AC-2014-01877 (2).tif i
CITYOFBLAIR
218 S. 16TH STREET
BLAIR, NEBRASKA 68008
Building Permit Application (402) 426 -4191 -Phone
(402) 426 -4195 - FAX
AC- 20 ;se o , a o�`' www.blairnebraska.org
08104/2014 m7 JACCESS Residential August 8, 2014
LOCATIONOFIMPROVEMENT: 10281 Crystal Lake Dr, Blair, NE 68008
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ARCHITECT:
GENERAL SELF
Gregory D And Jolene M Kulus
OWNER: CONTRACTOR:
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rl 10281 Crystal Lake Dr Blair, NE 68008
BLAIR, NE 68008 -0000
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NATURE OF WORK STRUCTURE
New Construction Accessory Building
PROJECT NAME PERMIT EXPIRES 02/0212015
10281 Crystal LakeDr- 140804 - Accessory
Building ESTIMATED COMPLETION DATE 1014/2014
DESCRIPTION OF WORK
Accessory Building - no electrical and will sit on skids on a concrete pad.
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DEPOSIT PAID BY: SITE PLAN SUBMITTED: Received
Contractor
REScheck/COMcheck SUBMITTED: NA
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DEPOSIT STATUS:
BUILDING PLANS SUBMITTED: Received
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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
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
£- Buildi Official, shall consti to sufficient ground for the revocation of any permit issued which was ba on the approval of this
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CITY OF , NEBRASKA
Phone 402 - 426 -4191
RECEIVED OF.
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ADDRESS
CITY, STATE, ZIP CODE
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THANK YOU KEEPTHIS COPY FOR YOUR RECORDS.
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RECEIVED BY
Pounds Printing, Blair, NE 68008
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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
great a the
LaddA time of y our building permit application.
200.00 refundable deposit is being collected for any residential remodel,
itio� r accessory building valued under $10,000.
A $50.00 refundable deposit is being collected for all misc. permits.
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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.
ontractor/ e Contractor /Owner
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City of Blair
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BUILDING PERMIT SUPPORTING DOCUMENTS
This building permit packet includes various items dealing with particular code
requirements and /or building 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 packet is only
designed and distributed to aid you in your building 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.
er /Oc CO ant Contractor
City of Blair
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218 South 16th Street • Blair, Nebraska 68008 • 402 - 426 -4191 • Fax 402 - 426 -4195 E -mail cityofblair @cl,blalr,ne.us •.•xRe