BPE3226ELECTRICAL PERMIT APPLICATION
Jurisdiction of City of B lair , Nebraska
218 South 16t Street
Blair, Nebraska 68008
Fax (402) 426-4195 E+
426-4191
Application Date: Perin $ 41 0a
-R - rz- Clzaq 1/,�3 467q
Job Address
Owner Mail Address zip Phone
1.
Contractor // V Z Phone �-671-0 -V49
2 H el r o 2 0Z
1• C of Work' C1 WEW RESIDENTIAL ❑ NEW COMMERCIAL 171 REMODELING/ADDITIONS C3 UPGRADE SERVICE
Doscribe Work:
5.Current License on File 'M'Yes 0 No 0 N/A Completion Date
ELECTRICAL PERMIT FEES
Service Fee = (Amp Fee + $5.00 per branch circWt)
Upgrade Existing Se.t*jce ............. $25,00
1-100 Amp Fee .... . I ..................
Temporary Service ....... ...... -- $15�00
101-200 Amp Fee ...... .... .............. $35,00
201-300 Amp Fee ..,.,. ........... .... $55,00
Fire Alarm System ... I - — - � ......... $15.00
3 01 -400 Amp Fee ............... ....... $75,00
S igns(each) .. . ...... --.—....$25.00
401-500 Amp Fee .................... - 395.00
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 ................ -1—$155100
801400 Amp Fee ...... ... $175,00
#f of Circuits x' $5.00
901-1000 Amp .... ....... ..... S-195.00
Amp Fee
IF OVUR 1000 Amp
V 1000 Amp Fee ........... ---$195.00
Amp Fee + Circuit Total
Each additional 100 Amps— .... -$20.00
New Residential: (Finished Area)
Singtefrwo Family Dwellings
Notice
sq, ft. x.063
I hereby certify that I have read and examined this
applicadonand 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 9pecified.herein or
not. The granting of a permit,dotts not pre.-nme to giv
Receptacles/Switches/Lighting Fixtures (110 voh 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,
PoNver Apparatus'(2 Volt or higher)
# of Apparatus.., X $8.00
Smoke Detectors-- x$3.00
57 Pon Issuance Fee. .... . ...... ... ...$25.00
Total
Date
Comment:
WHEN PROPEW,Y VALIDAIED (IJNTBIN' SPAUE) - 1 - HIS Is YUUX FLIKimll
Approved Bv
Rev. 2008-10
6 Y",
Application Date: — �'- I �
Permit Fee: $ ! oo
Job Address 26 11
Owner Mail Address zip Phone
1.
Contractor 'I ddress Phone
PYj0-;'-y
2. ( 900-5W-
3. Class of Work: C3 AEW RESIDENTIAL 13 NEW COMMERCIAL CJ REMODELING/ADDITIONS C3 UPGRADE SERVICE
Describe Work:
4. p vaz'L �)
5.Current License on File "MeYes C3 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
Fire Alarm S
y ..................... $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 ..............
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
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
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 00
Total
Date
Comment:
WHEN PROPERLY VALIDATED (IN THIS SPACE) THIS IS YOUR PERMIT
Approved By: '?
Rev. 2008-10
BUI LDING INSPECTION
BLAIR ❑ WASHINGTON COUNTY ❑ OTHER kg 1
4 41 (a 6
LOCATION OF INSPECTION•
F
y t
F �
i �,. ✓ � gar
' ;r` ' s �t.. ` t rrf t CONTRACTO •
NAME OF OWNER '
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ffr � , 2f ,t $y I t" c {� � _ • � ' y a - , � F
DATE INSPECTION REQUESTED '' a TIME INSPECTION REQUESTED S PERMIT NO
