HomeMy WebLinkAboutBRADLEY ST., 1316
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BREMER TON PERMIT CENTER ~
286 4th Street" Bremerton~ WA 98337
Phone: ( 360) 478-5275 FAX: (360) 478-5278
BUILDING PERMIT
Job Addr: 1316 BRADLEY 5T Permit No: 02-0718
Location: Status: ISSUED
I Parcel No: 3937003-006-0000 Applied: 11/20/2002
I Issued: 11/20/2002
I Applicant: ROMINGER MARK & TERRI Expires: 05/19/2003
t 1316 BRADLEY ST BREMER TON WA 9B310
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Owner: ROMINGER MARK & TERRI
1316 BRADLEY ST BREMERTON WA 98310
I ,Cont ractor: SELF Lie #: SE~F Exp:
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1 Subcontr:
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I Dsse: REPAIR RAILING SYSTEM ON DECK, REPLACE 8 BOARDS
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Valuation * Permit Fees: 23.50 Total Calculated Fee: 28.00
100.00 )I( Plan Check Fees: .00 Additional Fees: .00
. other Fees: 4.50 Total Permit Fee: 28.00
1**..***1*..*****...*..**********.****.**.*.*....**..***********~****************..*****.****
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r. This permit. shall beCOflklt !'lUll and void if the building or wor'k authoYi:z:ed by this permit. is not. c.Ol11l'I1e~d within
I 180 day", from the date of such permit, or if this building or wo1"k a.uthorized by such permit "is suspended 01"
,
i abandoned at any time aft.er t.he work is COl"IIImrrlCed for. .a peYi~tof 1.80 days.
NOTICE - It is the responsibility ~f the permit. holdeY.not. the City of Sremerton or Building Official to $ee
to it thatyequiYed impections ayl.& made. The permit holder MUst notify the Building Official when read>' for
! inspections. Failuy& of the peyooit. holder to notify the Building Official of yequired impections may result
f in the stoppase of the woYk until such time that the pennit holder can substantia.te to the building official
f that the concealedwoYk ~tsor exceeds code requi'r"emerlts. Any derooli tion, testing. or finarlCial btJ.rdllm shall
be borne directly by the permit holder. failure to $Ub$tantia"te code yequhements l<Jill indemnify the city
f agair~t any and all responsibility oy liability connected with the construction.
l I herebY cerHfy that I have read and examined this peymit and know the same to be true and conect. All
[ provision$ of lawe and ordinances SQvemiY1Q thi$ type of woyk will be complied with whetMY SlP€cified heyein
01' not.. Thegyanting of a permit ~ no.t pyesume to give authority to violate OY cancel the provisions of
t any other ate or local law lat.ing construction or the perf o Yrnance of construction.
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I Permit Center--Approved By:
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BREME:R,TO~"",e,~.tR=M:L,;:T,.i;;,':,~ENTER
286 4th Stre:at:!~d:i81t.m.$m~:~ri:"'NA 98337
Phone: (360) 47E:f-5275 "" FAX': ( 360) 478...:.5278
Building Permit No: 02-0718,
Job Address: 1316 BRADLEY 51 Status: ISSUED
~ Location: Issued: 11/20/2002
~ Ass! Acct No: 3937903-006-0000 Expires: 0.5/19/2003
I, IW;N S P~ E C"T I Q\fulN S
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Item: 02700 FINAL--BLDG Dept: 8LDG Division:
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TESTING: Must be recognized by the Washington Association of Building Officials
SPECINSP: ,Must be registered with the State of WA
ST OF WA: " State of WA Dept. of Labor and lndustr ies 478-4921
HEALTH: Bremerton/Kitsap Health District 478-5235
ALL INSPECTIONS PERFORMED 8Y THE CITY OF BREMERTON MUST BE SCHEDULED THROUGH THE
PERMIT CENTER, (360) 478-5275.. J
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P~nni t Holder s' " ," ,19~' , " /.y/~dZ- 1
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PERMIT CENTER
Depaltment of Community Development ':' 286 4th Stt-eet ':- Bl-emelton ,;- WA ':- 98337
(360) 478-5275 ':- Fax (360) 478-5278
Building Permit Application
APPLICANT: ~WNER o CONTRACTOR o AUTHORIZED AGENT
Site Address le,~ g~f~ Tax Account Number:
lMMLI<- ~ T~. OMI(l€)e{L
CONTRACTOR: b~u - J~l~ f3/U.)L~ ST.
Address: ,tate, Zip 8bvY1u.:rrs~~ wA..' ~ f~/()
City, State, Zip Phone #: ( 3~ ) 1~;2. - ,;lc(J Z.
License # & Expir. Date: Authorized Agent Address:
Contact Name: City, State, Zip
Contact Phone #: ( ) Phone #: ( )
Check the type of application for below:
D NEW SINGLE-FAMILY RESIDENCE D NEW COMMERCIAL D NEW GARAGE/CAR PORT
D NEW DUPLEX D COMMERCIAL REMODEL D NEW ACCESSORY SLOG
D NEW MANUFACTURED HOME D COMMERCIAL ADDITION D NEW SIGN
D RESIDENTIAL REMODEL D COMMERCIAL REPAIR D STRUCTUREDEMOUTION
D RESIDENTIAL ADDITION D NEW MUL TI-FAMIL Y D GRADING (Cubic yards: _ )
D RESIDENTIAL REPAIR D TENANT IMPROVEMENT D OTHER
IS THIS PROPERTY WITHIN 200 FEET OF A SHORELINE? YES D NO D
Scope of Work Proposed: R.e.p~a... RO:, Lt0'1 5''1 s .f.:e.M 0 ,,-( D.eLK1 R~-e.
o .l6ocu.-b5 t:rr1 i:x?Llc:..
Square F~~~ Dwelling: Garage: Decks:
~
/' Valuation F,lan Review Fee Permit Fee Surcharge Total Fees
(jtl-t'J ) -0- d3~D :J-3;5b ~
A lication for whi no permit is issued within 180 days following the date of application shall eXP~~ljmitation, and
lans Gata submitted for review may thereafter be returned to the applicant or destroyed by the building official.
The--ilwl.dJD.9...official may extend the time for action by the applicant for a period not exceeding 180 days on request by
the applicant showing the circumstances beyond the control of the applicant have prevented action from being taken. No
applican't shall be extended more than once. In order to renew action on an application after expiration, the applicant
shall resubmit plans and pay a new plan review fee.
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DATE:
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PERMIT CENTER
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Department of Community Development * 286 4th Street * Bremerton ::. WA * 9833:BREMfRTON
(360) 478-5275 ::- Fax (360) 478-5278 BUILDING DEPARTMENT
RESIDENTIAL SITE PLAN REVIEW QUESTIONNAIRE
Permit applications are reviewed by our staff to make a preliminary determination of the presence or
absence of unique areas on the property. To help us make this determination, please supply the following
information with a scaled and dimensioned site plan.
.
Applicant: MkLK- i TEfl./J:r RCA;{ IN6EJ!.,
.
Description of Proposal:
Street Address (or street name ifno address has been assigned): I~ I" 8~te.., b'7; .8kAt~, GU:~
Tax Account Number:
Critical Area Questionnaire:
1. Is there any standing or running water on the surface of the site at ANY time DYES rn NO
during the year? If YES, please describe conditions:
2. Are there wet areas on the site? If YES, please describe: DYES 3J NO
.., Is the site characterized as: D Forest 0 Cleared rK1 Developed
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4. Please give the overall slope of the parcel_% and the slope at the building site _ %.
5. Is the property within 200 feet of a shoreline? DYES ~ NO
6. Will the proposed structure be aesthetically or functionally disruptive to DYES J2Q NO
surrounding properties, the neighborhood or the community?
See diagram explaining the slope calculation on the back.
The applicant hereby certifies that all of the above statements and the information contained in any other
transmittals made herewith are true, and the applicant aclrnowledges that any action taken by the City of
Bremerton based in whole or in part on this application may be reversed if it develops that any such
statement or other information contained herein is false.
IY)~I?PlYW1 < ~FC~) 11~/t;z.
Signature of Applicant r Date
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Site Development Figures
Percent Slope Calculation
Slope is calculated by dividing the vertical distance
by the horizontal distance, then multiplying the result
by 100. Example:
Vertical Distance of 20 feet
Horizontal Distance of 100 feet = .2 x 100 = 20% slope
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Residential Site Plan Review Questionnaire Page 2
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I RE:CEXPT
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~, I~ECfn:r,;,)'f Nl,j,mber ~ O;W010'39 Amount j .00 11/2(V02 12~46
I nt 1'1f3thod ~ CASJ1 i () !'! : Rot"! 1: NGE.R CASH Init: "lltJ
___._____.-~~__h___~_____w.____~____~w.~.___~~_w~__._,______~~___________.w______
f>~rmi t N\:l: ()2 1f3 T:,'pe; al~DGCJNLY 8LDG! PERMIT---NO MECH./
P.!:,'rcel No: ::.~(~r3 '7'00 3'~OO6~()()\,)O
Site ~ 1.6 BRAf;LEY ~;;T
Total Fe~s:~ :;(:6 . 00
Th Payment 28 . ()O Total ALL Prrlt'i.'-!.: 2l:, .00
BaleHlce: .00
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Accou lIt Cod~ Ot~'$scr iptiotl t~lfnoU rlt
1 "10()1 ( 11 ) aUnj)IN~1 PERMIT 23.50
. 1 ~3 ( 023!S ) STATE OF WA SURCHARGE 4.f:'lO
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BREMERTON BUILDING DEPARTMENT
Inspection Report
(J Permit Number: ,()~- Ollg
Scope of work:
Address: 1
Owner: Phone: <
Contractor: Phone:
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FOUNDA liON
Inspection card/approved plans on site Setbacks
Footings: required steel placement Walls: required steel placement
Footings: required width & depth Walls: required size
Bearing soil (soils analysis if applicable) special inspector (when applicable)
COMMENTS:
FOOTINGS APPROVED: WALLS APPROVED:
FRAMING
Electrical approved Plumbing & mechanical approved
Crawl space access (min. 18 x 24) Floor joists and beams/proper clearance to earth
Positive connections .posts & beams Foundation vents
Posts properly supported Anchor bolts: nuts & washers in place
Mudsill: treated material Floor joists: size & span
Beams/girders: size & span Notching & drilling: joists & beams, studs
Smoke detectors: all required locations Exhaust fans: where required
Exhaust fans insulated: unconditioned space Whole house fan, outside air intakes each bedroom
Fans terminating directly outside Range hood
Dryer exhaust vent All vent terminations: windows & property line
Fireplace combustion air Windows: meets egress requirements
Windows: proper U valve Windows: safety glazed where required
Ceiling heights Stairs: headroom clearance
Stairs: rise & run; proper width Fire blocking wall to ceiling, furred walls every 10'
Fire blocking: stairs, soffits, lowered ceilings Fire blocking: tubs/showers
Fire blocking: lids in void spaces, shafts Fire blocking: stuff holes top & bottom plates
Sheet rock baCking Wall bracing
Rafters size/notching Trusses: specs, bracing
Attic access Attic ventilation
W~II & roof sheathing Shear nailing
Building dried in
COMMENTS:
APPROVED:
ENERGYCODECOMPL~NCE
Insulation: proper R valve , . Insulation: proper fastening
Insulation: vapor barrier Bottom plates caulked to floors
Penetrations caulked as required Electrical boxes gasketed or caulked
6 mil black pOly in crawl space
COMMENTS:
UNDER FLOOR/FOUNDATION INSULATION APPROVED:
WALL INSULATION APPROVED: CEILING INSULATION APPROVED:
~ ," ~.. ~., .. . ~
MECHANICAL
Appliance location and access, proper support Appliance clearance to combustibles
I Venting: clearance to combustibles Venting: size & support
Vent termination Combustion air
Ducts: size & support Gas pipe under test
Gas pipe size & support Gas pipe: underground min. 12" below grade
Gas pipe: within 6" or underground-coated Gas shutoff within 3' of appliance
Gas logs: safety shut-off Gas logs: damper permanently open
Wood stoves EPA certified Wood stoves & fireplaces: Tight-fitting doors
Wood stoves & fireplaces: proper health Manufacturer's specs on site
Chimney liner: when required Chimney: separate flues when required
COMMENTS:
GAS PIPING APPROVED: FURNACE APPROVED:
OTHER APPLIANCES APPROVED:
PLUMBING
OWV & water piping under test OWV: proper grade
OWV: proper Sizing OWV: proper drainage fittings where required
OWV & water piping proper support OWV: required cleanouts
Vent termination All fIXtures vented properly
Water supply: proper sizing Shut-off valves on all fixtures
Water heater: gate valve on cold water supply Vacuum breakers: where required
Water heater relief valve drain to outside Water heater: seismic strap
R-10 pad under water heater when required Water-piping insulated as required
Grease traps/interceptors: where required Proper indirect wastes: where required
COMMENTS:
PLUMBING GROUNDWORK APPROVED: PLUMBING ROUGH-IN APPROVED:
SHEETROCK
Proper fastening nails - 7" o.C. hariz. Plane Nails 8" o.c. vertical plane
Proper fastening screws 12" o.C. horiz. Plane (1/2") Screws - 12" a.c. hafiz. plane (1/2') 24" o.c. framing
Proper fastening: screws - 16" o.c. vert. Plane (1/2") Screws - 12" o.c. vert. plane (1/2") 24" a.c. framing
Proper fastening screws - 12" a.c. horiz. plan (5/8") Screws -12" o.C. hortz. plane (5/8')24" o.c. framing
Proper fastening screws - 16" o.c. vent. Plane (5/8") Screws - 12" o.c. vert. Plane (5/8") 24" o.c. framing
Area & occupancy separation walls Draftstops where required
Usable space under stairs (5/8" required) Waterboard where required (not on ceiling)
Corridors I
COMMENTS:
SHEETROCK APPROVED:
FINAL
Energy code requirements met, exhaust fans Plumbing & mechanical
Garage/dwelling door self closing solid core Smoke detectors where required
Handrails & guardrails, as required Fire ratin s maintained
Exit signs when required Emer ncy lighting when required
Occupant load posted when applicable Building weatherlight
Wood siding to earth separation (6") Building address posted
Randon monitor when required ~~
COMMENTS: {)~K <4 7/-. )Nt~ ~~/E,Plll((P{]
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BREMERTON PERMIT CENTER
286 4th Street~ Bremerton~ WA 98337
Phone: ( 360) 478-5275 FAX: ( 360) 478-5278
BUILDING PERMIT
Job Addr: 1316 BRADLEY ST Permit No: 02-0513
Location: Status: ISSUED ,
,
Parcel No: 3937003-006-0000 Applied: 09/09/2002
Issued: 09/09/2002
Applicant: ECONOMY SHEETMETAL AND HEATING 692-8709 Expires: 03/08/2003
8753 ST. HWY 303 BREMERTON WA 98311
Owner: ROMINGER MARK & TERRI
1316 BRADLEY ST BREMERTON WA 98310
'Contra.ctor: ECONOr1Y SHEETMETAL AND HEATING. 692-8709 Lic#: ECONOSHIOINM Exp: 03/19/04
8753 ST. HWY 303 BREMERTON WA 98311
Subcontr:
Desc= GAS FURNACE, GAS HOT WATER HEATER, GAS PIPING
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Valuation )(< Permit Fees: 61.55 Total Calculated Fee: 61. 55
.00 )I( Plan Check Fees: .00 Additional Fees: .00
)I( other Fees: .00 Total Permit Fee: 61.55
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MECHANIC~_/PLUMeING F!XTuRES-- M!:.""Cr!-Gas FUY11$ce to lOOk bt!l.: 1 MECH-Gas Piping (outlets)....: 2
PLB(;j-Watey Heate'(............: 1
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This peymit shall becon1e null and void if the buildil1!i'il or woyk authoyi:ted by this pe'(mit is not commenced within
180 days from the date of such peyroil:, or if this building or work authoriz:ed by $!Jeh permit is $Uspe~ or
abandoned at am' time sHel" the work is COllllJi41;>liCed foy a peYiod of 180 days.
