HomeMy WebLinkAboutCHESTER AVE., 1020
BREMER TON PERMIT CENTER
~ 2864th Street~ Bremertan~ WA 98337
Phone: (360) 478-5275 FAX: (360) 478-5278
BUILDING PERMIT
Job Addr= 1020 1/2 CHESTER AVE
Location: 8:5MI . U tJI,\
Parcel No~
Permit No: 01-0213
Status: ISSUED
Applied: 04/25/2001
Issued: 04/25/2001
Expires: 10/22/2001
Applicant: HALL. SUSAN 373-3097
1020 CHEST~R AVE BREMERTON WA 98337
Owner: HALL. SUSAN 373-3097
1020 CHESTER AVE BREMER TON WA 98337
Contractor: SUNOANCE SOLAR 373-1974
3301 W HWY 16 PORT ORCHARD WA 98366
Lic #: SUNOAS*066MG Exp: S/1~/2001
Subcontr=
Oase: NEW FREE-STANDING GAS FIREPLACE. GAS PIPING
w.~~~**********************************~**~***~***********************************************
Valuation * Permit Fees: 40.40 Total Calculated Fee: 40.40
.00 * Plan Check fees: .00 Additi~al Fees: .00
* Other Fees: .00 Total Permit Fee: 40.40
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MECHMlICAL/Pl,UMBING FIXTURES-- I'1ECH-Wood/Pellet Stove.......: 1 MECt-1-.Gas Piping (outlets)....: 1
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This pennit shall become 111..111 and void if t.he building 01' wor.k authodzoo by this peymit is not commenced within
180 days from the date of such permit. 01' if this building 01' WOYk authoYi:red by such permit is suspended or
abandOned at an)' time afUH' the work is <:Qmmenced for a p,wiod of 180 daY$-
NOnCE:. - It is the YElsportsibilit}' of the peyrnit hold,,"''', not the Cit>' (:-1' BYel\1l~\'t.on 01' 6uildi119 Official to see
to it'tlYdt tttquired inspections aye made>. The pen,lit rl<:d.Oel' must notify the )Buildirl9 Official when ready 1"0'(.
inSpecHons.. Faihlye of the peYMit hold~r to nr.;ltHy the Building Official 01' Yequin~d i'r1$pactions may yesult
in the stoPpage of t./w woyk until such time that the pli!ymit holde!' can substantiate to the- building official
that the concealed Woyk meets or exceeds code requin~ments. Any demolition. tes.li119. 01' financial buyden shall
be txnne direct!>' by the permit holdeI'. Pailure to substantiate c~ requjyemerrl:.s will indelllnj:fy the City
a9",inst any and all reSponsibility 01' liability cortnected with the conetl'uction-
I !1eyeby ceytify that 1 have read and e>w.mlned this per'mit and krow the :!lame to be tyue and con'ect. All
p,'ovisions of laws and or'dinances govenli!19 this type of woyk will b& complied with wheUleY specified herein
or rot. The 9yantins o'f a permit does not pYiI!$Ul!le to give authoYity t.o violate 01' cancel the pl'ovisio'flS of
any othE' atat. Of' local laM r~lJlat.in9 constYl.ll::Hon 01' the pedormance of COr\::Sltyuction,
.4./llfJ1 L~.----._-- Oate:_,:.4-e'e-Dl
I t~yU that I 8.rn e,xempt from t~ yequir@ments of the state contractOl":;; n~9istration la~I.. under
Section 3., Chaptel' 126. laws of 1967.
siGnatti.Ye:_..~____,~____._.______,________._ Oate:____
~*U~)IOJ:U~>K**ll\ltol()!;:u*nu*** / /J J ., A~ ') c:: 0
Pe::rnut Ceflter-~Approved BY:-4..~-...---_. Date:__==r:_:::::..~_:- (
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BREMERTON' P~~MIT CENTER
286 4th Street., Brem'e.rton, tJA 98,337
Phone: (360) 478-5275 FAX: ('360) 478-5278
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Building Permit No: 01-0213
Status: ISSUED
Issued: 04/25/2001
Expires: 10/22/2001
Job Address: 1020 1/2 CHESTER AVE
Location:
f~ssr Acct No:
R E QUI RED
INS PEe T ION S
Item: 01400 MECHANICAL
Dept:. SLDG
Division:
************************************************************~********************
TESTING: Must be reco~nized by the Washington Association of 8uildingOffit:ials
SPECINSP: Must be registered with the state of WA
S1' OF W?1": State of WA Dept" of Labor and ,1 ndust r les 478--4921
HEALTH: Bremerton/Kitsap Health District 478-5235
ALL INSPECTIONS PERFORMED BY THE CITY OF 8REMERTON MUST BE SCHEDULED THf-<OUGH THE
PERMIT-CENTER, (360) 478-5275.
