HomeMy WebLinkAbout133 W 3rd St - Building ELECTRICAL PERMIT ti
CITY OF PORT ANGELES
360 -417 -4735
Application Number 11- 00001354 Date 12/01/11
Application pin number 919822 REPORT SALES TAX
Property Address 133 W 3RD ST on your excise tax form
ASSESSOR PARCEL NUMBER: 06-30-00-0-0- 5348 -1000-
Application type description ELECTRICAL ONLY to the City of Port Angeles
Subdivision Name (Location Code 0502)
Property Use
Property Zoning RESIDENTIAL HIGH DENSITY
Application valuation 0
Application desc
Ductless heat pump
Owner Contractor
GLORIA /HERBERT REMPEL EXTRA MILE TECH ELECT., LLC
133 W 3RD ST 418 N. RACE ST.
PORT ANGELES WA 983622824 PORT ANGELES WA 98362
45) 2677 (360) 457 -0198 K-1
Permit ELECTRICAL ALTER RESIDENTIAL O W
Additional desc 0
Permit Fee 73.50 Plan Check Fee .00 �J
0 Issue Date 12/01/11 Valuation 0
Expiration Date 5/29/12
Qty Unit Charge Per Extension
1.00 73.5000 ECH EL- BRANCH CIRCUIT WO /FEEDER 73.50
Fee summary Charged Paid Credited Due
Permit Fee Total 73.50 73.50 .00 .00
Plan Check Total .00 .00 .00 .00
Grand Total 73.50 73.50 .00 .00
0
INSPECTION.TYPE DATE: RESULTS: INSPECTOR:
DITCH
SERVICE
ROUGH IN I 2 1 L���
FINAL r z' 1 i 1
COMMENTS:
PERMIT WILL EXPIRE SIX (6) MONTI -IS FROM LAST INSPECTION
Signature of owner or Electrical Contractor X Date:
G: \EXCHANGE \BUILDING
NOV -30 -2011 01:36 PM E.JANSSEN 360 452 2982 P_01
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CITY ()1' PORT 7�NGE ANGELES I'ER1V11'I' APPLICATION DEr, a
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Building Division/Electrical Inspections ELECTRICAL —V—
321 East. Fifth Street P.O. Box I 15 Port Angeles Washington, 98362 INSPECTIONS 1
Ph: (369) 417-4735 Fax: (360) 417 -4
7 6- 1
Dat 1�:
1 B. 2 Single Family Dwellinc Multi•Family or Commercial* Commercial r+rlritinn Alteration Remodel Repair
Plan Review May Be Required, Please Complete Electrical Plan Review information Sher.
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Job Address: 'a r 7.3,•c r r. t___________
auilding Square footage: I r a te
r�rrscription of abUV j 1 f 1 z— a.._� �L,. ""1M
Owner Intoimataiof Contractor Information
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Name. e 5 r'
1_ Mailir Address: —k�C:
Mailing Address. 3 c L_
DI State: vy Vi a,. 'ii n .S 4.:..:,._ City: 1.r-: 2- A.,.,_L. staate: i s* i
License If iixp..... i `i v i T 'I7 •3 1..G
Item Unit Charge qty Thal (Qtv.Multiiegi„ly Unit 4t' !rge.)
Service/Feeder 200 Amp. 119 90
Service /Feeder 201-400 Amp. 145.5(
Service /Feeder 401 -600 Amp 204.311
Service /Feeder 601 -1000 Amp. 262.20
Service /Feeder over 1000 Amp. 3 "2.50
Branch Circuit Wi Service Feeder 2 60
Branch Circuit W/O Service Feeder 71.50 i.- S L
Each Additional Branch Circuit S. l i O
Temp. Service/ Feeder 200 Amp. ;;2.70
Temp Service/Feeder 201-400 Amp. 11030
Temp. Service,Feeder 401 -600 Amp, 146.71' d.-
Temp. SorvicelFeeder 601 -1000 Amp 13 41'
Portal to Portal Hourly 95 90
Sign /Outline L.ghling 88.20
Signal Circuit/ Liinited Energy First 1500 Commercial 95.90
Note. $5.30 for each additional 1500
Signal Circuit/ Limited Energy -1 2 Family ()wolfing 0.9()
Signal Circuit/ Limited Energy Multi•Eamih °wolfing S (13.90
Manufactured Hoine Connection S 119.90
Renewable Electrical Energy -5KVA f5y5tcun nr i.,rs1.1 K 102.30
Thermostat 56.00
yaw CONNI8.Q1MQ11.21L
First 1300 Square Ft. S I tO ;fl'- S
Each Additional 500 Square Ft. or Portlr;n 01 39 20
Each Outbuilding or Detached Garage S 73.50
Eac31 Swimming Pool or Hot Tub .,10 3('.
