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HomeMy WebLinkAbout1133 E Park Avenue Address: 1133 E Park Avenue PREPARED 11/15/16, 9:42:19 INSPECTION TICKET PAGE �' S CITY OF PORT ANGELES INSPECTOR: JAMES LIERLY DATE 11/15/16 ------------------------------------------------------------------------------------------------ ADDRESS : 1133 E PARK AVE SUBDIV: CONTRACTOR PHONE OWNER ALC REAL ESTATE LLC PHONE PARCEL 06-30-11-5-1-0800-0000- APPL NUMBER: 16-00001564 RES MECHANICAL PERMIT ------------------------------------------------------------------------------------------------ PERMIT: ME 00 MECHANICAL PERMIT REQUESTED INSP DESCRIPTION TYP/SQ COMPLETED RESULT RESULTS/COMMENTS ---—-------------------------------- -------- --- —- - - ME99 01 11/15/16 J L MECHANICAL FINAL November 15, 2016 9:06:17 AM jlierly. Tim 670-6297 -------------------------------------- COMMENTS AND NOTES ----------------------------- PREPARED 11/16/16, 9:12:28 INSPECTION TICKET PAGE 3 - CITY OF PORT ANGELES INSPECTOR: JAMES LIERLY DATE 11/16/16 ----------------------------------------------- ------------------------------------------------- ADDRESS . : 1133 E PARK AVE SUBDIV: CONTRACTOR : PHONE OWNER ALC REAL ESTATE LLC PHONE PARCEL 06-30-11-5-1-0800-0000- APPL NUMBER: 16-00001564 RES MECHANICAL PERMIT ------------------------------------------------------------------------------------------------ PERMIT: ME 00 MECHANICAL PERMIT REQUESTED INSP DESCRIPTION TYP/SQ COMPLETED RESULT RESULTS/COMMENTS -------------------—----------------------------------—--—------------------—-—----------- ME99 01 11/15/16 JLL MECHANICAL FINAL 11/15/16 CA November 15, 2016 9:06:17 AM jlierly. Tim 670-6297 November 15, 2016 4:35:07 PM jlierly. Need to meet new onwer and walk through and see all items for finals/jll ME99 02 11/16/16 MECHANICAL FINAL November 16, 2016 9:16:52 AM jlierly. Tim 808-6291 -------------------------------------- COMMENTS AND NOTES -------------------------------------- C91 ) CITY OF PORT ANGELES DEPARTMENT OF COMMUNITY & ECONOMIC DEVELOPMENT- BUILDING DIVISION 321 EAST 5TH STREET, PORT ANGELES, WA 98362 Application Number . . . . . 16-00001564 Date 10/24/16 Application pin number . . . 570476 Property Address . . . . . . 1.133 E PARK AVE REPORT SALES TAX ASSESSOR PARCEL NUMBER: 06-30-11-5-1-0800-0000- Application type description RES MECHANICAL PERMIT on your state excise tax form subProperty Name . . . . . . to the City of Port Angeles Pro ert Use Property Zoning . . . . . . . RESIDENTIAL MEDIUM DENSTY (Location Code 0502) Application valuation 0 Application desc FINAL INSPECTION ONLY FOR PERMIT 09-191 HEAT PUMP ---------------------------------------------------------------------------- Owner Contractor - ----------------------- ------------------------ ALC REAL ESTATE LLC OWNER W 140 N 8981 LILLY RD MENOMONEE FALLS WI 53051 Permit . . . . MECHANICAL PERMIT Additional desc INSPECTION ONLY FOR #9-191 Permit Fee . . . . 64.80 Plan Check Fee . . .00 1 Issue Date . . 10/24/16 Valuation . . . . 0 Expiration Date 4/22/17 Qty Unit Charge Per Extension BASE FEE 50.00 1.00 14.8000 EA ME-FURN/HP/FAU < OR = 5 TON 14.80 ---------------------------------------------------------------------------- Fee summary Charged Paid Credited Due =---------------- ---------- ---------- ---------- ---------- ry Permit Fee Total 64.80 64.80 .00 .00 Plan Check Total .00 .00 .00 .00 Grand Total 64.80 64.80 .00 .00 Separate Permits are required forelectrical 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 has 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 re lating construction or the performance of construction. Date Print Name Signature of Contractor or Authorized Agent Signature of Owner(if owner is builder) T:Forms/Building Division/Building Permit BUILDING PERMIT INSPECTION RECORD PLEASE PROVIDE A MINIMUM 24-HOUR NOTICE FOR INSPECTIONS Building Inspections 417-4815 Electrical Inspections 417-4735 Public Works Utilities 417-4831 Backflow Prevention Inspections 417-4886 IT IS UNLAWFUL TO COVER, INSULATE OR CONCEAL ANY WORK BEFORE INSPECTED AND ACCEPTED. POST PERMIT INCONSPICUOUS LOCATION. KEEP PERMIT AND APPROVED PLANS AT JOB SITE. Inspection Type Date Accepted By Comments FOUNDATION: Footings Stemwall Foundation Drainage/Downspouts Piers Post Holes(Pole Bldgs.) PLUMBING: Under Floor/Slab Rough-In Water Line Meter to Bldg) Gas Line Back Flow/Water AIR SEAL: Walls Ceiling FRAMING: Joists/Girders/Under Floor Shear Wall/Hold Downs Walls/Roof/Ceiling Drywall Interior Braced Panel Only) T-Bar INSULATION: Slab Wall/Floor/Ceiling MECHANICAL: Heat Pump/Furnace/FAU/Ducts Rough-In Gas Line Wood Stove/Pellet/Chimney Commercial Hood/Ducts MANUFACTURED HOMES: Footing/Slab IBlocking&Hold Downs Skirting PLANNING DEPT. Separate Permit#s SEPA: Parkin /Lighting ESA: Landscaping SHORELINE: FINAL INSPECTIONS REQUIRED PRIOR TO OCCUPANCY/USE Inspection Type Date Accepted By Electrical 417-4735 Construction - R.W. PW /Engineering 417-4831 Fire 417-4653 Planning 417-4750 Building 417-4815 10/13/2016 THU 8: 15 FAX 0001/001 H For City Use CITY F ' Permit# `�. A s H I lv G T a N, u. s_ Date Received: /-C 321E 5t6 Street Date Approved lG� l)K Port Angeles.WA 9836 P:360-417-4817 F:360-417-4711 Email:permlts(&cityofoa.us BUILDING PERMIT APPLICATION Project Address: 11, '5-3 Phone: Primau Contact: L4V JZ(_-A)1} Email: ame D j one V 4 d1 3',~ GS Property Mailing Address r .