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HomeMy WebLinkAbout531 E 10th St - Building ELECTRICAL PERMIT CITY OF PORT ANGELES 360- 417 -4735 r Application Number 11- 00000650 Date 6 /24/11 Application pin number 659450 REPORT SALES TAX Property Address 531 E 10TH ST on your excise tax form ASSESSOR PARCEL NUMBER: 06-30-00-0-2- 8780 -0000- Application type description ELECTRICAL ONLY to the City of Port Angeles Subdivision Name Property Use (Location Code 0502) Property Zoning RS7 RESDNTL SINGLE FAMILY Application. valuation 0 Application desc New home Owner Contractor MICHAEL J HOAGLAND OWNER 330 E 6TH ST PORT ANGELES WA 98362 (360) 477 -0006 Permit ELECTRICAL NEW RESIDENTIAL Additional desc Permit pin number 188268 C_/ Permit Fee 145.50 Plan Check Fee .00 Issue Date 6/24/11'". Valuation 0 Expiration Date 12/21/11' Qty Unit Charge Per Extension 1.00 110.3000 ECH EL -R -SQFT FIRST 1300 110.30 1.00 35.2000 ECH EL-R-SQFT ADDITIONAL 500 35.20 Fee summary Charged. Paid Credited Due Permit Fee Total 145.50 145.50 .00 .00 Plan Check Total .00 .00 .00 .00 Grand Total 1''45..50 145.50 .00 .00 r V bN*'- s s BNG 7 M* 1/640 f 7 -/1 AQ INSPECTION TYPE DATE: RESULTS: INSPECTOR: DITCH SERVICE 7/i I CI ROUGH -IN FINAL COMMENTS: 'V 2 *_17 PERMIT WILL EXPIRE SIX (6) MONTHS FROM LAST INSPECTION Signature of owner or Electrical Contractor X Q Date: G:AEXCHANGE \BUILDING CITY OF ANGELES PERMIT APPLICATION 0 Building DPOion/Electrical Inspections i fpt u f 3 Osk 21 East Fifth Street P.O. Box 1150 Port Angeles Washington, 9836 Ph: (360) 417 -4735 Fax: (360) 417 -4711 JUN 2 4 2011 0' Date: -2 1 I ELECTRICAL X 1 2 Single Family Dwelling Multi Family or Commercial* Commercia Vg Alteration Remodel Repair* Plan Review May Be Required, Please Complete Electrical Plan Review Information Sheet Job Address: 5 3 i i 4 a 0 3--k_ Square Footage: (tip 0 Description of above _i1115\12__ .aw∎%1 f- esI6- e4A.oz Owner Information Contractor Ipformationr Name: f o Name: n C-ACV.. t t 5 ��a� NG�4 I' Mailing Address: 'c Z �-1 ,5}re.c.+ Mailing Addres 3,SO e 6 5 1 -e City: Porgy 4w e t5 State: ■.i A Zip: 9X3 3 (z City: Por I KS eta...5 State: W 1° Zip: 'i A36 Phone: 4 177- oocG Fax: Phone: t- 177- CO63(_Fax: License Exp. License Exp. Item Unit Charge Qty Total (Qty Multiplied by Unit Charge) Service /Feeder 200 Amp. 119.90 Service /Feeder 201 -400 Amp. 145.50 Service /Feeder 401 -600 Amp 204.60 Service /Feeder 601 -1000 Amp. 262.20 Service /Feeder over 1000 Amp. 372.50 Branch Circuit W/ Service Feeder 2.60 Branch Circuit W/O Service Feeder 73.50 Each Additional Branch Circuit 2.60 Temp. Service/ Feeder 200 Amp. 92.70 Temp. Service /Feeder 201 -400 Amp. 110.30 Temp. Service /Feeder 401 -600 Amp. 148.70 Temp. Service /Feeder 601 -1000 Amp 167.90 Portal to Portal Hourly 95.90 Sign /Outline Lighting 88.20 Signal Circuit/ Limited Energy First 1500 sf Commercial 95.90 Note: $5.00 for each additional 1500 sf Signal Circuit/ Limited Energy 1 2 Family Dwelling 63.90 Signal Circuit/ Limited Energy Multi Family Dwelling 63.90 Manufactured Home Connection 119.90 Renewable Electrical Energy 5KVA System or Less 102.30 Thermostat 56.00 NEW CONSTRUCTION ONLY: First 1300 Square Ft. 110.30 1 1 10 .3 Each Additional 500 Square Ft. or Portion of 35.20 l 3s, ZO Each Outbuilding or Detached Garage 73.50 Each Swimming Pool or Hot T ub 110.30 1( 5 ,SUTotal 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 -46B, 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: Cash X Check 1 Credit Card x 111/ Dated: C Z 3 I 01101/2010 ..x,., CITY OF PORT ANGELES "TOW DEPARTMENT OF COMMUNITY ECONOMIC DEVELOPMENT BUILDING DIVISION 321 EAST 5TH STREET, PORT ANGELES, WA 98362 Application Number 10- 00001168 Date 10/25/10 Application pin number 605536 Property Address 531 E 10TH ST REPORT SALES TAX ASSESSOR PARCEL NUMBER: 06-30-00-0-2- 8780 -0000- Tenant nbr, name MICHAEL J HOAGLAND on your state excise tax form Application type description RES NEW SFR Subdivision Name to the City of Port Angeles Property Use (Location Code 0502) Property Zoning RS7 RESDNTL SINGLE FAMILY Application valuation 111690 Application desc 1,314 SQ. FT. SINGLE FAMILY RESIDENCE Owner Contractor MICHAEL J HOAGLAND NORTHWEST DESIGN HOMES LLC 330 E 6TH ST 131 PRISTINE LN PORT ANGELES WA 98362 PORT ANGELES WA 98362 (360) 477 -0006 (360) 457 -5052 Structure Information 000 000 1,314 SQ. FT. SINGLE FAMILY RESIDENCE Other struct info TOTAL LOT COVERAGE 29.00 FIRE SPRINKLERS REQUIRED NO NUMBER OF STORIES 1.00 EXISTING LOT COVERAGE 720.00 LOT SIZE 6991.00 PROPOSED LOT COVERAGE 1314.00 TOTAL LOT COVERAGE 2034.00 NUMBER OF UNITS 1.00 Permit BUILDING PERMIT RESIDENTIAL Additional desc 1,314 SF SFR Permit pin number 175232 Permit Fee 1087.45 Plan Check Fee 706.84 Issue Date 10/25/10 Valuation 111690 `(1� Expiration Date 4/23/11 Qty Unit Charge Per Extension (27/ BASE FEE 1020.25 12.00 5.6000 THOU BL- 100,001 -500K (5.60 PER K) 67.20 Permit MECHANICAL PERMIT Additional desc Permit pin number 175240 Permit Fee 178.45 Plan Check Fee .00 Issue Date 10/25/10 Valuation 0 Expiration Date 4/23/11 Qty Unit Charge Per Extension BASE FEE 50.00 4.00 7.2500 EA ME -VENT FAN (SINGLE DUCT) 29.00 1.00 10.6500 EA ME- STOVE /FIREPLACE /MISC. APP. 10.65 6.00 14.8000 EA ME- HEATER(SUSP /WALL /FLOOR -MTD) 88.80 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. /0/4 Date Print Name Signature of Contractor or Authorized Agent Signature of Owner (if owner is builder) T:Forms /Building Division /Building Permit f 1 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 Water FINAL Date Accepted by AIR SEAL: Walls Ceiling FRAMING: Joists Girders Under Floor Shear Wall Hold Downs Walls Roof Ceiling Drywall (Interior Braced Panel Only) T -Bar INSULATION: Slab Wall Floor Ceiling MECHANICAL: Heat Pump Furnace FAU Ducts Rough -In Gas Line Wood Stove Pellet Chimney Commercial Hood Ducts FINAL Date Accepted by MANUFACTURED HOMES: Footing Slab Blocking Hold Downs Skirting PLANNING DEPT. Separate Permit #s SEPA: Parking Lighting ESA: Landscaping SHORELINE: FINAL INSPECTIONS REQUIRED PRIOR TO OCCUPANCY/ USE Inspection Type Date Accepted By Electrical 417 4735 Construction R.W. PW Engineering 417 -4831 Fire 417 -4653 Planning 417 -4750 Building 417 -4815 T:Forms /Building Division /Building Permit a CITY OF PORT ANGELES a 1 DEPARTMENT OF COMMUNITY ECONOMIC DEVELOPMENT BUILDING DIVISION `m`* 321 EAST 5TH STREET, PORT ANGELES, WA 98362 Page 2 Application Number 10- 00001168 Date 10/25/10 Application pin number 605536 REPORT SALES TAX Permit PLUMBING PERMIT Additional desc on your state excise tax form Permit in number 175265 to the City of Port Angeles Permit Fee 149.00 Plan Check Fee .00 Issue Date 10/25/10 Valuation o (Location Code 0502) Expiration Date 4/23/11 Qty Unit Charge Per Extension BASE FEE 50.00 10.00 7.0000 EA PL- PLUMBING TRAP 70.00 1.00 7.0000 EA PL -WATER LINE 7.00 1.00 15.0000 EA PL -SEWER LINE 15.00 1.00 7.0000 EA PL -WATER HEATER 7.00 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. October 19, 2010 12:08:17 PM sroberds. The proposal will result in a new sfr in the RS -7 for total lot coverage of 29%. Proposal also results in demo of a portion of nonconforming carport to make lot coverage. With demo, no land use issues are anticipated. October 14, 2010 4:25:35 PM Bob Larson 360 417 -4706. A power pole will need to be set in the rear 1/4 of the lot to increase clearance of an existing overhead supply power line to the house on the east side of this property. MAINTAIN CLEARANCES FROM SERVICE WIRES Electrical load calculations and electrical permits are required. Any modifications to the City's electrical facilities will be at the customer's expense. Connection to existing sewer requires an inspection by Public Works to verify condition and integrity of the existing on site sewer lateral. Locate and expose the end of piping prior to any connection for this inspection. Sanitary sewer connection inspection is required by Public Works prior to back fill of ditch. 24 hour advance notice is required. Other Fees STATE SURCHARGE 4.50 Fee summary Charged Paid Credited Due Permit Fee Total 1414.90 1414.90 .00 .00 Plan Check Total 706.84 706.84 .00 .00 Other Fee Total 4.50 4.50 .00 .00 Grand Total 2126.24 2126.24 .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. Date Print Name Signature of Contractor or Authorized Agent Signature of Owner (if owner is builder) T:Forms /Building Division /Building Permit BUILDING PERMIT INSPECTION RECORD o PLEASE PROVIDE A MINIMUM 24 -HOUR NOTICE FOR INSPECT IONS 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: ?Cea)r U Fe Ih544(e.4 Footings i2 01- fQ TLA- Stemwall 1. 2 {'3 10 foundation Drainag9j Downspouts 1Z 2.1 •iers Post Holes (Pole Bldgs.) PLUMBING: Under Floor Slab Rough -In 5 -27- 11 314L Water Line (Meter to Bldg) 1 1 8 3 (,,t 4 5Qwet- (41e r. h S 1- eH.t Gas Line Back Flow Water FINAL Date C 1 l i l t Accepted by I'LL-- AIR SEAL: 7- 12 -11 Walls Ceiling A FRAMING: 7-- 1 l SLL- E)C for S�n e iViC, 2O -1t �aL, V� Joists Girders Under Floor 1 Shear Wall Hold Downs Walls Roof Ceiling Drywall (Interior Braced Panel Only) T -Bar INSULATION: °7 -14. 31L Slab Wall Floor Ceiling MECHANICAL: 0 Heat Pump Furnace FAU Ducts Rough -In Gas Line Wood Stove Pellet Chimney Commercial Hood Ducts FINAL Date 'n Accepted by /1 MANUFACTURED HOMES: Footing Slab Blocking Hold Downs Skirting /Cj PLANNING DEPT. Separate Permit #s SEPA: Parking Lighting ESA: Ch Landscaping _SHORELINE: N 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 V Planning 417 -4750 Building 417 -4815 i0-13- It 9!L/ii "'iernp Cat 0 3t.L e,< re d�! T:Forms /Building Division /Building Permit CITY OF PORT ANGELES PUBLIC WORKS UTILITIES 321 EAST 5TH STREET, PORT ANGELES, WA 98362 Application Number 10- 00001168 Date 10/25/10 Application pin number 605536 Property Address 531 E 10TH ST REPORT SALES TAX ASSESSOR PARCEL NUMBER: 06-30-00-0-2- 8780 -0000- Tenant nbr, name MICHAEL J HOAGLAND on your state excise tax form Application type description RES NEW SFR to the City of Port Angeles Subdivision Name Property Use (Location Code 0502) Property Zoning RS7 RESDNTL SINGLE FAMILY Application valuation 111690 Application desc 1,314 SQ. FT. SINGLE FAMILY RESIDENCE Owner Contractor MICHAEL J HOAGLAND NORTHWEST DESIGN HOMES LLC 330 E 6TH ST 131 PRISTINE LN PORT ANGELES WA 98362 PORT ANGELES WA 98362 (360) 477 -0006 (360) 457 -5052 Structure Information 000 000 1,314 SQ. FT. SINGLE FAMILY RESIDENCE Other struct info TOTAL LOT COVERAGE 29.00 FIRE SPRINKLERS REQUIRED NO NUMBER OF STORIES 1.00 EXISTING LOT COVERAGE 720.00 LOT SIZE 6991.00 PROPOSED LOT COVERAGE 1314.00 TOTAL LOT COVERAGE 2034.00 NUMBER OF UNITS 1.00 Permit SANITARY SEWER HOOK UP Additional desc Permit pin number 175554 Permit Fee 135.00 Plan Check Fee .00 Issue Date 10/25/10 Valuation 111690 Expiration Date 4/23/11 Qty Unit Charge Per Extension 1.00 135.0000 EA SAN SEW RECON 135.00 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. October 19, 2010 12:08:17 PM sroberds. The proposal will result in a new sfr in the RS -7 for total lot coverage of 29 Proposal also results in demo of a portion of nonconforming carport to make lot coverage. With demo, no land use issues are anticipated. October 14, 2010 4:25:35 PM Bob Larson 360- 417 -4706. A power pole will need to be set in the rear 1/4 of the lot to increase clearance of an existing overhead supply power line to the house on the east side of this property. MAINTAIN CLEARANCES FROM SERVICE WIRES 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. 20/0 Signature Signature of Contractor or Authorized Agent Date Signaoowner (if owner is builder) Date T: \Policies \1102.15 [10/08] PERMIT INSPECTION RECORD L 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 DATE 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 FIRE DEPT. PLANNING DEPT. 417 -4750 PLANNING DEPT. BUILDING 417 -4815 BUILDING T: \Policies \1 102.15 [10/08] o f .e O 4, CITY OF PORT ANGELES PUBLIC WORKS UTILITIES 321 EAST 5TH STREET, PORT ANGELES, WA 98362 Page 2 Application Number 10- 00001168 Date 10/25/10 Application pin number 605536 REPORT SALES TAX Special Notes and Comments on your state excise tax form Electrical load calculations and electrical permits are to the City of Port Angeles required. Any modifications to the City's electrical facilities will (Location Code 0502) be at the customer's expense. Connection to existing sewer requires an inspection by Public Works to verify condition and integrity of the existing on site sewer lateral. Locate and expose the end of piping prior to any connection for this inspection. Sanitary sewer connection inspection is required by Public Works prior to back fill of ditch. 24 hour advance notice is required. Other Fees STATE SURCHARGE 4.50 Fee summary Charged Paid Credited Due Permit Fee Total 135.00 135.00 .00 .00 Plan Check Total .00 .00 .00 .00 Other Fee Total 4.50 4.50 .00 .00 Grand Total 139.50 139.50 .