E0312Jurisdiction of City of Blair, Nebraska
218 South 16th Street
Blair, Nebraska 68008
(402) 426-4191 Permit
Application Date: ~ ~ ~ y~~-~~°
LECTICAL PERMIT FEES
Upgrade Existing Service .,..,. $10.00
Temporary Service ................ $10.00
Fire Alarm System ................. $10.00
Signs ..................................... $15.00
JOB ADDRESS ~~ ,,,, /'
LEGAL
1 ° DESCR. LOT N0. ~ BLK. TRACT
®SEE ATTACHED SHEET
2 OWNER ( ,~ i ~ IL AD RESS q j r ,~} 7, p PHONE
3° CONT (~{lCa~l ~ ~~~~~~ ~~MAI~~D,ARESS~~,~ ~~~ t"~ ~ ~~PHDNE _LI~CEdNSENO.
4° Class of Work: ®NEW RESIDENTIAL O NEW COMMERCIAL REMODELING/ADDITIONS O UPGRADE SERVICE
5. Describe Work: ~4 t"/ ~'(~~ ~~ ~~~~ ~ () ~ ~ ~
6• Current License on File ,IYes O No O 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.
The 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.
Miscellaneous Apparatus ...... $11.00 ) ~ f~
Commercial/Multi-Family and All Upgrades:
of Circuits x $2.00 ~°~ • ~ ~~
Amp Fee
Amp Fee + Circuit Total
New Residential: (Finished Area)
Single/Two Family Dwellings
sq. ft. x .045
Receptacle/Switch Outlets
Fixtures x $.75
Residential/Commercial Appliance
# Fixect Outlets x $3.00
Power Apparatus (220 Volts)
# Apparatus x $3.00
/ ___...
~.
~~ ~'~ ~ "~ r/~i Permit Issuance Fee .....
DATE
Approved By:
~n u
WHEN PROPERLY VALIDATED (IN THIS SPACE) THIS IS Y,Q~ UR PERMIT
POUNDS PRTG.-Blair, NE
Permit Fee: $ ~-~° f.-
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$15.00 ~ ~=A'"~~,
~®T~Io. e~ 3 ~ ~YS~y~
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ReV. 12/95
JOB ADDRESS ~~** (~
LEGAL
~ • DESCR. LOT NO. BLK. TRACT
O SEE ATTACHED SHEET
OWNER ) MAIL ADDRESS ZIP PHONE ,
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,3 CONTRACTOR / (+ (I p tp MAIL ADDf~ES~ ((
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4• Class of Work: O NEW RESIDENTIAL O NEW COMMERCIAL O REMODELING/ADDITIONS REPLACEMENTS
5. Describe Work:
Comments:
MECHANICAL PERMIT FEES
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Forced Air Systems
Per Unit Commercial/Residential (New) ...................................... $25.00
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-- Air-Conditioner Unit
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g ((g Per Unit Commercial/Residential (New) ...................................... $i 0.00
~~
Refrigeration Units/Coolers
Per Unit Commercial (New or Replacement) .............................. $10.00
NOTICE
I hereby certify that I have read and examined this
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All Forced Air Systems/Air Conditioner
~
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app
cation an
now t
e same to
e true an
correct. Unit Replacement _\t ~
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provisions of laws and ordinances governing this type of
work will be complied with whether specified herein or not.
Per Unit Commercial/Residential (Replacement)
........................ $10.00
The 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.
Permit Issuance Fee ............. $15.00
f ~` ~ ~~~
'TO'TAL ~F~~ ~, . ~~~
SIGNATURE OF CONTRACTOR OR q'CJy ORIZ AGENT
~.c~ / ~ Current License on File Yes ®No O NA
DATE
WHEN PROPERLY VALIDATED (IN THIS SPACE) THIS IS YOUR PERMIT
Comment: Approved By: /~ /`
r
POUNDS PRTG: Blair, NE ~ Rev. 1?J95
i
IJII~ - - CT E T
~~ CTTY OF BLAIR ^ WASHINGTON COUNTY ^ OTHER
~~
LOCATION OF INSPECTION: =-~~-~ ~.~~ ~ ~j {~?t` I :~_>,~.. ~ ~ _, 4~~.~` ~~-.~•?
_.
NAME OF OWNER: ~ ~ `~~. %~ i =~~ `" j
' '~~ i`; ~° ~ CONTRACTOR: ~~~--~---:C~?r`~ ~~e~
DATE INSPECTION REQUESTED: ~ ~ ~. >_- r 1 ~ PERMIT N0:
TIME INSPECTION REQUESTED: ~ ~ ~'
TYPE OF INSPECTION REQUESTED:
• BUILDING: ~ 1
,,~ `R
^ FOOTING ^ FRAMING ^ DRYWALL ~j ~~ FINAL
-t.
`• ; UTILITIES: _ ` _ __'
._____ ,_
^ SEWER TAP ^ SEWER . ^ SEPTIC ^ WATER TAP
'~
^ REMOTE ^ WATER SERVICE
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ELECTRICAL:
~,
C: ' ~ ~~.r
^ ROUGH IN ^ FIXTURES ^ FINAL ^ MOTORS r ~ ~~~ ~ r
.- ~'~
f~ ^;PERMANEI~T SERVICE ^:TEMPORARYSERVICE" "~ Ir~~~ ~~
MECHANICAL:. I
C":
f; ^ ROUGH-IN ^ A/C [~l -.FINAL ~~ 1; ~~. ~
t Y~
`' PLiJM.BING:
ii
^ GROUNDWORK ^ ROUGH-W ^ FINAL
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RESULTS OF THEINSPECTION: PASSED (s~rroTES~ ^FAILED (s~xo~s> ~
i. , _ -
- NOTES/REMARKS: 1
i
.:__ _~
~'~ ' INSPECTOR:~~~ ~`°UG'~t~7''+d-, ~
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_ MATE OF WSPECTION MADE: ~ j ~~ ~ ~~N(E: `~? ~ -~ / ~I
• ~ ... _
• - I' CALLED OPPD\ TO CONNECT SERVICE: ^ YES ^ NO
~.
,.
WANT OFFICE STAFF TO CALL OPPD\ _ ^ YES ^ NO BLR 1
9