HomeMy WebLinkAbout2201 W 18th St - Building CITY OF PORT ANGELES
,s DEPARTMENT OF COMMUNITY ECONOMIC DEVELOPMENT BUILDING DIVISION
321 EAST 5TH STREET, PORT ANGELES, WA 98362
Application Number 11- 00001117 Date 10/12/11
Application pin number 499234
Property Address 2201 W 18TH ST I
ASSESSOR PARCEL NUMBER: 06- 30- 99 -1 -1 -0310 -0000- REPORT SALES TAX
Tenant nbr, name EVRGRN FAM VLG CHLDCR CTR
Application type description MECHANICAL APPL. PERMIT On your state excise tax form
Subdivision Name to the City of Port Angeles
Property Use
Property Zoning RESIDENTIAL MEDIUM DENSTY (Location Code 0502)
Application valuation 3350
Application desc
HEAT PUMP
Owner Contractor
SERENITY HOUSE OF CLALLAM PENINSULA HEAT INC
PO BOX 4047 782 KITCHEN -DICK RD
PORT ANGELES WA 98362 SEQUIM WA 98382
(360) 452 -1439 (360) 681 -3333
Permit MECHANICAL PERMIT
Additional desc HEAT PUMP
Permit pin number 194126
Permit Fee 64.80 Plan Check Fee .00
.Issue Date 10/12/11 Valuation 0
Expiration Date 4/09/12 j
Qty Unit Charge Per. Extension
BASE FEE 50.00 11
1.00 14.8000 EA ME- FURN /HP /FAU OR 5 TON 14.80
Fee summary Charged Paid Credited Due
1-
Permit Fee Total 64.80 64.80 .00 .00
Plan Check Total .00 .00 .00 .00 t\
Grand Total 64.80 64.80 .00 .00 V
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 o sta e or local law regulating construction or the performance of
construction,
d �/1 di it /,A lr
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
PLEASE PROVIDE A MINIMUM 24 -HOUR NOTICE FOR INSPECTIONS
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 1
Rough -In
Water Line (Meter to Bldg)
Gas Line
Back Flow Water FINAL Date Accepted by
AIR SEAL:
Walls d
Ceiling
FRAMING:
Joists Girders Under Floor
Shear Wall Hold Downs
Walls Roof Ceiling
Drywall (Interior Braced Panel Only)
T-Bar
INSULATION:
ISULATION:
Slab
Wall Floor Ceiling
MECHANICAL:
Heat Pump Furnace FAU Ducts
Rough -In
Gas Line
Wood Stove Pellet Chimney f�\\ l I
Commercial Hood Ducts FINAL Date 1 Vim I Accepted by c1✓`
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
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BUILDING PLUMBING MECHANICAL PERMIT APPLICATION SHORT FORM
(To be used for projects that do not require plan review.)
Date Received 1 -1
Permit U— 1(17
City of Port Angeles Please print in ink. Date Approved
Attn: Building Permit Technician Approved by
321 E, 5 St., Port Angeles, WA 98362
360-417-4815 fax: 360-417-4711 .Credit card payments are accepted Mon-Fri 8-5 pm (no American Express)
Hours: Mon through Fri 8 5 pm Cash checks are accepted Mon-Thurs 8:30-4 pm Fri 8:30-12:30 pm
Contact personV)/ i 4 Phone:
ilc.';‘:-,' ie /7 i."--e-i---/ i
i i Property owner- i
1 2 _L
a vi dk 6 ktly) Phone:
r Property ownes mailing ess:
6 1: L i 1 Po r' t A-)ac (e 5 w71-7 c n (0___ i
Contractor's business name: --ei r? 5 i 4. I el: el r -1-Phone! i
(or property owner's name if he/she is doing/overseeing the work) 1 :3 -1
6:5- 3
Contractors mailing ad•res
A I n 1 C."'
7 .,...7::-?_ e.'". 1 1./..r rz. ....,._)L- i;-.-7 7,,
Contractors license number y 1 i
1 Expiration date; y
/S /Z.-
Project Address I
22o 4 r
y
ey eirr-epAi-------1
4
2- z 0 r kt, i V-b- 5 e„ 1- z-
i
akk Project Type: 2, Residential 1 rir-C G Industrial p Multi-fam 1
ily CM-0CH
Project Busin N
ess ame:
Ske)( (for commercial, industrial, or multi-family projects)
A following permits are usually issued over-the-counter imniediately, without the need for plan review,
complete only the portions of this permit that are relevant to your project.
Ksu
Re-roof: c house c garage c other
tear off re-roof C lay over one layer
Licensed contractor Submit a copy of you,r re-roof bid.
Project Valuation (labor materials, not including sales tax)
Re-side: m house c garage b other
Project Valuation 1 (labor materials, not including sales tax)
Repair: (explain the project)
Project Valuation
"Homeowner: If you will be doing overseeing the work, then the project valuation will be determined by doubling the
cost of materials, to reflect the value the repair adds to your property.
Cost of materials x 2 Project Valuation
T:Forms/Building Division/Building/PlurnbingNechanIcai Permit AppHcat■on Short Form (Revised 2O11)
Page 1 of 2
I"- Swimming Pool mr SPA ta 24" deepl: For prefabricated swirnmil74 f 00! or See freects that
do not require plan review:
Obtain the City ofPA handout entitled "Pools Spas" follow tnerequirements.
Project Valuation
Demolition: A demolition permit is needed when un entire building gets demolished,
What will bedemolished? o house o garage i7_7 other
Note: some demolition permit applications need to be reviewed by various City depertmen1o, and may take
approximately o weeks tc obtain,
Agree to ensure that all utilities areiwiUUe properlyturneo off land capped off ifneedod)
prior hodemolition.
Obtain (from the City of PA) an aerial view map of the parcel and put an "x" over the structure(s) to
be demolished. Submit the map with this application.
Obtain (from the City'of PA) a copy of the Olympic Region Clean Air Agency (ORCAA)
Demolition Permit Application.
Contact ORCAA at 38O-417-146 $odisruoawhethmrornotanORCAADemn|ihonPernitwi8a|so
be needed.
oywo o no Will the debris be going to the Regional Transfer Station in Port Angeles?
m yes o No If yes, wi|| a licensed contractor be taking it there?
If yes, ohtain (from the City of PA) a copy of the Waste DsposaI Appllcation.
Complete and submit the waste dieposal eppcation to the Building Permit Technician now
;or \aUar\fasbeatoa«estinGioneeded).