� Email Owner City State Zi 9 F e Name _ Phone y ' Contractor Address Email Information City State Zig Contractor License# Exp.Date: v Legal Description: Zoning: Tax Parcel# Project Value:(materials and tabor) lks.meo I $ y Residential ❑ Commercial ❑ Industrial ❑ Public ❑ Permit Demolition ❑ Fire ❑ Repair ❑ Reroof(tear off/lay over) ❑ t Classification For the following fill out both p_ag@s o permit application: (check New Construction ❑ Exterior Remodel ❑ Addition ❑ Tenant Improvement ❑ appropriate) Mechanical IKPlumbing ❑ Other ❑ Fire Sprinkler System.Proposed Irrigation System Proposed or Proposed Bathrooms Proposed Bedrooms or Existing? Yes ❑ No ❑ Existing? Yes ❑ No ❑ I In addition to standard hard copy submittals please send a PDF copy of all Stormwater.plans and Engineering to www.stormwaterfibeltvo R.41s C Project Description A et�9 iTG5''�9 �r L` r Is project in a Flood Zone: Yes ® No® Flood Zone Type: If in a Flood Zone, what is the value of the structure before proposed improvement? $ I have read and completed the application and know it to be true and correct,I am authorized to apply for this permit and understand that it is my responsibility to determine what permits are required and to obtain permits prior to work. I understand that plan review fees are not refundable after review has occurred. I understand that I will forfeit review fees if I withdraw the application before the permit is issued. I understand that if the permit is not picked up/issued within x8o days of submittal,the application will be considered abandoned and the fees will be forfeited. p i � _6 Y" NIT f 7 Dat Print Name Signature Address: 1133E Park Avenue CERTIFICATE F�wO CUPAN CY Cly of Port Angeles Building Division This certificate is issued. // to the requirements�bf Section 171-of the N1, This Building / . de _. \� Code certifying that at,,Ae tame of issuance this structure was in compliance with the various ordinances of the City regulatangtbualding con taction or use for the followings , �... � s Business name: t' LaureMark j Business address East Park!Ave Business owner: Laurel Park AIDOPCO LLC YF C/O Hason Bndgett Attn P 5oljougI- Business owner' address,:�425 Market-St=26th FI San-Francisco�CA%94,105 Automatic fire sprinkler system: N/A� Use &occupancy cl,'czssifacatiou: Business ,-mow.. .. _ Occupant load: Per2:012 fBCTable 1:004 1:1w,, 17 Type of construction: 10/28/2013 -anager Date 1 Post on the premises in a conspicuous place. This certificate shall not be removed except by the Building Official. l RECEIVED AN 0 5 2013 �-7,3 23 Cv� 0411v&ej_11_f' ,CITY ELIK TIFICATE OF OCCUPANCY APPLICATION Permit 13-Le� B N FEES CITY OF PORT ANGELES $50 Certificate/Inspection Attn: Permit Technician 321 E. Fifth St., Port Angeles,WA 98362 $100 Parking Business Improvement Area (PBIA) (360)417-4815 fax(360)417-4711 fee charged for Downtown locations PLEASE PRINT M INK Check one: New business in P.A.?E Change of ownership only? ❑ Moving location from within P.A.? ❑ Zon i ng BUSINESS NAME Laurel Park Business address 1133 East Park Avenue Mailing address c/oHanson Bridgett, Attn:P. Soljoughian, 425 Market St 26th Phone number 360-452-7201 Opening date Days & hours of operation 24/7 Business owner's name LAUREL PARK AID OPCO LLC Contact phone 415-995-5135 Business owner's address c/oHanson Bridgett, Attn:P. Soljoughian, 425 Market St, 26th Fl, San Fran, CA 94105 Brief description of business Assisted Living Property owner's name LAUREL PARK AID PROPCO LLC Contact phone 415-995-5135 Property owner's address/contact c/oHanson Bridgett, Attn:P. Soljoughian, 425 Market St, 26th Fl, San Fran, CA 34105 BUILDING DEPARTMENT phone 417-4815 Bldg approval by,:�'"— 0_41E] n e? Is the business a restaurant or bar that will seat 50 or more people? Yes ❑ No D Construction changes planned (moving walls, adding/enlarging windows or doors, roofing, siding,foundation work, adding/altering stairways, ramps, bathrooms, electrical, heating/cooling/ventilation systems, etc). Work planned: None FIRE DEPARTMENT phone 417-4653 Fire approval by on Changes to a fire sprinkler system or fire alarm system? Yes ❑ No Z Work planned: None PBIA (Parking Business Improvement Area -Downtown) phone 417-4623 Square footage of business? 