HomeMy WebLinkAbout124 E 1st St - Building OG �O
CERTIFICATE OF OCCUPANCY
City of Port Angeles Building Division
This certificate is issued pursuant to the requirements of Section 111 of the 2009 International Building Code
certifying that at the time of issuance this structure was in compliance with the various ordinances of the City
regulating building construction or use for the following:
Business name: FURNITURE FOR LESS
Business address: 124 E. 1S Street 0
Business owner: Les Samples
Property owner's address: 70 Mains Road, Sequim, WA 98382
Automatic fire sprinkler system:
Use occupancy classification: Business
Occupant load: Per 2009 IBC, Table 1004.1.1
Type of construction: VB
10/16/2012
Sue Roberds, Planning Manager Date
Post on the premises in a conspicuous place. This certificate shall not be removed except by the Building Official.
a0c> -O
T
..-our, CE T F /CA TE OF OCCCJPA NC A PPL /CATION Permit# L Z'4 g�
FEES
ti/" C ITY OF PORT ANGELES
Attn: Permit Technician $50 Certificote Inspection
E. Fifth St., Port Angeles, WA 98362 $10. Porking Business Improvement Are. (PBIA)
60) 417 -4815 fax (360) 417 -4711 fee chorged for bowntown locotions
J UN 1 S 2012 Pd--- CO vg- 1--,,- PLE7.4SE PR VT _Z S/
S/VK GP Q 005 I 1 1
„El :!P. ?1aL S_•N.l67( .177. n P.A. ?FliP Change of ownership only? Li Moving location from within Y.A.? Zoning erl'`
BUSINESS NAME ,�j i'/- J �lTZ S
IB usiness address I,„</ �i'." S 9 Mailing address Sw-
Phone number 3(.x H /7 2./ 9 Opening date l- -zcY -Z -_pays a, hours of operation cloSP,� fr >eS /o -W
Business owner's name S Sn. //az Co ntact phone ti
Business owner's address T /S
2..a_4 r S �c:«.
Brief description of business .0.4 d,',
Property owner's name %X5%---, /Y7Ti C ontact phone
Property ow address/ contact -�--e_- •-4 ic.6o cJe_ ✓kY�C�
BUILDING DEPARTMENT phone 4'17 -4615 B/r1g approval bt. C- C- o 3-it c=:•\,‘,
n 't l
Is the business a restaurant or bar that will seat 50 or more people? Yes I 1 No
Construction changes planned (moving walls, adding /enlarging windows or doors, roofing, siding, foundation work,
adding /altering stairways, ramps, bathrooms, electrical, heating /cooling /ventilation systems, etc).
Work planned:
F /RE OEPA R TMENT phone 417 -4653 Fire approva/ by �f� on -Z\ —1,Z
Changes to a fire sprinkler system or fire alarm system? Yes Li No 1
Work planned:
PB /A (Parking Business Improvement Area [Downtown) phone 417 -4623 n
Square footage of business? IC), U�C-D P131.4 noriseri vvia YI�C N (pii,$ I 1'a�
Is business moving within the PBIA? Yes "Alf No -I
CITY CLERK ph one 417-4634 �L City Clerk approva/ byes U' Z�
Second -hand dealer /pawnbroker business? Yes Li No./�_I
Will there be dancing at this business? Yes I No�_l
A City of Port Ange /es Business License is required for:
Taxi, Peddlers, Second -Hand Dealer, Pawnbroker, Oance,
Hotel- Motel, Fireworks, Ambulance, and Tattoo Businesses.
Page 1 of 2
COMMUNITY ECONOMIC DEVELOPMENT phone 417 -4750 CED approval by on /.9r5//.'-'7--
Number of off- stre�,parking spaces available for employees and
customers? XJ
(A parking plan may be required.)
Signs? (wall- mounted, freestanding, projecting, awning, A- frame, etc
Signs planned:
t W Y Jhe k
PLEASE NOTE: NO flashing, intermittent, or chasing signs are permitted in the City of Port Angeles.
PWE approval by V Mop (O 1
PUBLIC WORKS DEPARTMENT- ENGINEERING phone 417 -4812
Is site work planned (new or re- located sewer or water service, V\b ct rl\ mutts
excavation, grading or filling, work in City right -of -way,
new driveway openings, site drainage, parking lots, downspouts,
irrigation system backflow devices, etc.). Yes NoSC
Work planned:
PWW approval by N K on
PUBLIC WORKS WASTEWATER phone 417 -4845
Will waste, other than domestic household waste, be discharged into the sewer system? Yes No X
If yes, what will be discharged:
Call for Certificate of Occupancy inspections BEFORE opening business.
Building Department Inspection 417 -4815
Fire Department Inspection 417 -4653
Please sign up for utility services at the cashiers' counter.
1 hereby apply for a Certificate of Occupancy. I acknowledge that I have read this application and state that the
information I have supplied is correct to the best of my knowledge. Incorrect information may result in revocation of
permit.
Date6 Print Name 5a` es Signature 4/
T. \Forms \Building Division \Certificate of Occupancy Application (2010).doc
Page 2 of 2
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Application Number
Application pin number
Property Address
ASSESSOR PARCEL NUMBER
Application type description
Subdivision Name
Property Use
Property Zoning
Application valuation
Application desc
200 amp service change
Owner
MC CRORIE ROBERT M
175 AMBER LN
SEQUIM
Permit
Additional desc
Permit pin number
Permit Fee
Issue Date
Expiration Date
Qty Unit Charge Per
1 00 93 7500 ECH EL -0
Fee summary
Permit Fee Total
Plan Check Total
Grand Total
INSPECTION TYPE
DITCH
SERVICE
ROUGH IN
FINAL
COMMENTS
WA 983828017
155168
93 75
10/15/09
4/13/10
ELECTRICAL PERMIT
CITY OF PORT ANGELES
360-417-4735
09 00001067
782815
124 E 1ST ST
06 30 00 5 1 3115 0000
ELECTRICAL ONLY
0
Contractor
ELECTRICAL ALTER COMMERCIAL
BOTERO SON ELECTRICAL
940 TAMARACK WAY
PORT ANGELES WA 98362
Plan Check Fee
Valuation
200 SRV FEEDER
Special Notes and Comments
MAINTAIN CLEARANCES FROM SERVICE WIRES
Any modifications t� the City s electrical facilities will
be at the customer s expense
Charged Paid Credited
93 75 93 75 00
00 00 00
93 75 93 75 00
Date 10/15/09
`jSZ q GL
Due
DATE RESULTS
00
00
00
Izz/io St§V
12-41 ti
00
0
Extension
93 75
Signature of owner or Electrical Contractor X Date
INSPECTOR.
3
0
City of Port Angeles Permit Application
Building Division /Electrical Inspections
'321-East Fifth Street P.O. Box 1150
Port Angeles Washington, 98362
Ph. (360) 417 -4735 Fax: (360) 417-4711
Date -l' 2 60
1 2 Single Family Dwelling
Multi- Family or Commercial*
J Commercial Addition Alteration Remodel Repair*
Plan Review May Be Required, Please Co
Job Address: .z V
Building Square'Footage. n
Unit Charoe
93.75
$113.75
$160.00
$205.00
$291.25
2.00
57.50
2.00
72.50
86.25
$116.25
$131.25
75.00
69.00
75.00
50.00
50.00
93,75
80.00
86.25
27.50
57.50
86.25
43,75
Qty
Description of above c
Owner Information
Name. .72 C
Mailing7ddress: r C./ f SSA
City xr Statue_ Zip'
Phone: Fax:
License Exp
•ature of owner electrical contractor or eic. J adminisl!etor
RECEVED
OCT 14 2009
ELECTRICAL
INSPECTIONS
lete Eler.trical Plat Revie formation Sheet
Cash
Li Check
L rI card 7
Contractor Information
Name: �t.
Mailin Address•
City' d
PhoneW i 94
License Exp 7/,
Total (Qty Multiplied by Unit Charnel
c Service /Feeder 200 Amp.
Service /Feeder 201 -400 Amp.
Service /Feeder 401 -600 Amp.
Service /Feeder 601 -1000 Amp.
Service /Feeder over 1000 Amp.
Branch Circuit W/ Service Feeder
Branch Circuit W/0 Service Feeder
Each Additional Branch Circuit
Temp. Service/ Feeder 20D Amp.
Temp. Service /Feeder 201 -400 Amp.
Temp. Service /Feeder 401 -600 Amp.
Temp. Service /Feeder 601 1000 Amp
Portal to Portal Hourly
Sign /Outline Lighting
Signal Circuit/ Limited Energy Commercial
Signal Circuit/ Limited Energy 1 2 Family Dwelling
Signal Circuit/ Limited Energy Multi- Family Dwelling
Manufactured Home Connection
Renewable Electrical Energy 5KVA System or Less
First 1300 Square Ft.
Each Additional 500 Square Ft. or Portion of
Each Outbuilding or Detached Garage
Each Swimming Pool or Hot Tub
Thermostat
Total
Owner as defined by PC W 19.28.261 (1) Owner will occupy the structu,:e for two years after this electricai.permit is finalized. (2) Owner is required to hire an
electrical contractor if above said property is for sale, rent or lease.
iter reading the above statement, I hereby cellar that I am the owner of the above named property or a licensed electrical contractor I am m king the electrical
installat!on or alteration in compliance with the eiectrical laws N E.C. RCN Chapter 19.28, WAC Chapter 296.468, The City of Port Angeles Municipal Code, and
Utility Spe f'',alions
C
Statee,o/ Zip: 9 nb 'S
Fax: c/if'a
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CITY OF PORT ANGELES
PUBLIC WORKS - UTILITIES DNISION
321 EAST51HSTREET, PORT ANGELES, WA 98362
Application Number
Application pin number
Property Address
ASSESSOR PARCEL NUMBER:
Tenant nbr, name
Application type description
Subdivision Name
Property Use
Property Zoning . . .
