HomeMy WebLinkAbout1345 E 7th St - Building CITY OF PORT ANGELES
DEPARTMENT O COMM UNITY ECONOMIC DEVELOPMENT BUILDING DIVISION
m
321 EAST 5TH STREET, PORT ANGELES, WA 98362
Application Number 12- 00000263 Date 3/09/12
Application pin number 099142
Property Address 1345 E 7TH ST
ASSESSOR PARCEL NUMBER: 06- 30- 11 -5 -5 -0550 -0000- REPORT SALES TAX.
Application type description MECHANICAL APPL. PERMIT on your state excise tax foam
Subdivision Name
Property Use to the City of Port Angeles
Property Zoning RS7 RESDNTL SINGLE FAMILY (Location Code 0502)
Application valuation 2000
Application desc
HEAT PUMP
Owner Contractor
RALSTON JOHN M /GAIL T ALL WEATHER HTG COOLING INC
PO BOX 1405 302 KEMP ST
PORT ANGELES WA 983620259 PORT ANGELES WA 98362
(360) 452 -9813
Permit MECHANICAL PERMIT
Additional desc HEAT PUMP
Permit Fee 64.80 Plan Check Fee .00
Issue Date 3/09/12 Valuation 0
Expiration Date 9/05/12
Qty Unit Charge Per Extension
BASE FEE 50.00
1.00 14.8000 EA ME- FURN /HP /FAU OR 5 TON 14.80
Fee summary Charged Paid Credited Due
Permit Fee Total 64.80 64.80 .00 .00
Plan Check Total .00 .00 .00 .00
Grand Total 64.80 64.80 .00 .00
Separate Permits are required for electrical work, SEPA, Shoreline, ESA, utilities, private and public improvements. This permit becomes
null and void if work or construction authorized is not commenced within 180 days, if construction or work is suspended or abandoned
for a period of 180 days after the work has commenced, or if required inspections have not been requested within 180 days from the
last inspection. 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. The granting of a permit does
not presume to give authority to violate or cancel the provisions of any state or local law regulating construction or the performance of
construction.
IF -w-
Date Print Name Sign re of Contractor or orized Agent Signature of Owner (if owner is builder)
T:Forms /Building Division /Building Permit
BUILDING PERMIT INSPECTION RECORD
PLEASE PROVIDE A MINIMUM 24 -HOUR NOTICE FOR INSPECTIONS
Building Inspections 417 4815 Electrical Inspections 417 4735
Public Works Utilities 417 4831 Backflow Prevention Inspections 417 4886
IT IS UNLAWFUL. TO COVER, INSULATE OR CONCEAL ANY WORK BEFORE INSPECTED AND ACCEPTED.
POST PERMIT IN CONSPICUOUS LOCATION. KEEP PERMIT AND APPROVED PLANS AT JOB SITE.
Inspection Type Date Accepted By Comments 1
FOUNDATION:
Footings
Stemwall
Foundation Drainage Downspouts
Piers
Post Holes (Pole Bldgs.)
PLUMBING:
Under Floor Slab
Rough -In
Water Line (Meter to Bldg)
Gas Line
Back Flow Water FINAL Date Accepted b
AIR SEAL:
Walls
Ceiling
FRAMING:
Joists Girders Under Floor
Shear Wall Hold Downs
Walls Roof Ceiling
Dywall (Interior Braced Panel Only)
T -Bar
INSULATION:
Slab
Wall Floor Ceiling
MECHANICAL:
Heat Pump Furnace FAU Ducts
Rough -In
Gas Line
Wood Stove Pellet Chimney
Commercial Hood Ducts FINAL DateL• S' i
MANUFACTURED HOMES:
Footing Slab
Blocking Hold Downs
Skirting
PLANNING DEPT. Separate Permit #s SEPA:
Parking Lighting ESA:
Landscaping SHORELINE:
FINAL INSPECTIONS REQUIRED PRIOR TO OCCUPANCY/ USE
Inspection Type Date Accepted By 1
Electrical 417 -4735
Construction R.W. PW Engineering 417 -4831
Fire 417 -4653
Planning 417 -4750
Building 417 -4815
T:Forms /Building Division /Building Permit
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E I V E
MAR -8 2012
BUILDING PLUMBING MECHANICAL PERMIT APPLICATION SHORT r -.4 i-
0 i Y OF PORT ANGELES
(To be used for projects that do not require plan review.) BUILDING DIVISION
Date Received 1a.
Permit* �r
City of Port Angeles Please print in ink. Date Approved 1
Attn: Building Permit Technician Approved by._ KC
321 E. 5'" St., Port Angeles, WA 98362
360- 417 -4815 fax: 360 -417 -4711 Credit card payments are accepted Mon -Fri 8 -5 pm (no American Express)
Hours: Mon through Fri 8 5 pm Cash checks are accepted Mon -Thurs 8 :30 -4 pm Fri 8:30 -12:30 pm
0
.1 t •er.•n: o e:
t i. Lit, .Cad_,lIA 1) Al •_lr 'ri1 0
Proppgr; w ei PC Phone: D
e s glaaditn Prop erty o „to
tR ill E L •e4
Contractor's business name: v- 1 Phv b20�t3 3
(or property owner's name if he /see i doing /overseeing the wor
Contractor m -il'n6 address:
III Ao 0 I ari-- A t:� 0 0a(1.2 VI
Cont t is L &I I' ee umber: Exral l�te:
Project Address: 1 -free
5
Project Type: *Residential D Commercial o Industrial o Multi- family
Project Business Name:
(for commercial, industrial, or multi- family projects)
The following permits are usually issued over the counter immediately, without the need for plan review.
Complete only the portions of this permit that are relevant to your project.
Re -roof: in house garage ID other
a tear off re -roof o lay over one layer
Licensed contractor: Submit a copy of your re -roof bid.
Project Valuation (labor materials, not including sales tax)
Re -side: a house o garage o other
Project Valuation (labor materials, not including sales tax)
Repair: (explain the project)
Project Valuation awe
*Homeowner: If you will be doing overseeing the work, then the project valuation will be determined by doubling the li
P
cost of materials, to reflect the value the repair adds to your property.
Cost of materials x 2 Project Valuation
INJ
RECEIVED cie
T:Forms /Building Division /Building /Plumbing /Mechanical Permit Application Short Form (Revised 2011;
Page 1 of 2 MAR 8 2012 f V)
'ctTY OF PORT Aids
BJ1LD!NG Il $fO i
V0/60 39Vd 9NIIV3H a31-L127/3M 11C LLTSZSb09ET 8Z :ST ZTOZ /80/80
Swimming Pool or Spa 24" deep): For prefabricated swimming pool or spa pro /acts tl gt
do not require Alen review:
Obtain the City of PA handout entitled "Pools Spas" follow the requirements.
Project Valuation
Demolition: A demolition permit Is needed when an entire building gets demolished.
What will be demolished? 0 house Q garage ra other
Note: some demolition permit applications need to be reviewed by various City departments, and may take
approximately two weeks to obtain.
Agree to ensure that all utilities are /will be properly turned off (and capped off if needed)
prior to demolition.
Obtain (from the City of PA) an aerial view map of the parcel and put an "x" over the structure(s) to
be demolished. Submit the map with this application.
Obtain (from the City of PA) a copy of the Olympic Region Clean Alt Agency (ORCAA)
Demolition Permit Application.
Contact ORCAA at 360 -417 -1466 to discuss whether or not an ORCAA Demolltlon Permit will also
be needed.
o yes in no VVill the debris be going to the Regional Transfer Station in Port Angeles?
c y ca No If yes, will a ticensed contractor be It there?
if yes, obtain (from the City of PA) a copy of the Waste Disposal Application.
Complete and submit the waste disposal application to the Building Permit Technician, now
(or later If asbestos testing Is needed).
al
Plumbing Permit: jexolaln the proLect)
Project Valuation
Mechanical Permit: f explaln the project)
Installation of Heat Pump 'r''''�llElilt'lik
Project Valuation OW2
have read and completed this application and know It to be true and correct, I am authorized to apply for this permit
and understand that it is my responsibility to determine what permits are required, and to obtain permits prior to
working on p Jects.
Data j Signature Cl -1 -7 1j
Print Name ani-K
Page 2 of 2
17121/t70 39Vd 9NI.L 3H �13HLV3M 77v LLZ5Z5b09£Z 8Z Si ZTOZ /80/E0
ELECTRICAL PERMIT
CITY OF PORT ANGELES 0
360 417 -4735
Application Number 12- 00000265 Date 3/09/12 V
Application pin number 691620
Property Address 1345 E 7TH ST REPORT SALES TAX
ASSESSOR PARCEL NUMBER: 06-30-11-5-5- 0550 -0000-
Application type description ELECTRICAL ONLY on your excise tax form
Subdivision Name to the City of Port Angeles
Property Use (Location Code 0502)
Property Zoning R57 RESDNTL SINGLE FAMILY
Application valuation 0
Application desc
T -stat 4 ton heat pump
Owner Contractor
RALSTON JOHN M /GAIL T ALL WEATHER HTG COOLING INC
PO BOX 1405 302 KEMP ST
PORT ANGELES WA 983620259 PORT ANGELES WA 98362
(360) 452 -9813
Permit ELECTRICAL ALTER RESIDENTIAL �J
Additional desc
Permit Fee 56.00 Plan Check Fee .00
Issue Date 3/09/12 Valuation 0
Expiration Date 9/05/12
Qty Unit Charge Per Extension
1.00 56.0000 ECH EL- LVT- THERMOSTAT 56.00
Fee summary Charged Paid Credited Due
Permit Fee Total 56.00 56.00 .00 .00
Plan Check Total .00 .00 .00 .00
Grand Total 56.00 56.00 .00 .00
INSPECTION TYPE DATE: RESULTS: INSPECTOR:
DITCH
SERVICE
ROUGH -IN J r
FINAL 511 Z
COMMENTS: 6„iia, At,- t 6H
PERMIT WILL EXPIRE SIX (6) MONTHS FROM LAST INSPECTION
Signature of owner or Electrical Contractor 4 4 A Date: Z.
