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Contr ftor f F— / (,( f Mail Address Zip Phone
2. K Ir e A (� C-
3. Class of Work: O NEW RESIDENTIAL O NEW COMMERCIAL '-REMODELING/ADDITIONS O UPGRADE SERVICE
Describe Work:
4. ,'�' 6 "1CC.�Y
5.Current License on File O Yes O No O 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
Fire Alarm System .....................$15.00
201 -300 Amp Fee .......................$55.00
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 60 .
901 -1000 Amp . ........................$195.00
Amp Fee °
IF OVER 1000 Amp
-
I" 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
Other: (alterations, additions and modifications)
work will be complied with whether specified herein or
not. The granting of a permit does not presume to give
Receptacles /Switches /Lighting Fixtures (110 volt only)
authority to violate or cancel the provisions of any other
# of Apparatus x $1.00
state or local law regulating construction or the
..........
performance of construction.
Power Apparatus (220 Volt or higher)
# of Apparatus....... x $8.00
Smoke Detectors..... x $3.00
Signature of Co tractor or Authorized Agent
0 0
Permit Issuance Fee ...................$25.00
,,, }}
Total t V�
Date
Comment:
I
WHEN PROPERLY VALIDATED (IN THIS SPACE) THIS 1S YOUR PERMIT
Approved By:
Rev. 2008 -10
PLUMBING PERMIT APPLICATION
Jurisdiction of City of Blair, Nebraska ' D
218 South 16 Street
Job Address
U/
Owne Mail Address Zip Phone
1.
Contrac Map Address Zip Phone
2.
3. C ass of Work: ❑ COMMERCIAL sIDENTI ❑New ❑ Addition teration ❑ Repair C3 Replacement
Describe Work: rl
PLUMBING PERMIT FEES
Comments:
Modular Home ......................$50.00
Type of Fixture No.
Kitchen .............................. $12.00 x
Bath..... Residential/Single Stall $12.00 x /v?
...... ..............Multi -Stall $25.00 x
Rough -In Bath ........................$8.00 x
Additional Sinks .....................$6.00 x A • 400
Slop Sink/Laundry Tray/Drain ..... $6.00 x
Water Heater .........................$10.00 x
Notice
Outside Water Faucet ...................$6.00 x
I hereby certify that I have read and examined this
application and know the same to be true and correct. All
.
Drinking Fountain ........:...............$6.00 x
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
Backflow /Grease Trap 15.00
p
authority to violate or cancel the provisions of any other
Water Service .......................$15.00
state or local law regulating construction or the
performance of construction.
Sewer ........ .........................$15.00
Groundwork .........................$15.00
Septic Tank & Laterals............ $15.00
Lawn Sprinkler System ............ $10.00
Sprinkler System (Commercial)..$30.00
Gas /Water Piping System
(Commercial) .........$50.00
' nature of Contractor or Authorized Agent
Permit Issuance Fee .................$25.00 • to U
Total
Current License on File A4es ❑ No ❑ N/A
Date
Comment:
WHEN PROPERLY VALIDATED (IN THIS SPACE) '1'Hls 1S YOUR PERMIT
Approved By: ;;?a
Rev. 2008 -10
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1 ORO 1 p 0
CITY OF BLAIR ❑
LOCATION OF INSPECTION
WASHINGTON COUNTY ❑ OTHER
7
I
NAME OFOWNER:
CONTRACTOR•,
?6
SEWER TAP
SEWER ❑ SEPTIC ❑ WATER TAP [:] REMOTE ❑ WATER SERVICE
_
FAILED
DATE INSPECTION REQUESTED:' TIME INSPECTION REQUESTED
"'I
"PERMIT
NOL__
/cyoqL ' /o
El
COMMENTS:
TYPE OF INSPECTION REQUESTED:
CONFERENCE
[:1 STATUS CHECK
ELECTRICAL
L
X
ROU( H IN�%,l
BUILDING: F FOOTING E:l
DECK FOOTIN FRAMING ❑ DRYWALL
E:l FINAL [:1 PARTIAL
PASSED FAILED
PARTIAL
❑ F
COMMENTS:
UTILITIES: ❑
SEWER TAP
SEWER ❑ SEPTIC ❑ WATER TAP [:] REMOTE ❑ WATER SERVICE
PASSED
FAILED
El
PARTIAL
F]
El
COMMENTS:
ELECTRICAL
L
X
ROU( H IN�%,l
111,
JERMANENT SERVICE ❑ TEMPORARY SERVICE E:l PRECONNECT
SSED�oF
PA AILED SSED
F
PARTIAL
_.p<
❑
COMMENTS:
MECHANICAL:F
ROUGH —IN
❑ A/C
❑ FURNACE ❑ RADIANT HEAT ❑ FINAL ❑ PARTIAL
PASSED
FAILED
F
F1
COMMENTS:
PLUMBING: F GROUNDWORK ❑ ROUGH-IN ❑ FINAL ❑ WATER METER INSTALLED F1 PARTIAL PASSED FAILED
COMMENTS: El PRESSURE TEST El 1
F OCCUPANCY GRANTED ❑ CONDITIONAL OCCUPANCY GRANTED
NOTES/REMARKS• / 11 __IZA � (1/ -1
BUILDING INSPECTION REPORT
CITY OF BLAIR
❑ WASHINGTON COUNTY ❑ OTHE
LOCATION OF INSPECTION:
NAME OFOWNER-
CONTRACTOR* J'V Jl_�l 17A!
