BP13377
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CITY OF BLAIR - e-J>>PUCAnON-FOR BUILDING P~MIT (' '.'2. 2 'II <.:::0'c:tv'
" Permit # "J ;,)
Approximate Completion Date: d"" III - 07 t! 10
Date; '\ J ~91 \. t D
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) _
'SatellfteDishes/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 _
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Additional Description of project if necessary: \ l,{... m L vw,J-eD S; ~ n cI ~
Proiect Information:
Job Address:
\?J~
S <6 1)\ ~t-
Legal Description (if applicable)
Owner: Goc\~C1\ \UX5
contractor:c,f::0 S ~
AddressdJftdO P . - VIr),)) l2el
B1tJO -:) q l;30
Phone#:~ J~ OJiElb
Address: ~t1\.JL-
Phone #:
COv~ Nt. lo~DL~II#: Y:od ,t{D r7~
Email Address for Contractor:
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,?ora ances of the City of Blair and the State of Nebraska. I understand that this permit is void if work is not commenced within
150<1."" I, 00' ",m,]"" withl'.!. ye'~ ald""Ii,,",. ~ _,'."
, y . }-)<A-10
Signa re f Owne 7'Contractor are
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: Ai Pre-
Conditional Use Permit Required: Yes _ No ~
Date c~pproved: ' .
State Fire Marshal Required: Yes _ No \ Variance Required: Yes _ No_
Minimum Setbacks: Front _ Second Front Side Side _ Rear_
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
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
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 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:
Businessjl ndustrialjEd ucationalj AssemblyjFactory jStoragejUtility
*Porches with roofs/screened patios are considered additions
Construction valuation computation: Sqjft area X $63
Except for the following:
Accessory Buildings & Interior Remodeling Proiects: 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 $2000)
Construction valuation computation:
Finished sqjft area
~.s
X$~S
$ D\~1.C)o
Construction valuation is ...................................Permit fee is:
$0 TO $50...........................................................$0
$51 TO $500........................................................ $25
$501 TO $2,000........................................................ ~,2~ + $3
$2,001 TO $25,000.......................................................($70)+ $13
$25,001 TO $50,000......................................................$3"16 + $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
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
flo 00
$
Issuance Fee:
$
25.00
Total Permit Fee = Deposit + Permit Fee + Issuance Fee
, ' OlJ
$ 1 'jb ~ I <-is '.-
o.q<<o~ ~
Additional Comments:
Approved by:
c;:;z,~' / ?1:/',?k..
'/ I
Date: I .;;t:) , I 0
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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FILE C
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18'.8"
15'-4"
Scale: %" = l'
0, 5"
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SCOPE OF WORK:
Manufacture and install (1) one set of internally illuminated channel letters & logo as
shown. Letters & logo are 5" deep with BLACK returns, RED faces (letters), WHITE
faces (logo) with 230-25 SUNFLOWER & BLACK vinyl graphics & BLACK trim cap,
& are illuminated with RED LEOs (letters & WHITE LEOs (logo). The power supply for
the letters & logo will be located inside an aluminum raceway that is painted to match
the fascia onto which the letters & logo are mounted.
All electrical work to be UL approved.
ADDRESS /,3g S' 811'-\21.
L PERMIT NO: /3377 J
CHANNEL LETTERS MOUNTED TO RACEWAY
CONSTRUCTION ElEMENTSI Not to Scale
i!
i APPROVAU AS A ESUL.: OF A
_'~c...~:...):~~~;~v~8JA~~oCJ'b~~~~~.~1~~,~t~Nt.b~~~4~......
i1cODE OR; OF OT; ER 0: DINAflJCES OF THf;S
!IJURISDIc;r~ON. f ! ; r
AP~ROVAL AS! I' ~ AN INSPECTION t
SHALL NOT BE ( ;~D T, BE Af\\ APPROVAL !
OF;lA VIOLATld . 1 '~9~ PR; VISIOt'JS OF THE I
CO.bE OR O~! ~ u dE6.; O.RDI! ANCEF OF THIS !
JURISDICTIOIN. . n ....: :.' .' . !.
