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Home My WebLink About1114 E 4th St - Building fi "-Or""'-"" CITY OF PORT ANGELES PUBLIC WORKS - ELECTRICAL DIVISION :l21 EAST 5TH STREET. PORT ANGELES. WA 9l!:l62 Application Number pin number Property Address ASSESSOR PARCEL NUMBER: Application description Subdivision Name Property Use Property Zoning . . . Application valuation 04-00001194 Date .165626 1114 E 4TH ST 06-30-00-0-1-7825-0000- ELECTRICAL ONLY 12/23/04 RS7 RESDNTL SINGLE FAMILY o Owner Contractor LOHR, LYNNE 781 N. KENDALL RD SEQUIM ( 3) 683-5947 WA 98382 HARRINGTON ELECTRIC 20312 46TH AVE. E. SPANWAY WA 98387 (253) 847-8943 Permit Additional desc Sub Contractor Permit Fee Issue Date Expiration Date ELECTRICAL ALTER RESIDENTIAL CIRCUIT FOR HEAT PUMP HARRINGTON ELECTRIC 48.10 Plan Check Fee 12/23/04 Valuation 6/22/05 .00 o Qty Unit Charge Per 1.00 48.1000 ECH EL-R OR RM 1-4 ALT CIRCUITS Extension 48.10 ~ " ~. Fee summary Charged Paid Credited Due ----------------- ---------- ---------- ---------- ---------- Permit Fee Total 48.10 48.10 .00 .00 plan Check Total .00 .00 .00 .00 Grand Total 48.10 48.10 .00 .00 1\ ~ ~ 't COMMENTS/ACTION NEEDED \ ELECTRICAL PERMIT INSPECf,lON 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 INSPECTION TYPE DATE COMMENTS NO GENERAL COMMENTS: PW-II02.1S (4196) ~ ci'?OfI"~ t~~~ ,. __ -==>r ~ ~WiP CITY OF PORT ANGELES DEPARTMENT OF COMMUNITY DEVELOPMENT - BUILDING DNISION 321 EAST 5TH STREET, PORT ANGELES, WA 98362 Application Number pin number . . . . Property Address ASSESSOR PARCEL NUMBER: Application description Subdivision Name Property Use Property Zoning . . . Application valuation 04-00000733 Date .726625 1114 E 4TH ST 06-30-00-0-1-7825-0000- RES MANUFACTURED HOME 9/29/04 RS7 RESDNTL SINGLE FAMILY 82057 Owner Contractor LOHR, LYNNE 781 N. KENDALL RD SEQUIM ( 36) 683-5947 Structure Information Construction Type Occupancy Type Other struct info WA 98382 CONSOLIDATED BUILDERS INC. 251 OLD OLYMPIC HWY SEQUIM (360) 683 - 9522 NEW 1528 SF MANUFACTURED HOME TYPE V NON-RATED SINGLE FAM & CONGREGATES TOTAL % LOT COVERAGE EXISTING LOT COVERAGE LOT SIZE PROPOSED LOT COVERAGE TOTAL LOT COVERAGE NUMBER OF UNITS WA 98382 ~ ~ , 23.20 100.00 7000.00 1528.00 1628.00 1. 00 '\'\ r- ' '\ .... > ~ }c) ~. ~ "-I W VJ Permit Additional Permit Fee Issue Date Expiration "'" ............ .......... ~ Qty 1. 00 Unit Charge Per 78.7000 ECH EL-MANF HOME SERVICE & FEEDER Extension 78.70 "'-. C) ---------------------------------------------------- Special Notes and Comments Building address sign shall not be less than 6" & not more than 12" in height. Numbers colors must contrast with wall color they are mounted on. (Ord. 14.36.050-E) When roof gutters are installed, drains will located in dry wells or piped to approved storm drain locations. Manufactured home must be pit set so that no more than 12" of skirting is visable above grade. Proposal is to place mfg home in RS-7 for lot coverage of 23%. Setbacks are good. No land use issues are noted. Electrical load calculations and elctrical permits are required. Any modifications to the City'S electrical facilities will be at the customer's expense. Construct driveway to City Standards. No concrete with exposed aggregate is allowed in the City road right of way. Sanitary sewer connection inspection is required by Public Works prior to back fill of ditch. Building water line connection to water meter requires a Public Works inspection prior to back fill of ditch. \:J) (\1\ <") r-, ---, -t. ~ o ~ Other Fees STATE SURCHARGE 4.50 Fee summary Charged Paid Credited Due 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 ot presume to give authority . e or canc the provisions of any state or local law regulating construction or the performance f construction. Signature of Owner (if owner is builder) Date T:\PLANNING\FORMS\1102.15 [11/14/2003] BUILDING PERMIT INSPECTION RECORD CALL 417-4815 FOR BUILDING INSPECTIONS. 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 INSPECTED AND ACCEPTED. POST PERMIT IN A CONSPICUOUS LOCATION. KEEP PERMIT CARD AND APPROVED PLANS AT JOB SITE. INSPECTION TYPE DATE I ACCEPTED COMMENTS YES I NO FOUNDATION: FOOTINGS WALLS FOUNDATION DRAINAGE/DOWN SPOUTS ELECTRICAL (LIGHT DEPT) SEPARATE PERMIT: II ROUGH-IN 1 PLUMBING UNDER FLOOR / SLAB ROUGH-IN WATER LINE (METER TO BLDG) GAS LINE BACK FLOW / WATER AIR SEAL WALLS CEILING I FRAMING JOISTS / GIRDERS SHEAR W ALLIHOLD DOWNS WALLS / ROOF / CEILING DRYWALL (INTERIOR BRACED PANEL ONLY) T-BAR INSULATION SLAB WALL / FLOOR / CEILING MECHANICAL HEAT PUMP GAS LINE WOOD STOVE / PELLET / CHIMNEY HOOD / DUCTS PW UTILITIES / SITE WORK (Engineering Division) SEPARATE PERMIT II's: WATERLINE / METER SEWER CONNECTION SANITARY STORM PLANNING DEPT. SEPARATE PERMIT II's SEPA: PARK1NGILIGHTING 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./ 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:\PLANNJNG\FORMS\II02.15 [l1/14/2003] ,~" - o' .<>,,<:~ l~~~ rea __ -==>r .....- ~WiP CITY OF PORT ANGELES DEPARTMENT OF COMMUNITY DEVELOPMENT - BUILDING DNISION 321 EAST 5TH STREET, PORT ANGELES, WA 98362 Application Number . . . . . 04-00000733 Pin number . . .726625 Page Date 2 9/29/04 Permit Fee Total plan Check Total Other Fee Total Grand Total 78.70 .00 4.50 83.20 78.70 .00 4.50 83.20 .00 .00 .00 .00 .00 .00 .00 .00 Separate Permits are required for electrical work, SEP A, 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. Signature of Owner (if owner is builder) Date Signature of Contractor or Authorized Agent Date T:\PLANNING\FORMS\1102.15 [11114/2003) BUILDING PERMIT INSPECTION RECORD CALL 417-4815 FOR BUILDING INSPECTIONS. CALL 417-4735 FOR ELECTRICAL 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 I YES NO FOUNDATION: FOOTINGS WALLS FOUNDATION DRAINAGEfDOWN SPOUTS ELECTRICAL (LIGHT DEPT) SEPARATE PERMIT: # /1. 1Jtb~J il'\/J.-I ~+- ROUGH-IN I ct.~. elf r(~ I~ ./ .... ... ~ (") Jr.' PLUMBING UNDER FLOOR 1 SLAB ROUGH-IN WATER LINE (METER TO BLDG) GAS LINE BACK FLOW 1 WATER AIR SEAL WALLS CEILING I I FRAMING JOISTS 1 GIRDERS SHEAR W ALLIHOLD DOWNS WALLS 1 ROOF 1 CEILING DRYWALL (INTERIOR BRACED PANEL ONLY) T-BAR INSULATION SLAB WALL 1 FLOOR 1 CEILING I MECHANICAL HEAT PUMP GAS LINE WOOD STOVE 1 PELLET 1 CHIMNEY HOOD 1 DUCTS PW UTILITIES 1 SITE WORK (Engineering Division) SEPARATE PERMIT #'s: WATERLINE 1 METER SEWER CONNECTION SANITARY STORM PLANNING DEPT. SEPARATE PERMIT #'s SEPA: P ARKINGILIGHTlNG ESA: LANDSCAPING SHORELINE: FINAL INSPECTIONS REQUIRED PRIOR TO OCCUPANCYIUSE RESIDENTIAL DATE YES NO COMMERCIAL DATE ACCEPTED L1 YES NO ELECTRICAL - LIGHT DEPT. 417-4735 ,a- -. <[- crl fiJ:- ELECTRICAL LIGHT DEPT CONSTRUCTION RW./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 T:\PLANNING\FORMS\lI02.J5 [11114/2003] .... ;1. ~I'ORT~ $4.0~~~ ~ __ -==>r ~ 'l.ri:~ CITY OF PORT ANGELES DEPARTMENT OF COMMUNITY DEVELOPMENT - BUILDING DNISION 321 EAST 5TH STREET, PORT ANGELES, WA 98362 Application Number pin number . . . . Property Address ASSESSOR PARCEL NUMBER: Application description Subdivision Name Property Use Property Zoning . . . Application valuation 04-00000720 Date .904320 1114 E 4TH ST 06-30-00-0-1-7825-0000- DEMOLITION 9/01/04 RS7 RESDNTL SINGLE FAMILY 3500 Owner Contractor LOHR, LTNNE JAMESTOWN EXCAVATING 781 N. KENDALL RD 3630 WEST SEQUIM BAY RD SEQUIM WA 98382 SEQUIM WA 98382 (360) 683-5947 (360) 683-2025 Structure Information DEMO HOUSE Construction Type . . .. TYPE V NON-RATED Occupancy Type . . . .. SINGLE FAM & CONGREGATES Permit Additional desc Permit Fee Issue Date Expiration Date DEMOLITION DEMO HOUSE 47.00 8/26/04 2/23/05 Plan Check Fee Valuation .00 o Qty Unit Charge Per Other Fees STATE SURCHARGE 4.50 ~ ..