HomeMy WebLinkAbout531 E 8th St - Building CITY OF PORT ANGELES
DEPARTMENT OF COMMUNITY ECONOMIC DEVELOPMENT BUILDING DIVISION
.7! 321 EAST 5TH STREET, PORT ANGELES, WA 98362
1
Application Number 12- 00000745 Date 6/11/12
Application pin number 393235
Property Address 531 E 8TH ST
ASSESSOR PARCEL NUMBER: 06- 30- 00 -0 -2- 2775 -0000- REPORT SALES TAX
ti I Application type description PLUMBING PERMIT on your state excise tax form
Subdivision Name
Property Use to the City of Port Angeles
Property Zoning COMMERCIAL NEIGHBORHOOD (Location Code 0502)
Application valuation 1200
Application desc
REPLACE WATER MAIN SERVICE
Owner Contractor
VANBROCKLIN MICHAEL D ANGELES PLUMBING INC
73 S RIDGE VIEW DR PO BOX 1151
PORT ANGELES WA 983628157 PORT ANGELES WA 98362
(360) 452 -8525
Permit PLUMBING PERMIT
Additional desc REPLACE WATER MAIN SERVICE
Permit Fee 57.00 Plan Check Fee .00
Issue Date 6/11/12 Valuation 0
Expiration Date 12/08/12
Qty Unit Charge Per Extension
BASE FEE 50.00
1.00 7.0000 EA PL -WATER LINE 7.00
Fee summary Charged Paid Credited Due (A. 1
Permit Fee Total 57.00 57.00 .00 .00 1 6 W 6 lY v
Plan Check Total .00 .00 .00 .00
Grand Total 57.00 57.00 .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
I not presume to give authority to violate or cancel the provisions of any state or local law regulating construction or the performance of
construction.
t L z L
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 Backfiow 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. CA
Inspection Type Date Accepted By Comments n
FOUNDATION: v
Footings
Stemwall
Foundation Drainage Downspouts
Piers
Post Holes (Pole Bldgs.)
PLUMBING:
Under Floor Slab
Rough -In i
Water Line (Meter to Bldg) 1p �a
Gas Line
Back Flow Water FINAL Date LP 19" I v 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 t"
Construction R.W. PW Engineering 417 -4831
Fire 417 -4653
CA
Planning 417 -4750
Building 417 -4815
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06/11/2012 09:19 3604528583 ANGELESPLUMBING PAGE 02/02
BUILDING PERMIT APPLICATION Print in ink
CITY OF PORT ANGELES
For City U.e Only:
t" Attn: Building Permit Technician Date Received It'
321 E. Fifth St., Port Angeles, WA Q8362 Permit r-
(360) 417 -4815 fax (350) 417 -4711 Date Approved cam
Pro
Applicant or Agent ANGELES PLUMBING, INC. Phone 452 -8525
Property Owner MICHAET, VAN BROCKLIN Phone 452 -1151
Property Owner's Address 73 S Ridgeview Dr. Pott Angeles
Contractor /Engineer ANGELES PLUMBING. INC. Phone 452 -8525
Contractor /Engineer's Address P.O. Box 1151, Port Angeles, WA 98362
License ANGELP1077KP Expires 5 -15 -13
PROJECT ADDRESS 517 E 8t b St
Parcel Number (9 10 d�� 't r Lot Zoning CA
Project Tyne 8 Brf f escrfpfyon: *Residential Commercial l&iIt famr7y o Industrial
Check all that apply
o New Construction
Addition
Remodel
Repair
Re-roof
Demolition
in Heat System o Heat pump d wood burning stove gas fireplace pellet stove other
-140ther Replace main wa.tes service
Floor Areas EaldStinA (sq fL) Projsed (s x It)
Basement per sq. ft...
