HomeMy WebLinkAbout1815 W 13th St - Building Building Permit
1815 W 13 `" St
12 - 1564
PREPARED 12/17/12, 14:37:23 INSPECTION HISTORY REPORT PAGE 1
PROGRAM BP521L 0/00/00 THRU 0/00/00
CITY OF PORT ANGELES
—--- -—-------------------—-----—-------- -- --------
APPLICATION PROPERTY ADDRESS ASSESSOR PARCEL NUMBER ALTERNATE ID
STRUCTR PERMIT INSPECTION RESULT DATE/STATUS INSPECTOR
------------------------------------------------------------------------------------------------------------------------------------
12 00001564 1815 W 13TH ST 06-30-00-0-3-6280-0000- 063000036280
000 000 ME 00 MECHANICAL PERMIT ME99 0001 MECHANICAL FINAL 12/11/12 APPROVED JLL _
REQ COMM: December 11, 2012 8:24:48 AM pbarthol.
REQ COMM: Summer 509-307-5522
RES COMM: December 11, 2012 4:48:51 PM jlierly.
CITY OF PORT ANGELES
DEPARTMENT OF COMMUNITY& ECONOMIC DEVELOPMENT- BUILDING DIVISION
321 EAST 5TH STREET, PORT ANGELES,WA 98362
Application Number . . . . . 12-00001564 Date 11/30/12
Application pin number . . . 710340
Property Address . . . 1815 W 13TH ST
ASSESSOR PARCEL NUMBER: 06-30-00-0-3-6280-0000- REPORT SALES TAX
Application type description RES MECHANICAL PERMIT
Subdivision Name . . . . . . on your state excise tax form
Property Use . . . . . . . . to the City of Port Angeles
Property Zoning . . . . . . . RS7 RESDNTL SINGLE FAMILY. . (Location CO�J
Application valuation . . 600
---------
Application desc
FREE STANDING PELLET STOVE
----------------------------------------------------------------------------
Owner Contractor
------------------------ ------------------------
JASON AND SUMMER SCHNEIDER OWNER
1815 W 13TH ST
PORT ANGELES WA 983636883
(360) 670-5888
------------------------------------------------------------
Permit . . . . . . MECHANICAL PERMIT
Additional desc .
Permit Fee . . . . 60.65 Plan Check Fee .00
Issue Date . . . . 11/30/12 Valuation . . . . 0
Expiration Date 5/29/13'
Qty Unit Charge Per Extension
BASE FEE 50.00
1.00 10.6500 EA ME-STOVE/FIREPLACE/MISC. APP. 10.65
-------------------------------------------------------=--------------------
Fee summary Charged Paid Credited Due
----------------- ---------- ---------- ---------- ----------
Permit Fee Total 60.65 60.65 .00 .00
Plan Check Total 00 .00 .00 .00
Grand Total 60.65 60.65 .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 isnot 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 construetion or the performance of
construction.
to Print Name Signature of Contractor or Authorized Agent Signature of Lner(if owner is builder)
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
1
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 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 b
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 Pum /Furnace/FAU/Ducts
Rough-in
Gas Line
Wood Stove/Pellet/Chimney
Commercial Hood/Ducts FINAL Date Accepted b
MANUFACTURED HOMES:
Footing/Slab
Blocking&Hold Downs
Skirting
PLANNING DEPT. Separate Permilt#s SEPA:
Parkin /Lighting ESA:
Landscaping SHORELINE:
FINALINSPECTIONS.REQUIRED PRIOR TO OCCUPANCY/USE
Inspect'Jon•Type " Date Accepted By
Electrical 417-4735
Construction- R.W. PW I Engineering 417-4831
Fire 417-4653
Planning 417-4750
Building 417-4815
T:Forms/Building Division/Building Permit
THEA T,; . !��i Yls03
CITY p For City Use
4 ,,
U71
.. �
W A S H I N C; T O PSI, U . S. Permit#
Date Received: f
321 East 51h Street
Port Angeles, WA 98362 Date Approved
P: 360-417-4817 F: 360-417-4711
permits@cityofpa.us
Building Permit Application
Project Address: $ Q�l Wk S t Nrt AAudtc lAt A
Main
Contact: ny'r\eg, W\k� Phone 360) r70 -
JE-Mail:
�O W c E Mail:S r 7 Sc r .
