HomeMy WebLinkAbout104 W 11th St - Building CITY OF PORT ANGELES
DEPARTMENT OF COMMUNITY ECONOMIC DEVELOPMENT BUILDING DIVISION
321 EAST 5TH STREET, PORT ANGELES, WA 98362
Application Number 12- 00000199 Date 2/23/12
Application pin number 873359
Property Address 104 W 11TH ST
ASSESSOR PARCEL NUMBER: 06- 30- 00 -0 -3- 4400 -0000- REPORT SALES TAX
Application type description RES REPAIR on your State excise tax form
Subdivision Name
Property Use to the City of Port Angeles
Property Zoning RS7 RESDNTL SINGLE FAMILY
(Location Code 0502)
Application valuation 1000
Application desc
REPIAR FIRE DAMAGE TO ROOF TRUSS
Owner Contractor
REBECCA JACKSON- OWNER
1004 GRANT AVE.
PORT ANGELES WA 98362
Permit BUILDING PERMIT RESIDENTIAL
Additional desc REPAIR FIRE DAMAGE AS NEEDED T
Permit Fee 65.25 Plan Check Fee .00
Issue Date 2/23/12 Valuation 1000
Expiration Date 8/21/12
final 1-7
Qty Unit Charge Per Extension
BASE FEE 50.00
5.00 3.0500 HND BL- 501 -2K (3.05 PER C) 15.25
Other Fees STATE SURCHARGE 4.50
Fee summary Charged Paid Credited Due
Permit Fee Total 65.25 65.25 .00 .00
Plan Check Total .00 .00 .00 .00
Other Fee Total 4.50 4.50 .00 .00
Grand Total 69.75 69.75 .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 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 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 vi�� or cancel the provisions of any state or local law regulating construction or the performance of
construction.
Date Print Name ature of Contractor or Authorized Agent Signature of Owner (if owner is builder)
T:Forms /Building Division /Building Permit
BUILDING PERMIT INSPECTION RECORD C�
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 IN CONSPICUOUS LOCATION. KEEP PERMIT AND APPROVED PLANS AT JOB SITE.
Inspection Type Date Accepted By Comments
FOUNDATION:
Footings rv/
Stemwall ri
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 by
AIR SEAL:
Walls IAMS1t
Ceiling
FRAMING:
Joists Girders Under Floor
Shear Wall Hold Downs
Walls Roof Ceiling
Drywall (Interior Braced Panel Only)
T -Bar
INSULATION:
Slab
Wall Floor Ceiling (,I
MECHANICAL:
Heat Pump Furnace FAU Ducts
Rough -In
Gas Line
Wood Stove Pellet Chimney
Commercial Hood Ducts FINAL Date Accepted by
MANUFACTURED HOMES:
Footing Slab
Blocking Hold Downs
Skirting
PLANNING DEPT. Separate Permit #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 Engineering 417 -4831 r--
Fire 417 -4653
Planning 417 -4750
Building 417 -4815 1 a a- •SLR
T:Forms /Building Division /Building Permit
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BUILDING PLUMBING MECHANICAL PERMIT APPLICATION LONG FORM
(To be used for projects that require plan review.)
Date Received rig-' 12-
Permit#
City of Port Angeles Please print in ink. Date Approved,
Attn: Building Permit Technician Approved by
321 E. 5` St., Port Angeles, WA 98362
360- 417 -4815 fax:'360- 417 -4711 Credit card payments are accepted Mon -Fri 8 -5 pm (no American Express)
Hours: Mon through Fri 8 5 pm Cash checks are accepted Mon -Thurs 8:30 -4 pm Fri 8:30 -12:30 pm
Contact person: F Phone: #1,a 3
Property owner: tfri
3469 Ifione: ga* D� 7
Property owner's mailing address:
lOct 14/0S7 11 /9i1,
Contractor's business name: Phone:
(or property owners name if he /she is doing /overseeing the work)
Contractor's mailing address: 4,a-14
4 sr li'e7 .�ri y acs t c.JA
Contractor's L &I license number: OL PMPRI g 9.� 8� Expiration date:
FLs8 .20 2-
Project Address:
Olt wesr 11* E c 114c
Project Type: Residential D Commercial c Industrial Li Multi- family
Project Business Name: Zoning:
(for commercial, industrial, or multi family projects)
Parcel Lot
Complete only the portions of this permit that are relevant to your project.
