HomeMy WebLinkAbout535 E Front St - BuildingApplication Number
Application pin number
Property Address
ASSESSOR PARCEL NUMBER
Application type description
Subdivision Name
Property Use
Property Zoning
Application valuation
Application desc
Repair asphalt drive RCP #10 14
Owner
PATEL DILIP KUMAR /MINAXIBEN
535 E FRONT ST
PORT ANGELES WA 98362
Permit
Additional desc
Permit pin number
Permit Fee
Issue Date
Expiration Date
Special Notes and Comments
If traffic control becomes necessary contractor shall
submit a plan for City review /approval Partially broken down
curb section in driveway shall be removed Work to be in
accordance with current Urban Services Standards and
Guidelines
Fee summary
Permit Fee Total
Plan Check Total
Grand Total
Si nature of Contract
T \Policies \1102 15 [10/08]
Qty Unit Charge Per
DRIVEWAY INSTALLATION
REPAIR ASPHALT DRIVE
165902
180 00 Plan Check Fee 00
5/21/10 Valuation 0
11/17/10
Charged Paid Credited
r Authorized Agent
10 00000519
060233
535 E FRONT ST
06 30 00 5 1 4180 0000
PUBLIC WORKS UTILITES
UNKNOWN
0
BASE FEE
CITY OF PORT ANGELES
PUBLIC WORKS UTILITIES
321 EAST 5TH STREET PORT ANGELES, WA 98362
Contractor
OWNER
180 00 180 00 00
00 00 00
180 00 180 00 00
Date 5/21/10
Due
Extension
180 00
00
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 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
constr ion
2
Date
Signature of Owner (if owner is builder) Date
PW UTILITIES (Engineering Division)
WATERLINE METER
SEWER CONNECTION
SANITARY
STORM
SITE DRAINAGE
SITE EROSION CONTROL
PARKING
SIDEWALK
CURB GUTTER
DRIVEWAY APPROACH
BACK -FLOW DEVICE
CONSTRUCTION R.W PW/ I
ENGINEERING 417 -4831
I FIRE 417 -4653 I
PLANNING DEPT 417 -4750 I
BUILDING 417 -4815
T \Policies \1102.15 [10/08]
RESIDENTIAL
PERMIT INSPECTION RECORD
CALL 417 -4831 FOR UTILITY INSPECTIONS PLEASE PROVIDE A MINIMUM 24 HOUR NOTICE. IT IS UNLAWFUL TO COVER,
INSULATE OR CONCEAL ANY WORK BEFORE INSPECTED AND ACCEPTED. POST PERMIT IN A CONSPICUOUS LOCATION
KEEP PERMIT CARD AND APPROVED PLANS AT JOB SITE
INSPECTION TYPE DATE ACCEPTED COMMENTS
YES I NO
I
I
I I
I I
FINAL INSPECTIONS REQUIRED PRIOR TO OCCUPANCY/USE
DATE YES NO COMMERCIAL DATE ACCEPTED
YES NO
CONSTRUCTION R.W
PW ENGINEERING
I FIRE DEPT
I PLANNING DEPT
BUILDING
Application Number 09 00000289
Application pin number 878123
Property Address 535 E FRONT ST
ASSESSOR PARCEL NUMBER 06 30 00 5 1 4180 0000
Application type description PUBLIC WORKS UTILITES
Subdivision Name
Property Use
Property Zoning UNKNOWN
Application valuation 0
Application desc
sewer repair
Owner Contractor
PATEL DILIP KUMAR /MINAXIBEN GARY S PLUMBING INC
2580 E RILES CIR PO BOX 255
ANAHEIM CA 92807 PORT ANGELES
(360) 457 8249
Permit
Additional desc
Permit pin number
Permit Fee
Issue Date
Expiration Date
Fee summary
T \Policies \1102 15 [10/08]
CITY OF PORT ANGELES
PUBLIC WORKS UTILITIES
321 EAST 5TH STREET PORT ANGELES, WA 98362
SANITARY SEWER HOOK UP
Qty Unit Charge Per
1 00 40 0000 EA SAN SEW REPAIR
