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2506 W 19th St - Building
CITY OF PORT ANGELES PERmn APYLICAnoN f k Building DivisionXteetrical Inspections 321 East Fifth Street-P.O.Sox 31501 Part Angeles Washington,98362 � Ph.- (360)417-47351Fax-�(350)417-4711 Date: d- .26_f'Z Multi-Family or Commercial* Zcommercial Addition 1 Alteration I Remodel 1 Repair *Plan Review May Be Re Fired,Please Co pl t Electrical PI n Re lew Inff�rm ton S eel Job Address: Id� (,fJ. �f° a'cit.C � Buklding Square Footage: Description of above Owner In mation Cont; lnformatl o Nam ar" SA FagMSTIC Namera , Mailing Ad ress; Mailing re s: W. die ja city liniQ 1A State:AZ&Zip: City; Slate: Zip Phone:�Fax;T Phone: ax: User. a#1 Exp. License#i Sxp,y d .rte--1 !tern Unit Char e lied by Unit Char a ServicelFeeder 200 Amp, $132,00 $ Service/Feeder 201400 Amp. $160.00 Service/Felder 401-600 Amp $22.5.00 Serviceffeeder 601-1600 Amp, $28$.00 $_ Ser0celFeederover 1040 Amp. $410.00 $ Branch Circults 1-4 $ 86.00 Branch Circuit W/Service Feeder $ 5100 $ Branch Circuit W/O Service Feeder $ 74,00 $ Each Additional Branch Circuit $ 5.00 $ Temp.Service/Feeder 200 Amp. $102,00 $� Temp.Service/Feeder201400 Amp. $121.00 Temp.SenrlcelFeeder401-600 Amp, $164.00 $� Temp.SarulcelFeeder 601-1000 Amp, $185,00 $� Portal to Portal Hourly $ 96.00 $� SignIOutllne Lighting $ 88,00 Signal Circuit/Umited Energy-Multl-Famlly $ 64.00 � $� Signal Circuit!limited Energy l Flrst 1500 sf-Commercial $ 98,00 $ _ _ Note; $5.00 foreach additional 1500 sf Renewable Electrical Energy-5KVA System or Less $113,00 Thermostat $ 56,00 $ Total Owner as defined by ROW.1 V8.261:(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,t 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 29646B,The City of Fort Angiele6 Municipal Cods,and Utility Specifications and PAMC 14,05.050 regarding Electrical Permit Applications. Signa e f owner,electrical contra o or electrical administrator: 0 Cash n Check Credlt Card# n Dated: .v __ tltf01l2U92 ELECTRICAL PERMIT CITY OF PORT ANGELES 1 360-417-4735 Ch .Application Number . . , . , 12-00001556 Date 11/28/12 Application, pin number , . , 753092 REPORT SALES TAX Property Address . . , , , , 2506 w 19TH ST ASSESSOR PARCEL NUMBER: 06-30-00-1-1-1900-5008° on your excise tax form Application type description ELECTRICAL ONLY Suhdivision game . . , , . , to the City of Port Angeles .Property Use (Location Codes 0502) Property Zoning . . . , , . . INDUSTRIAL LIGHT Application valuation , , , 0 Owner Contractor PORT OF PORT ANGELES SIMPSON ELECTRIC PO BOX 1350 243035 W HWY 101 PORT ANGELES WA 98362 PORT ANGELES WA 98363 0360) 457-9270 -------------------------------------------------------- °------^----------- Permit ELECTRICAL ALTER COMMERCIAL Additional desc 1-4 CIR T-STAT Permit Fee 86.00 Plan Check Fee QO Issue Date 11/28/12 Valuation . . . . 0 Expiration Date 5/27/1,3 J' Qty Unit Charge Per Extension BASE FEE 86.00 Fee summary Charged Paid Credited Due Permit Fee Total 86,00 86.00 .00 40 Plan Check Total ,00 .00 .00 00 Grand Total 86.00 86.00 . 00 .00 �v V INSPECTION TYPE DATE; RESULTS: INSPECTOR; DI'f CH SERVICE ROUGH-IN F COMMENTS: PERMIT WILL.EXPIRC SIX(6)MONTHS FROM LAST INSPECTION Signature Of OWiaer or Electrical Contractor X G:1P.XCHAN GE\BlJ ILD IN G 1 O 4 1 +t ,3µ C it y o f Po r t A Bs uilding ,D i v is i o n This certificate is issuedp to the requirements of Section 110 of the 006 International Building Code certing that atthe time; of zssuaz?ce this structure was in compliance with the various ordinances of the City regulating building construction oz use foz the following y Business name: Twin Brewing &Maltin Business addres ,250 W 19 Str ee s ha,* w t 'tee P az I t s Property owner: 4 Po rt ':M, of Port Angeles Property owner s e 33 VU Street, Port Angeles, TW 98362 Automatic fire sp r2nkl e r s��stem: per Butt �F Use &occupancylasszfication: Business Building p ermit nu mber 11-11 z.� Type of construction �k' Occupant load: e`r l f 12/08/2011 ze r1 a^c0 e g3,t znager Date Post on the prem in a conspicuous placed T iss certaflcate s hat notmb rem oved except by the Building Official. ue� :az b �0; r CERTIFICATE OF OCCUPANCY APPLICATION Permit I' 1 9'1 CITY OF PORT ANGELES $50 Certificate /Inspec tion Attn: Permit Technician 321 E. Fifth St., Port Angeles, WA 98362 /Parking Business Improvement Area (PBIA) (360) 417 -4815 fax (360) 417 4711 fee charged for Downtown locations PLEASE PRINT IN INK Check one: New business in P.A.7JA. Change of ownership only? Moving location from within P.A.? Z oning BUSINESS NAME j'W,4 A /<S RE I/ c Oa— /MAl ti,"/ Business address So L)ssr /9'�� V Mailing address /,3k 3 L j M r n i( Phone number 3 be Sf p 9 3 9 5' Opening date f�, r.J Days hours of operation P /s /r 414.9.{ Business owner's name (-c ,5 V►• 14 1 ContactRhone 34,o- Fog 319 r Business owner's address /9 0 Al POLE L,d 1 3 L a, Brief description of business W■ r e. e cJ Z Property owner's name Poe t 11' P R Contact phone Property owner's address /contact Fe) P3t; 13 GO PM- UJP, 9g36z BUILDING DEPARTMENT phone 417 -4815 Bldg approval by 12 l or l G Is the business a restaurant or bar that will seat 50 or more people? Yes No Construction changes planned (moving walls, adding /enlarging windows or doors, roofing, siding, foundation work, adding /altering stairways, ramps, bathrooms, electrical, heating /cooling /ventilation systems, etc). Work planned: LEc 1rQ1n/f t d G t;J ;Fit 72._"1 FIRE DEPARTMENT phone 417 -4653 Fire approval by on Changes to a fire sprinkler system o_ r fire alarm system? Yes No g Work planned: PBIA (Parking Business Improvement Area Downtown) phone 417 4623 Square footage of business? -4 0 0 0 PBIA notified on Is business moving within the PBIA? Yes No 1K. CITY CLERK phone 417 -4634 City Clerk approval by on Second -hand dealer /pawnbroker business? Yes No (X Will there be dancing at this business? Yes No A City of Port Angeles Business License is required for: Taxi, Peddlers, Second -Hand Dealer, Pawnbroker, Dance, Hotel- Motel, Fireworks, Ambulance, and Tattoo Businesses. Page 1of2 COMMUNITY ECONOMIC DEVELOPMENT phone 417 -4750 CED approval by on Number of off street parking spaces available for employees and customers? "I A- (A parking plan may be required.) Signs? (wall- mounted, freestanding, projecting, awning, A- frame, etc Signs planned: PLEASE NOTE: NO flashing, intermittent, or chasing signs are permitted in the City of Port Angeles. PUBLIC WORKS DEPARTMENT- ENGINEERING phone 417 -4812 rPVN b_ G Is site work..,planned (new.or re- located sewer or water service, excavation, grading or filling, work in City right -of -way, new driveway.openings, site- drainage, parking lots, downspouts, irrigation system backflow devices, etc.). Yes No g Work planned: PUBLIC WORKS WASTEWATER phone 417 -4845 PWW approval by on Will waste, other than domestic household waste, be discharged into the sewer system? Yes No If yes, what will be discharged: Li .,4 c Call for Certificate of Occupancy inspections BEFORE opening business. Building Department Inspection 417 -4815 Fire Department Inspection 417 -4653 Please sign up for utility services at the cashiers' counter. I hereby apply for a Certificate of Occupancy. l acknowledge that l have read this- application and state that the inforration I have supplied is correct to the best of my knowledge. Incorrect information may result in revocation of permit. Date I "a I 9° /Print Name Et.) R12 5 P- v'�' 11 1 Signature t■ t 1;0 T: \Forms \Building Division \Certificate of Occupancy Application (2010).doc Page 2 of 2 Linda Pangrle From: Edith Parker Sent: Wednesday, October 19, 2011 1:35 PM To: Linda Pangrle Subject: RE: C of 0 for Twin Peaks Brewing Malting 2506 W. 19 Street, PA From: Linda Pangrle Sent: Wednesday, October 19, 2011 1:33 PM To: Edith Parker Subject: RE: C of 0 for Twin Peaks Brewing Malting What is the address? From: Edith Parker Sent: Wednesday, October 19, 2011 11 :16 AM To: Linda Pangrle Subject: C of 0 for Twin Peaks Brewing Malting Linda, Do you have a C of 0 for the above referenced. He is wanting to sign up for service? Thank you, Edie Parker eparkerPcityofpa.us 417 -4619 1 2 1 I Su C-4 t> 1,t) (I1A3 1 1) e 1 aki L- I to p T-01 Imo- °KA 3 7[ 1 n� T ,a CERTIFICATE OF OCCUPANCY APPLICATION Permit ti' 1 011■ FEES 11 CITY PORT ANGELES r $50 Certificate Inspection Attn: Permit Technician 321 E. Fifth St., Port Angeles, WA 98362 Parking Business Improvement Area (PBIA) (360) 417 4815 fax (360) 417 4711 fee charged for Downtown locations PLEASE PRINT IN INK Check one: New business in P.A.754. Change of ownership only? El Moving location from within P.A.? Zoning BUSINESS NAME' 1Al P g► /4 J" 2si,:; ink d— blilAC1' ,I,./ ri Business address ,Sr c, l,� sr /9 9 -4ti Mailing address 5 L i n/ 4( Phone number 4 S 0 y 3 9 S Opening date A, n 0 Days &hours of operation s' �S 16.:;.'k Business owner's name rcL ‘,5 i 1-f'- In Contact hone 3 Y Gq 9 s Business owner's address 19 d i 1 I'VE P 0 L �1(• f G of Brief description of business VI M a G g' Property owner's name Poe t b P P' Contact phone