Pay the plan check fee (based on the valuation of the project) at the time of submittal
Residential Projects submit:
Two sets of plans* (including engineering calcs, geotech reports, etc. if applicable)
Prescriptive Approach Simple Form (confirming conformance to the Energy Code)
Commercial Projects submit:
Three sets of plans* (including engineering calcs, geotech reports, etc. if applicable)
Paperwork confirming conformance to the Energy Code
For large projects, a pre- construction meeting with various City department
personnel is highly recommended. To schedule a pre- construction meeting, contact,
the Planning Manager at (360) 417 -4750.
Additional information may need to be submitted including:
landscape plan, parking plan (including ADA spaces, ramps, etc.), utilities
(existing proposed), curbs, sidewalks, storm water plan, etc.
For Additions New Structures also submit:
Site plan (8 1/2" x 11 showing all structures (existing proposed), setbacks, new driveways
If an architect or engineer drew the plans or calculations, include at least one "wet- stamped" set of plans
and /or calculations.
T:Forms /Building Division /Building /Plumbing /Mechanical Permit Application Long Form (Revised 2011)
Pagelof4
Repaii Solar Panels Miscellaneous: (explain the project) A*oi%" Ale 1
S7 (.J c r74 G 04'mlt IV in 44/ LW/ a.r1.4/ 772 dsrSe% She e<eecx �Qltr�
ehoDel
Project Valuation
Remodel: (explain the project, including how the building space is currently being used and what the new,
remodeled use will be)
"Aer t name a'r off' iners?i v 1,4141/
Project Valuation
If the space will change from commercial to residential, submit:
"Checklist Converting Commercial Space into Residential Space"
Addition: (explain the project and complete submit page 3)
Maximum height of the new addition feet Project Valuation
New Structure: (explain the project and complete submit page 3,
Maximum height of the new structure feet Project Valuation
PLUMBING PERMIT: Will there be ANY plumbing changes (items moved, added, replaced, or altered)
Check one:
No Yes If yes, complete submit page 4 "Plumbing Changes"
MECHANICAL PERMIT: Will there be ANY mechanical changes (items moved, added, replaced, or altered)
Check one:
No Yes If yes, complete submit page 4 "Mechanical Changes"
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
*Homeowner: If you will be doing overseeing the work, then the project valuation will be determined by doubling the
cost of materials, to reflect the value the repair adds to your property.
Cost of materials x 2 Project Valuation
I have read and completed this application and know it to be true and correct. I am authorized to apply for this permit
and understand that it is my responsibility to d er ine what permits are required, and to obtain permits prior to
working on projects.
Date /./7./2, Signature
Print Name Z
Page
Floor Areas Existing square New square Price per new
footage footage square foot
Basement X
1St Floor
2 Floor
3rd Floor
Garage
Carport
Covered Porch
Deck
30" high)*
.Deck
30" high)*
Shed
Other
Other
Remodel project valuation
TOTAL VALUATION
3 -6)
Walking surface of the deck above ground
For residential building projects the minimum square foot valuation we accept is:
Dwelling $85.00 per sq. ft. garage /utility /misc.structure $30.00 per sq. ft. porch /deck/carport $12.00 per sq. ft.
LOT COVERAGE SITE COVERAGE
Lot coverage is the amount or percent of ground area on which buildings are located.
It includes: houses, garages, carports, covered patios, cantilevered portions of buildings, roof overhangs that are longer
than 30- inches, uncovered decks or porches having walking surfaces higher than 30- inches off the ground, etc.
Total footprint of structures sq. ft. lot size sq.ft. Lot coverage
Site Coverage is the amount of impervious surface on a parcel, including structures, paved driveways, sidewalks,
patios, and other impervious surfaces. (see Port Angeles Municipal Code 17.94.135 for exemptions)
Does the project include a new driveway? o yes o no
If yes, what will the driveway be made of? o cement o asphalt o gravel o other
(NOTE: 18 feet is the recommended minimum driveway length for residential projects)
Does this project include a new parking pad? o yes in no
If yes, what will the parking pad be made of? o cement o asphalt o gravel o other
a) Total footprint of structures sq. ft. (existing new)
b) Total concrete, asphalt, other impervious surfaces sq. ft. (existing new)
c) Add lines "a" "b" above to get the total impervious sq. ft. (existing new)
Total impervious sq. ft. lot size sq. ft. Site coverage
Page3of4
PLUMBING CHANGES
Check "No" or "Yes" (and enter quantities) for each line item.
