HomeMy WebLinkAbout1611 S O St - Building
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FROM
FAX NO.
Oct. 25 2004 07:25AM Pi
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ELECTRICAL PERMIT APPLICATION
, i=0J< t)J'I;ff;,jjflt,l. \IS~(I"'l~.' .
1..1.1;.....;:1. ._n...".""__o._______
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Ploul ryp~ or reprint in inIL If)'ouNt'''8eI7)''QuuUQnI. pl.... ulJ t36U, ..17....135
f=81 n'Utnbe>I'": ()SO. 417~711 .
"hc Elecuital Permit ApglicatlQtl must ~ fUlled oUt eomD'-tetv.
Own=,or El~e. con~'~'W'k., ~~2"~ Phone.HS:)~ tr/"'H fax:
Property Owner _ ~ P~no
Adltfll..' '2""0 ~ S.~ CIly; P v4-
el.Cb1calcontr.c\Ol~ Sa..n,ir..l'lr"",,- ~;_Ir: 'jff.fr~.:1/l.Jf'~
~':l... ~~(j'r PI .c;ty:..yA:.
Lot ~ '1. -t, Lfr:LJf
~ S'L.- 1'& ~I
Zlp:- q y~{.~
"t"'"=:.!jS':J.. ~4f2
Zop: 9~~c..-:L
Address:
INSTALLATION W1R~D BY:
(J OWNER
o ELE'CTRlCAL CONTRACToR
BIlling Addre.s:
Credit C"d Numt>er:
-@.~
'--
. Cl'fldll Card Holder Name:_
o-n
Zip:
,/
VlSA,__ Me:
- -
PROJECT AIl11RESS:
llc>q
'S' 0 ,.
~
-\:
TYPE OF ~ Check all that apply 0 New
~tlal :J Mulli-family ;::: Commercial
o AlteratlonlAlldttion
::J Mobile Home
Sq. ft
!-(..oo
...(
---.!
D Sign~
."
Cl Remote MeIer 0 Detached garage 0 Hol Tub 0 Swim Pool D Septic Pump
:J Low Voltage 0 Telecom.
NUlTlber of Circul18 added or altered:_.
~ (-J2.,
()- Q.
r.,.. ---.
,
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DESCRIPTION OF TH!; ELECTRICAL PROJl:CT:
tv~J<
~
~
Electrical Heat Load Addltlcms and or Subtractions
Service Inform.tlan
:.l 9,aeooard
:l Furnace
:J He.! Pump
:J Fan-Wall
_KW
KW
- 'TON LRA
~KW ---
o O"erhead SefIIice
;J T ..mp S&rvIce
C Unoarground Service
Vollll\le: t'2.<> ~"-o
Ph",e: ~ 3
Slotvlce Sixe: Zoo
. Feeder Size:
.
,
.~
i
,
,
I herebycertlfy that I neve read and fJx,,/";necJ this application and know that same to be true and correct, and J a~~
9lithorized /0 apply for lI,is permit. I understand It is not the City's legill responsibility to determine what permits
3r9 required; it remains the applicants responsibi/ily to determine what P&rmits Bre required and to obtain such.
Credit Card Hold......" Slgnat~re:---li?~1.JijJ, ,-.I Oltl:~
Owner or Elee. Cont. Signature: ~.f 11 [j?1~ - II Olte: 1000-5____
::/ELECTR.CALPERMIT APF'LICA TJON
PERMIT FEE: $
9r:.. ~O
~
~
~
IElE.tTRfi'CAl ~NSPIE(c"~ON
W~IRl~NCG fRllElPOlRll
417-4735
.sf
APPROVED NOT APPROVED
o ................... DITCH ................... 0
,.8f.. . .. .. . .. . . .. ROUGH IN/COVER. . .. . .. . . ... .. 0
o .................. SERVICE .................. ~
o ........... (j) . . . . . FINAL. . . . . . . . . . . . . . . . . . .. 0
CORRECTIONS NEEDED: ~,I7p /f'o/V,/p ~.....,.::>6K
. ,
AfJl10rI
1) tJtlUrl t-i
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NOTIFY INSPECTOR WHEN CORRECTIONS
ARE COMPLETED WITHIN 15 DAYS
- DO NOT REMOVE -
OLYMPIC PRINTERS, INC. (360) 452-1381
\
IEllECTIPWCAIL ~IMSPrECT~ON
W~IFa~INIG [R1IEPO~1f'
417-4735
.. ,
DATE
PERMIT'
~
9, "5' 01'-'f7b
NERI NTAACTOR
~71Uc. SV1 ?
