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FROM
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ELECTRICAL WORK PERMIT APPLICATION .
~tractor
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o Request Inspection
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or -7'7
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I:J Annual Permit 0 Ala.rm D Carnival D Commenial
r ~ical Contraetor II\SIallation description
Job ..ired by o Owner
E.lectrical conlrQctor name ~o-'\J~ License number I goD $1-A- ~
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o Cash o Check #
I hl;fcby certify lbat I am the owner of the above named property or a licensed ~ ..-viSa Mastercard Discover
electrical contractor (or the fifTll.... authorized agen.c) and am making the c1ccmcal
installation or altCTlltion in compliance with tbe electrical law, Chapter 19.28 RCW. Card # --~~---------
'- ~gn""r. o~.<~ or .1.mlc.1 'dmlnl"~..or Expiration Date ($nspc~~c: ~ [)
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WALLS
Insulation Only
I)lle Appro~twl By
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CEILING
Insulation Only
Dale ^~l'OvedBy
~ . Cover Av:J
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THERMOSTAT
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App"wod 1:1...
SERVICE
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Electrical Load Additions and or subtract'oM t
IJ NO LOAD CHANGES 1\
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o H~at Pump Ton LAR D~ ~ Y}\ D Temp Service
o Fan-Wall - KW - \' 0 Underground $etvioe
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Service Information
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VOltage
Phase IJ 1 IJ 3
Service Size: _
~eader SI:e:
Inspection Area, Building or Equipment lnspcctcd Action Taken Electrical
Datc Inspector
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PERMIT.
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APPROVED NOT APPROVED
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o .............. ROUGH IN/COVER.. ... .. .. .. ... 0
o .................. SERVICE .................. 0
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NOTIFY INSPECTOR WHEN CORRECTIONS
ARE COMPLETED WITHIN 15 DAYS
- DO NOT REMOVE -
OLYMPIC PRINTERS, INC. (360) 45,2.1381
FROM
~~ractor
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Q Annual Permit 0 Alarm Q
Job wired by ~
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Address of htspecUon
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I hereby eertif)' lhat I am the owner of the above
electrical contractor (or the finn's authorized agent
installation or alteration in compliance with the elec
;gn.,ure o'O:-.,~ or ,
/ WALLS
Insulation Only h
DAle ApPNvllIo! By I),.Ie
Cover
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CJ NO LOAD CHANGES
o Baseboard _ KW
o Furnace _ KW
o Heat Pump _ Ton _LAR
o Fan-Wall KW
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ELECTRiCAL !NSPECT~ON
W!iRING REPORT
417-4735
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o .................. SERVICE .................. 0
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NOTIFY INSPECTOR WHEN CORRECTIONS
ARE COMPLETED WITHIN 15 DAYS
tnspection Area,B - DO NOT REMOVE -
Date
OLYMPIC PAINTERS, INC. (360) 452-'351
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CITY OF PORT ANGELES
DEPARTMENT OF COMMUNITY DEVELOPMENT - BUILDING DIVISION
321 EAST 5TH STREET, PORT ANGELES, W A 98362
Application Number
pin number . . . .
Property Address
ASSESSOR PARCEL NUMBER:
Application description
Subdivision Name
Property Use . . . .
Property Zoning . . .
Application valuation
04-00000097 Date
.833698
1619 S 0 ST
06-30-01-5-5-0050-0000-
RES NEW SFR
RESIDENTAL SF 9000
RS9 RESDNTL SINGLE FAMILY
71573
Owner
Contractor
HOUSING AUTHORITY OF CLALLAM
2603 S FRANCIS ST
PORT ANGELES WA 983626710
OWNER
Structure Information
Construction Type
Occupancy Type
Other struct info
NEW 1180 SF SFR W/ATT 520 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
Permi t . . . .
Additional desc
Permit Fee
Issue Date
Expiration Date
MEC lANICAL PERMIT
76.00 Plan Check Fee
4/09/04 Valuation
10/06/04
Qty
Unit Charge f'~r
4.00
BASE FEE
7.2500 ECH ME-VENT FAN
Permit . . . .
