HomeMy WebLinkAbout1431 W 5th St - Engineering
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CITY OF PORT ANGELES
PUBLIC WORKS - BUILDING DIVISION
321 EAST 5TH STREET, PORT ANGELES, W A 98362
PUBILIC WORKS & R/W PERMIT
o Attached Notes
OWNER/APPLICANT
ELIZABETH SANDBERG
1431 W 5TH ST
PW'CITY, PW'State PW:Zip
000/600-0000
PROJECT INFO
Work is.
Plans Required
Contractor' APS ELECTRIC
Performance Bond Required
Proof of Insurance
Work to Perform
Issued
11118/1999
Permit No
Work Order'
~~
o /0' '1
PROPERTY LOCATION
1431 5TH ST W
Lot. 13
Subdivision.
Parcel No
Block: 122
TPA
o Long Legal
Start Date
1 1
Finish Date
360/452-6753
$000 ~
1 1 '\N
---
~
cJl
~5i
Value Work.
Amount:
$000
~ Install
o Repair
o Watermain
~ Sanitary Sewer
o Storm Drain
o Underground Tele/Elec
o Mise
PROJECT NOTES
connect into existing sidesewer on property
FEES ASSESSMENT
1 ) R/W Excav' $000 15 ) Other San Sewer' $000
2.) Sidewalk: $000 16) Sew Tap Wye/Man Tap $000
3 ) Curb/Gutter' $000 17 ) Sew Capl W/M Removal $000
4 ) Driveway' $000 18 ) Alter Repair Sewer' $30 00
5 ) Dwy Culvert. $000 19 ) Storm Drain $000
6) Street Cut: $000 20 ) Catch Basin per ea $000
7 ) Other R/W' $000 21 ) Sewer System Dev' $000
8 ) Fire Hydrant: $000 22.) Mifwaukee Dr Sew Ass. $000
9 ) Res Water Servo $000 23 ) R/W Use Perm $000
10 ) Comm Water Servo $000 24 ) Admin Cost (0 RA) $000
11 ) Other Water Service $000 25) D.RA $000
12.)Water System Dev' $000 26 ) Mise: $000
13 ) San Sewer SFR $000 TOTAL FEE. $30.00
14 ) San Sewer MFR $000
add unit: 0 Amount Paid $30 00
Receipt No 5480
Inspection Fee $000 Balance Due $0.00
R/W SANIT AR Y WATER DWY STORM DRA 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.
Signature of Contractor or Authorized Agent
Date
Signature of Owner (if owner is builder)
Date
.....
CITY OF PORT ANGELES
DEPARTMENT OF PUBLIC WORKS
. . . . . . INSPECTION REPORT. . .
REQUEST i' , /"
1/ L\ '1/
1"'~{ l"",.
Date v I) ,
Location of Work to be inspected
Name of person requesting inspection j4-.;as
Address of person requesting inspection
Type of Inspection (circle appropriate one) _--
Sewer Foundation Framing Chimne~~ Final
~' -.-..
INSPECTION NOTES " <-(5--
Inspected Date / (- / cf -1;1' Time I! ~
Remarks
-,
d
,I j
Received by
--c{'
~,.....
-.:.>
~.d<,
(
f
(phone, person)
Time ) / ~
~ 4-cL
Phone No
. I
Permit No . -'-- ,.
Sewer Excav OtherC 701 ~)
~~
By
RESTORATION REQUIRED
YES
NO
t~ouse ~Ik~
~ '201 0~
7 1/4-E5
"-
-- -
~ \
-- -
0
\ 1~~G'1 -
J
-="- I
SURFACE RESTORATION
SURFACE TYPE 0 Unimproved 0 Gravel 0 Asphalt 0 PCC
\
\
o Other
D Repaired by City
[] Repaired by Permittee
[] No Damage Found
Work Order #
o COMPLETE
o INCOMPLETE
(Continue on reverse side if necessary)
STREET SUPERINTENDENT
(DATE)
BUILDING PERMIT INSPECTION RECORD
CALL 417-4815 POR BUILDING INSPECTIONS. 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
YFS NO
FOUNDATION:
FOOTINGS
WAllS
FOUNDATION DRAINAGE
ELECTRICAL (UGHT DEPl)
ROUGH-IN I I I
PLUMBING
UNDER FLOOR I SLAB
ROUGH.IN
WATER LINE
BACK FLOW I WATER
AIR SEAL
WAllS
CEIllNG I I
FRAMING
JOISTS I GIRDERS
SHEAR WAlL
WAllS I ROOF I CEIllNG
DRYWAlL
T-BAR
INSULA nON
SLAB
WAlL I FLOOR I CEIUNG I
MECHANICAL
CInMNEY
WOODSTOVE I PEllET
DUCTS
PW UI1LITIES I SITE WORK (Engineering Division)
WATERLINE I METER
SEWER CONNECTION
SANITARY
STORM
SITE DRAINAGE I EROSION CONTIWL
PARKING
OTIIER
FINAL INSPECTIONS REQUIRED PRIOR TO OCCUPANCYIUSE
RESIDENTIAL DATE YFS NO COMMERCIAL DATE ACCEl'TED
YFS NO
ElECTRJCAL UGHT DEPT 417-4746 ElECTRJCAL
UGHT DEPT
CONSTRUCTION R. W I PWI CONSTRUCTION R.W
ENGINEERING 417-4807 PW I ENGINEERING
FIRE (MULTI-FAM. ONLY) 417-4654 FIRE DEPT
BUILDING 417-4815 BUILDING
GENERAL COMMENTS:
PW-II02.13 (4/96)