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HomeMy WebLinkAbout1105 E 1st St - Building Certificate of Occupancy 1105 E 1St St 14- 598 CERTIFICATE OF OCCUPANCY may. City'of Port Angeles - Building Division This certificate is issued pursuant to the requirements of Section 111 of the 2012 International Building Code certifying that athe time of issuance this structure was in compliance with the various ordinances of the City regulating:building construction or use for the following: Business name: Taco Time Business address 11057,E 1st St Business owner: ACcoyd Inc Business owner's address $ 3300 MapleValley Hwy.Renton,WA 9805$ Automatic fire sprcnklersystem: N/A Use &occupancy c=lassification: Business Occupant load: 1.t Per 2012 IBC, Table 1004.1.1 Type of construction ' `A = 3 ' i <�c . c ��': ; � _ `i .� 12/12/2014 $ erDate Post on the premises in a conspicuous place.—This shall not removed except by the Building Official. o_ 44>0 �g Z' -706 poor4Ate CERTIFICATE OF OCCUPANCY APPLICATION Permit# Aow 'Up CITY OF PORT ANGELES FEES $50 C tificate/Inspection Attn: Permit Technician 321 E. Fifth St., Port Angeles, WA 98362 $100 Parking Business Improvement Area (PBIA) (360)417-4815 fax(360)417-4711 fee charged for Downtown locations PLEASE PRINT IN INK Check one:New business in P.A.? Change of ownership only? Moving location from within P.A.? Zoning BUSINESS NAME -C-A-e..C) -TA'M-t= Business address \\C`S \ Mailing address Me Phone number 452-&95LA Opening date 5 I 1 11y Days& hours of operation M- ‘o- �O Business owner's name pcCLt5rr-s> ev L Contact phone Q-1-1-S) Z't b --(V X Z 2- Business Business owner's address cc) r -4 > y w'1 cZ� � ‘M ci 46c.S$ Brief description of business `2�•5K-' ..+tZA�S�C" Property owner's name '2-A=P- g`f z��� Contact phone (42s) -(01•S b x 2.2 Property owner's address/contact `3'3 cc 1A,w-E IL t 1 JJ 1 46©S 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 - 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: FIRE DEPARTMENT phone 417-4653 Fire approval by on Changes to a fire sprinkler system or fire alarm system? Yes No Work planned: PBIA (Parking Business Improvement Area-Dovtinto-inn) phone 417-4623 Square footage of business? PBIA notified on Is business moving within the PB IA? Yes No 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 • A City of Port Angeles Business License is required for: Taxi, Peddlers, Second-Hand Dealer, Pawibroker, Dance, Hotel-Motel, Firevwrks, 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? (A parking plan may be required.) Signs?(wall-mounted,freestanding, projecting, awning,A-frame, etc?) Signs planned: 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 Work planned: PUBLIC WORKS WASTEWATER phone 417-4845 PWN approval by on Will waste, other than domestic household waste, be discharged into the sewer system? Yes No 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. / hereby apply for a Certificate of Occupancy. I acknovdedge that I have read this application and state that the information I have supplied is correct to the best of my knov/edge. Incorrect information may result in revocation of permit. 136 Ii w�S � 1 S 8 / / Date Print Name Signature T:\Fonns\Building Division\Certificate of Occupancy Application(2010)doc Page 2 of 2 NAME OF PREMISES. CG` /7 L 4e4- A/ SERVICE ADDRESS c 5 L S s 101 e LOCATION OF DEVICE. U A/ G f A2 A /A( e i- vice ASSEMBLY W if Manufacturer Model Size Serial No IS THIS AN APPROVED ASSEMBLY'? YES C fO IS ASSEMBLY INSTALLED CORRECTLY' YES IS 0 DATE OF INSTALLATION Al/6. ?