1 Floor
2 Floor
3 Floor
Garage
Carport
Covered Porch
Deck II
Shed 20
Other
-Nc
BUILDING DIVISION
TOTAL VALUATION 1, 200.00
Total footprint of structures sq. it T Lot size sq. ft.. Lot coverage
Max. height of proposed structures ft. Occupancy group of bedrooms
Will a lawn sprinkler system be installed? Occupant road of full baths
1/1411 a fire sprinkler system be installed? Construction type of half baths
I have read and completed this application and know it to be true and correct. l em 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 e Print Name DALE BRUNTZ
Signature
T:Forms/Building Division /Bldg Permit Appl_ 2006 Code.doa
s
.....~
CITY OF PORT ANGELES
PUBLIC WORKS - BUILDING DNISION
321 EAST 5TH STREET, PORT ANGELES, W A 98362
BUILDING PERMIT
OWNER/APPLICANT
MIKE VAN BROCKLlN
4-SEASONS RANCH
Port Angeles, WA 98362
360/457-4742
T:
S:
ISSUED: 10/0212001 PERMIT NO: 13009
PROPERTY LOCATION
531 8TH ST E
Lot: 17
Block: 227 [8J Long Legal
Subdivision: TPA
Parcel No: 063000022775000
CONTRACTOR
OWNER
VARIOUS
Port Angeles, WA 99360
206/000-0000
PROJECT INFO
Project Value: $500.00
Project Type: CARPORT
Occupancy Type: RESIDENTIAL
Occupancy Group:
Construction Type:
Zoning Use: RS7
ARCHITECT
N/A
, 98360-0000
360/000-0000
SFD Units: 0
SFD sa FT: 0
MFD Units: 0
MFD sa FT: 0
Commercial:
Industrial:
Garage:
V'1
vJ
---..:>
o
o
o
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PROJECT NOTES
REMOVE AND RECONSTRUCT CARPORT
RECEIPT # 8134
FEES ASSESSMENT
Building Permit:
Plan Check:
State Surcharge:
House Moving:
Manufactured Home:
Sign:
Plumbing:
Mechanical:
Radon:
$23.50
$0.00
$4.50
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
D\J
I):
Mise Fee 1:
Mise Fee 2:
Mise Fee 3:
$0.00
$0.00
$0.00
TOTAL FEE:
AMOUNT PAID:
BALANCE DUE:
$28.00
$28.00
$0.00
Separate Permits are required for electrical worK, SEPA, Shoreline, ESA, utilities, private and public improvements. This permit becomes
null and void !fwOrK or construction authorized is not commenced within 180 days, if construction orwork is suspended or abandoned
fora period of180 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.
/ 0- l~~ ock-
Signature of Contractor or Authorized Agent
IDI ~/D I
Date
Signature of Owner (if owner is builder)
Date
BUll..DING PERMIT INSPECTION RECORD
CALL 417-4815 FOR BUILDING INSPECTIONS. PLEASE PROVIDE A MINIMUM 24 HOUR NOTICE. IT IS UNLA WFUL TO COVER,
INSULA TE 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 I ACCEPTED COMMENTS
I YES I NO
FOUNDATION:
FOOTINGS
WALLS
FOUNDATION DRAINAGE
ELECTRICAL (LIGHT DEPT) SEPARATE PERMIT: #
ROUGH-IN I I
PLUMBING
UNDER FLOOR I SLAB
ROUGH-IN
WATER LINE
GAS LINE
BACK FLOW I WATER
AIR SEAL
WALLS I I I
CEILING I I I
FRAMING
JOISTS I GIRDERS
SHEAR WALL
WALLS I ROOF I CEILING
DRYWALL
I.BAR
INSULATION
SLAB I I I
WALL I FLOOR I CEILING I I I
MECHANICAL
HEAl PUMP
WOODSTOVE I PELLET/CHIMNEY I INSERT
HOOD/DUCTS
PW UTILITIES I SITE WORK (Engineering Division) SEPARATE PERMIT #'s:
WATERLINE I METER
SEWER CONNECTION
SANITARY
STORM
PLANNING DEPT. SEPARATE PERMIT #'s SEPA:
PARKINGILIGHTlNG ESA:
LANDSCAPING SHORELINE:
FINAL INSPECTIONS REQUIRED PRIOR TO OCCUPANCYIUSE
RESIDENTIAL DATE YES NO COMMERCIAL DATE ACCEPTED
VES NO
ELECTRICAL - LIGHT DEPT. 417-4735 ELECTRICAL
LIGHT DEPT
CONSTRUCTION R.W.I PWI CONSTRUCTION - R.W.