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 presume to give authority to violate or cancel the provisions of any state or local law regulating construction or the performance of construction. Signature of Contractor or Authorized Agent Date Signature of Owner (if owner is builder) Date T' \Policies\ 1102.15 10/08] 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 DATE ACCEPTED COMMENTS YES 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 FIRE DEPT. PLANNING DEPT. 417 -4750 PLANNING DEPT. BUILDING 417 -4815 BUILDING T: \Policies\ 1 102.15 10/08] 4. I, 1 r Lo i RECEIVED Q I OCT 1 4 2010 C ITY OF PORT ANGELES BUILDING DIVISION i... i f O I 1 Qi b 1. y �a 1 I I C I i Tr -1:-$-- 1 J CI LLI -63 Q o i -k 2 i oc i I Q N 36 vil 0 0 1 H 1 0 1 0 1 H I a 0 0 0 a 0 H 01 .1-/ H N a N L•.i O U H cn 0 F 1 'd U 0 0 a 0 1 a) 3 '0 m E U v a) H 1. a 0 3 0 Nto O \a) a N O Si 'O Y, 0 o 0, N (1) 10 o S-1 0 H 'F )0 0 x 0 0 (0 w E 0 a) 0 a) 0 1 00 0 a)'0 0 0 to to H N s+ 00 U In r '0 a w a 1 l-1 rt- H a H Hi w0�k a ao F 1 0 Z a) O 010 cn 0 0 1 0 00 00'O w o0 as w x 0 1 0 x x 0 0 0 0 a s F 0 1 0 a s m m 00 x 00 4 0 H b H S N o ,n 0 F 1 co m 0 x 14 0 H 0 0 cn -I -H W z X H a W FF H 0'O S, H Hi x cn U0 1 Z N 0 >a rli w F0 aHa H w w w 00 a) N 4 1 Z a s 1 z 'H 0s+ cn 0000 w v)U) 1 Z O CO .--Y 0O x •OH OH X Z 1 00 P. a aN0 H H 1 H0 sa'0 E 0 FCH 1 FCF 0 H� a) C.0 a) 3 Z 00FU U 0 acn 00 ,d10 H SI r-z cn r4 a as wm'0� H w .0 0 1 a U 0 I 0 0 0 a U' Ow ax cn 0w (0 0,a) 00'0 100 0LOHH01 w 00)) 41 PI 01070100 a 0000 7 y E 0 00 00 0)U O10 0000" -C O o 3 0 0 0 1 0 o z za� C7ar0 F to t U' 0000 a a r 10 x 0 x N 0 H W a e•/ H x o to a a FC h F h H O 1 H 0 1 0 0 o ff 0 0 0 0 .1 O o w, 0 3 w 1 o 00 a 1 w x Z o o LOW H H H H w 1 H x r o F H H H H H 0 1 H U O U 1 1 w 1 roH0000 an n 1 X3 0 0 0 (4,4 O r) 0 0 0 H H r 0 0 00 H w m m o o a t a a 0 10 0 H H 0 1 0 10 w 101 Z 0 01 F X O.1 0 N U 0 H N a o 1 0(00 az 0 0 o a a d F w u a o 00 41 H lgzzza a a m 01 XU� <H N a 10 CITY OF PORT ANGELES 321 E 5TH STREET P.O. BOX 1150 PORT ANGELES WA 98362 C E R T I F I C A T E O F O C C U P A N C Y T E M P O R A R Y Issue Date 9/08/11 Expiration Date 10/10/11 Parcel Number 06-30-00-0-2- 8780 -0000- Property Address 531 E 10TH ST PORT ANGELES WA 98362 Subdivision Name Legal Description LOT 17 BL 287 Property Zoning RS7 RESDNTL SINGLE FAMILY Owner MICHAEL J HOAGLAND Contractor NORTHWEST DESIGN HOMES LLC 360 457 -5052 Application number 10- 00001168 000 000 Description of Work RES NEW SFR Construction type Occupancy type Flood Zone Special conditions September 8, 2011 8: 6:34 AM j ierl Finish items on li7 and recal when comp -'e. Ok to occupy barricade sliding do.r from ac' es Jll Approved A Of' VOID UNLESS SIGNE% BY BUILDING OFFICIAL NH 1 H 1 I r O O 1 01 1 4141 U' H 0 0 0 Q N 40 1f) O 0 0 N O rr a) 1A r HH 0 aJ a) N d' d Cl.) 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H W W -5Th aQ 0 N 0 cZ 0 0 0 0 V1 O 0 0 E r-S a) o,a a. ..r 0 N 0 to H o m G F 0 0 0 o of u \0 l0 0 0 0 r, r H a H w 0 a H F a 0 ZZ 0 z cn 0 cn 0.l 0 0 0 H 0 0 Li H W Ul a s H O 0 0-. Z E ,-D 0 EO n \V/ 0o 0 oa0 a0 0 u u z o 0 0 0 h as Hz E. 4EE 0 U) z o 0 n r o 0 H H 0 H U n< 0 U A WWW A a c n o aWi r-- C0 F .7 u a HHE. aA.7. Zcn0 a y [s7 a a E H W cn 0w 0000 0 >xoow 0 o (I] 00 .-101-101.12 0 0 Ana OZEw0F 0 0 0 0 0 F Z 0 7. �d C7 0 0 up F 1 0 E. 0 0000 0 (noQ 00 2 H0 *7) rn FOFh °0° H a OO o m o 0 0 0 0 0 0 o •,-1 W 4 0000 00 0 o ow Z F0r,o MIFF 0 H O H 0 0 0 cn W 0 H 0 H l0 O O W rl H H ,n E z E O H 000 o 0 00 \F W 0 0 a Q 0 a W i:41 U H a z0 0 2 0 F L0 0 0 H H t r ;_i u e' .7 2 F 0 o W N 0 E' W U r-7 E a H 0 0 0 0 3 4 0 W Z a4 a au FU0a< a F W 2 4 BUILDING PERMIT APPLICATION Print in ink CITY OF PORT ANGELES For City Use Only Permit Technician Attn: Building Date Received in— II-10 321 E. Fifth St., Port Angeles, WA 98362 Permit 10 11 (360) 417 -4815 fax (360) 417 -4711 Date Approved Applicant l I CKCt,-e--1 11-0a. 3 Phon 1 -1 77- o0o E, Property Owner (A crha .2k l oaglq iAti Phone Property Owner's Address 33o g 6 4-1, 6: r-ee -f o�n 2� WiA Contractor N.) Of )J.ez5 -t ees ins }4,,, hone /1 oop C, Contractor's Address 330 z 6 i!,4re.,e.;1 License 6 for dhgs Lt L" Expires 6.-14 20/1 E -mail PROJECT ADDRESS S 3 (D' S- Po rgy y.Le-S Parcel Number Lot Zoning IBS -1 w Project Type Brief Description: Residential Multi- family Commercial Industrial Check all that apply XNew Construction I L( 5F n j S R Addition Remodel Repair Demolition Re -roof House garage other tear off re -roof lay over one layer `Heat System Heat pump wood- burning stove gas fireplace pellet stove other Other (N0.\ l t Floor Areas Existing (sq. ft.) Proposed (sq. ft.) Basement yap. it6t0 per sq. ft. 1ntlFloor 0 a3t�� i314 �5,0o tit E{ao,00 3rd Floor t' C� Q \e` Garage prt� 3 c DS" Carport It Q�z, _,,.1 -V TtO w U v Covered Porch Ir'evA01 h ash w e Deck terno■i sH't•n� °he 11 Shed X54- of 41k Other Carr t TOTAL VALUATION l 00. 00 Total footprint of structures 20 3 (4 sq. ft. T Lot size 0 'L I sq. ft. Lot coverage ?A 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 40,5 792-+ f d $0 2 S ato Max. height of proposed structures 11 ft. Occupancy group of bedrooms Z Will a lawn sprinkler system be installed? NQ Occupant had v of full baths Z Will a fire sprinkler system be installed? n) 0 Construction type ,A of half baths qj I have read and completed this application and know it to be true and correct. I am authorize• to apply for this permit and understand that it is my responsibility to determine what permits are required, and to obtain permits prior to working •n p i.. Date 10- 11 '1°0 Print Name Ko kAy'tC) Signature A�,r T:Forms /Building Division /Building permit application Y Y *2 NOTES Permit 11 1 A A i. _i It.h o C1 1 G 1■ A J is t ■i _A- j T va- ;3' I 150 s f itt 411l2.1-•-4 ".AL. t i CLOJYYL13-3 NIA oJ u 10 -19 O e, Ow a Ine)r W e, a revi s-e 54e- tarn O. C1 I ra 1 O t1 T:Forms /Building Division/Notes mob 4 4. r l a a '''9:1-1''f5'''";::;!,:ii,;;*;:ire'il:'°:„' -'4'7!;',2;',"'''',467.11'1:1.,:;::''.4'1:11::4t:';'14:1"Y:;;;I; 1***** r, 1 J."1 r 14 e P w ,s i '0 O M (Zr.—....r 1 e„ N '•'w. .A' (2 •1 m N o� '1; m, rra i ta C A d A Q- k tsn w RECEIVED n OCT 14 2010 CITY OF PORT ANGELES BUILDING DIVISION r Q 2 0 O v 5 2 J a W c) 4 Q k 2 1 A 3® Q I_}S 11+0I L 4te X (S .s Ai ley $k i F 1! tom_ S 56 45'08" E 50.00' I `'Z Pr o 20' -0" B.S.B.L. 1 >7f r �S 1 c' 0" I i,l, ,i 36 -0" r\jK I 1 9 1 0 p 30_0„ 10' p.. 1 O I I O O O J W m 1 f Q 2 f CO A 1 aj o ..1 Z i s CO gyp s E� I I :.:1,t, 1 N -a ‘c.) I tyf sv O, s 5 ru S.': 111 I l ,,,-74 ,X` OS Q a�' 5 I 1 ro n YE,tca'. .-4; 1 Alt y 0 1 �1 1' I I 1 7we: o 20' 0" B.S.B. L. r I y 7, -0 36' -0" i. 7 _p N 56 44'59" W 50.00' L i. ?C)RT.A PRESCRIPTIVE APPROACH- SIMPLE FORM 0 7. £7F For the Washington State Energy Code (2006 Edition) r Climate Zone 1 CITY GOVERNMENT Site Information: Building Department Use Only: Lot: Permit Address: S31 1.0# Notes: City: PO R12 elp..5 State: Vi Zip: q B3 b-- Contact: r1 I(J( Phone: X 111 0 00 Phone 2: FAX: Table 6 -1 PRESCRIPTIVE REQUIREMENTS FOR GROUP R OCCUPANCY CLIMATE ZONE 1 (Unlimited Glazing Option Only) Glazing` Glazing U Factor Door Wall Wa11 Wall Vaulted Interior Exterior Slab 'on Option Area of Vertical Overhead Factor Ceiling Ceiling G ade Below.: .Below Floor Concretes, Grade rade de Unlimited �G Group R -3 IV and R -4 0.35 0.58 0.20 R -38 R -30 R -21 R -21 R -10 R -30 R -10 Occupancies Only This Project complies with the following: 1 The project is a single family residence or duplex. 