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HomeMy WebLinkAbout413 E 3rd St - BuildingAgkvo CITY OF PORT ANGELES DEPARTMENT OF COMMUNITY ECONOMIC DEVELOPMENT BUILDING DIVISION 321 EAST 5TH STREET PORT ANGELES, WA 98362 Application Number Application pin number Property Address ASSESSOR PARCEL NUMBER Tenant nbr name Application type description Subdivision Name Property Use Property Zoning Application valuation Application desc NEW WATER LINE METER TO GARAGE Owner Contractor ROBERT R PHILP 413 E 3RD ST PORT ANGELES WA 983623204 10 00000073 251866 413 E 3RD ST 06 30 00 6 5 0024 0000 ROBERT R PHILP PLUMBING REPAIR COMMERCIAL ARTERIAL 200 Date 1/22/10 MORRISON EXCAVATING INC P 0 BOX 3051 PORT ANGELES WA 98362 (360) 452 7179 Permit PLUMBING PERMIT Additional desc WATER LINE METER TO GARAGE Permit pin number 159913 Permit Fee 57 00 Plan Check Fee 00 Issue Date 1/22/10 Valuation 0 Expiration Date 7/21/10 Qty Unit Charge Per Extension BASE FEE 50 00 1 00 7 0000 EA PL -WATER LINE 7 00 Fee summary Charged Paid Credited Due Permit Fee Total 57 00 57 00 00 00 Plan Check Total 00 00 00 00 Grand Total 57 00 57 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 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 1 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 pe tt not presume tome autl ority to violate or cancel the provisions of any state or local law regulating construction or the performance of cons 7 j 6 bate Print Name Signature of Contractor or Authorized Agent 7 Signature of Owner (if owner is builder) T.Forms/Building Division/Building Permit 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 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 IN CONSPICUOUS LOCATION. KEEP PERMIT AND APPROVED PLANS AT JOB SITE. Inspection Type Date Accepted By Comments PLANNING DEPT Separate Permiit #s SEPA. Parking Lighting 1 ESA. Landscaping 1 SHORELINE. FINAL Date Accepted by FINAL Date Accepted by FINAL INSPECTIONS REQUIRED PRIOR TO OCCUPANCY/ USE Inspection Type Date Accepted By Electrical 417 -4735 1 Construction R.W PW Engineering 417 -4831 Fire 417 -4653 1 Planning 417 -4750 j� 1 x Building 417 -4815 r (J 1 Y X k 2% 0 C Clallam County Assessor Treasurer Property Details 62224 ROBERT R PHILP for Page 1 of 4 Clallam County Assessor Treasurer Property Search Results 62224 ROBERT R PHILP for Year 2010 2011 k 0 e�r RogeY' V� 5se- PluYvibin5 P Ne to .fir 0. ,n.e J xze Nouse Property ID 62224 Legal Description. LEIGHTON'S SUBDIVISION LT13 BL 57 Property Account Geographic ID' 0630006500240000 Agent Code Type Real s e(1 O -i'S r Tax Area. 0010 PA 121 PORT ST CNTY H2 L Land Use Code 11 Co +1tA6i'�1� Open Space N DFL N Historic Property' N Remodel Property N Multi Family Redevelopment: N Location Address. 413 E THIRD ST PORT ANGELES Neighborhood. Cycle 5 Res Neighborhood CD 10955130 Owner Name ROBERT R PHILP Mailing Address 413 E 3RD ST PORT ANGELES WA 98362 3204 Taxes and Assessments Due Property Tax Information as of 01/22/2010 Amount Due if Paid on 7. Mapsco Map ID Owner ID' Ownership' Exemptions. 46306 100 0000000000% First Second Half Half Statement Base Base Base Amount Year ID i Taxing Jurisdiction Due Due Penalty Interest Paid Due 2009 622242008 ST SCH STATE SCHOOL $95 95 $95 95 $21 11 $17.27 $0 00 $230.28 2009 622242008 CC -GEN COUNTY $48 57 $48 55 $10 68 $8 74 $0 00 $116 54 2009 622242008 PORT PORT $6 88 $6 88 $1 51 $1.24 $0 00 $16 51 2009 622242008 PORT ANG PORT ANGELES $106 52 $106 50 $23 43 $19 17 $0 00 $255 62 2009 622242008 SD #121 SCHOOL DISTRICT #121 $118 66 $118 65 $26 10 $21 36 $0 00 $284 77 2009 622242008 NTH OLY LIB NORTH OLYMPIC LIBRARY $14 11 $14 11 $3 11 $2.54 $0 00 $33.87 2009 622242008 HOSP #2 HOSPITAL #2 $19 92 $19 91 $4 38 $3 58 $0 00 $47 79 2009 622242008 CITY_STORMWATER CITY STORMWATER $36 00 $36 00 $7 92 $6 48 $0 00 $86 40 2009 622242008 WEED_CONTROL WEED CONTROL $0 82 $0 81 $0 18 $0 15 $0 00 $1 96 2009 622242008 TOTAL. $447.43 $447.36 $98.42 $80.53 $0.00 $1073.74 2008 622242007 ST SCH STATE SCHOOL $101 89 $101 90 $8 15 $15.28 $101 89 $125 33 2008 622242007 CC -GEN COUNTY $49 30 $49 30 $3 94 $7 40 $49 30 $60 64 2008 622242007 PORT PORT $7 20 $7.20 $0 58 $1 08 $7 20 $8 86 2008 622242007 PORT ANG PORT ANGELES $106 18 $106 17 $8 49 $15 92 $106 18 $130 58 2008 622242007 SD #121 SCHOOL DISTRICT #121 $118 84 $118 85 $9 51 $17 83 $118 84 $146 19 2008 622242007 NTH OLY LIB NORTH OLYMPIC LIBRARY $14 33 $14 32 $1 15 $2 15 $14 33 $17 62 2008 622242007 HOSP #2 HOSPITAL #2 $4 90 $4 89 $0 39 $0 73 $4 90 $6 01 2008 622242007 CITY_STORMWATER CITY STORMWATER $36 00 $36 00 $2.88 $5 40 $36 00 $44.28 2008 622242007 WEED_CONTROL WEED CONTROL $0 81 $0 82 $0 07 $0 12 '$0 81 $1 01 http. /vpn.clallam.net. 8084 propertyaccess /Property.aspx ?cid =0 &year= 2010 &prop_id =62 1/22/2010 Application Number Application pin number