HomeMy WebLinkAbout220 W 5th St - BuildingApplication Number
Application pin number
Property Address
ASSESSOR PARCEL NUMBER
Application type description
Subdivision Name
Property Use
Property Zoning
Application valuation
Owner
LOFTUS JOHN JOYCE
2306 ALKI AVE SW
SEATTLE
WA 98116
Permit
Additional desc
Permit pin number 58859
Permit Fee 57 65
Issue Date 8/26/05
Expiration Date 2/22/06
Qty Unit Charge Per
BASE FEE
1 00 10 6500 ECH ME -GAS PIPE
Fee summary
Permit Fee Total
Plan Check Total
Grand Total
CITY OF PORT ANGELES
DEPARTMENT OF COMMUNITY DEVELOPMENT BUILDING DIVISION
321 EAST 5TH STREET PORT ANGELES, WA 98362
MECHANICAL PERMIT
Charged
57 65
00
57 65
T \Policies \1 102_15 building permit inspection record05 wpd [1/4/20051
05 00000797 Date 8/26/05
944086
220 W 5TH ST
06 30 00 0 -0 9215 0000
FIREPLACE/ INSERTS /FREESTANDING
RESIDENTIAL HIGH DENSITY
2794
Contractor
OWNER
Paid Credited
57 65
00
57 65
Signature of Contractor or Authorized Agent Date
1 TO 5
Plan Check Fee
Valuation
00
00
00
00
00
00
00
0
Extension
47 00
10 65
Due
0\ ock
-Z
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.
k ec)
i iature. of Owner (if owner48 builder) Date
CALL 417 -4815 FOR BUILDING INSPECTIONS. CALL 417 -4735 FOR ELECTRICAL INSPECTIONS.
CALL 417 -4807 FOR PUBLIC WORKS UTILITIES
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 1 NO
FOUNDATION•
FOOTINGS
WALLS
FOUNDATION DRAINAGE DOWN SPOUTS
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
SHEAR WALL/HOLD DOWNS
WALLS ROOF CEILING
DRYWALL (INTERIOR BRACED PANEL ONLY)
T -BAR
INSULATION
SLAB
WALL FLOOR CEILING
MECHANICAL
HEAT PUMP /FURNACE /DUCTS
GAS LINE
WOOD STOVE PELLET CHIMNEY
COMMERCIAL HOOD DUCTS
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
RESIDENTIAL DATE YES NO COMMERCIAL DATE ACCEPTED
YES 1 NO
ELECTRICAL LIGHT DEPT
CONSTRUCTION R.W PW/
ENGINEERING 417 -4807
FIRE
PLANNING DEPT
417 -4735 ELECTRICAL
LIGHT DEPT
417 -4653
BUILDING
T \Policies \1102_15 building permit inspection record05 wpd [1/4/200
BUILDING PERMIT INSPECTION RECORD
/b�N -oS e r.3
417 -4750 I I t I
417 -4815 1 gXPi r I1/ v17
CONSTRUCTION R.W
PW ENGINEERING
I FIRE DEPT
I PLANNING DEPT
1 BUILDING
PREPARED 10/04/05 13 29 15 INSPECTION TICKET PAGE 10
CITY OF PORT ANGELES INSPECTOR JAMES L LIERLY DATE 10/04/05
ADDRESS 220 W 5TH ST SUBDIV
CONTRACTOR PHONE
OWNER LOFTUS JOHN JOYCE PHONE
PARCEL 06 30 00 0 0 9215 0000
APPL NUMBER 05 00000797 FIREPLACE /INSERTS /FREESTANDING
PERMIT ME 00 MECHANICAL PERMIT
REQUESTED INSP DESCRIPTION
TYP /SQ COMPLETED RESULT RESULTS /COMMENTS
ME6 01 10/04/05 JLL
QI
MECHANICAL GAS LINE
10/03/2005 04 42 PM PBARTHOL
JOHN 253 261 1537
COMMENTS AND NOTES
11 p L d 1
Applicant or Agen1�.1 U�DC..P �i C.
Owner 'LQ k 1 6 6 h 11
Address OGG Y JT Q. lb City c-N202-
Architect /Engineer• 9.11`€.kk A)CJ\.NY\
Contractor
Address
PROJECT ADDRESS
LEGAL DESCRIPTION Lot:
CLALLAM COUNTY PARCEL NUMBER.
COMMERCIAL ESIDENTIAL) Occupancy Group:
No. of Stones. Lot Size: Existing Sq. Ft.
Total lot coverage
PLANNING USE ONLY
ESA/Wetland(s) Yes No SEPA Checklist required? Yes No Other
T\Policies\BL1102_13.wpd Applicant;
BUILDING PERMIT APPLICATION
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
State License Exp
City
ao j s 4,r
Block:
Phone: (0_ 1- /S 3
Phone:
(t Zip q Cn
Phone:
Subdivision.
Phone:
Zip.
ZONING
FOR OFFICIAL QNLY
Date Rec. t i
Permit /y a
Date Approved: 'VP G
Date Issued. A(o /04
Credit Card Holder Name:
Billing Address: City.
Credit Card Type VISA MC Exp. Date:
YPE OF WORK. SIZE/VALUATION Residential 0 New Constr Re -roof ".Stove SF /SF
Multi family Addition Move Garage SF /SF
Commercial Remodel Demolition Deck SF /SF
Repair Sign Other TOTAL VALUATION $9,, Pi
BRIEF DESCRIPTION OF THE PROJECT 12..Q_ IN (a c4 1 r`&- edv_4 43r0.4
v
Occupant Load. Construction Type:
Proposed Sq. Ft. TOTAL Sq. Ft.
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 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 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, 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 R105.3.2
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 permits prior to work.
4 w, Date:
APPROVALS
PLAN
BLDG:
DPWU
FIRE.
OTHER
Application Number
Application pin number
Property Address
ASSESSOR PARCEL NUMBER
Application type description
Subdivision Name
Property Use
Property Zoning
Application valuation
Owner
LOFTUS JOHN JOYCE
2306 ALKI AVE SW
SEATTLE
Permit
Additional desc
Permit pin number
Sub Contractor
Permit Fee
Issue Date
Expiration Date
WA 98116
Qty Unit Charge Per
1 00 48 1000 ECH EL R OR RM 1 4
Fee summary
Permit Fee Total
Plan Check Total
Grand Total
Charged Paid
COMMENTS /ACTION NEEDED
ELECTRICAL ALTER
ANGELES /1 4 CIR
60780
ANGELES ELECTRIC
48 10
9/26/05
3/25/06
CITY OF PORT ANGELES
PUBLIC WORKS ELECTRICAL DIVISION
321 EAST 5TH STREET PORT ANGELES. WA 98362
05 00000904
709072
220 W 5TH ST
06 30 00 0 0 9215 0000
ELECTRICAL ONLY
RESIDENTIAL HIGH DENSITY
0
48 10 48 10
00 00
48 10 48 10
Contractor
ANGELES ELECTRIC
524 E 1ST ST
PORT ANGELES
(360) 452 9264
RESIDENTIAL
Plan Check Fee
Valuation
ALT CIRCUITS
Credited
00
00
00
Date 9/26/05
WA 98362
Due
Extension
48 10
00
00
00
00
0
DITCH
ROUGH -IN COVEk
SERVICE
FINAL
GENERAL COMMENTS:
ELECTRICAL PERMIT INSPECTION RECORD
CALL 417 -4735 FOR ELECTRICAL INSPECTIONS. PLEASE PROVIDE A MINIMUM 24 HOUR NOTICE. IT IS UNLAWFUL TO COVER,
INSULATE OR CONCEAL ANY WORK BEFORE IT IS INSPECTED AND ACCEPTED.
KEEP PERMIT CARD AND APPROVED PLANS AT JOB SITE
INSPECTION TYPE DATE ACCEPTED
YES NO
COMMENTS
I I I
I I I
I I
I I Ex,o
I I I
I I I
I I
I I
rW- 1102.15 fa961
CITY OF PORT ANGELES
DEPARTMENT OF COMMUNITY DEVELOPMENT - BU1LD1NG DIVISION
321 EAST 5TH STREET, PORT ANGELES, WA 98362
DUlI-LIII~I~ I"~MI I ISSUED: 7/09~2002 PERMIT NO: 13552
OWNER/APPLICANT PROPERTY LOCATION
220 5TH ST W
PATRICE PERSON
220 W 5TH STREET Lot: 5
Port Angeles, WA 98362 Block: 92 [] Long Legal
360/000-0000 Subdivision: TPA
T: S: Parcel No: 063000009215000
CONTRACTOR ARCHITECT
REI HIT COMPANY N/A
Port Angeles, WA 98360 , 98360-0000
360/417-6774 360/000-0000
PROJECT INFO
Project Value: $2,400.00 SFD Units: 0 Commercial: 0
Project Type: FLOOR SYSTEM SFD SQ FT: 0 Industrial: 0 "~
Occupancy Type: Garage: 0 (:~
Occupancy Group: MFD Units: 0
Construction Type: MFD SQ FT: 0
Zoning Use:
PROJECT NOTES ~o
REPLACE ROTTED/DAMAGAED SILL, RIM JOIST, SUB FLOOR, JOIST, DIG OUT
RECEIPT#9427 ~
FEES ASSESSMENT
Building Permit: $83.25 Misc Fee 1: $0.00
Plan Check: $0.00 Misc Fee 2: $0.00
State Surcharge: $4.50 Misc Fee 3: $0.00
House Moving: $0.00
Manufactured Home: $0.00
Sign: $0.00 TOTAL FEE: $87.75
Plumbing: $0.00 AMOUNT PAID: $87.75
Mechanical: $0.00
BALANCE DUE: $0.00
Radon: $0.00
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
3resume to give authority to violate or cancel the provisions of any state or local law regulating construction or the performance of
:onstruction.