11 The project is a wood frame OR all of the insulation is interior or exterior of the framing. All building components meet the requirements listed above. *Ni The project will meet all other provisions of the WSEC and VIAQ. The Project will take advantage of the following exceptions to the prescriptive option. 602.6 Exception 2. One unlabeled or untested exterior swinging door, 24 sq.ft. or less, may be installed per unit for ornamental, security, or architectural purposes. Location of the door taking this exception: 602.6 Exception 2. If a door is mostly glass, it should meet the requirement of the vertical glazing U- factor listed above. Location of the door(s) taking exception: Type of Heat Source: L�QL77 ZorLSz_ T:f-O!m /Building Division /Pescriptive Approach pie Form Clallam County Assessor Treasurer Property Details 58733 MICHAEL J HOAGLA... Page 1 of 5 Clallam County Assessor Treasurer Property Search Results 58733 MICHAEL J HOAGLAND for Year 2010 2011 1 Property i Account Property ID: 58733 Legal Description: LOT 17 BL 287 Geographic ID: 0630000287800000 Agent Code: Type: Real Tax Area: 0010 PA 121 PORT ST CNTY H2 L Land Use Code 91 Open Space: N DFL N Historic Property: N Remodel Property: N Multi Family Redevelopment: N Township: Section: Range: Location Y Address: 531 E TENTH Mapsco: PORT ANGELES, WA 98362 Neighborhood: Cycle 5 Comm Map ID: 2 j \C\3L. Neighborhood CD: 20953140 Owner '.7),..isis..._ Name: MICHAEL J HOAGLAND Owner ID: 148261 Mailing Address: 330 E 6TH ST Ownership: 100.0000000000% PORT ANGELES, WA 98362 Exemptions: faxes and Assessment Details Property Tax Information as of 10/11/2010 Amount Due if Paid on: Y.2; NOTE: If you plan to submit payment on a future date, make sure you enter the click RECALCULATE to obtain the correct total amount due. First Second: j Half Half ;Base ;Base 1 i Year Statement ID Taxing Jurisdiction Amt. Amt. Penalty Interest Base Paid i Q 2010 41652 ST SCH STATE SCHOOL $56.79 $56.79 $0.00 $0.00 $113.58 2010 41652 CC -GEN COUNTY $30.22 $30.23 $0.00 $0.00 $60.45 2010 41652 PORT PORT $4.25 $4.25 $0.00 $0.00 $8.50 12010 41652 PORT ANG PORT ANGELES $69.98 $69.97 $0.00 $0.00 $139.95 12010 41652 SD #121 SCHOOL DISTRICT #121 $73.56 $73.56 $0.00 $0.00 $147.12 2010 41652 NTH OLY LIB NORTH OLYMPIC LIBRARY $8.78 $8.78 $0.00 $0.00 $17.56 2010 41652 HOSP #2 HOSPITAL #2 $12.40 $12.40 $0.00 $0.00 $24.80 2010 41652 WSMET PK DIST WILLIAM SHORE MET PARK DIST $3.94 $3.95 $0.00 $0.00 $7.89 I 2010 41652 CITY STORMWATER CITY STORMWATER $36.00 $36.00 $0.00 $0.00 $72.00 1 2010 41652 WEED CONTROL WEED CONTROL $0.82 $0.81 $0.00 $0.00 $1.63 3 2010 41652 TOTAL: $296.74 $296.74 $0.00 $0.00 $593.48 i 2009 587332008 ST SCH STATE SCHOOL $66.28 $66.28 $0.00 $0.00 $132.56 1 2009 587332008 CC GEN COUNTY $33.54 $33.55 $0.00 $0.00 $67.09 2009 587332008 PORT PORT $4.75 $4.75 $0.00 $0.00 $9.50 2009 587332008 PORT ANG PORT ANGELES $73.58 $73.57 $0.00 $0.00 $147.15 2009 587332008 SD #121 SCHOOL DISTRICT #121 $81.96 $81.97 $0.00 $0.00 $163.93 2009 587332008 NTH OLY LIB NORTH OLYMPIC LIBRARY $9.75 $9.74 $0.00 $0.00 $19.49 http: /vpn.clallam.net: 8084 propertyaccess /Property.aspx ?cid =0 &year= 2010 &prop_id =5... 10/11/2010 m J Electrical Information Form Al Public Works Utilities Department (360) 417 -4700 City Electrical Inspector (360) 417 -4735 Please complete and return to Public Works Utilities Department Applicant 'Information Permanent service: Name: f k C* c .L\ �c�,nd Name and address of party Street: 330 6 S 's+ n responsible for permanent City State ZIP: rpt-fi el. INvv us k A 4 83( service billing? Daytime Phone: 1-001".4) Home Phone: 4 /7 7 0 0 tContact `.Information: (if other than above) Site contact: Name: SQL X15 Gk®wL_ Title: Daytime Phone: Contractor: Name: Company: Daytime Phone: Electrician: Name: Company: Daytime Phone: Excavator: Name: Company: Daytime Phone: ProjectType Existing )g(New ►t Single-family residence ❑Multi- family residence; of units Commercial ❑Subdivision; of lots "-Overhead service CI General service Underground. service ❑'Other: Projectylnformation Description of work: --lev0 (v" Street address lot number: 53/ /0 5 ri Nearest cross street: Al b f- 4 d-, 10± Desired connection date: Electrical transformer.serving property is: Won a pole on the ground Electrical Load A Total square footage: t3 sq. ft. Main disconnect size: 200 amps Voltage: X120/240 1 ph ❑120/208 3ph 277/480 3ph ❑120/240 3ph 0480 3W 3ph Li Other ;Standard residential loads (Lighting, refrigerator, dishwasher, washer) Check all that apply: A/C ton) Range /Oven Hot Tub ,'Clothes Dryer Heating Pumps Hp) No Load Change ,Water Heater Elevator Hp) Other SuppOTting'DDCUmelltatlon t. 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 50hp. Applicant's Signature: r Date: 10 1 t 2L 0 MAIL OR DELIVER COMPLETED FORM TO: 321 E 5TH STREET; PORT ANGELES, WA 98362 FAX TO: 360- 417 -4711 WS WF Information form.xls N:AP IKStE GH T \F:NGR #JOriginalsllnform<ation form Revised 1 -15 -09 r 7 •1" ,1 4 1'''' e ..,.,,....,,...,,„,..,;,,,,,7,1, -spn 5 i u fi '10,iiii,.:Omov. yam 4. mob. t a 1 J 1 o f ..a 4 `w 777 P z d Ci .erg° J6 O 4X b tai 3 'i a 9 G^ ?N 1 a r 1r lea y 1:"- fi 'd `V J l i rm Gov 0 J Ar t,9 0 r /7 F °W 4a j r ani, i b -yt� 4 r Q r i;a w 1. i S c a mw jil.,",,x,,,,'„,-0'4,;;3;-4:"-,4‘:'4","-Ii'l' r L Application Number Application pin number Property Address ASSESSOR PARCEL NUMBER Application type description Subdivision Name Property Use Property Zoning RS7 RESDNTL SINGLE FAMILY Application valuation 0 Application desc t STAT NEV HOME Owner MICHAEL J HOAGLAND 330 E 6TH ST PORT ANGELES (360) 477 0006 Permit Additional desc Permit pin number Permit Fee Issue Date Expiration Date Fee summer Permit Fee Total Plan Check Total Grand Total WA 98362 ELECTRICAL NEW RESIDENTIAL 187161 56 00 6/09/1 12/06/11 Qty Unit Charge Per 1 00 56 0000 ECH EL LVT THERMOSTAT Signature of owner or Electrical Contractor X G \EXCHANGE \BUILDING ELECTRICAL PERMIT CITY OF PORT ANGELES 360 -417 -4735 11 00000570 864410 531 E 10TH ST 06 30 00 0 2 8780 0000 ELECTRICAL ONL Contractor PENINSULA HEAT INC 782 KITCHEN DICK RD SEQUIM (360) 81 3333 Plan Ch °ck Fe Valuat on Charged Paid Credited 56 00 56 00 00 00 00 00 56 00 56 00 00 INSPECTION TYPE DITCH SERVICE ROUGH 1N FINAL COMMENTS PERMIT WILL EXPIRE SIX (6) MONTHS FROM LAST INSPECTION DATE. RESULTS 7htk 47 u 9 °7-11 he Date 6/09/11 WA 98382 4$J zc& 0 0 0 Extension 56 00 Due 00 00 00 INSPECTOR. Az:2 Date REPORT SALES TAX on your excise tax form to the City of Port Angeles (Location Code 0502) Jun 0711 01 42p PENINSULA HEAT CITY OF PORT ANGELES PERMIT APPLICATION Building Division/Electrical Inspections 321 East Fifth Street P O, Box 1150 Port Angeles Washington, 98362 Ph: (360) 417-4735 Fax: (360) 417 -4711 Date: 67 1 2 Single Family Dwelling Multi- Family or Commercial* Commercial Addition Alteration Remodel Repair* Plan Review May Be Required, Please Complete Electrical Plan Review Information Sheet Job Address: /o 517- r' Building Square Footage: Description of above r 4 7`71; c -.