Property Address ASSESSOR PARCEL NUMBER Application type description Subdivision Name Property Use Property Zoning COMMERCIAL ARTERIAL Application valuation 0 Application desc re locate sewer lateral ROBERT R PHILP 413 E 3RD ST PORT ANGELES WA 983623204 Qty Unit Charge Per 1 00 135 0000 EA SAN SEW RECON CITY OF PORT ANGELES PUBLIC WORKS UTILITIES 321 EAST 5TH STREET PORT ANGELES, WA 98362 10 00000070 222540 413 E 3RD ST 06 30 00 6 5 0024 0000 PUBLIC WORKS UTILITES Owner Contractor Date 1/22/10 MORRISON EXCAVATING INC P 0 BOX 3051 PORT ANGELES WA 98362 (360) 452 7179 Permit RIGHT OF WAY Additional desc RE LOCATE SEWER LATERAL Permit pin number 159871 Permit Fee 150 00 Plan Check Fee 00 Issue Date 1/22/10 Valuation 0 Expiration Date 7/21/10 Qty Unit Charge Per 1 00 150 0000 ECH PW RW CONST EXCAVTION OTHER Extension 150 00 Permit SANITARY SEWER HOOK UP Additional desc RE LOCATE SEWER LATERAL Permit pin number 159863 Permit Fee 135 00 Plan Check Fee 00 Issue Date 1/22/10 Valuation 0 Expiration Date 7/21/10 Fee summary Charged Paid Credited Due Permit Fee Total 285 00 285 00 00 00 Plan Check Total 00 00 00 00 Grand Total 285 00 285 00 00 00 Extension 135 00 Separate Permits are required for electrical work, SEPA, Shoreline ESA, utilities private and public improvements This permit becomes null and void if work or construction authorized is not commenced within 180 days if construction or work is suspended or abandoned for a period of 180 days after the work as commenced, or if required inspections have not been requested within 180 days from the last inspection. I hereby certify that I have read and examined this application and know the same to be true and correct. All provisions of laws and or es governing this typ- •f work will be complied with whether specified herein or not. The granting of a permit does not presume give authority to iol -te or ca the provisions of any state or local law regulating construction or the performance of constru n//2/ Signature of Contractor or Authorized Agen Date Signature of Owner (if owner is builder) Date T \Policies\ 1 102 15 10 /08] SITE EROSION CONTROL PARKING I SIDEWALK I CURB GUTTER CALL 417 -4831 FOR UTILITY INSPECTIONS PLEASE PROVIDE A MINIMUM 24 HOUR NOTICE IT IS UNLAWFUL TO COVER, INSULATE OR CONCEAL ANY WORK BEFORE INSPECTED AND ACCEPTED. POST PERMIT IN A CONSPICUOUS LOCATION INSPECTION TYPE DATE ACCEPTED PW UTILITIES (Engineering Division) WATERLINE METER SEWER CONNECTION SANITARY STORM SITE DRAINAGE DRIVEWAY APPROACH BACK -FLOW DEVICE FIRE PLANNING DEPT BUILDING T \Policies\ 1102 15 10/08] RESIDENTIAL CONSTRUCTION R W PW/ ENGINEERING 417 -4831 KEEP PERMIT CARD AND APPROVED PLANS AT JOB SITE 417 -4653 417 -4750 I 417 -4815 PERMIT INSPECTION RECORD YES NO COMMENTS FINAL INSPECTIONS REQUIRED PRIOR TO OCCUPANCY/USE DATE YES NO COMMERCIAL DATE ACCEPTED YES I NO CONSTRUCTION R W PW ENGINEERING FIRE DEPT I PLANNING DEPT I BUILDING I I I I I I I I Application Number 08 00001446 Application pin number 481180 Property Address 413 E 3RD ST ASSESSOR PARCEL NUMBER 06 30 00 6 5 0024 0000 Application type description ELECTRICAL ONLY Subdivision Name Property Use Property Zoning COMMERCIAL ARTERIAL Application valuation 0 Application desc 200 amp service to shop Owner Contractor PHILP ROBERT R /SHERIL 413 E 3RD ST PORT ANGELES WA 983623204 ELECTRIC SERVICE 82 DRAPER RD PORT ANGELES (360) 452 6424 Date 11/17/08 WA 98362 Permit ELECTRICAL ALTER COMMERCIAL Additional desc Permit pin number 137943 Permit Fee 75 00 Plan Check Fee 00 Issue Date 11/17/08 Valuation 0 Expiration Date 5/16/09 Qty Unit Charge Per Extension 1 00 75 0000 ECH EL COM ALT 0 200 SRV FDR 75 00 Fee summary Charged Paid Credited Due Permit Fee Total 75 00 75 00 00 00 Plan Check Total 00 00 00 00 Grand Total 75 00 75 00 00 00 [NSP F CTION TYPE DAT F DITCH SERVICE ROUGH IN AL COMMENTS /2.111(), cfre °NV ELECTRICAL RESULTS INSPECTOR Job wired by Qlectrical Contractor 0 Owner Electrical lc contractor name License number Date Expires Qt art S Y CA Zhu r LfCts L I Purchase s madrn address City r Premiseiwnei's name Address of i action City n r g Inspection Date i .i d *2- t r ae& V 117 )2S Date FINAL �Z -8 -o9 i,E7wieves D State ZIP Telephone number FAX number Approved By J Dole Approvld By e 114L-1..e 1 15 1.- sat, r►, Phone num b to schedule Inspection. s ctlon. j 4 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 electrical contractor if above said property is for sale. rent or lease. After reading the above statement, 1 hereby certify that 1 am the owner of the above named property or a licensed electrical contractor. 