Loading...
The URL can be used to link to this page
Your browser does not support the video tag.
Home
My WebLink
About
1111 Columbia St - Building
OF PORTA.v Application Number Application pin number Property Address ASSESSOR PARCEL NUMBER Application type description Subdivision Name Property Use Property Zoning Application valuation 08 00000229 111983 1111 COLUMBIA ST 06 30 00 5 3 0265 0000 PUBLIC WORKS UTILITES COMMERCIAL OFFICE 0 Application desc Drop wire from Front Jones to 1111 Columbia Owner BIRCH GREGORY 918 CAROLINE STREET PORT ANGELES (360) 457 3183 T•\Policies \1102.15R [1/05] Qty Unit Charge Permit Fee Total Plan Check Total Grand Total WA 98362 Permit RIGHT OF WAY Additional desc DROP WIRE FROM FRONT ST Permit pin number 121517 Permit Fee 70 00 Issue Date 2/26/08 Expiration•Date 8/24/08 Fee summary Charged Per BASE FEE 70 00 00 70 00 CITY OF PORT ANGELES PUBLIC WORKS UTILITIES DIVISION 321 EAST 5TH STREET PORT ANGELES, WA 98362 Contractor EXCEL UTILITIES CONSTRUCTION 54 MISTY LN PORT ANGELES (360) 452 1110 Plan Check Fee Valuation Paid Credited 70 00 00 00 00 70 00 00 Date 2/26/08 WA 98362 0 0 -0 'Extension 70 00 Due- 0 0 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 1 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 CALL 417 -4807 FOR UTILITY INSPECTIONS. PLEASE PROVIDE A MINIMUM 24 HOUR NOTICE. IT IS UNLAWFUL TO COVER, INSULATE OR CONCEAL ANY WORK BEFORE INSPECTED AND ACCEPTED. POST PERMIT IN A CONSPICUOUS LOCATION KEEP PERMIT CARD AND APPROVED PLANS AT JOB SITE INSPECTION TYPE DATE ACCEPTED COMMENTS PW UTILITIES (Engineering Division) WATERLINE METER SEWER CONNECTION SANITARY STORM SITE DRAINAGE SITE EROSION CONTROL PARKING SIDEWALK CURB GUTTER DRIVEWAY APPROACH BACK -FLOW DEVICE CONSTRUCTION R.W PW/ ENGINEERING 417 -4807 FIRE 417-465: I PLANNING DEPT 417 -4750 I BUILDING 417 -4815 T•\Policies \1102.15R 1/05) RESIDENTIAL PERMIT INSPECTION RECORD YES I NO FINAL INSPECTIONS REQUIRED PRIOR TO OCCUPANCY/USE DATE YES NO COMMERCIAL DATE ACCEPTED YES I NO I I I I I I I I CONSTRUCTION RW PW ENGINEERING I FIRE DEPT I PLANNING DEPT BUILDING Group: B Owner of Business/Residence CERTIFICATE°=sOFOQCUPANCY City of Port Angeles Building Division This Certification issued pursuant to the requirements of SectionG109 of the UniformBuilding. Code certifying that at the time of issuance this structure was i compliance with the various ordinances of the City regulating Building construction or use. For the following I Use Classification: Medical Office Building Permit No: 03 -688 Business Name: Gregory L. Birch DDS Use Zone: CO Type of Construction: VN Gregory L. Birch Address: 1111 Columbia Street. Port Angeles WA 98362 ti �x Building Address: i11 1 Columbia Street. Sen tember 16.2004 Date Post �n t[, rernisesFrnn conspicuous place Shall not be i4moyed'ex`de Official 1� Port Angeles. WA 98362 E7 4 0 U\ ~RT~ &'~ ~~~ Ra ~ -- 'li:",~ CITY OF PORT ANGELES DEPARTMENT OF COMMUNITY DEVELOPMENT - BUILDING DIVISION 321 EAST 5TH STREET, PORT ANGELES, WA 98362 Application Number Property Address ASSESSOR PARCEL NUMBER Application description Subdivision Name Property Zoning Application valuation 03-00000688 Date 1111 COLUMBIA ST 06-30-00-5-3-0265-0000- COMM NEW CONST 7/21/03 326500 ~~f Owner Contractor ------------------------ BIRCH, GREGORY HOCH CONSTRUCTION 918 CAROLINE STREET 4201TUMWATER TRUCK TRAIL PORT ANGELES WA 98362 PORT ANGELES WA 98.363 (360) 457-3183 (360) 452-5381 Structure Information NEW 3265 SF DENTAL OFFICE Construction Type TYPE V NON-RATED Occupancy Type BUSINESS OFF/PRO/MED/REST Other struct info NUMBER OF UNITS 1 00 ---------------------------------------------------------------------------- Permit Additional desc Permit Fee Issue Date Expiration Date BUILDING PERMIT - COMMERCIAL 2288 45 7/21/03 1/18/04 Plan Check Fee Valuation 1487 49 326500 Qty Unit Charge Per Extension 1017 25 1271 20 BASE FEE 227 00 5 6000 THOU BL-100,001-500K (5 60 PER K) ---------------------------------------------------------------------------- Permit MECHANICAL PERMIT Additional desc Permit Fee 90 70 Plan Check Fee 00 Issue Date 7/21/03 Valuation 0 Expiration Date 1/18/04 Qty Unit Charge Per Extension BASE FEE 47 00 1 00 14 7000 ECH ME- INSTALL 100- FAU 14 70 4 00 7 2500 ECH ME-VENT FAN 29 00 ---------------------------------------------------------------------------- Permit Additional desc Permit Fee Issue Date Expiration Date PLUMBING PERMIT NEED PERMIT FOR 126 00 7/21/03 1/18/04 00 o BACKFLOW DEV Plan Check Fee Valuation Qty Unit Charge Per BASE FEE 16 00 7 0000 ECH PL- EA. FIXTURE ON ONE TRAP 1 00 7 0000 ECH PL- EA INSTALL WATER PIPE 1,.00 7 0000 ECH PL- EA WATER HEATER Extension 00 112 00 7 00 7 00 ---------------------------------------------------------------------------- Other Fees STATE SURCHARGE 4 50 Fee swnmary Charged Paid Credited Due ----------------- ---------- ---------- ---------- ---------- Permit Fee Total 2505 15 2505 15 00 00 plan Check Total 1487 49 1487 49 00 00 Other Fee Total 4 50 4 50 00 00 - - - '"- ~ ~ ~\ry~ - /~ C. ~ ~ <! P 6 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 specifiterein or not. The granting of a permit does not presume to give authority to violate or cancel the provisions of any state or 10 I reg ting construction or the performance of construction / ' " ~ Signature of Contractor or Authorized Agent Date T'\PLANNlNG\FORMS\II02.IS [4/2002] 7- 1-03 Date Owner Contractor 'S CITY OF PORT ANGELES . . . DEPARTMENT OF coMMUNITY DEVELOPMENT - Bun..DING DIVISION 321 EAST 5TH STREET, PORT ANGELES, WA 98362 Application Number Property Address ASSESSOR PARCEL NUMBER: Application description SubQivisionName Property Zoning . . . Application valti'ation '. 03~00000621 Date 6/27/03 1111 COLUMBIA ST 06-30-00-5-3-0265-0000- DEMOLITION 10000 BIRCH". GREGORY BOCH CONSTRUCTION 918 CAROI,INB STREET 4201TUMWATBR TRUCK TRAIL PORT ANGELES WA 98362 PORT ANGELES WA 98363 '(360) 457-3183 (360)452-5381 -'--n-Structure Information DEMO 1 FLOOR AND CAR PORT Construction Type . . . . . TYPE V NON-RATED Occupancy Type .. . . . . SINGLE FAM & CONGREGATES -------------~--------------------------~-~---~-----------~--------~---~------ Permit . . . . Additional desc Permit Fee Issue "Date Expiration D"te DEMOLITION 47.00 6/27/03 12/24/03 Plan Check Fee Valuation .00 o - Qty Unit ~rge Per BASE FEE Extension 47.00 .-' -. - :~~~~~::_----- Charged Paid Credited Due ---------- ---------- ---------- ---------- Perinit, Fee Total 47.00 47.00 .00 .00 Plan Check Total .00 .00 .00 .00 Grand ,Total 47.00 47.00 :00 .00 .~.. --.: C ~ & - p' ~.""'..'...'.'.."'. .' .. T:\PLANNlNG\FORMS\1102.15 [412002] Separat~Permlts are required for electrical work, SEP A, Shoreline, ESA, citilltles, private and public improvemEmts.Thi~'pefinlt i)~comes nullandvoldifwork or copstructlon authori~ed is not commenced within 180 days, if construction or work l!j suspen~~dp"~bandoned for aP13riod ot180 days after the work as commenced, or if required Inspections have not been requested within t80'days fromthel.ast InspeCtlon,'j hereby certify that I have read and examined thisapplicatlcmand know the same to be. true and correct~AI!"p,r~Xi,!>i9n!> 9f laws and ordinancesgoveming this type of work will be complied with whether specified herein or not. The granting of a permitdoes not presume to give authority to 'violate or cancel the provisions of any state or local law regulating construction orthe performance of construction.' " . . .~~ .'Z'1/Jw~~ Signature of Contractor or Authorized Agent. . date Signature of Owner (if owner is builder) ~1"';-~ :QUlLDING PERMIT-INSPECTION RECORD /y ;,~;.~:-\; . . . CALL 417 -4815 FOR BUILDING INSPECTIONS. PLEASE PROVIDE A MINIMUM 24 HOUR NOTICE.. IT IS UNLA WFULTO COJ/~l!:, INSULATE OR CONCEAL ANY WORKBEFqJ.lF,!NSPECTED AND ACCEPTED. POST PERMIT IN A CONSPICUOUS LOCATION. KEEP PERMIT CARD AND APPROVED PLANS A T JOB SITE' ,i INSPECTION TYPE DATE ACCEPTED COMMENTS . YES I NO FOUNDATION: FOOTINGS .. WALLS . " . .. FOUNDATIO\,! DRAINAGE ELECTRiCAL (LIGHT DEPT) SEPARATE PERMIT: # ROUGH-IN I I PLUMBING .,..,. UNDER FLOOR / SLAB : ROUGHclN WATER LINE GAS LINE. . BACK FLOW / WATER . . . , AIR SEAL , ,,;.... WALLS I CEILING I I . . FRAMING I JOISTS / GIRDERS SHEAR WALl,. WALLS / ROOF / CEILING ' ,. . DRYWALL '. T-BAR . INSULATION . SLAB WALL / FLOOR / CEILING .' I MECHANICAL '. . HEAT PUMP WOOD STOVE I PELLET / CHIMNEY HOOD I DUCTS " PW UTILITIES I SITE WORK . (Engineering Division) SEFARATE PERMIT #'s: WATERLINE / METER . SEWER CONNECTION . .' SANITARY . '. . . STORM . PLANNING DEPT. SEPARATEPERMIT#'s . SEPA: P ARKING/LlGHTING ESA: LANDSCAPING..... ..._....>;,.~. .. .' SHORELINE: ::FINAL INSPECTIONS rtEQUlRED PRIOR TO OCCUP~CYatSE '.. .. '. - -""" .' -'. 0: DATE" rL NO , ACCEPTij:D . .RESIDENTIA'" YES COMMERCIAL DATE , .' '. ..... .. " it L' ,YES 'NO '. ,. ..' ...... '. . . " . . ELECTRICAL c LIGHT DEPT. 417-4735 ELECTRICAL . ' '. .' LIGHT DEPT . . , . CONSTRUCTION R. W./ PW/ CONSTRUCTION - R.W. ENGINEERING 417-4807 . PW / ENGINEERING FIRE 417-4653 ' FIRE DEPT, ..... "". ..... PLANNING DEPT. 417-4750 .'