HomeMy WebLinkAbout933 W 9th St - Building wA,
CITY OF PORT ANGELES
0 DEPARTMENT OF COMMUNITY ECONOMIC DEVELOPMENT BUILDING DIVISION
321 EAST 5TH STREET, PORT ANGELES, WA 98362
Application Number 11- 00000430 Date 5/17/11
Application pin number 371040
Property Address 933 W 9TH ST REPORT SALES TAX
ASSESSOR PARCEL NUMBER: 06-30-00-0-2- 5920 -0000-
Tenant nbr, name CLALLAM CNTY HIST. SCTY on your state excise tax form
Application type description DEMOLITION to the City of Port Angeles
Subdivision Name
Property Use (Location Code 0502)
Property Zoning PUBLIC BUILDINGS PARKS
Application valuation 39957
Application desc
DEMOLISH THE SOUTH BRICK ADDITION /RESTROOM BLDG
Owner Contractor
CLALLAM COUNTY HISTORICAL SOC HOCH CONSTRUCTION
P 0 BOX 1327 4201 TUMWATER TRUCK RT
PORT ANGELES WA 983620244 PORT ANGELES WA 98363
(360) 452 -2662 (360) 452 -5381
Structure Information 000 000 DEMO SOUTH ADDITION /RSTRM BLDG
Permit DEMOLITION
Additional desc DEMO SOUTH ADDITION /RSTRM BLDG
Permit pin number 185207
Permit Fee 50.00 Plan Check Fee .00
Issue Date 5/17/11 Valuation 0
Expiration Date 11/13/11
Qty Unit Charge Per Extension
BASE FEE 50.00
Special Notes and Comments
The Fire Department has reviewed the project application and
has no comments
May 12, 2011 11:07:30 AM Brian 417 -4708. OK g
Public Works Utility Engineering has no requirements for this plan review. r q`
Other Fees STATE SURCHARGE 4.50 j
Fee summary Charged Paid Credited Due
Permit Fee Total 50.00 50.00 .00 .00
Plan Check Total .00 .00 .00 .00
Other Fee Total 4.50 4.50 .00 .00
Grand Total 54.50 54.50 .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.
11 m ai 11 c N�►jz�.� 5 r i
Date Print Name Signature of Contractor or Authorized Agent Signature of Owner (if owner is builder)
T:Forms /Building Division /Building Permit
BUILDING PERMIT INSPECTION RECORD -G
PLEASE PROVIDE A MINIMUM 24 -HOUR NOTICE FOR INSPECT IONS 0
Building Inspections 417 4815 Electrical Inspections 417 4735
Public Works Utilities 417 4831 Backflow Prevention Inspections 417 4886
IT IS UNLAWFUL TO COVER, INSULATE OR CONCEAL ANY WORK BEFORE INSPECTED AND ACCEPTED.
POST PERMIT IN CONSPICUOUS LOCATION. KEEP PERMIT AND APPROVED PLANS AT JOB SITE.
Inspection Type Date Accepted By Comments
FOUNDATION:
Footings
Stemwall
Foundation Drainage Downspouts
Piers
Post Holes (Pole Bldgs.)
