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Date: lilil 01
CITY OF BLAIR - APPLICATION FOR BUILDING PERMIT
Permit # /3:iP8
Approximate Completion Date: if - / ~ ;20 f ()
X
Site Plan Attached: REScheck Attached: Complete Plans Attached
Application for: Residential L Commercial/Industrial _
New Construction Manufactured Home Modular
Move-on: H~e _ Accessory Building Other
Remodel --1.-. 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 _
Additional Description of project if necessary~ fY v.~O 1-1 V Ad ell it G VI LLJ L
~We.. t m cl c V' 21l1(' 3 ~ - _ide l~lI\Je- WIt ( ~ "I ?V1 \'1.ffi1'V1
- \)ec\r1;Ov~. -- _{)~\AJ(E-_! - ~~1,I?.. LC)n~:\^_
Proiect Information:
Job Address:
(;;;Z~ (p Ie'to l ( 0 L--u R.oJ
t5 roO if ttJl/J /?? 0
,3 j/ k 78 //.3 f'~ 10
Phone#f)!)3 ., 10 Y3
Phone #:.03 -3"758
Cell #:
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 co leted within two (2) years of date of issue,
&i11@lJL 4 IJ- 7 -(}9
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:
Zonin Flood Plain Utilities:
Current Zoning:
Conditional Use Permit Required: Yes _ No ~
Date CUXAPproved:
State Fire Marshal Required: Yes _ No Variance Required: Yes _ No_
Minimum Setbacks: Front ~--Second Front Side ---T- Side fj-- Rear~
lot Sauare Foot~g~ f,) I I _.L n_ nJ;
length x Width: ~verage % LI"=-----,
Driveways/Sidewalks: ~
Sidewalk required: Yes_ No Sidewalk Waiver: Yes _ No
Date Waiver Approved:
Preexisting Garage requires driveway to be less than 3' from property line: Yes_
Approved by:
Flood Plain: Yes No ~
If yes, specify special r~~s:
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 reauired 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:
Buildin~ 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
$
$
$
$
$
$
$ 25.00
$
X $56
X $29
X$25
Total Vaiuation
Multiplied by 0.006 =
Issuance Fee:
Total Permit Fee = Deposit + Permit Fee + Issuance Fee
(~EsrDc.I:NTUtt: - DDITION",' REMODELS and
-eeMMmCfAL - NE NSTRUCTION / ADDITIONS / REMODELS:
Businessjl ndustrialjEducationalj Assem blyjFactoryjStoragejUtility
*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 sulface floor: sqjft area X $25
Sign Erecting/Awnings and Decks/Handicap Ramps: sqjft area X $25 (Minimum
valuation of $2000) J 0 ~ t-- j' VI' uJ.8 iI.S', 31.# (1. t' 0 ._
7 Lf~ So, 1 bo. 00 -
n: .
(ll X$~
Construction valuation com
Finished sqjft area
Construction valuation is ...................................Permit fee is:
$0 TO $50.......... ......... .................... ....................$0
$51 TO $500........................................................ $25
$501 TO $2,000........................................................ $25 + $3
$2,001 TO $25,000........................................................ $70 + $13
$25,001 TO $50,000......................................................$370 + $10
$50,001 TO $100,000......................................................$620 + $7
$100,001 TO $500,000......................................................$970 + $5
$500,001 TO$1,OOO,OOO.................................................. $2,970 + $4
$1,000,001 AND OVER.................................................. $4,970 + $3
Permit Fee calCUlated from chart above
Issuance Fee:
Total Permit Fee = Deposit + Permit Fee + Issuance Fee
7(p, 3:to cp
~ I qiB() 06
't .,..--
.