. PLANNING PJ:;PT. . . , .' I BUILDING 417-4815- l,...22-0'l k'1/ BUILDING , T:\PLANNING\FORMS\1102.15 [412002] r-- .. BUILDING PERMIT - APPLICATION FOR OFFICIAL USE ONLY: Date Rec.: t. - 2 7 ~63 Permit #: Date Approved: Date Issued: Fill out COMPLETELY and in INK. Your application and site plan MUST BE COMPLETE to be accepted for review. Uyou have any questions, call (360) 417-4815 Applicant or Agent: .:::::; I-lbfiZl, trS ~ J..{ I rn Phone: ~ '2.... bl) b Owner: Grf2&~'1 f!=.l ~ ~ Phone: 4-57 - ~/"O '3 Address: q I~ CA/'ZO/,.lNg" <q;f'. City: ~\I .fwc,a-Las Zip: ~ f;%2- ArchitectlEngineer: iJlNO~ '? S1Y111')-l A/ZC-~Irgt;r? Phone: 4-6'Z" 1;,1 It, HDC,~C 1 ~ ~ Contractor~J.J Co~G77oN StateLicense#:~ IbbW-r Exp: Phone: ~w-,,=,3t>1 Address: 4'Zo1 7UfV)f)J~ 11:f!2-- f/ZU~)t. IZ'Eity: P~P.T AN4elJSS Zip: e;M~~ PROJECT ADDRESS: Ill) CC;Wmf'$/ A C;;Jr. ZONING: ~ 0 LEGAL DESCRIPTION: Lot: /2 ~ /?:J Block: 1- Subdivision: P$?C" CLALLAM COUNTY PARCEL NUMBER: Ofp 30005~$ Credit Card Holder Name: Billing Address: Credit CardType VISA MC # TYPE OF WORK: SIZEN ALUATION: o Residential 0 New Constr. 0 Re-roof 0 Stove SF. @ $ /SF. = $ o Multi-family ~Addition 0 Move 0 Garage SF. @$ /SF. = $ ~Commercial '"h...Remodel 'B-Demolition 0 Deck SF. @$ /SF. = $ o Repair 0 Sign ... 0 Other TOTAL V ALVA nON $ I tJ . ~o ~ BRIEF DESCRIPTION OF THE PROJECT: t::eMO #1'1 Ja-::fr 'fet ~ c::Jjr ~~ Nat .~~I'l:>f$Y\JGg::- D-\I1. d (It):f'fc r-i- COMMERCIALIRESIDENTIAL: Occupancy Group: -B Occupant Load: ZO Construction Type: V...N No. of Stories: ~ Lot Size: J 4;(1011- Existing Sq. Ft. 2b 0 ,_ & Proposed Sq. Ft. '2 t +0 = TOTAL Sq.Ft,4'74Cf Existing lot coverage~ % & Proposed lot coverage ~ = Total lot coverage 2.(, % APPROVALS: PLAN : BLDG: DPWU: FIRE: OTHER:_ City: Exp. Date: PLANNING USE ONLY: ESA/Wetland(s): 0 Yes 0 No SEPA Checklist required? 0 Yes 0 No Other: ' BlliLDING PERMIT APPLICATION SUBMITTAL: The Building Division can provide you with information on the application and plan submittal requirements if you have questions. 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. i EXPIRATION OF PLAN REVIEW: Ifno permit is issued within 180 days of the date o(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 107.4 of the Uniform Building Code, current edition). No application can be extended more than onc'e. I , ; I hereby certify that I have read and examined this application and know the same to be true and cqrrect. 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 /'must obtain such permits prior to work. I nFORMSIAPPSIB,Hd;,gpmn;twpd APPli"nt'~ -,. Dat,,!!!o' fl?A1' O~ ~ORT ANGELES. . . W AS H I N G TON, U. S. A. PUBLIC WORKS & UTILITIES DEPARTMENT June 27, 2003 Hoch Construction, Inc. 4201 Tumwater Truck Rt Port Angeles, W A 98363 RE: p,ort Angeles Landfill Waste Disposal Application,WDA 03-13 . . Building demolitiQn(1111 Columbia Street) Dear Dan: We have received your application for disposal ofbuilding demolition debris from the referenced site and reviewed the testing results forasbestos content. Based on the testing results the debris . appears to be acceptable for use in the landfill. A copy of your approved application is attached. This approved application must be shown to the landfill scale attendant at the time of disposal. Please be advised that this disposal application is only for the material~ and quantities listed in the application. Materials not listed or in excess of the quantities noted may require separate applications and approval. Please call if you have questions. J=~.. . GaryW.Kenworthy,P.E. .. r CIty Engineer , . Deputy Director of Engineering Services GWK:tf Ene\.: WDA 03-13 Copy: Gregory Birch Lindberg Smith Architects Ken Loghry N:\PWKS\ENGINEER\WDAPPUa03-13. WPD FILE: Landfill Solid Waste Disposal Applications 321 EAST FII7TH STREET · P.O. BOX 1 150 · PORT ANGELES, WA 98362-0217 PHONE: 360-417-4805 · FAX: 360-417-4542 · TTY: 360-417-4645 E-MAIL: PUBWORKS@CI.PORT-ANGELES.WA.US ., \J. ,~ . '\. .' WPA- 03-13 PORT ANGELESLANDElLL ., ."1:~ WASTE DISPOSAL APPLICATION Phone: (360) 417-4803 ,/5'13 - h ~'l . FAX: (360) 417-4709 To: City of Port Angeles, City Engineer 321 E Fifth Street P.O. Box 1150 Port Angeles, Washington 98362 NOTE: All questions must be answered for waste to be approved. 1. Generator Information: Company Name: Mailing Address: Contact: Phone: Project Name: Project Location: ~J2e4iioJ 0 ~ ~ t ~14 tJfl~ vA~IMS' ~. POf%.-t P.Nl.(1!ff{".frS I VVA ~g~'2- ~12S"'~'J2., ~11ZU)..\ 4 P.S1 - ~I f,=3 NtSW II 11 GO~UWl~J~ ~., .P~ ~6,tf1.,tr5 , 2. Other Contacts (if applicable): Consulting Firm: Contact: Phone: Contractor Name: Contact: Phone: Laboratory: Contact: Phone: N~ ~5""'Sf' ~ CS?!?S'csn- O? CoN ~ Vi (, 'T AtVrS ~~ Wlj'~~' b~S" t!~1 ~~- oS/?4 ~14 c.oNSTJ2..lAu'T10N { I NG. J;2.t ~H ~VJ.,:J -s~ / 4J:;z,- ~%I . c..L.~'1I'()Y\J atJ20Vlp s~v 168'G 2otP( 7&;?- ~leq CYA)) Page - 1 City of Port Angeles - Landfill Waste Disposal Application ~ .t 6. Estimated Quantity of Waste for Disposal: /80 Cubic yards I Drums I 36 Tons (estimate both) Tons (estimate both) Other NOTE: Estimated quantity for disposal must be within 20% of the quantity actually disposed. (10% for projects over 7,500 tons or 5,000 cubic yards.) 7. Frequency of Disposal: ~ x One time Monthly Annual Other 8. Waste Sampling: Proper characterization of the waste for disposal requires the collection of representative samples. The methods and equipment necessary for obtaining representative samples of a ~ waste, and the frequency of sampling, will vary with the type and form of the waste. Check the appropriate box and briefly describe how and where the waste was sampled. Include site maps with sampling locations if possible. Number of COMPOSITE samples & number of'discrete samples per composite _ Number of DISCRETE samples " '." ..< " " . . "')1 NOTE 1: Unless prior approval has been granted by Port Angeles, the following sampling frequency will be used: = 1 composite sample \ 3 composite samples 5 composite samples 7 composite samples 10 composite samples 10 plus one sample for each additional 500 cubic yards 0-25 25 - 100 101-500 501 - 1000 1001 - 2000 >2000 cubic yards cubic yards cubic yards cubic yards cubic yards cubic yards = = = = = NOTE 2: One composite sample shall contain a minimum of three/maximum of five discrete samples. Page - 3 City of Port Angeles - Landfill Waste Disposal Application ,,' . ,..... 12. Certification: We, THE UNDERSIGNED, certify that this application is true to the best of our knowledge. All infonnation provided is correct and the enclosed analytical results represent the proposed waste material to the best of our abilities. ~~ c. \'"' "1Z-\.~" .:?M 1 ~ \, \ -.JQ"80Wc.. ~ ?M) ~ Waste Generato Signature c:: t-' lat#-\..rs SMl t11 Printed Name L, 'Nf) ~~ ~ St'Vll na j:1 tzt~ 1 7"l:J1:i"" S Company ~? I ) VlYf' / /)3 Date N:\POLICY _P\1000_SW\ 1009_01.WPD city of Port Angeles - Landfill Waste Disposal Application Page - 5 ... . ,'. Date: lob Location: Owner: Contact: Contractor: Inspector: lA)1):A- D~~13 Northwest Asbestos Consultants 406 Reed St. Port Townsend, W A 98368 360-385-0584 huggybear@olympus.net 6/12/03 1111 Columbia St. Port Angeles, WA 98362 Gregory Birch 918 Caroline St. Port Angeles, WA 98362 Charles Smith of Unnberg and Smith Architects. 318 S. Peabody St. Suite B Port Angeles, WA 98362 Hoch Construction 4201 Tumwater Truck Rt. Port Angeles, WA 98363 Bob Witheridge AHERA - Building inspector / Management Planner WAMOA - 0042-02 Expires - 11/1/03 /, Scope of work 1) Inspect for asbestos containing building materials (ACBM). 2) Survey, sample and record suspect materials. 3) Report to Charles Smith of Linnberg and Smith Architects with results of testing by Clayton Services. 4) Copies for owner, Hoch Construction and Olympic Region Clean Air Agency. Inspection Report The inspection started with a visual survey looking for Asbestos Containing Building Material (ACBM). The suspect materials were: Sample #1: Sample #2: Sample #3: Sample #4: Sample #5: Kitchen floor vinyl top layer. Yellow mosaic pattern. Kitchen floor vinyl bottom layer. White with black. Bathroom floor vinyl. Various colors with brown mastic. Sheet rock /plaster. Vermiculite attic insulation. All samples were sent to lab. See results. . " ASBESTOS BULK SAMPLE DATA Northwest Asbestos Consultants 406 Reed St. Port Townsend, WA 98368 360-385-0584 huggybear@olympus.net To Clayton Services Date: lob Location: Contact: Contractor: Sample #1: Sample #2: Sample #3: Sample #4: Sample #S: Inspector: 6/9/03 1111 Columbia St. Port Angeles, WA 98362 Charles Smith of Linnberg and Smith Architects. 318 S. Peabody St. Suite B Port Angeles, WA 98362 \ Hoch Construction 4201 Tumwater Truck Rt. Port Angeles, WA 98363 Kitchen floor vinyl top layer. Yellow mosaic pattern. Kitchen floor vinyl bottom layer. White with black. Bathroom floor vinyl. Various colors with brown mastic. Sheet rock / plaster. Attic insulation. Vermiculite Bob Witheridge AHERA - Building inspector / Management Planner WAMOA - 0042-02 Expires - 11/01/03 Please call with test results when completed. Thank you, Bd~ Bob Witheridge. EFM ~l.YUJU. "'. v...., "'Ctl .. &...~ &,J",.....&.. .... ---. -_..,..~.. \... ........,..__..... .. - ,. I. .._....:.__.._ I . W.' w-' --I eUeat: Nor:~~1';T-t:'t .!l",1~1titf.f C01iIir:!!tn:;tI Log ## 34211 LoeatioD; 111 i Coiumoia Sneet, ion AIl,eies, W A Job I PO # (--~;;;;~;"!1 'M~~ --.