1 am making the electrical instal- lation 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. "'Signature owner, electrical contractor or electrical administrator X Electrical Load Additions and or subtractions a NO LOAD CHANGES Baseboard KW O Fumace KW Heat Pump Ton LAR O Fan -Wall KW Date. SAME DAY .INSPECTION, CALL BEFORE 7:00 AM 360- 417 -4735 ROUGH -IN THERMOSTAT WW Overhead Service Temp Service O Underground Service DITCH Dole Approved By Area, Building or Equipment Inspected ,tip noo.€4 .wt -u. Garr ailn m I ILbLTt O1 1721792Sb ELECTRICAL, WORK PERMIT APPLICATION \(Installation dcscription Commercial Residential New o Cash CI Check O Credit Card Visa Card Expiration Date of card Approved By 1 O Altered /Addition c2 0 ct-evL. p &ccv Date 3 3JIrld3S Dale 7� rvice Information/ Voltage IA f'Ll{p Phase 1 Service Si e: x Feeder Size: SERVICE Aa'roreuI y FEEDER Action Taken gentAv6-13 Inspection fee Approved By Mastercard Discover Electrical Inspector I f 3I81J313 Wad tj6b 60 S002- 2 -Ntjt Application Number Application pin number Property Address ASSESSOR PARCEL NUMBER Application type description Subdivision Name Property Use Property Zoning Application valuation Owner PHILP ROBERT R /SHERIL 413 E 3RD ST PORT ANGELES WA 983623204 Structure Information 000 000 SINGLE FAMILY RESIDENCE Construction Type TYPE V NON RATED Permit DEMOLITION Additional desc DEMOLITION Permit pin number 73528 Permit Fee 47 00 Plan Check Fee Issue Date 3/27/06 Valuation Expiration Date 9/23/06 Qty Unit Charge Per Other Fees Signature of Contractor or Authorized Agent Permit Fee Total Plan Check Total Other Fee Total Grand Total BASE FEE Fee summary Charged Paid Credited Due Separate Permits are required for electrical work, SEPA, Shoreline, ESA, utilities, private and public improvements. This permit becomes null and void if work or construction authorized is not commenced within 180 days, if construction or work is suspended or abandoned for a period of 180 days after the work as commenced or if required inspections have not been requested within 180 days from the last inspection. I hereby certify that I have read and examined this application and kn he same to be true and correct. All provisions of laws and ordinances goveming this type of work will be complied with whether s cifie' herein or Th ting of a permit does not presume to give authority to violate or cancel the provisions of any state loca �attila ng on 1•r the performance of construction. T \Policies \I 102_15 building permit inspection record05 wpd [1/4/2005] CITY OF PORT ANGELES DEPARTMENT OF COMMUNITY DEVELOPMENT BUILDING DIVISION 321 EAST 5TH STREET PORT ANGELES, WA 98362 06 00000285 186475 413 E 3RD ST 06 30 00 6 5 0024 0000 DEMOLITION COMMERCIAL ARTERIAL 500 Contractor OWNER STATE SURCHARGE Date 3/27/06 Extension 47 00 4 50 47 00 47 00 00 00 00 00 00 00 4 50 4 50 00 00 51 50 51 50 00 00 00 0 Date Signature of Owner (if owner is bui 6; Date BUILDING PERMIT INSPECTION RECORD CALL 417 -4815 FOR BUILDING INSPECTIONS. CALL 417 -4735 FOR ELECTRICAL INSPECTIONS. CALL 417 -4807 FOR PUBLIC WORKS UTILITIES PLEASE PROVIDE A MINIMUM 24 HOUR NOTICE. IT IS UNLAWFUL TO COVER, INSULATE OR CONCEAL ANY WORK BEFORE INSPECTED AND ACCEPTED. POST PERMIT IN A CONSPICUOUS LOCATION KEEP PERMIT CARD AND APPROVED PLANS AT JOB SITE. INSPECTION TYPE DATE ACCEPTED COMMENTS YES NO FOUNDATION: FOOTINGS SHEAR WALLS WALLS FOUNDATION DRAINAGE DOWN SPOUTS PIERS POST HOLES (POLE BLDGS.) PLUMBING UNDERFLOOR /SLAB ROUGH -IN WATER LINE (METER TO BLDG) GAS LINE BACK FLOW WATER AIR SEAL WALLS CEILING FRAMING JOISTS GIRDERS SHEAR WALL/HOLD DOWNS WALLS ROOF CEILING DRYWALL (INTERIOR BRACED PANEL ONLY) T -BAR INSULATION SLAB WALL FLOOR CEILING MECHANICAL HEAT PUMP FURNACE DUCTS GAS LINE WOOD STOVE PELLET CHIMNEY COMMERCIAL HOOD DUCTS MANUFACTURED HOMES FOOTING SLAB BLOCKING HOLD DOWNS SKIRTING PLANNING DEPT SEPARATE PERMIT #'s PARKING /LIGHTING LANDSCAPING RESIDENTIAL ELECTRICAL LIGHT DEPT FINAL INSPECTIONS REQUIRED PRIOR TO OCCUPANCY/USE DATE YES NO COMMERCIAL DATE ACCEPTED YES I NO CONSTRUCTION R.W PW/ ENGINEERING 417 -4807 FIRE 417 -4653 PLANNING DEPT 417 -4750 BUILDING 417 -4815 \‘i T \Policies \1102 15 building permit inspection record05 wpd [I/4//005] 417 4735* ELECTRICAL LIGHT DEPT 1 I I I I 1 1 I I 1 1 I I 1 I I I I I 1 1 I I I I 1 1 I I 1 1 I I 1 1 I I 1 1 1 1 1 1 I I I I I I I I I I FINAL FINAL SEPA. ESA. SHORELINE. CONSTRUCTION R.W PW ENGINEERING I FIRE DEPT I PLANNING DEPT I BUILDING DATE ACCEPTED BY., DATE ACCEPTED BY. 1 1 I 1 1 I 1 1 I May 12, 2005 ORTGEI W A S H I N G T O N U S A PUBLIC WORKS UTILITIES DEPARTMENT Bob Phillip P O .Box 1291 Port Angeles, WA 98362 RE Port Angeles Landfill Waste Disposal Application, WDA 05 -12, Building demolition at 413 East 3r St, Port Angeles, WA 98362 We have received your application for disposal.ofbuilding demolition debns from the referenced site and reviewed the testing results for lead content. Based on the testing results the debns appears to be acceptable for use in the landfill. A copy