HomeMy WebLinkAbout311 W 3rd Street Address:
3,dStreet
PREPARED 9/23/14, 10:23:11 INSPECTION TICKET PAGE 2
CITY OF PORT ANGELES INSPECTOR: JAMES LIERLY DATE 9/23/14
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ADDRESS . : 311 W 3RD ST SUBDIV:
CONTRACTOR POWER TRIP ENERGY CORP PHONE (360) 643-3080
OWNER MATTHEW/C. DUCHOW/R. ANDERSON PHONE 45) 7882
PARCEL 06-30-00-0-0-5165-0000-
APPL NUMBER: 14-00000901 RES SOLAR PROJECT
------------------------------------------------------------------------------------------------
PERMIT: BSOL 00 BUILDING PERMIT - SOLAR
REQUESTED INSP DESCRIPTION
TYP/SQ ' COMPLETED RESULT RESULTS/COMMENTS
-------------------------- -------------------------------------------------------------------
BL99 01 9/23/14 L BLDG FINAL
&2 September 23, 2014 9:22:51 AM jlierly.
V- '
--------------------------- --------- COMMENTS AND NOTES --------------------------------------
CITY OF PORT ANGELES
DEPARTMENT OF COMMUNITY& ECONOMIC DEVELOPMENT- BUILDING DIVISION
3 21 EAST 5TH STREET, PORT ANGELES,WA 983 62
Application Number . . . . . 14-00000901 Date 8/08/14
Application pin number . . . 887013
Property Address . . . . . . 311 W 3RD ST
ASSESSOR PARCEL NUMBER: 06-30-00-0-0-5165-0000- REPORT SALES TAX
Application type description RES SOLAR PROJECT
Subdivision Name . . . . . . on your state excise tax form
Property Use . . . . . . . . to the City of Port Angeles
Property Zoning . . . . . . . RESIDENTIAL HIGH DENSITY
Application valuation . . . . 23424 (Location Code 0502)
----------------------------------------------------------------------------
Application desc
ROOF MOUNTED GRID-TIED PV SOLAR ARRAY
----------------------------------------------------------------------------
Owner Contractor
------------------------ ------------------------
MATTHEW/C. DUCHOW/R. ANDERSON POWER TRIP ENERGY CORP
Pb BOX 2984 2343 THOMAS ST
SEQUIM WA 98382 PORT TOWNSEND WA 98368
45) 7882 (360) 643-3080
----------------------------------------------------------------------------
Permit . . . . . . BUILDING PERMIT - SOLAR
Additional desc . . ROOF MOUNTED.SOLAR ARRAY
Permit Fee . . . . 403.75 Plan Check Fee 50.00
Issue Date . . . . 8/08/14 Valuation . . . . 23424
Expiration Date 2/04/15
Qty Unit Charge Per Extension
BASE FEE 95.75 W
22.00 14.00OQ THOU BL-2001-25K (14 PER K) 308.00
----------------------------------------------------------------------------
Special Notes and Comments
August 7, 2014 4:30:12 PM sroberds.
No land use issues anticipated. Engineering on file.
Public Works Utility Engineering has no requirements for
this plan review.
July 30, 2014 1:05:45 PM banders.
OK
----------------------------------------------------------------------------
Fee summary Charged Paid Credited Due
----------------- ---------- ---------- ---------- ----------
Permit Fee Total 403.75 403.75 .00 .00
Plan Check Total 50.00 50.00 .00 .00
Grand Total 453.75 453.75 .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.
Date Print Name Signature of Contractor or Authorized 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 INCONSPICUOUS LOCATION. KEEP PERMIT AND APPROVED PLANS AT JOB SITE.