2 3. Total
Owner as defined by RCW.19.28.261. (1) Owner will occupy the structure for two years alter this electrical permit is finalized. 12) Owner is required
to tore an etectncat contractor if above•said property is for sate, rent or lease, Permit expires after six ilionti of last inspection
Atter reading the above statement, I hereby certify that l am the owner of the above named property 'Jr a licensed electrical contractor. I am making
the electrical installation or alteration in compliance with the electrical laws, N.E.C., RCW. Chapter 1 '.I 7y WAC. Chapter 296 466. The City of Port
Angeles Municipal Code, and Utility Specifications and PAMC, 14.05.050 regarding Electrical Permit :1nplications.
Signature of owner, electrical contractor or electrical administrator: n Cost, .Ame.
Grndit Caro
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1 CITY OF PORT ANGELES
DEPARTMENT OF COMMUNITY ECONOMIC DEVELOPMENT BUILDING DIVISION
3 321 EAST 5TH STREET, PORT ANGELES, WA 98362
Application Number 11- 00001343 Date 11/29/11
Application pin number 506604
Property Address 133 W 3RD ST REPORT SALES TAX
PARCEL NUMBER: 06-30-00-0-0- 5348 -1000
Application type description MECHANICAL APPL. PERMIT On your state excise tax form
Subdivision Name
Property Use to the City of Port Angeles
Property Zoning RESIDENTIAL HIGH DENSITY (Location Code 0502)
Application valuation 5345
Application desc
DUCTLESS HEATPUMP
Owner Contractor
GLORIA /HERBERT REMPEL DAVE'S HTG COOLING SRVC INC
133 W 3RD ST PO BOX 413
PORT ANGELES WA 983622824 PORT ANGELES WA 98362
45) 2677 (360) 452 -0939
Permit MECHANICAL PERMIT
Additional desc DUCTLESS HEATPUMP
Permit Fee 64.80 Plan Check Fee .00
Issue Date 11/29/11 Valuation 0
Expiration Date 5/27/12
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.
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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 y
V" 1
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
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 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 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
Electrical 417 -4735
Construction R.W. PW Engineering 417 -4831
Fire 417 -4653
Planning 417 -4750
Building 417 -4815 Y/
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Nov 23 11 11:48a Dave's Heating Cooling 3604520939 p.1
BUILDING PLUMBING I MECHANICAL PERMIT APPLICATION SHORT FORM
(To be used for projects that do not require plan review.)
Date Received .M -11
Permit I/ /7','3
City of Port Angeles Please print in ink. Date Approved
Attn: Building Permit Technician Approved by
321 E. 5`" St., Port Angeles, WA 98362
350 -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
Contact person: Phone:
Q C 0 '73
Property owner: r T
f t -cif-- f' G t" 1 r� E-r-� e-e- l Phone: 5 .2- C
Property owners mailing address:
3 3 (-)-cs-i-
Contractor's business name: 2s Phone:
(orproperty owner's name if he/she is doing /ove seeng the wor
Contractor's mailing address:
P O 1
ADC (21 /POr3k I
Contractor's L &1 license number: xpiratio t
t/�sFtc.G�? k�r3
Project Address:. 3 3 (/)e-s
Project Type: Residential Commercial Industrial Multi- family
Project Business N e:
(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: o house a garage other
o tear off re -roof lay over one layer
Licensed contractor: Submit a copy of your re roof bid.
Project Valuation S (labor materials, not including sales tax)
Re-side: n house in garage other
Project Valuation (iabor materials, not including sales tax)
Repair: (explain the project)
Project Valuation
*Homeowner: If you will be doing overseeing the.work, then the project valuation will be determined by doubling the
cost of materials, to reflect the value the repair adds to your property.
Cost of materials x 2 Project Valuation
T :Forms /Building Division /Building /Plumbing /Mechanical Permit Application Short Form (Revised
Page 1 of 2
Nov 23 11 11:49a Dave's Heating Cooling 3604520939 p.2
Swimming Pool or Spa 24" deep): For prefabricated swimming pool or spa projects that
do not require plan review:
Obtain the City of PA handout entitled "Pools Spas° follow the requirements.
