HomeMy WebLinkAbout1928 W 5th St - BuildingPREPARED 8/29/08 9 10 30 INSPECTION TICKET PAGE 9
CITY OF PORT ANGELES INSPECTOR JAMES LIERLY DATE 8/29/08
ADDRESS 1928 W 5TH ST SUBDIV
TENANT NBR ROBERT STOCKWELL
CONTRACTOR PELLET HEAT CO PHONE (360) 457 4406
OWNER ROBERT A /CAROL J STOCKWELL PHONE (360) 565 0441
PARCEL 06 30 00 9 0 0220 0000
APPL NUMBER 08 00001049 MECHANICAL APPL PERMIT
PERMIT ME 00 MECHANICAL PERMIT
REQUESTED INSP DESCRIPTION
TYP /SQ COMPLETED RESULT RESULTS /COMMENTS
ME99 01 8/29408
MECHANICAL FINAL TIME 01 00
August 27 2008 4 56 58 PM 1pangrle
BOB 565 0441
MECHANICAL FINAL PELLET STOVE
AFTERNOON
COMMENTS AND NOTES
Application Number
Application pin number
Property Address
ASSESSOR PARCEL NUMBER
Tenant nbr name
Application type description
Subdivision Name
Property Use
Property Zoning
Application valuation
Application desc
INSTALL A PELLET STOVE
Owner
ROBERT A /CAROL J STOCKWELL
1928 W 5TH ST
PORT ANGELES
(360) 565 0441
Qty Unit Charge Per
1 00 10 6500 ECH
Fee summary Charged
Permit Fee Total
Plan Check Total
Grand Total
Krilyn46 saw ft
Date Print Name
T Forms /Building Division /Building Permit (05/13/08).wpd
CITY OF PORT ANGELES
DEPARTMENT OF COMMUNITY DEVELOPMENT BUILDING DIVISION
321 EAST 5TH STREET PORT ANGELES, WA 98362
WA 98363
Permit MECHANICAL PERMIT
Additional desc INSTALL A PELLET STOVE
Permit pin number 132944
Permit Fee 60 65
Issue Date 8/26/08
Expiration Date 2/22/09
60 65
00
60 65
08 00001049
757476
1928 W 5TH ST
06 30 00 9 0 0220 0000
ROBERT STOCKWELL
MECHANICAL APPL PERMIT
RS7 RESDNTL SINGLE FAMILY
4300
Extension
50 00
ME OTHER APPL N/R 10 65
Paid Credited Due
BASE FEE
Contractor
60 65
00
60 65
Plan Check Fee
Valuation
00
00
00
Date 8/26/08
PELLET HEAT CO
230 EAST 1ST SUITE C
PORT ANGELES WA 98362
(360) 457 4406
00
00
00
00
0
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
not presume to give authority to violate or cancel the provisions of any state or local law regulating construction or the performance of
construction
tature of Contractor cV uthorized Agent Signature of Owner (if owner is builder)
CALL 417 -4815 FOR BUILDING INSPECTIONS CALL 417 -4735 FOR ELECTRICAL INSPECTIONS
CALL 417 -4807 FOR PUBLIC WORKS UTILITIES CALL 417 -4886 FOR BACKFLOW PREVENTION 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 AND APPROVED PLANS AT THE JOB SITE.
INSPECTION TYPE
FOUNDATION:
FOOTINGS
SHEAR WALLS WALLS
FOUNDATION DRAINAGE DOWN SPOUTS
PIERS
POST HOLES (POLE BLDGS.)
PLUMBING
UNDER FLOOR SLAB
ROUGH -IN
WATER LINE (METER TO BLDG)
GAS LINE
BACK FLOW WATER
AIR SEAL
WALLS
CEILING
FRAMING
JOISTS GIRDERS
SHEAR WALL/HOLD DOWNS
WALLS ROOF CEILING
DRYWALL (INTERIOR BRACED PANEL ONLY)
T -BAR
INSULATION
SLAB
WALL FLOOR CEILING
MECHANICAL
HEAT PUMP /FURNACE /DUCTS
GAS LINE
WOOD STOVE PELLET CHIMNEY
COMMERCIAL HOOD DUCTS
MANUFACTURED HOMES
FOOTING SLAB
BLOCKING HOLD DOWNS
SKIRTING
PLANNING DEPT SEPARATE PERMIT tl's
PARKING /LIGHTING
LANDSCAPING
RESIDENTIAL
ELECTRICAL LIGHT DEPT 417 -4735
CONSTRUCTION R.W PW/
ENGINEERING 417 -4807
I FIRE 417 -4653 I
I PLANNING DEPT 417 -4750 I
BUILDING 417 -4815
BUILDING PERMIT INSPECTION RECORD
DATE ACCEPTED
YES NO
FINAL
SEPA.
ESA.
SHORELINE.
FINAL INSPECTIONS REQUIRED PRIOR TO OCCUPANCY /USE
DATE YES NO COMMERCIAL
DATE ACCEPTED BY.
FINAL 311 -eg DATE V ACCEPTED BY.
ELECTRICAL
LIGHT DEPT
CONSTRUCTION R.W
PW ENGINEERING
FIRE DEPT
PLANNING DEPT
BUILDING
COMMENTS
DATE
ACCEPTED
YES I NO
08/20/2008 09 33 13604520503
1 'roiect Tvae 8 Brief Description.
Check all that apply
o New Construction
o Addition
o Remodel
o Repair
o Re -roof
o Demolition
o Sign
t(Heat System
o Other
door Areas
Basement
1 Floor
2 Floor
3 Floor
Garage
Carport
Covered Porch
Deck
Shed
Other
otal footprint of structures
lax. height of proposed structures
/ill a lawn sprinkler system be installed?
/ill a fire sprinkler system be installed?
Forms /Building DivisionlBidg Permit Appl. -2006 Code.doc
BUILDING PERMIT
CITY OF PORT ANGELES
Attn Building Permit Technician
321 E. Fifth St. Port Angeles, WA 98362
(360) 417 -4815 fax (360) 417 -4711
Applicant or Agent Bst, CO
Owner Rama aroCK )E L
Owner s Address L42p rn
Contractor /Engineer a Ll r Qrjyr
Contractor /Engineer's Address 2)A I sr
License L F -Woe° 1^
PROJECT ADDRESS IG2g 14/ Fj
Parcel Number 0020nO°10Q22 p
Residential o Commercial
SPA SHOP PELLET HEAT PAGE 01
o wall- mounted o projecting o freestanding o awning other
Total sign area sq ft. Maximum allowed sign area sq ft.
o Heat pump o wood burning stove o gas fireplace pellet stove o other
Existing (sq. ft) Posed (sq. ft.)
APPLICATION Print in ink
For City Use Only
Date Received
('9$— IOLfej
Date Approved
Phone Afil- 4 400
Phone k) -O44 I
Phone 457_44
Expires ...f:.a
L laLIO 4LDviLS Sas.
Lot
TOTAL VALUATION
Zoning
o Multi family o Industrial
per sq. ft.
sq ft. 4- Lot size sq ft. Lot coverage
ft, Occupancy group of bedrooms
Occupant load of full baths
Construction type of half baths
have read and completed this application and know if to be true and correct. I am authorized to apply for this permit and
iderstand that it is my responsibility to determine what permits are required, and to obtain permits prior t,� working on
oiect
ate gir N Print Name be �trsSi Signature_ ,S
. '\
"'s....:.
~.
.~
~W:if:r{
JGITYj OF.PO~! ~QELES ..
DEPARTMENT OF coMMuNITY DEVELOPMENT - BUILDING DIVISION
321 EAST;STHSTREET. PORT ANGELES.WA 98362
Application Number
Property Address
ASSESSOR PARCEL NUMBER:
Application description
Subdivision Name
PropertyZonirig . . .
Application valuation
03-00000871 Date 9/18/03
1928 W 5TH.ST
06-30-00-9-0~0220-0000-
RES DETACHED GARAGE
Permit . . . .
Additional desc
Permit.Fee
Issue Date
Expiration Date
BUILDING PERMIT -RESIDENTIAL
DETACHED 576 SF GARAGE
218.75 Plan Check Fee
9/18/03 Valuation
3/17/04
87.50
11000
11000
Owner
Contractor
ROBERTA/CAROL JSTOCKWELL
PO BOX 77563
SEATTLE
WA 981770563
HELGELSON'~CONSTRUCTION
132 ANGELES LAIR LANE
PORT.ANOELES'
PORT. ANGELES
(360)928-9588
NEW 576 SF DETACHED GARAGE
TYPE V NON-RATED
GARAGES, CARPORTS, SHEDS
NUMBER OF UNITS
WA 98363
-- -- -- . Structure Information
COnstruction Type .
Occupancy Type .. .. .
Other struct info.. . . .
1.00
- - - -- -.-..-,- ~ -,- - -.-.:-: ~ ~.-.....-- -.-.- - -.- - - - --- - - - - - ~ - -- -- ---,-- - -,-.- - -, "":'.- - - - - - - - - - - - - - - - - - --
Qty Unit Charge Per
Extension
92.75
126.00
....Q
~
~
'BASE FEE
9.00 14.0000 THOU BL-2001-25X (14 PER X)
Other Fees
STATE SURCHARGE
4.50
Fee summary Charged Paid Credited Due
----------------- ---------- ---------- ---------- ----------
Permit Fee Total 218.75 218.75 .00 .00
Plan' Check Total 87.50 87.50 .00 .00
Other Fee Total 4.50 4.50 .00 .00
Grand.Total 310..75 310.75 .00 .00
~
c".
~
....~
:-t-
Signature of Owner (/fowner Is builder)
,: ".' ",.._"""",-,,_"
Sepa.~8PfJlWlts a~requlred for electrical WO.rtt.. SEPA:Sho~.ii~e!. e8Aiutllltles. private and public ImproverJ1entS;.T~ls~it1,llitt)8e~rnes
nulla,nd'Vold:lfwdrk orconstructlon authorized is not commen~ Within 180 daYs. If con~ctIon or work Is.sus~"ct~.(j'ofabandon8d
foril~~ri,Qd~t;1,89'(jaysafterthe work as commenced;.or ,If required Inspections have not been requestedwithin1~~,~~~fr'oT the last
InsPffCtIOm"the~bYcertify that I have read and examinedthisal?plication and know the. same. to be . true.and correct;';,b.!/pro,.,lslons of
laws a.nd9rdinances governing this type of work will be complied with whether specified herein or not. The granting Of;f:l,j:)ennit;does not
presulTleJ()gi:veauth()rity to violate or cancel the l?J"C)vlslons of any state or local law.regIJlatlng constructlonQf tI1~.P~1f91jJ1ilnce of
cons '.
T:\PLANNINCfuiORMs\1102..15 [412002]
;.,\i.,.-; __
BUILD~G PERMtfiNs~ECTloN RECORD
j. ,~' .. , ';' " ,-,;! '"};,;f ";-:." t, ;:< "''''','',
CALL 417-4815 FOR BUILDING INSPECTIONS.PLEA~E PROVIDE A MINIMuM 24 HOUR NOTICE, IT IS UNLAWFUL TOCOJrER,
INSQL(JTE QIJ. COlYCEAL ANY WORKBEFO/J.Plfi.$ppqED /lJ':{D /lq~pPT~D. "POST ,PERMIT IN A CONSPICUOUS LOCATION,
~,',. .',;'-'~'~""""...." ".._.,' "c.,. ',;,,-.:~,..-;,. ',~". ".'- .. ':"i;:~. ".~.;-.._":.-:' ,,:O.r':'-.:.:'~:,;'/~:'~"'" ,...'.::..::._';.:.... .~.:.'.,:._..'.:.><'.:..._.... ""-'''~:'-:
KEEP PERMIT CARD AND APPROVED PLANS AT JOB SITE
- ).
INSPECTION TYPE DATE A<;CEPTED,. CQMMENTS
. H I YES NO
FOUNDATION: p' " . : "
.
FOOTINGS ~/,.. h ~4~'1l-,,1. ~\ L.
WALLS , - , :
FOUNDATION DRAINAGE ',. .. .
ELECTRICAL (LIGHT DEPT) SEPARATE PERMIT: 1/ " ....:..:..: .'
ROUGH-IN J I .,' " ..
PLUMBING ,
-
UNDER FLOOR f SLAB ,;
ROUGH-IN
WATER L[NE "
GAS LINE '.. : /
BACK FLOW f WATER \
AIR SEAL "
WALLS ,
CEILING I:.';'", ..,.i., I .' , ';
FRAMING . ." " ',,'.."
"
JOISTS f G[RDERS
SHEAR WALL
WALLS f ROOF f CEILING IIJ -It. - tJ1 Jd.a
DRYWALL ,;h: "
T.BAR ; ~.'\.;:
INSULATION " : :
SLAB
WALL f FLOOR f CEILING I
MECHAN[CAL .,
HEAT PUMP
WOOD STOVE f PELLET f CHIMNEY
nOOD f DUCTS
PW UTILITIES f SITE WORK (Engineering Division) SEPARATE PERMIT I/'s:
WATERLINE f METER .'
SEWER CONNECT[ON ,
SANITARY
STORM
PLANNING DEPT. SEPARATE PERMIT #'s SEPAl
PARKINGfLlGHTING ESA:
LANDSCAPING " ", SHORELINE: ,,'
;,._.......:::"..,.,;,,--< -
, ,!jPIN~JNSI'ECTJp~S1tEQUIRED PRIOR,TO OCCQMJl/t;Ytl1S" ','I, ".'.;',", c',';:: .., ,
, " '0"0\ ' ~ r'OATE"'; '. , ; #.s.. ....NO t6'MMtRCt~L " DATE'
RESIDENTIAL ->-;0..1 .; , ACCEPTED:
J ',C:,,;" . \ '" .: ,L NO
. , .' , YES
.,
ELECTRICAL. LIGHT DEPT. 4 [74735' . .. " ~~ ...
\ o~~ ~
" ,'. ,'L"" 'it" ,j' , ~ .
CONSTRUCTION R.W.I PWf CONSTRUCTION - RoW..
ENGINEERING 4[74807 pW I ENGINEERING
FIRE 417.4653 , fIRE DEPT, ,'; . ,I " "
-
PLANNING DEPT. 4174750 '. PLANNING DEPT. .l. , , .,"
BUILDING,. .. " ,., ",4.\.7.4815, .1/)-16~1'J.~" <oJ... ),. , - BUILDING
, ,"
T:\PLANNING\FORMS\1102.15 [4f2()()21
;.:..[-....
BUILDING PERMIT - APPLICATION
FOR OFFICIAL USE ONLY:
DateRec.:q- Z"'Cf?
Pennit#:~
DateAPproVed:~
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
(360) 417-4815
City:
/) ;:1_
Phone:
Phone:
92.'6'-'75 ilt
~&J - :;L~ 7 'd?
S6S~d4q I
Zip: 9' ~~~ . g
Applicant or Agent: ~ ~ \l:~ f
Owner: ~ ~Iz(".p"/I
Address: 1t.2~g 'IV.?II{ sf;
r!},),?J /-
Architect/Engineer: Phone:
Contractor :;k,J '1 h.;41y~ State License #: ~/..C,E'!> c.f1bi~: '1 J ~I ~ 5' Phone: ~; b
Address: /32- /4-;U'Jel>:1' Mr~ t~/f City: P-d... Zip: 2?>~ ~
PROJECT ADDRESS: ~ 9. 2 e . ~UJ S-"-I-t, ZONING:
LEGAL DESCRIPTION: Lot: #-7 Block: tfo-C Subdivision:
CLALLAM COUNTY PARCEL NUMBER: 06~ 6~ 90CZ2 OQ::JO 0
Credit Card Holder Name:
Billing Address:
Credit CardType VISA
TYPE OF WORK:
o Residential 0 New Constr. 0 Re-roof ~
o Multi-family 0 Addition 0 Move am e
o Commercial 0 Remodel 0 Demolition ec
o Repair 0 Sign 0 Other
BRIEF DESCRIPTION OF THE PROJECT: J) c17++e4
City:
MC
#
Exp. Date:
SIZEN ALUATION:
SF. @ $ /SF. = $ .
51F SF.@$ 17,,- /SF.=$ j/~, dJ
SF. @ $ /SF. = $
TOTAL VALUATION $
<$4~ e-
COMMERCIAL/RESIDENTIAL: Occupancy Group: Occupant Load: Construction Type: ,t;(i.K ;::.8fIH~
No. of Stories: ~ Lot Size: >() ~ / 'to" Existing Sq. Ft. j 'I B~ & Proposed Sq. Ft. 57(; = TOTAL Sq.Ft. 2.0 ~y
Existing lot coverage _ % & Proposed lot coverage _% = Total lot coverage 'Z. '9', 'I %
APPROVALS:
PLAN:
BLDG:
DPWU:
FIRE:
OTHER:_
PLANNING USE ONLY:
ESA/Wetland(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 constmction 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 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.
T,\FORMS\APPS\B.Udin"""",,,lwpd APPlicant~;;C, ~ . Date: '7 -2-- t:l 3
PREPARED 10/16/03, 12:49:12
CITY OF PORT ANGELES
INSPECTION TICKET
INSPECTOR JAMES L LIERLY
PAGE
DATE
6
10/16/03
ADDRESS
CONTRACTOR
OWNER
PARCEL . .
APPL NUMBER:
1928 W 5TH ST
HELGELSON CONSTRUCTION
ROBERT A/CAROL J STOCKWELL
06-30-00-9-0-0220-0000-
03-00000871 RES DETACHED GARAGE
SUBDIV:
PHONE
PHONE :
(360) 928-9588
PERMIT: BPR 00 BUILDING PERMIT - RESIDENTIAL
REQUESTED INSP DESCRIPTION
TYP/SQ COMPLETED RESULT RESULTS/COMMENTS
BLFS 01
9/26/03
9/26/03
10/16/03
BUILDING FOOT /SLAB
BL99 01
JLL
AP
~L BUILDING FINAL
John Helgeson requests a Final on the Garage in the alley.
Ph# 460-2675
-------------------------- ----------- COMMENTS AND NOTES --------------------------------------
PREPARED 9/26/03, 12:41:52
CITY OF PORT ANGELES
INSPECTION TICKET
INSPECTOR JAMES L LIERLY
PAGE
DATE
4
9/26/03
ADDRESS
CONTRACTOR
OWNER
PARCEL . .
APPL NUMBER:
1928 W 5TH ST
HELGELSON CONSTRUCTION
ROBERT A/CAROL J STOCKWELL
06-30-00-9-0-0220-0000-
03-00000871 RES DETACHED GARAGE
SUBDIV:
PHONE
PHONE :
(360) 928-9588
I
PERMIT: BPR 00 BUILDING PERMIT - RESIDENTIAL
REQUESTED INSP DESCRIPTION
TYP/SQ COMPLETED RESULT RESULTS/COMMENTS
B"":":::-;I"I":::~:_BB'"D'~:o::::':;~-~~~:,-_::::::::-----_::__:::::::::::::::_:-:
~I
Installed By:
CITY OF PORT ANGELES
LIGHT DEPARTMENT
PERMIT NO.
;2~ 7;/
s /...<>00
.
ELECTRICAL PERMIT
DATE
Site Address:
.s-~
~READY FOR
INSPECTION
License Number:
o WILL CALL FOR
INSPECTION
Phone:
Owner/Business:
Phone:
Owner/Business Address:
Sq. Ft.
~ Residential
Heat KW
o Baseboard 0 Furnace/Boiier
o Heatpump 0 Other
o Commercial/Industrial load
Total Connected load
(attach breakdown)
Total Motor load
(attach breakdown)
o New Construction
o Remodel
o Service update/alter/repair
o Overhead
o Underg73und I:. c.fD
~Itage . '),~ ~
t:10 03
Service size Amps
o Temporary
o Add/alter circuits
o Auxiliary power
(list below)
)(Special equipment
( ~Iist below)
DetallslDescription:
1M-
7cJ-
.
t~
.
W.S. No. Service Size
Capacity: 0 O.K. 0 Not O.K. Comments
o Ditch inspection O.K.
o Rough.in/cover O.K.
o O.K. to connect service
/lP~ Fin:' O.K.
G-f..l. ~
Date
Hold for: 0 Easement 0 Letter
o Signed up for service/meter
o Meter Department notified for installation
o Fire Department notified of inspection
o Plan Review approved/pending
Installer:
'f&
PermitfReceipt No.
Site Address:
02
o
New Meters
.
Notify the Dep nt of City Light by Street Address and Permit Number when ready for inspection. Work
must not be covered or electrically energized before inspection and O.K. for covering or service has been given
by the Inspector in Writing on the Wiring Report or the Building Permit. PHONE 457.0411, EXT. 158 or EXT. 224.
~ NO OCCUPANCY OR USE ESTABLISHED UNDER THIS PERMIT .;;20 ~
I ns'pector Amount paid
WHITE - file by address YELLOW - file by number PINK - Top: Eng, Bottom: Customer GREEN - Top: Inspector, Bottom: City Hall
OLYMPIC PRINTERS. INC.
CITY or PORT ANGELES
LIGHT DEPARTMENT
ELECTRICAL PERMIT
"
N? l6234
. . 9'-:;2../ ))
Port Angeles, Washlngton...................._.._..................................... 19.....'n
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 d6 electrical work as listed below.
/ l' ,;?~- vr 51/~. . ./U'-1SZ--'
:::'~:;~~~~~;~~=~~;-:=::=~=::==
51 0 / :2. 0/ ;?~iI
Light Outlets...................___........_.._..... Service, volts .............)'........__..............
yo 3
Receptacle Outlets..........______....____....... No. wires ..00......__............__..............
D'ye,. KW mmnn~;;;nm.mnn..nnn.'n Size wlresnn~-F-.._..
Range, KW...___../...~......................... Main fuse .....__.....__.........d......__
S
Enclosure n.................____..........__....
Water Heater: /"'
if>
KW nnnmm..,u.mmnmmn.
. /7- 13.8
lleat: KW ...__ ._..._.............__ ______ __.. ..
Type of wiring:
Entrance Cable ....................__00.....
Motors: size, volts and phase:
/ t:€i.,.t..l.>
,mmj.mn'ii.n1:;:,m..mnnn.nmmm
......_....~..._....n....................
, .
Rigid Conduit m.mm.nmm.m....m.
Metallic Tubing 00..__.
Current transformers:
No. & Size.............__...............
Ser. No.............................__..__............
Ser. No...............................__...........__
Ser. No...............................................
Type of Wiring:
Armored Cable ..............................
Non-Metallic ...n...hh.....................
Knob & Tube................__..............~
RIgid Conduit .n.,mnn'mmnnnmn'
Metalllc TUbing 'm.nmn'n.n.mnm
Raceway ..............................._....._
C.
Circuits, Light....................n.................
. C;
Utility n'r:;mmn,mn.nnnn.nnnnnm
y
Heat .__.......__..........................._......
;:J-
Range .............................................
~
Water Heater .............................__
Motor .............................................
D'ye, n.!?=nnmmnmm,.n.nnmnnnn
Furnace .........................._...................
t?U;
Total wad____......................... Ser. NO.................._........h...____...h..__ Total ............00.......................__
Remarks: ....,.1'1~~!.."'..~.......nC~!,e:!?4.m.........m..nn..n....m.........nn......m.....'....................,......
.:~,~i,~~.,',',~,'...~..~..~~~..~....m..::~.~.~:..:~.~.~~~.~~.'.~.....................::.2?Z]~:z=:
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 belore concealment.
NOTIFY THE INSPECTOR BY PERMIT NUMBER WHEN REPlDY FOR INSPECTION
i
\'-.
ELECTRICAL PERMIT
N?
16234
Address..................._...................................................................................................................Date..._......_.._.._.._.........._......_......_.........
Owner .....................n............._.........._.............._.._........................................................... Tenant...................................................nn...........n
Wiring Contractor........................._...~...._......_.............._n..h......00..00........00................................. By.....................n..................:....................
NOTICE-Current must not be turned on untll Cert1t1cate 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.
J;\p I
d. . j
1M
OlvIDoic Printers. Inc.
-,~-
"~h~