-
per additional $100
per additional $1,000
per additional $1,000
per additional $1,000
per additional $1,000
per additional $1,000
per additional $1,000
tytJt/. 00
$ Q-Ilf:~
$ 25.00 -r;;: ~ Jt'/. ()f)
$ " bf .:J'1 . 6' 0. ; /8 2- Ct. (Jo
Additional Comments:
~u Ih
Approved by: ~ yV' /J./'/f'y r,~ _
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
Date:
I;)~ 1d9
For Office Use Only
Date Permit Paid:
Permit Fee:
Deposit Amount
Receipt #
Deposit Paid by for return to:
Building Inspection Pouch given: Yes _ No
MECHANICAL PERMIT APPLICATION
Jurisdiction of City of Blair, Nebraska 2 2�
218 South 16 Street J J
Blair, Nebraska 68008
Fax (402) 426 -4195 M 1978
l / p (402) 426 -4191
Application Date: `T ' ✓ ', ® Permit Fee: $ ®
I
Job Address s� &
Owner Mail Ad res� Zip Phone
Contra Mail Address jp� 9 Phone
•
3. Class of Work: O CO ERCI ESIDENTIAL O N w O Addition O Alteration O Repair O Replacement
Describe Work: � ®�
Z) c✓
MECHANICAL PERMIT FEES
Heat Pump Tons
Central A/C Tons
Furnace/Heat Pump /Air Conditioner (Per Unit)
Furnace BTU/H
Up to and including 100,000 BTU / 3Ton ... .........................$15.00
# of Units A/C
Furnace/Heat Pump /Air Conditioner (Per Unit)
Furnace
Over 100,000 BTU / 3 Ton .................... .........................$25.00
Completion Date:
Refrigeration Units /Coolers/Lines /Compressor — Commercial
(New or Replacement) (Per Unit)
...................... .............I................. .........................$15.00
Boiler Chart
BTUFee
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
Boiler (apse BTU Chart to left) ....................
Appliance Vent / Fans ........................$10.00
Notice
I hereby certify that I have read and examined this
Duct System ...................... $15.00 l
application and know the same to be true and correct. All
provisions of laws and ordinances governing this type of
Gas /Air Outlets .................First 5 x $6.00
work will be complied with whether specified herein or
not. The granting of a permit does not presume to give
.........Additional x $1.00
authority to violate or cancel the provisions of any other
state or local law regulating construction or the
Radiant Heat Systems /Gas /Water
performance of construction.
Piping System ....... .........................$50.00
r'
Modular Home ............................... $50.00
ignature of Contractor or Authorized Agent
n Q D
Permit Issuance Fee . .........................$25.00 ex
Total
Current License on File Wes O No O N/A
Date
Comment:
WHEN PROPEKLY VAL11JAIEL) (1N IHIN NrAUE) 11 IN YUUKrr,K1V111
Approved By: � L
T Rev. 2008 -10
air, rt
ELECTRICAL PERMIT A PPLICATION
Jurisdiction of City of Blair, Nebraska
218 South 16 Street
Blair, Nebraska 68008
Fax (402) 426 -4195 E 3193
(402) 426- 4191
Application Date:
'� Permit Fee: $
Job Address �,. - j _ l � � '',,
Owner , Mail Address Zip Phone
>-
Contractor Z,� ail ddress 2 Z' 6 Phone _
3. Class of Work: O NEW RESIDENTIAL O NEW COMMERCIAL Cl REMODELING /ADDITIONS - PGRADE SERVICE
Describe Work: e V
5.Current License on File es O N O N/A Completion Dat
ELECTRICAL PERMIT FEES
Service Fee = (Amp Fee + $5.00 per branch circuit)
Upgrade Existing Service .............$25.00 61 0
1 -100 Amp Fee .......................$25.00
Temporary Service............. ..... $15.00
101 -200 Amp Fee .......................$35.00
