BP13174E
m
W&w ala, Yi1
A Promis° °tQ
CITY OF BLAIR ® APPLICATION FOR BUILDINGIT
Permit #<
Date: � t' 6) 4Li Approximate Completion Date:
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
r
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 Private Weil
If yes, responsible entity: Blair OPPD Line Kennard
Agreement needed: Date Agreement Received:
Public Sewer: Yes No Septic Drawing Provided:
If yes, responsible entity: Blair Kennard
County Road Permit Required: Yes No Submitted: Yes No
Additional Description of project if necessary: / � "i �/ � �3-�� A
�'Y�£Y G�f� �,/ �% C.(/ Y�� ,.�i'� r:P"! r,¢'' ;`y�? �1 �°'✓C;`""�? �'' ,
r � "3 may/ 5 > 1,y
z / ✓i l� 1 t ! Jld+1 l . sW El+e. ewe�C" ✓ %. f �A SG L GL "y�iC 4E
Project Information:
Job Address: _) /4> ���`�
Legal Description (If applicable) �° o '� /,y c y �� r
A/ f
Owner Ac �nlwlf"l Address: �v % ` )'7" Phone#:
r
Contractor: Phone #:
� f
Address:
:� r'�,'� �. G�'r��� ::_,� Cell #:
'� �'� '
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 ithin two (2) years of date of issue.
a
{Signa re of Owner%Contractor Date
Zoning/Flood Plain/Utilities:
Current Zoning: Conditional Use Permit Required: Yes No
ate CUP Approved:
4—
State Fire Marshal Required: Yes No Variance Required: Yes No
Minimum Setbacks: Front Se and Front Side Side 4ftRear ITT
Lot Square Footage:
Length x Width: Lot Coverage %
D riveways/S i d ewa i ks:
Sidewalk required: Yes No Sidewalk Waiver: Yes No
Date Waiver Approved:
Preexisting Garage requires driveway to be less than 3' from property line
Approved by:
Flood Plain: Yes No
If yes, specify special require ents:
Yes
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
Egress in Basement: Required: Yes No
Sleeping Rooms Living Area
Fireplaces Gas Electric
Provided on Plans: Yes No
_ Other Egress
Square Footage -
Main Main Level: Second Level: e Third Level
Basement: (Unfinished) (Finished) i ` "i
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
Occuoancv 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)
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. Al will review all second access requests and industrial and
commercial driveway requests)
Required Off Street Parking:
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 $
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:
f
Total Permit Fee = Deposit + Permit Fee + Issuance Fee $
RESIDENTIAL - ADDITIONS / REMODELS 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 Erecting/Awnings and Decks/Handicap Ramps: sq/ft area X $25 (Minimum
valuation of $2000)
Construction valuation computation:
Finished sq/ft area i X $ $ O
Construction va uation 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
TO$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
Additional Comm
v -s km -
App ` U s .
+ $3
per additional $100
+$13
per additional $1,000
+$10
per additional $1,000
+ $7
per additional $1,000
+ $5
per additional $1,000
+ $4
per additional $1,000
+ $3
per additional $1,000
$ 25.00 I 11-5 - 00
$ 7 000-
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 Alk-
For Office Use Only
Date Permit Paid:
Permit Fee:
Deposit Amount
Receipt # 6m a
Deposit Paid by for return to:
Building Inspection Pouch given: Yes NotC�
MECHANICAL PERMIT APPLICATIONLlJurisdiction of City of Blair, Nebraska /
Qi 218 South 16th Street
Blair, Nebraska 68008
Fax (402) 426-4195 M 1971
(402) 426-4191
Application Date: Permit Fee: $
(y �,
Job Address 215t�`
Own Mail Address zip Phone
ontrac Majk� r sr"'"� w j 'Lip Phone
2. j[/ , t
3. Class of Work: ❑ COMMERCIAL O RESIDENTIAL O NE9 O Ad ion O Alteration O Repair O Replacement
Describe Work:
4.
,4� /xa"--)d
MECHANICAL PERMIT FEES
Heat Pump Tons
Central A/C Tons
Fumace/Heat Pump/Air Conditioner (Per Unit)
Furnace BTU/H
Up to and including 100,000 BTU / 3Ton............................$15.00
# of Units A/C
Furnace/Heat Pump/Air Conditioner (Per Unit)
Furnace
Over 100,000 BTU/ 3 Ton.............................................$25.00
Completion Date:
Refrigeration Units/Coolers/Lines/Compressor — Commercial
(New or Replacement) (Per Unit)
Boiler Chart
BTUFee
..............................................................................$15.00
Up to 100,000 ................................$15.00
100,000-500,000 ..............................$30.00
500,000-1,000,000 ........................... $40.00
1,000,000-1,750,000 ........................$60.00
Over 1,750,000 ..............................$100.00
Boiler (apse BTU Chart to left)....................
Appliance Vent/Fans ........................$10.00
Notice
I hereby certify that I have read and examined this
Duct System......... ................$15.00
" ° °' ° ° ° °
application and know the same to be true and correct. All
provisions of laws and ordinances governing this type of
Gas/Air Outlets.................First 5 x $6.00
work will be complied with whether specified herein or
not. The granting of a permit does not presume to give
.........Additional x $1.00
authority to violate or cancel the provisions of any other
state or local law regulating construction or the
Radiant Heat Systems/Gas/Water
performance of construction.
