MS-2010-00025.tif Aug 05 2010 1 :03PM HP LASERJET FAX Page 1
Aug. 5, 2010 1:54PM CITY Of BLAIR (4C2, 426, 41911 Na, 5546 P, 1
CITY OF BLAIR
218 5. 16TH STREET
BLAIR, NEBRASKA 88048
. - Building Permit Application (402)426 -4191 -Phone
MS- '2010.00025 9b�»k� 01 qU� w blai nebraskm.org
08!05/2010 bpeterse MISC Residential August 5, 2010
LOCATIONOFIMPROVEMENT. 11323 Rambleridgo Dr, Blair, NE 68008
ARCHITECT: GENERAL
e Q iER Michael R And Kerry A Jonas Hometown Roofing, Inc.
13316 Millard Ave
218 Box Omaha, NE 68157
BLAIR, NE 65046 -4218
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NATURE OF WORK PROPOSED USE
RoofinglSoffit/RaveslGutters Primary Residence
PROJECT NAME PERMIT EXPIRES 09104/2012
113 1008084 ESTIMATED COMPLETION DATE 2010 -08.31
D ESCRIPTION OF WORK
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Tearing otf one layer and replacing with asphalt shingles. With ice guard -two rows.
DEPOSIT PAID BY: SITE PLAN SUBMITTED, NA
Contractor RESch9ck1COMchsck SUBMITTED; NA
DEPOSIT HELD: BUILDING PLANS SUBMITTED: NA
1. No work will be started before a permit is ISSUED AND POSTED,
2. For commercial permits, a set of plans for this project must be submitted to the Nebraska State Fire Marshal's Office for review.
3. Separate permits are required for electrical, plumbing, heating, ventilating and air conditioning, and septic system.
4. The undersigned owner or agent understands and acknowledges this building permit application does not constitute issuance of,
this building permit. It is further understood that construction covered by this permit application shall not be commenced until a
copy of a permit signed by the Building Inspector Is issued.
6. The undersigned owner or agent agrees 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. Any omission of or misrepresentation of
fact With or without the intention of the undersigned or any alteration or change from this application without approval of the
Buildin 4ofp11aent Official, shall cons tiW a sufficient ground for the revocation of any permit issued which was based on the approval of this
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V!coiatur i
Aug 05 2010 12:48PM HP LASERJET FAX page 1
Aug. 5. 2010 1 06P CITY OF BLAIR (402 426.4191) No, 5544 P. 4/5
CITY OF 5LA1Q
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ROOF PERMIT SUPPORTING DOCUMENTS
This supporting document includes information healing with particular code
requirements and/or roofing permit requirements. It in no way includes ►L particular
code items. Also, it is your responsibility to know the 2OIrdernational Building
QM requirements that apply to your project. Please understand this document is only
designed and distributed to aid( you in your rooring . permit process, A copy of the
Intemationai Building Code is available for your use at the Blair Public Library.
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I have read the above disclosure and accept this building permit documentation on my
own behalf assuming full responsibility as the ownerlcontractor for this project.
Owner /Occupant Contractor
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City of Blair $
n Nebraska 68006.402.426-4191 Fox 402. 426.419'5 E -mall c
218 South 161h Sheet Bb , Nab a nY4 rdQV®o1b1*ne.us
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Aug 05 2010 12:48PM HP LASERJET FAX page 2
Aug. 5. 2010 1 06P CITY OF BLAIR (402 426.4190 No, 5544 P, 3/5
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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 - coessory building valued under $10,000.
A $50.00 r ndable deposit is being collected for all miso, permits, j
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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.
G) 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 S, HALL be forfeited or
discounted upon the discretion of the City of Blair, Building and Inspections
Department.
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ractor /Owner Contractor /Owner
City of Blair
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