HomeMy WebLinkAbout409 W 2nd St - Engineering
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CITY OF PORT ANGELES
PUBLIC WORKS - BUILDING DIVISION
321 EAST 5TH STREET, PORT ANGELES, WA 98362
~
PUBLIc vVVK1\.~ CVN;::llKUCllUN Issued:02 1?1-9?'
& R/W PERMIT Cond:
OWNER/APPLICANT------------------------PROPERTY
DOBSON L.TRUST C/O B. AMERICA : 409
101 NORTH 1ST DEPT 4422 : Lot:
PHOENIX,AZ85003 : Block:
602/594-2861 : Sub:
PROJECT INFO-----------------------------------------~--------------------------
Work is N/A traveled road Value Work: $0.00
Plans Required: N/A
Contractor:
PermIt No:
Work Order:
LOCATION------------------------
2ND ST W
18
35
Long Lega 1 :
Start:
Finish:
/ /
/ /
~
'='
--S;:\
Performance Bond Required: N/A
Proof Insurance:
Amount:
$0.00
C
Work to Perform: INSTALL * Watermain Storm Drain ~
Sanitary Sewer Underground Tele/Ele ~
Mise ~
PROJECT NOTES-------------------------------------------------------------------
INSTALL 1" SVC WITH 5/8" METER AT WAREHOUSE WEST OF DOBSON'S AUTO
PROJECT FEES ASSESSMENT---------------------------------------------------------
R/W Excav:
Sidewalk:
Curb/Gutter:
Driveway:
Dwy Culvert:
Street Cut:
Other R/W:
Fire Hydrant:
Res Water Serv: *
* 5/8"
3/4"
1 "
Comm Water Serv:
1 "
1 1/2"
2"
Oth Water Serv:
Water Sys Dev:
Receipt No:
Inspection Fee:
R/W SANITARY
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$550.00
San Sewer SFR:
San Sewer MFR:
Add Unit: 0
Other San Sewer:
Sew Tap Wye/Man Tap:
Sew Cap/ W/M Removal:
Alter/Repair Sewer:
Storm Drain Tap:
Catch Basin per ea:
Sewer System Dev:
Milwaukee Dr. Sew Assess:
R/W Use Perm:
D.R.A. :
Admin Costs (D.R.A):
Mise:
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
------------------------------
------------------------------
$0.00
$0.00
TOTAL FEE:
AMT PAID:
G50.QQ)
$0.00
3<JJ1
$0.00
BAL DUE: ~
DRA?/;iJtj~THEr
WATER
STORM
DWY
Separate Permits are required for electrical work, utilities, private and public improvements. This permit becomes null and void if work or
construction authorized is not commenced within 180 days, if construction or work is suspended or abandoned for a period of 180 days after
the work as commenced, or if required inspections have not been requested within 180 days from the last inspection. I hereby certify that I have
read and examined this application and know the same to be true and correct. All provisions of laws and ordinances governing this type of work
will be complied with whether specified herein or not. The granting of a permit does not presume to give authority to violate or cancel the
provisions of any state or local law regulating construction or the performance of construction.
Signature of Contractor or Authorized Agent
Date
Sianature of Owner (if owner is builder)
Date
r
~'
ACCOUNT
NAME
PERMIT
NUMBER
CITY OF PORT ANGELES PUBLIC WORKS DEPARTMENT
DOLLAR
AMOUNT
,\.,onsuucnon
iPlan Check Fee
ISurcharge (:Ji4.50)
iPlumblng
Mechanlca
Sign
Electncal Permits /Inspections
House Moving
SidewalkIDnveway/Curb PermitlRight of Way Permit
Publications
l:lIUepnnts- Aena
Engmeenng SeMce Fees
Clear/Grade Permit
Fire InspectlPermit Fee
Fire Spnnkler Plan ReView Fee
Mmlnlstrat on Cost (5%)
DRA Fees Plus Interest
IPBIA
ACCOUNT
NUMBER
lUU.l:I:lll
700.9449
001.
f vv.,,'" 1-'
'V~. I"
'V~. I"
91 .~ 37
fUU.tI-'''O
700.9409
700.9429
700.9462
700.9241
600.9677
600.9449
7UU.l:I4:l6
001.
650.
j~~~l~~!;~~~:l~~~:t~i::~~~1~~~~f:;:-::::' :::: :" ". .:. :' ..... :"::'.:.. ........... :...... ::::;;~~:~~~: ..f~~t~;;:::::~?f~~~ :S~~@~;.: .' : .' :: ::.... ~. :::~l~:::~~t :~;;~;~~~:~~;;*w.~~: :......... :?..
!o:-~~:lli=%~tt~~~.~%'.
IStorm Drain/Tap
StreeV Alley Restoration
SIW Co-Op
1:;;1:t:::1t:::::f.....~.. . '.' y ..~ . : :::~ .'. '. ': .....:; ...... : .J~:~~~~:::::?-:~::~
:::
.' .'