201 -300 Amp Fee .......................$55.00
Fire Alarm System............ ......$15.00
"'
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
„ f
801 -900 Amp Fee .....................$175.00
# of Circuits x $5.00 4
901 -1000 Amp . ........................$195.00
Amp Fee
IF OVER 1000 Amp
1 1000 Amp Fee ..................$195.00
Amp Fee + Circuit Total s
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
Receptacles /Switches/Lighting Fixtures (I 10 volt only)
authority to violate or cancel the provisions of any other
# of Apparatus x $1.00
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
Signature of Contr to r Authorized Agent
5 , 00
Permit Issuance Fee........... $25.00
r
0
" e o
l
Total
Date
Comment:
WHEN PROPERLY VALIDATED (IN THIS SPACE) THIS 1S YOUR PERMIT
Approved By:
Rev. 2008 -10
Version 7.032 INTEGRITY QUOTE 12/07/09
*** CAUTION: IT IS RECOMMENDED THAT A MINIMUM OF 1/4 INCH BE ADDED ***
*** TO THE ROUGH OPENING HEIGHT WHEN USING MARVIN SILLGUARD ***
*** UNIT AVAILABILITY AND PRICE SUBJECT TO CHANGE ***
*** LIST PRICE (in USD) ***
0000-001 REQUESTED SHIP DATE:
BILL S.E. SMITH AND SONS LUMBER CO. SHIP VIA: OUR TRUCK
TO: 1680 FRONT STREET PO:
BLAIR, NE 68008 JOB NAME:
SHIP S.E. SMITH AND SONS LUMBER CO CONTACT: CURT PEDERSON
TO: 1680 FRONT STREET PHONE: (402) 426-3333
BLAIR, NE 68008
PROJECT: BART MOORE
QUOTE: 00000001
QTY: 1 MARK UNIT -
RO 57" X 47 5/8" - 2W1H
**A1
I CA - LH
WOOD - ULTREX SERIES
CN 2947
IG - 1 LITE
LOW E II W / ARGON
AF HDWE
INTERIOR SCREEN
ALMOND SURROUND
CHARCOAL FIBERGLASS MESH
0.00
369.00
0.00
0.00
16.00
0.00
0.00
**A2
I CA - RH
WOOD - ULTREX SERIES
CN 2947
IG - 1 LITE
LOW E II W/ARGON
AF HDWE
INTERIOR SCREEN
ALMOND SURROUND
CHARCOAL FIBERGLASS MESH
NAILING FIN
6 9/16" JAMBS
BA PINE INTERIOR
STONE WHITE EXTERIOR
369.00
0.00
0.00
16.00
0.00
0.00
0.00
44.00
0.00
0.00
TOTAL LIST PRICE
814.00
AS VIEWED FROM THE EXTERIOR
SUB TOTAL:
7.000% SALES TAX:
814.00
56.98
PROJECT TOTAL LIST PRICE:
870.98
CITY OF BLAIR, NEBRASKA
Phone 402-426-4191
RECEIVED OF:
ADDRESS
CITY, STATE, ZIP CODE
THANK YOU
NO
KEEP THIS COPY FOR YOUR RECORDS.
RECEIVED BY
Pounds Printing, Blair, NE 68008
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Ad08 311:1
Version 7.031
INTEGRITY QUOTE
*** CAUTION: IT IS RECOMME.NDED THA T A MINIMUM OF 1/4 INCH BE ADDED ***
*** TO THE ROUGH OPENING HEIGHT WHEN USING MARVIN SILLGUARD ***
*** UNIT AVAILABILITY AND PRICE SUBJECT TO CHANGE ***
*** LIST PRICE (in USD) ***
QTY: 1 MARK UNIT -
RO 49" X74 3/4" -1W2H
**A1
I CAP
WOOD - ULTREX SERIES
CN 4947
IG - 1 LITE
LOW Ell W/ARGON
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STONE WHITE EXTERIOR
TOTAL LIST PRICE
D..........
" .
...
, .
. .
AS VIEWED FROM THE EXTERIOR
12/()2109
-"
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425.00
0.00
430.00
95.00
0.00
19.00
0.00
0.00
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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.
(j) ~ rJ/;;2
o e ccupant
Contractor
City of Blair
(1)-2
Date
;.:::. J; ) U
G)-
218 South 16th Street. Blair, Nebraska 68008 . 402-426-4191 . Fax 402-426-4195 . E-mail cityofblair@cLblair.ne,us ,~~:,O~J~:
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Promise
BUILDING PERMIT DEPOSIT AGREEMENT
.$500.00 r undable deposit is being collected for any new commercial, new
r 'e i.a, 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.
