HomeMy WebLinkAbout1718 W Lauridsen Blvd - Engineering
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CITY OF PORT ANGELES
DEPARTMENT OF PUBLIC WORKS
. . . . . INSPECTION REPORT. . . . . .
REQUEST
Date ~ ~ 1 ~ ~ () '-I
______ Time
7 t)o /I tv\. Received by f)eVlt1. I ? E..
(phone. person)
~
Location of Work to be inspected 17 (8 W Lc...vvL~5eVl... g Ivd.
Name of person requesting inspection DeV\- vt t <5 E
Address of person requesting inspection L..ov-D Y6-.rJ 17 't- B Phone No <f ( '7 -Lf8<.(4
I
Type of Inspection (circle appropriate one) Permit No ~
Sewer Foundation Framing Chimney Plumbing Final Sewer Excav OthCa..J~+ e. r }'
INSPECTION NOTES
Inspected Date C;; -/(, ~Oc.( Time 3 ffVl..
Remarks iJ et..J ("'x 5/8 ~( ~y v; c e-
By D.el-'\.V\./'S E
C-- .I /3 ?
~ D4D6g'34 7
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RESTORA liON REQUIRED
YES x:
NO
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SURFACE RESTORATION I.()t:. ..{'
SURFACE TYPE 0 Unimproved OGravel ~sphalt OPCC o Other
o Repaired by City Work Order # /'170') - 03'=.
[] Repaired by Permittee 0 COMPLETE
[] No Damage Found 0 INCOMPLETE
10";'
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(Continue on reverse side if necessary)
STREET SUPERINTENDENT
(DATE)
;{S;?- '51"I--3o~
~
Port Angeles, W A 98360
000/600-0000
PROJECT INFO
Work is:
Plans Required: Start Date:
Contractor: QWEST COMMUNICATIONS
Performance Bond Required: Amount:
Proof of Insurance:
Work to Perform:
Permit No:
Work Order:
Alta"hed N-"tes_. ______PROPERTY LOCATION
I 1718 LAURIDSEN BLVD W
Lot:
Subdivision:
Parcel No:
Issued:
6/14/2004
1404
o
PUBILle WORKS & RIW PERMIT
'-I
OWNER/APPLICANT ~.
city of port angeles
Block:
D Long Legal
Value Work:
$0:00
~ Install
o Repair
D Watermain
D Sanitary Sewer
D Storm Drain
~ Underground Tele/Elec
D
/ /
Finish Date:
$0.00
PROJECT NOTES
place 300' of burided service wire within city right of way.
FEES ASSESSMENT
1.) R/W Excav: $0.00 15.) Other San Sewer: $0.00
2.) Sidewalk: $0.00 16.) Sew Tap Wye/Man Tap: $0.00
3.) Curb/Gutter: $0.00 17.) Sew Cap/ W /M Removal: $0.00
4.) Driveway: $0.00 18.) Alter Repair Sewer: $0.00
5.) Dwy Culvert: $0.00 19.) Storm Drain: $0.00
6.) Street Cut: $0.00 20.) Catch Basin per ea: $0.00
7.) Other R/W: $0.00 21.) Sewer System Dev: $0.00
8.) Fire Hydrant: $0.00 22.) Milwaukee Dr. Sew Ass: $0.00
9.) Res Water Serv: $0.00 23.) R/W Use Perm: $0.00
10.) Comm Water Serv: $0.00 24.) Admin Cost (D.RA) $0.00
11.) Other Water Service: $0.00 25.) DRA $0.00
12.)Water System Dev: $0.00 26.) Mise: $0.00
13.) San Sewer SFR: $0.00 TOTAL FEE: $0.00
14.) San Sewer MFR: $0.00
add unit 0 Amount Paid: $0.00
Receipt No:
Inspection Fee $0.00 Balance Due: $0.00
6-11-04; 2: 16PM;QWEST CONo /MAINT
;253 597 5066
# 2/ 3
w~ 0,hd !ZJ~
Pl..lBUCWORK.S
Permit To Perfonn Work In Street Right-of-Way
APPLICATION is her<by made to the municipality of PORI' ANGELES _ to perform work as
noted hereon and as ,~hown on attached drawing:
PLEASE. seE:. AI1'ACtte: 'D
ft-I}CEr1E/l/T OF !5v,r?/{f/
For'<. aU,1( CV 57 0,9,'",' .-t}T
7Q INC-L- uIJE ?, 00 CC r:-
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...5~:tt# W()(lY'I.~ 32.i/Jl r
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s~ev!cE v>///2:E
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Approved:
Water Department - Superintendent
Sewer Department - Superintendent
The estimated time for completion of the above work is 10 DAYS A.FT'ER.. (l prEtp"!
Date
'J 1I"" f /j 7..D tJ '1
I
?;'foi, f.; 2. 55, "i?) -r:} 7t?ff
fAX L~3-CI.7i-15Z.i
By gYAN /"1, FUQv-4
Contractor X Owner
o WE.S, / ATf'i~ ; 13>SvJ fl.oOtv\ I' 0
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THE ABOVE APPLICATION IS HEREBY GRANTED SUBJECT TO APPI.lCANT'S:
Complying with all Municipal Ordinances;
Notifying the Street Superintendent of the time the work will star:, and when it will finish;
Prose.cuting '[he work with diligence and with due. respect to all property, contracts. persons'
rights and the interesls and convenience of the public;
Saving the M unicipaliIY harmless from any and all damages which lnay accrue rc any person
or propeny because of this installation or the maintenance thereof;
Complying ilk following special conditions:
~
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.
