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Date Iss Ll ed: Address: ii G () Lf 2 tl () 4 Phone: 9'$7 - ~ cF.7'? r-j;j6t:Z{;5 Zip: 9S362 / Phone: L/~'? -c:;; .5-'/ 6-7/ /Exp: /~ Phone: <<57.... & .f y. /JJ 'q'7L/~ \-., ... .' . City: Pt!J~T Arr 0cLt.: .). 1{.7.4 Zip: -/ h 3d):< (:;OCB~ :] (-::r.:<) 0 C) ZONING: jr~. :, Block: , 3i~tS Subdivision: PROJECT ADDRESS: LEGAL DESCRlPTION: Lot: 9 CLALLAM COUNTY PARCEL NUMBER: Credit Card Holder Name: Billing Address: Credit Card Type VISA MC TYPE OF WORK '"t:- Residential ~ew COlistr. o Multi-family 0 Addition o Commercial 0 Remodel o Repair BRIEF DESCRIPTION 9 City: EJ..ll. Date: # o Stove o Garage o Deck o Other SIZEN ALUATION: SF. @ $ /SF. = $ SF. @ $ /SF. = $ SF. @ $ /SF. = $ TOTAL VALUATION o C.J .~. ~ COMMERCIALIRESIDENTIAL:_ Occupancy Group: No. of Stories: -.i.. Lot Size~ Existing Sq. Ft.' ct' , Total lot coverage 2.." I Occnpant Load: Construction Type: & Proposed Sq. Ft.1.!l..Q.l,.. = TOTAL Sq. Ft. 19 fJ L % APPROVALS: PLAN: BLDG: DPWU: FIRE: OTHER: PLANNING USE ONLY: ESAfWetland(s): 0 Yes 0 No SEPA Checlclist required? 0 Yes 0 No Other: BUILDING PERMIT API)LICATION SUBMITTAL: The Building Division can provide you with infonnation on the application and plan submittal requirements if you have questions. V ALUATION 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 41 7-4815 for assistance. PLAN CHECK FEE: IF a plan check fee is due it must be submitted at the tin1e the building permit application and construction plans are submitted. All other permit fees are due at the time of pemrit issuance. EXPIRATION OF PLAN REVIEW; 1fno pemlit is issued within 180 days ofthe 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 107.4 of the Uniform Building Code, cunent edition). No application can be extended more than once. I hereby cerlify 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 ,no it's, and that I mu t obtain such permits prior to work. ,0 Applicant: Date: s- If) ()ff - I T:\FORMS\AJ'PS\Buildingperrni t. wpd WASHINGTON STATE ENERGY CODE . I TABLE 6-2 PRESCRIPTIVE REQUIREMENTS' * * FOR GROUP R OCCUPANCY CLIMATE ZONE 1 · HEATING BY OTHER FUELS HV AC9 Glazing Glazing U-Factor Door '0 Vaulted Wall Wall- Wall- SIab6 Option Equip. Area": Overhead' U-Factor Ceiling2 Ceiling3 Above int4 ext4 Floors on Ettie. % of Vertical Grade Below Below Grade 2 Floor Grade Grade I. Med. 10% 0.70 0.68 0.40 R-30 R-30 R-15 R-15 R-lO R-19 R-lO II. Med. 12% 0.65 0.68 0.40 R-30 R-30 R-15 R-15 R-lO R-19 R-lO III. High 21 % 0.75 0.68 0.40 R-30 R-30 R-19 R-19 R-lO R-19 R-I0 IV.'" Med. 21 % 0.65 0.68 0.40 R-30 R-30 R-19 R-19 R-lO R-19 R-lO V. Low 21 % 0.60 0.68 0.40 R-30 R-30 R-19 R-19 R-lO R-19 R-lO VI.7 Med. 25% 0.457 0.68 0.40 R-38 R-30 R-19 R-19 R-lO R-25 R-lO VII. 7 Med. 30% 0.407 0.68 0.40 R-30 R-30 R-19 R-19 R-lO R-25 R-lO VIII. Med. unlimited 0.25 0.40 0.40 R-30 R-30 R-19 R-19 R-lO R-25 R-lO * Reference Case ** Nominal R-values are for wood frame assemblies only or assemblies built in accordance with Section 601.1. 1. Minimum requirements for each option listed. For example, if a proposed design has a glazing ratio to the conditioned floor area of 19%, it shall comply with all of the requirements of the 21 % glazing option (or higher). Proposed designs which cannot meet the specific requirements of a listed option above may calculate compliance by Chapters 4 or 5 of this Code. 2. Requirement applies to all ceilings except single rafter or joist vaulted ceilings. 