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Home My WebLink About1313 W Lauridsen Blvd - BuildingSeptember 26, 2006 Dear Mike ORT NGELES W A S H I N G T O N U S A. Community Economic Development Department Mr Mike Haller 63 South Alder Lane Port Angeles, WA 98362 RE 1313 West Laundsen Boulevard This letter is a follow up to the recent meeting of September 21, 2006, between City representatives and yourself regarding property sold to your parents by the United States Government due to the inadvertent construction of a portion of their home on Government property You stated your desire to resubdivide the property mhented from your parents to create an additional building site. In order to accomplish this, it is necessary for the City to agree to the removal of trees from within the 50' wide stnp of property purchased from the U S Government. That area is covered by a no disturbance easement to prevent alteration of the natural state of the property At this time, the City is in agreement that trees may be removed from within the restncted easement in order to allow the development of an additional reasonable building site with one condition. Those trees that exist within the minimum 20' rear yard setback shall remain undisturbed unless they are declared to be potentially dangerous by a qualified individual. This will allow an additional 30' of buildable area along the property boundanes. This modification of the City's previous position is made with the belief that, as conditioned, the action will not violate the intent of the ongmal restncted easement while allowing a reasonable building site to be developed. A reasonable exception may be considered at a future time if it is determined that danger trees exist within the setback area or to allow further reasonable use of the property The City will work with you, or future property owners, at that time to determine whether further tree removal is needed for safety purposes. This approval does not constitute approval of a short plat. Application and review is still required. If you have any questions regarding the condition cited herein, please don't hesitate to contact Department of Community Economic Development staff for assistance. Sincerely, G e k E. Madsen City Manager Phone 360- 417 -4750 Fax: 360- 417 -4711 Website www cityofpa.us Email smartgrowth@cityofpa us 321 East Fifth Street P 0 Box 1150 Port Angeles WA 98362 -0217 ff'ORT'~ lO~~~ r'IIii L~ ~ ~,,~ 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 04-00001106 Date .282226 1313 W LAURIDSEN BLVD 06-30-99-1-1-5620-0000- RES REMODEL 12/01/04 RS7 RESDNTL SINGLE FAMILY 5000 Owner Contractor HALLER, TTE BRIAN FRANK 1313 W LAURIDSEN BLVD PORT ANGELES WA 983636832 OWNER ---------------------------------------------------------------- Permit . . _ _ Additional desc Permit Fee Issue Date Expiration Date MECHANICAL PERMIT 54.25 Plan Check Fee 12/01/04 Valuation 5/31/05 .00 o Qty Unit Charge Per Extension 47.00 7.25 BASE FEE 1.00 7.2500 ECH ME-VENT FAN ----------------------------------- Permit PLUMBING PERMIT Additional desc Permit Fee 75.00 Plan Check Fee .00 Issue Date 12/01/04 Valuation 0 Expiration Date 5/31/05 Qty Unit Charge Per Extension BASE FEE 47.00 4.00 7.0000 ECH PL- EA.FIXTURE ON ONE TRAP 28.00 ----------------------------------------- STATE SURCHARGE 4.50 ---- \...N ---- W ~ ~ '/-- ~ p ~ C 'I 'i f.l-...