(//G UNKNOWN 0 Initial Test Repairs Details AIR GAP INSPECTION COMMENTS Cleaned Replaced Backflow Assembly Test Report City of Port Angeles Public Works and Utilities Department Water/Wastewater Collection Division REDUCED PRESSURE PRINCIPLE ASSEMBLY DOUBLE CHECK VALVE ASSEMBLY CHECK VALVE #1 I CHECK VALVE #2 I RELIEF VALVE Leaked Leaked Did Not Open r� Closed Tight Er— z Held at �O.6 psi Held at psi Opened at In psi P REQUIRED MINIMUM SEPARATION YES NO Cleaned Cleaned Replaced Replaced Final Closed Tight 13// Test Held at psi Held at psi :TA/ S'P C l L r E S i e 9k ,4 f'Sf /J COG,N7C, ,qG. h' /.57: /1 fo 3 psi Buffer YES NO Opened at 7 C p si Replaced Official Use Only Assem.# Received RP m/' RPDA DC DCDA PVB Air Gap SVB AVB PVB /SVB AIR INLET Did Not Open Opened at psi CHECK VALVE Leaked Held at psi REPAIRS Cleaned AIR INLET Opened at psi CHECK VALVE Held at psi BACK PRESSURE NO YES TYPE OF HAZARD 5 01 2 .4 Line Pressure psi Held Backpressure YES ❑'NO #2 Shutoff Held YES Ca/' NO Relief Valve Exercised YES 121/NO Date /Time Tester Signature Cert. Test Kit Passed Failed Initial Test F 9 0 le C C.4 C A /t'll Slit, I..a+? YJ AT I i'1 b4/6'57 Repairs Final �]j ,�t, �`�j �J Test f l f Ne C k f 1 r%'c.,F-t. f r Can /7 .7- 7" t) S e 1 I 1 /1 iv I- 5 T WHITE CUSTOMER COPY YELLOW PURVEYOR COPY PINK TESTER COPY Application Number Application pin number Property Address ASSESSOR PARCEL NUMBER Tenant nbr name Application type description Subdivision Name Property Use Property Zoning Application valuation Owner KENNETH C PARSONS 626 E ANGELES RIDGE RD PORT ANGELES (360) 452 8954 T:Forms /Building Division /Building Permit CITY OF PORT ANGELES DEPARTMENT OF COMMUNITY ECONOMIC DEVELOPMENT BUILDING DIVISION 321 EAST 5TH STREET PORT ANGELES, WA 98362 Qty Unit Charge Per 1 00 7 0000 EA WA 983628936 10 00000786 613408 1105 E 1ST ST 06 30 00 6 2 0355 0000 TACO TIME PLUMBING REPAIR COMMERCIAL ARTERIAL 400 Application desc INSTALL BACKFLOW PROTECTION FOR SODA DISPENSER Contractor Permit PLUMBING PERMIT Additional desc SODA DISPENSER BACKFLOW Permit pin number 170225 Permit Fee 57 00 Issue Date 7/28/10 Expiration Date 1/24/11 THE PLUMBING CONNECTION INC 175 S BAYVIEW AVE PORT ANGELES (360) 457 1690 PROT Plan Check Fee 00 Valuation 0 BASE FEE PL- BACKFLOW PROTECTION <OR =2 Fee summary Charged Paid Credited Permit Fee Total 57 00 57 00 00 Plan Check Total 00 00 00 Grand Total 57 00 57 00 00 Date 7/28/10 WA 98362 Due Extension 50 00 7 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 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 regulating construction or the performance of construction (2rafc.cr REPORT SALES TAX on your state excise tax form to the City of Port Angeles (Location Code 0502) Date Print Name Signature of Contractor or Authorized Agent Signature of Owner (if owner is builder) 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 IN CONSPICUOUS 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 bWater ATR SEAL. Walls Ceiling FRAMING Joists I Girders Under Floor Shear Wall Hold Downs Walls Roof Ceiling Drywall (Interior Braced Panel Only) T -Bar INSULATION Slab Wall I Floor Ceiling MECHANICAL. Heat Pump Furnace FAU Ducts Rough -In Gas Line Wood Stove Pellet Chimney Commercial Hood Ducts MANUFACTURED HOMES Footing Slab Blocking Hold Downs Skirting PLANNING DEPT Separate Permit #s SEPA. Parking Lighting I ESA. Landscaping I SHORELINE. 