Type Plumbing Changes (Moved, Added, Replaced,
or Altered)
Sink (hand, mop, floor etc.) No Yes Quantity
Toilet No Yes Quantity
Bathtub No Yes Quantity
Shower No Yes Quantity
Washing Machine No Yes Quantity
Hot Water Heater No Yes Quantity
Water Line (meter to structure) No Yes Quantity
Re -plumb the structure No Yes Quantity
Sewer Line No Yes Quantity
Backflow Prevention Device Types:
Beverage Machine No Yes Quantity
Landscape Watering System No Yes Quantity
Fire Sprinkler System s 2 inch line No Yes Quantity
Fire Sprinkler System 2 inch line No Yes Quantity
Please list all other planned plumbing changes or additions that aren't listed above.
MECHANICAL CHANGES
Check "No" or "Yes" (and enter quantities) for each line item.
Type Mechanical Changes (Moved, Added, Replaced,
Furnace, heat pump, or or Altered)
forced air unit 5 tons No Yes Quantity
Furnace, heat pump, or
forced air unit 5 tons No Yes Quantity
Ductless heat pump No Yes Quantity
Wall (recessed) heater No Yes Quantity
Baseboard heater No Yes Quantity
Steffes room heater No Yes Quantity
Wood- burning stove No Yes Quantity
Pellet stove No Yes Quantity
Radiant floor heat No Yes Quantity
Gas fireplace or freestanding stove No Yes Quantity
Gas cooking stove No Yes Quantity
Propane tank set No Yes Quantity
Gas line No Yes Quantity
Boiler No Yes .Quantity
Clothes Dryer No Yes Quantity
Ventilation fan (single duct) No Yes Quantity
Hood duct mechanical exhaust No Yes Quantity
Ventilation system (not part of a heating or air
conditioning system) No Yes Quantity
Air handler No Yes Quantity
Evaporative cooler (non portable) No Yes Quantity
Please list all other planned mechanical changes or additions that aren't listed above.
Page4of4
ELECTRICAL PERMIT Ni
CITY OF PORT ANGELES
360 417 -4735 N
Application Number 12- 00000276 Date 3/12/12
Application pin number 895684 kJ-
Property Address 104 W 11TH ST REPORT SALES TAX
ASSESSOR PARCEL NUMBER: 06- 30- 00 -0 -3- 4400 -0000- on our excise tax form
Application type description ELECTRICAL ONLY Y
Subdivision Name to the City of Port Angeles
Property Use (Location Code 0502)
Property Zoning. RS7 RESDNTL SINGLE FAMILY
Application valuation 0
Application desc
House remodel 20 circuits
Owner Contractor
REBECCA JACKSON TWEETER ELECTRIC INC.
1004 GRANT AVE. 423 BLACK HAWK LOOP
PORT ANGELES WA 98362 PORT ANGELES WA 98362
(360) 417 -1151 `,l4 t.Z 1,)5
Permit ELECTRICAL ALTER RESIDENTIAL
Additional desc
Permit Fee 158.00 Plan Check Fee .00
Issue Date 3/12/12 Valuation 0
Expiration Date 9/08/12
Qty Unit Charge Per Extension
19.00 5.0000 ECH EL -ECH ADDNT BRANCH CIRCUIT 95.00
1.00 63.0000 ECH EL -R- BRANCH CIR WO/ SER FEED 63.00
F._,
Fee summary Charged Paid Credited Due
Permit Fee Total 158.00 158.00 .00 .00
Plan Check Total .00 .00 .00 .00 77.-4u-
Grand Total 158.00 158.00 .00 .00
V
INSPECTION TYPE DATE: RESULTS: INSPECTOR:
DITCH
SERVICE
ROUGH -IN 3 /i2-)
f Z i'
I
FINAL 174 lt- 4 4 7 l
COMMENTS:
PERMIT WILL EXPIRE SIX (6) MONTHS FROM LAST INSPECTION
Signature of owner or Electrical Contractor X Date:
G: \EXCHANGE \BUILDING
PORT 44,0,,
ELECTRICAL INSPECTION
i N G REPORT
.c,
t ■111.11V
417-4735
ht,F,
DATE: I PERMIT INSPECTOR
t7-- 7-- Z76, 2114
OWNER
CONTRACTOR
fa— 2r-1-,C__rre-(C__
APPROVED NOT APPROVED
O DITCH
O ROUGH IN/COVER 0
O SERVICE
O FINAL
CORRECTIONS NEEDED: 7sf75 0-39,
rz:E.A.*TrPtcLrm. rz-r-d%.
