HomeMy WebLinkAbout2532 W 16th St - Buildinge P O T AV
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Application Number 04- 00000052 Date 3/10/04
Pin number 781164
Property Address 2532 W 16TH ST
ASSESSOR PARCEL NUMBER 06 30 -00 4 4 0050 0000
Application description RES MANUFACTURED HOME
Subdivision Name
41 16 Property Use
Property Zoning RS9 RESDNTL SINGLE FAMILY
4 r Application valuation 64600
Owner
GERALD MORRIS /MARILYN DAVIS
1009 S LAUREL STREET
PORT ANGELES WA 98362
Other Fees
T \PLANNING\FORI4s 1 :102:1 [11/14/2003]
CITY OF PORT ANGELES
DEPARTMENT OF COMMUNITY DEVELOPMENT BUILDING DIVISION
321 EAST 5TH STREET PORT ANGELES, WA 98362
Contractor
OWNER
Structure Information NEW 1280 SF MAN W /ATTACHED GARAGE
Construction Type TYPE V NON RATED
Occupancy Type SINGLE FAM CONGREGATES
Other struct info TOTAL LOT COVERAGE 19 00
EXISTING LOT COVERAGE 1 00
LOT SIZE 9075 00
PROPOSED LOT COVERAGE 1760 00
TOTAL LOT COVERAGE 1760 00
NUMBER OF UNITS 1 00
Permit ELECTRICAL NEW RESIDENTIAL
Additional desc MOBILE HOME
Sub Contractor QUALITY ELECTRIC
Permit Fee 76 30 Plan Check Fee 00
Issue -Date 3/10/04 Valuation 0
Expiration Date 9/06/04
Qty Unit Charge Per
1 00 76 3000 ECH EL -MANF HOME SERVICE FEEDER
Special Notes and Comments
Address numbers shall be plainly visible from the street
Address numbers shall be a minimum of six inches high and be
in contrast in color of there background
A residential fire sprinkler system shall be installed per
NFPA 13D will be required
2nd option is to install an out side alarm bell that is
eletronicly connected to the residence s smoke detectors
The alarm bell will be painted red in color and identified
as Fire alarm
Electrical load calculations and elctrical permits are
required
SEWER SYSTEM DELV CHARGE
STATE SURCHARGE
PW WATER SYSTEM USE FEE
Extension
76 30
745 00
4 50
1025 00
Fee summary Charged Paid Credited Due
Permit Fee Total 76 30 76 30 00 00
Plan Check Total 00 00 00 00
Other Fee Total 1774 50 1774 50 00 00
Grand Total 1850 80 1850 80 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 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 Signature of Owner (if owner is builder) Date
c-,:
CALL 417 -4815 FOR BUILDING INSPECTIONS. CALL 417 -4735 FOR ELECTRICAL 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
FOUNDATION:
FOOTINGS
WALLS I
FOUNDATION DRAINAGE /DOWN SPOUTS I I I
ELECTRICAL (LIGHT DEPT) SEPARATE PERMIT
ROUGH -IN I I I
PLUMBING
UNDER FLOOR SLAB
ROUGH -IN I
WATER LINE (METER TO BLDG) I
GAS LINE I I
BACK FLOW WATER I I
AIR SEAL
WALLS I
CEILING I I I I
FRAMING
JOISTS GIRDERS I
SHEAR WALL/HOLD DOWNS I
WALLS ROOF CEILING I I I
DRYWALL (INTERIOR BRACED PANEL ONLY) I I I
T -BAR I I I
INSULATION
SLAB I I
WALL FLOOR CEILING I I I I
MECHANICAL
HEAT PUMP I
GAS LINE I I I
WOOD STOVE PELLET CHIMNEY I I I
HOOD DUCTS I I I I
PW UTILITIES SITE WORK (Engineering Division) SEPARATE PERMIT 4's:
WATERLINE METER I
SEWER CONNECTION I
SANITARY
STORM I I I
PLANNING DEPT SEPARATE PERMIT #'s
PARKING/LIGHTING I I I
LANDSCAPING I I I
RESIDENTIAL
ELECTRICAL LIGHT DEPT
CONSTRUCTION R.W PW/
ENGINEERING 417 -4807
FIRE 417 -4653
PLANNING DEPT 417 -4750 I
BUILDING 417 -4815 I
T\PLANNING\FORMS \1102.15 [11/14/2003)
BUILDING PERMIT INSPECTION RECORD
DATE ACCEPTED
YES I NO
SEPA.
ESA.
SHORELINE.
COMMENTS
FINAL INSPECTIONS REQUIRED PRIOR TO OCCUPANCY/USE
DATE YES NO COMMERCIAL DATE ACCEPTED
YES I NO
417 -4735 ELECTRICAL
LIGHT DEPT
CONSTRUCTION R.W
PW ENGINEERING
I FIRE DEPT
I PLANNING DEPT
I BUILDING
I I I
I I I
I I I
a -NO r
CITY OF PORT ANGELES
DEPARTMENT OF COMMUNITY DEVELOPMENT BUILDING DIVISION
321 EAST 5TH STREET PORT ANGELES, WA 98362
Application Number 04 00000052
Pin number 781164
Page 2
Date 3/10/04
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 Signature of Owner (if owner is builder) Date
T•\PLANNING\FORMS \1102.15 [11/14/2003]
ELECTRICAL LIGHT DEPT 417 -4735
BUILDING PERMIT INSPECTION RECORD
CALL 417 -4815 FOR BUILDING INSPECTIONS. CALL 417 -4735 FOR ELECTRICAL 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 NO
FOUNDATION:
FOOTINGS
WALLS
FOUNDATION DRAINAGE /DOWN SPOUTS
ELECTRICAL (LIGHT DEPT) SEPARATE PERMIT
ROUGH -IN
PLUMBING
UNDERFLOOR /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
GAS LINE
WOOD STOVE PELLET CHIMNEY
HOOD /DUCTS
PW UTILITIES SITE WORK (Engineering Division) SEPARATE PERMIT #'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 I NO
CONSTRUCTION R.W PW/
ENGINEERING 417 -4807
FIRE 417 -4653 I
PLANNING DEPT 417 -4750 I
BUILDING 417 -4815 I
T \PLANNING\FORMS \1102.15 [11/14/2003]
,fig L160. I
ELECTRICAL
LIGHT DEPT
CONSTRUCTION R.W
PW ENGINEERING
I FIRE DEPT
I PLANNING DEPT
I BUILDING
~
..........-
. . . . CITY OF PORT ANGELES . .