-- ...c: -< b ""1 r-- I BASE FEE Extension 47.00 Special Notes and Comments CAP SEWER AFTER DISCONNCT Fee summary Charged Paid Credited Due ----------------- ---------- ---------- ---------- ---------- Permit Fee Total 47.00 47.00 .00 .00 Plan Check Total .00 .00 .00 .00 Other Fee Total 4.50 4.50 .00 .00 Grand Total 51.50 51.50 .00 .00 ~~ ~"-.... r-f.... ~S' C\ {::. ~ I: 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 pertormany of consl,"cl;on. \ Signature of Contractor or Authorized Agent Date Signature of Owner (if owner is builder) Date T:IPLANNINGIFORMSII102.15 [11/14/2003] ., BUILDING PERMIT INSPECTION RECORD CALL 4) 7-4815 FOR BUILDING INSPECTIONS. CALL 417-4735 FOR ELECTR1CAL 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 PERM1T CARD AND APPROVED PLANS A T JOB SITE. INSPECTION TYPE DATE ACCEPTED COMMENTS YES I NO FOUNDATION: FOOTINGS WALLS FOUNDATION DRAINAGE/DOWN SPOUTS ELECTRICAL (LIGHT DEPT) SEPARATE PERMIT: # ROUGH-IN PLUMBING UNDER FLOOR / SLAB ROUGH-IN WATER LINE (METER TO BLDG) GAS LINE BACK FLOW / WATER AIR SEAL I WALLS CEILING FRAMING JOISTS / GIRDERS SHEAR WALL/HOLD DOWNS WALLS / ROOF / CEILING DRYW ALL (INTERlOR BRACED PANEL ONLY) T-BAR INSULATION SLAB WALL / FLOOR / CEILING MECHANICAL HEAT PUMP GAS LINE WOOD STOVE / PELLET / CHIMNEY HOOD / DUCTS PW UTILITIES / SITE WORK (Engineering Division) SEPARATE PERMIT #'s: WATERLINE / METER SEWER CONNECTION SANITARY STORM PLANNING DEPT. SEP ARA TE PERMIT #'s SEPA: PARKING/LIGHTING ESA: LANDSCAPING SHORELINE: FINAL INSPECTIONS REQUIRED PRIOR TO OCCUPANCY/USE RESIDENTIAL DATE YES NO COMMERCIAL DATE ACCEPTED YES NO ELECTRlCAL. LIGHT DEPT. 417-4735 ELECTRlCAL LIGHT DEPT CONSTRUCTION R.W. / PW/ CONSTRUCTION - R.W. ENGINEERING 417-4807 PW / ENGINEERlNG FIRE 417-4653 FIRE DEPT. PLANNING DEPT. 417-4750 PLANNING DEPT. BUILDlNG 417-4815 q - ~,;./ "J i-- L BU1LDlNG T:\PLANNING\FORMS\I 102.15 [11/14/2003] f if , , , , t-<1Jj , ><c:: , ~~ , , t'l0 , H t-<Z 10 n OGl 0 :I: 3: :0'" 3: Z ~ t'l Z ;J> >-3 't-< [J) S 1'; "'>-3 0 CD H 2 w3: Z 't'l 0 v; .. >-3 '" t'l ""H [J) ...,..., 0 0 ~ ~ ? ~ 5 U @ (; c l\J ~ ? ~ "f" ~ Llr \' r r- IJj t-< '" '" o H >-3 '0 ;J>'Oon;J> n'O >< ~ 'O;J>:>:00 H:O '0 'O:Ozzo >-3t'l '- t-<nt'l>-3:O ><'0 [J) H tI:l::U::Utr.l ;J> 0 >-3 Zt-< ;J>[J) 0:0 ';1. n[J) "'t'l >-3 0 0 IJj 0 '0 trl. :0. 0 n:o~ :0 :0'" Otrl >-3'- 3:0 0 'OC::o oor-tC.jt-' 1';~ t-<trlo o;~~~~ t'l[J) Glo >-3>-30 ow:;dtI:loJ:>. trl"" trltrl~ 00' [J) t-<' 00 0 , >-3trl trl oot"lO [J)H I:" oOI-3::8ol:> "-' H ;:3~~Z~ w :0 >-3 trlHH 0 , trltrl w [J)zo H ><[J) C::UliZi 0' n>-3 0 t-<'O trl..., ;J> v; >-3 3: CD < 0"-' ;J> t-<v; >-3 H , Z >-30 :00 H 0 Gl trltrl 00 UlUl zo c::n t-<:O >-3H Ul'O '->-3 nH H 00 HZ 3:Z ZUl :s: Ul'O trl 'Otrl Z trln >-3 n>-3 Ul >-3H 00 :OZ y>-3 'O'OUl ~~ t5t56J trl~ Ultrl ZZO >-3 trltrlH t-< < t-< H trl w w :0 '" '" t-< 00 >< '" '" CD CD W W , , V;'" "'0 ""'" ...,v; 0'0 ;J>;J> >-3Gl trltrl '" '- 0 W '- 0 ""'" BUILDING PERMIT - APPLICATION 009 P1S JUL 21 '04 11:57 I F<J~ ()rr!(,;lA.:" U::>1O ()loJLY Dale Rec.: e -) 1- oij PCI"t11i:lI: DL/.~ 7W Date Approyed: Dn Ie Issu ed: 360-581-8737 SPHCECOPIES Fill out COMPLETELY and in INK. Y()ur application and site plan MUST BE COMPLETE to be accepted f(lr review. If you have any questions, call PERMITS (360) 417-4815 FAX(360)417-4711 Applicant or Agent: L'i '->1 ,.." ~ OW11er: Ly'YI"Y1"'" L C:/). t!.- Address: 79'1 71. /\.f?-1 da. t..t. Lnhl? - Phone:5C:;~ ~ f'?-$ 9'/7 Phcne: ,,? 3- S~ rr'7 WA Zip: '&-3lr<-. eel City: ~J(.(/h. I Architect/Engineer: Phone: Acodndtrl'eascst:oor- P, <ho f. ~)'I"~" ~'; S "" Sute Lioeme #:&1 } {,If ItIkpr ~p7 - '}tt- (}/srhDne:< W 7 (J :?d :::r~=--tr~_:L (t,d City: 16 r t,4/97~~)(~> , (xJt+- Zip: ?F3 t:J PROJECT ADDRESS: 1//"1' .f:, ~ ST. ZONING:---- LEGAL DESCRIPTION: Lot: <0 Block:..J '7 B Subdivision: 'TPA- CLALLM.1 COUNTY PARCEL NUMBER: c> 63DC:J:;:. 0 /78"25' ~ ~ "",e."; + ~""t'\. E xC-a. v a. i; ~ Credit Card Holder Name: Billing Address: Credit CardType VlSA_MC _ # TYPE OF WORK: CJ Re$idential A New ConstI'. t:I Re-l'oof Cl Multi-family 0 Addition Cl Move o Commerci~l CI Remodel .~ Demolition C Repair 0 Sign BRIEF DESCRIPTION OF THE PROJECT: Ci~'; Exp. Date; o Stove o Garage CI Dec.k Q Other De.fY" () SIZEN ALUA nON: SF @ $ ISF. ... $ SF. @ $_ ISF. = $ SF. @$ /SF.=$ TOTALV~U~TION; $-: ..9- rP O'\(\i)~ t? X€./ sh f',j Am, d~. t \ ! '" I '^ _,,_ _ /'l Occupant Load: ConStruction Type: & Proposed Sq. Ft. = TOT.iU... Sq. Ft. COMMERClALIRESIDEN'I1AL: OccupanCy Group: No. of Stories: _ Lot S:W:: Existing Sq. Ft. TOtl110t coverage ~ AFPROV ALS: PLAN: BLDG: I DPv\I'(J:_ FIRE: I OTHER:_ I PLANNlNGUSEONLY, ESMWetland(s): CI Yes 0 No SEPA Cbecklistrequited? CJ Y(!;$ Cl No Oth&: BUILDING I'ER,MIT APPLlCA TION SUBMITTAL: The Building Division Call provide YOll with information on the applicat!.Oll and plan submittal requirements if you have questions. vALUATION OF CONSTRUCTION: In all cases, II VIlluation amount must be entered by the applicant. This figure will be reviewed and may be revised by the Building Division to comply with CUlTen! 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 scb:mitted. All other penJ1lt fees are due at the time of permit issuance. EXPIRA TlON OF PliAN REVIEW: If no pelmit is issued within 180 days of the date of applioation, the application wlll expire. The Building Official call extend tIle time fo1' llctioD by the applicant up to 180 days upon written ::equest by the applicant (see Se;:tiOD 107.4 of the UnifoPTI Building Code, cuner:l! editiolJ). No application can be extended Inore than once. I hereby certify that I have read and examinecl this applicstion and Imow the same te be tfI.JEi and Gorrect. I am authorized to apply for this permit and understand that it is my responsibility to determine what permits are required ,not the City's, and that 1 must obtain such permits prior to work. T:\FORMS\APl'S\'Suildjngp~I'l11it.wpd Applicant: ,"f~nJ.Z-?t.../ Date: f? - 5 --0 Y ~ I?ORTANGELES CITY OF WAS H I N G TON, U. S. A. PUBLIC WORKS & UTILITIES DEPARTMENT August 30, 2004 Lynne Lohr 781 N. Kendall Road Sequim, WA 98382 RE: Port Angeles Landfill Waste Disposal Application, WDA 04-17; Building demolition at 1114 East 4th Street, Port Angeles, Washington We