Charged Paid Credited
Date 4/01/09
WA 98362
143776
40 00 Plan Check Fee 00
4/01/09 Valuation 0
9/28/09
Due
Permit Fee Total 40 00 40 00 00 00
Plan Check Total 00 00 00 00
Grand Total 40 00 40 00 00 00
Extension
40 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 as commenced or if required inspections have not been requested within 180 days from the last
inspection !hereby certify that 1 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
constru tion
Signature of Contractor or Authorized Agent Date Signature of Owner (if owner is builder) Date
CALL 417 -4831 FOR UTILITY INSPECTIONS PLEASE PROVIDE A MINIMUM 24 HOUR NOTICE. IT IS UNLAWFUL TO COVER,
INSULATE OR CONCEAL ANY WORK BEFORE INSPECTED AND ACCEPTED. POST PERMIT IN A CONSPICUOUS LOCATION
KEEP PERMIT CARD AND APPROVED PLANS AT JOB SITE
INSPECTION TYPE DATE ACCEPTED COMMENTS
PW UTILITIES (Engineering Division)
WATERLINE METER
SEWER CONNECTION
SANITARY
STORM
SITE DRAINAGE
SITE EROSION CONTROL
PARKING
SIDEWALK
CURB GUTTER
DRIVEWAY APPROACH
BACK -FLOW DEVICE
RESIDENTIAL
CONSTRUCTION R.W PW/
ENGINEERING 417 -4831
FIRE 417 -4653
PLANNING DEPT 417 -4750 I
BUILDING 417 -4815
T \Policies \1102 1 [10/08]
PERMIT INSPECTION RECORD
YES 1 NO
FINAL INSPECTIONS REQUIRED PRIOR TO OCCUPANCY/USE
DATE YES NO COMMERCIAL DATE ACCEPTED
YES 1 NO I
I I
I I
I I
I I
CONSTRUCTION R.W
PW ENGINEERING
I FIRE DEPT
I PLANNING DEPT
I BUILDING
I I I
I I I
I I I
I I I
b
0
CERTIFICATE OF OCCUPANCY
This Certification issued pursuant to the requirements of Section1,301 of the
International Building Code certifying that at the time of issuance this structure was
in compliance with the various ordinances of the City regulating Building
4 construction or use. For the following
Use Classification: Bu iness Building Permit No. 05 -209 Business Name: Riviera Inn
Group B Type of Construction. VN Use Zone:.'? CBD
Owner of Business: Dilin Patel Address: 535 East Front Street. Port Angeles. WA. 98362
Building Address: 535 East Front Street Port Angeles. WA. 98362
r f�' -1 -,I
A ugust 8. 2005
Bu■lding f v' Date
N h znq sS3:tir" a
Post on the °p a "conspicuous place
Shall not be removedrexcept.by Official
City of Port Angeles'
Building Division
0
A
R 4vft 0. VtY1
DATE 3- -z5`oS
Address of Proposed Business
S 2
Applicant VV I v P t
Address
Phone. business '7 3 i- 5 S home
Brief description of proposed business. M P
Legal Description Lot
Current Use of Property
Zoning Classification of Property
WILL THERE BE ANY OF THE FOLLOWING?
Construction changes
Electrical changes
Mechanical (heating, cooling, stoves)
Plumbing changes
New or relocated signs
New septic tanks
New sewer service
Admission charged to patrons
Is this a home occupation?
Excavation of filling of lots
Work done in City right -of -way
Is there sufficient off street parking?
New driveway openings
A grading plan for site drainage
(parking lots, downspouts, etc.)
Are the existing streets paved?
Are there existing sidewalks?
Is there curb and gutter?
