BP13383CITY OF BLAIR - APPLICATION FOR BUILDING PERMIT
Ap om,sa Permit #
Date: zu 1 10 Approximate Completion Date: /-9-31
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 pian required)
Satellite Dishes/Radio Antenna/Cell Towers (plot pian required)
Other
Utilities: Public Water: Yes No Private Well
If yes, responsible entity: Blair OPPD Line Kennard
Agreement needed:Date Agreeme t Received:
Public Sewer: Yes No Septic Drawing Provided:
If yes, responsible entity: BI it Kennard
County Road Permit Required: Yes o Submitted: Yes No
Prolect Information:
�„ ��
Job Address: 160 91 9— 2®1 oo, i q 1
g Description ( applicable) L SI S IS ®� l �'® KIi ) �° � � "1,�
Legal. Descrl tion If a licable "' -� � �"-� �' �
Owner: —rfm PbAs Address: 10 ? Phone#:
Contractor: 1 Phone #:
Address: saCell #:
Email Address for Contractor: o . CAIrn
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
In pb tor. I hereby agree to perform the proposed work in accordance with the specifications set forth above and in accordance with the
codes rdinances of the City of Blair and the State of Nebraska. I understand that this permit is void if work is not commenced within
180 da s or is not completed within t ) years of date of issue.
® /Y®
�'Iatu e f 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: W, Conditional Use Permit Required: Yes No
Date C P Approved:
State Fire Marshal Required: Yes No A Variance Required: Yes No
Minimum Setbacks: Front Second Front Side 0, 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: Yes
Approved by:
Flood Plain: Yes No
If yes, specify special require ents:
BUILDING INSPECTOR REVIEW:
Number of Stories
One Two Three Four >Fou'r 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: f if A Second Level: �, `� �-- Third Level
Basement: (Unfinished) /rfi=r a- (Finished)
Garage: 4s_ 2 bay 3 bay 4 bay 5+ bay
Detached Garage: Pole Barn:
Addition: Remodel:
Porch: Front Rear Side
Deck that affect setbacks: Rear 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 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 areaX $56
Unfinished basement sq/ft area , % ,1 X $29
Garage sq/ft area X $25
Total Valuation:
Total Valuation d � 2'; J`'% � ' 4}`) Multiplied by 0.006 =
Issuance Fee:
Total Permit Fee = Deposit + Permit Fee + Issuance Fee
$
$ v5,q 7 d�
$ 2 5.0 0 f ( t
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 ings 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: I -IL e I Date: A
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
-,'rise of av
CITY Of 5LAIQ
HOMEOWNER VERIFICATION FOR PLUMBING AND/OR
MECHANICAL PERMITS
states the following:
Print your full name on line above:
1. I am the owner of the single family dwelling for which I am applying for a
plumbing and/or mechanical permit.
Address: 10 �/Z Co �C/) 29'
2. I am applying for a plumbing and/or mechanical permit for a single family
dwelling and it is or will be my principal residence.
3. I will install and connect the plumbing and/or mechanical by myself, without
compensation or pay from or to, any other person.
4. I have sufficient knowledge of the 2006 International Code requirements to make
an electrically safe and mechanically secure installation, which will meet the
minimum standards referenced in the 2006 International Code.
5. I am aware of all inspections required prior to a final.
6. I will call twenty-four (24) hours in advance for an inspection. I am also aware
that it is not the inspector's job or duty to be my instructor in plumbing and/or
mechanical.
7. I am aware that violation of the code makes it a Class 1 misdemeanor to make a
false statement on a request for inspection.
8. By signing this form I am stating the above information is true an correct.
Date
218 South 16th Street • Blair, Nebraska 68008 - 402-426-4191 • Fax 402-426-4195 • E-mail cityofblair@ci,blair.ne.us
PLUMBING PERMIT APPLICATION
Jurisdiction of City of Blair, Nebraska
218 South 16th Street
Blair, Nebraska 68008
Fax (402) 426-4195 P 2097
(402) 426-4191
Application Date: I v d Permit Fee: $
Job Address
Own r Mail AddressPhone
1. iia "ip .2 6,
Contracto Mail Address Zip Phone
2.
3. Class of W rk: O COMMERCIAL a -RESIDENTIAL ew O Addition O Alteration O Repair O Replacement
Describe Work:
PLUMBING PERMIT FEES
Comments: Modular Home ......................$50.00
Type of Fixture No.