~;PLI.LO~TIONIKJtcheD.;o;Iay.;' . '''-'. ! SOURCE. VIDyl ~_m. '._J r AJIt'''-;'-C~~iI'''htlriilf-_._-_n. LAV:~:-- _. -iAfcn ~;.b.d.~-~. I -.- .... .... I. -. I noo':'Ubtstoi"'--- i%odler i --"ildftbrolI. r" . .,-. i ;- ~;:;~~:..e." +:~!!!~:!' ',; i &iiiii.;c n ~-'. , u ui !l!~1-'--lriiJ;;iili1:'.R:r,tJl\'____.n'_,_- ~~~~~ I I I ,. . . ... . i :! ! Vinyl Filler and Binder I j\i I ' I I I I i I ! I I : [..-... -.----..- _..L_ -.-.... I D~Ptloa: Yellow Mosaic pattern Vlftyi ~lth wblte fibrous backing .";;~11a a;.~",:!c I I' - h~~;; . 'ii..bk' ;;-we~IU"~~ ",:;.ti~ :JVm ..belt.:..-co..~lli;~;;;J ~~cKhai ~.;;j;d~ti.~~; euJy-,.. i.__ _ .....................,...... .....:.. ..= ( SAMPLE';i . - - . ... ....... - . t4~jtU. SAMPLE LOCAnONl.KJtdlea, botwm layer I 5OlJRCI:"S O'~ ~ ~~erl .' , T ... 'V'Il'DlI'n C I ~ '"L" 'IlI/'. ,....".,. ..... - _.It .. V_"".&c ----.tit' - T-.;o nn'i"~="l&v"- 1.... .....~.._ .... ~ nnriM llanarar,Mv "-~............. .....1. '.loA ~.,. .\ .w.,""''''''? r-::l.'. ..1.'.'............ J .I~. .1~=..::;sIUl"... _"..,.. us ...._"..~ ...u r",:-:~~:- -:t_ ___,,' i I LAYERI i I r A~~eltoll ... - '" T~b~~.;;~-r---8~'l~~~;~r.~'1---..ii~.r ,_._.___._...__u.. ....!. . I It... ..." ...... ..... j I ' C:llulr.~~~ S I i , I ! i ... ~', ; I \ r No: Arohtr.t,].:1 nrt,,~:~d J i - -~. ,,~I '\ i I J I ! Q(,Anbr:oiii"""' - --. . '1"....- -- .. . . ~ : -......-.. i 1l01lf.btoq. "'" I i.,II,;:~~:;;::;......,. - "';;; ] I , I I I I '''.. --~ ! i ~M"''''''~ i I I i ---...-.. --..",.. .-1 '''1 I -.j .~~~o..w % I \0 I I I I I . ~_. I I I I I r I _ L__ . .. ,.-... ..r........- ~ ~ .."" ,.-. , i , Note: I . ..:"t'rrr~p,...~?'..n~.....r.M..,... "':!'....w'r.,.T".r.':";':"~,..'l'~...'f'......':fff...r.. .,.. . t',,,,,,\,','.'r:._ ~:..._.: .. ._..... ( C!"'LnW~. '..i~:: S".r .....I.A.".' i.'.. . ~"a&'''II/''. 3~11.4lD ,...... ....., ..l.. ~ .. ...J.' "t.o..... . I I ~viJiiCi I ....i~y; "'- n.'j. \.. ,,~i' i I I~-'" j I /- .. - - - -i------ aOIl~$ 1% other DODf!broIQ 1-~~!!2~ l ~.,~~~~.~.~! .~t coliu1 c;c _nJlI;f]. . -. -'" - j .!l~~ .0.' (piiiir &~~~~n .' ... I I Syntberlc 2 i Asphalt Filler &. Binder I I j IVinyl Filler and Binder ! ! I I I I I I DesuJpdoa: White vInyl wUb black fibrous aspbal11e blckiD.'.d brown nwtJc ...... I ., .. "".a ....___ :t:'\YER" 43 30 J I ! I i ~ote: I I I PRELIMINARY REPORt L"bo,1IUJ1'J1 lJ". Slte<< ill'" IIIb am GlldfrIXiIIg Dilly. Th,jI1ftll rtlpOft will/oUow ill the",fdL V,rifled by: '-1- ,-I, z. ( o"!7 , ANAL VZED BY: Jude Cumarinp ON 611~003 ...................... ~~ ~ .............. .~ .. ,. 1- .... ~.... _ _ __ . _ _ __ '\.. .~~.""""_"V"'. ~....: .1'...'...,......." ....j- .. ,'~ CUellt: Nol1hwe.t Asbesto. Con.ult.no Loc.tl~~; H!!C~l!!!!!~~~ St~~~t; !'~rt A~e;i~, ""fA LoI #II 34211 Job / POI .-.... -"'-. (1.--;:~~:~.i~;:3'.. .. ......._.F.trr.:..~~ SAMF~...E LOCATION:B.tlar~m 1 i : SOURCE: Mattie I I LAYEREr "A.MPLE: NESHAP and ABElA re,ulation; l'iqwi'i:li)''tri oe anaiyzed and uported separately. I [\. ~ J -"':!lIt9.,j).t;;;:;:ed- -T Uml.l..------ ... :~- H___ -I .... ..... . ....- - --" ~~ .-.-.----,--t-.'.-iol-asbtsto. !% otiler I nooflbroua ' Ar.bes I ! A iIH.r~.,~" I rJben I ft~, ~~:::~entl i R,.ftb!'VJ!!! % f -'.- ------.-~.- ,. .,.. --, ----....... '''oi . '1"1;-:";::-'11""" -~.. '~,""'''''~7' ...----j , ! J'J"l.':'~'. ! .I . t ,,,,' ,\;:Itll\Il~ I I ! i: I Iii i L-__ ._____.____~'_._-.._.._._--.- __._____. .... I. I, I :DescripdODI Drog nwtle I Notel rS~MPu#i l SOu:ao: I VlDY~_. I NO.AB"'ii'~li D~teiO:~ I LAYER1 l. - .- '-. .-- l..- -. ii.a:...b;"I-~ _.ftb..... ._-,...... .0..- I Aabeatol1 i Albesto~ % I +;j. '1 Inh"; :-r;-..uii",,7.tJ. I ~;i1ni;rlia % I I ; IO=lIulO....: .Ji.}J;."'i ....--.... i ""'20 "'~m~i&1~cr..r':"-_'----r"'" 'i'-'~ I I! !: A.r.j'!ll::!t F:l.1m- I~ '9~"t'T( 42 I I I II"':' vI '!!:"....._.l """- '._ -r; f '''.1 . .. .. S 1\., ,.1 , . ..(~ I i I I ~ I I f .__.1.._ . ;-j.~.;.;",..,uV:;;~I;:~;i~;;;,~;;;"" b~.";-_fl'''''' ..'kI'l Jd~r...~ _lie 1 I, . ,......'.--.-.....__..___.. _......h",_.. .. .. ._............... ._j I Nohr.. i I__.,...~-_...: ,",,;, .".... -', -.-. ..............".__... _.....,..__--~- __.__.. ___._....._ --.--..-----;or-'7""'j j( SAMPLE.,,';'-' -.. . .,.... -. . h~i-..s.wPLE~(n::ATtON:KIt,.hi,~1 $OUllQ: r ,~.~:~~ I ~1~--NOAJbestolDeiOCied. .-r----- .... - ..- --. "'i..;.;;;~;or~'.- ....-1 ; .! : l.;J'EI' I t .-.--.. '''--j-~'t..-...~~.-t. '. ~:m..~:~~:;':"-":"_"':I~\o"nil'!; i' !l';lIft;:'~f~II1-"--I'-" ... . "'''-1 -., ~b..t?o' I ..r- -".em;.;, . : . ftb... -~_.-: -. .. !,~!lIJ!'!II!J!" ~.fIb"" % I I I . IA.~JTCiate I 4~ ! IFiIler &: Binder j'~ i I I j I ~. . --.- 1 -r- LplID., _ yellow .Dd ~w.:.;;;; ~;..;.:;.d;;;"" I .. ~ ...--..-......- . ,. ...."'.. '-...~ I ..J I i- I LAB': .~.m' jll! . . ,'J. ". .~...a:a.;.....of..I"'.. . ~~'~.,~ I , i I J SAMPLE LOCA nONIBltIlroom Note: " l~..... '., PRELIMINARY REPORT Ldo~ry DIIIII Sit. Is /orW us. a"'/I""'I 0IJ.(p. TIt, fIlIal "POrl HJltllo~w in tIur ",lIlt VerJnedbYI .. ~ c.lll.l c~ ANALYzaDBY: J...d; Cwnmings ON 6/ 12I~OO3 JUN-12-2003 17:02 CLHyTUN G~uu~ 5c~v~CE~ ~......& ....... ___J W__ "l!o"f!& --.. ...-- . ...,..-., Client: Nor'3lwest Asbestos Consultants Location: 1111 Columbia Street, Port Angeles, W A I~AMPLE #:5 3~1t1.~ SAMPLE LO~ATlON:A~C: i SOURCE: Insulation Low Asbestos Content HOMOGENE01JS non-asbest04 % other 1..1]1_,,, Cellulose I 2 I I I I ~___L.. . _. __ I I nMr.rfntl(".~: .:~" ;~I..1\PY loose materi.,1 I . .1. "__U'___' Asbestos ...-.-.----...... Tremolite Asbestos % Trace i~ l~ I Note: 2067634189 P.03/03 \.... .. .............v... .....VN' .. .w...~.. ...~.... J Log,# 34211 Job fPO# .', -'I ___J nonfibrous . ... ~~P.C}~.y.gts... Non-Fibrous Trcmolit.e l1onnbrollS % ~... .-f"-..... --. 95 I I I I ____1_.__.._.__ _.~ I ... ... . ....-. .' ..- .- ._-_._--~ I v cnniculite PRl:Ll!'.~~~Uty REPORT LRIN'r~..:~' .Dat;t Sh!r.t is for lab USe and faxing ""ly. The final report will follow In the maiL Verified by: _~ IJ J ,j,~ ANALYZED BY: Jude Cummings ON 6/1212003 -rn-rt"ll 0 r'>? IUIML- I .y...J . ~ \ . ,. SummaI)' of Inspection: This survey includes all areas of inspection with the report results from Clayton Environmental Testing Labs. Sample #1: Kitchen floor vinyl top layer. Yellow mosaic pattern. 18% chrysotile asbestos. Sample #2: Kitchen floor vinyl bottom layer. White with black. No asbestos detected. Sample #3: Bathroom floor vinyl. Various colors with brown mastic. No asbestos detected. Sample #4: Sheet rock / plaster. No asbestos detected. Sample #5: Vermiculite attic insulation. Trace The total square footage of asbestos containing building material needing abatement prior to demolition is approximately 86 sq. ft. All flooring with a reading of 1 % or greater is to be removed by a certified abatement contractor which follows the rules of the EPA and governed by Olympic Region Clean Air Agency. This report is not a guarantee that all suspect of A.C.B.M. were found. The possibility of concealed material exist and may be found during demolition. After the facility is completely cleaned out a walk through and inspection is required by the original AHERA building inspector (NW Asbestos) after abatement, then a copy of the letter certifying that abatement has been completed needs to be received by the City of Port Angeles and Olympic Region Clean Air Agency. Thank you, f3c;b W~ Bob Witheridge, E.F.M. CITY OF PORT ANGELES DEPARTMENT OF PUBLIC WORKS . . . . . . . . . . . INSPECTION REPORT . . . . . . . . . . . REQUEST: Date ~-/e-OS ~/ Time Received by Rv (phone, person) Location of Work to be inspected Name of person requesting inspection Address of person requesting inspection Type of Inspection (circle appropriate one): Sewe Foundation Chimney Plumbing t..V a..lt s J t , t ~-I~lk-bJ~ J~ h.\A. F.rCt.z eV'-- Phone No. L./6/ - 322<:1 Permit No. b a 8 Final Sewer Excav. Other Ill~ Time tz ,--------- JL Inspected: Date Remarks: By RESTORATION REQUIRED . . . . .. YES NO 0~/,IOf rd SURFACE RESTORATION: SURFACE TYPE: 0 Unimproved 0 Gravel 0 Asphalt 0 PCC o Other o Repaired by City o Repaired by Permittee o No Damage Found Work Order # o COMPLETE o INCOMPLETE (Continue on reverse side if necessary) STREET SUPERINTENDENT (DATE) PREPARED 5/17/04, 13:21:54 CITY OF PORT ANGELES ADDRESS CONTRACTOR OWNER PARCEL . . APPL NUMBER: INSPECTION TICKET INSPECTOR ROGER VESS PAGE DATE 3 5/17/04 1111 COLUMBIA ST HOCH CONSTRUCTION BIRCH, GREGORY 06-30-00-5-3-0265-0000- 03-00000688 COMM NEW CONST SUBDIV: PHONE (360) 452-5381 PHONE : (360) 457-3183 PERMIT: BPC 00 BUILDING PERMIT - COMMERCIAL REQUESTED INSP DESCRIPTION TYP/SQ COMPLETED RESULT RESULTS/COMMENTS BI2 01 8/01/03 JLL 8/01/03 AP BL1 01 8/19/03 JLL 8/19/03 AP BL1 02 9/03/03 JLL 9/03/03 AP BI2 02 9/05/03 JLL 9/05/03 AP BL9 01 10/29/03 JLL 10/30/03 AP BL3 01 1/14/04 JLL 1/14/04 AP BLWS 01 1/16/04 JLL 1/16/04 AP BL99 01 4/20/04 JLL 4/21/04 DA BL99 02 4/28/04 JLL 4/28/04 DA BUILDING FOUNDATION WALL BUILDING FOUNDATION FOOTING TIME: 17:00 BUILDING FOUNDATION FOOTING foundation footing john frazer BUILDING FOUNDATION WALL foundation stem wall inspection Greg birch BUILDING SHEARWALL TIME: 17:00 sheeting insp wed Jim this inspection was for exterior sheathing and nail patterns so that the builder can cover to protect from the elements.iterior shear hold downs will be inspected on frame inspection/jim BUILDING FRAMING BUILDING INSULATION WALL/FLOOR TRACY 460-9544 BUILDING FINAL hoch construction finish items on list basement floor to be continued on this permit/jll BUILDING FINAL hoch const. contractor portion is complete and dr burch will complete the basement portion. still need items listed on pervious inspection/jll BL99 03 _5~1.04 ~\ / BUILDINGFINAL ~ ~ GREGORY 457-3183 -------------------------------------- COMMENTS AND NOTES ---------------~-(-------)---------- AJ.eed~ c/€c1r/co...L J-/lv\'4 ,4 It ('.0 rr-ec:.