DEPARTMENT OF COMMUNITY DEVELOPMENT - BUTI...DING DIVISION
321 EAST 51H STREET,"PORT ANGELES, W A 98362
95.00
1/27/04
7/25/04
Plan Check Fee .
Valuation . . .
.00
64600
;~:'" '
^');- :".G.0,~1:(;'}~'i:" <.1 ".;',
Application Number
Property.Address .
ASSBSSORPARCELNUMBER:
..Application description
... ~pbdivision Name
'ProJ;lerty Use . . . .
'Property Zoning . ..
~plication valuation
04-00000052 Date 1/27/04
2532 W16TH ST
06-30-00~4~4-0050-0000-
RES MANUFACTURED HOME
RS9 RBSDNTL SINGLE FAMILY
64600
Contractor
GBRALD.MORRIS/MARILYN DAVIS
1009 S'LAORBL STREET
PORT ANGBLES WA 98362
;;I!-';'--M-.-c.:--c;~,
-..,_':_~:Structure Information
Construction. Type '.
. Occupancy Type . . .
Otherstruct info. . . .
NEW 1280 SF MAN W/ATTACHED GARAGB
TYPB V NON-RATED
SINGLE FAM & CONGREGATES
TOTAL Ik LOT. COVERAGB
EXISTING LOT CovERAGB
LOT SIZE
PROPOSED LOT COVERAGB
TOTAL LOT COVERAGB
NUMBBR OF UNITS
19.00
1.00
9075.00
1760.00
1760.00
1.00
------~-----------------------~------------~-------------------------------~
Permit . . . .
.' Additionai desc
Permit Fee '. .
Issue nate
EXpiration Date
BUILDING PERMIT -RESIDENTIAL
480SF ATTACHED GARAGB
204.75 Plan Check Fee .
1/27/04 Valuation ..
7/25/04
81.90
9600
WE FEE
8.00 14.0000 THOU BL-2001-2SK (14 PER K)
Qty Unit CharsJe Per
Extension
92.75
112.00
--~---------------------------------------~-_._-----~-------.-,~--------------
Permit . . . .
Additional desc
p~rmit Fee
Issue Date
~~fationDate
PUBLIC WORKS RES WATER SERV
DROP IN WATER METER
150.00 Plan Check Fee
1/27/04 . Valuation . .
7/25/04
.00
64600
-......._,..;;....
c.:;:?J~~y unit Charge Per
Extension.
150.00
:'. C0~ r:; BASE FEE
.' .
- - -.- - -:"'J"'l;~.7"~ ,~\.---- -- - - - - - - - ~ - - -- - - - - - - - - - - - - - - - - - - - - - -- - - - - - -... - - - --......... -... - -'- - ~ --
Permit ... . RIGHT OF WAY
,~.__Additi9naldesc
Permit Fee
i:ssu~Date
EXpifa:tion nate
45.00
1/27/04
7/25/04
Plan Check Fee .
Valuation .
.00
64600
Qty Unit Charge Per
1.00 45.0000 ECH RIGHT OF WAY PBRMIT
Extension
45.00
------~~~~~---~-~-.------~-------~~_..._-------~-~'----~~~~--------------~-----~
Permit . . . .
_ . _.. .,Additional desc
Permit Fee
Issue Date
'EXpiration Date
SANITARY SBWBR BOOK UP
Separat~f'. . m,ltsaRtreqUlrefor efebbical work, SEPA, Shoreltne. ESA, utilities,1fJffiP.ROWRI public improvements.' This pel1l1lt.~comes
nullan(j.vqldjf.wor:kor construction authorized is notcommencedwithin1.80days, if construction or work Issuspendedo~a~iri~oned
fora period of180 days after the work as commenced, or if requiredlrispections havenot been requested within 180 days from.thEfl.ast
inspectio.n~J hereby certify that I have read and examined tI:lis application and know the same to be true and correct. AHprov!Sionspf
laws and ordinances governing thistype.of work will be complied with whether specified herein or not. The granting of a permitdoesp~t
presumE;t.tqgive authority to violate or cancel the provisions of any state or local law regulating construction or the performance (If
conskUOQon. . . ~aht()f7J1{~. ..
Date
Signature 6fOWner (ffowner is builder)
. T:'l'I..ANN'IN~RMS\1I02.1S [1111412003]
P8'~,~'. -.
,V~.\:::~":. '
. .:,~\-.~_. -:."
.::'~L~j'r~"
BUILDING PERMIT INSPECfiON RECORD
CALL4 I 7-48 IS FOR BUILDING INSPECTIONS. CALL 4 I 7-4735 FOR ELECTRICAL INSPECfIONS.
PLEASE PROVIDE A MINIMUM 24 HOUR NOTICE; "IT IS UNLAWFUL TO COVER,IIVSupATE ORqONCEALANY WOo
INSPECTEDAjVD ACCEPTED. POST PERMIT IN A CONSPICUOUS LOCATION.
.0
, \,..
KEEP PERMIT CARD AND APPROVED PLANS AT JOB SITE. ......... .....
.... INSPECTION TYPE DA.TE ACCEPTED .... . COMMENTS . ,
.'
YEs I NO '.' .
FOUNDATION: .
. ........< I
FOOTIJIlGS ...... I
WALLS ,....
<~ .'
FOUNDATION DRAINAGEIOOWN Spours .
ELECTRICAL (UGHT DEPT) SEPARATE PERMIT: t# . .... ,:" [e.
ROUGH-IN l , . .' - '0 J .' .( .."Di....... t'
'. .'
PLUMBING "', .:. "....
UNDER FLOOR I SLAB ...
ROUGH-IN I
WATER LINE (METER TO BLDG) .
GAS LINE
BACK FLOW I WATER '. ..
