BP13365
CITY OF BLAIR - APPLICATION FOR BUILDING PERMIT
Permit # i 38&5'
Date: ) J. -3 - {) 1 Approximate Completion Date: I - ~ ~ i - 2 {; I 0
Site Plan Attached: X REScheck Attached:
Complete Plans Attached ~~
Application for: Residential Commercial/lndustrial.2s::;::.
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
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 _
~11
AdciitionaJ Description of project if necessary: '111tiCltJ
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Utilities:
, 1 1 .
1~/dtH?
Proiect Information:
Job Address:
{..ll50Z/fICftZd fvu"Uf ?.a1L-..ltt,
Legal Description (if applicable)
/7 A-' /J(!
Owner: La? tjU:A/
1/
Contractor: (~! {,uj!/
. (j J" 1
!.//f () .:Z:- "71 c;l>?fr.:Jf- c/v oJ
/76;7
, .? r ,/ .' ,. .1 Pp..z,kDA,
Address: {;J5t..--4/C.IMI-4.;cJ Phone#:
'1, IE-, /1/1
G c:vU/f l7iW'.' -/0 Z -6 d:?" 1.13[
Pho~ #:
r~ \ J'j~
T a '/ L .(L/Z, Cell~ #: i/tJ,d;t- 3p~ -3'1'0,-1
II il tJ
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.
,/ ) ~ ~( 03> DcG.~~ 6~~/ 01
(tSignature of ~/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.
/"',
t!:)ignature of Owner/Contractor
Date
ZONING REVIEW:
Zoning/Flood Plain/Utilities:
Current Zoning:
Conditional Use Permit Required: Yes _ No_
Date CUP Approved:
Yes No Variance Required: Yes _ No_
Second Front Side Side Rear_
State Fire Marshal Required:
Minimum Setbacks: Front
Lot Square Footage:
Length x Width:
Lot Coverage %
Driveways/Sidewalks:
Sidewalk required: Yes_ No_
Sidewalk Waiver: Yes
Date Waiver Approved:
Preexisting Garage requires driveway to be less than 3' from property line: Yes_
Approved by:
No
Flood Plain: Yes No
If yes, specify special requirements:
BUILDING INSPECTOR REVIEW:
Number of Stories
One 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)
, ....
Date:. J~ -3 - DC}
Site Plan Attached: )(
CITY OF BLAIR - APPLICATION FOR BUILDING PERMIT
Permit # (38&6
Approximate Completion Date: I -,3/- 2010
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 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 _
110dJ uJ~;'O)
A~o rr
Proiect Information:
Job Address:
&50 .. J/J1ckdf,/v;;;; fJML,ltt.
Legal Description (if applicable)
Owner: t!t2J ~
Contractor: (1/V1 j-'j) . .
IJ,,/;r {) :z- "71 cia:; -/- Ai 'oJ
Address:
, -- I .. ~ p'cvt f:.../JA .
&5t),.L-.If'IL7MPvC~ Phone#:
a Ci/U1.. J/tdI.. ~02 -5'.313.. /15J
Phot{e #:
PaAL JJA' J'j~:i.ftJ~-3t1~:3t/oo
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.
C73> D.eG.~ 6,e/ 01
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.
fl:J;gnature of Owner/Contractor
Date
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 bv 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
FILE COpy
B U I LD I N G PER M I TOR A WIN G T RAN S M I T TAL
Date: 03 December 2009
Transmittal No:
039
To:
Howard Wolfe
Chief Permit Inspector
Blair City Hall
218 South 16th Street
Blair, Nebraska 68008
Number of Documents:
Cargill Polyols Job Number:
1
CGZHI-013783
ADDRESS
({;(50 J:_41tbA,fi/U~J /?t/vL
jyJ.
DESCRIPTION OF ISSUE: CWP 931 Project Drawings for
Building Permit Approval
File No: 931
The listed documents are hereby transmitted AS REQUESTED.
DRAWING NUMBER SHT REV
TITLE OR DESCRIPTION
APN 22175 1 of 1 Rev #2, dated 290CT09
Architectural Plan EL. 175'-0"
SN 2253005 1 of 1 Rev #0, dated 290CT09
Framing Plan & Details@ 169'-11"
093360 AlBIC 1 of 3 Rev #2, dated 20NOV09
Bin Top Replacement Project
093360 - GA 1 of 1 Rev #0, dated 20NOV09
General Arrangement of Bin Top
Replacement Project
Caroill Polvols Craio DeSmet
APPROVED
BUilDING
PLANNING
PUBLIC WORKS
FIRE DEPT
Remarks: Please advise receipt of documents.
