MS-2015-00142.tif I
CITY OF GLAIR
218S.16THSTREET
== BLAIR, NEBRASKA 68008
(402) 426 -4191 - Phone
° = uilin Permit lic #ion
(402) 426 -4195 -FAX
MS - 2015 - 00142 A ' °mrs 01 a� www.blairnebraska.org
03!1612015 MI-9c Residential March 20, 2015
LOCATIONORMPROVEMENT. 9348 Co Rd P35, Blair, NE 68008
r ARCHITECT:
r GENERAL Pella Products of Omaha and Lincoln i
r OWNER: Mark A And Deborah A Frederick CONTRACTOR:
9845 S 142nd St
9348 Co Rd P35 OMAHA, NE 68138
BLAIR, NE 68008 -0000
I
I
NATURE OF WORK STRUCTURE
WindowiDoor Replacement Pirmary Residence
PROJECT NAME
PERMIT EXPIRES 03/16/2017
9348Co Rd P35 - 160316- Window ESTIMATED COMPLETION DATE 3116/2015
DESCRIPTION OF WORK
Taking out fireplace and adding a window.
I
DEPOSIT PAID BY: SITE PLAN SUBMITTED: NA
Contractor
REScheck/COMcheck SUBMITTED: NA
DEPOSIT STATUS: BUILDING PLANS SUBMITTED: Received
1. No work will be started before a permit is ISSUED AND FROSTED,
2, For commercial permits, a set of plans for this project must be submitted to the Nebraska State l=ire 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 Of'cial, shall constitute sufficient ground for the revocation of any permit issued which was based on the approval of this
application.
Date
Signature of Applicant
i
i
c
I
I
I
�S
Promiso
ok
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 lasing 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
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.
1
C actorlOwner Contractor /Owner
C
City of Blair
j t"
Date