- c.n ~ r---- ,-jJ -- ~- (\ -., , ------------------------------------------------ Permit BUILDING PERMIT -RESIDENTIAL Additional desc RES. REMODEL Permit Fee 134.75 Plan Check Fee 53.90 Issue Date 12/01/04 Valuation 5000 Expiration Date 5/31/05 Qty Unit Charge Per Extension BASE FEE 92.75 3.00 14.0000 THOU BL-2001-25K (14 PER K) 42.00 ---------------------------- ----------------------------- Other Fees -------------------------------- Fee summary Charged Paid Credited Due ----------------- ---------- ---------- ---------- ---------- Permit Fee Total 264.00 264.00 .00 .00 Plan Check Total 53.90 53.90 .00 .00 Other Fee Total 4.50 4.50 .00 .00 Grand Total 322.40 322.40 .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. r /7:1/ I?~t Signature of Contractor or Authorized Agent / 7--1 ~ :;1 Date Signature of Owner (if owner is builder) Date T:\PLANNING\FORMSlI102.15 (11114/2003] 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 YES NO FOUNDATION: FOOTINGS WALLS FOUNDATION DRAINAGEIDOWN SPOUTS ELECTRICAL (LIGHT DEPT) SEPARATE PERMIT: # ROUGH-IN I PLUMBING UNDER FLOOR / SLAB ROUGH-IN ,:'fjil-OS- j L I WATER LINE (METER TO BLDG) GAS LINE BACK FLOW / WATER AIR SEAL WALLS CEILING FRAMING JOISTS / GIRDERS SHEAR W ALLIHOLD DOWNS WALLS / ROOF / CEILING i-Kl-C),) J /.,. DRYWALL(INTEroORBRACEDPANELONL~ T-BAR INSULATION SLAB WALL / FLOOR / CEILING MECHANICAL HEAT PUMP GAS LINE WOOD STOVE / PELLET / CHIMNEY HOOD / DUCTS PW UTILITIES I SITE WORK (Engineering Division) SEPARATE PERMIT #'s: WATERLINE / METER SEWER CONNECTION SANITARY STORM PLANNING DEPT. SEPARATE PERMIT #'s SEPA: P ARKINGILIGHTING ESA: LANDSCAPING SHORELINE: FINAL INSPECTIONS REQUIRED PRIOR TO OCCUPANCYIUSE RESIDENTIAL DATE YES NO COMMERCIAL DATE ACCEPTED YES NO ELECTroCAL - LIGHT DEPT. 417-4735 ELECTroCAL LIGHT DEPT CONSTRUCTION R. W. / PW / CONSTRUCTION - R. W. ENGINEEroNG 417-4807 PW / ENGINEEroNG FIRE 417-4653 FIRE DEPT. PLANNING DEPT. 417-4750 PLANNING DEPT. BUILDING 417-4815 II oJ g. ~..oS- .J \..L BUILDING T:\PLANNING\FORMSII 102.15 [11114/2003] '0 o-J "d tJ:l tJ:l o-J "d ::;:;;~8El n'O " >< ~ " S >< ~ H" N '0 '" '0 'O"ZZO o-J01 ----- '" ----- t"'()tI1~::U ><'0 UJ H UJ H ttj::d:::dtI:l )> 0 10 o-J 0 0 10 o-J Z" )>UJ 0" H H H ~. nUJ ",01 o-J 0 "d III tJ:l 0 '0 t'" "d 01' ". OH n" ~ n"" " "H H H 001 HHH 001 o-J----- ---------- :;:10 "'----------- :;:10 N NN 'OCO I r\..l........... 