BP13331
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CITY OF BLAIR - APPLICATION FOR BUILDING PERMIT
Permit # I 3 (
Date: i () .J :22 -' 0 Cj
Approximate Completion Date: 12.../ - 0 Cj
Site Plan Attached:
REScheck Attached:
Complete Plans Attached
Application for: Residential Commercial/Industrial V
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 V 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 _
Adcftionat Description of project if necessC}ry: 3& i/ X' 1J;>,~lj II C 7f~~~~~
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Proiect Information:
Job Address:
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Address:
Legal Description (if applicable) L<) 7' 00 :39830
Ownef:: is} CU'1L,)cvfl CJi 0/1 tvu Address:
Contractor: '/fu cft'lh0 ~o 6:
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Separate permits are required far electrical, plumbing, he~ttng; ventilating and air canditianing, and septic systems,
Phone#: q2uJ ~ i/ I~SD
Phone #: t.f Ziti ~
Cell #:
By my signature
belaw, I acknawledge this building permit applicatian daes nat canstitute issuance af this building permit. I further agree that
canstructian cave red by this permit applicatian shall nat be cammenced until I have received a capy af a permit signed by the Building
Inspectar, I he~y agree to. perfarm the prapased wark in accardance with the specificatians set farth abave and in accardance with the
cades/o~d~afic~! af the City af BI' nd the State af Nebraska, I understand that this permit is vaid if wark is nat cammenced within
180 daYrr is n eted . i a 2) ye s af date f' ue,
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Date
Si
Far Building Permits ather than One & Two. Family Residential Structures:
I hereby acknawledge and agree that I have/will submit a set af plans far this praject to. the Nebraska State Fire Marshal's Office far
Review,
Signature of Owner/Contractor
Date
RESIDENTIAL - ADDITIONS / REMODELS and
COMMERCIAL - NEW CONSTRUCTION I ADDITIONS / REMODELS:
Business/I nd ustria VEducationa V Assem bly/F actory/Storage/Utility
*Porches with roofs/screened patios are considered additions
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Construction valuation computation: Sqjft area X $63
Except for the following:
Accessory Buildings & Interior Remodeling Projects: sqjft area X $43_
Pole barns with no hard surface floor: sqjft area X $25 --
Sign Erecting! Awnings and DeCks/Handicap Ramps: sqjft area X $25 (Minimum
valuation of $2000)
Construction valuation computation: 39
Finished sqjft area ~
X $ t71C"
Construction valuation is ...................................Permit fee is:
$0 TO $50...........................................................$0
$51 TO $500........................................................ $25
$501 TO $2,000........................................................ $25 + $3
$2,001 TO $25,000........................................................ $70 + $13
$25,001 TO $50,000......................................................$370 + $10
$50,001 TO $100,000......................................................$620 + $7
$100,001 TO $500,000......................................................$970 + $5
$500,001 TO$1,OOO,OOO.................................................. $2,970 + $4
$1,000,001 AND OVER.................................................. $4,970 + $3
Permit Fee calculated from chart above
Issuance Fee:
Total Permit Fee = Deposit + Permit Fee + Issuance Fee
Q15/:P
$~
per additional $100
per additional $1,000
per additional $1,000
per additional $1,000
per additional $1,000
per additional $1,000
per additional $1,000
$
$
$
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Additional Comments:
25.00
I 00. c:o
Approved by: ,)~:? 1/ rl' ~:~
Date:
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
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For Office Use Only
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Date Permit Paid: 'F 11-1 i) -u~
Permit Fee: ~O U):
Deposit Amount <:"'0 oj..
Receipt # :) ~<:;<1 (
Deposit Paid by for return to:
Building Inspection Pouch given: Yes _ No
ZONING REVIEW:
Zonin Flood Plain
Current Zoning:
Conditional Use Permit Required: Yes _ No-L
Date CUP Approved:
Yes No Variance Required: Yes _ No.x..
