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HomeMy WebLinkAbout2151 W 4th St - BuildingBuilding Permit 2151 W 4 th St 12-1352 CITY OF PORT ANGELES DEPARTMENT OF COMMUNITY & ECONOMIC DEVELOPMENT - BUILDING DIVISION � 321 EAST 5TH STREET, PORT ANGELES, WA 98362 Application Number . . . . . 12-00001352 Date 10/11/12 Application pin number . . . 007072 Property Address . . . . . . 2151 W 4TH ST ASSESSOR PARCEL NUMBER: 06 -30 -00 -9 -4 -0018 -0000 - Application type description PLUMBING PERMIT Subdivision Name . . . . . . Property Use . . . . . . . . Property Zoning . . . . . . . RS7 RESDNTL SINGLE FAMILY Application valuation . . . . 2000 ---------------------------------------------------------------------------- Application desc NEW WATER LINES AND WATER SUPPLY LINE ---------------------------------------------------------------------------- Owner Contractor ------------------------ ------------------------ WILLIAMSON, JR JOHN SCOTT JP PLUMBING INC 2151 W 4TH ST 246 FORS RD. PORT ANGELES WA 983631401 PORT ANGELES WA 98363 (3 60) 457-6767 ---------------------------------------------------------------------------- Permit . . . . . . PLUMBING PERMIT Additional desc . . NEW WATER SUPPLY/DISTRIBUTION Permit Fee . . . . 64.00 Plan Check Fee .00 Issue Date . . . . 10/11/12 Valuation . . . . 0 Expiration Date 4/09/13 Qty Unit Charge Per...... .. Extension BASE FEE 50.00 2.00 7.0000 EA PL -WATER LINE 14.00 ---------------------------------------------------------------------------- Fee summary Charged Paid Credited ----------------- ---------- ---------- ---------- ---------- Due Permit Fee Total 64.00 64.00 .00 .00 Plan Check Total .00 .00 .00 .00 Grand Total 64.00 64.00 .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 Contract r or Authorized Agent Signature of Owner (if owner is builder) T:Forms/Building Division/Building Permit BUILDIING 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 Date Accepted By Comments FOUNDATION: Footings Stemwall Foundation Drainage / Downspouts Piers Fire 417-4653 Post Holes (Pole Bldgs.) PLUMBING: FINAL Date Accepted b 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: FINAL Date Accepted b Heat Pum / 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 ft SEPA: ESA: SHORELINE: Parkin / Lighting Landscaping FINAL INSPECTIONS REQUIRED PRIOR TO OCCUPANCY/ USE Inspection Type Date Accepted By Electrical 417-4735 Construction - R.W. PW / En neenn 417-4831 Fire 417-4653 Planning 417-4750 Building 417-4815 T-Fnrmc/Riiilriinn r)ivicinn/Riiildinn Permit ti c� �1 THE RT AGELES CITY OF WASH 1 N G T O hl, U.S. 321 East S' Street Port Angeles, WA 98362 P: 360-417-4817 F: 360-417-4711 hcatuzo@cityofpa.us Building Permit Application For City Use Permit # 1'2- -13 SZ Date Received: Date Approved:z— Project Address: the ;Z451 ug'yf Main Contact: -q-04N -I - P him Phone # Property Owner Na Dae �l�i`Ys6�2-35 Phon Z 3 Mailing Address 2/15/ GU -0 `A Email City P ff `�8�63 State LVA- Zip % 136 3 Contractor Name �' urn �� Ph ne 360-(157- Mailing Address f Email cityState Zip 9$363 Contractor License # Expiration: Project Val e• Zoning: Tax Parcel # Lot # 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 11Addition 13Tenant Improvement ❑ Mechanical ❑ Plumbing &J Other ❑ Existing Fire Sprinkler System? Maximum height of structure Proposed Bedrooms Proposed Bathrooms Yes ❑ No ❑ Project Description 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 application will be considered abandoned, and the fees forfeit. Date /0 -11 -ice Print Name �o�� G;i���tsoti Signa Residential Structures Area Description (SQ FT) Existing Proposed Minimum $ value For Office Use Basement Appliance Vent # Heater (Suspended, Floor, Recessed wall) # First Floor Size: # Heating/Cooling appliance repair/alteration # Second Floor # Pellet Stove/Wood-burning/Gas Fireplace/Gas Stove Gas Cook Stove/Misc. # Fuel Gas Piping Covered Deck/Porch/Entry Ventilation Fan, single duct # Furnace/Heat Pump/ Forced Air Unit Size: Deck Ventilation System # Garage Carport Other (describe) Area Totals Commercial Structures Area Description (SQ FT) Existing Proposed Minimum $ value For Office Use Structure (s) Appliance Vent # Heater (Suspended, Floor, Recessed wall) # Addition Size: # Heating/Cooling appliance repair/alteration # Tenant Improvement # Pellet Stove/Wood-burning/Gas Fireplace/Gas Stove Gas Cook Stove/Misc. # Fuel Gas Piping Other (describe) Ventilation Fan, single duct # Furnace/Heat Pump/ Forced Air Unit Size: Area Totals Ventilation System # Lot Site Coverage Calculations Footprint (SQ FT) of all Structures: Lot Size: % Lot Coverage SQ FT Site coverage (all impervious + structures Haz/Non-Haz Piping % Site Coverage 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/alteration # Evaporative Cooler (attached, not portable) # Pellet Stove/Wood-burning/Gas Fireplace/Gas Stove Gas Cook Stove/Misc. # Fuel Gas Piping # of Outlets: Ventilation Fan, single duct # Furnace/Heat Pump/ Forced Air Unit Size: # Ventilation System # 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): PREPARED 4/03/13, 15:56:19 INSPECTION HISTORY REPORT PAGE 1 PROGRAM BP521L 0/00/00 THRU 0/00/00 CITY OF PORT ANGELES --------- ------------ ------------------------------ —------------ ----- — — ------ -- ---- APPLICATION PROPERTY ADDRESS ASSESSOR PARCEL NUMBER ALTERNATE ID STRUCTR PERMIT INSPECTION RESULT DATE/STATUS INSPECTOR ------------------------------------------------------------------------------------------------------------------------------------ 12 00001352 2151 W 4TH ST 06-30-00-9-4-0018-0000- 063000940.018 000 000 PL 00 PLUMBING PERMIT PL6 0001 PLUMBING WATER SUPPLY 10/12/12 APPROVED JLL REQ COMM: October 12, 2012 9:00:36 AM pbarthol REQ COMM: John 460-6902 RES COMM: October 12, 2012 4:21:16 PM jlierly. 000 000 PL 00 PLUMBING PERMIT PL99 0001 PLUMBING FINAL 10/12/12 APPROVED JLL REQ COMM: April 3, 2013 10:50:55 AM pbarthol. RES COMM: April 3, 2013 10:51:08 AM pbarthol. CITY OF PORT ANGELES o �1 DEPARTMENT OF COMMUNITY & ECONOMIC DEVELOPMENT BUILDING DIVISION 321 EAST 5TH STREET PORT ANGELES WA 98362 Application Number 09 00000371 Date 4/27/09 Application pin number 100188 Property Address 2151 W 4TH ST ASSESSOR PARCEL NUMBER 06 30 00 9 4 0018 0000 Tenant nbr name JOHN SCOTT WILLIAMSON JR Application type description PLUMBING REPAIR Subdivision Name Property Use Property Zoning RS7 RESDNTL SINGLE FAMILY Application valuation 2500 Application desc DOUBLE CHECK BACKFLOW DEVICE FOR TRRTG SYSTEM Owner JOHN SCOTT WILLIAMSON JR 2151 W 4TH ST PORT ANGELES WA 983631401 -- �vanS 22 Contractor EVANS EARTHWORKS INC 282 MILLER.RD PORT ANGELES WA 98363 (425) 328 6399 Permit PLUMBING PERMIT Additional desc DBL CHK BACKFLOW.DEVICE Permit pin number 144865 Permit Fee 57 00 Plan Check Fee 00 Issue Date 4/27/09 Valuation 0 Expiration Date 10/24/09 Qty Unit Charge Per Extension BASE FEE 50 00 1 00 7 0000 EA PL -LAWN SPRNKLR BCKFLW PREV 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 16 Ro V1 g Die ,ns�ka A c�Qrove& Qf--Vom 6 L, r) P `- -) S-G,q 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 1 Print Name Signature of Contractor or Authorized "Agent Signature of Owner (if o�xntr is built]` r:FormsBuilding DivisiorB- dmg,pennu PORT AV a Official Use Only G _ m Assem.# Backflow Assembly Test Report Received g City of Port Angeles tion ANp Public Works and Utilities Department Water/Wastewater Collection Division NAME OF PREMISES. 141 SERVICE ADDRESS LOCATION OF DEVICE. 12 4 i' fi I f" A- 1 ASSEMBLY Manufacturer Model Size Serial No IS THIS AN APPROVED ASSEMBLY'? YESeNO ❑ IS ASSEMBLY INSTALLED CORRECTLY') YESIT-NO 0 DATE OF INSTALLATION ,14119 "-/0 —/0 UNKNOWND WHITE CUSTOMER COPY YELLOW PURVEYOR COPY PINK TESTER COPY REDUCED PRESSURE PRINCIPLE ASSEMBLY RP ❑ RPDA ❑ DC 0-" DCDA ❑ PVB ❑ Air Gap E3 DOUBLE CHECK VALVE ASSEMBLY svB ❑ AVB ❑ CHECK VALVE #1 CHECK VALVE #2 RELIEF VALVE PVBiSVB Initial Leaked ❑ Leaked ❑ Did Not Open ❑ AIR INLET O Closed Tight ❑ , Did Not Open CI Test Held at 1° psi Held at psi Opened at 3 psi Opened at psi Repairs Cleaned 0 Cleaned ❑ Cleaned ❑ CHECK VALVE Leaked ❑ Held at psi Replaced ❑ Replaced ❑ Replaced ❑ REPAIRS Cleaned ❑ Details Replaced ❑ 3 psi Buffer YES ❑ NO ❑ Final Closed Tight ❑ AIR INLET Opened at psi Test `' Held Held Opened CHECK VALVE Held at psi at psi at psi at psi BACK PRESSURE NO ❑ YES ❑ AIR GAP INSPECTION REQUIRED MINIMUM SEPARATION YES ❑ NO ❑ A* k TYPE OF HAZARD 11 Line Pressure .,,, psi COMMENTS �� % t,,; c f' �i Held Backpressure YES EY'NO ❑ 42 Shutoff Held YES 0 --'NO ❑ Relief Valve Exercised YES ❑ NO ❑ Date?ime Tester Signature Cert. # Test Kit Passed Failed Initial Test (,� '�� 6 9°f ���r "h%/moi!/ _ �, �!� / r ❑ r" 'j Repairs ❑ ❑ Final f/>fl� ECP,, A °— 1 ! ' ❑ "' ❑ ,?,•, Test f / WHITE CUSTOMER COPY YELLOW PURVEYOR COPY PINK TESTER COPY ^%tea 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 09 00000371 Date 4/27/09 100188 2151 W 4TH ST 06 30 00 9 4 0018 0000 JOHN SCOTT WILLIAMSON JR PLUMBING REPAIR RS7 RESDNTL SINGLE FAMILY 2500 Application desc DOUBLE CHECK BACKFLOW DEVICE FOR IRRIG SYSTEM Owner JOHN SCOTT WILLIAMSON JR 2151 W 4TH ST PORT ANGELES WA 983631401 Contractor EVANS EARTHWORKS INC 282 MILLER RD PORT ANGELES WA 98363 (425) 328 6399 Permit PLUMBING PERMIT Additional desc DBL CHK BACKFLOW DEVICE Permit pin number 144865 Permit Fee 57 00 Plan Check Fee Issue Date 4/27/09 Valuation Expiration Date 10/24/09 Qty Unit Charge Per 1 00 Fee summary BASE FEE 7 0000 EA PL LAWN SPRNKLR BCKFLW PREV Permit Fee Total Plan Check Total Grand Total Charged Paid 57 00 57 00 00 00 57 00 57 00 Credited 00 00 00 00 0 Extension 50 00 7 00 Due 00 00 00 4 c� 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) 1:1•ormS/ buldmg UrvisioNButlding 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 Date Accepted By Comments FOUNDATION Electrical 417-4735 Footings Stemwall Foundation Drainage / Downspouts Piers Post Holes (Pole Bldgs ) PLUMBING FINAL Date Accepted by 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. FINAL Date Accepted b Heat Pum / Furnace / FAU / Ducts Rough -In Gas Line Wood Stove / Pellet / Chimney Commercial Hood / Ducts MANUFACTURED HOMES .Footing / Slab 113locking & Hold Downs Skirting PLANNING DEPT Separate Permit #s SEPA. ESA. SHORELINE. Parking / Lighting Landscaping 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 Planning 417-4750 Building 417-4815 T Forms/Building Division/Building Permit LA poRT AN 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 For City Use Only - Date Received 14 -05 Permit #-0, (1 1T— Date Approved ApplicantPhone Property Owner ���, ��1,.�.��� Phone Property Owner's Address y q Contractor �� �T,c PhondJ Contractor's Address aur An, ke 0- i„-,_ License # ires Q(,/, J©,) E-mail st��a�f c,� ,M,S/U.c.ow, PROJECT ADDRESS q -� Parcel Number Lot Zoning Project Type & Brief Description. )r'Residential ❑ Multi -family ❑ Commercial °❑ Industrial Check all that apply ❑ New Construction ❑ Addition ❑ Remodel ❑ Repair ❑ Demolition ❑ Re -roof ❑ Heat System ❑ Other Floor Areas Basement 15' Floor 2nd Floor 3rd Floor Garage Carport Covered Porch Deck Shed Other ❑ House ❑ garage ❑ other ❑ tear off & re -roof ❑ lay over one layer ❑ Heat pump ❑ wood -burning stove ❑ gas fireplace ❑ pellet stove ❑ other Existing (sq. ft.) Proposed (sq. ft.) Total footprint of structure sq ft. T Lot size Site -Coverage = the amount rvious surface on a parcel, including and other impervious su s s AMC 17 94 135 for exemptions) Max. height of proposed structures ft. Occupancy group Will a lawn sprinkler system be installed? %t ec -Occupant load Will a fire sprinkler system be installed? %` Construction per sq ft. = $ TAL VALUATION $ q �= sq n. o res paved drivew sidewalks patios \ Site coverage % # of bedrooms full baths # of h-alf baths /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 ta working on ojects. Date— Print Name L's Signature -, Lq T Forms/Building DivisioniBirig Permit.doc Application Number 08 00000641 Date 6/02/08 Application pin number 002607 Property Address 2151 W 4TH ST ASSESSOR PARCEL NUMBER 06 30 00 9 4 0018 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 Owner Contractor WILLIAMSON JR JOHN SCOTT AIR FLO HEATING & COOLING 2151 W 4TH ST 221 W CEDAR PORT ANGELES WA 983631401 SEQUIM WA 98382 (360) 683 3901 Permit ELECTRICAL ALTER RESIDENTIAL Additional desc Permit pin number 127431 �J1 Permit Fee 35 00 Plan Check Fee 00 Issue Date 6/02/08 Valuation 0 Expiration Date 11/29/08 Qty Unit Charge Per Extension 1 00 35 0000 EC EL Fee summary Charged LOW VOLTAGE Paid Credited 35 00 Due r �(v Permit Fee Total 35 00 35 00 00 00 Plan Check Total 00 00 00 00 Grand Total 35 00 35 00 00 00 INSPECTION TYPE DATE RESULTS ELECTRICAL INSPECTOR BITCH SERVICE OUCH - IN FINAL COMMENTS: 1�j�roT,M4 u Job wired by ❑ Electrical Contractor ❑ Owner Electrical contractor name License number Date Expires AtrrLo Kpt:\k gcR Purchaser's mailing address aa�\ %J 011-1D Cit W k V State3 (i 2 Telephone number FAX number (off 3 - 2A 01 t $3 3q'1 l Premises owner's name :o V -a W k ��� � nnsorl Address of inspection 0As1 w STREtiT cVf)RT 061,,UCs Phone number tos hedule inspection. 3(Q0- s 59 - 3sa�6 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. 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 instal- lation 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. ELECTRICAL WORK PERMIT APPLICATION 'Installation description ❑ Commercial (K Residential ❑ New ❑ Altered/Addition Q�p�P�E ►�E nIT' ® F I-57MT ❑ Cash ❑ Check # Credit Car Mastercard ver Card Signr of owner electrical contractor or electrical administrator Expiration Date Inspection fee X Date 5 `� 0 of card $ 3Sr 60 Electrical Load Additions anAmr subtractions Service Information ❑ NO LOAD CHANGES ❑ Baseboard _ KW Voltage ❑ Furnace _ KW ❑ Overhead Service Phase ❑ 1 ❑ 3 ❑ Heat Pump _ Ton _ LAR ❑ Temp Service 0 Service Size: ❑ Fan -Wall _ KW ❑ Underground Service Feeder Size: SAME DAY INSPECTION, CALL BEFORE 7 00 AM 360-417-4735 ROUGH -IN Date Appr ed By FINAL Appr ed By THERMOSTAT Date Appr ed By DITCH � Da[e Appr ed By � SERVICE Date Appr ed By FEEDER Date Appr ed By Inspection Date Area, Building or Equipment Inspected Action Taken Electrical Inspector 3 tD 8.) ircXQ1'R P4— r -la Ae-,,-_i*6S 5 AL.L K- CITY OF PORT ANGELES LIGHT DEPARTMENT ELECTRICAL PERMIIT M 17222 Port Angeles, Washington. -------f..- -------------1 191P 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 electrical work as fisted below. ,y 7215/' �p y Address -/�_ r -- ? Occupancy - Owner ._ -- ---e � �N1 2. (-t�� I Tenant- - - - - - - Wir ng Contractor _K� 8&�V -------------- By------------- Liglit Outlets..._ .......................... ... ..... Service, volts 45" d Type of Wiring: Receptacle Outlets ............................... % Fo. wires.....�..j..�_...................... I Armored Cable ............................ Dryer, KW ......................................... //, Size wires .._r.T........ .. ...._.. Range, KW .............................._.--------- Main fuse .....`....° ......... Water Heater: Enclosure ........�' ' ,r KW .............. ---------`-'-'��---- - Type of wiring: Hear. KW...... f�""""`':�. Entrance Cable ................___....... ....................... Motors: size, volts and phase: Rigid Conduit ................. -............ ........................................................... Metallic Tubing ...................... Current transformers: ....---...__.............._...._.......__...-'---... No. & Size....................................... ........................................... -.............. Ser. No.............................................. ........................................................... Ser. No.............................................. ................... -................................... � TotalLoad ............................. Ser. No ................... .......................... Remarks- -------- ----- ------- ---- ------ — --- Permit Fee Treas. Receipt ° Non-Metallic ..... Knob & Tube..... Rigid Conduit ... Metallic Tubing Raceway ............. Circuits, Light........... Utility ................. I -feat ................... Range ................. Water Heater ... Motor ......... Dryer...................... Furnace ................ Total ........... $ ------------------------------------- No --------------------------- By -2-'--v...----... ..t,'L--------------- ---------- NOTICE—Current must not be turned on until Certificate of Inspection has been issued. If work is to be con- cealed due notice most be given the Inspector so that work may be inspected before concealment. NOTIFY THE INSPECTOR BY PERMIT NUMBER WHEN READY FOR INSPECTION ELECTRICAL PERMIT AT° 17222 Address................... -............................. _.............................................. ........................... ........... Date ..................................................... Owner................................... _........... ...... ....... ... _......... -................................................. Tenant .............................................................. WiringContractor .................................... ....................... _............................................................. By .............................................................. 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. 1M Olympic Printers, Inc.