BP13285
EP 4
CITY OF BLAIR - APPLICATION FOR BUILDING PERMIT
Permit # /3;; 8!5
~/I 0- OCt
Date: U
Approximate Completion Date: 8- 10 - c;?ol 0
Site Plan Attached:'~ REScheck Attached:
Complete Plans Attached
~
Application for: Residential V Commercialjlndustrial_
New Construction Manufactured Home _ Modular_
Move-on: Home _ Accessory Building Other
Remodel Addition
Accessory Building: Garage V 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 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 _
Additional Description of project if necessary: d? 8 )l 30 AId t!A14~ .2 d~ r
711 ar 61 YJ1 a:t /It> t AClI/~ ~ {~/</v t!r
Proiect Information:
Job Address:
cYc:;3;7 L~e.0C J'f.
Legal Description (if applicable) _,L- 5(0 I 11-1 R~ ( I
Owner: {lhtl cJd~6~
Contra~tor: cS 4
dt?3 d cc-flc~ J'f-
@9003Q/93
118 pc :J15
Address:
Phone#: L'5/t)- t;J9tJ;;(
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.
t/~
Signature of Owner/Contractor
;-/o~o9'
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:
Zonin Flood Plain
Current Zoning:
Conditional Use Permit Required: Yes _ No X
Date CUp Approved:
Yes _ No ~ Variance Required: Yes _ No_
Second Front Side 5 Side _ Rear~
State Fire Marshal Required:
Minimum Setbacks: Front
. k 1\,a:s:xJiA ~J du
Lot Coverage % D . n U --l J .1
7n - 31 ~c){'(\ L~
Driveways/Sidewalks::{- 11- t"\.A0~(\~ ~ plupt(I-1
Sidewalk required: Yes . No.:p:z- Sidewalk Waiver: Yes No L;J\P
Date Waiver Approved:
Preexisting Garage requires driveway to be less than 3' from property line: Yes_
Approved by:
Lot Square Footage:
Length x Width:
Flood Plain: Yes No
If yes, specify special requirements:
BUILDING INSPECTOR REVIEW:
Number of Stories
One tI Two
Th ree
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)
Garage:
Detached Garage:
Addition:
Porch: Front
Deck that affect setbacks:
Second Level: Third Level
(Finished)
2 bay_ 3 bay_ 4 bay_ 5+ bay
Pole Barn:
Remodel:
Side
Front Side
Rear
Rear
Occupancy 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, incapacitated _
Institutional, day care facilities_
Residential, multiple family _
Residential, care/assisted living facilities
Storage, moderate hazard _ Storage, low hazard _ Utility, miscellaneous _
Institutional, supervised environment _
Institutional, restrained _
Mercantile Residential, hotels _
Residential, one- and two-family
Is building reauired 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. AI 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 sqjft area
(not including finished basement area)
Finished basement sqjft area
Unfinished basement sqjft area
Garage sqjft area 6 0 D
Total Valuation:
X$92
$
$
$
$
$
$
$
$
X $56
X$29
X$25
Total Valuation
Multiplied by 0.006 =
Issuance Fee:
25.00
Total Permit Fee = Deposit + Permit Fee + Issuance Fee
RESIDENTIAL - ADDITIONS / REMODELS and
COMMERCIAL - NEW CONSTRUCTION / ADDITIONS / REMODELS:
Business/I nd ustrialjEd ucationalj Assembly/Factory/Storage/Utility
*Porches with roofs/screened patios are considered additions
Construction valuation computation: Sqjft area X $63
Except for the followinJ:!:
Accessory Buildings & Interior RemodelinJ:! Proiects: sqjft area X $43
Pole barns with no hard surface floor: sqjft area X $25
Sign Erecting/Awning:s and Decks/Handicap Ramps: sqjft area X $25 (Minimum
valuation of $2000)
Construction valuation computation: . tJ
Finished sqjft area (j)tJ .
X$ 43
$ j1~ t tJo, pc)
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,OOO,OOO.................................................. $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
37 t;. 00
Issuance Fee:
$
$
$
25.00 ~ 315. c)eJ
elf':) .06
Total Permit Fee = Deposit + Permit Fee + Issuance Fee
Additional Comments:
I'd e0 G a-~ c..--
Approved by: ~ 1.-JV4'~
Date:
g ..IL{--o~
Contingent On Approval by Fire Marshall
Meet IBC, IPC, IMC and NEe 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, NEBRASKA
Phone 402-426-4191
RECEIVED OF:
ADDRESS
CITY, STATE, ZIP CODE
THANK YOU
KEEP THIS COPY FOR YOUR RECORDS.
NO
RECEIVED BY
Pounds Printing, B~air, NE 68008
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.
d<vJ2-. a~/~-/
Contractor/Owner
Contractor/Owner
City of Blair
Date
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III~ 6CL- PERMIT NO: 13,)85 :l-t;
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1111 APPROVED vII
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~l: APPROVAL AS A RESULT OF AN INSPECTION 'rIll
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ff .~. CODE OR OF OTHER ORDINANCES OF THIS 1
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<THU) AUG
6 2009 1 0 : 58 /S T. 1 0 : 54 /N o. 68 1 0 1 284 86 P
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CITY 0 F BLAIl~
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.
clJ cL~
Owner/Occupant
Contractor
City of Blair
Date
(S)-
218 South 16th Street. Blair, Nebraska 68008 . 402-426-4191 . Fax 402-426-4195 . E-mail cifyofblair@ci.blair,ne,us :WJ-:tJJ~:
CITY or BLNQ
August /9 , 2009
RE: Tax Lot 561, Section 11, Township 18, Range 11- 2032 Colfax Street
New Construction of Accessory Building
As you are aware, the construction of your new accessory building (28x30) cannot be made on
the above Tax Lot unless the accessory building that currently exists (14 x 20) is removed.