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 Inspection Type FINAL Date Accepted by RO FINAL Date Accepted by FINAL INSPECTIONS REQUIRED PRIOR TO OCCUPANCY/ USE Date Accepted By Applicant Property Owner WA J"-? i rc C Property Owner's Addi J/� 5 .E Contracto t i'-,t u6 fed tw /'c 7 ID )1-1 Contractors Address License PROJECT ADDRESS Parcel Number Project Tune Brief Description. Check all that apply New Construction 1tii rig t. IA Addition Remodel Repair Demolition Re -roof Heat System Other Existinq (sq. ft.) Basement r 1 Floor 2 Floor 3 Floor Garage I Carport I I Covered Porch I Deck j I Shed I Other Floor Areas Total footprint of structures Site Coverage the amount of impervious surfa and other impervious surfaces (see PAMC 17 Max. height of proposed structures Will a lawn sprinkler system be installed? Will a fire sprinkler system be installed BUILDING PERMIT APPLICATION Print in ink CITY OF PORT ANGELES Attn Building Permit Technician 321 E Fifth St. Port Angeles WA 98362 (360) 417 -4815 fax (360) 417 -4711 Expires ,-6 v i) /v s E d,� r Lot Residential Multi- family QEputF_ PtEt._ri.80- House garage other tear off re -roof lay over one layer Heat pump wood- burning stove gas fireplace pellet stove other Proposed (sq. ft.) q ft. T Lot size a parcel including structures p 135 for exemptions) Occupancy group Occupant load onstruction t �r�LK rLo I/J Phone Phone E -mail per sq ft. (TOTAL VALUATION For City Use Only Date Received-2 $.10 Permit# i0 7% Date Approved CIS z 95 4 Phone c.)5 /6 qc Nate-7 l. g 3r Zoning Commercial Industrial .rre z. v ,T o 7/,nnn.ei PC sq ft. Lot coverage ved eways sidewalks patios Site coverage ok 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 determine what permits are required, and to obtain permits prior to wo ing on projects. Date 2-2R- /D 1 Print Name Eu P »foC Signature .4 T Forms /Building Division /Building permit application of bedrooms of full baths alf baths OA Clallam County Assessor Treasurer Property Details 62187 KENNETH C PARSON Page 1 of 6 Clallam County Assessor Treasurer Property Search Results 62187 KENNETH C PARSONS for Year 2010 2011 Property Account Property ID Geographic ID Type Tax Area. Open Space. Historic Property Multi Family Redevelopment: Township Range. Location Address. Neighborhood: Neighborhood CD Owner Name. Mailing Address. 62187 0630006203550000 Real 0010 N N N Taxes and Assessment Due Property Tax Information as of 07/28/2010 Amount Due if Paid on. 'M. Year Statement ID 2010 44843 2010 44843 2010 44843 2010 44843 2010 44843 2010 44843 2010 44843 2010 44843 2010 44843 2010 44843 2009 621872008 2009 621872008 2009 621872008 2009 621872008 2009 621872008 2009 621872008 Legal Description. Agent Code PA 121 PORT ST CNTY H2 L Land Use Code DFL Remodel Property 1105 E FIRST ST PORT ANGELES WA Cycle 5 Comm 20953140 KENNETH C PARSONS 626 E ANGELES RIDGE RD PORT ANGELES WA 98362 -8936 Taxing Jurisdiction ST SCH STATE SCHOOL CC -GEN COUNTY PORT PORT PORT ANG PORT ANGELES SD #121 SCHOOL DISTRICT #121 NTH OLY LIB NORTH OLYMPIC LIBRARY HOSP #2 HOSPITAL #2 WSMET PK DIST WILLIAM SHORE MET PARK CITY_STORMWATER CITY STORMWATER WEED_CONTROL WEED CONTROL 2010 44843 TOTAL. ST SCH STATE SCHOOL CC -GEN COUNTY PORT PORT PORT ANG PORT ANGELES SD #121 SCHOOL DISTRICT #121 NTH OLY LIB NORTH OLYMPIC LIBRARY Section. Mapsco Map ID Owner ID Ownership Exemptions: First Half Base Due $790 54 $420 70 $59 13 $974 06 $1023 97 $122.24 $172 58 DIST $54 92 $183 80 $0 82 $3802.76 $922.59 $466 90 $66 14 $1024 13 $1140 92 $135 67 MORSES DW SUBDIVISION LT 8 -10 15- 19 BL 129 SURVEY V18 P26 58 N N 45193 100 0000000000% Second Half Base Due Penalty Interest Base $790 54 $0 00 $0 00 $7f $420 71 $0 00 $0 00 $42 $59 13 $0 00 $0 00 $974 05 $0 00 $0 00 $97 $1023 96 $0 00 $0 00 $102 $122.25 $0 00 $0 00 $12 $172.58 $0 00 $0 00 $17 $54 91 $0 