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120 E 10th St - Building
PREPARED 10/16/09 10 20 13 INSPECTION TICKET PAGE 8 CITY OF PORT ANGELES INSPECTOR JAMES LIERLY DATE 10/16/09 ADDRESS 120 E 10TH ST SUBDIV TENANT NBR TOM HARLAN CONTRACTOR BUY RITE HOMES PHONE (360) 681 0777 OWNER TOM HARLAN PHONE (360) 457 7646 PARCEL 06 30 00 0 3 2820 0000 APPL NUMBER 09 00000829 RES MANUFACTURED HOME PERMIT BLM 00 BL MANUFACTURED HOME REQUESTED INSP DESCRIPTION TYP/SQ COMPLETED RESULT RESULTS/COMMENTS BLRI 01 8/28/09 PB BLDG REBAR INSPECTION TIME 01 00 8/28/09 AP August 27 2009 4 55 00 PM 1pangrle BIRDIE 670 5014 STEEL AFTERNOON August 28 2009 4 07 32 PM pbarthol BLBT 01 9/14/09 JLL BLDG MFG HOME BLOCK/TIEDOWNS 9/15/09 AP September 14 2009 9 40 17 AM 1pangrle BIRDIE 681 0777 BLOCK & TIE DOWNS September 15 2009 8 06 58 AM jlierly DRW 01 9/22/09 JLL BLDG DRYWELL 9/22/09 AP September 22 2009 9 02 51 AM 1pangrle DON 808 0479 DRYWELL PLEASE INSPECT AS SOON AS POSSIBLE September 22 2009 4 15 24 PM jlierly DSD 01 9/22/09 JLL BLDG DOWN SPOUT DRAINS 9/22/09 AP September 22 2009 8 59 09 AM 1pangrle DON 808 0479 DOWNSPOUT DRAINS PLEASE INSPECT AS SOON AS POSSIBLE September 22 2009 4 15 24 PM jlierly BL99 01 10/16/09 BLDG FINAL TIME 01 00 October 15 2009 3 48 16 PM 1pangrle BIRDIE 670 5014 BLDG FINAL MANUFACTURED HOUSE AFTERNOON PERMIT PL 00 PLUMBING PERMIT REQUESTED INSP DESCRIPTION TYP/SQ COMPLETED RESULT RESULTS/COMMENTS PL6 01 9/14/09 JLL PLUMBING WATER SUPPLY 9/15/09 AP September 11 2009 3 58 40 PM 1pangrle BRUCE 808 4758 WATER SUPPLY LINE FROM THE METER TO THE HOME HE REQUESTED A MORNING INSPECTION September 15 2009 8 06 58 AM jlierly PL99 01 10/16/09 PLUMBING FINAL TIME 01 00 October 15 2009 3 48 42 PM 1pangrle BIRDIE 670 5014 PLUMBING FINAL MANUFACTURED HOUSE AFTERNOON COMMENTS AND NOTES 9 PREPARED 10/16/09 10 20 13 INSPECTION TICKET PAGE 9 CITY OF PORT ANGELES INSPECTOR JAMES LIERLY DATE 10/16/09 ADDRESS 120 E 10TH ST SUBDIV TENANT NBR TOM HARLAN CONTRACTOR DIAMOND CONST & EXCAVATING INC PHONE (360) 683 2257 OWNER TOM HARLAN PHONE (360) 457 7646 PARCEL 06 30 00 0� 3 2820 0000 APPL NUMBER 09 00000831 DEMOLITION PERMIT DEMO 00 DEMOLITION REQUESTED INSP DESCRIPTION TYP/SQ COMPLETED RESULT RESULTS/COMMENTS BL99 01 10/16/09 +L BLDG FINAL TIME 01 00 (v,' October 15 2009 3 47 20 PM 1pangrle BIRDIE 670 5014 BLDG FINAL DEMO HOUSE AFTERNOON COMMENTS AND NOTES PREPARED 9/22/09 9 04 04 INSPECTION TICKET PAGE 1 CITY OF PORT ANGELES INSPECTOR JAMES LIERLY DATE 9/22/09 ADDRESS 120 E 10TH ST SUBDIV TENANT NBR TOM HARLAN CONTRACTOR BUY RITE HOMES PHONE (360) 681 0777 OWNER TOM HARLAN PHONE (360) 457 7646 PARCEL 06 30 00 0 3 2820 0000 APPL NUMBER 09 00000829 RES MANUFACTURED HOME PERMIT HIM 00 BL MANUFACTURED HOME REQUESTED INSP DESCRIPTION TYP/SQ COMPLETED RESULT RESULTS/COMMENTS BLRI 01 8/28/09 PB BLDG REBAR INSPECTION TIME 01 00 8/28/09 AP August 27 2009 4 55 00 PM 1pangrle BIRDIE 670 5014 STEEL AFTERNOON August 28 2009 4 07 32 PM pbarthol BLBT 01 9/14/09 JLL BLDG MFG HOME BLOCK/TIEDOWNS 9/15/09 AP September 14 2009 9 40 17 AM 1pangrle BIRDIE 681 0777 BLOCK & TIE DOWNS September 15 2009 8 06 58 AM jlierly DRW 01 9/22/09 BLDG DRYWELL September 22 2009 9 02 51 AM 1pangrle DON 808 0479 DRYWELL PLEASE INSPECT AS SOON AS POSSIBLE DSD 01 9/22/ 9 BLDG DOWN SPOUT DRAINS UJ— September 22 2009 8 59 09 AM 1pangrle DON 808 0479 DOWNSPOUT DRAINS PLEASE INSPECT AS SOON AS POSSIBLE COMMENTS AND NOTES PREPARED 9/14/09 10 03 45 INSPECTION TICKET PAGE 6 CITY OF PORT ANGELES INSPECTOR JAMES LIERLY DATE 9/14/09 ADDRESS 120 E 10TH ST SUBDIV TENANT NBR TOM HARLAN CONTRACTOR BUY RITE HOMES PHONE (360) 681 0777 OWNER TOM HARLAN PHONE (360) 457 7646 PARCEL 06 30 00 0 3 2820 0000 APPL NUMBER 09 00000829 RES MANUFACTURED HOME PERMIT HIM 00 BL MANUFACTURED HOME REQUESTED INSP DESCRIPTION TYP/SQ COMPLETED RESULT RESULTS/COMMENTS BLRI 01 8/28/09 PB BLDG REBAR INSPECTION TIME 01 00 8/28/09 AP August 27 2009 4 55 00 PM 1pangrle BIRDIE 670 5014 STEEL AFTERNOON August 28 2009 4 07 32 PM pbarthol BLBT 01 / /0 JLC, BLDG MFG HOME BLOCK/TIEDOWNS September 14 2009 9 40 17 AM 1pangrle BIRDIE 681 0777 BLOCK & TIE DOWNS PERMIT PL 00 PLUMBING PERMIT REQUESTED INSP DESCRIPTION TYP/SQ COMPLETED RESULT RESULTS/COMMENTS PL6 01 9/14 09 JLL, �, PLUMBING WATER SUPPLY ,—f/�,fi.(J= September 11 2009 3 58 40 PM 1pangrle BRUCE 808 4758 WATER SUPPLY LINE FROM THE METER TO THE HOME HE REQUESTED A MORNING INSPECTION COMMENTS AND NOTES Application Number Application pin number Property Address ASSESSOR PARCEL NUMBER Tenant nbr name Application type description Subdivision Name Property Use Property Zoning Application valuation CITY OF PORT ANGELES PUBLIC WORKS & UTILITIES 321 EAST 5TH STREET PORT ANGELES. WA 98362 09 00000829 Date 9/09/09 729757 120 E 10TH ST 06 30 00 0 3 2820 0000 TOM HARLAN RES MANUFACTURED HOME RS7 RESDNTL SINGLE FAMILY 58431 Application desc 1 286 SQ FT MANUFACTURED HOME Owner Contractor TOM HARLAN BUY RITE HOMES 120 E 10TH ST 259403 HWY 101 PORT ANGELES WA 98362 SEQUIM WA 98382 (360) 457 7646 (360) 681 0777 Structure Information 000 000 1 286 SQ FT MANUFACTURED HOME Other struct info TOTAL % LOT COVERAGE 25 30 EXISTING LOT COVERAGE 454 00 LOT SIZE 6994 00 PROPOSED LOT COVERAGE 1318 00 TOTAL LOT COVERAGE 1772 00 NUMBER OF UNITS 1 00 Permit RIGHT OF WAY Additional desc TRENCH POWER ACROSS ALLEY Permit pin number 152942 Permit Fee 50 00 Plan Check Fee Issue Date 9/09/09 Valuation Expiration Date 3/08/10 Qty Unit Charge Per 1 00 50 0000 ECH RIGHT OF WAY PERMIT Special Notes and Comments Address numbers shall be plainly visible from the street Address numbers shall be a minimum of six inches high and be of contrasting color from the background August 18 2009 1 53 54 PM sroberds The proposal will result in placement of a manufactured home in the RS 7 zone for total lot coverage of 25% and site coverage of 27% No land use issues are anticipated Electrical load calculations and electrical permits are required MAINTAIN CLEARANCES FROM SERVICE WIRES Any modifications to the City s electrical facilities will be at the customer s expense August 18 2009 8 23 22 AM Bob Larson 360 417 4706 Consult Public Works Electrical Engineering for power requirements and costs 00 58431 Extension 50 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 taand or ances governin his type of work will be complied with whether specified herein or not. The granting of a permit does not presNmeX,gjve iAhorityX v1 late or cancerthe provisions of any state or local law regulating construction or the performance of ure *C,n r Authorize Ag nt Date Signature of Owner (if owner is builder) Date T \Policies\1102 15 [10/08) NO T�- PERMIT INSPECTION RECORD CALL 417-4831 FOR UTILITY INSPECTIONS. PLEASE PROVIDE A MINIMUM 24 HOUR NOTICE. IT IS UNLAWFUL TO COVER, INSULATE OR CONCEAL ANY WORK BEFORE INSPECTED AND ACCEPTED. POST PERMIT INA CONSPICUOUS LOCATION KEEP PERMIT CARD AND APPROVED PLANS AT JOB SITE INSPECTION TYPE DATE I ACCEPTED COMMENTS I YES I NO PW UTILITIES (Engineering Division) WATERLINE / METER SEWER CONNECTION SANITARY STORM SITE DRAINAGE SITE EROSION CONTROL PARKING SIDEWALK CURB & GUTTER DRIVEWAY APPROACH BACK-FLOW DEVICE l+ FINAL INSPECTIONS REQUIRED PRIOR TO OCCUPANCY/USE RESIDENTIAL DATE YES NO COMMERCIAL DATE ACCEPTED YES NO /PW/ CONSTRUCTION R.W ICONSTRUCTIONR.W ENGINEERING 417-4831 PW / ENGINEERING FIRE 417-4653 FIRE DEPT PLANNING DEPT 417-4750 PLANNING DEPT BUILDING 417-4815 I BUILDING T \Policies\1102.15 [10/08] OFpORT,,,�,0 F�N>i Imo' 07 CITY OF PORT ANGELES PUBLIC WORKS & UTILITIES 321 EAST 5TH STREET PORT ANGELES, WA 98362 Page 2 Application Number 09 00000829 Date 9/09/09 Application pin number 729757 Special Notes and Comments Re connect to existing sewer lateral on 10th Street Sanitary sewer connection inspection is required by Public Works prior to back fill of ditch 24 hour advance notice is required Fee summary Charged Permit Fee Total 50 00 Plan Check Total 00 Grand Total 50 00 Paid Credited Due 50 00 00 00 00 00 00 50 00 00 00 Separate Permits are required for electrical work, SEPA, Shoreline ESA, utilities private and public improvements This permit becomes null and void if work or construction authorized is not commenced within 180 days if construction or work is suspended or abandoned for a period of 180 days after the work as commenced or if required inspections have not been requested within 180 days from the last inspection I hereby certify that ) 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 T•\Po1icies\1102 15 [10/08] Date Signature of Owner (if owner is builder) Date PERMIT INSPECTION RECORD CALL 417-4831 FOR UTILITY 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 PW UTILITIES (Engineering Division) WATERLINE / METER SEWER CONNECTION SANITARY STORM SITE DRAINAGE SITE EROSION CONTROL PARKING SIDEWALK lI CURB & GUTTER I DRIVEWAY APPROACH BACK-FLOW DEVICE RESIDENTIAL I CONSTRUCTION R.W / PW/ ENGINEERING FIRE PLANNING DEPT IBUILDING T \Policies\1102.15 [10/081 DATEIACCEPTED YES I NO FINAL INSPECTIONS REQUIRED PRIOR TO OCCUPANCYIUSE DATE I YES NO COMMERCIAL COMMENTS DATE ACCEPTED YES I NO CONSTRUCTION RW 417-4831 PW / ENGINEERING 417-4653 FIRE DEPT 417-4750 PLANNING DEPT 417-4815 BUILDING COMMENTS DATE ACCEPTED YES I NO ELECTRICAL PERMIT CITY OF PORT ANGELES 360-417-4735 Application Number 09 00000910 Date 