Application valuation
06-00000743 Date
642749
124 E 1ST ST
06-30-00-5-1-~115-0000-
D & K PAINTING
PUBLIC WORKS UTI LITES
7/11/06
o
~
Owner
Contractor
\
MC CRORIE ROBERT M
175 AMBER LN
SEQUIM WA 983828017
OWNER
~
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Permit . . . . .
Additional desc .
Permit pin number
Permit Fee
Issue Date
Expiration Date
RIGHT OF WAY
R/W USE #06-16
82255
70.00
7/11/06
1/07/07
Plan Check Fee
Valuation
.00
o
Qty Unit Charge Per
BASE FEE
Extension
70.00
Fee summary Charged Paid Credited Due
----------------- ---------- ---------- ---------- ----------
Permit Fee Total 70.00 70.00 .00 .00
Plan Check Total .00 .00 .00 .00
Grand Total 70.00 70.00 .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 constructio'n or the performance of
construction.
Signature of Contractor or Authorized Agent
Date
Signature of Owner (if owner is builder) .
Date
T:\Policies\1102.ISR (I/OSJ
~
PERMIT INSPECTION RECORD
CALL 417-4807 FOR UTILITY 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.
KEEP PERMIT CARD AND APPROVED PLANS AT JOB SITE
I INSPECTION TYPE DATE ACCEPTED COMMENTS
I YES 1 NO
PW UTILITIES (Engineerin8 Division)
WATERLINE / METER
SEWER CONNECTION
SANITARY
STORM
SITE DRAINAGE
SITE EROSION CONTROL
PARKING
SIDEWALK
CURB & GUTTER
DRIVEWAY APPROACH
BACK-FLOW DEVICE I
I I
FINAL INSPECTIONS REQUIRED PRIOR TO OCCUPANCYIUSE
RESIDENTIAL DATE YES NO COMMERCIAL DATE ACCEPTED
YES NO
CONSTRUCTION R. W./ PW/ CONSTRUCTION - R. W.
ENGINEERING 417-4807 PW / ENGINEERING
FIRE 417-4653 FIRE DEPT.
PLANNING DEPT. 417-4750 PLANNING DEPT.
BUILDING 417-4815 BUILDING
T:\Policics\1102.15R (1/05]
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CITY OF PORT ANGELES
PUBLIC WORKS - ELECTRICAL DIVISION
121 EAST 5TH STREET. PORT ANGELES. WA 91B62
Application Number
Application pin number
Property Address
ASSESSOR PARCEL NUMBER
Application type description
Subdivision Name
Property Use
Property Zoning .
Application valuation
07-00000486 Date
209916
124 E 1ST ST
06-30-00-5-1-3115-0000-
ELECTRICAL ONLY
5/15/07
o
Owner
Contractor
MC CRORIE ROBERT M
175 AMBER LN
SEQUIM WA 983828017
OLYMPIC ELECTRIC
4230 TUMWATER
PORT ANGELES
(360) 457-5303
WA 98363
Permit
Addit~onal desc
Perm~t pin number
Sub Contractor
Permit Fee
Issue Date
Expiration Date
ELECTRICAL ALTER COMMERCIAL
OL Y EL. / EAST SIDE PANEL CHAN '
100941
OLYMPIC ELECTRIC
75.00
5/15/07
11/11/07
Plan Check Fee
Valuation
00
o
"-
)..J
,"'"
Qty Unit Charge Per
1 00 75 0000 ECH EL-COM ALT 0-200 SRV FDR
Extension
75.00
Fee summary Charged Paid Credited Due ~
----------------- ---------- ---------- ---------- ----------
Permit Fee Total 75.00 75 00 .00 .00
plan Check Total 00 .00 .00 .00
Grand Total 75 00 75 00 .00 00
........
\'i
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:1
COMMENTS/ACTION NEEDED
ELECfmCAL PERMIT INSPECfION RECORD
CALL 417-4735 FOR ELECTRICAL INSPECTIONS PLEASE PROVIDE A MINIMUM 24 HOUR NOTICE IT IS UNLA WFUL TO COVER.
INSULA TE OR CONCEAL ANY WORK BEFORE IT IS INSPECTED AND ACCEFI'ED.
KEEP PERMIT CARD AND APPROVED PLANS AT JOB SITE
INSPECTION TYPE
DATE
COMMENTS
NO
GENERAL COMMENTS:
PW.lI02.1S (4'96)
Of ,"ORT ~
~~~~<..
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CITY OF PORT ANGELES
DEPARTMENT OF COMMUNlTY DEVELOPMENT - BUILDING DIVISION
321 EAST 5TH STREET, PORT ANGELES, WA 98362
Application Number
App11cation pin number
Property Address
ASSESSOR PARCEL NUMBER:
Tenant nbr, name
App11cat1on type descr1ption
Subdivision Name
Property Use
Property Zoning . . .
Application valuat10n
06-00000166 Date
595866
124 E 1ST ST
06-30-00-5-1-3115-0000-
ROBERT MCCRORIE
RE-ROOF
2/15/06
24000
Owner
Contractor
MC CRORIE ROBERT M
175 AMBER LN
SEQUIM WA 983828017
LARIAT CONSTRUCTION INC
P. O. BOX 280
PORT ANGELES WA 98362
(360) 457-0952
71316
403.75
2/15/06
8/14/06
plan Check Fee
Valuation
.00
24000
AVL~W
2!~V!()C-
:]~
Permit
Add1tional desc .
Perm1t pin number
Permit Fee
Issue Date
Expirat10n Date
BUILDING PERMIT - NO PR FEE
Qty Un1t Charge Per
Extension
95.75
308.00
BASE FEE
22.00 14.0000 THOU BL-2001-25K (14 PER K)
Other Fees
STATE SURCHARGE
4.50
Fee summary Charged Paid Cred1ted Due
----------------- ---------- ---------- ---------- ----------
Perm1t Fee Total 403.75 403.75 .00 .00
Plan Check Total .00 .00 .00 .00
Other Fee Total 4.50 4.50 .00 .00
Grand Total 408.25 408.25 .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.
LJJ' b
Date
Signature of Owner (if owner is builder)
Date
T:\Pohcles\1102_15 bUlldmg permIt mspectlOn record05.wpd [1/4/20051
BUILDING PERMIT INSPECTION RECORD
CALL 417-4815 FOR BUILDING INSPECTIONS. CALL 417-4735 FOR ELECTRICAL INSPECTIONS.
CALL 417-4807 FOR PUBLIC WORKS UTILITIES
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 NO
FOUNDATION:
FOOTINGS
WALLS
FOUNDATION DRAINAGE 1 DOWN SPOUTS
PIERS
POST HOLES (POLE BLDGS )
PLUMBING
UNDER FLOOR 1 SLAB
ROUGH-IN
WATER LINE (METER TO BLDG)
GAS LINE FINAL DATE ACCEPTED BY
BACK FLOW 1 WATER
AIR SEAL
WALLS
CEILING I I I
FRAMING
JOISTS 1 GIRDERS
SHEAR W ALL/HOLD DOWNS
WALLS 1 ROOF 1 CEILING
DRYWALL (INTERIOR BRACED PANEL ONLY)
T-BAR
INSULATION
SLAB
WALL 1 FLOOR 1 CEILING I I I
MECHANICAL
HEAT PUNWI FURNACE 1 DUCTS
GAS LINE
WOOD STOVE 1 PELLET 1 CHIMNEY FINAL DATE ACCEPTED BY'
COMMERCIAL HOOD 1 DUCTS
MANUFACTURED HOMES
FOOTING 1 SLAB
BLOCKING & HOLD DOWNS
SKIRTING
PLANNING DEPT. SEPARATE PERMIT #'s SEPA:
PARKlNGILIGHTING ESA'
LANDSCAPING SHORELINE:
FINAL INSPECTIONS REQUIRED PRIOR TO OCCUPANCYIUSE
RESIDENTIAL DATE YES NO COMMERCIAL DATE ACCEPTED
YES NO
ELECTRICAL - LIGHT DEPT. 417-4735 ELECTRICAL
LIGHT DEPT
CONSTRUCTION R W 1 PWI CONSTRUCTION - R W.
ENGINEERING 417-4807 PW 1 ENGINEERING
FIRE 417-4653 FIRE DEPT
PLANNING DEPT. 417-4750 PLANNING DEPT.
