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BP13468CITY OF BLAIR - APPLICATION FOR BUILDING PERMIT Permit # , Date: -dl-lo Approximate Completion Date: 1�e_ 1 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 _ If yes, responsible entity: Agreement needed: Public Sewer: Yes No _ If yes, responsible entity: County Road Permit Required: Yes No _ nal Descriptionof roje�yct ifnecess ry: .,a}� i Project Information: Private Well Blair OPPD Line Kennard Date Agreement Received: Septic Drawing Provided: Blair Kennard Submitted: Yes No Job Address: Legal Description (if applicable) �g /�%�' d Owner: SieoC 6LL1 ler Address: Phone#:�I�L-) S~ ) Contractor: (fl Tk,kVe6J ^e Phone #: m� Address:�`� I� �, 1w,V" 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 or is not completed within two 2) ye rs of date of issue. 64" _ /-/0- % _ 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 Date CUP Approved: State Fire Marshal Required: Yq* No -.4- Variance Required: Yes No Minimum Setbacks: Front 4� Second Front Side Side Rear C Lot Square Footage: I Length x Width: Le#-�age % Driveways/Sidewalks Sidewalk required: Yes Y No Sidewalk Waiver: Yes No Date Waiver Approved: Preexisting Garage requires driveway to be less than 3' from property line: Approved by: Flood Plain: Yes No If yes, specify special requirements: BUILDING INSPECTOR REVIEW: Number of Stories One Two Three Four lype of Residential Structure: Ranch Two Story Split Entry — Rooms Bedrooms Bathrooms _ Egress in Basement: Required: Yes No Sleeping Rooms Living Area Square Footage: Main Level: Basement: (Unfinished) Garage: Detached Garage: Yes >Four High Rise (>75 ft) Raised Ranch Other Fireplaces Gas Electric Provided on Plans: Yes No Other Egress Second Level: Third Level (Finished) _ 2 bay 3 bay 4 bay 5+ bay Pole Barn: Addition: Remodel: Porch: Front Rear Side Deck that affect setbacks: Rear Front Side Occuoancv 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 reauired 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. Al will review all second access requests and industrial and commercial driveway requests) Required Off Street Parking: Permit Fee Calculation: Building Permit Deposit Fee: Commercial, new homes and residential additions/remodels/accessory buildings valued $10,000 or greater $ Fee - $500.00 Residential additions/remodels/accessory buildings valued under $10,000 $ Fee = $200.00 All other permits Fee = $50.00 $ RESIDENTIAL - NEW CONSTRUCTION: Permit fee is: Finished sq/ft area X$92 (not including finished basement area) Finished basement sq/ft area X$56 Unfinished basement sq/ft area Garage sq/ft area Total Valuation: X $29 X $25 Total Valuation Multiplied by 0.006 = Issuance Fee: $ 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 Erect! ng/Awn Ings and Decks/Handicap Ramps: sq/ft area X $25 (Minimum valuation of $2000) Construction valuation computation: Finished sq/ft area 16 X $--L3 $ 1'.1 (job, 0(, 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 $ C)'-21' OC) Issuance Fee: $ 25.00 = 9 Total Permit Fee = Deposit + Permit Fee + Issuance Fee $ 74t, . vo Additional Comments: Approved by: Date: (0 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. n Permit Fee: Deposit Amount Receipt # Deposit Paid by for return to: Building Inspection Pouch given: Yes No mto MECHANICAL PERMIT APPLICATION Jurisdiction of City of Blair, Nebraska 218 South 16th Street Blair, Nebraska 68008 Fax (402) 426-4195 M 2015 (402) 426-4191 Application Date: 7 - l Permit Fee: $ i d 1 6 0 Job Address Owner CJ /Mail Addtp Phone Contractor Mail Address Zip Phone 2. 