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H , >-3 :J> '" III OH>-3 ~ U1 , OlHc;J '" , M '" , UlZ H 8 C::"''d :>:> , tll U1 , ~tQ~ 0lU1:>:> '" 0 , "''''H 01 :>:>::;~ Z , .... , >i 01 , tll , :;::0'" r< >-3tll , :>:>tJ I 00:>:> <: oc:: , MOl ~g~ tJ :;::H , gj~~ r< , r< , " tJ , r<:>:>tIl Z , >-3H.... , "''dtj (J Gl , '->-3~ 0 , ()H H :;:: '" , 00 HZ :;:: ..:>:> , :;::Z.... z'" 01 ~~ , :;:: ~ "''d Z 01 'dOl >-3 ' H Z Ol() '" wZ >-3 ()>-3 wGl , '" >-3H ~ 00 , 00 -..J , :>:>Z tJ , , <-<>-3 Z , ~~ 0 I 'd'd'" >-3 , 55@ 01" 01 , "'01 '" ZZtJ >-3 MOlH r< , <: , r< , H , 01 , :>:> I r< , >< , , , , , , , , , , , , tJ'd , :J>:J> , >-3Gl , 0101 I , , , , H '- , H , 00 '- , 0 , U100 FOR OFFICIAL USE ONLY: BUILDING PERMIT - APPLICATION Date Rec.: , I ~ fJ.- 3 -OJ..! ,P it#:tOI-{-1 ~O b / ate Approved I A /1/1 ate Issued: Fill out COMPLETELY and in INK. Your application and site plan MUST BE COMPLETE to be accepted for review. If you have any questions, call PERMITS (360) 417-4815 FAX(360)417-4711 Applicant or Agent: 1 $r~GP-~ 41!.e/ Phone: Owner: -?r7lf/ c~ (, '3 S~ ,d-l~ LV. ~ Contractor ~ State License #:/I1,'c.Jltu:lH ?~xp: Address: 1'3 J~ ~ I LL;.""".\4"~ ilk/City: f', /I PROJECT ADDRESS: ) LEGAL DESCRIPTION: Lot: M.2 sf ;)V~lock: '1 CLALLAM COUNTY PARCEL NUMBER: '7 a..-t: ;>~ Phone: /:.y~.<- b6 77 S#lU € 9 f; ::JbZ Address: City: ?c~( ~<?h/J 144 Zip: Architect/Engineer: Phone: /2/(//'1 f Phone: Zip: r~_3"b ~ ZONING: Subdivision: 663071 J/ J 6'z... 0 Credit Card Holder Name: Billing Address: City: Credit Card Type VISA MC # Exp. Date: TYPE OF WORK: SIZENALUATION: /Residential 0 New Constr. 0 Re-roof 0 Stove ~ SF. @$ ..z.S- /SF. = $ C;?e?O c) o Multi-family 0 Addition 0 Move 0 Garage SF. @ $ /SF. = $ o Commercial ~emodel 0 Demolition 0 Deck SF. @ $ /SF. = $ o Repair 0 Sign 0 Other TOTAL VALUATION $ ~DO() BRIEF DESCRIPTION OF THE PROJECT: ~% ~ ~ 5ufTl5 ~~:;:r ~ EZoJYtt?/Ja> 0~~ COMMERCIALIRESIDENTIAL: Occupancy Group: Occupant Load: ConstructGn Type: No. of Stories: Lot Size: Existing Sq. Ft. & Proposed Sq. Ft = TOTAL Sq. Ft Total lot coverage % APPROVALS: PLAN: BLDG: DPWU: FIRE: OTHER:_ PLANNING USE ONLY: ESAlWetland(s): 0 Yes 0 No SEPA Checklist required? 0 Yes 0 No Other: BUILDING PERMIT APPLICATION SUBMITTAL: The Building Division can provide you with infornlation on the application and plan submittal requirements if you have questions. 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 Pemrit Coordinator at 417 -4815 for assistance. PLAN CHECK FEE: IF a plan check fee is due it must be submitted at the time the building permit application and construction plans are submitted. All other permit fees are due at the tin1e of permit issuance. EXPIRATION OF PLAN REVIEW: Ifno permit is issued within 180 days of the date of application, the 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 Rl 05.3.2 of the International BuildinglResidential Code, 2003). 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. I am authorized to apply for this permit and understand that it is my responsibility to determine what permits are required ,not the City's, and that I must obtain such permits prior to work. T:\RVESS\BLDG-forms-brochures\2003-Buildingpermitwpd Applicant: ~ Date: 1/, c:p., ~ ! [\0----[ ~D & - --t5--- \ ~. ~ ~~ 1 t ~1 V', ~ ~~ \J\..L ==-..~~ <i 3 ~ '1~,!fit ~ r:. (";C~a......:; CI C:.:..;-:;- '"' c> ,_ .~ -:~:~,: .~ ~g ~ ~ . ... ",. C'1<"'00 "-_ .... .r< r,:;. ~"- ..... C) '"E --:- ~ rnHH~. =. ; .... E~ ,<. S ;. <:; :::I ~ I."" 0 Z - o ~ ;::: e ". u 0- C~~-~ ~~ ~ (-_ (.I j~Ir c:l ~ t-'\ 8" w~, ~ ~.... \~ i( l.J ~ IQ ft l~ LL~ ~ ~t Q ~ \-- l< \\ . .-.v \\ ,~ , , ':) u t,- ~ ~ --- (, -- -- ! M \-= ~ '{} ~ Ci ~ ~, !( - ~;-7 \))i- , { " ';:. XI:' d -------~rl,.,. Ii" \::) I l~ - .u. ~rl:~;x ,:- ~ ~ ~- \ ~J \itt ' \:.--- L(/ ~ T '\~ j- ill ~ ~, II " 1'." <./---" lj II ~ i' \... .4. 3 I, ~ $) i I ( -... ~~r . Ii ~I i !e "-~'I' ~ ~ e. - oD ~ :~-:r%:~O- ~ ~-'~ t ~~~. )[ Cfu '*~~ ~., ( 1 ~) ~ . ~ r-- ----- - t+ 1: ~~--iG~4f- ~ I *~ ~.. . . ---. . .. -- Go ..... ':::> #------ I I Ii -or ~i '!': ~0; I ' ~ ~: -' ~i ~ I ~-~ . -~ ....-.......""'..._.. ~_~.,...."'._... ",_,..~..,."o,._........ .... _. ___.-......._._._','.......". ~"'" -~ t- .(\ 1-- \ ill. \ \ - , - ..... ~ :1' ? \J -Go ] - -<;' ~~ ..,... -1~ ,~ :\ it",,;.jl. $ l.i- I ~ t-;! ~ ~l tiS ~ ~ '" \L. C::.- ~ ~ ~ (jt+- ~ ~ -:) }-? .,..1 - 4J -m -:2 r: .:2 '") ~ .' ~u ,U} -; -< ~... 4.. ~ , ! Y ~ t1~2 ,9 j ~ .~l) ~ ~' QL,() , iJ.- .} .t t ~ I ~ A> ..ie. ,~- t.. \]) - X .j i~ -~ ,,/ e ~;~ %.. ;, " lU G... ~,~ J Jill , f} !. \\ ~ '; ~'" fr'i>, IV -,f ~ -. } , I ,\ ::-+.- i_lJ l0\j - -~ -- ! I I ; YL.. L~7~ ~/// - , 'I ,-;\ i ':J-~ I ~ ,\ i ~ I ; ~~ i (~ 1\ I Q~"'\W -~ I ill """- 'i \) -(~ 11 &; I )( <", :1 ~W ~i~ ~~ j ~" cQ ~ i .~ ~F 11 " 5Z.~ Ii ~l 115 1 ~ -i ,... 9 ~ @" ~ \\) -r ~ <C2 [" .' ' rl (- \ \ - \ I -- 1 : ._ II {:} .:f~ J)' t-:.~ }- ^', r< ~t!~ ~\f)~ ~'"~,... :..." \j\ -r~~ S' '311.) <Pi" t;j ,I "f ; ..J \i \' ...,_ v u- ..).. ,..- \~\ A -:J. ...... ~;~ i -2~ 7' 4,- ~ /~"' :J- ~) ~ (:! +\j\ ~ -4 )-> .... 1;\') ~ .D" ~ ~4-- ,,\ C '\;' ,r ~ .~ (:;;L 'V .r:-\.~ :oJ. ~\J ~ill ~ ~~ 5 ~ \ '.......~ \ ---- t ~ ~f ~~ ~\f\ ~~ - ~ ~ \I' J.. g' f .;( tJ.5- ~ J ~'l~ ~.... t4' ~ \. ., ;/ \; ~, ,- 'I-, '-' -.,': -, ,. .. "'< ,x ~..L~ \, \ ,.__,".._, -\l'''-''''~''''''''-''''---'-'---' :,.i ,'Y- ' -- ~ I' '1.. ~ il ' \'.' ~ Ji : \1 r. t i'\ ,,) J.- I a~ i (:1: 1.----. i ...- ill I I? . r ~~- :l~ 1 ,,\-' . ' I ".~ < : j ~~ , .' i !l~ L 'i;~t i: ~ ( ~ i \--l 1 ! \ti r- r...' ,{ \...... IV \r.l~~~ ~G ~ \;, J i~ - - '- Q - L - r--- ~~ I d~ G-. ~ l' .J :> ~I Jm Q,L \jl \i)6 ~~ .~ ~~-:) lS '(I '-'r"'---" CITY OF PORT ANGELES PUBLIC WORKS - ELECTRICAL DIVISION 121 EAST 5TH STREET. PORT ANGELES. WA 91062 Application Number pin number Property Address ASSESSOR PARCEL NUMBER: Application description Subdivision Name Property Use Property Zoning . . , Application valuation 04-00001106 Date .282226 1313 W LAURIDSEN BLVD 06-30-99-1-1-5620-0000- RES REMODEL 1/06/05 RS7 RESDNTL SINGLE FAMILY 5000 Owner Contractor HALLER, TTE BRIAN FRANK 1313 W LAURIDSEN BLVD PORT ANGELES WA 983636832 OWNER ---------------------------------------------------------------------------- Permit Additional desc Sub Contractor Permit Fee Issue Date Expiration Date ELECTRICAL NEW RESIDENTIAL 200 A + REMODEL- CURRENT ELECTRICAL 78.70 1/06/05 7/05/05 CNTRG INC. Plan Check Fee Valuation .00 o Other Fees STATE SURCHARGE 4,50 .