'Adv' denotes Advanced Framed Ceiling. 3. Requirement applicable only to single rafter or joist vaulted ceilings. 4. Below grade walls shall be insulated either on the exterior to a minimum level ofR-l0, or on the interior to the same level as walls above grade. Exterior insulation installed on below grade walls shall be a water resistant material, manufactured for its intended use, and installed according to the manufacturer's specifications. See Section 602.2. 5. Floors over crawl spaces or exposed to ambient air conditions. 6. Required slab perimeter insulation shall be a water resistant material, manufactured for its intended use, and installed according to manufacturer's specifications. See Section 602.4. 7. The following options shall be applicable to buildings less than three stories: 0.50 maximum for glazing areas of25% or less; 0.45 maximum' for glazing areas of 30% or less. 8. Reserved. 9. Minimum HV AC equipment efficiency requirement. 'Low' denotes an AFUE of 0.74. 'Med.' denotes an AFUE of 0.78. 'High' denotes an AFUE of 0.88. Minimum HV AC equipment efficiency requirement for heat pumps. 'Low' denotes an HSPF of 6.35. 'Med.' denotes an HSPF of 6.8. 'High' an HSPF of 7.7. Water and ground source heat pumps shall be considered as medium efficiency and have a minimum COP as required in Table 5-7. 10. Doors, including all fire doors, shall be assigned default U-factors from Table 10-6C. 11. Where a maximum glazing area is listed, the total glazing area (combined vertical plus overhead) as a percent of gross conditioned floor area shall be less than or equal to that value. Overhead glazing with U-factor of U=0.40 or less is not included in glazing area limitations. 12. Overhead glazing shall have V-factors determined in accordance with NFRC 100 or as specified in Section 502.1.5. 38 7/01/01 2000 EDITION TABLE 6-1 PRESCRIPTIVE REQUIREMENTS 1* * FOR GROUP R OCCUPANCY CLlMA TE ZONE 1 . HEATING BY ELECTRIC RESISTANCE * Glazing Glazing U-Factor Wall Wall- Wall- SIab4 Option Area 10: Door 9 Ceiling2 Vaulted Above int4 ext4 Floors U-Factor CeilingJ Below Below on % of Floor Vertical Overhead t 1 Grade Grade Grade Grade I. 10% 0.46 0.58 0.40 R-38 R-30 R-21 R-21 R-lO R-30 R-1O J 12% 0.43 0.58 0.20 R-38 R-30 R-19 R-19 R-lO R-30 R-1O III. 12% 0.40 0.58 0.40 R-38 R-30' R-21 R-21 R-lO R-30 R-1O IV.'" 15% 0.40 0.58 0.20 R-38 R-30 R-!9 R-19 R-1O R-30 . R-IO v. 18% 0.39 0.58 0.20 R-38 R-30 R-21 R-2l R-1O R-30 R-IO VI. 21 % 0.36 0.58 0.20 R-38 R-30 R-21 R-2! R-I0 R-30 R-IO VII.' 25% 0.32' 0.58 0.20 R-38 R-30 R-!9 R-2l R-1O R-30 R-1O + R_5s VIII.7 30% 0.29' 0.58 0.20 R-38 R-30 R-19 R-21 R-IO R-30 R-lO + R-58 * Reference Case ** Nominal R-values are for wood frame assemblies only or assemblies built in accordance with Section 601.1. 1. Minimum requirements for each option listed. For example, if a proposed design has a glazing ratio to the conditioned floor area of 19%, it shall comply with all of the requirements of the 21 % glazing option (or higher). Proposed designs which cannot meet the specific requirements of a listed option above may calculate compliance by Chapters 4 or 5 of this Code. 2. Requirement applies to all ceilings except single rafter or joist vaulted ceilings. 'Adv'denotes Advanced Framed Ceiling. 3. Requirement applicable only to single rafter or joist vaulted ceilings. 