ms-2015-268_0001.tif i
CITY OF BLAIR
218 S, 16TH STREET
BL AIR, NEBRASKA 68008 j
B uilding Permit lic (402) 426 -4191 - Phone
a�. °e (402) 426 -4'195 - FAX
IBS - 2U I5- i3CIZ68 °firs„ of a ° www. blairnebrasko.org WEEMEM
0411712015 MISC Res €dential April 17, 2015
LOCATIONOFIMPROVEMFNT: 10363 Crystal Lake Dr, Blair, NE 6800E
ARCHITECT:
GENERAL McKtnnis Roofing & Sheet Metal
OWNER: Allen L And Slnead A Chaffee CONTRACTOR:
x 164 S 1st St
10363 Crystal Lake Dr Blair, NE 68008
BLAIR, NE 68008.0000
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NATURE OF WORK STRUCTURE
I
Storm Repair Primary Residence
PROJECT NAME PERMIT EXPIRES 04116
rystalLakel3r- 150417- 2014Storm
Damage ESTIMATED COMPLETION DATE 12/3112018
Damage
DESCRIPTION OF WORK
Roof and Gutters on house, roof on shed.
DEPOSIT PAID BY: SITE PLAN SUBMITTED: NA
Contractor
REScheck/COMcheck SUBMITTED: NA
DEPOSIT STATUS: BUILDING PLANS SUBMITTED NA
$50
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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
Building Official, shall constitute sufficient ground for the revocation of any permit issued which was based on the approval of this
application.
Signature of O plicant Date