HomeMy WebLinkAbout1103 Columbia St - BuildingThis certificate is issue
cent f;ing that at the
regulating building c �n
Business name
Business address
Property owner
Property owner s
Automatic fire spri
Use occupancy c
Building permit num
Type of construction.
Occupant load. P
CIVIC' SS /Tr nsc i:ptiom
103TColumbia St
Clallam C6
939 Carolir e ....j
system Per I C
cat Business
onhor use
aspa
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Bales 8362
C E RTI A kU PA Nl CY
Port Angel Bui1din DI ision
ur ant to„ the requirements of Section 110 of the 2016- International Building Code
ancethzs strut -cure was in conzplfancewith the v °ious ordinances of the City
*ware
strut
nager
Center)
909
05 -05 -08
Re -issue Date
Post on the premises in a conspicuous place. This a I not be removed except by the Building Official.
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CITY OF PORT ANGELES
DEPARTMENT OF COMMUNITY DEVELOPMENT - BUILDING DIVISION
321 EAST 5TH STREET, PORT ANGELES, W A 98362
Application Number
Application pin number
Property Address
ASSESSOR PARCEL NUMBER:
Tenant nbr; name
Application type description
Subdivision Name
Property Use
Property Zoning . . .
Application valuation
07-00000860 Date 7/20/07
170160
1103 COLUMBIA ST
06-30-00-5-3-0245-0000-
OLYMPIC MEDICAL CENTER
RE-ROOF
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6'
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7000
Owner
Contractor
PUBLIC HOSPITAL DISTRICT #2
939 CAROLINE ST
PORT ANGELES WA 983623909
(360) 417-7163
OWNER
Permit . . . . .
Additional desc .
Permit pin number
Permit Fee
Issue Date
Expiration Date
BUILDING PERMIT - NO PR FEE
TEAR OFF AND RE-ROOF
107615
165.75 Plan Check Fee
7/20/07 Valuation
1/16/08
.00
7000
Qty Unit Charge Per
Extension
95.75
70.00
BASE FEE
5.00 14.0000 THOU BL-2001-25K (14 PER K)
Other Fees
STATE SURCHARGE
4.50
,.-
Fee summary Charged Paid Credited Due
----------------- ---------- ---------- ---------- ----------
Permit Fee Total 165.75 165.75 .00 .00
Plan Check Total .00 .00 .00 .00
Other Fee Total 4.50 4.50 .00 .00
Grand Total 170.25 170.25 .00 .00
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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.
/61 9thh,
Signature of Contractor or Authorized Agent
7 -2..0-<::.7
Date
7J
(t>
I
g
"
Signature of Owner (if owner is builder)
Date
T:\Policies\l102_15 building pennit inspection record05.wpd [1/4/2005]
'\
BUll-DING PERMIT INSPECTION RECORD
CALL 417-48] 5 FOR BUILDING INSPECTIONS. CALL 4] 7-4735 FOR ELECTRICAL INSPECTJONS.
CALL 4] 7-4807 FOR PUBLIC WORKS UTJLITIES
PLEASE PROVIDE A MINIMUM 24 HOUR NOT]CE. IT IS UNLA WFUL TO COVER, INSULATE OR CONCEAL ANY WOPJ{ BEFORE
JJVSPECTED AND ACCEPTED. POST PERMIT IN A CONSPICUOUS LOCA TlON.
KEEP PERMIT CARD AND APPROVED PLANS AT .lOB SITE.
INSI'ECTlON TYPE DATE ACCEl'TED COMMENTS
YES NO
FOUNDATION:
FOOTINGS
SHEAR WALLS I WALLS
FOUNDA TlON DRAINAGE I DOWN SPOUTS
PIERS
POST HOLES (POLE BLDGS.)