Plumbing Permit: 'expain the project)
Project Valuation
Mechanical Permit; (explain the proiecV
e iki oL
7 1- 7 �^t� �o[
Project Valuation
i have read and completed this application and know it
and understand �a�� to '~`o'~^' '="au'x^ueom apply for thiq permit
working
on projects,
and to pexv^«phorm
Date /O/� Signature ''~.~.e_
Print Name
Page 2of2
Clallam County Assessor Treasurer Property Details 70572 SERENITY HOUSE 0... Page 1 of 1
Clallam County Assessor Treasurer
Property Search Results 70572 SERENITY HOUSE OF CLALLAM COUNTY for Year 2011 2012
Property
Account
Property ID: 70572 Legal Description: BENNETT SP V27
P43 LOT 1 EASE
SUB LT 103- 1.89A
SURVEY V39 P3
Geographic ID: 0630991103100000 Agent Code:
Type: Real
Tax Area: 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: Section:
Range:
Location (1
Address: 2201 WEST EIGHTEENTH ST Mapsco: O
PORT ANGELES, WA 98363
*.vi)
Neighborhood: PA Exempt Ref Map ID: 3
Neighborhood CD: 50985200
Owner
Name: SERENITY HOUSE OF CLALLAM COUNTY Owner ID: 51687
Mailing Address: PO BOX 4047 Ownership: 100.0000000000%
PORT ANGELES, WA 98362
Exemptions: EX
Taxes and Assessment Details
Property Tax Information as of 10/06/2011
Amount Due if Paid on: q 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.
Click on "Statement Details" to expand or collapse a tax statement.
1, First Half l Second Half
Year 1 Statement ID Base Amt. 1 Base Amt. Penalty Interest 1 Base Paid 1 Amount Due
P Statement Details
2011 163355 $360.88 $360.88 $0.00 $0.00 $360.88 $360.88
Statement Details
2010 51661 $360.88 $360.88 $0.00 $0.00 $721.76 $0.00
Values
Taxing Jurisdiction
Improvement Building
Sketch
Property Image
Land
Roll Value History
Deed and Sales History
Payout Agreement
This year is not certified and ALL values will be represented with "N /A
Website version: 9.0.32.2200 Database last updated on 10/6/2011 3:47 AM 2011 True Automation, Inc. All Rights
Reserved. Privacy Notice
http: /websrv8.clallam. net propertyaccess /Property .aspx ?cid =0 &year =2011 &prop_id =70572 10/6/2011
D Reviec
Rev
0 Final Review
COMMENT
NO
gue.,\ Vt-
PLAN REVIEW COMMENTS
SENT FOR DEPARTMENT REVIEW ON: _12.-19-i')
REVIEWING DEPARTMENT Building PW Engineering J Wastewater J Water Street Solid Waste J Light Fire
DEPARTMENT COMMENTS RETURNED COMMENTS TO SUBMITTER: SUBMITTER RESPONSE DATE:
NOTE 10 PLAN SUBMIT nat. AII plan comments require written response and/or correction for permit issuance. Return response with plan resubmival. Approval of hal reviewin8 departments requited prior io
permit issuance
0 Revision
DRAWING OR
SPEC REF
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abet 0 Reviewed by
by__.
REVIEWING DEPARTMENT FINAL APPROVAL:
Date
COMMENTS
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BACK CHECK
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STATUS CODES.
A COMMENT ACCEPTED
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COMMENT
NO
PROJECT NAME.
PW 110404 [12/93)
SENT FOR DEPARTMENT REVIEW ON: 120 t 11
REVIEWING DEPARTMENT
22o i i g+i k of
PLAN REVIEW COMMENTS
Building PW Engineering Wastewater Water Street Solid Waste Light Fire
DEPARTMENT COMMENTS RETURNED COMMENTS TO SUBMITTER. SUBMITTER RESPONSE DATE.
NOTE TO PLAN SUBMITI'ER. All plan comments require written response and/or correction for permit issuance. Return response with plan resubmittal. Approval of ALL reviewing departments required prior to
permit isn"An e.
Concept Review Revision
Preliminary Review
Final Review
DRAWING OR
SPEC REF
134
other
Not approved. Comments returned to submiaer for response and or correction.
Reviewed by
by
REVIEWING DEPARTMENT FINAL APPROVAL.
LOCATION
Date
COMMENTS
dvitiummtolikv
tutk
I PERMIT a
BACK CHECK
BY/DATE.
STATUS CODES.
A COMMENT ACCEPTED
C CORRECTION MADE
N NO RESPONSE REQ'D
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COMMENT
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REVIEWING DEPARTMENT
DEPARTMENT COMMENTS RETURNED COMMENTS TO SUBMITTER:
NOTE TO PLAN SUBMITTER. All plan comments require written response and/or correction for permit issuance. Return response with plan resubmival. Approval awl, reviewing departments required prior to
permit issuance
Revision
0
DRAWING OR
SPEC. REF
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PROJECT NAME. c
Not approved. Comments returned to subminer for response and or correction.
other Reviewed by
PLAN REVIEW COMMENTS
Building PW Engineering Wastewater Water Street Solid Waste Light Fire
REVIEWING DEPARTMENT FINAL APPROVAL.
by Date
COMMENTS
22 o l w (8*, m2c)FI
SUBMITTER RESPONSE DATE.
BACK CHECK
BY/DATE:
STATUS CODES.
PW 1104_04 [12/93]
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A COMMENT ACCEPTED
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LOCATION 6, /8 I PERMIT l 00 Z 0
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SENT FOR DEPARTMENT REVIEW ON
REVIEWING DEPARTMENT `�Q Building PW Engineering Wastewater Water Street 1 Solid Waste 1 Light Fire
DEPARTMENT COMMENTS RETURNED-M f6 COMMENTS TO SUBMITTER. SUBMITTER RESPONSE DATE.
NOTE TO PLAN SUBMITTER. All plan comments require written response and /or correction for permit issuance. Return response with plan resubmittal. Approval of ALL reviewing departments required prior to
permit issuance.
Concept Review Revision i yNot approved. Co mer is returned to submiiter for response and or correction.
1 8•Preliminary Review
Final Review other Reviewed by-
COMMENT DRAWING OR
NO SPEC. REF
54< 5 /o/
PROJECT NAME. t!0/ ~beerga)
PW- 1104.04 (12/93)
by
PLAN REVIEW COMMENTS
REVIEWING DEPARTMENT FINAL APPROVAL.
