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CITY OF PORT ANGELES
DEPARTMENT OF COMMUNITY DEVELOPMENT - BUILDING DNISION
321 EAST 5TH STREET, PORT ANGELES, WA 98362
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Application Number
Pl.n number
Property Address
ASSESSOR PARCEL NUMBER:
Application description
Subdivision Name
Property Use
Property Zoning . . .
Application valuation
04-00001214 Date
.277820
1039 W 5TH ST
06-30-00-0-1-0944-0000-
MECHANICAL APPL. PERMIT
12/30/04
RS7 RESDNTL SINGLE FAMILY
500
t::Kr(e~
lO/II/uS
Owner
Contractor
CARPENTER, TED
218 SOUTHRIDGE RD
PORT ANGELES
( 36) 457-8129
OWNER
WA 98363
Permit MECHANICAL PERMIT
Additional desc
Permit Fee 57.65 Plan Check Fee .00
Issue Date 12/30/04 Valuation 0
Expiration Date 6/29/05
Qty Unit Charge Per Extension
BASE FEE 47.00
1. 00 10.6500 ECH ME-GAS PIPE 1 TO 5 10.65
Fee summary Charged Paid Credited Due
----------------- ---------- ---------- ---------- ----------
Permit Fee Total 57.65 57.65 .00 .00
Plan Check Total .00 .00 .00 .00
Grand Total 57.65 57.65 .00 .00
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Separate Permits are required for electrical work, SEPA, Shoreline, ESA, utilities, private and public improvements. This permit becomes
null and void if work or construction authorized is not commenced within 180 days, if construction or work is suspended or abandoned
for a period of 180 days after the work as commenced, or if required inspections have not been requested within 180 days from the last
inspection. I hereby certify that I have read and examined thiS application and know the same to be true and correct. All prOVisions of
laws and ordinances governing this type of work will be complied with whether specified herein or not. The granting of a permit does not
presume to give authority to violate or cancel the provisions of any sta or cal law regulating constru ion or the performance of
construction.
J
Signature of Contractor or Authorized Agent Date
T \PLANNING\FORMS\1102.15 [11/14/2003]
PREPARED 4/20/05, 13 31 20
CITY OF PORT ANGELES
INSPECTION TICKET
INSPECTOR JAMES L LIERLY
PAGE
DATE
3
4/20/05
ADDRESS
CONTRACTOR
OWNER
PARCEL
APPL NUMBER.
1039 W 5TH ST
SUBDIV.
PHONE
PHONE
( 36) 457-8129
CARPENTER, TED
06-30-00-0-1-0944-0000-
04-00001214 MECHANICAL APPL
PERMIT
PERMIT: ME 00 MECHANICAL PERMIT
REQUESTED INSP DESCRIPTION
TYP/SQ COMPLETED RESULT RESULTS/COMMENTS
ME6
01
~~
MECHANICAL GAS LINE
04/20/2005 09 44 AM RVESS
May have a gas llne lnspectlon already, check permlt, not
recorded In flle record.
Ted Carpenter 452-1713
-------------------------------------- COMMENTS AND NOTES --------------------------------------
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CITY OF PORT ANGELES
DEPARTMENT OF COMMUNITY DEVELOPMENT - BUILDING DIVISION
321 EAST 5TH STREET, PORT ANGELES, W A 98362
Application Number
pin number . . . .
Property Address
ASSESSOR PARCEL NUMBER:
Application description
Subdivision Name
Property Use
Property Zoning . . .
Application valuation
04-00000116 Date
.457828
1039 W 5TH ST
06-30-00-0-1-0944-0000-
RES REMODEL
2/11/04
.,...
