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CITYOF BLAIR
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218 S. 16TH STREET
BLAIR, NEBRASKA 68008
B uilding Permit Application (402) 426 -4191 - Phone
(402) 426 -4195 - FAX
MS- 2014 -01238 p � ° � /se of a www.blairnebraska.org
07/14/2014 MISC Residential July 14, 2014
LOCATION OF IMPROVEMENT: 1169 S 13th Ave, Blair, NE 68008
ARCHITECT:
x � GENERAL SELF
® OWNER: Joel T And Ashley C Bacon CONTRACTOR:
Blair, NE 68008
f 1169 S 13th Ave
BLALIR, NE 68008 -0000
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NATURE OF WORK STRUCTURE
Storm Repair Primary Residence
PROJECT NAME PERMIT EXPIRES 0711312016
1169S13thAve- 140714 -2014 Storm Damage
ESTIMATED COMPLETION DATE 1213112014
DESCRIPTION OF WORK
Roog, siding, gutters, windows
DEPOSIT PAID BY: SITE PLAN SUBMITTED: NA
Contractor
REScheck/COMcheck SUBMITTED: NA
DEPOSIT STATUS: BUILDING PLANS SUBMITTED: NA
_ ---
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 j
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
application
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Date
$ tyre of Applicant
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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 Bus only
designed and distributed to aid you in your roofing Code requirements that apply your project. Please understand this document i
---- 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.
4
O Occupant Contractor
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City of Blair Date
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218 South 16th Street • Blair, Nebraska 68008 • 402- 426 -4191 • Fax 402 - 426 -4195 E -mail cityofblalr @d.blair.n9'us
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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.
t 5 10--- 00 fundable 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.
hereby agree to the above conditions, and understand that should any or
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.
ctor /Owner Contractor /Owner
City of Blair
Date