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BP13466CITY OF BLAIR - APPLICATION FOR BUILDING PERMIT 'gp,om„a Permit # Date: " 1, �f-) Approximate Completion Date: Site Plan Attached: REScheck Attached: Complete Plans Attached Application for: Residential V 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 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 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: Rc icL(A I cl ( (N!5 a f6 c u-46 C - V -e I - W, I r vwsk . J qtr tC �i ( �Jr C C?, ( ( t t n' 4 0 GOProject Information: ' z - hO C Job Address: 10 M aidi( foo+ f Legal Description (if applicable) t0f 11 �: , (if i ac L � d � • EJ L Owner: " �` ��►ddress: 1 - 6' fc2/ 1 Phone#: ,_ `1 d Contractor: lici t Phone #: 2300 11 Address: o'r'\+ �� - Cell #: Email Address for Contractor: Separate permits are required for electrical, plumbing, heating, 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 ori not completed within two (2) years of date of issue. 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: ZoningZFlood Plain Utilities: Current Zoning: Conditional Use Permit Required: Yes No.X-- Date CUP Approved: State Fire Marshal Required: Yes No Variance Required: Yes No Minimum Setbacks: Front ' l econd Front Side Side Rear Lot Square Footage: v Length x Width: Lot Coverage %®,. Driveways/Sidewalks: Sidewalk required: YesNo 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 req�uir ments: BUILDING INSPECTOR REVIEW: Number of Stories One Two Three Four Type of Residential Structure: Ranch Two Story Split Entry Yes >Four High Rise (>75 ft) 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: Second Level: Third Level Basement: (Unfinished) I (Finished) Garage: 2 bay 3 bay 4 bay 5+ bay Detached Garage: Addition: Porch: Front Deck that affect setbacks: Occupancv 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: 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 Garage sq/ft area Total Valuation: Total Valuation Issuance Fee: X $29 X $25 Multiplied by 0.006 = $ $ 25.00 Total Permit Fee = Deposit + Permit Fee + Issuance Fee $ 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 ErectingLAwnings and Decks/Handicap Ramps: sq/ft area X $25 (Minimum valuation of $2000) Construction valuation computation: , Finished sq/ft area 6) 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 1 Total Permit Fee = Deposit + Permit Fee + Issuance Fee $ CIO Additional Comments: Approved by: L `l Date: / Contingent On Approval by Fire Marshall Meet IBC, IPC, IMC and NEC Code Requirements Sleeping Rooms below Story and in Basement required to have egress For Office Use Only Date Permit Paid. Permit Fee: Deposit Amount Receipt # Deposit Paid by for return to: Building Inspection Pouch given: Yes No CITY OF BLAIR, NEBRASKJ, Phone 402-426-4191 RECEIVED OF: ADDRESS CITY, STATE, ZIP CODE THANK YOU KEEP THIS COPY FOR YOUR RECORDS. NO RECEIVED BY Pounds Printing, Blair, NE 68008 2/18107 Directions �. Fill in the blanks on pages 2 and 3 with dimensions 12 -P and materials which will be used to build the structure. Please print legibly. 