HomeMy WebLinkAbout130 Dolan Ave - Building CITY OF PORT ANGELES
(f DEPARTMENT OF COMMUNITY ECONOMIC DEVELOPMENT BUILDING DIVISION
321 EAST 5TH STREET, PORT ANGELES, WA 98362
Application Number 10- 00001265 Date 11/02/10
Application pin number 610265
Property Address 130 DOLAN AVE
ASSESSOR PARCEL NUMBER: 06-30-09-5-2- 1730 -0000-
Tenant nbr, name ERIC KELLEY SMART REPORT SALES TAX
Application type description RES REMODEL
Subdivision Name on your state excise tax form
Property Use to the City of Port Angeles
Property Zoning RS7 RESDNTL SINGLE FAMILY
Application valuation 30500 (Location Code 0502)
Application desc
CONVERT A ROOM INTO A BATHROOM, ETC
Owner Contractor
ERIC KELLEY SMART OWNER
2022 S CHERRY ST
PORT ANGELES WA 98362
(805) 550 -8256
Structure Information 000 000 CONVERT ROOM TO BATHROOM, ETC
Permit BUILDING PERMIT RESIDENTIAL
Additional desc CONVERT ROOM TO BATHROOM, ETC
Permit pin number 176446
Permit Fee 478.35 Plan Check Fee 310.93
Issue Date 11/02/10 Valuation 30500
Expiration Date 5/01/11
Qty Unit Charge Per Extension
BASE FEE 417.75
6.00 10.1000 THOU BL- 25,001 -50K (10.10 PER K) 60.60
Permit MECHANICAL PERMIT
Additional desc
Permit pin number 176453
Permit Fee 75.15 Plan Check Fee .00 Phet(4.0)
Issue Date 11/02/10 Valuation 0
Expiration Date 5/01/11
Qty Unit Charge Per Extension 1 3—
BASE FEE 50.00
2.00 7.2500 EA ME -VENT FAN (SINGLE DUCT) 14.50
1.00 10.6500 EA ME -STOVE /FIREPLACE /MISC. APP. 10.65
Permit PLUMBING PERMIT
Additional desc
Permit pin number 176461
Permit Fee 114.00 Plan Check Fee .00
Issue Date 11/02/10 Valuation 0
Expiration Date 5/01/11
Qty Unit Charge Per Extension
BASE FEE 50.00
Separate Permits are required for electrical work, SEPA, Shoreline, ESA, utilities, private and public improvements. This permit becomes
null and void if work or construction authorized is not commenced within 180 days, if construction or work is suspended or abandoned
for a period of 180 days after the work has commenced, or if required inspections have not been requested within 180 days from the
last inspection. I hereby certify that I have read and examined this application and know the same to be true and correct. All provisions
of laws and ordinances governing this type of work will be complied with whether specified herein or not. The granting of a permit does
not presume to give authority to violate or cancel the provisions of any state or local law regulating construction or the performance of
construction.
11 C,
i `Swk V-
Date Print Name Signature of Contractor or Authorized Agent Signature of Owner (if owner is builder)
T: Forms /Building Division /Building Permit
BUILDING PERMIT INSPECTION RECORD
PLEASE PROVIDE A MINIMUM 24 -HOUR NOTICE FOR INSPECTIONS
Building Inspections 417 4815 Electrical Inspections 417 4735
Public Works Utilities 417 4831 Backflow Prevention Inspections 417 4886
IT IS UNLAWFUL TO COVER, INSULATE OR CONCEAL ANY WORK BEFORE INSPECTED AND ACCEPTED.
POST PERMIT IN CONSPICUOUS LOCATION. KEEP PERMIT AND APPROVED PLANS AT JOB SITE.
Inspection Type 1 Date Accepted By Comments
FOUNDATION:
Footings
Stemwall
Foundation Drainage Downspouts
Piers
Post Holes (Pole Bldgs.)
