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Home My WebLink About1000 Caroline St - Engineering s ~~ CITY OF PORT ANGELES PUBLIC WORKS - BUILDING DIVISION 321 EAST 5TH STREET, PORT ANGELES, WA 98362 /~ // PUBILlC WORKS & R/W PERMIT D Attached Notes Issued 1/26/2000 Perm it No Work Order' 1035 o OWNER/APPLICANT '....... CITY r'F rA 1>"<1 I'-J _J l C-".. PW CITY, PW State PW.zip 000/600-0000 PROJECT INFO Work is Plans Required Start Date Contractor' EXCEL UTILITIES CONSTRUCTION Performance Bond Required Amount: Proof of Insurance Work to Perform PROPERTY LOCATION 1000 CAROLINE Lot: st r/w Subdivision. D W MORSE Parcel No Block. 128 -- ~ ~ a (J ~ ( <::- ... ~ ~ \. C8J Long Legal Value Work, $000 / / Finish Date 360/452-1110 / / $000 D Install D D Repair D D Watermain D Sanitary Sewer Storm Drain Underground Tele/Elec D Mise PROJECT NOTES Excell Utilities install Fiber Optics south side of Caroline Streeet. RJSvc subcontractor for excavation / installation. Open cut Chambers Street. Traffic Control required. Verify with hospital and Clallam Transit about street closure. Notify dispatch about street closure. FEES ASSESSMEN"F 1 ) R/W Excav' $45 00 15 ) Other San Sewer' $000 2) Sidewalk $000 16) Sew Tap Wye/Man Tap $000 3 ) Curb/Gutter' $000 17 ) Sew Cap/ W /M Removal $000 4 ) Driveway' $000 18 ) Alter Repair Sewer' $000 5 ) Dwy Culvert: $000 19 ) Storm Drain $000 6 ) Street Cut: $400 00 20) Catch Basin per ea, $000 7 ) Other R/W $000 21 ) Sewer System Dev' $000 8 ) Fire Hydrant: $000 22.) Milwaukee Dr Sew Ass $000 9 ) Res Water Servo $000 23 ) R/W Use Perm $000 10) Comm Water Servo $000 24) Admin Cost (D RA) $000 11 ) Other Water Service $000 25 ) D RA $000 12.)Water System Dev' $000 26 ) Mise: $000 13 ) San Sewer SFR $000 TOTAL FEE $445.00 14) San Sewer MFR $000 add unit: 0 Amount Paid $445 00 Receipt No 5811 Inspection Fee $000 Balance Due $0.00 R/W SANIT AR Y WATER DWY STORM DRA OTHER Separate Permits are required for electrical work, utilities, private and public improvements. This permit becomes null and void if work or construction authorized is not commenced within 180 days, if construction or work is suspended or abandoned for a period of 180 days after the work as commenced. or if required inspections have not been requested within 180 days from the last inspection. I hereby certify that I have read and examined this application and know the same to be true and correct. All provisions of laws and ordinances governing this type of work will be complied with whether specified herein or not. The granting of a permit does not presume to give authority to violate or cancel the provisions of any slate or local law regulating.~nstr~tion the performance of construction. ~ - C-C/J-"1?/1.1)( Signature of Contractor or Authorized Agent Date Date v rr.......................o...........................................r;t;;.;.;.;;:~~:::::;::~;;:;:::;:;:;;.ii:::}::~::;;;~~r;T~~;:~;:::;::::::::~:~~iiit:::;:;::~;t:;:rr:r:::t~;:;:;:;:\:;:;:::;~,:::::::~:;::.::,~::;;;;;:;:;~::::$.,~;;:................... ...'~;::~iI~?\r:;:~;;~:~::::". ..... ....................w.. :r::~;M@WtmM@t.......r;~:;t(.M.r;~~;.YV).............. ....t:': ..' AC RD ....SlItItm..1iB.'gE"II.'. x ,.'. ~n' .. .m.........m.........m '..,. ::!~~~~~~.:.:.:.:.:.:.:.:.:.:.:.".>:.:.~~.:.:::~l:~;:::::::::~:;:;:;;:;;;:;:;:~~:::::~::::l:::;:;:;:J;:;:j::;;;::;;::~~::;:;~~:::::~~~::::;;;:;:J:~~~;;::::::;:;;;:::;~l~::::::::;:::;:;:;;;:;:~;);~L;:::;;::::::.......... * J+~IS CERTi.A;~~~E "I~ ISSUED A~::::~=~!