PB-2013-00479.tif CITYOFBLAIR
218 S. 16TH STREET
BLAIR, NEBRASKA 68008
-� Building Permit Application (402) 426 -4191 - Phone
(402) 426 -4195 - FAX
PB- 2013 -00479 ms of www.blairnebraska.org
10/16/2013 POLEBARN Residential October 22, 2013
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LOCATIONOFIMPROVEMENT: wy ,
13339 H 91 Blair NE 68008
ARCHITECT:
GENERAL Jorgensen Contracting, Inc.
OWNER: Victor G And Myrna J Brown CONTRACTOR: 530 Front St
91 13339 State Hwy Blair, NE 68008
r BLAIR, NE 68008 -0000
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NATURE OF WORK PROPOSED USE
Addition Pole Barn
PROJECT NAME PERMIT EXPIRES 10/16/2015
13339Hwy 91- 131016 -Pole Barn
ESTIMATED COMPLETION DATE 4/16/2014
DESCRIPTION OF WORK
New part of barn to replace old part that was destroyed by wind /storm damage.
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DEPOSIT PAID BY: SITE PLAN SUBMITTED: Received
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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
ilding Official, shall constitute sufficient ground for the revocation of any permit issued which was-based on the approval of this
ap licaon.
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gnature of Ap �licant 1 ,
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a BUILDING PERMIT DEPOSIT AGREEMENT
�0 refundable deposit is being collected for a new commercial, new
I, and any additions, remodels and access o building valued $10,000 or
greater at . time of your building permit applicat'
A $200.00 refu able deposit is being Ilected for any residential remodel,
addition or accesso building valued u er $10,000.
A $50.00 refundable dep it is b ` g collected for all mist. permits.
The City reserves the ri t not refund this deposit if any of the following
conditions occur during a constr ion period:
1) Theft of wa r service by the umber, owner or general contractor.
2) All perm° have not been obtai
3) All re ired inspections have not be obtained.
4) Oc panty occurs prior to a final inspe 'on.
5) a project is completed without a final in pection being done.
Storm Water Management Plan inspection not obtained. (If Required)
If an or all of these situations occur during construction, you may forfeit your
de sit.
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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ntr c r/ w tir" Contractor /Owner
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.
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O ner cc pang ontractor j
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City of Blair to
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218 South 16th Street • Blalr, Nebraska 68008 • 402 - 426 -4191 • Fax 402- 426 -4195 E -mall cltyofbra1r @c1.bla1r.ne.us • �'
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