2130.tif CITYOFBLAIR
218 S. 16TH STREET
BLAIR, NEBRASKA 68008
(402) 426 -4191 - Phone
��� (402) 426 -4195 - FAX
1 ��Ise of a�a www . blairnebraska.org
08/1212014 MISC Residential August 12, 2014
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a LOCATION OF IMPROVEMENT: 1072 S 13th Ave, Blair, NE 68008
ARCHITECT:
GENERAL Valley Boys, Inc.
�z OVVNER: Randal E M eyer CONTRACTOR:
10547 Bondesson Cir
i 3143 215th St Omaha, NE 68122
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WOODBINE, IA 51579 -0000
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NATURE OF WORK STRUCTURE
Storm Repair Primary Residence
PROJECT NAME IT EXP IRES 0811112016
1072S13thAve- 140812 -2014 Storm Damage
EST IMATED I 12/31/2014
DESCR
R oof, gutters, siding, windows
DEPOSIT PAID Y: SITE PLAN SUBMITTED: NA
Contractor
Scheck/CO check SUBMITTED: NA
DEPOSIT STATUS: B UILDI N G PLANS SUBMITTE 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
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 Offi hall constitute sufficient ground for the revocation of any permit issued which was based on the approval of this
appl'
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Date
Signature of Applicant j
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BUILDING IT DEPOSIT
A $600.00 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
A $60.00 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.
law
Con actor /Owner Contractor /Owner
City of Blair
Date
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CITY
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PERMIT ROOF I
This supporting document includes information dealing with particular code
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requirements and /or roofing permit requirements. It in no way includes AL particular
code items. Also, it is your responsibility to know the ter ti
re uirements that ply your project. Please understand this document is only
Code q
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.
Owner /Occu nt
Contractor
City of Blair ate
low
218 South 16th Street ® Blair, Nebraska 68008 ® 402 - 426.4191 Fax 402.426 -4195 ® 8 -mall clfyofblair@dblalr ne,us