BUILDING 417-4815 BUILDING ")rfyv/()~ J(,,'V
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T:\Policles\1102_15 bw1dmg permit mspectlOn record05.wpd [1/4/2005]
PREPARED 2/22/06, 13:30 13
CITY OF PORT ANGELES
ADDRESS
TENANT, NBR
CONTRACTOR
OWNER
PARCEL
APPL NUMBER
INSPECTION TICKET
INSPECTOR- JAMES L LIERLY
PAGE
DATE
124 E 1ST ST
ROBERT MCCRORIE
LARIAT CONSTRUCTION INC
MC CRORIE ROBERT M
06-30-00-5-1-3115-0000-
06-00000166 RE-ROOF
SUBDIV:
PHONE (360) 457-0952
PHONE
PERMIT: BNOP 00 BUILDING PERMIT - NO PR FEE
REQUESTED INSP DESCRIPTION
TYP/SQ COMPLETED RESULT RESULTS/COMMENTS
BL99 01
~~
BUILDING FINAL
02/21/2006 09
LARRY 460-2088
NORTH SIDE 2ND
TIME _ 13 00
54 AM DYASUMUR
PERMIT IN STORE,
AVE
ENTERANCE TO ROOF IS ON
12
2/22/06
-------------------------------------- COMMENTS AND NOTES --------------------------------------
CiDnDn~IlE
LARIAT CONSTRUCTION, me.
P.O. BOX 280
PORT ANGELES, WA 98362
(360) 457-0952
r
No
Date
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ProDosal Submitted To:
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Phone
Date of Plans
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We hereby propose to furnish the matel'lals and perform the labor necessary for the completion of
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All material IS guaranteed to be as specified, and the above work to be performed In accordance with the
specifications submitted for above work and completed In a substantial workmanlike manner for
Dollars [$
with payments to be made as follows
ft.
F
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drawings and
the sum of
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Any alteration or deviation from above specifications Involving extra
costs will be executed only upon written orders, and will become an
extra charge over and above the estimate All agreements contingent
upon strikes, accidents or delays beyond our control Owner to carry
fire, tornado and othel' necessary Insurance upon above work Work-
men's Compensation and Public Liability Insurance on above work to be
taken out by
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Note-This proposal may be withdrawn by us If not accepted
'f/)
within !I days
"("/tAI
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Respectfully submitted
Per
ACCEPTANCE OF PROPOSAL
The above prices, specificatIOns and conditIOns are satisfactory and are hereby accepted You are authorized to do the work as specified
Payment will be made as outlined above
Signature
Date
\
Signature
.~ lOPS
i=ni=l~A "lR"in
nIICIIt""^Ta::
II A ^r'lr- '1\1 II C' ^
BUILDING PERMIT - APPLICATION
Fill out COMPLETELY and in INK. Your application and site plan MUST BE
COMPLETE to be accepted for review. If you have any questions, call
PERMITS (360) 417-4815 FAX(360)417-4711
ApplIcant or Agent: Lar ,'/vl Co /I ,f f,
Owner: fJ.. Qb~r't h( (ri)r/-e
Address: r).. '1 B. F,'r (1.
f 1'1(_.
Phone: J "] C (/ ) Yto -2.oa.?
Phone:
~f' i' 11/1.9 .//( f (,vA- ZIp:
CIty:
'fJ.?t'2...
ArchItect/Engmeer:
Contractor L..~ 1-11 fJ r ("n fJ<, Ihl((. State LIcense #:
Phone'
Exp:
Phone:
Address:
CIty:
ZIp:
ZONING:
PROJECT ADDRESS:
LEGAL DESCRIPTION: Lot:
CLALLAM COUNTY PARCEL NUMBER:
Block:
SubdIVISlOn:
TYPE OF WORK:
D ResIdennal D New Constr D Re-roof
D Multl-family D AddItlOn D Move
D CommercIal D Remodel 0 DemolItlOn
D Reparr 0 SIgn
BRIEF DESCRIPTION OF THE PROJECT.
D Stove
D Garage
D Deck
D Other
SIZEN ALUATION:
SF. @ $ /SF = $
SF @ $ /SF. = $
SF. @ $ /SF. = $
TOTAL VALUATION $
COMMERCIALIRESIDENTIAL: Occupancy Group.
No. of Stones. Lot Size: EXIStmg Sq Ft
Total lot coverage %
Occupant Load.
& Proposed Sq. Ft
ConstructlOn Type'
= TOTAL Sq. Ft
APPROVALS: i
PLAN: :
BLDG:
DPWU:
FIRE:
OTHER:_
PLANNING USE ONLY:
ESA/Wetland(s): DYes D No SEPA Checkhst requrred? DYes D No Other
VALUATION OF CONSTRUCTION: In all cases, a valuation amount must be entered by the apphcant. Th1s figure will be revIewed
and may be reVIsed by the BuIlding DlVlslOn to comply with current fee schedules. Contact the Peront Coordmator at 417 -4815 for aSSIstance.
PLAN CHECK FEE. IF a plan check fee is due it must be submitted at the trme the buildmg permIt applicatlOn and constructlOn plans are
sublTlltted. All other permIt fees are due at the time of penmt Issuance.
EXPIRATION OF PLAN REVIEW: lfno peront IS Issued WIthin 180 days of the date of applIcation, the application will expire. The
Buildmg OffiCIal can extend the trme for actlOn by the apphcant up to 180 days upon written request by the applicant (see SectIOn R105.3.2
of the International Building/ResIdential Code, 2003). No apphcanon can be extended more than once.
J hereby certify that J have read and exammed thIS appilcatlOn .and know the same to be true and correct. I am authonzed to apply for this permit and
understand that it IS my responslbJlity to determme what permits are reqUIred ,not the City's, and that I must obtain such permits prior to work.
T'\Pohcies\BL-1102 _13 wpd Applicant.
Date:
.::.~~ 1..'\ ,.
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. .
. .. ., \ f.
'.)',
.~~
. ~\t~1ml_'fJit1tERtQaf,l:lISsttaf9~lJta~~~m
.. I '~
PLUMBING
TRAPS:
WATER HEATER:
SEWER
WATER:
MECHANICAL:
VENTS:
FURNACE:
GAS FIREPLACE:
WOOD FIREPLACE/STOVE:
MECH APPLIANCE:
~ pORT ~
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rea
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CITY OF PORT ANGELES
DEPARTMENT OF COMMUNITY DEVELOPMENT - BUILDING DNISION
321 EAST 5TH STREET, PORT ANGELES, WA 98362
~
Application Number
Application pin number
Property Address
ASSESSOR PARCEL NUMBER:
Tenant nbr, name
Application type descr~pt~on
Subdivision Name
Property Use
Property Zon~ng . . .
Application valuation
06-00000163 Date 2/15/06
314013
124 E 1ST ST
06-30-00-5-1-3115-0000-
MCCORIE BLDG.
DEMOLITION
60000
EXPIRED
t!J/~4Iw
Owner
Contractor
MC CRORIE ROBERT M
175 AMBER LN
SEQUIM WA 983828017
HOCH CONSTRUCTION
4201TUMWATER TRUCK TRAIL
PORT ANGELES WA 98363
(360) 452-5381
permi t . . . . .
Additional desc .
Permit pin number
Permit Fee
~ssue Date .
Expiration Date .
DEMOLITION
71290
50.00
2/15/06
8/14/06
Plan Check Fee
Valuation
.00
o
Qty unit Charge Per
Extens~on
50.00
BASE FEE
Fee summary Charged Paid Credited Due
----------------- ---------- ---------- ---------- ----------
Perm~t Fee Total 50.00 50.00 .00 .00
Plan Check Total .00 .00 .00 .00
Grand Total 50.00 50.00 .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 orwork is suspended or abandoned
for a period of 180 days atter 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 ot
presume to give authority to violate or cancel the provisions of any state or local law regulating construction or the performance f
CO~;d~ //IJ~6'
Signature of Contractor or Authorized Agent Date Signature of Owner (if owner is builder) Date
T:\Pohcles\1102_15 bUIldmg permIt mspectlon record05.wpd [1/4/2005]
,
\
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BillLDING PERMIT INSPECTION RECORD
CALL 417-4815 FOR BUILDING INSPECTIONS. CALL 417-4735 FOR ELECTRICAL INSPECTIONS.
CALL 417-4807 FOR PUBLIC WORKS UTILITIES
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
I YES I NO
FOUNDATION:
. . .~' ~,
FOOTINGS ,
WALLS ... . .. J ~ 1.
..........- ~ <i!'" ~
FOUNDATION DRAINAGE/DOWNSPOUTS
PIERS
POST HOLES (POLE BLDGS )
PLUMBING
UNDER FLOOR / SLAB
ROUGH-IN
WATER LINE (METER TO BLDG)
GAS LINE FINAL DATE ACCEPTED BY'
BACK FLOW /WATER
AIR SEAL
WALLS I I
CEILING I
FRAMING
JOISTS / GIRDERS
SHEAR W ALL/HOLD DOWNS
WALLS / ROOF / CEILING
DRYWALL (INTERIOR BRACED PANEL ONLY)
T-BAR
INSULATION
SLAB
WALL / FLOOR / CEILING
MECHANICAL
HEAT PUMP/FURNACE/DUCTS
GAS LINE
WOOD STOVE / PELLET / CHIMNEY FINAL DATE ACCEPTED BY:
COMMERCIAL HOOD / DUCTS
MANUFACTURED HOMES
FOOTING / SLAB
BLOCKING & HOLD DOWNS
SKIRTING
PLANNING DEPT. SEPARATE PERMIT #'s SEPA:
PARKlNG/LIGHTING ESA:
LANDSCAPING SHORELINE:
FINAL INSPECTIONS REQUIRED PRIOR TO OCCUPANCY/uSE
RESIDENTIAL DATE YES NO COMMERCIAL DATE ACCEPTED
YES NO
ELECTRICAL - LIGHT DEPT. 417-4735 ELECTRICAL
LIGHT DEPT
CONSTRUCTION R. W / PW / CONSTRUCTION - R. W.