KAI' *du o a- 81g:c.. 1 10CP `S
NOTIFY 0 SPECTOR W0-0EN CORRECTIONS
ARE CO','PLETED WIT0-11', 15
Di NOT rEMOVE
p,;;;; o,, ELECTRICAL INSPECTION
ihmis WIRIo:. C l' „EPOIRT
�`'o .8 417 -4735
DATE: PERMIT INSPECTO
OWNER
Par--KS
CONTRACTOR
ADDRESS
/a) kD 2J r
APPROVED OT APPROVED
DITCH
ROUGH IN /COVER
SERVICE
FINAL
CORRECTIONS NEEDED: J I” CS o A. a F t
5 S/51 M Stt r c Fd AP
rrz_e_ 5 11)-x1 N 0 s 116
NOTIFY INSPECTOR WHEN CORRECTIONS
ARE COMPLETED WITHIN 15 DAYS
DO NOT REMOVE
ELECTRICAL INSPECTION
WIRING REPORT
417 -4735
DATE
,Z 6 1 PERMIT 1 riLY INSPECTOR
OWNER /CONTRACTOR
A /*soC A~rIts 1 2824
ADDRESS
L)
APPROVED OT APPROV
DITCH
ROUGH IN /COVER 4
SERVICE
FINAL
CORRECTIONS NEEDED: I n S YE 1r"1Q ALL ROO 1
■l51 DaIrt-cT•ES
ALL -L3E- -TYZ) G34 L S HAW 13o- I F-1 bT Z4.E1D
NOTIFY INSPECTOR WHEN CORRECTIONS
ARE COMPLETED WITHIN 15 DAYS
DO NOT REMOVE
OLYMPIC PRINTERS, INC. (360) 452 -1381
L-t i t 1J L� l j` s 44,,
CITY OF PORT ANGELES PERMIT APPLICATION A
Building Division /Electrical Inspections MAR 12 MI
321 East Fifth Street P.O. Box 1150 Port Angeles Washington, 98362
Ph: (360) 417 -4735 Fax: (360) 417 -4711 ELECTRICAL
INSPECTIONS
Date: 3/ /Z Z 1 2 Single Family Dwelling
Plan Review May Be Required, Please Complete Electrical Plan Review Information Sheet
Job Address: v 4 Vv TA/ PA,
Building Square Footage: 9 e fo. FT
Description of above
Owner Information Contractor Information
Name: L Name: 7'w_7 n7-2. C
Mailing Address: /c7'4 `I" Mailing Address:
City: 1 State: 1.c ip: Z— City: State: Zip:
Phone: Fax: Phone: Fax:
License 1 Exp. License Exp. 447grr< i -.b1
Item Unit Charge Qty Total (Qty Multiplied by Unit Charge)
Service /Feeder 200 Amp. 120.00
Service /Feeder 201 -400 Amp. 146.00
Service /Feeder 401 -600 Amp 205.00
Service /Feeder 601 -1000 Amp. 262.00
Service /Feeder over 1000 Amp. 373.00
Branch Circuit W/ Service Feeder 5.00
Branch Circuit W/O Service Feeder 63.00 i
Each Additional Branch Circuit 5.00 c'i
Branch Circuits 1 -4 75,00
Temp. Service/ Feeder 200 Amp. 93.00
Temp. Service /Feeder 201 -400 Amp. 110.00
Temp. Service /Feeder 401 -600 Amp. 149.00
Temp. Service /Feeder 601 -1000 Amp 168.00
Portal to Portal Hourly 96.00
Signal Circuit/ Limited Energy -1 2 Family Dwelling 64.00
Manufactured Home Connection 120.00
Renewable Electrical Energy 5KVA System or Less 102,00
Thermostat 56.00
Note: $5.00 for each additional T -Stat
NEW CONSTRUCTION ONLY:
First 1300 Square Ft. 120.00
Each Additional 500 Square Ft. or Portion of 40.00
Each Outbuilding or Detached Garage 74.00
Each Swimming Pool or Hot Tub 110.00
/-5 'Total
Owner as defined by RCW.19.28.261: (1) Owner will occupy the structure for two years after this electrical permit is finalized. (2) Owner is required
to hire an electrical contractor if above said property is for sale, rent or lease. Permit expires after six months of last inspection.
After reading the above statement, I hereby certify that I am the owner of the above named property or a licensed electrical contractor. I am making
the electrical installation or alteration in compliance with the electrical laws, N.E.C., RCW. Chapter 19.28, WAC. Chapter 296 -46B, The City of Port
Angeles Municipal Code, and Utility Specifications and PAMC 14.05.050 regarding Electrical Permit Applications.
Signature of owner, electrical contractor or electrical administrator: Cash g Check
i
7 1:1 Credit Card
X l Dated: Z- 01/0112012
eF
ELECTRICAL PERMIT
CITY OF PORT ANGELES
360 -417 -4735
Application Number 11- 00001431 Date 12/22/11
Application pin number 838429
Property Address 104 W 11TH ST REPORT SALES TAX
ASSESSOR PARCEL NUMBER: 06- 30- 00 -0 -3- 4400 -0000- on your excise tax form
Application type description ELECTRICAL ONLY
Subdivision Name to the City of Port Angeles
Property Use (Location Code 0502)
Property Zoning RS7 RESDNTL SINGLE FAMILY
Application valuation 0
Application desc
Temp power
Owner Contractor
REBECCA JACKSON TWEETER ELECTRIC INC.
1004 GRANT AVE. 423 BLACK HAWK LOOP
PORT ANGELES WA 98362 PORT ANGELES WA 98362
(360) 417 -1151
Permit ELECTRICAL TEMPORARY SERVICE
Additional desc
Permit Fee 92.70 Plan Check Fee .00
Issue •Date 12/22/11 Valuation 0
Expiration Date 6/19/12
Qty Unit Charge Per Extension
1.00 92.7000 ECH EL -TEMP SRV 0 -200 SRV FDR 92.70
Fee .summary Charged Paid Credited Due
Permit Fee Total 92.70 92.70 .00 .00
Plan Check Total .00 .00 .00 .00 V
Grand Total 92.70 92.70 .00 .00
INSPECTION TYPE DATE: RESULTS: INSPECTOR:
DITCH
SERVICE 12.,4 t ciSP 101
ROUGH -IN
FINAL r41 z 1 4P
COMMENTS:
PERMIT WILL EXPIRE SIX (6) MONTHS FROM LAST INSPECTION
Signature of owner or Electrical Contractor X Date:
G: \EXCHANGE \BUILDING
0 {yCAr
CITY OF PORT ANGELES PERMIT APPLICATION f �t Ec.
V
Building Division/Electrical Inspections GC
321 East Fifth Street P.O. Box 1150 Port Angeles Washington, 98362 �mr �Q�
Ph: (360) 417 -4735 Fax: (360) 417 -4711
Date: Z-/-/ ELECTRICAL
1 2 Single amity Dwelling Multi Family or Commercial* Commercial AdditigivOltelation Remodel Repair*
Plan Review May Be Required, Please Complete Electrical Plan Review information Sheet
Job Address: 10 ei w
Building Square Footage: moo
Description of above
Owner Information Contractor Information
Name: j/C d ,1c x Name: T-to F /F Diu
Y i ..-,,7' Mailing Address: 3 f3 /2/eiefirkw C. uo
Mailing Address: i O y a State: f Cit p, State: Zip:
City Pfr F ax: 4,,, Zip: Phone: </i7/1 `i Fax:
Phone: Fax: ,License /Exp.
License It/ Exp.
Unit Charge Qty Total (Qty Multiplied by Unit Charge)
Item
Service /Feeder 200 Amp. $119.90
Service /Feeder 201 =400 Amp. 145.50
Service /Feeder 401 -600 Amp 204.60
Service /Feeder 601 -1000 Amp. $262.20
Service /Feeder over 1000 Amp. $372.50
Branch Circuit W/ Service Feeder 2.60
Branch Circuit W/O Service Feeder 73.50
Each Additional.Branch Circuit 2.60 92.70 9 7
Temp. Service/ Feeder 200 Amp. 110.30
Temp. ServicelFeeder 2011100 Amp.
148.70
Temp. Service/Feeder 401 =600 Amp. 167.90
Temp. Service /Feeder 601 =1000 Amp
Portal to Portal Hourly 95.90
Sign /Outline Lighting .88.20
Signal Circuit/ Limited Energy First 1500 sf— Commercial 95.90
Note: $5.00 for each additional 1500 sf
Signal Circuit/ Limited Energy -1 2 Family Dwelling 63.90
Signal Circuit/ Limited Energy Multi Family. Dwelling 63.90
Manufactured Home Connection 119.90
Renewable Electrical Energy 5KVA System or Less 10 2. 3 0
Thermostat
NEW CONSTRUCTION.ONLY: $110.30
First 1300 Square Ft. 30.30
Each Additional 500 Square Ft. or. Portion of
Each Outbuilding or. Detached Garage 73.50
Each Swimming Pool or Hot Tub 110.30 9?,70 Total
Owner as defined by RCW.19.28.261: (1) Owner will occupy the structure for two years after this electrical permit is-finalized. (2) Owner is required
to hire an electrical contractor if above said property is for sale, rent or ,lease. Permit expires after six months of last.inspection.
am making
After reading the above statement, I hereby certify that I am the owner of the above
RCW property or a 296-46B, City of Port
the electrical installation or alteration incompliance with the electrical laws, N E C
Angeles Municipal Code, and Utility Specifications and PAMC 14.05.050 regarding Electrical Permit Applications...
Signature of owner,. electrical contractor or electrical administrator: Cash SZI Check
Credit Gard
Dated: Z 0110112010
X
Application Number 05 00000813 Date 9/08/05
Application pin number 283900
Property Address 104 W 11TH ST
ASSESSOR PARCEL NUMBER 06 30 00 0 3 4400 0000
Application type description ELECTRICAL ONLY
Subdivision Name
Property Use
Property Zoning RS7 RESDNTL SINGLE FAMILY
Application valuation 0
Owner Contractor
BECKY
104 W 11TH ST
PORT ANGELES
Fee summary
WA 983627710
CITY OF PORT ANGELES
PUBLIC WORKS ELECTRICAL DIVISION
321 EAST 5TH STREET PORT ANGELES WA 98362
OWNER
Permit ELECTRICAL ALTER RESIDENTIAL
Additional desc COLEMAN/ 200A SVC CHANGE
Permit pin number 59071
Sub Contractor COLEMAN ELECTRIC
Permit Fee 66 90 Plan Check Fee 00
Issue Date 9/08/05 Valuation 0
Expiration Date 3/07/06
Qty Unit Charge Per Extension
1 00 66 9000 ECH EL R OR RM 0 200 ALT SRV FDR 66 90
Charged Paid Credited
Due
Permit Fee Total 66 90 66 90 00 00
Plan Check Total 00 00 00 00
Grand Total 66 90 66 90 00 00
COMMENTS /ACTION NEEDED
DITCH
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 COMMENTS
YES I NO
ROUGH-IN COVER
SERVICE
GENERAL COMMENTS:
ELECTRICAL PERMIT INSPECTION RECORD
FINAL I 9 -&51 ,l-c411
I
I I
I I
PW- 1IO2.13 (4/961
Rug 31 05 08 lla Bobby 0 Coleman
,f:',.:- h
r Request Inspection
A Electrical Contractor 0 Owner
D Annual Permit 0 Alarm 0 Carnival D Commercial Residential Residential Maint. Signs 0 Thermostat Telecom. (q)
.(Installation description A 'Z-
Job wired by electrical Contractor 0 Owner f
1 Electrical co for n e Lice je number
Purchaser's mailig addliss
le) e4
City State ZIP
6:- r 6.512
Telephone number
,-;2-- `7/ 1
FAX number
7/9
Premises owncr/l��rY�
Address of inspection l an/ -Ai QEL—
City L
I hereby certify that I am the owner of the above named property or a licensed Credit Card Visa i Mastercard Discover
electrical contractor (or the firm's authorized agent) and am making the electrical
installation or alteration in compliance with the electrical law, Chapter 19.28 RCW Card
"Signature of .,ow ele rector r electrical administrator
/'`i WALLS
Insulation Only
y am. -ti•
Dale
Da
Inspection
Date
Cover
Appro cd By Dam
Electrical Load Additions and or subtractions
NO LOAD CHANGES
Baseboard KW
Furnace KW
Heat Pump Ton LAR
D Fan -Wall KW
CEILING
Insulation Only
Approval By
Area, Building or Equipment Inspected
ELECTRICAL WORK PERMIT APPLICATION
6 0 9
Cash Check
Expiration Date
of card
THERMOSTAT
Dale Approved By Dale Approved By
Approved By Dam Approved BY DITCTI FEEDER
Cover
Dare
Overhead Service
Temp Service
Underground Service
360 452 7594
Action Taken
C Inspection fee
Approved Dy Date Appr ed By
Service Information
Voltage
Phase 010 3
Service Size:
Feeder Size:
g/.5/A3-
SERVICE
P 1
Electrical
Aspcctor