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HomeMy WebLinkAbout1133 E Park Ave - BuildingPREPARED 5/17/10 8 45 03 INSPECTION TICKET PAGE 4 CITY OF PORT ANGELES INSPECTOR JAMES LIERLY DATE 5/17/10 ADDRESS 1133 E PARK AVE SUBDIV TENANT NBR LAUREL PARK ASSISTED LVNG CONTRACTOR ALL WEATHER HTG COOLING INC PHONE (360) 452 9813 OWNER ALC REAL ESTATE LLC PHONE (360) 452 7201 PARCEL 06 30 11 5 1 0800 0000 APPL NUMBER 09 00000191 MECHANICAL APPL PERMIT PERMIT ME 00 MECHANICAL PERMIT REQUESTED INSP DESCRIPTION TYP /SQ COMPLETED RESULT RESULTS /COMMENTS ME99 01 5/17/10 JLL MECHANICAL FINAL TIME 03 00 May 17 2010 8 40 01 AM 1pangrle JENNY 452 9813 MECHANIAL FINAL HEAT PUMP (LAUREL PARK ASSISTED LIVING) REQUESTED A 3 00 PM INSPECTION IF POSSIBLE COMMENTS AND NOTES (Do Application Number Application pin number Property Address ASSESSOR PARCEL NUMBER Application type description Subdivision Name Property Use Property Zoning Application valuation Application desc Like and kind Heat pump replacment 7 5ton Owner FIR LANE TERRACE CONVL CTR #259 ATTN TAX DEPT WILWAUKEE WI 53203 Permit Additional desc Permit pin number Permit Fee Issue Date Expiration Date Fee summary Permit Fee Total Plan Check Total Grand Total INSPECTION TYPE DITCH SERVICE ROUGH IN FINAL COMMENTS ELECTRICAL ALTER COMMERCIAL 142364 43 75 3/02/09 8/29/09 ELECTRICAL PERMIT CITY OF PORT ANGELES 360 -417 -4735 09 00000192 747584 1133 E PARK AVE 06 30 11 5 1 0800 0000 ELECTRICAL ONLY RESIDENTIAL MEDIUM DENSTY 0 Contractor Qty Unit Charge Per 1 00 43 7500 ECH EL LVT THERMOSTAT Charged Paid Credited DATE ALL WEATHER HEATING COOLING 302 KEMP RD PORT ANGELES WA 98362 (360) 452 9813 43 75 43 75 00 00 00 00 43 75 43 75 00 Plan Check Fee Valuation Date 3/02/09 RESULTS Due 00 0 Extension 43 75 00 00 00 Signature of owner or Electrical Contractor X Date INSPECTOR. 1 CITY OF PORT ANGELES DEPARTMENT OF COMMUNITY ECONOMIC DEVELOPMENT BUILDING DIVISION 321 EAST 5TH STREET PORT ANGELES WA 98362 Application Number 09 00000191 Date 2/27/09 Application pin number 393148 Property Address 1133 E PARK AVE ASSESSOR PARCEL NUMBER 06 30 11 5 1 0800 0000 Tenant nbr name LAUREL PARK ASSISTED LVNG Application type description MECHANICAL APPL PERMIT Subdivision Name Property Use Property Zoning RESIDENTIAL MEDIUM DENSTY Application valuation 10812 Application desc HEAT PUMP INSTALLATION ALC REAL ESTATE LLC W 140 N 8981 LILLY ROAD MENOMONEE FALLS WI 53051 (360) 452 7201 T.Forrns/Building Division/Building Permit Owner Contractor ALL WEATHER HTG COOLING INC 302 KEMP ST PORT ANGELES WA 98362 (360) 452 9813 Permit MECHANICAL PERM Additional desc INSTALL HEAT PUMP Permit pin number 142356 Permit Fee 64 80 Plan Check Fee 00 Issue Date 2/27/09 Valuation 0 Expiration Date 8/26/09 Qty Unit Charge Per Extension BASE FEE 50 00 1 00 14 8000 EA ME FURN /3P /FAU OR 5 TON 14 80 Fee summary Charged Paid Credited Due Permit Fee Total 64 80 64 80 00 00 Plan Check Total 00 00 00 00 Grand Total 64 80 64 80 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 fora period of 180 days after the work has commenced, or if required inspections have not been requested within 180 days from the last inspection. I hereby certify that I have read and examined this application and know the same to be true and correct. All provisions of laws and ordinances governing this type of work will be complied with whether specified herein or not. The granting of a permit does not presume to give authority to violate or cancel the provisions of any state or local law regulating construction or the performance of construction. 7/09 ---104 _.4 1 All0 Gc)it/ 41 P Da Print Name Signature of Contractor or Authorized Agent Signature of Owner (if owner is builder) �i' Feb 27 09 11:02a Applicant or Agent /l' Owner Laitr,I a LrM)1 Owner's Address /1 3:3 ,61 ��j, �ca' Contractor/Engineer a1'] Contractor /Engineer's Address 381 Jig 4 ef License ri'/d.,kL H( /5CT X t1 PROJECT ADDRESS Parcel Number d (0 36 Pra'ect Titi2 8 Brief Description. Check all that apply New Constructivn- o Addition Remodel Repair Re -roof o Demolition o Sign 'tHeat System c Other Floor Areas Basement 1st Floor 2" Floor 3 Floor Garage Carport Covered Porch Deck Shed Other Max. height of proposed structures Will a lawn sprinkler system be installed? WiII a fire sprinkler system be installed? ex cbcr)+3 v1/4fek i4-e ALc Rea[ ES-take, LL-6 w 144 NI gg81 Li ly RA, 1 .Ils ki l 53451 BUILDING PERMIT APPLICATION Print in ink CITY OF PORT ANGELES Attn. Building Permit Technician 321 E. Fifth St. Port Angeles, WA 98362 (360) 417 -4815 fax (360) 417 -4711 f/33 /lzl i; 11 t k(9t) Residential itisk4e, o wall- mounted o projecting c freestanding awning o other Total sign area sq ft. Maximum allowed sign area sq. ft. )(Heat pump o wood- burning stove o gas fireplace pellet stove o other Existing (sq. ft.) Proposed (sq. ft.) Total footprint of structures sq. ft. Lot size ft. 1! Phone 3(of 45Z-9V3 Phone 1 /pQ 1152 -720 ommercia! Occupancy group Occupant load Construction type p1 For City Use Only' Date Received 2. 7-09 Permit Date Approved Phone ,329 q5?-11/5 Expires q/, 9q Lot Zoning a Multi- family c Industrial per sq ft. TOTAL VALUATION ��,8742,.9l) sq. ft. Lot coverage /have read and completed this application and kbow it to be true and correct. I am authorized to apply for this permit and understand that it is my responsib,iit to determine what pe its are required, and to obtain permits prio workrn n projects Date Print Nam lain 77 /5 Signature T:Forms uilding Division/Bldg Permit Appl. -2005 Code.d'Ifc of bedrooms of full baths of half baths BUILDING PERMIT INSPECTION RECORD PLEASE PROVIDE A MINIMUM 24 -HOUR NOTICE FOR INSPECT IONS Building Inspections 417 4815 Electrical Inspections 417 4735 Public Works Utilities 417 4831 Backflow Prevention Inspections 417 4886 IT IS UNLAWFUL TO COVER, INSULATE OR CONCEAL ANY WORK BEFORE INSPECTED AND ACCEPTED POST PERMIT IN CONSPICUOUS LOCATION. KEEP PERMIT AND APPROVED PLANS AT JOB SITE. Inspection Type Date Accepted By Comments FOUNDATION Footings Stemwall Foundation Drainage Downspouts Piers Post Holes (Pole Bldgs.) PLUMBING Under Floor Slab Rough -In Water Line (Meter to Bldg) Gas Line Back Flow Water AIR SEAL. Walls Ceiling FRAMING Joists Girders Under Floor Shear Wall Hold Downs Walls Roof Ceiling Drywall (Interior Braced Panel Only) T -Bar INSULATION Slab Wall Floor Ceiling MECHANICAL. Heat Pump Furnace FAU Ducts Rough -In Gas Line Wood Stove Pellet Chimney Commercial Hood Ducts MANUFACTURED HOMES Footing Slab Blocking Hold Downs Skirting PLANNING DEPT Separate Permit #s SEPA. Parking Lighting 1 ESA. Landscaping 1 SHORELINE. T:Forms /Building Division /Building Permit FINAL Date Accepted by FINAL Date Accepted by TtN Qc, FINAL INSPECTIONS REQUIRED PRIOR TO OCCUPANCY/ USE Inspection Type Date Accepted By Electrical 417 -4735 I Construction R.W PW Engineering 417 -4831 1 I Fire 417 -4653 I I C Planning 417 -4750 1 I 3 Building 417 -4815 )('pi (2-1 (o Feb 27 09 11'02a City of Port Angeles Permit Application Building DivisionlElectricai Inspections 321 East Fifth Street P.O. Box 1150 Port Angeles Washington, 98352 Ph: (360) 417.4735 Fax: (360) 417 -4711 2-/ 1 Date: 1 2 Single Family Dwelling Multi- Family. or Commercial* Commercial Addition Alteration Remodel./ Repair' Plan Review May Be Required, Please Complete Electrical Plan Review Information Sheet Job Address: //ti woo °Y /C !-l VO itl�t.t' Building Square Footage: .4 Jain, Description of above Owner Information Name: J .4 Lir Par/( i S9SheL!✓/n Mailing Address: 1.1 Ark 14- ✓e City rfrt /JI?ft' State: GUM Zip: DMZ Phone: 5E/ 72 Fax License Exp. Unit Charae 93.75 $113.75 $160.00 $205.00 $291.25 2.00 57.50 2.00 72.50 86.25 $116.25 $131.25 75.00 69.00 75.00 50.00 50.00 93.75 80.00 86.25 27.50 57.50 86.25 43.75 I Ct/4/ 711 J Signature of owner, electrical contractor or electric administrator S 1 1 RECEIVED FEB 6 5 2009 LIGHT DEPT Total fQty Multiolied by Unit Chapel Service /Feeder 200 Amp. ServicelFeeder 201 -400 Amp. ServicelFeeder 401 -600 Amp. Service /Feeder 601 1000 Amp. Service/Feeder over 1000 Amp. Branch Circuit W1 Service Feeder Branch Circuit W10 Service Feeder Each Additional Branch Circuit Temp. Service/ Feeder 200 Amp. Temp. Service/Feeder 201 -400 Amp. Temp. Service/Feeder 401 -600 Amp. Temp. ServiceiFeeder 601 -1000 Amp. Portal b Portal Hourly Sign /Outline Lighting Signal Circuit/ Limited Energy Commercial Signal Circuit/ Limited Energy 1 2 Family Dwelling Signal Circuit/ Limited Energy Multi -Family (Meting Manufactured Home Connection Renewable Electrical Energy 5KVA System or Less First 1300 Square Ft. Each Additional 500 Square Ft or Portion of Each Outbuilding or Detached Garage Each Swimming Pool or Hot Tub 11 Thermostat 14'022 Cash Check 11 J► Credit Card 6 C 442ai ,l 705Y1 R 7 0.)/k Contractor Information f Name: 411 tilare+lf Jkdmq 9 ir4 /f1 C Mailing,Address:, CiL Kemp City' 14r m%eMMS State:W* Tip: 133b Phone:5 2 9fSi 3 Fax 3/#) Y57-'517 License Exp. Ai,Ln)E it/ 4 fl34,4 b Owner as defined by RCW.19.28.261: (1) Owner will ocw y the structure for two years after this electrical permit is finalized. (2) Owner is required to hire an electrical contractor fabove said property is for sale, rent or lease. After reading the above statement, I hereby certify that I am the over of the above named property or a licensed electrical contractor. I am making the electrical installation or alteration in compliance with the electrical laws, N.E.C, RCW. C hapter 19.22, WAC. Chapter 296-46B, The City of Port Angeles Municipal Code. and Utaity Specifications. COMMENT NO PW 110404 [12/93) SENT FOR DEPARTMENT REVIE REVIEWING DEPARTMENT' NOTE TO PLAN SUBMITTER. All plan comments require written response and/or correction for permit isa+nance. Return response with plan resubmival. Approval of ALL reviewing departments required prior to Permit issuance Concept Review Revision 'preliminary Review Final Review DEPARTMENT COMMENTS RETURNED' COMMENTS TO SUBMITTER: SUBMITTER RESPONSE DATE. DRAWING OR SPEC REF 113'3 Pa-He PLAN REVIEW COMMENTS ur: ng PW Engineering Wastewater Water Street Solid Waste Light Fire Not approved. Comments returned to submitter for response and or correction. other Reviewed by REVIEWING DEPARTMENT FINAL APPROVAL. by Date_ COMMENTS 13/44/0 1 /10=7/1 ne l-n z e 88 d 7.uod,s I I ..4 acs 1,1v eo. 2e741. Ai /c_ J a (z) I iii»z d 7.4 d:/2)v/uC-f it) I ,19i9i 452 7dA) �e r.44)6— 1 /sr c 2xief Z L3'4/ i/ l=i fse4J ;:r i 7 Zo,s& 2ee.esw fail .77 /4 -377 v1 34-1 -(ze) 7 I (es T ,5;g5/ 3,o- cee vy S#r'E S I ?�''II/ Ge A r 6 A &_)//apet.J 1D Dc./L.6 exi I 1 z 2 a _D/e412-/:r_ Js v c12,■ 364 /7Jci- 1:Dati v -s PROJECT NAME 1 /1;t2 Z1 r LOCATION L 3 3 1,4( l BACK CHECK BY/DATE. STATUS CODES A COMMENT ACCEPTED C CORRECTION MADE N NO RESPONSE REQ'D PERMIT S T A T U S 2013 -05 -13 06:35 CASCADE ELECTRIC 3603799043» 3604174711 tO CITY OF PORT ANGELES PERM tT,d►PPLICATION Building Division /Electrical Inspections MAY 13 2013 321 Fast Fifth Street — P.O. Box 11501 Port Angeles Washington, 98362 ELECTRICAL Ph: (360) 417 -4735 Fax; (360) 417 -4711 INSPECTIONS Date: / 3 , Mufti- Family or Commercial* * Plan Review ay Be Required lease Complete Electrical Pian eview Informatlon Sheet Job Add,ess: 1 Q r Building Square FooLV4! Desuiplioh of above P III Owner I ormation Name: Q 'A41 ,41� Contraclpf Inform Name: 4,01Z4 Ion c- Mailing A rgss: ._ _ Mailing A res a o City; fi- 5ta w 16I.AE ZIP: City; State: ZIP: Phone: - Fax: Phone: 2.�, F91t: 3 License # I Exp, License # 1 EKp, 6!2,{E,4 ,E L4 9 Y ,H lum Mari Charge Total LOU Mukl Ilea by U m K Chamo) ServicWFeeder 200 Amp $132.00 $ 5eNicelFeeder 201 -400 Amp. $160,00 $� Service/Feeder 401.600 Amp $ 225.00 $ ServtVeeder 601.1000 Amp $ 268.00 $ ServicelFeeder over 1000 Amp, $ 410.00 $� Branch Circuit WI Service Feeder $ 5,00 $ Branch Circuit WIO Service Feeder $ 74,00 $ Each Addibonat Branch Circuit $ 5,00 Branch Circuits 14 $ 86,00 Temp, 5ervlcel Feeder 200 Amp. $102,00 $ �� Temp. Service/Feeder 201 -400 Amp, $121.00 $ Temp. Service/Feeder 401 -600 Amp. $164.00 $ Temp. SerMICelFeeder 601.1000 Amp . $185,00 Portal to Portal Hourty $ 96.00 $ SignlOvlline Lighting $88,00 $ Signal ClrcuiULimited Energy - Multi- Family $ 64.00 Sigrai Circuit/ Limited Energy I First 1500 sf - Commercial $ 96.00 -" Nate: $5,00 for each additional 15M sr Renewable Electrical Energy - 5KVA System or Less $113,00 $� Tharimslat $ 56,00 _ $ Note: $5.00 for each additional T -Stet Total Owner as defined by RCW,19,28.261: (1) Owner will occupy the structure for two years after this electrical permit is finalized, (2) Owner is required to hire an alecirical contractor it above said property is for sale, rent or lease, Permit expires after six months of last inspection. After reading the above statement, I hereby certify that I am the owner of the above named property or a licensed electrical contractor. I am making the electrical installation or alteration in compliance with the electrical laws, N.E.C., RCW, Chapter 19.26, WAC, Chapter 296 -468, The City of Port Angeles Municipal Code, and Utility Specifications and PAMC 14,05.050 regarding Eiecl6cal Permit Applications. Slgnoture Azi of owner, electrical contractor or electrical administrator: ❑ cath ❑ check Cn6€I card s.... Dated � �' ,,.. —..... W a u°, ELECTRICAL INSPECTION U �� 4fiN WIRING REPORT {lc . 