ADDRESS
/b// :5. 0.. :5/,
APPROVED NOT APPROVED
o ................... DITCH ................... 0
o .............. ROUGH IN/COVER ..............0
o .................. SERVICE .................. 0
o .................... FINAL.... ... .............fir
fj)/
CORRECTIONS NEEDED: l;?""C ( ~.uo r; /'79
.L.44;J< // "7 (2- LN~ C A/" /Z/.6<Jn1Jfl)_
\
NOTIFY INSPECTOR WHEN CORRECTIONS
ARE COMPLETED WITH.IN 15 DAYS
- DO NOT REMOVE -
OLYMPIC PRINTERS, INC. (360) 45.2-1381
."
"
, "
IEIUEC11R~CAl ~NSIPIEC1r~<OJNI
W~ IRWMG 1RllEIP<OJIRll
417-4735
6JC/' -
PERMIT'
IN$o
~.e/c:.. .sL.~/ce--
ADDRESS
.... /b/l.:5" 0 Sf
APPROVED NOT APPROVED
o """"""""'" DITCH """",""""" 0
o "'",,''''''' ROUGH IN/COVER", " "",,'" 0
o """',""""" SERVICE """"""""" 0
o """";;f{[)""" FINAL, , , ' , , , , , , , , , , , , , , " 0
CORRECTIONS NEEDED: J /V ~r~ /7'7/0 (J .~ /9-fi."
@Df:-;NS7nU- /17UOrZ-tN& hrc M.-rrr~
&PUN-.o ~..s
/)v<<
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NOTIFY INSPECTOR WHEN CORRECTIONS
ARE COMPLETED WITHIN 15 DAYS
OLYMPIC PRINTERS, INC. (360) 452-1381
- DO NOT REMOVE -
IEllEt:ninCAl flNSPlEC1fU:llN
Wfl~BNG REPORT
417-4735
"
.'
..
Ie,
APPROVED NOT APPROVED
o .".",."".,.,." DITCH .,..,.,."".".", 0
o """........ ROUGH IN/COVER... .. ... ... '" ~
o ,."..".,.".,.,. SERVICE ,.,.,."""""" 0
o ',.,.".,..,.,.,.". FINAL, , , , . , , , , . , , , , . , , , ,. 0
CORRECTIONS NEEDED:
~1 ~~f'
IS ' O/l/.....
Cb> Q /J.X Pa ~r '
~vniJ ,
~.~, ZA ~..
l.-Y\ l:...u.-. k ry
I/v\ ~~ iW\
NOTIFY INSPECTOR WHEN CORRECTIONS
ARE COMPLETED WITHIN 15 DAYS
- DO NOT REMOVE _
OLYMPIC PAINTERS, INC. (360) 452-1381
FROM :
FRX NO. :
RU9.
05 2003 08: 03PM P2 \., ;....~
FOk OFI'ICI.u. VS"..;,;.-tI
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ELECTRICAL PERMIT APPLICATION
The EloelIICal P.....lt "~Ucatlon mdllt II. Riled out ,,_a_Iv.
p ,.... type Q( "pMI'.. I..k. If V DU """. ..Y IIVMlIone. pia.. e.11 (380) 811-41.
Fa .umb." (380)4170<6711
P,opOl\y Owner:
i..t <;;2. (./1~ '1Fu:. "f 5 '2- It, lot?.. Lj
Phon.: Lt
Add_: \ 1
1:' e: c..F'
. EI__ Contraatar; E.! ft ,'./ n (...- kv; ~ ,"lht...... Li......#:S & '32..",
AddresS: .f!:'";).. ~..-.. 1/c.!lI..,f?J CIty:A:J /,,"'l'iJ.;!J..~
INSTALLATION WIRED BV; 0 OWNER ~ICAL CONTRACTOR
CfrJdit Carrl Hold. Name:
e",,: "'1
c"f
ZIp: ~)
Phone: 1., ~ . t.'f
Zip: 9g:=:"..
~ City:
~ . , Exp. Date:
OY\
PROJecT ADIIlU!!ss: It/I .5. &J. oS r. / n 1/ /
. /
::2F WORK: Check il1l thllt apply: 0 New
. eskIentlal 0 MultI-family . 0 Commercial
CnHIIf Carrl Number:
Zip:
VISA:
Bllllnll Addrass:
.::5.
cJ. S77 / /709
/
a A1teratlan/Addlllon
....5.0.sr-;.
.0 MobJIeHome
Sq.Ft.
o RemDte Meter 0 Detached glll'age" d Hol Tub Cl SwlmPDOl' 0 Septic Pump' o' 0 L-oW Voltage 0 Telecom.
