MS-2013-00212.tif CITYOFBLAIR
218 S. 16TH STREET
° BLAIR, NEBRASKA 68008
Building Permit Application (402) 426-4191 -Phone
r\ a (402) 426 -4195 - FAX
MS- 2013 -00212 �'��„ �f Q� °y' www.blairnebraska.org
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06/19/2013 MISC Commercial June 20, 2013
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a LOCATIONORMPROVEMENT: 250 S Industrial Park Dr, Blair, NE 68008 j
—1 ARCHITECT: �°
i GENERAL Graham Construction, Inc.
OWNER: Terra,,NNitrogen Lmtd Partnership CONTRACTOR: 13210 Centennial Rd Ste 1
x£ 4 Parkwa to 400 Omaha, NE 68138
ti DEERFIELD, IL 6 2542
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NATURE OF WORK PROPOSED USE
Misc. Permit Primary Commercial -CF Industries
PROJECT NAME PERMIT EXPIRES 06/19/2015
250SIndustrial ParkDr- 130619 - Concrete
Foundation ESTIMATED COMPLETION DATE 7/19/2013
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DESCRIPTION OF WORK
Concrete foundation for heater at CF Industries.
DEPOSIT PAID BY: SITE PLAN SUBMITTED: Received
Contractor
REScheck /COMcheck SUBMITTED: NA
DEPOSIT STATUS: BUILDING PLANS SUBMITTED: Received
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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
Buildin Official, shall constitute sufficient ground for the revocation of any permit issued which was_based on the approval of this
ppl °ea ion.
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ignature of A�pi cant
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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 efundable 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 l
Department. �
on /Owner Contractor /Owner
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City of Blair
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BUILDING PERMIT SUPPORTING DOCUMENTS
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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.
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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.
Owner /Occupant ntractor'
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City of Blair
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218 South 16th Street • Blair, Nebraska 68008 • 402 - 426 -4191 • Fax 402 - 426 -4195 E-mail cltyofblalr @cl,blair.ne.us
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COMMERCIAL PLANS SUBMITTAL FORM
Date: � -) � - 13 Permit Number: M 3 66
Address of job site: 2.5
Description of submittal:
Number of plan sets submitted:
Name of person delivering the plans: LD s ,� u
Company name of delivery person:
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Phone number of delivery person: (` 02)
Person we should contact if we have questions about these plans:
Contact person: Company name:
Position with company:
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Office Phone number: ('0_2f gfl - 96? f
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W - e ll Phone riumber : v , r
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E -Mail: � L ) - S M o q r_o US O .M
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SABuilding Dept. FormsTormsTlans Submittal Form- 2- 9- 2012.doe
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218 South 16 #h Street ! 81p1 r, Nebraska 68008 + 402 -42b 4141 •Fax 402-426-4195 � E mall c.'ilyofbtair @cl,blalr,ne ;u's i
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