MS-2010-00105.tif CITY OF BLAIR
218 S. 16TH STREET
BLAIR, NEBRASKA 68008
Building Permit Application (402)426 -4191 -Phone
(402) 426 -4195 - FAX
MS -2010 -00105 A`�nIse of a ° ° www.blairnebraska.org
09/10/2010 MISC Residential Septem=10,
/U IV
\ LOCATIONOFIMPROVEMENT: 2220 Crestridge Dr, Blair, NE 68008
\� ARCHITECT: GENERAL
\ OWNER: Donald And Julie M Sorensen CONTRACTOR: 3493 ,
93�Co Rd G
2220 Crestridge Dr Tekamah, NE 68061
BLAIR, NE 68008 -0000
No
�o.
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\\ \\ \\\ \\1\ \\ \ \ \ �'� \ \\ \\\\ \ \'\ � \' \\ \ \ \\\ \�\ \� \ �\ �' \\ mol
NATURE OF WORK PROPOSED USE
Roofing /Soffit/Eaves /G utters
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PROJECT NAME PERMIT EXPIRES 09/0912012
2220CrestridgeDr- 100910 -Roof ESTIMATED COMPLETION DATE 2010 -09 -10
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DESCRIPTION OF WORK
Tearing off and replacing with asphalt shingles
DEPOSIT PAID BY: SITE PLAN SUBMITTED: NA
Contractor
REScheck /COMcheck SUBMITTED: NA
DEPOSIT STATUS:
BUILDING PLANS SUBMITTED: NA
$50
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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 _.co�stitute sufficient ground for the revocation of any permit issued which was based on the approval of this
applicatfon _
Date
Signature of Applicant
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CI Of I)tAIQ
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OP-
ROOF PERMIT SUPPORTING DOCUMENTS
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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.
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 Con ractor
City of Blair -n Da e
218 South 16th Street • Blair, Nebraska 68008 • 402 - 426 -4191 • Fax 402 - 426 -4195 E -mail cityofblair @ci,blaicne.us oPPOa. r.