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Jurisdiction of Gity of i3lair, Nebraska
218 South 16th Street
Stair, Nebraska 68008
(402) 426-4191 Permit
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Application Date: (~~i ~~' ~ ~
Permit Fee: $'. - ~ 4
JOB ADDRESS „~-~ ,,.~- ,~, a ~ ' `"
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LEGAL
1 • DESCR. LOT NO. BLK. TRACT
®SEE ATTACHED SHEET
OWNER ~` ~ "~ ~~ A'.A!LADDRESS ZIP °~ ~ HONE
3• CONTRACTOR ~„~~~ ~ ~ ~ ~ %'.'-'DAESS
;.: PHONE LICENSE NO.
4. Class of Work: O NEW RESIDENTIAL ®NEW COMMERCIAL ®REMODELING/ADDITIONS O UPGRADE SERVICE
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Describe Work:
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6• Current License on File `~ Yes ®No O NA
New Service Fee = (Amp Fee + $2.00 per branch circuit) ELECTRICAL PERMIT FEES
1-100 Amp Fee ............................ $ 13.00 Upgrade Existing Service ...... $10.00
101-200 Amp Fee ............................ $ 18.00 Temporary Service ................ $10.00
201-300 Amp Fee ............................ $ 30.00 Fire Alarm System ................. $10.00
301-400 Amp Fee ............................ $ 42.00
Signs .....................................$15.00
401-500 Amp Fee $ 55.00
............................
501-600 Am Fee $ 67.00
p ............................ Miscellaneous Apparatus ...... $11.00
601-700 Amp Fee $ 80.00
............................ AC/DC Circuit ........................ $5.00
701-800 Amp Fee ............................ $ 92.00
801-900 Amp Fee ............................ $105.00
Commercial/Multi-Famil and All U rades•
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901-1000 Amp ................................. $117.00 # of Circuits x $2.00
IF OVER 1000 Amp
1st 1000 Am Fee
p ....................... $117.00
Amp Fee `
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Each additional 100 Amps ........... $ 13.00 Amp Fee + Circuit Total ~
New Residential: (Finished Area)
N®TIC Single/Two Family Dwellings
I hereby certify that I have read and examined this sq. ft. x .045
application and know the same to be true and correct. All
provisions of laws and ordinances governing this type of Modular/Manufactured Homes ....... $30.00
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The granting of a permit does not presume to give authority Receptacle/Switch Outlets
to violate or cancel the provisions of any other state or local Fixtures x $.75
law regulating construction or the performance of Smoke Detectors x $3.00
construction.
Residential/Commercial Appliance
# Fixed Outlets x $3.00
Motor(s) x $3.00
-.. Power Apparatus (220 Volts)
SIGNATURE OF CONTRACTOR OR A HORIZED AGENT # Apparatus x $3.00
~®-,~~~°~ Permit Issuance Fee .............$15.00
DATE
WHEN PROPERLY VALIDATED (IN THIS SPACE) THIS IS YOUR PERMIT
Comment: Approved By:
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POUNDS PRTG: Blair, NE Rev. 9/97
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I [~, CITY OF GLAIR ~ ^ WASHINGTON COjJNTY ^ OTHER -
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LOCATION OF INSPECTION: ~`'~ -~' =~ C%~ ~ ~~= _ s I
NAME OF OWNER ~ ~ ~_~, ~ t.~4 ~ Li ~ ~~ ~ `~ ~~ CONTRACTOR: ,~. s~ ,~~ ~ ~_-~`+`~ ~i%.
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`` DATE INSPECTION REQUESTED: PERMIT NO:~' =''~j'~ •~ ~~' s`~~" ~ ~-~a~
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TIME INSPECTION REQUESTED: ,s'
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~,, TYPE OF INSPECTION REQUESTED: ~ i
f' BUILDING:
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^ FOOTING
^ FRAMING
^ DRYWALL ^ FINAL
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UTILITIES:
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e, . ^ SEWER TAP ^ SEWER ^ SEPTIC ^ WATER TAP
b, ~ ^ REMOTE ^ WATER SERVICE
~ ELECTRICAL: 3
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C`' ^ ROUGH IN ^ FIXTURES ^ FINAL ^ MOTORS
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PERMANINT SERVICE
^ TEMPORARY SERVICE
C MECHANICAL:
~: ^ ROUGH-IN ^ A/C ^ FINAL
i. PLUMBING:
^ GROUNDWORK ^ROUGH-IN ^ FINAL
RESULTS OF THE INSPECTION: ASSED (s~xorES> ^ FAILED (sue xo~rFS~
NOTES/REMARKS:
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