4. Below grade walls shall be Insulated either on the exterior to a minimum level of R.la,oroD the interior to the same level as walls above grade. ExteJ'iorinsulation installed on below grade walls shall be a water resistant material, manufactured for its intended us.e, and installed according to the manufacturer's specifications. See Section 602.2. 5. Floors over crawl spaces or exposed to ambient air conditions. 6. Required slab perimeter insulation shall be a water resistant material, manufactured for its intended use, and installed according to manufacturer's specifications. See Section 602.4. 7. The following options shall be applicable to buildings less than three stories: 0.35 maximum for glazing areas of 25 % or less; 0.32 maximum for glazing areas of 30% or less. 8. This wall insulation requirement denotes R-19 wall cavity insulation plus R-5 foam sheathing. 9. Doors, including all fire doors, shall be assigned default V-factors from Table 1O-6C. I Q. \\Iherea maximllm glazingc~Iea is listed, the total glazing area (coIllbilled vertical plus overhea_d) as a percent of gross conditioned floor area shall be less than or equal to that value. Overhead glazing with V-factor of V =0.40 or less is not included in glazing area limitations. II. Overhead glazing shall have V-factors determined in accordance with NFRC 100 or as specified in Section 502.1.5. Effective 7/01/01 17 ~ 'PORr ~ o (VQ ~ - ~ U ill 'lCa-~ - Iz-~o~ SHING" Washington State Energy Code Plan Review Checklist Applicant please Check write in N/ A, or fill in value on boxes or lines. Project Address: Compliance Approach:(check one) 0 Systems analysis o Component performance o Prescriptive path HEATING SYSTEM o Zone Heating X Electric Furnace DHeat Pump FOUNDATION PHASE A /- ~ o Slab R-_ Exterior down to frost~e/~rab";;tGm; Interior 24" horizontal or vertical; or, Ifradiant under entire slab 'ti!J Below grade exterior wall insulation: R- _ (If interior -see Insulation Phase) FRAMING PHASE o Standard o Intermediate KJ.1(dvanced o Standard air seal: sole plate/sub floor; rimjoist; window & door frames; wires, plumbing, ducts, light fixtures o Source specific exhaust fans: bath & laundry(50 cfill) kitchen(100 cfm) o Whole house exhaust fan _ cfm intermittent system has manual & auto controls: Outdoor air supply reg. for habitable rooms or o Integrated forced -air system, fan _ cfm, outside air duct(with motor damper) allowing .35 and .5 ACH INSULATION PHASE o R-~ Wall insulation(above grade) (v..~ R-_ Wall insulation(below grade): Interior wall insulation o R-~ Floor insulation o R-2L Ceiling insulation: Including attic hatch o R - ,) (.-, Vaulted Ceiling insulation D Vapor retarders: Walls, Ceiling: 0 4 mil poly DPerm rated paint ~aft faced batts o Vapor retarders: Floors: 0 4 mil poly lid1&'aft faced batts ~round cover: 6 mil Black polyethylene, 12" lap at joints & extending to foundation wall T :\ROGERIBLDG-FORMS-BROCHURESIENERGYPLANREVIEW Over: Fill in back side also. WINDOW GLAZING Please fill out window information. inclued skylights. glass doors. and all other glazing on this form. Use rough opening area for calculations. SIZE QUANTITY AREA U-VALUE & MANUFACTURER .)0 <;,- 0 2- .S 0 t../ t..-{L) 'J- 0 1 f: { I g [ ( t? i) ? .~ ( 2.. { { ( Z- /'1 C, it U L '-( <;{ I I (, .::.