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BP13489Site Plan Attached: REScheck Attached: Complete Plans Attached Application for Residential, New Construction Move -on: Home Commercial /Industrial Manufactured Home Accessory Building Modular 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 plan required) Other Utilities: Public Water: Yes No If yes, responsible entity: Agreement needed: Public Sewer: Yes No If yes, responsible entity: Private Well Blair OPPD Line Kennard Date Agreement Received: ® Septic Drawing Provided: Blair Kennard County Road Permit Required: Yes No Submitted: Yes No Additional De�scriptiop of project if necessary: C �- ' ' ' c — /d Project Information Job Address: Legal Description (if applicable) Owner: ( ddress: Contractor: ('7 ya l 11 e Phone #: V -" Phone #: Address: /' � �( 'f 1 / Cell #: 9 7 1- 33'1 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 /ordina of the City of Blair and the State of Nebraska. I understand that this permit is void if work is not commenced within ZA 0 days t compI to ithin two (2) years of date of issue. w Signat a of Owner /Contrac or to 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: y —\, Conditional Use Permit Required: Yes No Date C P Approved: State Fire Marshal Required: Yes No Variance Required: Yes No Minimum Setbacks: Front Second Front Side Side Rear Lot e: Square Footage: g Length x Width: Lot Coverage Driveways /Sidewalks: Sidewalk required: Yes No /Sidewalk Waiver: Yes No I 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: 1.1111>A71gri1f"kIaxi poly Number of Stories One Two Three Four >Four High Rise ( >75 ft) Type 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 Square 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 Occuaancv Classification: Assembly, theaters, with stage Assembly, nightclubs Assembly, churches Assembly, general, community ha Business Educational Factory and industrial, low hazard Side Assembly, theater, without stage Assembly, restaurants, bars, banquet halls Assembly, arenas Ils, libraries, museums Factory and industrial, moderate hazard High Hazard, explosives (section continued on next page) r 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 Erecting/Awnings and Decks /Handicap Ramps sq/ft area X $25 (Minimum valuation of $2000) Construction valuation computation Finished sq/ft area Ntg - X$ 143 Construction valuation is .......... .........................Permit fee is: $0 TO $ 50 .............................. .............................$0 $51 TO $ 500 ......................... ............................... $25 $501 TO $2, 000 ......................... ............................... $25 $2,001 TO $25, 000 ......................... ............................... $70 $25,001 TO $50, 000 ........................... ...........................$370 $50,001 TO $100, 000 ........................... ...........................$620 $100,001 TO $ 500, 000 ........................... ...........................$970 $500,001 T^ $1, 000, 000 ......................... .........................$2,970 $1,000,001 AND OVER ......................... .........................$4,970 Permit Fee calculated from chart above Issuance Fee: Total Permit Fee = Deposit + Permit Fee + Issuance Fee $ 25.00 " 43, ` " $ 7q 3 r 0 Additional Comments: Approved by: 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 lfl Date Permit Paid: Permit Fee: Deposit Amount Receipt # Deposit Paid by for return to: $ , 0 d� + $3 per additional $100 +$13 per additional $1,000 + $10 per additional $1,000 + $7 per additional $1,000 + $5 per additional $1,000 + $ per additional $1,000 + $3 per additional $1,000 Building Inspection Pouch given: Yes No 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 Multiplied by 0.006 = Issuance Fee: $ $ 25.00 Total Permit Fee = Deposit + Permit Fee + Issuance Fee $ q9 l ELECTRICAL PERMIT APPLICATION Jurisdiction of City of Blair, Nebraska 218 South 16 Street Blair, Nebraska 68008 Fax (402) 426 -4195 E' 3230 (402) 426 -4191 f Application Date: �' �" �� Permit Fee: $ 0 1940 6v.� 76 WHEN PROPERLY VALIDA1ED (1N 1141a IFAUh) lril�i IN Y V Uxrh1"1v111 Approved By: Rev. 2008 -10 Job Address � � o _ a • j � �� (��` (� C {J ^!.V Owner . M Zip Phone z 11 '&V 7/1Q Contra 7t at �r Zip Phone d� 2. 3. Class of Work: CJ NEW REST ENTIAL O NEW COMMERCIAL EMODELING /ADDITIONS 0 UPGRADE SERVICE Describe Work: 4, /-P, .d e vla-mad 5.Current License on File jWVes O No O N/A Completion Date ELECTRICAL PERMIT FEES Service Fee = (Amp Fee + $5.00 per branch circuit) Upgrade Existing Service .............$25.00 1 400 Amp Fee .... ..................$25,00 . Temporary Service ....................