BPE3183Jurisdiction of City of Blair, Nebraska
218 South 16 Street
Blair, Nebraska 68008
Fax (402) 426 -4195
(402) 426 -4191
Application Date: j Gyeq , Permit Fee: $
Job Address
/V /
Owner - M ail Address Zip Phone _
1. & � et Ls .5313 .- ° 7,``� � /13
Contractor � � , Mail ddress Zip Phone
2.
3. Class of Work: O NEW RESIDENTIAL O NEW COMMERCIAL O REMODELING /ADDITIONS O UPGRADE SERVICE
Describe Work:
4. 7e4t T rr � 11
2�/
S.Current License on File 4K Yes O No 0 N/A Completion Date
ELECTRICAL PERMIT FEES
Service Fee = (Amp Fee + $5.00 per branch circuit)
Upgrade Existing Service .............$25.00
1 -100 Amp Fee .......................$25.00
Temporary Service............ ..... $15.00
101 -200 Amp Fee .......................$35.00
201 -300 Amp Fee .......................$55.00
Fire Alarm System ............ ......$15.00
"'
301 -400 Amp Fee... .................... $75.00
Signs ( each) ..... .........................$25.00
401 -500 Amp Fee... $95.00
Miscellaneous Apparatus ..............$15.00
501 -600 Amp Fee .....................$115.00
601 -700 Amp Fee .....................$135.00
Commercial/Multi Family and All Upgrades:
701 -800 Amp Fee .....................$155.00
801 -900 Amp Fee .....................$175.00
# of Circuits x $5.00
901 -1000 Amp . ........................$195.00
Amp Fee
IF OVER 1000 Amp
1" 1000 Amp Fee ..................$195.00
Amp Fee + Circuit Total
Each additional 100 Amps ......... $20.00
New Residential: (Finished Area)
Single /Two Family Dwellings
Notice
sq. ft. x .063
I hereby certify that I have read and examined this
application and know the same to be true and correct. All
Modular /Manufactured Homes ....... $50.00
provisions of laws and ordinances governing this type of
work will be complied with whether specified herein or
Other: (alterations, additions and modifications)
not. The granting of a permit does not presume to give
to the
Receptacles /Switches /Lighting Fixtures (110 volt o l
authority violate or cancel provisions of any other
state or local law regulating construction or the
# of Apparatus .......... x $1.00 f� '
performance of construction.
Power Apparatus (220 Volt or higher)
# of Apparatus....... x $8.00
N
c
Smoke Detectors..... L- t x $3.00
Signature of Contractor or Authorized Agent
7 _
Permit Issuance Fee.. ..$25.00
...............
2 � 0
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Total
Date
Comment:
WHEN PROPERLY VALIDATED (1N THIS SPACE) THIS IS YOUR PERMIT
Approved By: &' '��
�7
Rev. 2008 -10