BPE3179,0
ELECTRICAL PERMIT APPLIC
Jurisdiction of City of Blair, Nebraska
218 South 16 Street
Blair, Nebraska 68008
Fax (402) 426 -4195 E 3179
(402) 426 -4191
Application Date: i '° b °'t fd 1 Q
Job Address
Owner
1. /
Permit Fee: $
Phone
Phone
ADDITIONS -" 9ZGPGRADE SERVICE
Contractor Mail Address °
2. /` ��
3. Class of Work: O NEW RESIDENTIAL O NEW COMMERCIAL O
Describe Work:
5.Current License on File `�W Yes O No O /A
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
0 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.
Completion 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
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 (I 10 volt only)
# of Apparatus ........ x $1.00
Power Apparatus (220 Volt or higher)
# of Apparatus....... x $8.00
Smoke Detectors..... x $3.00
Signature of C tor or Authorized Agent eoo
(l Permit Issuance Fee ...................$25.00 °� `
Total
Date Comment:
WHEN PROPERLY VALIDATED (IN THIS SPACE) THIS IS YOUR PERMIT
Approved By:
Rev. 2008 -10
X , ,
"
. ,❑y'CITY OF BLAIR
LOCATION OF
❑ WASHINGTON COUNTY ❑
x { r/
COMMENTS:
UTILITIES: ❑ SEWER TAP ❑ SEWER ❑ SEPTIC ❑ WATER TAP ❑ REMOTE ❑ WATER SERVICE // PASSED FAILED
F] PARTIAL _ n ^ 7._Al ? /J ❑ ❑
COMMENTS:
K9//
ELECTRICAL: ❑ ROUGH IN ❑ FINAL s❑ PERMANENT SERVICE ❑ TEMPO RY SERVICE ❑ PRECONNECT P(1SS pj FAILED
RTIAL ❑
COMMENTS
MECHANICAL: ❑
ROUGH -IN ❑ A/C ❑ FURNACE
❑ RADIANT HEAT ❑ FINAL ❑ PARTIAL
PASSED
.+F fI ✓T ''. Y Q .✓l. � J' 1/4 J f �t ,
NAME OF OWNER = -� ° CONTRACTO
DATE INSPECTION REQUESTED �''���
TIME INSPECTION REQUESTED / f °� PERMIT NO
❑
4
TYPE OF INSPECTION REQUESTED:
❑ CONFERENCE
❑ STATUS CHECK
BUILDING: ❑ FOOTING ❑ DECK FOOTING ❑
FRAMING ❑ DRYWALL ❑ FINAL ❑ PARTIAL
PASSED FAILED
❑
PRESSURE TEST
❑ ❑
COMMENTS:
UTILITIES: ❑ SEWER TAP ❑ SEWER ❑ SEPTIC ❑ WATER TAP ❑ REMOTE ❑ WATER SERVICE // PASSED FAILED
F] PARTIAL _ n ^ 7._Al ? /J ❑ ❑
COMMENTS:
K9//
ELECTRICAL: ❑ ROUGH IN ❑ FINAL s❑ PERMANENT SERVICE ❑ TEMPO RY SERVICE ❑ PRECONNECT P(1SS pj FAILED
RTIAL ❑
COMMENTS
MECHANICAL: ❑
ROUGH -IN ❑ A/C ❑ FURNACE
❑ RADIANT HEAT ❑ FINAL ❑ PARTIAL
PASSED
FAILED
❑
❑
COMMENTS:
PLUMBING: ❑
GROUNDWORK ❑ ROUGH -IN ❑
FINAL ❑ WATER METER INSTALLED ❑ PARTIAL
PASSED
FAILED
❑
PRESSURE TEST
❑
❑
COMMENTS:
❑ OCCUPANCY GRANTED CO GRAN TED
NOTES /REMARKS
L
�Mdq
TE OF INSPECTION MADE T IME- s 6
AXED PD \BURT RE iA d f G TO CONNECT SERVICE: ON BY
1
BUILDING INSPECTION REPORT
CITY OF BLAIR
CONTRACTOR'
/":;{};')~ II ,/~'
o WASHINGTON COUNTY
LOCATION OF
NAME OF
l /~/,r";-F$'!
DATE INSPECTION REQUESTED,l/;~t:::'iPi
TIME INSPECTION REQUESTED' '
~ (:~;) e-_~<,r,~? l."r? "
PERMIT NO'
\-';f;
I
TYPE OF INSPECTION REQUESTED: 0 CONFERENCE
BUILDING: 0 FOOTING 0 DECK FOOTING 0 FRAMING 0 DRYWALL 0 FINAL 0 PARTIAL
o STATUS CHECK
PASSED FAILED
o 0
COMMENTS:
UTILITIES: 0 SEWER TAP 0 SEWER 0 SEPTIC 0 WATER TAP
o PARTIAL
ELECTRICAL: p ",ROUGH IN 0
~RTIAL
COMMENTS:
o REMOTE 0 WATER SERVICE 17 PASSED FAILED
~/';/~ef/,(l 0 0
I , iJt'{a~
'.,'7&.. .,~
SERVICE 0 PRECONNECT P{\S~ FAILED
C)~~ f/J1\ r~r2Y:J 0
COMMENTS:
MECHANICAL:D ROUGH-IN 0 AlC 0 FURNACE 0 RADIANT HEAT 0 FINAL [;J PARTIAL
PASSED FAILED
o 0
COMMENTS:
PLUMBING: 0 GROUNDWORK 0 ROUGH-IN 0 FINAL 0 WATER METER INSTALLED 0 PARTIAL
o PRESSURE TEST
PASSED FAILED
o 0
COMMENTS:
'[) rNDITIONALt~CCUPAN(GRANTED
~~ ~ FCd: "V1
s;;CJa~'e W E/'e[--rt//'r ~/!?~~-e2. A ~,T~v-
I I' /
Yif ~ / I 1;;zj
Cct (7' -H ~(u//t en 0/i '2>r;~
O/\~'c(5f1t1ec: Y ~ 11J,;&/: At:4fPP(
~ATE OF INSPECTION MADE: 0 1- / ~F Olole? TIME' ~; t../' cJ
INSPECTO '
~PD\BURT REA -1'" Z I) I tJ
C/' 1W ( I t/
TO CONNECT SERVICE: ON BY