HomeMy WebLinkAbout1235 W 5th St - BuildingPREPARED 8/31/07 10 11 48 INSPECTION TICKET PAGE 16
CITY OF PORT ANGELES INSPECTOR JAMES LIERLY DATE 8/31/07
ADDRESS 1235 W 5TH ST SUBDIV
TENANT NBR JOHN SIMPSON
CONTRACTOR PHONE
OWNER HARMS HENRY F PHONE
PARCEL 06 30 00 0 1 1520 0000
APPL NUMBER 07 00000496 RES REMODEL
PERMIT BPR 00 BUILDING PERMIT RESIDENTIAL
REQUESTED INSP DESCRIPTION
TYP /SQ COMPLETED RESULT RESULTS /COMMENTS
3.Hz_
BL3 01 8/15/07 PB BLDG FRAMING
8/15/07 AP 08/14/2007 09 09 AM LPANGRLE
JOHN 457 8591
FRAMING
CALL FIRST
08/15/2007 04 53 PM PBARTHOL
BAIR 01 8/29/07 JLL BLDG AIR SEAL
8/29/07 DA 08/29/2007 08 16 AM LPANGRLE
JOHN 457 8591
AIRSEAL
BOTTOM BACK DOOR IS OPEN
08/29/2007 04 58 PM JLIERLY
door locked /j11
BLI 01 8/31/07 JLL BLDG INSULATION
08/31/2007 08 38 AM LE
/3 '1' JOHN 457 8591 OR CELL 477 77 097 0970
INSULATION
COMMENTS AND NOTES
Correction Notice
I cr14"
Job Located at I o� 3cs
Inspection of your work revealed that the following is
not in accordance with the codes governing the work in
this jurisdiction
These corrections must be made and are not to be
covered until reinspection is made. When corrections
have been made, please call C
for inspection
Date
c i/d.,(:
BUILDING DIVISION
CITY OF PORT ANGELES
6,- 114 C.7.1.-)
DO NOT REMOVE THIS TAG
A
e tor for�uiiding Division
PREPARED 8/29/07 9 07 20 INSPECTION TICKET PAGE 14
CITY OF PORT ANGELES INSPECTOR JAMES LIERLY DATE 8/29/07
ADDRESS 1235 W 5TH ST SUBDIV
TENANT NBA JOHN SIMPSON
CONTRACTOR PHONE
OWNER HARMS HENRY F PHONE
PARCEL 06 30 00 0 1 1520 0000
APPL NUMBER 07 00000496 RES REMODEL
PERMIT BPR 00 BUILDING PERMIT RESIDENTIAL
REQUESTED INSP DESCRIPTION
TYP /SQ COMPLETED RESULT RESULTS /COMMENTS
BL3 01 8/15/07 PB
8/15/07 AP
BAIR O1 8/29j07 C ILL
BLDG FRAMING
08/14/2007 09 09 AM LPANGRLE
JOHN 457 8591
FRAMING
CALL FIRST
08/15/2007 04 53 PM PBARTHOL
BLDG AIR SEAL
08/29/2007 08 16 AM LPANGRLE
JOHN 457 8591
AIRSEAL
BOTTOM BACK DOOR IS OPEN
COMMENTS AND NOTES
PREPARED 8/15/07 11 39 21 INSPECTION TICKET PAGE 24
CITY OF PORT ANGELES INSPECTOR JAMES LIERLY DATE 8/15/07
ADDRESS 1235 W 5TH ST SUBDIV
TENANT NBR JOHN SIMPSON
CONTRACTOR PHONE
OWNER HARMS HENRY F PHONE
PARCEL 06 30 00 0 1 1520 0000
APPL NUMBER 07 00000496 RES REMODEL
PERMIT BPR 00 BUILDING PERMIT RESIDENTIAL
REQUESTED INSP DESCRIPTION
TYP /SQ COMPLETED RESULT RESULTS /COMMENTS
BL3 01 8/15/07
A
JLL
BLDG FRAMING
08/14/2007 09 09 AM LPANGRLE
JOHN 457 8591
FRAMING
CALL FIRST
COMMENTS AND NOTES
Application Number 07 00000496
Application pin number 741056
Property Address 1235 W 5TH ST
ASSESSOR PARCEL NUMBER 06 30 00 0 1 1520 0000
Tenant nbr name JOHN SIMPSON
Application type description RES REMODEL
Subdivision Name
Property Use
Property Zoning UNKNOWN
Application valuation 10000
Owner Contractor
HARMS HENRY F
12 W 5TH ST
PORT ANGELES
'Permit ELECTRICAL NEW, RESIDENTIAL
Additional desc COLEMAN/ REWIRE +200A S
.Permit,pin number 103069
Sub Contrac COLEMAN ELECTRIC
Permit Fee 75 00 Plan Check Fee 00
Issue Date 7./30/,0. Valuation 0
Expiration Date :1,/26/08`
Qty i ljniit Char "ge Pe'r, n Extension
1 00 75 '20,00 BCH EL RM 0 200 1ST SRV FEEDER 75 00
Other Fees
Fee summary
Permit Fee Total
Plan Check Total
Other Fee Total
Grand Total
WA 983632005
C OMMI_NTS /ACTION NEEDED
CITYOF PORT. ANGELES
PUBLIC WORKS ELECTRICAL DIVISION
32.1 EAST 5TH STREET PORT ANGELES. WA'98362
OWNER
STATE SURCHARGE 4 50
Charged Paid Credited Due
75 00 75 00 00
00 00 00
4 50 4 50 00
79 50 79 50 00
Date 7/30/07
00
00
00
00
DITCH
ROUGH -IN COVER
SERVIC
GENERAL COMMENTS:
ELECTRICAL PERMIT INSPECTION RECORD
CALL 417 -4735 FOR ELECTRICAL INSPECTIONS. PLEASE PROVIDE A MINIMUM 24 HOUR NOTICE. IT IS UNLAWFUL 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 ACCEPTED
YES I NO
FINAL 1 4=12 a ..�I
I
I I
I I
I I
I I
COMMENTS
14-1102.15I<1941
Si
Application Number
Application pin number
Property Address
ASSESSOR PARCEL NUMBER
Tenant nbr name
Application type description
Subdivision Name
Property Use
Property Zoning
Application valuation
Owner
HARMS HENRY F
1235 W 5TH ST
PORT ANGELES
Permit
Additional
Permit pin
Permit Fee
Issue Date
Expiration
Qty
8 00
desc
number
Date
Permit
Additional desc
Permit pin number
Permit Fee
Issue Date
Expiration Date
Qty Unit
2 00 7 2500 ECH
Permit
Additional desc
Permit pin number
Permit Fee
Issue Date
Expiration Date
Qty Unit Charge
5 00
1 00
1 00
Other Fees
Fee summary Charged
Permit Fee Total 379 25
Plan Check Total 83 10
laws and ordinance g
presume to giv
constructio
CITY OF PORT ANGELES
DEPARTMENT OF COMMUNITY DEVELOPMENT BUILDING DIVISION
321 EAST 5TH STREET PORT ANGELES, WA 98362
Charge Per
7 0000 ECH
7 0000 ECH
15 0000 ECH
WA 983632005
tractor or Authorized /Age
07 00000496
741056
1235 W 5TH ST
06 30 00 0 1 1520 0000
JOHN SIMPSON
RES REMODEL
UNKNOWN
10000
Contractor
OWNER
BUILDING PERMIT RESIDENTIAL
WALLS WINDOWS BATHS KITCHEN
101246
207 75
5/16/07
11/12/07
Unit Charge Per
BASE FEE
14 0000 THOU BL -2001 25K (14 PER K)
�T \Poli 102_15 building permit inspection record05 wpd [1/4/2005]
Plan Check Fee 83 10
Valuation 10000
MECHANICAL PERMIT
BATHROOMS
101261
64 50 Plan Check Fee 00
5/16/07 Valuation 0
11/12/07
Per
BASE FEE
ME VENT FAN
PLUMBING PERMIT
BATHROOMS KITCHEN
101253
107 00 Plan Check Fee 00
5/16/07 Valuation 0
11/12/07
BASE FEE
PL- EA FIXTURE ON ONE TRAP
PL- EA INSTALL WATER PIPE
PL EA BLDG SEWER
STATE SURCHARGE
Paid Credited
379 25 00
83 10 00
Date
Date 5/16/07
Extension
95 75
112 00
Extension
50 00
14 50
Extension
50 00
35 00
7 00
15 00
4 50
Due
00
00
o
oQ
Separate Permits are required for electrical work, S EPA, 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 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
rni this type of work will be complied with whether specified herein or not. The granting of a permit does not
violate or cancel the provisions of any state or local law regulating construction or the performance of
Signature of Owner (if owner is builder) Date
73
CD
ELECTRICAL LIGHT DEPT
INSPECTION TYPE DATE
FOUNDATION:
FOOTINGS
SHEAR WALLS WALLS
FOUNDATION DRAINAGE DOWN SPOUTS
PIERS
POST HOLES (POLE BLOGS.)
PLUMBING
UNDERFLOOR /SLAB
ROUGH -IN
WATER LINE (METER TO BLDG)
GAS LINE
BACK FLOW WATER
AIR SEAL
WALLS
CEILING
FRAMING
JOISTS GIRDERS
SHEAR WALL /HOLD DOWNS
WALLS ROOF CEILING
DRYWALL (INTERIOR BRACED PANEL ONLY)
T -BAR
INSULATION
SLAB
W ALL FLOOR CEILING
MECHANICAL
ROUGH IN
HEAT PUMP /FURNACE /DUCTS
GAS LINE
WOOD STOVE PELLET CHIMNEY
FIRE 417 -4653 I
I PLANNING DEPT 417 -4750 I
BUILDING 417 -4815 I
T \Policies \l 102 15 building permit inspection record05 wpd [I/4/20051
BUILDING PERMIT INSPECTION RECORD
CALL 417-481 FOR BUILDING INSPECTIONS. CALL 417-473 FOR ELECTRICAL INSPECTIONS
CALL 417 -4807 FOR PUBLIC WORKS UTILITIES
PLEASE PROVIDE A MINIMUM 24 HOUR NOTICE. IT IS LWLAN FUL TO COVER INSULATE OR CONCEAL 4_n/7' WORX BEFORE
INSPECTED 4ND ACCEPTED POST PERMIT IN 4 CONSPICUOLS LOCATION
KEEP PERMIT CARD AND APPROVED PLANS AT JOB SITE.
YES
ACCEPTED
NO
FINAL
FINAL
MANUFACTURED HOMES
FOOTING SLAB I
BLOCKING HOLD DOWNS
SKIRTING
PLANNING DEPT SEPARATE PERMIT ti's SEPA.
PARKING /LIGHTING ESA.
LANDSCAPING I SHORELINE:
FINAL INSPECTIONS REQUIRED PRIOR TO OCCUPANCY/USE
RESIDENTIAL DATE YES NO COMMERCIAL
417 -4735 ELECTRICAL
LIGHT DEPT
CONSTRUCTION R.W PW/ CONSTRUCTION R.W
ENGINEERING 417 -4807 PW /ENGINEERING
I FIRE DEPT
I PLANNING DEPT
BUILDING
COMMENTS
DATE ACCEPTED BY.
DATE ACCEPTED BY.
DATE ACCEPTED
YES I NO
I I I I
I I I I
I I I I
Application Number
Application pin number
Other Fee Total
Grand Total
CITY OF PORT ANGELES
DEPARTMENT OF COMMUNITY DEVELOPMENT BUILDING DIVISION
321 EAST 5TH STREET PORT ANGELES, WA 98362
4 50
466 85
07 00000496
741056
4 50
466 85
T \Policies \1102 15 building permit inspection record05 wpd [1/4/2005]
00
00
Page 2
Date 5/16/07
00
00
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 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
CALL 417-4815 FOR BUILDING INSPECTIONS. CALL 41 FOR ELECTRICAL INSPECTIONS
CALL 417-4807 FOR PUBLIC WORKS UTILITIES
PLEASE PROVIDE A MINIMUM 24 HOUR NOTICE. IT IS UNLA61 FbL TO COVER, INSULATE OR CONCEAL 4_'tT WORE BEFORE
INSPECTED 4ND 9 CCEPTED POST PERMIT IN A CONSPICUOUS LOCATION
KEEP PERMIT CARD AND APPROVED PLANS AT JOB SITE.
MANUFACTURED HOMES
FOOTING SLAB
I NS PECT ION TYPE DATE
FOUNDATION:
FOOTINGS
SHEAF WALLS WALLS
FOUNDATION DRAINAGE, DOWN SPOUTS
PIERS
POST HOLES (POLE BLDGS.)
PLUMBING
UNDERFLOOR /SLAB
ROUGH -IN
WATER LINE (METER TO BLDG)
GAS LINE
BACK FLOW WATER
AIR SEAL
WALLS
CEILING
FRAMING
JOISTS GIRDERS
SHEAR WALL /HOLD DOWNS
W ALLS ROOF CEILING
DRYWALL (INTERIOR BRACED PANEL ONLY)
T -BAR
INSULATION
SLAB
WALL FLOOR CEILING
MECHANICAL
ROUGH -IN
HEAT PUMP /FURNACE /DUCTS
GAS LINE
WOOD STOVE PELLET CHIMNEY
BLOCKING HOLD DOWNS
SKIRTING
PLANNING DEPT SEPARATE PERMIT 4's
PARKING /LIGHTING
LANDSCAPING
RESIDENTIAL
ELECTRICAL LIGHT DEPT
CONSTRUCTION R.W PW/
ENGINEERING 417 -4807
FIRE 417 -4653
PLANNING DEPT 417 -4750
BUILDING 417 -4815 15-13-08
T \Policies \1102 15 building permit inspection record05 wpd [1/4/20051
BUILDING PERMIT INSPECTION REC ORD
YES
ACCEPTED
$I154o0 5C,L
b (45(1a 7
LC,
NO
FINAL 5 I V V DATE ACCEPTED BY.
I FINAL 5H DATE ACCEPTED BY.
SEPA.
ESA.
SHORELINE:
FINAL INSPECTIONS REQUIRED PRIOR TO OCCUPANCY /USE
DATE YES NO COMMERCIAL
41 4 1 35 ELECTRICAL
LIGHT DEPT
CONSTRUCTION R.W
PW I ENGINEERING
I FIRE DEPT
I PLANNING DEPT
BUILDING
COMMENTS
DATE
ACCEPTED
YES NO
C3
I I I I t
I I I
Applicant or Agent. icy Lt to .-S1 U Phone. 3(,0 77- 07 7
Owner �J c� i L Qv-- Phone 3 (oC) ?27 7
Address 1,R3 .h C,--) lr -ke__ City ���`i
Q Zip GJSf�� Z
Architect/Engineer S IF Phone: 446,-
Contractor c /-c- State License VUP' Exp ✓a Phone �'�0
Address v City Zip
1'RO.TECT ADDRESS i 7_ 3 5 t U ZONING �-eC
LEGAL DESCRIPTION Lot: Block. Subdivision.
CLALLAM COUNTY PARCEL NUMBER.
YPE OF WORK. SIZE /VALUATION
Residential New Constr Re -roof Stove SF /SF
Multi- family Addition Move Garage SF /SF
Commercial X Remodel Demolition ti, Deck SF /SF
Repair Sign Other TOTAL VALUA7. ION /Q. 'OCO 57
1
BRIEF DESCRIPTION OF TILE PROJECT Mc-we A C al i Si d loo✓` d... PtJve
I� l0l f 1 i 1h�SU i C{- I�
e. e L c -c-I CoCJ( Q6 0�h
t New VPAnt Frk.h5 i h le)cd-Nr6o m
Occupant Lo d. Construction Type:
Proposed Sq Ft. TOTAL Sq Ft.
B aij reYY\o ,l 1/21 )et 4+1.6 4 new
COMMERCIAL/RESIDENTIAL. Occupancy Group
No of Stories Lot Size: Existing Sq Ft.
Total lot coverage
PLANNING USE ONLY
T•\FORMS\BIdgPermitform.wpd Applicant:
BUILDING PERMIT APPLICATION
Fill out COMPLETELY and in INK. Your application and site plan MUST BE
COMPLETE to be accepted for review If you have any questions, call
PERMITS (360) 417 -4815 FAX(360)417 -4711
ESA/Wetland(s) Yes No SEPA Checklist required? Yes No Other
VALUATION OF CONSTRUCTION In all cases, a valuation amount must be entered by the applicant.
This figure will be reviewed and may be revised by the Building Division to comply with current fee schedules. Contact the Permit
Coordinator at 417 -4815 for assistance.
PLAN CHECK FEE IF a plan check fee is due it must be submitted at the time the building permit application and construction plans are
submitted. All other permit fees are due at the time of permit issuance.
EXPIRATION OF PLAN REVIEW If no permit is issued within 180 days of the date of application, the application will expire. The
Building Official can extend the time for action by the applicant up to 180 days upon written request by the applicant (see Section
R105.3.2 of the International Building/Residential Code, 2003). No application can be extended more than once.
I hereby certify that I have read and examined this application and know the same to be true and correct. I am authorized to
apply for this permit and understand that it is my r s•'• sibilitVto determine what permits are required not the City's, and that I
must obtain such permits prior to work.
Date: SIB /7
FOR OFFICIAL USE ONLY
Date Rec. 05-03- 07
l'ermit 01' 9
DDate Approved: .fir,
Date Issued:
5116X07
APPROVALS
PLAN
BLDG
DPWU
FIRE.
OTHER.
C__ -t— �C7
G 5^
a i 7)
tl
t
t
\A f 3pe-
cr
T° ,,,,g1
W
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11 11 11._...
0
E
CITY OF PORT ANGELES Construction Plans
The Issuance of this permit based upon these plans, specifi-
cations and other data shall not prevent the building official
from thereafter requiring the correction of errors in said
plans, specifications and other data, or from preventing
building operatio s being carried on thereunder when in
violation of all codes and ordinances of this jurisdiction.
4EGREIN -7e 2003
Approval Date �U a By c
111..t1 tADoit-
40
RECEIVED 2
MAY 16 2007 4
CITY OF PORT
BUILDING D
emsMIIMIO—
"Whom it May Concern"
This Letter will serve to inform that John Simpson is under Contract for
purchase and has full authority to Remodel the Trust Home located at 1235
West 5 th Port Angeles, Wa.
Should further information or clarification be needed, I can be contacted at
the above address or phone Number
Signed.
Tom Lemaar
Trustee for Hank Harms Trust
360- 417 -5254 P 1
Tom Lemaar
Trustee for Hank Harms Trust
12 Findley Rd
Port Angeles, Wa 98362
360 417.5254
05/16/2007
Street Lookup Page 1 of 1
Parcel Number 0630000115200000
Site Address 1235 W FIFTH ST PA
Description
LOT 8 BLOCK 115
Quit
Taxpayer
HARMS TRUST HENRY F 1235 W 5TH ST
PORT ANGELES WA 98363 -2005
Title Owner
HARMS TRUST HENRY F 1235 W 5TH ST
PORT ANGELES WA 98363 -2005
Value Summary
Note. Listed values do not reflect adjustments made for exemption programs such as
Senior /Disabled or Current Use programs (except Commercial Forestland properties)
Land Value 56 575
Improvements Value 97,255
Total Assessed Value 153 830
Property Characteristics
Note. Use Code is for Assessor's purposes only Contact the appropriate planning or
building departments for Zoning and allowable usage of property
Use Code 1112 TWO BEDROOM
Land Size (acreage). 00
Note. Acreage is not listed for all properties in the
Assessor's records. More information about land size.
Tax Status Taxable
Tax Code Area 0010
Note Zoning and zoning codes change constantly Verify all
zoning with the appropriate planning or building department.
Building Characteristics. (Click on Bldg. for more details
Blda. Type Blda. Style Total S.F. BD BA
01 House One Story 954 2 1
Tax History Sales History
Other parcels at this address
Quit
http. apps. clallam.net /website /sitis ?address =1235 &street =FIFTH ST &pur 5/8/2007
CITY OF PORT ANGELES
LIGHT DEPARTMENT
ELECTRICAL PERMIT
N?
17273
Port Angeles. washlngton___..__h______.L;:).'m__m.m....m...m_m. 19__J.:.P
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 d6 electrical work as listed below.
Address ./~___7.___:?:__n.__?'!!.m::.?.=tJ:..m_______m_n.mm__m Occupancy___jU~_'t1.n_~_______________m_m___
O~er ---------------..------.m--m--m-r"j"-------m-Y;;J(--A})n~------------m--..__..__________________n_m___________m__m___..
Wmng Contractor __~,k'._~l2:7d~m.mn'_____~<:m By_____mm__m_mm_m_m__m___mmmm_mmm_____....
Light Outlets..............................._.._..... Service, volts _/__.............................. Type of Wiring:
Receptacle Outlets...............................
Dryer. KW _........___..._.__._.__....____._.._..__.
Range, KW _un__..___.....______________.____
Water Heater:
No. wires ___.._______...___....._..............
Size wlres.__.__________...._......___......._..
Main fuse .................._.........___.____...
Enclosure ........__........_..____.._______.....
KW._________________________n______n....
_ /) 9, 'ft>
Heat: Kw._.........h/......__._..;;;..._..__....
Motors: size, volts and phase:
Type of wiring:
Entrance Cable .......___...................
Rigid Conduit ...._______.___m.............
Metallic Tubing h.nm.......n
Current transformers:
No. & Size_.........__.___..._____..._
Ser. No....._......._..__..___.___....................
Ser. No. ...................._...___......._..........
Ser. NO.__.._..._.._..........................h..___
Armored Cable ..................___.....__
Non-Metallic ........____.._u............_h_
Knob & Tub.........._......_______....._____
RIgid Conduit _...__.........____...._______
Metallic Tubing .........._................
Raceway ......................._._..___._
Circuits. Llght..._...._______..._...__...........____
Utillty............____....____._.....__.......____
I-Ieat ______..._....._..__.........___......._.._.
Range .............................................
Water Heater ....h.........................
Motor ..._........................................
Dryer _n.__....._____._.........__.................__
Furnace ......................._.'_......_...........
Total I..oad_.......h........_......_... Ser. No. ................._.h...............h..._.. Total _h__...._._...........................
Remarks: -------Q.Qv.r.'i~.~.-----------;-/.L~------------':':":-~.--..p-,~
u....uu__nnu_..nnu..u.uu____..nuu.unnnnu..u_...nu..un.nu..uuu._u._______n_n..nn___u__u_......_n_nuuu.nu...__..n_n_n___n_nun
_mmm___nn.n_____m____m_______________________m__m_m__n__n__n_______________m_mm_______;;__;;;::;m__________mn______m._____m__.__..____
;~_=.~~..~~~m__m________m ::~_~_~:__~~.~:~.~~__...... By _9!~--~L-L1!-~
NOTICE-Current must not be turned on untU Certificate of ~!t1on has been issued. It 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
ELECTRICAL PERMIT
N?
17273
Address........___..___..__.............__..__.__._...__.......___....____.__......_..............._....._.................___..__.__.........Date..._......__._.._.._.........____..._..__.__........
Owner.._...__.__.........._______..____.__._..._.._.__...______.__.___.........__....____..___.........._...___._..__.__.._....Tenant__._......._..________.___..............._....__.__.._________.__...
Wiring Contractor .................__.__.....____...._........._..._.._....._...._.............___._..........................._..__._n.. By.__...........................................................
'\
NOTICE--Current must not be turned on untU Certificate ot Inspection has been issued. It work Is to be COD.
cealed due notice must be given the Inspector so that work may be inspected before concealment. .
1M \_. Olympk P,int".. In,_
Ma~ 23 07 02:21p
Bobb~ O. Coleman
em OF PA BLOC DEPT ,'A,\ r',' JQU '" ,,~60-452-7594
p.l
~v_: Ii AH,.'2~, TilE 01. B ?M
"
ELECTRICAL wORK pERMIT APPLICATION
i
.
JH .",;,.~d by
o Eiutrital CODtnctor a OWDer
losul1-liOl\ delcriptioll_ L/~
o CvoIJDUcia\ ~deollal
~Ws
Da1c:EApilES
0"'"
o AlleredlAdd1t1oD
ZIP
~
I1hlX) t6-A./
.
_ tJ;/l/r->c '16
. 7Jr
'"-RliI..' ."nu" lIaDle
O.,Ul' as d4[i~J by /lCWI9.18.261:(I) O_r will (JU:UPY the ,tuvcrv" far IlOJIO
}WlIT,s tl/k7drU ~rctril2Jl pfT'Vl is finoUHtl. (1) 0-'" is repind fO U. 411 ~l<<'l,I'QI
;;o1,rrllctQr " lIkve .said p,."".rty is lOT s.r~. ,.-.. or I~
After IWdiIo,B l'ra ~vc IUtt:tDatt. 1 heRb)' outify thai I a!I the ",rw:r o{ dllt .hove
TWOdI ~ m . HClD~ cktUical can_tor. J .. tDJk;tnl the ele<;aice1 ias;Ul-
lmon or al\a1ltilJtl in CQD'IiIlilllC& with IbI: cloc:tri~l I.~ N.E.C., RtW. ChaPUI
19..26. WAC. Ch.pla.296-46B, ne City fir Port AnlP'les M\U1ic'pal Code:, u4
.UD}jrySpecif\~ri01lS..
1:1 Cash 1:1 Cbeck.
o C,..\it Cord VIS"
Cord ~
MSS\Cfcard
Discover
. . .
------------------
rtnell1 C.OIl',..r;'.... or ..lu.riul ...i....tratof
ExpiPtionDate
ofcan!
s~~~o
Serv\ce Intormation
,
Date:
x
If8C
Elec
() NO LOAD C
a_.'"
Q FufTlQC9
o Heal PUlT'P
o Fan-WaP
KW
KW
_ Ton_LAA
_KW
a Overhead SeN\C9
o Temp Serv1eG
a UndeI'9'0u0d SeMl:8
Vohage
PtluoO,OS
$eMce Size: _
Feeder S\$~ _
,
Actio>> Taken
Electrical
tnsptctor
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MA
4 2007
LIGHT DEPT.
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ELECTRICAL INSPECTION
WIRING REPORT
417-4735
IN~
ADDRESS
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ARE COMPLETED WITHIN 15 DAYS
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