~!!l~~~F IN:~~~~ION M ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIACATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW COMPANIES AFFORDING COVERAGE Bratrud Middleton Insurance Tacoma Division P. O. Box 11205 Tacoma, W A 98411-0205 COMPANY A Trinity Universal Insurance INSURED Excel Utility Construction Inc 54 West Misty Lane Port Angeles, W A 98362 COMPANY B COMPANY C TDG COMPANY D THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED NOTWITHSTANDING ANY REQUIREMENT TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. CO TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION LIMITS LTR DATE (MMlDDIYY) DATE (MINDDIYY) A GENERAL LIABILITY CP A2036832 10/19/99 10/19/00 GENERAL AGGREGATE $ 2 000 000 COMMERCIAL GENERAL LIABILITY PRODUCTS COMP/OP AGG $ 2 000 000 CLAIMS MADE [i] OCCUR PERSONAL & ADV INJURY $ 1 000 000 OWNER'S & CONTRACTOR'S PROT EACH OCCURRENCE $ 1 000 000 X W A Stop Gal!...-_ FIRE DAMAGE (Anyone fire) $ 300 000 MED EXP (Anyone person) $ 1 A AUTOMOBILE LIABILITY 1,000,000 X CPA2036832 10/19/99 10/19/00 COMBINED SINGLE LIMIT $ ANY AUTO ALL OWNED AUTOS BOOIL Y INJURY $ SCHEDULED AUTOS (Per person) X HIRED AUTOS BODILY INJURY $ X NON-OWNED AUTOS (Per accident) X Physical Damage PROPERTY DAMAGE $ GARAGE LIABILITY AUTO ONLY EA ACCIDENT ANY AUTO OTHER THAN AUTO ONLY EACH ACCIDENT AGGREGATE A EXCESS LIABILITY U02036833 10/19/99 10/19/00 EACH OCCURRENCE 1,000,000 X UMBRELLA FORM AGGREGATE 1,000,000 OTHER THAN UMBRELLA FORM WORKERS COMPENSATION AND EMPLOYERS' LIABILITY $ THE PROPRIETOR/ INCL EL DISEASE POLICY LIMIT $ PARTNERS/EXECUTIVE OFFICERS ARE. EXCL EL DISEASE EA EMPLOYEE $ A OTHER Equipment Floater CP A2036832 10/19/99 10/19/00 See Below for Description & Limits if Applicable DESCRIPTION OF OPERATIONSlLOCATIONSIVEHICLES/SPEClAL ITEMS RE. HOSPITAL CITY OF PORT ANGELES A TTN TRENIA FUNSTON P.O. BOX 1150 PORT ANGELES, W A 98362 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF THE ISSUING COMPANY WILL ENDEAVOR TO MAIL AL DAYS WRmEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR L1ABLITY OF ANY KIND UPON THE COMPANY, ITS AGENTS OR REPRESENTATIVES, AUTHORIZED REP .. .. ~~I_I_::.'~~:::::.~.:.:;~~~~t~t:~i~H~@~~:~::t~~~*:~:~~\:~~\:@~l~:~\:\l~:~~\i~~\~~~~t~~~:~~~~~~~~~~~m\~mm@~\m~mm\if@~%WM@~~mfmf~\i\K....::::~::;,:;~:;;~~~:~rw:,;:~~~MtWIijl~~:~~~~\M\~\M~.r.:~,:.~:...~:..:.:.~::.~_.t.;~j: BUILDING PERMIT INSPECfION RECORD CALL 417-4815 FOR BUILDING INSPECTIONS. PLEASE PROVIDE A MINIMUM 24 HOUR NOTICE. IT IS UNLA WFUL TO COVER, INSULA TE 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 WAllS FOUNDATION DRAINAGE ELECTRICAL (UGIIT DEP1) ROUGH-IN I PLUMBING UNDER FLOOR / SlAB ROUGH-IN WATER 1lNE BACK FLOW / WATER AIR SEAL WAllS CEIliNG I FRAMING JOISTS / GIRDERS SHEAR WAll.. WAllS / ROOF / CEIliNG DRYWAll.. T-BAR INSULATION SlAB WAll../ FLOOR / CEIUNG T I MECHANICAL CffiMNEY WooDSTOVE / PEllET DUCTS PW UI'ILITIES / SITE WORK (Engineering Division) WA TERUNE / METER SEWER CONNECTION SANITARY STORM SITE DRAINAGE / EROSION CON'ffiOL PARKING OTIlER FINAL INSPECTIONS REQUIJlID PRIOR TO OCCUPANCYIUSE RESIDENTIAL DATE YES NO COMMERCIAL DATE ACCEPTED YES NO ElECTRlCAL UGIIT DEPT 417.4746 ElECTRlCAL UGIIT DEPT CONSTRUCTION R.W / PW/ CONSTRUCTION R.W ENGINEERING 417-4807 PW / ENGINEERING FIRE (MULTI-FAM. ONLY) 417-4654 FIRE DEPT BUIWING 417-4815 BUIWING GENERAL COMMENTS: PW.II02,15 (4/96J