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Home My WebLink About1820 Woodhaven Ln - BuildingCITY OF PORT ANGELES DEPARTMENT OF COMMUNITY DEVELOPMENT BUILDING DIVISION 321 EAST 5TH STREET PORT ANGELES, WA 98362 Application Number 03 00000213 Date 4/11/03 Property Address 1820 E WOODHAVEN LN ASSESSOR PARCEL NUMBER 0630141491700000 Application description ELECTRICAL NEW RESIDENTIAL Property Zoning Application valuation 0 Owner Contractor TAYLOR WARREN LEE OWNER 1102 W 12TH ST PORT ANGELES WA 98363 Permit Additional desc Permit Fee Issue Date Expiration Date ELECTRICAL NEW RESIDENTIAL 252 40 Plan Check Fee 00 4/11/03 Valuation 0 10/08/03 Qty Unit Charge Per Extension 1 00 70 8000 ECH EL -R SQFT FIRST 1300 70 80 8 00 22 7000 ECH EL -RM 0 200 ADD SRV FEEDER 181 60 Fee summary Charged Paid Credited Due Permit Fee Total 252 40 252 40 00 00 Plan Check Total 00 00 00 00 Grand Total 252 40 252 40 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 regulating construction or the performance of construction. Signature of Contractor or Authorized Agent Date T \PLANNING \FORMS \1102.15 [4/2002] if owner is bu der nature of Owne Date CALL 417-4815 FOR BUILDING INSPECTIONS. PLEASE PROVIDE A MINIMUM 24 HOUR NOTICE. IT IS UNLAWFUL TO COVER, INSULATE 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 FOUNDATION: FOOTINGS I I WALLS II I I FOUNDATION DRAINAGE I I ELECTRICAL (LIGHT DEPT) SEPARATE PERMIT II ROUGH -IN I I PLUMBING UNDERFLOOR /SLAB I ROUGH -IN I I WATER LINE I I GAS LINE I BACK FLOW WATER AIR SEAL WALLS I I CEILING I I FRAMING JOISTS GIRDERS I I SHEAR WALL I I WALLS ROOF CEILING I DRYWALL I T -BAR I I INSULATION SLAB I I WALL FLOOR CEILING I I MECHANICAL HEAT PUMP I I WOOD STOVE PELLET CHIMNEY I I HOOD DUCTS I I PW UTILITIES SITE WORK (Engineering Division) SEPARATE PERMIT #'s: WATERLINE METER I SEWER CONNECTION I I SANITARY I I STORM I 1 PLANNING DEPT SEPARATE PERMIT 4's SEPA. PARKING /LIGHTING I I I ESA. LANDSCAPING I I I SHORELINE: FINAL INSPECTIONS REQUIRED PRIOR TO OCCUPANCY /USE RESIDENTIAL ELECTRICAL LIGHT DEPT CONSTRUCTION R.W PW/ ENGINEERING FIRE PLANNING DEPT BUILDING T• \PLANNING\FORMS \1102.15 [4/2002] BUILDING PERMIT INSPECTION RECORD 417 -4735 417 -4807 417 -4653 I 417 -4750 I 417 4815 I YES I NO DATE YES NO COMMERCIAL DATE ACCEPTED YES I NO I ELECTRICAL LIGHT DEPT CONSTRUCTION R.W PW ENGINEERING I FIRE DEPT I PLANNING DEPT I BUILDING ScPI oe.—$-J Z o>,S CITY OF PORT ANGELES DEPARTMENT OF COMMUNITY DEVELOPMENT - BUILDING DIVISION 321 EAST 5TH STREET, PORT ANGELES, WA 98362 Application Nut,be r ..... 03-00000386 Date 4/11/03 Property Address ...... 1820 E WOODHAVEN LN ASSESSOR PARCEL NUMBER: 0630141491700000 Application description . . . RES NEW SFR Property Zoning ....... Application valuation .... 199440 Owner Contractor TAYLOR WAR~EN LEE OWNER 1102 W 12TH ST PORT ANGELES WA 98363 ...... Structure Information NEW 3542 SF SFR W/ATT 1496 SF GARAGE ..... Construction Type ..... TYPE V NON-RATED Occupancy Type ...... SINGLE FAM & CONGREGATES Other struct info ..... NUMBER OF UNITS 1.00' Permit ...... BUILDING PERMIT -RESIDENTIA~ Additional desc . Permit Fee .... 