1056 Fairview Application.tif CITY OF BLAIR
218 S. 16TH STREET
BLAIR, NEBRASKA 68008
B uilding Pe r It App licatio n (402) 426-4191- Phone
te a° (402) 426 -4195 - FAX
AD-2012-00558 e of a� www.blairnebraska.org
12/06/2012 ADDITION Residential December 7, 2012
LOCATIONOFIMPROVEMENT: 1056 Fairview Dr, Blair, NE 68008
ARCHITECT:
GENERAL SELF
OWNER: Jack A And Christine A Sarnowski CONTRACTOR:
1056 Fairview Dr Blair, NE 68008
BLAIR, NE 68008 -0000
Y
NATURE OF WORK PROPOSED USE
Addition Primary Residential
PROJECT NAME PERMIT EXPIRES 06/05/2013
1056FairviewDr- 121206 - Enclose existing 6/30/2013
deck ESTIMATED COMPLETION DATE
DESCRIPTION OF WORK
Enclose existing deck. will have electric and heat. -as per owner -12 -6 -2012
DEPOSIT PAID BY: SITE PLAN SUBMITTED: Received
Contractor
REScheck/COMcheckSUBMITTED: NA
DEPOSIT STATUS: BUILDING PLANS SUBMITTED: Pending
1
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
9pplication.
ignature of Applicant Date
City of Blair Paid Invoice
{ 218 S 16th Street Page 1 of 1
Blair, NE 68008
DATE INVOICE #
Se °, a Phone: (402) 426 -4191 12/7/2012 2012 -01381
Fax: (402) 426 -4195
PAID DATE 12/7/2012
ACCOUNT:
SELF
PERMIT NUMBER AD- 2012 -00558
Blair NE 68008
1056 Fairview Dr
BC BECKS ADD LOT 8 BLK 2 115 PC 8
Phone:
Blair, NE 68008
Date Status Payment Amount
12/7/2012 Original Due 832.00
12/7/2012 Paid Check receipt # 32310 / ck #2465 ( -) 832.00
Total Paid 832.00
1 hereby certify that i have read and examined this application and know the same to be true and correct. All
provisions of laws.
Signature of Contractor or Authorized Agent
Save Time & Money with Online Permits and Inspections. Go To: www.buildingdepartment.com
CITY Of
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BUILDING PERMIT SUPPORTING DOCUMENTS
This building permit packet includes various items dealing with particular code
requirements and /or building permit requirements. It in no way includes ALL particular
code items. Also, it is your responsibility to know the 2009 International Building
Code requirements that apply to your project. Please understand this packet is only
designed and distributed to aid you in your building permit process. A copy of the
International Building Code is available for your use at the Blair Public Library.
I have read the above disclosure and accept this building permit documentation on my
own behalf assuming full responsibility as the owner /contractor for this project.
f'
Owner /Occupant ontractor
/ -
City of Blair ®ate
218 South 16th Street • Blair, Nebraska 68008 • 402 - 426 -4191 • Fax 402 -426 -4195 • E -mail cityofblair @ci,blaicne,us "
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promise
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 refundable 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.
I 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
discounted upon the discretion of the City of Blair, Building and Inspections
Department.
Contractor /Owner , ontractor /Owner
City of Blair
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