HomeMy WebLinkAbout1315 Caroline St - BuildingBuilding Permit
1315 Caroline St
12-692
CITY OF PORT ANGELES
DEPARTMENT OF COMMUNITY & ECONOMIC DEVELOPMENT - BUILDING DIVISION
321 EAST 5TH STREET, PORT ANGELES, WA 98362
Application Number . . . . . 12-00000692 Date
6/04/12
Application pin number . . . 797680
Property Address . . . . . . 1315 CAROLINE ST
ASSESSOR PARCEL NUMBER: 06 -30 -00 -7 -8 -0330 -0000 -
Application type description MECHANICAL APPL. PERMIT
Subdivision Name . . . . . .
Property Use . . . . . . . .
Property Zoning . . . . . . . RS7 RESDNTL SINGLE FAMILY
Application valuation . . . . 5000
----------------------------------------------------------------------------
Application desc
WOOD BURNING INSERT
----------------------------------------------------------------------------
Owner Contractor
NICPON JR MICHAEL F B & B ENTERPRISES
1315 CAROLINE ST 520 ROSE ST.
PORT ANGELES WA 983624502 PORT ANGELES
WA 98362
(360) 417-0436
----------------------------------------------------------------------------
Permit . . . . . . MECHANICAL PERMIT
Additional desc . . WOOD BURNING INSERT
Permit Fee . . . . 60.65 Plan Check Fee
.00
Issue Date . . . . 6/04/12 Valuation . . . .
0
Expiration Date . . 12/01/12
Qty Unit Charge Per
Extension
BASE FEE
50.00
1.00 10.6500 EA ME-STOVE/FIREPLACE/MISC. APP.
10.65
----------------------------------------------------------------------------
Fee.summary Charged Paid Credited
------------------------------
Due
---------------------------
Permit Fee Total 60.65 60.65 .00
.00
Plan Check Total .00 .00 .00
.00
Grand Total 60.65 60.65 .00
.00
REPORT SALES TAX
on your state excise tax form
to the City of Port Angeles
(Location Code 0502)
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.
Date Print Name Signature of Contractor or Authorized Agent Signature of Owner (if owner is builder)
T:Forms/Building Division/Building Permit
BUILDING PERMIT INSPECTION RECORD
— PLEASE PROVIDE A MINIMUM 24-HOUR NOTICE FOR INSPECTIONS —
Building Inspections 417-4815 Electrical Inspections 417-4735
Public Works Utilities 417-4831 Backflow Prevention Inspections 417-4886
IT IS UNLAWFUL TO COVER, INSULATE OR CONCEAL ANY WORK BEFORE INSPECTED AND ACCEPTED.
POST PERMIT INCONSPICUOUS LOCATION. KEEP PERMIT AND APPROVED PLANS AT JOB SITE.
Inspection Type
FOUNDATION:
Footings
Stemwall
Foundation Drainage / Downspouts
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 / Under Floor
Shear Wall / Hold Downs
Walls / Roof / Ceiling
Drywall (Interior Braced Panel Only)
T -Bar
INSULATION:
Slab
Wall / Floor / Ceiling
MECHANICAL:
Heat Pump / Furnace / FAU / Ducts
Rough -In
Gas Line
Wood Stove / Pellet / Chimney
Commercial Hood / Ducts
MANUFACTURED HOMES:
Footing / Slab
Blocking & Hold Downs
Skirting
PLANNING DEPT. Separate Permit #s
Parking / Lighting
Landscaping
Date I Accepted By
Comments
FINAL Date Accepted by
FINAL Date Accepted by
I
I
1
SEPA:
ESA:
SHORELINE:
FINAL INSPECTIONS REQUIRED PRIOR TO OCCUPANCY/ USE
Inspection Type Date
Electrical
417-4735
Construction - R.W. PW I Engineering
417-4831
Fire
417-4653
Planning
417-4750
Building
417-4815 ze-7r—/Z_
T•Fnrmc/Ruilrlinn niviSinn/Riiildino Permit
Accepted By
PREPARED 10/03/12, 10:15:10 INSPECTION TICKET PAGE 2
CITY OF PORT ANGELES INSPECTOR: JAMES LIERLY DATE 10/03/12
---- ------ -- ----------------------
ADDRESS . : 1315 CAROLINE ST SUBDIV:
CONTRACTOR B & B ENTERPRISES PHONE (360) 417-0436
OWNER NICPON JR MICHAEL F PHONE
PARCEL 06-30-00-7-8-0330-0000-
APPL NUMBER: 12-00000692 MECHANICAL APPL. PERMIT
-- ----- ---- ----------- ------------
PERMIT: ME 00 MECHANICAL PERMIT -
REQUESTED INSP DESCRIPTION
TYP/SQ COMPLETED RESULT RESULTS/COMMENTS
---------------------- -- -----------------'----------------------------------------
ME99 01 10/03/12 MECHANICAL FINAL
October 3, 2012 9:26:01 AM pbarthol.
�.Heather 360-797-1578
------------------------- ----------- COMMENTS AND NOTES --------------------------------------
THE
CITY OFOT1 � ELLS
y..
W A S H 1 N G T G N, U. S.
321 East S' Street
Port Angeles, WA 98362
P: 360-417-4817 F: 360-417-4711
hcatuzo@cityofpa.us
Building Permit Application
Project Address:
1 SIS
Main Contact:
For City Use
Permit #
Date Received: 1'e'-"ir/zr—
Date Approved:
Property I Name ,
k/ I,, C
Owner Mailing Address
9 3 1 5'- C 614 Lin e
City
P0 ✓T 4 n q e / eS u, A- 9 & 3 A 3L -
Contractor Name
co vro k, soca,, .18&8
Mailing Address
S 9-0 064d Ro .S - S
city
Po rgy el es wfi- 9836
DL -
Contractor License # . r �
3 t3 rivT: - -� �i 3 PA
Phone #
Phone
Email
State I zip
Phone
Email
State
LA p-.
Expiration:
161,5113
Zip 99J�0—
Project Value: I Zoning: Tax Parcel # Lot #
$ S000
Type of Residential Commercial ❑ Industrial ❑ Public ❑
Permit Demolition ❑ Fire ❑ Repair ❑ Reroof (tear off/lay over) ❑
For the following, fill out both pages of permit application:
New Construction ❑ Remodel ❑ Addition ❑ Tenant Improvement ❑
Mechanical JE� Plumbing ❑ Other ❑
Existing Fire Sprinkler System? Maximum height of structure Proposed Bedrooms Proposed Bathrooms
Yes ❑ No ❑
Project
Description i
I have read and completed the application and know it 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, and to obtain
permits prior to working on projects. I understand the plan review fee is not refundable after review has
occurred. I understand that I will forfeit 20% of the review fee if I cancel or withdraw the application before
plan review has occurred. I understand that if the permit is not issued within 180 days of receipt, the
_pplication will be considered abandoned, and the fees forfeit.
Date Print Name Signa e
6 /l -1/l a-- Co LTo n ,edd �� �,
S
7 Residential Structures
Area Description (SQ FT) Existing Proposed Minimum $ For Office Use
value
Basement
First Floor
Second Floor
Covered Deck/Porch/Entry
Deck
Garage
Carport
Other (describe)
Area Totals
Commercial Structures
Area Description (SQ FT) Existing Proposed Minimum $ For Office Use
value
Structure (s)
Addition
Tenant Improvement
S
Other (describe)
Area Totals
Lot/Site Coverage Calculations
Footprint (SQ FT) of all Structures: Lot Size: % Lot Coverage
SQ FT Site coverage (all impervious + % Site Coverage
structures)
Mechanical Fixtures
Indicate how many of each type of fixture to be installed or relocated as part of this project.
Air Handler Size:
#
Haz/Non-Haz Piping
# of Outlets:
Appliance Vent
#
Heater (Suspended, Floor, Recessed wall)
#
Boiler/Compressor Size:
#
Heating/Cooling appliance
#
repair/alterattLon -,
Evaporative Cooler (attached, not
#
Pellet Stove((\Wood-burnin Gases 05f (-r
#
portable)
Fireplace/Gas Stove/Gas Cook Stove/Misc.
Fuel Gas Piping
# of Outlets:
Ventilation Fan, single duct
#
Furnace/Heat Pump/Size:
#
Ventilation System
#
Forced Air Unit
Plumbing Fixtures
Indicate how many of each type of fixture to be installed or relocated
Plumbing Traps # Fuel gas piping # of Outlets:
Water Heater # Medical gas piping # of Outlets:
Water Line # Vent piping #
Sewer Line # Industrial waste pretreatment #
interceptor
Other (describe):
CITY OF PORT ANGELES
DEPARTMENT OF COMMUNITY & ECONOMIC DEVELOPMENT - BUILDING DIVISION
321 EAST 5TH STREET, PORT ANGELES, WA 98362
Application Number . . . . . 11-00001348 Date 11/30/11
Application pin number . . . 785492
Property Address . . . . . . 1315 CAROLINE ST
ASSESSOR PARCEL NUMBER: 06 -30 -00 -7 -8 -0330 -0000 -
Application type description RE -ROOF
Subdivision Name . . . . . .
Property Use . . . . . . . .
Property Zoning . . . . . . . RS7 RESDNTL SINGLE FAMILY
Application valuation . . . . 1970
----------------------------------------------------------------------------
Application desc
TEAR OFF SECTION OF COMP INSTALL TORCH DOWN
----------------------------------------------------------------------------
Owner Contractor
------------------------ ------------------------
NICPON JR MICHAEL F LARRY'S ROOFING
1315 CAROLINE ST 352 AVIS ST.
PORT ANGELES WA 9.83624502 PORT ANGELES
WA 98362
(360) 452-2215
----------------------------------------------------------------------------
Permit . . . . . . BUILDING PERMIT - NO PR FEE
Additional desc . . COMP TEAR OFF/TORCH DOWN INSTA
Permit Fee . . . . 95.75 Plan Check Fee
.00
Issue Date . . . . 11/30/11 Valuation . . . .
1970
Expiration Date . . 5/28/12
Qty Unit Charge Per
Extension
BASE FEE
50.00
15.00 3.0500 HND BL -501-2K (3.05 PER C)
45.75
----------------------------------------------------------------------------
Other Fees . . . . . . . . STATE SURCHARGE
----------------------------------------------------------------------------
4.50
Fee summary Charged Paid Credited
-------------------------------------
Due
--------------------
Permit Fee Total 95.75 95.75 .00
.00
Plan Check Total .00 .00 .00
.00
Other Fee Total 4.50 4.50 .00
.00
Grand Total 100.25 100.25 .00
.00
REPORT SALES TAX
on your state excise tax form
to the City of Port Angeles
(Location Code 0502)
VW l2 2
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 applicaliorland know the same to be true and correct. All provisions
of laws and ordinances governing this type of work will be complie with w etherecified herein or not. The granting of a permit does
not presume to give authority to violate or ncel the provisions o ny stat or to law regulating construction or the performance of
construction.
Date Print Name Signature of Contractor or Authorized Agent Signature of Owner (if owner is builder)
T:Forms/Building Division/Building Permit
V)
BUILDING PERMIT INSPECTION RECORD
Ns' -- PLEASE PROVIDE A MINIMUM 24-HOUR NOTICE FOR INSPECTIONS
Building inspections 417-4815 Electrical Inspections 417-4735
t. Public Works Utilities 417-4831 Backflow Prevention Inspections 417-4886
IT IS UNLAWFUL TO COVER, INSULATE OR CONCEAL ANY WORK BEFORE INSPECTED AND ACCEPTED.
POST PERMIT IN CONSPICUOUS LOCATION. KEEP PERMIT AND APPROVED PLANS AT JOB SITE.
T n �tR if3 ifnn nrurGinn/A717tdino Permit
IInspection Type ( Date
Accepted By
Comments
FOUNDATION:
Footings
Stemwall I
I
Foundation Drainage / Downspouts
Piers (
j
Post Holes (Pole Bldgs.) j
!PLUMBING:
Under Floor / Slab
l Rough -in
Water Line (meter to Bldg) I
leas Line
Flow / Water
I
I FINAL Date
Accepted by
1Back
AIR SEAL:
j
!walls
Ceiling I
I
I
FRAMING:
Joists / Girders / Under Floor
{
Shear Wall / Hold Downs
j
!Watts / Roof / Ceiling
IDrywall (Interior Braced Panel Only)
T -Bar j
INSULATION:
Slab I
l Wall / Floor / Ceiling I
I
MECHANICAL:
Heat Pump / Furnace / FAU / Ducts
Rough -In
Gas Line
{
Wood Stove / Pellet / Chimney
{
Commercial Hood / Ducts
j
FINAL Date
Accepted by
MANUFACTURED HOMES:
Footing / Slab I
Blocking & Hold Downs
Skirting
PLANNING DEPT. Separate Permit #s
SEPA:
Parking / Lighting I
Landscaping
I
I
ESA.:
SHORELINE:
,j
FINAL INSPECTIONS REQUIRED PRIOR
TO OCCUPANCYI USE
Inspection Type
Date
Accepted By
III
Electrical
417-4735
Construction - R.W. PW / Engineering
417-4831
\�
Fire
417-4653
Planning
417-4750
Building
417-4815
t
1 a" off.'
�(��✓
T n �tR if3 ifnn nrurGinn/A717tdino Permit
BUILDING / PLUMBING / MECHANICAL PERMIT APPLICATION - SHORT FORM
(To be used for projects that do not require plan review.)
Date Received 5✓ -It
Permit #-/,/-/340
City of Port Angeles Please print in ink. Date Approved ao -- If
Attn: Building Permit Technician Approved by_J
321 E. 5'h St., Port Angeles, WA 98362 "
360-417-4815 fax: 360-417-4711 Credit card payments are accepted Mon -Fri 8-5 pm (no American Express)
Hours: Mon through Fri 8 - 5 pm Cash & checks are accepted Mon-Thurs 8:30-4 pm & Fri 8:30-12:30 pm
Contact person: Oro�n
Property owner:
r' t�
Property owner's mailing addr ss:
A
Contractor's business name:�� �(oo db�
(or property owner's name if he/she is oing/overseei g the work)
Contractor's mailing address: Z his J_ 0-
Contractor's
L&I license number: 4_9t cr� no 6ga)
Project Address: '0 -
Phone: 4 SZ�,�
Phone: I� "'�
Phone: qsZ ais
1
Expirati o � date
Project Type: )<Residential o Commercial o, Industrial o Multi -family
Project Business Name:
(for commercial, industrial, or multi -family projects)
The following permits are usually issued over-the-counter immediately, without the need for plan review
Complete only the portions of this permit that are relevant to your project.
_ A j
Re -roof: house ❑ garage ❑ other 04aloLJA 'oln -on I
tear off & re -roof ❑ lay over one layer
(✓) Licensed contractor: Submit a copy of your re -roof bid.
Project Valuation $ 10o-70.— * (labor & materials, not including sales tax)
Re -side: ❑ house ❑ garage ❑ other
Project Valuation $
Repair: (explain the r)roiect)
Project Valuation $
* (labor & materials, not including sales tax)
*
*Homeowner: If you will be doing / overseeing the work, then the project valuation will be determined by doubling the
cost of materials, to reflect the value the repair adds to your property.
Cost of materials x 2 = Project Valuation $
T:Forms/Building Division/Building/Plumbing/Mechanical Permit Application — Short Form (Revised 2011)
Page 1 of 2
Swimminq Pool or Spa (> 24" deep): For prefabricated swimming pool or spa proiects that
do not require plan review.-
Obtain
eview:
Obtain the City of PA handout entitled "Pools & Spas" &.follow the requirements.
Project Valuation $
Demolition: A demolition permit is needed when an entire building gets demolished.
What will be demolished? ❑ house ❑ garage ❑ other
Note: some demolition permit applications need to be reviewed by various City departments, and may take
approximately two weeks to obtain.
(✓) Agree to ensure that all utilities are/will be properly turned off (and capped off if needed)
prior to demolition.
(✓) Obtain (from the City of PA)'an aerial view map of the parcel and put an 'Y' over the structure(s) to
be demolished. Submit the map with this application.
(✓) Obtain (from the City of PA) a copy of the Olympic Region Clean Air Agency (ORCAA)
Demolition Permit Application.
Contact ORCAA at 360-417-1466 to discuss whether or not an ORCAA Demolition Permit will also
be needed.
❑ yes ❑ no Will the debris be going to the Regional Transfer Station in Port Angeles?
❑ yes ❑ No If yes, will a licensed contractor be taking it there?
V) If yes, obtain (from the City of PA) a copy of the Waste Disposal Application.
Complete and submit the waste disposal application to the Building Permit Technician, now
(or later if asbestos testing is needed).
Plumbinq Permit: (explain the proiect)
Project Valuation $
Mechanical Permit: (explain the proiect)
Project Valuation $
I have read and completed this application and know
and understand that it is my responsibility deter
working on projects.
Date (��—�� Signature
Print Name
Page 2 of 2
true and correct. 1 am authorized to apply for this permit
Lat permits are required, and to obtain permits prior to
t
r '
Y, r'
t
i
1
, I
._.. .... .....-._.. - c
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spin• i r
a
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�`L�1rNr�tk°a'r •ie'zL. "Mot
c �
- ` r 5 1' � � r`��'' i z -'�`�* x '� � � _ � pro?- � ' " � � '�`� > y✓s'
1 i -_� @ `3r,r,�, z1�"� o-'r� .'2� -� u�'x`�,.. rr,•k5a - �'r` - `£ .
r�� _ � 4�.y s �� 5 xis � r�`' ,�,~���,�' � `f,. x, . ' � •
t7 i �� �;� ���� .`�tf���U'� L ." ��`a r' i .�• �s.� 'Y- a s& � 1
Contractors or Tradespeople Printer Friendly Page
General/Specialty Contractor
Page 1 of 2
A business registered as a construction contractor with I -Ed to perform construction work within the scope
of its specialty. A General or Specialty construction Contractor must maintain a surety bond or assignment
of account and carry general liability insurance.
Business and Licensing Information
Name
LARRY'S ROOFING UBI No.
600448541
Phone
3604522215
Status
Active
Address
352 Avis St
License No.
LARRYR*088LN
Suite/Apt.
License Type
Construction Contractor
City
Port Angeles
Effective Date 6/15/1992
State
WA
Expiration
Date 11/21/2013
Zip
98362
Suspend Date
County
Clallam
Specialty 1
Roofing
Business Type
Individual
Specialty 2 Unused
Parent Company
Other Associated
Licenses
License
Name
Type
Specialty 1
Specialty
Sp
Effective Expiration
Status
2
Date Date
Framing And
WESSES*9421_6
WESSEL SERVICES
Construction
Rough
Unused
6/26/2006 6/26/2012 Active
Contractor
Carpentry
WESSEC1035NJ
WESSEL
CONSTRUCTION
Construction
General
Unused
8/11/1997 9/30/2013 Active
Contractor
INC
ICLALLC*04405
CLALLAM
Construction
General
Unused
9/10/1996 9/5/1999 Archived
CONSTRUCTION
Contractor
THROOLCO55PB
THROOP LAYMAN
Construction
General
Unused
10/2/1995 9/5/1996 Archived
CONSTRUCTION
Contractor
IWESCOGC084D4WESCOGENERAL
Construction
General
Unused
3/24/1992 1/11/1998 Archived
CONSTRUCTION
Contractor
IWESCOGC1 1 OCZWESCO
GENERAL
Construction
General
Unused
2/9/1989 1/11/1992 Archived
CONSTRUCTION
Contractor
(RAINMR*141KT
RAIN MASTER
Construction
Roofing
Unused
5/30/1986 5/9/1989 Archived
ROOFING
Contractor
IWESCOR*164PQ
WESCO ROOFING
Construction
Roofing
Concrete
10/18/1984 4/1/1988 Archived
Contractor
RAINMR*193R3
RAIN -MASTER
Construction
Roofing
Unused
12/23/1981 12/7/1985 Archived
ROOFING
Contractor
ILARRYSR221C7
LARRY'S ROOFING
Construction
Roofing
Unused
2/27/1978 2/28/1992 Archived
Contractor
RAINMR*099MK
RAINMASTER
Construction
Roofing
Unused
7/12/1991 11/9/2012 Suspended
ROOFING
Contractor
Business Owner Information
https://fortress.wa.gov/lni/bbip/Print.aspx 11/30/2011
Contractors or Tradespeople Printer Friendly Page Page 2 of 2
Name Role Effective DateEx iration Date
RHODES, THOMAS W 'Owner 101/01/1980 1 p
Bond Information
Bond Bond Company Bond Account Effective Expiration Cancel Impaired Bond Received
Name Number Date Date Date Date Amount Date
AMERICAN Until
5 NATIONAL FIRE 790286531690 10/03/2001 Cancelled $6,000.0010/11 /2001
INS CO
Assignment of Savings Information No records found for the previous 6 year period
Insurance Information
Insurance
Company
policy Number
Effective
Expiration Cancel
Impaired Amount Received
Name
Date
Date Date
Date Date
ENDURANCE
18
AMER SPEC
CBC10000051900 01 /29/2011
01/29/2012
$300,000.00 01/14/2011
INS CO
17
INS
GL00309010
01/29/2010
01/29/2011
$300,000.00 01/19/2010
COTHAM
FIRST
16
MERCURY INS
FMIL003923
01/29/2009
01/29/2010
$300,000.00 01/29/2009
CO
FIRST
15
MERCURY INS
FMIL003133
01/29/2008
01/29/2009
$300,000.00 01/17/2008
CO
FIRST
14
MERCURY INS
FMIL002286
01/29/2007
01/29/2008
$300,000.00 02/07/2007
CO
FI RST
13
MERCURY INS
FMIL000352
01/29/2005
01/29/2007
$300,000.00 01 /26/2006
CO
Summons/Complaint Information No unsatisfied complaints on file within prior 6 year period
Warrant Information No unsatisfied warrants on file within prior 6 year period
Infractions/Citations Information
Infraction / Citation Date RCW Code Type Status Violation Amount
IFFERD00508 13/22/2010 143.22.435 RCW IFAS INFRACTION (Satisfied I $200.001
https://fortress.wa.gov/lni/bbip/Print.aspx 11/30/2011
CITY OF PORT ANGELES
LIGHT DEPARTMENT ELECTRICAL PERMIT N° 16197
*fir
Port Angeles, Washington - --------------------------------------------- 19 !..
In accordance with the City Ordinance to regulate the installation, extension, or repair of elec-
trical equipment in, on, or about any building or other structure in the City of Port Angeles, per-
mission is hereby granted to do eIctrical work as listed below.
Occu y---.- ----- -- -
Address = -- -- ---------- --- -------------v- Panc---'�-----------------------
J �� ° '--
Owner ---- -_ - Tenant - -
MS ....--------------------------------
, ._ _ _
Wiring Contractor,,.---='--=---'--=--=--=---------'-----------------------------$y------------------------------- ----------------------------------•---
Light Outlets....................L. ......-_----_-----
Receptacle
..._.._..-.._Receptacle Outlets..------ �....i.......
Dryer. KW ----- ._----------------------------------
Range, KW ------------------ ---------- ------ __.
Water Heater:
KW-----------------------------------✓�----- -
Heat: KW......_,7.1....
i. .:t �.^a::".::..........
Motors: size, volts and phase:
Total
Remarks:
Permit Fee Tress. Receipt �y7). j Y! -
NOTICiTCurrent must not be turned on until Certificate of Inspection has been issued. If work is to be con-
cealed due notice must be given the Inspector so that work may be inspected before concealment.
NOTIFY THE INSPECTOR BY PERMIT NUMBER WHEN READY FOR INSPECTION
Address
Owner
ELECTRICAL PERMIT
N° 16197
Tenant...................................................................
WiringContractor........................................................... _............. ................................................ Ry -------- '............ ..................... ------ .............
NOTICE --Current must not be turned on until Certificate of Inspection has been issued. If work Is to be con-
cealed due notice must be given the Inspector so that work may be inspected before concealment.
Service, volts .- '� -----
Type of Wiring:
No. wires ....... :............. ................
Armored Cable ........................
Size wires
Non -Metallic .................................
.....................
Knob ube.....................---.......
Main fuse .............................
Rigid Conduit ...............................
Enclosure --------------------
Metallic Tubing
Type of wiring:
Raceway — ............................_.....—
Entrance Cable --------------- ..............
.
Circuits, Light..................................-....
Rigid Conduit ... ............................
..Utility .............................................
Metallic Tubing -`...... ................
Heat -----..........................................
Current transformers:
Range .............................................
No. & Size ......----_-----------------_-.....
Water Heater ...............................
Ser. No ----------- ......---------................
Motor .............................................
Dryer ....................... ..........................
Ser. No.---------------------------------------------
Furnace _ .......................-..._.............
Ser. No. ---------------------- ...........`--........
Total .......................................
Permit Fee Tress. Receipt �y7). j Y! -
NOTICiTCurrent must not be turned on until Certificate of Inspection has been issued. If work is to be con-
cealed due notice must be given the Inspector so that work may be inspected before concealment.
NOTIFY THE INSPECTOR BY PERMIT NUMBER WHEN READY FOR INSPECTION
Address
Owner
ELECTRICAL PERMIT
N° 16197
Tenant...................................................................
WiringContractor........................................................... _............. ................................................ Ry -------- '............ ..................... ------ .............
NOTICE --Current must not be turned on until Certificate of Inspection has been issued. If work Is to be con-
cealed due notice must be given the Inspector so that work may be inspected before concealment.