1287 5, . . .
20851 Scofiild i, ve , Lor No.. 37
NO. STREET ;S_ Cfi
• ' APPLICI TION" FOR BUILDING PERMIT//' ° �_
�� c_ . `F LTy OF CUPERTINO 1�ry�7��
Date l�3 ;-• - "'L •�1 It 195_ Permit No. /c2
• I .- build I
Al>'yArta berebyf'�t e f a•permit to I
M O
a la story,Type 51J Building
at 23(Se ffal o�ertinoo California
to be occupied only as 1 family residence
in accordance with Plans, Specifications and Plot-Plan Med herewith. I -
Estimated Value of Improvements,$ 18,000,00 Fee$ 57.00 {I
I
2 It is hereby agreed that the requirements of the Cupertino Building and Zoning Ordinances and
u all other laws applicable to the construction, location, and use of buildings within the City of
;.a Cupertino will he complied with.
II OwnerCQImn fLlp 1thBuilders, lac AddressWinohestar Rd atlnaarid. Ave
f, By 9 Address Sari Jose 28, Cal'fnrni a
/ Q FR n_j,QlyTpnCTOR, AGENT
�ionc O }!}.LtS • Approvedt:
• BUILDING INSPECTOR
yQ ..
RECORD `O INSPECTION, "PP:OVALS ,
FOUNDATION I - / /00
E INSPECTOR ✓
FRAME, 0 / oo/ ��,��
Ars.. 40 r= INSPECTOR.
end PLASTER _A; 4/ i''�`
DATE �' •INSPECTOR
FINAL BLDG. x.21/0 i Ira
U TE INSPECTOR
FINAL ELEC. /aft VA/ I /
D TSN/� INSPECTOR
FINAL PLBG.
�c �T/!��
_ D TE SPEC OR \I
/ �_�
FINAL GAS /��..r.
:•1 /DA‘ / INSPECTOR
i
•
CERTIFICATE `OF ' COMPLETIONA
BUILDING INSPECTOR'S OFFICE
CITY OF CUPERTINO
/ _' 7
Date .4...�T 19tf7� ,�+'' Building Permit No. , �iI
The Building Located at _r2l 9.5'1 44::-. -(2&='✓� '�'.4f0".
Owned by •.`•; i ."s'"`r(o.F 24,;r / i
Has Been 1(C°19215•55-65'For Use As: L''...:••-'`f'%, �'- •
(Altered)
f
..
•
2. ,a E..
•
yamf, •
:'''../.1.;...:,:..01..•-r=-•,-,"
ss . g.,,:: - ' Pfi .;;) I
N
.� (BUILDING. INSPLCTOP. I -
102 4/61.500 • ti•.! r: -/ +^ . ',.•
"
4720W.NO. c. ,-(1;„ 4-¢j.ie, LOT NO. ....._r
p •,'4-1-..itA IO FOR ELECTRICAL PERMIT J'
SEP 7 1967 tare
I Y OF CUPERTINO
Dat y (�' p� , 195_ Permit No. N--3 Z '
U�� 1 �� V�PER �1'1� pee $ 73 '7J i
Application is hereby made to the City of Cupertino for a permit to install electrical
C.:! ,
wiring and/or fixtures as listed on the reverse side hereof, and agrees to install said
(V) wiring and/or fixtures in accordance with the provisions of the Electrical Code of the
City of Cupertino, and all other laws applicable thereto.
v Use of Premisrc (7F. Pro-!�+(
'C'
a Owner U az Le k:'..
' v By .4/79,4x 7� .Fig^ Address ' . .v=:-! i
,r G//ONc�ACTO ,41nRATi11 Pp
C2RIUL INSPECTOR
. NEW RPL FEES
Size Service Conduit Number,of Outkets I
R
Size Service Wires Number of Switches 2.3 •30
Size Service Switch Number of Receptacles ' .0.. .......... ...3. 00
Size Sub Feed Conduit Number of Fixtures 2/ 2 • /0
Size Sub Feed Wires Ranges / KW .75
Number of-Circuits Oven / KW _ 75-
Number of Meters Signs Transformers
Misc Dryers .✓ I .713
Motors HP Phase
Motors HP Phase Permit Fee $1.00 •
Motors y HP Phase H P Charge h 00
TOTAL'FEES ,3 1 7L✓ '
rr •4 O'tinINSPECTION APPRsA
•/e
•,�Rnagh Wiring*/ ,�. 1 • ,Fixtures f / I
i
:i%: ;•-•-• •Wn �� 7A �i' rTOR -.M.
oors -✓�� p�14p-.R l
a', aiyihiny . INSPECTOR ' / l y � -
• R y, Final / " I .>s .^ r _
, : DAT[ INSPECTOR
...
