BP13446CITY OF BLAIR - MISC LLANEOUS BUILDING PERMIT
a, Permit #
Ilp
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Date: -5-,Z- /0 Approximate Completion Date: ,�"��� Site Plan Attached:
Estimated Valuation of Project:
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
Curb Grind
Fee: $75 plus bond
Length / Y °
Utility Excavation
Length 4-1 Lin. Ft.; Width Lin. Ft
Type: Water ; Sewer ; Other
Amount of Bond Posted: /1* Bond Check #
(Curb grind - $9.00 per Lin. Ft.; Utility Excavation - $6.00 per Sq. Ft.)
Add�ipt,io�nal Description of project if necessary: �� cs
PROJECT INFORMATION:
Job Address:
Legal Description (if applicable) 2Lzli
Owner:,g � 1 r llw
Contractor:
I
Address:671
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: $ 25.00
Deposit: $ 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.
i atu of wner/Contractor
For Office Use Only
Date Permit Paid:
CITY OF BLAIR, NEBRASKA
Phone 402-426-4191
THANK YOU KEEP THIS COPY FOR YOUR RECORDS.
NO
RECEIVED BY
Pounds Printing, Blair, NE 68008
0700016Iq
STATE OF NEBRASKA COUNTY OF WASHINGTON)SS 2a 9
ENTERED IN NUMERICAL INDEXANp FILED FOR RECORD
THIS DAY OF A,D, 20=
ATS O'CLOCK _tL CORDED IN BOOK }- � Iµ„V f� D
.3 1 to AT PAGE
COUNTY CLERK 1, �f_ �
DEPUTY.��'�, 2 a - 00 APR 17 AM 9: 23
CONTIGUOUS PARCEL AGREEMENT
This agreement is made this 12&h_ day of -942r,
by
by Walter and Patricia Groves hereinafter referred
to as "Owners."
Whereas, owners are all of the record title holders, enti-
ties, or persons having any interest in the following described
real estate, to -wit:
Lots 13 and 14, Block 2 in Evergreen Bluffs
and,
Whereas, the individually described parcels are contiguous
and adJacent to each other; and,
Whereas, pursuant to Section 1110(2) provides an owner of
real estate may by an agreement with the terms and conditions set
forth herein utilize the outside boundary of the entire tract as
the lot or boundary line for set back purposes and waive building
across or the requirement of any set back line with regard to the
interior contiguous line for building purposes.
For and in consideration, the waiver of said set back re-
quirements from and the right to build across the interior lines
of the contiguous lots by the City of Blair, the undersigned
hereby irrevocably agree in perpetuity all the above described
real estate shall after the date of this agreement be conveyed
only in a simultaneous conveyance to the same grantee or gran-
tees, and that said real estate shall not be conveyed, sold,
divided, or otherwise transferred except in conformity with this
agreement.
The Owners further -hereby agree this agreement may be termi-
nated only upon express written approval of the City. of Blair
releasing the Owners from the irrevocable nature of this -agree-
ment.
The Owners further warrant and covenant this agreement shall
run with the land and shall be binding upon the heirs, personal
representatives, successors, and assigns of the Owners.
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Owner
Recordea
General
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-CITY Of t)LAIQ-
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 know the 2006 Internationai 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.
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.
wrier ccupant
City of Blair
Contractor
®_ _
218 South 16th Street • Blair, Nebraska 68008 • 402-426-4191 • Fax 402-426-4195 • E-mail cityofblair@ci.blalr,ne,us