HomeMy WebLinkAbout710 W 5th St - Building CITY OF PORT ANGELES
VT IMO PUBLIC WORKS UTILITIES
321 EAST 5TH STREET, PORT ANGELES, WA 98362
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Application Number 11- 00000217 Date 3/11/11
Application pin number 859787 REPORT SALES TAX
Property Address 710 W 5TH ST
ASSESSOR PARCEL NUMBER: 06- 30- 00 -0 -1 -0010 -0000- on your state excise tax form
Application type description PUBLIC WORKS UTILITES
Subdivision Name to the City of Port Angeles
Property Use (Location Code 0502)
Property Zoning RS7 RESDNTL SINGLE FAMILY
Application valuation 0
Application desc
Repair sewer
Owner Contractor
HOLBROCK JULIE E OWNER
81 HART RD
PORT ANGELES WA 98363
Permit SANITARY SEWER HOOK UP
Additional desc
Permit pin number 182386'
Permit Fee 40.00 Plan Check Fee .00
Issue Date 3/11/11 Valuation 0
Expiration Date 9/07/11
Qty Unit Charge Per Extension
1.00 40.0000 EA SAN SEW REPAIR 40.00
Fee summary Charged Paid •Credited Due
Permit Fee Total 40.00 40.00 .00 .00
Check Total .00 .00 .00 .00
Grand Total 40.00 40.00 .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
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Signature of Contractor or Authorized Agent Date Signature of Owner (if owner is builder) Date
T:Forms /Building Division /Public Works Permit
PERMIT INSPECTION RECORD
CALL 417 -4831 FOR UTILITY INSPECTIONS. 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 I NO
PW UTILITIES (Engineering Division)
WATERLINE./ METER
SEWER CONNECTION
SANITARY
STORM
SITE DRAINAGE,:
SITE EROSION CONTROL
PARKING
SIDEWALK j .i
CURB &:GUTTER
DRIVCWAY REPROACH
BACK FLOW DEVICE;' I
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t�., r 3 ,am wa• .�,.Y .��1� #,d'".•'. tr���' d? -v i,. ,,��n 3.,,„ ,2_. i t ,e
ETNAL, INSPECTIONS, REQUIRED PRIOR.TO OCCUPANCS /USE'
RESIDENTIAL a DATE I ES NO COMMERCIAL 1 DATE ACCEPTED
Y,ES. .NO.
CONSTRUCTION R W /]PWl, "CONSTRUCTION, R.W
ENGINEERING 417 -4807 PW ENGINEERING
FIRE 417 -4653 FIRE DEPT..
PLANNING DEPT. 417 -4750 PLANNING. DEPT.
BUILDING 4 .7 ,BUILDING
'4815
T Forms /Bu0dm Drvision/Public Worl s Permit
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CITY OF PORT ANGELES
DEPARTMENT OF COMMUNITY DEVELOPMENT - BUILDING DIVISION
321 EAST 5TH STREET, PORT ANGELES, W A 98362
Application Number
Application pin number
Property Address
ASSESSOR PARCEL NUMBER:
Tenant nbr, name
Application type description
Subdivision Name
Property Use
Property Zoning . . .
Application valuation
07-00000447 Date
199746
710 W 5TH ST
06-30-00-0-1-0010-0000-
JULIE HOLBROOK
RE-ROOF
4/27/07
RS7 RESDNTL SINGLE FAMILY
1700
Owner
Contractor
JULIE HOLBROOK
710 W 5TH ST
PORT ANGELES
(360) 301-4480
OWNER
WA 983632248
Permit BUILDING PERMIT - NO PR FEE
Additional desc RE-ROOF SFR
Permit pin number 100412
Permit Fee 86.60 Plan Check Fee .00
Issue Date 4/27/07 Valuation 1700
Expiration Date 10/24/07
Qty Unit Charge Per Extension
BASE FEE 50.00
12.00 3.0500 HND BL-501-2K (3.05 PER C) 36.60
Other Fees
STATE SURCHARGE
4.50
Fee summary Charged Paid Credited Due
----------------- ---------- ---------- ---------- ----------
Permit Fee Total 86.60 86.60 .00 .00
Plan Check Total .00 .00 .00 .00
Other Fee Total 4.50 4.50 .00 .00
Grand Total 91.10 91.10 .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.