ENGINEERING 417-4807 PW / ENGINEERING
FIRE 417-4653 FIRE DEPT.
PLANNING DEPT. 417-4750 PLANNING DEPT.
BUILDING 417-4815 BUILDING
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T.\Po1icles\1102_15 bUilding permit Inspection record05 wpd [1/4/2005]
, '
, "l\h""
~ORTANGELES
WhA- 0 (p --0]0
WAS H I N G TON, U. S. A.
PUBLIC WORKS & UTILITIES DEPARTMENT
Febmary 15, 2006
Hoch Constmction
4201 Tumwater Tmck Rt
Port Angeles, W A 98363
RE: Port Angeles Landfill Waste Disposal Application, WDA 06-06; (Interior Building
demolition) at 124 East 1 st ( McCrorie Bldg ), Port Angeles
We have received your application for disposal of building demolition debris from the referenced
site and reviewed the testing results. Based on the testing results the debris appears to be
acceptable for use III the landfill, A copy of your approved application is attached. This
approved application must be shown to the landfill scale attendant at the time of disposal:
Please be advised that this disposal application is only for the matenals and quantities lIsted in
the application. Matenals not listed or in excess of the quantities noted may require separate
applications and approval,
Please call if you have questions.
Very tmly yours,
~~r
City Engineer '
Deputy Director of Engineering Services
GWKtf
Encl WDA 06-06
Copy Ken Loghry
N IPWKSIENGINEERIWDAPPLICI06-06 WPD
FILE Landfill Sohd Waste DIsposal ApplIcatIons
321 EAST FIFTH STREET'. POBOX 1150 · PORT ANGELES, WA 98362-0217
PHONE 360-417-4805. FAX 360-417-4542. TTY 360-417-4645
E-MAIL publlcworks@cltyofpa us
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9
BUILDING PERMIT - APPLICATION
FOR OFFICIAL USE ONLY
Date Rec 3'1S/b6
Pelmlt # tJV ~ '''?J
Date Approved o/t/Pc.
Date h,med ~/r-" 'Db
-
~
Fill out COMPLETELY and in INK. Your application and site plan MUST BE
COMPLETE to be accepted for review. If you have any questions, call
PERMITS (360) 417-4815 FAX(360)417-4711
ApplIcant or Agentlloe /7 C (,) S+(U-t Jf()'IL tPU Phone: 3bf(?J -{.-!.<:?:) -5:1~/
Owner. rl('i/}() r (.II cfk'/?1l{. '/lU'() / S 11 / P Phone: 717 - / d / r
Address: J;y it jS'I 51. Clty.H)i-ll)n.gLt{o ZIp: q~i~) Z
Phone:
State LlCense ttIIc"'(1A~ Exp: rL.:.J/c)ri Phone: .f5~ ::S~~/
IJL ~Ol/I' /
CIty: A"htjLI?/ /) ZIp: 9~::s&_-q
fi I2-S-t- ZONING:
ArchItect/Engmeer:
Contract014)( f; C(f)u~..f I~U
Address: 0)/ '/A;.u.J../2/ j) r
PROJECT ADDRESS: \ 24' e.
LEGAL DESCRIPTION: Lot:
CLALLAM COUNTY PARCEL NUMBER:
Block:
SubdIVIsIOn:
TYPE OF WORK:
o ReSIdentIal 0 New Constr. 0 Re-roof
o MultI-family 0 AddItion 0 Move
o CommercIal 0 Remodel V DemolItIOn
o RepaIr /0- SIgn
BRIEF DESCRIPTION OF THE PROJECT
i)p /)J o.~ /1 {/fl ey ~ fJ1 () t) u.f
o Stove
o Garage
o Deck
o Other
SIZEN ALUATION:
SF @ $ /SF = $
SF. @ $ /SF. = $
SF. @ $ /SF. = $ c
TOTAL VALUATION $--:r~/ll"-l9.P.'_-'
-~/-
ijI/1 Jb-.rkJ
rilL hll1Jefl c1/vax:Lt-f
/
COMMERClAL/RESIDENTIAL: Occupancy Group'
No. of Stones' Lot Size: EXIStIng Sq. Ft.
Total lot coverage %
Occupant Load:
& Proposed Sq. Ft.
ConstructIOn Type
= TOTAL Sq. Ft
ESAlWetland(s)' 0 Yes 0 No SEPA ChecklIst reqUIred? 0 Yes 0 No Other
APPROVALS:
PLAN:
BLDG:
DPWU:
FIRE:
OTHER:_
PLANNING USE ONLY:
VALUATION OF CONSTRUCTION. In all cases, a valuation amount must be entered by the applicant. This figure will be reVIewed
and may be reVIsed by the Bmlding DlVlsIOn to comply with current fee schedules. Contact the Permit Coordmator at 417-4815 for assIstance.
PLAN CHECK FEE. IF a plan check fee IS due It must be subrmtted at the trme the building pennit applicatIOn and construction plans are
subnutted All other pefIDlt fees are due at the time of pefIDlt issuance.
EXPIRATION OF PLAN REVIEW: Ifno pefIDlt IS Issued WIthm 180 days of the date of applicatIOn, the application will expire. The
Buildmg OffiCial can extend the trme for action by the applIcant up to 180 days upon wntten request by the applicant (see SectIOn R105.3.2
ofthe Internatlonal Bmldmg/Residential Code, 2003) No applIcatlon can be extended more than once.
I hereby certify that I have read and examined this applicatlOn.and know the same to be true and correct I am authonzed to apply for this permit and
understand that it is my responsibility to cje ermin what permits are required~not the City's, and that I must obtain such permits pnor to work
T\Pohcles\BL-1102_13.wpd APPlican~: . ~Date: ~J.fl!J6
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"u~Ilr~~FJE1QJi;UlSG~G1mg~st~&i~~~~
- . .
PLUMBING
TRAPS:
WATER HEATER:
SEWER:
WATER:
MECHANICAL:
VENTS:
FURNACE:
GAS FIREPLACE:
WOOD FIREPLACE/STOVE:
MECH APPLIANCE:
~ ,"ORT ~
~~O~",,:..,
U,._
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~
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CITY OF PORT ANGELES
DEPARTMENT OF COMMUNITY DEVELOPMENT - BUILDING DIVISION
321 EAST 5TH STREET, PORT ANGELES, WA 98362
Appllcation Number
Appllcation pin number
Property Address
ASSESSOR PARCEL NUMBER:
Tenant nbr, name
Application type description
Subdivision Name
Property Use
Property Zoning . . .
Appllcatlon valuatlon
3/13/06
06-00000057 Date
322155
124 E 1ST ST
06-30-00-5-1-3115-0000-
ROBERT MCCORIE
COMM REMODEL
H"JA~
3/2&lIO~ ~
18000
Owner
Contractor
MC CRORIE ROBERT M
175 AMBER LN
SEQUIM
HOCH CONSTRUCTION
4201TUMWATER TRUCK TRAIL
WA 983828017 PORT ANGELES WA 98363
(360) 452-5381
Structure Informatlon 000 000 ----------------------
TYPE II NON-RATED
BUSINESS:OFF/PRO/MED/REST
Construction Type . .
Occupancy Type
Permit . . . . .
Additional desc .
Permit pln number
Permit Fee
Issue Date
Expiration Date
BUILDING PERMIT - COMMERCIAL
~-\4
72769
319.75
3/13/06
9/09/06
Plan Check Fee
valuation
207.84
18000
Qty Unit Charge Per
Extension
95.75
224.00
BASE FEE
16.00 14.0000 THOU BL-2001-25K (14 PER K)
Fee summary Charged Pald Credlted Due
----------------- ---------- ---------- ---------- ----------
Permit Fee Total 319.75 319.75 .00 .00
Plan Check Total 207.84 207.84 .00 .00
Grand Total 527.59 527.59 .00 .00
Separate Permits are required for electrical work, SEPA, Shoreline, ESA, utilities, private and public improvements. This permit becomes
null and void jf 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 ordi nces governing this pe of work will be complied with whether specified herein or not. The granting of a permit does not
presume t ~Je authority to violate or c el the provisions of any state or local law regulating construction or the performance of
construct' nhn '\ /
~7
f Contrac r or Authorized Agent Signature of Owner (if owner is builder) Date
T:\PoJicies\II02_15 bUlldmg permit inspection record05.wpd [1/4/2005]
~
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Pil
.........
\~
't
\
BIDLDING PERMIT INSPECTION RECORD
CALL 417-4815 FOR BUILDING INSPECTIONS. CALL 417-4735 FOR ELECTRICAL INSPECTIONS.
CALL 417-4807 FOR PUBLIC WORKS UTILITIES
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.
B
INSPECTION TYPE DATE ACCEPTED COMMENTS
YES NO
FOUNDATION:
FOOTINGS
WALLS
FOUNDATION DRAINAGE 1 DOWN SPOUTS
PIERS
POST HOLES (POLE BLDGS )
PLUMBING
UNDER FLOOR I SLAB
ROUGH-IN
WATER LINE (METER TO BLDG)
GAS LINE FINAL DATE ACCEPTED BY:
BACK FLOW 1 WATER ~
AIR SEAL .....,J
WALLS
CEILING I I
FRAMING
JOISTS 1 GIRDERS
SHEAR W ALLlHOLD DOWNS I
WALLS/~/CE~ ~/lf,g I 0 (.I) ;y~
DRYWALL (INTERIOR BRACED PANEL ONLY) I ~
T-BAR 37., a /f.9 c.. (TL-..-I
.
