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CITY OF BLAIR - APPLICATION FOR BUILDING PERMIT
Permit #
Date: *�A I (0
Approximate Completion Date: -
Site Plan Attached: REScheck Attached:
Complete Plans Attached
Application for: Residential Commercial/Industrial
New Construction Manufactured Home ular
Move -on: Home Accessory BuildingOther
ee
Remodel Addition
Accessory Building: Garage Pole Barn Other
Floor Type: Dirt Concrete Electricity: Yes No
Sign Erecting, Awnings ecks andicap Ramps (plot pian required)
Satellite Dishes/Radio Ant 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
Additional Descrintioi of
to
ti I ,--i n n i"- n o nv,
Project Information:
-- I Job Address:
Legal. Description (if applicable) S
Owner: PAV' 0
Contractor: l
Address: O -A e-' Phone#:
Phone #:
Address: Cell #:
Email Address for Contractor:
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 act rdan ith the
codes /or'anoft Cit Blair and the tate of Nebraska. I understand that this i i void if work i ngt," enced within
1 aor is tes 'c p d withi 7woars of date of issue.
Signator of 0 er/Contract D to
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:
State Fire Marshal Required: Yes No Variance Required: Yes No
Minimum Setbacks: Front Second Front Side Side Rear
Lot Square Footage:
Length x Width: Lot Coverage %
D r i vew a vs /S i d ewa I ks:
Sidewalk required: Yes No Sidewalk Waiver: Yes No
Date Waiver Approved:
Preexisting Garage requires driveway to be less than 3' from property line: Yes
Approved by:
Flood Plain: Yes No
If yes, specify special requirements:
BUILDING INSPECTOR REVIEW:
Number of Stories
One Two Three Four >Four High Rise (>75 ft)
lype 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:
Occur)ancv Classification:
Rear
Rear
Second Level: Third Level
(Finished)
_ 2 bay 3 bay 4 bay 5+ bay
Pole Barn:
Remodel:
Side
Front Side
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)
CITY OF
NEBRASKA
9
Phone 402-426-4191
RECEIVED OF:
ADDRESS
F 4 l
CITY, STATE, ZIP CODE
THANKYOU KEEP THIS COPY FOR YOUR RECORDS.
NO
,RECEIVED Bl"
Pounds Printing, Blair, NE 68008
FILE COPY
A.' d
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Fce, .
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APPROVED
,r BUILDING ... �!
1��rsiz, PLANNING
._ ..... PUBLIC WORKS -
FIRE DEPT
• � Lam,-�,j,{'d [' +nd G �� . t`4 �,. g. `` _
ADDRESS
PERMIT
APFLI
' OVAL AS A RESULT OF AN INSPECTION
SHALL NOT RE CONS TH U ED T RE AN APP ,, �xi
_....._ _..OF --A V[OLATlolq-opTHE PROVISIONS OF `d E
CODE OR F OTHER ORDINANCES OF THIS
JURISDICTION.
