HomeMy WebLinkAbout1111 S Race St - BuildingElectrical Permit
1111 S Race St
13 -040
INSPECTION TYPE
DATE:
RESULTS:
INSPECTOR:
DITCH
SERVICE
ROUGH -IN
Iv-1,113
FINAL
1 1)14
w ill
COMMENTS:
Application Number
Application pin number
Property Address
ASSESSOR PARCEL NUMBER:
Application type description
Subdivision Name
Property Use
Property Zoning
Application valuation
Application desc
Security system.
Owner
POUL G /MIKKI S BORUP
1111 S RACE ST
PORT ANGELES WA 983626760
Permit
Additional desc
Permit Fee
Issue Date
Expiration Date
Fee summary Charged
Permit Fee Total
Plan Check Total
Grand Total
ELECTRICAL ALTER RESIDENTIAL
64.00
1/09/13
7/08/13
64.00
.00
64.00
Signature of owner or Electrical Contractor X
G: \EXCHANGE\BUILDING
ELECTRICAL PERMIT
CITY OF PORT ANGELES
360- 417 -4735
13- 00000040
345320
1111 S RACE ST
06-30-10-5-1- 0135 -0000-
ELECTRICAL ONLY
RS7 RESDNTL SINGLE FAMILY
0
Contractor
Qty Unit Charge Per
1.00 64.0000 ECH EL- SINGLE CIR LIMITED MULTI
ADT SECURITY SERVICES INC.
11824 NORTH CREEK PKWY
BOTHELL WA 98011
4 2 5 489 -3668 gQ B ?233
Paid Credited Due
64.00
.00
64.00
PERMIT WILL EXPIRE SIX (6) MONTHS FROM LAST INSPECTION
Plan Check Fee
Valuation
.00
.00
.00
Date 1/09/13
.00
0
Extension
64.00
.00
.00
.00
REPORT SALES TAX
on your excise tax form
to the City of Port Angeles
(Location Code 0502)
Date:
CITY OF PORT ANGELES PERMIT APPLICATION
Building Division /Electrical Inspections
321 East Fifth Street P.U. Box 1150 Port Angeles Washington, 98362
Ph: (360) 417 -4735 Fax: (360) 417 -4711
Date: 11/05/2012
1 2 Single Family Dwelling l Multi Family or Commercial* 0 Commercial Addition Alteration Remodel Repair*
Plan Review May Be Required, Please Complete Electrical Plan Review Information Sheet
Job Address: 1111 S RACE ST
Building Square Footage: 2024
Description of above INSTALLING LOW VOLTAGE SECURITY SYSTEM
*ADT LLC
Owner Information
Name: MIKKI BORUP
Mailing Address: 1111 S RACE ST
City: Port Angeles
Phone:3604600337
License Exp.
Jennifer
X
urgess
State: WA
Fax:
Zip: 98362
Item
Service /Feeder 200 Amp.
Service /Feeder 201 -400 Amp.
Service /Feeder 401 -600 Amp
Service /Feeder 601 -1000 Amp.
Service /Feeder over 1000 Amp.
Branch Circuit W/ Service Feeder
Branch Circuit W/O Service Feeder
Each Additional Branch Circuit
Temp. Service/ Feeder 200 Amp.
Temp. Service /Feeder 201 -400 Amp.
Temp. Service /Feeder 401 -600 Amp.
Temp. Service /Feeder 601 -1000 Amp
Portal to Portal Hourly
Sign /outline Lighting
Signal Circuit/ Limited Energy First 1500 sf Commercial
Note: $5.00 for each additional 1500 sf
Signal Circuit/ Limited Energy -1 2 Family Dwelling
Signal Circuit/ Limited Energy Multi Family Dwelling
Manufactured Home Connection
Renewable Electrical Energy 5KVA System or Less
Thermostat
NEW CONSTRUCTION ONLY:
First 1300 Square Ft.