NOTICE- It is the rElsponsibilit)i of the permit holder ,not thE- City of Brertlerton oy Buildi 1'19 Official to see
to it that YEiqlJired inspections are made. The peymi t holdel' must l10ti fy the Buildir~l Official when yead}' foy
impectiol1$. Failure of the permit holdeY to notify the Building Official of n~qt..lired impecUol'\$ fll;5lY l"esult
in the stoppage of the work until $Uch time that the l:Je~'mit holde~' can $Ubstantiate to the buildirlS official -
; -
that the concealed WJ:)Yk meets or t'xceeds code yequiyemerrb&. Anydoololition. testing, or financia.l buyden shall .
00 bome di recUy by the pf<lymi t, holder. Fail~re to substantiate code~ l"equ,irements will irdemniry the City .
agail'\$t any and all r~on$ibility or\liability connected with the col'\$truction. -
I hereby certify that, I have ~'ead and eXlll,ll'Iined this p&rmit and know the' sa.me to be true and con-eeL All
prOvisions of laws and oYdinances govemin9 this type of work will be complied with whether specified herein ~
or' not. The 9y~ting of a peymit does not preswlw to give authoYity to violate or cancel t~~ provisions of
0"" ot....'s:.L 0< ~l laW '~loti". conat"",tlon 0' t.... ..rio".."", of _co,,"...uction. -
;
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t cortif)' tt~ am ltX\tfIlI:lt: l'"Qro thlll' Yltc.'/lJir'6'I'Mmt\tl ofth. stilt. contr-.etOY'$ yesi$tystion law, UT'ldtH' .
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section 3, Chapter 126, laws of 1967.
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Permit Center--Approved By: . ___ "
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BREMERTON PERMIT CENTER
286 4th Street" Bremer ton , WA 98337
Phone: (360) 478-5275 FAX: (360) 478-5278
Building Permi~ No: 02-0513
r Job Address: 1316 BRADLEY ST status.': ISSUED
! Location: Issued: 09/09/2002
I Aeer Acct No: 3937003-966-0000 Expires: 03/08/2003
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IS R QUI RED INS PEe T ION S
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I, Item: 01400 M.ECHANICAL Dept: SLDG Division:
, Item: 01550 PLUMBING Dept: 8LDG Division:
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I" *******************************;;:*************************************************
I TESTING: Muse"be recognized by the t..Jashi ngton Association of Bui Idi ng Off 1c1als
I SPECINSP: Must be r~gistered-with the State of WA
I. ST OF WA: State of WP~ Dept. of Labor a"nd I ndustr les 478-4921
I HEALTH: Bremerton/f<i tsapHeal th Distr let.~ 478-5235
!
t ALL INSPECTIONS PERFORf'1ECPSY 'tHE: CITY OF 8REMERTOI',t MUST BE SCHEDULED THROUGH ,TH,E
, PERMI"r CCl>...ITCR C,-;,zO' 47"" ,-1:::';'17.5 ,-(:, ',": '. '
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II." Signatu'( '~~...".. ~ Da.te= '7'-/";'!12'j~.....,k'"
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I RECEIPT
j((lI(li(ll(***>lllll***nu*****:nt**lt:u****:tft*******lltll(,W(JII;:Ul/(ll(>>l.*,**UlI:;n**X<;.>>l~lI!lIl
;H~e:CE!PT Number: 02000795 Am.ounn ""'1""''''61.,55 O'1'filt/Ct2 15:27
I Payment Method: CK Notatiron: e:CONOMY C~: Joit:: vw
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Permit No= 02-0S13 ,'/l'ype: MIl' MECH/PLBG PERMIT
Pan-;el No: 3937003;006-0000
$jt~ (~ddre$s: 1316 a~AOt.E'( Sf"
. Total fes$: 61.5!>
lhl$ Payment 61.55 Total ALl. Pmts: 61.55
aalancel .00
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Account Ce>de Oescription Amount
16,..322.1005(2215) I1ECHANrCAL PERI1HFEES 44.55
14,,322.1003 (2213) PlUMB1NG PERMIT FIrES 17.00
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~ ' "'MECHANICAL 0 ' PLUMBING I D {S,
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, Type of Fuel: Electric ~,Gas Oil
Occupancy: Residen tial Commercial
Site Address:
, Owne~ ~ I Contractor:M~v' ,$1.~JH.e1M.,1 #~
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Add,e"I;]/ ( 1JIUI/7 fry sr-ef i\ddress: a';S3 / $7Hre.. Iftojl .3()3
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Phone: (!u./. '8'i,~ 6'~~" I Phone 6 ?;;9.. <zI? tJ '1
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i Contractor's License Number/Expiration Date:
I e eet:e''( i!t!rmoSI! I tP/ "Q1 8'0'1
TYPE OF FIXTURE "
No. TYPE OF EQUIPMENT No.
'-
RA..."lGE W A 1ER CLOSET
WOOD/PELLET STOVE/GAS FIREPL\CE BA ruTIlB
~ G.\S FCRNACE btu: ~~ LW ATORY (bath sink)
C01\i,,"ERSION BURNER btu: SHO\VER
C~IT HEATER btu: KITCHEN SINK
BOILER btu: DISHWASHER
dL. G.\S PIPING LAUNDRY TRAY
EVAPORATION COOLERS btu: CLOTHES WASHER I
i{>
AC U,,"IT btu: ~ WA1ERHEA1ER r--\ ;1:::: f r;=:J ~ rJ
HEAT PUMP btu: URINAL ii'q Ie. ,,(5; Ie" U ~
... ;; L),1,' ;~~-~ ......r t...:.:::J
REHE.\T BOX btu: DRINKIN(i FOUNTAIN 1~'ll c;!,.-b) {\ n I
AIR H.:\.:.'\!DLING UNIT btu: FLOOR SINK OR DRAIN . U '-", v Ii 20D2
EXHAl.ST FANS SLOP SINK BRtMl:RTON
R:\.:."JGE HOOD (residentiul) WA1ER PiPING & AL1ERATIO~ILDINC D[PARTnEi\lT
R.\NGE HOOD (commercial) GREASE TRAP /IN1ERCEPTOR
CLOruESDRYER HOSE BIBBS
I~CI"ERATOR L\\VN SPRINKLER SYSTE:.v[
Dl"CT c\L1ERATION SWIlYllilING POOL
T.~'JKS type: BLDG. SEWER: (mobile/moved house)
REFRIGEIL\TION UNIT ROOF DRAINS
OlliER: OTHER:
;\1ECJ-IA.l\II CAL FEES:
PLU1-illING FEES:
CIn'SURCH.:\RGE:
TOTAL FEES:
APPLICANT'S SIGNATURE:=?u.o? d& .
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! v lCI~ITY MAP
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BREMERTON 'I
BUILDING DEPARTMEt\iT
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City of Bremerton, Washington = ~--.
Phone: (206) 478~5281 ASSESSOR'S ACCOUNT NO. 3937-003-006-0000
; SITE ADDRESS/LOCATION 1316 Bradley St..
OWNER'S NAME Roy o. Markham OWNE,R'S A8DRESS . PHONE II:
,same 171-21 R4 III
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; CONTRACTOR Sears $TATE CONTRACTOR'S L1C. # ~
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ADDRESS Kitsap Mall, Silverdale PHONE 692-1515 357
QtJIRED' BEFORE OCdJPYING BUILDING
Authorized Agent
\.,!SEE AND READ NOTICE ON. REVERSE SIDE) j
r Ii] REPAIR o DE,MOLlSH "'
IKJ RESIDENCE o BUSINESS o OTHER o NEW o REMODEL o ADDITION.
o SIGNS
PLANNING/ZONING # STORIES OCCI,JPANCY .
THIS PERMIT ISSUED FOR: Reroof of ex:Lsting single family residence
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 giv~ authority to violate or cancel the provisions of any other state or local law regulating construction or the performance of construction.
INSPECTIONS REQUIRED: Foundation 0 Framing 0 Plumbing 0 Electrical 0 Wallboard 0 FINAL
OWNER OR BUILDER SHALL CALL FOR ALL REQUIRED INSPECTIONS AND RECEIVE APPROVAL PRIOR TO OONTINU
. '
; SEPARATE PERMITS ARE REQUIRED (WHERE APPLICABLE) FOR PLUMBING, MECHANICAL AND ELECTRICAL.
COMMENTS: 30 x 56 17 s uares x 135.00
~
,
,
BUILDING. OFFICIAL: cj .
VALUATION PLAN CHECK FEE RECEIPT NO. PERMIT FEE RECEIPT NO. DATE
$ 2,295.00 $ 0 $ 54~ 00 7s:i1 ~ I 7/21/86
BUILDING INSPECTION DIVISION - Bremerton, WA 98310 + $1.50 state surcharge :
\.... Permit No.1 7396 1../
COPIES TO: WHITE - BUilDING, YEllOW - ASSESSOR, PINK -OWNER
-------------- --
e e
~BUI LOI NG PERMIT APPLICATION "'
City of Bremerton, Washington
Phone: (206) 478-5281 ASSESSOR'S ACCOUNT No,3~5 7 ....c::x,3-r:c).S" ~
SITE ADDRESS/LOCATION /.a/~ -r?3/e::;?
-
~ OWNER'S NAME pl.~ PHONE~73-~./J"'~ ffi
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- CONTRACTOR STATE CONTRACTOR'S L1C. # ~
=
ADDRESS PYONE 0
aUIRED BEFORE OCCUPYING BUILDING
OWNER'S SIGNATUR BY
Authotimd Agenl
'-.. ../
r tz5: REPAIR "
~ ~ RESIDENCE o BUSINESS o OTHER o NEW o REMODEL o ADDITION o DEMOLISH
o SIGNS,
PLANNING/ZONING # STORIES OCCUPANCY
THIS PERMIT ISSUED FOR: 9k-7d~~~
~
~
-
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 other state or local law regulating construction or the performance of construction.
OWNER OR BUILDER SHALL CALL FOR ALL REQUIRED INSPECTIONS AND RECEIVE APPROVAL PRIOR TO CONTINUING WORK.
- SEPARATE PERMITS ARE REQUIRED (WHERE APPLICABLE) FOR PLUMBING, MECHANICAL AND ELECTRICAL.
COMMENTS:
= /~~"A /7 (~ ~)(.~ )
~Q, Gy,
.
BUILDING OFFICiAL:
VALUATION PLAN CHECK FEE RECEIPT NO. PERMIT FEE RECEIPT NO. 0ATE/
$ c7dO;C ~ $ U ~s4~
'7:;/ ~<S
BUILDING INSPECTION DIVISION - 817 PACIFIC, Bremerton, WA 98310 I ~~ 'Sf ~-r<s ""SU.JZ
1.../
,'" ->,;,,;,,)'!'- -,.--\..-. '.~'. . \.. ". ~.,......,.::;....-\..::.....::::-:~.'--~-- - "
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:,:~" ; ~~_,,_'~~-~'iMATE AN~, PROPOSAL e No. 15250
'..- ~" 187/64
Roofing Shingles Store ;; j <r'l. ' .... .-
Customer's R [.J ",-
Name , u ') /! /'./1,1 r . ,1(/; ,1-,;
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Address ,," j/ " "." "
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RETAIL g'J . If'
MERCHANDISE SHIPPED FROM: FLOOR 0 WHSE. 0 DIST. 0 City /.e:, /' /.}! '" f /""1 State //?r:j ,,;;ic 51'?
CENTER .' .. .
Instidlatian /
C. O. POOL 0 SOURCE 0 INSTALLER 0 INSTALLER PICKUP 0 Address'::' ,,?,,-i
/ / t; ';.'/' L" \- .' ,/' , < ' ../ r
SALES' CHECK NO(S.) ,'" .;, ,~) Nearest Cross S~reet /'.' , >, ,
Phone /..-.,/} ~"11 2y .
Home ';', ,)':"\ I:..; , BUSiness
Sears agrees to arrange installation of: SKETCH Show roof measurements including rise. .' . , '
;_ ",,' I" .' .1\' 1 ; ,....,' <:"- ' !, ~J -1' . Shade out ~ny part of roof(s) not to be covered.. .
Type Roofing ') , y .". / IN) 5 Color / H : .' ," ;t" ) ./! ' Show location of any roofleaks. '
. . " f . .. DGU1TER INSTAUAnONTO FOLLOW '.
Blends show less variation in shade due to light reflection than solid'colors, Black nonnally has .
some shade variation, " ,', r . ., .. ... .. ...,.,.... ,. ~. .'. . "
I ji> . .... II! " ~ ~ .. ~ ~ ~ ,. '%. '" i) 1;\ '\> '!II ... .~>f '" Ii 'l- ~ 4
To be installed on a _ stol'( house. crtiarage Included . ~ . " , . '.. '.' I. "., . ,. '," '.:. ' ,. ,.. .' .
., .,.." '\" ' ' ,t.,.,,.,, "..~
, J/( - ;.....A: --, ' . , . ;, ~ I ~ '- c, 6.j'y. ,. .."
Roof Pitch ltJ-'IValkable 0 Non-Walkable ' , , , . ..,. ' , , , ., ." ,....
. ~/ r I ;t-- 4 >> .f # ,# ". '" ~... g " -(; i JIlt ~ .~ ~ -'.~;." ~ ,I ~ "" 'f /f>~"
o Cut Back Roof Edge ~ Lin, Ft. Eave ____ Lin. Ft. Rake, . . .~!,.. "', '~....: . ~ ;..".... . ,f~';P ; ,/" .~ . :
O SI IZ"R' . ")' P/4 ""Z" ....>.... i _.,.~., f'.',.C""I...7.....J
Low ope Ise up to 4 : Rise'''' , I,~ 1. I. ' .J," j . '~
D. BuilHJp (Must be used unde.r. 2''): Rise ! k'/I~ '. "IN 1Z" . .... ' .". A.;.".. . .. !"~" 1.,.. '. ~.' '. . '..... . ,f,
~./.'- ,,', ,1) <.,J J..I 'I. .,.,. I" . .. I"'~';'" .',;..,~ ',,'
~etalEdge D~~k; ", LIO,Ft. DDnp lin.Ft.-17. .. ... .:,.. ~.vt.":,.tl.,,.,....'....:\('..,...,.
o Valley type ....;/ I! ) Lin. Ft . . , , . . " r ,,', It ," . ." . , 1\ , ,., , ., . . " " ". .' ~ ')
_"/ . ;lJ:1>1i b... # .....?.. ~......,'>'I.~...i..f..,_1S,'.-l1>-t;,~~...'lJt.J'IS ~~\:I..'" ,)(j
Hip &%ge S:'7 Lin. Ft No, . ",/,.:.;., ~ .,,, ... '.' ,~.~. ,f '('.:.' ;.'." i..i....-.. '. ,,;_ ~~-.
~DVENTILATION erSk tch ' ..~.,~ ,..:,' I . '..'': .;, !.' "~', . ..,' , . - . . "',! .'
Adequate ventil;ion' ~onsiSls of 1 Sq, Ft.Free open Area for evel'(l50 Sq. Ft of anic : : ~ : :: : >! : .: : : : :<":~)c:1 ::: :::0:: :: \;: :: 13
f1.00rspace(50%locatedatridgeany~o/~~eavesl'!/''''1T". -:-:-:-:-:-:- " I... + .,. ..1.:.' '." ~_. :~..-:~_ J
Type of Ventilators to be Installed ;"( '/-';. .. ,'. ). . , ~ . .. .. \.... " , J' . ',' . , . . . .....