PLUMllING
UNDER FLOOR I SLAB
ROUGH-IN
WATER LINE (METER TO BLDG)
GAS LINE FIN AL DATE ACCEPTED BY:
BACK FLOW I WATER
AIR SEAL
WALLS
CEILING I
FRAMING
JOISTS I GIRDERS
SHEAR W ALL/HOLD DOWNS
WALLS I ROOF I CEILING
DRYW ALL (INTERJOR BRACED PANEL ONLY)
T-BAR
INSULATION
SLAB
WALL I FLOOR I CEILING
MECHANICAL
ROUGH-IN
HEATPUMY/FURNACE/DUCTS I
GAS LINE FINAL DATE ACCEPTED BY:
WOOD STOVE I PELLET I CHIMNEY
MANUFACTURED HOMES
FOOTING I SLAB
BLOCKING & HOLD DOWNS
SKJRTING
PLANNING DEPT. SEPARATE PERMlT #'s SEPA:
PARKING/LIGHTING ESA:
LANDSCAPING SHORELINE:
FINAL INSPECTIONS REQUIRED PRIOR TO OCCUPANCYIUSE
RESIDENTIAL DATE YES NO COMMERCIAL DATE ACCEPTED
YES NO
ELECTRJCAL - LIGHT DEPT. 417-4735 ELECTRJCAL
LIGHT DEPT
CONSTRUCTION R.W. I PWI CONSTRUCTION - R.W.
ENGINEERJNG 417-4807 PW I ENGINEERJNG
FIRE 417-4653 FIRE DEPT.
PLANNING DEPT. 4]7-4750 PLANNING DEPT.
BUTLDING 417-4815 BUTLDING O~T''iIOI -:ILL.
T:IPoliciesl] 102 15 bUlldmg penTIlt mspectlon record05.wpd [1/4/2005]
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,,--
BUILDING PERMIT - APPLICATION
FOR OFFICIAL USE ONLY:
Date Rec.: 0 1-2-0 - 07
Pennit#: 01". gCoo
Date Approved: () 7 -2-0 - 7
Date Issued: II
Fill out COMPLETELY and in lNK. Your application and site plan MUST BE
COMPLETE to be accepted for review. If you have any questions, call
PERMITS (360) 417-4815 FAX(360)417-4711
7C CJ~ (.,6. k..
met1\-<Gj \ C&\.h.r
Phone:
---
tJc,o- Id8tf
'f{)- 7/b]
Phone:
-
City:
Zip:
Architect/Engineer:
Contractor
Phone:
State License #:
Exp: Phone:
Zip:
ZONING:
City:
Colu \II.'\.\" ,'0. s+~
Address:
PROJECT ADDRESS: / I () '3
-- --=- ..."
LEGAL DESCRIPTION: Lot:
CLALLAM COUNTY PARCEL NU.MBER:
Block:
Subdivision:
TYPE OF WORK:
o Residential. D New Constr. J(Re-roof D Stove
o Multi-family 0 Addition '/0 MoveD Garage
o Commercial 0 Remodel 0 Demolition 0 Deck
o Repair 0 Sign 0 Other
BRIEF DESCRIPTION OF THE PROJECT: "Tt'tLr ~
a.JJ Ne-v ?D,!r lYkt(tir l<,} KM:^'t+{
SIZEIV ALUATION:
SF. @$ /SF. = $
SF.@$ /SF.=$
SF. @ $ /SF. = $
TOTAL "O.N. . $
oU. t1lll
~I '<~ ""'r tS' ,
1\, ~
7000. <.lc:.:.
~lL' .fe./+.!
Construction Type:
= TOTAL Sq. Ft.
COMMERCIAL/RESIDENTIAL: Occupancy Group:
No. of Stories: Lot Size: Existing Sq. Ft.
Total lot coverage %
Occupant Load:
& Proposed Sq. Ft.
APPROVALS:
PLAN:
BLDG:
DPWU:
FIRE:
OTHER:
PLANNING USE ONLY:
ESAlWetland(s): 0 Yes 0 No SEPA Checklist required? 0 Yes D No 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 time of permit issuance.
EXPffiA TION OF PLAN REVIEW: If no permit is issued within 180 days of the date of application, the application will expire. The
Building Official can extend the time for action by the applicant up to 180 days upon written request by the applicant (see Section
R105.3.2 of the International Building/Residential Code, 2003). No application can be extended more than once.
I hereby certify that I have read and examined this application and know the same to be true and correct. I 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. .
UJJ~
,
Date:
--
7-20.07
T:\FORMS\BldgPennitfonn.wpd Applicant:
------
CITY OF PORT ANGELES
DEPARTMENT OF COMMUNITY DEVELOPMENT - BUILDING DIVISION
321 EAST 5TH STREET, PORT ANGELES, WA 98362
Application Number ..... 03-00001136 Date 12/01/03
PropertyAddress ...... 1103 COL~4BIA ST
A~SESSOR PARCEL NUMBER: 06-30-00-5-3-0246-0000-
Application description . . . ELECTRICAL ONLY
Subdivision Name ......