ENGINEERING 417-4807 PW I ENGINEERING
FIRE 417-4653 FIRE DEPT.
417-4750 t' -cr PLANNING DEPT.
PLANNING DEPT. >_ f),U,
BUILDING 417-4815 h.i 1<:' '\.!\/ BUlLDING
I
C:\APPL.WPD
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The Building Permit .. Pre-application _t befUled out completely.
Please type or prillt iD iDIL Hyou bave auy quatiou, please caD 417-4815
Applicant and/or Agent:R~ c.-\.(1 }-\.cu'05-\ocl<:' Phone:
Owner: fI1,'ch<>-(1 V6tr'\ f3'oC~(I\'0 Phone:
Address: L( ~co. C; '-' n" ~ ",c- In City:
ArchitectJEngineer:~~ ; "s t DC \c
Contractor Ria" \-\a ,'"s-\"ocL License#:
Address: City:
PROJEer ADDRESS: 53 It. 'if r~::s-t, P <.J( t /~h~ e\ (<,
LEGAL DESCRIPTION: Lot: Block: J Subdivision:
CLALLAM COUNTY PARCEL NUMBER: Credit Card Holder Name:
BiIIiDc Add....s: City:
Credit Card II: Exp. Date:
Par\- Ar~r\( ~
FOR omCIAL USE ONLY:
0aIl: RIiC.:!5!:::. ~ - 0 ,
Pamil':
Dale Approved:
0aIl: Issuod:
S r!>oo,\
l/S2-7"1'82
l(S7-f{7'i2.
Zip: Q'8'3b'-.
BUILDING PERMIT - APPLICATION
Phone:
Exp:
Phone:
Zip:
ZONING:
VISA
MC
SlZElVALUATION: ."" 00
2-D OSF.@$ :2, o~, /SF.=$ ,SaC> -
SF. @ $ /SF. - $
SF.@$ /SF.=$
TOTAL VALUATION $ 500 0'"
o...A re. .,C" f'\siT Vl.ct Cd. p<><; t.
TYPE OF WORK:
o Residential 0 New Constr. 0 Re-roof 0 Woodstove
o Multi-family 0 Addition '\. 0 Move 0 Garage
o Commercial ,-0 Remodel 'Ill Demolition 0 Deck
lID Repair 0 Sigu 0
BRIEF DESCRIPI'ION OF THE PROJEer: -r a . r, .", c> V (.
COMMERClAURESIDENTIAL: Occupancy Group: ,', Occupant uaar ' Construction Type:
No. of Stories: Lot size: % Lot Cc)vtlJ'agil: ' " %
ExistingLotG~erage:' . , Isq. ft. + Proposed LotCoverage:';", ' Isq.1\;.. toTAL LOT COVERAGE:' , .
.\.' ~ ',. i'
Isci.fi
PLANNING uSE ONLV:
Notes:
PLAN
BLDG.
DPW
FIRE
ESAlWctland(s): 0 Yes 0 No SEPA Checklist required? 0 Ves lJ No Other: OTHER.
Bun.DING APPLICATION SUBMl'ITAL: Your opp/klldDII ami s~ pia must befUled Old CDmpIetely to be IICCeJIIftfor UIIIew. The
Building Division can provide you with more detailed iDformation on the application and plan submittal requiremeuts.
APPROVALS:
BUILDING PERMIT APPLICATION SUBMl'ITAL: Your compleIed application. site plan (for additions) and building construction
plans are to be submitted to the Building Division.
VALVA TION OF CONSTRUcnON: In all cases, a valuation anlOlDlt 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 Pennit Coordinator at 417-481 S for assistance.