have received your application for disposal of building demolition debris from the referenced site and reviewed the testing results for lead and asbestos content. Based on the testing results the debris appears to be acceptable for use in 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 materials and quantities listed in the application. Materials not listed or in excess of the quantities noted may require separate applications and approval. Please call if you have questions. Very truly yours, 'L~~~~ City Engineer Deputy Director of Engineering Services GWK:tf EncL: WDA04-I7 Copy: Ken Loghry N:\PWKSIENGINEER\WDAPPLIC\04_17. WPD FILE: Landfill Solid Waste Disposal Applications 321 EAST FI FTH STREET · P. O. BOX 1 150 · PORT ANGELES, WA 98362-0217 PHON E: 360-417-4805 · FAX: 360-417-4542 · TTY: 360-417-4645 ~ t ....? ~I ", ~.:. , ~ ~' ~ l'" ~ ,\ \S 360-681-8737 SPRCECOPIES 009 P10 JUL 21 '04 11:54 /AJDA--04+f PORTANGELESLANDF~L WASTE DISPOSAL APPLICATION To: City of Port Angeles, City Engineer 321 E Fifth Street P.O. Box 1150 Port Angeles, Washington 98362 Phone: (360) 417-4803 FAX: (380) 417-4709 NOTE: All questions must be answered for waste to be approved. 11. Genentor Information: Company Name: Mailing Address: Bi3hej:) IERhirr~ri"o" 982 Lewis Road Port Angeles, v'1A !8362 Contact: 7\,1 ~ I)\- M ~J() t~ Phone: 360 -\.f /7 -ot b 1 Project Name: L Y IJ IVQ L 0 ~ ~ Project Location: I J J '1 b. &./:--Jl !Sf. 8 , ~~-or=' 2. Other Contacts (if applicable): Consulting Firm: Contact: Phone: ~o;thWQ.'&t ~~tos ~s41~f.--s ~ w rthQ.'(" ~J~r.(.2-- 3bO- 3~b-O~Lj. Contractor Name: Contact: Phone: Laboratory: Contact; Phone: City of Port Angeles'- Landfill Waste Disposal Application Page - 1 360-681-8737 SPHCECOP1ES 039 P1;. !Ul.. 2::' '0.:1 1.1:5~ 13. Source of Waste: Check the appropriate box below and briefly describe the project, process, and/or cleanup thatl will or has produced the waste requiring disposal. Include the gasoline service station number (if applicable). CERCLAlMTCA Remediation Independent Remedial Action Unused Chemical Product Spill Agency Contact UST Removal -L Other Source: "Z>e.rnb' h -h~ EtI'7J11?1 ~5-t<"- * L3e_ ':7:>PrrJD/;S;' e-L r/}- 4. Waste Material Composition: (check all that apply and include percent of total) Soil - % _ Foundry Slag - % Concrete! Asphalt - % _ Dredge Sediments - % Preserved Wood - % ~ Debris /(70 % Coal Ash - % _ Other (list) Wood Ash - % - % - % NOTE; Total must equal 100%. 15. Waste Material Contaminants: (check all that apply) Gasoline Solvents UnuMd Motor Oil Other I Ji-"i.J - ff71JE?7(o~ Metals _ Heating Oil Used Motor OiVWaste Oil Other Petroleum Product Diesel PCBs Unknown NOTE: Supply any MSDS information with application, if available. City of Port Angeles. Landfill Waste Disposal Application Page - 2 ..-.-.... ...-....,............... ....-.' ".- "'-"-'--'. 360-681-8737 SPACECOPJES 00'3 P12 JUL 21 '04 11:54 6. Estimated Quantity of Waste for Disposal: /00 Cubic yards I Drums I -r~ Tons (estimate both) Tons (estimate both) Other NOTE; Estimated quantity for disposal must be within 20% of the quantity actually disposed. (10% for projects over 7,500 tons or 5,000 cubic yards.) 17. Frequency Of Disposal: I -L One time _ Monthly Annual Other 8. Waste Sampling: I Proper characterization of the waste for disposal requires the collection of representative i samples. The methods and equipment necessary for obtaining representative samples of a 1\ waste, and the frequency of sampling, will vary with the type and form of the waste. Check the appropriate box and briefly ~scribe how and where the waste was sampled. Include site maps. with sampling locations if possible. I Number of COMPOSITE samples _ & number of discrete samples per composite _I I Number of DISCRETE samples _ NOTE 1: Unless prior approval has been granted by Port Angeles, the following sampling frequency will be used: 1 composite sample 3 composite samples 5 composite samples 7 composite samples 10 composite samples 10 plus one sample for each additional 500 cubic yards NOTE 2: One composite sample shall contain a minimum of three/maximum of five discrete samples. 0-25 25 - 100 101 - 500 501 ~ 1000 1001 .2000 >2000 cubic yards cubic yards cubic yards cubic yards cubic yards cubic yards = ::: :;;: = I: = City of Port Angeles - Landfill Waste Disposal Application Page" 3 360-681-8737 SP~ECOP)ES 009 P13 JUL 21 '04 11:55 19. Waste Analysis: I The "Dangerous Waste Regulations" (WAC 173-303) shall be utilized to determine thel I appropriate analytical requirements for waste characterization. Ecology Publication #91-30 (Revised April 1994) "Guidance for Remediation of Petroleum Contaminated Soils" shall also bel I' used to characterize petroleum contaminated soils from UST releases. Submit all laboratory analytical results, QAJQC data, and Chain of Custody sheets along with this application. I I (NOTE: The laboratory must be accredited by the Washington State Department of Ecology.) 1\ I 0) List all anolyticallesl methods used: I . I I I I I I I b) Provide a narrative as to why the above analytical methods were selected: -PU e.... (7? at; e. CJ:f? 5>f-u~ v e _ 'Y7tev e_ N.~ A::::: ? C'~ /p? I ~T t ~;:-.Y ~-dd ~,/(<:e-4 /?; 1;-, i- C/7 5h?f~ r~ NOTE: Additional sheets attached: L YES NO 110. i I I I Soil Classification: (aaFOR PETROLEUM CONTAMINATED SOILS ONLya,,) I i Based on the analyticai data and Ecology Publication #91-30, the soil classification is: (check one) Class 1 Class 2 Class 3 Class 4 Calculated Hazard Index 111. Dangerous Waste Affidavit: I Based on a review of the analytical test results, site history, and the applicable regulations, this I waste is classified as: (check one) --L Neither Dangerous Waste (OW) nor Extremely Hazardous Waste (EHW) Dangerous Waste (DW) and Waste Code: Extremely Hazardous Waste (EHW) and Waste Code: City of Port Angeles - Landfill Waste Disposal Appiication Page - 4 360-681-8737 SPRCECOPIES 009 P14 JUL 21 '04 11:55 12. Certification: We, THE UNDERSIGNED, certify that this application is true to the best of our knowledge. All information provided is correct and the enclosed analytical results represent the proposed waste material to the best of our abilities. ~~~~ (~/sbf) ~/)ictrr/ :r~J Waste Gen tor Signat e I jJJ~~ /3/,5)O/J Printed N' I I3I~Jof) ~nkrp/,/S& Company I , ,R'- 7-tJY Date N:~oueY _1I\1000_SW\1009_01.WPO City of Port Angeles - Landfill Waste Disposal AppUcation Page - 5 ..-.-.----,.........................---..........,.-.- RUG - 2 - 2004 22: 37 FR0f'1: N !AI ASBESTOS 360-385-058~ TO: 13604171S32 )> ~ ~ ~ ~ g ~ ~ ..0 ~ 0 ~ ~ ~,... rD .... .... ~ N ~C r.n ~ ~ ~ I. ~8 ~ (:)~ ~~ ~,g ;: ~ g.. ~ 0 "l:l ~ ~ I""t " .... ~.~ r:fJ tsll:l @l ~ m ~. ro -t ~ ~E! -< o ~ --= . ~. ~ -i n ~ ~. OJ f-to\ ....... ~ ---. ~ ~ .... , trl z ..... ~'-:=' 4""t ~ ~ ~ Z t'I) ,... ~ ~ f""'f\ .... . ., Z ........~ ~ ~ ~ tR. ~. ~. " "" (:) Z ~ ~,... ~ ~ ....... ...... g. oCi tR. (:) ~ (:) ~I _. 