Additional desc
permi t Fee
Issue Date
Expiration Date
PLUMBING PERMIT
132.00
4/09/04
1 )/06/04
Plan Check Fee
Valuation
Qty Unit Charge F!r
BASE FEE
8.00 7.0000 ECI PL- EA.FIXTURE ON ONE TRAI
1. 00 7.0000 ECI PL- EA. INSTALL WATER PIPE
1. 00 15.0000 EC I PL- EA. BLDG SEWER
1. 00 7.0000 EC I PL- EA.WATER HEATER
permi t
Additional desc
Permit Fee
Issue Date
Expiration Date
BUJ JDING PERMIT -RESIDENTIAL
821.25
1/09/04
. 0/06/04
Plan Check Fee
Valuation
Qty
Unit Charge :C'er
BASE FEE
4/09/04
GARAGE
19.00
V-N
1. 00
1. 00
9006.00
1700.00
1700.00
1. 00
.00
o
---
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Extension
47.00
29.00
.00
o
Extension
47.00
56.00
7.00
15.00
7.00
328.50
71573
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
construction.
~o
T:\PLANNING\FORMS\1102.15 (11114/2003]
Signature of Owner (if owner is builder)
Date
BUILDING PERMIT INSPECTION RECORD
CALL 4] 7-4815 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 ACCEPTED COMMENTS
YES I NO
FOUNDATION:
FOOTINGS
WALLS .
FOUNDA TION DRAINAGE/DOWN SPOUTS
ELECTRICAL (LIGHT DEPT) SEPARATE PERMIT: #
ROUGH-IN I
PLUMBING
UNDER FLOOR 1 SLAB
ROUGH-IN
WATER LINE (METER TO BLDG)
GAS LINE
BACK FLOW 1 WATER
AIR SEAL
WALLS
CEILING I
FRAMING
JOISTS 1 GIRDERS
SHEAR W ALLIHOLD DOWNS
WALLS 1 ROOF 1 CEILING
DR YW ALL (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:
PARKINGILIGHTlNG 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\1102.15 [11114/2003]
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
04-00000097 Date
.833698
1619 S 0 ST
06-30-01-5-5-0050-0000-
RES NEW SFR
10/25/04
RESIDENTAL SF 9000
RS9 RESDNTL SINGLE FAMILY
71573
Owner
Contractor
HOUSING AUTHORITY OF CLALLAM
2603 S FRANCIS ST
PORT ANGELES WA 983626710
OWNER
Structure Information
Construction Type
Occupancy Type
Other struct info
NEW 1180 SF SFR W/ATT 520 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
9006.00
1700.00
1700.00
1. 00
~
---
..Q
permi t . . . .
Additional desc
Sub Contractor
Permit Fee
Issue Date
Expiration Date
FIRE SPRINKLER RESID
KNIGHT FIRE
.00
10/25/04
4/24/05
PROTECTION INC
Plan Check Fee
Valuation
.00
o
If\
~
Special Notes and Comments
The site is located in the Madrona Woods Subdivision. The
residence may NOT be finaled until infrastructure
improvements for the subdivision are installed and improved.
New subdivision outside the four minute response time shall
be equipped with a residential sprinkler system that is
installed and maintained in accordance with Uniform Fire
Code (UFC) and National Fire Protection Association(NFPA)
standards.
Electrical load calculations and elctrical permits are
required.
o
q
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
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
~~~I~n~UrOri~ violate 0' canoe I the pm:s;ons 01 any state 0' local law ,egulal;ng construction 0' Ihe pertonnance of
-W1k~ ~
Signature of ContracTor or Authorized Agent Date Signature of Owner (if owner is builder) 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 UNLA WFUL TO COVER, INSULA TE 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 NO
FOUNDATION:
FOOTINGS
WALLS
FOUNDA TlON DRAINAGEIDOWN SPOUTS
ELECTRICAL (LIGHT DEPT) SEPARATE PERMIT: #
ROUGH-IN I I
PLUMBING
UNDER FLOOR I SLAB
ROUGH-IN
W f'TER LINE (METER TO BLDG)
dAS LINE
BACK FLOW I WATER
AIR'SEAL
WALLS I
CEILING I
FRAMING
JOISTS I GIRDERS
SHEAR W ALLIHOLD DOWNS
WALLS I ROOF I CEILING
DRYWALL (INTERIOR BRACED PANEL ONLY)
T-BAR
INSULATION
SLAB I
W ALL I FLOOR I CEILING I
MECHANICAL
HEAT PUMP
GAS LINE
WOOD STOVE I PELLET I CHIMNEY
HOOD I DUCTS
PW UTILITIES I SITE WORK (Engineering Division) SEPARATE PERMIT #'s:
WATERLINE I METER
SEWER CONNECTION
SANITARY
STORM
PLANNING DEPT. SEP ARA TE PERMIT #'s SEPA:
PARKINGILIGHTlNG ESA:
LANDSCAPING SHORELINE:
FINAL INSPECTIONS REQUIRED PRIOR TO OCCUPANCYIUSE
RESIDENTIAL DATE YES NO COMMERCIAL DATE ACCEPTED
YES NO
ELECTRICAL - LIGHT DEPT. 417-4735 ELECTRICAL
LIGHT DEPT
CONSTRUCTION R.W.I PWI CONSTRUCTION - R.W.