INSULATION
SLAB
WALL 1 FLOOR 1 CEILING I ~-ut !()~ I JLv
#'
MECHANICAL
HEAT PUMP 1 FURNACE I DUCTS
GAS LINE
WOOD STOVE 1 PELLET I CHWMNEY FINAL DATE ACCEPTED BY'
COMMERCIAL HOOD 1 DUCTS
MANUFACTURED HOMES
FOOTING 1 SLAB
BLOCKING & HOLD DOWNS
SKIRTING
PLANNING DEPT. SEPARATE PERMIT#'s SEPA:
PARKINGILIGHTING ESA-
LANDSCAPING SHORELINE
FINAL INSPECTIONS REQUIRED PRIOR TO OCCUPANCYIUSE
RESIDENTIAL DATE YES NO COMMERCIAL DATE ACCEPTED
YES NO
ELECTRICAL - LIGHT DEPT. 417-4735 ELECTRICAL
LIGHT DEPT
CONSTRUCTION R. W.I PWI CONSTRUCTION - R. W.
ENGINEERING 417-4807 PW 1 ENGINEERING
FIRE 417-4653 FIRE DEPT.
PLANNING DEPT. 417-4750 , I PLANNING DEPT.
BUILDING 417-4815 ?/v:t /tJf.p V~ BUILDING
,
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T.\Pohcles\1102_15 bulldmg pennlt mspeCl10n record05.wpd [1/4/2005]
PREPARED 3/29/06, 16 02.22
CITY OF PORT ANGELES
ADDRESS
TENANT, NBR:
CONTRACTOR
OWNER
PARCEL . .
APPL NUMBER:
INSPECTION TICKET
INSPECTOR JAMES L LIERLY
124 E 1ST ST
ROBERT MCCORIE
HOCH CONSTRUCTION
MC CRORIE ROBERT M
06-30-00-5-1-3115-0000-
06-00000057 COMM REMODEL
PERMIT: BPC 01 BUILDING PERMIT - COMMERCIAL
REQUESTED INSP DESCRIPTION
TYP/SQ COMPLETED RESULT RESULTS/COMMENTS
BLWS 01 3/15/06 JLL
3/16/06 DA
BL3 01 3/16/06 JLL
3/16/06 AP
BL99 01 3/29/06 ~
\\
BLI 01 3/29/06 JLL
3/29/06 AP
BLTB 01 3/29/06 JLL
3/29/06 AP
BUILDING INSULATION WALL/FLOOR
03/15/2006 12 27 PM JLIERLY
hoch
03/16/2006 09 28 AM JLIERLY
frame and electr1cal rough reqd
BUILDING FRAMING
03/16/2006 10 03 AM PBARTHOL
bob 417-1219
03/16/2006 01:51 PM PBARTHOL
03/16/2006 01.51 PM PBARTHOL
BUILDING FINAL
03/29/2006 04 02 PM
BUILDING INSULATION
03/29/2006 09 59 AM
03/29/2006 03 54 PM
BUILDING T-BAR TIME
03/29/2006 10 20 AM
RICK @ 460-3824
03/29/2006 03 54 PM
PAGE
DATE
3
3/29/06
SUBDIV.
PHONE
PHONE
(360) 452-5381
bfore 1nsulat1on/]11
JLIERLY ----------------------------
TIME: 13 00
DYASUMUR
JLIERLY ----------------------------
13 00
DYASUMUR
-------------------------------------- COMMENTS AND NOTES --------------------------------------
JLIERLY ----------------------------
PREPARED 3/29/06, 12 30,28
CITY OF PORT ANGELES
INSPECTION TICKET
INSPECTOR. JAMES L LIERLY
PAGE
DATE
21
3/29/06
ADDRESS
TENANT, NBR
CONTRACTOR
OWNER
PARCEL
APPL NUMBER
124 E 1ST ST
ROBERT MCCORIE
HOCH CONSTRUCTION
MC CRORIE ROBERT M
06-30-00-5-1-3115-0000-
06-00000057 COMM REMODEL
SUBDIV
PHONE
PHONE
(360) 452-5381
PERMIT: BPC 01 BUILDING PERMIT - COMMERCIAL
REQUESTED INSP DESCRIPTION
TYP/SQ COMPLETED RESULT RESULTS/COMMENTS
BLWS 01 3/15/06 JLL BUILDING INSULATION WALL/FLOOR
3/16/06 DA 03/15/2006 12.27 PM JLIERLY ----------------------------
hoch
03/16/2006 09 28 AM JLIERLY ----------------------------
frame and electr1cal rough reqd bfore 1nsulat1on/]11
BL3 01 3/16/06 JLL BUILDING FRAMING
3/16/06 AP 03/16/2006 10 03 AM PBARTHOL ---------------------------
bob 417-1219
03/16/2006 01 51 PM PBARTHOL ---------------------------
03/16/2006 01.51 PM PBARTHOL ---------------------------
BLI 01 3/(1/06 ~ BUILDING INSULATION TIME 13:00
03/29/2006 09:59 AM DYASUMUR
BLTB 01 3/29/06 BUILDING T-BAR TIME 13 00
'-\ ~ 03/29/2006 10 20 AM DYASUMUR
RICK @ 460-3824
-------------------------------------- COMMENTS AND NOTES --------------------------------------
PREPARED 3/15/06, 13-27 26
CITY OF PORT ANGELES
INSPECTION TICKET
INSPECTOR, JAMES L LIERLY
PAGE
DATE
6
3/15/06
ADDRESS
TENANT, NBR
CONTRACTOR
OWNER
PARCEL
APPL NUMBER-
124 E 1ST ST
ROBERT MCCORIE
HOCH CONSTRUCTION
MC CRORIE ROBERT M
06-30-00-5-1-3115-0000-
06-00000057 COMM REMODEL
SUBDIV
PHONE
PHONE
(360) 452-5381
PERMIT: BPC 01 BUILDING PERMIT - COMMERCIAL
REQUESTED INSP DESCRIPTION
TYP/SQ COMPLETED RESULT RESULTS/COMMENTS
BLWS 01
~
BUILDING INSULATION WALL/FLOOR
03/15/2006 12 27 PM JLIERLY ----------------------------
hoch
-------------------------------------- COMMENTS AND NOTES ---------------------- ---------------
~J- ~~
~ ~I ~UL
YcNUf
~W'I
BUILDING PERMIT - APPliCATION
ApplIcant or Agent
Owner. (Y\
Address: \ ~L:li-J ~ G ~,
Phone.
3/d) . J-k:5t2 . 5~g'J
CIty.
ZIp. q~3(P3
ArchItect/Engmeer.
Contractor ~GJ\ ~ r~OwJ
Address. J-{ d-D I I tudL- 12.+.
PROJECT ADDRESS: \ ~ L\- <C..
LEGAl DESCRIPTION: Lot'
CLAlLAM COUNTY PARCEL NUMBER:
Phone:
State LIcense #:rtoc.ltC;t1f'.ll.?ONlExp.
CIty PoYt- G "'9fl~/
\ Sj::- ~t-.
Phone: ~ ~S.~~f
ZIp: q g-:<; /.0 ';),
ZONING:
Block
SubdIVIsIon:
Credit Card Holder Name:
Billing Address:
Credit Card Type VISA MC #
TYl'E OF WORK:
o ResIdenhal 0 New Constr 0 Re-roof
o Mulh-family 0 AddITIon 0 Move
~ CommercIal ~Remodel 0 DemohTIon
o Reparr 0 SIgn
BRIEF DESCRIPTION OF THE PROJECT:
City:
Exp. Date:
o Stove
o Garage
o Deck
o Other
SIZEN ALUATION:
SF. @ $ /SF. = $
SF @ $ /SF. = $
SF @ $ /SF = $
TOTAL VALUATION
$ /~ ~O~ dfX:J
COMMERCIAL/RESIDENTIAL: Occupancy Group:
No of Stones: _' Lot Size: EXlStlng Sq Ft.
Total lot coverage %
Occupant Load:
& Proposed Sq. Ft
ConstrucTIon Type:
= TOTAL Sq Ft
ESAIW etland(s) 0 Yes 0 No SEP A Checkhst reqUITed? 0 Yes 0 No Other
APPRO V ALS:
PLAN:
BLDG:
DPWU:
FIRE:
OTHER:
PLANNING USE ONLY:
VALUATION OF CONSTRUCTION In all cases, a valuation amount must be entered by the apphcant Tills figure will be revIewed
and may be revIsed by the Buildmg DlVlslOn to comply with current fee schedules Contact the PermIt Coordmator at 417-4815 for aSSIstance.
PLAN CHECK FEE' IF a plan check fee IS due It must'b'e'submitted at the tlme the buildmg permIt apphcation and construCTIon plans are
subnntted All other permIt fees are due at the tnne of permIt Issuance.
EXPIRATION OF PLAN REVIEW: lfno permIt IS Issued WIthIn 180 days of the date ofapplicatlOn, the application will expire. The
Bmldmg OffiCIal can extend the time for actIon by the applicant up to 180 days upon wntten request by the apphcant (see SectIOn RI05.3.2
of the InternatlOnal Buildmg/Residentml Code, 2003) No applicatIOn can be extended more than once
J hereby cerlify that J have read and examined thiS applicatIOn and know the same to be true and correct. J am authorized to apply for this permit and
understand that it IS my responSibility to detennme what p~U1red ~ the City:S, and that J must obtain such pennits pnor to work.
