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Home My WebLink About2127 W 8th St - Building Backflow Assembly Test Report City of Port Angeles Public Works and Utilities Department WaterlWastewater CollectIOn DIvIsion Official Use Only A,~el11 # Received NAME OF PREMISES: SERVICE ADDRESS: LOCA nON OF DEVICE' ASSEMBLY. J../ ,f t.. L jJ t' J? F ? ..e<.,. (; /' .r .:/ ~ \ <J1 '-l ~ J ' A/ J ,,? ;- /"I' 5 r /r ~e 7"- It-/? /'.1 ~ ;- ~ /f r.t.. ,'/ /l r lV.A J../c C ,:- ? / rb( ,~ Manufacturer , ~ // ~_:_' /. Model Size ISenal No IS ASSEMBL Y INSTALLED CORRECTL Y? YES [J:..NO 0 . IS THIS AN APPROVED ASSEMBLY? YES lQ--NO 0 DATE OF INSTALLATION '" ) '';' ~ UNKNOWND REDUCED PRESSURE PRINCIPLE ASSEMBL Y RP ,0 RPDA 0 , DC EJ...... DCDA 0 DOUBLE CHECK VALVE ASSEMBLY PVB 0'" All G.lp D. SVB 0 AVB EI CHECK VALVE #1 CHECK VALVE #2 RELIEF VALVE PVB/SVB Imtlal Leaked 0 Leaked 0 Old Not Open 0 AIR INLET H'~'ld at .J. (, pSI Closed Tight 0 Old Not Open 0 Test Held at J. ~ pSI Opened at _ pSI Opened .It _ p" . Repairs Cleaned 0 Cleaned 0 Cleaned 0 CHECK VALVE Leaked 0 Held al -p" Replaced 0 Replaced 0 Replaced 0 REPAIRS Cleaned 0 DetaIls Replaced 0 3 pSI Buffer YES 0 NO 0 Final Closed Tight 0 AIR INLET Opened al _ pSI ') . Held al :. ;-;'SI CHECK VALVE Held al _pSI Test Held at ".. . (-J pSI Opened at _ pSI BACK PRESSURE NO 0 YES 0 AIR GAP INSPECTION REQUIRED MINIMUM SEPARATION YES 0 NO 0 TYPE OF HAZARD L / JA, ,'\ ~ /"'';/1. I -...., COMMENTS Line Pressure ~ pSI "'-, II / J/'.,; ," 16;/ 1"t 7 c // 'i . "A 5' Ie f? ....t- , '- t j Held Backpressure YES m......NO 0 I / #2 Shutoff Held YES [iJ-NO 0 Rehef Valve Exercised YESD NO 0 DatelTllne Testel SIgnature Cert # Test Kit ~~~~~''''Falled Imtlal ". Test ., 1':.,-' ;..? --.... .~; /1"1 ;J .9 0 .~, : ~ i) V ] !. I Arlf' -'h~ . ~, ~ tI-- ) , ", - ." Repall S 0 0 - - Final . J [3:..- 0 -': . , (, -fl ,I-....;{ , -: '. ( Test . - _~:.-.....I...--::- r) 'v <f .I/} (t ;-, ,- oJ " . .' , 1. ~ ~ - ~ .-......:t t ~ }. r; WHITE - CUSTOMER COPY YELLOW - PURVEYOR COPY PINK - TESTER COPY \ CITY OF PORT ANGELES DEPARTMENT OF COMMUNITY DEVELOPMENT - BUILDING DIVISION 321 EAST 5TH STREET, PORT ANGELES, WA 98362 Application Number pin number Property Address ASSESSOR PARCEL NUMBER: Application description Subdivision Name Property Use Property zoning . . . Application valuation 04-00000570 Date .679370 2127 W 8TH ST 06-30-00-9-8-0190-0000- PLUMBING REPAIR 6/29/04 RS7 RESDNTL SINGLE FAMILY o Owner Contractor HOLLDORF HARLAN L 2127 W 8TH ST PORT ANGELES WA 983631646 DOWN TO EARTH LANDSCAPING 306 S VALLEY PORT ANGELES WA 98362 (360) 452-0824 ---------------------------------------------------------------------------- Permit PLUMBING PERMIT Additional desc Permit Fee 54.00 Plan Check Fee .00 Issue Date 6/29/04 Valuation 0 Expiration Date 12/26/04 Qty unit Charge Per Extension BASE FEE 47.00 1. 