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Home My WebLink About519 E 3rd St - BuildingPREPARED 2/01/10 9 24 49 INSPECTION TICKET PAGE 3 CITY OF PORT ANGELES INSPECTOR JAMES LIERLY DATE 2/01/10 ADDRESS 519 E 3RD ST SUBDIV TENANT NBR CAROLE VAN BROCKLIN CONTRACTOR PHONE OWNER CAROLE VAN BROCKLIN PHONE (360) 457 7370 PARCEL 06 30 00 5 2 5866 0000 APPL NUMBER 10 00000046 RES ADDITION PERMIT BPR 00 BUILDING PERMIT RESIDENTIAL REQUESTED INSP DESCRIPTION TYP /SQ COMPLETED RESULT RESULTS /COMMENTS BL99 01 2/01/10 JLL BLDG FINAL February 1 2010 8 22 55 AM 1pangrle DAN 6 0 655 BLDG FINAL STEPS COMMENTS AND NOTES Application Number 10 00000046 Date 1/21/10 Application pin number 471504 Property Address 519 E 3RD ST ASSESSOR PARCEL NUMBER 06 30 00 5 2 5866 0000 Tenant nbr name CAROLE VAN BROCKLIN Application type description RES ADDITION Subdivision Name Property Use Property Zoning RS7 RESDNTL SINGLE FAMILY Application valuation 700 CAROLE VAN BROCKLIN 519 E 3RD ST PORT ANGELES (360) 457 7370 Other struct info CITY OF PORT ANGELES DEPARTMENT OF COMMUNITY ECONOMIC DEVELOPMENT BUILDING DIVISION 321 EAST 5TH STREET PORT ANGELES, WA 98362 Application desc ADD ENTRY STAIRWAY ON THE SOUTH SIDE OF THE HOME Owner Contractor WA 983623401 OWNER HARD SURFACE AREA Permit BUILDING PERMIT RESIDENTIAL Additional desc MODIFY STAIRS IN FRONT Permit pin number 159525 Permit Fee 56 10 Plan Check Fee 36 47 Issue Date 1/21/10 Valuation 700 Expiration Date 7/20/10 Qty Unit Charge Per Extension BASE FEE 50 00 2 00 3 0500 HND BL -501 2K (3 05 PER C) 6 10 Other Fees STATE SURCHARGE 4 50 Fee summary Charged Paid Credited Due Permit Fee Total 56 10 56 10 00 00 Plan Check Total 36 47 36 47 00 00 Other Fee Total 4 50 4 50 00 00 Grand Total 97 07 97 07 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 1 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 construct. n f( b� be n€ Date/ Print Name i Division/Building Divisionuilding Permit Sign re of Contractor or Authorized Agent of Owner (if owner is builder) 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 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 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 MANUFACTURED HOMES Footing Slab Blocking Hold Downs Skirting 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 Inspection Type PLANNING DEPT Separate Permit #s SEPA. Parking Lighting 1 ESA. Landscaping 1 SHORELINE. FINAL Date Accepted by FINAL Date Accepted by FINAL INSPECTIONS REQUIRED PRIOR TO OCCUPANCY/ USE Date Accepted By 0 -01 -�o P3 1 Applicant Property Property Contractor Contractor's License PROJECT ADDRESS Parcel Number Proiect Type Brief Des Check all that apply New Construction )(Addition Remodel Repair Demolition Re -roof Heat System Other Floor Areas Basement 1st Floor 2 Floor 3 Floor Garage Carport