MS-2010-00074.tif CITY OF BLAIR
218 S. 16TH STREET
BLAIR, NEBRASKA 68008
Building Permit Application (402)426- 4191 -Phone
9 �a (402) 426 -4195 - FAX
MS- 2010 -00074 A � O m;s e at www.blairnebraska.org
08/25/2010 MISC Residential August 25,
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LOCATIONOFIMPROVEMENT: 337 S 17th St, Blair, NE 68008
ARCHITECT: GENERAL
OWNER: Safley, Harland I and Darlene P Trust CONTRACTOR: MatProLLC
936 N 20th Ave Cir FT CALHOUN, NE 68023
BLAIR, NE 68008 -1299
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NATURE OF WORK PROPOSED USE
Roofing /Soffit/Eaves /Gutters Primary Residence
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PROJECT NAME PERMIT EXPIRES 0812412012
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337S 17thSt- 100825 -Ro ofi n g
ESTIMATED COMPLETION DATE 2010 -09 -01
DESCRIPTION OF WORK
Tearing off down to decking and replacing with one layer of asphalt shingles.
DEPOSIT PAID BY: SITE PLAN SUBMITTED: NA
Contractor REScheck/COMcheckSUBMITTED: NA
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DEPOSIT HELD: BUILDING PLANS SUBMITTED: NA
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N/A
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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 unde signed or any alteration or change from this application without approval of the
Building Official, shall constitute sufficient.-`ound for the revocation of any permit issued which was based on the approval of this
�appc atio
Date
Signature of Applicant
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CITY Of BtAIQ
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ROOF PERMIT SUPPORTING DOCUMENTS
This supporting document includes information dealing with particular code
requirements and /or roofing 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 document is only
designed and distributed to aid you in your roofing 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.
Owner /Occupant Contractor
City of Blair Date
218 South 16th Street • Blair, Nebraska 68008 • 402 - 426 -4191 • Fax 402 - 426 -4195 E -mail cityofblalr @cLblalr,ne.us oPOw. r.
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BUILDING PERMIT DEPOSIT AGREEMENT
A $500.00 refundable deposit is being collected for any new commercial, new
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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 rundable 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.
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Contractor /Owner Contractor /Owner
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City of Blair
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Date