9/08/09 Application pin number 994830 Property Address 120 E 10TH ST ASSESSOR PARCEL NUMBER 06 30 00 0 3 2820 0000 Application type description ELECTRICAL ONLY Subdivision Name Property Use Property Zoning RS7 RESDNTL SINGLE FAMILY Application valuation 0 Application desc new manufactored home 200 amp service Owner DATE Contractor INSPECTOR. Harlan Tom G Ir7lb ' KIRSCH ELECTRIC INC 120 east 10th street 6 1•L�7 P 0 BOX 3396 1%*}7 PORT ANGELES WA 98362 SEQUIM WA 98382 FINAL (360) 683 68193 Permit ELECTRICAL ALTER RESIDENTIAL Additional desc Permit pin number 152926 Permit Fee 93 75 Plan Check Fee 00 Issue Date 9/08/09 Valuation 0 Expiration Date 3/07/10 Qty Unit Charge Per Extension 1 00 93 7500 ECH EL MANF HOME SERVICE & FEEDER 93 75 Special Notes and Comments September 4 2009 8 23 21 AM Brian 417 4708 Right of way use permit required to underground conductor across alley Fee summary Charged Paid Credited Due Permit Fee Total 93 75 93 75 00 00 Plan Check Total 00 00 00 00 Grand Total 93 75 93 75 00 00 INSPECTION TYPE DATE RESULTS INSPECTOR. DITCH G Ir7lb ' SERVICE 6 1•L�7 RV 1%*}7 ROUGH IN v FINAL COMMENTS Signature of owner or Electrical Contractor X Date SEP -3-2009 11 18A FROM KIRSCH ELECTRIC 3606830869 TO 4174711 P '1 ' RECEIVED City of Port Angeles Permit Application Building DivisionfEtecuical Inspections 321 East Fifth Street P.Q. Boa 1150 Port Angeles Washington, 98362 Ph: (360) 4174735 Fax. (360) 417.4711 Date: QPoQ 11 & 2 Single Farnily Dwelling _ Mufti -family or Commercial' Commercial Addition / Alteration l Remodel / Repair' SEP 3 2009 ELECTRICAL INSPECTIONS got FORI'm.. 0 ,S) Plan Review May Be Requ_ od, P�e et E earn Pan R i�w In f nnalin Sheet Job Address: k -T7 1 q� p p� Building Square Footage: _ d Description O1 above 'c _ - Owner In�fo �"tion Contrac Informati n Name: — rm )3n Name: C. . Mailing Address: Mallin Address: City state: Zip: City�C5U-' Zip:oL Phone: Phone: License # /Exp. License #/ Ex11 Unit Charge City Total Qty Multiplied btr Ung CbArn !e $ 93.75 S ServicelFseder 200 Amp. $113.75 $ Service/Feeder 201400 Amp. $160.00 $ ServioelFeader 401-600 Amp. $205.00 $ Service/Feeder 601-1000 Amp. $291.25 $ ServicelFeeder over 1000 Amp. $ 2.00 $ Branch circuit W/ Service Feeder $ 57.50 $ Branch Circuit W/O Service Feeder $ 2.00 $ F mh Additional Branch Circuit $ 72.50 $ 1 ixm. 9ervicd Feeder 200 Amp. $ 86.25 f Temp. Service/Feeder 201.400 Amp. 00 Amp. $131.15 $ Temp. ServicefFeeder601 1000 Amp. $ 75.00 $ Pa W to Portal Hourly $ 69.00 $ SignlOulline lighting $ 75.00 $ Signal CircuitfUmited Energy Commercial $ 50.00 $ Signal Circult/ Limited Energy t & 2 Family Dwalling $ 50.00 $ Signal Circuill Limited Energy Multi-FentOy Dwelling $ 93.75 $ _ Manutectured Home Connection $ 80.00 $ Renewable Electrical Energy 5KVA System or less $ 86.25 $ Fitt 1300 Square Ft $ 27.50 $ Each Additional 500 Square Ft or portion of $ 57.50 $ Each Outbuilding or Detached Garage $ 86.25 $ Each &*nming Pool or Hot Tub $ 43.75 $ Thermostat $ q Total (?J 75- 0nvneras &fmmdby RCN! 19.ANI: (7) Owrwwl8 occupy ft sbvcWm far tw years after (Ids efecbica/ permJl is flna8ied (1) Owner Is required to hire an electrical conhactcr 11abowe sald property Is forsale, rent or lease. After reading the above statement. I hereby certify that I am the owner of the r 4:*ve 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 1928, WAC. Chapter Z9W611, The city of Pon Angeles Municipal code, and Utility Specifications. Signature of owner, electrical contractor or electrical adminktrator Dille;Et V - V� SEP -3-2009 11 19A FROM KIRSCH ELECTRIC 3606830869 TO 4174711 P e? • RECEIVED SEP 3 aug EleCkfiPAService Information Form INSPECTIONS Public Works Engineering Department (360) 417.A700 Please complete and return to Public Works Engineering Department Applicant (rill'brmatio- Permanent service. Name Name and address of party Istreet. t Jr, responsible for permanent Icily I state I'ZIP. service billing? IDayarne Phone; Home Phone: Street address / lot number Nearest cross street: Desired connection date. Electrical transformer servino Prop `- K I . . -1..."Dw. N 0 on a Dole on th nd Total square footage, Maln disconnect size ---amps voltage_ 20d40 1ph [D1261208 3ph 0277/480 3ph 101 2Of240 3ph 0480 3VV 3ph 171 Other Cg Standard residential loads (Lighting, refrigerator dishwasher washer) Hot Tub Check all that apply A/C ( FLA) Range/Oven [3 6Clothes Dryer qHeating 0 Pumps (Hp) Water Heater 0 Elevator f Hp) 0 Other Please provide a copy of the following* 'Detailed plot plan (.dwg or.dxf format mandatory for subdivisions). *Electrical one -line drawing showing the service entrance panel and location, *Connected load data. Size and locked rotor amps of all motors over 50hD Applicant's Signature LZO; 1;4,a. - Date QPD9 MAIL OR DELIVER COMPLETED FORM47321 E 5TH STREET PORT ANGELES WA 98362 cAX TO360-417-4709 EMAIL, riarson@cityofpa.us EMAIL. bandersocitycl'pa us WS information form N-.DVVKSI,LIGHTIENC,R%#OiiginatsMnicwmatioii form Revised 4.17-08 0 0 IName. -nue Site contact; Daytime Phone. iName: Company Contractor Daytime Phone: Electrician iName-VN Daytime Phone: Excavator, Name: iDaytime Company Phone. Project Type �ingle-famlly residence ,commercial []Multi -family residence* 7 MIS RSubdlvision; # of lots ❑Overhead service 00ene ral service ❑ underground service 1710ther Street address / lot number Nearest cross street: Desired connection date. Electrical transformer servino Prop `- K I . . -1..."Dw. N 0 on a Dole on th nd Total square footage, Maln disconnect size ---amps voltage_ 20d40 1ph [D1261208 3ph 0277/480 3ph 101 2Of240 3ph 0480 3VV 3ph 171 Other Cg Standard residential loads (Lighting, refrigerator dishwasher washer) Hot Tub Check all that apply A/C ( FLA) Range/Oven [3 6Clothes Dryer qHeating 0 Pumps (Hp) Water Heater 0 Elevator f Hp) 0 Other Please provide a copy of the following* 'Detailed plot plan (.dwg or.dxf format mandatory for subdivisions). *Electrical one -line drawing showing the service entrance panel and location, *Connected load data. Size and locked rotor amps of all motors over 50hD Applicant's Signature LZO; 1;4,a. - Date QPD9 MAIL OR DELIVER COMPLETED FORM47321 E 5TH STREET PORT ANGELES WA 98362 cAX TO360-417-4709 EMAIL, riarson@cityofpa.us EMAIL. bandersocitycl'pa us WS information form N-.DVVKSI,LIGHTIENC,R%#OiiginatsMnicwmatioii form Revised 4.17-08 0 0 SEP -.3-2009 11 19A FROM KIRSCH ELECTRIC fiL74711 tt GrJUy Ur 1L 1JOUOdlU/n (jj,,■■//LlVVt East 10th Street SEP 3 2009 ELECTRICAL Grass area INSPECTIONS motcc�-: Al4rwalK 30-W), Harlan, Tom 120 E. 10th St Port Angeles Parcel #� p630�0032$2QQ000 North Propo-4.U'0 --- -- Romp 1.40 00' zdxaa of 14000 112.22' 75=1 i r _ I I _ I 1 �xlsting I PNrking gan�gc I i I I Alley Power Pula scale 1" = 20 as Of 7/2.1/09 Ug6%f-Q cQ-bv NLY-> 5fvi(—rr— -6z'r c i O 1 0 PREPARED 8/28/09 8 56 33 INSPECTION TICKET PAGE 11 CITY OF PORT ANGELES INSPECTOR JAMES LIERLY DATE 8/28/09 ADDRESS 120 E 10TH ST SUBDIV TENANT NBR TOM HARLAN CONTRACTOR BUY RITE HOMES PHONE (360) 681 0777 OWNER TOM HARLAN PHONE (360) 457 7646 PARCEL 06 30 00 0 3 2820 0000 APPL NUMBER 09 00000829 RES MANUFACTURED HOME PERMIT BLM 00 BL MANUFACTURED HOME REQUESTED INSP DESCRIPTION TYP/SQ COMPLETED RESULT RESULTS/COMMENTS BLRI 01 8/28 09 JLL LDG REBAR INSPECTION TIME 01 00 ugust 27 2009 4 55 00 PM 1pangrle (Fj( BIRDIE 670 5014 EEL "AF� RNOON ' COMMENTS AND NOTES "d wF CITY OF PORT ANGELES PUBLIC WORKS & UTILITIES 321 EAST 5TH STREET PORT ANGELES, WA 98362 Application Number 09 00000829 Date 8/24/09 Application pin number 729757 Property Address 120 E 10TH ST ASSESSOR PARCEL NUMBER 06 30 00 0 3 2820 0000 Tenant nbr name TOM HARLAN Application type description RES MANUFACTURED HOME Subdivision Name Property Use Property Zoning RS7 RESDNTL SINGLE FAMILY Application valuation 58431 Application desc 1 286 SQ FT MANUFACTURED HOME Owner Contractor TOM HARLAN BUY RITE HOMES 120 E 10TH ST 259403 HWY 101 PORT ANGELES WA 98362 SEQUIM WA 98382 (360) 457 '7646 (360) 681 0777 Structure Information 000 000 1 286 SQ FT MANUFACTURED HOME Other struct info TOTAL % LOT COVERAGE 25 30 EXISTING LOT COVERAGE 454 00 LOT SIZE 6994 00 PROPOSED LOT COVERAGE 1318 00 TOTAL LOT COVERAGE 1772 00 NUMBER OF UNITS 1 00 Permit SANITARY SEWER HOOK UP Additional desc Permit pin number 152298 Permit Fee 135 00 Plan Check Fee Issue Date 8/24/09 Valuation Expiration Date 2/20/10 Qty Unit Charge Per 1 00 135 0000 EA SAN SEWER HOOKUP Special Notes and Comments Address numbers shall be plainly visible from the street Address numbers shall be a minimum of six inches high and be of contrasting color from the background August 18 2009 1 53 54 PM sroberds The proposal will result in placement of a manufactured home in the RS 7 zone for total lot coverage of 25% and site coverage of 27% No land use issues are anticipated Electrical load calculations and electrical permits are required MAINTAIN CLEARANCES FROM SERVICE WIRES Any modifications to the City s electrical facilities will be at the customer s expense August 18 2009 8 23 22 AM Bob Larson 360 417 4706 Consult Public Works Electrical Engineering for power requirements and costs 00 58431 Extension 135 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 o inances governing this type of work will be complied with whether specified herein or not. The granting