BPE3069
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ELECTRICAL PERMIT APPLICATION
Jurisdiction of City of Blair, Nebraska
218 South 16th Street
Blair, Nebraska 68008
Fax (402) 426A 195
(402) 426-4191
Application Date: ~ ~ t:t - 0 '1
Job Address
Owner
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 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 ofIaws 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 10cal1aw regulating construction or the
performance of construction.
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E 3069
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Zip
Pennit Fee: $ U...F{. Of.?
~1> #aOD hldt
Phone
ELECTRICAL PERMIT FEES
U d E .. S .1J?tkW $25 00
pgra e xlstmg ervlCe............. .
Temporary Service.................... $15.00
Fire Alarm System.................. ...$15.00
Signs (each)......................... .....$25.00
Miseellal~uut> Appi:l1atuS......... .....$15.00
c;(~f?JfU
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
ModularlManufactured Homes... ... .$50.00
Other: (alterations, additions and modifications)
Receptacles/SwitcheslLighting Fixtures (110 volt only)
# of Apparatus .......... x $1. 00
,J(.5."'~
/~'Y,oO
Power Apparatus (220 Volt or higher)
# of Apparatus....... x $8.00
Smoke Detectors.....
x $3.00
Permit Issuance Fee... .............. ..$25.00 ck'c5'.~C>
Total l.M:i: (}o
Comment:
WHEN PROPERLY VALIDATED (IN THIS SPACE) THIS IS YOUR PERMIT
I Approved By: :z .D L
c .. FJiT~
6' 5 l
I
Rev. 2008-10
ELECTRICAL PERMIT APPLICATION
Jurisdiction of City of Blair, Nebraska
218 South 16th Street
Blair, Nebraska 68008
Fax (402) 426-4195 E 3069
(402) 426-4191
Application Date: ?-~l_ Cf- 0 cr
Permit Fee: $ U15 ct?
Job Address (;;,5 t) ,J;;, ~t~WJ lA-i J flu Jt
Owner I. . I Mail Address ." . . Zip
1. { t~l t}: (1' c21JUi c4;{) c:c.6 0 ,/,
Contract~t / ,(;) 1 Mail Ad~ress (}. . " ,~ip, '.' ,Phone" .,
2. ~)/lJl t5t.tl CL- CU' ('f-,tj (! \,~1 t/:..t CJJ a:5od;? 711 dd0tn1 r 0.1/1 ,:;<:./JCZ- &78/;11 ,:577-
3. Class of Work: 0 NEW RESIDENTIAL 0 NEW COMMERCIAL 0 REMODELING/ADDITIONS 0 UPGRADE SERVICE
Describe Work: 'l.," '-f1/1 /' ,'J .
4. I l/iti'f!LTVJ1' /f// tJ t~ (1/l1 C' J/ c:. E r1 t:
5.Current License on File g-Yes No 0 NjA Completion ate' Lf - /t! ~ (/! l'
ELECTRICAL PERMIT FEES
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........................ .$195.00
IF OVER 1000 Amp
1st 1000 Amp Fee..................$l95.00
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 oflaws 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.
CD
Signature of Contractor or Authorized Agent
(fJ
Date
U d E .. S .jJP/ltt>"lIj/ $25 00
pgra e xlstmg ervlCe............. .
Temporary Service.................... $15.00
Fire Alarm System................. ....$15.00
Signs (each)........................ ......$25.00
Mif:JcoHan~uu~ Aw<ualus......... .....$15.00
r;=:7!'~ PJ;V
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)
(lJ) #8DD &dt.
Phone
d25,O~
/'<~, t){.)
ReceptacIes/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
. $2 00 r)c t?()
PermltlssuanceFee................... 5. r..><U'
Total {jJL,J 00
WHEN PROPERLY VALIDATED (IN THIS SPACE) THIS IS YOUR PERMIT
I Approved By: .:if D".L /.
( r' /. JI T <.AYt4-v'V]
Comment:
Rev. 2008-10