HomeMy WebLinkAbout4607 Old Mill Rd - Building
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!;J ElectrIcal Contractor CJ Owner .......
o Annu.a1 Permit Q Alum 0 Carnival 0 Commercial ~~Sideoti;d
l.i"'\1
ELECTRICAL WORK PERMIT APPLICATION
1:1' Request Inspection
o Resldenti:d Malot. CJ Signs 0 Thermostat Q Telecom.
Job wired by
'15 Electrical Contractor CJ Owner
Installation description
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Electr1c31 contractor name License number
/,J,/Jrrrnp F::7:El.:-reXAL L oiJ71?fl'r'TINCr IN(',
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I hereby certify that I am the owner of th.e above named 'Property or s. licensed Q Credit Card Visa Mastercard Discover
elecuical Contn!ctOl" (or the finn's amhoriud agent) and am making rhe el~ctrical r-}
instdl:Hion or alteni.t;on in compliance with the electrical taw, Chapter 19.28 RCW. Card # _ ~ &l. _~ _ __ _ _ _ _ _ _ __
re 01 Owaer, tJectrJc.a~ € ntr nor or eJ~ctricll' lldm'o'JU',UDr
Expiration Date
of card
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Electrical Load Additions and or 9ubtractions
Q NO LOAD CHANGES
a easeboard KW
o Furnace KW
D Heat Pump _ Ton _ LAA
Q Fan-Wall KW ,,~\
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ServIce Information ('
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Feeder Size: ,_
o Overhead Service
o Temp Servtce
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Inspection
Date
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Action Taken
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09/15/2005 05:51
3606830869
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)(Electrical Contractor 0 Owner ~_...:I
D Annual Permit 0 Alarm Cl CD.mival 0 Commercfisl
KIRSCH ELECTRIC INC
PAGE 01
El...ECTRICAL WORKPERMlT APPLICATION
I:J RCQuest Inspection
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~esidentlal 0 ResidelldoJ Maint, 0 Sill1ls 0 Thermost.t 0 Tclecom.
.fob ..ired by ~Electrical Contractor 0 Owncr
~'~~ ng-\e_cJ-n c..\~r.;lZ\ 'i2GCE 10;
purchaser'st511cns ade;SO')( 3 ~4..b
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I hereby ccrtij)' that I am the owner of the above named propcny or a licC=n!jt;d
electrical contractor (or the finn'~ authorized agent) lInd am maklng the: electrical
installation or ..lteration in compliance with the cleclricallaw, Chapter 19.28 RCW.
WALLS
IMul:ltion Only
CEILING
Insuhllion Only
1f/~eover ^ifP
D ~ vedey
^1l1'l'flllc,j By
/b<O
Al'm'olllld fly
ElectricllU.oed Addlllons end or !i\lJ>J):eclions
1:1 NO LOAD CHANGES
o easeboard KW
a Furnace KW
Q Heat Pump _ Ton _LAR
~ Fan.Wall _ KW
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Instnllation dC!lcription
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of card
lnspcction fee
$ tfo~ .f.oo
THERMOSTAT
SERVICE
U"'e ^1\r'I:'''~1I 9y
Dille ^flflM\letll'ly
DITCH
FEEDER
Dnte ^Pllrrwed By
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S_ervlce Info.t!!!sllon
o Overhead Service
1:1 Temp Service
Cl Underground Service
Voltage
Ph..e0103
Service Size: __
Feeder Size:
Inlipection
Date
Area. Building orEquipmenl1nspccted
oj: ~ C-<sv,~"'f.+1- 'iPe.DC..c;+v1
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Action Taken
Electrical
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ELECTRICAL INSPECTION
WIRING REPORT
417-4735
PERMIT #
05-~
ADDRESS
/"7/ L-L C ~~
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APPROVED NOT APPROVED
o .................... DITCH. . . . . . . . . . . . . . . . . . . . 0
o. . . . . . . . . . . . . . . . ROUGH IN/COVER. . . . . . . . . . . . . . . 0
o. . . .. . . . . . . . .. . . . . . . SERVICE. . . . . . . . . . .. . . . . . . . 0
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CORRECTIONS NEEDED@ /n'L.~-----<- dA-:StL CcvJfA
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NOTIFY INSPECTOR WHEN CORRECTIONS
ARE COMPLETED WITHIN 15 DAYS
- DO NOT REMOVE -
OLYMPIC PAINTERS, INC. (360) 452-1381
Page 1 of2
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POST ON JOBSITE PRIOR TO BEGINNING WORK
.