Property owner's address /contact BUILDING DEPARTMENT phone 417 4815 Bldg approval by on Is the business a restaurant or bar that will seat 50 or more people? Yes No Construction changes planned (moving walls, adding /enlarging windows or doors, roofing, siding, foundation work, adding /altering stairways, ramps, bathrooms, electrical, heating /cooling /ventilation•systems, etc). Work planned: g L F C t aEA/f I'S d L' 4 L c.3 l., 4,4i t rC FIRE DEPARTMENT phone 417 -4653 Fire approval by on Changes to a fire sprinkler system o_ r fire alarm system? Yes No g Work planned v PBIA (Parking Business Improvement Area Downtown) phone 417 4623 Square footage of business? LI C' 0 0 PBIA notified on Is business moving within the PBIA? Yes No IK1. CITY CLERK phone 417 4634. City Clerk approval by O� on 101a1IIt Second -hand dealer /pawnbroker business? Yes No X Will there be dancing at this business? Yes No FJ A City of Port Angeles Business License is required for: Taxi, Peddlers, Second -Hand Dealer, Pawnbroker, Dance, Hotel- Motel, Fireworks, Ambulance, and Tattoo Businesses. Page 1 of 2 COMMUNITY ECONOMIC DEVELOPMENT phone 417 -4750 CED approval by on 4 Number of off- street parking spaces available for employees and customers? Al 4 (A parking plan may be required.) Signs? (wall- mounted, freestanding, projecting, awning, A- frame, etc Signs planned: i. l.A- PLEASE NOTE: NO flashing, intermittent, or chasing signs are permitted in the City of Port Angeles. PWE approval by on PUBLIC WORKS DEPARTMENT- ENGINEERING phone 417 -4812 Is site work planned (new or re- located sewer or water service, excavation, grading or filling, work in City right -of -way, new driveway openings, site drainage, parking Tots, downspouts, irrigation system backflow devices, etc.). Yes No gl Work planned: PUBLIC WORKS WASTEWATER phone 417 4845 PWW approval by on Will waste, other than domestic household waste, be discharged into the sewer system? Yes No If yes, what will be discharged: 4 ,4 e_ Call for Certificate of Occupancy inspections BEFORE opening business. Building Department Inspection 417 -4815 Fire Department Inspection 417 -4653 Please sign up for utility services at the cashiers' counter. I 'hereby apply for a Certificate of Occupancy. l acknowledge that l have read this application and state that the information I have supplied is correct to the best of my knowledge. Incorrect information may result in revocation of permit. N Date h .g a0 //Print Name ECGto Nn S t F h Signature te. L ilt■ A A T:1Forms\Building Division1Certificate of Occupancy Application (2010).doc Page 2of COMMUNITY ECONOMIC DEVELOPMENT phone 417 -4750 CED approval by on Number of off street parking spaces available for employees and customers? (A parking plan may be required.) Signs? (wall- mounted, freestanding, projecting, awning, A- frame, etc Signs planned: PLEASE NOTE: NO flashing, intermittent, or chasing signs are permitted in the City of Port Angeles. PINE approval by 1/ on 10 1 PUBLIC WORKS DEPARTMENT- ENGINEERING phone 417 -4812 n.i 5 Is site work planned (new or re- located sewer or water service, excavation, grading or filling, work in City right -of -way, new driveway openings, site drainage, parking lots, downspouts, irrigation system backflow devices, etc.). Yes No Work planned: PUBLIC WORKS WASTEWATER phone 417 4845 PWW approval by on Will waste, other than domestic household waste, be discharged into the sewer system? Yes No If yes, what will be discharged: Li �4 Call for Certificate of Occupancy inspections BEFORE opening business, Building Department Inspection 417 -4815 Fire Department Inspection 417 -4653 Please sign up for utility services at the cashiers' counter. I hereby, apply for a Certificate of Occupancy. l acknowledge that I have read this application and state that the information I have supplied is correct to the best of my knowledge. Incorrect information may result in revocation of permit. metro Date it° .g 1-Po //Print Name j- 416) >RI? S t f 1 Signature t. t T: \Forms\Building Division \Certificate of Occupancy Application (2b10).doc Page 2 of 2 SOPTq CERTIFICATE OF OCCUPANCY APPLICATION Permit 11. 9 FEES CITY PORT ANGELES $50 Certificate Inspection Attn: Permit Technician 321 E. Fifth St., Port Angeles, WA 98362 Parking Business Improvement Area (PBIA) (360) 417 4815 fax (360) 417 4711 fee charged for Downtown locations PLEASE PRINT IN INK Check one: New business in P.A. ?'X Change of ownership only? LI Moving location from within P.A.? Ll Zoning BUSINESS NAME '1 L\)' P All <C JkE' I /i► L?/1 ,�1. "f i.A/ Business address -,5'"c 01:51 /9 -0, Mailing address c S L n/ c-:, 4 4 Phone number 3 (,,i) 07- 9 s Opening date nt.) Days hours of operation 4 6- C-9t Business owners name f d (5 g'r. Contact phone 3,k u e o 9 3/95 Business owner's address /9 Al A pL g- LA/. 3 1 Brief description of business C. o iw► P, r. t A 2 4- c„ Property owner's name Poe 1 fi P R Contact phone Property owner's address /contact BUILDING DEPARTMENT phone 417 -4815 Bldg approval by on Is the business a restaurant or bar that will seat 50. or more people? Yes No 1R Construction changes planned (moving walls, adding /enlarging windows or doors, roofing, siding, foundation work, adding /altering stairways, ramps, bathrooms, electrical, heating /cooling /ventilation systems, etc). Work planned: g Lc( fi LLi✓ l� t 6 FIRE DEPARTMENT phone 417 -4653 Fire approval by CAA on O' 38-20 ■A Changes to a fire sprinkler system or fire alarm system? Yes No g Work planned: Al PBIA (Parking Business Improvement Area Downtown) phone 417 4623 Square footage of business? Li 0 0 0 PBIA notified on Is business moving within the PBIA? Yes No g.. CITY CLERK phone 417 4634. City Clerk approval by on Second -hand dealer /pawnbroker business? Yes No X Will there be dancing at this business? Yes No T. A City of Port Angeles Business License is required for: Taxi, Peddlers, Second -Hand Dealer, Pawnbroker, Dance; Hotel Motel,. Fireworks, Ambulance, and Tattoo Businesses. Page 1. of 2 ........_.Th N H H 0 H 0 0; H N H H H 00 a 0 H F H H 0 0 f z 0 H H a H W H w C w F o O d 0 Z N 0 SL H 0 a 41 H 0 0 0 a a H 00 ••14 H o cn m a W 00 0 x O o o o E H. m a s w a m a Z F h H> 0 Z H a Z F CO r) a 0 0 (1) Z H E ww 0 w ,4 ,C0 Z C. t a z(0 H F .co< HH 0 HH R. 0 HHZ 0 O F\ 0H S+r0a0 o a U) a W 1 0 a H F 0 0 .0 0 0 Z O 0 0 0> N m w w m w W m m 0 0 O F m o z p 0 a (0 Z w u 4 w n 10q z w o u H 0 o m E CI mF a 0 oa bS 0, x a~ 0 o H w N F m o H m a 0 m a a i H w (0 H a 0 H 0 U1 41 44 0 0 w 3 a 0 0 i 0 0 0 o w w 0 0 0 l0 z F M 0 F F 0 H0 0 H a m0 Ln3 0l0H 041 0 CO m A.0 N F 0 0 0 o a a o 0 0 0 a 1,4 x a 0 0 H a Z 0 (0 0 a 0 0 tm U 1)E+< 0 E-0 0 0 wH O a a m a u aE a E 00 CITY OF PORT ANGELES s DEPARTMENT OF COMMUNITY ECONOMIC DEVELOPMENT BUILDING DIVISION a ems 321 EAST 5TH STREET, PORT ANGELES, WA 98362 Application Number 11- 00001321 Date 5/04/12 Application pin number 353419 Property Address ASSESSOR PARCEL NUMBER: 06- 30-00 1x1-1900 -5008- REPORT SALES TAX Application type description PLUMBING PERMIT on your state excise tax form Subdivision Name Property Use to the City of Port Angeles Property Zoning INDUSTRIAL LIGHT (Location Code 0502) Application valuation 200 Application desc BACKFLOW PREVENTER Owner Contractor PORT OF PORT ANGELES OWNER PO BOX 1350 PORT ANGELES WA 98362 Permit PLUMBING PERMIT Additional desc Permit Fee 57.00 Plan Check Fee .00 Issue Date 5/04/12 'Valuation 0 Expiration Date 10/31/12 Qty Unit Charge Per Extension BASE FEE 50.00 1?-.9'‘ 1 1.00 7.0000 EA PL- BACKFLOW PROTECTION <OR =2" 7.00 fl,nal 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 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 rw, f V BUILDING PERMIT INSPECTION RECORD Q 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 G. 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: CAL eG1� v Under Floor Slab Rough -In Water Line (Meter to Bldg) Back Flow Wate I a1 f p �.4, FINAL Date Accepted by AIR SE 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 k_ Planning 417 -4750 Building 417 -4815 T /Riiilriinn nivisinn /Riiikiinn Parmit F p i l�v✓ 2q1 OR Official Use Only c Assem.# Backflow Assembly Test Report Asseived g 0 City of Port Angeles Public Works and Utilities Department Water/Wastewater Collection Division NAME OF PREMISES: r "/A/ Pt4k g E(S`/4/ 9i M/�. T /A G SERVICE ADDRESS: OR 5-- 1 C g 7,/r e( j LOCATION OF DEVICE: 1k(5 f e Cr A 1'_ f} t i F 0 6i A7 A r. i f t f L 3 ASSEMBLY: V' /q X O 0 /t r l f C� i cZ Manufacturer Model Size Serial No. IS THIS AN APPROVED ASSEMBLY? YES D NOD IS ASSEMBLY INSTALLED CORRECTLY? YES 17 Sio DATE OF INSTALLATION NO 1, a 11 UNKNOWN REDUCED PRESSURE PRINCIPLE ASSEMBLY RP t RPDA DC DCDA PVB Air Gap DOUBLE CHECK VALVE ASSEMBLY SVB AVB CHECK VALVE #1 CHECK VALVE #2 RELIEF VALVE PVB /SVB Initial Leaked Leaked Did Not Open AIR INLET jy Closed Tight 3 It Did Not Open Test Held at psi Opened at psi Held at psi Opened at psi Repairs Cleaned Cleaned Cleaned CHECK VALVE Leaked Held at psi Replaced Replaced Replaced REPAIRS Cleaned Details Replaced 3 psi Butler YES NO Final Closed Tight AIR INLET Opened at psi 7 CHECK VALVE Held at psi Test Held at •o psi Held at psi Opened at psi BACK PRESSURE NO YES AIR GAP INSPECTION: v REQUIRED MINIMUM SEPARATION: YES NO TYPE OF HAZARD A f -71:6 COMMENTS Line Pressure psi A/5( erf 6 imire Held Backpressure YES ONO #2 Shutoff Held YES NO Relief Valve Exercised YES LB" NO Date Time Tester Signature Cert. Test Kit Passed Failed Initial Test r 2 't g i 7 Prx E /I (A 4=.