, OFFICE
i
ELECTRIC SERVICE NOTICE z , COPY
BUILDING INSPECTOR'S OFFICE •..1. 1. -,
I i
CITY OF CUPERTINO. To
1
You are hereby authorized to connect the.ELECTRIC service for 0
.,.s.
Owner or Tenant / --r9n2----Wej-itees-r--cil.:Of.K.• -C4re,
At .: Te 7.57— ,--/-;-,e)-,..it.A.7 Lel -4••• •
1 ...e.• _.?4,4, ,,,,,
No. of Wires .--- Siie of Wires - i-X --
-Size of Switch .49/2",•
Motor Load Voltage Phase -
. ; -:-:.
I. •; oili ' ' c'-^-•al:Aroltage - 1
- ---- ------------- --- -- -- ------- - - -----••• ` '-k-- 4 - '''''' - •
Light 110 .•.,- - New§ervicet:-. , it.Reconnect
. .,!:: .i4o. of Meters . /
Heat 220 Three Wire Move Service
1.i. .:-.X. .1•1;: of Add. Meters
Power -
Three Phase Move Meter
'
t...---';:r. }./ • /
''
-.•
1/60-500 6 •,-,, „,,,...-"ri-ELECTRICAL INSPECTOR 4; •• I. ' I
''.•..I::: •::,/i 04
L.7- - -
NO. STRER LOT NO. _ e1
Pt!".dt OR ELECTRICAL PERMIT
- I F CUPERTINO
i
j3 P02/
o i
n,`i-.i
Date �/ , 19Permit No. /
1yF Fee $ o. Oti
Anvilen. pQity
of Cupertino for a permit to install electrical
wiring and'/or fixtures as listed on the reverse side hereof, and agrees to instill said
wiring and/or fixtures in-accordance_with,the provisions of the Electrical Code'of the
City of Cupertino, and all o[herlaNIs applicable thereto.
ti
v 'Use of-Premi ; i,Ld�•--- iii., f
Y.
�t Owner �,Iiai�6LL,��-1• i� �s
lir I
Ey eiit '
- Address
CONTRACTOR, AGENT .1
Approved r''''
O - IGL (NSPHCrOlt
NEW RPI. FEES
Size Service Conduit Number,of Outlets ;11
c.
Size Service Wires Number of Switches
Size Service Switch Number of Receptacles
Size Sub Feed Conduit Number of Fixtures
Size Sub Feed Wires Ranges KW
Number of Circuits Oven KW
Number of Meters Signs Transformers
Misc Dryers
Motors HP Phase .. Permit Fee $1.00
Motors HP Phase
Motors HP Phase H P Charge
TOTAL'FEES
RECORD OF INSPECTION APPROVALS , y3r?
:. a
Rough Wiring I Fixtures - �"Sx.'rw. T +
DATE INSPECTOR DATE --iimiptuR. .
Finish Wiring 1 Motors �
4 DATE ANSPECTOR S. G/ D 'IIK�-
Final _9 Z./. I. ■-.-
, N DATE . INSPECTOp
J. 1.
• . . .
. .• ... .• i
. I .
t , 1
-I * 21, 'ELECTRIC(00SERVICE NOTICE
go • ,
I BUILDING INSPECTOR'S OFFICE
CITY OF CUPERTINO
/
(;)
. h I 0 HiCE
IEN 0, G PY
,
, 1196/
1
Yo are hereby aut ' ed to connect the ELECTRIC service fur,7 , ,,.....,11 ,--•
Owner or Tenant ser•,17-W--e-"le ...." #0•"/
At. iclaf?-57-• -,e47eciej . 1
z,......1 n
No. of Wires •--- SipaWires #4:7Size of Switch troiter •
Motor Load •• Voltage Phase
I ' 1
Heating Load K. W. Voltage
. I
. ,
. fr..- .---
Light 110 New Service Reconnect I
No. of Meters . vi
Heat ' 220 ......- Three Wire Move Servicei
' No. of Add. Meters ........ •
.. Power ...a.-- Ph. - o. •• Meter . • -
1
I . • (H Ca, ....• ," -- .... ; •
— ;' •dles.- --
/60-500 - I . I I' ECTRICAL INSPECTOR I . .,...
.