PLUMBING:
Under Floor Slab
Rough -In
Water Line (Meter to Bldg)
Gas Line
Back Flow Water FINAL Date Accepted by
AIR SEAL:
Walls
Ceiling
FRAMING:
Joists Girders Under Floor
Shear Wall Hold Downs
Walls Roof Ceiling
Drywall (Interior Braced Panel Only)
T -Bar
INSULATION:
Slab
Wall Floor Ceiling
MECHANICAL:
Heat Pump Furnace FAU Ducts
Rough -In
Gas Line
Wood Stove Pellet Chimney
Commercial Hood /Ducts FINAL Date Accepted by
MANUFACTURED HOMES:
Footing Slab
Blocking Hold Downs
Skirting
PLANNING DEPT. Separate Perrnit #s SEPA:
Parking Lighting ESA:
Landscaping SHORELINE:
FINAL INSPECTIONS REQUIRED PRIOR TO OCCUPANCY/ USE
Inspection Type Date Accepted By
Electrical 417 -4735
Construction R.W. PW Engineering 417 -4831
Fire 417 -4653
Planning 417 -4750
Building 417 -4815
T:Forms /Building Division /Building Permit
,a H CITY OF PORT ANGELES
DEPARTMENT OF COMMUNITY ECONOMIC DEVELOPMENT BUILDING DIVISION
321 EAST 5TH STREET, PORT ANGELES, WA 98362
Page 2
Application Number 10- 00001265 Date 11/02/10
Application pin number 610265
Qty Unit Charge Per Extension REPORT SALES TAX
5.00 7.0000 EA PL- PLUMBING TRAP 35.00
1.00 7.0000 EA PL -WATER LINE 7.00 on your state excise tax form
1.00 15.0000 EA PL -SEWER LINE 15.00 to the City of Port Angeles
1.00 7.0000 EA PL -WATER HEATER 7.00
Other Fees STATE SURCHARGE 4.50 (Location Code 0502)
Fee summary Charged Paid Credited Due
Permit Fee Total 667.50 667.50 .00 .00
Plan Check Total 310.93 310.93 .00 .00
Other Fee Total 4.50 4.50 .00 .00
Grand Total 982.93 982.93 .00 .00
Separate Permits are required for electrical work, SEPA, Shoreline, ESA, utilities, private and public improvements. This permit becomes
null and void if work or construction authorized is not commenced within 180 days, if construction or work is suspended or abandoned
for a period of 180 days after the work has commenced, or if required inspections have not been requested within 180 days from the
last inspection. I hereby certify that I have read and examined this application and know the same to be true and correct. All provisions
of laws and ordinances governing this type of work will be complied with whether specified herein or not. The granting of a permit does
not presume to give authority to violate or cancel the provisions of any state or local law regulating construction or the performance of
construction.
Date Print Name Signature of Contractor or Authorized Agent Signature of Owner (if owner is builder)
T:Forms /Building Division /Building Permit
BUILDING PERMIT INSPECTION RECORD 0 d
PLEASE PROVIDE A MINIMUM 24 -HOUR NOTICE FOR INSPECTIONS
Building Inspections 417 4815 Electrical Inspections 417 4735
Public Works Utilities 417 4831 Backflow Prevention Inspections 417 4886
IT 1S UNLAWFUL TO COVER, INSULATE OR CONCEAL ANY WORK BEFORE INSPECTED AND ACCEPTED.
POST PERMIT IN CONSPICUOUS LOCATION. KEEP PERMIT AND APPROVED PLANS AT JOB SITE.
Inspection Type Date Accepted By Comments
FOUNDATION:
Footings
Stemwall
Foundation Drainage Downspouts
Piers
Post Holes (Pole Bldgs.)
PLUMBING:
Under Floor Slab
Rough -In O(— O rt Ll.
Water Line (Meter to Bldg)
Gas Line (1 J
Back Flow Water FINAL Dat :2:2,, Accepted by V L t V
AIR SEAL: O (L ('I v
Walls
Ceiling
FRAMING: O l t t 1 751--L"
Joists Girders Under Floor
Shear Wall Hold Downs
Walls Roof Ceiling
Drywall (Interior Braced Panel Only)
T -Bar
INSULATION: a1 (y -L(
Slab
Wall Floor Ceiling
MECHANICAL:
Heat Pump Furnace FAU Ducts
Rough -In
Gas Line
Wood Stove Pellet Chimney 1
Commercial Hood Ducts FINAL Date Accepted epted by c.)
