MS-2015-00626.tif i
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CITYOF BLAIR
218 S. 16TH STREET
BLAIR, NEBRASKA 68008
� Building Permit Application (402) 426 -4191 Phone
�a (402) 426 -4195 - FAX
MS-2015-00626
° arse of a ° ° �� www.blairnebraska.org
08103/2015 MISC Residential August 3, 2015
LOCATIONOFIMPROVEMENT: 8953 John Deere Ln, Blair, NE 68008
s ARCHITECT:
GENERAL MJ Builders
OWNER: David P And Nancy E Nielsen CONTRACTOR:
87697 580th Ave
8953 John Deere Lin Dixon, NE 68732
t BLAIR, NE 68008 -0000
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NATURE OF WORK STRUCTURE
Roofing /SoffitlEaves /Gutters
Primary Structure j
PROJECT NAME PERMIT EXPIRES 08/0212017
8953John DeereLn- 150803 -1 9/30/2015
ESTIMATED COMPLETION DATE
DESCRIPTION OF WORK
Reroofing with asphalt on two buildings and three buildings with steel
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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.
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
applicat'
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Signature of Applicant
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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
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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,
addit on 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.
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Contractor /Owner Contractor /Owner
City of Blair
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