Signature of Contractor or Authorized Agent
Date
~=:J~'~.~/ CzL;;/--'--"-- t-j /2.7/ ()?
\Jignature of Owner (if owner is builder) Date
T:IPoliciesII102_15 building pennil inspection reeord05.wpd [1/4/2005]
BUILDING PERMIT INSPECTION RECORD
CALL 417-4815 FOR BUILDING INSPECTIONS. Ci\LL 417-4735 FOR ELECTRICAL INSPECTIONS.
CALL 41 7-4807 FOR PUBLIC WORKS UTILITIES
PLEASE PROVIDE A MINIMUM 24 HOUR NOTICE. iT is UNLA WFUL TO COVER, iNSULATE OR COiVCEAL A.NY WORJ( BEFORE
I/VSPECTED AND ACCEPTED. POST PERMIT IN A CONSI)ICUOUS LOCATlON.
KEEP PERMIT CARD AND APPROVED PLANS AT JOB SITE
INSPECTION TYPE IJATE ACCEPTEIJ COMMENTS
YES NO
FOUNDATION:
FOOTINGS
SHEAR WALLS 1 WALLS
FOUNDA TION DRAINAGE 1 DOWN SPOUTS
PIERS I I
POST HOLES (POLE BLDGS.)
PLUMBING
UNDER FLOOR 1 SLAB
ROUGH-IN
WATER LINE (METER TO BLDG)
GAS LlNE FINAL DATE ACCFPTED BY:
BACK FLOW / WATER
AIR SEAL
WALLS
CEILING
FRAMING
JOISTS 1 GIRDERS
SHEAR WALL/HOLD DOWNS I
WALLS 1 ROOF 1 CEILING
DRYW ALL (Th'TERJOR BRACED PANEL ONLY)
T-BAR
INSULATION
SLAB
WALL 1 FLOOR 1 CEILING
MECHANICAL
ROUGH-IN
HEAT PUMY I FURNACE 1 DUCTS
GAS LINE FINAL DATE ACCEPTED BY:
WOOD STOVE 1 PELLET 1 CHIMNEY
MANUFACTURED HOMES
FOOTING 1 SLAB
BLOCKING & HOLD DOWNS
SKJRTING
PLANNING DEPT. SEP ARA TE PERMIT #'s SEPA:
Y' ARKING/LI GHTING ESA:
LANDSCAPING SHORELINE:
FINAL INSPECTIONS REQUIRED PRIOR TO OCCUPANCY/USE
RESIDENTIAL DATE .YES NO COMMERCIAL DATE ACCEPTED
YES NO
ELECTRICAL. LlGHT DEFT. 417-4735 ELECTJUCAL
LIGHT DEPT
CONSTRUCTION R.W. 1 PWI CONSTRUCTION - R.W.
ENGTNEERING 4] 7.4807 PW 1 ENGINEERING
FIRE 4 J 7-4653 FIRE DEPT.
PLANNING DEPT. 417-4750 PLANNING DEPT.