PLUMBING:
Under Floor Slab
Rough -In
Water Line (Meter to Bldg)
Gas Line
Back Flow Water FINAL Date Accepted by
AIR SEAL:
Walls
Ceiling
FRAMING:
Joists Girders Under Floor
Shear Wall Hold Downs
Walls Roof Ceiling
Drywall (Interior Braced Panel Only) P
T -Bar V
INSULATION: W
Slab
Wall Floor Ceiling
MECHANICAL:
Heat Pump Furnace FAU Ducts
Rough -In
Gas Line
Wood Stove Pellet Chimney
Commercial Hood Ducts FINAL Date Accepted by
MANUFACTURED HOMES:
Footing Slab
Blocking Hold Downs
Skirting
PLANNING DEPT. Separate Permit #s SEPA:
Parking Lighting ESA:
Landscaping SHORELINE:
FINAL INSPECTIONS REQUIRED PRIOR TO OCCUPANCY/ USE
Inspection Type Date Accepted By
Electrical 417 -4735
Construction R.W. PW Engineering 417 -4831
Fire 417 -4653
Planning 417 -4750
Building 417 -4815 \\—?7-11
T:Forms /Building Division /Building Permit
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°kT44, .B UILDING PERMIT APPLICATION Print in ink
CITY OF PORT ANGELES 5' 1
For City Use Only:
Attn: Building Permit Technician R a Received 5 I
321 E. Fifth St., Port Angeles, WA 98362 .�a:+`9 z
(360) 417 -4815. fax (360) 417 -4711 o b
(A`k fir^ e >nit
P sr ate Ap d it
i
Applicant GI,AL- 1 -Ar,r,
Cou+v I ST aC 1 1 Phone 4r2 2G
Property Owner G t.AU,Am 1.- I e.„ p2,1 Us t Phone 4-52- 2.6G 2
Property Owner's Address 1,j q -1-43 S7• 1: ANeur WA 4 11165
Contractor Gd InoT Phone ¢6z- 5391
Contractor's Address 4Zo1 TurY1V A1J2- Pa)2:7 4N4 0,135 '31
License 41661 -IcG *c Il2N4 Expires E -mail haoh a !Lim F 5' com
PROJECT ADDRESS 6153 W c 1 71 1 1
Parcel Number 063O 0002 51 ZO Lot Zoning
Project Type Brief Description: Residential Multi- family Commercial Industrial
Check all that apply
New Construction "Dtrrno 7'N bI T1otv 4- 1243,71"1200 rv, IAA VD I OCa
Addition rJp1l 1 wa e sxt NG )70 :12. wild rt4)C> Tl-WY operivb
Remodel NTb P.1 :701110N W Ink '24 ptza►MI PA mop
Repair 11461 venurrves PrAitr Rftbfio btSt atvws-c in
)(Demolition wpo r VI-Imou4 L. A'p. W) Li, 'u rm' T7 j
Re -roof House garage other tear off re -roof lay over one layer
Heat System Heat pump wood- burning stove gas fireplace o pellet stove other
Other
Floor Areas Existing (sq. ft.) Proposed (sq. ft.)
Basement per sq. ft.
1 Floor
2nd Floor Z
3rd Floor
Garage
Carport
Covered Porch
Deck
Shed
Other
TOTAL VALUATION 3I 1 y
Total footprint of structures sq. ft. Lot size sq. ft. Lot coverage
Site Coverage the amount of impervious surface on a parcel, including structures, paved driveways, sidewalks, patios,.
and other impervious surfaces. (see PAMC 17.94.135 for exemptions) Site coverage
Max. height of proposed structures ft. Occupancy group of bedrooms
Will a lawn sprinkler system be installed? Occupant load of full baths
Will a fire sprinkler system be installed? Construction type of half baths
I have read and completed this application and know it to be true and correct. l 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 wo i g on projects.
Date S•11 11 Print Name G 1-1424 6 Ws 5 M 11 4 Signature
T:Forms /Building Division /Building permit a K IN411./.4 N
Clallam County Assessor Treasurer Property Details 58343 CLALLAM COUNTY Page 1 of 2
it
Clallam County Assessor Treasurer
Property Search Results 58343 CLALLAM COUNTY HISTORICAL SOCIETY for Year 2011 2012
Property
Account
Property ID: 58343 Legal Description: LTS 5 -16 BL 259
EXC R/W AKA
PARCEL'B' 2.05A
SURVEYS V49 P99
V50 P20
Geographic ID: 0630000259200000 Agent Code:
Type: Real
Tax Area: s, 0010 PA 121 PORT ST CNTY H2 L WMP Land Use Code 89
Open Space: N DFL N
Historic Property: N Remodel Property: N
Multi Family Redevelopment: N
Township: .L 7 Section:
Range: q33 w -1 S 1
Location J
Address: WEST EIGHTH ST Mapsco:
PORT ANGELES, WA 98363
Neighborhood: Exempt Ref Region 5 Map ID: 2
Neighborhood CD: 50985200
Owner
Name: CLALLAM COUNTY HISTORICAL SOCIETY Owner ID: 18282
Mailing Address: P O BOX 1327 Ownership: 100.0000000000%
PORT ANGELES, WA 98362 -0244
Exemptions: EX
Taxes and Assessment Details 1
Property Tax Information as of 05/05/2011
Amount Due if Paid on: E. NOTE: If you plan to submit payment on a future date, make sure you enter the date and
click RECALCULATE to obtain the correct total amount due.
First Second i
Half Half
Base Base
Year' Statement ID Taxing Jurisdiction Amt. Amt. Penalty Interest Base Paid' Amount Due
12011 153001 ST SCH STATE SCHOOL $0.00 $0.00 $0.00 $0.00 $0.00
$0.00
2011 153001 CC -GEN COUNTY CLALLAM $0.00 $0.00 $0.00 $0.00 $0.00 $0.00
2011 153001 SD #121 SCHOOL DISTRICT #121 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00
2011 153001 CITY PORT ANG CITY OF PORT ANGELES $0.00 $0.00 $0.00 $0.00 $0.00 $0.00
2011 153001 PORT PORT OF PORT ANGELES $0.00 $0.00 $0.00 $0.00 $0.00 $0.00
2011 153001 NTH OLY LIB NORTH OLYMPIC LIBRARY $0.00 $0.00 $0.00 $0.00 $0.00 $0.00
2011 153001 HOSP #2 HOSPITAL #2 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00
2011 153001 WSMET PK DIST WILLIAM SHORE MET PARK DIST $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 3
i 2011 153001 CITY STORMWATER CITY STORMWATER $252.47 $252.46 $0.00 $0.00 $252.47 $252.46
12011 153001 WEED CONTROL WEED CONTROL $0.82 $0.81 $0.00 $0.00 $0.82 $0.81
2011 153001 TOTAL: $253.29 $253.27 $0.00 $0.00 $253.29 $253.271
12010 41292 ST SCH STATE SCHOOL $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 j
1 2010 41292 CC -GEN COUNTY CLALLAM $0.00 $0.00 $0.00 $0.00 $0.00 $0.001
12010 41292 SD #121 SCHOOL DISTRICT #121 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00]
2010 41292 CITY PORT ANG CITY OF PORT ANGELES $0.00 $0.00 $0.00 $0.00 $0.00 $0.00
2010 41292 PORT PORT OF PORT ANGELES $0.00 $0.00 $0.00 $0.00 $0.00 $0.00
2010 41292 NTH OLY LIB NORTH OLYMPIC LIBRARY $0.00 $0.00 $0.00 $0.00 $0.00 $0.00
2010 41292 HOSP #2 HOSPITAL #2 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00
2010 41292 WSMET PK DIST WILLIAM SHORE MET PARK DIST $0.00 $0.00 $0.00 $0.00 $0.00 $0.00
http: /websrv8.clallam. net propertyaccess /Property.aspx ?cid =0 &year= 2011 &prop_id =58343 5/5/2011
Linda Pangrle
From: Linda Pangrle
Sent: Thursday, May 05, 2011 3:33 PM
To: Bill Hale
Cc: Billy McCurdy; Roger Vess
Subject: What is the true address for PNUM 0630 0002 5920?
Hi Bill,
Today I received a demo permit application for a portion of the old Lincoln School. I'm trying to attach it to an address,
but I saw three different addresses for it.
Which is correct?
The County shows the address as 926 W 8 St.
GIS shows the address as 933 W 8 St.
HTE shows the address as 933 W 9 R.
It seems to me like the 933 W 9 St. is the correct address, because odd numbers are on the north side of the street.
Please let me know, and update GIS if needed.
Thanks,
Linda
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Port Angeles, WA 98362 L School
aasb ARC H 1[ T 1E C T S Phone:(360) 452 -6116 6i C1allCam County Historical Society
Far (360) 452 -7064
iUtAl CITY .OF
Y I v e S N U. S. A.
