HomeMy WebLinkAbout839 W 6th St - Building ELECTRICAL PERMIT
CITY OF PORT ANGELES t
360-417-4735 d
Application Number 11- 00000619 Date 6/21/11 REPORT SALES TAX
Application pin number 511041
Property Address 839 W 6TH ST on your excise tax form
ASSESSOR PARCEL NUMBER: 06- 30- 00 -0 -1 -0150 -0000- to the City of Port Angeles
eles
Application type description ELECTRICAL ONLY Y g
Subdivision Name (Location Code 0502)
Property Use
Property Zoning RS7 RESDNTL SINGLE FAMILY
Application valuation 0
Application desc
2 circuit remodel
Owner 4,1Fz Contractor
LEAH ERB TTE ELECTRIC SERVICE
839 W'6TH ST 82 DRAPER RD
PORT ANGELES WA 98363 PORT ANGELES WA 98362
(360) 452 -5254 (360) 452 6424.;
Permit ELECTRICAL ALTER RESIDENTIAL a)
Additional desc
Permit pin number 187823
tki
Permit Fee 76.10 Plan Check Fee .00
Issue Date 6/21/11 Valuation 0
Expiration Date 12/18/11
Qty Unit Charge Per Extension
1.00 73.5000 ECH EL- BRANCH CIRCUIT WO /FEEDER 73.50
1.00 2.6000 ECH EL -ECH ADDNT BRANCH CIRCUIT 2.60
Fee summary Charged Paid Credited Due
Permit Fee Total 76.10 76.10 .00 .00
Plan Check Total .00 .00 .00 .00
Grand Total 76.10 76.10 .00 .00
cAUD I Z /2.9in
INSPECTION TYPE DATE: RESULTS: INSPECTOR:
DITCH
SERVICE
ROUGH -1N �a
FINAL 1 Aheo
COMMENTS:
PERMIT WILL EXPIRE SIX (6) MONTHS FROM LAST INSPECTION
Signature of owner or Electrical Contractor X Date:
G: \EXCHANGE \BUILDING
JUN -20 -2011 07:29A FROM: ELECTRIC SERVICE 4526424 TO: 4174711 P.1 2
LV ill/ 1.%./1/ 11/ ��YY 11 JT luu uj l lbrnnl..(j vvv
RECEIVED O PORT
CITY OF PORT.ANGELES PERMIT APPLICATION JUN 2 O 2011
Building Division/Electrical Inspections 1<.,. IIE=7
321 East Fifth Street -P -O. Box 1150 /Port Angeles Washing: r ,n, 98362 ELECTRICAL
I Ph: (360) 417 -4735 Fax: (360) 417 4711 INSPECTIONS
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Date: Co
If2.Single Family Dwelling, Multi- Family or Commerci Commercial Addition Alteration Remodel l Repair*
1 Plan Review May B R- ired, Please Complete Electrical Plan Re Information Sheet
I Job Address: :-.6
Building Svuam Footage: V 0 40 ti
Description or above r
mot e' c�v r
Owner Information Contractor In alion
l." tt L r b Name 3.e k---4
Mett� dree v- 4 I.J 6' Mailing.4ddres0 l 10 2 t
b City: VI 7- State. Zip: L
P Phone; Fa t�J v Z1p: 2f 4 3 Phone: n S 2 -L v Fax: Sc
License 4 /Exp. License 41 Exp. i '—e_ Gr S r 3 o it
Item
Unit Chartle At Total (Qty Multiplied by Unit Chargel
Service/Feeder 200 Amp. 119.90
Seryice/Feeder 201 -400 Amp. $145.50
f ervice/Feeder 401600 Amp 204.60
'Service/Feeder W1 =1000 Amp. 26220
.ServiceiFeeder over 1000 Amp, 372.60
8n ,eA Clrcull W Service Feeder 2.60
Brands Circuit W!D Service Feeder 73.50 —.1-- 7 4'
Each Additional Blench Circuit S 260 ___I 2 .017
Temp. Service/ Feeder 200 Amp. 92.74
Temp. Service/Feeder 201-000 Amp. 110.30
Temp. ServicelFeeder401-600 Amp• $148.70
Temp. Service/Feeder 601 -1000 Amp $167.90
Portal Io Portal Hourly 95.80
Sign/OuWne Ughting 8820
Signal Circuit! Umited Energy I First 1500 a1- Commerdal, 95.90
Note: $5.00 for each additional 1500 cf
Signet Circuit! Umhed Energy -1 2 Fanuly Dwelling 63.90
SignalCircuit/UnitedEnergy- Multi- FamilyDwdiing 63.90
Manuractured Home Connection $119.00
Renewable Electric al Energy 5KVA System or Less $102.30
Thermostat 58 .E
NEW CONSTRUCTIQN ONLY;
First 1300 Square Ft. $110.30
l=ath Additional 500 Square Ft. or Portion of 3
Each Outbuilding or Detached Garage 73.50
Each Swfmmlrg Pod or Hot Tub 5110.30 '7 to r Total
Owner as defined by RCW.19.26.261: (1) Owner will occupy the structure for l; years after this electrical permit is finalized. (2) Miner Is required
tothire an electrical wntractor If above said property Is for sale, rent or lease. -.-mkt expires after sac months of last inspection•
After reading the above statement, I hereby certify that I am the owner of the rove named property or a licensed electrical contractor. I am making
the electrical Installation or alteration in compliance with the electrical laws, N. RCW. Chapter 19.28, WAC. Chapter 296 468, The City of Port
Angeles Municipal Code, and Utility SpedfIcations rood PAMC 14.06.050 reg i g Electrical Permit Applications.
Signature of owner, electrical co etor or electrical administrator: Cash Chad
n CrediLCaI f CT'
0110111010
1
iiiiIN
CITY OF PORT ANGELES
Numpr/ DEPARTMENT OF COMMUNITY ECONOMIC DEVELOPMENT BUILDING DIVISION
3 21 EAST 5TH STREET, PORT ANGELES, WA 98362
Application Number 11- 00000294 Date 4/22/11
Application pin number 300864
Property Address 839 W 6TH ST REPORT SALES TAX
ASSESSOR PARCEL NUMBER: 06-30-00-0-1- 0150 -0000-
Tenant nbr, name LEAH ERB TTE on your state excise tax form
Application type description RES ADDITION
Subdivision Name to the City of Port Angeles
Property Use (Location Code 0502)
Property Zoning RS7 RESDNTL SINGLE FAMILY
Application valuation 4200
Application desc
ADD 120SF CVRD PATIO ATTACHED TO THE GARAGE
Owner Contractor
LEAH ERB TTE MICHAEL RIVERS CONSTRUCTION
839 W 6TH ST 840 W 6TH ST
PORT ANGELES WA 98363 PORT ANGELES WA 98363
(360) 452 -5254 (360) 808 -7050
Structure Information 000 060 ADD 120SF CVRD PATIO TO GARAGE
Other struct into HARD SURFACE AREA
Permit BUILDING PERMIT RESIDENTIAL
Additional desc ADD 120SF CVRD PATIO TO GARAGE
Permit pin number 183368
Permit Fee 137.75 Plan Check Fee 89.54
Issue Date 4/22/11 Valuation 4200
Expiration Date 10/19/11
Qty Unit Charge Per Extension
BASE FEE 95.75
3.00 14.0000 THOU BL- 2001 -25K (14 PER K) 42.00 t
Special Notes and Comments c;\,\f°j
The Fire Department has reviewed the project application and has no comments April 22, 2011 2:54:48 PM sjohns d w
Planning has no issues with this project.
April 12, 2011 4:34:46 PM Brian 417 -4708. OK
Public Works Utility Engineering has no requirements for
this plan review.
Other Fees STATE SURCHARGE 4.50
Fee summary Charged Paid Credited Due
Permit Fee Total 137.75 137.75 .00 .00
Plan Check Total 89.54 89.54 .00 .00
Other Fee Total 4.50 4.50 .00 .00
Grand Total 231.79 231.79 .00 .00
Separate Permits are required for electrical work, SEPA, Shoreline, ESA, utilities, private and public improvements. This permit becomes
null and void if work or construction authorized is not commenced within 180 days, if construction or work is suspended or abandoned
for a period of 180 days after the work has commenced, or if required inspections have not been requested within 180 days from the
last inspection. I hereby certify that I have read and examined this application and know the same to be true and correct. All provisions
of laws and ordinances governing this type of work will be complied with whether specified herein or not. The granting of a permit does
not presume to give authority to violate or cancel the provisions of any state or local law regulating construction or the performance of
construction.
?Si-g\-/ I
Date Print Name Signature of Contractor or Authorized Agent Signature of Owner (if owner is builder)
T:Forms /Building Division /Building Permit
i•
BUILDING PERMIT INSPECTION RECORD
N
PLEASE PROVIDE A MINIMUM 24 -HOUR NOTICE FOR INSPECTIONS
Building Inspections 417 -4815. Electrical Inspections 417 -4735
Public Works Utilities 417 -4831 Backflow Prevention Inspections 417 -4886
IT IS UNLAWFUL TO COVER, INSULATE OR CONCEAL ANY WORK BEFORE INSPECTED AND ACCEPTED.
POST PERMIT IN CONSPICUOUS LOCATION. KEEP PERMIT AND APPROVED PLANS AT JOB SITE.
Inspection Type Date Accepted By Comments
FOUNDATION:
Footings
Stemwall
Foundation Drainage Downspouts
Piers
Post Holes (Pole Bldgs.)
PLUMBING:
Under Floor Slab
Rough -In
Water Line (Meter to Bldg)
Gas Line
Back Flow Water FINAL Date Accepted by
AIR SEAL:
Walls
Ceiling
FRAMING: 5'11.. f,1 TTV-
Joists Girders Under Floor 0/
Shear Wall Hold Downs
Walls Roof Ceiling
Drywall (Interior Braced Panel Only)
T -Bar
INSULATION:
Slab
Wall Floor Ceiling
MECHANICAL:
Heat Pump Furnace FAU Ducts
G s
Gas a Line
Wood Stove Pellet Chimney
Commercial Hood Ducts FINAL Date Accepted by
MANUFACTURED HOMES: U
Footing Slab
Blocking Hold Downs
Skirting
PLANNING DEPT. Separate Permit #s SEPA:
Parking Lighting ESA:
Landscaping I SHORELINE:
FINAL INSPECTIONS REQUIRED PRIOR TO OCCUPANCY/ USE
Inspection Type Date Accepted By
Electrical 417 -4735
Construction R.W. PW Engineering 417 -4831
Fire 417 -4653
Planning 417 -4750
Building
417-4815 111 I)
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T:Forms /Building Division /Building Permit
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BUILDING PERMIT APPLICATION Print in ink
CITY OF PORT ANGELES
;.z For City Use Only:
Attn: Building Permit Technician Date Received 4 4 -fit
321 E. Fifth St., Port Angeles, WA 98362
(360) 417 -4815 fax (360) 417 -4711 rate Approved
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Applicant -pp j SCI4LA BA Ph.i e O Zo 7
Property Owner 1'EA,I- 6 R-6 Ph•ne 1 .1 1 6 z S z S
Property Owner's Address 8 3 7 id 6 'T
Contractor 16Pliel„ 2/u s co N ST2- 0cYno»I Phone
Contractor's Address
License Expires E -mail
PROJECT ADDRESS 8 31 W.
Parcel Number Lot Zoning
Project Type Brief Description: XResidential Multi- family Commercial Industrial
Check all that apply A-f-HA cke-6
New Construction ,4.7)%7 -r /ON OF CO (16P -ED pf4 o To 7 STI /'J 61 6-6
)4- Addition
Remodel
Repair
Demolition
Re -roof House garage other tear off re -roof lay over one layer
Heat System Heat pump wood- burning stove gas fireplace pellet stove other
Other
Floor Areas Existing (sq. ft.) Proposed (sq. ft.)
Basement per sq. ft.
1St Floor //6
'7/
2 Floor
3rd Floor
Garage 6
Carport
Covered Porch 7o 5P. 17�
Deck
Shed 3 2 SP
Other
TOTAL VALUATION
Total footprint of structures ��j sq. ft. T Lot size 470(0 sq. ft. Lot coverage Z-7
Site Coverage the amount of impervious surface on a parcel, including structures, paved driveways, sidewalks, patios,
and other impervious surfaces. (see PAMC 17.94.135 for exemptions) Site coverage 2.7
Max. height of proposed structures 7— 6' r ft. Occupancy group of bedrooms
Will a lawn sprinkler system be installed? xJD Occupant load of full baths
Will a fire sprinkler system be installed? /,/D Construction type of half baths
1 have read and completed this application and know it to be true and correct. I am authorized to apply for this permit and understand
that it is my responsibility to determine what permits are required, and to obtain permits pri. working on projects.
Date I I I Print Name DDNA"�t cC#(11 3 i1 Signature /L�.�.
T:Forms /Building Division /Building permit application
4,4E4 .411,P11474
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Clallam County Assessor Treasurer Property Details 56476 LEAH ERB TTE for Ye... Page 1 of 3
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ti Cialiam County Assessor Treasurer
Property Search Results 56476 LEAH ERB TTE for Year 2011 2012
Property
Account
Property ID: 56476 Legal Description: LOT 11 BL 101
Geographic ID: 0630000101500000 Agent Code:
Type: Real
Tax Area: 0010 PA 121 PORT ST CNTY H2 L WMP Land Use Code 11
Open Space: N DEL N
Historic Property: N Remodel Property: N
Multi- Family Redevelopment: N
Township: Section:
Range:
Location
Address: 839 W SIXTH ST Mapsco:
PORT ANGELES, WA 98363 0
Neighborhood: Cycle 5 Res Map ID: 3
Neighborhood CD: 10955130 r 0 1
Owner
Name: LEAH ERB TTE Owner ID: 23460
Mailing Address: 839 W 6TH ST Ownership: 100.0000000000%
PORT ANGELES, WA 98363
Exemptions:
Taxes and Assessment Details
Property Tax Information as of 04/06/2011 I, 10 `If
Amount Due if Paid on: NOTE: If you plan to submit payment on a future date, make sure you enter the date and
click RECALCULATE to obtain the correct total amount due.
First Second
Half Half
Base Bass e
Year Statement ID Taxing Jurisdiction Amt. Amt. Penalty Interest Base Paid Amount Due,
2011 151218 ST SCH STATE SCHOOL $180.11 $180.11 $0.00 $0.00 $0.00 $360.22:
2011 151218 CC -GEN COUNTY CLALLAM $99.44 $99.42 $0.00 $0.00 $0.00 $196.86
2011 151218 SD #121 SCHOOL DISTRICT #121 $235.44 $235.42 $0.00 $0.00 $0.00 $470.86
2011 151218 CITY PORT ANG CITY OF PORT ANGELES $229.54 $229.53 $0.00 $0.00 $0.00 $459.07
2011 151218 PORT PORT OF PORT ANGELES $14.00 $13.99 $0.00 $0.00 $0.00 $27.99!
2011 151218 NTH OLY LIB NORTH OLYMPIC LIBRARY $41.70 $41.70 $0.00 $0.00 $0.00 $83.40
2011 151218 HOSP #2 HOSPITAL #2 $40.82 $40.81 $0.00 $0.00 $0.00 $81.63.:
2011 151218 WSMET PK DIST WILLIAM SHORE MET PARK DIST $12.41 $12.40 $0.00 $0.00 $0.00 $24.81
2011 151218 CITY_STORMWATER CITY STORMWATER $36.00 $36.00 $0.00 $0.00 $0.00 $72.00,
2011 151218 WEED_CONTROL WEED CONTROL $0.82 $0.81 $0.00 $0.00 $0.00 $1.63
2011 151218 TOTAL: $890.28 $890.19 $0.00 $0.00 $0.00 $1780.47'
2010 39516 ST SCH STATE SCHOOL $178.30 $178.31 $0.00 $0.00 $356.61 $0.00.
2010 39516 CC -GEN COUNTY CLALLAM $94.88 i $94.90 $0.00 $0.00 $189.78 $0.00
2010 39516 SD #121 SCHOOL DISTRICT #121 $230.95 $230.96 $0.00 $0.00 $461.91 $0.00
2010 39516 CITY PORT ANG CITY OF PORT ANGELES $219.70 $219.70 $0.00 $0.00 $439.40 $0.00
2010 39516 PORT PORT OF PORT ANGELES $13.34 $13.33 $0.00 $0.00 $26.67 $0.00
2010 39516 NTH OLY LIB NORTH OLYMPIC LIBRARY $27.57 $27.57 $0.00 $0.00 $55.14 $0.00
2010 39516 HOSP #2 HOSPITAL #2 $38.92 $38.93 $0.00 $0.00 $77.85 $0.00''
2010 39516 WSMET PK DIST WILLIAM SHORE MET PARK DIST $12.38 $12.39 $0.00 $0.00 $24.77 $0.00:
2010 39516 CITY_STORMWATER CITY STORMWATER $36.00 $36.00 $0.00 $0.00 $72.00 $0.00
2010 39516 WEED_CONTROL WEED CONTROL $0.82 $0.81 $0.00 $0.00 $1.63 $0.00
2010 39516 TOTAL: $852.86 $852.90 $0.00 $0.00 $1705.76 50.00
Values
Taxing Jurisdiction
Improvement Building
Improvement #1: HOUSE State Code: 11 1145.0 sqft Value: N/A
Exterior Wall: 2 Siding Foundation: 3 Concrete Perimeter
Freestanding Woodstove: 3 Average Heating /Cooling: 2 Baseboard Electric
Kitchen Quality: 2 Average Roof Covering: 6 Metal
Type Description Class CD Sub Class CD Year Built Area
DET GAR DETACHED GARAGE 01 03 1920 532.0
MA Main 01 03 1920 1145.0
PORCH -3 PORCH DECK 01 03 1920 56.0
PORCH -3 PORCH DECK 01 03 1920 42.0
http: /websrv8.clallam. net propertyaccess /Property.aspx ?cid =0 &year =2011 &prop_id =56476 4/6/2011
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CITY OF PORT ANG LLES Construction Plans
The Issuance of this permit based upon these
cations and other data shall not prevent the building' specifi-
h
th
from tereaft requiring the correction
plans, s g official
CURB specifications and other of errors in said
r `lvi operations being ata or from preventi
ation l g carried on thereunder when r in g
o viol of al codes s of this lurisdicti
1 and ordinance
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CENTERLINE OF 6th STREET
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LEAH E R B 839 W 6th St 452-5254 drawn march 2011 Don Schuba 452 0207
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PREPARED 12/28/10 8 46 05 INSPECTION TICKET PAGE 7
CITY OF PORT ANGELES INSPECTOR JAMES LIERLY DATE 12/28/10
ADDRESS 839 W 6TH ST
TENANT NBR LEAH ERB TRUST
CONTRACTOR KANDU ENTERPRISE
OWNER LEAH ERB TRUST
PARCEL 06 30 00 0 1 0150 0000
APPL NUMBER 10 00000631 RES REMODEL
PERMIT BPR 00 BUILDING PERMIT RESIDENTIAL
REQUESTED INSP DESCRIPTION
TYP /SQ COMPLETED RESULT RESULTS /COMMENTS
BL3 01 6/24/10 JLL BLDG FRAMING TIME 01 00
6/24/10 AP June 24 2010 8 14 35 AM 1pangrle
GREG 460 3617
FRAMING
AFTERNOON
June 24 2010 4 04 11 PM jlierly
BL99 01 12/28/10 BLDG FINAL TIME 01 00
I L December 23 2010 8 44 05 AM 1pangrle
LEAH 452 5254 (I CALLED HER TO FINAL THIS PERMIT
BUILDING FINAL SHEETROCK THE GARAGE CHANGE ENTRY DOOR
Y
AFTERNOON
SUBDIV
rnMMENTS_AND_NOTFc
PHONE (360) 565 8383
PHONE (360) 452 5254
Permit to (0 3 1
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NOTES
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PREPARED 6/24/10 8 16 04 INSPECTION TICKET PAGE 1
CITY OF PORT ANGELES INSPECTOR JAMES LIERLY DATE 6/24/10
ADDRESS 839 W 6TH ST
TENANT NBR LEAH ERB TRUST
CONTRACTOR KANDU ENTERPRISE
OWNER LEAH ERB TRUST
PARCEL 06 30 00 0 1 0150 0000
APPL NUMBER 10 00000631 RES REMODEL
PERMIT BPR 00 BUILDING PERMIT RESIDENTIAL
REQUESTED INSP DESCRIPTION
TYP /SQ COMPLETED RESULT RESULTS /COMMENTS
BL3 01 6/24/10
JLL
SUBDIV
PHONE (360) 565 8383
PHONE (360) 452 5254
BLDG FRAMING TIME 01 00
June 24 2010 8 14 35 AM 1pangrle
GREG 460 3617
FRAMING
AFTERNOON
COMMENTS AND NOTES
Date
Application Number 10 00000631
Application pin number 806089
Property Address 839 W 6TH ST
ASSESSOR PARCEL NUMBER 06 30 00 0 1 0150 0000
Tenant nbr name LEAH ERB TRUST
Application type description RES REMODEL
Subdivision Name
Property Use
Property Zoning RS7 RESDNTL SINGLE FAMILY
Application valuation 1700
Application desc
SHEETROCK THE GARAGE CHANGE ENTRY DOOR
Owner
LEAH ERB TRUST
839 W 6TH ST
PORT ANGELES
(360) 452 5254
Permit BUILDING PERMIT RESIDENTIAL
Additional desc NEW GARAGE DOOR /DRYWALL
Permit pin number 167882
Permit Fee 86 60
Issue Date 6/22/10 Valuation
Expiration Date 12/19/10
Qty Unit Charge Per
BASE FEE
12 00 3 0500 HND BL -501 2K (3 05 PER C)
Special Notes and Comments
June 18 2010 5 23 46 PM sroberds
The proposal is to replace a sliding door on a nonconforming
accessory structure with a roll up door Interior sheeting
can be replaced but no new areas within the setback can be
created Site is located on an alley in the RS 7 zone
Other Fees
Fee summary
Permit Fee Total
Plan Check Total
Other Fee Total
Grand Total
C 2 ID
T:FormsBuilding DivisionBuilding Permit
CITY OF PORT ANGELES
DEPARTMENT OF COMMUNITY ECONOMIC DEVELOPMENT BUILDING DIVISION
321 EAST 5TH STREET PORT ANGELES, WA 98362
WA 98363
Charged
86 60
56 29
4 50
147 39
STATE SURCHARGE 4 50
Paid Credited Due
86 60
56 29
4 50
147 39
Contractor
KANDU ENTERPRISE
714 WEST 6TH
PORT ANGELES
(360) 565 8383
Plan Check Fee
Separate Permits are required for electrical work, SEPA, Shoreline, ESA, utilities, private and public improvements. This permit becomes null and
void if work or construction authorized is not commenced within 180 days, if construction or work is suspended or abandoned for a period of 180 days
after the work has commenced, or if required inspections have not been requested within 180 days from the last inspection. I hereby certify that I have
read and examined this application and know the same to be true and correct. All provisions of laws and ordinances governing this type of work will
be complied with whether specified herein or not. The.gra ti rmit does not presume to give authority to violate or cancel the provisions of any
state or local law regulating construction or the perfo ction.
00
00
00
00
Date 6/22/10
WA 98363
Extension
50 00
36 60
00
00
00
00
56 29
1700
REPORT SALES TAX
on your state excise tax form
to the City of Port Angeles
(Location Code 0502)
2 .z$ 10
Print Name Signature of t ont actor or Authorized Agent Signature of Owner (if owner is builder)
BUILDING PERMIT INSPECTION RECORD
PLEASE PROVIDE A MINIMUM 24 -HOUR NOTICE FOR INSPECTIONS
Building Inspections 417 4815 Electrical Inspections 417 4735
Public Works Utilities 417 4831 Backflow Prevention Inspections 417 4886
IT IS UNLAWFUL TO COVER, INSULATE OR CONCEAL ANY WORK BEFORE INSPECTED AND ACCEPTED
POST PERMIT IN CONSPICUOUS LOCATION. KEEP PERMIT AND APPROVED PLANS AT JOB SITE.
Inspection Type Date Accepted By Comments
FOUNDATION.
Footings
Stemwall
Foundation Drainage Downspouts
Piers
Post Holes (Pole Bldgs
PLUMBING
Under Floor Slab
Rough -In
Water Line (Meter to Bldg)
Gas Line
Back Flow Water
AIR SEAL.
Walls
Ceiling
FRAMING
Joists Girders Under Floor
Shear Wall Hold Downs
Walls Roof Ceiling
Drywall (Interior Braced Panel Only)
T -Bar
INSULATION
Slab
Wall Floor Ceiling
MECHANICAL.
Heat Pump Furnace FAU Ducts
Rough -In
Gas Line
Wood Stove Pellet Chimney
Commercial Hood Ducts
MANUFACTURED HOMES
Footing Slab
Blocking Hold Downs
Skirting
Electrical 417 -4735
Construction R.W PW Engineering 417 -4831
Fire 417 -4653
Planning 417 -4750
Building 417 -4815
T:Forms /Building Division /Building Permit
G-24-10 S&L-
Inspection Type
PLANNING DEPT Separate Permit #s SEPA.
Parking Lighting I ESA.
Landscaping I SHORELINE.
FINAL Date Accepted by
FINAL Date Accepted by
FINAL INSPECTIONS REQUIRED PRIOR TO OCCUPANCY/ USE
Date Accepted By
12- 2$ -10
Applicant 1<Am) S-
Property Owner LizAA
Property Owner's Address $3q
Contractor V.,A)Jh.) FoT
Contractor's Address 7141 )1,/
License cz)
PROJECT ADDRESS
Floor Areas
Parcel Number
Basement
1St Floor
2 Floor
3rd Floor
Garage
Carport
Covered Porch
Deck
Shed
Other
Project Type Brief Des
Check all that apply
New Construction
Addition
Remodel
Repair
Demolition
Re -roof
Heat System
Other
cription.
Max. height of proposed structures
Will a lawn sprinkler system be installed?
Will a fire sprinkler system be installed?
ft.
■l -r 'S )C
si
Expires
W (0 Sk
Existing (sq ft.) Proposed (sq. ft.)
Occupancy group
Occupant load
Construction type
:BUILDING PERMIT APPLICATION Print in ink
CITY OF PORT ANGELES
Attn Building Permit Technician
321 E Fifth St. Port Angeles WA 98362
(360) 417 -4815 fax (360) 417 -4711
I have read and completed this application and know it to be true and correct. I am authorized to
that it is my responsibility to determine what permits are required, and to obtain permits prior to wo
Date #4 16 Print Name r.,a Signature
T Forms /Building Division /Building permit application
For City Use Only
Date Received 6-12-0
Permit 1 O
Date Approved
Phone 360 44O 36 0
Phone 360 45Z- SZ5
Phone 360- 56c -8A ,s3
E -mail pbo,peL '3 Co t"-
Lot Zoning
TOTAL VALUATION
per sq ft.
Total footprint of structures sq ft. T Lot size sq ft. Lot coverage
Site Coverage the amount of impervious surface on a parcel including structures paved driveways sidewalks patios
and other impervious surfaces (see PAMC 17 94 135 for exemptions) Site coverage
of bedrooms
of full baths
of _I .aths
residential Multi- family Commercial Industrial
a�►�C F `ice �A 51 i�-izT ICJ C 01.1 l v AU 9 J T 1} J T ROCK
r_XisT CE 1'1 ?AC IL Do02 wiTN-
�o
DDO.9 At i), ELF ci- L o PEN .16_12
l 706 2
House Vgarage other ear off re -roof lay over one layer
Heat pump wood burning stove gas fireplac pellet stove other
I oo
ap ly or /s permit and understand
is
Permit# SO w
�pl e ta cag eh:66416g
1
4 p W .5 of-t -�-4 s s Ede- t
T Forms /Building Division /Notes
NOTES
/ZANDU enterprises
13 1 7
Sue Roberds, Planning Manager
City Of Port Angeles
417 -4750
RE. Garage door replacement
Leah Erb
839 West Sixth
Mrs. Roberds:
I have been in the field and confirmed m,.asurements on the above mentioned garage. The building is outside of
the cities property line as shown in the att ached photograph taken from the outside of the siding and not the
frame. Adding an electric opening garage door May be considered and improvement but is not a change in
current use. The area of discussion is also outside of the 10' setback of the alley I don't think that the
replacement of this garage door or the adc :ition of another outlet warrants a survey or the energy of Planning or
Public Works. The existing skip sheeting partition being covered with a one hour fire barrier is also a prudent
safety improvement for storage and repair of the client's motorcycle. There may be an inch or two discrepancy
but I'm really surprised that this project e Ten requires a building permit.
I have prepared the permits and right of way applications per your instructions. I hope that I have presented
enough information to negate their neces;ity Please keep me informed for my client is overwhelmed at what
seemed to be a simple $1,500 project.
Gregory Bondy, Sole Proprietor
714 West 6`''
Port Angeles, WA. 98363
565 -8383 or 460 -3617
GELES
Dept. of Community Development
Clallam County Assessor Treasurer
Clallam County Assessor Treasurer
Property
Taxes and Assessment Due
Property Tax Information as of 06/18/2010
Amount Due if Paid on. 2.
Year Statement ID Taxing Jurisdiction
2010 39516 ST SCH STATE SCHOOL
2010 39516 CC -GEN COUNTY
2010 39516 PORT PORT
2010 39516 PORT ANG PORT ANGELES
2010 39516 SD #121 SCHOOL DISTRICT #121
2010 39516 NTH OLY LIB NORTH OLYMPIC LIBRARY
2010 39516 HOSP #2 HOSPITAL #2
2010 39516 WSMET PK DIST WILLIAM SHORE MET PARK DIST
2010 39516 CITY STORMWATER CITY STORMWATER
2010 39516 WEED CONTROL .IJEED CONTROL
2010 39516 TOTAL:
2009 564762008 ST SCH STATE SCHOOL
2009 564762008 CC -GEN COUNTY
2009 564762008 PORT PORT f
2009 564762008 PORT ANG PORT ANGELES
2009 564762008 SD #121 SCHOOL DISTRICT #121
2009 564762008 NTH OLY LIB NORTH OLYMPIC LIBRARY
2009 564762008 HOSP #2 HOSPITAL #2
2009 564762008 CITY STORMWATER CITY STORMWATER
Property Details 56476 LEAH ERB TRUST for Page 1 of 5
Property Search Results 56476 LEAH ERB TRUST for Year 2010 2011
Account
Property ID 56476 Legal Description. LOT 11 BL 101
Geographic ID 0630000101500000 Agent Code
Type. Real
Tax Area. 0010 PA 121 PORT ST CNTY H2 L Land Use Code 11
Open Space N DFL N
Historic Property' N Remodel Property N
Multi Family Redevelopment: N
Township Section
Range
Location
Address: 839 W SIXTH ST Mapsco
PORT ANGELES WA
Neighborhood Cycle 5 Res Map ID
Neighborhood CD 10955130
Owner
Name LEAH ERB TRUST
Mailing Address: 839 W 6TH ST
PORT ANGELES WA 98363
Exemptions:
Owner ID 23460
Ownership 100 0000000000%
First Half Second Half
Base Due Base Due Penalty Interest Base
$178 30 $178 31 $0 00 $0 00 $17
$94 88 $94 90 $0 00 $0 00 $f
$13 34 $13 33 $0 00 $0 00 $1
$219 70 $219 70 $0 00 $0 00 $21
$230 95 $230 96 $0 00 $0 00 $2Z
$27 57 $27 57 $0 00 $0 00 $2
$38 92 $38 93 $0 00 $0 00
$12.38 $12 39 $0 00 $0 00 $1
$36 00 $36 00 $0 00 $0 00 $C
$0 82 $0 81 $0 00 $0 00 9
$852.86 $852.90 $0.00 $0.00 $8;
$204 19 $204 19 $0 00 $0 00 $4C
$103 34 $103 33 $0 00 $0 00 $2C
$14 64 $14 64 $0 00 $0 00 $2
$226 66 $226 66 $0 00 $0 00 $4E
$252.51 $252.53 $0 00 $0 00 $5C
$30 03 $30 02 $0 00 $0 00 $E
$42.38 $42.38 $0 00 $0 00 $f
$36 00 $36 00 $0 00 $0 00 $7
http. /vpn.clallam. net. 8084 /propertyaccess /Property.aspx ?cid =0 &year= 2010 &prop_id =56 6/18/2010
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FILE
CITY OF P&RT ANGELES ;onstruclion Plans
The Issuance o this permit based ul an these plans, specifi-
cations and oth 3r data shall not prey int the building official
from thereafter requiring the corm lion of errors in said
plar specific, lions and other dat 1, or from preventing
building operas Ions being carded o thereunder when in
violation of all codes and ordinans s of this jurisdiction.
j 20E)(0
Approval Date (.j71 L fJ B, J L`
/0th 'as &t
r
6C3
a—
ELECTRICAL PERMIT
CITY OF PORT ANGELES
360- 417 -4735
Application Number 10 00000607 Date 6/16/10
Application pin number 419989
Property Address 839 W 6TH ST
ASSESSOR PARCEL NUMBER 06 30 00 0 1 0150 0000
Application type description ELECTRICAL ONLY
Subdivision Name
Property Use
Property Zoning RS7 RESDNTL SINGLE FAMILY
Application valuation 0
Application desc
Garage remodel 2 circuits double fee
Owner Contractor
ERB LEAH
3225 47TH AVE SW
SEATTLE
20) 935 4154
Permit ELECTRICAL ALTER COMMERCIAL
Additional desc DOUBLE FEE WORK WITH NO PERMIT
Permit pin number 167593
Permit Fee 152 20 Plan Check Fee 00
Issue Date 6/16/10 Valuation 0
Expiration Date 12/13/10
Qty Unit Charge Per Extension
BASE FEE 76 10
1 00 73 5000 ECH EL BRANCH CIRCUIT WO /FEEDER 73 50
1 00 2 6000 ECH EL ECH ADDNT BRANCH CIRCUIT 2 60
Fee summary Charged Paid Credited Due
Permit Fee Total 152 20 152 20 00 00
Plan Check Total 00 00 00 00
Grand Total 152 20 152 20 00 00
INSPECTION TYPE
DITCH
SERVICE
ROUGH IN
FINAL
COMMENTS
WA 98116
ELECTRIC SERVICE
82 DRAPER RD
PORT ANGELES
(360) 452 6424
DATE
7) lk /lt -mil
WA 98362
RESULTS INSPECTOR.
Signature of owner or Electrical Contractor X Date
In?
1 if7
x
AUG -2 -2006 03 26P FROM ELECTRIC SERVICE
City of Port Angeles Permit Application
Building DivisionlElectrical Inspections
321 East Fifth Street P.O. Box 1150
Port Angeles Washington, 98362
Ph: (360) 417 735 Fax: (360) 417 -4711
Date: CA )Z
1 2 Single Family Dwelling
Multi- Family or Commercial`
Commercial Addition I Alteration I Remodel I Repair'
Plan Review May Be R�glr g,Plea C o! rnpete Electrical Plan Review Informatlo
Job Address: b
Building Square Footage:
Description of above
Owner Information
Name: x--27- ErILD Name:
Mailin ddress:�3� Lv Lam`" Mailin
City D° r State L 5' k ?3
Zip City' V
Phone: 1— S4_FX: Phone:
License Exp.
Unit Charge
93.75
$113.75
$160.00
$205.00
$291.25
2.00
57.50
2.00
72.50
8625
$116.25
$131.25
75.00
69.00
75.00
50.00
50.00
93.75
80.00
86.25
27.50
57.50
86.25
43.75
aty
Signature of owner electrical contractor or electrical administrator
Gnu'
4526424
2 .na_ Each Additional
Temp. Service/ 1
Temp. Service /F'
Temp. ServicelF
Temp. Service/
Portal Id Portal
Sign /Outline Ligi
Signal Circuit/ Li,
Signal Circuit/ 4.
Signal Circuit/ Li
Manufactured Hi•
Renewable Etec
First 130D Squa
Each Additional
Each Outbuildin
Each Swimminc
Thermostat
Total
fa
Contracto
License
O Cash
D r,
Crec
L 4 2009
01 CTRICAL
OE 'ECOIONS
r
t ?et
Total (Qty Multiplied by Unit Cf.
Service/Feeder'
Service/Feeder
Service/Feeder
Service/F0eder t 000 Amp
Service/Feeder y 000 Amp.
Branch Circuit W vice Feeder
T1 CO Branch Circuit Vtr! service Feeder
h Circuit
TO 4174711
'mation
State. IL)
l ft- -'(o`er Fax:
c..
mp.
00 Amp.
4 00 Amp.
1 r 200 Amp.
r 201.400 Amp.
r 401 -600 Amp.
601 -1000 Amp.
Energy Commercial
i Energy 1 2 Family Dwelling
t l Energy Multi- Family Dwelling
Connection
31 Energy 510VA System or Less
pquare Ft. or Portion of
etached Garage
or Hot Tub
,lectrical permit is finalized. (2) Owner is required to hire an
Owner as defined by RCW.19.28. (1) Owner will occupy the structure for two years after
electrical contractor if above said property is for sale, rent or lease
After reading the above statement, I hereby certify that I am the owner of eh,, above named r, rty or a licensed electric :1r contractor I am making the electrical
installation or alteration in compliance with the electrical laws, N.E.C. 'RCW Chapter 15.28,1 Chapter 296-46B, The C, of Port Angeles Municipal Code, and
Utility Specifications.
0.9.-
zip: 4'Ff3
Stern --o
P 1
Application Number
Application pin number
Property Address
ASSESSOR PARCEL NUMBER
Tenant nbr name
Application type description
Subdivision Name
Property Use
Property Zoning
Application valuation
Owner Contractor
ERB LEAH
3225 47TH AVE SW
SEATTLE
20) 935 4154
Permit BUILDING PERMIT NO PR FEE
Additional desc TEAR -OFF 30# FELT COMP
Permit pin number 97659
Permit Fee 109 75 Plan Check Fee 00
Issue Date 3/21/07 Valuation 2167
Expiration Date 9/17/07
Qty Unit Charge Per Extension
BASE FEE 95 75
1 00 14 0000 THOU BL -2001 25K (14 PER K) 14 00
Other Fees STATE SURCHARGE 4 50
Fee summary Charged Paid Credited Due
Permit Fee Total 109 75 109 75 00 00
Plan Check Total 00 00 00 00
Other Fee Total 4 50 4 50 00 00
Grand Total 114 25 114 25 00 00
Separate Permits are required for electrical work, SEPA, Shoreline ESA, utilities private and public improvements This permit becomes
null and void if work or construction authorized is not commenced within 180 days if construction or work is suspended or abandoned
for a period of 180 days after the work as commenced or if required inspections have not been requested within 180 days from the last
inspection I hereby certify that I have read and examined this application and know the same to be true and correct. All provisions of
laws and ordinances governing this type of work will be complied with whether specified herein or not. The granting of a permit does not
presume to give authority to violate or cancel the provisions of any state or local law regulating construction or the performance of
construction
Signature of Contractor or
CITY OF PORT ANGELES
DEPARTMENT OF COMMUNITY DEVELOPMENT BUILDING DIVISION
321 EAST 5TH STREET PORT ANGELES, WA 98362
WA 98116
thorized Agent
07 00000293
808044
839 W 6TH ST
06 30 00 0 1 0150 0000
LEAH ERB
RE ROOF
T \Policies \1102_15 building permit inspection record05 wpd [1/4/2005]
RS7 RESDNTL SINGLE FAMILY
2167
07
Date 3/21/07
TOPNOTCH ROOFING GUTTER
1235 W 9TH
PORT ANGELES WA 98362
(360) 457 0066
Date Signature of Owner (if owner is builder) Date
CALL 417-4815 FOR BUILDING INSPECTIONS. CALL 417 -4735 FOR ELECTRICAL INSPECTIONS
CALL 417 -4807 FOR PUBLIC WORKS UTILITIES
PLEASE PROVIDE A MINIMUM 24 HOUR NOTICE. IT IS UNLAWFUL TO COVER, INSULATE OR CONCEAL ANY WORK BEFORE
INSPECTED AND ACCEPTED. POST PERMIT IN A CONSPICUOUS LOCATION
KEEP PERMIT CARD AND APPROVED PLANS AT JOB SITE.
INSPECTION TYPE DATE I ACCEPTED COMMENTS
FOUNDATION:
FOOTINGS
SHEAR WALLS WALLS
FOUNDATION DRAINAGE DOWN SPOUTS
PIERS
POST HOLES (POLE BLDGS.)
PLUMBING
UNDERFLOOR /SLAB
ROUGH -IN
WATER LINE (METER TO BLDG)
GAS LINE
BACK FLOW WATER
AIR SEAL
WALLS
CEILING
FRAMING
JOISTS GIRDERS
SHEAR WALL/HOLD DOWNS
WALLS ROOF CEILING
DRYWALL (INTERIOR BRACED PANEL ONLY)
T -BAR
INSULATION
SLAB
WALL FLOOR CEILING
MECHANICAL
ROUGH -IN
HEAT PUMP FURNACE DUCTS
GAS LINE
WOOD STOVE PELLET CHIMNEY
MANUFACTURED HOMES
FOOTING SLAB
BLOCKING HOLD DOWNS
SKIRTING
PLANNING DEPT SEPARATE PERMIT #'s
PARKING /LIGHTING
LANDSCAPING
RESIDENTIAL
BUILDING PERMIT INSPECTION RECORD
YES 1 NO
I FINAL DATE ACCEPTED BY.
FINAL
SEPA.
ESA.
SHORELINE:
FINAL INSPECTIONS REQUIRED PRIOR TO OCCUPANCY /USE
DATE YES NO COMMERCIAL
ELECTRICAL LIGHT DEPT 417 -4735 ELECTRICAL
LIGHT DEPT
CONSTRUCTION R.W PW/ CONSTRUCTION R.W
ENGINEERING 417 -4807 1 PW ENGINEERING
FIRE 417 -4653 I 1 1 I FIRE DEPT
I PLANNING DEPT 417 -4750 I 1 A I PLANNING DEPT
BUILDING 417 -4815 1 i6 V7 -0`1 1 (XP i VT I BUILDING
T: \Policies \1102 15 building permit inspection record05 wpd [1/4/2005] 1
DATE ACCEPTED BY.
DATE I ACCEPTED
1 YES .I NO
I I I I
I I 1
1 I I
2,28/07
Company signature _Paul C Weitz
Bid prices are subject to reasonable increases due to any necessary alterations, additions, increases in material and /or labor
to complete work. Homeowner will be notified of any necessary changes, which may affect cost.
Property owners are responsible for obtaining any hermits required for work and materials described herein. TOPNOTCH is happy to provide
permit. but will add the cost to the final bill.
Bid prices are applicable for 30 days* from date below, unless otherwise stated or agreed to Please feel welcome to call if you
have questions concerning this estimate /bid If bid is accepted, please sign one copy and return it to TOPNOTCH ROOFING GUTTER, at the
address above. Work is scheduled upon receipt of cloned bid. Verbal aareements will not guarantee scheduled work.
References are available!
TO• Leah Erb 452 5254 3/ La 4 a g ire 3
FOR Roof repair roof replacement on garage and gutter replacement 729 Georgiana 3L
Port Angeles WA 98362
House roof is in good condition except for the missing shingles Garage roof is in need of
replacement estimate included Gutter system on both the house and garage are in very bad shape
Recommend replacement estimate included
House Missing shingles from wind storm. Replace missing shingles
Material and labor and sales tax
200 00
16.80 e i r A/o Perm/ ,7 !Q
$216 80
Garage Tear off existing single layer of roofing Clean up and disposal included. Roof with 30 -year
3 tab composition over 30# felt Install starter course composition. Material labor and sales tax
2167 00
182.02 A $2348 02
House and garage Gutter replacement Remove old galvanized gutters Install 5" aluminum continuous
gutter downspouts and accessories Material labor and sales tax
$1150 00
97.50
$1247 50
Authorized party to accept bid
OP ��TCH ROOFING G
5 W 9t
2 n ales, W A St
port 3 60. 457 -0066 98363
topnotchroofinga@qwest.net
TOPNORG994DA EXPIRATION DATE. 5/18/08
Date 2/28/07
ESTIMATE AND BID PROPOSAL CONTRACT
cL
MATERIAL WARRANTY BY MANUFACTURER, WORKMANSHIP GUARANTEED BY LICENSED, BONDED, INSURED CONTRACTOR
PAYMENT TERMS: ONE HALF TO START WORK, BALANCE DUE IN FULL WHEN WORK IS COMPLETED ALTERNATIVE PAYMENT ARRANGEMENTS
MUST BE DISCUSSED AND AGREED TO PRIOR TO THE START OF THE JOB
Date 3 I C---07
I~"""'"
I'
,; ,
~ "':;. J,',
t,"~!~",; -.;;' <
1J....~...
-
~~.
"I,?,::;.:;.,," '.
j' " , CITY OF PORT ANGELES
DEP ARlMENT OF COMMUNITY DEVELOPMENT - BUILDING DNISION
I,.r, .. 321 EAST 5TH STREET, PORT ANGELES, W A 98362' "
I ,"C '
I
Date 11/26/0'3,
Qty Unit Charge IPer . . .,.,".. Extension
'. ii_. ~E m 47.00
~_.t..~ - - --,. - ~-~-- - - - - - - -~--. - - - - - + ;'t"""::~~ .,:- -,-~--7~- -- --- - .,.;.~---- - - - - --- - - - ---~-.- - - - --
Other Pees . . t.~.. STATE SURCHARGE 4.50
I
ChArged;
I ' 'I-
----------------- ---~------ ---------- ---------- ----------
J ,41)00 "
j ,.00
I ~.50
j ~1.50'
r" '
-,t,
"r '
,-~,l .,-.-
";,:',,1,,':,
T ."
,;',.l;:;i';'
-1''''',. "
. <ff;n'
'.- -.;-..",1"..
'-" '-"',1
I
Separate Permits are required fo'relectrical work,SEPA, Shoreline, ESA,utilities, private and public improvements.T~ise:~rtnjt,l:l~cC)ri1'lS ,
null an~,void if work or construction authorized is not commencedwithin180 days, if construction or work issuspende~ oraJ:)ahdoned
fora periOd of1.80 days after the workascommenced,orif required inspections have not been requestedwit~iri,1eQ'~~~Jrol'llth'~last
r~spectlon.Lhereby certify thatll have read and examined this application and knowthe same to be true and correcLAIJ'prOyislonsQf
lawsan~,ordinances governing this type of work will be complied with whether specified herein or not. ,The grantingof'~p~rl'llifqoElsno~
presume to give authority to violate or cancel the provisions of any state or local law regulating construction or the':performance of
const~u~ion.~ .. .."~.;;:I'i . '.
~,~ 1~!.2~/raOte3
Signature of Contractor orAuthonzed Agent ~
. - ., ! -
ApplicationNumber . . . . .
Property Address .r .
ASSESSOR PARCEL NUMBER:!
ApplicatiOn description
SUbdifuion Name .j . . .
Property Zoning . . . ., . . ~ 'RS7 RBSDNTL SINGLE PAMILY
,:,-" ',., ,Application. valuation.J ...' ' . 0
'", h'",'. i ", ,
,> " Owner . I ',{,J: Contractor
.,~,j,. ;;~-~------------"r;::': ~~-~-~;;----
3225 47TH AVE SW I" P. O. BOX 4074
SEATTLE Wl}9~l1ti PORTANGBLBS
,. (206) 935-4154! (360) 452-9292.
;\.,-------- StructUre InformatiOn DEMO 303 SQ. FT. ADDNT ON REAR
Construction Type . . .. TYPE V NON-RATBD
;,,'i,\ / OCcupmClY Type ... ,; .SINGLBPAM & CONGREGATES
.-~~~-------~-----------~----~-----~------------------------------------~-~---
PeJ:1lli t . . . .. DBMoLIT!ON .
Additional desc . . lmA#03-23
permitpee.. ~ ,,7.00
Issue Date J 11/26103
Expiration Date [5/25/04
i .
03-00001094
839 W 6TH ST
06-30-00-0-1-0150-0000-
DEMOLITION
:;-- ~,
WA 98362
Plan Check Pee
Valuation . .
.00
o
Paid
Credited
Pee SU1lIlIary
Due
PeJ:1llit Fee Total
Plan Check" Total
Other Fee Total
Gx1mdTotal
.00
.00
.00
.00
.00
.00
.00
.00
Signature of Owner (if owner is builder)'
T,\PLANNING\FORMS\I 102.15 (11/141200 ]
I
r"
"
I
.- - ,':,,0,', ::.V;j':(; >~"':'>:":-\\~',,\., ''','- ,'i>,':" -',
'r::'~~"'< t.'
· . ,'., '''''1;;;':'''';';';;'.'.:r''': ~:,,:tr'l
BUILDING PERMIT INSPECTION RECORD
~
CALL 417-4815 FOR BUILDING INSPECTIONS. CALL 417-4735 FOR ELECTRICAL INSPECTIONS.
PLEASE PROVIDE A MINIMUM 24 HOUR NOTICE.ITIS UNLA WFUL TO COVER, INSULATE OR CONCEAL ANY WORKBEFQRE
INSPECTED AND ACCEPT.E,D. POST PERMIT IN A CONSPIClJOUS~OCATION.
KEEP PERMIT CARD AND APPROVED PLANS AT JOB SITE
INSPECTION TYPE DATE ACCEPTED . '. COMMENTS ..,.'
YES I NO , ,,: .'....'...
F;()UNDA TION: . ">r,
FOOTINGS "',.
WALLS .
FOuNDA nON DRAINAGEIDOWN SPOUTS ,
ELECTRICAL' (LIGHT DEPT) .SEPARATE PERMIT: # . "
ROUGH.IN , I
PLUMBING .
UNDER FLOOR/ SLAB
ROUGH.IN
WATER LINE (METER TO BLOG)
"
GAS LINE .. '.
BACK FLOW/WATER '.' .
,
AIR SEAL .
WALLS
CEILING I
FRAMING
JOISTS / GIRDERS
SHEAR W ALLlHOLD DOWNS ..' ,
WALLS / ROOF / CEILING
DRYWALL (INTERIOR BRACED PANEL ONLY)
T-BAR ..
INSULATION '" '. .
SLAB I
W ALLl FLOOR/ CEILING I I
MECHANU::AL ,- -- ~
HEAT PUMP
Gi\S LINE
WOOD STOVE / PELLET / ClDMNEY
HOOD / DUCTS . .
PW UTILITIES / SITE WORK (Engineering Division) SEPARATE PERMIT #.5:
W A TERtINE / METER
SEWER CONNECTION
SANITARY
STORM
PLANNING DEPT. SEPARATE PERMIT #'5 SEPA:
PARKlNGILIGHTING . ESA:
LANDSCAPING , SHORELINE: .
'. ".' FINAL 1~:SPECTlONS REQUIRED PRIOR TO OCCUPANCYIUSE ....
RESIDENTIAL DATE YES NO COMMERCIAL DATE ACCEPTED
YES .' NO
-c-
ELECTRICAL - LIGHT DEPT. 417-4735 . ELECTRICAL
LIGHT DEPT
CONSTRUCTION R. W./ PW/ CONSTRUCTION - R. W.
ENGINEERING 417-4807 PW / ENGINEERING
, . ."
FIRE 417-4653 FIRE DEPT.
PLANNING DEPT. 417-4750. PLANNING DEPT. ;
BUILDING 417-4815 I ~ -!)~.{),~ 1'<\1 BUILDING ,
T:\PLANNING\F9RMS\II02.15 [I111412oo3J
,~
\"
BUILDING PERMIT - APPLICATION
FOR OFFICIAL USE ONLY:
Date Rec.: 11- / 'Z-<::J3
Permit #: 11)9 LJ
Date Approved:
Date Issued:
Fill out COMPLETELY and in INK. Your application and site plan MUST BE
COMPLETE to be accepted for review. If you have any questions, call
(360) 417-4815
Applicant or Agent: VV\, e-1I\cu. t flA. V ~ Phone: 4~2 -12... 92-
Owner: ~. ~ W 10 Phone:).o~ - 'i.3 r - 1/ ~ 4-
Address: 52.--2-\ 4-1-6 ANt ),w' City: ~ .~ Zip: 1~ (/ ~
Architect/Engineer: ::Do\/\. $'(.. kJ\o P\.. Phone: 4 Q - 02- 01-
Contractor tIt\ V \Aeu.-{l ~ \J<./v~ (p~;k License #: M IC-H A,ec.02./~~: 12-/20 f 04 Phone: 4- S2- -7 2. ~ Z-
Address: f. O. ~ox 4o~1 City:_po~ .t'tA~lt) Wl\ Zip: 98 3c,.3
PROJECT ADDRESS: ~ 31 (A) . f..e f::.
LEGAL DESCRIPTION: Lot: J I
Subdivision:
ZONING:
TfA
Block: 10 {
CLALLAM COUNTY PARCEL NUMBER: Db3. 6600 10/ S OCCCJ
Credit Card Holder Name:
Billing Address:
Credit Card Type VISA
TYPE OF WORK:
o Residential 0 New Constr. 0 Re-roof
o Multi-family 0 Addition 0 Move
o Commercial 0 Remodel ~Demolition
o Repair 0 Sign
BRIEF DESCRIPTION OF THE PROJECT:
-J o..ck C)..( h.oth(,
COMMERCIALIRESIDENTIAL: Occupancy Group:
City:
MC
#
Exp. Date:
o Stove
o Garage
o Deck
.,0 Other, k
~l( o/...,
SIZEN ALUATION:
SF. @ $ /SF. = $
SF.@$ /SF.=$
SF.@$ /SF.=$
T~OT (\.L V AUJA TION $
"f' _ 2.)A. dell' f, 0"" $ --f.o
/
Occupant Load:
Construction Type:
No. of Stories: Lot Size: Existing Sq. Ft. & Proposed Sq. Ft.
Existing lot coverage _ % & Proposed lot coverage _% = Total lot coverage
APPROVALS:
PLAN:
BLDG:
DPWU:
FIRE:
OTHER:_
PLANNING USE ONLY:
ESAlWetland(s): 0 Yes 0 No SEPA Checklist required? 0 Yes 0 No Other:
BUILDING PERMIT APPLICATION SUBMITTAL: The Building Division can provide you with information on the application and
plan submittal requirements if you have questions.
VALUATION OF CONSTRUCTION: In all cases, a valuation amount must be entered by the applicant. This figure will be reviewed
and may be revised by the Building Division to comply with current fee schedules. Contact the Permit Coordinator at 417 -4815 for assistance.
PLAN CHECK FEE: IF a plan check fee is due it must be submitted at the time the building permit application and construction plans are
submitted. All other permit fees are due at the time of permit issuance.
EXPIRATION OF PLAN REVIEW: If no permit is issued within 180 days ofthe date of application, the application will expire. The
Building Official can extend the time for action by the applicant up to 180 days upon written request by the applicant (see Section l07.4 of
the Uniform Building Code, current edition). No application can be extended more than once.
I hereby certify that I have read and examined this application and know the same to be true and correct. I am authorized to apply for this permit and
understand that it is my responsibility to determine what permits are required ,not the City's, and that I must obtain such permits prior to work.
T:\FORMS\APPS\Buildingpennit.wpd Applicant:~ ~ Date: 1/ /2.{' /0.:3
r '
SITE PLAN
o I 110
fu
-1
~
FENCE
NEB
839 W. 6th STREET, PORT ANGELES. WA 98362
7' SETBACK
140'
J
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ADDITION TO
BE REMOVED
ltf'f(lJj. 103 <.iJ -0.
------------------------------------------------------------------------------------------------------
140'
CURB
CENTERLINE OF B STREET
DRAWN: NOV 2003
DON SCHU8A 452-0207
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~ORTANGELES
WA 5 H (, N G TON, U. S. A.
PUBLIC WORKS & UTILl11ES DEPARTMENT
November 26, 2003
Michael Rivers Construction
P.O. Box 4074
Port Angeles, WA 98363
RE: Port AngelesLandfill Waste DisposalApplication, WDA 03-23; Building demolition
at839 West6th Street
We have received your application for disposal ofbuilding demolition debris from the referenced
site and reviewed the testing results for lead and asbestos content. Based on the testing results
-the debris appears to be acceptable for use in the landfill. A copy of your approved application
is attached: This approved application must be shown to the landfill scale attendant at the time
of disposal. . -
Please be advised that this disposal application is'onlyfortlle materials andquantitie's liste<liii
the application. Materials not listed or in' excess of the quantities noted mayreqilire separate
applications and approval.
I I"
Please call if you have questions. '
Very truly yours,
J/uMA~
GaryW. Kenworthy, P.E.
City Engineer
Deputy Director of Engineering Services
GWK:tf
Ene\.: WDA 03-23
Copy: Ken Log1uy
Northwest Asbestos Consultants.
N:\PWKS\ENGINEER\WDAPPLIC\03-23.WPD
FILE: Landfill Solid Waste Disposal Applications
321' EAST FI FTH STREET · P. O. BOX 1 150 · PORT ANGELES, WA 98362-0217
PHON E: 360-417-4805 · FAX: 360-417-4542 · TTY: 360-417-4645
E~MAIL: PUBWORKS@CI.PORT-ANGELES.WA.US
I-
I.
I ~
, '
/)JJ:* o3~Z8
PORT ANGELES~NDFILL
WASTE DISPOSAL APPLICATION
Phone: (360) 417-4803
FAX: (360) 417-4709
To: City of Port Angeles, City Engineer I
321 E Fifth Street
P.O. Box 1150
Port Angeles, Washington 98362
NOTE:
All questions must be answered for waste to be approved.
1. Generator Information:
Company Name:
Mailing Address:
Contact:
Phone:
Project Name:
I
Project Location:
M\(.,l1~ ~\VE12_S~ Co/VSmvCDotJ
'p. v . a o'f(. 10 '14-
po t2."1 ffrJ&t tl..-6-,
M,\.tAI\.~~.t fu.~
4 S-2 - C; 2-7 2-
L-G.~H. a (5
<2< ~ '1 ftJ '
wA
7~.31o ~
'4-~o -: Do 4 ie
IL€ I/V.1) o€: z-
'''LL~'~+. 'Povf~W
I '
2: Other Contacts (if applicable):
Consulting Firm:
Contact:
Phone:
Contractor Name:
Contact:
Phone:
Laboratory:
Contact:
Phone:
(M
fJ()V~ i1i~~ ~ ~\h75
(31J.!> w,~\~ J
(3bO) 38')" - ar8+
tcL.. s v,~h
E.FYlA
~ l^-; -/tJ'1 G, re;vp $-v-VI ~j
<oj V elL €-v v~ W\ I ~:>
~ {( /30 b 1N1~4e k>v
~o(P -71?3- 1-1
~o L... bt cf- l'" Iv
Page - 1
City of Port Angeles - Lapdfill Waste Disposal Application
'.
~. Source of Waste:
Check the appropriate box below and briefly describe the project, process, and/or cleanup that
will or has produced the waste requiring disposal. Include the gasoline. service station number
(if applicable).
,
CERCLAlMTCA Remediation Agency Contact:
,
Independent Remedial Action - UST Removal
, ~Wt.-o ~ (
Unused Chemical Product Spill XJ Other Source:
,
,D~ Wlo ( I -hTJ€., of S~" 'S.fc...., ck-v,j, ~ JeL hlJ~ ~ h.
f'n Vh~ry r~sl~ c-it-a.v'd ro 0."",- ~y- /l.uc..AJ
U/~/~ 1Y--v C h 07.-; .
I
,
4. Waste Material Composition: (check all that apply and include percent of total)
Soil % Foundry'Slag - %
~ (3811\11 alstAsphalt ;).-. % Dredge Sediments %
-
Preserved Wood % v'DebriS .:lL%
Coal Ash % Other (list)
Wood Ash % - %
- %
NOTE: Total must e uaI100%.
5. Waste Material Contaminants: (check all that apply)
Gasoline
Solvents
Unused Motor Oil
Other
Metals
Heating Oil
Used Motor Oil/Waste Oil
Other Petroleum Product
Diesel
PCBs
Unknown
NOTE:
Supply any MSDS information with application, if available.
City of Port Angeles - Landfill Waste Disposal Application
Page - 2
1-
9. Estimated Quantity of Waste for Disposal:
bl/
Cubic yards /
Drums /
~
Tons (estimate both)
Tons (estimate both)
Other
NOTE:
Estimated quantity for disposal' must be within 20% of the quantity actually disposed.
(10% for projects over 7,500 tons or 5,000 cubic yards.)
7. Frequency of Disposal:
One time
Monthly
Annual
'I-- Other
1"WO fy~r:> ?
8. Waste Sampling:
Proper characterization of the waste for disposal requires the collection of representative
samples. The methods and equipment necessary for obtaining representative samp'les ora
waste, and the frequency of sampling, will vary with ~he type and form of the waste. Check the
appropriate box and briefly describe how and where the waste was sampled. Include site maps
with sampling locations if possible. ' , , .'
Number of ,COMPOSITE samples I &, numb~r otdiscrete,samples p~r composite -"-------'-
Number of DISCRETE samples I~
S'e.L UfD~;f.:, .l; (Dub ~\J ( '~l !y-- I E f: 1'\;'\' I
,
1 t.,
NOTE 1: Unless prior approval has been granted by Port Angeles, the following sampling
frequency will be used:
=
1 composite sample
3 composite samples
5 composite samples
7 composite samples
10 composite samples
10 plus one sample for each additional 500
cubic yards
0-25
25 - 100
101 - 500
501 - 1000
1001 - 2000
>2000
cubic yards
cubic yards
cubic yards
cubic yards
cubic yards
cubic yards
=
=
=
=
=
NOTE 2: One composite sample shall contain a minimum of three/maximum of five discrete
samples.
City of Port Angeles - Landfill Waste Disposal Application
Page - 3
9.. Waste Analysis:
The "Dangerous Waste Regulations" (WAC 173-303) .shall be utilized to determine the
appropriate analytical requirements for waste characterization. Ecology Publication #91-30
(Revised April 1994) "Guidance for Remediation of Petroleum Contaminated Soils. shall also be
used to characterize petroleum contaminated soils froni UST releases. Submit all laboratory
analytical results, QAlQC data, and Chain of Custody sheets along with this application.
. .
(NOTE: The laboratory must be accredited by the Washington State Department of Ecology.)
a) List all analytical test methods used:
b) Provide a narrative as to why the above analytical methods were selected:
I
~
~
~
~~Vl
~/l-J CJ'r-e,,/j.vYl ~ J ] lJ-e...
f
NOTE:
Additional sheets attached: ---)t1- YES
NO
10. Soil Classification: (**FOR PETROLEUM CONTAMINATED SOILS ONLY-)
Based on the analytical data and Ecology Publication #91-30, the soil classification is: (check
one)
Class 1
Class 2
Class 3
Class 4
Calculated Hazard Index
11. Dangerous Waste Affidavit: .
Based on a review of the analytical test results, site history, and the applicable regulations, this
waste is classified as: (check one)
Neither Dangerous Waste (OW) nor Extremely Hazardous Waste (EHW)
Dangerous Waste (OW) and Waste Code:
Extremely Hazardous Waste (EHW) and Waste Code:
city of Port Angeles- Landfill Waste Disposal Application
Page - 4
1-.. -----
------
..
..
12. Certification:
, I
We, THE UNDERSIGNED, certify that this application is'true to the best of our knowledge. Ali
infonnation provided is correct and the enclosed analytical results represent the proposed waste
material to the best of our abilities.
/'77(~ ;~ I
Waste Generator Signature
tvlt (il-1~..e t ~\J~ , I
Printed Name
M I ukeu-l f.A\J~ C6L-./~{I-t\Jv~ ,
Company
1/ (2&/ b3
Date. I
t I., .
N:\POLICY _P\1000_SW\1009_01.WPD
city of Port Angeles - Landfill Waste Disposal Application
Page - 5
(
" (
('
Figure C~3
. ( . ...
Problem'WastenisposaIAcc~~tane~Proeess. . .
. it
Qenenlorcontacts city
ofPoJt~or .
CCEHD-' niquestins .-
dispose of problem
WIISteS at Ihe PALr.
~ or City. or POd AD&ela
rorwanla .the .... . Copy of
tile PALP WDA. (A.nac:IImeIit A
to Waste. Acceptancc Policy)
~-- ............- :
.~~ ~~~ I
md Jubmita 10 City the .
WDA inclUdin. i
laborataiY analytical ~
results ... ~
atrol iftfonnation.
,.City of Port ~ City
EaJinecr or clestpalCd
~tive reviews
WDA (or completencsa
MId accuracy.
Ves
. ,
City 'of. PortAnplOl Enaincer. or
cIeI1pated ~ve.tliJftl WD~
and foiwards . copy to CCBHD for :
their mriew and ~zation.. .
Yes
City aencb au .pprov.a
Idllft' to the pn<<aaor.
Upon receipt' of the
waste It the landfill,
the pte attendant
verla. tba the
qaatity received is
within 20% of the
qUIIIdty .1IpOI1cd In .
the WDA (within I~
For >1500 tons or
. SOOO cy ).
Ya
No
City noUfielpnaator in writin& of
. reason for di:aapp1ovalmd (0f'WII'ds
copy to CCElfD. Oencrator may
resubmit WDA after Iddreuina City
and or CCEHD conc:cma.
.CCEHD: ct....... Counth Enviroi1menIallWlh Division PAL'; Port AntIcI. Landfill WOk Waste Disposal AppIic:ation
. .
.'
~~
. ull
Northwest Asbestos Consultants 3'~. {e,L'
406 Reed St. ':: ",,1/ .- r-'"
Port Townsend, W A 98368.'
360-385-0584
huggybear@olympus.net .
Date: . 11/23/03
lOb Location: 839 W. 6th St.
Port Angeles, WA 98363
Contact: Michael Rivers
840 W. 6th St.
Port Angeles, WA 98363
Owner: . Leah Erb
3225 47th Ave. SW
Seattle, WA 98116
Inspector: Bob Witheridge
AHERA - Building inspector / Management Planner
WAMOA - 0042-03
Expires - 10/28/04
Stope of work
1) Inspect for asbestos containing building materials (ACBM).
2) Survey, sample and record suspect materials.
3) Report to Michael Rivers with results of testing by Clayton
Services.
4) Copies for owner, City of Port Angeles, Olympic Region Clean Air Ag~ncy
and abatement contractor. '
'I I"' ,I,
I I.,
lrispection Report
The inspection started with a visual survey looking for Asbestos
Containing Building Material (ACBM).
This structure was built in 1938. The single story wood frame home was on
post and block foundation. Roofing material was a.three tab composition
and windows were wood frame. Heating system was all electric. .
The suspect materials taken were:
Sample #1~
Sample #2:
Sample #3:
Sample #4:
Sa.mple #5:
Sample #6:
Sample #7:
Sample #8:
Sample #9:
Sample #10:
Sample #11:
Sample #12:
Bathroom floor tile, 9"x9" with mastic. Brown pebble
pattern.
Pantry floor tile, 12"xI2" with mastic. Top layer. Tan and
brown shades. I
Pantry floor vinyl, bottom layer with mastic. Browns.
Kitchen floor vinyl, with mastic. Top layer. Cream with
brown trim.
Kitchen floor vinyl, with mastic. Bottom layer. Gold. and
orange. ,i . .
Dining room floor vinyl. Flower pattern.
East bedroom floor vinyl. Dark brown.
South bedroom floor vinyl. Green.
Attic space rock wool. Charcoal color.
Chimney mortar, gray.
Exterior home skirting on base of structure~
Window glazing on wood frame windows.
All samples were sent to lab. See results.
I
ASBESTOS BULK SAMPLE DATA
Northwest Asbestos Consultants
406 Reed St.
Port Townsend, WA 98368
360-385-0584
huggybear@olympus.net
To Clayton Services
~ 11/19/03
lob Location: 839 W. 6th St.
Port Angeles, WA 98363
Contact: Michael Rivers
840 W. 6th St.
Port Angeles, WA 98363
Owner: Leah Erb
3225 47th Ave. SW
Seatlie, WA 98116
Samnle #1: Bathroom floor tile, 9"x9" with mastic. Brown pebble pattern.
Sample #2: Pantry floor tile, 12"x12" with mastic. Top layer. Tan and broWn shades.
I I I II ','1 -,'II' I ,I" I i ,I.' 1,1, I I I " I 101
Sample #3: Pantry floor vinyl, bottom layer with mastic. Browns.
Sample #4: Kitchen floor vinyl, with mastic. Top layer. Cream with brown trim.
Sample #5: Kitchen floor vinyl, with mastic. Bottom layer. Gold and orange.
Sample #6: Dining room floor vinyl. Flower pattern.
Sample #7: East bedroom floor vinyl. Dark brown.
Sample #8: South bedroom floor vinyl. Green.
Sample #9: Attic space rock wool. Charcoal color.
Sam.,ple #10: Chimney mortar, gray.
Sam,ple #11: Exterior home skirting on base of structure.
Sample #12: Window glazing on wood frame windows.
Inspector:
Bob Witheridge
AHERA - Building inspector / Management Planner
WAMOA - 0042-03
Expires - 10/28/04
Please call with test results when completed.
:~~
uen1: Northwest Asbestos ConsultaDts
! I '
ation: 839 W. 6th St. Port Angeles, W A
.. .. ~~:
&AMl'L~#:l 35Z13.JA SAMPLE LOCATION:Batbroom floor
SOURCE: 9~'X9" Fl66r Tile
LAYERED SAMPLE: NESBAP and AHERA regnlations require layers be apalp:ed and reported aeparately.
. - ..... - .. - ,.. '... -. - ..... .. - .O'
Asbestos Containing Material LA YEll 1
. (ACM)
11----- -
--
20-200..S . 14: ~
,"un '-" ~ U'U U~. T a",,^,
U-HY I UN t.:iI<lJlJI-' Sl:::i'<V 1 U::~
\... ______._ __I
Log # 35213
JoblPOtl
llon.asbestos
fibers
cdiwose
%otbet
fibers
1
DOniibro1l$
cempODen~
Aggregate ,
Vinyl Filler md Binder
Asbestos '
- -..-
Chryso~e
Asbestos %
-
2
.... ", -. 1" -' ~Ci})tioll: White pebble.-uxtured viIlyl
Note: t'ld)" TIle, brown pebble pattern
(
SAMPLE #:1
SOURCE: ~
~B SAMPLE LOCA T10N:Bathroom f1~r
No Asbestos DeteCted
LAYER. 1
AsbestOs
DOD';sb~
flbers
Cellulose
*' other
fibers
2
Donfibrous
. _ components
Filler & BindeT
Asbestos %
~'(b.j41~
Doullbrous -4
~,
62
-.. .-
nonfihrous %
98
De5criptioD: Clear mastk
Note; Mastic
\
____, .'1- LABih .. . -- - .-
SAMPLE #il 351.13.2 SAMPLE LOCATIQl'i18athroom tloor
SOURCE: Not Noted.
,
No ~bestos Deteciied - ... - .. .
~ LAYERED
- -. . .-- % otber
Asbestos Asbestos o/e pon-asbatos Donfi
. ,.......- .._libers . .. fiben ~P9.
Cellulose .30 Asphalt Filler &.
rillcr &, Binder
, Vinyl Filler and a
I -- -- -- . . -
Description: Tlln "'Ulyl with blade llsphaltk fibrous mate .
.--.....-...- .-- -.- -
Note; Unllb~ to separate 1'IlllS't1c for individuahnalysis.
-- . .
Imiut .
ReIfb
Binder
inder
~.l11
.J
---...
. .'1
.-
.~~%I
:)S
10
IS
I
rial and red caatl.n.g
. .._..J
I
I
PRELIMINARY REPORT
LllborlStory DGta SheQ is ftlrlRb use "lid fulng only. The./ili4l1 repDrt will follow in the mlliL
VerJfted by: <1f II /J.JI tl '?
ANALYZED BY:
Jude C\Jmmings
ON 11/20/2003
NU~~-d~~ 14:d~
~... 'J ...u..... ~ &. ~'M V ........& .. ."~'WU
Client: Nor~west Asbestos Consultants
-Locatiou: 839 W, 6th St. Port Angeles, W A
~ . LABI#: '"-- 1
SAMPLE tfll ~$Zl;UA SAMPLE LOCATlONu"""try floor. top aye!"
SOURCE I 12"XlZ" Floor Tile
LA~ S~LE: l'II'ESHAP and AHERA regulations r~e layers be analYzed 2nd reported sep.arateJy.
--"'NoAlbe&to;Deteeted - 'LAYERI .. ,- ' " --- '
LLHY I UN l:iI<UUI"' o!::t<v 1 U:.o
,d~'(bS4189
, P.02
oJ
-. -----
,\.
Log ## 35213
Job/POj
nOl1tIbroas : ..
_ c(Jmpo~~.ts
Aggregate
W:ollastoJ'lite
Vinyl Filler and Binder
Mn-asbestl)$
fibers '
cCll~lose
% otiler
fibm
1
noDfibro(i:~ %
30
Asbestos
Asbesto$ %
,68
._, 'w .. \- ~~ll; Tan \1nylwith gold and wbite s1reaks
Note; llffx11" THe, Wi and brOWII. ikades
M'_~
,_ _l
.J
........-
.... ,.,._.
-'to.-
SAM.P.LE #:2
SOUacE: 1\bstie
LAB#:
m1~.3B
SAMPLE LOCA TlON1Pantry nOW'
-
No ~estos Detected
LAYER 2
Asbest0.8
Asbestos %
. % -od1<<,
fibers
g
IlOJIfWrOWi
_ compoDen~
Filler 84 Bindel'
n~b~~
92
I' 'i I ','11' II ,.1,. 1\"
I;"
I I'i
'l.-J
., "D:~PtiOn;
-.J
.~
I,
Clear mastic
Note: Ma'*
r- SAM:PJ.,~ #~
.. SOURCE: ytnyl me
..._~-_.. -- ----
No ~bestos Detected
LAB#:
3SZ13.4
SAMPLE LOCATION: Pt.nW poor. bottom layer
LaYers Homogenized for ~i;-
Asbes",s
LAYERED
~.4other - . nOnftbt'OU$ .., . . "'-
j fib~"on.. com1JOJ1ent.! ILODfibrcu$ ~~
[30 . . Piller &. Binder 10
Asphalt Filler & Binder 35 .
Vmyl Filla and 'Binder 2S
I. Description: Shades of bro~, ora~ge. and y~low vinyl witb blllek' aspbalti' ObrollS
___ ___" _ " _ _, material and Ted materl41
Un:abl~ to separaU mastie for individual Mal)'.,
~~~~~_%
nOD-asbestos
fi ~
Cellulose
Note~
PRELIMIN~YREPORT
, 1Aihor4tOty Ditta Sheet is fot l/lb use and faxing only. The fUle! report will follow in the mlli!
Verified by; ~ e"bA((Y~
ANAL'YZEDSV;
Jude Curnmingi
ON 11120/2003
NDv-20-2003 14: 29
\....12l~'UnU-n'up 0-=1 n~.,
;,.: ';.:.,::'. '.'.,i :.':',,'
CLAYTON GROUP SERV ICES
~~a.'~
,( .&........,..._-_.
2067634189
..6___-__ __. __ ...
, P.03
../
'Cliellt: Northwest Asbe$tOs Consultants
. Location: 83,9 W. 6th St. Port Angeles, WA
SAMPLE #:4 ,'Is~ SAMPLE 'U)CATlON1Kitchel1 floor
SOURCE: 'fmyl Tile
Log 1# 35213
Job/ PO##
-l
-No'Asbestos Deteeted.
-~_.._.". ..
Layen Homogenized for An2Iysis
Asbestos
Asbestos %
LAYERED
DOn-asbeStos I % other'
cCliulose-1ibers .~~
Synthetic . 5
Donfibrol1s
__ . tompooeBU..,__._:
, Filler /JL Binder
Vinyl Filler and Binder
D~~nbrouft ~ I
ss
.1
'!
:l5
--=J'
, .:~I
_. . ._ _ - .1'D~~60":
Note: Unab~ to scparate mastie for iltdividaal analysis.
Wttlte vinyl with lray f1hrous backing aud tan mastic
SAMPLE #;5
SOUR~: VlB)rl Tile
LAB#:
3S113.6
SAM1'LE LOCATION:Kltcheo flotJr, Bottom layer
Asbestos
I ft..,~-- Ir
Chry~e
Asbestos 0/&
15
I' - - LAYERED '
~ n~HSbestos ootll.et nODfibrolH
t:"me.rs tiben c:omPDnen~_ 0
to Filler & 6jnder
"'01'" ,'.1. Vinyl Filler and Biltder
- 0
Layers Homogenized for AJtalysis
-.....-.-
Asbestos :Containing Material
\- (ACM)
CeUulOS8
Ilomtbrous %
4.5" . .,-
~o,.,
I I 1"
, r -pti~, --....w, aDd ....g. ';';yi ~ :<<.....110 ti~~tai~ .1i4 ~ ~_~
Not~: UUII-bie to separate mastic from asJ:testos-contaiDiDg 'Vinyl baddDg for individual analysis.
1
-.... -... .. ...
..----...I. I ",.. .....
-iAB#:
35213.7
,...
.... .......,
SAMPLE M
SOURa: VInyl Tile
SAMPLE LOCATlON:Dtn~ room floor
No ~sbestos Deteeted
Layers Homogenized for AnaIysi.s
Asbes~B
AsbestOIl %
110n--asbestos
LAYERED
r% otbei- DODfIbCOllt-
fibers .., . ., eompoaents
15 Filler &. Binder
2 Vinyl Filler and Binder
, "Ceiiulose
Synthetic
nonDbrOU$ %
53
30
.to -
DescriptJoJU T:ll.!). Gower patterned vl.Dy1 with tau fibrous baekillg aDd tall mastic
Note: UnablC: to separate masfu: for IndMduaJanalpis;
..-.---.. ....... ..-.. ... ...
lIRELlMINARY REPORT
LlIborlStory Dtmi Sheet is for lab use llnd faxing only. The final report will follow in tlal! ma.il..
VerWedby: \" ~, f .~ lJ(Q~
ANALYZlm BY:
Jude Cummings
ON 11120/2003
I'"
Nt!U-20-2003 14: 29
. \.....lOlVWD U'l'UUlI ':'Cl v."w;::t
CLAYTON ~' SJ::RV lU::l:i
j,Mb'(b.S41W
f'.~
j
~A',&"""
\.. ._..~--_...... -...
Log ## 35213
Sob/PO#
.
'Client: Northwest Asb~tos Consnltants
, "
",Location: 8J9 W. 6t1t St. Port Angeles, W A
G- ,- W#;
SAMPLE 11:7 3S21:U
SOURCE I ~nYl Tile
t .._. I""'"
No Asbestos Detected
--'J
.__. .J
SAMPLE LOCATION: East bedroom floor
Layers Homogenized for Analysis
l1on-asbestos
fibers _
Cellulose
Synthetic
LAYERED
% otber
fibers
is"
S
nonflbrous -, ~ .
.. JompOJlen~ . ----1. . ~~fjbrou~ o~
Filler &. Binder l10
Asphalt Fill~ & Binder '. 45
, Vinyl Filler and Binder ' 25
. -.
Asbestos '
Asbestm %
DescrlpUou: Various ealcred vinyl with black fibrons asphaltie buldnC aDel rtd mastic
Note: UlUlble to sqJarate mastic for b1dividual analysis.
_...........-
-"
I _
. LAB#:
3S213.9
SAMPLE LOCATION: SOllth bedroOm lloor
.
SAMPLE,:8
SOURCE: ViDyI Tile
No ATsbtstos Detect;;d 1--
Layers HomOf:e"IIIizt:cl for Analysis
.-..--"
As~~:,!~
Asbestos %
LAYERED
non-awestos ~rother
fib.ea nbe~
30
noRflbroos
components
Aspba1i Filler lk- Binder
, Filler & Binder
Vmyl Filler and Binder
nonfibrou$ %
40'
.5
25
CelluloE
. ~ ..
Description: Green vinyl With black aspJLa.tlc fibrous mater:bd !lDd gree nta$dc
Note: Unabl, to separate mastic for indMduat analysis.
LABi: .
35'-13.10
~
. ~ '..:;1
SAMrU; ~:9
SOURCE I Rodt. Wool
SAMPLE LOCA. 'tIQN:Attic space
,
-*.,-
No Asbestos Detected
AsbestOs
non-asbmos
fi n
Mineral Wool dBcad&
LAYERED
% vtber. .
fiben
80
Asbestos 0/0
lloDiJbroa
~ompoDenta _,
MiscelllLllCOUS Particles
nonfibrous 0'"
20'" -
--... .. _~ 1- Deseriptioll~ Dark..gray fibrous compressed mllterial
N(lte: :aocl"voo~ dlarcoal color
PRELIMIN~Y ImPORT
Laboratory Datil Sheet is for ltW u:e and fttxihg cnly. The fmal report will fbl10w in the maiL
Verified by: '}1- If ) 2A ( ~
ANAL YZBD J;lY:
Jude Cummi~
ON W20/2003
o ~ , . 01 ~Ptio.t Wblte paint on cray gritty eompreased materl1ll
. ,-:!".k4"::.;;'I!:l~~~... 2-2..' ~_ u...Hl I UN Ut<ULlt" ocKV! U::o
"Client: N ortb"est AsbeStos Consultants
~LocatioD: 839 w. 6th St. Port Angeles, WA
,---- -~. ...
LAB##: .
35113.11
SAMPl.E LOCATJON:CblmDey
SAMPLE #:10
SOURCE: ~o.rtar
.
No ASbestos Detected
LAYERED
".r olber
fibeJ'S
Asbestos
Asbestos %
non-asbestos
_mW::L.'.
, .
Note; MorUr, gray
.---. .--
SAMPLE LOCATlON:E.xterior, 0& base of st....cture
v- .
SAMPLE #:11
SOURCE: Some SkIrtiDg
L.Uik .
35Z13.1:
Asbestos: Containing Material
. (ACM)
HOMOOENEOl!S
DOll-MbeRtOI % otlaer
filtert ~
Asbestos
Crocidolite
Chrysqtile
Asbestos %
3
20
, , .',', ~ , ~\ I' I' ,-10.
DC$Criptirm: Gray I1bYOQ compressed brittle material
Note; Exterior home skll1Jng
,
....~ "'1 ,- ~.... ,;.."
_.. . t
, SAMPLELOCATION:Winduw, onwoodframcWl
. .. ... . ..
'..clows
-. --
for AB1I1y9is
- ...u,.,....-
DoafibrOlU %
74
25
L...... ."
al
..
~
'-'J ~~~~Pti~:. __~.hit~ paint on white compressed powdery materi
LAW#~
39\).'3
SAMPLE ~12
SOURCE; :windowGIofng
No Asbestos De~
_. .00_
AsbestOs
LAYERED
non:Ubestos . % other
.o__~ ~el'!
Cellulose 1
Asbestos %
.
Note; Wlpdbw gl87.blg
- I, __ _
.a!Jb' (b.;S41 tI~
P.\if:)
\..
Log # 35213
lob IJ'O #.
I 1
Lay... H........_..... -.,..... =-J
DonfibrvllS
. ~!ftpoDeDt8 _ __ _ DOllllbrous %
Aggregate 45
Filler &, Binder
Paint
4S
,10'
Donfibrous
'0 romPODR~..
Filler &. Binder
nonfibroU$ ~
77
I i..
. ..
LAyen Homogenized
nollfibroUS
co onentl
Filler & Binder.-
Paint
PREUMINAltY REPORT
LllbDr/Ztory DMil Sheet is for lIlb use #lid fflXiflg tlnly. The fintll report will ft>l/ow in the mllil.
Verified by: ,~ ( t l2d( 0-;'
.o\NAL Y2lID BY:
Jude Cummings
ON 11/20/2003
Summary of Inspection:
This survey includes all areas of inspection with the report results from
Clayton Environmental Testing Labs.
Sample results are as follows:
Sample #1:
Sample #2:
Sample #3:
Sample #4:
Sample #5:
Sample #6:
Sample #7:
Sample #8:
Sample #9:
Sample #10:
Sample #11:
Sample #12:
Bathroom floor tile, 9"x9" with mastic. ,Brown pebble
pattern. 2% chrysotile asbestos with negative mastic.
Pantry floor tile, 12"xI2" with mastic. Top layer. Tan and
brown shades. No asbestos detecteQ.
Pantry floor vinyl, bottom layer with mastic. Browns.
No asbesto's detected. I
Kitchen floor vinyl, with mastic~ Top layer. Cream with
brown trim. No asbestos detected.
Kitchen floor vinyl, with mastic. Bottom layer. Gold and
orange. 15% chrysotile asbestos with negative mastic.
Dining room floor vinyl. Flower pattern.
No asbestos detected.
East bedroom floor vinyl. Dark brown.
No asbestos detected. .
South bedroom floor vinyl. Green.
No asbestos detected.
. Attic space rock wool. Charcoal color.
No asbestos detected.
Chimney mortar, gray.
No asbestos detected.
Exterior home skirting on base of structure.
3% crocidoliteasbestos and 20% chrysotile asbestos.
Window glazing on wood frame windows.
No asbestos detected.
summary continued:
The total square footage of asbestos containing building material needing
abatement prior to demolition is approximately 168 sq. ft. of 9"x9" floor.
tile, 132 sq. ft. of sheet vinyl and 280 sq. ft. of ASB skirting material.
All asbestos containing building material (ACBM) with a reading of 1 % or .
greater is to be removed by a certified abatement contractor which follows.
the rules of the EPA and governed by Olympic Region Clean Air Agency~ '
This report is not a guarantee that all suspect of ACBM were found. The
possibility of concealed material exist and may'be found during demolition.
After the facility is completely cleaned out a walk through and inspection
is required by the original AHERA building inspector (NW Asbestos) after
abatement, then a copy of the letter certifying that abatement has been
completed needs to be received by the City of Port Angeles and Olympic
Region Clean Air Agency.
I have contacted abatement contractors to send you proposals for the
removal of the flooring and skirting materials. Feel free to contact me if I
can be of further assistance.
Thank you,
13~~
Bob Witheridge, E.F.M.
'".,', :"1 ',11' I' ,.1"
"I ,.
I I"
..
\ .
Northwest Asbestos Consultants
406 Reed St.
Port Townsend, WA 98368
360-385-0584
huggybear@olympus.net
Date:
11/24/03
lob Location:
839 W. 6th- St.
Port Angeles, WA 98363
Contact:
Michael Rivers -
840 W. 6th St.
Port Angeles, WA 98363
Leah Erb
3225 47th Ave. SW
Seattle, WA 98116
Owner:
Regards to:
Survey, inspection and testing'for suspect lead.
Inspector:
Bob Witheridge
EPA-AHERA-Building Inspector
Management Planner
ID# WAMOA-0042-03
Expires - 10/28/04
Scope of wor~
1) Building survey and inspection for'lead in painted interior.
2) Sample and record suspect material requested by Michael Rivers.
I .
3) Report to Mr. Rivers results of testing by Clayton Services / NVL
Laboratories, Inc. .
Inspection Report
The inspection was requested Michael Rivers to sample for lead.
A walk was made throughout the home finding sample #1 of off white
interior paint. Color and texture was homogeneous to many areas of this
home. . I
See attached report from Clayton Services / NVL I:.abs.
I, ."'1'1 ;11' I '0.1"
I I
Summary of Inspection:
The inspection of this home was to test for suspect lead. This was requested
by the Michael Rivers.
Sample was taken and sent to the testing labs. The results for lead base
paint is as follows.
Sample #1: Lead testing from interior paint. .0046%
Lead base paint required reporting liniit is 48.0%.
The results show a level of lead that can be disposed of with regular
construction debris.
If you have anymore questions call NW Asbestos at 360-385-0584.
Sincerely,
B~LJ~~
Bob Witheridge, E.F.M.
LEAD SAMPLE DATA
Northwest Asbestos Consultants
406 Reed St.
Port Townsend, W A 98368:'
360-385-0584
huggybear@olympus.net '
To Clayton Services
Date:
11/19/03
lob Location:
839 W. 6th St.
Port Angeles, WA 98363
Contact
Michael Rivers
840 W. 6th St.
Port Angeles, WA 98363
Owner:
Leah Erb
3225 47th Ave. SW
Seattle, WA 98116
Sample #1:
Suspect lead base paint in living room.
Inspector:
Bob Witheridge
AHERA - Building inspector / Management Planner
WAMOA ~ 0042-03
Expires - 10/28/04
Please call with test results when completed.
Thank you,
'\;06W 1 ~e..-
Bob Witherldge, EFM .
1''It.JV-'::''f-'::~ .1....,J.J
.
. N\IL tBbQratories, Inc.
. 4708 Aurora Ave.. N.. Seattle. WA 98103
Tel~ 206.547.0.100. Fa)C 206.634.1936
. .' WWW!lWllabs.com I
client Clayton GroUp Services, Inc.
Addre~: 4636 East. Marginal Way S
: Seattle. WA 98134
Attention: Ms. Tracy Perkins
project LOcation: n/a
lab ID
Client Sample .
#1
, 230'.488
o...o...Ml 11..1I'1 ~uur ~Vlo...c;;:)
Analysis Report
Total Lead (Pb)
Sample
wt (9)
0.2154
.':1, '.11' I ",I"
RLln
mg/Kg
46.0
~~ro~.LC~ 'r.~.L~~.L
AIHA ~ 11'1
t101861
.'
AI'"
~
AG'!da',!1'S.
LA.uRA'.OIft'
Elatch ':2315280.00
Matrix: Paint Ch.,.
Method: EPA 7OO0B
Client Project #:200.751X4262
. samples Received: 1
TQtaI Samples Anatyzed:1
Results
in mgIKg
<. 46.0
Results in
percent
.( 0.0046
I '..
Sampled b~: Client
Analyzed bj: Holly Tuttle
.
Date: 11121/2003
DRAFT
'mg1 Kg =MiUigr.am.s per idIogram
'Percent - MifliSramo per kilognlm /1 ??oo
Note: Method ~C results are acceptable unless stated otherwise.
Bench Run NO:23-1121-1
RL ::; Reponing limit
'oC .. liJelQW the ~P9rtin9 Limit
Page 1 of 1
TnTClI P V11
Date:
IQb Location:
Contact:
Owner:
Subject:
Inspector:
ccl
c t+-/ D~ PA
Northwest Asbestos Consultants
406 Reed St.
Port Townsend, WA 98368
360-385-0584
huggybear@olympus.net
11/23/03
839 W. 6th St.
Port Angeles, WA 98363
Michael Rivers
840 W. 6th St.
Port Angeles, WA 98363
Leah Erb
3225 47th Ave. SW
Seattle, WA 98116
Regards to re-inspection after flooring material was
removed by Assured Quality and Abatement Contractors.
Areas that were noted in the inspection report on
11/23/03 have been abated. These areas are ready for
completion of project by Michael Rivers.
~~
Bob Witheridge
EPA-AHERA - Building
Inspector/Management Planner
WAMOA-0042-03
Expires- 10/28/04
City of Port Angeles
Olympic Region Clean Air Agency
~
V"
,.
, < ~~:;':~~r\;~;" ;::~~:~T!;~":~W:) \~:G::5'
<.~-i' -,.
> -, "';'S';' ""~-_(%:"'<-~EFs;:_~~~\~,~,~iK~1/?r,f%ff;;~?,_;f(::r~:::.~~7"~~'t;~::~;::~
BUll.J)ING PERMIT INSPECTION RECORD
PLEASE PROVIDE AMIl'IlIMYM21H0URN0TICE.ITIS UNLAWFJ!L TO,COVER;INSUL4TE<qR,(JQfvCiAI.~NYlfqRJ(B,~I[01lE .
INSPECTB~ANDACCEPTED. .P0STPERMITIN.AC0:NS~I910USLOCATION;....'",,''.''' ',.'.......:.ii."..,.,. ,,'
KEEP PERMIT CARD AND APPR0VED PLANS'AT JOB SITE: I' )if," .
.'- '..-;;.,-~
INSPECTION TYPE > DATE I ACCEPTED " '. CO~ENTS ,-.'i""'. . . -,"
., " I YFS I NO , .,' . ,}V,......"..,.
FOUJIl,DA,11ON: " . ""i ..
FOOTINGS ,
,',
W ALL~ " .
FOUffl)ATION DRAINAGEIDOWN SPOUTS
ELECnUCAL . (LIGHT DEPl) SEPARATEPERMIT: #
ROUGH~IN I "
PLUMBING . ,
. ,',., ,
UNDER-FLOORI SLAB
ROUGH~1N
WATIl~UNE(METERTO SLOG) , .
GAS LINE .
BACK. FLOW / WATER , . ,n
AIR SEAL .
"
WALLS .
CEILING I I
FRAMING .
'.
JOISTS I GIRDERS
SHEAR WALL/HOLD DOWNS , .' ,
WALLS / ROOF I CEILING "
DRYWALtCINTERIORBRACED PANEL ONLY) ,
T.BAR . .... . ,... ,i
INSULATION .. .' ,.
SLAB I
WALL/FLOOR/CEILING I
. ',,' .", ,.
MECHANICAL .
HEAT PUMP "
"" .
,';GAS LINE . "
,
'.\ ,WOOD STOVE /PELLET / CHIMNEY
HOOD/ DUCTS .,' .
PW UTILITIES I SITE WORK ' (Engineering Division) SEPARATE PERMIT #'s:
WATERLINE / METER "
SEWER CONNECTION . ,
SANITARY "
STORM ,
PLANNING DEPT. SEPARATE PERMIT #'s , SEPA:
PARKINGILIGHTING ESA:
".' LANDSCAPING . , SHOREi.~: .
")" '- -- - ,>'" _,J. ,
. . FINALI)'iSPECTlONS REQUIRED PRIOR. TO OCCUPANCY/1JSE >" ,n ,........., '.'Y'''. ,
.
. RESIDENTIAL DATE , YES NO COMMERCIAL' . DAT~ ...... i:'A(:CEPTED' .'
c"'>" YES NO
. . '.
ELECTRICAL - UGHT DEPT. 417-4735,; IIhi;' 3 "f&tJ ELECTRICAL . ". .i..... ....
.' UGHT DEPT
CONSTRUCTION R. W./ PW/ , . CONSTRUCTION - R. W. I .'
ENGINEERING 417-4807 . .PWI ENGINEERING
... FIRE ., 417-4653 FIREDEP'J.'. p
'.'
PLANNIJ'IG DEPT. 417-4750 PLANNING DEPT. .' .
BUILDING 417-4815 BOILDING .. ..... ... .. .
T:\PLANNING\J:'ORMS\1102.15 [11/1412003] .
r.;~'i;0: ".". i;;"~';, ;;.....:.....,',-...'.' '. ,,,,,',,:;-;"'...-, .;t.:;;;'; .
~-,-- ------
1:'1
1C"ORT~
'~~""
"~..
if 'E!iII
"-~
~
~"'~
CITY OF PORT ANGELES
DEPARTMENT OF COMMUNITY DEVELOPMENT - BUILDING DIVISION
321 EAST 5TH STREET, PORT ANGELES, WA 98362
Application Number
Property Address
ASSESSOR PARCEL NUMBER:
Application description
Subdivision Name
Property Use . . . .
Property Zoning . . .
Application valuation
04-00000016 Date
839 W 6TH ST
06-30-00-0-1-0150-0000-
RES ADDITION
1/23/04
RS7 RESDNTL SINGLE FAMILY
94205
Owner
Contractor
WA 98116
MICHAEL RIVERS
P. O. BOX 4074
PORT ANGELES
(360) 452-9292
537SF ADDNT & REMODEL
TYPE V NON-RATED
SINGLE FAM & CONGREGATES
TOTAL % LOT COVERAGE
CONSTRUCTION TYPE
HARD SURFACE AREA
NUMBER OF STORIES
EXISTING LOT COVERAGE
LOT SIZE
PROPOSED LOT COVERAGE
TOTAL LOT COVERAGE
NUMBER OF UNITS
CONST
ERB, LEAH
3225 47TH AVE SW
SEATTLE
( 20) 935-4154
Structure Information
Construction Type
Occupancy Type
Other struct info
WA 98362
23.30
V-N
1. 00
1060.00
7000.00
575.50
1635.50
1. 00
~
\/J
--D
,"
Permit BUILDING PERMIT -RESIDENTIAL
Additional desc
Permit Fee 982.25 Plan Check Fee
Issue Date 1/23/04 Valuation
Expiration Date 7/21/04
392.90
94205
~
45.00
BASE FEE
7.0000 THOU BL-50,001-100K (7.00 PER K)
Extension
667.25
315.00
~
4-
c
Qty Unit Charge Per
-----~-~----------------------------------------------------------
permi t . . . .
Additional desc
Permit Fee
Issue Date
Expiration Date
PLUMBING PERMIT
89.00
1/23/04
7/21/04
Plan Check Fee
Valuation
.00
o
~
~
~
Qty Unit Charge Per
5.00
1. 00
7.0000 ECH
7.0000 ECH
BASE FEE
PL- EA.FIXTURE ON ONE TRAP
PL- EA.WATER HEATER
Extension
47.00
35.00
7.00
Permit MECHANICAL PERMIT
Additional desc
Permit Fee 79.40 Plan Check Fee .00
Issue Date 1/23/04 Valuation 0
Expiration Date 7/21/04
Qty Unit Charge Per Extension
BASE FEE 47.00
3.00 7.2500 ECH ME-VENT FAN 21.75
1. 00 10.6500 ECH ME-GAS PIPE 1 TO 5 10.65
-
Separate Permits are required for electrical work, SEPA, Shoreline, ESA, utilities, private and public improvements. This permit becomes
null and void if work or construction authorized is not commenced within 180 days, if construction or work is suspended or abandoned
for a period of 180 days after the work as commenced, or if required inspections have not been requested within 180 days from the last
inspection. I hereby certify that I have read and examined this application and know the same to be true and correct. All provisions of
laws and ordinances governing this type of work will be complied with whether specified herein or not. The granting of a permit does not
presume to give authority to violate or cancel the provisions of any state or local law regulating construction or the performance of
construction.
~tk{ IL~ 1/23/t4-
Signature of Contractor or Authorized Agent' , Date Signature of Owner (if owner is builder) Date
T:IPLANNINGIFORMSII102.15 [11/14/2003]
BUILDING PERMIT INSPECTION RECORD
CALL 417-4815 FOR BUILDING INSPECTIONS. CALL 417-4735 FOR ELECTRICAL INSPECTIONS.
PLEASE PROVIDE A MINIMUM 24 HOUR NOTICE. IT IS UNLAWFUL TO COVER, INSULATE OR CONCEAL ANY WORK BEFORE
INSPECTED AND ACCEPTED. POST PERMIT IN A CONSPICUOUS LOCA nON.
KEEP PERMIT CARD AND APPROVED PLANS AT JOB SITE.
INSPECTION TYPE DATE ACCEPTED COMMENTS
YES I NO
FOUNDATION:
FOOTINGS
WALLS
FOUNDATION DRAINAGE/DOWN SPOUTS
ELECTRICAL (LIGHT DEPT) SEPARATE PERMIT: #
ROUGH-IN I I I
PLUMBING
UNDER FLOOR / SLAB
ROUGH-IN
WATER LINE (METER TO BLDG)
GAS LINE
BACK FLOW / WATER
AIR SEAL
WALLS
CEILING I
FRAMING
JOISTS / GIRDERS
SHEAR W ALUHOLD DOWNS
WALLS / ROOF / CEILING
DRYWALL (INTERIOR BRACED PANEL ONL Y)
T-BAR
INSULATION
SLAB
WALL 1 FLOOR 1 CEILING I
MECHANICAL
HEAT PUMP
GAS LINE
WOOD STOVE 1 PELLET 1 CHIMNEY
HOOD 1 DUCTS
PW UTILITIES 1 SITE WORK (Engineering Division) SEPARATE PERMIT #'s:
WATERLINE 1 METER
SEWER CONNECTION
SANITARY
STORM
PLANNING DEPT. SEPARATE PERMIT #'s SEPA:
PARKINGILIGHTING ESA:
LANDSCAPING SHORELINE:
FINAL INSPECTIONS REQUIRED PRIOR TO OCCUPANCY/USE
RESIDENTIAL DATE YES NO COMMERCIAL DATE ACCEPTED
YES NO
ELECTRICAL - LIGHT DEPT. 417-4735 ELECTRICAL
LIGHT DEPT
CONSTRUCTION R. W.I PWI CONSTRUCTION - R.W.
ENGINEERING 417-4807 PW , ENGINEERING
FIRE 417-4653 FIRE DEPT.
PLANNING DEPT. 417-4750 PLANNING DEPT.
BUILDING 417-4815 BUILDING
T:\PLANNINGIFORMS\1102.15 [11/14/2003]
~ ~C~)T ~
~4.C~~~
r..
"-~
~
~"'~
CITY OF PORT ANGELES
DEPARTMENT OF COMMUNITY DEVELOPMENT - BUILDING DIVISION
321 EAST 5TH STREET, PORT ANGELES, WA 98362
Application Number
04-00000016
Page 2
Date 1/23/04
Qty Unit Charge Per
.00 50.0000 ECH ME-WOOD STOVE
Extension
.00
Special Notes and Comments
Electrical load calculations and elctrical permits are
required.
Other Fees
STATE SURCHARGE
4.50
Fee summary Charged Paid Credited Due
----------------- ---------- ---------- ---------- ----------
Permit Fee Total 1150.65 1150.65 .00 .00
Plan Check Total 392.90 392.90 .00 .00
Other Fee Total 4.50 4.50 .00 .00
Grand Total 1548.05 1548.05 .00 .00
Separate Permits are required for electrical work, SEPA, Shoreline, ESA, utilities, private and public improvements. This permit becomes
null and void if work or construction authorized is not commenced within 180 days, if construction or work is suspended or abandoned
for a period of 180 days after the work as commenced, or if required inspections have not been requested within 180 days from the last
inspection. I hereby certify that I have read and examined this application and know the same to be true and correct. All provisions of
laws and ordinances governing this type of work will be complied with whether specified herein or not. The granting of a permit does not
presume to give authority to violate or cancel the provisions of any state or local law regulating construction or the performance of
construction.
Signature of Owner (if owner is builder)
Date
Signature of Contractor or Authorized Agent
Date
T:\PLANNINGIFORMS\1102.15 [11/14/2003]
BUILDING PERMIT INSPECTION RECORD
CALL 417-4815 FOR BUILDING INSPECTIONS. CALL 417-4735 FOR ELECTRICAL INSPECTIONS.
PLEASE PROVIDE A MINIMUM 24 HOUR NOTICE. IT IS UNLA WFUL TO COVER, INSULATE OR CONCEAL ANY WORK BEFORE
INSPECTED AND ACCEPTED. POST PERMIT IN A CONSPICUOUS LOCATION.
KEEP PERMIT CARD AND APPROVED PLANS AT JOB SITE.
INSPECTION TYPE DATE ACCEPTED COMMENTS
YES NO
FOUNDATION:
FOOTINGS 1\).- ?,.~. D l\ I-SLL
WALLS l~
FOUNDATION DRAINAGE/DOWN SPOUTS
ELECTRICAL (LIGHT DEPT) SEPARATE PERMIT: #
ROUGH-IN
PLUMBING ()/"nJ blfl~) ht~'l/ i~ -8"-01
UNDER FLOOR 1 SLAB
ROUGH-IN ~ -Ii -OJ .I I
WATER LINE (METER TO BLDG)
GAS LINE
BACK FLOW 1 WATER
AIR SEAL
WALLS 1>~......,.((....rl.li
CEILING .....,. T I
FRAMING
JOISTS 1 GIRDERS
SHEAR WALL/HOLD DOWNS -:;,-::1,~f)~ J J h,
WALLS 1 ROOF 1 CEILING "7 _ JI/,N J .1-1
DR YW ALL (INTERIOR BRACED PANEL ONL Y) ./ ~
T-BAR
INSULATION
SLAB
WALL 1 FLOOR 1 CEILING K .;)" I I
" I l;l}l~cltdfllc'a-1 hf)~J ,-; -r~C7ll IY(
MECHANICAL
HEAT PUMP
GAS LINE ,t) -I ?'---o--J J~ 1~
WOOD STOVE 1 PELLET 1 CHIMNEY
HOOD 1 DUCTS
PW UTILITIES' SITE WORK (Engineering Division) SEPARATE PERMIT #'s:
WATERLINE 1 METER
SEWER CONNECTION
SANITARY
STORM
PLANNING DEPT. SEPARATE PERMIT #'s SEPA:
PARKINGILIGHTING ESA:
LANDSCAPING SHORELINE:
FINAL INSPECTIONS REQUIRED PRIOR TO OCCUPANCYIUSE
RESIDENTIAL DATE YES NO COMMERCIAL DATE ACCEPTED
YES NO
ELECTRICAL - LIGHT DEPT. 417-4735 ELECTRICAL
LIGHT DEPT
CONSTRUCTION R.W.I PW' CONSTRUCTION - R.W.
ENGINEERING 417-4807 PW 1 ENGINEERING
FIRE 417-4653 FIRE DEPT.
PLANNING DEPT. 417-4750 PLANNING DEPT.
BUILDING 417-4815 j ~J... -4 ~O .; J,L BUILDING
T:\PLANNlNGIFORMS\1102.15 [11/14/2003]
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CITY OF PORT ANGELES
DEPARTMENT OF PUBLIC WORKS
. . . . . . . . . . . INSPECTION REPORT. . . . . .
REQUEST'
Date 1;2} '71of
, ,
Time
IJ-{V}
Received by
~---_.._--_.__.."._-
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(phone, person)
Location of Work to be inspected
Name of person requesting inspection
Address of person requesting inspection
Type of Inspection (circle appropriate one):
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Permit No. (,) L{ "- , l~
Sewer Foundation Framing Chimney Plumbing Final Sewer Excav. Other
INSPECTION NOTE!, / 0
Inspected: Date P ~ (5 l L
Remarks:
Time 8 VVl
By
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RESTORATION REQUIRED. . . . .. YES NO
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SURFACE RESTORATION:
SURFACE TYPE: 0 Unimproved DGravel 0 Asphalt 0 PCC
o Other
o Repaired by City
o Repaired by Permittee
o No Damage Found
Work Order #
o COMPLETE
o INCOMPLETE
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BUILDING PERMIT - APPLICATION
Fill out COMPLETELY and in INK. Your application and site plan MUST B
COMPLETE to be accepted for review. If you have any questions, call
(360) 417-4815
!Ill 'eM I4EL fUt \1'1:;..12. \ Phone: crS Z - ~ 27 2-
~. V b Phone: (..2o~) '15 r- 11 s-4-
/
Address: '52.. 2 )' 4 ? D rlvl( ) t..0 City: ck c, +f ~ Zip: J' ~ lIlt
Architect/Engineer: :VOl.-\. )<:: h v k,/(~o\/' c-}e1oo,~i~l"ff Phone: 4- 52- - 02 o?
Contractor "^ \ ( hc...J VL\ \.fu......-.r to'_JfState License #: (VI ,'c.rl I'I/(o.02/.e Exp: izlzo /04- Phone: "T 5-2 -72-92-
Address: p, 0, fSl)'f. 4or4- City: (?o~-I iM.l-,,",-~j Zip: f'8?e; 3
PROJECT ADDRESS: g 37 ~ , b 1j ~+( ZONING: i<. 3
Applicant or Agent:
Owner: kef h
LEGAL DESCRIPTION: Lot:
CLALLAM COUNTY PARCEL NUMBER:
Block:
Subdivision:
Credit Card Holder Name:
Billing Address: City:
Credit CardType VISA MC # Exp. Date:
TYPE OF WORK: SIZEN ALUATION:
.if'Residential D NewConstr. D Re-roof D n5.';SF.@$/o S- /SF.=$ s6. $3S-
D Multi-family 2"Addition D Move D b.;;J.. <t SF. @ $ <P S- /SF. = $ 4-n. g 2..-0
D Commercial ..er Remodel D Demolition D SF. @ $ /SF. = $ /
D Repair D Sign D TO;:rAL VALU nON $
BRIEF DESCRIPTION OF THE PROJECT: Ih~ Y' ck) ~ Jd, b
hovY j~{JI/J/J rueJ h'./AJC./U}h;/TW/lu.., euc,/r,-(4.! p/UI-'>16i~
COMMERCIAL/RESIDENTIAL: Occupancy Group: Occupant Load: Construction Type:
No.ofStories:L Lot Size: 5-U"j. (ttO ExistingSq.Ft. IObD &ProposedSq.Ft.57S,S- =TOTALSq.Ft./~3S,5
Existing lot coverage _ % & Proposed lot coverage _% = Total lot coverage '2.'5 I :So %
APPROVALS:
PLAN:
BLDG:
DPWU:
FIRE:
OTHER:_
PLANNING USE ONLY:
ESAlWetland(s): 0 Yes 0 No SEPA Checklist required? 0 Yes 0 No Other:
BillLDlNG PERMIT APPLICATION SUBMITTAL: The Building Division can provide you with information on the application and
plan submittal requirements if you have questions.
VALUATION OF CONSTRUCTION: In all cases, a valuation amount must be entered by the applicant. This figure will be reviewed
and may be revised by the Building Division to comply with current fee schedules. Contact the Permit Coordinator at 417 -4815 for assistance.
PLAN CHECK FEE: IF a plan check fee is due it must be submitted at the time the building permit application and construction plans are
submitted. All other permit fees are due at the time of permit issuance.
EXPIRATION OF PLAN REVIEW: Ifno permit is issued within 180 days of the elate of application, the application will expire. The
Building Ufficial can extend the time for action by the applicant up to 180 days upon written request by the applicant (see Section 107.4 of
the UnifOllli Uuilding Cu>, k. current edition). No application call he extended more than once.
I hen!... r~erljfy that I have read and :'xamined [/'is Application and know the same to be trim and correct. I am authorizt.f to apply fil!" 'his permit and
understwllj that it is my responsibility to determine v,lla! nermits are required ,not the City's, and that I must obtain such permits prior to wor!,
...
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CURB DO'N SCHUBA 452..0207
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'. CITY OF PORT ANGELES
DEPARTMENT OF COMMUNITY DEVELOPMENT - BUILDING DIVISION
32] EAST 5TH STREET, PORT ANGELES, WA 98362
Application Number
pin number . . . .
Property Address
ASSESSOR PARCEL NUMBER:
Application description
Subdivision Name
Property Use . . . .
Property Zoning . . .
Application valuation
04-00000016 Date
.298224
839 W 6TH ST
06-30-00-0-1-0150-0000-
RES ADDITION
3/16/04
RS7 RESDNTL SINGLE FAMILY
94205
Owner
Contractor
ERB, LEAH
3225 47TH AVE SW
SEATTLE
( 20) 935-4154
Structure Information
Construction Type
Occupancy Type
Other struct info
WA 98116
MICHAEL RIVERS
P. O. BOX 4074
PORT ANGELES
(360) 452-9292
537SF ADDNT & REMODEL
TYPE V NON-RATED
SINGLE FAM & CONGREGATES
TOTAL % LOT COVERAGE
CONSTRUCTION TYPE
HARD SURFACE AREA
NUMBER OF STORIES
EXISTING LOT COVERAGE
LOT SIZE
PROPOSED LOT COVERAGE
TOTAL LOT COVERAGE
NUMBER OF UNITS
CONST
WA 98362
23.30
V-N
1.00
1060.00
7000.00
575.50
1635.50
1.00
Permit . . . .
Additional desc
Sub Contractor
Permit Fee
Issue Date
Expiration Date
ELECTRICAL NEW RESIDENTIAL
200A SER/200A FEEDER
ELECTRIC SERVICE
99.00 Plan Check Fee
3/16/04 valuation
9/12/04
.00
o
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Qty
1. 00
1. 00
Unit Charge Per
76.3000 ECH EL-RM-0-200 1ST SRV FEEDER
22.7000 ECH EL-RM-0-200 ADD SRV FEEDER
Extension
76.30
22.70
~
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Special Notes and Comments
Electrical load calculations and elctrical permits are
required.
..."
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Other-Fees
STATE SURCHARGE
4.50
_Fee summary.. Charged Paid Credited Due
----------------- ---------- ---------- ---------- ----------
.',n ',___ .-..'_
Permit. Fee Total 99.00 99.00 .00 .00
Plan Check Total .00 .00 .00 .00
Other Fee Total 4.50 4.50 .00 .00
Grand Total 103.50 103.50 .00 .00
Separate Permits are required for electrical work, SEPA, Shoreline, ESA, utilities, private and public improvements. This permit becomes
null and void if work or construction authorized is not commenced within 180 days, if construction or work is suspended or abandoned
for a period of 180 days after the work as commenced, or if required inspections have not been requested within 180 days from the last
inspection. I hereby certify that I have read and examined this application and know the same to be true and correct. All provisions of
laws and ordinances governing this type of work will be complied with whether specified herein or not. The granting of a permit does not
presume to give authority to violate or cancel the provisions of any state or local Jaw regulating construction or the performance of
construction.
Signature of Contractor or Authorized Agent
Date
Signature of Owner (if owner is builder)
Date
T:IPLANNINGIFORMSI1102.15 [11/14/2003]
BUILDING PERMIT INSPECTION RECORD
CALL 4]7-48]5 FOR BUILDING INSPECTIONS. CALL 417-4735 FOR ELECTRICAL INSPECTIONS.
PLEASE PROVIDE A MINIMUM 24 HOUR NOTICE. IT IS UNLAWFUL TO COVER, INSULATE OR CONCEAL ANY WORK BEFORE
INSPECTED AND ACCEPTED. POST PERMIT IN A CONSPICUOUS LOCA nON.
KEEP PERMIT CARD AND APPROVED PLANS AT JOB SITE.
INSPECTION TYPE DATE ACCEPTED COMMENTS
YES NO
FOUNDATION:
FOOTINGS
WALLS
FOUND A TION DRAINAGEIDOWN SPOUTS
ELECTRICAL (LIGHT DEPT) SEPARATE PERMIT: #
ROUGH-IN
PLUMBING
UNDER FLOOR 1 SLAB
ROUGH-IN
WATER LINE (METER TO SLDG)
GAS LINE
BACK FLOW 1 WATER
AIR SEAL
WALLS
CEILING I I
FRAMING
JOISTS 1 GIRDERS
SHEAR WALL/HOLD DOWNS
WALLS I ROOF I CEILING
DRYW ALL (INTERIOR BRACED PANEL ONLY)
I-BAR
INSULATION
SLAB
WALL 1 FLOOR 1 CEILING
MECHANICAL
HEAT PUMP
GAS LINE
WOOD STOVE 1 PELLET 1 CHIMNEY
HOOD 1 DUCTS
PW UTILITIES I SITE WORK (Engineering Division) SEP ARA TE PERMIT #'s:
WATERLINE 1 METER
SEWER CONNECTION
SANITARY
STORM
PLANNING DEPT. SEPARATE PERMIT #'s SEPA:
P ARKING/LlGHTING ESA:
LANDSCAPING SHORELINE:
FINAL INSPECTIONS REQUIRED PRIOR TO OCCUPANCY'USE
RESIDENTIAL DATE YES NO COMMERCIAL DATE ACCEPTED
YES NO
ELECTRlCAL - LIGHT DEPT. 417-4735 It);;;n/ IAit} ELECTRlCAL
LIGHT DEPT
CONSTRUCTION R.W.I PWI / / CONSTRUCTION - R.W.
ENGINEERING 417-4807 PW 1 ENGINEERING
FIRE 417-4653 FIRE DEPT.
PLANNING DEPT. 417-4750 PLANNING DEPT.
BUILDING 417-4815 BUILDING
T:IPLANNINGIFORMSIII02.15 [11/1412003]
CITY OF PORT ANGELES
LIGHT DEPARTMENT
ELECTRICAL PERMIT
N?
15337
-
~-Jl . ~.r;
Port Angeles. Washington...noon...:.n......nnnn.nn.noon................m.. 19oo...m
In accordance with the City Ordinance to regulate the installation, extension, or repair of elec-
trical equipment in, on. or about any building or other structure in the City of Port Angeles, per-
mission is hereby granted to do el~ctrlcal work as listed below.
~::::s..:::;:~::~;{::~2~~~~:::~:::::::::::::::::..oo;:=:~~::.n~~~~:~.~~~:::::::~:=:~::::::::::::::~:::::::::::::::
Wiring !.t;~ntractor ___n_~.:~~/j~_.:t;~~.~~~_::!:~m__u___n__. By.n____n__n_n____n________mu_____u....____m....mn_.___._.
,
/.:>.r./::i V-:.-'
Service, volts ......~......................m_m.._
No. wires .......!....m....mnn...._.m_._
7/?/ f/
Size wiresm__.~.nn.n...~~mm_____
Main luse ..n~:'!~.<?/l..m.m'h.
Light Outletsm___m__..n...____.___...___m...__..
Receptacle Outlets..._....m..mmn___..__...
Dryer, KWI_______..___.__n_n___n________________.
Range, KW.__.___h___.__..____
Water Heater:
Enclosure _m_..n__~.m_.mm..m__._....
KW..hn.nmmnmnmmmnnnmmn
'70"/3
Heat: Jl,\\r '.n_..._____..._!.n..__n.nn_n__..____.__..___
Type of wiring:
Entrance Cable __..n..._....n.mmm___
Motors: size, volts and phase:
Rigid Conduit m_mn___mmn____.m__.
Metallic Tubing ___m____m_._m_.m...
Current transformers:
No. & Size........n..._._..nmnmmmnm
Ser. No.__........______....._.......__..._..........
Ser. No..__...._.._._____......._..............__..__.
Ser. NO.__....nnn.__n...........__............n_
Type of Wiring:
Armored Cable _..___m__...m__m_.m__.
Non-Metallic .mm.m___m...._....._.....
Knob & Tube_____mnnm.m__m..n......
Rigid Conduit ___...__.......nmmm__m
Metallic Tubing nnnn.m_..............
Raceway .__..,.....m___..__m._...mn....___.
Circuits, Light...._____m_n_mn___m.mm_....
Utility ___nnnnn__.____...___......._.....__..__
Heat
Range ........._........__....__..._..____.________
Water Heater ...m_mumm.....m.._..
Motor
Dryer.
Furnace ___n____n______n_..n. ___..._..___...
Total Load_.._....__....___.__...._._ Ser. NO._.......____..._................n__..nn___ Total ............n.____.nn...............
.}
(- a (oj
Remarks: .____.__u_.::'~tnQ_:::'___....d!:::___._:;;J~:f!:'___:::n.l'..__~'-':..P:.t1d_._h___n_____.n________..._____..Uh_.._____nn______nh____._____..____...n.
i:.~~~.:~:.:......::::.....:.:..::....:m.......i~~.~.~::..~~.~.~~.~.~..::::::....oo..m.....m:~..:l::Z~:~f:~:Z~=:::::k;.:::~:::::.
NQTICE--Current must not be turned on until Certificate of Inspection has been issued. U work is to be con.
cealed due notice must be given the Inspector so that work may be inspected before concealment.
NOTIFY THE INSPECTOR BY PERMIT NUMBER WHEN READY FOR INSPECTION
3-0 c,-'(1
17 //'
; Iller-
ell
ELECTRICAL PERMIT
N?
15337
Date called .gipl:ufn~(L:..nt.f.....CL.nmn.nm.mm_mnnm.,..nnm.mnnnmnmnn '; -/'/ - ~'j'
, I . I. ./'~ n___.n_....._nn_.___n..............._....h._n_....._....
Preliminary,J,!lli ebtllJ"d'ateJ7~~.~~.:...mnm..m...nmn...nh...n.nm,m..
InSpeCtiOncomPleted__......~..._=..~!~~:.:~:.~.=:::::.~.~mm...u...mm__..m..:..~~~~::~~~:::~:::::::~::::::::::~:::::~::::::~~::~:::::::=:::::::~::::::=
Total Load nn_n_nnn..nnnn................h..............n...n...n....n..nnn.._.n_ ..n.._........n_____nn...__...._..nn
1M 3-72 Olympic Printers, Inc.
1~ll. 1I""n,''II'1 , ,..._, ~'I~' . .
# iIrt: 11 //0" REQUEST INSPECTION \e
. (' r Ie- .' I
{j. OwnororElec.Con~aclorP.aent: ~g,."..,,\r. ~"l<<I: ,..J'.....-- Pllono: I...n-<J>IJ~\J Fax: Llt-L-'.'l....f"
. IV\ ,,,k....>- (2, UL~ . C---.,,.... !Onon.: <J S '2- q t. "l' .?
ProporlY av..-e._
Addre..: \~l3~ W tt'l-- ....,tv: ,?o..",," ~ Zi!l: .<\'''''7< L-
EloctriCllI Contra'ler: . \ZIA '-'1"\&.'<" ~-.r-......L._ L1can...,g, .:IeNI' Jtt;; cr/'~I.~ Phone: 4> 2..-6..~
~ 0" ~ - . - ~ ,
Add,e.': ~ 'IL tJ. ~ V~ re..i ~ \ r6~ I ~ . L-V--. Zip: oJ n. ......
INSTAl.lJ.TION WIRED BY: 0 OWNER :JIItCCTRICAL CONTRACTOR
~
.
Credit Card Holder N"",e:
~..~
6N' "'. City:
Credit Card 7r:
PROJECT A 188:_ B 3>4 y{ (; ~
Check all that apply: ~-
~~~
mercial
Exp. Date:
Zip:
VISA:_MC
BIlling Add,..,:
o Alteration/Addition
o Multl-femlly
o Mobile Home
Sq. Ft
Remote Meter 0 Oetached garage 0 Hot Tub 0 Swim Pool 0 Septic pump
Number of Circuits added or altered:
o Low Voltage 0 Telecom. D.
'S> yv-~~-'" A. ~)
DiSCRIP.I1DN.QF THE ELECTRICAL. PROJECT:
t;.__
Electrical Heat Load Additions
PERMIT FEE:
81Ni91nforlNltlan
o Beseboard
o Furnace
:::; Heel Pump
o Fan-Willi
~
-~
-TON
-~
LRA
~amead Service
o Temp SaMcI
w Underground SaNico
Vollage: I 2J; /......0
Phase: :J 1 0 3
SeNlce Size: "<:)
Feeder Size: .... 'f
PAMC 14.0S.060(B): For Industrial, commerclel, & residential projects larger than a dLlple~, a one -line drawing of the Electrical Service
Feedele, building size (811. fl.), load celC'Jletlone, and tnl type b 01 conductors and/or raceway Ie required and shell accompany the Electl
Perm~ eppIlCB~on: .
I hereby cerl/fy that I have reed and axamined this application end know that same to be true end correct. and I
author/zed to apply for this perm/to I understand It is not the City's lega/ responsibility to determine what permits
required; it remains the applicants responsibility to determine what permits arB required Bnd to obtain such,
Cm' C..., H...;, .....,"'~ ~
,. }
Owner or Elee. Cont. Signatu,e:' U.::t!-
C :/ELECTRICALPERMIT APPLICATION
Date:
<:fIlA-
Tf2-r-
Dlte:
S:'I(\S-rIN~
I-h95 Thc~e:
Hvo5G b
Bse:u
rO c:;-. . '(26 ,VV)V6'D '(
fl pp,e; AP /;, -rh \;, )
~,-I ! l(j4/~ ~
~
.. .,........-:.-1:
.'{;?b tj
FAX NO.
Jul. 292003 11:iiAM Pi
?(~
..
FOR DFl'IOA&.. 1JS8 OWl
[)Ud18l:
1'tim:U..:
Ual.~__
D_lIIu_
ELECTRICAL PERMIT APPLICATION
Tho E loclrIoaI Pormll A~Ucatlon mUR 1I,1l11e11 ....1 tom DI,I.ly.
P ...... l3/ll8 or ..print In Ink. If ~ 0.. MY' ,nv """Ion., plo.., call (380) 417-'73'
F.. numb..: (3eoI417~7"
OwnerorElec.ConlraC1DfAgenl: . Eb}-,..:<- SJl1'..,i C2.. k.Phono:
Properly ~ner. L e ~ w . '.
Add"""':. B'3ot \./->. (p~ C'ty.Yo..-tA",t'~
EllKlIrIca' ConltllalDr: El <1 ,.J n '.' ku I' U .1.ht.,. ~- t: S1:1'J iI....
Address: K''":l.. ~,- Vc../lt, R.:i Clty:'-'&I ,At'l:~'~U"-
INSTA~~TION WIRI!D BY: Cl OWNER 0 E~CTRIC~ CONTRACTOR ,
i..t:)2'(PIJ~'iFOx:. 'i6'l.l,'7'lL.,
T
Phon",
EIIP:
"Ih",/p'"$
I
ZIp: 'i &-3h?
. Phone:", l'':'l
Zip; "i f.':? ~.
Credit Card Hold", Name:
SU/iIl" ArIctNa:
Credit C.rrI Number.
On
8~j
fCtr Chy.
\.. " I:xp. D.aa:
ZJp:
VTSA:
PRQ.leCT AODIU:SB:
w. ~~
t, -rL t>I- A
TYPE CF WORK:
Check iI1!that apply. 0 New
o AlIEH'lllior1/AddiUon
D R..ldentilll 0 Multi-family
o Commercl.1 .0 Mobil. Home
Sq. Ft.
.. ".' ,
o Remolll Meter }(belaChed garage 0 Hot Tub 0 Swim Pool 0 Septic PUITlP .. ..0 LoW VaIlage 0 Telecom.
Number of Circuits adcl8d or eltlll'lld:
DESCRIPTION OF TME aECTR'C~ PROJECT:
200 Ol.
:200 o..~f
Electrical L'llld ~dltlon. and or subtraction.
ho~'t.f~
Oils ~".,J ~KW
o F..maC8 KW
D rl..l Pump _ TON
D Fan-Wall KW
Servlo. Information
~erl\ead Service TO CtGlo.....e<.<.._
o Temp SeMce (j.r
'ljtlJnclal'Qlllllnd Service .:J"'-~e.-
-1-.. ~"',,~
PAMC'14.0~:O&O(B): For Industrial. commercial, & residenllal projecto hllger !hln e cluplex, I ona -lIna dniwlng of the EIecIn~1 Sarli
F"!"l8l8, b..Udlng Size .(sq. Il), Iood calculationo. encllhe ty pe & of condueto", andIor raceway is required sOOmall eccomP8ny the
Electrtc..1 Permit appllcallon.
\ .
l'herebY ce,.;;fy thstJ have read end examined this application and know that same to be true and correct, ane
a~thorized to apply for this permit. I understand It is not the City's legal responsibility to determine what perm
are required; it remains the applicants responsibility to determine what permits are required and to obtain sue,
cAR
Vollilga: Vl....O /'2. '<0.
Pheae: l>t1 0 3
Service Size: :L~O Q..-,p
Feeder SIZe: I
/~) '9\\~G\
~w.3f:~oi/
Cr.dll Cord HoJdo"o Slgn.I....: ~fJfi?~
Pote:
V~~ 9; ~1 Oole:
PERMIT FEE: ...31..00
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