HomeMy WebLinkAbout2038 Lindberg Rd - Building ELECTRICAL PERMIT l
CITY OF PORT ANGELES CY
360 -417 -4735
Application Number 12- 00000511 Date 4/30/12
Application pin number 832396
Property Address 2038 LINDBERG RD REPORT SALES TAX
ASSESSOR PARCEL NUMBER: 06- 30- 13 -2 -3 -0020 -0000- on your excise tax form
Application type description ELECTRICAL ONLY
Subdivision Name to the City of Port Angeles
Property Use (Location Code 0502)
Property Zoning RS9 RESDNTL SINGLE FAMILY
Application valuation 0
Application desc
200 amp panel
Owner Contractor
KERRIGAN BETTY BLACK DIAMOND ELECTRICAL CONTR
2038 E LINDBERG RD 502 BLACK DIAMOND RD
PORT ANGELES WA 983629345 PORT ANGELES WA 98363
(360) 565 -1035
Permit ELECTRICAL ALTER RESIDENTIAL N v
Additional desc V
Permit Fee 120.00 Plan Check Fee .00
Issue Date 4/30/12 Valuation 0 t
Expiration Date 10/27/12 S.0
Qty Unit Charge Per Extension
1.00 120.0000 ECH EL -0 -200 SRV FEEDER 120.00 GO
Special Notes and Comments
April 30, 2012 7:56:14 AM tamiot.
Maintain all required clearances, service drop to be pulled
up by COPA.
Fee summary Charged Paid Credited Due
Permit Fee Total 120.00 120.00 .00 .00
Plan Check Total .00 .00 .00 .00
Grand Total 120.00 120.00 .00 .00
V (4 `7123 5 (Z.
INSPECTION TYPE DATE: RESULTS: INSPECTOR:
DITCH
SERVICE �1 i 3 1
1 2
ROUGH -IN
FINAL ^7 12` ,•..r,
COMMENTS:
PERMIT WILL EXPIRE SIX (6) MONTHS FROM LAST INSPECTION
Signature of owner or Electrical Contractor X Date:
G: \EXCHANGE \BUILDING
REcEllliS1 v 4'ti r 1,; N n...,-,. t
CITY OF PORT ANGELES PERMIT APPLICATION APR n
E
Building Division /Electrical Inspections
t
321 East Fifth Street P.O. Box 1150 Port Angeles Washington, 98362 ELECTRICAL ■11111111W
Ph: (360) 417 -4735 Fax: (360) 417 -4711 INSPECTIONS
f
Date: 30 L K1 2 Single Family Dwelling
*Plan Review May Be Required, Please Complete Electrical Plan Review Information Sheet
Job Address: 20 3 9 4
Building Square Footage:
Description of above 124i_9>EG.. C—telAk.5Cse
Owner Infor ation �j� Contractor Information
Name: PE1ry 6- �KlCnit-t) Name: ObE
Mailing Address: 2c9 3f' 4NObLA(,— Mailing AddresL 'pcA ..NO
City: State: Zip: City: V.. State: Zip:
Phone: K2.2oVf Fax: Phone: Fax:
License Exp. License Exp. 3 L Ak.E G $'.1P z..
Item Unit Charge Qty Total (Qty Multiplied by Unit Charge)
Service /Feeder 200 Amp. 120.00 20
Service/Feeder 201 -400 Amp. 146.00
Service /Feeder 401 -600 Amp 205.00
Service /Feeder 601 -1000 Amp. 262.00
Service /Feeder over 1000 Amp. 373.00
Branch Circuit W/ Service Feeder 5.00
Branch Circuit W/O Service Feeder 63.00
Each Additional Branch Circuit 5.00
Branch Circuits 1-4 75.00
Temp. Service/ Feeder 200 Amp. 93.00
Temp. Service /Feeder 201 -400 Amp, 110.00
Temp. Service /Feeder 401 -600 Amp. 149.00
Temp. Service /Feeder 601 -1000 Amp 168.00
Portal to Portal Hourly 96.00
Signal Circuit/ Limited Energy -1 2 Family Dwelling 64.00
Manufactured Home Connection 120.00
Renewable Electrical Energy 5KVA System or Less 102.00
Thermostat 56.00
Note: $5.00 for each additional T -Stat
NEW CONSTRUCTION ONLY:
First 1300 Square Ft. 120.00
Each Additional 500 Square Ft. or Portion of 40.00
Each Outbuilding or Detached Garage 74.00
Each Swimming Pool or Hot Tub 110.00
1-0 'Total
Owner as defined by RCW.19.28.261: (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 said property is for sale, rent or lease. Permit expires after six months of last inspection.
