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BP13471CITY OF BLAIR — APPLICATION FOR BUILDING PERMIT Permit # Date: �` Approximate Completion Date: 0 - 0 ° Site Plan Attached: REScheck Attached: Complete Plans Attached Application for Residential Co_mmercal /Industrial New Construction Manufactured Home Modular. Move -on: Home Accessory Building Other Remodel i,- Addition Accessory Building: Garage Pole Barn Other Floor Type: Dirt Concrete Electricity: Yes No Sign Erecting, Awnings Decks /Handicap Ramps (plot plan required) Satellite Dishes /Radio Antenna /Cell Towers (plot plan required) Other Utilities: Public Water: Yes No _ If yes, responsible entity: Agreement needed: Public Sewer: Yes No _ If yes, responsible entity: County Road Permit Required: Yes No _ Private Well Blair OPPD Line Kennard Date Agreement Received: Septic Drawing Provided: Blair Kennard _ Submitted: Yes No Additional Description of project if necessary: %� d L 2 &� h' fGJ �'� �d a e� �-rc G�✓. zy � et rip �e�nr► r-() tie- CV[A 146�,Me- Project Information ^ Job Address: ,` / A4 eg Legal Description (if applicable) L 1 °" / C / - "ZSZ' e _ , Owneff 2 & ��� Address: � 1 � '�' Phone #: a ° � r7m Contractor: Phone #: 573 /44 .'5 i t� Address: & 0 0 �-�� fl � c� y Cell #: Email Address for Contractor: Separate permits are required for electrical, plumbing, heating, 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 8-deys-em of co plat wo (2) years of date of issue. C d° ignature of ownerlcon&mCor Date 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 /U tilities: 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 % Driveways /Sidewalks: Sidewalk required: Yes No Sidewalk Waiver: Yes No Date Waiver Approved: Preexisting Garage requires driveway to be less than 3' from property line: Approved by: Yes Flood Plain: Yes No If yes, specify special requirements: BUILDING INSPECTOR REVIEW: Number of Stories One Two Three Four >Four lype of Residential Structure: Ranch Two Story Split Entry Raised Ranch Rooms Bedrooms Bathrooms Egress in Basement: Required: Yes No Sleeping Rooms Living Area Square Footage Main Level: Basement: (Unfinished) Garage: Detached Garage: (Finished) _ 2 bay 3 bay 4 bay Pole Barn: Addition: Remodel: Porch: Front Rear Side Deck that affect setbacks: Rear Front Side Occupancv Classification: Assembly, theaters, with stage _ Assembly, nightclubs Assembly, churches Assembly, general, community ha Business Educational Factory and industrial, low hazard High Rise ( >75 ft) Other Fireplaces Gas Electric _ Provided on Plans: Yes No Other Egress Second Level: Third Level Assembly, theater, without stage Assembly, restaurants, bars, banquet halls Assembly, arenas ils, libraries, museums Factory and industrial, moderate hazard _ High Hazard, explosives 5+ bay (section continued on next page) 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 reauired 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 131) Driveway Grade: 20% grade or less? Yes No (Dale will review new residential construction. At 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 Garage sq/ft area Total Valuation: 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 / 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 following: Accessory Buildings & Interior Remodeling Projects sq/ft area X $43 Pole barns with no hard surface floor sq/ft area X $25 Sign Erecting/Awnings and Decks /Handicap Ramps sq/ft area X $25 (Minimum valuation of $2000) Construction valuation computation Finished sq/ft area X$ $ 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 Permit Fee calculated from chart above $ 1 7 Lo ° ` 0 Issuance Fee: $ 25.00 /01. Total Permit Fee = Deposit + Permit Fee + Issuance Fee $ 3 Additional Comments: Approved by: L4 Date: b 4: v 1 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 a III Y W m 0. Q } (q LL Z� ® W .1 ® cc :E f-- WC) -)Wn ® LL Q J �¢Z Qd~ Z (n iccd, O �f.D x w �o00N -O ��j T II 0Q(n z�0 LLQZN N w Q CC O A T /Vl - P1 LL < 1 Site Plan Attached: REScheck Attached: Complete Plans Attached _ Application for _ Residential ✓ Commercial /Industrial New Construction Manufactured Home Modular n Move -on: Home Accessory Building Other. Remodel I/ Addition Accessory Building: Garage Pole Barn Other Floor Type: Dirt Concrete Electricity: Yes No Sign Erecting, Awnings 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 Additional Description of project if necessary 1 1 2aM d cz � or; f � ",_td IZ6 r J)"', /(4 dl') L-/, a /1 Contractor: (_7 Cl 1�©6 &" ©r�L�- l V �a- S /J. Address: � � Cell #: 59 " 3 39� Email Address for Contractor: Owner /�� XJV412 aa Address: f 3/D ✓J• Phone #: � - 4d2�- rl/2 Phone #: 5� -14 Separate permits are required for electrical, plumbing, heating, 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 SSE }days -er- is-o-ot con)pIzM'% tt h jwo (2) years of date of issue. ig an ture of Owner/ConftLrCor Date 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. Cidn �lnvn r.f Auu�ev /l+.n v.�v..nF.... 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 greeDle ime of your building permit application. A $fundable deposit is being collected for any residential remodel, essory buildin g 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. �nt ractarr/ - Own4 - ' Contractor /Owner City of Blair Date - W . 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 Building 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 a� ownerkgntractor for this project. Owner /Occupant p City of Blair ate 218 South 16th Street • Blair, Nebraska 68008 • 402 - 426 -4191 • Fax 402 - 426 -4195 • E -mail cityofblair @ci,blalr.ne.us