1577.25 Plan Check Fee . . 630.90. Issue Date .... 4/11/03 Valuation .... 199440 Expiration Date . . 10/08/03 Qty Unit Charge Per Extension BASE FEE 1017.25 100.00 5.6000 THOU BL-100,001-500K (5.60 PER K) 560.00 Permit ...... MECHANICAL PERMIT Permit Fee .... 115.85 Plan check Fee . . .00 Issue Date .... 4/11/03. Valuation .... 0 _ Expiration Date . . 10/08/03 Qty unit Charge Per Extension BASE FEE 47.00 1.00 14.7000 ECH ME- INSTALL 1OO- FAU 14.70 7.2500 ECH ME-VENT FAN 43.50 6.00 1.00 10.6500 ECH ME-G~S PIPE. 1 -TO 5 10.65 .......................................................... -_ .......... ~__L_ Permit ...... PLUMBING PERMIT Per~it Fee .... 202.00 Plan Check Fee . . .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 cqnstruction 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. Ail 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 constr,ction. ~.~.~__~ Signature of Contractor or Authorized Agent Date SignatUre of (~wner (if e"wner is builder) / / Date CITY OF PORT ANGELES DEPARTMENT OF COMMUNITY DEVELOPMENT - BUILDING DIVISION 321 EAST 5TH STREET, PORT ANGELES, WA 98362 Separate Permits are required for electrical work, SEPA, Shorelinel ESA, utilities, privat; and publ'ic improvements. This permit b;comes 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. Signature of Contractor or Authorized Agent Date Signature of Owner (if owner is builder) Date u� F pOR7 q N FOR OFFICIAL USE 01LY ELECTRICAL PERMIT APPLICATION DaidRec: Permit a: Date Appmved: t:;:^ ti:. L Date IssueJ: U The Electrical Permit Application must be filled out compietelv. B� Please type or reprint in ink. Ii you have any questions, please call (360. 417-0T35 Fax number: (360) 417-4711 Owner or Elec. Contractor Agent: T�� Phone: 7�7 �6 b� F�: Property Owner: �J� Phone: ��o� 9 Address: jI D Z �02 Clly: �p ,G'.Gd�S' L��• Z 9 Electrical Contractor. License Exp: Phone: Address: City: Zip: INSTALLATION WIRED BY: �OWNER ELECTRICAL CONTRACTOR Credit Card Ho/der Name: Billing Address: City: Z�P� Credit Card Number: Exp. Date: V/SA: MC: PROJECT ADDRESS: L�� -rJ L'�� TYPE OF WORK: Check all that apply: New Alteration/Addition O Residental O Multi-family O Commercial Mobile Home Sq. Ft. C7 Remote Meter Detached garage Hot Tub Swirri Pool O Septic Pump Low Voltage O Telecom. Sign Number of Circuits added or altered: DESCRIPTION OF THE ELECTRICAL PROJECT:---�� fs1�� Electrical Heat Load Additions Service Information Baseboard K�N Vottage: Furnace KW Overhead Service Phase: 3 O Heat Pump KW emp Service Service Size: Fa.n-Wall KW �Underground Service Feeder Size: PAMC 14.05.060(B): For industrial, commercial, 8 residential projects larger than a duplex, a one line drawing of the Electrical Se►vice 8 Feeders, building size (sq. ft.), load calculations, and the type 8� of conductors and/or raceway is required and shall accompany the Electrical Permii application. hereby certify thai 1 have read and examined this application and know that same to be true and correct, and I am authorized to apply for this permit. 