)J
DATE INSPECTION REQUESTEDL_�
i
TIME INSPECTION REQUESTED- PERMIT NOL---
TYPE OF INSPECTION REQUESTED: ❑ CONFERENCE
❑ STATUS CHECK
BUILDING: ❑
FOOTING ❑ DECK FOOTING ❑ FRAMING ❑ DRYWALL ❑ FINAL ❑ PARTIAL
PASSED
FAILED
COMMENTS:
UTILITIES: ❑
SEWER TAP ❑ SEWER ❑ SEPTIC ❑ WATER TAP REMOTE ❑ WATER SERVICE
PASSED
FAILED
El
PARTIAL
El
El
COMMENTS:
ELECTRICAL: ❑
ROUGH ME] FINAL SERVICE ❑ - 1
PERMANENT TEMPORARY SERVICE E] PRECONNECT
PASSED
FAILED
❑
COMMENTS:
PARTIAL r
d
El
k
MECHANICAL: El
ROUGH-IN ❑ A/C ❑ FURNACE ❑ RADIANT HEAT ❑ FINAL PARTIAL
PASSED
FAILED
❑
❑
COMMENTS:
PLUMBING: ❑
GROUNDWORK E] ROUGH -IN ❑ FINAL WATER METER INSTALLED ❑ PARTIAL
PASSED
FAILED
El
PRESSURE TEST
❑
El
COMMENTS:
❑ OCCUPANCY GpoqED
❑ CONDITIONAL OCCUPANCY GRANTED
NOT MARK
A rt.�
I A
BUILDING INSPE
y
CITY OF BLAIR ❑ WASHINGTON COUNTY ❑ OTHE
LOCATION OF INSPECTION
L f I f �e
NAME OF OWNER Y "' ' a. CONTRACTO
DATE INSPECTION REQUESTED ,Z ` �' TIME INSPECTION REQUESTED ` ' $' PERMIT NO
TYPE OF INSPECTION REQUESTED: ❑ CONFERENCE
❑ STATUS CH ECK
BUILDING ❑
FOOTING ❑ DECK FOOTING -Er ❑ DRYWALL ❑ FINAL ❑ PARTIAL
PASSED
FAILED
El
COMMENTS:
UTILITIES: ❑
SEWER TAP ❑ SEWER ❑ SEPTIC ❑ WATER TAP ❑ REMOTE ❑ WATER SERVICE
PASSED
FAILED
❑
PARTIAL
❑
❑
COMMENTS:
ELECTRICAL: ❑
ROUGH IN ❑ FINAL ❑ PERMANENT SERVICE ❑ TEMPORARY SERVICE ❑ PRECONNECT
LL% PASSED
FAILED
❑
PARTIAL
❑
❑
COMMENTS:
�
�❑
� � �
MECHANICAL: ❑
ROUGH -IN ❑ A/C ❑ FURNACE ❑ RADIANT HEAT FINAL ❑ PARTIAL
PASSED
FAILED
❑
❑
COMMENT
PLUMBING: ❑
GROUNDWORK ❑ ROUGH -IN ❑ FINAL ❑ WATER METER INSTALLED ❑ PARTIAL
PASSED
FAILED
❑
PRESSURE TEST
❑
❑
COMMENTS:
❑ OCCUPANCY GRANTED ❑ CONDITIONAL OCCUPANCY GRANTED
INSPECTO L 6'v lr� DATE OF INSPECTION MADE: / O "f 0 T IME � a J o A
FAXED OPPD\BURT REA TO CONNECT SERVICE: ON BY
BUILDING INSPECTION REPORT
CITY OF BLAIl2 ❑ WASHINGTON COUNTY F] OTHE
9
LOCATION OF INSPECTION -� (Zs `
NAME OF OWNER
s - CONTRACTO