CONTRACTOR NAME
ABSOLUTE AIR INC
ELECTRICAL CONTRACTOR
ELECTRICAL WORK PERMIT # EP1097612
LICENSE NUMBER INSTALLATION DESCRIPTION:
ABSOLAI990NN T-STAT
PURCHASER'S MAILING ADDRESS
2820 E HWY 101
PORT ANGELES
TELEPHONE NUMBER
(360) 452-8444
WA 98362
FAX NUMBER
()-
SERVICES TO INSPECT:
DESCRIPTION
AMOUNT
RESIDENTIAL THERMOSTATS
NUMBER OF T-STATS
Inspection fee: $36,40
QUANTITY
11 I 1$36.40 I
PREMISES OWNER'S NAME
MILL CREEK CONST
ADDRESS OF INSPECTION
4607 OLD MILL RD
PORT ANGELES
Date Approved By
POWER COMPANY
Clallam County PUD
Date
WALLS
Insulation Only
Cover
CEILING
Insulation Only
Cover
Inspection Date Area, ui
Action Taken Electrical Inspector
Property ner: This is your permanent record of inspection
FAILURE TO POST PRIOR TO BEGINNING WORK WILL
RESUL T IN CIVIL PENALTIES
I Print Permit I
http://scsd. apps-insideJni. wa.gov/pairspermit/rptPenni t.aspx? ApplD= 122
9/22/2005
CITY OF PORT ANGELES
DEPARTMENT OF COMMUNITY DEVELOPMENT - BUILDING DIVISION
321 EAST 5TH STREET, PORT ANGELES, W A 98362
MILL CREEK CONSTRUCTION
4619 OLD MILL RD
PORT ANGELES
(360) 452-8281
TOTAL % LOT COVERAGE
NUMBER OF STORIES
LOT SIZE
TOTAL LOT COVERAGE
NUMBER OF UNITS
Application Number
Application pin number
Property Address
ASSESSOR PARCEL NUMBER:
Application type description
Subdivision Name
Property Use
Property Zoning . . .
Application valuation
05-00000357 Date
988125
4607 S OLD MILL RD
06-30-22-2-1-9020-0000-
RES NEW SFR
RS9 RESDNTL SINGLE FAMILY
177470
Owner
Contractor
JAMES W/SHERRIE L SCHOUTEN
4619 OLD MILL RD
PORT ANGELES
WA 983621911
Other struct info .
5/23/05
t=T NA. l "tV
~3/~
WA 98362
17.50
1. 00
17550.00
3085.00
1. 00
----------------------------------------------------------------------------
permi t . . . . .
Additional desc .
Permit pin number
Permit Fee
Issue Date
Expiration Date
BUILDING PERMIT -RESIDENTIAL
2309SF SFR W/ATT 632SF GARAGE
49601
1454.05 Plan Check Fee
5/23/05 Valuation
11/19/05
Qty
Unit Charge Per
78.00
BASE FEE
5.6000 THOU BL-100,001-500K (5.60 PER K)
----------------------------------------------------------------------------
Extension
1017.25
436.80
ct!"~
t. '
)
-.:L
6'>
~
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Permit MECHANICAL PERMIT
Additional desc
Permit pin number 49627
Permit Fee 108.60 Plan Check Fee
Issue Date 5/23/05 Valuation
Expiration Date 11/19/05
Qty Unit Charge Per
BASE FEE
1. 00 14.7000 ECH ME- INSTALL 100- FAU
5.00 7.2500 ECH ME-VENT FAN
1. 00 10.6500 ECH ME-GAS PIPE 1 TO 5
581.62
177470
.00
o
Qf)
0.
