MS-2015-00669.tif r
II I
ROOF PE ITS CHEC IST
(Check.Off)
Fax In- person city hall
Information sent by: Email O
formation will be returned b Email _ Fax In- person city hall ® Cn
In y• ®.
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Master Company Signed Packet on file: Yes No
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(Date & Initial)
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Building Application: Sent
Returned Signed
Building Deposit Form: Sent
Returned Signed �
Roof Supporting Sheet: Sent Returned Signed
Roof Code & Check off: Sent
Paid: Picked up:
(Initial)
Roof Code Check off sheet returned: Yes No
Inspection Scheduled:
CITY0FBLAIR
218 S. 16TH STREET
BLAIR, NEBRASKA 68008
Building Permit Application (402) 426-4191 - Phone
k, (402)426- 4195 - FAX
MS-2015-00669 10 he 01 q ua www.blairnebraska.org
kathy l MISC MMMMTResidential August 13, 2015
08 mmm7�
LOCATION OFIMPROVEMENT: 1243 Colfax St, Blair, NE 68008
ARCHITECT. GENERAL Romeros Dream Builders LLC
CONTRACTOR:
OWNER: William Eugene Ryan 4525 B St
M. 1243 Colfax St Blair, NE 68008
BLAIR, NE 68008-0000
771777
M MR,
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NATURE OF WORK STRUCTURE
Primary Structure
Roofing/Soffit/Eaves/G utters
PERMIT EXPIRES 08112/2017
PROJECT NAME r
1243ColfaxSt-150813-201 Storm Damage ESTIMATED COMPLETION DATE 8/3112015
DESCRIPTION OF WORK
Reroofing, gutters, siding, concrete
DEPOSIT PAID BY: SITE PLAN SUBMITTED: NA
Contractor REScheck/COM check SUBMITTED: NA
DEPOSIT STATUS: BUILDING PLANS SUBMITTED: NA
$50
N
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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. accordance with the specifications set forth above and
5. The undersigned owner or agent agrees to perform the proposed work in ebraska. Any omission of or misrepresentation of
in accordance with the codes/ordinances of the City of Blair and the State of N
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 3
Date
Signature of Applicant
I
CITY Of I)LAI
i
wise of a�
ROOF PERMIT SUPPORTING DOCUMENTS
I
This supporting document includes information dealing with particular code
requirements and /or roofing 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 document is only
designed and distributed to aid you in your roofing 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 Contractor
ity of Blair Date
oeo
218 South 16th Street • Blair, Nebraska 68008 • 402 - 426 -4191 • Fax 402 - 426 -4195 E -mail cityofblair @cl.blair,ne,us aa,