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Home My WebLink About116 W 12th St - Building ~ pORT ~ $.J"O~~~ ~ W- ~ ~ ~~ CITY OF PORT ANGELES DEPARTMENT OF COMMUNITY DEVELOPMENT - BUILDING DIVISION 321 EAST 5TH STREET, PORT ANGELES, WA 98362 Application Number pin number Property Address ASSESSOR PARCEL NUMBER: Appl~cation description Subd~vision Name Property Use Property Zoning . . . Appl~cat~on valuat~on 04-00000297 Date .332613 116 W 12TH ST 06-30-00-0-3-7915-0000- PLUMBING REPAIR 4/12/04 RS7 RESDNTL SINGLE FAMILY 600 Owner Contractor WILLIAM SODERLIND/LAUREL CRIPE 116 W 12TH ST PORT ANGELES WA 983627714 (360) 452-9058 OWNER Perm~t Additional desc Permit Fee Issue Date Exp~ration Date PLUMBING PERMIT 54.00 4/12/04 10/09/04 Plan Check Fee Valuation Qty Unit Charge Per Extension 47.00 7.00 BASE FEE 1.00 7.0000 ECH PL- EA LAWN BACKFLOW Fee summary Charged Paid Credited Due ----------------- ---------- ---------- ---------- ---------- Permit Fee Total 54.00 54.00 .00 .00 Plan Check Total .00 .00 .00 .00 Grand Total 54.00 54.00 .00 .00 HA/Aim .8/~/Od- .00 o -.. -- ~ ~ - 'i=> ~ (;) ~ 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 construe' n. Signature of Owner (If owner is builder) T \PLANNING\FORMS\1102 15 [11/14/2003] ~. -~'~~-'~r~'\--.'~'"'(~""""",'. - -.- Backflow Assembly Test Report CIty of Port Angeles PublIc Works and UtIlItIes Department WaterlWastewater CollectIOn DIvIsIon .,.." c - , OfficIal Use Only A,~<:m # ;).. C. J... . R<:~<:lv<:d .) NAME OF PREMISES l:f / t:" ( SERVICE ADDRESS: II [ lA/ . 4 \"'- LOCATION OF DEVICE: I' . \ ASSEMBLY: ,yV I <- l.: " IV J Manufacturer )- {.,r 7',L./ C /( l .../ .~i'" P r I :> _.~. ../- / ....t' c r /- I // ~ l; r::: )-" /) 1/ .~ E cr. '/ >vY( / Model SIze I C /J I ,-' ,1// t I I I. t;~ ;;). c ~: > Senal No IS THIS AN APPROVED ASSEMBLY? YES Er~O 0 IS ASSEMBL Y INSTALLED CORRECTL Y' YES 0 NO 0 DATE OF INSTALLATION ,/1..1.A ,"" f/ rUNKNOWND REDUCED PRESSURE PRINCIPLE ASSEMBLY RP 0 RPDA 0 DC r!!.- DCDA 0 DOUBLE CHECK VALVE ASSEMBLY PVB 0 All G<lp 0 SVB 0 AVB 0 CHECK VALVE#I CHECK VALVE #2 RELIEF VALVE PVB/SVB Imtlal Leaked 0 Leaked 0 Did Not Op<:n 0 AIR INLET Held at I.. ;;). pSI Closed TIght 0 DId Not Open 0 Test Held at ("fl. (/ pSI Opened at _ p~1 Op<:ned at _ P,I Repairs Cleaned 0 Cleaned 0 Cleaned 0 CHECK VALVE I 0 , Leaked Held at _pSI I Replaced 0 Replaced 0 Replaced 0 I REPAIRS , Cleaned 0 I Details I " 0 Replaced I I 3,PSI Buffer YES 0 NO 0 I I Fmal Closed Tight 0 AIR INLET Opened at _ pSI I Held at I .. ;;>- pSI :'>C CHECK VALVE Held at _pSI Test Held at ~ pSI Opened at _ pSI BACK PRESSURE NO 0 YES 0 AIR GAP INSPECTION REQUIRED MINIMUM SEPARATION YES 0 NO 0 TYPE OF HAZARD ,ii',(/ COMMENTS Lme PressUle '1 > pSI .- , J.. ,- - C~ J' ...J II I r j"',.... l -..: () I J. i' Held Backpressure YESO NO 0 ./ I - . I (... '- , I' A ;",;~ f- p , #2 Shutoff Held YESO NO 0 I I I Rehel' Valve ExerCised YESO NO 0 I I I Date/Tlme Testel Signature Celt # Test KIt Passed FaIled I I ImtJal (, I . , ;rl Test II' (I , cti:..e,d ".v ~ {'; ! t/ A. r ;,-0- 0 I \ ?" " ~..., i"- ~,J,. , Repalls , 0 0 , Fmal ( 'u .. j; ,..j., ,; .,. .. ,1i'J-- Test ~ , ,., ,'('.(C,"( i ..~...!.l> I."........"") 0 . , -" ~, -, .,. ,/ ) u., J....~ I I --- I .............. ~ ( -- <f> ~ ~ WHITE - CUSTOMER COPY YELLOW. PURVEYOR COPY PINK. TESTER COPY J ' :f fORT ~ lO~~~ ,. --- ~ ~ "tOt",~ CITY OF PORT ANGELES DEPARTMENT OF COMMUNITY DEVELOPMENT - BUILDING DIVISION 321 EAST 5TH STREET, PORT ANGELES, WA 98362 Applicat~on Number P~n number Property Address ASSESSOR PARCEL NUMBER: Application description Subdivis~on Name Property Use Property Zoning . . . Application valuation 05-00000088 Date .010112 116 E 12TH ST 06-30-00-0-3-8025-0000- RE-ROOF 2/08/05 Owner Contractor EXPIRED ~7/o~ RS7 RESDNTL SINGLE FAMILY 8900 KETCHUM FRANCES L C/O JOHN KETCHUM PORT ANGELES WA 98363 THE FINISH CREW 1919 E 1ST PORT ANGELES (360) 457-1670 WA 98362 Permit Additional desc Permit Fee Issue Date Exp~ration Date BUILDING PERMIT - NO PR FEE TEAR OFF, SHEET, FELT, COMP 190.75 Plan Check Fee 2/08/05 Valuation 8/07/05 .00 8900 Qty Unit Charge Per Extens~on 92.75 98.00 \) BASE FEE 7.00 14.0000 THOU BL-2001-25K (14 PER K) Other Fees STATE SURCHARGE 4.50 rrr Fee summary Charged Paid Credited Due ----------------- ---------- ---------- ---------- ---------- Perm~t Fee Total 190.75 190.75 .00 .00 plan Check Total .00 .00 .00 .00 Other Fee Total 4.50 4.50 .00 .00 Grand Total 195.25 195.25 .00 .00 f'J T S 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 t give authority to violate or cancel the provisions of any state or local law regulating construction or the performance of construe ture of Contractor or Authorized Agent Date Signature of Owner (if owner is builder) I 2.... ~-oS T.