Property N me one
Owner s FS C S c P3 6CJ Z -S
Mailing Address Email
S S r7 0. ca
city state zip
Port A r,81 (-C 3
Contractor Ne Phone
Mai mg Address Email
city State zip
Contractor License# Expiration:
roject Value: Zoning: Tax Parcel# Lot#
Type of Residential J, Commercial ❑ Industrial ❑ Public ❑
Permit Demolition ❑ Fire ❑ Repair ❑ Reroof(tear off/lay over) ❑
For the following,fill out both pages of permit application:
New Construction ❑ Remodel ❑ Addition ❑ Tenant Improvement ❑
Mechanical EZPlumbing ❑ Other ❑
Existing Fire Sprinkler System? Maximum height of structure Proposed Bedrooms Proposed Bathrooms
Yes ❑ No .10
Project y� 0` S t0 a
Description
V eqt ' V� � e
I have read and completed the application and know it to be true and correct.I am authorized to apply for this
permit. I understand that it is my responsibility to determine what permits are required and to obtain permits
prior to working on projects. I understand that the plan review fee is not refundable after plan review has
occurred. I understand that I will forfeit the review fee if I cancel or withdraw the application before the
permit is issued. I understand that if the permit isnot issued within 180 days of receipt,the application will be
considered abandoned and the fees forfeit.
Date Prin Name Signature
Q� &Ahtlktr
Residential Structures
For Office Use
Area Description(SQ FT) Existing Proposed $$value
Basement
First Floor
Second-Floor
Covered Deck/Porch/Entry
Deck
Garage
Carport
Other(describe)
Area Totals
Commercial Structures
For Office Use
Area Descriptions(SQ FT) Existing Proposed $$Value
Existing Structure(s)
Proposed Addition
Tenant Improvement?
Other work(describe)
Area Totals
Lot/Site Coverage Calculations
Footprint(SQ FT)of all Structures: Lot Size: %Lot Coverage
SQ FT Site coverage(all impervious+ %Site Coverage
structures
Mechanical Fixtures
Indicate how many of each type of fixture to be installed or relocated as part of this project.
Air Handler Size: # Haz/Non-Haz Piping #of Outlets:
Appliance Vent # Heater(Suspended,Floor,Recessed wall) #
Boiler/Compressor Size: # Heating/Cooling appliance #
alteration
Evaporative Cooler(attached,not # Pellet,Stov /Wood-burning/Gas #
portable) Fire ace Gas Stove Gas Cook Stove/Misc.
Fuel Gas Piping #of Outlets: Ventilation Fan,single duct #
Furnace/Heat Pump/ Size: # Ventilation System #
Forced Air Unit
Plumbing Fixtures
Indicate how many of each type of fixture to be installed or relocated
Plumbing Traps # Fuel gas piping #of Outlets:
Water Heater # Medical gas piping #of Outlets:
Water Line # Vent piping #
Sewer Line # Industrial waste pretreatment #
interceptor
Other(describe):
T:\BUILDING\APPLICATION FORMS\BUILDING PERMIT 081212.DOCX
w y F y: s. nu::i:!`1i
TI'OF POi TANGT; S
DEPATs EIS: . r t s
M TaOFkCOM1V�iTNiT�Y�DEjvE rxOPMEN� -4
v BUII DING.DFVI'S�01
s 9i 321'x"
^u �S T 5; 1 STitET P.ORTANGt
:t,.;M 4•.<� - "': ,,.ek'�'`a,`,°-, '+ ,,,•ca-' - �=,,:z', !. .. �,.�'``;{-. .�s•;S#;�,. .. e
1r22a'.` aar.. H-. Aa :2;
,. .,,:.:, ..,.., p,..,,,, _..._.,....,......:.. ...:... , :...,,,.,.... �r,.fim :hk,+v'�St �'�Y: ""s't'!. '1t'"P:�yY9'"„�•,5�°?'�a;'�,,. - ".:Cvgw "' ° �' - .•t
` .. ::g':,cta�g+. ,- •;%1•r,'. .�.,a.- A. ., .,-,. { ''�' ;n;_�r.,,x..,: -� n>.. �......;..`,.t}„�.a ,F.��t....s.^«btrr�:x',...x..,.,r...:�i.,.u'-:.t4`. 'i.�:
�i;, F �; ,F,„ .,.;ti;,:• aa<,v;A ;' �rat..'s= ,, -`sem<?� -:, '.: a "4.-.•-�`"
�!:s: 'k> ���{ v,=r�.-,�3•�."t':�+'f%i�s, •,s;�*, -..�,.r�..ig;.` a�`' ..';,z��'s+��.`€F,_ �''`�;.` k,:;�.�ivan'?4g„ ,�,
Py='-a.�:�atc ve�,n ..$!^';i'. ?i�',���(?�;+?