of a permit does not presum give author' o violate or cancel the provisions of any state or local law regulating construction or the performance of nstr ion S&ature of Cork r or Authoriz gent Date Signature of Owner (if owner is builder) Date T-\Policies\1 10215 [10/08] PERMIT INSPECTION RECORD CALL 417-4831 FOR UTILITY INSPECTIONS PLEASE PROVIDE A MINIMUM 24 HOUR NOTICE. ITIS UNLAWFUL TO COVER, �r INSULATE OR CONCEAL ANY WORK BEFORE INSPECTED AND ACCEPTED. POST PERMIT INA CONSPICUOUS LOCATION KEEP PERMIT CARD AND APPROVED PLANS AT JOB SITE INSPECTION TYPEI DATE I ACCEPTED I COMMENTS YES I NO PW UTILITIES (Engineering Division) WATERLINE / METER SEWER CONNECTION I` SANITARY STORM SITE DRAINAGE ' SITE EROSION CONTROL PARKING SIDEWALK CURB & GUTTER DRIVEWAY APPROACH I BACK-FLOW DEVICE FINAL INSPECTIONS REQUIRED PRIOR TO OCCUPANCY/USE RESIDENTIAL DATE YES NO COMMERCIALI DATE ACCEPTED YES NO CONSTRUCTION R.W /PW/ CONSTRUCTION R.W ENGINEERING 417-4831 PW / ENGINEERING FIRE 417-4653 FIRE DEPT PLANNING DEPT 417-4750 PLANNING DEPT BUILDING 417-4815 BUILDING T \Policies\1102 15 [10/08] CITY OF PORT ANGELES PUBLIC WORKS & UTILITIES 321 EAST 5TH STREET PORT ANGELES, WA 98362 Page 2 Application Number 09 00000829 Date 8/24/09 Application pin number 729757 Special Notes and Comments Re connect to existing sewer lateral on 10th Street Sanitary sewer connection inspection is required by Public works prior to back fill of ditch 24 hour advance notice is required Fee summary Charged Paid Credited Due Permit Fee Total 135 00 135 00 00 00 Plan Check Total 00 00 00 00 Grand Total 135 00 135 00 00 00 Separate Permits are required for electrical work, SEPA, Shoreline ESA, utilities private and public improvements This permit becomes null and void if work or construction authorized is not commenced within 180 days if construction or work is suspended or abandoned for a period of 180 days after the work as commenced, or if required inspections have not been requested within 180 days from the last inspection I hereby certify that I have read and examined this application and know the same to be true and correct. All provisions of laws and ordinances governing this type of work will be complied with whether specified herein or not. The granting of a permit does not presume to give authority to violate or cancel the provisions of any state or local law regulating construction or the performance of construction. Signature of Contractor or Authorized Agent T-\Po1icies\1102 15 [10/08] Date Signature of Owner (if owner is builder) Date PERMIT INSPECTION RECORD CALL 417-4831 FOR UTILITY INSPECTIONS. PLEASE PROVIDE A MINIMUM 24 HOUR NOTICE. IT IS UNLAWFUL TO COVER, ,? INSULATE OR CONCEAL ANY WORK BEFORE INSPECTED AND ACCEPTED. POST PERMIT INA CONSPICUOUS LOCATION ' KEEP PERMIT CARD AND APPROVED PLANS AT JOB SITE INSPECTION TYPEI DATE I ACCEPTED I COMMENTS I YES I NO PW UTILITIES (Engineering Division) WATERLINE / METER SEWER CONNECTION SANITARY 1 STORM I` SITE DRAINAGE SITE EROSION CONTROL PARKING SIDEWALK CURB & GUTTER DRIVEWAY APPROACH BACK-FLOW DEVICE I 1 I FINAL INSPECTIONS REQUIRED PRIOR TO OCCUPANCY/USE RESIDENTIAL DATE YES NO COMMERCIAL DATE ACCEPTED YES NO CONSTRUCTION R.W /PW/ CONSTRUCTION R.W ENGINEERING 417-4831 PW / ENGINEERING FIRE 417-4653 FIRE DEPT PLANNING DEPT 417-4750 PLANNING DEPT BUILDING 417-4815 BUILDING T Policies\1102 15 [10/08] Application Number Application pin number Property Address ASSESSOR PARCEL NUMBER Tenant nbr name Application type description Subdivision Name Property Use Property Zoning Application valuation Application desc DEMOLISH THE BURNED HOME Owner CITY OF PORT ANGELES PUBLIC WORKS & UTILITIES 321 EAST 5TH STREET PORT ANGELES, WA 98362 09 00000831 Date 8/24/09 621524 120 E 10TH ST 06 30 00 0 3 2820 0000 TOM HARLAN DEMOLITION RS7 RESDNTL SINGLE FAMILY 0 Contractor TOM HARLAN DIAMOND CONST & EXCAVATING INC 120 E 10TH ST PO BOX 700 PORT ANGELES WA 98362 SEQUIM WA 98382 (360) 457 7646 (360) 683 2257 Structure Information 000 000 DEMOLISH THE BURNED HOME Permit SANITARY SEWER HOOK UP Additional desc Permit pin number 152124 Permit Fee 300 00 Plan Check Fee Issue Date 8/24/09 Valuation Expiration Date 2/20/10 Qty Unit Charge Per 1 00 300 0000 EA SAN SEW CAP/PULL W/M Special Notes and Comments Sewer lateral shall be exposed to the property line an inspection by Public Works Engineering is required The sewer lateral will be capped A 2 X4 X36 pressure treated post painted green and marked S S Stub indicate depth to service to the nearest foot Attach a 12 gauge galv wire to cap and stake An approved Public Works Waste Disposal Application is required prior to taking material to transfer station 00 0 Extension 300 00 Other Fees STATE SURCHARGE 4 50 Fee summary Charged Paid Credited Due Permit Fee Total 300 00 300 00 00 00 Plan Check Total 00 00 00 00 Other Fee Total 4 50 4 50 00 00 Grand Total 304 50 304 50 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 Vumegive autho ' to violate or cancel the provisions of any state or local law regulating construction or the performance of _ /f Co ra for or Auth iz Agent Date Signature of Owner (if owner is builder) Date T \Policies\1 102 15 [ 10/08] PERMIT INSPECTION RECORD CALL 417-4831 FOR UTILITY INSPECTIONS PLEASE PROVIDE A MINIMUM 24 HOUR NOTICE. ITIS UNLAWFUL TO COVER, INSULATE OR CONCEAL ANY WORK BEFORE INSPECTED AND ACCEPTED. POST PERMIT INA CONSPICUOUS LOCATION KEEP PERMIT CARD AND APPROVED PLANS AT JOB SITE INSPECTION TYPE DATE I ACCEPTED COMMENTS YES I NO PW UTILITIES (Engineering Division) WATERLINE/METER SEWER CONNECTION SANITARY STORM SITE DRAINAGE SITE EROSION CONTROL PARKING SIDEWALK CURB & GUTTER DRIVEWAY APPROACH BACK-FLOW DEVICE FINAL INSPECTIONS REQUIRED PRIOR TO OCCUPANCY/USE RESIDENTIAL DATE YES NO COMMERCIAL DATE ACCEPTED YES NO CONSTRUCTION R.W /PW/ CONSTRUCTION R.W ENGINEERING 417-4831 PW / ENGINEERING FIRE 417-4653 I FIRE DEPT PLANNING DEPT 417-4750 I PLANNING DEPT BUILDING 417-4815 I BUILDING 1 1 T Policies\l 102 15 [10/08) CITY OF PORT ANGELES ���� DEPARTMENT OF COMMUNITY & ECONOMIC DEVELOPMENT BUILDING DIVISION W 321 EAST 5TH STREET PORT ANGELES, WA 98362 Application Number Application pin number Property Address ASSESSOR PARCEL NUMBER Tenant nbr name Application type description Subdivision Name Property Use Property Zoning Application valuation 09 00000829 Date 8/24/09 729757 120 E 10TH ST 06 30 00 0 3 2820 0000 TOM HARLAN RES MANUFACTURED HOME RS7 RESDNTL SINGLE FAMILY 58431 Application desc 1 286 SQ FT MANUFACTURED HOME Owner Contractor TOM HARLAN BUY RITE HOMES 120 E 10TH ST 259403 HWY 101 PORT ANGELES WA 98362 SEQUIM WA 98382 (360) 457 7646 (360) 681 0777 Structure Information 000 000 1 286 SQ FT MANUFACTURED HOME Other struct info TOTAL % LOT COVERAGE 25 30 EXISTING LOT COVERAGE 454 00 LOT SIZE 6994 00 PROPOSED LOT COVERAGE 1318 00 TOTAL LOT COVERAGE 1772 00 NUMBER OF UNITS 1 00 Permit BL MANUFACTURED HOME Additional desc 1 772 SF MANUF HOME Permit pin number 151845 Permit Fee 230 00 Plan Check Fee Issue Date 8/24/09 Valuation Expiration Date 2/20/10 Qty Unit Charge Per BASE FEE Permit PLUMBING PERMIT Additional desc WATER LINE MTR TO HOME Permit pin number 151852 Permit Fee 57 00 Plan Check Fee Issue Date 8/24/09 Valuation Expiration Date 2/20/10 Qty Unit Charge Per BASE FEE 1 00 7 0000 EA PL WATER LINE Special Notes and Comments Address numbers shall be plainly visible from the street Address numbers shall be a minimum of six inches high and be of contrasting color from the background August 18 2009 1 53 54 PM sroberds 00 58431 Extension 230 00 `via lei 00 0 Extension 50 00 7 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 grant' a permit d s not presume to ive authority to violate or cancel the provisions of any state or local law regulating construction or the performance of co structi, 3 Date Print Name Signature o on or or AuthorizAgent Si nature of Owner (if owner is builder) T:FormsBuilding Division/Building Permit IF 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 I Date ( Accepted By Comments FOUNDATION Footings Stemwall I 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 by AIR SEAL. Walls Ceiling FRAMING jI Joists / Girders / Under Floor I Shear Wall / Hold Downs i Walls / Roof / Ceiling Drywall (Interior Braced Panel Only) T -Bar INSULATION Slab Wall / Floor/ Ceiling MECHANICAL. Heat Pump / Furnace / FAU / Ducts Rough -In I Gas Line Wood Stove / Pellet / Chimney Commercial Hood / Ducts FINAL Date Accepted by MANUFACTURED HOMES I Footing / Slab Blocking 8 Hold Downs I I Skirting PLANNING DEPT Separate Permit #s SEPA. Parking / Lighting I ESA. Landscaping I 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/Buiiding Division/Building Permit CITY OF PORT ANGELES DEPARTMENT OF COMMUNITY & ECONOMIC DEVELOPMENT BUILDING DIVISION 321 EAST 5TH STREET PORT ANGELES, WA 98362 Page 2 Application Number 09 00000829 Date 8/24/09 Application pin number 729757 Special Notes and Comments The proposal will result in placement of a manufactured home in the RS 7 zone for total lot coverage of 25% and site coverage of 27% No land use issues are anticipated Electrical load calculations and electrical permits are required MAINTAIN CLEARANCES FROM SERVICE WIRES Any modifications to the City s electrical facilities will be at the customer s expense August 18 2009 8 23 22 