Other
PPR
VED REJECTED
d
ROUTING SLIP
p Certificate of Occupancy
$47 00 Certificate /Inspection Fee
YES
Block
I hereby apply for a Certificate of Occupancy and acknowl-
edge that I have read this application and state that the
information I have supplied is correct to the best of my
knowledge
Building Section
Public Works Department
Planning Department
Fire Department
City Clerk
PB I.A.
tz:z 6 a &/0 Io Apr, 1 5 T`
New Business
Transfer of Business Location
Change of Ownership
New Building
Remodel
Temporary Business
Change of Use
Date
Signed
Subdivision
THE FOLLOWING W
PERMITS
1) Building
2) Plumbing
3) Electrical
4) Mechanical
5) Sewer
6) Sidewalk installation
7) Driveway installation
8) Curb installation
9) Sidewalk obstruction
10) Water meter installation
11) Fire
12) Occupancy
13) Sign
14) Shoreline
15) Home occupation
16) Conditional use
17) Other
R l�
Comments Conditions
cis -26
ILL BE REQUIRED
BUSINESS LICENSE
1) Taxi
2) Peddlers
3) 2nd Hand Dealer
4) Pawn Broker
5) Dance
6) Hotel Motel
7) Fireworks
8) Ambulance
9) Tattoo shop
10) Other
4.44
CERTIFICAT Q,CCUPANCY
Post on�`t
Shall not be rim
Build
Th Cert pursuant to the requirements of i B Section' ,109 of the
uilding cdetcerttfytng thaf issuance this structure was
in
m ne wit vari us¢ord t at the time =o nancesof�'the C' gulating Building
y° c ons t ruc t a r useForithefo1lowing
Use Classification: 1 .Burldi Permit Noy vi i a
Group: B
Owner of Business/Residence:
Building Address:
53 .East Front Street.
CA
Asi ront t ea Port Angeles. WA 98362
.-Poi :Angles WA 98362
ctober 3. 2002
Date
uous place.
.yBuilding Official
APPS( P
I1r
o2�SsZ
00
REJECTED
DATE
Address f Proposed usine
35 A/7
Applicant P i V i e Yta.
Address .�5 'FYO t-I-
Pori- Pvt L e,s i✓ 4 c? 36
Phone: business 1: 413 31:5 1- homes`''- 3t 141
WILL THERE BE ANY OF THE FOLLOWING?
Construction changes
Electrical changes
Mechanical (heating, cooling, stoves)
Plumbing changes
New or relocated signs
New septic tanks
New sewer service
Admission charged to patrons
Is this a home occupation?
Excavation of filling of lots
Work done in City right -of -way
Is there sufficient off street parking?
New driveway openings
A grading plan for site drainage
(parking lots, downspouts, etc.)
Are the existing streets paved?
Are there existing sidewalks?
Is there curb and gutter?
Other
ROUTING SLIP
Certificate of Occupancy
D Certificate /Inspection Fee
Brief description of proposed business. /16 7
Legal Description Lot -(7 Block 'it
Current Use of Property' /ftB"
Zoning Classification of Property'
Vw
YES NO
I hereby apply for a Certificate of Occupancy and acknowl-
edge that I have read this application and state that the
information I have supplied is correct to the best of my
knowledge.
Building Section
Public Works Department
Planning Department
Fire Department
City Clerk
PB I.A
New Business
Transfer of Business Location
Change of Ownership
New Building
Remodel
Temporary Business
Change of Use
1) Building 1) Taxi
2) Plumbing 2) Peddlers
3) Electrical 3) 2nd Hand Dealer
4) Mechanical 4) Pawn Broker
___I 5) Sewer 5) Dance
I✓ 6) Sidewalk installation 6) Hotel Motel
7) Driveway installation 7) Fireworks
tV 8) Curb installation 8) Ambulance
9) Sidewalk obstruction 9) Tattoo shop
10) Water meter installation 10) Other
i 11) Fire
t/ 12) Occupancy
13) Sign
14) Shoreline
15) Home occupation
16) Conditional use
17) Other
Date.
