MS-2012-00416_0001.tif i
CITY OF BLAIR
218 S. 16TH STREET
BLAIR, NEBRASKA 68008
Building Permit Application (402)426- 4191 -Phone
MS-2012-00416 (402) 426 -4195 -FAX
° nf� s of n °° www.blairnebraska.org
09/26/2012 M — IS C Residential October 4, 2012
LOCATIONOFIMPROVEMENT: 2916 Westridge Dr, Blair, NE 68008
ARCHITECT.
GENERAL Donald Andersen
. OWNER: David C And Lana L Hiller CONTRACTOR: 410 Co Rd M
2916 Westridge Dr Oakland, NE 68045
BLAIR, NE 68008 -0000
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NATURE OF WORK PROPOSED USE
Roofing /Soffit/Eaves /Gutters Primary Residence
PROJECT NAME PERMIT EXPIRES 09/26/2014
2916 WestridgeDr- 120926 - Roofing
ESTIMATED COMPLETION DATE 9/2812012
DESCRIPTION OF WORK
Reroofing with Asphalt Shingles
DEPOSIT PAID BY: SITE PLAN SUBMITTED: NA
Contractor
REScheck /COMcheck SUBMITTED: NA
DEPOSIT STATUS: BUILDING PLANS SUBMITTED: NA
$50
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 Date