0... ~ ..., ~ 1 . ~ =. tll) .... , "" ~ t'I) ~= ~. ".....-< tll) :z: ~ ""d I-' · " ~ -< I""t ~~ ., ..... 8=' ..... m " M .... . Z ~ ~ aq f""'f\ m ~-= ;:za (:) ~ :)I:H:)Vd > G)= S'= ro (:) ~ ~. ...... ~ ~~ ~ .... - "tS ~ ~ = ~= ~ == .....-< I-' · p.;t 0 ~ f") p.. ...... ~a ....... > r:n f") tT'l Q ~ts\ ~ ~Cf crq >t:S ~ Q ~a Ul ro G' m d ~ ~ ('D ~ ~ ~ e> >< ~O N ~ ;:2". Cll ~(") I -- (j := 0 s (J) "" 0 ~ = 'J'JON (',;) r-t- c 8 -r 0 ~~ e> ..... ~ ~ N (:) ~ .. ~. 8 ~ 0 z .~ == r') " ::s ..... >0(1 N ~ N 0 0 ~ P.6 AUG-2-2004 22:37 FROM:N W ASBESTOS 360-385-0584 HUli-\i:J,j-~ ~: 4~ I..LHY I U>I lJt(\.JlI'" ~I:.r<v I \,;~ TO: 13604171932 P.5 ~'(CJ41~ ~.~l ,. '\ CAsE NARRATIVE ----~-- -:'~~:":'=:=:~~''':-",,:-:,,::,: .......- C.t.IINtl CLA YlON seA TUE Projeet \\'o..k o....~ N. 0.071129 , i DltI: 01..4",.04 ----===-=-.-~~ ".;, " , :" AD&1)4ioal commentl: The Ciayton Novi Laboratory is NBLAP and AlHA a.cc:.redited, These lcorcditatiOns require 1bat we provi~c the fallowing intonnttiOll 0Jl nch report; k; an analytical result proarelSeI aho'fe tb. rtportina limit (RL1 it baa less variability tbar1 a result reported at, or near, the RL. , u~ othcrwbe indiOltcd. below, the indusUial hyJiarn: relUlg ha~ not been blank corrected. ',' . " ". , I, n . . . .. : " i. ~ ! 1,. I '. r ,. ~ I : I " I '. , ,~ ' i ..,..~.....,...._--... .,11_...... ,...._...___.,.._.. ..~_ ~. t ,.. ,. AUG-2-2004 22:37 FROM:N W ASBESTOS 360-385-0584 f""'L!U-II:J"J-c;.g~ gQ.....~ "'-L..r'1J IU.'1 U~ wE;~\I.&"""'.;:J TO: 13504171932 ''CJgr~'''IQ;;J t ANALYTICAL RESULTS Dltt: OJ-~tu ==--=-~:::"='::"=;"-=:'~"J~::-.:-' CLJI~: CLA'nON Il!ATTLB 'Work p...... Nell Ooi071ut f'~1CJ: lAilllDt 0407112t-001A ..~,.:.;:.~~~--_._--~:--=...- - .--..... ...-- _...... _....._... It ............. . cu.., 8ulpl.lD~ SAMPLE' I TqNullhn COllecttOD DIu: 712"1004 Matrix; PAINT CHIP ........ -- ...-----....------..... ..-- .-........-.~.--- 4\1'&" r,PA ~UI.: Iei' '"tAtS; PAINT CDS te.f : alJlClrtblt Renal! LIIIlt QIIal 011.11 DF Dlb Aft'b"ad AU"" Nt) 0.0097 ~ 1!2J2QQ4 --- " -...-.... .;'.."'" ., Q\l.I&~rt: s . S,'lce R.M0WI7 .lItIl~C" Ira,.. 1Q:lIWW) JiMi. It- ~E> 0lI1!14. ~ lftPCII) IiIMI I . V.IlI,.,""" lJlU&irMlo IWI&I T. r.......,.. kIaaIJGM ~ I11CJ Nt) . NoI o.tdId It iNlqIorUJIIl.lIMit (N.,). - J. Aalytt.... ~eIowtAJ Repriq Lilllu . . MabCl d-.CIId III TA. UlDtiNd MelM68/w · - \'a/__ k.atmUl c:utIlIIillIm ~I " , " OM P,4 r ........ " ! . j~ . ", ,. " .h, " , I' , '.. I:, l' . :. ; ~l . .r . I ~~. .'~ . r \ ~ : " . ~: ~ j'" .'r .~,' : ~ = ; . ".' .' !',' , \. . J:. 1:' . , .l'':' ..' '. '\ . it ,I:" ", .., .. , . " ,I t. :~ ~ .' , .'. I'" " .J i; : AUG-2-2004 22:35 FROM:N W ASBESTOS 360-385-0584 TO: 13504171932 LEAD SAMPLE DATA Northwest Asbestos Consultants 406 Reed St. Port Townsend, WA 98368 360.385-0584 northwestasbestosconsultants@cablespeed.com J&1e; 7/28/04 Owne~ Lynne Lohr 781 N. Kendall Rd. Sequim, WA 98382 1114 4th St. PortAngeres,VVA 9&362 Tob S1t~; Contact: JIm BJshop, Contractor Subject: Demolition Sample #1: Lead testing of homogeneous paint. Inspector: Bob Wltherldge AHERA - Building inspector I Management Planner WAMOA - 0042-03 Expires - 10/28/04 Please call with test results when completed. Thank you, 6~~ Bo b Witherldge, E.F .M. P.3 AUG-2-2004 22:36 FROM:N W ASBESTOS 360-385-0584 TO: 13513"171932 P ~, .C SCQpe of work 1) Building survey and inspection for lead containing building material 2) Sample and record suspect material requested by owner Lynne Lohr. 3) Report to owner Lynne Lohr and Contractor, Jim Bishop, results of testing by Clayton Services. Inspection R~port The inspection was requested by owner Lynne Lohr to sample for lead. A walk was made throughout the building finding sample #1 of gray palnt. Color and texture was homogeneous throughout this building. See attached report from Clayton Services. Summal)' of Inspection: The inspection of this home was to test for suspect lead. This was requested by the owner Lynne Lehr. Sample was taken and sent to the testing lab. The results for lead base paint is as follows. Sample #1: Lead testIng of homogeneous paint was non detectable. Lead base paint required reporting limit is 0.0097%. If you have anymore questions call NW Asbestos at 360.385-0584. Sincerely, ~\.0~ Bob Witheridge, E.F.M. AUG-2-2004 22:35 FROM:N W ASBESTOS 360-385-0584 ~ Owner: To b Site: Contact: Sub1ect: R~iards to: Inspector: Northwest Asbestos Consultants 406 Reed St. Port Townsend, W A 98368 360-385-0584 northwestasbestosconsultants@cablespeed.com 8/3/04 Lynne Lohr 781 N. Kendall Rd. Sequlm, WA 98382 1114 4th St. Port Angeles, WA 98362 Jim Bishop, Contractor Demolition TO: 13604171932 P.l Survey, inspection and testing for suspect lead. Bob Witheridge EP A-AHERA- Building Inspector Management Planner ID# WAMOA-0042-02 Expires - 11/01/03 360-681-8737 SPACECOPIES 009 P15 JUL 21 '04 11:56 ',,-, flte B .lll1 I ~ ilH t}iJ ~ itJ'i i tin! j ~, - II" I .J u 8 11 = J .. I ~. ~... .. ....,.-. ~ . .. . 0( ! u l:t I ~.8 ~ ~.J! . I: l~ I - ] . Jt~1 -< S. sin Q B 1. &' 1 .5 .J\H ~ ~. )11111 . e. .y, ! ~'. lll'i I "-' 8 11 ..... . e I I: a~ < it ~. , }fli s = < Q. 1";1 .fI:a. -I~J 5 .- o. . = . < i& .~ i 'i .U~! ~ Q.} '1 ~ ~ . , s 1 = ~ ~ tf') a '~ s r ~ ] .CU o ~. ~ J= .%!.J.Ei~ U... J '<l11~hlU I ~.c lith ~ e. 1~ I' J I, -;1" 0 h'ii s .11'fJif~~t' Q S~ :: e-J !I~l crt ~!!I e "-" o~." . 360-681-8737 SPACECOPJES 009 P06 JUL 21 '04 11:52 Scope of wort 1) Inspect for asbestos containing building materials (ACBM). 2) Survey, sample and record suspect mater1al5. 3) Copies for owner, City of Port Angeles, Olympic Region Clean AIr Agency and on site for demoUtion. ln~~tlon Repo{t The inspection started with a visual survey looldng for Asbestos Containing Buildlng Material (ACBM). The suspect materials were: ~ Exterior Asb. board. ~ampl~ #2: AttiC rockwooltnsulation. Sample #3! Kitchen and bathroom 12"x12" celUng tlle. Uvtng and dining rooms 21X2' ce1llna tile. Uving room wood stove fibre wall backing. KJtchen floor vinyl. Gray Sample Q4: Sample IS; Sample #6: All samples were sent to lab. See results. 360-681-8737 SPACECOPJES 009 P05 JUL 21 '04 11:52 SummN:)' of Jnspection This survey includes all areas of inspection witb the report results from Clayton Environmental Testing Labs. Sample results are as follows: ~mple #1:. ~~ple #2; Sample #3: ~ ~n'\ple #5: Sarnpl~ #6~ Exterior Asb. board. 