UNKNOWN
25000
Owner
Contractor
CARPENTER, TED
218 SOUTHRIDGE RD
PORT ANGELES
(360) 457-8129
OWNER
WA 98363
-----------------------------------------------------------
Permit
Additional desc
Permit Fee
Issue Date
Expiration Date
BUILDING PERMIT -RESIDENTIAL
NEW ROOF TRUSS SYSTEM
414.75 Plan Check Fee
2/11/04 Valuation
8/09/04
165.90
25000
Qty Unit Charge Per
Extension
92.75
322.00
BASE FEE
23.00 14.0000 THOU BL-2001-25K (14 PER K)
Fee summary Charged Paid Credited Due
-~--------------- ---------- ---------- ---------- ----------
Permit Fee Total 414.75 414.75 .00 .00
,Plan Check Total 165.90 165.90 .00 .00
Other Fee Total 4.50 4.50 .00 .00
Grand Total 585.15 585.15 .00 .00
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Other Fees
STATE SURCHARGE
4.50
1J)
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Separate Permits are required for electrical work, SEPA, Shoreline, ESA, utilities, private and public improvements. This permit becomes
null and void if work or construction authorized is not commenced within 180 days, if construction or work is suspended or abandoned
for a period of 180 days after the work as commenced, or if required inspections have not been requested within 180 days from the last
inspection. I hereby certify that I have read and examined this application and know the same to be true and correct. All provisions of
laws and ordinances governing this type of work will be complied with whether specified herein or not. The granting of a permit does not
presume to give authority to violate or cancel the provisions of any state or local law regulating construction or the performance of
constr cion.
J~
Signature of Owner (if owner is builder)
Date
uthorized Agent
T:\PLANNfNG\FORMS\1102,15 [11/14/2003]
BUILDING PERMIT INSPECTION RECORD
CALL 417-4815 FOR BUILDING INSPECTIONS. CALL 417-4735 FOR ELECTRICAL INSPECTIONS.
PLEASE PROVIDE A MINIMUM 24 HOUR NOTICE. IT IS UNLAWFUL TO COVER, INSULATE OR CONCEAL ANY WORK BEFORE
INSPECTED AND ACCEPTED. POST PERMIT IN A CONSPICUOUS LOCA nON.
KEEP PERMIT CARD AND APPROVED PLANS AT JOB SITE.
INSPECTION TYPE DATE I ACCEPTED COMMENTS
I YES NO
FOUNDATION:
FOOTfNGS 2..- q_oJ.-( J/.-I.--
WALLS I~ -4_ OU
FOUNDATION DRAfNAGE/OOWN SPOUTS
ELECTRICAL (LIGHT DEPT) SEPARATE PERMIT: #
ROUGH-fN
,.- 3 -, J -os -J ).. J.- fJ--(J
PLUMBING rJ H 1)-)-
UNDER FLOOR / SLAB
ROUGH-fN CJ, .),<<"0,.1 11w
WATER LfNE (METER TO BLDG) I
GAS LINE
BACK FLOW / WATER
AIR SEAL
WALLS -=J in >7 -ooJ I Ll.-
l' ~
CEILING
FRAMING
JOISTS / GIRDERS
SHEAR W ALUHOLD DOWNS
WALLS / ROOF / CEILfNG / 1'1- 7 - 0-/ J L- I.-
DRYW ALL (fNTERIOR BRACED PANEL ONLY)
T-BAR
INSULATION
SLAB
WALL / FLOOR / CEILfNG 'i! i { (./;--4 !_\J..\..
MECHANICAL
HEAT PUMP
GAS LfNE
WOOD STOVE / PELLET / CHIMNEY
HOOD / DUCTS
PW UTILITIES / SITE WORK (Engineering Division) SEPARATE PERMIT #'s:
WATERLINE / METER
SEWER CONNECTION
SANITARY
STORM
PLANNING DEPT. SEP ARA TE PERMIT #'s SEPA:
PARKING/LIGHTING ESA:
LANDSCAPING SHORELINE:
FINAL INSPECTIONS REQUIRED PRIOR TO OCCUPANCYIUSE
RESIDENTIAL DATE YES NO COMMERCIAL DATE ACCEPTED
YES NO
ELECTRICAL - LIGHT DEPT. 417-4735 ELECTRICAL
LIGHT DEPT
CONSTRUCTION R.W. / PW/ CONSTRUCTION - R.W.