AM Bob Larson 360 417 4706 Consult Public Works Electrical Engineering for power requirements and costs Re connect to existing sewer lateral on 10th Street Sanitary sewer connection inspection is required by Public Works prior to back fill of ditch 24 hour advance notice is required Fee summary Charged Permit Fee Total 287 00 Plan Check Total 00 Grand Total 287 00 Paid Credited Due 287 00 00 00 00 00 00 287 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 1 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. Date Print Name T.Forms/Building Division/Building Permit Signature of Contractor or Authorized Agent Signature of Owner (if owner is builder) T.Forms/Building Division/Building Permit 4L, BUILDING PERMIT INSPECTION RECORD g — PLEASE PROVIDE A MINIMUM 24-HOUR NOTICE FOR INSPECTIONS — 00 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 I Accepted ByComments FOUNDATION (�Fi��i 8-�,� P.3 Footings I Stemwall q Foundation Drainage (Downspouts) 11 C11 �Gr Piers Post Holes (Pole Bldgs.) PLUMBING Under Floor / Slab Rough-in Water Line (Meter to Bldg) 9- M-M -SI ,Io Gas Line I ® J u- Back Flow / Water BackFINAL Date Accepted by SEAL. I N Walls 0 Ceiling I I FRAMING. Joists / Girders / Under Floor Shear Wall / Hold Downs Walls / Roof / Ceiling Drywall (Interior Braced Panel Only) 0 T-Bar INSULATION. Slab Wall / Floor / Ceiling MECHANICAL. Heat Pump / Furnace / FAU / Ducts t Rough-In I Gas Line Wood Stove / Pellet / Chimney Commercial Hood / Ducts FINAL Date Accepted by MANUFACTURED HOMES I Footing / Slab Blocking & Hold Downs �1 Skirting (PLANNING DEPT Separate Permit#s SEPA. Parking / Lighting ESA. 11-andscaping I 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 lo— 16- Dq T1' l T.Forms/Building Division/Building Permit 4L, CITY OF PORT ANGELES DEPARTMENT C IMMUNITY & ECONOMIC DEVELC :NT BUILDING DIVISION 321 EAST 5TH STREET PORT ANGELES 98362 Application Number Application pin number Property Address ASSESSOR PARCEL NUMBER Tenant nbr name Application type description Subdivision Name Property Use Property Zoning Application valuation Application desc DEMOLISH THE BURNED HOME Owner 09 00000831 Date 8/24/09 621524 120 E 10TH ST 06 30 00 0 3 2820 0000 TOM HARLAN DEMOLITION RS7 RESDNTL SINGLE FAMILY 0 Contractor TOM HARLAN DIAMOND CONST & EXCAVATING INC 120 E 10TH ST PO BOX 700 PORT ANGELES WA 98362 SEQUIM WA 98382 (360) 457 7646 (360) 683 2257 Structure Information 000 000 DEMOLISH THE BURNED HOME Permit DEMOLITION Additional desc DEMOLISH THE BURNED HOME Permit pin number 151878 Permit Fee 50 00 Plan Check Fee Issue Date 8/24/09 Valuation Expiration Date 2/20/10 Qty Unit Charge Per BASE FEE Special Notes and Comments Sewer lateral shall be exposed to the property line an inspection by Public Works Engineering is required The sewer lateral will be capped A 2 X4 X36 pressure treated post painted green and marked S S Stub indicate depth to service to the nearest foot Attach a 12 gauge galv wire to cap and stake An approved Public Works Waste Disposal Application is required prior to taking material to transfer station 00 0 Extension 50 00 Other Fees STATE SURCHARGE 4 50 Fee summary Charged Paid Credited Due Permit Fee Total so 00 50 00 00 00 Plan Check Total 00 00 00 00 Other Fee Total 4 50 4 50 00 00 Grand Total 54 50 54 50 00 00 01 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 regulatin construction or the performance f co structio . z�/Ag�� Date Print Name Signature of Contractor or AuthorizedAgent 5ignature of Owner (if owner is builder) T:Forms/BuiWing Division/Building Permit C> 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 I Date I Accepted By Comments FOUNDATION Footings I Stemwall Foundation Drainage / Downspouts Piers Post Holes (Pole Bldgs) PLUMBING Under Floor / Slab ( j Rough -In Water Line (Meter to Bldg) Gas Line Back Flow/ Water FINAL Date Accepted by AIR SEAL. N Walls I Q Ceiling FRAMING Joists / Girders / Under Floor �> Shear Wall / Hold Downs Walls / Roof / Ceiling Drywall (Interior Braced Panel Only) T -Bar INSULATION Q Slab Wall /Floor /Ceiling MECHANICAL. +I Heat Pump / Furnace / FAU / Ducts In Gas Li Gas Li i Wood Stove / Pellet / Chimney I Commercial Hood / Ducts I FINAL Date Accepted by MANUFACTURED HOMES Footing / Slab Blocking & Hold Downs Skirting (PLANNING DEPT Separate Permit#s SEPA. IParkinq / Lighting I ESA. (Landscaping I 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 0 Planning 417-4750 Building 417-4815 C T.Forms/Building Division/Building Permit 04 1,1 DEPT f IF 11D FAX Rn 3bij4174711 F out BUILDING PERMIT APPLICATIONPrint in ink CITY OF PORT ANGELES D te Received F OlU' i -' Attn*,Building Permit Technician qr'ived §.1-nNtly S o U-1 ,321'E- Fifth St. Port Angeles, W4 9,8362 .Permit# (Olf-2541 (360) 417-4815 fax (360) 417-4111 Dat A 11 bi I_r Applicant ;V/11jnX6L7) 67.sw Property OwmV Property Owner's Address Contractor Ly 0 Contractor's Address License # ftex PROJECT ADDRESS Parcel Number 7 7?Y.1,'rj.4A)' 011'TIN(r, 11W Phone `7 -7 ZFAIL- NIV7 1,�6 'Pt F — Phone �Z 7 416, 4AI&S-It-1 , WA pp.36d_ —0 / role Phony(OF3 -2 0 C -7. 169 V eg Expir6s / 0/ - d" 0 16 E-mail- � -St4yALIbX 7M - Lot ming Proiect Tvjje & Brief Descriotion; XResidenth4l Ohack all that apply kil o New Construction AZ 4 15 &S-ro-S o Addition o Remodel -qmulti-family to C omMerOgI n Industrial ll ,4Z "O'el .04 404AF,6 Rd u Repair Al -6, 4/p/ /IZ� 1)6WWAlflelre XDemolition IS 04'15 9447,M01 _F4 ?&Lbe &V,645 DCAT*. o Re -.roof Nouse o garage -o other o tear off & re -roof o lay over one layer o, Heat System o.Heat pump o wood -burning stove, o gas fireplace o pellet stove o other o Other Floor Areas Raserrient 15'rioor 2"c'Floor 3,d Floor Garage Carport Covered Porch Deck Shed Other Exlstlaci (sct. ft.) Proposed (Scy, ft.) per sq, ft. = $ TOTAL-VA-LUATIOM-$ Total footprint of structures sq ft. Lot sizeLot coverage Site Coverage = the am urn of imperviolksurface ona parcel inc structures . /pWed driveways, sidewalks, patios, and other impervious stVaces. {se ,'AMC 17 94 135 for exemptions) Site coverage % Max, height of proposed str t es ft: Occupancy group # of bedrooms Will a lawn sprinkler systen installed? Occupant 10,11, # of full baths pe o u I VVIII a fire sprinkler syste be i tallQd? Construction type It of half baths 1. have Mad end cornple ed this apply', tion and know it to he true end correct /le-ni authorize to jppf for this permit and understand th9t It is My responsibility to determine what -permits are required, andto obtain permits prg n proib Date -X"- Print Name D&V 1t"1&Z115X D1,19W4 Signatures TF'orrns;Buildlnq Divisionlaid,q &01_y�',1017 Permit,doo / ^ / / / ~ / / / / / / / / / / u I / / / / / / / / / / / / / I � / / / � / / / / / u I / / / / / / / / / / / / / I � / / Ilk After recording, return to (Name, Address, Zip): ---_-----1�ur•/ ------------------------- -------- - r!- --------------------------- QUITCLAIM DEED (Statutory /Form) Grantor(s): C� r ___ -"I_1_ -L!�2 Grantee(s): -a Abbreviated Legal Description._ l __-4 Assessor's Property Tax Parcel or Account No: _Q.1� Reference No(s) of Documents Assigned -or Released NO q I o? I CLALLAM COUNTY — TRANSACTION EXCISE TAX DATE PAID JUN 2 9 2009 t" h4cLI0 M AQ— COUNTY TREASURER 'ZU ---5200 ----------------------- -c9 d %j1_-����✓`-�-------------------------------------------- rls�"p7ey-------------------------------------------------------------------------- for and in consideration of ----------------------------------I--------------------- --- a ------------------------------------------------------ conveys and quitclaims to----f-r�-----rLu-------------------------------------------=-------- ----------------------------------------------------------------------------------------------------------- Grantee, all right, title and interest in the following described real estate, situated in ------------------------ County ______________ ________County State of Washington, together with all after acquired title of the Grantor therein. DATED ----- STATE OF WASHINGTON County of ___- C1Q ff-a -w- ) s . I ce that I k ow o av ahsfa tory evidence that------�---� ----- - - ________-_ _ __-_ _ _ _________ is/are the individual(s) who appeared be ore me, and who acknowledged that he/she/they signed this instrument and acknowledged it to be his/her/their free and voluntary act for the uses and puyposes,mentioned in the irsf,,. aat. /I _ �----- ,'¢ENE DATED ----- _ p� PTY Q ------ ----- tart' Public f Washingto D�.O�Wn /� 12 / "' appointment expires _____ .I J_✓� U-- PUBLISHER'S NOTE. it a corporate grantor, complete Acknowledgment. r— Form No. 289 — Ouilclaim Deed (Statutory Form) =r © 2006 Washington Legal Blank, Portland, OR www.wlbforms.com �' NO PART OF ANY WASHINGTON LEGAL FLANK FORM MAY BE REPRODUCED IN ANY FORM On BY A.JY ELECTRONIC OR MECHANICAL MEANS. J 2009-1239196 Page 1 of 2 Quit Claim Deed Tom Harlan Clallam County Washington 06/29/2009 11 57 36 AM ■III h'i'p PVilVlV54V tNi11,W IW'& PAW, Nil, Mill 11111 After recording, return to Name, Address, Zip): c� [Q------------- NO. f� -------------------- CLALLAM COUNT t TRANSACTION EXCISE TAX *� ---- gW34� ----- DATE JUN 2 9 2009 ---------------------------------------------------- ---- '�Vr QUITCLAIM DEED (Statutory Form) COUNTY TREASUR�ER BY P�� r—c�w� i Grantor(s).