HomeMy WebLinkAbout330 Hancock Ave - Engineering
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W VI?/o f;\d City P~one. 206-457-0411, ext. 124
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vtUCANT/OWNER ~ Y'tLlq ~ n ADDRESS OF JOB .;:3~ t+A.l--\r' ~K
APPUCANT ADDRESS. PHONE LEGAL OF JOB LJ"S'" ~-J~ ~ I~ -20
WORK IS 0 OUTSIDE or 0 INSIDE OF TRAVELED ROAD vALUE OF WORK IS $ 1>t..+- 'Z3(If w rk rt~igJ forc1wav
and is equal to or less than $2,000, then permIt may be ISSUed to other than licensed and bonded contractor)
PUBLIC WORKS CONSTRUCTION
and RIGHT-OF-WAY PERMITS
PERMIT 00236
-7 ., ,,4 .~
/ .;
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PLANS REQUIRED 0 YES 0 NO CONTRACTOR. DATES FOR START & FINISH
PERFORMANCE BOND REQUIRED 0 YES 0 NO AMOUNT $
PROOF OF INSURANCE. 0 Work $2.000 or leSs: $50,000 personal injury, $100,000 per incident. $20000 property
o Worle over $2,000' $200,000 personal injury, $500,000 per incident, $100.000 property
o Right of Way Use: $300.000 personal injury, $300.000 per mCldent. $100,000 property
Permittee understmda that no street may be closed to traffic unless approved by the City Engineer and Chief of Police in adVlDce of the
closure; that there is a 24 hour minimum notice prior to inspection, and to call 48 hours before diggmg to' 1-800424-5555
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far.., -. "* ... -.. 10 _ ...~. ..--............... .Iia __.. _ 01_ """.......... _Ibo ...... oi lhio .pplicaliat aod lite pemll' or penn... ..... may bo ..- ill -__
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TYPE re:E R~rl'D PAID n'l'E FEE REO'D PAID I
I
IUGHT OF WAY EXCA V S40.110 L--- 4D ~~EIl (SFR) (6' ID PIL. 6.... sao.CO '2>0- I
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......CIO. SAN. SEWER /UFIt' hI'" un.CO
.wouTml. SI23.CO SAN SEWEll/UFltl ADD. UNIT U.CO
DlJVEWA Y SI23.C1O SAN lEWD 0THEIlS MiD-57Hlll: $O.cDS I..
Ma-575O ICO CXXloflSO.CI01S ""....
DWY CULVEKT S4O.CIO ( SEWEll TAP BY CTTY,.O SI23.C101SlCIO.110
~- ~ WYElMANHOLE TAP
mEEI' cur "-- S3llI.CIO SEWEll CAPIWATEJl METD sns.CO
REMOVAL
0T1IEI. aJOHT OF WAY WOIlX SolO.CIO ALTERATlO,., SJO.CO
REPAIR TO SEWER
mE HYDIW'(T DEPOSIT STORM DRAIN TAP SI2.I.CO
RES. W ATEIl Sl!Jl.VICI! 10 X ".' U5O.CO C,nCH BASINS IN lOTS PEIl EACH sao.CO
RES. WATEIl SEJ.VICI! \' X 3/.' U".CO J~CO"DAll Y SEWEll ASSESS. $OIO.CO in S6I5.CO........ 41 () i
RES. W ATEIl SDVV"Il: \' X \ ........co If) on, 1/ SEWER SYS. DEV. CHAllGE sn..co /EWM .=32.l.../ I
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COMM. WAT'EJI. SEJ.V\CE I - SI,COIl MIl.WAUKEE DR. SEWER ASSESS. SI5O.CO iEWM
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W ATEIl SEJ.V\CE 0T1IEI. ESTDofATE lIGHT OF W" Y USE PERMITS VARIES S3 SICO
WATEIl SYS. DEV CHAJ.GE S75O.CO /EWt.4 ~~ 1/ TOTALS S S Z/Jld. <3
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Thio -.lloa _ Ibo _ _ .....u- .. ..- Ibo ,._U ID do Iia _i -.nbod ... aaI I... Iia ~ .- III Ibo _liaa..... Eada "'mil' .. ~ ._ LO lI'C "'....... 01 lite .,- .....- ... .... awUcall""
.....,.. to _....,.,... oidia City 01 Paft ~ M~ Cc:dc. Nothinc pcrraalleG be........ tiaLI ~ o-r.a LO OWrnM U. P'fV'VlIJMIIW of any .ppticabl& I.... o( u.: Cily Cexwy SlAwt or Fedcnl GaveI"l'ml:N.
COMMENTS/CONDITIONS.
Cl Inall 0 Repair
OWatermain
o Slllitary Sewer
o Storm Drain
o Underground TeIephonelE1ectrical
tfl:)
_.KMIT TOTALS $ 220 ~ RECEIPT
1/ 0 3~
ISSUED BY
~~~-
DATE.#95
WORK ORDER No.
INSPECTION FEES $
PW-0209.03 \12J931
INSPECTOR'S COPY - WHTTE APPLICANT'S COPY. PINK
OFFICE COPY. CANARY PERl\1IT
00236
CITY OF PORT ANGELES
DEPARTMENT OF PUBLIC WORKS
. . . . . . . . . . . INSPECTION REPORT . . . . . .
REQUEST' / /
Date ~-3 / Z 7 It! ~ime file-- Received by
.....
(phone, person)
location of Work to be inspected
Name of person requesting inspection
Address of person requesting inspection
Type of Inspection (circle appropriate one)
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Jon SAA--tJ -r-re4t1k
--
Phone No
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Permit No
Sewer Foundation Framing Chimney Plumbing Final Sewer Excav Other
INSPECTION NOTES
Inspected Date Time By .
Remarks OE;:~U"'W e2!!:;ae':/)t//d. Vh~~"'-;
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70 c:n::LJ ~N~ I!' 0/--/0 -Yl~~ ---
RESTORATION REQUIRED, <yEs NO
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SURFACE RESTORATION
SURFACE TYPE D Unimproved OGravel 0 Asphalt
7?7"):'::
~
/
OPCC
D Other
D Repaired by City
D Repaired by Permittee
D No Damage Found
Work Order #
o COMPLETE
D INCOMPLETE
(Continue on reverse side if necessary)
STREET SUPERINTENDENT
(DATE)
---.--- _._----~~--_.~------
,
CITY OF PORT ANGELES
DEPARTMENT OF PUBLIC WORKS
. . . . . INSPECTION REPORT.
. . . .
REQUEST
Date ,1).... J..
.' r'
- (/ "
,
J
Time
Received by R
LPH
(phone, person)
Location of Work to be inspected
Name of person requesting inspection
Address of person requesting inspection
Type of Inspection (circle appropriate one)
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Sewer Foundation Framing
Chimney Plumbing Final
Phone No If> ')-tJ,k11 ~J( ,..~ ~,
Permit No ,';l J b
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Sewer Excav Other W-P 305
OW JOe s
INSPECTION NOTES
Date (- - ,;J
Inspected
Remarks
By /1' />.
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7 ~ 7ci .
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RESTORATION REQUIRED YES
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Time
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SURFACE RESTORATION
SURFACE TYPE 0 Unimproved 0 Gravel 0 Asphalt 0 PCC [g,Other -- i( -
o Repaired by City Work Order # :3 ~ S-
O Repaired by Permittee [WCOMPLETE
o No Damage Found 0 INCOMPLETE
(Continue on reverse side if necessary)
STREET SUPERINTENDENT
(DATE)