COMMENTS
2 2-051 W lgttn
SHEET f,ft J
Date
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BY /DATE. T
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C CORRECTION MADE
N NO RESPONSE REQ'D
aox/
PERMIT 1
;$
""".....f1I'
CITY OF PORT ANGELES
PUBLIC WORKS - ELECTRICAL DIVISION
:121 EAST 5TH STREET. PORT ANGELES. WA 98:162
ELECTRICAL PERMIT
Issued: 6/09/98
Permit No:
6336
OWNER/APPLICANT------------------------PROPERTY LOCATION------------------------
SERENITY HOUSE OF CLALLAM CO 2201 18TH ST W
1022 S. "C" ST Lot: SL 103
Port Angeles, WA 98362 Block: Long Legal:
360/452-3112 Sub: BENNETT SP 95-07-04
T: COMMONS BLDG. S: Parc No: 0630991103100
CONTRACTOR-----------------------------DESIGNER---~-----------------------------
SHAMP ELECTRICAL CONTRACTING INC.
P.O. BOX 383
Port Angeles, WA 98362
360/452-1689
,
000/000-0000
PROJECT INFO--------------------------------------------------------------------
prj Type: COML.NEW prj Value: $0.00
Occ Type: Cnstr Type:
Occ Grp: Occ Load: Land Use: RMD
Electrical Heat Service Type
Baseboard KW: 0 Riser Voltage: 120,240
X Furnace KW: 0 Overhead Service Diameter: X-I -3
X Heat Pump KW: 0 X Underground Service Service Size: 600 AMPS
Fan/Wall KW: 0 Temp Service Feeder Size: 0 AMPS
PROJECT NOTES-------------------------------------------------------------------
COMMONS BUILDING, HEAT LOAD 2-15KW, 2-5KW, 1-8KW FURNACES
2-11KW, 2-5KW, 1-9KW HEATPUMPS
PERMIT INCLUDES FIRE ALARM
PROJECT FEES ASSESSMENT---------------------------~------~----------------------
Service: $182.00
Additional Feeders: $0.00
Circuit wiring: $0.00
Temp Service: $0.00
$0.00
Misc
TOTAL FEE:
Amount Paid:
$182.00
$182.00
---------------------------------
------------~--------------------
TOTAL FEE:
$182.00
Balance Due:
$0.00
COMMENTS/ACTION NEEDED
ELECTRICAL PERMIT INSPECTION RECORD
CALL 417-4735 FOR ELECTRICAL INSPECTIONS. PLEASE PROVIDE A MINIMUM 24 HOUR NOTICE. IT IS UNLA WFUL TO COJlER,
INSULA TE OR CONCEAL ANY WORK BEFORE IT IS INSPECTED AND ACCEPTED.
KEEP PERMIT CARD AND APPROVED PLANS AT JOB SITE
INSPECTION TYPE DATE I ACCEPTED COMMENTS
I YES I NO
UnU1
m -IN IcuVER C;/ tt I ?~ IV
t5'/;-/ yll'
r
FINA lo/L1t'-l?1 I~' I .
"""C"
GENERAL COMMENTS,
P'W.I 102.15 14961
Jfi
"'........
CITY OF PORT ANGELES
PUBLIC WORKS - ELECTRICAL DIVISION
J2\ EAST 5TH STREET. PORT ANGELES. WA 9RJ62
ELECTRICAL PERMIT
Issued: 2/26/98
Permit No:
6243
OWNER/APPLICANT------------------------PROPERTY LOCATION------------------------
SERENITY HOUSE OF CLALLAM CO 2201 18TH ST W
1022 S. "CD ST Lot: SL 103
Port Angeles, WA 98362 Block: Long Legal: .
360/452-3112 Sub: BENNETT SP
T: S: Parc No:
CONTRACTOR-----------------------------DESIGNER---------------------------------
SHAMP ELECTRIC
P.O. BOX 383
Port Angeles, WA 98362
360/452-1689
,
000/000-0000
PROJECT INFO--------------------------------------------------------------------
prj Type: TEMPORARY SVC. prj Value: $0.00
Occ Type: Cnstr Type:
Occ Grp: Occ Load: Land Use: RMD
Electrical Heat
Baseboard KW:
Furnace KW:
Heat Pump KW:
Fan/Wall KW:
o
o
o
o
Service Type
Riser
Overhead Service
X Underground Service
X Temp Service
Voltage:
Diameter:
Service Size:
Feeder Size:
-1
o
-3
o AMPS
o AMPS
PROJECT NOTES-------------------------------------------------~-----------------
TEMP FOR COMMONS BUILDING
PROJECT FEES ASSESSMENT---------------------------------------------------------
Service: $0.00
Additional Feeders: $0.00
Circuit Wiring: $0.00
Temp Service: $41.00
$0.00
Misc
TOTAL FEE:
Amount Paid:
$41.00
$41.00
---------------------------------
---------------------------------
TOTAL FEE:
$41. 00
Balance Due:
$0.00
COMMENTS/ACTION NEEDED
ELECTRICAL PERMIT INSPECTION RECORD
CALL 417-4735 FOR ELECTRICAL INSPECTIONS. PLEASE PROVIDE A MINIMUM 24 HOUR NOTICE. rr IS UNLA WFUL TO COlIER,
INSULA TE OR CONCEAL ANY WORK BEFORE rr IS INSPECTED AND ACCEPTED.
KEEP PERMIT CARD AND APPROVED PLANS AT JOB SITE
INSPIC'IlON TYPE DATE ACCEP1m COMMENTS
YES I NO
-IN I ,<'
:S1<.~CE 2../2" /at' -f?1'1
lOTNAI I I I
GENERAL COMMENTS:
PW.II02.1~I061
I
dI'OIlT~
tD
~
CITY OF PORT ANGELES
PUBLIC WORKS . ELECTRICAL DIVISION
321 EAST 5TH STREET, PORT ANGELES, WA 98362
.~
ELECTRICAL PERMIT
Issued: 10/15/96
Permit No:
5690
OWNER/APPLICANT------------------------PROPERTY LOCATION------------------------
SERENITY HOUSE OF CLALLAM CO 2201 18TH ST W
1022 S. "C" ST Lot: SL 103
Port Angeles, WA 98362 Block: Long Legal:
360/452-3112 Sub: BENNETT SP
T: BLDG B S: BLDG Parc No:
CONTRACTOR- ----- - ------- - - - -- -- -------- DES IGNER----.- ------ - ----- --- --- ------- ---
KIRSCH ELECTRIC
141-H FALCON RD.