G: \EXCHANGE \BUILDING
1
0
N
CITY OF PORT ANGELES PERMIT APPLICATION IS`
Building Division /Electrical Inspections ilik ``a
321 East Fifth Street P.O. Box 1150 Port Angeles Washington, 98362 El EBU]iri
Ph: (360) 417 -4735 Fax: (360) 417 -4711
Ili 12. IfVSPECu��,.:.
Date:
_41 2 Single Family Dwelling Multi Family or Commercial" Commercial Addition Alteration Remodel Repair*
Plan ReviclorAlki B t ase mpl_ete Electrical Plan Review Information Sheet
Job Address: 1`)-rD to 1J
BuNding Square Footage: f
Description of abo
11JU.1kartl miffarmi 1I6 illittiaral eil►O[tL NiMs
OwnerInf :ti.: r Cont •r •f.r :tion y.
1
Name: A '4 I J r' ti l 4
Nam e: al
Mallln! •dd Fiai tt iliM 1lG�1r, Maili!! Ad. oss: C *7� :1�
City: kI state: t!1yi zip: °W ttt' Cry. 1 A L .i Zip: r!1U/
Phone.' n d %III 1 Fax: Phone: 0X`iV L A
License Exp. License Exp. ill. VP d i�tligi L
It?m Unit Charge Q y Total (Qty Multiplied by Unit Charctel
ServicelFeeder 200 Amp. 119.90
ServicelFeeder 201.400 Amp. 145.50
ServicelFeeder 401 -600 Amp 204.60
ServicelFeeder 601 -1000 Amp. 262.20
Service /Feeder over 1000 Amp. 372.50
Branch Circuit W/ Service Feeder 2.60
Branch Circuit W/O Service Feeder 73.50
Each Additional Branch Circuit 2.60
Temp. Service/ Feeder 200 Amp. 92.70
Temp. ServicelFeeder 201-400 Amp. 110.30
Temp. ServicelFeeder 401.600 Amp. 148.70
Temp. Service/Feeder 601 -1000 Amp 167.90
Portal to Portal Hourly 95.90
Sign /Outline LighUng 68.20
Signal Circuit/ Limited Energy First 1500 sf Commercial 95.90
Note: $6.00 for each additional 1500 sf
Signal CircuiV Limited Energy 1 2 Family Dwelling 63.90
Signal Circuit/ Limited Energy Multi- Family Dwelling 63.90
Manufactured Home Connection 119.90
Renewable Electrical Energy 5KVA System or Less 102.30
Thermostat 56.00 1
NEW CONSTRUCTION ONLY
First 1300 Square Ft. 110.30
Each Additional 500 Square Ft. or Portion of 35.20
Each Outbuilding or Detached Garage 73.50
Each Swimming Pool or Hot Tub 110.30
8—Etna—Total
Owner as defined by RCW.19.28.261: (1) Owner will occupy the structure for two years after this electrical permit is finalized. (2) Owner is required
to hire an electrical contractor If above said property is for sale, rent or lease. Permit expires after six months of last inspection.
After reading the above statement, I hereby certify that I am the owner of the above named property or a licensed electrical contractor. I am making
the electrical installation or alteration in compliance with the electrical laws, N.E.C., RCW. Chapter 19.28, WAC. Chapter 296 -46B, The City of Port
Angeles Municipal Code, and Utility Specifications and PAMC 14.05.050 regarding Electrical Permit Applications.
Signature of owner, electrical contractor or electrical administrator: D Cash Chuck
,1 R L 7 1 I Credit Card
x ^Y 1 /l Oated: I� 1 01/01/2010
b0 /Z0 39Cd ONI.L H 213H1v3M 17v LLTSZ5b09ET 8Z :5T ZTOZ /80/E0
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CITY OF PORT ANGELES
DEPARTMENT OF COMMUNITY DEVELOPMENT - BUILDING DIVISION
321 EAST 5TH STREET, PORT ANGELES, WA 98362
~
,
.,
Application Number
pin number
Property Address
ASSESSOR PARCEL NUMBER:
Application description
Subdivision Name
Property Use
Property Zoning . . .
Application valuation
04-00000703 Date
.418909
1345 E 7TH ST
06-30-11-5-5-0550-0000-
RES REMODEL
9/30/04
RS7 RESDNTL SINGLE FAMILY
30000
Owner
Contractor
RALSTON JQHN M/GAIL T
PO BOX 1405
PORT ANGELES WA 983620259
J & J CONSTRUCTION
233 ALICE RD.
PORT ANGELES
PORT ANGELES WA 98363
(360) 457-1809
Permit ELECTRICAL NEW RESIDENTIAL
Additional desc
Permit Fee 42.20 Plan Check Fee
Issue Date 9/30/04 Valuation
Expiration Date 3/30/05
.00
o
~
~
~
V\
Qty Unit Charge Per
1.00 42.2000 EL-LOW VOLT SYS <=2500 SQFT
Extension
42.20
Special Notes and Comments
The proposal will add a caregiver's space to the basement of
a sf res. No second kitchen to be installed but
handicapped accessibility will be added. No land use issues
are noted as no second unit is being created.
f\\\
Other Fees
STATE SURCHARGE
4.50
'-.\
\~
Fee summary Charged Paid Credited Due
----------------- ---------- ---------- ---------- ----------
Permit Fee Total 42.20 42.20 .00 .00
Plan Check Total .00 .00 .00 .00
Other Fee Total 4.50 4.50 .00 .00
Grand Total 46.70 46.70 .00 .00
(j\
~1
Separate Permits are required for electrical work, SEPA, Shoreline, ESA, utilities, private and public improvements. This permit becomes
null and void if work or construction authorized is not commenced within 180 days, if construction or work is suspended or abandoned
for a period of 180 days after the work as commenced, or if required inspections have not been requested within 180 days from the last
inspection. 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. The granting of a permit does not
presume to give authority to violate or cancel the provisions of any state or local law regulating construction or the performance of
construction.
Signature of Contractor or Authorized Agent
Date
Signature of Owner (if owner is builder)
Date
T:\PLANNING\FORMS\1102.15 [11/14/2003]
BUILDING PERMIT INSPECTION RECORD
,
CALL 417-4815 FOR BUILDING INSPECTIONS. CALL 417-4735 FOR ELECTRICAL INSPECTIONS.
;
.J'.
PLEASE PROVIDE A MINIMUM 24 HOUR NOTICE. IT IS'UNLAWFUL-tO COVER, INSULATE OR CONCEAL ANY WORK BEFORE
INSPECTED AND ACCEPTED. POST PERMIT IN A CONSPICUOUS LOCATION.
KEEP PERMIT CARD AND APPROVED PLANS AT JOB SITE.
INSPECTION TYPE DATE ACCEPTED COMMENTS
I YES NO
FOUNDATION:
FOOTINGS
WALLS
FOUNDATION DRAlNAGEIDOWN SPOUTS
ELECTRICAL (LIGHT DEPT) SEPARATE PERMIT: #
ROUGH.IN I I
PLUMBING
UNDER FLOOR { SLAB
ROUGH-IN
WATER LINE (METER TO BLDG)
G';\S LINE
BACK FLOW { WATER
AIR SEAL
WALLS
CEILING I I I
FRAMING
JOISTS { GIRDERS
SHEAR W ALLIHOLD DOWNS
WALLS { ROOF { CEILING
DRYWALL (INTERIOR BRACED PANEL ONLY)
T-BAR
INSULATION
SLAB
WALL {FLOOR {CEILING I
MECHANICAL
HEAT PUMP
GAS LINE
WOOD STOVE { PELLET {CHIMNEY
HOOD { DUCTS
PW UTILITIES { SITE WORK (Engineering Division) SEPARATE PERMIT #'s:
WATERLINE { METER
SEWER CONNECTION
SANITARY
STORM
PLANNING DEPT. SEPARATE PERMIT #'s SEPA:
PARKINGILIGHTING ESA:
LANDSCAPING SHORELINE:
FINAL INSPECTIONS REQUIRED PRIOR TO OCCUPANCYIUSE
RESIDENTIAL DATE YES NO COMMERCIAL DATE ACCEPTED
YES NO
ELECTRICAL - LIGHT DEPT. 417-4735 q-;2'ltJ~ ,keD ELECTRICAL
LIGHT DEPT
CONSTRUCTION R.W. {PWI CONSTRUCTION - R.W.
ENGINEERING 417-4807 PW 1 ENGINEERING
FIRE 417-4653 FIRE DEPT.
PLANNING DEPT. 417-4750 PLANNING DEPT.
BUILDING 417-4815 BUILDING
T:IPLANNlNG\FORMSI1102.15[11/14/2003]
~0~ ~/SE?! "2.3./:'.:~ ~.:: j~; AM
CITY OF PM BLDG JEPT
Fp.:.~ N~. 35C;
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Sep. 29 2004 10: 41RM pi' ,0 '"
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~~~M : HI-TECH ELECTRONICS
FRX NO. : 360 452 8560
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ELECTRICAL PERMIT APPlICAT:ON ..l>n\.~I<..., ::;-,:':..::.::' '::"-=,~
.~_. - .- .-.- -......- .-"""'":"'".~_...~ . - ,... .....- --~.~ -.-:--------.-:-- ...-..- ._-.. - . ..";' -...---:~.... :'&...~~,.'~~:.i ~_~_
....._...T.~~.El~c:rl~a~~er~".~.pPIlC~U.O~~~.~llrlll~d.o\J~~o",~I..~eIV.. ". _. ~"',h,u.~ ......---:::-- ,
. PiaaS6 lJ'pe "r r,$prinl ir: ink., IfyoU,MvB any QIJAt:tio"s, p19~1iI call (~60) ~1'..4'i'!6 .