S~gnature of Contractor or Authonzed Agent/ Date Signature of Owner (if owner is builder) Date
T:\PLANNING~FORJvtS\1102,15 [4/2002]
BUILDING PERMIT INSPECTION RECORD
CALL 417-4815 FOR BUILDING INSPECTIONS. PLEASE PROVIDE A MINIMUM 24 HOUR NOTICE. IT IS UNLAWFUL TO 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 / ~'~ ~
INSPECTION TYPE DATE ACCEPTED COMMENTS
YES I NO
FOUNDATION:
FOOTINGS
WALLS
FOUNDATION DRAINAGE
ELECTRICAL (LIGHT DEPT) SEPARATE PERMIT: #
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
WOOD STOVE / PELLET / CHIMNEY
HOOD / DUCTS
PW UTILITIES / SITE WORK (Engineering Division) SEPARATE PERMIT ti's:
WATERLINE / METER
SEWER CONNECTION
SANITARY
STORM
PLANNING DEPT. SEPARATE PERMIT #'s SEPA:
PARKING/LIGHTING ESA:
LANDSCAPING SHORELINE:
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/ CONSTRUCTION - R.W.
ENGINEERING 417-4807 PW / ENGINEERING
FIRE 417-4653 FIRE DEPT.
PLANNING DEPT. 417-4750 PLANNING DEPT.
BUILDING 417-4815 2 - t! - 0 'L )~g/' BUILDING
T:LPLANNING\FORMS\1102.15 [4/2002]
_~o~ ~.~e FOR OFFICIAL USE ONLY:
c~o Date Rec.:
BUILDING PERMIT - APPLICATION ?ermit#:~
Date Approved:
Date Issued:
~t-..~_~ The Building Permit Application must be filled out completely.
Please type or print in ink. If you have any questions, please call 417-4815
Applicant
or
A~.,:gent t~ /
Owner: ~--~)t.~ 6./~d! ~c~,,:¢-,~ ~ /z94~-' ~°,~'-r a AJ Phone:
Address: ~raD~O ~. J~ City: ~ Zip: ~~
~chitec~ngineer: Phone:
Con,actor ~ ~ ?~ ~ License~: ~d~~:~3 Phone: ~[~ -~ ~
Address: ~o ~ ~e ~ CiW: ~ Zip:. ~
PROJECT ~D~SS: 2~ ~ ~ ZONING:
LEGAL DESC~PTION: Lot: Block: Subdivision:
CL~L~ COUNTY P~CEL N~BER: Credit Card ~older Name:
Billing Address: City:.
Credit Card ~: Exp. Date: VISA MC
~Res OF WORK: SIZE/VALUATION:
idential r3 New Constr. [] Re-roof [] Wood-stove SF. ~ $. /SF. =.$ '
[] Multi-family [] Addition [] Move [] Garage SF. ~ $ /SF. = $
[] Commercial ?,,~model [] Demolition [] Deck SF. @ $ /SF. = $
ffi Repair [] Sign [] TOTAL VALUATION $ ~_.~dz/~) ~
/
./
COMMERCIAL/RESIDENTIAL: Occupancy Group: Occupant Load: Construction Type:.
No. of Stories: __ Lot Size: % Lot Coverage: %
Existing Lot Coverage: /sq. fi. + Proposed Lot Coverage: /sq. ft. = TOTAL LOT COVERAGE: /sq. ft.
PLANNING USE ONLY: APPROVALS: PLAN
Notes: BLDG.
DPW
FIRE
ESA/Wetland(s): [] Yes [] No SEPA Checklist required? [] Yes 13 No Other: OTHER
BUILDING PERMIT 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. 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 Division 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. The
Building Official can extend the time for action by the applicant up to 180 days upon 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 certify 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.
