PB-2013-00471.tif CITYOF BLAIR
u. 218 S. 16TH STREET
BLAIR, NEBRASKA 68008
�! Building Permit Application (402) 426 -4191 - Phone
'I ' �o``��� (402) 426 -4195 -FAX
PE- 201 3- 0047 I
rse of a www.blairnebraska.org l
10/11/2013 POLEBARN Residential October 11, 2013
LOCATIONORMPROVEMENT: 947 Skyline Dr, Blair, NE 68008
ARCHITECT:
GENERAL SELF
OWNER: Brad Alan And Jane Ann Jaworski- Anderse
CONTRACTOR:
h 9411:18Wthe Dr Blair, NE 68008
BLAIR, NE 68008 -1859
,Y
a
s ^� `" x .5r`� ,..r = "^; wS �` s .: f,<.., _. _ ..,.; `�*-r ; �s� „z. � �.o- .,....� z-' M... 7,..,. ' '-T,�• `�f .a"'. z'".f � � .' �,;, � i",
�.�'^r.
NATURE OF WORK PROPOSED USE
New Construction secondary structure
i
I
PROJECT NAME PERMIT EXPIRES 10111/2015
947SkylineDr- 131011 -Pole Barn
ESTIMATED COMPLETION DATE 10/11/2015 �
i
DESCRIPTION OF WORK j
40 x 80 metal pole barn with fine rock floor, no electrical or plumbing, one garage door, one walk thru
I
i
DEPOSIT PAID BY: SITE PLAN SUBMITTED: Received
Contractor
REScheck/COMcheckSUBMITTED: NA
DEPOSIT STATUS: BUILDING PLANS SUBMITTED: Received
i
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 wi ut the intention of the undersigned or any alteration or change from this application without approval of the
Building,,(;c' ,shall constitute sufficient ground for the revocation of any permit issued which was based on the approval of this
ap H r ior�;"
Signature of Applicant Date t(
T
uTY O
O
o mIse oS a�
�I
BUILDING PERMIT SUPPORTING DOCUMENTS
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.
I '
I
I
�
I
I have read the above disclosure and accept this building permit documentation on my
own behalf as uming full responsibility as the owner /contractor for this project.
Owner Occupant Contractor
City of Blair Date
I
r
OIPOPtVNIIV "'.
218 South 16th Street • Blalr, Nebraska 68008 • 402 - 426 -4191 • Fax 402 -426 -4195 E -mall dtyofblalr @ctbla(r.ne.us
...........
p romise om ise 0
BUILDING PERMIT DEPOSIT AGREEMENT
A $500130 re undable deposit is being collected for any new commercial, new
je ---, nd any additions, remodels and accessory building valued $10,000 or
e the a
�e 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 $60.00 refundable 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
Department.
Contractor/Owner
City of Blair
ate
C ITY OF BLAI NEBRAS
Phone 402 -426 -4191
RECEIVEDOF: -
ADD_ RESS
as'
CITY, STATE, ZIP CODE
1i rr`^Il.i li )_i »• {. 0 7iq'•.,:
~� 5 ) 1
\ JIA
THANK YOU KEER HIS COPY FOR YOUR RECORDS.
N 3449
RECEIVED DY
Pounds Printing, Blair, NF 08000
I
I
I
i