HomeMy WebLinkAbout116 E Ahlvers Rd - Building ELECTRICAL PERMIT
CITY OF PORT ANGELES
360-417-4735 C7
Application Number 11- 00000546 Date 6/02/11
Application pin number 251660 REPORT SALES TAX
Property Address 116 E AHLVERS RD on your excise tax form
ASSESSOR PARCEL NUMBER: 06-30-15-3-2-0000-0000- to the City ofPortAn Angeles
Application type description ELECTRICAL ONLY y g
Subdivision Name (Location Code 0502)
Property Use
Property Zoning RS9 RESDNTL SINGLE FAMILY
Application valuation 0
Application desc
100 amp feeder to ball feild
Owner Contractor
INDEPENDENT BIBLE CHURCH OF PA BLACK DIAMOND ELECTRICAL CONTR
112 N LINCOLN ST 502 BLACK DIAMOND RD
PORT ANGELES WA 983622919 PORT ANGELES WA 98363
(360) 565 -1035
Permit ELECTRICAL ALTER COMMERCIAL
Additional desc
Permit pin number 1
Permit Fee 122.50 Plan Check Fee .00
Issue Date 6/02/11 Valuation 0
Expiration Date 11/29/11
Qty Unit Charge Per Extension
1.00 2.6000 ECH EL- BRANCH CIRCUIT W /FEEDER 2.60
1.00 119.9000 ECH EL -0 -200 SRV FEEDER 119.90
Fee summary Charged Paid Credited Due
Permit Fee Total 122.50 122.50 .00 .00 e
Plan Check Total .00 .00 .00 .00
Grand Total 122.50 122.50 .00 .00
co
V
INSPECTION TYPE DATE: RESULTS: INSPECTOR:
DITCH 10 /4 U 1 1,
SERVICE *Ohl—
ROUGH -1N
d
FINAL
111
COMMENTS:
PERMIT WILL EXPIRE SIX (6) MONTI -IS FROM LAST INSPECTION
Signature of owner or Electrical Contractor X .1., 7 Date:
G:AEXCHANGE \BUILDING
i I EV:- IV ED ,--cL„,,,..,,
CITY OF PORT ANGELES PERMIT APPLICATION
t 4 6
Building Division/Electrical Inspections 21I11 rz
321 East Fifth Street P.O. Box 1150 Port Angeles Washington, 98362
b g ELECTRICAL omi
Ph: (360) 417 -4735 Fax: (360) 417 -4711 INSPECTIONS
Date: V-2
1 2 Single Family Dwelling Multi Family or- Commercial* }`.-Commercia!Addition_ AIteration Remodel Repair*
Plan Review May Be-Required, Please Complete Electrical Plan Review Information Sheet
Job Address: 1/ E. A.1LVEIU
Building Square Footage: If
Description of above Ru• PowEA_ A..) Cc"' POW 1 1A F1 E. L -D 71) .Soc. 74• i
Owner Information Contractor Information
Name: 3 G GEfVILG K Name: $G. a KL Vt Ah.ONo E!_[.cr'ucA JT
Mailing•Address: Mailing Address: SIZ. 13c.A tc Pt s}#..n
City: State: Zip: City: r. A State: w>h Zip: 4 7'634 3
Phone: Fax: Phone: 31.0 3957 Fax:
License Exp. License Exp. BLA-e K ft c.- 89 Y D 2
Item Unit Charge Qty Total (Qty Multiplied by Unit Charge)
Service /Feeder 200 Amp. 119.90 t /9 l
Service /Feeder 201 -400 Amp. 145.50
Service /Feeder 401 -600 Amp 204.60
Service /Feeder 601 -1000 Amp. 262.20
Service /Feeder over 1000•Amp. 372.50
Branch Circuit W/ Service Feeder 2.60 1 2 t
Branch CircuitW /O Service Feeder 73.50
Each Additional, Branch Circuit 2.60
Temp. Service /Feeder 200 Amp. 92.70
Temp. Service /Feeder 201 -400 Amp. $110:30
Temp. Service /Feeder 401 -600 Amp. 148.70
Temp. Service /Feeder 601 -1000 Amp 167:90
Portal to Portal Hourly 95.90
Sign /Outline Lighting 88.20
Signal Circuit/ Limited Energy First 1500 sf Commercial 95.90
Note: $5.00 for each additional 1500 sf
Signal Circuit/,Limited- Energy 1. 2 :Family Dwelling 63.90
Signal Circuit Limited -Energy Multi Family,Dwelling 63 :90
Manufactured Home Connection 119.90
Renewable Electrical Energy 5KVA System or Less 102.30
Thermostat 56.00
NEWCONSTRUCTIONONLY:
First 1300 Square Ft. 110.30
Each Additional 500 Square Ft. or Portion of 35.20
Each Outbuilding Detached Garage 73.50
Each Swimming Pool or Hot Tub 110.30
11-2 S'' Total
Owner as defined by RCW.19.28.261: (1) Owner will occupy the structure for two years after this electrical permit.is finalized. (2) Owner is required
to hire an electrical contractor if above said property is for sale, rent or lease. Permit expires after six months of last inspection.
After reading the above statement, I hereby certify that I am the owner of the above named property or a licensed electrical contractor. I am making
the electrical installation or alteration in compliance with the electrical laws, N.E.C., RCW. Chapter 19.28, WAC. Chapter 296 -46B, The City of Port
Angeles Municipal Code, and Utility Specifications and -PAMC 14.05.050 regarding Electrical Permit Applications.
Signature of owner, electrical contractor orelectrical administrator: Cash Chec 013
Credit Card
X �'■44 r
Dated: 1 0110112010
pORT)
Application Number
Application pin number
Property Address
ASSESSOR PARCEL NUMBER
Application type description
Subdivision Name
Property Use
Property Zoning
Application valuation
Application desc
Replace sidewalk driveway entrence
Owner
INDEPENDENT BIBLE CHURCH OF PA
112 N LINCOLN ST
PORT ANGELES
Permit
Additional desc
Permit pin number
Permit Fee
Issue Date
Expiration Date
Fee summary
Permit Fee Total
Plan Check Total
Grand Total
T \1102.15R [1/051
WA 983622919
CITY OF PORT ANGELES
PUBLIC WORKS UTILITIES DIVISION
321 EAST 5TH STREET PORT ANGELES, WA 98362
08 00000760
047800
116 E AHLVERS RD
06 30 15 3 2 0000 0000
PUBLIC WORKS UTILITES
RS9 RESDNTL SINGLE FAMILY
0
Contractor
OWNER
RIGHT OF WAY
REPLACE SIDEWALK DRIVEWAY
128900
00
6/27/08
12/24/08
Plan Check Fee
Valuation
Charged Paid Credited
00 00 00
00 00 00
00 00 00
Date 6/27/08
Due
00
00
00
00
0
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 Signature of Owner (if owner is builder) Date
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
PW UTILITIES (Engineering Division)
WATERLINE METER
SEWER CONNECTION
SANITARY
STORM
SITE DRAINAGE
SITE EROSION CONTROL
PARKING
SIDEWALK
CURB GUTTER
DRIVEWAY APPROACH
BACK -FLOW DEVICE
RESIDENTIAL
CONSTRUCTION RW' PW/
ENGINEERING 417 -4807
FIRE 417 -4653
PLANNING DEPT 417 -4750
BUILDING 417 -4815
T•\Policies \1102.15R'[ 1 /05j
PERMIT INSPECTION RECORD
INSPECTION TYPE DATE ACCEPTED COMMENTS
YES 1 NO
FINAL INSPECTIONS REQUIRED PRIOR TO OCCUPANCY/USE'
DATE' YES. NO COMMERCIAL DATE'- ACCEPTED
YES I- NO
CONSTRUCTION RW
PW ENGINEERING
I FIRE DEPT.
I PLANNING DEPT
BUILDING
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Port Angeles Fire Department
Hood & Duct Suppression System Inspection and Test
Business Name: I 13 C Address:
Suppression System Installed By:
Address: 3:1/3 "S ,.11We. No/"~
Inspected By: d t/ItI
Hood /
IJIJA
Seqfl(t I wA
q3(l1Jq Phone: (200) Z~4- 177. I
Date: ~'C'f-v"" PAFDPermit# 07-66/
B" Seams and joints liquid tight
[;?' Sized to capture and remove vapors
Grease Extractors
Skte
on J 9J Je A- r::1re
[id/ Installed in frames with handles
El Angle of not less than 45 degrees
~6C
L ~. <.A" ~"TV1
Suppression Equipment
~ Approved fire extinguishing system
as-3-dOB -I d~1
~ All cooking surfaces protected
~ System activation shuts off fuel and all electric under hood
f:&l System tied in to building fire alarm system if present
~ Manual pull station in path of exit travel
E(' "K" Class extinguisher provided and mounted
System Test
g] Balloon test
~ Fusible link
~ Manual pull station
System Description: fJ YJ S t..( {
RI02
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CITY OF PORT ANGELES
DEP ARTMENT 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
07-00000715 Date
950720
116 E AHLVERS RD
06-30-15-3-2-0000-0000-
COMM ADDITION
7/13/07
RS9 RESDNTL SINGLE FAMILY
12200
Owner
Contractor
INDEPENDENT BIBLE CHURCH OF PA
112 N LINCOLN ST
PORT ANGELES WA 983622919
OWNER
Other struct info .
HARD SURFACE AREA
Permit BUILDING PERMIT - COMMERCIAL
Additional desc ADD STORAGE ROOM
Permit pin number 104802
Permit Fee 249.75 Plan Check Fee 162.34
Issue Date 7/13/07 valuation 12200
Expiration Date 1/09/08
Qty Unit Charge Per Extension
BASE FEE 95.75
11.00 14.0000 THOU BL-2001-25K (14 PER K) 154.00
Permit MECHANICAL PERMIT
Additional desc
Permit pin number 105957
Permit Fee 60.65 Plan Check Fee
Issue Date 7/13/07 Valuation
Expiration Date 1/09/08
Qty Unit Charge Per
BASE FEE
1. 00 10.6500 ECH ME-OTHER APPL. N/R
.00
o
Extension
50.00
10.65
Special Notes and Comments
06/27/2007 03:41 PM KDuBUC -----------------------------
Sprinklers must be extended into new area.
06/29/2007 05:18 PM SROBERDS --the proposal will result
in the addition of a storage room for a church permitted by
CUP in the RS-9 zone. No land use issues anticipated.
Public Works Utility Engineering has no requirements for
this plan review.
Other Fees
STATE SURCHARGE
4.50
Fee summary Charged Paid Credited Due
----------------- ---------- ---------- ---------- ----------
Permit Fee Total 310.40 310.40 .00 .00
Plan Check Total 162.34 162.34 .00 .00
Other Fee Total 4.50 4.50 .00 .00
Grand Total 477.24 477.24 .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
conC:?~^, 7; V"'?
Signature of Contractor or Authorized Agent Date Signature of Owner (if owner is builder) Date
T:\PoliciesIl102_15 building penilit inspection record05.wpd [1/4/2005]
BUILDING PERMIT INSPECTION RECORD
G
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~
CALL 417-4815 FOR BUILDING INSPECTIONS. CALL 4] 7-4735 FOR ELECTRICAL INSPECTIONS.
CALL 4] 7-4807 FOR PUBLIC WORKS UTILITIES
PLEASE PROVIDE A MINIMUM 24 HOUR NOTICE. IT IS UNLA WFUL TO COVER, INSULATE OR CONCEAL ANJ' WOPJ1 BEFORE
I1VSPECTEDANDACCEPTED. POST PERMIT IN A CONSPICUOUS LOCATlON.
KEEP PERMIT CARD AND APPROVED PLANS AT .lOB SITE.
'J\
INSPECTION TYPE DATE ACCEPTED COMMENTS
YES NO
FOUNDA nON:
FOOTINGS
SHEAR WALLS 1 WALLS
FOUNDATION DRAINAGE 1 DOWN SPOUTS
PIERS
POST HOLES (POLE BLOGS.)
PLUMBING
UNDER FLOOR 1 SLAB
ROUGH-IN
WATER LINE (METER TO BLDG)
GAS LINE FINAL DATE ACCEPTED BY:
-
BACK FLOW 1 WATER -
AIR SEAL 0-
WALLS rt\
CEILING I
FRAMING It} / It'd (), --;r LL
JOISTS 1 GIRDERS , , ~
SHEAR W ALUHOLD DOWNS
...--
WALLS 1 ROOF 1 CEILING <-
DRYW ALL (rNTERJOR BRACED PANEL ONLY) ~
T-BAR
INSULATION
SLAB ~
WALL 1 FLOOR 1 CEILING
MECHANICAL
ROUGH-IN
HEAT PUMP I FURNACE 1 DUCTS
FINAL jO~ 0' /."
GAS LINE DATE J LJ-- ACCEPTED BY:
WOOD STOVE 1 PELLET 1 CHIMNEY
MANUFACTURED HOMES
FOOTING 1 SLAB
...-:'I
BLOCKING & HOLO DOWNS l~
SKJRTING ~. ~
~
PLANNING DEPT. SEPARATE PERMIH's SEPA: -~
PARKING/LIGHTING ESA: .~ ~
LANDSCAPING SHORELINE:
FINAL INSPECTIONS REQUIRED PRIOR TO OCCUPANCYIUSE ~
RESIDENTIAL DATE YES NO COMMERCIAL DATE ACCEPTED
'YES NO ~
ELECTRJCAL .
ELECTRICAL - LIGHT DEPT. 417-4735
LIGHT DEPT
CONSTRUCTION R.W.I PWI CONSTRUCTION - R.W. ~
ENGINEERING 417-4807 PW 1 ENGINEERING
FIRE 417-4653 FIRE DEPT. IIf
1/ II - .
PLANNING DEPT. 417-4750 PLANNING DEPT. I I ~
BUILDING 417-4815 BUILDING /rt$fLl 'IV 0
T:\Policies\II02 15 building penn it inspection record05.wpd [1/4/2005] ;>
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I
1(712/2007) LindaPangrle - Permit Applications 07-756 & 07-715
Page 1;1
From:
To:
Date:
Subject:
Robert Larson
Linda Pangrle
7/2/2007 12:31 PM
Permit Applications 07-756 & 07-715
Hi Linda,
J 07-756 Their neighbor's existing overhead electric service conductor goes right over the proposed construction site. It
does not look as though they will have enough clearance over the new structure to meet code. Their option will be to
relocate the conductor or convert it to underground power.
V 07-715 They will need to maintain truck access to the eXisting pad-mount transformer. This new addition will block the
preferred route.
Both of these notes have been entered in HTE. I chose "Approve with comments". The comments can be found under
"Action Log Inquiry.
Let me know if you need me to reenter them.
Thanks,
Bob Larson
Electrical Engineering Specialist
360-417-4706
rlarson@cityofpa.us
.
~
(WCA S M \ sri a. ceJ. a fouV'\C:~)
"U 0 '" fo(Z'5/01
BUILDING PERMIT - APPLICATION
Fill out COMPLETELY and in INK. Your application and site plan MUST BE /
COMPLETE to be accepted for review. If you have any questions, call f J
PERMITS (360) 417-4815 FAX(360)417-4711
1
FOR OFFICIAL USE ONLY:
Date Rec.: G, -tS""""O\
~m"")~
ate Approve 67
Date Issued:
Applicant or Agent: C~cJL f2; V'l9tjAJ
Owner: / Y\ cL.pQ.n h...f f!nbl-( Clw.v-d?
Address: / / J- /J, 1-,,^ c.q{/J >t-
Architect/Engineer: /=..'1e 5""H> J,)./l...
Contractor I (Z, L I tf)(,J IJ F-!t..
.
Address: I ().... JJ. L jnuP~
Phone:
City: Pl9r{.. ~...k)
De.S'ln )
State License #:
'7;:)- 53S1
Phone: Lr S' 2.. . J J r;/
Zip: QgJ6:l.
Phone: l-t >7- J410
tv/}-
Exp:
W--
Phone:
PROJECT ADDRESS:
//6
5t-
I=- 4I.JLlrr=A )
City: Purl- ~12h J
/<.a II. d
Zip:
ZONING:
'U J6 2.