1 understand it is not the City's legal responsibility to defermine what permits are required; it remains the applicants responsibiliry to determine what permits are required and to obtain such. .�Y 0 �f Credit Card Holder's Signature: Date: Owner or Elec. Cont. Signature: Date: PW-9019 Z"��° �3� FOR OFFICIAI, USE O�LY ELECTRICAL PERMIT APPLICATION �f �e� r r.., R. Dace Appnrved: I Ys:�� Dace IssueJ: The Electrical Permit Application must be filied out comDletelv. Y+� Please type or reprint in ink. If you have any questions, please call (360. 417-4735 Fax number: (360) 41�-4711 Owner or Elec. Contractor Agent• �/�'�/WrL— Phone: ,C—�—�Fax: �S7 F�J J Properry Owner. Phone:yS� �O Q J Address: ��✓�7'� Z� City: �U✓LL7'_�� zp: 9�3 I Electrical Contractor: l�I,.�n1 tY' License Exp: Phone: Address: GtY� Z P� INSTALLATION WIRED BY: �OWNER ELECTRICAL CONTRACTOR Credit Card Ho/der Name: Bllling Address: City: Z�p: Credit Ca�d Number: Exp. Date� V/SA: MC:_ PROJECTADORESS: I� 11CJ LJf�i��Ld�ULN C�NL�� -1' IN�i`� Y1fPE OF WORK: Check all that apply. �New O Alteration/Addition e/ 9Z �`Residental Mufti-family Commercial O Mobile Home. Sq. Ft �d D S E [,B�Remote Meter O D�tached garage Hot Tub Swim Pool Septic P Low Voltage I� Telecom. S Number of Circuits added oraltered: DESCRIPTION OF THE EiECTRICAL PROJECT: s�''� I�"✓� Sv�-' i`'�'� /7'��L�J C�+�-�'3Q Electrical Heat Load Additions L�� Sen►ice (nformation Baseboard KW Voltage: Furnace —KW Overhead Service Phase: 1 D 3 �Heat Pump KW emp Service Service Size: O Fan-W all KW �Underground Senrice Feeder Size: PAMC 14.05.060(B): For industrial, commercial, residential projects larger than a duplex, a one line drawing of the Electrical Service 8 Feeders, building size (sq. ft.), load calculations, and the type of conductors and/or raceway is required and shall accompany the Electrical Permit application. I hereby�ertify that 1 have read and examined this application and know that same fo be true and correct, and I a authorized to apply for this permit. I understand it is not the City's legal responsibiliry ro defermine what permits are re_quired; it remains the applicants r�esponsibiliiy to determine what permiis are required and to obtain such. e��' 1 Q `°.�t�,�.. �v�.; �-�3'� �+a- (•t �f�`''e��.-r� GU r C P rJ� °r j( �7c �.5��_. 7�i4�l- ��Q. I� C V� 6 pi�� Credit Card Holder's Sigv�a4ure: Date• Owner or Elec. Cont._ Signature: Date: Z�`' PW-9019 Lx-p �z�D o G .�-�c� 14:5 ~ t4~*,%' <, FOR OFFICIAL USE ONLY: BUILDING PERMIT- APPLICATION permit #:~ Fill out COMPLETELY and in INK. Your application and site plan MUST BE Date Approved: COMPLETE to be accepted for review. If you have any questions, call Date Issued: (360) 417-4815 Applicant or Agent: ~)~J C '~',___. Phone: ~/~' 7- 0 6 dO ~ Owner: ~ ~.~ Phone: ~V-~6 Ad&ess: //~ ~ ~'P iV~ Ciw:~~e% :~ Zip: ~2~ ~chitee~ngineer: ~/~ Phone: Con~acto~ ~,~4 ~ S~te License g:T~v~o~ Exp: 0~,~° q Phone: Ad,ess: //0~ ~VA /3~ Ci~: .~~ Zip:.