Kitchen .............................. $12.00 x
Bath..... Residential/Single Stall $12.00 x G6
....................Multi -Stall $25.00 x
Rough -In Bath ........................$8.00 x•
Additional Sinks.....................$6.00 x -I �V ° U
Slop Sink/Laundry Tray/Drain ..... $6.00 x �_ G
Water Heater .........................$10.00 x
Notice Outside Water Faucet...................$6.00 x
I hereby certify that I have read and examined this
application and know the same to be true and correct. All Drinking Fountain ........................$6.00 x
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
performance of construction. Sewer.................................$15.00
Groundwork .........................$15.00
Septic Tank & Laterals............ $15.00
Lawn Sprinkler System ............ $10.00
rre
Sprinkler System (Commercial)..$30.00
Gas/Water Piping System
(Commercial) ........................ $50.00
C n &tor or Authorized Agent Permit Issuance Fee.................$25.00 J
Total D Ga
® a Current License on File O Yes O No O N/A
Date Comment:
WHEN PROPERLY VALIDATED (IN THIS SPACE) THIS IS YOUR PERMIT
Approved By:
Rev. 2008-10
CITY OF
NEBRASKA
9
Phone 402-426-4191
THANKYOU KEEPTHISCOPYFORYOUR RECORDS.
NO
RECEIVED BY
Pounds Printing, Blair, NE 68008
Energy Code:
2006 IECC
Location:
Washington County, Nebraska
Construction Type:
Single Family
Building Orientation:
Bldg. faces 180 deg. from North
Conditioned Floor Area:
2154 ft2
Glazing Area Percentage:
11%
Heating Degree Days:
6499
Climate Zone:
5
Construction Site:
Owner/Agent: Designer/Contractor:
10097 County Road 29
Tim Potts Tim Potts
Blair, NE
402-289-7014
Compliance: 3.5% Better Than Code
Ceiling 1: Flat Ceiling or Scissor Truss
Ceiling 2: Cathedral Ceiling (no attic)
Wall 1: Wood Frame, 16in. o.c.
Orientation: Front
Window 1: Vinyl Frame:Double Pane with Low -E
SHGC: 0.29
Orientation: Front
Door 1: Solid
Orientation: Front
Wall 2: Wood Frame, 16in. o.c.
Orientation: Left Side
Window 2: Vinyl Frame:Double Pane with Low -E
SHGC: 0.29
Orientation: Left Side
Wall 3: Wood Frame, 16in. o.c.
Orientation: Back
Window 3: Vinyl Frame:Double Pane with Low -E
SHGC: 0.29
Orientation: Back
Door 2: Glass
SHGC: 0.29
Orientation: Back
Wall 4: Wood Frame, 16in. o.c.
Orientation: Right Side
Basement Wall 1: Solid Concrete or Masonry
Orientation: Front
Wall height: 9.0'
Depth below grade: 8.8'
Insulation depth: 9.0'
Basement Wall 2: Solid Concrete or Masonry
Orientation: Front
Wall height: 9.0'
Depth below grade: 8.8'
Insulation depth: 9.0'
Basement Wall 3: Solid Concrete or Masonry
Orientation: Left Side
Wall height: 9.0'
Depth below grade: 8.8'
Project Title:
Data filename:
1362 0.0 38.0 34
60 38.0 0.0 2
771 15.0 1.0 46
130 0.300 39
42 0.140 6
504 15.0 1.0 36
33 0.300 10
1098 15.0 1.0 76
81 0.300 24
21 0.300 6
394 15.0 1.0 30
261 11.0 1.0 14
72 0.0 1.0 9
54 0.0 1.0 7
Report date: 02/12/10
Page 1 of 5
J&L TESTING SERVICE
13O23CR28
BLA(R.NE. 08OO8
PHONE#(4O2)426-4851
FA>0#4O2)533-2U46
STATE CERTIFICATE NO. C141
F -PERCOLATION TEST
To Whom this may concern:
This letter outlines the procedures for the field percolation test for the proposed sewage disposal system
conducted at the referenced site. The following procedures were used in doing the test.
