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BP13481X CITY OF BLAIR - APPLICATION FOR BUILDING PERMIT Permit # / LI Date: Approximate Completion Date: `/ -3/ /v Site Plan Attached: REScheck Attached: Complete Plans Attached _Application for: Reside ti I Commercial/Industrial New Construction Manufactured Home Modular Move -on: Home Accessory Building Other Remodel Addition Accessory Building: GaragePole Barn Other Floor Type: Dirt oncrete 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 Agreement Received: Public Sewer: Yes No Septic Drawing Provided: If yes, responsible entit . B air Kennard County Road Permit Required: Yes No V Submitted: Yes W Project Information: Job Address: 52, 5. (� X4)0,8 r Legal Description (if applicable) Lo+ i q. (S I K 92- 114 Owner: bN (J 4tlf ( - Address: Phone#: Contractor: Phone #: ' Address: 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 is not completed within two (2r) // ye//Ars of date of issue. @ A Signature of Owner/Cbntragtor 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: 'Ye - No Variance Required: Yes No Minimum Setbacks: Front Second Front Side Side /,1 Rear Lot Square Footage: Length x Width: Lot Coverage % Driveways/Sidewalks: Sidewalk required: Yes No Sidewalk Waiver: Yes No Date Waiver Approved: Preexisting Garage re uires iveway to be less than 3' from property line: Yes Approved by: Flood Plain: Yes No If yes, specify special re ire s: BUILDING INSPECTOR REVIEW: Number of Stories One Two Three Four Type of Residential Structure: Ranch Two Story Split Entry Rooms Bedrooms Bathrooms Egress in Basement: Required: Yes Sleeping Rooms Square Footage: Main Level: Basement: (Unfinished) >Four High Rise (>75 ft) Raised Ranch Other Fireplaces Gas Electric No Provided on Plans: Yes No Living Area Other Egress Second Level: Third Level (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) CITY OF BLAIR, NEBRASKA Phone 402-426-4191 RECEIVED OF: THANK YOU KEEP THIS COPY FOR YOUR RECORDS. NO. RECEIVED BY Pounds Printing, Blair, NE 68008 r THANK YOU KEEP THIS COPY FOR YOUR RECORDS. NO. RECEIVED BY Pounds Printing, Blair, NE 68008 FN: 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. 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 1' fjel- ( 0v� Q Permit fee is: Finished sq/ft area / X $92 (not including finished basement area) Finished basement sq/ft area I X$56 Unfinished basement sq/ft ared6- ' ' X $29 Garage sq/ft area —X$25 Total Valuation: 40 Z Total Valuation Multiplied by 0.006 = Issuance Fee: Total Permit Fee = Deposit + Permit Fee + Issuance Fee R R $�� ® r $ $�• $ 0 $ 25.00 t 'r '\ ti t `f� J �S� �E I� f 'r '\ ti t `f� J RESIDENTI - ADDITIONS ZREMODELS 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) 160? I 4L.t.A Construction valuation computation: pi 154ns AJ Finished sq/ft area /. X $ $ +7 Com^ 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: Total Permit Fee = Deposit + Permit Fee + Issuance Fee Additional Comments: $ 25.00 Approved by: , 0i1V Date: C -- ( e 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 x CITY OF BLAIR - APPLICATION FOR BUILDING PERMIT Permit #1 Date: �71/0 Approximate Completion Date: lq3/ /y Site Plan Attached: REScheck Attached: Complete Plans Attached Aaalication for: __Reside _tial Commercial/Industrial _ New Construction Manufactured Home Modular Move -on: Home Accessory Building Other Remodel Ad7;,oncrete Accessory Building: Garage Pole Barn Other Floor Type: Dirt Electricity: Yes No Sign Erecting, Awnings Decks/Handicap Ramps (plot pian required) Satellite 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 n e d: Date Agreement Received: Public Sewer: Yes No Septic Drawing Provided: If yes, responsible entit . B air Kennard County Road Permit Required: Yes No Submitted: Yes No Additional Description of project if necessary. Project Information: Job Address: Legal Description (if applicable) L -o+ i Li , B I K 92- Owner: 2Owner: �Q\�l(� L`C.