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MS-2014-00181.tif CITYOFBLAIR 218 S. 16TH STREET BLAIR, NEBRASKA 68008 Building Permit Application (402) 426 -4191 - Phone (402) 426 -4195 -FAX MS- 2014 -00181 6 01 a le\` www.blairnebraska.org 04/2412014 MISC Residential April 24, 2014 LOCATIONOFIMPROVEMENT. 2050 Lincoln St, Blair, NE 68008 ARCHITECT: �.r GENERAL F/S Contracting T CONTRACTOR: OWNER: Nathan P And Jessica Jo Kempcke 324 S 13th St f r 2050 Lincoln St Tekamah, NE 68061 BLAIR, NE 68008 -0000 wome IN / Y E p ttg c NATURE OF WORK PROPOSED USE Roofing /Soffit/Eaves /Gutters Primary Residence i PROJECT NAME PERMIT EXPIRES 04/23/2016 2050 LincolnSt- 140424 -Roof ESTIMATED COMPLETION DATE 5/24/2014 i DESCRIPTION OF WORK Re- roofing house with asphalt shingles. DEPOSIT PAID BY: SITE PLAN SUBMITTED: NA Contractor REScheck /COMcheck SUBMITTED: NA DEPOSIT STATUS: BUILDING PLANS SUBMITTED: NA mof s 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 j fact with or without the intention of the undersigned or any alteration or change from this application without approval of the uilding Official hall constitute sufficient ground for the revocation of any permit issued which was based on the approval of thi i ti � Date j G' I nature ! ' I I E?1 p P17tz!IC! f AECEIVFI7C� } ' x f 4 ,+?. r a T ftDDRESS n r a 3 r Z{3XS7A E ZfPCODE r }: t � r J At _ S ^t f Z n g?-T-' Tl X W�R n f {y� r s t § J d' t wl az 1 � r 110A V�t CE �I ©Y f3 fi3t R 0E�D5 7 -N0 } i j promise 0 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, I addition,or accessory building valued under $10,000. 50.00 efundable deposit is being collected for all misc. permits. e 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. on r r/ wrier Contractor /Owner City of Blair i I D e i � T .............. . . . . . . . . CI - - - - - - - - ...... 41. °I nise of av i ROOF PERMIT SUPPORTING DOCUMENTS This supporting document includes information dealing with particular code requirements and /or roofing permit requirements. It in no way includes ALL particular code items. Also, it is your responsibility to know the 2009 International Building j Code requirements that apply to your project. Please understand this document is only ! designed and distributed to aid you in your roofing permit process. A copy of the International Building Code is available for your use at the Blair Public Library. I 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. A er/Occupant ontractor `l City of Blair e ou.xouswo 0 P 218 South 16th Street • Blair, Nebraska 68008 • 402 - 426 -4191 • Fax 402 - 426 -4195 E -mail cltyofbialr @cl.blair.ne.us