RN-2010-00164.tif CITY OF BLAIR
218 S. 16TH STREET
BLAIR, NEBRASKA 68008
4 �j��"�(� �� 1 i'' 1 '��r� B uilding Permit Application (402)426- 4191 -Phone
�, ��' (402) 426 -4195 - FAX
RN- 20 he of q, www.blairnebraska.org
10/1512010 RES -NEW Residential October 29, 2010
LOCATIONOFIMPROVEMENT: 1417 Fieldcrest Dr, Blair, NE 68008
ARCHITECT:
-;° GENERAL Integrity Custom Construction, Inc.
r; OWNER: Ashley L Frederick CONTRACTOR: 218 S 201 St j
9348 Co Rd P35 ELKHORN, NE 68022
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BLAIR, NE 68008 -0000
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NATURE OF WORK PROPOSED USE
New Construction Primary
PROJECT NAME PERMIT EXPIRES 04/27/2011
1417FieldcrestDr- 101015 -New Residential
ESTIMATED COMPLETION DATE 2011 -10 -15
DESCRIPTION OF WORK
New Residential Structure -3 bedroom, 3 car garage, 2 bath, rear deck j
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DEPOSIT PAID BY: SITE PLAN SUBMITTED: Received
Contractor i
REScheck /COMcheckSUBMITTED: Pending
DEPOSIT STATUS: BUILDING PLANS SUBMITTED: Received
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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.
Signature of Applicant Date
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entify from: fi�Rarcel & Address
a Parcel &Address Location 93 555 �iQOr ��,5�#�.950i Fe6k j
B.. Ownership Parcels
... Fuld 'value �
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4• Taxlaks SooI'Rage 557 - 226 <'
CalcArea
Dissolve Shape Polygon
Legal 5C DEERFIELD RERLAT 2 LOT 8 PC 8 114
Ma il l i
Mail2 9348 CO RD R35
Mail3 BLAIR, NE �
SJE TID 1781
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OSJECTID_1 9631
owner FREDERICK, ASHLEY L
Own ; 209264
RarcellD '890082103
RarcelIdentiky 890082103 F
RarcelTrpe ; Single Owner Parcel
RID 890082103
Problems
RropClass ` 1000
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RropType ; RES
Shape Area 20724,55325
Shape Length 666,3647 _
Sikus VACANT
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TransLevel .
Zipcode 65005 -0000
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5ntified features
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Friday, Oct 15, 2010 08:41 AM
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City of Blair Due Invoice Summary
218 S 16th Street Page 1 of 1
Blair, NE 68008
DATE 11/10/2010
Phone: (402) 426 -4191
Fax: (402) 426 -4195
ACCOUNT:
Integrity Custom Construction, Inc.
218 S 201 St PERMIT NUMBER RN- 2010 -00164
ELKHORN NE 68022 1417 Fieldcrest Dr
Phone: 492 708 3142 BC DEERFIELD REPLAT 2 LOT 8 PC 8 114
Blair, NE 68008
Date Reference Number Invoice Number FeeCat Description Status Amount
10120/2010 RN- 2010 -00164 2010 -00252 0100020229 Building Permit Deposit Due 500.00
10120/2010 RN- 2010 -00164 2010 -00252 0100042024 Building Permit Fees Due 1412.00
10/20/2010 RN- 2010 -00164 2010 -00252 0100042024 Building Permit Issuance Fee Due 25.00
F Total Due 1,937.00
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I hereby certify that I have read and examined this application and know the same to be true and correct. All
provisions of laws.
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Signature of Contractor or Authorized Agent
Save Time & Money with Online Permits and Inspections. Go To: www.buildingdepartment.com
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