1056 (2).tif CITY0FBLAIR
218 S. 16TH STREET
BLAIR, NEBRASKA 68008
- - - - - - - (402) 426-4191 - Phone
t Application
Building Permi
(402) 426-4196 - FAX
EL-2013-00329 "'7/se 01 www.blairnebraska.org
I N
08/14/2013 ShellyJ ELECTRIC Residential August 14, 2013
LOCATION OF IMPROVEMENT: 1056 Fairview Dr, Blair, NE 68008
ARCHITECT:
GENERAL SELF
CONTRACTOR:
0 OV\NER: Jack A And Christine A Sarnowski
.....................
1056 Fairview Dr Blair, NE 68008
. . . . . . . . . . 11 BLAIR, NE 68008-0000
. ........ . UT
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NATURE OF WORK PROPOSED USE
Sub-Work New Const Primary Residential
PROJECT NAME PERMIT EXPIRES 08/14/2015
1056FairviewDr-121206-Enclose existing ESTIMATED COMPLETION DATE 12/1/2014
deck
DESCRIPTION OF WORK
Electrical for all season porch
DEPOSIT PAID BY: SITE PLAN SUBMITTED: NA
Contractor
REScheckICOMcheck SUBMITTED: NA
DEPOSIT STATUS: BUILDING PLANS SUBMITTED: NA
N/A
NOME—
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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
r)application.
Date
Signature of Applicant
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Cl' Ot'l) AILJ-
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wi o f av
ELECTRIC HOMEOWNER VERIFICATION FOR
states the following: I
print your full name on line above:
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1. I am the owner of the single family dwelling for which I am applying for an
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electrical permit.
Address:
2. I am applying for an electrical permit for a single family dwelling and it is or will
be my principal residence.
3. I will install and connect the electrical wiring for myself, without compensation
or pay from or to, any other person.
E
4. I have sufficient knowledge of the 2005 National Electrical Code requirements to
make an electrically safe and mechanically secure installation which will meet the
minimum standards referenced in 81 -2104.
5. I am aware of all inspections required prior to a final.
6. I will call twenty -four (24) hours in advance for an inspection. I am also aware
that it is not the inspector's job or duty to be my instructor in electrical wiring.
7. I am aware that Nebr. Rev. Stat. 81 -2143 makes it a Class 1 misdemeanor to
make a false statement on a request for inspection.
8. By signing this form I am stating the above information is true an correct.
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Homeowner /Applicant Signature Date
I
EOUAIHOUSINO
OPPORTUNITY
218 South 16th Street • Blair, Nebraska 68008 • 402 -426 -4191 • Fax 402 - 426 -4195 E -mail cityofblair @ci.blair,ne,us
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