HomeMy WebLinkAbout1934 W 4th St - BuildingNAME OF PREMISES
SERVICE ADDRESS
LOCATION OF DEVICE.
ASSEMBLY z! K /.r1,,/ r
Initial
Test
Repairs
Details
Final
Test
AIR GA'P INSPECTION
REQUIRED MINIMUM SEPARATION YES CI
COMMENTS
l A/ i 7) 1 /2
Initial
Test 7 ;I• U f, J /t� l` e
Repairs
Final
Test
iVEfit/
PORT
DOUBLE CHECK VALVE ASSEMBLY
CHECK VALVE #1
Leaked
Held at psi
Cleaned Cleaned
Replaced Replaced
Held at psi
Date'Time Tester
7 J1
WHITE CUSTOMER COPY
Backflow Assembly Test Report
City of Port Angeles
Public Works and Utilities Department
Water/Wastewater Collection Division
H A/ Fie L. 44/%
147 *4
Manufacturer Model Size
IS THIS AN APPROVED ASSEMBLY? YES 13 NO IS ASSEMBLY INSTALLED CORRECTLY'
DATE OF INSTALLATION .7h C S UNKNOWN 0
REDUCED PRESSURE PRINCIPLE ASSEMBLY
CHECK VALVE #2
Leaked
Closed Tight
Held at /psi
Closed Tight
Held at /2; /psi Opened at psi
NO TYPE OF HAZARD /1/4/ X
Cleaned
Replaced
Signature Cert.
i,.
A/ t'A /Nk
97
RELIEF VALVE
Did Not Open
Opened at psi
3 psi Buffer YES NO
RP RPDA
DC It]/ DCDA
PVB Air Gap
SVB AVB
PVB /SVB
Line Pressure psi
Held Backpressure YES O.--NO
#2 Shutoff Held YESP NO
Relief Valve Exercised YES NO
Test Kit
Serial No.
YES f]'NO
AIR INLET
Did Not Open
Opened at psi
CHECK VALVE
Leaked Held at
REPAIRS
Cleaned
Replaced
AIR INLET Opened at psi
CHECK VALVE Held at psi
BACK PRESSURE NO YES
177 !2C g/e
0
V A /I 2 wCi i 421
YELLOW PURVEYOR COPY PINK TESTER COPY
Official Use Only
Assem.# 6
Received
A
/f
Passed Failed
psi
_C
P
1 -0
Date
Application Number 08 00000856 Date 7/17/08
Application pin number 382144
Property Address 1934 W 4TH ST
ASSESSOR PARCEL NUMBER 06 30 00 9 0 0130 0000
Tenant nbr name JEFF SHARON FREELAND
Application type description PLUMBING REPAIR
Subdivision Name
Property Use
Property Zoning RS7 RESDNTL SINGLE FAMILY
Application valuation 1000
Application desc
IRRIGATION BACKFLOW PREVENTION
Owner Contractor
JEFFREY S FREELAND
1934 W 4TH ST
PORT ANGELES
(360) 457 1193
Fee summary
CITY OF PORT ANGELES
DEPARTMENT OF COMMUNITY DEVELOPMENT BUILDING DIVISION
321 EAST 5TH STREET PORT ANGELES, WA 98362
WA 98363
Permit PLUMBING PERMIT
Additional desc IRRIGATION BACKFLOW PREVENTION
Permit pin number 130260
Permit Fee 57 00 Plan Check Fee 00
Issue Date 7/17/08 Valuation 1000
Expiration Date 1/13/09
Qty Unit Charge Per Extension
BASE FEE 50 00
1 00 7 0000 ECH PL- EA LAWN BACKFLOW 7 00
Charged Paid Credited
Permit Fee Total 57 00 57 00 00 00
Plan Check Total 00 00 00 00
Grand Total 57 00 57 00 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 has 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.
