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Home My WebLink About815 Church Ave - Building r-- . ~~ ,. . . . .............. .CITYOFPORT~g:ELES DEPARTMENT OF COMMUNITYDEVELOP:N1ENT - BUILDING DMSION 321 EAST 5TH STREET, PORT ANGELES, W A 98362 Applicatio~Number Application pin number Property Address ASSESSOR. PARCEL NUMBER: Application type description Subdivision Name Property Use Property Zoning . . . Application'valuation . 05-00001103 Date'11/10/0S 176439 81SCHtJRCH AVE 06-30-15-5-3-9040- MECHANICAL APPL. PERMIT RS9 RESDNTL SINGLE FAMILY 1375 OWner Contractor VANNAUSDLE RAYMOND'R 815 CHURCH AVE PORT ANGELES WA 983627929 DAVE I S HEATING & COOLING PO BOX 413 PORT ANGELES WA 98363 (360) 452-0939 Permit . . . . . Additional desc . Permit pin number Permit Fee Issue Date Expiration Date . ELECTRICAL ALTER RESIDENTIAL LOW VOLT THERMOSTAT 65011 36.40 Plan Check Fee Valuation .00 o 5/09/06 Qty Unit Charge Per 1. 00 36.4000 ECH EL-LVT-FIRST THERMOSTAT Extension 36.40 Permit . . . . . Additional desc.J. Permit pin number Permit Fee Issue .Date Expiration Date . MECHANICAL PERMIT PROPANE HEATER IN GARAGE 65003 57.65 Plan Check Fee 11/10/05 Valuation 5/09/06 .00 o permit.FeeTotal plan Check Total' Grand Total 94.05 .00 94.05 94.05 .00 94.05 .00 .00 .00 .00 .00 .00 (tvf1J V / r)t!~? 'JlIV ~ U \ Qty Unit Charge Per Extension 47.00 10.65 BASE FEE 1.00 10.6500ECH ME-GAS PIPE 1 TO 5 Fee suinmary Charged Paid Credited Due o ~ t ~ ~ ~ SeparatePermltsar~Jequired far electrical work, SEPA,Shoreline,ESA, utilities, private and public improvements.Thisp~trrilfb~9~mes null andvoldif;'IIClrkor constructian autharlz.ed ispat cammenc~d.'IIitl'lip18Q. days, if construction arworkiss~sr:>>en~edC)~~~ill'1dC)ned fora peri9d ,.of 180 ~aysafter the wark as comm~nced,. ()rif reqUired Inspections. have nat be.en requested within 180 dayS'trOfT1t~e last inspection.,. J hereby certify that I have read and examined thi~ applicatien and knew the same te be true and. co'Tept..I\IJpl"()vi~lelJs '.of laws..andar~inanc~~~ovemingthis type ofwark will be campUedwithwhetherspecified herein .or nat. Thegnmting ota permitdo~,snat presume to. give. autharity ta vialate .or cancel thepravisionsafany state' .or. lacal. law' regulating constructian orthe;perf9rmance .of construction. nature .of Cantractor orAuthorized Agent Signature .of Owner (if owner is builder) D~te T:\Policies\IIOV5 buildingpennit inspection record05.wpd [11412005] I ~~ ~ 'C'" , . >. ;<-,,~,,";('''' .(-f:;~f}'>' " ';, - ':;--':'':';,:7::, ;c'!"''''~'::''~~:;~;_'~J' '':'O!'f .--\ -:;:,. . . B1JlIj)l~GPERMIT INS~~CTlON RECORD. .O~-- 110'3 ",:~-'-'1< --""-';f:-,-,O< . CAI.,L 417-4815 FOR BUILDING INSPEcrIONS. CALL 417-4735 FOR ELEcrRICAL INSPECTIONS. ," . CALL 417-4807 FOR PUBLIC WORKS UTILITIES ... ..' . . . . ,.," )'LEASB PROVIDE A MINIMUM 24 HOUR NOTIC~. .1'[ 1s UNLAWFUL TO COVER, INSULATB OR CONCEAL ANY WORK BBFORE .;~ ::;~':~i ,'. "INSPECTED AND ACCEPTED. POST PERMIT IN A CONSPIGUQUS LOCA'I'JON. .' , . "j KEEP PERMIT CARD AND APPROVED PLANS AT JOB SITE . .' . ' . ." ..> , " j;.,,) INSPECTION TYPE '. DATE ACCEPTED \ COMMENTS 7: i.. ".: .. ,. '. YES NO '. .: '... . .. .: . FOUNDAnON: .' "': : '. ..:. .- ., ' .... FOOTINGS '..:'" <> .... ',' ' . VI ALLS ....< .:.... . '. 'i. . FOUNDATION.; DRAINAGE I DOWN SPOUTS . '. '.. PIERS '. :'. . --c' . . ~ ; POST HOLES (poLE BLDGS.) '. ...... .. ) -~? .. .... .. ..... ". . . .' . : . PLUMBING. ....... UNDER FLOQRI SLAB ..' .' . . .. ROUGH-IN .. '. :::;';." " . WATER LJNE (METER TO BLDCJ) . . \', I , '. GAS LINE . ..... . ... . . '. " BACK FLOW IWATER '.' '" ?:" . .' ,{:'i -.- ~:,'- .: .:'., .,. AIR SEAL " .:. ........... .... . WALLS .. 1 I -.- ... c ....... ..... .. . CEILING' , I I I . .', . :1\ . . '. FRAMING .... . ..... . . JOISTS I . GIRDERS .' ";::,;' .. .. .' .... SHEARWAU/HOLD DOWNS --' .' .... , ".} . WALLS tROOF I CEILING' . . "j;:.",...; ;;!ii"iij;::'\Ji.iC' ' .. . . .. '. DRYW ALL (INTERlPR~CEDPANm..()NLY) '.' . . ii, >it '. ,. T-BAR ';y.~, ..... .... ..... .... .'. , . . ... . '. ....'~{~~\"' ' ". ~. '. INSULATION .... ". .'. . \ .. 1 . 1>/ SLAB : . . '" W AEl:r&JJLQORI CEILING .... I . I >.... ... .' ..... , . .... . ",' c >~ ,.' ">r.' , MECHAr.t!~ ..' . .... HEAT p~ I FURNACE I DUCTS . GAS LINE /e., , .... 11/-f)..J-o"c, -1W , ;: WOOD STOvE'/PELLET/C~Y .",' \ .. .: -.- COMMERCIAL HOOI) I DUCTS ...' ..... '. . ..... .' '..... , .. '. . ..... MANUFACTURED HOMES .. .... . .. ,.C;. ".' FOOTING I SLAB .... . "",,","iiiji . . , . BLOCKING &. HOLD DOWNS . .' /..;:. '. . ." .... '.' "'{ ". I.. SKIRTING.. ...... . :. ... '.. . .<,~ -.- ..... .........i..ii ....................... .'. ... . PLANNING DEPT. SEPARATE PERMIT #'5 ~: ' SEPA: ",f'.,',. ..... I ."c'" .....'.'. .. '. .>;" ,......:.,..:."< PARKlNGlLIGIfl'lNG '" ESA: ...... ;':." ...... LAND~ING. ..... .. ..' . .. . ..~.-. ~~Wmf .1,.... . 'i. . . '.' .'. .~. . ..FIN~'"lNSPEC1lONS REQ~ PRIOR T()OC<:UP~PXIU~.'" '. " ',. "' . ~ RESIDENTJAl. '.' "DATE I YES NO CoMMERCIAL DATE F ACCEPTED . .... '. .' , . .. ..... ". YES ,NO .... ELEcnUCAL - LIGHT DEPT. ELECTRICAL , 4174735 rl-l<(--<9S' ". .' .... ........ '.. .' .'. '.' LIGHT DBPI' '" ". .... CONSTRUCTION R. W.I PWI ..-c..... . CONSTRUCnON-R.W. ENGINEERING .' 417-4807 :>< ...... ....... ., PW/~G i ..' FIRE > 417-4653 FIREDBPI'. ' .. ,. .: ., . ... .,... . '. .... .'.. PLANNING DEFT, ..:: ..: 417-4750 , I PLANNJN~DEPT; ..... ..... .. ....... '. I~Ti7ri ( '?flA, '" BUILDING 417-4815 BUILDING ". . . . '. ,.- .. rcc0rd05..!o1l1 (I14,floO$] , ..' ...... .. " PREPARED 12/01/05, 13:16:28 CITY OF PORT ANGELES INSPECTION TICKET INSPECTOR: JAMES L LIERLY PAGE DATE 7 12/01/05 ADDRESS CONTRACTOR OWNER PARCEL . . APPL NUMBER: 815 CHURCH AVE DAVE'S HEATING & COOLING VANNAUSDLE RAYMOND R 06-30-15-5-3-9040- 05-00001103 MECHANICAL APPL. SUBDIV: PHONE PHONE : (360) 452-0939 PERMIT PERMIT: ME 00 MECHANICAL PERMIT REQUESTED INSP DESCRIPTION TYP/SQ COMPLETED RESULT RESULTS/COMMENTS ME6 01 11/21/05 11/21/05 JLL AP MECHANICAL GAS LINE 11/21/2005 07:59 AM PBARTHOL --------------------------- dave 452-0939 11/21/2005 04:36 PM PBARTHOL --------------------------- MECHANICAL FINAL 11/28/2005 10:11 AM PBARTHOL --------------------------- VANAUSDLE- 452-0939 11/29/2005 04:12 PM JLIERLY ---------------------------- no answer at door or phone # left rnessage/j11 ME99 02 12/01/05 JLL MECHANICAL FINAL __________~~_~~~~-~_~___~~~::~2::~E::~4~DP:OT::A~~:~~_~~~~~~~~~~~~~~~~~~~~~~~~~~~_____ 11/29/05 11/29/05 JLL DA ME99 01 l PREPARED 11/29/05, 12:38:03 CITY OF PORT ANGELES INSPECTION TICKET INSPECTOR: JAMES L LIERLY PAGE DATE 4 11/29/05 ADDRESS CONTRACTOR OWNER PARCEL . . APPL NUMBER: 815 CHURCH AVE DAVE'S HEATING & COOLING VANNAUSDLE RAYMOND R 06-30-15-5-3-9040- 05-00001103 MECHANICAL APPL. SUBDIV: PHONE PHONE : (360) 452-0939 PERMIT PERMIT: ME 00 MECHANICAL PERMIT REQUESTED INSP DESCRIPTION TYP/SQ COMPLETED RESULT RESULTS/COMMENTS ME6 01 11/21/05 JLL 11/21/05 AP MECHANICAL GAS LINE 11/21/2005 07:59 AM dave 452-0939 11/21/2005 04:36 PM MECHANICAL FINAL 11/28/2005 10:11 AM VANAUSDLE- 452-0939 PBARTHOL --------------------------- PBARTHOL --------------------------- ME99 01 ~~ PBARTHOL --------------------------- -------------------------------------- COMMENTS AND NOTES-------------------------------------- ~ *- \}s.(L.- ~~ AuS~ -^-' yr-7 ~ s- 7 cfy GAl-- t"1.-t~~ ., PREPARED 11/21/05, 11:47:28 CITY OF PORT ANGELES INSPECTION TICKET INSPECTOR: JAMES L LIERLY PAGE DATE 4 11/21/05 ADDRESS CONTRACTOR OWNER PARCEL . . APPL NUMBER: 815 CHURCH AVE DAVE'S HEATING & COOLING VANNAUSDLE RAYMOND R 06-30-15-5-3-9040- 05-00001103 MECHANICAL APPL. SUBDIV: PHONE PHONE : (360) 452-0939 PERMIT PERMIT: ELAR 00 ELECTRICAL ALTER RESIDENTIAL SUB: DAVE'S HEATING & COOLING REQUESTED INSP DESCRIPTION TYP/SQ COMPLETED RESULT RESULTS/COMMENTS (360) 452-0939 EL99 01 11/18/05 11/18/05 ACO AP ELECTRICAL T-STAT FOR 12:42 PM 11/18/2005 FINAL GAS FIRED HEATER IN DETACHED GARAGE.11/18/2005 AOMAN ------------------------------ 12:44 PM AOMAN ------------------------------ PERMIT: ME 00 MECHANICAL PERMIT REQUESTED INSP DESCRIPTION TYP/SQ COMPLETED RESULT RESULTS/COMMENTS ,.'__"__~;::-~~~;~::;::::~~,::AR'"'"-:::::::-::::-:::::::-::-:::_____ Nov 09 05 12:04p DAVE'S HEATING & COOLING BUILDING PERMIT - APPLICATION p.1 FOR OFFJCJAL USE ONI. Y: Dale Rec.:.II~f-O G' Permit #: (!)S'- 1'103 D..le Approved: Date Issucrl: 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 Applicant or Agent: J) a ve...' s H-ea. +I'n 'f! Owner: R4'1r Va. n n a '^ 0 d (-€., Address: {? I 5 Ct, u. v-c..h . AII-e.... Phone: 'f5;;;1-093 CJ ~57-518'Y- Zip: 9 ~ 6b;;L Phone: City: lor-+- h,.~.J..C2~~ Architect/Engineer: Phone: , .vA VeS H C'99/ I:::..c Contractor..)::bve,l,s (-1e.a..+r~a/~State License #:T>4V~I;;lG BAll: 5./ c{ VI ~ C. /) J'2.? f n Address: to...6b)c- ~/..3 City: . roY"-/-A n_~s PROJECT ADDRESS: )! /5 Gh LA v6h .A V~ C,..{-e.. LEGAL DESCRIPTION: Lot:" Block: Subdivision: CLALLAM COUNTY PARCEL NUMBER: Phone: 'f5-;;J.-cfl37 Zip: '7'i?3 c;. d-. ZONlNG: Credit Card Holder Name: Billing Address: Credit Card Type VISA MC TY}'E OF WORK: VResidential 0 New Const!:. 0 Re-roof 0 Stove o Multi-family 0 Addition 0 Move 0 Garage o Commerci.al 0 Remodel 0 Demolition 0 Deck o Repair 0 Sign 0 Other BRIEFDESCRIFTION OF THE PROJECT: ; h.s+o-. l \ "'- -T\O\t\ I Y\ GAR.A G. E (,.VI +hevrno s..f"o- + COMMERCIALIRESIDENTIAL: Occupancy Group: No. of Stories: Lot Size: Existing Sq. Ft. Total lot coverage % City: # Exp. Date: SIZEN ALUATION: SF.@$ fSF.=$ SF.@$ ISF. =$ SF.@$ ISF.=$ TOTAL VALUATION .$ I{ 375esL o~ Pv-e,F"""-"H~.... 4.n\'+ /"~o-..~r Construction Type: = TOTAL Sq. Ft. Occupant Load: & Proposed Sq. Ft. I APPRO V ALS: PLAN: BLDG: DPWU: FIRE: OTHER:_ PLANNING USE ONLY: ESAfWetland(s): 0 Yes DNo SEPA Checklist required? 0 Yes 0 No Other: VALUATION OF CONSTRUCTION: 10 all cases, a valuation amount must be entered by the applicant. TIlls 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 pennit fees are due at the time of permit issuance. EXPIRATION OF PLAN REVIEW: If DO permit is issued within 180 days of the date of application, the application will el.-pire. 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 BuildingfResidential Code. 2003). No application can be extended more than once. I hereby certify that / have read and examined this application and knoVl the same to be true and COtrect. I am a/.{thorized to apply for this permit and understand that it is my responsibility to determine what permits are required ,not the City's, and that J must obtain such pennits prior to work. ","-VESSIBUlG-f,""'"""',,,",,,,,,,",_ldi,_'wp' Applic,,", ~at'" I { I q 105 ;"-:-'::~'~f~~';:::~~")~1~-~~~-~e'1~:r'%~r~~~~~\,:~ ":, ,~. <,,' ~,,> S 'l4ii,,~ CI'tYOFPORT ANGELES 'POBLICWORkS.,QB;JJUCALbIVJSION l2',f.A.4iT:SlJt~. PORT ANGEI.:ES; WI-. 98362 :',:::::~:;;'> ,:;,,'j',,'(' ::::',~-- ~"t, ,::",-k'"', >--\ " , ,'. ""_"_" ;,',', :,-':" >_C' ,: ,,:,:~:h' ,<';i~:i~::::':' -'i::.~.; ':'::_:;~_-', ' -, Application Number Application pin number Property Address ASSESSOR PARCEL NUMBER: Application type description Subdivision Name Property Use Property zoning . Application valuation 05-00001103 Date '11/18/05 176439 815 CHURCH AVE 06-30-15-5-3-9040- MECHANICAL APPL. PERMIT .'-\;~:~~::.:-~~>~ ;"'~::-~ :c' . "'-":::,~,;~":,i':.~:{:;': ,-:.,-,':'-:"-"':,:':: ''';.~ '~--::--.~f{;;-.{ ~< ;;;"'c'-I,-;::.,; "--:-;'::'<j', ,".- ;::'::,~-~. ;;,<':::;' '-;:;'. "",:,:<" Permit Additional desc . Permit pin number Sub Contractor Permit Fee Issue Date Expiration pate ELECTRICAL'ALTER,RESIDENTIAL LOW VOLT THERMOSTAT 65011 DAVE'S HEATING & 36.40 11/18/05 5/17/0~ COOLING Plan Check Fee Valuation .00 o ,; ',':, ';': ~~ RS9 RESDNTL SINGLE FAMILY 1375 Owner Contractor VANNAUSDLE RAYMOND R 815,CHURCH AVE PORT ANGELES WA 983627929 DAVE'S HEATING & COOLING PO BOX 413 PORT ANGELES WA 98363 (360) 452-0!=J39 Extension 36.40 Qty UnitCharge Per 1; 00 . 36AOOO ECH EL-,LVT~FIRSTTHERMOSTAT Fee summary Charged Paid Credited Due ----------------- ---------- ---------- ---------- ---------- .";i Permit Fee Total, 36.40 36.40 .00 Plan Check Total .00 .00 .00 Grand Total 36.40 36.40 .00 COMMEJ\TTSI ACTION NEEDED "ELECItUCALPERM1T.INSPECl10N:RECORD CALL 411-473S FORELECTRICAL~. "~fR0VJDEA.NlNlMUN24 HOUIl NOTICE.lTlSlI.NU"".ItmlJ.q,~ INSUUm OR CONc:ULANY WDRIBEFO~alS 1NSPBC,11.J:D"fiD.~CfCE1"lJj3). . ..' . ... -. .-- '. --. . . JCEEP PERMIT CARD AND APPROVED.f1.ANS ATJOBSlTE DAft M;\;&r'.a. '. c:oIOIIHI'I YII NO " ,'-". .... CITY OF PORT ANGELES d~..~ PUBLIC WORKS - ELECTRICAL DIVISION 321 EAST 5TH STREET, PORT ANGELES, WA 98362 ELECTRICAL PERMIT ISSUED: 9/12/2002 PERMIT NO 7818 OWNER/APPLICANT I PROPERTY LOCATION RAY VANNAUSDALE 815 CHURCH AVE 623 E. 10TH STREET Lot: B shp 02-04 Port Angeles, WA 98362 Block: 13 ~ I Long Legal 360/457-5784 Subdivision: BEN CHAMBRERS T: S: Parcel No: 063015521365000 CO"T"AcToR ^RC. TEC* AIR FLO HEATING N/A 221 W CEDAR SEQUIM, WA 98382-0000 , 98360-0000 360/683-3901 360/000-0000 PROJECT INFO ~ Project Type: RES. MISC. Project Value: $0.00 Occupancy Type: Construction Type: H. P./FURNACE ~,,, Occupancy Group: Zoning Use: Electrical Heat: ~ Baseboard 0 KW [ i Riser ~ Underground Service ~ Furnace 10 KW ~ [ Overhead Service Voltage: 0 ~'~ [~ Heat Pump 15 KW TempService Phase: [~ 1 iX 3 ~ · Fan Wall 0 KW Service Size: 0 ~ Feeder Size: 0 "5 PROJECT NOTES - Z FURNACE H.P. ~ REC # 9652 FEES AssESSMENT Service: $0.00 Additional Feeders: $0.00 Circuit Wiring: $0.00 Temp Service: $0.00 Misc Fee: T-STAT $35.30 TOTAL FEE: $35.30 AMOUNT PAID: $35.30 BALANCE DUE $0.00 COMMENTS/ACTION NEEDED ELECTRICAL PERMIT INSPECTION RECORD CALL 417-4735 FOR ELECTRICAL INSPECTIONS. PLEASE PROVIDE A MINIMUM 24 HOUR NOTICE. ITIS UNLAWFUL TO COVER, INSULATE OR CONCEAL ANY WORK BEFORE IT I$ INSPECTED AND ACCEPTED. KEEP PERMIT CARD AND APPROVED PLANS AT JOB SITE DITCH ROUGH-IN / COVER SERVICE GENERAL COMMENTS: CITY OF PORT ANGELES DEPARTMENT OF COMMUNITY DEVELOPMENT - BUILDiNG DiVISION 321 EAST 5TH STREET, PORt ANGELES, WA 98362 BUILDING PERMIT ISSUED: z/02/2002 PERMIT NO: 13516 OWNER/APPLICANT PROPERTY LOCATION RAY VANNAUSDALE 815 CHURCH AVE 623 E. 10TH STREET Lot: B Port Angeles, WA 98362 Block: 13 [] Long Legal 360/457-5784 Subdivision: BEN CHAMBRERS T: $: Parcel No: 063015521365000 CONTRACTOR ARCHITECT RAYMOND CONSTRUCTION N/A 519 SO. PEABODY Port Angeles, WA 98362 , 98360-0000 360/457-3119 360/000-0000 PROJECT INFO Project Value: $16,419.00 SFD Units: 0 Commercial: 0 Project Type: SHOP/STORAGE SFD SQ FT: 0 Industrial: 0 Occupancy Type: RESIDENTIAL Garage: 0 Occupancy Group: MFD Units: 0 Construction Type: MFD SQ FT: 0 Zoning Use: PROJECT NOTES DETACHED 768 SQ FT SHOP, INCLUDES SLAB PUMBING FOR TWO FIXTURES RECEIPTg9269 '~_~AJ~ ~ '- '7 FEES ASSESSMENT Building Permit: $279.25 Misc Fee 1: $0.00 Plan Check: $111.70 Misc Fee 2: $0.00 State Surcharge: $4.50 Misc Fee 3: $0.00 House Moving: $0.00 Manufactured Home: $0.00 Sign: $0.00 TOTAL FEE: $409.45 Plumbing: $14.00 AMOUNT PAID: $409.45 Mechanical: $0.00 BALANCE DUE: $0.00 Radon: $0.00 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 t 80 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. S'~g/n-~l:~ontrac-~=~A~Jthorized Agent Signature of Owner (if owner is builder) Date T:\PLANNING\FORMS\1102,15 [4/2002] BUILDING PERMIT INSPECTION RECORD CALL 417-4815 FOR BUILDING INSPECTIONS. PLEASE PROVIDE A MINIMUM 24 HOUR NOTICE. ITIS 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 I ACCEPTED COMMENTS YES ] NO FOUNDATION: FOOTINGS '~ __~ ~.,t"~ ~"~- WALLS FOUNDATION DRAENAGE ELECTRICAL (LIGHT DEPT) SEPARATE PERMIT: g PLUMBING UNDER FLOOR / SLAB ROUGH- N WATER LINE GAS LINE BACK FLOW / WATER AIR SEAL WALLS CEILING FRAMING JOISTS / GIKDERS SHEAR WALL WALLS/ROOF/CEILING DRYWALL T-BAR INSULATION SLAB , WALL / FLOOR / CEILING ' MECHANICAL HEAT PUMP WOOD STOVE / PELLET / CHIMNEY HOOD/ DUCTS PW UTILITIES / SITE WORK (Engineering Division) SEPARATE PERMIT g's: WATERLINE / METER SEWER CONNECTION SANITARY STOPdvl 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 ELECTRICAL ~ LIGHT DEPT. 41%4735 ELECTRICAL LIGHT DEFT CONSTRUCTION R,W. / PW/ CONSTRUCTION - RW. ENGINEERING 417-4807 PW / ENGINEERING FIRE 417-4653 FIRE DEFT. PLANNING DEPT. 417-4750 PLANNING DEPT. BUILDING 417-4815 1~--- } }~OZ /..-~ ~"[ BUILDING T:/PLANNING\FORMS~ 1102.1 $ [4/2002] CITY OF PORT ANGELES DEPARTMENT OF PUBLIC WORKS ........... INSPECTION REPORT ........... REQUEST: Date (~-/~--)"'~-~ Time Received by /~ ['/' (phone, person) Location of Work to be inspected ~-~J-~ C ~, L~f-~-,~ Name of person requesting inspection "~o,~/~5::~~ ~ Address of person requesting inspection Phone No. Type of Inspection (circle appropriate one): Permit No. Sewer Foundatio~ram~ng~ Chimney Plumbing Final Sewer Excav. Other INSPECTION NOTES: '~ ~?' ~'~ Time By Inspected: Date ~ ~' ~ Remarks: RESTORATION REQUIRED ...... YES NO SURFACE RESTORATION: SURFACE TYPE: [] Unimproved r~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) CITY OF PORT ANGELES DEPARTMENT OF PUBLIC WORKS ........... INSPECTION REPORT ........... REQUEST: Date / 2 - J~ ~-4:~'~ Time Received by ~ V (phone, person) Location of Work to be inspected ~ t,~' Name of person requesting inspection Address of person requesting inspection Phone No. Type of Inspection (circle appropriate one): Permit N~. Sewer Foundation Framing Chimney Plumbing (/Final~ Sewer Excav. Othe~ INSPECTION NOTES: ~ Inspected: Date i ~ ' ,? Time By / · Remarks: RESTORATION REQUIRED ...... YES_ NO SURFACE RESTORATION: SURFACE TYPE: [] Unimproved r~Gravel r~Asphalt []PCC []Other [] Repaired by City Work Order # ~ Repaired by Permittee [] COMPLETE r--] No Damage Found [] INCOMPLETE (Continue on reverse side if necessary) STREET SUPERINTENDENT (DATE) ~,~.*v ~% CITY OF PORT ANGELES z(~'l~ ' DEPARTMENT OF COMMUNITY DEVELOPMENT - BUILDING DIVISION ~ 321 EAST 5TH STREET, PORT ANGELES, WA 98362 ~UII_I.~IIY~ I"I~I~MII ISSUED: 7/02/2002 PERMIT NO: 13515 OWNER/APPLICANT PROPERTY LOCATION RAY VANNAUSDALE 815 CHURCH AVE 623 E. 10TH STREET Lot: B Port Angeles, WA 98362 Block: 13 [] Long Legal 360/457-5784 Subdivision: BEN CHAMBRERS T: S: Parcel No: 063015521365000 CONTRACTOR ARCHITECT RAYMOND CONSTRUCTION N/A 519 SO. PEABODY Port Angeles, WA 98362 , 98360-0000 360/457-3119 360/000-0000 PROJECT INFO Project Value: $160,705.00 SFD Units: 0 Commercial: 0 Project Type: NEW SFD SFD SQ FT: 0 Industrial: 0 Occupancy Type: RESIDENTIAL Garage: 0 Occupancy Group: MFD Units: 0 Construction Type: MFD SQ FT: 0 Zoning Use: ~,,.~ PROJECT NOTES CONSTRUCT NEW 1810 SQ FT SFR WITH ATTACHED 620 SQ FT GARAGE INCLUDES HEAT PUMP & THERMOSTAT & PROPANE LINE RECEIPT#9269 F:>~.FI l~,J-~ ~.. '-'"'7 FEES ASSESSMENT Building Permit: $1,335.35 Misc Fee 1: THERMOSTAT $34.40 Plan Check: $534.14 Misc Fee 2: $0.00 State Surcharge: $4.50 Misc Fee 3: $0.00 House Moving: $0.00 Manufactured Home: $0.00 Sign: $0.00 TOTAL FEE: $2,135.04 Plumbing: $140.00 AMOUNT PAID: $2,135.04 Mechanical: $86.65 Radon: $0.00 BALANCE DUE: $0.00 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 f 80 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; ^ 'g~t,~r .;'r'~.0~r~ or Authorized Agent Date Signature of Owner (if owner is builder) Date T:\PLANNING~FORMS\1102,15 [4/2002] BUILDING PERMIT INSPECTION RECORD CALL 417-4815 FOR BUILDING INSPECTIONS. PLEASE PROVIDE A MINIMUM 2~. 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 ACCEPTEB COMMENTS YES I NO FOUNDATION: WALLS 7- ~ ' 0'~' g Ii. FOUNDATION DRAINAGE ELECTRICAL (LIGHT DEPT) SEPARATE PERMIT:# PLUMBING UNDER FLOOR / SLAB WATER LINE BACK FLOW / WATER AIR SEAL CEILING WALLS FRAMING JOISTS / GIRDERS SHEAR WALL WALLS / ROOF / CEILING q'/O'O a_ L~ DRYWALL T-BAR INSULATION SLAB WALL/FLOOR/CEILING· MECHANICAL HEAT PUMP WOOD STOVE / PELLET / CHIMNEY HOOD / DUCTS PW UTILITIES / SITE WORK (Engineering Division) SEPARATE PERMIT #'s: WATERLINE / METER SEWER CONNECTION SANITARY STOR.M PLANNING DEPT. SEPARATE PEP. MIT #'s SEPA: PARKING/LIGHTING ESA: LANDSCAPING SHORELINE: FINAL INSPECTIONS REQUIRED PRIOR TO OCCUPANCY/USE RESIDENTIAL DATE YES NO COMMERCIAL DATE ACCEPTED YES NO ELECTRICAL - LIGHT DEPT. 417-4735 ELECTRICAL LIGHT DEPT CONSTRUCTION R.W. / PW/ CONSTRUCTION - R.W. ENGINEERING 417-4807 PW / ENGINEEPANG FIRE 417-4653 FIRE DEPT. PLANNING DEPT. 417-4750 PLANNING DEPT. T:~d? L ANNING\FOILM S\ 1102.15 [4/2002 ] BUILDING PERMIT- APPLICATION I Date Approved:~ - The Building Permit Application must befilled out completely. Datejlssued?~ ~ Please type or print in ink. If you have any questions, please call 417~815 ~/ Contractor ~n~ ~s~r~¢~2~ Licenseg: ~<.~ ~c. Exp: 3/~6/0~ Phone: gZT' LEG~ DESC~PTION: Lot: ~ Block: / g Subdivision: ~ CL~L~ COUNTY P~CEL NUMBER: ~/~;~/7~ Credit Card Holder Name:~ ~ Billing Address: City: Exp. Date: O,~ roSA ~ MC Credit Card g: ~ ~ Repair ~ Sign ~ TOTAL VALUATION $ No. of Stories: / ~t Size: /~ 2 Y~ % Lot Coverage: ~0 Exist~g Lot Coverage: ~ O~ /sq. fl. Proposed Lot Coverage: ~ / ~ /sq. ft. TOTAL LOT COVE~GE: PLANING USE ONLY: ; ~PROV~S: PL~ Notes: BLDG. DPW ES~efl~d(s): D Yes ~ No SEPA Checklist required? ~ Yes ~ No Other: OTHER B~LDING PE~IT APPLICATION S~MITT~: Your applica~on and site plan must be filled out completely to be accepted for review. The Building Division can provide you ~ more detailed ~fomtion on the applicahon and pl~ sub~l requirements. Your co~leted application, site plan (for additions) and bulldog cons~ction plans are to be subdued to the Bffild~g Division. V~UATION OF CONSTRUCTION: In all ~a~e~, a valuation amount must be entered by ~e applicant. ~is fig~e ~11 be reviewed and my be revised by the Build~g Division to co~ly wi~ cu~ent fee schedules. Contact ~e Pe~t Coordimtor at 4174815 fo~ assistance. PL~ CHECK FEE: Yo~ plan check fee is due at ~e t~e the building pe~t application ~d co~ction pl~s ~e subdued. All other pe~t fees are due at ~e t~e ofpe~t issuance. EXP~TION OF PL~ ~V~W: If no pe~t is issued wit~ 180 days of~e date of application, ~is application will Bulldog Official can extend ~e hme for action by ~e applicant up to 180 days upon ~i~en request by ~e applicant (see Section 107.4 of the U~fo~ Building Code, cu~ent edition). No application can be extended more ~an once. I hereby cert~ that I haue read and examined th~ applicatio~ and know the xame to be true and correct, and I am a~thori2ed to apply for this ~e~it. I u~dersta~d it ~ not the Ci~'x Iegal rexponsibility to determine what permitx are required; it remai~ the applicant's r~xpo~x~bi[i~ to dete~i~ what ~er~itx are required a~d to obtai~ ALLEY CHURCH AVE. Appendix E: Sample Checklists & Worksheets Attacllm t Plans Examiner and Inspector Checklist Plane Ex. miner: Check. ~vHte .i~ N/A. ~r ~ in value ~ shaded boxes. h~pector: C~eck off boxes at left as items a~e ~ound to comply. Gompflaflce epproecll: (cf~:~ 0~) '[:~ Sy~ems ~atys~s [] Component per"fo~TT~nco [~Pres~ip;ive A) compliance approach is Syste/'fls an~ysis or component perfon'na~co; B) compliance to minimup~ ventJlatio~ ~ileria is dernoi-,,~,-.7.;.ed ~mugh engin~rir~ cak3Jlation~ or pedormance te~ng [~ Slab: ~* i Extedor clow~ to rro~llr~'sJab holloa; or Interior' 24" hcx'fzcxltaJ or v~rUc~l; or-. If radiant, under enUre [] eelow greda extertor wall Iniluleflon: ~1- I (If Imedor-- see Insulation phase) [] Radon mitigation: ! if locally, required, or c~avv~pace vonUng <1fV3001~2 of c~awI, or v~fs Ir'~ude an operable damper [] Source ipeclflc exheuet firm: SIZe re<luh'emerd -- bel~. laundry (5<)cfm); kJ~ct~en [] Who~a houee oxharmt fan ~---~.'~.~ ~orm~ent system ~ menLmi & auto c~m~s; ~ air ,ul:)~/req. for he,table ms. [:::] Integrated forced-air ayttem ~-~ outdo eJr duct (V,~l c/rr~er) eJk~v~ng between .35 end .5 ACH [] R-~/ t Wall Insulation (above grade) [] ~ Waft Irmukdon (below grade): ln~dor ~ Irt~Jlation [] ~ Roor Imlullao~ [] ~ C4illng In~uleUon: Including affic h~ [] ~ Vaulted eeHIng kmuletlm~ r"] Redonm~l~Orm~ elte:wt~l~e~dgene~lln~c~'me~n l~-npi--: r c~Vou~llo~ .k .uR~y duct w~lamp~ dk~ct ~ ~Vebo~ l~ht ~nO OUm~ or n~.l dcy~.. DI~IV heet~l: NAEC, A lab~; a4~r-*e J:x3v~r w g&~ a~'t~If; on R-10 pod # etectrtc encl In un~-~, eH ~ ff ~ ~ u ~o Mlch~nlcal v~IUlltJon dL~'tl In~ulmt/d t~ R-4: extmu~t duc~ In ~ ~ ~reea/~J~oly ~ In ~ ~'Ptl~ Irmul~fJon: R-3 kx hot .nd coiCl v~11r pil3~ In uncxxlG11~,or~d m..a.g (ff .~.'~c~ or r~lrcul~V~, ii~ Table 5.12) E-52 Appendix E: Sample Checkltms & Wo:'k~heets Plan~ Examin~ -- fill ou~ this glazin~ ~c'don or .tta~ · window ~:he(kbe to this c:hecJd~. Inspe~o~ -- verify ~ ~n- lormabon dudr~ field inspecl~:.'~. Include skylights, glass ~:x~ a~d all other glaz"'l~ off this form. L~ae rough open~ area. lo~ calculmions. Size Quantity Area LI-Value/Manufacturer ~.ox ~ / 27,0 .~,~-~ Total gl~z~ng eme: Total conditioned line: / ~ / 0 Type/Quantity U-Value/Manufacturer Verified S~gnmum of Building Official: Date of Final InlpeCtk)n: ~ E-53 City of Porg Angeles Applicant Project Review Sheet CITY OF PORT ANGELES DEPARTMENT OF PUBLIC WORKS ........... INSPECTION REPORT ........... REQUEST:,7 '~ - 07-~ ~ 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 I~rcle appropriate one): Permit NO ' / ~ r~[ ~ Sewer Framing Chimney Plumbing 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 (Continua on revarse sida if necessary} STREET SUPERINTENDENT {DATE) CITY OF PORT ANGELES DEPARTMENT OF PUBLIC WORKS ........... INSPECTION REPORT ........... REQUEST: Date :i // ?/~:~ Time ' Received by~./~ (phone, person) Location of Work to be inspected ~ / ~ ,* Name of person requesting inspection l~ ~'~/~ Address of person requesting inspection !, , , , ,, Permit No. / Typeof Inspection (circle appropriate one): ~ ~ ' : '~ · Sewer :~:oundatior~'* Framing Chimney Plumbing Final Sewer Excav. Other INSPECTION NOTES: ' ~ Inspected: Date '~'- ~(~' Time. By Remarks: RESTORATION REQUIRED ...... YES NO SURFACE RESTORATION: SURFACE TYPE: [] Unimproved [~Gravel I-~Asphalt ~rPCC [~]Other [] Repaired by City Work Order # [-] Repaired by Permittee [] COMPLETE [] No Damage Found [] INCOMPLETE (Continue on reverse side if necessary) STREET SUPERINTENDENT (DATE) 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 Plumbing Final Sewer Excav. Other INSPECTION NOTES:~ Inspected: Date ~'~' ~i - "i"_ Time By ,~, Remarks: RESTORATION REQUIRED ...... YES NO SURFACE RESTORATION: SURFACE TYPE: [] Unimproved [-JGravel []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) CITY OF PORT ANGELES DEPARTMENT OF PUBLIC WORKS ........... INSPECTION REPORT ........... REQUEST: Date ~ '-/(-~-- (~-'~- Time Received by ~ j// (phone. person) Location of Work to be inspected ~ of person requesting inspection Name Address of person requesting inspection Phone No. ..... ~ -~ No~/~~ Type of Inspection (circle appropriate one).'../"~-'"~ Permit Sewer Foundation ~ Chimne/ .~t~g~ina, Sewer Excav.Otl~r~__ INSPECTION NO~TES: ? Inspected: Date - __Time By Remarks: /--? t RESTORATION REQUIRED ...... YES NO SURFACE RESTORATION: SURFACE TYPE: [] Unimproved []Gravel [~Asphalt []PCC ~lOther [] Repaired by City Work Order # I--} Repaired by Permittee [] COMPLETE []No Damage Found [] INCOMPLETE (Continue on reverse side if necessary) STREET SUPERINTENDENT (DATE} CITY OF PORT ANGELES DEPARTMENT OF PUBLIC WORKS ........... INSPECTION REPORT ........... REQUEST: Date ~:~' / [" ~)'~ Time Received by ~ ~ (phone, person) Location of Work tO be inspected (~[~ C I~.UihC.~'~ AV~) Name of person requesting inspection Address of person requesting inspection Phone No. Type of Inspection (circle appropriate one): Permit No. Sewer Foundation Framing Chimney Plumbing Final Sewer Excav. Other INSPECTION NOTES: - :~"~:~ Inspected: ~' ~'? _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) '~" CITY OF PORT ANGELES d~ PUBLIC WORKS - ELECTRICAL DIVISION 321 F, AST 5TIt STREF. T, PORT ANGELES. WA 98362 ELECTRICAL PERMIT ISSUED: 711212002 PERMIT NO 7739 OWNER/APPLICANT PROPERTY LOCATION RAY VANNAUSDALE 815 CHURCH AVE 623 E. 10TH STREET Lot: B shp 02-04 Port Angeles, WA 98362 Block: 13 [] Long Legal 360/457-5784 Subdivision: BEN CHAMBRERS T: S: Parcel No: 063015521365000 CONTRACTOR ARCHITECT BOB'S ELECTRIC INC. N/A 2293 DEER PARK PORT ANGELES, WA 98362-0000 , 98360-0000 360/457-6887 360/000-0000 PROJECT INFO Project Type: RES.NEW Project Value: $0.00 Occupancy Type: RESIDENTIAL Construction Type: Occupancy Group: Zoning Use: Electrical Heat: [] Baseboard 0 KW [] Riser [] Underground Service [] Furnace 10KW [] Overhead Service Voltage: 120,240 [] Heat Pump 2 KW [] TempService Phase: [] 1 [] [] Fan Wall 0 KW Service Size: 200 Feeder Size: 0 PROJECT NOTES NEW SFR, 400 AMP REMOTE AND OUT BLD. RECEIPT#9303 FEES ASSESSMENT Service: $119.80 Additional Feeders: $0.00 Circuit Wiring: $0.00 Tem p Service: $0.00 Misc Fee: $0.00 TOTAL FEE: $119.80 AMOUNT PAID: $119.80 BALANCE DUE $0.00 COMMI;~NTS/ACTION NEEDED ELECTRICAL PERMIT INSPECTION RECORD CALL 41%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 PLa. NS AT JOB SITE I DITCH ROUGH-IN/COVER FINAL I ! ~,//~/~ I,. I ,,~-(") I GENERAL COMMENTS: ',- I."' -;).:.:, AIR FLOW IlEATING ~001 09/11/02 WED 08: ._ . :-;"l I-:',;.l - , I = I,. ~ OAT..", ... .,,". q ..,~. -=--= ~iii"'~ TRICAl PERMIT APPLICATION fO~ OfROAl. USE 0Nl... Y Dir.1~ P.......i,.: [);ale "",",...cd: The E'eclrical Permit AppliC8tion musl b. filled oul comDleletv. '#78/8 Pleas. type or reprint in Ink. If you have any questions, pleClse can (360)417- 4735 Fa. number: (360) 417-4111 REQUEST INSPECTION 0 Owner or E'ec Conlraclor A9eot~ WI "r1~jj~+n ) ct:IDn..- Phon.' 4 h') - f) IAl FaX:. ~~~~~- - Address: fJJ-> ~ I , V fI Yt ~/e" Cily fw +--111 g '" J,y~ Electrical Conlraclor'. AtV' pt.o ~ n/"'7 License#~~ Addre.s: 22 I t\ \, (l k 1J. (JI .v Clly: ~q ~ 11 YVl Zip: q P:3~? phone,h R n 31(L\ Zip: q 'l?'t3, ~ INSTALLATIONWIREDBV: DOWNER )I1ELECTARlCALCO~T~CTOI'\ _',. CreditCardHo/derll/ame'!v1. l~r:;Gl)8t--fl:;,- ~JI1~ Billing Address' z., 7-1 \I\) , (I Jt Ai!!!. Y City: teV lJ IIdLJ Credit Card NumbeA~' PROJECT ADDReis915' ChU)lf ti\. . k\/ V . TYPE OF WORK: Check all lhat apply: '9 New z/p::t g3&z- v,sAd MC~ o Alleralion/Addition pResidential 0 Mulli-family o Commercial 0 Mobile Home Sq. Ft Remote Meier 0 Detached garage 0 Hol Tub 0 Swim Pool .. 0 Septic Pump . )(Low Voltage 0 Telecom. 0 S Number of Circuits added or altered: DESCRIPTION OF THE ELECTRICAL PROJECT: o Baseboard .fi([Fumace ~ Heat Pump o Fan-Wall _KW i..CL KW ..:k. TON Sf LRA _KW PERMIT FEE: -oU , y~ Service Infonnalion -$ 3~, 3D ~r.:d 7'~5z... Voltage: o Overtleall Service Phase: 0 1 0 3 o Temp Servic:e SefVice Size: o Underg~ound S-ervice Feedet' Size: Electrical Heat Load Additions' I hereby certify that I have read and examined this application and know that same to be true and correct, and I a authorized to apply for this permit, I understand it is not the City's legal responsibility to determine what permits are required; it remains the applicants responsibility to determine what permits are required and to obtain such. Cre'" C.", H.....'. ,~....re, ~ Owner or Elec. Cant. Signature:6 '. ... a C:/ELECTRICALPERMITAPPLlCATlON , . ~Ca~,- . '1- /2... - CI"L- Dale: Dale: q -1/ -1) C1 FROt1 : BOB'S Electric "/-/0 - ~'Z- ELECTRICAL PERMIT APPLICATION FAX NO. : 1 360 452 9943 Jul. 10 2002 09:41AM P2 (}.vB The. E.teemca1 Perm;, Ap:piication rnu!>t be fined out completely. FO~ r1m('"1"lo.lfC '1"1. - 0"'2. Ct.I~'R..... - __~ ""~", _,_. -, -.:_ <Z O"'.....rrr...~.I:_~t 0;0I~ !~"'",,!. Please type Or reprint fn lnlt. If you have 81ny questions, please call (360. 417-4735 Fu numbor: (360' .17'-4711 Own., 0' Elec, ConltaClo' Agent: J3,At:#.f- .i. a"'rIf""" f Ph""e~- "9:<7",?,f9 7Fax: iSfo _'I!;;,; _ <r,,'V~ ~ ~ k~ )N"~ P"'ll'l"YOwn." ~ ~h ~J-. Phone: ~ - V-- ::':::'OJnt,":A~4t.~_::':.l:-VC- Qry Li n. ; 2.~xp ::~noc/57_t,,(>n Add",." ~Y:3 iL., j)A"'~ C,ty: ,lki-l4tUtj'" ('" < ~a Z'p: <;f~C.<...: INSTALLATION WIRED BY: 0 OWNER ~LECTAICAL CONTAACTOR Credi/CardHolderName: 0 o.u6-' ~/A~' f' Billing Address: 2:l9 ~ 'lA:;-t"?"R &.< City: ./),.er Credit Card Number: /. Z;P:~ V/SA:L-MC:_ PROJECT AODR~SS: %L<. ~ L.""".f . TYPE OF WORlS: Check all that apply: 0 New o Alteration/Addition l1(Residental 0 Multi-family 0 Commercial 0 Mobile Home Sq, ~t Cu...-t-~~3-'-p.~ o Remote Meter ~el!t l . Jl!ra!je" 0 Hol Tub 0 Swim Pool 0 Seplic Pump 0 Low Vollege 0 Telecom, il $'gn NlJmber of Circuits added or altered: DESCRlON OF TliE ELECTRICAL PROJECT: ~ .r;A4I( - 1 "J-u../ LJ ,:"L . ~ y:;~~ ~-' a) AC-~-~I_~~ -</004- ~ -'~ Electrical Heat Load Additions _~'. Et. //'1_80 Service Information CJ B..eboard cs.Fumaca l)ijaat Pump CJ Fan-Wall _ I'm ~KW ...2_ TC>N _ I'm s,UI\- o Overhead Service .25l1t\110 Temp Sarvice <1a \lil Und.'gmund SaMce VOllage: ~qO II Phase: IS.l 0 3 Service Size: -'1 Of) Feeder SiZ9: "I D . '~,li1t;">~"~~mined this application and know that same to be true and correct, and f am ',' ,.; :'. C',> r-::\-'':'~;r;'v-:;~%e::~f/'" fiers/an~ i~ is not the C!ty's legal resp?nsibifity to ,determine whatpermits ji;!', "'" ,. . ~." [- '0 "'''~~ wha' P"='",ro ~""".,,.~ ""'..- _.__.._--____,..r'sSignature: O"".""LJ ~.Aj,j1 Date: ~/~/dZ- PW.9019 ,OwnerorElec.c;os~n-:ure:~~~ 11-- pale:y.; "Z-- AJ --- 6~ ;(-<7 IS - (2u 9>77. k -t~<;e '3 4vlIY!-'7 UJrR HP:s '-vl'l! jJ6f€--" 'l't..f ~ ~. ~ p~ fi-L -n.d.. yr~rf ,frvtiL.?- ".,(' TL\;~ ?7f<..----(- ~ rl' I L, "r7 "L'fl0 Yftt((( -1t<'1 IJ-U ~ r"1U'rJ<..J.i-- " & residential projects larger than a duplex, " one - line drawing 0' tt"le Eleelrieal Service & . . i)nd lhe type & of conduCIOrs andJor raeew;ay is required and shall accompany rhe