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BP13381CITY ,.. l ■ APPLICATION FOR BUILDING ■ ■ Date: �% "'��� Approximate Completion Date: Site Plan Attached: REScheck Attached: t--� Complete Plans Attached Application for: Residential Commercial/Industrial New Construction Manufactured Home Move -on: Home Accessory Building Remodel Addition Modular Other 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 pian required) Other Utilities: Public Water: Yes • No If yes, responsible entity: Agreement needed: Public Sewer: Yes No If yes, responsible entity: County Road Permit Required: Yes No _ Additi Project Information: of project if necessary: Private Well Blair OPPD Line Kennard Date Agreement Received: ® Septic Drawing Provided: Blair Kennard Submitted: Yes No Job Address: 11 All Legal Description (if applicable) :`�> 115-3 0 r /("%f� �r�./ Owne��: e'� Address: Phone#: Contractor:- �ri (_ �' ¢�' ��` Phone Address: -` `� Cell #: 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/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 completed within two (2) years of date of issue. )Siature of Owner/Contrac o'} 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 Ut' 'ties: Current Zoning: ®19M Conditional Use Permit Required: Yes No Date CUP Approved: 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 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 requirmenta: 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 Sleeping Rooms Living Area Other Egress No Square Footage: Main Level: Second Level: Third Level Basement: (Unfinished) (Finished) Garage: 1 2 bay 3 bay 4 bay 5+ bay Detached Garage: Addition: Porch: Front Deck that affect setbacks: Occur)ancv Classification: Pole Barn: Remodel: Rear Side Rear Front Side 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 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. 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 I 'SOC X $29 Garage sq/ft area X $25 Total Valuation: Total Valuation ILI'9 ->r � ` Multiplied by 0.006 = Issuance Fee: Total Permit Fee = Deposit + Permit Fee + Issuance Fee IN r Oe $ 25.00 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 followipg: 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/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 $ Issuance Fee: $ 25.00 Total Permit Fee = Deposit + Permit Fee + Issuance Fee $ Additional Comments: Approved by: Z Date: m 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 Application Date ELECTRICAL PERMIT APPLICATION Jurisdiction of City of Blair, Nebraska 218 South 16'h Street Blair, Nebraska 68008 Fax (402) 426-4195 (402) 426-4191 Permit Fee: $ E 3187 M Job Address 13--7 Own Mail Address -76 Zip Phone &� 6. 1. co�� /6 CoMail Address Zip Phone 2. %5X4 3. Class of Work: -,M',NEW RESIDENTIAL r7l NEW COMMERCIAL C3 REMODELING/ADDITIONS C3 UPGRADE SERVICE Describe Work: ", 1� 4. 1�v PVA"- 5.Current License on File Yes I Cl No 0 N/A Completion Date t-1 o 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 System...... ............... $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 1" 1000 Amp Fee ..................$195.00 Amp Fee + Circuit Total Each additional 100 Amps ......... $20.00 New Residential: (Finished Area) Single/Two Family Dwellings Notice I � 0o sq. ft. x.063 1 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 L"d Smoke Detectors..... x $3.00 Signature of Contractor or Aufflorized Agent Os Permit Issuance Fee.. .. $25.00 Total Date Comment: WHEN PROPERLY VALIDATED (IN THIS SPACE) THIS IS YOUR PERMIT Approved By: Rev. 2008-10 MECHANICAL PERMIT APPLICATION Jurisdiction of City of Blair, Nebraska I 218 South 16th Street Blair, Nebraska 68008 Fax (402) 426-4195 M 1981 (402) 426-4191 Application Date: a Permit Fee: $ Job Address OwMail Address 1. C'o M zip Phone Contr ctor Mail Address �1ekorl 'Lip Phone 510-31 2. mer;G4vj i c' 3. Class of Work: O COMMERCIAL ESIDENTIAL ew O Addition Cl Alteration O Repair O Replacement Describ ork: � 4. vp - MECHANICAL PERMIT FEES Heat Pump Tons Central A/C >� Tons j Z) Fumace/Heat Pump/Air Conditioner (Per Unit) 0, C) Furnace -70 , O'D 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) Boiler Chart BTUFee ..............................................................................