ENGINEERING 417-4807 PW I ENGINEERING
FIRE 417-4653 FIRE DEPT.
PLANNING DEPT. 417-4750 PLANNING DEPT.
BUILDING 417-4815 BUILDING
T:\PLANNlNG\FORMS\1102.15 (11/14/2003]
PORT ANGELES FIRE DEPARTMENT
102 East 5th, Port Angeles, WA 98362
360-417-4653
Fire Sprinkler System Plan Review
Project Name: Self-Help Housing Address: South 0 Street
Installer: Knight Fire Protection Telephone: 360-417-0505
Type of System: 13D R-3 IX] R-1 D Com D
Date: October 19, 2004 Permit #04-12
We have checked this plan and find that it conforms to the requirements of our ordinance.
Additionally:
1. All systems including underground mains, shall be installed by a state licensed and
certified company. The system shall be installed as per NFP A 13D.
2. All electrical components shall be compatible with the fire alarm system voltage and as
per P AMC and Washington Administrative Codes.
3. All systems will require witness underground flushing, hydrostatic tests for system, and
underground pipe schedule inspection by the Port Angeles Fire Department prior to being
covered. (R-3 and R-1 requires design sprinkler flow.)
4. Before final acceptance of the system, an inspection will conducted by the Port Angeles
Fire Department to ensure the system installation complies with NFP A 13D.
D Contractor
~ Building Department
D Fire Copy
Reviewed by _~~
Date
'O.\~.ft}L'
FP - 9
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BUILDING PERMIT - APPLICATION
FOR OFFICIAL USE ONLY:
Date RtJc.:L -3 <:Jlj .'
......" 0;- ~~
Date Approval: :;> J~ {; 1
Date Issued:
F1II out COMPLETELY aDd ill INK. Your applie.tion md site plm MUST BE
COMPLETE to be aeeepted for revi~. Ifyoa have aDY qaestiOIlB, eaII
(360) 417-4815
ApplicantorAgent: /IOVSIN~ A'Jr\.Ho~/rt COClNT"'j oFC~Phone: 'I.sJ..-7631 ~(I /
Owner:~IJ$ING- A~ll1GR 17/- or c~ rJ.[",-C:J:rH--f-h (ClAfCK)hone: ~r:J.::.2{3 /
Address: ,:)/,0:;'1 SCJ. fJJ.M(it5<s},_ . City: potU' frY\l?l~~ Zip: 1&'3' l.
Arcl1itectl&gineer: )..} ND6$ie~ A I2CkJ I tf'wrS Phone: //.0 - (lIt
Contractor /I A- C C- State License #: Bxp: Phone:
Address: :;..t:o?, .so, 'Pflbllel5 6". City: (J6d<<:r ANo:af:$' Zip: f~3 C;2
PROJECI' ADDRESS: It /9 Sa, ''c:/ Sr. PoRrr A1N~C;LE$ ZONING: /( S - 'I
.
LEGAL nEScRlPTIoN: Lot: .u;. s" Block: 0 5r: Subdivision: MHDf&d /t w C) at> S
CLAU.AM COUNlY PARCEL NUMBER: 06.3 00 /.:).J - 0 0 ~ 0
Credit Card Holder Name: .