TYPE OF INSPECTIO REQUESTED: ❑ CONFER
❑ S TATUS C HECK
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
PASSE
FAILED
❑ PARTIAL
❑
COMMENTS:
MECHANICAL: ❑ ROUGH -IN ❑ A/c F- FU ❑ RADIANT HEAT ❑ FINAL ❑ PARTIAL
PASSED
FAILED
/ E '
PAP V /6' f L/ �f�s
COMME NTS: r l'
El
1:1
PLUMBING: ❑ GROUNDWORK ❑ ROUGH -IN ❑ FINAL ❑ WATER METER INSTALLED ❑ PARTIAL
PASSED
FAILED
❑ PRESSURE TEST
❑
❑
COMMENTS:
❑ OCCUPANCY GRANTED ❑ CONDITIONAL OCCUPANCY GRANTED
NOTES /REMARKS
9 ,
f 4 � 166 1 e�Xt Ph
/ y /// a
DATE OF INSPECTION MADE: Q / L T
FAXED OPPDIBURT REA TO CONNECT SERVICE: 0 N BY
BLAIR
LOCATION OF INSPECTION:
NAME OF
BUILD
❑ WASHINGTON COUNTY ❑ OTHER 1 s o f m- lj i`d
5E �
.• rnrlTU ArTnn. t, . - .,.. �. �, �. , _ F a< h „r A
DATE INSPECTION REQUESTED a
TIME INSPECTION REQUESTED Al ° ° PERMIT NO
❑ WATER SERVICE
TYPE OF INSPECTION REQUESTED:
❑ CO N FE RENCE
❑ STATU CHECK
BUILDING: ❑ FOOTING ❑ DECK FOOTING
❑ FRAMING ❑ DRYWALL ❑ FINAL ❑ PARTIAL
PASSED
FAILED
COMMENTS:
❑
❑
COMMENTS:
ELECTRICAL: ❑ ROUGH IN ❑ FINAL ❑_`PERMANENT SERVICE ❑ TEMPORARY SERVICE ❑ PRECONNECT
PASSEW
FAILED
UTILITIES: ❑ SEWER TAP ❑
SEWER ❑ SEPTIC ❑ WATER TAP ❑ REMOTE
❑ WATER SERVICE
PASSED
FAILED
❑ PARTIAL
❑
❑
COMMENTS:
ELECTRICAL: ❑ ROUGH IN ❑ FINAL ❑_`PERMANENT SERVICE ❑ TEMPORARY SERVICE ❑ PRECONNECT
PASSEW
FAILED
❑ PARTIAL
Al
� l
�`` a ✓f i ;7.,
❑
COMMENTS
a
MECHANICAL: F ROUGH -IN F]
A/C El FURNACE ❑ RADIANT HEAT ❑ FINAL
❑ PARTIAL
PASSED
FAILED
❑
❑
COMMENTS: r�
C%' �`� �� ® d�/'�
PLUMBING:
COMMENTS:
❑ GROUNDWORK ❑ ROUGH -IN ❑ FINAL ❑ WATER METER INSTALLED ❑ PARTIAL PASSED FAILED
❑ PRESSURE TEST ❑ ❑
❑ OCCUPANCY GRANTED ❑ CONDITIONAL OCCUPANCY GRANTED
NOTES /REMARKS:
t m
f
I 1,5
1 �, . ,.. , 11111 1111111
�r �
DATE OF INSPECTION MADE / _l 1 4 0
FAXED OPPD\BURT REA TO CONNECT SERVICE: ON BY
INSPECTO TIM
• . "� A DATE OF INSPECTION MAD Ff
FAXED OPPD\BURT REA TO CONNECT SERVICE: 0 N BY
INSPEC REPORT
r.
❑; CITY OF BLAIR
❑ WASHINGTON COUNTY ❑ OTHE
LOCATION OF INSPECTION: j s
1
p f
1
NAME OF OWNER a _ k >r€ 9� ", air `. CONTRACTO " f {° a " ° T'p `:fit
DATE INSPECTION
r
� ' fd �e C�
� n p F
REQUESTED ° ; n s TIME INSPECTION REQUESTED r ' s PERMIT
sir
NO '
'.F [[
r
TYPEOF INSPECTION
REQUESTED °� o ,,. ❑CONFERENCE
❑ STATUS CHECK
s
BUILDING: ❑
FOOTING ❑ DECK FOOTING ❑ FRAMING ❑ DRYWALL ❑ FINAL ❑ PARTIAL
PASSED
FAILED
❑
❑
COMMENTS:
UTILITIES: ❑
SEWER TAP ❑ SEWER ❑ SEPTIC ❑ WATER TAP ❑ REMOTE ❑ WATER SERVICE
PASSED
FAILED
❑
PARTIAL
❑
❑
COMME
ELECTRICAL: ❑
ROUGH ll j j ,, FINAL ❑ PERMANENT SERVICE ❑ TEMPORARY SERVICE ❑ PRECONNECT
PASSED
FAILED
❑
PARTIAL
❑
COMMENTS:
MECHANICAL: ❑
ROUGH -IN ❑ A/C ❑ FURNACE ❑ RADIANT HEAT ❑ FINAL ❑ PARTIAL
PASSED
FAILED
❑
❑ a
COMMENTS:
PLUMBING: ❑
GROUNDWORK ❑ ROUGH -IN ❑ FINAL ❑ WATER METER INSTALLED ❑ PARTIAL
PASSED
FAILED
❑
PRESSURE TEST
❑
❑
COMMENTS:
❑ OCCUPANCY GRANTED ❑ CONDITIONAL OCCUPANCY GRANTED
NOTES/REMARKS
{
i
i
INSPECTO TIM
• . "� A DATE OF INSPECTION MAD Ff
FAXED OPPD\BURT REA TO CONNECT SERVICE: 0 N BY