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Home My WebLink About1701 W 11th St - BuildingApplication Number Application pin number Property Address ASSESSOR PARCEL NUMBER Application type description Subdivision Name Property Use Property Zoning Application valuation Application desc Replace underground feeders Owner SEE THOMAS E 1319 S K STREET PORT ANGELES 36) 452 8095 Permit Additional desc Permit pin number Permit Fee Issue Date Expiration Date WA 98363 179754 119 90 1/03/11 7/02/11 1 Qty Unit Charge Per 11- 00000002 150040 1701 W 11TH ST 06 -30 00 0 3 1195 0000 ELE2TRICAL ONLY RS7 RESDNTL SINGLE FAMILY 0 APS ELECTRIC 546 BENSON RD PORT ANGELES PORT ANGELES (360) 452 6753 ELECTRICAL ALTER RESIDENTIAL 1 00 119 9000 ECH EL 0 200 SRV FEEDER Fee summary Charged P Permit Fee Total 119 90 119 90 Plan Check Total 00 00 Grand Total 119 90 119 90 INSPECTION TYPE DITCH SERVICE ROUGH IN FINAL COMMENTS ELECTRICAL PERMIT CITY OF PORT ANGELES 360 417 -4735 Signature of owner or Electrical Contractor X G: \EXCHANGE \BUILDING DATE. PERMIT WILL EXPIRE SIX (6) MONTHS FROM LAST INSPECTION Contractor Plan Check Fee Valuation Credited 00 00 00 tl i J�i Date 1/03/11 RESULTS WA 98363 00 0 Extension 119 90 Due 00 00 00 INSPECTOR. Date: S REPORT SALES TAX on your excise tax form to the City of Port Angeles (Location Code 0502) D ..L CITY OF PORT ANGELES PERMIT APPLICATION Building Division /Electrical: inspection 321 East Fifth Street P 0 Box 1150 Port Angeles Washington, 98362 Ph (360) 417-4735 Fax (360) 417 -4711 Date,1 '3'-`2'Q' I NSP C TIONS X 1 2 Single Family Dwelling *Plan Review May _Be Required, Please Complete Elest l Plan Review Information Sheet ,icbAdd;ess: 7a 1 L AV.. -JL' TP 1 ,_i Building Square Footage: Description of above C'- t 4 L P CSI r" Pet rn. P�'t !j .E"....0 rh -r- me z c 1 a nc�-4 t-epcti t''r I 1 Owner) Drmation Name: t 0 yY1 Mailing Address 17O' t W 11 V City A State: Zip ff 3&3 Phone '-1 `1 .3 Fax: License Exp. Item, Unit Charge Service/Feeder 200 Amp. $'i19.90 Service/Feeder 201 -400 Amp, 145,50 Service /Feeder 401 600 Amp 204,60 Service /Feeder 601 1000 Amp. 5 262.20 Service /Feeder over 1000 Amp, 372.50 Branch Circuit W/ Service Feeder 2.60 Branch Circuit W/O Service Feeder 73,50 Each Additional Branch Circuit S 2.60 Temp, Service! Feeder 200 Amp. 92.70 Temp Service /Feeder 201 -400 Amp $110 30 Temp Service/Feeder 401.600 Amp S 148.70 Temp. Service /Feeder 601 -1000 Amp 167.90 Portal to Portal Hourly S 95.90 Sign/Outline Lighting 88.20 Signal Circuit/ Limited Energy First 1500 sf Commerci l 95.90 Note: $5.00 for each additional 1500 sf Signal Circuit/ Limited Energy 1 2 Family Dwelling 63.90 Signal Circuit/ Limited Energy Multi Family Dwelling 63.90 Manufactured Home Connection $119.90 Renewable Electrical Energy SKVA System or Less 102.30 Thermostat 56.00 NEW CONSTRUCTION ONLY. First 1300 Square Ft. 11x30 Each Additional 500 Square Ft. or Portion of 35.20 Each Outbuilding or Detached Garage 73,50 Each Swimming Pool or HotTub 110.30 x RECEIVE JAN 2 21 ELECTRICAL Dated: 01/0112010 le .,..i.�iFi {t'r,'dif11 jl Multi- Family or Commercial" Commercial Add TAlteration Remodel Repair* Contractor Itikortpation t e Name. S 0 1-; Lej eilYt+NtetcvyL Mailing Address: City' State: Fax: License Exp. Total (Qty Multiplied by Unit Charge), )1 f IQ S 5- 5— S.... S 7 f c OTotal Owner as defined by RCW 19.28,261 (1) Owner wi I occupy the structure for two years after this electrical permit is finalized. (2) Owner is required to hire en electrical contractor if above said property is for sale, rent or lease Permit expires after six months of last inspection. After reading the above statement, I hereby certify that I am the owner of the above named property or a licensed electrical contractor I am making the electrical installation or alteration in compliance with the electrical laws, N.E,C RCW Chapter 19.28, WAC. Chapter 296 -46B, The City of Port Angeles Municipal Code, and Utility Specifications and PAMC 14.05.050 regarding Electrical Permit Applications. Signature of owner, electrical contractor or electrical administrator Cash Check Credit Card O 0 d cJ "ORT~_ l~~ na ~-- ~IC~ CITY OF PORT ANGELES DEPARTMENT OF COMMUNITY DEVELOPMENT - BUILDING DIVISION 321 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 05-00000120 Date .262760 1701 W 11TH ST 06-30-00-0-3-1195-0000- RES DETACHED GARAGE 3/01/05 RS7 RESDNTL SINGLE FAMILY 11520 Owner Contractor SEE THOMAS E 1319 S K STREET PORT ANGELES (360) 452-8095 Structure Information Construction Type Occupancy Type Other struct info OWNER WA 98363 576 SF DETACHED GARAGE TYPE V NON-RATED GARAGES, CARPORTS, SHEDS 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 21.00 V-N 1. 00 2371. 00 14000.00 576.00 2947.00 1. 00 Permit BUILDING PERMIT -RESIDENTIAL Additional desc 576 SF DETACHED GARAGE Permit Fee 232.75 Plan Check Fee 93.10 Issue Date 3/01/05 Valuation 11520 Expiration Date 8/28/05 Qty Unit Charge Per Extension BASE FEE 92.75 10.00 14.0000 THOU BL-2001-25K (14 PER K) 140.00 Special Notes and Comments When roof gutters are installed, drains will located in dry wells or piped to approved storm drain locations. The proposal will result in a detached garage in the RS-7 zone for total lot coverage of 21%. A Zoning Lot Covenant is required unless one is already on file. Electrical load calculations and elctrical permits are required. Other Fees STATE SURCHARGE 4.50 Fee summary Charged Paid Credited Due ----------------- ---------- ---------- ---------- ---------- Permit Fee Total 232.75 232.75 .00 .00 Plan Check Total 93.10 93.10 .00 .00 Other Fee Total 4.50 4.50 .00 .00 r!......,;:,T'lr1 ".,......+-,;:,1 oon Ot: oon 0" nn nn _. 'J \) -. -. ~\ t t -. ~ ~ ~ "i .::r- 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 orwork 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. (I !..J ( ~ ~. '/ tvryv {if '(j or"( 3 -I .-;to Signature of Contractor or Authorized Agent Date Signature of Owner (if owne is builder) Date T:\Policies\1102.15 building permit inspection record05.wpd [1/4/2005] BUILDING PERMIT INSPECTION RECORD 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 r INSPECTION TYPE DATE ACCEPTED COMMENTS YES I NO FOUNDATION: r"fl () it- " :.:)/ A.- J, :g-}-O';' - J. l- L.- FOOTINGS WALLS FOUNDATION DRAINAGE 1 DOWN SPOUTS PIERS POST HOLES (POLE BLDGS.) PLUMBING UNDER FLOOR 1 SLAB ROUGH-IN WATER LINE (METER TO BLDG) GAS LINE BACK FLOW 1 WATER AIR SEAL WALLS CEILING I I I FRAMING JOISTS 1 GIRDERS SHEAR W ALLIHOLD DOWNS , WALLS 1 ROOF 1 CEILING Iii /~'l / Os jj,L DRYWALL (INTERIOR BRACED PANEL ONLY) . t ~ T-BAR INSULATION SLAB WALL 1 FLOOR 1 CEILING I I MECHANICAL HEAT PUMP 1 FURNACE 1 DUCTS GAS LINE WOOD STOVE 1 PELLET 1 CHIMNEY COMMERCIAL HOOD 1 DUCTS MANUFACTURED HOMES FOOTING 1 SLAB BLOCKING & HOLD DOWNS SKIRTING PLANNING DEPT. SEPARATE PERMIT #'s SEPA: PARKINGILIGHTlNG 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 PWI CONSTRUCTION - R. W. ENGINEERING 417-4807 PW 1 ENGINEERING FIRE 417-4653 FIRE DEPT. PLANNING DEPT. 417-4750 . J PLANNING DEPT. 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Ol , , >-Jo , >-JtJj ~O, ;1>0 , ::rc OlOl no o H gj~[:l :>:0 ;3 t' Ol , II> 0 t'~<J) 0 '" H >-JHH Z ill'dt:l Gl n "Gl '>-J~ ;I> 0 '" nH ~ H 3: N'd 00 ;I> HZ 3: , 0 3:ZH Gl ZUl Ol ~~ ~ ~ Ol Ul'd Z 'dOl >-J "'0 Z Oln ill "';I> >-J n>-J >-J ill >-JH ~ H 00 0 ~Z 0 Z c.,>-J Z 3: ~~ 0 0 'd'dUl >-J Z :>::>:C Ol;>: Ol 0 ootJj UlOl ill ZZO >-J Ul OlOlH t' t' <: ;I> t' tJj H Ol W ~ '" t' 0 ><: " '" N , ro 0 '" '" O'd ;1>;1> >-JGl OlOl w , 0 N , o H LnH I I I 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 V PERMITS (360) 417-4815 FAX(360)417 -4 711 BUILDING PERMIT - APPLICATION FOR OFFICIAL USE ONLY: Date Rec.:'Z. - I B .....O~ Pennit #: OS - I 20 ! ateAPp~ Date Issued: Phone: City: \JDRr -AkJG.blE"5 Phone: 3"'0' L\ 5 z... ~ D9 S- 3~ . c..\52-' ~(')<1 S- Zip:~ '"g % ~ Applicant or Agent: \ ~t'Ylf\S t. . c:s ~"-€ Owner: Jt-'O~ E. ~~ Address: 1 ~ \ q "9. \::::. "SI Architect/Engineer: N ) Ar , Contractor ~l..tF Phone: State License #: Exp: Phone: Address: City: \ \--r~ 71 "3 \ \ ti:. '3 (XXX) '3\ \ <1' 5" c.x.eo Zip: ZONING: ? - ((s 7 PROJECT ADDRESS: \10 \ W. LEGAL DESCRIPTION: Lot:~ ~ ~ CLALLAM COUNTY PARCEL NUMBER: Block: Subdivision: - Credit Card Holder Name:.J HQM5 Billing Address: I ~, '1 .t) . \<. ~ _ SIZENALUATION: SF. @ $ /SF. = $ '57 ~ SF. @ $ ~ /SF. = $ SF. @ $ /SF. = $ TOTAL VALUATION $ ~Atl:AG.~ tl?,W II(S 2D COMMERCIAL/RESIDENTIAL: Occupancy Group: Occupant Load: I No. of Stories: Lot Size: ILf/coo..o Existing Sq. Ft. 2~7' &ProposedSq.Ft. Total lot coverage e. t . % -----;r- ~tc>>l Construction Type: 51/,::. =TOTALSq.Ft.~ ESNWetland(s): DYes D No SEPA Checklist required? DYes D No Other: APPROVALS: PLAN: BLDG: DPWU: FIRE: OTHER: PLANNING USE ONLY: 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 subm g Official can extend the time for action by the applicant up to 180 days upon written request by the applicant (see Section RI05.3.2 of the International BuildinglResidential Code, 2003). 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 ff is my responsibility to detennine what pennffs are required ,not the City's, and that J .k obtain such pennits prior to worlr, T:\RVESS\BLDG-fonns-brochures\2004-Buildingpennit.wpd ApplIcant: ~ ~ L Date: 2/ If !2.()Or A LLE Y 1701 VI. 11TH PROPOSED GARAGE ioo' , 12. 1< 5..1/' "i / 576 SF; ;1.<1' ( 20 jq' i'" 101 --l-~~, ^ :2<1 ' (f'J r 4'-.' -i ::- () ..... ~ ~ >ll M r~ "I L.. . I T ~ 110' 'li 1 \.,- " IJlz' I~f '" - M ,j ~4-1 I<{./ [< <i\-S-I ~f-< ~ 30 II TH 5T "~'_~C~ t ......~\1 f' Feet Vertic'ol Datum = NA VD 88 Horizonttl[ Datum = NAD 83/91 N Area Map This map is not intended to be lIsed as a legal description. This map/drawing is produced by the 0(1' of Port Angelesfor its own use and pwposes. Any other use ~f this map/drawing shall not be the responsibili~l' of the City. 1701 W 11TH PROPOSED GARAGE (~ 101 () :r- -_._....,_..._~--~-- T ~! 11 Il{./ -t< A LLE Y 100' ./< 4'-' "- , \D '" (lJ\ ,..... '-0 M - ~ ~ ~."........--....._-_... ..-----.--..--.....+-. I I T H ST , 12. :J..rf' 1 / 576 SF , i ~" ( 2b / / jq' I - :1<1 ~L~I (f) -i ;:r;: ~ '<1 , M I Ic/ '1 I I 1~1z ('{f ~ y../ I -------,. , 3U ,&) 'toil .. "f;d" CITY OF PORT ANGELES PUBLIC WORKS - ELECTRICAL DIVISION ~21 EAST 5TH STREET, PORT ANOELES. WA 9R1(,2 Application Number Application pin number Property Address ASSESSOR PARCEL NUMBER: Application type description Subdivision Name Property Use Property zoning . . . Application valuation 05-00000783 Date 552800 1701 W 11TH ST 06-30-00-0-3-1195-0000- ELECTRICAL ONLY 8/29/05 RS7 RESDNTL SINGLE FAMILY o Owner Contractor SEE THOMAS E 1319 S K STREET PORT ANGELES ( 36) 452-8095 OWNER WA 98363 ---------------------------------------------------------------------------- permi t . . . . . Additional desc . Permit pin number Permit Fee Issue Date Expiration Date ELECTRICAL ALTER RESIDENTIAL ADD CIRCUIT TO GARAGE 58487 48.10 Plan Check Fee 8/29/05 Valuation 2/25/06 .00 o '- "'-i ~\) ~ ~ ~~ Qty 1. 00 Unit Charge Per 48.1000 ECH EL-R OR RM 1-4 ALT CIRCUITS Extension 48.10 Fee summary Charged Paid Credited Due ----------------- ---------- ---------- ---------- ---------- Permit Fee Total 48.10 48.10 .00 .00 Plan Check Total .00 .00 .00 .00 Grand Total 48.10 48.10 .00 .00 "- ~ \~ COMM1~NTS/ACTION NEEDED ELECTRICAL PERMIT INSPECTION RECORD CALL 417-4735 FOR ELECTRICAL INSPECTIONS. PLEASE PROVIDE A MINIMUM 24 HOUR NOTICE. IT IS UNLA WFUL TO COVER, INSULA TE OR CONCEAL ANY WORK BEFORE IT IS INSPECTED AND ACCEPTED. KEEP PERMIT CARD AND APPROVED PLANS AT JOB SITE INSPECTION TYPE DATE COMMENTS NO GENERAL COMMENTS: PW-1102.l5 [4196J ,- 1",.:""" CITY OF PbRTANGELES DEP ARThffiNTOF COMMUNTI}",DEVELQPMENT -BUll.DING DMSION , , 321 EASTSTH si'REET;P()R,:r~GELES, WA98362 '., .,_T~ . 'tJ"'" ~'c..," .,... " ~",,',::":': \,.'t.,r-"i ~..." c'j \:~Y/._\c-' Ap,plicationNumber prope:rtyAddress ASSESSOR. PARCEL NUMBER: Application. description P:ropertyZoning'. .'; Application valuation ~ '-T' DateS!2.7/03 , " Sep~[ateJ?erml~ arerequired for electrical work, SEPA, Shoreline, EsAiutilities, private and public improyel!1~~~,'lThisP~rmlt~~comes nul(culd:vol~,ifwork or construction authorized is nof commenced within 180days, if construction orworkl~ stJspprt'Ubc10rabandoned for,a period oM 80 days after the work as commenced,or.if~qI;lJ~((.lnspectlon!S hav~ no~ been re,quest~~,Xl!tl1,i[1 J'~L~~y!;,t!EJ1'l t!1e1ast Inspection.' I hereby certify that I have read and examined this application and know ,the same to ,be true and,colTect.,A.II pl'()"isions of laws and ordinancesgoveming this type of work wiUbe compli~~"y.lith ,^,h~ther specifi,ed herein or not.Thj;lgran~ngofapel'mit does not presume to give authority to violate or. cancel the provisions :of any state or locallaw regulating consm.ction or;thepEiiiorn;t~nce of construction. d " , oAJ F(6E: Signature of Owner (if'owneris builder) " ~J" ~l'" \\ " 03-00000482 1701 W 11TH ST 0630000311950000 INSPECTION ONLY o Owner Contractor - -,.':'"'---~-..-.- - _..~---- - - - - - --- HENNING BRENDA C/O'KEViIN/SHELLY'HARMON PORT ANGELES WA 98363 OWNER --------------------------------------------------------------~------------- Permit . . . . Additional'desc Pe'rmitFee Issue Date Expiration Date BUILDING PERMIT - NO PR' FEE Plan Check ,Fee Valuation 47.00 5/27/03 11/23/03 .00 o Qty Unit Charge Per Extension 47.00 BASE FEE --~-~~--~-----------------------------------'-~------------------------------ , . ","_Cr"_"'. ".. .' .. '. -.' ...-0....-...... .. , Other Fees STATE SURCHARGE 4.50 Fee summary Charged Paid Credited Due ----------------- ---------- ---------- ---------- ---------- Permit Fee Total 47.00 47.00 .00 .00 Plan check Total .00 .00 .00 .00 Other, Fee Total 4.50 4.50 .00 .00 Grand Total 51.50 51.50 .00 .00 Signature of Contractor or Authorized Agent T:\PLANNING\FORMS\1102.1S [412002] ~ ~.'.. ~.."','..".',,',',' "-J"-" ........, ,> 5:.., .'. ............. \S.....- . --, -..... ~' :S:-.. ell ~i; Date BUILDING PERMIT,mSPECTION RECORD .., \" , ... ,r"" ,,' ,'" i' \i ,", ., " .,... " '. CALL 417 -4815 FOR BUILDING INSPECTIONS. PLEAS!? ;p'R()VIDE:A M~IMU~9~HOUR NOTICE.. IT IS:'l[!YL.1Jfl'U~1;l!,~OJ?E:R, INSULATE OR CONCEAL ANY WORK BEFORE INSPECTED ANDACCEPTED. ' POST PERMIT IN A CONSPICUOUS LOeATION; KEEP PERMIT CARD AND APPROVEO-PLANSAT JOB srrE"" . :.-\ .-~; . - ,. ~. ,-, ;,;f:OMMENTS",i "I, ' ." '., 'I 'c I ACCEPTED YES 'NO i;, I_ , , INSPECTION TYPE DATE , ' FOUNDATION: FopTINGS WALLS , -'.' , " .. " FOUNDATION DRAINAGE ELECTRICAL (LIGHT DEPT) SEPARATE PERMIT: # , , ROUGH-IN I I " , PLUMBING UNDER FLOOR I SLAB , ROlJ,GH-1N WATERLINE GAS LINE " BACK FLOW I WATER AIR SEAL WALLS '\"t. CEILING FRAMING' " JOISTS I GIRDERS SHEAR WALL WALLS I ROOF I CEILING DRYWALL . . ~" , ". ' Ie '. " . -;c ','. " I ~..'! , . -- T-BAR INSULATION SI.AB WALL I FLOOR I CEILING MECHANICAL HEAT PUMP WOOD STOVE I PELLET I CillMNEY HOOD I. DUCTS PW UTILITIES I SITE WORK ,,(Engineering Division) SEPARATE PERMIT #'5: , ',,~,"""'" +-... 7: -" . .. I"'{; P: , WATERLINE I METER SEWER CONNECTION SANITARY STORM PLANNING DEPT. SEPARATE PERMIT #'5 . P ARKlNGILIGHTING LANDScApING SEP A: ESA: SHORELINE: - ,'", '" ,,' .. '-. ""~"FINAI;INSPECTIONS'REQ1JI~D PRIOR TO OCCup,AN(3.YIUSE ',' ~I~ENTIAh>" "J 'O'A'fEC":' .... '~If~ NO I""'; i,i~~M~CIAL 'ii,'\:""" '. , ""!..i.,...."""...., '.i ",' ELECTRICAL - LIGHT DEPT, 4i7-473S,lril" ELECTRICAL '. ,... ," 'I" ; .. .", ,i, ,,;, LlPHI:I>E~ ' ." CONSTRUCTION R.Wi I PWI -- .~:;'j,... ,.. CONsTRUCTlON-R.W. ENGINEERING 417-4807 .' PW I ENGINEERING ""~'''., "i;"""~,,' . DATE ......": ;A~Cifi'Ebi ;' ....~~"., ':"'NO, ,I,' "",., >. ".'.. " ,,<"" FIRE PLANNING DEPT. BUILDING ... "4)7,-465~, , 4174750 :\ .1J........ FIRE DEPT. PLANNING DEPT. >~..:.'''' '-' BUILDING' .' 417-4815 lJ)'II i/ I 0 ~ . c::-- . ..".C._.._'..,__. ", "'.,'; , '-- ,.-,... ~ - ~~:::::=-,:,~--".. ...--'...,. ,..",.." - T:\PLANNING\FORMS\1102.15 [412002] , 7~r- ~~~ ~ t1~L. REQUEST FOR INSPECTION- Adult Family Home ApPLICATION NUMBER: Applicant must complete sections 1, 2, 3, and 4. Application must be complete to be processed. SECTION 1- PROPERTY INFORMATION SITE ADDRESS: . . PROPERTY OwNER NAME, ~=~JQbo~on UCENSEE NAME (IF DIFFERENT): DAYTIME PHONE: ~- 451-4.1D1:> DAYJ1ME PHONE: ?idJ-l.l51 - if ~ 0 (, SECTION 3 - FLOOR PLAN A complete floor plan must include all sleeping rooms, identified by number (#1, #2, #3 etc.) and all components for exiting, i.e. stairs, ramps, platform lifts and elevators. (Attach additional sheets if necessary) S 'E."E ^l)~-r6\-\6'D -r:: LcoR. t=LMI. SECTION 4 - DISCLAIMER/SIGNATURE BLOCK I certify under penalty of perjury that the information furnished by me is true and correct to the best of my knowledge, and that I am authorized by the owner of the above premises to request inspection for and operate an Adult Family Home at this location. I further certify that I have made application to the Department of Social and Health Services and the jurisdiction for the appropriate Iicense(s) to conduct such business at this location. I further agree to hold harmless the jurisdiction conducting such inspections at my request as to any claim (including costs, expenses, and attorneys' fees incurred in the investigation of such claim), which may be made by any person, including the undersigned, and filed against the jurisdiction, but only where such claim arises out of the reliance of the jurisdiction, including its officers and employees, upon the accuracy of the information SUPPIia.o~:~~ur~~ionJ..J~a~ Of.th~~P~ication. NAME/TITLE: ~ DATE: ~ PROPERTY OWNER 'A APPLICANT ~ LICENSEE . '- -:::r N- C9 - N, - - gj ~ , I .o~ ~ll~e ~ ~ ~. ~ ~,~ ~ ~~ /~.. ~ ~ . 7"/ '.;../ , ~ ~/ . Ie. ~ /.. 'v ~..' . ~- 0> 1\ ? ~ .;1-- ~ ~~ ~~ / ~ci1- ~ -~ -c_G1 d ' :t:.. ~ N t.-- - C)J + lit =-+:= W >-- --> C CJ:r 6 8 .~ > c:::t: - I""D ::: - L~ 0 V1 u ~ 0 0 ~ u . I~ - {l-.J rG (-X' ~ ~ rp ~-j *' ~). N ~~ -9 ~ '4) J;. cu. ~ \.JJ ~~ .-c.~ ~8j <:::r:tlJ <;;q. ~u., Wu ~ E Lc~ ijE~ ":2 (: ~ ~.~ ~ I' SECTION 5 - INSPECTION CHECKLIST Home licensed (or applying for license) on or after July 1, 2001 SLEEPING ROOMS Sleeping Room #1 0 SONS 1 0 NS2 Bedroom door is openable from the outside when locked Closet doors are readily openable from the inside Smoke alarm is installed in the bedroom Sleeping room window has a minimum net openable area of 5.7 sf. (minimum dimensions- 24" high; 20" wide) Sleeping room window has a maximum sill height of 44" Sleeping Room #2 0 SONS 1 0 NS2 Bedroom door is openable from the outside when locked Closet doors are readily openable from the inside Smoke alarm is installed in the bedroom Sleeping room window has a minimum net openable area of 5.7 sf. (minimum dimensions- 24" high; 20" wide) Sleeping room window has a maximum sill height of 44" Sleeping Room #3 0 SONS 1 0 NS2 Bedroom door is openable from the outside when locked Closet doors are readily openable from the inside Smoke alarm is installed in the bedroom Sleeping room window has a minimum net openable area of 5.7 sf. (minimum dimensions- 24" high; 20" wide) Sleeping room window has a maximum sill height of 44" Sleeping Room #4 0 SONS I 0 NS2 Bedroom door is openable from the outside when locked Closet doors are readily openable from the inside Smoke alarm is installed in the bedroom Sleeping room window has a minimum net openable area of 5.7 sf. (minimum dimensions- 24" high; 20" wide) Sleeping room window has a maximum sill height of 44" Sleeping Room #5 0 SONS 1 0 NS2 Bedroom door is openable from the outside when locked Closet doors are readily openable from the inside Smoke alarm is installed in the bedroom , Sleeping room window has a minimum net openable area of 5.7 sf. (minimum dimensions- 24" high; 20" wide) Sleeping room window has a maximum sill height of 44" Sleeping Room #6 0 SONS I 0 NS2 Bedroom door is openable from the outside when locked Closet doors are readily openable from the inside Smoke alarm is installed in the bedroom Sleeping room window has a minimum net openable area of 5.7 sf. (minimum dimensions- 24" high; 20" wide) Sleeping room window has a maximum sill height of 44" GENERAL Bathroom doors are openable from the outside when locked Smoke alarms are installed on all levels of the dwelling All smoke alarms are audible in all parts of the dw ling upon activation of a single device Access road and water supply approved by Fire D artment ~ASSED INSPECTOR: DATE: YES NO ~ 0 C ~ L ! L [j L [J ~ 0 ~ [J [ [ ~ L ~ C ax [J ~ [J C ts( [: ~ L! kC lJ ~. [ X L ~ C ~. C ~ L ~ l~ ~ [. C ~ [J C ~ [J tf 0 ~ C IJi( [: ~ C C ()t.. C o ' PERM ;r REQUIRED AU latches on closets need to be openable from the inside. This is to allow an occupant, if they get into a closet and the door closes behind them, to get out of the closet by themselves. ~ Smoke Alarm Requirements: This is a significant change applicable only toadult family homes. This section requires that if one smoke detector activates, it will be audible in all parts of the building. For example: if a smoke detector inside the bedroom of an aged occupant activates, the sound of the activation has to be audible in the caregiver's room, the laundry room, the kitchen, or wherever the caregiver may be at the moment. Typically, this will require that smoke detection units are wired together so all activate at once. And, others may need to be added in non-sleeping room areas. ~ Escape Windows: All newly constructed or newly licensed adult family homes are required to have emergency escape and rescue windows meeting the requirements of Section 310.4. There are no exception:; for existing structures being converted to adult family homes after July 1,2001. ~ Fire Apparatus Access Roads and Water Supply: All adult family homes are required to be served by both access roadways and water supplies meeting the requirements as specified in the published Article 9 of the Uniform Fire Code. (Note: RCW 19.27, and WAC 51 specifically do not adopt Article 9 provisions into state law. The intent ofthis section is to apply those requirements as published, for adult family homes.] The exceptions for sprinklered structures could be applied by the local jurisdiction. The purpose of this requirement is to prohibit adult family homes in locations not readily accessible by emergency apparatus. In case ofa fire in these types of uses, evacuation of the occupants is paramount, and must be accounted for in the placement and design of the home. Attached to this clarification memo is a checklist developed by WABO, in cooperation with DSHSfor use by both building departments and licensors. CITY OF PORT ANGELES DEPARTMENT OF PUBLIC WORKS . . . . . . . . . . . INSPECTION REPORT . . . . . . . . . . . REQUEST: Date 5- 1~-63 Time Received by RV (phone, person) Location of Work to be inspected I~~ ~) . ut~ Name of person requesting inspection e ~o... Id eY\.V\~ Address of person requesting inspection ~hone No. ~- 4Z()b Type of Inspection (circle appropriate one): Permit No. Sewer Foundation Framing Chimney Plumbing Final Sewer Excav. Other INSPECTION NOTES: Inspected: Date <;; - / ~' - c>.:s Remarks: OAJc liME W AR() - By ~~-V::J'- LNS?EC [lOIN' Ach-<J+ 'FC4W1I\'~/ f/o~-p / Time RESTORATION REQUIRED . . . . .. YES NO SURFACE RESTORATION: SURFACE TYPE: 0 Unimproved 0 Gravel 0 Asphalt 0 PCC o Other o Repaired by City o Repaired by Permittee o No Damage Found Work Order # o COMPLETE o INCOMPLETE (Continue on reverse side if necessary) STREET SUPERINTENDENT (DATE) ~ {j CITY OF PORT ANGELES PUBLIC WORKS - ELECTRICAL DIVISION 321 EAST 5TH STREET. PORT ANGELES. WA 98362 ELECTRICAL PERMIT Issued: 9/24/97 Permit No: 6056 OWNER/APPLICANT------------------------PROPERTY LOCATION------------------------ BRENDA HENNING 1701 11TH ST W 1701 W.IITH STREET Lot: 19&20 Port Angeles, WA 98363 Block: 311 Long Legal: 206/457-6129 Sub: TPA T: S: Parc No: CONTRACTOR-----------------------------DESIGNER--------------------------------- OLYMPIC ELECTRIC 1805 TUMWATER PORT ANGELES, WA 98362 360/457-5303 , 000/000-0000 PROJECT INFO-------------------------------------------------------------------- prj Type: RES. MISC. prj Value: $0.00 Occ Type: Cnstr Type: FEEDER Occ Grp: Occ Load: Land Use: RS7 Electrical Heat Baseboard KW: Furnace KW: Heat Pump KW: Fan/Wall KW: o o o o Service Type Riser X Overhead Service Underground Service Temp Service Voltage: Diameter: Service Size: Feeder Size: 120,240 X-I -3 200 AMPS 100 AMPS PROJECT NOTES------------------------------------------------------------------- RAN 100 AMP FEEDER AND CONNECTED ADDITIONAL HOT WATER TANK PROJECT FEES ASSESSMENT--------------------------------------------------------- Service: $57.00 Additional Feeders: $0.00 circuit Wiring: .$0.00 Temp Service: $0.00 $0.00 Misc TOTAL FEE: Amount Paid: $57.00 $57.00 ================================= TOTAL FEE: $57.00 Balance Due: $0.00 COMMENTS/ACTION NEEDED ;"... \.vr.: ~"~..' ELECTRICAL PERMIT INSPECTION RECORD CALL 417-4735 FOR ELECTRICAL INSPECTIONS. PLEASE PROVIDE A MINIMUM 24 HOUR NOTICE. IT IS UNLA WFUL TO COVER. INSULATE OR CONCEAL ANI' WORK BEFORE IT IS INSPECTED AND ACCEPTED. KEEP PERMIT CARD AND APPROVED PLANS AT JOB SITE INSPECTION TYPE DATE .1 ACCEPTED COMMENTS I YES I NO Ull Cl1 KUU\.Jl1-1N I COVER SFKVII~h I / I 9'blV/?'71 /,?ut) , GENERAL COMMENTS, PW-l 101.1S [41961 ei CITY OF PORT ANGELES LIGHT DEPARTMENT 321 E. Fifth Street Port Angeles, WA 98362 .' (206) 457-0411 PERMIT NO. ~<f<.f'i DATE 1~1 ?(r /"1.3 ELECTRICAL PERMIT Site Address: o READY FOR INSPECTION License Number: o WILL CALL FOR INSPECTION Phone: Installed By' Phone: Owner/Business Address: Sq. Ft. A RESIDENTIAL o COMMERCIAL ~ BASEBOARD KW _ o FURNACE KW _ o FAN/WALL KW _ o HEAT PUMP KW_ o SIGN o TEMPORARY SERVICE o PERMANENT SERVICE o NEW CONSTRUCTION o REMODEL o ADD/ALTER CIRCUITS o SERVICE UPGRADE/REPAIR o SPECIAL EQUIPMENT (LIST BELOW) o OVERHEAD SERVICE W UNDERGROUND SERVICE VOLTAGE: o SINGLE PHASE o THREE PHASE SERVICE SIZE ~ DO AMPS DetailslDescription: ~, ~./,tfIV ~ . W.S. No. SERVICE SIZE CAPACITY: o O.K. NOT O.K. ACTION REQUIRED: 0 CHANGE TRANSFORMER o INSTALL SERVICE POLE DATE ENGR. o CHANGE SERVICE WIRE o OTHER o Ditch Inspection O.K. o Rough-in/cover OK -1fi'l/'f\ O.K. to connect service o Final O.K. Site Address: Permit/Receipt No. '-fLf'b'l Installer: -' . Notify Pon Angele ity Light by Street Address and Permit Numberwhen ready for inspection. Work must not be covered before inspection and O.K. for covering has been given by the electrical inspector in writing on either the Wiring Repon or on the Building P it PHONE 457-0411, EXT. 224. ~ NO OCCUPANCY OR USE ESTABLISHED UNDER THIS PERMIT $ ~1C)' (96 Permit Fee WHITE - File by address YELLOW - file by number PINK - Top: Eng, Bottom, Customer GREEN - Top: Meter Dept., Bottom: City Hall OLYMPIC PRINTERS INC ,_..,.. ELECTRICAL WORK PERMIT APPLIC Job wired by o Electrical Contractor Owner InstaJlatiqn description I:J Commercial ~ Residential Electrical contractor name License number Date Expires FiiNew D Altered/Addition Purchaser's mailing address City State ZIP WIlW..'C-IJP.tt~_.c- S ~~ t"M.,:) r.l(i..tt'/;:":, 1- '5OOW t~).1 MoTl()l.)~, 0- ~F WltlF.!.. 1- OiP1f~JJen... ~:AC ~ \ Telephone number FAX number Premises owner's name THOmAs E:... 'S~. Address of inspection 110\ IN" llTt< ~TPa?'r Cityn.. -p. IVll:r ~"3 Phone number to schedule inspection: :3 .4':.:):2.-37 Owner as defined by RCW.19.28.261:(l) Owner will occupy the structure for two years after this electrical permit is finalized. (2) O~i'ner is required to hire an 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 the above named property or a licensed electrical contractor. I am making the electrical instal- lation or alteration in compliance with the electrical laws, N.E.C., RCW. Chapter 19.28, WAC. Chapter 296-468, The City of Port Angeles Municipal Code, and Utility Specifications. Signature 0 11klt:l~~'D r~O:.t.rr Rl4;lM ~l~ 1"fll'.>-~6A.>J6:>..A~-L. ~I ~ rtttW '!:oW) LO LIl.G7 (lp:p') o Cash 0 Check # Glt'1Sedit Card @> Mastercard Card# L!-3-'fL~-5Z3.Q.--Ls-r~ -~Z-- Discover x r or electrical administrator Date: ~ Expiration Date of card C>3fD1 $nspec~~ / 0 Service Information c: Ii Electrical Load Additions and or subtractions iii' NO LOAD CHANGES I:J Baseboard KW I:J Furnace KW o Heat Pump Ton D Fan-Wall KW LAR o Overhead Service o Temp Service (lY'(inderground Service Voltage I2.LJ ~ Phase 9"1 D 3 Service Size: _ Feeder Size: "- V U SAME DAY INSPECTION, CALL BEFORE 7:00 AM 360-417-4735 ROUGH-IN THERMOSTAT SERVICE D31C Approved By Date Approved By Dale Approved By FINAL ;' DlTaI FEEDER "- Dale Approved By "- Dale Approved By Date Approved By Inspcct.on Area, Building or Equipment Inspected Action Taken Electrical Date .....,Inspector P:r 'L '2. ---0'3 n\(.. "\/7Llb- ~'ld -v .