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t RECEIVED
1 I February25 ,2011
r f Rick Hoch MAY 0 6 201
„,4
e s 4201 Tumwater Truck Route CITY OF P
y; s V y t Port Angeles, WA: 98382 BUILDING DIVISION
a ;k
4 RE: Port Angeles Landfill Transfer Waste Disposal Application, WDA #11-06 for Rick Hoch.
t ,10:
st``�" We have received your application for disposal of building demolition debr from the referenced
A*" Site and reviewed the testing results. Based on the testing results of the debris appears to be
l i ,1 acceptable for disposal at the transfer station. A copy of your approved application is attached. This
t'i:.1 approved application must be shown to the transfer station scale attendant at the time of disposal.
fi0 4 Please be advised that the disposal application is only for the materials and quantities listed in the
fx application. Materials not listed. or in excess of the quantities noted may require separate
eti V4 applications and approval.
i
4 1 1 4 4 Please call Tom McCabe, Solid Waste Superintendent at 360-417 -4872 or e -mail
3 te a
I4 .4 tmccabe @cityofpa.us if you have any questions.
r V i S incerely
r
s A 3# `u, Ifr
�'e,
f 4 ,i Tom McCabe
auk.} .'T.3$ 5 a1p"P�
£1 Solid Waste Superintendent
t Cc: Brian Tate, Operations Manager, Port Angeles Transfer Station
K,, Sonja Coventon, Scale Attendant, City of PA
4 �D 4 Enc: WDA
4 t C Waste Disposal /correspondence
4144% PO*
tt K w l f,y, 4 Phon 360-417-4805 Fax: 360-417-4542
"`ti Website: www.cityofpa.us Email: publicworks @cityofpa.us
r 321 East Fifth Street P.O. Box 1150 Port Angeles, WA 98362 -0217
a:6
POP.f
o artioNs„„1111P.- WASTE DISPOSAL APPLICATION
IF 'IMO
ete=7.7.z.x. PORT ANGELES SOLID WASTE TRANSFER STATION
hum,-
To: City of Port Angeles
Phone: (360) 4174872
Attn: Solid Waste Superintendent
Fax (360) 452-4972
321 E. Fifth Street
P.O. Box 1150 I/ 2-
Port Angeles, Washington 98362
NOTE: All questions must be answered for waste to be approved.
1. Applicant Information:
Company Name: tl (ChrtS7 "LOCI' Icrs)
Mailing Address: L a I Toi.,, Du,./.. Its irj
Ai■,e A
Contact: Q.
Phone:
Project Name: S fic.4,L„
Project Location: 92-C- L--' 23 T Afv6f 5
2. Other Contacts (if applicable):
Consulting Firm: L 41-zse6,
Contact:
Phone: q 7- cYir-:
Contractor Name: Hot
Contact: oc_ri
Phone: LIS?
Laboratory: i\+ VC_ 646-94.44
Contact: YA S) J.-014 7110A
phone:
3. L. Source of Waste:
Check the appropriate box below and briefly describe the project, process, and/or cleanup that will or has produced
the waste requiring disposal. Include the gasoline service station number (if applicable).
O CERCLA/MTCA Remediation Agency Contact:
O Independent Remedial Action 0 UST Removal
O Unused Chemical Product Spill 'Other Source: 17)/•43- t 5
t
City of Port Angeles Waste Disposal Application Page 1 of 4
(last updated January 2011)
4. Waste Material Composition: (Check all- thatapply.and. include percent of total)
Soil ,Foundry Slag
Solvents Dredge Sediments
Preserved Wood Debris
Coal Ash 2S Other (list)
Wood Ash )k., C)(5
NOTE: Total must equal 100
5. Waste Material Contaminants: (check all that apply)
Gasoline Metals Diesel
Solvents Heating Oil PCBs
Unused Motor Oil Used Motor Oil /Waste Oil
Other "(8W4) RCP Other Petroleum Product
Unknown L i)
Note: Supply and MSDS information with application, if available.
6. Estimated Quantity of Waste for Disposal:
Cubic yards Tons (estimated both)
Drums Tons (estimated both)
Other:
NOTE: Estimated quantity for disposal must be within 20% of the quantity actually disposed. (10% for projects `over
7,500 tons or 5,000 cubic yards)
7. Frequency of Disposal:
One time Monthly Annual other
8. Waste Sampling:
Proper characterization of the waste for disposal requires the collection of representative samples. The methods
and equipment necessary for obtaining representative samples of a waste, and the frequency of sampling, will vary
with the type and form of the waste. Check the appropriate box and briefly describe how the waste was sampled.
Identify site and location where material is being removed from.
Number of COMPOSITE samples: X Number of DISCRETE samples:
1 I P p/V
P 1
r j �tll�)� J �'Garl.� 1' 6'C::•a t�, fi G gd... "�C.'; �.C.
1 il f 1 Ski `.�T, fP
City of Port Angeles Waste Disposal Application Page 2 of 4
(last updated January 2011)
DOTE 1: Unless prior approval has been granted by Port Angeles, the following sampling frequency will be used:
0 25 cubic yards 1 composite sample
25 —100. cubic yards 3 composite samples
101 500 cubic-yards 5 composite samples
501 -1000 cubic yards 7 composite samples
1001— 2000 cubic yards 10 composite samples
>2000 cubic yards 10 plus one sample for each. additional 500 cubic yards
NOTE 2:- One :composite-sample shall contain a minimum of three /maximum of five discrete samples.
9. Waste Analysis:
The "Dangerous Waste Regulations" (WAC 173 -303) shall be utilized to determine the appropriate analytical
requirements forwaste characterization. Ecology Publication #91 -30 (Revised November 1995) or any future
updates "Guidance for Remediation of Petroleum Contaminated Soils" shall also be used to characterize petroleum
contaminated soils from underground storage tanks releases. Submit all laboratory analytical results, QA /QC data,
and Chain of Custody sheets along with this application.
(NOTE: The sampling laboratory must be accredited by the Washington State Department of Ecology.)
a) List all analytical test methods used:
b) Provide a narrative as to why the above analytical methods were selected:
t
NOTE: Additional sheets attached: NJ YES NO
—r-
10. Soil Classification: *FOR PETROLEUM CONITTAMINATED SOILS ONLY"
Based on the analytical data and Ecology Publication #91 -30, the soil classification is: (check one)
Class 1 Class 2 Class 3 Class 4
Calculated Hazard Index
11. Dangerous Waste Affidavit:
Based on a review of the-analytical test results, site history, and the applicable regulations, this-waste is classified as:
(check one)
Neither Dangerous Waste (DW) nor Extremely Hazardous Waste (EHW)
0 Dangerous Waste (DW) and Waste Code:
0 Extremely Hazardous Waste (EHW) and Waste Code:
City of Pori: Angeles Waste Disposal Application Page 3 of 4
(last updated January 2011)
12. Special Notes for Asbestos Disposal
All asbestos containing materials (with the exception.of roofing: material in good condition that, is not peeling,
cracking or crumbling, with petroleum binder that still exhibits plasticity to prevent release of asbestos fibers) must:
e Be tightly wrapped or bagged in 6 mil plastic with no excess air in the packaging
o Not exceed 50 pounds per bundle
O Be labeled as asbestos with required information regarding its origin
o Be transported with a manifest in the vehicle
Arrive at the transfer station only by appointment with Brian Tate of Waste Connections at 360 452.0427 or cell
phone 360 -912 -7080, so that the material can be deposited In a lock box.
Certification:
We, THE UNDERSIGNED, certify that this application is true to the best of our knowledge. All information provided is
correct and the.endosed analytical results represent proposed waste material to the best of our abilities.
Waste Generator's Signature:
Printed Name Company Position .;�c• 1, �'•.f�a. %`w`•�
Company:
Date;
If you have any questions please contact Tom McCabe, Solid Waste Superintendent at 417- 4872,oremail
tmcca!,aPcitvotHaws.
THIS SECTION TO BE FILLED OUT BY AUTHORIZED STAFF 1/0* f o&
Appr val:
'iii I //it.
rvironm /al Health Specialist Date
Approval with the following conditions if applicable:
I certify under penalty of law that the.statements made on this form are true and correct to the best of my
knowledge, information and belief.
Tom McCabe, Solid Waste Superintendent Date
Contractor shall present their copy of approved application to Scale House.
A Demolition Permit must be obtained if demolition occurs in the City. Permit forms are available at the
building counter at City Hall or on the City's website under the link hhtp:lwww.citvof pa.us/ Phone 360-417
'4815
t.JDy of Pot t A geL i•Vast ..\oi,ii•:ation Page 4 ui
(last updated ianuary ?llO.