Three test holes were drilled at the site with o5"diameter continuous flight auger
tothe depth ufabout 4feet. All loose material was removed from the borings, Sides
and the bottoms of the holes are roughened to provide a natural surface, and the
bottoms cfeach were covered with gravel toprevent scour.
The drill team filled the borings with clean tap wmter. Water was nafilledfrom a
surplus reservoir ufwater(automatiusiphon) for atleast 4hours,
Measurements ofthe water drop hneach hole are recorded i2-1Ohours after pre-
saturation
From afixed reference point the drop in water level was measured at 30 -minute
intervals for a4'huurperiod. The drop that occurred during the final 3O-minuh»
period isused todetermine the percolation rate. The percolation rate imthe
average time in minutes for water to fall one inch. Your percolation rate for your
- -------------'--perk test- is-- - 9.93 -'minuh*mper inch. .This figurudatenaineo�viaMhe-cbart'-
-
Test results indicate percolation rates at the time ofour investigation. Variable soil conditions Gan cause
highly variable rates at any site, and differing weather conditions can affect results.
Ifwamay beof additional assistance please donot hesitate to contact us.
rIrvm I --
BUILDING PERMIT DEPOSIT AGREEMENT
A $500.00 r fundable deposit is being collected for any new commercial, new
, 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 tractor/Owner
v
ate
Contractor/Owner
City of Blair
Insulation depth: 9.0'
Basement Wall 4: Wood Frame
Orientation: Left Side
Wall height: 9.0'
Depth below grade: 0.5'
Insulation depth: 9.0'
Window 4: Vinyl Frame:Double Pane with Low -E
SHGC: 0.29
Orientation: Left Side
Door 3: Glass
SHGC: 0.29
Orientation: Left Side
Basement Wall 5: Solid Concrete or Masonry
Orientation: Back
Wall height: 9.0'
Depth below grade: 7.0'
Insulation depth: 9.0'
Basement Wall 6: Solid Concrete or Masonry
Orientation: Right Side
Wall height: 9.0'
Depth below grade: 8.8'
Insulation depth: 9.0'
Furnace 1: Forced Hot Air 95 AFUE
Air Conditioner 1: Electric Central Air 13 SEER
252 19.0 1.0
30
21
504
0.0
1.0
162 0.0 1.0
12
0.300 9
0.300 6
96
20
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 2006 IECC requirements in
REScheck-Web and to comply with the mandatory requirements listed in the REScheck Inspection Checklist.
Name - Title Signature Date
Project Title: Report date: 02/12/10
Data filename: Page 2 of 5
J<ESTING SERVICE
13O213CR28
BL4|R, NE. 68008
iNAME� Tim Potts
Blair, Ne. 68008
DATE OFTEST: 02/19/10 TO 02/20/10
SUINI OF PERCOLATiONIRKJES: 29-80
NIIINIUTES PEER !NCH� 9,93
SN: 2201002
STAT ECERT | ICA TENO, Ci41O
PHONE #(4O2)428-4851
FIELD DATA SHEET- --
- -
HOLE
NOLE1
HOLE
HOLE -3
TIME FILLI
READING
LOSS FILL
READING LAWS FILL
READING
LOSS
�:W6
PERCOLATION TEST DATA FILE
PERCOLATION READINGS
FINAL 30 MINUTE RESULTS
START
END
Elapsed ater Level
Percolation
Time
Water Level
Time
Time(Min.) (Drop In.)
Rates(Min. per In.)
