HomeMy WebLinkAbout528 W 12th St - BuildingPREPARED 9/02/11 8 42 57 INSPECTION TICKET PAGE 5
CITY OF PORT ANGELES INSPECTOR JAMES LIERLY DATE 9/02/11
ADDRESS 528 W 12TH ST SUBDIV
TENANT NBR CARY L CLEARMAN
CONTRACTOR PHONE
OWNER CARY L CLEARMAN PHONE (360) 452 5956
PARCEL 06 30 00 0 3 7530 0000
APPL NUMBER 11 00000813 RE ROOF
PERMIT
TYP /SQ
BL99 01
BNOP 00 BUILDING PERMIT NO PR FEE
REQUESTED INSP DESCRIPTION
COMPLETED RESULT RESULTS /COMMENTS
9/02/11
BLDG FINAL
September 1 2011 1 28 34 PM 1pangrle
KERRIE 461 4276
BUILDING FINAL RE ROOFED THE HOUSE
COMMENTS AND NOTES
Date
CITY OF PORT ANGELES
DEPARTMENT OF COMMUNITY ECONOMIC DEVELOPMENT BUILDING DIVISION
321 EAST 5TH STREET PORT ANGELES, WA 98362
Application Number 11 00000813
Application pin number 232591
Property Address 528 W 12TH ST
ASSESSOR PARCEL NUMBER 06 30 00 0 3 7530 0000
Tenant nbr name CARY L CLEARMAN
Application type description RE ROOF
Subdivision Name
Property Use
Property Zoning RS7 RESDNTL SINGLE FAMILY
Application valuation 6000
Application desc
TEAR OFF RE ROOF THE HOUSE
Owner
CARY L CLEARMAN
528 W 12TH ST
PORT ANGELES
(360) 452 5956
Structure Information 000 000
Qty Unit Charge Per
4 00
Other Fees
Fee summary Charged
T:Forms /Building Division /Building Permit
WA 983627503
Permit BUILDING PERMIT NO PR FEE
Additional desc RE ROOF THE HOUSE
Permit pin number 190280
Permit Fee 151 75
Issue Date 8/02/11
Expiration Date 1/29/12
BASE FEE
14 0000 THOU BL -2001 25K
Permit Fee Total 151 75
Plan Check Total 00
Other Fee Total 4 50
Grand Total 156 25
Contractor
OWNER
RE ROOF THE HOUSE
STATE SURCHARGE
Plan Check Fee 00
Valuation 6000
(14 PER K)
Paid Credited
151 75
00
4 50
156 25
00
00
00
00
Date 8/02/11
Print Name Signature of Contractor or Authorized Agent
Extension
95 75
56 00
4 50
Due
00
00
00
00
REPORT SALES TAX
on your state excise tax form
to the City of Port Angeles
(Location Code 0502)
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
Signature of Owner (if owner is builder)
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
AIR SEAL.
Walls
Ceiling
FRAMING
Joists Girders Under Floor
Shear Wall Hold Downs
Wails Roof Ceiling
Drywall (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
MANUFACTURED HOMES
Footing Slab
Blocking Hold Downs
Skirting
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
PLANNING DEPT Separate Permit SEPA.
Parking Lighting I ESA.
Landscaping I SHORELINE.
FINAL INSPECTIONS REQUIRED PRIOR TO OCCUPANCY USE
Inspection Type
Electrical 417 -4735
Construction R W PW Engineering 417 -4831
Fire 417 -4653
Planning 417 -4750
Building 417 -4815
r c nrr.,c /P rision /Ruildina Permit
FINAL Date Accepted by
FINAL Date Accepted by
Date Accepted By
_.7J-11 I LCD
N
00
V
l
Applicant CA 2y Ug#4,6r,f►n)
Property Owner /,I< 1.4„,
Property Owner's Address 5 a W.-1)
Contractor 6Arn As LL o
Contractor's Address
License Expires
PROJECT ADDRESS S 29 1- ia•A P. l t I Qc G�
Parcel Number
Project Tvpe Brief Description. )(Residential Multi- family Commercial Industrial
Check all that apply
New Construction
Addition
Remodel
Repair
Demolition
k Re -roof )-House garage other tear off re -roof lay over one layer
Heat System Heat pump wood burning stove gas fireplace pellet stove other
Other
Floor Areas
CITY OF PORT ANGELES
Attn Building Permit Technician
321 E. Fifth St. Port Angeles WA 98362
(360) 417 -4815 fax (360) 417 -4711
Existing (sq. ft.) P posed (sq. ft.)
