MS-2015-00666.tif i
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CITYOFBLAIR
218 S. 16TH STREET
BLAIR, NEBRASKA 68008
- Ulldlllg Permit Application (402) 426 -4191 - Phone
MS-2015-00666 9A�ofi (402) 426 -4195 - FAX
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0811212015 MISC Residential August 12, 2015
i LOCATIONOFIMPROVEMENT: 957 N 24th Ave, Blair, NE 68008
ARCHITECT:
GENERAL SELF
OWNER: Steven A And Nicole B Bolton CONTRACTOR:
957 N 24th Ave Blair, NE 68008
rK BLAIR, NE 68008 -0000
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NATURE OF WORK STRUCTURE
Patio /Driveway Primary Residence
PROJECT NAME PERMIT EXPIRES 0811112017
957N24thAve- 150812 -Patio ESTIMATED COMPLETION DATE 9/12/2015
DESCRIPTION OF WORK
Concrete patio in the back of the house.
DEPOSIT PAID BY: SITE PLAN SUBMITTED: Received
Homeowner
REScheck/COMcheckSUBMITTED: NA
DEPOSIT STATUS: BUILDING PLANS SUBMITTED: NA
$50
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
aRpficafion.
Date
Signature of Applicant
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BUILDING PERMIT DEPOSIT AGREEMENT
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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.
(dA $60.00 ref dable 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.
1 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.
ontractor /Owner Contractor /Owner
City of Blair
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