�. i� i �s 1 74'i /r'� t i 7 0 Repairs Final �t Test —I0 it R kC_474ey (6- 41 gar'• f/7 w� T J WHITE CUSTOMER COPY YELLOW PURVEYOR COPY PINK TESTER COPY BUILDING PLUMBING MECHANICAL PERMIT APPLICATION SHORT FORM (To be used for projects that do not require plan review.) Date Received ,1/422/ Permit -32-/ City of Port Angeles Please print in ink. Date Approved a Attn: Building Permit Technician Approved by 321 E. _5th St., Port Angeles, WA 98362 360- 417 -4815 fax: 360- 417 -4711 Credit card payments are accepted Mon -Fri 8 -5 pm (no American Express) Hours: Mon through Fri 8 5 pm Cash checks are accepted Mon -Thurs 8:30 -4 pm Fri 8:30 -12:30 pm Contact person: Phone: tin 1`) 3 h`D -809 —3i7 Property owner: Phone: Property owner's mailing address: 5 n 4. I,i s r /1111 Phone: Contractor's business name: (or property owner's name if he/she is doing /overseeing the work) Contractor's mailing address: 10 J Al PJA Ks h ira.L. 0/ 4 3 a ir,9L- -I.1 C. 5 Contractor's L &I license number: Expiration date: Project Address: -AC0 �sl /q Project Type: D Residential .ommercial D Industrial o Multi- family Project Business Name: J (for commercial, industrial, or multi family projects) The following permits are usually issued over the counter immediately, without the need for plan review. Complete only the portions of this permit that are relevant to your project. Re -roof: house garage other tear off re -roof lay over one layer Licensed contractor: Submit a copy of your re -roof bid. Project Valuation (labor materials, not including sales tax) Re -side: house garage other Project Valuation (labor materials, not including sales tax) Repair: (explain the protect) Project Valuation *Homeowner: If you will be doing overseeing the work, then the project valuation will be determined by doubling the cost of materials, to reflect the value the repair adds to your property. Cost of materials x 2 Project Valuation T:Forms /Building Division /Building /Plumbing /Mechanical Permit Application Short Form (Revised 2011) Page l of 2 Swimming Pool or Spa 24" deep): For prefabricated swimming pool or spa projects that do not require plan review: Obtain the City of PA handout entitled "Pools Spas" follow the requirements. Project Valuation Demolition: A demolition permit is needed when an entire building gets demolished. What will be demolished? house in garage other Note: some demolition permit applications need to be reviewed by various City departments, and may take approximately two weeks to obtain. Agree to ensure that all utilities are /will be properly turned off (and capped off if needed) prior to demolition. Obtain (from the City of PA) an aerial view map of the parcel and put an "x" over the structure(s) to be demolished. Submit the map with this application. Obtain (from the City of PA) a copy of the Olympic Region Clean Air Agency (ORCAA) Demolition Permit Application. Contact ORCAA at 360- 417 -1466 to discuss whether or not an ORCAA Demolition Permit will also be needed. yes no Will the debris be going to the Regional Transfer Station in Port Angeles? yes No If yes, will a licensed contractor be taking it there? If yes, obtain (from the City of PA) a copy of the Waste Disposal Application. Complete and submit the waste disposal application to the Building Permit Technician, now (or later if asbestos testing is needed). Plumbing Permit: (expl the protect) .,0‹ K f L Re- v 'iLg Project Valuation Mechanical Permit: (explain the project) Project Valuation I have read and completed this application and know it to be true and correct. I am authorized to apply for this permit and understand that it is my responsibility to determine what permits are required, and to obtain permits prior to working on projects. Date ))1). Signature rG Print Name n 4-- 5 !-r\ 'f 4- Page 2of2 OF L��� OR qNC �Fs APPLICATION TO DISCHARGE INDUSTRIAL WASTEWATER TO A PUBLICLY -OWNED TREATMENT WORKS (POTW) This application is for a wastewater discharge permit for a discharge of industrial wastewater to the City of Port Angeles' wastewater treatment plant (POTW) as required by Chapter 13.06.085. It is designed to provide the City of Port Angeles with information on pollutants in the discharged wastestream, materials that may enter the waste stream, and the flow characteristics of the discharge. Information previously submitted to the City that applies to this application should be referenced in the appropriate section. The City and the Washington State Department of Ecology may request additional information to clarify the conditions of this discharge. SECTION A. GENERAL INFORMATION 1. Applicant Name: c L1J p f-4 j r i HA 2. Facility Name: L A `l ^I P E A K 5 h p e u) 4 1 'j co (if different from Applicant) V 3. Applicant Mail Address: 1 3 0 \S L-1 AI co LAI Street PT t G f. 1_ E S L4 f. Z 9 c3 c City/State 1 4. Facility Location Address: ,a c b L W E S r' 15 rh (if different from 3 above) Street eocr AAi Ls ge,3 City/State Zip 5. Latitude /longitude of the facility: 6. UB1 Number N o 3 W 7. Latitude /longitude of the point of discharge to the municipal collection system if greater than 100 feet from facility location N W 8. Contact person: Pe F,s Name Title F o c i 3 I `I 5' rAs F i d 5 3 TVI S/ Telephone Number Fax Number E -Mail 1 FOR OFFICE USE ONLY Check One: New/Renewal Modification Date Application Date Fee Application/ Date Application Received Paid Permit No. Accepted 9. Check One: Permit Renewal (including renewal of temporary permits) Does this application request a greater amount of wastewater discharge, a greater amount of pollutant discharge, or a discharge of different pollutants than specified in the last permit application for this facility? YES NO For permit renewals, the current permit is an attachment, by reference, to this application. Permit Modification Existing Unpermitted Discharge Proposed Discharge i 11 0 c cu N Anticipated date of discharge: �W r �l L1.1 g V I certibi under penalty of law that this document and all attachments were prepared under my direction or supervision in accordance with a system designed to assure that qualified personnel properly gather and evaluate the information submitted. Based on my inquiry of the person or persons who manage the system, or those persons directly responsible for gathering the information, the information submitted is, to the best of my knowledge and belief true, accurate, and complete. I am aware that there are significant penalties for submitting false information, including the possibility of a fine and/or imprisonment for knowing violations. fA L52, it i I 1 1 o it s Signature* Date Title Printed Name *Applications must be signed by an authorized or duly authorized representative as follows: If the user is a corporation by a president, secretary, treasurer, or a vice-president of the corporation in charge of a principal business function, or any other person who performs similar policy or decision- making functions for the corporation; or The manager of one or more manufacturing, production, or operating facilities, provided the manager is authorized to make management decisions which govern the operation of the regulated facility including having the explicit or implicit duty of making major capital investment recommendations, and initiate and direct other comprehensive measures to assure long -term environmental compliance with environmental laws and regulations; can ensure that the necessary systems are established or actions taken to gather complete and accurate information for control mechanism requirements; and where authority to sign documents has been assigned or delegated to the manager in accordance with corporate procedures. If the user is a partnership or sole proprietorship: a general partner or proprietor, respectively. If the user is a Federal, State, or local governmental facility: a director or highest official appointed or designated to oversee the operation and performance of the activities of the government facility, or their designee. SECTION B. PRODUCT INFORMATION 1. Briefly describe all manufacturing processes and products, and/or commercial activities, at this facility. Provide the applicable Standard Industrial Classification (SIC) Code(s) for each activity (see Standard Industrial Classification Manual, 1987 ed). Description: s e I��'1 a� c 4:�.4 <C;UI h oS" I 2. List raw materials and products used at his facility: prod u,, d. prior b ,ph C k S w y eA S el, A 6 s woolle•mmm/044 :;!s!A 'UO148UJJOIUI eJOLU JOA 'JO Nos mi. J9)ieUIXV3 Ide Aq SeM Xej. 5191 ...t,... le. (74- 4) Ch Cr4 i ree Cil ke....1 +-4-------v-- i I 7 0 Lt) g 9, .olownEl.. 1 .2 S., 0 i 0 a. t 9 NA3 3.