AIR SEAL ....
WALLS .. I
,
CEILING , ..
FRAMING ,. . Jr, ..' ,
JOISTS/.GIRDERS
SHEAR W ALLIHOLD DOWNS .
WALLS I ROOF I CEILING ....
DRYWALL (INTERIOR BRACED PANEL ONLY)
T-BAR .
INSULATION
SLAB
WALL I FLOOR I CEILING . . I
.
MECHANICAL .
HEAT PUMP
GAS UNE
WOOD STOVE I PELLET I CHIMNEY
HOOD I DUCTS
PW UTILITIES I SITE WORK. (Engineering Division) SEPARATE PERMIT.#'s:
W ATERLINEI ~TER I....
SEWER CONNECTION .
.,
SANITARY
. STORM
.
PLANNING DEPT. SEPARATEPERMITtI's SEPA:
PARKINGlLIGHTlNG . ESA:
. . ~DSC.~PING ....... " St!()~:
...... ' " .. ,,' ,,",, ','; ..... "
,. ;7" : . " ',. '. FlNAli INSPECTIONS REQUIRED PRIOR TO OCCUPANcYtuSE .,. . .
;I- ;; '.
RESIDENTIAL n.' '" DATE .' YES NO COMMERCIA.L DATE." ACCEl"rED .
'/1 YES. ."NO ~,
'. .... ,
ELECTRICAL - UGHT DEPT. 417-4735 I' ELECTRICAL "
UGHT DEPT
CONSTRUCTION R. W; I PWI CONSTRUCTION - R. W.
ENGINEERING 417-4807 PW I ENGINEERING
FIRE 417-4653 , FIRE DEPT. "
: "
~LANNING DEPT. ..
417-4750 PLANNING DEPT. .
BUILDING .' :417-4815 BUILDING ' ..
T:\PLANNING\FORMS\II02.15 [II/14IlOO3]
j.:;'
...CITY qF PORT ANGELES
DEPARTMENT OF coMMUNITY DEVELOPMENT -'BUlliDINGDIVISION
321 EAST 51H STREET,PORT ANGELES, W A 98362
Separate P~rmltsare required for electrical work, SEPA, Shoreline, ESA, utilities, private and public improvements. Thispe.-mltbecomes
nullllnd void. if work orconstructlon authorized is not commenced within 180 days,. if construction or work Is sus~nded or1lbandoned
for a p~iiodof180days after the work as commenced, or if required Inspections have not been requested within180daysf@lTl.the.last
Insp~ctlon. J here~y certify that I have read. and examinedthisapplication and know the same to be true and . correct,A1IPr:6yi~i~ns(>f
laws and ordinances govemingthls type of work will be complied with whether specified herein or not. The grantirigof a perrriitdOesnot
presum~"togiveauthority to violate or cancel the provisions of any state or local law regulating construction or theperf()rmanceof
constructlOrl," .
::;'.:~:::;.~:
tl4-00000052
Page . 2
Date 1/27/04
unit Charge Per
95.0000 SA SANSEWBR HOOKUP
Extension
95.00
~~~.~-~~-~~~--~-----~-----~-------~-------~._~~~~--~--~~--~~-----------~-----
. . .
Permit . . . .
Additional desc
Pem1tFee
Issue Date
Expiration Date .
BL . MANUFACTURED HOME
HOMBS NORTHWEST MOD#48724
230.00 Plan Check Fee.
1/27/04 Valuation
7/25/04
.00
64600
Per
Extension
230.00
BASE FEE
~---~----~-~------------~-----------~---~---------~------~------------------
Special. "Notes and Comments
. Addrflssnumbers shall be plainly visible from the street.
Address numbers shall be a minimum of six inches high and be
ill contrast in color of there background.
A residential fire sprinkler system shall be installed per
NFPA13D will be required. .
2nd option is to install an out side alarm bell that is
elet;-onicly connected.. to the residence's smoke detectors.
The alarm bell will be painted red in color ~d identified
as nFire alarmn .
Electrical load .calculations and elctrical permits are
required.
--~---~-~-----------------~~-~--~_...~--------------------.----------.-.-----
Other Fees
SEWER SYSTEM DEr.V CHARGE
STATE SURCHARGE
PW WATER SYSTEM USE FEE
745.00
4.50
1025.00
., . . '.' ,0. . ,_ .. ..
" ~ . ..
Fee. summary
credited
Charged
Paid
Due
,-- - -,.....-----,----_...
perinit Fee Total
~liU1~Check.Total
.,pther Fee Total
;J~i;~~ Total
:o'C: .,",,:
.00
.00
.00
.00
.00
.00
.00
.00
'724.75
81.90 .
1774.50
2581.1~
724.75
81.90
1774.50 .
2581.15
0~~-;
Date
Signature of Owner (if owner is builder)
Signature of Contractor or Authorized Agent
T:\PI;AJllNING\FORMS\IIQ2.IS [1111412003)
f
:.:~~C!";:~:';l~t~:':,":::i;~,:~;':~?,:~'" , " ' ~.:.'t~~1rr:':"i:~'~"1~':('~'''ffi}~:i~".,(i;;l;i('::'~'':\ , ,',' ::,,"'~i~i,,::,,,,,),,~~, ~:i'~,f~ '
BlJILi)ING PERMIT~SPECrlON RECORD
:,:;.1 ' : /',.' .,
CALL 417-4815 FOR BUILDING INSPECflONS. CALL 417-4735 FORELECfRICAL INSPECfIONS.
I.", ,c' . , ','.." ' ",( ,..',.... ;,,0,' ",' '''', " ",':i,:":,>',:,
PLEASE PROVIDE A MINIMUM 24H01JR;.l'IOTICE.lTIS UNLAWPut TO'COVER;'INSuy,'ff10R-CONCEAL ANY WORiBEirO~',
INSPECTElfAimAPg1PTED. ' POST PllltMIT IN A: C;{)NS~IgtOUS:I.OCATION. ' ,',' ,
KEEPPElUJ1!r CARD ANDAPPROVEDPLANS:ATI0B:SITE
.'
