E2589Blair Building Permit Detail
Permit #: E2589 Issued: 11/16/2006
Completed: 11 /20/2006
Location: 1156 N. 18th Ave.
Owner: Jerry Uehling
Address: 1156 N. 18th Ave.
Blair, NE 68008
Phone: 402 426 2889
Section: Township
Subdivision:
2 circuits and 3 outlets.
Contractors
Dick's Electric
Remarks
Type: Electrical Miscellaneous
Valuation:
Range:
Lot:
General Contractor
Inspections Date By
11/20/2006 DEM Electrical Final
11/20/2006 DEM Final Inspection of Project
Permit Fee: 6.25
Issue Fee: 15
Deposit Amt.:
Receipt #:
Block:
Permit # Issued
Pass
Pass
ELECTRICAL PERMIT APP
Jurisdiction of City of Blair, Nebraska
218 South 16th Street
Blair, Nebraska 68008
(402) 426-4191
Application Date:
LIGATION
Permit E 2 5 8 9
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Permit Fee: $ ~~
JOB ADDRESS ~ / ~ ~ ~ ,//L ~•
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LEGAL
1 • DESCR. O SEE ATTACHED SHEET
2. OWNER MAILADDRESS ~~`v,u ZIP HOME PHONE n a
WORK/CELL PHONE
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4. Class of Work: ~ NEW RESIDENTIAL O NEW COMMERCIAL ~ REMODELING/ADDITIONS O UPGRADE SERVICE
5. Describe Work: ~ ~ ~ ~
6. Current License on File ~ Yes ~ No O NA Completion Date
ELECTRICAL PERMIT FEES
New Service Fee = (Amp Fee + $2.00 per branch circuit)
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
y ...............
Fire Alarm S stem $10.00
301-400 Amp Fee ............................ $ 42.00 Signs $15.00
.....................................
401-500 Amp Fee ............................ $ 55.00
501-600 Amp Fee ............................ $ 67.00 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-Family and All Upgrades:
901-1000 Amp ................................. $117.00 # of Circuits x $2.00 _ ~• a ~
IF OVER 1000 Amp Amp Fee
1st 1000 Amp Fee ....................... $117.00 ~
~~
Each additional 100 Amps ...,....... $ 13.00 `
Amp Fee + Circuit Total
New Residential: (Finished Area)
NOTICE 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 AUTHO D AGENT # Apparatus x $3.00
~v7-/Z ~ ~,~o Permit Issuance Fee ............. $15.00 ~J`'• D ~
DATE
TOTAL ~l~y~]
WHE PROPERLY VALIDATED (IN THIS SPACE) THIS IS YOUR PERMIT
Comment: ~ ~~ ,~ ~np~ ;a e ~(~Q Approved By: -
POUNDS PRTG.-Blair, NE Rev. 11/99
BUILDING INSPECTION REPORT
OF BLAIR ER_
^ WASHINGTON COUNTY
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LOCATION OF INSPECTION: //~~ /y' /~~` `L~'
NAME OF OWNER• v `~~~ ~~~ r ~ 0 N RACTOR: ~ e~ /~~
DATE INSPECTION REQUESTED: ~~'' ~ 'JG ~ TIME INSPECTION REQUESTED: ~ PERMTI' N0: ~ ~`~~
~,~, ,~.~
TYPE OF INSPECTION REQUESTED: ^ CONFERENCE
^ STATUS CHECK
BUILDING: ^ FOOTING ^ DECK FOOTING ^ FRAMING ^ DRYWALL ~IIVAL ^ PARTIAL t PAS D FAILEI
COMMENTS:
UTILITIES: ^ .SEWER TAP' ^ SEWER ^ SEPTIC ^ WATER TAP ^ REIVIOTE ^ WATER SERVICE PASSED FAILEI
^ PARTIAL ^ ^
COMMENTS:
ELECTRICAL: ^ ROUGH IN]AL ^ PERMANENT SERVICE ^ TEMPORARY SERVICE ^ PRECONNECT PASSED FAILEI
COMMENTS: ^ PARTIAL L.~ o ~ ~ f~ ~S ^
MECHANICAL: ^ ROUGH-IN ^ A/C ^ FURNACE ^ RADIANT HEAT ^ FINAL ^ PARTIAL . AS FAILEI
COMMENTS:
PLUMBING: ^ GROUNDWORK ^ ROUGH-IN ^ FINAL ^ WATER METER INSTALLED ^ PARTIAL PASSED FAILE]
^ PRESSURE TEST ^ ^
COMMENTS:
^ OCCUPANCY GRANTED ^ CONDITIONAL OCCUPANCY GRANTED
NOTES/REMARKS•
~
INSPECTO
• ~ (l~
DATE OF INSPECTION MADE:
c
FAXED OPPD~BURT REA TO CONNECT SERVICE: ON BY
ACORD~, CERTIFICATE ®F LIABILITY INSURANCE DATE
11-09-2006
PRODUCER
GRACE-MAYER INS AGENCY, INC/PHS
911635 P: (866)467-8730 F: (877)538-8526 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
ALTER THECOVERAGEA FORDEDB~THEPOLCIESBE OW.