*********~ **********************************************************************
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~ · RECEIPT
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PE IP f NUlfiben 0iOOO:nS t-HllOlHlt: ,,40..40 04/25/01 09 ~ 3'1
Payment Mlt~od: CK Notation: HALL tKlnit= VW
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":)1 t,'f'!.inddress, lOi~() 1/'2 CHf:ST\;:R IWE
rotal Fee8~ 40.40
{his Payment 40.40 Total ALL Pmtsc 40.40
Baldnce: .00
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flCCCHH'Jt (>)d'i:~ Oe::J,crir>t 1011 AnWt,lnt
1~-322.1005 (2215) MECHANICAL PERMIT FEES MO.40
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nr-.I:_.~~__-c______~_ P!-UMllINGn__.. .
. . MECHANICAL .....
Type of Fuel:
Occupancy:
Electric
Residen tial
Gas ---- :=LQiL._~ Propane
Commercial
Owner:
?u~. .,.. ~~+ p.~+
Contractor: \f) \J
Address: 330\ l.;J \-1.~'-l \~
J :me.
Site Address: t 0 z..OIJz. t.'ne~-t~\
-t.
Address:
\02.0 ~e,::')"t~ QU ~
-i- "1
Phone: .3
1&,0 -
Phone
~
Contractor's License Number/Expira60n Date:
~u.~ t:A6 ~ Otolt1 m<;
5-19-200\
No. 'IYPE OF EQUIPMENT No. 'IYPE OF FIXTURE
RANGE W AIER CLOSET
"'- WOOD/PELLET STOVF..jGAS FIR WLACE) J !, , ... BA'mTUB
GAS FURNACE btu: -~ -/ 17 Y 1; F" q LAVATORY (bath sink)
-
CONVERSION BURNER bIll: V C SHOWER
UNIT HEA1ER btu: KITCHEN SINK n ~(~I~U\Y7~
BOILER btu: DISHWASHER LJ
A
I GAS PIPING LAUNDRY TRAY j ~ ArK l. ~ lUUl
EVAPORATION COOLERS bIll: CLOIHES WASHER BREMERTON
AC UNIT btu: WA1ER HEAlER BUILDING DEPARTMENT
HEAT PUMP btu: URINAL
REHEAT BOX btu: DRINKIN(~ FOUNTAIN
AIR HANDLING UNIT btu: FLOOR SINK OR DRAIN
EXHAUST FANS SLOP SINK
RANGE HOOD (residential) WATER PIPING & ALlERA'nON
RANGE HOOD (commercial) GREASE TRAP /INTERCEPl'OR
CLOlHES DRYER HOSE BIBBS
INCINERATOR LAWN SPRINKLER SYSTEM
DUCT ALIERATION SWIMlVIlNG POOL
TANKS type: BLDG. SEWER: (mobile/moved house)
REFRIGERATION UNIT ROOF DRAINS ~ ~
0IBER: OllIER: / ,..h.f' \
LYV~ J
MECHANICAL FEES:
PLUMBING FEES: 40 .9 V
CITY SURCHARGE:
TOTAL FEES:
/ .0'
J ., . . .""2\-' 5-0
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API LTCAN1 S SIGNATURE., (~/Jl t gp
DAlE.