~c~
(J. 0 actor/Owner
Contractor/Owner
City of Blair
(j) d- ~eJo IV
Date
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CITY OF BLAIR
LOCATION OF INS]
I la 0-1 fro I I a
❑ WASHINGTON COUNTY I F
NAMEOFOWNER - �� > ` QQXX CONTRACTOR
DATE INSPECTION REQUESTED TIME INSPECTION REQUESTED PERMIT
NO
TYPE OF INSPECTION REQUESTED: ❑ CONFERENCE
❑ STATUS CHECK
BUILDING: El' FOOTING ❑ DECK FOOTING ❑ FRAMING ❑ DRYWALL ❑ FINAL ❑ PARTIAL
PASSF-D
FAILED
COMMENTS:
El
UTILITIES: F SEWER TAP SEWER ❑ SEPTIC ❑ WATER TAP ❑ REMOTE ❑ WATER SERVICE
PASSED
FAILED
F PARTIAL
F
F
COMMENTS:
ELECTRICAL: F ROUGH INF1 FINALE] PERMANENT SERVICE E] TEMPORARY SERVICE❑ PRECONNECT
PASSED
FAILED
❑ PARTIAL
❑
❑
COMMENTS:
MECHANICAL:F ROUGH-IN F A/C ❑ FURNACE ❑ RADIANT HEAT ❑ FINAL PARTIAL
PASSED
FAILED
1
❑
COMMENTS:
PLUMBING: F GROUNDWORK E] ROUGH-IN ❑ FINAL WATER METER INSTALLED ❑ PARTIAL
PASSED
FAILED
❑ PRESSURE TEST
F
❑
COMMENTS:
❑ OCCUPANCY GRANTED F CONDITIONAL OCCUPANCY GRANTED
NOTES/REMARKS-
INSPECTOR• DATE OF INSPECTION MADE: 0,4
FAXED OPPD\BURT REA TO CONNECT SERVICE: ON BY
BUILDING INSPECTION REPORT
❑ CITY OF BLAIR ❑ WASHINGTON COUNTY ❑ OTHE
S j �
LOCATION OF INSPECTION
NAME OF OWNER CONTRACTO
DATE INSPECTION REQUESTED - - TIME INSPECTION REQUESTED PERMIT NO
TYPE OF IN SPECTION REQUESTED:
❑ CONFERENCE
❑ STATUS CHECK
BUILDING: ❑
FOOTING ❑ DECK FOOTING
❑ FRAMING ❑ DRYWALL ❑ FINAL ❑ PARTIAL
PASSED
FAILED
COMMENTS:
❑
❑
COMMENTS:
PASSED
FAILED
❑
PRESSURE TEST
UTILITIES: ❑
SEWER TAP ❑ SEWER ❑
SEPTIC ❑ WATER TAP ❑ REMOTE ❑ WATER SERVICE
PASSED
FAILED
❑
PARTIAL
❑
❑
COMMENTS:
ELECTRICAL: ❑
ROUGH IN ❑ FINAL ❑ PERMANENT SERVICE ,0:< TEMPORARY SERVICE ❑ PRECONNECT
PASSEV
FAILED
F
PARTIAL
"`
a
_❑
COMMENTS:
s f `
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
❑
❑
COMMENTS:
❑ OCCUPANCY GRANTED ❑ CONDITIONAL OCCUPANCY GRANTED
NOTESIREMARKS-,
G
Q_,,CITY OF BLAIR
r LOCATION OF INS]
❑ WASHINGTON COUNTY ❑ OTHE
NAME OF
r m,-
DATE INSPECTION REQUESTED � r ��'
TIME INSPECTION REQUESTED--
d PERMIT
NO
TYPE OF INSPECTION REQUESTED:
❑ CONFERENCE
❑ STATUS CHECK
BUILDING: ❑ FOOTING ❑ DECK FOOTIN G ❑ 7=FRAMING ❑ DRYWALL ❑
FINALARTIAL
PASSED FAILED
❑
COMMENTS:
UTILITIES: ❑ SEWER TAP ❑ SEWER ❑