Piping System................................$50.00
C��/' /��
Modular Home ............. ° ................. $50.00
Signature of Contractor or Authorized Agent
Permit Issuance Fee .......................... $25.00
'�_
Total
Current License on File --jkfes O No O N/A
Date
Comment:
WHEN PROPERLY VALIDATED (INTHIS SPACE) THIS IS YOUR PERMIT
Approved By:
Rev. 2008-10
MECHANICAL PERMIT APPLICATION
Jurisdiction of City of Blair, Nebraska
218 South 16th Street
Blair, Nebraska 68008
Fax (402) 426-4195
(402) 426-4191 M1923
Application Date: / Permit Fee: $
r4
Job Address'
// yy J
Owneri Ma' d �s�� / Zip Phone
Contracto 'M ' Address Zip Phone
3. Class of Work: ql<COMMERCIAL O RESIDENTIAL O New O Addition Alteration Cl Repair O Replacement
Describe Work:
4. � �'i !�'� �a 4%e -f t9, A/ ,0h 4�19
MECHANICAL PERMIT FEES
Heat Pump Tons
Central A/C Tons
Furnace/Heat Pump/Air Conditioner (Per Unit)
Furnace BTU/H
Up to and including 100,000 BTU/ 3Ton............................$15.00
# of Units A/C
Furnace/Heat Pump/Air Conditioner (Per Unit)
Furnace
Over 100,000 BTU/ 3 Ton.............................................$25.00
Completion Date:
Refrigeration Units/Coolers/Lines/Compressor — Commercial
(New or Replacement) (Per Unit)
Boiler Chart
BTUFee
.............................................................................$15.00
Up to 100,000 ................................$15.00
100,000-500,000 ..............................$30.00
500,000-1,000,000 ........................... $40.00
1,000,000-1,750,000 ........................ $60.00
Over 1,750,000 ..............................$100.00
Boiler (arse BTU Chart to left)....................
Appliance Vent/Fans........................$10.00U'
Notice
I hereby certify that I have read and examined this
Duct System..................................$15.00
application and know the same to be true and correct. All
provisions of laws and ordinances governing this type of
Gas/Air Outlets.................First 5 x $6.00
work will be complied with whether specified herein or
not. The granting of a permit does not presume to give
.........Additional x $1.00
authority to violate or cancel the provisions of any other
state or local law regulating construction or the
Radiant Heat Systems/Gas/Water
performance of onst tion.
s
Piping System................................$50.00
Modular Home ............................... $50.00
• �,s
Sig uCf Cont btf5rorAu sized Agent
Permit Issuance Fee .......................... $25.00
I (� (�
Total) 1)
Current License on File Yes O No Cl N/A
ate
Comment:
WHEN PROPERLY VAUDA' ED (1N IHIS SPACE) THIS IS YOUR PERMIT
Approved By:
;"Iff q
Rev. 2008-10
7/10/2009 1 M 06116-09
,-3
i
NEBRASKA STATE FIRE MARSHAL
PLANS DIVISION
Code Review
Franciso Herrera, AIA A
Lloyd Dannen Hosanna's Children Daycare
1821 L Street 556 N 21 st Street
Tekamah, NE 68061- Blair 68008-
(402) 689-5951
Your items have been reviewed for compliance with the Nebraska State Flre Marshal Act.
Final Architectural Plan Remodel
REMARKS:
Plan review is for a two level day care occupancy, 31 occupants on main level, 28 occupants on lower
level.
1. Handrails shall be provided on both sides of existing interior stairs between 34 inches and 38 inches
above the surface of treads. Additional handrails may also be provided at a height range of 28 to 32
inches where children under the age of five are the major users of the facility. LSC 16.2.2.3, 7.2.2.4.5
2. Interior stair from lower level does not meet requirements for an approved exit component as pursuant
to LSC 7.2.2.5.1, Thus lower level exterior exits shall be separated by a distance of 27 feet. LSC 16.2.5,
7.5.1.4
3. Emergency lighting shall be provided at the interior stairs and it's corridor. Emergency lighting provided
in the assembly areas shall provided illumination not less than one foot candle along the path of egress.
LSC 16.2.9, 7.9.2
4. Door number ST1-1 at top of stair shall be 60 minute fire rated where used for a vertical opening. LSC
16.3.1, 8.2.3.2.3.1
This code review does not determine compliance with the State of Nebraska Accessibility Guidelines.
This determination shall be done by the local jurisdiction in which the project is
located.
cc. Blair Codes
Page 1 of 2
PLEASE CONTACT OFFICE INDICATED BELOW FOR A FINAL INSPECTION.
FINAL ONSITE APPROVAL IS REQUIRED PRIOR TO OCCUPANCY OR USE.