417 -4735 CATE: PERMIT INSPECTOR CONTRACTOR L ADDRESS �g� l NOT APPR ®V EI3 .............. ......DITCH .................... I� . . .............. ROUGH IN /COVER .............. , ® ............... .....SERVICE................... ❑ ............... ......FINAL.................... Ll CORRECTIONS NEEDED: _I -S au A% F ' w v rz—) L tllft� ► . �Z5Z NOTIFY INSPECTOR WHEN CORRECTIONS ARE COMPLETED WITHIN 15 DAYS ® DO NOT REMOVE ELECTRICAL PERMIT CITY OF PORT ANGELES - 360- 417 -4735 Application Number . . . . . 13- 00000506 Date 5/13/13 Application pin number 952604 s TAX Property Address . . . . . 1133 E PARK AVE REPORT SALES n ASSESSOR PARCEL NUMBER: 06- 30- 11 -5 -1 -0800- 0000 - on 1 /our excise fax form Application type description ELECTRICAL ONLY J Subdivision dame . . . . . , to the City of Port Angeles Property Use , , , (Location Code 0502) Property Zoning RESIDENTIAL MEDIUM DENSTY Application Valuation , , , , 0 Application desc 1 -4 alterred circuits owner Contractor FIR LANE TERRACE CONVL CTR#k259 CASCADE ELECTRIC & VAC INC ATTN: TAX DEPT PO BOX 369 *..�. WILWAUKEE W7' 53203 PORT HADLOCK WA 9$339 .r (360) 379-S347_____ t --------------------------------------------------------- V.j Permit , , . . . . ELECTRICAL ALTER COMMERCIAL q Additional desc 1 -4 CTRCUTTS Permit Fee 86.00 Plan Check Fee 00 Issue Date 5/13/13 Valuation . . . . 0 Expiration Date 11/09/13 Qty Unit Charge Per Extension SASE FEE 86,00 Fee summary Charged Paid Credited Due Permit Fee Total 66.00 06.00 00 .00 Plan Chock Total 00 DO OD ,00 Grand Total. 86.00 86.00 ,OD 00 INSPECTION TYPE DATE: RESULTS: INSPECTOR: DITCH SERVICE ROUGH -IN FINAL COMMENTS: PERMIT WILL EXPIRE SIX (6) MONTHS FROM LAST INSPECTION Signature of owner or Electrical Contractor X Date: G:IEXCHANGEIBUILDING J ! , I L I';'""'; --- ). i-..?-.....~7!~~-..~.l._~-(~. ..,......".~~ ." .~.."'i,':: ' ~ ~~3;. ,,(','- '~."3'T';:"~:. t'-:f~:...~' - ",_\",-:, " '"'~ '-.'"'--" ...~:..~"';i"".,..,-1: ./' 729,19 " !:'-"EIlEIl'r v.a..-..;r THIS INDENTURE made thi8~L- day of Oc.toh.~ , 1995, by and between PUBLIC UTILITY DISTRICT NO. 1 OF CLALLAM COUNTY .. Grantor, and HENRY B. FOLDEN as Grant... For and in consideration of $6,000 in hand paid and other benefits accruing to the Grantor, the undersigned Grantor hereby grants to HENRY 8. FOLDEN .!II non-exclusive easement for .!II roadway over and across the following-described real property, toqetber with the right to improve and maintain the easement for roadway purposes, including landscaping: The east thirty (3D) feet of vacated Lafayette Street, abutting Lots 2 and ) of Block 1; vacated Manhattan Avenue, and Lots 12 through 14 of Block 12, all in Campbell's Addition to Port Angeles, as per plat thereof recorded in Volume 2 of Plats, Page 2, Record.. of Clallam County, Washinqton. This easement shall be a runninq covenant with the land tor the uses and benefit of the parcel described on Appendix -A-. This easement recognizes the prior rights by easement_ heretofore granted, in particular the overhead lines and pole. now existing and the sewer line. The roadway shall not conflict vitb the existing utilities. It is understood that the Grantor, or it. Grantees and assigns, may utilize the ease~ent above rlescribed tor iilgress, egress and utilities and such utiliut:on shall not constitute an interference with the above descTibe~ ea..ment. ~r rfl:1- a~ __~_!/ ff#/. PUBLIC UTILITY DISTRICT NO. 1 OF Cu,Ll..AM COUNTY, WASHINGTON H~~lL f.' , ,- r-: (~i 1'" -/.I j,). State or Wash n~~j County or Clal1~ On the ~.f1.. 'day of oc:l-bLt..- ~ !I(~ ,v .L-{/. J Secretary 3,{,t) A ~ . '" '--<--- , 1995, before me came ~ tate of Wash nqton nt expires 1~"l.5'-'(' 9C~\ 1112"0E 360 JU'IIm~"l.~V-~7":(I';'f$ I 1.- ~ , '. , :J r- .... . . I : -:\. . ; ,~:;~ :/~<.. , '". ~;~~'.' \ ~ . ....~ .j, ::..~. ~. .. ..., UHIIDU . PARCEL -A-, 1 Blocks 2 and J of Campbell'. Addition. as recorded 1n Volume 2 of Plats, page 2, recorda ot CIall.. County, Washington; TOGETHER WITH those portions of vacated str..ts and. a lleys attaching thereto by operation of lav; AND ALSO that portion of the SOuth halt of vacated Manhattan Avenue in said Campbell'5 Addition. described ~. beqinninq at the intersection of the centerline of Manhattan and Greyburn Avenue, RUNNInG THENCE South 86043'40. East 550.75 to the centerline of Lafayette Avenue: Thence South 3022'38- West 20.97 teet: Thence North 85051'23- West 550.82 feet to said centerline of r.reyburn Avenue; Thence North )028' 55- East 12.59 teet to the POINT Of' BEGINlfING. PARCEL -8-: i , I 1 I j 1 Vacated Block 11 ot Campbell'. Addition, as recorded in Volume 2 of Plats, page 2, records of Clallam County, Wasnington: TOGETHER WITH those portions of vacated streets and alleys attacbtnq thereto by operation of law; EXCEPT that portion lying North ot a line running North 85051'23- West from a point on the centerline of Lafayette Avenue, South 3022'38" West 20.97 feet from its intersection with the centerline of Kanhattan Avenue. Situate in the County of Clallaa, State ot Washington. ! j BOOk 1112im 361 I .. " , '{ J :.,. , ~ ;J t.:) '" ~ ( , \J~ ~=t; \~ <193€~1.. EASEMENT GRANT OF RIGHT-or-WAY (12653 THIS INDENTURE made this Zu~ day of Fd>rv", 'i . 19JL. by and bet....e::!..' l'UBLIC UTILITY DISTRICT NO. 1 OF Ci.ALLAM COUNTY as . l Crento., and the en'Y Of PORT ANGELES as Grantee. . For and in consideration of One Dollar ($1.00) in hand paid and other benefits accruing to the Grantor, the undersigned Grantor hereby grants to the CITY OF PORT ANGELES a right-ot-....ay for utility purposes over and across the following-described real property: The east thirty (30) feet of vacated Lafayette Street, abutting Lots 2 and 3 of Block 1; vacated Manhattan Avenue, and Lots 12 through 22 of Block 12, all in Campbell's Addition to Port Angeles, as per plat thereof recorded in Volume 2 of Plats, Page 2, Records of Clallam County, Washington. This easement recognizes the prior rights by easements heretofore granted, in particular the overhead lines and poles now existing, and that the proposed sewer line shall not conflict with the existing utilitles. '0. PD~LIC uTILITY DISTRICT NO. 1 OF CLALLAH COUNTY, WASHINGTON 1\tU!l~\..\liOl{;V; .~ ". r.F ~O . \I lDS!lfCHllUltC. 'ltuJ1C~' . GiS MnR 23 rM 2: 08 '-;",111 ".SlJ~ ~llE woq", ~L1UY!Ro'''iY. .'SH. CU. ~ ., I,ll' Z",11 81" J . . rJ B~~..J~ President By ~__ V1ce Pres1den By Secretary STATE OF WASHINGTON SS. CO~NTY OF CLALLAH On this ~~~ day ot f~br~~1 ' 19~, before me, the undersigned, a Notary Public ~n and for the State of Washington, duly commissioned and sworn, personally appeared to me known to be the Board of Commissioners of Public Utility District No. 1 of Clallam County, ~ashington that executed the foregoing instrument, and ackno~- ledged the said instrume:1t to be the free and voluntary act and deed of said utility, for the uses and pur;loses therein mentioned. Witness my hand and official first above written. seal hereto affixed the day and year '---7-n . / ~~. ~rLL"1d. ''lLll<.k Notary PubllC' n an ~or the State. of ~ashington, residing at L2~[~~~fC~~ .' .~ " CITY OF PORT ANGELES DEPARTMENT OF PUBLIC WORKS . . . . . . . . . . . INSPECTION REPORT. . . . . . . . . . . REQUEST: Date ~ - 7-q1 . Time Received by (phone, person) Location of Work to be inspected I ( J ) ~ f? A V k Name of person requesting inspection -r-t p 1 \ Q, '1<.- Address of person requesting inspection ) !HI. '& 'rs Phone No, Type of Inspection (circle appropriate one): Permit No, {/&'::3 Sewer Foundation Framing Chimney Plumbing Final Sewer Excav, Other (~ INSPECTION NOTES: Inspected: Date Remarks: Time By 1-)../S ..fuL11 ~ ~ ,'t- '?u ~1-eY- ~.. LV "G -\--eY $-or t.I, '-^- /' RESTORATION REQUIRED AJ~.. YES NOV ?-.l~~ C peA~$ c. 700/ MnP t F71q 40q8 - r 'j "c-1o</ flVt K {'J,?' ?- SURFACE RESTORATION: SURFACE TYPE: 0 Unimproved OGravel o Asphalt OPCC o Repaired by City o Repaired by Permittee o No Damage Found Work Ord OMPLETE o INCOMPLETE o Other 130 (Continue on reverse side if necessary) STREET SUPERINTENDENT (DATE) CITY OF PORT ANGELES DEPARTMENT OF PUBLIC WORKS . . . . . . INSPECTION REPORT. . . . . . REQUEST: Date Time Received by (phone. person) Location of Work to be inspected C ~TI.~.p-", Name of person requesting inspection Address of person requesting inspection Type of Inspection (circle appropriate one): Sewer Foundation Framing Chimney Plumbing Final (Bl"ij /13~ F'l?td0 Phone No. Permit No. (t7~3 ./ Sewer Excav. @9 ~ ~"I'P'1:u1 INSPECTION NOTES: Inspected: Date 9- ~ -9?' Remarks: Ill.. .. \ I,'I'LL ....,..... '-t/ " hlA I fQ ,-:>. I ...ed + n... Time II.' :36 . o~~('_.,,'Z...i!!-d. LiJ /. '1-1 rw,,-...-ty _, M ~ 7:ii. <' u. ,r ~ By: .A Ad ~/."- /1. <; d nd r7L:J J~~ JIt't D",j.$",re.1 / / RESTORATION REQUIRED . . . . .. YES NO SURFACE RESTORATION: SURFACE TYPE: 0 Unimproved 0 Gravel 0 Asphalt 0 PCC o Other o Repaired by City o Repaired by Permittee o No Damage Found Work Order # o COMPLETE o INCOMPLETE (Continue on reverse side if necessary) STREET SUPERINTENDENT (DATE) CITY OF PORT ANGELES DEPARTMENT OF PUBLIC WORKS . . .. .. INSPECTION REPORT. . . . . . . . . . . REQUEST: Date CJ -~'1- ,g' . Time I" --I tJ Received by ~ (Phone,~rs0 Location of Work to be inspected Name of person requesting inspection Address of person requesting inspection Type of Inspection (circle appropriate one): ~Foundation Framing Chimney Plumbing Final lIt)O 15/k .... r.?.. k we.s+ Phone No. Permit No. SevverExcav.~ ~">1<1 r L~b3 INSPECTION NOTES: Inspected: Date Remarks: Time By RESTORATION REQUiRED...... YES NO SURFACE RESTORATION: SURFACE TYPE: 0 Unimproved OGravel o Asphalt OPCC o Other o Repaired by City o Repaired by Permittee o No Damage Found Work Order # o COMPLETE o INCOMPLETE (Continue on reverse side if necessarvl STREET SUPERINTENDENT (DATE) rO,P-'- ()e,/11L-- lY'.Y-- vJot YUKi ANl.i~L~~ JiJ.1'U, 1J~rAKllVllir~ 1 Fire Sprinkler Acceptance Inspection & Tests proj ect: La v re:A Pari: Address: I" G t= 131 V Installer: fC.oGkeJ- C:J 'QoC<::;vc. Telephone: 457 -' '-t.;)l...f,;l. Address: c9'5()C, vJ /CjJ-h Permit #q,-.;J;;>-q(b3~ 1. Underground piping flushed per NFPA 13. Witnessed By: t~ less than 200 psi r5Wr:,-.J-- IY/4fn Date: q/C;/97 '-I h6 2N gs. ro ~cordance with a~p~~~d Witnessed By: 2. Underground piping hydrostatically te NFPA 13. 3. Inspection of piping for installation 13 . Witnessed By: 4. Inspection of p~p~ng being hydrostatically tested at 200 psi for two hours (includes all piping not previously tested). Wet/dry system. ! Witnessed By: ! Area: Date: I ! Witnessed By: i Area: Date: I I Witnessed By: i Area: Date: I 5. Inspection drop. II Witnessed By: of piping being air tested at 40 psi for 24 hours with less than 1~ psi I Date: I Start Pres: I End Pres: II 6. Dry pipe valve trip test. II Witnessed By: I Time: I Date: II 7. Inspection II Witnessed By: of back flow preventor (to be inspected by Public I Date: Works) II 8. Sprinkler alarm components tested. II Witnessed By: I Date: II 9. Two-inch drain test. II Witnessed By: I Date: I Static: I Residual: II 10. Final inspection with control valves locked in open position, connection capped, and system in service. II Witnessed By: I Date: FP-I0 Fire Department II Revised 1/29/97 0j(~ ; 0 ~G~ f}tSV ~ \) 0 \)~ b 9J JJ' \fA~ \\~f 'f \u\\ ..;., ~ , , i I v STATE OF WASHINGTON DEPARTMENT OF HEALTH WATER BACTERIOLOGICAL ANAlYSIS~ SAMPLE COLLECTION: READ INSTRUCTIONS ON BACK OF GOLDENROD COpy t1ln.tructlon. are not followed, sample will be reJected. I 1- DATE COLLECTED TIME COLLECTED COUNTY NAME "~rn I,D:; I .;~ ---.L :}iL (~-{~("l !ti-'-,,- 1 ,.....~ / DAM [2JPM TYPE OF SYSTEM IF PUBLIC SYSTEM. COMPLETE: [] PUBLIC lID. Nollf.~ 18 k~s-I.v 1M I CIRCLE GROUP D INDIVIDUAL A B (serveson/ylresidence) NAME OF SYSTEM . ;7 bll -I ft.... J./s. SPECIFIC LOCATION WHERE SAMPLE COlLECTED ('2.>~S tw'O()(]} (:c;~, y t. i., ~l r-i- {.