Number of Clrl:U/1I 8dded or all8nld:
DESCRIPTION OF TH~ aECTR.lc~ PROJECT:
~-4-:e~ '0.~'-
.(Q& o--.p
.EI~I LnlU'i additions and Dr suhtnlctiaM
service Inform.~
o Overlle8d Service
o Temp Service
o Underground Service
vollilge;
Ph"e: 1:11 03
Service Size:
Feeder Size:
o BlIS8boerd
o Fumeae
o Heal Pump
o Fan-Well
KW
KW
_TON_LAR.
KW
PAMC 14.05.060(B): For Induelrtel. comrnen:lel. & residential projects largerlhan a dUplell, a one .ltnedl'8Wlng ofllle EI8C\riCII/ Sen.
Feeclel5, buil~lng slz It (sq. fl.), load calculations. and the ty pe & of CQnductolll sndIor racew ey is raqulrec:l and shsJI Deconn pany llIe
Electrical Pennlt application.
I hereby certify that I have read and examined this application and know that same to be tftJe and correct, tine
authorized to apply for this permit. I understand II is not the City's legal responslbifIty to determine whet perm
are reqUired; it remains the applicants rea"onslbility to determine what permits are required and to obtain SlJe,
OWnor elf IiI,Go GClIll. Slgnatur.:
(~) ! 0./7) j
'~Vv._f.p.lCLI4H DII" .../'"1 ~y
!/A.J ~ c:2 ,~I Dlw: ~ /17 (OV
PERMIT FEE: $ +b.90x-3
Cnt~11 Cud Hal.". SI,netu..'
PI/V.!101QJ7J03
MAR 26 2004 13:32
HOUS1NG AUTH CLALLAM
3604577001
p. 1
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2603 S. Francis Street
Port Anfleles, WA 98362
- I. .1 {'" . ., .
Housing ~uthoritY"ofthe
County o~CI~lIa~_".. -1'::;.
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(360) 45~!.7631 . (360) 457-7001 Fax
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The hlonnallon _lWi...d In the facsimile message Is legally prlvlleged 8IId confid8nllal Information
InlenCled only for the ... of the IndMdual or entlty to whom the fax Is addl'lSS4ld. If the I8lIder of fhfs
....... Is lIot the Intended recipient, Y\llI- notified that 8IlY dlssernnaUon, dlatrl>ution or copy of this
tIlIecapy IS sIJ1cl1y prohIbll8d. If Y\llIIIaw .....1vlId fhfs lBlecopy III .nor, please I~ notify us by
lIlIep/llOll8 and l!IIum the origlnal_lo us at the addresa lIbov8 via the united StatIls Postl"SioMce.
1hanIt you.
~1'ov<... I" b U-.:;. (.v if:t:. ,:, Z II VI' 'r'- -, ~ ,SI - 'I ~ II ~ 1
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f< ~S., (0 FOL)...o<J frY' h3cvtr" fl..- W'lE.;CS
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MAR 26 2004 13:32
HOUSING AUTH CLALLAM
3604577001
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PORT AlfGELES,WASHING70N 983//2
(380) 457-9600
. FAX (380) 457-9556 .
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CITY OF PORT ANGELES
DEPARTMENT OF COMMUNITY DEVELOPMENT - BUILDING DIVISION
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
04-00000102 Date
.649868
1611 S 0 ST
06-30-01-5-5-0060-0000-
RES NEW SFR
4/09/04
RESIDENTAL SF 9000
RS9 RESDNTL SINGLE FAMILY
69610
Owner
Contractor
BAMER, REBECCA
211 FORSBERG RD
PORT ANGELES
(360) 452-9654
Structure Information
Construction Type
Occupancy Type
Other struct info
OWNER
WA 98362
NEW 1199 SF SFR W/ATT 524 SF
TYPE V NON-RATED
SINGLE FAM & CONGREGATES
TOTAL % LOT COVERAGE
CONSTRUCTION TYPE
NUMBER OF STORIES
EXISTING LOT COVERAGE
LOT SIZE
PROPOSED LOT COVERAGE
TOTAL LOT COVERAGE
NUMBER OF UNITS
GARAGE
19.00
V-N
1. 00
1. 00
9004.00
1723.00
1723.00
1. 00
76.00 Plan Check Fee
4/09/04 Valuation
10/06/04
.00
o
-
~
---
-
" ~
-..
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~ ~
"
~
~
Permi t
Additional desc
Permit Fee
Issue Date
Expiration Date
MECHANICAL PERMIT
Qty
Unit Charge Per
4.00
BASE FEE
7.2500 ECH ME-VENT FAN
Extension
47.00
29.00
Permit PLUMBING PERMIT
Additional desc
Permit Fee 132.00 Plan Check Fee .00
Issue Date 4/09/04 Valuation 0
Expiration Date 10/06/04
Qty Unit Charge Per Extension
BASE FEE 47.00
8.00 7.0000 ECH PL- EA.FIXTURE ON ONE TRAP 56.00
1. 00 7.0000 ECH PL- EA. INSTALL WATER PIPE 7.00
1. 00 15.0000 ECH PL- EA. BLDG SEWER 15.00
1. 00 7.0000 ECH PL- EA.WATER HEATER 7.00
Permi t . . . .
