HomeMy WebLinkAbout104 E Lauridsen Blvd - Building
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J-FEE AETPT NUMBEA
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CITY OF PORT ANGELES
DEPARTMENT OF LIGHT
APPLICATION AND ELECTRICAL PERMIT
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PERMIT NUMBER
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TOTAL FEE ?--0 17'(f'
,I CONT. Lie. NO. T1METOCOMPLETE NO. STORIES LEGAL OCCUPANCY
. f. ,ELECTRICAL PERMIT ONLY NO OCCUPANCY OR USE ESTABLISHED UNO,ER THIS PERMIT , '_ _ ,
Site Address JA.J A-'LT:S R.o v~ 4tCD ($-(UJJUPJ 10 L( €. t.-/tt){1-d) s M
.1-. COAAECT ADD~ESS IS AESPONSIBILlTY OF APPLICANT PEAMITS WITH WAONa;:J& A~E CANCELLED
Owner Installation By W S I ~
Owner's Abdress Installers Address "2-'2-1., .p~
Day Phonr' . ? - 7/ 'iS1 Installers Phone 4s"Z-..--r2--:Z-"'iJ
Appllcati9n is hereby made for Permit to install Electrical Equipmenf as follows: I f<J 1./A- L-L <: L/
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Wiring Method (' f2) JJ> 'Ii l ...--
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NUMBER AMP 120V 240V NUMBER AMP 120V 240V
USE QF CIRCUIT PEA 100R FEE USE OF CIRCUIT PEA l00R FEE
CIRCUITS CIA 10 30 CIRCUITS CIA 10 30
, 1'2h 414
LIGHT i SIGN J 4; K
LIGHT I 50 VOLTS
I OR LESS
CONVE,HENCE MOTOR
,
CONVE~IENCE MOTOR
APPllA~CE MOTOR
DISHW~SHEA .. FIRE ALARMS .
,
DISPOSAL BURGLAR ALARM
,
, M'SC.
RANGE
I
OVEN I
, ~
WATERIHEATER
LAUND~Y
DRYER ,~.. REINSTALLATION LIGHT FIXTURE #
FURN~t~ SUB TOTAL FEE
GAS-( IL
FURNACE ENERGY FEE
~r-'C BASIC FEE
ELECTriC HEAT TOTAL FEE ""/_J ,,-"
f--,
ELECT!~IC HEAT SIZE OF SERVICE SWITCH OR CIRCUIT BREAKER
A.C. U+'T AMP PHASE
FEEDE~ ' .' SIZE OF SERVICE ENTRANCE CONDUCTORS
SEAVI<tE I AW.G.
, I SUB: TOTAL
I SIZE OF GROUND SIZE OF ENTRANCE SWITCH
.
I certif~ that the work to be performed u~1r thispermit.will be done by the installer and In
Date A~PIiCatlOn made . q 2...A. . ,19 ~(. B;
I " CONTRACTOR OR OWNER (OR AUT lZED AGENT)
Permission Is hereby given to do the above described work, according to the conditions hereon and according to the approved plans and
specifi~ations pertaining thereto, subject to compliance with the Ordinanc~s .9f tre City 01 Port Angeles.
I. DIREC~OR OF, ITY LIGHT
I By '-71J4d
Date Prm1f Issued PLANS APPAOVED " . - ,dp
6ft-:rr/tfj::, Notify Department of City Light by Stre.et A9dr~s~ and Permit Numb~r when re~dy'for.inspec~ion. Work mustn!?t
I. I ~. be covered or current turned on before inspection and OX. for,covenng or service. has been gIven by Inspector In
I W.!.,RNING Writing on Permit Placard. A,. Permits Phone: 457.04" Ex!. 158. '. :
. ... PERMIT PLACARD MUST BE KEPT POSTED ON THE WORK - SEE OVER _
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the N.E.C. Electrical Code.
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OLYMP1~ PRINTERS, INC.
WHITE. Original CANARY. Duplicate PINK. Triplicate WHITE CARD. Inspector's Report
REPORT OF INSPECTOR
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DATE OF VISIT
MADE BY
REMARKS
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CITY OF PORT ANGELES
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DEPARTMENT OF LIGHT A 41.
FEE RECEIPT NUMBER PERMIT NUMBER
". APPLICATION AND ELECTRICAL PERMIT
I - . 1Il</<,,~c4rrd V C'oMM
S-~, ,,<"> I
IOTAL FEE
CONT. Lie. NO. TIME TO COMPLETE NO. STORIES LEGAL OCCUPANCY
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ELECTRICAL PERMIT ONLY NO OCCUPANCY OR USE ESTABLISHED UNDER THIS PERMIT
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Site Adrress
Owner WA /
Owner's Address
Day ph6ne -' -
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CORRECT ADDRESS IS RESPONSIBILITY OF APPLICANT PERMITS WITH WRONG ADDRESSES ARE CANCELLED
T:s G (J n c P iO r Installation By Jill\. ,. IF'''.v A .J
Installers Address -:2 3 &- 1-lJ R-'7 '""
Installers Phone 't~'l7 -5" Ie, 8' q.
/L/e. V(.../ c;,.~ v ~ ~ l4?
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Wiring.Mi?thod
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us~ OF CIRCUIT NUMBER AMP 120V 240V NUMBER AMP 120V 240V
PER 100R FEE USE OF CIRCUIT PER 100R FEE
I CIRCUITS CIR 10 30 CIRCUITS CIR 10 30
lIGH~ SIGN
L1GH~ 50 VOLTS ..
OR LESS
CONVENIENCE . . MOTOR ,
I
CONVENIENCE MOTOR
,
APPLI~NCE MOTOR
OISHV~ASHER FIRE ALARMS -
,
DISpobAL BURGLAR ALARM
,
RANG$ MISC.
OVEN:
WATE~ HEATER
LAUNdRY'
,
DRYER! REINSTALLATION LIGHT FIXTURE #
FURNACE SUB TOTAL FEE
GAS - OIL
FURNACE ENERGY FEE
ELECTl:'UC - -
ELECTRIC HEAT BASIC FEE
, TOTAL FEE j2,oo
ELECTF:lIC HEAT SIZE OF SERVICE SWITCH OR CIRCUIT BREAKER
A.C. UNIT -Y-P? 4"1P~ AMP / PHASE
,
FEE DEI! SIZE OF SERVICE ENTRANCE CONDUCTORS
SERVICE -YM S-;.. ,,~ .::2..50 />1~: "1 ;oA.~" //C' / AW.G.
! I SUB. TOT A"C S-;., 00 SIZE OF GROUND SIZE OF ENTRANCE SWITCH
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I certify that the work to be performed under this permit will be done by the installer and in conformance with the N.E.C. Electrical Code.
Date APJlication made IjJ;h'~.), /~ .19 ?,;- By y:) /;?1~ .
- CONTAACTOR R OWNER (OR AUTHORIZED AGENT)
Perd,lssion is hereby given to qo th.e above described work, according to the conditions hereon and-according to the approved plans and
specific1tions pertaining thereto, subject to compliance with the Ordinances of the City,of Port Angeles. _ .', t' '~
I' ..' _ ~- r~ By /YJ~T;t?eLI~HT..
Date Pe,,;ni! Issued "'3 I . . PLANS AP:'!./ ~ . ...~.
I Notify Department of City light by Street Address and Permit Number when ready for inspection. Work must not
be covered or current turned on before inspection and O.K. for covering or service has been given by Inspector in
. j Writing on Permit Placard. A_ - Permits Phone: 457-0411 Ext. 158.
WARNING
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PERMIT PLACARD MUST BE KEPT POSTED ON THE WORK - SEE OVER _
.
WHITE - Original CANARY - Duplicate PINK - Triplicate WHITE CARD -Inspector's Report
OLYMPIC pAINTERS, INC.
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REPORT OF INSPECTOR
DATEOFVIS\T MADE BY REMARKS
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- O.K. FOR COVERING
'J- I~- i'J " 1/.-f/. O..!<. TO C9N~ECT SERVICE .
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J FINAL O:K. .
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TURN ON
LIGHT 0
WATER 0
LIGHT 0
WATER 0
Date
SHUT OFF
NAME
ADDRESS
ACCT. NUMBER
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DEPOSIT
Mailing Address AMOUNT
The undersigned hereby makes application to the City of Port Angeles for Utility Service subject to the terms and conditions
of applicable City Ordinances which are hereby agreed to and are made a part of this application.
NEW APPLICANTS:
EMPLOYER
ADDRESS
PHONE NO.
OWN
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RENT
PROPERTY OWNERS NAME
PREVIOUS RESIDENCE
ADDRESS CITY STATE
APPLICANT ACKNOWLEDGES RECEIPT OF A COPY OF "CITY OF PORT ANGELES. GENERAL
INFORMATION RESIDENTIAL UTILITY SERVICE".
SIGNATURE
Date
OL.YMPIC PRINTI<RS, INC.