E3222_0004.tif i
ELECTRICAL PERMIT APPLICATION
Jurisdiction of City of Blair, Nebraska
218 South 16 Street
Blair, Nebraska 68008
Fax (402) 426 -4195 E 3222
(402) 426 -4191
Application Date [ Permit Fee: $
Job Address � j
Owne w ail Address Zip Phone
1.
Contractor , M ' �A ress ) Zip Phone
2. ,�
3. Class of Work: O NEW RESIDENTIAL O NEW COMMERCIAL O REMODE NG /ADDITIONS O UPGRADE SERVICE
Describe Work:
4. P
5.Current License on File Xyes 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 93- 1
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
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 (I 10 volt only)
authority to violate or cancel the provisions of any other
state or local law regulating construction or the # of Apparatus .......... x $1.00
performance of construction.
Power Apparatus (220 Volt or higher)
# of Apparatus...... x $8.00
Smoke Detectors..... x $3.00
:
l;. Signature of Contractor or Authorized Agent _
Permit Issuance Fee ...................$25.00 '6 '�
Total°
Date Comment:
WHEN PROPERLY VALIDATED (IN THIS SPACE) THIS IS YOUR PERMIT
Approved By:
Rev. 2008 -10
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