• E 1 3 3•.--- t. .-C' c (a 3 0 (.0 c) c, j cs.) 4..._,-i •ic is --------1/4----1--r-----""----------"-"---4'.. 1. e 1 'C.- r .....N., ..5 ....e 41 tri 1....) 7-Not (4) u ..-g 14 -kit 1 0 1 04 cz, e i i s f f. ULL Le ,,A 0 7 Doe. k. o vt, o !Aid ££:1.17:9 I. 1.0Z/9Z/0 I. :94e0 6/C L. 6669Z91709C :Wald woo n//:d}4q :11sin '11011eWJO4w (NOW Jod •JeMJas xe} Jajewrid Ho Aq paniaoaJ SeM xej. s!qi 9, ,4 ;y y J 4 i 1/ V 1 I 7' I v .3 1 1 ..,,,..r.: I i' p,t1). Z 1 iii Villk. L 141 at17NIpY ,t.l .d L. yr, l t/ 1.t. 111 is,: 1 r :i Ti's t Ur eV dY i a� E M .19 .0 1 i ll Iti i 1 i I i 8„, 1 1 1 1 1 1!' h I a I .;11 11 d WI .01. 44 ..1 1 PORT OF PoRr ANGLES a-4RK 4 *WOW +ar b m►r t *Weimar a alit Wd :6V :S 1.60Z /9Z /06 :a4ea 6£ /V4 66£9ZSV09£ ;wad Type RAW MATERIALS Quantity f2 Q.-' rn A.(1 s 4. 66 C 5 AU.d n l 5 Type PRODUCTS Quantity EZ A Lct \')0 F SECTION C. PLANT OPERATIONAL CHARACTERISTICS 1. For each process listed in B.1. that generates wastewater, list the process, assign the waste stream a name and an ID and describe whether it is a batch or continuous flow. Waste Batch (B) or Process Waste Stream Name Continuous (C) Stream ID# Process 001 13 ►�.i,i� C.t;�'Gl�'1 2. On a separate sheet, produce a schematic drawing showing production processes, water flow through the facility, wastewater treatment devices and waste streams as named above. The drawing should indicate the source of intake water and show the operations contributing wastewater to the effluent. The treatment units should be labeled. Construct a water balance by showing average flows between intakes, operations, treatment units, and points of discharge to the POTW. (See the example on page 16 of this application form) t d i 01/4 3. What is the maximum daily discharge flow? gallons /day What is the maximum average monthly discharge flow (daily flows averaged over a month)? gallons /day 4. Describe any planned wastewater treatment improvements or changes in wastewater disposal methods, and the schedule for these improvements. (Use additional sheets, if necessary and label as attachment C4) A o lam, 5. If production processes are subject to seasonal variations, provide the following information. List discharge for each waste stream in gallons per day (GPD). The combined value for each month should equal the estimated total monthly flow. MONTHS Waste Stream ID# J F M A M J J A I S 0 N D Estimated Total Monthly Flow (GPD) 6. How many hours a day does this facility typically operate? How many days a week does this facility typically operate? 5 How many weeks per year does this facility typically operate? .5 O 7. List all incidental materials, such as oil, paint, grease, solvents, and cleaners, that are used or stored on site (list only those with quantities greater than 10 gallons for liquids and 50 pounds for solids). For solvents and solvent based cleaners, include a copy of the material safety data sheet and estimate the quantity used. (Use additional sheets, if necessary, and label as attachment C.7.) Materials /Quantity Stored: r Oc1 £I1 sc1Vc 8. Some types of facilities are required to have spill or waste control plans. Does this facility have: a.. An Emergency Response Plan (per WAC 173- 303 350)? Cam' YES D NO b. A runoff, spillage, or leak control plan (per WAC 173 216 110(0)? YES I NO c. Any spill or pollution prevention plan required by local, state or YES NO federal authorities? If yes, specify: d. A Solid Waste Management Plan? YES NO e. An Accidental Discharge /Slug Discharge Control Plan (40 CFR 403.8(f)(2)(v)) and required by the City of Port Angeles? YES NO SECTION D. WATER CONSUMPTION AND WATER LOSS 1. Water source(s): 1- Public System (Specify) Ci,ty. p 1 Private Well Surface Water a. Water Right Permit Number: b. Legal Description of Water Source: 14S, 1/4E, Section, TWN, R 2. Water use a. Indicate total water use: Gallons per day (average) Gallons per day (maximum) b. Is water metered? YES NO DEFINITIONS Significant Industrial User (SIU) 1) All industrial users subject to Categorical Pretreatment Standards under 40 CFR 403.6 and 40 CFR Chapter 1, Subchapter N; and 2) Any other industrial user that: discharges an average of 25,000 gallons per day or more of process wastewater to the POTW (excluding sanitary, noncontact cooling, and boiler blow -down wastewater); contributes a process wastestream that makes up 5 percent or more of the average dry weather hydraulic or organic capacity of the POTW treatment plant; or is designated as such by the Control Authority on the basis that the industrial user has a reasonable potential for adversely affecting the POTW's operation or for violating any pretreatment standard or requirement (in accordance with 40 CFR 403.8(0(6)). Upon finding that the industrial user meeting the criteria in paragraph 2, above, has no reasonable potential for adversely affecting the POTW's operation or for violating any pretreatment standard or requirement, the Control Authority may at any time, on its own initiative or in response to a petition received from an industrial user or POTW, and in accordance with 40 CFR 403.8(0(6), determine that such industrial user is not a significant industrial user. Minor Industrial Use (MIU) -A non categorical industrial or commercial user of the POTW identified by the sewer facility that: 1) Have some discharges of wastewater that could cause elevated detection levels or metals or toxics in the pretreatment quarterly analysis; or 2) Have a discharge of small quantities of dangerous waste to the POTW which have been excluded from regulation under Chapter 173 -303 WAC through the domestic sewage exclusion; or 3) Have a potential to discharge. or spill chemicals to the POTW. Control Authority The Washington State Department of Ecology in the case of non delegated POTWs. Categorical Industrial User (CIU): An industrial user subject to national categorical pretreatment standards promulgated by EPA (40 CFR 403.6 and40 CFR parts 405 -471). Summary of Attachments That May be Required for This Application: (Please check those attachments that are included) C.1. Production schematic flow diagram and water balance C.4. Wastewater treatment improvements C.7. Additional incidental materials E.5. Additional results of effluent testing F.1. Facility site map H.8. Stormwater drainage map Example 1 for application section C.2. (SCHEMATIC DIAGRAM) ALL WATER USED IS FROM MUNICIPAL SUPPLY 6,000 gal /day Average, 11,000 gal /day maximum TRUCKS UNLOADING STORAGE (2) low- COOKING -30- PRESSING DRYING -$1.- DRIED MEAL I� PRODUCT CLEANUP LEAKAGE CONDENSATE WASHWATER TO WASTEWATER WASTE STREAM #1 TO SAN. SEWER (SS) TO SS (A) STORM DRAIN AVG. 100 GPD AVG 20 GPD AVG. 100 GPD MAX. 600 GPD MAX. 20 GPD MAX. 600 GPD WASTE STREAM #1 (A) WASTE STREAM #2 WASTEWATER TO SS PRETREATMENT (B) PRETREATMENT DETAIL (4) AVG. 5000 GPD UNIT (4) (SEE MAX. 10,000 GPD 1 DETAIL) OIL TO SKIMMING RECYCLER LEAKAGE WASTEWATER CHEMICAL TO SS STICK WATER ADDITION AVG. 20 GPD SHORTAGE (5) MAX. 20 GPD I, WASTE STREAM #2 SOL DS L SETTLING WASTE STREAM #1 (B) (A) 9 COOLING WATER TO STICK WATER --30.- STORM SEWER EVAPORATOR (6) AVG. 100 GPD MAX. 250 GPD WASTEWATER I_ TO SS WASTE STREAM #1 CONCENTRATED (A) FISH PRODUCT 4111 N 6TH LOADING DOCK AVE STORM D. N (Bo ROOF DRAIN STORM SANITARY DRAIN ,A1 O SEWER ACCESS 10TH ST. 3. Have you designated the wastes described above according to the applicable YES NO procedures of Dangerous Waste Regulations, Chapter 173 -303 WAC? SECTION J. CERTIFICATIONS 1. Approval by Publicly -Owned Treatment Works [required by WAC 173 216- 070(4)(b)] I approve of the discharge as described in this application. The applicant is: (Please check the appropriate box below.) A Significant Industrial User (see Definitions at the end of this Section) A Categorical Industrial User A Minor Industrial User (MIU) Neither of the above Name and location of sewer system to which this project will be tributary: Treatment Works Owner: Street: City /State: Zip: Signature of Treatment Works Authority Date Title Printed Name SECTION I. OTHER INFORMATION 1. Describe liquid wastes or sludges being generated by your facility that is not disposed of in the wastestream(s) and how they are being disposed of. For each type of waste, provide type of waste and the name, address, and phone number of the hauler. �j�- ccr1� ._d us psc 2. Describe storage areas for raw materials, products, and wastes. —I3ih5 Application or Disposal of Wastewaters Storage and Maintenance of Material Handling Equipment Vehicle Maintenance El Areas Where Significant Materials Remain Access Roads and Rail Lines for Shipping and Receiving El Other (please specify): 4. Material handling/management practices a. Types of materials handled and /or stored outdoors: (check all that apply) Solvents Hazardous Wastes g--Scrap Metal El Acids or Alkalies Petroleum or'Petr- ocJeniical Products CI Paints/Coatings Plating Products Woodtreating Products Pesticides, t Other (please list): (ri 17i k. b. Identify existing management practices employed to reduce pollutants in industrial stormwater discharges: (check all that apply) Oil /Water Separator Detention Facilities Containment Infiltration Basins Spill Prevention El Operational BMPs Surface Leachate Collection Vegetation Management Overhead Coverage Other (please list): 5. Attach a facility site map showing stormwater drainage /collection areas, disposal areas and discharge points. This may be a hand -drawn map if no other site map is available (See example on page 16 of this application). Label this as attachment H.8. O iC1/48r6\■[1," SECTION O. OTHER PERMITS 1. List all environmental control permits or approvals needed for this facility; for example, air emission permits. -emu SECTION H. STORMWATER 1.Do you have coverage under the Washington State Industrial Stormwater YES XNO NPDES General Permit? If yes, please list the permit number here. If no, have you applied for a Washington State Stormwater Baseline General YES *0 Permit? If you answered no to both questions above, complete the following questions 2 through 5. 