SEQUIM, WA 98382
360/683-6819
,
000/000-0000
PROJECT INFO----~---------------------------------------------------------------
prj Type: MULTI-FAMILY prj Value: $0.00
Occ Type: Cnstr Type:
Occ Grp: Occ Load: Land Use: RMD
Electrical Heat
X Baseboard KW:
Furnace KW:
Heat Pump KW:
Fan/Wall KW:
10
o
o
o
Service Type
Riser
Overhead Service
X Underground Service
Temp Service
Voltage:
Diameter:
Service Size:
Feeder Size:
120,240
X-1 -3
400 AMPS
100 AMPS
PROJECT NOTES-------------------------------------------------------------------
NEW 4.-PLEX 2. 5KW HEAT / UNIT 100 AMP FEEDER/UNIT
PROJECT FEES ASSESSMENT---------------------------------------------------------
Service: $65.00
Additional Feeders: $60.00
Circuit Wiring: $0.00
Temp Service: $0.00
$0.00
Misc
TOTAL FEE:
Amount Paid:
$125.00
$125.00
---------------------------------
---------------------------------
TOTAL FEE:
$125.00
Balance Due:
$0.00
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 INSPECTEDAND ACCEPTED.
KEEP PERMIT CARD AND APPROVED PLANS AT JOB SITE
INSPECTION TYPE DATE I ACCEPTED COMMENTS
I YES I NO
I DITCH
R I-iN / I.-VVCK 11J)/-z..,/~ '1'--
I SEKVICh It!) /:L 1/4.. 'T~
FINAL I ///1/97 I '1
GENERAL COMMENTS:
pw.II02.1~14I901
~
~....
CITY OF PORT ANGELES
PUBLIC WORKS - ELECTRICAL DMSION
321 EAST 5TH STREET, PORT ANGELES, WA 98362
ELECTRICAL PERMIT
Issued: 10/15/96
Permit No:
5689
OWNER/APPLICANT------------------------PROPERTY LOCATION------------------------
SERENITY HOUSE OF CLALLAM CO 2201 18TH ST W
1022 S. "C" ST Lot: SL 103
Port Angeles, WA 98362 Block: Long Legal:
360/452-3112 Sub: BENNETT SP
T: BLDG A S: Parc No:
CONTRACTOR-----------------------------DESIGNER---------------------------------
KIRSCH ELECTRIC
141-H FALCON RD.
SEQUIM, WA 98382
360/683-6819
,
000/000-0000
PROJECT INFO-----------------------------------------_________-_________________
prj Type: MULTI-FAMILY prj Value: $0.00
Occ 'rype: Cnstr Type:
Occ Grp: Occ Load: Land Use: RMD
Electrical Heat
X Baseboard KW:
Furnace KW:
Heat Pump KW:
Fan/Wall KW:
10
o
o
o
Service Type
Riser
Overhead Service
X Underground Service
Temp Service
Voltage:
Diameter:
Service Size:
Feeder Size:
120,240
X-1 -3
400 AMPS
100 AMPS
PROJECT NOTES--------------------------------------------------_________________
NEW 4 PLEX 2.5 KW BASEBOARD PER UNIT 100 AMP FEEDER PANEL/UNIT
PROJECT FEES ASSESSMENT----------------------------------------_________________
Service: $65.00
Additional Feeders: $60.00
Circuit Wiring: $0.00
Temp Service: $0.00
: $0.00
Misc
TOTAL FEE:
Amount Paid:
$125.00
$125.00
---------------------------------
---------------------------------
TOTAL FEE:
$125.00
Balance Due:
$0.00
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 I ACCEPTED
IYESINO
COMMENTS
DITCH
-IN / cuvhR
SERVICE
{olz;} IQ(p ~ 6"V
'n,,/Z J/tf/~
"TINAL
1//,,1,"-7 I 7~ I
.
GENERAL COMMENTS,
PW.II02.l5(4I96]
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~-
CITY OF PORT ANGELES
PUBLIC WORKS . ELECTRICAL DIVISION
321 EAST 5TH STREET, PORT ANGELES, WA 98362
ELECTRICAL PERMIT
Issued: 10/15/96
Permit No:
5691
OWNER/APPLICANT------------------------PROPERTY LOCATION------------------------
SERENITY HOUSE OF CLALLAM CO 2201 18TH ST W
1022 S. "C" ST Lot: SL 103
Port Angeles, WA 98362 Block: Long Legal:
360/452-3112 Sub: BENNETT SP
T: BLDG C S: Parc No:
CONTRACTOR-----------------------------DESIGNER---------------------------------
KIRSCH ELECTRIC
141-H FALCON RD.
SEQUIM, WA 98382
360/683-6819
,
000/000-0000
PROJECT INFO--------------------------------------------------------------------
prj Type: MULTI-FAMILY prj Value: $0.00
Occ Type: Cnstr Type:
Occ Grp: Occ Load: Land Use: RMD
Electrical Heat
X Baseboard KW:
Furnace KW:
Heat Pump KW:
Fan/Wall KW:
10
o
o
o
Service Type
Riser
Overhead service
X Underground Service
Temp Service
Voltage:
Diameter:
Service Size:
Feeder Size:
120,240
X-l -3
400 AMPS
100 AMPS
PROJECT NOTES-------------------------------------------------------------------
NEW 4-.PLEX 2. 5KW HEAT/UNIT 100 AMP FEEDER/UNIT
PROJECT FEES ASSESSMENT---------------------------------------------------------
Service: $65.00
Additional Feeders: $60.00
Circuit Wiring: $0.00
Temp Service: $0.00
$0.00
Mise
TOTAL FEE:
Amount Paid:
$125.00
$125.00
---------------------------------
----------------------------------
TOTAL FEE:
$125.00
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
INSPECTION TYPE DATE I ACCEPTED COMMENTS
YES I NO
DITCH
R :-LN I CUy.t.K II IQ6 1'~
SERVICE II. 'al. TtPfM
FINAl I I '1 h/W'o I
-,
GENERAL COMMENTS:
PW.IID2.l:5(4I96)
.~~
~~
CITY OF PORT ANGELES
PUBLIC WORKS - ELECTRICAL DIVISION
321 EAST 5TH STREET, PORT ANGELES, WA 98362
ELECTRICAL PERMIT
Issued: 10/15/96
Permit No:
5692
OWNER/APPLICANT------------------------PROPERTY LOCATION------------------------
SERENITY HOUSE OF CLALLAM CO 2201 18TH ST W
1022 S. "C" ST Lot: SL 103
Port Angeles, WA 98362 Block: Long Legal:
360/452-3112 Sub: BENNETT SP
T: BLDG 0 S: Parc No:
CONTRACTOR-----------------------------DESIGNER---------------------------------
KIRSCH ELECTRIC
141-H FALCON RD.