~J -4~ r-t- TELEPHONE NO. DAY (It..' I .5'(;;- EVENING ( ) SYSTEM OWNERlMGR.: (Name) SAMPLE COLLECTED BY: (Name) r7~)' J. '-(Iv r "_' It.. SOURCE lYPE D GROUND WATER UNDER SURFACE INFLUENCE D SURFACE I] WEll 0' D SPRING D PURCHASED 0' D COMBINATION WELL FIELD . INTERTIE or OTHER SEND REPORT TO; (Prinl 7,11 Name, Ad,dress and Zip Code) J?t,I,., , f"A(Wf,il.-tA . Pc [1()>< I))'{) ;'),. 11 t ,it" ,; .'1 , '" I TYPE OF SAMPlE(check only one in this column) o ~~~~~~ WATER [J ChlOrinated (Residual: _ Total-.....L Free) check treatment I 0 Filtered ,0 Untreated orj)lher WASHINGTON 9 'X.5 feZ- '. D REPEAT SAMPLE Previous coliform presence Lab It Date o RAW SOURCE WATER Source It [I] CD [B"NEW CONSTRUCTION or REPAIRS D OTHER (Specily) o Total Coliform o Fecal Coliform REMARKS: t..-:: ..,;, (LAB USE ONLY) DRINKING WATER RESULTS o UNSATISFACTORY, Coliforms present ~ SATISFACTORY, . Coliforms absent REPEAT o E. Coli present o E. Coli absent SAMPLES REOUIRED o Fecal present o Fecal absent OTHER LABORATORY RESULTS TOTAL COLIFORM _ 1100 ml E. COLI _ 11oom! FECAL COLIFORM _ 1100 ml PLATE GOUNT _ Iml ANOTHER SAMPLE REQUA ED SAMPLE NOT TESTED BECAUSE: I TEST UNSUITABLE BECAUSE: o Sample too old o Confluent growth o Wrong container D TNIC o Incomplete form o Turbidcultum D o Excess debris SEE REVERSE SIDE Of GREEN COPY FOR EXPlAN.'..TIO', Of III SuL TS {..AS NO. (7 DIGiTS) DATE, TIME RECEIVED R!:CEIVED 8Y - /0/( ~ . : , ~, - , DATE RElATED LABORATORY; ~!2C; 9':;. r>'\B REMARKS 00>1306.002 (REV 4.'~2) . .',' fPORr~ -l..O~~~ ~ - ~~ "--. . it~ ~ -=..:or ~~ BACKFLOW DEVICE TEST REPORT CITY OF PORT ANGELES PUBLIC-WORKS DEPARTMENT WATER DIVISION RETURN NO LATER THAN: DEVICE # ,;) / ~ NAME OF PREMISES: LAvj(EC {153 flJRk f/l tf i< ,4V{' SERVICE ADDRESS: DEVICE: A fvl F~ - Manufacturer r<WI'f', 1\ ( ff/fCI( I 'JtJ{i05S Model of 8 VILI?/IVr;. -'--l:QCATJON OF DEVICE: C ON r~() ( ~ I, Size 3KI'1US3 SeriaJ No. IS THIS AN APPROVED DEVICE? YES aJ-NO 0 IS DEVICE INSTALLED CORRECTLY YES I9-1fcJ 0 DATE OF INSTALLATION f q 1 7 UNKNOWN 0 . LINE PRESSURE AT TIME OF TEST:1'L LBS. PRESSURE DROP ACROSS FIRST CHECK VALVE:-L LBS. CHECK VALVE CHECK VALVE DrFFERENTlAL PRESSURE NO.1 NO.2 RELIEF VALVE 1. LEAKED I. LEAKED 1. OPENED AT _ LBS REDUCED INITIAL TEST PRESSURE 2. CLOSED TIGHT 1./ 2. CLOSED TIGHT V 2. DID NOT OPEN AT PSI AT PSI REPAIRS CLEANED CLEANED CLEANED REPLACED: REPLACED: REPLACED: DISC DISC DISC. UPPER SPRING SPRING DISC. LOWER GUIDE GUIDE SPRING PIN RETAINER PIN RETAINER DIAPHRAGM. LARGE HINGE PIN HINGE PIN UPPER SEAT SEAT LOWER DIAPHRAGM DIAPHRAGM DIAPHRAGM. SMALL OTHER, DESCRIBE OTHER, DESCRlBE UPPER LOWER SPACER, LOWER OTHER, DESCRIBE: FINAL TEST CLOSED TIGHT CLOSED TIGHT V V V OPENED AT LBS. REDUCED PRESSURE AIR GAP INSPECTION: REQUIRED MINIMUM AIR GAP SEPARATION: YES 0 NO 0 R!M..y,u<:S: New IN.s'TAL.L/t-TIP,v_ - ;=/;:[' SYJ'7Et;i;, y~ lJy I'//S5' /J.e.. ALfd f,<JS5cP,/1ANClF.-Afl1t?f,. PIlEl-,;lV-VtJ..!l snuAL- (j/J(/3d-1'd- / THE ABOVE REPORT IS CERTIFIED TO BE TRUE: STATUS TESTER NAME TESTING FIRM CERT. # STATE CONTRACTOR'S DATE Lie. # INITIAL TEST BY: REPAIR BY: FINAL TEST BY: K~IV 13 ECKCIi cfT}' (f f, 4. I (J)!ftl'7 ;;. -11-9cf PW-903.02 jf96 r I WHITE, CUSTOMER COPY YELLOW, PURVEYOR COPY PINK - TESTER COpy TECHNICAL Permit Address 13 3 E '6-K Prv Project description I du re-1 Pa-rK /\ss S V1 n 2evious netma Cres- kocroA, As5isied L;vi J Date the permit was finaled 7 Number of technical pages 3� A P\end\u m 5 ne 117 l• =Al IMIMI iz m M I D W E S T ARCHITECTURE PLANNING INTERIOR DESIGN CONSTRUCTION CONSTRUCTION MANAGEMENT June 9 1997 Mr Lou Haehnlen Building Inspector City of Port Angeles 321 East 5th Street Building Division Port Angeles, Washington 98362 Re Laurel Park Assisted Living (previously named Crestwood Assisted Living) Dear Mr Haehnlen The following written response is pursuant to the attached comments from the Port Angeles Fire Departmant dated May 2, 1997 comments from David Sawyer Senior Planner with the City of Port Angeles, and your comments pertaining to the above referenced project. PORT ANGELES FIRE DEPARTMENT. May 2. 1997 Dan McKeen Port Angeles Fire Marshall 360 -417 -4655 Plan #97 22 -9635 Response to Comment #1 I have added the reference to the 1994 Uniform Fire Code with Washington amendments under Applicable Codes on the Title Sheet. See CD -2 attached to Addendum #1 Response to Comment #2 6' high address numbers will be located on the front canopy facing Park Avenue The letters will contrast with the background Color to be determined by Architect. See CD -6 attached to Addendum #1 Response to Comment #3 We will provide a 12' stripe of red paint on the pavement at the south access road and provide 6' high white letters stating "NO PARKING FIRE LANE" in this area. See revised sheets C200 and C700 included with Addendum #1 Response to Comment #4 We have widened the north access road located near the loading dock to 20' -0' See revised sheets C100 and C200 included with Addendum #1 Response to Comment #5 We will provide fire extinguishers as specified in revised Spec Section 10522. See attached Addendum #1 We will add a fire extinguisher and cabinet to Resident Kitchen #138 and relocate the one in Corridor #133 See CD -4 attached to Addendum #1 Response to Comment #6 Acknowledged The sprinkler contractor will submit plans prior to installation of the system for review and approval as referenced in Spec Section 15500C Response to Comment #7 Acknowledged The fire alarm contractor will submit plans prior to installation of the system for review and approval as referenced in Spec Section 16720 (Continued on Page 2) PDC MIDWEST INCORPORATED 700 WALNUT RIDGE DRIVE HARTLAND WISCONSIN 53029 414 -367 7770 FAX 414 -367 7761 Page 2 Response to Comment #8 The contractor will pick up application for key box (Knox Box) from the Fire Department. Fire Department to verify the exact location for placement. See CD -3 attached to Addendum #1 Response to Comment #9 The kitchen equipment supplier will provide a `Type 1 hood for the 4- burner range in the kitchen The mechanical contractor will provide a 'Type 1 duct The sprinkler contractor is to provide an automatic fire suppression system for the hood and duct. Submit drawings for approval prior to installation The fire alarm contractor will provide connection to the fire suppression system All appliances and electrical outlets under the hood at the time of activation of the system shall have the power shut off Response to Response to The range in Resident Kitchen #138 will not allow cooking which emits grease laden vapors. See CD -8 attached to Addendum #1 Comment #10 LPG is not being used on this job Comment #11 Each HVAC unit with 2,000 cfm or greater will be provided with a smoke detection system in the supply which will be connected to the fire alarm system to allow shut down upon activation If the smoke detector is not accessible to the Fire Department, a remote LED will be provided indicating activation of the detector Contact the Fire Department for LED location Response to Comment #12 The contractor will contact the Fire Department prior to relocating the existing fire hydrant. Verify exact placement with the Fire Department. See revised sheet C100 included with Addendum #1 Response to Comment #13 The Fire Department Connection will be located as shown on revised sheet C100 included with Addendum #1 Response to Comment #14 Concrete walkways have been added from exits 1A and 2A to the access road See revised sheets C100 C200 and C700 included with Addendum #1 Response to Comment #15 A 3 -0' compacted crushed stone walkway from exit 2A around the south and east sides of the building will be provided See revised sheet C700 included with Addendum #1 Response to Comment #16 Doors 133A at the lobby swing into the one hour rated exit access corridor The lobby area is not intended to serve as an exit access corridor for the functions that are connected to the main corridor of the building In the event of a smoke or fire emergency the lobby and dining room doors will close The two directions of egress in the corridor will be at the ends of the corridor The Dining room and the Lobby area will exit to the outside or through the exit access corridor If there are further questions on this, I would be happy to discuss them (Continued on Page 3) 700 WALNUT RIDGE DRIVE HARTLAND WISCONSIN 53029 414 -367 7770 Page 3 ARCHITECTURAL PLAN REVIEW COMMENTS Lou Haehnlen Port Angeles Building Inspector 360- 417 -4816 Permit #9635 Detail 21A410 Response The handrails at the exit stairs will be continuous at the center of the stair See CD -7 attached to Addendum #1 Detail 21A400 Responses 1) The correct detail number should be 8/S301 2) The corridor walls are one hour rated construction as referenced on the Overall Floor Plan Sheets A110 and Al20 The different U.L. Designs being used are as follows. U L. DES #U3117 U.L. DES #U3144 U:L °DES_ #U344 U.L. DES #0469 See Appendix E at the back of the specification book for more information 3) The occupancy separation between the first and second floor is achieved with the revised one hour rated floor /ceiling system The U.L. Design being used is L528 i The floor system is as follows. 3/4 gypsum concrete floor topping over 3/4 T &G 0 S.B floor sheathing over Prefabricated wood floor trusses at 24 o c with 3' sound batt insulation and 5/8' type 'x' gypsum wallboard over 1/2' resilient channels at 16' o c Sheet A110 Responses Doors 133A at the lobby swing into the one hour rated exit access corridor The lobby area is not intended to serve as an exit access corridor for the functions that are connected to the main corridor of the building In the event of a smoke or fire emergency, the lobby and dining room doors will close The two directions of egress in the corridor will be at the ends of the corridor The Dining room and the Lobby area will exit to the outside or through the exit access corridor If there are further questions on this, I would be happy to discuss them 2) The glass in the doors and sidelites at the vestibule are specified to be safety glass in the door and hardware schedule Sheet Al20 Responses 1) 42' high guardrails will be installed at the Lobby and Balcony See CD -5 attached to Addendum #1 Sheet E115 Responses 1) Required clearances will be maintained at all electrical panels. Electrical drawings are diagramatic only The electrical contractor shall follow Spec Section 16400 3 3.A regarding panelboard installation Gen. Comment Responses 1) The door schedule is located in Appendix A at the back of the specification book. 2) The window area computations and window types are located in Appendix B and C' at the back of the specification book. (Continued on Page 4) 700tWALNUT RIDGE DRIVE HARTLAND WISCONSIN 53029 414 -367 7770 g Page 4 PLANNING DEPARTMENT REVIEW COMMENTS David Sawyer Port Angeles Senior Planner 360 417 -4752 If there are any additional questions or concerns, please feel free to contact me directly at (414)367 7778 Sincerely S L1+„ S 1 6-r^ Steven J Keymar PDC Design Group cc David Hammonds, Unicare Health Facilities, Inc Ken Barton Unicare Health Facilities, Inc Rob Stieg Unicare Health Facilities, Inc Dennis Spindler PDC Midwest, Inc. Peter Johnston PDC Midwest, Inc Dale Franjevic PDC Midwest, Inc. Attachments. (1) City of Port Angeles copy of original bid documents (1) Copy of Structural calculations (3) Copies of Addendum #1 dated June 9 1997 (3) Copies of this letter addressed to Lou Haehnlen F \PROJECTS \6061 PORT LETTER CO D E02 3) Floor drains will be provided in the two laundry rooms. They will be provided with appropriate water seals for the traps. See CD -18 attached to Addendum #1 1 f 4) The dryers•are electric. No venting is required of this equipment. There -is- however room venting provided per code 5) Emergency lighting and exit lighting has been provided to meet all applicable codes. 