BPE3222J'
ELECTRICAL E APPLI
Jurisdiction of City of Blair, Nebraska
218 South 16 Street
Blair, Nebraska 68008
Fax (402) 426 -4195 E 3222
(402) 426 -4191
Application Date: 1 7 - 6 q — l 0
Permit Fee: $ d
Job Address f� C 7 qd /-/ 7
Own ail Address Zip Phone
1. t 11 f U, C` r!D / �. % 6
Contractor M '1 ress ) L Zip Phone
2. T�1 n
3. Class of Work: O NEW RESIDENTIAL 0 NEW COMMERCIAL ®REMODE NC /ADDITIONS O UPGRADE SERVICE
Describe Work:
Z��
4.
5.Current License on File Yes O No O N/A V Completion Date
ELECTRICAL PERMIT FEES
Service Fee = (Amp Fee + $5.00 per branch circuit)
Upgrade Existing Service .............$25.00 4 5 , 0 0
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 $25.00
( each )..............................
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 &t 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
.
ignature f ntracto or Authorized Agent
d
Permit Issuance Fee ...................$25.00
1
Av
Total
Date
Comment:
WHEN PXUPEKLY VAL1llAIED (IN THIN arAUh ) IHV) 1� Y UulcrrmvllI
Approved By: I 4 ."�
Rev. 2008 -10
Job Address 7
Own,&') h4ail Address zip Phone
Contracto
Contract M MA res zip Phone
j
2. f 4 11V 61i 4—)
3. Class of Work 0 NEW RESIDENTIAL 13 NEW COMMERCIAL Cl REMOD4NG/ADDITIONS 13 UPGRADE SERVICE
Describe Work:
4. e X C te/a lav d 'S
5.Current License on File XYes C3 No 0 N/A V 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 .......................
Fire Alarm S
S ..................... $15.00
301-400 Amp Fee ... .................... $75.00
Signs (each) .............................. $25.00
401-500 Amp Fee ............ ... $95.00
Miscellaneous Apparatus ..............
501-600 Amp Fee .....................
601-700 Amp Fee .....................$135.00
Commercial/Multi Family and All Upgrades:
701-800 Amp Fee .....................
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
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 Contractor or Authorized Agent
Permit Issuance Fee ................. $25.00
Total
Date
Comment:
WHEN FRUPEKLY VALIDA'IED (1N THIS SPACE) THIS IS YOUR PERMIT
Approved By: �? /'? '-, Rev. 2008-10
❑`CITY OFBLAIR El WASHINGTON COUNTY - 1 OTHE
LOCATION OF INSPECTION.
2 5 J '; t f eo,`�y!.r 1
NAME OF OWNER �. {.f CONTRACTO �B
DATE INSPECTION REQUESTED ? ' ar k ' '0 W TIME INSPECTION REQUESTED t `" f a a 5 "' } • g ='# PERMIT N0 t
TYPE OF INSPECTION REQUESTED f ❑ CONFERENCE ❑ STATUS CHECK
BUILDING: ❑ FOOTING ❑ DECK FOOTING ❑ FRAMING ❑ DRYWALL ❑ FINAL ❑ PARTIAL PASS D FAILED
`r ❑
COMMENTS:
k
Jr, _
UTILITIES: ❑ SEWER TAP ❑ SEWER ❑ SEPTIC ❑ WATER TAP ❑ REMOTE ❑ WATER SERVICE PASSED FAILED
❑ PARTIAL ❑ ❑
COMMENTS
ELECTRICAL: ❑ ROUGH IN_ .m - FINAL, - PERMANENT SERVICE ❑ TEMPORARY SERVICE ❑ PRECONNECT P SS AILED
❑ ❑
COMMENTS: PARTIAL , 4., 'Ns
y ,
MECHANICAL: ❑ ROUGH -IN ❑ A/C ❑ FURNACE ❑ RADIANT HEAT ❑ FINAL ❑ PARTIAL PASSED FAILED
❑ ❑
COMMENTS:
PLUMBING: ❑
❑
COMMENTS:
GROUNDWORK ❑
PRESSURE TEST
ROUGH -IN ❑ FINAL ❑ WATER METER INSTALLED ❑ PARTIAL
PASSED FAILED
❑ ❑
❑ OCCUPANCY GRANTE /D J� CONDITIONAL OCCUPANCY GRANTED
NOTES/REMARKS (� r �1 ^ c F'
INSPECTO
FAXED OPPD \BURT REA
DATE OF INSPECTION MADE: d 6 `. G
TO CONNECT SERVICE: ON BY
T TMR