I=.li "umber: (36D) 417-4711
, . .
.. ....-.... - . ... ....._.....- --.,.... --- -- ........- - -..... -_.. - _OJ, ...~_._ .
'Ownilr~r Elec;, Cor.!t.aCIOf AgQl)t; G EtIZR E:T M (J6LITU~fl' ~non6;3/dJ.:.qj':.(-J.1J.7r.8X;.3{PO -~S ~~. ?f5~()
?rQ".llfttO!'d'cr:~TO\-t~I. .RPrL.C:rotJ '. . ._ .._ ..' Phon55L"'{)"'~7S1~.~, 1'700
Addrr.ss;J3'-l-S E 7i-'" ST . . CllY-.Pa/<..7'fJ-N &.EL€.s . wl7 . Zip: q 93 C? 2-
E,g;;Jrt.:.al CCll'l:raClI)r:j~ 1- TE.CH- ELE c.:r Ro Iv I c:..s" UCQn~u~ hkif-t l.v~I~~k tl.:t -c9-u,e; p~.Oi\S:3faJ -'-IS :(~.i1J:;..-'1
~ddr~s; 7~3-tE.'r~ON''''t'. SOT ......'r...... .': ._~...:.~;;;;-ftJ~T7J;';:6id.s-"-"t;:JYj' ---'-''';;;>~'f3 ~';z
'1 NSTAt;.1,A'l',QN WIREO"SY; ._, . --0 OWNeR. ..:-..- '-'--~Et.ECT~ICA:;:CONTAAC1'OR" ~- - ...--.---.
Cr~dit Card Holder Namfl;h~12 gET. 11.1 ~-L'TIIC-Jtf . .... .
BlIffngAddr~sj~8 f ~o"~~7- 6/ '~ti;:J1g/ AAJ i:iElE...~
Cradit Card Number. ~ ; E:qJ:pate:
wlj.... ., Zip: 193~.z
, VJSA:~ Me: _
Cj Reijdential 0 Multi-family
o Commercial
~. f2. r /J iJ {.. €.--l:.E.s oJ ft: q 83 '" ~
'~ . ~ AJteratlon/Addilion'" .'
o Mobile Homs Sq. Ft . ~ ."(jOG
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)
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b
uJ
F'RCJ~ AnDRESS; \ 34 5 . ~ 7 j-h ,,5 7
TYPE OF WORK,
Check all mat apply: 0 NGW
." .
I:;J Remote Mater [J Detached gerage 0 Hot Tub.O Sw1r:' Pool . D Sep~i6 'Pump ~. " OLow VOltage 0 Telecom. Cl Sign
_. _._ "'... ._._ _. .. ..._._.. .._ _. _._....._.... ..._,....~.-........._..._-.._-.----.._~....~.~:--'7:".--. _-:-_...._..--:'.--_....~.-..~----.. -:-_....._w ----......~.. ..._...~.............,.,
Numbsr of Cjr~it); added Or attered;
OeSCR.lF'TJON OF THE iI..ECTRlCAl.. PROJeCT:. ~. E r!...u. 12.J711 .' ,4.
. ,
. .
E c;al Haat l..oad Additions and or SUbtnietions'
.. I
Sal)li~.lnform:!tion.
D.Overhe&d Seivice
. DTemp Service
Cl Undergr?Und ServiCE!
Voltage:
Phase: 0 1 0 a
ServIce StZIi:
Feeder Sli-a:
:J 61iS~PQ;Hd
] Furn~ce
J Heat Pump
J Fan-WaU
_KW
tt:;-.N
iON LR.A
=KW-
.. ..
hereby oertify that I .1ave r6Bd and examinad thiFJ appllcgtjon and know that same to be trLie and oorrec:t.. and J am
wthorizs~ to apply for thf$ psrmlt ! IJndfirstanc it is not the City's /egalresponsibUJry to determine what permits ..
il'ft requIred; !t remains the alpp/lcanis responsibIlity to ds Ins what permits roqL1ired and to obtain such.
Credit Cz.rd' H"gld~$ S~gnllbn;; . D21te:-M ?;09f
OWner or E1ec. Cent. SIgnature: Oat,,; o~f~ ~
:' pE~JV1iT'FE.E; $ ,,1~2-c'L6
:IELECTRICAl.PERMITA~!"LlCATION .'
f ~ORT ~
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CITY OF PORT ANGELES
DEPARTMENT OF COMMUNITY DEVELOPMENT - BUILDING DIVISION
321 EAST 5TH STREET, PORT ANGELES, WA 98362
Application Number
pin number
Property Address
ASSESSOR PARCEL NUMBER:
Application description
Subdivision Name
Property Use
Property Zoning . . .
Application valuation
04-00000703 Date
.418909
1345 E 7TH ST
06-30-11-5-5-0550-0000-
RES REMODEL
9/03/04
RS7 RESDNTL SINGLE FAMILY
30000
Owner
Contractor
RALSTON JOHN M/GAIL T
PO BOX 1405
PORT ANGELES WA 983620259
J & J CONSTRUCTION
233 ALICE RD.
PORT ANGELES
PORT ANGELES
(360) 457-1809
WA 98363
Permit
Additional desc
Sub Contractor
Permit Fee
Issue Date
Expiration Date
ELECTRICAL ALTER RESIDENTIAL
ALL WEATHER,
36.40
9/01/04
3/01/05
HEATING & COOLING
Plan Check Fee
Valuation
.00
o
Qty
1. 00
Unit Charge Per
36.4000 EC EL-LOW VOLTAGE
Extensibn
36.40
Permit
Additional desc
Sub Contractor
Permit Fee
Issue Date
Expiration Date
MECHANICAL PERMIT
HEAT PUMP & DUCTS
ALL WEATHER, HEATING & COOLING
61.70 Plan Check Fee
9/01/04 Valuation
3/01/05
.00
o
-.
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" ...:t.
0'.
.z- I
r \'t. .
I
,)
.)
,.
l,,?
'i
Qty
Unit Charge Per
1. 00
BASE FEE
14.7000 ECH ME- INSTALL 100- FAU
Extension
47.00
14.70
Special Notes and Comments
The proposal will add a caregiver's space to the basement of
a sf res. No second kitchen to be installed but
handicapped accessibility will be added. No land use issues
are noted as no second unit is being created.
Other Fees
STATE SURCHARGE
4.50
Fee summary Charged Paid Credi ted Due
----------------- ---------- ---------- ---------- ----------
Permit Fee Total 98.10 98.10 .00 .00
Plan Check Total .00 .00 .00 .00
Other Fee Total 4.50 4.50 .00 .00
Grand Total 102.60 102.60 .00 .00
Separate Permits are required for electrical work, SEPA, Shoreline, ESA, utilities, private and public improvements. This permit becomes
null and void if work or construction authorized is not commenced within 180 days, if construction or work is suspended or abandoned
for a period of 180 days after the work as commenced, or if required inspections have not been requested within 180 days from he last
inspection. I hereby certify that I have read and examined this application and know the same to be true and correct. All provis ns of
laws and ordinances governing this type of work will be complied with whether specified herein or not. The granting of a permit do not
presume to give authority to violate or cancel the provisions of any state or local law regulating construction or the performan of
construction.
of\)
F I L-~
Signature of Contractor or Authorized Agent
Date
Signature of Owner (if owner is builder)
Date
T:\PLANNING\FORMS\ 1102.15 [11/14/2003]
BUILDING PERMIT INSPECTION RECORD
CALL 417-4815 FOR BUILDING INSPECTIONS. CALL 4 17-4735 FOR ELECTRICAL INSPECTIONS.
PLEASE PROVIDE A MINIMUM 24 HOUR NOTICE. IT IS UNLA WFUL TO COVER, INSULA TE OR CONCEAL ANY WORK BEFORE
INSPECTED AND A CCEPTED. POST PERMIT IN A CONSPICUOUS LOCATION.
KEEP PERMIT CARD AND APPROVED PLANS AT JOB SITE.
INSPECTION TYPE DATE ACCEPTED COMMENTS
YES NO
FOUNDATION:
FOOTINGS
WALLS
FOUNDA TION DRAINAGE/DOWN SPOUTS
ELECTRICAL (LIGHT DEPT) SEPARATE PERMIT: #
ROUGH. IN I I
PLUMBING ~ I vt<,< I / -/1 -0 ) - J. L..