-EEE]
-
WASTE DISPOSAL SIZING
-_� -
L
SQUARE FEET OF
DRAIN FIELD TRENCH REQUIRED FOR
ASINGLE FAMILY DWELLING
CITY
p/'o v�\\
177 of a
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 Buildincg
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
Date
218 South 16th Street • Blair, Nebraska 68008 • 402-426-4191 • Fax 402-426-4195 • E-mail cityofblair@ci,blair,ne,us
Ceilings:
❑ Ceiling 1: Flat Ceiling or Scissor Truss, R-38.0 continuous insulation
Comments:
❑ Ceiling 2: Cathedral Ceiling (no attic), R-38.0 cavity insulation
Comments:
Above -Grade Walls:
❑ Wall 1: Wood Frame, 16in. o.c., R-15.0 cavity + R-1.0 continuous insulation
Comments:
❑ Wall 2: Wood Frame, 16in. o.c., R-15.0 cavity + R-1.0 continuous insulation
Comments:
❑ Wall 3: Wood Frame, 16in. o.c., R-15.0 cavity + R-1.0 continuous insulation
Comments:
❑ Wall 4: Wood Frame, 16in. o.c., R-15.0 cavity + R-1.0 continuous insulation
Comments:
Basement Walls:
❑ Basement Wall 1: Solid Concrete or Masonry, 9.0' ht / 8.8' bg / 9.0' insul, R-11.0 cavity + R-1.0 continuous insulation
Comments:
❑ Basement Wall 2: Solid Concrete or Masonry, 9.0' ht / 8.8' bg / 9.0' insul, R-1.0 continuous insulation
Comments:
❑ Basement Wall 3: Solid Concrete or Masonry, 9.0' ht / 8.8' bg / 9.0' insul, R-1.0 continuous insulation
Comments:
❑ Basement Wall 4: Wood Frame, 9.0' ht / 0.5' bg / 9.0' insul, R-19.0 cavity + R-1.0 continuous insulation
Comments:
❑ Basement Wall 5: Solid Concrete or Masonry, 9.0' ht / 7.0' bg / 9.0' insul, R-1.0 continuous insulation
Comments:
❑ Basement Wall 6: Solid Concrete or Masonry, 9.0' ht / 8.8' bg / 9.0' insul, R-1.0 continuous insulation
Comments:
Windows:
❑ Window 1: Vinyl Frame: Double Pane with Low -E, U -factor: 0.300
For windows without labeled U -factors, describe features:
#Panes Frame Type Thermal Break? Yes No
Comments:
❑ Window 2: Vinyl Frame:Double Pane with Low -E, U -factor: 0.300
For windows without labeled U -factors, describe features:
#Panes Frame Type Thermal Break? Yes No
Comments:
❑ Window 3: Vinyl Frame:Double Pane with Low -E, U -factor: 0.300
For windows without labeled U -factors, describe features:
#Panes Frame Type Thermal Break? Yes No
Comments:
Project Title: Report date: 02/12/10
Data filename: Page 3 of 5
❑ Window 4: Vinyl Frame:Double Pane with Low -E, U -factor: 0.300
For windows without labeled U -factors, describe features:
#Panes —
Comments:
Frame Type Thermal Break? Yes No
Note: Up to 15 sq.ft. of glazed fenestration per dwelling is exempt from U -factor and SHGC requirements.
Doors:
❑ Door 1: Solid, U -factor: 0.140
Comments:
❑ Door 2: Glass, U -factor: 0.300
Comments:
❑ Door 3: Glass, U -factor: 0.300
Comments:
Heating and Cooling Equipment:
❑ Furnace 1: Forced Hot Air: 95 AFUE or higher
Make and Model Number:
❑ Air Conditioner 1: Electric Central Air: 13 SEER or higher
Make and Model Number:
Air Leakage:
❑ Joints, penetrations, and all other such openings in the building envelope that are sources of air leakage are sealed.
❑ Recessed lights are either 1) Type IC rated with enclosures sealed/gasketed against leaks to the ceiling, or 2) Type IC rated and ASTM
E283 labeled, or 3) installed inside an air -tight assembly with a 0.5" clearance from combustible materials and a 3" clearance from
insulation.
Sunrooms:
❑ Sunrooms that are thermally isolated from the building envelope have a maximum fenestration U -factor of 0.50 and the maximum
skylight U -factor of 0.75. New windows and doors separating the sunroom from conditioned space meet the building thermal envelope
requirements.
Vapor Retarder:
❑ Vapor retarder is installed on the warm -in -winter side of all non -vented framed ceilings, walls, and floors; or it has been determined that
moisture or its freezing will not damage the materials; or other approved means to avoid condensation are provided.
Comments:
Materials Identification and Installation:
❑ Materials and equipment are installed in accordance with the manufacturer's installation instructions.
❑ Insulation is installed in substantial contact with the surface being insulated and in a manner that achieves the rated R -value.
❑ Materials and equipment are identified so that compliance can be determined.
❑ Manufacturer manuals for all installed heating and cooling equipment and service water heating equipment have been provided.
❑ Insulation R -values, glazing U -factors, and heating equipment efficiency are clearly marked on the building plans or specifications.
Duct Insulation:
❑ Ducts in unconditioned spaces or outside the building are insulated to at least R-8.
❑ Ducts in floor trusses above unconditioned spaces or above the outdoors are insulated to at least R-6.
Duct Construction:
❑ Air handlers, filter boxes, and duct connections to flanges of air distribution system equipment or sheet metal fittings are sealed and
mechanically fastened.
❑ All joints, seams, and connections are made substantially airtight with tapes, gasketing, mastics (adhesives) or other approved closure
systems. Tapes and mastics are rated UL 181A or UL 181 B.
❑ Building framing cavities are not used as supply ducts.
❑ Automatic or gravity dampers are installed on all outdoor air intakes and exhausts.
❑ Additional requirements for tape sealing and metal duct crimping are included by an inspection for compliance with the International
Mechanical Code,
Temperature Controls:
❑ Thermostats exist for each separate HVAC system. A manual or automatic means to partially restrict or shut off the heating and/or
cooling input to each zone or floor is provided.
Project Title: Report date: 02/12/10
Data filename: Page 4 of 5
Heating and Cooling Equipment Sizing:
O Additional requirements for equipment sizing are included by an inspection for compliance with the International Residential Code.
Circulating Service Hot Water Systems:
Lj Circulating service hot water pipes are insulated to R-2.
❑ Circulating service hot water systems include an automatic or accessible manual switch to turn off the circulating pump when the
system is not in use.
Heating and Cooling Piping Insulation:
F-1 HVAC piping conveying fluids above 105 degrees F or chilled fluids below 55 degrees F are insulated to R-2.
Certificate:
A permanent certificate is provided on or in the electrical distribution panel listing the predominant insulation R -values; window
U -factors; type and efficiency of space -conditioning and water heating equipment.
NOTES TO FIELD: (Building Department Use Only)
Project Title: Report date: 02/12/10
Data filename: Page 5 of 5
Energy,
006 IIEGIC-01
CAJ Eff'Ou'lency Certificate
Ceiling / Roof
38.00
Wall
16.00
Floor I Foundation
1.00
Ductwork (unconditioned spaces):
�s M
Window
0.30 0.29
Door
0.14 0.29
Forced Hot Air Furnace
95 AFUE
Electric Central Air Conditioner
13 SEER
Water Heater:
Name:
Date:
Comments:
44
iO�
BUILDING INSPECTION REPORT
�_�
CITY OF BLAIR ❑ WASHINGTON COUNTY El OTHER
LOCATION OF INSPECTION
Al,
NAME OF OWNER-
vI
CONTRACTOR -
DATE INSPECTION REQUESTED-
TIME INSPECTION REQUESTED PERMIT
NO -
-I
TYPE OF INSPECTION REQUESTED:
❑ CONFERENCE
F STATUS CHECK
BUILDING:
FOOTING F -I DECK FOOTING ❑
FRAMING F1 DRYWALL E:l FINAL E:l PARTIAL
PASSED
FAILED
El
COMMENTS:
UTILITIES: F-1
SEWER TAP F-1 SEWER F1 SEPTIC F -I WATER TAP ❑ REMOTE F1 WATER SERVICE
PASSED
FAILED
F-1
PARTIAL
F]
F]
COMMENTS:
ELECTRICAL: F -I
ROUGH IN F] FINAL F] PERMANENT SERVICE F] TEMPORARY SERVICE F1 PRECONNECT
PASSED
FAILED
F]
PARTIAL
F -I
F]
COMMENTS:
MECHANICAL: F -I
ROUGH -IN F] A/c F-1 FURNACE
F -I RADIANT HEAT F1 FINAL El PARTIAL
PASSED
FAILED
1-1
R
COMMENTS:
PLUMBING: F -I
GROUNDWORK F -I ROUGH -IN F-1
FINAL El WATER METER INSTALLED El PARTIAL
PASSED
FAILED
F-1
PRESSURE TEST
El
El
COMMENTS:
F OCCUPANCY GRANTED F-1 CONDITIONAL OCCUPANCY GRANTED
NOTES/REMARKS:
-3-1
INC. i,21 Y-\
INSPECTOR DATE OF INSPECTION MADE: - kt T 1 -3
FAXED OPPD\BURT REA TO CONNECT SERVICE: ON B
-117;se of a�
CITY Of I)LAIQ
RE: Tax Lot 51 in Section 15, Township 18, Range 11, Blair, Washington County,
Nebraska (10097 County Rd 29)
As you are aware, your new residence cannot be constructed on the above Tax Lot,
since a residence already exists on this Tax Lot. According to the City of Blair Zoning
Regulations, the construction of more than one (1) structure on a Tax Lot is not
permitted in the AGG Zoning District. Therefore, you agree that within one hundred and
eighty (180) days following the final inspection in which you are granted occupancy of
the newly constructed residence, you will remove the existing residence. We
understand that as part of your financing package, $5000 has been set aside to
complete the demolition of this residence prior to the closing of your permanent loan
with Bank of Nebraska.
If you are in agreement with these stipulations please sign and date this document.
Further, by signing this document you are authorizing the City of Blair to enter on your
property to remove the existing residence and charged back to you the cost of removal,
including a lien, if you fail to comply with the terms of this agreement.
We, the undersigned, hereby acknowledge receipt of a copy of this document and agree
to its terms and conditions.
CITY OF BLAIR, NEBRASKA
B A��✓ C
JAWS E. REALPH, MAYOR
._�o/00vFe6
WASHINGTON COUN �_ 4, STAM OF NEBRASKA
RECORDt�# 4, AT N -
BOOK -'5-6 . PAGES) Y(o
P,EGISTER OF DEEDS
OiOORTUNTY
218 South 16th Street e Blair, Nebraska 68008 e 402-426-4191 • Fax 402-426-4195 e E-mail cltyofblair@ci.blair.ne.us
rl-In
Dated:
��' , 2010
LJ
Recorded
,�..,.
6
General
Numerical
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Photostat
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ATTEST:
i
BidWDA R. WHEELER, CITY CLERK
CITY OF BLAIR, NEBRASKA
B A��✓ C
JAWS E. REALPH, MAYOR
._�o/00vFe6
WASHINGTON COUN �_ 4, STAM OF NEBRASKA
RECORDt�# 4, AT N -
BOOK -'5-6 . PAGES) Y(o
P,EGISTER OF DEEDS
OiOORTUNTY
218 South 16th Street e Blair, Nebraska 68008 e 402-426-4191 • Fax 402-426-4195 e E-mail cltyofblair@ci.blair.ne.us
rl-In
TIM POTTS
STATE OF NEBRASKA )
) :ss:
WASHINGTON COUNTY j
S 6 2
B a
Jo OOTTS
On this 2-�o day of FCb(u w 2010, before me, the undersigned a Notary
Public, duly commissioned and qualified for in said county, personally came James E.
Realph, Mayor of the City of Blair, Nebraska, to me known to be the identical person
whose name is affixed to the foregoing agreement and acknowledged the execution
thereof to be his voluntary act and deed.
WITNESS my hand and Notarial Seal the day and year last above written.
c (�I fARY
Id
JLOMTHMNE D. LOU
My Cornet 6Xp..lune 17.201
STATE OF NEBRASKA )
) :ss:
WASHINGTON COUNTY )
Kc4�\nuu-,bUu&&/\-
NOTARY PUBLIC
On this day of _rtb f -V- Ck ! 2010, before me, the
undersigned a Notary Public, duly commissione and qualified for in said county,
personally came Tim and Jodi Potts, to me known to be the identical person whose
name is affixed to the foregoing agreement and acknowledged the execution thereof to
be his/her voluntary act and deed.
WITNESS my hand and Notarial Seal the day and year last above written.
dum=-
„wne20,Z+012 NOTARY PUBLIC
ZZ
Brenda Wheeler
From: Tim and Jodi Potts [tandjpotts@huntel.net,
Sent: Thursday, February 25, 2010 9:08 AM
To: Brenda Wheeler
Subject: Removal of Existing home letter
Here is the email from Tim Riewer of Bank ®f Nebraska, I am sure he will answer any
questions if y®u give him a call.
