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0 .. V g ID AT a ' <br /> T f ELECTRICAL <br /> DEPARTMENT OF PUBLIC SERVICES BUILDING INSPECTION DIVISION P ermit Number <br /> 400 Grand Avenue, South San Francisco, Ca. 94080 Phone 877 -8545 <br /> APPLICATION FOR ELECTRICAL PERMIT <br /> Job Address BUILDING PERIVIIT NO. <br /> * COMMERCIAL AND INDUSTRIAL QT Name <br /> R' <br /> TEMPORARY POWER POLE ' 7.50 <br /> uu Address <br /> TEMP. LIGHTING UP TO 30 AMPS 2.00 City <br /> OVER 30 AMPS $ 3.00 <br /> Tel. No. <br /> SERVICES 2.00/KVA AMPERES or: <br /> Name '< �� <br /> 240 V 10 $2,00/100 AMP 0 <br /> r I ® - Address ' <br /> 240 V t1 <br /> 30 $2.00180 AMP <br /> 480 <br /> V 30 $2.00/30 AMP cc City . , Tel. No. <br /> V 30 $2.00/70 AMP <br /> 208 � ` ! � State License No. <br /> BUS DUCT .10 Ft to 1001 <br /> City Bus. Lic. No. <br /> $ .02 /Ft over 100' <br /> OUTLETS - CEILING EACH $ .25 nom SWITCHES EACH $ .25 <br /> WORKMAN'S COMPENSATION INFORMATION <br /> PLUGS EACH $ .25 <br /> 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 <br /> °: the certificate designated in (1) below shall sign item (2) whichever is <br /> FLOURESCENT or MERCURY EACH $ .50 I 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 <br /> (2) l certify that in the performance of the work for which this <br /> 4 MOTORS, HEATERS, TRANSFORMERS, ETC. permit is issued that I shall not employ u <br /> ��° p y any person in any manner so as <br /> ac 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 y y <br /> * HP TO BE COMPUTED 0.75 K.W. PER HP <br /> �_. .�. - _ � SIGNED: <br /> MAX. FEE FOR ONE IT $25.00 I hereby <br /> SIGNIDECOR LIGHTING PER CIR $1.00 that heabove s and agree to comply with all City Orrdinances <br /> g pp <br /> i 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 <br /> $.02 /LAMP or $.50 BALLAST or TRANS Expiration Date <br /> * REINSPECTION FEE $10.00 <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 87.50 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 SQ. FT. pended at any time for more, than 120 days, or if any work is <br /> WITHOUT ELECTRIC HEAT per SQ. FT. $.0175 IIIIIIIIIIII done in violation of any city ordinance or state lave relating <br /> WITH ELECTRIC HEAT per SQ. FT. $.020 <br /> thereto. No materials may be stored on the street or public <br /> GARAGE OVER 3000 SQ. FT. per SQ. FT. $.002 r <br /> property without an encroachment permit from the City <br /> OTHER Engineer. <br /> Approved l <br /> ■ <br /> TOTAL PERMIT FEE ( MIN 87.50) By Building' Inspector Date <br /> * SEE ORDINANCE #718 -76 FOR. DETAILS <br /> WHITE - Bldg, YET,LOW °Applicant PINK - Inspector`s_ Copy <br /> WHEN PROPERLY VALIDATED THIS IS YOUR IT. PS /8 110 3/80 500 <br />