INSPECl'ION TYPE " , ,DATE ' " A~gpnm ,'" >', COMMENTS ,".
", I - ""
YES NO " " "
" "" J'~~iJlHI, !J14tq:f).'~11~1
FOUNDATION:
FOOTINGS ""~~', 3 -I? ,,6 f.(
WALLS " , ~,A '. ' '," 'C_ ~ A12-> ~.t..(~
"FOUNDATION DRAlNAGEIDOWN SPOUTS ' , " 1.L "
ELECTRICAL (LIGHTDEPT) SEPARATEPERMrr: # V
,1 I I ,
ROUGH-IN , ,
PLUl\f~ING , ";";,,' ~
:'1,' "
~,ERFLooR:1 SLAB " ,
,
ROUGH-IN ,"
W A TERUNE (METER TO BLDO) ,
GAS'LINE ,
BACK FLOW I WATER :
'"
AIR SEAL
I .
WALLS
CEILING " I , , " ,', " , " .:
FRAMING
JOISTS I GIRDERS ,
SHEAR WALUHOLD DOWNS IS"?'~OIJ ,J..-L.
WALLS I ROOF I CEILING l~ -'tj.-(:)l-' ~l~ 1"
DRYWALL (INTBRIOR )3RACED PANEL ONLY) I
T-BAR " , :
INSULATION "
SLAB ,
WALL t FLOOR I CEILING I -
MECHANICAL '
HEAT PUMP
GAS LINE , '"
, WOOD STOVE I PELLET I CHIMNEY
HOOD I DUCTS ""
PW UTILmES1 SITE WORK (Engineering Division) SEPARATE PERMIT #'s:
WATERLINE I METER "
SEWER CONNECTION
SANITARY
SWRM ,
, , ,'" "
P~~G DEPT., sEPARATE PERMIT #'5 SErA:
PARKING/LIGHTlNG , ESA:
LANDSCAPING> . "".
, ., '," ~'1,+ \3:'1':" ,'\ ,t":,,', " ,., , ,8,HO~, " ',;, .. ,
.' ..... , "; " ".., ," FIl\I,AA1JltlSI',EqTI()~s,RE9UIRED PRIOR. TO,~C~~CYLUSEJ\~iii';!,i';\':' '" ::, ',: -, ,,:;'; -c__:" ....... I",
"
RESIDEN'I'IAi. ,,,-\c "DATE, ';'.'.' YES NO " 1 :.' '.' cOMMEIlCIA'l::" DATE ';\ 'AC(!~D I....
~: '.' I,,':;, "
. ";','; , .";iB, '" I.~,r:, YES .' I'NO
ELECTRICAL - LifuIT DEPT. 417-:4735.: , , ELECtRICAL
, YGHTDEIT "
CONSTRUCTION R. W.I PWI t,... ~f)lJ ~F. CONsnWcnON,~R. W.
ENGINEERING 417-4807 'PW!:~qINEERlNG
FIRE 417-4653 ','" " ,'.. '.' ""'~""'-'-~"'"
'.' , FIRE DEPT. .. \! ,) ., ,'e"",
PLANNING DEn 417-:4750 PL~GDEPT. ..
BUILDING 417-4815 BUILDING ;., P >
~'~"""~'t ;'~;L~~~~~_~__
T:\PLANNlNG\FORMS\1 102.15 [1111412003]
PREPARED 6/15/04. 13:26:29
CITY OF PORT ANGELES
ADDRESS
CONTRACTOR
OWNER
PARCEL . .
APPL NUMBER:
2532 W 16TH ST
INSPECTION TICKET
INSPECTOR JAMES L LIERLY
PAGE
DATE
GERALD MORRIS/MARILYN DAVIS
06-30-00-4-4-0050-0000-
04-00000052 RES MANUFACTURED HOME
SUBDIV:
PHONE
PHONE :
PERMIT: BLM 00 BL MANUFACTURED HOME
REQUESTED INSP DESCRIPTION
TYP/SQ COMPLETED RESULT RESULTS/COMMENTS
BLM
2/19/04
2/20/04
3/17/04
3/17/04
4/08/04
~~
01
JLL
AP
JLL
AP
JLL
BLBT 01
BLM
02
BL99 01
BUILDING FOUNDATION MONO SLAB
JIM 808-3281 MANUFACTURED HOME
BUILDING BLOCK AND TIEDOWNS
KEITH 461-1999
BUILDING FOUNDATION MONO SLAB
this slab is for garage /jll
BUILDING FINAL
JIM 417-4737
SLAB
4
6/15/04
CONTINUED ONTO NEXT PAGE -----------------------------------
PREPARED 6/15/04, 13:26:29
CITY OF PORT ANGELES
ADDRESS
CONTRACTOR
OWNER
PARCEL . .
APPL NUMBER:
2532 W 16TH ST
INSPECTION TICKET
INSPECTOR JAMES L LIERLY
GERALD MORRIS/MARILYN DAVIS
06-30-00-4-4-0050-0000-
04-00000052 RES MANUFACTURED HOME
PERMIT: BPR 00 BUILDING PERMIT - RESIDENTIAL
REQUESTED INSP DESCRIPTION
TYP/SQ COMPLETED RESULT RESULTS/COMMENTS
BL9 01 5/07/04 JLL
5/07/04 AP
BL3 01 6/07/04 JLL
6/07/04 AP
BL99 01 ~ JLL
~
BUILDING SHEARWALL
JIM 808-3281
BUILDING FRAMING
JIM 477-1737
BUILDING FINAL
JIM 417-4737
PAGE
DATE
SOODIV:
PHONE
PHONE :
5
6/15/04
COMMENTS AND NOTES --------------------------------------
PREPARED 6/07/04, 12:41:28
CITY OF PORT ANGELES
2532 W 16TH ST
INSPECTION TICKET
INSPECTOR JAMES L LIERLY
PAGE
DATE
ADDRESS
CONTRACTOR
OWNER
PARCEL . .