SEPTIC ❑ WATER TAP ❑ REMOTE ❑ WATER SERVICE
PASSED FAILED
❑ PARTIAL
❑ ❑
COMMENT
- -- ---------- - - - - --
ELECTRICAL: ❑ ROUGH IN ❑ FINAL ❑ PERMANENT SERVICE ❑ TEMPORARY SERVICE ❑ PRECONNECT PASSED FAILED
❑ PARTIAL ❑ ❑
COMMENTS:
MECHANICAL,jn ",ROUGH -IN ❑ A/C ❑ FURNACE ❑ RADIANT HEAT ❑ FINAL ❑ PARTIAL PASSED FAILED
COMMENTS: El
PLUMBING: ❑ GROUNDWORK ❑ ROUGH -IN ❑ FINAL ❑ WATER METER INSTALLED ❑ PARTIAL
❑ PRESSURE TEST
COMMENTS:
PASSED FAILED
❑ ❑
❑ OCCUPANCY GRANTED ❑ CONDITIONAL OCCUPANCY GRANTED
f �
r
NOTES/REMARKS .;
US 2 V L41
���1ZUti `� �GY1I���? /� �cC1� l✓3✓I S �$ S('tL� �o �, S62C'
INSPECTO / DATE OF INSPECTION MADE: TTMF
FAXED OPPD\BURT REA TO CONNECT SERVICE: ON BY
BUILDING I NSPECTI O N RE
",,CITY OF BLAIR
❑ WASHINGTON COUNTY
,
DATE INSPECTION REQUESTED � ' �'� � -2
TYPE OF INSPECTION REQUESTED: QR 4 VX
BUILDING: ❑ FOOTING ❑ DECK FOOTING ❑
COMMENTS:
0
TIME INSPECTION REQUESTED ' ''�
❑ CONFERENC
FR G DRYWALL ❑ FINAL ❑ PARTIAL
d -
NO
❑ STATUS CHECK
PASSED FAILED
n n
UTILITIES: ❑
SEWER TAP ❑ SEWER ❑ SEPTIC ❑ WATER TAP ❑ REMOTE ❑ WATER SERVICE
PASSED
FAILED
❑
PARTIAL
❑
❑
COMMENTS:
ELECTRICAL `Rm ROUGH IN [I FINAL F1 PERMANENT SERVICE F1 TEMPORARY SERVICE ❑ PRECONNE
PASSED
AILED
❑
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
El PRESSURE TEST El El COMMENTS:
❑ OCCUPANCY GRANTED ❑ CONDITIONAL OCCUPANCY GRANTED
NOTES /REMARKS nA ,
i 1 JUDENN , 0 a, a
QT< CITY OF BLAIR ❑ WASHINGTON COUNTY ❑
LOCATION OF INSPECTION
FOOTING ❑ DECK FOOTING ❑ FRAMING ❑ DRYWALL ❑ FINAL ❑ PARTIAL
PASSED
FAILED
NAME OF OWNER a ?
$c
' "r s € °+ 'l
_ CONTRACTO
COMMENTS:
O
° '`
DATE INSPECTION REQUESTED
, Q
-�"
.-
4 TIME INSPECTION REQUESTED- —
P ERMIT ' IT NO
❑
PARTIAL
"
9 � fi r,.•
TYPE OF INSPECTION REQUESTED:
` ��
� � � �
❑ CONFERENCE El 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 [_1 PRECONNECT
P
F]
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
F]
PRESSURE TEST
❑
El
COMMENT
❑ OCCUPANCY GRANTED ❑ CONDITIONAL OCCUPANCY GRANTED
NOTES/REMARKS-
4
INSPECTO DATE OF INSPECTION MADE: ®_5 - J 41— C2610 T
FAXED OPPD\BURT REA TO CONNECT SERVICE: ON BY
DATE INSPECTION REQUESTED = f ° °`
TYPE OF INSPECTION REQUESTED:
13WILDING
BUILDING: ❑
COMMENTS:
FOOTING ❑ DECK FOOTING ❑