6) The hood for the 4 burner range will be a "Type I' hood See Response #9 above for more information Response PDC is still discussing options concerning the 3' -0' to 6' -0' tall vision obsuring fence or vegetation at the west property line with Mr Brad Collins Planning Director with the City of Port Angeles. No action at this time Response We will provide two additional `G" trees (Maple Red Sunset) as required See revised sheet C700 included with Addendum #1 700 WALNUT RIDGE DRIVE HARTLAND WISCONSIN 53029 414 -367 7770 PDC Project No 6061 SECTION 00901 ADDENDUM NO 1 ADDENDUM NO 1 133 E Perk Pt Laurel Park Assisted Living Port Angeles, WA 9 June 1997 This addendum is issued to modify explain or correct the original Bidding Documents. Bidders must acknowledge receipt of addendum in space provided on the Bid Form Failure to do so may subject the Bidder to disqualification If issued after execution of contract, Contractor must acknowledge as an Owner Initiated Change Order Proposal Request,`specified in Division 1 Section 'Modification Procedures. Failure to do so may subject the Contractor to disqualification of adjustment to the contract amount. CHANGES TO PROJECT MANUAL (datedl7 April 19971 1 Cover Page of Project Manual a. Remove "For Review Only Not Construction b Change project name from 'CRESTWOOD RETIREMENT CENTER to 'LAUREL PARK ASSISTED LIVING See CD -1 2 Table of Contents a Add Section 00901 Addendum No 1 3 DIVISION 0 a. Section 00900 ADDENDA i. Add Article 2. to read ADDENDUM ISSUED (1) ADDENDUM NO 1 June 9 1997 b Section 00901 ADDENDUM NO 1 i. Add Section 4 DIVISION 1 No Changes 5 DIVISION 2 16 a Section 08630 Vinyl Windows i. Page 08630 -4 Article 2.2 Materials, Paragraph I Sub paragraph 1 Replace with the following sub paragraph in its entirety* 1 From the Washington State Energy Code Chapter 51 -11 effective 6 -30 -95 502.1.5 Glazing and Door U- Values. Glazing and door U- values shall be determined in accordance with Sections 502 1 5 1 and 502.1 5.2 All products shall be labeled with the NFRC certified or default U -value The labeled U -value shall be used in all calculations to determine compliance with this Code Sealed ADDENDUM NO 1 00901 1 PDC Project No 6061 insulating glass shall conform to or be in test for ASTM E 774 -81 class A. All windows to achieve a U -value rating of 4 throughout the building b Section 10522 Fire Extinguishers, Cabinets and Accessories i. Page 10522 -2, Article 2.2 Fire Extinguishers, Paragraph B Replace with the following sub paragraph in its entirety B Multipurpose Dry Chemical Type UL -rated in enameled steel container Size and type as listed below 1 2A -10 -BC located in the corridors and the mechanical rooms as shown on plans. 2. 40 -BC located in the kitchen as shown on plan 3 2A -20BC located in the resident kitchen as shown on plan CHANGES TO DRAWINGS (dated 17 April 19971 I ARCHITECTURAL DRAWINGS A. Sheet T Title Sheet 6 Laurel Park Assisted Living Port Angeles, WA 9 June 1997 1 CHANGE Occupancy Group from Group R, Div 1 to Group LC See CD -2 2 ADD information under Applicable Codes. See CD -2. B Sheet C100 Grading Drainage and Sewer Plan (REISSUE SHEET) C Sheet C200 Paving and Striping Plan (REISSUE SHEET) D Sheet C400 On -Site Profiles (REISSUE SHEET) E. Sheet C500 Park Avenue Improvement Plan (REISSUE SHEET) F Sheet C700 Landscape Plan (REISSUE SHEET) G Sheet A110 Overall First Floor Plan 1 ADD information on 'Knox Box location. See CD -3 2 RELOCATE the FEC in Corr #133 ADD a FEC in Resident Kitchen #138 See CD -4 H Sheet Al20 Overall Second Floor Plan 1 CHANGE wording from 'railing' to 42' high guardrail' at Lobby #236 and Balcony #235 See CD -5 I Sheet A310 Building Sections 1 ADD address signage at the front canopy See CD-6 J Sheet A410 Stair Sections 1 MODIFY the stair handrail at the center switchback to be continuous. See CD -7 ADDENDUM NO 1 00901 2 PDC Project No 6061 K. Sheet A600 Interior Elevations 1 ADD the following signage above the stove in the Resident Kitchen COOKING WHICH EMITS GREASE LADEN VAPORS IS PROHIBITED See CD -8 L. Sheet K1 Food Service Equipment and Special Conditions Plan 1 ADD information about flooring at the walk -in freezer See CD -9 2. ADD detail about floor system at the walk -in freezer cooler See CD -10 II MECHANICAL DRAWINGS Laurel Park Assisted Living Port Angeles, WA 9 June 1997 A. Sheet M100 Mechanical Legend and Notes 1 ADD the following note to Plumbing Notes 'Ball valves are acceptable substitutes for globe valves. B Sheet M110 First Floor Plan Mechanical 1 MODIFY Heat Pump descriptions. ADD general notes See CD -11 2. MODIFY Water Heater descriptions. See CD -12. 3 ADD exhaust fan in Janitor #122. See CD -13 4 MODIFY duct sizes and CFM in Dining #132. See CD -14 5 MODIFY HVAC as shown on attached sheet CD -15 C Sheet M120 Second Floor Plan Mechanical 1 DELETE exhaust fan on west wall of Laundry #232. MODIFY exhaust fan on east wall See CD -16 2. MODIFY CFM of exhaust fans in toilet rooms to 50 CFM See CD -17 D Sheet M130 First Floor Plan Plumbing 1 MODIFY plumbing as shown on attached sheet CD -18 E. Sheet M140 Second Floor Plan Plumbing 1 MODIFY plumbing as shown on attached sheet CD -19 F Sheet E100 Electrical Site Plan 1 MODIFY Wire Schedule and Riser Diagram as shown on attached sheet CD -20 G Sheet E110 First Floor Plan Lighting 1 CHANGE light fixtures at canopy to 'Type W' See CD -21 H Sheet E115 First Floor Plan Power 1 ADD 1600 amp NEMA 3R lockable disconnect switch Verify location with Architect. See CD -22. 2. ADD push plate locations for automatic door openers at the front vestibule See CD -23 3 CHANGE the panel designation for HP -E to P119 See CD -24 4 ADD 'Elevator Recall One -Line Diagram See CD -25 ADDENDUM NO 1 00901 3 PDC Project No 6061 Laurel Park Assisted Living Port Angeles, WA 9 June 1997 I Sheet E120 Second Floor Plan Lighting 1 MODIFY rating of Panel P139A to 225A. See CD -26 J Sheet E800 Electrical Schedules and Symbol Legend 1 MODIFY lights `K' `Qa and 'S' as shown on attached sheet CD -27 END OF SECTION 00901 ADDENDUM NO 1 00901 4 P D C D E S I G N G R O U P PROJECT MANUAL- Prepared By ADDENDUM #1 LAUREL PARK ASSISTED LIVING PORT ANGELES WASHINGTON PDC MIDWEST PROJECT NO 6061 REV st1 For Laurel Park Assisted Living 45 Unit Assisted Living Facility Park Avenue Laundsen Blvd Port Angeles Washington Robert L. Gummer AIA PDC Design Group 700 Walnut Ridge Drive Hartland Wisconsin 53029 PDC Project No 6061 17 April 1997 700 Walnut Ridge Drive P 0 Box 900 Hartland, Wisconsin 53029 -0900 REF SHEET BUILDING CLASSIFICATIONS A APPLICABL CODES BUILDING CODE PLUMBING CODE MECHANICAL CODE ELECTRICAL CODE HANDICAPPED CODE HEALTH CODE FIRE CODE ENERGY CODE 1994 UFC W/ WASH'NGTON AMENDMENTS NON RES DEN E \ERG? CODE 1994 CONSTRUCTION TYPE SPRINKLER BUILDING DATA RS FLOOR SECOND FLOOR TOTAL BUILDING AREA U L DESIGNS SEE °ROJEC T MANUAL APPENDIX E ADDENDUM 1 LAUREL PARK ASSISTED LIVING PORT ANGELES WASHINGTON PDC MIDWEST PROJECT NO 6061 REV #I 1994 UBC W/ WASH!NGTON AMENDMENTS 1994 UPC W/ WA5i-4 AMENDMENTS 1994 UMC NGTON AMENDMENTS 1994 UBC WI WASHINGTON AMENDMENTS 1994 UBC 4J/ WASHINGTON AMENDMENTS WASHINGTON S_A E DEPT OF HEALTH BOARDING uES CH '46 316 WAC 1996 NEW CONS'RUC ON T? E v 1 HR, HOUR SEPARA ON 5E ..JEEN R AND A 3 OCCUPANCIES NFPA 13 BUILD NG FULL SPRINKLED 16 683 GSF 15,635 GSF 32,318 GSF REF SHEET T 6 CD -2 A430 i MECHANICAL 119 F.E. STORAGE 120 208 -2" 1 0.1411 11314 5' -1" I 1 ry I 1 ADDENDUM 01 FREEZER COOLER v 121 STORAGE 121 JAN. 122 x L LAUREL PARK ASSISTED LIVING PORT ANGELES WASHINGTON PDC MIDUEST PROJECT NO 6061 REV ttI 64' -11" 00 n PASSAGE 152 KITCHEN 121 4 53 —6 V r "KNOX BOX' VERIFY LOCATION WITH FIRE DEPARTMENT (CONTRACTOR TO GET APPLICATION FOR KNOX BOX FROM FIRE DEPARTMENT) FEC 126 42' -5 1!2" CORR. i_t'i 123 I ®I I L mimnirml X REF SWEET At t0 6 -9 -91 CD-3 1 O �I IAL NI J v II SPACE BALCONY ABOVE ■430 131 n DINING 132 98 SEATS/ 19/A500 RECEPT 131 K/// LOBBY (134) 20NY STAIR 3 UP TV LOUNGE 136 r 1 L NEN STORAGE 1 1 42 142 LO AC ADDENDUM 01 LAUREL PARK ASSISTED LIVING PORT ANGELES WASI-IINGTON PDC MIDWEST PROJECT NO 6061 REV #1 MECH. 139 LAUNDRY 148 BEAUTY 144 144 JAN. 0 IA; 1 in ALTERNATE BID. FOLDING PARTITION I 138 r4 19SY -/1 T v�j I4 TLT Si V 3 )i 1933 m 194 COUNTRY STOIC C 1V 146 A 3 r LT I 140 I RESIDENT o 138 8 SEATS REF SWEET A 110 6 -9 -97 GE) 4 132B OFFICE 141 v r i ADDENDUM 01 LAUREL PARK ASSISTED LIVING PORT ANGELES WASHINGTON PDC MIDWEST PROJECT NO 6061 REV #I REF SWEET A I 20 6 -9 -9'1 CD -5 0 0 o 4 PROVIDE ADDRESS SIGNAGE WITH 6 HIGH RAISED NUMBERS ON S HIGH -I PLAQUE W /CONTRASTING COLOR COLORS TO BE SELECTED BY ARCHITECT 0 0 �'i'���� 4. u ,i'A'i'i'AXO' :7 O (s) K' O ADDENDUM 01 LAUREL PARK ASSISTED LIVING PORT ANGELES WASHINGTON PDC MIDWEST PROJECT NO 6061 REV 01 CANOPY ELEVAT ON A310 1/8" 0 1' -O" REF SHEET A3 O DN 3UM WALL S 16 O C OOR '10WUM VAPOR 03300) NK INSIDE HANDRAIL AT SWITCHBACK TO BE CONTINUOUS ADDENDUM #1 1 —1I LAUREL PARK ASSISTED LIVING PORT ANGELES WAS4- 1INGTON PDC MIDWEST PROJECT NO 6061 r REV #I 8 TREADS AT I1 EACH 1 I 5/8 TYPE 'X' GYPSUM WALL BOARD 3/4 WOOD CAP STAIN AND VARNISH (SEC 06200) 7 11/2 WOOD HANDRAIL i STAIN AND VARNISH -J RETURN TO WALL i (SEC 06200) -J I J 0 C" WOOD STAIR (SEC 06200) •c h REF SHEET A4to 3 jf f .0 -0 •oV n-0 J' o .lY cg CORNER BLOCKS TYPE I STAIN E. VARNISH CASING TYPE 2 STAIN VARNISH PLINTH BLOCKS TYPE I STAIN E. VARNISH UPPER CABINETS WITH SHELF E. WIRE PULLS SINK, SEE PLUMBING DRAWINGS 30 T� T PROVIDE SIGN ABOvE STOVE WITI -I I I/2 HIGH LETTERING 30' P LAM COUNTERTOP I WITH SIDE AND oRER BACKSPLASH B C BASE CABINET WITH I RESIDENT KITCHEN #138 1/4" o r-O" ADDENDUM 01 LAUREL PARK ASSISTED LIVING PORT ANGELES WASHINGTON PDC MIDUEST PROJECT NO 6061 REV 01 42' T COOKING WHICH EMITS GREASE LADEN VAPORS IS PROHIBITED 30' RANGE L RANG: 0% NOOOD B YrUk E II t J I J f _F II =T 30' .,J 30' DRAWERS SHELF AND 30' 30' 42" 30' 30' WIRE PULLS c REF BY aIt•ER REF SHEET A,00 6 -9 -91 CID-8 0 i 0 ADDENDUM #1 12' -2'%i (Actual Wolk —In Box 12' -6W) DIMENSIONS SHOWN ARE TO CENTERLINES OF 2 REDWOOD PERIMIETER SEE DETAIL ABOVE. (ACTUAL WALK IN BOX DIMENSIONS ARE SHOWN IN PARENTHESIS STORAGE (121 LAUREL PARK ASSISTED LIVING PORT ANGELES WASHINGTON PDC MIDWEST PROJECT NO 6061 REV #1 N PASSAGE 152 u, T CO REF SHEET K I 6 -9 -97 CD -9 WALK -IN DOOR CONCRETE FLOOR WALK -IN COOLER /FREEZER FLOOR CONSTRUCTION (INSULATED FLOOR FURNISHED BY GENERAL CONTRACTOR) V PARTITION FINISHED FLOOR BY G.C. (CONFIRM FLOOR TYPE WITH BOELTER PRIOR TO COOLER/ FREEZER INSTALLATION 4 EXTRUDED POLYSTYRENE SLAB INSULATION BY G C COOLER 6 MIL. POLYETHYLENE FILM VAPOR BARRIER BY G C FINISHED FLOOR BY G.C. (CONFIRM FLOOR TYPE WITH BOELTER PRIOR TO COOLER/ FREEZER INSTALLATION SCREED 'f 3 CONCRETE WEARING FLOOR u u FREEZER 2 REDWOOD PERIMETER BY GENERAL CONTRACTOR COORDINATE DIMENSIONS WITH BOELTER CO OUTSIDE WALL r D fl a z r rn 7C —1 rn -0 D D (Pd-; n m 0 0 z B G� CP 111 m —4 O I4F -AJ HEAT PULP SIP -51 HP -q J -IP -DI HP-E1 1 -lP -F� EFFITI IEF -21 �EF -31 I EF -4 HEAT PLMP HEAT PIMP HEAT PU`1P HEAT PIMP HEAT PUlP EXHAUST FAN EXHAUST FAN EXHAUST FAN EXHAUST FAN LOUVER 1 EBB 1 ELECTRIC BASE BOARD HEATER NvAC SCNED�_E LOiCAT1CN Mc gbtIOD EL 234 234 139 119 RESIDENT KITCHEN TYPICAL RESIDENCE TYPICAL RESIDENCE 144)48 ,232 131 140)43 SUITE CARRIER CARRIER CARRIER CARRIER CARRIER CARRIER/ GE/ AMANA NUTONE GREENHEOQ N JTONE/JEMFAN GREENHEOC/ NJTONE /JEJ 1»FAN GREENNECKJ NJTONE /JENNFAN GREENHECK/ RUSKIN/ARROW CADET DE6CRIPTICN 29 I'1BH HEATING, 48 MBH COOLING, 2,000 CR1, 5.0 !all COIL, COP 3.0 14 MBH HEATING, 24 MBH COOLI'4 800 CFM, SDKU, COP 3.0 4 MBH HEATING, 24 MBH COOLING, 900 CR1, 521(W, COP 3.0 14 MBH HEATING, 24 MBH COOL ING, 100 CR1, 5.0KJU, COP 3.0 85 MBH IEATING, 60 MBN COOLING, 25oo CR1, 200 KW CFri, 2.0 KW Co MESH HEATING, (0.q MBH COOLING, 2800 ELECT. RESIST HEAAT, 5.0 EER W ALL E�W�ST FAN, 50 R 2E SONE5 200 CR1, WALL MOUNT AT NOT RATER THAN 5.0 SONES AT 0J" SP )00 O3'1, WALL MOUNT AT NOT GREATER THAN 50 SONES AT 0J" SP 50 O 1, WALL MOWT AT NOT GREATER THAN 5.0 SONES AT 0.1" SP ALUMINUM, STATIONARY WITH BIRD SCREEN 3000 BTU, 5 LONG, 208/60/3 950 WATTS NOTES OR EQUAL OR EQUAL OR EQUAL OR EQUAL OR EQUAL OR EQUAL OR EQUAL OR EQUAL OR EQUAL OR EQUAL SIZE PER DWCz NOTES OR EQUAL NOTE. ALL COOLING AND HEATING VALUES ARE NOMINAL VALUES BASED ON 0.1% EDB CF 80 EWB OF 62'F AND 0,2% EAT OF 24'F �,1-'" ALL HEAT PUMPS MUST HAVE A COP 0= 3 0 OR BETTER ALL HEAT PUMPS ARE TO BE SUPPLIED WITH SUPPLEMENTAL ELECTRIC RESISTANCE COIL FOR FREEZE PROTECTION ALL HEAT PUMPS ARE TO BE SUPPLIED WITH 20% GLYCOL HEAT PUMP HP E IS TO BE SUPPLIED WITH AUTOMATIC SHUTOFF AND DUCT SMOKE DETECTOR PER UMC SECTION 6OS THERMOSTATS ARE TO HAVE MINIMUM vE DEGREE DEADBAND AND INTERLOCK CAPABILITIES PROvIDE BACKDRAFT DAMPERS NEAR LOUVERS ON ALL EXHAUST DUCTS w417ER NSA E1� SCNE��_E ITEM LOCAT1Ci4 1111tAlODfi,. DESCRI'T1CN 0-1 -1,2 WATER NEATER UM-3 WATER NEATER 119 F C I RC RUMP 234 AO SMITH AD 6MITH 234 TACO I 120 DEG WATER HEATERS TO BE SIZED TO DELIVER 200 GPH WITH 140 GALLON CAPACITY AT NOT MORE THAN 22KW PER HEATER 20S/60/3 140 DEG WATER HEATER TO BE SIZED TO DELIVER 40 GPs-1 WITH 100 GALLON CAPACITY AT NOT MORE THAN 10KW, 208/60/3 IN -LINE CIR LILATIC 4 PUMP l8 GPM, 113 NP MOTOR HOTEt or egos I or equa or aqua I r ADDENDUM #1 MECHANICAL In )0 5TORAGE 10 50 CR Sib 8=10 'A' LAUREL PARK ASSISTED LIVING PORT ANGELES W.451-IINGTON PDC MIDWEST PROJECT NO 6061 REV el 1e1/8 SOFFIT PRIVATE I) NI1%6 (124 STORAGE _r rii 3 10¢. 