A Tscatiori N ,s, »: r a, `
P,P umber.. r X07 000;00203"°h a ? . t' ;Date: :,T ,k
Application pin' number 53'153'5"' ' ' i' `,,,t� t iSr '
Pro'ert Aciclre w y. t� `r " ,".
'41
p. ASSESS,OR�PARCEL NUMBER .. ,•-• """"`+ /'-+
ap1ication 'type,clescr'iption..
•"+wie'.'??';; F„aar�. y+v.,r„tis w,hw;� i.,� ..�w�G,,,,�,,..<... BING��REPAIR } d i' F :s,. '� ,���15:
SiitidVison Name
Pfgperty`IIse; �:•scay?T �.;�' .a - _ �.�.,- t:,=,�y *?�'uv�g�. "i,;a:
Propeity Zgning, RST RESDN;TL,SINGhk,VAMiL
Application`'valuation ;p� °'� ` �� �^?t" `'�: "y*°' ^�' °�:�". •^� _'
ri++'r,-=N?�.+ ,4y,:mi yr-4NA #r,_ -w.-aw..`...,�• w+ «n,.. ;:kaio:it,;���,,��' 4� F9'S?�
.A" Ag,
Contractor. :�'' "n• ti°�'
Z014OVETZ3'GREGORY L'V= - OWNER' - - ` - `--' - z' �£
T, A.r s�
PORT ANGELES- 983636 ':�(' ;� .,'� ;,,w;.,�„�*w •�;tiw�;:,: �;;��� �:�� ,��-� +„�. i''
F1A
Ml'
Permit PliUMBING`-PERMI Ems, ,.fie, 4 wn „ 3 :a _:;b' •p.y %
Additional desc- BACKFLOW VALVE' ' ° tis^dr
j .Permit pin number. 9631=3-:»
.Permit Fee,
57- 00' Plan`,
Check+aFee .ny <� +00» k
r
{ r Issue:.Date � tia`_43/Q1;��' r« valuation' :.
:E ration,Dahe, 8 2;8 0:7(.d 4#4q •��,f=_'�,;ei :�;--:�<,�wi...t�, ''`�,;�^`
`,& r�j�'; ,Yl,+ :k''.,.-°-�4t: �a3'rep+, � Kq+++"% `, ,? �,r�'a?�itiyg,�-' •.;ee; ''.ti�, +4+is✓* u.: -.k..,,...alx, � �.: - _ ,� ,ti= i+.,; ;' r;;--�
rge .Per: £rbc+atx
,Eicl±ension' �" y'
BASE,FEE; a �p rtlt
5V'00.
+
�
7
Fee summar r;p ,,, m , q ara., a✓�.. :.
_Y Charged Paid, `Credi ted' D e
Permit Fee'' Total 57 00 `
57"oo
Plan Check Total 00: 0
00;;-s: ? : 00 �' , >: •^ r° n°` �'\
0 '^
Graiicl'.Total 57'.Q,U 57w g' t ,...,.., f> IQ7�1,i;
.. -°,+a. _ !',":tT`-4.`'r-•:..a::, .q '','`��d *hce�;a+»:OAp�'4hkfi=aan�Zs ,.".� aS O,Q,;t;, .:w.�.. -.w.. <a,.,.,,r,..-..,:; ia ,,:.:
a=�t1;�:;�ag�=.�� ns�aa,'='�?i&��,',3k,�''�•:;;eK:ss,`� :;;..> .:ra,-.�,r�. >:s;, ,r.�.
a �t A,:.L� x;�cw;-'«�„:,Z M`�';r1n {`,k�.�,t`,+". :i' +:'k:aL'. Li si'Y"-»,» ig-,r>.r.,"#„ vis: �e', .y,;F se•.