--i Owner Information Contractor Information Name: i'9/ k c 7 /9 /ci, /l 6, i�S /l"1 "Y'$ Name: Malting Tess: 7 4 L —T ri .5' 7` Mailing Address: r en) n s u la lea t f"n mp City: o: f-=� State: U6• :'LLD: 4 7 S" 5- 4 7 S" 5- 2_ City: St Phone: `t77— u C- 1Jh t'a]t' Fax: Phone: Q ick Rd. License /Exp License /Exp. `PL1nim WA 98382 6:,& 3 Item Unit Charge .g.. Total (C3ty Multiolied by Unit Charq Service/Feeder 200 Amp. 119.90 Service/Feeder 201-400 Amp. 145.50 Service/Feeder 401 -600 Amp 204.60 Service/Feeder 601 -1000 Amp. 262.20 Service/Feeder over 1000 Amp. 372.50 S Branch Circuit W/ Service Feeder 2.60 Branch Circuit W/O Service Feeder 73.50 S Each Additional Branch Circuit 2,60 Temp. Service/ Feeder 200 Amp. 92.70 Temp. Service/Feeder 201-400 Amp. 110.30 Temp. ServiceiFeeder401-600 Amp. 148.70 Temp. Service/Feeder 601-1000 Amp $167.90 Portal to Portal Hourly 95.90 Sign/Outline Lighting 88.20 Signal Circuit/ Limited Energy First 1500 sf Commercial 95.90 Note: $5.00 for each additional 1500 sf Signal Circuit/ Limited Energy 1 2 Family Dwelling 63.90 Signal Circuit/ Umited Energy Multi -Family Dwelling 63.90 Manufactured Home Connection $119.90 Renewable Electrical Energy 5KVA System or Less $102.30 Thermostat 56.00 NEW CONSTRUCTION ONLY: First 1300 Square FL $110.30 Each Additional 500 Square FL or Portion of 35.20 Each Outbuilding or Detached Garage 73.50 Each Swimming Pool or Hot Tub $110.30 S 5L- 3 '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 296.46B, 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 Cash Check 7 J cremtca;a z 7).41 e L I Dated: 1 _)6-(11(:- 3606812086 RECEi'E JUN E 2011 ELECTRICAL INSPECTIONS 01/01r2D10 p1 ELECTRICAL PERMIT CITY OF PORT ANGELES 360 -417 -4735 Application Number 10 00001322 Application pin number 252332 Property Address 531 E 10TH ST ASSESSOR PARCEL NUMBER 06 30 00 0 2 8780 0000 Application type description ELECTRICAL ONLY Subdivision Name Property Use Property Zoning RS7 RESDNTL SINGLE FAMILY Application valuation 0 Application desc Temp pole Owner MICHAEL J HOAGLAND 330 E 6TH ST PORT ANGELES (360) 477 0006 Permit Additional desc Permit pin number Permit Fee Issue Date Expiration Date Fee summary Permit Fee Total Plan Check Total Grand Total WA 98362 177212 92 70 11/12/10 5 /11 /11 Signature of owner or Electrical Contractor X Contractor ELECTRICAL TEMPORARY SERVICE Plan Check Fee Valuation Qty Unit Charge Per 1 00 92 7000 ECH EL TEMP SRV 0 200 SRV FDR Charged Paid Credited 92 70 92 70 00 00 00 00 92 70 92 70 00 INSPECTION TYPE DATE. DITCH SERVICE ROUGH IN FINAL COMMENTS PERMIT WILL EXPIRE SIX (6) MONTHS FROM LAST INSPECTION 11115 /It 1.11 10 ke Date 11/12/10 OLYMPIC ELECTRIC CO INC 4230 TUMWATER PORT ANGELES WA 98363 (360) 457 5303 Jh -v- Due RESULTS 00 00 00 0 0 0 Extension 92 70 REPORT STATE SALES TAX on your excise tax form to the City of Port Angeles (Location Code 0502) INSPECTOR. 4zep Date 11/10/2010 09 00 FAX 360 452 3498 hiC SIN ED- a Dal 10 2010.] City of Port Angelee Permit Application ELECTRICAL yco, N i„tre W 321 Building EastFI Fifth Street 1150 INSPECTIONS L s 321 East th Strt -P.O. P.O. Box 1150 Alriftwegpmew- Port Angeles Waehington, 99382 Ph: (360) 4174735 Fax: (36014174711 W lit,.. SP lir Date: /./Ol /lJ ✓1 2 Single Family Dwelling Multi Family or Commercial' Commercial Addition Alteration Remodel Repair' Plan Review May Be Required, Please Complete Electrical Plan Review Information Sheet J0b Address: S? /li Building Square Footage: Description of above ,r7,,-/ 7%,r7. Owner information Name Mailing Address: City' /0e/ ,-er Slate: /1/7 Zip: Phone: y» License d Exp. Unit Charge 5 119,90 145.50 5 204.60 1 262,20 5 372.50 5 2.60 5 73.50 2.80 92.70 5 110.30 148,70 $197.90 5 95.90 88,20 95.90 S 63.90 e3,90 5119,90 5102,30 110.30 35.20 73.50 $110.30 56.00 ati Owner es defined byRCW.19.29.261: (1) Owner will occupy the structure tar two years after this electrical penult k finalized. (2) Owner is required to hire in electrical contractor If above sold property le for sale, rent or geese. Permit expires after mix months of Mel Inspection, After reading the above etetement, I hereby certify that 1 am the owner of the above named property or licensed electrical contactor I em making the electrical installation or alteration In compliance with the electrical taws, N.E.C. RCW, Chapter 19.29, WAC. Chapter 295-409, The City of Port Angeles Municipal Code, end Utility Speelncetione, Signature of owner, electrical contactor or electrical administrator 0 Cash yy� (3 Check X- 77 G Date: /l> 4 �/7 Contractor Informal I), Name: r ii Mellln9 City' State' h/9 Zlp_ f 'iJ Phone: Fax: V _T ri� License Exp., iox .v.�i- Total (Oty MultIolleg by UnitChernel Service/Feeder 200 Amp. S Service/Feeder 201.400 Amp. SeMCe/Feeder 401.600 Amp. Service/Feeder 601.1000 Amp. Service /Feeder over 1000 Amp. Branch Circuit W/ Service Feeder 5 Branch Circuit W/) Service Feeder Each Additional Branch Chcvll 97 >9 Temp. Service! Feeder 200 Amp. Temp. ServlcelFeeder 201.400 Amp, 5 Temp. Service /Feeder 401.600 Amp. Temp. Service /Feeder 601.1000 Amp, Portal lo Portal Hourly Sign /Outline Lightlng Signal Circuit Limited Energy Commercial, Addltional 1500 $5.00 Signal Circuit/ Llmlted Energy 1 2 Family Dwelling Signal ClroulV Llmlted Energy Multi Femgy Dwa9Ing Manufactured Home Connection Renewable Electnoal Energy 5KVA System or Less 5 Flrel 1300 Square Ft. Each Additional 500 Square Ft•or Portion of Each Outbuilding or Detached Garage Each Swimming Pool or Not Tub Thermostat 5 •J Total Olympic Electric Co PA CITY INSPECT a 001/001 Cre dit Card It PREPARED 2/21/08 8 59 24 INSPECTION TICKET CITY OF PORT ANGELES INSPECTOR JAMES LIERLY ADDRESS 531 E 10TH ST TENANT NBR ANN LEINAAR CONTRACTOR J GRICE CONSTRUCTION LLC OWNER DENNIS J LEINAAR PARCEL 06 30 00 0 2 8780 0000 APPL NUMBER 07 00000999 DEMOLITION PERMIT DEMO 00 DEMOLITION REQUESTED INSP DESCRIPTION TYP /SQ COMPLETED RESULT RESULTS /COMMENTS BL99 01 2/21/08 BLDG FINAL February 21 2008 8 45 48 AM 1pangrle SARAH 809 0560 BLDG FINAL DEMO (BURNT