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''"''' - • -' '., - - . Ne , ' ' ' "-''' '"'''?-'"' '''.' -- '''''' 7- 7, ' ' ' ,'''' ' ' 't ,7,7- - ',' ,', " , * ,, , , , x , , - - , :wetwAt , 3 - ‘ ' ,‘,..; ,,,,,,,,, v.,..."'"''''';''':'''',7"":77 <br /> CITYXOFSOUTH SAN FRANCISCO , <br /> 4 RENT 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 /> A. — $10.00 Supplement $3.00 QTY FEE Name O <br /> i1 • k le . #3A '84 Nat. Elec. Code for specific w Address <br /> - Ordinance No. 1007 -86 $10.00 z n <br /> o `"City , .•; -, r o • 41 � <br /> 1 M FEE SCHEDULE TeL No. <br /> At ,. Residential: m <br /> Ma a Name • At Multi Family $ .02 per sq. ft. r <br /> w Single Family $.025 per sq. ft. cc Address g ' -e.. <br /> v her types of residential occupancies & Q City _ a <br /> rat — Unit Fee Schedule 1- Tel. No. <br /> z <br /> titt ming Pools $20.00 o State License No. <br /> y • l ivals, Circuses, Expos <br /> City Bus. Lic. No. <br /> �� ectrical Generators & Rides ... ..... $10.00 ea. y ---------,/,:r':::/<, � <br /> �' ®S <br /> AZ-e3'1, play lighting for rides ................ $ `3.00 ea. <br /> WORKMAN'S COMPENSATION INFORMATION <br /> In conformity with the provisions of Sec. 3800 of the Labor <br /> Stem & Booth lighting $ 3 ea. Code of the state of Calif. each applicant shall file with <br /> 1 s ' rmanently installed rides etc. ea. the Building Inspector the certificate designated in (1) below ,, ,„ <br /> ' Unit Fee Schedule or shall sign item (2) whichever inapplicable. <br /> x.r p $ 10.00 ea. (1) Certificate (or exact or duplicate copy) of Workmen's <br /> 0 Power ..... .... ... Compensation Ins. issued by an admitted insurer. <br /> T ‘ s <br /> • Lighting /Outlets ..... .. $ 5.00 ea. (2) 1 certify that in the performance of the work for <br /> FEE SCHEDULE 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 /> -ts — Plugs, Switches, Controllers Workmen's Compensation Laws of Calif. <br /> i First 20 ..... $ .50 ea. <br /> ti <br /> �X Additional ................. . $ .30 ea. SIGNED: <br /> � a� Or fract Of mult Outlet aSSy; is O ne Outlet) I hereby acknowledge that I have read this application <br /> a nd state that the above is correct and agree to comply <br /> - &. ii'reS —First 20 ........... ..... $ .50`ea. with all City Ordinances and State Laws regulating building <br /> . Additional $ .30 ea. construction. <br /> �' p • ances Residential $ 2.00 ea. <br /> Policy No. , r - i ' <br /> SA i l n Residential less than 1 lip. ..... $ 2.00 ea. y <br /> ttA les than 1 kw.......... $ 2.00 ea. , <br /> • a Exp Date <br /> less than 1 kva. ........ $ 2.00 ea. <br /> Fii r Apparatus: — (hp) (kw) (kva) (kvar) This application is an Electric Permit when properly co <br /> .-.4k , ,. to and including 9 ...:: ............ $ 2.00 ea. filled out, signed and validated for the correct fee in C <br /> the validation space. Permission is therefore granted r <br /> �� 5 0 ; $1 0.00 ea. p g p <br /> to do such work as indicated in this application in ac- <br /> :k 100 $20.00 ea. cordance with and subject to all of the provisions of � Z <br /> ®0 + <br /> $30.00 ea. the Electric Code of South San Francisco and all <br /> 't4 ot e: M ulti - motor equipment — use sum of - related laws. Renew only once at full fee. m <br /> This permit becomes null and void if work is not com- XI <br /> y ,„ ®mbined rating. Fees include all related control menced within 180 days from the date of issuance, or E <br /> riailuipment. if work is suspended at any time for more than 180 - <br /> .gays 100 ft. or fraction $ 3 00 ea. days, or if any work is done in violation of any city or- Z <br /> dinance or state law relating thereto. No materials may O <br /> � � 4 One circuit . ...... ..... ' ' ' ' ' ' $10.00 ea. be stored on the street or public property without an <br /> , ® • Tonal circuits for same sign ...........$ 2.00 ea. encroachment permit from the City Engineer. '. <br /> E es <br /> : than 600 V @ 200 amps max ..... . $12.50 ea. Approved ` h <br /> iv than 600 V C�1 200. to 1000 amps .... $25.00 ea. By - ) : , `, 7 Date w�. <br /> 4 i re than 600 V or over 100 amps ...... $50.00 ea 7 , Buil din g Inspector p ector �� <br /> li •1• atus not listed herein $ 7.50 ea. <br /> ���IPT # Apparatus: <br /> to <br /> t � .� °'L PERMIT FEE 3 m <br /> :X C1 <br /> F WHEN PROPERLY VALIDATED THIS IS YOUR PERMIT.` ; or> <br /> , WHITE - "Bldg. YELLOW -- Applicant PINK — Inspt ctor's Copy <br />