{(S- q
LEGAL DESCRIPTION: Lot:
CLALLAM COUNTY PARCEL NUMBER:
Block:
Subdivision:
o G ? 01 5 - '3:2.-(5) f) 0
~I 'J-F, per phone <All oJifu chv.:K Bmw VI I~;a~ '-l~ 20& s~ ff-
TYPEOF~ORK: SIZE/VALUATION: J ~ 2ltLf
D ResidentIal 0 New Constr. D Re-roof D Stove . is SF. @$ /SF. = $ -to '2...(,8
D Multi-family o/Addition 0 MoveD Garage ~ SF. @$. /SF. = $ .Ii 'T1J _ ~~ ff
5Y'Commercial 0 Remodel 0 Demolition D Deck ~ SF. @ $_ 5 D =-/SF. = $_ 'I;Z ~ _' .e Zry
D Repair 0 Sign D Other TOTAL VALUAllON $- I z ~ Ii:, 'i-I-) ~.-c
BRIEF DESCRIPTION OF THE PROJECT: , I I IS' ~ ill '1--.
;J. 44 'f ref ~ 4.....,.. /1....... A-J)r~ -I . o~" ~';1 Ilk Mr, h l P c.....ke e~~ ~6~~
COMMERCIALIRESIDENTIAL: Occupancy Group: Occupant Load:. 1~onstruction Type: ~
No. of Stories: i Lot Size: .2:2J J 7Q'l Existing Sq. Ft. I R. 1..).. 5 & Proposed Sq. Ft. '91 = TOTAL Sq. Ft. / ~?
Total lot coverage .,J~ 8',3 % '\\ ./ ----, g /1 q '3
E}...j >'/-.r FIre S rl n K \er S.$ ~\ S;
PLANNING USE ONLY:
APPRO V ALS:
PLAN:
BLDG:
DPWU:
FIRE:
OTHER:_
ESAlWetland(s): 0 Yes 0 No SEPA Checklist required? 0 Yes 0 No Other:
VALUATION OF CONSTRUCTION: In all cases, a valuation amount must be entered by the applicant.
This figure win be reviewed and may be revised by the Building Division to comply with current fee schedules. Contact the Permit
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 permit application and construction plans are
submitted. All other permit fees are due at the time of permit issuance.
EXPIRATION OF PLAN REVIEW: If no permit 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
RI05.3.2 of the International Bui1dingIResidential 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 authorized to
apply for this permit and understand that iUs my responsibility to determine what permits are required ,not the City's, and that I
must obtain such permits prior to work.
T:\FORMS\BldgPermitform.wpd Applicant: ~
Date: 6;;S-/~()7
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FOUNDATION / FLOOR PLAN
1/4" = l'
PAGE
2 //
CITY OF POKT ANU.l:-:LES
FIRE DEPARTMENT PERMIT
321 East 5th Street, .Port Angeles, W A 98362
~
I
0-
0'
Application Number
Application pin number
Property Address
ASSESSOR PARCEL NUMBER:
Tenant nbr, name
Application type description
Subdivision Name
Property Use
Property Zoning . . .
Application valuation
07-00000661 Date 6/11/07
720649
116 E AHLVERS RD
06-30-15-3-2-0000-0pOO-
INDEPENDENT BIBLE CHURCH
HOOD/DUCT SUPPRESSION SYSTEM
-
RS9 RESDNTL SINGLE FAMILY
2765
Owner
Contractor
INDEPENDENT BIBLE CHURCH OF PA
112 N LINCOLN ST
PORT ANGELES WA 983622919
AAA FIRE & SAFETY INC
3013 3RD AVE N
SEATTLE, WA
SEATTLE WA 98109
(206) 284-1721
Permit . . . . .
Additional desc .
Permit pin number
Permit Fee
Issue Date
Expiration Date
BUILDING PERMIT - COMMERCIAL
ANSUL 6.0 GAL RANGE HOOD
104018
109.75 Plan Check Fee
6/11/07 Valuation
12/08/07
. 71.34
2765
-
Qty Unit Charge Per
Extension
95.75
14.00
0'
BASE FEE
1.00 14.0000 THOU BL-2001-25K (14 PER K)
----------------------------------------------------------------------------
-. ....
Permit . . . . .
Additional desc .
Permit'pin number
Permit Fee
Issue Date
Expiration Date
BUILDING PERMIT -
INSPECTION & TEST
10402'6"
25 '00' .
- ~ - - . ;:;.~ , ~, '{
6/11/07
12/08/07
COMMERCIAL
rt-\
," ',;,' ,,,,,;__,,:,, <E ~_<6_ _. ....,~
- ...-"-'-......',. 'i~"
Plan Check Fee
Valuation'
.00
2765
:P
5'
-
Qty
Unit Charge
Per
BASE FEE
Extension.
~,~':OO'"
~.
/Q'
'?
Jl 9'/
.~.~
"-
0,..:)
":s'~ .
-}.9\f\ ~ d
~~ 3'~
.~.~' ~~!~!O
. "0' i5 ~ .~.~
.~.~,~.~ %- 't ~
'.0~%~.
~. "').'
-~ ':S "
(.Q.......-::
,...,
<.
~
~
Fee summary Charged Paid Credited Due
----------------- ---------- ---------- ---------- ----------
Permit Fee Total 134.75 134.75 .00 .00
Plan Check Total 71.34 71.34 .00 .00
Grand Total 206.09 206.09 .00 .00
This permit becomes null and void if work authorized is not commenced within 180 days, if work is suspended or ):>
:5
abandoned for a period of 180 days afer the work has commenced, or if required inspections have not been requested with \.f)
180 days from the last inspection. I hereby certify that I have read and examimrl this application and know the same. to be C
trueand correct. All provisions of recognized standards, laws and ordinances governing this type of work will be compled
wit11whether specified herein or not. Thegr~mting of this permit does not p~esuine to give autKo;:it.Yt6;.\iioiat~\)i'c\andel V)
,;c .... ....... ,., . .' Co' ,.... . c..c
the.provisionso~xi~e;~~;;:;~~~~~11J~~;.;~~~1~;ti~~;;h~~Y::~~~ spec~!}ed in, the':"i.';i','.~' ....,.
~~'l.~L_i;1~(;J.>:j~,( ~~, -'?~-
~,,'..,;,.i".:-.h:~t:...;;..'~,\ .,. . _ _',.., Y,'''' . :;;;:~. .~
~!l!,~'" of Owner (If Owner IS builder l':)t': " D::,,~
FIRE PERMIT INSPECTION RECORD
Call 360-4 I 7-4655 for fire 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 Passed Comments
FIRE SPRINKLER
Underground piping hydrostatically tested
Underground piping flushed
Interior piping hydrostatically tested
Interior piping inspection
Dry system air tested at 40 psi (24 hours)
Sprinkler final
FIRE ALARM
Rough-in inspection
Alarm final
LP-GAS Completed by Contractor:
Underground piping inspection/pressure test Test # I
Above ground piping inspection/pressure test Piping pressure test pSI
Tank (container) inspection Time initiated
Test #2
Appliance inspection Piping pressure test pSI
Time initiated
LP-gas final
UNDERGROUND STORAGE TANK (UST) ABANDONMENT
Removal of flammable/combustible liquids
Tank appropriately abandoned
UST abandonment final
PERMIT OTHER (specify) J
permit final
,
+\000 '. b\l(.. T r\Q.C S"pp~~" \O~ a'2~'o7 .:rof tJ H~ ?AFJ)
GENERAL COMMENTS:
2/15/00
PORT ANGELES FIRE DEPARTMENT
HOOD/DUCT SUPPRESSION SYSTEM PLAN REVIEW
Project Name:
IBC Family Life
Address: 116 East Ahlvers
HID Installer:
Telephone:
System Installer:
AAA Fire and Safety
Telephone: 206 284-1721
Permit # 07 -03
We have checked this plan and find that it conforms to the requirements of our ordinance.
The following items must be noted:
1) The exact location of the manual pull station for the system is not shown. The pull
station must be in the path of exit travel and easily accessible.
2) A "K" class fire extinguisher must be provided along with the system. The extinguisher
must be located in an easily accessible location, with the top no more than 5' off the
floor.
3) The hood and duct fire extinguishing system must be connected to the fire alarm system.
Activation of the suppression system must initiate a fire alarm at the F ACP.
4) A full witnessed acceptance test of the system will be required. This test will include
a balloon test, as well as tests of the fuel/electrical shut-offs, the pull station and the
fusible links.
Reviewed By: ~~~
Date: " . ~ . 0 7
~ Building Department
D Contractor
D Fire Department
BUILDING PERMIT - APPLICATION
FOR OffiCIAL USE ONLY:
Date Rec.: Co - b - 0 '7
Pcrmit#: ()"1 - Co~
Date Approved:~3..::O
Date Issued: ()( () - ( \-07
Fill out COMPLETELY and in INK. Your application and site plan MUST BE
COMPLETE to be accepted for review. If you have any questions, caD
PERMITS (360) 417-4815 FAX(360)417-4711
ere lL 5'~... 202..-" <61.-
Applicant or Agent: A -4 A ;:1/2E ..A AJ,() ~ ;;~ rl/ Phone: ~ ~. 2 ~(I - /7 Z I
. J . I
Owner: I.N/}J.c /l/~ j-...IJ()J~ ~ I /3//3//:,- {;/-!c.lI"1. C H
.
Address: //b ~AST .A;I;t/EI'l.S I?~ City: /ht17 AN9~LF.- ("
ArchitectlEngineer: Phone:
~~3
Contractor :5Titu/.! 'STlto-rH/:/L. Sw.teLicense#:.AAA{r/40ns Exp: //-07 Phone:ZOZ-72.,."
Address: 30/ 3 3"'10 ,Av/! N6. City: 5 If'" rrll!. Zip: ? fl ~ if
PROJECT ADDRESS:-' I Co E - A bJ \/ ev s &J. ZONING:
LEGAL DESCRIPTION: Lot: Block: Subdivision:
CLALLAM COUNTY PARCEL NUMBER:
Phone:
Zip: fflo '7
TYPE OF WORK:
o Residential 0 New Constr. 0 Re-roof 0 Stove
o Multi-family 0 Addition 0 Move 0 Garage
o Commercial 0 Remodel 0 Demolition 0 Deck
o Repair 0 Sign 0 Other
BRIEF DESCRIPTION OF THE PROJECT:
1/<J~T.AII~fI{)JJ ANSvL/210Z. ~'O 6,AIIOJ..J U,L 3~o
;-1000 {'Nt/;. S vtJjP/l.ESSlo~ Sl( Slit. VV\
COMMERCIALlRESIDENTIAL: Occupancy Group: Occupant Load:
No. of Stories: Lot Size: Existing Sq. Ft. & Proposed Sq. Ft.
TotaI lot coverage 0/0
SIZEIVALUATION:
SF. @ $ ISF. == $
SF. @ $ /SF. == $
SF. @ $ ISF. == $
TOTAL VALVA TION $
2..7 (,:s-
.
L-15 T/~JO ~fiP7/=-
Construction Type:
= TOTAL Sq. Ft.
APPROVALS:
PLAN:
BLDG:
DPWU:
FIRE:
OTHER:_
PLANNING USE ONLY:
ESNWetland(s): 0 Yes 0 No SEPA Checklist required? 0 Yes 0 No Other:
VALUATION OF CONSTRUCTION: In all cases, a valuation amount must be entered by the applicant.
This fi~ will be reviewed and may be revised by the Building Division to comply with current fee schedules. Contact the Permit
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 permit application and construction plans are
submitted. All other permit fees are due at the time of permit issuance.
EXPIRATION OF PLAN REVIEW: If no permit 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
RI05.3.2 of the International BuildinglResidential 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 authorized to
apply for tpis permit and understand that it is my responsibility to determine what permits are required ,not the City's, and that I
must obtain such permits prior to work.
APPlicant~ / S;(-~ Date: frJ - if. 0 7
T:\FORMS\BldgPermitAppl.. wpd
[!!] AN~UL I
Flow Summary:
Coverage
Hood: Single Bank
Duct: Square
Duct: Square
Range: 4 burners
Griddle
Range: 4 burners
Total Flow Points
Install Date: undefined
Independent Bible Church
11 6 east Ahivers Rd
Port Angeles, wa 98362
undefined
undefined
AAA Fire And Safety
3013 3rd Ave No.
Seattle, WA 98109
Steve
253-202-7259
AAAFISI140 DS
Ansul R 102 3.0 gallon
Untitled Layout
lAJCt
17x 17 in.
Ncn-Usted iten"t-table
(no hazard)
Nm-Usted item-table
(no hazard)
Nm-Usted item 0Yen
(no hazard)
Overall Dimensions Nozzle
174 x48 in. 1N x2
17x17in. 2W
17x17in. 2W
24 x 24 in. 245
48 x 24 in. 260
24 x 24 in. 245
Flows Nozzle Location
2 0-4 in. from filter face, center of height dimension, aimed down filter length.
2 2-8 in. into center of duct opening, aimed up
2 2-8 in. into center of duct opening, aimed up
2 40 in.-50 in., center of cooking surface, or 11 3/8 in. max to centerline of an ... See Note 1
2 30 in.-50 in., 0-2 in. inside perimeter, aimed at center
2 40 ;n.-50 in., center of cooking surface, or 11 3/8 in. max to centerline of an ... See Note 2
12
PLANS APPHOVED 3Y
l'OHT ANGELES FIH.E DEPT.
~Q.1AD
DAlE: (s).e.Of
~
.-~
SYSTEM DESIGN
The Ansul R-102 Restaurant Fire Suppression System may be
used on a number of different types of restaurant cooking appli-
ances and hood and duct configurations. The design information
listed in this section deals with the limitations and parameters of
this pre-engineered system. Those individuals responsible for the
design of the R-102 system must be trained and hold a current
Ansul certificate in an R-102 training program.
The R-102 and the PIRANHA systems use compatible agents and
components, therefore, they may be used together for cooking
appliance, hood, and duct protection. The primary ANSUL
AUTOMAN Release can be either an R-102 or a PIRANHA
ANSUL AUTO MAN Release and can actuate up to two additional
R-102 or PIRANHA Regulated Actuators. In systems utilizing a
101 remote release, any combination of the maximum number of
regulated actuators can be used.
. Both systems must actuate simultaneously.
. Each system must be designed and installed per its appropri-
ate manual.
. Adjacent appliances requiring protection must be protected
with the same type of system, either R-102 or PIRANHA,
unless the center-to-center spacing between the adjacent
R-102 and PIRANHA nozzles is no less than 36 inches.
. When appliances are protected with R-102 nozzles. the hood
and connecting duct above those appliances cannot be pro-
tected with PIRANHA nozzles.
. Mixing systems in a common plenum is not allowed.
One of the key elements for restaurant fire protection is a correct
system design. This section is divided into ten sub-sections: Noz-
zle Placement Requirements, Tank Quantity Requirements, Actu-
ation and Expellant Gas Line Requirements, Distribution Piping
Requirements, Detection System Requirements, Manual Pull Sta-
tion Requirements, Mechanical Gas Valve Requirements, Electri-
cal Gas Valve Requirements, Electrical Switch Requirements, and
Pressure Switch Requirements. Each of these sections must be
completed before attempting any installation. System design
sketches should be made of all aspects of design for reference
during installation.
~ NOZZLE PLACEMENT REQUIREMENTS
This section gives guidelines for nozzle type, positioning, and
quantity for duct, plenum, and individual appliance protection. This
section must be completed before determining tank quantity and
piping requirements.
Duct Protection - Single Nozzle
All duct protection is UL listed without limitation of maximum duct
length (unlimited length). This includes all varieties of ductworks
both horizontal and vertical including ducts that run at angles to
the horizontal and ducts with directional bends.
The R-102 system uses different duct nozzles depending on the
~ size of duct being protected.
SECTION IV - SYSTEM DESIGN
UL EX. 3470 ULC CEx747 Page 4-1
10-1-02 REV. 5
~ GENERAL INFORMATION
1. Nozzles must be located 2-8 in. (5-20 cm) into the center of the
duct opening, discharging up. See Figure 1.
2-8IN.
(5 - 20 em)
FIGURE 1
000173
2. In installations where a UL listed damper assembly is
employed, the duct nozzle can be installed beyond the 8 in.
(20 cm) maximum, to a point just beyond the damper assem-
bly that will not interfere with the damper. Exceeding the max-
imum of 8 in. (20 cm) in this way will not void the UL listing of
the system.
3. Previously listed 3 flow number and 5 flow number duct pro-
tection detailed in earlier published manual, Part No. 418087-
06, can also still by utilized.
DUCT SIZES UP TO 50 IN. (127 cm)
PERIMETERl16 IN. (41 cm) DIAMETER
. One 1100 nozzle (Part No. 430912) = one flow number
. 50 in. (127 cm) perimeter maximum
. 16 in. (41 cm) diameter maximum
DUCT SIZES UP TO 100 IN. (254cm) _
PERIMETERI 32 IN. (81.3 cm) DIAMETER
. One 2W Nozzle (Part No. 419337) = two flow numbers
. 100 in. (254 cm) perimeter maximum
. 32 in. (81.3 cm) diameter maximum
. A 2WH nozzle (Part No. 78078) must be substituted for a 2W
nozzle for any installation using Option 2 of the 1.5 gallon sys-
tem coverage (duct and plenum protection only). A 2WH nozzle
is limited to a maximum of 75 in. (190 cm) perimeter or a maxi-
mum diameter of 24 in. (61 cm) of coverage.