> -LJ3 { .:./ 2-. I, "' Total glazing area: Total conditioned floor area: Percentage of glazing: J S-7 I'~ d2, . ~ , (.., :] h5 DOORS List doors by type(solid core, insulated, Etc.)quantity, U-value, and Manufacture. SIZE QUANTITY AREA U-VALUE & MANUFACTURER ") D. ( Ml!:# 1:: I f'l',r 1:-. \ -/'_,03 S ~ it-2 . L :; '1 ",r "/ ~ T:\ROGER\BLDG-FORMS-BROCH U RES\EN ERGYPLAN REVI EW-2 I ! 1 . 1 \J t~ ~ I /9/ I-t ~ "- 1 ,. " Lot ?! 'I :" \ ........ ~ ~ '- fl/l-r eel t1- Of, 30 b o3G. L ~ r q I c/o J t:>; 5-e e f,~~ ~ ft:' / I ~,4'../ ~ ).. t/)O clOD f'/tJ C .3 OtJ ToV1vSJ./ ""'" s to f q ~ ~ ~ I? fl, ) I 1 \ t ~ ~1 1 I t ~ I ? " -,r \ . d '\ \ ~ \1 .; -... \ ~ ~ /~ I.z.?"'- fj- t'3~ :LA -n -- :.t---1--- -----i-----dt/ ;4-;; / cJI-. t..- t:: <- 'c ' {;/~'/---? 97 Q-- c ~ I (./ 6 c) ... '7 II ~- t/ . ,. __.~_ '_'~__ .__~_,._.._,_.... ..._~.,__ /______._,__u.. L~t If) . '-_M_"'_~_'__~_'_ .__,__,,'~''''__''__,_ . , . i . ~-+---1 , , I ~-~-_...-..-~~_.- ~.. j 'i -"'--'i--"'-'~,.-i-_.-.--n- \ : ! i!, - --_._-'--V~-- --- , J --'-T--r:-';-"'--;-- -;-~ - ! . ' . : I I _..,.__,", __.__',,__ -- . ,.- __.l.__ ._-~-, :....... '--~J-' ...., - ...;----... \ CITY OF PORT ANGELES DEPARTMENT OF PUBLIC WORKS . INSPECTION REPORT. . . . . . ..... REQUEST Date Z - Z. '-I ~ 0 ~ Time 10 AM Received by De "1. "t i ., C (phone, person) -tl- iZ - Location of Work to be inspected / Z , '-I 4) Name of person requesting inspection Zi-"t-t i-t. j S Address of person requesting inspection 6 v iJ Type of Inspection (circle appropriate one) ( .F to-- Yc...,J) (7 ~ i; Phone No '1-17 - -IYYC; Sewer Foundation Framing Permit No...-.....- ..::::::, Chimney Plumbing Final Sewer Excav Othe~4...fe r _) --- RESTORATION REQUIRED YES NO X , ____~______J V\ uJ 1-"'- /'2 - CjI f! ..r ..?~d. ~c, 2 t L_'L SURFACE RESTORATION SURFACE TYPE 0 Unimproved 0 Gravel D Repaired by City [] Repaired by Permittee D No Damage Found o Asphalt 0 PCC 0 Other Work Order # >0 3L{ '8' - 0 { '-L o COMPLETE o INCOMPLETE (Continue on reverse side if necessary) STREET SUPERINTENDENT (DATE) i\ , . JroRTA..<, t,"~'V<;'- '''&1- L -- ~JC~"\. CITY OF PORT ANGELES PUBLIC WORKS - UTILITIES DIVISION 321 EAST 5TH STREET, PORT ANGELES, WA 98362 () </~44L; Application Number pin number Property Address ASSESSOR PARCEL NUMBER: Application description Subdivision Name Property Use Property Zoning . _ . Application valuation 04-00000445 Date .398195 1234 W 12TH ST 06-30-00-0-3-6830-0000- RES NEW SFR 2/03/05 RESIDENTAL SF 7000 RS7 RESDNTL SINGLE FAMILY 70000 th /~J; 4 W 12 :.--- Owner Contractor WA 98362 IU;tl~ LUNDERVILLE, THOMAS P.O. BOX 1750 PORT ANGELES (360) 457-6897 Structure Information' construction Type Occupancy Type Other struct info WA 98362 COLUMBIA PACIFIC P. O. BOX 1750 PORT ANGELES (360) 457-7525 NEW 1416 SF SPR WiATT 474 SF TYPE V NON-RATED SINGLE FAM & CONGREGATES TOTAL % LOT COVERAGE CONSTRUCTION TYPE NUMBER OF STORIES EXISTING LOT COVERAGE LOT SIZE PROPOSED LOT COVERAGE TOTAL LOT COVERAGE NUMBER OF UNITS BUILDERS INC GARAGE 27.10 V-N 1. 00 1. 00 7000.00 1902.00 1902.00 1. 00 Permit Additional desc Permit Fee Issue Date Expiration Date CONCRETE SIDEWALK SCHOOL WALKING ROUTE 70.00 Plan Check Fee 2/03/05 Valuation 8/02/05 .00 o Qty Unit Charge Per Extension _________________________________~~:~_~~~________________________~ 70.00~ Permi t PUBLIC WORKS RES WATER SERV Additional desc Permit Fee 640.00 Plan Check Fee .00 Issue Date 2/03/05 Valuation 70000 Expiration Date 8/02/05 Qty Unit Charge Per ExtenC:t1 ,..,,.., 1.00 640.0000 EA PW W/M 1" SERV 5/8" METER ~ 640.00~ ------------------------~-~------------------------------------~---- permi t RIGHT OF WAY Additional desc Permit Fee Issue Date Expiration Date 45.00 2/03/05 8/02/05 Plan Check Fee Valuation .00 70000 Qty Unit Charge Per ~xtens' 1.00 45.0000 ECH RIGHT OF WAY PERMIT 45.00 ---------------------------------~--------------------------- Permit SANITARY SEWER HOOK UP Additional desc Permit Fee 95.00 Plan Check Fee .00 Issue Date 2/03/05 Valuation 70000 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 fora 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. AIi 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 vioiate or cancel the provisions of any state or local law regulating construction or the performance of construction. 'r-f!JW--d/:j I~~ d-/3/6 ':) Signature of Contractor or Authorized Agent Date Signature of Owner (if owner is buiider) Date T:\Policies\l102.15R [1105] .. " U"~ORT"," .l~~~ rfiii ~ -- ~IC~" CITY OF PORT ANGELES PUBLIC WORKS - UTILITIES DIVISION 321 EAST 5TH STREET, PORT ANGELES, W A 98362 '. Application Number pin number Expiration Date . . 04-00000445 .398195 8/02/05 Page Date 2 2/03/05 Qty Unit Charge Per ~xte SJ.O 1.00 95.0000 EA SAN SEWER HOOKUP 95.00.- ----------------------------------------------------------------- ------- 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-El When roof gutters are installed, drains will located in dry wells or piped to approved storm drain locations. Electrical load calculations and elctrical permits are required. Sidewalk to City standards required for school walking route. -- ---------------------------------------------------- ---~ ---~~~~~-Fees . . . . . . . . . SEWER SYSTEM DELV CHARGE l745.00 STATE SURCHARGE 4 ~ PW WATER SYSTEM USE FEE ~025.00' Fee summary Charged Paid Credi ted Due ----------------- ---~--~--- ---------- ---------- ---------- Permit Fee Total 850.00 850.00 .00 _00 Plan Check Total .00 .00 .00 .00 Other Fee Total 1774.50 1774.50 .00 .00 Grand Total 2624.50 2624.50 .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. Ail provisions of laws and ordinances governing this type of work wiil 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\II02.15R [1/05] CITY OF PORT ANGELES DEPARTMENT OF PUBLIC WORKS . . . . . . . . . . . INSPECTION REPORT. . . . . . REQUEST: -I. / / Date ,,/ / z.,.~/ /), ~ Time " " Received by jF (phone, person) /01r1 L-UI1 dMV/ lie- /Z~/f:-JI /231 /1) IZ-!:f- ' Location of Work to be inspected Name of person requesting inspection Address of person requesting inspection Type of Inspection (circle appropriate one): Sewer ,Foundation Framing Chimney Plumbing Phone No, Permit No, Fina~wer EX~ Other c:; f -1 <f_':=; INSPECTION NOTE~: h J Inspected: Date ---'2f--#-?J l~ Time Remarks: ' /rD By f(V RESTORATION REQUIRED . . . . .. YES NO ---- I 4"YV<'- N' t " I itJl" " , t ,P/L I ,- Iv I -- , , "',lq"O J sod l' , cD Phi. rr'~ !,,,,,, MH Wd-?L-~ 1Z.LJ, _ ,~1'" /4.(/1 ~ SURFACE RESTORATION: SURFACE TYPE: 0 Unimproved 0 Gravel 0 Asphalt 0 pcc o Other o Repaired by City o Repaired by Permittee o No Damage Found Work Order # o COMPLETE o INCOMPLETE (Continue on reverse side if necessary) STREET SUPERINTENDENT (DATE) ( )" tv ISl,,'\1g.;z ~ APPLICATION FOR WATER City Water Department Port Angeles, Wash. z.. - S. "'2cXl> I hereby apply for weter to be furni shed in accordance w;th rates and rules of the City far the fallowing pre:? ,. /77~ Name of Applicant 10m &)1(/"")--1//&" J?t?IEoX' /757') . ... PH /~84 J1/ /2 M 1JO-4.24L' z/..