---^lag-k--L_'ra Grantee(s) -- 3--- --1 ------------------------------------------------------------------- Abbreviated Legal Description. ___L Q _____/ _ -V____________ ___________________________ Assessor's Property Tax Parcel or Account No -_________________________ Reference No(s) of Documents Assigned or Released_QL2K�_21_dQ v_______________________________________ P�u_r - ---- ��=---�_I�r_1�r r�_c�► �� lA- --------------------------------------------------- - ------------------------ - ---- �------------- --------------------------dvvv -- �,----------- Grantor, - for and in consideration of __�__4_�_-1��_��/ _ _/ ----------------------------------------------------------------------------------------------------------------- conveys and quitclaims to -- c� 1Cc.L--- ----- ----------------------------------------------------- ----------------------------------------------------------------------------------------------------------- Grantee, all nght, title and interest in the following described real estate, situated in ___(jCL-j✓? ________________________ County State of Washington, together with all after acquired title of the Grantor therein "k) ra-'O se O �- /'off- STATE OF WASHINGTOCounty of ___ L! K LCA-'__________________ ss. I. e th knoA,7--= tisfactory evidence that ______-___ ___ __ __ --------------------- is/are the individual(s) who appeared before me, and who acknowledged that he/she/they signed this instrument and ackno)eedit to be his/her/their free and voluntary act for the uses and p rpose menti ne m the instrument. �DATED ---- - --------------------------l Notary Public f6dWashington J My appointment expires _____/( �t GENE �F PUBLISHER'S NOTE. If a corporate grantor, complete and attach Form No. 68, Corporate Acknowledgment Form No. 289 — Quitclaim Deed (Statutory Form) ES ng 2006 Washington Legal Blank, Portland, OR www.wlbforms.com NO PART OF ANY WASHINGTON LEGAL BLANK FORM MAY BE REPRODUCED IN ANY FORM OR BY ANY ELECTRONIC HANICAL MEANS. �nr1 N ILA"% C I TY F TANGELES YV WASHINGTON U S A. A, Public -Wo rks & Utilities DeP artment August 20 2009 Diamond Construction & Excavating Inc. P 0 Box 700. Sequim, WA 98382 RE. Port Angeles Landfill I Transfer Waste Disposal Application, WDA 09-0 for 120 E. 10"' Street. We have received your application for disposal of building demolition debris fi-orh the referenced site and reviewed the testing results for asbestos content. Based on the -testing 'results the debris' Appears to be,acceptable for disposal at the transfer station .Atopy of your approved:application is attached. This .approved application must be shown to. the transfer station scale attendant at the time of disposal. Please be advised that this disposal application -is only for the material's and quantities listed in the application. Materials not listed orin excess of the quantities noted may require separate al, Pkations and approval. Please call if you have questions. Sincerely Stephen Sperr P.E. City Engineer Encl. WDA 09-13 Cap Transfer -Station waste Connections NI:NPWKSkENGINtil�'RNN%IDAI,PLIC wzj3 File: le: Lindfill Solid WasteDisposal Applit: Phone- 360 -417 -4800,/ -Fax: 360 417-4542 Website wvw cityofpa us / Email pubficworks,��)cityofpa,us 321 East Fifth Street P 0 Box 1150 / Port Angeles %,VA 98362-0217 J 4 DFr'T IN TIINI DEV F " Uk.31604174" . I A .Pon,[ gyp fi Gm PORT A.,NGELES LANDFILL D N r" -A WASTE DISPOSAL APP1,11CATION 2009 city of W Age.l. To City -of Port Angeles, City Engineer Phon{3G0): �D) 417-4803 Pubilc Viorks and 'fillies oep, IngweeringLes Division 'Sery M E. Fifth Streat FAX, (WO).417-47'09 P 0 Hoo 1150 Port Angeles, Washington 98362 NOTE. All questions must be answered for waste to be approved. 'I Generator Information: Company Name. gL_ Mailing Address. 101le 'A.T"IX Contact: /x/ Phone: Z --2,r 7* 6-01 Project Name. 4/— 4A,) Project Location: 112Z4 2. Other Contacts (if applicable)' Consulting Firm. A111'10%,�'vlr Contact: 3d 6 /C-/ Phone, Cbriti-actor Name, /< L/ Contact: \1,-'AA1e- �y�o< - 1�6eAIIY'41'26 Ke 9 14 Ar— phone p l.ahoratory- atCAR conia(T Phone Pori p<)e 1 of 5 ii :U11; ,' DE _r u 1'•3 Source of Waste: i i Check the appropriate box. below and briefly describe the proJect, process, andlor cleantip thatl will or has produce_ d the waste requiring disposal. Include the. -gasoline service.statinn.number} (it applicable). I I 1 f:FRGLAfMTCA Remediation Agency Contact: i Independent Remedial Action _— UST Removal _-_-- Unused Chemical Product Spill Other Source J ! 114 Waste Material Composition- 1 (check all that apply and .include,percent of total) Soil '; 'Foundry Slag % Goncrete7Asphalt y % Dredge Sediments - - ) °/v Preserved Wood -��� % -_--- Debris t !_ Coal A.sh _% _ Other (list) ` Wood Ash 1; - -- - __ - %n MOTE. Total must equal Wasto Material Contaminants. (ehec_k all that apply) Gasoline � ---- -- sclWellts. 1 UnLrsed Moior Oil -- Other -- -- _.— r� ! t�letats. ��' DIP.SP.I - . ting-Dil. ._i -PCBs- i __—_— Used Mo - 'I/Waste 0 i j ___-- Other Petroleum Product'`;-�- -�_-- Unknown NOTE. Supply any MSDS information with appl;cat,on if available City or PQrt Angolo,: .t_: rr:Iroi Waste nisposal Aupiic tion Paye 2 of 5 UG ' 2"ISI' TIE {i J4 I DEFT SIF GOl4M DEV RAX uo ;6J'=1 i� 71 6 Estimated Quantity of Waste for Disposal' F' J04 _ Cubia yards 1 Tons (estimate both) - Drums / Tons (estimate both) Other NOTE. Estimated quantity for disposal. must be within 20% of the quantity actually disposed. (10% for projects over 7,500 tons or 5,000 cubic yards.) t Freguenny of disposal. -- / one time r Monthly Annual tither 8 Waste Sampling, - Proper characterization of the waste for disposal. requires the collection of representative samples The methods and equipment necessary for obtaining representative samples of a waste,and the frequency 9fsampling will vary with the type and farm of the waste. CHO& the appropriate box and briefly describe how and where the waste was sampled. Include site+chaps v4th sampling, locations if possible Number of COMP0811TE samples & number of discrete samples per composite Number of DISCRETE. samples w,l/ fAx 'PrAgr�� s�M�i�,/ZWAr-e-M To 104 W6'je -3 lA"c.' NOTE 1 Unless prior approval has been granted by Port Angeles, the following sampling .frequency-will,be. used 0 - 25 cubic yards 1 composite -sample 25 100 cubic yards - 3 composite samples 101-500 cubic yards - 5 composite samples 501 1.000 cubic yards - 7 composite samples 1001-2000 cubic yards = 10 composite samples >2000 cubic yards - 10 plus one sample for each additional 500 cubic yards NOTI" 2: One composite sample shall contain a cnininium of three/maximum of five discrete sample City of Port Angeles Land ill Waste; Disposal Application mage 3 of 6 1 `I [ T 1.11. 1 i.�llt1 .)EV Iry , q Waste Analysis `---- --- - ---------_.—__ . -- . The 'Dangerous Waste Regulations (WAC 171-303) shall be utilized to determine .the appropriate anaiytical requirements for waste characterization. Ecology Publication ##91 30 i (Revised April 1994) 'Guidance for Remediation of Petrolaum Contaminated Soils' shall.also. kre Lased to charictr.rize petrt)leum.contaminated soils from 1.181- releases Submit all laboratory analytical results CSA/QC data, and Chain of Custody sheets along with this application. (NOTE The laboratory must be accredited by the"Washington State Department of Ecology j 1 a) List all analytical test methods used. i j b) Provide, a narrative as to why the bbrve analyticaf methods Were selected: � NOTE: Additional sheets attached: YES NO 10. Soil Classification (."FOR PETROLEUM CONTAMINATED SOILS ONLY") i Based can the anal al data and Ecology P blieation -#91�-30 the soil classification is: l'� fJ. (check one.) ClassI ' _ Class 3 _ _ Class 4 ) Calculated Hazard Index 1 11 .Dangerous - Waste Affidavit: -- - --�-� i Lased un a review of the analytical test results, site history and the applicable re ulelions, l this waste is classified as: (check one) l Weitlior Dangerous Waste (DW) nor Extremely Hazardous Waste (EHW) Dangerous Waste (DW) and Waste Code _ Exh'Gmely l-lazardous W°astp. (EHW) and Was .e Code City of ,Porl-Angek;s 21-an(Nbl,11 Wa6le DiSpo*;ai ArapticatiQn Pact� 4 of o 3i 1, ,,f _,Iyff,- )F 1,"RAIvi DF.". Special Notes far Asbestos Disposal' <' All asbestos containing materials, (with the exception of roofing M19tQr1ai in good condition that is ridt peeling cracking, or crumbling e with PWR)IeUrn based binder that still exhibits plasticity to prevent I the releasP, of asbestos fibers) must - be tightly wrapped or bagged in -6 rnIl plastic with no excess air in the pacitziging not exceed 50 pdunds per bundle be labeled as asbestos; with required information regarding its origin be, transported with a manifest in the vehicle arrive at the transfer station only by appointrnorit with Brian Tate, Of kAJ2Ste Connection so that the material can be. deposited in a lock box {his cell. number I Certification. We THE UNDERSIGNED certify that.this application is true to the best of our knowledge. All information provided is correct and the enclosed analytical results repi-psent the pro ed waste material to the best Of our abilities. T 1 vvas.fs., Ganem i6mtl.lre. Printed Narns (,onvany City of Port Angeles ApJv rQVW Oily Enqih: —: Date Approval Expiration Date' CRY of Pori Ancielps I rlildfilf Waste Disposal Ap;;Jic2t.on age 5 o1 6 08/1-8/2009 13 18 3607683-7216 IAMODCONS .L i 1 4 if I i if It h.)) I A A3 PAA ZISA) 1383 414n Omy.stcv Sm4J.cmse, Poriter DIAWIONO FAX 4141 OLD OLYMPIC PIWY PO BOX 700 Ssoulm WA WSP I'aY.':3litldi49�7?1A y% PAGE 01/10 (M.