Date
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BY \
6-11-04; 2'16PM;QWEST CON./MAINT
;253 597 5066
# 3/ 2,
Qwest Job #
VVD(/J'1m ~Z(>>l /1.-1 '52 C
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This request for permit is for the placement of underground telephone service wire to
our customer at the following address:
1118
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This work will require:
Trenching in the R/W (total footage)
Push or bore 2 inch PVC or BIP under roadway (total footage)
Push or bore 2 inch PVC or BIP under driveway (total footage)
Push or bore 2 inch PVC or BIP unde~2!1JJ~ple driveways (total footage)
Applicant Signature/Date .;z::<.... _~u- 6-! 1-0'1
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Road Number ~.
'S001
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CITY OF PORT ANGELES
DEPARTMENT OF COMMUNITY DEVELOPMENT - BUILDING DIVISION
321 EAST 5TH STREET, PORT ANGELES, W A 98362
04- 3~h
Application Number
Pin number,
Property Address
ASSESSOR PARCEL NUMBER:
Tenant nbr, name
Application description
Subdivision Name
Property Use
Property Zoning .
Application valuation
04-00000396 Date
.482672
1718 W LAURIDSEN BLVD
06-30-08-2-2-9000-0000-
OUTSIDE CITY LIMITS
PUBLIC WORKS UTILITES
5/10/04
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UNKNOWN
Owner
Contractor
BIRNEY, CW/LAVELLA
1818 WEST LAURIDSEN BLVD
PORT ANGELES WA 98363
(360) 417-2675
OWNER
Permit
Additional desc
Permi t Fee
Issue Date
Expiration Date
PUBLIC WORKS RES WATER SERV
PER NON PROTEST LID/PRE- ANNEX
640.00 Plan Check Fee
5/10/04 Valuation
11/06/04
.00
o
Qty
1. 00
Unit Charge Per
640.0000 EA PW W/M 1" SERV 5/8" METER
Extension
640.00
Other Fees
PW WATER SYSTEM USE FEE
1025.00
Fee summary
Charged
Paid
Credited
Due
Permit Fee Total
Plan Check Total
Other Fee Total
Grand Total
640.00
.00
1025.00
1665.00
c- 640~ n(L5-----~~~
.00 .00
~ 1025.0q:> .00
lbb~.OO .00
.00
.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 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 regular onstruction or the performance of
construction. )
~ 0, ,\ ~
Signature of Owner (if owner is buibl
Signature of Contractor or Authorized Agent
Date
Date
T:\PLANNING\FORMS\ 11 02.15 ! 11/14/2003]
. ..
. , '
CITY OF PORT ANGELES
DEPARTMENT OF PUBLIC WORKS
. . . . INSPECTION REPORT. . . . . .
REQUEST:
Date 0 - (G - 0 cf
Time 7: c)o Ii M Received by f)e.~l1."'5 E. (phone, person)
Location of Work to be inspected (1 (8' W. L<:AVv"i.'..d5elA..
Name of person requesting inspection De",- '" ;., E.
Address of person requesting inspection L.ovD Yll..rJ /7 't- B
I
Type of Inspection (circle appropriate one):
"6lvd.
Sewer Foundation Framing Chimney Plumbing Final
Phone No. 'I ( (-<(8<(9
Permit No. tJ. - 'tV
Sewer Excav. Oth r VG...+ e.. ~
INSPECTION NOTES:
Inspected: Date C; -;(., -Ocf Time 3 flvvt
Remarks: ;Jew ("x. 5/8" ~rv;c..e...
By De",-",-,,; E
L--//~3
;::: fy!-o5.f-34 7
I
RESTORATION REQUIRED . . . . .. YES K NO
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blow-off
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7-l()PLIlIA"( +($
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SURFACE RESTORATION: '.(x <-I'
SURFACE TYPE: D Unimproved DGravel ~sPhalt. D PCC D Other
D Repaired by City Work Order # ('170+ - () S(."
DRepaired by Permittee ~ COMPLETE (~teD-. \'~\<,ed
DNo Damage Found D INCOMPLETE \}.nV~ ~C')'\ 0,.\)/
6-7 Y -0 L(
10'3'
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'''cle..
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ICnntimIA.nn"rAVArs,A,sideif,necessarvJ ___~
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C;:TD~I=T C::IIDt:DII\.ITE:l\lnE:I\IT
InATt:\
CITY OF PORT ANGELES
DEPARTMENT OF PUBLIC WORKS
. . . . . . . . . . . INSPECTION REPORT. . . . . . . . . . .
REQUEST:
Date q -{'7 -OS-
,"
Time
7ACVl
Location of Work to be inspected / 71 8. uJ. i AU r ~d s e t/\ is ( v'd. .
Name of person requesting inspection De".. VI. ,'S E.
Address of person requesting inspection Phone No.
Type of Inspection (circle appropriate one): Permit No.
Sewer Foundation Framing Chimney Plumbing Final Sewer Excav. Other WdL.r
Received by tJevtV! (S E .
(phone. person)
INSPECTION NOTES:
Inspected: Date Cf-I'1- 05 Time (D A vV'-
Remarks: Re-.ove..d. bloc-~~e. -4200........ -h..~
By De.,^-vi.. E .
NO )(
RESTORATION REQUiRED...... YES
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SURFACE RESTORATION:
SURFACE TYPE: 0 Unimproved DGravel
o Repaired by City
o Repaired by Permittee
o No Damage Found
-' t I
10 Sived q It1/ PtJp
(Continue on reverse side if necessary) .'
jgJ Asphalt 0 PCC 0 Other
Work Order # ;; 0 3 ~'7 - z. ;'0
~l[e(!)II1P,IiE.TB~17/Q5'"
o INCOMPLETE
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