489.tif i
i
CITYOF BLAIR
218 S. 16TH STREET
BLAIR, NEBRASKA 68008
f (402) 426 -4191 - Phone
t
' Building Permit Applicati (402) 426 - 4196 - FAX
www.blairnebraska.org
MS- 2014 -0048 9a `On� /se of Q mom
Residential June 23, 2014
06/23/2014 bpeterse MISC
LOCATIONOFIMPROVEMENT: 933 N 28th St, Blair, NE 68008
b
ARCHITECT: GENERAL SELF
A CONTRACTOR:
OWNER: John M Maschman Blair, NE 68008
933 N 28th St
BLAIR, NE 68008 -0000
7
W ORK STRUCTURE
NATURE OF W Primary Residence
Storm Repair
PERMIT EXPIRES 06/22/2016
PROJECT NAME
933N28thSt- 140623 -2014 Storm Damage
ESTIMATED COMPLETION DATE 12/31/2014
DESCRIPTION OF WORK
Re- Roofing with asphalt
DEPOSIT PAID BY:
SITE PLAN SUBMITTED: NA
Contractor REScheck/COMcheck SUBMITTED: NA
DEPOSIT STATUS: BUILDING PLANS SUBMITTED: NA
$50
im
1. No work will be started before a permit is ISSUED AND POSTED bmitted to the Nebraska State Fire Marshal's Office for review.
2. For commercial permits, a set of plans for this project must be su
3. Sep permits ermits are required for electrical, plumbing, heating, ventilating and air conditioning, and septic system. uance of 4. The undersigned constitute
iss
owner or agent understands and acknowledges this building permit apps app l i cation shall not
copy commenced until a
this building permit. It is further understood that s ssued°tion covered by this perms app
copy of a permit signed by the Building Inspector '
accordance with the spe cif i c a t i ons
r a agent agrees to perform the proposed work in sion of or misrepresentation of
5. The undersigned owner o g g orris
in accordance with the codes /ordinances of the City of Blair and the State of Nebraska. Any
ication without fact with royal of the
h or without the intention of the undersigned or any alteration or Chang Ova based on the approval of this
Building Official, shall constitute sufficient ground for the revocation of any perms sued which
a 'cation.
Z Z/
i
Dat
S gnature of Applicant
I
I
Y
I
C
„� •yam^- '
CITY Of t)LAIQ
77774-_
"0",
e of a
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
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.
O er /Occupant Contractor
i
City of Blair D4Dto
r
EQUAL HOUSING
OPPORTUNITY
218 South 16th Street • Blair, Nebraska 68008 • 402 - 426 -4191 • Fax 402 - 426 -4195 E -mail cityofblalr @cLblair,ne,us
kk
4
I
t
t
k
t
NIt
- gy p,,• ay- :`�, :t .,;�.�;;�^�`{. 0`
OX AJ
• 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,
add' i or accessory building valued under $10
$50.00 r fundable deposit is being collected for all misc. permits.
T 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. '
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.
A� r
Co t ctor /Owner Contractor /Owner
City of
Blair
/7-3 Z
e