UNDER FLOOR / SLAB Iq -q_ nJ i L
ROUGH-IN 1<7-1 lr_r)U t f
WATER LINE (METER TO BLDG)
GAS LINE
BACK FLOW / WATER
AIR SEAL
WALLS I iJ..I ~ - C1 Jf;/ j,L
CEILING , I
FRAMING
JOISTS I GIRDERS
SHEAR WALL/HOLD DOWNS
WALLS I ROOF / CEILING vO - 1/-0 1-/ Ij i L
DRYW ALL (INTERJOR BRACED PANEL ONLY)
T-BAR
INSULATION
SLAB
WALL / FLOOR / CEILING Ii,., -/7, -O.J J.L
MECHANICAL f, '1 A I I -I Jy - (7)'- i, I-,
HEA T PUMP
GAS LINE
WOOD STOVE / PELLET / CHIMNEY
HOOD / DUCTS
PW UTILITIES / SITE WORK (Engineering Division) SEPARATE PERMIT #'5:
WATERLINE / METER
SEWER CONNECTION
SANIT AR Y
STORM
PLANNING DEPT. SEPARATE PERMIT #'5 SEPA:
PARKINGILIGHTING ESA:
LANDSCAPING SHORELINE:
FINAL INSPECTIONS REQUIRED PRIOR TO OCCUPANCY/USE
RESIDENTIAL DATE YES NO COMMERCIAL DATE ACCEPTED
YES NO
ELECTRJCAL - LIGHT DEPT. 417-4735 ELECTRJCAL
LIGHT DEPT
CONSTRUCTION R.W./ PW/ CONSTRUCTION, R.W.
ENGINEERJNG 417-4807 PW I ENGINEERJNG
FIRE 417-4653 FIRE DEPT.
PLANNING DEPT. 417-4750 PLANNING DEPT.
BUILDING 417-4815 I-P/-OS- j.J-, BUILDING
T:\PLANNINGIFORMS\1102.I5 [1 ]/14/2003]
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PREPARED 1/14/05, 125610 INSPECTION TICKET PAGE 5
CITY OF PORT ANGELES INSPECTOR JAMES L LIERLY DATE 1/14/05
ADDRESS 1345 E 7TH ST
CONTRACTOR J J CONSTRUCTION
OWNER RALSTON JOHN M/GAIL T
PARCEL 06 30 11 5 5 0550-0000-
APPL NUMBER: 04-00000703 RES REMODEL
PERMIT: PL 00 PLUMBING PERMIT
REQUESTED INSP DESCRIPTION
TYP/SQ COMPLETED RESULT RESULTS/COMMENTS
SUBDIV:
PHONE (360) 457-1809
PHONE
PL1 01 8/09/04 JLL PLUMBING UNDER SLAB TIME 1700
8/11/04 AP Jerry 461-4725
PL2 01 9/15/04 JLL PLUMBING ROUGH-IN TIME 1700
9/15/04 AP Steve 461-2259
This is the Ralston house being remodeled in the basement
for the Parapalegic Son. Water and Sewer is currently cut
off waiting for an inspection. Consider this a priority
please.
PL99 01 1'14/)5 JLL PLUMBING FINAL TIME: 17:00
COMMENTS AND NOTES
BUILDING PERMIT. APPLICATION _
Th. Building Pmn.it . In-applicotkm .rut be JllId .., CO~=- ~
Pleue type or print in ink. If you bave any questions, please c:all417-4815
Applicant or Agent: C,\\ \~ U^~\.lY- ~{O,~hf~~. 0 DO\', \I\~ Phone: .~ 00, YS 1..- -- '1 rl3
Owner:)'*'0 Kc,\~~{1 Phone: "J,(p(J- YSI -- 110(0
Addrcaa: \2.,<--\S ~ - 'ltb S-h-,u--\- City:~(lI'\ {\\'\C\8 \-{c1 \ \,Jt-\ Zip: ~<(3(PL--
ArchitectlBngincer:~ A Phone:
Contractor (l t \ -J ~uful( ~ {ll-hv'~ License #: {\ \ \ w 't-,K t\ CjJ(JExP:...1j I ! D ~ Phone: 1(P0' Y"5 2- - c7 2'1 '3
A.ddrcM; '?61.t'erv'f~A;vG-e..-' City: V(\-(\ ~~t.\tJ ,l0f\ Zip: ~'t3Co2-
. -\- ~
'~4PPI~N; \.~ L\~ ~ . 'l :h. ~~u:--\- . . . . ZONING:
LEGAL DJ:SCJUPTION: Lot: Block: SubdivlSlon:
CJ.,"'J.J .W COUNTY PARCEL ~R: Credit Card Bolder Name:
BIWa& AddNl: City:
Credit Card .: Exp. Date:
r/.POIU,
.
F
11
VISA
MC
TYPE OF WORK: SIZE/V ALUATION:
c Retidlnyial -p"New Cons1r. C R.c-roof C Woodstove SF. @ S /SF. = $
C Multi-family C Addition C Move [J Garage SF.,@S /SF. = $
C Commercial C R.cmodcl [J Demolition [J Deck SF.@"S- - /SF. = $
C Repair 0 Sign [J TOTAL V ALUA nON $ \ ~\ ~() '-{ ~
BRlP'DESClUPTJON OFTBE PROJECT: '\=-' (l '(' \-\ P : \')', ~0..?-t\ Or) o..s. S; (~\ \r,\~<:"" :. \-\ ~ ',(\s~Cf....\ t
. wi L- Y WI If \ u\~ ~y '\ 'S'rA,) due't<
COMMER~SII)ENTlAL: Occupancy Group: Occupant Load: Construction Type:
No. of StoricI: _ Lot Size: % Lot Coverage: %
Existing Lot Coverage: /sq. ft. + Proposed Lot Coverage: /sq. ft. = TOTAL LOT COVERAGE: /sq.ft
PL4NNJNG USE ONLY: APPROVALS: PLAN
Nota: BLDG.
DPW
FIRE
ESAlWct1and(I): 0 Yes 0 No SBPA Checklist required? 0 Y~ [J No Other: OTHER
. .
." BUILDING PERMIT APPLICATION SUBMITTAL: F.,II' tlppUcllllDlllllld slt~ plllll."., bejlllMl .,IItCIJryl.ulyltl be IICCqttlllfo,
,niew. The Building Division can provide you with more detailed information on the application and plan submittal requirements. Your
completed application, site plan (for additions) and building construction plans are to be submitted to the Building Division.
V ALUA110N OF CONSTRUcnO~: In all cua,a valuation amount must be entered by the applicant 'Ibis figure will be reviewed
and may be revised by the Building Division to comply with current fee schedules. Contact the Permit Coordinator at 417-4815 for assistance.
PLAN CllECKFEE : Your plan check fee is due at the time the building permit application and construction plans an: submitted. All other
permit fees arc due at the time of permit issuance.
EXPIRATION OF PLAN REVIEW: If no permit is issued within 180 days of the date of application, this .appUcation..m expire. The
Building Official can extend the time for action by the applicant up to 180 days upon written request by the applicant (see Section 107.4 of
the UnifolDl Building Code, current edition). No application can be extended more than once.
1 hereby certify that 1 have read and examined this application and know the same to be true and correct, and I am authorized to apply for
this permit. J understand it is not the City's legal responsibility" to determine what permits are required; it remains the applicant's
.....poMbillty .. determin. what permits an ""luired and .. abtal"/ich.
. Applicant: Ua~ )) ~ H'~ Date: a 1\ { 01
I T:\FORMS\APPS\BllildinlPC"llil . t4 --.If
CITY OF PORT ANGELES
DEPARTMENT OF COMMUNITY DEVELOPMENT - BUILDING DIVISION
321 EAST 5TH STREET, PORT ANGELES, WA 98362
Application Number
pin number
Property Address
ASSESSOR PARCEL NUMBER:
Application description
Subdivision Name
Property Use
Property Zoning . . .
Application valuation
04-00000703 Date
.418909
1345 E 7TH ST
06-30-11-5-5-0550-0000-
RES REMODEL
9/03/04
--
c
,
..s:-
'0
--L:
\
"'-J.
~ ~
$ w
i
~
"-. W
f0.J -r
\ Ul
.~
<:) M
~
~
,....
~
RS7 RESDNTL SINGLE FAMILY
30000
Owner
Contractor
RALSTON JOHN M/GAIL T
PO BOX 1405
PORT ANGELES WA 983620259
J & J CONSTRUCTION
233 ALICE RD.
PORT ANGELES
PORT ANGELES
(360) 457-1809
WA 98363
Permit
Additional desc
Sub Contractor
Permit Fee
Issue Date
Expiration Date
ELECTRICAL ALTER RESIDENTIAL
ALL WEATHER,
36.40
9/01/04
3/01/05
HEATING & COOLING
Plan Check Fee
Valuation
.00
o
Qty
1. 00
Unit Charge Per
36.4000 EC EL-LOW VOLTAGE
Extension
36.40
Permit
Additional desc
Sub Contractor
Permit Fee
Issue Date
Expiration Date
MECHANICAL PERMIT
HEAT PUMP & DUCTS
ALL WEATHER, HEATING & COOLING
61.70 Plan Check Fee
9/01/04 Valuation
3/01/05
.00
o
1. 00
BASE FEE
14.7000 ECH ME- INSTALL 100- FAU
Extension
47.00
14.70
Qty
Unit Charge Per
Special Notes and Comments
The proposal will add a caregiver's space to the basement of
a sf res. No second kitchen to be installed but
handicapped accessibility will be added. No land use issues
are noted as no second unit is being created.
Other Fees
STATE SURCHARGE
4.50
Fee summary Charged Paid Credited Due
----------------- ---------- ---------- ---------- ----------
Permit Fee Total 98.10 98.10 .00 .00
Plan Check Total .00 .00 .00 .00
Other Fee Total 4.50 4.50 .00 .00
Grand Total 102.60 102.60 .00 .00
Separate Permits are required for electrical work, SEPA, Shoreline, ESA, utilities, private and public improvements. This permit becomes
null and void if work or construction authorized is not commenced within 180 days, if construction or work is suspended or abandoned
for a period of 180 days after the work as commenced, or if required inspections have not been requested within 180 days from the last
inspection. 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. The granting of a permit does not
presume to give authority to violate or cancel the provisions of any state or local law regulating construction or the performance of
construction.