Property Zoning .......
Application valuation .... 0
Owner Contractor
PUBLIC HOSPITAL DISTRICT #2 OLYMPIC ELECTRIC
939 CAROLINE ST 4230 TUMWATER
PORT ANGELES WA 983623909 PORT ANGELES WA 98363
(360) 457-5303
Permit ...... ELECTRICAL ALTER RESIDENTIAL
Additional desc . . 400 A U/G FROM OVERHEAD
Sub Contractor . . OLYMPIC ELECTRIC
Permit Fee .... 94.80 Plan Check Fee . . ,00
Issue Date .... 12/01/03 Valuation .... 0
Expiration Date . . 5/30/04
Qty Unit Charge Per Extension
1.00 94.8000 ECH EL-R OR P34 201-600 ALT SRV FDR 94.80
Fee s%um~ary Charged Paid Credited Due
Permit Fee Total 94.80 94.80 .00 .00
Plan Check Total ,00 .00 .00 .00
Grand Total 94.80 94,80 .00 .00
Separate Permits are required for electrical work, SEPA, Shoreline, ESA, utilities, private and public improvements. This permit becomes
null and void if work or construction authorized is not commenced within 180 days, if construction or work is suspended or abandoned
for a period of 180 days after the work as commenced, or if required inspections have not been requested within 180 days from the last
inspection. I hereby certify that I have read and examined this application and know the same to be true and correct. All provisions of
laws and ordinances governing this type of work will be complied with whether specified herein or not. The granting of a permit does not
presume to give authority to violate or cancel the provisions of any state or local law regulating construction or the performance of
construction.
Signature of Contractor or Authorized Agent Date Signature of Owner (if owner is builder) Date
BUILDING PERMIT INSPECTION RECORD
CALL 417-4815 FOR BUILDING INSPECTIONS. CALL 417-4735 FOR ELECTRICAL INSPECTIONS.
PLEASE PROVIDE A MINIMUM 24 HOUR NOTICE. IT IS UNL.4WFUL TO COVER, INSULATE OR CONCEAL ANY WORK BEFORE
INSPECTED AND ACCEPTED. POST PERMIT IN A CONSPICUOUS LOCATION.
KEEP PERMIT CARD AND APPROVED PLANS AT JOB SITE.
INSPECTION TYPE DATE I ACCEPTED COMMENTS
I
YES I NO
FOUNDATION:
FOOTINGS
WALLS
FOUNDATION DKAINAGE/DO~fN SFODTS
ELECTRICAL (LIGHT DEPT) SEPARATE PERMIT:#
PLUMBING
UNDER FLOOR / SLAB
ROUGH-IN
WATER LINE (METER TO BLDG)
GAS LINE
BACK FLOW / WATER
AIR SEAL
WALLS
CEILING
FRAMING
JOISTS / GIRDERS
SHEAR WALL/HOLD DOWNS
WALLS / ROOF / CEILING
DRYWALL (INTERIOR BRACED PANEL ONLY)
T-BAR
INSULATION
SLAB
WALL / FLOOR / CEILING
MECHANICAL
HEAT PUMP
GAS LINE
WOOD STOVE / PELLET / CHIMNEY
HOOD / DUCTS
PW UTILITIES / SITE WORK (Engineering Division) SEPARATE PERMIT #'s:
WATEKLINE / METER
SEWER COlX,rNECTION
SANITARY
STOPdVI
PLANNING DEPT. SEPARATE PERMIT #'s SEPA:
PARRING/LIGHTING ESA:
LANDSCAPING SHORELINE:
FINAL INSPECTIONS REQUIRED PRIOR TO OCCUPANCY/USE
RESIDENTIAL DATE YES NO COMMERCIAL DATE ACCEPTED
YES NO
CONSTRUCTION R W. / PW/ CONSTRUCTION - R.W.
ENGINEERING 41%4807 PW / ENGINEERING
FIRE 417-4653 FIRE DEPT.
PLANNING DEPT. 417-4750 PLANNTN G DEPT.
BUILDING 417-4815 BUILDING
T:XPLANNING\FORMS\
CITY' OF PORT ANGELES
LlyHT DEPARTMENT
ELECTRICAL PERMIT
N? 16380
1.( - c. /,;;'
Port Angeles, Washlngtonnmm.mLm......m..m.m.m.__..m......m.m, 19,0000'.__
In accordance with the City Ordinance to regulate the installation, extension, or repair of elec-
trical equipment In, on, or about any building or other structure In the City of Port Angeles, per-
mission is hereby granted to do electrical work as listed below.