Extension
47.00
14.70
36.25
10.65
(),
'V
-
CL
PLUMBING PERMIT
----------------------------------------------------------------------------
Permit . . . . .
Additional desc .
Permit pin number
Permit Fee
Issue Date
Expiration Date
49619
138.00
5/23/05
11/19/05
Plan Check Fee
Valuation
Qty Unit Charge Per
BASE FEE
11.00 7.0000 ECH PL- EA.FIXTURE ON ONE TRAP
1. 00 7.0000 ECH PL- EA. INSTALL WATER PIPE
1. 00 7.0000 ECH PL- EA.WATER HEATER
-
~
-.::;;.
,...
-
.00
o
Extension
47.00
77.00
7.00
7.00
?t>
o
6-.
----------------------------------------------------------------------------
,,~=~,~, T\T~t-=~ ~~... .~
SeparatE!lP~Mi{lg~<M~tHte@j:if9f1e~j1ji!;aMtJr~,eS[AA, ~/:1@relfi1'e,!f:S~ uffiitil!ls, 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 Authorized Agent
Date
t ~ <~L~ k"
. t-i.,.~/t. ')i\
~gnature of Ow r (if owner is builder)
,/1
55/Z-:J)O S-'
/ ' Date
T:\Policies\1102_15 building pemlit inspection record05,wpd [l/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.
INSPECTION TYPE DATE ACCEPTED COMMENTS
, ~ . '. .
YES NO
FOUNDATION:
FOOTINGS . .
WALLS
FOUNDATION DRAINAGE / DOWN SPOUTS
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
SHEAR WALL/HOLD DOWNS
WALLS / ROOF / CEILING
DR YW ALL (INTERIOR BRACED PANEL ONLY)
T-BAR
INSULA nON
SLAB
WALL / FLOOR / CEILING I
MECHANICAL
HEAT PUMP / FURNACE / DUCTS
GAS LINE
WOOD STOVE / PELLET / CHIMNEY
COMMERCIAL HOOD / DUCTS
MANUFACTURED HOMES
FOOTING / SLAB
BLOCKING & HOLD DOWNS
SKIRTING
PLANNING DEPT. SEPARATE PERMIT #'s SEPA:
PARKING/LIGHTING 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. / PW/ CONSTRUCTION - R,W.
ENGINEERING 417-4807 PW / ENGINEERING
FIRE 417-4653 FIRE DEPT.
PLANNING DEPT 417-4750 PLANNING DEPT
BUILDING 417-4815 BUILDING
T:\Policies\ 11 02_15 building pennit inspection record05. wpd [1/4/2005]
CITY OF PORT ANGELES
DEPARTMENT OF COMMUNITY DEVELOPMENT - BUILDING DIVISION
321 EAST 5TH STREET, PORT ANGELES, WA 98362
Application Number . . . . . 05-00000357
Application pin number 988125
Page
Date
2
5/23/05
----------------------------------------------------------------------------
Special Notes and Comments
than 12" in height. Numbers colors must contrast with wall
color they are mounted on. (Ord. 14.36.050-E)
When roof gutters are installed, drains will located in dry
wells or piped to approved storm drain locations.
Install an out side alarm bell that is eletronicly
connected to the residence's smoke detectors. The alarm
bell will be painted red in color and identified as "Fire
alarmll
05/12/2005 04: 58 PM SROBERDS _ _ _ __ __ __ __ __ __ __ _ _ _ _ __ _ _ __
The proosal will resu}t in a new s.f. res w/attached garage
in the RS-9 zqne for total lot coverage of 18%. No land
use issues are n~ed. -', .
