HomeMy WebLinkAbout2003 (4)ELECTRICAL PERMIT APPLICATION
City of Hermosa Beach - Community Development Department
VEW BRANCH CIRCUITS - LIGHTING OR GENERAL USE
%ND DWELLING APPLIANCES
QTY
Amount
JOB ADDRESS:
1. 15 or 20 AMP., 120V 240V
a. 1-10 Circuits, Total Fee
b. 11-40 Circuits, Total Fee
c. 41 or More Circuits, Total Fee
?. 15 or 20 AMP. @ 208V to 277V (Commercial)
3. All Other Lighting Circuits 600V or Less
$43
$88
$131
1
4 0
217193/�
JOB DESCRIPTION:
2,p,to3'r' /4/0
$22 each
$22 each
ADDED OUTLETS (TO EXISTING CIRCUITS), LAMPHOLDERS
.IGHTS AND YARD LIGHTING
OR TEMPORARY
PROPERTY OWNER(S) NAME:
Ba. e"4'7� ` v,L~C-
L. Receptacles/Outlets
1- 5 Outlets (Inclusive), Total Fee
b. 6 - 10 Outlets (Inclusive), Total FeeI
c. Over 10 Outlets (Every 10 outlets or
fraction thereof will be an additional
$20 added to the $33 above)
I. Light Fixtures/Lampholdersell
a. 50 or Less (Inclusive), Total Fee
b. 51-100 (Inclusive), Total Fee
c. Over 100 (Every 100 or fraction thereof will
be an additional $66 added to the $99 above)
$22 1
$33
$33 plus
$20 & up
)
15 0
2-
ADDRESS:
ZZ O' //2c,DP 7
CITY, STATE, ZIP:
A4 �• '
$66
$99
$99 plus
$66 & up
1
2 0
PHONE:
�a $ ,./z..1
ELECTRICAL CONTRACTOR:
ed./A 6,A,Dow41-7or1
JIOTORS, TRANSFORMERS, HEATING APPLIANCES AND
)R APPLIANCES
MISC. EQUIPMENT
Rating of Equipment; H.P., K.W., or K.V.A)
. 3 - 5
. 21- 50
. 51- 100
.. Over 100
$66 each
EMAIL ADDRESS:
$66 each
c.te (s/Jre& . c.i9i0I
$66 each
ADDRESS: sr
,.3/ i���y sT .3
�• 5 • C/9
$66 each
$66 each
:EQUIRED FIRE WARNING, COMMUNICATIONS AND
:ONTROL SYSTEMS
EMERGENCY
CITY, STATE, ZIP:
.�—
. a. Up to 50 Devices, Total Fee
b. 51- 100 Devices, Total Fee
c. 101- 200 Devices, Total Fee •
d. 201- 300 Devices, Total Fee
e. 301- 500 Devices, Total Fee
f. Over 500 Devices, Total Fee
. Each Control Panel, Standby Power Panel,
or Similar Main Piece of Control Equipment
$35
$64
$99✓
$132
$166
$196
)
C. 5 . C 9?2�f.5
PHONE: !a '327_7'0-7t,
BUSINESS LICENSE NO:
STATE LICENSE NO: -2,394
$35 each
TYPE OF BUILDING: Fie.
ERVICE PANELS/SUBPANELS (INCLUDING BREAKERS)
.M P. and Voltage Ratings of Service Entrance
r Conductors, Services Switches or Circuit
reakers or Switchboard Sections
. 200 AMP or Less @ 600V or Less
$55
/
NO. OF STORIES: --
NO. OF METERS: d
. 201- 600 AMP @ 600V or Less
$55
NO. OF FAMILIES:
. Over 600 AMP @ 600V or Less
$55
. Over 600V Rating
$55
DATE ISSUED:
. Temporary Power Pole
$43
IISCELLANEOUS
$33
ISSUED BY:
UPPLEMENTAL PERMIT FEE
$17
;SUANCE FEE
$60
PERMIT NO: n
OTAL FEE/��l/��
I hereby certify that I have read and examined this application and know the same to be true and correct. All provisions of laws and
3rdinances governing this type of work will be complied with whether specified herein or not. No person shall be allowed to perform
work under this permit in violation of the labor code of the State of California. I further state that I am properly licensed as required
3y Section 7031.5 of the State License Business and Professional Code (or claim exemption under Section 7044).
gnature of Contractor
f...\application\electric 9/1/13.xlsx rev 8/31/13 Signature of Owner (If Owner/Builder)