MS-2015-00520.tif i
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CITYOF BLAIR
218 S. 16TH STREET
,1 BLAIR, NEBRASKA 68008
B uil d ing Permit App (402) 426 -4191 -Phone
r ��d (402) 426 -4195 - FAX
MS- 2015 -00520 A��`n;se of °° www.blairnebraska.org
06122/2015 =WSC Residential June 23, 2015
LOCATION OF IMPROVEMENT: 101 Riverview Dr, Blair, NE 68008
ARCHITECT:
GENERAL SELF
OWNER: Glen E And Joyce S Hudson CONTRACTOR:
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� 101 Riverview Dr
Blair, NE 68008
sff BLAIR, NE 68008 -0000
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NATURE OF WORK STRUCTURE
Patio /Driveway Primary Residence
PROJECT NAME PERMIT EXPIRES 0612112017
101 RiverviewDr- 150622 - Concrete Patio 7/22/2015
ESTIMATED COMPLETION DATE
DESCRIPTION OF WORK
Extending original concrete patio to the length of the back of the house.
DEPOSIT PAID BY: SITE PLAN SUBMITTED: Received
Contractor
REScheck /COMcheckSUBMITTED: NA
DEPOSIT STATUS: BUILDING PLANS SUBMITTED: NA
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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 sed on the approval of this
application.
1.
S' na re of Applicant Date
CITY OF BLAIR, NEBRASKA
Phone 402 - 426 -4191
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THANKYOU KEER,THIS COPY FOR YOUR RECORDS.
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RECEIVED BY
Pounds Printing, Blair, NE 68008 j
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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,
a7'r- ccessory building valued under $10,000.
A undable 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 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
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.
*tr!c Wr/w��er Contractor /Owner
City of Blair
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