RN-2010-00178.tif i
CITY OF BLAIR
218 S. 16TH STREET
BLAIR, NEBRASKA 68008
B uilding P ermit Application (402)426- 4191 -Phone
() 426-4195 - FAX
RN -2010 -00178 10 /S o , a � ° www.blairnebraska.org
10121/2010 RES -NEW Residential October 21, 2010
LOCATIONOFIMPROVEMENT: 1192 S 13th Ave, Blair, NE 68008
ARCHITECT:
n GENERAL Les Johnsen Construction LLC
®V OWNER: Les Johnsen Construction, Inc CONTRACTOR: 902 Meadow Dr
902 Meadow Dr Blair, NE 68008
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BLAIR, NE 68008 -0000
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NATURE OF WORK PROPOSED USE
New Construction Primary Structure
PROJECT NAME PERMIT EXPIRES 10/20/2012
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1192S13thAve- 101021 -1 ESTIMATED COMPLETION DATE
2011 -05 -31
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DESCRIPTION OF WORK
Residential New Construction -3 bedrooms, 2 bath, unfinished basement with bath rough -in, 10x30 rear wood deck,
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19x5 concrete stoop in front, 3 car garage
DEPOSIT PAID BY: SITE PLAN SUBMITTED: Received
Contractor
REScheck /COMcheckSUBMITTED: Received
DEPOSIT STATUS: BUILDING PLANS SUBMITTED: Received
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1. No work will be started before a permit is ISSUED AND POSTED. w
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
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fact with or without the intention of the undersigned or any alteration or change from this application without approval of the
Building Official, shall con711 t sufficient ground for the revocation of any permit issued which was based on the approval of this
application. /
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Date
Signature ofAn_pli ant
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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
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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. j
° Con ractor /,Owner Contractor /Owner
City of Blair
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Date