Each Additional 500 Square R. or Portion of
Each Outbuilding or Detached Garage
Each Swimming Pool or Hot Tub
Date: 2012.11.05 09:30:37 08'00'
Unit Charge
119.90
145.50
204.60
262.20
372.50
2.60
73.50
2.60
92.70
110.30
148.70
167.90
95.90
88.20
95.90
63.90 (e4
63.90
119.90
102.30
56.00
Digitally signed by Jennifer Burgess
DN: cn =Jennifer Burgess,
o =NORTH WEST PERMIT,
ou =NORTHWEST PERMIT, Dated: 01/07/2013
Finat1 el met y,wpwr,tn eum, cua
I, i
C
r
ELECTRICAL
INSPECTIONS
Contractor Information
Name: ADT LLC
Mailing Address: 11824 N CREEK PKWY N, SUITE #105
City: BOTHELL State: WA Zip: 98011
Phone.206- 774 -9499 Fax: 888 -400 -0383
License E DO
1-
110.30
35.20
73.50
110.30
Total
Owner as defined by RCW.19.28.261: (1) Owner will occupy the structure for two years after this electrical permit is finalized. (2) Owner is required
to hire an electrical contractor if above said property is for sale, rent or lease. Permit expires after six months of last inspection.
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 installation 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 Utility Specifications and PAMC 14.05.050 regarding Electrical Permit Applications.
Signature of owner, electrical contractor or electrical administrator: Cash Check
Total (Qty Multiplied by Unit Charge)
Credit Card
0110112010
Hello,
Please process this permit applications and fax or email it back to me asap.
Thank y() U,
Jennifer Burgess
Regional Account Manager
Di red: (206) 774-9400 jennifernwpermit.com
NOT.-211ERV:Pcf PERMIT Permits In he. On tine. fn time. Since1985
2440 ‘Vesten:in A.ve Suite 4 6 tr. Seatlie, WA 981.21
Main.: (3(o) 94.5-2787 Fax: (888) 400-0383 www.nwpermit.com
JA j 09 211:
ELECTRICAL
tIGPECTIONS
BUILDING PERMIT
OWNER/APPLICANT
POUL G. BORUP
1111 S RACE STREET
Port Angeles, WA 98632
360/457 -8325
T:
CONTRACTOR
SUMS CONSTRUCTION
254895 HWY 101
Port Angeles, WA 98363
360/452 -2268
FEES ASSESSMENT
Building Permit:
Plan Check:
State Surcharge:
House Moving:
Manufactured Home:
Sign:
Plumbing:
Mechanical:
Radon:
$391.25
$0.00
$4.50
$0.00
$0.
$0.00
$0.00
$0.00
$0.00
CITY OF PORT ANGELES
PUBLIC WORKS BUILDING DIVISION
321 EAST 5TH STREET, PORT ANGELES, WA 98362
S:
ISSUED: 1/31/2001
PROPERTY LOCATION
1111 RACE ST S
Lot: LT 10 15
Block: 1 Long Legal
Subdivision: DANN'S PARK ADDITION
Parcel No: 063010510135000
ARCHITECT
N/A
98360 -0000
360/000 -0000
PROJECT INFO
Project Value: $25,000.00 SFD Units: 0 Commercial: 0
Project Type: SUNROOM SFD SQ FT: 0 Industrial: 0
Occupancy Type: Garage: 0
Occupancy Group: MFD Units: 0
Construction Type: MFD SQ FT: 0
Zoning Use: RS7
PROJECT NOTES
