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Home My WebLink About1848 Harborcrest Pl - BuildingPREPARED 3/31/11 8 00 11 INSPECTION TICKET CITY OF PORT ANGELES INSPECTOR JAMES LIERLY ADDRESS 1848 HARBORCREST PL TENANT NBR WILLIAM BEAL CONTRACTOR ALL WEATHER HTG COOLING INC OWNER WILLIAM BEAL PARCEL 06 30 00 9 6 0045 0000 APPL NUMBER 11 00000182 MECHANICAL APPL PERMIT PERMIT ME 00 MECHANICAL PERMIT REQUESTED INSP DESCRIPTION TYP /SQ COMPLETED RESULT RESULTS /COMMENTS SUBDIV PHONE (360) 452 9813 PHONE (360) 452 7128 ME99 01 3/31/11 .LL j MECHANICAL FINAL TIME 01 00 March 29 2011 4 46 08 PM 1pangrle JENNY (ALL WEATHER HTG 452 9813) MECHANICAL FINAL HEAT PUMP AFTERNOON COMMENTS AND NOTES PAGE 2 DATE 3/31/11 r a oim- a Leg e Application Number 11 00000184 Application pin number 805520 Property Address 1848 HARBORCREST PL ASSESSOR PARCEL NUMBER 06 30 00 9 6 0045 0000 Application type description ELECTRICAL ONLY Subdivision Name Property Use Property Zoning RS7 RESDNTL SINGLE FAMILY Application valuation 0 Application desc Like and kind furnace heat pump Owner WILLIAM BEAL 1848 HARBOR CREST PL PORT ANGELES WA 983629032 (360) 452 7128 Permit Additional desc Permit pin number 181990 Permit Fee 56 00 Issue Date 3/02/11 Expiration Date 8/29/11 Qty Unit Charge Per 1 00 56 0000 ECH EL LVT THERMOSTAT Special Notes and Comments March 2 2011 10 46 50 AM rlarson Approved based on No Load Change marked on Electrical Information Form Any modifications to the City s electrical facilities will be at the customer s expense Fee summary Permit Fee Total Plan Check Total Grand Total ELECTRICAL ALTER RESIDENTIAL Charged Paid Credited INSPECTION TYPE DATE. DITCH SERVICE ROUGH N FINAL COMMENTS PERMIT WILL EXPIRE SIX (6) MONTHS FROM LAST INSPECTION Signature of owner or Electrical Contractor X G• \EXCHANGE \BUILDING ELECTRICAL PERMIT CITY OF PORT ANGELES 360 417 -4735 Contractor ALL WEATHER HTG COOLING INC 302 KEMP ST PORT ANGELES WA 98362 (360) 452 9813 Plan Check Fee Valuation 56 00 56 00 00 00 00 00 56 00 56 00 00 v )H1 v 3ho hat Date 3/02/11 Due RESULTS 00 0 Extension 56 00 00 00 00 INSPECTOR. REPORT SALES TAX on your excise tax form to the City of Port Angeles (Location Code 0502) Date: City of Port Angeles Permit Application Building DlvIsionlElectrical Inspections 321 East Fifth Street P.O. Box 1150 Port Angeles Washington, 98362 Ph: (360) 4174735 Fax: (360) 4174711 Date: V1 2 Single Family Dwelling Multi- Family or Commercial* Commercial Addition Alteration Remodel Repair' Plan Review ly y, Job Address: I Building Square Footage: Description of abov Owners f• at on Name: a 1 1 i:tirtlar/ Phone: License #1 Exp. Unit Charge 93.75 $113.75 $160.00 $205.00 $291.25 2.00 57.50 2.00 72.50 86.25 $116.25 $131.25 75.00 69.00 75.00 50.00 50.00 93.75 80.00 86.25 27.50 57.50 86.25 43.75 b0 /V0 39Vd wired, Ple se C pie Elect n evr w llnfo a n et �;�X r 11S .f rical Tl ,g X71 �C/ I ts gieiazQ 14 1(1 nOc lain. I 'r State: LU4 Zip: Fax: Data: �jt Total: (Qty Multelied by Unit Champ Owner as defined by RCW.19.211.261: (1) Owner will occupy the structure for two years after this electrical permit is finalized. (2) Owner is required to hire an electrical contractor If above sald property Is for sale, rent or lease. After reading the above statement, Thereby certify that I am the owner of the above named property or a licensed electrical contractor. I am making the electrical Installation or alteration in compllance with the electrical laws, N.E.C., RCW. Chapter 19.28, WAC. Chapter 296468, The City of Port Angeles Municipal Code, and Utility Specifications. Signature of owner, electrical contractor or electrical administrator 9NI1b3H ei3H1ti3M 1 Contrac Name: Mailing City: Phone: License Exp RE EIV MAR 2 2011 ELECTRICAL INSPECTION Service/Feeder 200 Amp. Service/Feeder 201.400 Amp. Service/Feeder-401.600 Amp. Service/Feeder 601.1000 Amp. Service/Feeder over 1000 Amp. Branch Circuit WI Service Feeder Branch Circuit W/O Service Feeder Each Additional Branch Circuit Temp. Service/ Feeder 200 Amp. Temp.'Service/Feeder 201 400 Amp. Temp. Service/Feeder 401 -600 Amp. Temp. Service/Feeder 601 1000 Amp. Portal to Portal Hourly Sign/Outline Lighting Signal Circuit/ Limited Energy Commercial Signal Circuit/ Limited Energy 1 2 Family Dwelling Signal Circuit/ Limited Energy Multi Family Dwelling Manufactured Home Connection Renewable Electrical Energy 5KVA System or Less First 1300 Square Ft Each Additional 500 Square Ft or Portion of Each Outbuilding or Detached Garage Each Swimming Pool or Hot Tub Thermostat Total L7 Cash L7 Check In Credit Card S dePORT.N i 10611 ''91! LLTSZSU09ET Z0 LT TTOZ /T0 /E0 Date CITY 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 Application desc INSTALL A CARRIER HEAT PUMP Owner WILLIAM BEAL 1848 HARBOR CREST PL PORT ANGELES WA 983629032 (360) 452 7128 Fee summary Permit Fee Total Plan Check Total Grand Total T:Forms /Building Division /Building Permit 11 00000182 140020 1848 HARBORCREST PL 06 30 00 9 6 0045 0000 WILLIAM BEAL MECHANICAL APPL PERMIT RS7 RESDNTL SINGLE FAMILY 4818 Contractor Permit MECHANICAL PERMIT Additional desc INSTALL A CARRIER HEAT PUMP Permit pin number 181966 Permit Fee 64 80 Issue Date 3/01/11 Expiration Date 8/28/11 Plan Check Fee Valuation Qty Unit Charge Per BASE FEE 1 00 14 8000 EA ME FURN /HP /FAU OR 5 TON Charged Paid Credited 64 80 64 80 00 00 00 00 64 80 64 80 00 aek,a/40_7i__ Date 3/01/11 ALL WEATHER HTG COOLING INC 302 KEMP ST PORT ANGELES WA 98362 (360) 452 9813 Due Print Name Signature of Contractor or Authorized Agent 00 00 00 00 0 Extension 50 00 14 80 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. `t (7111 ,1oi tr mu,14eo„.)n 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 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 IN CONSPICUOUS LOCATION. KEEP PERMIT AND APPROVED PLANS AT JOB SITE. Inspection Type Date Accepted By Comments Inspection Type Electrical 417 -4735 Construction R.W PW Engineering 417 -4831 Fire 417 -4653 Planning 417 -4750 Building 417 -4815 PLANNING DEPT Separate Permit #s SEPA. Parking Lighting 1 1 ESA. Landscaping 1 1 SHORELINE. FINAL Date Accepted by FINAL INSPECTIONS REQUIRED PRIOR TO OCCUPANCY/ USE 0 mo t♦ 1. 1.1 FINAL Date 1 Accepted by Date Accepted By I!1 U11121E 'h l e' KUM 1 Applicant Property Owner Property Owner's Address Contractor A Contractor's Address License PROJECT ADDRESS ktrbY Ct a Parcel Number Prmiect Tvoe Brief Descrintion. Chock all that apply o New Construction .o Addition a Remodel a Repair o Demolition a Re -roof Meat System. o Other Floor Areas Basement 1 Floor 2 Floor 3 Floor Garage Carport Covered Porch Deck Shed Other BUILDING PERMIT APPLICATION Print in ink CITY OF PORT ANGELES. Attn. Building Permit Technician 321 E. Fifth St. Port Angeles, WA 98362 (360) 417 -4815 fax (360) 417 4711 yIt ExpiresL Jt Irl p y� fesldential n A Existing (sq. ft.) P oposed (sq, ft.) o WV-family a House o garage o other o tear off re -roof o lay over one layer )sCeleat pump o wood buming stove o gas fireplace o pellet stove o other Total footprint of structures sq. ft, Lot size Site Coverage the amount of impervious surface on a parcel. Including structures and other impervious surfaces. (see PAMC 17.94 135 for exemptions) Max. height of proposed structures WiII a lawn sprinkler system be Installed? 1Mll a fire sprinkler system be installed? ri IT I-J 1 111 IJ1M 1 ft. Occupancy group Occupant load Construction type Phone Phone On 1- nc.114en COffl Zoning Phone E -mail Lot J J TC7Cbrlgc'T For City Use Only' Date Received a 1 t Permit# 11 —I22 Date Approved o Commercial a Industrial per sq ft. of bedrooms of full baths of half baths TOTAL VALUATION .51% 3 sq. ft. Lot coverage paved driveways, sidewalks patios, Site coverage 1 have read and completed this spplicatiori and know it to be iris and correct am authorized to apply for this permit end understand that it is my responsibility to deco ne what pe s are re uired, and to obtain permits prior to w. r+g on ejects. 1 n p Date SIN 11,1 Print Na J i 1't� J/ Signature T:Forms /Buptltng Division /Bldg Permit.doc 7.R /T T.T.R7 /T.ta R Clallam County Assessor Treasurer Property Details 62841 WILLIAMS BEAL for Page 1 of 5 Clallam County Assessor Treasurer Property Search Results 62841 WILLIAMS BEAL for Year 2011 2012 Property Account Property ID 62841 Legal Description: HARBOR CREST LOT Geographic ID' 0630009600450000 Agent Code. Type: Real Tax Area. 0010 PA 121 PORT ST CNTY H2 L WMP Land Use Code 11 Open Space N DFL N Historic Property' N Remodel Property' N Multi Family Redevelopment: N Township: Section: Range: Location Address: 1848 HARBORCREST PL Mapsco PORT ANGELES WA Neighborhood Cycle 5 Res Map ID' 2 Neighborhood CD' 10955130 Owner Name. WILLIAMS BEAL Owner ID' 13073 Mailing Address: 1848 HARBOR CREST ST Ownership 100 0000000000% PORT ANGELES WA 98362 -9032 Taxes and Assessment Details Property Tax Information as of 03/01/2011 Amount Due if Paid on 7 Exemptions. 15 NOTE If you plan to submit payment on a future date make sure you enter the date and click RECALCULATE to obtain the correct total amount due First Second Half Half Base Base Year Statement ID Taxing Jurisdiction Amt. Amt. Penalty Interest Base Paid Amount Due 2011 _1_57124_ ST SCH STATE SCHOOL $184 77 $184 76 $0 00 $0.00 $0 00 $369 53 i 2011 157124 CC -GEN COUNTY CLALLAM $102.01 $101.99 $0 00 $0 00 $0 00 $204 00 2011 157124 SD #121 SCHOOL DISTRICT #121 $241 52 $241 51 $0 00 $0 00 $0 00 $483 03 2011 157124 CITY PORT ANG CITY OF PORT ANGELES $235 48 $235.46 $0 00 $0 00 $0 00 $470.94 2011 157124 PORT PORT OF PORT ANGELES $14.36 $14.35 $0 00 $0 00 $0 00 $28 71 2011 157124 NTH OLY LIB NORTH OLYMPIC LIBRARY $42 78 $42.77 $0 00 $0 00 $0.00 $85.55 2011 157124 HOSP #2 HOSPITAL #2 $41.87 $41.87 $0 00 $0 00 $0 00 $83 74 2011 157124 WSMET PK DIST WILLIAM SHORE MET PARK DIST $12.73 $12.72 $0 00 $0 00 $0.00 $25 45 2011 157124 CITY_STORMWATER CITY STORMWATER $36 00 $36.00 $0 00 $0.00 $0 00 $72.00 2011 157124 FIRE_PATROL FIRE PATROL $8 70 $8 70 $0 00 $0 00 $0 00 $17 40 2011 157124 WEED CONTROL WEED CONTROL $0.82 $0.81 $0 00 $0 00 $0 00 $1.63 2011 157124 FP Fee FIRE PATROL COUNTY FEE $0.25 $0.25 $0 00 $0.00 $0 00 $0.50 2011 157124 TOTAL. $921.29 $921 19 $0.00 $0.00 $0.00 $1842.48 2010 45401 ST SCH STATE SCHOOL $202.04 $202.05 $0 00 $0 00 $404.09 $0 00 2010 45401 CC -GEN COUNTY CLALLAM $107.52 $107.52 $0 00 $0 00 $215 04 $0 00 2010 45401 SD #121 SCHOOL DISTRICT #121 $261 70 $261 70 $0 00 $0 00 $523 40 $0 00 2010 45401 CITY PORT ANG CITY OF PORT ANGELES $248.96 $248.93 $0 00 $0 00 $497.89 $0 00 2010 45401 PORT PORT OF PORT ANGELES $15 11 $15 11 $0 00 $0.00 $30.22 $0 00 2010 45401 NTH OLY LIB NORTH OLYMPIC LIBRARY $31.24 $31.25 $0.00 $0 00 $62 49 $0 00 2010 45401 HOSP #2 HOSPITAL #2 $44 11 $44 11 $0.00 $0.00 $88.22 $0 00 2010 45401 WSMET PK DIST WILLIAM SHORE MET PARK DIST $14.04 $14.03 $0 00 $0 00 $28 07 $0 00 http. /websrv8 clallam.net/propertyaccess /Property aspx ?cid =0 &year= 2011 &prop_id =62841 3/1/2011 ~ CITY OF PORT ANGELES DEPARTMENT OF COMMUNITY DEVELOPMENT - BUILDING DIVISION 321 EAST 5TH STREET, PORT ANGELES, WA 98362 Application Number Property Address ASSESSOR PARCEL NUMBER: Application description Subdivision Name Property Zoning . . . Application valuation 03-00000691 Date 7/30/03 1848 HARBORCREST 06-30-00-9-6-0045-0000- MECHANICAL PERMIT 6715 @ Owner Contractor BEAL WILLIAMS 1848 HARBOR CREST ST PORT ANGELES WA 983629032 ALL WEATHER, HEATING & COOLING 302KEMP ST. PORT ANGELES, WA PORT ANGELES WA 98362 (360) 452-9813 Permit Additional desc Permit Fee Issue Date Expiration Date MECHANICAL PERMIT 61.70 Plan Check Fee 7/30/03 Valuation 1/27/04 .00 o Qty Unit Charge Per Extension 47.00 14.70 BASE FEE 1.00 14.7000 ECH ME- INSTALL 100- FAU Fee sununary Charged Paid Credited Due ----------------- ---------- ---------- ---------- ---------- Permit Fee Total 61. 70 61. 70 .00 .00 Plan Check Total .00 .00 .00 .00 Grand Total 61. 70 61. 70 .00 .00 .............. ~ -.t:.. ~ f ~ Q " (0 ~ OJ '-t Separate Permits are required for electrical work, SEPA, Shorelme, ESA, utilities, private and public improvements. This permit becomes null and void if work or construction authorized is not commenced withm 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 herem 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 Owner (If owner is bUilder) Date T.\PLANNING\FORMS\II02 15 [4/2002J BUILDING PERMIT INSPECTION RECORD r CALL 417-4815 FOR BUILDING 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 ELECTRICAL (LIGHT DEPT) SEPARATE PERMIT # ROUGH-IN I PLUMBING UNDER FLOOR / SLAB ROUGH-IN WATER LINE GAS LINE BACK FLOW / WATER AIR SEAL WALLS CEILING I FRAMING JOISTS / GIRDERS SHEAR WALL WALLS / ROOF / CEILING DRYW ALL T-BAR INSULATION SLAB WALL / FLOOR / CEILING MECHANICAL HEAT PUMP 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 PARKING/LIGHTING ESA- LANDSCAPING SHORELINE FINAL INSPECTIONS REQUIRED PRIOR TO OCCUPANCY/USE RESIDENTIAL DATE YES NO COMMERCIAL DATE ACCEPTED YES NO ELECTRJCAL - LIGHT DEPT 417-4735 ELECTRJCAL LIGHT DEPT CONSTRUCTION R W / PW/ CONSTRUCTION - R W ENGINEERJNG 417-4807 PW / ENGINEERJNG FIRE 417-4653 FIRE DEPT PLANNING DEPT 417-4750 PLANNING DEPT BUILDING 417-4815 I) -?, J_ n'2,. J .1-. BUILDING T \PLANNING\FORMS\1102 15 [4/2002] FRo~ : ALL WEATHER HEATING & COOLING FAX NO. : 360 452 5177 BUILDING PERMIT. APPLICATION Jul. 16 2003 08:42AM Pi r~IIUL". . / G I Date ApPrOVed. ~ ~ - [)aID lawell: "(1 ~~ . H IIII'*" old colllJlkte)y. J/ f'> 7 The Building Permit - Pre-appl.catJolI"'lISt J-- aU 417-4815 (!)') UP ~ P..... - or prilIl ioloJ<. If". ba.. ~ q_~oa, pie... e, 1 0 ~I '52- - q f; 3 f 7 hone: I b "1 :. Applicant or Agent: Owuer:. f 'a City: WiIlnF> Addrcu Phone: ArdUtoctIEqineer. - !r I ~ (:cmInGlOI {hi (A)![t/h2// 1/tiIr:J LiceJlllC #:lHflilf1jfJ&J!)!.xp: q (IO-? ~~;~~~~~~ c~. : p'frt4rJrreftjs A&WraI; '7 1/ Ii bt ;)5 l . _ ZONING: ., .~~-, -, Ij:~.- · SobdiViaioIC .:,; ," LEGAl. DUnlDTION: Lot NUMBER." . Credit Carel Bolder NUDe: CL~U.A.MCOVNTYPARCEL .' City: BIIIIDI ~: Exp. Date: CredIt C.-d I: Phone: Zip: tjf:~ 2- Phone: ~5}'-- Cf i/? Zip:1J3/f 2 vw Me SIZEIV ALUATION: ~:m~o~ New Couatr. 0 Rc-roof 0 WoodBtove SF. @ $ ---.JSF. ;; $ )J-.~ c Move [1 Garage SF.@$ /SF. =$ o Multi.fImilY C AdditioD lJ I>e.;k SF. @ $ ISF. ... S 1) c C.........w ~~ ~;1iIiorl c TOTAL VALUATION S &-7 /:SJ');f . _ DBSCIUP'llON OF THE PJlOBCf: !If;;): {ltvlJ:1fJ ! J7 rlt; I/u/rt'fl i) / LtL -r- SIlL_ % Isq. ft. ... TOTAL LOT COVERAGE: APPROVALS: PLAN BLDG. DPW FIRE ESAlWet1and(s): 0 Yoa C No SEPA Cbec;ldist required? 0 y~ [J No Other: OTBEk s:..' :,., !,' BI1ILDINC PaoaT APPLICATION SUBMITI' AL: 1'011' IIpplictll/.tlll ad slm plllll at'" H flllMI 0lIt C41..,.,...... cuptMfor nvkw. The Buildiq Division can provide you with more detailed information on the appl1cation and plan submittal requirements. Your completed application, site plan (for additions) and building construction plans are to be submitted to the Building Division. CQ~ENTIAL: Occupancy Group; Nu. of StoricI: Lot Size; % Lot Coverage: BmtiDs Lot Coverage: Isq. ft. + Proposed Lot Coverage: ~GU8E ONLY: Hotel::" ': Occupant Load: Construction Type: Isq.ft v ALUAnoN 011' CONSTRUCftON: ID all cuea, . valuation amount must be entered by the appliQaat. This figure will be mviewed and may be revised by the Building Division to oomply With cunent fee schedules. Contact the Pennit Coordinator at 417-4815 for assistance. PLAN CHECK FEE: Your plan cheek fee is due at the time the building permit application aud coostruetion plana are submitted. AU other peJJDit fees are due as: the time of permit issuance. EXPIRATION OF PLAN REVIEW: Ifno permit is issued within 180 days oftbe date of application. this appUcadoD 1Irill opire. 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 UDifonn Building Code. current edition). No application can be extended more than onCe. I hereby ~ tlt4t l/tinle read and eumilletl tllis application alld know the same to be true aIld C017"eCt. arJd / am awIKJrlzed ro tJPply /or this permil. I unJenltlnd it is not the City's legal respoIIJibiliry to determine what permits are required; it remains tlae applicfI1tt'J f'f!.Sponsibllity 10 determine what permits are required tlnd to obtain SU~.h 4- , I < /, . APP~' y,1~.J Date: 7JL1/J2 ' \ T:\FORMS\APPS\BlllldinlPG1f\it , , \.<. 6 ,; CITY OF PORT ANGELES DEPARTMENT OF PUBLIC WORKS . . . . . . . . . . . INSPECTION REPORT . . . . . . . . . . . REQUEST: Date 7..... ~o --0 =J / Time l ~ J"3> Received by &F- c..-R... (phone, person) Location of Work to be inspected I ~ J..j ?( ;/0. r-bo...- (r.e-& f- Name of person requesting inspection W I II ( a W7 f3-e..o<-j Address of person requesting inspection Phone No. t-j.s-::2- 71 ()% Type of Inspection (circle appropriate one): C~ Permit No. 6 q I Sewer Foundation Framing Chimney Plumbing V Sewer Excav. ~f f1.1M1f INSPECTION NOTES:~~ Inspected: Date , ~ Time I J Y""'L By J-L./ Remarks: =::IT RESTORATION REQUIRED . . . . .. YES NO SURFACE RESTORATION: SURFACE TYPE: 0 Unimproved 0 Gravel 0 Asphalt 0 PCC o Other o Repaired by City o Repaired by Permittee o No Damage Found Work Order # o COMPLETE o INCOMPLETE (Continue on reverse side if necessary) STREET SUPERINTENDENT (DATE)