HomeMy WebLinkAbout319 W 15th St - Building
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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:
Applicatlon description
Subdivision Name
Property Use
Property Zoning . . .
Applicatlon valuatlon
10/05/04
04-00000909 Date
.080418
319 W 15TH ST
06-30-00-0-4-2070-0000-
PLUMBING REPAIR
RS7 RESDNTL SINGLE FAMILY
2475
Owner
Contractor
REIDEL MARILYN L
319 W 15TH ST
PORT ANGELES
SANFORD IRRIGATION
PO BOX 2246
SEQUIM WA 98382
(360) 683-9807
WA 983627609
Permit
Additlonal desc
Permlt Fee
Issue Date
Expiration Date
PLUMBING PERMIT
Plan Check Fee
Valuatlon
.00
o
54.00
10/05/04
4/04/05
,.1
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
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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 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. .
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Signature of Contractor or Authorized Agent
(OhiO'!
, ,
Date
Signature of Owner (if owner is builder)
T.\PLANNING\FORMS\I 102.15 [11/14/2003]
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Official Use Only
A "em #
NAME OF PREMISES
SERVICE ADDRESS,
LOCA nON OF DEVICE-
Backtlow Assembly Test Report
City of Port Angeles
PublIc Works and UtIlItIes Department
I( () IJe 121( c} WaterIWastewater ColIectlOn DIVIsIOn
Iti -1;f( I L //\/ If E I PEL
(J!..
Received
75;; -If/1ft/'
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Senal No
ASSEMBLY
Manufacturer Model
IS THIS AN APPROVED ASSEMBL Y'l YES D'1'JO 0
Size
IS ASSEMBLY INSTALLED CORRECTLY" YES G NO 0
DATE OF INSTALLATION
I'
(:' UNKNOWND
REDUCED PRESSURE PRINCIPLE ASSEMBLY RP 0 RPDA 0
DC 0 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
Initial Leaked 0 Leaked 0 Did Not Open 0 AIR INLET
1d- Closed TIght 0 Did Not Open 0
Test Held at~ pSI Held at ,>. {/ pSI Opened at _ pSI
Opened at _ P'I
Repairs Cleaned 0 Cleaned 0 Cleaned 0 CHECK VALVE
Leaked 0 Held at _P,I
Replaced 0 Replaced 0 Replaced 0
REPAIRS
Cleaned 0
Details
Replaced 0
3 pSI Buffer YES 0 NO 0
Final Closed Tight 0 AIR INLET Opened at _ pSI
., q - CHECK VALVE Held at _pSI
. /~ ,
Test Held at ~ pSI Held at ~ pSI Opened dt _ pSI BACK PRESSURE NO 0 YES 0
AIR GAP INSPECTION
REQUIRED MINIMUM SEPARATION YES 0 NO 0 TYPE OF HAZARD I
/
Line PressUI e ;"{j
COMMENTS ~pSI
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" r .' ,/ ,.,; f <. .J .. ,c/,; / /./1' Held Backpressure YESD NO 0
.. v I I. , , , ~
#2 Shutoff Held YESD NO 0
Rehel' Valve Exercised YESD NO 0
Daterrllne Testel SIgnature Cen # Test Kit Passed Failed
Initial
Test ~ .",. e ~ -; ..., ~ 0
Repalls 0 0
Final 1iJ~ 0
Test , . .. ) ( , ( ,<, .
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WHITE - CUSTOMER COPY
YELLOW - PURVEYOR COPY
PINK - TESTER COPY