MS-2015-00180_0001.tif i
CITYOFBLAIR
218 S. 16TH STREET j
BLAIR, NEBRASKA 68008
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(402) 426 -4191 - Phone I
Building Permit Application (402) 426 -4195 - FAX
MS -2015 -00180 ise of Q www.blairnabraska.org j
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03H9/2015 =bpeterse MISC Commercial March 20, 2015 I
LOCATIONOFIMPROVEMENT: 1440 State St, Blair, NE 68008
e ARCHITECT:
GENERAL Jorgensen Contracting, Inc.
OWNER: Duane And Barbara, Co- Trustees Moffatt CONTRACTOR.
530 Front St
4701 Country Ln Blair, NE 68008
BLAIR, NE 68008-0000
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NATURE OF WORK STRUCTURE
Storm Repair Commercial Building
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PROJECT NAME PERMIT EXPIRES 03/19/2017 I
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1440StateSt- 150319 -2014 Storm Damage ESTIMATED COMPLETION DATE 12/31/2015
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DESCRIPTION OF WORK
Replace roof, west and north wall metal, gutters and 3 north end doors.
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DEPOSIT PAID BY: SITE PLAN SUBMITTED: NA
Contractor
REScheck /COMcheckSUBMITTED: 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. 1
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
dI ci , sh stit e s fcient ground for the revocation of any permit issued which was based on the approval of this
appli do
S' ature of Applica Date
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