Electrical load calculations and elctrical permits are
required.
> $713 Connect Fee.
05/11/2005 04:51 PM JHEBNER ____________________________
Any modifications to the electrical facilities will
be at the customer's expense.
05/11/2005 04:53 PM JHEBNER ____________________________
----------------------------------------------------------------------------
Other Fees
. . . . . . . . .
STATE SURCHARGE
PW WATER SYSTEM USE FEE
4.50
1025.00
----------------------------------------------------------------------------
Fee summary Charged Paid Credited Due
----------------- ---------- ---------- ---------- ----------
Permit Fee Total 1700.65 1700.65 .00 .00
Plan Check Total 581.62 581.62 .00 .00
Other Fee Total 1029.50 1029.50 .00 .00
Grand Total 3311.77 3311.77 .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 Authorized Agent
Date
Signature of Owner (if owner is builder)
Date
T:\Policies\ 11 02,15 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 UNLA WFUL TO COVER, INSULA TE OR CONCEAL Ai"Y 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
I YES NO
FOUNDATION:
FOOTINGS &/I&/OC, f\,;l/
WALLS 0h-;; 1(;1:1 r[.rV
FOUNDATION DRAINAGE 1 DOWN SPOUTS {PI'"}./j /o,c:J JU/
/ .
PIERS
POST HOLES (POLE BLDGS.) ~.......
PLUMBING ~J -12-l~~
UNDER FLOOR 1 SLAB
ROUGH-IN Iq-q-os I L J..
WATER LINE (METER TO BLDG) I ,
GAS LINE
BACK FLOW 1 WATER ~
AIR SEAL
WALLS ~- !).~(),<) I_I ~L.
,
CEILING
~
FRAMING
JOISTS 1 GIRDERS
SHEAR WALL/HOLD DOWNS '1-q....nS ,U~
WALLS 1 ROOF ICElLING ?_I\n_nc:"' oJ ~\.-
DRYW ALL (INTERIOR BRACED PANEL ONLY) , v .
T-BAR
Ir\SULA TlON
SLAB
WALL 1 FLOOR 1 CEILING 110-5- oS J 1..)...
MECHANICAL .p;.'A~f.! -.flir~c-
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:
PARKING/LIGHTING 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
CONSTRUCTlOl\: R.W. / PWI CONSTRUCTION - R.W.
ENGINEERING 417-4807 PW 1 ENGINEERING
FIRE 4 I 7-4653 FIRE DEPT.
PLANNING DEPT. 417-4750 PLANNING DEPT.
BUILDING 417-4815 BUILDING
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BUILDING DIVISION
CITY OF PORT ANGELES
* *
Correction Notice
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Inspection of your work revealed that the following is
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BUILDING DIVISION
CITY OF PORT ANGELES
* *
Correction Notice
Job Located at 1Go 7 s' 0/1 r1r/lJ
Inspection of your work revealed that the following is
not in accordance with the codes governing the work in
this jurisdiction:
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covered until reinspection is made. When corrections
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Date i / ;)~Jv S--
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Inspector for Building Division
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BUILDING PERMIT - APPLICATION
FOR OFFICIAL USE ONLY:
Date Rec.: ..:; -~ - C S-
;i !pennit#:~
ate APproved:~
ate 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
PERMITS (360) 417-4815 FAX(360)417-4711
Applicant or Agent-=r h,,^~> _ Y ...~t-Olll e......J
Owner:
1\ \\
Phone: it S-z. B-2-fil Lt40 (r,wA
Address: 4(01 q
o ~ fV\ \ LA...... [2..v.;/
Phone:
City: POil.. r Al"'.Jb~S
