HomeMy WebLinkAbout106 Fogarty Ave - Building
CITY OF PORT ANGELES
DEPARTMENT OF COMMUNITY DEVELOPMENT - BUILDING DIVISION
321 EAST 5TH STREET, PORT ANGELES, W A 98362
Application Number
Application pin number
Property Address
ASSESSOR PARCEL NUMBER:
Application type description
Subdivision Name
Property Use
Property Zoning . . .
Application valuation
Owner
05-00000268 Date
873532
106 FOGARTY AVE
06-30-09-5-2-2600-0000-
RES NEW SFR
5/16/05
RS7 RESDNTL SINGLE FAMILY
190741
/--...
-....y
~"-
7",. ~
"t::J.
Contractor
WILLSON, D PAULETTE
3012 OAKCREST LOOP
PORT ANGELES WA 98362
(360) 457-5394
Other struct info
MICHAEL RIVERS
P. O. BOX 4074
PORT ANGELES
(360) 452-9292
TOTAL % LOT COVERAGE
NUMBER OF STORIES
LOT SIZE
TOTAL LOT COVERAGE
NUMBER OF UNITS
CONST
WA 98362
25.00
1. 00
14000.00
3393.50
1. 00
----------------------------------------------------------------------------
Permit . . . . .
Additional desc .
Permit pin number
Permit Fee
Issue Date
Expiration Date
Qty
BUILDING PERMIT -RESIDENTIAL
2345SF SFR W/ATT 768SF GARAGE
48223
1526.85 Plan Check Fee
5/16/05 Valuation
11/12/05
610.74
190741
4~
N~
~.,~
"
"\
~
p
"'"
,~-+-
~
<C
(t.
Unit Charge Per
BASE FEE
5.6000 THOU BL-100,001-500K (5.60 PER K)
Extension
1017.25
509.60
..............
~,
G''-
91.00
--------------------------------------------------------
MECHANICAL PERMIT
Permit . . . . .
Additional desc .
Permit pin number
Permit Fee
Issue Date
Expiration Date
48249
140.70 Plan Check Fee
5/16/05 Valuation
11/12/05
.00
o
Qty Unit Charge Per
BASE FEE
1. 00 14.7000 ECH ME- INSTALL 100- FAU
4.00 7.2500 ECH ME-VENT FAN
1. 00 50.0000 ECH ME-WOOD BURNING APPL.
Extension
47.00
14.70
29.00
50.00
----------------------------------------------------------------------------
Permit . . . . .
Additional desc .
Permit pin number
Permit Fee
Issue Date
Expiration Date
PLUMBING PERMIT
48231
132.00
5/16/05
11/12/05
Plan Check Fee
Valuation
.00
o
Qty Unit Charge Per
BASE FEE
8.00 7.0000 ECH PL- EA.FIXTURE ON ONE TRAP
1. 00 7.0000 ECH PL- EA. INSTALL WATER PIPE
1. 00 15.0000 ECH PL- EA. BLDG SEWER
1. 00 7.0000 ECH PL- EA. WATER HEATER
Extension
47.00
56.00
7.00
15.00
7.00
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.
Date
P a.u.P -ilt~ ~, }J. ) IJj~~Yj
Signature of Owner (if owner is builder)
-s ) ) 4 )cJ::\
Date
Signature of Contractor or Authorized Agent
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 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
WALLS
FOUND A TlON 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 I
FRAMING
JOISTS / GIRDERS
SHEAR WALL/HOLD DOWNS
WALLS I ROOF / CEILING
DRYW ALL (INTERIOR BRACED PAt"lEL ONLY)
T-BAR
INSULATION
SLAB
WALL / FLOOR / CEILING
MECHANICAL
HEA T PUMP / FURNACE / DUCTS
GAS LINE
WOOD STOVE / PELLET / CHlMNEY
COMMERCIAL HOOD / DUCTS
MANUFACTURED HOMES
FOOTING / SLAB
BLOCKING & HOLD DOWNS
SKJRTING
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 _ ] 5 building permit inspection record05.wpd [1/4/2005]
CITY OF PORT ANGELES
DEPARTMENT OF COMMUNITY DEVELOPMENT - BUILDING DIVISION
321 EAST 5TH STREET, PORT ANGELES, WA 98362
AppJication Number . . . . . 05-00000268
Application pin number 873532
Page
Date
2
5/16/05
----------------------------------------------------------------------------
Spe~ial 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.
.Q4j20/2005 12: 33 PM SROBERDS
---------------------------The proposal will result in the
construction of a sf residence with attached garage for
..t;9t!;l.1 lot coverage of 25%. Setbacks are good. No land use
issues are noted.
Electrical load calculations and elctrical permits are
required.
CONNECTION FEE $410.00
05/13/2005 01:30 PM GMCLAIN ____________________________
Sanitary sewer connection inspection is required by
Public Works prior to back fill of ditch.
A signed no protest LID required.
C~nstruct driveway to City Standards.
. No 'concrete with exposed aggregate allowed in the City
road right of way.
----------------------------------------------------------------------------
Other Fees
. . . . . . . . .
SEWER SYSTEM DELV CHARGE
STATE SURCHARGE
PW WATER SYSTEM USE FEE
745.00
4.50
1025.00
------------------------------------------------
Fee summary Charged Paid Credited Due
----------------- ---------- ---------- ---------- ----------
Permit Fee Total 1799.55 1799.55 .00 .00
Plan Check Total 610.74 610.74 .00 .00
Other Fee Total 1774.50 1774.50 .00 .00
Grand Total 4184.79 4184.79 .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 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
P tuJ-dh ~"). /J. j J J.l nYJ
Signature of Owner (if owner is builder)
5/ )~)l):5
Date
T:IPolicieslll02, 15 building permit inspection record05_wpd [1/4/2005]
BUILDING PERMIT INSPECTION RECORD 0 $"- fJ.-hE3
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 1/67010 J vI.;
WALLS l-J-t- C, ...J ~. L.
