RE-2013-00021.tif i
CITY OF BLAIR
218 S. 16TH STREET
BLAIR, NEBRASKA 68008
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Buildin Permit Application
(402) 426 -4191- Phone
g (402) 426 -4195 - FAX
www.blairnebraska.org
RE- 2013 -00021
01/21/2013
REMODEL Residential January 23, 2013 7_
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LOCATIONOFIMPROVEMENT: 1324 Skyline Dr, Blair, NE 68008
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ARCHITECT: GENERAL Stirtz Construction Inc.
CONTRACTOR: 1413 Hwy 127
w OWNER: Phillip F Martens j
1324 Skyline Dr MONDAMIN, IA 51557
�i BLAIR, NE 68008 -0000
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PROPOSED USE
NATURE OF WORK Primary Residential
Remodel
PERMIT EXPIRES 01/21/2015
PROJECT NAME
1324SkylineDr- 130 -Remodel ESTIMATED COMPLETION DATE 1/21/2013
DESCRIPTION OF WORK
Remodeling basement, there will be a family room, 2 bedrooms and a bathroom.
DEPOSIT PAID BY:
SITE PLAN SUBMITTED: NA
Contractor
RESchecklCOMcheckSUBMlTTED: NA
DEPOSIT STATUS: BUILDING PLANS SUBMITTED: Received
1 No work will be started before a permit is ISSUED AND POSTED.
2. For commercial permits, a set of plans for this ctt lat to the
air condition ng and septic syst Office for review.
3. Separate permits are required for electrica , p lumb n 9 , heating, ven
itute issuance of
4. The undersigned owner or agent understands and l e covered by this permit application shall not co until a
this building permit. it is further understood that construction
copy of a permit signed by the Building Inspector is issued.
5. The undersigned owner or agent agrees to perfo th e
Blair andt he State of Nebraska.'tAny omission of or misrepresentation n work in accordance srepresentati nof
in accordance with the, codes /ordinances of the y
fact with or without the intention of the unoundgfortherrevocation o any r permig issued which was based on the approval of this
Building Official, shat stitute sufficient gr
applica 5
i Date
Sign a f App scant
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q promise o 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)
situations occur during construction, you may forfeit your
If any or all of these
deposit.
any or
I hereby agree to the above conditions, and understand that shou or I '
all of the above situations occur, the building permit deposit SHALL be forfeited
discounted upon the discretion of the City of Blair, Building and Inspections
Department.
Con r for . w er Contractor /Owner
City of Blair
1
Date
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BL
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WI-1- C O
ise of
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.
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.
caner /Occupant Co a or
City of Blair Date i
F 1 YRTYNI
218 South 16th Street •Nair, Nebraska 68008 • 402 - 426 -4191 • Fax 402- 426 -4195 E -mall cltyofblair @ci,blalr,ne.us