After reading the above statement, I hereby 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 compliance with the electrical laws, N.E.C., RCW. Chapter 19.28, WAC. Chapter 296 -46B, The City of Port
Angeles Municipal Code, and Utility Specifications and PAMC 14.05.050 regarding Electrical Permit Applications. r2 0-C
S i g n at u r e
VO of owni, el;- trical contractor or electrical administrator: Cash heck
l I: Credit Card
X r Dated: 161 0110112012
N
ELECTRICAL PERMIT N. I
CITY OF PORT ANGELES W
360- 417 -4735
Application Number 12- 00000355 Date 3/29/12 -1
Application pin number 059945
Property Address 2038 LINDBERG RD REPORT SALES TAX
ASSESSOR PARCEL NUMBER: 06- 30- 13 -2 -3- 0020 -0000- on your excise tax form
Application type description ELECTRICAL ONLY
Subdivision Name to the City of Port Angeles
Property Use (Location Code 0502)
Property Zoning RS9 RESDNTL SINGLE FAMILY
Application valuation 0
Application desc
1 circuit ductless heat pump
Owner Contractor
KERRIGAN BETTY BLACK DIAMOND ELECTRICAL CONTR
2038 E LINDBERG RD 502 BLACK DIAMOND RD
PORT ANGELES WA 983629345 PORT ANGELES WA 98363 O
(360) 565 -1035 (/�{1
Permit ELECTRICAL ALTER RESIDENTIAL
Additional desc
Permit Fee 63.00 Plan Check Fee .00 `J�
Issue Date 3/29/12 Valuation 0
Expiration Date 9/25/12
Qty Unit Charge Per Extension
1.00 63.0000 ECH EL -R- BRANCH CIR WO/ SER FEED 63.00
Fee summary Charged Paid Credited Due i�
Permit Fee Total 63.00 63.00 .00 .00 Y
Plan Check Total .00 .00 .00 .00 �i
Grand Total 63.00 63.00 .00 .00 �J�
I A
b
Cg
INSPECTION TYPE DATE: RESULTS: INSPECTOR:
DITCH
SERVICE
ROUGH -IN AI/30112—
FINAL 1 4 1 16 Z _Y
COMMENTS:
PERMIT WILL EXPIRE SIX (6) MONTHS FROM LAST INSPECTION
Signature of owner or Electrical Contractor X Date:
G: \EXCHANGE \BUILDING
�'��hr ,i,.
CITY OF PORT ANGELES PERMIT APPLICATION 0) jr rn' i t iv i r 7 d
Building Division /Electrical Inspections h L' isL i r,J t -;I1
321 East Fifth Street P.O. Box 1150 Port Angeles Washington, 98362
Ph: (360) 417 -4735 Fax: (360) 417 -4711 t I ,4 2) %ii‘
(S
Date: 1& 2 Single Family Dwelling ELECTICA
�+!�r� �.r++7 rr��
ui PECTIUiJ,i S
Plan Review May Be Required, Please Complete Electrical Plan Review Information Sheet
Job Address: 2.038 E. t— tn-'b2
Building Square Footage:
Description of above
ADA C &c. Fat T7�CSi -i. P_
Owner Inform tion Contractor Information
Name: 5r7 `f /f Rtertlu Name: 'g DE
Mailing Address: 20 3S? F. i.--w De -,e.Gr Mailing Address: 5c'2 73t.A -cK '.7t n '-.o
City: State: Zip: City: 7 State: Zip:
Phone: Fax: Phone: Fax:
License Exp. License Exp. EL AC C. "f L
Item Unit Charge Qty Total (Qty Multiplied by Unit Charge)
Service /Feeder 200 Amp. 120.00
Service /Feeder 201 -400 Amp. 146.00
Service /Feeder 401 -600 Amp 205.00
Service /Feeder 601 -1000 Amp. 262.00
Service /Feeder over 1000 Amp. 373.00
Branch Circuit W/ Service Feeder 5.00
Branch Circuit W/O Service Feeder 63.00 Ay
Eac ffional Branch Circu 5.00
Branch Circuits 1-4 75.00 1 7`s--
Temp. Service/ Feeder 200 Amp. 93.00
Temp. Service /Feeder 201 -400 Amp. 110.00
Temp. Service /Feeder 401 -600 Amp. 149.00
Temp. Service /Feeder 601 -1000 Amp 168.00
Portal to Portal Hourly 96.00
Signal Circuit/ Limited Energy -1 2 Family Dwelling 64.00
Manufactured Home Connection 120.00
Renewable Electrical Energy 5KVA System or Less 102.00
Thermostat 56.00
Note: $5.00 for each additional T -Stat
NEW CONSTRUCTION ONLY:
First 1300 Square Ft. 120.00
Each Additional 500 Square Ft. or Portion of 40.00
Each Outbuilding or Detached Garage 74.00
Each Swimming Pool or Hot Tub 110.00 ‘3
Total
Owner as defined by RCW.19.28.261: (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 said property is for sale, rent or lease. Permit expires after six months of last inspection.
After reading the above statement, I hereby 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 compliance with the electrical laws, N.E.C., RCW. Chapter 19.28, WAC. Chapter 296 -46B, The City of Port
Angeles Municipal Code, and Utility Specifications and PAMC 14.05.050 regarding Electrical Permit Applications.
Signature of own: r, ectrical contractor or electrical administrator: Cash Check
Credit Card
x d Dated: 0110112012
CITY OF PORT ANGELES
i� ii DEPARTMENT OF COMMUNITY ECONOMIC DEVELOPMENT BUILDING DIVISION
321 EAST 5TH STREET, PORT ANGELES, WA 98362
I
ft Application Number 12- 00000295 Date 3/15/12
Application pin number 033065
Property Address 2038 LINDBERG RD
ASSESSOR PARCEL NUMBER: 06- 30- 13 -2 -3 -0020 -0000- REPORT SALES TAX
Application type description MECHANICAL APPL. PERMIT on your state excise tax form
4. T Property Name t the City of Port Angeles
Pro ert Use .,l n �f
Property Zoning RS9 RESDNTL SINGLE FAMILY' (Location Code 0502)
tt.,a Application valuation 7061
Application desc
HEAT PUMP- DUCTLESS
Owner Contractor
to
KERRIGAN BETTY ALL WEATHER HTG COOLING INC
.0 AM 2038 E LINDBERG RD 302 KEMP ST
PORT ANGELES WA 983629345 PORT ANGELES WA 98362
i (360) 452 -9813
Permit MECHANICAL PERMIT
Additional desc HEAT PUMP- DUCTLESS
4 o x Permit Fee 64.80 Plan Check Fee .00
Issue Date 3/15/12 Valuation 0
'Ia Expiration Date 9/11/12
It
y
Qty Unit Charge Per Extension
BASE FEE 50.00
1.00 14.8000 EA ME- FURN /HP /FAU OR 5 TON 14.80
Fee summary Charged Paid Credited Due
Permit Fee Total 64.80 64.80 .00 .00
Plan Check Total .00 .00 .00 .00
Grand Total 64.80 64.80 .00 .00
�1 nc�1 I
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
4/ 14 ifor a period of 180 days after the work has commenced, or if required inspections have not been requested within 180 days from the
o
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 construction.
3 II� 4cn
Md4t0wn
it- di 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 CIO
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
FOUNDATION: p
Footings
Stemwall
Foundation Drainage Downspouts
Piers
Post Holes (Pole Bldgs.) 0,
PLUMBING:
Under Floor Slab
Rough -In
Water Line (Meter to Bldg)
Gas Line
Back Flow Water FINAL Date Accepted by C
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 �I
Commercial Hood Ducts FINAL Date 'V V Accepted by
MANUFACTURED HOMES:
Footing Slab
Blocking Hold Downs
Skirting
PLANNING DEPT. Separate Permit #s SEPA:
Parking Lighting ESA:
Landscaping SHORELINE:
FINAL INSPECTIONS REQUIRED PRIOR TO OCCUPANCY USE
Inspection Type Date Accepted By
Electrical 417 -4735
Construction R.W. PW Engineering 417 -4831
Fire 417- 4653 0
Planning 417 -4750
C R
Building 417 -4815
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03/14/2012 11:22 13604525177 ALL WEATHER HEATING PAGE 02/03
BUILDING PLUMBING %MECHANICAL PERMIT APPLICATION SHORT FORM
(To be used for projects that do not require plan review.)
Date Received 3-14. 2'
City of Port Angeles Permit 12-'
Attn: Building Permit Technician Please print in ink. Date Approved 3.t5 v"?'
321 E. 5 St., Port Angeles, WA 98362 Approved by I'r1z-L■
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: Phone:
11 /DA VI }i� d. COO ClVag 1 154.-9813
Property owner: Q l
3 Phone: 'I5a- o1O(pe
Property owner's mailing address:
a u3 8 E: Li t.4. bcar d�
Contractor's business name: All V'J r I .0,4 nel 1. tootrell Phone:
or ro ert owner's name If he /she is doing /overseelnp"the work w 5a. Cll I3
Contractor's mailing address: 303,
1`
Ip 5
Contractor's L &I license number: A LL we I Expiration date:
to l .4 C.1SO�U 9/1_6\
Project Address:
a0-S2 E- Li bul
Project Type: itOesidential 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.
Re roof: house o garage other
tear off re -roof d lay over one layer
Licensed contractor: Submit a copy of your re roof bid.
Project Valuation (labor materials, not including sales tax)
Re side: house o garage a other
Project Valuation (labor materials, not including sales tax)
Repair:, (explain the project)
Project Valuation
*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 Pe'rrnit Application Short Form (Revised 2011) RECEIVED
Page 1 of 2 MAR 14 2012
CITY OF PORT ANGELES
BUILDING DIVISION
03/14/2012 11:22 13604525177 ALL WEATHER HEATING PAGE 03/03
Swimming Pool or Spa (a 24" deep,: For prefabricated swimming pool or soa_pro/ects the(
do not require plan review:
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? n house ra garage 4 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 "x" 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 debrls be going to the Regional Transfer Station in Port Angeles?
o yes o No If yes, will a licensed contractor be taking It there?
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),
Plumbing Permit: (explalnitle project)
Project Valuation
Mechanical Permit: jexpialn the project)
7,natallatjon of Heat Pump bucfje.JS
Protect Valuation 1
I have read and completed this application and know it to be true and correct: 1 am authorized to apply for this permit
end understand that it is my responsibility to determine whal permits are required, end to obtain permits prior to
working on projects.
Date I ti l e Signature MP/04A MA11
Print Name Karen McKeown
Page 2 of 2
CITY OF PORT ANGELES
DEPARTMENT OF COMMUNITY DEVELOPMENT - BUILDING DIVISION
321 EAST 5TH STREET, PORT ANGELES, WA 98362
I:.$UILLIIN($ PERMIT ISSUED: 11/07/2002 PERMIT NO: 13843
OWNER/APPLICANT PROPERTY LOCATION
BETTE J. KERRIGAN 2038 LINDBERG RD
2038 E. LINDBERG RD Lot:
Port Angeles, WA 98362 Block: [] Long Legal
360/452-2069 Subdivision: TX#5358
T: S: Parcel No: 063013230020
CONTRACTOR ARCHITECT
EVERWARM N/A
257151 HWY 101
Port Angeles, WA 98362-0000 , 98360-0000
360/452-3366 360/000-0000
PROJECT INFO
Project Value: $2,900.00 SFD Units: 0 Commercial: 0
Project Type: PROPANE INSERT SFD SQ FT: 0 Industrial: 0
Occupancy Type: RESIDENTIAL Garage: 0
Occupancy Group: MFD Units: 0
Construction Type: MFD SQ FT: 0
Zoning Use: RS9
PROJECT NOTES
INSTALL PROPANE INSERT, LINES, TANK
RECEIPT#9904
FEES ASSESSMENT
Building Permit: $0.00 Misc Fee 1: $0.00
Plan Check: $0.00 Misc Fee 2: $0.00
State Surcharge: $0.00 Misc Fee 3:
House Moving: $0.00
Manufactured Home: $0.00
Sign: $0.00 .)
Plumbing: $35.00 ~0
Mechanical: $0.00
Radon: $0.00 30
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 pedod 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
construction.
Signature of Contractor or Authorized Agent Date Signature of Owner (if owner is builder) Date
T:\PLANNINGkFORMS\I 102.15 [4/2002]
MOV 07 ~0~ iO:~?~M EVERN~RN
PERMIT-
BUILDING
~ P~s ~ or p~t lo I~ If you hav~ 8ny
Applic~m~or ~eat: ~~ ~
c~~P~~
~ ~ . ~ s~ o :
No of Sto~e~ _ Loc S~:, % Lot Co~e:
Bx~g ~ ~e:..
NOt~: .............
~1~ ~e ~o ~ submi~d ~ ~e B~
~c fees ~ ~e it ~e ~e of ~tt ~.
E~TIO~ OF PL~ ~W: If no ~it h isled
timita~o~. ~ ~u[l~[ O~{~ ~ ~d ~ ~e for
Se~lon 107.4 of ~e U~o~ Build~ ~e, ~l
rwspo~/biIl~ ~ ~t~l~ W~ ~ID m~ r~ a~ tO obloI~
CITY OF PORT ANGELES
DEPARTMENT OF PUBLIC WORKS
........... INSPECTION REPORT ...........
REQUEST:
Date ~ Time Received by (phone, person)
Location of Work to be inspected ~'
Name of person requesting inspection
Address of person requesting inspection Phone No.
Type of Inspection (circle appropriate one): Permit No.
Sewer Foundation Framing Chimney~ Plumbi~Final Sewer Excav. Other
INSPECTION NOTES:~
Inspected: Date Time By
Remarks:
RESTORATION REQUIRED ...... YES. NO
SURFACE RESTORATION:
SURFACE TYPE: [] Unimproved []Gravel [~Asphalt [~PCC [~Other
[] Repaired by City Work Order #
[] Repaired by Permittee [] COMPLETE
[] No Damage Found [] INCOMPLETE
(Continue on reverse side if necessary) STREET SUPERINTENDENT (DATE)
.~'
Wi
CITY OF PORT ANGELES
PUBLIC WORKS - ELECTRICAL DIVISION
12\ EAST 5TH STREET. PORT ANGELES. WA 98162
ELECTRICAL PERMIT
I
OWNER/APPLICANT------------------------PROPERTY LOCATION------------------------
BETTE ~. KERRIGAN 2038 LINDBERG RD
2038 ~. LINDBERG RD Lot:
Port Angeles, WA 98362 Block:
360/00P-0000 Sub:
T: I S: Parc No: 063013230020'
Issued:
3/25/98
Permit No:
6265
Long Legal:
CONTRACTOR-----------------------------DESIGNER---------------------------------
BOB'S ,ELECTRIC
1227 DEER PARK RD.
PORT ArGELES, WA 98362
360/45~-6887
,
000/000-0000
PROJECT i[NFO--------------------------------------------------------------------
prj Tvpe: RES. MISC. prj Value: $0.00
Occ Type: Cnstr Type: ADD CIRCUITS
Occ Grp: Occ Load: Land Use: RS9
Electrical Heat
Baseboard KW:
Futnace KW:
Hel1t Pump KW:
Fan/Wall KW:
Service Type
o Riser
o Overhead Service
o Underground Service
o Temp Service
Voltage:
Diameter:
Service Size:
Feeder Size:
-1
o
-3
o AMPS
o AMPS
PROJECT ~OTES-------------------------------------------------------------------
wire sewer pump
PROJECT ~'EES ASSESSMENT---------------------------------------------------------
. Service: $0.00
Additional Feeders: $0.00
Circuit Wiring: $41.00
Temp Service: $0.00
Misc $0.00
====~============================
TOTAL FEE:
Amount Paid:
$41.00
$41.00
TOTAL FEE:
$41. 00
Balance Due:
$0.00
COMMENTS/ACTION NEEDED
ELECfRICAL PERMIT INSPECfION RECORD
CALL 417-4735 FOR ELECTRICAL INSPECTIONS. PLEASE PROVIDE A MINIMUM 24 HOUR NOTICE. IT IS UNLA WFUL TO COVER,
INSULATE OR CONCEAL ANY WORK BEFORE IT IS INSPECTED AND ACCEPTED.
KEEP PERMIT CARD AND APPROVED PLANS AT JOB SITE
INSPECTION TYPE DATE I ACCEI'TED COMMENTS
I YES I NO
III 1111 .H-lN I CUVER
~.
,
Il.i../Z/A /qJ( I-Tv -I
GENERAL COMMENTS:
PW.I 102.." 14'961