~ U\ ~ Qty 1. 00 Unit Charge Per 78,7000 ECH EL-RM-0-200 1ST SRV FEEDER Extension 78.70 ---------~------------------------------------------------------------------ Fee summary Charged Paid Credited Due ----------------- ---------- ---------- ---------- ---------- Permit Fee Total 78.70 78.70 .00 .00 Plan Check Total .00 .00 .00 .00 Other Fee Total 4.50 4.50 .00 .00 Grand Total 83.20 83.20 .00 .00 ~ " f ~ ~ ~ ~ ~ COMMENTS/ACTION NEEDED ELECTRICAL PERMIT INSPECf,lON RECORD CALL 417-4735 FOR ELECTRICAL INSPECTIONS. PLEASE PROVIDE A MINIMUM 24 HOUR NOTICE. IT IS UNLA WFUL TO COVER, INSULA TE OR CONCEAL ANY WORK BEFORE IT IS INSPECTED AND ACCEPTED. KEEP PERMIT CARD AND APPROVED PLANS AT JOB SITE r INSPECTION TYPE DATE 1 ACCEPTED COMMENTS I YES I NO IlIT('H -, IU 1I IGH=IN / COVER ~bK Y lCb J J<'ThT AT IJJ-2R-o:sl KY. / .- GENERAL COMMENTS: PW.1102.lS (4196) . Site Address: CITY OF PORT ANGELES LIGHT DEPARTMENT ELECTRICAL PERMIT PERMIT NO. ;;;Z9 if / ~)27/,?/ DATE Installed By: /X'READY FOR INSPECTION license Number: o WILL CALL FOR INSPECTION Phone: Owner/Business: Phone: Owner/Business Address: Sq. Ft. o Residential Heat KW o Baseboard 0 Furnace/Boiler o Heatpump 0 Other o Commercial/Industrial load Total Connected load (attach breakdown) Total Motor load (attach breakdown) o New Construction o Remodel o Service update/alter/repair o Overhead ~undergJ.und ~ JD Voltage .? d Z Y '0'"10 D3~ (Service size Amps o Temporary o Add/alter circuits o Auxiliary power (list below) ~Special equipment (list below) DetailslDescription: ~/) ~. . W.S. No. Service Size Capacity: 0 O.K. 0 Not O.K. Comments o Ditch inspection O.K. o Rough-in/cover O.K. o O.K. to connect service ~ Final O..K. Date Hold for: 0 Easement 0 Letter o Signed up for service/meter o Meter Department notified for instaliation o Fire Department notified of inspection o Plan Review approved/pending Installer: w. Permit/Receipt No. 02'1 q Date: Site Address: New Meters . Notify the Department 01 City Light by Street Address and Permit Number when ready lor inspection. Work must not be covered or electrically energized before inspection and O.K. for covering or service has been given by the Inspector In.Writing on the Wiring Report or the Building Permit. PHONE 457-0411;;7XT. 158 or EXT. 224. ~~ NO OCCUPANCY OR USE ESTABLISHED UNDER THIS PERMIT ? .;;:;z 0 li'tipector Amount paid WHITE -' file by address YELLOW - file by number PINK - Top: Eng, Bottom: Customer GREEN - Top: Inspector, Bottom: City Hall OLYMPIC PJl:INTIERS. INC. ,.i Installed By: CITY OF PORT ANGELES LIGHT DEPARTMENT . ELECTRICAL PERMIT PERMIT NO. ..:2 7',3 ;( DATE j/J;}/9/ Site Address: o READY FOR INSPECTION License Number: o WI LL CALL FOR INSPECTION Phone: Owner/Business' Phone: OwnerfBusiness Address: Sq. Ft. o Residential Heat KW o Baseboard 0 Furnace/Boiler o Heatpump 0 Other o