Project Valuation 5
Demolition: A demolition permit is needed when an entire building gets demolished.
What will be demolished? house ci garage 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 tumed off (and capped off if needed)
prior to demolition.
(J) 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 Air Agency (ORCAA)
Demolition Permit Application.
Contact ORCAA at 360 -417 -1466 to discuss whether or not an ORCAA Demolition Permit will also
be needed.
yes or no Will the debris be going to the Regional Transfer Station in Port Angeles?
yes No If yes, will a licensed contractor be taking it there?
{J) 1f 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).
Plumbina Permit (explain the project)
Project Valuation 5
Mechanical Permit: (explain the project)
(;Jr F v C:› r (,un
Project Valuation 5 53 `1.5.
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 1 93 f Signature it aC jj!� 1
Print Name v j 7 kc:Ce-n ket
Page2of2
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CITY OF PORT ANGELES
DEPARTMENT OF COMMUNITY DEVELOPMENT - BUILDING DIVISION
321 EAST 5TH STREET, PORT ANGELES, WA 98362
Applicat~on Number
P~n number
Property Address
ASSESSOR PARCEL NUMBER:
Appl~cation descript~on
Subd~v~sion Name
Property Use
Property Zon~ng . . .
Application valuation
04-00001193 Date
.601829.
133 W 3RD ST
06-30-00-0-0-5348-0000-
RE-ROOF
12/22/04
RESIDENTIAL HIGH DENSITY
1850
t=xP/~ED
~/~l/~
Owner
Contractor
GLORIA/HERBERT REMPEL
133 W 3RD ST
PORT ANGELES WA 983622824
(452) 2677
AFFORDABLE SERVICES
258663 HI - WAY 101
SEQUIM WA 98382
(360) 683-9619
Permit
Additional desc
Perm~t Fee
Issue Date
Expiration Date
BUILDING PERMIT - NO PR FEE
TEAROFF, FELT, COMP
89.70 Plan Check Fee
12/22/04 Valuation
6/21/05
.00
1850
Qty Unit Charge Per
Extension
47.00
42.70
--
BASE FEE
14.00 3.0500 HND BL-501-2K (3.05 PER C)
Other Fees
STATE SURCHARGE
4.50
~
l,t)
Fee summary Charged Paid Credited Due
----------------- ---------- ---------- ---------- ----------
Permit Fee Total 89.70 89.70 .00 .00
Plan Check Total .00 .00 .00 .00
Other Fee Total 4.50 4.50 .00 .00
Grand Total 94.20 94.20 .00 .00
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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.
('-9 IV ~I J..E
Signature of Contractor or Authorized Agent
Signature of Owner (if owner is builder)
Date \
Date
T.\PLANNING\FORMS\II02.15 [11/14/20031
DEC-20-2004 08:05 AM 2D673A53.73784237
360 582 9029
P.01
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BUilDING PERMIT.. APPL.lCATION
rut out COI\lf'l.ll'EL Y and In INK. Your appllcaUoD and lilt. plan MUS'J BE
COMJ'LETE to be attcpted for rcvl."" If you 11I!"e any quntJcllul, u.c
(36U) 417-4815
I API'l1can' or Apt: -Affi,~.d:J:>lJ: ~ r{)~=::~p,:-:;;; ~3: ~t'otL~l
owner:~_~1_ 12.a>J'r~ I __~____ Phon~' i~() lf5Z- Un .
Addrctl$. f5~ Vtl..2.!~~.::ztvt'f~~- City:. POY't rrl,\(~ r/~"? _~__~ _zip:L C(f(;,~hQ- .
