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BP13283VI CITY OF BLAIR — APPLICATION FOR BUILDING PERMIT IP -1e Permit # L ' Date: LIZ -01 LIZ-01Approximate Completion Date: /® 21 'e), Site Plan Attached: REScheck Attached: Complete Plans Attached Application for: Residential New Construction Move -on: Home Commercial/Industrial Manufactured Home Accessory Building _ II•! _M, 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 pian required) Other Utilities: Public Water: Yes No Private Well 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 i of project if necessary.- Project ecessary: Project Information: Job Address: ✓ �%� � (2e, / r� Legal Description (if applicable) —Z y / 7- /g.- /% 1&,8 Pis /. Owner: 1etell I 11,1(2e� * Address: /A ? �� � � Phone#: Contractor: Phone #: Address: 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. ignature of Owner/Contractor Date 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: Conditional Use Permit Required: Yes No Date CUP Approved: State Fire Marshal Required: Yes NoX--� Variance Re uired: Yes No Minimum Setbacks: Front ` ,� I Second Front Side Side Rea Lot Square Footage: Length x Width: Lot Coverage D r i v ewa ys/S i d ewa i ks: Sidewalk required: Yes N�V4Sidewalk 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 requirements: BUILDING INSPECTOR REVIEW: 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 Fireplaces Gas Electric Egress in Basement: Required: Yes No Provided on Plans: Yes No Sleeping Rooms Living Area Other Egress Square Footage: Main Level: Basement: (Unfinished) Second Level: Garage: 2 bay Detached Garage: Third Level (Finished) 3 bay 4 bay 5+ bay Pole Barn: Addition: Remodel: Porch: Front Rear Side Deck that affect setbacks: Rear Front Side Occupangy 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: 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 Garage sq/ft area Total Valuation: Total Valuation Issuance Fee: X $29 X $25 Multiplied by 0.006 = $ 25.00 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 Erect! ng/Awn1ngs and Decks/Handicap Ramps: sq/ft area X $25 (Minimum valuation of $2000) Construction valuation computation. Finished sq/ft area G6) X $ '25 Construction valuation is ...................................Permit fee is: $0 TO$50...........................................................$0 $51 TO $500 ........................................................ $25 $501 TO $2,000........................................................ $25 + $3 per additional $100 $2,001 TO $25,000........................................................ $70 +$13 per additional $1,000 $25,001 TO $50,000......................................................$370 + $10 per additional $1,000 $50,001 TO $100,000......................................................$620 + $7 per additional $1,000 $100,001 TO $500,000......................................................$970 + $5 per additional $1,000 $500,001 TO$1,000,000.................................................. $2,970 + $4 per additional $1,000 $1,000,001 AND OVER..................................................$4,970 + $3 per additional $1,000 Permit Fee calculated from chart above $ c299, t)0 Issuance Fee: $ 25.00 -,v & 2. 00 Total Permit Fee = Deposit + Permit Fee + Issuance Fee $ 71421 00 Additional Comments: Approved by: Date: Date: I' d 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 Date Permit Paid. Permit Fee: Deposit Amount Receipt # Deposit Paid by for return to: Building Inspection Pouch given: Yes No CITY OF 1, NEBRASKA Phone 402-426-4191 THANK YOU KEEP THIS COPY FOR YOUR RECORDS. >i NO RECEIVED BY Pounds Printing, Blair, NE 68008 3 r04se of ago June 8, 2010 Richard E. Vlcek 10917 Co Rd 27 Blair NE 68008 RE: Work without a building permit Dear Mr. Vlcek: I am writing you this letter to confirm the following information per our phone conversation. As you already understand, a permit is required prior to starting a project and any work done