(/ a 7- &,?<?7 BI~ Lot--+- A.dd :rf'Q Ou,.3aQ:?&Z-oaxv Meter Numbert j'" - 037- F..d- 0'l0<>8ZZ7- D 5000RIf> Service Left On D Service Left Off Signea-<: ~ P.p t'ffl;jL/ rI !t?4viP- + :I/ce.:s~ Oy- 445'" Address Renewal D Si ze of Servi ce Installed by Remarks: w ~Je"'t -tl.<. 12- - S-r ,I~ N .t: "<-;: 'f) \1. ~ <::, ;f) 97' E '>1 f.-1.u.J. z" c(,st (""" 0 B>.rr., 3' Oeef 12''-1 +~ W r2- s CITY OF PORT ANGELES DEPARTMENT OF PUBLIC WORKS . . . . . . . . . . . INSPECTION REPORT. . . . . . . . . . . REQUEST: / J J.--' Date <;(/71 iPS Time Received by -r;- (phone, person) I -I-J. , 1 /I 1-; ~;A 14):f' r /;?3~ /;2'<- ----.! MtU& - ~I7____'_d...,~dV2<J Location of Work to be inspected Name of person requesting inspection Address of person requesting inspection Type of Inspection (circle appropriate one): Sewer Foundation Framing Chimney Phone No. Permit No. 0,/ . 'Iv S Plumbing Final Sewer Excav. ~ Do/' \ u t................. 'i Time /,,2:S00" ~~ I ~A)~A-":t ~ -,;;d<'-<VaP.k 01::._ ~re. - Po......r -ole::. - '1-1- oS:- r'l1Cc( -01:: 9- g-.-vS: INSPECTION NOTESI ~ Inspected: Date 9j . /)-;- Remarks: RESTORATION REQUiRED...... YES NO SURFACE RESTORATION: SURFACE TYPE: 0 Unimproved OGravel o Asphalt OPCC o Other o Repaired by City o Repaired by Permittee o No Damage Found Work Order # o COMPLETE o INCOMPLETE (Continue on reverse side if necessary) STREET SUPERINTENDENT (DATE) Off ~~T ~Q -~t;,"~~ ~r. ~ -- '1.00:" w;II" CITY OF PORT ANGELES PUBLIC WORKS - UTILITIES DIVISION 321 EAST 5TH STREET, PORT ANGELES, W A 98362 Application Number pin number Property Address ASSESSOR PARCEL NUMBER: Application description Subdivision Name property Use property zoning . . . Application valuation 04-00000445 Date .398195 1234 W 12TH ST 06-30-00-0-3-6830-0000- RES NEW SFR 2/03/05 RESIDENTAL SF 7000 RS7 RESDNTL SINGLE FAMILY 70000 Owner Contractor ------------------------ WA 98362 COLUMBIA PACIFIC P. O. BOX 1750 PORT ANGELES (360) 457-7525 NEW 1416 SF SFR W/ATT 474 SF TYPE V NON-RATED SINGLE FAM & CONGREGATES TOTAL % LOT COVERAGE CONSTRUCTION TYPE NUMBER OF STORIES EXISTING LOT COVERAGE LOT SIZE PROPOSED LOT COVERAGE TOTAL LOT COVERAGE NUMBER OF UNITS BUILDERS INC LUNDERVILLE, THOMAS P.O. BOX 1750 PORT ANGELES (360) 457-6897 Structure Information Construction Type Occupancy Type Other struct info WA 98362 GARAGE 27.10 V-N 1. 00 1. 00 7000.00 1902.00 1902.00 1. 00 ---------------------------------------------------------------------------- Permit Additional desc Permit Fee Issue Date Expiration Date CONCRETE SIDEWALK SCHOOL WALKING ROUTE 70.00 Plan Check Fee 2/03/05 Valuation 8/02/05 .00 o BASE FEE Extension 70.00 Qty Unit Charge Per ---------------------------------------------------------------------------- Permit PUBLIC WORKS RES WATER SERV Additional desc Permit Fee 640.00 plan Check Fee Issue Date 2/03/05 Valuation Expiration Date 8/02/05 .00 70000 Qty 1.00 unit Charge Per 640.0000 EA PW W/M 1" SERV 5/8" METER Extension 640.00 ---------------------------------------------------------------------------- Permit Additional desc Permit Fee Issue Date Expiration Date RIGHT OF WAY 45.00 2/03/05 8/02/05 Plan Check Fee Valuation .00 70000 Qty 1. 