-4195
(402) 426-4191
Application Date:
(l /dL{ ( 01
Job Address
E 3169
Permit Fee: $
-ill
3"\0 E eD.V. Onus )
Mail Address
., n
Zip
Phone
tt~~LfCHo-
Phone
Owney
L \~t.\l\V\
Contractor ('
2. ~
3. Class of Work: 0 NEW RESIDENTIAL 0 NEW COMMERCIAL
Describe Work: i'l... f' ~. ^. " , 1\. () , ' I . il
4. '~YULL\....X' /<.JLVV'OCu->-
5.Current License on File 0 Yes 0 No 0 N/A
Service Fee = (Amp Fee + $5.00 per branch circuit)
1-100 Amp Fee..................... ..$25.00
101-200 Amp Fee..................... ..$35.00
201-300 Amp Fee... ...... ......... .. ...$55.00
301-400 Amp Fee..................... ..$75.00
401-500 Amp Fee...... ... .......... .. ..$95.00
501-600 Amp Fee.................... .$115.00
601-700 Amp Fee................... ..$135.00
701-800 Amp Fee...... ...............$155.00
801-900 Amp Fee................... ..$175.00
901-1000 Amp....................... ..$195.00
IF OVER 1000 Amp
1 st 1000 Amp Fee... ... ...... .. ....$195.00
Each additional 100 Amps...... ...$20.00
Notice
I hereby certify that I have read and examined this
application and know the same to be true and correct. All
provisions oflaws 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 cons -ruction.
OIL-
Zip
REMODELING/ADDITIONS 0 UPGRADE SERVICE
Completion Date
ELECTRICAL PERMIT FEES
Upgrade Existing Service... ......... .$25 .00
Temporary Service.................... $15.00
Fire Alarm System.................. ...$15.00
Signs (each)................... ..... ......$25 .00
Miscellaneous Apparatus......... .....$15.00
CommerciaIIMulti Family and All Upgrades:
# of Circuits x $5.00
Amp Fee
Amp Fee + Circuit Total
New Residential: (Finished Area)
Single/Two Family Dwellings
sq. ft. x .063
Modular/Manufactured Homes...... .$50.00
Other: (alterations, additions and modifications)
Receptacles/Switches/Lighting Fixtures (110 volt only)
# of Apparatus .......... x $1. 00
It>
~q
Power Apparatus (220 Volt or higher)
# of Apparatus....... x $8.00
Smoke Detectors.....
x $3.00
Permit Issuance Fee................. ..$25.00
-25. DC>
\0
Total
Comment:
WHEN PROPERL Y VALIDATED (IN THIS SPACE) THIS IS YOUR PERMIT
I Approved By: X Usodtu--
Rev. 2008-10
MECHANICAL PERMIT APPLICATION
Jurisdiction of City of Blair, Nebraska
218 South 16th Street
Blair, Nebraska 68008
Fax (402) 426-4195
(402) 426-4191
Application Date: \q 2'-t I D q
Job Address
M 1944
<-{)9
Permit Fee: $5S
3\{D E .9aJ^O VI a.
Mail Address
S~
Mail Address
~~ h \:-\a.A..A
~~ntra~-l~
3. Class of Work: 0 COMMERCIAL 0 RESIDENTIAL
Describe Work:
4.
Heat Pump
CentralAlC
Tons
Tons
Furnace
BTU/H
AlC
# of Units
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 oflaws 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 regUlatin~con truction or the
Of~O~d:
Signture of Contractor or Authorized Agent
\p
/ //z- Lf/?'l
{ D~te' ,
./)r
Zip
~, ,-/q {:d-
Phone
Zip
o New
o Addition
o Replacement
o Alteration 0 Repair
MECHANICAL PERMIT FEES
FurnacelHeat Pump/Air Conditioner (Per Unit)
Up to and including 100,000 BTU / 3Ton............................$15.00
FurnacelHeat Pump/Air Conditioner (Per Unit)
Over 100,000 BTU / 3 Ton.............................................$25.00
Refrigeration Units/Coo1ers/Lines/Compressor - Commercial
(New or Replacement) (Per Unit)
. . . .. . . . . . . . .. . . . . .. . . .. . .. . . . . . . .. . . .. . . . . . . . .. .. . . .. .. .. . . . . . . . . . . .. . .. . . ... $15.00
Boiler (use BTU Chart to left)....................
Applian~............ ............$10.00
Duct System... ... ... ... ... ... ... ........... ..$15.00
\O.OD
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
(;J3 .00
...3S.o0
Current License on File
DYes 0 No 0 NjA
Comment:
WHEN PROPERLY VALIDATED (IN THIS SPACE) THIS IS YOUR PERMIT
I Approved By: ~lV\.J c0lA
Rev. 2008-10
BUILDING INSPECTION REPORT
hr
M'CITY OF BLAIR
o WASHINGTON COUNTY
o OTHER
, /\,'/
LOCATION OF INSPECTION'
'::;'~) l ./ "r,r)
~.,,} ;:,.<;:' (/
S:~".- !)