;; fXISTING ROOFING consists of -L layers_of DWood Shingles 0 Shakes .0 Roll Roofing ! : :!i:. :: :: I:::: :C!:' :: Il:fk":: : ':: '~::::
ill Asphalt Shmgles . . . , , . . , . I. u . > . .', ,. j > . , . . , . .. ......
r ,,' ~1 ' IX' I
Contractor will . . . . . , ~!l~ '.. )jL( . fV---f7f. . . . . . .. .....
. -lo .. .. ~ ,. ~ ! I '" 01 ... '$ 3l> .~ ~ '" <II i'~ "'" '" ~". '" Cf ,. 'It ill -';I. "*
o Apply over existing shingles. CAUTIO N: New shingles will conlol1ll \0 lIDevenness 01 existing . .,. .,. . .... i'" ',' . -.. j-..,.,... .. - -.'
, deck and/or shingles. '" . . " , . .. I....".... I.. . -, . . . .'. .;.,..
i 0 Cut off and haul away tabs of existing asphalt' shingles to proVide a' smoOifier more even .. .. . , .. !.". ,', . .,. I......... .....
: . deck. apply shingles, Some unevenness will remain, - : : :. . ~ :: I::::::::: -I: :': : : : :: : ::.:::
i .':! Tear off existing Roofing. /.:vUaul away debris. I. , . : . , . . ..., , ;.. . . , . . .. ...., .
, ~, . ~II _ t 1> ~ ~ ... " ~ " .,.. d '''II' ~ .. .. '" " 11 <I! .. I ~ .~ '"' 1t . !t ... "" '"' <Il' ~ -$ ,.-
RDOF LEAKS 0 Existing leaks are indicated on sketch with an X i - . . ",' . .. j......... I.... ''',' .. I ~ . ......1'
ROTTEN OR DETERIORATED WOOll, - No charge has been madec for replacing ronen or deteriorated j . . ' . ":: : : :' ::: 1::: : :: : ::: ::: : j
wood, unless specifically stated under special instructions. If such conditions are found during in~ L 1 i - ~ I
stallation, an additional charge will be made in writing using a separate fonn. 1 . . . . ... j-"::: : :: t::' :. : :.. (
NOTES' ) i . - " , ,,~ " , i, /1 ( -"'., j. ; " - .. .-. ," .", " 1'.. , :
/1 ',.' L.f (/{" 1/ (,"?! ~,- [!..; <"./ ""'1/ ;; -J. ! . . ~ . ~J .', !'." ',''/''.'" . 1;.,. .'. ';' ",' . " l~,. ,... \
',>' l. /'. 1 " , , I' :ji I . ! - j4'-t~111-'"1/ '?'.f~ -Yf',;: ,.11 / ' . ~;';'lf"/':;" I X--/.., ;('". \
X ".,.. ~. " ,... ,-. _. Cr. // ~ ," /'" ;'~~.-1 tt//., i-:-'_'~<:':-"':""~U'^<:':m.'-':.__:^~,___.~".'_.j...~','^~~:::.."",_.--:...:..-rL--___A-L::,l..'~='- L" (
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NOTICE TO CALIFORNIA RESIDENTS ONLY
IF THIS CONTRACT IS IN EXCESS OF $500. "YOU AS OWNER OR TENANT HAVE THE RIGHT TO REQUJRE "COPIES OF WARRANTIES WHICH MAY PERTAIN TO THIS SALE MAY BE
THE CONTRACTOR TO HAVE A PERFORMANCE AND PAYMENT BOND OR FUNDING CONTROL." INSPECTED AT ANY TIME DURING THE SALES PRESENTATION."
(PROVISIONS ARE STATED ON REVERSE) X DATE OF SALE I, SEAR~.ROEfiifckAND CD. ClI. Lie. Z5455 WA. Lie. SE.AR-SR~31ZNT
X " --, / (-' " 900,SO. FREM9NT AVE~ ~AM8~A, CAlIFORI;If~91802
,'; "I ./1/ ./"<," r, X//"" /'. ~/ / X /",_
./ ,:'-1 ...'.... By.~'" ...J ".: .J' .( .;/ . ',/ .;...{,
Approved and Accepted (Customer) .x. . Reonrsentative' Col.l.ic. No.
X ~ ,Mo. Doy Year
SIGNED: 0 IN STORE ~ ELSEWHERE _.Cash Price.., " X
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i THIS MESSAGE APPLIES TO IN-HOME SALES ONLY,'" I i j / Reviewing Division Mgr.
, YOU THE BUYER MAY CANCEL THIS TRANSACTION AT ANY 0 Warranty D~liv8r8d Work will b~9in with.in approximat~IY 60 days from t~e ~ate of sale
, .. shown herem and WIll be SUbstantIally completed WIth," 90 days
TIME PRIOR TO MIONIGHT OF THE THIRD BUSINESS DAY AFTER 0 Cash 0 P.O.C. thereafter unless different estimated starting and/or completion
THE DATE OF THIS TRANSACTION. SEE THE ATTACHED NOTICE 0 E.P. 0 S.R.C. dates are shown herein: X
OF CANCELLATION FORM FOR AN EXPLANATION OF THIS RIGHT. 0 M.C.P. 0 _ APproximate starting date:
Approximate completion date:
SEARS -INSTALLATION WARRANTY 'In addition to any warranty extended to you on the Sears
merchandise involved. which warranty becomes !,lIactllfe the dateth!, merchandise is in,,:talled, Sho!,ld 477 4-013 1/83 BULLETIN 0 187 Supp ZIPC-7/80
tha wnrkmA",.hln nlanv Saars arranaed mstallat.on prove faulty wlth,n one year. Sears Will upon notice .
BREMERTON BUILDING DEPARTMENT
Inspection Report
Scope of work: ~. Permit Number: O~- 6! 7 7
Address:
Owner: Phone:
Contractor': c.. Phone: ,qd.-- d.-S/t'J5
-€.-lJe j\Il Q.. Wl ~
FOUNDATION
Inspection card/approved plans on site Setbacks
Footings: required steel placement Walls: required steel placement
Footings: required width & depth Walls: required size
Bearing soil (soils analysis if applicable) Special inspector (when applicable)
COMMENTS:
.
.'
FOOTINGS APPROVED: WALLS APPROVED:
FRAMING
Electrical approved Plumbing & mechanical approved
Crawl space access (min. 18 x 24) Floor joists and beams/proper clearance to earth
Positive connections posts & beams Foundation vents
Posts properly supported Anchor bolts: nuts & washers in place
Mudsill: treated material Floor joists: size & span
Beams/girders: size & span Notching & drilling: joists & beams, studs
Smoke detectors: all required locations Exhaust fans: where required
Exhaust fans insulated: unconditioned space Whole house fan, outside air intakes each bedroom
Fans terminating directly outside Range hood
Dryer exhaust vent All vent terminations: windows & property line
Fireplace combustion air Windows: meets egress requirements
Windows: proper U valve Windows: safety glazed where required
Ceiling heights Stairs: headroom clearance
Stairs: rise & run; proper width Fire blocking wall to ceiling, furred walls every 10'
. t. ., F.ire blocking: stairs, soffits, lowered ceilings Fire blocking: tubs/showers
Fire blocking: lids in void spaces, shafts Fire blocking: stuff holes top & bottom plates
Sheet rock backing Wall bracing
Rafters size/notching Trusses: specs, bracing
Attic access Attic ventilation
Wall & roof sheathing Shear nailing
Building dried in
COMMENTS: /
APPROVED: ~;;J (}/O- 01
.
ENERGY CODE COMPLIANCE
Insulation: proper R valve I Insulation: proper fastening
Insulation: vapor barrier I Bottom plates caulked to floors
Pene~rations caulked as required Electrical boxes gasketed or caulked
6 mil black poly in crawl space
COMMENTS:
UNDER FLOOR/FOUNDA TION INSULATION APP
WALL INSULATION APPROVED:
MECHANICAL I
I
Appliance location and access, proper support Appliance clearance to combustibles I
Venting: clearance to combustibles Venting: size & support
Vent tennination Combustion air
Ducts: size & support Gas pipe under test
Gas pipe size & support Gas pipe: underground min. 12" below grade
Gas pipe: within 6" or underground-coated Gas shutoff within 3' of appliance
Gas logs: safety shut-off Gas logs: damper pennanently open
Wood stoves EPA certified Wood stoves & fireplaces: Tight-fitting doors
Wood stoves & fireplaces: proper health Manufacturer's specs on site
Chimney liner: when required Chimney: separate flues when required I
COMMENTS: I
I
I
GAS PIPING APPROVED: FURNACE APPROVED:
OTHER APPLIANCES APPROVED: ~D q-jO- 62
PLUMBING
DWV & water piping under test DWV: proper grade
DWV: proper sizing DWV: proper drainage fittings where required
DWV & water piping proper support DWV: required c1eanouts
Vent tennination All fixtures vented properly
Water supply: proper sizing Shut-off valves on all fixtures
Water heater: gate valve on cold water supply Vacuum breakers: where required
Water heater relief valve drain to outside Water heater: seismic strap
R-10 pad under water heater when required Water-piping insulated as required
Grease traps/interceptors: where required Proper indirect wastes: where required
COMMENTS:
PLUMBING GROUNDWORK APPROVED: PLUMBING ROUGH-IN APPROVED:tO c;/1ftJ!..
SHEETROCK
Proper fastening nails - 7" o.c. horiz. Plane Nails 8" o.c. vertical plane
Proper fastening screws 12" o.C. horiz. Plane (1/2'1 Screws - 12" o.C. horiz. plane (1/2'124" o.c. framing
Proper fastening: screws -16" o.c. vert. Plane (1/2") Screws - 12" o.c. vert. plane (1/2") 24" o.c. framing
Proper fastening screws - 12" o.c. horiz. plan (5/8") Screws - 12" o.C. horiz. plane {5/8'1 24" o.c. framing
Proper fastening screws - 16" o.c. vent. Plane (5/8") Screws - 12" o.c. vert. Plane (5/8") 24" o.c. framing
Area & occupancy separation walls Draftstops where required
Usable space under stairs (5/8" required) Waterboard where required (not on ceiling)
Corridors
, , , , ,
COMMENTS:
.SHEETROCK APPROVED:
FINAL
Energy code requirements met, exhaust fans , Plumbing & mechanical
Garage/dwelling door self closing solid core Smoke detectors where required
Handrails & guardrails, as required Fire ratings maintained
Exit signs when required Emergency lighting when required
Occupant load posted when applicable Building weatherlight
Wood siding to earth separation (6") Building address posted
Randon monitor when required
COMMENTS:
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"'i/!' BREMERTON PERM'XT C N-r R I
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286 4th Street. Bremer-ton. WA 98337
Phone:. (36t"}) 478-5275 FAX: ( 360) 478-5278
BUILDING PERMIT
Job Addr= 1316 BRADLEYST Perm No: 02-0177
Location:: s;tatus: ISSUED
Parcel No: 3937003-006-0000 ,
~lpplicant ; NORDIC SERVICES INe 792 ,.~ 2 E><pites~
PO BOX 1492 BREMER TON WA ~B310
Owner: ROllINGER I"IARK & TERRI
1316 BRADLEYST BREl1ERTON l;,l~) 98310
Contractor: NORDIC SERVICESINC 792-2565 L it: NOROISI180QA Ex[): 01-01-'
%18 NIDVA1At N SEA TTLE W~1 98103
Sube:ontr:
Desc= FIRE DAMAGE REPAIR TO RES
******************************************************11*****11**11**************************
Va.luation * Perrnit Fees~ 1,076.80 Total Calculal 1, ,,59
% ,047" 00 * Plan Ched Fees~ ",'~? AddH "oc
/),;\.,.
>>: Ot hET Fees:. >4 ,,50 Total Pe ,t,,7 "S9
************************************************************** :*', ~~, *: * >~: '.~K * ~i< * )K :,~ :#
tv!ECHIl',NICAl/Pll.ll"ISING FIXTUR(<?8~" H::C!-i-l';:$,\l!;W?" , " " . . " " " .. " " " , .. " " " " ~ 1 Ml':':CH-E)(hwJ.Jst FZXlif'.. ,. '" ,. .. ".. , .. . " .. : 1:
t'lISCr+"R",,~~HO'..:d (n?,,,,) ".. , " ... " " ~ pt,86'-Wal;)sy , .. 1. ,Pl...gi::i'"'fr1~lthtl.(t<......."".. ., ~ ,: ,,'.,.. .. , .. :
" ,~ ,ft :<." ......,,"'>'1 "
I; .. .. /".'" '" ". " '" '" " .. >' .. .. .. ~ ' 1 FtJ:J2l"-1<H:c,:h,,;1"l Sink...."......."""". ~ . '" " .. " " " ... " ,,' ~ .. .. " 1
",
1
;K:~)I(::+:: *'::+:: *)K \~)}:: *::+:: **)1()1.: * *)K 1* **)ir. '*:<< ** * >i:* J!::)K;r.,;:(( **:<<ii:: *' *;:<<)j( ;1(*::(<: '* ':i::>r, *)K::K;<< * *:* * * iI<.* Ink:f( * * >I( W. *,:t)i< ;t"ji: ~K)ji;lc *)~ *. \K::K)!< :*: * *:*: * )~* *' **: *:/5
Thi"" permit $lhal1 become null and void ldi.ng tW v,IOl'k au'tl',:'YJ.:z:",c1 b>' t,h:L:s i r~'1t
180 d:S)i$ 'fYOfl) 'f.,he dst€.> elf euch p",:"mit"c;'rc i+ this t~,jildin;~ OJ''" 1;,fOT'k:allth,,~\"b,'2d b/$l.ich P~)'(~:it }((, or'
aba,~~1ed at anytime aftey '.NOYk j,$ comme\'1c1?d {en' $, p",'rice of 180
1\1OT!C[ ~ It is tbe yespornibil i'1:./01' thil'pa"rmit hc)ldeY, not Upe CH)t 8r'\?fI1EiYtOl1.Cl]"
to :tt that r'equi,Yed iTh.~ecHoll$ ;!ln~made" The: p>!itymit :holdey' must notify the BuUdin9
il1>1>pectioY1$.. Fai,h.lY4!-~ of'the pa'Ylr!J t holr.::1>!iti' to notify the Huild:!. ng OfHc;i;~J ';:Jf Y;;Jqtll nod
1.n the \1id;.clppase of thO! work until $iJ,ch tj,me: t.hat t,he penl! thrJldtil'( can $IJ.br,;,t:"nt, iz 1;,1,!, .to the bu.i
that the cr:mc:eal<t1<j woyk ~$t$ o.~'exceedc::, ccd," nlqt.!i Yem1'1l"rts.. At'>' demol:itioil'J tfi'$tir.'kS; en'
be OO'!'l1e di Y~ctly bl' the P>P.l'fllit holQ;:J\"" F$,iluy<w to $u.bst;jl,nti.:!ilt~~ (;c:d~ nlJquirements;<. l'li,ll ind&mni )~y
<ls~airnt :!IY'll' and a'll Y~c)'h$ibility 01' habilH>' cc:nmect.!x:.l ~,.dthth",
r heY1fu'b)i certify that I have ,mdeY,:i:Ill1i.y'\iit'd this Dennit kn~1 the $Z!.me to be t:l'-'lj.~~ ax)e1 'CO'(tf.?(:~I~', ~.-, ~!ll
pt't,:'\',/iWif.Yf't.reI crf l~ i!l1'1f:J ciYdil'lal1C~$ 9('f,/e0nins thie t.ype of t>tOrk t;Jill btl\l c..:>lrlPUtl!/d fdHh wh~'bh~'I' $PtiCiH~lCj
t:!y nC'!i:,'i'hi;;J~'~rli::l.nS I:lf' a Pil1i"fl11t OOllili no'!;; l~r'"Utl1@ to 9i\'* authoYity to violate- or can,:""l thij> rm:Jvtfllil:';)f!$l
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I PERMIT CONDITIONS
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Applica'flt: NORDIC SERVICES INC
Owner: ROMINGER & TERRI
Contractor: NORDIC SERVICES INC
Description:
FIRE DAMAGE REPAIR TO
Conditions:
1" SMOKE DETECTORS REQUIRED IN ALL SLEEPING AREAS, ADJACENT
HALLWAYS AND FLOOR LEVELS.