Applicant'~~ Date: ~~
TSFORMS~APPS\B uildingpermit /
,~ SITE PLAN
~ ~11!~ * DEPARTMENT OF PUBLIC WORKS, BUILDING DIVISION
PROJECT/DEVELOPMENTADDRESS' ~ ~ ~
See Page 4 for instmctions on completing the site plan. For more info~ation, ca8 417~815.
CITY OF PORT ANGELES
DEPARTMENT OF PUBLIC WORKS
........... INSPECTION REPORT ...........
REQUEST: .
Date ~/~//O ~-- Time / /: -~ ~)~Received by (phone, person)
Location of Work to be inspected ~.~__~
Name of person requesting inspection ~ /C~-- ~/
Address of person requesting inspection ~ ~~ Phone No.
Type of Inspection (circle appropriate one): Permit No.
Sewer Foundation Framing Chimney Plumbin~So~orExeav. Othor
lffiS~fi~TlOffi
~emarks:
RESTORATION REQUIRED ...... YES. NO
SURFACE RESTORATION:
SURFACE TYPE: [] Unimproved ~]Gravel [~]Asphalt ~IPCC [~Other
[] Repaired by City Work Order #
[] Repaired by Permittee [] COMPLETE
[]No Damage Found [] INCOMPLETE
(Continue on reverse side if necessary) STREET SUPERINTENDENT (DATE)
r
tJ~;)./
CITY OF PORT ANGELES
DEPARTMENT OF LIGHT
APPLICATION AND ELECTRICAL PERMIT
A
000373
FEE RECEIPT NUMBER
PERMIT NUMBER
-
. ., /f () />1
, )'~:o o. t3 0 t3J' e. t1E),'I/ .J t..- ., . L-/ e.~ ;\ ,
TOTAL FEE ' "
CONT. Lie. NO. rIME TO COMPLETE NO. STORIES LEGAL OCCUPANCY
Site Address
Owner JAI,)I.'uJA
Owner's Address
ELECTR1CA~ .PERMIT ONLY:" NO OCCUPANCY OR USE ESTABLISHED. UNDER nils PERMIT
'. ;. 11..'
J '
J)CORRECT ADDRESS IS AESPO 51 ILlTY OF APPLICANT!,
_to"" /.. vi
'J~_'? ? tV ..rf-....
. '.'
.'
Day Phone Installers Phone
Appl~c.ation is hereby made for Permit to install Electrical Equipment as follows:
PE~MITS WITH WRONG &tES ARE CANCELLED
Installation By 'J F k <' -I
Installers Address /;1,j P ~ c- r t:< J..;( ./:/
"/S7-(Mf?
Wiring Method
f?o.N1e;<
.
.
NUMBER AMP. .12DV 240V NUMBER AMP 120V 240V
USE OF CIRCUIT CIRCUITS PEA '0 100R FEE USE OF CIRCUIT CIRCUITS PEA '0 l00R- FEE
CIA 30 CIA 30
LIGHT '1 SIGN
LIGHT 50 VOLTS
OR LESS
CONVENIENCE -t1 MOTOR
CONVENIENCE MOTOR
APPLIANCE '. MOTOR ,
DISHWASHER / FlAE ALAAMS
DISPOSAL BURGLAR ALARM
J .
RANGE MISC.
OVEN
-
WATER HEATER I
LAUNDRY I . '
DAYEA I REINSTALLATION LIGHT FIXTURE # ' ,
FURNACE SUB TOTAL FEE
GAS. OIL
FURNACE ENERGY FEE
ELECTRIC BASIC FEE
ELECTRIC HEAT II . ~/'J e9-
TOTAL FEE
ELECTRIC HEAT SIZE OF SERVICE SWITCIi OR ~1UIT BREAKER
A.C. UNIT ~ t:J7J AMP / · PHASE
FEEDER SIZE OF SERVICE ENTRANCE CONDUCTORS .
SERVICE 74> ~ //0 A.W.G.
I SUB. TOTAL . SIZE OF GRo"UND $/ SIZE OF ENTRANCE SWITCH
, .. .1,
I certIfy that the work to be performed under this permit will be done by the Installer and in
';/13,/ rr
Date Application made
.19
By
.
CONTRACTOR OR OWNER (OR THORIZED AGENT)
Permission is hereby given to do the above described work, according to the conditions hereon and according to the approved plans and
specifications pertaining thereto, subject to compliance with the Ordinances of the City of Port Angeles;, ' .. .