15% Chrysot1le asbestos. Attic rockwoollnsulatlon. No asbestos detected. Kitchen and bathroom 12"x1211 cel1!ng tile. No asbestos detected. Uvlng and dining rooms 2'D' ceiling tile. No asbestos detected. living room wood stove fibre wall backing. No asbestos detected. Kitchen floor vinyl. Gray No asbestos detected. The total square footage of asbestos containing bulldlng material needing abatement prior to demoUtion is approximately 80 lineal feet. All asbestos containing bunding material with a reading of 1% or greater is to be removed by a cert1tled abatement contraCtor which follows the rules of the EPA and governed by Olympic Region Clean Air Agency. This report is not a guarantee that all suspect of AC.B.M. were found. The posslbUltY of concealed material exist and may be found during demolition. Please contact N'WAC for further inspection If needed. After the faclllty Is completely cleaned out a walk through and Inspection Is required by the original AHERA building inspector (NW Asbestos) after abatement, then a copy of the letter certifying that abatement has been completed needs to be received by the City of Port Angeles Permit Center and Olympic Region Clean Air Agency. ~ you, BobWl~.M. 360-681-e7~'" ..;;., SPACECCPIES 009 P02 JUL 21 '04 11:50 360-681-8737 SPACECOPIES w__ ~. ___ . __ __ D.itG. CNna:: Job Sit~ ~ In$p~to~ 003 P01 JUL 21 '04 11:50 Northwest Asbestos Consultants 406 Reed St. Port Townsend, W A 98368 360.385..0584 northwestasbestosconsultants@cablespeed.com 7/20/04 Lynne Lohr 781 N. Kendall Rd. Sequlm, WA 98382 1114 4th St. Port Angeles, WA 98362 Regards to re-Inspection; All areas that were noted on the Inspection report on 7/6/04 have been abated. All work were completed by KD&S Environmental. e EPA.AHERA - Building Inspector/Management Planner WAMOA-0042-o3 Expires-- 10/28/04 eel Olympic Region Clean Air Agency. KD&S Environmental ~ Da1I:. Owne~ Job Site Subject: Inspector: 350-681-8737 SPRCECOPJES Northwest Asbestos Consultants 406 Reed St. Port Townsend, W A 98368 360-385-0584 northwestasbestosoonsultants@cablespeed.com 7/19/04 Lynne Lohr 781 N. Kendall Rd. Sequim, WA 98382 1114 4th St. Port Angeles, WA 98362 DemoRtlon Bob Wltherldge EPA-AHERA-Building Inspector Management Planner WAMOA - 0042-03 Expires.. 10/28/04 009 P08 JUL 21 '04 11:53 360-681-e737 SPACECOFJES 009 P07 JUL 21 '04 11:53 ASBESTOS BULK SAMPLE DATA Northwest Asbestos Consultants 406 Reed St. Port Townsend, WA 98368 360-385...0584 northwestasbestosconsultan1s@cablespeedcom To ClaytOn Services 4636 E. Marginal Way South, Suite 215 Sea~e,VVA 98134 DaII: OWner: Job Site: ~ Sample il2: Sa.mple #3: Sample /14: Sample #5:. Sa.~le /ffi: Inspecto~ 7/6/04 Lynne Lobr 781 N~ Kendall Rd. Sequim, WA 98382 1114 4th SL Port Angeles, WA 98362 Exterior Asb. board. Attic rock wool insulation. Kitchen and bathroom 12"x12" cell1ng tile. Uving and dining rooms 2'X2' ceiling tile. Living room wood stove fibre wall backing. Kitchen floor vinyL Gray Bob Witheridge EPA-AHERA.Buildlng Inspector I Management Planner WAMOA.. 0042.03 Expires... 10/28/04 Please call with test results when completed. J)lank you, '~ceb.)~ Bob Wltbertdge,'t.F.M. 360-681-8737 SPACECOPIES Northwest Asbestos Consultants 406 Reed St. Port Townsend, WA 98368 360-385-0584 northwestasbestosconsultants@cablespeed.oom Datf;. 7/19/04 Owner: Lynne Lohr 781 N. Kendall Rd. Sequlm, WA 98382 1114 4th St. Port Angeles, WA 98362 DemoUtion Job Sitfl!. Sub,ect= 1) 4 hr's. for survey and Inspection. This includes the time for re inspection after abatement. $260.00 2) Sample, handling, postage 6 samples at $35.00 50 S210.00 $470.00 Tax 8.2% $38.54 Balance due upon receipt: S508.54 Thank you, &~ Bob Wlther1dge, E.F .M. 009 P09 JUL 21 '04 11:54 . 360-681-8737 SP~:ECOPIES t!. "-'C.-"~Iri-~. ASBESTOi BtiLK"8:AMPLE DATA I ~"'U i'IM.AI'&.AaCOH"01111N G It 0" Sf. V leu MlndifIICJ "'lIndIIJ ..... ........ iii. .,...." ..... ..1Il ca,. Name: Nertnu1.4Jbettm CnnJtatl , . '0'" Loc:ItioA; lit.... S&. Port MpIeI, WA'UQ . ~~(1 ~ ,_ '-'Ia HID.' ~ ~~ AlIlIt bDII'd LOCAnoN: ....... ) La)wI....,..,~ M AMl)IIlJ ~. 01.__ M"'(iCCMJ .........aTOS TYP& ~ ~1It 11 , ~.&"l'III.'Af.~,~~ LA\'IUI) -,... ............ ~f" .JJII/~ ; /11M( ~~(2: . .: .) ~ 3MlU ' ~. ~lMUa'" ~'ft()N! ~ LIYI"~fir~ NoMiJllft DdH/f4 68.B198 'I'YK m~ . I ~""AL~ IAYIUD t.,......~rw-........ -- ... __ AI ~.,.,.....-w "., ~..~~ - ~ ) J.AU 3ll5&U . aM.,..: 1J~XlZ" Ci116111'De T nrATION: KlWMa.. N6__ l.IpI ~... for ADIl)'til ~~CMl' ~-r-..I n.u......,. LA.YDlID .......,..,.:..I.~.,.,,/ItHfI.f I[ ,,-.I .,.., '; ~ 009 P04 JUL 21 '04 11:51 3'583 ..... . .n , IAI #: ~ .,......,. ~of""" Cootac:tBob WtdI__ POIloWi: nnrn. ....WlllI 0TRml. UA.TI!RlA.UI PI_.8lNlcr ... ~ ..._, ~ ~ NATIlII1~'Jl AaJ.. ....6..,.. ......... ....... CD1IB PlRRRf CctIulaIo ~ VAftR~W ,m. 6 8illGtr ... . . " % 1J '0 .. " ." t6 ) \, to 10 ~ U. ,. S to .. ANALVZU> By".... 0....;0;., DA'I'Ik 711.l J>.BAfi- . I ,.- UNlUD.~; ::.... ~T8: 1/612004 , (X))(PANY: NetIBIIII...... ~ r . 1t.8c;:mvtm~: ~.... OATS: .,f8/2C04 __ ....-. .... ___'-''''''''''''.~''''''''''''~ ..............Ia . __ ~..1IIIl" . J' ......_ _...~..--. ----.............. ......... ................ ......... ............... ..............~.~ ..__.......... ...............~llta.-. -_"........... ............ ....~_..___~ ~.._..........._.............-.- ~o.,. ............ ...... ~ ~..0lIIlMII.... ~lII,r'~,laf~AliIIIuIlIII_~-~~' . ...~ ~.........tI............._.'"_............... ~ ......, _1III......."'ffW' 360-681-8737 SPACECOPIES ....--""~...~~~ ...,.~ ~,....~ .....""""""". ..".,.......,,,'"-- C. ,.~. 'Im7tnD- ASBESTOS BULK SAMPLE DATA I ~ . "-'1fI.1 ~ l'MMLA8 QODUlOJi06oO . : G R 0 ~ P U It " ICES MCI'edim" lao....sy ............... ......, . ""9"'" ....,.. a-Name: Ifortiawat AI.... COJMUltutl Job.l.A)GItion: *144* It. rortJ...... WA 9DA I ,~~..(. ~ J W\IJe; ~ , IIOtlll~" 1,*' C",1Ie LOC,.t. 'I'1DN! tMq... _... NO_ I I Laycn 1IolIIOIOU- '" ~ Ne AIHItM DftIM:If4 A,PJl'M.~ ~~ .,~.:~: J UJU; 365IU t WI"'! .... WIG ..~ . . ~"ON!~..... w...._. I ) No MbaIM DtItM;tM ~r.&TOS mE P8llC1r.NT ..,.AL ~! IIONOGINB01J5 ~I'O~ "."...,.,... lfMJ -...""..,. -.......... , ' UMPUl': @ : _ ~,: ~: ) &.aU *".6 ! a"".,,, ~ T ~~: KIidl.lhler ~~t'or~ ~~caT . . , f ~TllRI~ ~~ LAYJIUD 1....- ffIIlIw"."...... ..~..... p,.. ........ _ifill........ .., NIIItR ........... --"It',..,..,.... 009 P03 JUL 21 '04 11 : 50 LoI'; 3S83 rrtRItJ1 ......- ....,.. ..,., N......r ",...'-' · CoIIfaG1:'" wtda..... I'OIJM: Q1IIBR 1I'IIlIWc. c.a.- " If Q1RIIIlIolA '\J'l1A.t.Jl PAt.. ...... .... " . to Q""8l1l ~'AII4! ~ .,..Ihado % 90 I mJJP: MA-n:nty~ IIIIIr &..... " ,s QDJV. PmOS ()mQl8Ie % "1$ 't ~ MATDlAlS Jlik .I\*t ~fIJlIr& IiSNIf ~ 1'l1IIr'" ..... % 1* '\ . l' s;uG'LBD BYr 8Gb wldlert4et OAn: 7/6I.lOO4 ANALVZJDJBV: w.~ DATS: 7!lSl2OO4 . c:a.G'ANY) Nd..-AllleRolCouu1tll:a nn A VT tq;qiIVIID a~ Gtude ~ DAT8: 7/1/2004 ~ ........ - - ~ ........ ....-..-.~...",..... .................... ... ....... 111___ .. .IoMIJNHIe.... 1> tl>lr".... -..............,...~..... ................. ,."..,. ,..,.~.... -..- ............ ~~"~._ ...... _"~tf"" ,........-...... ......,...--t~.o.,-. "'-_..........................WM. _ _ ............,.- ,......11...........................---.... ....... ....,...~. MrllI>>_~"-"": ~~lMI ~Ia'~........~... ~aa.