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BILLING & PERMIT STATEMENT
PERMIT #
i S- 00 0 W2
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- - - - - - - - - - - - -
"IN
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BAKERSFIELD FIRE DEPARTMENT
Prevention Services
2101 H Street
Bakersfield, CA 93301
Phr)np- • Fay- 661-Rr,2-2171
i
P tVT
01Y
TREASURY;
ACCT NO
I SITE INFORMATION
LOCATION OF PROJEC7, t-, ;or
PROPERTY OWN
STARTING DATE - lq- COMPLETION DAT
-I
NAME
4 5a y y
PROJECT NAME
NAME V 6 b
C(aj
ADDRESS
PHONE #
PROJECT AQDRES:)
1 _0
CITY STATE 3A
ZIP CODE
CONTRAC`WL4E.-,-,
CONTRACTOR INFORMATION
CA LICENSE #
170qa6n
' EXP_1RATION DATE
O?FtICENSE -L—
ITYbOg
❑
CONTRACTOR COMPANS&,,e
FAX #
ADDRESS
CITY
ZIP CODE
C
Please make checks payable to CITY OF BAKERSFIELD. NO CASH Please. Thank you.
El PERMIT TYPE FEE CALCULATION TOTAL
DUE
❑ Alarm - New & Modification (minimum charge) $280
P tVT
01Y
TREASURY;
ACCT NO
❑
Over 10,000 sq ft
$0 .028 x sq ft
❑
Sprinkler - New & Modification (minimum charge)
$280
❑
Over 10,000 sq ft
$0 .028 x sq ft
❑
Sprinkler - Minor Modification (<10 heads)
$ 96 (inspection only)
84
❑
Commercial Hood (New & UL 300 Upgrade Modification)
Additional Hood
$235
$ 58 hood
❑
Commercial Hood - Minor Modification (add/move nozzle)
$ 96 (inspection only)
84
❑
Spray Booth (New & Modification)
$235
98
❑
Aboveground Storage Tank (I inspection per installation) AST
$180/tank
82
❑
Additional Tank ATI
$ 96/tank
82
❑
Aboveground Storage Tank (Removal, Mod,or Inspect'n) ATR
$109/tank
82
❑
Underground Storage Tank (Installation/Inspection) NI
$878/tank
82
❑
Underground Storage Tank (Modification) MOD
$878/site
82
Ok
Underground Storage Tank (Minor Modification) MTM
$167/site
82
❑
Underground Storage Tank (Removal) TR
$573/tank
84
❑
leven
Mandated UST Testing: Fuel Mont Cert/SB989/Cath. Prot.
NOTE: $96/hr for each type of test/per site/per UST system
if scheduled at the same time
$ 96/hr (2 hrs minimum) $192
82
❑
Oil well (Installation, Inspection, or re-inspection) X
$ 96/hr
82
❑
Tent #
$ 96/tent
84
❑
After-hours inspection fee
$121/hr (2 hrs minimum) = $242
❑
Pyrotechnic (1 permit per event, plus an inspection fee of
$96/hr during business hours) Py
NOTE: After hours Pyrotechnic event inspection is @ $121/hr
$ 96/hr + (5 hrs min standby fee/insp) $576
(5 hrs min standby fee /ins p) = $605
84
❑
Re-inspection/Follow-up Inspection
$ 96/hr
84
❑
Portable LPG (Propane): # of Cages?
$ 96/hr
84
❑
Explosive Storage
$235
84
❑
Copying & File Research (File Research fee $57/hr)
$0.25/page
84
❑
Miscellaneous
84
FD2021 (Rey 3/14) 1
UNDERGROUND STORAGE TANK
,KR.' �3�' r n,v s,T y 'F of 'fs�£�S.s,xisf'..>..a..re, .',i 3s.�... .,a u�'h 3•r, ,k u.� H >,,.�....,.. .. ��ti�'nrEjw sx t
�s
PERMIT APPLICATION B E R ST I D
TO CONSTRUCT - INSTALL NEW TANK (NEW FACILITY) /NEW F1Rl
TANK INSTALL (EXISTING FACILITY) /MOD -MINOR MOD
ARTM T
yy �<
sr
Permit #
BAKERSFIELD FIRE DEPARTMENT
Prevention Services
2101 H Street
Bakersfield, CA 93301
Phone: 661 - 326 -3979 • Fax: 661 -852 -2171
Page 1of1
TYPE OF APPLICATION: ❑ NEW TANK INSTALL /NEW FACILITY ❑ NEW TANK INSTALL /EXISTING FACILITY
CHECK ONE ONLY ❑ MODIFICATION OF FACILITY MINOR MODIFICATION OF FACILITY
STARTING DATE / ` PROPOSED COMPS N DATE
FACILITY NAME ` XISTING FACILITY, #
FACILITY ADDRESS V CI ZIP CODE
TYPE OF BUSINESS Gc6 A P N #
TANK OWNER \ ' PHONE #
�V\
ADDRESS C� n _ CITY ZIP CODE
WATER TO FACILITY PROVIDED BY
DEPTH TO GROUND WATER
SOIL TYPE EXPECTED AT SITE
# OF TANKS TO BE INSTALLED ARE THEY FOR MOTOR FUEL? SPILL PREVENTION CONTROL AND COUNTERMEASURES PLAN ON FILE?
❑ YES ❑ NO 1 ❑ YES ❑ NO
THIS SECTION IS FOR STORAGE TANK IDENTIFICATION
TANK # VOLUME UNLEADED REGULAR PREMIUM DIESEL OTHER
Tank Testing Company
NAME OF TESTING COMPANY Lo PHONE NUMBER
MAILING ADDRESS �� �� • r `I
alcm + V-�56 t � �� W___)
NAME OF TESTER , ` _ ICC# �*A 4 '��T
THE APPLICANT HAS RECEIVED, UNDERSTANDS, AND WILL COMPLY WITH THE ATTACHED CONDITIONS OF THIS
PERMIT AND ANY OTHER STATE, LOCAL, AND FEDERAL REGULATIONS. THIS FORM HAS BEEN COMPLETED UNDER
PENALTY OF PERJURY, AND TO THE BEST OF MY KNOWLEDGE IS TRUE AND CORRECT.
NAME OF TESTER � ICC#
THIS APPLICATION BECOMES A PERMIT WHEN APPROVED
FOR OFFICIAL USE ONLY
DATE APPROVED APPROVED BY
FD2086 (Rev 08/09)