The chart below shows the maximum protection available from
each duct nozzle.
Part 3.0 Gallon 1.5 Gallon
Description No. System System
2W Nozzle 419337 Maximum Maximum
100 in. (254 cm) 100 in. (254 cm)
Perimeter Perimeter
1100 Nozzle 430912 Maximum Maximum
50 in. (127 cm) 50 in. (127 cm)
~ Perimeter Perimeter
I
I
SECTION IV - SYSTEM DESIGN
UL EX. 3470 ULC CEx747 Page 4-6
REV. 4 10-1-02
Plenum Protection (Continued)
· HORIZONTAL PROTECTION - OPTION 2
1100 NOZZLE - PART NO. 430912 - "V" BANK PROTECTION
1W NOZZLE - PART NO. 419336
One 1100 or 1 W nozzle will protect 6 linear feet (1.8 m) of "V" bank
plenum. The nozzle must be mounted horizontally, positioned 1/3
the filter height down from the top of the filter. Nozzles can be locat-
ed at 6 ft. (1.8 m) spacings on longer plenums. See Figure 10.
1100 NOZZLE OR 1W NOZZlE
1/3 (H) t
HEIGHT OF
FILTER (H)
I_4FT. i -I
(1.2m)
MAXIMUM ~
FIGURE 10
006524
1N NOZZLE - PART NO. 419335 - "V" BANK PROTECTION
Two IN nozzles will protect 10 linear feet (3.1 m) by 4 ft. (1.2 m)
wide of "V" bank plenum. The nozzles must be mounted in the
plenum, 2 to 4 in. (5 to 10 em) from the face of the filter, centered
between the filter height dimension, and aimed down the length.
See Figure 11.
/
000203
I_4FT. (1.2m)_!
MAXIMUM
.
FIGURE 11
For a plenum, either single or "V" bank, with a linear extension
longer than 10 feet (3.1 m). each bank may be protected using one
1N nozzle every 10 ft. (3.1 m) or less depending on the overall
length of the plenum. See Figure 12. The nozzles may point in the
opposite directions as long as the entire plenum area is protected,
and the 10 ft. (3.1 m) limitation is not exceeded. See Figure 13.
The nozzle positioning shown in Figure 14 is not an acceptable
method of protection because the plenum area directly under the
tee is not within the discharge pattern of either nozzle.
10 FT. (3.1 m)/
MAXIMUM
FIGURE 12
000206
10 FT. (3.1 m)/
MAXIMUM
FIGURE 13
000207
FIGURE 14
000206
SECTION IV - SYSTEM DESIGN
UL EX. 3470 ULC CEx747 Page 4-14
REV. 5 10-1-02
Range Protection 2-Flow Nozzle
High Proximity Application (2-Flow Nozzle): 40 in. to 50 in.
(102 cm to 127 cm) above the cooking surface.
~ This high proximity application uses the 245 nozzle, Part No.
419340.
The nozzle tip is stamped with 245 indicating this is a two-flow
nozzle and must be counted as two flow numbers.
One 245 nozzle will protect a maximum cooking area of 672 sq. in.
(4335 sq. cm) with a maximum longest dimension of 28 in. (71
cm).
When using this nozzle for range protection, the nozzle must
~ be pointed vertically down and positioned as shown in Figures
29 and 30.
~
~
~
~
245 NOZZLE TIP LOCATION
CENTERLINE OF COOKING SURFACE
~
t
I
i 1
I 40 IN.
'I (102 em)
MINIMUM
I I HEIGHT
I I OF 245
NOZZLE
hiP
I
J
ool~
c:!E
r
50 IN.
(127 em)
MAXIMUM
HEIGHT
OF 245
NOZZLE
TIP
000236
FIGURE 29
NOTICE
Four burner grates shown in Figure 30. For sin-
gle or double burner grates, locate nozzle at
center of cooking surface or 11 3/8 in. (29 cm)
maximum from nozzle centerline to center of
any burner grate.
COOKING
AREA
mm
m~
~
245 NOZZLE TIP
LOCATION CENTER OF
COOKING SURFACE
OR
11 318 IN. (29 em)
MAXIMUM FROM
CENTERLINE OF NOZZLE
TO CENTER OF ANY
BURNER GRATE
~
245 NOZZLE TIP
LOCATION CENTER OF
COOKING SURFACE
OR
11 318 IN. (29 em)
MAXIMUM FROM
CENTERLINE OF NOZZLE
TO CENTER OF ANY
BURNER GRATE
~
COOKING
AREA
0+0
00
COOKING
AREA
000766
FIGURE 30
2-Flow Griddle Protection (Continued)
Option 2 - Nozzle Perimeter Located
High Proximity Application: 30 in. to 50 in. (76 cm to 127 cm)
above the cooking surface.
This high proximity application uses the 260 nozzle, Part No.
419341.
The nozzle tip is stamped with 260 indicating this is a two-flow
nozzle and must be counted as two flow numbers.
One 260 nozzle will protect a maximum cooking area of 1440 sq.
in. (9290 sq. cm) with a maximum dimension of 48 in. (122 cm).
When using this nozzle for griddle protection, the nozzle must be
positioned along the cooking surface perimeter to 2 in.
(5.1 cm) inside perimeter, and aimed at the center of the cooking
~ surface. See Figure 39 and 40.
I I NOZZLE LOCATION
I I 0-2IN. (0-5em)
I I INSIDE PERIMETER
_I l.- OF COOKING SURFACE
II
I'
If
II
II
II
II
II
EDGE II
OF-II
COOKING I I
SURFACE I I
I I t
I 50 IN.
t, (127 em)
, I MAXIMUM
I I I HEIGHT
/ iP OF 260
.If! _ t NOZZLE TIP
/ J I 30 IN. (76 em)
I / I I MINIMUM
/ I I HEIGHT
I I OF260
/ I I NOZZLE TIP
: I
~
000243
FIGURE 39
000243
SECTION IV - SYSTEM DESIGN
UL EX. 3470 ULC CEx747 Page 4-19
10-1-02 REV. 3
. COOKING AREA
I
+
r-r- MJO;;;;"~--'
I COOKING SURFACE I .. I--
I / I COOK
I I AREA
r--. I AIM POINT I 1
/- . I
L-________-.I
t
I
ING
260 NOZZLE LOCATED ALONG COOKING SURFACE EDGE
ANY SIDE OF GRIDDLE SURFACE
WITHIN 0 - 2 IN. (0 - 5 em) OF
COOKING SURFACE EDGE.
NOZZLE MUST BE AIMED AT MID-
POINT OF COOKING SURFACE.
~
FIGURE 40
000241
,~
. SECTION IV - SYSTEM DESIGN
UL EX. 3470 ULC CEx747 Page 4-52
REV. 2 3-1-04
DISTRIBUTION PIPING REQUIREMENTS (Continued)
Distribution Piping Requirements - 6.0 Gallon Manifolded
System (Continued)
This configuration consists of two 3 gallon tanks. Both tanks are
connected to a common manifold tee and are pressurized from a
single double tank (Part No. 73022) nitrogen cartridge in the reg-
I. ulated release assembly. See Figure 96. Note: A tank mounting
bracket can be utilized instead of the tank/enclosure assembly.
. See Figure 98.
3/8 IN.
BRANCH
3/8 IN ~ 318 IN. j
SUPPlY SUPPLY ~
3/8IN~8INBRANCH
SUPPLY
· Distribution Piping Requirements - 6.0 Gallon System with
Independent Pipe Runs
Independent pipe runs can also be used with the regulated release
assembly and the tank/enclosure assembly. See Figure 97. When
manifolding is not used, each of the two (2) 3 gallon tanks utilize
. the piping limitations of a single tank system.
r~~
F~~
USE HOSEI
GROMMET
PACKAGE
(PART NO.
418511)
HOSEI
GROMMET
PACKAGE
(PART NO.
418511)
D D
D D
3.0
GALLON
TANK
3.0
GALLON
TANK
3~0 GALLON
TANK
OR
1.5 GALLON
TANK
3~0 GALLON
TANK
OR
1.5 GALLON
TANK
DOUBLE TANK
NITROGEN
CARTRIDGE OR
101.30 C02
CARTRIDGE
(LT-A-101-30
CARTRIDGE -
REGULATED
ACTUATOR ONLY)
DOUBLE TANK
NITROGEN
CARTRIDGE OR
(LT-A-101-3O
CARTRIDGE -
REGULATED
ACTUATOR ONLY)
.
I
.
REGULATED RELEASE ASSEMBLY OR
REGULATED ACTUATOR ASSEMBLY
TANKlENCLOSURE
ASSEMBLY
3.0 GAUON REGULATED RELEASE
ASSEMBLY OR 3.0 GALLON REGULATED
ACTUATOR ASSEMBLY
FIGURE 97
000186
TANK/ENCLOSURE
ASSEMBLY
NOTE 1: THE PIPE CONNECTION FROM TANK CENTER TO TANK
CENTER CANNOT EXCEED 8-112 IN. (21.5 em). ALSO.
OEM RELEASE/BRACKET ASSEMBLY CAN BE UTILIZED
WHEN MANIFOLDING 3.0 GALLON TANK.
NOTE 2: ONLY 3 GALLON TANKS CAN BE MANIFOLDED.
.
FIGURE 96
0002n
. SECTION IV - SYSTEM DESIGN
UL EX. 3470 ULC CEx747 Page 4-50
REV. 3 3-1-04
DISTRIBUTION PIPING REQUIREMENTS (Continued)
Distribution Piping Requirements - 3.0 Gallon System
1. The maximum length between the start of the first branch line
and the start of the last branch line must not exceed 24 ft.
(7.3 m). When the supply line is split, the combined total of
both legs of the supply line (from the start of the first branch
line to the start of the last branch line) must not exceed 24 ft.
.. (7.3 m). See Figure 94.
2. The total length of all branch lines must not exceed 36 ft.
.. (10.9 m). See Figure 94.
3. Use a 3/8 in. union to connect the tank adaptor to the 3/8 in.
supply line.
4. A maximum of two nozzles are allowed per duct branch line.
5. The requirements of the following table must not be exceeded:
COMBINED LENGTH OF
BOTH LEGS OF SUPPLY
LINE MUST NOT
EXCEED 24 FT. (7.3 m)
3 BRANCH LINES
(BRANCH LINE IN BOLD)
COMBINED LENGTH MUST
NOT EXCEED 36 FT. (10.9 m)
000502
..
FIGURE 94
Duct Plenum Appliance
Reauirements Suoolv Line Branch Line Branch Line Branch Line
Pipe Size 3/8 in. 3/8 in. 3/8 in. 3/8 in.
Maximum Length 40 ft. 8 ft. 4 ft. 12 ft.
(12.2 m) (2.4m) (1.2 m) (3.7 m)
Maximum Rise 6 ft. 4 ft. 2 ft. 2 ft.
(1.8 m) (1.2 m) (.6m) (.6 m)
Maximum 900 9 4 4 6
Elbows
Maximum Tees 1 2 2 4
Maximum Flow 11" 4 2 4
Numbers
..
-Exceptions:
1. Twelve (12) flow numbers are allowed in anyone tank not containing twcrflow appliance nozzles. and/or, a 1 N nozzle for wok or griddle protection, and/or, a 1 F or 1 N nozzle for
range protection. and/or. a 3N nozzle for fryer protection.
2. Twelve (12) flow numbers are allowed in anyone lank for duct and plenum protection only.
3. Twelve (12) flow numbers are allowed with anyone tank using only two-flow appliance nozzles.
4. Twelve (12) flow numbers are allowed with anyone lank using only th~flow appliance nozzles.
Speclallnslructions:
1. Twelve (12) flow numbers are allowed when four (4) Dean Industries GTI Gas Fryers are protected at low proximily as shown in Figure 58 on Page 4-32. The discharge piping
must be as shown in Figure 59 on Page 4-32.
2. For oerlain McDonald's applications. 11.5 flow numbers are allowed when using a oombination of one (1) 2W duct nozzle, one (1) 112N electrostatic precipitator nozzle,
one (1) 1 N planum nozzle, and four (4) two-fIow appliance nozzles. Contacl Ansul Applications Engineering Department for additional information.
..
..
..
CITY OF PORT ANGELES
FIRE DEPARTMENT PERMIT
321 East 5th Street, Port Angeles, WA 98362
Application Number
Application pin number
Property Address
ASSESSOR PARCEL NUMBER:
Tenant nbr, name
Application type description
Subdivision Name
Property Use
Property Zoning . . .
Application valuation
06-00000891 Date 4/02/07
890037
116 E AHLVERS RD
06-30-15-3-2-0000-0000-
INDEPENDENT BIBLE CHURCH
COMM NEW CONST
CQ
~
I
~
.-0
RS9 RESDNTL SINGLE FAMILY
-r400000 hB) qq2>
Owner
Contractor
INDEPENDENT BIBLE CHURCH OF PA
112 N LINCOLN ST
PORT ANGELES WA 983622919
OWNER
Other struct info .
TOTAL % LOT COVERAGE
NUMBER OF STORIES
EXISTING LOT COVERAGE
LOT SIZE
PROPOSED LOT COVERAGE
TOTAL LOT COVERAGE
NUMBER OF UNITS
13.70
1. 00
18225.00
221799.00
12092.00
30317.00
1. 00
Permit . . . . .
Additional desc .
Permit pin number
Permit Fee
Issue Date
Expiration Date
. .
FIRE SPRINKLER COMM
COMM FIRE SPRINKLER
97949
803.25 Plan Check Fee
4/02/07 Valuation
9/29/07
522.11
68998
Qty
Unit Charge
'.
19.00
7.0000 THOU
BASE FEE
BL-50,OOl-100K (7.00 PER K)
Extension
670.25
133.00
Per
Permit . . . . .
'Additional desc .
Permit pin number
Permit Fee
Issue Date
Expiration Date
FIRE SPRINKLER COMM
98608
100.00 Plan Check Fee
4/02/07 Valuation
9/29/07
.00
68998
-
--
CS'
BASE FEE
Extension
100.00
fihqL
o 0/
D_SO
-0>
~
Qty Unit Charge Per
Other Fees
STATE SURCHARGE
4.50
=+>
.:t::..
.<
fl(
~
s:
Special Notes and Comments
Address numbers shall be plainly visible from 'the street.
Address numbers shall be a minimum of six inches high and be
of contrasting color from the background.
Fee summary Charged Paid Credited Due
----------------- ---------- ---------- ---------- ----------
Permit Fee Total 903.25 903.25 .00 .00
Plan Check Total 522.11 522.11 .00 .00
Other Fee Total 4.50 4.50 .00 .00
Grand Total 1429.86 1429.86 .00 .00
This permit becomes null and void if work authorized is not commenced within 180 days, if work is suspended or
abandoned for a period of 180 days afer the work has commenced, or if required inspections have not been requested with
180 days from the last inspection. I hereby certify that I have read and examine:! this application and know the same to be
true and correct. All provisions of recognized standards, laws and ordinances governing this type of work will be compled
with whether specified herein or not. The granting of this permit does not presume to give authority to violate or cancel
the provisions of any state or local law regulating the work specified in the perm it.
(}~ Lt/~/O/ --,'
Signature of Contractor or Authorized Agent Date S}gnature of Owner (if Owner is builder) Date
~
..
* ~~
-b:J.
FIRE PERMIT INSPECTION RECORD
Call 360-417-4655 for fire 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
FIRE SPRINKLER
Underground piping hydrostatically tested
Underground piping flushed
Interior piping hydrostatically tested
Interior piping inspection
Dry system air tested at 40 psi (24 hours)
Sprinkler final 8.30 -01 l~
FIRE ALARM
Rough-in inspection
Alann final
LP-GAS Completed by Contractor:
Underground piping inspection/pressure test Test # 1
Above ground piping inspection/pressure test Piping pressure test pSI
Time initiated
Tank (container) inspection Test #2
Appliance inspection Piping pressure test pSI
Time initiated
LP-gas final
UNDERGROUND STORAGE TANK (UST) ABANDONMENT
Removal of flammable/combustible liquids
Tank appropriately abandoned
UST abandonment final
PERMIT OTHER (specify)
permit final
Inspection Type
I Date Passed I
Comments
GENERAL COMMENTS:
2/15/00
,--------
PORT ANGELES FIRE DEPARTMENT
102 East Fifth Street, Port Angeles, Washington 98362
(360) 417-4650 FAX (360) 417-4659
Fire Sprinkler System Plan Review
Project Name: mc Address: 116 East Ahlvers
Installer: Knight Fire Protection Installer Telephone: 417-0505
Type of System: Wet and Dry 13[ZJ 13RO 13 DO
Date: 3.26.2007 PAFD Permit #: 07-12
We have checked this plan and find that it conforms to the requirements of the code.
