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BP13366o CITY OF BLAIR - APPLICATION FOR BUILDING PERMIT Permit # 0 Date: - Approximate Completion Date: Y-146 Site Plan Attached: REScheck Attached: Complete Plans Attached Application for: ResidentialCommercial/Industrial New Construction Manufactured Home Modular Move -on: Home T Accessory Building Other Dec le Remodel Addition Accessory Building: Garage Pole Barn Other Floor Type: Dirt Concrete Electricity: Yes No Sign Erecting, Awnings Decks/Handicap Ramps (plot pian 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 Description iRf project if necessary: I)- �4 ) 6 Project Information: r Job Address: Legal Description (if applicable)' _ L C -- ,yr 'el 1 74- ma�yy°° o Owner iC ' �ti Al " ` '5 dd er s: 1,3 Contractor: Address: �r o rl. 7//`61 II Phone#• �� " 143 3 �dhone#: 2b"&ll Cell #: q q6- q3 96 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 180s^/yds or its not completed within two (2) years of date of issue. gnat'are of Owner/Contractor 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: State Fire Marshal Required: Yes No L�L Variance Required: Yes No Minimum Setbacks: Front . Second Front Side Side Rear Lot Square Footage: -- /, Length x Width: Lot Coverage % DrivewaysLSidewalks: Sidewalk required: Yes No Sidewalk Waiver: Yes No 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 Square Footage: Main Level: Second Level: Basement: (Unfinished) Garage: Detached Garage: 2 bay, Third Level (Finished) 3 bay 4 bay 5+ bay Pole Barn: Addition: Remodel: Porch: Front Rear Deck that affect setbacks: Rear 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, 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 reauired to be Drotected 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 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/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 Erect! ng/Awn 1 ngs and Decks/Handicap Ramps: sq/ft area X $25 (Minimum valuation of $2000) Construction valuation computation: ,4-4,6 Finished sq/ft area i 3 6 e k /M) X $ 6 $ "Rev. 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 $ / 6% CITY OF BLAIR, NEBRASKA Phone 402-426-4191 RECEIVEDOR �'J A ADDRESS CITY, STATE, ZIP CODE THANKYOU KEEP THIS COPY FOR YOUR RECORDS. NO RECEIVED BY Pounds Printing, Blair, NE 68008 �'J THANKYOU KEEP THIS COPY FOR YOUR RECORDS. NO RECEIVED BY Pounds Printing, Blair, NE 68008 I ............. I co C/) I; c 3 m V) m C= Z M rQ MCD C= Z z Cb!, z CEE 0 V 0 len-I Ol ............. I co C/) =r 3 m C= rr, M m C= rr, rQ MCD C= C> m WOO C= CEE M len-I ref viral= - BUILDING PERMIT DEPOSIT AGREEMENT 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. Con ractor/Owner 's-/l'-zio/D Date Contractor/Owner City of Blair 77' 91 xd ........ ..... � �� I - O (D C4, N C) ik rs C4, C4, N C) rs C4, i i------------------- --- - ----- ----- AUL- -- -- -- \\A/ A —A !-Law + R, - Cl A cUf>hif dS 3 trtrr«.ty - BUILDING INSPECTION REPORT CITY OF BLAIR El WASHINGTON COUNTY ❑ OTHER LOCATION OF INSPECTION- x4 12, INSPECTORL-- DATE OF INSPECTION MADE: FAXED OPPD\BURT REA TO CONNECT SERVICE: ON B NAME OF OWNER- CONTRACTOR - DATE INSPECTION REQUESTED' ___ TIME INSPECTION REQUESTEDPERMIT N� TYPE OF INSPECTION REQUESTED: [:1 CONFERENCE F -I STATUS CHECK BUILDING: FOOTING F -I DECKFQO'e]NG F-1 FkAiMING ❑ DRYWALL [_1 FINAL E:l PARTIAL PASSED FAILED Tr E COMMENTS: UTILITIES: F -I SEWER TAP F -I SEWER El SEPTIC F -I WATER TAP F1 REMOTE F -I WATER SERVICE PASSED FAILED El PARTIAL COMMENTS: ELECTRICAL: F] ROUGH IN F FINAL F -I PERMANENT SERVICE F] TEMPORARY SERVICE F -I PRECONNECT PASSED FAILED F -I PARTIAL ❑ F -I COMMENTS: MECHANICAL: F] ROUGH -IN F A/C El FURNACE El RADIANT HEAT F1 FINAL F1 PARTIAL PASSED FAILED F -I F -I COMMENTS: PLUMBING: F -I GROUNDWORK F ROUGH -IN El FINAL F1 WATER METER INSTALLED El PARTIAL PASSED FAILED F-1 PRESSURE TEST COMMENTS: F-1 OCCUPANCY GRANTED El CONDITIONAL OCCUPANCY GRANTED INSPECTORL-- DATE OF INSPECTION MADE: FAXED OPPD\BURT REA TO CONNECT SERVICE: ON B IxsrfIT00. OAl OF INSPFTMON m oe rt r R\SfL pppplp ppT Hl!A N(bNNECf SF.RV1('E: ON RYA PIM12010 PM 4 X04/0 +2610 0394 PM - � _ B"WILDING INSPECTION REPORT ❑�CITY OF BLAIR ❑ WASHINGTON COUNTY ❑ OTHER :. LOCATION OF INSPECTION• NAME OF OWNERS -Y ' � � ° " �" CONTRACTOR ` u Y, { DATE INSPECTION REQUESTED. rFt rs Y� E ° TIME INSPECTION REQUESTED r` PERMITNO- .' ;r TYPE OF INSPECTION REQUESTED: _ ❑ CONFERENCE ❑ STATUS CHECK BUILDING: ❑ FOOTING ❑ DECK FOO.TfNG ❑ FRAMING ❑DRYWALL D' -FINAL ❑ PAR AL PASSED FAILED E]�lUe�.(� COMMENTS ! - - ��i� - �fl}ct�F rrPASSED UTILITIES: ❑ SEWER TAP ❑ SEWER ❑ SEPTIC ❑ WATER TAP ❑ REMOTE ❑ WATER SERVICE FAILED ❑ PARTIAL ❑ ❑ COMMENTS: ELECTRICAL: ❑ ROUGH IN ❑ FINAL ❑ PERMANENT SERVICE ❑ TEMPORARY SERVICE ❑ PRECONNECTT uvLA PASSED FAILED ❑ PARTIAL ❑ ❑ COMMENTS: MECHANICAL: ❑ ROUGH -IN ❑ A/C ❑ FURNACE ❑ RADIANT HEAT ❑ FINAL ❑ PARTIAL PASSED FAILED COMMENTS: PLUMBING: ❑ GROUNDWORK ❑ ROUGH -IN El FINAL ❑ WATER METER INSTALLED ❑ PARTIAL+ J w PASSED FAILED ❑ PRESSURE TEST ❑ ❑ COMMENTS: ❑ OCCUPANCY GRANTED ❑ CONDITIONAL OCCUPANCY GRANTED NOTES/REMARKS - o 6- y INSPECTOR1 DATE OF INSPECTION MADE: /-� ' — '__� TIMF- FAXED OPPMBURT REA TO CONNECT SERVICE: ON BY