00 7.0000 ECH PL- EA LAWN BACKFLOW 7.00 Fee summary Charged Paid Credited Due ----------------- ---------- ---------- ---------- ---------- Permit Fee Total 54.00 54.00 .00 .00 Plan Check Total .00 .00 .00 .00 Grand Total 54.00 54.00 .00 .00 ? ~ -.::J ~ ~ ] V\ :-1 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 regulating construction or the performance of construction. -01-1 Date Signature of Owner (if owner is builder) Date T:\PLANNlNG\FORMS\1102.1S [11/14/2003J BUILDING PERIVIIT INSPECTION RECORD CALL 417-4815 FOR BUILDING INSPECTIONS. CALL 417-4735 FOR ELECTRICAL 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 I NO FOUNDATION: FOOTINGS WALLS FOUNDA TION DRAINAGE/DOWN SPOUTS ELECTRICAL (LIGHT DEPT) SEPARATE PERMIT: # ROUGH-IN I PLUMBING UNDER FLOOR / SLAB ROUGH-IN WATER LINE (METER TO BLDG) GAS LINE BACK FLOW / WATER AIR SEAL WALLS CEILING I FRAMING JOISTS / GIRDERS SHEAR WALL/HOLD DOWNS WALLS / ROOF / CEILING DR YW ALL (INTERIOR BRACED PANEL ONLY) T-BAR INSULATION SLAB WALL / FLOOR / CEILING I I MECHANICAL HEAT PUMP GAS LINE WOOD STOVE / PELLET / CHIMNEY HOOD / DUCTS PW UTILITIES / SITE WORK (Engineering Division) SEPARATE PERMIT #'s: WATERLINE / METER SEWER CONNECTION SANITARY STORM PLANNING DEPT. SEPARATE PERMIT #'s SEPA: PARKING/LIGHTING ESA: LANDSCAPING SHORELINE: FINAL INSPECTIONS REQUIRED PRIOR TO OCCUPANCY/USE RESIDENTIAL DATE YES NO COMMERCIAL DATE ACCEPTED YES NO ELECTRICAL - LIGHT DEPT. 417-4735 ELECTRICAL LIGHT DEPT CONSTRUCTION R.W. / pw/ (-01-0,", R,8~ CONSTRUCTION - R.W. ENGINEERING 417-4807 PW / ENGINEERING FIRE 417-4653 FIRE DEPT. PLANNING DEPT. 417-4750 PLANNING DEPT. -- II BUILDING 417-4815 .L BUILDING T:\PLANNING\FORMS\1102.15 [11/14/2003] CITY OF PORT ANGELES LIGHT DEPARTMENT ELECTRICAL PERMIT N? 15579 Port Angeles, washlngton.......l.(..::::::?__~_m_m_..._......__.__m...... 19>-:5. / In accordance with the City Ordinance to regulate the installation, extension. or repair of elec- trical equipment in, on. or about any building or other structure in the City of Port Angeles. per- mission is hereby granted to do electrical work as listed below. Address ~..d..7m~;'....~.m..m._mmm.m..m....... Occupancy.~_J1?m~:.....m....._m_......_.. ~:::;~n::::::JJ::::i1~~~:~:~~=:::::::-...~~:~~~;=~:::::~:~~:'.'::---~~:::::::::=::::=::::::::::::::::::::::::::::::::: ~ LIght Out1et8...m..m.___..~.:'...._.._..... Service, volts I...f.!.:.(),/....:?::r...~m. ~""'(j ;3 :::::::e....~.~tl~.~;:.::::::::::.n::n-::::":. ::'~nw:::s~:f':::~:: 5 Enclosure ....u...-....u....m.nomu....... Water Heater: KW..m...........y:.'.2.......n 0000.00... Heat, KW..m;.r....!3../J..___n__________ Type of wiring; Entrance Cable ..m........................ Mot~:~:~~:::~:~~":~.:::::::: Rigid Conduit ..m............ Metalllc Tubing '_'___ Current transformers: No. & Size....................................... Ser. No.............................................. Ser. No. ............................................. Type of Wiring: Armored Cable .............m.m.......... Non.Metalllc ....mmn.m_..........m.. Knob & Tube.................................. RIgid Conduit nn___........mm'''.n.m Metallic TUbing .______.___m....m.nn. Raceway ..........-;;i;.........................- Circuits, LighL.....i!.'>........................_.. 0' Utlllty ..n....mm....n_______n._.._mn___ Heat .../...<2_.m.........._...._........ Range .n.tt:!......m.___.n.._.mmmm.. Water Heater ..:2.:....................... Motor ..._........................................ Drycr.........~..........................n..... Furnace ..........................w................... Ser. No.............................................. F Total Load............................. Ser. No.................._.......................... Total .Ol................................. Remarks: _m,~_~_-::mm~,!t.1~L.,,~('~:~nmm.nnmm...._..m...nnmmm__mmn..n....m Permit Fee $m..~..~____....m____m.. Treas. Receipt NO.____mm__._____m__nm By.9/.._~mff~~ NOTICE-Current must not. be turned on until Certificate of Inspection has been issued. If work Is to be con. cealed due notice must be given the Inspector so that work may be inspected before concealment. , ,- NOTIFY THE INSPECTOR BY PERMIT NUMBER WHEN READY FOR INSPECTION I :f- A~- BB , ELE~TRICAL_PERMIT N? 15579 dl Cd ? 4r Ftf if - - ' ~ :::;=,~~:=:=:=::~:==:=~;~: --.- ..- NOTIC~urrent must not be turned on until Certificate of Inspection has been Issued. It work is to be con- cealed due notice must be given the Inspector so that work may be inspected before concealment. 'I \ 1M Olvmcfc Printers. Inc. \ , CITY OF FORT ANGELES PERMIT APP.L- WATION Building Divislion/ + iectrical inspections 321 Fast F'tth Street — P,O. BOAC I150 /Port Angeles 'Washington, 98362 Ph. (360) 417 -4735 .Ii arc: (360) 4.17 -4711 Date. x plan Review May Be Required, Please i Job Address; Building Square Faclage: J _ 0esoopilon of above 41 & 2 Single Family Dwelling Plan Review Information Sheet Owner Information Name; Contract Melling � -Vmss; City Name; a tale, � honor �..`-. P. -�-? Fax; Melllndc City; 2 Lcens #1 Exp, Phone, Aj \� 030, ^�`f License #11 kem� 5ervicelFeeder200Amp, 0r� $ 1t20.00 $1 SoNlce/Feeder 201.400 Amp. ServicefFeeder 401 -600 Amp $146.00 Sarvlce /Feeder 601.1000 Amp. $ 205,00 ServicelFeedor over 1000 Amp. $ 262.00 $ 373.00 _ Branch Circuit W1 Service Feeder $ 5,00^ 'Branch Circul( W/O 5ery €ce Feeder $ 63,00 — Each Addlt €onal Branch Circuit $ 5100 Branch Circuits 1.4 Temp, Service) Feeder 200 Amp, Temp. Service /Feeder 201400 Amp, 93.00 1300 $ . Temp, SsrWMIPeedar401 -600 Amp, R 110,00 $169,00 Temp. 5e(vice /Feeder 6014000 Amp , $168,00 D — Portal to Portal Hourly Signal Cimuill Llrnitod Ene & 2 Family Dwelling $ 96.00 $ Manufactured Home Connection B4 p0 120.00 T Renewable Electrical Energy T'hermostal ►gY - SKVA System or Less $102,00 - -- Nate, $5,00 far each additional TStat $ 56,00 CONSTRUCTION First 1300 Square Ft, each Additional 500 Square Pt- or Portion $120.00 of Each Outbuilding or Detached Geroge $ 40.00 $ $ 74 -'� Each Swimming Pool or Hot Tub -00 170,00 Owner as defined b RCW 19 2 kk)' PII !Bd bar Uni4 Chaney �_ $ Z� o19 Y . . 