PERMITS
Signed
Makesk, Y;
Subdivision 4 S -1'77V
THE FOLLOWING WILL BE REQUIRED
BUSINESS LICENSE
Comments Conditions \Ae q112dd
0 Q crowL z
‘go132,012LaitieL__
~_~ ROUTING SLIP
Certificate of Occupancy
.a~J ~Certificate/Inspection Fee
DATE "Ir - I - o ~ New Business ............................ ( )
Address_g_f Proposed J~.gsine~.~. _.... Transfer of Business Location ................ ( )
~-"..~5 ~"-' JT-"/~/~- ~-7--', Change of Ownership ...................... (,/,~¢~)
Applicant .J~iV~ ~y'(3,. "~%%,v,-~ . New Building ............................. ( )
Address .~'- ~z:"..~"YO~.-~ ~>'~. Remodel ................................. ( )
{)LqF'~L ~.,,,~,-~_e__t ) /.-~'~ ~'~',:3~;~ TemporarySusiness ....................... ( )
Phone: busines~ ~ I-{J~.~Z..~T homeS-~- .~;/4-~-5'~- Change of Use ............................ ( )
Brief description of proposed business: /~
Legal Description: Lot /~ -J~7~/,,~ Block .,z./J'/ Subdivision /~//~
Current Use of Property: /~7-~
Zoning Classification of Property: ~,
WILL THERE BE ANY OF THE FOLLOWING? YES NO..~ THE FOLLOWING WILL BE REQUIRED:
Construction changes ...........................~'~ PERMITS BUSINESS LICENSE
Electrical changes .............................. 1) Building 1) Taxi
Mechanical (heating, cooling, stoves).. 2) Plumbing 2} Peddlers
Plumbing changes ............................. //7 3) Electrical 3) 2nd Hand Dealer
New or relocated signs .......................... I~ 4) Mechanical 4) Pawn Broker
New septic tanks ............................... ~ 5) Sewer 5) Dance
New sewer service ............................. ~/ 6} Sidewalk installation 6) Hotel - Motel
Admission charged to patrons .................... / 7) Driveway installation 7) Fireworks
Is this a home occupation? ..................... /,,"/ 8) Curb installation 8) Ambulance
Excavation of filling of lots ....................... ~ 9) Sidewalk obstruction 9) Tattoo shop
Work done in City right-of-way... 10) Water meter installation 10) Other
Is there sufficient off-street parking? ............... ~:~ tl) Fire
New driveway openings .........................~l~ 12) Occupancy
A greding plan for site drainage .... 13) Sign
(parking lots, downspouts, etc.)// 14) Shoreline
Are the existing streets paved? ........... --~ 15} Home occupation
Are there existing sidewalks? ............~' 16) Conditional use
Is there curb and gutter? ........................ ~ 17) Other
Other .........................................
hereby apply for a Certificate of Occupancy and acknowl-
/
edge that I have read this application and state that the Date:
knowledge,inf°rmati°n I have supplied is correct to the best of my signed: %~__.~ --% ~
REJECTED Comments / Conditions ,~.~)t~
/, ,. BuildingSection nl J l n o ~ ~ I J ~ O J~ ~J~ O 0 ~
Public Works Department -_~_~"~ -~ ~ ~0/~y~-~
RB.I.A.
CERTIFICATE :CUPANCY
This Certification issucd pursuant to the requirements of Section 109 of the
Uniform Building Code certifying that at the time Of issuance this structure was
in compFtance with the vario~ ordinances of the't~'y regulating Building
Use Claasification: Motel
c. oup: B CA
Owner of Business/Residence: WA !
Building Addr~qs:
20O2
Date
Post place.
