DR=2015-00364.tif -- CITY OF BLAIR
218 S. 16TH STREET
BLAIR, NEBRASKA 68008
i, (402) 426 -4191 - Phone
Building Permit Applicat
r (402) 426 -4195 - FAX
DR-2015-00364 ° o,W se o, Q www.blairnebraska.org
05/12/2015 bpeterse DECKRAMP Residential May 18, 2015
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LOCATION OF IMPROVEMENT: 1049 Westridge Dr, Blair, NE 68008
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ARCHITECT:
GENERAL Hayworth Enterprises LLC r
I OWNER: James R And Linda J Jorgensen CONTRACTOR:
€� 16505 Weir St
1049 Westridge Dr Omaha, NE 68135
BLAIR, NE 68008 -0000
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NATURE OF WORK STRUCTURE
Deck Primary Residence
PROJECT NAME PERMIT EXPIRES 05/17/2017
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1049WestridgeDr- 150512 -Deck �
ESTIMATED COMPLETION DATE 8/12/2015
DESCRIPTION OF WORK
10 x 20 deck on the back of the house.
DEPOSIT PAID BY: SITE PLAN SUBMITTED: Received
Contractor
REScheck /COMcheck SUBMITTED: NA
DEPOSIT STATUS: BUILDING PLANS SUBMITTED: Received
$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 o the approval of this
p lycation. -
i Applicant 4 a � te
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CITY OF BLAIR, NEBRASKA
Phone 402 - 426 -41
RECEIVEDOF:
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ADDRESS
CITY, STATE, ZIP CODE yy
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THANK YOU KEEP THIS COPY FOR YOUR RECORDS.
NO RECEIVED BY
I. Pounds Printing, Blau, NE 68008
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Promise
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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 re6ndable deposit is being collected for all misc. permits.
�he—C 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. j
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 j
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.
o ra for /Owner U Contractor /Owner
City of Blair
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