ADDITION OF SUN ROOM ON NORTH SIDE WITH SUN DECK ABOVE
Misc Fee 1:
Misc Fee 2:
Misc Fee 3:
TOTAL FEE:
AMOUNT PAID:
$0.00
$0.00
$0.00
$395.75
$395.75
BALANCE DUE: $0.00
PERMIT NO: 12467
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 goveming 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 Contractor or Authorized Agent
Date Signature of ner (if o re s builder)
INSPECTION TYPE
DATE
ACCEPTED
COMMENTS
YES NO
FOUNDATION:
FOOTINGS
3 Ul
L F
WALLS
FOUNDATION DRAINAGE
ELECTRICAL (LIGHT DEPT) SEPARATE PERMIT: it
ROUGH -IN
PLUMBING
UNDER FLOOR SLAB
ROUGH -IN
WATER LINE
GAS LINE
BACK FLOW WATER
AIR SEAL
WALLS
CEILING
FRAMING
JOISTS GIRDERS
SHEAR WALL
WALLS ROOF CEILING
DRYWALL
T -BAR
INSULATION
SLAB
WALL FLOOR CEILING
MECHANICAL
HEAT PUMP
WOODSTOVE /PELLET /C'HIMNEY /INSERT
HOOD /DUCTS
PW UTILITIES SITE WORK (Engineering Division) SEPARATE PERMIT #'s:
WATERLINE METER
SEWER CONNECTION
SANITARY
STORM
SEPA:
ESA:
SHORELINE:
PLANNING DEPT. SEPARATE PERMIT 8
PARKING /LIGHTING
LANDSCAPING
FINAL INSPECTIONS REQUIRED PRIOR TO OCCUPANCY/USE
RESIDENTIAL
DATE
YES
NO
COMMERCIAL
DATE
ACCEPTED
YES
NO
ELECTRICAL LIGHT DEPT. 417 -4735
ELECTRICAL
LIGHT DEPT
CONSTRUCTION R.W. PW/
ENGINEERING 417 -4807
CONSTRUCTION R.W.
PW ENGINEERING
FIRE 417 -4653
FIRE DEPT.
PLANNING DEPT. 417 -4750
PLANNING DEPT.
BUILDING 417 -4815
ID 1t O i
L-
BUILDING
BUILDING PERMIT INSPECTION RECORD
CALL 417 -4815 FOR BUILDING INSPECTIONS. PLEASE PROVIDE A MINIMUM 24 HOUR NOTICE. IT IS UNLA WFULTO CO.VER,
INSULATE OR CONCEAL ANY WORK BEFORE INSPECTED AND ACCEPTED. POST PERMIT IN A CONSPICUOUS LOCATION.
KEEP PERMIT CARD AND APPROVED PLANS AT JOB SITE
C./APPL. W PD
vonrg
•i
etsucv,...fr
BUILDING PERMIT
The Building Permit Preapplication
Please type or print in ink. If you have
Applicant and/or Agent: /7? o 6. s o f.
Owner: At. 4 4/* /77a/
Of
Address: 111/ 5 RACE or City:
Architect/Engineer: Phone:
Contractor Sum/ Cow( rucA p 0 License #:5uf5c I26L4 E lo I Zed Phone: 68
Address: 21146r tvyW/IY /0/ City: P4
PROJECT ADDRESS: 1( C Race. 5'
LEGAL DESCRIPTION• Lot: f er Block:
CLALLAM COUNTY PARCEL NUMBER:
TYPE OF WORK:
o Residential 0 New Constr. 0 Reroof
o Multi family W. Addition 0 Move
o Commercial 0 Remodel 0 Demolition
0 Repair 0 Sign
BRIEF DESCRIPTION OF THE PROJECT:
PW -1 to2_17ircv.2/99i
APPLICATION
must be filled out completely.
any questions, please call 417-481S
o Woodstove
o Garage
O Deck
0
Ss tot ht to a in
Applicant:
FOR OFFICIAL USE ONLY:
Date Rec.: i 31- 0/
Permit N:
Date Approved:
Date blued:
Ys7- Ls
Phone:
Phone:
Zip: 9 tP 3 2.
SIZE VALUATION:
't if Z. SF.@S /SF.
SF. (a3 /SF.
SF4 /SF.
TOTAL VALUATION t5
r•
u94 Zip: SC 3 G Z.