100 �M CFM CFFICE CORR. 2 4/6 (_t23 Id' -I ii 3 LOLW-sE (130 toi KITCHE i REF SHEET M I 1 0 CD- 13 UP Tv LOUNGE 136 200 CFM ADDENDUM 01 Q STAI 3 O 200 LAUREL PARK ASSISTED LIVING PORT ANGELES WASI-IINGTON PDC MIDWEST PROJECT NO 6061 REV #1 CFM 10 DIA. 200 CFM MECH 139 C FFTI CORF12. BEAUTY 141 1 144 12 DIA. DINING 132 L \CFM 11 GF M HC s TLT HC TLT (140 5m EF 4 200 14 DIA. 8 DIA. 200 CFM 2 1 1 0 1 6 DIA. 1 r PROVIDE /20 RETURN I U' 8/14 GRILLE •N WALL 1 AND IN TO 1 DU BENEATH 200 AB SUPPLY t RETURN GiT'i 1 DUCTS TO RUN 16 I UNDER SLAB DIA. 1 6 DIA. 1 1 r i 8/14 8/14 HP 140 L_ T E 12 I 1 I RESIDENT I DIAl KITCHEN 1 �0 8 DIA.( 138 I DIA. 8 DIA. REF SHEET MI (0 6 -9 -91 CD -14 Tv LOUNGE 136 18x18 UP STAFF LOUNGE 149 STAI 3 ADDENDUM 01 LAUREL PARK ASSISTED LIVING PORT ANGELES WASHINGTON PDC MIDWEST PROJECT NO 6061 PROVIDE -/20 RETURN GRILLE •N WALL AND N TO DU BENEATH 200 a 6/8 200 CFM NDRY 148 JAN. 145 REV $tI N _200 CFM CORR. 141 14/6 -0 AB N HG TLT 140 5m CF`9 EF 6O Qo HG EF -4 TLT 143 I 12 DIA I RESIDENT DIAI KITCHEN I 8 DIA.( 135 I— 10 I DIA. 8 I DIA. 8 DIA. 200 CFM C CFM SUPPLY 4 RETURN DUCTS TO RUN 16 UNDER SLAB DIA. N- 6 DIA. 100 100 J COUNTRY STOR% OFFICE 146 Irk( 141 7 6 DIA. c_ 8/14 rt 8/14 1 8/14 L 1- HP 140 E STUDIO A REF S1 -IEET PV1 110 6 -9 -91 CD- 15 .1••=111 -1 8/6 EF-3- ADDENDUM #1 LAUREL PARK ASSISTED LIVING PORT ANGELES UJA514INGTON PDC MIDWEST PROJECT NO 6061 REV it KITC1-1g13 1-100D DUCT 1 ittittuf REF 514EET Mt 20 CD- IG a) Lr 11 ADDENDUM #1 LAUREL PARK ASSISTED LIVING PORT ANGELES W,4514INGTON PDC MIDWEST PROJECT NO 6061 REV ik4 1 (210) 12' TTP -4- REF SWEET M2.0 LOUVER IN SOFFIT N rn rn W 0 GO 135 HB -1 UP 136 PRovIDE 2" F1_c c DRa.lt4 U11UER UT IL-1`T SINK CT YP A•71" 2N» FL-oc)R L4 4 1 Cd M EC-T To TRAP w I`T H 149 \ANT S PER (-15c, C i NOTE EACH WASHING MACHINE ON BOTH FLOORS WILL RECIEVE. WM -1: WASHING MACHINE SUPPLY AND DRAIN: GUY GRAY WASHING MACHINE SUPPLY AND DRAIN, MODEL B -200 FOR 2 DRAIN. PROVIDE MECHANICAL WATER HAMMER ARRESTOR ON EACH SUPPLY t /2'CW S-1 137 S -3 144 1 /2'HW 3/4 CW 3 /4'HW 139 WM 148 LT 1 MB -1 145 n a C.O. 14 0 z I /2'W I'CW/HW C L 2'VTR C WC S -2 143 146 DISHWASHER u 138 100 147 HB -1 A5 g15�fE it RE 01 L p,URE AN E� 5 WASO �N'© �000` d POR PR I CJ O c Oz rn -D N D O D n m Z 4 O 0- V U, N Lo 0 DISCONNECT PER PA REQUIREMENTS 1 600 AMP TO UTILITY TRANSFORMER WIRE SCHEDULE (THHN) SYMBOL FEEDER SIZE AMPACITY lO 2 1/2 C, 4 -4/0 CU W #2 CU GO 230 A 2 SETS OF 2O 2 1/2 C, 4 -4/0 CU W #2 CU CD c 460 200 2 C, 4 -3/0 CU W #6 CU GD r1 0 4 SETS OF ---N----N 1680 L 3 -1/2" C, 4- 600MCM Cu (THWN) Os 1 1/2" C, 4-#1/0 CU 150 N. a Q ro P) re) N N N a a a a. a_ P139 rL n P119 1_ 150 I I 225 n. 150 a_ 200 P 150 3P O O 3X 0 P (CP la lo MOP MDP MAIN POWER PANEL 1 600 AMP MAIN 30 000 AIC MINIMUM 1600 AMP GROUND PER NEC a SHUNT TRIP BREAKER W/ #1 CU PER RACEWAY 0 J W E. i 124 Ni (1 30 ADDENDUM 01 LAUREL PARK ASSISTED LIVING PORT ANGELES WA51-1INGTON PDC MIDWEST PROJECT NO 6061 REV tI i 135 1 E 1 Y PROVIDE J —BOX W/ POWER FOR FUTURE LIGHT SAME CIRCUIT AS OTHER CANOPY LIGHTS. UP K K REF SWEET Elio 16 -9 -91 CD -21 I al '1 111 mR, ADDENDUM 01 I A\MP NE MA 3R Loc...KA.E>Le b sc.c.t.i ktec-1- ci ci LAUREL PARK ASSISTED LIVING PORT ANGELES LIJAS1-4INGTON PDC MIDU.EST PROJECT NO 6061 REV 11 s PR9K-29.31 I TT...a I MUTT PIETER ss,,,, _A 6 U- GM 0 1---E5gir 1011, P119-10 .2.----- 0 -7 4 I09 P119K-25.21 lig TV CABLE BACKBD rusi PII1A LT T ,„Ll 4 r PII9A-01 v E --_dill ..m .AGI :,--I 11 L— I. ,,---1 WADI' i F.T.T1i.a.m........, I „....1 I i ,e t N. "J■ IGFI GFI% I IGFI 120 tiAGj P11911 22.24 PHONE. BACK13D Nall HP -D FRL P119 A-42 121 5- 124 REF SI-IEET 11 6-9-91 C CD-2a r 1I j I i r ti I S Q �q o>1.- p p ti -t- I 0 APpE ARK A5515TE� L'y`N� �AuR�� P ANGELES �A54- IIN�TON �m�� RSV sal POR 5T PRO JECT NO a 4 3 133 (132 .P, PI39A -3 Mm 9A -3 I 141 e 9 ADDENDUM 1 1 i F I LAUREL PARK ASSISTED LIVING PORT ANGELES WASHINGTON PDC MIDWEST PROJECT NO 6061 HP- 'RECESSED PI39A -10 REFRIG. i PI39A -13)5 (198 208 RANGE D REV 01 9' WP/ GFI Pll f131-22.24.26 1S3 141;) —1-:- (C1 PII9M -15J1 PII9M -26.28 7 1-4P-E,/ i JHP -C REF SWEET E11 E 6 -9 -91 CD -24 O 0 D O n 70 O z m r rn L.' D rn (l O p r ELEVATOR SHUNT TRIP LOCATED IN ELECT ROOM I I r SD I (H) SD ELEVATOR MACHINE ROOM ELEVATOR SHAFT ELEVATOR L AR ELEVATOR PIT LOBB r SD LOBBY SCALE NTS PLAN NOTES TO FRCP LOWER LEVEL HEAT DETECTORS ARE AN AUXILIARY FUNCTION OF THE ELEVATOR EQUIPMENT PROVIDE LABEL ON EACH DETECTOR THAT STATES ELEVATOR CONTROL ONLY- DO NOT TEST' ELEVATOR RECALL ONE -LINE DIAGRAM -4 TO FACP UPPER LEVEL n N 6 t i p t9 1 3 5 7 9 11 13 15 17 19 21 23 25 27 29 31 33 35 37 39 41 PANEL NAME/ LOCATION: FED FROM AIC RATING CIRCUIT DESCRIPTION RECEPT RM 146,147 RECEPT RM 150,138,137 RECEPT RM 132 HALL(E)RM 204 -212 ODD HALL(E)RM 201,203,205,207,209 RANGE VENDING MACHINES RECEPT RM 130,135,136 ELEVATOR SERVICE RECEPT LIGHT HEAT RN 149 HEAT RM 130 HEAT RN 136 RECEP RM 130,134,133 P139 HALL(141) RM132 RM 130,131,135,136,151,134,133 PARKING LOT LIGHTS UGHTING RECEP 10 RECEP 10 LARGE MOTOR OTHER MOTOR HEATING A.C. VENTILATION KITCHEN MISC. P139A/RM139 CONNECTED 16.7 Kva 10.0 Kva 13.2 Kvo 0.0 Kva 0.0 Kva 16.9 Kva 0.0 Kvo 8.5 Kvo 10.0 Kva 10,000 LOAD (KVA) CODE 1 441R 1 62IR 1 62IR 1.38IL 1 8081L 71K 1 861R 1.8IR 1.51R 2IH 2IH 2IH 1 1 81L 1 921L 1 51L 1 1 81R 125% 100% 50% 125% 100% 100% 100% 100% 100% BRKR 20 1P 20 1P 20 1P 20 1P 20 1P 40 2P 20 1P 20 1P 20 1P 20 2P 20 2P 20 2P 20 1P 20 1 P 20 2P PANEL SCHEDULE 20 1P DEMAND 20.8 Kva 10.0 Kva 6 6 Kva 0.0 Kva 0.0 Kva 16.9 Kva 0.0 Kva 8.5 Kva 10.0 Kva BRKR ICODE 20 1P IR 20 1P IR 20 1P IR 20 1P 1K 30 2PIM 30 2PIM 20 1P IR 20 1P IR 20 1P IR 20 1P IR 20 2P 20 1P IL 20 1P IL 20 1P IL 20 1P IL 20 1P IL 60 2P 1H RATING: VOLTS /AMPS 120/208V 1 2@9-' 225A MAIN LUGS 3PHASE 4WIRE. WI ISO GRD SURFACE__X__ LOAD (KVA) I CIRCUIT DESCRIPTION 1 O8IRECEPT RM 138,140,143 1 62IRECEPT RM 131,133,1343 1 621REC RM 121,122,127,128,132,152 1.5IREFER RM138 5IDRYER 1 1 5IDRYER 2 1 1.861 WASHER 1.861 WASHER 1.871RM 104 1 681RM 104 2IRM 104 1 708IHALL(W)RM 148,149,103,105,107 1 6441 RM142,148,149,103,105,107 1 6051RM 138,140,143,146,147 1 65IRM 100,102,104,106,144 1 6441RM 103,105,107,149,148 8.94IHEAT PUMP C SUPPLY VOLTAGE CONNECTED LOAD DEMAND LOAD DEMAND AMPS AMPS PER PHASE. A B C 182 212 234 1, RECEPT RN 149 2 RECEPT RM 142,149 K RECEPT G RECEPT HEAT 208 V 75.3 Kva 72.9 Kva 202 A 12 14 16 18 110 112 114 116 118 120 122 124 126 128 130 132 134 136 138 140 142 o E rn 0 7tl O C- rn z 0 K L M N Na 0 P Q Qa S T U V W X Z RESIDENT KITCHEN RESIDENT LANDRY ACTIVITY MAN KIT OFFICES, BEAUTY SHOP FED REC. UNDER CABINET LIGHTING ET"ER TENCY BACK-UP CEILIT. FAN CEILING FAN MIDDEN crr CANOPY RECESSED DO.LNLIGHT (flat) RECESSED DOUNLKaHT RECESSED DOLNLIGHT (slope) CORRIDORS LANDSCAPE rECH. STORAGE. CORRIDORS OHM, LOBBY HAIN ENTRANCE LANTERN ELEVATOR PIT PARK 11.6 LOT SIGN LIGHT I SEAGULL SEAGULL LITHONIA X NUTONE X MUTONE VERIFY WITH OILNER SEAGULL LITHONIA LITHONIA LITHONIA COLUMBIA O HYDREL COLUMBIA SEAGULL IGCHLER PO DAY -BRITE Iffir• EMCO Y I EMCO 5913-68 4911 15 EIJI2 PLF -52WE FR'18 -52WH 1926 15 AFI/13TT 6AR AFUJ 2/13TT 6AR AF I/13TT 6AR SC6 C SPA -222AG -43661 5 A 4583A -FL1 CSR4- 240 -LE 120 5951 -02 K 9101 POLISHED BRASS VP509CDI N -W -G ECA23234-1QV15011-1 AM5- M- 50M1-I- 208 -LA r L 4 32W T -8 1 15W T -8 122120 5-4W TUNGSTEN 2 13W FL SURFACE I13W TWIN TUBE 2 13W FL TWIN TUBE 12 I 113W L. RECESSED TWIN TUBE 2 FB9331 4 RECESSED T 1 PLl th 12 2- F40 -ES 3 13W FL 18 2 9W -FL WALL 150 MH150N/BT31 POLE 50 I MHSO/U I GROUND SURFACE WALL SURFACE NOT USED SURFACE NOT USED NOT USED SURFACE NOT USED RECESSED NOT USED SURFACE SURFACE SURFACE WALL NOT USED LOUVERS TO BE CHAMPAGNE GOLD PL1 RATED FOR 4P OPERATION COMPLETE W/ 30' SQUARE POLE AND FOOTING J1D5GQPE ELQOp LIGHT +E Cck1+P.G1lM l a CITY 4F'PORT ANGELES Application Number . . . . 21-00000405 Date 4/01/21 Application pin number 134915 Property Address 1133 E PARK AVE ASSESSOR PARCEL NUMBER: 06-30-11-5-1-0800-0000- Application type description ELECTRICAL ONLY subdivision Name . . . . Property Use . . Property Zoning . RESIDENTIAL MEDIUM DENSTY Application valuation 0 -_-_ _ --------- _- - Application desc Door access' Owner Contractor LAUREL�PARK AID PROPCO LLC COSCO FIRE PROTECTION INC C/O ASSISTED LIVING CONCEPTS 4308 S 131ST PL 330 N WABASH AVE SUITE 3700 SEATTLE WA 98168 CHICAGO IL 60611 _ (949) 245-6491 (312) ;725-7U0 ---------------------------------------------------------------------------- Permit' . . . ELECTRICAL ALTER COMMERCIAL Additional desc Permit Fee 96.00 Plan Check Fee .00 Issue Date . 4/01/21 Valuation . . 0 Expiration Date 9/28/21 4ty Unit Charge Per Extension 1.00 96.0000 ECH EL-LIMITED 1ST 1500 SO FT 96.00 ------------------------------- ---- Fee summary Charged Paid Credited" Due ----------------- ------- -- - - Permit Fee Total' 96.00 96.00 .00 .00- Plan Check Total .00 .00 .00 .00' Grand Total 96.00 96.00 _00 .00 REPORT SALES TAX on your excise tax form to the City of Port Angeles (Location Cade 0502) INSPECTION TYPE DATE: RESULTS: INSPECTOR: DITCH SERVICE ROUGH-INAIR FINAL " COMMENTS: PERMIT WILL EXPIRE SJX`(6)MONTHS FROM LAST INSPECTION Signature of owner or Electrical Contractor X Date: G:\EXCHANGE\13UILDING � ,t 3 s ~ ' MULTI-FAMILY / COMMERCIAL � ELECTRICAL PERMIT APPLICATION Public Works and Utilities De lD�Qt ' � 321 F. 5\h SbceL Port Angeles. VV& g#382 \ 360.417.4735 | xww.oitywfpnuw | e lectr iou|poon its(�ikiiyo6pu.us a Project Address: 1133 E. Park Avenue Port Angeles, \8/A98362 Project Description: Memory Care Facility [] Multi-Family Residential 0 Commercial/Industrial/Public Building Square : OWNER INFORMATION Name: Extreme Elements Email: Joni&extremeelements.us Mailing Address: po box 3378 Central Point, Or 98502 Phone: 206-888-7650 ELECTRICAL CONTRACTOR INFORMATION Name: Cosco Fire Protection License: COSCOFP935MS Mailing Address: 2501 SE Columbia Way, Suite 100 Vancouver,WA 98661 Expiration Date: 7/2/21 Email: ctyree@coscofire.com Phone: 360-883-6383 PROJECT DETAILS 112M Unit Charae Qual3tily J2W(Quantity x Unit Charge) Branch Circuit W1 Service Feeder $5.00 $ Branch Circuit W/O Service Feeder $74.00 $ Each Additional Branch Circuit $5.00 $----______ Branch Circuits 14 $86.00 $ Temp. Service/Feeder 2OO Amp. �.� �� $1O2�0 ' $ Temp. GemimdFoener2U14u0}Amp. ����� $121.00 $ Temp. Temp. 8ervice/Feed u Portal ho Portal Hourly Sign/Outline Lighting ������� /,'������� ^�����0����v' $88.00 ^'�� ��� `� Signal Circuit/Limited Energy-Multi-Family $88.00 $ Signal Circuit/Limited Energy/First 1500 sf-Commercial $96.00 1 ,$ 96L10 Renewable Elec. Energy: 5KVA System or less *----______ Thermostat(No0e: oS for each additional) �^�:,�`� "��`n � *`` $--___-___ $ 961TgTAL Owner as defined by RCW19.28.261:(1)Owner will occupy the structure for two years after this electricalpermit is finalized.(2)Owner is required to hire an electrical contractor ifabove said property im for sale, rent urlease. Permit expires after six months of last inspection. After reading the above statement, I hereby certify that I am the owner of the above named property or a licensed electrical contractor. I am making the electrical installation or alteration in compliance with the electrical laws,N.E.C.,RCW Chapter 19.28,WAC. Chapter 296- 46B,The City of Port Angeles Municipal Code,and Utility Specifications and PAMC 14.05.050 regarding Electrical Permit Applications. 3/31 Chris Tyree Date Print Name Signature(VI Owner V Electrical Contractor/Administrator) [Electrical Permit Applications may be submitted to City Hall or electricalpermits@cityofpa.us or faxed to 360.417.4711] Address: 1133 E Park Avenue PREPARED 11/15/16, 9:42:19 INSPECTION TICKET PAGE �' S CITY OF PORT ANGELES INSPECTOR: JAMES LIERLY DATE 11/15/16 ------------------------------------------------------------------------------------------------ ADDRESS : 1133 E PARK AVE SUBDIV: CONTRACTOR PHONE OWNER ALC REAL ESTATE LLC PHONE PARCEL 06-30-11-5-1-0800-0000- APPL NUMBER: 16-00001564 RES MECHANICAL PERMIT ------------------------------------------------------------------------------------------------ PERMIT: ME 00 MECHANICAL PERMIT REQUESTED INSP DESCRIPTION TYP/SQ COMPLETED RESULT RESULTS/COMMENTS ---—-------------------------------- -------- --- —- - - ME99 01 11/15/16 J L MECHANICAL FINAL November 15, 2016 9:06:17 AM jlierly. Tim 670-6297 -------------------------------------- COMMENTS AND NOTES ----------------------------- PREPARED 11/16/16, 9:12:28 INSPECTION TICKET PAGE 3 - CITY OF PORT ANGELES INSPECTOR: JAMES LIERLY DATE 11/16/16 ----------------------------------------------- ------------------------------------------------- ADDRESS . : 1133 E PARK AVE SUBDIV: CONTRACTOR : PHONE OWNER ALC REAL ESTATE LLC PHONE PARCEL 06-30-11-5-1-0800-0000- APPL NUMBER: 16-00001564 RES MECHANICAL PERMIT ------------------------------------------------------------------------------------------------ PERMIT: ME 00 MECHANICAL PERMIT REQUESTED INSP DESCRIPTION TYP/SQ COMPLETED RESULT RESULTS/COMMENTS -------------------—----------------------------------—--—------------------—-—----------- ME99 01 11/15/16 JLL MECHANICAL FINAL 11/15/16 CA November 15, 2016 9:06:17 AM jlierly. Tim 670-6297 November 15, 2016 4:35:07 PM jlierly. Need to meet new onwer and walk through and see all items for finals/jll ME99 02 11/16/16 MECHANICAL FINAL November 16, 2016 9:16:52 AM jlierly. Tim 808-6291 -------------------------------------- COMMENTS AND NOTES -------------------------------------- C91 ) CITY OF PORT ANGELES DEPARTMENT OF COMMUNITY & ECONOMIC DEVELOPMENT- BUILDING DIVISION 321 EAST 5TH STREET, PORT ANGELES, WA 98362 Application Number . . . . . 