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Blair Building Permit Detail
Permit #: 13362 Issued: 12/1/2009
Completed: 12/17/2009
Location: 775 N 14th St
Owner: Lu Eriksen
Address: 775 N 14th St
Blair, NE 68008
Phone:
Section:
Subdivision:
Township:
Range:
Lot: 2
2 main floor bedroom egress windows and siding.
Contractors
Elkhorn Home Improvement
Type: Siding Permits - All types
Valuation: 11300
General Contractor
Remarks
Inspections Date
12/17/2009
By
HOW
Final Inspection of Project
Permit Fee:
Issue Fee:
Deposit Amt.:
Receipt #:
Block:
Permit #
Pass
40
25
50
25713
Issued
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~ CITY OF BLAIR - MISCELLANEOUS BUILDING PERMIT '- ~
Permit # 13,-"~1I ~
Date:' 1/2SIr.5-r Approximate Completion Date:l,j} lis lOCi Site Plan Attached:
Estimated Valuation of Project: ---,-"p \ I ) 3D'.L ,).:"J
Application for: Permit Fee $40 + Issuance Fee $25 + $50 Deposit
Fee: $115.00
Egress Window floor Ian drawin required)
Fences (plotPlan required)'
Gazebos (plot plan required)
Patios/~/Sidewalks (new or replacement)
Roofin~offit 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.)
n ~ ~"
Additional Description of project if necessary: 0< 00Cl~V\~"lt.\\( <'d (rl)ur,rl
r:~\fL<:5::'\ ~\, v~ lJ( uS ..~ 4- .5\ cl\ VI ~
PROJECT INFORMATION:
Job Address:
'"S 1\1 1 ~'T1\j't-
Legal Description (if applicable) i3~ N. &;2. S'
.
Owner: Ltl CC)v\~~CI Address:
Contractor: S \ \<. hO V h\-bv1'\eJ '.l m p~1J'vcn'lJUfid-
8 fo6 L{ 8'32 I
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C vel[ L' (\J ~ III) t! s; f ,8/1:: 1/8
--' ;1 Phone#: /I,'cy pC! '14
Phone #:
Address:
Cell #: ~ IlL) , I q{jJ I
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 only be allowed with the
stipulation that all exterior site work and outside finish work is completed and interior Iife-
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.
Signature of Owner/Contractor
Date
For Office Use Only
WHEN PROPERLY VALIDATED (BELOW) THIS IS YOUR PERMIT
Date Permit Paid:
Receipt #
Approved by: 9~! ~f~ _ (:+.~. 0'1
CITY OF BLAIR - MISCELLANEOUS BUILDING PERMIT
Permit # /3311 ~
, Date:' 1/2C::,! d1 Approximate Completion Date:l,j} 1151 O~ Site Plan Attached:
Estimated Valuation of Project: ~ \ I ) 3CX.L 2x:>
Application for: Permit Fee $40 + Issuance Fee $25 + $50 Deposit
Egress Window oor Ian drawin required)
FenceS(P1otPlan required) ----.~
Gazebos (plot plan required)
Patios/~/Sidewalks (new or replacement)
Roofin~offit 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:
Fee: $115.00
Utility Excavation and Curb Grinding
Curb Grind
Length
Utility Excavation
Length
Type: Water
Fee: $75 plus bond
Un. Ft
Un. Ft.; Width
; Sewer
; Other
Amount of Bond Posted: Bond Check #
(Curb grind - $9.00 per Un. Ft.; Utility Excavation - $6.00 per Sq. Ft.)
Additional Description of project if necessary: ~ n-LOJ.V\ +' l~( W VTI\)(Vl
~K%\ ,0\,\!\.d(J( uS - 4-- S\c..l\ VI ~ '
PROJECT INFORMATION:
(;jIi/
l ~mJT
Job Address:
L~{S 1\1
Legal Description (if applicable)
Owner: Ltl ~v\~~
Contractor: S ~ KhOY"Yl tbV1'\e..- ~mrV1J'vG~
Address:
ri f\)t-
~ Vat;) Phone#:
Address:
Phone #:
Cell #:<g lJeJ ' {q~ (
CITY OF BLAIR, NEBRASKA
Phone 402-426-4191
RECEIVEO OF:
ADDRESS
'I
CITY, STATE, ZIP CODE
THANK YOU
KEEP THIS COPY FOR YOUR RECORDS.
NO
RECEIVED BY
Pounds Printing, Blair:. NE 66008
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Promise
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.
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/Owner
City of Blair
(jj Illi~r
ate
CITY OF BL1\IQ
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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.
Owner/Occupant
~ ff~
ptlor
City of Blair
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218 South 16th Street. Blair, Nebraska 68008 . 402-426-4191 . Fax 402-426-4195 . E-mail cityofblair@cLblair.ne.us ~~';'1l-,'\OJ~~:
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La:' CITY OF BLAIR
BUILDING INSPECTION REPORT
o WASHINGTON COUNTY
o OTHER
LOCATION OF INSPECTION'
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NAME OF OWNE:!L: f.;
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DATE INSPECTION REQUESTED'
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TIME INSPECTION REQUESTED'
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TYPE OF INSPECTION REQUESTED: 0 CONFERENCE
BUILDING: 0 FOOTING 0 DECK FOOTING 0 FRAMING 0 DRYWALL :.:t:J~.? FINAL 0 PARTIAL
o STATUS CHECK
COMMENTS:
UTILITIES: 0 SEWER TAP 0 SEWER 0 SEPTIC 0 WATER TAP 0 REMOTE d/ WATER SERVICE
o PARTIAL
PASSED FAILED
~ 0
PASSED FAILED
o 0
COMMENTS:
ELECTRICAL: 0 ROUGH IN 0 FINAL 0 PERMANENT SERVICE 0 TEMPORARY SERVICE 0 PRECONNECT
o PARTIAL
PASSED FAILED
o 0
COMMENTS:
MECHANICAL:D ROUGH-IN 0 A/C 0 FURNACE 0 RADIANT HEAT 0 FINAL 0 PARTIAL
PASSED FAILED
o 0
COMMENTS:
PLUMBING: 0 GROUNDWORK 0 ROUGH-IN 0 FINAL 0 WATER METER INSTALLED 0 PARTIAL
o PRESSURE TEST
PASSED FAILED
o 0
COMMENTS:
o OCCUPANCY GRANTED 0 CONDITIONAL OCCUPANCY GRANTED
NOTES/REMARKS'
INSPECTOR'
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DATE OF INSPECTION MADE:
JJ-Ij, 69
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FAXED OPPD\BURTREA
TO CONNECT SERVICE: ON
BY