BPE3158
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: /0 - dO .- U (1
Job Address
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E 3158
Permit Fee:
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2.
3. Class ofWor
Describe Work:
4.
5.Current License on File
REMODELINGj ADDITIONS
NEW RESIDENTIAL D NEW COMMERCIAL D
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v C mpletion Date
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
151 1000 Amp Fee............... ...$195.00
Each additional I 00 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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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 Total
New Residential: (Finished Area)
Single/Two Family Dwellings
sq. ft. x .063
Modular/Manufactured Homes...... .$50.00
Other: (alterations, additions and modifications)
Receptac1es/Switches/Lighting Fixtures (110 volt only)
# of Apparatus .......... S' x $1. 00 O~. () c.>
Power Apparatus (220 Volt or higher)
# of Apparatus....... I x $8.00
/300
Smoke Detectors.....
x $3.00
Permit Issuance Fee.................. .$25.00
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Total,::) [/ 0
Comment:
WHEN PROPERLY V ALIDA TED (IN THIS SPACE) THIS IS YOUR PERMIT
I Approved By:,'J ~. I.... ,', /
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Rev. 2008-10
CITY or BL1\IQ
HOMEOWNER VERIFICATION FOR ELECTRICAL 'VIRING PERMITS
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print yhur full name on line above: .
, states the following:
1. I am the mvner of the single family dwelling for which I am applying for an
electrical permit.
Address: S- S- ~ (5/t/2 tv (f /f {.'!-;:;- ('/, /e,
, 2, I am applying for an electrical permit for a single family dwelling and it is or will
be my principal residence.
3. I will install and connect the electrical wiring for myself, without compensation
or pay from or to, any other person.
4. I have sufficient knowledge of the 2005 National Electrical Code requirements to
make an electrically safe and mechanically secure installation which will meet the
minimum standards referenced in 81-2104.
5. I am aware of all inspections required prior to a final.
6. I will call twenty-four (24) hours in advance for an inspection. I am also aware
that it is not the inspector's job or duty to be my instructor in electrical wiring.
7. I am aware that Nebr. Rev. Stat. 81-2143 makes it a Class 1 misdemeanor to
make a false statement on a request for inspection.
8. By signing this form I am stating the above information is true an correct.
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H6fueown~r! Applicant Signature
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Date
218 South 16th street. Blair, Nebraska 68008 . 402-426-4191 . Fax 402-426-4195 . E-mail cilyofblair@cLblair,ne.us
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