HomeMy WebLinkAbout2126 W 10th St - Engineering
CITY OF PO~T ANGELES
DEPARTMENT OF PUBLIC WORKS
. . . '". . . . . . . . INSPECTION REPORT . . . . . . . . . . .
REQUEST:
DateL:6 -- J-- 1 - ^ 6 ~ I Time
...
OW. 2S61. t9~ I
1E~
/
Received by
(phone, person)
d-.I ~-( w J6+A
location of Work to be inspected
Name of person requesting inspection I W i \ j (c)-/
Address of person requesting inspection 1 ( t11 ~ 13 Phone No
Type of Inspection (circle appropriate one) Permit No
Sewer Foundation Framing Chimney Plumbing Final Sewer Excav Other LA j ~.::i::e j-
INSPECTION NOTES
Inspected Date
Remarks
~
#1'
/6 }~ "
t-l(1-
~ ?7 ~ 0 1- f--V(~
I( ~
)0 Pre
~~
\
RESTORA TION REQUIRED ..... YES
SURFACE RESTORATION:
SURFACE TYPE 0 Unimproved 0 Gravel
o Repaired by City
o Repaired by Permittee
o No Damage Found
o Asphalt 0 PCC 0 Other
Wor'Ylrder # 11 3 /
[1r'COMPlETE
o INCOMPLETE
~
(Continue on reverse side if necessary)
STREET SUPERINTENDENT
(DATE)
t;~
S
~
,
CITY OF PORT ANGELES
PUBLIC WORKS - BUILDING DIVISION
321 EAST 5TH STREET, PORT ANGELES, W A 98362
~
PUBLIC WORKS CONSTRUCTION Issued: 3/05/98 TF Permit No: 815
& R/W PERMIT Cond: Work Order: 0
OWNER/APPLICANT------------------------PROPERTY LOCATION---------------~--------
ROBERT DOSTER 2126 10TH ST W
2126 WEST 10TH ST Lot:
Port Angeles,WA98363 Block: 301 Long Legal:
j60/452-7349 Sub:
PROJECT INFO--~-----------------------------------------------------------------
Work is lNSIDE traveled road Value Work: $0.00
Storm Drain
* Underground Tele/Ele
Misc
NOTES-------------------------------------------------------------------
3 3PAIR DROPS X STREET PLACE 125 3 PAIR TO EAST SIDE OF HOME
Plans Required: N/A
Contractor: US WEST COMMUNICATIONS
Start:
Finish:
Performance Bond Required: N/A
Proof Insurance:
Amount:
Work to Perform: INSTALL
Watermain
Sanitary Sewer
PROJECT
PLACE
/ /
/ /
$0.00
PROJECT FEES ASSESSMENT---------------------------------------------------------
R/W Excav:
Sidewalk:
Curb/Gutter:
Driveway:
Dwy Culvert:
Street Cut:
Other R/W:
Fire Hydrant:
Res Water Serv:
5/8"
3/4"
1"
Comm Water Serv:
1"
1 1/2"
2"
Oth Water Serv:
Water Sys Dev:
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
San Sewer SFR:
San Sewer MFR:
Add Unit: 0
Other San Sewer:
Sew Tap Wye/Man Tap:
Sew Cap/ W/M Removal:
Alter/Repair Sewer:
Storm Drain Tap:
Catch Basin per ea:
Sewer System Dev:
Milwaukee Dr. Sew Assess:
R/W Use Perm:
D.R.A. :
Admin Costs (D.R.A):
Misc:
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
------------------------------
------------------------------
$0.00
$0.00
TOTAL FEE:
AMT PAID:
Receipt No:
Inspection Fee:
$0.00
WATER
BAL DUE:
DRA
OTHER
DWY
STORM
R/W
SANITARY
$0.00
$0.00
$0.00
Separate Permits are required for electrical work, utilities, private and public improvements. This permit becomes null and void if work or
construction authorized is not commenced within 180 days, if construction or work is suspended or abandoned for a period of 180 days
after the work as commenced, or if required inspections have not been requested within 180 days from the last inspection. I hereby certify
that I have read and examined this application and know the same to be true and correct. All provisions of laws and ordinances governing
this type of work will be complied with whether specified herein or not. The granting of a permit does not presume to give authority to
violate or cancel the provisions of any state or local law regulating construction or the performance of construction.
Signature of Owner (if owner is builder)
Date
Signature of Contractor or Authorized Agent
Date
P. 01/01
1178- bD -/6
B -108 u
^ F~ 27'98 13:59 FR US WEST CC11MUNIGlTION 60 452 4673 TO 13604766696
OI-L9-98 OZ.l~fll HUM 141011 IV "J.O'''"'V'' UV""^'
WORK LOCATION WlntCent<lr. Me A".,s'Z- . BURIED GBMCS WIRE 1;~3 7383 k,
~.ItU *zf:f;: ("~~~ ~~ WORKORDE1l DATE: ~t::J:o/99
"- ..,) ... I ~-f<-+ COf'lTRAl':TOR'1l ACCR>TANCE
SubdMslon firm
Cust- SlgnatunlllOPiionoQ SlgnatulG
Title
Subm/ttlKf bY:~~ /'agfI' ~l USWest oroup doing work
Ilil to: USWat Com/rJutJIC8ti($
A"*"tlon:
~l
~ C"1l\f:
t,J ~7 EBb
:) 75<ilj~:
.'f!S'l..-7:3 '19 Appttived b>,I:
Is there IIddltiotW customer biDina? 0 Yes;, 0 No
Does T Gd1 ~ notiflad? C] YIIS C No
I~ ~ ? --- j
_ = =-_ i.J21 l<l161-1 'jA"
.-
lNSY'ALLADONIREPAIR
Naw 0 Cf I] SOl
~lIe 0 Add Una 0
Ropait 1Y' OOS!:I na
TTNI
= g..,y ;:UN
PRE-MOVISlONlNG
Pre ButV C]
Coodult Placed J>ittial 0 Complete (]
SSW In ()pen Tr. Plutiil I] Compltte [J
&mnd SSW on parliaI conduit or opan trench [)
HOlM Raady far SNI/(JAJIJ t:1 Not RUdy CI
L
---------
SSletJ:h WoTl< Requised. /nc1utk ~ c:rOSS $ftrlGt and
wire fength
nf/)(lj-'
L1
~IA1
I '
I
0a1a:
Zip:
Date:
DaIB:
~
\
~I!S ..
,.EIlMIT r.~::lIJtRE07 [] NO
~vod ffom Verbal []
J/.Irhdic/kltl _C-I.,.Y No. D6ta:
--....:.
\J
\))
c.
coMI'LETEO BY:
Call
Date:
for I8lVlce COIlMCtiOn
~
Q/ill h... h .-f1,/h. bY,~,
.-- -- -...-
__1IGIt\
~
~
\1+
, '
.
-,It<".
..Jf,~~.aJ
y:-
o '_
D"l~
L2J1lK-- j... ~~ J ,.of
l1/-t ~.ot+-h. ~ t>-
, eOfr~~1
_""*"'IIIId.
l\l- "':> I
nd__/lClb>..._~In"doboIs,.._INo~
JRi 2S'$ 1:3:<\8
R-94%
...
- S 4'78 5S93
360 452 4673
** TOTAl Pl'1GE, 001 lI<lI<.
02-27-98 02,27PM POOl #23