HomeMy WebLinkAbout212 E Ahlvers Rd - Engineering
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CITY OF PORT ANGELES
PUBLIC WORKS - BUILDING DIVISION
321 EAST 5TH STREET, PORT ANGELES, WA 98362
PUBLIC WORKS CONSTRUCTION Issued: 2/02/98 TF Permit No: 796
& R/W PERMIT Cond: Work Order: 0
OWNER/APPLICANT------------------------PROPERTY LOCATION------------------------
CHAMBERLIN 212 AHLVERS RD E
212 E AHLVERS RD Lot: 34
Port Angeles,WA98362 Block: 1 Long Legal:
360/457-7705 Sub: HAWTHORNE
PROJECT INFO--------------------------------------------------------------------
Work is INSIDE traveled road Value Work: $0.00.
Plans Required: N/A
Contractor: US WEST COMMUNICATIONS
Start:
Finish:
Performance Bond Required: N/A
Proof Insurance:
Amount:
Work to Perform: INSTALL
Watermain
Sanitary Sewer
/ /
/ /
$0.00
Storm Drain
* Underground Tele/Ele
Misc
PROJECT NOTES-------------------------------------------------------------------
BORE UNDER AHLVERS RD 200' BSW FROM WEST SIDE OF HOUSE ACROSS AHLVERS
APPROX 200' FROM OLD MILL RD
PROJECT FEES ASSESSMENT---------------------------------------------------------
R/W Excav:
Sidewalk:
Curb/Gutter:
Driveway:
Dwy Culvert:
Street Cut:
Other R/W:
Fire Hydrant:
Res Water Serv:
5/8"
3/4"
I"
Comm Water Serv:
I"
1 1/2"
2"
Oth Water Serv:
Water Sys Dev:
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
San Sewer SFR:
San Sewer MFR:
Add unit:
Other San.Sewer:
Sew Tap Wye/Man Tap:
Sew Cap/ W/M Removal:
Alter/Repair Sewer:
Storm Drain Tap:
Catch Basin per ea:
Sewer System Dev:
Milwaukee Dr. Sew Assess:
R/W Use Perm:
D.R.A. :
Admin Costs (D.R.A):
Misc:
$0.00
$0.00
$0.00
o
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
------------------------------
------------------------------
$0.00
$0.00
TOTAL FEE:
AMT PAID:
Receipt No:
Inspection Fee:
$0.00
WATER
BAL DUE:
R/W SANITARY
STORM
DWY
DRA
$0.00
$0.00
$0.00
OTHER
Separate Permits are required for electrical work, 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.
Sianature of Owner (if owner is builder)
Date
Sinnature of Contractor or Authorized Aaent
Date
P.fll/01g-t../0 U
BURIED SERVICE WIRE #15 I 7 '310 5"3
WORK ORDER DATE: I /~., ;., e
,
,JFf' 28'98 11:50 FR US WEST COl1'1UNICATTiJN 60 452 4f'?' TO 13f;lM786696
W26, 4 S-z...
J:4
Slate fA} 11
WORK lOCATION Wire center
Addrns I).. z: 5
CIty lid d County CI.I-IIH1
MImB 4,.. MA. I.,,,,,, · A-PI"
Subdivision
Cust. SigJ'llltUre (Optional)
Customer may refer Questions to: 800-737- 0417
Sabm/ttBdby: 'h'll-,..e.() OCB'I/){. Pagw .t6.l..-/J...'S"
.
Ir,rSTAUJ\T10NIREPAIR
New 0 CF lJ SOli
Reatrange lJ Add Une lJ
Repair ~ 005 TN"
TlN#
CBRfI
Y ~ N
-"
I.jJ7- 7/1~
'1>17r6.>"3
'117 - 77tJ :>'
Found Temp
T empori;z6d?
o
CJ
PRE-PROVlSIONING
Pre Bury (j
Conduit Placed Partial lJ Complete (j
SSW in Open Tr. Partial lJ Complete lJ
E~d SSW on par1lal conduit or open trench 1:1
HotmJ Ready for SNUGND a Not Rudy a
l T ( )
---- - -
( Add $ to right if $ke\cll sent to contractor )
Is there additional customer billing?
Does Ted1 need notified?
MAP /I
CBL
o Yes a No
lJ Yes lJ No
CONTRACTOR'S ACCEPTANCE
Firm
Signature
TItle Date:
USWect group doing work.
Bill to: . USWesr Communicadon:s
Attention:
Addres&:
City: ZIp:
Reconunanded: Date:
Approved by: Date.Y
PER~aulREn? Xies :Y No
. 1PII
Rece' fro Verbal 0
Jurisdiction No. DIiUI:
COMPLETED BY:
Call
Date:
for service connection
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Sketch Work Required -Include neat'eSt cross:street"'-O C tJi
am/wire length
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A~LVERS "Rt>. .'
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N"": Thi..lretcl1 may not bean""""",",~1on In" <le\;lil$, ~..........1ha c:on!r.lctDI'. ~to propeltflocalewor1<ln f.eld.
R-94%
360 452 4673
"0" TOTAl PFl3E.001 """
01-28-98 12: IBPM POOl 1119
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PU8UCWORKs
Permit To Perform Work In Street Right-of-Way
APPLICATION is hereby made to the municipality of PORT ANGELES to p~rform work as
noted hereon and as shown on attached drawing:
A rt L- VE r<..S
~LeAS15 see f\. 11 -AC~~
~ILE\CH #- 8 - '-I b U
0/1, ___.:+-=iI- 7q~
r ...t/VJ?lA..A.-' Approve(i:
(Lb.
~Qb
u sJ '{::> B12--
Water Department - Superintendent
Sewer Department - Superintendent
The estimated time for completion of the above work is
By '(Y\ ~~ ~ Co
3...0 - '-178 "''f4ZL
Contractor Owner
US WEST /ATTN: ..MISTY
(...1 \ -=- (.,~. STREET .-M56tn6VT
13REME.RTON I WI\SHINGrDN q8~i3~
THE ABOVE APPLICATION IS HEREBY GRANTED SUBJECT TO APPLICANT'S:
Date
-z...
1998
Complying with all Municipal Ordinances;
Notifying the Street Superintendent of the time the work will start, and when it will finish;
Prosecuting the work with diligence and with due respect to all property. contracts. persons'
rights and the interests and convenience of the public:
Saving the Municipality harmless from any and all damages which may accrue to any person
or property because .of this installation or the maintenance thereof:
Complying with fOllowing special conditions:
Date
uv
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C>tYof_;L::
BY Jr.-P -"1/"'< ? ~