SIGNED:
Reviewed By: Main Office
246 South 14th Street
Lincoln, NE 68508-1804
(402) 471-2027
Jim Kenney
Contact for Inspection: District A
246 South 14th Street
Lincoln NE 68508-1804
(402) 471-2590
13�'7y
Howard Wolfe
From:
Howard Wolfe
Sent:
Monday, November 09, 2009 9:51 AM
To:
'F. J. Herrera'
Cc:
Howard Wolfe
Subject:
RE: Code Review 06116-09 Hosanna's Children Daycare -Blair
Date: 11-9-09
Mr. Herrera: I have reviewed your revised plans and the following items need to be clarified:
1. Sheet Al: Show the ADA stall door as self closing.
2. Show width of ADA stall as 60" clear.
3. Sheet A2/detail H1: Show handrails extending past bottom stair risers for a distance of 12".
4. Sheet M1/fan schedule clouded notes: Remarks should read: vent to exterior of building, not to attic.
5. P1/detail 2: Show the flusher for water closet on the wide side for the ADA stall.
6. M1: Note at bottom of sheet reads: non -ducted hood?
From: F. J. Herrera[mailto:flatiander1969@hotmail.com]
Sent: Friday, November 06, 2009 12:47 PM
To: Howard Wolfe
Subject: FW: Code Review 06116-09 Hosanna's Children Daycare -Blair
> From: Sharon. Brandt(a)nebraska.gov
> To: flatlander1969Ca hotmail.com
> Date: Tue, 21 Jul 2009 08:04:51 -0500
> Subject: Code Review 06116-09 Hosanna's Children Daycare -Blair
Hotmail: Trusted email with powerful SPAM protection. Sign up now.
1
Howard Wolfe
From: F. J. Herrera [flatlander1969@hotmail.com]
Sent: Friday, November 06, 2009 12:47 PM
To: Howard Wolfe
Subject: FW: Code Review 06116-09 Hosanna's Children Daycare -Blair
Attachments: Code Review 06116-09 Hosanna's Children Daycare-Blair.pdf
> From: Sharon. Brandt( )nebraska.gov
> To: flatlander1969Ca)hotmail.com
> Date: Tue, 21 Jul 2009 08:04:51 -0500
> Subject: Code Review 06116-09 Hosanna's Children Daycare -Blair
Hotmail: Trusted email with powerful SPAM protection. Sign up now.
MECHANICAL PERMIT APPLICATION
Jurisdiction of City of Blair, Nebraska
218 South 16th Street
Blair, Nebraska 68008
Fax (402) 426-4195 M 1923
(402) 426-4191
Application Date: //)'',;?' 0 7
4
r4
Permit Fee: $
Job Address /(/ , / 5 /111� C VY ✓
Owner ( Ma' Adc s Zip Phone
Contracto � M ' Addres Phone
2. �? ��° cam" ` % L5,
3. Class of Work: COMMERCIAL O RESIDENTIAL M New O Addition 49fAlteration O Repair O Replacement
Describe Work:
4.
MECHANICAL PERMIT FEES
Heat Pump Tons
Central A/C Tons
Fumace/Heat Pump/Air Conditioner (Per Unit)
Furnace BTU/H
Up to and including 100,000 BTU / 3Ton............................$15.00
# of Units A/C
Fumace/Heat Pump/Air Conditioner (Per Unit)
Furnace
Over 100,000 BTU / 3 Ton.............................................$25.00
Completion Date:
Refrigeration Units/Coolers/Lines/Compressor — Commercial
(New or Replacement) (Per Unit)
Boiler Chart
BTUFee
..............................................................................$15.00
Up to 100,000 ................................$15.00
100,000-500,000 .............................. $30.00
500,000-1,000,000 ........................... $40.00
1,000,000-1,750,000 ........................$60.00
Over 1,750,000 ..............................$100.00
Boiler (use BTU Chart to left) ....................
Appliance Vent/Fans ........................$10.00
Notice
I hereby certify that I have read and examined this
Duct System..................................$15.00
application and know the same to be true and correct. All
provisions of laws and ordinances governing this type of
Gas/Air Outlets.................First 5 x $6.00
work will be complied with whether specified herein or
not. The granting of a permit does not presume to give
.........Additional x $1.00
authority to violate or cancel the provisions of any other
state or local law regulating construction or the
Radiant Heat Systems/Gas/Water
performance of construction.
Piping System................................$50.00
Modular Home ............................... $50.00
Signature of Contractor or Authorized Agent
Permit Issuance Fee .......................... $25.00 C>e�
Total J 1- ' � Ct
Current License on File Yes 0 No O N/A
Date
Comment:
WHEN PROPERLY VALIDATED (IN THIS SPACE) THIS IS YOUR PERMIT
Approved By: '3
Rev. 2008-10
CITY OF BLAIR, NEBRASKA
Phone 402-426-4191
THANK YOU KEEP THIS COPY FOR YOUR RECORDS.
NO
RECEIVED BY
Pounds Printing, Blair, NE 68008
RECEIVED OR
ADDRESS
-
36
CITY, STATE, ZIP CODE
c` �A
THANK YOU KEEP THIS COPY FOR YOUR RECORDS.
NO
RECEIVED BY
Pounds Printing, Blair, NE 68008
Structures Requiring a Licensed Architect and/or Professional Engineer
Residential Structures
10,000 sq. ft. structures (International Building Code Classification Group R-3)
State law requires all residential structures which will be 10,000 sq. ft. or larger, to be designed by an architect
and/or professional engineer. This includes:
• Single family homes
• Multiple -unit residences with four or fewer units
• Congregate living facilities for 16 or fewer persons
• Adult or child care facilities for five or fewer persons for less than 24 hours
4,000 sq. ft. structures (R-1, R-2, R-4)
State law requires the following types of residential structures, if 4,000 sq. ft. or larger, to be designed by an
architect and/or professional engineer.
• Hotels, motels, boarding houses or any transient sleeping structures
• Permanent dwelling units such as apartment houses, dormitories, fraternities and sororities, monasteries,
convents, vacation timeshare properties, and non -transient hotels and motels
• Residential care and assisted living facilities designed for more than five but no more than 16 occupants,
excluding staff.