without a building permit will result in a doubled permit fee. Thank you in advance for your compliance with the above requirement. If you have any questions, feel free to contact either me or Brenda Wheeler. Sincerely, l Phil Green Assistant City Administrator Enc Cc: Geoff Hall, City Attorney Brenda Wheeler, City Clerk 218 South 16th Street • Blair, Nebraska 68008 • 402-426-4191 • Fax 402-426-4195 • E-mail cityofblair@ci.blaicne.us Wa. Assc 76—L 7Tp-i WIA � �-cl 5vc /v6J I)6 w 431 EAST LOCUST STREET, SUITE 300 0 DES MOINES, Iowa 50309 M VOICE: (515) 243-1558 m FAx (515) 243-2049 ,6309 ADDRESS/6 ; OOMOMMMMMME lop Kim; PLANNING -'`?ise of a, CITY OF BLAIQ ROOF PERMIT SUPPORTING )py of the 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 Contractor Date 218 South 16th Street • Blair, Nebraska 68008 • 402-426-4191 • Fax 402-426-4195 • E-mail cityofblair@ci,blaicne.us oePOR.xr. i;unurm BUILDING PERMIT DEPOSIT AGREEMENT 'A $500.00 r fundable deposit is being collected for any new commercial, new residential, nd 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. (*—C Date Contractor/Owner City of Blair Water Well Association �y Cid v o @ at-L� Ha' I 010 e �Ivl�e5 (A Lp 4,e 5 5 lei G L 6 b/ 431 EAST LOCUST STREET, SUITE 300 E DES MOINES, IOWA 50309 m VOICE: (515) 243-1558 N FAX (515) 243-2049 Blair Building Permit Detalo-NI OCT19 Permit #: 13283 Issued: 10/1/2009 Completed: 10/15/2009 Location: 10917 Co Rd 27 Owner: Rich Vlcek Address: 10917 Co Rd 27 Type: Ag Barn Addition Valuation: 15000 Blair, NE 68008 Phone: 402 426 9369 Section: 17 Township: 18 Range: 11 Subdivision: Lot: 8 Addition to Pole barn. No electric. 20x30 addition. Contractors SELF General Contractor Remarks Permit Fee: 238 Issue Fee: 25 Deposit Amt.: 500 Receipt M Block: Permit # Issued 10/15/2009 BMP THIS PERMIT VOIDED PER RICH VLCEK. HE WILL NOT BE DOING THIS PROJECT UNTIL SOMETIME NEXT SPRING OF 2010. Inspections Date By 00 k eL� J, Well Association l l_ ujooel VA 431 EAST LOCUST STREET, SUITE 300 m DES MOINES, IOWA 50309 m VoicE: (515) 243-1558 m Fax (515) 243-2049 Blair Building Permit Detail Permit #: 13283 Issued: 10/01/2009 Completed: Location: 10917 Co Rd 27 Owner: Rich Vlcek Type: Ag Barn Addition Valuation: 15000 Address: 10917 Co Rd 27 Blair, NE 68008 Phone: 402 426 9369 Section: 17 Township: 18 Range: 11 Subdivision: Addition to Pole barn Contractors SELF Remarks Inspections Date Permit Fee: 238 Issue Fee: 25 Deposit Amt.: 500 Receipt #: Block: Permit # Issued DE REQUIREMENTS i Water Well Association C I i x 431 EAST LOCUST STREET, SUITE 300 m DES MOINES, Iowa 50309 M Vold: (515) 243-1558 M FAX (515) 243-2049 Jv"v4*0 Water Well Association 6t r V,f �J 11 `3 v e tL-,, e, C E? {o 0 cirGA' 3 431 EAST LOCUST STREET, SUITE 300 M DES MOINES, Iowa 50309 E VOICE: (515) 243-1558 N Fax (515) 243-2049 e f 431 EAST LOCUST STREET, SUITE 300 M DES MOINES, Iowa 50309 M VOICE: (515) 243-1558 M Fax (515) 243-2049 Blair Building Permit Deta NIT OCT1 00 Permit #: 13283 Issued: 10/1/2009 Completed: 10/15/2009 Location: 10917 Co Rd 27 Owner: Rich Vlcek Address: 10917 Co Rd 27 Type: Ag Barn Addition Valuation: 15000 Blair, NE 68008 Phone: 402 426 9369 Section: 17 Township: 18 Range: 11 Subdivision: Lot: 8 Addition to Pole barn. No electric. 20x30 addition. Contractors SELF General Contractor Remarks Permit Fee: 238 Issue Fee: 25 Deposit Amt.: 500 Receipt #: Block: Permit # Issued 10/15/2009 BMP THIS PERMIT VOIDED PER RICH VLCEK. HE WILL NOT BE DOING THIS PROJECT UNTIL SOMETIME NEXT SPRING OF 2010. Inspections Date By a� CITY OF BLAIR — APPLICATION FOR BUILDING PERMIT gPromba° Permit # Date: Approximate Completion Date: /'6 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 A i of project if necessary: _ Private Well Blair OPPD Line Kennard Date Agreement Received: Septic Drawing Provided: Blair Kennard ® Submitted: Yes No del - o�,-� ezvC2� Project Information: ~� / Job Address: ` / C,c� •44I Legal Description (if applicable) �� / A°/ / (p j