~'~ VRO CT 9 SS: l 0oO Z0 NG: LEG~ DESC~TION: Lot: '~ Block: Subdivision: ~0~ %~ Credit Card Holder Name: Billing Address: City: Credit CardType VISA__MC __ # Exp. Date: TYPE OF WORK: SIZE/VALUATION: .~ Residential I~NewConslr. [] Re-roof [] Stove /t./~&. SF.~$. /~ /SF.=$ ~-~t._~ D Multi-family [] Addition [] Move r3 Garage ~b"qtZ--- SF.~$. ~'g) /SF.=$ l-7~1 /0 0 [] Commercial [] Remodel [] Demolition [] Deck SF. ~ $ /SF. = $ [] Repair [] Sign rn Other TOTAL VALUATION $ /c] ~[~/~t./r~) BRIEFDESCRIPTIONOFTHEPROJECT: p/'~,-O ~,%0 o ,,~2 ~-l} ~4t/ ...'t.7-/¢o~y1 /5/?o,¢f--- COMMERCIAL~RESIDENTIAL: Occupancy Group:. Occupant Load: Construction Type: !',),~o~ Ne. of Stories: 2-LotSize: 1'3°)~(-- ExisfingSq. Pt. 0 & Proposed Sq. Ft.~${'~ =TOTALSq. Et.~ffg~t Existing lot coverage O % & Proposed lot coverage __% = Total lot coverage % APPROVALS: PLANNING USE ONLY: PLAN: __ BLDG: DPWU: FIRE: ESA/Wetiand(s): t3 Yes [3 No SEPA Checklist required? El Yes El No Other: OTHER: BUILDING PERMIT APPLICATION SUBMITTAL: Tha Building Division can provide you with inforrnafion on the application and plan submittal requirements if you have questions. VALUATION OF CONSTRUCTION: In all cases, a valuation amount must be entered by the applicant. This figure will be reviewed atut may be revised by the Building Division to comply with current fee schedules. Contact the Permit Coordinator at 4174g 15 fat assistance. PLAN CHECK FEE: IF a plan check fee is due it must be submitted at the time the building permit application and construction plans are submitted. All other permit fees are due at the time ofperrmt issuance. EXPIRATION OF PLAN REVIEW: If no permit is issued within 180 days of the date of application, the application will expire. The Building Official can extend the time for action by the applicant up to 180 days upon written request by the applicant (see Section 107.4 of the Uniform Building Code, current edition). No application can be extended more than once. I hereby ceaify that I have read and examined this application and know the same 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 ,~ot the City's, ~nd that I must obtain such permits prior to T:\FORM SXAPpSXBuildingpe~nit.wpd App lic ant :C/~A_ ~/~>~ Date: V I C ASSOCIATES All g ~]~s,~'2s h ii1 ~ [o i1 ( O R P O R A I E D (360) 417{}5{}I Fix (360) 4/7 March 10, 2003 - -- Mr. Brad Collins City of Pofl Angeles Depadment of Community Development 321 East FiSh Street Po~ Angeles, WA 98362 SUBJECT: Warren Taylor - New Single Family Residence located at 1820 Woodhaven Lane, Po~ Angeles Dear Mr. Collins: I have examined the plans for the proposed single ~amily residence to be built by Taylor Made Construction at 1820 Woodhaven Lane, in Pod Angeles for the following: 1997 Uniform Building Code Current Washington State Ventilation and Indoor Air Quality Code Washington State Energy Code Based on the attached comments revised plans and structural calculations should be provided for review prior to issuance of a building permit for the proposed structure. Please call me i~ you have any fu~her questions on this matter. Tracy Gud~el, P.fi. Fc: JN 