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APPLICATION AND
<br />ELECTRICAL PERMIT
<br />(TYPEWRITE OR PBINT IN INK)
<br />Q;l.;s::nlllix^
<br />834-4186
<br />o
<br />APPLICANT FILT IN AREA BELOW
<br />t-Izo
<br />oo,m
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<br />LAb1 5 0ra-vr4,<--E Resdenr,a
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<br />9(lndusr,,ar L,comme,clar EACH
<br />03
<br />t"t < S. Ora-
<br />*-"Az \+-STA ZP
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<br />MAILINGAODBESS
<br />50 ,5c
<br />Each
<br />Lrsl W.X:"A, nklpt^500 SttD
<br />5.00
<br />Firc Signaling SlstsB. Mininum leo
<br />oull6l, smoke or h€al senso.
<br />10.00
<br />50
<br />Lighting Slandards wilh On€ LaBp
<br />Each Add'l linure on same slandard
<br />5.00
<br />100
<br />Own.?-BdH.lH!.'rn n
<br />lh€.6by alltrh lhar lad €xempr lrom rheC@r&ror's Licens€ t?w lor lhe foliow'ng.eaen lsec
<br />7031 5, Busne$6nd Prolessions Cod6: Anycity orcounly which Gqunosa psrmil lo consfilcl,
<br />alto., improvo, demolish, or epananysr!.ture, pnorloirsisuon.e, al$.€qurcs lheapplicadlor
<br />soch permir lo lile 6 eg@d nareme.l lh.r he is lice.sed puEuanl lo lho provisrons ot tho Conlrac-
<br />ldr's Licens Law lchapE 9lcomm€ncng wirh S@ton T0O0lol DMsion 3ollhe Busine*.nd
<br />Prolssnons Code, o. lhar he is€x6mpr theretromandlhe bsis tor thealLEgedexemplion Any viola.
<br />lio ol Secion 7031 5 by any applrca.r lor a pemrt subje.ts lhe apprE.nl to a civil penalv ol nol
<br />mor6 lhan I ve hundred dollaB l$ 5001:
<br />! S."tl- lOaa I, as owner ol the p.opertv. or ny employoes wnh w6ges as rhen sb com-
<br />ponsarid, wir do fio wo.t, and $€ $tucru€ is nol inlended d oftered lor $le.
<br />E Saton TOaaB l, as owner ol lhe prop".ly, sm exclusNery conlraclng wirh licon*d con-
<br />PHONECONTF
<br />+r1,
<br />V!,,
<br />'2
<br />I L
<br />CTY
<br />t)
<br />4 IC
<br />,Ae<1't(ZI
<br />r / irtt L/+
<br />o,,"-Sr-15j.4-u"".,,s'g,
<br />lr c D 3
<br />q ol4'1 c IL
<br />Conrractor Uso Only
<br />relds ro consitucr rho proi&r.
<br />D6re- Own.rlsig
<br />50 00
<br />15.00
<br />35.00
<br />7500
<br />Up lo 400 amps, pe. m€t6.
<br />Over 400 amps. per m€lsr
<br />Over 1200 amps, per melsr
<br />S'gns and h'gh polenlial gas lut e lrgnting r5 00
<br />35 00Swihmlng pools lountains, spas
<br />Swilchboad, motor conlrol c€nler or sub-pansls
<br />Each
<br />r5 00
<br />?Temporary conslrucrion m6ier service pole
<br />Each disiribution pole
<br />2 00
<br />00
<br />Temoorary construciion liqhting
<br />500 lamps or less
<br />Ove. 500 lamps
<br />Tim6 clock o. pholo €leclnc ceil
<br />I
<br />2.00
<br />5.00
<br />10 00
<br />20 00
<br />30.00
<br />40.00
<br />5,oo
<br />PowEF APPABATUS: Gen€.arors. molors,
<br />Iranslormers, re.tiliers, indusrial haating,
<br />cooking, o. bakiog equipmenl and olh6r
<br />apparaius as lollows:
<br />Up io and includino 1 HP. KW, KVA
<br />Ov€r 1 and noi over 10 HP. KW. KVA
<br />Over l0 and not ovsr 50 llP. Kw. KvA
<br />Over 50 and nol ovsr 100 HP, Kll/, KVA
<br />Over 100 and nol ovsr 500 HP, KW, KVA
<br />Over 500 HP, KW, KvA
<br />.(k_ t,('ovanv€*,a(t\>.
