DR-2013-00113.tif CITYOFBLAIR
218 S. 16TH STREET
BLAIR, NEBRASKA 68008
IE� (402) 426 -4191 - Phone
Building Permit Application
yr y a' (402) 426 -4195 - FAX
DR- 2013 -00113 m;s� �;, a� www.blairnebraska.org
04/18/2013 DECKRAMP Residential April 23, 2013
LOCATIONOFIMPROVEMENT: 1123 Westridge Dr, Blair, NE 68008
ARCHITECT:
k GENERAL SELF
OWNER John E And Lorrie J Samson CONTRACTOR:
1123 Westridge Dr Blair, NE 68008
BLAIR, NE 68008 -0000
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NATURE OF WORK PROPOSED USE
Deck Primary Residence
PROJECT NAME PERMIT EXPIRES 04/18/2015
1123WestridgeDr- 130418 -Deck ESTIMATED COMPLETION DATE 5115/2013
DESCRIPTION OF WORK
Wood Deck to be replaced on the back of the house.
DEPOSIT PAID BY: SITE PLAN SUBMITTED: Received
Contractor
REScheck /COMcheck SUBMITTED: NA
DEPOSIT STATUS: BUILDING PLANS SUBMITTED: NA
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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.
Date
Signature of Applicant
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CITY OF , NEBRASKA
Phone 402 - 426 -4191
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RECEIVED OF:
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ADDRESS
CITY, STATE, ZIP CODE
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THANK YOU KEEP THIS COPY FOR YOUR RECORDS.
NO Ll' RECEIVED BY
Pounds Printing, Blau, NE 68008
Apr 2413 08:26a Mike Jansen Custom Decks 402 - 896 -1676 p.1
CITY Of 15LAIQ
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BUILDING PERMIT SUPPORTING D®GUMENTS
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This building p ermit packet includes various items dealing with particular code
requirements andlor building permit requirements. It in no way includes ALL particular
code items. Also, it is your responsibility 'to know the 2 009 International Buildin
Code requirements that apply to your project. Please understand this packet I the
designed and distributed to aid you in your building permit process. A copy of
International Building Code is available for your use at the Blair Public library.
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I have read the* above disclosure and accept this building permit documentation on my
own behalf assuming full responsibility as the ownerlcontractor for this project.
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Owne €loccupant Contractor
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City of Blair Date
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218 South 16th Street Blot Nebraska 68008 • 402 - 4264191 • Fax 402-426-4195 ' E-mail cWotbialr @cl,blak.ne.us
Apr 2413 08:27a Mike Jansen Custom Decks 402 - 896 -1676 p.2
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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 or accessory building valued under $10,000.
A $50.00 refundable deposit is being collected for all mist. permits.
The City reserves the right to not refund this deposit if any of the following
conditions occur during the construction period: j
1) Theft of water service by the plumber, owner or general contractor. j !
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
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hereby agree to the above conditions, and understand that should any or .
all of the above situations occur, the building pen d eposit SHALL be forfeited or
discounted upon the discretion of the City of Blair, Building and Inspections
Department.
Contract&]Owner Contractor /Owner
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City of Blair
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