BiIIiDg Address: City:
Credit CardType VISA Me tI Exp. ~te:
TYPE OF WORK: SIZElVALUATlON: ..'
~ ResideotiaI KNew Constr. tJ Re--roof C Stove Itg'o SFz @s. tj 7. "3'/SF. = S {f z:'}
c Multi-family [] Addition. '0 Move )r'Garage ~f}.o SF.@S' "30~;> ISF.-$ _. ____
C CO.....~c;w [] RcDiodcl .'.. .[].Demolition ODeck SF.@$ '. . ../SF.=S
[] Repair. . . Q Sign . c Other TOTAl. VALUATION $ '71. .J73
BRIEFDESCRIPTIONOFTBE'PR~: NE..w 'l'5Ir1t-h~ F~"1JJ..r (<.tz6/l'iVV<l,2.. - .'
'oAt.. STORy t.J'17f~'hT17J::C;1/U) .~-~ ~~_ .'
COMMERClAl.lRESlDEN'Ib\L::~'GrouP:' Occu#mtU>a~..;' :', ;"-'~mi'type:
No. ofStorics:i LotSize: Joot . BxistiDgSq.Ft. C:? &ProposedSq.Ft. /700 '=TOTALSq.Ft. 1100
Existiog lOt covemge . 0 % & Proposed lot coverage -'..2-% = TofallOt ~ /9 %
. APPROVALS: .
PLANNING USE ONLY: PLAN:~. '
BLDG:.~
DPWU:
FIRE:
ESAlWet1and(s): eyes 0 No SEPA Checldistrequired? 0 Yes c No Other.
OTHER:_
BUILDING PERMIT APPUCA110N SUBMITrAL: The Building Division can provide you wid1 infonnation on the application and
plan submittal requircmcDts if you have questions.
. -
V ALUA110N O~ CONSTRUCrION: Ia aD eases, a valuation amoaat mast be entered by the applicant. This figure viiIl be IeV:iewed
and maybe revised by1he Building Division tacomplywithcurrentfee schedules. ContactthePermit Coordinator at417-481S for~e.
PLAN CHECK FEE: IF a plan check fee is doe it mqst be submitted at the time the building permit application and coustmction plans are
submitted. AU other permit fees are doe at the time ofpennit issuance.
EXPIRATION OF PLAN REVIEW: Ifno permit is issued wi1bin 180 days of1he .date of application, the application wiD ~Ire. 'The
Building Official can extend the time for action lJy 1he applicant up to 180 days upon written request by the applicant (see Section 107.4 of
the UDiform Building Code. cmrent edition). No application can be extended more 1han ou,ce.
I hereby certify that , have I88d and e~ed this application and know the same to be true and conect..., am authorized to apply for this pennit. and
undeIlltlIIId thai f Is my Il>SpOIIl1i>IiIIo del..mi".."at pemIiIs... mquied .n IIJe cry. and '" ""';.~7: pemiI.r r;;::y ... ...... .
. ..' " ~.. ..-:).. t...<.....~
. . . '.' '. . ~:~~r:.~;~~:i~;7-\:\'~;;.:';;':):}<;;
CITY OF PORT ANGELES
DEPARTMENT OF PUBLIC WORKS
. . . . . . INSPECTION REPORT. . . . . . .
REQUEST:
Date J-/ - ~7 -oI-l
.
Time II '- 1)-
Received by <..~ ~.-...A-
(Q person
Location of Work to be inspected
Name of person requesting inspection
Address of person requesting inspection
Type of Ins~circle appropriate one):
..-"f" .~', "--
.' \
Sew / FoundatiO? Framing Chimney Plumbing
~o/-. i-V
/b19 Sn,
B '" l) e--.J2......
1\ ..
t!)
Phone No. ^/77-/::J-tJ5
Permit No. 04 - 97
Sewer Excav. Other
Final
NN~
o;jj C r 'I ; .,~\ \ Q ~\':f'l "l~:e-6~
By i; ( /
~cll-.'d t;>u -,.
