MS-2015-00855.tif CITYOF BLAIR
218 S.16TH STREET
BLAIR,NEBRASKA 68008
(402)426-4191 - Phone
.� Building Permit Application
...,,:.��,�a (402)426-4195-FAX
MS-2015-00855 �Om/se of arc www.blairnebraska.org
IN
10/07/2015 bpeterse MISC Residential October 7,2015
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b LOCATIONOFIMPROVEMENT: 2374 Hollow Rd, Blair, NE 68008
ARCHITECT:
*, GENERAL Romeros Dream Builders LLC
� OWNER: Timothy Charles Cape CONTRACTOR:
4525 B St
2374 Hollow Rd Omaha, NE 68106
;
BLAIR,NE 68008-0000
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NATURE OF WORK STRUCTURE
Storm Repair Primary Residence
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PROJECT NAME PERMIT EXPIRES 10/06/2017
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2374HollowRd-151007-2014 Storm Damage 12/31/2015
ESTIMATED COMPLETION DATE
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DESCRIPTION OF WORK
Roof, Siding and Windows.
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
a. pleatio �--
Signature of Applicant Date