BUTLD1NG 4 J 7-4815 i-j - '30 --()1 r-B BUILDING
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BUILDING PERMIT - APPLICATION
Date Issued:
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
Applicant m Agent ^ ...:-t If e_ Hut hJ1JDIL
Owner: \.)"11 \ I (:. I 110 r 0U/C
Address: / / U W 5,/11 <5T City: I, jIJ-
Phone: 3{po 30 /~L/V 00
Phone:
Zip: 96'36 L
Architect/Engineer:
Contractor
Phone:
State License #:
Exp:
Phone:
Zip:
ZONING:
71f)
City:
W j'f-lI\
Address:
PROJECT ADDRESS:
LEGAL DESCRIPTION: Lot:
CLALLAM COUNTY PARCEL NUMBER:
Block:
Subdivision:
TI7E OF WORK: SIZEN ALUATION:
ct'Residential D New Constr. ~roof D Stove SF. @$ /SF. = $ i 700, c):;
D Multi-family D Addition D MoveD Garage SF. @ $ /SF. = $
D Commercial D Remodel D Demolition D Deck SF. @ $ /SF. = $
D Repair D Sign D Other TO;rAL VALUATION $
BRIEF DESCRIPTION RF THE PROJECT: R e - R (9(,1- ,
'{<-e.-WI i) J ffl D I ~ 7M pCt\ ' :5tl1v1~ / -e 5 ~) A$tct II-dJN e. t.d
COMMERCIALIRESIDENTIAL: Occupancy Group:
No. of Stories: Lot Size: Existing Sq. Ft.
Total lot coverage %
Occupant Load:
& Proposed Sq. Ft.
Construction Type:
= TOTAL Sq. Ft.
APPROVALS:
PLAN:
BLDG:
DPWU:
FillE:
OTHER:
PLANNING USE ONLY:
ESAlWetland(s): DYes DNo SEPA Checklist required? D YesD 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 Building Division to comply with current fee schedules. Contact the Permit
Coordinator 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. .
EXPffiATION OF PLAN REVIEW: lino permit is issued within 180 days ofthe 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
RI05.3.2 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. ---- .
T:\FORMS\BldgPermitform.wpd Applicant: ~)~ CJ/ 'lr----- Date: Lj /2-? / rJ 7
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CITY OF PORT ANGELES
DEPARTMENT OF COMMUNITY DEVELOPMENT - BUll..DING DIVISION
321 EAST 5TH STREET, PORT ANGELES, W A 98362
Application Number
Application pin number
Property Address
ASSESSOR PARCEL NUMBER:
Application type description
Subdivision Name
Property Use
Property Zoning . . .
Application valuation
06-00001346 Date 12/26/06
253200
710 W 5TH ST
06-30-00-0-1-0010-0000-
MECHANICAL APPL. PERMIT
RS7 RESDNTL SINGLE FAMILY
3000
Owner
Contractor
HOLBROOK JULIE
710 W 5TH ST
PORT ANGELES
(360) 301-4480
WA 983632248
RUDY'S CONSTRUCTION CO.
5228 49TH AVE SW
SEATTLE WA 98136
(206) 300-2208
Permit . . . . .
. Additional desc .
Permit pin number
Permit Fee
Issue Date
Expiration Date
MECHANICAL PERMIT
FREE STANDING PROPANE FIRE PLC
92528
71.30 Plan Check Fee
12/26/06 Valuation
6/24/07
.00
o
Qty Unit Charge Per
Extension
50.00
10.65
10.65
BASE FEE
1.00 10.6500 ECH ME-OTHER APPL. N/R
1.00 10.6500 ECH ME-GAS PIPE 1 TO 5
Fee summary Charged Paid Credited Due
----------------- ---------- ---------- ---------- ----------
Permit Fee Total 71.30 71.30 .00 .00
Plan Check Total .00 .00 .00 .00
Grand Total 71.30 71.30 .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.lhereby-certify-that--ll"lave-read-and examined this application and know the same to betrue 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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Signature of Contractor or Authorized Agent
Date
r
'ignature of Owner (if owner is builder)
Date
T;\Policies\1102_15 building pennit inspection record05.wpd [1/412005]
BUILDING PERMIT INSPECTION RECORD
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 NO
FOUNDATION:
FOOTINGS
SHEAR WALLS 1 WALLS
FOUNDATION DRAINAGE 1 DOWN SPOUTS
PIERS
POST HOLES (POLE BLDGS.)