~ DIR~R OF CIT~ LIGHT . - , .
By _'d~~~
Date Permit Issued PLANS APPR VED
t{"" -/3 ._g>-S- Notify Department of City Light by Street Address and Permit Number when ready for Inspection. Work must not
be covered or current turned on before Inspection and O.K. for covering or service has been given by Inspector in
I I Writing on Permit Placard. A. . Permits Phone: 457'()411 Ext. 158.
. WARNING
. . PERMIT PLACARD MUST BE KEPT POSTED ON THE WORK - SEE OVER -
WHITE - Original CANARY. Duplicate PINK. Triplicate WHITE CARD. Inspector's Report
OLYMPIC PRINTERS, INC.
.,
, ~
REPORT OF INSPECTOR
DATE OF VISIT MADE BY REMARKS
f- ,7-,.r- /J1 /'rl ffo8rP~ RecP'(f/z(/? rl\Or'1 M ~'7f. ~ elf S c::. To
tI'i yjs-~.ri'v'1 ( e.-
Ar- #ff2 v I G~()"ff!7 (Vltl5T &6 {Jt!?? c rl y 10 6I(OC-1N'LJ ~()
4;/lq'~/ f'" oK (!o /IC ~ tJ,rcJ... TO 6"r I( /I v-e
, '.
-, .
.
. . . . ,
.
1-(l{-~') -?If.f O.K. FOR COVERING
"l' /Y- n- -'l!P:~ O.K. TO CONNECT SERVICE
FINAL O.K.
-
z
Cl
II:
c(
:l!:
!!!
:J:
I-
Z
W
l-
.
I-
o
Z
o
c
.
~
~
i
,
ELECTRICAL WORK PERMIT APPLICATION
Job ..ired by
Electrical Contractor 0 Owner
Installation description
o Commercial ~eDtial
o New
D Altered/Addition
P cha."er'~ mailing addTe:>...
52'1 #!. hat S,-
City jj.e:;- ~e ZIP
Tckphonc nu ber FAX number
~-
prem;';qQiiJ) n''"1.onltS
Address or inspection ~
'2,?fJ. fA), \.5'
PA-
(Jlaudv
.'
wA--
:s-
$~
.
City
spcction:
O...mer a.~ defined by RCW.J9.28.26/:(J) OWller KiiU nccupy the .~tTJIcturc fur two.
YC(tr;>' oj/e." this elect,.ical permit i.f fin.alized. (2) Owrn:," i~' n:qm,.(!d to hire an electrical
crl7ltrf1Cmr if above' said prop~rty is fur suIt::. rer.l {lr leD-ft!.
After reading the aoove !\tatt:ment, I hereby certify t"at I ai'll the owner of tbe above
named property or a licensed dectrical contractor. I am m~king Ihe electrical imilal-
lation Of alter.Hion in" compliance with the electrical laws, N.E.C.. RCW. Chapter
19.28, WAC. Chapter 296-46D, The City of Port An8cl~!\ Municipal Code. <ind
Utility Specifications.
o Cash 0 Check #
o Credit Card
VISa
Mastercard
Discover
Card# ._ ---.-~.-ELe:..----
x
Date:
Expiration Date
of card
Electrical Load M
D NO LOAD CHANGES
o Baseboard KW
CI Furnace _KW
CI Heat Pump Ton.
D Fan-Wall _ KW
r btractions Service Information
(!~ '.~ ~ ,-,~ ~ ~-Vo'lage~f5't?
CI Overhead Service Phase 3
LAR 0 Temp SelVic€I Service Size: ~
CJ Underground Service Feeder $ile: ~
SAME DAY INSPECTION, CALL BEFORE 7:00 AM 360-417-4735
ROUGH-IN -" / THERMOSTAT / SERVICE
"- Oall; App,o>,,('\1 J:ly O:ll~ ."'opro,,~~ ey "- D.l~ At'I'm~cd Hy
/ FlNAL "- / FEEDER
DITCH
f;.Y.f d.. iD L( .. ;;fj. 08
.,,- D;I(e .",PClT"W~,jay ""/ O.ll.te '\llP~By:':; Dille Al'J)m\'C(! ~y
InspCClion I .'\1'eat Building or Equipment In!>pected Action Taken Electrical
Date Inspcctnr
I ...--
I
..
.- .-
~L/ /j 1:7,/ /r;5' r
r , .
L -d
S9~6 ~SV 09E IN! J!~~J313 S3138N~ NO~~
N~~0'0L S0~-6L-6