BP13457CITY OF BLAIR - MISCELLANEOUS BUILDING PERMITi 'AA -
Permit # %
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'9 Promise
Date: x"41 Approximate Completion Date.. r/ -3f - Site Plan Attached:
Estimated Valuation of Project: 1 Obo - O°
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.)
PROJECT INFORMATION:
Job Address: � /C�c,� I a.� a- VJ f IN PC
Legal Description (if applicable)k
wne • IF -a-12 Address: AP ��� °' � Phone#:
Contractor /` c I Phone #: 5171
Address: /f415 . a #',--)
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.
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Signature of Owner/Contractor D e
For Office Use Only WHEN PROPERLY VALIDATED (BELOW) THIS IS YOUR PERMIT
Date Permit Paid:Yom-_' 1 Receipt #` Approved by:
�d�
CITY OF BLAIR, NEBRASKA
Phone 402-426-4191
THANK YOU KEEP THIS COPY FOR YOUR RECORDS.
NO
RECEIVED BY
Pounds Printing, Blair, NE 68008
COMMENTS:
F OCCUPANCY GRANTED F1 CONDITIONAL OCCUPANCY GRANTED
INSPECTOR :-- DATE OF INSPECTION6-
MADE: �' -� - / 0 E- & 3 0
FAXED OPPD\BURT REA TO CONNECT SERVICE:
BUILDING INSPECTION REPORT
CITY OF BLAIR
❑ WASHINGTON COUNTY ❑ OTHER
LOCATION OF INSPECTION
NAME OF OWNER',
CONTRACTOR -
DATE INSPECTION REQUESTED' Z TIME INSPECTION REQUESTED-- PERMIT
NO
TYPE OF INSPECTION REQUESTED: El CONFERENCE
F1 STATUS CHECK
BUILDING: F-1
FOOTING El DECK FOOTING Ej DRYWALL E:l FINAL [:] PARTIAL
PASSED
FAILED
El
COMMENTS:
UTILITIES: F-1
SEWER TAP F1 SEWER F1 SEPTIC F1 WATER TAP F1 REMOTE 0 WATER SERVICE
PASSED
FAILED
F1
PARTIAL
El
F-1
COMMENTS:
ELECTRICAL: n
ROUGH IN F1 FINAL F1 PERMANENT SERVICE 0 TEMPORARY SERVICEE] PRECONNECT
PASSED
FAILED
El
PARTIAL
F-1
n
COMMENTS:
MECHANICAL:F-1
ROUGH -IN F1 A/C 0 FURNACE El RADIANT HEAT F1 FINAL [I PARTIAL
PASSED
FAILED
F-1
Fl
COMMENTS:
PLUMBING: F-1
GROUNDWORK El ROUGH -IN El FINALE] WATER METER INSTALLED El PARTIAL
PASSED
FAILED
F-1
PRESSURE TEST
Fl
F -I
COMMENTS:
F OCCUPANCY GRANTED F1 CONDITIONAL OCCUPANCY GRANTED
INSPECTOR :-- DATE OF INSPECTION6-
MADE: �' -� - / 0 E- & 3 0
FAXED OPPD\BURT REA TO CONNECT SERVICE:
r' U11111 -
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,
addi ' ccessory building valued under $10,000.
A $50.00 r undable deposit is being collected for all misc. permits.
ity 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.
Contractor/Owner Contractor/Owner
City of Blair
Date
06/04/2010 10:54 4023595808 R-SIDING,INC PAGE 02/02
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06/04/2010 10:54 4023595808 R-SIDING,INC PAGE 01/02
Jun. 4, 2010 11, 22AM CITY Of BLAI R (402,426-4191) Na. 4808 P. I
city of Btslr
218 S le MMM
Mir, NE 68008
Voice (402) 426.41$1
fax (402)426.4185
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-BUILDING INSPECTION REPORT
CITY OF BLAIR ❑ WASHINGTON COUNTY El OTHER
LOCATION OF INSPECTION' _J-V
..
. . .......
NAME OFOWNER-', CONTRACTOR -
DATE INSPECTION REQUESTED TIME INSPECTION REQUESTED-- PERMIT N
TYPE OF INSPECTION REQUESTED: El CONFERENCE
El STATUS CHECK
BUILDING: ❑ FOOTING E] DECK FOOTING Ej,-FRAMING E] DRYWALL El FINAL El PARTIAL
PASSED
FAILED
COMMENTS:
UTILITIES: ❑ SEWER TAPE] SEWER E SEPTIC El WATER TAP F1 REMOTE D WATER SERVICE
PASSED
FAILED
F] PARTIAL
F1
F�
COMMENTS:
ELECTRICAL: ❑ ROUGH IN El FINALE] PERMANENT SERVICE F1 TEMPORARY SERVICE El PRECONNECT
PASSED
FAILED
El PARTIAL
1-1
El
COMMENTS:
MECHANICAL: 1-1 ROUGH -IN El A/C 0 FURNACE El RADIANT HEAT El FINAL F1 PARTIAL
PASSED
FAILED
F]
F]
COMMENTS:
PLUMBING: F -I GROUNDWORK F1 ROUGH -IN EI FINAL El WATER METER INSTALLED El PARTIAL
PASSED
FAILED
F] PRESSURE TEST
El
El
COMMENTS:
P OCCUPANCY GRANTED El CONDITIONAL OCCUPANCY GRANTED
INSPECTOR: DATE OF INSPECTION MADE: o
, C) 1
FAXED OPPD\BURT REA TO CONNECT SERVICE: ON B