32,318 PB/Anodfied on Is business moving within the PBIA? Yes ❑ No LXI CITY CLERK phone 417-4634 City Clerk approval by on Second-hand dealer/pawnbroker business? Yes ❑ No X❑ Will there be dancing at this business?Yes ❑ No X❑ A City of Port Angeles Business License is required for: Taxi, Peddlers, Second-Hand Dealer, Pawnbroker, Dance, Hotel-Motel, Fireworks, Ambulance, and Tattoo Businesses. Page 1 of 2 COMMUNITY&ECONOMIC DEVELOPMENT phone 417-4750 CED approval by on Number of off-street parking spaces available for employees and customers? 21 (A parking plan may be required.) Signs? ( all-mounteeestandin projecting, awning, A-frame, etc?) Signs planned: None PLEASE NOTE: NO flashing, intermittent,or chasing signs are permitted in the City of Port Angeles. PWE approval by on PUBLIC WORKS DEPARTMENT-ENGINEERING phone 417-4812 Is site work planned (new or re-located sewer or water service, excavation, grading or filling, work in City right-of-way, new driveway openings, site drainage, parking lots, downspouts, irrigation system backflow devices, etc.). Yes ❑ No M Work planned: PUBLIC WORKS WASTEWATER phone 417-4845 PWW approval by_on _] Will waste, other than domestic household waste, be discharged into the sewer system? Yes ❑ No E If yes, what will be discharged: Call for Certificate of Occupancy inspections BEFORE opening business. Building Department Inspection 417-4815 Fire Department Inspection 417-4653 Please sign up for utility services at the cashiers' counter. I hereby apply for a Certificate of Occupancy. I acknowledge that I have read this application and state that the information I have supplied is correct to the best of my knowledge. Incorrect information may result in revocation of permit. Date Print Name Daniel cuill Signature T:\Forms\Building Division\Certificate of Occupancy Application(2010).doc Page 2 of 2 • City of Port Angeles • Page 2 EXHIBIT A DESCRIPTION OF APPLICANT, LICENSE AND FACILITY Applicant/Business Property Type of Facility Name Facility Owner Owner License Address LAUREL PARK AID LAUREL Certificate of Laurel Park 1133 East Park OPCO LLC PARK AID Occupancy Avenue PROPCO LLC Port Angeles, WA 98362 THE RECEIVED NATHANSON GROUP JUN, 0. 5 2013 CITY OF PORT ANGELES BUILDING DIVISION June 3, 2013 VIA FIRST CLASS MAIL City of Port Angeles Attn: Permit Technician 321 E. Fifth Street Port Angeles, WA 98362 Re: Certificate of Occupancy (the "Application") for the issuance to the applicant identified in Exhibit A (the "Applicant") of the license described in Exhibit A (the "License") with respect to the assisted living facility described on Exhibit A (the "Facility"). To Whom It May Concern: I am writing on behalf of the Applicant. The Applicant is a party to a pending transaction pursuant to which it would become the new licensed operator of the Facility. We currently anticipate that the closing of this transaction will occur July 1, 2013 (the "Effective Date"). However, we are filing the Application in order to ensure that the Applicant has secured all necessary licenses and permits by the Effective Date. Although we would ask that you begin to process the Application at your earliest convenience in order to ensure that the License will be issued on the Effective Date, we must ask that you do not issue the License to the Applicant prior to the Effective Date since the Applicant will have no legal right to operate the Facility prior to the Effective Date. Also, if applicable, please fee free to contact the Facility Administrator to schedule any required inspections of the Facility in connection with the processing of the Application. The Facility Administrator can be contacted at 360-452-7201. Should you have any questions or concerns while processing the Application, please do not hesitate to contact me at 206-623=6239 or by email at shandal@nathansongroup.com. Once the License is issued to the Applicant, please provide a copy via fax at 206-299-3983 or by email. Thank you in advance for your cooperation. Sincerely, Shanda London Paralegal One Union Square 600 University Street,Suite 2000 Seattle,WA 98101-1192 206.623.6239 www.NathansonGroup.com /-06/I3 , 15 : 53c01 � � 6OU� PAYMENTS DUE RECEIPT CITY OF PORT ANGELES PROGRAM BP820L APPLICATION NUMBER: 3-00000624 1 33 E PARK AVE FEE DtSCRIPTION OUNT DUE — - -- - ----- ---------- -- ---- --------- ------------------- ----- CHANGE OCC/USE FIRE DEPT 25 . 00 CHANGE OF OCCUP/USE 25 . 00 TOTAL DUE 50 . 