() (),I no I J1� AUG 18 2009 CitY 01 PM, Angeles PublicWO'lls and tifififies Dept TO; VE From., Se"ices bi"isib" Fax; phone.- Re., W.f�(.-A/l). lw++_ _. ..._— /�,t'J_ %dr,�lj _�_. El Urgent 0 For Review 0 Ploose Comment 0 Please Reply Ci Please Recycle -Ax AAS 71hk 0 7k,, Ct L,.fj rjj 11J ef 06/18/2009 13 18 3607683-7218 02-:15P FROM IAMODCONS PAGE 02/10 TO IY50563TE15* f, I Northwest Asbestos Consultants 406 Reed St. Port Townsend, WA 98368 360-385-0584 northwe.stasbestosc6nsultants@cablcspeed,..com 7/18/09 1012 120 E Ift St. Port Angeles, WA 98362 Ckilm # 10x3802827 Dwzaer Tom 14arl= 120 E. 10th St. Port Angeles, WA 98362 contact, Peter Farnung Farmers Insurance Company Seattle, WA subiect. Regards to re -inspection for d after / renovatloj:L. The purpose of re -inspection after ACBMwas removed by the abat.ement contractor These areas that were noted on -4/15/09 inspection report has been abated, I -find this building ready for demolltion / renovation as according to the reguladois of Olympic Region Clean Air Agency and EPA guldelmles In S pe c TQr;' Rob Witheridge E?A ATIPPLA - Building Inspector / N%nagement Planner WAMOA - 0D42-101709-01 Expires - 10/1.7/09 cc/ Olympic Region Clean. Air Agency OR/18/2009 13 18 3607683-7218 JUL 09 34A FROM- IAMODCONS 1U'1-JW683Y?1U a) Good faith inspection for asbestos containing building materials (ACBM) 2) Survey sample and record suspect materials. 3) Report to Peter FaTnung with results of testing by Northern IndusErial Hygiene, Inc. PAGE 0-3/10 F a The Inspection started with a visual survey looking for Asbestos Containing Builditzg .Material (ACBM). This single story building approx. 600 sq. ft. was heavily fire damaged. Cement and post and beam foundation. Composition roof. material, vinyl, carper and wood floors. vinyl clad window and fiber glass rock wool insulation. Some textured painted walls. Sample results are as follows. A=auic Rock wool attic imulation. Laundry room. floor vinyl PAth mastic*. Gold / brown. Sarrzr�le 3, Bathroom paper backing on floor Sample *4-. Bathroom floor vinyl with mastic. Tan, gray and brown. umult #5, Bed -room floor vinyl. iAdth mastic. Tan, gray and xed. Living room walls. Textured coating, =Die P1 laundry room w.esr end. 12" x 1211 floor tile. Tan Roofing material. Samples were sent to lab: See results. 08/10/2009 13 18 3607683-7218 1AMODCONS PAGE e4/10 J(:-L--S-2r3'0q 09 34R FROM lu 1.�bLibbir?-18 F - ASBESTOS BULK SAMPLE DATA Northwest Asbestos Consultants 406 Reed St Port Townsend,.'WA 99368 360-385-0584 nor-thwestasbcstosconsultants@cablespeed,cotn To -WorthOrn Yndustrial Hygiene, inc. 4/1$/09 lg2b Locadgn, 120 E. 10th St Port Angeles, WA 98362 Claim #1013802827 owner: Tom Harlan 120 E. -loth St Port Angeles, WA 98362 Peter Farnung Farmers Insurance Company Seattle, WA SarrmleAl. Rock Wool attic insulation. Sa=lc -#2,. Laundry room floor vinyl v4th. mastic, Gold / brown. Saw,ple OL Bathroom paper backing on floor Bathroom floor vinyl with mastic. Tan, gray and brown, sa=le 6'. Bedroom. floor vinyl With mastic, Tan, gray and red. S=Dle A5, Uving roorn walls. Textured coating. Samp.1 e #7 La-andry room west end. 12 x 12" floor tae. Tan S=pje-M Roofing material. Bob Witheridge AHERA - Building Inspector / -Management Planner WAMOA-'0042 10170901 Expires 10/17/09. Picase cafl,%ith festresutts when, completed, See attachmcht. Tk you, Bob Wirher-idge, UM 08/18/2009 13 10 3607663-7278 IAMODCONS PAGE 05/10 3'i L -3 -?009 09 '34A 1: P,fOM I'013SOJ SS3` Z!jE3 P 4 2115 SW a53rd Stmet Surian, WA 98166 OFFMF- j;kO ) 985.8346 TAX. (206) 988-11978 EMAI-L n#hl'n helo'n.voM rwtau�inerttr�t4 "Wairtcwos. NMC. PtVLAP#.2WS,11.0 Bulk Asbestos Analysis Report Noftwest Asbestos ConsultarrbrNIF►.B ct�TA"Merr 2" AW Re"d 8tmet C ttt:ldb Nurrtbt¢c Pett Townsend, WA "883W Tum ^fond 1 *M- 5 Dar C P!a]od Loostow 120F. 10th 8L P&f WA u9t1rQ iirialjRt rt: III Client Sample Ntimber. T G a4Z9CQWI Cron sample Description: Rock woof insuiatian Client Sample Location: AIM ,smote Comments: Ohedwo ffSnmple Not ArAlyzed Black loose tieM"* mamiui. Asbas as f1brotl2Componam :. No(}-MbeslosFibmuSC-it ,, No Asbestos; DoWcyed 3% [:eIM&WW Z% t +CMM futatcr» 95% Mtneml.3Nbal and 9a9As Ment Sample Number x Lab Sample Number: 1134 D2940012 Ghent Sample Oestxipaorr. Flour Vinlrt witttUastic G6101t lasers Client Sample Location: LaulxfryRoom SamOla Comrmnty: C attkod If Sample Not flrraWed 0 Vinown-and Yellow vinyl with white Mwous bodSM and UM roddift l Asbestos Fitrt'crtts-componv AtonAsbestosFibrcrsrsC. �; r -r,;�;,��-tt" 2y "dn'FibiumCsttmpor W25: tJ yy�� �( ,,.fir's 10% C:eitteirsSe i:IILIOIt4i*6-400 � '.tw' - 2M t�rentf BNNter ' � YYt+jt%itCl9rltli3litde! , [ Client Sample number- $ fab Sample Number: O.164NO4.0003 cow, sample Description-. PWRr Oacting Client sample Location., Atth><a m Floor Sample CommsMs: Gtretilted If Sample Nat Analyzed Ci r Black"fiDccuaasptmk A.sbesm Fibrous GomporwrMs. Wn-AsbestosFbt MCOrrprRnrfft t WW*WUU$ Cmq seats: trio Asbestos Detected 35% Geflutose 13596 Asph" FWW arm t3tneer Sampled, by- Bob Wrtharldge Recalved hy: FetMIn U ttfe ttwvta"d fay' judo cumf"irrgs (34MPIO felt w 4111 Gr2M AM71200 ctA Jude Cuff rn"srgs, LAbor3 `MV KartPge+ i?ape" 1 08/18/2009 13 18 3607683-7218 IAIAPDCONS PAGE' 06/10 7UL-Z-e809 09.34H FROM TO. nsessVail� 215 SW 153rd Street SuAon,WA 98166 GIRPME: (2") 388 47A -FAX- (2067 ass-rIsTs, L EMAIL nlhlnc@e.owbefbn.com sw*w, NV"P# 200511.0 Bulk Asbestos Analysis Report NorthwQ Agtlesltos Consul"M M11 Batch Amobar 015-ft29w AM Reed 90"t Pod Townsend, WA 083M 7=0 AMUM Tin*, 6 Day C Pngeq Lomftn: 120 F 10th $1. Awr Avobx WA_ S4tT4*5 Anowmerl., at Client Sample Number 4 Lab SMple WWnb8r D9. 029+ Client Sample DeWplien; Viftyl*fth Wlasfic -Tan I Ofay and grown Client Sample LoCallaW RalthfDOM Floor Sample Comments: Mawrlab dbUnqutaftable but innowam Choc*ed IfSample Not Anaiyzed 0 Tan and. hraw iqo vinyl an briact Mmuw bacifing and aspbA neeidue Asbestos Obrous No As!xvsftm Deftaled ;.Is% calitilcm 45% A300 FVW nod aintler W% tJi ryl FZ" ano SWAar Client Sample Number 8 Leib Sample Number 694W25COWS .Client Sample Descripflon: V1n0with MaWc Tan /C%tayandfted Cliem Sample Locatian: Badmarn Floot Sample Comments: MaUtlait dialiv quisbatrie bin Itumarabrit! CMdred ff4Sampfe Not Analyzed Tan, gray and bm*n.vtnyl W.1% black 111hrma-b*bko and ftd Wold.00 Astwsws-Fibrous No AtbeWWs Date, N 26% Ceffu)ow 1096 f"Ar alm Binder W% Asptal Filer and Bindet US Vkvji, filpr and Sinter Clieryl Sample Number 6 Lab Sample Number. 019�W29&OWS Client Sample DesrApWn-. TeAumd Cbamhg Clieni Sample Location, Lh&V Room Vftflx Sam* cOMMants- Mxwials disfinquisbable but frmevanhis Checked.U.Sample Not Analyzed 0 Sig(ek c0a"g an qff-wht% lwnpy rempmsted powdWand 1xvWx nu total Asbestos Fibraus Comp6mftW N0j).,Ube5tW F11WOUS componems: No"+-Anws companerft: Ntt ii t illi =I xd�296 30% Casting 63% f9lerand 131rWer {Sunpt6 te%ft =v*nt d Cn fMW tlaIP Sampled W. Bob VI 00addW Recel%md by: Fermin Uribe 41 74=2 rieviewmd by- Jude Cummift_4P Jum Cummkmr. Labamtory Iftnaw Page 2 08 18/2M 13 18 3607683-7218 IAMODCONS PAGE 07/10 JUL-3-2M4 -� H FRUM TO 13.6069372le, P 6. iii 215SW153rd'Sweet BurieoWA 90166 iEMAIL, n1h1n.cP_eschbIoft.cam Mariora ................. wpm. NVLAP#200511-0 Bulk Asbestos Analysis Report NwfthWest Aaboatm CoAmft's N" 80" "U01*3M 09402" 4w ,Iwo Strmt cowdiab Ntanter Pon Townsend, INA 93356- Twn Atound Tftw; .6"C I PrOad Lacbtan: 12o E, imh se. Awt Aroa6m WA sam*s Awlyzed* a rAlent Semple Number 7 1Z"X1rFRWTl* Un Client Sample Locallon; UwPdrYRoom, WewtEnd Sample comments: Lwar I Tan uirtyt AgbnM F(bows (,wnP0r16(tW NQrp-PSbwl05 Fibrous C. No,AsbeslosDetewild Ljtyer2 CtettradhEahrt AmbeSMS No Asbe%Ws DOWCW 3% twilulase Lab Sample Number 04302M.OIX17 Chedied tf Sample Not AnsWed N*n.+-Pmm CWTponefft. -IW% Vinyl Filter and 81"der -PJWI-FlbtcuS Cwnpopvats- 95% Filler and Binder 2% Half Lab sampw Nu.m1wr a94w294.400g if, CaerdsamploDucription- Client SaMple Locdpn,, Sample ComMeMl. Gray pabbleX an&black fibmtWAISPh2ft AAbestas Fibmus COMPOnefft- Non-ftbealas Ffftur, C. No Asbestm DeW09d is% Fiberowris Chac*ed ff Spernple Not Arsalyzwl 0 . 3&)6 Aggrg%ft w% Apptuitmer-and Binder Sampled by; 901) WMI"Irld" 4061M9 *—A— � { . +CS' ReceiwQ bp, ForMin UnbC 41177.408 Re'viowed by. Jude CUf=lngr 4namm prpe 3 08/1BI/2009 13 18 3607683=72.1e IAMODCONS PAGE 08 10 T11--3-Per49 09 73GA FROM, TO, i360553TC10 P 7 This survey includes all areas of inspection with report results from Northern Industrial Hygiene, Inc Rock -wool attic insulation. No. asbestos detected. SamWe &Z, Laundry room floor vinyl WlCh mastic Gold / brown. 209'o chrysotile asbestos. Approx. 