Commercial Structures
Nebraska state law requires that all commercial structures must be designed by an architect and/or professional
engineer, with the following exceptions. Following are general definitions. For complete details consult a
professional engineer or architect, or refer to Nebraska Revised Statutes and Rules.
Assembly (A-1 thru A-5) — Less than 1,000 sq. ft.
All structures intended for the gathering of persons for civic, social or religious functions; recreation; or food or
drink consumption.
Business (B) — Less than 3,000 sq. ft.
This includes any part of a structure used for office, professional, or service -type transactions.
Mercantile (retail sales) (M) — Less than 3,000 sq. ft.
This includes any part of a structure used for the display or sale of any merchandise, including department
stores, drug stores, markets, motor fuel -dispensing facilities, and retail or wholesale stores.
Storage (S) — Less than 5,000 sq. ft.
This includes any structure used for storage that is not classified as a hazardous occupancy.
{ ducational (E) — Less than 1,000 sq. ft. n%
This includes any part of a structure which can serve six or more persons, and will be used for educational
purposes or personal care services.
Factory Industrial (F-1, F-2) — Less than 5,000 sq. ft.
This includes any part of a structure used for assembling, disassembling, fabricating, finishing, manufacturing,
packaging, repair or processing operations that are not classified as high -hazard or storage occupancies.
High -Hazard Structures (H-1 thru H-5) — Less than 2,000 sq. ft.
The high -hazard category includes any portion of a structure that involves the manufacturing, processing,
generation or storage of materials that constitute a physical or health hazard. There is a 4,000 sq. ft. exemption
for semi -conductor and similar facilities.
There are multiple definitions of high -hazard categories too numerous to list here. For details, please
consult with an architect or professional engineer or refer to International Building Code (IBC) Section
414.
MI VI111I-
BUILDING PERMIT DEPOSIT AGREEMENT
(A $500.00 efundable deposit is being collected for any new commercial, new
esidentia�; 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 $50.00 refundable deposit is being collected for all misc. permits.
The City reserves the right to not refund this deposit if any of the following
conditions occur during the construction period:
1) Theft of water service by the plumber, owner or general contractor.
2) All permits have not been obtained.
3) All required inspections have not been obtained.
4) Occupancy occurs prior to a final inspection.
5) The project is completed without a final inspection being done.
6) Storm Water Management Plan inspection not obtained. (If Required)
If any or all of these situations occur during construction, you may forfeit your
deposit.
hereby agree to the above conditions, and understand that should any or
all of the above situations occur, the building permit deposit SHALL be forfeited or
discounted upon the discretion of the City of Blair, Building and Inspections
Department.
��on r ctor•wner
Date
Contractor/Owner
City of Blair
-16e o1
BUILDING PERMIT SUPPORTING DOCUMENTS
This building permit packet includes various items dealing with particular code
requirements and/or building permit requirements. It in no way includes ALL particular
code items. Also, it is your responsibility to know the 2006 International Building
Cade requirements that apply to your project. Please understand this packet is only
designed and distributed to aid you in your building permit process. A copy of the
International Building Code is available for your use at the Blair Public Library.
I have read the above disclosure and accept this building permit documentation on my
own behalf assuming full responsibility as the owner/contractor for this project.
Owner/Occupant
City of Blair
a - s
._ -
A
218 South 16th Street • Blair, Nebraska 68008 • 402-426-4191 • Fax 402-426-4195 • E-mail cityofblair@cl.blair.ne.us
aoGgoa�l9
WASHINGTON COUNTY, STATE OF NEBitAM 1 1 S$
RECORDED.Iu 3 aya®ATq
BOOK 51/! PAGE(S)_LLU
CdEGISTER OF DEQU
EALCR
CONTIGUOUS PARCEL AGREEMENT
This , agreement is made this 7 day ofJ t,t ne 2001, by
C A�/y!t �_ 'D ca n 4 -ein , hereinafter referred to as "Owners".
Whereas, the Owners are all of the record titleholders, entities or persons having any
interest in the following described real estate, to -wit:
C Ln yen -1' -h'A L 4 a net Lo
and,
Whereas, the individually described parcels are contiguous and adjacent to each other;
and,
Whereas, pursuant to Section 1110(2) provides an owner of real estate may be in
agreement with the terms and conditions set forth herein utilize the outside boundary of the
entire tract as the lot or boundary line for set back purpose and waive building across or the
requirement of any set back line with regard to the interior contiguous line for building purposes.
For and in consideration, the waiver of said set back requirements from and the right to
build across the interior lines of the contiguous lots by the City of Blair, the undersigned hereby
irrevocably agree in perpetuity all the above described real estate shall after the date of this
agreement be conveyed only in a simultaneous conveyance to the same grantee or grantees, and
that said real estate shall not be conveyed, sold, divided, or otherwise transferred except in
conformity with this agreement.
The Owners further hereby agree that all required sidewalk will be extended across all
parcels referenced in this agreement either at the time of initial construction or within 90 days of
this agreement.
The Owners further hereby agree this agreement may be terminated only upon express
written approval of the City of Blair releasing the Owners from the irrevocable nature of this
agreement.
The Owners further warrant and covenant this agreement shall ran with the land and shall
be binding upon the heirs, personal representatives, successors, and assigns of the Owners. .
O r Owner CO
Y'-`
X -. >
W
0
ti7:..