PLUMBING
UNDER FLOOR 1 SLAB
ROUGH-IN
WATER LINE (METER TO BLDGl
GAS LINE FINAL DATE ACCEPTED BY:
BACK FLOW 1 WATER
AIR SEAL
WALLS I
CEILING I
FRAMING
JOISTS 1 GIRDERS
SHEAR W ALUHOLD DOWNS
WALLS 1 ROOF 1 CEILING
DRYWALL (INTERIOR BRACED PANEL ONLY)
T-BAR
INSULATION
SLAB
WALL 1 FLOOR 1 CEILING I I
MECHANICAL
HEAT PUNW 1 fuRNACE 1 DUCTS
GAS LINE l'2.hll/() 7 .In FINAL 4-,U-ol DATE 3t-L-
WOOD STOVE 1 PELLET 1 CHIMNEY , ACCEPTED BY:
COMMERCIAL HOOD 1 DUCTS
MANUFACTURED HOMES
FOOTING 1 SLAB
BLOCKING & HOLD DOWNS
SKIRTING
PLANNING DEPT. SEPARATE PERMIT#'s SEPA:
PARKlNG/LlGHTlNG ESA:
LANDSCAPING SHORELINE:
FINAL INSPECTIONS REQUIRED PRIOR TO OCCUPANCYIUSE
RESIDENTIAL DATE YES NO COMMERCIAL DATE ACCEPTED
YES NO
ELECTRICAL - LIGHT DEPT. 417-4735 ELECTRICAL
LIGHT DEPT
CONSTRUCTION R W.I PWI CONSTRUCTION - R.W.
ENGINEERING 417-4807 PW 1 ENGINEERING
FIRE 417-4653 FIRE DEPT.
PLANNING DEPT. 417-4750 PLANNING DEPT.
BUILDING 417-4815 BUILDING
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T:\Policies\1102_15 building permit inspection record05.wpd [1/412005]
BUILDING PERMIT - APPUCA TION
DateJssued:
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)417-47U
Applicant or Agent: LlI~' e,
Owner: -S 'A1t\t\ -e....-
Address: lID W f:) i- f\
o (lofDc)/L-
Phone:
3(;0 -3{)'/~ 44
. Zip:
q f'S6J.
Architect/Engineer:
Contractor~t I L ~ C AW\ ",--t,
\
Address:
State License #:
Exp:
f)Dt, ~()O
Phone:, ;l.::LO ~
Zip:
ZONING:
PROJECT ADDRESS:
LEGAL DESCRIPTION: Lot:
CLALLAM COUNTY PARCEL NUMBER:
{to
\J
City:
'5+1\ 5'1:.,
Block:
Subdivision:
. .
Ty,pE OF WORK: SIZEN ALUATION:
ZResidential 0 New Constr. 0 Re-roof 0 Stove - SF. @$ /SF. = $
o Multi-family 0 Addition 0 Move 0 Garage SF, @ $ /SF: = $
o Commercial 0 Remodel 0 Demolition 0 Deck SF, @ $ /SF, = $ 1::. ~r_,l
o Repair 0 Sign 0 Other , .f< J TOTAL VALUATION $ ,L~
BRIEF DESCRIPTION OF THE PROJECT: I (II J T"'ll \ P ,.l) Da1' ( +a/IJ Ie ff
~ tI [) P OM e. f~ flz P J ({~ ' ,
COMMERCIAL/RESIDENTIAL: Occupancy Group:
No. of Stories: Lot Size: Existing Sq. Ft.
Total lot coverage %
Occupant Load:
& Proposed Sq. Ft.
Construction Type:
= TOTAL Sq. Ft.
PLANNING USE ONLY:
APPROVALS:
PLAN:
BLDG:
DPWU:
FIRE:
OTHER:_
ESAlWetland(s): 0 Yes 0 No SEPA Checklist required? 0 Yes oNo 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 Building Division to comply with current fee schedules. Contact the Permit
Coordinator at 4 17 -48 I 5 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: Ifno 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
RI05.3.2 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 tf?)'~~rk~' " J~.