" ';7P':'~:<,:,-{ 1/ (;t~,i} /.~l (~:l.-,f,J
NAME OF OWNER'
J/(~/ /l//}\)
, .
/::'~..l',,//:/
CONTRACTOR-
/"\_" ,,',,' -..~ ' ff / '
_,," \! Ii" ,r;" o~ """ ~" ~~:'~::<> ,~..# /t'" l~' , c>
DATE INSPECTION REQUESTED'
f/,{;;7'<'->
t~'~l {~) ('~1"
TIME INSPECTION REQUESTED',/l: ::;;i () /f) '1"/
PERMIT
TYPE OF INSPECTION
CONFERENCE
o STATUS CHECK
BUILDING: 0 FOOTING 0 DECK FOOTING 0 FRAMING 0 DRYWALL 0 FINAL 0 PARTIAL
PASSED FAILED
o 0
COMMENTS:
UTILITIES: 0 SEWER TAP 0 SEWER 0 SEPTIC 0 WATERTAP 0 REMOTE 0 WATER SERVICE
o PARTIAL
PASSED FAILED
o 0
COMMENTS:
ELECTRICAL: 0 ROUGH IN 0
o PARTIAL
COMMENTS:
MECHANICAL:D 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:
o OCCUPANCY GRANTED 0 CONDITIONAL OCCUPANCY GRANTED
NOTES/REMARKS- (J:r I kcl .I ~/o 0 Prl) I /3 <-C;--
INSPEcroR.J{'m xrr:t ~~ DAlE OFINSPECflON MAUE,
(~n~;;_fb" d q JktI J;OCINEcrsFJi.Vlrn ON
) :~-/~-;?Cb? TIMF' )11.' 30
t ,
BY
, U]" CITY OF BLAIR
LOCATION OF
BUILD INSPECTION q --
Vx
❑ WASHINGTON COUNTY ❑ OTHER
A ,
NAME OF OWNER
DATE INSPECTION REQUESTED I TIME INSPECTION REQUESTED v ` PERMIT NO -
TYPE OF INSPECTION REQUESTED: ❑ CONFERENCE ❑ S CHE
BUILDING: F OTING ❑, DECK F00 ;LN ❑ FRAMN ❑ DRYW L .I ❑ F ❑ PAR AL PASSED FAILED
COMMENTS: I",o ' /i ✓!�® t i C f' `��� C��lv C 1
UTILITIES: ❑ SEWER TAP SEWER ❑ EPTIC ❑ W T R TAP Q RE OT rr WATER SERVICE PASSED FAILED
❑ PARTIA /Q ld °'�'�' c° ���K un �, 1l I� ff zeJ ` /+ �c`°l ❑ ❑
COMMENTS:
ELECTRICAL : ROUGH IN ❑ FINAL F PERMANENT SERVICE ❑ TEMPORAR SERVICE ❑ PRECONNECT PASSED F IL
❑ PARTIAL ❑
COMMENTS:
MECHANICAL: ❑ ROUGH IN ❑ A/C ❑ FURNACE ❑ RADIANT HEAT ❑ FINAL ❑ PARTIAL PASSED FAILED
❑ ❑
COMMENTS:
PLUMBING: ❑ GROUNDWORK ❑ UGH ❑ INAL El �V TERM TER INgTALLED PARTIA PASSED FAILED
❑ PRESSURE TEST Ol, V e) d Ci � 2 ttse� s���� � C' ❑ ❑
COMMENTS: l°�l'Lf31) c
F1 OCCUPANCY GRANTED ❑ CONDITIONAL OCCUPANCY GRANTED
NOTES/REMARKS ! " �`' !° e�'1
o m � l r S EL6 ''tea` - -e eel-
+ n ` tbAen rdt l �/� �'1 1�� /�d7�CL° ,c
erA
a�� -r?,� �� ��vl��`��ti�t•� ��r� Gi�� �5 � �e; � ®- cc�. -- � �t�l�`���CC�' �
"'w
�CITY OF BLAIR
BUILDING INSPECTION �
Fl WASHINGTON COUNTY El OTHE a w &o-x w0 � C I 1 ` - c c g
LOCATION OF INSPECTION
NAME OF OWNER ` 6 _ r CO
�.