2. Indicate in the check box which detail from page 3 will be used. Size and Amount of�ags (example: Two 3/8'7< 4 &Tlags @ 16"0. C.) Existing bldg. Approved Beam splices to occur over posts with 1 1/2" bearing Attach decking with non corrosive fasteners ❑ Detail B ❑ Alternate Detail 131 a� ❑ Alternate Detail 132 Detail A (see page 3) (see page 3) LE Conditions such as allachment to 00 cantilevers or veneers may require Engineer's approval Detail C (see page 3) Finished grade Note: Emergency escape windows are allowed to C Type of decking x ,/G. - t t be installed under decks and porches provided the Cn (example: 1 x 4 or 2 x 6- Trex) 36"high guard with balusters 2x—i— joists spaced " apart spaced so that a less than 36" in height to a yard or court. 6'8" required (example: 2 x 10"spaced 24" apart) 4 Inch diameter c' — sphere cannot passthrough M Beam splices to occur over posts with 1 1/2" bearing Attach decking with non corrosive fasteners ❑ Detail B ❑ Alternate Detail 131 a� ❑ Alternate Detail 132 Detail A (see page 3) (see page 3) LE Conditions such as allachment to 00 cantilevers or veneers may require Engineer's approval Detail C (see page 3) Finished grade Note: Emergency escape windows are allowed to be installed under decks and porches provided the Cn location of the deck allows the emergency escape W window to be fully opened and provides a path not less than 36" in height to a yard or court. 6'8" required CO for walk out basements or patios. c' :C (-) x o beam (example: (2) 2 x 10 - see detail B) 2xrim joist +' (example: 2x 10 -see Alternate B1&B2) x 6 posts spaced apart (example: 4 x 4 posts spaced 8' apart) Span ZOJ (example: 13'- 4") Type of siding (existing) LA,-,(�C-> e Note: A plot plan (plan view) showing the dimensions of your project or additions and its relationships to existing buildings or structures on the property must be included. In addition to project dimensions, your plot plan must also show other details such as post locations and spacing, joist and beam spans, and any other pertinent information not shown on the section drawing. BUILDING INSPECTION REPORT El -'CITY OF BLAIR El WASHINGTON COUNTY El OTHER LOCATION OF INSPECTION - NAME OF OWNER CONTRACTOR DATE INSPECTION REQUESTED- TIME INSPECTION REQUESTED PERMIT NO TYPE OF INSPECTION REQUESTED: CONFERENCE F-1 STATUS CHECK BUILDING: ❑ FOOTING F-1 DECK FOOTING 0 FRAMING El DRYWALL [:1 FINAL [-I PARTIAL PASSED FAILED COMMENTS: UTILITIES: F-1 SEWER TAP 0 SEWER El SEPTIC El WATER TAP El REMOTE F1 WATER SERVICE PASSED FAILED El PARTIAL F-1 F-1 ELECTRICAL: Fl ROUGH INE] FINALE] PERMANENT SERVICEEI TEMPORARY SERVICEE] PRECONNECT PASSED FAILED F-1 PARTIAL F-1 Fl COMMENTS: MECHANICAL: Fl ROUGH -IN El A/C El FURNACE El RADIANT HEAT El FINALE] PARTIAL PASSED r FAILED ❑ F-1 COMMENTS: PLUMBING: F-1 GROUNDWORKE] ROUGH -IN 0 FINAL El WATER METER INSTALLED ❑ PARTIAL PASSED FAILED El PRESSURE TEST COMMENTS: ❑ OCCUPANCY GRANTED F1 CONDITIONAL OCCUPANCY GRANTED 1Y oy 44 Lill (1 61, ca;L"A L4A FILE COPY [iPERMIT NO: ADDRESS 1- 0 t y.�. r a f ZIF— �j , sa 'vim r. e, TV— APPROVED id, 5 BUILDING 7-� PLANNING i qcPUBLIC WORKS 11 01d FIRE DEQ APPROVAL LT OF AN INSPECTION HALL NOT BE CONSTRUEDTO BE ANA APPROVAL P A VIOLATION F PROVISIONS _OF T HlE CODE OR FTHEORDINANCES F T r ,.<j JURIS ICT ON. _ _ 6- Application Date: MECHANICAL PERMIT APPLICATION Jurisdiction of City of Blair, Nebraska 218 South 16th Street Blair, Nebraska 68008 Fax (402) 426-4195 M 1998 (402) 426-4191 Permit Fee: Job Address /J V Mail Address Zihone C-114 117 -�>Pn Contrac 0 Mail Address Zip Phone 2. 3. Class of W t 13 COMMERCIAL'- -ESIDENTIAL 0 New 13 Addition Iteration 11 Repair 11 Replacement Describe Work: "1 11 X.% 4. 