.;; .' .
Address .__jl..(2_3.m.m:'n~.~.t_~!_LL._:,__...I!:_!_';:~'.n._.nmnnm._.__00 Occupancyn.4.L.4.,____..n._n___..n.....mn
...l '')f:
Owner uunn_un.:!._t_!.~.!!._::~='.~:.~__u_nuunnn...u.n...___nu__.u Tenantd__u____Uuuuu__..n.n.n__nnnn_.uuu__...._nn.nnn__u
i .~ '.. .-. '/",
Wiring Contractor mm_.m____::_:..__m~.:.nn::n:n:.:nm_n:?:nn___.. By.._________.mm.____nnm..mn.mnnn.___.______m.n__..__
LI~ht Outlets..........~......-.__.__.... Service, volts ...../~:_h~/:.~.~:.~....
);1::6~' .
Re:eptacle Outr.~.----....h-..m...... No. wires -...h";;.-;;;:-.;;;;.nlj----:t/
Dryer, KW 0000.......__...............__......______ Size wlres_..._...~.___.'.....(:..__~___..f~_...__.
01'1/ ,~
'l'" -~ Mlf i"-.'"
...;;- /J Ralfge, K. W m.....:;:..._u__....____ a n use ......y;...::..t.................
Water Heater: ,. Enclosure .......::-.L.:...!..".::'J..............
pf,'
KW "
.--.....:.';i';jjjf;~'O';~:~ "';',a
Heat: KW.....~~..'~.~Llf1,~..._!.',..~~~!.. I
.-
MQtors: size, volts and phase:
,t.=r..-<__".",,'....h..mnmhnnh.nnm.n
/ A'r.", /~
r--__/'...mm.mn_mnn..m....n..
Type of Wiring:
Armored Cable .._._.....nh................
Non-MetalUc ............____.................
Knob & Tuben.......hh.................h.
RIgid Cc>ndult ............h..mnn..._....
Metallic Tubing ...........................
Type of wIring:
Entrance Cable ......00...............
Raceway ............__........................._
CIrcuits, LighL.......................n........_....
Rigid Conduit hmn____nn__...............
Utility ..................m.......nmhhmh...
MetaI11c TUbing ..................
J.Jeat .__..__.____..............................._...
CUrrent transformers:
Range ....._.________________..___..._..............
No. & Size..n........___._............
Water Heater ....h....................._h.
Ser. NO.n__..........._...._......hn__........._n_.
Motor ._._.........._.....h...................n_.
Ser. No. nn__h...nn__nn.nn_...._.............
Dryer..............___.___.....__.____.____.._..__..._
Furnace .........................'_................00.
Ser. No.
Total wad...................n___h...
Ser. No.
Total .....00.0000......_00_00.....00._......
Remarks: __._________.n_______....nnn_____________m..______m...._____...._______.___.___._______m_____mm_____.______.____m______..__...___m_____m
.__...__Uh_._____.__..___nnn.nn_nnnn_uuuU_______n_..nn______.n__n.__nuu....nu___huU._.__n_nunnn_nn.nnunnu.un..unu....nu......_00_
Permit Fee
Treas, Receipt
NO..___.m.___........___.....
By .._________..m..____________n_.__.m..___..m...___.___._________
$.._..............m_________._______.
NOTICEr-Current must not be turned on unttl Certificate of Inspection has been issued. It work Is to be con.
cealed due notice must be gIven the Inspector so that work may be inspected before concealment.
NOTIFY THE INSPECTOR BY PERMIT NUMBER WHEN READY FOR INSPECTION
ELECTRICAL PERMIT
N?
16380
Address
Date..._....._____.___._._........_.__..._......_...___...
Owner ......h.n.n_..nn_........_.___........____......_..._..__._...._..........................nnn_nn...n............ Tenant................nn..n..n.._.._...nn._..._..__.................
Wiring Contractor .........n....._........_........_............n_._n.n__.................._..n......n_._...____.........._....__... By........nnnn.....n...n__._..n......n___...........n..
NOTICE-Current must not be turned on unttl Certificate of Inspection has been Issued. If work Is to be con-
cealed due notice must be given the Inspector so that work may be inspected before concealment.
~"-., 1M
Olympic Printers, Inc.
11/24/2003 12:02 FAX 3604523498
OLYMPIC ELECTRIC
I4i 01
,
.-_ - . I
.
~
~
b' \1\1 ELECTRICAL PERMIT APPL/CA TION
The EIBC-rncal Perml~ -'l,PP\fc.atlJ)rl mU$t bo filled oul com Dl'NIY.
R:l0t affinAL. 1;510 ONL'"
D-.I.c<.R...._.....___
~., .._--- ----
!"lIo'''~~cd.'
0IIr.t .b...~ _.., ,__. ~__...._.
...: ",
,
j) luue ~ or reprint In i1\k. It you ha...,e nny QlHletlora. pl~~ all (~50) .c17-47J5
Fax nurn ber: (360) 417.."1"
/lTt.-# //.3CP
Qv..nerOl'e:loc.Conrr8ClQfAgCW1t~mpic Elect! ic Co., Inc.
Pnl:lll~r 457- 5 303
()NC-
"ox 452-3498
Property Oknar:
Phone:
417- 7/70
21.: q~3b '2--
Phone: il57-5303
Zlp: 98363
Address:
City:
fort Anqdes
lica>.. II' (L\'M'EC2B5[JlEx.: 3/31/03
POJ l Arlgdes
EIO<lrlcalC=,lIC1OC Olympic Electric Co., Inc.
Aadre..: 4230 Tlimwa ter
~
City:
INSTA1.LA-;-IO~ WI~E:O BY;
c..::i OWNER
i<J ELECTRICAC CONTR.I\C TOR
CrttditC.rdHolderName: Charles 1. Burkhardt, Olympic Electric Co., In2.
Bil/ln'i Addrus:
Same
Cffy:
Zip:
Credit Card Number.
~'
Exp. Da",:
VISA: X Me:
PROJECT ADDRESS:
//0]
(!O/'" "'bra.
TYPE OF WORK:
Check all that apply: 0 New
~ AJtera\lonIAdd~lon
~es/dentiaJ 0 Multl.family
rJ Ramole Meter lJ Detached garage
Commercial~ _ I MDbile Home
Sq. Ft.
o Hol Tub 0 Swim Pool 0 Septic Pump
. n Low V,",age 0 Telecom.
o Slg
Number of ClrcultB add8d or altared:
DESCRJPTION OF THE ELECTRICAL PROJECT:_flI'iAJ (.(/JderJrp7L'Ic! serviCe
~c''l:- )..)0 U>/h:? C4~?,p(t:.- )
(~......~
owae../.M.4t1
Electrical L~d Additions and or 511bt~
doei' u!4
S'lYic:e In/ormatiOl)
VOltage: ).'1 tJ h2<.J
Phas.: ~1 / C 3
Service Size: Z/tfO.I(,
Feeder SI..:
c: Basetloartt
,.-; Fumaee
':.J He-Pf Pump
::;Fan-WCtlI
KW
KW
_TON
KW
tAR
l~l Overhead Service
'-' Temp S..-;Ice
1l<::Undergmund Service
P/i.MC 14.05.060(8): For Ind.ustrial, cOOlm8rcial, & reiiidential prefects large!" th~n a dUPlex. B one ~ line drawins of the Electrical SBrVic8 &
Feeders. bvrldln9 size (SQ- ft.), klad calculations. and the ty De & of conductors and/or raceway is required and sh.all accom pany th
fijctr'rcal Permit applicaoon_
I hereoy eettify that I havs read snd examined this application and know thet same 10 be true and corract, and I I1r
authorized to apply for this permff. I understand it is not the City's legel responsibility to determine what permits
are requirfKi; it ramains the applicants responsibility /0 determine what permits are required and to obtain such.
/t.(,
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Owo.rorElec.Conl,Signalure: '__' ~ JI -' ') -~--
It( - f2f.-r- .J11..... 9bJO ( PERMITF~E; $ 9'180 . ...
HTr lit" 411.+/o f A/I ~(u..-(. J.f-, I; Ii- Fee~ It ~ ~ P"""'.J) __
c...u ~ u.... -ro IAJ I It.l..- b ~k... 'fo "''tMJ .
C' ~ 11/1-4173 '5lC peo - ok. ks is 7k)< d6l_
?W-9C19n!J3
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