STATE OF NEBRASKA
ss 0
sr
WASHINGTON COUNTY )-
The foregoing instrument was acknowledged before me on ZY-v y-< 19 , 20 Oq, by
lecorded Z - -
aeneral
6merica{ a/THOMAS
Q. gBfate of TOWSE0
Photostat A .2011
Proofed ✓ NOTARY PUBLIC
Scanned
BUILDING INSPECTION REPORT
NCITY OF BLAIR El WASHINGTON COUNTY El
LOCATION OF INSPECTION -
NAME OF OWNER- 60rl VQ/ V CONTIZj
DATE INSPECTION REQUESTED: F u C3 t TIME INSPECTION
TYPE OF INSPECTION REQUESTED:
'* is 0 V '61" PERMIT
[:1 CONFERENCE [:�-SfA
BUILDING: El
FOOTING 0 DECK FOOTING El FRAMING El DRYWALL El FINAL El PARTIAL
PASSED FAILED.
COMMENTS:
El
El
UTILITIES: ❑
SEWER TAP El SEWER------ SEPTIC El WATER TAP El REMOTE El WATER SERVICE
PAS 11 SED
FAILED
F1
PARTIAL
COMMENTS:
ELECTRICAL: 0
ROUGH IN 0 FINAL El PERMANENT SERVICE El TEMPORARY SERVICE El PRECONNECT
PASSED FAILED
F -I
PARTIAL
0
❑
COMMENTS:
MECHANICAL: [_1
ROUGH -IN F1 A/c El FURNACE El RADIANT HEAT El FINAL El PARTIAL
PASSED
FAILED
COMMENTS:
PLUMBING: El
GROUNDWORK El ROUGH -IN F1 FINAL ❑ WATER METER INSTALLED El PARTIAL
-
PASSED' FAILED
El
PRESSURE TEST
❑
El
COMMENTS:
F -I OCCUPANCY GRANTED E] CONDITIONAL OCCUPANCY GRANTED
NOTES/REMARKS*
42?
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CITY OF BLAIR ❑ WASHINGTON COUNTY ❑
LOCATION OF INSPECTION
NAME OF OWNER- CONTRACTOR -
DATE INSPECTION REQUESTED- TIME INSPECTION REQUESTED- PERMIT
TYPE OF INSPECTION REQUESTED:
CONFERENCE ❑ STATUS 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
❑
❑
COMMENTS:
PLUMBING: ❑
GROUNDWORK ❑ ROUGH IN ❑ FINAL F1 WATER METER INSTALLED❑ PARTIAL
PASSED
(FAILED
❑
PRESSURE TEST
❑
❑
COMMENTS:
❑ OCCUPANCY GRANTED ❑ CONDITIONAL OCCUPANCY GRANTED
NOTES/REMARKS:
INSPECT DATE OF INSPECTION MADE: T t
FAXED OPPD\BURT REA TO CONNECT SERVICE: ON BY
BUILDING INSPECTION REPORT
,. <s CITY OF BLAIR ❑ WASHINGTON COUNTY ❑ OTHER
LOCATION OF INSPECTION:
NAME OF
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MNTR ACTf1R •" a -
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DATE INSPECTION
REQUESTED - 'f TIME INSPECTION REQUESTED: ` x y ` PERMIT
NO
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TYPE OF INSPECTION REQUESTED: "d. CONFERENCE
❑ STATUS 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
COMMENTS:
PLUMBING: ❑
GROUNDWORK ❑ ROUGH -IN ❑ FINAL ❑ WATER METER INSTALLED ❑ PARTIAL
PASSED
FAILED
❑
PRESSURE TEST
❑
❑
COMMENTS:
❑ OCCUPANCY GRANTED ❑ CONDITIONAL OC_cvPANCY GRANTED I ® /�
w
% r4rAo,-AFor
INSPECTOR- 9" DATE OF INSPECTION MADE: TIME
FAXED OPPD\BURT REA TO CONNECT SERVICE: ON BY
BUILDING INSPECTION REPORT
F -I CITY OF BLAIR ❑ WASHINGTON COUNTY El OTHER
�
'(, , f , , -� �
LOCATION OF INSPECTION C' �" .1
NAME OFOWNER - CONTRACTOR -
-
DATE INSPECTION REQUESTED- 2 TIME INSPECTION REQUESTED- 9 PERMIT NO"
4-
TYPE OF INSPECTION REQUESTED: IRCONFERENCE
F—I STATUS CHECK
BUILDING: F1 FOOTING F -I DECK FOOTING ❑ FRAMING ❑ DRYWALL F1 FINAL F -I PARTIAL
PASSED
FAILED
1:1
El
f
COMMENTS: J
e"Ll 64's
Io r
UTILITIES: F] SEWER TAP F1 SEWER F1 SEPTIC F] WATER TAP F-1 REMOTE F1 WATER SERVICE
PASSED
FAILED
F] PARTIAL
j
L
A
COMMENTS:
ELECTRICAL: F] ROUGH IN ❑ FINAL F1 PERMANENT SERVICE F1 TEMPORARY SERVICE F -I PRECONNECT
PASSED
FAILED
F] PARTIAL
F]
❑
COMMENTS:
MECHANICAL: F -I ROUGH -IN F1 A/c F-1 FURNACE F] RADIANT HEAT El FINAL F1 PARTIAL
PASSED
FAILED
F -I
1-1
COMMENTS:
PLUMBING: F -I GROUNDWORK F -I ROUGH -IN F1 FINAL El WATER METER INSTALLED El PARTIAL
PASSED
FAILED