PLAN CHECK FEE: Your plan check fee is due at the time the building pemrit application and constmction plans are'submitted. Ail 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 applkatioa wiD expire by
limitations. The Building Official can extend the time for action by the applicant up to 180 days, on writteu request by the applicant (see
Section 107.4 Dfthe 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, ami 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 remaiJrs the applicant's
responsibility 10 determine what permits are required and to obtain such.
PW-1l0U3[revSJ01) Applicant: w-tr ~do de.-
Date:
10/dlo I
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CITY OF PORT ANGELES
PUBLIC WORKS - BUILDING DIVISION
321 EAST 5TH STREET, PORT ANGELES, WA 98362
BUILDING PERMIT
PERMIT NO: 12668
OWNER/APPLICANT
MIKE VAN BROCKLlN
4-SEASONS RANCH
Port Angeles, WA 98362
360/457-4742
T:
S:
ISSUED: 5/21/2001
PROPERTY LOCATION
531 8TH ST E
Lot: 17
Block: 227
Subdivision: TPA
Parcel No:
[8J Long Legal
ARCHITECT
N/A
CONTRACTOR
OWNER
VARIOUS
Port Angeles, WA 99360
206/000-0000
PROJECT INFO
Project Value: $500.00
Project Type: SHED
Occupancy Type:
Occupancy Group:
Construction Type:
Zoning Use: RS7
, 98360-0000
360/000-0000
SFD Units:
SFD sa FT:
o
o
MFD Units:
MFD sa FT:
o
o
Commercial:
Industrial:
Garage:
o
o
o
10
vJ
-
\"'l
"<1
,j
v
PROJECT NOTES
OPEN SHED ATTACHED TO EXISTING GARAGE
-,
FEES ASSESSMENT
Building Permit $23.50 Mise Fee 1: $0.00
Plan Check: $0.00 Mise Fee 2: $0.00
State Surcharge: $4.50 Mise Fee 3: $0.00
House Moving: $0.00
Manufactured Home: $0.00 $28.00
Sign: $0.00 TOTAL FEE:
Plumbing: $0.00 AMOUNT PAID: $28.00
Mechanical: $0.00 BALANCE DUE: $0.00
Radon: $0.00
RW
SANITARY
WATER
DWY
STORM
DRA
OTHER
Separate Permits are required for electrical work, utilities, private and public improvements. This permij becomes null and void ~ work or
construction authorized is not commenced within 180 days, ~ construction or work is suspended or abandoned for a period of 180 days after
the work as commenced, or ~ 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. Ail provisions of Ijlws and ordinances governing this type of work
will be complied with whether specified herein or not. The granting of a permij does not presume to give authority tD violate or cancel the
provisions of any state or local law regulating construction or the performance of construction,
Sionature of Contractor or Authorized Aaent
Date
OH~e-k.
Sionature of Owner en owner is builder)
S"/o-.{ I bl
Date
BUILDING PERMIT INSPECTION RECORD
CALL 417-4815 FOR BUll..DING INSPECTIONS. PLEASE PROVIDE A MINIMUM 24 HOUR NOTICE. IT IS UNLA WFUL TO COVER.
INSULA TE OR CONCEAL ANY WORK BEFORE INSPECTED AND ACCEPTED. POST PERMIT IN A CONSPICUOUS LOCATION.