00 Please present this receipt to the cashier with full payment . CITY OF PORT ANGELES # CUSTOMER RECEIPT Oper: SCORDERY Type: CT Drawer: 1 Date: 6/06/13 16 Receipt no: 55476 Year Number Amount 2013 624 1133 E PARK AVE PORT ANGELES NA 98362 BP hUILDING PERMITS $50.00 Trans number: 1503647 THE NATHANSON GROUP THE NATHANSON GROUP 1133 E PARK AVE Tender detail CK CHECK 16698 $50.00 Total tendered X50.00 = Total payment $50.00 Trans date: 6/06/13 Time: 15:55:03 * THANK YOU FOR YOUR PAYMENT FOR INQUIRIES 360-457-0411 PRESS 1 WWW.CITYOFPA.US I PREPARED 6/06/13 , 15 : 53 : 01 PAYMENTS DUE RECEIPT CITY OF PORT ANGELES ' PROGRAM BP820L -------- ---- - --------_---------------- - - ------------------ --------------- APPLICATION NUMBER: 3-00000624 1 33 E PARK AVE FEE DESCRIPTION ----'MOUNT DUE - - - ----- ------- ----------------- ---------- - ------ ----- --------------------- CHANGE OCC/USE FIRE DEPT 25 . 00 CHANGE OF OCCUP/USE 25 . 00 TOTAL DUE 50 . 00 Please present this receipt to the cashier with full payment. CITY OF PORT ANGELES Oper: SCORDERYSTOMERType: CT Drawer: 1 Date: 6/06/13 16 Receipt no: 55476 Year Number Amount 1133 E2013 OPARK AVE 624 PORT ANGELES UA 98362 BP UILDING PERMITS Trans number: $50.00 THE NATHANSON GROUP 1503647 THE NATHANSON GROUP 1133 E PARK, AVE Tender detail CK CHECK 16698 $50.00 Total tendered $50.00 Total payment $50.00 Trans date: 6/06/13 Time: 15:55:03 * * THANK, YOU FOR YOUR PAYMENT * FOR INQUIRIES 360-457-0411 PRESS 1 UUU.CITYOFPA.US RECEIVEDI 11 JAN o >> zo 1, j CITY GEL TIFICATE OF OCCUPANCY APPLICATION Permit# l3—(02"'( e N ` FEES CITY OF PORT ANGELES $50 Certificate/Inspection Attn: Permit Technician 321 E. Fifth St., Port Angeles,WA 98362 $100 Parking Business Improvement Area (PBIA) (360)417-4815 fax (360)417-4711 fee charged for Downtown locations PLEASE PRINT DV INK Check one: New business in P.A.°x. Change of ownership only? :.. Moving location from within P.A.? _. Zoning BUSINESS NAME Laurel Park 1133 E35L Park Avenue c'c'an= Brijaet:. Atcr -. S--�c—h—, ;-_ + rke 5 Business address Mailing address _ ep . - Phone number 36C-452-'.201 Opening date Days&hours of operation 2 Business owner's name LAUREL PARK AID OPCO LLC Contact phone 415-995-51135 Business owner's address c/oHanson Br'_daett, Attn:P. Soi oughian, 425 Marker. St, 2Eth Fl, San Fran, C= 94105 Brief description of business Assisted Li in_ Property owner's name LAJREL PARK RID PROPCO LLC Contact phone 415-995-5135 Property owner's address/contact c/oHanson Bridgett, Attn:P. Soijoughian, 425 Market St, 26th Fl, San Fran, .A 4.05 BUILDING DEPARTMENT phone 417-4815 Bldg approval by on Is the business a restaurant or bar that will seat 50 or more people? Yes No .X Construction changes planned(moving walls, adding/enlarging windows or doors, roofing, siding,foundation work, adding/altering stairways, ramps, bathrooms,electrical,heating/cooling/ventilation systems,etc). Work planned: None FIRE DEPARTMENT phone 417-4653 Fire approval by V47X on Ttf l 3 Changes to a fire sprinkler system or fire alarm system? Yes No Work planned: Mone PBIA (Parking Business Improvement Area-Downtown) phone 417-4623 < �� Square footage of business? 32,318 PB/A noted on Is business moving within the PBIA? Yes No x CITY CLERK phone 417-4634 City Clerk approval by on Second-hand dealer/pawnbroker business?Yes __ No .. Will there be dancing at this business?Yes _ No x A City of Port Angeles Business License is required for.- Taxi, or:Taxi, Peddlers, Second-Hand Dealer. Pawnbroker, Dance. Hotel-Motel, Fireworks,Ambulance, and Tattoo Businesses. Page 1 of 2 r Address: 1133 E Park Avenue PREPARED 8/14/14, 13:23:32 INSPECTION TICKET PAGE 4 CITY OF PORT ANGELES INSPECTOR: JAMES LIERLY DATE 8/14/14 -------------------------------------------------------- ADDRESS . : 1133 E PARK AVE SUBDIV: CONTRACTOR PENINSULA HEAT INC PHONE (360) 681-3333 OWNER ALC REAL ESTATE LLC PHONE PARCEL 06-30-11-5-1-0800-0000- APPL NUMBER: 14-00000918 COMM MECHANICAL PERMIT ------------------------------------------------------------------------------------------------ PERMIT: ME 00 MECHANICAL PERMIT REQUESTED INSP DESCRIPTION TYP/SQ COMPLETED RESULT RESULTS/COMMENTS --------------------------------------------------------------- ------------------------ ME99 01 8TL MECHANICAL FINAL August 14, 2014 9:52:35 AM pbarthol. Eric 912-1564 -------------------------------------- COMMENTS AND NOTES CITY OF PORT ANGELES DEPARTMENT OF COMMUNITY&ECONOMIC DEVELOPMENT-BUILDING DIVISION ® 321 EAST 5TH STREET, PORT ANGELES,WA 98362 Application Number . . . . . 14-00000918 Date 8/04/14 Application pin number . . . 611156 Property Address . . . . . . 