1. The owner is responsible for the ongoing inspection, testing and maintenance of this
system.
Additional Comments:
All systems, including underground mains, shall be installed by a state licensed and certified
company. Systems shall be installed per the applicable NFP A Standard.
All electrical components shall be compatible with the fire alarm system.
All underground piping must be inspected and hydrostatically tested by the Port Angeles Fire
Department PRIOR to being covered. A witnessed flush of the underground piping is required.
Before final acceptance of the system, an inspection will be conducted to ensure that the
installation complies with the applicable NFP A Standard.
Contractor
Reviewed by: _~j Q(J djiJ
Date: ~ .~~ '0 "7
o
~
o
Building Department
Fire Department
BUILDING PERMIT - APPLICATION
FOR OFF1ClAL YSE OtjLY:
Date Rec.: "3 ab I 07
, I
Pennit #: /?G .- fj9 J
Date Approved:
Date Issued:
Fill out COMPLETELY and in INK. Your application and site plan MUST BE
COMPLETE to be accepted for review. If you have any questions, call
PERMITS (360) 417-4815 FAX(360)417-4711
Applicant o~Agent: Phone: or ~ f/ h. ]) (I
Owner: I h ~ !t1 c.- / /, Phone: 3 kJI fr-L - ) 3 S- J
Address: /)'-.. I!/ -LitJ14 r+ City: I~ Zip: 761 bJ
Architect/Engineer: t:::' y.t!'S 17YJ ? "at:' J"':7.1j Phone: .
Con1ractor \LlIJJ OIt r tllte ~T. State License #: \4iII.tl- A'o't!L( EXP:$
Address: ;?~('A IA)~ \0 \1, ~ City: l?-rv- ~~) )1Pft-
PROJECT ADDRE.SS: \ I t. 13~-T ~~ ~tJ
LEGAL DESCRIPTION: Lot: Block:
Phone:A\l"'S-~
Zip '92sst.~
ZONING: '#f -
,
Subdivision:
CLALLAM COUNTY PARCEL NUMBER: (l ~ 301'-- J2-cJt1:/ ()
TYPE OF WORK: /
~esidential ;t'New Constr. D Re-roof D Stove
D ulti-family D Addition D MoveD Garage
Commercial D Remodel D Demolition D Deck
D Repair D Sign D Other
BRIEF DESCRIPTION OF THE PROJECT:
G/?'11l1CY1 CA I
SIZEN ALUATION:
SF. @ $ /SF. = $
SF. @ $ /SF. = $
SF. @ $ /SF. = $
TOTAL VALUATION $
I
ItJ@.1 4'Cfr? -
,)pJ2/Vk.) If/f
Pi J"~
COMMERClAL/RESIDENTIAL: Occupancy Group:
No. of Stories: Lot Size: Existing Sq. Ft.
Total lot coverage %
Occupant Load:
& Proposed Sq. Ft.
Construction Type:
= TOTAL Sq. Ft.
APPROVALS:
PLAN:
BLDG:
DPWU:
FIRE:
OTHER:
PLANNING USE ONLY:
ESAlWetland(s): DYes D No SEPA Checklist required? DYes D No 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 tlle 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 permit application and construction plans are
submitted. All other permit fees are due at the time of permit issuance.
EXPIRATION OF PLAN REVIEW: If no permit 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
R105.3.2 of the International Building/Residential Code, 2003). No application can be extended more than once.
I hereby certify that I have read and e
apply for this permit and understand t
must obtain such permits prior to war.
ined this application and know the same to be true and correct. I am authorized to
t tis my responsibility to determine what permits are required ,not the City's, and that I
1 tj-f-: v~{{)V'tt
l/ Date: 3 v~ tJ
T:\FORMS\BldgPermitform.wpd Applicant:
?~f-J) 01-1 z....
CITY OF PORT ANGELES.
FIRE DEPARTMENT PERMIT
321 East 5th Street, Port Angeles, WA 98362
Application Number
Application pin number
Property Address
ASSESSOR PARCEL NUMBER:
Tenant nbr, name
Application type description
Subdivision Name
Property Use
Property Zoning . . .
Application valuation
06-00001238 Date 12/11/06
310312
116 E AHLVERS RD
06-30-15-3-2-0000-0000-
INDEPENDENT 'BIBLE CHURCH
FIRE ALARM SYSTEM
INDEPENDENT BIBLE CHURCH OF PA
112 N LINCOLN ST
PORT ANGELES WA 983622919
FEDERAL FIRE SAFETY
2032 SOUTH 0 STREET
PORT ANGELES WA 98363
(360) 457-3308
~
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RS9 RESDNTL SINGLE FAMILY
16495
Owner
Contractor
Permit . . . . .
Additional desc .
Permit pin number
Permit Fee
Issue Date
Expiration Date
FIRE ALARM SYSTEM
90704
150.00 plan Check Fee
12/11/06 Valuation
6/09/07
.00
o
Qty
1. 00
1. 00
Unit Charge Per
100.0000 ECH FIRE INSPECTION & TESTING
50.0000 ECH FIRE ALARM PLAN REVIEW
Extension
100.00
50.00
Special Notes and Comments
Owner is responsible for ongoing fire alarm system
inspection and maint~~ance per the current addition of NFPA
72.
A full acceptance test will be required for all fire alarm
systems.
11/28/2006 10:48 AM KDUBUC -----------------------------
11/28/2006 10:48 AM KDUBUC -----------------------------
Per City of Port Angeles Code, since this is a fully
sprinklered building, OK to eliminate heat detectors.
Owners option to eliminate or not.
11/28/2006 10:52 AM KDUBUC -----------------------------
System to be tied into kitchen fire suppression system if
installed.
Fee summary Charged Paid Credited Due
----------------- ---------- ---------- ---------- ----------
Permit Fee Total 150.00 150.00 .00 .00
Plan Check Total .00 .00 .00 .00
Grand Total 150.00 150.00 .00 .00
~
~
~~
~
~
~
~~
~
h~
~
~
This pennit becomes null and void if work authorized is not commenced within 180 days, if work is suspended or
abandoned for a period of 180 days afer the work has commenced, or if required inspections have not been requested with
180 days from the last inspection. I hereby certify that I have read and examine:l this application and know the same to be
true and correct. All provisions of recognized standards, laws and ordinances governing this type of work will be compied
with whether specified herein or not. The granting of this permit does not presume to give authority to violate or cancel
the provisions of an)' state or local law regulating the work specified in the permit.
~~ /d/II!...D6
Signature of Co ractor or Authorized Agent' Date Signature of Owner (if Owner is builder) Date <::....
I
FIRE PERMIT INSPECTION RECORD
Call 360-417-4655 for fire 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
FIRE SPRINKLER
Underground piping hydrostatically tested
Underground piping flushed
Interior piping hydrostatically tested
Interior piping inspection
Dry system air tested at 40 psi (24 hours)
Sprinkler final
FIRE ALARM
Rough-in inspection
. .
Alarm final
LP-GAS Completed by Contractor:
Underground piping inspection/pressure test Test #1
Above ground piping inspection/pressure test Piping pressure test psi
Tank (container) inspection Time initiated
Test #2
Appliance inspection Piping pressure test psi
Time initiated
LP-gas final
UNDERGROUND STORAGE TANK (UST) ABANDONMENT
Removal of flammable/combustible liquids
Tank appropriately abandoned
UST abandonment final
PERMIT OTHER (specify)
permit final ~/3o/o( kb
Inspection Type
I Date Passed I
I.
Comments
GENERAL COMMENTS:
2/15/00
PORT ANGELES FIRE DEPARTMENT
FIRE ALARM SYSTEM PLAN REVIEW
Project Name: mc Multi Purpose Building
Address: 116 Ahlvers
Plan # 06-10 I Installer: Federal Firesafety I Date: 11.28.2006
We have checked this plan and find that it conforms to the requirements of our codes and
ordinances, with the following comments:
1) Per Port Angeles code, OK to eliminate heat detection ion a fully sprinklered building.
Owners' option to delete or not.
2) System to be tied to kitchen fire suppression system if installed.
This system is monitored by an off-site central station monitoring company. The building must
be equipped with a KNOX locking keybox.
Contact the Fire Department at 417-4653 for a KNOX order form and for mounting location
information.
The following comments apply to all systems:
1. All systems shall be installed per NFP A 72.
2. A final field acceptance test will be conducted before final approval. The field
acceptance test will be a test of ALL system components.
NOTE: Prior to the issuance of a Certificate of Occupancy, compliance with the above
conditions must be met.
Reviewed by:
~&~
\
Building Department Copy
Date:
It. zg . 0 6
~
o
o
o
Contractor/ Owner Copy
Fire Department Copy
Light Department
BUILDING PERMIT - APPLICATION
Fill out COMPLETELY and in INK. Your application and site plan MUST BE
COMPLETE to be accepted for review. If you have any questions, call
PERMITS (360) 4] 7-4815 FAX(360)417-4711
Applicant or AgenN'A L -r 1-1 A F e:=.----K:. Phone: 3<00 - lfS7 - 3'3 0 ~
Owner: \~O~~J~ 'R1"P:.l ~ C-i-1-VU2 L.H Phone:~ -l(~z- fit q(
Address: \ t"2- ~ b I L ( N c..OL 0 City: R~\ AjJ& (EL CS; ~ Zip: q~#3 <0 Z-
Architect/Engineer: Phone:
FeD6R..F I \8"(p t>d' lfS ~ _
Contractor ~ ~L- F, tZe::AFryState License #: Exp: ?; - 7-~~ Phone: 7 s"3 (.J {}
Address: It e~-n-{<" l'LA L~ City: Seq v I,,^, W A . Zip: q~ S <:;( L.
PROJECT ADDRESS: l' ~ A LV se...~ f2-D ZONING: /f~ -9
LEGAL DESCRIPTION: Lot: Block:
CLALLAM COUNTY PARCEL NUMBER:
Subdivision:
Credit Card Holder Name:
Billing Address:
Credit Card Type VISA
TYPE OF WORK:
o Residential .....g] New Constr. 0 Re-roof 0 Stove
o Multi-family"'1li Addition 0 Move 0 Garage
o Commercial 0 Remodel 0 Demolition 0 Deck
o Repair 0 Sign 0 Other
BRIEF DESCRIPTION OF THE PROJECT: F\ 12~ A L~-L'"
City:
MC
#
Exp. Date:
SIZE/v ALUATION: ad
SF. @ $ /SF. = $ /? f9C::;- -
SF. @ $ /SF. = $ I .
SF. @ $ /SF. = $
TOTAL VALUATION $
P<41>J \c::.i ~//
No. of Stories: Lot Size:
Total lot coverage
Existing Sq. Ft.
Occupant Load:
& Proposed Sq. Ft.
Consl1uction Type:
I
I
~
COMMERCIAL/RESIDENTIAL: Occupancy Group:
%
= TOTAL Sq. Ft.
PLANNING USE ONLY:
APPROVALS:
PLAN:
BLDG:
DPWU:
FIRE:
OTHER:_
ESA/Wetland(s): 0 Yes 0 No SEPA Checklist required? 0 Yes 0 No 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 Permit 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 peront application and constlUction plans are
submitted. All other peront fees are due at the time of permit issuance.
EXPIRATION OF PLAN REVIEW: 1fno pemnt is issued witl1in 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 lntemational 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 correct. I am authorized to apply for this permit and
understand that it is my responsibility to determine what permits are required ,not the City's, and that I must obtain such permits prior to work.
T:\RVESS\BLDG-forms-brochures\2004-Buildingpermit.wpd APPlican~b~~ Date: \ \ - 14" - 2DOt,f'
s
"- --
~~
CITY OF PORT ANGELES
DEPARTMENT OF COMMUNITY DEVELOPMENT - BUILDING DIVISION
321 EAST 5TH STREET, PORT ANGELES, WA 98362
Application Number
Application pin number
Property Address
ASSESSOR PARCEL NUMBER:
Tenant nbr, name
Application type description
Subdivision Name
Property Use
Property Zoning . . .
Application valuation
06-00001121 Date 10/11/06
162335
116 E AHLVERS RD
06-30-15-3-2-0000-0000-
PART OF #06-891
MECHANICAL APPL. PERMIT
RS9 RESDNTL SINGLE FAMILY
o
Owner
Contractor
INDEPENDENT BIBLE CHURCH OF PA
112 N LINCOLN ST
PORT ANGELES WA 983622919
OWNER
Permit . . . . .
Additional desc .
Permit pin number
Sub Contractor
Sub Contractor
Permit Fee
Issue Date
Expiration Date
MECHANICAL PERMIT
KITCHEN HOOD & SURPRESSION SYS
88856
AAA FIRE & SAFETY INC
KESSLER BROTHERS CONST. INC.
.00 Plan Check Fee
10/11/06 Valuation
4/09/07
.00
o
Fee summary Charged Paid Credited Due
----------------- ---------- ---------- ---------- ----------
Permit Fee Total .00 .00 .00 .00
Plan Check Total .00 .00 .00 .00
Grand Total .00 .00 .00 .00
g
/);
d' < y'Zc 0/
'0
:>
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-certifythat-lhave-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. /::J 1) fiIJ
~ cf)d :LJ.2rs06
Signature of Contractor or Authorized Agent Date Signature of Owner (if owner is builder) Date
T:\Policies\1102_15 building pennit inspection record05.wpd [1/412005]
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 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
I YES NO
FOUNDATION:
FOOTINGS ~
SHEAR WALLS 1 WALLS ~
\
FOUNDATION DRAmAGE/DOWNSPO~ -
PIERS ~
POST HOLES (POLE BLDGS.) -
PLUMBING
UNDER FLOOR 1 SLAB
ROUGH-m
WATER LmE (METER TO BLDG)
GAS LmE FmAL DATE ACCEPTED BY:
BACK FLOW 1 WATER
AIR SEAL
WALLS
CEILmG
FRAMING
JOISTS 1 GIRDERS
SHEAR W ALUHOLD DOWNS
WALLS 1 ROOF 1 CEILmG
DRYWALL(mTE~ORBRACEDPANELONL~
T-BAR
INSULATION
SLAB
WALL 1 FLOOR 1 CEILmG I
MECHANICAL
HEAT PUNW 1 FURNACE 1 DUCTS
GAS LINE -'1
WOOD STOVE 1 PELLET 1 CHIMNEY FmAL DATE ACCEPTED BY: ~
COMMERCIAL HOOD 1 DUCTS
MANUFACTURED HOMES
FooTmG 1 SLAB ~ j
BLOCKmG & HOLD DOWNS
SKIRTING
PLANNING DEPT. SEPARATE PERMIT#'s SEPA: ~
P ARKlNG/LIGHTING ESA:
LANDSCAPING SHORELmE: ~--
FINAL INSPECTIONS REQUIRED PRIOR TO OCCUPANCYIUSE ~
RESIDENTIAL DATE YES NO COMMERCIAL DATE ACCEPTED
YES NO
ELECTRICAL - LIGHT DEPT. 417-4735 ELEC~CAL
LIGHT DEPT
CONSTRUCTION R. W. 1 PW 1 CONSTRUCTION - R.W.
ENGINEERmG 417-4807 PW 1 ENGmEERmG
FIRE 417-4653 6'2~ '01 \~. FIRE DEPT.
PLANNmG DEPT. 417-4750 J PLANNmG DEPT.
BUILDmG 417-4815 ( BUlLDmG
T:IPolicieslI102_15 building pennit inspection record05.wpd [1/412005] '4 l~"r Fi OJ4Jo!. tf~"L
~
~
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~
~
fJ'f F' f p,,- :J
PORT ANGELES FIRE DEPARTMENT
HOOD/DUCT SUPPRESSION SYSTEM PLAN REVIEW
Project Name: Independent Bible Church
Address: 116 East Ahlvers
HID Installer: TRS Custom Stainless Steel
Telephone: (253) 444-1555
System Installer: AAA Fire and Safety
Telephone: (253) 202-7259
Permit # 06-02
We have checked this plan and find that it conforms to the requirements of our ordinance.
The following items must be noted:
1) The exact location of the manual pull station for the system is not shown. The pull
station must be in the path of exit travel and easily accessible.