SEQUII1, WA 98382
360/683-6819
,
000/000-0000
PROJECT INFO--------------------------------------------------------------------
prj Type: MULTI-FAMILY prj Value: $0.00
Occ ~rype: Cnstr Type:
Occ Grp: Occ Load: Land Use: RMD
Electrical Heat
X Baseboard KW:
Furnace KW:
Heat Pump KW:
Fan/Wall KW:
10
o
o
o
Service Type
Riser
Overhead Service
X Underground Service
Temp Service
Voltage:
Diameter:
Service Size:
Feeder Size:
120,240
X-1 -3
400 AMPS
100 AMPS
PROJECT NOTES-------------------------------------------------------------------
NEW 4-PLEX 2.5KW HEAT/UNIT 100 AMP FEEDER/UNIT
PROJECT FEES ASSESSMENT---------------------------------------------------------
Service: $65.00
Additional Feeders: $60.00
Circuit Wiring: $0.00
Temp Service: $0.00
$0.00
Mise
TOTAL FEE:
Amount Paid:
$125.00
$125.00
---~------------------------------
---.------------------------------
TOTAL FEE:
$125.00
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 InS INSPECTED AND ACCEPTED.
KEEP PERMIT CARD AND APPROVED PLANS AT JOB SITE
INSPECTION TYPE
DATE T ACCEPTED
rYESINO
COMMENTS
DlTCH
ROUGH-IN I COVER
~ERVltE
.
II Nlfv 7dM'\
II Iii 11{;; 'i~
FINAL
I 2/1 f4., 1"7'~
GENERAL COMMENTS:
PW-II02J514196]
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~~
CITY OF PORT ANGELES
PUBLIC WORKS - ELECTRICAL DIVISION
321 EAST 5TH STREET, PORT ANGELES, WA 98362
ELECTRICAL PERMIT
Issued: 10/15/96
Permit No:
5693
OWNER/APPLICANT------------------------PROPERTY LOCATION------------------------
SERENITY HOUSE OF CLALLAM CO 2201 18TH ST W
1022 S. "C" ST Lot: SL 103
Port Angeles, WA 98362 Block: Long Legal:
360/452-3112 Sub: BENNETT SP
T: LAUNDRY S: Parc No:
CONTRACTOR-----------------------------DESIGNER---------------------------------
KIRSCH ELECTRIC
141-H FALCON RD.
SEQUIM, WA 98382
360/683-6819
,
000/000-0000
PROJECT INFO---------------------------------------------------_________________
prj Type: MULTI-FAMILY prj Value: $0.00
Occ Type: Cnstr Type:
Occ Grp: Occ Load: Land Use: RMD
Electrical Heat
X Baseboard KW:
Furnace KW:
Heat Pump KW:
Fan/Wall KW:
5
o
o
o
Service Type
Riser
Overhead Service
X Underground Service
Temp Service
Voltage:
Diameter:
Service Size:
Feeder Size:
120,240
X-I -3
200 AMPS
o AMPS
PROJECT NOTES---------------------------------------------______________________
LAUNDRY BUILDING
3-DRIERS 3-WASHING MACHINES
PROJECT FEES ASSESSMENT--------------------------------------------_____________
Service: $50.00
Additional Feeders: $0.00
Circuit Wiring: $0.00
Temp Service: $0.00
$0.00
Misc
TOTAL FEE:
Amount Paid:
$50.00
$50.00
---------------------------------
---------------------------------
TOTAL FEE:
$50.00
Balance Due:
$0.00
COMMENTS/ACTION NEEDED
ELECTRICAL PERMIT INSPECTION 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 r ACCEPTED
IYESINO
COMMENTS
D
R -IN I CUVbK
~VILE
lofz"J/qb 1""'"
/()h~ 7~
FINAL
I J /.
'I"T~
I
GENERAL COMMENTS:
PW-II02.15(4I96]
.
CITY OF PORT ANGELES LIGHT DEPARTMENT
321 E. Fifth Street
Port Angeles, WA 98362
(206) 457-0411
ELECTRICAL PERMIT
PERMIT NO. .s-r;, ZL
8' /z-/9c.
DATE
I nstalled By:
o READY FOR
INSPECTION
License Number:
o WILL CALL FOR
INSPECTION
Phone:
Site Address:
Owner/Business:
Phone:
Owner/Business Address:
Sq. Ft.
ELECTRIC HEAT
o BASEBOARD KW _
o FURNACE KW _
o HEAT PUMP KW_
o FAN/WALL KW _
o RESIDENTIAL
o COMMERCIAL
o NEW CONSTRUCTION
o REMODEL
o ADD/ALTER CIRCUITS
o SERVICE UPGRADE/REPAIR
XTEMPORARY SERVICE
o RISER
~OVERHEAD SERVICE
o UNDERGROUND SERVICE
VOLTAGE:
D1~ D3~
SERVICE SIZE
FEEDER SIZE
AMPS
AMPS
DetailslDescription:
.
W.S. No. SERVICE SIZE
CAPACITY:
o O.K. 0 NOT O.K.
ACTION REQUIRED: 0 CHANGE TRANSFORMER
o INSTALL SERVICE POLE
DATE
ENGR.
o OVERHEAD SERVICE APPROVED
o CHANGE SERVICE WIRE
o OTHER
o Ditch Inspection O.K.
o Rough-in/cover O.K.
~'f: O.K. to connect service
o Final O.K.
Site Address:
Installer:
52<9-0.
Kr'u
0'1-4
~
permit?6:;2.-
New Meters
.
Notify Port Angeles City Light by Street Address and Permit Number when ready for inspection. Work must not be covered
before inspection and O.K. for covering has been given by the electrical inspector in writing on either the Wiring Report
or on the Buildin!!ftermit. PHONE 457-0411, EXT. 224. ;I
~()2;UIl NO OCCUPANCY OR USE ESTABLISHED UNDER THIS PERMIT $ 20
Efeclr~allnspector Permit Fee
WHITE - File by address
PINK - Top: Eng, Bottom, Customer
GREEN - Top: Meter Dept., Bottom: City Hall
OLYMPIC PRINTERS INC_
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.
CITY OF. PORT ANGELES. . "
DEPARTMENT OF COMMUNITY DEVELOPMENT - BUlLDING DMSION
321 EAST STH STREET,.PORT ANGELES,W~ 98362
Appiication.Nwnber
pin .nwnber . . . .
prop~rty Address
ASSBSSOR-PARCEL NUMBER:
App~;c~~\9ndescription
S~d(V'ision Name '.. .
prcip~~Y; Use . . . .