APPL NUMBER:
GERALD MORRIS/MARILYN DAVIS
06-30-00-4-4-0050-0000-
04-00000052 RES MANUFACTURED HOME
PERMIT: BPR 00 BUILDING PERMIT - RESIDENTIAL
REQUESTED INSP DESCRIPTION
TYP/SQ COMPLETED RESULT RESULTS/COMMENTS
BL9 01 5/07/04 JLL BUILDING SHEARWALL
5/07/04 AP JIM 808-3281
~:~__::____~\~)~~_~__::~:~~N::::::::~AND
SUBDIV:
PHONE
PHONE :
4
6/07/04
NOTES --------------------------------------
\ EOR OFFICIAL USE ONLY:
BUILDING PERMIT - APPLICATION ~f>~\i~... ~teRec.: 12--/2.-63
c-o~,\""f, " permit#:~
Fill out COMPLETELY and in INK. Your application and site plan MUS~ BE Date Approve . '0
COMPLETE to be accepted for review: Uyou have any questions, call
(360) 417-4815 Date Issued: "
Q.,
,
Applicant or Agent: ~~ft;f1J:;;::~~/~;
Owner: Cfii2A L-/l It (l w::.s
Address: City:
Zip:
Architect/Engineer: Phone:
Contractor/"lfC ~A.t~~..J"NState License #:JII~A&-~xp:IO/ ()l~-
, " I
Address: CIS'" -S/V ? W.' City: S~ ~....v1
PROJECT ADDRESS: '2...5.52 \Iv \ to ...,. \..t
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Block:
Phone: t:83- ~v-?/
Zip: 9~3e2
(
ZONING:
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"Subdivision:;" l!j/.es.~d.' r ..l.L
Db~OCXJ4'1(JoS~
LEGAL DESCRIPTION: Lot:
CLALLAM COUNTY PARCEL NUMBER:
Credit Card Holder Name:
Billing Address: City:
Credit CardType VISA MC # Exp. Date:
TYPE OF WORK: SIZEN ALUATION: _ ~
)(Residential 0 NewConstr. 0 Re-roof 0 Stove Ij:O SF.@$.....s.~8 ~/SF.=$~S...:>oqO ~
o Multi-family 0 Addition 0 Move . Garage _80 SF. @ $ .x; cp ISF. = $ t (;-0 "
o Commercial 0 Remodel 0 Demolition 0 Deck SF. @ $ ISF. = $_ '_ ~
o Repair 0 Sign 0 Other TOTAL VALUATION $--..Gf GO () ;;0..--'
BRIEF DESCRIPTION OF THE PROJECT: lv/5.cA..I ~A,uU~Ae7?//2.4C/J .~~.!!! ~77.,L
A-r:7J ~4 (;A72--~// Htt>"1- "
COMMERCIALIRESIDENTIAL: Occupancy Group: . Occupant Load: Construction Type: .
No. of Stories: ---1- Lot Size: 9" 7 S- Existing Sq. Ft. ," 0 & Proposed Sq. Ft. /7~ = TOTAL Sq.Ft. J?e-.O
Existing lot coverage~ % & Proposed lot coverage ~% = Total lot coverage / r %
APPROVALS:
PLAN:
BLDG:
DPWU:
FIRE:
OTHER:_
PLANNING USE ONLY:
ESAlWetland(s): 0 Yes 0 No SEPA Checklist required? 0 Yes 0 No Other:
BUILDING PERMIT APPLICATION SUBMITTAL: The Building Division can provide you with information on the application and
plan submittal requirements if you have questions.
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 atthe 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 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. 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.
nFORMSIAPPSlB'i1di,gpemicwpd APPliC/~ ~ Date: /"2 ~//..."
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CITY OF 'PORT ANGELES - Construction Plans
The issuance of this permit based upon these' plans, specifi.
catlofoS and other data shall not prevent thebuHdin~o(fi~ial'
irom thereafter requiring thecorrectionol.ertor~in'~id
plans, specifications and other d~ta, orfromipre~enb6g
building operations being carried on Ihereundeiwhen in
vIOla !ion of all codes and ordinances of risdiction.
(S~'::TiON 303(c) - U form uilding Code,'
\
:\pproval Date
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in the footing and centered beneath the pier locations (See
Figure 303.7);
(9) A minimum of 4 inch (10 cm) nominally thick con-
tinuous footings. not less than 48 inches (121 cm) wide,
reinforced with approved fibers or with 10 gauge 6 inch
( 15 cm) by 6 inch (15 cm) wire fabric centered vertically
within the continuous footing and no closer than I inch
(3 cm) from the edge of the continuous footing. (See Fig-
ure 303.8); ,
(I OFR'minimum 4 irich "(TO cmfilominl1lyth"icK slaD ~
-I es~.areaJhan.the.manufactured,dw.tl.lltng. and.cabam~,
-;reinforcea~witn.apP'r.oveaJiberlor with 10 gauge 6 inch
( 15 cm) by 6 inch (15 cm) wire fabric c,entered vertically
within the slab and no closer than I inch (3 cm) from the
edge of the slab. (See Figures 303.9 and 303.10);
( 11 ) Tested and listed prefabricated footings;
(12) Footings designed by an Oregon licensed professional
engineer or architect and approved by the Division; or
(13) Other equivalent materials approved for the intended
use by the authority having jurisdiction.
(b) Piers. Piers shall be placed on footings and shall not
exceed the size of the footing. Piers shall be:
(I) 8 inch (20 cm) by 8 inch (20 cm) by 16 inch (41 cm)
concrete blocks (See Figure 303.11);
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- ""N,MUM 256 SOUARE INCH PL YWOOO FOOTING
PRESSURE TREATED ON AU SIX SIDES
liOJ!; FJELD TREAn.tENT OF CUT EDGES
IS NOT ACCEPTABLE
Fig.ure 303.5
Single Layer 'Plywood Footing
16
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MINIMUM 256 SQUARE INCH
OOUBLE PLYWOOD FOOTING
PRESSURE TREATED ON AU SIX SIDES
.tIllIt; FJELD TREAn.tENT OF CUT EDGES
IS NOT ACCEPTABLE
Figure 303.6
Double Layer Plywood Footing
so
L-MIN.