Basement
1 Floor
2 Floor
3 Floor n
Garage
Carport
Covered Porch
Deck
Shed
L
Other
Max. height of proposed structures
Will a lawn sprinkler system be installed?
Will a fire sprinkler system be installed;
BUILDING PERMIT APPLICATION Print in ink
Total footprint of structures sq ft. Lot size
Site Coverage the amount of impervi•us surface •n a parcel including str
and other impervious surfaces (see P C 17 :'4 135 for exemptions)
Occupancy •up
Occupa oad
onstruction type
For City Use Only
Date Received A-2c I
Permit 11 R1 12
Date Approved
Phone Sdv-S9575
Phone
Phone
E -mail
Lot Zoning
per sq ft.
inZeri a l 5 COO
I-4 V (WI
TOTAL VALUATION (O
sq ft. Lot coverage
aved driveways si• walks patios
Site covers e
of bedr• ms
of baths
of half baths
I 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 projects.
Date 9'cZ') Print Name (_42 C, /Mi2m ate) Signature
T Forms /Building Division /Building permit application
Clallam County Assessor Treasurer Property Details 59920 CARY L CLEARMAN Page 1 of 1
Clallam County Assessor Treasurer
Property Search Results 59920 CARY L CLEARMAN for Year 2011 2012
Property
Account
Property ID
Geographic ID
Type:
Tax Area.
Open Space:
Historic Property
Multi-Family Redevelopment: N
Township
Range
Location
Address. 528 W TWELFTH ST
PORT ANGELES WA
Neighborhood: Cycle 5 Res
Neighborhood CD 10955130
Owner
Name: CARY L CLEARMAN
Mailing Address. 528 W 12TH ST
PORT ANGELES, WA 98362 7503
Taxes and Assessment Details
59920
0630000375300000
Real
Property Tax Information as of 08/02/2011
Amount Due if Paid on: EL
0010 PA 121 PORT ST CNTY H2 L WMP Land Use Code 11
N DFL
N Remodel Property N
Click on 'Statement Details' to expand or collapse a tax statement.
Values
Taxing Jurisdiction
Improvement Building
Sketch
Property Image
Land
Roll Value History
Deed and Sales History
Payout Agreement
NOTE. If you plan to submit payment on a future date, make sure you enter the date and
click RECALCULATE to obtain the correct total amount due.
First Half Second Half
Year Statement ID Base Amt. Base Amt. Penalty Interest Base Paid Amount Due
Statement Details
2011 154518 $864 75 $864.66 $0 00 $0 00 $864 75 $864.66
0 Statement Details
2010 42802 $828.47 $828.47 $0 00 $0 00 $1656.94 $0.00
Legal Description:
Agent Code:
Section:
Mapsco:
Map ID
Owner ID
Ownership
Exemptions:
LT7 BL 375
2
18546
100.0000000000%
This year is not certified and ALL values will be represented with N/A
Website version: 9 0 32.2200 Database last updated on: 8/2/2011 3:53 AM 2011 True Automation, Inc. All Rights
Reserved. Privacy Notice
http.//websrv8 clallam.net/propertyaccess/Property .aspx?cid=0&year=2011&prop_id=59920 8/2/2011
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OWN~~LlCANT c"'"'PtmPE,RTYLQC.~TION'
.....CA~~ClEARMAN '52812TH ST W
S2ttW12TH STREET lot: 7
PoriAf1geles,WA98362..\;~:.Block::. 375
360/000-0000 Subdivision:' TPA
T: .. q,., J?:\",ve~f~el Np,: 06~()()Q0375~.QO.OQ'
CQN!:RACiOR
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.t!20W 7TH STREET
- PORTANGf:lES, W A98362-o000
360/417-3696
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.. ~~,j,."..:.emject Value: .$., $9,072.00
.PtojectType: GARAGE NEW
~~ ,', -.' .
Occupancy Type: RESIDENTIAL
".pcdOp~ncYGroup~ .