Covered Porch Deck Shed Other BUILDING PERMIT APPLICATION CITY OF PORT ANGELES Attn Building Permit Technician 321 E. Fifth St. Port Angeles WA 98362 (360) 417 -4815 fax (360) 417 -4711 2 (c- 3o_ce_a x Owner CarOk— di vi gro Owner' Address 5t9 2 S P-\ I Address crip E 5N E 31e-0, A Residential Multi family yk Add S -4zx�r j Cso h s of. t House garage other tear off re -roof lay over one layer Heat pump wood- burning stove gas fireplace pellet stove other Existing (sq. ft) Proposed (g. ft.) Q (n O oZ S�- E -mail Print in /1 For City Us i Date Received Il Permit 1 I;1 �ate Approved per sq ft. Labor- 35o ink Only 1 +-L� Phone' 7 7 37CD r Phone 73 7C:2) P Phone /Ou �ZS shows \i k 5f3 but Guilt bash i Lot Zoning Rs 7 o. Commercial o Industrial 3 50 TOTAL VALUATION 700 Total footprint of structures 704 sq ft. T Lot size 3500 sq ft. Lot coverage ZO Site Coverage the amount of impervious surface on a parcel including structures paved driveways sidewalks patios and other impervious surfaces (see PAMC 17 94 135 for exemptions) Site coverage 1._\ Max. height of proposed structures ft. Occupancy group of bedrooms Will a lawn sprinkler system be installed? Occupant load of full baths Will a fire sprinkler system be installed? Construction type of half baths have read and completed this application and know it to be true and correct. t am authorized to apply for this permit and understand that it s my respon ability to dete i e wha, permits are required, and to obtain permits prior to working on projects. Date ®Fr�nt Name \C. cgrevie Vv i OrOt 1 f /lignatur T Forms /Building Division /Bu id' ig permit ptication A- 114,)- i t G o 1 dvor 4_ BILE CITY OF PORT ANGELES Construction Pions The Issuance of this permit based upon these plans, speifi- cations and other data shall not prevent the building offic' from thereafter requiring the correction of errors in :ti id plai specifications and' other data, or from prey nting building operations being carried on thereunder hen in violation of at codes and ordinances of this isdiction. Approval Date it Za 1 By \V -k 1v i H�31H „LZ S� asp -nag z -a wcpda -)Nf9..ia QZ. .1P 1 9/N Icon x 9 -73c).-.. ctCtiL 0 anSS'z,A xi l -c z vc�s zL -a tr Ni.o -n om s =7 Sc") .3 k sa +PPAZt..,E ti Z x4 S t tX 2#,i, 1- c ,\7C--SC6 TO Clallam County Assessor Treasurer Property Details 61712 CAROL VAN BROCK. Page 1 of 5 Clallam County Assessor Treasurer Property Search Results 61712 CAROL VAN BROCKLIN for Year 2010 2011 Property Account Property ID Geographic ID Type Tax Area. Open Space Historic Property' Multi Family Redevelopment: Location Address. 0630005258660000 Agent Code Real 0010 PA 121 PORT ST CNTY H2 L Land Use Code N N N 519 E THIRD ST 4 Mapsco PORT ANGELES Neighborhood Cycle 5 Res a Map ID Neighborhood CD 10955130 0, g` 014 Owner n Name CAROL VAN BROCKLIN Owner ID 57445 Mailing Address. 