00 Unit Charge Per 45.0000 ECH RIGHT OF WAY PERMIT Extension 45.00 ---------------------------------------------------------------------------- permi t . . . . Additional desc Permit Fee Issue Date SANITARY SEWER HOOK UP 95.00 2/03/05 Plan Check Fee valuation .00 70000 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 Owner (if owner is builder) Date Signature of Contractor or Authorized Agent Date T:\Policies\ll02.15R [1/05] PERMIT INSPECTION RECORD CALL 417-4807 FOR UTILITY INSPECTIONS. PLEASE PROVIDE A MINIMUM 24 HOUR NOTICE. IT IS UNLA WFUL TO COVER, INSULA TE 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 I NO PW UTILITIES (Engineering Division) WATERLINE 1 METER SEWER CONNECTION SANITARY STORM SITE DRAINAGE SITE EROSION CONTROL PARKING SIDEWALK CURB & GUTTER DRIVEWAY APPROACH BACK-FLOW DEVICE I I I FINAL INSPECTIONS REQUIRED PRIOR TO OCCUPANCY/uSE RESIDENTIAL DATE YES NO COMMERCIAL DATE ACCEPTED YES NO CONSTRUCTION R. W. 1 PWI CONSTRUCTION - R.W. ENGINEERING 417-4807 PW 1 ENGINEERING FIRE 417-4653 FIRE DEPT. PLANNING DEPT. 417-4750 PLANNING DEPT. BUILDING 417-4815 BUILDING T:\Policieslll 02.15R [1105] " ,;._ ....O~f>QfT..v.~ l~~ ha ~ -- ~-~ CITY OF PORT ANGELES PUBLIC WORKS - UTILITIES DIVISION 321 EAST 5TH STREET, PORT ANGELES, WA 98362 Application Number pin number Expiration Date . . 04-00000445 .398195 8/02/05 Page Date 2 2/03/05 Qty Unit Charge Per 1.00 95.0000 EA SAN SEWER HOOKUP Extension 95.00 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. Electrical load calculations and elctrical permits are required. Sidewalk to City standards required for school walking route. 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 850.00 850.00 .00 .00 plan Check Total .00 .00 .00 .00 Other Fee Total 1774.50 1774.50 .00 .00 Grand Total 2624.50 2624.50 .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,ifcom;truction or work is suspended or Cipandoned 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\II02.l5R [1/05] PERMIT INSPECTION RECORD CALL 417-4807 FOR UTILITY INSPECTIONS. 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 PW UTILITIES (Engineering Division) WATERLINE 1 METER SEWER CONNECTION SANITARY STORM SITE DRAINAGE SITE EROSION CONTROL P ARK.ING SIDEWALK CURB & GUTTER DRIVEWAY APPROACH BACK-FLOW DEVICE I FINAL INSPECTIONS REQUIRED PRIOR TO OCCUPANCYIUSE RESIDENTIAL DATE YES NO COMMERCIAL DATE ACCEPTED YES NO CONSTRUCTION R. W. 1 PW 1 CONSTRUCTION - R.W. ENGINEERING 417-4807 PW 1 ENGINEERING FIRE 417-4653 FIRE DEPT. PLANNING DEPT. 417-4750 PLANNING DEPT. BUILDING 417-4815 BUILDING T:\Policiesll102.15R [1/05] , 07/23/2004 10:53 13504521589 SHAMP ELEC PAGE 02 , 6i "tllle,,,., (~ V Please type Dr ",print in Ink. If you have any questions', please call (360)417-4735 , . ~ ':) fa. number: (360) 417-4711 . ~er or Elee. Contraelor Agent.3ifd1.pP FJ.Ef.TI<J(ltLC ON Tf/tC']7 Nb IU e. Phone: 452 -Ib 8Cl Propert,vowner.J.o\lA6\.hLJbci~k~f I 'It . Address J.D. ~ 1950 CiIY'~t-f~~C~:>B5 ElectIlcal contractor:ClW'r1nP 9.R"TI'IUI1-C[)\.l11!A(.-nNb lI.J<!'. LO""'Me/" Exp: I -1:i-oLl City: .j)~T A\~ M:'.1 FSW'/\ . ELECTRICAL PERMIT APPLICATION FOR omoN.. USE ONLY n..t.nLn:: "Cl"TI;~~: . DileApprClved: Ou~ Iutld: ~ The Elec:trlC31 Perrr'ta ApplicatiM mU!l:t be fill@n nu1 comDletl:!lv. oi - Lj'Lj::: ~ax: 3?rr.-e-- Phone:~ - to0'i1 ZiP;qF3({fl.. Phone'-., %1. -([,Xl1 Zip; Cj33 i7'L 'Address: \)D rr,)( 38?l INSTALI.ATION WIRED BY: o OWNER ~ECTRICAL CONTRACTOR . Credit Card Holder Name: f\!\f\1\ K W. ::>!H111W BillingAddress: CliO W. jO'itJ 5+Y(.d City: .j>o-e..r p..~~ 1.04. Credit Card Number:~ &lg w,031. t31J:1.J.ML EKp. Date:__ Zip: 98310"3 VlsA:ll Me: PROJECT ADDRESs:.....-1 il. 3 Y W. \ 2.-1r\~.5:h-t:L + Ch~ck ~ that apply: ~ew 1YPE OF WORK: ~eSjdential 0 Multi-family o Alteration/Addition o Commercial o Mobile Home Sq. Ft o Remote Meter. 0 Detached garag9 0 Hnt Tub n Swim Pool 0 Septic Pump o Low Voliaqe 0 Telecom. 0 Sigr Number of Circuits added or altered: -r~. ~MrrK DESCRIPTION OF THE ELECTRICAL PROJECT: Electrical Heat Load Additions end or Subtractions Service Information LRA 5Eerhead Servee , mp Service Underground Service Voltage: Phase: 0 1 0 3 Service Size: Feeder Size: o Baseboard o Fumace o Heet Pump o Fan-Wall _KW KW TON KW f hereby certify that / have read and examined this appllcat/on and know that SClme 10 lJe /rut: emu l;um:r.;t, elllU lem authorized to appfy for this permit (understand it is not the City's fegaf responsibility to determine what permits fire re~uired; it remains the applicants responsibiiity to determine what permits are requiffir( "Inri to nhtain .~IJr:h . 1""; ""';'C,"H.""...,"..,~ ~ ~ ~W, V lj.l/-~U) (0.1( Owner Dr Eloc. Cant. Signature: IC'~ Date: t'?> /I) V d1 l {tV> o 1.\ 1, PERMIT FEE: $-..11..'l.,o ~ C:IELECTRICALPERMITAPPWCATION R/J 7/;6/0<1 IElIEC11Rl~CAl ~INlSIPlIEC"f~OINl W~ 1Rl~ INIG IRllElPlOIRrr 417-4735 PERMIT , tJ4-"1"~5 INSPECTOR ~ J/I,<?~ ADDRESS 6~. jZ-3" (...J / z.. ~ .:5Tr APPROVED NOT APPROVED O...................DIT~...................O o .............. ROUGH IN/COVER...... ... ..... 0 o ....... TJi-n/? .. SERVICE ..................;R. o .................... FINAL. . . . .. . . . .. . .. .. . ... 0 CORRECTIONS NEEDED: 0 ~t-c.ri.A'--r- No r 6Jl"CI /'~~- (l) b'""Arf/-' /VI;'- ~LQ,~ ,,~L> D.r'C... (! t!'l<--~- ~_~~z7i</1 ,,4>..c.. ~",a .:S~rc< C' - I CAtd- </17 - 473< w~ t"-P/'h,""',b7T-~ NOTIFY INSPECTOR WHEN CORRECTIONS ARE COMPLETED WITHIN 15 DAYS - DO NOT REMOVE - (1):,,/tJ, e \0 Electrical Contractor Cl Owner +........l'" o Annual Permit 0 Alarm 0 Carnival Q Commercial~ReSldcntial ELECTRICAL WORK PERMIT APPLICATION vcr Request Inspection a Residential Maiol. a Signs (J Thermostat CJ Telecom. Job wired by ~Iectrical Contractor DOwner lnsnlJalion dCl'c:riplion Electrical contractOr nIlmc License number Sl-,lIIiAfi\.P tI-Pr-W\~ftL ('CW'T ~O"E:L('J 1:'-,3 ~'s mailing addr... ~ () P:i:::>'>l.. "",1'1 3 City.... State ZIP BsRT ~l.,.d 0; vJ{J q2'36'L Telephone number tAX numbeT -t1 ( 111)/1 ">C ::::Sfr~~~~' \~~' ::: ~:Mr ~"31 w d sr.'~ ~H . 19XJ City," o Cash 0 Check # I hereby certify that I am (he Owner of the above named property 01' a licensed el~trical contraclor (or the Clrm's 3mhori:led agent) and am making the eleeu'ica] installation or alteration in. compliance wilh (he decrricaI law, Chapter 19.28 RCW. Cl Credit Card VISa Mastercard Discover c~#__~b~___~____ or or electrical I1dminjllntoc Expiration Dare of card x ~ AlJllr\)"~d5y ~eo'er ^,jq?, " ~." CoveT " AllPro"~d By DITCH cs- ~ ^ppro"~By I SERVICE t / A:<O D. ....Ppro'~d By FEEDER D"'l~ ....PplV\ledtly WALLS lnsulation Only CElllNG Insulation Only .1HERMOSTAT *P Approvlld By . PP,o"cdOy Electrical Load Addlllons and or subtractions CJ NO LOAD CHANGES o Baseboard K)N Q Fumace KW Q Heat Pump Ton _ LAA )(I'a"-Wall i KW Service Informaltlon o Overhead Service o Temp Service a Underground Service Voltage PhaseI:J11:J3 Service Size: _ Feeder Size: lnspcction Date "0 Zz. ~ Electrical InspectoT . Area, Building or Equipment inspected AClion T3.kt=n ~ ~fi/p~ LOOILOO ~ X~;j SL :SL ,OOGIGO/SO