84 Sq. fL samgle g3A. Bathroom paper backing on floor No. asbestos detected. Sample #4, Bathroom floor vinyl with mastic. Tan, gray and brown, No asbestos detected. sam.ulg 4., Bedroom floor vinyl wirh mastic. Tan, gray and red. No asbestos detected, Sa=lt #6, Living room: walls. Texrured coating 5% chrysotile asbestos, Approx 6§0 Sq ft. samnle A7, lAundry room west end, 12" x 12" floor tile. Tan No asbestos detected, Sarni? p. #8. Roofing material. No asbestos detected. All asbestos containing building -Materials with a reacting greater than 1% is considered a hazardous material if disturbed. If removed the owner or a certified abateraerit.contractor must follow the rules of the EPA and governed by Olympic Region Clean Air Agency During renovation it is possible that additional suspect asbestos containing building material (ACBM) may be found. Should such suspect material be discovered an AHERA certified inspector will have to sample and test thematerial, to .prove it is of non - asbestos. Northwest Asbestos Consultants is not responsible for identification of hidden materials that are not identifiable with reasonable diligence After the facility is completely cleaned out a walk through and inspection Is required. by the original AHERA building Inspector (NW Asbestos) after abatement, then a copy of the letter c.ertifying that abate,ment has been completed needs to be received by the local permit center and Olympic Region dean Air Agency Thank you, � 04 Bob Witheridge, E.F.M. 081181 X009 13 18 3607683-721.8 IAMODGONS PkGE 09/10, 06. i.d.'2vi-a9 1.5.1:1 13E1551,97SO OVIVZOt10 14-27 FAX 380 830 6020 Coe MIN �trslctl K C 8 CERT4.01MO AMIMCSTia•..t' 4Z'DNTRAcra.m PH6Np # i380l830.ao22 P.O. Bax 2W PAX # (3600 0-8020 sIEA13�01(, WX 88381) August 14, .2009 Mr Torn Narien 1?oF 1.01Street Port Angeles. WA 9436) CERTIFICATION Or COMPLIANCE AND COM UTION. FOR THE REMOVAL OF ASBESTOS CONTAINING MATER.i LS The aubectns•conteining rnntdrinis that were digcnvmd by Norilmost Asbestos Corl'luttan% a the fire dcamagsa at 120 E. Slrcot, Port Angim WA 933f2, tvcru ramr3vnd on August 12 & I3, 2009 in strict OmpHarlce-to at r4uiations pertaining to nsbcstm remediation in IbcW. skate and federal juriadit tlotrl, The ACNI Was l6cat6d'in the livibg room on the wall and ceilings and also in -the fiooring.in tlrc laundry resom, The ACM was removed. wet, and senlerl in two, layom of£s rail'poly end will be delfmad to Olympic Vim Typmfcr Station.whcrc we ryWl hand load it into containcra for ih4prnent 5y rail to Columbia RidV. in Arl4W, Omgpn for permanent disposal. The work -was undertaken only by Wasltitlgtvn Stara Coifed Asbestos -Workoirs and a Washington State C'collied Axbestcss Supervisor (#2010026091 A) who axe tmincd a nd:t::pericnced m handling these types Of in,6MI tis, Ppitxiits +rase ,purchased from Olympic Rerion Cic an Air Agency and ntso W-"Vmgton State DrrpsrUn nt of Labor and Induacries Office of IDASkI, al) fens Are included. The mrueinve earl now be demolished as 411 ACM that was identified in the. A.MRA, report leas boon removed. Runic Taylor., Coordinator for It C 8..n Washington'Ststc lvL'ttx£ieA- A #1osta5 Cot�Gtot�(0$y WA @TA7fi.i.tCeNSRri CONTMAL l.'UN"I'ltnCTM u KCA• •007t; 1 08/18/2009 13 18 3607683-7218 W/20/9009 20!92 -3687600-7216 MMOM O*MkRcgionCJcsft 4irAVwcy 2940-8 VSmi�rd TAM WW 0"04, WA 9MM U&1044 - FAX,(3"-4010= Poo Asgcks OMW (3" 4171466 Rq=wd COM P" 9422157 -WWJDRCAAOT PAGE 10/10 PAGE' 82/16 Demolition Permit *%*.,*,Ji OWT%MR 0, Mofft.Addrim = -t# CAM r R Me I ci—k e—s IVA 7*34� /0 sMIAftp,d arAojwp Am Amw swovelf Axi 010 0OWmatim, Aw A& -"#Ae*op AINd AW"UMNAW AMR OTIiiii harrAW DM 'JUL 9 0 2600. R.divl 4M,ft7uft.cbz# * Asbii 1h=k Pzvicw dM� Daiz*Maaj��t Pmn* # qIpj!b(OO--O—Wa7 AV" u jr Q 2VI =AANrkIM FAM- j%o) 040i" L Mid-607"..A;C)k A? Mrr rll Iii II C=99MLA w Lag& ply -.ACV*--R Mawbed -9 -#eyes OHIM28AOMM DEPAMiTiMPM-Micr CATEGOVX YT 06ftivi- sMIAftp,d arAojwp Am Amw swovelf Axi 010 0OWmatim, Aw A& -"#Ae*op AINd AW"UMNAW AMR OTIiiii harrAW DM 'JUL 9 0 2600. R.divl 4M,ft7uft.cbz# * Asbii 1h=k Pzvicw dM� Daiz*Maaj��t Pmn* # qIpj!b(OO--O—Wa7 AV" u jr Q 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 Applicant ,,/D`rcES Property Owner h,,g,eLi,j , Property Owner's ddress /,ZA z, Contractor - ,rF '40rneS Contractor's Address 251V-03 License # 6& ytE14,lf 6 p i Phr Phone Phone is i �E9a �� 9�38z Expires S /2a /jo E-mail PROJECT ADDRESS /Z,0 C' /a r// r Parcel Number 6 43h UOO 3 28,20 DOOo �,eT�rigc�S For City Use Only - Date Received k - 17 -01� Permit # CD q - SZ9 Date Approved o S1 -0 7 -7 7 (,;e G 76 -SO i54 x.57- 76 44 -677"7 Lot SOX /SSD Zoninq kS-7 Proiect Tune & Brief Description. Residential ❑ Multi -family ❑ Commercial ❑ Industrial Check all that apply New Construction ��,�� j,¢� �u,fEd /.16mE- ❑ Addition ! t X� S -E i n �rv�m� bu�tn� o�aWr ❑ Remodel ❑ Repair ❑ Demolition ❑ Re -roof s House ❑ garage ❑ other ❑ tear off & re -roof ❑ lay over one layer >(Heat System ❑ Heat pump ❑ wood -burning stove ❑ gas fireplace ❑ pellet stove Xother �ZEcT,erC. ❑ Other Floor Areas Existing (sa. ft.) Proposed (sa. ft.) Basement 1s' Floor 2nd Floor 3rd Floor Garage 1$ Carport Covered Porch Deck Shed Other LeaY\_+0 26'7 a.•l�_6N"4p qaxwo�e_ @ $ per sq. ft. = $ iz86 X61831 . _3L (4-mY A re&v- eY*v1i 1660 ern tesf� -') TOTAL VALUATION $ S84-,51 Total footprint of structures _��7 7 2 sq. ft. T Lot size sq. ft. = Lot coverage SFJ 3 % Site Coverage = the amount of impervious surface on a parcel, including structures, paved driveways sidewalks, patios, and other impervious surfaces. (see PAMC 17 94 135 for exemptions) Site coverage -2k.1 % 10Z. se f+ Concrtiv_ -f- I.'772 = 1 g7`f = 6,414 Max. height of proposed structures 16 ft. Occupancy group # of bedrooms Will a lawn sprinkler system be installed?,�v Occupant load # of full baths Will a fire sprinkler system be installed? v Construction type # of half baths I have read and completed this application and know it to be true and correct. I am thodzed t ply for permit and understand that it is my responsibility to determine what p/ermits a required,/and to obtain permit or to ing�n�rojts. Date g / Print Name�/fid -- /-v,H Sig atur v T:Forms/Building Division/Bldg Permit.doc l m / / / / / / / / , � , East 10th Street i Grass area w:War meter sidewalk North 3000 Harlan, TOM front 120 E 10th St Port Angeles door Parcel # 0630000328200000 10 00 12.00 1 scale i = 20 Proposed II Horne 14000 28X48 as of 7/21/09 14000 Meter ii URM rear door F I UE' 1 62.22 CITY OF PORT ANGELES — Construction Plans 75.27' The Issuance of this permit based upon these plans, specifi. cations and other data shall not prevent the building official from thereafter requiring the =wtion of errors in said plans, specifications and other dam. or from preventing building operations being co"M an thereunder when in violation of all codes and mdw ces of this jurisdiction. existing Parking( 1lpifA;MR-'ildiRFGAdQ -7 >- 'garage ........ [ -- , I — Approvai Date By Alley Power Pole 66/30/20@9 12 12 S03769405S .OENWW 11 11 M C �� PAGE 02/02 �t IL �-`1 74 tl A M- o l —! ! C"' �..i^�j i fiN�.-.i,4t L 1 [ 4^""�.i l il✓d "'4 G.. S I 3 ` i��sti�r, hSSv,.,�P�LvtS M A r f cuv P I TZ11 .I n iaoors f Zb M w, VC x z ovCr- ri"e', § . 7,`O t4 rvx P i V' -e1 H r r'r'o G-,eavN>7 ANc.++fl� sP ! la i Hl 2-s y° T y -175t 3Li'AA� 3(r '1n L Iii H ray r/50 Ir -7 ( S ) rrz M 7 8 v 500 /\sr o"I (zo vx t•iay(-�) -1 "µ 5 LaNiINVCr.7S Mme' P,9 -1L CAPAc. V—Y ZvU t � i t i $A 5 a O of, PI( rL LGt V A-aCA Zg 3 88 Fi 2- r IOU ofj I888 L1U40 K P7ElG LUh4 !r"� /Z6 L 1=-A4PfZf-'A VARIES 5 TIE DOWN HOOK 10'-0" MAX. �0. SEE SECTION A/1 OPTION IF HOOKS / ARE TO BE TURNED OPPOSITE DIRECTION)` p ° a d !_!J B 4 - #5 CONTINUOUS = 4" CONIC. SLAB o OR PIT RUN /5 TIE DOWN HOOK— " O EA. CORNER r, IIILLL �4 � 6 EACH SIDE P� 2 - /4 CONTINUOUS CENTER of FRAME c 2 - /4 CONTINUOUS W/y4 CORNER BARS \ i ^ , W#4 CORNER BARS a d e o o d o e G d e'4 ° ° d ° o ° Q Ll e \ 7 \ °\N_ ° 0 0 o LI \ d MATING LINE --A d ° .5.. ° ° d d ° H a o o d \ d d d #4 CONTINUOUS. 0 CENTER ° d ° ° a ° ° O a e e C• {.J d ° ° d o� o d ° U e�d .o ° dam— �d ° Li d a I ) rrad�' d � ° o ° �•. n n n n #4 0 6" EACH SIDE OF CENTER OF FRAME 4" CONC. SLAB 10 LONGITUDINAL \� \� ( C) OR PIT RUN TIEOOWN AS REO'D Q r INSTALL5 CORNER BARS TYP PER INSTALLATION \ \ 4 - /5 CONTINUOUS ( ) MANUAL a d d I d. ° e ° o d 4-L - . 4 'N. d 2'-0" /5 TIE DOWN HOOK SPACED AS NOTED ABOVE I MAX. � /5 TIE DOWN HOOK. l" MIN. 5' MAX. TYP r� / M 1s'f /5 TIE DOWN HOOK 4 - /5 CONTINUOUS /4. CONC. SLAB 1MIN. 5' MAX./ 4 - /5 CONTINUOUS a o ° °d o o' ° 41 ' maI F I'=71 n HOOK TO BE EACH SIDE " OF 4'-0" �u�rr�rr�- 4'-0" CONTINUOUS OR OF HOOK OE /5 X42- TIED AN TO HOOK AND NOTE. USE THIS OPTION IF HOOKS ARE TO BE TURNED OPPOSITE DIRECTION. TIED SECTION EXTENDING UNDER REINFORCING AS SECTION -OPTION rA NTS � w � SHOWN NTS GENERAL NOTES 1 ENGINEERING DESIGN LOADS ROOF LIVE LOAD: 20 PSF (SNOW) WIND LOADING BASED ON: WIND ZONE 1 SEISMIC ZONE. D PER I.R.C. SOIL BEARING CAPACITY- 1500 PSF 1000 PSF SEE NOTE BELOW MANUFACTURED HOME REQUIREMENTS 28' DOUBLE WIDE 99 1/2- FRAME SPACING STRAP ANGLE. 40' MAX. 24" MAX. PIER HT SIDEWALL FRAMING HT =7'-6" MAX. 2. CONSTRUCTION SHALL CONFORM TO THESE PLANS, ALL APPLICABLE CODES AND ORDINANCES INCLUDING THE 2006 EDITION OF THE UNIFORM BUILDING CODE AND THE MANUFACTURED HOME INSTALLATION MANUAL CONCRETE NOTES 1 CONCRETE SHALL BE A COMMERCIALLY AVAILABLE TRANSIT- MIX PROPERLY PROPORTIONED AND DELIVERED TO THE SITE IN READY -MIX TRUCKS, AGGREGATE SIZE SHALL BE A MAXIMUM OF 1-1/.2' IN FOUNDATIONS AND 3/4" AT ALL OTHER LOCATIONS. SLUMP SHOULD NOT EXCEED 4 CURING COMPOUND SHALL BE SPRAYED ON ALL EXPOSED SURFACES IMMEDIATELY AFTER FINAL TROWELLING. 