SA-2013-00553.tif Dec. 20. 2013 4.25PM CITY OF BLAIR (402.426.4191) No, 1971 P. 2
CITYOFBLAIR
218S.16TN STREET
eU1iR,NEBRASKA68008
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Building P e rm it Application (402) 426,4491` -Phone
(402) 4 26 -4196 - FAX
A- 201'3.00553 ° `aM�, e of a � ° ° � a www.blairoebranka.org
1 112712013 SIGN -AWN Commercial December 17, 2013
LOCATIONOFIMPIRMMII 2028 Kettle Dr, Blair, NE 68008
r 'ARCHITECT:
e GENERAL SELF
t CONi'RACTOR:
y a OWNER: Casey's Retail Company
PO Box 3001 Blair, NE 68000
ANKENY, IA 50021.0000
NATURE OF WORK PROPO$ED USE
Sign Primary Commercial - Casey's
PROJECT NAME: PERMIT EXPIRES 11/27/2015
20281(eilieDr•13119g -New Commercial E$TIMATED COMPLETION DATE 11/27/2016
DESCRIPTION OF WORM
Wall signs and monument for new Casey's convenience store.
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DEPOSIT PAID BY: SITE PLAN SUBMITTED: Received i
Contractor _
R5Scheck1COMcheckSUBMITTED: NA
DEPOSIT STATUS: BUILDING PLANS SUBMITTED: Received
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1. No work will be started' before a permits 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 duos 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
applic ion.
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Signature of Appilcant f Date
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Dec.. 2.0. 20113 4-26PM ciTY OF BLAIR (402, 4261 41W No. 1971 P, 3
BUILDING PERMIT DEPOSIT AGREEM9NT
A'$50000 refundabI6 deposit i,9 being co ll ec t e d far any n - new commercial, new
i ng valued $T,000 or
residential' ' and any additions, mmodils and: accessory build!
greater ti of your building permit 9P.PIIcAtI
for any residential 'remodel,
A $200-00 refundable deposit is being collected
addition or a00d8s*0rY buildiriqvalued under $%000
A.$90.0 1 0 refundable, deposit It being . collected for all misc. permits:
The City reserves the right to not refund Wis. deposit if any of 'the following
conditions occur �during the construction period*
I I Theft of
water service by the plumber, owner or general contractor.
2) All permits have not been obtained.
3) All required inspkflons have not been obtained.
4) Occupancy occurs prior to:afinal ihspection.
6) Tie project is complefed without a final inspeotjoh 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,.
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I hereby agree to the above conditions, and understand that should any or
occur, the. building permit depositSHALL, be forfeited or
all of,the above situations
disoduh 'upon: the discretion of the City of 1316. Building, and Inspections
Department
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Contractor/owner
or/owner cowpon,
City of.BIair
D
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Dec. 20. 201.3 4 :26PM CITY OF &LAIR (402, 426.419.1 No, 1911 P. 4 I
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CITY n �y: 1 1
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BUILDING PERMIT'SUppowriNG 'DOCUMENTS
This building permit packet includes various items dealing with particular code
requirements and/or building permit requirements. It to noway includes: ALL particular
code items. Also, 1t. f6 your responsibility to know the 2009 international Buildin
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
lnternational. Building Code is availabla for your use at the: glair Public Library.
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have read the above`discTasurO and accept thls pe rmit docdmentat on my --
own behalf :assuming full responsibility as the owner/contractor for this project.
AtAL
Owner /Occupant S ��..C(j ontractor I
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City of Blair
®ate
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118 South 16th Sfreet Blair, Nebtaskca 66068 , 402426-4191 ' Fak 402 =426 -4195 E•mall cltyofbtalr@ct:bldKr e.us
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GENERAL STORE
CASEY'S GENERAL STORES, INC.
P.O. Box 3001 > One Convenience Blvd,, Ankeny, Iowa 50021 -8045 ® 515- 965 -6100
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December 13, 2013
City of Blair
Attn: Brandy Petersen
218 S. 16 Street
Blair, NE 68008
RE: Casey's General Store
2028 Kellie Dr, Blair, NE
Dear Brandy,
Enclosed, please find check number 2475374 in the amount of Two Thousand Three Hundred
Sixty -seven Dollars $2,367.00 for payment of the building permit fee for the new Casey's General Store.
Also included is check number 2475373 in the amount of One Hundred Forty -five Dollars ($145.00) for
payment of the sign permit. Casey's is currently bidding for the general contractor for this project, and
the information will be provided to the City of Blair once available. Please issue the permits and forward
to my attention at your earliest convenience.
If you have any questions, please contact me at 515 - 963 -3829 or via email at
I<atie.derouchey @caseys.com. Thank you for your assistance!
Sincerely, I�VK
Katie DeRouchey
Real Estate /Store Development
Enclosure
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