DATE INSPECTION REQUESTED f ` !X- '# k_ "° TIME INSPECTION REQUESTED ; ° } p v. { ° PERMIT N0
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: ❑
ROUGH IN ❑ FINAL ❑ PERMANENT SERVICE ❑ TEMPORARY SERVICE ❑ PRECONNECT
PASSED
FAILED
❑
PARTIAL
❑
❑
COMMENTS:
MECHANICAL ] ROUGH -IN ❑ A/C ❑ FURNACE ❑ RADIANT HEAT ❑ FINAL ❑ PARTIAL
PASSED
FAILED
COMMENTS:
PLUMBING: ❑
GROUNDWORK ROUGH -IN ❑ FINAL ❑ WATER METER INSTALLED ❑ PARTIAL
PASSED
FAILED
❑
PRESSURE TEST
El
y
COMMENTS:
❑ OCCUPANCY GR ❑ CONDITIONAL OCCUPANCY GRANTED
to% /. e-E- �'ceLC C.,yiw�e4y dieeGe m l°"�i ce wclkeoz- I
NOTES /REMARKS
f "
1 kV
d Vl C
+0
I
iN ou✓ t1 , j ( - " ! I co „n .•u
t
INSPECTO 6-L4� DATE OF INSPECTION MADE: :� ” 1 6` 1 T IM 1. I l A W
FAXED OPPD \BURT REA TO CONNECT SERVICE: ON BY
BUILD
f
11 , = CITY OF BLAIR ❑ WASHINGTON COUNTY ❑
LOCATION OF INSPECTION
ROUGH IN ❑ FINAL ❑ PERMANENT SERVICE ❑ TEMPORARY SERVICE ❑ PRECONNECT
PARTIAL
�❑
PASSE D
El
MECHANICAL: ❑
COMMENTS:
PLUMBING: ❑
❑
COMMENTS:
Z .
PASSED
❑
PASSED
❑
FAILED
❑
FAILED
❑
❑ OCCUPANCY GRANTED ❑ CONDITIONAL OCCUPANCY GRANTED
NOTES/REMARKS
NAME OF OWNER / . °�
CONTRACTO
DATE INSPECTION REQUESTED-
TIME INSPECTION REQUESTED
d,F'- > a ^' PERMIT NO
p
Ae_
TYPE OF INSPECTION REQUESTED:
❑ CONF ERENCE
❑ STA TUS CHECK
BUILDING: ❑ FOOTING ❑ DECK FOOTING
❑ FRAMING ❑ DRYWALL
❑ FINAL ❑ PARTIAL
PASSED FAILED
❑ ❑
COMMENT
UTILITIES: ❑ SEWER TAP ❑ SEWER ❑ SEPTIC ❑ WATER TAP ❑ REMOTE ❑ WATER SERVICE PASSED FAILED
❑ PARTIAL ❑ ❑
COMMENTS:
ELECTRICAL ,a
❑
COMMENTS:
ROUGH IN ❑ FINAL ❑ PERMANENT SERVICE ❑ TEMPORARY SERVICE ❑ PRECONNECT
PARTIAL
�❑
PASSE D
El
MECHANICAL: ❑
COMMENTS:
PLUMBING: ❑
❑
COMMENTS:
ROUGH -IN ❑ A/C ❑ FURNACE ❑ RADIANT HEAT ❑ FINAL PARTIAL
GROUNDWORK ❑ ROUGH -IN ❑ FINAL ❑ WATER METER INSTALLED ❑ PARTIAL
PRESSURE TEST
PASSED
❑
PASSED
❑
FAILED
❑
FAILED
❑
❑ OCCUPANCY GRANTED ❑ CONDITIONAL OCCUPANCY GRANTED
NOTES/REMARKS
INSPECTO J l� l — C DATE OF INSPECTION MADE: ` - 20 W T IMF
FAXED OPPD\BURT REA TO CONNECT SERVICE: ON BY
TYPE OF INSPECT REQ ❑ CONFERENCE
❑ STATUS CHECK
BUILDING: ❑
FOOTING ❑ DECK FOOTING ❑ FRAMING ❑ DRYWALL FINAL ❑ PARTIAL
❑ . OF BLAIR ❑
WASHINGTON COUNTY ❑ OTHE
COMMENTS:
LOCATION OF INSPECTION
UTILITIES: ❑
SEWER TAP SEWER ❑ SEPTIC ❑ WATER TAP ❑REMOTE ❑ WATER SERVICE
PASSED
FAILED
❑
NAME OF OWNER ' _' / r�
- ` r _
CONTRACTO
CO MMENTS:
ELECTRICAL: ❑
ROUGH IN ❑ FINAL ❑ PERMANENT SERVICE ❑ TEMPORARY SERVICE ❑ PRECONNECT
>
4
B "k
DATE INSPECTION REQUESTED
❑
TIME INSPECTION REQUESTED
�" k' a f ° PERMIT NO �-
TYPE OF INSPECT REQ ❑ 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
❑
❑
CO MMENTS:
ELECTRICAL: ❑
ROUGH IN ❑ FINAL ❑ PERMANENT SERVICE ❑ TEMPORARY SERVICE ❑ PRECONNECT
PASSED
FAILED
❑
PARTIAL
❑
❑
COM MENTS:
MECHANICAL: ❑
ROUGH IN ❑ A/C ❑ FURNACE ❑ RADIANT HEAT �❑�FINAL ❑ PARTIAL
PASSED
FAILED
❑
❑
COMMENTS:
PLUMBING: ❑GROUNDWORK
❑ ROUGH -IN ,❑ AL F1 WATER METER INSTALLED ❑ PARTIAL
PASSED
FAILED
❑
PRESSURE TEST
❑
❑
COMMENTS:
❑ OCCUPANCY GRANTED ❑ CONDITIONAL OCCUPANCY GRANTED
NOTES /REMARKS:
DATE OF INSPECTION
FAXED OPPD \BURT REA TO CONNECT SERVICE: ON BY