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4 <br /> 4 <br /> CITY OF SOUTH SAN FRANCISCO ELECTRICAL <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 FOR ELECTRICAL PERMIT <br /> Job Address 5 / ;55: ;.° ; -7 BUILDING PERMIT NO. 5. <br /> APPLICANT TO FILL IN BETWEEN HEAVY LINES <br /> Name ; <br /> * COMMERCIAL AND INDUSTRIAL QTY FEE CC <br /> Address <br /> TEMPORARY POVVER POLE $ 7.50 <br /> TEMP. LIGHTING UP TO 30 AMPS $ 2.00 City <br /> OVER 30 AMPS $ 3.00 Tel, No. <br /> SERVICES $2.00/KVA or: AMPERES <br /> Name <br /> 240 V 10 $2.00/100 AMP <br /> 240 V 30 $2.00/60 AMP 1 Address <br /> 480 V 30 $2.00/30 AMP g City 2`i TeL No. <br /> 280 V 30 $2.00/70 AMP J State License No. <br /> BUS DUCT $ .10/Ft to 100 0 <br /> ci City Bus. Lic. No. <br /> $ .02/Ft over 100' <br /> OUTLETS- CEILING EACH $ .25 <br /> WORKMAN'S COMPENSATION INFORMATION <br /> SWITCHES EACH $ .25 <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 <br /> (1) Certificate (or exact or duplicate copy) of Workman's Compen- <br /> sation Ins. issued by an admitted insurer. <br /> c, THREE PHASE $ .75 (2) 1 certify that in the performance of the work for which this <br /> 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 $ .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 <br /> MAX. FEE FOR ONE UNIT $25.00 1 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 /> OWNER: <br /> * ELECTRIC TYPE SIGN $ 1.50 I <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 /> This application is an Electric Permit when properly filled out, <br /> TRAILER SPACE OUTLET $ 1.00 <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 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 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. $.0175 <br /> thereto. No rnaterials may be stored on the street or public <br /> WITH ELECTRIC HEAT per SQ. FT. $.020 <br /> property without an encroachment permit from the City <br /> GARAGE OVER 3000 SQ. FT. perSQ. SQ. FT. $.002 <br /> Engineer. <br /> Approved <br /> f TOTAL PERMIT FEE ( MIN $7.50) 'et Building Inspector <br /> * SEE ORDINANCE #718-76 FOR DETAILS <br /> t WHITE-Bldg . YELLOW-Applicant PINK-- Inspector s Copy <br /> WHEN PROPERLY VALIDATED THIS IS YOUR PERMIT. PS-8 lio <br />