+:e,,,,,s fD. bv...~\d : '^S 6> ~ ('p -H\ ~le.+e& ~ ok +0 -r~<-lACl\ G.\.~V- Bfec.:-f..v2<:.cJ ~~s ~~ PREPARED 4/28/04. 12:49:36 CITY OF PORT ANGELES ADDRESS CONTRACTOR OWNER PARCEL . . APPL NUMBER: INSPECTION TICKET INSPECTOR JAMES L LIERLY PAGE DATE 1 4/28/04 1111 COLUMBIA ST HOCH CONSTRUCTION BIRCH, GREGORY 06-30-00-5-3-0265-0000- 03-0000~ COMM NEW CONST SUEDIV: PHONE (360) 452-5381 PHONE : (360) 457-3183 PERMIT: BPC 00 BUILDING PERMIT - COMMERCIAL REQUESTED INSP DESCRIPTION TYP/SQ COMPLETED RESULT RESULTS/COMMENTS BI2 01 8/01/03 JLL 8/01/03 AP BL1 01 8/19/03 JLL 8/19/03 AP BL1 02 9/03/03 JLL 9/03/03 AP BI2 02 9/05/03 JLL 9/05/03 AP BL9 01 10/29/03 JLL 10/30/03 AP BL3 01 1/14/04 JLL 1/14/04 AP BLWS 01 1/16/04 JLL 1/16/04 AP BL99 01 4/20/04 JLL 4/21/04 DA BL99 02 ~ JLL DP. BUILDING FOUNDATION WALL BUILDING FOUNDATION FOOTING TIME: 17:00 BUILDING FOUNDATION FOOTING foundation footing john frazer BUILDING FOUNDATION WALL foundation stem wall inspection Greg birch BUILDING SHEARWALL TIME: 17:00 sheeting insp wed Jim this inspection was for exterior sheathing and nail patterns so that the builder can cover to protect from the elements.iterior shear hold downs will be inspected on frame inspection/jim BUILDING FRAMING ----------------------------------- CONTINUED ONTO NEXT PAGE ----------------------------------- BUILDING INSULATION WALL/FLOOR TRACY 460-9544 BUILDING FINAL hoch construction finish items on list basement floor to be continued on this permit/jll BUILDING FINAL hoch const. ~e j;te-5 PREPARED 4/28/04, 12:49:36 CITY OF PORT ANGELES ADDRESS CONTRACTOR OWNER PARCEL . . APPL NUMBER: INSPECTION TICKET INSPECTOR JAMES L LIERLY 1111 COLUMBIA ST HOCH CONSTRUCTION BIRCH, GREGORY 06-30-00-5-3-0265-0000- 03-00000688 COMM NEW CONST PERMIT: ME 00 MECllANICAL PERMIT REQUESTED INSP DESCRIPTION TYP/SQ COMPLETED RESULT RESULTS/COMMENTS ME99 01 4/20/04 4/21/04 JLL DA ME99 02 ~+ L SUEDIV: PHONE (360) 452-5381 PHONE : (360) 457-3183 MECHANICAL FINAL finish items on list/ basement permit/j 11 MECHANICAL FINAL PAGE DATE TIME: 17:00 to be complete on this 2 4/28/04 CONTINUED ONTO NEXT PAGE ----------------------------------- PREPARED 4/28/04, 12:49:36 CITY OF PORT ANGELES ADDRESS CONTRACTOR OWNER PARCEL . . APPL NUMBER, INSPECTION TICKET INSPECTOR JAMES L LIERLY PAGE DATE 3 4/28/04 1111 COLUMBIA ST HOCH CONSTRUCTION BIRCH, GREGORY 06-30-00-5-3-0265-0000- 03-00000688 COMM NEW CONST SUBDIV, PHONE (360) 452-5381 PHONE , (360) 457-3183 PERMIT: PL 00 PLUMBING PERMIT REQUESTED INSP TYP/SQ COMPLETED RESULT PL2 01 12/19/03 JLL 12/19/03 AP PL3 01 1/22/04 JLL 1/22/04 AP PL99 01 4/20/04 JLL 4/21/04 DA DESCRIPTION RESULTS/COMMENTS PLUMBING ROUGH-IN TIME: 17:00 MIKE 683-8336 TOM'S PLUMBING PLUMBING GAS LINE TIME: 17:00 medical gas line under pressure and ready for test/jim this inspection is for the suction and compressed air lines medical gas is to be inspected by thrid party special inspector or use portable n02/co2/jim PLUMBING FINAL TIME: 17:00 finsih plumbing connections/label bath/trip hazard in operatory/ finish elctrical and include inspection. basement to be finished at later date under this permit by owner/jll PLUMBING FINAL TIME: 17:00 PL99 02 ~28/ 4 JLL V~ -------------------------------------- COMMENTS AND NOTES -------------------------------------- PREPARED 4/20/04, 12:52:31 CITY OF PORT ANGELES INSPECTION TICKET INSPECTOR JAMES L LIERLY PAGE DATE 3 4/20/04 ADDRESS CONTRACTOR OWNER PARCEL . . APPL NUMBER: 1111 COLUMBIA ST HOCH CONSTRUCTION BIRCH, GREGORY 06-30-00-5-3-0265-0000- 03-00000688 COMM NEW CONST SUBDIV: PHONE (360) 452-5381 PHONE : (360) 457-3183 PERMIT: PL 00 PLUMBING PERMIT REQUESTED INSP DESCRIPTION TYP/SQ COMPLETED RESULT RESULTS/COMMENTS PL2 01 12/19/03 JLL 12/19/03 AP PL3 01 1/22/04 JLL 1/22/04 AP PL99 01 ~\ JLL ,DA- PLUMBING ROUGH-IN TIME: 17:00 MIKE 683-8336 TOM'S PLUMBING PLUMBING GAS LINE TIME: 17:00 medical gas line under pressure and ready for test/jim this inspection is for the suction and compressed air lines medical gas is to be inspected by thrid party special inspector or use portable n02/co2/jim PLUMBING FINAL TIME: 17:00 -------------------------------------- COMMENTS AND NOTES -------------------------------------- , PREPARED 9/05/03, 13:11:19 CITY OF PORT ANGELES INSPECTION TICKET INSPECTOR JAMES L LIERLY ADDRESS CONTRACTOR OWNER PARCEL . . APPL NUMBER: 1111 COLUMBIA ST HOCH CONSTRUCTION BIRCH, GREGORY 06-30-00-5-3-0265-0000- 03-00000688 COMM NEW CONST PERMIT: BPC 00 BUILDING PERMIT - COMMERCIAL REQUESTED INSP DESCRIPTION TYP/SQ COMPLETED RESULT RESULTS/COMMENTS SUBDIV: PHONE (360) 452-5381 PHONE : (360) 457 - 3183 BI2 01 8/01/03 JLL BUILDING FOUNDATION WALL 8/01/03 AP BL1 01 8/19/03 JLL BUILDING FOUNDATION FOOTING TIME: 17:00 8/19/03 AP BL1 02 9/03/03 JLL BUILDING FOUNDATION FOOTING 9/03/03 AP foundation footing john frazer BI2 02 9/05/03 ~ BUILDING FOUNDATION WALL foundation stem wall inspection Greg birch PAGE DATE 1 9/05/03 -------------------------------------- COMMENTS AND NOTES -------------------------------------- PREPARED 1/22/04, 12:16:53 CITY OF PORT ANGELES INSPECTION TICKET INSPECTOR JAMES L LIERLY PAGE DATE 4 1/22/04 ADDRESS CONTRACTOR OWNER PARCEL . . APPL NUMBER: 1111 COLUMBIA ST HOCH CONSTRUCTION BIRCH, GREGORY 06-30-00-5-3-0265-0000- 03-00000688 COMM NEW CONST SUBDIV: PHONE (360) 452-5381 PHONE: (360) 457-3183 PERMIT: PL 00 PLUMBING PERMIT REQUESTED INSP TYP/SQ COMPLETED RESULT DESCRIPTION RESULTS/COMMENTS PL3 JLL PLUMBING ROUGH-IN TIME: 17:00 AP MIKE 683-8336 TOM'S PLUMBING ~. L PLUMBING GAS LINE TIME: 17: 00 . . medical gas line under pressure and ready for test/jim . / I ------------------------ -------- ---- COMMENTS AND NOTES -------------------------------------- 01 12/19/03 12/19/03 1/22/04 PL2 01 , ~ ~ ;\\ l 2 \' ;( ~\< PREPARED 10/29/03, 13:03:48 CITY OF PORT ANGELES INSPECTION TICKET INSPECTOR JAMES L LIERLY PAGE DATE 1 10/29/03 ADDRESS CONTRACTOR OWNER PARCEL . . APPL NUMBER: 1111 COLUMBIA ST HOCH CONSTRUCTION BIRCH, GREGORY 06-30-00-5-3-0265-0000- 03-00000688 COMM NEW CONST SUBDIV: PHONE (360) 452-5381 PHONE : (360) 457-3183 PERMIT: BPC 00 BUILDING PERMIT - COMMERCIAL REQUESTED INSP DESCRIPTION TYP/SQ COMPLETED RESULT RESULTS/COMMENTS BI2 01 8/01/03 8/01/03 8/19/03 8/19/03 9/03/03 9/03/03 BUILDING FOUNDATION WALL BL1 01 JLL AP JLL AP JLL AP BUILDING FOUNDATION FOOTING TIME: 17:00 BI2 BUILDING FOUNDATION FOOTING foundation footing john frazer BUILDING FOUNDATION WALL foundation stem wall inspection Greg birch ftLL BUILDING SHEARWALL TIME: 17:00 sheet1ng insp wed Jim ------------------------~ ------------ COMMENTS AND NOTES -------------------------------------- 02 9/05/03 9/05/03 JLL AP BL1 02 BL9 01 10/29/03 1\0 ~~ ,~ "--'-l~ B'+ .....~ - ',' ,,,,, ~ .... BUIj.DING DIVISION CITY OF PORT ANGELES * * Correction Notice Job Located at III I (P1r/n-,~~tO Inspection of your work revealed that the following is not in accordance w' .. this jurisdiction: c.......\ \ Fof\.- ti'L&~~ J.c . \ \\ I-,^", IIJ-j ?J' ~g.\2- ?\\JM b It-\ ~\~\il oiL CoMP\~ ~ rJ-<;.6tdj ~ 1r4f' ~42~ 1/4 t;1_'2-(~) ~lAhQ\ ~ ~ ~ ~:J 4 ~.\-'P"~ ~~~. t..~.. r\.\~ /).~~~ ~s) These corrections must be made and are not to be covered until reinspection is made. When corrections have been made, please call ~,., - L.I K ,.s- for inspection. Date j):lc,jb~ DO NOT REMOVE THIS TAG PREPARED 4/20/04, 12:52:31 CITY OF PORT ANGELES ~ ..... INSPECTION TICKET INSPECTOR JAMES L LIERLY PAGE DATE 1 4/20/04 ADDRESS CONTRACTOR OWNER PARCEL . . APPL NUMBER: 1111 COLUMBIA ST HOCH CONSTRUCTION BIRCH, GREGORY 06-30-00-5-3-0265-0000- 03-00000688 COMM NEW CONST SUBDIV: PHONE (360) 452-5381 PHONE : (360) 457-3183 PERMIT: BPC 00 BUILDING PERMIT - COMMERCIAL REQUESTED INSP DESCRIPTION TYP/SQ COMPLETED RESULT RESULTS/COMMENTS BI2 01 8/01/03 JLL 8/01/03 AP BL1 01 8/19/03 JLL 8/19/03 AP BL1 02 9/03/03 JLL 9/03/03 AP BI2 02 9/05/03 JLL 9/05/03 AP BL9 01 10/29/03 JLL 10/30/03 AP BUILDING FOUNDATION WALL BUILDING FOUNDATION FOOTING TIME: 17: 00 BUILDING FOUNDATION FOOTING foundation footing john frazer BUILDING FOUNDATION WALL foundation stem wall inspection Greg birch BUILDING SHEARWALL TIME: 17:00 sheeting insp wed Jim this inspection was for exterior sheathing and nail patterns so that the builder can cover to protect from the elements.iterior shear hold downs will be inspected on frame inspection/jim BUILDING FRAMING BL3 JLL AP JLL AP JLL DA 1/14/04 1/14/04 1/16/04 1/16/04 BL99 01 ~~ ----------------------------------- CONTINUED ONTO BUILDING INSULATION TRACY 460-9544 BUILDING FINAL hoch construction WALL/FLOOR 01 BLWS 01 NEXT PAGE ----------------------------------- PREPARED 4/20/04, 12:52:31 CITY OF PORT ANGELES ADDRESS CONTRACTOR OWNER PARCEL . . APPL NUMBER: 1111 COLUMBIA ST HOCH CONSTRUCTION BIRCH, GREGORY 06-30-00-5-3-0265-0000- 03-00000688 COMM NEW CONST INSPECTION TICKET INSPECTOR JAMES L LIERLY PERMIT: ME 00 MECHANICAL PERMIT REQUESTED INSP DESCRIPTION TYP/SQ COMPLETED RESULT RESULTS/COMMENTS ME99 01 ~\~~ ~ MECHANICAL FINAL SUBDIV: PHONE (360) 452-5381 PHONE : (360) 457-3183 PAGE DATE 2 4/20/04 ----------------------------------- CONTINUED ONTO NEXT PAGE ----------------------------------- Time 8:ff' fA By P!2 RESTORATION REQUiRED....... YES NO SURFACE RESTORATION: SURFACE TYPE: 0 Unimproved o Gravel o Asphalt OPCC o Other o Repaired by City o Repaired by Permittee o No Damage Found Work Order # o COMPLETE o INCOMPLETE (Continue on revers~si<te if necessary I STREET SUPERINTENDENT,/ (DA TEl CITY OF PORT ANGELES DEPARTMENT OF PUBLIC WORKS . . . . . . . . . . . INSPECTION REPORT . . . . . . . . . . . REQUEST: Date r-2g-63 Time Received by Rt/ (phone, person) I J II e,o" Lt..