HomeMy WebLinkAbout216 N Laurel St - Engineering
tilL'-~!. PUBLIC WORKS CONSTRUCTION
and RIGHT-OF-WAY PERMITS
~ City Phone: 206-457-0411, ext. 124
urUCANT/OWNER. W 5.1>e n n [-3. ADDRESS OF JOB. Z I f.o
APPUCANT ADDRESS: PHONE LEGAL OF JOB
WORK IS r:J OUTSIDE or 0 INSIDE OF TRAVELED ROAD VALUE OF WORK IS.S (If work is outside roadway
and IS equal to or less than S2,OOO, then permIt may be issued to other than licensed and bonded contractor )
PERMlT 00 r~86
?/~3
~. f;fu~j
PLANS REQUIRED 0 YES 0 NO CONTRACTOR. DATES FOR START & FINISH
PERFORMANCE BOND REQUIRED r:J YES r:J NO AMOUNT S
PROOF OF INSURANCE. 0 Work $2.000 or leSs: $50,000 personal injury, SI00,OOO per lDcident, S20000 property
r:J Work over $2.000: S200,OOO personal injury. S500,OOO per IDcldent, $100,000 property
r:J Right of Way Use: $300,000 personal inJury, $300,000 per mcident. $100,000 property
Permittee undentaDda that DO street may be closed to traffic unless approved by the City Engineer and Chief of Police in advance of the
closure; that there is a 24 hour minimum notice prior to inspection, and to call 48 hours before dlggmg to 1-800-424-5555.
.. . . . fill_ .......f111111io .....11.. ......__ "'.............. a, fill ,. MeM-'" _ fill 110 ..... ..--.- oIIaII. ...... __ Ie 11Io ......... "- _.......,.. ~
for _........ Do....... lD _ ..~. ....... -..... . u. __ _ 01_ _1InIloIoa.... _Ibo ...... 01 thio .""lieolieD aad Ibo pcrmil or pcrmi.. _..." .. .,- ill _
.-. .. - all 1'Mid IIoIIiIkIoo - ...., __'" ... .......
Sipod: X;-'~~~'-'-~ ~ DATE. 7/ si"iS-
n'l'I! FEE REO'O PAID TYPE FEE REQ'D PAID Ii
I
,
RIOHT OF WAY EXCAV S<<I.oo SAN. SEWEll (SFR) (6.... PI1.. 6.... SIO.OO
_I
SlII.oo' SAN. SEWEll. /MFR1. Ill'" 110.00
.wourT'E]l. .- $123.00 SAN SEWEll. /MFRI ADD. UNIT $3.00
IllUVI!W A Y $123.00 SAN SEWEll. 0THEJlS M;,,-$73,OO; SO.l105 III
M...-17'" 100 00ll0~.0025 Cll.,...
DWY ctJLVERT .--10 S<<I.110 SEWEll TAP BY erN NO SI2S.llOISJOO.oo
0..- WY1!IMANHOLE TAP
STUET CllI' ~ SDl.OO SEWEll CAPIWATER METER S225.00
REMOVAL
<mlE1 aJOHT OF WAY WOJK S<<I.oo ALTERATIONI S30.00
REPAIR TO SEWER
mE HYDIlANT DEPOSIT STORM DRAIN TAP SI2S.00 11
RES. WATER SI!I.VIC1! I" X "'" $3"'.00 CATCH BASINS IN LOTS PER EACH S40.00 11
RES. WATER SEJlVlC1! ." X 3"- $3".00 SECONDARY SEWER ASSESS. S.IO.OO in S613.00 cuolllc !I
,
RES. WATER SEIlVlC1! '" X I SlDl.OO SEWEll SYS. DEV. CHARGE U2..00 iEWM I!
COMM. WATER SEJlVlC1! I - 51,000 MD..WAUKEE DR. SEWEll ASSESS. SI~.OO /EWM I'
11t"- 11.>>0
;" _ riim
WATER SEJlVlC1! <mmR ESI1MATE RIGHT OF WAY USE PERMITS v ARIES S3 SIOO
WATER SYS. DEV CHAIlGE S7"'.00 /EWM "'~ /'lA
TOT AU S
~
Thia -- .... ... - - __ it .- u. po.... 10 do "'" ..... _bod ill... r.. u. _.-. .. u.~. EadI "'!nUl ia ~ 0""- 10 "'" ...... of Ibo ._ _ .. Ibo 0IlIlU0U"'"
.... ~ lD'" -- 0111Io Ciry 01_ ~ M...... Ccdo. NcoNnc pomUnod __ ahaII be _ 10 CMlondo Ibo ,...,.,..- of any .ppjieoblo 1&", of Ibo Ci.. County SLlIC 0<' Fode..l GCMI_.