ProPerty zoning . . .
Application valuation
04-00000411 Date
.589353
2201. W 1.8TH ST
06-30-99~1.-1.-031.0-0000~
SIGNS
5l21./04
RESIDENTIAL MEDIUM DENSTY
320
owner
Contractor
~ . " ,-, ,;:'~ ,;' _,J
--~----~-------------~---
- -... -'- - -- - - - - - - - - - - - - - - --
,', ' ,
. . SERENITY HOUSE OF CLALLAM
PO BOX'4047
PORT ANGELES WA 983630997
OWNER
----------------------------------------------------------------------------
Permit .... . .
Additional desc
pennit Fee
Issue Date
Expiration Date
SIGN
30.00
5/21./04
1.1./1.7/04
Plan Check Fee
Valuation
.00
320
Qty unit Charge Per
1..00 30.0000 PER S- SIGN ALL 25-
Extension
30.00
Fee swnmary Charged Paid Credited Due
----------------- ---------- ---------- ----------' ----------
Pe:tJl\i.t Fee Total 30.00 30.00 .00 .00
Plan Check Total .00 .00 .00 .00
Grand Total 30.00 30.00 .00 .00
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Separate Permits are required for electrical work,SEPA, Shoreline,E~A, utiliti~, private and public iruJ?~ye,m!n~;niiS'p,'i-nllt~omes
nuU.and v()ld:If-WOrkorconstrudion auth()rized is not COrnrnel'lc~.~tI)h'180 dl:iY;5" if construction or w()i'It~!~u~~M''" .r:a~.antl()l'l~d
for.a periodo~ 18() days afterthework as commenced,orifreql:!lredil'nspeCtlons have not been reque~.tEl~J~jHlh~t,~6,' .... ,.,: ,l:f\th~iast
Insp~on. I. here~ycertify that I ~ave read and examinedth~ application and know the same to betrUf)'and'~~~,.. >:p,rev.isiolls~of
laws andorclinances goveming thislype of work will be complied withwhetherspecified herein or not., Tl1e:g~ntillgQf-.€lRemiUd,oesnot
preSume to give authority to violate or cancel the provisions of any state or local law regulating construction orthtrperfom1anceof
co- . n.
r
Signature of Owner (if owner isbliilder)
Date
T:\PLANNlNG\FORMS\II02.IS [1111412003]
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BUILDING PERMFfINSPECTION RECORD .
~- .} ,,' ,
CALL 417-4815 FOR BUILDING INSPBCI'lON~. CALL 417-4735 FOR BLBCfRICAL INSPBCI'lONS.
PLEASE JiRO\ltDB' AMINIMUM 24ijOURJi~OTIC.E. ITIS UNLA WFUL T(J 90VER'lNS,f/LATE,.OIl,t:;()J'ig(iL4fVXWORJfBEFQIlE
; .lNSPECTQD4NDAl'6EPTBD..iPOSTPERMITINACONSPIcUOlJ~LQcATION;' '''':
IffiEPPERMIT'CA!W'ANDAPPROVElfpLANs ATJOBSI'rB
.. ,
INSPECTION TYPE . DATE'i~ ACCEPTED t CO~ .":
". .. . I YES NO . ...... e
FOUND~;rION: ; , ,..',
.
FQOTINGS .
WALLS
FOl:1NDArION.: ,DRAlNAGEIDOWN SPOUTS v..'
(UGHTDEPT) SEPARATE PERMIT: .. .
ELEC'QU~ #
,- ,- ,
ROUGH,fN. .' .... I I .'
PLilMBIN~' : . .
.
, ~E~~99It,l SL"AB ..' "
.....
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WATERi~~ro BLOG) .;
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,._-.',,;",,-,',.:'1. "
BlicK1=LOW I WATER . ..' '.
..' "
AIR SF#i '. . ... "
"
WALLS . .
'C.,
C$IL~" . . I ... .- .
~~'D:." , '." ". '.'
,.IQ1S1:S{;~~
.' ;. ~WAJlJHOLD DOWNS , '.
wALts ('ROoFl'CEILING
DRYWMJ.(INTERIOR BRACED PANEL ON!: Y) .
T.BAR. .
'.
INSULA nON
SLAp . I I
WALL I FLooR I Cl!ILlNG I '.' I "
~~ '.'
HEAT J'tJMp
GAS LINE " .."
" , .
WoODS1:.OYE I PELLET J CHIMNEY ,....
HOOD I.DUC'fS .' "'"", , .. :.'
PW UTILri'IES I SITE WORK ~nceIing,DjYisilm) ~PARA TE PERMIT N's: .
"
WATERLINE/METER >..7 , 'C
i' ,
SE~t:!1)NNECTION e-:-
.. SANITARY '"
STO~ - " ....
'. '.,- - .... "
PLANNJlIi~ DEYJ'. SEPARATE PERMIT. #'5 " ",' SBPA:
". .
PARKlI'!(;1LI~G .' . BSA:
. LANJ?SCAP~G .', "",:<.; <- '.. ;;,$I,lQ~:
.. ., .... .', .
',. , : '7 .. ....' , '!'~V'ri.4,~~~E(:,l1!?N,S~UIREDPRlOR~,~M~~"'. .d". .,.... c, .... ",.., ~.
'.i .,....
RESIDENTIAL '. c.. ''''!DATIt YES NO " ,,-, ." ". D~1"I:, "Itj,~
COMMERCIAL
.'.... .. " ,
." .. . " '" . " . ~,..: <' " .' .: .... .... ".'!'\'ESu :'tic'NO
Ei:BcnuCAL- LIGHT . ELECTIuCAL i-e,', ,...-,', ". .
DEPT. 417-4735.
'. . '- LlGH,I'DEPT' .' .i! ; .'
t_ "CONSTRUCI10N- R.W.
CONSTRUCTION R. W. IPWI
ENGINEERING 417-4807 PW I ENGJNBERJNG .. . '. " I",
e-:- 417-4653 , . . FIREDEPT( - .. . ,,' '.... : .c;'
FIRE '. :~
P~GpEPT. 417-4750 PLANNING J)EPT. ,'j ". " '.' \.
~--. , ...... '. ,.
