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HomeMy WebLinkAbout1600 (9)ELECTRICAL PERMIT APPLICATION City of Hermosa Beach - Community Development Department NEW BRANCH CIRCUITS - LIGHTING OR GENERAL USE AND DWELLING APPLIANCES QTY Amount JOB ADDRESS: /600 /b b`noe Sat 1. 15 or 20 AMP., 120V - 240V a. 1-10 Circuits, Total Fee b. 141- or0 Cioreuits, Total Fee c. 41 or More Circuits, Total Fee 2. 15 or 20 AMP. @ 208V to 277V (Commercial) 3. All Other Lighting Circuits 600V or Less $ 43 $130 $ 22 each $ 22 each JOB DESCRIPTION: D „(mac -'f 114142001a- FA tJ _'Y' J S('te// '' ,n,,n,` e d4 ii Lc �. i2t O u e-4 ADDED OUTLETS (TO EXISTING CIRCUITS), LAMPHOLDERS OR TEMPORARY UGHTS AND YARD LIGHTING PROPERTY OWNER(S) NAME: 4L Q o 9 2 1. Receptacles/Outlets a. 1 - 5 Outlets (Inclusive), Total Fee b. 6 - 10 Outlets (Inclusive), Total Fee c. Over 10 Outlets (Every 10 outlets or fraction thereof will be an additional $20 added to the $33 above) 2. Light Fixtures/Lampholders 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 $65 added to the $98 above) $22 $33 $33+$20 and up $65 $98 $98+$65 and up `1-- ADDRESS: /too ,(4A C� e✓ 3.2 CITY, STATE, ZIP: %a�SYl' / `-t 070. 4 -each. (')g- PHONE: 37.0 - 529. 7 ec 7 ELECTRICAL CONTRACTOR: (3,2�1y -j4-C7ec•ccs./JI/ MOTORS, TRANSFORMERS, HEATING APPLIANCES & MISC. EQUIP. OR APPLIANCES EMAIL ADDRESS: fl — IR7A- i' O/✓t c- @ Q moi / - (0.0--) (Rating of Equipment; H.P., K.W., or K.V.A) 1. 1. 3 - 5 2. 6 - 20 3. 21 - 50 4. 51 - 100 5. Over 100 $ 65 each $ 65 each $ 65 each $ 65 each $ 65 each ADDRESS: 7G�/< �a 1il���ra CITY, STATE, ZIP: 9 a4 Y9 Ku-�r 'xi- G,, 6eac— ` REQUIRED FIRE WARNING, COMMUNICATIONS AND EMERGENCY CONTROL SYSTEMS PHONE: 'C- S.77 • // DO 1. 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 2. Each Control Panel, Standby Power Panel, or Similar Main Piece of Control Equipment $ 35 $ 63 $ 98 $131 $164 $194 $ 35 each BUSINESS LICENSE NO.: STATE LICENSE NO.: 9, / 6 TYPE OF BUILDING: COvhbrj SERVICE PANELS/SUBPANELS (INCLUDING BREAKERS) NO. OF STORIES: u / AMP. and Voltage Ratings of Service Entrance Conductors, Services Switches or Circuit Breakers or Switchboard Sections 1. 200 AMP or Less @ 600V or Less 2. 201 - 600 AMP @ 600V or Less 3. Over 600 AMP © 600V or Less 4. Over 600V Rating 5. Temporary Power Pole $ 54 $ 54 $ 54 $ 54 $ 43 NO. OF METERS: / NO. OF FAMILIES: ��t(�il��� DATE ISSUED:/ J V 7i� L Li ISSUED BY: (P4'4 MISCELLANEOUS $ 33� SUPPLEMENTAL PERMIT FEE $ 17 PERMIT NO.: (4— 6O c 02 ISSUANCE FEE $ 59 TOTAL FEE 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 ordinances 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 tate that I am properly licensed as required by Section 7031.5 of the State License Business and Professional Code (or claim exe on u , er Section 7044). Signature of Contractor g =ture •f 0 (If Owner/Builder) F:b95/cd/forms-handouts/application/electric 9/1/11 revised 2-1-12