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CITY OF PORT ANGELES
DEPARTMENT OF COMMUNITY DEVELOPMENT - BUILDING DIVISION
.321 EAST 5TH STREET, PORT ANGELES, WA 98362
Application Number
pin number . . . .
Property Address
ASSESSOR PARCEL NUMBER:
Application description
Subdivision Name
Property Use
Property Zoning . . .
Application valuation
05-00000216 Date
.597504
1247 E LAURIDSEN BLVD
06-30-11-5-5-9040-0000-
RES NEW SFR
.4/12/05
RS7 RESDNTL SINGLE FAMILY
183283
,.-. ,
rlHA f..-eO
11/"7105
Owner
Contractor
MYERS, SUZANNE M
915 WEST 6TH # B
PORT ANGELES
(360) 565-9000
Structure Information
Construction Type
Occupancy Type
Other struct info
WA 98363
QUALITY BUILDERS
610 DRYKE ROAD
SEQUIM
(360) 461-3312
2518SF SFR W/ATT 556SF GARAGE
TYPE V NON-RATED
SINGLE FAM & CONGREGATES
TOTAL % LOT COVERAGE
CONSTRUCTION TYPE
NUMBER OF STORIES
EXISTING LOT COVERAGE
LOT SIZE
PROPOSED LOT COVERAGE
TOTAL LOT COVERAGE
NUMBER OF UNITS
WA 98382
21.20
V-N
2.00
1. 00
9575.00
2033.00
2033.00
1. 00
<-9
..:t.
............:t
Permit . . . .
Additional desc
Permit Fee
Issue Date
Expiration Date
BUILDING PERMIT -RESIDENTIAL
2518SF SFR W/ATT 556SF GARAGE
1487.65 Plan Check Fee
4/12/05 Valuation
10/09/05
595.06
183283
~
<::--
\i\
Qty Unit Charge Per
Extension
1017.25
470.40
BASE FEE
84.00 5.6000 THOU BL-I00,OOI-500K (5.60 PER K)
Permit MECHANICAL PERMIT
Additional desc
Permit Fee 101.35 Plan Check Fee
Issue Date 4/12/05 Valuation
Expiration Date 10/09/05
Qty Unit Charge Per
BASE FEE
1. 00 14.7000 ECH ME- INSTALL 100- FAU
4.00 7.2500 ECH ME-VENT FAN
1. 00 10.6500 ECH ME-GAS PIPE 1 TO 5
.00
o
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<..
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0-
V'
~
Extension
47.00
14.70
29.00
10.65
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VV
Permit . . . .
Additional desc
Permit Fee
Issue Date
Expiration Date
PLUMBING PERMIT
139.00
4/12/05
10/09/05
Plan Check Fee
Valuation
.00
o
(-
fL
Qty Unit Charge Per
Extension
47.00
63.00
BASE FEE
9.00 7.0000 ECH PL- EA.FIXTURE ON ONE TRAP
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 c;Iays 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.
~h_jNL Yn . 111Uf;tJ( 1-/;) -os
Signature of Contractor or Aut~ Agent Date Signature of Owner (if owner is builder) Date
T:\Policies\II02_15 building pennit inspection record05.wpd [1/4/2005]
BUILDING PERMIT INSPECTION RECORD
CALL 417-4815 FOR BUILDING INSPECTIONS. CALL 417-4735 FOR ELECTRICAL INSPECTIONS.
CALL 417-4807 FOR PUBLIC WORKS UTILITIES
PLEASE PROVIDE A MINIMUM 24 HOUR NOTICE. IT IS UNLAWFUL TO COVER, INSULATE OR CONCEAL ANY WORK BEFORE
INSPECTED AND ACCEPTED. POST PERMIT IN A CONSPICUOUS LOC~ nON.
KEEP PERMIT CARD AND APPROVED PLANS AT JOB SITE.
INSPECTION TYPE DATE ACCEPTED COMMENTS
YES I NO
FOUNDATION:
FOOTINGS
WALLS
FOUNDATION DRAINAGE 1 DOWN SPOUTS
PIERS
POST HOLES (POLE BLDGS.)
PLUMBING
UNDER FLOOR 1 SLAB
ROUGH-IN
WATER LINE (METER TO BLDG)
GAS LINE
BACK FLOW 1 WATER
AIR SEAL
WALLS
CEILING I
FRAMING
JOISTS 1 GIRDERS
SHEAR W ALLIHOLD Q{)WNS
WALLS 1 ROOF 1 CEILING
DRYW ALLAWfERlQR BRACED PANEL ONLY)
T-BAR
INSULATION
SLAB
WALL 1 FLOOR 1 CEILING I I
MECHANICAL
HEAT PUMP 1 FURNACE 1 DUCTS
GAS LINE
WOOD STOVE 1 PELLET 1 CHIMNEY
COMMERCIAL HOOD 1 DUCTS
MANUFACTURED HOMES
FOOTING 1 SLAB
BLOCKING & HOLD DOWNS
SKIRTING
PLANNING DEPT. SEPARATE PERMIT #'5 SEPA:
PARKINGILIGHTING . ESA:
LANDSCAPING SHORELINE:
FINAL INSPECTIONS REQUIRED PRIOR TO OCCUPANCYIUSE
RESIDENTIAL DATE YES NO COMMERCIAL DATE ACCEPTED
YES NO
ELECTRICAL - LIGHT DEPT. 417-4735 ELECTRICAL
LIGHT DEPT
CONSTRUCTION R. W. 1 PWI CONSTRUCTION - R. W.
ENGINEERING 417-4807 PW 1 ENGINEERING
FIRE 417-4653 FIRE DEPT.
PLANNING DEPT. 417-4750 PLANNING DEPT.
BUILDING 417-4815 BmLDING
T:\Po1icies\1102_15 building pennit mspectJon record05.wpd [1/4/2005]
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CITY OF PORT ANGELES
'DEPARTMENT OF COMMUNITY DEVELOPMENT - BUILDING DIVISION
321 EAST 5TH STREET, PORT ANGELES, WA 98362
Application Number
pin number
05-00000216
.597504
Page
Date
2
4/12/05
Qty
1. 00
1. 00
1. 00
Unit Charge
7.0000
15.0000
7.0000
Per
ECH
ECH
ECH
PL- EA. INSTALL WATER PIPE
PL- EA. BLDG SEWER
PL- EA.WATER HEATER
Extension
7.00
15.00
7.00
Special Notes and Comments
Building address sign shall not be less than 6" & not more
than 12" in height. Numbers colors must contrast with wall
color they are mounted on. (Ord. 14.36.050-E)
When roof gutters are installed, drains will located in dry
wells or piped to approved storm drain locations.
The proposal will result in a new s.f. residence
with attached garage in the RS-7 for total lot coverage of
21%. No land use issues are noted.
Electrical permits are required.
> $713 Connection Fee Applies.
Permanent elect service will be from the pedestal at the SW
prop corner.
Temp SVC may be overhead from the Pole at the SE prop
corner.
MAINTAIN CLEARANCES FROM SERVICE WIRES.
Contact Mike Hill @ PUD for review. 565-3286.
The recommended electric meter loctaion is on the Garage
Wall closest to the SW Prop corner.
Any modifications to the electrical facilities will
be at the customer's expense.
Sanitary sewer connection inspection is required by
Public Works prior to back fill of ditch.
Construct driveway to City Standards.
No concrete with exposed aggregate allowed in the City
road right of way.
-----------------------------------------,-----------------------------------
Other Fees
SEWER SYSTEM DELV CHARGE
STATE SURCHARGE
PW WATER SYSTEM USE FEE
745.00
4.50
1025.00
Fee summary Charged Paid Credited Due
----------------- ---------- ---------- ---------- ----------
Permit Fee Total 1728.00 1728.00 .00 .00
Plan Check Total 595.06 595.06 .00 .00
Other Fee Total 1774.50 1774.50 .00 .00
Grand Total 4097.56 4097.56 .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 tbis 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:\Policies\1102_15 building penn it inspection record05.wpd [114/2005]
BUILDING PERMIT INSPECTION RECORD
,
..
CALL 417-4815 FOR BUILDING INSPECTIONS. CALL 417-4735 FOR ELECTRICAL INSPECTIONS.
CALL 417-4807 FOR PUBLIC WORKS UTILITIES
PLEASE PROVIDE A MINIMUM 24 HOUR NOTICE. IT IS UNLA WFUL TO COVER, INSULATE OR CONCEAL ANY WORK BEFORE
INSPECTED AND ACCEPTED. POST PERMIT IN A CONSPICUOUS LOCATION.
KEEP PERMIT CARD AND APPROVED PLANS AT JOB SITE.
INSPECTION TYPE DATE ACCEPTED COMMENTS
YES I NO
FOUNDATION:
FOOTINGS 4 - 2.,J~-D5" JLL
WALLS 4- l:.f-. -(."l~-
FOUNDATION DRAINAGE 1 DOWN SPOUTS
PIERS
POST HOLES (POLE BLDGS.)
PLUMBING Ft~ })-7-r9S M ~ J-)...
UNDER FLOOR 1 SLAB
ROUGH-IN /n ~ 9Ii -~S' J 1-&..-
WATER LINE (METER TO BLDG) ~ / I /0 ,/ (')t.-L-
GAS LINE
BACK FLOW 1 WATER
AIR SEAL
WALLS
CEILING I
FRAMING ,I
JOISTS 1 GIRDERS
SHEAR W ALLlHOLD DOWNS
WALLS 1 ROOF 1 CEILING
DRYWALL (INTERIOR BRACED PANEL ONL Y)
T-BAR
INSULATION
SLAB f#/14 /0 S \fLA.;
WALL 1 FLOOR 1 CEILING I
MECHANICAL FIf{pJ,. 11-0~-~ .H").. M
HEAT PUMP 1 FURNACE 1 DUCTS
GAS LINE ~ -!l'" -oS j ':'L
WOOD STOVE 1 PELLET 1 CHIMNEY
COMMERCIAL HOOD 1 DUCTS
MANUFACTURED HOMES
FOOTING 1 SLAB
BLOCKING & HOLD DOWNS
SKIRTING
PLANNING DEPT. SEPARATE PERMIT #'5 SEPA:
PARKINGILIGHTlNG ESA:
LANDSCAPING SHORELINE:
FINAL INSPECTIONS REQUIRED PRIOR TO OCCUPANCYIUSE
RESIDENTIAL DATE YES NO COMMERCIAL DATE ACCEPTED
YES NO
ELECTRICAL - LIGHT DEPT. 417-4735 ELECTRICAL
LIGHT DEPT
CONSTRUCTION R. W.I PWI CONSTRUCTION - R.W.
ENGINEERING 417-4807 PW 1 ENGINEERING
FIRE 417-4653 FIRE DEPT.
PLANNING DEPT. 417-4750 PLANNING DEPT.
BUILDING 417-4815 tf- '1- O~" ")1-J... BUILDING
. . . .
T:\Pohcle5\1102_15 butldmg pennll mspectlOn record05.wpd [1/4/2005]
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This map is not intended to be used as a legal description.
This map/drawing is produced by the City of Port Angeles for its own use and pU1poses.
Any other use of this map/drawing shall not be the responsibility of the City,
Area Map
'(i
~r';;
CITY OF PORT ANGELES
PUBLIC WORKS - ELECTRICAL DIVISION
.-21 EAST 5TH STREET. PORT ANGELES. WA 98:\62
Appllcation Number
Application pin number
Property Address
ASSESSOR PARCEL NUMBER:
Application type description
Subdivision Name
Property Use
Property Zoning . . ,
Application valuation
05-00000216 Date
597504
1247 E LAURIDSEN BLVD
06-30-11-5-5-9040-0000-
RES NEW SFR
6/27/05
RS7 RESDNTL SINGLE FAMILY
183283
Owner
Contractor
MYERS, SUZANNE M
915 WEST 6TH # B
PORT ANGELES
(360) 565-9000
Structure Information
Construction Type
Occupancy Type
Other struct info
QUALITY BUILDERS
610 DRYKE ROAD
WA 98363 SEQUIM
(360) 461-3312
000 000 2518SF SFR W/ATT 556SF
TYPE V NON-RATED
SINGLE FAM & CONGREGATES
TOTAL -% LOT COVERAGE
CONSTRUCTION TYPE
NUMBER OF STORIES
EXISTING LOT COVERAGE,
LOT SIZE
PROPOSED LOT COVERAGE
TOTAL LOT COVERAGE
NUMBER OF UNITS
WA 98382
GARAGE
21.20
V-N
2,00
1. 00
9575,00
2033,00
2033,00
1. 00
"'-
tp'
~
'J
Pe rmi t , , . ' .
Additional desc '
Permit pin number
Sub Contractor
Permit Fee
Issue Date
Expiration Date
ELECTRICAL NEW RESIDENTIAL
QUALITY/ 3074 SQFT SFR.
52860
QUALITY ELECTRIC
166,60
6/27/05
12/24/05
~
Plan Check Fee
Valuation
.00
o
~
~
~
~
~
,
<:
Qty
1. 00
4,00
Unit Charge Per
73.0000 ECH
23.4000 5C
EL-R-SQFT FIRST 1300
EL-R-SQFT ADDITIONAL 500
Extension
73.00
93.60
Special Notes and Comments
Building address sign shall not be less than 6" & not more
than 12" in height, Numbers colors must contrast with wall
color they are mounted on. (Ord. 14.36,050-EI
When roof gULters are installed, drains will located in dry
wells or piped to approved storm drain locations,
The proposal will result in a new s,f, residence
with attached garage in the RS-7 for total lot coverage of
21%. No land use issues are noted,
Electrical permits are required.
> $713 Connection Fee Applies.
Permanent elect service will be from the pedestal at the SW
p=p corner,
Temp SVC may be overhead from the Pole at the SE prop
corner.
MAINTAIN CLEARANCES FROM SERVICE WIRES.
Contact Mike Hill @ PUD for review. 565-3286.
The recommended electric meter loctaion is on the Garage
Wall closest to the SW Prop corner.
~
\'
~
"
COMMENTS/ACTION NEEDED
ELECTRICAL PERMIT INSPECf.lON RECORD
CALL 4) 7-4735 FOR ELECTRICAL INSPECTIONS. PLEASE PROVIDE A MINIMUM 24 HOUR NOTICE. IT IS UNLA WFUL TO COVER,
INSULA TE OR CONCEAL ANY WORK BEFORE rr IS INSPECTED AND ACCEPTED.
KEEP PERMIT CARD AND APPROVED PLANS AT JOB SITE
INSPECTION TYPE DATE ACCEPTED . COMMENTS
YES NO
IITI 'H
ROI J(TH-IN I CUV-h.K.
SERVICE
FINAL I I
GENERAL COMMENTS:
PW-I 102.1' 14'96\
4
d'Oll'~_
${i~~
De
""~,...
CITY OF PORT ANGELES
PUBLIC WORKS - ELECTRICAL DIVISION
:\21 EAST 5TH STREET. PORT ANGELES. WA 9R~62
Application Number , . , . , 05-00000216
Application pin number 597504
Page
Date
2
6/27/05
special Notes and Comments
Any modifications to the electrical facilities will
be at the customer's expense.
Sanitary sewer connection inspection is required by
Public Works prior to back fill of ditch.
Construct driveway to City Standards,
No concrete with exposed aggregate allowed in the City
road right of way.
Other Fees
SEWER SYSTEM DELV CHARGE
STATE SURCHARGE
PW WATER SYSTEM USE FEE
745,00
4.50
1025.00
Fee summary Charged Paid Credited Due
----------------- ---------- ---------- ---------- ----------
Permit Fee Total 166,60 ,J.66,60 .00 .00
Plan Check Total ,00 ,00 .00 .00
Other Fee Total 1774,50 1774,50 .00 .00
Grand Total 1941,10 1941.10 .pO .00
COMMENTS/ACTION NEEDED
ELECfRICAL PERMIT INSPEQ'.ION RECORD
CALL 417-4735 FOR ELECTRICAL INSPECTIONS. PLEASE PROVIDE A MINIMUM 24 HOUR NOTICE. IT IS UNLA WFUL TO COVER.
INSULA TE OR CONCEAL ANY WORK BEFORE IT IS INSPECTED AND ACCEPTED.
KEEP PERMIT CARD AND APPROVED PLANS AT JOB SITE
INSPECTION TYPE DATE ACCEPTED COMMENTS
YES NO
IlIT( :H 17- ,rT- 0';- JIli:::-
RuuGH-IN I COVER I t~;I-'1- 0::> Azo
:S~K VIC~ 7-.;t.?-oS' ~o
I/o ./-~>..~ ..L. ...."')1
..
GENERAL COMMENTS:
PW-II02.l~ (41'96\
'ti
...... .. ..'iI"
. ~ "
Application pin number
Property Address
ASSESSOR PARCEL NUMBER:
Application type description
Subdivision Name
Property Use
Property zoning . . .
Application valuation
CITY OF PORT ANGELES
PUBLIC WORKS - ELECTRICAL DIVISION
~21 EAST 5TH STREET. PORT ANGELES. WA 98~()2
v;.;) vvvvV"",,..LO
1.JClL..t::::
"'I.!.':j/Uo,
597504
1247 E LAURIDSEN BLVD
06-30-11-5-5-9040-0000-
RES NEW SFR
RS7 RESDNTL SINGLE FAMILY
183283
Owner
Contractor
MYERS, SUZANNE M
915 WEST 6TH # B
PORT ANGELES
(360) 565-9000
Structure Information
Construction Type
Occupancy Type
Other struct info
QUALITY BUILDERS
.,610 DRYKE ROAD
WA 98363 SEQUIM
(360) 461-3312
000 000 2518SF SFR W/ATT 556SF
TYPE V NON-RATED
SINGLE FAM & CONGREGATES
TOTAL % LOT COVERAGE
CONSTRUCTION TYPE
NUMBER OF STORIES
EXISTING LOT COVERAGE
LOT SIZE
PROPOSED LOT COVERAGE
TOTAL LOT COVERAGE
NUMBER OF UNITS
WA 98382
GARAGE
21.20
V-N
2.00
1. 00
9575.00
2033.00
2033.00
1. 00
permi t . . , , .
Additional desc .
Permit pin number
Sub Contractor
Permit Fee
Issue Date
Expiration Date
ELECTRICAL TEMPORARY
QUALITY/ TEMP SVC.
48074
QUALITY ELECTRIC
48.10
4/29/05
10/26/05
SERVICE..
..........
~
--Z
"J
Plan Check Fee
Valuation
.00
o
Qty
1. 00
Unit Charge Per
48.1000 ECH EL-TEMP SRV - 0-100 SRV FDR
Extension
48.10
"\~
~
~ ~
{ ~'
~\
",
~&
~r
Special Notes and Comments
Building address sign shall not be less than 6" & not more
than 12" in height, Numbers colors must contrast with wall
color they are mounted on. (Ord, 14.36.050-E)
When roof gutters are installed, drains will located in dry
wells or pi~ed to approved storm drain locations.
The proposal will result in a new s.f, residence
with attached garage in the RS-7 for total lot coverage of
21%. No land use issues are noted,
Electrical permits are required.
> $713 Connection Fee Appl~es,
Permanent elect service will be from the pedestal at the SW
prop corner.
T~mp SVC may be overhead from the Pole at the SE prop
corner.
MAINTAIN CLEARANCES FROM SERVICE WIRES.
Contact Mike Hill @ PUD for review. 565-3286.
The recommended,electr~c meter loctaion is on the Garage
Wall closest to the SW Prop corner.
Any modifications to the electr~cal facilities will
c-,
t-.."
~
\....>
COMMENTS/ACTION NEEDED
ELECTRICAL PERMIT INSPEg.JON RECORD
. CALL 4174735 FOR ELECTRICAL INSPECTIONS. PLEASE PROVIDE A MINIMUM 24 HOUR NOTICE. <<IS UNL,A WFUL TO COVER.
INSULA TE OR CONCEAL ANY WORK BEFORE IT IS INSPECTED AND ACCEPTED.
KEEP PERMIT CARD AND APPROVED PLANS AT JOB SITE
INSPECTION TYPE DATE ACCEPTED COMMENTS
YIS I NO
nrn'l-I
IU111~J.I_IN I COVER
~RVlCE
rINAL I T
GENERAL COMMENTS:
PW-II02.U 106\
d''''''~.
$(j~
DI
.....r..?
CITY OF PORT ANGE~ES
PUBLIC WORKS - ELECTRICAL DIVISION
:\21 EAST 5TH STREET. PORT ANGELES. WA 98J(l2
"
"
Application Number . . . . . 05-00000216
Application pin number 597504
t"dge
Date
2
4/29/05
--------------------------
--------------------------------------------------
special Notes and Comments
be at the customer's expense.
Sanitary sewer connection inspection is required by
Public Works prior to back fill of ditch.
Construct driveway to City Standards.
No concrete with exposed aggregate allowed in the City
road right of way.
-----~----------------------------------------------------------------------
Other Fees
. . . . . . . . .
SEWER SYSTEM DELV CHARGE
STATE SURCHARGE
PW WATER SYSTEM USE FEE
745.00
4.50
1025.00
----------------------------------------------------------------------------
Fee summary Charged Paid Credited Due
----------------- ---------- ---------- ---------- ----------
Permit Fee Total 48.10 48.10 .00 .00
Plan Check Total .00 .00 .00 .00
Other Fee Total 1774.50 r'774.50 .00 .00
Grand Total 1822.60 1822.60 .00 .00
COMMENTS/ACTION NEEDED
ELECTRICAL PERMIT INSPEQ'JON RECORD
. CALL 4174735 FOR ELECTRICAL INSPECTIONS. PLEASE PROVIDE A MINIMUM 24 HOUR NOTICE. IT IS UNLA WFUL TO COVER,
INSULATE OR CONCEAL ANY WORK BEFORE IT IS INSPECTED AND ACCEPTED.
KEEP PERMIT CARD AND APPROVED PLANS AT JOB SITE
INSPECTION TYPE DATE I ACCItPTED COMMENTS
YIS I NO
UnCH
WIJllIiH_!N I CUV,hK
~bK V 1l.,;~
JOIN A T I
GENERAL COMMENTS:
PW-IJ02.U (4'96)
04/28/2005 05:57
3505830859
/_."h1/ ~
~/ ~
'" Electrical Contract.or Cl Owner '1,.......l
o Annua' Permit 0 Alarm Q Carnival 0 Commercial
KIRSCH ELECTRIC INC PAGE 01 .
"I, 7 - Ii 71/ - 1";;1 i<
ELECTRICAL WORK PERMIT APPLICATIGlN
J:d Request Inspection
'Residential a Residential Mainl. 0 Signs 0 Thermost:lt 0 Telecom.
Job wired by
Electrical Contractor 0 Owner
In$I3:l\ation description
PurehDser'S mailing add' ss
1133 C",me.r",,.,
Ciry ~
S e~ ..; I V1'\
TeleptJonl:: nu er
. C' - ....? fS {
RLJ'\c:l-u'-s
La. V ,.~ Je,..sc."
State ZIP
WI'.
FAX number
Pre-mlJts owner'.. Q.lme
OJ", \, -t~1
^ddren Gt Inspedlv .
I 'N.'i7 E
r-\--
City
c. ~
I hereby certify that I am the owner of the above named property or a lieen!lcd
electrical contractor (or the firm's authorized agent) and am making the c1ccn'ical
installation or alteration, in compliance with the electrical law, Chapter 19.28 RCW.
x
al contractor or eh:ctrlcal Administrator'
iI-
WALLS
InsulRtion Only
CEILING
[n,~ul:llion Only
CUlt
AppRI"CO By
ll_IC
.,APPfOl'C1lBy
Cover
Cover
Olle
"'pp~9y
DOH
Approved By
Electrical Load Additions and or subtractions.
o NO LOAD CHANGES
Q Baaeboard t<:W
o Furnace _ KW
Cl Heat Pump _ Ton _ LAA
o Fan.Wg/1 KW
~A
--
J ~ 1'.-1 0
, I
tG__~..J 'f
o c;ash 0 Check #
o Credit Card Visa
Card #
(IC'k'
Mastercard
- - -
----------------
Discover
Expiration Dale
of card
TIlERMOSTAT
Dille
^1'Pl'Q"tC 9y
DITCH
ODic
Appro-ytG B~'
o Overhead Service
o Tamp Service
Q Underground ServIce
Inspeetion
DBte
Areal Building or Equipment Inspected
A~ SC
n
~ 1~A!o5'
I
Grr~'
1oJI.
"
rJ
I
~
~
SERVICE
Dille
ApprD"cd a)'
FEEDER
DIle
Approvcd 9y
Swape Inform<U/.on
Vollage
Pha5.010s
ServIce Sl~e; _
Fee~er Size:
Action Taken
I':> ~..J
~lcctr;ca!
Inspector
0&/24/2005 06:28
3&0&8308&9
KIRSCH ELECTRIC INC
PAGE 01
_ ~f)/
Q7\
S ~ ELECTRICAL WORK PERMIT APPLICATION
Request Inspection
a Owner \l,..~/
Q Carnival Q Commerdal Q Residential 0 Resldenttal MalnL Q Slgo, 0 TbermoSUI 0 Telecom.
o Electrical Contractor
o Anoual Permit Q Alarm
Job wired by
o Electrical Contractor I:l Owner
tnslolh'llion de!cription
Electriee.\ contractor fl.ame
Q \,,..~ \ ,-\'1
Purchaser's mailing address
\ l '33 <::'0.'1">-\.. rOl\
License number
r.\e..C+,....l~.
FZ ,.1.
Sla" ZIP
I JJ.A
FAX numbtr
~.:;}(7l'1
.r:; p(:{
. ...
Cily .
Se~",,,,^
Telephone: nurn er
0-
Premise. owaer'IIDame
QlI ....II-T'\./
Address or InspeellGI'I J
~,.r,
I
.;15/8
:550
(.3071/
tSQ rT, 5r~)
Clt,.
/ -33/.2....
! I hereby c:enify thal I am the owner of the above named property or a licensed
elecaical contractor (or the finn's authorized agent) and 1m making the electrical
in.<tallation or ahmtion in compliance with the c:lc:ctricallaw, Chapter 19.2& R.CW.
o Cash 0 Cheek #
o Credit Card Visa
Mastercard
Discover
Card#, . _ _
----....,....-----------
Expirarion Date
of card
o
VI
gl"
^9Jlf(lvocl 51
SER~ -,
7--:x1-c6 IC~
PI" AP!'l'Gyea By
I
V
--..,
()'
WALLS
Insulation Only
CEILING
Insulation emly
THERMOSTAT
~D'lt ^ppna....8y
. .. Cover Arfl
D ^prnlYIC'll By
DalO AppI'DYOlI By
b /.:~.~ - Cove, .kO
~ 'APlIlov.d8y
DrrqH) ,
747-0S O~
Dale Approved By
FI!U.JEK
Dlle ^pprovecl fly
:Ifletrlcal Load Additions and or subtTD.ctlonA
J NO LOAD CHANGES
J ea.aboam KW
J Fumaoa KW
J Heat Pump _ Ton _ LAR
J Fan-Wall KW
v esz,
o Overhead Service
CJ Temp Service
o Underground Service
Servlc@ InformatlQjJ
Inspeet!on Area, 8uilding or Equipmentlnopccted Electrical
D~tc Ac tion Taken Inspeel~r
~/q ole- ~ CK-'fJ7/2, (~)
(() II P /"S' c ",.., /7?' ;4c(}
/ /
.
/.
Vollaga
PhasoO,03
Service Size; _
Feecter Size:
,
.
.
J)Uf?
tf; '?-~fi~
P.01/01
TRANSACTION REPORT
2005/JUN/23/THU 21:52
.
RECEIVER
96830869
TYPE/NOTE
OK
FILE
ECM 4791
I
i
!
ELECTRICAL INSPECTION
WIRING REPORT
417-4735
INSPECTOR
-
A=:O
e ~-t./J,.Sf-.A &v:
: i
, I
I
!
j
i
I
\
APPROVED NOT APPROVED
o ................... DITCH ................... 0
o .............. ROUGH IN ICOVER . . . . . . . . . . . . .. 0
0................... SERVICE .................. 0
o .................... FINAL. . . . . . .. . . . . . . . . . . .. 0
CORRECTIONS NEEDED: 6) /eR-#1/.r ~--&'.J ,.....~./)
D-F~P;- A/P~.L-, ~Jt:hl-2 <; ~
@ 'BU// /),;.-cI,..; DII2; ~ /A) ~~
,/.J~~' ~ tA.J,,,,,,-'::),p..J-S /p..:;j~ .I3~b~.
~~^ ~.
~ r,p,_MAr-.e AP"~{"If/~ f-Y/)~,O~
;;:2w.,)A,/ . ~ r~A11" E .
f!)rUrZIY~ (,.(..I,I~- UL .5'iuO .sp~
JivD ~ ~E ~ .~~ ~ ~
,%fJZ~yc ~Z-' '
~ ' , ~7- ~7.~S:- (Q---~~.?X?,.r 7)
, /'
NOTIFY INSPECTOR WHEN CORRECTIONS
l..j:::'-- "'-1 ='
~-
t~r~J
1832-83
CONNECTION FEE PAYMENT
Customer: SUZA'/JIJ(:; M~BCS
Contractor: JD-e. /b KI'rs~
Project Address: 12-4- J \E- LIrJ(Z.-/ DS>e.-.... tWb
Connection fee due: $ 7/3:> & Date Paid: BIG"" /oc:::--
/ (
~s 7~q5)d-
CASHIER:
1. Please post check to:
Capital Contributions f Construction Contributions
LT 401-7180-343.30-24
In "additional comments":
WFOO ~ ~I ~ '"
y ~?-v-(It J~\J'7cL
2. Send a receipt-of payment upstairs to:
John G. Hebner
Public Works & Utilities Dept
417-4706
~~~
C--e-D< ~ ~ J)
g/s~
><"".
'-,
CITY OF PORT ANa~LES
+ft CUSTO~~R P.~CEIPT *ft
DOEr; '3~D5IN3! TVDe: CT Draw~~: 1
I,a:E~ 5/eS/rti5 15 Receipt no: 7431;2
DescriotiGn Quantity
: T 401-ELECTRIC LITILiTY FUND
l.~
H[QUlit
Tran~ nULib~l":
17:2.00
345014
MYERS~ SUZRNNE
SUZANNE MY~P.S
SA[ITAL CONT ~ CONSTRUCTIOh
TenDer detail
CC CREDIT cmw
Total tendered
Total oaYlent
$713.00
PB.00
i7E.00
Tre!:S datE: BieS/05
Tiu?~ 12:31:55
~*f THANK YOU FOR YOUR PP.YV~NT iff
FOR INQUIRIES 350-457-Q1411 PRESS ZERO
ww~j. CITYOFPA. US