F-1 PRESSURE TEST
El
El
COMMENTS:
F-1 OCCUPANCY GRANTED F -I CONDITIONAL OCCUPANCY GRANTED
NOTES/REMARKS,
4-
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INSPECTOR DATE OF INSPECTION MADE: T
FAXED OPPD\BURT REA TO CONNECT SERVICE:
BUILDING INSPECTION REPORT
❑ CITY OF BLAIR ❑ WASHINGTON COUNTY ❑ OTHER
LOCATION OF INSPECTION
,
�1, A, ku'' Af d` ( "CONTRACTOR
NAME OF OWNER- � '� ' � k"�`
DATE INSPECTION REQUESTED ti3 '' TIME INSPECTION REQUESTED• PERMIT NO
TYPE OF INSPECTION REQUESTED: ❑ CONFERENCE `STATUS 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
❑
El
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
tw
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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:
FAXED OPPMBURT REA TO CONNECT SERVICE: ON BY
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INSPECTOR DATE OF INSPECTION MADE:
FAXED OPPMBURT REA TO CONNECT SERVICE: ON BY
;j
-BUILDING INSPECTIO N REPORT
CITY OF BLAIR ❑ WASHINGTON COUNTY ❑ OTHER
LOCATION OF INSPECTION -
f,
NSPECTION
NAME OF OWNER
f,
s ( '°`
_ k
CONTRACTOR
DATE INSPECTION REQUESTED: i"° :
TIME INSPECTION REQUESTED- PERMIT
NO- ¢
TYPE OF INSPECTION REQUESTED:
❑ CONFERENCE
' Ea STATUS 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
❑
❑
COMMENTS:
PLUMBING: ❑
GROUNDWORK ❑ ROUGH -IN ❑
FINAL ❑ WATER METER INSTALLED ❑ PARTIAL
PASSED
FAILED
❑
PRESSURE TEST
❑
❑
COMMENTS:
❑ OCCUPANCY GRANTED ❑ CONDITIONAL OCCUPANCY GRANTED
NOTES/REMARKS-
kJ ac
rt-
' . t,t C o
INSPECTOR E DATE OF INSPECTION MADE: TIME -
r'
FAXED OPPD\BURT REA TO CONNECT SERVICE: ON BY
1VOG(���Tu- 1133 AM - - -_-- - -
IIII' IIIII I'�'illll li�l
CITY OF BLAIR
❑ WASHINGTON COUNTY ❑
LOCATION OF INSPECTION -
NAME OF OWNER sl
ORT
p�
, I t✓ej d' p Uc �W
J° 1 F
DATE INSPECTION REQUESTED e,,,, ~`f TIME INSPECTION REQUESTED -' ?_ ✓? PERMIT
k
NO a
TYPE OF INSPECTION REQUESTED: ❑ CONFERENCE
❑ STATUS CHECK
BUILDING: ❑ FOOTING ❑ DECK FOOTING ❑ FRAMING ❑ DRYWALL ❑ FINAL ❑ PARTIAL
PASSED
FAILED
❑
❑
COMMENTS:
UTILITIES: ❑ SEWER TAP ❑ SEWER ❑ SEPTIC ❑ WATER TAP ❑ REMOTE ❑ WATER SERVICE
PASSED ryFAILED
F1 PARTIAL
1-1
1-1COMMENTS:
ELECTRICAL: ❑ ROUGH IN ❑ FINAL ❑ PERMANENT SERVICE ❑ TEMPORARY SERVICE ❑ PRECONNECT
PASSED
FAILED
F-1PARTIAL❑
❑
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
NOTFVRFMART / ii / 1 Li PA /T "L,
a F
INSPECTOR - C DATE OF INSPECTION MADE: ( 6 TIME.
FAXED OPPD\BURT REA TO CONNECT SERVICE:
l Olv--)
,a
y CITY OF BLAIR
LOCATION OF INSPECTION:
19,41
j 1111-1 1111, 1111,R] U OEM
❑ WASHINGTON COUNTY
❑ OTHER
TYPE OF INSPECTION REQUESTED: ❑ CONFERENCE
❑ STATUS CHECK
BUILDING: ❑
FOOTING ❑ DECK FOOTING ❑ FRAMING ❑ DRYWALL ❑ FINAL ❑ PARTIAL
PASSED
NAME OF OWNER: '$
�•
NIRA R
CONTRACTOR -
0 TO
❑
COMMENTS:
UTILITIES: ❑
DATE
DATE INSPECTION REQUESTED
PASSED
TIME INSPECTION REQUESTED
" PERMIT NOry
PARTIAL
❑
❑
COMMENTS:
r
TYPE OF INSPECTION REQUESTED: ❑ CONFERENCE
❑ STATUS 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
❑
❑
COMMENTS:
PLUMBING: ❑
GROUNDWORK.❑ ROUGH -IN ❑ FINAL ❑ WATER METER INSTALLED PARTIAL
PASSED FAILED
❑
PRESSURE TEST
❑
COMMENTS:
❑ OCCUPANCY GRANTED ❑ CONDITIONAL OCCUPANCY GRANTED
y_3 AM f 152y✓"ie, kn ec.A A rufcr - G f'��v� t ,�9 clJL� co { �,;, CLiG c_.- /=c6ea
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INSPECTOR- DATE OF INSPECTION MADE: "f �" b TIME. 3
FAXED OPPD\BURT REA TO CONNECT SERVICE: ON BY
f --r> t4 a itoca-A FAN i s pew z o eels Pev"t-ct.