FOUNDATION DRAINAGE 1 DOWN SPOUTS
PIERS
POST HOLES (POLE BLDGS.)
PLUMBING plvm bmcj (,,,,,~L ~ /l).OjOG J~
UNDER FLOOR 1 SLAB
ROUGH-IN /0-,1 ll-O.C; -' Ll~
WATER LINE (METER TO BLDG) t /-:;0 lor_ I/LV
GAS LINE ,
BACK FLOW 1 WATER
AIR SEAL
WALLS 11- cr -() ~ ,JLJ..
CEILING
FRAMING
JOISTS 1 GIRDERS
SHEAR WALL/HOLD DOWNS I/o-rS -05 . \J..).
WALLS 1 ROOF 1 CEILING tI-sl,n<r II-V
DRYW ALL (INTERIOR BRACED PANEL ONLY) 11 -0} '3--0 S- _\ y\..-
T-BAR
iNSULATION
SLAB
WALL 1 FLOOR 1 CEILING 11_1'"-'0 C J Lt......
MECHANICAL ifJ ~ t:,.. /, en..< e-./ F'NI)J-- f /ujv6 .J~
HEAT PU:vlP 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 Ws 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.I PW/ CONSTRUCTION - R.W.
ENGINEERING 4 I 7-4807 PW 1 ENGINEERING
FIRE 417-4653 FIRE DEPT.
PLANNING DEPT. 417-4750 , PLANNlKG DEPT.
BUILDING 417-4815 i-17~/()t, J..~'- BUILDIKG
T:IPolicicslll 02.15 building permit inspection record05.wpd [1/4/2005]
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BUILDING PERMIT - APPLICATION
Fill out COMPLETELY and in INK. Your application and site plan MUST
COMPLETE to be accepted for review. If you have any questions, call
PERMITS (360) 417-4815 FAX(360)417-4711
Applicant or Agent: Winborn Archi tects
Owner: Paulette Willson
Phone: 45 7-7 895
Phone:
457-5394
Address:
3012 Oakcrest Loo~
City:
Port Anqeles Zip: 98362
Phone: 452-7895
Architect/Engineer:
Winborn Architects
Contractor
Michael Rivers
State LicensMiti:CHARC21 RO Exp:
Phone: 452-9292
Address: 840 W 6th
PROJECT ADDRRs-~ 9~ S'-'
City: Port Anqeles Zip:98363
j~ ~...'"nf.~ JC>b F~o.,..t"l Av~ ZONING: RS7
LEGAL DESCRIPTION: Lot: 1 ^- ?
CLALLAM COUNTY PARCEL NUMBER:
Block: 7. fi
Subdivision: Foaartv & Dolans
063009522600
Credit Card Holder Name:
Billing Address:
Credit Card Type VISA
TYPE OF WORK:
~ Residential lsl. New 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:
HtiE\i- t>\.C....... Single Family Residence
MC
City:
Exp. Date:
#
o Stove
'B...Garage
"5l....Deck
o Other
SIZEN ALUATION:
2345 SF.@$/O,l(, /SF.=$
7 fi Ii SF. @ $ '2, ,_s'B /SF. = $
fi Ii i SF. @ $ '1 ou /SF. = $
TOTAL VALUATION $
I '=:,LJ 7S-Cj 1/6
11,.;,'-/19 ,6'1
~ ~~ 2 06
f 9 .-- V /,5'f
1 Story 3BDRMs 2 Bath
COMMERCIAL/RESIDENTIAL: Occupancy Group:
No. of Stories:..L Lot Size: 14 , 000 Existing Sq. Ft. ;6
Total lot coverage 25 %
Occupant Load: Construction Type:
& Proposed Sq. Ft..30C;.3 .~ = TOTAL Sq. Ft.~~/5-
PLANNING USE ONLY:
ESA/Wetland(s): 0 Yes 0 No SEPA Checklist required? 0 Yes 0 No Other:
APPROVALS:
PLAN:
BLDG:
DPWU:
FIRE:
OTHER:_
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 Pennit 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 pernnt application and construction plans are
subnntted. All other pernrit fees are due at the time of permit issuance.
EXPIRATION OF PLAN REVIEW: Ifno perunt 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 Rl 05.3.2
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 co ct. I am authorized to apply for this permit and
understand that it is my responsibility to determine what permits are requifi d, ot the City's, an that mu obtain such permits prior to work.
~
T:\RVESS\B LDG- forms-brochures\2004-Buildingpenni t. wpd
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COVENANT CONSENTING TO THE
FORMA TION OF A LOCAL IMPROVEMENT DISTRICT
WE, the undersigned owners, owners in fee simple of the land herein described, consent
to the formation of a Local Improvement District (L.I.D.) including said platted land, for the
purpose of installing sidewalk as authorized by RCW 35.43.040 as now or hereafter amended,
which consent shall be binding on the owners' heirs, assigns and successors in interest.
By signing this Covenant, the undersigned owners, and their heirs, assigns and successors,
shall be deemed to have signed a petition initiating an L.I.D. including said land under RCW
35.43.120 as now or hereafter amended, and shall be precluded from having their signatures
counted as part of a protest to divest the City's jurisdiction to proceed with an L.I.D. including
said land under RCW 35.42.180 as now or hereafter amended.
This Covenant authorizes the formation of no more than one Local Improvement District
after the completion of which the City shall deliver a signed release of this Covenant to the owners
or owners' heirs, assigns and successors.
This Covenant shall be deemed to run with the title and shall be recorded with land
described as follows:
P4ni7~_ ~. )j :)}jo~
)06 t=b34Yt1:j A)}~])lJ..z.