Signature of Contractor or Authorized Agent
Date
Signature of Owner (if owner is builder)
Date
~
T:\PLANNING\FORMS\1102.15 [11114/2003]
BUILDING PERMIT INSPECTION RECORD
CALL 417-4815 FOR BU1LDING INSPECTIONS. CALL 417-4735 FOR ELECTRICAL INSPECTIONS.
PLEASE PROVIDE A MINIMUM 24 HOUR NOTICE. IT IS UNLAWFUL TO COVER, INSULATE OR CONCEAL ANY WORK B.EFORE
INSPECTED AND ACCEPTED. POST PERMIT IN A CONSPICUOUS LOCATION.
KEEP PERMIT CARD AND APPROVED PLANS A T JOB SITE.
INSPECTION TYPE DATE ACCEPTED COMMENTS
YES I NO
FOUNDATION:
FOOTINGS
WALLS
FOUNDATION DRAINAGE/DOWN SPOUTS
ELECTRICAL (LIGHT DEPT) SEPARATE PERMIT: #
ROUGH-IN I
PLUMBING
UNDER FLOOR 1 SLAB
ROUGH-IN
WATER LINE (METER TO BLDG)
GAS LINE
BACK FLOW 1 WATER
AIR SEAL I
WALLS
CEILING
FRAMING
JOISTS 1 GIRDERS
SHEAR WALL/HOLD DOWNS
WALLS 1 ROOF 1 CEILING
DR YW ALL (INTERJOR BRACED PANEL ONLY)
T-BAR
INSULATION
SLAB
WALL 1 FLOOR 1 CEILING
MECHANICAL
HEA T PUMP
GAS LINE
WOOD STOVE 1 PELLET 1 CHIMNEY
HOOD 1 DUCTS
PW UTILITIES I SITE WORK (Engineering Division) SEPARATE PERMIT #'5:
WATERLINE 1 METER
SEWER CONNECTION
SANITARY
STORM
PLANNING DEPT. SEPARATE PERMIT #'5 SEPA:
PARKING/LIGHTING ESA:
LANDSCAPING SHORELINE:
FINAL INSPECTIONS REQUIRED PRIOR TO OCCUPANCY/USE
RESIDENTIAL DATE YES NO COMMERCIAL DATE ACCEPTED
YES NO
ELECTRICAL - LIGHT DEPT. 417-4735 ELECTRJCAL
LIGHT DEPT
CONSTRUCTION R.W.I PWI CONSTRUCTION - R.W.
ENGINEERING 417-4807 PW I ENGINEERING
FIRE 417-4653 FIRE DEPT.
PLANNING DEPT. 417-4750 PLANNING DEPT.
BUILDING 417-4815 BUILDING
T:\PLANNING\FORMS\1102.15 [11/14/20031
CITY OF PORT ANGELES
DEPARTMENT OF COMMUNITY DEVELOPMENT - BUILDING DIVISION
321 EAST 5TH STREET, PORT ANGELES, WA 98362
Application Number
pin number
Property Address
ASSESSOR PARCEL NUMBER:
Application description
Subdivision Name
Property Use
Property zoning . . .
Application valuation
04-00000703 Date
.418909
1345 E 7TH ST
06-30-11-5-5-0550-0000-
RES REMODEL
9/03/04
RS7 RESDNTL SINGLE FAMILY
30000
Owner
Contractor
RALSTON JOHN M/GAIL T
PO BOX 1405
PORT ANGELES WA 983620259
J & J CONSTRUCTION
233 ALICE RD.
PORT ANGELES
PORT ANGELES
(360) 457-1809
WA 98363
Permit
Additional desc
Sub Contractor
Permit Fee
Issue Date
Expiration Date
ELECTRICAL ALTER RESIDENTIAL
12 CIRCUITS/ BASEMENT
ELECTRIC SERVICE
90.50 Plan Check Fee
9/03/04 Valuation
3/03/05
.00
o
<0
~
l
~ <
----J
" 0
~ \JJ
t
-......
"" W
l ~
- V\
w
() M
\J1
.J
~
~
Qty
1. 00
8.00
Unit Charge Per
48.1000 ECH EL-R OR RM 1-4 ALT CIRCUITS
5.3000 ECH EL-R OR RM ALT ADDNT CIRCUITS
Extension
48.10
42.40
Special Notes and Comments
The proposal will add a caregiver'S space to the basement of
a sf res. No second kitchen to be installed but
handicapped accessibility will be added. No land use issues
are noted as no second unit is being created.
Other Fees
STATE SURCHARGE
4.50
Fee summary Charged Paid Credited Due
----------------- ---------- ---------- ---------- ----------
Permit Fee Total 90.50 90.50 .00 .00
plan Check Total .00 .00 .00 .00
Other Fee Total 4.50 4.50 .00 .00
Grand Total 95.00 95.00 .00 .00
Separate Permits are required for electrical work, SEPA, Shoreline, ESA, utilities, private and public improvements. This permit becomes
null and void if work or construction authorized is not commenced within 180 days, if construction or work is suspended or abandoned
for a period of 180 days after the work as commenced, or if required inspections have not been requested within 180 days from the last
inspection. 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. The granting of a permit does not
presume to give authority to violate or cancel the provisions of any state or local law regulating construction or the performance of
construction.
Signature of Contractor or Authorized Agent
Date
Signature of Owner (if owner is builder)
Date
T:\PLANNING\FORMS\1102.15 [11/14/2003]
BUILDING PERMIT INSPECTION RECORD
CALL 4] 7-4815 FOR BUILDING INSPECTIONS. CALL 4] 7-4735 FOR ELECTRICAL INSPECTIONS.
PLEASE PROVIDE A MINIMUM 24 HOUR NOTICE. IT IS UNLAWFUL TO COVER, INSULATE OR CONCEAL ANY WORK BEFORE
INSPECTED AND ACCEPTED. POST PERMIT IN A CONSPICUOUS LOCATION.
KEEP PERMIT CARD AND APPROVED PLANS AT JOB SITE.
INSPECTION TYPE DATE ACCEPTED COMMENTS
YES I NO
FOUNDATION:
FOOTINGS
WALLS
FOUNDA TlON DRAINAGE/DOWN SPOUTS
ELECTRICAL (LIGHT DEPT) SEPARATE PERMIT: # I) .. .'1_ ,t
oK. C./L,~j '- -
11'-' -5-0(( It'(. (( ; . ..A
ROUGH-IN ;
PLUMBING
UNDER FLOOR / SLAB
ROUGH-IN
WATER LINE (METER TO BLDG)
GAS LINE
BACK FLOW / WATER
AIR SEAL !
WALLS
CEILING
FRAMING
JOISTS / GIRDERS
SHEAR WALL/HOLD DOWNS
WALLS / ROOF / CEILING
DR YW ALL (INTERJOR BRACED PANEL ONLY)
T-BAR
INSULATION
SLAB
WALL / FLOOR / CEILING
MECHANICAL
HEAT PUMP
GAS LINE
WOOD STOVE I PELLET I CHIMNEY
HOOD I DUCTS
PW UTILITIES I SITE WORK (Engineering Division) SEPARATE PERMIT #'5:
WATERLINE / METER
SEWER CONNECTION
SANITARY
STORM
PLANNING DEPT. SEPARATE PERMIT #'5 SEPA:
PARKING/LIGHTING ESA:
LANDSCAPING SHORELINE:
FINAL INSPECTIONS REQUIRED PRIOR TO OCCUPANCY/USE
RESIDENTIAL DATE YES NO COMMERCIAL DATE ACCEPTED
YES NO
ELECTRJCAL - LIGHT DEPT. 417-4735 1 .. , '3 ~O5 12/(, ELECTRJCAL
LIGHT DEPT
CONSTRUCTION R.W./ PW/ CONSTRUCTION, R.W.
ENGINEERJNG 417-4807 PW / ENGINEERJNG
FIRE 417-4653 FIRE DEPT.
PLANNING DEPT. 417-4750 PLANNING DEPT.
BUILDING 417-4815 BUILDING
T:\PLANNING\FORMS\1102.15 [11/14/2003]
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CITY OF PORT ANGELES
DEPARTMENT OF COMMUNITY DEVELOPMENT - BUILDING DIVISION
321 EAST 5TH STREET, PORT ANGELES, W A 98362
Appllcatlon Number
pin number
Property Address
ASSESSOR PARCEL NUMBER:
Application description
Subdivision Name
Property Use
Property Zoning . . .
Applicatlon valuation
04-00000703 Date
.418909
1345 E 7TH ST
06-30-11-5-5-0550-0000-
RES REMODEL
8/11/04
Owner
Contractor
Mi~~
VI4(O[
RS7 RESDNTL SINGLE FAMILY
30000
RALSTON JOHN M/GAIL T
PO BOX 1405
PORT ANGELES WA 983620259
J & J CONSTRUCTION
233 ALICE RD.
PORT ANGELES
PORT ANGELES WA 98363
(360) 457-1809
Permit
Additlonal desc
Permit Fee
Issue Date
Explration Date
BUILDING PERMIT -RESIDENTIAL
INTERIOR REMODEL
465.25 Plan Check Fee
8/11/04 Valuatlon
2/08/05
186.10
30000
Qty Unit Charge Per
Extension
414.75
50.50
BASE FEE
5.00 10.1000 THOU BL-25,001-50K (10.10 PER K)
Permit MECHANICAL PERMIT
Additional desc
Permit Fee 68.75 Plan Check Fee
Issue Date 8/11/04 Valuatlon
Expiratlon Date 2/08/05
Qty Unit Charge Per
BASE FEE
3.00 7.2500 ECH ME-VENT FAN
.00
o
-.