519 E 3RD ST Ownership 100 0000000000% PORT ANGELES WA 98362 3401 Taxes and Assessments Due Property Tax Information as of 01/15/2010 Amount Due if Paid on. 7. Statement Year ID 2009 617122008 2009 617122008 2009 617122008 2009 617122008 2009 617122008 2009 617122008 2009 617122008 2009 617122008 2009 617122008 2008 617122007 2008 617122007 2008 617122007 2008 617122007 2008 617122007 2008 617122007 2008 617122007 2008 617122007 2008 617122007 61712 Legal Description. P S CO -OP COLONY SUBD LOT 23 LT28 BL 58 Taxing Jurisdiction ST SCH STATE SCHOOL CC -GEN COUNTY PORT PORT PORT ANG PORT ANGELES SD #121 SCHOOL DISTRICT #121 NTH OLY LIB NORTH OLYMPIC LIBRARY HOSP #2 HOSPITAL #2 CITY_STORMWATER CITY STORMWATER WEED_CONTROL WEED CONTROL 2009 617122008 TOTAL. ST SCH STATE SCHOOL CC -GEN COUNTY PORT PORT PORT ANG PORT ANGELES SD #121 SCHOOL DISTRICT #121 NTH OLY LIB NORTH OLYMPIC LIBRARY HOSP #2 HOSPITAL #2 CITY STORMWATER CITY STORMWATER WEED_CONTROL WEED CONTROL DFL Remodel Property' Exemptions. 2/ *IC IOU t VA.\ V1) 04 air Calq 11 N N SNR /DSBL First Second Half Half Base Base Base Amount Due Due Penalty Interest Paid Due $0 00 $0 00 $0 00 $0 00 $0 00 $0 00 $0 00 $0 00 $0 00 $0 00 $0 00 $0 00 $0 00 $0 00 $0 00 $0 00 $0 00 $0 00 $0 00 $0 00 $0 00 $0 00 $0 00 $0 00 $0 00 $0 00 $0 00 $0 00 $0 00 $0 00 $0 00 $0 00 $0 00 $0 00 $0 00 $0 00 $0 00 $0 00 $0 00 $0 00 $0 00 $0 00 $36 00 $36 00 $0 00 $0 00 $72.00 $0 00 $0 82 $0 81 $0 00 $0 00 $1 63 $0 00 $36.82 $36.81 $0.00 $0.00 $73.63 $0.00 $0 00 $0 00 $0 00 $0 00 $0 00 $0 00 $0 00 $0 00 $0 00 $0 00 $0 00 $0 00 $0 00 $0 00 $0 00 $0 00 $0 00 $0 00 $0 00 $0 00 $0 00 $0 00 $0 00 $0 00 $0 00 $0 00 $0 00 $0 00 $0 00 $0 00 $0 00 $0 00 $0 00 $0 00 $0 00 $0 00 $0 00 $0 00 $0 00 $0 00 $0 00 $0 00 $36 00 $36 00 $0 00 $0 00 $72.00 $0 00 $0 82 $0 81 $0 00 $0 00 $1 63 $0 00 http /vpn clallam net 8084 /propertyaccess /Property aspx ?cid =0 &year= 2010 &prop_id =61 1/15/2010 :'( 90RT "'-'\I; ~.J..O~~((' V".~ "-~ ~ CITY OF PORT ANGELES DEPARTMENT OF COMMUNITY DEVELOPMENT - BUILDING DIVISION 321 EAST 5TH STREET, PORT ANGELES, W A 98362 Lasereri CED - o .-J 1 6""- vJ 6" Application Number Appllcation pln number Property Address ASSESSOR PARCEL NUMBER: Tenant nbr, name Appllcation type description Subdivlsion Name Property Use Property Zoning . . . Applicatlon valuatlon 6/01/07 07-00000636 Date 791816 519 E 3RD ST 06-30-00-5-2-5866-0000- CAROL VAN BROCKLIN RE-ROOF RS7 RESDNTL SINGLE FAMILY 1500 Owner Contractor VAN BROCKLIN CAROL 519 E 3RD ST PORT ANGELES WA 983623401 OWNER Permit . . . . . Addltlonal desc . Permit pin number Permit Fee Issue Date Expiration Date BUILDING PERMIT - NO PR FEE TEAR OFF HOUSE ROOF 103556 80.50 Plan Check Fee 6/01/07 Valuatlon 11/28/07 Qty Unit Charge Per Extension 50.00 30.50 BASE FEE 10.00 3.0500 HND BL-501-2K (3.05 PER C) Other Fees STATE SURCHARGE 4.50 Fee summary Charged Paid Credlted Due ----------------- ---------- ---------- ---------- ---------- Permit Fee Total 80.50 80.50 .00 .00 Plan Check Total .00 .00 .00 .00 Other Fee Total 4.50 4.50 .00 .00 Grand Total 85.00 85.00 .00 .00 .00 1500 ~ o ~ ~ C(/ e %- 0> U\ -. ~ \\1 V\l ~ ~ 7\) (tl , 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 penod 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 const~u;.2' c ~ /j ..-; /~r/#P /-L-' Z Signature of Contractor or thorized Ager<<' Date Signature of Owner (if owner IS bUilder) Date g 'il T IPohcles\! 102_15 buIldmg penlllt mspectlOn record05 wpd [1/4/2005] \.. BUILDING PERMIT INSPECTION RECORD CALL 417-48].5 FOR BUILDING INSPECTIONS CALL 417-473.5 FOR ELECTRICt.,L INSPECTIONS CALL 417-4807 FOR PUBLIC WORKS UTILITIES PLEASE PROVIDE A h11NIMUM 24 HOUR NOTICE IT IS UNLA WFUL TO COVER, INSULATE OR CONCE";'L AN}' WOP,J,: BEFORE LNSPECTED AND ACCEPTED POST PERMIT IN A CONSPICUOUS LOCATJON KEEP PERMIT CARD AND APPROVED PLANS AT lOB SITE g \ ()'> ~ 6""' INSI'ECTlON TYPE DATE ACCEPTED C.OMMENT.'. YE.'. NO FOUNDA TlON FOOTINGS SHEAR WALLS / WALLS FOUNDA TION DRAn"AGE/ DOWN SPOUTS I PIERS I I I POST HOLES (POLE BLDGS ) PLUMBING LINDER FLOOR I SLAB ROUGH-fN WATER LINE (METER TO BLDG) GAS LlNE FINAL DATE ACCEPTED BY BACk FLOW I WATER AIR SE....L WALLS CEILING FRAMING JOISTS / GIRDERS SHEAR WALL/HOLD DO\VNS WALLS / ROOF I CEILING DRYWALL (fNTERlORBRACED PANEL ONLYj T-BAR INSULA nON SLAB WALL / FLOOR / CEILING MECHANICAL ROUGH-IN HEAT PUMY lFURNACE/DUCTS GAS LINE FINAL DATE ACCEPTED BY WOOD STOVE / PELLET / CHIMNEY MANUFACTURED HOMES FOOTING I SLAB BLOCKING & HOLD DOWNS SKJRTING PLANNING DEPT SEPARATE PERMlT #'s SEPA PARKING/LIGHTING ESA LANDSCAPING SHORELINE FINAL INSPECTIONS REQUIRED PRIOR TO OCCUPANCY/USE RESIDENTIAL DATE YES NO COMMERCIAL DATE ACCEPTED YES NO ELECTRlCAL - LIGHT DEPT 417-4735 ELECTRlCAL LIGHT DErT CONSTRUCTIONR W /PW/ CONSTRUCTION - R W ENGINEERING 417-4807 PW / ENGINEERING FIRE 4! 7-4653 FIRE DEPT PLANNING DEPT 417-4750 PLANNING DEPT BUILDfNG 417-4815 () <;;/20/t\f I-:s" U-- BUILDING T IPo]1ClesIII02 15 bUlldmg penn It II1S eetlOn reeOld05 wpd [1/4/2<f05] IJl. .-n (\J V'J ~ ~ p (0 I 8 -p p PREPARED 8/20/07, 10 23 50 CITY OF PORT ANGELES ADDRESS TENANT, NBR CONTRACTOR OWNER PARCEL APPL NUMBER 519 E 3RD ST CAROL VAN BROCKLIN VAN BROCKLIN CAROL 06-30-00-5-2-5866-0000- 07-00000636 RE-ROOF INSPECTION TICKET INSPECTOR JAMES LIERLY PAGE DATE SUBDIV PHONE PHONE PERMIT: BNOP 00 BUILDING PERMIT - NO PR FEE REQUESTED INSP DESCRIPTION TYP/SQ COMPLETED RESULT RESULTS/COMMENTS BL99 01 8/20/07 1f BLDG FINAL 08/20/2007 08 50 AM LPANGRLE KEVIN 457-7370 BLDG FINAL - RE-ROOF 10 8/20/07 Lasered CEO -------------------------------------- COMMENTS AND NOTES -------------------------------------- LaserF " CEO' BUILDING PERMIT - APPLICATION FOR OFFICIAL USE ONLY DaleRec, Ofo-Of-OJ Penmt# 07-Co-Sfn Date Appl oved 0(0 - 0 [r-cJ7 Date Issued 0(9 ~ 01--07 Fill out COMI'LETEL Y 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 City: Phone ~ 57 - 7 -S> >ZJ Phone' ~ ~?- /'3'72) Zip: :9<66" .6;?( Archltect/Engmeer: Contractor Phone: State LIcense #: Exp. Phone: Address' CIty: , 6/.9 EdGr 6>~/ Zip: ZONING: PROJECT ADDRESS LEGAL DESCRIPTION. Lot. CLALLAM COUNTY PARCEL NUMBER: Block, SubdivIsion: TYPE OF WORK: SIZEN ALUATION: o Residential 0 New Canstr. ;ZJ Re-roof 0 Stove SF @ $ /SF. = $ ZJ o Multi-family 0 Addition 0 Move 0 Garage SF @ $ /SF = $ ~ S -,peJe .() o Commercial 0 Remodel 0 DemolitIOn 0 Deck SF @ $ /SF = $ / o Repmr 0 Sign 0 Other ~ dTOTAL VAL1J~TION $ / BRIEFDES~IPTIONOFTHEPROJECT. ,~b--1 ~/r /e~r#(}r- /-PP',c;./"/ ~~e#'C?:5..5/2/v ~K~ aP~/), riDv~ / /' /' v COMMERCIAL/RESIDENTlAL: Occupancy Group Occupant Load' & Proposed Sq Pt. ConstructIOn Type: No. of Stones: Lot Size' Total lot coverage EXisting Sq Ft. = TOTAL Sq Ft. % APPROVALS: PLAN: BLDG: DPWU: FIRE: OTHER: PLANNING USE ONLY: ESAlWetland(s) 0 Yes 0 No SEPA ChecklistreqUlred? 0 Yes 0 No Other 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 Buildmg DIVIsion to comply with current fee schedules. Contact the PermIt Coordmator at 417 -4815 for assistance. PLAN CHECK FEE: IF a plan check fee is due it must be submitted at the tIme the buildlllg permIt applicatIOn and constructIOn plans are submitted. All other permIt fees are due at the time of permit issuance. EXPmATION OF PLAN REVIEW: Ifno permIt IS Issued WIthin 180 days of the date of application, the application will expire. The BUlldmg Official can extend the tIme for action by the applicant up to 180 days upon wntten request by the applicant (see Section Rl 05.3.2 of the International Building/Residential 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 penTIffs prior to wory ~ . d// /. /7h1 I / T,IFORMSIBMgPomitfunn.wpdApplioant ~ Date, ~7 ~~~~iit~1~~~~~G1,~EI'eB:WSSl@~MI!~~JJr~~~~!27:~~ PLUMBING TRAPS: WATER HEATER. SEWER: WATER: MECHANICAL: VENTS: FURNACE: GAS FIREPLACE: WOOD FIREPLACE/STOVE. MECH APPLIANCE: ., g w CITY OF PORT ANGELES PUBLIC WORKS - ELECTRICAL DIVISION 321 EAST 5TH STREET. PORT ANGELES. WA 98362 ~ Application Number Application pin number Property Address ASSESSOR PARCEL NUMBER: Application type description Subdivision Name Property Use Property Zoning . . Application valuation 06-00001281 Date 12/04/06 136892 519 E 3RD ST 06-30-00-5-2-5866-0000- ELECTRICAL ONLY ~ RS7 RESDNTL SINGLE FAMILY o Owner Contractor VAN BROCKLIN CAROL 519 E 3RD ST PORT ANGELES WA 983623401 PENINSULA ELECTRIC 761 FRESHWATER PARK RD PORT ANGELES WA 98363 (360) 477-1764 Permit Add~tional desc Permit pin number Sub Contractor Permit Fee Issue Date Expiration Date ELECTRICAL NEW RESIDENTIAL PEN. EL./ 200A SVC.