Inspection Type Date Accepted By Comments
FOUNDATION:
Footings
Sternwall
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 by
AIR SEAL:
Walls
Ceiling
FRAMING:
Joists/Girders/Under Floor
Shear Wall/Hold Downs
Walls/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 FINAL Date Accepted by
MANUFACTURED HOMES:
Footing I Slab
Blocking&Hold Downs
,Skirting
PLANNING DEPT. Separate Permit#s SEPA:
Parking/Lighting ESA:
Landscaping ISHORELINE:
FINAL INSPECTIONS REQUIRED PRIOR TO OCCUPANCY1 USE
Inspection Type Date Accepted By
Electrical 417-4735
Construction-R.W. PW I Engineering 417-4831
Fire 417-4653
I Planning 417-4750
Building 417-4815
T:Forms/Building Division/Building Permit
..........
CITY OF PORT ANGELES
DEPARTMENT OF COMMUNITY&ECONOMIC DEVELOPMENT-BUILDING DIVISION
321 EAST 5TH STREET, PORT ANGELES,WA 98362
Application Number . . . . . 14-00000901 Date 8/08/14
Application pin number . � . 88'1013
Property Address . . . . 311 W 3RD ST
ASSESSOR PARCEL NUMBER: 06- 3D 00.0 0-51G5-0000- REPORT SALES TAX
Application type description RES SOL_A_R PROJ_ECT
Subdivision Name . . . . . . on your state excise tax form
Property Use . . . . . . . . to the City of Port Angeles
PrOperLy Zoning . . , � . . . RESIDENTIAL, HIGH DENSITY
Application valuation . . . . 23424 (Location Code 0502)
------------------------------------------------------------------------------
Application desc
ROOF MOUNTED GRID-TIED PV SOLAR ARRAY
----------------------------------1--------------------------------------------
Owner Contractor
------------------------ -------------------------
MATTHEW/C. DUCHOW/R, ANDERSON POWER TRIP ENERGY CORP
P6 BOX 2984 12-343 q44 53 MO.
SEQTJIM WA 98382 PORT TOWNSEND WA 98368
45) 7882 (360) 643-3080 51
----------------------------------------------------------------------------
Permit . I . . . . BUILDINd. PERMIT - SOLAR
Additional desc ROOF MOUNTED.SOLAR ARRAY
Permit Fee 403.75 Plan Check Fee 50.00
Issue Date . . . . 8/08/14: valuation 23424
Expiration Date . . 2/04/15
Qty Unit Charge Per Extension
BASE FEE 95.75
22.00 14.006Q TT40U BL-2001-25K (14 PER X) 308.00
---------------I—- --------------------------------------------------------
Special Notes and Comments
August 7, 2034 4!3C:12 PM sroberds.
No land use issues anticipated. Engineering on file.
Public Works Utility Engineering has no requirements for
this plan review.
July 30, 2014 ,1.05:45 PM banders.
OK
----------------------------------------------------------------- -------7-
Fee summary Charged Paid Credited Due
----------------- ---------- ----- ---- ---------- --------
Permit Fee Total. 403.75 403.-/S .00 .00
Plan Check Total 50.00 50.00 .00 .00
Grand Total 453.75 453.75 .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 a'nd 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.