00 $0 00 $E $183 79 $0 00 $0_00 $1E $0 81 $0 00 $0 00 9 $3802.73 $0.00 $0.00 $38C $922.58 $0 00 $0 00 $184 $466 92 $0 00 $0.00 $97. $66 13 $0 00 $0 00 $1 $1024 12 $0 00 $0 00 $204 $1140 95 $0 00 $0 00 $22E $135 66 $0 00 $0 00 $27 http. /vpn.clallam. net. 8084 propertyaccess /Property.aspx ?cid =0 &year= 2010 &prop_id =62 7/28/2010 Application Number Application pin number Property Address ASSESSOR PARCEL NUMBER Application type description Subdivision Name Property Use Property Zoning Application valuation Owner PARSONS KENNETH C 626 E ANGELES RIDGE RD PORT ANGELES WA 983628936 Permit Additional desc Permit pin number Sub Contractor Permit Fee Issue Date Expiration Date Qty Unit Charge Per 1 00 73 5000 ECH EL BRANCH CIRCUIT WO /FEEDER Fee summary Permit Fee Total Plan Check Total Grand Total INSPECTION TYPE DITCH SERVICE ROUGH IN FINAL COMMENTS ELECTRICAL PERMIT CITY OF PORT ANGELES 360 -417 -4735 10 00000530 104060 1105 E 1ST ST 06 30 00 6 2 0355 0000 ELECTRICAL ONLY COMMERCIAL ARTERIAL 0 Contractor APS ELECTRIC 546 BENSON RD PORT ANGELES PORT ANGELES (360) 452 6753 ELECTRICAL ALTER COMMERCIAL APS/ ICE CREAM CIRCUIT 166553 APS ELECTRIC 73 50 Plan Check Fee 5/26/10 Valuation 11/22/10 Charged Paid Credited 73 50 73 50 00 00 00 00 73 50 73 50 00 DATE 9 z.71rn X127 to Date 5/26/10 WA 98363 Due 00 00 00 RESULTS 00 0 Extension 73 50 Signature of owner or Electrical Contractor X Date INSPECTOR. Hoti9 FROM A. P S. ELECTR I CAL CONTRACTOR FAX NO. City of Port Angeles Permit Application Building Division /Electrical Inspections 321 East Fifth'Street— P.O. Box 1150 Port Angeles Washington, 96362 Ph: (360) 417 -4735 Fax: (360) 417.4711 Date: S 'Z aQ r 1 2 Single Family Dwelling Multi- Family or Commercial` Commercial Addition Alteration [Remodel I Repair` Plan Review May a Re aired, Please Complete Complete,Electrical.Plan Review Information Sheet Job Address; r E of 4d I v2i P A Building Square Footage: n Description of above _r a G"J tf i P 12 4 4 Owner Information t-. Name: )'?.f. 4 `0.41 5 Mailing Address: t 10 i 6 ST City State: Zip: 4 1 �s 3b., Phone: Fax: License Exp. Unit Charoe 119.90 S 145.50 S 204.60 5 262.20 372.50 S 2.60 73.50 2.60 92.70 110.30 148.70 S 167.90 95.90 S 88.20 95,90 63,90 63.90 S 119.90 S 102. $110.30 35.20 5 73.50 $110.30 S 56.00 f y� 0 Check 1�— /J 7 y 9142 Date: C o?' 360 452 6753 1 Z(if -For 1C.. Cfe4 Con rector Information Name; .A .P_ i C tvlalling Address: City: State: `t Zip: Phone: Fax: License Exp. Total (City Multiplied by Unit Charnel Service /Feeder 200 Amp. S Service /Feeder 201-400 Amp. Service /Feeder401 -600 Amp. S Service/Feeder 601 -1000 Amp. Service /Feeder over 1000 Amp. 5 Branch Circuit Wi Service Fevre' S 7. S.O Branch Circuit W/O Service Feeder 5_ EachAddidonel Branch Circuit S Temp. Service/ Feeder 200 Amp. Temp. Service /Feeder 201 -400 Amp. Temp, Service/Feeder401.600 Amp. 'temp. Service /Feeder 601 -1000 Amp. S Portal to Portal Hourly S Sign /Outline Lighting Signal Circuit/ Limited Energy Commercial. Additional 1500 $5.00 S 'Signal Circuit/ Limited Energy 1 2 Family Dwelling S Signal CircuiV Limited Energy Multi- Family Dwelling Manufactured Home Connection c Renewable Electrical Energy 5KVA System or Less First 1300 Square FL S Each Additional 500 Square Ft, or Portion of S Each Outbuilding or Detached Garage Each Swimming Pool or Hot Tub Thermostat 73 ,Total May. 25 2010 09 28AM P1 Owner as defined by ACW.19.28.261. (1) Owner will occupy the structure for Iwo years after this electrical permit's finalized (2) Owner is required to h/re 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 