BP13356D
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ITY OF BLAIR — MISCELLANEOUS BUILDING PERMIT
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"Promise*
promiseo tQ° Permit # 1335!
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Date: 1 HI - Approximate Completion Date: Site Plan Attached:
Estimated Valuation of Project: i11SQ0 . 00
Application for: Permit Fee $�40 + Issuance Fee $25 + $50 Deposit Fee: $115.00
Egress Window (floor plan drawing required)
Fences (plot plan required)
Gazebos (plot plan required)
Patios/Driveways/Sidewalks (new or replacement)
Roofing/Siding/Soffit and/or Eave Repair/Gutters
Swimming Pools with Fence (plot plan required)
Window/Door Replacement (size change only)
Miscellaneous Building Permits (items not covered by one of the above)
Description:
Utility Excavation and Curb Grinding Fee: $75 plus bond
Curb Grind
Length
Utility Excavation
Length Lin. Ft.; Width Lin. Ft
Type: Water ; Sewer ; Other
Amount of Bond Posted: Bond Check #
(Curb grind - $9.00 per Lin. Ft.; Utility Excavation - $6.00 per Sq. Ft.)
Addition,al Description of
PROJECT INFORMATION:
Job Address:
if necessary:
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2-9 F4��7,�7el
Legal Description (if applicable) C D l 7 //z/ 1,0e -
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Owner: Address: Phone#:
Contractor:
Phone #:
Address: Cell #:
ESTERED NOV 2 anis°��L
ITY OF BLAIR - MISCELLANEOUS BUILDING PERMIT
A Promiso °t
Permit # 335lo�
Date:�(=O / Approximate Completion Date: Site Plan Attached:
Estimated Valuation of Project: 1500. 0 t
Application for: Permit Fee $ 0 + Issuance Fee $25 + $50 Deposit Fee: $115.00
Egress Window (floor plan drawing required)
Fences (plot plan required)
Gazebos (plot plan required)
Patios/Driveways/Sidewalks (new or replacement)
Roofing/Siding/Soffit and/or Eave Repair/Gutters
Swimming Pools with Fence (plot plan required)
Window/Door Replacement (size change only)
Miscellaneous Building Permits (items not covered by one of the above)
Description:
Utility Excavation and Curb Grinding Fee: $75 plus bond
Curb Grind
Length
Utility Excavation
Length Lin. Ft.; Width Lin. Ft
Type: Water ; Sewer ; Other
Amount of Bond Posted: Bond Check #
(Curb grind - $9.00 per Lin. Ft.; Utility Excavation - $6.00 per Sq. Ft.)
1-7
PROJECT INFORMATION:
Job Address:
Legal Description (if applicable) ` � ,6 7 li z-1
Owner:Address: Phone#:�
Contractor:
Phone #:
Address: Cell #:
PERMIT RENEWAL FEE:
This fee is based on the amount of the original permit fee and is charged when work is not
completed within two years and the permit expires. Renewals will only be allowed with the
stipulation that all exterior site work and outside finish work is completed and interior life -
safety issues have been properly address. Permit renewals are for one (1) year, with a
maximum of two (2) renewals for a maximum permit span of four (4) years.
Original valuation of $0-$50,000 $150.00 $
Original valuation of $50,000 - $100,000 $200.00 $
Original valuation of $100,000 - $500,000 $300.00 $
Original valuation of $500,000 or more $400.00 $
Issuance Fee:
Deposit:
$ 25.00
$ 50.00
Total Renewal Remit Fee = Permit Fee + Deposit + Issuance Fee $
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.
Signat of caner/Contractor Date
For Office Use Only WHEN PROPERLY VALIDATE04ULOIh )ZHIS IS YOUR PERMIT
Date Permit Paid: // / / _ &' /Receipt # 0,�D U",:�ys Approved
CITY OF BLAIR, NEBRASKA
Phone 402-426-4191
RECEIVED OF:
ADDRESS
CITY, STATE, ZIP CODE
Pounds Printing, Blair, NE 66008
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CITY OF BLAIQ
ROOF PERMIT SUPPORTING DOCUMENTS
This supporting document includes information dealing with particular code
requirements and/or roofing permit requirements, it in no way includes ALL particular
code items. Also, it is your responsibility to [snow the 2006 international Building
Code requirements that apply to your project. Please understand this document is only
designed and distributed to aid you in your roofing permit process. A copy of the
International Building Code is available for your use at the Blair Public Library.
1 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.
J ZA
w r1 ccupant
City of Blair
Contractor
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218 South 16th Street • Blair, Nebraska 68008 • 402-426-4191 • Fax 402-426-4195 • E-mail cityofblair@ci blair.ne,us
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.
&� 50 OO.r fundable deposit is being collected for all misc. permits.
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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.
44
9D e
Contractor/Owner
City of Blair
"CITY OF BLAIR
C 1 U DIN It •t•
❑ WASHINGTON COUNTY ', ❑
LOCATION OF INSPECTION: r `' F -.y
NAMEOFOWNER' iA ,e`F t. rft a y^r
DATE INSPECTION REQUESTED -Z ''
TIME INSPECTION REQUESTED
PERMIT
2
ELECTRICAL: ❑
TYPE OF INSPECTION REQUESTED:
PASSED
❑ CONFERENCE
❑ STATUS CHECK
BUILDING: ❑ FOOTING ❑ DECK FOOTING
❑ FRAMING ❑ DRYWALL ❑'"FINAL ❑ PARTIAL
PASSED FAILED
COMMENTS:
COMMENTS:
19
si''y
FAILED
UTILITIES:
Fl SEWER TAP ❑ SEWER '❑ SEPTIC ❑ WATER TAP ❑ REMOTE ❑ WATER SERVICE
❑ PARTIAL
PASSED FAILED
❑ ❑
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'l,'
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INSPECTOR :. DATE OF INSPECTION MADE:
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FAXED OPPDIBURT REA TO CONNECT SERVICE: ON BY
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124 AM
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