$1S.Q0 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 / 9 I 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 (110 volt only) authority to violate or canecl the provisions of any other state or local law regulating construction or the # of Apparatus .......... x $1.00 petforrnance of construction, Power Apparatus (220 Volt or higher) # of Apparatus....... x $8.00 �a Smoke Detectors..... x $3.00 nature of tractor or Auth ize gent ,,. Permit Issuance Fee ...................$25.00 " Total `7 ° Date Comment: '74 CITY OF BLAIR, NEBRASKA 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 1 Application Date: 7 / _ —;� 0 Permit Fee: $ 0 Job Address I r � Owner Mail dress Zip Phone Contract at ddress � �i � � Zip Phone 3. Class of Work: O NEW RESI15ENTIAL O NEW COMMERCIAL REMODELING /ADDITIONS O UPGRADE SERVICE Describe Work: 4. & j G/ 5.Current License on File es 0 No O 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 3 1 4 sq. ft. x.063 ZP I 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 give Receptacles /Switches/Lighting Fixtures (I 10 volt only) authority to violate or cancel the provisions of any other # of Apparatus 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 Signature of Contractor or Authorized Agent Permit Issuance Fee.... ..$25.00 / �T Total ° Date Comment: WHEN PROPERLY VALIDATED (1N THIS SPACE) THIS 1S YOUR PERMIT Approved By: M Rev. 2008 -10 / %w It m F - COPY ILE °�� C e��tiv� VK 111111 ,C �c Se _A AAL efv— bC. ate Y�uT I `+ __ CITY OF BLAIR - APPLICATION FOR BUILDING PERMIT ` Promise QJe 1 7 - / (o - ( D Permit # j3o Date: Approximate Completion Date: 5 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 plan 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 Additlonal Descript' of project if necessary: �,�.__ , 7-, < Private Well Blair OPPD Line Kennard Date Agreement Received: _ Septic Drawing Provided: Blair Kennard _ Submitted: Yes No Project Information Job Address: Legal Description (if ap 6 �CLt �/d 0:�Z Owner• a al u /41' 22 �ddress: (�� Contractor: P - 7,,V al z .GyrG�acJ �.1 Address: _ r�fDa?� � clr (ash -i �icc OgI4/ / "!�V-57z &7 /r3 ?e,Z Phone #• VZ6 - 5727 7 Phone #: Cell #: 871 - 9 3 d12 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 1 have received a copy of a permit signed by the Building Inspector. I hereb agree to perform the proposed work in accordance with the specifications set forth above and in accordance with the co des /ord12 of the City of Blair and the State of Nebraska. I understand that this permit is void if work is not commenced with! 0 dayss t comp) to ,Within two (2) years of date of issue. Signat a of Owner /contras or to 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 MI VII11 + BUILDING PERMIT DEPOSIT AGREEMENT A $500.00 r ndable deposit is being collected for any new commercial, new ,re� identaal� and any additions, remodels and accessory building valued $10,000 or Y .. 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 Contractor /Owner City of Blair Date CITY Of F)tAIP e of 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. Contractor City of Blair Date 218 South 16th Street • Blair, Nebraska 68008 • 402 - 426 -4191 • Fax 402 - 426 -4195 • E -mail cityofblair @ci.blair,ne,us INSPECTOR DATE OF INSPECTION MADE: f a TIME: FAXED OPPD\BURT REA TO CONNECT SERVICE: BUILDING INSPECTION REPORT CITY OF BLAIR ❑ WASHINGTON COUNTY F OTHER LOCATION OF INSPECTION- 't 4/t a vl_:, v « a K1 NAME OF OWNER- _3 V' I CONTRACTO DATE INSPECTION REQUESTED TIME INSPECTION REQUESTED- PERMIT N 6 -Z - .A TYPE OF INSPECTION REQUESTED: ❑ CONFERENCE F STATUS CHECK BUILDING: F FOOTING ❑ DECK FOOTING ❑ FRAMING ❑ DRYWALL FINAL ❑ PARTIAL PASSED FAILED COMMENTS. UTILITIES: ❑ SEWER TAP ❑ SEWER ❑ SEPTIC ❑ WATER TAP F REMOTE ❑ WATER SERVICE PASSED FAILED ❑ PARTIAL ❑ ❑ COMMENTS: ELECTRICAL: F ROUGH IN [—] FINAL ❑ PERMANENT SERVICE ❑ TEMPORARY SERVICE ❑ PRECONNECT PASSED FAILED ❑ PARTIAL ❑ 1:1 COMMENTS: MECHANICAL: ❑ ROUGH-IN ❑ A/C ❑ FURNACE F RADIANT HEAT ❑ FINAL ❑ PARTIAL PASSED FAILED ❑ ❑ COMMENTS: PLUMBING: ❑ GROUNDWORK F ROUGH-IN F FINAL ❑ WATER METER INSTALLED F PARTIAL PASSED FAILED F PRESSURE TEST ❑ ❑ COMMENTS: ❑ OCCUPANCY GRANTED F CONDITIONAL OCCUPANCY GRANTED NOTES/REMARKS- 4 [a INSPECTOR DATE OF INSPECTION MADE: f a TIME: FAXED OPPD\BURT REA TO CONNECT SERVICE: B UILDING OM ❑ -�ITY OF BLAIR ❑ WASHINGTON COUNTY ❑ OTHE FAILED ❑ ❑ COMMENTS: LOCATION OF INSPECTION UTILITIES: ❑ SEWER TAP ❑ SEWER ❑ SEPTIC ❑ WATER TAP ❑ REMOTE ❑ WATER SERVICE � PASSED FAILED ❑ PARTIAL ❑ ❑ COMMENTS: NAME OF OWNER mf ; c` • s y . -° PASSED FAILED ❑ PARTIAL " ' ❑ CONTRACTO DATE INSPECTION REQUESTED ' « � TIME INSPECTION REQUESTED � ' ' PERMIT N0 � e ;. k �� TYPE OF INSPECTION REQUESTED: ❑ CONFERENCE ❑ STA 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 ❑ El COM MENTS: PLUMBING: ❑ GROUNDWORK ❑ ROUGH -IN ❑ FINAL ❑ WATER METER INSTALLED ❑ PARTIAL PASSED FAILED ❑ PRESSURE TEST ❑ ❑ COMMENTS: ❑ OCCUPANCY GRANTED ❑ CONDITIONAL OCCUPANCY GRANTED INSPECTO �� /la DATE OF INSPECTION MADE: FAXED OPPDXBURT REA TO CONNECT SERVICE: ON BY