Additional desc
Permit Fee
Issue Date
Expiration Date
BUILDING PERMIT -RESIDENTIAL
807.25
4/09/04
10/06/04
Plan Check Fee
Valuation
.00
69610
Qty
Unit Charge Per
BASE FEE
Extension
667.25
Separate Permits are required for electrical work, SEPA, Shoreline, ESA, utilities, private and public improvements. This permit becomes
null and void if work or construction authorized is not commenced within 180 days, if construction or work is suspended or abandoned
for a period of 180 days after the work as commenced, or if required inspections have not been requested within 180 days from the last
inspection. I hereby certify that I have read and examined this application and know the same to be true and correct. All provisions of
laws and ordinances governing this type of work will be complied with whether specified herein or not. The granting of a permit does not
presume to give authority to violate or cancel the provisions of any state or local law regulating construction or the performance of
construe' n. ,'/vd:
Signature of Owner (if owner is builder)
Date
T:\PLANNING\FORMS\1102.1S [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 UNLAWFUL TO COVER, INSULATE OR CONCEAL ANY WORK BEFORE
INSPECTED AND ACCEPTED. POST PERMIT IN A CONSPICUOUS LOCATION.
KEEP PERMIT CARD AND APPROVED PLANS AT JOB SITE.
INSPECTION TYPE DATE ACCEPTED COMMENTS
YES NO
FOUNDATION:
FOOTINGS
WALLS
FOUNDATION DRAINAGE/DOWN SPOUTS
ELECTRICAL (LIGHT DEPT) SEPARATE PERMIT: #
ROUGH-IN I I
PLUMBING
UNDER FLOOR / SLAB
ROUGH-IN
WATER LINE (METER TO BLDG)
GAS LINE
BACK FLOW / WATER
AIR SEAL
WALLS
CEILING I I
FRAMING
JOISTS / GIRDERS
SHEAR W ALL/HOLD DOWNS
WALLS / ROOF / CEILING
DR YW ALL (INTERIOR BRACED PANEL ONLY)
T-BAR
INSULATION
SLAB I
WALL / FLOOR / CEILING I
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. SEPARATE PERMIT #'s SEPA:
PARKING/LIGHTING ESA:
LANDSCAPING SHORELINE:
FINAL INSPECTIONS REQUIRED PRIOR TO OCCUPANCY/USE
RESIDENTIAL DATE YES NO COMMERCIAL DATE ACCEPTED
YES NO
ELECTRICAL - LIGHT DEPT. 417-4735 ELECTRICAL
LIGHT DEPT
CONSTRUCTION R.W. / PW/ CONSTRUCTION - R.W.
ENGINEERING 417-4807 PW / ENGINEERING
FIRE 417-4653 FIRE DEPT.
PLANNING DEPT. 417-4750 PLANNING DEPT.
BUILDING 417-4815 BUILDING
T:\PLANNING\FORMS\ 11 02.15 [11/14/2003]
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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
04-00000976 Date
.798288
1611 S 0 ST
06-30-01-5-5-0060-0000-
ELECTRICAL ONLY
10/26/04
RESIDENTAL SF 9000
RS9 RESDNTL SINGLE FAMILY
o
Owner
Contractor
BAMER, REBECCA
211 FORSBERG RD
PORT ANGELES
(360) 452-9654
WA 98362
ELECTRIC SERVICE
82 DRAPER RD
PORT ANGELES
(360) 452-6424
WA 98362
Permit ELECTRICAL NEW RESIDENTIAL
Additional desc
Permit Fee 96 .40 Plan Check Fee .00
Issue Date 10/26/04 Valuation 0
Expiration Date 4/25/05
Qty Unit Charge Per Extension
1. 00 73.0000 ECH EL-R-SQFT FIRST 1300 73.00
1. 00 23.4000 5C EL-R-SQFT ADDITIONAL 500 23.40
"'-
~
'"
'"
Fee summary Charged Paid Credited Due
----------------- ---------- ---------- ---------- ----------
Permit Fee Total 96 .40 96.40 .00 .00
Plan Check Total .00 .00 .00 .00
Grand Total 96.40 96.40 .00 .00
~~
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Separate Permits are required for electrical work, SEPA, Shoreline, ESA, utilities, private and public improvements. This permit becomes
null and void if work or construction authorized is not commenced within 180 days, if construction or work is suspended or abandoned
for a period of 180 days after the work as commenced, or if required inspections have not been requested within 180 days from the last
inspection. I hereby certify that I have read and examined this application and know the same to be true and correct. All provisions of
laws and ordinances governing this type of work will be complied with whether specified herein or not. The granting of a permit does not
presume to give authority to violate or cancel the provisions of any state or local law regulating construction or the performance of
construction.