296-46B, The City of Port Angeles Municipal Code, and Utility Specifications. Signature of owner, electrical contractor or electrical administrator O Cash .b Credit Card if 6 ,1 k ti O Application Number Application pin number Property Address ASSESSOR PARCEL NUMBER: Application type description Subdivision Name Property Use Property Zoning . Application valuation 08-00000280 Date 956320 1105 E 1ST ST 06-30-00-6-2-0355-0000- ELECTRICAL ONLY 3/05/08 COMMERCIAL ARTERIAL o Owner Contractor PARSONS KENNETH C 626 E ANGELES RIDGE RD PORT ANGELES WA 983628936 SIMPSON ELECTRIC 243036 W HWY 101 PORT P-..NGELES (360) 457-9270 WA 98363 Permit ELECTRICAL ALTER COMMERCIAL Additional desc Permit pin number 122200 Permit Fee 58.00 plan Check Fee .00 Issue Date 3/05/08 valuation 0 Expiration Date 9/01/08 Qty Unit Charge Per Extension 1. 00 58.0000 ECH EL-COMM ALT <5 CIRCUITS 58.00 ---- ----- o \f( Fee summary Charged Paid Credited Due - - ~ - - ~ - - - - - - - - - ---------- ---------- -------- Permit Fee Total 58 .00 58. 00 .00 .00 plan Check Total .00 .00 .00 .00 Grand Total 58. 00 58. 00 .00 .00 r\ \~ ~\ SPECTION ELECTRlCAL TYPE DATE: RESULTS: INSPECTOR: DITCH SERVICE OUGH - IN ~ / !Jt3 FINAL OMMENTS: I / /. . CITY OF PORT ANGELES LIGHT DEPARTMENT PERMIT NO .;:< cf J9 /~//~/,O ELECTRICAL PERMIT DATE Site Address: o READY FOR piLL CALL FOR INSPECTION INSPECTION License Number: Phone: Installed By: Phone: Sq. Ft. Owner/Business: Owner/Business Address: o Residential Heat KW o Baseboard 0 Furnace/Boiler o Heatpump 0 Other o Commercial/Industrial load Total Connected load (attach breakdown) Total Motor load (attach breakdown) o New Construction o Remodel o Service update/alter/repair o Overhead o Underground Voltage o 1.0' 03.0' Service size o Temporary Amps o Add/alter circuits o Auxiliary power (list below) o Special equipment (list below) Details/Description: -; 4co 7//11 t. SiN Date Hold for: 0 Easement 0 Letter W.S. No. Service Size Capacity: 0 O.K. 0 Not O.K. Comments o Ditch inspection O.K. o Rough-in/cover O.K. o O.K. to connect service At Final O.K. o Signed up for servicefmeter o Meter Department notified for installation o Fire Department notified of inspection o Plan Review approved/pending Permit/Receipt No. ;;:;83? Site Address: E. . / 121 Installe'Rl'I-ltJb New M~ 0 Notily the Department 01 City Light by Street Address and Permit Number when ready lor inspection. Work must not be covered or electrically energized before inspection and O.K. for covering or service has been given by the Inspector in Writing on the Wiring Report or the Building Permit. PHONE 457.0411, EXT. 158 or EXT. 224. --t;jf"'A/tII NO OCCUPANCY OR USE ESTABLISHED UNDER THIS PERMIT .;;2S ~ / -;-n~p:Clor Amount paid WHITE _ file by address YELLOW _ file by number PINK - Top: Eng, Bollom: Customer GREEN - Top: Inspector, Bollom: City Hall ~. v"""'" PRINTER5. INC. Installed By: CITY OF PORT ANGELES LIGHT DEPARTMENT .. . . ELECTRICAL PERMIT PERMIT NO. .;:17 ~ DATE_Z//6/f'O / Site Address: ILL CALL FOR INSPECTION Phone: Owner/Business: Phone: Owner/Business Address: Sq. FL o Add/alter circuits o Auxiliary power (list below) o Special equipment (list below) ~ Overhead o Underg~~nU /?? Voltage ~~ ~o o 10 ~3%.o Service size Amps . o Temporary o Residential Heat KW o Baseboard 0 Furnace/Boiler o Heatpump 0 Other }G Commercial/Industrial load Total Connected load (attach breakdown) Total Motor load (attach breakdown) )!l New Construction o Remodel o Service update/alter/repair Details/Description: . W.S. No. Service Capacity: 0 OX 0 Not OX ;E3.. Ditch inspection O.K. 9lf Rough-in/cover