<br />'1.1 (I 4.oo
<br />frro*cocomprn:rdon Ded*don 7 |I
<br />r heEbl afinm rhsr I rsve a centcdle ot con*.r ro *ll'nre or d c€n
<br />'cars
<br />o' Wote' { Corpen.
<br />lcenifylhar in the pedomance of lhe work torwhich rhis pemi
<br />po.en in a.v manoer e.srobecm subjer ro 6e Wbrke.'sComp€n$lion Laws ol Calid^6
<br />tlate- Aool,canr ls'q. )-
<br />elron lnsurance Corlilied copy sirledwlhihe
<br />o",. u,0,." I z 1 &/o u"'" n,
<br />o","Y153/o**,.,o,
<br />)l.oc)
<br />Penalry Fee (when app lcabre)
<br />viorarion Fee tm nrmum 535.00)
<br />Plan Check Fee (minim0m 515.00)
<br />PC No
<br />10 00
<br />4<LtTOTAL PEAUIT FEE (minrmum $35.00)
<br />ta7 dq
<br />Erptr! ioo
<br />Thispermirshallexpr6bylimiialionandbecome^ullandrodillh6wolkaolhonzodbythBpemil6
<br />norcommo.ced wrhrn 180 &ys lrom Ihe dale o, rhis peon or ilwolk eulhoized bv lhs pe.mil is
<br />suspsndodorabando.eddanyimoahorth€workrscommoncedlorapeiodorrS0days A new
<br />o.dn shall b€ obrarn6d li.sl bolore such wo.k can bo reommonced
<br />Apolc.nt'. D.cbr.ton
<br />I cen4 dlar I haw r6ad lhE applr@to. and sr6re rhal rh€ abovo rntormaton is cor6or I agree lo
<br />comp[ wnh .ll ciry ordnances 6nd sbre laws relar'ng ro building cosr.ucli@, rnd h€rsby.urh]
<br />ize repB$.ranves ol rhrs crty lo e.to, u pon fie abow mentoned
<br />I
<br />OATE PENMIT NO
<br />zWPEBMITISSUEDBYISTs,
<br />VALIDATION IOf FICI USE ONLY)
<br />laccouNTrlr-413t
<br />Distribution: l lnspector Copy 2 FileCopy 3. FinanceCopY 4. Applicant CopY
<br />k R ,kmd.<-r stl.,"'"'
<br />CITY
<br />ic!. Bot6ti, fot6t{ Apt. Sq Fr
<br />Grr. or carport Sq Fr
<br />Bus*ays. special race{ays, unde. lbor ducl
<br />trolley o. pluq-in busways sa 100'
<br />Mainianance Pe.m( (annual)
<br />AUILOING
<br />PEnM!T No
<br />-vEnlFlED
<br />BY ls'q I
<br />ATR O1A .,
<br />,rr
<br />lrl...........LL
<br />/l .50 | ,30
<br />--f,.*-T_-| :oo I
<br />lr. l
<br />;l
<br />=
<br />i-l
<br />odc. fo Applc.nr:
<br />ll, atbrmakng rhrs C6rti,i€re o, Exehpnon, yo! should b€com6 subF.r ro 6e Woder'sCompen
<br />sion p.ov6ro.s of lhe L.bor Code, you m!$ to.rhurh comply wirh such p.wrsionso.thlsperoil
<br />shall be d@mod revokod.
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