2. I,..JINDOWS IN SL,EEPING AREAS !V!UST t"lEET Et"iERGEr".lC:Y
REQUIREJ1ENTS.
:3. PLAN F:E\/IElJ'-SI IN;~;PEJ':::TIOt'~. CO!''lDITION:3/COi''WiEJ4TS
A) ONE-HOUR FIRE SEPARATIO~ RECUIRED BETWEEN GARAGE TO
RESIDEt'H;::E,
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C) REPLACE POST UNDER BEAM IN LIVING ROOM (DOWN STA )
D) DRAFT STOP WALLS EVERY 10' HORI LY AND AT
OF" \"..lALL.
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'':':0 ,. !:~~\ BREMERTON PERMIT CENTER
. 286 4th Street, 8remert,on, UA 983::'~7
. Phone: (360) 478-S275 FAX:: (360) 478-5278
J()b F-iddress :L316 B~ADLEYST Building Permit No:
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I. (-.!ssr Acct No: ::;~937003-006~OOOO E xp I r 8S ~
R E (1.1) IRE D INS PEe T ION 5
01400 t1ECHp::"NICf'iL 1)5..'..,/ 1.::3~ic~r! ~
01600 PLUI'''18It',IG ROUGI"!'-If',! [)fvislon:
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t_em 01900 SHEETROCK NAILING DE;pt: BLDG n"- ,
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It:-I"'lm: 02700 FINAL~-8LDG f:>i\/is ()r!::
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TING: Must 'r.eiC: f) <;1 by t A~sociation of Building
SPEC Il\ISF>: Must be registered with ~"IA
ST OF IrJr-'1: State of WA Dept. of L fles tl 7 E3 '-.-. it (1:2 1.
HEAL. TH : 8remerton/Ki th
INSPECTIONS)~ERFORMED nIECrT'Y' OF tiREr"IEFnON MlJS;T BE' SCHEDUL.ED THROUGH
PERMIT CENTER. (360),4 .5,
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> - 1'5 0 FRAM<LI 0
~ Bremerton I'liddle Scb. NE. WY()l1ING ST. ~cn
<:. Ij ~ NE.
~ . E. 30TH ISUNsfT NE. WARNER ST. j VIEbl
~ tri VI5T~ E. 30m ST. . 30TH T 3'JTH
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"i1I t!~!5 " e_n ST, '" ",_, "
~.. . State Farm Insurance Companies
ft, ~....: '" ~~ 3260 NW Randall Way
- \' P.O. Box 3483
Silverdalei WA 98383
04/0 /2002
"
Estimate: 47-M093-583R Claim Number: 47-M093-583
Insured: Mark & Terri Rominger Policy Number: 47-CY~5828-1
,
- Home: 1316 Bradley St Type of Loss: Fire
Bremerton, WA 98310-3503 Deductible: $0.00
Price List: WASE4F2AI
Date of Loss: 31212002
Date Inspected: 3/7/2002
,
Summary for Fire
Line Item Total 96,047.22
Sales Tax @ 8.500% x 96,047.18 8,164.01
Replacement Cost Value 104,211.23
Less Depreciation (0.00)
Actual Cash Value (ACV) 104,211.23
Overhead @ 10.0% x 96,047.22 9,604.72
Profit @ 10.0% x 96,047.22 9,604.72
TaX on O&P , 1,632.80
Actual Cash Value (Including Overhead and Profit) 125,053.47
Less Deductible (0.00)
Net Actual Cash Value Payment $125,053.47
"_I~
Al Meeds
(206) 431-1859
ALL AMOUNTS PAYABLE ARE SUBJECT TO THE TERMS, CONDITIONS AND
LIMITS OF YOUR POLICY.
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State Farm Insurance Companies
~~ ~.'"'''''' ".~ 3260 NW Randall Way
P.O. Box 3483
Silverdalei W A 98383
04/0 /2002
Estimate: 47-M093-583R Claim Number: 47-M093-583
e! Insured: Mark & Terri Rominger Policy Number: 47-CY-5828-1
Home: 1316 Bradley St Type of Loss: Fire
Bremerton, W A 98310-3503 Deductible: $ 0.00
Price List: WASE4F2AI
Date of Loss: 3/2/2002
Date Inspected: 3/7/2002
Summary for Fire WtD.~ [JJ:047.22 ~
Line Item Total
Sales Tax @ 8.500% x 96,047.18 8,164.01
Replacement Cost Value 104,211.23
Less Depreciation (0.00)
Actual Cash Value (ACV) w/r~~ C~1.2~
Overhead @ 10.0% x 96,047.22 9, 4.72
Profit @ 10.0% x 96,047.22 9,604.72
Tax on O&P 1,632,80
Actual Cash Value (Including Overhead and Profit) 125,053.47
Less Deductible (0.00)
Net Actual Cash Value Payment $125,053.47
.
AI Meeds
(206) 431-1859
ALL AMOUNTS PAYABLE ARE SUBJECT TO THE TERMS, CONDITIONS AND
LIMITS OF YOUR POLICY.
THIS IS A ROUGH DRAFT ONL Yl THE PURPOSE OF THIS DRAFT IS TO REVIEW THE
SCOPE. THE FINAL DRAFT MA Y BE SUBST ANTIALL Y DIFFERENT THAN THIS DRAFT.
THERE MA Y BE ITEMS ADDED AND/OR DELETED.
POLICYHOLDER: DO NOT USE THIS DRAFT AS A BASIS FOR A CONTRACT WITH A
REPAIR FIRM.
CONTRACTORS: DO NOT USE THIS DRAFT AS A BASIS FOR A CONTRACT WITH A
PROPERTY OWNER.
.
'.
State Farm Insurance Companies
~. Mark ~,Terri Rominger 04/02/2002
47-M093-583R
Interior
) Room: Entry/Foyer Upper Floor
LxWxH 6'2" x 4'0" x 12'10"
Missing Wall: 1 - 6'0" X 4'6" Opens into E
Subroom 1: Stairway Up Formula Stairway 6'5" x 3'1" x 4'10"
Missing Wall: 1 - 3'J" X J2'10" Opens into 0 Goes to Floor/Ceiling
Subr~om 2: Stairway Down Formula Stairway 4'3" x 3' 1" x 3'0"
Missing Wall: 1 - 3'1" X 8'0" Opens into 0 Goes to Floor/Ceiling
Missing Wall: 1 - 4'3" X 8'0" Opens into E Goes to Floor/Ceiling
384.28 SF Walls 61.11 SF Ceiling 445.38 SF Walls & Ceiling
81.71 SF Floor 9.08 SY Flooring 42.55 LF Floor Perimeter
79.14 SF Long Wall 51.33 SF Short Wall 42.80 LF Ceil. Perimeter
CAT SEL DESCRIPTION
V ARlQUAN QUAN UNIT REMOVE REPLACE TOTAL
INS BIl2 + Blown-in insulation - 12" depth - R38
C 61.11 SF Insulation
-
INS BT4+ + Batt insulation - 4" - R 13
LWO 79.14 SF Insulation
)
. DRY 5/8 + 5/8" drywall - hung, taped, floated, ready for paint
C 61.11 SF ~ -
DRY 1/2 + 1/2" drywall- hung, taped, floated, ready for paint
W 384.28 SF
PNT SP + Seal then paint the walls and ceiling (2 coats)
WC 445.38 SF
FCV V + Vinyl tile
FO 24.67 SF Flooring
FCC PAD + Carpet pad
F-FO 57.04 SF Flooring
* FCC AV + Carpet - (material and labor)
1 1.00 EA Flooring
PNT TRD + Seal & paint stair tread - per side
13 13.00 EA
)17-M093-583R Page: 2
I
State Farm Insurance Companies 04/02/2002
-~Mark <%Terri Rominger
PNT RISER + Seal & paint stair riser - per side
12 12.00 EA
FNC MISC + Stairway skirt
(LLl *2)+(LL2*2) 21.33 LF *
PNT MISC + Paint stairway skirt - two coats
21,4 21.33 LF *
DOR X+ + Exterior door - metal - insulated / wood - High grade
1 1.00 EA
FNH DORHX + Door lockset - exterior
1 1.00 EA
FNH DB + Deadbolt
1 1.00 EA
FNH PEEP + Door peep hole
1 1.00 EA
PNT XDOR + Prime & paint door slab only - exterior (per side)
2 2.00 EA
-
PNT DORT + * Paint door trim & jamb (per side)
2 2.00 EA
)WDW P< + Wood window - picture (fixed), 12 - 22 sf
3 3.00 EA
WDR OBS + Add for obscure glass
15.54 15.54 SF
PNT WDW + Seal & paint wood window (per side)
6 6.00 EA
WDT BLND + Window blind - horizontal or vertical
3 3.00 EA Window Cover
FNC IX6 + Trim board - I" x 6" - installed (pine)
5,6 5.50 LF
FNC IX2 + Trim board - I" x 2" - installed (pine)
11,6 11.50 LF
PNT TRIM + Seal & paint trim
11,6+5,6 17.00 LF
/7-M093-S83R Page: 3
. ~---------------
------- -
State Farm Insurance Companies
'.Mark &, Terri Rominger 04/02/2002
FNC HR + Handrail - wall mounted
6,10 6.83 LF
''1 PNT HR + Paint handrail - wall mounted
t 6.83 LF
6,10
LIT FNL + Ceiling fan & light
I 1.00 EA
Room Totals: EntrylFoyer
-
)
) 47-M093-583R Page: 4
"
State Farm Insurance Companies
\ Mark ~. Terri Rominger 04/02/2002
Room: Landing LxWxH 5' 1" x 3'3" x 8'0"
Missing Wall: 1 - 5'1" X 8'0" Opens into E Goes to Floor/Ceiling'
) Missing Wall: 2 - 3'3" X 8'0" Opens into E Goes to Floor/Ceiling
. Missing Wall: 1 - 3'0" X 8'0" Opens into E Goes to Floor/Ceiling
16.67 SF Walls 16.52 SF Ceiling 33.19 SF Walls & Ceiling
16.52 SF Floor 1.84 SY Flooring 2.08 LF Floor Perimeter
40.67 SF Long Wall 26.00 SF Short Wall 2.08 LF Ceil. Perimeter
CAT SEL DESCRIPTION
V ARlQUAN QUAN UNIT REMOVE REPLACE TOTAL
INS BIl2 + Blown-in insulation - 12" depth - R38
C 16.52 SF Insulation
DRY 5/8 + 5/8" drywall - hung, taped, floated, ready for paint
C 16.52 SF , ,-
DRY 1/2 + 1/2" drywall - hung, taped, floated, ready for paint
W 16.67 SF
PNT SP + Seal then paint the walls and ceiling (2 coats)
WC 33.19 SF
.
FCC PAD + Carpet pad
F 16.52 SF Flooring
..,) * FCC AV + Carpet - (material and labor)
1 1.00 EA Flooring
FNC B + Baseboard - 2 1/4"
2,1 2.08 LF
PNT B2 + Paint baseboard - two coats
2,1 2.08 LF
Room Totals: Landing
Room: Living Room LxWxH 14'7" x 14'7" x 8'0"
Missing Wall: 1 - 14'7" X 8'0" Opens into E Goes to Floor/Ceiling
350.00 SF Walls 212.67 SF Ceiling 562.67 SF Walls & Ceiling
212.67 SF Floor 23.63 SY Flooring 43.75 LF Floor Perimeter
I 16.67 SF Long WalJ 116.67 SF Short Wall 43.75 LF Ceil. Perimeter
)47-M093-583R Page: 5
State Farm Insurance Companies 04/02/2002
'Mark &. Terri Rominger
CAT SEL DESCRIPTION
V AR/QUAN QUAN UNIT REMOVE REPLACE TOTAL
-'J
.. INS BI12 + Blown-in insulation - 12" depth - R38
C 212.67 SF Insulation
INS BT4+ + Batt insulation - 4" - R13
LWO+SWO 233.33 SF
DRY, 5/8 + 5/8" drywall - hung, taped, floated, ready for paint
C 212.67 SF
DRY 1/2 + 1/2" drywall- hung, taped, floated, ready for paint
W 350.00 SF
PNT SP + Seal then paint the walls and ceiling (2 coats)
WC 562.67 SF
PNT UL . + Seal underlayment for odor control
F 212.67 SF
FCC PAD + Carpet pad
F - 212.67 SF Flooring
* FCC AV + Carpet - (material and labor)
) 1 1.00 EA Flooring
FNC B + Baseboard - 2 1/4"
PF 43.75 LF
PNT B2 + Paint baseboard - two coats
PF 43.75 LF -
WDW C< + Wood window - casement, 3 - 11 sf
2 2.00 EA
WDW P< + · Wood window - picture (fixed), 3-1 I sf
2 2.00 EA *
PNT WDW + Seal & paint wood window (per side)
8 8.00 EA - -
WDT RU>> + Window shade - roll up - Extra large
1 1.00 EA Window Cover
CLN FPL + · Clean fireplace face & hearth
1 1.00 EA *
) 17-M093-583R Page: 6
.
\ Mark &.Terri Rominger State Farm Insurance Companies
04/02/2002
FPL GDOR + Glass fireplace door
1 1.00 EA
) FPL MNTL- + Fireplace mantel - wood beam or shelf only (per LF)
5 5.00 LF
ORI ORSP + Ornamental iron handrail wi straight pickets, 3' high
9,9 9.75 LF ,
PNT ORI + Prime & paint ornamental iron handrail, 36" to 42" high
9,9 9.75 LF :.
Room Totals: Living Room
Room: Kitchen LxWxH 12'0" x 8'0" x 8'0"
Missing Wall: 1 - 6'0" X 6'8" Opens into E Goes to Floor
Missing Wall: 1 - 12'0" X 8'0" Opens into E Goes to FloorlCeiling
184.00 SF Walls . 96.00 SF Ceiling 280.00 SF Walls & Ceiling
96.00 SF Floor 10.67 SY Flooring 22.00 LF Floor Perimeter
96.00 SF Long Wall 64.00 SF Short Wall 28.00 LF Ceil. Perimeter
) CAT SEL DESCRIPTION
VAR/QUAN QUAN UNIT REMOVE REPLACE TOTAL
INS BIl2 + Blown-in insulation - 12" depth - R38
C 96.00 SF Insulation
INS BT4+ + Batt insulation - 4" - Rl3
LW+SW 160.00 SF Insulation
DRY 5/8 + 5/8" drywall- hung, taped, floated, ready for paint
C 96.00 SF
DRY II2 + 1/2" drywall- hung, taped, floated, ready for paint
W 184.00 SF
PNT SP + Seal then paint the walls and ceiling (2 coats)
WC 280.00 SF
FCV V + Vinyl tile
F 96.00 SF Flooring
) 47-M093-583R Page: 7
\Mark'~ Terri Rominger State Farm Insurance Companies
04/02/2002
FNC B + Baseboard - 2 1/4"
PF-I0,6 11.50 LF
PNT 82 + Paint baseboard - two coats
) PF-I0,6 11.50 LF
FNC DOP> + Door opening trim Uamb & casing) - 36" to 60" opening
1 1.00 EA
WDP 6M2 + 6-06-8 mill finish sliding patio door insulated (2 panes)
1 1.00 EA
WDT BLND>> + Window blind - horizontal or vertical - Extra large
1 1.00 EA Window Cover
PNT DOR1> + * Paint door trim & jamb - Large (per side)
2 2.00 EA
CAB UP + Cabinetry - upper (wall) units
18 18.00 LF
CAB LOW + Cabinetry - lower (base) units
10,6 10.50 LF
CAB CTFL . + Countertop,- Flat laid plastic laminate
15,2 15.17 LF
)MSD TIL + Mirror tile
3 3.00 SF
PLM SNKD + Sink - double
1 1.00 EA
PLM FAU+ + Sink faucet - Kitchen - High grade
1 1.00 EA - .
* APP RGRS + Range - electric
1 1.00 EA Pending
APP HD + Range hood
1 1.00 EA
* APP DWRS + Dishwasher
1 1.00 EA Pending
* APP GDRS + Garbage disposal
1 ].00 EA Pending
LIT FL- + Fluorescent light fixture - Standard grade
)47-M093-583R Page: 8
,Mark'&.Terri Rominger State Farm Insurance Companies
04/02/2002
1 1.00 EA
LIT AV + Light fixture
1 1.00 EA
')
Room Totals: Kitchen
Room: Dining Room LxWxH 12'0" x 10'0" x 8'0"
Missing Wall: 1 - 5'6" X 5'10" Opens into E
Missing Wall: 1 - 12'0" X 8'0" Opens into E Goes to Floor/Ceiling
Missing Wall: 1 - 10'0" X 8'0" Opens into E Goes to Floor/Ceiling
143.92 SF Walls 120.00 SF Ceiling 263.92 SF Walls & Ceiling
120.00 SF Floor 13.33 SY Flooring 22.00 LF Floor Perimeter
96.00 SF Long Wall 80.00 SF Short Wall 22.00 LF Ceil. Perimeter
CAT SEL DESCRIPTION
V AR/QUAN QUAN UNIT REMOVE REPLACE TOTAL
.
INS BI12 + Blown-in insulation - 12" depth - R38
C 120.00 SF Insulation
) INS BT4+ + Batt insulation - 4" - R13
SW 80.00 SF Insulation
DRY 5/8 + 5/8" drywall - hung, taped, floated, ready for paint ,
C 120.00 SF
DRY 1/2 + 1/2" drywall - hung, taped, floated, ready for paint
W 143.92 SF
PNT SP + Seal then paint the walls and ceiling (2 coats)
WC 263.92 SF
FCV V + Vinyl tile
F 120.00 SF Flooring
FNC B + Baseboard - 2 1/4"
PF 22.00 LF
PNT B2 + Paint baseboard - two coats
PF 22.00 LF
WOW P + Wood window - picture (fixed), 23 - 33 sf
)47-M093-583R Page: 9
State Farm Insurance Companies 04/02/2002
,Mark' &, Terri Rominger
1 1.00 EA
PNT WOW> + Seal & paint wood window (per side) - Large
2 2.00 EA
)WOT BLND>> + Window blind - horizontal or vertical - Extra large
1 1.00 EA Window Cover
FNC MISC + Room divider - custom
5,9 5.75 LF *
Room Totals: Dining Room
Room: Hall LxWxH 14'11" x 3'0" X 8'0"
Missing Wall: 1 - 3'0", X 8'0" Opens into E Goes to Floor/Ceiling
Subroom 1: Closet LxWxH 2'11" x 2'2" x 8'0"
Subroom 2: Hall Closet LxWxH 2'2" x 2'0" x 8'0"
-
Subroom 3: Linen Closet LxWxH 2'0" x 1 '8" x 8'0"
) 469.33 SF Walls 58.74 SF Ceiling 528.07 SF Walls & Ceiling
58.74 SF Floor 6.53 SY Flooring 58.67 LF Floor Perimeter
^"l
176.00 SF Long Wall 70.67 SF Short Wall 58.67 LF Ceil. Perimeter
CAT SEL DESCRIPTION
VARlQUAN QUAN UNIT REMOVE REPLACE TOTAL
INS BIl2 + Blown-in insulation - 12" depth - R38
C 58.74 SF Insulation
DRY 5/8 + 5/8" drywall - hung, taped, floated, ready for paint
C 58.74 SF
DRY 1/2 + 1/2" drywall- hung, taped, floated, ready for paint
W 469.33 SF
PNT SP + Seal then paint the walls and ceiling (2 coats)
WC 528.07 SF
PNT UL + Seal underlayment for odor control
F 58.74 SF.
)7-M093-583R Page: 10
.'
State Farm Insurance Companies 04/02/2002
tVlark & Terri Rominger
, -
FCC PAD + Carpet pad
F 58.74 SF Flooring
) * FCC AV + Carpet - (material and labor)
1 1.00 EA Flooring
FNC B + Baseboard - 2 1/4"
PF-13,6 45.17 LF
PNT B2 + Paint baseboard - two coats
PF-13,6 45.17 LF
DOR BIRCH + Interior door - birch - pre-hung unit
3 3.00 EA
FNH DORH + Door lockset - interior
3 3.00 EA
PNT DORS + Stain & finish door slab only (per side)
6 6.00 EA
PNT DORTS + * Stain & finish door trim & jamb (per side)
6 6.00 EA
.
FNC SH12 + Shelving - 12" - in place
LLI +(LL2*5)+(LL3 23.75 LF
) *5)
FNC CLROD + Closet rod
LLI 2.92 LF
FNC A TIIC + Attic entrance cover and trim
1 1.00 EA
ELE CHIME + Door chime
1 1.00 EA
ELE SMOKE+ + Smoke detector - High grade
1 1.00 EA
LIT AV + Light fixture
2 2.00 EA
Room Totals: Hall
)47-M093-583R Page: II
State Farm Insurance Companies
I Mark &r Terri Rominger 04/02/2002
Room: Bedroom 1 LxWxH 10'3" x 8'9" x 8'0"
Subroom 1: Closet LxWxH 3'10" x 2'4" x 8'0"
) Missing Wall: 1 - 3']0" X 8'0" Opens into 0 Goes to Floor/Ceiling
341.33 SF Walls 98.63 SF Ceiling 439.97 SF Walls & Ceiling
98.63 SF Floor 10.96 SY Flooring 42.67 LF Floor Perimeter
112.67 SF Long Wall 88.67 SF Short Wall 42.67 LF Ceil. Perimeter
CAT SEL DESCRIPTION
V ARlQUAN QUAN UNIT REMOVE REPLACE TOTAL
INS BIl2 + Blown-in insulation - 12" depth - R38
C 98.63 SF Insulation
INS BT4+ + Batt insulation - 4" - RI3
SWO 70.00 SF Insulation
DRY 5/8 . + 5/8" drywall - hung, taped, floated, ready for paint
C 98.63 SF
DRY 1/2 + 112" drywall- hung, taped, floated, ready for paint
W - 341.33 SF
PNT SP + Seal then paint the walls and ceiling (2 coats)
) WC 439.97 SF
WPR BORDR+ + Wallpaper border - High grade
PCO 34.17 LF
PNT UL + Seal underlayment for odor control
F 98.63 SF
FCC PAD + Carpet pad
F 98.63 SF Flooring
· FCC AV + Carpet - (material and labor)
1 1.00 EA Flooring
FNC B + Baseboard - 2 ] /4"
PF -2,6 40.17 LF
PNT B2 + Paint baseboard - two coats
PF-2,6 40.17 LF
DOR BIRCH + Interior door - birch - pre-hung unit
1 1.00 EA
)n-M093-583R Page: 12
,MarK &, Terri Rominger State Farm Insurance Companies 04/02/2002
FNH DORH + Door lockset - interior
1 1.00 EA
) PNT DORS + Stain & finish door slab only (per side)
2 2.00 EA
PNT DORTS + * Stain & finish door trim & jamb (per side)
2 2.00 EA
DOR BP+ + Bypass (sliding) door set - birch
1 1.00 EA
PNT BPS + Stain & finish door slab only - bypass set (per side)
2 2.00 EA
WOW C< + Wood window - casement, 3 - 11 sf
1 1.00 EA
WDW P< + * Wood window - picture (fixed), 3-11 sf
1 1.00 EA
PNT WOW + Seal & paint wood window (per side)
4 4.00 EA
.
FNC SHl2 + Shelving - 12" - in place
LLl 3.83 LF
') FNC CLROD + Closet rod
LLI 3.83 LF
ELE BBH< + Baseboard electric heater - 4'
1 1.00 EA
ELE TS + Thennostat - electric heat
1 1.00 EA
ELE SMOKE+ + Smoke detector - High grade
1 1.00 EA
LIT AV + Light fixture
1 1.00 EA
Room Totals: Bedroom 1
) 47-M093-583R Page: 13
,,-
State Farm Insurance Companies 04/02/2002
M~rk & Terri Rominger
I .
Room: Bedroom 2 LxWxH 10'6" x 10'3" x 8'0"
Subroom 1: Offset LxWxH 6'11" x 1 '1" x 8'0"
1 Missing Wall: 1 - 6'11" X 8'0" Opens into 0 Goes to Floor/Ceiling
Subroom 2: Closet LxWxH 3'10" x 2'4" x 8'0"
Missing Wall: 1 - 3'10" X 8'0" Opens into 0 Goes to Floor/Ceiling
386.67 SF Walls 124.06 SF Ceiling 5lO.73 SF Walls & Ceiling
124.06 SF Floor 13.78 SY Flooring 48.33 LF Floor Perimeter
170.00 SF Long Wall lO9.33 SF Short Wall 48.33 LF Ceil. Perimeter
CAT SEL DESCRIPTION
VAR/QUAN QUAN UNIT REMOVE REPLACE TOTAL
INS BIl2 + Blown-in insulation - 12" depth - R38
C 124.06 SF Insulation
INS BT4+ + Batt insulation - 4" - Rl3
LWO+SWO+SWl+S 193.33 SF Insulation
W2
DRY 5/8 + 5/8" drywall - hung, taped, floated, ready for paint
.
C 124.06 SF
DRY 1/2 + 1/2" drywall- hung, taped, floated, ready for paint
) W 386.67 SF
PNT SP + Seal then paint the walls and ceiling (2 coats)
WC 510.73 SF
WPR BORDR+ + Wallpaper border. High grade
PCO+PCl 39.83 LF
PNT UL + Seal underlayment for odor control
F 124.06 SF
FCC PAD + Carpet pad
F 124.06 SF Flooring
* FCC AV + Carpet - (material and labor)
1 1.00 EA Flooring
FNC B + Baseboard - 2 1/4"
PF-2,6 45.83 LF
) 47-M093-583R Page: ] 4
, Mark ~ Terri Rominger State Farm Insurance Companies 04/02/2002
PNT B2 + Paint baseboard - two coats
PF-2,6 45.83 LF
-) DOR BIRCH + Interior door - birch - pre-hung unit
1 1.00 EA
FNH DORH + Door lockset - interior
1 1.00 EA
PNT DOR + Paint door slab only (per side)
2 2.00 EA
PNT DORT + * Paint door trim & jamb (per side)
2 2.00 EA
WDW C< + Wood window - casement, 3 - 1 I sf
2 2.00 EA
WDW P< + * Wood window - picture (fixed), 3-1 I sf
2 2.00 EA
PNT WDW + Seal & paint wood window (per side)
8 8.00 EA
-
FNC SH12 + Shelving - 12" - in place
(4*6,10)+(4*1,8) 34.00 LF
)FNC CLOSW- + Shelving - wire (vinyl coated)
12,6 12.50 LF
ELE BBH< + Baseboard electric heater - 4'
2 2.00 EA
ELE TS + Thermostat - electric heat
1 1.00 EA
ELE SMOKE+ + Smoke detector - High grade
1 1.00 EA
LIT FNL + Ceiling fan & light
1 1.00 EA
Room Totals: Bedroom 2
3,205.98
)47-M093-583R Page: ) 5
.'
State Farm Insurance Companies
,Mar\{ &.Terri Rominger 04/02/2002
Room: Bedroom 3 LxWxH 12'10" x 10'3" x 8'0"
Subroom 1: Closet LxWxH 6'11" x 2'4" X 8'0"
) Missing Wall: 1 - 6'11" X 8'0" Opens into 0 Goes to Floor/Ceiling
406.67 SF Walls 147.68 SF Ceiling 554.35 SF Walls & Ceiling
147.68 SF Floor 16.41 SY Flooring 50.83 LF Floor Perimeter
158.00 SF Long Wall 100.67 SF Short Wall 50.83 LF Ceil. Perimeter
CAT SEL DESCRIPTION
VAR/QUAN QUAN UNIT REMOVE REPLACE TOTAL
INS BIJ2 + Blown-in insulation - 12" depth - R38
C 147.68 SF Insulation
INS BT4+ + Batt insulation - 4" - RI3
LWO+SWO+SWl 203.33 SF Insulation
DRY 5/8 + 5/8" drywall- hung, taped, floated, ready for paint
C 147.68 SF
DRY 1/2 + 1/2" drywall- hung, taped, floated, ready for paint
W . 406.67 SF
PNT SP + Seal then paint the walls and ceiling (2 coats)
) WC 554.35 SF
PNT UL + Seal underlayment for odor control
FO 131.54 SF
FCW FIN + Sand & finish wood floor (natural finish)
Fl 16.14 SF
FCC PAD + Carpet pad
F-Fl 131.54 SF Flooring
* FCC AV + Carpet - (material and labor)
1 1.00 EA Flooring
FNC B + Baseboard - 2 1/4"
PF-2,6 48.33 LF
PNT B2 + Paint baseboard - two coats
PF-2,6 48.33 LF
DOR BIRCH + Interior door - birch - pre-hung unit
1 1.00 EA
)47-M093-583R Page: 16
State Farm Insurance Companies 04/02/2002
,Mark &, Terri Rominger
FNH DORH + Door lockset - interior
I 1.00 EA
) PNT DOR + Paint door slab only (per side)
2 2.00 EA
PNT DORT + * Paint door trim & jamb (per side)
2 2.00 EA
WDW C< + Wood window - casement, 3 - II sf
2 2.00 EA -
WDW P< + * Wood window - picture (fixed), 3-11 sf
2 2.00 EA - *
PNT WOW + Seal & paint wood window (per side)
8 8.00 EA
FNC SHI2 + Shelving - 12" - in place
11 11.00 LF
FNC CLOSW- + Shelving - wire (vinyl coated)
7,3+7,3+3,6 18.00 LF
-
ELE BBH< + Baseboard electric heater - 4'
2 2.00 EA
) ELE TS + Thermostat - electric heat
I 1.00 EA
ELE SMOKE+ + Smoke detector - High grade
1 1.00 EA
LIT AV + Light fixture
I 1.00 EA
Room Totals: Bedroom 3
2,977.35
Room: Bathroom LxWxH 7'11" x 5'0" X 8'0"
) 47-M093-583R Page: 17
.Mark &. Terri Rominger State Farm Insurance Companies 04/02/2002
Subroom I: Offset LxWxH 2'11" x 2'3" x 8'0"
Missing Wall: 1 - 2'11" X 8'0" Opens into 0 Goes to Floor/Ceiling
242.67 SF Walls 46.15 SF Ceiling 288.81 SF Walls & Ceiling
) 46.15 SF Floor 5.13 SY Flooring 30.33 LF Floor Perimeter
86.67 SF Long Wall 58.00 SF Short Wall 30.33 LF Ceil. Perimeter
CAT SEL DESCRIPTION
V AR/QUAN QUAN UNIT REMOVE REPLACE TOTAL
INS, BII2 + Blown-in insulation - 12" depth - R38
C 46.15 SF Insulation
INS BT4+ + Batt insulation - 4" - R 13
SWO 40.00 SF Insulation
DRY 5/8 + 5/8" drywall- hung, taped, floated, ready for paint
C 46.15 SF -
DRY 1/2 + 1/2" drywall - hung, taped, floated, ready for paint
W 242.67 SF
PNT SP + Seal then paint the walls and ceiling (2 coats)
WC . 288.81 SF
WPR BORDR+ + Wallpaper border - High grade
) PC 30.33 LF
FCV V + Vinyl tile
F 46.15 SF Flooring
FNC B + Baseboard - 2 1/4"
PF-13,7 16.75 LF
PNT B2 + Paint baseboard - two coats
PF-13,7 16.75 LF
DOR BIRCH + Interior door - birch - pre-hung unit
1 1.00 EA
FNH DORB + Door lockset - interior
1 1.00 EA
PNT DORS + Stain & finish door slab only (per side)
2 2.00 EA
PNT DORTS + · Stain & finish door trim & jamb (per side)
2 2.00 EA
) 47-M093-583R Page: 18
State Farm Insurance Companies
I Mark &, Terri Rominger 04/02/2002
WDA AV<++ + Aluminum window, horiz. slider 3-11 sf(2 pane w/thermal)
1 1.00 EA
)'FNC WOP + · Window wrap
8,10 8~83 LF
TIL SIL4 + Window sill- tile on 2" x 4" wall
2 2.00 LF
MSD AV + Mirror - J/4" plate glass
1,4*4,8 6.22 SF
CAB MC+ + Medicine cabinet - High grade
1 1.00 EA
CAB VAN + Vanity
2,3 2.25 LF
CAB CTFL + Countertop - Flat laid plastic laminate
2,4 2.33 LF
CAB BS + Backsplash - plastic laminate
2,4*.5 1.17 SF
.