STATE OF WASHINGTON )
) ss:
COUNTY OF CLALLAM )
;{fFO~; ME, a Notary Public in and for the County and State aforesaid, personally
appeare~l'~and - known to me to be the persons who executed the
within Covenant, who acknowledged the same to be their free and voluntary act and deed for the
uses and purposes therein mentioned.
GIVEN under my hand and official seal this /;{. day of '/J/a/
20 {)~
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. ~\..I\\~ ._
~l1j,< V~~<Vi"J,^ ,
NOTARY PUBLIC in d for the State of
Washington, residing in Port Angeles
DEPARTMENT OF PUBLIC WORKS, BUILDING DIVISION
APPLlCANT:~~ .,frJ
PROJECTIDEVELOPMENT ADDRESS:
See Page 4 for instructions on comPlBtlng the site plan.
PHONE:' ~'-2- (~ -
~F~ ~.. PA
For more/nformation, caI/417-4815.
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I CITY OF PORT ANGELES
i :)'~r>L of Community DeveloplTIAnt
r,._ .....____
Post Office Box 4074 Port Angeles, Washington 98363 (360) 452-9292
Licensed and Bonded General Contractor
MICHARC21RQ
June 27, 2005
Sue Roberds/ Assistant Planner
P A Department of Community Development
321 East Fifth Street
P. O. Box 1150
Port Angeles, W A 98362-0217
Dear Ms. Roberds,
I am hereby requesting permission to build at 106 Fogarty with the following
slight modifications to the setback guidelines: l' beyond the allowable 2' variance to
the North and 7" to the West (already within standard allowances.) My request
comes out of my efforts to find a solution to a problem which was caused by a lack of
thorough research on my part and the part of the architect, a lack of careful review by the
building department, and the confusion caused by the non-standard lot sizes South of the
Boulevard.
I appreciate the efforts made by all involved to find a solution that protects the
right of the owner to build her home while maintaining her obligation to be in compliance
with the spirit of the guidelines set by the Department of Community Development.
Thank you for your attention to this matter.
Si.n.. c~r.el, ') .-
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Michael Rivers
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BUILDING DIVISION
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Correction Notice
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CITY OF PORT ANGELES
PUBLIC WORKS - ELECTRICAL DIVISION
:\21 EAST 5TH STREET. PORT ANGELES. WA 98~('2
Application Number
Application pin number
Property Address
ASSESSOR PARCEL NUMBER:
Application type description
Subdivision Name
Property Use
Property Zoning . . .
Application valuation
05-00000454 Date
135052
106 FOGARTY AVE
06-30-09-5-2-2600-0000-
ELECTRICAL ONLY
6/10/05
RS7 RESDNTL SINGLE FAMILY
o
Owner
Contractor
RIVERS, MICHAEL
106 FOGARTY AVE
PORT ANGELES
WA 98362
ELECTRIC SERVICE
82 DRAPER RD
PORT ANGELES
(360) 452-6424
WA 98362
----------------------------------------------------------------------------
Permit . . . . .
Additional desc .
Permit pin number
Sub Contractor
Permit Fee
Issue Date
Expiration Date
ELECTRICAL TEMPORARY SERVICE
ELECTRIC SVC/ 60 AMP TEMP.
51607
ELECTRIC SERVICE
42.20 Plan Check Fee
6/10/05 Valuation
12/07/05
.00
o
Qty
1. 00
unit Charge Per
42.2000 ECH EL-TEMP SRV - 0-60 SRV FDR
Extension
42.20
,
"-
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----------------------------------------------------------------------------
Fee summary Charged Paid Credited Due
----------------- ---------- ---------- ---------- ----------
. permi t Fee Total 42.20 42.20 .00 .00
Plan Check Total .00 .00 .00 .00
Grand Total 42.20 42.20 .00 .00
\;- ~
r' ~
.~
COMMENTS/ACTION NEEDED
ELECTRICAL PERMIT INSPEgJON 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
INSPECTION TYPE DATE ACCEPTED COMMENTS
YES NO
Unc.H.
JH)I J(TH-lN I \;u V ~K
~bK VICb
J
6/Jt.....,/~~ I Az:~)
,
GENERAL COMMENTS:
PW-lI02.IS (4196)
S
....r.;~
Annllr.r1tlnn Nllmh&:>"Y'"
Application pin number
Property Address
ASSESSOR PARCEL NUMBER
Application type descriptlon
Subdivision Name
Property Use
Property Zoning
Application valuation
CITY OF PORT ANGELES
PUBLIC WORKS - ELECTRICAL DIVISION
~21 EAST 5TH STREET. PORT ANGELES. WA 98J62
^r ^^^^^^r^ -
873532
106 FOGARTY AVE
06-30-09-5-2-2600-0000-
RES NEW SFR
=,' I v-'
RS7 RESDNTL SINGLE FAMILY
190741
Owner
Contractor
WILLSON, D PAULETTE
3012 OAKCREST LOOP
PORT ANGELES
(360) 457-5394
Other struct info
MICHAEL RIVERS
POBOX 4074
WA 98362 PORT ANGELES
(360) 452-9292
TOTAL % LOT COVERAGE
NUMBER OF STORIES
LOT SIZE
TOTAL LOT COVERAGE
NUMBER.. OF UNITS
CONST
WA 98362
25.00
1 00
14000 00
3393 50
1 00
Permlt
Addltional desc
Permit pin number
Sub Contractor
Permit Fee
Issue Date
Explration Date
ELECTRICAL NEW RESIDENTIAL
EL SVC /3100SQFT SFR
56242
ELECTRIC SERVICE
166 60 plan Check Fee
8/03/05 Valuatlon
1/30/06
00
o
Qty
1 00
4 00
Unit Charge Per
73 0000 ECH
23 4000 5C
Extension
73 00
93 60
EL-R-SQFT FIRST 1300
EL-R-SQFT ADDITIONAL 500
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.
