MS-2011-00563_0001.tif NOV -I -2006 02:02 FROM: TO :4024264195 P.4f4
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CITY OF BLAIR
218 S. 96TH STREET
BLAIR, NEBRASKA 68008
Building Perm l icati n (402)426- 4199- Phone
MS -201 1 -0 563 a s ad;,�+ (402) 426 -4196 - FAX
m�. of a www.blaimebrasko.org
12123/2011 bpeterse Misc Residential Qecember23, 2011
LOCAMNOPIMPRQVEMENT: 9776 Pine Crest Rd, Blair, NF. 08008
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ARCHITECT;
" GENERAL, Walley's Heartland Construction
® +` Joseph J And Lola M Nigrin CONTRACTOR: 13601 A St
9776 Plnecrest Rd OMAHA, NE 68144
BLAIR, NE 68008.0000
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NATURE OF WORK PROPOSED USE
Misc. Permit Prlrmary Residence
PROJECT NAME PERMIT EXPIRES 1212212013
077sPlnoCrestRd- 111223 - 1100fing ESTIMATED COMPLETION DATE 2911 -02 - 29
DESCRIPTION OF WO RK
Re- roofing home with asphalt.
DEPOSIT P AID BY: SITE PLAN SUBMITTED: NA
NA
REScheck/COMahack SUBMITTED: NA
DEPOSIT STATUS: BUILDING PLANS SUBMITTED: NA
N/ A
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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 Ofte for review.
3. Separate permits are required for electrical, plumbing, hosting, 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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iignatur of plicant Date