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• . <br /> ,,, <br /> 1 <br /> • VALIDATION • <br /> CITY OF SOUTH SAN FRANCISCO <br /> DEPARTMENT OF PUBLIC SERVICES F3UI LDING INSPECTION DIVISION <br /> 400 Grand Avenue, South San Francisco, Ca. 94080 Phone 877-8545 <br /> APPLICATION FOR ELECTRICAL PERMIT <br /> , <br /> ) <br /> , Job Address , - , ' , - , ;.. BUIILDING PERMIT NO. <br /> „, .. <br /> I ' <br /> ,q <br /> Name <br /> 1 " * COMMERCIAL AND INDUSTRIAL QTY FEE cc <br /> 1 TEMPORARY POVVER POLE w Address <br /> ' <br /> i $ 9.00 <br /> City <br /> TEMP. LIGHTING UP TO 30 AMPS $ 2.40 g <br /> 1 : OVER 30 AMPS $ 3.60 — Tel. No. <br /> — <br /> SERVICES $2.40/KVA or: AMPERES <br /> Name <br /> 240 V 10 $2.40/100 AMP <br /> . . I - Address <br /> I ? 240 V 30 $240/60 AMP 0 <br /> i cc < Ci ' T N " <br /> 480 V 30 $2.40/30 AMP <br /> .= <br /> 208 V 30 $2.40/70 AMP z State License No." , <br /> . BUS DUCT $ .12/Ft to 100' (..) City Bus. Lic. No. <br /> $.025/Ft over 100' <br /> , <br /> OUTLETS CEILING EACH $ .30 <br /> I <br /> ' SWITCHES EACH $ .30 <br /> , . PLUGS EACH $ 30 WORKMAN'S COMPENSATION INFORMATION <br /> In conformity with the provisions of Sec. 3800 of the Labor Code of <br /> A . ' the State of Calif. each applicant shall file with the Building Inspector <br /> I FIXTURES -INCANDESCENT EACH $ .30 the certificate designated in (1) below shall sign item (2) whichever is <br /> , FLOURESCENT or MERCURY EACH $ .30 applicable. <br /> SPECIAL CIRCUITS - SINGLE PHASE $ .60 <br /> (1) Certificate (or exact or duplicate copy) of Workman's Compen- <br /> i <br /> i — sation Ins. issued by an admitted insurer. <br /> t THREE PHASE $ .60 (2) I certify that in the performance of the work for which this <br /> I . <br /> 1 ' 4 MOTORS, HEATERS, TRANSFORMERS, ETC. permit is issued that I shall not employ any person in any manner so as <br /> : UP TO 5 K.W. PER KW $ .60 to become subject to the Workman's Compensation Laws of Calif. <br /> 0 4 <br /> I ' * OVER 5 K.IN. PER KIN $ .30 , <br /> I * HP TO BE COMPUTED 0.75 K.W. PER HP , SIGNED: ' - ■ <br /> 0 MAX. FEE FOR ONE UNIT $30„00 I hereby acknowledge that I have read this application and state , <br /> that the above is correct and agree to comply with all City Ordinances , <br /> SIGN/DECOR LIGHTING PER CIR $ 1.20 I <br /> ■ and State Laws regulating building construction. <br /> ' BILLBOARD TYPE SIGN/SERVICE $ 4.00 ' <br /> SIGN CIRCUIT OUTLET EACH $ .30 <br /> Pol No. <br /> $ * ELECTRIC TYPE SIGN $ 1.80 <br /> I <br /> 4 $.02/LAMP or $.50 BALLAST or TRANS <br /> Expiration Date <br /> * REINSPECTION FEE $12.00 i <br /> * NON-PRESCRIBED EQUIP FEE PER HR $12.00 Igor <br /> SPECIAL CIRCUIT NOT HEREIN LISTED $ 1.20 <br /> This application is an Electric Permit when properly filled out, ' <br /> TRAILER SPACE OUTLET $ 1.20 <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 9.00 This permit becomes null and void if work is not commenced <br /> . , <br /> 1- <br /> TOTAL PERMIT FEE within 60 days from the date of issuance, or if work is sus" <br /> 4 * RESIDENTIAL - sQ. FT. pended at any time for more than 120 days, or if any work is <br /> done in violation of any city ordinance or state law relating <br /> ',.. WITHOUT ELECTRIC HEAT per SQ. FT.$.020 <br /> thereto. No materials may be stored on the street or public <br /> 1 WITH ELECTRIC HEAT per SQ. FT.$.025 <br /> , . <br /> z <br /> GARAGE OVER 3000 SQ.FT. per SQ property without an encroachment permit from the City , <br /> ,.' <br /> 0., ' FT . $ . 0024 Engineer. , <br /> i OTI-IER <br /> Approved <br /> 3 . SEE ORDINANCE #718-76 FOR DETAILS <br /> 1 By Date <br /> - RECEIPT # Building Inspector ' <br /> TOTAL PERMIT FEE (Min. $9.00) ' <br /> WHITE—Bldg. YELLOW-Applicant PINK-Ins Copy <br /> ELECTRICAL <br /> , <br /> Perrnit Number <br /> I WHEN PROPERLY VALIDATED TINS IS YOUR PERMIT. <br /> , <br />