ENGfNEERfNG 417-4807 PW / ENGINEERfNG
FIRE 417-4653 FIRE DEPT.
PLANNfNG DEPT. 417-4750 PLANNfNG DEPT.
BUlLDfNG 417-4815 ~ ,.. ~ J-O S' BUILDfNG
T:\PLANNfNG\FORMS\ II 02.15 [11/14/2003]
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BUILDING PERMIT - APPLICATION
Date Approved:
Date Issued:
Fill out COMPLETELY and in INK. Your application and site plan MUST
COMPLETE to be accepted for review. If you have any questions, call
(360) 417-4815
Applicant or Agent:_lED C f\vLFV1\t.YL-
Owner: S'f\wl.~
Address: d. \~ :;001\.:(\ '01c;- \'?-Q.. City: P, Pi .
Architect/Engineer:
Contractor X L f'
Phone: -=t S7 - ?? \ L S
Phone: /I
Zip: q ~?) Co 3
Phone:
State License #:
Exp:
Phone:
Address: City:
PROJECT ADDRESS: l 07Y q L0E'ST S ~
.
LEGAL DESCRIPTION: Lot-----11-- Block: I 0 9
CLALLAM COUNTY PARCEL NUMBER: O~ ~ 00 00
Zip:
ZONING:
Subdivision:
ID'\4'4
.
aooo
Credit Card Holder Name:
Billing Address:
Credit CardType VISA MC #
TYPE OF WORK:
o Residential 0 New Constr. ~ Re-roof
o Multi-family 0 Addition 0 Move
o Commercial )q Remodel 0 Demolition
o Repair 0 Sign
BRIEF DESCRIPTION OF THE PROJECT:
City:
Exp. Date:
~ Stove
o Garage
o Deck
o Other
SIZEN ALUATION:
SF. @ $ /SF. = $
SF. @ $ /SF. = $
SF. @ $ /SF. = $
TOTAL VALUATION $ L.~, 000
COMMERCIALJRESIDENTIAL: Occupancy Group:
No. of Stories: Lot Size: Existing Sq. Ft.
Existing lot coverage % & Proposed lot coverage
Occupant Load:
& Proposed Sq. Ft.
% = Total lot coverage
Construction Type:
= TOTAL Sq.Ft.
%
- -
APPROVALS:
PLANNING USE ONLY: PLAN:
BLDG:
DPWU:
SEPA Checklist required? 0 Yes 0 No Other: FIRE:
ESAlWetland(s): 0 Yes 0 No OTHER:
-
BillLDING PERMIT APPLICATION SUBMITTAL: The Building Division can provide you with information on the application and
plan submittal requirements if you have questions.
VALUATION OF CONSTRUCTION: In all cases, a valuation amount must be entered by the applicant. This figure will be reviewed
and may be revised by the Building Division to comply with current fee schedules. Contact the Permit Coordinator at 417 -4815 for assistance.
PLAN CHECK FEE: IF a plan check fee is due it must be submitted at the time the building permit application and construction plans are
submitted. All other permit fees are due at the time of permit issuance.
EXPIRATION OF PLAN REVIEW: Ifno permit is issued within 180 days of the date of application, the application will expire. The
Building Official can extend the time for action by the applicant up to 180 days upon written request by the applicant (see Section 107.4 of
the UnifOllli BuIlding Code, current edition). No application can be extended mOle than once.
I hereby certify that I have m[]d and eX2mined this application and know the same to be true and correct. J am authorized to apply for this permit and
understand that it is my responsibility to determine what permits are required, the City's, and that I must obtain such permits; 'rior to work.
. Appiicant: \' G"-'vr~ __Date: '2( II I C~
T:\FORMS\APPS\B lli I, i j n c'pcnnit.wpd
INSTRUCTIONS FOR WORKING DRAWINGS: ELEVATIONS
Elevations show roughly what the exterior of
the building will look like when finished. You
should submit elevations to show the house from
all four directions: east, west, north, and south.