TRIPLEX) SUBDIV COMMENTS AND NOTES PHONE (360) 457 1708 PHONE (360) 457 4400 %%I� 7 ..60/101111 04.1114 .,lice_ rar r iF r V I F PAGE 6 DATE 2/21/08 eLe S ch) P i 01)61- 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 Permit Additional desc Permit pin number Permit Fee Issue Date Expiration Date Qty Unit Charge Per Fee summary Permit Fee Total Plan Check Total Grand Total T \Policies \1102_15 building permit inspection record05 wpd [1/4/2005] CITY OF PORT ANGELES DEPARTMENT OF COMMUNITY DEVELOPMENT BUILDING DIVISION 321 EAST 5TH STREET PORT ANGELES, WA 98362 07 00000999 456461 531 E 10TH ST 06 30 00 0 2 8780 0000 ANN LEINAAR DEMOLITION RS7 RESDNTL SINGLE FAMILY 9500 DEMOLITION DEMO BURNT TRIPLEX 109918 50 00 Plan Check Fee 9/18/07 Valuation 3/16/08 BASE FEE Contractor Charged Paid Credited 50 00 50 00 00 00 00 00 50 00 50 00 00 Date DENNIS J LEINAAR J GRICE CONSTRUCTION LLC PO BOX 2944 223 MARSDEN RD PORT ANGELES WA 983620336 PORT ANGELES (360) 457 4400 (360) 457 1708 Structure Information 000 000 DEMO REMOVE BURNT TRI PLEX Special Notes and Comments The Fire Department has reviewed the project application and has no comments 09/14/2007 03 18 PM SROBERDS No land use issues with demo Sanitary sewer is to be capped and the location marked at the property line at the alley An inspection is required by Public Works prior to back fill of ditch 24 hour advance notice is required If a structure is not rebuilt within 6 months the existing water meter will be pulled 09/10/2007 10 23 AM RVESS 9/18/07 WA 98362 Due Extension 50 00 00 00 00 0 0 0 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 fora 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. v7-r2)\ R ,t JAn ci (S" (.5 Signature of Contractor or Authorized Agent Date Signature of Owner (if owner is builder) Date BIDING PEPJVIIT INSPECTION RECORD o CALL 41 7 -4S 15 FOR BUILDING INSPECTIONS. CALL 417 -4735 FOR ELECTRICAL INSPECTIONS CALL 417 -4807 FOR PUBLIC WORKS UTILITIES 1 PLEASE PROVIDE A MINIMUM 24 HOUR NOTICE. IT IS UNLAWFUL TO COVER, INSULATE OR CONCEAL ANY WORK BEFORE INSPECTED AND ACCEPTED POST PERMIT IN A CONSPICUOUS LOCATION KEEP PERMIT CARD AND APPROVED PLANS AT JOB SITE. INSPECTION TYPE DATE FOUNDATION: FOOTINGS SHEAR WALLS WALLS FOUNDATION DRAINAGE DOWN SPOUTS PIERS POST HOLES (POLE BLDGS.) PLUMBING UNDERFLOOR /SLAB ROUGH -IN WATER LINE (METER TO BLDG) GAS LINE BACK FLOW WATER AIR SEAL WALLS CEILING FRAMING JOISTS GIRDERS SHEAR WALL/HOLD DOWNS WALLS ROOF CEILING DRYWALL (INTERIOR BRACED PANEL ONLY) T -BAR INSULATION SLAB WALL FLOOR CEILING MECHANICAL ROUGH -IN HEAT PUMP /FURNACE /DUCTS GAS LINE WOOD STOVE PELLET CHIMNEY MANUFACTURED HOMES FOOTING SLAB BLOCKING HOLD DOWNS SKIRTING PLANNING DEPT SEPARATE PERMIT #'s PARKING /LIGHTING LANDSCAPING RESIDENTIAL ELECTRICAL LIGHT DEPT 417 -4735 YES ACCEPTED COMMENTS NO FINAL FINAL SEPA. ESA. SHORELINE: FINAL INSPECTIONS REQUIRED PRIOR TO OCCUPANCY/USE DATE YES NO COMMERCIAL ELECTRICAL LIGHT DEPT CONSTRUCTION R.W PW/ CONSTRUCTION R.W ENGINEERING 417 -4807 PW ENGINEERING FIRE 417 -4653 1 1 I I FIRE DEPT I PLANNING DEPT 417 -4750 I I I I PLANNING DEPT 1 BUILDING 417 -4815 1 0 D R 1 TN 1-1 -1 1 BUILDING T' \Policies \l 102 15 building permit inspection record05 wpd [1/4/ DATE ACCEPTED BY. W I DATE ACCEPTED BY. CP I DATE 1 ACCEPTED YES I NO 0 I I I 1 Project Site Address G5 P (T Cit YES Starting Date. S. 2607 NO L AHERA Certified Inspector This approved permit must be available at the job site An r O L Y M 1P I C A IR POLLUTI-ON CONTROL AUTHORITY Notification of Demolition Penult It is unlawful for any person to cause or allow the demolition (or major renovation) of any structure unless all asbestos containing materials have been removed from the area to be demolished. Work shall not commence on an asbestos project or demolition unless the owner or operator has obtained written approval from OAPCA. A written application for a demolition shall include a certification that there is no known asbestos containing material remaining in the area of the structure. Property Owner. \!(A Mailing Address Cit Q Enclose $25 Processing Fee Completion Date State Telephone State Asbestos Survey Completed by Certification \M W\C) J )O 1 N");; 909 Sleater Kinney Rd SE, Suite #1 Lacey Washington 98503 360 438 -8768 800 -422 5623 fax 360 -491 -6308 homepage: www oapca.org email info @oapca.org County L, a Zip G i< 2 t zip 00 2[92_ Demolition Contractors, Y (on LI-L./State License cr :n. r_n 01 Mailing Address. Z2. A Cit A f S State Zip O Contact Person. D.)(\ i SOY\ Telephone )c Demolition by Wrecking or Dismantling? ($25 fee) Trammg Fire Demolition? (If yes, attach fire department request for training fire) Renovation, Alteration, Remodeling, Maintenance, or other Construction? Asbestos found or suspected* An OAPCA `Notice of Intent to Remove or Encapsulate Asbestos' form and appropriate fee must be submitted prior to any asbestos removal work. Asbestos removal projects involving demolition must be preformed by a Certified Asbestos Contractor and all friable or potentially friable asbestos must be removed before any demolition begins. Refer to OAPCA Regulation I Article 14 for additional requirements that may apply Certification of the Asbestos Survey must accompany this form PLANNING USE ONLY 'BUILDING PERMIT APPLICATION Fill out-COMPLETELY and in INK. Your application and site plan MUST BE COMPLETE to be accepted for review If you have, any PERMITS (360) 417 -4815 FAX(360)417 -471'1 Applicant or Agent: 5 W VV 11 SIM Phone: 3 (j w)01- D cD Owner Arun L j Yl aC' Phone' L NOD Address:5 F", \DM ii City. IPC)Y nn ifS Zip: "1 Architect/Engmeer 1 rail il box \iy 1 Phone: big)" Contractor`s S�r t3 l G State License �C1Ra.Gf1L4 M EScp:_ Phone: 4P) 1 71)8 Address: Z S ,-t; V1 (a, •Cit L Zip: PROJECT ADDRESS. 