1133 E PARK AVE ASSESSOR PARCEL NUMBER: 06-30-11-5-1-0800-0000- REPORT SALES TAX Application type description COMM MECHANICAL PERMIT Subdivision Name . . . . . On your State eXC1Se tax form Property Use . . . . . . . . to the City of Port Angeles Property Zoning . . . . . . . RESIDENTIAL MEDIUM DENSTY (Location Code 0502) Application valuation . . . . 4730 Application desc Like in kind Air handler/heat pump replacement ------------------------------------------------------------ Owner Contractor ------------------------ ------------------------ ALC REAL ESTATE LLC PENINSULA HEAT INC W 140 N 8981 LILLY RD 782 KITCHEN-DICK RD MENOMONEE FALLS WI 53051 SEQUIM WA 98382 (360) 681-3333 Permit MECHANICAL PERMIT Additional desc HEAT PUMP/AIR HANDLER REPLACEM Permit Fee . . . . 64.80 Plan Check Fee .00 {� Issue Date . . . . 8/04/14 Valuation . . . . 0 Expiration Date . . 1/31/15 Qty Unit Charge Per Extension BASE FEE 50.00 �\ 1.00 14.8000 EA ME-FURN/HP/FAU < OR = 5 TON --- 14.80 - Fee summary Charged Paid Credited Due ----------------- ---------- ---------- ---------- ---------- Permit Fee Total 64.80 64.80 .00 .00 Plan Check Total .00 .00 .00 .00 Grand Total 64.80 64.80 .00 .00 . Separate Permits are required forelectrical 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 has 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 la regulating construction or the performance of construction. 6Date Print Name Signature of Contractor or Authorized rent Signature of Owner(if owner is builder) T:Forms/Building Division/Building Permit BUILDING PERMIT INSPECTION RECORD PLEASE PROVIDE A MINIMUM 24-HOUR NOTICE FOR INSPECTIONS— Building Inspections 417-4815 Electrical Inspections 417-4735 Public Works Utilities 417-4831 Backflow Prevention Inspections 417-4886 IT IS UNLAWFUL TO COVER,INSULATE OR CONCEAL ANY WORK BEFORE INSPECTED AND ACCEPTED. POST PERMIT INCONSPICUOUS LOCATION. KEEP PERMIT AND APPROVED PLANS AT JOB SITE. Inspection Type Date Accepted By Comments FOUNDATION: Footings Stemwall Foundation Drainage/Downspouts Piers Post Holes(Pole Bldgs.) PLUMBING: Under Floor/Slab Rough-In Water Line Meter to Bldg) Gas Line Back Flow/Water FINAL Date Accepted b AIR SEAL: Walls Ceiling FRAMING: Joists/Girders/Under Floor Shear Wall/Hold Downs Walls/Roof/Ceiling Drywall Interior Braced Panel Only) T-Bar INSULATION: Slab Wall/Floor/Ceiling MECHANICAL: Heat Pum /Furnace/FAU/Ducts Rough-in Gas Line Wood Stove/Pellet/Chimney Commercial Hood/Ducts FINAL Date Accepted b MANUFACTURED HOMES: Footing/Slab Blocking&Hold Downs Skirting PLANNING DEPT. Separate Permit#s SEPA: Parkin /Lighting ESA: Landscaping SHORELINE: FINAL INSPECTIONS REQUIRED PRIOR TO OCCUPANCY/USE Inspection Type Date Accepted By Electrical 417-4735 Construction-R.W. PW I Engineering 417-4831 Fire 417-4653 Planning 417-4750 Building 417-4815 T:Forms/Building Division/Building Permit TD-9E tORT NGE,CIYY ®t= For City Use W A S H t N G,::T O N . U . S . Permit# 321 East 5lh Street Date Received: Port Angeles, SNA 98362 Date Approved P: 360-417-4817 F: 360-417-4711 permits@cityofpa.us Building Permit Application Project Address: ,.l l � 3 6A5 r A5T PAA�. AVE Main Contact: Phone # 36*0 - ?I,2 - IS-6y &I G D L 5,6AI E-Mail: a 01S Cv cdc co• COPY. Property Nam Phone Owner Mailing Address Email r 3 • W mac' 3 City State Zip TWN01S Contractor Name �^ Phone 3�1191 52 LA (O/ C`/ . 333 3 Mailing Address Email •o• 90X 173 fay a / •coy.. City G A4,5&14 State W Zip g0Z 3 Contractor License# � ' ' r Expiration: (� 'K OO (L' Project Value: Zoning: Tax Parcel# Lot# $ 30 ' , 06 30 1 t,5'10ftopoo Type of Residential ❑ Commercial Industrial ❑ Public ❑ Permit Demolition ❑ Fire ❑ Repair ❑ Reroof(tear off/lay over) ❑ For the following,fill out both pages of permit application: New Constructiop ❑ Remodel ❑ Addition ❑ Tenant Improvement ❑ Mechanical L>1 Plumbing ❑ Other ❑ Existing Fire Sprinkler System? Malrimum height of structure Proposed Bedrooms Proposed Bathroom: Yes ❑ No ❑ Project Description 7-NS ALL, PUMP � At D -K '� L! .0 FbX- L-1WE I have read and completed the application and know it to be true and correct.I am authorized to apply for thi permit. I understand that it is my responsibility to determine what permits are required and to obtain permi prior to working on projects. I understand that the plan review fee is not refundable after plan review has occurred. I understand that I will forfeit the review fee if I cancel or withdraw the application before the permit is issued. I understand that if the permit is not issued within 180 days of receipt,the application will l considered abandoned and the fees forfeit. Date Print Name Signa Address: 1133 E Park Avenue _71 PREPARED 12/19/14, 9:16:17 INSPECTION TICKET PAGE 3 CITY OF PORT ANGELES INSPECTOR: JAMES LIERLY DATE 12/19/14 ------------------— --------------' ADDRESS . : 1133 E PARK AVE SUBDIV: CONTRACTOR MCKIBBIN, WILLIAM SAMUEL PHONE OWNER ALC REAL ESTATE LLC PHONE PARCEL 06-30-11-5-1-0800-0000- APPL NUMBER: 14-00001034 SIGNS -- ------- ----- --- PERMIT: SIGN 00 SIGN REQUESTED INSP DESCRIPTION TYP/SQ COMPLETED RESULT RESULTS/COMMENTS -- ------------------------------------------------- BL99 01 12/19/14 L BLDG FINAL December 19, 2014 9:15:06 AM pbarthol. Sign Final Bill 503-516-3419 ** Permit in office ** -------------------------------------- COMMENTS AND NOTES -------------------------------------- CITY OF PORT ANGELES (1f7) DEPARTMENT OF COMMUNITY&ECONOMIC DEVELOPMENT-BUILDING DIVISION 321 EAST 5TH STREET, PORT ANGELES,WA 98362 Application Number . . . . . 14-00001034 Date 8/29/14 Application pin number . . . 164190 Property Address . . . . . . 1133 E PARK AVE ASSESSOR PARCEL NUMBER: 06-30-11-5-1-0800-0000- REPORT SALES TAX Application type description SIGNS on your state excise tax form Subdivision Name . . . . . . Property Use . . . . . . . . to the City of Port Angeles Property Zoning . . . . . . . RESIDENTIAL MEDIUM DENSTY (Location Code 0502) Application valuation . . . . 0 ---------------------------------------------------------------------------- Application desc 16 sq.ft. double faced sign -------------------------------------------------------------------- Owner Contractor ------------------------ ------------------------ ALC REAL ESTATE LLC MCKIBBIN, WILLIAM SAMUEL W 140 N 8981 LILLY RD PO BOX 821261 MENOMONEE FALLS WI 53051 VANCOUVER, WA VANCOUVER WA 98682 ---------------------------------------------------------------------------- Permit . . . . . . SIGN Additional desc . . FREE STANDING SIGN Permit Fee . . . . 47.00` Plan Check Fee .00 Issue Date . . . . 8/29/14 Valuation . . . . 0 Expiration Date . . 2/25/15 Qty Unit Charge Per Extension 1.00 ------47.0000 PER S-ALL SIGNS a OR = TO 25 SF- --- -47.00- --------------------------------------- Special Notes and Comments August 29, 2014 8:31:31 AM sroberds. Signage for this use in the RMD zone was approved to a maximum of 62 sq.ft. per CUP 98-01. The illuminated sign is NOT an electronic readerboard. It is a stationary sign per Lora Senbach of Oakhurst Signs. No land use issues anticipated. ---------------------------------------------------------------------------- Fee summary Charged Paid Credited Due ----------------- ---------- ---------- ---------- ---------- Permit Fee Total 47.00 47.00 .00 .00 Plan Check Total .00 .00 .00 .00 Grand Total 47.00 47.00 .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 has 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 w rk will be mplied with whether specified herein or not. The granting of a permit does not presume to give authority to violate or can I the pro i ions of any state or local law regulating construction or the performance of construction. -k4 ,Ad Date Print Name S nat re of Contractor or Authorized Agent Signature of Owner(if owner is builder) T:Forms/Building Division/Building Permit BUILDING PERMIT INSPECTION RECORD — PLEASE PROVIDE A MINIMUM 24-HOUR NOTICE FOR INSPECTIONS— Building Inspections 417-4815 Electrical Inspections 417-4735 Public Works Utilities 417-4831 Backflow Prevention Inspections 417-4886 IT IS UNLAWFUL TO COVER,INSULATE OR CONCEAL ANY WORK BEFORE INSPECTED AND ACCEPTED. POST PERMIT INCONSPICUOUS LOCATION. KEEP PERMIT AND APPROVED PLANS AT JOB SITE. Inspection Type Date Accepted By Comments FOUNDATION: Footings Stemwall Foundation Drainage/Downspouts Piers Post Holes(Pole Bldgs.) PLUMBING: Under Floor/Slab Rough-in Water Line Meter to Bldg) Gas Line Back Flow/Water FINAL Date Accepted b AIR SEAL: Walls Ceiling FRAMING: Joists/Girders/Under Floor Shear Wall/Hold Downs Walls/Roof/Ceiling Drywall Interior Braced Panel Only) T-Bar INSULATION: Slab Wall/Floor/Ceiling MECHANICAL: Heat Pum /Furnace/FAU/Ducts Rough-in Gas Line Wood Stove/Pellet/Chimney Commercial Hood/Ducts FINAL Date Accepted b MANUFACTURED HOMES: Footin /Slab 1131ocking&Hold Downs Skirting E G DEPT. Separate Permit#s SEPA: htin ESA: g SHORELINE: FINAL INSPECTIONS REQUIRED PRIOR TO OCCUPANCY/USE Inspection Type Date Accepted By Electrical 417-4735 Construction-R.W. PW /Engineering 417-4831 Fire 417-4653 Planning 417-4750 Building 417-4815 T:Forms/Building Division/Building Permit 0 ►H - (D_5 PORT4ye. SIGN PERMIT ®4 PLICA TIO ;Rei J CITY OF PORT ANGELES Attn: Building Permit Technician g*:�I U) 321 E. Fifth St., Port Angeles, WA 98362(360)417-4815 fax(360)417-4711 Applicant or Agent S p s Phone "1,">J, 53�. Property Owner r\ GkjiA - lEcA,ue-,reA Phone .&Q., 1 a S• -"7CL-)u Property Owner's Address p %. � Contractor h moo .,• Phoneya?S, S A*, 344 A Contractor's Address $ License# igg gV, Expires • apt!;: Project Address 1133 e�� , A- \OA 9S314a Business Name w,�c Parcel Number ( Lot Zoning Submit an 8 % "x 11"site plan & three sets of plans that include: r ■ Type of sign (wall-mounted, projecting,freestanding, illuminated, other...) ■ Placement and sq. ft. area ® How the sign will be securely attached (Engineering specs may be required for freestanding signs) JC ® Separation distance between the bottom of projecting and freestanding signs and the surface below See "Chapter 14.36 Sign Code"of the City of Port Angeles Municipal Code for sign requirements. Sian Type&Brief Description: (Type, location,sq.ft.) Sign #1 Sign #2 ta- Sign #3 Sign #4 Totals(Unit charges Signs)© Unit Chara Quand multiplied by quantities) Type of Sian Valuation S $47.00 x i = $ 41.p(D All signs less than or equal to 25 sq. ft. $85.00 x = $ Wall sign or marquees,over 25 sq. ft. $115.00 x = $ Freestanding sign or projecting sign, over 25 sq.ft. GRAND TOTAL Make Checks Payable to: City of Port Angeles $ y-1,00 Credit Cards(Except American Express)are accepted Ex ting sign(s)area_ sq.ft. +Proposed sign(s)area 75.6 sq.ft. = Total sign(s)area /5, .Tq. ft. re'',wo Building fagade area (height ft. X width ft.) = sq. ft. (if a building has more than one business in it, only measure the area of the building fagade that is used by the business applying for this permit) I have read and completed this application and know it to be true and correct. I am authorized to apply for this permit and understand that it is my responsibility to eter ' e what permits are required, and to obtain permits prior to working on projects. Date Print Name- M Signatur T:Forms/Building Division/Sign Permit Application.doc SignFooter 2ft.cdr Concepts Only - Not For Production Purposes scat 1/2"=1' O F. n.-- .S 47 s E 1 J .� PROJECT NAME: 00 z T G Enlivant LUJ z .0A a H c a tl0 i 6/6/14 IR N ��. v a d �R � n o � • 0 S ` m o 0 0 Lesley Seymour N CO C d CD Q o N a 727.532.8255 Op V v 4= cL Q '> 6 - __- L060614S ❑SW 7 O White Pure White O N ❑Metallic Silver sW 6918 Humorous Green ® 6718 Overt Green SW 6739 ,e}" 4++ Eco Green ■SW 6762 Poseidon SW 6767 OPTION 1) 1 - Double-Faced Post Sign ■Aquamarine 62"x 36" .063 Aluminum W/Vinyl Digital Print(qty 2-one for each side of aluminum frame) ■SW 649:1 1"x 1"aluminum framing as shown with custom welded brackets painted Ebbtide SW 7062 POSTS: Mount To 2-4"x 4"x 68" PT Posts W/ PVC Sleeve Rock Bottom80%Black Custom Painted 6"x 6"x 9" Base(s) I Custom Painted 5"x 6"x 1"Cap(s) ■(This is for address only) (Posts Installed 2 Ft Below Grade) Client Approval - Print Name: Signature: Date: Thank You These sign designs are the sole property of Oakhurst Signs and may not be used for bidding purposes.The ownership of 12445 62nd St. North, Suite 305 For these designs will be transferred to the listed customer in the event that signs are purchased from Oakhurst Signs. If this Largo, FL 33773 artwork is used without our consent,you will be invoiced for the design fees-these fees typically range between$275-$750. Phone: 727-532-8255 1 Fax: 727-532-4334 Opportunity! www.oakhurstsigns.com SignFooter..2ft.cdr Concepts Only - Not For Production Purposes POST SIGN FRAME DETAIL scale 1/2"=1' -PROJECT 3D View Of Post Mount Enlivant Post Frame Aluminum Frame W/Brackets Welded On Sides For Mounting To Posts 6/6/14 Lesley Seymour 727.532.8255 L060614S SIGN FACES TO BE MOUNTED TO EITHER SIDE OF FRAME i Client Approval - Print Name: Signature: Date: Thank You These sign designs are the sole property of Oakhurst Signs and may not be used for bidding purposes.The ownership of 12445 62nd St. North, Suite 305 For The these designs will be transferred to the listed customer in the event that signs are purchased from Oakhurst Signs. If this Largo, FL 33773 artwork is used without our consent,you will be invoiced for the design fees-these fees typically range between$275-$750. Phone:727-532-8255 1 Fax:727-532-4334 L Opportunity! www.oakhurstsigns.com t SAIRL .f� fw •• 44P • • • •�.• T � ., � • ��P M� f � •.r,;► - � _—OqW Alm..rqp• Y 4 i, �}�oma.. ed •+�f !,,.,T. i►l�w� ` ' y • r `"•s "• , �T X• i P7.'. v yY � -.•��4�* r.p, � - � .♦ ». l r T4 '��. •�1,�•Ri �: � farm"'"'��¢�� � •.. * ::: F•x aAd '� • ♦ ij# wa- ;• w z ♦y i• e�,. f Curent sign location and Proposed new sign —" • lFq location o• LS U"C111iS M LETTER OF AUTHORIZATION Date:—Z-/ 3// /'- To whom it may concern: This letter is to grant written authorization to Oakhurst Signs or their authorized agent to act on our behalf in all manners relating to application and retrieval for pulling a permit for Z A!