I
MAN
UAKI
PLUMBING PERMIT APPLICATION
Jurisdiction of City of Blair, Nebraska
218 South 16th Street
Blair, Nebraska 68008
Fax (402) 426-4195 P 2086
(402) 426-4191
66)
Application Date: Permit Fee: 111,
Job Address tl
OwnerMddress Zip Phone
Contractor Mail Address
2. /'<'L 42?ItI4�rl
Zip
Phone
3. Class of Work: !2KOMMERCIAL 11 RESIDENTIAL
.0 New C3 Addition -IStAIteration 0 Repair 0 Replacement
Describe Work:
z6ill
PLUMBING PERMIT FEES
Comments:
Modular Home ......................$50.00
Type of Fixture No.
Kitchen .............................. $12.00 x
Bath.....Residential/Single Stall $12.00 x
....................Multi -Stall $25.00 x
Rough -In Bath ........................$8.00 x
Additional Sinks .....................$6.00 x
Slop Sink/Laundry Tray/Drain ..... $6.00 x 4__
�l -00
Water Heater .........................$10.00 x
Id. 00
Notice
Outside Water Faucet ...................$6.00 xJ
0
I hereby certify that I have read and examined this
Drinking Fountain ........................ $6.00 x
9
application and know the same to be true and correct. All
provisions of laws and ordinances governing this type of
work will be complied with whether specified herein or
Backflow/Grease Trap ............. $15.00
6Dnot.
The granting of a permit does not presume to give
authority to violate or cancel the provisions of any other
Water Service .......................$15.00
state or local law regulating construction or the
Sewer
performance of construction.
.................................$15.00
Groundwork .........................$15.00
Septic Tank & Laterals............ $15.00
Lawn Sprinkler System ............ $10.00
Sprinkler System (Commercial)..$30.00
Gas/Water Piping System
(Commercial) ........................ $50.00
Signature of Contractor or Axfthorized Agent
Permit Issuance Fee ................. $25.00
Total_a/,
00
Current License on File es 0 No 0 N/A
Date
Comment:
WHEN PROPERLY VALIDATED (IN I HIS �FAUE) I HIN IJ Y U UK rhKIVII I
Approved By:
Rev. 2008-10
❑> CITY OF BLAIR
LOCATION OF INSPECTION:
BUILDING INSPECTION REPORT
❑ WASHINGTON COUNTY
❑ OTHER
NAME OF OWNER' _ - , `214 it °, k `1
- E � =� . f CONTRACTOR
DATE INSPECTION REQUESTED .- TIME INSPECTION REQUESTED r.1 PERMITNO-
TYPE OF INSPECTION REQUESTED: ❑ CONFERENCE
❑ STATUS 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 -Q,"'ROUGH-IN
❑ A/C ❑ FURNACE ❑ RADIANT HEAT ❑ FINAL ❑ PARTIAL
PASSED
FAILED
El
IS�
COMMENTS:
_
PLUMBING. ❑
GROUNDWORK ❑ ROUGH -IN ❑ FINAL ❑ WATER METER INSTALLED ❑ PARTIAL
PASSED
FAILED
❑
PRESSURE TEST
❑
❑
COMMENTS:
❑ OCCUPANCY GRANTED ❑ CONDITIONAL OCCUPANCY GRANTED
1F
NOTES/REMARK
-S IeA10 o L ,J
INSPECTOR` DATE OF INSPECTION MADE: TIME €
FAXED OPPD\BURT REA TO CONNECT SERVICE: ON B
CITY OF BLAIR
LOCATION OF INSPECTION:
i
❑ WASHINGTON COUNTY ❑
NAME OF OWNER a r' _i �' F' CONTRACTOR -
DATE INSPECTION REQUESTED TIME INSPECTION REQUESTED ` �� �" d ' / PERMIT NO,--i-
11
O i
TYPE OF INSPECTION REQUESTED: ❑ CONFERENCE
❑ STATUS 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
COMMENTS:
PLUMBING: ❑
GROUNDWORK, ❑a -ROUGH -IN ❑ FINAL ❑ WATER METER INSTALLED PARTIAL
PASSED
FAILED
F-1
PRESSURETEST
El
COMMENTS:
❑ OCCUPANCY GRANTED ❑ CONDITIONAL OCCUPANCY GRANTED
K(�L iRYV
1
NOTES/REMARKS
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cote.,
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INSPECTOR�9, DATE OF INSPECTION MADE:' -• / 9 -10 TII�9E/
FAXED OPPD\BURT REA
TO CONNECT SERVICE:
BY
❑ 11CCUPANLVGRANTkO ❑ C MUMOSAL OCCUPAVCI GR SII L
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04/19/2010 11:44 AM
4 AM
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04119/2010 it 4 AM
M 06116-09
NEBRASKA STATE FIRE MARSHAL
PLANS DIVISION
•
a, AIA �f 0 a n ji
1821 L Street
Tekamah, NE 68061-
(402) 689-5951
1
Hosanna's Children Daycare
556 N 21 st Street
Blair 68008-
F$RXr- P
Your items have been reviewed for compliance with the Nebraska State Fire Marshal Act.
Final Architectural Plan Remodel
REMARKS:
Plan review is for a two level day care occupancy, 31 occupants on main level, 28 occupants on lower
level.