~ b~q 6,'r-<:-h. Phone No.~6/-..s2:i(j Permit No. C; .55~ Plumbing Final Sewer Excav. Other # INSPECTION NOTES: Inspected: Date~. ~ \~ \ .../ Remarks: Time~ ~BY 6C ~~ RESTORATION REQUIRED . . . . .. YES NO SURFACE RESTORATION: SURFACE TYPE: 0 Unimproved o Gravel o Asphalt OPCC o Other o Repaired by City o Repaired by Permittee D No Damage Found Work Order # o COMPLETE o INCOMPLETE (Continue on reverse side if necessary) STREET SUPERINTENDENT ".:,;JDATE) D~~~~T~~:r~~~U~~~~~~~S /~ . . . . . . . . . . . INSPECTION REPORT . . . . . . . . . . . REQUEST: Date 7.... 3/-03 Time ~: 'i ~ Received by $1e..v.e- (phone, person) 1111 Co (u~6,~ 6 r~___ B I re-h Phone No. "" ''f}--?--O Pe~~ tP iff Final Sewer Excav.~ I;ii~ ~ JL-c1- Location of Work to be inspected Name of person requesting inspection Address of person requesting inspection Type of Inspection (circle appropriate one): Sewer Foundation Framing Chimney Plumbing F~I d.u..,~ INSPECTION NOT~f: I /'to r Inspected: Date ~ Time (l)(VJ . By Remarks: -v+--- ~~ , RESTORATION REQUIRED . . . . .. YES NO SURFACERESTORA TION: SURFACE TYPE: 0 Unimproved o Gravel o Asphalt OPCC o Other o Repaired by City o Repaired by Permittee o No Damage Found Work' Order # o . COMPLETE o INCOMPLETE (Continue on reverse side if necessary) STREET SUPERINTENDENT (DATE) PREPARED 9/03/03, 11:42:03 CITY OF PORT ANGELES INSPECTION TICKET INSPECTOR JAMES L LIERLY PAGE DATE 1 9/03/03 ADDRESS CONTRACTOR OWNER PARCEL . . APPL NUMBER: 1111 COLUMBIA ST HOCH CONSTRUCTION BIRCH, GREGORY 06-30-00-5-3-0265-0000- 03-00000688 COMM NEW CONST SUBDIV: PHONE (360) 452-5381 PHONE : (360) 457-3183 PERMIT: BPC 00 BUILDING PERMiT J COMMERCIAL - REQUESTED "--""lNSP' DESCRIPTION TYP/SQ COMPLETED RESULT RESULTS/COMMENTS BI2 01 8/01/03 JLL BUILDING FOUNDATION WALL 8/01/03 AP BL1 01 8/19/03 JLL BUILDING FOUNDATION FOOTING TIME: 17:00 8/19/03 AP BL1 02 ~/03/0 .~, J BUILDING FOUNDATION FOOTING . foundation footing john frazer -------------------------------------- COMMENTS AND NOTES ---------------------------------_____ PORT ANGELES FIRE DEPARTMENT PLAN RE VIE W Project Name: Birch Dental Building Address: 1111 Columbia Plan #03-7 I Com 1XI R-ID I Date: July 21,2003 We have checked this plan and find that it conforms to the requirements of our codes and ordinances. The following inspections will be required: 1. Please provide and mount two 2A-10BC fire extinguishers for the building. One is to be mounted in the basement and one is to be mounted on the first floor. The preferred placement is adjacent to an exit. Extinguishers are to be mounted in a readily accessible location with the tops no more than 5 feet off the floor. 2. Provide address numbers for the building. Numbers are to be at least 6 inches tall, readily visible from the street and of contrasting color from their background. ) Reviewed by ~<DG...~ \ Date 7-ll.(bS. ~ Building Department D File Copy FP - 22 Page 1 of 1 ri~ ~ to.. BUILDING PERMIT R APPLICATION FOR OFFICIAL USE ONLY: Date Rec.:7 - -, - ~ Permit #: t::,. ~ ~ Date Approved: Date Issued: Fill out COMPLETELY and in INK. Your application and site plan MUST BE COMPLETE to be accepted for review. If you have any questions, call (360) 417-4815 Phone: 4-Gz ~1J f/J Phone: 4-51 R 3)~ City: . f"ol2r ANCJ,i5LtrS Zip:--=:j9J'-1(P'L ArchitectlEngineer: L1N~ + sm rrJ-J ~J.JJ1lrdf1;; Phone: 4B2,-c;;,/J (,p Contractor J..Ia:;JJ ~tf?J72U(JJiON State License #.J..Icr::;J..Ju/ib()t6f.P: Phone46Z- 6~6 ) Address4'Zt'J/7ZI/K1!I1fT14!. ~ }Z:T. City: ~ tw~~ Zip:.1~%~ PROJECT ADDRESS: 1/( J 0::;)1../.,,/"" 81 ~ ~T. ZONING: &:0 LEGALDESCRIPTION:Lot: l~c:l-J~ Block: f). Subdivision: f S" c;, op Ca/oYl'J-- CLALLAM COUNTY PARCEL NUMBER: (J) 6> '?> to cPO 530@-' S- 1000'0 . I Applicant or Agent: L\ N~ t ~M \W . A~~L" gor;. Owner: ~ 12.... 6P;- L.'. "FbI ~J-4 Address: ~ 16 C"It./3::JI.,.l ",5" ot?7 . Credit Card Holder Name: Billing Address: Credit CardType VISA TYPE OF WORK: o Residential 0 New Constr. 0 Re-roof 0 Stove o Multi-family )( Addition 0 Move 0 . Garage /< Commercial 0 Remodel 0 Demolition 0 Deck o Repair 0 Sign 0 Other BRIEF DESCRIPTION OF THE PROJECT: t Dn~~ 7;-vc../ City: MC # Exp. Date: SIZEN ALUATION: :S:i?~6 SF. @ $ ICtJ /SF. = $ 5~, 6a::>. Goy SF. @ $ /SF~ = $ SF. @ $ /SF. =$ TOTAL VALUATION $ t7 e..t1 eYfA.j l )-L .-1 tl S' T O.m c..e COMMERCIAL/RESIDENTIAL: Occupancy Group: e,. Occupant Load: Construction Type: -& AI No. of Stories: ~ Lot Size: J 4-tJOO Existing Sq. Ft. 1-1- ~ L & Proposed Sq. Ft.12-66 = TOTAL Sq.Ft.~ Existing lot cOVera8f"~ % & Proposed lot coverage _% = Total lot coverage '23.!!' % APPRO V ALS: PL~AN. BLDG DP : FIRE: OTHER:_ PLANNING USE ONLY: ESAlWetland(s): 0 Yes 0 No SEPA Checklist required? 0 Yes 0 No Other: BUILDING PERMIT APPLICATION SUBMITTAL: The Building Division can provide you with inforrnationon the application and plan submittal requirements if you have 'questions. 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. EXPIRATION OF PLAN REVIEW: 1fno 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 107.4 of the Uniform Building Code, current edition). No application canbe 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 pennit and understand that ;t is my responsibility to detennine what permits are required ,not the City's, and that I must obtain such pennits prior to work. T,IFORMSIAPPSIB,i1di.gponnil.wpd . APPli"..t~ Dale: ~ J 1/1'1."11 0 ~ r I CITY O.FPORT ANGELES DEPARTMENT OF PUBLIC WORKS . . . . . . . . . . . INSPECTION REVORT . . . . . . . . . . . REQUEST: . J Date 7 - 16 - 03 Time Received by Rv Sewer ~ RESTORATION REQUIRED . . . ... YES NO SURFACE RESTORATION: SURFACE TYPE: 0 Unimproved 0 Gravel 0 Asphalt 0 PCC o Other o Repaired by City o Repaired by Permittee o No Damage Found Work Order # o COMPLETE o INCOMPLETE (CQ..,~inHe Qn reverse side if nece.ssaryl STREET SUBERINTENOENT, (OA TEl ""'" / iI . ,,'effY 0F PORTANGEEES DEPARTMENT OFc;6~ DEVEEOPMENT - BUll..DING PMSION 321EASTSTH STREnI:,PqRTANGELES, WA 98362 OLYMPIC ELECTRIC 40.90 ,Plan Check Fee 7/08/03 Valuation 1/05/04 .00 o ~ ,","-'of' l' Application Number 'PropertyAddress .. ASSESSOR PARCEL NUMBER: Application description SUbdivision Name Property,. Zoning . . . Application val~t~ion owner 03~00000527 Date 7/08/03 1111 COI.UMBIA ST 06-30-00~5-3-0265-0000- ELECTRICAL ONLY', o Contractor PUBLIC HOSPITAL DISTRICT #2 939 CAROLI:NE ST PORT ANGELES KA 983623909 OLYMPIC, . ELECTRIC 4230TUMWATER PORT,ANGELES (360) 457-5303 KA 98363 ------------------------~--------------------------------------------~------ Permit .' . .. Additional desc Sub Contractor Permit Fee Issue Date Expiration Date ELECTRICAL TEMPORARY 'SERVICE Qty Unit. Charge, Per 1. 00 40.9000 ECH EL-TEMP SRV - 0'"60SRV FDR Extension. 40.90' Fee summary ." Charged Paid Credited Due ---------- ---------- ---------- ---------- 40.90 40.90 .00 .00 .00 .00 .00 .OQ, 40.90 40.90 .00 .00 permit. Fee Total PlaIJ.' Check Total Grand Total ~ Separate Permits are required for electrical Work; SEPAI'Shoreline, ESA. utilities, private and public improvements. ThJsper:J11lt~~~()rne~ nuUcmdyold ifW9rk or construction authorized is not ~onimenced within 180 days, if construction or work Issuspended()~abanCl()ned foraperi9d 01.180 dClys~fterthe work as comll1en<;ed"q~[tr,4iqulred Inspectl()nsbave not beenrequestedViithin180~ays'fr91T1tQ~ I~st Inspe~lon. . Ihe~by certify that I have read and exa,mined this application and know the same to' be true and COrreCt; . Jl.lr)jrOVi,sions,9f laws.an!i.ordinap~es governing this type ofwork~m becornplied with whether specified herein or not. The granting 'of apelmildoes not presume to give authority to .violate or cancel theprovisi6ris 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) T:\PLANNING\FORMS\1102.1S [412002] r 1--. 'r:'::_,*~w:r''''/ '";,."~ BUlLDJNG PE~TINSPECnON RECORD CAtL4 1 7;48 IS FOR BUILDING IN&Paor,J:ON:S,'P,L;E~SEP,~OVIDJ;AMINiMUM 24 HO~ NOTICE.. IT ISllNLAWFUL TO CpJ/ER. INSULATE OR CONCEAL ANY WORK BEFORE INSPECTED AND ACCEPTED. POST PERMIT INA CONSPICQOUS l.OCA TlaN.' ic':""" ~.. ,,'''''0,-'''"'-'''';',_ .~.~ . ",.n ---.'-.,....-..".,.,;.>'/-,,< -,."~'- KEEP PERMIT CARD AND APPROVED PLAt;!;~A T JOB SITE ,/ . .