$15.00 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 (use BTU Chart to left).................... Appliance Vent/Fans ........................$10.00 ' Notice Duct System......... ............$15.00 """"" �, cell I hereby certify that I have read and examined this 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 n Modular Home ............................... $50.00 Signature of Contractor or Authorized Agent U Permit Issuance Fee .......................... $25.00 Total 22 Current License on File /<Yes O No O N/A Date Comment: WHEN PROPERLY VALIDATED (IN THIS SPACE) THIS IS YOUR PERMIT Approved B Rev. 2008-10 k - PLUMBING PERMIT APPLICATION, Jurisdiction of City of Blair, Nebraska 218 South 16 Street Blair, Nebraska 68008 Fax (402) 426-4195 P 2092 (402) 426-4191 Application Date: —A Permit Fee: $ % az� Job Address Owacr 9Mail Addr s Zip Phone I. / +>ZuG Contractor d ess�= Pp�� 2. � ,�v /,gym C��/ � f-+ �j r �-L% t /��'!�� 3. Class of Work: [J C0MMERCfAL;WRES1DEYYjP mew O Addition O Alteration 0 Repair O Replacement Describe Work: 4. PLUMBING PERMITt , ES Comments: Modular Home ......................$50.00 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 Fee ................ Current License on File ,Yes 0 No D N/A WHEN PROPERLY VALIDATED (IN THIS SPACE) THIS IS YOUR PERMIT Approved By: Rev. 2008-10 Type of Fixture No. Kitchen .............................. $12.00 x Bath.....Residential/Single Stall $12.00 x' Od ....................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 _ ze U 0 Water Heater .........................$10.00 x �_ jD. -rp Notice Outside Water Faucet...................$6.00 x % • (J Gi 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 Fee ................ Current License on File ,Yes 0 No D N/A WHEN PROPERLY VALIDATED (IN THIS SPACE) THIS IS YOUR PERMIT Approved By: Rev. 2008-10 PLUMBING PERMIT APPLICATION Jurisdiction of City of Blair, Nebraska 218 South 16th Street Blair, Nebraska 68008 Fax (402) 426-4195 P 2092 (402) 426-4191 Application Date: j, 0 _/ Permit Fee: $ lau, Job Address 13 7 t � *J Owner Ax) ✓Y /Nail Addrgss Zip Phone Contractor M 2. _ E 3. Class of Work: O COMMERCIAL 4. Comments: Notice I hereby certify that I have read and examined this 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 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. Signature of Contractor or Date Agent P ' % A/ R:N ew O Addition O Alteration O Repair O Replacement 4 PLUMBING PERMIT FEES Modular Home ......................$50.00 Type of Fixture No. Kitchen .............................. $12.00 x 6 o Bath.....Residential/Single Stall $12.00 x ....................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 1"9,60 Outside Water Faucet...................$6.00 x Drinking Fountain ........................$6.00 x Backflow/Grease Trap.............$15.00 Water Service .......................$15.00 Sewer.................................$15.00 Groundwork .........................$15.00 —1— I° 0 Septic Tank & Laterals............ $15.00 Lawn Sprinkler System ............ $10.00 Sprinkler System (Commercial)..$30.00 Gas/Water Piping System (Commercial) ........................ $50.00 Permit Issuance Fee.................