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10392 Application CITYOFBLAIR 218 S. 16TH STREET � BLAIR, NEBRASKA 68008 426 -4191 - Phone q wilding Permit Application { 402 > (402) 426 -4195 - FAX RN- 2015 -00549 b � °� /sB Of ° www.blairnebraska.org 1 0710112015 RES -NEW Residential July 9, 2015 : lr LOCATiONOF1MPROVE(NENT: 10392 Co Rd 26, Blair, NE 6800$ did IG ARCHITECT: GENERA! Woodland Homes Inc. . , OWNER: David M And Cynthia M Burns CONTRACTOR: a gal If 11205 S 150th St 6713 S 174th St Omaha, NE 68138 ' OMAHA, NE 68135 -0000 ,..:a_ ,.,xu•.i a _ -- r s NATURE OF WORK STRUCTURE New Construction Primary Residence PROJECT NAME PERMIT EXPIRES 06/30/2017 10392 Co Rd 26 150701•New Residential ESTIMATED COMPLETION DATE 121112015 DESCRIPTION OF WORK 2 bedroom, 2 bath ranch with 3 car garage and unfinished basement. Has trussed roof. I I i DEPOSIT PAID BY: SITE PLAN SUBMITTED. Received Contractor I2EScheck /COMcheck SUBMITTED: Received DEPOSIT STATUS; BUILDING PLANS SUBMITTED; Received 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, shalf ground for the revocation of any permit issued which was based on the approval of this a lication. � re of Applicant to i a l q promise 0 BUILDING PERMIT DEPOSIT AGREEMENT A $600.00 fundable deposit is being collected for any new commercial, new dent'a , 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 refundable deposit is being collected for all misc. permits. The City reserves the right to not refund this deposit if any of the following j 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. I &ntractor/Owner Contractor /Owner i I I I City of Blair Da i I PART Z Energy ConsertlAtlbn CNAG'ir �i~: Clarafi cation' _j e ggs and xim joist IunetioM 1 1 0 g �, CIriAE�+ SU (A�Ys Attio sooess op ufxin sealing to of the OuRdI119 haire been. added; to the list a s BGii�1G locatianseci g , �ltcatioax , •; xevent `�bebuild- , l e.IP[��Ii�i@ Thermal n. The nvelote. s = �a COn t 11o2,43 ba durably sGgeato t ltratio thermal envolcs ilar mataSials shall altowox dif£exen , sealing 3nethods betwe en. dissim shall. be ORO, gas The f0110wm•g bav sr mate t � tial e,ansion`d o ed or otherwise sealed witb an �'. keted.,•`weatltexsl, �� . ��9 . j Aal, suitable ox soliclmatexial s end L�eneteatlans, . �,,, d A313 seam s ky li g h t s, c 1, } 1` 'dn d �+ t lows! doo_9, enin s between•w''•dow' and door assembl?es and their xe� f an d fca ing. �' s� ecid�ra jam.:bs ' �. t7til%ty lyB netsations. '} � i a 5, � ceilings 0 10 hases adjaoentto the thexma anus ope, 'rr ;.� �. �} (je p� U "rt F Snee was . the axaga f com Gonditianed spaces, ;�; i s se arating g 7, ,W8118 and aeilix!g � e bb,d,tubs and shov s Q e�exioxwalts AOL /dwelling us ts. ''` �, �ox>nnpn` walla `between ;� � ; �� �L 035�'117710t1031, ,�,� g ©ther SOMOOS Gf Aitio hatch; BIM r / . joist lei l�/ 0 41 : y c f, JS ; Ceiling flim joist " , ` GQrners junq�Gns windows ' c reautre " 4 ` Door sealing!: # . ~ 4l 1 ? .J=. ' t ,,t• )• it 1= feotriGal !, o utlets Basement ms.