High Hazard HPM Institutional, supervised environment
Institutional, incapacitated Institutional, restrained
Institutional, day care facilities Mercantile Residential, hotels
Residential, multiple family Residential, one- and two-family
Residential, care/assisted living facilities
Storage, moderate hazard Storage, low hazard Utility, miscellaneous
Is building required 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'n6Wresidential 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 sq/ft area X $92 $
(not including finished basement area)
Finished basement sq/ft area X $56 $
Unfinished basement sq/ft area X $29 $
Garage sq/ft area X $25 $
Total Valuation: $
Total Valuation Multiplied by 0.006 = $
Issuance Fee:
$ 25.00
Total Permit Fee = Deposit + Permit Fee + Issuance Fee $
RESIDENTIAL � ADDITIONSEMODELS and
COMMERCIAL - NEW CONSTRUCTION / ADDITIONS / REMODELS:
Business/Industrial/Educational/Assembly/Factory/Storage/Utility
*Porches with roofs/screened patios are considered additions
Construction valuation computation: Sq/ft area X $63
Except for the followiog
Accessory Buildings & Interior Remodeling Projects: sq/ft area X $43
Pole barns with no hard surface floor: sq/ft area X $25
Sign Erect! ng/Awn ings and Decks/Handicap Ramps: sq/ft area X $25 (Minimum
valuation of $2000)
Construction valuation computation:
Finished sq/ft
00
X $
area
$
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$1,000,000..................................................$2,970
+ $4
per additional $1,000
$1,000,001
AND OVER..................................................$4,970
+ $3
per additional $1,000
60
Permit Fee calculated from chart above $ 1 R
Issuance Fee: $ 25.00
Total Permit Fee = Deposit + Permit Fee + Issuance Fee $
Additional Comments:
Approved by: Date: f 10
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
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2118/07
Directions 41
1. Fill in the blanks on pages 2 and 3 with dimensions C)O Q 2q q4 -
and materials which will be used to build the
structure. Please print legibly.
2. Indicate in the check box which detail from page 3 will be used.
Size and Amount of Lags
C—
(example: Two 316'x41/2'lags@96.0.C.)
Type of decking
1"n-guara::....: - -:
with balusters
spaced so that a
4 Inch diameter
sphere cannot
passthrough
splices to occur over
is uuith-V°_b_earing.—
with non
i
❑ Detail B
❑ Alternate Detail 131
❑ Alternate Detail B2
Detail A (seepage 3)
(see page 3)
Conditions such as attachment to
cantilevers or veneers may require
Engineer's approval
Detail C L
(seepages) 17
Finished
Note: Emergency escape windows are allowed to
be installed under decks and porches provided the
location of the deck allows the emergency escape
Window to be fully opened and provides a path not
less than 36" in height to a yard or court. 6'8" required
for walk out basements or patios.
:1x4or2x6-
2x_f 'olsts
spaced " apart
(example: 2 x 10"spaced 24" apart)
(1) 2. x Y beam
(example: (2) 2 x 10 - see detail B)
_ rim joist �-
2�}� V
x10-seeAltemate B1 &82)
7—X V posts
spaced apart
(example: 4 x 4 posts spaced 8' apart)
Span?` '(' f /,'5-"/
(exa ple:13 - 4")
)
Note: A plot plan (plan view) showing the dimensions of your project or additions and its relationships to existing buildings or
structures on the property must be included. In addition to project dimensions, your plot plan must also show other details such
as post locations and spacing, joist and beam spans, and any other pertinent information not shown on the section drawing..
'GI
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CITY OF BLAIR — APPLICATION FOR BUILDING PERMIT
Permit #
Date: '�)l2`1 1 to
Site Plan Attached:
Approximate Completion Date: �, C-�O to
REScheck Attached: Complete Plans Attached
Application for: Residential Commercial/Industrial
New Construction Manufactured Home ular
Move -on: Home Accessory Building Other
Remodel Addition
Accessory Building: Garage Pole Barn Other
Floor Type: Dirt Concrete Electricity: Yes No
Sign Erecting, Awnings ecks' andicap Ramps (plot plan required)
Satellite Dishes/Radio Ant 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
Additional Description of
Project Information:
Legal. Description (if applicable)
Owner:["0(- (1 Address: Phone#: Z('.--'11 �s
Contractor: Phone #:
Address: Cell #:
Email Address for Contractor:
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 a f rdan ith the
codes/or ' antes oft Cit Blair and the tate of Nebraska. I understand that this it void if work i n i co enced within
1 or s ret Op d withiWwo gry6ars of date of issue. �� - � --n /
Signaturq,lbf Ovyffer/Contractdr / Da`te
For Building Permits other than One & Two Family Residential Structures: I
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.
Cieinotrrvn of nn}p
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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
Contractor/Owner
City of Blair