Shall not be ~g Official.
d''''"'~
~
~
CITY OF PORT ANGELES
PUBLIC WORKS - ELECTRICAL DIVISION
J21 EAST 5TH STREET. PORT ANGELES. WA 98J62
ELECTRICAL PERMIT
Issued: 12/17/98
Permit No:
6512
OWNER/APPLICANT------------------------PROPERTY LOCATION------------------------
RIVIERA INN 535 FRONT E
535 E. FRONT Lot: 16,17,18
Port Angeles, WA 98362 Block: 41 Long Legal:
360/000-0000 Sub: NR Smith
T: S: Parc No: 063000514180000
CONTRACTOR-----------------------------DESIGNER---------------------~-----------
ADVERTISING SALES & MORE
.1327 E. 1ST ST
Port Angeles, WA 98362
360/452-7785
,
000/000-0000
PROJECT INFO--------------------------------------------------------------------
prj Type: COML. MISC. prj Value: $0.00
Occ Type: Cnstr Type: SIGN
Occ Grp: Occ Load: Land Use: CA
Electrical Heat
Baseboard KW:
Furnace KW:
Heat Pump KW:
Fan/Wall KW:
Service Type
o Riser
o Overhead Service
o Underground Service
o Temp Service
Voltage:
Diameter:
Service Size:
Feeder Size:
-1
o
-3
o AMPS
o AMPS
PROJECT NOTES-------------------------------------------------------------------
VACANCY SIGN ON POLES
PROJECT FEES ASSESSMENT~-------------~-----------------------------_____________
Service: $0.00
Additional Feeders: $0.00
Circuit Wiring: $0.00
Temp Service: $0.00
Misc SIGN $32.25
TOTAL FEE:
Amount Paid:
$32.25
$32.25
=========================~=======
--------------------------
TOTAL FEE:
$32.25
Balance Due:
$0.00
C0I\1MENTS/ACTION NEEDED
<In>'''~.
.~
~
CITY OF PORT ANGELES
PUBLIC WORKS - ELECTRICAL DIVISION
:121 EAST 5TH STREET. PORT ANGELES. WA 98362
ELECTRICAL PERMIT
Issued: 8/05/98
Permit No:
6399
OWNER/APPLICANT------------------------PROPERTY LOCATION------------------------
RIVIERA INN 535 FRONT E
535 E. FRONT Lot: 16,17,18
Port Angeles, WA 98362 Block: 41 Long Legal: .
360/000-0000 Sub: NR Smith
, T: S: Parc No:
CONTRACTOR-----------------------------DESIGNER----~-------------------~--------
COLEMAN ELECTRIC
PO BOX 1326
PORT ANGELES, WA 98362
360/452-7194
,
000/000-0000
PROJECT INFO--------------------------------------------------------------------
prj Type: SIGN prj Value: $0.00
Occ Type: Cnstr Type:
Occ Grp: Occ Load: Land Use: CA
Electrical Heat
Baseboard KW:
Furnace KW:
Heat Pump KW:
Fan/Wall KW:
o
o
o
o
Service Type
Riser
X Overhead Service
Underground Service
Temp Service
Voltage:
Diameter:
Service Size:
Feeder Size:
-1
o
-3
o AMPS
o AMPS
PROJECT NOTES-------------------------------------------------------------------
WIRE READERBOARD SIGN
PROJECT FEES ASSESSMENT-----------------~---------~------~----------------------
Service: $0.00
Additional Feeders: $0.00
Circuit Wiring: $0.00
Temp Service: $0.00
Misc SIGN $32.50
TOTAL FEE:
Amount Paid:
$32.50
$32.50
---------------------------------
---------------------------------
-------------------------~
TOTAL FEE:
$32.50
Balance Due:
$0.00,
COMMENTS/ACTION NEEDED
ELECfRlCAL 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
INSPECI'lON TYPE DATE ACCID'TIW coMMENTS
YES I NO
IUIH...n
I KUULiH-IN I "
, .
IX/,/'11( II~I . I
GENERAL COMMENTS:
l'W-l\0'2.UI06l
ELECfRICAL PERMIT INSPECfION RECORD
CALL 417-4735 FOR ELECTRICAL INSPECTIONS. PLEASE PROVIDE A MINIMUM 24 HOUR NOTICE. IT IS UNLA WFUL TO COlIER.
INSULA TE OR CONCEAL ANY WORK BEFORE IT IS INSPECTED AND ACCEPTED.