OX ~ ~ O.K. to connect service "JP Final O.K. ~ Size Comments Date Hold for: 0 Easement 0 Letter o Signed up for service/meter o Meter Department notified for installation o Fire Department notified of inspection o Plan Review approved/pending Site Address: c! . Notify the partme,ri of City Light by Street Address and Permit Number when ready for inspection. Work must not be covered or electrically energized before inspection and O.K. for covering or service has been given by the ~ Writing on the Wiring Report or the Building Permit. PHONE 457.0411, EXT. 15~ EXT. 224. NO OCCUPANCY OR USE ESTABLISHED UNDER THIS PERMIT /08 ...-- Inspector Amount paid WHITE - file by address YELLOW - file by number PINK - Top: Eng, Bottom: Customer GREEN - Top: Inspector, Bottom: City Hall ~ OLYMPIC PRINTERS. INC. Installed By: CITY OF PORT ANGELES LIGHT DEPARTMENT . ELECTRICAL PERMIT PERMIT NO. 027,,;2 7 7 P'~;'l 0 DATE Site Address: READY FOR ILL CALL FOR INSPECTION INSPECTION Phone: Owner/Business: ....--. /Il&~ Phone: Owner/Business Address: Sq. Ft. o Residential Heat KW o Baseboard 0 Furnace/Boiler o Heatpump 0 Other o Commercial/Industrial load Total Connected load (attach breakdown) Total Motor load (attach breakdown) o New Construction o Remodel o Service update/alter/repair ~Overhead ~~~~:rg?~YD p10 03.0 \~vice size (/(9-0 Amps ~ Temporary o Add/alter circuits o Auxiliary power (list below) o Special equipment (list below) DetailslDescription: . / ,,') ~r/ W.S. No. Service Capacity: 0 O.K. 0 Not O.K. o Ditch inspection O.K. o Rough.in/cover O.K. o O.K. to connect service "fl Final O.K. Ar Site Address: Size Comments Date Hold for: 0 Easement 0 Letter o Signed up for service/meter o Meter Department notified for installation o Fire Department notified of inspection o Plan Review approved/pending I- Os InsSit Permit/Receipt No. 027;2 . I Notify the partmerl of City Light by Street Address and Permit Number when ready for inspection. Work must not be covered or electrically energized before inspection and O.K. for covering or service has been given by the Inspe~ Writing on the Wiring Report or the Building Permit. PHONE 457.0411, EXT. 158 or EXT. 224. 1 ~ NO OCCUPANCY OR USE ESTABLISHED UNDER THIS PERMIT cQtJ ~ Inspector Amount paid WHITE - file by address YELLOW - file by number PINK - Top: Eng, Bottom: Customer GREEN - Top: Inspector, Bottom: City Hall O~YMP)C PRJN~ERS. JNC. J 03/04/2008 11:02 4579270 SIMPSON ELECTRIC PAGE 01 , C6 -() 280 . ELECfRlCAL WORXPERMIT APPLICATION j&lEleetrioal Coatr_ Q 0..0..' Licm!IcI nwnbar Date bJrif'ee / ~I'r..- SffnP<:;~'2:7:3.e-e Purtb. . mOllinQ .dd.... ~ ' "\ d.Lf:=Jo_~", I, /OJ (,.U City f) State Z'P ro~A- fh.?f:j..PAe.~ JJJ~ Cfrf:-:Sb3 ~Iepho"e .nq~her , FA.X Dum1m' If- ~aClon dDlcnption r....-....' 0 R........IllII a 1'1... 1;1 Ahcred/AddllIoa / - C; {I r' k.(I. /If v-s ~ /,.{-I'7 &{ / ;)0 yq. ~. C-/fe.(1J'-L<3:f io C-t-h ..p y; /~>J.In:J ~.,p.-.hp ~~. . II (/ Jill wi,," b.J> Prellllle. fntder'. 11_lIlfl l1'+('D T;me. A.d'nll ..r I".pettlon j...-...[ /I/JS F J~ S. CIIY Pt. + ~ / 5 19 rt ~l.e Pbonl! ~u"Dbe,. ,. u:bedllle D.qlerlla - '7 Ownr,' 41 dIVI.~ 6) RCw../9.28,J6J.'