$25.00 Total C Current License on File es O No O N/A Comment: WHEN PROPERLY VALIDATED (IN THIS SPACE) THIS IS YOUR PERMIT Approved By: Rev. 2008-10 VP r" s PLUMBING PERMIT APPLICATION Jurisdiction of City of Blair, Nebraska 218 South 16th Street Blair, Nebraska 68008 Fax (402) 426-4195 T43618 (402) 426-4191 Application Date: ( - / f1' 'ld Permit Fee: $ C.)dd° �© Job Address /9 9"? oMajl Address Zip Phone Contract r sit Ad ess ' ip rj�� ne� ( 3. Class of Work: 0 COMMEMALSKESIDWML >Aew 0 Addition 0 Alteration 0 Repair 0 Replacement Describe Work: ! �. PLUMBING PERMIT FEES Comments: Water Tap Fee — %11 $150.00 Water Tap Fee —1" Water Tap Fee —1. %11 $200.00 $250.00 otice 1 have I hereby certify that read and examined this 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 Water Tap Fee — 2" $300.00 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 . i �' S' nature of ontractor or Authorized Agent TotalGiDr DU a'/O Current License on File -1;Ms 0 No O N/A Date Comment: WHEN PROPERLY VALIDATED (IN THIS NPAC;E) THIS IS YOUR PERMfl' Approved By: 91 Rev. 2008-10 0 Jurisdiction of City of Blair, Nebraska 218 South 16th Street Blair, Nebraska 68008 Fax (402) 426-4195 (402) 426-4191 Application Date: �__ M' Permit Fee: $� Job Address f Ones y I Mao Address Zip Phone Contract r'JZip ne 2. / ailAddress a �i� 1i lc 3. Class of Worlc: O COMMERCIAL ESID TIAL ew 11 Addition O Alteration O Repair O Replacement Describe Work: r ✓ 4. PLUMBING PERMIT FEES Comments: Water Tap Fee —3/411 $150.00 Water Tap Fee —1" Water Tap Fee —1 1/2" $200.00 $250.00 Notice I hereby certify that I have read and examined this 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 orWater T 5' Tap Fee — 2 $300.00 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. Signature of Contractor or Authorized Agent Total a Current License on File Yes 11 No O N/A Date Comment: WHEN FKUFEKL Y V AL1llA l Ell (1N "l HIS SPACE) THIS 1S YOUR PERMIT Approved By: r � Rev. 2008-10 19 THANK YOU KEEP THIS COPY FOR YOUR RECORDS. NO RECEIVED BY Pounds Printing, Blair, NE. 68008 REScheck Software Version 4.1.3 Compliance Certificate Project Title: Lot 53, Deefeld, Mair Report Date: 02/18/10 Data filename: Untitled.rck Energy Code: 2000 ICC Location: Blair, Nebraska Construction Type: Single Family Glazing Area Percentage: 8% Heating Degree Days: 6506 Construction Site: Lot 53 Blair, NE 68008 Owner/Agent: McCaig Construction Blair, NE 68008 Umm"3.-Mst! r a Compliance: 40.9% Better Than Code Maximum UA: 301 Your UA: 178 Designer/Contractor: Ceiling 1: Flat Ceiling or Scissor Truss 1300 38.0 38.0 18 Wall 1: Wood Frame, 16" o.c. 1300 15.0 15.0 51 Window 1: Vinyl Frame:Double Pane with Low -E 16 0.560 9 Window 2: Vinyl Frame:Double Pane with low -E 16 0.560 9 Window 3: Vinyl Frame:Double Pane with Low -E 16 0.560 9 Window 4: Vinyl Frame:Double Pane with Low -E 10 0.560 6 Window 5: Vinyl Frame:Double Pane with Low -E 10 0.560 6 Door 1: Glass 36 0.560 20 Door 2: Solid 24 0.350 8 Door 3: Solid 24 0.350 8 Basement Wall 1: Solid Concrete or Masonry 1000 13.0 13.0 34 Wall height: 9.0' Depth below grade: 7.0' Insulation depth: 9.0' Furnace 1: Forced Hot Air90 AFUE Air Conditioner 1: Electric Central Air14 SEER Compliance Statement. The proposed building design described here is consistent with the building plans, specifications, and other calculations submitted with the permit application. The proposed building has been designed to meet the 20001ECC requirements in REScheck Version 4.1.3 and to comply with the mandatory requirements listed in the REScheck Inspection Checklist. Name - Title Signature Date Project Title: Lot 53, Deerfield, Blair Report date: 02/18/10 Data filename: Untitled.rck Page 1 of 4 ' Aromis� 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. 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 Date 6-C""A' Contractor/Owner 2,__.; City of Blair Date: 02/18/10 Ceilings: ® Ceiling 1: Flat Ceiling or Scissor Truss, R-38.0 cavity + R-38.0 continuous insulation Comments: Above -Grade Walls: ® Wall 1: Wood Frame, 16" o.c., R-15.0 cavity + R-15.0 continuous insulation Comments: Basement Walls: ® Basement Wall 1: Solid Concrete or Masonry, 9.0' ht / 7.0' bg / 9.0' insul, R-13.0 cavity + R-13.0 continuous insulation Comments: Exterior insulation has a rigid, opaque, weather -resistant protective covering that covers the exposed (above -grade) insulation and extends at least 6 in. below grade. Windows: ® Window 1: Vinyl Frame:Double Pane with Low -E, U -factor: 0.560 For windows without labeled LI -factors, describe features: #Panes — Frame Type Thermal Break? — Yes — No Comments - C3 Window 2: Vinyl Frame:Double Pane with Low -E, U -factor: 0.560 For windows without labeled LI -factors, describe features: #Panes — Frame Type Thermal Break?. Comments - Yes _ No LI Window 3: Vinyl Frame:Double Pane with Low -E, U -factor: 0.560 For windows without labeled LI -factors, describe features: #Panes _ Frame Type Thermal Break? Yes No Comments - LI Window 4: Vinyl Frame:Double Pane with Low -E, U -factor: 0.560 For windows without labeled U -factors, describe features: #Panes — Frame Type Thermal Break? — Yes T No Comments - LJ Window 5: Vinyl Frame:Double Pane with Low -E, U -factor: 0.560 For windows without labeled U -factors, describe features: #Panes — Frame Type Thermal Break? ____ Yes Comments: Doors: ® Door 1: Glass, LI -factor: 0.560 Comments: ® Door 2: Solid, U -factor: 0.350 Comments: ® Door 3: Solid, LI -factor: 0.350 Comments: Heating and Cooling Equipment: No Project Title: Lot 53, Deerfield, Blair Report date: 02/18/10 Data filename: Untitled.rck Page 2 of 4 CITv Of 5LAIQ rise of av 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 Dat 218 South 16th Street • Blair, Nebraska 68008 • 402-426-4191 • Fax 402-426-4195 • E-mail cityofblair@ci,blair.ne.us CITY OF BLAIR BUILDING INSPECTION REPORT ❑ WASHINGTON COUNTY V . ,-._ (a a LOCATION OF INSPECTION: t ` - i y : r NAME OF OWNER: C' __ (-, ❑ OTHER DATE INSPECTION REQUESTED f TIME INSPECTION REQUESTED- f PERMIT TYPE OF INSPECTION REQUESTED: d ❑ CONFERENCE ❑ STATUS CHECK BUILDING: Ey FOOTING ❑ DECK F09TING ❑ FRAMING F-1DRYWALL El FINAL [I PARTIAL PASSED FAILED COMMENTS: t F� ! .� ") ' ' ' e W ! (��' Ld 1:1 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 ❑ ❑ COMMENTS: ❑ OCCUPANCY GRANTED ❑ CONDITIONAL OCCUPANCY GRANTED l-o-4_�o��� 3-3-t� INSPECTOR • DATE OF INSPECTION MADE: — " f TTME ,1 FAXED OPPD\BURT REA TO CONNECT SERVICE: ON BY ❑": CITY OF BLAIR REPORTUILDING INSPECTION ❑ WASHINGTON COUNTY ❑ OTHER � a LOCATION OF INSPECTION• t` • 1% �} i. � r 7 s F`x o n P F'g ?tl�ONTRACTOR NAME OF OWNER+ / _/,"- E tlz r DATE INSPECTION REQUESTED- TIME INSPECTION REQUESTEDLI " PERMIT No- O TYPE 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: ;K ELECTRICAL: ❑ ROUGH IN ❑ FINAL ❑ PERMANENT SERVICE ❑ TEMPORARY SERVICE ❑ PRECONNECT PASSED FAILED ❑ PARTIAL ❑ ❑ COMMENTS: MECHANICAL: ❑ ROUGH -IN ❑ A/C ❑ FURNACE ❑ RADIANT HEAT ❑ FINAL ❑ PARTIALS PASSED FAILED ❑ ❑ COMMENTS: PLUMBING: ❑ GROUNDWORK ❑ ROUGH -IN ❑ FINAL ❑ WATER METER INSTALLED ❑ PARTIAL PASSED FAILED ❑ PRESSURE TEST ❑ ❑ COMMENTS: ❑ OCCUPANCY GRANTED ❑ CONDITIONAL OCCUPANCY GRANTED ffi INSPECTOR: DATE OF INSPECTION MADE: ` ! ® T IPS FAXED OPPD\BURT REA TO CONNECT SERVICE: ON BY ❑~ CITY OF BLAIR BUILDING ' INSPECTION REPORT ❑ WASHINGTON COUNTY ❑ LOCATION OF INSPECTION NAME OF OWNER; t` J } 4 CONTRACTOR DATE INSPECTION t REQUESTED v 5 € _ ? TIME INSPECTION REQUESTED a •1 ;' 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: ❑ ROUGH IN ❑ FINAL ❑ PERMANENT SERVICE ❑ TEMPORARY SERVICE ❑ PRECONNECT PASSED FAILED ❑ PARTIAL ❑ ❑ COMMENTS: MECHANICAL: ❑ ROUGH IN ❑ il A/C ❑ FURNACE ❑ RADIANT HEAT ❑FINAL ❑PARTIAL PASSED FAILED COMMENTS: t - PLUMBING: ❑ GROUNDWORKrRROUGH-IN ElFINALE] WATER METER INSTALLED ElPARTIAL PASSED FAILED COMMENTS: FlPRESSURE TEST ❑ ❑ OCCUPANCY GRANTED ❑ CONDITIONAL OCCUPANCY GRANTED NOTES/REMARKS 1 c IQ'� 5�h %��� /S I il J r� o— C i- S � PS � /,� %Gz� ,n,M fel � � ` � ;�� �/�� err, � v✓� �� e� INSPECTOR- e Blies DATE OF INSPECTION MADE: d`� ! h TIM • FAXED OPPD\BURT REA TO CONNECT SERVICE: ON 04129/2010 Ot43 PM 04012rT 01:43 =wl i .wl.f,-. 04012rT 01:43 =wl �fk �� h A � . /: '��r Z�i2� l� k:�;`T '�1 ♦,c . �t ` {�j`r $'i. ..' 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