Zip: cy ft~ it /_
_Architect/Engineer: Phone:
M /1. .. _. /~ M IL<.....-U-i Ol#&Mh
Contractor' -lJl..o(...; '-"1~,-.l.A)rJ':>7 State License #: . Exp: 7/ 0(, Phone:ij52....S2.8/
Address: '1tJI q DLv.? IVl/U -' f2.::/ City: Zip:
PROJECT ADDRESS: 'tuG'"7 CCt-j I'" \ lit., I"~;..;I ZONING:
LEGAL DESCRIPTION: Lot;.3 Block: Subdivision: f.^.\ \,A./ C.tef:r<: I ( r:<' In jj:,~:;"J'
CLALLAM COUNTY PARCEL NUMBER: oev ]072... 2,) 9020 oc'C-c,
Credit Card Holder Name:
Billing Address:
Credit Card Type VISA
TYPE OF WORK:
)8( Residential KNew Constr. 0 Re-roof
o Multi-family 0 Addition 0 Move
o Commercial 0 Remodel 0 Demolition
o Repair 0 Sign
BRIEF DESCRIPTION OF THE PROJECT:
City:
Exp. Date:
MC
#
o Stove
o Garage
o Deck
o Other
N~LV
SIZENALUATION:
f).2 cD 3 SF. @ $~SF. = $ I (O~t3::J, ~
, 3 SF. @ $~/SF. = $ J" -- J [)." ,~
/ H If SF. @ $ J Q,oo /SF. = $ I? ~Y:. f.o#I
TOTAL VALUATION $ I ??J./ '7 06 Q$?
~"J YJ(JJp ~''''vli? h I[1rYl..p '-II / f-i1 ~ fJ;; c h-Qrj
G " ....,> 3 ~
COMMERCIAL/RESIDENTIAL: Occupancy Group:
No. of Stories: L Lot Size: I '1 ~~~ Existing Sq. Ft. -
Total lot coverage 17# F>
Occupant Load: Construction Type:
& Proposed Sq. Ft. 30 cg' 0- = TOTAL Sq. Ft. 3086--
%
APPROVALS:
PLAN:
BLDG:
DPWU:
FIRE:
OTHER:_
PLANNING USE ONLY:
ESAIW etland( s): 0 Yes 0 No SEP A 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 cunent 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 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 RI05.3.2
of the International Building/Residential 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 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:\RVESS\BLDG-fonns-brochures\2003-Buildingpennit.wpd Applicant: ,~ /(/..':)~ Date: ~~ f'jS'"
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This map is /lot intended fo be IIsed as a legal description.
Tin'.. mnn/dmwinrr i, nrnn'llcpd bv the Citl! o(Port ill/f!l?ies (or its Oll'lt use and p1llposes.
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" ~ rn REVt5ICNS BY DRAV\I'N IW A NEW RESIDENCE \). "
^' /)' -1
" -_....----
"' " '. DRAFTING & DESIGN .
'; J> ;
I if c;.ttO"fl) E>Y DArE FOR Jerry O'C1aire
------"- Deeigner Freelance Draft8man
01J MILL CREEK CONSTRUCTION INC. (360) 452-3130
~ ----- SM2 Ew'llCe. Port AngeIee. WA SNJ362
Prescriptive Approach - Simple Form
For the Washington State Energy Code (2003 Edition)
Climate Zone 1
Site Information
Building Department Use Only
Lot:
Permit.#:
Address: tf' 0 7 0 LD Mil-'- RD
.
City: P d (' -\- A. '^-3 e I .e <7
State: 1)/ A Zip:
Contact-.Jc,-"",,- e<; <;C' hti (A+-e.V\
Phone: LfS--z. 752 'Of
Phone 2: 4 b 0 C, 7 6 F
Notes:
Fax:
n ImIte azmg tIon ny
Glazing Glazing U-Factor Door9 Wall Wall Wall SIab4
Option Area 10 U- Ceiling2 Vaulted Above Int4 Ext4 Floors On
% of Floor Vertical Overhead 1 ] factor Ceiling3 Grade Below Below Grade
Grade Grade
ill Unlimited
Group R-3 0.40 0.58 0.20 R-38 R-30 R-21 R-21 R-I0 R-30 R-I0
Occupancy
Only
Table 6-1
PRESCRIPTIVE REQillREMENTS 0,1 FOR GROUP R OCCUPANCY
CLIMATE ZONE 1
(D r . d GI . O' 0 I )
See the code text for footnote references
This project complies with the following:
,( The project is a single family residence or duplex.