2. Does your facility discharge stormwater: (Check all that apply) To storm sewer system (provide name of storm sewer system operator: Directly to any surface waters of Washington State (e.g., river, lake, creek, estuary, ocean). Specify waterbody name(s) Indirectly to surface waters of Washington State (i.e., flows over adjacent properties first). To a Sanitary Sewer Directly to ground waters of Washington State via: Dry well Drainfield Other 3. Areas with industrial activities at facility: (check all that apply) Manufacturing Building Material Handling Material Storage Hazardous Waste Treatment, Storage, or Disposal (Refers to RCRA, Subtitle C Facilities Only) Waste Treatment, Storage, or Disposal 6. Are any other pesticides, herbicides or fungicides used at this facility? YES NO If yes, specify the material and quantity used: 7. Are there other pollutants that you know of or believe to be present? YES y NO If yes, specify the pollutants and their concentration if known (attach laboratory analyses if available): 8. Is the wastewater being discharged, or proposed for discharge, to the POTW designated as a dangerous waste according to the procedures in Chapter 173 -303 WAC YES y NO DON'T KNOW 9. If the answer to question 8 above is yes, how did the waste designate as a dangerous waste (check appropriate box)? For Listed and TCLP Characteristic Wastes only, also provide the Dangerous Waste Number(s). Listed Waste Dangerous Waste Number(s) Characteristic Wastes Ignitable Reactive Corrosive TCLP Dangerous Waste Number(s) State Only Dangerous Wastes Toxicity Persistent For questions about waste designation under the Dangerous Waste Regulations, Chapter 173 -303 WAC, contact Ecology's Hazardous Waste and Toxics Program at: Southwest Regional Office Lacey (360) 407 -6300 SECTION F. SEWER INFORMATION 1. Is an inspection and sampling manhole or similar structure available on -site? YES NO If yes, attach a map or hand drawing of the facility that shows the location of these structures (this may be combined with map in 118, if H8 is applicable to your facility.) METALS j Antimony 7440 -36 -0 Mercury 7439 -97/6 Arsenic 7440 -38 -2 Nickel 7440 -02=0 Beryllium' 440 -41 -7 Selenium 7782 -49 -2 Cadmium 7440 -43 -9 Silver 7440 -22 -4 Chromium 7440 -47 -3 Thallium 7440 -28 -0 Copper 7440 -50 =8 Zinc 744 Lead 7439 -92 -1 Cyanide 57 -12 -5 r PESTICIDE S Aldrin 309 -00 -2 1 idosulfan I 115 -29 -7 alpha -BHC 319 -84 -6 Endosulfan II 115 -29 -7 beta -BHC 319 -85 -7 Endosulfan Sulfate 1031 -07 -8 gamma -BHC 58 -89 -9 Endrin 72 -20 -8 delta -BHC 319 -86 -8 Endrin Aldehyde 7421 -93 -4 Chlordane 57 -74 -9 Heptachlor 76 -44 -8 4,4' -DDD 72 -54 -8 Heptachlor Epoxide 1024-57-3 4,4' -DDE 72 -55 -9 t/ PCB (7 Aroclors) 4,4' DDT 50-29-3 Toxaphene 8001 -35 -2 Dieldrin 60 -57 -1 r BASE N EUTRAL COMPOUNDS Acenaphthene 83 -32 -9 Hexachlorobenzene 118 -74 -1 Acenapthylene 208 -96 -8 Hexachlorobutadiene 87 -68 -3 Anthracene 120 -12 -7 Hexachlorocyclopentadiene 77 -47 -4 Benzidine 92 -87 -5 Hexachloroethane 67 -72 -1 Benzo(a)anthracene 56 -55 -3 1 Indeno(1,2,3- cd)pyrene 193 -39 -5 Benzo(a)pyrene 50 -32 -8 lsophorone 78 -59 -1 3,4 Benzofluoranthene 205 -99 -2 Naphthalene 91 -20 -3 Benzo(ghi)Perylene 191 -24 -2 itrobenzene 98 -95 -3 Benzo(k)fluoranthene 207 -08/9 nitrosodimethylamine 62 -75 -9 Bis(2- chloroethoxy) Metha 111 -91 -1 N- itrosodi- n- propylamine 621 -64 -7 Bis(2- chloroethyl) Ether 1, 1 --44 -4 N- nitrgsodiphenylamine 86 -30 -6 Bis(2- chloroisopropyl) Ether 102 -60 -1 Phenanthfene 85 -01 -8 Bis(2- ethylhexyl) Phth 4ate 117 -81 -7 Pyrene 119 00 -0 4- Bromophenyl Phenyl Ether 101 -55 -3 1 2 4- Trichl obenzene 120 -82 -1 Butyl Benzyl Phthalate 85 -68 -7 2- Chloronaphthale,pie 91 -58 -7 4- Chlorophenyl ,henyl Ether 7005 -72 -3 Chrysene 218-01-9 Dibenzo(a,h)anihracene 53 -70 -3 1,2- Dichlorob 95 -50 -1 1,3- Dichlorgbenzene 541 -73 -1 1,4- Dichlorobenzene 106 -46 -7 3,3- Dichl'orobenzidine 91 -94 -1 Diethyl Phthalate 84 -66 -2 Dimeth 4 Phthalate 131 -11 -3 Di -n -butyl Phthalate 84 -74 -2 2,4- Dinitrotoluene 121 -14 -2 2,6- Dinitrotoluene 606 -20 -2 Di -n -octyl Phthalate 117 -84 -0 1,2- Diphenylhydrazine 122 -66 -7 Fluoranthene 206 -44 -0 Fluorene 86 -73 -7 3. Describe the collection method for the samples analyzed above (i.e., grab, 24 -hour composite, and flow proportional). 4. Has the effluent been analyzed for any other parameters than those identified in question E.2.? YES I�' NO If yes, attach results and label as attachment E.4. This data must clearly sh w the date, method and location of sampling. (Note: The City and Ecology may require additional testing.) 5. Does this facility use any of the following chemicals as raw materials or produce them as part of the manufacturing process, or are they present in the wastewater? (The number following the chemical name is the Chemical Abstract Service (CAS) reference number to aid in identib,ing the compound.) YES NO If yes, specify how the chemical is used and the quantity used or produced: VOLATILE COMPOUNDS Acrolein (107 -02 -8) 1,1- Dichloroethylene (75 -35 -4) Acrylonitrile (16'7 1,2- Dichloropropane (78 -87 -5) Benzene (71 -43 -2) ti 1,3-Dichloropropene (542-75-6) Bis (chloromethyl) Ether 42 -88 -1) Ethylbenzene (100 -41 -4) Bromoform (75 -25 -2) N,, Methyl Bromide (74 -83 -9) Carbon Tetrachloride (108-90-71N Methyl Chloride (74 -87 -3) Chlorobenzene (108 -90 -7) Methylene Chloride (75 -09 -2) Chlorodibromomethane (124 -48 -1) 1,1,2,2 Tetrachlo roethane (79 -34 -5) Chloroethane (75 -00 -3) Tetrachloroethylene (127 -18 -4) 2- Chloroethylvinyl Ether (110 -75 -8) NO Toluenne (108 -88 -3) Chloroform (67 -66 -3) N -•1,2- Trans Dichloroethylene (156 -60 -5) Dichlorobromomethane (75 -27 -4) j{ 2. 1,1,1 Trichloroethane (71 -55 -6) Dichlorodifluoromethane (75 -71 -8) •..2. 1,1,2,- Trichloroethane (79 -00 -5) 1,1- Dichloroethane (75 -34 -3) ,,,7" 2 ichloroethylene (79 -01 -6) 1,2- Dichloroethane (107 -06 -2) Triich rofluoromethane (75 -69 -4) Vinyl Chloride (75 -01 -4) N. ACID COMPOUNDS N 2- Chlorophenol 95- 57 -8_" 4- Nitrophenol 100 -02 2,4- Dichlorophenol J-20-83-2 p- Chloro -M- cresol 59- 50- 7\.. 2,4- Dimethylphenol 105 -67 -9 Pentachlorophenol 87 -86 -5 4,6- Dinitro- oocresol 534 -52 -1 Phenol 108 -95 -2 2,4- Dinitr phenol 51 -28 -5 2,4,6 Trichlorophenol 88 -06 -2 2-Nitrophenol 88 -75 -5 a x t I c c 0 C '-c9 s EA Cd w a �v) p-1 y [V N O C V O Vl O O O N N N O V, T. O O ort Q 0 p bA N o O O y Ca O v N 0 a J G. Cxl On C= CO CO o U CO c+. W L z o Q x U :a .0 .o on Z o co a O r U o o o Q v U U U Ca o vp N 3 az- at c" tn a i 'n o ,,n o 0 0 0 0 0 o ,n o d d r:+ c o O rY '11 v, r v, vy 'n vj v, e n vt O O P- 7= U i.. l.. M M en M M M M r M M el O o a. Q CA 1 0.3E d o n g a) on -o o •E 0 al W y Oat z oclE� rg a. ad a fl a C Q a Ct to E CA COL 1. -0 U 0 cI) 2s z 44 7 c L O c Fri 0 O G O S1 az s- E. 0 a�i e a o o 5 N M e V O o c y o a o 0 o c o a o CZ 0 0 g5. 0 V 2 F, E' 40 0 O o O Q C]a Y b o x u a) 'I c .a? a U F d a h I H CG U U U i Z N 4 W a.., s a ct ,tiG ELECTRICAL PERMIT CITY OF PORT ANGELES 360-417-4735 o Application Num1er 11- 00000801 Date 8/01/11 3 Application pin number 490037 REPORT SALES TAX Property Address 2506 W 19TH ST on your excise tax form ASSESSOR PARCEL NUMBER: 06-30-00-1-1- 1900 -5008- Application type description ELECTRICAL ONLY to the City of Port Angeles Subdivision Name (Location Code 0502) Property Use Property Zoning INDUSTRIAL LIGHT Application valuation 0 Application desc 1 feeder 4 circuitts brewing equipment Owner Contractor DARIGOLD, INC STRAITS ELECTRIC SO BOX 79007 PO BOX 2914 SEATTLE WA 981197907 PORT ANGELES WA 98362 V"...) (360) 452 -9104 q5Z o7'11 Permit ELECTRICAL ALTER COMMERCIAL Additional desc Permit pin number 190140 Permit Fee 130.30 Plan Check Fee .00 Issue Date 8/01/11 Valuation 0 Expiration Date 1/28/12 Qty Unit Charge Per Extension 4.00 2.6000 ECH EL- BRANCH CIRCUIT W /FEEDER 10.40 1.00 119.9000 ECH EL -0 -200 SRV FEEDER 119.90 Fee summary Charged Paid Credited Due Permit Fee Total 130.30 130.30 .00 .00 Plan Check Total .00 .00 .00 .00 Grand Total 130.30 130.30 .00 .00 V INSPECTION TYPE DATE: RESULTS: INSPECTOR: DITCH SERVICE ROUGH -IN i 2)Si FINAL 1 2 COMMENTS: V tpt fq. SIX (6) I4M'LAST INSPECTION PERMIT WILL EXPIRE S MONT Signature of owner or Electrical Contractor X .Date: G: \EXCHANGE \BUILDING °F �N oRT ELECTRICAL INSPECTION U WIRING REPORT 417 -4735 c °aKS B DATE 1.