17 tnzei 56wervcelaf
Print Name Signature of Contracto
T Forms /Building Division/Building Permit (10 /O1 /07).wpd
SCHOENFELDT LAND SERVICES
242514 W HWY 101
PORT ANGELES WA 98363
(360) 417 5159
Due
Authorized Agen Signature of Owner (if owner is builder)
BUILDING PERMIT INSPECTION RECORD
CALL 417 -4815 FOR BUILDING INSPECTIONS CALL 417 -4735 FOR ELECTRICAL INSPECTIONS 09
CALL 417 -4807 FOR PUBLIC WORKS UTILITIES I
PLEASE PROVIDE A MINIMUM 24 HOUR NOTICE. IT IS UNLAWFUL TO COVER, INSULATE OR CONCEAL ANY WORK BEFORE c,
INSPECTED AND ACCEPTED POST PERMIT IN A CONSPICUOUS LOCATION
KEEP PERMIT CARD AND APPROVED PLANS AT JOB SITE.
INSPECTION TYPE DATE I ACCEPTED
YES I NO
FOUNDATION.
FOOTINGS
SHEAR WALLS WALLS
FOUNDATION DRAINAGE DOWN SPOUTS
PIERS
POST HOLES (POLE BLDGS.)
PLUMBING
UNDER FLOOR SLAB
ROUGH -IN
WATER LINE (METER TO BLDG)
GAS LINE
BACK FLOW WATER
AIR SEAL
WALLS
CEILING
FRAMING
JOISTS GIRDERS
SHEAR WALL/HOLD DOWNS
WALLS ROOF CEILING
DRYWALL (INTERIOR BRACED PANEL ONLY)
T -BAR
INSULATION
SLAB
WALL FLOOR CEILING
MECHANICAL
HEAT PUMP /FURNACE /DUCTS
GAS LINE
WOOD STOVE PELLET CHIMNEY
COMMERCIAL HOOD DUCTS
MANUFACTURED HOMES
FOOTING SLAB
BLOCKING HOLD DOWNS
SKIRTING
Rb
FINAL
COMMENTS
DATE ACCEPTED BY.
FINAL DATE ACCEPTED BY.
c
PLANNING DEPT SEPARATE PERMIT N's SEPA.
PARKING /LIGHTING ESA.
I LANDSCAPING I SHORELINE.
FINAL INSPECTIONS REQUIRED PRIOR TO OCCUPANCY /USE
RESIDENTIAL DATE YES NO COMMERCIAL DATE ACCEPTED I
YES I NO I "'n
ELECTRICAL LIGHT DEPT 417 -4735 ELECTRICAL C�
LIGHT DEPT a
CONSTRUCTION R.W PW/ CONSTRUCTION R.W
ENGINEERING 417 -4807 PW ENGINEERING -lb
FIRE 417 -4653 I I I I FIRE DEPT I I I
I PLANNING DEPT 417 -4750 I I I I PLANNING DEPT I I I I
I BUILDING 417 -4815 I I I I BUILDING I I I
T Forms /Building Division /Building Permit (10 /0l /07).wpd 0+
3
Applicant or Agent S 6.,n A L-64 3.q^v■62_5
Property Owner (5 ha F lea
Property Owner's Address 19 3 4
t;Contract° Engineer 4cM Lcvf\ SP'v►cpS
ngineer's Address 2_.‘425-)4 k t ,,.0 0 St.
License# 3cH 0 ELSE X14e P
PROJECT ADDRESS j q3/1 r
Parcel Number Q(o3000 con hit- n c0Dt�
Project Type Brief Description.
Check all that apply
New Construction
Addition
Remodel
Repair
Re -roof
Demolition
Heat System
Other
Floor Areas
BUILDING PERMIT APPLICATION Print in ink
CITY OF PORT ANGELES
Attn Building Permit Technician
321 E. Fifth St. Port Angeles WA 98362
(360) 417 -4815 fax (360) 417 -4711
Bad -Pb'1 Pvwinir
Residential Commercial
10,1 ta,J IBS 6.v\-'6 al
Heat pump wood- burning stove gas fireplace pellet stove other
Existing (sq. ft.) Proposed (sq. ft.)
Basement per sq ft.
1 Floor
2nd Floor
3rd Floor
Garage
Carport
Covered Porch
Deck
Shed
Other
Total footprint of structures sq ft. T Lot size
Max height of proposed structures ft. Occupancy group
Will a lawn sprinkler system be installed? Occupant load
Will a fire sprinkler system be installed? Construction type
Date 7 -a Print Name Thyvall J c
T Forms /Building Division /Bldg Permit Appi. 2006 Cude doc
1. l by 490211
`47 )l�3
cw/+ 6361
Phone 2
PA (AA 91].3413
Expires j/2..6 l D q
w 3o' Lre, v- 40' 1.7 9 r3L f
Lot Zoning
TOTAL VALUATION J, coo .O7
I have read and completed this application and know it 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, and to obtain permits prior to working on
projects.