2. ALL CEMENT SHALL CONFORM TO ASTM STANDARD C-150. ALL AGGREGATES SHALL CONFORM TO ASTM STANDARD C-33. ALL REINFORCING BARS SHALL CONFORM TO ASTM STANDARD A-615 AS FOLLOWS: #3 -X15 BARS AND WWM - GRADE 40 3. CONCRETE USED FOR FOUNDATIONS AND SLABS ON GRADE SHALL HAVE A MINIMUM 28 -DAY COMPRESSIVE STRENGTH OF 3000 PSI. PER CHAMPION HOME BUILDERS CO. MANUFACTURED HOME INSTALLATION MANUAL, AND SHALL NOT CONTAIN LESS THAN 5 SACKS OF CEMENT PER CUBIC YARD. 4. SPLICES IN CONTINUOUS REINFORCEMENT SHALL LAP AS NOTED ON THE PLANS OR AS FOLLOWS: GRADE 40 REINFORCING BARS: MINIMUM OF 32 BAR DIAMETERS. 5. UNLESS SHOWN OTHERWISE, THE MINIMUM CONCRETE COVER FOR REINFORCING SHALL BE 2" EXCEPT WHEN CONCRETE IS TO BE PLACED DIRECTLY AGAINST EARTH WHERE IT SHALL BE 3" NOTES. I MAX. PIER LOADS: 4000 LB W/ 1000 PSF ALLOWABLE SOIL BEARING, 5800 LB W/ 1500 PSF ALLOWABLE SOIL BEARING W/ 128 SO. IN. PIER BASE AREA. 2. THIS DESIGN DOES NOT APPLY TO OVER -THE -ROOF STRAPS. 3. SLAB TO BE SLOPED 1/16" PER FOOT (FROM CENTER TO OUTER EDGE) TO PREVENT STANDING WATER. 4. REFER TO KARSTEN HOMES INSTALLATION MANUAL FOR PERIMETER BLOCKING SUPPORT REQUIREMENTS, IF NECESSARY LONGITUDINAL TIEOOWN PER SHEET S-21 OF SETUP 24 t MANUAL, ONE AT X15 TIE DOWN HOOK EACH /SECTION 0 OF EACH 1 MIN 4 - 1YP #5 CONTINUOUS io I TF lwlfi,�I—r,—I„iiF�Il �m� ,i , II #5 EACH SIDMl 4'-0' OF HOOK SECTION rB_� NTS I PGY 0. ?� 32777 .f STOVA I EXPIRES: 8/12/00 1 DTIE: MANUF HOME FOUNOATIDY PLAN FOR BUY -RITE HOMES CLALLAM COUNTY; WA FVUAM7=DffAWA4VAV= CLIENT. DRAWING:&./0431e Bur -RITE 04316-FOUMARON BUY—RITE HOMES 259403 HWY 101 ,YOB Na SHEET SEQUTAI, WA 98382 04316 DATE sl PO ENOVIC & s W PEABr St. sTE, sz SEPTEMBER 2004 PONT ANGELES. WA,9&362 ASSOCIATES PHONE: (deo) 417-0501 SCALE INCORPORATED FAX (360) 417-0514 NTS OF 1 125 !, 70sQ (4e, / / f / / I / / ! \.1006, 'GO / / 125 STATE OF WASHINGTON Department of Labor and Ldustries Certified Manufactured Dome Installer James H Hoesel Manager Factory AssembledStructures Expires 07/31/2010 w� N After recording, return to (Name, Address, Zip): ------- ---1�u--- ------------------------- -------- ------------------------ v__ 40-------------------------------- ------�---A MIPs 1 ---q � QUITCLAIM DEED (Statutory Form) Grantor(s)- Grantee(s)- .L oy12�i NO. �7 �? 17 CLALLAM COUNTY — TRANSACTION EXCISE TAX PAI E JUN Z 9 2009 AMGJJNT P-- COU�7l' TREA URER Abbreviated Legal Description ---- L Assessor's Property Tax Parcel or Account No ------------ ____________ Reference No(s) of Documents Assigned or Released- -------------------- ____________________ ----------------cf 1L r - - -------------------------------------------------------------------------- ----------------------------=-------------------------- ---------------------------------------------/ranto for and in consideration of---��lCY_I__ __D�_z0�JL7---O----c�'`_� ------------------------------------------------------- ------------------------ ----------------------------------- conveys and quitclaims to----{-�-`----1�'��-------------------------=------------------------- ----------------------------------------------------------------------------------------------------------- Grantee, all right, title and interest in the following described real estate, situated in ___----------- _--------- County __ _____County State of Washington, together with all after acquired title of the Grantor therein. 357t-iA04)nr r4` d1�!'6 ` aeidr STATE OF WASHINGTON, County of - - -- I ce that I k ow o ave, llat�i acknowledged that he/she/they signed this instrument and acknowledged it to be his/her/their free and voluntary act for the uses and pumoses, mentioned in the incrr�nt. /1 DATED PUBLISHER' Forn @2006 Washington Legal Blank, Portiend. OR www.wfbforms.com NO PART OF ANY WASHINGTON L FGAL EI_ANK FCRM MAY BE REPRODUCED IN ANY ORM OR BY A 'f ELECTRONIC OR MECHAIJICAL MEAP4S. k " 2009-1239196 Page 1 of 2 Quit Claim Deed Tom Harlan Clallam County Washington 0I6,/q29/2009 11 57 36 AM ■III �'i P�I11�� i0��.' 'I� t«�� I�11 ■ IW'& WiiLkii Nil, lk 11111 After recording, return 10 Name, Address, Zip): --r No. .a --1--1-------------------=--------------- '7 l A* CLALLAM COUNTY -12c-) --- E /47 --//-----------------/------------------ TRANSACTION EXCISE TAX --�8✓f 6r1 e lc's_g----= C>��.�- ----- DATE - -- t -- PAID JUN 2 9 2009 ------------------------------------------------------ - . QUITCLAIM DEED (Statutory Form) COU TY TREASURER Grantor(s). ---1�} �'I'�-_L Pl�_C / -- ------------- 74 ---------------------------------1--=- Grantee(s) - I -3 ----1Ce------------------------------------------------------------=--=- Abbreviated Legal Description --- L.Q / f _---------------------------7---------------------- Assessor's Property Tax Parcel or Account No _LZ C)�0-0 329-�__.pp. U__________________________ Reference No(s) of Documents Assigned or Released-QD_,1J_71_i2v v____________________ ------------------ (-/ _________________ f/ "r for and in consideration of ----------------------------7----------------------- ---------- --------------------------------------------------- conveys and quitclaims to --� on-utiJ---- — 1 -----------------------------------------=------------ ----------------------------------------------------------------------------------------------------------- Grantee, all right, title and interest in the following described real estate, situated in ---- C&L1CL21----2_------------------------ County State of Washington, together with all after acquired title of the Grantor therein. - I A, 9" S I'M r ou�v� s�><t o f -/nova- Al A, F/ DATED ---------- q------------------- I-�, - / 4 --- -------- -- ------ ------------------ STATE OF WASHINGTON County of ___ � KL(�Lk_'__________________ _______) ss. n ....... Mel th kno or have s tisfactory evidence that __________ ___ _ __ QJ----_( - ---,CLOT------------------- is/are the individual(s) who appeared before me, and who acknowledged that he/she/they signed this instrument and acknowle Qed it to be his/her/their free and voluntary act for the uses and p ose nm7}enti%�ne in the instrument. DATED----��_""---------------------- Notary Public fodWashington My appointment expires _____// __-__ GENE N✓� PUBLISHER'S NOTE. If a corpor, ie grantor, complete and attach Form No. 68. Corporal A :knowledgment. Form No. 269 — Quitclaim Deed (Statutory Form) ES G/� 1Wn 2006 Washington Legal Blank, Por ,and, OR www.wlhfnrms.com. , NO 'ART OF ANY WASHINGTON LEGAL BLANK FORE✓ Y BE REPRODUCED IN ANY FORM OR BY ANY ELEC" ,ONIC HANICAL MEANNSyy. �r` �O CITY or POAT ANGUM UGaT DT1 "nMiT ELECTRICAL PERMIT N° 155211 Port Angeles, Washington........ / _.. _._.. --- - --------------- 19........ 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. AddressZ r, . , —� - Occupancy Address...... = -- --- y----------------------------------------------- Owner----------------------------------------------------------------------- Tenant--------------------------------------------------------------------- WiringContractor .------ ............................................. By ........................ .......................... ------------- Light Outlets ............................... .... .... Receptacle Outlets ............................... Dryer. KW......... Range, KW..... --- Water Heater: a Heat: KW......... ........ ...._... Motors: size, volts and phase: Total Service, volts ................... _.I ... ............. No. wires ......:................................ Size wires ..._!........... ..............._.. Main fuse ....... ------------ ............. Enclosure ........................................ Type of wiring: Entrance Cable ----------------------------- Rigid Conduit ......, Metallic Tubing - Current transformers: No. & Size ............... Ser. Ser. Sec No. Sec No. Type of Wiring: Armored Cable ............................. Non -Metallic ................. ............... Knob & Tube ................................. Rigid Conduit ............................... Metallic Tubing ........................... Raceway ............................... _..... - Circuits, Light ................................... _.. Utility............................................. Heat--------------------------- --.. -. --.._ Range............................................. Water Heater ............................... Motor..._ ........................................ Furnace Total Remarks: ------------------------=--------- = _=`'------------------------------------------------------------------------------------------------------------ Permit Fee Treas. Receipt No. B ; '.1 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 ,J iJ ELECTRICAL PERMIT N° 15521 i. / Address ...---....../ ..... ...... ...... /.. ........ '.._...=--............................................................... Date ...................................................... Owner-------------- ..................... .......... ....... -...... _.._........................................................... Tenant ....................... ............ .-------------------- ..-..------ WiringContractor.-..'.................:..:......':-_..................._...::.._?................................................... By .............................................................. NOTICFrCurrent 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. im Nvmnic Printers. Inc.