2
VICINITY MAP
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\ru APR 2 5 2001 ~
BREMERTON
BUILDING DEPARTMENT
Scope of work:
Address: 0
Contractor:
BllEMElll'ON BUILllIN(; DEI.AlrrMEN1'
PlulubinglMechanlcallnspectioll Ileport
I)enllit Nunlb~r: 0 (- Oc7Ll3
oWller:~ HtJ lj" j~t:;:nq 7
I)bolle:' I A' 0 ',3:., 3.;38K-
U nd,:~t (I Ol~~~?!....1].!.1.!!.'.!-~~e!I) . _~~1'!.r_!!_~.!.'IL&~.r.P~~(
12" millimulII hdo~r::ule whell t111dcrgrolllul -- _~.~~~<:'..I!~.!_a.rJ?<:<.I_~~C:'!_~J(leTow,~ or withih 6" of cartll
Grolll;J~;J~~lio-;-', I';J~ibi~~Xjn ce';;~i',~I<;~;j~ nushill~s IIot :lllo~d in collccak(l ueu
GA...4i I)IPING
COMMENTS:__,
GAS PIPING APPROVED:
Manufacturer', ,~fi~E~ns o!-,-~_ite L>o.t~.?!!.!...OI:...~.!.!!~pr.<!.~(
Ckaranoe to colllbustihk, _V~~'-~!Ig: duulloc 10 (:()lOhuslibla
----- --
Vellt siti,']L lie s~l'portlconnectiOl-" Vent termin;a,tion
______w___
Combustion air C1~illl~~: li,J~":2-I1d!..?.!:...!CJ?aratc:ll'lC3 ;n required
G:lS shllt-off withill 3' Pi.~~e~~I<x1 off_~_~.!:...i!!Jl.~~e
-----------
Ducts: she & support/insulated when requir<xl Return air
FURNACE
COMMENTS:
FURNACE APPROVED:
Ma.,~.r~~,~~,:r's speollations Oil site ~_t.i~!.'..!..!cces~~l'J)on
Cbr:lllcc to (:()lIIbllStihb Venting: de:luncc to combll8lihla
-- -----_.- -,---------.--
VeJ!~~iti_~'g & support/collncctio!1s Vent termill:lItioll
-----~-
Comhllscioll air Ch~J1uey: Hiler aluUor scpara,te nues a5 required
Gas Ihut-off wit/liu 3' Woo>l15tove &. fi~9'!2_a:s.:l'!..~C2rth
Wood 5tova: EPA a.rr.roved -- __g,~.'~!:l.~':.t~ltt-off -
Wood s{Ova &. (jrg>~~: Li~~t fining dOOr! Gas Ihut-oIT witllin 3'
----~---
MISC. APPLIANCES
COMMENTS:
MISC. APPUANCES APPROVED:
WATER DEATER
Mantlfacture~_(jc.a.~iolU O~I ,ite locatio!.'!... a~~.~.Ff.ort
Ckarallce to combustibles Vt;n~~'l;: ~ral_lce to combll5tibles
Vent ,izh~~~H..<<?rtlcon~i~~ Vent termination
--..----- ----
Combustion air C~}..!!~ney: liner and/or ~_rate nues all required
Gas sllUt-offwitllin 3' Pil~,t e~~!..~~i!_~~0~:,-!!ge
Gale valve on coM ~~ 5~1'1'.1y Relief valve draiue<1 to olltsi<le
-- _.~_._._.- ---- ---"-_._-----
Copper to g:llvalli~~~~~~~on. Uni~.!..?~wa~~~
Scillllic BfU.p
COMMENTS:
WATER HEATER APPROVED:
ALL WORK UNDEIt TIllS PERIDT APPIIOVIID:
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L.ocation:
Pt:rfcEd, No:
BREMERTON PERMIT CENTER
286 4th streetg Bremertong bJA 98337
Phone: (360) 478-5275 FAX: (360) 478-.5278
BUILDING PERMIT
IOd--O~ ~
Per m i t No:
App 1 t cant: DEPEE I DONAt,1)
1 ()~~ 1!::; GLENWOt1D RD.
B9S"".8Sf.lO
POfH or~CHAF<D, WA, 9B~jt:)6
Si;.a.t~.~~] :
Applied~
I Bsu(-!ld:
l:::xp'l.r€l*l{:f
99"'"()::i4~1 r n
I~:;~::~;!::::~~: ~/Vt~~J
09/~:'7/1999 ',1 I tJtJ
09/t.:~7/19fI9 Cf;()4
03IL~5/20()O
Owm~r: CH I LDS, !,EN
1. 020 CHESTER AVE Br~EMEFrrON WA 98337
Subcontr:
895''''8::;80 t, 1. c W: DI~~PEED~'()5E)LB Exp l 04l:30nOOO
POF~T ORCHARD '~'" WA" 9B2~66
Contractor: DEPEE, DbNAIJ)
1. O~~\ 15 GLFNWOOD RD.
Dt.%1IC: GAS. FUf~NACE ~GAS '. PIP J NG
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ValuatIon * Permit Fees: .82.30 Total Calculated Fee: 32.30
,,00 * Plf.H1 Cht~r.:;k Fees: ,,00 A.ddj.t:i.oT'lal Fee~3: .00
,* Other Feer~: .()() Total P~;rmi.t Fee: a~:~,,::.IO
*********************************************************************************************
MECHANICAL/PLUMBING FIXTURES":- MECH-Wood/Pellet Stove....".: 1 MECH-Gas Piping (outlets),....: 1
".
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This permit shall become null and void if the building or work authorized by this permit is not commenced within
180 days fn;m the date of such permit, or if this building or work authorized by such permit is suspended or
abandoned at any time after the work is commenced for a period of 180 days"
NOTICE - It is the responsibi Ii ty of the permit holder. not the C:i ty of Bremerton or Building Official to see
t.o it that required inspections are made. The permit holder mlJst notify the Building Official when ready for
inspections. Fa"ilureof the permit holder to notify the Building Official of required inspections may result
In the stoppage of the work until such time that the permit holder can substantiate to the building official
that the concealed work meets or exceeds code requirements. Any demolition. testing, or financial burden shall
be borne direct 1y by the permit holder. Failure to substant iate code requirements wi 11 indemni fy the Ci ty
against any and all responsibility or liability cormected with the construction.
I hereby certify that I have read and examined this permit and know the same to be true and CQrrect. All
provisions of laws and ordinances governing this type of work will be complied with whether specified herein
or not. T~a;:Fng of a permit does not presu.e to give authority to violate or cancel<lhe provisions of
::~::::_:~_;;a;:::_::_:::_per::::::_::_:::::::::~_______,,__
I certify that I am\exernpt from the requirements of the state contractclr's registration laW', under
Sect ton 3, Chapter 126, laws of 1967. /
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~:::~~:;;;.,;.;;.*;;*i....*;;;.-;f;r--+---------------- Date: 0---:;-:-7------;=;----- .
Perm] t Ct:mtr::lr--"".APP,(,ovf.:lt:J ny//W"",_""""""",,. Dt1te~~ ,..,"'..........,._.--:I...-:~__., -- VJ q
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BREMERTON PERMIT CENTER
286 4th Stre~t. Breme.rton, WA98337
Phone: (360). ,478-5275 FAX: (360) 478-5278.
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5PtCINSP: Must be reg:i.stered with the State of WA
::;;"1" . OF' lAlA:: State!oi:;"~'WA Dapt" of L..i:1boy' and Industr j,e*:~ 478....-4921
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f~t:~ CE: I PT N\Hflt::H::J't" ~ 990008'?O (~mount:: 3~? : :::<() 091?1/9'l' :! b:: S::;j
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MECHANICAL
PLUMBING:.
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Oil
Type of Fuel:
Occupancy:
Ele
esiden cial
/
Site Address:
Contractor:
Owner:
Address:
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Address:
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Phone
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Contractor's'License Number/Expiration Date:
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- h/'€ 6 fe I '~
O'~~et::- f)
dJd'",l1}
"7' 1
No.
TYPE OF EQUIPMENT
No.
TYPE OF FIXTURE
WATER CLOSET
BA TIITI..'B
LAVATORY (bath sink)
SHO'W'ER
KITCHEN SINK
DISHWASHER
LAUNDRY TRAY
CLOTIIES WASHER
WATER HEATER
URINAL
DRINKING FOUNTAIN
FLOOR SINK OR DRAIN
SLOP SINK
WATER PIPING & ALTERATION
GREASE TRAP/INTERCEPTOR
HOSE BIBBS
L\ WN SPRINKLER SYSTEi\f
SWL.\11vfING POOL
BLDG. SEWER (mobile/mov ouse)
ROOF DRAINS
OTHER:
RANGE
WOOD/PELLET STO'lE/GAS FIREPLACE
GAS FURNACE btu:
CONVERSION BURNER btu:
UNIT HEATER btu:
BOILER btu:
GAS PIPING
EVAPORATION COOLERS btu:
AC UNIT btu:
HEAT PlJMP btu:
REHEAT BOX btu:
AIR HANDLING UNIT btu:
EXHAUST F At"JS
RANGE HOOD (residential)
RANGE HOOD (commercial)
CLOTHES DRYER
INCINERATOR
DCCT ALTERATION
TAJ."JKS type:
REFRIGERATION UNIT
OTIIER:
6 ,-9~}
:MECHANICAL FEES:
PLWvf.BING FEES:
CITY SURCHARGE:
TOTAL FEES:
APPLICANT'S SIGNATUR~)~ ~~
,
DATE:
,.-. \ '" r "
, \".. 1 . 1 A 1" .'
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<(3-2.-7" 'l't
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BIIEMElll'()N BUILDIN(; DEI)Altl'MEN1'
PIUJubing/Mechalllcal Inspection Ueport
Scope of work: C~,) +()y'^CLC~ J Ol'i/J]'V\y l)ennitNumber: q,~ ~ 0 '5 ~V
Address: I u-;ro C,iA (3 -I-.f/~~ OWller: I~ -f /\ cl", \ d Y ,
Contractor: 00./\ r;. I J. O-cfe. <..-- Phone: 94 )-' ~ ? -) t ~
.
GAS I)IPING
Under [eSt (IOpsi for 15 minu~es) Prol'~l:_!i_z.ing & support
I r m}l\ilfll~n bdo~~l,e whe'.) und~oufl(l C~~_~~I!wuJ.l~_~~~~dergrow,d or withih 6" of earth
GroUlul-joillt ulliom I'rohibice(1 in oeruin locatioWl nushin~s not allo~d in colloe:lk(1 areas
COMMENTS:
GAS PIPING APPROVED:__~_.:z!~/9tf
FURNACE
Manufacturer's s~!i.?ti_~I~!_1 ,ite ~~~~~~_~.!-'!ll'l'_<!.~t
Cbranoc: to colllbustihks Ve~~till~: dc:ualloe 10 comhuscihb
Vellt siu!.!.&.. & support/connections Vent terminacion
Combustion air Cl~im,-~: liI~r and/or separate flUC3l as required
Gas sllllt-off within 3' Pi.l!!.t elevalC(1 off ~oor i!.. g:uage
.------
Duct,: she & support/insulated wilen requirC(1 ]ktllrn air
COMMENTS:
FURNACE APPROVED:
~~ o/Vi/ff
MISC. APPLIANCES
~
"Z. 0 ~,~'" +--e. cI..c ov-
fvV'.....~,e. c-': U be..
-h> ~4!:.. ,......!>/..-ll<.c ~o v-
e.. (.e ~ 4- k..! l e, ,... ...c:-, < )
M3!1U~~Urer's specifications on ~ite Loa~i~!.'.!.!c.cc:s~~Hort
C\e;uanoe to combustibles Vc:.~c~~~Ji: ~!anoe to cornbustihles
Vent sil.i.~lg &: supl'ort/connections Vent lennin2tion
..----
Combustion air Chimney: I~)er a.ruUOI' s<:puate flues as required
Gas ahut-off withln 3' W~I stove &: fi~epl;tCrs: proper hearth
Wood stoves: EPA al'l'.roved Gas logs: sa_~':.ty ,hllt-off
Wood lItoves lie fireplaoea: tight fitting doon Gas shut-off witllin 3'
COMMENTS:
MISC. APPliANCES APPROVED:
WATER HEATER
Manufacture~ficationll on ,ite Locatio~, aC0C3S. Sl~IPl'ort
Ckaranoe to combustibb Ven~i.!"j;: dearanoe to comhustibb
Vent sizing lie sUHort/connectiolU Vent termination
Combustion air C~mney: liner and/or ~rate fluc:s all required
Gas sllUt-off wiLl,in 3' Pilot elevated off floor j~rage
Gate valve c:'n co~(l waca- su'p.l'.1y Relief valve drained to outsi<le
--.--.-.---
Copper to lI::Ilv:aniud co~uJOCtjon. Unions on water pipes
Seismic attap
COMMENTS:
WATE.RHEATER APPROVED:
ALL WORK UNDEIl TIllS PERMI'l' APPI10VIID:
BUILDINGC~}RMIT
re~Q
~~
,,:,.fo
5260
AI
City of Bremerton, Washington
Phone; (206) 478-5281
OWNER'S VALUE BLDG. DEPT. VALUE PLAN CHECK FEE RECEIPT NO. PERMIT FEE RECEIPT NO. DATE
$ 1/;;/;) ~ $ $ SO. S'O 72zy7 /I; -/ "2- P.3
SITE ADDRESS I LOCATION
OWNER'S NAME 41.A.A14\-
/
16.~O eA~
w~ ADDRESS
CONTRACTOR
ADDRESS
,Pt RESIDENCE
PLANNING I ZONING
PHONE
STATE CONTRACTOR'S L1C. #
PHONE
Q(REPAIR REMODEL
STORIES
o ADDITION 0 DEMOLISH
o SIGNS
OCCUPANCY
THIS PERMIT ISSUED FOR:
;q~.. .. i ,,(J..,~ 0-0 ..a.-
- /
;e "~f/ ~.
~~
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.
INSPECTIONS REQUIRED: Foundation 0 Framing )!t. Plumbing Electrical ~ Wallboard )2(.
SEPARATE PERMITS ARE REQUIRED (WHERE APPLICABLE) FOR PLUMBING, MECHANICAL AND ELECTRICAL.
FINAL.~
FOR INSPECTORS USE ONLY:
REINSPECTION:
NOT
TYPE OF INSPECTION DATE TIME APPROVED APPROVED
,.".J;
""'''') - ';;.,.. '-1 !
J.f..
.
FINAL INSPECTION APPROVED BY
COMMENT DATE TIME APPROVED
.
ISSUANCE OF OCCUPA
Building Inspector
OWNER'S SIGNATURE,'
I
I
REQUIRED BEFORE OCCUPYING BUILDING
BY
BUILDING DEPT.
/~
, N!
AI
BUILDING ~ERMIT
5260
. City of Bremerton, Washington
Phone: (206) 478-5281
it
7/'
~/,./
~/
OWNER'S VALUE BLDG. DEPT, VALUE PLAN CHECK FEE RECEIPT NO. PERMIT FEE . . RECEIPT NO. DATE
$ i./;2/.). ~ $ $ 5'0. sO 72ZfJ"7 /t) _/-z - .&'3
SITE ADDRESS I LOCATION
OWNER'S NAME k--
~
/6;{() (~_~
wo-~~ ADDRESS
"-~
CONTRACTOR
ADDRESS
fRt. RESIDENCE
PLANNING I ZONING
OTHER
PHONE
lX'HEPAIR REMODEL
STORI ES
o ADDITION 0 DEMOLISH
o SIGNS
OCCUPANCY
THIS PERMIT ISSUED FOR:
Q~
~~ L . (l:::::~~(J-o r- h~~j
;r!L ~t-t ~~~
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,
FINAL~ .
INSPECTIONS REQUIRED: Foundation 0 Framing ~ Plumbing ElectricalA. Wallboard A
SEPARATE PERMITS ARE REQUIRED (WHERE APPLICABLE) FOR PLUMBING, MECHANICAL AND ELECTRICAL.
FOR INSPECTORS USE ONLY:
REINSPECTION:
JAPPROVED NOT
TYPE OF INSPECTION DATE TIME APPROVED
FINAL INSPECTION APPROVED BY
COMMENT DATE TIME APPROVED
.
Building Inspector
REQUIRED BEFORE OCCUPYING BUILDING
BUILDING DEPT,
BY
Authorized Agent
.... -"
e PERMIT e
CITY OF BHEMERTON BUILDING DEPARTMENT
PHONE: 478-5281
JOB ADDRESS
i O~O
OWN >B
~eLF
CONTRACTOR
C (:-f r:rs ., u ~
MAIL ADDRESS
?r7j~Y t:4-l!S:Ol-v/
MAIL ADDRESS
q 11 / 0.
ZIP
1-71- s~ ~o
PHONE
PHONE
LICENSE NO.
Class of work: 0 NEW
o ADDITION
JIl.ALTERATION
o REPAIR
0 MECHANICAL ~ PLUMBING
CHIMNEY (No fee information only) INSPECTION: Groundwork Gas Test
Masonary Lines Unlined Wasted Vents Water
Factory Mfg Type B Type L Htg. Ruffin Chimney
Location: Internal Outside Wall Stove or Insert Refrig.
No. Type of Equipment Fee No. Type of Fixture or Item Fee
. , "'0 tt 5iF '3 S-V
STOVES Gas_ Oil_ Wood4~ WATER CLOSET (TOILET) J V
FIREPLACE INSERT BATHTUB :s SU
I .J g<O
FURNACE Gas (Nat._ LPG. _) Oil_ LAVATORY (WASH BASIN) J
Wood add on _ Other_ Electric_ SHOWER
BTU KITCHEN SINK & DISP.
Type: Up flow_ Down flow_ DISHWASHER
Horizontal_ Wali_ LAUNDRY TRAY
CONVERSION BURNER: Gas_(Nat._ LP_) CLOTHES WASHER
Under 100,000_ Over 100,000_ WATER HEATER
Oil_ URINAL
UNIT HEATERS BTU_ Gas_ Elec._ DRINKING FOUNTAIN
BOILER Gas_ Oil_ Electric_ FLOOR - SINK OR DRAIN
Other_ HP_ SLOP SINK
GAS SYSTEM Max. 5 outlet Total_ WATER PIPING & TREATING EQUIP.
EVAPORATION COOLERS Roof_ Wall_ WASTE INTERCEPTER (Grease)
BTU_ VACUUM BREAKERS & BACKFLOW DEVICE
AC UNIT Electric_ Gas Elec. Combo LAWN SPRINKLER SYSTEM
BTU_ SWIMMING POOL - Private Public
HEAT PUMP Single Package_ SpliL- GROUNDWORK
Add on_ BTU Ton_ SUMP
MIXING OR REHEAT BOX CFM_ BTU_ ALTERATION j
AIR HANDLING UNIT CFM_ BTU_ POST & BEAM <;- 00
FANS Exhaus~ Supply---,-- Batl:1-t-- 3 00 flteuJ. .,
RANGE HOOD R~d~ntial r Comm. PERMIT $ S S--o
- - 4 5"0 ell Do
CLOTHES DRYER Res._ Comm._ TOTAL $
Incinerator 1 ~ /') <"'l-.
NOTICE 1 .3 0 ()
ALTERATION TO DUCT SYSTEM THIS' PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRU T~N ~UTHOR-
Heating/Cooling_ Exhaus~ IZED IS NOT COMMENCED WITHIN 120 DAYS, OR IF CONSTRUCTION OR WORK is
TANKS Oil_ Gas_ Propane w/OK SUSPENDED OR ABANDONED FOR A PERIOD OF 120 DAYS AT ANY TIME AFTER
from Fire Dept._ Galions_ WORK is COMMENCED.
REFRIGERATION UNIT I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATiON AND
KNOW THE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF LAWS AND
ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED WITH WHE-
PERMIT $ THER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT DOES NOT PRE-
TOTAL FEE $ , \), 00 SUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY
OTHER STATE OR LOCAL LAW REGULATiNG CONSTRUCTION OR THE PERFOR-
MANCE OF CONSTRUCTION.
RECEIPT NO.
AUTHORIZED AGENT
-ls--&'4-
(DA TE)
FINAL APPROVAL
(SEE OTHER SIDE)
/ J-." I ~
(IF OWNER BUILDER)
PERMIT NO. ~I.!
(DA TE)
2220
(White-ORIGINAL, Yellow-INSPECTOR, Pink-APPLICANT)
I