MS-2014-00238_0001.tif i
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CIt"YOF GLAIR
218 S. 16TH STREET
BLAIR, NEBRASIKA68008
Building Permit Applicati ( 402) 426-4 - Phone
(402) 426-419S - FAX
M -2014 -00238 �' ++a 61 ��� www.biairnebraska.org
05I20l2014 bpeterse MiSC Residential May 20, 2014
LOCAT10NOFIMPROVEMENT: 739 N 10th Ave, Stair, NE 68008
ARCHn,r--T: GENERAL Blackshirt Exteriors
WER: Thomas J And Maurits J Churchill CONTRACTOR 733 Hill St Ste B
739 N 10th Ave LINCOLN, NE 68502
BLAIR, NE 6800840000
SELECTED CH ARACTERISTICS OF eR
NATURE OF WORK PROPOSED USE
Roofing/Soffit/Eaves/Gutters Primary Residence
PROJECT NAME PERMIT EXPIRES 0511912016
739N10thAve 140520- Roofing ESTIMATED COMPLETION DATE 7/2012014
DESCRIPTION OF WORK
Re- roofing with asphalt shingles and replacing vinyl siding along with all new windows going in the existng openings.
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DEPOSIT PAID BY: SITE PLAN SUBMITTED: NA
Contractor
RESchecklCOMchsck SUBMITTED: NA
DEPOSIT STATUS: BUILDING PLANS SUBMITTED: NA
$50
AFF ADAVIT oF APPLICANT
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 codeslordinances 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
application. ,q
Date
Signature of Applicant
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CITY OF 1 , NEBRASKA
Phone 402-426-4191
REC ED P
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ADDRESS
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CITY, STATE ZIP CODE p
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THANKYOU K IS 9OPY FOR YOUR RECORDS.
NO
EIVED BY j
Pounds Printing, Blair, NE 68008
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Promise °
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,
addition or accessory building valued under $10,000.
A $50.00 refundable deposit is being collected for all misc. permits. i
The City reserves the right to not refund this deposit if any of the fallowing
conditions occur during the construction period: i
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.
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I hereby agree to the above conditions, and understand that should any or I
all of the above situations occur, the building permit deposit SMALL be forfeited or
discounted upon the discretion of the City of Blair, Building and Inspections
Department.
Contractor/ Contractor /Owner
City of Blair
Date