E0042ELECTRICAL PERMIT APPLICATION
Jurisdiction of City of Blair, Nebraska
218 South 16th Street
Blair, Nebraska 68008 0 0 4 2
(402) 426-4191 Permit
Application Date: r / ~~ Permit Fee: $
JOB ADDRESS ~~
LEGAL
1 • DESCR. LOT ND. BLK• TRACT
O SEE ATTACHED SHEET
,~• OWE AIL ADD SS ZIP PHONE
C RACTOR M~, ASS
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4• Cass of Work: O NEW RESIDENTIAL O NEW
COMMERCIAL O REMODELING
/ADDITIONS O UPGRADE SERVICE
5• Describe Work:
6• Current License on File O Yes O 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 S stem $10.00
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301-400 Am Fee $ 42.00
p ............................
401-500 Amp Fee ............................ $ 55.00 Signs ..................................... $15.00
501-600 Amp Fee ............................ $ 67.00
Miscellaneous Apparatus ...... $11.00 ~ pc>
601-700 Amp Fee ............................ $ 80.00
701-800 Amp Fee ............................ $ 92.00
801-900 Amp Fee ............................ $105.00 Commercial/Multi-Family and All Upgrades:
901-1000 Amp ................................. $117.00 # of Circuits x $2.00
IF OVER 1000 Amp Amp Fee
1st 1000 Amp Fee ....................... $117.00
Each additional 100 Amps ....,.,.... $ 13.00 Amp Fee + Circuit Total
NOTICE
I hereby certify that I have read and examined this New Residential: (Finished Area)
Single/Two Family Dwellings ~ C ~~
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application and know the same to be true and correct. All sq. ft. x .045
provisions of laws and ordinances governing this type of
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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
construction. Residential/Commercial Appliance
# Fixect Outlets x $3.00
Power Apparatus (220 Volts)
` # A
aratus x $3
00
pp
.
SIG URE 0 NTR CTOH OR AUT ORIZED AGENT
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~ ~ ~ ~
Permit Issuance Fee ............. $15.00 ~~
DAT
TOTAL
WHEN PROPERLY VALIDATED (IN THIS SPA6€~IIS IS YOUR PERMIT
POUNDS PRTG: Blair, NE Rev. 12/95