+ G 1 P I lIT b INSPECTOR N OWER/CONTRACTOR I ADDRESS 2 5 b 19 L7 9 s�-r APPROVED NOT APPROVED DITCH S ►RVI -PCB- ROUGH IN /COVER SERVICE FINAL CORRECTIONS NEEDED: t NOTIFY INSPECTOR WHEN CORRECTIONS ARE COMPLETED WITHIN 15 DAYS DO NOT REMOVE OLYMPIC PRINTERS, INC. (360) 452 -1381 1 CITY OF PORT ANGELES PERMIT APPLICATION 1 1 F L J Building Division/Electrical Inspections' 321 East Fifth Street P.O. Box 1150 Port Angeles Washington, 98362 Ph: (360) 417 -4735 Fax: (360) 417 -4711 millifiWir Date: 7 I _I& 2 Single Family Dwelling Multi Family or Commerc x Commercial Addition Alteration Remodel Repair* Plan RevieyMay B quir Ie a Iete lect P Review Information Sheet Q Job Address: tt t r t' 2' t7 6 L) 1 Building Square Footag Description of above ?i Jii1 �1i\7 -G�'C. L_ Owner Contra., Contra•, r In( Nam Name: Name. V 1 (fC (G Mailing Address: G Maili 1o1 Iiairar7� City: State: Zip: City: tate: Zip: Phone: Fax:. Phone: F License Exp. License Exp Item Unit Charge Total Iti ied by Unit Charge) Service/Feeder 200 Amp. 4 119.90 —T--- Service/Feeder 201 -400 Amp. 145.50 Service /Feeder 401 -600 Amp 204.60 Service/Feeder 601 -1000 Amp. 262.20 Service/Feeder vSr 100d. 372.50 Branch W h Circuit W/ Service 0 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 Each Additional 500 Square Ft. or Portion of 35.20 Each Outbuilding or Detached Garage 73.50 Each Swimming Pool or Hot Tub 110.30 r Vv otal 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 lectrical contractor if above said property is for sale, rent or lease. Permit expires after six months of last inspection. -r eadin the above statement, I hereby certify that I am the owner of the above named property or a licensed electrical contractor. I am making i e ectri ..I'•stallation or alteration in compliance with the electrical laws, N.E.C., RCW. Chapter 19.28, WAC. Chapter 296 -46B, The City of Port Ang: les h, icipal Code, and Utility Specifications and PAMC 14.05.050 regarding Electrical Permit Applications. Sign to i er, electrical contractor or electrical administrator: Cash check "`M--°— Dated: t 0110112010 0 v I l() 1 'cr) D II 2 C 'f�' en o EE- O Q) 1C� N 'L: II [n a a_ 0_ c) r) co o 0 0 T.) a c c co 0) o- a) O a0 .v U cn cu c O U l O O, 0-• 0 ID O O c 3 c C -t Z. O ca U hi:. c s o cna:; r-.: cam C7 t6 h Z i co o D c cam) W Q N T. I D C Z i E_ o a> .5‘J w l C 10 El p7 0 M J Z O `-G ch c Tn Y i u a> o X 6 o w E I—' 1J iii L d 1.bLO 09£ Ja>ionl a!Tsuyo d9£ :60 I.6 9Z In(' Jul 22 11 09:45a Christie Tucker 360- 452 -0741 p.1 Straits Electric Coinnaercial- Iladiist ,rival Marine- Resideftiaml P.O. Box 2914 P: 360 452 -9104 Port Angeles, WA 98362 F: 360 452 -0741 'To City of PA 1 Attention: Trent Fax number: 417-4711 Date: 7 -22 -11 Regarding: Twin Peaks Brewery Number of pages: 2 Comments: Take a look at the attached. Give JT a call to discuss. Thanks' Cam,: i Tooke. straits ©olypen.com 7 11.4 f Jul 22 11 09:46a Christie Tucker 360- 452 -0741 p.2 i Twin Peaks Brewery One -Line Drawing and Load Calculation Existing Service 1' f:: 90K Brewmaster EX1STING 208V 2 "C (3)1/0 THWN 1.25Ax1.25 =1562A 3 -phase EXIS,7NG EXISTING 1 "C (3) #6 THWN Chrl ler. 30Axl .25 =37.SA (90x1 )00) 9000CW 359 84 250 1 Amps+ 193.7 A continuous l (Ex1..'3) X -fmr rating '25A non continuous ,load 22887 NE Townsend Way I ntertek Fairview OR 97024 Telephone: 503-676-2311 Facsimile: 503 676 -2350 www.intertek.com '10/31/2011 Mr. Eddy Smith Phone: 360- 809 -3195 Twin Peaks Brewing 130 S Lincoln St e-mail: fasteddy 53 @msn.com Port Angeles WA 98362 Subject: Field Evaluation Report of Brewing Equipment Control Panels Intertek 'Project No. G100506711 Intertek Report No. 100506711 FLW -001 Dear Mr. Mr. Smith: This letter and report concludes and represents the results of the evaluation and tests of the above referenced equipment to the requirements contained in the following standard. UL 508A Standard for Safety for Industrial Control Panels, First Edition, Rev. 2009/09/02 This investigation was authorized by Proposal Number 500323033, dated 8/8/2011. The investigation was begun and concluded on 10/24/2011. Production -line sample(s) were made available and tested at the location identified in the attached Field Evaluation Report. Attached to this letter is our Field Evaluation Report, which identifies all pertinent information related to this evaluation. At the conclusion of this evaluation, the subject equipment was labeled with ETL Serialized Field Labels under the conditions indicated in the Field Evaluation Report. If you have any questions, please feel free to contact us at your convenience. We are looking forward for future opportunities to work together. Sincerely, &k V Christine Porter Field Label Evaluations christine. porter intertek.com 206 841 -1707 cc Mr. Trent Peppard, City of Port Angeles, tpeppard @citvofpa.us This report is for the exclusive use of Intertek's Client and is provided pursuant to the agreement between Intertek and its Client. Intertek's responsibility and liability are limited to the terms and conditions of the agreement. Intertek assumes no liability to any party, other than to the Client in accordance with the agreement, for any loss, expense or damage occasioned by the use of this report. Only the Client is authorized to permit copying or distribution of this report and then only in its entirety. Any use of the Intertek name or one of its marks for the sale or advertisement of the tested material, product or service must first be approved in writing by Intertek. The observations and test results in this report are relevant only to the sample tested. This report by itself does not imply that the material, product, or service is or has ever been under an Intertek certification program. i 110 112) F ($EAB 40 iApProveA, Int ertek Intertek Intertek Intertek Intertek Intertek Intertek Intertek Testing Services NA, Inc. SD 8.8.1 (2/11/2011) Mandatory I ntertek Page 2 of 7 Report No 100506711 FLW -001 Field Evaluation Report 100506711 FLW -001 10/31/2011 Rendered To: Twin Peaks Brewing 130 S Lincoln St Port Angeles WA 98362 Contact: Mr. Eddy Smith Phone: 360- 809 -3195 Performed By: Intertek Testing Service NA, Inc. 22887 NE Townsend Way Fairview OR 97024 Ph: 503 676 -2350 Fax: 503 676 -2311 Products Covered: Brewing Equipment Control Panels Inspection Site: Twin Peaks Brewing 2506 W 19th Street Port Angeles, WA 98362 Results The equipment noted in this Report has been investigated to the following Standard as far as practical in the field and has been found to be in essential compliance with those requirements. UL 508A Standard for Safety for Industrial Control Panels, First Edition, Rev. 2009/09/02 The installation methods and final approvals at the installation site are the responsibility of the Authority Having Jurisdiction. Complete investigation information is on file at this office. Please note this Letter of Compliance does not represent authorization for the use of the ETL Mark. In Charge of Testing: Approved by Christine Porter Wendell Whistler Field Label Evaluations Engineering Team Leader NFL West Intertek Portland Intertek Portland Christine.porter@intertek.com Wendell.whisterl intertekcom Intertek Testing Services NA, Inc. SD 8.8.1 (2/11/2011) Mandatory ntertek Page 3 of 7 Report No 100506711 FLW -001 TABLE OF CONTENTS Table of Contents 3 1.0 Scope 4 2.0 Product Evaluation Procedures 4 2.1 Standards 4 2.2 Visual Inspection 4 2.3 Product Type Testing 5 2.4 Resolution of Deficiencies 5 2.5 Technical Report 5 3.0 Products Evaluated 6 3.1 Equipment Identification and Field Label Number 6 3.2 Conditions of Use and Acceptability 6 3.3 Photographs and Schematics 6 Intertek Testing Services NA, Inc. SD 8.8.1 (2/11/2011) Mandatory Intertek Page 4 of 7 Report No 100506711 FLW -001 1.0 Scope This Final Field Evaluation Report provides the results of the evaluation of non certified or other special equipment as noted in this report. The purpose of these inspections is to provide a review of the electrical constructions of the subject products and provide a degree of assurance that the constructions comply with the requirements of appropriate standards. This evaluation is limited to the equipment itself and is not specifically intended to identify issues with the field installed wiring other than how it interacts with the equipment. 2.0 Product Evaluation Procedures 2.1 Standards: The standard noted on the cover page was used to evaluate the subject products. The standards are the applicable American National Standards Institute (ANSI), National Fire Protection Association (NFPA) or other Approved product standard. 2.2 Visual Inspection: A visual inspection of the product was conducted, comparing product construction to requirements of the applicable product standard. Any unlisted /unmarked components were identified and evaluated. Visual inspection included any directly connected loads to the product evaluated. Complete inspection records are on file at the Intertek office. Overcurrent Protection: All overcurrent protection provided in the unit was of the proper rating and type. The rating of the branch circuit supplying the equipment is: 100 A, using circuit breakers with an interrupt rating of 10k A Wiring Ampacities: All wiring is certified and used within its voltage and temperature ratings. All external wiring also complies with size requirements in the NEC. Grounding: All required noncurrent carrying metallic parts of the equipment have been checked and determined to be suitably bonded to the supply equipment grounding conductor. Connection of the equipment grounding conductor was properly done. Wiring Methods: All internal wiring is routed properly and splices are made with means acceptable to the standard. Field Wiring means are in compliance with the standard and appear to be wired properly in the product. Guarding of Equipment: All possible casualty hazards and any live parts are guarded or warnings provided in accordance with the standard. Damaged Components: Any component or part of the equipment that was or appeared to be damaged was checked and determined to be acceptable for use. General Engineering Practices: The product was constructed in a workmanlike fashion and was new or in cleaned condition. Special features of the equipment location are: The equipment is located in the cool section of a brew house with concrete floors and non combustible walls. Intertek Testing Services NA, Inc. SD 8.8.1 (2/11/2011) Mandatory Intertek Page 5 of 7 Report No 100506711 FLW -001 2.3 Product Type Testing: The following non destructive tests required by the applicable product standard were conducted with satisfactory results. Test results are on file at the Intertek office. Grounding Continuity Insulation Resistance 2.4 Resolution of Deficiencies: The following deficiencies were identified on the equipment during the initial evaluation. Methods of resolution by the client have been reviewed, agreed upon, and verified by Intertek. Deficiency Approved Resolution There were unused cable and conduit openings Unused fittings were removed and KO seals into the main control panel installed Not all EGC and bonding terminations were Identification was added for all EGC and bonding marked terminals The mounting means for a Luntze component A replacement part was ordered, in the meantime was broken the component was held in place by pressure of the din rail end mount terminal fitting Electrical information on nameplate was missing Information was added including the FLA for the control panel The SCCR was not provided The default rating of 5kA was applied to all three panels 2.5 Technical Report: Upon completion of the Field Evaluation and application of the Field Evaluation Label, this final technical report was prepared and issued to Mr. Eddy Smith, of Twin Peaks Brewing, and the Authority Having Jurisdiction (AHJ Local inspection authority), Mr. Trent Peppard, City of Port Angeles, tpeppard @cityofpa.us Intertek Testing Services NA, Inc. SD 8.8.1 (2/11/2011) Mandatory Intertek Page 6 of 7 Report No 100506711 FLW -001 3.0 Products Evaluated 3.1 Equipment Identification and Field Label Number: Field evaluation of the control panels for a small commercial brewery. The system that consists of the main tank (mashtun vessel) with the main controller panel, and a robotic arm containing an operator station. This combi vessel has two compartments, the upper is where the mashing and sparging occurs. Next is the lower section (the hot liquor tank) where the wort occurs. There are four heating elements in the lower section to bring the temperature up to boiling. From there the product is run through a chiller to one of two fermenting tanks. Once fermented the product is then pumped to one of two maturizing tanks for aging before the final stage where the product is pumped into kegs for resale purposes Manufacturer Model Serial No. Ratings ETL Label Munker Main Control Panel D1000 63A 208V 60Hz 228000 Munker El D1000 Fed from Main 228001 Munker P1 D1000 Fed from Main 228002 3.2 Conditions of Use and Acceptability: This product is intended for use and installation in a non classified (non- hazardous) location and for connection to the appropriately sized branch circuit. The installation methods and final acceptability at the installation site are the responsibility of the Authority Having Jurisdiction. 3.3 Photographs and Schematics: Drawings and manuals were provided, photographs are next c... a 1. k 4 „,iii 1," i sg';'-'"° s ',7;4 31 4: t",, ''.i 1 4 ,4,; t i iisf' 1 s 7-7-1 °L, —Is° ;',..Wii«.°;,r; 7 1`. 7 i, s !,1/ i;" "cq, y i The brewing system tanks on the left, the chilling system on the right g, N l 10 i t 4 r l 1 t t 1 WC w+, xw e .t� •J 4 r t J as r s i r. t f i t Main control panel on the first tank (the combi) SD 8.8.1 (2/11/2011) Mandatory Intertek Testing Services NA, Inc. 1 intertek Page 7 of 7 Report No 100506711 F -001 t' .4 sz- 'Ltd* Y._ -1 tt,' Al't 't ttli" Fs', '00,-,44.-.7..`iiil 0.,- 's, A i t, a ::c,. dfi L i d,. t e.° C HI 7 ter, 1% :/'.r'.,!.; k Operator station on the robotic arm at the fi tank '.4&'''' 'i4;tat'll,4 't 'a �m 1 4 aw I m uiY i V,.....•?: fr a. _f ..prf.trlitgi41... y� 'i ail 1 k x w �.a �y .mow Third control panel in the tank opposite the three tanks and chilling system. Interte Testing Service NA, Inc. SD 8.8.1 (2/11/2011) Mandatory / S '21 FEE RECEIPT NUMBER CITY OF PORT ANGELES DEPARTMENT oF" LIGHT APPLICATION AND ELECTRICAL PERMIT 083 A PERMIT NUMBER ,.. " . ,. &~M TOTAL FEE 60 c5!- CONT. Lie. NO. TIMETO COMPLETE NO, STORIES LEGAL OCCUPANCY ELECTRICAL PERMIT QNL Y Site Address 2. S' 0 r;. /)J / q 71< D CORRECT ADDRESS IS RESPONSIBILITY OF APPLICANT Owner _M I 'j--Q1 d 'FAJt.M S Owner's Address . - -. . ~. <fS7 -<{-'n I NO OCCUPANCY OR USE ESTABLISHED UNDEA THIS PERMIT PERMITS WITH WRONG ADDRESSES ARE CANCELLED 10 ( '1/11.. J1 tC f'( f (ftttG- Installation By Installers Address Wiring Method I certify that the work to be performed under this permit will be done by the insta-lIer and in conformance with the N.E.C. Electrical Code. 7/11 I r j ,19 By ~({r . CONTRACTOR OR OWNER (OR AUTHOAIZED AGENT) Permission i~ h~reby given to do the above de~cribed work, according to the condition~ hereon and according to the approved plans and specifications pertaining thereto, subject to compliance with the Ordinances of t e ity of Port Angeles. 111~/ft, _ " ,(0, Notify Department of City Light by Street Address and Permit Number when ready for inspection. Work must not be covered or current turned on before inspection and O.K. for covering or service has been given by Inspe_ctor in Writing on Permit Placard. A. - Permits-Phone: 457-0411 Ext.158. USE OF CIRCUIT LIGHT LIGHT CONVENIENCE CONVENIENCE APPLIANCE DISHWASHER DISPOSAL . RANGE OVEN WATER HEATER LAUNDRY DRYER FURNACE GAS - OIL FURNACE ELECTRIC ELECTRIC HEAT ELECTRIC HEAT A.C. UNIT FEEDER SERVICE NUMBER . CIRCUITS AMP PER CIR FEE AMP PER CIR 240V 100R 30 240V 100R 30 .120V 10 NUMBER CIRCUITS 120V 10 FEE USE OF CIRCUIT /.1- F1 f./J V'< 1<>', -4le- A {k/ .-:; S- /()I A 7ft'Mtt'. t,1-J..ffv ~~o A.~ VlMN ..I!~ SIGN 50 VOLTS OR lESS M~cq ~Bo 7~~~' i-Mo"~ 25 /. MOTOR1 F!RE A,LARMS . BURGLAR ALARM ~ 1 -~ I ht--- , . , ., I \ , ~ / \Do / \ /iv / ~\V Jl , \ ~ / \ I / I , MISC. . REINSTALLATION LIGHT FIXTURE # S~B TOTAL FEE ENERGY FEE BASIC FEE TOTAL FEE ... SIZE OF SERVICE SWITCH OR CIRCUIT BREAKER AMP SIZE OF SERVICE ENTRANCE CONDUCTORS PHASE: AW.G. I SUB-TOTAL SIZE OF GROUND SIZE OF ENTRANCE SWITCH Date Application made . Date Permit Issued WARNING \ nl YMPIr. PRINTFI=IR lNC PERMIT PLACARD MUST BE KEPT POSTED ON THE WORK - SEE OVER - WHITE. Original CANARY. Duplicate PINK. Triplicate WHITE CARD . Inspector's Report REPORT OF INSPECTOR DATE OF VISIT MADE BY REMARKS , , , , O.K. FOR COVERING , , -tK O.K. TO CONNECT SERVICE ~\ \'A<\\' ......0... '" '\ 'VT I . z Cl a: <C :!E !!.! J: I- Z W I- ;. I- o Z o C . ELECTRICAL PERMIT CITY OF PORT ANGELES 360-417-4735 Application Number . . . . . 18-00000976 Date 6/28/18 Application pin number . . . 156256 Property Address . . . . . . 2506 W 19TH ST ASSESSOR PARCEL NUMBER: 06 -30 -00 -1 -1 -1900 -5008 - Application type description ELECTRICAL ONLY Subdivision Name . . . . . Property Use . . . . . . . . Property Zoning . . . . . . . INDUSTRIAL LIGHT Application valuation . . . .. 0 Application desc Meter socket ---------------------------------------------------------------------------- Owner Contractor PORT OF PORT ANGELES ANGELES ELECTRIC PO BOX 1350 524 E. IST ST., PORT ANGELES WA 98362 PORT ANGELES WA 98362 (360) 452-9264 ------- — ------------------------------------------------------------------- Permit . . . . . . ELECTRICAL ALTER COMMERCIAL Additional desc . Permit Fee . . . . 132.00 Plan Check Fee .00 Issue Date . . . . 