13.281, (1) OWner will Occupy the structure for two years after this electrical permit is finalized. (2) Ov rner Is required to hire an electrical contractor if above said property is for sale, rent or lease, permit expires after six months of last inspection, After reading the above statement. I hereby certify that I am the owner of the above named property or a licensed electrical contract y. I am making the electrical installation or alteration in compliance with the electrical laws, N.E,C., RCW, Chapter 19.28, WAC, Chapter 296488,1 he Clt of p Angeles Manicipal Code, and Utility Speeiofcations and PANIC 105,050 regarding Electrical permit Applications, y ort Si aturo f owner, electrical ntractor oreleetHcal administrator; d Cash d Cheek •-- _ nllotrzatx INSPECTIONTYPE ELECTRICAL PERMIT DATE: RESULTS: INSPECTOR: CITY OF PORT ANGELES �- 360 -417 -4735 SERVICE Application Number . . . . . 15- 00000511 Date 7/16/15 ROUGH-IN Application pin number . . . 246065 FINAL Property Address 2127'W 8TH ST REPORT SALES TAX COMMENTS: ASSESSOR PARCEL NUMBER; 06-30- 00-9 -B- 8190 -0000- Application type description FL$CTRICAL ONLY on your excise tax form Subdivision Name . . . . . . to the City of Port Angetes Property Use Property Zoning . . . . . . RS7 RESDNTL SINGLE FAMILY (Location Code 0502) Application valuation . . . . 0 Application desc Heat and can lights Owner Contractor TERRY V70LLAM RICHARD BROSIUS A SIMPSON ELECTRIC 4525 SE 164TH AVE 243036 W.HWY 101 VANCOUVER WA 986B3 PORT ANGELES WA 98363 (360) 457 -9270 Permit . . . . ELECTRICAL ALTER RRSID$NTIAL Additional desc . Permit Pee . . . . 83.OQ Plan Check Fee 0'0 Issue Date 5/12/15 Valuation 0 Expiration Date 11/08/15 Qty Unit Charge Per Extension 4,00 5.0000 ECH 'EL -ECH ADDNT BRANCH CIRCUIT 20.00 1.00 63.0000'ECH EL-R- BRANCH CIR WO/ SER FEED 63.00 Fee summary Charged Paid Credited Due Permit •Fee Total 83,00 B3100 ,00 .00 Plan Check Total ..00 .00 .00 .00 Grand Total 83.00 83,00 .00 .00 INSPECTIONTYPE DATE: RESULTS: INSPECTOR: DITCH SERVICE ROUGH-IN � FINAL COMMENTS: PERMIT WILL EXPRE SIX (6) MONTHS FROM LAST INSPECTION Signature of owner or Electrical Contra_ ctor X G:IEXCHANGEIBUILD1NG Date: Application Number . . . . . 22-00001424 Date 11/16/22 Application pin number . . . 400720 Property Address . . . . . . 2127 W 8TH ST ASSESSOR PARCEL NUMBER: 06-30-00-9-8-0190-0000- Application type description ELECTRICAL ONLY Subdivision Name . . . . . . Property Use . . . . . . . . Property Zoning . . . . . . . RS7 RESDNTL SINGLE FAMILY Application valuation . . . . 0 ---------------------------------------------------------------------------- Application desc Heat pump ---------------------------------------------------------------------------- Owner Contractor ------------------------ ------------------------ NADYA ROSSBERG SWAFFORD TTE BLACK DIAMOND ELECTRICAL CONTR 2127 W 8th 502 BLACK DIAMOND RD PORT ANGELES WA 98362 PORT ANGELES WA 98363 (360) 565-1035 ---------------------------------------------------------------------------- Permit . . . . . . ELECTRICAL ALTER RESIDENTIAL Additional desc . . Permit Fee . . . . 63.00 Plan Check Fee . . .00 Issue Date . . . . 11/16/22 Valuation . . . . 0 Expiration Date . . 5/15/23 Qty Unit Charge Per Extension 1.00 63.0000 ECH EL-R- BRANCH CIR WO/ SER FEED 63.00 ---------------------------------------------------------------------------- Fee summary Charged Paid Credited Due ----------------- ---------- ---------- ---------- ---------- Permit Fee Total 63.00 63.00 .00 .00 Plan Check Total .00 .00 .00 .00 Grand Total 63.00 63.00 .00 .00 1 - 2 SINGLE-FAMILY ELECTRICAL PERMIT APPLICATION Pub! ic \Yorks and ULili ties Department 32 l E. 5th Street. Port ;\ngeles. WJ\ 98362 300.417.47]5 ! www.cilyofjJa us I electricalpcnnitsr21/cityofpa.us Project Address:-------------------------------------- Project Description:--------------------------------------□Single-Family Residential D Duplex/ ARU Building Square footage: _______________ _ OWNER JNFORMATtON Name: ________________________ Email: ______________ _ Mailing Address: ________________________ Phone: ___________ _ ELECTRfCAL CONTRACTOR fNFORMATION Name: ___________________________ License: ___________ _ Mailing Address: ________________________ Expiration Date: ________ _ Email: Phone: ___________ _ PROJECT DETAILS Item Unit Charge Qy51ntit3£ :To1s.l (Quantity x Unit Charge) Service/Feeder 200 Amp. $120.00 $ Service/Feeder 201-400 Amp. $146.00 $ Service/Feeder 401-600 Amp. $205.00 $ Service/Feeder 601-1000 Amp. $262.00 $ Service/Feeder over 1000 Amp. $373.00 $ Branch Circuit W/ Service Feeder $5.00 $ Branch Circuit W/O Service Feeder $63.00 $ Each Additional Branch Circuit $5.00 $ Branch Circuits 1-4 $75.00 $ Temp. Service/Feeder 200 Amp. $93.00 $ Temp. Service/Feeder 201-400 Amp. $110.00 $ Temp. Service/Feeder 401-600 Amp. $149.00 $ Temp. Service/Feeder 601-1000 Amp. $168.00 $ Portal to Portal Hourly $96.00 $ Signal CircuiULimited Energy - 1 &2 DU. $64.00 $ Manufactured Home Connection $120.00 $ Ren ewable Elec. Energy: 5KVA System or less $102.00 $ Thermostat (Note: $5 for each additional) $56.00 $ First 1300 Sql;Jare Feet $120.00 $ Each Additional 500 square feet" $40.00 $ Each Outbuilding / Detached Garage $74.00 $ Each Swimming Pool/ Hot Tub $110.00 $ TOTAL $ Owner as defined by RCW.19.28.261: (1) Owner will occupy the structure for two years after this electrical permit is finalized. (2) Owner is required to hire an electrical contractor if above said property is for sale, rent or lease. Permit expires after six months of last inspection. After reading the above statement, I hereby certify that I am the owner of the above named property or a licensed electrical contractor. I am making the electrical installation or alteration in compliance with the electrical laws, N.E.C., RCW. Chapter 19.28, WAC. Chapter 296- 468, The City of Port Angeles Municipal Code, and Utility Specifications and PAMC 14.05.050 regarding Electrical Permit Applications. Date Print Name Signature (0 Owner D Electrical Contractor/ Administrator) [Electrical Permit Applications may be submitted to City Hall or electricalpermits@cityofpa.us] '"'CJ CD PREPARED 11/10/22,10:21:44 PAYMENT DUE CITY OF PORT ANGELES PROGRAM BP820L --------------------------------------------------------------------------- APPLICATION NUMBER:22-00001424 2127 W 8TH ST FEE DESCRIPTION AMOUNT DUE --------------------------------------------------------------------------- ELECTRICAL ALTER RESIDENTIAL 63.00 TOTAL DUE 63.00 Please present reciept to the cashier with full payment