6 I A/ LEGAL DESCRIPTION Lot: Block: CLALLAM COUNTY PARCEL NUMBER. COMMERCIAL/RESIDENTIAL. Occupancy Group: No. of Stories: Lot Size: Existing Sq. Ft. Total lot coverage ESA/Wetland(s): Yes No SEPA Checklist required? Yes No Other: T•\FORMS\BIdgPermitAppl. wpd Applicam Subdivision: ZONING TYPE OF WORK. SIZE/VALUATION. Residential New Constr. Re -roof Stove I SF 1 7J 1)' Multi family Addition Move Garage SF /SF Commercial Remodel iii Demolition Deck SF /SF Repair Sign Other TOTAL VALUATION BRIEF DESCRIPTION OF THE PROJECT 1 1 I I 1 i 9\.;)( ed: a ill Occupant Load: Construction Type: Proposed Sq. Ft. TOTAL Sq. Ft. Date: FFICIAL USE ONLY R p i 0 APPROVALS. PLAN BLDG: DPWU FIRE: OTHER VALUATION OF CONSTRUCTION In all cases, a valuation amount must be entered by the applicant. This figure will be reviewed and maybe revised by the Building Division to comply with current fee schedules. Contact the Permit Coordinator at 417 -4815 for assistance. PLAN CHECK FEE. IF a plan check fee is due it must be submitted at the time the building permit application and construction plans are submitted. All other permit fees are due at the time of permit issuance. EXPIRATION OF PLAN REVIEW If no permit is issued within 180 days of the date of application, the application will expire. The Building Official can extend the time for action by the applicant up to 180 days upon written request by the applicant (see Section R105.3.2 of the International Building/Residential Code, 2003). No application can be extended more than once. I hereby certify that I have read and examined this application and know the same to be true and correct. '1 am authorized to apply for this permit and understand that it is my responsibility to determine what permits are required ,not the City's, and that l must obtain such permits prior to work. PORTANGELES W A S H I N G T O N U S A. Public Works Utilities Department August 29 2007 State Farm Insurance Attn. Karen Sato P O Box 437 Dupont, WA 98327 RE. Port Angeles Landfill Transfer Waste Disposal Application, WDA 07 -42, Building demolition at 531 East 10 Street We have received your application for disposal of building demolition debris from the referenced site and reviewed the testing results for lead content. Based on the testing results the debris appears to be acceptable for disposal at the transfer station. A copy 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 materials and quantities listed in the application. Materials not listed or in excess of the quantities noted may require separate applications and approval. Please call if you have questions Very truly yours, Stephen Sperr P.E. City Engineer Encl. WDA 07 -42 Copy Claudia Stromski Bldg file Jason Grice N:\PWKS\ENGINEER \WDAPPLIC\07 37 File: Landfill Solid Waste Disposal Applications Phone 360- 417 -4805 Fax 360- 417 -4542 Website www cityofpa.us Email publicworks @cityofpa.us 321 East Fifth Street P 0 Box 1150 Port Angeles WA 98362 -0217 AJ6.22 28O1 8 21AM NVL LABORATORIES INC NVL latOortatodes,km. CHAIN of CUSTODY 4708 Aurora Ave N. Seattle. WA 9810 Tel; 206.547.0100 ):merge Peger 206.344.1878 SAMPLE LOG 1.888.NVLIABS (665.w Client Zeeuovic Assoctgtes Inc. street 3U\ C— (off"..` 1.01 ti 06i Port Angeles Project illianegsr Cs Project Iceman 631 gA- I METALS M U' Other of le rint Below Sampled by Refineuiis hr heed t Received by r 1 Analyzed bar l f 14,44A, Rearms Called by Results +byI Below ,149.v44 gAz link. Batch Number Client Job Number Total Samples Tarn Around Time 8 iddress Condition of Padoga: CJ Good 0 Damaged Ma spilage) 0 Sevyere dema Vie) see). s Lab ID Client Sample Number I Cceemeros 1 t¢~-1 1st FilleLg 61A- it..0cour 2 3 4 5 6 7 8 9 10 11 12 13 14 15 NO.2162 P 3' bATCn IL) 2711804 00 a-1j(+ I 01-Hr 24-Hrs D 4 Days 0 2-Hrs D 2 Des Days Q 4 a r Phase corTATl His 1 trays Phon (360) 417-0501 Fax: (360) 417 -05i4 10 Aabn ies Air 10 PCM (NIOSH 7400) TEM (NOSH 7402) U TEM (AHEM) 0 TEM (EPA Level 11) 0 Other 10 Mantas Erik 0 Pt.M (EP/000/114:o UR 0 PLM (EPA Point Count) 0 PLM (EPA Graviinatly) 0 TEM Bulk 1 Ppm 0 Air er Paint Chips Arsenic (As) D L L (Phi o ppb (GFAA) 0 Drinking water 0 Paint Chips Wee) 0 sedum (88) m utiny Gi O C C c pp (Cu) U DuetMipe 0 Waste Water D Cadmrum (Co) CI selenlann (se) 0 NI 0 Soil 0 Chromium (Cr) 0 Sliver (Ag) VA 0 Froarglass 0 Nuance Oust 0 Rotometer Calibration 0 Other Opacity) =se Respirable Dust MoldlFu gus r• 1 Arc 1 NI/1.- 1 I 1_ Special Instructions: Unless requested in waling. all samples will be d'j5posed of two (2) weeks after analysis. l� 4 Tins 71 ofw jpr /a7 7 1 0 A we AUG. 11. 200/ 8 21AM NVL LABORATORIES INC NO. 2162 P 2 NVL Laboratories, Inc. AIR 4706 Aurora Ave. N. Seattle, WA 98103 Tel: 206.547.0100, Fax: 208.634.1936 AIHA -11.1# 101861 ACCOMPITED www.nvllabs.com Analysis Report WA DOE C1765 LARO bonne, Toxicity Characteristic Leaching Procedure Lead (Pb) Client Zenovic Associates, Inc. Address: 301 E. 6th St. Suite 1 Port Angeles, WA 98362 Attention; Mr Tracy Gudgel Project Location: 531 East 10th St. Lab ID 27078917 07181 Client Sample Sampled by Client Analyzed by Tanveer Khan Date Analyzed: 08/22/2007 RL m0/ L 04 Results In and /L 17 mg/ L =Milligrams per liter ppm parts per million Note Method QC results are acceptable unless stated otherwise. Unless otherwise indicated, the condition of all samples was acceptable at time of receipt. Batch 2711804.00 Matrix: Bulk Method: EPA 1311/7000B Client Proiect it 07181 Date Received: 08/08/2007 Samples Received: 1 Samples Analyzed: 1 DRAFT Results in ppm 17 RL Reporting Limit Below the reporting Limit Date: JQb Sitg, Owner: 1 55 Cont @cts: Subject: Inspector: Northwest Asbestos Consultants 406 Reed St. Port Townsend, WA 98368 360 385 -0584 northwestasbestosconsultants@cablespeed.com 8/3/07 541 E. 10th St. Port Angeles, WA 98362 .twe 5+1 E. 10th St. Port Angeles, WA 98362 State Farm Insurance Port Angeles, WA 98362 Zenovic and Associates Tracy Gudgel, PE 301 E. 6th St. Suite #1 Port Angeles, WA 98362 Demolition Bob Witheridge AHERA Building inspector Management Planner WAMOA 0042- 10270601 Expires 10/27/07 AUG 0 7 2007 3J�J 5sppe of work, 1) Building survey and inspection to inspect for asbestos containing building materials (ACBM) 2) Survey, sample and record suspect materials. 3) Report to Tracy Gudgel, PE of Zenovic and Associates. immar of Inspgstion Requested by Tracy Gudgel, PE of Zenovic and Associates. Inspection of suspect asbestos containing building material (ACBM) Inspection was made of a split level home with extreme fire damage. Approx. 1500 sq ft. This home was deemed unsafe to enter for inspection. All asbestos containing building materials with a reading of greater than 1% is considered a hazardous material if disturbed. Removal of any hazardous materials must be abated by a certified abatement contractor which follows the rules of the EPA and governed by Olympic Region Clean Air Agency During building demolition, it is possible that additional suspect asbestos containing building material (ACBM) may be found with in a wall, floor, ceiling or other areas not accessible at the time of the survey Should such suspect material be discovered an AHERA certified inspector will have to sample and test the material 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 re inspection is required by the original AHERA building inspector (NW Asbestos) after abatement, then a copy of the letter certifying that abatement has been completed needs to be received by the City of Port Angeles Permit Center and Olympic Region Clean Air Agency Thank you, Bob Witheridge, EYM. eulaualCA.:6- •k I WASHINGTON ASSOCIATION pf ':NI,A114,1TEtiAilEanci OP ADIVEIN !Sit t- _Participated in the pA, ARERA impEcToR, MANACiEIVIENT PLANNER efreshef cOurseroffefed- by the- WA$RINGTON- ASSOCIATION of MAINTENANCE and OPERATIONS ADMINISTRATORS The full day _traming -prografh covered alt topics _specified in the MOdelrA Plan _under Section' 206 Title 11 of T$CA The course was taken on October 27, 2006 in Silverdale, Washington Certificate #M270601 Expiration October 27 2007 Co i ii;)-M'acRae- Coy 2714:22801 St SE Bothell WA. ,9f3021 (45) 4564560 0'0'0 0'00 To City of Port Angeles City Engineer 321 E Fifth Street P O Box 1150 Port Angeles Washington 98362 PORT ANGELES LANDFILL WASTE DISPOSAL APPLICATION NOTE. All questions must be answered for waste to be approved. 