~ A ___......................iIlIMla...ll4lII--. .... ___ .........11.....,. S ..,tJI ~~ CITY OFPOR:r ANGELES PUBLIC WORKS - BlJll.,DING DMSION 321. EAST 5TH STREET, PORT ANGELES, W A 98362 BUILDING PERMIT OWNER/APPLICANT AUBBY MIDLETON POBOX 686 PORT TOWNSEND, WA 98368 360/385-0251 T: S: ISSUED: 8/08/2001 PERMIT NO: 12828 PROPERTY LOCATION 1114 4TH ST E Lot: 6 Block: 178 0 Long Legal Subdivision: TOWNSITE Parcel No: 063000017825000 CONTRACTOR OWNER VARIOUS Port Angeles, W A 99360 206/000-0000 PROJECT INFO Project Value: $19,000.00 Project Type: AODITrON. Occupancy Type: RESIDENTIAL OCcupancy Group: Construction Type: Zoning Use: ,ARCHITECT N/A , 98360-0000 360/000-0000 SFD Units: SFD SOFT: Commercial: Industrial: Garage: .....c: \'^ -t: ~, o o o o o - MFD Units: MFD sa FT: o o PROJECT NOTES ADDITION OF 276 SQ FT LIVING SPACE FEES ASSESSMENT Building Permit: ,Plan Check: State Surcharge: House Moving: Manufactured Home: Sign: Plumbing: Mechanical: Radon: $307.25 $0.00 $4.50 $0.00 $0.00 $0.00 $69.00 $46.00 $0.00 Misc Fee 1: Misc Fee 2: Misc Fee 3: $0.00 $0.00 $0.00 TOTAL FEE: AMOUNT PAID: BALANCE DUE: $426.75 $426.75 $0.00 Separate Permits are required for electrical work, SEPA, Shoreline, ESA, utilities, private and public improvements. 'This pennttbecornes null and void if work or construction authorized is not commenced with,in 18,0 days, if construction or work Is suspendedor~bandoned for a period of 180 days after the work as commenced, or if requIred trisp8Cttons have not been requested Within 180 days from the tast 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 goveming thl~ type of worl5wiU be complied with whether s eclfied herein or n 1. The granting ofa penriit does not =~ng~ ll\lthorii>' to violate Dr concaltha provisions of any stale ocalla 'J; CD stru;~: ~ Signature of Co.l'ltractor or Authorized Agent Date Signature of Owner (if owner is builder) Date <';0 , ""\~ Bun.DIN'GPERMITINSPECTION RECORD ,:.,' CALL 417..48 15. FOR BUILDING INSPECTIONS;;,Pl.EASE PROVIDE A MINIMUM 24 HO{jR NOTICE. ilT IS. UNLAWFUL TO..l:(}VER. INSULATE OR CONCEAL ANY WORK BEFORE INSPECTED AND ACCEPTED. POST PERMIT IN ACONSPICUOUS LOCATION. c_ ---^ "c_"'_,_.,-__r,_.~'~' -",..-,-,_.,. ,--~_.,,- . ,-.- -.- -""~ ~1. .~t:_:-- -:-:~~- ,'- -- ;- -i-:<;;;: KEEP PERMIt:~~!U> AND APPROVED PLANS AT JOB SITE , .-~ -. INSPECTION TVPE ',Ii' "'DATE' ACCEPTED COMMENTS ' .c i"'..y.. . ".' '. " YES 1 NO \ " "", , FOUJIlpATlON: .',' ,T" . FOOTINGS , 'qi '. ,. , , WALLS ....",.., "h ',,',{ . ;;< i FOlJNl}ATlON' DRAINAGE. .' i,;' ',.'.' ",' ".h,'" I.,. . ", " ",.",,' ,'., ELEcijUCAL {LlGfiT DEPT) SEP~TEP~:# ,} ROUGH-IN ' ;,';::.r; I ''. , '".. ,; "';A~ti', PLUMBING j "'" UNDER FLOOR I SLAB ROUGH-IN ", ',', WATER LINE ., ,G7. '. , , GAS LINE ",7/ BACK FLOW/ WATER , "', h.' .J ,. -:- '.',",' " , AIR SEAL ", WALLS , '.... " '...... I CEILING C '',l,c,'.':,> I r i 'y';,. . ,FRAMING .. '. :,'r' JOISTS / GIRDERS SHEAR WALL WALLS / ROOF / CEILING " DRYWALL T-BAR INSULATION SLAB WALL / FLOOR I CEILING T , . MECHANICAL .., '......, . / HEAT PUMP WooDSTOVE I PELLET/CHIMNEY/INSERT HOODIDUCTS " ,,..iV. , i PW UTILITIES I SITE WORK <EifslneeringDiYision) , SEPARATE PERMIT #'$: '0; '-"',S: W A TERLINEl METER . ,I, ,.' .,';' SEWER CO~TIoN "'."i,,, . i.' SANITARY ,.,: i , """ , 'J' ';i", .,' STORM ceo , ""j PLA\liNlNGDEPT. SEPARATEPeRM!T #'s " --c: SEPAl PARKINGILI(:fmNG ESA: LANDSCAPING SHORELJNE: , .' , fiNAL INSPECTIONS REQUIRED PRIOR TO OCCUPANCYlVSE ., ,~ ., . RESIDENTJA,I,. ,., , , -DATE .YES NO .;cOMMER.C:IAJ,; ,ii - ....... . ,. 'ACC~~'f' it ....' . ["'i,,'i' , ." .,... ".',' "...,f'. ,/i'i",' ,,', ,}9 ..' i'", '" . t, :'+-';;,i.d' "';'1"".'.J:1 ;'Y") ",I ,1; YES ,NO' ELECnUCAL ~ LICiHT DEPT." '"u','::" .' .. ~ i )'t~CAL" .'y,,," ",." :,'" 1"");, I", .... . , ',: i ',;" . . ;:'Y~1.>~ I'" ; ,;' .. 'iLlGHT DEP'r '.';. . ",'i.' ',' .', CONSTRUCTION R. w5pwI .f ." ,..... , ,. :~W_&w.',rj T.i;~; ........... " ',i ENGINEmUNG ,;, i_-, 4 I 7-4801:' ". ,. l G D,..,'! I:. '. FIRE ,417-'16S3 FIRE DEPT. i " ..... '.. . .,\ ". P~GDEPT. , \ '. 417-!17S0 ' ',,~ PLANNING DEPT. . .... , """"" - . .. '. BUILDING ',h,., "".;417-4&IS L'?"" ~e.dh x-'I/ , .. BtritDINGY ..... ..,......>).11') I"'.. , ~,y >,.. ,. C:\APPL:WPD ". ~/- DZ,...; r\ FOR. OFFIC"" &. .-- -~":' --" DateR=.- ',-42..bo-O( , Permit #: I 7-'87- f3 - Date App~: - Date Issuccl: BUILDING PERMIT - APPLICATION ~~ The Building Permit - Preapplication must bej1Jled out completely. Please type or print in ink. Uyou have any questions, please call 417-4815 n{~cJ~ fC?,,- . Applicant and/or Agent: O~er: III tf 7,..1/'9 f Address: f'. tJ. Bo)( b ~t: Architect/Engineer: A"j)t Phone: 3b~ ~~z5'/ City: riP v f f;p tVJI ~ JtI~ tL Phone: Zip: 2f""'J6'~ Phone: Contractor License #: Exp: Phone: Zip: ZONING Address: . City: PROJECf ADDRESS:~ 4 ....'" LEGAL DESCRIPTION: Lot: h BIOckt!~ . Subdivision: T? A CLALLAM COUNTY PARCEL NUMBER: Ch~ __ t .., e 'ZSOt.:t::c:> TYPE OF WORK: . " Residential C New Constr. C Multi-family .. Addition C Commercial . Remodel C Repair BRIEF DESCRIPTION OF n ~~.,r AI. ~. ATION: .. Reroof C Woodstove.. t 2.. 74' SF. @ $ /SF. _ $ C Move C Garage SF.@$ /SF.-$ C Demolition C Deck SF. @ $ ISF. = $ C Sign C TOTAL V,ALUAnON $ 1'1.0&:>0 PROJEeI': !t-fJP J~S'o"ioF-..t !'our F(p,,~lJo...... ~~"Q,,:?~ ;"'1~v;,,,..... I".q../Ls- r V',/;.. . COMMERCIALlRESIDENTlAL: Occupancy Group: Occupant Load: Construction Type: F-:.~ No. of Stories: / Lot Size: ~ X / f{i:J % Lot Coverage: 2./, ?' % Existing Lot Coverage: I;} 2-~ Isq. ft. + Proposed Lot Coverage: /7 h Isq. ft. = TOTAL LOT COVERAGE: I SO ~- Isq.ft PLANNING USE ONLY: Pennits Required: Max. Height: Setbacks: Site Plan and Use Approved by: ESAlWetland(s): eYes C No SEPA Checklist required? C Yes C No APPROVALS: PLAN BLDG DPW FIRE OTHER Notes: Zoning: Date: Other: BUILDING APPLICATION SUBMITTAL: You, tlppUCllt/on tlnd site pltln must beflJled out completely to be tlccepte4fo, ,evlew. The Building Division can provide you with more detailed information on the application and pian submittal requirements. BUILDING PERMIT APPLICATION SUBMITTAL: Your c:ompleted appUcmon, site phm (for ~dditions) and building COnstruction plans are to be submitted to the Building Division. 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 Div. to c:omply with current fee schedules. Contact the Permit Coordinator at 417-4815 for assistance. PLAN CHECK FEE: Your plan check fee is due 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 ofapplication, this application will expirfl by limitations. The Building Official can extend the time for action by the applicant up to 180 days, on written request by the applicant (see Section 107.4 of the Unifonn Building Code, current edition). No applicatig~ can be extended more than once. I hereby certify that I have read and examined this application and mow the same to be true and correct, and 1 am authorized to apply for this permit. 1 understand it is not the City's legal responsibility to determine whpt permi are required; it remains the applicant's ,,",ponsibRity to determine what permi.. ani required and to obtain svc/r. ,f J.. . , Applicant: r; ~ Date: /6 JaI/Y e> / PVV-II02_13[~~) ,---- ~ Gl1! PI" ti -~ ~AN~ SITE PLAN 0\ / ~/}U DEPARTMENT OF PUBUC WORKS, BUILDING DIVISION APPUCANr: PROJECTIDEVELOPMENT ADDRESS: 1 J I tj ;;. if #c- PHONE: f(J?