Date
Signature of Contractor or Authorized Agent
Date
Signature of Owner (if owner is builder)
T:\PLANNING\FORMS\1 102.15 [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, INSULA TE OR CONCEAL ANY WORK BEFORE
INSPECTED AND ACCEPTED. POST PERMIT IN A CONSPICUOUS LOCATION.
KEEP PERMIT CARD AND APPROVED PLANS AT JOB SITE.
INSPECTION TYPE DATE ACCEPTED COMMENTS
YES NO
FOUNDATION:
FOOTINGS
WALLS
FOUNDATION DRAINAGE/DOWN SPOUTS
ELECTRICAL (LIGHT DEPT) SEPARATE PERMIT: # n, R /r: (.,.,J2~1 <:: ~~. J.."1.~~
ROUGH-IN III -. '-~nf.J I .:.X I
/; ! ,
PLUMBING \ I
.r -
UNDER FLOOR 1 SLAB r..~- ....
.,""- . -
ROUGH-IN r;,: 'r'
~A TER LINE (METER TO BLDG) ,I - ,: !.1
I 'f(' / !
GAS LINE
BACK FLOW 1 WATER /0 ;)7 c) \..( 1\ , i i
AIR SEAL
WALLS
CEILING I
FRAMING
JOISTS 1 GIRDERS
SHEAR WALL/HOLD DOWNS
WALLS 1 ROOF 1 CEILING
DRYWALL (INTERJOR 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:
PARKINGILIGHTlNG ESA:
LANDSCAPING SHORELINE:
FINAL INSPECTIONS REQUIRED PRIOR TO OCCUPANCY/USE
RESIDENTIAL DATE YES NO COMMERCIAL DATE ACCEPTED
YES NO
ELECTRJCAL - LIGHT DEPT. 417-4735 !,-/J h 'S" kO ELECTRJCAL
LIGHT DEPT
CONSTRUCTION R.W.I PWI , CONSTRUCTION - R- W.
ENGINEERJNG 417-4807 PW 1 ENGINEERJNG
FIRE 417-4653 FIRE DEPT.
PLANNING DEPT. 417-4750 PLANNING DEPT.
BUILDING 417-48]5 BUILDING
T:\PLANNING\FORMS\1102.15 [11/14/2003]
1C \,ORT ""'-\0:
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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
04-00000289 Date
.041550
1611 S 0 ST
06-30-01-5-5-0060-0000-
ELECTRICAL ONLY
4/12/04
RESIDENTAL SF 9000
RS9 RESDNTL SINGLE FAMILY
o
Owner
Contractor
BAMER, REBECCA
211 FORSBERG RD
PORT ANGELES
(360) 452-9654
WA 98362
ELECTRIC SERVICE
82 DRAPER RD
PORT ANGELES
(360) 452-6424
WA 98362
Permit
Additional desc
Sub Contractor
Permit Fee
Issue Date
Expiration Date
ELECTRICAL TEMPORARY SERVICE
60A
ELECTRIC SERVICE
40.90 Plan Check Fee
4/12/04 Valuation
10/09/04
.00
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Qty Unit Charge Per
1.00 40.9000 ECH EL-TEMP SRV - 0-60 SRV FDR
Extension
40.90
Fee summary Charged Paid Credited Due
----------------- ---------- ---------- ---------- ----------
Permit Fee Total 40.90 40.90 .00 .00
plan Check Total .00 .00 .00 .00
Grand Total 40.90 40.90 .00 .00
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Separate Permits are required for electrical work, SEPA, Shoreline, ESA, utilities, private and public improvements. This permit becomes
null and void if work or construction authorized is not commenced within 180 days, if construction orwork is suspended or abandoned
for a period of 180 days 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
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 UNLAWFUL TO COVER, INSULATE OR CONCEAL ANY WORK BEFORE
INSPECTED AND ACCEPTED. POST PERMIT IN A CONSPICUOUS LOCA nON.
KEEP PERMIT CARD AND APPROVED PLANS AT JOB SITE.