[
FRAMING WALL ❑ FINAL ❑ PARTIAL
PASSED
❑_, CITY OF BLAIR ❑
WASHINGTON COUNTY ❑ OTHE
SEWER TAP ❑ SEWER ❑ SEPTIC ❑ WATER TAP ❑ REMOTE ❑ WATER SERVICE
PARTIAL
PASSED
❑
LOCATION OF INSPECTION
ELECTRICAL: ❑
El
COMMENTS:
ROUGH IN ❑ FINAL ❑ PERMANENT SERVICE ❑ TEMPORARY SERVICE ❑ PRECONNECT
PARTIAL
NAME OF OWNER a.. A
MECHANICAL: ❑
COMMENTS:
ROUGH -IN ❑ A/C ❑ FURNACE
DATE INSPECTION REQUESTED = f ° °`
TYPE OF INSPECTION REQUESTED:
TIME INSPECTION REQUESTED a`.� ' '`' °' PERMIT NO
❑ CONFERENCE ❑ STATUS CHECK
BUILDING: ❑
COMMENTS:
FOOTING ❑ DECK FOOTING ❑
[
FRAMING WALL ❑ FINAL ❑ PARTIAL
PASSED
FAILED
❑
UTILITIES: ❑
❑
COMMENTS:
SEWER TAP ❑ SEWER ❑ SEPTIC ❑ WATER TAP ❑ REMOTE ❑ WATER SERVICE
PARTIAL
PASSED
❑
FAILED
❑
ELECTRICAL: ❑
El
COMMENTS:
ROUGH IN ❑ FINAL ❑ PERMANENT SERVICE ❑ TEMPORARY SERVICE ❑ PRECONNECT
PARTIAL
PASSED
❑
FAILED
Fl
MECHANICAL: ❑
COMMENTS:
ROUGH -IN ❑ A/C ❑ FURNACE
❑ RADIANT HEAT ❑ FINAL ❑ PARTIAL
PASSED
❑
FAILED
❑
PLUMBING: ❑
El
COMMENTS:
GROUNDWORK ❑ ROUGH -IN ❑
PRESSURE TEST
FINAL ❑ WATER METER INSTALLED ❑ PARTIAL
PASSED
F
FAILED
❑
❑ OCCUPANCY GRANTED ❑ CONDITIONAL OCCUPANCY GRANTED
F
NOTES/REMARKS / Gl ",
INSPECTO l,1/ /-�.ee� DATE OF INSPECTION MADE: ® f 0 T IME C _
FAXED OPPD\BURT REA TO CONNECT SERVICE: ON BY
BUILDING INSPECTION REPORT
❑ WASHINGTON COUNTY ❑ OTHER
LOCATION OF INSPECTION-
t
NAME OFOWNE CONTRACTO
4
DATE INSPECTION REQUESTED:- TIME INSPECTION REQUESTED PERMIT NO
TYPE OF INSPECTION REQUESTED: EICONFERENCE ❑ STATUS CHECK
BUILDING:
❑ FOOTING ❑ DECKFOOTING [:1 FRAMING [:1 DRYWALL ❑ FINAL ❑ PARTIAL
PASSED
FAILED
❑
❑
COMMENTS:
UTILITIES:
F SEWER TAP ❑ SEWER, ❑ SEPTIC [_1 WATER TAP ❑ REMOTE ❑ WATER SERVICE
PASSED
FAILED
❑ PARTIAL
COMMENTS:
ELECTRICAL: F ROUGH IN74 - PERMANENT SERVICE ❑ TEMPORARY SERVA RECONNECT ASS FAILED
F PARTIAL El
"d,
COMMENTS:
MECHANICAL: ❑ ROUGH -IN ❑ A/C ' FU ❑ RADIANT HEAT ❑ FINAL ❑ PARTIAL
PASSED FAILED
F ❑
COMMENTS:
PLUMBING: ❑ GROUNDWORK [_1 ROUGH-IN ❑ FINAL ❑ WATER METER INSTALLED ❑ PARTIAL PASSED FAILED
❑ PRESSURE TEST
COMMENTS:
❑ OCCUPANCY GRANTED ❑ CONDITIONAL OCCUPANCY GRANTED
NOTES/REMARKS
INSPECTO 7 DATE OF INSPECTION MADE:-5 l TIME � �.O-
AXE PPD REA TO CONNECT SERVICE: ON BY
-�,
�� �.
.3��