4., r•<. :,
�r,S• _
°�°',�"`'�• �, � 11urn�" �,e�3��+)�la�y�s•�z;�,�'.�:,.r.:��..@_;�+ i=�•'�a�: .�,., �=:N�����e,'•..� ria '`;�',
Q- •g_,51�.q, , gid' b:S, x�.nizA.4:3e+rla' ',.i+,-u`:�:'Terrv'.e«s:.e..a..•�,. "',�F:' •,�E-4 y4.
.:
i e. :'fir �•
ap
-,« a....: we, x �?»=�i.;eu+�-d:»S.n tc��3r.� h,�� :ks •;�.a,, -t t"..a�r� �-;,�k -`.� �ti:,p ._, ':4i�t'..4. ���:
rr.• w
;t �.'3(^?w�,.�y%U'c��T�,;,n.-.•fie::-. t.:: :a.Y:in;-r•'=?�€Y.w, .. i'�ai"=., ,. !l
-b: ..# 'xw.ai-: a.es .tT.vs. :,� .r.,_;. ,,,tea' v` :�?� "`,.3+., ., •wAs�g:-'^'r 4.
xx� �'�.K` �: ...�. ."r.- �zr%�T� v4;-rs,°�:n*-� :.c ;�v;s:,•.d,;',<;r�;za•,�s
,daao- anrSdw.hr.•:s «i.45 r�!. 3.,", i`*.,,,, n;y ,y;,.,;� ::4.,.'..:iy.�:,�- `s�• ,y�`:�''"�+ -^r:.�:�'��..�� {
,ij, -?r,��"."».,��,a:,f 3r1"'y'd«• ,i;�aF, .sr':' '�` �•;a-;:,, <i;<: ..,t.�.-�.:..S.t{•'r�:r�;�;' a'?v;.�.-;+,e�:t,..'��'. 3:'4i-,•'>`Y`„
=-K n'e �r: m*gat . s k;«,•,`Tin
,."
vek�'t,,'Yr .NN3N,b".. �V'. +,lees: 'i4..b>va+Sr'"^3�`e•,�,'-
_ (
._ >.`e� . t"�.cc'.ti. r�'+,.:":�.`�sa*�". ,�4°.�.;a.,,;s..a,,,.+,�a.w�.,�.vt€;:".e<k�;c;:��;,:,ft'::H s.3- •y'.
p ate'P.ermits,a�e'required forelectcical+work,SEPA,<Shorellne,•ESX,L tihtles lodvate,and public improvements This ermit+becomes
^'�yt.,"a' ..ti `4,,r. . , -1+. :.9°5y' mU a nt', i.w., �a.,;4�E�-a-:yrs
null:andvoid<ifwgrfc.o :constructionrauthonzed is.notcomrneneed:witfnln.1:80'.da. s,of,constriietion„or'work is sus ended' F
<„ 5 ti � r� �stt y x*.'tF;s r, ,., s 'x' p ,,.,,.. oVaba'donecl;N.
fora periodof;180;aays$after¢,thd-,wbrk asµco' hidnced oc if requiredtlnspectionsf�ave°not beenc.re uesfed within'1804iia s'fr
}e : 7 _...`. .: _ •-t.: vie syr' A„Q , i ' / Y, ,'y n,70fTlthe last c,
inspectio
-7g,herebyrtify that l have r ad and'examiped thlsfiapphcatlon�gnd%now_the same to be tfuef'and correct Alh`rowslon
law =and ordmaneesgovern ng_this type'of work=wlllkbe;'comphed;wlth whether''specifed°herein or;not: The: rantln
9= 9 • .Pe_, t does not
l +.. `Wh'i4:t ..:,.�-,r'thip`” '+':tCb'f:'..4..,'Y-:�'+v•wX ZL,a`2, "I”,
i Wit,; ,yc..J.. r• R. ".:n _ 4.� t a�
presume to`glve'authority to violate°or cancel the,provisions' o 'any state or locaf'law Fegiilating constructidri or the performance of.
construction.