Extension
47.00
21.75
Fe
Ul
.:t.
~
Permit
Additional desc
Permlt Fee
Issue Date
Expiration Date
PLUMBING PERMIT
1t1
110.00
8/11/04
2/08/05
Plan Check Fee
Valuatlon
.00
o
""1'
1
fI)
~
Qty Unit Charge Per
Extension
47.00
56.00
7.00
BASE FEE
8.00 7.0000 ECH PL- EA. FIXTURE ON ONE TRAP
1.00 7.0000 ECH PL- EA.WATER HEATER
Special Notes and Comments
The proposal will add a caregiver's space to the basement of
a sf res. No second kitchen to be installed but
handicapped accessibility will be added. No land use issues
are noted as no second unlt is belng created.
Other Fees
STATE SURCHARGE
4.50
Fee summary Charged
Pald Credited
Due
Separate Permits are required for electncal work, SEPA, Shoreline, ESA, utilities, private and public improvements. ThiS permit becomes
null and void If work or construction authorized is not commenced within 180 days, if construction or work is suspended or abandoned
for a period of 180 days after the work as commenced, or if required inspections have not been requested within 180 days from the last
inspection 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. The granting of a permit does not
presume Ive authonty to violate or cancel the provisions of any state 0 law regulating nstru tlon or the performance of
constr. ctio
Date
?-If -2JtJOtfl
Date
T \PLANNlNG\FORMS\1102 15 [11/14/2003]
... ~9'ORT~
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,.
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~
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CITY OF PORT ANGELES
DEPARTMENT OF COMMUNITY DEVELOPMENT - BUILDING DIVISION
321 EAST 5TH STREET, PORT ANGELES, WA 98362
Applicatlon Number
pin number
Permlt Fee Total
Plan Check Total
Other Fee Total
Grand Total
04-00000703
. .418909
644.00
186.10
4.50
834.60
Page 2
Date 8/11/04
644.00
186.10
4.50
834.60
.00 .00
.00 .00
.00 .00
.00 .00
Separate Permits are required for electrical work, SEPA, Shoreline, ESA, utilities, private and public improvements. This permit becomes
null and void If work or construction authorized is not commenced within 180 days, If construction or work is suspended or abandoned
for a period of 180 days after the work as commenced, or if required inspections have not been requested within 180 days from the last
inspection. 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. The granting of a permit does not
presume to give authority to violate or cancel the proviSions of any state or local law regulating construction or the performance of
construction.
Signature of Owner (if owner IS bUilder)
Date
Signature of Contractor or Authorized Agent
Date
T'\PLANNING\FORMS\1102 15 [11/14/2003]
BUILDING PERMIT INSPECTION RECORD
CALL 417-4815 FOR BUILDING INSPECTIONS CALL 417-4735 FOR ELECTRICAL INSPECTIONS.
PLEASE PROVIDE A MINIMUM 24 HOUR NOTICE IT IS UNLAWFUL TO COVER, INSULATE OR CONCEAL ANY WORK BEFORE
INSPECTED AND ACCEPTED. POST PERMIT IN A CONSPICUOUS LOCATION
KEEP PERMIT CARD AND APPROVED PLANS AT JOB SITE
INSPECTION TYPE DATE ACCEPTED COMMENTS
I YES NO
FOUNDATION:
FOOTINGS
WALLS
FOUNDA TION DRAINAGE/DOWN SPOUTS
ELECTRICAL (LIGHT DEPT) SEPARATE PERMIT #
ROUGH-IN I
PLUMBING
UNDER FLOOR / SLAB 1~.,q~H J LJ
ROUGH-IN ~_/~'- O/.J -/ LL
WATER LINE (METER TO BLDG) I'
GAS LINE
BACK FLOW / WATER
AIR SEAL
WALLS l/o~lI-oJ./ J...l
CEILING
FRAMING
JOISTS / GIRDERS
SHEAR WALL/HOLD DOWNS
WALLS / ROOF / CEILING 10-1/-00-/ J, L
DRYW ALL (INTERIOR BRACED PANEL ONL Y)
T-BAR
INSULATION
SLAB
WALL / FLOOR / CEILING Lo ._, "?l-,t),.' I J.. L
MECHANICAL
HEAT PUMP
GAS LINE
WOOD STOVE / PELLET / CHIMNEY
HOOD / DUCTS
PW UTILITIES / SITE WORK (Engmeenng DIVISion) SEPARATE PERMIT #'s
WATERLINE / METER
SEWER CONNECTION
SANITARY
STORM
PLANNING DEPT. SEPARATE PERMIT #'s SEPA
PARKING/LIGHTING ESA
LANDSCAPING SHORELINE
FINAL INSPECTIONS REQUIRED PRIOR TO OCCUPANCYIUSE
RESIDENTIAL DATE YES NO COMMERCIAL DATE ACCEPTED
YES NO
ELECTRICAL - LIGHT DEPT 417-4735 ELECTRICAL
LIGHT DEPT
CONSTRUCTION R W / PW/ CONSTRUCTION - R W
ENGINEERING 417-4807 PW / ENGINEERING
FIRE 417-4653 FIRE DEPT
PLANNING DEPT 417-4750 PLANNING DEPT
BUILDING 417-4815 BUILDING
T.\PLANNINGIFORMS\1102 15 [11/14/2003]
PREPARED 10/13/04, 12 40.30
CITY OF PORT ANGELES
INSPECTION TICKET
INSPECTOR JAMES L LIERLY
PAGE
DATE
ADDRESS
CONTRACTOR
OWNER
PARCEL
APPL NUMBER:
1345 E 7TH ST
J & J CONSTRUCTION
RALSTON JOHN M/GAIL T
06-30-11-5-5-0550-0000-
04-00000703 RES REMODEL
SUBDIV
PHONE
PHONE
(360) 457-1809
PERMIT: BPR 00 BUILDING PERMIT - RESIDENTIAL
REQUESTED INSP DESCRIPTION
TYP/SQ COMPLETED RESULT RESULTS/COMMENTS
BAIR 01
10/11/04
10/12/04
10/11/04
10/11/04
BUILDING FRAMING TIME. 17.00
scott 461-4724 key under rock or brlck by basement door
alr seal approved on thlS date also/]ll
BUILDING INSULATION
SCOTT 461-4724
JLL
AP
JLL
AP
BUILDING AIR SEAL
BL3
01
BLI 01 w( ~
-------------------------------------- COMMENTS
9
10/13/04
AND NOTES --------------------------------------
PREPARED 10/12/04, 8 42 34
CITY OF PORT ANGELES
INSPECTION TICKET
INSPECTOR JAMES L LIERLY
PAGE
DATE
ADDRESS
CONTRACTOR
OWNER
PARCEL
APPL NUMBER
1345 E 7TH ST
J & J CONSTRUCTION
RALSTON JOHN M/GAIL T
06-30-11-5-5-0550-0000-
04-00000703 RES REMODEL
SUBDIV
PHONE
PHONE
(360) 457-1809
PERMIT: BPR 00 BUILDING PERMIT - RESIDENTIAL
REQUESTED INSP DESCRIPTION
TYP/SQ COMPLETED RESULT RESULTS/COMMENTS
BAIR 01
BUILDING FRAMING TIME 17 00
scott 461-4724 key under rock or brlck by basement door
alr seal approved on thlS date also/]ll
:p
JLI;
AP
BUILDING AIR SEAL
BL3 01
2
10/11/04
-------------------------------------- COMMENTS AND NOTES --------------------------------------
PREPARED 10/11/04, 12 30 58
CITY OF PORT ANGELES
INSPECTION TICKET
INSPECTOR JAMES L LIERLY
ADDRESS
CONTRACTOR
OWNER
PARCEL
APPL NUMBER
1345 E 7TH ST
J & J CONSTRUCTION
RALSTON JOHN M/GAIL T
06-30-11-5-5-0550-0000-
04-00000703 RES REMODEL
PERMIT: BPR 00 BUILDING PERMIT - RESIDENTIAL
REQUESTED INSP DESCRIPTION
TYP/SQ COMPLETED RESULT RESULTS/COMMENTS
SUBDIV-
PHONE _ (360) 457-1809
PHONE
PAGE
DATE
7
10/11/04
'"'__"'__~;;:i';~~'(~___:~:~':::::~::~::, ~:::,;:,~"o<_o:::'_o'_o.':m::'_'o:<_________
~Lrv So b"9- }
o~
~:\$
c5SJ
~
,J<w~
PREPARED 9/15/04, 13 17 59
CITY OF PORT ANGELES
ADDRESS
CONTRACTOR
OWNER
PARCEL
APPL NUMBER
1345 E 7TH ST
J & J CONSTRUCTION
RALSTON JOHN M/GAIL T
06-30-11-5-5-0550-0000-
04-00000703 RES REMODEL
PERMIT: PL 00 PLUMBING PERMIT
REQUESTED INSP
TYP/SQ COMPLETED RESULT
PL1
8/09/04 JLL
8/11/04 AP
~~
01
PL2
01
INSPECTION TICKET
INSPECTOR JAMES L LIERLY
PAGE
DATE
1
9/15/04
-------------------------------------- COMMENTS AND NOTES --------------------------------------
SUBDIV:
PHONE (360) 457-1809
PHONE
DESCRIPTION
RESULTS/COMMENTS
PLUMBING UNDER SLAB
Jerry 461-4725
PLUMBING ROUGH-IN TIME 17 00
Steve 461-2259
Th1S 1S the Ralston house be1ng
for the Parapaleg1c Son Water
off wa1t1ng for an 1nspect1on
please
TIME
17 00
remodeled 1n the basement
and Sewer 18 currently cut
Cons1der th1S a pr1or1ty
r/
I
BUILDING PERMIT - APPLICATION
Fill out COMPLETELY and in INK. Your application and site plan MUST B
COMPLETE to be accepted for review. If you have any questions, call
PERMITS (360) 417-4815 FAX(360)417-4711
ApplIcant or Agent.