,( The project is wood frame OR all of the insulation is interior or exterior of the framing.
,( All building components meet the requirements listed in Table 6-1, Option III.
,( The project will meet all other provisions of the WSEC and VIAQ.
The prgiect will take advantage of the following exceptions to the prescriptive option:
u::r 602.6 Exception 1. One door, that is 24 ft.2 or less, that does not meet the standards is allowed.
Location of the door taking this exception
o 602.6 Exception 2. Doors with a U-factor of DAD allowed without calculations, Option III only.
Location of the door(s) taking this exception
Copyright 2002, WSUCEEP02-056
Copied by permission from the Washington State University Extension Energy Program
Prescriptive - Simple Form - Climate Zone 1
712612004
~~---,--- ...'"
205009
Jacobs Gust #
DIVISION OF ENVIRONMENTAL HEALTH
223 EAST FOURTI-f STREETIP.O. Box 863
PORT ANGE! ES, WA 98362
(360) 417-2332
CLALLAM COUNTY DEPARTMENT OF COMMUNITY DEVELOPMENT
DIVISION OF ENVIRONMENTAL HEALTH
SITE REGI&TRA TlON
ON-SITE SEWAGE CONSTRUCTION PERMIT
SIR#
APPLICANT INFORMATION (Property Title Owner)*
NAME: Jim Schouten!
~~~~~~: 4619 Old Mill Road
CITY: Port Angeles, WA, 98362
PHONE: 360-452-8281
Denial or approval of an On-Site Sewage Disposal Permit may be
appealed to the Health Officer within 15 days of the decision date.
This construction permit expires 3 years from date of issuance.
Repair Permits are valid for 6 months only.
Any change in building or sewage disposal plans or location invalidates this
penult unless prior approval is obtained from the Environmental Health Division
and Certified Designer.
JERRY L. JACOBS
I hereby acknowledge that I have read this application and state that the
information supplied is correct I agree to comply with all County and
State laws regulating activities covered by this permit
No refund available after plan review completed.
.Purchaser may also be listed here:
APPLICANT SIGNATURE
Jim Schouten
By Designer:
DATE
1/27/05
Name:
JACOBS INC.
Address: 221-C South Peabody
\~ Port Angeles W A 98362 360-452-4592
SEP# /,1 C,-) ') ~ (J{! ~) 4 _~I
PROJECT INFORMATION
DIRECTIONS TO PROJECT SITE (from Courthouse):
South on Peabody Street to W Ahlvers
Road, then south on S Old Mill Road.
Subject property is past E Scribner Road
on east side.
PROJECT ADDRESS: S Old Mill Road
LOT SIZE 0.40 J (A)/SF ZONING RS9 #BEDROOMS 3
WATER SYSTEM: City of Port Angeles
PROJECT DESCRIPTION: Single Family Residence
(NEW X EXPANSION- REPAIR- )
PLOT PLAN
NORTH
Draw a scaled or dimensioned plot plan of
the proposed site. Include all applicable
items listed in instructions. .
~
NO ~RITICAL AREAS SHOWN ON MAPS
ole.. ~ z.. "~ ..0'5
o
SCALE: 1 =
DATE: MARCH 5, 2003
CUSTOMER NO: 203126
)
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CITY OF PORT ANGELES
PUBLIC WORKS - ELECTRICAL DIVISION
~21 EAST 5TH STREET. PORT ANGELES. WA 911~62
pp lcatlon Number
Application pin number
Property Address
ASSESSOR PARCEL NUMBER:
Application type description
Subdivision Name
Property Use
Property Zoning . , .
