MS-2010-00042.tif CITY OF BLAIR
218 S. 16TH STREET
BLAIR, NEBRASKA 68008
Building Permit Application (402)426- 4191 -Phone
(402) 426 -4195 - FAX
MS -2010- 00042 p � ej hise of Q� www.blairnebraska.org
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08/13/2010 bpeterse MISC Residential August 30,
LOCATIONOFIMPROVEMENT: 1964 Washington St, Blair, NE 68008
ARCHITECT:
r i , GENERAL F/S Contractin
t_21 OWNER: Russell A And Valorie Myn Hedges CONTRACTOR: g
324 S 13th St
1964 Washington St Tekamah, NE 68061
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` BLAIR, NE 68008 -0000
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NATURE OF WORK PROPOSED USE
Sidewalk
Primary Residence
PROJECT NAME PERMIT EXPIRES 08/29/2012
1964Was hi ngtonSt- 100813 -Roof
ESTIMATED COMPLETION DATE 2010 -09 -30
DESCRIPTION OF WORK
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Tearing off and replacing with one layer of asphalt shingles and gutter replacement
DEPOSIT PAID BY: SITE PLAN SUBMITTED: NA
Contractor REScheck /COMcheck SUBMITTED: NA
DEPOSIT HELD: BUILDING PLANS SUBMITTED: NA
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 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
applicati n.
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Signature of Applicant Date
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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 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 $
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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.
ignature of Owner /co ractor Date
For Office Use Only WHEN PROPERLY VALIDATED (BELOW) THIS IS YOUR PERMIT
Date Permit Paid: Receipt # Approved by:
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