BPE3057
ELECTRICAL PERMIT APPLICATION
Jurisdiction of City of Blair, Nebraska
218 South 16th Street
Blair, Nebraska 68008
Fax (402) 426-4195
(402) 426-4191
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Application Date:
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Job Address
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
601-700 Amp Fee......... .......... ..$135.00
701-800 Amp Fee.......... .......... .$155.00
801-900 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.
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Date
3 <1 '*i
E 3057
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Permit Fee: $ U?o'
Phone
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$ -:5 ,()L) '1~
Upgrade Existing Service.. . . . . . . . .... 25.00 0<,-
Temporary Service.................... $15.00
Fire Alarm System.... ..... ...... ......$15.00
Signs (each)......................... .....$25.00
,Mi8ecl1&ft8CHl.S ApptM'Gtus......... .....$15.00 /5.0 ()
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Commercial/Multi 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
Modular/Manufactured 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
Permit Issuance Fee................. ..$25.00
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Total 6:?5. (> [)
Comment:
WHEN PROPERL Y VALIDATED (IN THIS SPACE) THIS IS YOUR PERMIT
I Approved By: :J") p f.., '/
Lf). I j JUaer.
I
Rev. 2008-10
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:
Job Address
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
601-700 Amp Fee................... ..$135.00
701-800 Amp Fee................... ..$155.00
801-900 Amp Fee.................... .$175.00
901-1000 Amp........................ .$195.00
IF OVER 1000 Amp
1 sl 1000 Amp Fee.............. ....$195.00
Each additiona1100 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
E 3057
Permit Fee: $ 6::. )5'
Phone
.t:'L"
# of Circuits x $5.00
Amp Fee
Amp Fee + Circuit Total
New Residential: (Finished Area)
Single/Two Family Dwellings
sq. ft. x .063
Modular/Manufactured 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
Permit Issuance Fee.................. .$25.00
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Total U.
Comment:
WHEN PRO PERL Y V ALIDA TED (IN THIS SPACE) THIS IS YOUR PERMIT
I Approved By: ,.;1\) /?; /~'(/.M'f'
Rev. 2008-10
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IZJ CITY OF BLAIR D WASHINGTON COUNTY D OTHER
r LOCATION OF INSPECTION' 6So ~2=-/llZh(S7J2//9!. /~ICK ~]) K
NAME OF OWNER' (~//1,er;.I/L.L, , CONTRACTOR' V/l//!}I/1 L'//!-L..~7;[j(~/
DATE INSPECTION REQUESTED' / ;/9.~~'9 TIME INSPECTION REQUESTED' /J r- PERMIT NO' 1:-:&),5- "';7
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TYPE OF INSPECTION REQUESTED: 0 CONFERENCE D STATUS CHECK
~~ T .==----=:n.=....~__=..:>.....--.- ~~~~~====
BUILDING: D FOOTING D DECK FOOTING D FRAMING D DRYWALL D FINAL D PARTIAL PASSED FAILED
D D
COMMENTS:
UTILITIES: [J, SEwpR TAP, D SEWER D SEPTIC D WATER TAP D REMOTE D WATER SERVICE
o PARTIAL
PASSED FAILED
D D
COMMENTS: ,
. ELECT~~CAL:~;8Y;;IN D /~. AZD~~NT~~I~~.D;~;;:I;;~~o;;;;~T ~-~)6AS. D ;~
[2f PARTIAL ,/ / A 'h' / r- -~;-::::;::::;1 tj D
COMMENTS: A (;./toLe- / r~7 7 ' ,
~~"",~ ....""'""~""r.<#,...,..."..,.......,.,... " ...t::=:t~~~~~~~~
MECHANJCAL:D RqUGH-IN D A/C D FURNACE 0 RADIANT HEAT D FINAL 0 PARTIAL PASSED FAILED
o D
COMMENTS:
PLUMBING: ", D GRoUNDWORK D ROUGH-IN 0 FINAL, WATER METER INSTALLED 0 PARTIAL
" 0 TEST
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o
PASSED FAILED
DO