(I
INSPECTION TYPE DATE ACCEPTED COMMENTS
YES NO
FOUNDATION:
FOOTINGS
WALLS
FOUNDA TION DRAINAGEIDOWN SPOUTS
ELECTRICAL (LIGHT DEPT) SEPARATE PERMIT: #
ROUGH-IN I I
PLUMBING
UNDER FLOOR 1 SLAB
ROUGH-IN
W A !ER LINE (METER TO BLDG)
,/" ;#'S LINE
.':..} aA,CK FLOW 1 WATER
"" AtfI!kAL
't:A..LLS
C iI1ING
,,,- Fa!nHNG
rt5iSTS 1 GIRDERS
SliiAR WALL/HOLD DOWNS
A WA'tLS 1 ROOF 1 CEILING
I'" IilRYW ALL (INTERJOR BRACED PANEL ONL Y)
T~BAR
INSULATION
~. SLAB
" ~tL 1 FLOOR I CEILING I
~ tHANICAL
~ ... T PUMP
G ~INE
WOOD STOVE 1 PELLET 1 CHIMNEY
HOOD 1 DUCTS
PW UTILITIES 1 SITE WORK (Engineering Division) SEPARATE PERMIT #'s:
..#FA TERLINE 1 METER
. ~~ER CONNECTION
'J^N1T ARY
TORM
JL:4NNING DEPT. SEPARATE PERMIT #'s SEPA:
PARKING/LIGHTING ESA:
LANDSCAPING SHORELINE:
FINAL INSPECTIONS REQUIRED PRIOR TO OCCUPANCY/USE
RESIDENTIAL DATE YES NO COMMERCIAL DATE ACCEPTED
YES NO
ELECTRJCAL - LIGHT DEPT. 417-4735 3h;?~'1' IAe'-O ELECTRJCAL
LIGHT DEPT
CONSTRUCTION R.W.I PWI II' I' CONSTRUCTION - R.W.
ENGINEERING 417-4807 PW 1 ENGINEERJNG
FIRE 417-4653 FIRE DEPT.
PLANNING DEPT. 4 J7~4750 PLANNING DEPT.
BUILDING 417-4815 BUILDING
T:\PLANNING\FORMS\l102.15 [11114/2003]
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CITY OF PORT ANGELES
DEPARTMENT OF COMMUNITY DEVELOPMENT - BUILDING DIVISION
321 EAST 5TH STREET, PORT ANGELES, WA 98362
Application Number
pin number
04-00000102
.649868
Page
Date
2
4/09/04
Qty Unit Charge Per
20.00 7.0000 THOU BL-50,001-100K (7.00 PER K)
Extension
140.00
Special Notes and Comments
The site is within the Madrona Woods Subdivision. The
residential structure may NOT be finaled until
infrastructure improvements for the subdivision are
installed and approved.
Electrical load calculations and elctrical permits are
required.
Other Fees
SEWER SYSTEM DELV CHARGE
STATE SURCHARGE
PW WATER SYSTEM USE FEE
745.00
4.50
1025.00
Fee summary Charged Paid Credited Due
----------------- ---------- ---------- ---------- ----------
Permit Fee Total 1015.25 1015.25 .00 .00
Plan Check Total .00 .00 .00 .00
Other Fee Total 1774.50 1774.50 .00 .00
Grand Total 2789.75 2789.75 .00 .00
Separate Permits are required for electrical work, SEPA, Shoreline, ESA, utilities, private and public improvements. This permit becomes
null and void if work or construction authorized is not commenced within 180 days, if construction or work is suspended or abandoned
for a period of 180 days after the work as commenced, or if required inspections have not been requested within 180 days from the last
inspection. I hereby certify that I have read and examined this application and know the same to be true and correct. All provisions of
laws and ordinances governing this type of work will be complied with whether specified herein or not. The granting of a permit does not
presume to give authority to violate or cancel the provisions of any state or local law regulating construction or the performance of
construction.
Signature of Contractor or Authorized Agent
Date
Signature of Owner (if owner is builder)
Date
T:\PLANNING\FORMS\1102.lS [11/14/2003]
BUILDING PERMIT INSPECTION RECORD
CALL 417-4815 FOR BUILDING INSPECTIONS. CALL 417 -4 735 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 LOCA nON.
KEEP PERMIT CARD AND APPROVED PLANS AT JOB SITE.
INSPECTION TYPE DATE ACCEPTED COMMENTS
YES I NO
FOUNDATION:
FOOTINGS c.. c.--O '-I ...JLL
WALLS <:- -1I-D4 12v
FOUNDATION DRAINAGE/DOWN SPOUTS :::--,fj,i_ CH iR ,)
ELECTRICAL (LIGHT DEPT) SEPARATE PERMIT: #
ROUGH-IN I I
PLUMBING
UNDER FLOOR 1 SLAB
ROUGH-IN R.. If)' 0 J.{ ~} J.. L-
WATER LINE (METER TO BLDG) 'l.. - '1, -10 r j . L .