3. Class of Work: O COMMERCIAL . SIDENTIAL ❑ New O Addition eration O Repair O Replacement Describe Work: 4.%c1�Cf'/C2iZfC�CGd �icv� ECHANICAL PEPMIT FEES Heat Pump Tons Central A/C Tons Furnace/Heat Pump/Air Conditioner (Per Unit) Furnace BTU/H Up to and including 100,000 BTU / 3Ton............................$15.00 # of Units A/C Furnace/Heat Pump/Air Conditioner (Per Unit) Furnace Over 100,000 BTU / 3 Ton.............................................$25.00 Completion Date: Refrigeration Units/Coolers/Lines/Compressor — Commercial (New or Replacement) (Per Unit) Boiler Chart BTUFee 500 ......................................................................... 1 . $ 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 (arse BTU Chart to left).................... Appliance Vent/Fans ........................$10.00 Notice Duct System..................................$15.00 15-6c) I hereby certify that I have read and examined this application and know the same to be true and correct. All Gas/Air Outlets5 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 Contras or r Authorized Agent Permit Issuance Fee..........................$25.00 Total Current License on File pYes O No O N/A (� Date Comment: WHEN PROPERLY VALIDATED (INTHIS SPACE) THIS 1S YUUR PEKMll' Approved By: f� Rev. 2008-10 I Jurisdiction of City of Blair, Nebraska 218 South 16th Street Blair, Nebraska 68008 Fax (402) 426-4195 (402) 426-4191 Application Date: 1 -2 c/.- / 0 Permit Fee: $— q�? 0 Job Address Owner it 'KI, Phone Contractor A d Zip Phone 2. ,'�Mai �— 3. Class of Work: 0 NEW RESIDENTIAL 0 NEW COMMERCIAL "EMODELING/ADDITIONS 0 UPGRADE SERVICE Describe Work: 4. 5.Current License on File -'MrYes 0 No 0 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 .......................$35.00 201-300 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 work will be complied with whether specified herein or Other: (alterations, additions and modifications) not. The granting of a permit does not presume to giveReceptacles/Switches/Lighting Fixtures (110 volt only) authority to violate or cancel the provisions of any other of Apparatus C�/ 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 ignature of Contractor or Authorized Agent Permit Issuance Fee... . $25.00 0 Total 0 61 Date Comment: WHEN PROPERLY VALIDATED (1NTHIS SPACE)THIS IS YOUR PERMIT Approved By: , 6, 'f_ Rev. 2008-10 HOMEOWNER WIRING PERMITS OIVAV % 2� 1Da L-G.,5k_ print your full name on line above: states the following: 1. I am the owner of the single family dwelling for which I am applying for an electrical permit. Address: `7159 -, Gf %L z- 2. I am applying for an electrical permit for 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. _ 1-,i�2, Date o 0 218 South 16th Street • Blair, Nebraska 68008 - 402-426-4191 • Fax 402-426-4195 • E-mail cityofblair@ci,blair.ne,us -Joie of CITY OF 5LAIQ HOMEOWNER VERIFICATION FOR PLUMBING AND/OR MECHANICAL PERMITS IoHlv v Mr full name on line above: states the following: 1. I am the owner of the single family dwelling for which I am applying for a plumbing and/or mechanical permit. Address: Elair A, E 6902 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'sign' g this fo I am stating the above information is true an correct. /,:;: R Hon caner/Applicant Signature Date I/ 218 South 16th Street • Blair, Nebraska 68008 • 402-426-4191 • Fax 402-426-4195 E-mail cityofblair@ci,blair,ne.us oWo.r."Y v s—z7 -5 1, ' Ga Cy esz. `c e! v� -2, d �J Buller's Addition 1458 Butler x (402) 426-2570 �.�t�csT �' /SGC .T�/! �=�t���e / c✓�CCS-�- G�.��i'.�s �" coves rcE �.� �/ 112 t %CC .Z,✓ r � �.r a4 ,mac vG.� � �:,�,�f��=`-T �=�� Z^/S'�✓�� /%!/� 7- _T T. 7 of 16 Kenneth E. Begg Home Improvement 4812 Circle Dr. Blair, NE 68008 Home (402) 533-8230 Cell (402) 427-4228 E-mail: kbegg@aol.com /- m o i -C �✓ G- s / l 7_2 o.✓ Trs�- �'y spa F"CodR 7 ^ir �•C.,-r ,,-;r_ oma/ lSJJ i l� ML< PGY rZGM STo.vc- + ( y) T ," /2 _567:4 ✓ ¢ C vE"-✓T 5 Z-.✓ s" TA G C 4-- /Z Fo rt C.[ � rte. --r_' v�-� r.r [ -¢ rr �-✓ - C STUCK w C C A�, aJ✓ CC :'� 2 Ji + u %�i7S,� o� f ooTL'v�.- =s Td I3F ! 2 SS To �a ;z s rl.✓G- T�� sc= ��ti ;� C mtnmer:t� G L �� cj.: Print. Nn_ 2 LocationC` t� � c 64, nate- 06 - j /O De.crintinn ,�� � � . T �,• ,s / �K FSS U•f E J �F`A YG m- Fo tQ V (d �o o,' d.sd' C.C�M �£ A Z a' S Tom pGi9`TF ✓c -Ni �- 2)rG STw e ."[G rLal Sf✓ G �AOr s[ owe 7 J/ 112 2 -9 %�OTiOM �GA%E ZNR Foorr o- Pirf + ( y) T ," /2 _567:4 ✓ ¢ C vE"-✓T 5 Z-.✓ s" TA G C 4-- /Z Fo rt C.[ � rte. --r_' v�-� r.r [ -¢ rr �-✓ - C STUCK w C C A�, aJ✓ CC :'� 2 Ji + u %�i7S,� o� f ooTL'v�.- =s Td I3F ! 2 SS To �a ;z s rl.✓G- T�� sc= ��ti ;� C mtnmer:t� G L �� cj.: Print. Nn_ 2 LocationC` t� � c 64, nate- 06 - j /O De.crintinn ,�� � � . T �,• ,s CITY OF BLAIR, NEBRASKA Phone 402-426-4191 RECEIVED OF: ADDRESS CITY, STATE, ZIP CODE THANK YOU KEEPTHIS COPY FOR YOUR RECORDS. NO RECEIVED BY Pounds Printing, Blair, NE 68008 Y\ (�m'r0 O C7®<Z< d:1)00> ©o�wA zm-mtn ozoA MO M 3'�7Dc Ommr; vMo �o E00 -n A < aw A zu,mz MOZE Cj)ZAC/) O -n R:10 0 --1 -4 -4 Fn m r Z zm M O z n � m W cn n o < M a° Kenneth E. Begg Home Improvement 4812 Circle Dr. Blair, NE 68008 Home (402) 533-8230 Cell (402) 427-4228 E-mail: kbegg@aol.com .4,1C rc)z rry /4 0- e e - All h-1 el 4 Print No- Oistomer: 13 7-4 e-, 6=�e 15 Location IY3-9 nate - Des.crintion- X�00,e- �-00Z>7- Z41c)07- N&crrt 4,14 11 Kenneth E. Begg Home Improvement 4812 Circle Dr. Blair, NE 68008 Home (402) 533-8230 Cell (402) 427-4228 E-mail: kbegg@aol.com /1r GJ�ST LdRLC EAST ws44L l 32.4c ARF /6 0.✓ cE r�� 1�✓Svc,¢ Tzo,✓ sr✓ Foon�� cam/ 3" Lr�Cr SC.tEwS E"vc-" rr Z Cove=,(�,r ;�✓rrN TyvEK � o✓s F c✓,c �� VS�y� 52D_2tiU To Customer: g5cl6, �e � �✓� �i �G�. �, Print Nn_ Location� `f � � co E � � -� L5' ' �� bate. nescrintion z cac� /y 0-5,3 _ /��rwoa(C) 1—/2, 3o r° 5'444- ✓G Kenneth E. Begg Home Improvement 4812 Circle Dr. Blair, NE 68008 Home (402) 533-8230 Cell (402) 427-4228 E-mail: kbegg@aol.com rte---- / — 2 N� CF2G rvv Customer' s vTa TSG' , Print. No. .5- Location 7-Z-c�e ms mate- C d /0 Descrintinn-e7ca� C, , Kenneth E. Begg Home Improvement 4812 Circle Dr. Blair, NE 68008 Home (402) 533-8230 Cell (402) 427-4228 E-mail: kbegg@aol.com po�c w�cC Q- 14 rrY'c < s�•c.F rs��•✓ E'x=S 7-X-1 &- PZ7-C "" Roo" VFN 7-S Customer: 1,��, 4LL`s�.�x , � �f Print No. �6 o Location iV15 0 1.�e-.., i, bate: Descrintion: Roe"- ,;- Kenneth E. Begg Home Improvement 4812 Circle Ar, Blair, NE 68008 Home (402) 533-8230 Cell (402) 427-4228 ° E-mail: kbegg@aol.com 30" !E-*,4"�' vF^'i SAtf 4c� t t �t� go yF,�r I 4 r- r/FST CuOomer C� �� *��D� TLPrint No. '7 or /0 Locition RL Date- Dewrintion-L-C-,Z Z,4OC, ✓ / /j -v -C z �1 1 /7 L C Poops 4 r F 30 5 Tt .wS� �t lri( 4 LSF S 4- 12+ 12- + _Tt/5T�4L/ CuOomer C� �� *��D� TLPrint No. '7 or /0 Locition RL Date- Dewrintion-L-C-,Z Z,4OC, ✓ / /j -v -C Kenneth E. Begg Home Improvement 4812 Circle Dr. Blair, NE 68008 Home (402) 533-8230 Cell (402) 427-4228 E-mail: kbegg@aol.com Customer Customer_ 15 L, ` & � � ;i el 7-7;, � L, 9, Print Nn_ Location y y 5�''?!�'� � � �-%� t�L�� � late Descrintinn- r- 4oe,,e Kenneth E. Begg Home Improvement 4812 Circle Dr. Blair, NE 68008 Home (402) 533-8230 Cell (402) 427-4228 E-mail: kbegg@aol.com Customer. Print No. � or- /() Location f `7'' 5-3 lute- 6 — f?—/O lDescrintien �'7 �:�T.t L,k'c 7 1. FOUNDATION 2 3. Kenneth E. Begg Home Improvement 4812 Circle Dr. Blair, NE 68008 Home (402) 533-8230 Cell (402) 427-4228 E-mail: kbegg@aol.com a. Permanent wood foundation with crawl b. All foundation wood 2x6 and 2x8 pressure treated c. Footing to be 42" deep d. Footing base crushed stone 6" deep by 16" width e. Crawl is to be min. 18" clearance f Grade around perimeter to be %Z" per 6" slope g. Crawl to be vented h. Crawl covered with 6 mil. poly. Film i. Crawls exterior walls to be insulated with 2" poly foam j. Excess panel to be installed between crawl and existing basement DECKING a. All floor joists 2x6 b. All floor joists are to be 16" on center c. Floor to be insulated with R-30 (unfaced) d. Sub -floor to be % OSB tongue and groove e. Flashing between floor joist and foundation wall f. Center support beam is to be a double 2x12 LVL beam g. LVL beam is to be supported on three concrete piers h. Concrete piers are to be 42" deep WALLS a. Walls to be framed for three rooms i. Master bedroom 12'x12' ii. Closet #1 6'x6' iii. Closet #2 6'x6' b. All walls are to be constructed with 2x4 studs- c. tudsc. All 2x4 studs are to be 16" on center d. All wall to be strengthened with steel nd braces e. All walls are to be insulated with R- insulation (faced) f Walls are to be attached to foundation with 3" lag screws every 24" g. All exterior walls to be covered with 5/8 ox -board h. All exterior walls to be covered with Tyvek house wrap i. All exterior walls to be covered with vinyl siding to match existing j . No windows in addition k. One 5' vinyl clad door wall 1. Steps to be installed for door wall m. Door wall header to be a double 2x8 4. ROOF & CEILING a. Ceiling rafters are to be 2x6 b. Excess door to addition's attic located in master bedroom's ceiling c. All ceiling rafters to be 16" on center d. Ceiling is to be insulated with R-30 (unfaced) e. Roof pitch to be 12 / 6 or to match existing f. All roof rafters to be 2x6 g. All roof rafters to be 16" on center h. All roof rafters to be secured to walls with steel hangers i. Ridge beam to be 2x8 j. All eaves are to be a min. 12" with venting k. Roof decking to be covered with 3/a OSB plywood tongue and groove 1. Roof is to be finished with 30 lbs felt in. Roof to be covered with 30 yr. architectural shingles to match existing n. Drip edge to be installed around perimeter o. A minimum of four standard roof vents p. Gutters with down spouts to be installed around perimeter 5. INTERIOR a. %z " interior grade drywall to be installed on all interior walls b. %2 " interior grade drywall to be installed on all interior ceilings c. All drywall to be finished d. All walls and ceilings to be primed and painted e. Install two 30" L -hand interior grade doors £ Install one 30" R -hand interior grade door g. Install all necessary base molding and casings 6. HEATING & COOLING a. Three air vents and one cold air return to be installed b. Air vents to be installed with 8" insulated flex pipe in crawl 7. ELECTRICAL a. Seven interior receptacles b. One exterior receptacle c. Two exterior coach lights with switch d. Two closet lights with switch e. One ceiling fan/light with switch f. Two switches on west wall to control west receptacles g. One hard wired smoke detector h. One phone jack i. One cable jack (,'u4nmer_ Print. No. CCS OF /0 Location IY5--,y � � L: ! � y � Trate_ ( - ""L? — /'C7 Descrintion ❑ yPI'Y OF BLAIR LOCATION OF BUILDING INSPECTION REPORT ❑ WASHINGTON COUNTY Al NAME OF OWNER i i- a /f s .� ., CONTRACTOR t f y :; J'� /✓ r r't DATE INSPECTION REQUESTED• TIME INSPECTION REQUESTED PERMIT NO TYPE OF INSPECTION REQUESTED: Mµ^ m_..1 a , , 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 COMMENTS: PLUMBING: ❑ GROUNDWORK ❑ ROUGH -IN ❑ FINAL ❑ WATER METER INSTALLED ❑ PARTIAL W ❑ PRESSURE TEST COMMENTS: ❑ OCCUPANCY GRANTED ❑ CONDITIONAL OCCUPANCY GRANTED NOTES/REMARKS- PASSED PASSED ❑ FAILED FAILED ❑ INSPECTOR: !h DATE OF INSPECTION MADE: 76-1 E:___ ❑� FAXED OPPDIBURT REA TO CONNECT SERVICE: ON BY rise 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 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. 9 F Owner/Occupant ontractor City of Blair 2- 2YO Late 218 South 16th Street • Blair, Nebraska 68008 • 402-426-4191 • Fax 402-426-4195 • E-mail cityofblalr@cl.blair,ne,us rvnn� BUILDING PERMIT DEPOSIT AGREEMENT $500.00 r undable deposit is being collected for any new commercial, new side , 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. r/Owner �/' Contractor/Owner City of Blair Date i u pCITY OF BLAIR ❑ WASHINGTON COUNTY ❑ OTHER LOCATION OF INSPECTION °' NAME OF OWNER- DATE WNER DATE INSPECTION REQUESTEDL_( CONTRACTOR • ,' TIME INSPECTION REQUESTED--,/ j'� ` PERMIT .. ............--.-..... s 1 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 F1 PARTIAL `u 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 - DATE OF INSPECTION MADE: 'C%®� `1 OF FAXED OPPDTURT REA TO CONNECT SERVICE: ON BY �n..,'�� i*�' d �� � . �..� ►. ,Z—. tie'... ��3'_..r ��.I. � ` ._�_ f ! �y INSPECTOR- DATE OF INSPECTION MADE: 0 TIME - FAXED OPPD\BURT REA TO CONNECT SERVICE: ON B BUILDING INSPECTION REPORT lall CITY OF BLAIR F -I WASHINGTON COUNTY F -I OTHR LOCATION OF INSPECTION. NAME OF OWNER- J CONTRACTOR DATE INSPECTION REQUESTED- TIME INSPECTION REQUESTED. PERMIT NO- 3 TYPE OF INSPECTION REQUESTED: EICONFERENCE F] STATUS CHECK BUILDING: �< FOOTING E:l DECK FOOTINQ=!tWAMfNG F -I DRYWALL [:] FINAL [:1 PARTIAL PASSED FAILED El COMMENTS: UTILITIES: F] SEWER TAP F-1 SEWER [:1 SEPTIC F-1 WATER TAP F-1 REMOTE F-1 WATER SERVICE PASSED FAILED n PARTIAL 1-1 1-1 COMMENTS: ELECTRICAL: F] ROUGH INFI FINAL n PERMANENT SERVICE R TEMPORARY SERVICE F] PRECONNECT PASSED FAILED D PARTIAL F -I F -I COMMENTS: MECHANICAL:F] ROUGH -IN [_1 A/C n FURNACE El RADIANT HEAT F] FINAL 0 PARTIAL PASSED FAILED F] El COMMENTS: PLUMBING: F -I GROUNDWORK F] ROUGH -IN F -I FINAL F] WATER METER INSTALLED El PARTIAL PASSED FAILED F1 PRESSURE TEST El El COMMENTS: ❑ OCCUPANCY GRANTED F] CONDITIONAL OCCUPANCY GRANTED INSPECTOR- DATE OF INSPECTION MADE: 0 TIME - FAXED OPPD\BURT REA TO CONNECT SERVICE: ON B BUILDING INSPECTIO ❑ CITY OF BLAIR ❑ WASHINGTON COUNTY ❑ OTTER LOCATION OF INSPECTION- NAME NSPECTION NAME OF OWNER ❑ STATUS CHECK F /L r CONTRACTOR<< FAILED `*� p' ,6 ' f` '' DATE INSPECTION REQUESTED UTILITIES: ❑ TIME INSPECTION REQUESTED' -s PERMTT NO•` TYPE OF INSPECTION REQUESTED: ❑ CONFERENCE ❑ STATUS CHECK BUILDING: FOOTING ❑ DECK FOOTIN AMING ❑ 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 ❑S ROUGH -IN ❑ FINAL ❑ WATER METER INSTALLED ❑ PARTIAL PASSED FAILED ❑ PRESSURE TEST ❑ ❑ COMMENTS: ❑ OCCUPANCY GRANTED ❑ CONDITIONAL OCCUPANCY GRANTED '�"" 1 r d F,,+t_!' <.. ..a f, h,r':,• ..s'; r 1 f.... e�, ,:�.t- t.'• if :,' „<< s ,z,,.a cy=s�.f N(1TF.C/RFMARK.C• INSPECTOR• 164" DATE OF INSPECTION MADE: `'f TIME FAXED OPPD\BURT REA TO CONNECT SERVICE: ON B