549 N 22nd Application.tif CITYOF BLAIR
218 S. 16TH STREET
BLAIR, NEBRASKA 68008
® Building Permit Application (402) 426 -4191 - Phone
(402) '426 -4195 - FAX
RE- 2015 -00613 p 'on se o , www.blairnebraska.org
07/2912015 REMODEL Residential July 29,20 5
LOCATIONOFIMPROVEMENT: 549 N 22nd St, Blair, NE 68008
® ARCHITECT:
� GENERAL Bart Moore Subcontracting, Inc.
OWNER: Wyatt Moore CONTRACTOR:
841 N 24th Ave
841 N 24th Ave Blair, NE 68008
BLAIR, NE 68008 -0000
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NATURE OF WORK STRUCTURE
Remodel
PROJECT NAME PERMIT EXPIRES 07/28/2017
549 N22ndSt- 150724 - addition
ESTIMATED COMPLETION DATE 8/30/2015
DESCRIPTION OF WORK
Remodel /small addition to front porch and rear laundry room. Reroof and siding.
DEPOSIT PAID BY: SITE PLAN SUBMITTED: Received
Contractor
REScheck/COMcheckSUBMITTED: NA
DEPOSIT STATUS: BUILDING PLANS SUBMITTED: Pending
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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 codeslordinances 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
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Signature of Applicant Date
CITY OF , NEBRASKA
Phone 402 - 426 -4191
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THANKYOU KEEP THIS COPY FOR YOUR RECORDS.
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Pounds Printing, Blair, NE 68008
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CITYOF BLAIR
218 S. 16TH STREET
BLAIR, NEBRASKA 68008
Building Permit Application (402) 426 -4191 - Phone j
(402) 426 -4195 -FAX
prO �Ise of gJOp www.blairnebraska.org
07/29/2015 ELECTRIC Residential July 29, 2015
LOCATIONORMPROVEMENT: 549 N 22nd St, Blair, NE 68008
ARCHITECT: j
� GENERAL SELF
® OWNER: Wyatt Moore CONTRACTOR:
841 N 24th Ave Blair, NE 68008
BLAIR, NE 68008 -0000
NATURE OF WORK STRUCTURE
Sub -Work New Const
PROJECT NAME PERMIT EXPIRES 07/28/2017
549N22ndSt- 150724 - addition
ESTIMATED COMPLETION DATE 8/30/2015
DESCRIPTION OF WORK
Electrical for new addition
I
DEPOSIT PAID BY: SITE PLAN SUBMITTED: NA
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 based on the approval of this
application.
Signature of pplicant t
CITY OF BLAIR
218 S. 16TH STREET
BLAIR, NEBRASKA 68008
Building Permit Application (402) 426 -4191 - Phone
(402) 426 -4195 - FAX
ise of Q www.blairnebraska.org
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07/29/2015 77 PLUMBING Residential July 29, 2015
LOCATIONOFIMPROVEMENT: 549 N 22nd St, Blair, NE 68008
ARCHITECT:
GENERAL SELF
OWNER: Wyatt Moore CONTRACTOR:
841 N 24th Ave Blair, NE 68008
BLAIR, NE 68008 -0000
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NATURE OF WORK STRUCTURE
Sub -Work New Const
PROJECT NAME PERMIT EXPIRES 07/2812017
549N22ndSt- 150724 - addition ESTIMATED COMPLETION DATE 813012015
DESCRIPTION OF WORK
Plumbing for washer only
DEPOSIT PAID BY: SITE PLAN SUBMITTED: NA
Contractor
REScheck/COMcheckSUBMITTED: NA
DEPOSIT STATUS: BUILDING PLANS SUBMITTED: NA
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
applica 'on.
Signature of pplicant to
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promise
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 ref ndable deposit is being collected for any residential remodel,
dition or essory 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 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.
W ontrtor /Owner Contractor /Owner
City of Blair
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Date