The elevations should include:
- Position and height of windows and doors.
- Roof slope.
- Relationship of an addition (if applicable) to
the rest of the building.
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CITY OF PORT ANGELES
DEPARTMENT OF COMMUNITY DEVELOPMENT - BUILDING DIVISION
321 EAST 5TH STREET, PORT ANGELES, WA 98362
Application Number
pin number
Property Address
ASSESSOR PARCEL NUMBER:
Application description
Subdivision Name
Property Use . . . .
Property Zoning . . .
Application valuation
04-00000116 Date
.457828
1039 W 5TH ST
06-30-00-0-1-0944-0000-
RES REMODEL
2/19/04
RS7 RESDNTL SINGLE FAMILY
25000
Owner
Contractor
CARPEN'l:ER, TED
218 SOUTHRIDGE RD
PORT ANGELES
(360) 457-8129
OWNER
WA 98363
----------------------------------------------------------------------------
Permit . . . .
Additional desc
Permit Fee
Issue Date
Expiration Date
ELECTRICAL NEW RESIDENTIAL
200 A PNL / RE-WIRE
76.30 Plan Check Fee
2/19/04 Valuation
8/17/04
.00
o
Other Fees
STATE SURCHARGE
4.50
~
~
~
Qty unit Charge Per
1.00 76.3000 ECH EL-RM-0-200 1ST SRV FEEDER
Extension
76.30
----------------------------------------------------------------------------
Fee summary Charged Paid Credited Due
----------------- ---------- ---------- ---------- ----------
Permit Fee Total 76.30 76.30 .00 .00
Plan Check Total .00 .00 .00 .00
Other Fee Total 4.50 4.50 .00 .00
Grand Total 80.80 80.80 .00 .00
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Separate Permits are required for electrical work, SEPA, Shoreline, ESA, utilities, private and public improvements. This permit becomes
null and void if work or construction authorized is not commenced within 180 days, if construction or work is suspended or abandoned
for a period of 180 days after the work as commenced, or if required inspections have not been requested within 180 days from the last
inspection. I hereby certify that I have read and examined this application and know the same to be true and correct. All provisions of
laws and ordinances governing this type of work will be complied with whether specified herein or not. The granting of a permit does not
presume to give authority to violate or cancel the provisions of any state or local law regulating construction or the performance of
construction.
Date
Signature of Contractor or Authorized Agent
Date
Signature of Owner (if owner is builder)
T:\PLANNfNGIFORMS\1102.15 [11/14/2003]
BmLDING PERMIT INSPECTION RECORD
CALL 417-4815 FOR BUILDING INSPECTIONS. CALL 417-4735 FOR ELECTRICAL INSPECTIONS.
PLEASE PROVIDE A MINIMUM 24 HOUR NOTICE. IT IS UNLAWFUL TO COVER, INSULATE OR CONCEAL ANY WORK BEFORE
INSPECTED AND ACCEPTED. POST PERMIT IN A CONSPICUOUS LOCA nON.
KEEP PERMIT CARD AND APPROVED PLANS AT JOB SITE.