J�k Lyg
Cate Print Name Sign�tAure of Contractor o0A thorized Agent Signature'of Owner(if owner is builder)
r.Formsfflullding Division[Buildifig Permit
THE For City U
CITY OF
Permit#
W A S H I N G T 0 N. U. S
Date Received: /7/5--f #
321 E Sth Street Date Approved /X / / 11�
Port Angeles,WA 9836 //0-A
P:360-417-4817 F:360-417-4711
Email:perm!ts@cJtyofpaus BUILDING PERMIT APPLICATION
ProjectAddress: Aru c,-� W A- 8
Phone: :!5(&-,0'Of 31, 0 0
Primary Contact: Email: Tc-H�4 4& R-W T'R4 i�14 1�:P-4'Y,C-014�
Name Phone
kR AA OMSIA�
3,4;:�,0 -708 153
Property MailingAddress Email
'p JLD 5;r AA, *-Krb-c:CM
7 C'-
Owner
city State
Pe P-T Av eNcl'cs-
Nape Phone
Address Email
Contractor TCKN & PC,.,J J��-rJZJ CC^
QVB,
Information city State WA Zip erj.3�6 e
Contractors license# T�?(-IlAaEkM- 13,4tQE Ev.Date: it/-5 7-2-0 15
Legal Description: Zoning: Tax Parcel# e,6-3o'- Proj ect Value: (materials and labor)
-f A R,�kP �M)-tC'510iCCVC) s Z �>,;q2q, Zi
Residential 0 Commercial El Industrial 11 Public
Permit Demolition 0 Fire 11 Repair 11 Reroof(tear off/lay over)(
Classification For the following,fill out both 11ag-es of permit application:
(check New Construction 11 Exterior Remodel 11 Addition 1:1 Tenant Improvement
appropriate) I Mechanical 0 Plumbing El Other 11
Fire Sprinkler System? Irrigation Syste oposed Bathrooms roposed Bedrooms
Yes 0 No )9 Yes 13 No Ef
Project Description
Is project in a Flood Zone: Yes NoC4 Flood Zone Type:
If in a Flood Zone,what is the value of the structure before proposed improvement? $
I have read and completed the 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 towork. I understand that plan review fees are not refundable after review has
occurred. I understand that I will forfeit review fees if I withdraw the application before the permit is
issued. I understand that if the permit is not picked up/issued withint8o days of submittal,the application
will be considered abandoned and the fees will be forfeited.
Date Print Name Signature
I cc_�))I rip
WAK Z3W(Jc) 2�,
I(�o
g)Fit n eA M z%- ,�007 00,-, Z�
Proposed 24 solar modules on house's southwest roof
-nate Property
Approxit
3rd Street
NORTH
Base nial) from Google Maps X
SnapNrack Series 100 Snap rack-
Project Info:
Dealer: Trip Energy Cc Project Namie:1 Duchow
Create Dated 2014-07-29Tl5:50:25-0760-1
PV Module Data:
Module Brand itek Energy Length 64.80 inches
Model iT-270 Width 39.1 inches
Depth 2.00 inches
Environmental Requirements: Weight 43.00 pounds
Topographic Condition Coast:a:l== Rated power @ STC 27000 W
Standard IBC 2012 Rail Color
Snow Load 21-30 psf Item 8 checklist Racking Color
Item 7 checklist
Wind Speed 130 mph eff
R fter Spacing 24 inches douglas fir 2A spans 3',5.5'&6.5'
Roof Attachment Flashed L-Foot
System Style:
Rail Finish Clear Anodized
End Clamp Type Universal
Grounding Method UL 2703 Listed
Micro Attachment Kits No
Edge Screen Trim? No if 11 Yes",4" or 8"screen? Screen Height inches
Tilt Up? No
Sub-Arrays: UL2703 Yes Premium Allay Rail No Bulk customer No
Sub-Array Sub-Array 122" Rail 162" Rail Rail Mid End Edge Roof
Modules Splices Clamps Clamps Screen Attachments
1 12 0 6 0 18 12 0 18
F_ 18
TOTALS 12 0 0 12 0 18
CITY OF PORT ANGELES—Construcl ion r1wift
The Issuance of this permh tipon these plans,spn�_ifi-
cations and other dati q�,4 not p;�it the building official
from thereafter repv�,;ig the corre,`na of errors in said
plans, specification! and other data, tw 11mm preventing
building operations king carried on t�,ereunder when in
violation of all codes md o,- w,-�ces of this jurisdiction.