Other Fund
752.9619
752.9242
f
.?:::.;:::....
';:::;o;ili?~~
":::: :.
~::::-t :.0;1
~~~~~;f:*~~t==. : ..... . '., . . .:.:.
~
I
I
. :. ..~~ ~l~:~t~r:~:I~~: .:: ".
715.9634
I
1-
... ::::....
'.
.'.
Property Sales
~:~~~*~:::::::.::~..;~. '.' :" ~.. ....... .:..... . .... .. ........:.J:..:..:........:..:~~. ......
.:!:
.' : ......:.:~~~J:::i ~;~1**~~.. :s.:..:: :.'.
.' ~'.~ :::~. .'
~ ~X
water system Developement Charge
Hot Tap (watermaln)
I- .H. InstalV Meter
W/M Installation
XQ-3
::' N'.l w:::r;'
~:~.;: ....
: .: ...:t.:-; .... : ..1&:i~~~~,..~. ~
..' :::::
ISanltary Sewer aP/Cap or MH Tap
Isewer system [ evelopement Charge
ISanitary Sewer ermit
~j-*:::::..
.. .'. ':-. :.;
Milwaukee Dr Assessment
:::~!:::~i:'~q*, ? :::.., : :..... ~.~ .' :: .....:...;....... ..:.:..J..::..:".:...:Al~~fJ:: :.... ..
753.9403
753.9619
753.9619
f:>".~ll:l
"
~~-
354.9619
3~4.l:I4U3
""0' ..."''''~
~~:t<
>.
755.9403
~,J:W$. .~~:::::~:t:~f. . ..' ::"}
:".>~.,
I
I
I
'.
",
Secondary Sewer AssessmenT
.' : :X: '.'.f..'
..
RECEIPT # N~ 381 9 ,.
rlll- -IU AI -
--:Z=:;:>OBSO h S c::./ ~.I;" 9 /' "-?lS!-
4 D q W 2/:J d ( 1/1 /A-j;?.,r::yM I/<:;~ '\
T
I
I
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':$
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f:> f .~""
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/o/tU. /ST ~~~
.---,-, L . " ,./77 (}:if '" ~ ~
J
PORT 8NGELES CITY LT ID:360-4l7-4709 FEE 12'98 10:30 No.OOl P.Ol
._____' l(~~"X 'rl{AN~M"1 I AI...
CITY Ole I'ORT ANGELES
ENGINEERING DIVISION
321 E. 5th St
PORT ANGELES. WA 08362
(360)0&67 ~11
I COM, .p. .'A_'-.', NY-NAM E:] I .. . ~A ~ I
~ _ ~f!MtK C/,F kr/~t! /;4 -,-.----,......-- , .'
I~~NTACTNAME:! r-13t.,4/ii€~7;ek,lj,/)4;e".-._.-~==~~_~_~,1
I...~ FAX NO.: J [~_...... ~OZ'--- 5q;;".;'Z8/~". .--..', 1
L...~ITY/STATE: I [.~pe~.!..)f ,4;;".. ..m." '7;S.OL)~ ~~~=-"']
L.. SENT BY: 1
[!?ESCRIPTION: I ~-enla hhS~-'?
~A-re7t:;. h?r!f:/~~ l?-~L?Z-
~ Ii!. -10.2.. w 2 not E5~.
-:Z;;P~$,C),{/~ ~/ V/h1?-_~ --
1V#~e~pse .w~ ~
- Pt' St>/:J ~ ~ -
RJl)ON
j)C) . .