KEEP PERMIT CARD AND APPROVED PLANS AT JOB SITE
19-&0S'
INSPECTION TYPE
DATI<
ACCEPTED
YES I NO
COMMENTS
FOUNDATION:
FOOTINGS
WAllS
FOUNDATION DRAINAGE
ELECfRlCAL (LIGHr DEPT)
ROUGH-IN
PLUMBING
UNDER FLOOR I SLAB
ROUGH-IN
WATER LINE
BACK FLOW I WATER
AIR SEAL
WALLS
CEILING
FRAMING
JOISTS I GIRDERS
SHEAR WALL
WALLS I ROOF I CEILING
DRYWALL
I-BAR
INSULATION
SLAB
WALL I FLOOR I CEILING
MECHANICAL
CHIMNEY
WOODSTOVE I PELLET
DUCTS
I
I
I
I
I
T
I
T
I
I
I
I
I
T
PW UTll.JTIES J SITE WORK (Engineering Division)
WATERLINE I METER
SEWER CONNECTION
SANITARY
STORM
SITE DRAINAGE I EROSION CONTROL
PARKING
OTHER
FINAL INSPECTIONS REQUIRED PRIOR TO OCCUPANCY/uSE
ApplicanI and/or Agent:J.vD.N\. \-10..', f\ ~\"ocl.< Phone: 4'5 do. - 7 , A.J
Owner: 1'0\'\('..\1"'\1>1 Vevqgrod\.\;", Phone: "'5~ "3"'lf1o
Address: ~ -'1 L e ~~. l>, tto, S a<', f\ reM".., City:--t'or -I- A ~ Zip: If i 3,lP:t
ArcbitectJEnginee.-lDesigner: R.'f~ "o.:.(\..'toc:A.~ Phone: YS'~ -7'; K do
Contractor:~1 iA Ucense #: Exp: Phone:
Address:--1L1 ^ City:
PROJECT ADDRESS:: 5 ~ I E.. e't"o\ 5\.
LEGAL DESCRIPTION: Lot: Block:
r:lf'ORT~
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~~~
BuildinglUtility/Electric/Fire Pennit Application
Please fill out completely. Type or print in ink. If you have questions
please call (360) 417-4815 or Fax: (360) 417-4711
e-mail: www.ci.port-angeles.wa.us
FOR OFFICIAL USE ONLY:
DateRec.: Ii. ~r-o 1
Pemu'#: I", 7
I'R>-Appl CO"l'I_
SHBI724: Y N
Letter ofCoqJleteness:-===-
Bldg. Permit Appl:
B.P. laue<!:
Zip:
ZONING
Subdivision:
CLALLAM COUNTY PARCEL MlMBER:
Billing Address:
Credit Card #
Credit Card Bobier Name:
City: ,
Jidp. Date:
TYPE OF WORK:
o Residential 0 New Constr.
o Multi-filmily ,t- Addition
o Commercial 0 Remodel
o Electrical 0 LP-gas
SIZFJV ALUATION:
Sf.@S
Sf.@S
Sf.@S
TOfAL VALUATION
o SIovelInsert
o Garage
o Deck
DUST
o Reroof
o Move
o Demolition
o Sign
....MCoJJ..
~hed
BRIEF DESCRIPTION OF T~ PROJECT: nu.:, \d ~""-~
~ ~ .."i;,,,~ ;(,,^:,:>o
CO RC SIDENTIAL: Occup cy Group: Occupant Load:
No. of Stories: Lot Size: % Lot COVt2'age:
Existing Lot Coverage: Isq. ft. + Proposed Lot Coverage:
%
Isq. ft. = TOfAL LOf COVERAGE:
Isq.ft
PLANNING USE ONLY:
Permits Required:
Max. Height: Setbacks:
SiIe Plan and Use Approved by:
ESNWeIland(s): 0 Yes 0 No SEPA Checklist required? 0 Yes 0 No
APPROVALS:
Notes:
Zoning:
Date:
Other:
Zip:_
VISA_MC_
/SF. = S
ISF. = S
ISF. = S
;)CP, ':c.-
$
( M-I- ~(\c..lo~ 'j
Construction Type:
PLAN
BLDG
DPW
FIRE
OTHER
PRE-APPLICA nON SUBMIlTAL: Your application and site plan must be jilled out completely to be acceptedfar review. The
Building Division can provide you wiIh more detailed information on Ihe application and plan submittal requirements.
BUILDING PERMIT APPLICATION SUBMI1TAL: Your complaed application, siteplan (fur additions) and building construction
plans are to be submitted to Ihe Building Division.
VALUATION OF CONSTRUCTION: In all cases, a valuation amount must be entered by Ihe applicant. This figure will be reviewed
and may berevisw by Ihe Building Div. to comply wiIh currmt fee schedules. Contact Ihe Permit Coordinator at 411-4815 for assistance.
PLAN CHECK FEE: Your plan check fee is due at Ihe time Ihe building permit application and construction plans are suhmitted. AU
OIher permit fees are due at the time of permit issuance.
EXPIRATION OF PLAN REVIEW: Ifno permit is issued within 180 days of the date of application, this application will expire
by limitations. The Building Official can extend Ihe time fur action by Ihe applicant up to 180 days, on written request by Ihe 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 authoriud 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 obtllin such.
PW-1102_13I<eV.6100)
Applicant: itA ~ H~:vt6vt-)
I
Date: S),?I )01
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CITY OF PORT ANGELES
LIGHT DEPARTMENT
ELECTRICAL PERMIT
Nl!
17072
./0 - ;-;.:). p9'
Port Angeles, Washlngtoll.m,.__.m__m___.._m_m.mm.._m....__._____.m. 19__m/
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 ~ Ucal work as listed below.
Address ___~__:Jm/..____.nf;!.m___m__m__mmnn..n_n______n__nnmn... Occupancyn_-;r"'1..A~!9_<.---.-.nm-m--.
~:~:~ ~~:~~:~~~-:~~~:~J}:n~;:::::::::::::::.__.-_~::::::::::=::::::::::::::::=::::::::::=:::::::::
Light Outlets..._....._...................._.._..._ Service, voits ../,,;)..9/~.t::'c.i Type of Wtrlng:
II t I Outl t No wires 3 ..-. Armored Cable .............................,
ecep ac e e s................_.............. 'S'iz'e wlre#......... ....d..-................./f..... /........". ,..",.._.....
~ Non-Metallic ............_....................
Dryer, KW nnn..........n......n................
~t:J Knob & Tube...................._..........._
Range, KW.................................__....... Main fuse ....~..~....... ... .........
.>
Enclosure .............h........................
Rigid Conduit .....__.....__......__.........
Water Heater: .
Metallic Tubing ...........................
KW.__...mmmnm............m...m__...'
Heat, Kw...../k...Ll.I3...................
Type of wiring:
Entrance Cable ......................
Raceway ......................._......___._
Circuits, Light.......................................
Utility .........__......__..........................
Motors: size, volts and phase:
Rigid Conduit ...............................
MetalUc Tubing _.m._.........
Current transformers:
No. & Size...............................
Heat .........................._......_._._.._..
, ,
Ser.~N~::~;._..............__.................
.:~
Ser. N o. ...................~.:.::.:,;:c.;.;;.........
Ser. NO....__....n..................................
Range .............................................
Water Heater ....h.........................
Motor ..._........................................
Dryer ....................__...................._...._
Furnace .............._........_.'_......_.._.......
Remark:~ta:__=~~:;~._~:~:~~_/GS_~::.:~:~:_;ei2...~~______~_~~::n~::~:::~_:~.__._::_-:::~:_~:.:~:
\
I _nm__m.m__mm_m.nmmm___m_mm.m..._...n_m._mmmmmm__mm___m....__...m____m.mmmm______.....__._.mm_mn_mm.m__
,I mm____:mmm_m________.._________m__m__mn_n_____m.:m_m._nm_mmnm___mnn--h-.-.:-m~--_:z:;..m_-----mm-:nm.mmm-n"m.
./ ;~_:.~~._~~~__mm___.....m ::~_~_~:__~~_~:~.~.~........ By ---;r/;t--ll~~:~
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
Nt?
17072
I
I
S:::':::::=i===::====:==:=;:.::::=::=:::::::=
WirlngContractor..................................._._....................................._............................._...............By.__...........................................................
\ \
NOTICE-Current must not be turned on unUi Certificate of Inspection has been issued. It work is to be con-
cealed due notice ri,tust be given the Inspector so t1l~ may be Inspected before cODcealment.
. 1M Olympic Pdnte". Inc. " ~
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