04/20/2005 12'33 PM SROBERDS
---------------------------The proposal will result in the
construction of a sf residence wlth attached garage for
total lot coverage of 25% Setbacks are good No land use
lssues are noted
Electrical Load calculations and elctrical permits are
required
CONNECTION FEE $410 00
05/13/2005 01 30 PM GMCLAIN ----------------------------
Sanitary sewer connection inspection is required by
Public Works prlor to back fill of ditch
A signed no protest LID requlred.
Construct drlveway to City Standards
N~ concrete with exposed aggregate allowed In the Clty
road right of way
Other Fees
SEWER SYSTEM DELV CHARGE
STATE SURCHARGE
PW WATER SYSTEM USE FEE
745 00
4 50
1025 00
COMMENTS/ACTION NEEDED
..
~
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CITY OF PORT ANGELES
PUBLIC WORKS - ELECTRICAL DIVISION
~21 I-::AST 5TH STREET. PORT ANGELES. WA 98:\62
t'
Application Number
Application pin number
05-00000268
873532
rCl':::lt:: :2
Date 8/03/05
Fee summary Charged Paid CredJ.ted Due
----------------- ---------- ---------- ---------- ----------
Permit Fee Total 166.60 166 60 00 00
Plan Check Total .00 00 00 00
Other Fee Total 1774 50 1774 50 00 00
Grand Total 1941 10 1941 10 00 00
COMMENTS/ACTION NEEDED
S
'\tiir~
CITY OF PORT ANGELES
PUBLIC WORKS . ELECTRICAL DIVISION
:121 EAST 5TH STREET, PORT ANGELES, WA 983(12
'.
Application Number
Application pin number
Property Address
ASSESSOR PARCEL NUMBER.
Application type description
Subd~v~sion Name
Property Use
Property Zoning .
Application valuation
05-00000268 Date 11/17/05
873532
106 FOGARTY AVE
06-30-09-5-2-2600-0000-
RES NEW SFR
RS7 RESDNTL SINGLE FAMILY
190741
Owner
Contractor
WILLSON, D PAULETTE
3012 OAKCREST LOOP
PORT ANGELES
(360) 457-5394
Other struct info
MICHAEL RIVERS
POBOX 4074
WA 98362 PORT ANGELES
(360) 452-9292
TOTAL % LOT COVERAGE
NUMBER OF STORIES
LOT SIZE
TOTAL LOT COVERAGE
NUMBER OF UNITS
CONST
WA 98362
25 00
1 00
14000 00
3393 50
1 00
.......
~
~
Permit
Additional desc
Permit pin number
Sub Contractor
Permit Fee
Issue Date
Expiration Date
ELECTRICAL NEW RESIDENTIAL
DAVE'S HEAT/ T-STAT
63255
DAVE'S HEATING
36 40
11/17/05
5/16/06
& COOLING
Plan Check Fee
Valuation
00
o
~
\i~
~J
t
Qty
1 00
Unit Charge Per
36 4000 ECH EL-LVT-FIRST THERMOSTAT
Extension
36 40
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.
04/20/2005 12.33 PM SROBERDS
---------------------------The proposal will result in the
construction of a sf residence with attached garage for
total lot coverage of 25% Setbacks are good. No land use
issues are noted
Electrical load calculations and elctrical permits are
required
CONNECTION FEE $410 00
05/13/2005 01 30 PM GMCLAIN ----------------------------
Sanitary sewer ~onnection inspection is required by
Public Works pr~or to back fill of ditch
A signed no protest LID required
Construct driveway to City Standards.
No concrete with exposed aggregate allowed in the City
road right of way
Other Fees
SEWER SYSTEM DELV CHARGE
STATE SURCHARGE
PW WATER SYSTEM USE FEE
745 00
4 50
1025 00
Fee summary
Charged
Paid
Credited
Due
COMMENTS/ACTION NEEDED
g
VI!
CITY OF PORT ANGELES
PUBliC WORKS - ELECTRICAL DIVISION
~21 EAST 5TH STREET. PORT ANGEL-ES. WA 98362
"'
Application Number . . . . . 05-00000268
Applicatlon pin number' 873532
Page 2
Date 11/17/05
Permit Fee Total
Plan Check Total
Other Fee Total
Grand Total
36 40
.00
1774 50
1810 90
36.40
.00
1774.50
1810.90
00
00
00
00
.00
.00
00
00
, "
COMMENTSI ACTION NEEDED
,
(
ELECl'RlCAL PERMIT INSPECfION RECORD
"
CALL 4174735 :FOR ELECTRICAL INSPECTIONS. PLEASE PR0VIDE A MJN1NUM 24 HOUR NOTICE. IT IS UNLAWFUL TO COVER,
" INSULATE OR CONCEAL ANY WORK BEFORE IT IS INSPECTED AND ACCEPTED.
KEEP PERMIT CARD AND APPROVED PLANS AT JOB SITE
1NSPBC110N TYPE DATI I ACCIPTID coMMENTS
1 ns NO
IITI 'H
llnTTnJ.l.IN:l (.;uv~
SHK VI(:H
l<llIJ AT I 4J"'/~...D(, I hAJ I
. .
GENERAL COMMENTS:
"'.1102.15 I4"6J
S
""'r~
CITY OF PORT ANGELES
PUBLIC WORKS - ELECTRICAL DIVISION
nl EAST 5TH STREET. PORT ANGELES. WA 98362
Application Number
Application pln number
Property Address
ASSESSOR PARCEL NUMBER:
Application type description
Subdivision Name
Property Use
Property Zoning .