{f963~b l-\- NUMBER OF PAGES (INCLUDING COVER SHEET): 2-
itScjQY6 Ir: W1etQ)'("' ReTURNFAXNO.:(*).5t..e~S' =-1/?-~"D~
I \ '.. (\ n woJl.Vy' II \. If THERE ARE ANY PROBLEMS WITH THIS TRANSMISSION
nSr~ (gO'D CALl:(380)~~1~"1 4/'1 -4ao~
~(Y\l Y cD 0,
if S SO I t2 (yIj . g
}--Jo-rr~ /1 J j{
CITY LT
ID:360-4l7-4709
FEE 12'98
10:31 No.OOl P.02
ic' ""\:IKt.::t" '1,,;.\:J1'\I" 'l'KU\.: l' 1 UN I s sued:
& R/W PE~IT Cond:
R/.AP.P.L:ICANT.i7:.;-;~'~:'" - - --- - - - - - - -- ---- -- PROPERTY
BSON L.TRUST C/O B. AMERICA : 409
01 NORTH 1ST DEPT .422 : Lot:
HOENIX,AZ85003 : Block:
~602/S~~-28~~""""" : Sub:
ROJ EeT" 'lNF~ ---,- -- ----- ---- -- - - ---------.-- -- - - -- - -- - -: - -- --- - - --- ----:--- ---- - ----
Work is N~A traveled road Value Work: $0.00
Plans Required: N/A
Contractor:
CITY OF PORT ANGELES
PUBUC WORKS . BUILDING DMSION
321 EAST 5TH STREET, PORT ANGELBS. Wit. 98362
/
(~I"'"
Perm1.t No:
Work Order:
LOCATION------------------------
2ND ST W
18
35
I
Long Legal:
Start:
r-inish:
I I
/ /
Performance Bond Required: H/A
Proof Insurance:
Amoun t :
SO.oo
Storm Drain
Underground Tele/Ele
Mise
kOJECT NOTES-------------------------------------------------------------------
INSTALL I" SVC WITH S/8" METER AT WAREHOUSE WEST OF DOBSON'S AUTO
Work to Perform: INSTALL . Watermain
Sanitary Sewer
ROJEtlT:: PEBS:: :A:S S:BS:SMENT~.;.;.~.;.;.- --------------- ------ -------------------------------
R/W Excav:
Sidewalk:
Curb/Gutter:
Driveway:
Dwy Culvert:
Street Cut:
Other R/W:
Fire Hydrant:
Res Water Serv: *
* S/8"
3/4"
1 u
Comm Water Serv;
I"
1 1/2"
2"
Oth Water Serv:
Water Sys Dev:
Receipt No:
Inspection Pee:
$0.00
SO.OO
$0.00
$0.00
$0.00
$0.00
$0.00
SO.OO
$0.00
$0.00
$550.00
San Sewer SFR:
San Sewer MFR:
Add Unit: 0
other San Sewel":
Sew Tap Wye/Man Tap:
Sew Cap/ w/~ Removal:
Alter/Repair Sewer:
Storm Drain Tap:
Catch Basin per ea:
Sewer System Dev:
Milwaukee Dr. Sew Assess:
R/W Use Perm:
D.R.A. :
Admin Costs (D.R.A):
Mise;
$0.00
$0.00
$0.00
SO.OO
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
SO.OO
$0.00
=~===================~========
$0.00
$0.00
TOTAL FEE:
AMT PAID:
G50.0Q)
$0.00
$0.00
BAL DUE:
$550.00
R/W SANITARY WATER DWY STORM DRA OTHER
Separate Permits are required for electrical work, u1ilitiea, private and public imprQvements~ This permlt'becomes'null:and'void:ifwork:or :
aonelrUction euthorized is not commenced wilhin 180 days, if con.uuction or work is &uspendecl or .bendoned for . p.riod 01180 d8ya.rter '
thewonc 88 convnenced, or I requtred Npedions nINe not been requested within 180 days from the last inepectlon. . I herebV certIfV 1hat I h....
reed and IIll8mined thia epPieetion and knCMI the same to be true and correct., All prOYision5 of laM am:! ordinances :goveming thie~ :of work :
wiN be compiled with whllthw spedhd herein or not. The granting of . permit don not presume to give authority to violate or cancel th. '
provilion. of any illite or Iocellaw regulating construction OJ the J>8Iformanc& of cOnatruetion.
~InnAtt Ira nf CnnlrA~nr or Authorized Aoent
Date
SiQnature of Owner (if owner is builder)
Oete
CITY OF PORT ANGELES
DEPARTMENT OF PUBLIC WORKS
. . . . . . . . . . . INSPECTION REPORT. . . . . . . . . . .
REQUEST: _.~
Date A. - A b 1
Time
---".r> '. . r
1.- ,.q.~ r-: ( k '..
Received by
(phone, person)
Location of Work to be inspected
Name of person requesting inspection
Address of person requesting inspection
Type of Inspection (circle appropriate one):
Ljo r ~:;;l vvl
--r:- (J,.) I , Co ~
I 7-t/1 <(r 13 Phone No.
Permit No.
c?O_=5
Sewer Excav. Other UV~e y
A e 0....4 1&.., tJ 001
k>o "8., I 0 (p <./
1)w-:J.oo(
By
) 'X c:;-/s W?cf-(v
" I
Sewer Foundation Framing
Chimney Plumbing Final
INSPECTION NOTES:
Inspected: Date
Remarks:
Time
::p./V S 1-e"t.l! llJ-€u.. \
S-e Jr U" C...Q <
RESTORATION REQUIRED .
/
YES V NO
lIt"~ ,(...R..
IVOC Jl
1; r v:- )/3
6" C-"I-- i~ J 0'3 t /
I
SURFACE RESTORATION:
SURFACE TYPE: D Unimproved D Gravel
D Repaired by City
o Repaired by Permittee
o No Damage Found
/5, iJ~e/-
(Continue on reverse side if necessary)
I
C- 5051-
.c:: /i ".-'" t -'''~ ,.--c,-
/ ....1- D 'i..~.-ll .,/ _;<~ ,~-.)
" i:\
'(
~
'J-Vl~' 5.fr
~'It D PCC 0 Other
Work Order # J 06 yr'
'-W- COMPLETE =7 / I' I~g pW
~COMPLETE
c5' Is-hp/
STREET SUPERINTENDENT
(DATE)