PLM SNK + Sink - single
1 1.00 EA
) PLM F AUBA + Sink faucet - Bathroom
1 1.00 EA
PLM TLT+ + Toilet - High grade
1 1.00 EA
PLM TLTS + Toilet seat
1 1.00 EA
PLM TUB+ + Bathtub - High grade
1 1.00 EA
TIL TUB + Tile tub surround- up to 60 SF
1 1.00 EA
PLM TSFAU + Tub/shower faucet
1 1.00 EA
FNH SROD + Shower curtain rod
1 1.00 EA
) 47-M093-583R Page: 19
-----------------
State Farm Insurance Companies 04/02/2002
I Mark &; Terri Rominger
FNH BAC + Bath accessory
1 1.00 EA
') ELE MISC + Baseboard electric heater - 2'6"
1 1.00 EA *
ELE TS + Thermostat - electric heat
1 1.00 EA
LIT BAR5 + Light bar - 5 lights
1 1.00 EA
Room Totals: Bathroom
Area Totals: Upper Floor
2,925.53 SF Walls 981.56 SF Ceiling 3,907.08 SF Walls & Ceiling
1,002.16 SF Floor 111.35 SY Flooring 363.22 LF Floor Perimeter
1,131.81 SFLongWall 765.33 SF Short Wall 369.47 LF Ceil. Perimeter
Area Items Total: Upper Floor
-
>> Lower Floor
Room: Recreation Room LxWxH 14'6" x 12'0" x 7'8"
406.33 SF Walls 174.00 SF Ceiling 580.33 SF Walls & Ceiling
) 74.00 SF Floor 19.33 SY Flooring 53.00 LF Floor Perimeter
1) 1.17 SF Long Wall 92.00 SF Short Wall 53.00 LF Ceil. Perimeter
CAT SEL DESCRIPTION
V AR/QUAN QUAN UNIT REMOVE REPLACE TOTAL
INS BTlO + Batt insulation - ) 0" - R30
C 174.00 SF Insulation
INS BT4+ + Batt insulation - 4" - Rl3
LW 111.17 SF Insulation
DRY 5/8 + 5/8" drywall- hung, taped, floated, ready for paint
C 174.00 SF
) 47-M093-583R Page: 20
-------------
--
State Farm Insurance Companies 04/02/2002
,MarK &. Terri Rominger
DRY 1/2 + 1/2" drywalI- hung, taped, floated, ready for paint
W 406.33 SF
') PNT SP + Seal then paint the walls and ceiling (2 coats)
we 580.33 SF
PNT UL + Seal underlayment for odor control
FO 174.00 SF
FCT BCEMl/4 + 1/4" Cement board
4,4 * 4,5 19.14 SF Flooring
FCT AV + Tile floor covering
19.14 19.14 SF Flooring
FCC PAD + Carpet pad
F-19.14 154.86 SF Flooring
* FCC AV + Carpet - (material and labor)
1 1.00 EA Flooring
DOR BIRCH + Interior door - birch - pre-hung unit
2 2.00 EA
.
FNH DORH + Door lockset - interior
2 2.00 EA
)PNT DOR + Paint door slab only (per side)
2 2.00 EA
PNT DORS + Stain & finish door slab only (per side)
2 2.00 EA
PNT DORT + * Paint door trim & jamb (per side)
2 2.00 EA
PNT DORTS + * Stain & finish door trim & jamb (per side)
2 2.00 EA
WDW C< + Wood window - casement, 3 - II sf
1 1.00 EA
WDW P< + * Wood window - picture (fixed), 3-11 sf
1 1.00 EA *
PNT WDW + Seal & paint wood window (per side)
4 4.00 EA
) 47-M093-583R Page: 21
I
-------~------
State ~'arrri insurance Companies 04/02/2002
I M'at1< & Terri Rominger
FNC SH12 + Shelving - 12" - in place
24 24.00 LF
FNC MISC + Shelving - 6" - in place
) 7*3,10 26.83 LF *
ELE BBH> + Baseboard electric heater - 8'
1 1.00 EA
ELE TS + Thennostat - electric heat
1 1.00 EA
ELE SMOKE+ + Smoke detector - High grade
1 1.00 EA
LIT AV + Light fixture
1 1.00 EA
Room Totals: Recreation Room
2,701.46
-
)
) 47-M093-583R Page: 22
I
'Marl< &'Terri Rominger State Farm Insurance Companies 04/02/2002
Room: Closet Formula Sloped Ceiling 8'0" x 3'1" x 7'8"
107.14 SF Walls 30.23 SF Ceiling 137.37 SF Wafls & Ceiling
'} 24.67 SF Floor 2.74 SY Flooring 22.17 LF Floor Perimeter
25.77 LF Ceil. Perimeter
CAT SEL DESCRIPTION
V ARlQUAN QUAN UNIT REMOVE REPLACE TOTAL
INS BTIO + Batt insulation - 10" - R30
C 30.23 SF Insulation
DRY 5/8 + 5/8" drywaIl - hung, taped, floated, ready for paint
C 30.23 SF
DRY 112 + 112" drywaIl - hung, taped, floated, ready for paint
W 107.14 SF
PNT SP + Seal then paint the waIls and ceiling (2 coats)
WC 137.37 SF
PNT UL + Seal underlayment for odor control
FO 24.67 SF
-
FCC PAD + Carpet pad
F 24.67 SF Flooring
) AV + Carpet - (material and labor)
" * FCC
1 1.00 EA Flooring
ELE SMOKE+ + Smoke detector - High grade
1 1.00 EA
LIT AV + Light fixture
1 1.00 EA
LIT POR + Porcelain light fixture
1 1.00 EA
Room Totals: Closet
Room: Master Bedroom LxWxH 15'0" x 13'0" x 7'8"
)47-M093-583R Page: 23
I
State Farm Insurance Companies
,Ma'rk &,Terri Rominger 04/02/2002
Subroom 1: Offset LxWxH 8'8" x 8'5" x 7'8"
Missing Wall: 1 - 8'5" X 7'8" Opens into 0 Goes to Floor/Ceiling
- Missing Wall: 1 - 6'0" X 6'8" Opens into E Goes to Floor
) 522.22 SF Walls 267.94 SF Ceiling 790.17 SF Walls & Ceiling
267.94 SF Floor 29.77 SY Flooring 67.33 LF Floor Perimeter
181.44 SF Long Wall 164.19 SF Short Wall 73.33 LF Ceil. Perimeter
CAT SEL DESCRIPTION
V AR/QUAN QUAN UNIT REMOVE REPLACE TOTAL
FRM SH1X6TG + Sheathing - I" x 6" - tongue and groove
267.94 267.94 SF Framing
FRM 4LF +Studwall-2"x4"x8'-16"oc
12 12.00 LF Framing
FRM 2XI2 + 2" x 12" lumber (2 BF per LF)
16*4 64.00 LF Framing
INS BTIO + Batt insulation - 10" - RJO
C 267.94 SF Insulation
INS BT4+ - + Batt insulation - 4" - RI3
LWO+SWO+SWl 279.19 SF Insulation
'" DRY 5/8 + 5/8" drywall- hung, taped, floated, ready for paint
)
C 267.94 SF
DRY 1/2 + 1/2" drywall - hung, taped, floated, ready for paint
W 522.22 SF
PNT SP + Seal then paint the walls and ceiling (2 coats)
WC 790.17 SF
FCC PAD + Carpet pad
F 267.94 SF Flooring
* FCC AV + Carpet - (material and labor)
1 1.00 EA Flooring
DOR BIRCH + Interior door - birch - pre-hung unit
2 2.00 EA
FNH DORH + Door Jockset - interior
2 2.00 EA
) 47-M093-583R Page: 24
State Farm Insurance Companies 04/02/2002
,Mark &.Terri Rominger
PNT DOR + Paint door slab only (per side)
4 4.00 EA
')PNT DORT + · Paint door trim & jamb (per side)
4 4.00 EA
WOP 6M2 + 6-06-8 mill finish sliding patio door insulated (2 panes)
1 1.00 EA
WOW C< + Wood window - casement, 3 - 11 sf
2 2.00 EA
WOW P< + * Wood window - picture (fixed), 3-11 sf
2 2.00 EA *
FNC WOP + * Window wrap
35 35.00 LF
PNT WDW + Seal & paint wood window (per side)
4 4.00 EA
CLN FPL + * Clean fireplace face & hearth
1 1.00 EA *
.
FPL SCR+ + Fireplace screen - High grade
1 1.00 EA
)ELE SMOKE+ + Smoke detector - High grade
1 1.00 EA
LIT AV + Light fixture
1 1.00 EA
Room Totals: Master Bedroom
4,093.94
)47-M093-583R Page: 25
------
~--~------~-~-----~
State Farm Insurance Companies
, Mark ~ Terri Rominger 04/02/2002
Room: Walk-in Closet LxWxH 7'8" x 4'3" x 7'8"
182.72 SF Walls 32.58 SF Ceiling 215.31 SF WaIls & Ceiling
') 32.58 SF Floor 3.62 SY Flooring 23.83 LF Floor Perimeter
58.78 SF Long Wall 32.58 SF Short Wall 23.83 LF Ceil. Perimeter
CAT SEL DESCRIPTION
VAR/QUAN QUAN UNIT REMOVE REPLACE TOTAL
FRM SHIX6TG + Sheathing - I" x 6" - tongue and groove
32.58 32.58 SF Framing
INS BTIO + Batt insulation - 10" - RJO
C 32.58 SF Insulation
INS BT4+ + Batt insulation - 4" - RI3
LW+SW 91.36 SF Insulation
DRY 5/8 + 5/8" drywall - hung, taped, floated, ready for paint
C 32.58 SF
DRY 1/2 + 1/2" drywaJl- hung, taped, floated, ready for paint
W 182.72 SF
-
PNT SP + Seal then paint the walls and ceiling (2 coats)
WC 215.31 SF
) FCC PAD + Carpet pad
F 32.58 SF Flooring
* FCC AV + Carpet - (material and labor)
1 1.00 EA Flooring
FNC CLOSW- + Shelving - wire (vinyl coated)
WW*10 42.50 LF
LIT AV + Light fixture
1 1.00 EA
Room Totals: Walk-in Closet
Room: Bathroom LxWxH 11'2" x 6'5" x 8'0"
Missing Wall: 2 - 8'0" X 7'0" Opens into E Goes to Floor
) 17-M093-583R Page: 26
"
I "
----
'Mark &- Terri Rominger State Farm Insurance Companies 04/02/2002
169.33 SF Walls 71.65 SF Ceiling 240.99 SF Walls & Ceiling
71.65 SF Floor 7.96 SY Flooring 19.17 LF Floor Perimeter
89.33 SF Long Wall 51.33 SF Short Wall 35.17 LF Ceil'. Perimeter
') CAT SEL DESCRIPTION
V ARlQUAN QUAN UNIT REMOVE REPLACE TOTAL
INS BTI'O + Batt insulation - 10" - R30
C 71.65 SF Insulation
INS, BT4+ + Batt insulation - 4" - R13
SW 51.33 SF Insulation
DRY 5/8 + 5/8" drywall - hung, taped, floated, ready for paint
C 71.65 SF
DRY 1/2 + 1/2" drywall- hung, taped, floated, ready for paint
W 169.33 SF
PNT SP + Seal then paint the walls and ceiling (2 coats)
WC 240.99 SF
FCV V + Vinyl tile
F - 71.65 SF Flooring
DOR BIRCH + Interior door - birch - pre-hung unit
) 1 1.00 EA
FNH DORH + Door lockset - interior
1 1.00 EA
PNT DOR + Paint door slab only (per side)
2 2.00 EA
PNT DORT + * Paint door trim & jamb (per side)
2 2.00 EA
WDA AV<++ + Aluminum window, horiz. slider 3-11 sf(2 pane w/thermal)
1 1.00 EA
FNC WOP + * Window wrap
9,4 9.33 LF
WDR OBS + Add for obscure glass
2*2,8 5.33 SF
CAB MC+ + Medicine cabinet - High grade
1 1.00 EA
) 47-M093-583R Page: 27
-~--------- ---- --------~- _ ____n_n__________"
State Farm Insurance Companies 04/02/2002
IMatk &. Terri Rominger
CAB VAN + Vanity
2 2.00 LF
) MBL VTSNK + Vanity top - one sink - cultured marble
2 2.00 LF
PLM F AUBA+ + Sink faucet - Bathroom - High grade
1 1.00 EA
PLM TLT + Toilet
1 1.00 EA
PLM TLTS + Toilet seat
1 1.00 EA
PLM SWR + Fiberglass shower unit
1 1.00 EA
PLM TSFAU + Tub/shower faucet
1 1.00 EA
MSD SDOR + Shower door
1 1.00 EA
.
FNH BAC + Bath accessory
3 3.00 EA
) PLM WBOX + Washing machine outlet box with valves
1 1.00 EA
HVC DVENT + Clothes dryer vent - installed
1 1.00 EA
ELE FAN + Exhaust fan
1 1.00 EA
LIT BAR5 + Light bar - 5 lights
1 1.00 EA
Room Totals: Bathroom
) 47-M093-583R Page: 28
State Farm Insurance Companies
.Mark &,Terri Rominger 04/02/2002
Room: Garage LxWxH 24'0" x 21 '1 0" x 8'0"
Missing Wall: 2 - 8'0" X 7'0" Opens into E Goes to Floor
621.33 SF Walls 524.00 SF Ceiling 1,145.33 SF Walls & Ceiling
') 524.00 SF Floor 58.22 SY Flooring 75.67 LF Floor Perimeter
192.00 SF Long Wall 174.67 SF Short Wall 91.67 LF Ceil. Perimeter
CAT SEL DESCRIPTION
V AR/QUAN QUAN UNIT REMOVE REPLACE TOTAL
CLN. AV + Clean the walls and ceiling
WC 1,145.33 SF
PNT SP + Seal then paint the walls and ceiling (2 coats)
WC 1,145.33 SF
CLN CNC + Clean concrete on the floor
F 524.00 SF
PNT CNC + * Paint concrete on the floor
F 524.00 SF
CLN X + Clean exterior door (per side)
2 . 2.00 EA
PNT XDOR + Prime & paint door slab only - exterior (per side)
) 2 2.00 EA
PNT DORT + * Paint door trim & jamb (per side)
2 2.00 EA
CLN OH + Clean overhead door & hardware
2 2.00 EA
PNT OH + Paint/finish overhead door (per side)
4 4.00 EA
CLN WO< + Clean window unit (per side) 3 - 9 SF
4 4.00 EA
PNT WOW + Seal & paint wood window (per side)
8 8.00 EA
Room Totals: Garage
Area Totals: Lower Floor
2,009.08 SF Walls 1,100.41 SF Ceiling 3,109.49 SF Walls & Ceiling
) 47-M093-583R Page: 29
-
State Farm Insurance Companies
.Mark &.Terri Rominger 04/02/2002
1,094.85 SF Floor 121.65 SY Flooring 261.17 LF Floor Perimeter
632.72 SF Long Wall 514.78. SF Short Wall 302.77 LF Ceil. Perimeter
-
)Area Items Total: Lower Floor
General
Room: Floor Coverings
CAT SEL DES{:RIP1:ION
VARlQUANH QUAN- UNJ-T. REM{)\lE REPLACE 'faTAL
FCC PAD + Carpet pad
U-19.2S- l-,119.25-SF.
)FCC AV + Carpet - (material and labor)
1179.25*1.15 1,356.14 SF
FCV V + Vinyl tile
810.82. 81o.a2-SF
FCT BCEM 1/4 + 1/4" Cement board
19.14 19.14 SF
FCT AV + Tile floor oo,vering
19.14 19.14 SF
Room- 'fotaIs:.. F~ Coverings
, )47-M093-S83R Page: 30
. Mai.1c &: Terri Rominger State Farm InsuraD~e Companies
04/0212002
Room: Window Coverings
,.,-,
')
CAT SEL DESCRIPTION
VARlQUAN QUAN UNIT REMOVE REPLACE TOTAL
WDT BLND + Window blind - horizontal or vertical
3 3.00 EA
WDT BLND>> + Window blind - horizontal or vertical- Extra large
2 2.00EA
WDT RU>> + Window shade- rolluf}-Extra large
1 1.00EA
Room Totals: Window Coverings
AreaTotals; General
- "rea Items Total: General
)
AreaT etals: Interior
4,934.61 SF Walls 2,081.97 SF Ceiling 7,OJ.&.58 SF Walls & Ceiling
2,097.01 SF Floor 233.00 SY Flooring 624.39 LF Floor Perimeter
1,764.53 SF LongWaU 1,230.11 SF SlwrtWatt 672:24 LF Ceil: Perimeter
Area ItelM Total: Interior
Exterior
Room: W Exterior Formula Elevation 4&'0" x... x 17'0"
Missing Wall: 1 - 6'0" X 11'2" Opens into E Goes to Floor
Missing Wall: 1 - S'O" X 7'0" Opens into E Goes to Floor
~093.S83R Page: 3 1
. .
Mark & Terri Rominger State Farm Insurance Companies
04/0212002
Subroom I: Garage Extension Formula Elevation 10'0" x ... x 8'6"
, ')
Missing Wall: I - 8'0" X 7'0" Opens intoE Goes to Floor
586.00 SF Walls 586.0'0' SF Walls & Ceiling
28.00 LF Floor Perimeter
765.00 SF Long Wall 765.00 SF Short Walt 50.00 LF Ceil. Perimeter
CAT SEL DESCRIPTION
'~
:. V ARlQUAN QUAN UNIT REMOVE REPLACE TOTAL
INS HWRAP + House wrap (air/moisture barrier)DuPont Tyvekorequal
W 586.00 SF I~lation
SDO VINYL + Siding - vinyl
W 586.00 SF
SFa FACV + Fascia - vinyl coated aluminum, 4"- 6"
PC+6 56.00 LF
PNT SFTW + Prime & paint exterior soffit - wood
56*2 tt2.00 SF
LIT X + Exterior light fixture
- 1 1.00 EA
Room TotalS: W Exterior
Room: S Exterior Formula Elevation 27'0" x ... x 8'6"
Subroom 1: Lower Section Formula Elevation 24'0" x ... x 4'0"
406.50 SF Walls 406.50 SF Walls & Ceiling
51.00 LF Floor Perimeter
40650 SF Long Wall 406.50' SF Short Wall 53.55 LF Ceil. Perimeter
CAT SEL DESCRIPTION
VARlQUAN QUAN UNIT REMOVE REPLACE TOTAL
INS HWRAP + House wrap (air/moisture barrier) Du Pont Tyvek or equal
W 406.50 SF Insulation
p VINYL + Siding - vinyl
W 406.50 SF
47-M093-S83R Page: 32
I
. ~ .
Mark It. Terri Rominger State Farm Insurance Companies
04/02/2002
.r )>FG FACV + Fascia - vinyl coated aluminum, 4"_ 6"
PC 53.55 LF
SFG SFTW + Soffit - wood
24 24.00 SF
PNT SFTW + Prime & paint exterior soffIt- wood
PC*2 107.09 SF
Room TotalS: S Exterior
Room: E Exterior Formula Elevation 40'0" x ... x 17'0"
Missing Wall: 1 - 6'0" X 6'8" OpensJnto E
Missing Wall: 1 - 6'0" X 6'8" Opens into E Goes to Floor
Missing WaUl 1 - 5'6" X-S'lO" Opens-intoE
Subroom 1: Garage Extension Formula Elevation 10'0" x... x 8'6"
652.92 SF Walls 652.92 SF Walls & Ceiling
~ )
44.00 LF Floor Perimeter
765.00 SF LongWaU 765~OO SF-ShortWalt 50.00 LF CeiL Perimeter
CAT SEL DESCRIPTION
VARlQUAN QUAN UNIT REMOVE REPLACE TOTAL
INS HWRAP + House wrap (air/moisture barrier).Du Pont Tyvek or equal
W 652.92 SF Insulation
SDG VINYL + Siding - vinyl
W 652.92 SF
SFG FACV + Fascia - vinyl coated aluminum,A"- 6"
PC+6 56.00 LF
PNT SFTW + Prime & paint exterior soffit - wood
56*2 112.00 SF
LIT X + Exterior light fixture
1 1.00 EA
/,.m Totals:- E E~rior
47-M093-583R Page; 33
.
. - -'
Mark & Terri Rominger State Farm Insurance Companies
04I02QOO2
/)
Room~N [xt,erior Formula Elevation 27'0" x ... x 8'6"
Subroom 1: Lower Section FormulaElevatioo24'0" X'... ~ 8'6"
514.50 SFWalls 514.50 SF Walls & Ceiling
51.00 LF Floor Perimeter
514.50 SF Long Wall 5-1450 SF Short WaU- 53.55 LF Ceil. Perimeter
CAT SEL DESCRIPTION
V ARlQUAN QUAN UNIT REMOVE REPLACE TOTAL
INS HWRAP + House wrap (air/moisture barrier)Du Pont Tyvek or equal
W 514.50 SF In~latjon
SDG VINYL + Sidin~ - vinyl
W 514.50 SF
SFG FACV + Fascia - vinyl coated aluminum, 4"- 6"
PC*2 Un:.09 LF
- )T SFTW + Prime & paint-exterior sofflt- wood
PC*4 214.19 SF
Room Totals: N Exterior
Area Totals: Exterior
2,159.92 SFWaUs 2,159.92 SF Walls & Ceiling
174.00 LF Floor Perimeter
2.45 LOO SF Long Wan 2,451.00 SF- ShortWaU 207.09 LF Ceil. Perimeter
Ar.ea Items Total: Exterior
)
47-M09~-583R Page: 34
I
. :-
Mark &. Terri Rominger State Farm Insurance Companies
04102/2002
r-) General
Room~F~jng
CAT SEL DESCRIPTION
V ARlQUAN QUAN UNIT REMOVE REPLACE TOTAL
FRM SHlX6TG + Sheathing- I" x 6" - tongue and groove
302 302.00SF *
FRM 4LF + Studwall-2"x4"xS'-16"oc
12 12.00 LF *
FRM 2Xl2 + 2" x 12"lumber (2 BE per LF)
16*4 64.60. LF *
-
)om TotalS: Framing
Room: Electrical
CAT SEL DESCRIPTION
V ARIQUAN QUAN UNIT REMOVE REPLACE TOTAL
ELE REWIRE + Rewire - average residence - copper wiring
3288 3,288.00 SF
ELE MISe + Wiring trim out
3288 3,286.00 SF *
ELE BPNL200 + Breaker panel - 200 amp
1 1.00 EA
)
47-M093-S83R Page: 35
.
. . .
Mark &. Terri Rominger State Farm Insurance Companies
04/Of/2002
C-) CONTINUED - electrical
CAT SEL DESCRIPTION
V ARlQUAN QUAN UNIT REMOVE REPLACE TOTAL
ELE METR + Meter base and main disconnect - 200 amp
1 1.00 EA
ELE LV + Pbone / low voltage copper wiring
310 310.00- LF-
Room Totafs: Electrical
Room: Plumbing
-)
CAT SEL DESCRIPTION
V ARlQUAN QUAN UNIT REMOVE. REPLACE TOTAL
PLM ROUGH + Rough in plumbing - includes supply and waste lines
3280-524 2~756.00 SF
PLM WB40E + Water heater - 40 gallon - Electric
1 1.00 EA
Room Totals: Plumbing
)
47-M093-S83R Page: 36
. -
State Farm Insurance Companies
Mark & Terri Rominger 04/0212002
Room: Insulation
)
CAT- SEL DESCRW{ION
V ARlQUAN QUANUNIT REMOVE REPLACE T~T AL
INS Bll2 + Blown-ininsulation-. 12" depth-. R38
1080 1,080.00 SF
INS BTIO- + llattinsulation-lO" -R.30
676 676.00 SF
IN& BT4+ + Battinsulation-- 4" - R 13
1593- ~593.00-SF
INS HWRAP + House wrap (air/moisture barrier) Du Pont Tyvek or equal
2166. 2,.l60.00-SF
Room Totals: Insulation
)
Room: Heat; Vent; &(;oQI
CAT SEL DESCRIYflON
VARlQUAN QUAN UNIT REMOVE REPLACE TOTAL
RVe FRFAH>> + Furnace. fmcedaif: . high efficie~y -120;OOOB-TU
1 1.00 EA
HVC DCl>> + Ductwork system -hot or cold air - 2200ttt 2500 Sf110me
1 1.00 EA
)
47.M093.583R Page: 37
. . .
State Farm Insurance Companies
Mark &. TeniRominger 0410t/2002
~
) CONTINUED. Heat. Vent, ~ Cool
CAT SEL DESCRIPTION
VARlQUAN QUAN UNIT REMOVE REPLACE TOTAL
RVe TS++ + Thennostat - Premium grade (programmable)
1 1.00 EA
Room Totals: Heat, Vent, & Cool
Room: Temporary Repairs
-JT SEL DESCRIPTION
V ARlQUAN QUAN UNIT REMOVE REPLACE TOTAL
TMP POWHU + Temporary power - hookup
1 1.00 EA *
TMP POW + Temporary power usage (per month)
4 4.00 EA
TMP TIT + Temporary toilet (per month)
4 4.00 EA
R.ooJaTotals:- Temp9l1U"y- R~pairs
)
47.M~-S83R Page: 38
I
, ~ ....
State Farm Insurance Companies
Mark It Terri Rominger 04102/2002
Room: Demolition
r)
CAT SEb DESCRfPl'ION
VARlQUAN QUAN UNIT REMOVE REPLACE TOTAL
WRH MISe + General demolition
224 224.00 DR *
WRH MiSe + Dumpster load - Large
4 4.00 EA *
RoomTotaIc- De~jtion
Room: General Requirements
~ )
CAT SEL DESCRlRTION
VARlQUAN QUAN UNIT REMOVE REPLACE TOTAL
PNT SWALL 4- * Smoke seal open framing
7628 7,628.00 SF
CLN GN + General clean - up
40 40.00 HR
FEE TIPF + * Taxes, insurance, permits & fees
1 1.00 EA *
RoomTotals: GeoeratlU!quire~ents
Area Totals: General
)
47-M093-583R Page: 39
. ----
, c "',
State Farm Insurance Companies
Mark &, Terri Rominger 04/0212002
/ ~alteJRS.Totak ~eraJ
I
,
Line Item Totals: 47-M093-583R
~rand Total Areas:
7,094.53 SF Walls 2,081.97 SF Ceiling 9,176.49 SF Walls & Ceiling
2,097.01 SF Floor 233.00 SY Flooring 798.39 LF Floor Perimeter
4,215.51 SF Long Wall 3.,131. n Sf Short Wall- 87934 LFCeii. Perimeter
- )
)
41-MO-93-583R Page: 40
.
7_-. -------- ~
BREMERTON PERMIT CENTER
286 4th Street;$ Bremerton~ WA 98337
Phone: (360) 478-5275 FAX: (360) 478-5278
BUILDING PERMIT
Job Addr; 1316 BRADLEY ST Permit No: 02-0177
Location: Status: PENDING
Parcel No: 3937003-006-0000 Applied: 04/18/2002
Issued:
I Applicant: NORDIC SERVICES 792-2565 Expires:
I po box 1492 bremerton
I
I Owner: ROMINGER MARK & TERRI
1316 BRADLEY ST BREMERTON WA 98310
Contractor: NORDIC SERVICES INC 792-2565 Lic #; NORDISI180QA Exp: 01-01-2004
9618 NIDVALE N SEATTLE WA 98103
Subcontr:
Desc: FIRE DAMAGE REPAIR TO RES
*********************************************************************************************
valuation * Permit Fees: 1,076.80 Total Calculated Fee: 1,713.59
96,047.00 * Plan Check Fees: 632.29 Additional Fees: .00
* Other Fees: 4.50 Total Permit Fee: 1,713.59
****************~~**************************************************************************
ME:CHANICAL/PlUMBI!\TG'~ FIXTURES-- ME:CH-Range. . . . . . . . . . . . . . . . . . . ~ 1 ME:CH-Exhaust Fali$............: 1
MECH-Range Hood (yes)".." . . . . : 1 PLB6-Water Close~ ...........: 1 PL86-Bathtub................. : 1
PLBG-Lavato'r"y. . . . . . . . . . . . . . . . : 1 PLBG-Kitchen Sink. . 1 PLBG-Dishwasher..............: 1
PLB6-Water Heatey............: 1 ~.~ ,'/
r---...
- \~ 4 - J3 -oJ-,
\
************************************************ ***** **********'" ******
This permit shall become null and void if the building or work authori d by this permit is not commence ithin
180 days horn the date of such permit, 01' if this building or ~-JOrk autho ized by such permit is suspended or
I abandoned at any time after the woyk is commenced foy a peYiod of 180 days.
I NOTICE - It is the yesponsibility of the peymit holdey, not the City of Byemerton 01' Building Official to see
I to it that yequiYed inspections aye made. The peymit holdey must notify the Building Official when yeady foy
inspections. Failuye of the peymit holdey to notify the Building Official of yequiYed inspectioli$ may result
I in the stoppage of the work until such ~ime that the pe .~ h del' can substantiate to the building official
that tho eo """ed WOy k .. r ~ c ye..,ire nt. 11 t . , t~j ~. '" fi """,i., buydon .hall
be "'me di' tly b t Pc ho doy, . 0 · ant' .., . y_nt. will i ndomni fy the City
agaili$t any all ~e n 'bi ity 0 iab' it 0 ted wi 0 tru tic.
V . . ~
I hereby ceytify that I have yead and examined this oJ to ~ t a coyyect. All
provisions of laws and oydinances ning this iyp of ~i~ wi h whethey specified heyein
01' not. The granting of a peymi t do $I no l' 0 g' e ~9t>.;; 0 ViOla~l the provisions of
I any othey state 01' local law yegulati ,~truction oy the rfoymance of co ' '0' ~
Signatuye: {~n I :sS tA-Q Date:
r certify that I ., exempt fyom the y~i,...nts of the state contractoy's Y..istration ,.w, undey
Section 3, c~te~ laws of 1967.
Signature: 'V.. Date:
I ........................... ~ i kJ
Permit Center--Approved By: - '. - Date; ~l '7 ~
I .. -
r ,~..'ij i'( . ".:::'" ;).!~~'fJJ',~~'~~"~'~<\i::~;>~~'l!'T't~!ft';~:'!P0\' ~ . ~~.~-C'~ -
BREMERTON PERMIT eNTER
2(Jq 4th Street" Etr'~'fij~rton.~ MA 9833,7
Phone: (360) 478":"""5275 l:l-lK:: ( }
BUILDING PERMIT,
1316 BR~jOLEY ,i ',;
3937003~006~OOOO
rlPplicant~ 'NORDIC SERVICES Ires,
po box 1492 ton
O~mer, ROrlINGER.MARK g, TERRI
1316 BRADLEY $T BREMERTON WA 98310
Contr act 61": NORDIC SERVICES INC f,f:: NOF<DJSUf:lOQA Exp:
.~. IO.lIA.Lt". 1..1 CO::'" TT "Q
'r ' v;, ,c. 'l( o.JL t"t r r Wt I
Subf'ont 1" ~ \
, 'l,.,'. ..," '\,
FIRE REPAIR
****************~**** ******************
Valuation * Permit Fees: 076.80 Total Calculat Fee: 1,7 .59
96.047.00 * Plan C k: 632.29 Additional F~p"' .00
. . .'. ~~.~,_,Ot iJ:;"',s'::/J~. ..' '~41/Scvl__, Total i. Fee: . ',,713.59
*' *.*;!;' % ':i\..' 11<.'. * "."':1( \t. ">lOi::)\:' Y/'. .'" ';/1(.. ~., '*.' )f::.;e.'i(. )jr )((.'. .' 'k.'.'.';')". i"g 'l: '.*' '#. 'if; '.i1 Ylf:!'j(f' 'KK: 'j. '. ..':li'&)f::.t '~~..'... ..',4 '* in :.;0:;:1(* "'." ?t.) W)I! *' * * *' *,:4( ,y..:, . )f""" '1<' *' '*.')\(;<< *. n. "IC!C!( '* ')1';<< *' ){C'l' itn>::
^,' ", ",' '."~'{""'" ..l"r~..", <",'- ",,{..'''i''A/:\:.''\\~ l'"",:;,,,, '"\'',:~;7'~?''' '~,..~<.. '". ';'f-\" '~:+~'.~'" ",~_"_i'!'_" ""'_,if-.+.,.". ~,," 'f,-f., ~.~. ,. ,_,f, '",
~1ECHN~rCAlf~',-J)~1BIN8 Fl~. .TI~:ES- ..#/ v' -i'1i:::Ct,1rR""'t<?:n.. .', ;"):; .:(/" .>(", ..V I';:" MECH-f;:' 'la\,t,,'..(: Pa:(l$...."............:\ 1
',!CC'c.I,.R..~l''''1''" "","it,d ) . . ',;>1 "",.,_",/L,..-(.,"----.....1'. . < n; B' ~."l,J..I'b' .. \1
j.t;.;.....r.. _<,.;!.\ii~t.. r-l....-,-,......., ,'~";.;,,,,>I"'''' !-!.....~~!..;"r f(y~( ,,,4U::z,J/~,.,""'.. ....;-T~....",. "t, , rl,,,,, ~ i:;)a.....f!I~..,~_"'"..."'.."'''''''''''',..",'',."',,.., \
" ~,. \I'" .' ,,' ;:, -.."",.' :'i '. '" I' j' 'I \ \.
~,'LBI." U!i,ato\')'.... n'"'' n. H'''.t , LI?:,I.~ 1',Jt<;,IMi 5111,(..", ""/";L.,'t.-) ,
PLI;l..6~J;;):l;,ey He(ll.t""YH"...". ." , ; ), .
1--\ "J'. .~....." J j'" I i
\~\i~ 4 - (}3 -O~ .... ......
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This perm! t. S1Jhall be~ null and void if thebuildins; 01' t~od~ a,uthodz<<:d bythi$ petmit is not C;OlnfllenC€!'c\,;,pithin ,
1$0 days h'QIlI t,he date: of $uch p,?ymit. o,..if th1$ building Or' ,.,IO,K al.lH'!m' zed by :\.;u.::h pemld, is $uspend>&d
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abantJonecl at al"I;" time afti' the 'i'!o1'k _(;:ommell?'ed fcn :!\ f~nc I?'q lSC'da)' .
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NOnCE - It i, ty", r o~~" bi ,it~'; of 'er,? p~rmXt i{jl!tki.~", r,t t.h. fi~'f' >:;:,f o/~n'? to, .... ", 1:;0 !~1i'".
1;:0 it that '(.'#L.k '. tl~)Ye.l!:@J.,.j}.,-;r(,e~~~j;I hdldf.:'Y O\'!i"tI.-+A2,.iz1h'; th~ lEdjn~~ Of Lei ,3.1 ; ,'hE'll '((;0',:9.0)/
il1$pectioT1S. Failuye of tho" penn':!t hold~,r' t,o l10dfy the i?,:Uj,ldin::il IJff'ici,d of yeql,titoo In:ppl\Jctionl$ may result
in t,he $topP"',~ 'Of t~WCIYK until sud! time 't.hat: thG hold,,"c can A'j(1bStiC\\iti8:b';! to t.rce b,iilding oi"fici~1,1.
t.h$:t th$' ct:1T1Cealed Ido'(kl'OO.!ft;S 01' Coi~,~!equh'~lMl'llt,$~ Any del'l101H,ion. tll'St:inSl. 0, financiiZi.l bunj"m :3!1al1
bOI"11e di, rl.!'Ctly by the pennit hCJlcki.'(" Fa:l.1i.l,Y,,", t.o $lJ:bet.a.nl;,iate c.od<<:' qU 1 indr.Z1l1rdfy the City
~,,:t..Hl'1$t any alil.,1 all YIl'SPor~$ibi1it.)i or HabUit,>, r;";onn?)cj~ed ",lith tho!! cI,?n;"h'uction.
I hey(~bl" c>€wti,fyths,t I have re"d ~i?.i.:j e;>\<1.m1nfi!'e! '~hi$ p"n.01i.t andknc"i\<.J trn- $~).n"" to bi;; t\"\,l'cl ~':1,1"Id All
p'(ovisioT1$ c)'1' law$ .:1\nd o1"din:"lr~::,,*s ,;;c,v\W'(ningthis type of hloYk l"Jin be c. ',,,,'j w:i.th 1^!het.i~Y spr!lcifi~)d h~Yein
OY not. Jh~ Q,n~,l''I't,ir19of <I, p~i'(rni,t (.it,;,e'S. no~:. pn,,~ume ,t;,Q give ;!;:w:tho\'ibc: ,l ,t'tc,lal~~"r"':'''''t the p"(()\/h:,inns of
:any oth,",'( sbate Of" It;:Jc:'i!\l I cO\1$t'(ucUor, Of' t~; per. ~ llC1>' ,;)1' C~;P$iO\lctiorJ'
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I thi:\t r. am horn t"':\!',> ~<&,<uil{>rn,mts f" t $t$.tiPofl..t t}~:'~b:A'OOI1 .';;~Ai\..o.' :.ial./u u.n,;y~....
SEct 1 nn :3, of 1. ::!67, '\'f.-}/" f/lZJ;-V; V l/i.
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Permit Cent er--Approved. 8,':......".,_,____..._,___.... Oat e: __.,'-;'..__",-____...______,..
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BRllI'lERTON pEJ<l'IIT CENTllR
Apr 29, 2002
NORDIC SERVICES rNC
pO BOX 1492
BREMERTON WA
98310
SUBJECT: APpli.cation NO: 02-0177
site Address: 1316 BRADLE'L ST
we have received your application and find we do not have ~he info~ation
required to process it prom~tlY. Please prov~de the follow~nq
info~ation as soon as poss~ble.
1. please provide a site plan. It can either be drawn to scale
or dimensioned. please find the enclosed sample.
YOur application will be routed to other ,citY departmentS f~ r~~i~W'~her
During this process, additional info~at~O~ ma~ be requeste. ,ud-.
info~ation is required, the complete appl~cat~O~ must be,resuom~tte
with the updated info~ation. you will be not~f~ed bY th~s department
when the approval or disapproval dec~s~on haS been made.
If yOU have anY questiOns regarding thiS matter, please call me at
(360) 478-5275.
SincerelY,
. r !
I I JJ tllvJ.-
~ilding and DevelOpment specialist
Building Permit Application Od-0L77
c<o ~ ~
City of Bremerton, W A 98337 Phone: (360) 478-5275 Fax: (360) 478-5278 S.p,,? ~
APPLICAL'l"T: DOWNER ~CONTRACTOR DAUTHORIZED AGENT
Sire .-\Jdress: J 3 I b {:j eA-DLC y 5, T1X .\ccount :\;umber: ..:s ct ~ 7 - Do3-091..o ODDo
1312eM~}J WA- 98'3/0-3503
O\\-ne:: A'14-/2j:: i -r-e:R.R...I eOMIAJ6l5R .-\ddress: ;5.A./1.1C
C'JnC:-:lGor:lI/'oI2..PtC ~V(c::.e::s INC .-\ddress:
(~onC::1Cror License::;:: /lJd/2.:J)!51180QA-
Cont:J.ct Person: 5~ Allc.-MAAJUS COnt:J.ct Phone:t: ~ ~ let 2.- 2 S~S-
Check the type of application for below:
o SF RESIDENTIAL NEW o COMMERCIAL NEW o GARAGE
o DCPLEX o COMMERCIAL REMODEL o ACCESSORY BLDG
o lYL\l'WFACTURED HOME o COMMERCIAL ADDITION o SIGN
o RESIDENTIAL REMODEL o COMMERICAL REPAIR o DEMO
o RESIDENTIAL ADDITION o :vn:LTI-FAJ.vfILY o Gfu\DING (Cubic yards: )
~ RESIDENTIAL REP.I\lR o TENA..l"J'T IMPROVEMENT o OTHER:
73~ 57Vl75 St!&A-rtIIAJ6
~~ S
'"
Square Footage: D\veiling: / 5" 7 3 Gauge: S27-' Decks:
IS THIS PROPERTY WITHIN 200 FEET OF .-\. SHORELINE? x'ES NO K
Valuation Plan Review Fee I Permit fee Surchar es .; Total Fees i
9tpp4:l~ :'" Energ::: S50.00 .--.
, State: S -1-.50
A,pplicanons for which no permit is issued \vithin 180 days follo",ing the date of application shall expire by limitation, and plans
and other data sub mined for teview may thereafter be retumed to the applicant or destroyed by the building official. The building
official may extend the time for action by the applicant for a period not exceeding 180 days on request by the applicant 5howing
that circumstances beyond the control of the applicant have prevented action from being taken. No applicant shall be extended
more than once, In order to renew action on an application after expiration, the applicant shall resubmit plans and pay a new plan
reVle,;>- tee.
APPLICANT'S SIGNATURE: ~~ ~ DATE: ~/;r/o2-
ATS/C1411 LAND DATA FOR: 3937-003-006-0000 04/23/02
- ,
PROCESS# 1479856 BLDG 01 OF 01 ID RS14 DATE 03/14/97
;- APPR. CMNT: ANNUAL UPDATING --
11101 - -
_,_ LU
ZONE S3 A T S C W V 0 C PISfLAY ONLY
--- - - - ' - - -
ACRES .17 C 0 E 0 F I T 0
- - - ' --
C P R V T E H N
QUANT - - ffs - - - 'w - 'R - - --
MTH RATE S 0 R T (SEE SUMMARY SCREENS FOR)
-S-- 21000 -- -- ------
_1)__ 1 B C (CURRENT TAXABLE VALUES )
- - - - -- - - - ' - ,
1 S 23100 B PS C
- - - - - - -- - - --
,2 - - - , - - - , -- - - -- INDICATED VALUES:
- - - ' - -
- - - - - - - - - - - \
3 BLDGS 91,930 92,220 4.-------
- - - - - - - - - - - - -- - - - - r, - ~v
LAND 21,000 23,100
- - - - - - - - - , -- - - - - -- - -
A TOTAL 112,930 115,320
- - - - - - - - - - -, - - - , --
-:- -- - ~ ~ -- DATE 03/14'/97 - ,
LAND COMMENTS: ID RS14
AVG UTIL
AVG UTIL
ATS/T0250 CURRENT SUMMARY FOR 3~37-003-006-0000 #1479856 04/23/02
Tax Yr Land Bldg, etc. Total
- -
ROMINGER MARK A & TERRI L 2002 21000 91930 112930
340HNVAP98 2003 ( 23100) ( 92220) ( 115320)
- -
WILSHIRE MORTGAGE Situs
1776 SW MADISON ST 1316 BRADLEY ST 0
- - -
: PORTLAND OR 972051715 -
- - .
StatILe: T/0035 HOLLIS 1ST ADDN (MORE DESCRIPTION ON FILE) - -
~Land use: 11101 . - THE WEST 10.70 FEET OF LOT 6 AND THE EAST 61.30 FEET OF LOT
.17 . - 7, BLOCK 3, HOLLIS 1ST ADDITION, ACCORDING TO PLAT RECORDED
:Acres:
LMap #: ROIN-I05G.)N VOLUME 8 OF PLATS, PAGES 55 AND 56, IN KITSAP COUNTY,
Date Price Tp Ie Excise no_" Id Date Comments:
, 0898 109950 W EX 9807093 MG01 020422 ANNUAL UPDATING
- -
, 0198 91647 W TE 9800729 MG01 010419 ANNUAL UPDATING
-- 0198 . -
91647 D TE 9800728 MG01 000210 ANNUAL UPDATING
0993 109950 W 9307756 MG01 990506 ANNUAL UPDATING
- - - -
0390 Q QC 9003337 MG01 980124 ANNUAL UPDATING
- -
II ad -Dil7
[]: )'n...:..':.':;~e~~:'.{r:n.:n.::.H.':Wmcr:. '..'....'....:'..:":' .PLUMlJ~Qm@:t.....m:.m::@'::(~
Type of Fuel: Electric Gas Oil
Occupancy: Residential Commercial
Site Address: 131ft, T3l2A-ue-( sT 13.~IZro,u WfI-
i . Owner: . ~D,A1t vGl!51e- Contractor: A/OeDtC ZIZV ~ t 1lfC-
Address: t .."31.~ B/ZAblEo/ s-r Address: RO. 13t',J( t qCJ2-
BIV!7/4'l!5fZ--wftJ wA- B~~oI./ WA- ~3 7
Phone: 3f.RO-7c; 2 - 07" S- Phone 3tbo- 792. - ~5ft,5
Contractor's License Number/Expiration Date:
tvOlZV IS' ,g:-oQ,4 Ol/o//c;~
.
No. TYPE OF EQUIPMENT No. TYPE OF FIXTURE
l RANGE --1-. WA1ER CLosET
WOOD/PEllET STOVE(GAS FIREPLACE ---L- BATIfTUB
GAS FURNACE bm: ~ LAVATORY (bath sink)
CONVERSION BURNER btu: SHOWER
-!:f+ ~=F':b~"''''''U~~'' ~ :r==K
GAS PIPING e 6 f.. LAUNDRY TRAY
EVAPORATION COOLERS btu: CLOTIfES WASHER
AC UNIT bm: ~ WA1ERHEA1ER
HEAT P1JMP btu: URL."iAL
REHE.-\T BOX btu: DRlL"JKmG FOUNTAIN
AIR f-IAJ.'\TDLL."l G UNIT btu: FLOOR SINK OR DRAIN
J E.~CST FANS1B IJ':!fbf. SLOP SL.'\TK
I RA.."JGE HOOD (residential) WA1ER PIPING & AL1ERATION
RANGE HOOD (commercial) GREASE TRAP (INTERCEPTOR
CLOTHES DRYER HOSE BIBBS
INCIN~RATOR LAWN SPRINKLER SYSTE.\f
DUCT AL1ERATION SWIMMING POOL
TANKS type: BLDG. SEWER: (mobile/moved house)
REFRIGERATION UNIT -
ROOF DRAINS
OTIffiR: 01BER:
MECHANICAL FEES5d- .05
PLUMBING FEES: 5d-.. () D
CITY SURGL\.RGE:
TOTAL FEES: .. //
APPLICANT'S SIGNATU~ t4f~ DATE: tt;'(~z---
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