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HomeMy WebLinkAbout1600 (10)ELECTRICAL PERMIT APPLICATION City of Hermosa Beach - Community Development Department NEW BRANCH CIRCUITS — LIGHTING OR USE AND APPLIANCES G1. `2 QTY Amount JOB ADDRESS: A DO ,0 a aQ3 , ,,q 5 orr220 AMP.,L 12 V 0VING a. 1-10 Circuits, Total Fee b. 11-40 Circuits, 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 $ 87 $130 $ 22 each $ 22 each / JOB DESCRIPTION: _ J R..e ( C 1/ ✓1 t �r t, l n -6l+C— C. -el A kez,,ry-c , Ada. JI -?r2.- C -e-4 LI .(c h ADDED OUTLETS (TO EXISTING CIRCUITS), LAMPHOLDERS OR TEMPORARY LIGHTS AND YARD LIGHTING PROPERTY OWNER(S) NAME. 1-/.zins,neiSTe2 42�� 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){t 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 ADDRESS: /COO ,!and ,2 CITY, STATE, ZIP: T eovoO RRA CA FO ZCV PHONE: 3 /0 -4/ 9T- ' fV ELECTRICAL CONTRACTOR: At -Dy Cons-rieuc-/d,' MOTORS, TRANSFORMERS, HEATING APPLIANCES & MISC. EQUIP. OR APPLIANCES EMAIL ADDRESS: b eAd 024C- &L9fyi A 7 6/ . LC (Rating of Equipment; H.P., K.W., or K.V.A) 1. 3 - 5 2. 6 - 20 3. 21 - 50 4. 51 - 100 5. Over 100 $ 65 each $ 65 each $ 65 each $ 65 each ADDRE S: I //�� yi-,��i✓PiD �''`� / CITY, STATE, ZIP: c>� C/-/ ` q F�C� -ma o `�% REQUIRED FIRE WARNING, COMMUNICATIONS AND EMERGENCY CONTROL SYSTEMS PHONE) 56. • J 71 - //O O 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.: ! sJ / N / J C� TYPE OF BUILDING: COr-t b SERVICE PANELS/SUBPANELS (INCLUDING BREAKERS)1,1 NO. OF STORIES: 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: (/-h /Zd c,u n DATE ISSUED: Al ISSUED BY: -11-(111 MISCELLANEOUS $ 33 SUPPLEMENTAL PERMIT FEE $ 17 PERMIT NO.: /yam OP/72 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 goveming 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 by Section 7031.5 of the State License Business and Professional Code (or claim exemption under Section 7044). Signature of Contractor Signature of Owner (If Owner/Builder) F:b95/cd/forrns-handouts/application/electric 9/1/11 revised 2-1-12