of your approved application is attached. This approved •application must be shown to the landfill scale attendant at the time of disposal. Please be advised that this disposal application is only for the materials and quantities listed m the application. Materials not listed or in excess of the quantities noted may require separate applications and approval. Please call if you have questions. Very .truly yours, Gary W Kenworthy, P.E. City Engineer Deputy Director of Engineenng Services GWK:tf Encl. WDA 05 -12 Copy Ken Loghry N:\P WKS \ENGINEER \WDAPPLIC \05 -12. WPD FILE: Landfill Solid Waste Disposal Applications 321 EAST FIFTH STREET P 0 BOX 1 1 50 PORT ANGELES WA 98362-02'17 PHONE 360 -417 4805 FAX 360 -417 4542 TTY 360 -417 4645 E MAIL publicworks @cityofpa us Ifq 3 P O PORT ANGEI ES LANDFILL C WASTE DISPOSAL APPLICATION To City of Port Angeles City Engineer 321 E Fifth Street P O Box 1150 Port Angeles Washington 98362 MOTE. All questions must be answered for waste to be approved 1 Generator information Company Name Mailing Address J X /2. Contact. x„15 PI? I t' 0 Phone 1 2 Project Name Sir R. Project Location. 4/ 3 E. '3 11-4? 1ga 4UA( ,fS 2 Other Contacts (if applicable) Consulting Firm 4-- iJO )t L 3 Aagn C. Contact. Sa ti 426Z-/ c/c. Phone /7 Contractor Name ties, O Lit' Phone (360) 417 -4803 FAX (360) 417 -4709 Contact. Phone Laboratory J U ga-L ATon ,g r Contact Phone 2 2 7--7.?2c2 City of t'ott Angelus Landfill VV i to 1)r,po al Ali1►licnta n t' 'it's Check the appropriate box below and briefly describe the project process andfor cleanup that will or has produced the waste requiring disposal Include the gasoline service station number (►f applicable) Waste Material Composition. (check all that apply and include percent of total) NOTE. NOTE CERCLA/MTCA Remed►at►on Independent Remedial Action Unused Chemical Product Spill 1 cT /AJ Hv S Tc3 Soil Concrete /Asphalt Preserved Wood Coal Ash Wood Ash Total must equal 100% Gasoline Solvents Unused Motor Oil Other TIt 7 Y- �u P 44a./ 7 Unknown OA 5 Waste Material Contaminants (check all that apply) Agency Contact UST Removal Other Source O R'z i S orz,/C Foundry Slag Dredge Sediments X Debris Other (list) Metals Heating Oil Used Motor OiI /Waste Oil Other Petroleum Product Supply any MSDS information with application it available Diesel PCBs Ok City of fort Antt(,to• t mufti!, Waste Di!.f)o. al Aptilu.atioa Pn {ta 7 Other NOTE Estimated quantity for disposal must be within 20% of the quantity actually disposed (10% for projects over 7 500 tons or 5 000 cubic yards 7 Frequency of Disposal One time Monthly Annual Other Waste Sampling Proper characterization of the waste for disposal requires the collection of representative samples The methods and equipment necessary for obtaining representative samples of a waste and the frequency of sampling will vary with the type and form of the waste Check the appropnate box and bnetly describe how and where the waste was sampled Include site maps with sampling locations If possible Number of COMPOSITE samples Number of DISCRETE samples t 7 e ,,„7,-ED i )0,16-, I !hy A.. KJj51ITI LY7ILIoJ& SJ/7 iiv (ix Ad ivj t o /'/'J tf; RJuP 2� l iaw9 17- 1,41 J (A P h l a rt NOTE 1 Unless prior approval has been granted by Port Angeles frequency will be used z!0 2$.> 25 100 101 500 501 1000 1001 2000 >2000 Cubic yards Drums v V15posal cubic yards cubic yards cubic yards cubic yards cubic yards cubic yards City of Port Angeles Landfill W•i k Dispo al Application Tons (estimate both) Tons (estimate both) number of discrete samples per composit the following sampling 1 composite sample 3 composite samples 5 composite samples 7 composite samples 10 composite samples 10 plus one sample for each additional 500 cubic yards NOTE 2 One composite sample shall contain a minimum of three /maximum of five discrete samples Null 3 The Dangerous Waste Regulations (WAC 173 303) shall be utilized to determine the appropriate analytical requirements for waste characterization Ecology Publication #91 30 (Revised April 1994) "Guidance for Remediation of Petroleum Contaminated Soils shall also be used to charactenze petroleum contaminated sods from UST releases Submit all laboratory analytical results QA/QC data and Chain of Custody sheets along with this application (NOTE. The laboratory must be accredited by the Washington State Department of Ecology a) List all analytical test methods used Efti3L\ /73 i3 b) Provide a narrative as to why the above analytical methods were selected T/3f s74 7 NOTE. Additional sheets attached YES NO 10 Soil Classification ("FOR PETROLEUM CONTAMINATED SOILS ONLY Based on the analytical data and Ecology Publication #91 30 the soil classification is (check one) Class 1 Class 2 Calculated Hazard Index 11 Dangerous Waste Affidavit Class 3 Class 4 