-," INSPECTION TYPE .... DATE I ACCEP'I;EQ, . . . '.' COMMENTS . . I YES' NO , '. FOUNDATION: ". . FOOTINGS WALLS ". 0 Lt . FOUNDATION DRAINAGE .. ELECTRICAL ,....(LIGHT DEPT) SEPARATE PERMIT: # . '" ROUGH-IN I ' , I , . T , PLUMBING .... . UNDER FLOOR I SLAB , ROUGH-IN .. . WATER LINE . .' GAs LINE BACK FLOW I WATER " r<' ., .' <iF:' . AIR SEAL l,): \. WALLS CEILING FRAMING ~ .. -' ~' j \ J9ISrs I GIRDERS , .. SlffiAR WALL WALLS I ROOF I CEILING DRYWALL -; 0 1:-BAR . I~ULATION , .' 0 ~LAB . WALL I FLOOR I CEILING I M1:CuANICAL . . HEAT PUMP WOOD STOVE I PELLET I CHIMNEY HOOD I DUCTS' .,... . PW UTILiTIES I SITE WORK' (Engineering Division) SEPARATE PERMIT #'5: .... WATERLINE I METER SEWER CONNECTION SANITARY STORM . PLANNING DEPT. SEPARATE PERMIT #'5 SEPA: PARKINGILIGHTlNG ESA: LANDSCAPING SHORELINE: " " I. ,; . :.';"F~I';I~,FI~!,~~IONS REQlllJ.EP!~.ORT() Occl!1':~-N'i=YJU~E"',.\""" .... .,,,,. ..... \ RESIDENTIAL DATE . YES NO .,. COMMERCIAL' .' ACCEPTED (1 " ... r, ...... " . , , y ,', ,'" . ".. ?:I<YES.: :NO ELECTRICAL- LIGHT DEPT. iF 417-4735' 'ELeCTRICAL ~_:v.;.; . rt/ti/;." ":I- ~ i " ), .' , ,.,' LI~U;H)J.<:n,: ,> ,d, !.i, \<1 .lj:~3 :.,. " r-~;' --, ..; ',' "coNsliiicnbN'., ibv. :'; :.,1 7: ,: , CONSTRUCTION R. W.I PWI ENGINEERING . 417-4807 . PW I ENGINEERING , :. FIRE 417-4653 FIRE DEPT; PLtJ'lNING DEPT. , ~!?:1~50 ~ -.-- PUNNING DEP,T: " '" < I , BUILDING 417-4815 BUILDING , " ,,/ / ) u ~ "'PLANN"'G\FORM~l1".1S 1"'002] - - - --- ~ ~ ~ry~ c:- <:;'/\.. 3 ~ , p V> ~ - f9'ORT~.. ,lO~",:~ ~ .... -=-- ~ ~~ CITY OF PORT ANGELES DEPARTMENT OF COMMUNITY DEVELOPMENT - BUILDING DNISION 321 EAST 5TH STREET, PORT ANGELES, WA 98362 Application Number Property Address ASSESSOR PARCEL NUMBER: Application description Subdivision Name Property Zoning . . . Application valuation M' 03-00000688 Date 1111 COLUMBIA ST 06-30-00-5-3-0265-0000- COMM NEW CONST 7/21/03 326500 Owner Contractor BIRCH, GREGORY HOCH CONSTRUCTION 918 CAROLINE STREET 4201TUMWATER TRUCK TRAIL PORT ANGELES WA 98362 PORT ANGELES WA 98363 (360) 457-3183 (360) 452-5381 Structure Information NEW 3265 SF DENTAL OFFICE Construction Type TYPE V NON-RATED Occupancy Type . . . .. BUSINESS:OFF/PRO/MED/REST Other struct info. . .. NUMBER OF UNITS 1.00 Permit Additional desc Permit Fee Issue Date Expiration Date BUILDING PERMIT - COMMERCIAL 2288.45 7/21/03 1/18/04 Plan Check Fee Valuation 1487.49 326500 Qty Unit Charge Per Extension '101:7.25 1271. 20 BASE FEE 227.00 5.6000 THOU BL-100,001-500K (5.60 PER K) Permit MECHANICAL PERMIT Additional desc Permit Fee 90.70 Plan Check Fee .00 Issue Date 7/21/03 Valuation 0 Expiration Date 1/18/04 Qty Unit Charge Per Extension BASE FEE ,47.00 1.00 14.7000 ECH ME- INSTALL 100- FAU 14.70 4~00 7.2500 ECH ME-VENT FAN 29.00 Permit Additional desc Permit Fee Issue Date Expiration Date PLUMBING PERMIT NEED PERMIT FOR BACKFLOW DEV 126.00 Plan Check Fee 7/21/03 Valuation 1/18/04 .00 o Qty Unit Charge Per BASE FEE 16.00 7.0000 ECH PL- EA. FIXTURE ON ONE TRAP 1.00 7.0000 ECH PL- EA. INSTALL WATER PIPE 1,.00 7.0000 ECH PL- EA. WATER HEATER Extension .00 112.00 7.00 7.00 Other Fees STATE SURCHARGE 4.50 Fee summary Charged Paid Credited Due ----------------- ---------- ---------- ---------- ---------- Permit Fee Total 2505.15 2505.15 .00 .00 Plan Check Total 1487.49 1487.49 .00 .00 Other Fee Total 4.50 4.50 .00 .00 Separate Permits are required for electrical work, SEPA, Shoreline, ESA, utilities, private and public improvements. This permit becomes null and void if work or construction authorized is not commenced Within 180 days, if construction or work is suspended or abandoned for a period of 180 days after the work as commenced, or if required inspections have not been requested Within 180 days from the last inspection. I hereby certify that I have read and examined this application and know the same to be true and correct. All provisions of laws and ordinances governing this type of work will be complied with whether specifl erein or not The granting of a permit does not presume to give authOrity to violate or cancel the provisions of any state or 10 I reg ting construction or the performance of construction. Signature of Contractor or Authorized Agent 7- 1-03 Date T \PLANNING\FORMS\1102 15 [412002] Date , c19'ORT ~Q I:'~~<" Uha~ "- -=.;or ~ ~~ CITY OF PORT ANGELES DEPARTMENT OF COMMUNITY DEVELOPMENT - BUILDING DIVISION 321 EAST 5TH STREET, PORT ANGELES, WA 98362 Application Number Grand Total 03-00000688 3997.14 3997.14 Page 2 Date 7/21/03 .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 authonty to violate or cancel the provisions of any state or local law regulating construction or the performance of construction. Signature of Contractor or Authorized Agent Date Signature of Owner (If owner is builder) Date T \PLANNING\FORMS\1102 15 [4/2002] t BUILDING PERMIT INSPECTION RECORD -~ CALL 417-4815 FOR BUILDING INSPECTIONS PLEASE PROVIDE A MINIMUM 24 HOUR NOTICE. IT IS UNLAWFUL TO COVER, INSULA TE OR CONCEAL ANY WORK BEFORE INSPECTED AND ACCEPTED. POST PERMIT IN A CONSPICUOUS LOCA nON KEEP PERMIT CARD AND APPROVED PLANS AT JOB SITE INSPECTION TYPE DATE ACCEPTED COMMENTS YES NO FOUNDATION: ., Cc>~ fl1V~ IV\ ~ FOOTINGS .n ~-D-:z.. ~J. L. fl'Ol11 ~-I-t!J3 - '1-3.-63 WALLS 1-)1f'"t'J3 - _J. }.., ~II t; -"1-03 1W J-~ FOUNDATION 11,~ " -00-" ~ J.L. DeI~""We..J ff,/-03 HJJ.t v ELECTRICAL (LIGHT DEPT) SEPARATE PERMIT- # ROUGH-IN I PLUMBING fllJn1h/~9-.J 1-~--o1 PIi. UNDER FLOOR / SLAB ROUGH-IN. iZ -/'1~ 03 ~LL WATER LINE GAS LINE i .- '2/J,,'f} J.I ))..,J... BACK FLOW / WATER f AIR SEAL .- WALLS CEILING FRAMING ' JOISTS / GIRDERS SHEAR WALL ) 1l,IJ-q..,o "-> WALLS / ROOF / CEILING (-Ji./-CJ..l ~Ll- DRYWALL T-BAR INSULATION SLAB i - IIn - OJ.} J. ~'~j WALL / FLOOR / CEILING MECHANICAL ~YlGLI H 4J{ --0 10-/ fYlee-h041 lea- / HEAT PUMP WOOD STOVE / PELLET / CHIMNEY HOOD / DUCTS PW UTILITIES / SITE WORK (Engmeenng DIVISIon) SEPARATE PERMIT #'s WATERLINE / METER SEWER CONNECTION SANITARY STORM PLANNING DEPT SEPARATE PERMIT #'s SEPA PARKING/LIGHTING ESA LANDSCAPING SHORELINE FINAL INSPECTIONS REQUIRED PRIOR TO OCCUPANCYIUSE RESIDENTIAL DATE YES NO COMMERCIAL DATE ACCEPTED YES NO ELECTRICAL - LIGHT DEPT 417-4735 ELECTRICAL LIGHT DEPT CONSTRUCTION R W / PW/ CONSTRUCTION - R W ENGINEERING 417-4807 PW / ENGINEERING FIRE 417-4653 FIRE DEPT PLANNING DEPT 4 I 7-4750 PLANNING DEPT BUILDING 417-4815 7_7-0 H j J.. j...,).,!, BUILDING T \PLANNING\FORMS\1102 15 [4/2002J FIRE PERMIT INSPECTION RECORD Call 360-417-4655 for fire inspections. Please provide a minimum 24-hour notice. It is unlawful to cover, Insulate or conceal any work before inspected and accepted. Post permit in a conspicuous locatiOn. KEEP PERMIT CARD AND APPROVED PLANS AT JOB SITE FIRE SPRINKLER Underground piping hydrostatically tested Underground piping flushed Interior piping hydrostatically tested Interior plpmg inspection Dry system air tested at 40 psi (24 hours) Sprinkler final FIRE ALARM Rough-in Inspection Alarm final LP-GAS Completed by Contractor: Underground piping inspection/pressure test Test # I Above ground piping inspection/pressure test PIping pressure test pSI Tank (contamer) inspection Time initiated Test #2 Appliance mspectlOn Piping pressure test pSI Time initIated LP-gas final UNDERGROUND STORAGE TANK (UST) ABANDONMENT Removal of flammable/combustible liquids " -'5-o'~ -kJ>p Tank appropriately abandoned UST abandonment final PERl\1IT OTHER (specify) perm It final 1-15"-03 kbD ,- Cil-'^- \(. ~ ~ A, ~t'")_c;:\, Inspection Type I Date Passed I Comments GENERAL COMMENTS: 2/15/00 BUILDING PERMIT - APPLICATION FOR OFFICIAL USE ONLY DateRec 7-/4-03 Penmt# 66 q Fill out COMPLETELY and in INK. Your application and site plan MUST BE COMPLETE to be accepted for review. If you have any questions, call (360) 417-4815 Date Approved Date Issued 7 - J H -03 Applicant or Agent: L,"'"...p.... t( ~I\\'~ A~~ITtIVr'S Phone: ~-~I1. Owner: <::;;'~~fI:1'( L... ~t:U... Phone: 4f;;I- SIb'$ Address:q Ie ~Jw' ?I' City: paar AN~II1AI~ Zip: '12J~flt.. Archltect/Engmeer:_L'N~"'. ~,~ A1JU.~J~ Phone: ""'6~-G:,'1 ~ Contractor ~ ~ State License #:PtJ ~,t-JftJ{)AJTExp: Phon~ -~5b J Address: 4-ZDI 71'1w1INA~ /'TZlAa.. ~. City: P~TANutr\6-; ZIp: ~~~,,:s PROJECT ADDRESS:-11 II ~~,. ST. ZONING: C:;O LEGAL DESCRIPTION: Lot: CLALLAM COUNTY PARCEL NUMBER: Block: SubdIVIsion: Credit Card Holder Name: Billing Address: City: Credit CardType VISA MC # Exp. Date: TYPE OF WORK: SIZEN ALUATION: o ResidentIal q, New Constr. 0 Re-roof 0 Stove SF. @ $ /SF. = $ 15{)c)~ HJ o MultI-farmly 0 Addition 0 Move 0 Garage SF. @ $ /SF. = $ o CommercIal 0 Remodel 0 Demolition 0 Deck, ' ',SF. @ $ /SF. = $ , 0 RepaIr: 0 Sign )( Othc::rFw....7JoN"-' rOTAL VALUATION $ BRIEF DESCRIPTION OF: THE PROJECT: ",-~lWtr ~J~T'lNG. ,t=-IJ)~L ~Nl- COMMERCIAL/RESIDENTIAL: Occupancy Group: Occupant Load: ConstructIon Type: No. of Stones: Lot SIZe: Existmg Sq. Ft. & Proposed Sq. Ft. Existing lot coverage _ % & Proposed lot coverage _% = Total lot coverage APPROVALS: PLAN: BLDG: DPWU: FIRE: OTHER:_ PLANNING USE ONLY: ESAlWetland(s): 0 Yes 0 No SEPA Checklist reqUired? 0 Yes 0 No Other: BUILDING PERMIT APPLICATION SUB MITT AL: The BUilding DlVlsIOn can proVIde you WIth informatIon on the applIcation and plan submittal requrrements If you have questIons. 