PO BOX 29611
CHARLOTTE NC 2 8 2 2 9
INSURERS AFFORDING COVERAGE
INSURED INSURERA:HartfOrd CaSUalt Ins Co
wsuRERB:Hartford Underwriters '.Ins Co
DU-RITE ELECTRIC INC . wsuRER c:
PO BOX 2 3 9 INSURER D:
ELKHORN NE 6 8 0 2 2 wsuRER Er
COVERAGES
THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING
ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO-WHICH THIS CERTIFICATE MAY BE ISSUED OR
MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH
POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
ILTR I TYPEOF INSUflANCE I POLICY NUMBER I DATE MMFDDnYE PDATE MMIDD/YYN ~ LIMITS
GENERAL LIABILITY EACH OCCURRENCE $1 , 0 0 0, O O O
A COMMERCIAL GENERAL LIABILITY 91 SBA KU7 8 7 7 12 /14 / 0 6 12 / 14 / 0 7 FIRE DAMAGE (Any one fire) S3 O 0 , 0 0 0
CLAIMS MADE u OCCUR MED. EXP (Any one person) S1 0 , 0 0 0
X Business Llab PERSONAL&ADVINJURY S1, 000, 000
GENERAL AGGREGATE S2 , 0 0 0, O O O
GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS -COMP/OP AGG S2 , O O O , O O O
POLICY X PRO- -' LOC
JECT
AUT OMOBILE LIABILITY - ~ COMBINED SINGLE LIMIT
$
ANY AUTO (Ea accident)
'ALL OWNED AUTOS
BODILY INJURY
$
SCHEDULED AUTOS (Per personP
HIRED AUTOS
BODILY INJURY
$
NON-OWNED AUTOS (Per accident)
PROPERTY DAMAGE
$
(Per accident)
GARAGE LIABILITY AUTO ONLY - EA ACCIDENT S
ANY AUTO OTHER THAN EA ACC $
AUTO ONLY: qGG $
EXCESS LIABILITY EACH OCCURRENCE $1 , 0 0 0, O O O
A X OCCUR u CLAIMS MADE 91 SBA KU7 8 7 7 12 / 14 / 0 6 12 / 14 / 0 7 AGGREGATE $1 , O O O , O O O
DEDUCTIBLE $
X RETENTION $1 O, 0 0 0 $
WORKERS COMPENSATIONAND X WC STATU- 0TH-
TORY LIMITS ER
B EMPLOYEflS' LIABILITY
91 WEC KA7131
12 / 14 / 0 5
12 / 14 / 0 7
E.L. EACH AccIDENr
s5 0 0 , 0 0 0
E.L. DISEASE - EA EMPLOYEE S 5 O O, 0 0 0
E.L. DISEASE -POLICY LIMIT $5 O O, 0 0 0
OTHER
DESCRIPTION.OF OPERATIONS/LOCATIONSNEHICLESIEXCLUSIONS ADDED $Y ENUORSEPdENT/SPECIAL PROVISIONS
Those. usual to the Insured's Operations.
VLI\111-IVMIG fIV LVGf1 I IHUUII IVIYHI. IIVJUr1CU~11YLVnCn LCI IGn: Vh\IVLGLLHIIIlItl
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED. BEFORE THE
EXPIRATION DATE THEREOF-, THE ISSUING INSURER WILL ENDEAVOR TO MAIL
Clty Of Bla1r 30 DAYS WRITTEN NOTICE (10 DAYS FOR NON-PAYMENT) TO THE CERTIFICATE
Attn • Electrical Dept . HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL IMPOSE NO
OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR
2~8 S • ..6th Street REPRESENTATIVES.
Blair, NE 68008
A ~ORI~DfRE~ ESEN ATI
Nuunu [y-s 1~/~~1 ~' ACORD CORPORATION 1988