. COnstruction Type:
Zoning Use:
"';~0f:""
'~::: :~
, 98369:0<>90
3607000'-00'00
SFD Units:
SFD SOFT:
1
...1,512
MFD Units:
MFD SO FT:
;i:-~.
PROJEqrNoTES . ........ ., 'i . ,..;
'" CONSTRUCT ,18' X 28' DETACHED GARAGE'
. "eCEIPT#97 41
'*-1-i-~,j~;I't.~~""",~~~,",, ,- ~'-"-'"
FEES 'ASSESSMENT
'. ;i~' ":_"~..:"'-:<';"",:,:::',_,~_'>'!. _ -,'<',,:;,:
. BqUdlng Permit:
. "<!.:.. Plan Check:
:. "':. state:,SLJr;charge:
,'. 1-I0~$.~ Moving:
Manufactured Home:
c ~,
Sign:
'Plumbing:
. ..~.~"".<. Mechanical:
Radon:
$181.25
$72.50.
$4.50'
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
Misc Fee 1:
Misc Fee 2:.
Misc Fee 3:
TOTA[ FEE:
AMOUNT PAID:
,..BAI.ANCEOUE:
Sepa~~e~~tJP'tS are reguired fo~electr!~~I;~~rk,s~eA;Shbr~line;E~~..ufjiities,prix~te and pU.blicimprovern~9,~~)'
null antlYol~if wo~ or conStruction authonze~Js notcommenced within 180 days; If construption or work Issus,
for a,.&;I~!W,g9f11Q;,~ aUer the.v(Qr~~.C,Qml11e!lc;;,~~..prlfr~q\,llt'd.ln.sP<<M~t'ons.nave not Qe.~!lre.Q~~ted.within1,8
Inspection. t hereoy certify that I have readanqe~fl1lned this applicationandknowthe same to ,be true andcorre: . >laos. 01
laws~l)C!or~JD,an~~bovernll1g this ~,OfworkWlIU:l'e col'l1pli~d ~ith whether sp~cified here!nor.not,Jhe ,9.fCil~ting.9I~. ....". ." ..~ 'no~
presur:neto give authority to violatetorcancelth~provisions of any state or local law regulating construction orthe:;p~@I1Tll:1n~~of
rori~ ." ',~ .,
t-.'.... .... ' '. ~..,.,../o-?9h~2-
Signaturea,f Contra or or Authorized Agent .'. . ^' Date
T:\PLANNING\FORMS\1102.1S (412002)
',_..-
----------------- -
BUlLDI~9 PERMIT INSp~CnON RECORD
,',-'
CALL 417-4815 FOR BUILDING INSJ>>E~O~S,.::r1,.~~SE PROVl~,e A MINIMUM 24:~puRf..a)T~~E. ITlS'1.INfA":F:lJL'!;g.~Ri
INSULATE OR CONCEAL ANY WORK BEFORE INSPECTED AND ACCEPTED. POST PERMIT IN A CONSPICUOUS L()CA Up~.
,"" .,.",-
KEEP PERMIT~G.ARDAND AePROV,'ED PLANS AT JOB SITE
INSPECTION TYPE DATE " . 'A~~D 'f",,""'} ,!
; I "YES I NO "~,i. .'.~/,,;:: ,>
FOUNDATION: ' "
FOOTINGS "A lfj./I>-P'Z. RV '.
WALLS ,: , , ~_. .
FOUNDATION DRAINAGE : !\ .~.~;". ,j .; ., ','.
ELECTRICAL, , , (LIGHT DEPT) SEPARATE PERMIT: # ,
ROUGH-IN : ", " d' ," I
PLUMBING !,;y .
.
UNDER FLOOR/ SLAB "
ROUGH.IN -yy , ..._~
WATERLINE' , ')
GAS LINE ,'. c, " ., ,.,
BACK FLOW / WATER '41' "" ' :, t .i:
"
AIR SEAL ,. " ", lJ
WALLS
CEILING .,' ~i.' ,.~
,
FRAMING .,;. ,,"r" j '.,_~ " " , h'"
,
JOISTS / GIRDERS . ,
SHEAR WALL .
WALLS/ROOF/CEILING , 'L /,-OIJ- I L~J..I
DRYWALL . , ,
,
T.BAR ,
INSULATION
SLAB I I
WALL / FLOOR/ CEILING I I I ,
MECHANICAL '.' ., . "" , , ., -7-
HEAT PUMP " ,
. ,"
WOOD STOVE / PI!LLET / C~Y :,
HOOD / DUCTS .' , ,,'
"
PW UTILITIES / SITE WORK (Engineering Division) SEPARATE PERMIT#'s:
WATERLINE I METER '_i.~,. '. ','
.. ,
SEWER CONNECTION ;",' J . {
SANITARY " . ;i':" ' ,i,
STORM " ,
.. "
PLANNING DEPT. SEPARA TEJ>1;RMIT #'s .. ...., , SEPA:
"
P ARKlNGILIGHTlNG '.' ESA:
.
LANDSCAPING . SHOREJ,.INE:
"
-FJNAL INSPECTIONS REQUlR,E.I>rRIO!tTOOCCUP~cy'IUSE , ~,.,..-.,..., '0 . c.", , """',' .: ",
RESIDENTIAL .". DATE' . '''YES' 'N.O: '.' , COM.~ERC~ ,J>ATE AC~~~' .'
c. :), ,c. . " . ' .j' -, ',..! ..:.. T:'_" '. . ~ .,: .' -;OJ;' ,
, ~..< ,"P, . ~'. ;4 tt> "';'.~,;;':{r; .;'; "" .", '" (" 'j.; .,/, , .t"f1 r>; 'YES, .NO;
ELECTRICAIF~ UGHT DEPT. 417-4735 ,;., ';EL~C^L .,j' ..
....... -..'t ',...,~< ..'. \ ';j. J.IGIqD~PI:,'U ", .' -. ..' ,
CONSTRUcTION-R. wJ/ PWI '. i; . (i .;f" '. CONSTRUciloN:R'.W. '.'0
ENGINEERING 417-4807 PW I ENGINEERING 1.\". ';;
FIRE ..... 417-4653 ( \, FlREDEPT. I",
I , "
PLANNlNG'DEPT. . 417-4750 B;t(l PLANNING DBPT;' " "
. " " Rv ','
BUILDING , 417-4815 , I u::;, BUILDING
-........~.. '" " .. , ,.""" ..1 ,-._# ' . -. ~.-..... , '.
T:\PLANNING\FORMs.II02.15 [412002]
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BUILDING PERMIT - APPLICATION
FOR OFFICIAL USE ONLY:
Date Rec.:G} -15-0~
Permit #: I:? '7 ~ l./
Date Approved:
Date Issued:
.'
The Building Permit application must be filled out completely.
Please type or print in ink. If you have any questions, please call 417-4815 Cj t:,.O to 9 6<(3
Applicant or Agent: ~\k.( +- ~ \. y:>o~ Phone: l~{oD ') y Il-~l.oq lo
1~'lY C./ea..~,~~
City: ~ ()( -\- ~\ (J S
~/CV'f$.(i>
Owner:
Phone:
Address:
Zip: cr'63103
TYPE OF WORK:
IB Residential Ill! New Constr.
o Multi-family 0 Addition
o Commercial 0 Remodel
o Repair
Architect/Engineer: '" () 'r'\ Q Phone:
Contractor. t--J\ef~ (~y\ ~+ru.cto~icense #: ^,1Q.P6<"*9~~ ~-r2.-6t./ Phone:_BloO)4n -,5~'7~
Address: 172.0 ~es+ ;-\1-S.L City:_rO\~ f\n7~{~S Zip: C)'63lo3
PROJECT ADDRESS: ~29 uJ 121'-"-' ZONING: f57
LEGAL DESCRIPTION: Lot: '7 Block: ~7S- Subdivision:
CLALLAM COUNTY PARCEL NUMBER:0b3~~OQ!oO Credit Card Holder Name:
Billing Address: City:
Credit Card #: Exp. Date:
\
SIZEN ALUATION:
o Wood-stove5:JI/ ~ ~ SF. @ $ I~.oo /SF. = $ ~tf1 072
IB Garage SF. @ $ /SF. = $
o Deck SF. @ $ /SF. = $
o TOTAL VALUATION $ ~'t072.
VISA
MC
ORe-roof
o Move
o Demolition
o Sign
COMMERCIAL~SIriENTIAi:, O~cupancy Group: R 3L Occupant Load: '" Construction Type: !1;' , .
", ,,' , "",',".." , "," " aQ/t:,'"
i~,:';s:::J!:,1i:,'",.:,ov~~ge:" ~~.l:~~:;:;;.r~;~o~::g=.,,:,....~l;~ ~ ~iAiLoTCOVERAGE:'~/Sq.",ft..,
PL~NINGN~E o,N~ Y: i '" 50-" I' APPROVALS: . PLAN"."". .'.
Notes., , BLDG., .'.,.
DPW
FIRE ';C.'
ESAlWetland(s): 0 Yes 0 No SEPA Checklist required? 0 Yes 0 No Other: OTHER
BUILDING PERMIT APPLICATION SUBMITTAL: Your application and site plan must be filled out completely to be accepted for
review. 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.
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 Building Division to comply with current fee schedules. Contact the Permit Coordinator at 417-4815 for assistance.
PLAN CHECK FEE: Your plan check fee is due at the time the building permit application and construction plans are submitted. All other
permit fees are due at the time' of permit issuance.
EXPIRATION OF PLAN REVIEW: Ifno permit is issued within 180 days of the date of application, this. application will 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 Uniform Building 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 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 permits are required; it remains the applicant's
responsibility to determine what permits are required and to obtain such.
,
4#!2t~
Applicant:
Date:
911~1ofi/.
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TIE-DOWN DEVI€E WITH AN
APPROVED UPLIFT CAPACITY OF
1,800 POUNDS TYPICAL AT EACH
END OF EACH PANEL
TWO ANCHOR BOLTS, ONE AT EACH PANEL
OUARTER POINT. INSTALLED IN ACCORDANCE
WITH SECTION 1806.6, TYPICAl EACH BRACED
WALL PANEL
3te IN.' THICK (MIN.) WOOD STRUCTURAl PANEL
SHEATHING NAILED WITH 8d COMMON OR GALVANIZED
BOX NAILS NAILED IN ACCORDANCE WITH TABLE 23-II-B-1
AND ALL PANEL EDGES TO BE BLOCKED. TYPICAL EACH
BRACED WAlL PANEL
For 51: I inch = 15.4 mm. I fOOl = 304.8 mm. I pound = 4.45 N.
ONE-STORY BUILDINGS
'"
3/8 IN.- THICK WOOD STRUCTURAl
PANEL SHEATHING ON 80TH
FACES OF EACH BRACED WAlL
PANEL
BRACED WAlL PANELS AT SECOND
STORY TO BE IN ACCORDANCE WITH
SECTION 2320.11.3
...
SECOND-FLOOR LINE
TIE-DOWN DEVICE WITH AN
APPROVED UPLIFT CAPACITY
OF 3.000 POUNDS. TYPICAL AT
EACH END OF EACH PANEL
\THREE ANCHOR BOLTS. ONE AT EACH PANEL'S ONE-FIFTH
POINT. INSTALLED IN ACCORDANCE WITH SECTION 18066.
TYPICAL EACH BRACED WAll PANEL
./ TWO-STORY BUILDINGS
NOTE: Remaining .Iems as noted lor one-story
budding (Seclion 2320.11.4.llem 1).
Fur S/: I lOch" 15 -I mill. I '-0<11 " J04li IIlIII. I POUltd'" -I -I) ;\I
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ALTERNATE BRACED WALL PANELS
FIGURE 2320-19
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P /D+ Plan
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LU --..:
CITY OF PORT ANGELES
DEPARTMENT OF PUBLIC WORKS
. . . . . . . . . . . INSPECTION REPORT . . . . . . . . . . .
REQUEST:
Date 10-ID-6 '2-
V"
Time
Received by
Rv
(phone, person)
Location of Work to be inspected
Name of person requesting inspection
Address of person requesting inspection
Type of Inspection (circle appropriate one):
Sewer Foundation raming Chimney Plumbing
526 \JJ lL~~
-
J 0 tc,.1A- t-.r 0. 'G e,v-
Phone No. t.f61,:3Z1C
Permit No. 13 -, .3 <.../
Final Sewer Excav. . Other
INSPECTION NOTES:
Inspected: Date /D- /O--C)~ Time
Remarks:
By
Ru
uk
RESTORATION REQUIRED . . . . . . YES NO
[)
SURFACE RESTORATION:
SURFACE TYPE: 0 Unimproved o Gravel o Asphalt OPCC
o Other
o Repaired by City
o Repaired by Permittee
o No Damage Found
Work Order #
o COMPLETE
o INCOMPLETE
(Cor,til'!ueonreverse side if necessary)
STREET SUPERINTENDENT:Li.
(DATE)
r--
CITY OF PORT ANGELES
DEPARTMENT OF PUBLIC WORKS
. . . . . . . . . . . INSPECTION REPORT . . . . . . . . . . .
REQUEST:........ ~
Date /.(..;.,,1- tJ"2- Time ~ived by L/) (phone. personl
Location of Work to be inspected r:;;~ &cJ. /2- ~
Name of person requesting inspection
Address of person requesting inspection
Type of Inspection ICirc~priate one):
Sewer Foundation ~ Chimney Plumbing Final Sewer Excav. Other
Phone No.
Permit No.
~..'.'...
.'- '. .,- '
oP
INSPECTION NOTES:
Inspected: Date I /.- / " 0 -z.-.
Remarks:
Time
By
(J)K
RESTORATION REQUIRED . . . . .. YES NO
~
~
'1\1
a
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'0
~
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SURFACE RESTORATION:
SURFACE TYPE: 0 Unimproved 0 Gravel 0 Asphalt 0 PCC
o Other
o Repaired by City
o Repaired by Permittee
o No Damage Found
Work Order #
o COMPLETE
o INCOMPLETE
(Continue on reverse side if necessary)
STREET SUPERINTENDENT
--- -..----- -- --
(DATE)
~
9~5
FEE RECEIPT NUMBER
. CITY OF PORr ANGELES
DEPARTMENT OF LIGHT
APPLICATION AND ELECTRICAL PERMIT
A
,t;:77
PERMIT NUMBER
...
..
TOTAL FEE
/&',00
CONT. Lie. NO.
TIME TO COMPLETE
NO. STORI ES
LEGAL OCCUPANCY
ELECTRICAL PERMIT ONLY NO OCCUPANCY OR USE ESTABLISHED UNDER THIS PERMIT
Site Address .3- :<' ,? - t-v - / Z 2'- /,>
CORRECT ADDRESS IS RESPONSIBILITY OF APPLICANT
Owner ".r/ r G,i' q
Owner's Address /'.tp, /:?" X ?':< 7- P A -,.
D~y Phone . .k S .2 - .2 4 L.( I
PERMITS WITH WRONG ADDRESSES ARE CANCELLED I
Insta"ati~nBY j)Jttl/S .i?Z-Ce~; L
Installers Address /119 I J.} /(-1-1 ~:~~(J:..tu 72c1'
, ,
installers Phone &f3s - sf' If (2_ .. - ,
Application is hereby.made for Permit to install Electrical Equipment,as follows:
. ~Al1'~t IIHr~4?'/ . . .,
Wiring ty1ethqd _ .'
.:'
NUMBER AMP 120V. 240V NUMBER AMP - 120V - 240V
USE OF CIRCUIT 'PER 100R FEE USE OF CIRCUIT PER 100R FEE
CIRCUITS CIR 10 30 CIRCUITS CIR 10 30
LIGHT SIGN
LIGHT - 50 VOLTS
OR LESS
- ,. - - - .,
CONVENIENCE MOTOR
CONVENIENCE MOTOR
APPLIANCe _ -- - MOTOR .
DISHWASHER - , FIRE ALARMS
DISPOSAL BURGLAR ALARM
..
RANGE MISC.
OVEN
WATER HEATER
LAUNDRY ,
DRYER REINSTALLATION LIGHT FIXTURE #
FURNACE , SUB TOTAL FEE .
GAS-OIL -
FURNACE ENERGY FEE
ELECTRIC BASIC FEE
ELECTRIC HEAT - 16.00
TOTAL FEE
ELECTRIC HEAT SIZE OF SERVICE SWITCH OR CIRCUIT BREAKER
-
A.C. UNIT AMP PHASE
FEEDER SIZE OF SERVICE ENTRANCE CONDUCTORS
SERVICE - -
A.W.G.
. I SUB-TOT At: SIZE OF GROUND SIZE OF ENTRANCE SWITCH
.'
I certify that the work to be performed under this permit will be done by the ;~nstaller and In conf~rmance wIth the N.E.C. Electncal Code.
DateAPPllcatlonmad~ ~o /j~ ,19 J"t, By......:..' .
I ONTR TOR OR OWNER (OR AUTHORIZED AGENT)
Permission is hereby given ~o do the ab9ve described work, according to the conditions hereon and according to the approved plans and'
specifications pertaining thereto, subject to compliance with the Ordinances of theA-CitY.of Port Angeles. \
~4 ~ 4-iiiRECTOROFCtTY.'~IGHT ~l'. ''.:'"
Date Permi Issued By /1741 A , ~.y1.' '.
PLANS APPROVE~ .. - '"'~." _ .
0/~ /R"p Notify Department of City Light by Street Address and Permit Number when ready for inspection. Work must not
-. ~ _ ! II be covert;!d or current turn~d on before inspection and O.K. for covering or service has been given by Inspector in
Writing on Permit Placard. A. - Permits Phone: 457-0411 Ext. 158.
PERMIT PLACARD MUST BE KEPT POSTED ON THE WORK - SEE OVER _
WHITE. Original CANARY - Duplicate PINK. Triplicate WHITE CARD _ Inspector's Report
REPORT OF INSPECTOR
DATE OF VISIT MADE BY REMARKS
, , .,
, / j -<111 . _..__wlO"lrnr.____
41/1/tft .;1fi!- O.K. TO CONNECT SERVICE
* I '-. , .
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Property OWner: ('A R Y ~ t?J/J P mr'lrV
Address: 5 J.. li' L,() I a- -pJ-.,
Electrical Contractor: (J u) rv-ef?..,
C[~
~&
(,0
Please type or reprint In Ink. It you have any queallons, please call (360. 417-4735
Fax number: (360) 417-4711
C};c9
ELECTRICAL PERMIT APPLICATION
FOR OfFlCIAL USE ONLY
ChIdRa:: .
Pmni1 If:
Dale Appnlll'ed:
DaleluutlJ:
The Electrical Pennil Application musl be IIlIed oul comDlelelv.
#7 ~1'1
Owner or Elee. Contractor Agent:
Phone:
"]60 45J.-5CJ5~;'~ '-I17-7z.=-w
Phone:>C:O'l52->I'>,c
<-v,-'9 Zip: q /?'3 6 ;:z.
City:
fty-j- ,-'9~Lt.s
License #:
Exp:
Phone:
Address:
INSTALLATION WIRED BY: ~ OWNER
Credit Card Holder Name:
City:
o ELECTRICAL CONTRACTOR
Zip:
BII/ing Address:
City:
Zip:
VISA:
MC:_
Credit Card Number:
Exp. Date:
PROJECT ADDRESS:
TYPE OF WORK:
)' J.. c;( w I 0.-jJ,
Check all thai apply: 0 New
o A~erationlAddition
~Residental 0 MUlti-family 0 Commercial 0 . Mobile Home. . Sq. Ft. S- 0 ~
o Remote Meter jl(Detached garage 0 Hot Tub 0 Swim Pool 0 S,epticPumpO Low Voltage 0 Telecom. 0 Sig
Number of Circuits added or altered:
., .
: '." . ~
9()ratW / t;L>vDv, I- Tel
."
DESCRIPTION OF THE ELECTRICAL PROJECT:
N~v0
f'}l.e. r.(! ( ill~. 0rJ
/ ('6 f'1Of\.L/l.., 'V 9'Nv~
.... $ '11,'00 ~C!- # q 7&<(
Electrical Heat Load Additions
Service Information
o Baseboard
o Furnace
o Heat Pump
o Fan-Wall
_'<Wi
_'<Wi
_ '<Wi
_ '<Wi
~ Overhead Service
o Temp Service
o Underground Service
Voltagl!i. ;;( '-I () vi
Phase: ~ 0 3
Service Size: ~ a. 0 t1
Feeder Size: J.f I; "'.If' c;. jY
PAMC 14.05.060(B): For industrial, commercial, & residential projects larger than a duplex, a one. line drawing of the Eleclrlcal Service &
Feeders, building size (sq. II.), load calculations, and the type & 01 conductors andlor raceway Is required and shall accompany the
Electrical Permit application.
it:}
1/'-(/0.')-
PW-9019
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