(/) Ownw wI/1 Me.p)' rhl! .J",ctl4f'fl for' two J1f!!fJrJ qJlrr tAb ttJectrlcal /NITfI11 i~ /lttoIlmd. (2) 0...,. I~ 1WftIi~ In "ire lit' ~frlCQl COttrrtJt!fttr if choW! snld Pf'OJJmT1 i,r lor Sitk. ~l or leaft:'. All.. ,..dlns .... Rhov. "1lICm0lll, J _y .onity .bat I om tllc 0"''', 01 tllc 000.. nemDd pI'Openy at Jl Iiccnled dIIotnCIJ ~r. 1 Mh ""'klnJl me clcctrtcll jnJtaJ.. Ildlln Dr <<Iteratiol In CMnplillnee with lh~ elCdriCllI law., N.I3..C" RCW. Chapter '9.28. WAC. Chapter 2~6--4CiB.'l1u~ City or POri An.el~ MtUlicipll Code, and UlJlby Spo.' I;..,. Sl.,.atllll. fir ""et'. "Cll!t: leal ~tar or alectr1cAI .dmbll.ar.t~ - Date:3 ~IoF o Cash 0 Check /I Ja'CreditCard ~ Mo':,Jcn:a.rd. Di.coYCr C~#___~~___~____ X iilIcU.....U.l1lld AddltlllOlJl o NO LOAD CHIINGES Q ~8", _ f(W o Furno.. O<W Q Helot Pump = Ton _I.AR o Fon.W"" _I(W Ellpinatinn Dole ofean! SAME DAY INSPECTION. CALL BEFORE 7:00 AM .160-417-47.15 CJ O._~ Service o Tomp Setvtce t::I UnclRrground S"",,,,,, V.beg.. Pha.. lJ I 0 3 SoN!"" SIze: _ F....... SIze: r ROUGR-.lN ] 11IERMOSTAT SEltVICE ?bLce ~ -- I II "'011 Y./ 0." ....,pmw., 8)' nw ^"""",,,Il~ ./ r , FINAL / DrTCH "'U!AJ.I!:K !'Iz/re ~ nut. _.'/ D.", . "/ In:tpecHon Mo., Buildins 0' llqu;pmenlllllpllC\ed Bloafticllo. DIlto .^etioD bken InspCl:lor -_. _. - .. .., CITY OF PORT ANGELES DEPARTMENT OF PUBLIC WORKS . . . INSPECTION REPORT. . . . . . REQUEST: Date I::> - Z -Z --0 4-- Time 7 ;00 A- W'L Received by p~ ~ ""-.I'S E (phone, person) Location of Work to be inspected / ( OS E-. ,c;;r 5 + 5*. Name of person requesting inspection ~ V\. ('S E. Address of person requesting inspection Ccv p Y(krd {7 qj.... fS. Type of Inspection (circle appropriate one): Sewer Foundation Framing Chimney Plumbing Final Phone No. '-It7 - lff'tt Permit No. Sewer Excav. Other tAJa......+ -e. v- INSPECTION NOTES: Inspected: Date h -'2 -L.. - 0 4- Time S r M. By De V\. V\..l S E. Remarks: P<bMe-t-J Sev-Jl~e... {,~ .flYO~ '2.'< :5'Lk. ~D ~V.C. 70 2" r~Ss ~~ ~I'V\ +0 ~-t-er 5-e...+ter, RESTORATION REQUiRED...... YES X NO f ~ I ( or;> "/Ac.o tri~ 9 - )4~ 8,t 1/ ~ 3! Peep V'J ~ E r:, r$ 1- 9. ~ ~ ~ J \j , ~ SURFACE RESTORATION: 10',>< It:. ~'x 81 SURFACE TYPE: 0 Unimproved 0 Gravel ~ Asphalt 0 PCC :KI Other G,vtC y~re. o Repaired by City Work Order # 1'1278 - 037 o Repaired by Permittee 0 COMPLETE o No Damage Found 0 INCOMPLETE ftlzt !i4-rv J ( STREET SUPERINTENDENT (DATE) City of Port Angeles Public Works Department Water Distribution Repair Report IWork Order No: 1'-1- 'Z; 76- 037 JCrew: 7/~ <>i- Crew J DATE REPORTED: ~-2/--0c.f CONDITION: ENfERGENCY 0 ROUTINE 0 CITIZEN COMPLAINT ]J( LEAKAGE SURVEY 0 OTHER 0 DATE OF REPAlR: (;; - -Z-Z- - oc..[ TIME: 7A14-~ PM.. DAM. OP.M. REPAlRLOCATION: ADDRESS: (f 05 E... 1 ~ TYPE OF MAIN: ,4.c. orr SIZE: 0 ?r DEPTH OF MAIN: ~ I' CLOSEST VALVE DEPTII: Z COMPONENT REPAIRED: MAIN: JOINT 0 CIR BREAK 0 SPLIT BELL 0 LONG BREAK 0 HOLE 0 CLAMP 0 OTI1ER SERVICE: TAP 0 CORP. STOP 0 PIPE K.. CURB STOP 0 FITTING 0 METER SETTER 0 METER 0 LINE VALVE: FLANGE NUTS/BOL TS 0 STEM 0 BONNET 0 HYDRANT: BRANCH 0 VAL VE 0 BARREL 0 OTHER: COMPONENTS OF ~P AIR: CLAMPO DRESSER,llit OrnER e..'~ Bve- 'S1f7 f" p<- SITE CONDITION: GRAVEL 0 ASPHALT pI( SIDEWALK)( CURB 0 TOP SOIL AREA 0 SOIL TYPE CUTS: ASPHALT CUT {O~Uz.FT. CURB CUT _FT. SIDEWALK $'X 8' FT. DRIVEWAY CUT _FT. MAIN CONDITION: INTERNAL LINING N /A 1lJBERCULATION-MINOR 0 SEVERE 0 EXTERNAL CORROSION LOCALIZED 0 EXTENSIVE 0 CHLORINE RESIDUAL SAMPLE . <<-1'5 P.P.M. WATER OFF: FROM 7.'3011 M. TO 3 (J M. FROM M. TO M. AJlPA.RENT CAUSE OF LEAK: PIa.5-t"L +=dfl'''''j c. r~<:..ked . ELECTRICAL PERMIT CITY OF PORT ANGELES 360-417-4735 Application Number . . . . . 18-00000064 Date 1/19/18 Application pin number . . . 966464 Property Address . . . . . . 1105 E IST ST ASSESSOR PARCEL NUMBER: 06 -30 -00 -6 -2 -0355 -0000 - Application type description ELECTRICAL ONLY Subdivision Name . . . . . . Property Use . . . . . . . . Property Zoning . . . . . . . COMMERCIAL ARTERIAL Application valuation . . . . 