BP13217
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Blair Building Permit Detail
Permit #: 13217
Type: Patios/Driveways/Excavation & Curb Grind
Valuation: 800
Issued: 5/27/2009
Completed: 6/5/2009
Location: 1768 South St
Owner: Rodney & Ann Therkelsen (Holding a 50.00 deposit)
Address: 1768 South St
Blair, NE 68008
4024262747
Permit Fee:
Issue Fee:
Deposit Amt.:
Receipt #:
40
25
50
24678
Phone:
Section:
Subdivision:
Township:
Range:
Lot: 7
Block: 77
Replacing Driveway in same foot print from garage onto 18th Street. Will not need to curb grind. HOLDING A 50.00
DEPOSIT
Contractors
SELF
General Contractor
Permit #
Issued
Remarks
5/29/2009 BMP
HOLDING A 50.00 DEPOSIT UNTIL 8-29-2009
Inspections Date
5/29/2009
6/5/2009
By
KAR
MARH
Framing
Final Inspection of Project
Pass
Pass
'--/k kJ~ - ~fI.{JWay
CITY OF BLAIR - MISCELLANEOUS BUILDING PERMIT
Permit # /.3dl 7
Date: O' - ~ 7~ of Approximate Completion Date: ~ Site Plan Attached: )C
Estimated Valuation of Project: B ac> . 00
Application for: Permit Fee $40 + Issuance Fee $25
Fee: $115.00
Egress Window (floor plan drawing required)
Fences (plot plan required)
Gazebos (plot plan required)
Patios/Driveways/Sidewalks (new or replacement) .~
Roofing/Siding/Soffit and/or Eave Repair/Gutters
Swimming Pools with Fence (plot plan required)
Window/Door Replacement (size change only)
Miscellaneous Building Permits (items not covered by one of the above)
Description:
Utility Excavation and Curb Grinding
Curb Grind
Length
Utility Excavation
Length
Type: Water
Fee: $75 plus bond
Un. Ft.; Width
; Sewer
Un. Ft
; Other
Amount of Bond Posted: Bond Check #
(Curb grind - $9.00 per Un. Ft.; Utility Excavation - $6.00 per Sq. Ft.)
PROJECT INFORMATION:
Job Address: 17&g &ttMJYJ. 8foOI/1t15~?
Legal Description (if applicable) gC';;;?; t: 7 i .f?!- rf t?1~ ,-~Yf ./lIL -77 /I~q ?{!ft,
Owner: Jlp~ #A141';1~dress: /7!#8&u;A J11. Phone#: c;;lU -.7?t/7
Contractor: _ Phone #:
Address:
Cell #:
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PERMIT RENEWAL FEE:
This fee is based on the amount of the original permit fee and is charged when work is not
completed within two years and the permit expires. Renewals will onlv be allowed with the
stipulation that all exterior site work and outside finish work is completed and interior life-
safety issues have been properly address. Permit renewals are for one (1) year, with a
maximum of two (2) renewals for a maximum permit span of four (4) years.
Original valuation of $0-$50,000 $150.00 $
Original valuation of $50,000 - $100,000 $200.00 $
Original valuation of $100,000 - $500,000 $300.00 $
Original valuation of $500,000 or more $400.00 $
Issuance Fee:
$
25.00
Deposit:
$
50.00
Total Renewal Remit Fee = Permit Fee + Deposit + Issuance Fee $
Separate permits are required for electrical, plumbing, hearting, 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) years of date of issue.
/2~ ~~
Signature of Owner/Contractor
S" 27~ 206.9
Date
For Office Use Only WHEN PROPERLY VALIDATED (BELOW) THIS IS YOUR PERMIT
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CITY OF BLAIR, NEBRASKA
Phone 402-426-4191
RECEIVED OF:
ADDRESS
CITY, STATE, ZIP CODE
ie,
THANK YOU
KEEP THIS COPY FOR YOUR RECORDS.
NO
RECEIVED BY
Pounds Printing, Blair, NE 68008
THERKELSEN, RODNEY & ANN
1768 SOUTH ST
BLAIR, NE 68008-0000
1768 SOUTH ST BLA
BC LOT 7 & PT OF VAC ST BLK 77
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BUILDING PERMIT DEPOSIT AGREEMENT
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.