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Pro-Painted BLACK Alum. Returns
3/16" WHITE & REO Plexiglass Faces
1" BLACK Jewelite Trim-Cap
Internal LEO Illumination (WHITE & RED)
Pre-Painted White Alum. Backs
Leller Attachment wI non-corrosive all thread securement
As Required Per Location
Remote Transformers Enclosed as Required wI Disconnect Switch
'/," Condull
120 voll G.C. or Landlord Supplied Power Supply __
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Fabrication Specifications
ITEM I DESCRIPTION SIZE COLOR
1 i AhJminum Backs nfi~ ' , WHITF
2 lIluminum Returns .nfin ' , BLA~K
3 1 " B Mol(
4 A"rvlit,,!=,,~ 3/16" i VHIT!= fI. RFn
-
Electrical Specifications
ITEM QTY, DESCRIPTION SIZE
1 WHITE & RED LEDs
2 Power Suoolv 12V/60W
3 UL Listed Wirina
APPROVED
BUILDING
PLANNING
PUBLIC WORKS
FIRE DEPT
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Scale: 3/16" = l'
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Your Image Is Our Business
n. <:;QDJ~'i\I.HER'S
Client:
Address:
Location: Blair, NE
This is an original drawing designed by CBS Sign Co.
lt is intended for your personal use and shall remain the
property of CBS Sign Co, at all limes. This drawing is
not to be used by you in any way except the project
being planned for you by CBS Sign Co, You are not
authorized to show these drawings to anyone outside
your organization. Any unauthorized use or reproduction
will result in a lawsuit.
.iii
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Salesperson: Jay Muller
Design No.:196B0909 . Date: D913.o.LD9
Designer: ~ 4-u.--- .
Buyer:_m
Date:
Production:
Date:
Sales: ___
Date:
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~ BUILDING PERMIT DEPOSIT AGREEMENT
\ A ~500.00 refundable deposit is being collected for any new commercial, new
'J.e~dential, 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.
@o.oo 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.
Contractor/Owner
City of Blair
/ / ld-.I ( 0
Date
TIMEL_
INSPECTOR DATE OF INSPECTION MADE: 2
FAXED OPPD\BURT REA TO CONNECT SERVICE:
BUILDING INSPECTION REPORT
CITY OF BLAIR
❑ WASHINGTON COUNTY ❑ OTHE
LOCATION OF INSPECTION
NAME OFOWNER:
C J0 Jl "ka,11 J v o
CONTRACTOR - O
DATE INSPECTION
REQUESTED TIME INSPECTION REQUESTED: PERMIT
NO
TYPE OF INSPECTION REQUESTED: EICONFERENCE
[:1 STATUS CHECK
BUILDING: ❑
FOOTING ❑ DECK FOOTING E:l FRAMING [:] DRYWALL ❑,"fINAL [:1 PARTIAL
PASSED
FAILED
Fl
COMMENTS:
<
UTILITIES: ❑
SEWER TAP F SEWER ❑ SEPTIC F WATER TAP ❑ REMOTE ❑ WATER SERVICE
PASSED
FAILED
F1
PARTIAL
❑ - 1
❑
COMMENTS:
ELECTRICAL: ❑
ROUGH iNFI FINAL ❑ PERMANENT SERVICE ❑ TEMPORARY SERVICE ❑ PRECONNECT
PASSED
FAILED
❑
PARTIAL
1
❑
COMMENTS:
MECHANICAL:F
ROUGH-IN [:1 A/C ❑ FURNACE ❑ RADIANT HEAT ❑ FINAL ❑ PARTIAL
PASSED
FAILED
F
F
COMMENTS:
PLUMBING: F
GROUNDWORK ❑ ROUGH-IN ❑ FINAL ❑ WATER METER INSTALLED ❑ PARTIAL
PASSED
FAILED
❑
PRESSURE TEST
❑
❑
COMMENTS:
F OCCUPANCY GRANTED ❑ CONDITIONAL OCCUPANCY GRANTED
NOTES/REMARKS
jjok u
TIMEL_
INSPECTOR DATE OF INSPECTION MADE: 2
FAXED OPPD\BURT REA TO CONNECT SERVICE: