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Home My WebLink About517 E 12th St - Building CITY OF PORT ANGELES FIRE DEPARTMENT PERMIT 321 East 5'h Street, Port Angeles, W A 98362 ;~ Applicatlon Number pin number Property Address ASSESSOR PARCEL NUMBER: Application description Subdivlsion Name property Use Property Zoning . . . Appllcation valuation 04-00000651 Date .269752 124 W 13TH ST 06-30-00-0-3-8735-0000- FIRE ABANDON TANK INSPECTION 7/22/04 RS7 RESDNTL SINGLE FAMILY 100 Owner Contractor KEPLER III THOMAS/DENISE 3704 CRABAPPLE ST PORT ANGELES WA 983623714 OWNER Permit Additional desc Permit Fee Issue Date Expiration Date UNDERGROUND TANK RES ABANDON TANK IN PLACE SLURRY 15.00 Plan Check Fee 7/22/04 Valuation 1/19/05 .00 100 BASE FEE Extension 15.00 Qty Unit Charge Per Fee summary Charged Paid Credited Due ----------------- ---------- ---------- ---------- ---------- Permit Fee Total 15.00 15.00 .00 .00 Plan Check Total .00 .00 .00 .00 Grand Total 15.00 15.00 .00 .00 -. ~ .:!.. E ~ ;t lY\ -f This permit becomes null and void if work authorized is not commenced within 180 days, if work is suspended or abandoned for a period of 180 days afer the work has commenced, or if required inspections have not been requested with 180 days from the last inspection. I hereby certify that I have read and examimd this application and know the same to be true and correct. All provisions of recognized standards, laws and ordinances governing this type of work will be compled with whether specified herein or not. The granting of this permit does not presume to give authority to violate or cancel the provisions of any state or local law regulating the work specified ~'n the ermit. ~ ?t 7Mv Signature of Contractor or Authorized Agent Date Stgnat'ure f Owner (if Owner is builder) Date ~ FIRE PERMIT INSPECTION RECORD Call 360-417-4655 for fire 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 location. KEEP PERlViiT CARD AND APPROVED PLANS AT JOB SITE FIRE SPRlNKLER Underground piping hydrostatically tested Underground piping flushed Interior piping hydrostatically tested Interior piping inspection Dry system air tested at 40 psi (24 hours) Sprinkler final FIRE ALARM Rough-in inspection Alarm final LP-GAS Completed by Contractor: Underground piping inspection/pressure test Test #1 Above ground piping inspection/pressure test Piping pressure test pSI Tank (container) inspection Time initiated Test #2 Appliance inspection Piping pressure test pSI Time initiated LP-gas final UNDERGROUND STORAGE TANK (UST) ABANDONMENT Removal of flammable/combustible liquids Tank appropriately abandoned 1-25-6<'; kbD UST abandonment final PERMIT OTHER (specify) permit final Inspection Type I Date Passed I Comments GENERAL COMMENTS: 2/15/00 CITY OF PORT ANGELES IfTC uJP 774-S DEPARTMENT OF PUBLIC WORKS . . . . . . . . . . . INSPECTION REPORT. . . . . . . . . . . REQUEST 7 ?/ ){)-o Date () - Time Received by (phone, person) Location of Work to be inspected S / 7 F I J---ttl Name of person requesting inspection ,- W (' I L-(b X ' Address of person requesting inspection , 1 {-'It f:- r; Phone No Type of Inspection (circle appropriate one) Permit No Sewer Foundation Framing Chimney Plumbing Final Sewer Excav Other 4J C^'--+t' J,.- INSPECTION NOTES Inspected Date Remarks Time ~-e tH c0 91<-cAJ 'oV +0 By '>/y LUcc-l---r-y )*,r-u, c~ +c. C)11 e- .+? J-- I e~k UIVef-e y SI21'~ p. Vy) YVL , D u-€ LuL~/ k ~ ESTORA TION REQUIRED ~J\l- e -:y 5.t f.Qr:ct. YES NO Nt -t ~ ~(( (- y ~~7 f I ::J-+J\ SURFACE RESTORATION SURFACE TYPE 0 Unimproved 0 Gravel 0 Asphalt o Repaired by City [] Repaired by Permittee o No Damage Found o Other Work Order # 7 7 V ) LtVCOMPLETE o INCOMPLETE OPCC 1 ~ ~ ~ "'-L ~ (Continue on reverse side if necessary) STREET SUPERINTENDENT (DATE) CIty 01 l-Jort Angeles Ifl t: wf: 7?t.f S- Public 'Vorks Departnlent vVater Distribution Repair Report IWork Order No CONDITION .7113 '? -/6 --o} EMERGENCY D ROUTINE D CITIZEN COMPLAINT V LEAKAGE SURVEY D OTIIER D 0-/6-ls '} o TIME. DA.M. DP.M. I Crew fir DATE REPORTED DATE OF REPAIR. REPAIR LOCATION ADDRESS ~/7 ~ /:Lfl{ ;z r< c - r-- SIZE TYPE OF MAIN DEPTH OF MAIN CLOSEST VALVE DEPTH. LINE VALVE FLANGE NUTS/BOL TS 0 STEM 0 BONNET 0 HYDRANT BRANCH 0 VAL VE 0 BARREL 0 OTIIER. COMPONENTS OF REP AIR. CLAMPO DRESSERO OTHER SITE CONDITION GRA VEL D AS\~ T 0 SIDEWALK D CURB D TOP SOIL AREA ~ SOIL TYPE CUTS ASPHALT CUT _IT CURB CUT _IT SIDEW ALK _IT DRIVEWAY CUT _IT MAIN CONDITION INTERNAL LINING TUBERCULA TION-1'v1lNOR D SEVERE D EXTERNAL CORROSION LOCALIZED 0 EXTENSIVE 0 CHLORINE RESIDUAL SAMPLE ('3 ?P.P.M. WATER OFF FROM -<g pJt.< M. TO / {) 11:: " ! r () 0+ 0 P 5-en/IC'-f7 / ILO-V ~ e FROM M. TO M. 0/ J coe~+' J-- J/~cou/cI 11 Jr') 9Yt 0_ _ A'LJ ~~/ 0 of- APP ARENT CAUSE OF LEAK. k 'fa --( I .s_r~" ' '& Ii.~~"i ; \Y,'" 1I~<' , "CITY OFPORT ANGELES, ' ," DEPARTMENT OF COMMUNl'lYD;E'\';ELOl'MENT - BUILDING])IVISION' 321 EAST 5TH STREET, PORT ANGELES, WA98362 ' 1 MA~, INDY 517.EAST 12TH PORT !ANGELES WA 983629208 RJ SERVICES 122 S .."BROOK PORT, ANGELBS! WA pORT ANGELES ' (360.)""457:..1420' :) ~~1caC1on NUmDer proPerty Addres,s .d . . MlilESSOR PARCELNOMBER:, App~~pation description SUbd.t vision Name . .'. 'Prop'efty" Zoning'. '.', :~'. Application valuation . , '0.3-0.00.00654 517 E12TH ST 06-30-00-0;'3-3~7~:",00o.o.- FIRE ABANDON TANK INSPECTION ~. 'x l' Date> 7/09/03 600 owner Contractor WA 98362 - . ",. .'- ~------------------------------------------~--~--~-'~---~-------------------- Permit . . . . Additional desc ,Permit Fee Issue Date Expiration Date UNDERGROUND TANK. RES 15.00 7/09/03 1/06/04 Plan Check Fee Valuation .00 600 Qty unit Charge Per BASE' FEE Extension 15.00 Fee summary Charged Paid Credited Due. Permit Fee Total Plan Check Total Grand Total 15.00 .00 15.00 15.00 .00 15.00 ,,00 .0.0 .00. .00 .0.0 .0,0 CJ1 : / ........... Separate Pe~lts are required fo~ electrical.wo~, 9EPA, Shoreline, ~S~,utllitles. pri~ateand pu.blic Improvemen.!5:I~\S'f)et'11!l~co,ll1.)s null and void If work or construction authonzed IS notcommenced Within 180 days, If construction or work Is suspentfed,ora6andoned for a period of 180 days after the work as commenced, or if required Inspections have not beenrequested.witl1irit80 d~~i?btt1J~ftla~t Inspection., I hereby certify that I have read and exa,mined this application and know the same to be trueandcoO'ec4t.Nl:prQ"ls!ql1~ ,of laws and ordinances 9 veming this type of work will be complied with whether specified herein or not. The gre!)~ng Qfa r>~rm~, ~()~~ not presume to gl aut 'ty tovio te or cancel the provisions of any state or local law regulating constructionorthe perfol'l1iallCeof const tion ' ,,' , , 1)'-/-03 Date Signature o! ()wner (if owner is builder) T:\PLAJIlNING\FORMS\1102.15 (412002] BUILDING PERMIT INSPECTION RECORD . . . ~ . . > f .<_ " ,: "'. :' _ _ _ , -. c." '.' '.:._,:'.'_' _,;>:~,~,_~.i::-'c::~:__,:: CALL 417 -4815. FOR BUILDING INSPE<::1:IgNS... PLEJ\SE PROVIDE AM~IMtn~1,~4 JIOURNOTICE..I7' IS UNL1WfUL' TO GOPJf.R;, INSULATE OR CONCEAL ANY WOilKBEFOilE INSPECTED AND ACCEPTEbi"pOST PERMIT IN A CONSPICl.iOUSLOCATIDN.' . . . .~ . COMMENTS '. -"" : ". ',), " .. KEEP PERMIT CARD AND APPROVED PLANSAT"'jOffSITE INSPECTION TYPE DATE I ACCEPTED I YES I NO " FOUNDATION: ,,~., FOOTINGS WALLS FOUNDATION DRAINAGE ,.f " .. ", . .', 'J"';:.ft, ._,', ELECTRICAL ROUGH-IN PLUMBING UNDER FLOOR / SLAB (LIGHT DEPT) SEPARATE PERMIT: # . '., . oJ'",. ,.' .". " o' . . . I . ROUGH-IN WATER LiNE GAS LINE BACK FLOW / WATER AIR SEAL WALLS . CEILING FRAMING. JOISTS / GIRDERS SHEAR WALL WALLS / ROOF / CEILING DRYWALL . T-BAR INSULATION SLAB WALL / FLOOR / CEILING MECHANICAL HEAT PUMP WOOD STOYE / PELLET / CHIMNEY HOOD / DUCTS PW UTILITIES / SITE WORK (Engineering Division) SEPARATE PERMIT #'s: ,', ,,: '" I I... .. . .'.', " , ,-. ;' ~ f-"~ . .i'e . , I . . . WATERLINE / METER SEWER CONNECTION SANITARY STORM PLANNING DEPT. SEPARATE PERMIT #'s PARKINGILIGHTlNG LANDSCAPING . ". '0,., ..... ..' . " SEPA: ESA: SHORELINE: . ..:. "'." ". ... ..- DATE .... '.i'(<1CEPTED:J' .., U' _ ,yES .'J>:N'o'" . 'c:'" 0:" ., : '1 ',: t.J~':"', , . ',..,. .; RESIDENTIAL ;': .... FINAL INSPECTIONS REQUIRED PRIOR TQ,.OCCUPANCY/USE. .0, .~.. .. '" DATE' 'YES" 'NO' ".,~. COMMERCIAL ,,' hI' ;~..". .' ',,}" l:' 2.. ,', FIRE PLANNING DEPT. FIRE DEPT. PLANNING DEPT. BUILDING .... . .f- ' . ". .>. . . ',', . " .... ELECTRICAL - UGHT DEPT. '0 CONSTRUCTION R. W./ PW/ ENGINEERING . 417-4735, - ,,~,",' .~t C' ..... I; 417-4807 417-4653 417-4750 ~tN.4- 417-4815 ~~Z"'9-I-o.) 'I {.tV \ . . ; ELECTRICAL . UGHT DBPT _.-....;.;.1 ,,_,'.s,. CONSTRUCTION - R.W. PW / ENGINEERING. '. . " . .. .. I . 0 , .. .. , BUILDING '. ..._.",~..,,~ -,,' T:\PLANNING\FORMS\I 102.15 [412002] .r.'. . . ~;'i'::'" {, 1/<:.:)\ ~J; (.)' ;it;, -';.,.::::lq:;. PORT ANGELES FIRE DEPARTMENT Abandonment of Residential Fuel Storage Tanks 1,100 Gallons or Less Date Initial 7~?-O? -#J 1. 'l-f:::!2:. ~ 2. Permit Attachment Section I - Information Required Applicant is required to furnish the following information on the space provided on the next page. Attach a site plan showing the nu~ber, size, and location of the underground storage tank with reference to the existing home. Specify the type of liquid which was stored in the tank. Section II - Requirements and Limitations Issuance Qfpermit subject to compliance with recognized standards,. listed requirements and approval by a. field inspection from.the Port Angeles 'Fire .-,;:~,.-Departrnent. .-, .~-" .." '-".---~ .r......~,~,'"... '~,.M'>!:.,,-'....';..;;.'1:~_t;j~!C':7 .:-:."'~-, .,;___,_';i_.,..:_,:::~_"" -IL -~ -A/L FP - 25 A (revised 2/22/00) 1. . Th~re shall be' no welding, cutting, or other sources of'ignitibrl.' id the . area while abandoning operations are in progress1Weldingor cutting on tanks req~ire a separate permit from,rthe',:Port Ailgeles "fire Department. 2. Removal of all flammable and combustible liquids from the tank and all connecting lines shall be pumped out. Please use a hand pump or other means to remove remaining flammable or combustible liquids as far as practical. 3. If the tank is removed and stored on site temporarily, the tank shall be placed in a secure location and blocked to prevent movement. The tank would be required to be inerted prior to being transported. The hole created by removing the tank shall be filled with a suitable. material (earth, sand, etc.). Page 1 of 2 Date Initial -IL 4. If the tank is to be abandoned in place, all openings shall be capped or plugged and the vapor lines disconnected. One of the following methods of abandonment shall be used: ( ~e tank shall be filled as full as possible with an inert mixture 'l h d I . i suc as san or a s urry mIX, or () The fill pipe shall be removed below grade, to prevent refilling of the tank. (This method does not require filling with an inert mixture. ) In using this method, I understand the void created by the tank . may cause a collapse of the adjacent ground if the tank rusts out over time. ?--r-o 3 "1: Date: . .~:;:;:::r<'.'>~ I have read and understand the requirements of this applicatio~. J Applicant's signature: ';-- 7-0 :s To be completed by City of Port Angeles : Permit # To be completed by Fire Department Method of abandonment: ( ) Removal of tank ~lled with inert mixture ( ) Permaneritly capped or' plugged below grade. FP - 25 "A (revised 2/22/00) Page 2 of 2 r-- .. fJ w~-+- ~ 5 fJ l.. " 6^ r-.....f-<- . "...-\\0 'e tide (} Ch <... -t-"'l re. <f'-'r 0. IL \ "",,' \ ". ~ ( HOcJ$€ SI/.. -z.. I:J"'~ J ~ \ \. ~ 1^ \d- 5'f Cox 1-,_for- ... J~~ ---- 1- ~7 514 EPling JacobS Roa "'tCeJU Port Angeles. WA 98362 . (360) 457-1420 o W V\..l.t r- ~ ! fMY' h1 'l.(. E~~I(. '.(I.~.:.,. .~~..... CITY OF PORT ANGELES DEPARTMENT OF COMMUNITY DEVELOPMENT - BUILDING DIVISION 321 EAST 5TH STREET, PORT ANGELES, W A 98362 :~ . Applj,cation Nwnber Property Address ASSESSOR PARCEL NUMBER: Tenantnbr'name Application description Subdivision Name Property Zoning. . . Application valuation 03-00000754 Date 8/06/03 517 E 12TH ST 06-30-00-0-3-3978~0000- TEAR OFFiFELT COMP RB-ROOF OWner Contractor 4000 MACBANK, INDY 517 EAST 12TH PORT ANGELES WA 983629208 LINDQUIST. CONSTRUCTION 150'9 W.8TH!STRBET PORT ANGELES PORT ANGELES WA 98363 (360)452-4820 120.75 8/06/03 2/03/04 Plan Check Fee Valuation .00 4000 Permit Additional desc Permit Fee Issue Date . Bxpir~tionDate BUILDING PERMIT - NO PR FEE Fee summary Charged Paid Credited Due ----------------- ---------- ---------- ---------- ---------- Permit Fee Total 120.75 120.75 .00 .00 Plan check Total .00 .00 .00 .00 Other. Fee'. Total 4.50 4.50 .00 .00 Grand Total 125.25 125.25 .00 .00 Qty Unit Charge Per Extension 92.75 28.00 BASE FEE 2.00 14.0000 THOU BL-2001-25K (14 PER K) Other Fees STATE SURCHARGE 4.50 "- . ...;J ~\ ....'f> ~ '.~.'.' ~ Sepl:ll"Clt~.P~rTlltsare re.9uired for electrical work, SEP,A."Shoreline, ESA, utnltles,prl~ate ,and public improvements. TIJls P8,.rlJ1it~8,c:oTes nuli\~,nc:tv~t~!fwort5or construction authorized is not commenced 'withln 180 days, if oonstruction or work is suspended 'oraba~doned fora: eeriod, ()ft.80 ~ays after the work a~ commenced~or if required inspections have not been requested within 180 daysfrRmth~ last in~#e~ti~n.(lb~rebycertifY that I have read and .exall1i':1edtJiis applicaticfn'and.J<now the sameJb be true and corre8t.~"pto~i~i()rsof laws. ,and ,ordinances govemingth.is type of work will be complied with whether specified herein or not. The granting of a permit does not presull1e to',fgive authority to violate or cancel the provisiO'nsof any state or local law regull:lting construction .orthe performance of conslluctkm,. ' '., . . '., '. . .' . /) ..... ". . . ......~.~~ ..t-5... !-a;-'1. 13... 6.~o3 Signature of Contractor or Authorized Agent . Date Signature of Owne~ (if owneris tlullderJ Date T:\PLANNING\FORMS\1102.1S [412002] BUILDING PERMIT INSPECTION RECORD ~),. l' CALL 417~4815 FOR BUILDING INSPECTIONS. PLEASE PROVIDE A MINIMUM 24 HOUR NOTICE. IT1S 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 ,'1. INSPECTION TYPE DATE ACCEPTED I YES\. NO .,. '0 ,,< .'. COMMENTS , ., .,' !' .' "; , FOUNDATION: FOOTINGS WALLS FOUNDA nON DRAINAGE ELECTRICAL (LlGlIT DEPT) SEPARATE PERMIT: ## . ROUGH-IN h I j. .~:; " " .. ,. PLUMBING UNDER FLOOR / SLAB ROUGH-IN WATER LINE GAS LINE BACK FLOW / WATER AIR SEAL WALLS CEILING FRAMING r0 JOISTS / GIRDERS SHEAR WALL ~ WALLS / ROOF / CEILING L./ DRYWALL .' T-BAR '. ! . . , .. I I I .. eLl .'., - . ,-11 I J I INSULATION SLAB WALL/FLOOR/CEILING - MECHANICAL HEAT PUMP WOOD STOVE / PELLET / CHIMNEY HOOD / DUCTS PW UTILITIES / SITE WORK (Engineering Division) SEPARATE PERMIT ##'s: I i . . cp J: (...> i . cD y \ . WATERLINE / METER SEWER CONNECTION SANITARY STORM . PLANNING DEPT. SEPARATE PERMIT ##'s PARKINGILIGHTING SEPA: ESA: LANDSCAPING . ~HORELINE: ,'y.i. '.. .... ~;P,lPlM-I~S~()NS~lIl~DP~gRTOoccu~M1~PS",q.., . ',.f ;,.... ok". RESIDENTIAL'" ,'1", DArE YES 1+ NO 'GOMM~9AL.; 1~~T:j,~, b; Aq~l!:IITED """.,jii'f< ", .>.' '. "';'<<, .:. ..}li'1I~;,n'--",:,:'-'YES...NO-i '417:47;5" '~:. .;'" ,'..:n...'.';" '.' . '~CAt;,',iY' '"": ..... . . .. '.:-'. LlGHT'DEPT". .," ;';:1, Ql",/," < CONSTRU&10N'.:.R:w."" ",; C C In.,., , 417-4807 PW / ENGINEERING . . I;LE(;TRICAL ~ LIGHT DEPT. f1~/'\ '~-"-\'" '" ~-;, 417-4653 . : 411:-4759 ~ I'~_:~.-'~' *:).A'_~ .~ 417-4815 la-~~-e:n.. ) ~L .' . FIRE DEPT. ...... ,PLANNING jjf,~', ". BUILDING I, .... I....... -,' CONSTRUCTION R.W./ PW/ ENGINEERING PLANNING DEPT. BUILDING "1;",> ". . T:\PLANNfNG\FORMS\1102.15 [412002] PREPARED 9/23/03, 13:11:12 CITY OF PORT ANGELES ADDRESS TENANT, NBR: CONTRACTOR OWNER PARCEL . . : APPL NUMBER: INSPECTION TICKET INSPECTOR JAMES L LIERLY 517 E 12TH ST TEAR OFF/FELT COMP LINDQUIST CONSTRUCTION MACBANK, INDY 06-30-00-0-3-3978-0000- 03-00000754 RE-ROOF SUBDIV: PHONE PHONE (360) 452-4820 PERMIT: BNOP 00 BUILDING PERMIT - NO PR FEE REQUESTED INSP DESCRIPTION TYP/SQ COMPLETED RESULT RESULTS/COMMENTS ."'-"----'/"/"--~--_::;::':::::~::'.::'~:::: 1 PAGE DATE I 5 9/23/03 .. 1 BUILDING PERMIT - APPLICATION FOR OFFICIAL USE ONLY: Date Rec.: ,.. (p - C> 3 Permit #: '151 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: iAtJRGUt:e: ~'lJ<.Ef( Phone: 6tJ2 - 43B -9261 Owner: .1AtJ/2E/lXE RJ/?KE'a Phone: Address: 5:17 r /2 t!1 ~ r City: Ha.r I!M;I;;tES Zip: 183 (., 'l . Architect/En7ineer: A . Phone: Contractoyt /~ df L/,( ,-T ~ :f/te.State Licen~ '( J ~c:./o.~ 2. ~p: i-II'" ~ Phone: .y ~2 - ~J>;lU Address: /5"01 ,,^\ 81.6 ~r City: AII.:r f)IVGC:7-E<. Zip: 981(,3 PROJECT ADDRESS: Sit E /2+!J .5 r ZONING: ;I . LEGAL DESCRIPTION: Lot: Block: Subdivision: CLALLAM COUNTY PARCEL NUMBER: Credit Card Holder Name: Billing Address: Credit CardType VISA MC # TYPE OF WORK: SIZENALUATION: JIf.. Residential 0 New Constr. )i;[Re~roo(,. .0 Stove SF. @ $; . /SE,.;= $ o Multi-family 0 Addition o Move , 0 Garage SF. @ $, . /SF.;'; $ o Commercial 0 .Remodel O'Uemolitioni 0 Deck SF. @ $<: ./ '/SF. ;,; $ .J o Repair./. Q.,Sign,iVi,.';,~ 0 Other TOTAL YAl-\IAIIPN'.,J...$ ~-1;CJex:;;. "_;.;,,",,,BRlEF DESCRlPTIO~ ?~:T~,,~~~~C:r:"C~,K6 ~t,~ :~~'X::::Iril'irz:fEt~.~~:~}(:E' ~JI17-I' (' LU11./051'f76.N ~ '-'!/V1~~1rr:c ::l4lAJa I..ES I -- -__ --_ COMMERCIALIRESIDENTIAL:' Occupancy Group: . Occupant Load: No. of Stories: Lot Size: Existing Sq. Ft. & Proposed Sq. Ft. Existing lot coverage _ % & Proposed lot coverage _% = Total lot coverage City: Exp. Date: Construction Type: 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 buildi~g 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 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 107.4 of the Uniform Building Code, current edition). No application can be extended more than once. I hereby cerlify 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 " is my responsibility to delennlne what pennils a,. requi,.d ,not the City's,and th~st obtain such penn", prior to worlc. T:\FORMS\APPS\Buildingpermit.wpd ApplIcant: .It, ~~..->0 ~~ Date: , (, CITY OF PORT ANGELES LIGHT DEPARTMENT ELECTRICAL PERMIT Nt! 17139 /..;; ~ ..:5-c, /J? Port Angeles, Washlngton___._______________...__......._____________________________.. 19.,_~... 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- :~:::s: i:_~_e~~/?::-~:~:2;?:..~.~.~~.-::-:::~.~~--::10:~cupancy..._..____..__________..._____..___..._________ O~er ....?.:9d~~~;jmr_--::.fr-..-.... Tenant...____.n__...n._____..__________________..________..____::::_____::__ Wmng Contractor .._____!{J.!!,h._______.f24,...n__n_h.._______.____.___ By..................____..._____.______.____________....._ _____.. -. v ~. , Light Outlets..._..........._......._._....___._..... Receptacle Outlets___...._...___................_ Service, volts ....h._.nn___n...__................ No. wires ......................_._n.._..n...._ ~\.. Size wires...._.......................nn..._.. Dryer, KW.____u.._...n.unu......_______n_____ Range, KW ___n_______u._____.______________.. Main fuse ___...n___..................___h..n. Water Heater: Enclosure ..........._nm...___.............__. KW...nh__n_______nh________________ Type of wIrIng; Entrance Cable ........._............. Heat: KW..._..._............nnn....._.......... Motors: size, volts and phase: Rigid Conduit .__________mm....__........ Meta1l1c TubIng "m... Current transformers: No. & Size.......____.__....hn__.n Ser. NO...__n..__.....__..nn_.._......_.........._ Ser. No. n_...nnn...__................__..n.__... Ser. NO....................._....n____............... Type of Wiring: Armored Cable ....._.......___.............. Non-Metallic ............__............._..... Knob & Tube..._.______m____..__mm..._ Rigid Conduit m.....m_mmnm...._n Metalllc Tubing h_...____....n.........h Raceway ..______.........._...._.....___._ Circuits, Light...............__.n.._.._........_..._ UlilltY..mmnm.nnmn...__..m...nn...__ I'Teat ___.__.......___......................._.._.. Range ..........__.__._.n_...nn.__nn_.__n.... Water Heater ....._......._................. Motor ..._....................._............_..._ Dryer ................................___.....n._...._ Furnace n__...........n......._~___.._____....__. Total wad__....n...............nn.. Ser. No. ....nh......n___......n_..............n Total ....._............_..._..........._..n Remarks: ._nh_...:0....'"'_.f.~.~p._?d{~':.~nn~n____L-r"".,=-Q;::.:......._.._____________.h....________________._______..._.._ -.--.--.--.-..-..-..----.--...-..---.--.---.--.--.---------.---..--..---.-..--.------....--.--..--.-..---.-.---.-....--..---.--.-----..-..-----.---------..----.--..-.-.-...._-- -------------h-----___.___h____n_n.______h_.___._________hn_______...h.._.hnn._________._n_____---(};;....____._____......____...~------h-........... ;~-:-~~.-~~~.-----...--.------- ::~-~-~:--:~.~.~~.~-~---... By .--~~...._'L..{i~..~~~.e.~"~...'_ r ..... NOTICE-Current must not be turned on until Certificate of InspecUon has been issued. It work is to be COD- 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 ELECTRICAL PERMIT N? 17139 Address_______....._....._____.............___.__..__.__.n....__...__.._______.........._____........___..__.........---..........__.__......Date..._.....__h_.._.._.......____....___._....__........ Owner .__.........nn_n...........U..._n.._....._._U.._n_..___.___......._n...__n........____..___................n__... Tenant........_._.nnn........_..__nnn....._......nn_____._....... Wiring Contractor.................._._._.........................n_n...._........................nnn.............n._._........._nn. By......n._..._..._................_..__.........___...__...... NOTIC~urrent must not be turned on until CertIficate ot Inspection has been issued. It work is to be con. cealed due notice must be given the Inspector so that work may be inspected before concealment. 1M Olympic Printers, Inc.