E3222_0003.tif i
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ELECTRICAL PERMIT APPLICATI
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- 1- 6 q Permit Fee: d •
Job Address / l ( ZCV Z 7 9 c1aa 1 qd ,, j 7
Own ail Address _ Zip Phone
1. ,y i 0.B 13. lq (!,
Contractor M ' ress Zip Phone
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3. Class of Work: O NEW RESIDENTIAL CI NEW COMMERCIAL 0 REMODE NG /ADDITIONS O UPGRADE SERVICE
Describe Work: ap 0
4. 5.Current License on File XYes O No O N/A Completion Date j
ELECTRICAL PERMIT FEES
Service Fee = (Amp Fee + $5.00 per branch circuit)
Upgrade Existing Service .............$25.00 415 U
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 (110 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
,K ignature f ntracto or Authorized Agent
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Permit Issuance Fee ...................$25.00 rJ d
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Total
Date Comment:
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WHEN PROPERLY VALIDATED (IN THIS SPACE ) THIS IS YOUR PERMIT
Approved By:�_�
Rev. 2008 -10