. ... 1
: •
. .
1 . Cupertino Sanitary
Office Copy
BUILDING INSPECTOR'S OFFICE
CITY OF CUPERTINO
. i
0 Sewer Connection Sanitary Permit No.
../
Li Plumbing Final Plumbing Permit No Owner or Tenant ..
• Lot N g
At .... 62. cg--6–/ — %le°'of- .c/11-a,0• l
-)a/ae2//eilc,.e...
• Tract ‘ 1
• Date Connected • •• ' - 16./
i
• . Date Final /c-L • 191 .1..
_ .• • /
z -''
, '• .: •i_ • .
4"' •^ ''''' M::: _j\.•: . \NI
( 123. IMBING INSPECTOR ;
_ ,
III 1/60-509 - 1 -
L
-
• 2DQ,-/ I -seaF/t'r0 • LOT NO.
NO. STREET
- - _ -v"" A�I - ION FOR PLUMBING PERMIT -"• '
CITY OF CUPERTINO
C •
4eSSEP 1 " , 195_ Permit No. AV/
`a T (�� r,U��RTINO Fee $ /
a Ct NipphMtion Ts'hereby made to the City of Cupertino for a permit to install plumbing
pipes and/or fixtures listed on the reverse side hereof, and agrees to install saidP rices
Vand/or fixtures in accordance with the provisions of the Plumbing Code of the City of
\; Cupertino, and all other laws applicable thereto.
8 Use of Premises "el/Drarc e- '
Owner /Dmmdivwrnere %fl/7$. Address CAA/ foci'
By [eor PlumB)"tn.. Address C P8n-1-
\ CONTRACTOR, AGENT a e til-E-E•/l/ i i Approved *_ ; ;I,
j "� PLUMBING INSPECTOR
FIXTURES NUMBER MAIN DRAIN
UNITS I FEES II I UNITS I FEES
Waver Heater / I Size y" . I .t
Water Closets 3 I Material G/ I
Bath Tubs' / I To Curb I
Showers. ' .2 To Prop. Line I ✓ I .
Lavatories' 3 To F mg 40..........Kitchen Sinks / N Conn. ® 'ire;
Dish Washers / . I -
Waste Disposals /
Wash Trays 1 STORM DRAINAGE
Washing Machines / I Size t
Water Softeners y Material �.
Bar Sinks To Main Drain I
Comb. Sink s Trays To Curb �_ I
Dental Units I .
11.
Drinking Fountains II •
Floor Drains WATER SYSTEM
Hoppers Size . • I PC
Restaurant Sinks Material • Iena✓- I
Sand Traps TOTAL FEES
Urinals Fixture Fee :-.a'II-/6•$6
Area Drains Main Drain Fee I /. a 0
Water Leaders Storm Drain-Fee I!
Sprinkler Valves Water Sys. Fee I /. 0 0
Stn.'? Bax - / .1.3.9" Permit Fee 1 /. 0 0
TOTAL TOTAL FEE /g.FU
RE 1/ OF I• P/f'ION
Partial Ro•.?gh / AI
Rough Co.nplete / '/14
Final /c2//z/ !
- s-x•- --•.n-':.--�-aF: BPBLIEIRN:.c-1...L-A.
••t / , ` ' - -C�CKi LOT NO. ‘,..-q7
CDEC 2 0 9961 :, ,, (CATION FOR GAS PERMIT
CITY OF/ CUPERTINO
QTY DQF 0:‘'' -di T p 19(O / Permit No. 1515. .
ao
Fee $ al
Application is hereby made to the City of Cupertino for a permit to install gas pipes
and/or gas appliances as listed on the reverse side hereof, and agrees to install said pipes
•
1 and/or appliances in accordance with the provisions of the Plumbing Code of the City
of Cupertino, and all other laws+applkableithereto. . , •, __•.3___\ •
Al Use of Premises .r- • • r .,7 `1 =",_ -11k1,
_ k{ ` '.
y „-3 ,1T " iPR It - ;x. L"L4 '' i '1 �.: v.V"` 5 ; ' •!?v. i..
17, 0,y;<er �0 ` Address
1 I .SZ Address r
Phone �V P Approved Lea .
. AL 7.. - t JJ 3 / I - LUMBING INSPECTOR
a
•
Remarks (Check ✓)
Type of Appliance Units Fees New Replace Relocate
Gas Ranges - I
Wall Heaters
Gas Plates �
Circulating Heaters _
Blower Furnaces - - •
Gas Fired Boilers _ I
Warming Ovens - ;.
Percolators . =i-
Griddles II 7r'
Steam Tables II •
Gravity Furnaces II
Suspended Unit �!
Floor Furnace
Miscellaneous
A(Nio..4wPE)
aft,alryeet-• ted
Apii-zdiance Fees o0
Inspected and Approved .....___...:..-!-
DATE " ••,- INSPECTOR '/'
HOUSE GAS PIPING
' fi-
Number of Outlets I / I Size of ai
Gas Piping Fees o I
I '
Tested and Approved/a r .1.-50.1..x. '. : - •
DATE ` INSPECTOR, ...i "
•
02Ri.... C�i LOT NO. ,S7
n. NO. STREET
� A L TION FOR APPLIANCE PERMIT
t
'DEC 2 O 1961 11 • CITY OF CUPERTINO
n
,CITY Qat + . / ; ' 02 , 196 / Permit No. 7
1 y , ' Fee y II SC'
Application is'hereby made to the City of Cupertino for a permit to install
M gas appliances as listed on the reverse side hereof, and agrees to install said
tn appliances in accordance with the provisions of the Plumbing Code of the City
of Cupertino, and all other laws applicable thereto.
u Use of Premises
u
•7i Owner R,s R'?-e-`--�., Address •
.-7-2-e-
A / v % / .i.„,_ ,` Address_ ` 1
1:d3_ 6 �� ';-L Anproved -
Phnne_A_c__ _
I . 1 , ' , i , 1 I 1 1 I 1 • is' 1 1 1 ,21W/*BING INSPECTOR L
. .
L .
0. • r r.:-
Remarks (Cheek .IA -
Type of Appliance Units Fees New j Replace I Rklocate
Gas Ranges I w...
Wall Heaters -I4
Gas Plates
Circulating Heaters 1 ''..,, —
Blower Furnaces : '7"4- I
Gas Fired Boilers - I -
Warming Ovens - c.a t
Percolators -
Griddles •
Steam Tables - I
Gravity Furnaces I _
Suspended Unit ,.
I-
Floor Furnace II ..•
11
Miscellaneous III
(NAME PE) I . .
.
/ Sd . ;J.. •''''
• I -,-)
• I /
ApplianceFees A no
. .....?
Inspected and Approved it",-a.i.^CI7 ,
DATE ' . --..1i4SPECTOR
. . ,
•%eV ±'
q
ec 0 g C I SCOF/NLO LOT NO. 32
.STREET • •
CATION FOR GAS PERMIT
F. ii 1TY OF CUPERTINO
/397
n _
' '�`'�:C . l95_ 'Permit No.
�, , 0-0
^''p 1' ' Fee $
vL CJS �'R 't
N C�T�pp�j�t,Io � 'SOY. � e o the City of Cupertino for a permit to install gas pipes
� an /ow gasappliances as listed on the•reverse side hereof, and agrees to install said pipes
7s"+ and/or appliances in accordance with•the provisions of the Plumbing"Code of the City
✓ of Cupertino, and all other laws applicable thereto.
4
`V' Use of Premises - "
L3/(J/rn«r
• v j ez'
Owndr'COMMvwwvetTN 1ians _ ,Address (ANTofek'/4C
i
_ ,,B � L/D r ' u � Ai. + ±Address <_ P ' • ftL %,:.
.. ^ . ./"‘:C'°'pr''CONTRACTOR, AGENT . W `^'+':. tfl, �.
ri Phone fin— —c--/t,/ Approved .'
•
Or
$ PLUMBINGINSPECTOR
Remarks (Check 11-
--
Type of Appliance Units Fees New j Replace'l Relocate
Gas Ranges _
Wall Heaters -
Gas Plates
Circulating Heaters
Blower Furnaces
Gas Fired Boilers •
Warming Ovens _ -
;Percolators
Fy... t.C,�..
Griddles j
-:Steam Tables '> '(
Gravity Furnaces
Suspended Unit jj '''''
Floor Furnace
II
Miscellaneous •
NAME TYPE) - II'.�'!s�.,.`a.,
ILYJAZA
.t
Appliance Fees 2. . i-
Inspected and Approved ! • "`"'-
DATE '• INSPECTOR .
HOUSE GAS PIPING ;;.• `N: -'{3
Number;of Outlets I I Size of Main j 1/y
Gas Piping Fees 12. p 9 I ♦ v
Tested and Approved .42-, -di'..-.j. •
DATE INSPECTOR N
..:
1 .,.
41 , .. .
GAS SERVICE-NOtICE OFFICE
fiki:',‘ . , BUILDING INSPECTOR'S OFFICE 44
/.- -, e COPY
CITY OF CUPERTINO
7,. .
rAvy 196
. ,
To . •
You arc hereby authorized to connect the GAS Service for
I /
Owner or Tenant .4r
At 0.20,57 - . '0 tr.
. . .1".
/-- - - New Service 4"----
i.. •
No.? .of Meters ;. / Reconnect
..' .
.Move Service • '
..,
••NO. of Add. Meters . Move Meter
., •
. ,. dr.te
,i _ . tar .... a., ., .2„....;,„.. .. ,
,,k.,.....c.,LA._..s.k.kin,!..1..• • - . .
N: .• PL BING INSPE,CTOR ;;;‘,.;,:,;:rt'':
1) 1 t ,._ .
'I to 1/60540 -,• •
,.. 4 a...,
..... _ . _ . . ..•
•rilmis•-simm
&o$s- k Scofield Drive '
LOT NO. 37
..NO:
s HET?
• .
bi�P ICATow R APPLIANCE
IANCE PERMIT
f DFC 5 1961 cl OF CUPERTINO
Date 12-5-61 G Permit No. 6?-o
CITY OF :JJ IPERTIINU Fees 1, 50
Application is hereby made to the City of Cupertino for a permit to install
gas appliances as listed on the reverse side hereof, and agrees to install said
appliances in accordance with the provisions of the Plumbing Code of the City
of Cupertino, and all other laws applicable thereto. .,..,;.^ -
:".: :R.
Use of Premises Re0tcie1le
owner � '
Bhdra.— Address Cam.bei-1
?z
d'T+:, s Cv9!e u A.9 ' Co '`- \ Address 8 •011-
1ti
tsq r` nn 2,CONTRAri /11^8 9.34 . /
I �r��p� •""44�+ Y/�VlJV APProve _
`�^ -� IJ"iir'G':=i¢�$F21 r9 PLUMUING'•tN5Pe W 4
p '
Remarks (Check ✓)
Type of Appliance Units Fees New I Replace I Relocate
Gas Ranges
Wall Heaters
-
Gas P:',es
Circulating Heaters
Blower Furnaces 1 g
Gas Fired Boilers •
Warming Ovens •
Percolators
Griddles II : . , '
Steam Tables
•
Gravity Furnaces
Suspended Unit II '
Floor Furnace
Miscellaneous
NAME TYPE)
Appliance Fees ' /
Inspected and Approve4/ //* 4—.1 - %ice
DATE O INSPECTOR •
C:20 1-...V _:14 rI ' 1111 ' , ► LOT NO.
rf •
/-'� . PP , ori. lop FOR PLUMBING PERMIT
V ! !! OF CUPERTINO
'1DEC 26 1961
p3 Date _ 195— Permit No. i ZL V
Q •
CITY OF CUPERTINO Fee $ 1 -c1)00
.t Application is hereby made to the City of Cupertino for a permit to install plumbing
0 pipes and/or fixtures listed on the reverse side hereof, and agrees to install said prices
and/or fixtures in accordance with the provisions of the Plumbing Code of the City of
,y� Cupertino, and all other aws applicable there
d
• 8 Use of Premises s ' ��- . •
U
'" Owner,- e. r 4604474/ Address -1615s. .r/, t A )e, '
if ByAo1r Ceti i` �Ier Tizfe. C4 Address id ?fig • - i _S-..X'
CONTRACTOR-AGENT
� E1 Phone`ry-_OJr.3 ' _ Approve...k ki1o:-.Q1I___ •
y' / PLU 1 G INSPECTOR , 1
• .4.. -
FIXTURES NUMBER j MAIN DRAIN . -,
UNITS I FEES II . I UNITS I FEES
Water Heater I i Size
Water Closets I I Material
Bath Tubs I To Curb
Showers - j To Prop. Line
Lavatories I To Existing .1
•
Kitchen Sinks I Not Conn.
Dish Washers I . ,i
Waste Disposals '
Wash Trays STORM DRAINAGE
Washing Machines I Size
Water Softeners''' - I Material r”4:4*1-11:"' '
Bar Sinks I To Main Drain . j
_Tomb. Sink a Trays j To Curb _ "jL
Dental ?Jnits- " �`;`
Drinking Fountains II
Floor Drains I WATER SYSTEM
Hoppers . I Size I I
lestaurant Sinks j Material I _
;and Traps I ` TOTAL FEES
Urinals I Fixture Fee IT,,,
Area Drains I Main Drain Fee I ,
Water Leaders Storm Drain Feel_
Sprinkler Vain , j Water Sys. Fee j _,..,1:•
I' n Permit Fee, . 0
I
d?Co.,
rOTA j TOTAL FEE• J ., t
ORD OF INSPECTION • 't ;
?artial Rough / ..r.. 1
lough Complete n - • >'r
Final f:2z of iS —V r / • '{\•\I t
�;'+ :tib; .,9''y=1..y' .I
• aSC -� T _4 't - r LOT NO.
NO. STREET
N Q •
sCr
p �...APPL_IC TION FOR BUILDING PERMIT
.; ° iect OF CUPERTINO
3 a 7 Saniruy No.
_ u.0 D t I _ I.; OR' 196_ Ere
No.
CQZ(c) 1
o u Application is hereby made for a permit to E'C
a Cn �n/,�
Q N al/� ^43tE �G� eT� A t Y^o %� I Building
Ki
to be occupied only as IL X f t v tr 1r—t(`��1 ,c'
0 o in accordance with Plans, Specification nd Plot-Plan fled herewith.' •
o0
Estimated Value of Improvements,$ a t tO O Fee'$'.'! ^OOH
z J It is hereby agreed that the requirements of the Cupertino Building and Zoning Ordinances and
j a all other laws applicable to the construction, location, and use of buildings within the City 'of
d 0 Cupertino wil e co�m}'lied h.
WOwner X .moi Address d . wa 'moi.1 _� 192
Q .SRA , 7.cf_. I[
a a By k ' blr 1 Address _ ,, '
a o Phone 1C LC/hi:8-7/pT - r� i�g l
U , r •• . /-f� I Approved iVlIE - �. - - -A-
State Licens �/✓ BUILDING INSPECTOR
'i ,ip.:'„ /•
RECORD 'OF INS(P,ECTIOC• ' APPROVALS
FOUNDATION • ` .7- "231 /,I ' " '
/ DATE • INSPECTOR
UNDERFLOOR 1p — / H G i
DATE ~'/ INSPECTOR
FRAME O ' L_ %S .
DATE a INSPECTOR
LATH and PLASTER • " / 0 ( /t
DATE INSPECTOR
INSPECTOR
�j
FINAL BLDG. • 9 �`.` - /b - I11 1 /L
. PATE �• INSPECTOR
FINAL ELEC. � - k
DATE- • INSPECTOR,
FINAL PLBG.
DATE. • INSPECTOR
n FINAL GAS ' I `
y` .+ � . . I .vecro ' .
Y
,
i (r
NO. % TREET / 41 LOT NO. .
0
i� t lb ION J R ELECTRICAL PERMIT
^I L 10) ;'( JUN 24 1963C1Tt OF CUPERTINO
Date Ciu201
1PERTiv9�13 Permit No. / -o
d er
Fee $
Application is hereby made to the City of Cupertino for a permit to install electrical
wiring and/or fixtures as listed on the reverse side hereof, and agrees to install said
wiring and/or fixtures in accordance with the provisions of the Electrical Code of the
QCity of Cupertino, and all other laws applicable thereto.
v Use of Premises 70SS1 SCOl-lELO pQ CUc2I Ql IKO
L&'
a Owner 1 O W N S JI^
Address £ O
0,
ca By tt--1.—v'7i,�q(j Address
/�. ' ONTRACTOR7 AGENT .LsR. 0
.a
•
Approved . .� � e
‘ Q Phone: �"/L.'e.0 "' 1771 E&RIUL INSPECTOR
1
,-,
^ ,
• C NEW RN. FEES
,,..--....;
Size Service Conduit Numbs of Outle
Size Service Wires Number of Switc es c-'1--, p /, 00
Size Service Switch Number of Rece. acles 6 • •
Size Sub Feed Conduit Number of Fixtures --2
\ .
Size Sub Feed Wires Ranges KW
Number of Circuits Oven KW
.
Number of Meters Signs Transformers
Misc - I
.
Motors HP Phase -
Motors HP Phase ' Permit Fee $1.00
Motors ' HP Phase H P Charge
1 a 0 es
TOTAL.FEES t d_
••
RECORD OF INSPECTION APPROVALS
1 ' • Rough Wiring -, ."--- • I--
INSPECTOR . --Fixtures DATE 1 ire
Finial Wiring;'...
.t, Final 4 /
N .
-