Commercial/Industrial load Total Connected load (attach breakdown) Total Motor load (attach breakdown) o New Construction o Remodel o Service update/alter/repair o Overhead o Underground Voltage o 10 03.0' Service size o Temporary Detai I slDescri ption: o Add/alter circuits o Auxiliary power (list below) o Special equipment (list below) ~ ~~ ~ ~~fl/ Amps . W.S. No. Service Capacity: 0 O.K. 0 Not O.K. o Ditch inspection O.K. o Rough-in/cover O.K. I ..V\~ O.K. to connect service A)Y f Finai O.K. Size Comments Date Hold for: 0 Easement 0 Letter o Signed up for service/meter o Meter Department notified for instailation o Fire Department notified of inspection o Plan Review approved/pending Installer: /3/3 W~ n eel/', c::-- New Meters Site Addre~s: . Notify the Depa ent of City Light by Street Address and Permit Number when ready for inspection. Work must not be covered or electrically energized before inspection and O.K. for covering or service has been given by the Inspector'n Writing on the Wiring Report or the Building Permit. PHONE 457.0411, EXT.158 or EXT. 224. NO OCCUPANCY OR USE ESTABLISHED UNDER THIS PERMIT ~3'6/ OCJ Amount paid GREEN - Top: Inspector, Bottom: City Hall I nspector address YELLOW - file by number PINK - Top: Eng, Bottom: Customer ~lectrical Contractor 0 Owner o Annual Permit 0 Alarm 0 Carnival ~.~,..~ I).... "" .- IL.~. ~-t-~"'~ -... o Request Inspection ELECTRICAL WORK PERMIT APPLICATION /10-6 , . o Commerci31)<J Residential 0 Residential Maint. 0 Signs 0 Thermostat 0 Telecom. Job wired by RElectrical Contractor 0 Owner Installation description 1ft.- -rot C/12Lu I '5 Electrical contractor name License number 6., ... c.\I 40" Rv,1.... "'boW UlZLt./I <5 .. Purchaser's mailing address fN N- (JI./l..V6 Ci~ rOa, Telephone number {3C,O 51-lt:!/ A"'h ~Lz.S State ZIP Premises owner's name Mlt:.E IIAu--Efi.-. Address of inspection /.313 w fAU4elJ.xw ctt ~-r A,1.Jbt=l...:k;S W .J.t7D A SUA/let, 'ilLm 0 0 f..L- +- l3[..o/fl qg3~ o Cash 0 Check # I hereby certify that I am the owner of the above named property or a licensed electrical contractor (or the firm's authorized agent) and am making the electrical installation or alteration in compliance with the electrieallaw, Chapter 19.28 RCW. o Credit Card Card # Visa Mastercard Discover x Expiration Date of card o ner, electrical contractor or electrical administrator / WALLS Insulation Only l~t.tJ'- Approved By Dale Cover Dale Approved By "- /' CEILING Insulation Only I~,,-,r Date Approved By Cover Date Approved By "- /' THERMOSTAT "- Dale Approved By /' DITCH Date ApprovedBy / SERVICE Dale Approved By FEEDER Dale Approved By Electrical Load Additions and or subtractions D NO LOAD CHANGES D Baseboard KW D Furnace KW D Heat Pump Ton LAA D Fan-Wall KW Service Information o Overhead SelViee o Temp Service o Underground Service Voltage PhaseD1D3 Service Size: Feeder Size: Inspection Area, Building or Equipment Inspected Action Taken Electrical } Date, Inspector j//~8/05 r7N.4t- ...h'Y hf'/7 I I $;tf} J~L-(}~ <1