ZONING
I
Subdivision: 7) la f AO 4/1.»Oh
a
COMMERCIAL/RESIDENTIAL: Occupancy Group: Occupant Load:
No. of Stories: Lot Size: Lot Coverage: a/a
Existing Lot Coverage: /sq. ft. Proposed Lot Coverage: /sq. ft. TOTAL LOT COVERAGE:
PLANNING USE ONLY: APPROVALS: PLAN
Permits Required: Notes: BLDG
Max. Height: Setbacks: Zoning: DPW
Site Plan and Use Approved by: Date: FIRE
ESA/Wetland(s): 0 Yes 0 No SEPA Checklist required? 0 Yes 0 No Other: OTHER
BUILDING 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.
BUILDING PERMIT APPLICATION SUBMITTAL: 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 Div. 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: If no permit is issued within 180 days of the date of application, this application will expire by
limitations. The Building Official can extend the time for action by the applicant up to 180 days, on 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 certf 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.
Construction Type:
sq.ft
Date: Zen
Applicant:
Owner:
6 '/3or
Property address: /111 5. 1?I1 C t s r
Proposed use: Zoning:
Is the proposed use listed as a "permitted use" or an "accessory use" in this zone?
Is this the only use business, residence, etc.) on this site?
Has there ever been a subdivision, shortplat, or PRD approved for this site, or has one
been submitted and is pending approval?
Does the proposed use require a new buisness license?
Does the project extend into any required setbacks or cross any lot lines (interior or
exterior)?
Does the project exceed the permitted height allowance or cause the property to exceed
the allowed lot coverage in this zone?
Does the project require any additional parking or special design/landscape improvements
in this zone?
Does the project eliminate any existing parking spaces?
Is the project located within 200' of the shoreline?
Are there any environmentally sensitive areas on or within 200' of the property,
including:
wetlands or areas of standing water (year round or seasonal);
streams (year round or seasonal);
areas with a slope of 40% or greater, or
areas that have evidence of past ground movement or erosion?
Have all the required submittals been provided by the applicant?
Site Plan 0 Construction Drawings
0 Parking/Drainage Plan 0 Civil Drawings
Energy Cale 0 Supporting Engr. Cale
O Landscape/Lighting Plan 0 Other
City ofPort Angeles
Applicant Project Review Sheet
N ees: ok
yes: ok
yes: requires PD
review
yes: requires CC
review
yes: requires PD
review
yes: requires PD
review
yes: requires PD
review
yes: requires PD
review
yes: requires PD
review
yes: requires PD
review
yes: ok
no: requires PD
review
no: requires PD
review
ok
no:
lino: ok
ok
(6 no: ok
1 Xno: ok
i g•go: ok
)(no: ok
no: ok
no: mark
required
item(s)
II'Planning Department review is required, the processing time may be extended. If it is determined a separate Planning
Department permit(s) is needed, the Planning Department permit(s) must be approved prim to the issuance of any other permit.
The information provided above is :rue to the best ofmybotowledge, I understand that in the event that any of this information is determined
by the Ciry to be incorrect, this project will be stopped until such time the Ciry determines the correct information is provided and any
subsequently required review and approvals are completed and granted.
V h C VG-1/4 2!/DJ
App [cant Date
APRs.:
Permit Category 11 (see reverse side) Building Permit 1 Master Tracking 1
Route to: O BD CC OFD LD O PD O PW O File O Other
Staff Initials Date Completion of this form is required for all category lb, 2 3 permits. Completion is not
required for category I a permits unless they result in a potential change ofuse or occupancy.
REQUEST:
CITY OF PORT ANGELES
DEPARTMENT OF PUBLIC WORKS
INSPECTION REPORT
Date -3-20 .---Q Time Fees Received by 7 F (phone person)
Location of Work to be inspected (I I( S I ZIG
Sort, Ccn45 fi.
Name of person requesting inspection
Address of person requesting inspection Phone No.