Application valuation
06-00000433 Date
669850
106 FOGARTY AVE
06-30-09-5-2-2600-0000-
ELECTRICAL ONLY
5/09/06
RS7 RESDNTL SINGLE FAMILY
o
Owner
Contractor
WILLSON, D PAULETTE
3012 OAKCREST LOOP
PORT ANGELES WA 98362
(360) 457-5394
OWNER-
Permlt
Additional desc
Permit pin number
Sub Contractor
Permit Fee
Issue Date
Explration Date
ELECTRICAL NEW RESIDENTIAL
HI TECH/ SECURITY
76687
HI TECH SECURITY
42.20
INC
Plan Check Fee
Valuation
00
o
"
~
f\
Qty Unit Charge Per
1 00 42 2000 EL-LOW VOLT SYS <=2500 SQFT
Extenslon
42 20
~
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t
(\
...
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<..s
'\
~
6"\
~
t1
11/05/06
Fee summary Charged Paid Credited Due
----------------- ---------- ---------- ---------- ----------
Permlt Fee Total 42.20 42 20 00 00
Plan Check Total 00 00 00 .00
Grand Total 42 20 42 20 .00 00
to.
U
~
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('\
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
,
INSPECTION TYPE DATE I ACCEPTED COMMENTS
1
r YES I NO
Ilrn :H
11111 11TH-IN I COVER
~hK V lCh
FINAL S-IO. 1:1' I ,4,17
GENERAL COMMENTS:
PW-Jl02.1S (4'96]
~ pORT ~
tO~~~
ria
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~
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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
Subdivlslon Name
Property Use
Property Zoning . . .
Application valuatlon
04-00000805 Date
.282370
208 FOGARTY ST
06-30-09-5-2-2710-0000-
RES REMODEL
9/13/04
Owner
Contractor
(]3HldX3
~/t?/Do/
@J
RS7 RESDNTL SINGLE FAMILY
1000
STURGEON MIKE M
136 SOUTHRIDGE RD
PORT ANGELES
OWNER
WA 983639439
Permit
Additional desc
Permlt Fee
Issue Date
Expiration Date
BUILDING PERMIT -RESIDENTIAL
CLOSE 1/2 CARPORT FOR STOREAGE
62.25 Plan Check Fee
9/13/04 Valuation
3/13/05
24.90
1000
Qty Unit Charge Per
Extenslon
47.00
15.25
BASE FEE
5.00 3.0500 HND BL-501-2K (3.05 PER C)
Other Fees
STATE SURCHARGE
4.50
Fee summary Charged Paid Credited Due
----------------- ---------- ---------- ---------- ----------
Permit Fee Total 62.25 62.25 .00 .00
Plan Check Total 24.90 24.90 .00 .00
Other Fee Total 4.50 4.50 .00 .00
Grand Total 91. 65 91. 65 .00 .00
~
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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 atterthe 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 prov ions of
laws and ordinances governing this type of work will be complied with whether specified herein or not. The granting of a permit es not
presume to give authOrity to violate or cancel the provisions of any state or local law regulating construction or the perform~~ ce of
construction. \
1--(>-0' .
Signature of Contractor or Authorized Agent
Date
Signature of Owner (If owner is builder)
T'\PLANNINGIFORMS\1102.15 [11/14/2003]
PREPARED 10/07/04, 13 15 21
CITY OF PORT ANGELES
INSPECTION TICKET
INSPECTOR JAMES L LIERLY
PAGE
DATE
9
10/07/04
ADDRESS
CONTRACTOR
OWNER
PARCEL
APPL NUMBER
208 FOGARTY ST
SUBDIV
PHONE
PHONE
STURGEON MIKE M
06-30-09-5-2-2710-0000-
04-00000805 RES REMODEL
PERMIT: BPR 00 BUILDING PERMIT - RESIDENTIAL
REQUESTED INSP DESCRIPTION
TYP/SQ COMPLETED RESULT RESULTS/COMMENTS
BL3 01 L~(~1~j Ji~tl BUILDING FRAMING
~ ~ Mlke 460-3119
-------------------------------------- COMMENTS AND NOTES --------------------------------------
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
PERMITS (360) 417-4815 FAX(360)417-4711
Apphcant or Agent: /'f) jke Sf fA.,1I'jeo k. ' Phone: 4-C1 JL (6
Owner: /fA; k€ ~-::::'Z"'A' "I~ Phone: 1(,,1 ~2--'i 6
Address. 26.JY Fo ~r _ CIty: fb......lt A- t/\.'Je,{ eS ZIp: i8' ):,6.1.......
ArchItect/Engineer: n 6 ~ e..-- . Phone:
ContractorChr'l/€V / Itll'-Jelcg i)(J~u"!tate LIcense #:A/'I C-t:LdO 'ik'l'f}xp:
Address: · n, Il./k-<..r' 0' l' City: ~.! /1 A....J .v{-e:--(
PROJECT ADDRESS: 2.D~ '-'::=6 ~vv-I--7
LEGAL DESCRIPTION: Lot: 3 Block:.2 I SubdIvisIOn: PO ,""" .f7
CLALLAM COUNTY PARCEL NUMBER: ()~ J 00'1 ;;:"l. 1- i t 00000
--<'
-'
r
Phone: its- 7 t i 07
ZIp: '1 1> ,~ 62..
ZONING:
ct /)0 Ip-:~ t})i;.lu__
Credit Card Holder Name:
Billing Address:
Credit Card Type VISA
TYPE OF WORK:
d2-ResIdentIal 0 New Constr 0 Re-roof
o MultI-fannly 0 AddItIon 0 Move
o Commercial 0 Remodel 0 DemolItIOn
o RepaIr 0 SIgn
BRIEF DESCRIPTION OF THE PROJECT:
cj{)~ E!t i '-'v K / 0 J.- 6'r:J..-( &f ~ ""J
COMMERCIALIRESIDENTIAL: Occupancy Group:
No. of Stones: Lot SIZe: ExistIng Sq. Ft.