2) A "K" class fire extinguisher must be provided along with the system. The
extinguisher must be located in an easily accessible location, with the top no more
than 5' off the floor.
3) The hood and duct fire extinguishing system must be connected to the fire alarm
system. Activation of the suppression system must initiate a fire alarm at the
FACP.
4) A full witnessed acceptance test of the system will be required. This test will include
a balloon test, as well as tests of the fuel/electrical shut-offs, the pull station and the
fusible links.
~ Building Department
o Contractor
o Fire Department
Reviewed By: ~~ .0.0
Date: Ic.9.. 0 b
..~/.....
~~'~~r.--tw~.
~~l
{''l: r.woo-- ~! I
,- '--"~~I
\"~
"~
BUILDING PERMIT - APPLICATION
Fill out COMPLETELY and in INK. Your application and site plan MUST B
COMPLETE to be accepted for review. lfyou have any questions, call
PERMITS (360) 417-4815 FJ.-X(360)417-4711
Phone:
'-t S:l. .. 15'1
It >'2. .'J>/
Zip: CJ ~ J{:2
1- ~ ~ '.2.:2 - 444f
Applicant or Agent: audlJ3~~CJV
I Owner: /Y\lJ...ytw..JwJ. /$,tbloL ~
I Address: 112- AI. L.~ ( '6 Clty: P ()".:J- ~
I .
I Arcl1itect/Engjneer: aaV-,rl.4..AJ j; I',~ r"... lAc-
'Contractor lIS <:.... State License #:
I
Address: a ~ ~bc,"-L
PROJECT ADDRESS: III,
Phone:
Phone:
Exp:
Phone:
I LEGAL DESCRIPTION: Lot:
I CL'\LLAM COUNTY P1\RCEL NUMBER:
I
City:
jJJ,/~J R-j I P~t'-~~'~)
Block:
Zip:
ZONING:
R S- Cf
Subdivision:
a'- "3"-/)- "3 - 2. - 0ll906- O()~O
TYPE OF WORK.:
[] Residential ~ew Constr. 0 Re-roof 0 Stove
[] Multi-family 0 Addition 0 MoveD Garage
VCommercial 0 Remodel 0 Demolition 0 Deck
o Repair 0 Sign 0 Other
BRIEF DESCRIPTION OF THE PROJECT: It ~~# A/
-h, .,.. /8 c ~'y L,.+. ~ C...A",..
SIZENALUATION:
SF. @$ /SF. = $
SF.@$ /SF.=$
SF. @ $ /SF. = $
TOTAL VALUATION $
R.11LhlLUc+ /J..,pjJ tJo....I F.'r-e.. Suire Jt}u/ ryIh-,.
COlVliVIERClAL/RESIDENTLU: Occupancy Group:
Occupant Load:
& Proposed Sq. Ft.
Construction Type:
= TOT.AL Sq. Ft.
No. of Stories: Lot Size:
Totallo! coverage
Existing Sq. Ft.
%
ESAlWetland(s):DYesDNo SEPAChecklistrequired?D Yes 0 No Other:
APPROVALS:
PLAN:
BLDG:
DPWU:
FIRE:
OTHER: .
l)LANNING USE ONLY:
VALUATION OF CONSTRUCTION: In all cases, a valnation 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 Permit
Coordinator at 417-4815 for assistance.
PLA.!~ CHECK FEE: IF a plan check fee is due it must be submitted at the time the building permit application and construction plans are
submitted. All other permit fees are due at the time of permit issuance.
EXPIRAT10N OF PLAN REVIEW: lfno permit is issued within 180 days of the date of application, the application will expire. The
Buiiding Official can extend the time for action by the applicant up to 180 days upon written request by the applicant (see Section
RI05.3.2 of the International Building/Residential Code, 2003). No application can be extended more than once.
I her9by certify that I have read and examined this application and know the same to be true and correct. J am authorized to
apply for this permit and understand that itis my responsibility to dete/mine what permits are required ,not the City's, and that /
must obtain such permits prior to work.
ToIFORMSID1'lgPomUno=wpd Appli,""o CR B ~ Daleo -V ;? t :4J&6
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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 F.A..x(360)417-4711
Phone:
'-t S:l. .. 1S1
It >"2. <JJ>I
Zip: Cf '(J{2
1- &w - 1.2:2.. Lt4l.t1
Applicant or Agent: CkdLBV'-19CJ~
Owner: INr1.tfQN...J~ f,.'bl-L ~
Address://2-- AI. L~ (6 City: p()~ ~
i\.rcllltectlEngineer: fJav-,rl..e.AJ f; / I '~ rd'" /^'-
Contractor I IS C State License #:
I Address: t:l S i21H\I-L City:
PROJECT ADDRESS: /1' AJ../vcr-J kj t P~t'-f. ~,~,J
LEGl'~ DESCRIPTION: Lot: Block: Subdivision:
CL'\LLL\M COUNTYPARCELNUJ.v1BER: 0'- "3~-/)-' - 2 ... CJrC)D6- O()CI)O
Phone:
Phone:
Exp:
Phone:
Zip:
ZONING:
RS-~
TYPE OF WO:RK:
o Residential ~ew Constr. 0 Re-roof 0 Stove
o Multi-family 0 Addition 0 Move 0 Garage
VCommercial 0 Remodel 0 Demolition 0 Deck
o Repair 0 Sign 0 Other
.BRIEF DESCRIPTION OF THE PROJECT: It. i"~' It/
f;, .... I (l,c. ~ ~'y Ltf. ~ C...k,.
SIZENALUATION:
SF. @'$ /SF. = $
SF. @ $ /SF. = $
SF. @ $ /SF. = $
TOTAL VALUATION $
/2.JLhlLU.c+ JJ...r!)J A...J F.?e.- SY.~ JOUJ ..ry..rle.t..
Existing Sq. Ft
Construction Type:
= TOTAL Sq. Ft.
COIvIMERCIAL/RESIDENTL<\L: Occupancy Group:
Occupant Load:
& Proposed Sq. Ft.
No. of Stories: Lot Size:
Total lot coverage
%
ESAlWetland(s): 0 Yes 0 No SEPA Checklist required? 0 Yes 0 No Other:
APPROVALS:
PLAN:
BLDG:
DPWU:
FlRE:
OTHER: .
PLANNING USE ONLY:
VALUATION OF CONSTRUCTION: In all cases, a valuation amount must be entered by the applicant.
Tills figure will be reviewed and may be revised by the Building Division to comply with current fee schedules. Contact the Permit
Coordinator at 417-4815 for assistance.
PLA_N CRECK FEE: IF a plan check fee is due it must be submitted at the time the building permit application and construction plans are
submitted. All other permit fees are due at the time of permit issuance.
EXPIRATION OF PLAN REVIEW: lino permit 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
R105.3.2 of the lnternational 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 correct. J am authorized to
apply for this permit and understand that itis my responsibility to dete/mine what permits are required ,not the City's, and that I
must obtain such perm<<s prior to worn. _) D
T:\FORMS\DldgPrnuitform.wpd Applicant: ~, Date: __f~';2 ,? ~6
CITY OF PORT ANGELES
DEP AR TMENT OF COMMUNITY DEVELOPMENT - BUILDING DNISION
321 EAST 5TH STREET, PORT ANGELES, WA 98362
Application Number
Application pin number
Property Address
ASSESSOR PARCEL NUMBER:
Application type description
Subdivision Name
Property Use
Property Zoning . . .
Application valuation
05-00000562 Date
893640
116 E AHLVERS RD
06-30-15-3-2-0000-0000-
RE-ROOF
7/06/05
RS9 RESDNTL SINGLE FAMILY
36631
Owner
Contractor
INDEPENDENT BIBLE CHURCH OF PA
112 N LINCOLN ST
PORT ANGELES WA 983622919
HATHAWAY CONSTRUCTION
309 W. 7TH STREET
PORT ANGELES
PORT ANGELES WA 98362
(360) 457-5627
~
Permit . . . . .
Additional desc .
Permit pin number
Permit Fee
Issue Date
Expiration Date
BUILDING PERMIT - NO PR FEE
53827
535.95
7/06/05
1/02/06
'"
Plan Check Fee
Valuation
.00
36631
?
~
<
'0
~
C0
Qty Unit Charge Per
12.00
BASE FEE
10.1000 THOU BL-25,001-50K (10.10 PER K)
Extension
414.75
121. 20
Other Fees
DOUBLE PERMIT FEE
STATE SURCHARGE
535.95
4.50
Fee summary Charged Paid Credited Due
----------------- ---------- ---------- ---------- ----------
Permit Fee Total 535.95 535.95 .00 .00
Plan Check Total .00 .00 .00 .00
Other Fee Total 540.45 540.45 .00 .00
Grand Total 1076.40 1076.40 .00 .00
~
/0 ~
~ q/
~ y@ '"
S V
Separate Permits are required for electrical work, SEPA, Shoreline, ESA, utilities, private and public improvements. This permit becomes
nu II 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.
-0.>
Signature of Owner (if owner is builder)
Date
T:\Policies\ 1102_15 building"p~pnit inspection record05.wpd [1/4/2005]
~
I
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 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
WALLS
FOUNDATION DRAINAGE 1 DOWN SPOUTS
PIERS
POST HOLES (POLE BLDGS.)
PLUMBING
UNDER FLOOR 1 SLAB
ROUGH-IN
WATER LINE (METER TO BLDG)
GAS LINE
BACK FLOW 1 WATER
AIR SEAL
WALLS
CEILING I
FRAMING
JOI:iTS / GIRDERS
SHEAR W ALUHOLD DOWNS
WALLS 1 ROOF 1 CEILING
DRYW ALL (lNTERIOR BRACED PANEL ONLY)
T-BAR
INSULATION
SLAB
Vi ALL 1 FLOOR 1 CEILING I I
MECHANICAL
HEAT PUMP 1 FURNACE 1 DUCTS
GAS LINE
WOOD STOVE 1 PELLET 1 CHIMNEY
COMMERCIAL HOOD 1 DUCTS
MANUFACTURED HOMES
FOOTING 1 SLAB
BLOCKING & HOLD DOWNS
SKlRTING
PLANNING DEPT. SEPARATE PERMIT II's SEPA:
I' ARKING/LIGHTlNG ESA:
LANDSCAPING SHORELINE:
FINAL INSPECTIONS REQUIRED PRIOR TO OCCUPANCY/uSE
RESIDENTIAL DATE YES NO COMMERCIAL DATE ACCEPTED
YES NO
ELECTRICAL - LIGHT DEPT. 417-4735 ELECTRICAL
LIGHT DEPT
CONSTRUCTION R.W. 1 PWI CONSTRUCTION - R.W.
ENGINEERING 417-4807 PW 1 ENGINEERING
FIRE 417-4653 FIRE DEPT. 4
PLANNING DEPT. 417-4750 PLANNING DEPT. I / 1# f1
BUILDING I/D/'" /,.- '/II ~ ~
BUILDING 417-4815 :// S// I.
T:\Policies\ 1102_15 building permit inspection record05. wpd [1/4/2005] / t VI
r1 pORT ~
5
na
11:.--
~~
CITY OF PORT ANGELES
DEPARTMENT OF COMMUNITY DEVELOPMENT - BUILDING DNISION
321 EAST 5TH STREET, PORT ANGELES, WA 98362
Application Number
pin number
Property Address
ASSESSOR PARCEL NUMBER:
Application description
Subdivision Name
Property Use
property zoning . . .
Application valuation
04-00001104 Date
.386128
116 E AHLVERS RD
06-30-15-3-2-0000-0000-
CLEARING & GRADING
11/30/04
RS9 RESDNTL SINGLE FAMILY
o
Owner
Contractor
INDEPENDENT BIBLE CHURCH OF PA
112 N LINCOLN ST
PORT ANGELES WA 983622919
OWNER
Structure Information PLAY GROUND GRADING
Permit
Additional desc
Permit Fee
Issue Date
Expiration Date
CLEAR & GRADE
PLAYGROUND GRADING
22.50 Plan Check Fee
11/30/04 Valuation
5/30/05
.00
o
Qty Unit Charge Per
1.00 22.5000 MIN CLEAR & GRADE
Extension
22.50
Special Notes and Comments
Phase I Construction; Grading of proposed Play Field.
Fee summary Charged Paid Credited
----------------- ---------- ---------- ----------
Permit Fee Total 22.50 22.50 .00
Plan Check Total .00 .00 .00
Grand Total 22.50 22.50 .00
Due
~
.00
.00
.00
\t\
~
f
Of)
10
~
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:\PLANNING\FORMS\1102.15 [11/14/2003]
BUILDING PERMIT INSPECTION RECORD
CALL 417-4815 FOR BUILDING INSPECTIONS. CALL 417-4735 FOR ELECTRICAL 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
I YES I NO
FOUNDATION:
FOOTINGS
WALLS
FOUNDATION DRAJNAGElDOWN SPOUTS
ELECTRICAL (LIGHT DEPT) SEPARATE PERMIT: 1/
ROUGH-IN
PLUMBING
UNDER FLOOR / SLAB
ROUGH-IN
WATER LINE (METER TO BLDG)
GAS LINE
BACK FLOW / WATER
AIR SEAL
WALLS
CEILING
FRAMING
JOISTS / GIRDERS
SHEAR W ALLlHOLD DOWNS
WALLS / ROOF / CEILING
DRYWALL (INTERIOR BRACED PANEL ONLY)
T-BAR
INSULATION
SLAB
WALL / FLOOR / CEILING I
MECHANICAL
HEAT PUMP
GAS LINE
WOOD STOVE / PELLET / CHJMNEY
HOOD / DUCTS
PW UTILITIES / SITE WORK (Engineering Division) SEPARATE PERMIT /I's:
WATERLINE / METER
SEWER CONNECTION
SANITARY
STORM
PLANNING DEPT. SEPARATE PERMIT I/'s SEPA:
P ARKlNGILIGHTlNG 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:\PLANNINGIFORMS\1102.15 [I 1/1412003]
e
~
~~
CITY OF PORT ANGELES
DEPARTMENT OF COMMUNITY DEVELOPMENT - BUll..DING DMSION
321 EAST 5TH STREET, PORT ANGELES, WA 98362
Application Number
Application pin number
Property Address
ASSESSOR PARCEL NUMBER:
Tenant nbr, name
Application.,typ,e, 'dE;$C~iptioQ.
subdivisi6rl."NaI1\li~...\:.. . ..~ . .:'..
Property ua~,. : {.;: .~.,
Property ZelIll.ng.. ~.,.. I
Applica~ion. valuatiort .
~~ ~~ "~" '1~.. ,,' ....~.:<.':"~....:
Owner . .
06-00000991 Date
273892
116 E AHLVERS RD
06-30-15-3-2-0000-0000-
IND. BIBLE CHURCH
CO~ FOUNDATION ONLY
(-., . . '.' . ~., \ ..
,
9/11/06
~
~
~
~
RS9 RESDNTL SINGLE FAMILY
o
. .
"
Contractor
INDEPENDENT BIBLE CH.~.cll:})F p;. r. :.:.. \.b~ER
112 N LINCOLN ST
PORT ANGELES
WA 983622919
Permit . . . . .
Additional desc .
Permit pin number
Permit Fee
Issue Date
Expiration Date .
BUILDING PERMIT - COMMERCIAL
86678
.00
9/11/06
3/10/07
Plan Check Fee
Valuation
.00
o
Other Fees
STATE SURCHARGE
4.50
Fee summary Charged Paid Credited Due
----------------- ---------- ---------- ---------- ----------
Permit Fee Total .00 .00 .00 .00
Plan Check Total .00 .00 .00 .00
Other Fee Total 4.50 4.50 .00 .00
Grand Total 4.50 4.50 .00 .00
--..
--
~
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(0
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3'2 ~f
o
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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 after the work as commenced, or if required inspections have not been requested within 180 days from the last
. Inspection. . I'hereby-certity that-l 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 0
T:\Policics\J 102_15 building pennil inspection record05.wpd [1/412005]
~
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
I YES NO
FOUNDATION: I t?/ 'O/I/".jk, /() /to ~ -(/iN
FOOTINGS I q /'''2--/0~ ~ 'L A <fl<-10)~/66 ~
SHEAR WALLS 1 WALLS 1 I , Wft::k~ d-z.-~-/~J;"lb' F8
FOUNDA nON DRAINAGE 1 DOWN SPOUTS ~/It{1 pt, :1~
PIERS ~'~/~OL.~ (oro ~
POST HOLES (POLE BLDGS.)