Type of Inspection (circle appropriate one): Permit No.
Sewer (Foundation Framing Chimney Plumbing Final Sewer Excay. Other
ICJ
INSPECTION NOTES:
Inspected: Date g 20 Time By
Remarks:
RESTORATION REQUIRED
SURFACE RESTORATION:
SURFACE TYPE: Unimproved ❑Gravel
Repaired by City
Repaired by Permittee
El No Damage Found
(Continue on reverse side if necessary)
YES
NO
Asphalt PCC
Work Order
COMPLETE
INCOMPLETE
/2967
Li Other
STREET SUPERINTENDENT (DATE)
a2-313 7241(e6r-
al7,02)decis /x./ AGTZVZotort7
t)/A);,7 ieer °Ai% SX1/0/C- AWEerce
/0929d
ti 7100
aellrrii s etioeF -.0,tiret27/1t-E,
REQUEST:
Date S 3O O(
CITY OF PORT ANGELES
DEPARTMENT OF PUBLIC WORKS
INSPECTION REPORT
Time 5°
Received by
person)
Location of Work to be inspected /1 ll 5 e E
Name of person requesting inspection g 0 cop
r
Address of person requesting inspection k- t Sip -U-1 f S Phone No. 4 z 2 th' 8'
Type of Inspection (circle appropriate one):
Sewer Foundation (eraming Chimney Plumbing Final Sewer Excay. Other
INSPECTION NOTES:
Inspected: Date b% Time By
RESTORATION REQUIRED
SURFACE RESTORATION:
SURFACE TYPE: Unimproved ❑Gravel
E. Repaired by City
El Repaired by Permittee
El No Damage Found
(Continue on reverse side if necessary)
YES NO
Permit No. 121 (o 7
Remarks:
Asphalt PCC Other
Work Order
COMPLETE
INCOMPLETE
STREET SUPERINTENDENT (DATE)
CITY OF PORT ANGELES
DEPARTMENT OF PUBLIC WORKS
INSPECTION REPORT
REQUEST: C
Date 6 -.2 0 1 Time W, SCE �O 1 Received by C
I I 11 5 RAC eCia &e
Name of person requesting inspection S ()et S /colic"
Address of person requesting inspection
Type of Inspection (circle appropriate one):
Sewer Foundation Framing Chimney Plumbing
Location of Work to be inspected
INSPECTION NOTES:
Inspected: Date r"
RESTORATION REQUIRED
SURFACE RESTORATION:
SURFACE TYPE: Unimproved ❑Gravel
Repaired by City
Repaired by Permittee
El No Damage Found
(Continue on reverse side if necessary)
Time By
Phone No.ysZ— z 5?
Permit No. 1 67
Sewer Excay. Other
Remarks:
YES NO
Asphalt PCC
Work Order
[J COMPLETE
INCOMPLETE
(phone, person)
Other
STREET SUPERINTENDENT (DATE)
ELECTRICAL PERMIT
OWNER /APPLICANT
POUL G. BORUP
1111 S RACE STREET
Port Angeles, WA 98632
360/457 -8325
T:
CONTRACTOR
ELECTRIC SERVICE
924 DRAPER RD.
PORT ANGELES, WA 98362
360/452 -6424
PROJECT INFO
Project Type: RES. MISC.