Inspected:
Remarks:
RESTORATION REQUiRED...... YES NO
r
~~
SURFACE RESTORATION:
SURFACE TYPE: 0 Unimproved 0 Gravel 0 Asphalt 0 PCC
o Other
o Repaired by City
o Repaired by Permittee
o No Damage Found
Work Order #
o COMPLETE
o INCOMPLETE
o 571<Z. z. r
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r TITLE:MADRONA WOODS SUBDIVISION SCALE: "'""
C/..../ff( K lOl5 1" = 20'
JOB NO:
02030
CLIENT: FILE:
HOUSING AUTHROITY OF THE COUNTY OF CALLAM LOT5.DWG
2603 S. FRANCIS STREET DATE:
"- PORT ANGELES. WA 98362 11-25-0lJ
d'O'II'~_
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~~,.
CITY OF PORT ANGELES
PUBLIC WORKS - ELECTRICAL DIVISION
~21 EAST 5TH STREET. PORT ANGELES. WA 9ln62
Application Number
pin number
Property Address
ASSESSOR PARCEL NUMBER:
Application description
Subdivision Name
Property Use
Property Zoning . . .
Application valuation
04-00000097 Date
.833698
1619 S 0 ST
06-30-01-5-5-0050-0000-
RES NEW SFR
12/10/04
RESIDENTAL SF 9000
RS9 RESDNTL SINGLE FAMILY
71573
Owner
Contractor
HOUSING AUTHORITY OF CLALLAM
2603 S FRANCIS ST
PORT ANGELES WA 983626710
OWNER
Structure Information
Construction Type
Occupancy Type
Other struct info
NEW 1180 SF SFR W/ATT 520 SF
TYPE V ~ON-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
9006..00
1700.00
1700.00
1. 00
~
"-
,~
Permit
Additional desc
Sub Contractor
permi t Fee
Issue Date
Expiration Date
ELECTRICAL NEW RESIDENTIAL
1800 SQ FT SFR
ELECTRIC SERVICE
96.40
12/10/04
6/09/05
Plan Check Fee
Valuation
.00
o
~
,
Qty
1. 00
1. 00
Unit Charge Per
73.0000 ECH
23.4000 5C
EL-R-SQFT FIRST 1300
EL-R-SQFT ADDITIONAL 500
Extension
73.00
23.40
~
\
Special Notes and Comments
The site is located in the Madrona Woods Subdivision. The
residence may NOT be finaled until infrastructure
improvements for the subdivision are installed and improved.
New subdivision outside the four minute response time shall
be equipped with a residential sprinkler system that is
installed and maintained in accordance with Uniform Fire
Code (UFC) and National Fire Protection Association (NFPA)
standards.
Electrical load calculations and elctrical permits are
required.
LI\.
,\
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 96.40 96 .40 .00 .00
Plan Check Total .00 .00 .00 .00
COMMENTS/ACTION NEEDED
ELECTRICAL PERMIT INSPECT.JON 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 J08 SITE
INSPECTION TYPE DATE ACCEPTED COMMENTS
YES I NO
11IT( 'H
II 1I1(~~-IN I L:UVER
~h.K V lL:h
I I
-~
GENERAL COMMENTS:
PW-II02.1S[~1
'{i
"-'r"---"
CITY OF PORT ANGELES
PUBLIC WORKS - ELECTRICAL DIVISION
.l21 EAST 5TH STREET. PORT ANGELES. WA 9Rl62
Application Number
pin number
Other Fee Total
Grand Total
04-00000097
. .833698
1774.50 1774.50
1870.90 1870.90
Page 2
Date 12/10/04
.00 .00
.00 .00
COMMENTS/ACTION NEEDED
ELECTRICAL PERMIT INSPECT.ION RECORD
CALL 417-4735 FOR ELECTRICAL INSPECTIONS. PLEASE PROVIDE A MINIMUM 24 HOUR NOTICE. IT IS UNLA WFUL TO COVER,
INSULA TE OR CONCEAL ANY WORK BEFORE IT IS INSPECTED AND ACCEPTED.
KEEP PERMIT CARD AND APPROVED PLANS AT JOB SITE
INSPECTION TYPE
DATE
COMMENTS
NO
51A ,#+; /N,,' " y.; ).J I.,f'J'
FN" ;fL-
n /I/AL
"V - ;?-<'- 05'" ,0.1'1
~" . ;1,,&.-(."::': ,4 /"
ri':::t:.)
~....~
GENERAL COMMENTS:
PW-II02.15 [41961