HomeMy WebLinkAbout815 Church Ave - Engineering
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CITY OF PORT ANGELES
PUBLIC WORKS - BUILDING DIVISION
321 EAST STH STREET, PORT ANGELES, WA 98362
PUBILlC WORKS & R/W PERMIT
D Attached Notes
OWNER/APPLICANT
RAY V ANNAUSDALE
623 E. 10TH STREET
Port Angeles, W A 98362
000/604-7584
PROJECT INFO
Work is
Plans Required Start Date
Contractor' RAYMOND CONSTRUCTION
Performance Bond Required Amount:
Proof of Insurance
Work to Perform
Issued
7/09/2002
Permit No
Work Order'
1295
o
PROPERTY LOCATION
815 CHURCH AVE
Lot: B shp 02-04
Subdivision BEN CHAMBRERS
Parcel No 063015521365000
Block. 13
D Long Legal
Value Work.
$000
1 1
Finish Date
360/457-3119
1 1
$000
cg] Install
D Repair
cg] Watermain
cg] Sanitary Sewer
D Storm Drain
D Underground Tele/Elec
cg] Misc
PROJECT NOTES
RECEIPT#9319
FEES ASSESSMEN"F
1 ) RIW Excav' $000 15 ) Other San Sewer' $000
2.) Sidewalk. $000 16) Sew Tap Wye/Man Tap $000
3 ) Curb/Gutter' $000 17) Sew Capl W/M Removal $000
4 ) Driveway' $000 18 ) Alter Repair Sewer' $000
5 ) Dwy Culvert: $000 19 ) Storm Drain $000
6 ) Street Cut: $000 20) Catch Basin per ea, $000
7 ) Other RIW $000 21 ) Sewer System Dev' $74500
8 ) Fire Hydrant: $000 22.) Milwaukee Dr Sew Ass. $000
9) Res Water Serv' 5/8" $640 00 23 ) RIW Use Perm $000
10) Comm Water Serv' $000 24 ) Admin Cost (0 RA) $000
11 ) Other Water Service $000 25 ) 0 RA. $000
12.)Water System Dev' $1,025 00 26) Misc $000
13 ) San Sewer SFR $95 00 TOTAL FEE. $2,505.00
14 ) San Sewer MFR $000 $2,505 00
add unit: 0 Amount Paid
Receipt No
Inspection Fee $000 Balance Due. $0.00
RW SANITARY WATER DWY STORM DRA OTHER
Separate Permits are required for electrical work, 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.
Sianature of Contractor or Authorized Agent
Date
Sianature of Owner (if owner is builder)
Date
BUILDING PERMIT INSPECfION RECORD
CALL 417-4815 FOR BUILDING 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
i
KEEP PERMIT CARD AND APPROVED PLANS AT JOB SITE
INSPECTION TYPE DATE ACCEPTED COMMENTS
YES I NO
FOUNDATION:
FOOTINGS
WALLS
FOUNDATION DRAINAGE
ELECTRICAL (LIGHT DEPT)
ROUGH-IN I I
PLUMBING
UNDER FLOOR / SLAB
ROUGH-IN
WATERLINE
BACK FLOW / WATER
AIR SEAL
WALLS
CEILING I
FRAMING
JOISTS / GIRDERS
SHEAR WALL
WALLS / ROOF / CEILING
DRYWALL
T-BAR
INSULATION
SLAB
WALL / FLOOR / CEILING I
MECHANICAL
CHIMNEY
WooDSTOVE/PELLET
DUCTS
PW UTILITIEs / SITE WORK (Engineering Division)
WATERLINE/METER
SEWER CONNECTION
SANITARY
STORM
SITE DRAINAGE / EROSION CONlROL
PARKING
OTIlER
FINAL INSPECTIONS REQUIRED PRIOR TO OCCUPANCYIUSE
RESIDENTIAL DATE YES NO COMMERCIAL DATE ACCEPTED
YES NO
ELECTRICAL LIGHT DEFT 417-4746 ELECTRICAL
LIGHT DEFT
CONSTRUCTIONR.W /PW/ CONSTRUCTION - R. W
ENGINEERING 417-4807 PW / ENGINEERING
FIRE (MUL TI-F AM. ONLY) 417-4654 FIRE DEFT
BUILDING 417-4815 BUILDING
GENERAL COMMENTS:
PW-1102.15 (4196J
CITY OF PORT ANGELES
DEPARTMENT OF PUBLIC WORKS
. . . . . . . . . . . INSPECTION REPORT . . . . . . . . . . .
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REQUEST
Date 7--/@-o::2- Time
Received by
(phone, person)
t::'} I!) C ~-U Jr C /1 /!--U ~
Location of Work to be inspected ()
- .
Name of person requesting inspection I W , J C~ (<-
Address of person requesting inspection /-1 {tl -(:;- [3 Phone No .
I ' !
Type of Inspection (circle appropriate one) Permit No C- f
Sewer Foundation Framing Chimney Plumbing Final Sewer Excav Other~-
INSPECTION NOTES
Inspected
Remarks
Date
Time
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C 542- F 18'7.-5 8 70~
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RESTORATION REQUIRED
YES
./
NO t.,/
SURFACE RESTORATION
SURFACE TYPE 0 Unimproved D Gravel
o Repaired by City
[] Repaired by Permittee
[] No Damage Found
o Asphalt 0 PCC J 0 Other
Work Order # ,9.-/ 6 6
~MPLETE
o INCOMPLETE
(Continue on reverse side if necessary)
STREET SUPERINTENDENT
(DATE)
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APPLICATION FOR-WATER
CUy W..., D.......... n /~ 1,19_
Port Angeles, Wash. ~
.,;'
I hereby apply for water to be furnished in accordance with rates and rules of the City
for the following premises
K~-rnondCn.sr
1;23 e 1066
"~ame of Applicant ffl..l1-1lO-hn n.L4~dl '€-
Address $') '5 ~trl~,~ ~j-4_
Ren.w.] 0 N.w S.,_v;c.Q/ BI~ Lo.-1Z- Add (3enC!hornDetS
Size of Se<vk. J 1. 5/( ~f~ 1.J~ S~ oz:;
Fa-d- J9~3~76
Service Left On 0 Service Left Off 0 Signed v A
tR~ 06 CC1>O ~
Installed by .
Remarks 1/erMJT..:lt 1 z..tt5
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