MS-2015-00034.tif i
CITYOF BLAIR
r 3" 218 S. 16TH STREET
BLAIR, NEBRASKA 68008
Building Permit Application (402) 42s -4191 -Phone
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u a 402 426 -4195 - FAX
MS -2015 -00034 e of a o www.blairnebraska.org
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01/27/2015 ShellyJ MISC Residential =January 27, 2015
LOCATIONORMPROVEMENT: 283 N 23rd St, Blair, NE 68008
ARCHITECT: GENERAL SELF
OWNER: Dean J And Lisa R Thoene
CONTRACTOR:
283 N 23rd St Blair, NE 68008
BLAIR, NE 68008 -0000
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NATURE OF WORK STRUCTURE
Storm Repair Primary
PROJECT NAME PERMIT EXPIRES 0112612017
283N23rdSt- 150127 -2014 Storm Damage ESTIMATED COMPLETION DATE 1211/2015
DESCRIPTION OF WORK
Reroof, gutters and siding for house and garage. Replacing two small windows and combining to one.
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DEPOSIT PAID BY: SITE PLAN SUBMITTED: NA
Contractor
REScheck /COMcheckSUBMITTED: NA
DEPOSIT STATUS: BUILDING PLANS SUBMITTED: NA
$50
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
,—a 1 cation.
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Signatu a of Applicant
Date
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ROOF PERMIT SUPPORTING DOCUMENTS
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This supporting document includes information dealing with particular code
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requirements and /or roofing 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 document is only
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 /Occupant Contractor
City of Blair Date
218 South 16th Street • Blair, Nebraska 68008 • 402 - 426 -4191 • Fax 402 -426 -4195 E -mail cityofblair @ci,blair,ne.us oe >owr "'