'INVL Laboratories Inc. CHAIN of CUSTODY BATCH ID
4708 Aurora Ave N: Seattl WA 9810,E t 08
Tel: 206.547:0100 Emerg. Pager_ 206. 344.1878 SAMPLE LOG 0 0
1.888:NVLLABS:(685.5227) l� J J
Client .Zenovic &:,Associates, Inc. PMLBatch.Number
Street 6tJ\ G_ (p44 e el 1 Client-Job Number f 1 G 2
Port Angeles Total Samples
Project r 5 Lo YAL? Turn Around Time 1-Hr 24-Hr5 4 Days
`L i,,, S t O 2 -Hrs D2 Days 0-5- Days
Project Location
QU :r t c .0 4 -His D 3 Dave ..p6:to 10
Please can for TAT less than 24 His
En address ScoTr 2 SNooK (J..7
Phone: (360) 41:7 70501 Fax: (360).417 -0514
l Q Asbestos Air J Q'PCM (N1OSH'7400) TEM (NIOSH 7402) U TEM;(AHERA) D TEM. (EPA Level 11) D Other
[0 Asbestos Bulk 10 PLM (EPA/600/R- 93/116) 0 PLM (EPA Point Count) 0 PLM (EPA Gravimetry) Q TEM Bulk
METALS Det Limit Matrix l2 NI 8 Other Metals
Total Metals Cl Air Filter RCRA Metals
ppm (AAS) 0 Chips
0 Arsenic (As) Lead (Pb) U All 3
TCLP D PPb (GFAA) 0 Drinking water 0 Paint Chips (Area) Barium (ga) 1J Mercury (Hg) D Copper (Cu)
U Dust/wipe 0 Waste Water 0 Cadmium (Cd) 0 Selenium (Se) 0 Nickel (Ni)
Soil Chromium (Cr) 0 Silver (Ag) 0 Zinc (Zn)
Other Types 0 Ftherglass 0 Nuisance Dust Rotometer Calibration 0 Other (Specify)
of Analysis 0 Silica 0 Respirable Dust 0 Mold/Fungus
Condition of Package: 0 Good D Damaged (no splflage) 0 Severe damage (spalage)
Seq. Lab ID Client Sample Number Comments AIR
1 I /o Ft
2
3
4
5
6
7
8
9
10
11
12
13
15
Below Sran a ar+
Date Tare
Sampled by S.
CO
Rebnquished by S fci t c 1 C-1-' t.c Cr( 1 G Cv
Received by Mkc J 7.11211 E 'c :x
Analyzed by
Results Called by
Results Faced by
Special Instructions: Unless requested in writing, all samples will be disposed of two (2) weeks after analysis.
NVL Laboratories, Inc.
4708 Aurora Ave. N., Seattle, WA 98103
206.547.0100, Fax: 206.634.1936 AIHA IH 101861 ACCREDITED
www.nvllabs.com Analysis Report WA DOE C1765 LABORATORY
Toxicity Characteristic Leaching Procedure Lead (Pb)
Client: Zenovic Associates, Inc. Batch 3102408.00
Address: 301 E. 6th St. Suite 1 Matrix: Bulk
Port Angeles, WA 98362 Method: EPA 1311/70008
Client Project 11031
Attention: Mr. Scott Headrick Date Received: 02/18/2011
Project Location: 926 W. 8th St. Port Angeles, WA Samples Received: 1
Samples Analyzed: 1
RL Results Results in
Lab ID
Client Sample mg/ L in mg /L ppm
31013331 11031 0.5 0.5 0.5
Sampled by: Client
Analyzed by: Yasuyuki Hida Date Analyzed: 02/22/2011 DRAFT
mg/ L Milligrams per liter RL Reporting Limit
ppm parts per million Below the reporting Limit
Note Method QC results are acceptable unless stated otherwise.
Unless otherwise indicated, the condition of all samples was acceptable at time of receipt.