Application valuation
05 00000357 Date
988125
4607 S OLD MILL RD
06-30-22-2-1-9020-0000-
RES NEW SFR
6/07/05
RS9 RESDNTL SINGLE FAMILY
177470
Owner
Contractor
JAMES W/SHERRIE L SCHOUTEN
4619 OLD MILL RD
PORT ANGELES
WA 983621911
MILL CREEK CONSTRUCTION
'4619 OLD MILL RD
PORT ANGELES
(360) 452-8281
TOTAL % LOT COVERAGE
NUMBER OF STORIES
LOT SIZE
TOTAL ..LOT COVERAGE
NUMBER OF UNITS
WA 98362
Other struct info .
17.50
1. 00
17550.00
3085.00
1.00
----------------------------------------------------------------------------
Permit . . . . .
Additional desc .
Permit pin number
Sub Contractor
Permit Fee
Issue Date
Expiration Date
ELECTRICAL TEMPORARY
SHAMP/ TEMP SVC,
50260
SHAMP ELECTRICAL
42.20
6/07/05
12/04/05
SERVICE
CONTRACTING
Plan Check Fee
Valuation
.00
o
~
~
I\)
~
Qty
1. 00
Unit Charge Per
42.2000 ECH EL-TEMP SRV - 0-60 SRV FDR
Extension
42.20
VI
----------------------------------------------------------------------------
Special Notes and Comments
Building address sign shall not be less than 6" & not more
than 12" in height. Numbers colors must contrast with wall
color they are mounted on. (Ord. 14.36,050-E)
When roof gutters are installed, drains will located in dry
wells or piped to approved storm drain locations.
Install an out side alarm bell that is eletronicly
connected to the residence's smoke detectors. The alarm
bell will be painted red in color and identified as "Fire
alarmH
05/12/2005 04:58 PM SROBERDS ---------------------------
The proosal will result in a new s.f. res w/attached garage
in the RS-9 zone for total lot coverage of 18%. No land
use issues are noted.
Electrical load calculations and elctrical permits are
required.
> $713 Connect Fee.
05/11/2005 04:51 PM JHEBNER ----------------------------
Any modifications to the electrical facilities will
b~at the customer's expense.
05/11/2005 04:53 PM JHEBNER ----------------------------
'\
()
('
lJ
~
,
~
\
~
Other Fees
STATE SURCHARGE
PW WATER SYSTEM USE FEE
4.50
1025.00
Fee summary
Charged
Paid
Credited
Due
COMMENTS/ACTION NEEDED
ELECTRICAL PERMIT INSPEg.lON RECORD
CALL 4) 7-4735 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
INSPEC110N TYPE DATE ACCEPTED COMMENTS
I YES I NO
IJII (:H
- .-
KI JllhH-LN I CUVER
~b.K. V 1 Cb
~n\.T A T I
................
GENERAL COMMENTS:
PW-I 102.13 (061
d'O"'~
'(I
CITY OF PORT ANGELES
PUBLIC WORKS - ELECTRICAL DIVISION
~21 EAST 5TH STREET. PORT ANGELES. WA 9R~62
Application Number . . . . . 05-00000357
Application pin number 988125
Page 2
Date 6/07/05
Permit Fee Total
Plan Check Total
Other Fee Total
Grand Total
42.20
.00
1029.50
1071,70
42.20 .00
.00 .00
1029.50 .00
1071.70 .00
,00
.00
.00
.00
COMMENTS/ACTION NEEDED
ELECTRICAL PERMIT INSPEgION 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-II02.U (4196]
..
'~
w
CITY OF PORT ANGELES
PUBLIC WORKS - ELECTRICAL DIVISION
:l2\ EAST 5TH STREET. PORT ANGELES. W A 9RJ62
Application Number
Application pin number
Property Address
ASSESSOR PARCEL NUMBER:
Application type description
Subdivision Name
Property Use
Property Zoning . . .
