BPE3058
ELECTRICAL PERMIT APPLICATION
Jurisdiction of City of Blair, Nebraska
218 South 16th Street
Blair, Nebraska 68008
Fax (402) 426-4195
(402) 426-4191
Befoa flCl./ '7LP
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Zip
~
Application Date:
-lv-OOI
Job Address
'314)-.
E 3058
Permit Fee: $"Z)-tl . p(J
J:l/tI :# btJ5
Ownef/j
1. a''! u'
~~ntra()'111vl1?i.- t:C~fA;~c? '0& '-f17ocl~(yn <Sf. U/lJ1;h~ fJ;gl;:?7
3. Class of Work: 0 NEW RESIDENTIAL 0 NEW COMMERCIAL 0 REMODELING/ADDITIONS 0 UPGRADE SERVICE
Dcscribe Work: "7 ' / D.' 1/1' , '. }
4. ;<:::'1/17'1CI tiP;., 1 C#11 C'~ /Cfl' firt.O f CU}J.11 tf ~\::J !-vZ?t41-Li-t" 1-ct.i11J71 .i !VJ.:V;'
5.Current License on File ~es 0 No 0 N/A Com etion Date 1- .3: - () 9
ELECTRICAL PERMIT FEES
Mail Address
Service Fee = (Amp Fee + $5.00 per branch circuit)
1-100 Amp Fee...... ............... ..$25.00
101-200 Amp Fee...... ,............ ....$35.00
201-300 Amp Fee.......................$55.00
301-400 Amp Fee.................... ...$75.00
401-500 Amp Fee......... ..............$95.00
501-600 Amp Fee..,...... ,.. ...... .. .$115.00
60]-700 Amp Fee............,...... ..$135.00
701-800 Amp Fee.................... .$155.00
801-900 Amp Fee....,................$175.00
90 ]-1000 Amp........,.............. ..$195.00
IF OVER 1000 Amp
1st 1000 Amp Fee,.................$195.00
Each additional 100 Amps.........$20.00
Notice
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.
- &C(
Date
Phone
Upgrade Existing Service............ .$25.00 ,.;(;:;, () ()
Temporary Service.................... $15.00
Fire Alarm System............... ......$15.00
Signs (each).................. ...... ......$25.00
Miscellaneous Apparatus......... .....$15.00
CommerciallMulti Family and All Upgrades:
# of Circuits x $5.00
Amp Fee
Amp Fee + Circuit Total
New Residential: (Finished Area)
Single/Two Family Dwellings
sq. ft. x .063
ModularlManufactured Homes.. . ... .$50.00
Other: (alterations, additions and modifications)
Receptacles/Switches/Lighting Fixtures (110 volt only)
# of Apparatus.... .. .. .. x $1.00
Power Apparatus (220 Volt or higher)
# of Apparatus....... x $8.00
Smoke Detectors.....
x $3.00
Pennit Issuance Fee.................. .$25.00 c,:JS 0(">
Total ~.tJ. () 0
Comment:
WHEN PROPERLY VALIDATED (IN THIS SPACE) THIS IS YOUR PERMIT
I Approved By: ",'7) ";; j;'
-to f:n~1
<1) -<
Rev, 2008-] 0
ELECTRICAL PERMIT APPLICATION
Jurisdiction of City of Blair, Nebraska
218 South 16th Street
Blair, Nebraska 68008
Fax (402) 426-4195
(402) 426-4191
Application Date:
f"
~l
E 3058
Job Address
OwneF'
/ }
1 -' I ,
. I
ContracpE
2. 0''-<'71
3. Class of Work:
Describe Work:
4.
5.Current License on File
Mail Address
(,I )rlail.i).ddress
C.t.! (! f 04.1 t!
o NEW RESIDENTIAL
Service Fee = (Amp Fee + $5.00 per branch circuit)
1-100 Amp Fee.......................$25.00
101-200 Amp Fee.......................$35.00
201-300 Amp Fee..................... ..$55.00
301-400 Amp Fee......... ..............$75.00
401-500 Amp Fee.................... ...$95.00
50]-600 Amp Fee......... ............$115.00
60]-700 Amp Fee................... ..$135.00
701-800 Amp Fee. .. ... ... ...... ... ... $155 .00
80]-900 Amp Fee......... ............$175.00
901-1000 Amp.................... ... ..$195.00
IF OVER 1000 Amp
1st 1000 Amp Fee..................$195.00
Each additional100 Amps...... ...$20.00
Notice
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.