Occupancy Type:
Occupancy Group:
Electrical Heat:
Baseboard
Furnace
Heat Pump
Fan Wall
n
n
PROJECT NOTES
ADDITION WITH ONE CIRCUIT
S:
CITY OF PORT ANGELES
PUBLIC WORKS ELECTRICAL DIVISION
32I EAST 5TH STREET. PORT ANGELES. WA 98162
0 KW
0 KW
0 KW
0 KW
AMOUNT PAID:
BALANCE DUE
l)MM1LN I S /ACTION NEEDED
ISSUED: 5/30/2001
n
1I
ARCHITECT
N/A
98360 -0000
360/000 -0000
Riser
Overhead Service
Temp Service
FEES ASSESSMENT Service: $0.00
Additional Feeders: $0.00
Circuit Wiring: $0.00
Temp Service: $0.00
Misc Fee: ADD CIRCUIT $44.25
TOTAL FEE: $44.25
PERMIT NO 7288
PROPERTY LOCATION
1111 RACE ST S
Lot: LT 10 15
Block: 1 n Long Legal
Subdivision: DANN'S PARK ADDITION
Parcel No: 063010510135000
Project Value: $0.00
Construction Type: ADD CIRCUITS
Zoning Use: RS7
$0.00
$44.25
Underground Service
Voltage: 0
Phase n 1 3
Service Size: 0
Feeder Size: 0
INSPECTION TYPE
DATE
ACCEPTED
COMMENTS
YES NO
DITCH
ROUGH -IN COVER
.s /7o /0i
SERVICE
FINAL 9 /vi
CALL 417 -4735 FOR ELECTRICAL INSPECTIONS. PLEASE PROVIDE A MINIMUM 24 HOUR NOTICE. IT IS UNLAWFUL TO CO VER,
INSULATE OR CONCEAL ANY WORK BEFORE IT IS INSPECTED AND ACCEPTED.
GENERAL COMMENTS:
ELECTRICAL PERMIT INSPECTION RECORD
KEEP PERMIT CARD AND APPROVED PLANS AT JOB SITE
Pw- 1102.15(4961
CITY OF PORT ANGELES
LIGHT DEPARTb1ENT
In accordance 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 Angeles, per-
mission is hereby granted to do electrical work as listed below.
Address -...fl d
Light Outlets
Receptacle Outlets
Dryer, KW
Range, KW
Water Heater:
KW
Heat: KW
Motors: e izvo s and pha6e:
Yo
Total Load
Olympic Printers, Inc.
ELECTRICAL PERMIT
N? 16515
Port Angeles, Washington °2( 19 e
0 Occupancy
Owner C CP't'ls Tenant
Wiring Contractor Y e-tsr By
Permit Fee Treas. Receipt
No
Service, volts
No. wires
Size wires
Main fuse
Enclosure
Type of wiring:
Entrance Cable
Rigid Conduit
Metallic Tubing
Current transformers:
No. Size
Ser. No
Ser. No
Ser. No
Ser. No
By
Type of Wiring:
Armored Cable
Non Metallic
Knob Tube
Rigid Conduit
Metallic Tubing
Raceway
Circuits, Light
Utility
Heat
Range
Water Heater
Motor
Dryer
Furnace
Total
Remarks:
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? 16 515
AddressDate..._._...._.._.._.._
Owner Tenant
Wiring Contractor 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.
CITY Or PORT ANGELES
LIGHT DEPARTMENT ELECTRICAL PERMIT l N9 16195
Port Angeles, Washington i 19
In accordance 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 Angeles, per-
mission is hereby granted to do, electrical work as listed below.
Address f fi C Occupancy r
r
Owner Tenant
Wiring Contractor By
Light Outlets
Receptacle Outlets
Dryer, KW
Range, KW
Water Heater:
KW
Heat: KW
Motors: size, volts and phase:
IM Olympic Printers, Inc.
Service, volts
No. wires
Size wires
Main fuse
Enclosure
Type of wiring:
Entrance Cable
Rigid Conduit
Metallic Tubing
Current transformers:
No. Size
Ser. No
Ser. No
Ser. No
Permit Fee Treas. Receipt
No
By
Ser. No. Total
et" w%f iL- rf ),o -14i.
Type of Wiring:
Armored Cable
Non Metallic
Knob Tube
Rigid Conduit
Metallic Tubing
Raceway
Circuits, Light
Utility
Heat
Range
Water Heater
Motor
Dryer
Furnace
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? 16195
Address Date "00,"1
Owner Tenant
Wiring Contractor 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.