µ 8 , e t window L , c x '' Not R Bill pla tes { '' cat souroea of air [eakaga : � I i sa k yf F�Y i��ro27iVS'zi7 O Of I)LAID a m /se BUILDING PERMIT SUPPORTING DOCUMENTS I This building permit packet includes various items dealing with particular code requirements and /or building permit requirements. It in no way includes ALL particular code items. Also, it is your responsibility 'to know the 2009 International Building Code requirements that apply to your project. Please understand this packet is only designed and distributed to aid you in your building permit process, A copy of the International Building Code is available for your use at the Blair Public Library, i i have read the above disclosure and accept this building permit documentation on my own behalf assuming full responsibility as the owner /contractor for this project. Owner /Occupant Ac�n�tractor City of Blair # <;POn,oar, 218 South 16th Street -Blair, Nebraska 68008 • 402 -426 -4191 ^ Fax 402 -426 -4195 E -mail cltyofblalr @dbialr,ne.us l I PBMT JuJi.sdic& Of cj� q� ' ' Nebraska 2* Nebraska 68008 (402) 426 -4195 : �,�•}•�,: 426 -4191 h j licationD'ate: i pp ' ' • Tob Address VP PLOW ' Mail Address Pbona Qwner ZiP • • Mail Address Confragtor - 2. d New C7 Addition ❑Alteration 1�_ �epair C1 �epfacemeni 9. Class of Work: a C014MERC� d itESli)ENTlAL ` DescribaWork; C C 1)? FERS ' ' . 'Sons Iea�1'ump a eatpum IAix Gonditionex (Ter TTnit) $•15.00 TO-As urnac�(H • p 100000BTU1 3Ton ....... ,1.,,,.,,,....1 Centxal A1G Up to and including purnace AIG S'uznacel.ETea�EPumpl?� Conditioner (.der Unit) ,$25,00 4 o,£Units over 100,000 BTU / 3 Ton..,.... • �umaca ReiSigeration. �J' ni- tslGoolersllines /Compzessox -- Co�ezcial Completion Date; (New oxReplaeement) (per Unit) ..11.11. .1.1.11.; 11.............. .11.111. • • 1, 11.1.1••1. J30RD ,' Chart B U 1• ,.. fee 0, .. � ' U'ptox00, 000 ...........................:.. ..$15,00 111 +� $db $30,00 �r�� �•�� '��'�• � , 100,000- 500, 000 11,1..,.111:1111.1111.1.1111.1 Q0100 500, 000 -1, 000, 000., ,.,. ....................•60.00 ir] C�tartta left)...,...,.,,.,,...,.. 1, 000; 000 -1) 7 1,750, 000.,....,,1.,,• ..`•..'..' Boilex(useB , Q�ex :... 1.,. ;,..,.....,.1,,.,.$100,.0 , �ppl�anee�en�ans. ..,1 ...................$i0,0.0r • • uctsy .. 1111.11.1 $15,00 • Notice ' ' D sten.1.1..1.1..1111.1.11. .. hexebyoe i�5't�atIhayeleadat&Mnutedtius x $600 . application, and know t$a same to be true and ctfoiis type f Gras /Aix Outlets................. pirst 5 provisionsoflav „s and ordinancesgonee ndhereinor dditional_o_. $ workwi7.lbe cOmxuadir� Ylhetliei sp not. The granting od`aparn�it does notpresume othex authoxiry to violate ox cance egl the pxovzslons of any,• • „$80,00 state ox local lav rulating construction or the RadianE ........ Neat Systems /Car a er S stem” ' ance of construction' �iPg Y perform $50,00 M o d u iaxllome ..... - edASent � ,,.$25 Signatua of Coafractor or Alltho �erm%$Tssuancel ee•••.••`••" Total . i Yes d No ci NIA . Oafs Gurrentlricen..e o n,� ile . �T�EDO TO SP `� ; {t�1� Appgoved By'. 4 008 °`U- c"•f.�. I8dc&A of City 0 blab, IWUIUW'S � 218 gouth 16 Steet Blair, xebTaska 68008 ; a (402) 426.4195 (402) 426 -4191 ApplicatioaDafe: "� 3?emui: Fee: I Tob Address phone Zip . Omer Mail Address 1. Zip Phone Contractor Mail Address 2, p NeW CJ'Addifiion C1 Alteration • ©Repair B Replaceme nt: 3. Glass of Work: d COMMERCIAL C3 RESIDENTIAL , pescribeWork: 4. P,Cr'EI FEES Comments: ModulaxHome,•.,,•,.,•.• are .... $50,00 'pype a €I`ixtuxe ResidentmSilgle Stall $12,00 X , ,, • ,,,,,,,,,,,,,,,,Matti Stall$23,00 Roaghln:Bath $S OOX ! • Additional' Sinks ...................... $6,00% S1opSinkJJ�aUndryTray /��ain,,,.,$6,00� , i afex Heatex $10.00 X Notice e OaWl � � da atexp'aacet.,,,, ,,;,,$6.00X J ' xherebycerlifythatIhavareadandexaminedthis B ggountain;,,,,,,••,•.........• „ anplicationsarrllnZOw ;a saanc tot74 h'uc and conccf. All . _provisions of laws andordinmees governingthis of work wM be compliad with whether q ee�ed herein ox B f1ow�Gxeasd Txap..... not. The granting of a permit does not presume to gii o ' authorityto violate orcancelthepro •visionsofaayother watev96171Ge ,,.,.,.,•• $15 `••••••••••` sfateorloealla vrregalatingconsiruotIori Y�e,, ...•,•,•,,,,,,,,, Se performance of coasfradion, "$15,00 , �;-- -- W �atexats,,,,,,,••. $15.00 awzl Sprinkler Sysfem....,,,.•,,,$10,00- Spr; ier System (Commercial) „$3 aslV�aferFiping System (Commercial), $50,00 $25,00 Si�afure of C ontractor orAufhoriaed Agent Pex7vit Zssuanee Feo................ 0~o tat Current�icense onFila C7 Yes b No rl NIA Data �Ob]ment: D�.A '13 (1�T TIDES SP1FCB) TICS 15` Y OrtJR 'EktNtiT WHEN I'lu LY �l AL .A��rove� Bys � • Rev.2d0g - i t i Identify from j3 Parcel & Address � iE t-) Parcel & Address € 1 '1 Ownership Parcels 390036641; S{ 4 Taxlots j f E4 c r s! f Location ; 2,706,834.848 634,725 994 Feet I Field Value � Assessed 'value 13235 > Q14 -1673 � BookF'aga " Calc Area i 10.0328 _ Dissolve Shape Polygon Legal TL 73 19 -13 -12 12B PC 35 10,11 A _ I Maill Mail2 5713 S 174TH ST Mail3 OMAHA, NE f OBJECTID 80037 OBJECTID_1 165622 Owner BURNS, DAVID M & CYNTHIA M OwnID 2039226 ParcelID 390036641 ParcelIdentity 390036641 ParcelType Single Owner Parcel PID 390036641 Problems PropClass 4000 PropType FARM Shape.area 439207,33173 1 Shape,len 2930,613333 Situs VACANT _ TransLevel 0 2ipcode 63135 -0000 H _ t f Identified 2 futures � i i Wednesday, Jul 01, 2015 11:30 AM I Brandy Petersen i From: Tanna Wirtz [Tanna @washingtoncountyne.org] Sent: Wednesday, July 08, 2015 2:20 PM To: Brandy Petersen Subject: RE: Address Please.:) 10392 County Road 26, Blair, NE 68008 Tanna Wirtz Washington County Planning and Zoning Administrator 1555 Colfax St. Blair, NE 68008 402 - 426 -6872 tanna@washingtoncountyne.org planning@washingtoncountyne.org From: Brandy Petersen [ mailto :bpetersen@ci.blair.ne.us Sent: Wednesday, July 01, 2015 11:58 AM To: Tanna Wirtz Subject: Address Please.:) Tanna, Please see attachments. Thank you!! i Brandy Petersen Building Clerk City of Blair 218 S 16th St Blair NE 68008 Phone: 402 - 426 -4191 Fax: 402 - 426 -4195 I i