Signature of Contractor or Authorized Agent
Date
ELECTRICAL PERMIT FEES
Upgrade Existing Service............ .$25.00
Temporary Service.................... $15.00
Fire Alarm System.................. ...$15.00
Signs (each)......................... .....$25.00
Miscellaneous Apparatus......... .....$15.00
CommerciallMulti Family and All Upgrades:
# of Circuits x $5.00
Amp Fee
Amp Fee + Circuit Tota]
New Residential: (Finished Area)
Single/Two Family Dwellings
sq. ft. x .063
Modular/Manufactured Homes...... .$50.00
Other: (alterations, additions and modifications)
Receptacles/SwitcheslLighting Fixtures (110 volt only)
# of Apparatus.. . .. ... .. x $1.00
Power Apparatus (220 Volt or higher)
# of Apparatus....... x $8.00
Smoke Detectors.....
x $3.00
Permit Issuance Fee...... ........... ..$25.00
Total
Comment:
WHEN PRO PERL Y V ALIDA TED (IN THIS SPACE) THIS IS YOUR PERMIT
I Approved By: ,e") ,e;).; ... ,
'. -; i ;" // / v4~/L.-(J,i.,?r~'"'"
Rev. 2008-10
--~:"""'F"""":"--r;--","'~=:--~~~.....~'-~~""'-_,>""", -~~,'>_"-- ,_.-=-'~~__ <
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t:r~TY OF BLAIR
LOCATION OF INSPECTION-
/' ./ /l
1/,oA ;- jI
NAME OF OWNER' (. {//I eJ--{.l
I' &~.
DATE INSPECTION REQUESTED~~ d -
o WASHINGTON COUNTY
6,.50
o OTHER
,"71 ~
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f)" A~/ ,.- . .-!o'-d.-.- l "
CONTRACTOR' .-17!t:.'-U-7 c::l (,.--0(/ r./ve
/_6
- {XI TIME INSPECTION REQUESTED-
PERMIT NO'
z:: - 0 ~-- ;::{
C:j ,,--} 0
TYPE OF INSPECTION REQUESTED: 0 CONFERENCE 0 STATUS CHECK
==~~~......::,.::,... .~~~-=~~_......=~~~=- ........".,..,~ii:"~.::i!!
... "..-
BUILDING: 0 FOOTING 0 DECK FOOTING 0 FRAMING D DRYWALL ",~"FINAL 0 PARTIAL PASSED FAILED
o 0
~'r
COMMENTS:
~~,,,....
~.......~~~~~.
~...m'.fi?"'~~~"nF.:<':U;=::lZ<!f::;;;tt&_~=~
";
UTILITIES: 0 SEWER TAll 0 SEWER 0 SEPTIC 0 WATER TAp 0 REMOTE 0 WATER SERVICE
o PARTIAL
COMMENTS:
ELECTRI~~UGH~g;;Z* ci;;~;;;~:;;;'~-D~~~-;;V;;o;;~7c~ ~=-==;:;;~~;
D PARTIAL 0 D
PASSED FAILED
o 0
':~
COMMENTS:
MECHANICAL:D ROUGH-IN 0 AlC 0 FURNACE 0 RADIANTHEAT D FINAL 0 PARTIAL
PASSED FAILED
o D
'::>]
,
"
PLUMBING: D GRptJNDWORK D ROUGH-IN D FINAL WATERMETERINSTALLED D PARTIAL
o PRESSURE TEST
COM11ENTS;c '
..,.",' ~~~~'\""..".,.~ ~
D ocCDPA,tiC\rGRAN'I'ED 0 CONI)JT~ON~ ()CCUPANCY G~~~~:
PASSED FAILED
o 0
NOTESIREMARK~'
BUILDING INSPECTION REPORT
p( CITY OF BLAIR
D WASHINGTON COUNTY
D OTHER
LOCATION OF INSPECTION'
NAME OF OWNER ;/?'A k;~/L<:"',
'--"" - /
--? QA /.J'i /7
DATE INSPECTION REQUESTED' , :;J , . '5/U '7
I ./
TYPE OF INSPECTION REQUESTED: D CONFERENCE
BUILDING: D FOOTING D DECK FOOTING D FRAMING D DRYWALL D FINAL D PARTIAL
2'~ ~~ ~' ---;;jj('/
/7 // r' _,,',{,y, ~
CONTRACTOR' ;;;: I//;~ //1 --:(!/i/ C
TIMEINSPECTIONREQUESTE:: flJ{ PERMIT NO' f ;Jr1,-~8
./
"STATUSCHECK
COM:MENTS:
UTILITIES: D SEWER TAP D SEWER D SEPTIC D WATER TAP D REMOTE D WATER SERVICE
D PARTIAL
PASSED FAILED
D D
COM:MENTS:
PASSED FAILED
D D
ELECTRICAL: D
D
ROUGH IN JZf FINAL 0 PERMANENT SERVICE D TEMPORARY SERVICE D PRECONNECT
PARTIAL I'- /.-- ~/ :15- -'- -
~.S / L...L</)/ ~'"t /j I/o F\-i ~ Ud ( f.2( AJ ~_ ____
ROUGH-IN D A/C D FURNACE D RADIANTHEAT D FINAL D PARTIAL
PASSED FAILED
D D
COM:MENTS:
MECHANICAL: D
COMMENTS:
PASSED FAILED
D D
PLUMBING: D GROUNDWORK D ROUGH-IN D FINAL D WATERMETERINSTALLED D PARTIAL
D PRESSURE TEST
COMMENTS:
PASSED FAILED
D D
OCCUPANCY GRANTED D CONDITIONAL OCCUPANCY GRANTED
NOTES/REMARKS'
{g{)
FAXED OPPD\BURT REA
TO CONNECT SERVICE: ON
BY