Phone
Phone
For City Use Only
Date Received 7-1
Permit ng
Date Approved
Multi- family Industrial
sq ft. Lot coverage
of bedrooms
of full baths
of half baths
Signature
.
Off 'PORT ~
~~~....
Cha~
~ --
~~
CITY OF PORT ANGELES
DEP ARTMENT OF COMMUNITY DEVELOPMENT - BUU,DING DMSION
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
05-00001278 Date 12/27/05
212330
1934 W 4TH ST
06-30-00-9-0-0130-0000-
JEFF FREELAND
MECHANICAL PERMIT
RS7 RESDNTL SINGLE FAMILY
2900
~~
?/UJ/oC; ~
Owner
Contractor
JEFF FREELAND
1934 W 4TH ST
PORT ANGELES
WA 983631602
EVERWARM
257151 HWY101
PORT ANGELES
(360) 452-3366
WA 98362
Permit . . . . .
Additional desc .
Permit pin number
Permit Fee
Issue Date
Expiration Date
MECHANICAL PERMIT
67850
50.00 Plan Check Fee
12/27/05 Valuation
6/25/06
.00
o
SJ
\)\
3:~
8~
:t:..,
~
1ft-
Qty Unit Charge Per
1.00 50.0000 ECH ME-WOOD BURNING APPL.
Extension
50.00
Fee sununary Charged Paid Credited Due
----------------- ---------- ---------- ---------- ----------
Permit Fee Total 50.00 50.00 .00 .00
Plan Check Total .00 .00 .00 .00
Grand Total 50.00 50.00 .00 .00
Separate Permits are required for electrical work, SEP A, 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.
~s-
Signature of Owner (if owner IS builder)
Date
T:\Pohcles\1102_15 bUlldmg perout mspectlOn record05 wpd [1/4/20051
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
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 FINAL DATE ACCEPTED BY
BACK FLOW 1 WATER
AIR SEAL
WALLS
CEILING I I I
FRAMING
JOISTS 1 GIRDERS
SHEAR W ALL/HOLD DOWNS
WALLS 1 ROOF 1 CEILING
DRYWALL (INTERIOR BRACED PANEL ONLY)
T-BAR
INSULATION
SLAB
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 SEP A-
PARKING/LIGHTING 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
PLANNING DEPT 417-4750 PLANNING DEPT.
'l. I,... 1_' JW
BUILDING 417-4815 BUILDING
T:\Policles\1102 15 bUlldm ermit ms ectlon record05. d rl/4/2005
gp
p
wp[
4-30-03; 8:1ZAM;CITY PORT ANGELES
~ vo.u ~ ';;:/lP,
.(5 .. BUILDING PERMIT. APPLICATION
~ FlU out COM)'LETEL Y and In INK. You, applicaUon and site plan MUST BE
COMPLETE to be accepted for review. If you have any questions, caU
(360) 417-4815
:3604174711
'"
1 /
Date Issued.
-
Applicant or Agent: L V r: R LV R r< M
O~er: ..J.e p..{' r~ee IO;--7d
Address: / 9..5 'I LA. j , .Lj 7A... City:' P CL-
ArchitectJEngineer: ..------ Phone:
Contractor.JC JI.ftewnRM State License #: ~Yf' ~$61LExp: !S-/7,.(){,
Address~S7J.5/ ~)y 101 City: />a~
PROJECf ADDRESS: /;r3~ ?J../-/Yi.- .;>q
LEGAL DESCRIPTION: Lot:
CLALLAM COUNTY PARCEL NUMBER:
Phone: .J.f52 -33b~
Phone: 3{..40 L/S"""..l: - 8' q l./9
Zip: qg3~3
Phone;tfS2 r.331::b
ZIp: 9 g33<2
ZONING:
Block: Subdivision:
[') ~ "3 <::) e-,t). 0; OD /.:5 00 CJ {""'} 0
Credit Card Holder Name:
Billing Address: City:
Credit CardType VISA MC # Exp. Date:
TYPE OF WORK: SlZEN ALUATION:
o Residential 0 New ConstI'. 0 Re-roof 0 Stove SF. @ $ /SF. "" $
o Multi-family 0 Addition 0 Move 0 Garage SF. @ $ /SF. "" $
o Commercial 0 Remodel 0 Demolition 0 Deck SF. @ $ /SF. = $
o Repair 0 Sign 0 Other , TOTAL V ALUA nON $ ~ 9" C> O. (;) CD
BRIEF DESCRIPTION OF TIlE PROJECT: Fe .pPJ::;-I-a "tX,;,.-, j L-#)~ C!2.h .5 -:r Cl~J €. ~
COMMERC SIDEN~ ccupancy Group: Occupant Load: Construction Type:
No. of Stories: _ Lot Size: Existing Sq. Ft. & Proposed Sq. Ft. = TOTAL Sq Ft.
Existmg lot coverage _ % & Proposed lot coverage _% = Total lot coverage %
APPROVALS:
PLAN:
BLDG:
DPWU:
FIRE:
OTHER:_
"
PLANNING USE ONLY:
ESAlWetland(s): 0 Yes 0 No SEPA Checklist reqUlred? 0 Yes 0 No Other:
BUILDING PERMIT APPLICATION SUBMITTAL: The Building Division can provide you with information on the applical10n and
plan submittal requirements if you have questions.
VALUATION OF CONSTRUCTION: In all cases, a valuation amount must be entered by the applicant. This figure will be reVlewej _
and may be revised by the Building Division to comply with current fee schedules. Contact the Pemiit Coordinator at 417 -4815 for aSSistance.
PL.A1~' 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 iss.uance. . .' '
EXPIRATION OF PLAN REVIEW: lfno permit is issued within 180 days of the date of application, the application will expire. The
Buil.d.mgD.fficiaLcauXtcrid theJime..fouctio.n...hy_the.applicant up to 180-da-Y6-upen.written request by the-applicant (see SectIOn 107.4 0 f
the Uniform Building Code, current edition). 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 authorize.d to apply for thiS perrmt anrj
und9rstand that it Is my responsibility to determine what permits are ra uire ot the City's, and that I must obtain such permits prior to work.
e)
Appli
Date:
/..2 ..;:?.3 . 2J::r
T \FORMS\APPSIBuildingpermil.wpd
PREPARED 3/20/06, 12 49 31
CITY OF PORT ANGELES
INSPECTION TICKET
INSPECTOR JAMES L LIERLY
PAGE
DATE
11
3/20/06
ADDRESS
TENANT, NBR
CONTRACTOR
OWNER
PARCEL .
APPL NUMBER
1934 W 4TH ST
JEFF FREELAND
EVER WARM
JEFF FREELAND
06-30-00-9-0-0130-0000-
05-00001278 MECHANICAL PERMIT
SUBDIV
PHONE
PHONE
(360) 452-3366
PERMIT: ME 00 MECHANICAL PERMIT
REQUESTED INSP DESCRIPTION
TYP/SQ COMPLETED RESULT RESULTS/COMMENTS
3/16{7- ~ ME~IM;H~Au "vuc,tl Ll"
~ ~ 03/20/2006 08 39 AM
JEFF 452-8949
ME4 01 ,J12);~r6........, JL~ MJ;;ru'''I9'1. '''''''n "'rOVE/PELLET _ TIME: 13 00
~~ ~i'~0~;~~~94~8 41 AM DYASUMUR --t---:~J----------
-------------------------------------- COMMENTS AND NOTES --------------------------------------
MEl
01
J..La If! :" J --..0.0
DYASUMUR ---------------------------
.~
~
CITY OF PORT ANGELES
PUBLIC WORKS - ELECTRICAL DIVISION
121 EAST 5TH STREET. PORT ANGELES. WA 98162
ELECTRICAL PERMIT
Issued: 4/02/98
Permit No:
6275
OWNER/APPLICANT------------------------PROPERTY LOCATION------------------------
PAUL KILPATRICK 1934 4TH ST W
1934 W. 4TH ST Lot: 8-W30' & E40' OF LOT9
Port Angeles, WA 98362 Block: 1 Long Legal: .
360/452-1080 Sub: ALDWELL ADD
T: S: Parc No:
CONTRACTOR-----------------------------DESIGNER---------------------------------
OLYMPIC ELECTRIC
1805 TUMWATER
PORT ANGELES, WA 98362
360/457-5303
,
000/000-0000
PROJECT INFO--------------------------------------------------------------------
prj Type: RES. MISC. prj Value: $0.00
Occ Type: Cnstr Type: ADD HEAT
Occ Grp: Occ Load: Land Use: RS7
Electrical Heat Service Type
Baseboard Klv: 0 Riser voltage: 120,240
Furnace KW: 0 Overhead Service Diameter: X-I -3
X Heat Pump KW: 5 Underground Service Service Size: 200 MiPS
Fan/Wall KW: 0 Temp Service Feeder Size: 0 AMPS
PROJECT NOTES-------------------------------------------------------------------
ADD HEAT PUl1P
PROJECT FEES ASSESSMENT---------------------------------------------------------
service: $0.00
Additional Feeders: $0.00
Circuit Wiring: $41.00
Temp Service: $0.00
$0.00
Misc
TOTAL FEE:
Amount Paid:
$41. 00
$41. 00
---------------------------------
---------------------------------
TOTAL FEE:
$41. 00
Balance Due:
$0.00
COMMENTS/ACTION NEEDED
ELECTRICAL PERMIT INSPECTION RECORD
CALL 417-4735 FOR ELECTRICAL INSPECTIONS. PLEASE PROVIDE 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
INSPECrION TYPE
DATE
ACCEI'TIW
COMMENTS
YES NO
GENERAL COMMENTS:
pW-II02.ISI4'96l
CITY OF PORT ANGELES
LIGHT DEPARTMENT
ELECTRICAL PERMIT
N~
17728
/./.- / <"- ,1-",,)
7' / .. 9 ~ ~""
Port Angeles, Washlngtonm..u_..~u...""""".moom.m..mmm.,.m.m" 1 .mh..
In accordance with the City Ordinance to regulate the installation, extension, or repair of elec-
trical equipment in, on, or about any building or other structure In the City of Port Angeles. per-
mission Is hereby granted to do" electrical work as listed below.
/:
Address ../.,z.u.-;;'m'f(..'h.?cr.moo~~'.Z(oohhuumh_______.umm Occupancy____:,:__,!..;oo~mm.moo,._moommu
~:7:~~~~~:::::~~;~f:~~;:.::C:~~::.;~;;i:~.~i.~~~~;~:::::::::::'.:':.'.~::::::::::=:::::::::::::::::::::::::::::::::::::::
t/ J"" .'oj"".
, -';'Vr !.'
Light Outlets............nn.n__........__.._..... Service, volts .n_.._.n.L.........................
~~. -~
Receptacle Out1ets..X.~..................... No. wires ....--1...___............_.._.........
Dryer, KW.........___......_.____.........__.__....
Size wlres..........................nn..._._..
5'0
Main fuse ..j...m..~.m.n........._.._........
Range, KW.n_._n________....____...____.
Water Heater:
Enclosure ._...................n__.nn..n._...
KW.........................................,.....
/-- ~/' ~
Heat: KW........!.......!.:..?--::.:.::-:...;;..::'!E..:_:O:'.
J
Motors: size, volts and phase:
Type of Wiring:
Entrance Cable ............m___n.n
RigId ConduIt ...............................
MetalUc Tubing _____....................__
Current transformers:
No. & Size......n___n_____.....................
Ser. NO.............................___.__.n__......
Ser. NO._.nn.....nn.._...........................
Ser. NO..n_nnn_n_...................__....._n...
Type 01 WIring:
Armored Cable ..m_.......______...........
Non.MetalUc .................................
Knob & Tube......._........._.............._
RIgid Conduit ...............................
Metallle TubIng ...........................
Raceway ..............................._._..._
Circuits, Light.._..___.___.._..___.....___...........
UtIlity......................._....................
I-Ieat n..n__.......................................
Range ..............................__......._..._.
Water Heater ..........m___.............__
Motor .............__..............................
