BP7609BUILDING PERMIT APPLICATION
~~ ,~ Jurisdiction of City of Blair, Nebraska
Permit Fee: ~ 218 South 16th Street
Issuance Fee: Blair, Nebraska 68008
Deposit Receipt #: (402) 426-4191 ~ Fax (402) 426-4195 Permit 7 6 0 g
Application Date: 1' 3~ ~ Issue Date: ~~'~ ~~
JOB ADDRESS
LEGAL
1. DESCR. LOT NO. BLK. TRACT
^ SEE ATTACHED SHEET
OWNER l~-~l._ ~' J _ MAIL ADDRESS
2. LG(.c~t_ ZIP PHONE
~
CONTRACT
3.
IL ADDRESS
PHO~~~~~Z
~ ~ ZIP ~ ~(~ I~~''
~ ~ .~
~ c ~,
4. Class of Work: NEW O ADDITION REMODEL
5. Describe Work: ~C~"~ .~ ~ _(~~ ~ f f ~ (~~, ~ O Finished Basement O Unfinished Basement
~~ G~
6. Total Sq. Footage (IRCiuding Basement aRa Garage): Total Finished Area:
7. Valuation of Work: $ aj 7c~ ~ ~_ ~
Floodway O Yes O No Dev. Permit
8. Floodplain: Fringe O Yes O No BFE
Elev. Cert.
9. Current Zoning:
10. State Fire Marshall Required: O Yes
11. Special Use Permit Required: O Yes
12. Variance Required: O Yes O No
O No
O No
13. Minimum Setbacks: Front
Side Rear
14. Sidewalk Required: O Yes O No Waiver Approved
NOTICE
Separate permits are required for electrical, plumbing, heating, ventilating and air
conditioning, and septicsystems. By mysignature below, I acknowledgethatpayment
of the building permit application fee 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 acopy of ihis application form 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 2 years of date of issue.
" , ~` ~ .~,~ -- y 7
SIGNATURE OF OWNER/CONTRACTOR DATE
Comment:
O Site Plan Attached
Approximate Completion Date O Complete Pla s Attached
~ "-~ F3"t~~-
Inspections Required and Fees
Utilities
Sewer Water Service
Septic Remote
Stop Box Card
Building
Footings Drywall
(before finish)
Framing Final 5 ' 2-3' cl 1
Electrical
Rough-in Fixtures
Final Permanent Service
Temporary Service
Mechanical
Rough-in A\C
Final
Plumbing -
Ground Work
Rough-in
Final
WHEN PROPERLY
Approved By: ,/„I ~
THIS SPACE) THIS IS YOUR PERMIT
POUNDS PRTG.•Blair, NE ~ / '- Rev. 8/96
,, ~ ~ ~~
q~
Boettcher & Sons Roofin
g
PO Box 265, 200 North- Main
Ames, N E G8621-0265
727-4168, FAX, 727-5448
Representative / "I e-~ ~ 1~ ~s ~d h ~l
- Date ~ f-~ ~ 9
Name] ~~SSe ~~ ~ a u ~ Phone (iJ ~~- ~ °-~~P~
Job Address ~ ~ ~ ~ s d~ ~ ~ Sf ~ ~~ i l /1/e ~j ~00~'
Sweet Cary State Zip
The Undersigned Contractor agrees to furnish all materiels and tabor necessary for the work (apeciliod below).
(1) (We) the OWNER agrw to pay you the sum of
SPECIFICATIONS FOR LABOR AND
~eoover roof with ~uG /~ =I ~ ~~ (~
---
[ ] Repair root with T
Q~]'S`lyle of shingles ~ ~ / p ~ -
[,]~ ~~'_ Yean Bonded Rool _-._
(~]'colol of ehinglea ~rU y _/~ l e ~1 d - --
(] Doubl• ell eves
L4 ye/s
~-]'f~er off [ ] ~ /
~ew velteye C a ~i F ~~ G ~~ L A C E to i~
jJ a ~/ e y /Z+ ~ ~p /
[ J Ridge _ _ ~-
tA r ~'
ooh r)n st~~~wN~r
TERIAL a~;ny -
'[ ~J (~ ~-
i J / ~() --
7S °
Tf°~ '.3793 ~s
[ ] Install metal edging
[.YFslt ~~ ~
(] Cornice open or box
['~Clsen-up and haul oN ell Ireeh from roof
[-j~• lurnbh all materiel and labor
{~ ~ _____ Yser Guarantee on labor
[..]-Gutters cleaned of tooling debris
~de.N`c-yep
[~Parmll lurnished by
(-j'~oll yard with magnetic roller
{~ilvenlze nall• only (] Rsdeck with ___ Inch CD plywood
~,ement around all vents and flashing ~ ~SGS A' r v 2 ~ F (] Does driveway have cracks? yes / no
[ ] Extra work ~ ~ ~ ~ p i ~ e ~ A c r
I , owner of the above address, give my consent for Boettcher & Sons Roofing to act as my
agent concerning all roofing related matters with my insurance company. Upon in wren a company agreement, this
becomes a binding contract." Insurance Company and/or Agent ,~~tei~~ ~n ~z' ""~% Policy #
Payable on completion of roof job unless other arran •mente are made. 1'hl~roposel la for meterlale Ileted above. Any extras, ouch ^• roof )
an rolls woo wFiic tRi t~aan, wll a an extra c ergs. Pay upon completion, or when Insurance c eck~s receive .
1. All propceele •ub]ect to approval of menepement.
2. Owner further eQreee that the equity In thle property la eeeurlty for
Ihle Contract. ThI• Contract shall become binding only upon written
eoceptence hereol by the Contractor or by an euthorl:ed Agent of th•
Contractor or upon commencement of the work.
~. The Contractor shall be liable for any damage to the Interior of th•
building while work Is In progress end It Is understood that the Contrac-
tor is not an agent nor ssub-contractor of any other corporation and
that no other corporation Is a party to this Contract.
~. ThlaContraaloonetltutestheentireunderatendlnpo(tlrepertleeend
no other underelandlnp cotlaterel or otherwise shall be binding unlee•
In writing •Ipned by both parties.
S. Replawment of deteriorated decking, fade boards, root ]ecks,
ventilators, flashing, or other materlale, unless otherwise stated In this
contract, are not Included and will be charged ae an extra an a Ilene and
material basis.
ey_(vlel( ~~S~id~
e. Thle proposal will expire ZO day hom dale unless extended
wrlllnpbylheCompany. After20dey,wereeerwtherlphltorevlee~
price In accordance with costs In eBect et that Ume.
7. II material has to be reordered or restocked beeaue• of a dnoe0sl
by the customer, there will be ~ reetodtlnp fee equal to Illteen pare
(15X) of the contncl prlw.
8. Any -eprewntations of other oommunkallone not written In i
Contreet ere agreed to be Immaterial and rolled on by either party ~
do not survive the executbn of this Contract.
Y. LaborWerrentydonnotooverdemapelorooleoeueedbyllphln'
geN (SOkIPH), hurrkene, tornado. hailstorm, Impact or foreign of~[r
or other violent storm or casualty or dsmag• to roofs due to aettNm
dlstortlon, failure or cradling of the roof deck, vrall• or loundatlon
but g.
~- ~.
- 4 Date_
f.a ~ Ii ~ IJSit ,_• Date /
(Joint Purche~ier)
E.ru~ R,rn, tonal lE
7
- ~ BUILDING INSPECTION REPORT `~
_ ;~
~~CTTY OF BI:AIIt ^ WASHWGTON COUNTY ^ OTHER
~:
LOCATION OF INSPECTION: ~~ T rr'f ~~ `~ ~'~'`
~ ~ , ~ t,
II NAME OF OWNER: •~ f~-~~, /~ ~ ``~` !(`- CONTRACTOR:''~~~~ '~~ "~ ~ ~~tz tr
v
DATE INSPECTION REQUESTED: ~ ~^-~~~ `~ PERMIT N0: ~ .'`
TIME INSPECTION REQUESTED:
TYPE OF INSPECTION REQUESTED:
f,
BUILDING: ~ ~ "
` ~
FOOTING FRAMING DRYWALL FINAL
^ ^
i
I UTILITIES:
^ SEWER-TAP ^ SEWER ^ SEPTIC: ^ WATER TAP _ .
j ^ REMOTE ^ WATER SERVICE
ELECTRICAL:
^ ROUGH IN ^ FIXTURES ^ FINAL' ^ MOTORS _.
^ PERMANENT SERVICE ^ TEMPORARY SERVICE
~~ ~ ~ -
MECHANICAL:
. ^ ROUGH-IN ^ A/C ~ _^ FINAL
~~ PLUMBING:
^ GROUNDWORK ^ ROUGH-IN ^ FINAL
RESULTS OF THE INSPECTION: ~ PASSED Is~rrorES> ^ FAILED ~sEE xorEs~
.'
,~ NOTES/REMARKS:
i
t ~__
~ DATE OF INSPECTION MADE: ~.> `-~`~ ~ ~ .TIME: ~ ~ ~ L~r~
i
_CALLED OPPD\ ~ TO CONNECT SERVICE: ^ YES ^ NO
WANT OFFICESTAFF TQ CALL OPPD\ ~ ^ YES - ^ NO BLR 1