T\Pohcles\BL-1l02_13wpd APPhcant:~ ~ Date:. ~~? ,/0 C;
INTER-OFFICE MEMO
1/18/06
TO: Jim Lierly
Ken Dubuc
RE: 124 E. 1 ST STREET PERMIT # 06-057
I
, i
PLEASE REVIEW THE ATTACHED WORK FOR YOUR
APPROVAL. THIS PROJECT IS TO DEMO THE INTERIOR AND
REPAIR WATER DAMAGE.
THANKS
~
DAVE
I
!
Fill out COMPLETELY and in LNK. Your applicatlOn and site plan MUST
CGIvIPLETE LO be accepleu 101- ] evie"V\. If you have an~l' qucst::'Gn5~ ~:lll
PERMITS (360) 417-4815 FAX(360 )417-4711
..... (....\ 1l:)1~ f .1 \'(,/
'~(I
(~~)
r' ~~~
\; -:_...:- .. '" - /
.~~'
BUILDING PERMiT - APPLICATION
Apphcani or Agent: ItN DfiJ (!.otJS1tLu (..:no~ Phone. ~ 70 -"Q'7'1
Owner ~o~-+ Wl.C(2..0l2-\L Phone' 4/7 -/211
Address.-'2--Y ~ \ ~f" C1ty.~IZ..-r ~1-"t'.-s Zw 983' 2-
ArchItect/Engmeer 6A./b8bLb Phone: 4)2. - (;,/16
Contractor~ ~ foAJ1/ev41~'Me bcense # ANbtNG~?8~ 3-/2-' 0' Phone C 70 -~97?
Address. 2-37 w, Alc:f~ S1- CIty. ~t.a. viM... ZIp: 183?j7 '
PROJECT ADDRESS /21 L / '5r I?A.. tJ4 ZONING:
LEGAL DESCRJPTION Lot:
CLALLi\M COlJ:l'\TTY PARCEL NUMBER:
Block
SubdIVISIOn'
SIZE/VALUATION:
/1. so-o SF @ $ & :1D /SF = $
,
SF @ $ /SF = $
SF @ $ /SF = $
TOTAL ViuJUATION $
/1lf<d)L:.. "'r f!5u/L/)ltJ4 :R::fltlJe.. 4J.If1U....
~~trO ~l.1.41..J-.: ~kJ
..0
Gb, D/!>O --
18~ "?p C"\>.
TYPE OF WORK:
o ResIdentml 0 New Constr. rti- Re-roof
o MultI-fannly 0 Addmon 0 Move
~Commerclal 0 Remodel 0 DemolItlOn
~Reparr 0 SIgn
BRIEF DESCRIPTION OF THE PROJECT'
~fr!11-6e (~p
o Stove
o Garage
o Deck
o Other
~fVtt.>
A.Lt.L'\
COMMERCLL\L/RESIDENTIAL: Occupancy Group.
Occupant Load
& Proposed Sq Ft.
ConstructlOn Type'
No of Stones Lot SIZe
Total lot coverage
Existmg Sq Ft.
= TOTAL Sq Ft
PLANNING USE ONLY: \ b~::~t~---'~1-v~I- APPROVALS:
PLAN:
BLDG:
V ~ ~~ DPWU:
FIRE:
ESAlWetland(s). 0 Yes 0 No SEP A Checkhst requrred? 0 Yes 0 No Other OTHER:
-
%
VALUATION OF CONSTRUCTION In all cases, a valuation amount must be entered by the applIcant TIllS figure will be revIewed
and may be reVIsed by the Buildlllg DlVIsIon to comply WIth current fee schedules Contact the Pemnt Coordinator at 417 -4815 fOl asslstance_
PLAN CHECK FEE IF a plan check fee is due It must be subll1ltted at the trrne the bUlldmg pernnt apphcaTIon and construCTIon plans are
subll1ltted. All other pemnt fees are due at the tm1e of pernllt Issuance.
EXPIRATION OFPLA.N REVIEW: lino pernllt IS Issued withlll180 days of the date of applIcation, the application will expIre, The
BUlldlllg OfficIal can extend the trrne for actlOn by the apphcant up to 180 days upon wntten request by the applIcant (see Section Rl 05.3.2
of the InternatIOnal BUlldlllglResldentlal Code, 2003). No applicatlOn can be extended mOle than once.
I hereby certify that J have read and examined thl
understand that it is my responsibility to deter e
d know the same to be true and correct. I am authonzed to apply for this permit and
are reqUIred )not the City'S, and that J must obtam such permits pnor to work
1-/7- tJ'
Date:
T'\Pol1cles\BL-] ]02_13 wpd Apphc
\
\
.'
1',:;",..>/'1:," ,
e ~ 'V;;Rt-lll,.,...,,_."l""'..... ""'.jJ_*"''"''''^~ ~ ""'0, M}'
-I
~W.igit\st~~fTI;iii: "", ,,~~I~~;~;:>~~I: g1t~~j~}j4i~~i1%i3j
PLUMBING
TRAPS:
WATER HEATER:
SEWER:
WATER:
MECHANICAL:
VENTS:
FURNACE:
GAS FIREPLACE:
WOOD FIREPLACE/STOVE:
MECH APPLIANCE:
CITY OF PORT ANGELES
LIGHT DEPARTMENT
ELECTRICAL PERMIT
N?
14906
/;1-)3)3
Port Angeles, Washlngtonmm.uu.......um.mum.mmu..mm___m______.. 19,,000000
In accordance with the City Ordinance to regulate the installation. extension, or repair of elec-
trical equipment In, on, or about any building or other structure In the City of Port Angeles. per-
mission Is hereby granted to do electrical work as listed below.
i~'f {;/,;}/ I
Address .4;r;..~~...y..oo~:=:m::=;;;;::::.moooooooo---oo Occupancy._~oo_______________.oo..oou.
Owner ____'__moooooooo..mmmoo.m__mL,u..oooo.m.",;,.".__.n__ Tenantmoom.mmmmoom..oo__.oo.m.___oom.ununoo.oo.oomm__.
Wiring Contractor .oo(~:,:~:'.ri:.~q,.*__dfk::'.'./t.~..oooo By..mm.____.n.m.oom__.muu__..mmoooo__oooo__.__oooo.__oo
f/
Light Outlets.....___..______.____.........__..__...
Service, volts ..___nm.___m.___...n......._.....
Receptacle Outletsn..___m...m....__.........
No. wires .._......_...............00..00.0000...
Drye" KWloomn..oo....m..n.....__....,..,....,
Size wires...._.......__................n..._n.
Range, KW _...m___
Main fuse .__..______........nn.....m._______
Water Heater:
Enclosure ____...___...._____.___._.nmm_....
KW..____..n...........,..,..,..,..,n....,.....
Type of wiring:
Entrance Cable nm........n.m..n___.n
Heal: RW......__...n....__n_..n__n...nn.n______.....
RIgid Conduit ....______n___m..___._______
Metallic Tubing ...........................
Current transformers:
No. & Sizenm_..m___.m___m..nn__.___.n
Motors: size, volts and phase:
Ser. N 0..__..00___.00000000000000.._00..__._.._._..._
Ser. NO~.___._nn..__n_...n.n._.................
Ser. No.,_.____.........._..........._.______.._....
Type of Wiring:
Armored Cable h.......mh.._............
Non-Metallic ._.............._______.._.00..00
Knob & Tube...n....m___..______.___.___._.
RIgid Conduit ...............................
Metallic Tubing nnn___nm___..........
Race,vay ..hn..._......_...._.........__...._._..
Circuits, LighLm..___..___.._________h.____.._...
Utillty ....................................__..n...
Heat
Range 000000..000000..____00........._.............
Water Heater ....00.........00_____.______..
Motor _.._.___.___.___________...____..._........_
Dryer .....0000...00000000__00_.00__.00__00......._.__
Furnace ..n_nnn_nn..nh__.,_....n....___m..
Total Loadn..._...n_______.__..n.... Ser. No. n__..___n_..__......n._..._............_n Total .............n.......__............__.
Remarks: ...!.ltr:f~.'.~L____.__.:.~~____..too..,:.c!'::?~:!=/?::1:.'b.oo.-".::..:..,?-.<.u,=tk"X.oooo.oooooomm.
trJ[;. 1- .., V { ;/~ --., ',- . / #~.
m__(:'.l'.,t,C!;.'!:mmoo~:.'.:"'_r..mm.oooo~oo1?:oooo.oo=._____:.oo.".'0.:!__:__!:'__m..l__.!::./..!.ii.ooAI;b~~~oomoomm.m__m.m
IV v; J
,
:)/ "
:.~:.~~..~~~.__......__........ ~~~.~:..~~.~.~~.~.~.___m By :3.f..t...~.(0df~,~!~,-:,:.~....__.__....__
,I NOTICE-Current must not be turned on untll Certificate of Inspection has been Issued. If work Is to be con.
cealed due noUce must be given the Inspector so that work may be inspected before concealment.
NOTIFY THE INSPECTOR BY PERMIT NUMBER WHEN READY FOR INSPECTION
ELECTRICAL PERMIT
N?
