The URL can be used to link to this page

Home My WebLink About116 E 1st St - Engineering s ~~ CITY OF PORT ANGELES PUBLIC WORKS - BUILDING DIVISION 321 EAST 5TH STREET, PORT ANGELES, WA 98362 PUBLIC WORKS CONSTRUCTION Issued: 2/05/98 TF Permit No: 798 & R/W PERMIT Cond: Work Order: 0 OWNER/APPLICANT------------------------PROPERTY LOCATION-----------~-----------_ DONALD BETTGER 116 1ST ST E 1022 SOUTH CHERRY Lot: 6 Port Angeles,WA98362 Block: 31 Long Legal: ~ PR~;~~~O~;~~~~---------------_______________~~~:_~_~_~~~:~___________________ _~ Work is INSIDE traveled road Value Work: $0. o~ Plans Required: N/A Start: / / Contractor: R. J. SERVICES Finish: / / - Performance Bond Required: N/A Amount: Proof Insurance: Work over $2000: 200K PI/500K Per Inc/100K Prop \fl $ 0 . 00 ---\ Work to Perform: INSTALL Watermain Sanitary Sewer Storm Drain Underground Tele/Ele * Misc test boring PROJECT NOTES--------------------_______________________________________________ soil boring / set monitor wells on south side of East 1st st (100 blk) contractor to coordinate construction with Strider Construction for traffic contol. Waiver and rel~ase form required (hold harmless) Right of way Use permit for monitor wells required. PROJECT FEES ASSESSMENT------------------_______________________________________ R/W Excav: * $40.00 San Sewer SFR: $0.00 Sidewalk: $0.00 San Sewer MFR: $0.00 Curb/Gutter: $0.00 Add Unit: 0 Driveway: $0.00 Other San Sewer: $0.00 Dwy Culvert: $O~OO Sew Tap Wye/Man Tap: $0.00 Street Cut: $0.00 Sew Cap/ W/M Removal: $0.00 Other R/W: $0.00 Alter/Repair Sewer: $0.00 Fire Hydrant: $0.00 Storm Drain Tap: $0.00 Res Water Serv: -$0.00 Catch Basin per ea: $0.00 5/8" Sewer System Dev: $0.00 3/4" Milwaukee Dr. Sew Assess: $0.00 1" R/W Use Perm: $0.00 Corom Water Serv: $0.00 D.R.A.: $0.00 1" Admin Costs (D.R.A): $0.00 1 1/2" Misc: $0.00 2" ============================== Oth Water Serv: $0.00 Water Sys Dev: $0.00 Receipt No: 3791 Inspection Fee: TOTAL FEE: AMT PAID: $40.00 $40.00 ----------------------- R/W SANIT ARY $0.00 WATER DWY STORM BAL DUE: DRA $0.00 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 a te or 10 allaw regulating construction or the performance of construction. Date Si nature of Owner if owner is builder Date . . (,/1 ~. YJ ,,11> ACORD Certiifcate of Insurance--CITY OF PORT ANGELES-----Issue Date: 020598 __ Producer---------------__________ This certificate is issued as a matter of RaIston & Ralston, Inc. information and confers no rights upon the P. O. Box 1405 certificate holder. This certificate does Port Angeles, WA 98362 not amend, extend or alter the coverage af- forded by the policies below. Insured-----------------------------------Companies Affording Coverage------- Company A: OREGON MUTUAL INS. R.J. Services Inc. Company B: 514 Erving Jacobs Road Company C: Port Angeles WA 98362 Company D: Coverages-------------_______________________________________________________ This is to certify that the policies of insurance listed below have been is- sued to the insured named above for the policy period indicated, notwithstan- ding any requirement or condition of any contract or other document with re- spect to which this certificate may be issued or may pertain, the insurance afforded by the policies described herein is subject to all the terms, exclu- sions and conditions of such policies. Limits shown may have been reduced by paid claims.-------------____________________________________________________ Co ------------------ ------------- Effect Expire ________________________ Ltr Type of Insurance Policy Number Date Date Limits ------------------ ------------- ------- ------- ------------------------ A General Liability SMW008302 [X] Commercial [X]General Liab. [ ] Claims Made [X] Occurrence [ ]Own & Cont Prot [ ] ------------------ ------------- ------- ------- ------------------------ 040297 040298 General Agg $1,000,000 Prd/Comp Ops$l,OOO,OOO pers/Adv Inj$ 500,000 Each Occurnc$ 500,000 Fire Damage*$ 50,000 Med Expense*$ 5,000 *Any 1 Fire/Any 1 Person Auto Liability [ ] Any Auto [ ]AIl Owned Autos [X] Scheduled Autos A [X] Hired Autos SMW008302 [X]Non-Owned Autos [ ] Garage Liab. [ ] ------------------ ------------- ------- ------- ------------------------ Combined Single Limit $1,000,000 Bodily Injury - Per Person $ 040297 040298 Bodily Injury - Per Accident $ Property Damage $ Excess Liability [ ]Umbrella Form [ ] Other Than Umbo ------------------ ------------- ------- ------- ------------------------ Each Occurrence $ Aggregate$ A Workers Compo And Employers' Liab. SMW008302 Statutory Limits Each Acc. $500,000 040297 040298 Disease Lim.$500,000 Disease Emp.$500,000 Other ------------------ ------------- ------- ------- ------------------------ Description Of Operations: ACORD 25-S(7/90)-[CGW] Certificate Holder------------_____ Cancellation--------_____________________ Should any of the above described poli- cies be cancelled before expiration date the issuing company will endeavor to mail 10 days written notice to certificate holder named to the left, but failure to mail such notice shall impose no obliga- tion or liability of any kind upon the com n..y or it~~~r representatives rized W~ IIAU 5/94 CITY OF PORT ANGELES P.O. BOX 1150 PORT ANGELES, WA 983622 ATTN: TRENIA IA~t