MS-2010-00028.tif I '
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CITY OF BLAIR
218 S. 16TH STREET
BLAIR, NEBRASKA 68008
�Fl Building Permit Application (402)426- 4191 -Phone
(402) 426 -4195 - FAX I
MS- 2010 -00028 a10 � /se of a ° °\\ www.blairnebraska.org
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08/05/2010 MISC Residential August "2010
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LOCATIONOFIMPROVEMENT: 222 Jackson St, Blair, NE 68008
., ARCHITECT: GENERAL
CONTRACTOR: SELF j
OWNER: Kenneth W And Rita A Smock SEL Self
222 Jackson St Blair, NE 68008
BLAIR, NE 68008 -0000
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NATURE OF WORK PROPOSED USE
Siding Primary residence
PROJECT NAME PERMIT EXPIRES 08104/2012
222JacksonSt- 100805 - Siding
ESTIMATED COMPLETION DATE 2010 -10 -31
DESCRIPTION OF WORK
Removing vinyl siding and shake siding with cement board siding
DEPOSIT PAID BY: SITE PLAN SUBMITTED: NA
Contractor REScheck/COMcheckSUBMITTED: 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.
5. 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
Building Official, shall constitute sufficient ground for the revocation of any permit issued which was based on the approval of this
application.
Signature of Applicant Date
CITY OF BLAIR
218 S. 16TH STREET
BLAIR, NEBRASKA 68008
(402) 426 -4191- Phone
(402) 426 -4195 - FAX
www.blairnebraska.org
RESIDENTIA BUI L DING PERM b� /se. t
PERMITNUMBER: MS- 2010 -00028 EXPIRATION DATE: 08/04/2012
ISSUED: PAYMENTMETHOD:
PERMITTYPE: MI RECEIPTNO:
NAME OF PROJECT: 222JacksonSt- 100805- Siding PARCEL #
JOB SITE ADDRESS: 222 Jackson St
Blair, NE 68008 LOT 35
TYPE OF WORK: BLOCK
Siding
JOB COST: $1000.00 TOTALFEE: $
RML Residential Multifamily Low Densi District
USE GROUP: ( Y Y )
IN PURSUANCE OF THE FILING OF THE REQUIRED APPLICATION AND PLANS AND SPECIFICATIONS BY:
PRIME CONTRACTOR: OWNER:
SELF,SELF Kenneth W And Rita A Smock
SEL Self 222 Jackson St
Blair, NE 68008 BLAIR, NE 68008 -0000
PERMISSION IS HEREBYGRANTEDTO:
Removing vinyl siding and shake siding with cement board siding
# OF STORIES: 0 # OF BEDROOMS: 0 #OF BATHROOMS: 0
TOTAL LIVING SQ. FT: 0 TOTAL UNFINISHED BASEMENT SQ. FT: 0
TOTAL FINISHED BASEMENT SQ. FT: 0 TOTAL GARAGE SQ. FT: 0
THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION AUTHORIZED IS NOT COMMENCED WITHIN SIX (6)
MONTHS, OR IF CONSTRUCTION OR WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF SIX (6) MONTHS AT ANY
TIMEAFTER WORK IS STARTED, OR IF WORK IS NOTCOMPLETED WITHIN TWO (2)YEARS OF DATE OF ISSUE.
NO PREMISES SHALL BE OCCUPIED UNTIL A CERTIFICATE OF USE AND OCCUPANCY OR A WRITTEN CONDITIONAL
OCCUPANCY APPROVAL BY THE BUILDING OFFICIAL HAS BEEN ISSUED. THIS PERMIT DOES NOT AUTHORIZE ANY
ENCROACHMENTONPUBLICPROPERTY.
SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING, VENTILATING AND AIR CONDITIONING AND
SEPTIC SYSTEMS. ALL WORK WILL BE PERFORMED 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.
THE ISSUANCE OF THIS PERMIT IS FOR THE WORK SPECIFIED IN THE APPLICATION FILED. THEREFORE ANY
UNAUTHORIZED CHANGE OR ALTERATION FROM THE AFORESAID APPLICATION OR PLANS WILL RENDER THIS PERMIT
NULL AND VOID. ALL CORRECTIONS OR ALTERATIONS NOTED IN ANY ADDENDUMS ISSUED BY THIS DEPARTMENT
SHALL BE MADE A PART OF THE APPROVED PLANS AND SHALL BE PERFORMED AND INCORPORATED INTO THE WORK.
THE ISSUANCE OF A BUILDING PERMIT, OR THE ISSUANCE OF AN APPROVED SET OF PLANS DOES NOT ABSOLVE THE
OWNER, ORCONTRACTORFROM COMPLYING WITHALL
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BY: HOWARD WOLFE
CITY BUILDING INSPECTOR /CODE ENFORCEMENT OFFICER
MUST POST ON JOB SITE IN A VISIBLE LOCATION
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BUILDING PERMIT SUPPORTING DOCUMENTS
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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.
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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 owner /contractor for this project.
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Ownerloecupant Contractor
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Ct y f Blair Date
218 South 16th Street • Blair, Nebraska 68008 • 402 - 426 -4191 • Fax 402 - 426 -4195 E -mail cltyofblair @cl,blair,ne.us oPPOw...
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BUILDING PERMIT DEPOSIT AGREEMENT
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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.
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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.
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Contrac Owner Contractor /Owner
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