MS-2013-00111.tif CITYOF BLAIR
218 S. 16TH STREET
BLAIR, NEBRASKA 68008
Building Permit Application (402) 426 -4191 - Phone
(402) 426 -4195 - FAX
MS- 2013 -00111 10 /Se of quo www.blairnebraska.org
04/17/2013 JDP eterse MISC =Residential April 17, 2013
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LOCATIONOFIMPROVEMENT: 1758 Grant St, Blair, NE 68008
D ARCHITECT:
p GENERAL SELF
0- OWNER: Michael L And Sherry L Hansen CONTRACTOR:
1758 Grant St Blair, NE 68008
BLAIR, NE 68008 -0000
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NATURE OF WORK PROPOSED USE
Fence Primary Residence
PROJECT NAME PERMIT EXPIRES 04/17/2015
1758GrantSt- 130417 - Remodel and Fence 5/30/2013
ESTIMATED COMPLETION DATE
DESCRIPTION OF WORK
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4' chain link fence to enclose backyard. j
DEPOSIT PAID BY: SITE PLAN SUBMITTED: Received
Owner
REScheck/COMcheckSUBMITTED: NA
DEPOSIT STATUS: BUILDING PLANS SUBMITTED: NA
$50
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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 Offi ial, shall constitute sufficient ground for the revocation of any permit issued which was based on the approval of this
a piication.
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Date
Signature of Applicant
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CITY OF ' 9 NEBRASKA
Phone 402 - 426 -4191
RECEIVED OF
ADDRESS
CITY, STATE, ZIP CODE
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THANK YOU KEEPTHIS COPY FOR YOUR RECORDS.
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RECEIVED BY
Pounds Printing, Blair, NE 68008
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FENCE PERMIT SUPPORTING DOCUMENTS
This supporting document includes information dealing with particular zoning
requirements and /or fence permit requirements. It in no way includes ALL particular
zoning items. Also, it is your responsibility to know the City of Blair Zoning Ordinance
Section 1102 requirements that apply to fences, walls and hedges. Please understand
this document is only designed and distributed to aid in your fence permit process. A
copy of the City of Blair Zoning Ordinance is available for your use at the Blair Public
Library or on our website at www.blairnebraska.org
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I have read the above disclosure and accept this building permit documentation on my
own behalf ass ming full responsibility as the owner /contractor for this project.
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O Aer/Offcupant Contractor
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City of Blair f� Date
218 South 16th Street • Blair, Nebraska 68008 • 402 - 426 -4191 • Fax 402 - 426 -4195 E -mail cityofblair @ci.blalr.ne,us ooPOa.r.
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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 pr acct sory building valued under $10,000. j
A $50.00 undable deposit is being collected for all misc. permits.
e 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.
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Co ractor /Owner Contractor /Owner
City of Blair
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