HomeMy WebLinkAbout25ELECTRICAL PERMIT APPLICATION
City of Hermosa Beach - Community Development Department
ADDITION/REMODEL/NEW DEVELOPMENT
JOB ADDRESS:
NEW BRANCH CIRCUITS - LIGHTING OR GENERAL
USE AND DWELLING APPLIANCESS
1. 15 OR 20 AMP., 120V - 240V
a. 1-10 CIRCUITS $19 each
b. 11-40 CIRCUITS $16 each
c. 41 OR MORE CIRCUITS $14 each
2. 15 OR 20 AMP. @ 208V TO 277V (Commercial) $27 each
3. ALL OTHER LIGHTING CIRCUITS 600V OR LESS $31 each
QTY
AMOUNT
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PROPERTY OWNER(S) NAME:
I�eA0�Q� ��� eV)
ADDRESS:
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EXISTING DEVELOPMENT
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CITY, STATE, ZIP:
ADDED OUTLETS (TO EXISTING CIRCUITS),
LAMPHOLDERS OR TEMPORARY LIGHTS AND
YARD LIGHTING
1. RECEPTACLES/OUTLETS
a. 1 - 5 OUTLETS (INCLUSIVE), Total Fee $22
b. 6 - 10 OUTLETS (INCLUSIVE), Total Fee $30
c. OVER 10 OUTLETS (Every 10 outlets or $30+$12
fraction thereof will be an additional $12 added to and up
the $30 above)
2. LIGHT FIXTURES/LAMPHOLDERS
a. 50 OR LESS (INCLUSIVE), Total Fee $14
b. 51 - 100 (INCLUSIVE), Total Fee $35
c. OVER 100 (Every 100 or fraction thereof will be $35+$14
an additional $14 added to the $35 above) and up
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PHONE:
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ELECTRICAL CONTRACTOR:
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ADDRESS:
I VS- 144(it-44); ,i j ( J
CITY, STATE, ZIP:
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PHONE: OO
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MOTORS, TRANSFORMERS, HEATING
APPLIANCES & MISC. EQUIP. OR APPLIANCES66C,--&57-6
(RATING OF EQUIP.;H.P., K.W., OR K.V.A)
1. 3 - 5 $ 20 each
2. 6 - 20 $ 35 each
3. 21 - 50 $ 48 each
4. 51 - 100 $106 each
5. OVER 100 $164 each
BUSINESS LICENSE NOa.•
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STATE LICENSE NO.: /
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TYPE OF BUILDING:
REQUIRED FIRE WARNING, COMMUNICATIONS
AND EMERGENCY CONTROL SYSTEMS
NO. OF STORIES:
1. a. UP TO 50 DEVICES, Total Fee $ 35
b. 51 - 100 DEVICES, Total Fee $ 63
c. 101 - 200 DEVICES, Total Fee $ 98
d. 201 - 300 DEVICES, Total Fee $131
e. 301 - 500 DEVICES, Total Fee $164
f. OVER 500 DEVICES, Total Fee $194
2. EACHCH CONTROL PANEL, STANDBY POWER $ 35 each
PANEL, OR SIMILAR MAIN PIECE OF CONTROL
EQUIPMENT.
NO. OF METERS:
NO. OF FAMILIES:
NEW DEVELOPMENT:
EXISTING DEVELOPMENT:
SERVICE PANELS/SUBPANELS (INCL.
BREAKERS)
DATE ISSUED:/ "( '/ (1 (
OO(( vO
AMP. AND VOLTAGE RATINGS OF SERVICE N., .o�Mp�
ENTRANCE CONDUCTORS, SERVICES SWITCHES—`'
OR CIRCUIT BREAKERS OR SWITCHBOARD ��', w, ,oe,) befit^�
SECTIONS
1. 200 AMP OR LESS @ 600V OR LESS $ 20
2. 201 - 600 AMP @ 600V OR LESS $ 44
3. OVER 600 AMP @ 600V OR LESS $ 86
4. OVER 600V RATING $164
5. TEMPORARY POWER POLE $ 20
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ISSUED BY: Ok/i.
PERMIT NO.:
6q - 00 /7
(/
MISCELLANEOUS
SUPPLEMENTAL PERMIT FEE $ 9
ISSUANCE FEE $ 35
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 and his permit in violation of the labor code of the State of California. I further state that I am properly licensed as required by
Section 031x5 of the State Lieease Business and Professional Code (or claim exemption under Section 7044).
Signature of Contractor
Signature of Owner (If Owner/Builder)
F:B95/cd/forms/application/electric 9-1-2008
City of Hermosa Beach
Civic Center, 1315 Valley Drive, Hermosa Beach, California 90254-3884
NOTICE!
ALL ELECTRIC SERVICE UPGRADES,
SOLAR PANELS, OR NEW SERVICE FOR
NEW HOMES MUST BE APPROVED BY
SOUTHERN CALIFORNIA EDISON FIRST
BEFORE PERMIT WILL BE FINALED!
PLEASE CONTACT :
RYAN BARFIELD 310-783-9340
Please contact Public Works Department at (310)
318-0214 if work is going to be done in the public
right of way (sidewalk or street).
F:IB95ICDICD Temp Files/doc 3-31-2010