14906
Date called for inspection.__......_......._.._......................_____.....____..__________............._______.........._.._.___.._...__.___.......____.._.............__..__...___.......__.._...
Pr~.P1inaryinspectiondateB......................................_......__..._..____~___.__..........._.___._..._...._..._............__..._.........__..............._..._..___..............._
lnspectionccrmpleted...____.._.........._......_.........................._.._.......~._.......___..................___..._.........._...........__..._.___.........._____..___.._....._......_
/
I
\
,
Total Load ........_......_..................__.._...................._..00..000000........._......_ .0000___.
1M 3-72 Olympic Printers, Inc.
...........__nn.............n_....n..........._..__n_..._.._........n_._.__........._......_
dr<)l"~.
$(i~~
D!i
",",;,,;",.
CITY OF PORT ANGELES
PUBLIC WORKS - ELECTRICAL DIVISION
.121 EAST 5TH STREET. PORT ANGELES. WA 911:162
Application Number
pin number
Property Address
ASSESSOR PARCEL NUMBER:
Application description
Subdivision Name
Property Use
Property Zoning . . .
Application valuation
05-00000067 Date
.920346
124 E 1ST ST
06-30-00-5-1-3115-0000-
ELECTRICAL ONLY
2/01/05
o
Owner
Contractor
MC CRORIE ROBERT M
175 AMBER LN
SEQUIM
WA 983828017
SHAMP ELECTRICAL CONTRACTING
PO BOX 383
PORT ANGELES WA 98362
(360) 452-1689
Permit
Additional desc
Sub Contractor
Permit Fee
Issue Date
Expiration Date
ELECTRICAL ALTER COMMERCIAL
200A PANEL/ METER MAST REPAIR
SHAMP ELECTRICAL CONTRACTING
145.60 Plan Check Fee
2/01/05 Valuation
7/31/05
.00
o
Qty
1. 00
1. 00
Unit Charge Per
78.7000 ECH
66.9000 ECH
EL-COM ALT 0-200 SRV FDR
EL-COMM ALT- REPAIR ME!ER/MAST
Extension
78.70
66.90
~
~ "'-!."
\ \ "'-
~~
Fee summary Charged Paid Credited Due
----------------- ---------- ---------- ---------- ----------
Permit Fee Total 145.60 145.60 .00 .00
plan Check Total .00 .00 .00 .00
Grand Total 145.60 145.60 .00 .00
~::
" \ V\
U""
C\
".
,
\
COMMENTS/ACTION NEEDED
~
ELECTRICAL PERMIT INSPECT.ION RECORD
CALL 417-4735 FOR ELECTRICAL INSPECTIONS. PLEASE PROVIDE A MINIMUM 24 HOUR NOTICE. IT IS UNLA WFUL TO COVER,
INSULA TE OR CONCEAL ANY WORK BEFORE IT IS INSPECTED AND ACCEPTED.
KEEP PERMIT CARD AND APPROVED PLANS AT JOB SITE
INSPEcnON TYPE
DATE
COMMENTS
NO
;lll.~ Ii.' ')- '-114.8; ~~t:'--
/fP.I'iU',,'k~ ,t:c.c.. //zT~"t: -itp
;} /:7)t/ j' _;t;/hs / fJ/h.JU-- /f;O/J. ViE-d
GENERAL COMMENTS:
PW-II02.1S (4'96)
CITY OF PORT ANGELES
DEPARTMENT OF COMMUNITY DEVELOPMENT - BUILDING DIVISION
321 EAST 5TH STREET, PORT ANGELES, WA 98362
A~plication Number ..... 03-00001043 Date 10/27/03
Property Address ...... 124 E 1ST ST
ASSESSOR PARCEL NUMBER: 06-30-00-5-1-3115-0000-
Application description . . . RE-ROOF
Subdivision Name ......
Property Zoning .......
Application valuation .... 4000
Owner Contractor
MC CRORIE ROBERT M AN DEN CONSTRUCTION
175 AMBER LN 364 SHORE ~D.
SEQUIM WA 983828017 PORT ANGELES
PORT ANGELES WA 98362
(360) 457-9396
Pez~ait ...... BUILDING PERMIT - NO PR FEE
Additional desc . . TEAR OFF MID. SEC. TORCH DOM
Permit Fee .... 120.75 Plan Check Fee . . .00
Issue Date .... 10/27/03 Valuation .... 4000
E~piration Date . , 4/25/04
Qty Unit Charge Per Extension
BASE FEE 92,75
2.00 14.0000 THOU BL-2001-25K (14 PER K) 28,00
Other Fees ......... STATE SURCHARGE 4.50
Fee summary Charged Paid Credited Due
Permit Fee Total 120.75 120.78 ,00 .00
Plan Check Total .00 .00 .00 .00
Other Feu Total 4.50 4.50 .00 .00
Grand Te~al 125,25 125.25 .00 .00
Separste Permits are required for electrical work, SEPA, Shoreline, ESA, utilities, private and public improvements. This permit becomes
null ard void if work or construction authorized is not commenced within 180 days, if construction or work is suspended or abandoned
for a p(riod of 180 days after the work as commenced, or if required inspections have not been requested within 180 days from the last
inspe(tion. I hereby certify that I have read and examined this application End know the same to be true and correct. All provisions of
laws aid or(:~,3ences governJ~l this type of work will be complied with whether specified herein or not. The granting of a permit does not
presune/to/,~v/9%uthori~o.~iolate or cancel the provisions of any state or local law regulating construction or the performance of
constr~o,l~.// ~ / /
S'gn~re of Contracte/r or Authonzed Agent Datte" Signature o~ Owner (if owner is builder~ Dat~
T:\PLA,rNING\FOKM$\1102 15 [4/2002]
BUILDING PERMIT INSPECTION RECORD
CALL 417-4815 FOR BUILDING 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
FOUNDATION:
POOTINGS
WALLS
FOU~NDAT [ON DRAINAGE
EUECTRICAL (LIGHT DEPT) SEPARATE PERMIT: #
PLEMBING
ROUGH IN
WATER LINE
GAS LINE
BACK FLOW / WATER
AIR SEAL
CEILING
FRAMING
JOISTS / GIRDERS
S}IEAR WALL
WALLS / ROOF / CEILING
DRYWALL
T-BAR
INSULATION
SLAB
WALL / FLOOR / CEILING
MECHANICAl.
HEAT PUMP
WOOD STOVE / PELLET / CHIMNEY
HOOD / DUUTS
PWUTILITIES/ SITEWORK {EngineerlngDivision) SEPARATE PERMII #'S:
WATEILLINE / ME rER
SEWER CONNECTION
SANI [ARY
STORM
PLANNING DEPT. SEPARATE PERMII #'s SEPA:
PARKING/LIGHTING ESA:
LANDSCAPING SHORELINE:
FINAL INSPECTIONS REQUIRED PRIOR TO OCCUPANCY/USE
RESIDENTIAL DATE YES NO COMMERCIAL DATE ACCEIFED
YES NO
ELECTRICAL L1GHT DEPT. 4]7-4735 ELEC'I RICAL
CONSTRUCTION R W / PW/ CONSTRUCIION - R.W.
ENGYNEERING 417 4807 PW / ENGINEERING
FIRE 417 4653 FIRE DEPT
PLANNING DEPf 417 4750 PLANNING DEPT
BUILDING 417-4815 //"O,L/--O~ ,1./--. BUILDING ,
r:' PI ANN[NG\FORMS\I 102 15 [4/2002]
'~
~
CITY OF PORT ANGELES
PUBLIC WORKS - ELECTRICAL DIVISION
121 EAST 5TH STREET. PORT ANGELES. WA 98362
Application Number
Appl~cat~on p~n number
Property Address
ASSESSOR PARCEL NUMBER
Tenant nbr, name
Application type description
Subdivision Name
Property Use
Property Zoning
Appl~cat~on valuat~on
06-00000166 Date
595866
124 E 1ST ST
06-30-00-5-1-3115-0000-
ROBERT MCCRORIE
RE-ROOF
3/16/06
24000
Owner
Contractor
MC CRORIE ROBERT M
175 AMBER LN
SEQUIM
WA 983828017
LARIAT CONSTRUCTION INC
P. O. BOX 280
PORT ANGELES WA 98362
(360) 457-0952
Permit
Additional desc
Perm~t p~n number
Sub Contractor
Perm~t Fee
Issue Date
Exp~rat~on Date
ELECTRICAL ALTER COMMERCIAL
OLYMPIC/ 200 A SVC + CIR
71431
OLYMPIC ELECTRIC
140 00 Plan Check Fee
3/01/06 Valuation
8/28/06
.00
o
"'"
~
..z
Qty
1 00
1 00
Unit Charge Per
78.7000 ECH EL-COM ALT 0-200 SRV FDR
61 3000 ECH EL-COMM ALT <5 CIRCUITS
Extension
78.70
61 30
Other Fees
STATE SURCHARGE
4.50
~
Fee summary Charged Paid Credited Due
----------------- ---------- -------- - ---------- ----------
Permit Fee Total 140 00 140 00 00 00
Plan Check Total .00 00 .00 00 '""'
Other Fee Total 4 50 4 50 .00 .00 \~
Grand Total 144 50 144.50 00 00
COMMENTS! ACTION NEEDED
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
COMMENTS
NO
g.-~o- ()b eeu..II..Jb
GENERAL COMMENTS:
PW-1I02.J5 (4196]
B5/B2/2BB7 15:45
35B4523498
OLYMPIC ELECTRIC
PAGE 01
"","
"
ELECTRICAL WORKl"ERMlT APPLICATION
JDb wind by
rilectrlcal COJltta.tor tJ Owuer
IDst~atian 4esorlplion
IS'"C.lDlDer<lal 0 RuldtlltlaJ
Electricll oontrDCtor nlmo Lleell!lle number Date 1!lCplrea
t'?t~d?P/-. ~,,-I-.n"- (?'('Y#l;?~~.2Jrr-L??