DATE INSPECTION REQUESTED TIME INSPECTION REQUESTED VA • PERMIT NO
TYPE OF INSPECTION REQUESTED: ❑ CONFEREN ❑ ST CHECK
BUILDING: ❑FOOTING
❑ DECK FOOTING FRAMING ❑ DRYWALL ❑ FINAL ❑ PARTIAL
PASSED
FAILED
❑
❑
COMMENTS:
UTILITIES: ❑
SEWER TAP ❑ SEWER ❑ SEPTIC ❑ WATER TAP ❑ REMOTE ❑ WATER SERVICE
PASSED
FAILED
❑
PARTIAL
❑
❑
COMMENTS:
ELECTRICAL: ❑
ROUGH IN ❑ FINAL ❑ PERMANENT SERVICE ❑ TEMPORARY SERVICE ❑ PRECONNECT
PASSED
FAILED
❑
PARTIAL
❑
❑
COMMENTS:
MECHANICAL: ❑
ROUGH -IN ❑ A/C ❑ FURNACE ❑ RADIANT HEAT ❑ FINAL ❑ PARTIAL
PASSED
FAILED
❑
❑
COMMENTS:
PLUMBING: ❑
❑
GROUNDWORK ROUGH-IN L ❑ WATER METER INSTALLED PARTIAL
PRESSURE TEST
PASSED,' EAlLT1
COM MENT S: ;
❑ OCCUPANCY GRANTED ❑ CONDITIONAL OCCUPANCY GRANTED
NOTES/REMARKS
I ` e Igo cd 0 AV
INSPECTO �V U� ffi DATE OF INSPECTION MADE: T TMF. X15 a
FAXED OPPD \BURT REA TO CONNECT SERVICE: ON BY
COMMENTS:
MECHANICAL: F
BUILDING INSPECTION REPORT
PASSED
FAILED
'O.- OF BLAIR
❑ WASHINGTON COUNTY E:l OTHE
❑
F
COMMENTS:
LOCATION OF INSPECTION
/4
PASSED
FAILED
NAME OF OWNER -
Lt
CONTRACTOR
❑
COMMENTS:
DATE INSPECTION REQUESTED 3 TIME INSPECTION REQUESTED PERMIT
NO-
TYPE OF INSPECTION REQUESTED: ❑ CONFERENCE
❑ STATUS CHECK
BUILDING: ❑
FOOTING F DECK FOOTING E:l FRAMING ❑ DRYWALL F FINAL F PARTIAL
PASSED
FAILED
F
1
COMMENTS:
UTILITIES: F
SEWER TAP F SEWER ❑ SEPTIC F WATER TAP ❑ REMOTE ❑ WATER SERVICE
PASSED
FAILED
❑
PARTIAL
❑
❑
COMMENTS:
ELECTRICAL: F
ROUGH IN ❑ FINAL ❑ PERMANENT SERVICE ❑ TEMPORARY SERVICE F PRECONNECT
PASSED
FAILED
❑
PARTIAL
❑
1
COMMENTS:
MECHANICAL: F
ROUGH -IN F A/C [-] FURNACE ❑ RADIANT HEAT ❑ FINAL ❑ PARTIAL
PASSED
FAILED
❑
F
COMMENTS:
PLUMBING: ❑
-----------
GROUNDWORK [:1 ROUGH -IN ❑ WATER METER INSTALLED ❑ PARTIAL
PASSED
FAILED
F
- MFINAL
PRESSURE TEST
❑
COMMENTS:
[-] OCCUPANCY GRANTED ❑ CONDITIONAL OCCUPANCY GRANTED
elk
Onow.r.p-i►
/Pod a L=,
m
L -
INSPECTOR: DATE OF INSPECTION MADE:
I v t 1 �, t () T,
FAXED OPPDTURT REA TO CONNECT SERVICE: ON BY