HomeMy WebLinkAbout4003 Old Mill Rd - Engineering �j.�.4%. CITY OF PORT ANGELES
PUBLIC WORKS UTILITIES
321 EAST 5TH STREET, PORT ANGELES WA 98362
Application Number 11- 00000882 Date 8/18/11
Application pin number 300302 REPORT SALES TAX
Property Address 4003 OLD MILL RD
ASSESSOR PARCEL NUMBER: 06- 30- 15- 3- 4- 0100 2001- On your state excise tax form
Tenant nbr, name QWEST
Application type description PUBLIC WORKS UTILITES to the City of Port
Angeles
Subdivision Name (Location Code 0502)
Property Use
Property Zoning UNKNOWN
Application valuation 0
Application desc
Bore phone service RCP #11 -30
Owner Contractor
WALLACE KEITH EDWARD EXCEL UTILITIES CONSTRUCTION
4003 OLD MILL RD 54 W. MISTY LN
PORT ANGELES WA 983621905 PORT ANGELES WA 98362
(360) 452 -1110
Permit RIGHT OF WAY
Additional desc BORE PHONE SERVICE RCP #11 -30
Permit pin number 191155
Permit Fee 150.00 Plan Check Fee .00
Issue Date 8/18/11 Valuation 0
Expiration Date 2/14/12
Qty Unit Charge Per Extension
1.00 150.0000 ECH PW RW CONST EXCAVTION OTHER 150.00
Special Notes and Comments
No traffic revision allowed without prior approval of
traffic control plan. Applicant responsible for erosion
control and surface restoration.
Fee summary Charged Paid Credited Due
Permit Fee Total 150.00 150.00 .00 .00
Plan Check Total .00 .00 .00 .00
Grand Total 150.00 150.00 .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 abandonEid
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 au orit o violate or cancel the provisions of any state or local law regulating construction or the performance of
constru I�n.
tQ
1101/ of Contractor or Authorized Agent Date Signature of Owner (if owner is builder) Date
T:Forms /Building Division /Public Works Permit
PERMIT INSPECTION RECORD
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.
KEEP PERMIT CARD AND APPROVED PLANS AT JOB SITE
INSPECTION TYPE DATE ACCEPTED COMMENTS
YES NO
PW UTILITIES "'(Engineering Division)
WATERLINE METER
SEWER CONNECTION
SANITARY
STORM
SITE DRAINAGE,
SITE EROSION CONTROL
PARKING
SIDEWALK
CURB R.GUTTER
DRIVEWAY`APPROACH
BACK ELOW DEVICE
ry 1 k
C L x f 4 Y
1
b: I r i L a
FINAL INSPECTIONS.REQUIRED PRIOR `f0 OCCUPANCY /USE
RESIDENTIAL_ DATE YES` NO COMMERCIAL DATE 'ACCEPTED
ENGINEERING
CONSTRUCTION R W FPW( CONSTRUCTION, `.R W
417-4807 PW ENGINEERING
FIRE 417 -4653 FIRE DEPT..
PLANNING DEPT. .s. 417-4750 PLANNING.DEPT.
BUILDING 41 ;BUILDING
`4815
r
T Forms /Building Division /Pub11c Permit �r
,!) w - "2...00 r- 18 ~ "'l..,
CITY OF PORT ANGELES
DEPARTMENT OF PUBLIC WORKS
. . . . . . . . . . . INSPECTION REPORT. . . . . . . . . . .
REQUEST _ I _ (~
Date 6 "- 0 Time Received by
I.-,.~\ L3
/ !.-~
Location of Work to be inspected
Name of person requesting inspection
Address of person requesting inspection
Type of Inspection (circle appropriate one)
Phone No
Permit No
Sewer Foundation Framing Chimney Plumbing Final Sewer Excav Other
INSPECTION NOTES
Inspected Date
Remarks
-g Time
1:E~ L ~
'(1' e 1-6
P- ~~O'>'Vl
).. .p' (\..}( (
LtJ,-&r
By
!i:t ~' 1= ~'O-e
~ >. V I U--,<- +0
RESTORATION REQUIRED
1J1'
);
~
~
~
~
(j
~
\)
SURFACE RESTORATION
SURFACE TYPE 0 Unimproved 0 Gravel
o Repaired by City
Cl Repaired by Permittee
CI No Damage Found
./
YES t/ NO
R H-t:' bc:>
<{it ,~' i Pt /kt~~,
JI()61 I t2 it'
Yold q1t1/ net'
o Asphalt OPCC DOther ;C;~5<:.) /1-
Work Order # j 96 ?- '
o COMPLETE
o INCOMPLETE
(Continue on reverse side if necessary)
'(DATE)
STREET SUPERINTENDENT
City of Port Angeles
Public 'Vorks Department
Water Distribution Repair Report
~ (AJ .. "2...009 - /8' 2..
'work Order No: /.1. b ?-
'Crew:
7/(/
I
DATE REPORTED'
) -- J. 4 - o(
CONDITION EMERGENCY 0 ROUTINE 0 CITIZEN COMPLAINT ~
LEAKAGE SURVEY 0 OTIIER 0
DATE OF REPAIR. 6 - (-0 I TIME
'/0 6 '3
/ ~f( 0 ~ SIZE.
/ ( /J-fJ(OA.M. OP.M., /
6 lei #hl,.l! /fc! f'
REP AIR LOCATION ADDRESS
TYPE OF MAIN
DEPTH OF MAIN
CLOSEST VALVE DEPTII.
COMPONENT REPAIRED.
MAIN JOINT 0 CIR. BREAK 0 SPLIT BELL. 0 LONG BREAK 0
HOLE 0 CLAMP 0 OTIffiR
SERVICE. TAP 0 CORP STOP 0 PIPE ~URB STOP 0 FITTING 0
METER SETTER 0 METER 0
LINE VALVE. FLANGE NUTSIBOLTS 0 STEM 0 BONNET 0
HYDRANT BRANCH 0 VALVE 0 BARREL 0
OTIffiR. I? ~ 1'J~ lLY-ed 5-e j/'(/ ((.....e ~cu h -/-6 c,}1t -e"ft'r- ff /);
COMPONENTS OF REPAIR. CLAMPO DRESSERO OTIffiR
SITE CONDmON" GRAVEL 0 ASPHALT 0 SIDEWALK 0 CURB 0
TOP SOIL AREA 0 SOIL TYPE
CUTS ASPHALT CUT _FT CURB CUT _FT SIDEWALI(_FT
DRIVEWAY CUT _FT
MAIN CONDITION INTERNAL LINING TUBERCULATION-MINOR 0 SEVERE 0
EXTERNAL CORROSION LOCALIZED 0 EXTENSIVE 0
CHLORINE RESIDUAL SAMPLE ~P"P.M.
WATER OFF FROM //11- M. TO l:Lf M.
FROM M. TO
M.
f:; y- rtH-e
f,r
APPARENT CAUSE OF LEAK.