RN-2015-00252.tif f
CITY OF BLAIR
218 S.16TH STREET
BLAIR, NEBRASKA 68008
(402) 426 -419 - Phone
B uilding P ermit
A pplication (402) 426 -419 - FAX
iili ) www.blairnebraska.org
RN -2015 -00252 A ` O j�hSa Ot Q °� RES -NEW April 24, 2015
Residential
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0411512015
LOCATIONORMPROVEMENT: 1420 Fieldcrest Dr, Blair, NE 68008 Diamond Homes LLC
GENERAL
y ARCHITECT: CONTRACTOR:
12367 Merriam Dr
` OWNER: Diamond Homes, Llc BLAIR, NE 68008 -00
12367 Merriam Dr
BLAIR, NE 68008 -00
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STRUCTURE
NATURE OF WORK Primary Residence
New Construction 04/23/2017
PERMIT EXPIRES
PROJECT NAME 12/11512W5
142OFieldcrestDr- 150415 -New Residential
ESTIMATED COMPLETION DATE
DESCRIPTION OF WORK
3 bath, 2 story, 2 car garage with unfinished basement. Trussed roof.
4 bedroom,
SITE PLAN SUBMITTED:
Received
DEPOSIT PAID BY:
Contractor RESchecklCOMcheckSU13MITTED: Received
DEPOSIT STATUS: BUILDING PLANS SUBMITTED:
Received
$500
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permit is ISSUED AND POSTED.
4. No work will be started before a p stem.
t mus
for this project be submitted to the Nebraska State a Fire Mars
d septic Sy hat's Office for review issuance of
permits, a set of plans heating and acknowledges this building p , ventilating and
2. For commercial p permit application does not constitute i
3. Separate permits are required for electrical, plumbing, this permit application shall not be commenced until a
4. The undersigned owner or agent understands
this building permit. It is further understood thaticntruct n covered by accordance with the specifications set forth
copy of a permit signed by the Building above and
issued. in a n of or misrepresentation o e of Nebraska. osed work
rees to perform the p omissio
e from this application without approval of the
5.The undersigned owner or agent ag of Blair and the St or nY royal of this any alteration or chang
sed on the app
in accordance with the codes /ordinances of the City ermit issued which was ba
fact with or
without h shall suffic sufficient groundgfordthe r revocation of any p , /�
Building official, , - , Q 7
application. Date
Signature of Applicant
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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.
Contractor /Owner Contractor /Owner
City of Blair
Date
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of a�
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BUILDING PERMIT SUPPORTING DOCUMENTS
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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.
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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.
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Owner /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 cifyofblair @ci,blalcne,us Eo