2" MINIMUM I
MJ(JVf. GRADE
16" MINIM M
10"
so
MIN,
(2) CONTINUOUS #4 REBAR
CONTINUOUS POURED-iN-PLACE CONCRETE
FOOTING W!MiNiMUM 2500 PSi IN 28 DAYS.
,Figure 303.7
Continuous Concrete Footing
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MINIMUM
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SEE TABLE 304 FOR
REQUIRED PIER SPACING
Figure 303.8
Continuous Concrete Footing Isometric
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~" NOMINAl:=-
II POURED-IN-PLACE'l~,
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. Figure 303.9
Poured-In-Place Concrete Slab
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LlMINIMUM NO~AL
'4" CONTINUO'US...
'CONCRETE-FOOTING
2500;';;PSI-'/C28 DAYS
REINFORCED, PER
SECTION 303~ OF
THE-STANDARD?
10 GAUGE 6" X 6"
WIRE FABRIC CENTERED
VERTlge.LLY_If':L~.LAB OR
t:::::RElt\fFORCED WITf;j~
~~PROVED FIBER_eER:t
&SECTION '303....eF-THElI
l~J8NDARD- ----
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Figure 303.10
Poured-In-Place Concrete Slab Isometric
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(2) Tested and listed prefabricated piers (See;Figure
303.12);
(3) Designed by an Oregon licensed professional engi-
neer or architect and approved by the Division; or
(4) Of other equivalent materials approved for the intended
use by the authority having jurisdiction.
Exception: Concrete pier blocks may have wood
placed between each block to absorb
shock if the wood is equal in area to
the block and is one of the approved
materials identified in Section
303(c)(2). (3) and (4) of this standard.
(c) Pier Caps. Each concrete pier shall be capped with a
pier cap equal in area to the pier blocking (i.e., 8 inches
(20 cm) x 16 inches (41 cm) or 16 inches (4i cm) x 16
inches (41 cm)). Pier caps shall be (See Figure 303.13):
( I ) A 4 inch (10 cm) nominally thick solid concrete block;
(2) A I inch (2.5 cm) nominally thick group 2 or 3 paral-
lei laminated veneer wood plate;
(3) One 1-1/4 inch (3.18 cm) piece or two 3/4 inch (19
mm) pieces of plywood;
(4) One 2 inch (5 cm) nominally thick Number 2 or better
grade board lumber;
(5) One 2 inch (5 cm) nominally thick wood polymer com-
posite;
18
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\....4. NOMINAL L..
-:",POURED-IN - PLACE"
CONCRETE SLAB-FOOTING
-2~P"SI~IN...2B rDAYS-
(6) Tested and listed prefabricated pier caps;
(7) Designed by an Oregon licensed professional engi-
neer or architect and approved by the Division; or
(8) Of other equivalent materials approved for the intended
use by the authority having jurisdiction.
. Exception: Wood and wood product materials
specified in Subsections (2), (3) and (4)
of this section shall be pressure treated
on all six sides when placed in an area
subject to excess moisture (i.e. outside
the underfloor enclosure or below open
deck areas).
(d) Pier Shims. Where shim material is used between the
top of the pier cap and the bottom of the main frame. the
shimming material shall not exceed 9 vertical inches (23
cm). Pier shims shall not be used with prefabricated piers
unless the shims are included in and installed according
to the pier's listing. Pier shims, when used. shall be one or
more of the following (See Figure 303.13):
(I) 2 inch (5 em) nominally thick solid concrete block
equal in area to the pier cap;
(2) I inch (2.5 em) nominally thick group 2 or 3 parallel
laminated veneer wood plate equal in area to the pier cap;
(3) 3/4 inch (19 mm) or greater plywood equal in area to
the pier cap;
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~ DelSlgn .Loads
I Wltld 15 PS~
' Soil Be.a..-ing 1()(X) PSF
\1 TIt Down Stnpt 3150 t Wo0:in8l..oad '
S eismJc Zone 4
I Tle do'.lIll Sll'-fl' ~ fMaral sp<<l:ticltion, QQ-S.781H for Type 1,
CliL~ B, Gmdt I strapping and bt a.tleut 1-114" ll. ms. zinc plAted.
E.art:h Auger; 2962 ~ (TeMbd to 4750., rrunimum)
Crou Dri~. 1717 .. (Calculated)
. r_ !;:lSWi> -Anch~ 1390~ (C~l;Ubr.cd)
'~f,'el.4' M~"'" soil presl<rr i.J 1000 P SF wJhoutcuoilJ fCport
I G&~eraJ Notes
i
, I. The charts shown nere'J\ lIt't 10r the requirld nwnber of tlC cjowOJ
on the sides of the Marrufactllred HolDC.
2 Tie dowus m required at each ehassi! bea..1\, each end of each
trll.tl~b~ s<<tlOn of the Ma.tluf~turtd Ho~ 31\0 can be any
of th~ types shown herein. I
1 CombUutions of the differeD! cypt& of be downs ~ be used.
14.m the CYe%lt All 04Ith ;lUser cannot be inWlI.ed. d~c to UI ob&tnlc.
ciao. U$e of cross drive lJl,hors Is pe~ttod. pcovidt<i 2 c.tos.~ dri't'e
, anchors &re iDJ~ for et~h e.mll AUa<< that cannol be i.1lsWlod.
I
Ii 5, For a.llli~ down insullrions, the MM,.fl)Otu.Ied Home ehu,is
members ue shown u T btCfnj for illwtrntion purpo~s only,
I Cha.!w bemns can ~50 be "CO thaped Of RFC ~.
6. E.nd tic 00WnJ: C2Il ~. teared wlthm IS- of e.ither ~d. of ehusl.&
b.:.ml uil &$ soown
OM end \141 doW1'\ required '~G> Chassis eeam
at each ",' Mum end lb.'....
I ..
i 7, The &izes, types, lengths, etc. of nultrl.1& ~.11 herein are
. rril'll~rim: ~er, lonier, heavier rnmrials suppli1:d by
Tl~ Down EnPnoenog ma~ be ~ a: the Rme spaciux ana
locations shown.
8 Alternate devices may bo 5ubstiruted with en(ine.en approvals.
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State Approval ~
ENGINEERED T1E.DOWI~ ;3YSi'tN,-i
I APPROVED 1
roMC1 TO :OWC1lCMllmJ
IIW!QV~I does nvt IIl1i)OIIll! C' ""'~Y'l zr.; ~':'tl~>, ';
dl~. ttt:l'l rt<l~I~cClenU Q~ lpjl/i,C;lc SUt: 1:-", ,....;
ret"""'^"""~
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. ~. otCC'C!.SAl""ST:fo.~~..?~:
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nE DOWN ENGINEEf11NG
5901 Wheaton Driv",
AtI~nt~. GliIorgia 30336
404'3+HOOO
Fax 404,349-0401
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~" .5-02 04:02 PM TJT INC SALEM
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503 393 6134
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". . ",NSTALLATION INFORMATION
. I
ceoncr~t8 Anchd?
&..- ~,.
The MIJ2 Is designed lo ba In,1allo~ Into ;1 com:re\~ lilab a\
the time lhe ooncr6lo ID D&/no Dourad.
Patio Slab Anchor
This anchor Is de510nod 10 be Inserted through a 3/4' holo
drilled or formed Into l1n ex/sling concrete alab.
· Concrete m~t be.a 2500 PSI mInimum
sl:1h wIth 4" mInimum thlckneas and S/! )(
10/10 wire mesh or fiber mOih 111$111l1t~.
· Concrete slab must allow 4725 Ibs of
vertical tensIon on l/'lohor without nttinQ.
This II!Unwi that the Qonoretll \..elol\s
150 Ibe per cu. n.
· Minimum dIstance from the anchor shaft
to one edge or the '$lab Is 4 In. from ano
ttlge and 2 It. from any other lIdco.
· Concrete must be ; 2500 FSI
minimum slab with 4' minimum
thickness and ala x 10/1 0 wire mesh or
fiber mesh Instatred.
· Concr6't'l 51ab musl allow 4725 "bE (1
vertical tenclon on lInchor wltho\..\
IIttlng. This a~umes th,lt the concrete
weighs 160 Ibe pllr cu. ft.
· MinImum ol5tilnce from the anchor
ahaft to one edDe of the 'lab 16 4 In
from O~ caae Dne! 2 1t. trr>m any other
adQo.
· It Initllled In n 4" slab at mln:mi/r-,
dIStances from edges. an addltionJll4yer
of 5/5 or 10r10 mash (s recommended.
· Slab mu5t be B In. minimum thick"!!1 al location under
any onc:hor to ISlIow Sin. embedmant o111nahor 'J' roc.
Concrete Slab Anchor
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it1la anchor 15 d
· After fllvl.wlng raUrlCHOn; O$toa to &no rlgnt arUI a
ole In lC 3 In. holt In the .Iab whart tho DIlellor hB11d III
10 be looateo.
an a)(I~\Jng cOnl;n~ICl IOI&b.
· eoner.le must be II 2500 PSI minImum slilb y,iln .r
mlnlmum lhlck/'lfn and s/e x 1Cl110 wir1l mash or fjt.cr
lI1.titl r"'11Wa 11.
. Plac, IUlDI ~pal1$lon 81DM o~gr bolllnd place Into
th~ tjrUlca hole.
· C9norQlo $lab mUlll allow 4725 Ibs 01 ...ortl~110t1sion
on anchor wllhoul /if11J){). 'T'h" lIuvmOl rh~l 1110
cencrOID wolghs 1 ~a Ib~ per cu. It.
· Pbca rho wouhor onto the oxpanslan bon
" thread nut onlQ eXJlllnllim bait 11m! tighten 1Itltil
mvclmum 8xpanclon of 1I1ullxpUlclon I1MVll ~. baan
aohleved.
· Mlnlmum d!!tanGl! from the ancl1~H shAH to OliO 0000
Of ilia 'l~b i~ .. in. from onl tdQI anQ , It. trom ani'
other lldgo.
· " In.Udlid In , 'I" i'_b .al mlnJmiJm elm-MOS frc m
IIdges,iln DddUlon3ll.ly.r ot ale or 10/10 'rtlre me~h or
nbcr mosh Is nlCDmmended.
" RlImovi nul and Wil:lhgr und pIneo cnchor hand cvor
exposlld bolt.
· Placi W1IihQr and nul onto bon 10 :lltllch ilnthor he<ld,
tlon/on nut.
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11'6" I '1'10" I 12'0"---;_
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Master Bedroom Livi1g Room Cool. . i-3 .~ I
4bx5eJV 4bxSev 4bxSev
14'e" I 21'4" I 12'0"---;
4e'0"
Model: 4e124 HO MG;:. N(!)~," W e.sT i
l,2eo Sq. Ft.
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PREPARED 5/07/04, 13:53:04
CITY OF PORT ANGELES
INSPECTION TICKET
INSPECTOR JAMES L LIERLY
PAGE
DATE
3
5/07/04
ADDRESS
CONTRACTOR
OWNER
PARCEL . .
APPL NUMBER:
2532 W 16TH ST
SUBDIV:
PHONE
PHONE :
GERALD MORRIS/MARILYN DAVIS
06-30-00-4-4-0050-0000-
04-00000052 RES MANUFACTURED HOME
PERMIT: BPR 00 BUILDING PERMIT - RESIDENTIAL
REQUESTED INSP DESCRIPTION
TYP/SQ COMPLETED RESULT RESULTS/COMMENTS
BL9 01 ~7/ 4 ~ BUILDING SHEARWALL
JIM - 808-3281
------------------- ----- ------------ COMMENTS AND NOTES --------------------------------------
L
PREPARED 4/08/04, 12:48:15
CITY OF PORT ANGELES
INSPECTION TICKET
INSPECTOR JAMES L LIERLY
PAGE
DATE
7
4/08/04
ADDRESS
CONTRACTOR
OWNER
PARCEL . .
APPL NUMBER:
2532 W 16TH ST
SUBDIV:
PHONE
PHONE :
GERALD MORRIS/MARILYN DAVIS
06-30-00-4-4-0050-0000-
04-00000052 RES MANUFACTURED HOME
PERMIT: BLM 00 BL MANUFACTURRD HOME
REQUESTED INSP DESCRIPTION
TYP/SQ COMPLETED RESULT RESULTS/COMMENTS
BLM 01 2/19/04 JLL BUILDING FOUNDATION MONO SLAB
2/20/04 AP JIM 808-3281 MANUFACTURED HOME SLAB
BLBT 01 3/17/04 JLL BUILDING BLOCK AND TIEDOWNS
3/17/04 AP KEITH 461-1999
BLM 02 A4{0,!1,0-L-J. "L~ BUILDING FOUNDATION MONO SLAB
~ ~ this slab is for garage /jll
-------------------------------------- COMMENTS AND NOTES --------------------------------------
.L
~
INSPECTION TICKET
INSPECTOR JAMES L LIERLY
PREPARED 3/15/04, 12:15:09
CITY OF PORT ANGELES
ADDRESS
CONTRACTOR
OWNER
PARCEL . .
APPL NUMBER:
1028 W 16TH ST
HOCH CONSTRUCTION
HOCH, RICK/TERRY
06-30-00-0-4-4130-0000-
04-00000168 RES REMODEL
PERMIT: BPR 00 BUILDING PERMIT - RESIDENTIAL
REQUESTED INSP DESCRIPTION
TYP/SQ COMPLETED RESULT RESULTS/COMMENTS
SUBDIV:
PHONE (360) 452-5381
PHONE: (360) 452-5381
PAGE
DATE
8
3/15/04
BL3 01 3/15/04 JLL BUILDING FRAMING
---------~--~--------- COMMENTS AND NOTES ---------------------------------_____
--
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BUILDING DIVISION
CITY OF PORT ANGELES
* *
Correction Notice
Job Located at -fU 1.- ~
~
~
Inspection of your work revealed that the following is
not in accordance with the codes governing the work in
this jurisdiction: )
F\t2-f; b~ouk,B 'PuP- VeuJJ
~~\ itJ(~ 1--\~vJ ~~ ~,
These corrections must be made and are not to be
covered until reinspection i~de. When corrections
have been made, please call I, .... 4~ I S--
for inspection.
Dale ~
~~.
~.:..-.
Inspector for Building Division
DO NOT REMOVE THIS TAG
PREPARED 2/19/04, 13:02:00
CITY OF PORT ANGELES
INSPECTION TICKET
INSPECTOR JAMES L LIERLY
PAGE
DATE
5
2/19/04
ADDRESS
CONTRACTOR
OWNER
PARCEL . .
APPL NUMBER:
2532 W 16TH ST
SUBDIV:
PHONE
PHONE :
GERALD MORRIS/MARILYN DAVIS
06-30-00-4-4-0050-0000-
04-00000052 RES MANUFACTURED HOME
PERMIT: BLM 00 BL MANUFACTURED HOME
REQUESTED INSP DESCRIPTION
TYP/SQ COMPLETED RESULT RESULTS/COMMENTS
BLM 01 ~19/04 JL: 11 BUILDING FOUNDATION MONO SLAB
~ JIM 808-3281 MANUFACTURED HOME SLAB
---------------- ~-------------------- COMMENTS AND NOTES --------------------------------------
PREPARED 3/17/04. 12:46:32
CITY OF PORT ANGELES
INSPECTION TICKET
INSPECTOR JAMES L LIERLY
PAGE
DATE
2
3/17/04
ADDRESS
CONTRACTOR
OWNER
PARCEL . .
APPL NUMBER:
2532 W 16TH ST
SUBDIV:
PHONE
PHONE :
GERALD MORRIS/MARILYN DAVIS
06-30-00-4-4-0050-0000-
04-00000052 RES MANUFACTURED HOME
PERMIT: BLM 00 BL MANUFACTURED HOME
REQUESTED INSP DESCRIPTION
TYP/SQ COMPLETED RESULT RESULTS/COMMENTS
BLM 01 2/19/04 JLL BUILDING FOUNDATION MONO SLAB
2/20/04 AP JIM 808-3281 MANUFACTURED HOME SLAB
~~~~_::__~__~~_____~~:~~:~::~::::S~DT:::::N:_____________________________________
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FROM KIRSCH ELECTRIC
FAX NO. : 3606830869
Mar. 08 2004 09:03AM Pi
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EL..ECTRICAL PERMIT APPLICATION
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Zip;
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Credit Can! Holder Neme:
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~r:rRICAL pONTRACTOR
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INSTAlLATION WtRm BY: 0 OWNER
BIlling Adc1ress:
GilT,
cretfJt Card Number.
Exp, DaM'
Zip:
VISA: Me;
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PRO.lECT ADDRess: ?- ? 3 2- t..o> , I C, t!1 ,..:5T
TVP!; OF WORK: Cne~ ..lithe! apply: rN~ 0 A1teraUo!\lAddifion::
~ Residenlial 0 Multl-famny IJ Commercial 'A Mo~ne H~me., Sq. Ft }5'00. .
CJ Remote Maler 0 Detached g~e ' 0 Hot Tub O-Swlm Pool D SeptiC "'ump. 0. Low VoilBlIe. 0. Telecom, 0 Slgl
Number of ercuib!l !lltded or altsr9d: .
DESCRIPTION OF THE ELECTRICALPRCJECT;.
/110&1L-~
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e.octnc:a( Heat Load Additions and or Subtractfona
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CJ OVerhoad Service
o Temp Service . .
Xunde'll,ound S.rvice
'Sl!rvJce Infonnatto'l
VolIBge: I;). rf.. '-10
Phase: V:'1 0:>
. ServioeS1ze:~~
Feeder S~:~."
, hereby certify that I have rfJlJd and examined this application and know that same to tJt' Irve and correot, and I 8m
authorized to apply forthis permit I understand it is not the Clty's legal responsibility to determine Whot permits
3re roqulred: it remains the eppliCBnts responsibility to (ermine what pe ifJJ ar9 require!! and to obtein such.
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. .~It Card Holder.'s Signature:
Owner Dr Elle. Cont. Signature:
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Date::?:. -;L -01
Data:
PERMIT FEE: $ ~ 6. :s 0