03049 SINGLE FAMILY RESIDENCE FOR WARREN TAYLOR 1820 WOODHAVEN LANE, PORT ANGELES, WA FIRST PLANCHECK - MARCH 10, 2003 1. Portions of the residence are defined as unusually shaped per UBC Section 2320.5.4 and require engineering. There are several items of concern including the following: a) Second floor has discontinuities in the floor diaphragm making it unusually shaped. b) Some second floor braced panels land on beams which have spans greater than 8 feet. c) Portions of the second floor diaphragm are not adequately laterally braced by wails below. d) The wall height exceeds 10 feet on the front wall of the great room. 2. Documentation shall be provided to indicate conformance with the 2000 Washington State Energy Code and note which method of conformance is used to meet the requirements of the code. 3. Ventilation shall conform to the requirements of the current Washington State Ventilation and Indoor Air Quality Code. Plans shall indicate method of compliance. CLALLAM COUNTY DEPARTMENT OF COMMUNITY DEVELOPMENT 223 E. 4th St., Suite 5, Port Angeles, WA 98362-3015 (360) 417-2354 INVOICE '-. j Date I InvoiceI To: City of Port Angeles 04/10/2003 ~ DCD357 ~ Attn: Michael Ouinn 321 East Fifth StreetJP.O. Box 1150 Port Angeles, WA 98362 Quantity Description Rate Amount Residential Plan Review- 1820 Woodhaven Lane Warren Taylor 1.5 Plan Review Hours 50.00 75.00 DATE Please make check payable to: Clallam County Dept. of Community Development 223 E. 4th Street, Su;te 5 Port Angeles, WA 98362-3015 Total Invoice Amount Due TOTAL $75.00 Appendix E: Sample CheCkltete & Attachmem Plans Examiner and Inspector Checklist Perm. No. ~' ~"~ 6 Addmia i~' ~'~ P~na Ex~l~r: Clled~. w~te in t~'A, ~' ~11 in w/ue on s/~ded boxes. In.pgclor: Ched~ off boxes ~ lef~ ~ ifems are found to comply. Comp#Inca approach: (ch~k one) E} Systems anaJysis [] Component perlomlance ~PreSCnptive path Note: Some specifics on this form may nol apply if A) c~npliance approach is systems a.,~aJysis or component pedotmance; B) compliance Io minimum ventilation czifeda is demonstrated Ihmugh enginee~ng caJculations or pedorma~ce leafing. [] Slab: ~ i Extark:x dow~ lo fl'os~llne/~t~b bott~n; o~ ln~erkx 24' horlzofll~J o¢ verifca]; or. If radiant, urn:tel artUre slab [] Bedew grade axt®Hor wall Insulation: ~- I (If Interior ~ [] Radon relegation: i if locally req~tzed, of c~aw~.space venlthg <1W3OOf12 o1 c~awt, o~ ve~'~t~ Irtciude an operate d~mpef 8rd air ,,Nd: IK~WaUI~If; rf~ J~'mud eJII; V~bldOW & ~c.~- ~t~; ~ .Uo~.~4re. plumb, duc~. ~ ~. fl~. ~ ~ So~rce apeclflc exhaust farm: Size ;e~ulrem~lt --bath. ~ (50.cfm); kitchen (100~m) Integrate~ ferced-alr ayatem ~ ~ ~ duct (wflh danlpe~ aJk~Mng between .3S and ~; ACH ~] ~ Wall In~ula~on (tbove grade) [~ ~ '-J wen I~ulat~n ~ow gmdq:ln~'~ ~1 [~ ~ F~e~' tn~ulaUon [] I:~l,do~'l moftl~or' on l #t: W~/dl I~ and QIN'NKI~ IntO¢lTil~.~orl [] DHW hee~m: NAECA ~-be~; ~,,~e powe~ or gas ~hul-off; o~ R. 10 pe~d If electric and In ur,~.-~, e~N cr # on concrete E] p#~e thaulatf~t; R.3 lot ho{ and <x~l w~r I:~Ptng In uncondl~oned e~ (if ~,y'~oe or redzculllin~, lee Tab/,e 6-12) E-62 FILE COPY 'V ALLOWABLE UNIT STRESS FOR WOOD COLUMNS PER UBC 2307 F'c= Fc* 1 + (Fce/Fc*)- ] 1 + Fce/Fc*I - Fce/Fc* I E' = le = d= Kce= Fc* = Fce= KceE' = 311.21 (le/d)^2 F'c = 297.2 Ib/sqin REINFORCED CONCRETE/MASONRY DESIGN - ALTERNATE METHOD Sheet of Zenovic & Associates, Inc~ Job No, 519 South Peabody Street, Suite 22 Port Angeles, WA 96362 MATERIAL PROPERTIES: (Only for Normal Wt Concrete / Masonry without inspection) MATERIAL: ( C or M ) rm / fc -- psi Fs = ksi E = 2880952 psi n = 10.1 MEMBER# DESCRIPTION: LOCATION: b = in REINFORCING: SIZE: d = in NO. BARS: As = 0.40 APPLIED MOMENT: ~b-in k-ff Design Moment -- 168480 lb-in Stress Level: DESIGN CONSTANTS p = 0.002498 k = 0.200509 j= 0.9331638 STRESSES: fm / fc -- 421.3 psi Fm / Fc = 1496 psi OK fs = 16.9 ksi Fs = 26.6 ksi OK MEMBER DESCRIPTION: LOCATION: b = ~n REINFORCING: SIZE: d --- in NO. BARS: As = 0.93 APPLIED MOMENT: ; lb-in k-ft Design Moment -- 169989 lb-in Stress Level: DESIGN CONSTANTS p = 0.006458 k = 0.301387 j = 0.69953765 STRESSES: fm/ fc = 1088.6 psi Fm/ Fc = 1496 psi OK fs = 25.4 ksi Fs = 26.6 ksi OK MEMBER# DESCRIPTION: LOCATION: b = in REINFORCING: SIZE: d = in NO. BARS: As = #VALUEI APPLIED MOMENT: lb-in k-fi Design Moment = 0 lb-in Stress Level: DESIGN CONSTANTS p = #VALUE! k = #VALUE! j = #VALUE[ STRESSES: fm / fc = #VALUE! psi Fm/ Fc = 0 psi #VALUE fs = #VALUE! ksi Fs = 0 ksi #VALUE 01-Apr-03 CITY OF PORT ANGELES DEPARTMENT OF PUBLIC WORKS ........... INSPECTION REPORT ........... REQUEST: Date ~-~7~-~-~"-.~ Time Received by ~(~ (phone, person) Location of Work to be inspected /~ ~ ~) ~c~x~ Ac:~t.?~P._ ~ Name of person requesting inspection Address of person requesting inspection Phone No. '¢~/) Type of Inspection (circle appropriate one): Permit No. Sewer~ Framir~g Chimney Plumbing Final Sewer Excav. Other INSPECTION NOTES: Inspected: Date -~--'- ~ '--~'~' Time By ~-~L/ Remarks: RESTORATION REQUIRED ...... YES NO. SURFACE RESTORATION: SURFACE TYPE: [] Unimproved [~Gravel [-]Asphalt [~PCC []Other [] Repaired by City Work Order # I--] Repaired by Permittee [] COMPLETE [] No Damage Found [] INCOMPLETE (Continue on reverse side if necessary) STREET SUPERINTENDENT (DATE) CITY OF PORT ANGELES DEPARTMENT OF PUBLIC WORKS ........... INSPECTION REPORT ........... REQUEST: Date t../__ ~_ ~- (~ Time Received by ~ [// (phone, person) Location of Work to be inspected /(~ ? (-~' ~/<~<:~(~ ~:/~2~,c~( Name of person requesting inspection ~ o_v'~/.~ ~--~//o ~ Address of person requesting inspection Phone No. ~_,~) z, Yr~ Type of.~-ntin~[.~rcle appropriate one): Permit No. Sewer// Foundation ~=raming Chimney Plumbing Final Sewer Excav. Other INSPECTION-RIOTES: Inspected: Date /-//-~--~'- ~-'~' Time By Remarks: RESTORATION REQUIRED ...... YES_ NO SURFACE RESTORATION: SURFACE TYPE: [] Unimproved [~]Gravel []Asphalt []PCC []Other [] Repaired by City Work Order # [] Repaired by Permittee [] COMPLETE [] No Damage Found [] INCOMPLETE (Continue on reverse side if necessary) STREET SUPERINTENDENT (DATE)