6/28/18 Valuation 0 Expiration Date 12/25/18 Qty Unit Charge Per Extension 1.00 132.0000 ECH EL -COM 0-200 SRV FEEDER 132.00 ---------------------------------------------------------------------------- Fee.summary Charged Paid Credited -------------------- Due ---------- ----------------- ---------- Permit Fee Total 132.00 132.00 .00 .00 Plan Check Total .00 .00 00 .00 Grand Total 132.00 132.00 •00 .00 INSPECTION T'Y'PE DATE: RESULTS: tom" REPORTT S7ATE SALES TAX I n your excise tax form to the City of Port Angeles (Location Code 0500 INSPECTOR 06/26/2018 15:54 FAX 360 452 9265 Angeles Electric IM0002/0002 Project Address: Project Description: MULTI -FAMILY / COMMERCIAL ELECTRICAL PERMIT APPLICATION Fublic. Works and Utilities Department 321 E. 5th StTce(-, Port Angeles, W.A. 98362 360.417.4735 } www.cityofpa.us I electricalpemiits!a;cityofpa.us Aj 11 Multi -Family Residential 1900tommercial / Industrial /Public .Building Square footagg: Name: ��NL+tlwl Email: Mailing Address: Phone: ELECTRICAL CONTRACTOR Name: ANGELES ELECTRIC, INC. License: ANGELE1460RS Mailing Address: 524 E�OIRST.STREET Expiration Date: 02/01/2019 Email: ksimpson@)o Phone: 360-452-9264 PROJECTDETAILS Item Wan.. uspttq x Uri Charge) Service/Feeder 200 Amp.{ ,: Service/Feeder 201-400 Amp. $160.00 $ Service/Feeder 401-600 Amp. .$225.00 $ Service/Feeder 601-1000 Amp. $288:00. $ Service/Feeder over 1000 Amp. $41Q.'00;-,- Branch Circuit W/. Service Feeder Branch Circuit W/O Service Feeder $7#:i3i7 $ Each Additional•Branch Circuit $5.00 $ Branch Circuits 1-4 $ Temp. Service/Feeder 200 Amp. $1;4:,2.!)0. $ Temp. Service/Feeder 201-400 Amp. $124.00 $ Temp. Service/Fee11�t7tpt. Temp. Service/Feed - 00 Amp. Portal to Portal Hourly Sign / Outline Lighting., M,. Signal Circuit/Limited Ene ew - Signal Circuit/Limited Energy/ (Note: $5.00 for each Renewable Elec. Energy: 5KVA Syste $ Thermostat (Note: $5 for each additional) - $ $ _, 32 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. i Me Print Name Signature (❑ Owner electrical Contractor Administrator) [Electrical Permit Applications may be submitted to City Hall or electricaipermits@cityofpa.us or faxed to 360.417.4711 ] INSPECTION TYPE DITCH DATE: RESULTS: SERVICE ROUGH -IN 9, /X7 k I FINAL COMMENTS: PERMrr WILL EXPIRE SIX (6) MONTHS FROM LAST INSPECTION Sigaam of owner or Electrical Contractor X INSPECTOR: Date: ELECTRICAL PERAO T - CITY OF PORT ANGELES.`: 44 360417-4735 — Application Number . . . . . 18-00000780 Date 5/23/18 Application pin number . . . 619800 Property Address , . . . . . 2506 W 19TH ST REPORT STATE SALES TAX ASSESSOR PARCEL NUMBER: 06-30-00-1-1-1900-5008- tax form Application type description ELECTRICAL ONLY on your excise Subdivision Name . . . . . . to the City of Port Angeles Property Use . . . . . . . . (Location Code 0502) Property Zoning . . . . . . . INDUSTRIAL LIGHT Application valuation . . . . 0 ---------------------------------------------------------------------------- Application desc Circuit for control panel ----------- ---------------------------------------------------------------- Owner Contractor ------------------------ ------------------------ PORT OF PORT ANGELES BLACK DIAMOND ELECTRICAL CONTR PO BOX 1350 502 BLACK DIAMOND RD PORT ANGELES WA 98362 PORT ANGELES WA 98363 (360) 565-1035 ---------------------------------------------------------------------------- Permit . . . . . . ELECTRICAL ALTER COMKERCI Additional desc Permit Fee . . . . 74.00 Plan CA& Fee .00 Issue Date . . . . 5/23/18 Valuation . . . . 0 Expiration Date 11/19/18 'Qty Unit Charge Per Extension 1.00 74.0000 ECH EL -COMM BRANCH CIR Wd/ S/P 74.00 --------------------------------------- ------------------------------------ Fee summary Charged Paid Credited Due ---------- ---------- --------- - ---------- ----------------- Permit Fee Total 74.00 74,00 .00 .00 Plan Check Total .00 .00 .00 00 Grand Total 74.00 74.00 .00 .00 INSPECTION TYPE DITCH DATE: RESULTS: SERVICE ROUGH -IN 9, /X7 k I FINAL COMMENTS: PERMrr WILL EXPIRE SIX (6) MONTHS FROM LAST INSPECTION Sigaam of owner or Electrical Contractor X INSPECTOR: Date: Project Address: Project Description: MULTI -FAMILY / COMMERCIAL -.;,`," ' ' �V „ ELECTRICAL PERMIT APPLICATION Public Works and Utilities Department 321 E. 5th Street, Port Angeles, WA 98362 360.417.47351 www.cityofpa.us ( electricalpermits@cityofpa.us 2 S—D 6 ❑ Multi -Family Residential Commercial / Industrial / Public Building Square footage: A Itldu IIIIII 1IId,1Ili] I III .il1,hIYI II I III V... 111 11 . 1III IL II.1 Illi II ld I ll16dll milluiidul VilemlWex ldlx III., i. I I, I I ,,I I IJP IIWIILIJ .Ib,l Name: Mailing Address: Name: Mailing Address: Email: Item Service/Feeder 200 Amp. Service/Feeder 201-400 Amp. Service/Feeder 401-600 Amp. Service/Feeder 601-1000 Amp. Service/Feeder over 1000 Amp. Branch Circuit W/ Service Feeder Branch Circuit W/O Service Feeder Each Additional Branch Circuit Branch Circuits 1-4 Temp. Service/Feeder 200 Amp. Temp. Service/Feeder 201-400 Amp. Temp. Service/Feeder 401-600 Amp. Temp. Service/Feeder 601-1000 Amp. Portal to Portal Hourly Sign / Outline Lighting Signal Circuit/Limited Energy - Multi -Family Signal Circuit/Limited Energy/First 1500 sf - Commercial (Note: $5.00 for each additional 1500 sf) Renewable Elec. Energy: 5KVA System or less Thermostat (Note: $5 for each additional) Email: Unit Charae Quantity $132.00 $160.00 $225.00 $288.00 $410.00 $5.00 $74.00 $5.00 $86.00 $102.00 $121.00 $164.00 $185.00 $96.00 $88.00 $88.00 $96.00 $113.00 $56.00 Phone: 360 - 40- '77 Q License:y'IGL� Expiration Date: Phone: �� III(' 39.s°7 Total (Quantity x Unit Charge) $ $ $ $ $_1�_ OTAL 1 - Owner 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. am making the electrical installation or alteration in compliance with the etectri I laws, N.E.C., RCW. Chapter 19.28, WAC. Chapter 296- 466, The City of Port Angeles Municipal Code, and Utility Specifi s AMC 14.05.050 regarding Electrical Permit Applications. 5-22-1 d' Si, Date Print Name gtricalpermits@cityofpa.usorfaxedto360.417.4711] Owner ❑ Electrical Contractor /Administrator) [Electrical Permit Applications maybe submitted to Cit 1] ELECTRICAL PERMIT CITY OF PORT ANGELES 360-417-4735 Application Number . . . . . 18-00000976 Date 6/28/18 Application pin number . . . 156256 Property Address . . . . . . 2506 W 19TH ST ASSESSOR PARCEL NUMBER: 06 -30 -00 -1 -1 -1900 -5008 - Application type description ELECTRICAL ONLY Subdivision Name . . . . . Property Use . . . . . . . . Property Zoning . . . . . . . INDUSTRIAL LIGHT Application valuation . . . .. 0 Application desc Meter socket ---------------------------------------------------------------------------- Owner Contractor PORT OF PORT ANGELES ANGELES ELECTRIC PO BOX 1350 524 E. IST ST., PORT ANGELES WA 98362 PORT ANGELES WA 98362 (360) 452-9264 ------- — ------------------------------------------------------------------- Permit . . . . . . ELECTRICAL ALTER COMMERCIAL Additional desc . Permit Fee . . . . 132.00 Plan Check Fee .00 Issue Date . . . . 6/28/18 Valuation 0 Expiration Date 12/25/18 Qty Unit Charge Per Extension 1.00 132.0000 ECH EL -COM 0-200 SRV FEEDER 132.00 ---------------------------------------------------------------------------- Fee.summary Charged Paid Credited -------------------- Due ---------- ----------------- ---------- Permit Fee Total 132.00 132.00 .00 .00 Plan Check Total .00 .00 00 .00 Grand Total 132.00 132.00 •00 .00 INSPECTION T'Y'PE DATE: RESULTS: tom" REPORTT S7ATE SALES TAX I n your excise tax form to the City of Port Angeles (Location Code 0500 INSPECTOR 06/26/2018 15:54 FAX 360 452 9265 Angeles Electric IM0002/0002 Project Address: Project Description: MULTI -FAMILY / COMMERCIAL ELECTRICAL PERMIT APPLICATION Fublic. Works and Utilities Department 321 E. 5th StTce(-, Port Angeles, W.A. 98362 360.417.4735 } www.cityofpa.us I electricalpemiits!a;cityofpa.us Aj 11 Multi -Family Residential 1900tommercial / Industrial /Public .Building Square footagg: Name: ��NL+tlwl Email: Mailing Address: Phone: ELECTRICAL CONTRACTOR Name: ANGELES ELECTRIC, INC. License: ANGELE1460RS Mailing Address: 524 E�OIRST.STREET Expiration Date: 02/01/2019 Email: ksimpson@)o Phone: 360-452-9264 PROJECTDETAILS Item Wan.. uspttq x Uri Charge) Service/Feeder 200 Amp.{ ,: Service/Feeder 201-400 Amp. $160.00 $ Service/Feeder 401-600 Amp. .$225.00 $ Service/Feeder 601-1000 Amp. $288:00. $ Service/Feeder over 1000 Amp. $41Q.'00;-,- Branch Circuit W/. Service Feeder Branch Circuit W/O Service Feeder $7#:i3i7 $ Each Additional•Branch Circuit $5.00 $ Branch Circuits 1-4 $ Temp. Service/Feeder 200 Amp. $1;4:,2.!)0. $ Temp. Service/Feeder 201-400 Amp. $124.00 $ Temp. Service/Fee11�t7tpt. Temp. Service/Feed - 00 Amp. Portal to Portal Hourly Sign / Outline Lighting., M,. Signal Circuit/Limited Ene ew - Signal Circuit/Limited Energy/ (Note: $5.00 for each Renewable Elec. Energy: 5KVA Syste $ Thermostat (Note: $5 for each additional) - $ $ _, 32 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. i Me Print Name Signature (❑ Owner electrical Contractor Administrator) [Electrical Permit Applications may be submitted to City Hall or electricaipermits@cityofpa.us or faxed to 360.417.4711 ]