Bench Run No: 31- 0221 -07 Page 1 of 1
'(I
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CITY OF PORT ANGELES
PUBLIC WORKS - ELECTRICAL DIVISION
12\ EAST 5TH STREET. PORT ANGELES. WA 98362
06-00000188 Date
154680
933 W 9TH ST HS
06-30-00-0-2-5920-0000-
ELECTRICAL ONLY
3/10/06
Appl1cation Number
Appl1cat1on pin number.
Property Address
ASSESSOR PARCEL NUMBER.
Appl1cat1on type descr1pt1on
Subdivision Name
Property Use
Property Zoning
Appl1cat1on valuation
PUBLIC BUILDINGS & PARKS
o
Owner
Contractor
CLALLAM COUNTY HISTORICAL SOC
POBOX 1327
PORT ANGELES WA 983620244
APS ELECTRIC
546 BENSON RD
PORT ANGELES
PORT ANGELES
(360) 452-6753
WA 98363
Permit
Addit10nal desc
Permit pin number
Sub Contractor
Perm1t Fee
Issue Date
Expiration Date
ELECTRICAL TEMPORARY SERVICE
APS/ TEMP SVC
71654
APS ELECTRIC
48.10 Plan Check Fee
3/10/06 Valuation
9/06/06
.00
o
Qty Unit Charge Per
1 00 48 1000 ECH EL-TEMP SRV - 0-100 SRV FDR
Extension
48 10
Fee summary Charged Paid Credited Due
----------------- ---------- ---------- ---------- ----------
Permit Fee Total 48 10 48 10 00 00
Plan Check Total 00 00 00 00
Grand Total 48 10 48 10 .00 00
COMMENTS/ACTION NEEDED
Lasered
CEO
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ELECfRICAL PERMIT INSPECfION 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
INSPECTION TYPE DATE ACCItI'TKD COMMENTS
YES NO
I liT. 'H
RflIICTH_lN I CUVER
~~K VICE
"TN Ii T I '3 -/0 ... oCr:. MAJJ
GENERAL COMMENTS:
PW-II02.U 14196]
Job wired by
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~Iectrical Contractor 0 Owner
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ELECTRICAL WORK PERMIT APPLICATION
Add'fS llf-3spedioiJ, q.!-
~::.~~ s~;~f., lf5~-~7-5
Owner'~' de led by RCw'19,28,16J:(1) Owlle,. will occupy rhe slructurc[ur two
years tifk.,. this i!/ectJicaI permiJ i..v fi'tati:ed. (2) Owner is required to JJire lVl dectrical
COlln'actor If a/)ove :laid p,'operty if fol' sate, I'cnl Or least'.
After reading the above slatement, I hereby certify that I 3m the owner of the above
named 'Property or a licellsed electrical cont1'3ctor. I am mak.ing the electrical instal- 0 Credit Card
1ation or alteration in compliance with the electrical laws, N,E.C.. RCW. Chapter
19.28. WAC. Chapter 296-46D. The City of Port Angeles Municipal Code, and
lItility SpeciIk':~llion.s.
s~gn.tnre f wner, cl" C{ODr" 10' or .,;':;:; ;DI~i'b~~ to
Electrlcalloadil di sand
o NO LOAO CHANG ES
Q Baseboard KW
a Furnace KW a Overhead Service
a Heal Pump Ton LAR a Temp ServIce
a Fan-Waif KW 0 Underground Service
(SAME DAY INSPECTION, CALL BEFORE 7:00 AM 360-417-4735)
Installalio" description
")(Commercial 0 Residential
o New
D;('Altered/AddJtlon
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J 00 A.
o Cash
a Check #
A
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Visa
Mastercard
Discover
f'-
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Card# ____-____-____-____
Expiration Datc
of card
Voltage _,_
PhaseD 1 03
Service Size: _
Feeder Size:
ROUGH-lN "- THERMOSTAT '\ ( SERVICE
I
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D3.I~ Approvedtly D3.I~ AllPlV"wBy D3.te AlIil1ovellJ;!y ./
3/~J/::AL Ad) ,.- lJlIUl Fl:EDER
"--.oif, APJmlvedBy/ n.le. .\pprove.d Ry ./ o~, MProvctl8:f-:;
Inspection Area, Building or Equipment Inspected €lccrrical
Date Action Taken Inspector
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>d W~Sc:L0 900c >c 'qa~
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