Signature of Contractor or Authorized Agent Date ighature"of,Owner(if o er is buil r) Date
T"\Policies\I 102_1 S budding permit irspection record05 wpd 1/4/20051
OF POFi CITY OF PORT ANGELES
DEPARTMENT OF COMMUNITY DEVELOPMENT BUILDING DIVISION
321 EAST 5TH STREET PORT ANGELES,WA 98362
Application Number 07 00000203 Date 3/01/07
Application pin number 531535
Property Address 1815 W 13TH ST `
ASSESSOR PARCEL NUMBER 06 30 00 0 3 6280 0000 V
Application type description PLUMBING REPAIR
Subdivision Name
Property Use
Property Zoning RS7 RESDNTL SINGLE FAMILY
Application valuation 0
Owner Contractor
ZOHOVETZ GREGORY L OWNER
1815 W 13TH ST
PORT ANGELES WA 983636883
Permit PLUMBING PERMIT
Additional desc BACKFLOW VALVE
Permit pin number 96313
Permit Fee 57 00 Plan Check Fee 00
Issue Date 3/01/07 Valuation 0
Expiration Date 8/28/07
Qty Unit Charge Per Extension
BASE FEE 50 00
1 00 7 0000 ECH PL- EA LAWN BACKFLOW 7 00
Fee summary Charged Paid Credited Due
Permit Fee Total 57 00 57 00 00 00
Plan Check Total 00 00 00 00
Grand Total 57 00 57 00 00 00
c /
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.
o�/Li a7
Signature of Contractor or Authorized Agent Date Yignature of Owner(if ovK<er is buil r) Date
T\Policies\1102_15 building permit inspection record05 wpd 11/4/20051
BUILDING PERMIT INSPECTION RECORD
CALL 417-4815 FOR BUILDING INSPECTIONS.CALL 417-4735 FOR ELECTRICAL INSPECTIONS.
J CALL 417-4807 FOR PUBLIC WORKS UTILITIES
4I PLEASE PROVIDE A MINIMUM 24 HOUR NOTICE. ITIS UNLAN FUL TO COVER,IA'SULATE OR CONCEAL ANF WORK BEFORE
M DVSPECTED AND ACCEPTED. POST PERMIT IN A CONSPICUOUS LOCATION.
KEEP PERMIT CARD AND APPROVED PLANS AT JOB SITE.
INSPECTION TYPE DATE ACCEPTED COMMENTS
YES NO
FOUNDATION:
FOOTINGS
SHEAR WALLS/WALLS
FOUNDATION DRAINAGE/DOWN SPOUTS
PIERS
POST HOLES(POLE BLDGS.)
PLUMBING
UNDERFLOOR/SLAB
3 ROUGH-IN
p WATER LINE(METER TO BLDG) Ie� 1'.
J GAS LINE FINAL 0
5rb 9DATE ACCEPTED B
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 FINAL DATE ACCEPTED BY.
WOOD STOVE/PELLET/CHIMNEY
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
RESIDENTIAL DATE YES NO COMMERCIAL DATE ACCEPTED
YES I NO
ELECTRICAL LIGHTDEPT 417-4735 ELECTRICAL
OLIGHT DEPT
CONSTRUCTION R.W /PW/ CONSTRUCTION R.W
ENGINEERING 417-4807 PW/ENGINEERING
FIRE 417-4653 FIRE DEPT
PLANNING DEPT 417-4750 PLANNING DEPT
BUILDING 417-4815 BUILDING
T-\Policies\I 102 15 building permit inspection TeCord05.wpd[1/42005]
FOR OFFICIAL USE ONLY
BUILDING PERMIT - APPLICATION DateRec.
;. Permit#- 07 "VL 3
Fill out COMPLETELY and in WK.four application and site plan MUST BE Date Approved: —! o?
COMPLETE to be accepted for reviem, If you have any questions,call Date Issued: 3-1 d?
PERMITS (360)417-4815 FAX(360)417-4711
Applicant or Agent: /VII hd(e It C7re Ao r Zo kd V 6;�'— Phone: 36 �'/ 7 — -70 Z3
Owner- Phone:
Address: /9/6 W, 13 Lo s� City- �Q V�.�Z S Zip °I8 36 3
Architect/Eng lneer VllJ�l �r Phone:
Contractor State License.# Exp Phone:
Address: City. Zip
PROTECT ADDRESS ZONING
LEGAL DESCRIPTION Lot: Block. Subdivision.