T:\FORMS\BldgPennitfonn.wpd APPlican~ i~) L; ~. Date: J 2-/ L-Ct / cJ .6
'[i
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CITY OF PORT ANGELES
PUBLIC WORKS - ELECTRICAL DIVISION
,21 EAST 5TH STREET. PORT ANGELES. WA 98362
\
Applicatlon Number
Application pin number
Property Address
ASSESSOR PARCEL NUMBER:
Appllcatlon type description
Subdivision Name
Property Use
Property Zoning .
Application valuation
06-00001346 Date
253200
710 W 5TH ST
06-30-00-0-1-0010-0000-
MECHANICAL APPL PERMIT
3/29/07
RS7 RESDNTL SINGLE FAMILY
3000
Owner
Contractor
HOLBROOK JULIE
710 W 5TH ST
PORT ANGELES
(360) 301-4480
WA 983632248
RUDY'S CONSTRUCTION CO
5228 49TH AVE SW
SEATTLE WA 98136
(206) 300-2208
Permit
Addltional
Permit pin
Permit Fee
Issue Date
Expiration
desc
number
ELECTRICAL ALTER RESIDENTIAL
ALL GOOD/ FIREPLACE CIRCUIT
97865
46 00 Plan Check Fee
3/29/07 Valuation
9/25/07
00
o
Qty
1 00
Unit Charge Per
46 0000 ECH EL-R OR RM 1-4 ALT CIRCUITS
Extension
46.00
"l
"""
~
Date
Fee summary Charged Paid Credited Due
----------------- ---------- ---------- ---------- ----------
Permit Fee Total 46 00 46 00 00 .00
Plan Check Total 00 00 .00 00
Grand Total 46.00 46 00 00 00
t
~
~
COMMENTS/ACTION NEEDED
ELECfRlCAL PERMIT INSPECfION RECORD
CALL 417-4735 FOR ELECTRICAL INSPECTIONS. PLEASE PROVIDE A MINIMUM 24 HOUR NOTICE IT IS UNLA WFUL TO COVER,
INSULA TE OR CONCEAL ANY WORK BEFORE IT IS INSPECTED AND ACCEPTED.
KEEP PERMIT CARD AND APPROVED PLANS AT JOB SITE
INSPECTION TYPE
DATE
COMMENTS
I
NO
GENERAL COMMENTS:
PW.II02 1$1~]
CITY OF PORT ANGELES
LIGHT DEPAR~
ELECTRICAL PERMIT
Nt!
17426
Port Angeles. wasb1ngton....L:t...'::::...L.{!.nn...m..m..m....n_m.. 19nf.~
In accordance with the City Ordinance to regulate the Installation, extension. or repair of elec-
trical equipment In. on, or about any building or other structure In the City of Port Angeles. per-
:~:::s: 1:_~L~~.::~:.:~:{l::__~_o_r~..::.:::~::..~~.IO:~cupancy___~.J..n....._.n__.__.n..
Owner cY:.'rld!::: mnmf-.4e.~m..mnm Tenant.__...n__m.___nnnm_n.m_mnm____n...n..mmn...n...n
Wiring ~o~~~:~~~.:J~!.J!n~::n.~"f&~.nn--nn..--nn Byn.nm..mnmmmnm...mnm.mm'.n.m._.__._m.nn
Light OutletB---......h.........._._.._...._n_nn. Service, volts n.I_~_'!.Li$....'t!!.. Type 01 Wiring:
:3 I
No. wires ________.__......h........h.._~....
::~n 7~::s::~%~::
Enclosure __..........___....m.____m__m..n
Receptacle Outlets..........................__...
Dryer, KW....uun....n........n.......n.......
Range, KW m__mmmnmnn....
Water Heater:
KW.nnhhh_______nn____________nn_
Type of wiring:
Entrance Cable ............m.......
Heat: KW............__......__.__.....____....__.....
Motors: size, volts a.nd phase:
Rigid Conduit .....................
MetalUc Tubing "m__
Current transformers:
No. & Size.............................
Ser. No.............--...........--.....--.--........
Ser. No. ----.------.....--..------..--...----------..
Ser. NO....____.__.....................h.......__....
Armored Cable ................h............
Non.Metalllc .....n.........____._._._._._h_
Knob & Tube................................_
Rigid Conduit .hnh............_.__....__h
Metallic Tubing .........__................
Raceway ..............................._._..._
Circuits, Light.......................................
Utillty....___.____nh___hn.hh...............n
Heat ..........................................._..
Range .............................................
Water Heater ...............................
Motor ..............................................
Dryer ....__....__..__.__............................._
Furnace ..........................~......_.n........
Total I..oad............................. Ser. NO..____............_..__.h.h...____....__... Total.......................................
~~:~~~~:m:::::::.:::=2~::~~~:~=:=~=::~=:~:::~:=:=~::::::::::::::::::::::::::;~~::::::::::::::::::::::::::::::::::::::::::
.;:~;~-;~~-;-.n...---..-.-.......m..;~~~~:.~:~~;~~-----n.---m-----h--..---.--nG7/....../Jn..~nmmm...................m...
. No.-..-.-..~......................... B W. ^' ,,7/
..:_...___m.m...:........nn_._____ y ..7T--..V.p'----y..nm.mm.mnm...m.m.-.......----
NOTICE-Current must not be turned on until Certificate of Inspection has been issued. If work is to be COD-
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?
17426
AddJ;'ess..................._..........................................................................._......................................Date..._......_......................_......_.................
Owner..................................._.........._......_......_...............................................................Tenant..........................................-.........................
\
\
\.
Wiring Contractor........................................... ...............................................................................By..........~...................................................
NOTIC~urrent must n6t 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.
\
1M Olympic Printers, Inc..~
~
~
ELECTRICAL WORK PERMIT APPLICATION
,
..
Job wired by
o Ele<:trical Contractor 0 Owner
Installation description
o Commercial )ilResidential
.
DNew
D Altered/Addition
Purchaser's mailing addresk
t~'). (..,:\o\'., k t-
CilY
~'" i VV\ H,0'^'1
Tel~phone number
U;-
f..i
WlaA- ZIP
FAX number
crcrr-3^'s
Iv> c.\.. II ",1
0""'1',
\
Q.,
kv-er\(A( e,.
e.
ule Inspection:
. W
Owner as defined by RCW.19.28.26J:(l) 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. Tenl Qr lrose.
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-
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
Utility Specifications.
Signature or wner. eleclrlcal co tractor or electrical administrator
o Cash 0 Check #
~Credit Card @s;> Mastercard Discover
Card# !: ~
x
Date:
Expiration Dat
of card
Service Information
r Aditio sandorsu t
D NO LOAD CHANGES
o Baseboard KW
o Furnace KW 0 Overhead Service
o Heat Pump _ Ton LAR 0 Temp Service
;Jil!...Fan-wall .,s. t<:W D Underground Service
SAME DAY INSPECTION, CALL BEFORE 7:00 AM 360-417-4735
Voltage
PhaseD 1 D 3
Service Size: _
Feeder Size:
,,- ROUGH-IN THERMOSTAT SERVICE
Oal~ Approved By Dale Approved By Dale Approved By
~/;;€CAL.A9 DITCH FEEDER
D. Apprllvcd By Ollie Approved By / Dlle Appro..ro By
Inspection Area, Building or Equipment Inspected Action Taken Electrical
Date Inspector
fB~"rl!!!'V-
"u"",__n --
MAR 2 3 200 7
LIGHT DEPT.