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Home My WebLink About1309 E 7th St - Building ~1"ORT~ f::-..J,O~<(~ 0r1&ii~ L~ ~ "tOi,,~ CITY OF PORT ANGELES DEPARTMENT OF COMMUNITY DEVELOPMENT - BUILDING DNISION 321 EAST 5TH STREET, PORT ANGELES, WA 98362 o -.1 ~ ....0 0J Application Number Application pin number Property Address ASSESSOR PARCEL NUMBER: Tenant nbr, name Application type description Subdivision Name Property Use Property Zoning . . . Application valuation 07-00000793 Date 845530 1309 E 7TH ST 06-30-11-5-4~9010-0000- JIM DEBORD PLUMBING REPAIR RS7 RESDNTL SINGLE FAMILY 2000 Owner Contractor JAMES AND LINDA DEBORD 1309 E 7TH ST PORT ANGELES WA 983626605 OSTERBERG LANDSCAPING 706 S. H ST. PORT ANGELES WA 98362 (360) 452-_9511 Permit PLUMBING PERMIT Additional desc LAWN DBL CHK BCKFLOW Permit pin number 106302 Permit-Fee 57.00 plan Check Fee Issue Date 7/06/07 Valuation Expiration Date 1/02/08 Qty Unit Charge Per BASE FEE 1. 00 7.0000 ECH PL- EA LAWN BACKFLOW Extension 50.00 7.00 Fee summary Charged Paid Credited Due ----------------- ---------- ---------- ---------- ---------- Permit Fee Total 57.00 57.00 .00 .00 Plan Check Total .00 .00 .00 .00 Grand Total 57_00 57.00 _00 .00 7/06/07 .00 o 0l 12- 0>- q0~/ "~ q u, O? -~ o ~ (\) --J f. ~ 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 con~~ _ 7-(-0 ( Signa'",e of Contracto, O~d Agen' Da'e Signa'"", of Owne' (if owne, is b"ilde,) -.:) ...--, c: ~ ~ ..- .: S '-.s;) Date T:IPoliciesllI02_15 building pennit inspection recordOS wpd [1/4/2005] " BUJLDING PERMIT INSPECTION RECOJill CALL 417-48]5 FOR BUILD]NG INSPECTIONS. CALL 4] 7-4735 FOR ELECTRICAL INSPECTIONS. CALL 4] 7-4807 FOR PUBLIC WORKS UTILITIES PLEASE PRDVIDE AlvlINIMUM 24 HOUR NOTICE. IT IS UNLA WFUL TO COVER, INSULATE OR CONCEAL ANY WOFJ( BEFORE IlVSPECTED A/VD ACCEPTED. POST PERMIT IN A CONSPICUOUS LOCA DON. KEEP PERMIT CARD AND APPROVED PLANS AT .lOB SITE INSPECTION TYPE DATE ACCEPTED COMMENTS YES NO FOUNDA nON FOOTINGS SHEAR WALLS / WALLS FOUNDATION DRAIN/\GE / DOWN SPOUTS PIERS I I I POST HOLES (POLE BLDGS) PLUMBING UNDER FLOOR / SLAB i ROUGH-IN WATER LINE (METER TO BLDG) GAS LTNE FINAL DATE ACCEPTED BY: BACK FLOW / WATER "{ - ~l'I-~1 fZts AIR SEAL WALLS CEILING FRAMING JOISTS I GIRDERS SHEAR WALL/HOLD DOWNS WALLS / ROOF / CEILING DRYWALL (INTERJOR BRACED PANEL ONLY) T-BAR INSULA nON SLAB WALL / FLOOR / CEILING MECHANICAL ROUGH-IN }ffiAT PUMY I FURNACE I DUCTS GAS LINE FINAL DATE ACCEPTED BY. WOOD STOVE I PELLET I CHlMNEY MANUFACTURED HOMES FOOTING I SLAB BLOCKING & HOLD DOWNS SKJRTING PLANNING DEPT. SEPARATE PERMIT #'5 SEPA: P ARKING/LlGHTING ESA: LANDSCAPING SHORELINE: FINAL INSPECTIONS REQUIRED PRIOR TO OCCUPANCY/USE RESIDENTIAL DATE .YES NO COMMERCIAL DATE ACCEPTED YES NO ELECTRICAL - LIGHT DEPT. 417-4735 ELECTRJCAL LIGHT DEPT CONSTRUCTION R.W. I PWI CONSTRUCTION - R.W. ENGlNEER.JNG 417-4807 PW/ENGlNEER.JNG FIRE 417-4653 FIRE DEPT. PLANNING DEPT. 417-4750 PLANNING DEPT. BUTLDING 417-4815 BUILDING T:IPoliciesll ]02 15 bUlldmg penTIlt IDSpectJoll record05.wpd [1/4/2005] ... ,~^".. ...-~ "'V'W~_'~~ -.,_~~ '''~~''=~''.I><'''~'''''-'_~ "",~"'. ~J<~. "",,,,-,,,,,,,,,,..-.-.~-~-......;...c.. ....<.."...., "''''~'';''''''''''''~'4'''''''''''''''~"''''-''-~~-~''''''''''~'.pr<--" . '.' Y"- ........ """'...... 1U'oI,............p.-u.r TT.....V" or. . <IJ...~......,j~:'1,. '. {."'~., -'<;", , -~'''\"f~'I...--.,....... r .~..- ...,..'" 'Y-' - ."..::'.:..;;:..~~Lt"~Y""\l'lJ"..,~t;..J'-NIo '1"'"'.,....r...;....'w~>W'f'..-........-.-...,o.-."a'I-. ,~-. . I './ '.' . fIt VV', , ' ' ,. . (/ l ~. . . .. , ,/ ~ 1, r:--/ ) .~...-r.,., Backflow Assembly Test Report City of Port Angeles Public Works and Utilities Department WaterlWastewater Collection Division Official Use Only AssCIll.# C y / Rcccivcd ( . NAME OF PREMISES:J/ .1'14.- 11()'1 C /' . LOCATION OF DEVICE: 3 ;II [J /? ;- tr IJV/L/(//\/f SERVICE ADDRESS: L I AI /?A 7~ f) ~8 Il ~ p' 5 (/ete;- Manufacturer pf WAil-/? .C; t;'(; X L I Model /h f- (t!:)P .J,-- ~ /', Size ).f (, II/~y Serial No. ASSEMBLY: IS THIS AN APPROVED ASSEMBLY? YES ~O 0 IS ASSEMBL Y INSTALLED CORRECTL Y? YE~NO 0 , .... DATE OF INSTALLATION t/ UL7- 0 7 UNKNOWND ." ' ! REDUCED PRESSURE PRINCIPLE ASSEMBLY RP/ 0 RPDA 0 DC !;l/ DCDi) 0 PVB 0 Air Gap 0 DOUBLE CHECK VALVE ASSEMBLY SVB 0 AVB O. , CHECK VALVE #1 CHECK VALVE#2 RELIEF VALVE PVB/SVB .' " " , Initial .. Leaked 0 Leaked 0 , Did Not Open 0 AIR INLET .. Held at' '3, V~Si Closed Tight 0 bid Not Open 0 Test H~~t~ ..;; psi Opened at ~ psi ' , , .. Opcned at ~ p~; , \ '. Repairs Cleaned,,~ 0 Cleaned 0 Clt:aned 0 CHECK VALVE , ..,;,::,:.. .. . Leaked 0 Held at ~pSI ~" Repla.ced 0 Replaced 0 Replaced 0 " REPAIRS Cleaned .0 .' ..... " ' Details Replaced 0 3 psi Buffer YES 0 NO 0 , Final Closed Tight 0 AIR INLET Opened at ~ psi .. CHECK VALVE Held at ~psi Test Held at) . () pSI Held as2 . ..5;:i Opened at ~ psi ' BACK PRESSURE NO 0 YES 0 AIR GAP INSPECTION: , .,' REQUIRED MINIMUM SEPARATION: YES 0 NO 0 .. TYPE OF HAZARD IX/rl' .' ... COMMENTS Line Pressure r.;;;; psi , Itf.J 5/'Er1E// 7 f .;.i"L // , Y l~/J )" ~J.-- b Held Backpressure YES IW"'NO 0 , ( , -~ / '........ #2 Shutoff Held YES !:iJ/NO 0 . . - Relief Valve Exercised YESO NO 0 , Date/Time Tester Signature Cert, # Test Kit Passed Failed Initial 7- :JC~C7 I~ 13~~t [J; 0, ,., Test R. gte/:- t.1t .;;f7 ,/r-J- y fl( I 11 v!./::,f( , Repairs - 0 0 Final 7 7 U" 7 /<.M_ i!~~~ 8,;, g~ 0 Test . J. . ,J f!. jf r / kr l YII" .M 1111t11 H'1 . ... --:' V'J ',< o ,...5J . f1\ '. ," . .:~ ": . ~.; ,}.. ~. ~:';~ }. ,,:. '};- . ", .~ '0 WHITE.. CUSTOMER COPY YELLOW.. PURVEYOR'COPY PINK - TESTER COpy -"V'";l~~....,.J, ,".'.. .; c~;;~:&~~~~~~~7({j ~~'.~ ~'t: ~~',~;... ':1";) . '." ~",f . .-.. ..".,....~..., ':I ~wy BUILDING PERMIT - APPLICATION FOR OFFICIAL USE ONLY: Date Rec.: '-1- ~ .- 07 Permit#: 01-, <13 Date Approved 07 - 0(0-0 Date Issued: I , Fill out COMPLETELY and in INK Your application and site pIal1 MUST BE COMPLETE to be accepted for review. If you have any questions, call PERMITS (360) 417-4815 FkX(360)417-4711 Owner: . e Phone: Address: (.3 r5)q F 7 ~ City: ~v{- ~7yPlf:?.s -. Zip: 111 SA < Architect/Engineer: .me.:',. . Phone: . A . Contracto: 4/b/bb-j (liY<j$Cr~tate License ~Dsf-evU11~ ~ (61 Phone 452 -1S( ( Address: City: Zip: PROJECT ADDRESS: I ~q E 7 ~ ~ vi- .J4 CI-t~? ZONING: I . LEGAL DESCRIPTION: Lot: Block: Subdivision: CLALLAM COUNTY PARCEL NUMBER: TYPE OF WORK: o Residential 0 New Constr. 0 Re-roof 0 Stove o Multi-family 0 Addition 0 Move 0 Garage o Commercial 0 Remodel 0 Demolition 0 Deck o Repair 0 Sign 0 Other BRIEF DESCRIPTION OF THE PROJECT: -- &c SlZEN ALUATION: SF. @$ /SF. = $ SF. @$ /SF. = $ SF. @ $ /SF. = $ I TOTAL V DATION $ ,-(~ V COMMERClALIRESIDENTIAL: Occupancy Group: No. of Stories: Lot Size: Existing Sq. Ft. Total lot coverage % Occupant Load: & proposed Sq. Ft. Construction Type: = TOTAL Sq. Ft. ESAJWetland(s): 0 Yes 0 No SEP A Checklist required? 0 Yes 0 No Other: APPROVALS: PLAN: BLDG: DPWU: FIRE: OTHER: PLANNING USE ONLY: 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 -4 815 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 RI05.3.2 of the International BuildinglResidential 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 permfts priorto work~ I M ~ _ T:\FORMS\BldgPerrnitform.wpd Applicant: ~ U' 4d,_ . Date: 7 b 0 7 ~ ~ ~ORT ~ l"O~~~ ". ...~ :-=- "l,i{1C~ CITY OF PORT ANGELES DEPARTMENT OF COMMUNITY DEVELOPMENT - BUILDING DIVISION 321 EAST 5TH STREET, PORT ANGELES, WA 98362 ,,'.'.i!"~W~;';' ~f(";~~~~~~' . t 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 ;1~~ Signature of Contractor or Authorized Agent Application Number pin number Property Address ASSESSOR PARCEL NUMBER: Application description Subdivision Name Property Use Property Zoning . . . Application valuation 04-00000096 Date .833728 1309 E 7TH ST 06-30-11-5-4-9010-0000- MECHANICAL APPL. PERMIT 2/05/04 RS7 RESDNTL SINGLE FAMILY 960 EXPIRED C:Y1~/t?4- Owner Contractor JAMES AND LINDA DEBORD 1309 E 7TH ST PORT ANGELES WA 983626605 FERRELLGAS LP ONE LIBERTY PLAZA LIBERTY (360) 683-9029 MO 64068 Permit Additional desc Permit Fee Issue Date Expiration Date MECHANICAL PERMIT INSERT & COOK STOVE,PIPE, TANK 57.65 Plan Check Fee 2/05/04 Valuation 8/03/04 .00 o Qty Unit Charge Per Extension 47.00 10.65 BASE FEE 1.00 10.6500 ECH ME-GAS PIPE 1 TO 5 Fee summary Charged Paid Credited Due ----------------- ---------- ---------- ---------- ---------- Permit Fee Total 57.65 57.65 .00 .00 Plan Check Total .00 .00 .00 .00 Grand Total 57.65 57.65 .00 .00 ,. ;)-5,-O'! Date Signature of Owner (if owner is builder) T \PLANNING\FORMS\1102 15 [11/14/2003] w o ...Q Ci) -J + ~ Date 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 UNLA WFUL TO COVER, INSULA TE OR CONCEAL ANY WORK BEFORE INSPECTED AND ACCEPTED. POST PERMIT IN A CONSPICUOUS LOCA nON 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 I PLUMBING UNDER FLOOR / SLAB ROUGH-IN WATER LINE (METER TO BLDG) GAS LINE BACK FLOW / WATER AIR SEAL WALLS CEILING I FRAMING JOISTS / GIRDERS SHEAR W ALL/HOLD DOWNS WALLS / ROOF / CEILING DRYWALL (INTERIOR BRACED PANEL ONLY) T-BAR INSULATION SLAB WALL / FLOOR / CEILING MECHANICAL HEAT PUMP GAS LINE '-- -'ll}--o ~ J . j.., WOOD STOVE / PELLET / CHIMNEY HOOD / DUCTS PW UTILITIES / SITE WORK (Engmeenng DIVISIon) SEPARATE PERMIT #'s WATERLINE / METER SEWER CONNECTION SANITARY STORM PLANNING DEPT. SEPARATE PERMIT #'s SEPA P ARKINGILIGHTING 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 BUILDING T.\PLANNING\FORMS\1102 15 [11/14/2003] PREPARED 3/22/04, 12,35 46 CITY OF PORT ANGELES -INSPECTION TICKET INSPECTOR JAMES L LIERLY PAGE DATE 4 3/22/04 ------------------------------------------------------------------------------------------------ ADDRESS CONTRACTOR OWNER PARCEL APPL NUMBER 1309 E 7TH ST FERRELLGAS LP JAMES AND LINDA DEBORD 06-30-11-5-4-9010-0000- 04-00000096 MECHANICAL APPL SUBDIV PHONE PHONE (360) 683-9029 PERMIT PERMIT: ME 00 MECHANICAL PERMIT REQUESTED INSP DESCRIPTION TYP/SQ COMPLETED RESULT RESULTS/COMMENTS ME6 01 2/12/04 2/12/04 JLL DA MECHANICAL GAS LINE LINDA metal shav1ngs and 011 1n 11ne flush and a1r pressure test 301bs 24hrsIJ 11 MECHANICAL FINAL pressure 1n 11ne 1S ok but mach1ne 011 and metal shav1ngs 1n 11ne need to be purged/)1m MECHANICAL GAS LINE ME99 01 2/19/04 2/20/04 JLL DA ME6 02 ~/; JLL ----------~~~~-~--------- COMMENTS AND NOTES --------------------------------______ c- PREPARED 2/19/04, 13 02.00 CITY OF PORT ANGELES INSPECTION TICKET INSPECTOR JAMES L LIERLY PAGE DATE 6 2/19/04 ADDRESS CONTRACTOR OWNER PARCEL APPL NUMBER 1309 E 7TH ST FERRELLGAS LP JAMES AND LINDA DEBORD 06-30-11-5-4-9010-0000- 04-00000096 MECHANICAL APPL SUBDIV PHONE PHONE (360) 683-9029 PERMIT PERMIT: ME 00 MECHANICAL PERMIT REQUESTED INSP DESCRIPTION TYP/SQ COMPLETED RESULT RESULTS/COMMENTS ME6 01 2/12/04 JLL 2/12/04 DA ME99 01 2/19/04 ~ JLL I) \ Io.l.o D~ " \, MECHANICAL GAS LINE LINDA metal shavlngs and 011 ln Ilne flush and alr pressure test 301bs 24hrs/Jll MECHANICAL FINAL -------------------------------------- COMMENTS AND NOTES -------------------------------------- PREPARED- 2/12/04, 12 52 21 CITY OF PORT ANGELES ADDRESS CONTRACTOR OWNER PARCEL APPL NUMBER INSPECTION TICKET-- INSPECTOR JAMES L LIERLY PAGE DATE 6 2/12/04 1309 E 7TH ST FERRELLGAS LP JAMES AND LINDA DEBORD 06-30-11-5-4-9010-0000- 04-00000096 MECHANICAL APPL PERMIT PERMIT: ME 00 MECHANICAL PERMIT REQUESTED INSP DESCRIPTION TYP/SQ COMPLETED RESULT RESULTS/COMMENTS ME6__~~__~p_~ __~:~~~I:::M:::sL:: 30\'Ds> ?~~U1'-€ ~~U\~~ ~ I~ SUBDIV PHONE PHONE (360) 683-9029 .... NOTES -------------------------- 1U L/~G L '~G 624 I-J'2-~ F/v~ L, ) t A-~~b p~sc)~ '(\1\ &~'" ,~ i-ec; d- 51 j ) CITY OF PORT ANGELES LIGHT DEPARTMENT ELECTRICAL PERMIT N? 16560 F- 30 ";- Port Angeles, Washlngtonmm._nm..m.n.__...._.._...m._..m......_m...... 19Lm In accordance with the City Ordinance to regulate the installation. extension. or repair of elec- trical equipment in, on, or about any building or other structure in the City of Port Angeles, per- mission is hereby granted to do e~trica1 work as listed below. Address .j}..(?f....E2nP.Jif;7nm---~. .___.'nmm.m.__. Occupancy___.~:O'.q.h..mh.n....nh...m.m Owner ___._._d~~~kZ::f..~~.....~.~..-...... enant..__......-..__............__.____....__.._____m......__...m_..._ Wiring Contractor ....&~U~-:...<n.hhh...::~--:' .t: By...mm_mm.mnmnmnm_.mm..m..n..n__.m.m._n Light OUtlet.n______Lf.~no.---....----- Service, volts n/~.$/~~___. Type of Wiring: ;r:::~;:~---::tl.e~,~::.~::::::...:::::::::::.. =I:~ w~:::::::~~::?:::::4..:4it::::: ~:.:::s1~~cbl:..::::::::::::::::::::::::::::: / J.. " .-"4. Knob & Tube......._........._.__..........._ Range. KW ______n___.n.'::n:nn.___n Main fUBe 0000. ','00 ("n..:______.l:.(___n.. '-.) Rigid Conduit __n.______'___.....___........ Water Heater: ./ Enclosure __.__no.___.._......___.___........... 1~ ') HeatK:~:::::2.::7>.~:$~n Metallic Tubing _______________.h__n__h. Type. of wiring; Entrance Cable '''.___h_ Motors: size, volts and phase: Rigid Conduit ...._______;___...00_.._...... , " circ:::.e::;h-~::~~~::::~~~:~:~~~=~~~~~==~~~ r. Utility ......_..~......._........_..___...____._ Heat .___./.'1':..__.___...__....___....00.._ Range ___~.______nnn______n.______..___. Water Heater ....:;l.................... MetalUc TUbing ..______mnno Current transformers: No. & Size...........,.___.___________ Ser. No....._......____............_________________. Motor ____._......___._______.__...__.__........._ Dryer _.._...2.........__....................__ Furnace _.____._._..__...._.............._........... Ser. No. __n___________..........._.........h.....__ Ser. NO.._____..______...............h..___..__...... 3;) Total Load_...____._________________... Ser. NO........._........__h..___h_____._._.._... Total __..._.._.__....................._..... Remarks: n.....'__nnm.m;_~"-.e....=~:nn---.CA?L4..:tL!....h---....mm.._.m_mmnh...n.....__...mmmm.m_..m .--.-..---..-........---.----.---..--.........----..--.-..---........-----...-...--.--.---.....--..-.....-..-.-..-...--.-------.-...-.....--------.........-.......- PeI1llit Fee " .:f" 'r-"'D $___..._......_..._____..'___h._._____ Treas. Receipt NOhm_______...._.....__..._. By..tj{.K_~k~~/ NOTICE-Current must not be turned on until Certificate of Inspection has been Issued. It work is to be con- cealed due notice must be given the Inspector so that work may be inspected before concealment. , NOTIFY THE-INSPECTOR BY PERMIT NUMBER WHEN READY FOR INSPECTION "------. .",---~.,.......... ELECTRICAL PERMIT N? 16560 ..-- ( Address ........___.____..._........h...______...;__.........h._.h___...___.............hn______._....................._._._...........___ Date..._....h_h_.:.~.._.........._......_......_...h.... " Owner..___.l;.:.......__n______.._....__....._.._......__._...__.__......._____..____...._...____________._____.___.._____.__Tenant.....______.___._..........._____._.___________.._......_..._...... ) Wiring Contractor............................................. .........._.___.____._..__.._.__............____________._..._........._____.By........____._________..............h_.._______.............. NOTICE-Current must not be turned on until Certificate at 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. \ I 1M Olympic Printers, Inc. .~ t~~ DEPARTMENT OF PUBLIC WORKS ? . . . . . . . . . . . INSPECTION REPORT. . . . . . . . . . . REQUEST: Date ?5 - 17- 0'3 CITY OF PORT ANGELES Time I / ~07J /f/Vl Received by if) (~person) Location of Work to be inspected I '3oC; E 7 rL Name of person requesting inspection fA /CLI-e / tJft! Address of person requesting inspection 170.3 5'" r3 57 Phone No. if/7 - <1'i/'I9 Type of Inspection (circle appropriate one): Permit No. Sewer Foundation Framing Chimney Plumbing Final Sewer Excav. ~ C.-r/",.f ~ r INSPECTION NOTES: Inspected: Date <t -f 7 - o?l Remarks: Time /J; J7} l/.n , By 7 / 7 {; ,I ,;/-t:. /11P1P,-- /}(e.....!:. (e41,u"d J' o.P j},'t> e . , I r /fPf/'O-l 7~' 0+ ci5t?all/<pal L,n'''l"j f , RESTORATION REQUiRED...... YES X NO $ '" ~ 6"M f< (7cJ' ~ ~ '-. .. / i/, , ~ '" --J "" .2',;~ SURFACE RESTORATION: SURFACE TYPE: 0 Unimproved 0 Gravel JZl Asphalt 0 PCC 0 Other Work Order # Jo3'-f.) "0/1 ~COMPLETE '{Info'?, ~ p INCOMPLETE /5<SlrHwl rr;i 5 /~B r~ o Repaired by City o Repaired by Permittee o No Damage Found