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
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431 EAST LOCUST STREET, SUITE 300 0 DES MOINES, Iowa 50309 M VOICE: (515) 243-1558 m FAx (515) 243-2049
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PLANNING
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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.
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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.
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Date
Contractor/Owner
City of Blair
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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
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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
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Association C
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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