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CITYOFBLAIR
218 S. 16TH STREET
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BLAIR, NEBRASKA 68008
Budding Permit Application (402) 426 -4191 - Phone j
(402) 426 -4195 - FAX
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S- 2014 -00875 ise of a�� www.blairnebraska.org
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07/07/2014 ShellyJ MISC Residential July 7, 2014
a LOCATION OF IMPROVEMENT: 749 N 14th St, Blair, NE 68008
ARCHITECT:
GENERAL Millard Roofing & Gutter Co.
OWNER: Michael J And Heather R Mckinnis CONTRACTOR: 14545 Industrial Rd
Omaha, NE 68144
749 N 14th St
BLAIR, NE 68008 -0000
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NATURE OF WORK STRUCTURE
Storm Repair Primary
PROJECT NAME PERMIT EXPIRES 07/06/2016
749N14thSt- 140707 -2014 Storm Damage
ESTIMATED COMPLETION DATE 1213112014
DESCRIPTION OF WORK
Reroof, gutters and window repair
DEPOSIT PAID BY: SITE PLAN SUBMITTED: NA
Contractor
REScheck/COMcheck SUBMITTED: NA
DEPOSIT STATUS: BUILDING PLANS SUBMITTED: NA
$50
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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 f
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
application.
Date
Signature of Applicant
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ROOF PERMIT SUPPORTING DOCUMENTS
This supporting document includes information dealing with particular code
requirements and/or roofin g p ermit requirements. It in no way includes ALL p
Iso it is your responsibility to know the 2 this docu Y
009 Internati0naleB Il only
code items. A
ements that apply,to your project. Please understand
Code requir our roofing p ermit process. A copy of the
designed and distributed to aid you in Y 'our use at the Blair Public Library.
International Building Code is available for y
I have read the above disclosure and accept this buildin p ermit documentation on my
for this project.
own behalf assuming full responsibility as the owner/contractor
Owner /Occupant
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City of Blair
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all cliyofblair @cl r,ne,us
218 South 16th Street • Blair, Nebraska 68008. 402 - 426 -4191 • Fax 402 -426 -4195 8 -m `
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B UILDING PE 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.
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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�nactor/Owner Contractor /Owner
City of Blair
Date