1�1 -/I MECHANICAL PERMIT FEES Heat Pump Tons Central A/C Tons Furnace/Heat Pump/Air Conditioner (Per Unit) AJ Furnace w BTU/H Up to and including 100,000 BTU / 3Ton ............................$15.00 9 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 I hereby certify that I have read and examined this application and know the same to be true and correct. All Gas/Air Outlets 5 x $6.00 provisions of laws and ordinances governing this type of .................First 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 Modular Home ............................... $50.00 Signature of Contractor or Authorized Agent Permit Issuance Fee ..........................$25.00 Total Current License on File _ es 13 No C3 N/A Date Comment: WHEN PROPERLY VALIDATED (IN4 HIS SPAUE) I HIN IN Y U U K FLKIVII I Approved By: -Z Rev. 2008-10 RECEIVED AN 18 ?010 CITY OF BLAIF-� NEBRASKA m i 6�1 if ro Application Date: PLUMBING PERMIT APPLICATION Jurisdiction of City of Blair, Nebraska 218 South 16th Street Blair, Nebraska 68008 Fax (402) 426-4195 P 2125 (402) 426-4191 0 Permit Fee: $ 0 Job Address 6; Owner �fp, �/a % (//ff/f J ( Mail Address Jy f r � // �¢j �Z`ip L/ .1 VV .".l "" N'"""'""0 1 t 1 5,6 CM-. ,- �, 1 f,.,w ! J � Phone j yt F...Fv"`� 4✓ '�}' i1 ContractorMail Address Zip Phone 2...�11'. 3. Class of W 1c: C3 COMMERCIAL ESIDE TIAL O New O Addition teration 13 Repair O Replacement Describe Work: 4. PLUMBING PERMIT FEES Comments: Modular Home ......................$50.00 Type of Fixture No. o Kitchen .............................. $12.00 x . Bath.....Residential/Single Stall $12.00 x jC% ....................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 Notice Outside Water Faucet...................$6.00 x / 0 C 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).. $3 0. 00 Gas/Water Piping System . (Commercial)........................$50.00 " signature of Contractor or Authorized Agent Permit Issuance Fee.................$25.00 Total> f- Current License on File ZtYes 13 No O N/A Date Comment: WHEN PROPERLY V AL1llA 1 hL) (1N 1 r11�, �,FAUh) l 111;�, 1a Y v ulc rr,tctvii r Approved By: .j �/ Rev. 2008-10 k a `g Iv a b Q R y# v t v I �1 e'--j x 1 ., <"e -� �.'=' , a _ I I - Application Date: ELECTRICAL PERMIT APPLICATION Jurisdiction of City of Blair, Nebraska 218 South 16th Street Blair, Nebraska 68008 Fax (402) 426-4195 E 3221 (402) 426-4191 — & --2v-/0 Pen -nit Fee: $— ( '�' , Job Address Owne Mail Address zip- )/� Phone 1. j &"") If) - Contractor Mail Address zip Phone 2. 3. Class of Work' 11 NEW RESIDENTIAL 0 NEW COMMERCIAL =REMODELING/ADDITIONS 0 UPGRADE SERVICE Describe Work: /-/1/ 4. 5.Current License on File 45k -Yes C3 No 0 N/A Completion Date ELECTRICAL PERMIT FEES Service Fee = (Amp Fee + $5.00 per branch circuit) Upgrade Existing Service .............$25.00 0 1-100 Amp Fee .......................$25.00 Temporary Service.................... $15.00 101-200 Amp Fee .......................$35.00 201-300 Amp Fee .......................$55.00 Fire Alarm System ..................... $15.00 301-400 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 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 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 $1.00 state or local law regulating construction or the .......... —X performance of construction. Power Apparatus (220 Volt or higher) 4 of Apparatus....... x $8.00 Smoke Detectors..... % x $3.00 45' 6) & Signature f Contractor or Authorized Agent Permit Issuance Fee.. .. $25.00 0 Z� Total Z1061'' /A Date Comment: WHEN PROPERLY VALIDATED (INTHIS SPACE) 'I HIS IS Y U U K FEKMI I Approved By: 1�2 Rev. 2008-10 �� ww-CITY Of t)LAIQ_ aro Jd;��F "7ise of a _ L , 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: �a� 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. 