1. Handrails shall be provided on both sides of existing interior stairs between 34 inches and 38 inches
above the surface of treads. Additional handrails may also be provided at a height range of 28 to 32
inches where children under the age of five are the major users of the facility. LSC 16.2.2.3, 7.2.2.4.5
2. Interior stair from lower level does not meet requirements for an approved exit component as pursuant
to LSC 7.2.2.5.1, Thus lower level exterior exits shall be separated by a distance of 27 feet. LSC 16.2.5,
7.5.1.4
3. Emergency lighting shall be provided at the interior stairs and it's corridor. Emergency lighting provided
in the assembly areas shall provided illumination not less than one foot candle along the path of egress.
LSC 16.2.9, 7.9.2 1
4. Door number ST1-1 at top of stair shall be 60 minute fire rated where used for a vertical opening. LSC
16.3.1, 8.2.3.2.3.1
This code review does not determine compliance with the State of Nebraska Accessibility Guidelines.
This determination shall be done by -the local jurisdiction in which the project is
located.
cc. Blair Codes
Page 1 of 2
PLEASE CONTACT OFFICE INDICATED BELOW FOR A FINAL INSPECTION.
FINAL ONSITE APPROVAL IS REQUIRED PRIOR TO OCCUPANCY OR USE.
SIGNED: ,`' r-- "� Jim Kenney
ict for Inspection: District A
246 South 14th Street
Lincoln NE 68508-1804
(402) 471-2590
EASEMENT
This Agreement made this I" day of July, 2010 by and between the City of Blair, Nebraska, a
Municipal Corporation, hereinafter referred to as "Grantor" and Lloyd A. & Mary L. Dannen, a
married couple, hereinafter referred to as "Grantee".
In consideration of One Dollar and other mutual covenants contained herein the Grantor does
-hereby grant to the Grantee a right of way easement on the following described real estate:
A rectangular area fifteen (15) feet wide contiguous to the west property line of Lot 5,
Larsens 4th Addition, City of Blair, beginning three (3) feet north of the southern property
[ine and running a distance of sixty-three (63) feet. Total area of the easement is 9*2
square feet.
This easement is for the sole purpose of paving or hard surfacing municipal right of way to
provide vehicular parking. No modifications of such parking area shall be made without specific
authorization in writing from the Grantor consenting to such modifications.
This easement shall continue until such time as the Grantor desires to terminate same. Such
termination may be with or without cause and shall be in the sole and absolute discretion of the
Grantor. The Grantor shall give notice in writing of such termination not less than fifteen (15)
days prior to such termination, which such notice may be given to the Grantee by regular United
States mail, postage prepaid. In the event and at such time of the termination of this easement,
the Grantees shall remove such parking lot at their own expense. It is specifically understood
and agreed that the Grantor shall not be liable to the Grantee for any damages whatsoever upon
termination of this easement.
The Grantee ftirther hereby agrees to save harmless and indemnify the Grantor from any and a -I
claims, causes of action, damages, injuries, or any other liabilities of any nature or kin4
whatsoever, which may arise from any reason whatsoever as a result of the construction
maintenance, and the placement of such improvements on municipal right of way. Sucl
indemnification and save harmless shall apply not only to the Grantee but shall apply as well b
any claims, causes of action, damages, injuries, or any other liabilities of any nature or kin4
sustained by any third parties, persons, or any other entities which such claims, or causes o
action may be brought against the municipality. Such indemnification and save harmless shal
apply not only to such damages and injuries, but shall specifically include but not be limited b
attorney fees and reasonable cost of defense of any such claims. Such indemnification and savi
harmless
shall further specifically include but not be limited to any damages to munici al propert:
ip
including the right of way, grades, drainage structures, ditches, roadways, or any other municipa
property as the result of the construction of said parking lot and the Grantee shall further bi
liable to the municipality for any attorney fees, expenses, or other expenses incurred in recover,
of such damages.
This easement may not be assigned by the Grantee and the rights under this easement shall not
run with the land but shall terminate upon conveyance of the property adjacent to such right of
way which is owned by the Grantee.
CITY OF BLAIR, NEBRASKA
A MUNICIPAL CORPORATION,
Grantor
B
am s E. Realph, Mayor
STATE OF NEBRASKA )
) :ss:
WASHINGTON COUNTY )
Before me, the undersigned, a Notary Public in and for said county and states, personally came
James E. Realph, Mayor of the City of Blair, Nebraska, a Municipal corporation, to me known to
be the identical person who signed the above and foregoing Easement as Grantor and
acknowledged the execution thereof to be his voluntary act and deed on behalf of said City.
WITNESS my hand and seal this day of A �, , 2010.
LLOYD A. DANNEN, Grantee
tir
r. u ►NOTARY PUBLIC
MARY L. DANNEN, Grantee
BY >- BY
oyd . Dannen Mary L. annen,
3 � '
STATE OF NEBRASKA R
):ss: f T1!
WASHINGTON COUNTY ) ;OD
rn�
Before me the undersigned, a Notary Public in and for said county and states, personally came
Lloyd A. and Mary L. Dannen, to me known to be the identical person who signed the above and
foregoing Easement as grantee and acknowledged the execution thereof of to be his voluntary act
and deed.
WITNESS my hand and seal this day of , 201
/ Z
OM NOT - WO of MUM
woRmAN E. KASSMEIER
comm.my FXP. Oct 16, 2019