Archib:ctlEngineer:___--_. "-~"-'--- A _ -- ~~me --- ~ ~-
Contraetor~,! 6:. Ke,41.w J).u. ~~\ State License #r~~~~~~12/..c5- ~thonc:~~=s~~l,q
Address: 2.5S';4*.~ I-iu'-.l JG._~___ City: 5~lLJ..J:L_JAl..jjH____ Zip:~~~vl~1
,. -) I 7V I
PRo.n:Cf ADDRESS;~_~t.1. .S'h"e~'t- ____~__.~~-.. ,,_ 'r..ONINGt ,-----.... \
LlfOAl DESCRIPTlOlll: LI)~..: __-- Block: _ .-..--- SubdlV1StOri ," -.. ------- I
CLALLAM COUNfY PAllChl J\'UMBER: . __ "__. .______ - .....-.. --- I
I
-1
CredJ.t Cud Halder NUDe:.Q'(~'~. ~ N't'll l~ -~- -
BlWqt\lld....~ll}i;l j 01 VL/ ___CUY:~/i~'JM:= Ib~C/0;t0~-7uzr,,,-
CredltCanlTypeVlSA~.M(7 _._ # (;1"\ F.L..Le.:________._,--Exp. natel.G?5 J 01 __
rYPE 01' WORK: S(Z.E/V ALUA. nON: I
D R.o&i4ential C NewCODBtl: lfII'1(;.roof D Stove ~__ SP, @ S_._~",,_.....JSP." S
CJ Multi-Wy 0 Addilion l1 M(we 0 Garllge .______ SF. @S._.__-1SP,"S ~ ----'
a C'..omzNlI'Cial C1 Rabochl CJ Del'DOlitiou 0 Deck ~_._~SF.@S-~n-.JSl'.....S~
o 1lcpair :::l Slgll 0 Othlll' TOTAL VAUJATION t~_
BlUEP DESC1UPTI0N' OP THE I)ROJEC'f: -IZfJ. y- ~ (j't';.,& I-FdQ..1..il1.x:::tp " ---=
-------- ----..------- "...--..- ...
COMMlr.Il.CL\1JIlESmlNTLU.' Ooc:upaalcy Gro\1P __ Oc~anl LolUl. _ __.. ( nn:ltructton Typc:__.__ _._
No. orScoriea:_ LotS1ze: _ Ux.ilting Sq. Pt. & Propoeed Sq- f\- _..~___ -TOTAL Sq.Pt.__
Bxi31ing lot cavenp _ % '" Pl'Or.05Cd lot covCl'tge - % · Totullot cDverage____ . ... fa --l
-~- . .-.----- Arl"ROVJ\LS:
PLANNING USE ONLV: ...__._~. .______---, ~~I:==-l
-----~---- I>PWU,____
PIU:_
i ESAlWotWld(a): C Yet C No SEPA Ck:ckll5t requited? 0 Yei rJ No OlhCl:; ___--.
I
OTHI.B.:._
BL'ILDLNG PERMIT APPLICATION SUBMn'TAL: The Build~ DIVi'iIDIl can provid~ :"'1) '1I1th information au the apphcIlllOtl1l11d
phm sumnmaJ requ!t~1S it you have 'llJejt!.ons.
V ALUA110N OF CONSTRUCTION: Iu.u c..~, a valuation IUOOUDt mUlt be entd"ed by the l\Ppliclllt, 1'b1s figaro will be rr,viC'M::4
andmaybe miled bytbe BuJldID&DIVlILOD to ~mply with cumnt fee schc;dulcs. Contacttht Pen:nitCooIdiDatoraf417-4815 fOl'811list&llCC.
PLAN CHECK FEE: IF a plan cbcick l'ce I' due i1 DlWI be iubmtnad at the time the bw.ldiD.Il'[)Onw I Ipplicatiou and CQlL!Qucticm r. bw., an
1lI&bmltted. All ok pGDDII feet ere due at the tiDlIl of permit iIIumc!:.
EXPIRAnOl\l or PLAN REVIEWI (IDo permit 'a1uued within 18D daYI oHhe dato of apphclltion.lbe appUcatloD .tllaxplre. The
BuilciiD8 <>mew CaI R_ the time for aation by the applkant up to 180 daYI upon Tn'ittell rcqt~t by tbe appUcl11t (100 Section 107 4 ('"If
t~ tJcifonrt BuUdblB Code, Cl.ln'l!IDt' eciltiol1) 1'-10 &Plllu:atioll Ca:1 be extlmdtd more thlll OlX:
1 flSfSDY CiI1~ rtlBt I ~M fN.d 8/1C1 exarniled t/Jle epplica~on ond MOW the same to be true .rKi conwct. I am stlhorlzed '" 'pp~ for tills pmrrA 11'-'(
lIIdorlfend !hat ./a my 'eapotlSibi~1y 10 dlll8l71l/nO wtlst permits SIi requnrJ ,nollh' ClY8. ,nd tI1ar I mutr obtain ~ucll ~ prior kllt'Orlt d
llrolOl\SWI'S\!l\Ill4htllZl'mlLwp: APf'hcal)l: ~~:;.;._ -_.. J:)G~: /2 .~ W,:,," /2.L
CITY OF PORT ANGELES
LIGHT DEPARTMENT
ELECTRICAL PERMIT
N? 16364
. I-I Ji :/.?