CLALLAM COUNTY PARCEL NUNBER.
TYPE OF WORK. SIZE/VALUATION
'-i;i Residential ❑ New Constr ❑ Re roof ❑ Stove SF @$ /SF =$
❑ Multi-family",@ Addition ❑ Move❑ Garage SF @$ /SF =$
❑ Commercial ❑ Remodel ❑ Demolition ❑ Deck SF @.$ /SF =$
❑ Repair ❑ Sign ❑ Other TOTAL VALUATION $
BRIEF DESCRIPTION OF THE PROJECT
��.,� ��,Cisc%�� � •tet u, �` �
COMMERCIAL/RESIDENTIAL. Occupancy Group Occupant Load. Construction Type:
No.of Stones:_ Lot Size: Existing Sq Ft. &Proposed Sq Ft. =TOTAL Sq.Ft.
Total lot coverage %
PLANNING USE ONLY APPROVALS
PLAN
BLDG
DPWU
ESA/Wetland(s) ❑Yes❑No SEPA Checklist required? ❑ Yes❑ No Other- FIRE.
OTHER.
VALUATION OF CONSTRUCTION• In all cases,a valuation amount must be entered by the applicant.
This figure will be reviewed and may be 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 tune of permit issuance.
EX'IRATION 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
RI 05.3.2 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 l 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 I
must obtain such permits prior to work. ��
T•\FORMS\B1dgPermitform wPd Applicant; 4 licant: ' fi 4Date: Ur�i�ie 07
67
FPORTANeF� / !�w
o Official Use Only
—9
Assem.# ,.7 ,J
Backflow Assembly Test Report Received
City of Port Angeles
�RKSANOJ Public Works and Utilities Department
Water/Wastewater Collection Division
NAME OF PREMISES 1 ° ��" �` 14 '9
SERVICE ADDRESS l 5 V/1
.LOCATION OF DEVICE. U/I1,4��/ All// S�. /��%'/j)� C��✓�tG✓/ �/WZ> /�rF;1�' �a�c/' ✓ ���'G�' ��
ASSEMBLY ✓✓1 I � � / / s r� : �7- r
E' Manufacturer Model Size Serial No
IS THIS AN APPROVED ASSEMBLY'? YES❑'NO❑ IS ASSEMBLY INSTALLED CORRECTLY'? YES I]-°NO❑
DATE OF INSTALLATION Mdl\`\` ' j4 1/47 UNKNOWN
REDUCED PRESSURE PRINCIPLE ASSEMBLY RP RPDA 0
DC El'13 DC DA ❑
DOUBLE CHECKIVALVE ASSEMBLY SVB [3 Air cap ❑
r SVB ❑ AVB ❑
CHECK VALVE#1 [ CHECK VALVE#2 RELIEF VALVE PVB/SVB 00
Initial Leaked ❑ Leaked ❑ Did Not Open ❑ AIR INLET v
j Closed Tight [3 Did Not Open ❑
Test Held at ,7, psi 4 �a Opened at psi
Held at psi Opened at psi r.,l
Repairs Cleaned ❑ Cleaned ❑ Cleaned ❑ CHECKVALVE
Leaked ❑ Held at psi
Replaced ❑ Replaced ❑ Replaced ❑
REPAIRS 1
Cleaned ❑
Details
Replaced ❑
3 psi Buffer YES ❑ NO ❑
1
I
Final Closed Tight ❑ AIR INLET Opened at psi
�
1 CHECK VALVE Held at psi
Test Held at psi Held at Opened at psi BACK PRESSURE NO❑ YES❑
AIR GAP INSPECTION
I
REQUIRED MINIMUM SEPARATION YES ❑ NO ❑ TYPE OF HAZARD f
f
COMMENTS
Line Pressure „� "� psi
1 ! ✓ �, } ' y 1 #✓ 4 t Held Backpressure YES❑ NO ❑
#2 Shutoff Held YES❑ NO ❑
-0 Relief Valve Exercised YES❑ NO ❑
Date.rfitn/ Tester Signature Cert.# Test Kit Passed Failed
Initial / )�
Testf i 3 l �: /•� i p` a '. �I "` i� 1/ h''7, ra._. , ❑
Repass ! ❑ ❑
Final
Test f /�..-i .r .j✓ ';� 'l/ ,lM, . 13
WHITE CUSTOMER COPY YELLOW PURVEYOR COPY PINK TESTER COPY
1
OF PORT 4,yCF
CITY OF PORT ANGELES LIGHT DEPARTMENT
321 E. Fifth Street
Port Angeles, WA 98362 �/
(206) 457-0411 PERMIT NO.�";Q�
ELECTRICAL PERMIT DATE �-
Site Address: Com, /� ElREADY FOR 1 WILL CALL FOR
U L INSPECTION INSPECTION
Installed By: License Number: Phone:
Owner/Business: Phone:
OwnerlBusiness Addr s: Sq. Ft.
