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ELECTRI PERMIT APPLICATION
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Jurisdiction of City of Blair, Nebraska
218 South 16' Street
Blau, Nebraska 68008
Fax (402) 426 -4195 E226
(402) 426 -4191
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.Application Dater
''� °' Permit 'cc: $
3
Job Address
Owner Mail Address 7.ip Phone
1. I
Contractor ail Address - .1 Phone '
3. Class of Work' C1 NEWRESIDENTIAL 0 NE COMMERCIAL t7 REMODELING /ADDITIONS CI UPGRADE SERVICE
Describe Work:
4. ' )
5.Current License on File Yes O No 0 N/A Completion bate
ELECTRICAL, PERMIT FEES
Service Fee = (Amp Fee +,$5,00 per branch circuit)
1 -100 Amp Pee ...... ................$25.00
Upgrade Existing Service .............$25.00
10l 200 Ain Fee.,.,:. $35.00 Temporary Service......, ............. $15.00
Amp
(each). S ystem .....................$25 00
......5.00
201 -300 Amp Fee .... .............$7 - I
301 -400 1 mp J~ee . $75.00 401-500 Amp Fee:...,, ,..... ,,.....,,395.00 Miscellaneous Apparatus ..... $15.0 yP 61
501 -600 Amp Fee,,,... $115.00
601 -700 Amp Fee ..................... $135.00 Commercial /Multi Family and All Upgrades: l
701 - 800 Amp Fee $155.00
801 -900 Amp Fee ............ .3175,00 # of Circuits x$5.00
901 -1000 Anip ......,., .....S195.00 Amp Fee
IF OVER 1 000 Amp
1" 1000 Anip Fee... ......$195.00 Amp Fee + Circuit Total I (
Each additional 100 Amps.. .....$20:00 New Residential: (Finished Area)
Singlell'wo Family Dwellings
Notice sq, ft, x.063 j
1 hereby certify that I have read and examined this 1
application and know the same to be true and correct. All Modular /Manufactured Homes ....... $50.00 11
provisions of laws and ordinances governing this type of
work will be complied with whether specifled.hercin or Other: {alterations, additions and modifications)
not, The granting of a permit..dnec not presnme to give ,
authority to violate or cancel the provisions of any other �eceptaclesrSwitches /Lightingkixlures(110voltonly)
state or local lmvregulating construction or the # of Apparatus .......... x $1.00
performance of construction.
Power Apparatus'(220 Volt or higher)
# of Apparatus.,, ... , x $x:00
Smoke Detectors..... x$3.00
igna re of L ntrac ur or utfiorize e 1
Permit Issuance Fee ...................$25.00
l Total
Date Comment.
WHEN PROPERLY VALIDATED (IN THIS SPACE) THIS IS YOUR PI RJMIT
Approved By:
Rev. 2008 -10
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