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CITY OF SOUTH SAN FR <br />DEPARTMENT OF COMMUNITY DEVELOPMENT & ADMINISTRATION BUILDING INSPECTION DIVISION <br />400 Grand Avenue, South San Francisco, CA 94080 Phone 877 -8545 <br />APPLICATION FOR ELECTRICAL PERMIT <br />Permit EA.— $10.00 Supplement $3.00 <br />See Table #3A '84 Nat. Elea. Code for specific <br />details. - Ordinance No. 1007 -86 <br />QTY <br />FEE <br />Name <br />O <br />m <br />$10'00 <br />Z <br />Address <br />City <br />SYSTEM FEE SCHEDULE <br />Tel. No. <br />New Residential <br />Name <br />New Multi Family $.02 per sq. ft. <br />o <br />Addres <br />New Single Family $.025 per sq. ft. <br />� <br />C - <br />occupancies Other Types of residential o & <br />alterations - Unit i Fee Schedule <br />ac <br />t- <br />Tel. No. <br />Swimming Pools .. .........................$20.00 <br />v <br />State License No <br />Carnivals, Circuses, Expositions <br />Electrical Generators & Rides ........... $10.00 ea. <br />City Bus. Lic. No. <br />WORKMAN'S COMPENSATION INFORMATION <br />In conformity with the provisions of Sec. 3800 of the Labor <br />Code of the state of Calif. each applicant shall file with <br />Display lighting for rides .. ' .....:....... $ 3.00 ea. <br />Sy stem & Booth lighting ........ '. , ..... $ 3.00 ea. <br />Permanently installed rides etc. ea. <br />use Unit Fee Schedule <br />the Building Inspector the certificate designated in (1) below <br />or shall sign item (2) whichever is applicable. <br />(1) Certificate (or exact or duplicate copy) of Workmen's <br />Compensation Ins. issued by an admitted insurer. <br />Temp Power ........................... $10.00 ea. - <br />Temp Li htin /Outlets ...... . ........... $ 5.00 ea. - <br />(2) 1 certify that in the performance of the work for <br />which this permit is issued that I shall not employ any per - <br />son in any manner so as to become subject to the <br />Workmen's Compensation Laws of Calif. <br />UNIT FEE SCHEDULE <br />Outlets - Plug Switches, Controllers <br />First 20 . $ .50 ea. <br />Additional $ ;.30 ea. <br />SI <br />r acknowledge that I have read this application <br />I hereby ac ed <br />y 9 to <br />and state that the above. is correct and ag to comply <br />9 py <br />5 ft. or fraction of multi-outlet ss . Is one outlet a <br />' <br />Fixtures —F irst 0 $ <br />with all Ci ty Ordinances and State Laws regulating buil <br />ty <br />; <br />construction. <br />Additional .................... $ .30 ea. <br />Appliances Residential .................. $ 2.00 ea. <br />Policy No. <br />Non Residential less than 1 hp...'... , , ..$ 2.00 ea, <br />less than 1 kw... ....... $ 2.00 ea. <br />Expiration Date <br />less than 1 kva. ........ $ 2.00 ea. <br />Power Apparatus: — (hp) (kw) (kva) (kvar) <br />Up to and including 9 ................. $ 2.00 ea. <br />This application is an Electric Permit when properly <br />filled out, signed and validated for the correct fee in <br />the validation space. Permission is therefore granted <br />to do such work as indicated in this application in ac- <br />cordance with and subject to all of the provisions of <br />the Electric Code of South San Francisco and all <br />related laws. Renew only once at full fee. <br />This permit becomes null and void if work is not com- <br />menced within 180 days from the date of issuance, or <br />W <br />C <br />r <br />O <br />Z <br />V <br />11 <br />s <br />10 to 50 .... ...... ................ . $10.00 ea. <br />51 to 100 ........................... $20.00 ea. <br />100+ ...... . ....::........ . . . ....... $30.00 ea. <br />Note. Multi-motor equipment —use Suns of <br />combined rating. Fees include all related control <br />equipment. <br />if work is suspended at any time for more than 180 <br />—I <br />Busways, 100 ft. or fraction .............. $ 3.00 ea. <br />days, or if any work is done in violation of any city or- <br />dinance or state law relating thereto. No materials may <br />be stored on the street or public property without an <br />Z <br />O <br />Sig ns One circuit ............. ' .....:. $10.00 ea. <br />Additional circuits for same sig ........... $ 2.00 ea. <br />encroachment permit from the City Engineer. <br />Services <br />Approved <br />less than 600 V @ 200 amps max ..... ;. $12.50 ea. <br />less than 600;V @ 200 to 1000 amps .. x.$25.00 ea. ; <br />By <br />Building Inspector -- --- - --- <br />more than 600 V or over 100 amps ......$50.00 ea. <br />Apparatus not listed herein ............... $ 7.50 ea. - <br />, RECEIPT # Apparatus: r m, <br />TOTAL PERMIT FEE �, d.= ',. ���. M <br />c� <br />WHEN PROPERLY VALIDATED THIS IS YOUR PERMIT. rr <br />WHITE — Bldg. YELLOW — Applicant PINK — Inspector's Copy <br /> L <br />