0 ---------------------------------------------------------------------------- Application desc Lighting retrofit ---------------------------------------------------------------------------- Owner Contractor ------------------------ ------------------------ ACCORD INC R V B ELECTRIC & CONST INC 3300 MAPLE VALLEY HWY 2803 GRAND AVENUE OLYMPIA WA 98508 EVERETT WA 98201 (425) 344-9180 ---------------------------------------------------------------------------- Permit . . . . . . ELECTRICAL ALTER COMMERCIAL Additional desc . . 1-4 CIRCUITS Permit Fee . . . . 86.00 Plan Check Fee .00 Issue Date . . . . 1/19/18 Valuation . . . . 0 Expiration Date . . 7/18/18 Qty Unit Charge Per Extension BASE FEE 86.00 ---------------------------------------------------------------------------- Fee summary Charged Paid Credited Due --------------------------------------------------------- Permit Fee Total 86.00 86.00 .00 .00 Plan Check Total .00 .00 .00 .00 Grand Total 86.00 86.00 .00 .00 REPORT STATE SALES TAX on your excise tax form to the City of Port Angeles (Location Code 0502) INSPECTION TYPE DATE: RESULTS: INSPECTOR: DITCH SERVICE ROUGH -IN 3 /2 bo w FINAL„ COMMENTS: PERMIT WILL EXPIRE SIX (6) MONTHS FROM LAST INSPECTION Signature of owner or Electrical Contractor X` - Date: o4ponrgNC� ELECTRICAL INSPECTION WIRING REPORT RKS 417-4735 �b DATE: PERMIT # IINSPECTOR OW ER CONTRACTOR ADDRESS 9 h,5 APPROVED NOT APTRO ❑ ....................DITCH.................... ❑ ❑................ ROUGH IN/COVER ............. ❑ ....................SERVICE................... ❑ ❑ .....................FINAL.................... ❑ CORRECTIONS NEEDED: �J[IZfLL - g�s_ G ) a7 OL'6 4iv NOTIFY INSPECTOR WHEN CORRECTIONS ARE COMPLETED WITHIN 15 DAYS -- DO NOT REMOVE -- CITY OF PORT ANGELES PERMIT APPLICATION Building Division/Electrical Inspections 321 East Fifth Street - P.O. Box 1150 / Port Angeles Washington, 98362 Ph: (360) 4174735 Fax: (360) 417-4711 Date:C * Multi -Family or Commercial„ p, j?0Rr A'j, * Plan Review May Be,Re uired, Please C plete Ele cal Plan Review Information Sheet Job Address: TQCA Tatri\\7 �3�rbri A Building Square Footage: Description of above scdt, '1 M \40Q J M`%N \c0 Nf &t1e - 4Z) W W 1 b+oclr-= Owner Inform ion Name:c__n k' S Mailing Address: City: State: Zip: Phone.'Alln `i%)QL_61856 License # / Exp. Item Unit Charge Service/Feeder 200 Amp. $132.00 Service/Feeder 201-400 Amp. $160.00 Service/Feeder 401-600 Amp $ 225.00 Service/Feeder 601-1000 Amp. $ 288.00 Service/Feeder over 1000 Amp. $ 410.00 Branch Circuit W/ Service Feeder $ 5.00 Branch Circuit W/O Service Feeder $ 74.00 Each Additional Branch Circuit $ 5.00 Branch Circuits 1.4 $ 86.00 Temp. Service/ Feeder 200 Amp. $102.00 Temp. Service/Feeder 201400 Amp. $121.00 Temp. Service/Feeder 401-600 Amp. $164.00 Temp. Service/Feeder 601-1000 Amp . $185.00 Portal to Portal Hourly $ 96.00 Sign/Outline Lighting $ 88.00 Signal Circuit! Limited Energy – Multi -Family $ 64.00 Signal Circuit/ Limited Energy / First 1500 sf– Commercial $ 96.00 Note: $5.00 for each additional 1500 sf Renewable Electrical Energy - 5KVA System or Less $113.00 Thermostat $ 56.00 Note: $5.00 for each additional T-Stat Contractor lnfotmatio Name: Mail1 Addre '7+�Y`O� City: State �'i ZipLwao I Phon . License # / Exp. V \-k\ 1A 2V OWQ (QW Multiplied by Unit Charael $ $ $ �- �— $10. $ �b 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 296-4613, The City of Port Angeles Municipal Code, and Utility Specifications and PAMC 14.05.050 regarding Electrical Permit Applications. Signature of owner, electrical contractor or electrical administrator: x Dated: