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BP13401{—�CITY OF BLAi q 7i,_ r1l 10��OR BUILN RMIT Date: 125) ID Approximate Completion Date: /0 Site Plan Attached: REScheck Attached: Complete Plans Attached Application for: Residential C mme ial/Industrial New Construction Manufact Hom!1�0t�he du ar Move -on: Home Accessory Building�� Vl Remodel Addition Accessory Building: Garage Pole Barn Other Floor Type: Dirt Concrete Electricity: Yes No :i ign recting, Awnings Decks/Handicap Ramps (plot pian required) atellite 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 _ al Description of project if \ If V % V1 r Project Information: Job Address: Private Well Blair OPPD Line Kennard Date Agreement Received: Septic Drawing Provided: Blair Kennard Submitted: Yes No 0 WM Legal Description (if applicable) � 7-4*, q -g_D Owner: )--�4 ✓l /yl�7 26-11 L7 � A l(_`I CC �A�dd s: Phone#: Contractor:UhI m 1 d �A y"6yCc/h6g S Phone #�O -dlU Address: amk, 0,03-- 1t1. `'� Me 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 Sta e -of Nebraska. I understand that this permit is void if work is not commenced within 180 days or is not co_Wleted within two (2)yeafis of date of issue. 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 RECEIVED OF: ADDRESS f 4is, tJ CITY, STATE, ZIP CODE THANK YOU KEEP THIS COPY FOR YOUR RECORDS. NO RECEIVED BY Pounds Printing, Btair, NE 68008 ZONING REVIEW: Zoning/Flood Plain/Utilities: Current Zoning: —AI Qj- 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 jaidewalk 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 o_If yes, specify special requ BUILDING INSPECTOR REVIEW: Number of Stories One Two Three Four >Four High Rise (>75 ft) _ T_vae of Residential Structure: Ranch Two Story Split Entry Raised Ranch Other Rooms Bedrooms Bathrooms Fireplaces Gas Electric Egress in Basement: Required: Yes No Sleeping Rooms Living Area, Sauare Footage: Provided on Plans: Yes _ Other Egress Mks Main Level: Second Level: Third Level Basement: (Unfinished) (Finished) Garage: 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 Occupancv 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) 1015, 5 3u Pae 1 of 1 http://webmail.abbnebraska.net/cache/OADE5EA89D l 3F663 79891 DA7079F9DA6/41401... 3/17/2010 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 131) Driveway Grade: 20% grade or less? Yes No (Dale will review new residential construction. At 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 $ r- 3 Business/Industrial/Educational/Assembly/Fac ry 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 Erecting/Awnings and Decks/Handicap Ramps: sq/ft area X $25 (Minimum valuation of $2000) Construction valuation computation: Finished sq/ft area 0 12 0 X $ $ 9,100. 00 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 $ r7o . 00 Issuance Fee: $ 25.00 r q5, Total Permit Fee = Deposit + Permit Fee + Issuance Fee $ /45-00 Additional Comments: Approved by: ty--4� Date: - 9 ( o 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 3 \ a F~ i # a S pE j i i + S c I , R [ 9 , s a # i i 1.� 1 I it I ,1 rr, 9(� j 3 x CITY OF BLAIR — APPLICATION FOR BUILDING PERMIT Permit # 1?,4o Date:� 5) LO Approximate Completion Date: 10 Site Plan Attached: REScheck Attached: Complete Plans Attached Application for: Residential C mm e ial/Industrial New Construction Manufact Home u a odr ' �t Move -on: Home Accessory Building Othe Remodel Addition Accessory Building: Garage Pole Barn Other 1_ Floor Type: Dirt Concrete Electricity: Yes No -° (: iaiellite recting, Awnings Decks/Handicap Ramps (plot plan required) 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: (f,) S ( lelr1 Sx 12 c. lex Project Information: Job Address: I J 30 Legal. Description (if applicable) 11 Owner: 1 --OA I ak* Ad d e s: Phone#: Contractor:��,1(Y}'� 1 � ��1n�(Cl '1 S Phone #5� Address: 5=01 �a �`�� t l�lS V��`�- � � Cell #0 ( "-1(sl� 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 workin accordance with the specifications set forth above and in accordance with the codes/ordinances of the City of Blair and the Sta e-o"f Nebraska. I understand that this permit is void if work is not commenced within 180 days or is not co_Wleted within two (2) s of date of issue. �Dat 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 YV1OU@. r x vic"4 ,s e - In1. A c- r, r -n 44, ,� L �Q c.14 `} 7 Y'a� r n w `s i 3/y �` ( kt e r N to C.___, tM.ptm V-7,7.1.�C, nvN I,.D 1v� wt p�"n e k ��c� r Nl VIT11.- 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. Date Contractor/Owner City of Blair OFFICE kmm REAL ESTATE I� "�-Tylfxk ❑ CITY OF BLAIR LOCATION OF i rV, 61 v1 , 9, ❑ WASHINGTON COUNTY /', TYPE OF INSPECTION REQUESTED: ❑ CONFERENCE f r a FOOTING ❑ DECKFOOTING ❑ FRAMING ❑ DRYWALL ❑ FINAL XARTIAL fi v NAME OF OWNER`: - il' + ` ^ fi` , fr` ,° CONTRACTOR ❑' c .,,v . a r I_ ' Vie'` c s c.:_„e DATE INSPECTION REQUESTED' _ ” TIME INSPECTION REQUESTED I .7!. "f' UTILITIES: ❑ SEWER TAP ❑ SEWER ❑ SEPTIC LL❑ WATER TAP ❑ REMOTE ❑ WATER SERVICE PASSED FAILED ❑ PERMIT NO' ell, <. TYPE OF INSPECTION REQUESTED: ❑ CONFERENCE ❑ STATUS CHECK ®P BUILDING: ❑ FOOTING ❑ DECKFOOTING ❑ FRAMING ❑ DRYWALL ❑ FINAL XARTIAL SSED FAILED El COMMENTS: UTILITIES: ❑ SEWER TAP ❑ SEWER ❑ SEPTIC LL❑ 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 Co - INSPECTOR AVA2 DATE OF INSPECTION MADE: TIME. FAXED OPPD\BURT REA TO CONNECT SERVICE: ON BY ❑s CITY OF BLAIR LOCATION OF INSPECTION: U D1 01 j ❑ WASHINGTON COUNTY ❑ NAME OF OWNER " � BUILDING: ❑ FOOTING ❑ DECK FOOTING ❑ FRAMING ❑ DRYWALL �B FINAL PARTIAL CONTRACTOR- NT AC 0 FAILED INSPECTION REQUESTED- ° TIMEDATE TIMEINSPECTION REQUESTED-- PERMIT N0: TYPE OF INSPECTION REQUESTED: _ ❑ CONFERENCE ❑ STATUS CHECK BUILDING: ❑ FOOTING ❑ DECK FOOTING ❑ FRAMING ❑ DRYWALL �B FINAL PARTIAL P SSED FAILED El 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 ❑ 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 INSPECTOR- DATE OF INSPECTION MADE: L? T1MF 1 1 AvKA FAXED OPPD\BURT REA TO CONNECT SERVICE: ON BY ITE ELECTRICAL DIVISION $25.00 Inspection Fee Received $ UE ELECTRICAL DIVISION - - - - - - - South 13th Street ® P.O. Box 95066 • Suite 109 Date )In, NE 68509-5066 • (402) 471-3550 0 Fax 471-4297 tnspectoi ZING PERMIT # 20505.1 )lication for state electrical inspection has been received and roved. Proceed with work: ,t REMAX'CORNERS ONE PROPERTY S HWY MACS ELECTRIC . PO -.BOX 371 345N 2ND ARLINGTON., NE 68002 6/18/2010 By; LINDA WIRING PERMIT # Date Inspector 205051 Date Inspector JAMES WILSON NEC 2005 644 NORTH 23RD STREET ASHLAND, NE 68003 OFC: (402) 944-7405 CEL: (402) 499-5841 District # 14 i INSPECTOR'S OFFICE HOURS 8:00 A.M.-9:00 A.M. Wednesday 8:00 A.M.-12:00 Noon Friday j ]BUILDING INSPECTION REPORT CITY OF BLAIR ❑ WASHINGTON COUNTY ❑ OTHER LOCATION OF INSPECTION• k 7 t l i f i r NAME OF OWNER, ' ' r r ty . �.`,�r t « t r f << yf r CONTRACTOR F r . ..,c- a - c �, ,. DATE INSPECTION REQUESTEI)i TIME INSPECTION REQUESTED: ' PERMIT NO ,+ TYPE OF INSPECTION REQUESTED: ❑ CONFERENCE ❑ STATUS CHECK BUILDING: ❑ FOOTING ❑ DECKFOOTING ❑ FRAMING ❑ DRYWALL, FINAL [:1 PARTIAL PASSED FAILED 4 COMMENTS: a' o" "J" UTILITIES: ❑ SEWER TAP ❑ SEWER ❑ SEPTIC ❑ WATER TAP ❑ REMOTE ❑ WATER. SERVICE PASSED FAILED ❑ PARTIAL ❑ F]COMMENTS: ELECTRICAL: ❑ ROUGH IN ❑ FINAL ❑ PERMANENT SERVICE ❑ TEMPORARY SERVICE ❑ PRECONNECT� PASSED FAILED F1 PARTIAL El F]COMMENTS: MECHANICAL: ❑ ROUGH -IN ❑ A/C ❑ FURNACE ❑ RADIANT HEAT ❑ FINAL ❑ PARTIAL PASSED FAILED ❑ ❑ COMMENTS: PLUMBING: ❑ GROUNDWORK ❑ ROUGH -IN ❑ FINAL ❑ WATER METER INSTALLED ❑ PARTIALS PASSED FAILED ❑ PRESSURE TEST ❑ ❑ COMMENTS: ❑ OCCUPANCY GRANTED ❑CONDITIONAL OCCUPANCY GRANTED NOTES/REMARKS: A, y l Y' 7 r INSPECTOR �" f1E DATE OF INSPECTION MADE: ' TIME FAXED OPPD\BURT REA TO CONNECT SERVICE: