MS-2014-02890.tif l
CITYOFBLAIR
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218 S. 16TH STREET
_ BLAIR, NEBRASKA 68008
�\ Building Permit Application (402) 426 -4191 -Phone
5- 20'84- ®2890 �` 7,f p a a� ( www.bla nebraska or
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1/2612014 bpeterse MISC Commercial September 30, 2014
LOCATIONOFIMPROVEMENT: 2005 Davis Dr, Blair, NE 68008
ARCHITECT:
GENERAL Stonebrook Roofing Inc,
OWNER- A Corp St Francis Borgia Church CONTRACTOR
701 P Street #304
444 Regency Pkwy Dr Ste 310 LINCOLN, NE 68508
OMAHA, NE 68114 -3779
MATURE OF WORK STRUCTURE
Storm Repair St Francis Borgia Catholic Church
'ROJECT NAME PERMIT EXPIRES 09/2912016
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2005DavisDr- 140926 -2014 Storm Damage
ESTIMATED COMPLETION DATE 12/3112014
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)ESCRIPTION OF WORK
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Remoge and replace 275 square asphalt shingles and 18 sq of EPDM Membrane.
)EPOSIT PAID BY: SITE PLAN SUBMITTED: NA
Contractor
REScheck/COMcheck SUBMITTED: NA
)EPOSIT STATUS:
BUILDING PLANS SUBMITTED: NA
£50
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No work will be started before a permit is ISSUED AND POSTED.
For commercial permits, a set of plans for this project must be submitted to the Nebraska State Fire Marshal's Office for review.
Separate permits are required for electrical, plumbing, heating, ventilating and air conditioning, and septic system.
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.
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 cplqstitute sufficient ground for the revocation of any permit issued which was based on the approval of this
applicatio .
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Ina t re o Applic t Date
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CITY OF BLAIR, NEBRAW(A
Phone 402-426-4191
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ADDRESS
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CITY, STATE, ZIP CODE
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THANK YOU
I T IS CIOPY FOR YOUR RECORDS.
No 377174-f4i'
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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
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.
Co ract Owner Contractor/Owner
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City of Blair
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