Thanks,
Tim
----- Original Message -----
From: POTTS, TIMOTHY I [mailto.*tjpotts@oppd.co
Sent.* Thursday, February 25, 2010 9:00 AM
To: tandjpotts@huntel.net
Subject: Bank of Nebraska Letter
From: Tim Riewer [mailto:triewer@bankofnebraska.comj:
Sent: Tuesday, February 16., 2010 11:58 AM
To: POTTS, TIMOTHY 3
Subject: RE: letter for demolition of old house
Tim/Jodi Potts
10097 County Rd 29
Blair NE 68008
February 16 2010
I am writing to address your current dwelling which was purchased and closed 12/29/09. Since
you will be constructing a new residence on that 'homesitel(which we know will commence as
soon as the weather allows), please be aware, that the existing home will need to be removed
from the site or demolished at the new home's completion in order for the new home, permanent
financing to be put into place. In previous conversations, you had planned and/or budgeted
for $5000 removal/tear down expenses to accomplish this needed event and so that was the
amount included in the overall cost of construction of the new home. Please let me know or
call Bank of Nebraska Mortgage Center staff with any questions you may have. Thanks!
Tim Riewer., VP
Bank of Nebraska
2710 S. 140th St.
Omaha NE 68144
402-537-7197 off
402-537-7180 fax
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— MINE
RE: Tax Lot 51 in Section 15, Township 16, Range 11, Blair, Washington County,
Nebraska (10097 County Rd 29)
As you are aware, your new residence cannot be constructed on the above Tax Lot,
since a residence already exists on this Tax Lot. According to the City of Blair Zoning
Regulations, the construction of more than one (1) structure on a Tax Lot is not
permitted in the AGG Zoning District. Therefore, you agree that within one hundred and
eighty (160) days following the final inspection in which you are granted occupancy of
the newly constructed residence, you will remove the existing residence. We
understand that as part of your financing package, $5000 has been set aside to
complete the demolition of this residence prior to the closing of your permanent loan
with Bank of Nebraska.
If you are in agreement with these stipulations please sign and date this document.
Further, by signing this document you are authorizing the City of Blair to enter on your
property to remove the existing residence and charged back to you the cost of removal,
including a lien, if you fail to comply with the terms of this agreement.
We, the undersigned, hereby acknowledge receipt of a copy of this document and agree
to its terms and conditions.
1_z1yIU
Recorded �x
General ✓ B
Numerinal
Photostats JAWS E. REALPH, MAYOR
Proofed _� O l D O d F/6
darned WASHINGTON CONN T`4 STAM, OF N2B S&,
RECORDED ) h J - �W ATS ,
BOOK _55/ MOJE(S) S l 96-�
Jt C-• ,d
REGISTER OF DEEDS
218 South 16th Street ^ Blair, Nebraska 68008 a 402-426-4191 ^ Fax 402-426-4195 ^ E-mail cityofblair@ci,blair.ne.us
Dated:
1i1^C)
r' 2—'La.l
LLj
C'J
< t.LJ
1_z1yIU
Recorded �x
General ✓ B
Numerinal
Photostats JAWS E. REALPH, MAYOR
Proofed _� O l D O d F/6
darned WASHINGTON CONN T`4 STAM, OF N2B S&,
RECORDED ) h J - �W ATS ,
BOOK _55/ MOJE(S) S l 96-�
Jt C-• ,d
REGISTER OF DEEDS
218 South 16th Street ^ Blair, Nebraska 68008 a 402-426-4191 ^ Fax 402-426-4195 ^ E-mail cityofblair@ci,blair.ne.us
ELECTRICAL PERMIT APPLICATION3�
Jurisdiction of City of Blair, Nebraska f
218 South 16 Street
Blair, Nebraska 68008
Fax (402) 426-4195 E 3202
(402) 426-4191 0
Application Date: r f 7 f Permit Fee: $ l () 0
Job Address q C
j
0Wn9j— Mail Address Zip Phone
` RAi
1. I ✓ti -v S
Contractor Mail Address Zip honey ; _ ��
2. a(�'
3. Classbf Work: O NEW RESIDENTIAL O NEW COMMERCIAL REMODELING/ADDITIONS O UPGRADE SERVICE
Describe Work:
�e
4.
5.Current License on File O Yes O No O N/A Completion Date
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
Signs (each)..............................$25.00
301-400 Amp Fee .......................$75.00
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
��.JJ c
801-900 Amp Fee.....................$175.00
# of Circuits x $5.00 l 0
901-1000 Am $195.00
Amp .........................