Dryer n.._n___nnn._.............n..............._
Furnace .........................'_...................
Total Load........._....__nnn....... Ser. No. .................__._......n.._............ Total ......nn_nn........................
........t' _,,1 'J r)
Remarks: h.m.hu:z::~.:L6'.ood::'!?:.~~u..U.h~hhh.__J...<...~~i:~,"'-"'!!-:::~:.fmmoo':.':~~::.~:!i<..~.L...oo___.m.moom
if:/ / V
.n..n.____.____~n...__.________________..n_.n..._______.u_...nn__._________n___h..n.nnOuduu_.......___n__n__u_.___n__...oun..hnn.....uu__U"...nn
..Un.U.nnn___nnnnnn.__Uh...nnnn.Uh.hO..Un..n.nnU....U.U....-.....n_..__.n_._....n...uh.__...nnn..nnnnU..nuuhuU.__..nn_..nun
Permit Fee
$::......oommoom.m..__m___oo.
Treas. Receipt
No................._______._
By ...;i.~.j~.f;)(~:.;.~:.L:.:.:~:!::.::oo~.
NOTICE-Current must not be turned on until Certificate of Inspection haa been issued. If work Is to be con-
cealed due noUce must be given the Inspector so that work may be inspected before concealment.
NOTIFY THE INSPECTOR BY PERMIT NUMBER WHEN READY FOR INSPECTION
ELECTRICAL PERMIT
N~ 1 77 2 8
Address...____________........................_____.___..................__..._.__..__..................__.._.....---................_._.......Date..._.....__..__.__._.................._.._..__._.......
Owner ........nn_n___................._.........._...._.__....._.._.................n....__......._____.___._..n............ Tenant....nn_..........nn___.n...................n____.nu.........
Wiring Contractor ....h_.........n................................................................n_.__._................n.............. By._......._..n___n._......................_................._
\
NOTICE---Current must not be turned on until Certificate of Inspection has been issued. It work Is to be con.
cealed" due notice must be given the Inspector so that work may be inspected before concealment. .
1M Olympic Printers, Inc.
10/07/2014 7:35AM M
160001/0002
CITY OF FORT ANGELES PERMIT APPLICATIOT RECEI VE J."
ter► -J
Building Dh,Won /Elect —Acal Inspections ;
: -,•...
321 East VIR11 Street— P.O. Box 11 .50 / Port Angeles Washington, 98362
'M (360) 4174735 Fax: (360) 417 -471I
Dale ., �_ +6 ..- _ 1 & 2 Single Family Dwelling
Plan Review May Be Required, Please Complete Elect 'c I Plan Review Information Sheet
dob Address: 5-(
Building SquareFaotage
..eacription of above I �.•..•,�•�Yr,O ,S�v,.� ,—_._,. �..,.,..,,.,.... �.,. �...... ,.,�..,,..,�•,...�,..._�._..__�
Owner Infor lon Contractor formatio ,
Narne. Q Name.
Niailin0 d ss
city __ Slale:l�' 7,ip• crty Sltilr4. Lip
Phone r Phone. a�
,. License 1 Pxp. l
Item Un t Charge rat Total (4ty Mraltiolled bv,Unit Chara
5urwceil=eeder 700 Amp $120.00 S _
SorviceiFeeder 201 -400 Amp. $146.00 S
SeMcerFeeder 401.600 Amp $ 205.00 �� $
SorvrcelFoodor 601.1000 Amp $ 262 t)0
ServicelFeeder over 1000 Amp. $ 373.00 �. 5
Branch Circuit W1 Service Feeder S 500 $
Branch Circuit W;O Service l=eader S 6300
Each Additional Branch Circuit S 5.00 $
Branch Circuits 1-4 S 75.00 S _
Temp Service! Feeder 200 Amp $ 9300
Temp, Service)Feeder 201400 Amp. S110.00
Tnrrmp SeruicelFeodar401- 600Amp. S111900
Temp, ServrcelFeeder G01.10000 Amp $168.00 5 __
Portal to Portal Hourly $ 96.00 $
Signal Circurll Lrm4od knrrgy - 1 8 ? Hanlily hwellrug S 6400 � 5 ...... - _,..,--- _.M.._
Manufoolurcd dome Conneclion $120.00 S
Renewable Fleclncal Energy - SKVA System or less $102.00 =� S
Thermostat S 56.00 $�
Note $5.00 for each addititmal I -Slal
NEW CONSTRUCTION ONLY,
First 1304 Square Fl. .512000
5..... __— .._.....
Each Additional 500 Square Ft. or Portion of $ 40.00 S
Each Outbuilding or Detached Garage S 74.00
Each 5vnmming Pool or Hol Tub 5110.00
$_ 5 rU Total
Owner as defined by RCW.19.28.261: (1) Owner will occupy the structure for Iwo years after this electrical permit is finalized. (2) Owner i5 required
ID hire an electrical contractor if above saki property is for sale, rent or lease. Permit expires after six months of last inspection.
After reading the above•. slatertlent, I hereby ramify that I am the owner of the above named property or a licensed electrical ooritraclor. I am makrnq
IhP cler.Irical inylallation or alleration in cdrrrplianim with the elecirimil laws. N.E.C., RGW. Chapter 19.28, WAG. Chapter 706-4813, The City of Pod
Angeles Municipal Code, and Wilily Specificalions and PANIC 14.05.050 regarding Electrical Permit Applicaliums
Signature of owner, aleetrioal contractor or electrical administrator: 0 cash [J Check
/ R
?)/ CrW Ca
! rd
X 6eted: + T a91D112012
... -...8o s
ldtS�vr, Gcr+Jptia- �i7ts`. In
After reading the above•. slatertlent, I hereby ramify that I am the owner of the above named property or a licensed electrical ooritraclor. I am makrnq
IhP cler.Irical inylallation or alleration in cdrrrplianim with the elecirimil laws. N.E.C., RGW. Chapter 19.28, WAG. Chapter 706-4813, The City of Pod
Angeles Municipal Code, and Wilily Specificalions and PANIC 14.05.050 regarding Electrical Permit Applicaliums
Signature of owner, aleetrioal contractor or electrical administrator: 0 cash [J Check
/ R
?)/ CrW Ca
! rd
X 6eted: + T a91D112012
... -...8o s
ldtS�vr, Gcr+Jptia- �i7ts`. In
ELECTRICAL PERMIT
CITY OF PORT ANGELES
360- 417 -4735
Application Number . . . . .
14- 00001215 Date
10/08/24
Application pin number
423505
DITCH
Property Address
1934 W 4TH ST
ASSESSOR PARCEL NUMBER;
06-30-00-9-0- 0130 -0000-
Application type description
ELECTRICAL ONLY
Subdivision Name . . . . . .
4 P L4
Property use . . . . . . . .
FINAL
Property Zoning . . . . . . .
RS7 RESDNTL SINGLE FAMILY
Application valuation . . . .
0
Application desc
Replace heat pump furnace
---------------------------------.___-_-------------------------------------
Owner
Contractor
FREELAND, JEFFREY S
DAVE'S HTG & COOLING
SRVC INC
1934 W 4TH ST
PO 30X 413
PORT ANGELES WA 96363
PORT ANGELES
WA 98362
---------------------------------------------------------
(360) 452 -0939 4
q�3-7e�
Permit . . . I ELECTRICAL
ALTER RESIDENTIAL
,Additional desc . .
Permit Fee . . . . 56.00
Plan Check Fee
00
Issue Date 7.0/08/24
Valuation . . . .
0
Expiration Date 4/06/1.5
Qty Unit Charge Per
Extension
1.00 56.0000 ECM EL-
LVT- THERMOSTAT
56.00
Fee summary Charged
Paid Credited
Due
Permit Fee Total 56.00
56.00 .00
.00
Plan Check Total .00
.00 .00
00
Grand Total 56.00
5.61 00 .00
.00
REPORT SALES TAX
on your excise tax form
to the City of Port Angeles
(Location Code 0502)
INSPECTION TYPE
DATE:
RESULTS:
INSPECTOR:
DITCH
SERVICE
ROUGH -IN
4 P L4
4V
FINAL
T n M IN
COMMENTS:
PERMIT WILL EXPIRE SIX (6) MONTI-IS FROM LAST INSPECTION
Signature of owner or Electrical Contractor X Date:
G:IEXCHANGBIBUILDING
d..
C�
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