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 BUIldmg DiVISIOn to comply WIth current fee schedules. Contact the Perrmt Coordinator at 417 -4815 for assistance. PLAN CHECK FEE: IF a plan check fee IS due It must be submitted at the tIme the bUIldmg perrmt applIcatIon and construction plans are subrmtted. All other permit fees are due at the tIme of permit issuance. EXPIRATION OF PLAN REVIEW: Ifno permit is issued wIthm 180 days of the date of applicatIOn, the application will expire. The Buildmg OffiCIal can extend the tIme for actIOn by the applIcant up to 180 days upon wntten request by the apphcant (see Section 107.4 of the Umform Bmldmg Code, current edItIon). 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 responslblltty to determine what permIts are required ,not the City's, and that I must obtain such permits prtor to work T \FORMS\APPS\BUlldmgperrmt wpd Apphcant: ,~~ Date: "'1,4 / 03 ~ I " '':s '0"0 'II~)J!H '1 'AJo~ai5 :.IO.j {epomea PUg uomppy eOIJJO 1IV 1IlV.l....IOl"U..j.J~J..n \ :lG:fao.oo""'''l'I1"lLOo :a&'WIB ...... ..,.. \V...., ---,.. C WJ.. t.JI tCl WJ.. JL J[]L t.JI cw. VI 39G98 YJl 'lI8[duy 1.JOd 1UT 1T 1T1TAT~~~~ T'IJP"IT 18 ,(poq~ 8l::OS 81& ~ \1.IallfllJl<DLOL ~~ JL I q- H we 'a .... -'~f: .... ... :3s "', ....~ ~ .l\. \I' ~ W ~~ <I. ~ .j\ ~ iz.~~~ j;J~!C\ - <l \l\ 2 )...- ~ ~~f!i ~ ~ ~ ~~ a .o-.oH iQlu .M Q-,OE .m r.Kl fd 06-.L4 w..,.r;-LO :a.Lva tl ~ I ~~!d ~~ ~~J.~; , ~ ~~ B" --s.i --- --.----- -. ~ ~~ ~ · ~ ~ - I .. I ~ ~ ~ 11 ~.. ~ >t . "" ~ ~ ~. i 't .c--: " . " ~ ~ - ~~~ e I \ ~ == == ~~~~~~~~~~. ~ t :~ ! >~ ~ u -'~~ L.-.-.--' Iii 'i ' " ----. - "\ ~l -= ~ ~ · 8 IBd ~ il~ ~~ ,l = l"~ [ (~k- P'I ~ : ~~ ) i ~ 11\ i> !~~L h--.- VJ5<Jh "~.~~ ~ n)! I~' ~~ :'/ ~ 1 ') / '\~ ~~~__ ~..' - - /'1 V- "",/ == ~ ~~ ~ ~. ~.'."~ ~~ . ~ :. iftiD ID II ~ r . '.~I/ % : I, ...-;.- . . ~ ~ . B. -- ~~ ~ ! I i or ..... ~ ~ W f- a> ~i .:. .. '" .o-IIA .o-.n .Ihe .9-,t .o-,ft .D ,Ell ".'.o-ft .o-,L .M Q-,OE .m r.Kl 06-01.4 .o-.oH . t I 2 I ,. ,Q-,C . ~I I "" I << -& . . '<1.0 '<1.0 t- oc UJ 0 n .. " ----- --- -::=::, { . .. I ,. . .1:11-" ~ ~I II~ 2 2 I~ !~ ~~ I 'Ie I .0 t- ~ ~ <J) -l OC - '<I .. .. '<I '<I 0... 3 t- II 9 ~9 <J)~ U~ . =- U-; U. Z~ ()~ z~ Iii 8i ~i 8i If\ Nt'1oI.1lI.ItSI\fat ~ .e ~ . . CITY OF PORT ANGELES tIGHT DEPARTMENT ELECTRICAL PERMIT Nt,> 16701 Port Angeles. washJngton____.../L.::..L......_..__..._________m_____m. 19;Zr' 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 do electrical work as listed below. Address Ii If. ___m___mmmnmnm_ Occupancy_~nm-m-m.___m----n.m ~::; ;,~~~.:~~:':;;.~:::::::::::::::::::::::::::::::~:= LIght Outlet._..._.__.......____............_.__..__. Service, volts /~/~~..._:.....' Type of Wiring: Receptacle Outlets..................__.......____ No. wires ...3....____......_?'?___.... Armored Cable .............................. Si I W~~ Non-Metallic ..............--................. Dtyer, KW._..nn............h................__.. ze w res;7""O::;......................._.. ,. 9"2!J.\tf'd Knob & Tube................................_ Range, KW..........._........._.. Main fuse ..~Lm .._.......-....-.-- Water Heater: Enclosure :s..............._.............. Rigid Conduit ..............__........__._.. Metallic Tubing ..........__............... H~at~:~f!.i!..~. Type of wiring: Entrance Cable ........__................... Motors: sIze, volts and phase: Rigid Cond';lt ____c..........__ Metallic Tubing ........__....... Current transformers: No. & Size.._.........__................__....... Raceway ......................._......_.__._ Circuits, Llght.............__........................ Utmty ................._.......................... Ser. No...____..._.....__._.____...__......____....__ Heat ..__........____......................._...... Range .............................._.............. Water Heater .__............................ Motor ............_.._...._........._............... Ser. No............................................... Dryer ....................._.................._....__ Furnace .........................._................... Ser. No....___..............__...............___...... Total Load....._______................. Ser. No. ..____00__._______....______..____....__.... Total....................................___ Remarks: nmm.mnmnm.mn_nm__m__._nnnnnnn.m_mm.n__mmm.mmn__mmn__.n......__..__m_.m._mmnm_mm..__...... -.-..._.._______________________________._..._____.________________.___._._._u___.__._____._.___..__._____._.__________________u______._....___..._____________________________ _~~;~.;~~n..----------.n--------m-;~:~~.n~~~:;~~----nn.-----.n------mmm-V!J?f~---m/;-m-m.m./j---- $..__....______000_______.._____..____. No.__________________________.. By_________.._.____.__...__.____~~__ NOTICE-Current must not, be turned on until Certificate of Inspection has been issued. If work is to be con. cealed due notice must be given the Inspector so that work may be inspected before concealment. NOTIFY THE INSPECTOR BY PERMIT NUMBER WHEN READY FOR INSPECTION ELECTRICAL PERMIT N? 16701 Address........_.........._............_.......................___............__..........._..............................._.............:....Dat~'..._/:~..._.._~.~..._.........._......_..._.._......... Owner..................................._......____......_......_.._.................._................................._.....:Tenant............................__..........._.............._.......... Wiring Contractor _............__................................................................_...............................__....._... By.............................................................. NOTICE-Current must not be turned on until Certificate of Inspection has been issued. If work f~ to be COD- cealed due notice must be given the Inspector so that work may be inspected before concealment. 1M Olympic Printers. Inc. 0;/0;/2003 08:49 FAX 3604523498 ",-><<.",-..:,,; 1l.J;L."'_M;~II, .-u.., ...~~G":....,,.~ o..m.r or Elae. Conlractor Agellt: P~o...w: G~,,~ L, --:~l/( (,,/,......b,Q ST EIOClIt""'~ Olympic Electric Addr_: 4230 Tumwater ~ OLYMPIC ELECTRIC IfjJ t\2 . .i!ei!... I ,.... . I I .~ , / , ~ rv &,\ . ELECTRICAL PERMIT APPLICATION FOa Q~W U~l;,om.y OUr!'IL..: ~r#; OU'rAf'l'n_,j: 010I..1-.1" TM. Electrical Permit Applil::8tlOl'l rnullt baI filled DI1I camelalldv PI.aaM IyptI 01 reprint In Ink.. Lf YOIJ ~ any C3lJ1tM5ona, P'-N call (360. tn-473S ft'.aI~ nur1"lb.,.; p,eQ) 4U..04n 1 ~ 5,." Olympic Electric Co., Inc. Blrc1. D. !? S:. Phona: 457-5303 Fax: 452-3498 P-': City: ?oY+ Anije/e.s 1Jeo1nBe., OL YMPEC28~: Port Angeles, WA Zip: Q83" Z- 3/31/03 ~: 457-5303 Zip: 98363 Co., Inc. o OWNER City: I:!l EU:CTRlCAl. CONTRACTOR INSTAl.Lf.TION WIRED BY: Silllng ~; Cr<<JIt C.rd Holder fNme: Charles T. Burkhardt, Olympic Electric Co.. Inc. Same ZIp: ._.. x ._. ..,iii:UfI4._-....._ City; Exp. Oata' Cffldir ClIIfI Number: PRQ.l6CT~BS: "II Co /",,,, /,,~ S\ PA 9 g '3 f:, Z- :-.u ,,) nPE OF WORK' Check alllhat apply: )(New 0 A~er8UonlAdd1tlo" o Reslden1:aJ 0 Muttl-famlly )( Commercial 0 Mobile Hom.. SQ. Ft o Remote Meter 0 Dala!:had garage 0 Hot Tub 0 Swim Pool 0 Septic Pump 0 Low Voltage 0 Telecom. 0 Slgr Number ot Citl::uttB Bdd8d or 1lJtef'8d: DESCRIP'TlOH OFTliE IlUECTRICAL PROJECT;....J€.Wlf~ S erv I c:.e. .:tL(O .~O Eleetrlcal Hat L....d AddltJon. o a.....board OFI,/~ o Heal Pump o Far.Wall SeMee Information _KW _KW _KW -KW Voltage; Phase: 0 1 0 3 ServIce Si2:e: Feeder Size: o Ovom..ud SelVa Il Temp SGMce . 0 Unclorground Service PAMC '..05.060{B): For induotrial. commo,dol, &. ",.ldanlla! projects larger !hen a duple.. . One. line dtawlng 0' tho EI",,"IC8J SeMee & Fee<ier$. building size (sq. 1t.), load call;lJI8t10n0, end the type & of condue\or$ endIor ~y Is requlrlld aru:lohallllCCo/llpany \l1e ElQCtrical PsmIt application. I h6l'Bby certify mat I havs read and 8}(smlned this application and know that same !O be true and corracr, and I an ButfIorlzed to apply for tfIJs permit. I uncJsrstand It is not the City's /eg8J responsibility !O determine What permits are required; it remains tf19 BPPficants responsibility 10 determine what permits SrII required and to obrBln sudl. '7/s (0 > PW.901 4(- ~ cOw-. CNdIt Card Holder'a S/gnatu...: Owner or Elec. Cont. SI\1nlltlll1l: ,-7-03 7 - 7 -0 3 Dale: D8ta: ~~ ~,>() H-TL 4 124/01 -ok .-<lc;. ($ ~ -rty :..J~c..... 7/6/03 Jan-06-04 09:44A 360-457~021.2 . P.Ol \, '~.' v" , ELECTRICAL PERMIT APPLICATION fOH (11'rll'LA!. U!>F. OlllLY ",."""oc; _"'_ '_1'. - - --"'-.,,,. The Elecfrical P.(Jnll A~plir.etion m\lst b. nil" out comb!...I",. ~~~. ,~~~=..'-=-~_. "",...lype 0< ...prlnlln Ink. II..... ~... any _no, D_ .>1'(360) ..17-4735 ITTE.. 0$ - t&, BS Fex. number: (:JR) 417-4711 REQUEST INSPECTION 11 Ownc'",EJoc. C'''''OC10'^90''1.tfftJl5. vYnmun r'co....b.OI1.s -...'157- <f:37S- F... 457-0;2./2- "",portyO>M..c-.DC E/(Ch" bre~ Pn""", "'-I57-"'2y\<g3- Aa.,...._3.I~ ('r) n~/,rt '2::.+. c;lv._'P4 ~_ CIC(;lnco.' Contrec;toc LIcense II: Expo Phon,,: Add'OS:I:;:.~ City" INSr ALlA liON WIREO Rv f] OW,NER ~ ELECTRICAl CONTRAC 'OH Crr:dit C.1fl Holder Name: JJ()~I.