According to current Zoning Regulations, the maximum allowable size for an accessory building
on your lot size of 9323.87 sq. ft. is 864 sq. ft. which includes a combination of all accessory
buildings. The total square footage for the two (2) accessory buildings is 1120 sq. ft. Therefore,
you agree to remove the (14 x 20) existing accessory building within thirty (30) days following a
final inspection in which you are granted occupancy of the newly constructed accessory
structure.
If your understanding is as set forth in this letter and you are in agreement with these conditions,
please sign the notation below.
We, the undersigned, hereby acknowledge receipt of a copy of this letter and agree to its terms
and conditions,
Dated: August~, 2009
C/~~L:t?;;i-
Charles Salsbury
l.
~~~
Jennifer S bury
STATE OF NEBRASKA )
) ss
WASHINGTON COUNTY )
The foregoing instrument was acknowledged before me on August L.!1-, 2009 by Charles and
Jennifer Salsbury.
~L. t\ ?iJ~~
NOTARY PUBLIC
(5)-
218 South 16th Street. Blair, Nebraska 68008 . 402-426-4191 . Fax 402-426-41 95 . E-mail cilyofbiair@ci.blair.ne.us ~~~',':~J,~:
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D CITY 01J'BLAIR
BUILDING INSPECTION REPORT
D WASHINGTON COUNTY
LOCATION OF INSPECTION'
(~-"'c"~'"',~,l,_",'", ,- .....
.! ----', (:~ -l
NAME OF OWNER- I,.. k\
CONTRACTOR'
f",} ! J~i(
DATE INSPECTION REQUESTED-
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TIME INSPECTION REQUESTED'
PERMIT
TYPE OF INSPECTION
D CONFERENCE
D STATUS CHECK
BUILDING: FOOTING D DECK FOOTING D FRAMING D DRYWALL D FINAL D PARTIAL
COMMENTS:
UTILITIES: D SEWERTAp"D SEWER D SEPTIC D WATERTAp D REMOTE D WATER SERVICE
D PARTIAL
PASSED FAILED
')r' D
PASSED FAILED
D D
COMMENTS:
ELECTRICAL: D ROUGH IN D FINAL D PERMANENT SERVICE D TEMPORARY SERVICE D pRECONNECT
D PARTIAL
PASSED FAILED
D D
COMMENTS:
MECHANICAL:D ROUGH-IN D AlC D FURNACE D RADIANT HEAT D FINAL D PARTIAL
PASSED FAILED
D D
COMMENTS:
PLUMBING: D GROUNDWORK D ROUGH-IN D FINAL D WATER METER INSTALLED D PARTIAL
D PRESSURE TEST
PASSED FAILED
D D
COMMENTS:
D OCCUPANCY GRANTED D CONDITIONAL OCCUPANCY GRANTED
NOTES/REMARKS-
INSPECTOR-
71 tW+
DATE OF INSPECTION MADE: '3 - :J..8., c:yj
TIME' '3 prA.
FAXED OPPD\BURTREA
TO CONNECT SERVICE: ON
BY
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BUILDING INSPECTION REPORT
OF BLAIR
D WASHINGTON COUNTY
LOCATION OF
NAME OF
DATE INSPECTION REQUESTED' /' / ::]' ~> (,) (l TIME INSPECTION REQUESTED' {,,~3 (,:'J:J Ill/I
TYPE OF INSPECTION REQUESTED: D CONFERENCE
BUILDING: D FOOTING D DECKFOOTINq,jSt'rr,:FRAMING D DRYWALL D FINAL D PARTIAL
<'1;
D STATUS CHECK
~?D F~ED
COMMENTS:
UTILITIES: D SEWER TAP D SEWER D SEPTIC D WATERTAP D REMOTE D WATER SERVICE
D PARTIAL
PASSED FAILED
D D
COMMENTS:
ELECTRICAL: D ROUGH IN D FINAL D PERMANENT SERVICE D TEMPORARY SERVICE D PRECONNECT
D PARTIAL
PASSED FAILED
D D
COMMENTS:
MECHANICAL: D ROUGH-IN D NC D FURNACE D RADIANT HEAT D FINAL D PARTIAL
PASSED FAILED
D D
COMMENTS:
PLUMBING: D GROUNDWORK D ROUGH-IN D FINAL D WATERMETERINSTALLED D PARTIAL
D PRESSURE TEST
PASSED FAILED
D D
COMMENTS:
D OCCUPANCY GRANTED D CONDITIONAL OCCUPANCY GRANTED
'. ,/'J'i'~:f:(;:lj'J (<:j;:,tFl'~)
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INSPECTOR'
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DATE OF INSPECTION MADE:
/1-3-09
TIMF'
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FAXED OPPD\BURT REA
TO CONNECT SERVICE: ON
BY