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CITY OF BLAIR - APPLICATION FOR BUILDING PERMIT
Permit #
Date: I dJ. -- I fj <~ 0 Cj
Site Plan Attached:'~
REScheck Attached:
/3c37o
Approximate Completion Date: j/ (351- c2 vi {)
Complete Plans Attached 'K
Application for: Residential Commercial/Industrial L
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 Z 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 _
cfl J.-tl afnin lib? d Ml-!I
Proiect Information:
0'
j r tJ G,t! tt/1 f (J:;
81/)0 tJl &/,/3
Job Address:
Legal De[Zcri. tion (if apPlica. b.. Ie) dJ~ 7'1.> / 'I? f{ db::? ..'7- J8 - /.;1 //1/ FC:
, .'1 L'I '~th-l3:jlljl/~Y4acLU1iJ. 7'
Owner: 'JJt,':;a11"l/ 16' " Address: / tJ CJ 6;"la41 f (j r. Phone#:
Contractor: 1),171 t'JJ Cl ;J f: 0 AI cj~ ~ Phone #: 3 L/ i '- (; t) 7/1
Address: //.;1 {) r;;. /,lJ)I/v (~)f '
V.411 aJ1 c;v Nt:; U 8) p ;;<
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.,) by agree to perform the proposed work in accordance with the speCifications set forth above and in accordance with the
,. COd~S!. (ciinan es of the City of lair and the State of Nebraska. I understand th t this permit is void if work is not commenced within
180 a or' n completed w' in two (2) yea s date of issue.
~ ;gn ture of Owner/Contra.to '/:;, e ' '(Jf
67
/,?''? c/ bA &
Cell #:
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:
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 %
Drivewavs/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
Sauare 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 required 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
RESIDENTIAL - ADDITIONS / REMODELS and
COMMERCIAL - NEW CONSTRUCTION / ADDITIONS / REMODELS:
Business/I ndustrial/Ed ucational/ Assem bly/Factory/Storage/Utility
*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 ErectimUAwnings and Decks/Handicap Ramps: sqjft area X $25 (Minimum
valuation of $2000)
Construction valuation computation: . ::5
Finished sqjft area 5.
../
X $ ;?,-~
$ I 3 ;;l15', tJ 0
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
$ C:<6. 0 0
$ 25.00
$ /O{). 00
Issuance Fee:
Total Permit Fee = Deposit + Permit Fee + Issuance Fee
Additional Comments:
Approved by:
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
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:
,1,../";
ADDRESS
CITY, STATE, ZIP CODE
THANK YOU
KEEP THIS COPY FOR YOUR RECORDS.
NO
RECEIVED BY
Pounds Printing, Stair. NE 68008
CITY OF BL1\IQ
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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.
\
. Owner/Occupant
())~ {\"CD S~
Contractor
City of Blair
Q \2-~O~
ate
(5)-
EaUALllousma
218 South 16th Street. Blair, Nebraska 68008 . 402-426-4191 . Fax 402-426-4195 . E-mail cityofblair@cLblair.ne,us ""'"''''
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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.
Ualaht1 ~ jPflyl ~fb
Contractor/Owner
City of Blair
Brenda Wheeler
From:
Sent:
To:
Subject:
Attachments:
Pedro Vargas [pedr01@omahaneon.com]
Monday, December 14, 2009 1 :24 PM
Brenda Wheeler
FW: Versatile Blair,NE
C27665-S1 Blair, NE (190).jpg; C27665-S2 Blair, NE (190).jpg; Bueller Trading.pdf
Brenda,
The walls are 30' tall by 120' long each. Sign # 1 will go on the South elevation in the middle of the wall & sign # 2 on
the North elevation on the corner. The location address is 190 Grant Street. Please let me know if I'm missing anything.
Owner Info:
Walter Jay
402-426-8211
Pedro A. Vargas
Account Executive
Omaha Neon Sign Co,
1120 N. 18th Street
Omaha, Ne 68102
402-341-6077 Ext 207
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