Port Angeles, Washlngtonouomooooo!oomuooooooo'uummomomomuoooomoou, 1900000000
In aClCordance with the City Ordinance to regulate the installation, extension, or repair of elec-
trical equipment in, on, or about any building or other structure in the City of Port Angeies, per-
mission is hereby granted to do electrical work as listed below.
Address :oo'o3oou3o;,T~~~<f1),'~Qmoooononoomo.oummo.oum OCCUpanCy..~<1o!2,,~o'o.m.mooo.o~m..__nuo.
Owner .li7,oo't2."ko {:t:.-!'."o~m.umommmouoooon...n.oo TenanL__uoummmmuo..m.__._.m....nuuuuuooo.........mom
"~.. . - r. m.-dlf
Wiring Contractor oo.41'fr:oof;~,,,o,,,,."'o="'__.uoo,o~,o'.ou..mm By...muumoo__.mm.n.......ooon.uu.momo.ono....oo..oou
'3
Light Outlets......._.._..........._h......_.._.....
k
Receptacle Outtets...;......n.m......n.h_...
Service, volts ................00.......00..........._
No. wires ....._...........h....................
Dryer, KW........._U.h_.........___.n_..__..__..
Range, KW m_hmm.____mm_____
Water Heater:
Size wires..........__.n........._nn......_..
Main fuse ___.0000_._.._.._00._........_._.......
Enclosure h..._...................___._.........
KW..m....mmm..mm..n..m
Hea., Kw....3...Il.!3.........m.m
Type of wiring:
Entrance Cable ..mmm.mmm_._.....
Motors: size, volts and phase:
Rigid Conduit __..nm__.........m__...n.
Metallic Tubing .h__mn.......
Current transformers:
No. & Size............nm
Ser. NO..nh_.......................:...............
Ser. No. ......0000000000...00.000000..0000_____.00...
Ser. No. .nn_.............................__.....h.
Type ot Wiring:
Armored Cable ............m_m........_..
Non-Metallic ................n....._.___hh.
Knob & Tube........................m......
Rigid Conduit ..............................
Metamc Tubing .m............m..m...
Raceway ........___....._............_._......_
CIrcuits. Light..................__.n.m.....m....
Util1ty.....__.............m......................
lTeat .___.____._..................___......._.._..
Range .._._____.__.________..................__....
Water Heater _._m__.mm................
Motor
Dryer_
Furnace .........................._...................
~:=~;~:~~~::~::i~::o~~:.g:=:~f:~~:~:~~~o.o~~:~=:::::~:~~~~~~.~~
./ -y--.- ,.. -........ -.- ./' - --- '" -
nommmmmmummomommommmmmumomumoommoommmmunmoomu..mu.muoo~.m.m .m.o..mmmm.m.mo oom...oo..____. '.'
Permit Fee Treas. Receipt (2/ .' t!1; I J' ,/1
$. ''',4 I ~,f?/o";""'"''''_f4.1~ (
.__________._______________.__.._._._. No._______...._______________.. By .____!_.______._____._.!:.._._.:~_........::-:.____;_:;._:._.__~~_'/
, .
NOTICE-Current must not be turned on until Certificate of Inspection has been Issued. If work Is to be con.
cealed due notice must be given the Inspector so that work may be inspected before concealment.
NOTIFY THE INSPECTOR BY PERMIT NUMBER WHEN READY FOR INSPECTION
ELECTRICAL PERMIT
N?
16364
Address......................__..........._..__..._...___......._...__...__..._______....._._...........__.._......__.........__.........__....Date..._.....__......._.._.........._......_..._.._.._......
Owner ..........................__......._......_.._......_.........._...._...0000......___00......._...._._00..00......_.__00__. Tenant.n.........................h_.....................................
Wiring Contractor..........................hh............._......._............n.00_.._00_.._..00_..._.00.......00..........._......... By..........nnn...h___.............n_..........h........n
NOTICE-Current must not be turned on untU Certificate of Inspection has been issued. If work is to be con-
cealed due notice must be given the Inspector so that work may be inspected before concealment. '
1M Olympic Printers, Inc.