PLUMBING
UNDER FLOOR 1 SLAB
ROUGH-IN
WATER LINE (METER TO BLDO)
GAS LINE FINAL DATE ACCEPTED BY:
BACK FLOW 1 WATER
AIR SEAL
WALLS I
CEILING I
FRAMING
JOISTS 1 GIRDERS
SHEAR W ALL/HOLD DOWNS
WALLS 1 ROOF 1 CEILING
DRYWALL (INTERJOR BRACED PANEL ONLY)
T-BAR
INSULATION
SLAB I I
WALL 1 FLOOR 1 CEILING I
MECHANICAL
HEAT PUMP 1 FURNACE 1 DUCTS
GAS LINE
WOOD STOVE 1 PELLET 1 CHIMNEY FINAL DATE ACCEPTED BY:
COMMERCIAL HOOD 1 DUCTS
MANUFACTURED HOMES
FOOTING 1 SLAB
BLOCKING & HOLD DOWNS
SKIRTING
PLANNING DEPT. SEPARATE PERMIT#'s SEPA:
PARKING/LIGHTING ESA:
LANDSCAPING SHORELINE:
FINAL INSPECTIONS REQUIRED PRIOR TO OCCUPANCY/uSE
RESIDENTIAL DATE YES NO COMMERCIAL DATE ACCEPTED
YES NO
ELECTRJCAL - LIGHT DEPT. 417-4735 ELECTRJCAL
LIGHT DEPT
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. I f
BUILDING 417-4815 BUILDING 1-:z./7?1) /6' I /\
T:IPoliciesl1102_15 building permit inspection record05.wpd [1/4/2005] or 1 I II v
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WAS H I N G TON. U. S. A.
EXTENDED PERMIT INSPECTIONS
PROJECT: ItJDepF3N DI3IJ7 b! eift Cl/VIl6~IT # : a,.qq /
1. FOUNDATIONS:
ACCEPTED BY:
COMMENTS:
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,--
BUILDING PERMIT - APPLICATION
Fill out COMPLETELY and in INK. Your application andsite plan MUST BE
COMPLETE to be accepted for review. If you have any questions, call
PERMITS (360) 417-4815 FAX(360)417-4711
Applicant or Agent: ~ f> iNc.tJ/
Owner: Ih~<wt~t {),-bf-f CkY'~
Address: II ;L N- L'h~ ~ City: Ar~~
ArchitectlEngineer: ~.a..$ ~~ IOO..L<)l^", / 2'~{/\ ~
Contractor I /3 C (r')-v~ ) State License #: -
Address:
S <lL.W1 e.
City:
J{ {; ~ 4-J.J~ .s &-
p~
Phone: y S2-~17,5 / J >.> (
Phone: L.t ~.J-.... J; .>t
f~ Zip: qt 36 2-
Phone: l..t>7-;J'-7tD
Exp: Phone:
Zip:
ZONING:
PROJECT ADDRESS:
LEGAL DESCRIPTION: Lot:
CLALLAM COUNTY PARCEL NUMBER:
Block:
Subdivision:
TYPE OF WORK:
o Residential 0 New Constr. 0 Re-roof 0 Stove
o Multi-family 0 Addition 0 Move 0 Garage
o Commercial 0 Remodel 0 Demolition 0 Deck
o Repair 0 Sign 0 Other
BRIEF DESCRIPTION OF THE PROJECT:
FPt.lN"&>A-7~o"..j &:,qt. y
SIZEN ALUATION:
SF. @'$ /SF. = $
SF. @ $ /SF. = $
SF. @ $ /SF. = $
TOTAL VALUATION $
J!Z:;p/ ~ /NI#.
No. of Stories: Lot Size:
Total lot coverage
Construction Type:
= TOTAL Sq. Ft.
COMMERCIAL/RESIDENTIAL: Occupancy Group:
Occupant Load:
& Proposed Sq. Ft.
~ Existing Sq. Ft.
%
ESAlWetland(s): 0 Yes 0 No SEPA Checklist required? 0 Yes 0 No Other:
APPROVALS:
PLAN;
BLDG:
DPWU:
FIRE:
OTHER:_
PLANNING USE ONLY:
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 Permit
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 permit application and construction plans are
submitted. All other permit fees are due at the time of permit issuance.
EXPIRATION OF PLAN REVIEW: If no permit 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
R105.3.2 of the International BuildinglResidential Code, 2003). No application can be extended more than once.
I hereby cerrity 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 ,not the City's, and that I
must obtain such permits prior t~ ~rk. O' \ [) ^
T:\FORMS\BldgPermitform.wpd Applicant: ___fJKY~ \ate: ~ I /(J 6
, . I
:If pORT ~
J'""O~~~
r'Gii
L~
~
"l,\1C~
CITY OF PORT ANGELES
PUBLIC WORKS - UTILITIES DIVISION
321 EAST 5TH STREET, PORT ANGELES, WA 98362
Application Number
Application pin number
property Address
ASSESSOR PARCEL NUMBER:
Tenant nbr, name
Application type description
Subdivision Name
Property Use
property Zoning . . .
Application valuation
05-00001097 Date 11/14/05
825347
116 E AHLVERS RD
06-30-15-3-2-0000-0000-
INDEPENDENT BIBLE CHURCH
CLEARING & GRADING
RS9 RESDNTL SINGLE FAMILY
o
Owner
Contractor
INDEPENDENT BIBLE CHURCH OF PA
112 N LINCOLN ST
PORT ANGELES WA 983622919
OWNER
Structure Information 000 000 BLDG SITE WORK
Permit . . . . .
Additional desc .
Permit pin number
Permit Fee
Issue Date
Expiration Date .
CLEAR & GRADE
CLEARING & GRADING #05-20
64907
60.00 Plan Check Fee
11/14/05 Valuation
5/13/06
.00
o
BASE FEE
Extension
60.00
............
...........
\)'
Qty Unit Charge Per
Fee summary Charged Paid Credited Due
----------------- ---------- ---------- ---------- ----------
Permit Fee Total 60.00 60.00 .00 .00
Plan Check Total .00 .00 .00 .00
Grand Total 60.00 60.00 .00 .00
~
~
~
,
(\
1
"\
~
p-
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\ II 02.15R [1/05]
I
PERMIT INSPECTION RECORD
CALL 417-4807 FOR UTILITY 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
YES NO
PW UTILITIES (Engineering Division)
WATERLINE / METER
SEWER CONNECTION
SANITARY
STORM
SITE DRAINAGE
SITE EROSION CONTROL
PARKING
SIDEW ALK
CURB & GUTTER
DRIVEWAY APPROACH
BACK-FLOW DEVICE
FINAL INSPECTIONS REQUIRED PRIOR TO OCCUPANCYIUSE
RESIDENTIAL DATE YES NO COMMERCIAL DATE ACCEPTED
YES NO
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 02.15R [1105]
HTE: o5-tDCf7 L. Z-D Page 1
C & G APPLICATION No, 0 :/ ...
CLEARING AND GRADING PERMIT APPLICATION
CITY OF PORT ANGELES
i..,')~(')('nl,/7/'AJ-r- _ /, ,J/
APPLICANT: V //};J o;v j/ j::../v / CliO rt L If
APPLICANT MAILING ADDRESS: 1/2- ST.
APPLICANT PHONE NUMBER: Ly '6;).-- '33 S- cHuck....
PLAN PREPARER(ArchltectlEnglneer): C$.NO/))C ~ A~~cx:-';.qTr~ I J Nc",
PREPARERADDRESS&PHONE#:5/'o/ S, ;>{;~=<,ar::>y ~. #1--2-. r&tlT J1/fVf,-;t.ts, 1A/71 98)62.
.. ",...
LOCATION OFPROPOSAL(slIeel8ddress or lot & block .): // h E, A fit. U.f, fZ.-C; c;: t.
, ,OWNER OF PROPERTY(1f not eppIicant, Include letter of aulhorlz8tion from~ owner): / M?~ (/6f1) D .E{VT I~) 15 L Y
)
. DESCRIPTION OF PROPOSAL (Also Include p1ans,.ketchtiS or other information which would aaalst In our review): S E:. ~ -
/jUaof)ts: i-EIJEUN~ O~ p(20~oSeO t3(j)6, SlTt~ SP/lf;::Jf);N6 &kcK>)
ftIAThz/4L ' OA) JtJkU-) 'fL-I\J>- r:/f,L D AND A!JP/N6 JfL;ct 70 ,,301-11'
MI sr, f?t<JI0/::-J6Vht-or AN)~ LA.JE5TM.L)/ -Er/VTa,Y d/):4n
Estimated amount of material, in cubic yards, ~o be excavated, imported, or exported:
2"100 ~ ( MI:>v-c.A. ~-c;lk/
1\0 . UoI.j)d r1- 0.... ~ "fu-A- ) .
,If the answer to any of the following questions is yes, an ESA application with a SEPA check list is required to be submitted with
this application and will be processed according to the City's consolidated pennit procedures. ' .
1. Is the excavation or: fill associated with the development of a par1<ing lot for more than 20 vehides? NO
2. Does the total amount of excavation or fill exceed 100 c.y ? ., I M '
3. .~Oany portion of the grading, excavation or filling occur within 200 feet of any of the following; AJO ,Shoreline, () Stream,
, ': 40% or grater slope? If the answer to" yes, please check t!'e appropriate condition. ..',' , :,.,.,',; ,
.. . . .. . . I i'"-...,.
The, applicant hereby affirms and commits that the i1iformatio,n submitted for this permit application is acciurate and 'that the ap'p;(cantwilf' .
comply with the terms and conditions c;af the pennit and the city of Port Angeles Clearing and Grading Ordinance.
orized representative)
(Date)
The following pag.. are fo'r City use only:
PERMIT EXEMPTION DUE TO:
o NOT EXEMPT: C & G PERMIT REQUIRED '
c A. ' Land clearing, grading, filling, sandbagging, diking, ditching, or similar work during or after periodS of extreme weather or other emergency
conditions that present immediate danger to life or property, as authorized by the City Engineer. '
c B. Land clearing order, by the City Council for abatement of a publiC nuisance.
c C. Removal of deed, diseased, or damaged trees which might constitute a hazard to life or property; ,
c D. Clearing by a public agency of a franchised utility within a publiC right-of-Way or upon an easement, for the purpose ~ Installing and maintaining
. water, storm, sewer, power, cable, or communications lines. .
c E. Cemetery graves.
NOTE: EXEMPTIONS "P' THRU .... SHALL NOT APPLY IN SITUATIONS WHERE PROPERTIES INCLUDE ENVIRONMENTALLY SENSITIVE
AREAS '
c F. Land Is one acre or less, except where an adjacent area under the same ownership or chain of ownership has been similarly exempted so that
the combined area Is a greater than one acre and erosion control has not been re-established.
c G. If a building permit Is Issued, no additional clearing, grading, or filing permit or associated fee will be required; provided that the standards
established In this manual shall be applied to the issuance of said building permll
c H. Developments larger than one acre In Improved areas served by paved streets, curbs, gutters, storm drains, and other drainage fadlities, 8S
authorized by the City engineer. .
c I. Work, wilen ,approved by the City Engineer, In an Isolated, self-contained area, If there Is no danger to private or public propert{.
The proposed action has been determined to be exempt from a Clearing and Grading Permit based upon the information
provided by the applicant. The basis for this exemption is as checked above.
,
, ~emor .t"Janner
'Date
CIty Engmeer
Date
/. ()/J'
I:;-(_"f. _
,-
Page 2
Permit No.c5- ZO
Clearing and Grading Permit
PERMIT CONDITION REVIEW ROUTING:
o To Public Works for Engineering requirements Date
o To Planning Department (with engineering's requirements)
For ESA and SEPA requirements. Date
o Return to Engineering Permitting.
o Copy of conditions to applicant
Date
Date
,
,.
Additional plan review for changes, additions or revisions to approved
plans at $30 per hr. reg. and $60 per hr. overtime.
,.
SEPA review ($100)
$
$
$
Total Permit & SEA Review Fees
III. PERMIT APPROVAL:
This certifies that the named applicant is granted a Clearing
and Grading Permit for the work described and the purpose
shown in the application. This permit is granted subject to the
terms of the agreement contained in the application, subject to
the terms of the provisions of the City of Port Angeles
Municipal Code and subject to all special conditions which are
attached to this permit or as noted in sections IV thru VIII
following. Nothing permitted hereunder shall be deemed to
override the provisions of any applicable law of the City,
County, State or Federal Government. This permit expires
one year from the date of issuance, unless otherwise
specified by the City Engineer
'i&L~
/0,5/ -de-
Date
SZ:.-PA )062. 'OS
E. / S Cbr-n f1 L2-J~ oIJ 8.L i Y72 E-. .
p,,-'2b .r~c:t:
ND lut'?-IH~ S~,q. f!..evIEL<-J
!<<E-yV)/~ .
SEE REVERSE SIDE FOR PERMIT CONDITIONS
j
.
CITY OF PORT ANGELES LIGHT DEPARTMENT
321 E. Fifth Street
Port Angeles, WA 98362
(206) 457-0411
Site Address:
PERMIT NO. SOR3
S//PJ
DATE
Installed By:
o READY FOR
INSPECTION
License Number:
o WILL CALL FOR
INSPECTION
Phone:
Owner/Business:
Owner/Business Address:
ELECTRIC HEAT
o BASEBOARD KW _
o FURNACE KW _
o HEAT PUMP KW_
o FAN/WALL KW
o RESIDENTIAL
o COMMERCIAL
o NEW CONSTRUCTION
o REMODEL
~ ADD/ALTER CIRCUITS
o SERVICE UPGRADE/REPAIR
o TEMPORARY SERVICE
DetailslDescription:
Phone:
Sq. Ft.
o RISER
o OVERHEAD SERVICE
o UNDERGROUND SERVICE
VOLTAGE:
019\ 039\
SERVICE SIZE
FEEDER SIZE
AMPS
AMPS
W.M.R f~ /~~
.
W.S. No. SERVICE SIZE
CAPACITY:
o O.K. 0 NOT o.K.
ACTION REQUIRED: 0 CHANGE TRANSFORMER
o INSTALL SERVICE POLE
DATE
ENGR.
o OVERHEAD SERVICE APPROVED
o CHANGE SERVICE WIRE
o OTHER
o Ditch Inspection O.K.
o Rough-in/cover O.K.
o O.K. to connect service
~FinaIO.K.
Site Address:
----
.J
Notify Port Ang es City Light by Street Address and Permit Number when ready for inspection. Work must not be covered
before inspection and O. K. for covering has been given by the electrical inspector in writing on either the Wiring Report
or on the Building ~t. PHONE 457-0411, EXT. 224.
o ~ NO OCCUPANCY OR USE ESTABLISHED UNDER TH!S PERMIT # 3 0
, $
Electrical Inspector
19/'~
[
Installer:
,
.
WHITE - File by address
PINK - Top: Eng, Bottom, Customer
OLYMPIC PRINTERS INC.
Permit/Receipt No.
so6'3
New Meters
-
Permit Fee
GREEN - Top: MeIer Dept., Bottom: City Hall
4t"
CITY OF PORT ANGELES
LIGHT DEPARTMENT
ELECTRICAL PERMIT
PERMIT NO. ';::;$.:J 7
.;t/~/7'O
.
DATE
Site Address:
o READY FOR
INSPECTION
o WILL CALL FOR
INSPECTION
Phone:
Installed By:
-4'19
OwnerfBusi nass:
Phone:
Sq. Ft.
o Residential
Heat KW
o Baseboard 0 Furnace/Boiler
o Heatpump 0 Other
o Commercial/Industrial load
Total Connected load
(attach breakdown)
Total Motor load
(attach breakdown)
o New Construction
o Remodel
o Service update/alter/repair
o Overhead
o Underground
Voltage
01.0 03.0
Service size
o Temporary
o Add/alter circuits
o Auxiliary power
(list below)
9(Special equipment
(list below)
Amps
DetailslDescriptlon:
k/ U"~t:
Iff/' /JC
-f~,4-k ~,,/, ,
.
W.S. No. Service
Capacity: 0 O.K. 0 Not O.K.
o Ditch inspection O.K.
o Rough-in/cover O.K.
o O.K. to connect service
~ Final O.K.
~
Size
Comments
Date
Hold for: 0 Easement 0 Letter
o Signed up for service/meter
o Meter Department notified for installation
o Fire Department notified of inspection
o Plan Review approved/pending
Permit/Receipt No.
New Meters
o
-
.
Notify the Department of City Light by Street Address and Permit Number when ready for inspection. Work
must not be covered or electrically energized before inspection and O.K. for covering or service has been given
by the Inspector in Writing on the Wiring Report or the Building Permit. PHONE 457-0411, EXT.158 or EXT. 224.
T ~ NO OCCUPANCY OR USE ESTABLISHED UNDER THIS PERMIT j!f td:?C1!!fJ
Inspector Amount paid
WHITE - file by address YELLOW - file by number PINK - Top: Eng, Bottom: Customer GREEN - Top: Inspector, Bottom: City Hall
OLYMPIC PRINTERS. INC.
.'
Site Address:
Installed By:
Owner/Business:
Owner/Business Address:
o Residential
Heat KW
o Baseboard 0 Furnace/Boiler
o Heatpump 0 Other
o Commercialllndustrial load
Total Connected load
(attach breakdown)
Total Motor ioad
(attach breakdown)
Detai Is/Description:
CITY OF PORT ANGELES
LIGHT DEPARTMENT
PERMIT NO. t52y6/
/.x~RH?
,
ELECTRICAL PERMIT
DATE
o READY FOR
INSPECTION
License Number:
ILL CALL FOR
INSPECTION
Phone:
Phone:
Sq. Ft.
o New Construction
o Remodel
o Service update/alter/repair
o Overhead
o Underg~nd
Voltage . l:Ii'... j
01.0 03.0'
Service size
o Temporary
Amps
o Add/alter circuits
o Auxiliary power
(list below)
~ Special equipment
/' (list below)
/f~ 7(~
.
W.S, No. Service
Capacity: 0 O.K. 0 Not OK
o Ditch inspection OK
o Rough.in/cover OK
o O.K. to connect service
~ Final O.K.
Site Address:
~ It. .5
Installer:
~
Size
Comments
Date
Hold for: 0 Easement 0 Letter
o Signed up for service/meter
o Meter Department notified for installation
o Fire Department notified of inspection
o Plan Review approved/pending
~
New Meters
Notify the Department of City Light by Str t Address and Permit Number when ready for inspection. Work
must not be covered or electrically energized before inspection and O,K. for covering or service has been given
by the Insoector in Writing on the Wiring Report or the Building Permit PHONE 457.0411, EXT.158 or EXT. 224.
r- / A- NO OCCUPANCY OR USE ESTABLISHED UNDER THIS PERMIT ~t7!fj!!
Inspector Amount paid
WHITE - file by address YELLOW - tile by number PINK - Top: Eng, Bottom: Customer GREEN - Top: Inspector, Bottom: City Hall
..
. .
OLVMPIC PRINTERS, INC.
Installed By:
CITY OF PORT ANGELES
LIGHT DEPARTMENT
PERMIT NO.
".2..30 7
/0 //0 HP
,
I.:)
, J'
ELECTRICAL PERMIT
DATE
Site Address:
o READY FOR
INSPECTION
License Number:
~WILL CALL FOR
INSPECTION
Phone:
Owner/Business:
Phone:
Owner/Business Address:
Sq. Ft.
o Residential
Heat KW
o Baseboard 0 Furnace/Boiier
o Heatpump 0 Other
fjl Commercial/Industrial load
Total Connected load
(attach breakdown)
Total Motor load
(attach breakdown)
'Ii New Construction
o Remodel
o Service update/alter/repair
o Add/alter circuits
o Auxiliary power
(list below)
o Special equipment
(list below)
o Overhead
~ undergroun%._?
Voltage /610 C-'O
,
o 10 ~30
Service size /600 Amps
o Temporary
e..
DetailslDescription:
~l~1
../1 ;).
*'-3
-11,/
-#s
/0. t, ICW
IS. V /(w
/S. Y KuJ
IS.,! ew
.I..~ r ):w
'1tR btJ
~ " Kw
;;2" ):1.()
.;l , /( t.V
7D-hA../
COVAJFC..nrl /t!)~d
3/0 kc.u
9 - reu/U d:lJ4-rl,,$;.~
1/
W.S. No. Service Size
Capacity: 0 O.K. 0 Not O.K. Comments
o Ditch inspection O.K.
o Rough.in/cover O.K.
~ O.K. to connect service
~ Final O.K.
Date
Hold for: 0 Easement 0 Letter
o Signed up for service/meter
o Meter Department notified for installation
o Fire Department notified of inspection
o Plan Review approved/pending
Site Address:
PermitfReceipt No.
Installer:
~.
OJ
.
Notify the Dep rtm t of City Light by Street Address and Permit Number when ready for inspection. Work
must not be covered or electrically energized before inspection and O.K. for covering or service has been given
by the Inspector in Writing on the Wiring Report or the Building Permit. PHONE 457.0411. EXT.158 or EXT. 224.
---r~.J NO OCCUPANCY OR USE ESTABLISHED UNDER THIS PERMIT 1;;2 ~~ 60
I nspector Amount paid
WHITE - file by address YELLOW - file by number PINK - Top: Eng, Bottom: Customer GREEN - Top: Inspector, Bottom: City Hall
OLYMPIC PRINTERS. INC.
Installed By:
CITY OF PORT ANGELES
LIGHT DEPARTMENT
PERMIT NO.
,;2~OOL
~/s~p
.
ELECTRICAL PERMIT
DATE
~
o READY FOR
INSPECTION
License Number:
)(WILL CALL FOR
INSPECTION
Phone:
Site Address:
OwnerfBusiness:
Phone:
Owner/Business Address:
Sq. Ft.
o Add/alter circuits
o Auxiliary power
(list beiow)
o Special equipment
(iist below)
~verhead
~'\Underg~!.!n~ I/O
Voltage ,~ ;;2-
o 1.0' 03.0'
.Service size Amps
.xemporary
o Residential
Heat KW
o Baseboard 0 Furnace/Boiler
o Heatpump 0 Other
o Commercial/Industrial load
Total Connected load
(attach breakdown)
Total Motor load
(attach breakdown)
o New Construction
o Remodel
o Service update/alter/repair
Detai IslDescriptlon:
.
W.S. No. Service
Capacity: 0 O.K. 0 Not O.K.
o Ditch inspection O.K.
o Rough-in/cover O.K.
\ .
<-1 'r:t O.K. to connect service
Ia1f Final O.K.
Size
Comments
Date
Hold for: 0 Easement 0 Letter
o Signed up for service/meter
o Meter Department notified for installation
o Fire Department notified of inspection
o Plan Review approved/pending
Permit/Receipt No.
.
Notify the Department of Cit Light by Street Address and Permit Number when ready for i spection. Work
must not be covered or electrically energized before inspection and O.K. for covering or service has been given
by the Inspector in Writing on the Wiring Report or the Building Permit. PHONE 457-0411, EXT. 158 or EXT, 224.
/~ rJ2
NO OCCUPANCY OR USE ESTABLISHED UNDER THIS PERMIT
/~
mspector
WHITE - file by address YELLOW - file by number
Amount paid
PINK - Top: Eng, Bottom: Customer GREEN - Top: Inspector, Bottom: City Hall
OLYMPIC PRINTERS. INC.
e,~r CITY OF PORT ANGELES
'~ PUBLIC WORKS - BUILDING DIVISION
321EAST 5TH STREET, PORT ANGELES, WA 98362
BUILDING PERMIT ISSUED: 5/15/2001 PERMIT NO: 12643
OWNER/APPLICANT PROPERTY LOCATION
116 AHLVERS RD E
INDEPENDENT BIBLE CHURCH
116 E, AHLVERS RD. Lot: SURVEY V-12PG95 5.09A
Port Angeles, WA 98362 Block: [] Long Legal
206/000-0000 Subdivision: NWNWSWEXE289'&EXE30'
T: S: Parcel No: 063015320000000
CONTRACTOR ARCHITECT
OWNER N/A
VARIOUS
Port Angeles, WA 99360 , 98360-0000
206/000-0000 360/000-0000
PROJECT INFO
Project Value: $2,000.00 SFD Units: 0 Commercial: 0
Project Type: SHED SFD SQ FT: 0 Industrial: 0
Occupancy Type: Garage: 0
Occupancy Group: MFD Units: 0
Construction Type: MFD SQ FT: 0
Zoning Use: RS9
PROJECT NOTES
BUILD A 10'X20' STORAGE SHED TO BE BUILT ALONGSIDE EXISTING
STORAGE SHED
FEES ASSESSMENT
Building Permit: $69.25 Misc Fee 1: $0.00
Plan Check: $0.00 Misc Fee 2: $0.00
State Surcharge: $4.50 Misc Fee 3: $0.00
House Moving: $0.00
Manufactured Home: $0.00
Sign: $0.00 TOTAL FEE: $73.75
Plumbing: $0.00 AMOUNT PAID: $73.75
Mechanical: $0.00
BALANCE DUE: $0.00
Radon: $0.00
Separate Permits are required for electrical work, SEPA, Shoreline, ESA, utilities, pdvate 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
r a,pedod of 180 days after the work as commenced, or if required inspections have not been requested within 180 days from the last
Sl~ction. I hereby certify that I have read and examined this application and know the same to be true and correct. All provisions of
,vj~ ,and ordina)~ces governing this type of work wilt be complied with whether specified herein or not. The granting of a permit does not
~s~rne to giv~/autt)6rify to violate or cancel the provisions of any state or local law regulating construction or the performance of
tru tio .//_ f .
gnature of Contractor or Authorized Agent Date Signature of Owner (if owner is builder) Date
BUILDING PERMIT INSPECTION RECORD
CALL 417-4815 FOR BU1LDING INSPECTIONS. PLEASE PROVIDE A MINIMUM 24 HOUR NOTICE. ITIS UNLAWFUL TO COVER,
INSULATE OR CONCEAL ANY WORK BEFORE INSPECTED AND ACCEPTED. POST PERMIT 1N A CONSPICUOUS LOCATION
KEEP PERMIT CARD AND APPROVED PLANS AT JOB SITE
INSPECTION TYPE I DATE [ YEsACCEPTEDI NO COMMENTS
FOUNDATION:
BI. JlLDING 417-4815 ~'~f ,'~ BUILDING
FOR OFFICIAL USE ONLY:
Building/Utility/Electric/Fire Pmit App~mfion e~t~ / ~ u ~ ~
pl~e ~ (~60) 417~815 or Fax: (]60) 417~711 ~ ~c~l~.
Con,actor:. C)b,,~ Yt EC~ License #:. ~p:. Ph~
Ad~: Ci~ ~p:,
Bil~g A~s: C~: ~ ~p:.,
CMt C~ ~ .~. ~: ~A MC,
~ OF WO~:/ S~UA~ON:
O ~d~fi~ ~N~. o ~f oSto~m ZoO
o ~cd ~ LP-~ o Si~ o UST T~ V~UA~.
B~ D~C~ON OF ~ ~CT: ~oc~ E
No. ofamfim: ~ ~t S~ %~ ~.
E~g ~ ~ /~. ~ + ~ ~t C~ /~.
P~G USg O~Y: ~PROV~: ~_.
p~ ~: Nmm:
~ H6~t: S~: ~g: D~..
Site Pi~ ~ Use ~ ~ D~e:
ES~md(s): ~ Ym o No SEPA ~ r~? o Y~ u No ~: O'I'H
~~ON fi~: Y~r ap~caHon ~ ~teplan m~ ~d
B~D~G ~ ~CA~ON S~'t'l'~: Y~ ~l~ ~ ~ pl~ (~ ~fi~) ~ ~l~g ~on
V~UA~0N OF CONS~UC~ON: ~ ~ ~, a ~ ~t m~ ~ m~
P~ ~K ~: Y~ pl~ ~ ~ ~ ~ ~ ~e time ~e ~l~g ~ ~plicafi~
o~ p~t f~ ~e due at ~e time of p~t
~ON OF P~ ~W: ~no pu~t ~ i~ ~ 180 day~ of~e
~ l~s. ~e ~g ~M ~ ~md ~e ~e ~ ~on ~ ~e ~ii~t up to 18O days, on ~Rm r~u~ ~ ~e ~liC~t
(s~ S~io~ 107.4 of~e Un~ ~l~g CM~ ~mt ~ti~). No ~plicafl~ ca ~ ~tm~ more ~ ~.
I hereby ce~ t~t ~ ~ reed a~ ~mined tk~ ~pEca~on and k~w the same to he tree ~ co~ct, and I am eut~d to
apply for ~ pe~i~ 1 ander~a~ ~ ~ ~t the Ei~'s/leFi ~biS~ to ~temi~ wht ~e~iS ere refui~d; it ~ei~ the
~Ecant's re~o~biSw to dateline w~t pe~i~e reeu]re~non~o obtain suck
DEPARTMENT OF PUBLIC WORK,q, BG'ILDING DIVI~ON
Pag~ 4 for ~ on cvr61~tng ~ ~ pla~ Por mor~ ~ ~ 4~11, ~ i~
/
ti
\!J!!
CITY OF PORT ANGELES
PUBLIC WORKS --:-: 'ELECTRICAL DIVISION
:l21 EAST 5TH STREET. PORT ANGELES. WA 98J()2
~
~
Application Number
Application pin number
Property Address
ASSESSOR PARCEL NUMBER
Application type description
Subdivision Name
Property Use
Property Zoning
Application valuation
06-00001197 Date 11/08/06
050513
116 E AHLVERS RD
06-30-15-3-2-0000-0000-
ELECTRICAL ONLY
RS9 .RESDNTL SI~G_LE~.~~ILY
o
Owner
Contractor
INDEPENDENT BIBLE CHURCH OF PA
112 N LINCOLN ST
PORT ANGELES WA 983622919
SHAMP ELECTRICAL CONTRACTING
PO BOX 383
PORT ANGELES WA 98362
(360) 452-1689
Permit
Additional desc
Permit pin number
Sub Contractor
Permit Fee
Issue Date
Expiration Date
ELECTRICAL TEMPORARY SERVICE
SHAMP/ I-TEMP SVC 2- SUB FEED
90159
SHAMP ELECTRICAL
85 40
11/08/06
5/07/07
CONTRACTING
Plan Check Fee
Valuation
.00
o
Qty
1 00
2.00
Unit Charge Per
42 2000 ECH EL-TEMP SRV - 0-60 SRV FDR
21 6000 ECH EL-TEMP SRV - 0-60 ADD SRV FDR
Extension
42.20
43.20
'-
~
Fee summary Charged Paid Credited Due
Permit Fee Total
Plan Check Total
Grand Total
85.40 -' 85. 40'~'~o(~f~~i;fO". ""'~.. . 00
.00 ~"'~':;F'4':'bb'ET{,$ ...60-----~-.00
85 . 40 85 . 4 0 ~ n.' ~.. 00 . 00
{'l\
"""'"'r '
eOc )<>>~
~ ~.z.. ' !lt ". ,~l
ql,,____"';~~ ~"
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, , ~ \ I, r; ~ 1 itA'" I
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.
. ,
W'~-H"V~ r 9
~
~
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~
'!oo.
, ,~\>
"' ',,---1' '.-'J.8Mtl;j.~
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.~"
"'~.J-';fi-"
COMMENTS/ ACTION NEEDED
~..
l' "', > i,\.
-- ""-'J....., . ~ , '-., "i '._-
, ~.. " ~ ' \,."" "'I>
ELECfRlCAL PERMIT INSPECfION RECORD
CALL 4174735 FOR ELECTRICAL INSPECTIONS. PLEASE PR0VIDE A MINIMUM 24 HOUR NOTICE. IT IS UNLA WFUL TO COVER,
INSULATE 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 I NO
Ill'l'( :H
Rill 11TH_IN I \';UV~K
]IDtICE
- r...
~TlI.T AT VtJ-.,;23-t?b I .M"B} I
GENERAL COMMENTS:
PW-II02.1514'96l
10/23/2006 14:55 FAX
~001/001
--- - - -_.~- .....---------_.
G -fc 7
S.
~ 'I
~<t' ~...
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tf J I J.t? th
ELECTRICAL WORK PERMIT APPLICATION
.
Jab wired by
o Electrical Contractor 0 Owner
~~s~latiDn descriplio,.
'6 Commercial d'Resideatlnl
o New
I:l Altered/Addition
12 ~ arV~12: -
3 - ~O-NN ~cj10M-)
LAH
~0
-
Ow~e" Q~ d~fi"ed by RCW /9.2(J,26J:(J) Owner will QCCupy the structure for /Wo
)'('ur~' after this elew'lcal permit is finalized. (2) (}wiler Is required 10 hire an eleCII'ictJ(
coruraCf()I' If above said properTy tr for sule, 1'("" 0" /eau.
After rC3.ding the above statcm~t. I her~b)' certify that I am ~he owner of lhe above
named property or 01 licensed electrical COl1traClcr. I llm mak;n,g the electrical instill-
hHlon or s!tcr:iliOll in compliance with the electrical laws, N.e.C., RCW, Chaprer
19.28. WAC. Chsptcr 296.46B. Thl: City (If Port Angeles Municipal Code, and
Utjljty SpeciCiclitions.
Sicnat
x
o C~' 0 Check #
~edit Card visa Mastercard Discover
Card# _'01\ ~_-_________
Expiration Dare
of card
o
Electrical Load Additions and or subtractions
I:l NO I.OAD CHANGES
o Baseboard KW
o Furnace KW
D Heat Pump Ton LAA
o FI1l1-Wall KW
Se.nlJ.Qe Information
CJ Overhead Service
o Temp ServIce
lJ Underground SaNlee
Voltage
Phase 0 1 0 3
Sel\lice Size: _
Feeder Size;
SAME DAY INSPECTION. CALL BEFORE 7;00 AM 360-417-4735
ROUGH-IN THERMOSTAT r SERVICE
D~lt Arpl'\)v~~ lJy " Dal~ ^/lpr"veI'lRy " D~te A.ppru~~~ Br
" , r FUDER '\
ANAL Lk" b DITOI J
i'j:;l3/nb
/ Dale! / Mpr(lv,~!ir/ " Dale A.IlJll'Ove<JB,./ " DDle Approved By
Inspection Area, l3uildillg or Equipment [nspected Action Taken Electrical
I)~fe Inspector.
II- 3-0(;, IJo C:,;J~T I"rF ;VJ ,/U. ",<,
/Jd7 /I? /. . C/ /.,~
/ / /
(#1
~
~
""'..
~001/901'
, .' j
L\\l-Lll \\ "' .~
ELECTRICAL WORK PERMIT APPLICATION' .
10/19/2008 08:50 FAX
Job wired by
m Electrical Contracto.... 0 Owner
Inslallalion description
Ii Commercial Q Resideatilll
Date Expires
~ew
o A1tered/AdditioD
,
Pt7/r~i~SS
~rfft-Q~ i.li\ ~~Io2-
~en e \bM FA~
:3 Pkf\O}j:::O~P~hD'LM.J
A: ~aAlO\~~mJ
$trtJA S./(' ,$ 277.70
~Ifl) A ~ 1XhL:10:; .24S:~rJ
Owm:r a~' defi/led by RCw'J9.28.26J:(J) Owner wiJJ occupy the. struc:lwrcfor MO
years after rills elecfricul permir is finolized. (2) Owner is required co hire an eJecrrical
ceJ/lfracror ~r abolJe sald prO~rly i~' for JaJe, rem or it-a,St'.
After reading the above statement,. ( hereby certify tnrn I am the owner of the above
n3.med property (lr a licensed elec:tricllJ contractor, I am making lhc electrical instal-
lation or alteration in compliance with the electrical laws, !\,',E.C. RCW. Ch::Lpter
19_28, WAC. Chapler 296.46B, The City of Pon Angeles Municipal Cocc., and
Utility Specifications.
SiR" ure of own
Q Cash Q Check #
~cdit Card Visa Mastercard Discover
Card# _~~_-_________
x'
Expiration Date
of card
inspection fee
$ S)z. 90
Eleetr"ica . ' .ddition
o...NOLOAD C~ANGES
Baseboard KW
CJ Fumace KW
o Heat Pump _~: _~
o Fan-Wall _ ~
SAME DAY-INSPECTION. CALL BEFORE 7:00 AM 360-417-4735
'~
~~f'O""Qrt,.
FlNAL
7 ..J<0
A~Il","~d By
tr etlon
om
?
.
,
"7
,
o Overhead Service
a Temp Service
~Underground Service
VOltage
Phass 0 1}u: J
Service Size: _
Feeder Size:
l
D~t~
^ppf'Ov~ By
P~,,~.,..,
lHERMOSTAT
D.~^"ro"d.Y
FEEDER
Dal~
.-'\ppTDved By
(nspeCllon
Date
Area, Building or Equipment lnspectc:d
Action TELken
Electrical
Inspector
/ 3-07
#~
MA
6-~ -()-
~
-4E.o
F'ORTANGELES
WAS H I N G TON, U. s. A.
~
FAX TRANSMITTAL
Department of Public Works/Utilities
321 East Fifth Street, Port Angeles, Washington
Phone: (360) 417-4735 FAX: (360) 417-4711
TO:
COMPANY:
FROM:
FAX#:
NUMBER OF PAGES INCLUDING
COVER: J
110 E; r AflLv'tVGS f?d
I Alan Oman
Senior Electrical Inspector / Traffic Signal Technician
I Phone: 360-417-4735
Email: aoman@cityofpa.us
I
j Wel?slte: www.cityofpa.us Fax; 360-417-4711
! ~.21!=ast Fifth Street ~G.O. Box 1150 Port Angeles, WA 98362-0?J7_
$13C-
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10/23/2006 11: 16 FAX
~ 002/902 .,
,
1D- 23-06
Shamp Electrical Contracting, Inc.
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518 West Eighth Street. Port Angeles . Washington 98362
phone/fax 360-452-1689
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'll~~fJ~:=w~~'A~DJBirermtt Q Alarm 0 Carnival 0 Commercial
~,H:t'~1'; c', .' .. .
I :,..11]1', '~',;r~' ",1.;; J.;:" Job wlr~d by .: Q(Eleetri<o1 Contractor lJ Owner
j '~'RJJl~;:~' ~Iec "q'al!con acto!' name" Lice"se nUlllber
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l ~~~f ~~ ~TelePh~" . numb r FAX nUl1'lbB
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rit~j: TLillpellf'l,g,l!!1-
~'~~; r~ . ,4.ddrest of hupectlon
'''in ;"\ 'I' . nr'L.
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ELECTRICAL WORKPERl\1: c. f'PJ"ICATION
..
.
o Request Inspection
Installati:ln descriplion
I
t' t) Teleco~. ,.
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o Re!ildentlal 0 Restdentlal Maint. 0 Signs a The' 0:
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1 hereby cenify that J am (he owner of the above named property or a licensed
elett;rjcal contractor (or the finn's authorized agent) and am making the electrical
installation Of alt~tion in compliance with the c=lectticallaw, Chapter 19.28 RCW.
tJ Ca..h tJ Check #
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Expiratil In Date
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CEILING
THERMOSTAT
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Insulation Only
In3ulatiQn Only
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Electrical Load Additions and Dr subtractlon~
D NO LOAD CHANGES
. 0 .....bo.ro KW
o Fumace KW
a Heal Pump Ton
o Fan-Wall _ KW
~ I n .1Dl1tlRn
o Overhead SQrviee
D Temp Service
D Underground Service
Voltage _ .
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Service SizE'
Feeoor Size
LAR
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In,pection
Date
Action Ta'<el1
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ELECTRICAL WORK PERMIT APPLICATION
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Job wired by
\lP Electrical Contractor 0 Owner
lnstallation description
J{Commercial D Residential
~New
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State ZIP
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OWI/er as defined hy,RCW.19.28.26/:(l) Owner will occupy the structure for (11'0
years after t!lis electrical perlllit is finalized. (2) Owner is required to hire all electrical
contractor If above said property is Jor sale, rent or lease.
After reading the above statement, I hereby certify that I am the owner of the above
named property or a licensed electrical contractor. I am making the electrical insta]~
lution or alteration in compliance with the electrical laws, N.E.C., RCW. Chapter
19.28, WAC. Chapter 296-468, The City of Port Angeles Municipal Code, and
Utility Specifications.
Signature of owner electrical contractor or electrical administrator
flTS.
o Cash ~ Check #
o Credit Card
Card #
Visa
Mastercard
Discover
x J.J:.--
Date:'f.-/J-LJ7
Expiration Date
of card
Electrical Load Additions and or subtractions
D NO LOAD CHANGES
Q Baseboard _.KW _ ...
D Furnace rF KW A Of'(1..Of- fr
Q HeatPump",,--Thon~ LAR .!;'
D Fan"Wall KW
Service Information
Q Overhead Service
o Temp Service
o Underground Service
Voltage
PhaseD 1 D 3
Service Size:
Feeder Size:
SAME DAY INSPECTION, CALL BEFORE 7:00 AM 360-417-4735
ROUGH-IN
THERMOSTAT
SERVICE
~
Dale
Approved By
Dale
Approved By
Dale
Approved By
ANAL
DITCH
FEEDER
Dale
Approved I.ly
Dale
Approved By
Date
Approved By
Inspection
Date
Area, Building or Equipment Inspected
Action Taken
Electrical
Inspector
3"'1-07
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Application Number . . . . . 22-00000989 Date 8/10/22
Application pin number . . . 517415
Property Address . . . . . . 116 E AHLVERS RD
ASSESSOR PARCEL NUMBER: 06-30-15-3-2-0000-0000-
Application type description ELECTRICAL ONLY
Subdivision Name . . . . . .
Property Use . . . . . . . .
Property Zoning . . . . . . . RS9 RESDNTL SINGLE FAMILY
Application valuation . . . . 0
----------------------------------------------------------------------------
Application desc
Remodel
----------------------------------------------------------------------------
Owner Contractor
------------------------ ------------------------
INDEPENDENT BIBLE CHURCH OF PA OLYPEN INC
112 N LINCOLN ST 314 E 8TH ST
PORT ANGELES WA 983622919 PORT ANGELES WA 98362
(360) 683-1456
----------------------------------------------------------------------------
Permit . . . . . . ELECTRICAL ALTER COMMERCIAL
Additional desc . .
Permit Fee . . . . 101.00 Plan Check Fee . . .00
Issue Date . . . . 8/10/22 Valuation . . . . 0
Expiration Date . . 2/06/23
Qty Unit Charge Per Extension
1.00 96.0000 ECH EL-LIMITED 1ST 1500 SQ FT 96.00
1.00 5.0000 ECH EL-ADDNT LIMITED 1500 SQ FT 5.00
----------------------------------------------------------------------------
Fee summary Charged Paid Credited Due
----------------- ---------- ---------- ---------- ----------
Permit Fee Total 101.00 101.00 .00 .00
Plan Check Total .00 .00 .00 .00
Grand Total 101.00 101.00 .00 .00
PREPARED 8/08/22, 8:55:51 PAYMENT DUE
CITY OF PORT ANGELES PROGRAM BP820L
---------------------------------------------------------------------------
APPLICATION NUMBER:22-00000989 116 E AHLVERS RD
FEE DESCRIPTION AMOUNT DUE
---------------------------------------------------------------------------
ELECTRICAL ALTER COMMERCIAL 101.00
TOTAL DUE 101.00
Please present reciept to the cashier with full payment
ELECTRICAL INSPECTION WIRING REPORT
APPROVED NOT APPROVED
DITCH
ROUGH IN/COVER
SERVICE
FINAL
COMMENTS:
Phone / Data
NOTIFY INSPECTOR at (360) 808-2613
WHEN CORRECTIONS ARE COMPLETED
WITHIN 15 DAYS
DATE PERMIT # INSPECTOR
10/17/2022 22-989 TAP
OWNER
CONTRACTOR
Olypen
PROJECT ADDRESS
116 E Ahlvers Rd
Application Number . . . . . 23-00000142 Date 2/13/23
Application pin number . . . 646800
Property Address . . . . . . 116 E AHLVERS RD
ASSESSOR PARCEL NUMBER: 06-30-15-3-2-0000-0000-
Application type description ELECTRICAL ONLY
Subdivision Name . . . . . .
Property Use . . . . . . . .
Property Zoning . . . . . . . RS9 RESDNTL SINGLE FAMILY
Application valuation . . . . 0
----------------------------------------------------------------------------
Application desc
Exit lights
----------------------------------------------------------------------------
Owner Contractor
------------------------ ------------------------
INDEPENDENT BIBLE CHURCH OF PA BLACK DIAMOND ELECTRICAL CONTR
112 N LINCOLN ST 502 BLACK DIAMOND RD
PORT ANGELES WA 983622919 PORT ANGELES WA 98363
(360) 565-1035
----------------------------------------------------------------------------
Permit . . . . . . ELECTRICAL ALTER COMMERCIAL
Additional desc . .
Permit Fee . . . . 74.00 Plan Check Fee . . .00
Issue Date . . . . 2/13/23 Valuation . . . . 0
Expiration Date . . 8/12/23
Qty Unit Charge Per Extension
1.00 74.0000 ECH EL-COMM BRANCH CIR WO/ S/F 74.00
----------------------------------------------------------------------------
Fee summary Charged Paid Credited Due
----------------- ---------- ---------- ---------- ----------
Permit Fee Total 74.00 74.00 .00 .00
Plan Check Total .00 .00 .00 .00
Grand Total 74.00 74.00 .00 .00
MULTI-FA MILY/ COMMERCIAL
ELE CTRICAL PERMIT APPL ICATION
Public \Yorks and Utilities Department 321 E. 5th Street, Port Angeles. WA 98362 360.417.4735 I www.cityofpa.us I electricalpermits(s/.cityofpa.us Project Address:--------------------------------------
Project Description:--------------------------------------□Multi-Family Residential D Commercial I Industrial/ Public Building Square footage: __________ _
OWNER INFORMATION
Name: ________________________ Email: ______________ _
Mailing Address: ________________________ Phone: ___________ _
ELECTRICAL CONTRACTOR INFORMATION
Name: License: ___________ _
Mailing Address: ________________________ Expiration Date: ________ _
Email: Phone: ___________ _
PROJECT DETAILS
llim!
Service/Feeder 200 Amp.
Service/Feeder 201-400 Amp.
Service/Feeder 401-600 Amp.
Service/Feeder 601-1000 Amp.
Service/Feeder over 1000 Amp.
Branch Circuit W/ Service Feeder
Branch Circuit W/O Service Feeder
Each Additional Branch Circuit
Branch Circuits 1-4
Temp. Service/Feeder 200 Amp.
Temp. Service/Feeder 201-400 Amp.
Temp. Service/Feeder 401-600 Amp.
Temp. Service/Feeder 601-1000 Amp.
Portal to Portal Hourly
Sign / Outline Lighting
Signal Circuit/Limited Energy -Multi-Family
Signal Circuit/Limited Energy/First 1500 sf -Commercial
(Note: $5.00 for each additional 1500 sf)
Renewable Elec. Energy: 5KVA System or less
Thermostat (Note: $5 for each additional)
Unit Charge Quantity
$132.00
$160.00
$225.00
$288.00
$410.00
$5.00
$74.00
$5.00
$86.00
$102.00
$121.00
$164.00
$185.00
$96.00
$88.00
$88.00
$96.00
$113.00
$56.00
Total (Quantity x Unit Charge)
$ ____ _ $ ____ _$ ____ _$ ____ _
$ ____ _
$ ____ _ $ ____ _
$ ____ _ $ ____ _$ ____ _
$ ____ _
$ ____ _
$ ____ _
$ ____ _
$ ____ _
$ ____ _ $ ____ _
$ ____ _
$ ____ _
$ _____ TOTAL
Owner as defined by RCW.19.28.261: (1) Owner will occupy the structure for two years after this electrical permit is finalized. (2) Owner is
required to hire an electrical contractor if above said property is for sale, rent or lease. Permit expires after six months of last inspection.
After reading the above statement, I hereby certify that I am the owner of the above named property or a licensed electrical contractor. I
am making the electrical installation or alteration in compliance with the electrical laws, N.E.C., RCW. Chapter 19.28, WAC. Chapter 296-
46B, The City of Port Angeles Municipal Code, and Utility Specifications and PAMC 14.05.050 regarding Electrical Permit Applications.
Date Print Name Signature (0 Owner D Electrical Contractor/ Administrator)
[Electrical Permit Applications may be submitted to City Hall or electricalpermits@cityofpa.us]
lJ CD
PREPARED 2/09/23,14:56:32 PAYMENT DUE
CITY OF PORT ANGELES PROGRAM BP820L
---------------------------------------------------------------------------
APPLICATION NUMBER:23-00000142 116 E AHLVERS RD
FEE DESCRIPTION AMOUNT DUE
---------------------------------------------------------------------------
ELECTRICAL ALTER COMMERCIAL 74.00
TOTAL DUE 74.00
Please present reciept to the cashier with full payment
ELECTRICAL INSPECTION WIRING REPORT
APPROVED NOT APPROVED
DITCH
ROUGH IN/COVER
SERVICE
FINAL
COMMENTS
NOTIFY INSPECTOR at (360) 808-2613
WHEN CORRECTIONS ARE COMPLETED
WITHIN 15 DAYS
DATE PERMIT # INSPECTOR
11/20/2023 22-142
TAP
OWNER
CONTRACTOR
Black Diamond Electric
PROJECT ADDRESS
116 Ahlvers Rd