~s C6m~(l1~ tl010S B/lllnIlAdd",ss:f()Z K(')$S h!J,__Clty: If- 4~1-es er.dlt C.1fl Number:.! ~ . Zip: 'The. -' Zip: m(i3_ VlSA:.x_IlfC:_ PROJECT ADDRESSo 4 /1// C()!~ MPJa Sh tyPE Of WORK' Check lIIl tna! apply: )(New 0 Alteration/Addition o Resldenlal [i Multi-family )( Commercial 0 Mobile Home Sq. Ft 41(:(') , R~mote Moler 0 Detacned gerage U Hot Tub 0 Swim Pool U Septc Pump 0 Low Vollaga KTBlecorn. U Sig Numbi:f of QrcuilS .etted or altered' DESCRIPTION OF TilE ELECTRICAL PROJECT, "7elepYbf1.Q.. $, ~~ Co. bk u.Jof'~ Electricallleat Load Additions PERMIT FEE: 5'z.. ,00 Sarvlc. InformaUon LJ Baseboard (J Furnaco o Heat P\Jmp Ci ran-Wall KW KW -TON LRA --KW - o O._ad 5""'108 ('J Tamp Service U Underground Servje.a VoIlage: _....._ Phase: DIn 3 S.",1ea Size ___ F_ Sl.e:_~._ PAMC 14.05.060(B); FCT industrial, comR1o,clwf, & residential projec:ts '-erger than a duplex. a O"U - line drawing or the [leerical Service & Fooders, bolklln9 siz. (sq. n.), !oed calclllations, and Ihe typo & of COIlduelors aM/or raceway Is reQuired and s/lall accompany Ine Eleclri<:. . Permit applialion I herllbv c~rtlfy Ihat I have read and examinfJ(J this application and Imow that same to be true and conact, anell aft avthorized to apply lor this peml/"/. / understand it is not the Cllys legal responsibility to determine what permits ar requIred; it remains the applicants responsibility 10 determine what permits ale rtlquil1:td ..ml to obfaln such. Credit Card Holder's Slgn'lure: O,r.:. - Oet./-c, -a~ Owner or Elec. Cont. S liON I1tV I-I.. - 03 Ljo, '10 J) , 10 15?-p 0 Jun 30 2014 09:57AM Olympic Electric Co., Inc 3604523498 CITY OF PORT ANGELES PERMIT APPLICATION Building DivisionfElectrical Inspections 321 East Fifth Street -- P.O. Box 1150 / Port Angeles Washington, 98362 Ph: (360) 417 -4735 Fax: (360) 417 - 4711 Date: 455 ,W 11 ©. Multi - Family or Commercial" page 1 "Plan Review May Be Required, Please Complete Electrical Plan Review Information Sheet Job Address:—/-//-/ Building Square Footage:. If it r- an-- _. _ it Description of ahove J Owner In ormation Contractor Information Name: Name: OLYMPIC ELECTRIC Marro ddre's . +M Z city, State; / � zip: �� 4 Mailing Address: 1-23oruMWATeR Cit f, PCR TANCELE6 Slate; wa Zip: 99363 Phone; - Fax: Phone; WO. 457$303 Fax; 393x52.3499 License / Exp. License ft 1 Exp, 40— PEC2asc1 Iterr Unit Charge gty Total (Qty Multiplied by Unit Charge) ServicelFeecier 20D Am p. $132,00 $ ServieelFeeder 201.400 Amp. $160.00 $ Service /Feeder 401.600 Amp $ 225.00 $ Service /Feeder 601.10D0 Amp. $ 288.00 $ 3ervicalFeeder over 1000 Amp. $ 410,00 $ Branch Circuit Wi Service Feeder $ 5.00 $ Branch Circuit W10 Service Feeder $ 74.00 _ $ Each Additional Branch Circuit $ 5.00 $ Branch Circuits 1-4 $ 85.00 $ Temp, Service! Feed or 200 Amp $102.00 $ Temp. ServicelFeeder 201 -400 Amp. $121.00 $ Temp. Service)Feeder 401 -6 00 Amp. $164.00 $ Temp. Service)Feeder 601 -1040 Amp • $185.00 $ Aortal to Portal Hourly $ 98.00 $ SignfOutline Lighting $ 88.00 $ Signal CircuiV Limited Energy - Mult- Family $ 64.00 $ Signal Circuit/ Limited Energy I First 1500 sf - Commercial $ 96.00 $ Note: $5.00forea6h adddonal 1500 sf Renewable Electrical Energy - 5KVA System or Less $ 113.00 $ Thermostat $ 56.00 $ Note: $5.00 for each additional T -Scat $ rotal 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 farsale, 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 295-466, The City of Port Angeles Municipal Code, and Utility Specifications and PAMC 14.05.050 regarding Electrical Permit Applications. Signature of owner, electrical contractor or electrical administrator: © CPO ❑ Check D Credit Card # X 0110112012 Z d ELECTRICAL INSPECTION WIRING REPORT KS 417-4735 n D ................ ROUGH IN/COVER ............. 0 .......... ...... SERVICE ............. ..... El 0 ..................... FINAL .... ............... 11 CORRECTIONS NEEDED: c.trz4-l2l-r GIAAr4L-ZL�:, 4-mv A)f C- NOTIFY INSPECTOR WHEN CORRECTIONS ARE COMPLETED WITHIN 15 DAYS ELECTRICAL PERMIT CITY OF PORT ANGELES 360-417-4735 Application Number -. 74- 00000781 Dat• Application pin number , , , 183578 - -- ------------------------ OLYMPIC ELECTRIC Property Address . , , , 1311 COLUMBIA ST Ei REPORT SALES TAX PARCEL NUMBER: Application type description 06- 30- 00 -5 -3 -0265 -0000° ELECTRICAL ONLY on excise tax form , Subdivision Name , . , . (360) 457 -3183 -°--------------------------------- � 0 your Property Use Permit . . , . . . ELECTRICAL to the City Of Port Angeles Additional desc , . COMMENTS: Property �cning . . , , , . , COMMERCIAL OFFICE 74.00 (Location Code 0502) Application Valuation ., . . . 0 NS�icr�0 Valuation . , Application desc - -- - -- -- _ Vacuum system --------------------------------------------------------- ._._ -_ ---- ___ - - - -- Owner Contractor RESULTS: -- ---------------- - - - BIRCH, GREGORY - -- ------------------------ OLYMPIC ELECTRIC CO INC 918 CAROLINE STREET 4230 TUMWATER PORT ANGELES WA 98362 PORT ANGELES WA 58363 (360) 457 -3183 -°--------------------------------- - (360) 457 =5303 - - --- - Z' -� "t► 7e lt"Z'► Permit . . , . . . ELECTRICAL ALTER COMMERCIA14 Additional desc , . COMMENTS: Permit Fee . , . , 74.00 Plan Check Fee 00 Issue Late 7/01/14 Valuation . , . . o Expiration Date 12/28/14 44"y Unit Charge Per Extension 1.00 74.0000 ECH EL -COMM BRANCH CIR WO/ SIP 74.00 ----------------------------------------------------------------------------- Fee summary Charged Paid Credited - - -- Due -- - -- -------- --- - - - - -- ---- Permit Fee Total - - - - -- 74.00 ---- - - -- -- -- - - - - 74.00 .00 ---- - .00 Plan Chec]c. Total .00 100 00 .00 Orand Total 74.00 '74,00 00 00 INSPECTION TYPE DATE: RESULTS: INSPECTOR: DITCH SERVICE ROUGH -IN )/I l er FINAL f COMMENTS: PERMIT WILL EXPIRE SIX (6) MONTHS FROM LAST INSPECTION Signature of owner or Electrical Contractor X Date: G:IEXCHANGE\13UILDING Application Number . . . . . 23-00000709 Date 7/06/23 Application pin number . . . 751159 Property Address . . . . . . 1111 COLUMBIA ST ASSESSOR PARCEL NUMBER: 06-30-00-5-3-0265-0000- Application type description ELECTRICAL ONLY Subdivision Name . . . . . . Property Use . . . . . . . . Property Zoning . . . . . . . COMMERCIAL OFFICE Application valuation . . . . 0 ---------------------------------------------------------------------------- Application desc DHP ---------------------------------------------------------------------------- Owner Contractor ------------------------ ------------------------ BIRCH, GREGORY EXTRA MILE TECH & ELECT., LLC 918 CAROLINE STREET 418 N. RACE ST. PORT ANGELES WA 98362 PORT ANGELES WA 98362 (360) 457-3183 (360) 457-5222 ---------------------------------------------------------------------------- Permit . . . . . . ELECTRICAL ALTER COMMERCIAL Additional desc . . Permit Fee . . . . 79.00 Plan Check Fee . . .00 Issue Date . . . . 7/06/23 Valuation . . . . 0 Expiration Date . . 1/02/24 Qty Unit Charge Per Extension 1.00 74.0000 ECH EL-COMM BRANCH CIR WO/ S/F 74.00 1.00 5.0000 ECH EL-ECH ADDNT BRANCH CIRCUIT 5.00 ---------------------------------------------------------------------------- Fee summary Charged Paid Credited Due ----------------- ---------- ---------- ---------- ---------- Permit Fee Total 79.00 79.00 .00 .00 Plan Check Total .00 .00 .00 .00 Grand Total 79.00 79.00 .00 .00 MULTI-FA MILY/ COMMERCIAL ELE CTRICAL PERMIT APPL ICATION Public \Yorks and Utilities Department 321 E. 5th Street, Port Angeles. WA 98362 360.417.4735 I www.cityofpa.us I electricalpermits(s/.cityofpa.us Project Address:-------------------------------------- Project Description:--------------------------------------□Multi-Family Residential D Commercial I Industrial/ Public Building Square footage: __________ _ OWNER INFORMATION Name: ________________________ Email: ______________ _ Mailing Address: ________________________ Phone: ___________ _ ELECTRICAL CONTRACTOR INFORMATION Name: License: ___________ _ Mailing Address: ________________________ Expiration Date: ________ _ Email: Phone: ___________ _ PROJECT DETAILS llim! 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) Unit Charge 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 Total (Quantity x Unit Charge) $ ____ _ $ ____ _$ ____ _$ ____ _ $ ____ _ $ ____ _ $ ____ _ $ ____ _ $ ____ _$ ____ _ $ ____ _ $ ____ _ $ ____ _ $ ____ _ $ ____ _ $ ____ _ $ ____ _ $ ____ _ $ ____ _ $ _____ 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. Date Print Name Signature (0 Owner D Electrical Contractor/ Administrator) [Electrical Permit Applications may be submitted to City Hall or electricalpermits@cityofpa.us] lJ CD PREPARED 7/05/23,14:57:49 PAYMENT DUE CITY OF PORT ANGELES PROGRAM BP820L --------------------------------------------------------------------------- APPLICATION NUMBER:23-00000709 1111 COLUMBIA ST FEE DESCRIPTION AMOUNT DUE --------------------------------------------------------------------------- ELECTRICAL ALTER COMMERCIAL 79.00 TOTAL DUE 79.00 Please present reciept to the cashier with full payment ELECTRICAL INSPECTION WIRING REPORT APPROVED NOT APPROVED DITCH ROUGH IN/COVER SERVICE FINAL COMMENTS NOTIFY INSPECTOR at (360) 808-2613 WHEN CORRECTIONS ARE COMPLETED WITHIN 15 DAYS DATE PERMIT # INSPECTOR 7/7/2023 23-709 TAP OWNER CONTRACTOR Extra Mile Electric PROJECT ADDRESS 1111 Columbia St