Based on a review of the analytical test results site history and the applicable regulations this waste is classified as (check ono) Neither Dangerous Waste (DW) nor Extremely Hazardous Waste (EHW) Dangerous Waste (DW) and Waste Code t xtremcly Hazardous Waste (DM) and Waste Codo City of Poit mild h l t+>>dGil W.iato Disposal ANiti( Jima Patlu 4 We THE UNDERSIGNED certify that this application is true to the best of our knowledge All information provided is correct and the enclosed analytical results represent the proposed waste material to the best of our abilities Was enerator i c'eAt Printed Name Date I cU 1 c am. /4), Company Dale .Approval fxplr airor{ Date .1 N V'OIUCY_P11000_GW11009_01 WPO :t: City of Port AllUCIOS Landfill W,1 tc D1 :,11o:,a1 Application Putlu LL pboratarries 4708 Aurora Ave N, Seattle. WA 98103, Tel; 206.547.0100 Emerg. Pager 206.344.1878 1.668.NVL.I ABS (885.3227) Client Zenovic Associates. inc. Street 519 South Peabody Street Suite 4 Port Angeles Project Manager Project Location _mss Phone: (360) 417 -0501 Farr. (360) 4i7 -05i4 MCa Asbestos Air ICI PCM (NIOSH 7400) CI TEM (NIOSH 740) U TEM (AHERA) O TEM (EPA Level ll) p Other Asbestos Bulk I O PLM (EPAA6001R -831116) PLM (EPA Point Count) D_PLM (EPA Gravimelry) 0 TEM Bulk isms Cat. Limit babix RORA Meals O Ad 8 lamer wl em 0 Total Metals wpp (App Air Filler 0 Paint Chips 0 Arsenic (As) i Lead (Pb) U All 3 si TCLP p ppb (GFAA) Drinking water 0 Paint Chips (Area) Barium (8a) Mercury (Hg) Copper (Cu) IJ Oustlwipe O Waste Water 9 Cadmium (Cd) 0 Selenium (Se) 0 Nickel (Ni) Soil Chromium (Cr) 0 Silver (Ai1) 0 Zinc an) Other Types Fiberglass 0 Nuisance Dust 0 Rotometer Calibration 0 Other (Speccy) of Analysis Silica 0 Respirable Dust MoIdIFungus Condition of Package: 0 Good 0 Damaged (no sptilage) 0 Severe damage (spillage) Seq. fr Lab ID 1 Client Sample Number Comments 1 r9. f[ IS- fAx ficgc )1-7: 2 3 4 6 6 7 8 9 10 11 12 13 14 15 Sampled bile Relinquished by Received by Analyzed by Results Called by Results Farted by Print Below Sign Below NVL Batch Number Client ,lob Number Total Samples Turn Around Time E01 a ddre ss CHAIN of CUSTODY BATCH ID SAMPLE LOG d- Special lttstructians: times; requested in writing. all samples will be disposed of two (2) weeks after analysis. 2506243 00 OS/66 01-Hr 24-Hrs 4 Days iJ 241rs 2 Days 5 Days 4-1-Ira for T Days leis than 224 His NVL Laboratories, Inc, 4708 Aurora Ave. N., Seattle, WA 98103 Tel: 206.547.0100, Fax 206.634.1936 wv w.nvllebs.com Client: Address: Attention: Project Location: Lab ID 25038995 Toxicity Characteristic Leaching Procedure Lead (Pb) Zenovic Associates, inc. 519 South Peabody Street, Suite 22 Port Angeles, WA 98362 Mr Tracy Gudgel PORT ANGELES Client Sample 05166 Sampled by' Client Analyzed by Ahmed Izzat Date Analyzed: 05/11/2005 mg/ L Milligrams per liter ppm parts per million Note Method QC results are acceptable unless stated otherwise. Bench Run No:25- 0510 -5 AIHA IH Anal R #101861 RL mg/ L 05 Results in mg /L 05 DRAFT Batch 2506243.00 Matrix: Bulk Method. EPA 1311/7000B Client Project #05166 Samples Received: 1 Total Samples Analyzed 1 Results in ppm 05 RL Reporting Limit .c' T Below the reporting Limit ti Anik ACCREDITED LAECRATODY, Page 1 of 1 of: ~ORT ~ ~~~~<.. ~~~ 'L ~ ~ "l,\,,~ CITY OF PORT ANGELES DEPARTMENT OF COMMUNITY DEVELOPMENT - BUILDING DNISION 321 EAST 5TH STREET, PORT ANGELES, WA 98362 Application Number pin number Property Address ASSESSOR PARCEL NUMBER: Application description Subdivision Name Property Use Property Zoning . . . Application valuation 04-00000930 Date .912320 413 E 3RD ST 06-30-00-6-5-0024-0000- ELECTRICAL ONLY 10/12/04 COMMERCIAL ARTERIAL o Owner Contractor PHILP ROBERT R/SHERIL 413 E 3RD ST PORT ANGELES WA 983623204 ELECTRIC SERVICE 82 DRAPER RD PORT ANGELES (360) 452-6424 WA 98362 ----------------------------------------- Permit ELECTRICAL TEMPORARY SERVICE Additional desc TEMP SVC. Permit Fee 48.10 Plan Check Fee .00 Issue Date 10/12/04 Valuation 0 )1 Expiration Date 4/11/05 Qty Unit Charge Per Extension 1. 00 48.1000 ECH EL-TEMP SRV - 0-100 SRV FDR 48.10 ----------------------------------- Fee summary Charged Paid Credited Due ----------------- ---------- ---------- ---------- ---------- Permit Fee Total 48.10 48.10 .00 .00 Plan Check Total .00 .00 .00 .00 Grand Total 48.10 48.10 .00 .00 \'\ l) 5c) ~ ~' ~v ~CJ ~I ~ , ......... \,j ~ "- vJ - ~ f'v} '\ C) ~ w t~ ~ Separate Permits are required for electrical work, SEPA, Shoreline, ESA, utilities, private and public improvements. This permit becomes null and void if work or construction authorized is not commenced within 180 days, if construction or work is suspended or abandoned for a period of 180 days after the work as commenced, or if required inspections have not been requested within 180 days from the