E0460f~~
Application Date:
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Permit Fee: $
JOB ADDRESS ~ ~~~ ~ ~ }
LEGAL
' DES~R": LOT N0.
~. BLK. TRACT ®SEE ATTACHED SHEET
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2. ~~,''t?~o-i. MAIL ADDRESS ZIP
~~ __ PHONE.
CON CTOR ' ~
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~ - MAIL AD~QRESS. ~,, ~' PHONE LICENSE No.
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4. CI s of Work: ®NEW RESIDENTIAL O NEW COMMERCIAL ®REMODELING/ADDITIONS ~ ~ GRADE SERVICE
b• Describe Work:
6. Current License on File O 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
ELECTRICAL P MIT F ~
Upgrade Existing Service ...... $10.00 ~~)
Temporary Service ................ $10.00
Fire Alarm System ................. $10.00
Signs ..................................... $15.00
IViiscellaneous Apparatus ...... $11.00
Commercial/Multi-Family and A~U~grades:
# of Circuits x $2.00 ~ ~j
Amp Fee ,~ a~~ ~~ `°
Amp Fee + Circuit Total
N®TICE
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.
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CONTRACTOR OR A T ORIZED AGENT
DATE
New Residential: (Finished Area) 1
Single/Two Family Dwellings 1
sq. ft. x .045 _
Receptacle/Switch ®utlets
Fixtures x $.75
Residential/Commercial Appliance
# Fixect ®utlets x $3.00
Power Apparatus (220 Volts)
# Apparatus x $3.00
Permit Issuance Fee .............$15.00 ~=°
TTAL
WHEN PROPERLY VALIDATED (IN THIS SPA HIS IS YOUR PERMIT
POUNDS PRTG: Blair, NE Rev. 12/95
~_ INS T
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`'[~~CTTY OF BI:AIR ~ WASHINGTON COUNTY ~ OTHER
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~„ LOCATION OF INSPECTION:-' 6 ~~ -' f~ --_~.~' ~`' 9f~°-'
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