HomeMy WebLinkAbout3817 Park Knoll Dr - Engineering
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CITY OF PORT ANGELES
PUBLIC WORKS - BUILDING DIVISION
321 EAST 5TH STREET, PORT ANGELES, WA 98362
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PUBLIC WORKS CONSTRUCTION Issued: 1 1 Permit No: 978
& R/W PERMIT Cond: Work Order: 0
OWNER/APPLICANT------------------------PROPERTY LOCATION------------------------
MARY RUPPRECHT 3817 PARK KNOLL
3817 PARK KNOLL DRIVE Lot: TX # 3698 SENESW
Port Angeles,WA98362 Block: Long Legal: ~
360/457-6333 Sub: -
PROJECT INFO--------------------------------------------------------------------1
Work is N/A traveled road Value Work: $0.00
Plans Required: N/A
Contractor: R. J. SERVICES
Start:
Finish:
Performance Bond Required: N/A
Proof Insurance:
Amount:
Work to Perform: INSTALL
Watermain
* Sanitary Sewer
~
1 1
1 /
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0:::0
$0.00
Storm Drain
Underground Tele/Ele
Misc
PROJECT NOTES-------------------------------------------------------____________
CONNECTION INTO PRIVATE SAN. SEWER MAIN PER ROGER WHEELER RJ SERVICES
120' SOUTH OF SEPTIC TANK
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"
1"
Comm Water Serv:
1"
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: 0
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
$80.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$642.00
$0.00
$0.00
$0.00
$0.00
$0.00
------------------------------
------------------------------
$0.00
$0.00
TOTAL FEE:
AMT PAID:
Receipt No:
Inspection Fee:
$0.00
BAL DUE:
R/W SANIT AR Y
WATER
STORM
DWY
DRA
OTHER
$722.00
$0.00
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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 goveming
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
Rebecca Veldhouse, Accounting Tech
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FROM:
Date:
Request for Billing
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GenerallMiscellaneous
Landfill Accounts
Leasehold exCISe Tax
Ugh! Department
Medic 1 Transport
Police DeP8l1ment
Pants Department
ParXingIBus Improvement Area
PenCom DisP8Id1 Services
Public Works [)epartrnent
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Please send a invoice in the amount of $ 71l; to' ~~
Name. IfY\ A1L~~ Ye.uh
Address. 3B'L 1 rtL rk- K:hD 1\ Dy-
::::::~es 1
This invoice is for p~ \( Vv\. t T -=\:i- Cf 7 g - ,') A-n x-wex hDD k up ~E-
~ <6D c:2 T SA-rl S~U)-e Y' 5 Y '5/E VV\ us ER- Fee $ fc; 1- Z 0 (:)
Actual Labor Costs
Actual Material Costs
Actual Vehicle Costs
Misc. Costs
Billing Fee
Sales Tax
Total
Authonzing Signature
Accounting Code:
$
$
$
$
$---
$
$
7Z&~
72L02
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/C971
CITY OF PORT ANGELES
DEPARTMENT OF PUBLIC WORKS
. . . . INSPECTION REPORT . . . . . . . . . . .
REQUEST
Date 1/... ( --0 3
Time
Received by Det-i..VL IS E. (phone, person)
Location of Work to be inspected 38 '7 ~r k KlILotl 'Dr
Name of person requesting inspection D~ o.1.iI\.i'~ C.
Address of person requesting inspection ~r() 'd...r.d {7~ 1-8. Phone No
Type of Inspection (circle appropriate one) f Permit N~ .
Sewer Foundation Framing Chimney Plumbing Final Sewer Excav Othe _ ~
INSPECTION NOTES
Inspected Date I ( .... ,. " 0 ~
Remarks k~ f)o...( r 2. (, C r
I
Time ~ /'M By j)eV\.1A l~ iE
~"~1 Ar~~ Ie P1-.Jt'fL ~ ~u [t Calc.-'L b..Vl~
RESTORATION REQUIRED
2_ - ~-1 x. g A.~fk...l-t- fc...+c:...WL."
~ Asphalt 0 PCC 0 Other
Work Order # ID91 (
ps( COMPLETE At-e.0.... t-~~~ ~"'€Q\ w H-l\
o INCOMPLETE \V\~\ M~ \,f
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SURFACE RESTORATION
SURFACE TYPE 0 Unimproved 0 Gravel
D Repaired by City
D Repaired by Permittee
[] No Damage Found
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(Continue on reverse side if necessary)
YES X NO
1 f.~:].<ci\
2 {( ~.r
3 De.ep
STREET SUPERINTENDENT
(DATE)
CIty of Port Angeles
Public Works Department
Water Distribution Repair Report
'Work Order No' ICYJ 7 (
[Crew 715 - 7/1- 7/3
1
DATE REPORTED I!.... ( . {) 3
CONDITION EMERGENCY D ROUTINE D CITIZEN COMPLAINT ~
LEAKAGE SURVEY D OTHER D
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DATE OF REPAIR. I/-/----u':;>
TIME /- DC) DA.M. l(P.M.
321(7 ~/~k K?1.o!(
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SIZE.
REPAIR LOCATION ADDRESS
TYPE OF MAIN
C.I
3!
CLOSEST VALVE DEPTH.
( ~
2z
DEPTH OF MAIN
COMPONENT REPAIRED.
MAIN JOINT D CIR BREAK){ SPLIT BELL D LONG BREAK D
HOLE D CLAMP D OTHER
SERVICE TAP D CORP STOP D PIPE D CURB STOP D FITTING D
METER SETTER D METER D
LINE VALVE FLANGE NUTSIBOL TS D STEM D BONNET D
HYDRANT BRANCH D VALVE D BARREL D
OTHER.
COMPONENTS OF REPAIR. CLAMP){ DRESSERD OTHER
SITE CONDITION GRAVEL D ASPHALT)lQ SIDEWALK D CURB D
TOP ~OIL AREA D SOIL TYPE
CUTS ASPHALT CUT '-I-xlfo' FT CURB CUT _FT SIDEWALK_FT
DRIVEWAY CUT _FT
. / /1
MAIN CONDITION INTERNAL LINING tV, r? TUBERCULATION-MINOR D SEVERE D
EXTERNAL CORROSION LOCALIZED D EXTENSIVE D
CHLORINE RESIDUAL SAMPLE . 2..0 P.P.M.
WATER OFF FROM 3 /1?! M. TO Lj /) M.
FROM
M.TO
M.
APPARENT CAUSE OF LEAK 6 ('OL,~ tJ se. +f( (.