Owner: :[0"''''
::r-iI LOf'QS+~-\-\"N 0F"?..4- 1:'~t.
~\S~f\..
. ""2 J:' +4
Address: I J~5 ~ '7-
ArchItect/Engmeer:-ADApt~o VI'>
Contractor-:r-tt (., ^"'> +-
Address: 2 ~"3 ..A \ ~'-~ ~J..
PROJECT ADDRESS: \ 'S ~ 5 E 7 ffi
Phone: 3<00''''' S7-180~
Phone: 3w - '1 r;7-/7O(p
City: !/;tLI A.,r:;l kS W"'- ZIp: <J 9s~ z...
J ,.!>L.. Phone: 425- 7q6-l2 2..7
State LIcense #;:J:SlO~D'i9~p' r%l!2:Ji>5 Phone:3(.,'i)-L{S7-1~/
CIty: ~;:)..t-A"")r \(\\ WA.. ZIp: '785k3
ZONING:
LEGAL DESCRIPTION: Lot:
CLALLAM COUNTY PARCEL NUMBER:
Block:
SubdivisIOn:
Credit Card Holder Name:
Billing Address:
Credit CardType VISA
TYPE OF WORK:
I.Pf- ResIdenual 0 New Constr 0 Re-roof 0 Stove
o MultI-farmly 0 AddIuon 0 Move 0 Garage
o CommerCIal &!- Remodel 0 DemohtlOn 0 Deck
o Reparr 0 SIgn 0 Ohher
BRIEF DESCRIPTION OF THE PROJECT. te....,,,cfe,, I lAX.....".... f-
City:
Exp. Date:
MC
#
SIZEN ALUATlON:
;3.3"} SF. @ $ /SF. = $ 5~ (}iJO
,
SF. @ $ /SF. = $
SF. @ $ /SF. = $
TOTAL VAU}ATION $
+or /)ec-J,(, /!.cc-~ sibil'
000 -
COMMERCIAL/RESIDENTIAL: Occupancy Group:
Occupant Load:
& Proposed Sq. Ft.
ConstructlOn Type: r!-v.J",'1 &,,>.J.,.,,,
= TOTAL Sq. Ft. /331 -
No. of Stones:
Lot Size.
EXlstmg Sq. Ft.
Total lot coverage
%
ESA/Wetland(s): 0 Yes 0 No SEPA ChecklIst reqUIred? 0 Yes 0 No Other.
APPROVALS:
PLAN:
BLDG:
DPWU:
FIRE:
OTHER:
PLANNING USE ONLY:
BUILDING PERMIT APPLICATION SUBMITTAL: The BUIldmg DlVlSlOn can provIde you wIth informatIOn on the applIcatIOn and
plan subrmttal requirements if you have questlOns.
VALUATION OF CONSTRUCTION In all cases, a valuation amount must be entered by the applIcant. This figure WIll be reVIewed
and may be revised by the Bmldmg DIVISIOn to comply '?11th current fee schedules Contact the Penmt Coordmator at 41 7 -4815 for assistance.
PLAN CHECK FEE. IF a plan check fee IS due It must be subrmtted at the trme the bUIldmg penmt applIcatIOn and constructIOn plans are
subrmtted All other pemnt fees .are due at the tIme of penmt Issuance
EXPIRATION OF Pl;AN REVIEW: If no penmt IS Issued wIthm 180 days of the date ofapplIcatlOn, the application will expire. The
BUlldmg OffiCIal can extend the time for actlOn by the applIcant up to 180 days upon wntten request by the applIcant (see SectlOn 107.4 of
the Umform Bmlding Code, current edItIOn). No applIcation can be extended more than once.
I hereby certify that I have read and examined this application and know the same to be tf: and correct I am authonzed to apply for this permit and
understand that it is my responslbJ/ity to determme what permits are required ,n t th Itl J and at I must obtam such permits pnor to work.
Date' ;;/zAr
I
Applicant.
T \FORMS\APPS\BUJldmgpenmt wpd
\, ,
Washington State Energy Code
Plan Review Checklist
Applicant please Check, WrIte in N/ A. or fill in value on boxes or lines.
Project Address: (SY 5
t
7 "1-"
r.s.. M'lM l-
-Iy.
Compliance Approach:(check one) 0 Systems analYSIS
o Component performance ftI>rescriptive path
HEATING SYSTEM
OZone Heatmg
o Electric Furnace tn1eat Pump
FOUNDA TlON PHASE
o Slab R-_ Extenor down to frostlme/slab bottom, Intenor 24" honzontal or vertical; or, Ifradlant under entrre slab
o Below grade extenor wall msulatlOn' R-_ (Ifmtenor -see InsulatlOn Phase)
FRAMING PHASE
~tandard 0 Intermediate 0 Advanced
cEt"standard mr seal sole plate/sub floor; rllll]Olst, window & door frames, wrres, plumbmg, ducts, hght fixtures
~ Source specIfic exhaust fans' bath & laundry(50 cfrn) latchen(lOO cfrn)
xJj.4l Whole house exhaust fan _ cfrn mtenmttent system has manual & auto controls' Outdoor air supply reg for habitable rooms
or
~Integrated forced -aIr system, fan --t: cfm, outSIde arr duct(wlth motor damper) allowmg 35 and .5 ACH
71,/0..., ~ 11,4:.1- A.-r" >ysJc...........
INSULATION PHASE
~R-R Wall msulatlOn(above glade)
A I / '1 ., tG' 0./
Ii6 R- IV Wall msulatlOn(below grade)' Intenor wall msulatlOn€.6,j.l" /..J.IILl... "'ItA,;oJ} - l "
o RI-Floor msulatlOn
o R Cellmg msulatlOn Includmg attic hatch
o R- Vaulted Cellmg msulatlOn
gj Vapor retarders. Walls, Cellmg. 0 4 lllll poly ~erm rated pamt Dkraft faced batts
IIfJo Vapor retarders Floors 04 lllll poly Dkraft faced batts
JJI/fJ Ground cover: 611111 Black polyethylene, 12" lap atjomts & extendmg to foundation wall
T \ROGER\BLDG-FORMS-BROCHURES\ENERGYPLANREVIEW
Over: FIll in back side also.
r
WINDOW GLAZING
Please fill out window information, inclued skylights, glass doors, and all other glazing on this form Use rough opening area for calculations
SIZE I QUANTITY I AREA I U-VALUE & MANUFACTURER
IRt.......JL '1 ~S to I jq 35 - ~S...I'JL
AdJ S")L SO I i .~ J; - .I ~S<A.\..~
()P-O'>(... ~o,Ll.\'" 2> F... ....1.'_ S,_k "11."7-/1"",,,
.LL\'\ ~()ol.4\P L..- J Z.!; . ~; , - I.fo.><;u 1~ k. I
.
, ~ ..." :~.c . ~.; J"'l <t.... ")J'l
.. ... . t ,.
Total glazmg area.
Total conditioned floor area:
Percentage of glazing:
2LL
~
DOORS
List doors by type(solid core, Insulated, Etc )quantity, U-value, and Manufacture.
i S,.J".J.0
r,..,s..\.JJ
SIZE QUANTITY AREA U-VALUE & MANUFACTURER
2,1_//' J'... b ~81' { 24.S . '(t:) - -r~lt/V"'.....- fkv... 04 {Q.J~.j
L{ ;_0'1 " (",:B" I l-B ..'-Ie:) - n {".......co _ h..... -L <> r c,J..../
T \ROGERIBLDG-FORMS-BROCHURESIENERGYPLANREVIEW-2
2000 EDITION
TABLE 6-1
PRESCRIPTIVE REQUIREMENTS'** FOR GROUP R OCCUPANCY
CLIMATE ZONE 1 . HEATING BY ELECTRIC RESISTANCE
Glazing Glazing U-Factor Wall Wall- Wall- SIab4
Option Area '0; Door 9 Celling2 Vaulted Above Int4 ext4 Floor5 on
% of Floor Vertical Overhead' , U-Factor Celling3 Grade Below Below Grade
Grade Grade
I. 10% 046 0.58 0.40 R-38 R-30 R-21 R-21 R-10 R-30 R-lO
II. 12% 0.43 0.58 0.20 R-38 R-30 R-19 R-19 R-lO R-30 R-lO
III. 12% 0.40 0.58 0.40 R-38 R-30' R-21 R-21 R-lO R-30 R-10
IV.'" 15% 0.40 0.58 0.20 R-38 R-30 R-19 R-19 R-lO R-30 R-10
V. 18% 0.39 0.58 0.20 R-38 R-30 R-21 R-21 R-lO R-30 R-lO
VI. 21 % 0.36 0.58 0.20 R-38 R-30 R-21 R-21 R-10 R-30 R-lO
VII. 7 25% 0.327 0.58 0.20 R-38 R-30 R-19 R-21 R-lO R-30 R-lO
+ R-58
VIII.7 30% 0.297 0.58 0.20 R-38 R-30 R-19 R-21 R-lO R-30 R-lO
+ R-58
* Reference Case
** Nominal R-values are for wood frame assemblies only or assemblies built in accordance with Section 601.1.
1. Minimum requirements for each option listed. For example, If a proposed design has a glazing ratio to the conditioned
floor area of 19%, it shall comply with all of the requirements of the 21 % glazing option (or higher). Proposed designs
which cannot meet the specific requirements of a listed option above may calculate compliance by Chapters 4 or 5 of this
Code.