~!- 11-~4?,t> See Page 4 for instructions on completing lhe site plDn. For more iIfformalion, caU 457-0411, extension 125. Ifll J i2. V ,'l~ r \i & " ~ 1 .-,;; , {..;. . tf2. (h' "I ~ I' -.... Ifb' ,~ ~ ~... '\ ~ 16 " ~ {i _ .r, I- , \lV I. II), 1-' '28 tp" I - / 1\ I~ t ~I- :'-J~ t ~ - -- ~ t - - - -.. 1- - 4 ~(b ~ 4, ^ ~~ I " ~ ,\~ \ ~ ,::)-. .1\ f;:. ~ ~ \I'll v ,D-e" '1 \' ~ \ I . .' --'n 7fl~ dW!Wi " ~ \fI' u '15 E 14 M <;'1',.. eJJ ~ \% c{} '^' 0'1 ~ r.:z ~~*' N . .....r ~~~ A::.5> ~ \:5......~ 7'1<;> al~0 iY~/~ I -~ ~- - t< - ./G.' 1 J ...! ~ ~ r.d ."i . ~ l ~ { .,..... ~ ~ 'v" r - < ~ " " ~ <(l~ ,,' ...... '< J)")", ~ ~ , "'" . if . (" (:?!~;;f,~1!~~~-'trl;u~'\- , P)',';f;"~~'~t'~tt~;~ffi~ j \$ ~ , ::r ... !y~ . ~ l\j l'O~ <:;.;....lQ J~~ }!j'l ~, h i:::> "2 S \, ,-fE .~~u~t~ , I' i: ':\!k } -h ~ ~\ !,~'~",~ .':t- 'l ~ ~ I i 1- <e>~ .:ttl....5 WI i'.~ > ,QI ~l'" J" i 1 . ! :i ~o il II Q Jf, ~ - ~6g- ,()? ~ .. " ~ _~::::~, h - . ,,~,EI gf>'". ~ " il" '3. o '" ." o ~ .~ Gl '" '"' <J> \ " ~ " 'f, a. o ~ ~_ ~i,~ c. OJ. ':f"- '" -.l t ~ 1- "Z ~ l' ~ ,:S:: <11 '" .~ ),~ ~ "^.~' ; . -r I" -:::E !{ ;;t '2 I Xfr ~ ~ -..J C<. ~ '" '" ~ :: ., ,. (;I~r~ i ~..r ~ ~ oq) () ~ t,.' ::a~ .... f '" ~-IJ , ......... i ~ ~ "II :t- ~ " \)- LQ <c: <:I "\ ~/...l~ .... '" ~ ~ ~~~V; " AUBBY MIDDLETON POBox 686 Port Townsend, Wa 98368 Ph. 360 3850251 jD) IE ~ LE ~ W [E filI,-l,,' Ulll II1U FEB 2 4 2003 .~.' CITY OF PORT ANGelES Dept. of Community Developmeni , CITY OF PORT ANGELES PUBLIC WORKS-BUILDING DIY. . 321 E 5th Street Port Angeles, Wa 98362 Dear Sirs, rot- z fO 'Ze/{'j; I " I began a project at 1114 E 4th Street under Permit No 12828 in January of 2002 'when my father's health began to fail. Work commenced slowly but was soon postponed and no inspections were made. Dad died in January of 2003 and I stopped in your office to get the Permit current before going to his service in Pennsylvania and was given verbal approval to move the house 20' toward the front ofthe lot and leave a portion of the existing building to use as a garage behind the house. Upon my return I contacted your office by phone and was informed I would have to reduce the size of the house by six feet on one side and three feet on the other to meet set- back requirements. I told your employee that was not feasible, and was told to indicate exactly what I was proposing. . .here it is:, Almost centered at the rear of the house is a room 11' wide which will be gone in the remodel. That room will remain where it stands when the rest of the house is moved 20' further onto the property and the remodel is accomplished. That room will have one existing interior wall (which becomes an exterior wall), moved 5' and the rear wall will have a garage door installed with the end result of a 16'wide garage behind the house. What this will accomplish: The City will get a non-complying house becoming more ~pliant, (it presently sits about 5' off the alley), and an improvement to a nice Il~ighborhood. The owners will get a more user friendly house that hopefully is not right on the alley and a place to get the car off the street. Question: Do we dig the foundation where the house stands or 20' toward the front of the property? Your choice; we prefer the latter. Sincerely, ) (l1J/!t G. P. Middleotn -- ---,- ~ORTANGELES WAS H I N G TON, U. S. A. DEPARTMENT OF COMMUNITY DEVELOPMENT March 4, 2003 Mr. Aubby Middleton P.O. Box 686 Port Townsend, W A 98368 RE: 1114 East Fourth Street Dear Mr. Middleton: ..This is in response to your letter qfF~bruary 24,2003, in which you exp!ained concerns 'regarding the remodel/constnlcti6n oi:iyo~tre~idence located at 1114 East FourtQ.Str~~U.>t.,. '!~~When you visited the office ih Jahll~,:~~disctissed your proposal at thecountei.wittFLtou' ..iHaehnlen, tl}e City' s,Building Offtci~i.';~~e!~tiginal,site plan was. discussed'l~nd:fyo~t ~e~ire : .,to moye t~estrueturetgiIl~rt,~<l~~y 'fIdg1tl1e~lley,:!'believe'yollw'~r~ tg~?'~~~11Jfl;.c~al1ge' ',would be. possi1?I~I(l~ Jpng aspsta13lisijed . ~etba.~ks' are: met fO.rallY(l1ew:cQns,tl\llcti9u>.,: <le). j,_i~ '. ........ ...... ........ ....t. 'j ,+/-;;0:', _c '~" ,.-,.,,"," ,- """" . tt\ ~ .~ (YJ 'f )...{ Your letter of February 24, 2003,;indifatesthat you do not now believe you will ?e aple to .... accomplish the proposed addition/remodel if you are required to observe the required7~foot side yard setbacks as you would lose 6' on one side and 3' on the other. If the site plan on file is correct, you indicated the existing structure is currently located 6'6" from the west lot line with ai' setback on the east. A 10% administrative reduction can be allowed from the required 7' west setback to 6'6" but you will be required to observe a minimum 7' setback on the east portion for the new construction as previously stated. We can administratively approve a 10% reduction to setbacks where there are no alternatives to assist property owners with logical development problems such as on your west side. At this point it is important for you to decide whether you wish to proceed with your original building permit and approved plan, which has technically expired, will be renewed this one time. However, we do not administratively have the ability to waiver from established setback regulations more than 10%. If you decide to amend the site plan by moving the 321 EAST FIFTH STREET · PO BOX 1150 · PORT ANGELES, WA 98362-3206 PHONE: 360-417-4750. FAX: 360-417-4711 · TTY: 360-417-4645 E-MAIL: PLANNING@CI.PORT-ANGELES.WA.USORPERMITS@CI.PORT-ANGELES.WA.US , structure forward, a new building permit will be required,. When planning for yoUr construction, it is important that you take into account the minimum setbacktequirements.and design your development around those standards which are applied City wi4e.Your original approved plan appears.to have done that allowing for the 10% west side reduction to the indicted 6'6". ,Please let us know if you' have any, questions that we can answer at this time.lamenclQsing a copy of your original permit and both of the'site plans that were submitted for your' information. ' .. , Sincerely, ~~~ Sue Roberds . . ,'. . Assistant Planner CITY OF PORT ANGELES LIGHT DEPARTMENT N~ 18245 ELECTRICAL PERMIT t -I<j Fy Port Angeles, Washlngtonmm._.m...m._.._._.m...c.m..mnmmnmm, 19...00... 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- :~:::s: i~.~ijj:iJ::.~:.~.~:;?/._~~..~~.::~~.~~..:~.IO:~cupancy.....&:-L....._......_...... - ~A Owner ~" A j~~k1:..e'.J.?-_---oom-m. TenanLm__c.w.~.~m__mm_oo__.mmm.m.__ Wiring ~.~-:~:~~:~5i1.oo~_~..,.a_<,:a_L'!<>!~m~oo By...oomm._moomoo__.m._.m..n_mm__oooom.moo__._mn , . Light Outlets........_......................_........ Service, volts ......__.....__...._.................. No. wires ........__......n..................... Receptacle Outlets.....m.