2
Approval Da, By LL �A ef
SnapNrack Series 100 Calculator
Proposed Bill of Materials
Part Number Description Qty
015-09824 SNAPNRACK,STANDARD RAIL SET, 1621N,CLEAR,6 PC 1
242-02052 SNAPNRACK, BONDING MID CLAMP ASSEMBLY, 1.50-2.00IN,CLEAR 18
242-02063 SNAPNRACK, BONDING UNIVERSAL END CLAMP ASSEMBLY 12
232-01023 SNAPNRACI(RAIL END CAP,S TANDARD, BLACK 12
242-02700 SNAPNRACK, BONDING L-FOOT KIT W/BASE AND FLASHING,CLEAR L-FOOT 18
Item 13 checklist
242-02101 SNAPNRACK, GROUNDING LUG ASSEMBLY 3
Total SnapNrack Weight: 73.53 lbs
System Total Weight: 620.00 lbs
jArray Area=12 modules X(39.1"x 64.8"/144 sq.inch per sf)=211 sf I
Pounds per Square Foot of Array 620 lbs/211 sf=2.94 psf �Item 9�checkli
i�st
Pounds per Attachment=620 lbs 24=26 lbs per Attachment Item 11 checklist
U-C nj
'Duchow(v.0.6.16) 2014-07-29T14:27:31-0700
Sub-Array#1 P(3x5)
Group 1 Group 2 Group 3 Group 4 Group 5 122" 162" Row Mid Row End Row Attach- Module Rail
Rail Rail Rail Rail Rail Rail Rail Clamps Clamps Splices ments Bonding Bonding
Length Length Length Length Length Qty Qty
157.4 - 0 2 6 4 0 8 0 1
157.4 - 0 2 6 4 0 8 0 1
157.4 - 0 2 6 4 0 8 0 1
Sub-Array Totals: 0 6 18 12 0 24 0 3
n[]MM 4-- Tat
Orientation Rows Columns I It
Portrait 3 5 FINNI[Ir
Oloop
Array Pitch Building Attachment Attachment Spacing
Height Spacing Override ���w EK4
32 degrees 1 18 feet 72inches 48inches A4,W( LAYC-� CKCWPacF
Sub-Array Modules Edge Screen Array Po��e� W6-sT RAAf Of
12 0 ft 3 kW
wc HOW
SnapNrack PV Mounting System- +(877)732-2860-775 Fiero LN,Suite 200.San Luis Obispo,CA 93401 2 of 2
�s
itek Energy HE Solar Module
The high performance, high quality anc�
affordable solar solution
• Made-in-Washington using Cutting Edge
High Efficiency Mono Crystalline Cells
• 25-Year Power Output Warranty
• I 0-Year Workmanship Warranty
• Exceptional Power Density (watts/rr�)
MECHANICALDATA.
0 0 GENERAL DATA
Ceilf,p 60 Super High Efficiency Mono crystalline cells 39.1 X 64.8"X 2"
-6 X 10 cell matrix .3 by-pass diodes
Glass Ultia clear,low iron tempered solar glass with
anti-glare prisr-notic subsurface texture
Backsheet Multi layered,highly resistant polyester MAXIMUM RATINGS
Frame High strength anodized aluminum frame Operational Temperature -40...+90'C
compatible with both top-down clamps and Maximum System Voltage 600V
bottom flange mounting -Numerous flange Design I oad(UL 1703) up to 113 lbs/ft
mounting holes on inch dimension centers
-Mounting holes specifically for Maximum Load(UL 1703) 55,1=kg/ry� 5400 Pa)
micro-inverter applications
Cable 42"90C 11.AWG PV wire Max Series fuse Rating 15A
Connector N1 C 4 Max Reverse current 15A
Grounding Certified for Wiley Electronics WEEBT1 NOTE: Specifications subject
grounding clips -Eight standard grounding to change without notice
locations per module for reduced ground
wire length
1647mm(64.8") TEMPERATURE RATINGS
Nominal Opecaling
48.20 IC
Cell Temperature(NOCT)
Temperature Coefficient of P- -0,47%rc
3 Tempeiatuie Coefficient of V, -0.32%/*C
Temperature Coefficient of I +0.04 T./1C
Temperature Coefficient of V 0.45%J-C
50mm(2"thick)
Backside of5olar Module QUALIFICATIONS
UL Listing UL 1703
IT IT IT IT
ELECTRICAL DATA* 2551[HE 2610T HE 265 HE 270 FIE 275 HE 280 HE'
