E0139flair, Nebraska 6>300>3
(402) 426®4191 Permit
A lication Date:
pP
e~C,~
Permit Fee: $ °'
LEGAL
1 LOT NO. BLK. TRACT
O SEE ATTACHED SHEET
• DESCR.
WNER
2. MAIL ADDRESS ZIP PHONE
3• CONTRA ~~ f ~ IL ADDRES~ ~ ~~ ~~ PHONE ~ NO.
4• Class of Work: ®NEW RESIDENTIAL ®NEW COMMERCIAL ®REMODELING/ADDITIONS ®UPGRADE SERVICE
5• Describe Work:
6• Current License on File Yes ®No ®NA
New Service Fee = (Amp Fee + $2.00 per branch circuit)
1-100 Amp Fee ............................ $ 13.00
101-200 Amp Fee ............................ $ 18.00
201-300 Amp Fee ............................ $ 30.00
301-400 Amp Fee ............................ $ 42.00
401-500 Amp Fee ............................ $ 55.00
501-600 Amp Fee ............................ $ 67.00
601-700 Amp Fee ............................ $ 80.00
701-800 Amp Fee ............................ $ 92,00
801-900 Amp Fee ............................ $105.00
901-1000 Amp ................................. $117.00
IF OVER 1000 Amp
1st 1000 Amp Fee ....................... $117.00
Each additional 100 Amps ........... $ 13.00
N®TIC
I hereby certify that I have read and examined this
application and know the same to be true and correct. All
provisions of laws and ordinances governing this type of
work will be complied with whether specified herein or not.
l-he granting of a permit does not presume to give authority
to violate or cancel the provisions of any other state or local
law regulating construction or the performance of
construction.
t '"`~~ ter,
- SIGNATURE OF CONTRA TOR OR AUTHORIZED~SG'
~~~ ~~
DATE
LT ICAL PERMIT FEES
Upgrade Existing Service ...... $10.00
Temporary Service ................ $10.00
Fire Alarm System ................. $10.00
Signs ..................................... $15.00
Miscellaneous Apparatus ...... $11.00
~~ ~
Receptacle/Switch Outlets
Fixtures x $.75
Residential/Commercial Appliance
# Fixect Outlets x $3.00
Power Apparatus (220 Volts)
# Apparatus x $3.00
Permit Issuance Fee ............. $15.00
~~~~
WHEN PR®PERLY VALIDATED (IN THIS SP
TWIS IS Y®UR PERMIT
Approved 5y;
POUNDS PRTG.-Blair, NE Rev. 12/95
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