MS-2010-00191.tif CITY OF BLAIR
218 S. 16TH STREET
BLAIR, NEBRASKA 68008
"I Building Permit Application (402)426- 4191 -Phone
wF (402) 426 -4195 - FAX
MS- 2010 -00191 /se of gJep www.blairnebraska.org
10/26/2010 MISC Commercial November 10, 2010
LOCATIONOFIMPROVEMENT: 2242 Wright St, Blair, NE 68008
ARCHITECT: GENERAL Good Shepherd Lutheran Community
r. OWNER: Good Shepherd Lutheran Home CONTRACTOR: 2242 Wright St
p 2242 Wright St Blair, NE 68008
Blair, NE 68008
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NATURE OF WORK PROPOSED USE
Misc. Permit Propane Tank
PROJECT NAME PERMIT EXPIRES 10/25/2012
2242WrightSt- 101026- Propane Tank
ESTIMATED COMPLETION DATE 2010 -12 -31
DESCRIPTION OF WORK
500 gallon propane tank for an emergency generator.
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DEPOSIT PAID BY: SITE PLAN SUBMITTED: Received
Contractor
REScheck /COMcheck SUBMITTED: NA
DEPOSIT STATUS:
BUILDING PLANS SUBMITTED: NA I
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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
application
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Signature of Applicant
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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 r undable 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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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
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discounted upon the discretion of the City of Blair, Building and Inspections j
Department.
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Contractor/ caner Contractor /Owner
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City of Blair
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Date