16-00001564 Date 10/24/16 Application pin number . . . 570476 Property Address . . . . . . 1.133 E PARK AVE REPORT SALES TAX ASSESSOR PARCEL NUMBER: 06-30-11-5-1-0800-0000- Application type description RES MECHANICAL PERMIT on your state excise tax form subProperty Name . . . . . . to the City of Port Angeles Pro ert Use Property Zoning . . . . . . . RESIDENTIAL MEDIUM DENSTY (Location Code 0502) Application valuation 0 Application desc FINAL INSPECTION ONLY FOR PERMIT 09-191 HEAT PUMP ---------------------------------------------------------------------------- Owner Contractor - ----------------------- ------------------------ ALC REAL ESTATE LLC OWNER W 140 N 8981 LILLY RD MENOMONEE FALLS WI 53051 Permit . . . . MECHANICAL PERMIT Additional desc INSPECTION ONLY FOR #9-191 Permit Fee . . . . 64.80 Plan Check Fee . . .00 1 Issue Date . . 10/24/16 Valuation . . . . 0 Expiration Date 4/22/17 Qty Unit Charge Per Extension BASE FEE 50.00 1.00 14.8000 EA ME-FURN/HP/FAU < OR = 5 TON 14.80 ---------------------------------------------------------------------------- Fee summary Charged Paid Credited Due =---------------- ---------- ---------- ---------- ---------- ry Permit Fee Total 64.80 64.80 .00 .00 Plan Check Total .00 .00 .00 .00 Grand Total 64.80 64.80 .00 .00 Separate Permits are required forelectrical work,SEPA,Shoreline,ESA,utilities,private and public improvements. This permit becomes null and void if work or construction authorized is not commenced within 180 days,if construction or work is suspended or abandoned for a period of 180 days after the work has commenced, or if required inspections have not been requested within 180 days from the last inspection. I hereby certify that I have read and examined this application and know the same to be true and correct. All provisions of laws and ordinances governing this type of work will be complied with whether specified herein or not. The granting of a permit does not presume to give authority to violate or cancel the provisions of any state or local law re lating construction or the performance of construction. Date Print Name Signature of Contractor or Authorized Agent Signature of Owner(if owner is builder) T:Forms/Building Division/Building Permit BUILDING PERMIT INSPECTION RECORD PLEASE PROVIDE A MINIMUM 24-HOUR NOTICE FOR INSPECTIONS Building Inspections 417-4815 Electrical Inspections 417-4735 Public Works Utilities 417-4831 Backflow Prevention Inspections 417-4886 IT IS UNLAWFUL TO COVER, INSULATE OR CONCEAL ANY WORK BEFORE INSPECTED AND ACCEPTED. POST PERMIT INCONSPICUOUS LOCATION. KEEP PERMIT AND APPROVED PLANS AT JOB SITE. Inspection Type Date Accepted By Comments FOUNDATION: Footings Stemwall Foundation Drainage/Downspouts Piers Post Holes(Pole Bldgs.) PLUMBING: Under Floor/Slab Rough-In Water Line Meter to Bldg) Gas Line Back Flow/Water AIR SEAL: Walls Ceiling FRAMING: Joists/Girders/Under Floor Shear Wall/Hold Downs Walls/Roof/Ceiling Drywall Interior Braced Panel Only) T-Bar INSULATION: Slab Wall/Floor/Ceiling MECHANICAL: Heat Pump/Furnace/FAU/Ducts Rough-In Gas Line Wood Stove/Pellet/Chimney Commercial Hood/Ducts MANUFACTURED HOMES: Footing/Slab IBlocking&Hold Downs Skirting PLANNING DEPT. Separate Permit#s SEPA: Parkin /Lighting ESA: Landscaping SHORELINE: FINAL INSPECTIONS REQUIRED PRIOR TO OCCUPANCY/USE Inspection Type Date Accepted By Electrical 417-4735 Construction - R.W. PW /Engineering 417-4831 Fire 417-4653 Planning 417-4750 Building 417-4815 10/13/2016 THU 8: 15 FAX 0001/001 H For City Use CITY F ' Permit# `�. A s H I lv G T a N, u. s_ Date Received: /-C 321E 5t6 Street Date Approved lG� l)K Port Angeles.WA 9836 P:360-417-4817 F:360-417-4711 Email:permlts(&cityofoa.us BUILDING PERMIT APPLICATION Project Address: 11, '5-3 Phone: Primau Contact: L4V JZ(_-A)1} Email: ame D j one V 4 d1 3',~ GS Property Mailing Address r .� Email Owner City State Zi 9 F e Name _ Phone y ' Contractor Address Email Information City State Zig Contractor License# Exp.Date: v Legal Description: Zoning: Tax Parcel# Project Value:(materials and tabor) lks.meo I $ y Residential ❑ Commercial ❑ Industrial ❑ Public ❑ Permit Demolition ❑ Fire ❑ Repair ❑ Reroof(tear off/lay over) ❑ t Classification For the following fill out both p_ag@s o permit application: (check New Construction ❑ Exterior Remodel ❑ Addition ❑ Tenant Improvement ❑ appropriate) Mechanical IKPlumbing ❑ Other ❑ Fire Sprinkler System.Proposed Irrigation System Proposed or Proposed Bathrooms Proposed Bedrooms or Existing? Yes ❑ No ❑ Existing? Yes ❑ No ❑ I In addition to standard hard copy submittals please send a PDF copy of all Stormwater.plans and Engineering to www.stormwaterfibeltvo R.41s C Project Description A et�9 iTG5''�9 �r L` r Is project in a Flood Zone: Yes ® No® Flood Zone Type: If in a Flood Zone, what is the value of the structure before proposed improvement? $ I have read and completed the application and know it to be true and correct,I am authorized to apply for this permit and understand that it is my responsibility to determine what permits are required and to obtain permits prior to work. I understand that plan review fees are not refundable after review has occurred. I understand that I will forfeit review fees if I withdraw the application before the permit is issued. I understand that if the permit is not picked up/issued within x8o days of submittal,the application will be considered abandoned and the fees will be forfeited. p i � _6 Y" NIT f 7 Dat Print Name Signature Address: 1133E Park Avenue CERTIFICATE F�wO CUPAN CY Cly of Port Angeles Building Division This certificate is issued. // to the requirements�bf Section 171-of the N1, This Building / . de _. \� Code certifying that at,,Ae tame of issuance this structure was in compliance with the various ordinances of the City regulatangtbualding con taction or use for the followings , �... � s Business name: t' LaureMark j Business address East Park!Ave Business owner: Laurel Park AIDOPCO LLC YF C/O Hason Bndgett Attn P 5oljougI- Business owner' address,:�425 Market-St=26th FI San-Francisco�CA%94,105 Automatic fire sprinkler system: N/A� Use &occupancy cl,'czssifacatiou: Business ,-mow.. .. _ Occupant load: Per2:012 fBCTable 1:004 1:1w,, 17 Type of construction: 10/28/2013 -anager Date 1 Post on the premises in a conspicuous place. This certificate shall not be removed except by the Building Official. l RECEIVED AN 0 5 2013 �-7,3 23 Cv� 0411v&ej_11_f' ,CITY ELIK TIFICATE OF OCCUPANCY APPLICATION Permit 13-Le� B N FEES CITY OF PORT ANGELES $50 Certificate/Inspection Attn: Permit Technician 321 E. Fifth St., Port Angeles,WA 98362 $100 Parking Business Improvement Area (PBIA) (360)417-4815 fax(360)417-4711 fee charged for Downtown locations PLEASE PRINT M INK Check one: New business in P.A.?E Change of ownership only? ❑ Moving location from within P.A.? ❑ Zon i ng BUSINESS NAME Laurel Park Business address 1133 East Park Avenue Mailing address c/oHanson Bridgett, Attn:P. Soljoughian, 425 Market St 26th Phone number 360-452-7201 Opening date Days & hours of operation 24/7 Business owner's name LAUREL PARK AID OPCO LLC Contact phone 415-995-5135 Business owner's address c/oHanson Bridgett, Attn:P. Soljoughian, 425 Market St, 26th Fl, San Fran, CA 94105 Brief description of business Assisted Living Property owner's name LAUREL PARK AID PROPCO LLC Contact phone 415-995-5135 Property owner's address/contact c/oHanson Bridgett, Attn:P. Soljoughian, 425 Market St, 26th Fl, San Fran, CA 34105 BUILDING DEPARTMENT phone 417-4815 Bldg approval by,:�'"— 0_41E] n e? Is the business a restaurant or bar that will seat 50 or more people? Yes ❑ No D Construction changes planned (moving walls, adding/enlarging windows or doors, roofing, siding,foundation work, adding/altering stairways, ramps, bathrooms, electrical, heating/cooling/ventilation systems, etc). Work planned: None FIRE DEPARTMENT phone 417-4653 Fire approval by on Changes to a fire sprinkler system or fire alarm system? Yes ❑ No Z Work planned: None PBIA (Parking Business Improvement Area -Downtown) phone 417-4623 Square footage of business? 32,318 PB/Anodfied on Is business moving within the PBIA? Yes ❑ No LXI CITY CLERK phone 417-4634 City Clerk approval by on Second-hand dealer/pawnbroker business? Yes ❑ No X❑ Will there be dancing at this business?Yes ❑ No X❑ A City of Port Angeles Business License is required for: Taxi, Peddlers, Second-Hand Dealer, Pawnbroker, Dance, Hotel-Motel, Fireworks, Ambulance, and Tattoo Businesses. Page 1 of 2 COMMUNITY&ECONOMIC DEVELOPMENT phone 417-4750 CED approval by on Number of off-street parking spaces available for employees and customers? 21 (A parking plan may be required.) Signs? ( all-mounteeestandin projecting, awning, A-frame, etc?) Signs planned: None PLEASE NOTE: NO flashing, intermittent,or chasing signs are permitted in the City of Port Angeles. PWE approval by on PUBLIC WORKS DEPARTMENT-ENGINEERING phone 417-4812 Is site work planned (new or re-located sewer or water service, excavation, grading or filling, work in City right-of-way, new driveway openings, site drainage, parking lots, downspouts, irrigation system backflow devices, etc.). Yes ❑ No M Work planned: PUBLIC WORKS WASTEWATER phone 417-4845 PWW approval by_on _] Will waste, other than domestic household waste, be discharged into the sewer system? Yes ❑ No E If yes, what will be discharged: Call for Certificate of Occupancy inspections BEFORE opening business. Building Department Inspection 417-4815 Fire Department Inspection 417-4653 Please sign up for utility services at the cashiers' counter. I hereby apply for a Certificate of Occupancy. I acknowledge that I have read this application and state that the information I have supplied is correct to the best of my knowledge. Incorrect information may result in revocation of permit. Date Print Name Daniel cuill Signature T:\Forms\Building Division\Certificate of Occupancy Application(2010).doc Page 2 of 2 • City of Port Angeles • Page 2 EXHIBIT A DESCRIPTION OF APPLICANT, LICENSE AND FACILITY Applicant/Business Property Type of Facility Name Facility Owner Owner License Address LAUREL PARK AID LAUREL Certificate of Laurel Park 1133 East Park OPCO LLC PARK AID Occupancy Avenue PROPCO LLC Port Angeles, WA 98362 THE RECEIVED NATHANSON GROUP JUN, 0. 5 2013 CITY OF PORT ANGELES BUILDING DIVISION June 3, 2013 VIA FIRST CLASS MAIL City of Port Angeles Attn: Permit Technician 321 E. Fifth Street Port Angeles, WA 98362 Re: Certificate of Occupancy (the "Application") for the issuance to the applicant identified in Exhibit A (the "Applicant") of the license described in Exhibit A (the "License") with respect to the assisted living facility described on Exhibit A (the "Facility"). To Whom It May Concern: I am writing on behalf of the Applicant. The Applicant is a party to a pending transaction pursuant to which it would become the new licensed operator of the Facility. We currently anticipate that the closing of this transaction will occur July 1, 2013 (the "Effective Date"). However, we are filing the Application in order to ensure that the Applicant has secured all necessary licenses and permits by the Effective Date. Although we would ask that you begin to process the Application at your earliest convenience in order to ensure that the License will be issued on the Effective Date, we must ask that you do not issue the License to the Applicant prior to the Effective Date since the Applicant will have no legal right to operate the Facility prior to the Effective Date. Also, if applicable, please fee free to contact the Facility Administrator to schedule any required inspections of the Facility in connection with the processing of the Application. The Facility Administrator can be contacted at 360-452-7201. Should you have any questions or concerns while processing the Application, please do not hesitate to contact me at 206-623=6239 or by email at shandal@nathansongroup.com. Once the License is issued to the Applicant, please provide a copy via fax at 206-299-3983 or by email. Thank you in advance for your cooperation. Sincerely, Shanda London Paralegal One Union Square 600 University Street,Suite 2000 Seattle,WA 98101-1192 206.623.6239 www.NathansonGroup.com /-06/I3 , 15 : 53c01 � � 6OU� PAYMENTS DUE RECEIPT CITY OF PORT ANGELES PROGRAM BP820L APPLICATION NUMBER: 3-00000624 1 33 E PARK AVE FEE DtSCRIPTION OUNT DUE — - -- - ----- ---------- -- ---- --------- ------------------- ----- CHANGE OCC/USE FIRE DEPT 25 . 