MS-2010-00141.tif CITY OFBLAIR
218 S.10THSTREET
8LA|R NEBRASKA 68V08
Building Permit Application (402) 426-41 - Phone
MS-201 0-00141
S-2 0-00141 Is. ot www.blairnebraska.org
0912912010 =Residential September 29, 201
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LOCATIONoF|MPROVEMENT 21O7 Davis Dr, Blair, 0EGD008
ARCHITECT
GENERAL SELF
[mVNBR: Mark Steven And Julie Beth 8eoemonn CONTRACTOR:
2107 Davis Or Blair, NE 68008
BLA|R.NEG8O0D^U0UD
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NATURE OF WORK PROPOSED USE
PROJECT NAME PERMIT EXPIRES 09128/2012
2107DavisDr-1 00929IRoof ESTIMATED COMPLETION DATE 2010-10-16
DESCRIPTION OF WORK
Tearing off and replacing with asphalt shingles.
DEPOSIT PAID BY: SITE PLAN SUBMITTED: NA
Owner
REScheckfCOMcheck SUBMITTED NA
DEPOSIT STATUS: BUILDING PLANS SUBMITTED: NA
1.Nn work will ha started before o permit |o ISSUED AND POSTED.
2. For commercial permits, a set of plans for this project must be submitted to the Nebraska St Fire Marshal's Off ice for review.
3. Separate permits are required for electrical, plumbing, heating, ventilating and air conditioning, and septic sys
4. The undersigned owner or agent understands and acknowledges this building permit application does not constitute iaouenuo of
this building permit. |tio further understood that construction covered by this permit application shall not becommenced until a
copy ofa permit signed by the Building Inspector ioissued.
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 of the City of Blair and the State of Nebraska. Any omission ofnr misrepresentation nf
fact with ur without the intention of the undersigned or any alteration or change from this application without approval of the
Building Official shall constitute sufficient d for the revocation of any permit issued which was based on the approval of this
applica ion.
Date �ofApp||oont
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promise
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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 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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Contractor /Owner i, tontractor /Owner
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City of Blair
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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,
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1 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 NC40,ractor ?
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City of Blair Date
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218 South 16th Street • Blair, Nebraska 68008 • 402 -426 -4191 = Fax 402 - 426 -4195 E -mail cltyofblalr @cl,blair,ne.us
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