. I&"'!J. V"-IJ4 J.1- BtiJLi5ING ......, ."",,'. ",,'
BUILDING 417-4815
T:\PLANNING\FORMS\1102.15 [1111412003]
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BUILDING PERMIT - APPLICATION
FOR OFFICIAL USE ONLY:
Date Rec.: 5" ""I 3'-Cj~
Permit #: 0 'i .
Date Approved:
Date Issued:
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
(360) 417-4815
Owner:
Address:
Architect/Engineer:
Contractor
Phone: 736 0- ~ Sd -7~d Lf
) , , I
Zip:
OJ &'36 ~
Phone:
State License #:
Exp:
Phone:
Address: City:
PROJECT ADDRESS: ~;)...ol CJ es+- l ~
LEGAL DESCRIPTION: Lot: Block:
CLALLAM COUNTY PARCEL NUMBER:
Zip:
ZONING:
Subdivision:
Credit Card Holder Name:
Billing Address:
Credit CardType VISA
TYPE OF WORK:
o Residential 0 New Constr. 0 Re-roof 0 Stove
o Multi-family 0 Addition 0 Move 0 Garage
o Commercial 0 Remodel 0 Demolition 0 Deck "
o Roparr 0 Sign 'f>-Oth"S \j~
BRIEF DESCRIPTION OF THE PROJECT: _
Fre.e sto..,^-J ~ 't\~ I C>
COMMERCIAL/RESIDENTIAL: Occupancy Group: Occupant Load:
No. of Stories: Lot Size: Existing Sq. Ft. & Proposed Sq. Ft.
Existing lot coverage _ % & Proposed lot coverage _% = Total lot coverage
City:
MC
#
Exp. Date:
SIZEN ALUATION:
SF. @ $ /SF. = $
SF. @ $ . /SF. = $
SF. @ $ /SF. =$_ __
TOTAL VALUATION $ 3'20 ~
~ 'I. $ f S'D'A
Construction Type:
= TOTAL Sq.Ft.
%
PLANNING USE ONLY: /i.2 fY,. J"",.' U ~-lo.J L , J ,J
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APPROV
PLANS.
BLDG:
DPWU:
FIRE:
OTHER:_
, .
ESAlWetland(s): 0 Yes 0 No SEPA Checklist required? 0 Yes 0 No Other:
BUILDING PERMIT APPLICATION SUBMITTAL: The Building Division can provide you with information on the application and
plan submittal requirements if you have questions.
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 Building Division to comply with current fee schedules. Contact the Permit Coordinator at 417-4815 for assistance.
PLAN CHECK FEE: IF a plan check fee is due it must be submitted at the time the building permit application and construction plans are
submitted. All other permit fees are due at the time of permit issuance.
EXPIRATION OF PLAN REVIEW: Ifno permit is issued within 180 days of the date of application, the application will expire. The
Building Official can extend the time for action by the applicant up to 180 days upon written request by the applicant (see Section 107.4 of
the Uniform Building Code, current edition). No application can b ded more than once.
I hereby certify that I have read and examined this a ~now the same to be true and correct. I am authorized to apply for this permit and
understand that it is my responsibility to determin hat permits are re . d ,not the . y's, and that I must obtain such permits prior to work.
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T:\FORMS\APPS\Buildingpermit.wpd
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CITY OF PORT ANGELES - Construction Plans
The Issuance of this permit based upon these plans, specifl-
cations and other data shall not prevent the building official
from thereafter requiring the correction of enors in said
plans, specifications and other data,. or from preventing
building operations being carried on thereunder when in
violation of all codes and ordinances of tbis jurlsdictiOIL
(SECTION 303(c)- Uniform Building Code.) n \./
Approval Date 5-13- DC/By v~
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PREPARED 6/28/04, 13,07,57
CITY OF PORT ANGELES
INSPECTION TICKET
INSPECTOR JAMES L LIERLY
PAGE
DATE
8
6/28/04
ADDRESS
CONTRACTOR
OWNER
PARCEL . .
APPL NUMBER,
2201 W 18TH ST
SUBDIV,
PHONE
PHONE ,
SERENITY HOUSE OF CLALLAM
06-30-99-1-1-0310-0000-
04-00000411 SIGNS
PERMIT: SIGN 00 SIGN
REQUESTED INSP DESCRIPTION
TYP/SQ COMPLETED RESULT RESULTS/COMMENTS
;~;;-~~--~-;~~-------;~~~;~~;-;~~~~--------------------------------------------------
__________\P~~J~~-~---~~~~~- :O~::~:2::D NOTES ______________________________________
CITY OF PORT ANGELES
DEPARTMENT OF PUBLIC WORKS
. . . . . . . . . . . INSPECTION REPORT . . . . . . . . . . .
REQUEST:
Date J / /7/47 Time
Received by
(phone, person)
Location of Work to be inspected 2- 2-D I LU I ~-v.....
Name of person requesting inspection 0l?./> -"-A-Z.<~ ~~
Address of person requesting inspection Phone No
Type of Inspection (circle appropriate one) Permit No t===S I (~
C:S;;V~ Foundation Framing Chimney Plumbing Final Sewer Excav Other
INSPECTION NOTES' / /
Inspected Date / / /? I~ 7
Remarks ~~.~ &J__
Time By /t/ ~~ --'
-~Z;;-L. r::z-nd ~~~-^-' ej/
RESTORATION REQUIRED . . . . .. YES NO
SURFACE RESTORATION:
SURFACE TYPE 0 Unimproved 0 Gravel 0 Asphalt 0 PCC
o Other
o Repaired by City
o Repaired by Permittee
D No Damage Found
Work Order #
o COMPLETE
D INCOMPLETE
(Continue on reverse side if necessary)
STREET SUPERINTENDENT
(DATE)
~
~"""
CITY OF PORT ANGELES
PUBLIC WORKS - BUILDING DIVISION
321 EAST 5TH STREET, PORT ANGELES, WA 98362
PUBLIC WORKS CONSTRUCTION Issued: 8/26/96 TF Permit No: 510
& R/W PERMIT Cond: Work Order: 0
OWNER/APPLICANT------------------------PROPERTY LOCATION--------~---------------
SERENITY HOUSE OF CLALLAM CO 2201 18TH ST W
1022 S. "C" ST Lot:
Port Angeles,WA98362 Block: Long Legal:
360/452-3112 Sub: BENNETT SP
PROJECT INFO--------------------------~-----------------------------------------
Work is INSIDE traveled road Value Work: $0.00
Plans Required: N/A
Contractor: SYNERGY CONSTRUCTION INC
Start:
Finish:
/ /
/ /
Performance Bond Required: N/A
Proof Insurance:
Amount:
$0.00
Work to Perform: INSTALL * Watermain
* Sanitary Sewer
* Storm Drain
Underground Tele/Ele
* Misc
PROJECT NOTES-------------------------------------------------------------------
onsite utilities need to be pressure tested all water lines need
Bacteria & pressure tests prior to connection to w/m / additional FH ?