INSPECTION TYPE DATE ACCEPTED COMMENTS
YES NO
FOUNDATION:
FOOTINGS
WALLS
FOUNDATION DRAfNAGE/DOWN SPOUTS
ELECTRICAL (LIGHT DEPT) SEPARATE PERMIT: # -
1-:. (/'_/ .~., ( i/"A' " ( , ,
ROUGH-fN , j 'r , ,
\ ,~
PLUMBING
UNDER FLOOR 1 SLAB
ROUGH-fN
WATER LfNE (METER TO BLDG)
GAS LfNE
BACK FLOW 1 WATER
AIR SEAL
WALLS
CEILING I
FRAMING
JOISTS 1 GIRDERS
SHEAR WALUHOLD DOWNS
WALLS 1 ROOF 1 CEILfNG
DR YW ALL (fNTERlOR BRACED PANEL ONLY)
T-BAR
INSULATION
SLAB
WALL 1 FLOOR 1 CEILfNG I I
MECHANICAL
HEAT PUMP
GAS LfNE
WOOD STOVE 1 PELLET 1 CHIMNEY
HOOD 1 DUCTS
PW UTILITIES 1 SITE WORK (Engineering Division) SEPARATE PERMIT #'s:
WATERLINE 1 METER
SEWER CONNECTION
SANITARY
STORM
PLANNING DEPT. SEPARATE PERMIT #'s SEPA:
PARKING/LIGHTING ESA:
LANDSCAPING SHORELINE:
FINAL INSPECTIONS REQUIRED PRIOR TO OCCUPANCY/USE
RESIDENTIAL DATE YES NO COMMERCIAL DATE ACCEPTED
YES NO
ELECTRlCAL, LIGHT DEPT. 417-4735 :7/gl/o5" /bI;J ELECTRlCAL
LIGHT DEPT
CONSTRUCTION R. W. 1 PW 1 / , CONSTRUCTION - R.W.
ENGfNEERING 417-4807 PW 1 ENGfNEERING
FIRE 417-4653 FIRE DEPT.
PLANNfNG DEPT. 417-4750 PLANNfNG DEPT.
BUILDfNG 417-4815 BUILDfNG
T:\PLANNfNG\FORMS\1102.15 [11/14/2003]
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ELECTRICAL PERMIT APPLICATION
FOR OFFICIAL USE ONLY \
~~R~; .
Permit.:
Date Approved:
D31c:lssued:
Tha Electrical Permit Application must be filled out completelv.
P lease type or reprint in Ink. If you have any questions, please call (360) 417-4735
Fax number: (360)417-4711
tY'I- //6
Owner or Elec. Contractor Agent: r t3) C /h(f): 1JTl::.----re-
Property Owner: fj) ~~~
Address: In}.,.' me I.. .. City:
.
Phone: t.;-n '"? I d-.. 9 Fax:
Phone:
Pr!hvj
License #:
Zip: 9'1(,2,(02
Electrical Contractor:
Exp:
Phone:
Address:
City:
o ELECTRICAL CONTRACTOR
Zip:
INSTALLATION WIRED BY: )QOWNER .
Credit Card Holder Name: reo
Exp. Date:
Me:
PROJECT ADDRESS:
/039 '-'t.f~
~ft. kr.
TYPI: OF WORK: Check all that apply: 0 New
~sidential 0 Multi-family . 0 Commercial
l31IfteralionlAddition
o Mobile Home
Sq.Ft.
DESCRIPTIOt-/ OF THE ElEC,TRICALPROJECT:
!ZeP//kEfJ (I're u/7S,
I
o Remote Meter 0 Detached garag~' 0 H!Jt_Tub. QSwim f>ool. _0 Septir..Rump"-;, g LowVcltzge' 0 Te:acQ,n. -,USi;
N:mber -; ;i~U;S ~~ ~r-a~;e:d: ~/I}r;:O P!}we- .
Chf1Wr;,'E n1m,T; 1U~7J S~7ZU/CE tvJm
!tVfJGFr
Electrical Load Additions and or subtractions
~-",{_~ lit-
/" . Service Information
o Baseboard
o Fumace
o Heat Pump
o Fan-Wall
KW
KW
TON
KW
lAR
o Overhead Service
o Temp Service'
o Underground Service
Voltage:
Phase: 0 1 0 3
Service Size: ":Leo,,"
Feeder Size:
PAMC 14.05.060(B): For industrial. commercial. & residential projects larger than a duplex. a one - line drawing of the Electrical Service
Feeders. building size (sq. ft.). load calculations. and the ty pe & of conductors and/or raceway is required and shall accom pany the
Electrical Permit application.
I hereby certify that I have read and examined this application and know that same to be true and correct, and I ,
authorized to apply for this permit. I understand it is not the City's legal responsibility to determine what permits
are required; it remains the applicants responsibility to determine what permits are required and to obtain s
'!
PW.9019/7/03 PERMIT FEE: $17'.3-0