COMMENTS/CONDITIONS. c:::-- 4 1/ I ~ =-- /:' ,) /4/ 0 ~ ~." _ /}
[:J Install 0 Repair /-) rev j/C- L-/ /7 e..- a W (~c:;;e I7C~ I o(../~
[J Watermain
g ==- (C! - (p 00- ;;<;;;>-3-3S-o T 1'1-;(.41 ) A..t tl ~
[] UIIdeqJoomd Tc1ep/JoDo1E1ei:1r A J~
_KMITTOTALS $ 193>>'3 RECEIPT # //?/ISSUED~ c ~ .
DATE. ?4~.
INSPECTION FEES $
PW~09.03 (l2J93)
INSPECJ'OR'S COpy. WHrrE
WORK ORDER No.
OO~86
APPLICANT'S COPY. PINK OFFICE COPY. CANARY PERl\1IT
..,
. . . .
CITY OF PORT ANGELES
DEPARTMENT OF PUBLIC WORKS
. . INSPECTION REPORT. . . . . .
REQUEST:
Date -:;... (~ ~ 't ':J -
Time I '2- ~ /)I-vl
Received by hAC'. ,)( (I,)
(phone, p.~r~on)
Location of Work to be inspected 2.- Co f--J L A--t.'-. v..L~--
Name of person requesting inspection \7) ~~" C h.- I, ,{;, , \)
-tt+ 1,.- \
Address of person requesting inspection ( f ... i)" '.\ j ,) C. ..I.. 1 Phone No (; ~
I
Type of Inspection (circle appropriate one) Permit No :?; 8-S
Sewer Foundation Framing Chimney Plumbing Final Sewer Excav Other
~', {-I
....,Io......i ....
INSPECTION NOTES:
Inspected' Date ? - 1"3 -9 ~j-
Remarks :r- j.,,) <:, 41 (....cc{ I y. s/ 'd .
II U tc - tr'1 b LA. I (,j I U 5
D LA..) "2 u<..) I
tf"'"-~,
Time '3, 30 J t-l-\ By ,1..-".
,
r'),~';~o~q~7
~ ' 7::;J... 7 LIF
.....>
T .L!" ('
{;A'li:' , ,., ,. .
=~
~ - I~ZS70
RESTORATION REQUIRED.
. YES v
NO
I
( L ~.~ \C.:-.c C.
NJ
~\( '-O~ ~~
""e ::t: 4- I ~' 1
----:::-i ------------- :_=]'-- .----.........,..,.---.-
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, I .
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r- '"
Ai
~ -=-
0 t:
(\
2. ,~
SURFACE RESTORATION,
SURFACE TYPE 0 Unimproved 0 Gravel 0 Asphalt
'-M\I'l~L
GPCC
o Other
Work Order #
o COMPLETE
o INCOMPLETE
~Jlr{Jef 1/;311)
(Continue on reverse skIp jf nf'rec;c;~rv\
o Repaired by City
o Repaired by Permittee
o No Damage Found
3-:f'C(
f""'Tnrr-T .. ~..... -..-
CITY OF PORT ANGELES
DEPARTMENT OF PUBLIC WORKS
. . . . . . INSPECTION REPORT. . .
.....
REQUEST:
Date 7- 12-- ctS-
.....~ ~ ~
Time '1' ,::.1 0 P' vi
Received by -;:(f A R/ /c. (,) (phone, petson)
Z-/Y' !J ~ -
(1 + !- M( . n E I :' I I If' I-...J , L ", ( I
Location of Work to be inspected :5 VJ c iP /!..
Name of person requesting inspection 8 ' !~ .c(
Address of person requesting inspection t +:1; /
Type of Inspection (circle appropriate one)
.~, (') (,; ,I ',) Phone No
Permit No 3 R...c::J
Sewer Foundation Framing Chimney Plumbing Final Sewer Excav Other
i ...v.) '2-0(~
INSPECTION NOTES:
Inspected Date 7- /,3 - ?,)- Time By 0. Mf=.-c) ere"te. ()
Remarks. ..:p /.J <,-fA-lleD I H eel 4(( h i2.'~ --:;~'r (; ( (. ("-.
<..
,
I
I L ~LA teL (-
I
e-M \ ~ lA.--\)
~ t c.~ ~- ( 2.' ._~
.- ----..._.. . - -.- .. . .-~~~I---~
../l;
<j
rJ
~ '"
I
,
RESTORATION REQUIRED .
" YES t/
NO
SURFACE RESTORATION:
SURFACE TYPE 0 Unimproved 0 Gravel 0 Asphalt
[Bpcc
o Other
~'1-~
o Repaired by City
o Repaired by Permittee
D No Damage Found
Work Order #
o COMPLETE
o INCOMPLETE
/r:; ffit"pl
-'7.7/3/4')
STREET SUPERINTENDENT
(DATE)
(Continue on reverse side if necessary)