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BP13456t CITY OF BLAIR - MISCELLANEOUS BUILDING PERMIT A Y a Permit # ��� ��� 9 Promiso °t Date: l� ` vbl� Approximate Completion Date: % i'U Site Plan Attached: Estimated Valuation of Project: 200-00 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.) Additional Description of p l PROJECT INFORMATION: Job Address: 2 6V Legal Description (if applicable) /`-�� ��` 7 r rita Pd t Owner: f� ,`f ��, ,� Address: lo5e-9 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: $ 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. gnat a Owner Contractor Date For Office Use Only WHEN PROPERLY VALIDATED (BELOW) THIS IS YOUR PERMIT Date Permit Paid: Receipt #�f1 ` Approved by:' t' CITY OF BLAIR, NEBRASKA Phone 402-426-4191 RECEIVEDOF: ADDRESS CITY, STATE, ZIP CODE THANK YOU KEEPTHIS COPY FOR YOUR RECORDS. NO RECEIVED BY Pounds Printing, Blair, NE 68008 _--, r Building Sketch (Page - 1) BonowedUent Mitchell & Christy Chappelear Proper I Address 1050 N 27th Street _ Blair Coan l, Washington State NE _ _ ?iPCgdc 613008 Lewer First National Bank 74 ft I ,r . a � ' . • r l 1 �t. � y6 ` r 7 ` r 7 IFil llo,_ 055?LP_:gc rE 13 0.51 80.50 60.00 70.0 tuv7 tuvi ovv.,vc.v —.o-1 I- 12 `' I I 10 0 �v` ti 'Z i 12 11 0 10 9 o B - LARSEI n, 0.50' 80.50' 60' 70.0 0.0 7 �6 `o 37,91' � o. DRIVE SUNRISE 7 �304.17' r h © ti 4 a " 3 10 °REPLAT- FLOsTJS'' O LARSE-N s 5. 3LOCK 0. V 0, LARSE14 HEIGHTS E-WHEIGHTS ADD Hc! HTS3 a O- ao o' FOURTH N U s ADDITION 2 "' 5 � O° 6 NW 23 c a rn C� �' �D. i 7719• 60A• ' W rl.ra t -W a ti 2 BLOCK 1 10- O T I RD r 1 a30 llo.xA a, (�T , wO. 02 219 0 0 7 2 a `Y� l '' ,� �T 0S 36 Iv It0.0 1/I'�1 `01 u 2 M.14 �J . 10. tlo�� o. 7J•i7'u bt;�9 UD. 81 k. 6 o v NE tloo 16 13 _ O i 4 LpASE=� 1100 20 `,o•o '_ � , ' 7 7(1' 1 lodWEST 170...4 ORO°. d IS "3 71. )..0 ' O (�! LARSE� �..� O 0' ,z (D::, . 19 poi 9 3 f r r °o n ° o• _� Subject SkL,e 7s n' 7 n' 16 N o 15' 1 l o , 7 "o {.� ITS a C 0 Iq to � r�l� o i.E2•�' 14 �^ ' 4 o T.L. 54 c u. & 0.43 4 i3 FJ yb 1579a i� c 5n M� 12 O `` �' l II Y� e 111.4rr"' 30.0• �.J 06 �v 7a 00 i G r7e.J 3 r (� d6 �� itpn r' V111 - 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 refun able deposit is being collected for all misc. permits. The i y 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. ate Contractor/Owner City of Blair