Total lot coverage
City:
MC
#
Exp. Date:
o Stove
o Garage
o Deck
o Other
SIZEN ALUATION:
SF. @$ /SF. =$
SF. @ $ /SF. = $
SF. @ $ /SF. = $
TOTAL VALUATION $ laof) ~
~
cO/v jPu V"t'
Occupant Load:
Jov-' 8-t"^ '-1 ~~
Construction Type:
& Proposed Sq. Ft.
= TOTAL Sq. Ft
%
ESA/Wetland(s): 0 Yes 0 No SEPA ChecklIst requIred? 0 Yes 0 No Other:
APPROVALS:
PLAN:
BLDG:
DPWU:
FIRE:
OTHER:
PLANNING USE ONLY:
.
BUILDING PERMIT APPLICATION SUBMITTAL: The Buildmg DIvision can provIde you With mformatIOn on the applIcatIOn and
plan subnnttal 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 Bmldmg DIVISIon to comply WIth current fee schedules. Contact the Pernnt Coordmator at 417-4815 for aSSIstance.
PLAN CHECK FEE: IF a plan check fee is due It must be subnntted at the tln}e the bmldmg pernnt applIcation and constructIOn plans are
submitted. All other pernnt fees are due at the trme of pernnt Issuance. .
EXPIRATION OF PLAN REVIEW: Ifno pernnt is Issued WIthin 180 days of the date ofapphcatIOn, the application will expire. The
Bmldmg OffiCIal can extend the time for actIon by the applIcant up to 180 days upon wntten request by the applIcant (see Section Rl 05.3.2
of the InternatIonal Bullding/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 authonzed to apply for thiS permit and
understand that it is my responsibility to determme what permits are required ,not the City'S, and that I must obtain such permits prior to work.
T.\RVESS\BLDG-forms-brochures\2003-BUlldmgpermltwpd Applicant: ~A/'_-1h ---- Date: '1-7-0 y
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I Vertlcal Datum = NA VD 88
Honwntal Datum = NAD 83/91
Feet
I
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Fogarty AVe.
<{.AA.~
^ "'>,i;*","=,,,,
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N
ThIS map IS not Intended to be used as a legal descrIption
ThIS map/drawmg IS produced by the Clly of Port Angeles for Its own use and purposes
Any other use of thIs map/drawmg shall not be the responslblllly of the Clly
Area Map
AGREEMENT TO REMOVE ENCROACHMENT
within
PUBLIC RIGHT-OF-WAY
--
c:::r
~
WHEREAS: We, the undersigned owners in fee simple of the following described property:
- ::...
-t
do hereby acknowledge that private improvements have been or will be constructed in the next days by us within the
adjoining public street orroadwaydescribed as /r.:,,, FV5~'-7 Sf; r~>,j J~.,u' /.Vrf 9.Y30__.
NOW, THEREFORE: WI}. do h,ereby agree that said encroaching private improvements including, but not limited to,.-,---
I-< !!.C",cwl<. s.eiiY" /t.Md, s,..k wO and associated appurtenances shall be expeditiously
demolished, removed, modified, rebui or restored at the undersigned owner's expense within sixty (60) days of receipt of
written notice from the City Engineer with work to be done in accordance with the requirements and conditions deemed
necessary by the City Engineer or his designee at such time as the City finds that it is necessary to modify the use thereof.
If the required work is not done in a timely fashion and/or if the work does not meet the requirements and conditions set forth,
the City is authorized to have the work done and the cost thereof including reasonable overhead and attorneys fees shall
become a civil debt of the property owners and shall be a lien against the property.
We do also hereby agree that the City Engineer may, without notice, remove the private improvements as necessary to repair
utilities or other public facilities and that the City has no obligation to reconstruct or replace such private improvements.
The property owners agree to indemnify, hold harmless and defend the City, its employees, agents and assigns from and
against all claims or lawsuits as alleging injury or damage to persons or property as a result of the construction and location
of the private improvements as provided herein.
It is agreed that this agreement shall run with the land and shall be binding on the undersigned owners, their heirs, devisees,
successors and assigns and all owners now or hereafter of the land described above.
') vO 9- n <;::) ,
, 200W. 1l1lJ I ~_ _)1)} nNrY1
DATED this ~ day of JtfhVt.{,/
STATE OF WASHINGTON )
) ss.
COUNTY OF CLALLAM )
On this date, before me the undersigned Notary Public in and for the State of Washington, personally appeared ~Cclll e+1e O.W; I boll
_, to me known to be the individuals who executed the foregoing Agreement to Remove Encroachment within Public Right-af-Way and
acknowledged to me that they signed the same for the uses and contents therein mentioned.
51"
DATED this _ day of
ic..<'\uo..ri_' 2001:1:7
-
c//fl,cA,A ah~
NOTARY PUBLIC for Washi~gton,
residing at 101 tf) ':;-y<J/l/.:5f. f./l CO)l'7S'5>G2
My commission expires: ...I""':) 20 2C07
.v :...>
PW-0209_08 [12/98J
N6iary PUbI!c
SIclIe oI'W.:llliIngIon
MlCHREMANDER$ON
MvAIl"Oln.......d;EJipIrfA Jul20, 2009
-.
~
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o Request Inspection
ELECTRICAL WORK PERMIT APPLICATION,
.
o Commercial
,-
Job wired by
!SX.Electrical Contractor 0 Owner
Installation description
Residential 0 Residential Mainl. 0 Signs 0 Thermostat 0 Telecom.
o Credit Card Visa. M~S , cTv D.iscover
Card #
--tJn-- -----
Expiration Date
of card
Electrical contractor name License number
E..l'.rh \r~ Cl"'VI~,'Inc.-- ELEc..TSI:/3')J"1 Y\'1
Purchaser's mailing ress
~2
C;ty R
ort
Telephone number
rlL
~ State ZIP
. ~-> \;\)tj-
FAX number
3lnO
=::Bwne," nam~
(>.. \J ld(.,.,
Address of inspection
W',LI $~t"\
City
o Cash 0 Check #
I hereby certify that I am the owner of the above named property or a licensed
electrical contractor (or the firm's authorized agent) and am making the electrical
installation or alteration in compliance with the electrical law, Chapter 19.28 RCW.
x
Signature of 0
" WALLS
Insulation Only
Date Ail)
. //-7-0 ~ver
Date ' Approved By
\.
CEllJNG
Insulation Only
Dale Approved By
,?over A1r/J
/I- Z;,
'" Approved By
Approved By
THERMOSTAT
/fcro
Approved By
DITCH
/kO
Electrical Load Additions and or subtractions
D NO LOAD CHANGES
o Baseboard KW
o Furnace KW
o Heat Pump Ton LAR
D Fan.Wall KW
o Overhead Service
o Temp Service
o Underground Service
Inspection
Date
Area, Building or Equipment Inspected
~J -G-
o
CJ1
~
IT"'
<:>.\
\
.
:\)
f\J
SERVICE
~ ..leD
D , Approved By
FEEDER
Dale Approved By
Service Information
Voltage
PhaseD1D3
Service Size:
Feeder Size:
.,
Actiop Taken
-r
Electrical
.Inspector
7
.
IElIECTA~CAl ~ NS!PJIECT~OINl
W~IR~NG ~IEPOIRlT
417-4735
DATE I PERMIT' I INSPECTOR
OWNER/CONTRACTOR
ADDRESS
APPROVED NOT APPROVED
D """"..,.,.,.,., DITCH ",..,."...",..., D
D .,.""".,.,. ROUGH IN/COVER. , .. , .. , , .. , .' D
D ,.,...""..,."., SERVICE .,.,.,..,.,.,..,., D
D ".".,..,.,.,.",., FINAL. . , . , , . . . , , . . , . , ' . .. D
CORRECTIONS NEEDED: .8Lrc),"ZL "pP'V~ /c> f-it,..",5L.
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NOTIFY INSPECTOR WHEN CORRECTIONS
ARE COMPLETED WITHIN 15 DAYS
OLYMPIC PRINTERS, INC. (360) 452-1381
- DO NOT REMOVE -
IElIEC1rIRl~CAL INS~lECT~ON
W!IR~NG IRlIE!P>ORl
417-4735
INSPECTOR
5' -7_~, fI, - oz- /fz.O
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ADDRESS
tJ t;, To t A7I!.r
APPROVED NOT APPROVED
o ................... DITCH ................... 0
'].'l(. .. .. .. ... .... ROUGH IN/COVER.. ... .. .. ..... 0
o .................. SERVICE .................. 0
o ......... t!Joi<:; . . FINAL. . . . . . . . . . . . . . . . . . .. 0
CORRECTIONS NEEDED: j411<!.Gf t N /5/ A?v/]( {C>iy( LA-
'771A,(,j' b i M../)<<..,r-li' I # ()N ~AV(
~NO.
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({,rh-lt.
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NOTIFY INSPECTOR WHEN CORRECTIONS
ARE COMPLETED WITHIN 15 DAYS
- DO NOT REMOVE -
OLYMPIC PRINTERS, INC. (360) 452-1381
, .
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;J.410 131 PAudtrk-
1?/;74'i .f '1/ f) , tn>
PREPARED 8/02/05, 14:00:55
CITY OF PORT ANGELES
PAYMENTS DUE RECEIPT
PROGRAM BP820L,
.
APPLICATION NUMBER: 05-00000268 106 FOGARTY AVE
FEE DESCRIPTION AMOUNT DUE
RES OVERHEAD SERVICE FEE 410.00
TOTAL DUE 410.00
~~~ MkkN
Please present this receipt to the cashier with full payment.
y O~
s.
Ef8ectrical Contra~ CJ Owner \,--....,.'
Cl Annu:il Permit 2' AlarIn 0 Carnival 0 Commercial
ELECTRICAL WORKPERMlT APPLICATiON
a Request Inspcction
.
f rlnstaUatiQD dO:';;l:"nptioll
Job wired by CJ Electrical Contractor CJ Owner I
Electrical contraclor name t.iccnsc: number S'i:.,Cul".:\~)'
l-\ \ "'l'<.C \~ S~C~\"r~ r..., c.- l-I\,tcc."t"> 9S5lS:':>- :C'''-'>'t-A \ \
Purch<lser's miiiling address s,.- S U ~,..-e.,^,""
~"23 oz....,..,.. t=="R.O"""'"'"
City State ZIP
1(0"'-' (.'V"'''~ ~ 98~" "-
Telephone number F!\X number
3"0" '-/57-- 21-::1"";- 3,"0" '-IS2- 8<;tC,o
Premises owner"s name
~~\~"'- u.)\ \'>'00
Addr@$s of Inspection
I() b t=='Oe.~Y
City~ ~bt.,\..o<,.
D~
CJ Cash CJ Check # O~ f=1\~
I hereby certify that 1 am l,he owner of the above named property or a licensed CJ Credit Card Vtsa Mastercard Discover
cl~cltical contractor (or th~ Hrm's authorized ;l.gent) and am making the electrical
installation or all.eratioD ID cumplL:w(:c wjth the c!cClrical1.1w, Chapter 19,28 RCW. Card # - ..
----------------
;g~~ o.~~w.er,,~..~~~~nt'.cto~o, dwrie.' .dmloi,t..,.r Expiration Date (InspeCtion fee
of card $ ,-/Z. '20
-)
(" W.u.LS ? CEILING TIlER1'10snT SERVJCE "
Insulation Only (nsulation Only
Dlllu ApprovectBy-J Dal~ APIIt'CIved B~ /
D.. AIlpr(\vtol(lly 1).11.: ;\pp1Oved Fly / r
Cover Cover DITCH FEEDER
1)Me AI'I'l\lve(l f:iy Dille ApptVvc<ll;ly
"- " Omte ApPl\lV~ By D;lI~ AWmv.d Dy
o Residential 0 Residential Maint. 0 Signs Cl Tbermo)ut CJ Telecom.
Ele};;trical Load Additions and or subtractions
D NO LOAD CHANGES
o Baseboard KW
o Furnace KW
o Hsat pump --'_ Ton _ LAA
o Fan-Wall KW
Servic~ Information
IDspcction Area. Building. or Equipment Inspected Action Taken Electtica.1
Date Inspector
-
-. .-_.-
-,"- .-,--'- ~-=--=
-. -.--".-- -.
o Overhead Service
o Temp Service
o Underground Ssrvice
Voltage
PhaseD 1 Q3
Service Size: __
f:=eeder Size: ___
/b;T:::7,;---
.d WCl~l..t 4'~!60 'new
09SB "Sl' 09>:
'ON XCI.:!
SJINO~lJ3l3 HJ31-[H
WO~.:!
Oct 21 05 1255p
DAVE'S HEATING & COOLING
p1
I
[E('Eleetrical Contractor
",-'
....~-"-(.i..~".
-!~
~~ ,- ;f-l
........
ELECTRICAL WORK PERMIT APPLICATION
o Request Inspection
'I
o OWDer
Q Annual Permit 0 Alarm 0 Carnival 0 Commercial ~ResidentiaJ 0 Residential J\1aint. 0 Signs af'Thermostat D Telecom.
,,- """"'" 'Installation descriplion
Job wired by l]('Electrical Contractor o OwDer --rl.errno S+",,+- UJ,If'e...
Eleclrical contractor name License numb~
.Pave ':s i-l-ea+in U' J)A-V6SHO:1Q I~ c.,
:ta,c," maH;ng addee"
,0 tox 4/3
c;,?o....-..r- An~s I State ZIP
wA q~:2 ~ ~
Telephone number FAX number
LfS-:;)-O '13 '7 ~6;;-O939
prep~s~T~~+-nt~ will SOf'\
=r5 D( ;;pe~W~ Fo~v-+~ Av-ev\U.-€-
CilYPor-r AV'I ~e I eS ,
o Cash o Check #
[ hereby certify that] am the owner of the above named property or a licensed ~'edit Card @ Mastercard Discover
electrical contractor (or the firm's authorized agent) Dad am making the electrical
installation or alteration in compliance with the c1cctricallaw, Chapter 19.28 RCW. Card#! .,
Signature of owner, electrical contractor 01" electrical administrator Expiration Date
X Lp'.... AI A ~ /)p7 /2" J.e... L) of card ' ($"3Z:~
I
WALLS CEILING ;' THERMOSTAT SERVICE "
Insulation Only Insulation Only J/~~ .A7D I
\..../ 1<: ....!:'provcd By "- D31<: Awo~(d 8y
D~tc Approv(d By 0"-11; A;tprovc<l By DITCH
Cove~ Co\'e~ FEEDER
Ollie: ^ppro~cd By D:illC Appro,,(d By
Ollie ."'.-pprovcd By Dllt~ ApptC>Hd By
Electrical Load Additions and or subtractions
o NO LOAD CHANGES
o BasebOard KW
a Fumace KW
a Heat Pump Ton LAR
o Fan-Wall KW
Service Information
o Overhead Service
o Temp Service
a Underground Service
Voltage
PhaseD 1 03
Service Size: _
Feeder Size:
Inspection Area. Building or Equipment Inspected Action Taken Electrical
Date [nspector
i/-J,~ _ "t:, rO.fflk- .Ah.L> L6l
~
/t1/ Ii fJ J.,., '1 L..< i
I
. /
j
r,(\/
t/Y
'!j( Electrical Contractor
o Annual Permit 0 Alarm 0 Carnival 0 Commercial
ELECTRICAL WORK PERMIT APPLICATION
'1;7\' i
i'\ Request Inspection
Residential 0 Residential Maint. 0 Signs 0 Thermostat 0 Telecom.
Job wired by
'~ Electrical Contractor 0 Owner
Installation description
ciTiea] contrac;lor oa e .
Le. ' Ic...Q y-v I
pU"haser's~a~ addO~ . ,- Vc(jio~,-
City[) , IA ~~ State ZIP =r
--1::.-Vrl fT(i\~~~ W'fr- 9~3 ~ '}
Telephone number FAX number
I-f '2 - . .' .s. Ci ""21 <--
j!YJ
-+~ 0'1-F'Q1
5. UV"UI l a...-
Con 41.~
Premis;~s jwner:s name
J'Vl( C.hCc t.--)
Addrer &inSpection
City
r:J1~
I\. VH r
Cvh.i' t.. iJd~ m
o Cash 0 Check #
x
~a~::dit Card _ Vt~ Maste~tt:scove~_
Expiration Date -0 n
of card
Inspection fee
$ '1;)..~O
I hereby certify that I am the owner of the above named property or a licensed
electrical contractor (or the finn's authorized agent) and am making the electrical
installation or alteration in compliance with the electrical law, Chapter 19.28 RCW.
WALLS
Insulation Only
Date Approved By
Cover
Date Approved By
CEILING
Insulation Only
Date Approved By
Cover
Dale Approved By
/' THERMOSTAT
"- Dale Approved By
/' DTIUI
"- Date Approved By
SERVICE
Date Approved By
/'
FEEDER
"- Date Approved By
Electrical Load Additions and or subtractions
D NO LOAD CHANGES
o Baseboard KW
o Furnace KW
o Heat Pump Ton LAR
D Fan-Wall KW
Service Information
o Overhead Service
'U Temp Service
o Underground Service
Voltage
PhaseD1D3
Service Size:
Feeder Size:
Inspection
Date
Area, Building or Equipment Inspected
Action Taken
Electrical
Inspector
i/
r1c:D
~