fire Rating Class C
Maximum Power-t,.(Wp) 255 260 265 270 275 280 Made in Washington State
maximum Power voltage-V_(V) 31.5 31.7 31.8 32.0 32.1 32.3
Maximum Power Current-1-,(A) 8.1 8.2 8.3 8.4 8.5 8.6
Open Circulf Voltage-N�,(V) 38.4 38.6 38.7 38.9 39.0 39.2 *�Wgl P
Short Circuit Current-1,c(A) 8.8 8.9 9.0 9.1 9.2 9.3 0 0
Power Density(Wlrn') 155.8 158.8 161.9 164.9 168.0 171.0
kenergy
7-60.647.953' 1 itekenergy.corn
VO4.031 1
Friday,January 31,2014
N
SnapNrack S,,nap"I"' ., rack-
Norman 775 Fiero Lane,Suite 200
San Luis Obispo,CA 93401
Ncheel "Series 100 Roof Mount"Cover Letter
To Whom It May Concem,
0�4W
We have performed calculations for the 100 series roof mount PV system based on
Ntructural the information provided by SnapNrack. Included with this letter are the report and
calculations. We did the calculations in accordance with the 2012 IBC,ASCE 7-10,
2012 NDS, and guidelines slated in the Solar America Board for Codes and
En g i n e e r Standards.
Some of the components in the SnapNrack test data were used to determine the
5022 Sunrise Blvd. capacity and section properties of materials. We collected the test data using the
Fair Oaks,CA 95628 procedures outlined in the 2012 IBC Chapter 17.
(916)536-9585
(916)536-0260(fax) We included the following types of load combinations and building parameters into
our calculations:
1989-2013
24 yeanv of excellence 0 ASCE 7-10 wind speeds from 110 mph to 190 for B and C exposure
categories
ASCE 7-10 Seismic Design Category E
ASCE 7-10 Snow Loads up to 120 psf ground snow
Buildings with mean roof heights up to 60foot tilt angles / roof pitches
Norman Scheel,S.E. from 0 degrees to 60 degrees.
I ZED AP BD+C
IXED AP Homes The calculations have also been completed in accordance with the 2006 IBC,2009
Fellow—SEAOC IBC, and ASCE 7-05. To use the data contained in this packet for projects that are
Fellow-ASCE
E-ma il;n.(Li m(
�P_nssecqn) being evaluated to the older ASCE 7-05 wind speeds,refer to Appendix A for a
Rob Coon wind speed conversion chart. Find the ASCE 7-05 (IBC 2006/2009)wind speed in
General Manager the Chart in Appendix A,identify the corresponding.ASCE 7-10 (IBC 2012)wind
E-mail:191)�0011 a2m_�mn speed value,and proceed with using the charts contained in this packet with the
Steve Smith P.E. adjusted wind speed value.
Project Manager
E-mail: In our opinion, the mounting system, outlined by SnapNrack Senes 100 PV
Mounting System Code Compliance Installation. Manual, is acceptable and meets
Steven Cooksey the loading requirements as stated above. See the report and calculations included
CAD Supervisor
E-mail:stevcO�i)sse.co. with this letter for more information.
If there are any further questions,please contact Norm Scheel. J. Sc
Jaclde Winslow
Office Manager
E-mail:iackie nssc..�9�1.n Nonnan Scheel PE, SE
LEED-AP BD+C,LEED-AP Homes
Fellow S)ijiOC
Fellow,W.C.E.
NO,
S
EXPIRES DECEMBER 26. Z�&Fll
OVER-THE-COUNTER BUILDING PERMIT CHECKLIST FOR RESIDENTIAL SOLAR
r%
PHOTOVOLTAIC SYSTEMS: ROOFTOP MOUNTED
Contractors can apply for an over-The-Counter(OTC)permit where the PV system meets the requirements listed
in this Checklist All project plans and supporting documentation must be provided on sitefor the inspector.