o 1ST RIB UTI 0 N (NAMES)
APPROVAL AS A RESt}' 7' ~ - ","
SHAll NOT BE COf\1r'~,"
OF A VIOLATIOi\1
CODE on OF
JURISDICTIO;\j,
'N
\L
Ie
; S Cargill Construction Manager
\0
;2\ g 5JtjIC
HULL, GARY - GARY HULL@CRGL-THIRDPARTY.COM
Subject:
Winder, Shalis - Shalis Winder@cargill.com
Thursday, December 03,200911 :41 AM
HULL, GARY - GARY HULL@CRGL-THIRDPARTY.COM
McClelland, Annette - Annette_McClelland@cargill.com; Stricklett, Sandy -
Sandy _ Stricklett@cargill,com
FW: Cargill Polyols Courtesy Notification - Building Permit Application
From:
Sent:
To:
Cc:
Gary,
I would like for you to manage this. Get with me to discuss further. I'll need you to do the following:
1, Obtain appropriate documentation
2. Obtain a building permit application from the City office
3. Submit the permit with application fee (get with Sandy Striddett for a check?)
4. Submit the permit with two hard copies of drawings and a formal transmittal
5. Make a copy of what we submit and file it
Regards,
Shalis
From: Winder, Shalis - Shalis_Winder@cargill.com
Sent: Thursday, December 03, 2009 11:38 AM
To: Hackbarth, Mike - Mike_Hackbarth@cargill.comi McClelland, Annette - Annette_McClelland@cargill.comi Gartin,
Monty - Monty_Gartin@cargill.comi Atkinson, Gavin - Gavin_Atkinson@cargill.com
Cc: DeSmet, Craig - Craig_DeSmet@cargill.com
Subject: FW: Cargill Polyols Courtesy Notification'
All,
Craig and I met individually with Howard Wolfe (City of Blair) and Jeff Going (State Fire Marshall) this morning, Overall
both were satisfied with our plan. The Fire Marshal did not require a formal submittal, but for some reason the Building
Inspector has requested that we submit a building permit application. He would also like to be notified when we are
complete with construction to perform a walk-through inspection of the area.
If you have any questions, comments or concerns please contact either Craig or myself.
Shalis
From: Winder, Shalis - Shalis_Winder@cargill.com
Sent: Tuesday, December 01,20093:07 PM
To: 'jeff.going@nebraska.gov'
Cc: 'hwolfe@ci.blair.ne.us'i DeSmet, Craig - Craig_DeSmet@cargill.comi McClelland, Annette -
Annette_McClelland@cargill.comi Gartin, Monty - Monty_Gartin@cargill.comi Hackbarth, Mike -
Mike_Hackbarth@cargill.com
Subject: RE: Cargill Polyols Courtesy Notification
Jeff,
My mobile is 402.306-3400. Looks like I'm availableat 11:00 am if that works for you.
Shalis
1
RESIDENTIAL - ADDITIONS / REMODELS and
COMMERCIAL - NEW CONSTRUCTION / ADDITIONS / REMODELS:
Business/l ndustrialjEd ucational/ Assem bly/Factory/Storage/Uti lity
*Porches with roofs/screened patios are considered additions
Construction valuation computation: Sqjft area X $63
Except for the following:
Accessory Buildings & Interior Remodeling Proiects: 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 com utation'
Finished sqjft area b'J ,+0 (j
I ,/1
X $ (J. ~)
$ iLl) ;:" ,JL5J':1
r{.J_~ J w~ (.,.;'..
Construction valuation is ..............m..................Permit fee is:
$0 TO $50...........................................................$0
$51 TO $500........................................................ $25
$501 TO $2,000........................................................ $25 + $3 oer 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
$ <3; ,35/3
25.00 ~
t)()
Issuance Fee:
$
$
Total Permit Fee = Deposit + Permit Fee + Issuance Fee
Additional Comments:
Approved by:
"'::-:7:;,:; hlJ/
,1\1 /;'1/ . ''1V:'.~"
!
Date:
/cl ~7(JI
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 0 r BL^Il~
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.
? (
08~VC\
''f
. \
Contractor
City of Blair
(J) 0f3 ~C1
./ Date
(i)-
~(jIJ"'l-tlOIJSIN(l
218 South 16th Street. Blair, Nebraska 68008 . 402-426-4191 . Fax 402-426-4195 . E-mail cliyofblair@cLblair,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.
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.
Lil c:-) ,1
(h~ -64??f 1M
. Contractor/ ner
Contractor/Owner
City of Blair
fi) 0Z3 ~06::-- 01 '
l~'~'bate