KEEP PERMIT CARD AND APPROVED PLANS AT JOB SITE
JNSPEC1l0N TYPE DATE I ACCEPTED COMMENTS
YES I NO
n,TI'J..l
1l11l1r.J..l_lN I CUVER
~
IlzI/714ft I .
GENERAL COMMENTS,
pw.IID2.UI4'!l6]
~pORr~
....O~~
~~~
~~
~
~>::~ '"
CITY OF PORT ANGELES
PUBLIC WORKS & UTILITIES
32] EAST 5TH STREET, PORT ANGELES, WA 98362
Dq-Z~q
Application Number
Application pin number
Property Address
ASSESSOR PARCEL NUMBER:
Application type description
Subdivision Name
Property Use
Property zoning
Application valuation
09-00000289 Date
878123
535 E FRONT ST
06-30-00-5-1-4180-0000-
PUBLIC WORKS UTI LITES
4/01/09
o
630EF~
UNKl'mWN
Application desc
sewer repair
Owner
Contractor
PATEL, DILIP KUMAR/MINAXIBEN
2580 E RILES eIR.
ANAHEIM CA 92807
GARY'S PLUMBING INC
PO BOX 255
PORT ANGELES WA 98362
(360) 457-8249
~f~
Permit
Additional desc
Permit pin number
Permit Fee
Issue Date
Expiration Date
SANITARY SEWER HOOK UP
143776
40.00
4/01/09
9/28/09
plan Check Fee
valuation
.00
o
Qty Unit Charge Per Extension
_______ 1.00 ______~~~~~~~_~~____:~_:~~_~~=~~~___________________~~~~~~~
Fee summary Charged Paid Credited Due
Permit Fee Total
Plan Check Total
Grand Total
40.00
.00
40.00
40.00
.00
40.00
.00
.00
.00
.00
.00
.00
~~
Separate Permits are required for electrical work, SEPA, Shoreline, ESA, utilitjes, 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 periormance of
construction.
Date
Signature of Owner (if owner is builder)
Date
Signature of Contractor or Authorized Agent
T:\Policies\lI02.1S [lOt08]
~
CITY OF PORT ANGELES
DEPARTMENT OF PUBLIC WORKS
. . . . . . INSPECTION REPORT. . . . . .
/
. . . .
REQUEST:
Date 3-sl-o'i
Time
Received by
J2V
(phone. person)
Location of Work to be inspected 535 c;: F/'c>vt -f 5 t
Name of person requesting inspection B (- : 0. '^- C:,,,,,.. y'" f> 1!AlA<. h " vL 5
Address of person requesting inspection Phone No. ?~
Type of Inspection (circle approp;iCite one): Permit No. 09 - 28
,
Sewer Foundation Framing Chimney Plumbing Final Sewer Excav. Other <;ew ey- r~.JjQI'--
INSPECTION NOTES:
Inspected: Date 3.]1- 6 9 Time
'D f' , J' 1/
Remarks: ",ef'> "K<1. ~l('Sl''''.J 'I ~..c.",~e.
new Co ,'",.s1-all-e $1:; <e.<:.,st 0
-1-0 ell; 4 J 'V'! h./"I"c..cn,- r e. ~ uv
~~v...)e.v- I: vt e.5. CV\. +k.'s S,' i-e.-
1?V
,^-'E'.W
RESTORATION REQUIRED . . . . .. YES
NO 'x:
tJ4,!/ P(Co
~~Ir
.1
, 'a!'t
/ ,~o-
7 ,-
1 i ,
/;.\~'~
40
,
5<0
p.\be....f
:;-r
f.-ovd ::;-1 ~~ "(-
SURFACE RESTORATION:
SURFACE TYPE: 0 Unimproved OGravel o Asphalt OPCC
o Other
o Repaired by City
o Repaired by Permittee
o No Damage Found
Work Order #
o COMPLETE
o INCOMPLETE
(Contlnue_on.~e.v.erse side if necessary)
STREET_SUPERINTENDENT
(DATE)