00 CHANGE OF OCCUP/USE 25 . 00 TOTAL DUE 50 . 00 Please present this receipt to the cashier with full payment . CITY OF PORT ANGELES # CUSTOMER RECEIPT Oper: SCORDERY Type: CT Drawer: 1 Date: 6/06/13 16 Receipt no: 55476 Year Number Amount 2013 624 1133 E PARK AVE PORT ANGELES NA 98362 BP hUILDING PERMITS $50.00 Trans number: 1503647 THE NATHANSON GROUP THE NATHANSON GROUP 1133 E PARK AVE Tender detail CK CHECK 16698 $50.00 Total tendered X50.00 = Total payment $50.00 Trans date: 6/06/13 Time: 15:55:03 * THANK YOU FOR YOUR PAYMENT FOR INQUIRIES 360-457-0411 PRESS 1 WWW.CITYOFPA.US I PREPARED 6/06/13 , 15 : 53 : 01 PAYMENTS DUE RECEIPT CITY OF PORT ANGELES ' PROGRAM BP820L -------- ---- - --------_---------------- - - ------------------ --------------- APPLICATION NUMBER: 3-00000624 1 33 E PARK AVE FEE DESCRIPTION ----'MOUNT DUE - - - ----- ------- ----------------- ---------- - ------ ----- --------------------- CHANGE OCC/USE FIRE DEPT 25 . 00 CHANGE OF OCCUP/USE 25 . 00 TOTAL DUE 50 . 00 Please present this receipt to the cashier with full payment. CITY OF PORT ANGELES Oper: SCORDERYSTOMERType: CT Drawer: 1 Date: 6/06/13 16 Receipt no: 55476 Year Number Amount 1133 E2013 OPARK AVE 624 PORT ANGELES UA 98362 BP UILDING PERMITS Trans number: $50.00 THE NATHANSON GROUP 1503647 THE NATHANSON GROUP 1133 E PARK, AVE Tender detail CK CHECK 16698 $50.00 Total tendered $50.00 Total payment $50.00 Trans date: 6/06/13 Time: 15:55:03 * * THANK, YOU FOR YOUR PAYMENT * FOR INQUIRIES 360-457-0411 PRESS 1 UUU.CITYOFPA.US RECEIVEDI 11 JAN o >> zo 1, j CITY GEL TIFICATE OF OCCUPANCY APPLICATION Permit# l3—(02"'( e N ` FEES CITY OF PORT ANGELES $50 Certificate/Inspection Attn: Permit Technician 321 E. Fifth St., Port Angeles,WA 98362 $100 Parking Business Improvement Area (PBIA) (360)417-4815 fax (360)417-4711 fee charged for Downtown locations PLEASE PRINT DV INK Check one: New business in P.A.°x. Change of ownership only? :.. Moving location from within P.A.? _. Zoning BUSINESS NAME Laurel Park 1133 E35L Park Avenue c'c'an= Brijaet:. Atcr -. S--�c—h—, ;-_ + rke 5 Business address Mailing address _ ep . - Phone number 36C-452-'.201 Opening date Days&hours of operation 2 Business owner's name LAUREL PARK AID OPCO LLC Contact phone 415-995-51135 Business owner's address c/oHanson Br'_daett, Attn:P. Soi oughian, 425 Marker. St, 2Eth Fl, San Fran, C= 94105 Brief description of business Assisted Li in_ Property owner's name LAJREL PARK RID PROPCO LLC Contact phone 415-995-5135 Property owner's address/contact c/oHanson Bridgett, Attn:P. Soijoughian, 425 Market St, 26th Fl, San Fran, .A 4.05 BUILDING DEPARTMENT phone 417-4815 Bldg approval by on Is the business a restaurant or bar that will seat 50 or more people? Yes No .X Construction changes planned(moving walls, adding/enlarging windows or doors, roofing, siding,foundation work, adding/altering stairways, ramps, bathrooms,electrical,heating/cooling/ventilation systems,etc). Work planned: None FIRE DEPARTMENT phone 417-4653 Fire approval by V47X on Ttf l 3 Changes to a fire sprinkler system or fire alarm system? Yes No Work planned: Mone PBIA (Parking Business Improvement Area-Downtown) phone 417-4623 < �� Square footage of business? 32,318 PB/A noted on Is business moving within the PBIA? Yes No x CITY CLERK phone 417-4634 City Clerk approval by on Second-hand dealer/pawnbroker business?Yes __ No .. Will there be dancing at this business?Yes _ No x A City of Port Angeles Business License is required for.- Taxi, or:Taxi, Peddlers, Second-Hand Dealer. Pawnbroker, Dance. Hotel-Motel, Fireworks,Ambulance, and Tattoo Businesses. Page 1 of 2 r Address: 1133 E Park Avenue PREPARED 8/14/14, 13:23:32 INSPECTION TICKET PAGE 4 CITY OF PORT ANGELES INSPECTOR: JAMES LIERLY DATE 8/14/14 -------------------------------------------------------- ADDRESS . : 1133 E PARK AVE SUBDIV: CONTRACTOR PENINSULA HEAT INC PHONE (360) 681-3333 OWNER ALC REAL ESTATE LLC PHONE PARCEL 06-30-11-5-1-0800-0000- APPL NUMBER: 14-00000918 COMM MECHANICAL PERMIT ------------------------------------------------------------------------------------------------ PERMIT: ME 00 MECHANICAL PERMIT REQUESTED INSP DESCRIPTION TYP/SQ COMPLETED RESULT RESULTS/COMMENTS --------------------------------------------------------------- ------------------------ ME99 01 8TL MECHANICAL FINAL August 14, 2014 9:52:35 AM pbarthol. Eric 912-1564 -------------------------------------- COMMENTS AND NOTES CITY OF PORT ANGELES DEPARTMENT OF COMMUNITY&ECONOMIC DEVELOPMENT-BUILDING DIVISION ® 321 EAST 5TH STREET, PORT ANGELES,WA 98362 Application Number . . . . . 14-00000918 Date 8/04/14 Application pin number . . . 611156 Property Address . . . . . . 1133 E PARK AVE ASSESSOR PARCEL NUMBER: 06-30-11-5-1-0800-0000- REPORT SALES TAX Application type description COMM MECHANICAL PERMIT Subdivision Name . . . . . On your State eXC1Se tax form Property Use . . . . . . . . to the City of Port Angeles Property Zoning . . . . . . . RESIDENTIAL MEDIUM DENSTY (Location Code 0502) Application valuation . . . . 4730 Application desc Like in kind Air handler/heat pump replacement ------------------------------------------------------------ Owner Contractor ------------------------ ------------------------ ALC REAL ESTATE LLC PENINSULA HEAT INC W 140 N 8981 LILLY RD 782 KITCHEN-DICK RD MENOMONEE FALLS WI 53051 SEQUIM WA 98382 (360) 681-3333 Permit MECHANICAL PERMIT Additional desc HEAT PUMP/AIR HANDLER REPLACEM Permit Fee . . . . 64.80 Plan Check Fee .00 {� Issue Date . . . . 8/04/14 Valuation . . . . 0 Expiration Date . . 1/31/15 Qty Unit Charge Per Extension BASE FEE 50.00 �\ 1.00 14.8000 EA ME-FURN/HP/FAU < OR = 5 TON --- 14.80 - Fee summary Charged Paid Credited Due ----------------- ---------- ---------- ---------- ---------- Permit Fee Total 64.80 64.80 .00 .00 Plan Check Total .00 .00 .00 .00 Grand Total 64.80 64.80 .00 .00 . Separate Permits are required forelectrical work,SEPA,Shoreline,ESA,utilities,private and public improvements. This permit becomes null and void if work or construction authorized is not commenced within 180 days,if construction or work is suspended or abandoned for a period of 180 days after the work has commenced,or if required inspections have not been requested within 180 days from the last inspection. I hereby certify that I have read and examined this application and know the same to be true and correct. All provisions of laws and ordinances governing this type of work will be complied with whether specified herein or not. The granting of a permit does not presume to give authority to violate or cancel the provisions of any state or local la regulating construction or the performance of construction. 6Date Print Name Signature of Contractor or Authorized rent Signature of Owner(if owner is builder) T:Forms/Building Division/Building Permit BUILDING PERMIT INSPECTION RECORD PLEASE PROVIDE A MINIMUM 24-HOUR NOTICE FOR INSPECTIONS— Building Inspections 417-4815 Electrical Inspections 417-4735 Public Works Utilities 417-4831 Backflow Prevention Inspections 417-4886 IT IS UNLAWFUL TO COVER,INSULATE OR CONCEAL ANY WORK BEFORE INSPECTED AND ACCEPTED. POST PERMIT INCONSPICUOUS LOCATION. KEEP PERMIT AND APPROVED PLANS AT JOB SITE. Inspection Type Date Accepted By Comments FOUNDATION: Footings Stemwall Foundation Drainage/Downspouts Piers Post Holes(Pole Bldgs.) PLUMBING: Under Floor/Slab Rough-In Water Line Meter to Bldg) Gas Line Back Flow/Water FINAL Date Accepted b AIR SEAL: Walls Ceiling FRAMING: Joists/Girders/Under Floor Shear Wall/Hold Downs Walls/Roof/Ceiling Drywall Interior Braced Panel Only) T-Bar INSULATION: Slab Wall/Floor/Ceiling MECHANICAL: Heat Pum /Furnace/FAU/Ducts Rough-in Gas Line Wood Stove/Pellet/Chimney Commercial Hood/Ducts FINAL Date Accepted b MANUFACTURED HOMES: Footing/Slab Blocking&Hold Downs Skirting PLANNING DEPT. Separate Permit#s SEPA: Parkin /Lighting ESA: Landscaping SHORELINE: FINAL INSPECTIONS REQUIRED PRIOR TO OCCUPANCY/USE Inspection Type Date Accepted By Electrical 417-4735 Construction-R.W. PW I Engineering 417-4831 Fire 417-4653 Planning 417-4750 Building 417-4815 T:Forms/Building Division/Building Permit TD-9E tORT NGE,CIYY ®t= For City Use W A S H t N G,::T O N . U . S . Permit# 321 East 5lh Street Date Received: Port Angeles, SNA 98362 Date Approved P: 360-417-4817 F: 360-417-4711 permits@cityofpa.us Building Permit Application Project Address: ,.l l � 3 6A5 r A5T PAA�. AVE Main Contact: Phone # 36*0 - ?I,2 - IS-6y &I G D L 5,6AI E-Mail: a 01S Cv cdc co• COPY. Property Nam Phone Owner Mailing Address Email r 3 • W mac' 3 City State Zip TWN01S Contractor Name �^ Phone 3�1191 52 LA (O/ C`/ . 333 3 Mailing Address Email •o• 90X 173 fay a / •coy.. City G A4,5&14 State W Zip g0Z 3 Contractor License# � ' ' r Expiration: (� 'K OO (L' Project Value: Zoning: Tax Parcel# Lot# $ 30 ' , 06 30 1 t,5'10ftopoo Type of Residential ❑ Commercial Industrial ❑ Public ❑ Permit Demolition ❑ Fire ❑ Repair ❑ Reroof(tear off/lay over) ❑ For the following,fill out both pages of permit application: New Constructiop ❑ Remodel ❑ Addition ❑ Tenant Improvement ❑ Mechanical L>1 Plumbing ❑ Other ❑ Existing Fire Sprinkler System? Malrimum height of structure Proposed Bedrooms Proposed Bathroom: Yes ❑ No ❑ Project Description 7-NS ALL, PUMP � At D -K '� L! .0 FbX- L-1WE I have read and completed the application and know it to be true and correct.I am authorized to apply for thi permit. I understand that it is my responsibility to determine what permits are required and to obtain permi prior to working on projects. I understand that the plan review fee is not refundable after plan review has occurred. I understand that I will forfeit the review fee if I cancel or withdraw the application before the permit is issued. I understand that if the permit is not issued within 180 days of receipt,the application will l considered abandoned and the fees forfeit. Date Print Name Signa Address: 1133 E Park Avenue _71 PREPARED 12/19/14, 9:16:17 INSPECTION TICKET PAGE 3 CITY OF PORT ANGELES INSPECTOR: JAMES LIERLY DATE 12/19/14 ------------------— --------------' ADDRESS . : 1133 E PARK AVE SUBDIV: CONTRACTOR MCKIBBIN, WILLIAM SAMUEL PHONE OWNER ALC REAL ESTATE LLC PHONE PARCEL 06-30-11-5-1-0800-0000- APPL NUMBER: 14-00001034 SIGNS -- ------- ----- --- PERMIT: SIGN 00 SIGN REQUESTED INSP DESCRIPTION TYP/SQ COMPLETED RESULT RESULTS/COMMENTS -- ------------------------------------------------- BL99 01 12/19/14 L BLDG FINAL December 19, 2014 9:15:06 AM pbarthol. Sign Final Bill 503-516-3419 ** Permit in office ** -------------------------------------- COMMENTS AND NOTES -------------------------------------- CITY OF PORT ANGELES (1f7) DEPARTMENT OF COMMUNITY&ECONOMIC DEVELOPMENT-BUILDING DIVISION 321 EAST 5TH STREET, PORT ANGELES,WA 98362 Application Number . . . . . 14-00001034 Date 8/29/14 Application pin number . . . 164190 Property Address . . . . . . 1133 E PARK AVE ASSESSOR PARCEL NUMBER: 06-30-11-5-1-0800-0000- REPORT SALES TAX Application type description SIGNS on your state excise tax form Subdivision Name . . . . . . Property Use . . . . . . . . to the City of Port Angeles Property Zoning . . . . . . . RESIDENTIAL MEDIUM DENSTY (Location Code 0502) Application valuation . . . . 0 ---------------------------------------------------------------------------- Application desc 16 sq.ft. double faced sign -------------------------------------------------------------------- Owner Contractor ------------------------ ------------------------ ALC REAL ESTATE LLC MCKIBBIN, WILLIAM SAMUEL W 140 N 8981 LILLY RD PO BOX 821261 MENOMONEE FALLS WI 53051 VANCOUVER, WA VANCOUVER WA 98682 ---------------------------------------------------------------------------- Permit . . . . . . SIGN Additional desc . . FREE STANDING SIGN Permit Fee . . . . 47.00` Plan Check Fee .00 Issue Date . . . . 8/29/14 Valuation . . . . 0 Expiration Date . . 2/25/15 Qty Unit Charge Per Extension 1.00 ------47.0000 PER S-ALL SIGNS a OR = TO 25 SF- --- -47.00- --------------------------------------- Special Notes and Comments August 29, 2014 8:31:31 AM sroberds. Signage for this use in the RMD zone was approved to a maximum of 62 sq.ft. per CUP 98-01. The illuminated sign is NOT an electronic readerboard. It is a stationary sign per Lora Senbach of Oakhurst Signs. No land use issues anticipated. ---------------------------------------------------------------------------- Fee summary Charged Paid Credited Due ----------------- ---------- ---------- ---------- ---------- Permit Fee Total 47.00 47.00 .00 .00 Plan Check Total .00 .00 .00 .00 Grand Total 47.00 47.00 .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 has commenced, or if required inspections have not been requested within 180 days from the last inspection. I hereby certify that I have read and examined this application and know the same to be true and correct. All provisions of laws and ordinances governing this type of w rk will be mplied with whether specified herein or not. The granting of a permit does not presume to give authority to violate or can I the pro i ions of any state or local law regulating construction or the performance of construction. -k4 ,Ad Date Print Name S nat re of Contractor or Authorized Agent Signature of Owner(if owner is builder) T:Forms/Building Division/Building Permit BUILDING PERMIT INSPECTION RECORD — PLEASE PROVIDE A MINIMUM 24-HOUR NOTICE FOR INSPECTIONS— Building Inspections 417-4815 Electrical Inspections 417-4735 Public Works Utilities 417-4831 Backflow Prevention Inspections 417-4886 IT IS UNLAWFUL TO COVER,INSULATE OR CONCEAL ANY WORK BEFORE INSPECTED AND ACCEPTED. POST PERMIT INCONSPICUOUS LOCATION. KEEP PERMIT AND APPROVED PLANS AT JOB SITE. Inspection Type Date Accepted By Comments FOUNDATION: Footings Stemwall Foundation Drainage/Downspouts Piers Post Holes(Pole Bldgs.) PLUMBING: Under Floor/Slab Rough-in Water Line Meter to Bldg) Gas Line Back Flow/Water FINAL Date Accepted b AIR SEAL: Walls Ceiling FRAMING: Joists/Girders/Under Floor Shear Wall/Hold Downs Walls/Roof/Ceiling Drywall Interior Braced Panel Only) T-Bar INSULATION: Slab Wall/Floor/Ceiling MECHANICAL: Heat Pum /Furnace/FAU/Ducts Rough-in Gas Line Wood Stove/Pellet/Chimney Commercial Hood/Ducts FINAL Date Accepted b MANUFACTURED HOMES: Footin /Slab 1131ocking&Hold Downs Skirting E G DEPT. Separate Permit#s SEPA: htin ESA: g SHORELINE: FINAL INSPECTIONS REQUIRED PRIOR TO OCCUPANCY/USE Inspection Type Date Accepted By Electrical 417-4735 Construction-R.W. PW /Engineering 417-4831 Fire 417-4653 Planning 417-4750 Building 417-4815 T:Forms/Building Division/Building Permit 0 ►H - (D_5 PORT4ye. SIGN PERMIT ®4 PLICA TIO ;Rei J CITY OF PORT ANGELES Attn: Building Permit Technician g*:�I U) 321 E. Fifth St., Port Angeles, WA 98362(360)417-4815 fax(360)417-4711 Applicant or Agent S p s Phone "1,">J, 53�. Property Owner r\ GkjiA - lEcA,ue-,reA Phone .&Q., 1 a S• -"7CL-)u Property Owner's Address p %. � Contractor h moo .,• Phoneya?S, S A*, 344 A Contractor's Address $ License# igg gV, Expires • apt!;: Project Address 1133 e�� , A- \OA 9S314a Business Name w,�c Parcel Number ( Lot Zoning Submit an 8 % "x 11"site plan & three sets of plans that include: r ■ Type of sign (wall-mounted, projecting,freestanding, illuminated, other...) ■ Placement and sq. ft. area ® How the sign will be securely attached (Engineering specs may be required for freestanding signs) JC ® Separation distance between the bottom of projecting and freestanding signs and the surface below See "Chapter 14.36 Sign Code"of the City of Port Angeles Municipal Code for sign requirements. Sian Type&Brief Description: (Type, location,sq.ft.) Sign #1 Sign #2 ta- Sign #3 Sign #4 Totals(Unit charges Signs)© Unit Chara Quand multiplied by quantities) Type of Sian Valuation S $47.00 x i = $ 41.p(D All signs less than or equal to 25 sq. ft. $85.00 x = $ Wall sign or marquees,over 25 sq. ft. $115.00 x = $ Freestanding sign or projecting sign, over 25 sq.ft. GRAND TOTAL Make Checks Payable to: City of Port Angeles $ y-1,00 Credit Cards(Except American Express)are accepted Ex ting sign(s)area_ sq.ft. +Proposed sign(s)area 75.6 sq.ft. = Total sign(s)area /5, .Tq. ft. re'',wo Building fagade area (height ft. X width ft.) = sq. ft. (if a building has more than one business in it, only measure the area of the building fagade that is used by the business applying for this permit) I have read and completed this application and know it to be true and correct. I am authorized to apply for this permit and understand that it is my responsibility to eter ' e what permits are required, and to obtain permits prior to working on projects. Date Print Name- M Signatur T:Forms/Building Division/Sign Permit Application.doc SignFooter 2ft.cdr Concepts Only - Not For Production Purposes scat 1/2"=1' O F. n.-- .S 47 s E 1 J .� PROJECT NAME: 00 z T G Enlivant LUJ z .0A a H c a tl0 i 6/6/14 IR N ��. v a d �R � n o � • 0 S ` m o 0 0 Lesley Seymour N CO C d CD Q o N a 727.532.8255 Op V v 4= cL Q '> 6 - __- L060614S ❑SW 7 O White Pure White O N ❑Metallic Silver sW 6918 Humorous Green ® 6718 Overt Green SW 6739 ,e}" 4++ Eco Green ■SW 6762 Poseidon SW 6767 OPTION 1) 1 - Double-Faced Post Sign ■Aquamarine 62"x 36" .063 Aluminum W/Vinyl Digital Print(qty 2-one for each side of aluminum frame) ■SW 649:1 1"x 1"aluminum framing as shown with custom welded brackets painted Ebbtide SW 7062 POSTS: Mount To 2-4"x 4"x 68" PT Posts W/ PVC Sleeve Rock Bottom80%Black Custom Painted 6"x 6"x 9" Base(s) I Custom Painted 5"x 6"x 1"Cap(s) ■(This is for address only) (Posts Installed 2 Ft Below Grade) Client Approval - Print Name: Signature: Date: Thank You These sign designs are the sole property of Oakhurst Signs and may not be used for bidding purposes.The ownership of 12445 62nd St. North, Suite 305 For these designs will be transferred to the listed customer in the event that signs are purchased from Oakhurst Signs. If this Largo, FL 33773 artwork is used without our consent,you will be invoiced for the design fees-these fees typically range between$275-$750. Phone: 727-532-8255 1 Fax: 727-532-4334 Opportunity! www.oakhurstsigns.com SignFooter..2ft.cdr Concepts Only - Not For Production Purposes POST SIGN FRAME DETAIL scale 1/2"=1' -PROJECT 3D View Of Post Mount Enlivant Post Frame Aluminum Frame W/Brackets Welded On Sides For Mounting To Posts 6/6/14 Lesley Seymour 727.532.8255 L060614S SIGN FACES TO BE MOUNTED TO EITHER SIDE OF FRAME i Client Approval - Print Name: Signature: Date: Thank You These sign designs are the sole property of Oakhurst Signs and may not be used for bidding purposes.The ownership of 12445 62nd St. North, Suite 305 For The these designs will be transferred to the listed customer in the event that signs are purchased from Oakhurst Signs. If this Largo, FL 33773 artwork is used without our consent,you will be invoiced for the design fees-these fees typically range between$275-$750. Phone:727-532-8255 1 Fax:727-532-4334 L Opportunity! www.oakhurstsigns.com t SAIRL .f� fw •• 44P • • • •�.• T � ., � • ��P M� f � •.r,;► - � _—OqW Alm..rqp• Y 4 i, �}�oma.. ed •+�f !,,.,T. i►l�w� ` ' y • r `"•s "• , �T X• i P7.'. v yY � -.•��4�* r.p, � - � .♦ ». l r T4 '��. •�1,�•Ri �: � farm"'"'��¢�� � •.. * ::: F•x aAd '� • ♦ ij# wa- ;• w z ♦y i• e�,. f Curent sign location and Proposed new sign —" • lFq location o• LS U"C111iS M LETTER OF AUTHORIZATION Date:—Z-/ 3// /'- To whom it may concern: This letter is to grant written authorization to Oakhurst Signs or their authorized agent to act on our behalf in all manners relating to application and retrieval for pulling a permit for Z A!/I?4fL 91-AC4 Property Name //33 C,+s'7 P9K Ave Street Address City,State,Zip Any and all acts carried out by Oakhurst Signs on our behalf shall have the same affect as acts of our own. Sincerely, 1 Property er Signa Property Owner Name Company Name The foregoing inst ent w acknowledged befor n this _day of �9�3 2Uiy Notary signature JOHN A KRESL OFFICIAL SEAL Notary Public,State of Illinois „a My Commission Expires September 14,2016 v LETTER OF AUTHORIZATION August 12,2014 To whom it may concern: This letter is to grant written authorization to McKibben Inc.or their authorized agent to act on our behalf in all manners relating to application and retrieval for pulling a permit for: Laurel Place Property Name 1133 East Park Avenue Street Address Port Angeles,WA 98362 City,State,Zip Any and all acts carried out by McKibben Inc.on our behalf shall have the same affect as acts of our own. Sincerely, gent Signature Lora Sembach JOSEPH WALMM . NOTARY PUBLIC Agent Name STATE OF FLORIDA CXmm#FFi46= Oakhurst Signs4)Expirnmirmois Company Name The foregoing instrument was acknowledged before me on this Z day of (s JJ 2014 Notary signature: MCKIBBIN INC Page 1 of 2 Washington State Department of %,,# Labor & Industries MCKIBBIN INC Owner or tradesperson PO BOX 821261 MCKIBBIN,WILLIAM SAMUEL VANCOUVER, WA 98682 503-516-3419 Principals CLARK County MCKIBBIN, WILLIAM SAMUEL, PRESIDENT WA UBI No. Business type ;J 603 426 959 Corporation License Verify the contractor's active registration/license/certification (depending on trade)and any past violations. Construction Contractor Active. ................................................I.......................... Meets current requirements. License specialties Signs License no. MCKIBI*868NK Effective—expiration 08/12/2014—08/12/2016 Bond ................. American Contractors Indem CO $6,000.00 Bond account no. 100253911 Received by L&I Effective date 08/12/2014 07/31/2014 Expiration date Until Canceled Insurance .............................. AMCO Ins Co $1,000,000.00 Policy no. ACP7535151088 Received by L&I Effective date 08/12/2014 07/31/2014 Expiration date 07/31/2015 Savings No savings accounts during the previous 6 year period. Lawsuits against the bond or savings No lawsuits against the bond or savings accounts during the previous 6 year period. L&I Tax debts https:Hsecure.Ini.wa.gov/verify/Detail.aspx?UBI=603426959&LIC=MCKIBI*868NK&SAW= 8/28/2014 MCKIBBIN INC Page 2 of 2 No L&I tax debts are recorded for this contractor license during the previous 6 year period, but some debts may be recorded by other agencies. License Violations ........................................................ No license violations during the previous 6 year period. Workers' comp No active workers' comp accounts during the previous 6 year period. Workplace safety and health No inspections during the previous 6 year period. ©Washington State Dept.of Labor&Industries. Use of this site is subject to the laws of the state of Washington. .14civ, h> Wa+lnngton", 'Noh;ii i' https://secure.lni.wa.gov/verify/Detail.aspx?UBI=603426959&LIC=MCKIBI*868NK&SAW= 8/28/2014 OAKHURST SIGNS BANK OF AMERICA,NA "11484 a '- CLEARWATER,FL 33763 12445 62ND STN.SUITE 305 63-271631- LARGO,15:03773 OAKHURS7 727 5328255 SIGNS 811-8/2014 I LG PAY TO THE City of Port Angeles 7 0 ORDER OF y r Forty-Seven and 00/100******************************************************************************************** * *� LABS DO - A TAMPER RESISTANT TONER AREA A.City"of Poct,Angeles Y Attu: Building,Permit Technician d 321;E Fifth Street`: — Port Angeles, WA"98362 M`MO Branch Enlivant- Entry Signs Final "" r u■O L 1484I'm 1:063 100 2771: 0037696567a9uo OAKHURST SIGNS 11484 City of Port Angeles 8/18/2014 Date Type Reference Original Amt. Balance Due Discount Payment 8/18/2014 Bill Emailed 47.00 47.00 47.00 Check Amount 47.00 Primary B of A Accou Branch - Enlivant- Entry Signs Final 47.00 P AUG 2 7 20% D CITY OF PORT ANGELES Lora Sembach COMMUNfTY;4 ECONOMIC DEVELOPMENT Oakhurst Signs 12455 62nd Street N., Suite 305 Largo FL 33773 August 19, 2014 Building Permit Technician City of Port Angeles 321 E. Fifth Street Port Angeles, WA 98362 Good Morning- Here is a sign permit application and supporting documentation. Check#11484 in the amount of$47.00,for the permit fee was sent in a separate envelope (in error). I apologize for any confusion this may cause. Please confirm receipt of the check and the sign permit application. Thanks and have a great day. Sincer , r Ll�bra em ach Project Coordinator Oakhurst Signs Enc: Sign Permit Application and supporting documentation Oakhurst Signs 1 12455 62nd Street N., Suite 305 Largo FL 33773 727-532-8255