Application valuation
05-00000357 Date
988125
4607 S OLD MILL RD
06-30-22-2-1-9020-0000-
RES NEW SFR
9/21/05
RS9 RESDNTL SINGLE FAMILY
177470
Owner
Contractor
JAMES W/SHERRIE L SCHOUTEN
4619 OLD MILL RD
PORT ANGELES
WA 983621911
MILL CREEK CONSTRUCTION
4619 OLD MILL RD
PORT ANGELES
(360) 452-8281
TOTAL % LOT COVERAGE
NUMBER OF STORIES
LOT SIZE
TOTAL LOT COVERAGE
NUMBER OF UNITS
WA 98362
Other struct info .
17.50
1. 00
17550.00
3085.00
1. 00
~------------------------------------------------------------
Permit
Additional desc .
Permit pin number
Sub Contractor
Permit Fee
Issue Date
Expiration Date
ELECTRICAL NEW RESIDENTIAL
KIRSCH/2941 SQFT SFR
60376
KIRSCH ELECTRIC
166.60
9/21/05
3/20/06
INC.
Plan Check Fee
Valuation
.00
o
~
~
"'-J
Qty
1. 00
4.00
Unit Charge Per
73.0000 ECH
23,4000 5C
EL-R-SQFT FIRST 1300
EL-R-SQFT ADDITIONAL 500
Extension
73.00
93,60
G
--~-------------------------------------------------------------------------
Special Notes and Comments
Building address sign shall not be less than 6" & not more
than 12" in height. Numbers colors must contrast with wall
color they are mounted on. (Ord. 14.36.050-E)
When roof gutters are installed, drains will located in dry
wells or piped to approved storm drain locations.
Install an out side alarm bell that is eletronicly
connected to the residence's smoke detectors. The alarm
bell will be painted red in color and identified as "Fire
alarmll
05/12/2005 04:58 PM SROBERDS ---------------------------
The proosal will result in a new s.f. res w/attached garage
in the RS-9 zone for total lot coverage of 18%. No land
use issues are noted,
Electrical load-calculations and elctrical permits are
required,
> $713 Connect Fee.
05/11/2005 04:51 PM JHEBNER ----------------------------
Any modifications to the electrical facilities will
be at the customer's expense.
05/11/2005 04 :.53 PM JHEBNER ----------------------------
(j
[\
\J
~,
"'
(\.
~
~
~
----------------------------------------------------------------------------
Other Fees
STATE SURCHARGE
PW WATER SYSTEM USE FEE
4,50
1025.00
----------------------------------------------------------------------------
Fee summary
Charged
Paid
Credited
Due
COMMENTS/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
INSPEC110N TYPE DATE ACCEPTED COMMENTS
I YES NO
I II'll :H
Wl 'Vl -rH_IN / COVER
:S~K V lC~
I
GENERAL COMMENTS:
PW.Il02.J~ 14196)
,/;~
tw
w
CITY OF PORT ANGELES
PUBLIC WORKS - ELECTRICAL DIVISION
:l21 EAST 5TH STREET. PORT ANGELES. WA 98362
Application Number . . . . . 05-00000357
Application pin number 988125
Page 2
Date 9/21/05
Permit Fee Total
Plan Check Total
Other Fee Total
Grand Total
166.60
.00
1029.50
1196,10
166.60
.00
1029.50
1196.10
.00
,00
.00
.00
.00
.00
.00
..00
COMMENTS/ACTION NEEDED
ELECfRICAL PERMIT INSPECfIONRECORD
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 ACCEPTED COMMENTS
YES I NO
I III :H , -,.1. 3-0b ",hU
KIIIII.;.H_lN I CUYhK 'j-';'3-() ~ 1< ~ ,)
:S~K V 1\;~ '7--3"( - ~L .4 "1) )
----
'[;'",T AT S - f If - 0 C:. I dlrJt j
GENERAL COMMENTS:
PW-II02.U (4196)