last inspection. I hereby certify that I have read and examined this application and know the same to be true and correct. All provisions of laws and ordinances governing this type of work will be complied with whether specified herein or not. The granting of a permit does not presume to give authority to violate or cancel the provisions of any state or local law regulating construction or the performance of co nstruction. Signature of Contractor or Authorized Agent Date Signature of Owner (if owner is builder) " Dat~ T:\PLANNINGIFORMSIJ 102.15 [11/14/20031 \ \ BUILDING PERMIT INSPECTION RECORD CALL 417-4815 FOR BUILDING INSPECTIONS. CALL 417-4735 FOR ELECTRICAL INSPECTIONS. PLEASE PROVIDE A MINIMUM 24 HOUR NOTICE. IT IS UNLA WFUL TO COVER, INSULATE OR CONCEAL ANY WORK BEFORE INSPECTED AND ACCEPTED. POST PERMIT IN A CONSPICUOUS LOCATION. KEEP PERMIT CARD AND APPROVED PLANS AT JOB SITE. I INSPECTION TYPE DATE ACCEPTED COMMENTS I YES NO FOUNDATION: FOOTINGS WALLS FOUNDATION DRAINAGE/DOWN SPOUTS ELECTRICAL (LIGHT DEPT) SEPARATE PERMIT: # f) ht-v"f. /' ~U--./ ROUGH.IN /t1. I 2- I'U f{Ak PLUMBING Y UNDER FLOOR / SLAB ROUGH-IN WATER LINE (METER TO BLDG) GAS LINE BACK FLOW / WATER AIR SEAL WALLS CEILING I FRAMING JOISTS / GIRDERS SHEAR WALL/HOLD DOWNS WALLS / ROOF / CEILING DRYWALL (INTERIOR BRACED PANEL ONLY) T-BAR INSULATION SLAB WALL / FLOOR / CEILING MECHANICAL REA T PUMP GAS LINE WOOD STOVE / PELLET / CHIMNEY HOOD / DUCTS PW UTILITIES / SITE WORK (Engineering Division) SEPARATE PERMIT #'s: WATERLINE / METER SEWER CONNECTION SANITARY STORM PLANNING DEPT. SEPARATE PERMIT #'s SEPA: PARKING/LIGHTING ESA: LANDSCAPING SHORELINE: FINAL INSPECTIONS REQUIRED PRIOR TO OCCUPANCY/USE RESIDENTIAL DATE YES NO COMMERCIAL DATE ACCEPTED /1 YES NO ELECTRICAL - LIGHT DEPT. 417-4735 /O,IZ 01..( 7Cfi ELECTRICAL LIGHT DEPT CONSTRUCTION R.W. / PW/ CONSTRUCTION - R.W. ENGINEERING 417-4807 PW / ENGINEERING FIRE 417-4653 FIRE DEPT. PLANNING DEPT. 417-4750 PLANNING DEPT. BUILDING 417-4815 BUILDING T:\PLANNINGIFORMS\1102.15 [11/14/2003] FORTANGELES ~'t~, . t(Q)[PY WAS H I N G TON, U. S. 'A. PUBLIC WORKS & UTILITIES DEPARTMENT October 13, 2004 Ken E. Zeigler C/o COZI HOMES CONSTRUCTION, Inc. ' 324 East 9th' Street Port Angeles, W A. 98362 Subject: 413 East 3rd Street Job# Preliminary Estimate :t: '- Vl Dear Ken: The estimated cost of labor Qnd materials supplied by the City to provide three (3) phase electrical service for this property is $6,893~24. This estimate was based on the data you provided and is subject to review. This quote is good for 180 days. ~I ... The City will be responsible for the following: OJ ~ ~ * 1) Providing and installing the power pole. 2) Providing and instplling the transformers. 3) Providing and installing the 120/240v three (3) phase meter. 4) Providin'g and, installing the service wire ' (Unless underground service is requested) The owner/contractor will be responsible for the following: 1) Provic!ing, installing and future maintenance of the service riser on the pole (Ref: Underground Service-Secondary Riser CR 5 01) 2) Providing, fnstalling and future maintenance of the underground service wires in conduit from the power pole to the house and/or meter base. (Ref: Trenching Specifications UM 001-S) 3) Payment .of $6,893.24. 321 EAST FIFTH STREET · P. O. BOX 1150 · PORT ANG'ELES, WA 98362-0217 PHONE' 3'60-417-4805. FAX: 360-417-4542. TTY: 360-417-4645 E-MAIL: publlcworks@cltyofpa us This,estimate does not include the possible credit refund for the existing transformer. ' If the actual cost of construction exceeds the estimated amount, there will be no further billing. If the actual cost is less than the estimate, the difference will be refunded to you. Payment of the estimated amount will authorize the City to schedule the work. If you have any questions or concerns, feel free to contact me. Jo R G. Hebner Electrical Engineering Specialist ihebner{(i>.citvofpa.us 360.417.4706 Cc: James Harper, Electrical Engln!!ering Manager Rich Kendall, Electrical Inspector Roger Vess, Permit Tech Attachments: 3 Ref: WFXXXXXl01 -:. C'} _ , v '. c.;-J..91lI~",..... :r~.~'.. ~ <i>tr:. ('~t>~ .e 'I'bFiK5'J;:~iu"'" ELECTRICAL PERMIT APPLICATiON I 10 ~' ()n:ICH'~. ~.'S~ 0)11.'1: L>~'<-'l;~, ....... _u..___..__~_ I'~..,c'.~ . _ __..~_. '___'.'_ 1....:~AI'J".".".: __~_.___.____ ! lJ~;~ h......J _.. .,___~__~__. The Eie<:!rical Permit Applicaiion ~l~..~1 be filled oui COITl2.I~t8Iy. PleiO.Sl; type or rcprini in ink. If you have any QLJestions, please call (3130) 417-4735 Fax number: (360) 417-4711 Owner or Erec. Com,":lor :,genl~.~i..a,. 1j.,c ~. Phone J.i '5 J -ld-I J4 Fax ~'f> 2.:-~ >-t2...t-_ Prop?rly Own?r: ~~Lp.:s:::-- _ Po one: I-l!!J' 8D8 - Z 4 '-fS' Aclclross t-j 13 E. ~:-tJ Gily P A Zip: 9'?'"