GAS LINE
BACK FLOW 1 WATER
AIR SEAL
WALLS Ii/_Is-OJ-j j . L.
CEILING
FRAMING
JOISTS 1 GIRDERS
SHEAR WALL/HOLD DOWNS q- ?'--CJ) \ t-L--
WALLS 1 ROOF 1 CEILING i ;- U:J--O 1-1 ~1~
DR YW ALL (INTERIOR BRACED PANEL ONL Y)
T-BAR
INSULATION
SLAB
WALL 1 FLOOR 1 CEILING 111- , <{ - o~ l.i. \. .
MECHANICAL 1'-1 El Ii r IN it L 4 .- 25' - C' s- )LL ,~\
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:
PARKING/LIGHTING ESA:
LANDSCAPING SHORELINE:
FINAL INSPECTIONS REQUIRED PRIOR TO OCCUPANCY/uSE
RESIDENTIAL DATE YES NO COMMERCIAL DATE ACCEPTED
YES NO
ELECTRICAL - LIGHT DEPT. 417-4735 ELECTRICAL
LIGHT DEPT
CONSTRUCTION R.W. 1 PWI s=~~" #.")~ It) '-1"'';:- CONSTRUCTION - R.W.
ENGINEERING 417-4807 PW 1 ENGINEERING
FIRE 417-4653 FIRE DEPT.
PLANNING DEPT. 417-4750 PLANNING DEPT.
BUILDING 417-4815 71~l6-C5- .J t../.- BUILDING
;)
T:\PLANNINGIFORMS\1102.1S [11/14/2003]
f VORT ~
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CITY OF PORT ANGELES
DEPARTMENT OF COMMUNITY DEVELOPMENT - BUILDING DIVISION
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
04-00000102 Date
.649868
1611 S 0 ST
06-30-01-5-5-0060-0000-
RES NEW SFR
11/17/04
RESIDENTAL SF 9000
RS9 RESDNTL SINGLE FAMILY
69610
Owner
Contractor
BAMER, REBECCA
211 FORSBERG RD
PORT ANGELES
(360) 452-9654
Structure Information
Construction Type
Occupancy Type
Other struct info
OWNER
WA 98362
NEW 1199 SF SFR W/ATT 524 SF
TYPE V NON-RATED
SINGLE FAM & CONGREGATES
TOTAL % LOT COVERAGE
CONSTRUCTION TYPE
NUMBER OF STORIES
EXISTING LOT COVERAGE
LOT SIZE
PROPOSED LOT COVERAGE
TOTAL LOT COVERAGE
NUMBER OF UNITS
GARAGE
19.00
V-N
1. 00
1. 00
9004.00
1723.00
1723.00
1. 00
-------------------------------------------------------
Permit
Additional desc
Permit Fee
Issue Date
Expiration Date
FIRE SPRINKLER RESID
.00
11/17/04
5/17/05
Plan Check Fee
Valuation
.00
o
-----
Special Notes and Comments
The site is within the Madrona Woods Subdivision. The
residential structure may NOT be finaled until
infrastructure improvements for the subdivision are
installed and approved.
Electrical load calculations and elctrical permits are
required.
~
........
...........
V)
C;
--------------------------------------------------------------
Other Fees
SEWER SYSTEM DELV CHARGE
STATE SURCHARGE
PW WATER SYSTEM USE FEE
745.00
4.50
1025.00
~
Fee summary Charged Paid Credited Due
----------------- ---------- ---------- ---------- ----------
Permit Fee Total .00 .00 .00 .00
Plan Check Total .00 .00 .00 .00
Other Fee Total 1774.50 1774.50 .00 .00
Grand Total 1774.50 1774.50 .00 .00
V)
'-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 performance of
construction.
("J) ,'\! r:: I 1- 1 :.
Signature of Contractor or Authorized Agent
Date
Signature of Owner (if owner is builder)
Date
T:IPLANNINGIFORMS\1102.IS [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 UNLAWFUL TO COVER, INSULATE OR CONCEAL ANY WORK BEFORE
INSPECTED AND ACCEPTED. POST PERMIT IN A CONSPICUOUS LOCATION.
KEEP PERMIT CARD AND APPROVED PLANS AT JOB SITE.
INSPECTION TYPE DATE ACCEPTED COMMENTS
YES NO
FOUNDATION:
FOOTINGS
WALLS
FOUNDATION DRAINAGE/DOWN SPOUTS
ELECTRICAL (LIGHT DEPT) SEPARATE PERMIT: #
ROUGH-IN
PLUMBING
UNDER FLOOR 1 SLAB
ROUGH-IN
W '" TER LINE (METER TO BLDG)
GAS LINE
BACK FLOW 1 WATER
AIRISEAL
WALLS
CEILING I I
FRAMING
JOISTS 1 GIRDERS
SHEAR WALL/HOLD DOWNS
WALLS 1 ROOF 1 CEILING
DRYW ALL (INTERIOR BRACED PANEL ONLY)
T-BAR
INSULATION
SLAB
WALL 1 FLOOR 1 CEILING I 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:
PARKING/LIGHTING ESA:
LANDSCAPING SHORELINE:
FINAL INSPECTIONS REQUIRED PRIOR TO OCCUPANCYiUSE
RESIDENTIAL DATE YES NO COMMERCIAL DATE ACCEPTED
YES NO
ELECTRICAL - LIGHT DEPT. 417-4735 ELECTRICAL
LIGHT DEPT
CONSTRUCTION R. W. 1 PWI CONSTRUCTION - R. W.
ENGINEERING 417-4807 PW 1 ENGINEERING
FIRE 417-4653 FIRE DEPT.
PLANNING DEPT. 417-4750 PLANNING DEPT.
BUILDING 417-4815 BUILDING
T:\PLANNING\FORMS\1102.1S [11/14/2003]
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BUILDING PERMIT - APPLICATION
FOR OFFICIAL USE ONLY:
Date RIle.: ~. - ~ -D4
Pennit#:~
Date~ed:~
Date Issued:
Fill out COMPLETELY and in INK. Your application and site plan MUST BE
COMPLETE to be accepted for review. Hyou have any questions, caD
(360) 417-4815
Applicant or Agent: 110 us, IV (j.. AiJ'fHO (l 'rt C() i! NTY of C~i.JA1?1 Phone:
Owner: R E f3 z (' C' -4 f!:>,4-m 'fK.. Phone:
Address: g /I Fb/(S~Zf1J; RSD City: fof((( fJ,.Jc;.-t:-l-es
Architect/Engineer: LINDlOt'i( 6- ftRc I1lf~C,/~ Phone:
.
Contractor If4 ( G State License #: Exp: Phone:
Address: :I- to '3 .5 (1, r(C1trJ ~ I S 51. City: (/6te 'f M ~ t)" C 5- Zip: /83(,. 1.
PROJECT ADDRESS: / t II 56u'TH (oj +' 5'1"fl~'l'r, RA J ZONING: f( S-- 9
.
LEGAL DESCRIPTION: Lot: + G. Block: (~ 5rl!~ v Subdivision: P1ArJJlaJ/V,It WoaD S
CLALLAMCOUNTYPARCELNUMBER: Or:, "3 00 I r:~ - Dote
c.;SJ..-763/
,/5'";) - p t S-y
Zip: Y 8'3 C 2-
'If,)- tIlt
Credit Card Holder Name:
BU6ng Address: City:
Credit CardType VISA Me # Exp. ~.te:
TYPE OF WORK: .sIZElVALUATION: gt. .
~ResidentiaI KNewCons1r. 0 Re-roof 0 Stove IIfr ~ SF:@$ .tjy ../SF.=$ ~~/ ?/f,)
o Multi-family 0 Addition 0 Move X Garage ~ SF. @ $3{"7 ;"0 ISF. = $ I ~.;2. .~
o CoJJJIneI'Cial 0 Remodel 0 Demolition 0 Deck SF. @ $ . 'SF. = $
o Repair 0 Sign . 0 Other TOTAL VALUATION $ 61; t /0
BRIEF DESCRIPTION OF THE PROJECT: NEw\'JlrI?/..'f.., F/PnJJ..y je'iSFbfJ{<tg .-
o/lli.. S'/ORy W J17tM-1'.A-C.Ht:O :).-eAll ~F~
COMMERCIAIJRESIDENTIAL: Occ1Jpancy Group: Occupant LOad:'. Colist1iiction Type:
No. of Stories: --L Lot Size: 100 Lj Existing Sq. Ft. 0 & Proposed Sq. Ft. II;;' 3 = TOTAL Sq.Ft. / 7:2 3
Existing lot coverage ~ % & Proposed lot coverage -4-% = Total lot coverage I ? %
ESAlWetIand(s): 0 Yes 0 No SEPA Checklist required? 0 Yes 0 No Other:
APPROVALS:
PLAN:~
BLDG:~
DPWU:
FIRE:
OTHER:_
PLANNING USE ONLY:
BUILDING PERMIT APPLICATION SUBMIITAL: The Building Division can provide you with infonnation 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 viill. 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 IIlQSt 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: lino permit is issued within 180 days oftbe 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 be extended more than once.
I hereby certify that I have read and examined this application and know the same to be true and conect.. I am authorized to apply for this permit. and
understand that it is my responsibility to determine w~at permits are required ,
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