$250.00 charge for hot tap for fire hyd if city does tap
PROJECTR~~E~X~:e~S~MENT-$~~~~~-~~-----------------~~~-~~~~~-~;;~--------$~~~~--
Sidewalk: $0.00 f San Sewer MFR: * $80.00---
Curb/Gutter: $0.00 Add unit: 16
Driveway: $0.00 Other San Sewer: * $96.00 ---
Dwy Culvert: $0.00 Sew Tap Wye/Man Tap: $0.00
Street Cut: * $500.00 fcJ.. Sew Cap/ W/M Removal: $0.00
Other R/W: $0.00 Alter/Repair Sewer: $0.00
Fire Hydrant: $0.00 Storm Drain Tap: $0.00
Res Water Serv: $0.00 Catch Basin per ea: * $40.00 --
5/8" Sewer System Dev: * $3,210.00___
3/4" Milwaukee Dr. Sew Assess: $0.00
1" R/W Use Perm: $0.00
Comm Water Serv: $1,500.00 put D.R.A.: $0.00
1" Admin Costs (D.R.A): $0.00
* 1 1/2" Misc: $0.00
2 " d.. ==============================
Oth Water Serv: * $250.00 P./
Water Sys Dev: $4,415.00f(l>.-- /. TOTAL FEE: $10,131.00
, ~- I ~~ AMT PAID: $6,705.00
Insp=~~~;~tF~~~ /~~o.~Vl/ r~ -;~~-~~;~----~;;~~;~~~~aoP{
-0.
R!W SANITARY WATER DWY STORM DRA OTHER / -7
Separate Permits are required for electrical work, utilities, private and public improvements. This permn becomes null and void W work or
construction authorized is not commenced wijhin 180 days, W construction or work is suspended or abandoned for a period of 180 days after
the work as commenced, or W required inspections have not been requested wijhin 180 days from the last inspection. I hereby certify that I have
read and examined this applJcation 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 permn does not presume to give authority to violate or cancel the
provisionsof any state o( local,lawregulating construction or the performance of construction.
;Le. ---; - "",. ~1t-.'>"4 d<)s;;,,, /'770
S. nature of COnVactor or Au Date
~
Si nature of Owner W owner is builder
Date
CITY OF PORT ANGELES
DEPARTMENT OF PUBLIC WORKS
. . . . . . . . . . . INSPECTION REPORT. . . . . . . . . . .
REQUEST: /. /~
Date 1;/ /~~ Time Received by' ! r (phone. person)
~~ /!Z.,"",Z'f ~""
Phone No.
Permit No. (-5"/0
Location of Work to be inspected
Name of person requesting inspection
Address of person requesting inspection
Type of Inspection (circle appropriate one):
Sewer Foundation Framing Chimney Plumbing
Final Sewer Excav. Other
INSPECTION NOTES:
Inspected: Date
Remarks:
Time
By
t/fj (lA~r (l(7A~ ./(ffl
RESTORATlpN REQUIRED.. i!.-1fJ?!t& ~~
SURFACE RESTORATION: /
SURFACE TYPE: D Unimproved D Gravel ya-Asphalt D PCC
D Repaired by City Work Order #
D Repaired by Permittee ~OMPLETE
o No Damage Found 0 INCOMPLETE
D Other
~#ec/~/p-J ~o/9~
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__l':TRr:r:T l':IIPr:RINTr:Nnr:NT
!DATE I
CITY OF PORT ANGELES
DEPARTMENT OF PUBLIC WORKS
. . . . . . . . . . . INSPECTION REPORT. . . . . . . . . . .
REQUEST:
Date J()- I - 1--6
Time
Received by
(phone, person)
Location of Work to be inspected 2 ~ 6 1 lU ( ~ ~ ~
Name of person requesting inspection ~{.l (II,/( 0 O/>. J j < 'f,' )
Address of person requesting inspection Phone No.
Type of Inspection (circle appropriate one): Permit No.
Sewer Foundation Framing Chimney Plumbing Final Sewer Excav. Other
sin
INSPECTION NOTES:
Inspected: Date
Remarks:
Time
:J:A; S fee I! -(" r/
5>-ev-r// /~ 'f-
-
By
/Y2....
S-ef- .
/~a /H_
~~
RESTORATION REQUIRED
~ ~
~
NO
C7~17
pc9l 8'81f71
-;>" ,4 C-
\
l\1- ~
,1 ),,, ';-Y
-'
\
SURFACE RESTORATION:
SURFACE TYPE: 0 Unimproved OGravel o Asphalt OPCC
o Repaired by City
o Repaired by Permittee
o No Damage Found
Work Order #
~ETE
o INCOMPLETE
o Other
7:2-1
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STREET SUPERINTENDENT
(DATE)
CITY OF PORT ANGELES
DEPARTMENT OF PUBLIC WORKS
. . . . . . . . . . . INSPECTION REPORT. . . . . . . . . . .
REQUEST:
Date / tJ - )-1- fj .t;
.Time !} t7 0'
Received by
f !UJ /J/ .k
(phone, person)
Location of Work to be inspected J..:J..tJ I W I '7 ~ ($ I:keffl T 'r r(tvSC, /YEIv "'1"")
Name of person requesting inspection G /1 f< Y f /< /5 T
Address of person requesting inspection
Type of Inspection (circle appropriate one):
Sewer Foundation Framing Chimney Plumbing Final Sewer Excav. Other
P/v 3(/07
Phone No.
Permit No.
S/O
~-
INSPECTION NOTES:
Inspected: Date 1 {1 - ? I - 9 C
Remarks: ?; I, H v" 1/1 r
Time I" r! rJ
rt/R ~II< E
By I: () f.I
St::Kt//cE
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I
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---;).(79- - - - - -0
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, I t\
~
RESTORATION REQUIRED. . . . .. YES
NO ~
SURFACE RESTORATION:
SURFACE TYPE: B1Jnimproved DGravel D Asphalt D PCC
D Other
D Repaired by City
D Repaired by Permittee
o No Damage Found
Work Order # 731'
r:rcOMPLETE
D INCOMPLETE
. --. '.- - -,~-----_. ----- .-:..........J...........,ACtciClru'
C::TREET_SU~ERINTENDENT
(DATEl