?0-7 Electnc'" contraclor:-fWrl0 ~"'"II.r 1 ~ i Lhr - License" ~~~:r-~XP: '!PfLo..r: Phone: l.JS2- ".':!2!f Addr.ss ~2.. ~". '1tutkr i fJ IJ _ City~. Zip 9~.3 <.c ':2.. INSTAL.LATION WIRED BY: Cl0WNER ){Et.ECTRICAL CDNTRACTOR Credit Card Holder Name: ___ Billing Address: on \ro- ity:_ xp.ba e: ' Zip: Cr"dit Card Number:__._ V/SA.:........ Me: PROJECT ADDRESS: 413 -E "3 c-d ~ ~ CJ Residential CJ Multi-family :J Commercial o Mobile Home Sq. F! t ~ ~ TYPE OF WORK: Check;ill thm apply: o New C Aileralion/Addltion o Remote MeIer 0 Detached garage 0 Ho! Tub 0 Swim Pool 0 Septic Pump o Low Voltage 0 Telecom. 0 Sign Number of Circuits added or altered: DESCRIPTION OF THE ELECTRICAL PROJECT: \o.\\f1w +0 -~ lo ~ Electrical Heat Load Additions and oS Subtractions .Service Information :1 Baseboard :1 Fumace :J Heat Pump :J Fan-Wall _KW KW TON_lRA KW f.L ~ Overhead Service CI Temp Service o Underground Service VOltage: 1-:L~/2'-tV Phase: 01 .0 3 Service Size: ) Feeder Size:. I hereby 'certify that i have read and examined this appiication and know that same to be true and correct, and jam 3uthorized 10 apply for this permit, I understand it is not the City's legal responsibiilty to determine what permits 3re required; it remains the applicants responsibiii!y to determine what permits are required and to obtain such. Date:~k_ Date: lei /I /0 If Owner or Elec. Cont. Signature: ~- ~(M ::JELECTRICALPERMIT APPLlCA TJOI'J Nc O?~t V MA-J [}(M 1; (j? .u-.<~ t=1-a~ eo...~ PERMIT FEE: $ ~JL #IIf If e(~ Credit Card Holder's Signature: }oRr,,14 CITY OF PORT ANGELES PERMIT APPLICATION 1 Building DivisionlElectrical Inspections n�I 321 East Fifth Street — P.O. Box 11501 Port Angeles Washington, 98362 Ph: (360) 417 -4735 Fax: (360) 417 -4711 Date: - Z4---L2, _ 1 & 2 Single Family Dwelling * Plan Review May Be Required, Please Complete Electrical Plan Review Information Sheet Job Address: . _)LCD Building Square Footage: *sot ')Lk - 1 "� 'i7-� 14 01) 5 +1 - Description of above LY\ 01M � Owner I ormatio s7f Contractor Information Name: "r Y Name: Mailing Address: Mailing Address' City: State: Zip City State: Zlp: Phone; Fax: Phone: Fax: License # ! Exp. License # I Exp. Item Unit Charge tV Total (Qty Multiplied by Unit Char e Service /Feeder 200 Amp: $120.00 $ Service/Feeder 201 -400 Amp $146.00 $ Service/Feeder 401 -600 Amp $ 205.00 $ Service/Feeder 601 -1000 Amp. $ 262.00 $ ServicelFeeder over 1000 Amp. $ 373.00 $ Branch Circuit W/ Service Feeder $ 5.00 $.__.._.._ —_ Branch Circuit WIO Service Feeder $ 63.00 I $� Each Additional Branch Circuit $ 5.00 Branch Circuits 1 -4 $ 75.00 �— $ Temp. Service/ Feeder 200 Amp, $ 93.00 $ Temp. Service /Feeder 201 -400 Amp: $110.00 $ Temp. Service /Feeder 401 -600 Amp. $149.00 $ Temp. Service /Feeder 601 -1000 Amp . $168.00 $ Portal to Portal Hourly $ 96.00 $ Signal Clrcult! Limited Energy -1 & 2 Famlly Dwelling $ 64.00 $ Manufactured Home Connection $ 120.00 $ Renewable Electrical Energy - 5KVA System or Less $ 102.00 $ Thermostat $ 56.00 $ Note: $5,00 for each additional T -Stat NEW CONSTRUCTION ONLY: First 1300 Square Ft $120.00 $ Each Additional 500 Square Ft. or Portion of $ 40.00 $ Each Outbuilding or Detached Garage $ 74.00 $ Each Swimming Pool or Hot Tub $110.00 $ $ Total Owner as defined by RCW.19,28.261: (1) Owner will occupy the structure for two years after this electrical permit is flnallzed. (2) Owner is required to hire an electrical contractor if 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 Ilcensed 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 Cede, and Utility Specifications and PAMC 14.05.050 regarding Electrical Permit Applications. Signature of owner, electrical contractor or electrical administrator: ❑ Cash ❑ check © Credit Card# X ' bated: - 2'""" 01101012 ELECTRICAL PERMIT CITY OF PORT ANGELES 360-417-4735 Application Number . , . . . 12- 00001251 Date 9/25/12 Application pin number . . 961359 Property Address . . . 413 E 3RD ST ASSESSOR PARCEL NUMBER: 06-30-00-6-5- 0024 -0000- Application type description ELECTRICAL ONLY Subdivision Name Property Use . , . . . . , . Property Zoning . . , . , . . COMMERCIAL ARTERIAL Application valuation . . . . 0 Application desc 8 circuits basement remodel Owner Contractor ROBERT R PHI.LP OWNER 413 E 3RD ST PORT ANGELES WA 983623204 permit ELECTRICAL ALTER RESIDENTIAL DATE: Additional desc , ,INSPECTOR: DITCH Permit Fee 98,00 Plan Check Fee 00 Issue Date . . . 9/25/12 Valuation . . . . 