Second Front Side Side Rear_
State Fire Marshal Required:
Minimum Setbacks: Front
Lot Square Footage:
Length x Width:
Lot Coverage % {J(--------
Driveways/Sidewalks: J\ \ \ l\ /
Sidewalk required: Yes_ N~~ Sidewalk Waiver: Yes _
Date Waiver Approved:
Preexisting Garage requires driveway to be less than 3' from property line: Yes_
Approved by:
NOW~
Flood Plain: Yes No
If yes, specify special requirements:
BUILDING INSPECTOR REVIEW:
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)
Garage:
Detached Garage:
Addition:
Porch: Front Rear
Deck that affect setbacks: Rear
Second Level: Third Level
(Finished)
2 bay_ 3 bay_ 4 bay_ 5+ bay
Pole Barn:
Remodel:
Side
Front Side
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
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
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, Blair, NE 68008
APPROVAL AS A RESULT OF AN INSPECTION
SHALL NOT BE CONSTRUED TO BE AN APPROVAL
OF A VIOLATION OF THE PROVISIONS OF THE
CODE OR OF OTHER ORDINANCES OF THIS
JURISDICTION.
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APPROVED
BUILDING
PLANNING
PUBLIC WORKS
FIRE OEPT
PROJECT LAY ~e(/. e41e~ :~~5 f ::
- ONE SET CHANNEL LETTERS Y-- pC 06 #-L,/
- TO READ: "BLAIR DANCE CENTER" W/LOGO
- RETURNS: 5" BLACK
- BACKS: .050" ALUMINUM
- TRIM CAP: 1" BLACK
- FACES: 3/16" WHITE ACRYLIC
W/BURGUNDY VINYL OVERLAY
- ILLUMINATION: WHITE LEDs
THE LETTERS ARE TO BE MOUNTED
fJ- ~ {, t-a- f5d- n TO A RACEWAY PAINTED TO MATCH THE FASCIA.
~ASi'CNC.~S ,tAJ WIRED AND STICKER~~AS P~R UL CODE
F3-e. C O~ie."S(t~ ,.e.~S'5~;:- ADDRESS ttf 6 W ad1..u. ylC"h J"f.
CUSTOMER: BlAIR DANCE CENTER FINAL Ill.BCIlUCAL HOOK UP IS
SALESMAN: ANNIE SHOlWELL 1HE~~&1J~iMl:b~SW'<W
DESIGNER: AMBER NUN o..EARlMAGESIGNS&:GRAPHICS.
u.g &uth HWY 80 DATE 10/01/09 ANY USE OR REPRODUCTION WlLL
81m, JIIe RFSULT IN LEGAL ACITONS. EXACT COLORS
S i 9 n d e pot @ h u n t a I . net APPROVED BY: MAYNOTBBREPRFSENTEDDUE TOPRlNTERL1MITATIONS.
SCALE 112"= 1 FT.
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PERMITNO: /333/
PH(402)426-8052
FAX( 402)426-8494
BUILDING PERMIT DEPOSIT AGREEMENT
A $500.00 refundable deposit is being collected for any new commercial, new
residential, and any additions, remodels and accessory building valued $10,000 or
greater at the time of your building permit application.
A $200.00 refundable deposit is being collected for any residential remodel,
addition or accessory building valued under $10,000.
A $50.00 refundable deposit is being collected for all misc. permits.
The City reserves the right to not refund this deposit if any of the following
conditions occur during the construction period:
1) Theft of water service by the plumber, owner or general contractor.
2) All permits have not been obtained.
3) All required inspections have not been obtained.
4) Occupancy occurs prior to a final inspection.
5) The project is completed without a final inspection being done.
6) Storm Water Management Plan inspection not obtained. (If Required)
If any or all of these situations occur during construction, you may forfeit your
deposit.
I hereby agree to the above conditions, and understand that should any or
all of the above situations occur, the building permit deposit SHALL be forfeited or
discounted upon the discretion of the City of Blair, Building and Inspections
Department.
/'/
Contractor/Owner
City of Blair
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Date