__.n__............... Dryer, KW.n.....h.__.......................__.... Size wfres..................................._.. Range, KW uu"u____m__umu. Water Heater: MaIn fuse .__...__....__..__m............ Enclosure __..........................n... KW..n.....................n......... Type of wIring: Entrance Cable ....__...........h.......... Heat: KW......n.....................................__.... Motors: size, volts and phase: Rigid Conduit ."h...n"".......n.....n. Metallic Tubing ...__...................... Current transformers: No. & Size......._....__...n.................... Ser. NO.n...__._.........._______.................... Ser. No. ............................................. Ser. No. .h__..............__.......__n__......n... Type ot Wiring: Armored Cable ........m.........nm..._ Non-Metallic ....n..____.__..........__...... Knob & Tube_____..........................._ RIgid Conduit ............................... Metallic Tubing .................__........ Raceway .........._............................_ . Circuits, LighL...................................... Utilit).. .....n..__..............._....._______._____ I-Ieat .................._...................._...... Range ............................................. Water Heater ............._....______....... Motor ..._........................................ Dryer ....._....._._................_.........__........ Furnace .........................'_................... ~~=~~~~~:~l::~~~~~=::::::::::?~=~~::.:::..:...:::..:~~=::::::~~::~:..::~_~~~~ .::;r;j~~.i.~~......~~~~~~....m--..oo::~;.;.~Z~.oo.oo.~.------.--mm--::.__..112~-=~:~~.:.::::: NOTICE-Current must not be turned on until Certificate of Inspection has been issued. If work is to be con- cealed due notice must be given the Inspector so that work may be inspected before concealment. NOTIFY THE INSPECTOR BY PERMIT NUMBER WHEN READY FOR INSPECTION N~ 1 8 2 4 5 ELECTRICAL PERMIT Address ...!/..!.....q....::......~...5!.....~......................._......u..............._...u_........ Date...c...._-:::../_..S(..:::::...E..K.__. , / Owner .~-d~...._~~LLP....__.."-:::>....................u............................u....... Tenant...............................................u.u................ Wlrl:~;I::;::;~~.:~~!~:.::;~~~..~~..;=.~:~~~~..~= :~~u;~.~~~~:..;~..~~~~...;~..~=..~:...~~:: cealed due notice must be given the Inspector so that work may be Inspected before concealment. "'1.._~;... 'C~;...t..,.. T....... . fe//L-; \ /.J-.:> ELECTRICAL PERMIT APPLlCATIOI~ FOR !H'HC!A~. USE ()N!..-~' 1).Ute'l;n u." "_____._ h:""it!; .__ ___.. _____ lJ3l1;A)ll""vcd ~______ O~,,: l"u~,) __ ____._.._~~ The Electrical Permit Application must be filled out completely. Please type or reprint in ink. If you have any questions, please call (36G) 417 -4735 Fax number: (360) 417-4711 Owner or Elec. Contractor Agent: \. Je(f-AJ~ E(e c- /" c.- PropenyOwner 7 6Cot-tse(.dat-eJ 8ullder5 Address: II I-Y ~ "77/1 Electrical Contractor: ....../c{:f AJe(SCl1 ~c ;l,.c- Address: 32...:; C CV4Sj""Jiz,,, ff(~ City: Phone: 'i' 46 '(2..9' ( (eo,Jr ) P/-?- JCNIIIE( 'fWA'P License #: Exp: Fax: 6231 7'L:)'I Phone: Zip '7 J>7b Z- Phone:~ ~/z.q( Zip ?/3:YZ- City: 5'7'UH-7 tV/1- INSTAllATION WIRED BY: o OWNER ~ECTRICAL CONTRACTOR Credit Card Holder Name: Billing Address: City: Zip: Credit Card Number: Exp. Date: VISA: MC: o ): TYPE OF WORK: Check QII that apply: DNew Rr7- 4fc0-~ D AlterationlAddition PROJECT ADDRESS: III</' c:- 4/:?k D Residential D Multi-family o CDmmercial ;i Mobile Home Sq. Ft 1700 -J vJ uJ o Remote Meter D Detached garage 0 Hot Tub D Swim PODI D Septic Pump o Low Voltage D Telecom. D Sign Number DI Circuits added or altered: DESCRIPTION OF THE ELECTRICAL PROJECT: C()hheC 1'/017 II '( CJr. /1o.r/d--,f Ae<'w.(. J./1Yf,e- "Ieetrical Heat Load Additions and or Subtractions Service Information J Baseboard ] Furnace ] Heat Pump ] Fan-Wall KW KW TON_ LRA KW D Overhead Service o Temp Service o Underground Service Voltage: ;:::. 1"'0 Phase: )>91 D:J Service Size: ?-d31 Feeder Size: ~ 'f8 ~ hereby certify that I have read and examined this application and know that same to be true and correct, and I am lUthorized to apply for this permit. I understand it is not the City's legal responsibility to determine what permits lre required; it remains the applicants responsibility to determine what permits are required and to obtain such. ,(~'(O6( . ~(v~ / O~ Credit Card HDlder's Signature: Date: Owner Dr Elec. Cant. Signatur~~ 1J- ;rz, ;;, /h-_) Date: <f!2-5JftY / I ~f PERMIT FEE: $ :IElECTR ICALPERMIT APPLI CATION IEllECTlRlIlCAl ~NSPIEC'nONl W~RUNG REPORT 417-4735 DATE PERMIT" tNSP CTOR 04- 11'1Lj' ~ ~~~~hTPN c. , /('t!I sr , 1:2 2-3 ow AlCON ACTOR L~NE ADDRESS ///4 APPROVED NOT APPROVED o ................... DITCH ................... 0 o .............. ROUGH IN/COVER.... ... .. .. ... 0 o .................. SERVICE .................. 0 14 .................... FINAL. . . . . . . . . . . . . . . . . . .. 0 CORRECTIONS NEEDED: #~ A"'n-?;t:? . NOTIFY INSPECTOR WHEN CORRECTIONS ARE COMPLETED WITHIN 15 DAYS - DO NOT REMOVE - OLYMPIC PRINTERS, INC. (380) 452-1381 r- Sep ,(5 ,0'4 108: 39p _ LiJ'!B~Ut'CJ!L~1 n'lVN Uj: L~ tn1 'vJ II ur fM tsLl.JtJ ur.r 1 p.2 r,^ "0. jOU H I I f II r. UUL ~":_-~:~~~~'~~-':::':'8"'" ... . ...... .....ELE~-litle:Ai-wORK~ERMlT1\:P~tl~~O~=:~~ ~:.7.:.~~J~mil~~:;;r-~or~~;,,~;::.....'Z':~~:-~~~~D~st!:~~~~... _.~~:~--.~ :~~:~.:"'~ I q .~~.DD~"~,~imU [J 'AlarD:!. 0 <:~,r~.i.~.. [JCO~~d.l .,:~~sl~~,~~~ q.'~~c~ti~ .~~L 0 SliD' 1? ne.rmosbt IJ T~Jea)JI).. I T " I -1 t. I I I i I I :' ".Johviruby '.. Q.Elec.trtcal<::ontnctor.,,'.o Gw1aer. . .Installation doscription - . ; , , I iV" I , PretJf/?7' M/.:5 elly q.':' r i '1f..lO- o Cash lJ Checlc H I hcteby certify that 1 am. "C own~ ot the above DAmecl property or " JicellSed ~ .1.._ . lJ Credit Card Visa astc.rcard Discover electrical coIIfladar (or tbe fUm's llUlbclrizcd agc.ot) aod am. mak.i.ng we electnall insl3llati.. .'aI_ti.d... compliODct..;dl dleetectricall.w. Cb'pler 19.28 RCW, Card# Sf~n.'ure of n.n.u, d~tric.l !.ontrac:to, Of Irlcetrieal .dml.lllrator ExpirationDa1e of card x SERVICE' Insul-tion Only ~G lJlSllI.tion Only -------rB:ERMOSl"iU ............8, D.t~ ~B, D.. "",to'tOe, FUDDl OoM DITCH CoveT D.. ",..,.......ay Do. ~1O.......81 n... Af,n"",,1.1l EfectrieallMd Additionllllnd or 9ublmcHaru;: o NO LOAD CHANGES o Bas.be"'" _KW Q Furnace KW a Hea1 Pump ,Uron_ L.AF\ CI Fan.WaD _ KW SBrviCA hdlJl'm"ion . VoIlago PhoseO,03 Service Size: Feeder SIze: Q Overheed Servlo9 o Temp SoNtca a" Underground Service I bllpeclion A.tu. Building or Equipment Ill6{1OOted Action TaileD Elec:trical 1" ,D.le IDSpeclor , 1& V> O~ *~~(!-~: /.:J. ~3 - ~ -&"0 ! , , ;ttJ /~)?-Jo;/ Sep 15 04 08:40p , t I~l !i. 1 '.Y".' ,'d('\."'.1, '.z---'-~ --~-~ .------ CERTIFIED AS PROVIDED BY LAW AS MSTR ELEC GENERAL EXP. DATE 12/20/2005 12/20/1999 - r p.3 - ....."~'- -~- ~.-. --.--' . ,. -t.., h ';": lli_;'I;" (,'ral~, ,11" -- 'n ------