O
Amp Feel
IF OVER 1000 Amp
1St 1000 Amp Fee..................$195.00
Amp Fee + Circuit Total
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
Other: (alterations, additions and modifications)
work will be complied with whether specified herein or
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
Si afore of Contractor or Authorized Agent
!✓'} —�
Permit Issuance Fee.. ..$25.00
Total / 06
Date
Comment:
WHEN PROPERLY VALIDAIED (1N 1H1N NFAI ;) hila 1J Y U U X VhK1V111
Approved By:
Rev. 2008-10
By
TIM POTTS
STATE OF NEBRASKA )
) :ss:
WASHINGTON COUNTY
rZim
By (o-zu a A
JOOOTTS
On this 2—to day of 2010, before me, the undersigned a Notary
Public, duty commissioned and qua , lified for in said county, personally came James E.
Realph, Mayor of the City of Blair, Nebraska, to me known to be the identical person
whose name is affixed to the foregoing agreement and acknowledged the execution
thereof to be his voluntary act and deed.
WITNESS my hand and Notarial Seal the day and year last above written.
STATE OF NEBRASKA )
) :ss:
WASHINGTON COUNTY
NOTARY PUBLIC
On this _x2k day of 9KhfLk-a/!:j 2010, before me, the
undersigned a Notary Public, duly commissions and qualified for in said county,
personally came Tim and Jodi Potts, to me known to be the identical person whose
name is affixed to the foregoing agreement and acknowledged the execution thereof to
be his/her voluntary act and deed.
My comm- Ea im 2i 20NOTARY PUBLIC
a -P2r
i'se of a
CITI' OF f)tAIQ
HOMEONVNER VERIFICATION FOR ELECTRICAL WIRING PERMITS
yl� PO , states the following:
print your full name on line above:
1. I am the owner of the single family dwelling for which I am applying for an
electrical permit.
Address:
2. I am applying for an electrical permit for a single family dwelling and it is or will
be my principal residence.
3. I will install and connect the electrical wiring for myself, without compensation
or pay from or to, any other person.
�. I have sufficient knowledge of the 2005 National Electrical Code requirements to
make an electrically safe and mechanically secure installation which will meet the
minimum standards referenced in 81-2104.
s. I am aware of all inspections required prior to a final.
6. I will call twenty-four (24) hours in advance for an inspection. I am also aware
that it is not the inspector's job or duty to be my instructor in electrical wiring.
7. I am aware that Nebr. Rev. Stat. 81-2143 makes it a Class 1 misdemeanor to
make a false statement on a request for inspection.
8. By signing this form I am stating the above inforination is true an correct.
M3110
Date
218 South 16th Street - Blair, Nebraska 68008 - 402-426-4191 - Fax 402-426-4195 - E-mail cityofblair@ci.blair.ne.us
Brenda Wheeler
From: Tim and Jodi Potts [tandjpotts@huntel.net]
Sent: Thursday, February 25, 2010 9:08 AM
10: Brenda Wheeler
Subject: Removal of Existing home letter
Here is the email from Tim Qlemer of Bank of Nebraska, I am sure he will answer any
questions if you give him a call.
Thanks,
Tim
--- Original Message -----
From: POTTS, TIMOTHY I [mal]tm:tjpott .com]
Sent: Thursday, February 25" 2010 9z00 AM
To: tand'potts@hunteI.net
Subject: Bank of Nebraska Letter
From: Tim Riewer [mailto:triewep@bankofnebraska.coml
Sent: Tuesday, February 16^ 2010 11:58 AM
To: pOTTS, TIMOTHY 3
Subject: RE: letter for demolition of old house
Tim/Jodi Potts
I0097 County Rd 29
Blair NE 60008
February 16^ 2010
Dear Tim & Jodi
I am writing to address your current dwelling which was purchased and closed 12/29/09. Since
you will be constructing a new residence on that *humesite^(which we know will commence as
soon as the weather allows), please be aware, that the existing home will need to be removed
from the site or demolished at the new home's completion in order for the new home* permanent
financing to be put into place. In previous conversations, you had planned and/or budgeted
for $5000 removal/tear down expenses to accomplish this needed event and so that was the
amount included in the overall cost of construction of the new home. Please let me know or
call Bank of Nebraska Mortgage [enter staff with any questions you may have. Thanks!
Sincerely
Tim Riewor, VP
Bank of Nebraska
3710 S. 140th St.
Omaha N2 68144
402-537-7197 off
402-537-7108 fax
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