Purt*}I m.UinJ addroa
/./.2 ?/? /V/7?u-'l'kr
City 0 -L d_ / SIa'. ZIP
t22c:zp.g,,"r'j tvr? <....f16"3'
Tclq1hone number FAX llumber
<- -
o New
o A1lerodlAddltl..
,,,1/-fr,,-,/- ~_V..../:--:-
~Jny'
rremlu. o,..aftl, ..me1f
;1e.t!A-z:,,.., ....r 172M'7fi- n..,r-/U r;,h//7r
Addreu or lo.p..i1.. r ' -,
/2'/..c, IE.
CIl;t6'r-r ~,~/"r '
PJlODC .~lDb-er ;, I.-~'edute 1.lptCUODI ~/l-
Ow..,.. Ii.fln.d by RCIY./9.ZI.161:{I/ awn". wllloccll,P.l' IA. :lrve,.,./o, '.....
)1f!1GI7 4f!er "ds .J,:t"IOJJ ~lit. "JlndUml. (1) 0wI1tr U rlfulrcJ ID hiff an ela:rrlcal
C:oIllNClOr' ,,0&0,. IGtd profMt'Y IJ jof Ja'~. f:DfI or leMlt. '
Afta' reMlnJ 010 ibove..llIlemmt, J h.,.,ay certifY thOot lam. the Ownof' Qr the abOve
oamed P"'pe~ or . licenaed electricll eonttaclOr. I lPI'I mlklng lbe eleetrlca.ll11ltal-
lallon or alteration In. ~1Dp'iIDce with thll clcctricll l.wl. N,B,e.. Rev.'. Chapler
19.'2.8. WAC. Qup\er 296-46Bt The City orpotl Analllet Munlclpal Code, .nd
ULiJU:y Speclfio,riOD!.
SIC.tlllre -vt owau. eleurlnl eD'dttlclor or electrlul adlnh,lIlrator
Q Cash Q a.ecle #
~il Can! Y"" Mastercard Discover
Can! # ____-____.------,--~
x
Date:
7
I!.xpiralion Dale'
oloud
C NO LOAD CliANGES
o Ilasoboard _IC-N
C Fumace _IC-N 0 Overhead ServleG
o tiBet Pump _ Ton _ LAR C Tomp Servle<!
o Fan-Well _IC-N C Underground soNfce '
SAME DAY INSPECTION. CALL BEFORE 7:00 AM 360-417-4735
Voltaga
PhaaoOICS
Service Size: _
Foedo' SIze:
f
ROUGH-IN
THERMOSTAT
r
SERVICE
D.... 1\RI"","!fJ
Do.
A~Br
"
0111
G'hlo~ALkn
~","d BY7
DrrCH
FEEDER
D...
. A,.wovcdJlJ/
gilt!
~.alQy ~
IntPlcti01l
D,le
Area, Building or !!q.lpmCIIllnspcolcd
,
Actio" T.k..
Bloem.al
In.peo~r
....--
Iffj;;;;
MAY 03 20r
....1- ....
w~1JJ
,
UGKT DEPl
,
',;
rl
~
lob wired by
ti(tlectrical Contractor 0 Owner
ElectriC;l.1 contrac or name
o /Z Igff
:~t3-3 Oilins_/~V In vU "'+41-
Cp State ZIP
OJr I1I1J ~/e) IN/!}
Telephone lnlmbcr F..'\X numbtc
5 6303
Premi5~~ UWD~ O~
Addresj :?:'4.Cli.~ I sri-
City Po/tlfn,9t1t5
Phone number- tu !lcbedult! ia!lpecrlop:
Owner- a~' defilU:d by llCw'J9,18.16J:(1) Own!'!' will uccupy tllf! ~lruclurc jor two
YC(J/'J' aft!!, this t:/e;r:trlr..al pi!rmi( i~ jUlalized. (2) OW.le,. is requin,..ri to /tire an <:h:crric"J
COfW'at'tor if ubove said pruperty is for sulc, ,.~nt or least:.
Ai":r reading the above stutement, I hereby cel,itY that r iloffi the owner CJf lhe ubove
named property or ll. licensod ~lectrical coU1i'actor. 1 um lllakins [ht: e:1cctric::d inslal-
.alion O( alceratioa. in' complhmcc wittl the c1ccLricallaws, N.E.C.. tl.Cw. Chapter
19.21$, WAC. Chapter 296.466. Tne Cil)' of Port Angeles Municipal" Colic, and
Utility Specifications.
~g.Mn~, d.",lnl ,..tm'.'.' .,;:'::: '~?;'7/4'
Electrical Load AddItions and or subtractions
J;li( NO LOAD CHANGES
o Basaboard _ KW
o Furnace KW
o Heat p...mp _ Ton _ LAR
D Fan-Wall _ KW
1CTRICAL WORKPERMITAPPLICATlO~
Insta lation description
~ComlDel"clal 0 ResldeotiaJ
o Nl:w
~Ueredl Addielo>>
ftr t'e. PI", C-i!... 0 re Y" lie'" JtJ ·
M~{)c ~NiJ L. :6J.r r
t:. y. T j./ If<!,e}"
OC..h
o Check #
o Credit Card
Card #
VIsa
Mastercard
Discover
. .
----------------
Expirntion Date
of card
Servi~8 Information
vollaga
PhasaD1D3
Service Size: _
Feeder Size:
o Overhead Service
a Temp Service
o Undatgtound Service
SAME DAY INSPECTION. CALL BEFORE 7:00 AM 360-417-4735
f THERMOSTAT ( SERVICE "
ROUGH.IN
~ ;jrAQ lJlI'~ Appra~..d nr 1e4$/"c; 1:!;?,
\(.. ApprO~1I Y./
/' FEEDER
FINAL 1/f DlTOl
/.t..~/.Db
"- Dull; APf"(I~cd9y/ D"',, AJI"ro"~d By '- l)t.le "ppra~~d ny,./
Inspection Area, Building Qr Equipmt.:nl (nspecred Action Talen Electrical
Date Insp"ctor
3~ 3D.O b ee, LoWO -f:~" C:;Ovev ".,p TEf"
'-,- /.f'b{;, rlIV.,tIL At" I~
/\./ 1/ 1./ ,
17
r
. W 39\1d
JI~lJ3l3 JldW^lO
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01/27/2005 11: 11 FAX
~001/003
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~ ELECTRICAL WORK PERMIT APPLICATION
~ 0 Request Inspection
o Owner .~~~
o Carnival ~mDlerdB.1 . 0 Residential Cl Residential Maiol. C Signs 0 Thermostat 0 Telec::om.
'E1ilectrical Contractor
o Annual Permit 0 Alarm
Job wired by
~Iectrlcal Contractor 0 Owner
Ins~311a(ion description
Electrical contractor name
Sti.....ttm P Rr;CT/2/ (A-L
Purchaser's mailing address
fO I~ 31('3
c"\,
'f~ A /J&-E"1E:\,
Telephone number
.~ S J..- (., y,,/
License number
C c) ~ ri[l1-C T7 A I (~
4
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. C01f11ge 0/,/ f Z00I17M~(ViU
ill I
. f?"( f)1fi ( ()( t-
I l!"1 $, VfIJ
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SIP-II; ZIP
qf3~1..
FAX nU11lber
Premises owner's name
/YJ<('.,lJYie. f-k-rYlG ~UYl1i<:.h;nJ~
Address of inspection
I'l<./ C7lC+- 1St Sfrct'f
City;)
r6Y-{
~
o Cash 0 Check #
I hereby certify tha( I am the owner or lhe above named property or a licensed CI Credit Card Visa Mastercard Discover
electrical contractor (or the fiTTfl',s authorized agent) and am mak.ing the electrical
instaUation or alteration in compliance with the electrica11aw, Chapter 19.28 RCW. Card # _1.Jn_ 5__1 c::. ___ _ _ ___ _ __
ontractor or elec.trical adminiUr:Hor'
Expiration Date
of card
x
WALLS
[nsulation Only
DAte ApprovcdBy
Cover
Olte Approvt4 Hi
CEJUNG
Insulation Only
D~'e .All1'rovcd By
Cover
I.}ale Apprtlvcd B)'
r THERMOSTAT '\
Dalc Approved 9y
DITCH
Ollie AP\ll'Ovc4 By
SERVICE
"- Dall Approvod By
fiElDER
Dlle AIIPTtlV~ By
Electrical Load Additions and or subtractions
o NO LOAD CHANGES
(J Baseboard KW
CJ Fumace _ KW
o Heat PumQ _ Tol"l _ LAR
o Fan-Wall _ t<:>N
t..{o Ti'f:
Service Information
o Ol/srhead SelVice
o Temp Service
o Underground Service
Voltage
PhaseC,03
ServIce Size: _
Feeder Size:
Inspection
DfHe
~
Electrical
Inspector
Area, Building or Equipment lnsp<<:etecJ
Action Taken
A<"r:"'~
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~
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