ELECTRIC HEAT RESIDENTIAL ❑ RISER
❑ BASEBOARD KW ❑ COMMERCIAL ❑ OVERHEAD SERVICE
❑ FURNACE KW ❑ NEW CONSTRUCTION ❑ UNDERGROUND SERVICE
❑ HEAT PUMP KW ❑ REMODEL VOLTAGE:
El
KW ADD/ALTER CIRCUITS
❑ SERVICE UPGRADE/REPAIR S 1 ❑ 3 /pky
SERVICE SIZE AMPS
y Q❑ TEMPORARY SERVICE FEEDER SIZE AMPS
Details/Description:
C,,
W.S. No. SERVICE SIZE DATE ENGR.
CAPACITY:
❑ O.K. ❑ NOT O.K. ❑ OVERHEAD SERVICE APPROVED
ACTION REQUIRED: ❑ CHANGE TRANSFORMER ❑ CHANGE SERVICE WIRE
❑ INSTALL SERVICE POLE ❑ OTHER
❑ Ditch Inspection O.K.
❑ Rough-in/cover O.K.
❑ O.K. to connect service
L'f�X Final O.K.r
Site Address: Permit/Receipt No.
4 /3 S-
Installer: New Meters Date
Notify Po ngeles City Light byStreet Address and Permit-Number when ready for inspection.Work must not be covered
® before inspection and O.K.for covering has been given by the electrical inspector In writing on either the Wiring Report
or on the Building Permit. PHONE 457-0411, EXT. 224.
/// NO OCCUPANCY OR USE ESTABLISHED UNDER THIS PERMIT
//
/Electrical Inspector Permit Fee
WHITE—File by address PINK—Top:Eng,Bottom,Customer GREEN—Top:Meter Dept.,Bottom:City Hall
OLYMPIC PRINTERS INC.
+O 90
8
T 9,yCF
�•�`� CITY OF PORT ANGELES
LIGHT DEPARTMENT PERMIT NO.
ELECTRICAL PERMIT DATE //— n ` /Q/
Site Address: - READY FOR 11 WILL CALL FOR
,S
XT INSPECTION INSPECTION
Installed By: — License Number: Phone:
Owner/Busin s: Phone:
Owner/Business Address: Sq. Ft.
❑ Residential ❑ New Construction ❑ Overhead
Heat KW ❑ Remodel ❑ Underground
❑ Baseboard ❑ Furnace/Boiler ❑ Service update/alter/repair Voltage
❑ Heatpump ❑ Other ❑ 10 El30
❑ Commercial/Industrial load Add/alter circuits Service size Amps
Total Connected load ❑ Auxiliary power ❑ Temporary
(attach breakdown) (list below)
Total Motor load ❑ Special equipment
(attach breakdown) (list below)
Details/Description:
W.S. No. Service Size-Date-Hold for: ❑ Easement ❑ Letter
Capacity: ❑ O.K. ❑ Not O.K. Comments
❑ Ditch inspection O.K. ❑ Signed up for service/meter
❑ Rough-in/cover O.K. ❑ Meter Department notified for installation
❑ O.K. to connect service ❑ Fire Department notified of inspection
Final O.K. ❑ Plan Review approved/pending
Site Address: PermitlReceipt No.
le
S i /L� 5"/r
Installei New Meters Date:
® Notify 06 Department of Cit 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 Inspector in Writing on the Wiring Report or the Building Permit. PHONE 457.0411, EXT. 158 or EXT.224.
