BP13416CITY OF BLAIR - APPLICATION FOR BUILDING PERMIT
p.,m,saoa, Permit #
Date: Wh 3 4D Approximate Completion Date: m
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)
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 _
Additional Description of project if necessary:
Private Well
Blair OPPD Line Kennard
Date Agreement Received:
Septic Drawing Provided:
Blair Kennard
Submitted: Yes No
I X Q ' Cie.
Project Information: 27 C4 #4 4bacAo-vka ,Z e
k / III
Job Address: I J SCS Bgbo 3 /
Legal. Description (if applicable)
[� r
Owner: RC1` C AQIrnO�_ r Address:
Phone#:
Contractor: LbckQ4N Ly"!C -ty C_I OYl Phone #:
Address: LO Z
Email Address for Contractor: Q i\
q Cell #: X02~3o�-U21�
(09-0(0 1
Separate permits are required for electrical, plumbing, hearting, ventilating and air conditioning, and septic systems. By my signature
below, 1 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 dais or is not completed within two (2) years of date of issue.
,�� �, 6�1 �/_ / ? _16
Signature of Owner/Contractor Date
For Building Permits other than One & Two Family Residential Structures:
I hereby acknowledge and agree that I have/will submit a set of plans for this project to the Nebraska State Fire Marshal's Office for
Review.
Signature of Owner/Contractor
Date
ZONING REVIEW:
Zoning/Flood Plain/Utilities:
Current Zoning: Conditional Use Permit Required: Yes No
Date CUP Approved:
State Fire Marshal Required: Yes No Variance Required: Yes No
Minimum Setbacks: Front Ob Second From_ Side Side Rear
Lot Square Footage:
Length x Width: Lot Coverage
Driveways/Sidewalks:
Sidewalk required: Yes No -idewalk 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 requirements:
BUILDING INSPECTOR REVIEW:
Number of Stories
One ' Two Three Four >Four High Rise (>75 ft)
lype 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: 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
Occuaancv 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. 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
Issuance Fee:
Multiplied by 0.006 =
$ 25.00
Total Permit Fee = Deposit + Permit Fee + Issuance Fee $
CRESIDENTI 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 surf loor: sq/ft area X $25
Sign Erectin Awnin s and ecks Handica Ramps: sq/ft area X $25 (Minimum
valuation of $2000)
Construction valuation computation:
Finished sq/ft area 50 X $ I $ 9 �'
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 $ ✓ 00
Issuance Fee: $ 25.00
Total Permit Fee = Deposit + Permit Fee + Issuance Fee $�'
Additional Comments:
Approved by: z Val Date: L -f— f � - 10
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 a, NEBRASKA
Phone 402-426-4191
THANK YOU KEEP THIS COPY FOR YOUR RECORDS.
f
NO
RECEIVED BY
Pounds Printing, Blair, NE 68008 -
}
THANK YOU KEEP THIS COPY FOR YOUR RECORDS.
f
NO
RECEIVED BY
Pounds Printing, Blair, NE 68008 -
ri V1111 --
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.
Contractor/Owner
fl -W-16
Date
Contractor/Owner
City of Blair
DECK PERMIT SUPPORTING DOCUMENTS
This supporting document includes information dealing with particular code
requirements and/or deck 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 document is only
designed and distributed to aid you in your deck 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.
S � .
Owner/Occupant Contractor
City of Blair
t
/O
218 South 16th Street - Blair, Nebraska 68008 e 402-426-4191 e Fax 402-426-4195 e E-mail cityofblair@ci.blair,ne,us
P , r
AP AS A RESULT OF AN INSPIF--"MON
SW',LL NOT BE CONSTRUED TO BE AN APPROVAL x
OF A VIOLATION OF THE PROVISIONS OF THE PERMIT NO:
CODE OR OF OTHER ORDINAN.CES OF THIS•CD
m
JURISDICTION.
ADDRESS
V 11
1
m
0
a
�'9Promtso
CITY OF BLAIR - APPLICATION FOR BUILDING PERMIT
Permit # IN16
Date: � l l s l 0 Approximate Completion Date: q -30
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 (piofplan 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 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: r X '
_ te t A t,
Project Information:
Job Address 15 �5 SCS rr -
Legal. Description (if applicable) ('0y� aca��ed S� . rbc f Cf�f
t
Owner: �� '� Aar( Oo -k�r Address: Phone#:
Contractor: C-WYl _ Phone #:
Address: L.o Z
Email Address for Contractor: Q)
q Cell
X9-0(01
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 1 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 dais or is not completed within two (2) years of date of issue.
x Com/ �/— / r49
Signature of Owner/Contractor Date
For Building Permits other than One & Two Family Residential Structures:
I hereby acknowledge and agree that I have/will submit a set of plans for this project to the Nebraska State Fire Marshal's Office for
Review.
Signature of Owner/Contractor
Date
, � �1_1
CITY OF BLAIR
LOCATION OF
NAME OF
❑ WASHINGTON COUNTY ❑ OTHER
TION y ,
1 /
nTITRACTnR
DATE INSPECTION REQUESTED- ��� �
Q TIME INSPECTION REQUESTED: ,:' � €. `� �i'' °�� � � 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 ❑ 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
NOTES/REMARKS:
Sy W SL t e. — 3 �l`f 5
ogs-r
�a.g&
INSPECTOR �� % V / DATE OF INSPECTION MADE: � q ` (o
FAXED OPPD\BURT REA TO CONNECT SERVICE: ON BY
vU Mawr,: 1 RO NOwnxK iJ NtNFIJ.N O FB+AL O YArFt Mciu 13
❑ I'PFSSIiPF_ T[ 9T
Li M'CINANCI'GM [ CONT OMMCVV&YJC.LWIm
NOn,SRAIANKs_S, n0� SD xT e•�K w �! _ Z�+T�(*
MXBD�WFp ktl TK MMNYrrrsta M
�i
■r
■r
L.
4
INSPECTOR-
BUILDING INSPECTION
DATE OF INSPECTION MADE: �`
?� O
❑ CITY OF BLAIR
❑ WASHINGTON COUNTY ❑ OTHER
FAXED OPPD\BURT REA
J
LOCATION OF INSPECTION
TO CONNECT SERVICE: ON
BY
r
NAME OF OWNER:°, ?,My. r. tray mow, l %. s �, CONTRACTOR-
ONTRACTOR
DATE
DATE INSPECTION
REQUESTED �TIME INSPECTION REQUESTED: �� PERMIT NO -
TYPE OF INSPECTION REQUESTED ❑ CONFERENCE
❑ STATUS CHECK
BUILDING: ❑
FOOTING ❑ DECK FOOTING ❑ FRAMING ❑ DRYWALL FINAL ❑ PARTIAL
PASSED
FAILED
JM
❑
COMMENTS:
,� 0 �[.� fnI ,f C �G/'1� ela S ^ I�,ea'2— F/1-=� . cab
_
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
NOTES/REMARKS-
I i 1 � a (1 i Jc, o N 6x,, exc (- i
5+a o_
INSPECTOR-
DATE OF INSPECTION MADE: �`
?� O
TTMF.r
FAXED OPPD\BURT REA
TO CONNECT SERVICE: ON
BY