RE-2014-00124.tif i
CITYOF BLAIR
218 S. 16TH STREET
BLAIR, NEBRASKA 68008
Building Permit Application (402) 426-4191- Phone
(402) 426 -4195 - FAX
RE- 2014 -00124 ArO MIse of Q ° www.blairnebraska.org
04104/2014 REMODEL Residential April 16, 2014
- LOCATIONOFIMPROVEMENT: 1250 Nebraska St, Blair, NE 68008 j
ARCHITECT; GENERAL SELF
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OWNER: Albert D And Velma, Eta[ Boyce CONTRACTOR:
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1250 Nebraska St Blair, NE 68008
BLAIR, NE 68008 -0000
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NATURE OF WORK PROPOSED USE
Remodel Primary Residence
PROJECT NAME PERMIT EXPIRES 04/03/2016 j
1250NebraskaSt- 140404 - Residential 6/4/2014
Remodel ESTIMATED COMPLETION DATE
DESCRIPTION OF WORK
Remodeling bathroom, kitchen area and laundry.
DEPOSIT PAID BY: SITE PLAN SUBMITTED: NA
Contractor �
REScheck/COMcheckSUBMITTED: NA
DEPOSIT STATUS: BUILDING PLANS SUBMITTED: Received
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
app cation.
Signature of Applicant Date
CITY OF s NEBRASKA
Phone 402- 426 -4191
RECEIVED OF:
ADDRESS
CITY, STATE, ZIP CODE
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THANK YOU KEEPTHIS COPY FOR YOUR RECORDS.
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RECEIVED BY, ;
Pounds Printing, Blair, NE 68008
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PERMIT SUPPORTING DOCUMENTS
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This supporting document includes information dealing with particular code
requirements and /or permit requirements. It in no way includes ALL particular code
items. Also, it is your responsibility to know the 2009 International Buildtg Code
requirements that apply to your project. Please understand this document is only
designed and distributed to aid you in your permit process. A copy of the International
Building Code is available for your use at the Blair Public Library.
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I have read the above disclosure and accept this permit documentation on my own
behalf assuming full responsibility as the owner /contractor for this project.
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Owner /Occupant Contractor
City of Blair ate
218 South 16th Street • Blair, Nebraska 68008 • 402 - 426 -4191 • Fax 402 - 426 -4195 E -mail cityofblair @ci,blalr,ne,us oW <_...
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BUILDING PERMIT DEPOSIT AGREEMENT
A $500.00 refundable deposit is being collected for any new commercial, new
esidenti , and any additions, remodels and accessory building valued $10,000 or
gr r at the 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 $50.00 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.
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Contractor /Owner -- &(ontr9ctor/Owner
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City of Blair
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Date
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