4. 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. 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 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 information is true an correct. Homeowner/Applicant Signature Date 218 South 16th Street • Blair, Nebraska 68008 • 402-426-4191 ^ Fax 402-426-4195 • E-mail cityofblair@d,blaicne,us rise of ao' CITY HOMEOWNER14� VERIFICATION FOR PLUMBING AND/OR MECIIANICAL �✓%; L �� , , 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: / 2 ` � ' ( 1-C--" 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 phis form I am stating the above information is true an correct. Applicant Signature Date 218 South 16th Street • Blair, Nebraska 68008 a 402-426-4191 • Fax 402-426-4195 • E-mail cityofblair@ci,blaicne.us M r`111 C Of BtAIQ111L I It -a-• 01 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 ®ate 218 South 16th Street • Blair, Nebraska 68008 - 402-426-4191 - Fax 402-426-4195 • E-mail cityofblalr@ci.blair.ne.us r.vuna- 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/O ner Date ^3 Contractor/Owner City of Blair 113"UILDING INSPECTION REPORT ❑ CITY OF BLAIR ❑ WASHINGTON COUNTY ❑ OTHER LOCATION OF INSPECTION• !� ., ? 1�. e < `` NAME OF OWNER- CONTRACTOR- DATE INSPECTION REQUESTED: TIME INSPECTION REQUESTED PERMIT NO TYPE OF INSPECTION REQUESTED: ❑ CONFERENCE ❑ STATUS CHECK BUILDING y'FOOTING [; DECK FOOTING [:1FRAMING ❑ DRYWALL ❑ FINAL ❑ PARTIAL PASSED FAILED COMMENTS: e d,& - hD GG-o S C' dG 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 ❑ PARTIALS 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 FAXED OPPD\BURT REA TO CONNECT SERVICE: MADE: T1b4E.'i" l[7. INSPECTORS DATE OF INSPECTION MADE: TIME, FAXED OPPD\BURT REA TO CONNECT SERVICE: ON BY BUILDING INSPECTION REPORT ❑ CITY OF BLAIR ❑ WASHINGTON COUNTY ❑ OTHER 6D, ® Too o LOCATION OF INSPECTION: "r NAME OF OWNER- CONTRACTOR DATE INSPECTION REQUESTED: ,vv �� `' TIME INSPECTION REQUESTED• PERMIT NO: --i s TYPE OF INSPECTION REQUESTED: ❑ CONFERENCE ❑ STATUS CHECK BUILDING: '9" FOOTING ❑r DECK FOOTING ❑ FRAMING❑ DRYWALL ❑ FINAL [:1PARTIAL PASSED FAILED COMMENTS: ij G�-© SC YLc ❑ 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 ❑ PARTIALS PASSED FAILED ❑ ❑ COMMENTS: PLUMBING: ❑ GROUNDWORKS❑ ROUGH -IN ❑ FINAL ❑ WATER METER INSTALLED❑ PARTIAL ✓� ' PASSED'l FAILED ❑ PRESSURE TEST ❑ ❑ COMMENTS: 8�� ❑ OCCUPANCY GRANTED ❑ CONDITIONAL OCCUPANCY GRANTED INSPECTORS DATE OF INSPECTION MADE: TIME, FAXED OPPD\BURT REA TO CONNECT SERVICE: ON BY LO CtWP CI'4RANPF.p DATE OF INSPECIWN MADE: VNNECf SERVICE: ONS BY 10: 38a 7/16/2010 10:42am - - -.,; jy . , , � A i BUILDING INSPECTION REPORT ❑:CTTY OF BLAIR ❑ WASHINGTON COUNTY ❑ OTHER LOCATION OF INSPECTION <` ` 4" NAME OF OWNER: Ce. A iJ5 `e l-1 CONTRACTOR - DATE INSPECTION REQUESTED- 7 0 TIME INSPECTION REQUESTED: � � i � PERMIT NO TYPE OF INSPECTION REQUESTED: ❑ CONFERENCE ❑ STATUS CHECK BUILDING: ❑ FOOTING ECKFOOTING ❑ FRAMING ❑ DRYWALL ❑ FINAL ❑ PARTIAL PASSED FAILED El COMMENTS: F7T 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- INSPECTOR- .Jnni DATE OF INSPECTION MADE: - / 6@ TIME / ®f -0 FAXED OPPD\BURT REA TO CONNECT SERVICE: