HomeMy WebLinkAbout1301 Samara Dr - Building PREPARED 10/29/10 8 21 01 INSPECTION TICKET PAGE 10
CITY OF PORT ANGELES INSPECTOR JAMES LIERLY DATE 10/29/10
ADDRESS 1301 SAMARA DR SUBDIV
TENANT NBR ELIZABETH CLARK
CONTRACTOR AFFORDABLE SERVICES PHONE (360) 683 9619
OWNER ELIZABETH A CLARK PHONE (360) 457 1439
PARCEL 06 30 01 5 8 0150 0000
APPL NUMBER 10 00001254 RE ROOF
PERMIT BNOP 00 BUILDING PERMIT NO PR FEE
REQUESTED INSP DESCRIPTION
TYP/SQ COMPLETED RESULT RESULTS/COMMENTS
BL99 01 10/29/10 JLL BLDG FINAL
/ October 28 2010 4 53 20 PM 1pangrle
(/ JANE 683 9619
BUILDING FINAL RE ROOFED THE HOUSE
� j COMMENTS AND NOTES
CITY OF PORT ANGELES
DEPARTMENT OF COMMUNITY & ECONOMIC DEVELOPMENT BUILDING DIVISION
321 EAST 5TH STREET PORT ANGELES WA 98362
Application Number 10 00001254 Date 10/28/10
Application pin number 997940
Property Address 1301 SAMARA DR REPORT SALES TAX
ASSESSOR PARCEL NUMBER 06 30 01 5 8 0150 0000
Tenant nbr name ELIZABETH CLARK on your state excise tax form
Application type description RE ROOF to the City of Port Angeles
Subdivision Name (Location Code 0502)
Property Use
Property Zoning RS9 RESDNTL SINGLE FAMILY
Application valuation 2485
Application desc
RE ROOF THE HOUSE LAY OVER ONE LAYER
Owner Contractor
ELIZABETH A CLARK AFFORDABLE SERVICES
1301 SAMARA DR 258663 HWY 101 WEST
PORT ANGELES WA 98363 SEQUIM WA 98382
(360) 457 1439 (360) 683 9619
Permit BUILDING PERMIT NO PR FEE
Additional desc ROOF OVER 14 SQ
Permit pin number 176305
Permit Fee 109 75 Plan Check Fee 00
Issue Date 10/28/10 Valuation 2485
Expiration Date 4/26/11
Qty Unit Charge Per Extension
BASE FEE 95 75
1 00 14 0000 THOU BL-2001 25K (14 PER K) 14 00
Other Fees STATE SURCHARGE 4 50
Fee summary Charged Paid Credited Due
Permit Fee Total 109 75 109 75 00 00 n
Plan Check Total 00 00 00 00 'n I f l
Other Fee Total 4 50 4 50 00 00 V,
Grand Total 114 25 114 25 00 00
16 -21—(o
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 provisio of laws and ordinances governing this type of work will
be complied with whether specified herein or not. The granting of a ermit does not pres to give authority to violate or cancel the provisions of any
state or local law regulating construction or the performance of con ructio .
Date Print Name Signa ure of C tractor or Authorized Agent Signature of Owner(if owner is builder)
T:FormsBuilding Division/Building Permit
O
BUILDING PERMIT INSPECTION RECORD
N
— 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 Type7 Date Accepted By Comments
FOUNDATION:
Footings
Stemwall
Foundation Drainage/Downspouts
Piers
Post Holes(Pole Bldgs.)
PLUMBING
Under Floor/Slab
Rough-In
Water Line(Meter to Bldg)
Gas Line
Back Flow/Water FINAL Date Accepted b
AIR SEAL.
Walls —"
Ceiling
FRAMING C
Joists/Girders/Under Floor
Shear Wall/Hold Downs
Walls/Roof/Ceiling
Drywall Interior Braced Panel Only) ` ^
T-Bar V
INSULATION
Slab
Wall/Floor/Ceiling
MECHANICAL.
Heat Pum /Furnace/FAU/Ducts
Rough-In
Gas Line
Wood Stove/Pellet/Chimney
Commercial Hood/Ducts FINAL Date Accepted b
MANUFACTURED HOMES
Footing/Slab
1131ocking&Hold Downs
Skirting
PLANNING DEPT Separate Perrnit#s SEPA.
Parking/Lighting ESA.
Landscaping SHORELINE.
FINAL INSPECTIONS REQUIRED PRIOR TO OCCUPANCY/USE
Inspection Type Date Accepted By
Electrical 417-4735
Construction R.W PW I Engineering 417-4831
Fire 417-4653
Planning 417-4750
Building 417-4815
Lr
T-Forms/Building Division/Building Permit
"rBUILDING PERMIT APPLICATION Print in ink
I►� CITY OF PORT ANGELES
n Attn: Building Permit Technician For City Use Only
�i Date Received 10 321 E. Fifth St. Port Angeles, WA 98362 4 i0
Permit# [0�-12.5
(360)417-4815 fax(360)4174711
Date Approved
Applicant ,�S Phone 3(p
Property Owner C_(r�c,, �j��(^ Phone ,37, !l{�q
Property Owner's Address
Contractor � jr�G(���,�PYUCP S Phone c/
Contractor's Address 1/U 2—
License# S01Expires WZ E-mail I k-f+t✓h to m U5[tjjAfjC
PROJECT ADDRESS ��"" ( zj�� VYlG2 �Y
Parcel Number (/LY �CJ�S �U ` Lot Zoning
Project Type&Brief Description: ❑ Residential ❑ Multi-family ❑ Commercial ❑Industrial
Check all that apply
❑ New Construction
❑Addition
❑ Remodel
❑ Repair
❑ Demolition
e-roof douse ❑garage ❑other ❑tear off& re-roof Vlay over one layer
❑ Heat System ❑ Heat pump ❑wood-burning stove ❑gas fireplace ❑ pellet stove ❑other
❑Other
FloorAreas Existing(sq.ft.) Proposed Ism ft.)
Basement @$ per sq.ft. _$
1 st Floor
2nd Floor
3rdFloor
Garage
Carport
Covered Porch
Deck
Shed
Other
TOTAL VALUATION $ 1 G 0"
Total footprint of structures sq.ft. T Lot size sq.ft. = Lot coverage %
Site Coverage=the amount of impervious surface on a parcel, including structures, paved driveways, sidewalks, patios,
and other impervious surfaces. (see PAMC 17 94 135 for exemptions) Site coverage %
Max. height of proposed structures ft. Occupancy group #of bedrooms
Will a lawn sprinkler system be installed? Occupant load #of full baths
Will a fire sprinkler system be installed? Construction type #of half baths
I 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
y responsibility to determine what
permits are requ/ir/e/d�,1,and to obtain permits prior to working on r . cts.
Date 0 Print Name ���I i �•L I/V t Signatur
T:Forms/ uilding Division/Bldg Permit.doc
AFFORDABLE ROOFING Jr,rvr
258663 Hwy 101 West
Sequim,WA
(360)683-9619 (360)385-2724 (360)452-0840
Name ;) 1 ggLQ— �� k— Phone#1
Ad - z-, — C— Phone#2
CityState W Zip Code
11�v how perimeter to protect landscaping
Remove old roofing and haul to landfill
Install Plywood OSB
.Install Roofing Felt Install Drip Edge Metal
Install Pipe Flashing Install Metal W-Valleys
Install_Exhaust Vents Install Roof to Wall Flashing
Iftstall—Ridge Vents Install Roof to Wall Step Flashing
Install Attic Vents Cut In Chimney=Counteer-Flashing
:liilstsll. Sun Tube Install Chimney Step Flashing
InstallSkylights1 Skyligbt Flashing
Install
Instal
Install43
Install Y E j
Install.
Secure-%-Locate Septic/Drain Field on
Phice ;eludes Building Permit
Customer to Secure BuildinPermit
Dt cripiion: Tu s fa !1 1.�vy r I- ,4 ,,ah 511
Pay`nent in full.upon completson of project,
unless other arrangements accepted. SUBTOTAL.
We propose-hereby to furnish material and labor, SALES TAX
complete in,accordance with the above specifications. TOTAL
Mote this proposal may be witbdraaim by us if not
AU material is guaranteed to be as specified.Any allcration or deviation from the above &ccqAcd within 30 dr^
specific atiow iavolvmg extra costa will be excuted only upon written orders and wfll
become as extra charge ova and above the estimate.All agreements contingent upon
antics,accidents,or delays beyond our control.Owner to carry fire,tornado and other
necessary insurance.
A cceptance of Proposal-the above prices,specifications and conditions Bram��"K Year ( _
are satisfactory and are hereby accepted. You are authorized to do the Color Workmanship:
wo*as specified. Payment will be trade as otd ined above. Year WaRanty
"`��PP OO / Lifeti ne Warranty
Affordable Roofing's Date: — —
Customer's Signature of Accepw=
See attached Warranty►
PREPARED 9/01/06 8 12 21 INSPECTION TICKET PAGE 14
CITY OF PORT ANGELES INSPECTOR JAMES L LIERLY DATE 9/01/06
ADDRESS 1301 SAMARA DR SUBDIV
TENANT NBR ELIZABETH CLARK
CONTRACTOR EVERWARM PHONE (360) 452 3366
OWNER CLARK ELIZABETH A PHONE
PARCEL 06 30 01 5 8 0150 0000
APPL NUMBER 06 00000726 FIREPLACE/INSERTS/FREESTANDING
PERMIT ME 00 MECHANICAL PERMIT
REQUESTED INSP DESCRIPTION
TYP/SQ COMPLETED RESULT RESULTS/COMMENTS
ME99 01 9/01/06 JLL MECHANICAL FINAL TIME 13 00
/)ELIZABETH 457 1439
/X-- 08/31/2006 12 47 PM DYASUMUR
(/(Q �� /� COMMENTS AND NOTES
��'"
°°
aCITY OF PORT ANGELES
� DEPARTMENT OF COMMUNITY DEVELOPMENT BUILDING DIVISION
321 EAST 5TH STREET PORT ANGELES,WA 98362
Application Number 06 00000726 Date 7/07/06
Application pin number 818786
Property Address 1301 SAMARA DR
ASSESSOR PARCEL NUMBER 06 30 01 5 8 0150 0000
Tenant nbr name ELIZABETH CLARK
Application type description FIREPLACE/INSERTS/FREESTANDING
Subdivision Name
Property Use
Property Zoning UNKNOWN
Application valuation 2400
Owner Contractor
CLARK ELIZABETH A EVERWARM
1301 SAMARA DR 257151 HWY101
PORT ANGELES WA 98363 PORT ANGELES WA 98362
(360) 452 3366
Permit MECHANICAL PERMIT
Additional desc
Permit pin number 82016
Permit Fee 50 00 Plan Check Fee 00
Issue Date 7/07/06 valuation 0
Expiration Date 1/03/07
Qty Unit Charge Per Extension
1 00 50 0000 ECH ME WOOD BURNING APPL 50 00
Fee summary Charged Paid Credited Due
Permit Fee Total 50 00 50 00 00 00
Plan Check Total 00 00 00 00
Grand Total 50 00 50 00 00 00
A�
(J
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. /—
11l ms7s D o^/ '
1 �/U
nature of contractor or Auth rized Agent / 'Date Signature of Owner(if owner is builder) Date
T-\Policies\1102_15 building permit inspection record05 wpd[1/4/20051
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. ITIS UNLAWFUL TO COVER,INSULATE OR CONCEAL ANY WORK BEFORE
INSPECTED AND ACCEPTED. POST PERMIT INA CONSPICUOUS LOCATION.
KEEP PERMIT CARD AND APPROVED PLANS AT JOB SITE.
INSPECTION TYPE DATE ACCEPTED COMMENTS
YES NO
FOUNDATION:
FOOTINGS
SHEAR WALLS/WALLS
FOUNDATION DRAINAGE/DOWN SPOUTS
PIERS �I
POST HOLES(POLE BLDGS.)
PLUMBING
UNDERFLOOR/SLAB
ROUGH-IN
WATER LINE(METER TO BLDG)
GAS LINE FINAL DATE ACCEPTED BY.
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
WALL/FLOOR/CEILING
MECHANICAL
HEATPUMP/FURNACE/DUCTS
GAS LINE
WOOD STOVE/PELLET/CHIMNEY FINALq O 6 DATE L ACCEPTED BY. w
COMMERCIAL HOOD/ DUCTS O
MANUFACTURED HOMES
FOOTING/SLAB
BLOCKING&HOLD DOWNS
SKIRTING VVV
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 417-4735 ELECTRICAL
LIGHT DEPT
CONSTRUCTION R.W /PW/ CONSTRUCTION R.W
ENGINEERING 417-4807 PW/ENGINEERING
FIRE 417-4653 FIRE DEPT
PLANNING DEPT 417-4750 PLANNING DEPT
BUILDING 417-41315 06 J {.` BUILDING
T•\Policies\I 102_15 building permit inspection record05.wpd[1/4/20051
4-30-03 8 12AM CITY PORT ANGELES 3604174711 >z �
3.
CA
FOROMCLALjl�E OGN jy
Rec.
BUILDING PERMIT - APPLICATION Date Rec.
Fill out COMPLETELY a Permit#-a
7102
and in INK.Your application and site plan MUST BE 7
COMPLETE to be accepted for review If you have any questions,call
Date Approved 7
(360)417-4815 Date Issued.—Y/7 0�
Applicant or Agentc"F—o c dZ t-�aL Phone•
O`7ner• 1 z Ct beLot Ir IC Phone
Address: 1 -30 1 �je�►-,,n �a�rCity ��— c� 2.CQJ1 Zi
Architect/Engineer- Phone
Contractor t1 .2
2Nl State LicenseBNZExp
17--t-1-0/g, Phone 3 (o
Address. Shu)' / 0 / City P OL Zip
PROJECT ADDRESS• 3 S 4 q �. t 0, ZONING-
LEGAL DESCRIPTION Lot: Block: Subdivision.
CLALLAM COUNTY PARCEL NUMBER. D (0 3 a o l S` ® ! S O o
Credit Card Bolder Name:
Billing Address: City.
Credit CardType VISA MC #
TYPE OF WORK. Ezp.Date:
❑ Residential 11 New Constr. 13 Stove Re-roof ❑ Ste'VALUATION
E3Multi-fainly 13Addition D Move O SF @$�•/SF a$
Garage SF @$ /SF =$
❑ Commercial ❑ Remodel ❑ Demolition O Deck SF @$ SF =$
0 Repair O Sign �-❑ Other TOTAL VALUATION $
BRIEF DESCRIPTION OF THE PROJECT Y t''- 2 S�j Li)00 p S—r-0
CL
COMMERCIAIJRESIDENTIAL. Occupancy Group.__ Occupant Load. Construction Type:
No.of Stories:_ Lot Size: Existing Sq Ft. &Proposed Sq Ft. =TOTALS Ft.
e T
Existing lot coverage %&Proposed lot Covera q'
g %= otal lot coverage %
PLANNING USE ONLY APPROVALS
PLAN '
BLDG
DPWU
F.SA/Wetland(s). ❑Yes ❑No SEPA Checklist required? O Yes ❑ No Other- FIRE
OTHER.
BUILDING PERMIT APPLICATION SUBMITTAL. The Building Division can provide you with information on the application and
plan submittal requirements if you have questions.
VALUATION OF CONSTRUCTION In all cases,a valuation amount must be entered by the applicant. This figure will be reviewed
and maybe revised by the Building Division to comply with current fee schedules. Contact the Permit Coordinator at417-4815 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
B.urld -OfdckLean-exfendthe-time-fmactiomby-the-applicant up-to 180-days-upen-written-request bythe-applrcant(see Section'107*4 of
the Uniform Building Code,current edition). No application can be extended more than once.
Y
1 hereby cer#fy that I have read and examined this application and know the same to be true and correct. I amauthorized to apply for this permit and
understand that R/S my responsibility to determine what permits are required not the City's,and that t must obtain such permits prior to work.
T-\FORMSWPPS\Buildingpermit.wpd �( Applica t: • Y. 7� �_
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Datb 11/5/93
At -•irk JohnGon
Subj storm drain runoff for Bruca 1301 Samara Dr
Bnc.losod is a p~oposal for the handling of storm drain runoff on
ir, property It is a variance from the oL ginal plot plans
submitted earlier this Fummei fnr the conLtructl'vn ui c,ir house
iii original plans called for running the excess water unto
Samara drive Tiii.s is impose ble because there is less than a 28
slope betweei the storm drains on the '.souse and the curb There
is aibv a nrobiaff, with lateral ground-i:ater sepage due to a
shallow hardpan
The new proposal solves both probienm :>g z:_Iisrting groundwater
sapage as +ell an storm drain runoff and slowly r11spa-^ina it in
a sump pit located at the bac,: of the proper y
Please let me know if this plan doesn t meet city standards and I
will try to come up with an alterna* tvo If you have any
questions please give me a call
T'nank you for your time
Bruce W Emery
1301 Samara Dr
Port Angeles WA
98.162
457-0706
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?'. a ASTATEE,1��� LL... E t
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G. � 'r ENGINEERfNO. INC.fNC �/ 1V Y fT� 9Y' ; CHID "�"e "a�,F'
® ' nN
I0.Bm cm loco",vqA"dos imm sip-oax DATE:
'�
STRUCTURAL CALCULATIONS FOR A TYPICAL'
CENTURY HOMES MODULAR HOME
w . I SCOPE
1.CALCULATIONS APPLY TO UP TO A 28� X ro&HOME CON515T1NG
OF 2 HALF UNITS (NTH OPTION5'SHOWN IN SEC.V)OF LIGHT
FRAME CONSTRUCTION.THE HALF UNITS ARE SUPPORTED ON A
CONCRETE FOUNDATION AT THE EXTERIOR PERIMETER WITH PIER
FOOTINGS AND POSTS SUPPORTING.THE INTERIOR'LOAD5 (SEE
#.btar` wY�
"BUILDIN
x, G SECTION"ON PLANS .
,�.k. •64`� ..,�;r yds ;a��y `c:3':;4;,;r IBJ �, '�f�?_ �
2. FOR CONDITIONS IN EXCESS OF THE INDICATED CRITERIA OR
t:
SCOPE,A SEPERATE STRUCTUfzAL,IN_VESTIGATION 15 REQUIRED
II. CKITEKIA w' f
1. UBC 191
2. LOADS
NAL;
�i'4 a. ROOF SNOW LOAD= 50 psf max, DEAD LOAD= 17 psf yr S
b FLOOR LIVE LOAD=40 psf,,DEAD LOAD=10 psf 3s„
c.WIND VELOCITY=80 mp h AN0.90 mph}EXPOSURES•B'&'C,' r
4 4•
100mph EXPOSURE B r. 'tt
d. 5E1 M
5 IC ZONE 3 ,
3.SEE"BUILDING SECTION"FOR-GENERAL REQUIREMENTS. 7.
4 FOUNDATION DETAILS ARE PROVIDED WITH EACH HOME PLAN
HOWEVER CONFORMANCE TO Q EMENT k` �t
LOCAL�RE UIR 5 AND SITE' ,,� rc4*'• �?°�;'�°��p�q ��
CONDITIONS MUST BE VERIFIED BY OTHERS. ` `
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N�C: OfJ -F11.�@�C�Tt3R:Y•!•�O�GtES;.?;�;,�4��:� ::.
OF PORT 4HrJ
u+ �•���mN CITY OF PORT ANGELES LIGHT DEPARTMENT
��� 321 E. Fifth Street
Port Angeles, WA 98362 //// 77
E"' (206)457-0411 PERMIT NO. // '1-11;73'
' 1l,>
DATE
ELECTRICAL PERMIT
Site Address: ❑ READY FOR WILL CALL FOR
INSPECTION INSPECTION
I
I Installed By: License Number: Phone:
6 e "N
Owner/Business: / Phone:
Owner/Business Address: Sq. Ft.
RESIDENTIAL ❑ TEMPORARY SERVICE ❑ OVERHEAD SERVICE
j COMMERCIAL ;40d/ e- ❑ PERMANENT SERVICEUNDERGROUND SERVICE
ElBASEBOARD KW ElNEW CONSTRUCTION OLTAGE:
❑ FURNACE KW ❑ REMODEL ❑ SINGLE PHASE
i ❑ FAN/WALL KW ❑ ADD/ALTER CIRCUITS ❑ THREE PHASE
❑ HEAT PUMP KW ,,q- ElSERVICE UPGRADE/REPAIR SERVICE SIZE cPOC--) AMPS
❑ SIGN 6ABo WO-t& ❑ SPECIAL EOUIPMENT
(LIST BELOW)
Details/Description:
I
W.S. No. SERVICE SIZE DATE ENGR.
CAPACITY:
❑ O.K. NOT O.K.
ACTION REQUIRED: ❑ CHANGE TRANSFORMER ❑ CHANGE SERVICE WIRE
❑ INSTALL SERVICE POLE ❑ OTHER
❑ Ditch Inspection O.K.
❑ Rough-in/cover O.K. I
❑ O.K. to connect service
❑ Final O.K.
Site Address: Permit/Receipt No. '
/73
Installer: New Meters Date:
Notify Port Angeles Ci y Light by Street Address and Permit Number when ready for inspection.Work must not be covered
before inspection and O.K.for covering has been given by the electrical inspector in writing on either the Wiring Report
or on the Buildingz
it. PHONE 457-0411, EXT. 224. //��
NO OCCUPANCY OR USE ESTABLISHED UNDER THIS PERMIT �O` oo
Electria6l Inspector Permit Fee
WHITE—File by address YELLOW—rile by number PINK—Top:Eng,Bottom,Customer GREEN—Top:Meter Dept.,Bottom:City Hall
—J'LYMPIC PRINTERS INC
J,,*PORT 4NC=m� CITY OF PORT ANGELES LIGHT DEPARTMENT
321 E. Fifth Street
Port Angeles, WA 98362
rri (206) 457-0411 PERMIT N0. �S�
ELECTRICAL PERMIT DATE
Site Address: ❑ READY FOR IJWILL CALL FOR
Q INSPECTION INSPECTION
Installed By: 'C License Number: Phone:
OwnerlBusiness: f Phone:
Owner/Business Address: Sq. Ft.
RESIDENTIAL ❑ TEMPORARY SERVICE ❑ OVERHEAD SERVICE
❑ COMMERCIAL ❑ PERMANENT SERVICE UNDEROIlN 2 ICE
C] BASEBOARD KW El NEW CONSTRUCTION VOLTAGE: Zed
❑ FURNACE KW ❑ REMODEL SINGLE PHA8E
❑ FAN/WALL KW ❑ ADD/ALTER CIRCUITS THREE PHASE
❑ HEAT PUMP KW '❑ SERVICE UPGRADE/REPAIR SERVICE SIZE r3k_90 AMPS
❑ SIGN ❑ SPECIAL EQUIPMENT
(LIST BELOW)
Details/Description:
�� ll�r9 E2C/.P�Cre7 oS'�E�//C�
/V ey
W.S. No. SERVICE SIZE DATE ENGR.
CAPACITY:
❑ O.K. NOT O.K.
ACTION REQUIRED: ❑ CHANGE TRANSFORMER ❑ CHANGE SERVICE WIRE
❑ INSTALL SERVICE POLE ❑ OTHER
❑ Ditch Inspection O.K.
❑ Rough-in/cover O.K.
❑ O.K. to connect service
❑ Final O.K.
Site Address: Permit/Receipt No
0/ 0S'
Installer: / New Meters Date:
� F
Notify Port Angeles City Light by Street 4ddress and Permi Number when ready for inspection.Work must not be covered
® before inspection and O.K.for covering has been given by the electrical inspector in writing on either the Wiring Report
or on the Building Permit. PHONE 457-0411, EXT. 224.
NO OCCUPANCY OR USE ESTABLISHED UNDERTHIS PERMIT
Eleecttrriiccalal Inspector Permit Fee
WHITE—File by address YELLOW—file by number PINK—Top:Eng,Bottom,Customer GREEN—Top:Meter Dept.,Bo'
OLYMPIC PRINTERS INC.