d I C/) G1/' Owner: /e° ° ilice /� / Address: &I V% � d� , 7 Phone#: Contractor: Phone #: Address: 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 within two (2) years of date of issue. ignature of Owner/Contractor Date 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 i 'ti s: Current Zoning: Conditional Use Permit Required: Yes Date CUP Approved: State Fire Marshal Required: Yes No Variance Required: Minimum Setbacks: Front ` i Second Front Side 67> Side Lot Square Footage: Length x Width: Lot Coverage % Yes No Rear Driveways/Sidewalks: Sidewalk required: Yes Nc Sidewalk Waiver: Yes No // 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: BUILDING INSPECTOR REVIEW: Number of Stories One Two Three Four >Four _ lype of Residential Structure: Ranch Two Story Split Entry Raised Ranch Rooms Bedrooms Bathrooms Fireplaces Egress in Basement: Required: Yes No Sleeping Rooms Living Area High Rise (>75 ft) _ Other Gas Electric Provided on Plans: Yes _ Other Egress Square Footage: Main Level: Second Level: Third Level Basement: (Unfinished) (Finished) Garage: 2 bay 3 bay 4 bay_ Detached Garage: Pole Barn: Addition: Remodel: Porch: Front Rear Side Deck that affect setbacks: Rear Front Occupancv Classification: No 5+ bay Side 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) Blair Building Permit Detail Permit #: 13283 Issued: 10/01/2009 Completed: Location: 10917 Co Rd 27 Owner: Rich Vlcek Type: Ag Barn Addition Valuation: 15000 Address: 10917 Co Rd 27 Blair, NE 68008 Phone: 402 426 9369 Section: 17 Township: 18 Range: 11 Subdivision: Lot: 8 Addition to Pole barn. No electric. 20x30 addition. \ Contractors SELF Gene I Contractor Remarks Inspections Date Permit Fee: 238 Issue Fee: 25 Deposit Amt.: 500 Receipt #: Block: Permit # Issued �o'� 'ET IBC, IRC, IPC, IMC AND NEC CODE REQUIREMENTS 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 131) 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: 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 Issuance Fee: Multiplied by 0.006 = $ 25.00 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 $2000) Construction valuation computation: Finished sq/ft area Co -X$ ds Construction valuation is ...................................Permit fee is: $0 TO $50...........................................................$0 $51 TO $500 ........................................................ $25 $501 TO $2,000........................................................$25 + $3 per additional $100 $2,001 TO $25,000........................................................ $70 +$13 per additional $1,000 $25,001 TO $50,000......................................................$370 +$10 per additional $1,000 $50,001 TO $100,000......................................................$620 + $7 per additional $1,000 $100,001 TO $500,000......................................................$970 + $5 per additional $1,000 $500,001 T0$1,000,000.................................................. $2,970 + $4 per additional $1,000 $1,000,001 AND OVER..................................................$4,970 + $3 per additional $1,000 Permit Fee calculated from chart above $ g,� Issuance Fee: $ 25.00 00 Total Permit Fee = Deposit + Permit Fee + Issuance Fee $ 02, 00 Additional Comments: Approved by: Date: 2. f 4-u a� 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 Date Permit Paid. Permit Fee: Deposit Amount Receipt # Deposit Paid by for return to: Building Inspection Pouch given: Yes No ❑, CITY OF BLAIR LOCATION OF INSPECTION: NAME OF i U DEN W DUNCAN 01 a ❑ WASHINGTON COUNTY ❑ OTHER k F fr{'lk F 4 g DATE INSPECTION REQUESTED �� n3 t i� �t Z d ''tl �21.g TIME IN REQUESTEDL " PERMIT N0. TYPE OF INSPECTION REQUESTED: ❑ CONFERENCE ❑ STATUS CHECK BUILDING: ❑ FOOTING ❑ DECK FOOTING ❑ FRAMING ❑ DRYWALL ❑FINAL ❑ PARTIAL PASSED FAILED F-1 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 INSPECTOR_ f2:!?4ZA _ DATE OF INSPECTION MADE: FAXED OPPD\BURT REA TO CONNECT SERVICE: ON BY