-+ CIRCUIT, - 91637 PENINSULA ELECTRIC 78.70 Plan Check Fee 12/04/06 Valuation 6/02/07 00 o Qty Unit Charge Per 1 00 78 7000 ECH EL-RM-0-200 1ST SRV FEEDER Extension 78.70 Fee summary Charged Paid Credited Due ----------------- ---------- ---------- ---------- ---------- Permit Fee Total 78.70 .78.701 . .. _.00. .; It r .00 -. Plan Check Total .00 .00 .00 .00 Grand Total 78 70 78.70 .00 .00 , l'.1': [,. ':ULh ELl:C LU ; , :"t'S>; ArI~p', , COMMENTS/ACTION NEEDED .. ELECfRICAL PERMIT INSPECfION RECORD . CALL 417-4735 FOR ELECTRICAL INSPECTIONS. PLEASE PROVIDE A MINIMUM 24 HOUR NOTICE. IT IS UNLA WFUL TO COJlER, INSULATE OR CONCEAL ANY WORK BEFORE IT IS INSPECTED AND ACCEPTED. KEEP PERMIT CARD AND APPROVED PLANS AT JOB SITE . INSPEC110N TYPE DATE ACCItPTED COMMENTS I YIS NO IlITCH lUlIlf'yJ-l_IN /l,;UV.hK ~bK V lCb I J.l.- ~-o6 ~ GENERAL COMMENTS: PW.II02.lS 14'96] . ELECTRICAL WORK PERMIT APPLICATION / <t'''iii;;.....:s-'''' ~Iectrical Contractor Installation descriPtio~f Job wired by DOwner o Commercial Residential Electrical contractor na~ .. License number Date Expires o New o Altered/Addition "~_Ni:,\II.~v.,\u.. .. \, \9U1\""t-*44'()U,; 0'1/~ Purchaser's mailing address P..A. "Q.J.. 'I{ l_~o.\..ol. ~~ StbV~ '1\0\ \::/.l.}~wJ.U ;;a)1\Mfl City ~ ^'^-'1h:. State ZIP '-YO" vJo.. C\~3~ 3 Telephone number FAX number ~~O_l.n.,- \.114 PrenUies owner's TC t.J C...h .15/0(' khn c P-/'C Address of in~tion '>~ 1::) \~\ E ~.:u. Cl'\:l .J CjB3~J. Phon~u~e;~ed:e~in,pe~ Owner as defined by RCWJ9.28.261:(1) Owner will occupy the structure for two years after Ihis electrical pennit is finalized. (2) OWI/er is required to hire an electrical contractor if above said property is for sale, rent or lease. D Cash D Check # 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 instal- D Credit Card Visa Mastercard Discover lation 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 Card # - - - Utility Specifications. ---------------- Signature of owner, electrical contractor or electrical administrator Expiration Date X~, e,~ Date: \\-30-~ of card Gn,p;t~n f~ 0 Electrical Load Additions and or subtractions Service Information o NO LOAD CHANGES o Baseboard KW o Furnace KW o Heat Pump Ton o Fan-Wall KW LAR o Overhead Service o Temp Service o Underground Service Voltage PhaseD1D3 Service Size: Feeder Size: SAME DAY INSPECTION, CALL BEFORE 7:00 AM 360-417-4735 ROUGH-IN THERMOSTAT SERVICE Dale Approved By Dale Approved By "- Dale Approved By I. }""AL DITOI FEEDER ,~ ~ AtD Dale Approved By '- ,oate / Approved By/ Dale Approved By ./ Inspection Area, Building or Equipment Inspected Action Taken Electrical Date Inspector Nfl /"7. In //)t, , J '[ ,-