MS-2012-00377_0001.tif CITY OF BLAIR
r 218 S. 16TH STREET
BLAIR, NEBRASKA 68008
building Permit Application (402)426 -4191 -Phone
MS- 2012 -00377 �,4�' (402) 426 -4195 -FAX
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m,5� nt a www.blairnebraska.org
09/11/2012 bpeterse MISC Commercial September 11, 2012
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".� LOCATIONOFIMPROVEMENT: 1061 Grant St, Blair, NE 68008
ARCHITECT:
GENERAL Olson & Stewart Construction Inc.
OWNER Black Hills Ne Gas Utilities Co,llc CONTRACTOR: PO Box 271
PO Box 1400 Blair, NE 68008
RAPID CITY, SD 57709 -1400
NATURE OF WORK PROPOSED USE
Patio /Driveway Primary Commercial
PROJECT NAME PERMIT EXPIRES 09/11/2014
1061GrantSt- 120911 -Concrete Pad
ESTIMATED COMPLETION DATE 10/1512012
DESCRIPTION OF WORK
Re- locating existing building due to installation of test well. Rod visited site with Tim with Black Hills and ok °d
relocation.
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DEPOSIT PAID BY: SITE PLAN SUBMITTED: NA
NA
REScheck /COMcheck 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 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