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• • <br /> CITY SOUTH SAN FA ISC. <br /> Y OF U N R NC <br /> E LECTRICAL <br /> DEPARTMENT OF PUBLIC SERVICES BUILDING INSPECTION DIVISION Permit Number <br /> 400 Grand Avenue, South San Francisco, Ca. 94080 Phone 873 -8000 Ext. 271 <br /> APPLICATION N FR ELECTRICAL PERMIT <br /> Job Address BUILDING PERMIT NQ: ` L 2 - <br /> APPLICANT TO FILL IN BETWEEN HEAVY LINES <br /> Name <br /> * <br /> COMMERCIAL AND INDUSTRIAL QTY FEE <br /> w Address <br /> TEMPORARY POWER POLE $ 7.50 z <br /> TEMP. LIGHTING UP TO 30 AMPS $ 2.00 City <br /> 0 <br /> OVER 30 AMPS $ 3.00 Tel. No. <br /> SERVICES $2.00 /KVAor: AMPERES - <br /> cc Name <br /> 240 V 10 $2.00/100 AMP p <br /> I- Address <br /> 240 V 30 $2.00/60 AMP U <br /> 480 V 30 $2.00/30 AMP < City Tel No . <br /> 280 V 30 $2.00/70 AMP Z State License No. <br /> BUS DUCT $ .10/Ft to 100 <br /> 0 <br /> U City Bus. Lic. No <br /> $ .02 /Ft over 100' r <br /> OUTLETS - CEILING EACH $ .25 <br /> t <br /> SWITCHES EACH $ .25 WORKMAN'S COMPENSATION INFORMATION <br /> PLUGS EACH $ .25 In conformity with the provisions of Sec. 3800 of the Labor Code of <br /> the State of Calif. each applicant shall file with the Building Inspector <br /> FIXTURES - INCANDESCENT EACH $ .25 the certificate designated in (1) below shall sign item (2) whichever is <br /> FLOURESCENT or MERCURY EACH $ .50 applicable. <br /> SPECIAL CIRCUITS - SINGLE PHASE $ .50 (1) Certificate (or exact or duplicate copy) of Workman's Compen- <br /> sation Ins. issued by an admitted insurer. <br /> THREE PHASE $ .75 (2) I certify that in the performance of the work for which this <br /> MOTORS, HEATERS, TRANSFORMERS, ETC. permit is issued that 1 shall not employ any person in any manner so as <br /> UP TO 5 K.W. PER KW $' .50 to become subject to the Workman's Compensation Laws of Calif. <br /> OVER 5 K.W. PER KW $ .25 <br /> HP TO BE COMPUTED 0.75 K.W. PER HP SIGNED: <br /> MAX. FEE FOR ONE UNIT $25.00 I hereby acknowledge that I have read this application and state <br /> SIGN /DECOR LIGHTING PER CIR $ 1,00 that the above is correct and agree to comply with all City Ordinances <br /> and State Laws regulating building construction. <br /> BILLBOARD TYPE SIGN /SERVICE $ 4.00 <br /> SIGN CIRCUIT OUTLET EACH $ .25 <br /> * ELECTRIC TYPE SIGN $ 1.50 OWNER: <br /> $.02 /LAMP or $.50 BALLAST or TRANS <br /> * REINSPECTION FEE $10.00 BY: <br /> * NON- PRESCRIBED EQUIP FEE PER HR $10.00 <br /> SPECIAL CIRCUIT NOT HEREIN LISTED$ 1.00 <br /> TRAILER SPACE OUTLET $ 1.00 This application is an Electric Permit when properly filled out, <br /> signed, and validated for the correct fee in the validation space. <br /> OTHER: Permission is therefore granted to do such work as indicated in <br /> ® this application in accordance with and subject to all of the <br /> SUB - TOTAL provisions of the Electric Code of South San Francisco and all <br /> PENALTY FEE (100 %) related laws. <br /> PERMIT FEE $7.50 This permit becomes null and void if work is not commenced <br /> TOTAL PERMIT FEE within 60 days from the date of issuance, or if work is sus- <br /> * RESIDENTIAL so. FT. pended at any time for more than 120 days, or if any work is <br /> WITHOUT ELECTRIC HEAT per SQ. FT. $A175_ done in violation of any city ordinance or state law relating <br /> WITH ELECTRIC HEAT per SQ. FT. $.020 thereto. No materials may be stored on the street or public <br /> GARAGE OVER 3000 SQ. FT. per SQ. FT. $.002 property without an encroachment permit from the City <br /> Engineer. <br /> OTHER Approved <br /> By Date <br /> TOTAL PERMIT FEE ( MIN 57.50) <br /> Building Inspector <br /> *SEE ORDINANCE #718 -76 FOR DETAILS <br /> WHEN PROPERLY VALIDATED Till IS YOUR PERMIT. PS -B 110 <br />