1 Generator Information. Company Name. S TAT iiki vit,(\1(4 Mailing Address: Pa l y L 3 7 OP() ors' LA--) q a� 7 Contact: �1T C3 Phone H 3 I 79 1 Project Name. T it- PLC' r') ,itU Project Location GI &5 r 2. Other Contacts (if applicable) Consulting Firm. L oc-/ T S Contact: S cc) D(Llc -k. Phone 3C,r,U 9-17 ©5o Contractor Name //ce Stsiau c-.g Contact: CctcA Phone 3 I 47QE✓ Laboratory ,AJ/L Pore ovukS IJL Contact: T;a vk Eta_ kil AN Phone 8R8. C.a)S', .527 Phone. (360) 417 -4803 FAX. (360) 417 -4709 -1 01 `Karen Sad 5-644 the rvFek+y owner f S pt Le%naat 3 60 1 -151 (boa City of Port Angeles Landfill Waste Disposal Application Page -1 3 Source of Waste Check the appropriate box below and briefly describe the project, process and/or cleanup that will or has produced the waste requiring disposal Include the gasoline service station number (if applicable) CERCLA/MTCA Remediation Agency Contact. Independent Remedial Action UST Removal Unused Chemical Product Spill Other Source DAlgi4- 15 Est i roC /LA i'vt_il �F� ►vt-1 Pl-s k o 6.0 ,2grkr6 s 0 4 Waste Material Composition. (check all that apply and include percent of total) NOTE. NOTE. Soil Concrete /Asphalt Preserved Wood Coal Ash Wood Ash Total must equal 100% Gasoline Solvents Unused Motor Oil Other TTsr 0 Unknown OA 5 Waste Material Contaminants (check all that apply) City of Port Angeles Landfill Waste Disposal Application Foundry Slag Dredge Sediments X Debris Other (list) Metals Heating Oil Used Motor Oil /Waste Oil Other Petroleum Product Supply any MSDS information with application if available Diesel PCBs Page 2 6 Estimated Quantity of Waste for Disposal 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 7 Frequency of Disposal One time NOTE 1 0—S Cubic yards 2 x) Tons (estimate both) Drums Tons (estimate both) 0 -25 25 100 101 500 501 1000 1001 2000 >2000 cubic yards cubic yards cubic yards cubic yards cubic yards cubic yards Monthly Annual Other 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 of sampling will vary with the type and form of the waste Check the appropriate box and briefly describe how and where the waste was sampled Include site maps with sampling locations if possible Number of COMPOSITE samples number of discrete samples per composite Number of DISCRETE samples 3 1 Ss C rL -E4C f g 0 ft"- (k T Y. pr.A.410 j2 wN I r pc SID h I?rj TAa\_ ,4 v) L t—� MAW] PIA [s.ip 0 Unless prior approval has been granted by Port Angeles the following sampling frequency will be used NOTE 2: One composite sample shall contain a minimum of three /maximum of five discrete samples City of Port Angeles Landfill Waste Disposal Application 1 composite sample 3 composite samples 5 composite samples 7 composite samples 10 composite samples 10 plus one sample for each additional 500 cubic yards Page 3 9 Waste Analysis The Dangerous Waste Regulations' (WAC 173 -303) shall be utilized to determine the appropriate analytical requirements for waste characterization Ecology Publication #91 -30 (Revised April 1994) 'Guidance for Remediation of Petroleum Contaminated Soils" shall also be used to characterize petroleum contaminated soils from UST releases Submit all laboratory analytical results QA/QC data and Chain of Custody sheets along with this application (NOTE. The laboratory must be accredited by the Washington State Department of Ecology a) List all analytical test methods used. EPA 1t /7CcicA b) Provide a narrative as to why the above analytical methods were selected. DA i C�� A6g OF' A C J l-T o r CEO &4S D P nfr NOTE. Additional sheets attached YES 10 Soil Classification *FOR PETROLEUM CONTAMINATED SOILS ONLY Based on the analytical data and Ecology Publication #91 -30 the soil classification is (check one) Class 1 Class 2 Calculated Hazard Index 11 Dangerous Waste Affidavit: NO Class 3 Class 4 Based on a review of the analytical test results site history and the applicable regulations this waste is classified as (check one) Neither Dangerous Waste (DW) nor Extremely Hazardous Waste (EHW) Dangerous Waste (DVV) and Waste Code Extremely Hazardous Waste (EHW) and Waste Code City of Port Angeles Landfill Waste Disposal Application Page 4 12. 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 represent the proposed waste material to the best of our abilities Waide SigUture r Printed Name 2 4 Noutc-- A,ss6c, Lev& Company /a7/ 4.11% Date A 0 NAPOLICY P\1000_SVIA1009_01.WPO City of Port Angeles Landfill Waste Disposal Application Page 5 --........o...:'~-~- Site Address: CITY OF PORT ANGELES LIGHT DEPARTMENT PERMIT NO. :3 z.~~ 7-tf~P/ . ELECTRICAL PERMIT DATE Installed By: D READY FOR rill CAll FOR INSPECTION INSPECTION License Number: Phone: Owner/Business: Phone: Owner/Business Address: Sq. Ft. Jl( Residential D New Construction Heat KW D Remodel D Baseboard D Furnace/Boiler ')g[ Service update/alter/repair D Heatpump D Other ( - D Commercial/Industrial load D Add/alter circuits Total Connected load D Auxiliary power (attach breakdown) (list below) Total Motor load D Special equipment (attach breakdown) (list below) ~Overhead b Undergr~lJ.nd~O Voitage !~ ~10 D 30 !Service size ..::?~ Amps D Temporary Details/Description: . R~ oJ t1~ ~ ~~~~ ~ ~'-I%~ W.S. No. Service Capacity: D O.K. D Not O.K. D Ditch inspection O.K. D Rough.in/cover O.K. D O.K. to connect service ~ Final O.K. Size Comments Date Hold for: D Easement D Letter D Signed up for service/meter D Meter Department notified for installation D Fire Department notified of inspection D Plan Review approved/pending Installer: Permit/Receipt No. 3Gb3 New Meters Date: Site Address: -' . Notify the Department 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 Ins~pector in Writing on the W~~:;c~p~~~r~Ro:s:~~T~B~'~~EiDn;N:~~:~t~E:~TONE 457.0411, EXT~8 or EXT. 224. .;'i{J- spector - Amount paid WHITE - file by address YELLOW - file by number PINK - Top: Eng, Bottom: Customer GREEN - Top: Inspector, Bottom: City Hall OlVMPIC PRINTERS. INC.