11377 Bridgeview Application.tif CITYOF BLAIR
218 S.16TH STREET
BLAIR,NEBRASKA 68008
_ - Building Permit Application (402)426-4191 -Phone
a (402)426-4195-FAX
RE-2016-00016 10n,ise of Q`'° www.blairnebraska.org
Shell J REMODEL Residential January 19 2016
01/15/2016 Y rY
LOCATION OF IMPROVEMENT: 11377 Bridgeview Dr, Blair, NE 68008 L,
ARCHITECT:
GENERAL self
r
OWNER: Robert P And Susan Marie Juza CONTRACTOR:
St
11377 Bridgeview Dr Blair, NE 68008
BLAIR,NE 68008-0000
k
NATURE OF WORK STRUCTURE
Remodel Primary Structure
PROJECT NAME PERMIT EXPIRES 01/18/2018
11377BridgeviewDr-160115-Remodel
ESTIMATED COMPLETION DATE 3/11/2016
DESCRIPTION OF WORK
Remodel basement, adding a handicap bathroom, (1) bedroom, great room
is
i
k
DEPOSIT PAID BY: SITE PLAN SUBMITTED: NA
Contractor
REScheck/COMcheck SUBMITTED: NA
DEPOSIT STATUS: BUILDING PLANS SUBMITTED: Received
I'.
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
plication.
Date
Signature of Alica
'
promi5O
o '
BUILDING PERMIT DEPOSIT AGREEMENT
A $500.00 re ndable deposit is being collected for any new commercial, new
esidential, d any additions, remodels and accessory building valued $10,000 or
grea er a 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
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
k
deposit.
hereby agree to the above conditions, and understand that should any or
c
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.
'4o-n-traC-tor./bwn*r' Contractor/Owner
City of Blair
ate j,...,
i
CITY Of BtAIQ
......................'Zve.............
N
�
A0,
i'
o1�?ise ot ave 11
BUILDING PERMIT SUPPORTING DOCUMENTS
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.
r:
i
i
c
i
f
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.
i'
Owner/Occupant ontractor
i
i
i
i'
City of Blair Date
c
c
EQUAL NOU6IN4
OPPORTUNITY
218 South 16th Street• Blair,Nebraska 68008 • 402-426-4191 • Fax 402-426-4195 E-mail clfyofblair@cl.blalr,ne,us