--------TO BE COMPLETED BY APPLICANT-------
1) Project Information
Property owner Name: Matthew W. &Cheryl Duchow and Ruth V.Anderson vo ii
Project Address: 3 rl Street Parcel# 0630000051650000
ZIP:9836
city: Port Angeles State:WA 2
Day P email: 360-808-4153;duchowmc@yahoo.com
Contractor lame, Power Trip Energy Co.,John Fleming
-Primary Contact: -
Contractor License#: General:POWERTE934QE exp. 11/5/15, Electrical: POWERTE964JN exp.4/15/16
__Contractor Phone& 360-643-3080;john@powertripenergy.com
-email:
PV system description Roof mounted,Grid-tied PV system-6.48 kW nominal total module syste�;size,24�
(include manufacturer @ 270 watt Itek Energy PV modules,2 @ 3.8 kW Eltek inverters,7.6 kW total
and model#of major inverter size. FOXet-T VAL,4e'.
equipment):
2) Determine if your project qualifies for expedited permitting:
Yes No
1. PV system is designed and proposed for a detached one or two family dwelling or X 0
townhouse not more than three stories above grade or detached accessory structure that
is code compliant to setbacks and height,or code allows expansion of nonconformity for
solar modules. [IRC 101.21
2. Modules on pitched roofs do not exceed the highest point of the roof unless approved by X [I
the local jurisdiction.
3. Rooftop is made from lightweight material such as a single layer of composition shingles, X 0
metal roofing, lightweight masonry,or cedar shingles.
4. The installation shall comply with the manufacturer's instructions. [IRC M2302.2]_ X 11
5. The installation shall meet the requirements of NFPA 70 National Electrical Code,and all X 0
required electrical permit(s) must be obtained from the Authority Having Jurisdiction to
administer the electrical code. [IRC M2302.2]
6. The installation shall meet the requirements of the International Fire Code as amended X E3
by WA State. [I RC M2302.2]
7. The PV system is designed for the wind speed of the local area,and will be installed per X 0
the manufacturer's specifications. [IRC M2302.2.1(1)]
8. The ground snow load does not exceed 70 pounds per square foot. [IRC M2302.2.1(2)] X El
9. Total dead load of modules,supports, mountings,raceways and all other appurtenances X
weigh no more than four pounds per square foot. [IRC M2302.2.1(3)]
Enter total dead load of system (lbs/ft2):3
10. To address uplift,modules are mounted no higher than 18" above the surfac of the X 0
roofing to which they are affixed. [IRC M2302.2.1(4)]
11. Supports for solar modules are installed to spread the dead load across as many roof- X 0
framing members as needed to ensure that no point load exceeds fifty(50) pounds.
[IRC M2302.2.1(5)]
12. The photovoltaic modules and supporting structure shall be constructed of X
noncombustible materials or fire-retardant treated wood equivalent to that required for
the roof construction. [IRC M2302.2.1]
13. Roof and wall penetrations shall be flashed and sealed to prevent entry of water, X 0
rodents,and insects. [IRC M2302.2.2]
14. PV modules are listed and labeled with a fire classification in accordance with UL 1703. X 0
[IRC M2302.2.3] 11
Comments: Net metering agreement approved by Terry Dahlquist on 7/18/2014. Electrical permit approval is
pending.
=> if you answered yes to all of the above questions,the project qualifies for the over-the-
counter permitting process.
3) Submit this Checklist, Site Plan, and other required permit application forms to:
The City of Port Angeles
321 E S'Street
Port Angeles, WA 98362
P.360-417-4817f. 360-417-4711
Email:permits@city0fPa-us
=> As the property owner or authorized representative of the above listed property, I attest that
all information in this checklist is accurate to the best of my knowledge.
Applicant Signature: Date:7/21/2014
Applicant Name(Please Print): PowerTripEn o,John Fleming
--------TO BE COMPLETED BY CITY STAFF------
Qualifies for OTC Building Permit? OYes 514o Permit Application#:
Staff Initials Date:
2