\Pohcles\1102_15 bUilding perrmt Inspecl10n record05 wpd [1/412005] I ELECTRICAL PERMIT N'? 16933 I - . ?-;;J.r;- '/P Port Angeles, Washlngton_____.__.____________.______._________.______._.------------., 19'-7--- 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 __il.km_mm f4.:_I.:2:ii:....____m_____________n_____..n_n.. Occupancy___&.~4...,.._____m______..___..nm_ Owner ..____:__~~~-g~...--------y]-----a1enant-m.--------.-------------------_...__m_nmm...m...mmm__.. Wiring Contractor "'-'_~..-n-----..--m-~--&~J.-:---m- By_______m.__mm.n..m__m_m_________m___m___m_m___.. /~(J/.P90 serv;:., ::::: :~;ji~:::::~::::::::::~:::::: W/# Size wiresm."i"7.....C.f..!.............._.. ffJU'G1" A Main fuse ..1:':....__.__......__..........__..... .$ Enclosure ....__n......_.__.....______.......... CITY OF PORT ANGELES LIGHT DEPARTMENT Light Outlets....................___......___..____.. Receptacle Outlets....___.......__............... Dryer, KW __nnn.____...._h.........__.....____.. Range. KW un....._..__.h..._______.__ Water Heater: KWh____________________________________________ Heat' KW------/2..-P~~----------- Motors: size, vol' a.nd phase: Type of wiring: Entrance Cable __.._.m.....___.___........ Rigid Conduit _________h________h_________. Metallic Tubing ._m.__................... Current transformers: No. & Size.h.........____....__.____.........h. Ser. N O.h.....___.:.~.....__.........____.........__ Ser. No. .......--.................--..--......--..... Ser. No. ...__..........__.........___.........__..... Type of Wiring: Armored Cable ............................. Non.Metallic ................................. Knob & Tube................................_ RIgid Conduit ......--......---.......--..... Metalllc- Tubing .___....._._.....___....... Raceway ......................._.....__._ Circuits, Llght.___.....__..___.....__....._........._ Utility ....h......_.....................h......... fIeat ........._............................._.._ Range ..........................................._. Water Heater .._..................__........ Motor ._.................._........................ Dryer .....____.......__..........__.........__......._ F urnace ...........-.............~................... Remark:~ta:__:~_~_:_::~~~_::=~--m..~-~;.:~:~--.~~.--:::~~~~~_m_m.._m..n..._:~~::..~::'~~::-__:~_::'_::-_-::::::'~__~:: ........----...---..-...--.-..---------.----.-.--....-----..----.....--..-.---.---.-....---..-..----.--.-.-.----..-.-.-.------...-.-----.-...--.----.--.-.---.-----.-------_.-- Permit Fee ..nnh.u.unn__.un.nuhn_nn.__uun.nn_.uun_n..un.n.h_u._.h_U_____nn.n_..._u.nn.huu.n_.u_nn..u_u_u___.___.unn..u_..un___.__n_n By _m.~d..-.9j!L!..dr..~g-~,--c-L- / ' .. NOTICE-Current must nDt; be turned on until Certificate of Inspection has been issued. If work is to be con- cealed due notice must be given the Inspector so that work may be inspected before concealment. $:m..._...m..__......________m... Treas. Receipt NO....:._....__m....____..... NOTIFY THE INSPECTOR BY PERMIT NUMBER WHEN READY FOR INSPECTION ELECTRICAL PERMIT Nt? 16933 / Address............_......_............................_............................_.........................................................Date..._......_.._......_..........-.-..-......-.-.....- Owner .....__...__............__.........___...._.._......___...._.._................___.__.................__.........__....... Tenant.............__...h............__...__......____................... Wiring Contractor ....:.............................._._.................................................................................. By.............................................................. NOTICE-Current must not. be turned on until Certificate of Inspection has been issued. If work fs to be con- cealed due notice must be given the Inspector so that work may be inspected before concealment. .. \ '\ 1M Olympic Printers, Inc. 16913 .(" -L') )1' Port Angeles. washlngton......._.L.m._ _....mm.....mm......_m..... 19'_'000' 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 electric . work as listed below. Address ..//?m_..t<'!,'r...j.~.:.'ti:u:.........u__m.....u___.__m. OCCUpanCyu,_~...u...._.uum..m o~er......--e.....9i....'i~iflEJt-~~.--.mm..----m..-..umm-......m....m.------u---..-000..... Wiring Contractor .m.__._m.e..m.m__.um.m__......__2~..u_m By.m.mu...m.m__m.u..__......u......m_.__m.....__._... ./ ' 1.:Lb/~ y~ LIght Outlets.......__...........m........._._..... Servlc . vo ts "':7 - Receptacle Outlets........._m..........__...... N:. wi:es :::::::~..::::::::.:::::::::::= t././ {) dU:/ Size wtresh:.L......................._.. MaIn fuse ___@.~t4:.:_m_..... . S Enclosure h..n~...........__.............___ CITY OF PORT ANGELES LIGHT DEPARTMENT ELECTRICAL PERMIT Dryer, KW...nn.....................----.......--- Range, KW....__.___........__.__.._____ Water Heater: KW.....m____m__.._..n__________m_um___ Type of wiring: Entrance Cable ......m......__...... Heat: KW................................._n............... Motors: size" j;t8 and phase: ' Rigid Conduit ...n......._____...__..._____. ::::=:~=:=E. ~~rr:::a::::::::e~~;--m..-.... No. & Size__..........__........:......__........ Ser. NO.n_........____.~..........n........n...... Ser. No. ......n........._.................n....... Ser. No. .__...h...n.....................n......... Total Loadnn__n..............n..... Ser. NO.n..nh........._.........._.nn......... -.. NI! Type of Wiring: Armored Cable ..........................__ Non.Metalllc ___..____....__.....__....__.__.. Knoh & Tube....__.......______.___........._ RIgid Conduit .......__........___...._____ Metalllc Tubing __m.__..__.__________.__. Raceway ......................._........._..._ Circuits, LIght....___..................___......._.. UtHlty ....m__......___...____...._____..._____. I-Ieat .......................................-..-.. Range ............................................. Water Heater .....................-......... Motor ..._..................~............n....... Dryer ..............................................__ Furnace .. ........................_......_.._....... Total....................................... Remarks: .__...____________._4-,e_~1:._L..,Q.......__.u.___..___________...___._____....___m_____...__________.....__m___.________"'000 /' _._........_..........._........................__.............._............................._.........................____.........._............___............_...........u ._____._________._____________m.._____.__...._____.___......__..________.___.m______.____.___m___.______u_______.m.---)7'--U----------.------------..---m--..-- Permit Fee . Treas. Receipt /J/ i! &.i. ~ L $:....__..__.__.......:..__....__.__.__ No...____....__.....____....... B;iY~....!.....!7L!1t.:db!....:'l?:1,4'.L.. """.'11"1~' NOTICE-Current must not be turned on until Certificate of Inspection has been Issued. If work is to be con. cealed due noUce must be given the Inspector so that work may be inspected before concealment. .J ._.~. / NOTIFY THE INSPECTOR BY PERMIT NUMBER WHEN READY FOR INSPECTION , .0/ ELECTRICAL PERMIT Address ...................-............................-.-............................................-...................................... Owner..................................._.........._......_......_.._...........................................................Tenant..........................................-.........~............... Date..._......_.__.._.._.........._.._.._......_.._..._ \Wlrlng Contractor__...m__._____..:_____....n.__...m____.________nn__.u__..._________......._______m.__m____.....___.mm_____ By______n__..._______............._______.............__....... . NOTICE-Current must not be turned on until Certificate ot Inspection has been issued. It work Is to be con. 'cealed due noUce must be tIven the Inspector so that work may be inspected betore concealment.. .- // \ ./ 1M Olympic Prin~s, Inc. \ , I 1- .j~- N? 16913 ..* \