2. Requirement applies to all ceilings except single rafter or joist vaulted ceIlings. 'Adv' denotes Advanced Framed
Ceilmg.
3. Requirement applicable only to single rafter or joist vaulted ceilings.
4. Below grade walls shall be insulated either on the exterior to a minimum level of R-I0, or on the interior to the same
level as walls above grade. Exterior msulation installed on below grade walls shall be a water resistant matenal,
manufactured for its intended use, and installed according to the manufacturer's specifications. See SectlOn 602.2.
5. Floors over crawl spaces or exposed to ambient air conditions.
6. Required slab perimeter insulation shall be a water resistant material, manufactured for its intended use, and installed
according to manufacturer's specificatlOns. See Section 602.4.
7. The following options shall be applicable to buildings less than three stories: 0.35 maximum for glazing areas of 25 % or
less, 0.32 maximum for glazing areas of 30% or less.
8. This wall insulation requirement denotes R-19 wall cavity insulation plus R-5 foam sheathing.
9. Doors, including all fire doors, shall be assigned default U- factors from Table 1 0-6C.
10. Where a maximum glazing area is listed, the total glazing area (combined vertical plus overhead) as a percent of gross
conditioned floor area shall be less than or equal to that value. Overhead glazmg wIth U-factor of U =0.40 or less is not
included in glazing area limitations.
11. Overhead glazing shall have U- factors determined m accordance WIth NFRC 100 or as specified in Section 502.1.5.
Effective 7/01/01
37
\^j,II.SHINGTON STATE ENERGY CODE
TABLE 6-2
PRESCRIPTIVE REQUIREMENTS' * * FOR GROUP R OCCUPANCY
CLIMATE ZONE 1 . HEATING BY OTHER FUELS
HV AC9 Glazing Glazing U-Factor Door 10 Vaulted Wall Walle Walle SIab6
Option Equip. Areal': Overhead' U-Factor Celilng2 Celllng3 Above Int4 ext4 Floors on
Effic. % of Vertical Grade Below Below Grade
2
Floor Grade Grade
I. Med. JO% 0.70 068 040 R-30 R-30 R-J5 R-J5 R-JO R-J9 R-lO
II. Med. J2% 0.65 068 0.40 R-30 R-30 R-J5 R-J5 R-lO R-J9 R-lO
III. High 21 % 0.75 0.68 040 R-30 R-30 R-19 R-J9 R-lO R-J9 R-lO
IV.'" Med. 2J % 0.65 068 040 R-30 R-30 R-19 R-J9 R-I0 R-19 R-JO
V. Low 2J % 060 068 040 R-30 R-30 R-19 R-19 R-JO R-J9 R-IO
VI.' Med. 25% 045' 0.68 0.40 R-38 R-30 R-J9 R-J9 R-I0 R-25 R-lO
VII. ' Med. 30% 040' 068 0.40 R-30 R-30 R-J9 R-19 R-lO R-25 R-lO
VIII. Med unlimIted 0.25 0.40 040 R-30 R-30 R-J9 R-J9 R-lO R-25 R-lO
* Reference Case
** Nominal R-values are for wood frame assemblies only or assemblies built in accordance with SectIon 601.1.
1. Minimum requirements for each optIOn listed. For example, if a proposed design has a glazing ratio to the conditioned
floor area of 19%, it shall comply with all of the requirements of the 21 % glazing option (or higher). Proposed desIgns
which cannot meet the specific requirements of a listed option above may calculate complIance by Chapters 4 or 5 of this
Code.
2. Requirement applIes to all ceilings except single rafter or joist vaulted ceilings. 'Adv' denotes Advanced Framed Ceiling.
3 Requirement applicable only to single rafter or JOIst vaulted ceilings.
4. Below grade walls shall be insulated either on the extenor to a mmimum level ofR-10, or on the intenor to the same level
as walls above grade. Exterior insulation mstalled on below grade walls shall be a water resistant material, manufactured for
ItS mtended use, and installed according to the manufacturer's specifications. See SectIOn 602.2.
5. Floors over crawl spaces or exposed to ambient air conditions.
6. ReqUIred slab perimeter insulatIOn shall be a water resistant material, manufactured for its intended use, and installed
accordmg to manufacturer's speCIfications. See Section 602.4.
7. The following optIOns shall be applIcable to buildmgs less than three stories: 0.50 maxImum for glazing areas of 25% or
less; 0.45 maxImum for glazing areas of 30% or less.
8. Reserved.
9. Mmimum HVAC eqUIpment effiCIency reqUIrement. 'Low' denotes an AFUE of 0.74. 'Med.' denotes an AFUE of 0.78.
'High' denotes an AFUE of 0.88 Mmimum HV AC equipment effiCIency requirement for heat pumps. 'Low' denotes an
HSPF of 6.35. 'Med.' denotes an HSPF of 6.8. 'HIgh' an HSPF of7.7. Water and ground source heat pumps shall be
considered as medium effiCiency and have a minImum COP as required in Table 5-7.
10. Doors, includmg all fire doors, shall be assigned default U-factors from Table 10-6C.
11. Where a maximum glazing area is listed, the total glazing area (combined vertical plus overhead) as a percent of gross
condltlOned floor area shall be less than or equal to that value. Overhead glazmg WIth U-factor ofU=0.40 or less IS not
included in glazing area limitations.
12 Overhead glazing shall have U-factors determined in accordance WIth NFRC 100 or as specified in SectlOn 502.1.5.
38 7/01/01
CITY OF PORT ANGELES
DEPARTMENT OF PUBLIC WORKS
. . . . . . . . . . . INSPECTION REPORT. . . . . . . . . . .
REQUEST:
Date 1- 7-CJ~
Time
J:~
Received by ~r~
(PhOnea
location of Work to be inspected I J Ii::,- F. ~
Name of person requesting inspection ~ Y' ~ ~
Address of person requesting inspection (1- Phone No. 1/" i -I{ 'I ~
Type of Inspection (circle appropriate one): Permit No. D'f '- to?!:
Sewer Foundation Framing
Sewer Excav. Other
VI),
INSPECTION NOTES:
Inspected: Date
Remarks: i
I '1 5(2PC?~ I{}V!
Time
By
f~UP-'Bjpd 0( f-
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RESTORATION REQUIRED . . . . .. YES NO
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SURFACE RESTORATION:
SURFACE TYPE: 0 Unimproved DGravel 0 Asphalt 0 PCC
o Other
o Repaired by City
[] Repaired by Permittee
o No Damage Found
Work Order #
o COMPLETE
o INCOMPLETE
FROM
FAX NO.
Sep. 02 2004 07:50AM Pi
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ELECTRICAL PERMIT APPLICATION
FOJl. Ol't"ICl."1.. LSZ;: o:-a y
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l lIe Eleclrfear PcnnitAppHcation must ba fJllad out cOnlDletelv.
Please type or reprint in ink. If you have any questIons, please call t360} 0417-4735
Fa. number. (3&0) 417-4711
CJ'I-703
Own.' or EIe.. Contractor Agent: t:~,/ ~("; CL : 1l!&.. Phon.:
PropO"yOwn.': J..,hV\ ~_
Addr.....s: t'3'i'~ tt ~ 7- 11'\ City; f' A~
t=l_ ..1.... 0 , l'
Eloctrical COntl'aC1Or:~ <.- r ~ 0(' <{ In.-. ...fko_
Addr...:~1. -Ikr&fU- V l\, tl-T @1 City
'-16 '}, ~'f~ax: "'J'5';L- ~~2'1
Ph(KIs:
Lioo"..,#: Es~~~ ex;>
P(!)dAoaJJ.ts
Zip: q.S<:3t;> '2
q jJ~~ Phone:'i?"J-"~2/-
Zip; <jg3 "2
Billing Address:
Credit Card Number:
Ll OWNER "rj.ELECTRICAJ.. CONTRACTOR
--1ll1-C/~- ~
INSTALLATION WIRED BY;
Credit Card Holder Name:
Z;p:
VISA:_ MC:
EJfp. Dale:
13~5
t:=, ry J.i,..
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PROJECT ADDRESS:
1YPE OF WORK:
Ch"ck;!!! that apply: [, New
:J A1leration/AddiUon
~Bsidenlial [l Multi-family
:J Remote Mater 0 Detached garage n Hot Tub Cl Swim Pool
1'1-
[! Commercial
o Mobile Home
Sq. Fl
[J Septic Pump
o Low Voltage 0 ralecom.
o Sign
Number of Circuits added or altered: .
;'
DESCRIPTION OF THE EL.ECTRICAL PROJECT:
H, loll) "--ej
h~~
Electrical HeRt Load Addition!!. and or Subtractions
o BasebOi1(d
o Furnace
o Heat Pump
o Fan-Wall
_KW
~KW
..:t- TON_.. LRA
_KW
o Ovemead Service
e) Temp Service
~ Underground Service
Servlca Information
AQ: ol",....
Phase: ~
Service Siz.:
Feeder Size: -
I hereby certify that I have read and examined this application and know that same rc be true and correct, and I am
authorized to apply for this permit. I understand it is not the City's legal responsibility to determine what permjts
are required; it remains the applicants responsibility 10 determine what permits are required and to obtain suCh.
C"",, C","o""". s._,.' ~~~ D.~, .;Yo br-
Owner or Elee. Cont. Signature:~ '__ ___ Date: OJ.:/? j ~
PERMIT FEE: $ 90..s-o
=:IELECTR'CALPERM'T APPLICA TIO"
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