~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.
~ ~ftj_.~
Contractor/Owner
Contractor/Owner
City of Blair
~ S'~ 2. 7---;;>""001
Date
CITY or 5L1\I12
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 BuildinQ
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.
~~~
~ wner/Oc upant
Contractor
City of Blair
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218 South 16th Street. Blair, Nebraska 68008 . 402-426-4191 . Fax 402-426-4195 . E-mail cltyofblair@ci.blalr.ne.us ,.."',"'"
BUILDING INSPECTION REPORT
OF BLAIR
D WASHINGTON COUNTY
LOCATION OF INSPECTION'
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D OTHER
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NAME OF OWNER" \;;>)t/:' . r' it
DATE INSPECTION REQUESTED', .-) i;:? .:y ~ /),'/
f\1 ;7 /;.1
CONTRACTOR' ".,j" .I;!~')
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P ,/ "I
TIME INSPECTION REQUESTED"q. p'! '
PERMIT NO' /:.;:;7,:71 '//
TYPE OF INSPECTION REQUESTED: D CONFERENCE
BUILDING: fOOTING D DECK FOOTING "D3::'~RAMING D DRYWALL D FINAL D PARTIAL
D STATUS CHECK
COMMENTS:
UTILITIES: D SEWER TAP
D PARTIAL
PASSED FAILED
D
D WATER TAP D REMOTE D WATER SERVICE
PASSED FAILED
D D
COMMENTS:
ELECTRICAL: D ROUGH IN D FINAL D PERMANENT SERVICE D TEMPORARY SERVICE D PRECONNECT
D PARTIAL
PASSED FAILED
D D
COMMENTS:
MECHANICAL:D ROUGH-IN D AlC D FURNACE D RADIANT HEAT D FINAL D PARTIAL
PASSED FAILED
D D
COMMENTS:
PLUMBING: D GROUNDWORK D ROUGH-IN D FINAL D WATERMETERINSTALLED D PARTIAL
D PRESSURE TEST
PASSED FAILED
D D
COMMENTS:
D OCCUPANCY GRANTED D CONDITIONAL OCCUPANCY GRANTED
INSPECTOR'
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DATE OF INSPECTION MADE:
'TIMP'
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FAXED OPPD\BURT REA
TO CONNECT SERVICE: ON
BY
BUILDING INSPECTION REPORT
CITY OF BLAIR
CONTRACTOR' ',,\..,
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PERMIT
D WASHINGTON COUNTY
LOCATION OF
NAME OF
.I
DATE INSPECTION REQUESTED' ,::>;J
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TIME INSPECTION REQUESTED'
TYPE OF INSPECTION
BUILDING: D FOOTING D DECK FOOTING D FRAMING D DRYWALL
DCONFERENCE
D PARTIAL
D STATUS CHECK
COMMENTS:
UTILITIES: D SEWER TAP D SEWER D SEPTIC D WATER TAP D REMOTE D WATER SERVICE
D PARTIAL
PASSED FAILED
~ D
PASSED FAILED
D D
COMMENTS:
ELECTRICAL: D ROUGH IN D FINAL D PERMANENT SERVICE D TEMPORARY SERVICE D PRECONNECT
D PARTIAL
PASSED FAILED
D D
COMMENTS:
MECHANICAL:D ROUGH-IN D AlC D FURNACE D RADIANTHEAT D FINAL D PARTIAL
PASSED FAILED
D D
COMMENTS:
PLUMBING: D GROUNDWORK D ROUGH-IN D FINAL D WATERMETERINSTALLED D PARTIAL
D PRESSURE TEST
PASSED FAILED
D D
COMMENTS:
D OCCUPANCY GRANTED D CONDITIONAL OCCUPANCY GRANTED
NOTES/REMARKS'
DATE OF INSPECTION MADE:
fo/5-(O'(
TIMP' 13 $)
INSPECTO .
FAXED OPPD\BURT REA
TO CONNECT SERVICE: ON
BY
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