/I?4fL 91-AC4 Property Name //33 C,+s'7 P9K Ave Street Address City,State,Zip Any and all acts carried out by Oakhurst Signs on our behalf shall have the same affect as acts of our own. Sincerely, 1 Property er Signa Property Owner Name Company Name The foregoing inst ent w acknowledged befor n this _day of �9�3 2Uiy Notary signature JOHN A KRESL OFFICIAL SEAL Notary Public,State of Illinois „a My Commission Expires September 14,2016 v LETTER OF AUTHORIZATION August 12,2014 To whom it may concern: This letter is to grant written authorization to McKibben Inc.or their authorized agent to act on our behalf in all manners relating to application and retrieval for pulling a permit for: Laurel Place Property Name 1133 East Park Avenue Street Address Port Angeles,WA 98362 City,State,Zip Any and all acts carried out by McKibben Inc.on our behalf shall have the same affect as acts of our own. Sincerely, gent Signature Lora Sembach JOSEPH WALMM . NOTARY PUBLIC Agent Name STATE OF FLORIDA CXmm#FFi46= Oakhurst Signs4)Expirnmirmois Company Name The foregoing instrument was acknowledged before me on this Z day of (s JJ 2014 Notary signature: MCKIBBIN INC Page 1 of 2 Washington State Department of %,,# Labor & Industries MCKIBBIN INC Owner or tradesperson PO BOX 821261 MCKIBBIN,WILLIAM SAMUEL VANCOUVER, WA 98682 503-516-3419 Principals CLARK County MCKIBBIN, WILLIAM SAMUEL, PRESIDENT WA UBI No. Business type ;J 603 426 959 Corporation License Verify the contractor's active registration/license/certification (depending on trade)and any past violations. Construction Contractor Active. ................................................I.......................... Meets current requirements. License specialties Signs License no. MCKIBI*868NK Effective—expiration 08/12/2014—08/12/2016 Bond ................. American Contractors Indem CO $6,000.00 Bond account no. 100253911 Received by L&I Effective date 08/12/2014 07/31/2014 Expiration date Until Canceled Insurance .............................. AMCO Ins Co $1,000,000.00 Policy no. ACP7535151088 Received by L&I Effective date 08/12/2014 07/31/2014 Expiration date 07/31/2015 Savings No savings accounts during the previous 6 year period. Lawsuits against the bond or savings No lawsuits against the bond or savings accounts during the previous 6 year period. L&I Tax debts https:Hsecure.Ini.wa.gov/verify/Detail.aspx?UBI=603426959&LIC=MCKIBI*868NK&SAW= 8/28/2014 MCKIBBIN INC Page 2 of 2 No L&I tax debts are recorded for this contractor license during the previous 6 year period, but some debts may be recorded by other agencies. License Violations ........................................................ No license violations during the previous 6 year period. Workers' comp No active workers' comp accounts during the previous 6 year period. Workplace safety and health No inspections during the previous 6 year period. ©Washington State Dept.of Labor&Industries. Use of this site is subject to the laws of the state of Washington. .14civ, h> Wa+lnngton", 'Noh;ii i' https://secure.lni.wa.gov/verify/Detail.aspx?UBI=603426959&LIC=MCKIBI*868NK&SAW= 8/28/2014 OAKHURST SIGNS BANK OF AMERICA,NA "11484 a '- CLEARWATER,FL 33763 12445 62ND STN.SUITE 305 63-271631- LARGO,15:03773 OAKHURS7 727 5328255 SIGNS 811-8/2014 I LG PAY TO THE City of Port Angeles 7 0 ORDER OF y r Forty-Seven and 00/100******************************************************************************************** * *� LABS DO - A TAMPER RESISTANT TONER AREA A.City"of Poct,Angeles Y Attu: Building,Permit Technician d 321;E Fifth Street`: — Port Angeles, WA"98362 M`MO Branch Enlivant- Entry Signs Final "" r u■O L 1484I'm 1:063 100 2771: 0037696567a9uo OAKHURST SIGNS 11484 City of Port Angeles 8/18/2014 Date Type Reference Original Amt. Balance Due Discount Payment 8/18/2014 Bill Emailed 47.00 47.00 47.00 Check Amount 47.00 Primary B of A Accou Branch - Enlivant- Entry Signs Final 47.00 P AUG 2 7 20% D CITY OF PORT ANGELES Lora Sembach COMMUNfTY;4 ECONOMIC DEVELOPMENT Oakhurst Signs 12455 62nd Street N., Suite 305 Largo FL 33773 August 19, 2014 Building Permit Technician City of Port Angeles 321 E. Fifth Street Port Angeles, WA 98362 Good Morning- Here is a sign permit application and supporting documentation. Check#11484 in the amount of$47.00,for the permit fee was sent in a separate envelope (in error). I apologize for any confusion this may cause. Please confirm receipt of the check and the sign permit application. Thanks and have a great day. Sincer , r Ll�bra em ach Project Coordinator Oakhurst Signs Enc: Sign Permit Application and supporting documentation Oakhurst Signs 1 12455 62nd Street N., Suite 305 Largo FL 33773 727-532-8255