0 Expiration Date . , 3/24/13 Qty Unit Charge Per Extension 7.00 5.0000 ECH EL -ECH ADONT BRANCH CIRCUIT 35,00 1.00 43.0000 ECH EL -R- BRANCH CIR WO/ SER FEED 63,00 ---- ----- -- - -- - -- ----- - - Fee summary Charged - - -- Paid Credited Due Permit lee Total 98.00 98.00 .00 .00 plan Check Total 00 .00 .00 .00 Grand Total 98.00 98.00 .00 .00 REPORT SALES TAX on your excise tax form to the City of Port Angeles (Location Code 0502) INSPECTION TYPE DATE: RESULTS: ,INSPECTOR: DITCH SERVICE ROUGH -IN FINAL COMMENTS: PERMIT WILL EXPIRE SIX (6) MONTHS FROM LAST INSPECTION #' , . Signature of ow ei- or Electrical Contractor X _ Date: G:IEXCI-I.ANGEIBUILDING t f a CITY OF PORT ANGELES PERMIT APPLICATION ]Building Division/Electrical Inspections ELECTRICAL 321 East Fifth Street -- P.O. Box 11501 Port Angeles Washington, 95362 fflPFOONS Ph: (360) 417 -4735 Fax: (360) 417 -4711 Date: lb I A--9 & 2 Single Family Dwelling �OF ?OH �f * Plan Review May Be Re aired, Please Complete Electrica! Pian Review Information Sheet Job Address: `lt Building Square Footage: Description of above L i 6L �� i� a r 2g Owner Info nat'on l/ /1 �jr� Contractor Information Name: i C6 Iii Name: Mailing A�,d�e s : Mailing Address: City; P 51afe; Zip: City: State; Zip; Phone: ? x: Phone; Fax; License # 1 Exp, License # /'Exp, Item Unit Charge Qty Total (Qty Multiplied by Unit Charge) Servicel.Feeder.200 Amp, $120.00 $ Service /Feeder 201 -400 Amp, $146,00 $ * Plan Review May Be Re aired, Please Complete Electrica! Pian Review Information Sheet Job Address: `lt Building Square Footage: Description of above L i 6L �� i� a r 2g Owner Info nat'on l/ /1 �jr� Contractor Information Name: i C6 Iii Name: Mailing A�,d�e s : Mailing Address: City; P 51afe; Zip: City: State; Zip; Phone: ? x: Phone; Fax; License # 1 Exp, License # /'Exp, Item Unit Charge Qty Total (Qty Multiplied by Unit Charge) Servicel.Feeder.200 Amp, $120.00 $ Service /Feeder 201 -400 Amp, $146,00 $ Service /Feeder 401 -500 Amp $ 205.00 $ Service /Feeder 601 -1000 Amp. $ 262.00 $ Service /Feeder over 1000 Amp. $ 373.00 $ Branch Circuit WI Service Feeder $ 5,00 $ Branch Circuit WIO Service Feeder $ 63,00 $ Each Additional Branch Circuit $ 5.00 $ Branch Circuits 14 $ 75.00 $ Temp, Service/ Feeder 200 Amp, $ 93.00 $ Temp. Service/Feeder 201-400 Amp. $110,00 $ Temp, Service/Feeder 401 -600 Amp, $ 149,00 $ Temp, Service/Feeder 601 -1000 Amp , $168.00 $ Portal to Portal Hourly $ 962 $ Signal Circu!V Limited Energy - 1 & 2 Family Dwelling $ 64,00 $ Manufactured Home Connection $120.00 $ Renewable Electrical Energy - 5KVA System or Less $102,00 $ Thermostat $ 56.00 $ Note: $5,00 for each additional T -Stat NEW CONSTRUCTION ONLY; First 1300 Square Ft. $ 120.00 $ Each Additional 500 Square Ft. or Portion of $ 40.00 $ Each Outbuilding or Detached Garage $ 74,00 $ Each Swimming Pool or Hof Tub $110,00 $ $:� 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 electrical contractor if 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 l 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 -4613, The City of Port Angeles Municipal Code, and Utility Specifications and PAMC 14.05,050 regarding Electrical Permit Applications, Signature r, electrical ntrac or electrical administrator: ❑ Cash ❑ Check ❑ Credit Card 9 X I /� / /F Mtn Dated: 7 0110112012 0, 0 A T,%,12 ELECTRICAL INSPECTION Lam_ y WIRING REPORT RKS Z' 417-4735 DATE, NSPECIQB /V )-z-/ OWNER fl- t % ih - CONTRACTOR ADDRESS APPROVED NOT APPROVED 0 ........ ........... DITCH ....................® 0 ................ ROUGH IN/COVER ............... 0 0 .................... SERVICE .. . . ............... 11 0. . ............ ...... FINAL.... ... - -. ........ CORRE&IONS NEEDED: 4OFLI 21W--71 *!M 1<711-14 -r67 v Lrft-l��C�l I SM P-LA, I NOTIFY INSPECTOR WHEN CORRECTIONS ARE COMPLETED WITHIN 15 DAYS - DO NOT REMOVE - ELECTRICAL PERMIT CITY OF PORT ANGELES 360 -417 -4735 . Application Number . . . . . 14- 00001174 Date 10/01/14 Application pin number . . . 177470 Property Address . . . . . . 413 E 3RD ST ASSESSOR PARCEL NUMBER; 06-3o-00-6-5- 0024 -0000- Application type description ELECTRICAL ONLY Subdivision Name . . . . . . Property Use Property Zoning . . . . . . . COMMERCIAL ARTERIAL Applicat.ion valuation . . . . 0 Application desc Final for expired permit 12 -1251 Owner Contractor ------------------------- ------------------ - - - - -- ROBERT R PHILP OWNER 413 E 3RD ST PORT ANGELES WA 983623204 -------------------------------------._..----------- permit . . . . . . -------- --- -------- ELECTRICAL ALTER RESIDENTIAL - - - - -- Additional desc , INSPECTOR: DITCH Permit Fee . . . . 63.00 Plan Check Fee 00 15sue Date . . . . 10/01/14 valuation 0 Expiration Date 3/30/15 Qty Unit Charge per Extension 1.00 63.0000 ECH EL -R- BRANCH CIR WO/ SER FEED 63.00 Fee summary Charged Paid .Credited Due Permit Fee Total 63.00 63.00 .00 OQ Plan Check Total QO .00 .00 .00 Grand Total 63.00 63.00 .00 OQ REPORT SALE'S TAX on your excise tax form to the City of Port Angeles (Location Code 0502) INSPECTION TYPE DATE: RESULTS: INSPECTOR: DITCH SERVICE ROUGH -TN FINAL COMMENTS: PERMIT WILL EXPIRE SIX (6) MONTHS FROM LAST INSPECTION Signature of owner or Electrical Contractor X Date: G:IEXCHANGEWILDING ti