NO OCCUPANCY OR USE ESTABLISHED UNDER THIS PERMIT ^� 0 V
Inspector (/_IJ Amount paid
WHITE—file by address YELLOW—file by number PINK—Top:Eng,Bottom:Customer GREEN —Top:Inspector,Bottom:City Hall
OLYMPIC PRINTERS. INC.
OF 9087 4414,
,`� CITY OF PORT ANGELES ?
LIGHT DEPARTMENT PERMITNO.
ELECTRICAL PERMIT DATE /D
Site Address: /� ElREADY FOR IOW ILL CALL FOR
INSPECTION INSPECTION
Installed By: / ' _ (� License Number: Phone:
Owner/Business: Lr Phone:
�.
OwnerlBusiness Address: Sq. Ft.
ResidentialO New Construction 1-1Overhead
Heat KW o ❑ Remodel Rig Under roun
❑ Baseboard Furnac Boiler ❑ Service updatelalter/repair Voltage
❑ Heatpump ❑ er 10 1130
❑ Commerciallindustrial load ❑ Add/alter circuits ervice size �Z Amps
Total Connected load ❑ Auxiliary power ❑ Temporary
(attach breakdown) (list below)
Total Motor load ❑ Special equipment
(attach breakdown) (list below)
Details/Description:
Aft
W.S. No. Service Size-Date-Hold for: ❑ Easement ❑ Letter
Capacity: ❑ O.K. ❑ Not O.K. Comments
❑ Ditch inspection O.K. ❑ Signed up for service/meter
#"ItRough-in/cover O.K. ❑ Meter Department notified for installation
O.K. to connect service ❑ Fire Department notified of inspection
❑ Final O.K. ❑ Plan Review approved/pending
Site Address: PermitlReceipt N
81 a). '330 q,
Installer: New MetersDate:
eZ
D a -47/
® Notify the De rtment of City Light by Street Address and Permit Number when ready for inspection. Work
must not be c vered or electrically energized before inspection and O.K. for covering or service has been given
by the Inspector in Writing on the Wiring Report or the Building Permit. PHONE 457.0411, EXT. 11^5/p8 or EXT.224.
NO OCCUPANCY OR USE ESTABLISHED UNDER THIS PERMIT 00-
Inspector Amount paid
WHITE—file by address YELLOW—file by number PINK—Top:Eng,Bottom:Customer GREEN—Top:Inspector,Bottom:City Hall
OLYMPIC PRINTERS. INC.
OF pOHT ANC
sFN CITY OF PORT ANGELES
I- _- LIGHT DEPARTMENT PERMIT NO.
ELECTRICAL PERMIT DATE
Site Address: EADY FOR El WILL CALL FOR
�t INSPECTION INSPECTION
Installed By: License Number: Phone:
Owner/Business: Phone:
Owner/Business Address: Sq. Ft.
Residential ❑ New Construction ❑ Overhead
Heat KW ❑ Remodel Underground
[IBaseboard ❑ Furnace/Boiler EJService update/alter/repair voltage
❑ Heatpump ❑ Other ❑ 10 ❑ 3.0
❑ Commercial/Industrial load ❑ Add/alter circuits Service size Amps
Total Connected load ❑ Auxiliary powerTemporary
(attach breakdown) (list below)
Total Motor load ❑ Special equipment
(attach breakdown) (list below)
Details/Description:
W.S. No. Service Size-Date-Hold for: ❑ Easement ❑ Letter
Capacity: ❑ O.K. ❑ Not O.K. Comments
❑ Ditch inspection O.K. ❑ Signed up for service/meter
❑ Rough-in/cover O.K. L1Meter Department notified for installation
O.K. to connect service 1-1Fire Department notified of inspection
❑ Final O.K. ❑ Plan Review approved/pending
Site Address: Permit/Receipt No.
/8/s-<-v. '32G z
Installer: New Meters Date:
' 17- 641
® Notify the Dep ent 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 Inspector in Writing on the Wiring Report or the Building Permit. PHONE 457.0411, EXT. 1^588 or EXT.224.
T NO OCCUPANCY OR USE ESTABLISHED UNDER THIS PERMIT
Inspector Amount paid
WHITE—file by address YELLOW—file by number PINK—Top:Eng,Bottom:Customer GREEN —Top:Inspector,Bottom:City Hall