- Address: Wg3 Cd Phone#: '3� air N� Contractor: `Je ��° Phone #: Ad d ress: Email Address for Contractor: a i ar Cell #: . 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 is not completed within two (2) vaArs of date of issue. Signature of Owner/Cbntraptor" 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 -"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. Z_ .. X40 caner/Oe upent ontractor City of Blair 218 South 16th Street • Blair, Nebraska 68008 • 402-426-4191 • Fax 402-426-4195 • E-mail cityofblair@ci,blair.ne,us /+/ UI111l- BUILDING PERMIT DEPOSIT AGREEMENT A $500.re ndable 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. 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/ ner Contractor/Owner 19 City of Blair Date BIG Appraisals AMWA PW% SKETCH ADDENDUM File NoFILE UUPY 'RECEIVED Case No. Borrower JUL 13 Z01 Property Address Countv state Zip Code City I —1.,/r.11.nf Address CIN OF BLASKAI NEBRA, V3,, uv- cii 0 7— 1'el /3l, . .. ....... . j- � � 2C� 12 Gly :, _; X -qq ..... ...... . r. .... ...... . .. .......... 8,sf.: ....... A Garage First ,Floor ' 100810.t . . .... rr . .. .... L 4C S Comments: S 5 COOL- C'ek - a A[ Produced by ClickFORMS Software 800-622-8727 Page 1 of 1 0 N 1,n RL � �� -�,,,-,� r% ,R CITY OF BLAIR ❑ WASHINGTON COUNTY ❑ OTHER LOCATION OF INSPECTION " F e " NAME OF OWNER: ` CONTRACTORS DATE INSPECTION REQUESTED a TIME INSPECTION REQUESTED" TYPE OF INSPECTION REQUESTED: BUILDING: ❑ FOOTING ❑ DECK FOOTING ❑ FRAMING ❑ DRYWALL ❑ FINAL PARTIAL ❑ STATUS CHECK PASSED FAILED ❑ ❑ l 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 ❑ 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 MADE: l c TIMR FAXED OPPD\BURT REA TO CONNECT SERVICE: BUILDING INSPECTION REPORT ❑CITY OF BLAIR ❑ WASHINGTON COUNTY ❑ OTHER LOCATION OF INSPECTION NAME OF OWNER fps_ s e 3 p CONTRACTOR. DATE INSPECTION REQUESTED TIME INSPECTION REQUESTED:, �`' ` PERMIT NO, "r TYPE OF INSPECTION REQUESTED: ❑ CONFERENCE ❑ STATUS CHECK BUILDING: \Q 'F0 ING ❑ DECK FOOTING ❑ FRAMING ❑ DRYWALL ❑ FINAL ❑ PARTIAL PASSED F*D 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 to Aicx4- INSPECTORDATE OF INSPECTION MADE: < _ f TIME: A= �4+ FAXED OPPD\BURT REA TO CONNECT SERVICE: ON BY BUILDING INSPECTION REPORT CITY OF BLAIR ❑ WASHINGTON COUNTY [:1 OTHER LOCATION OF INSPECTION I t A NAME OFOWNER - All r 12 CONTRACTOR: Ae, DATE INSPECTION REQUESTED- -f TIME INSPECTION REQUESTED: PERMIT N TYPE OF INSPECTION REQUESTED: EICONFERENCE El STATUS CHECK BUILDING: ❑ FOOTING ❑ DECK FOOTING Ej FRAMING [:1 DRYWALL [:1 FINAL D PARTIAL PASSED FAILED COMMENTS: A F UTILITIES: F] SEWER TAP F1 SEWER El SEPTIC 0 WATER TAPE] REMOTE El WATER SERVICE PASSED FAILED El PARTIAL R El COMMENTS: ELECTRICAL: F -I ROUGH IN El FINAL D PERMANENT SERVICEE] TEMPORARY SERVICE [I PRECONNFCT PASSED FAILED F] PARTIAL COMMENTS: MECHANICAL: ❑ ROUGH -IN El A/C F1 FURNACE El RADIANT HEAT El FINAL El PARTIAL PASSED FAILED 1-1 R COMMENTS: PLUMBING: ❑ GROUNDWORK 0 ROUGH -IN F1 FINAL El WATER METER INSTALLED El PARTIAL PASSED FAILED F -I PRESSURE TEST El El COMMENTS: R OCCUPANCY GRANTED 0 CONDITIONAL OCCUPANCY GRANTED INSPECTORL-. DATE OF INSPECTION MADE: T I MEL— FAXED OPPD\BURT REA TO CONNECT SERVICE: ON BY Tei BUILDING INSPECTION REPORT ❑ CTTY OF BLAIR ❑ WASHINGTON COUNTY ❑ OTHER LOCATION OF INSPECTION - NAME OF OWNER- ve, CONTRACTOR- 7 DATE INSPECTION REQUESTED s TIME INSPECTION REQUESTED: PERMIT NO- TYPE O TYPE OF INSPECTION REQUESTED: ❑ CONFERENCE ❑ STATUS CHECK BUILDING: FOOTING ❑ DECK FOOTING ❑ FRAMING ❑ DRYWALL ❑ FINAL ❑ PARTIAL PASSED FAILED COMMENTS: a, _ L� t P. ❑ 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 1�® a- e- --- l 6s INSPECTOR- ' DATE OF INSPECTION FAXED OPPD\BURT REA TO CONNECT SERVICE: -;0-10 TII� 1. / d : 30 Atm i� ti - � � �� z LL � �i a ��{ � 3� fd(� 1A• ll - rr_ f �., .rte. - �' "'�'�G' � �� ` "� `ate � " � ." f 2ng f4 i 4�3 � � �j' �,�, .» ' . .F w� 4r