HomeMy WebLinkAbout120 N Lincoln St - BuildingCITY OF PORT ANGELES
DEPARTMENT OF COMMUNITY ECONOMIC DEVELOPMENT BUILDING DIVISION
321 EAST 5TH STREET PORT ANGELES WA 98362
Application Number
Application pin number
Property Address
ASSESSOR PARCEL NUMBER
Tenant nbr name
Application type description
Subdivision Name
Property Use
Property Zoning
Application valuation
09 00000321
673155
120 N LINCOLN ST
06 30 00 5 1 1601 2001
GATEWAY TAVERN
PLUMBING REPAIR
CENTRAL BUSINESS DISTRICT
200
Application desc
INSTALL A REDUCED PRESSURE BACKFLOW ASSEMBLY
Owner Contractor
LOUIS C REHLEN TRUST
%JOHN W REHLEN
PO BOX 385
CASTLETON
VT 05735
GARY S PLUMBING INC
PO BOX 255
PORT ANGELES
(360) 457 8249
Date 4/13/09
WA 98362
Permit PLUMBING PERMIT
Additional desc
Permit pin number 144147
Permit Fee 57 00 Plan Check Fee 00
Issue Date 4/13/09 Valuation 0
Expiration Date 10/10/09
Qty Unit Charge Per Extension
BASE FEE 50 00
1 00 7 0000 EA PL- BACKFLOW PROTECTION <OR =2 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
6 79 4 4 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 1 hereby certify that 1 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 constructfon.
.7 9 .P T�,� �3 W t t
Date Print Name
T:FormsBuilding Division/Building Permit
Signature of oC ntrac5r Authorized Agent Signature of Owner (if owner is builder)
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
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 IN CONSPICUOUS LOCATION. KEEP PERMIT AND APPROVED PLANS AT JOB SITE.
Inspection Type Date Accepted By Comments
PLANNING DEPT Separate Permit #s
Parking Lighting
Landscaping
BUILDING PERMIT INSPECTION RECORD
FINAL INSPECTIONS REQUIRED PRIOR TO OCCUPANCY/ USE
Inspection Type
Electrical 417 -4735
Construction R W PW Engineering 417 -4831
Fire 417 -4653
Planning 417 -4750
Building 417 -4815
FINAL Date Accepted by
FINAL Date Accepted by
SEPA.
ESA.
SHORELINE.
Date Accepted By
2 -09
0
J
0
z
ozD -77
J C
0 1,
E
T.Forms /Building Division /Building Permit
Application Number 09 00000321 Date 4/13/09
Application pin number 673155
Property Address 120 N LINCOLN ST
ASSESSOR PARCEL NUMBER 06 30 00 5 1 1601 2001
Tenant nbr name GATEWAY TAVERN
Application type description PLUMBING REPAIR 01 61)&3a— S
Subdivision Name
Property Use 1 1
Property Zoning CENTRAL BUSINESS DISTRICT V 1
Application valuation 200 Th Q� q
Application desc L C� 1
INSTALL A REDUCED PRESSURE BACKFLOW ASSEMBLY
Owner Contractor
LOUIS C REHLEN TRUST
%JOHN W REHLEN
PO BOX 385
CASTLETON
Permit PLUMBING PERMIT
Additional desc
Permit pin number 144147
Permit Fee 57 00 Plan Check Fee 00
Issue Date 4/13/09 Valuation 0
Expiration Date 10/10/09
Qty Unit Charge Per Extension
BASE FEE 50 00
1 00 7 0000 EA PL BACKFLOW PROTECTION <OR =2 7 00
Fee summary
T.Forms/Building Division/Building Permit
CITY OF PORT ANGELES
DEPARTMENT OF COMMUNIT i ECONOMIC DEVELOPMEN 1 BUILDING DIVISION
321 EAST 5TH STREET PORT ANGELES WA 98362
VT 05735
GARY S PLUMBING INC
PO BOX 255
PORT ANGELES
(360) 457 8249
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
v ion eLkfex
bctie speA4 a 3r frove-d
R eAtrrr\ '6 Li vldc. Pan r e
WA 98362
Date Print Name Signature of Contracr Authorized Agent
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 constructfon.
Signature of Owner (if owner is builder)
NAME OF PREMISES. Ct /7 L
SERVICE ADDRESS (5
LOCATION OF DEVICE. r/ .>f/ ,/1 K
ASSEMBLY I/j/ /C 5
Manufacturer Model Size Serial No
IS THIS AN APPROVED ASSEMBLY YES LNO IS ASSEMBLY INSTALLED CORRECTLY') YES [.NO
DATE OF INSTALLATION /lJ f( /G' l'4 UNKNOWN❑
DOUBLE CHECK VALVE ASSEMBLY
Initial Leaked
Test
Repairs
Details
Final
Test
COMMENTS
Initial
Test
Repairs
Final
Test
REDUCED PRESSURE PRINCIPLE ASSEMBLY
CHECK VALVE #1 CHECK VALVE #2
Held at 6 psi
Cleaned
Replaced
4
Held at #psi
AIR GAP INSPECTION
REQUIRED MINIMUM SEPARATION
Date/Time Tester
YES NO
Backflow Assembly Test Report
City of Port Angeles
Public Works and Utilities Department
Water/Wastewater Collection Division
k'.4 7 l/ ,Ir
4/, //G L. it' Tie e i
g4Ie /3F N /A' s G �li� P f f 51/1",>" g
Leaked
Closed Tight lj
Held at psi
Cleaned Cleaned
Replaced Replaced
Closed Tight Cep'
RELIEF VALVE
Did Not Open
9.
Opened at 7 psi
3 psi Buffer YES NO
Held at psi Opened at psi
A' g //ti 4 e
Signature Cert.
Test Kit
RP
DC
PVB
SVB
WHITE CUSTOMER COPY YELLOW PURVEYOR COPY PINK TESTER COPY
Replaced
Official Use Only
Asscm.#
Received
RPDA
DCDA
Air Gap
AVB
PVB /SVB
AIR INLET
Did Not Open
Opened at psi
CHECK VALVE
Leaked Held at psi
REPAIRS
Cleaned
AIR INLET Opened at psi
CHECK VALVE Held at psi
BACK PRESSURE NO YES
TYPE OF HAZARD G )/4
Line Pressure psi
Held Backpressure YES l NO
#2 Shutoff Held YES O` NO
Relief Valve Exercised YES NO
Passed Failed
Ars, -G 4' M /IVY e 5% t�-
r4 ff 1(Ze ftA- no- R? ga t Sr
o cxnev- Por count'
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 G/a 7 y 7 is2,/ Phone
1- Property Owner /mti4 <00 ,_2 V i S A y /,4,49,11,92 /'hone
Property Owner's Address
Contractor y S r'Lin4' l,L.q' Phone
Contractor's Address
License Expires E -mail
PROJECT ADDRESS /2 G ti //N L,t/
Parcel Number
Project Type Brief Description.
Check all that apply
New Construction
Addition
Remodel
Repair
Demolition
Re -roof
Heat System
Other
Floor Areas
Basement
1St Floor
2 Floor
3rd Floor
Garage
Carport
Covered Porch
Deck
Shed
Other
T Forms /Building Division /Bldg Permit.dcc
0“0 °psi /601 AO I
o/v, /.v j?j4I v exe
c
House garage other tear off re -roof lay over one layer
Heat pump wood- burning stove gas fireplace pellet stove other
Existing (sq. ft.)
Max height of proposed stru es
Will a lawn sprinkler syst be installe
Will a fire sprinkler em be installed?
Residential
Proposed (1g. ft)
L.c� vlS C Re IN. (e h Tres
e/a 5c hn W Re ten o g c)4 8S
APPLICATION P Ir n in" 4'T
5
Lot
Multi family )(Commercial
For City Use Only
Date Received q 1•;-01_
Permit (t'9 _321
Date Approved
1/4 7 .5-g 3
Zoning
f24c)ei70
per sq ft.
TOTAL VALUATION 2
Total footprint of str tures s5 ft. T Lot size sq ft. L. overage
Site Coverage the am t of impervious s ace on a parcel includin• tructures paved ■eways sidewalks patios
and other impervious surfa (see P: i C 17 94 135 for exemptions) Site coverage
ft. Occupancy group of bedrooms
Occupant to of full baths
Constr 'on type of half baths
Industrial
have read and completed this application and know it to be true and correct. 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.
Date /3 0 7 Print Name 57, Signature
1
Owner
Gateway Tavern
120 N Lincoln Street
Port Ange! WA 98367
Reference
120 N Lincoln Street
Gateway Tavern
Dear Customer
Sincerely N
Ronald D Becker
Backflow Prevention Inspector
GELES
W A S H I N G T O N U S A
Public Works Utilities Department
March 31 2009
Account 724
Install Due 05/31/09
Cross Connection Control /Backflow Prevention is a part of the City's ongoing Program to maintain the quality
of our drinking water One of the requirements the Washington State Department of Health Regulations
imposes on all water purveyors is that they have a program for identifying and eliminating cross connections
to the potable water system.
The City's goal is to ensure that all our residents have safe drinking water Identifying and eliminating cross
connections is a vital activity that helps to achieve that goal Backflow Prevention Assemblies help eliminate
me ossibiliy of a cross co neet'= occurr'ng.
As a part of our inspection program we have identified the need for the installation of a REDUCED
PRESSURE BACKFLOW ASSEMBLY on the Carbonated Beverage Despencer This installation is required
by the City of Port Angeles Public Works Department Policy and Procedures Backflow Prevention Policy
PW 903 and Municipal Codes 13.24 014 through 13.24 019 13.28 070 and 13.28 075 WAC 246- 290 -490
Cross Connection Control Enclosed is a hand out that explains the proper installation procedures for the
appropriate assembly required.
Before you install the backflow assembly, you will need to get a PERMIT from the building permit counter at
City Hall. When the installation of the assembly is complete, please contact me to schedule an inspection and
perform the initial test on your new assembly The inspection will be performed at no charge to you.
If you have any questions prior to installing the assembly I would be glad to work with you on the bac.kflow
prevention requirements. Please contact me at 417 4886E -mail rbecker @c'tyofpa.us
Phone 360 -417 -4805 Fax 360 -417 -4542
Website www cityofpa.us Email publicworks @cityofpa.us
321 East Fifth Street P 0 Box 1150 Port Angeles, WA 98362 -0217
Keep Your Water Supply Safe
Important Information for
do It yourself
Irrigation system Installers
1i4E41t)
Some laws and regulations regarding
cklbw protection and approval of type o1
'e used may vary depending upon local
luiremunls
For more specific inlormalion we
rise you to contact your local water
prier at
This parry/Ile( has been
prepared and edited by
Pacific Northwest Sec
American Water Works Association
,toss ConnoUion Control Committee
Important Information for
do•It•yourself
irrigation system Installers
a
4
Irrigation
Safety
HOME
4
L
DON'T LET YOUR
IRRIGATION SYSTEM
CONTAMINATE THE
WATER YOU DRINK
BACKFLOW
PREVENTION
ALTERNATIVES
FOR HOME
IRRIGATION SYSTEMS
Inigallon systems make watering lawns and
gardens easier and save lime, BUT water That
maybe contaminated by weed killers andror
fertilizers can be back- siphoned (backllow) Into
your drinking water. Irrigation systems not
protected by approved backlow prevenllon
assemblies could endanger the health of a
household. neighborhood or community
ALL IRRIGATION SYSTEMS. .new or
exlsting..MUST BE EOUIPRED with an approved
backllow prevention assembly Only properly
Installed. slate- approved backllow prevention
assemblies meet the plumbing code and provide
health protection lot your larNly and neighbors.
Your local water utility can give you a tree list of
stale- approved assemblies and Nut Iliad testers.
Freeze Prolecllon
All bacldlow prevention assemblies installed
above ground need to be protected hom hearing.
Recommendations are to Install a drip light shut-
oil valve (ball valve) below ground on the Inlet
side of the assembly Install a shut -ofl verva with
drain (stop and waste valve) Just above ground
level so piping ahead of the assembly can be
drained. Open all leslcodks and shut otl valves
on the bacdlow prevention assembly hall way
and leave open. A low point drain should also be
Installed on your Irrigation system
Please Nola:
ALL IRRIGATION SYSTEMS supplied by public
water systems REQUIRE A PLUMBING PERMIT
before Installation. Alt piping and materials
upstream 01 (belore) the bactdlow prevention
assembly must be of a type which Is approved by
the International Association of Plumbing and
Mechanical 011lclals.
APPROVED AIR GAP sgpARATION
An approved ac gap is a physical separation between the free flowing discharge end of potable water
supply pipeline, and the overflow rim of an open non-pressure receiving vessel. These separations
must be vertically orientated a distance of at least twice the snide diameter of the inlet pipe, but never
lm than one bah
An obstruction around or near an air gap may restrict the flow of air into the outlet pipe and nullify the
effectiveness of the air gap to prevent backsiphanage When the pier flow is such as the rase
of an air gap located rear a wall, the ac gap separation must be :.y..._,..] (see Table 6-1). Also, within
building where the air pr ssae is artificially increased above atmospheric, such as sports stadium
with flexible roof kept in place by air bbwers, the air gap- separation must be increased. Figure 6-1
illustrates the typical approved air gap. Table 6-1 the of an
approved as gap.
FOUR 'TY PES of
Backflow Prevention
Assemblies
4
4
Installation rectulrements for each type o(bacdlow prevention assembly
ATMOSPHERIC
VACUUM
BREAKER (AVB)
.the least expensive
.open the easiest to
Install
PRESSURE
VACUUM BREAKER
(PVB)
.mote sophisticated
.more versatile
requires annual testing
by certified tester
DOUBLE CHECK
VALVE ASSEMBLY
(DCVA)
.highly versatile
requires annual testing
by certified tester
REDUCED
PRESSURE
BACKFLOW
ASSEMBLY (RPBA)
usually most expensive
most complex
allows for application of fertilizer or
other chemicals into irrigation
system (Ho other type has this
approval)
.requires annual Costing
by certified tester
0
Ai- Gap
2 a D (1' Mu)
te a
Figure 64
Alr Cap For Makeup Tault
24hr period
Laws And Regulations Requiring Backflow Assemblies
WAC 246- 290 -490 State Regulations For Cross Connection Control
Port Angeles Municipal Code Ordinance No.2570.Regulation of Water System CrossConnections
Public Works Dept. Policy and Procedures Backflow Prevention Policy PW -903
AVB ATMOSPHERIC VACUUM BREAKER
One AVB required for each Irrigation zone; no control valves (oNoll valves)
allowed downstream of (after) an AVB.
Each AVB must be installed a minimum al stx Inches (61 above the highest
point of water in the zone it serves.
14a chemical or lenituer may be Introduced lnlo an irrigation system
equipped with AVB s
No pumps or back pressure source on downstream side of (after) an AVB.
The AVB shall not be pressurize6 6-
for more than l2hrs in any L minimum
u U L it
NO VALVES DOWNSTREAM OF AVB
PVB .PRESSURE VACUUM BREAKER ASSEMBLY
Only ona PVB required to serve the whole system; control valves can be
located downstream ol (aher) the PVB.
PVB'a trust be Installed a minimum oI 1 loot (121 above the highest point
of water they serve.
PVB's must be tested by a Statecerified Backflow Assembly Tester' .al
the time ol Installation .annually .when moved or repaired.
No chemical or lertilizer may be Introduced Info an Irrigation system
equipped with PVB's.
No pumps or back pressure on downstream side of after) an PVB.
12'
minimum
Some states may not require the PVB to be tested.
4
1
4
a DCVA. DOUBLE CHECK VALVE ASSEMBLY
Only one DCVA required to serve the whole system; control valves can be
located downstream of the DCVA.
DCVA should be installed a minimum of one loot (121 above ground level.
Some water suppliers may allow the DCVA to be installed below ground,
check for proper clearance on all sides ol the assembly
DCVA must be tasted by a State- certilied Backitow Assembly Tester when
Installed .annually when moved or repaired.
No chemical or fertilizer may be introduced into an irrigation system
equipped with DCVA s.
12" minimum I
RPBA. REDUCED PRESSURE BACKFLOW ASSEMBLY
Only one RPBA required to serve the whole system; control valves can be
located downstream of the RPBA.
RPBA s must be installed a minimum of one loot (12") above ground levet.
RPBA s must be tested by a Stale- cerlitied Backflow Assembly Tesler when
installed .annually when moved or repaired.
In an RPBA equipped system, ledillzer and other agricultural chemicals may
be introduced downstream of (alter) the RPBA.
12" minimum
L3
CROSS CONNECTION CONTROL MANUAL
Approved
Air Gap
Figure 7 -2
RPBA Installation
Figure 7 -3
RPBA Installation In Semi Buried Pit
Bore Sighted
Daylight Drain
(See Figure 6 -8)
PNWS -AWWA
6 Chapter 7 (6th Edition)
PNWS -AWWA CROSS CONNECTION CONTROL MANUAL
12' Minimum
24 Minimum
12' Minimum
Figure 7 -1
Minimum Clearances For RPBA Installation
Chapter 7 (6th Edition)
3' Minimum
When Valve is
Fully Open
0 0
Jo
o O
3'
Minimum
Drain
<See Figure 6 -8)
.
CITY OF PORT ANGELES LIGHT DEPARTMENT
321 E. Fifth Street
Port Angeles, WA 98362
(206) 457-0411
Installed By:
ELECTRICAL PERMIT
PERMIT NO. <j4::J Iff'"
DATE L/- ;J?,'?5
Sito Address:
READY FOR
INSPECTION
License Number:
o WILL CALL FOR
INSPECTION
Phone:
Owner/Business:
Phone:
Owner/Business Address:
Sq. Ft.
o RESIDENTIAL
~ COMMERCIAL
o BASEBOARD KW _
o FURNACE KW _
o FAN/WALL KW _
o HEAT PUMP KW_
o TEMPORARY SERVICE
o PERMANENT SERVICE
o NEW CONSTRUCTION
o .REMODEL
~ ADD/ALTER CIRCUITS
o SERVICE UPGRADE/REPAIR
o OVERHEAD SERVICE
o UNDERGROUND SERVICE
VOLTAGE:
o SINGLE PHASE
o THREE PHASE
SERVICE SIZE AMPS
o SIGN 0 SPECIAL EQUIPMENT
(LIST BELOW)
Details/Description: r::?..f/~~. /~ ~teJ ~".a.<" ~A ~;t;~
~;~~~dJ;;~
~4 !:2 - ;;;1;J. V (fI/.A.h~~
.
W.S. No. SERVICE SIZE
CAPACITY:
o O.K. NOT O.K.
ACTION REQUIRED: 0 CHANGE TRANSFORMER
o INSTALL SERVICE POLE
DATE
ENGR.
o CHANGE SERVICE WIRE
o OTHER
o Ditch Inspection O.K.
o Rough-in/cover O.K.
o O. K. to connect service
,1 Final O.K.
Permit/Receipt No.
~Og?
((?,13
:d~
New Meters
~
.
Notify Port Angeles City Light by Street Address and Permit Numberwhen ready for inspection. Work must not be covered
before inspection and O. K. for covering has been given by the electrical inspector in writing on either the Wiring Report
or on the Building Permit. PHONE 457-0411, EXT. 224.
NO OCCUPANCY OR USE ESTABLISHED UNDER THIS PERMIT
$
Electrical Inspector
Permit Fee
WHlTE - File by address
YELLOW - file by number
PINK - Top: Eng, Bottom, Customer
GREEN - Top: Meter Dept., Bottom: City Hall
OLYLlPICPAINTERSINC
,...
O"'$? <6
r
j
CITY OF PORT ANGELES
DEPARTMENT OF LIGHT
APPLICATION AND ELECTRICAL PERMIT
,
-,;.
FEE RECEIPT NUMBER
A~
V V \BE~ITf'l~ER
~,
.
TOTAL FEE tio 00 . .2i>Se I ~ I-'MS, / ti4V G~N
-
CO NT. LIe. NO. TIME TO COMPLETE NO. STORIES LEGAL OCCUPANCY
ELECTRICAL PERMIT ONLY NO OCCUPANCY OR USE ESTABLISHED UNDER THIS PERMIT
J.
/,2 0 NO. 1-/lIieo/.-.tJ Sr.
~9RRECT ADDRES~ IS RESPO~SlBILlTY o~ A~PU9ANT PERMITS WITH WRONG ADDRESSES ARE CANCELLED .
Owner ])A-w IV GM fI/ JL It!. In;tallation By () I- -f WI PicE i-E CT'Y"I C;
Owner's Address .9,<;, [) . ~()lJJ)ANee ;>.,4 '. -,nsta'lers Address ;;;0/ s;o. /-IN e.() I-,J
Day Phone '-/S2- - 2-1 ' - Installers Phone t.(f;7" S-.&O:,
Applica.t1o,n is hereby made for Permit to install Electrlca} Equipment as follows: INS 'f7'+i.1... 2-tTO A7>11" s;I~.; 40
A-mf' FEtt>IU'" IZ-e.I"I.N1S. EJ4is ~ 1\1 '- 316 56"./' <:'c G ENE~n-L- CU-F-A-N
-'" . -" I ..
i/ P. 61/- ~uJtl!1 TI} lei? // Wiring t.!e\hod (LvN9v;r
Site Address
.
NUMBER AMP 120V - 240V NUMBER AMP 120V 24QV
USE OF CIRCUIT PER 100A FEE --USE OF CIRCUIT 'PEA 100R FEE
CIRCUITS CIR 10 30 CIRCUITS CIR 10 30
LIGHT SIGN
. 50 VOLTS , -
LiGHT OR LESS
MOTOR ..
CONVENIENCE
CONVENIENCE - MOTOR
APPLIANCE .. MOTOR._. .
DISHWASI:iER FIRE ALARMS
DISPOSAL BURGLAR ALARM
RANGE MISC.
,
OVEN
WATER HEATER
LAUNDRY .
DRYER REINSTALLATION LIGHT FIXTURE # ,
FURNACE SUB. TOTAL FEE
GAS - OIL
FURNACE ENERGY FEE
ELECTRIC BASIC FEE
ELECTRIC I:'lEA! .. TOTAL FEE ,. ., dd,oO
ELECTmc HEAT . SIZE OF SERVICE SWITCH OR CIRCUIT BREAKER
,
A.C. UNIT AMP PHASE
FEEDER SIZE OF SERVICE ENTRANCE CONDUCTORS
-
SERVICE A.W.G.
.-.- , I SUB,TOTAL .,.-
SIZE OF GROUND SIZE OF ENTRANCE SWITCH
- - -
I, certify that the work to be performed under this permit wjll be done by the installer and in conformance with the N.E.C. Electrical Code.
Date Application made
;?-'!"O
,19 ~-:;
By ,77JHiJ '/lJC!-/tf.JE,z
.
, CONTRAcTOR OR OWNER (OR AUTHORIZED AGEND
Permission is heret?y given to do the above described work, according to the conditions hereon and according to.the approved plans and
specifications pertaining thereto, subject to compliance with the Ordinances of the City of Port Angeles.
'1 ~ ~ O' - Q'~' By1frf l7~'~
Date Permit Issued A r 0 .J PLANS PPRQVED '.'. , .
..
Notify Department of City Light by Street Address and Permit Number when ready for inspection. Work must not
be covered or current turned on before inspection and O.K. for covering or service has been given by Inspector in :
Writing on Permit Placard. A.. Permits Phone: 457.0411 Ext. 158.
PERMIT PLACARD MUST BE KEPT POSTED ON THE WORK - SEE OVER _
WARNING
WHITE - Original CANARY. Duplicate PINK - Triplicate WHITE CARD . Inspector's Report
OLYMPIC PRINTERS, INC.
<.
~
REPORT OF INSPECTOR
. .
,
\.
,
DATE OF VISIT MADE BY REMARKS
..
O.K. FOR COVERING
I ~ -1. :2 -<(I' I 7~.f O.K. TO CONNECT SERVICE
3 - / :J - '('5' /) ~Q FINAL O.K.
.
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