MANUFACTURED HOMES:
Footing Slab
Blocking Hold Downs
Skirting
PLANNING DEPT. Separate Permit #s SEPA:
Parking Lighting ESA:
Landscaping SHORELINE:
FINAL INSPECTIONS REQUIRED PRIOR TO OCCUPANCY/ USE
Inspection Type Date Accepted By
C
Electrical 417 -4735
Construction R.W. PW Engineering 417 -4831
Fire 417 -4653
Planning 417 -4750
Building 417 -4815 —2 I
P l u mbi h Riled 1.--Z l 3 c
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0\ ORr9vc. BUILDING PERMIT APPLICATION Print in ink
CITY OF PORT ANGELES
IL Attn: Building Permit Technician For City Use Only:
)bate Received �p 10
E. Fifth Port Angeles, WA 9
(36 Permit i (c 2A
(360) 417-4815 fax (360) 417-4711 ate Approved
Ph
Applicant e,
colt Pica s�c ZS"‘
Property Owner •4111. P ne
Property Owner's Address L3C) Qekar1 pk fbr4- f\ t 1/4 rTr6362_
Contractor o Phone
Contractor's Address
License Expires E -mail
PROJECT ADDRESS I' 3O .o\cr Ave_
Parcel Number Lot Zoning
Project Type Brief Description: jite Residential Multi- family Commercial Industrial
Check all that apply i1uk Poc -t- door i bQ.JLYOom t la Hectic /U'�nt cc. rv1.b
New Construction Convert !:L 5 01 kr.e.61, i tr, 1 d e 44,,, home +t a b a, f i, ra., I
Addition (urn rY, `acs z.. t if t.
I
XRemodel 0v R VA L3v Irk Fr,
door 4 u(4.11
"I
Repair Add sA- 0.cKin5 Loots her- itdiry.2.v 4 vent- fury Mel PcLievt Ca bine.{-
Demolition A-dd p` 54toc v2rl5 i vi /+a c te- E hctos ker ldr) rr
Re -roof House garage other tear off re -roof lay over one layer
Heat System Heat pump wood- burning stove gas fireplace pellet stove other
Other
Floor Areas Existing (sq. ft.) Proposed (sq. ft.)
Basement per sq. ft.
1 Floor
2nd Floor
3rd Floor 1's
Garage
Carport L_ Vicaeri S arif 'Jr
Covered Porch
Deck [bo 9 COO
Shed
Others
TOTAL VALUATION 7 Q
Total footprint of structures ft. T Lot size sq. ft. Lot coverage
Site Coverage the amount of impervious s. ',toe on a parcel, including struct -s, saved driveways, sidewalks, patios,
and other impervious surfaces. (see PA'. C 1 94.135 for exemptions) Site coverage cyo
Max. height of proposed structures ft. Occupancy group of bedrooms
Will a lawn sprinkler system be install Occupant load of full baths
Wili a fire sprinkler system be instal d? Construction type of half baths
I have read and completed this application and know it to be true and correct. I am authorized to apply for this permit and understand
that it is my responsibility to determine what permits are required, and to obtain permits prior to working on projects.
Date /D�2ct f jD Print Name 6 �Sy, Signature
T:Forms /B i lding Division /Building permit application
Clallam County Assessor Treasurer Property Details 64481 ERIC AND KELLEY S... Page 1 of 5
Clallam County Assessor Treasurer
Property Search Results 64481 ERIC AND KELLEY SMART for Year 2010 2011
Property
Account
Property ID: 64481 Legal Description: W 10' LOT 9 AND ALL LOT
10 BLK 17 FOGARTY AND
DOLANS ADDN
Geographic ID: 0630095217300000 Agent Code:
Type: Real
Tax Area: 0010 PA 121 PORT ST CNTY H2 L Land Use Code 11
Open Space: N DFL N
Historic Property: N Remodel Property: N
Multi Family Redevelopment: N
Township: Section:
Range:
I
Location
Address: 130 W DOLAN AVE Mapsco: 4
PORT ANGELES, WA 98362
Neighborhood: Cycle 5 Res Map ID: 3
Neighborhood CD: 10955130
Owner
Name: ERIC AND KELLEY SMART Owner ID: 208578 i
Mailing Address: 2022 S CHERRY ST Ownership: 100.0000000000%
PORT ANGELES, WA 98362
Exemptions:
Taxes and Assessment Details
Property Tax Information as of 10/29/2010
Amount Due if Paid on: 0M. NOTE: If you plan to submit payment on a future date, make sure you enter the
click RECALCULATE to obtain the correct total amount due.
1
First 1 Second i
1
Half 1 Half
Base 'Base
1 Year Statement ID Taxing Jurisdiction [Amt. i Amt. Penalty Interest I Base Paid il
2010 46794 ST SCH -STATE SCHOOL $127.26 $127.25 $0.00 $0.00 $254.51
12010 46794 CC -GEN COUNTY $67.72 $67.72 $0.00 $0.00 $135.44
2010 46794 PORT PORT $9.52 $9.52 $0.00 $0.00 $19.04
2010 46794 PORT ANG PORT ANGELES $156.80 $156.80 $0.00 $0.00 $313.60
2010 46794 SD #121 SCHOOL DISTRICT #121 $164.83 $164.83 $0.00 $0.00 $329.66
:2010 46794 NTH OLY LIB NORTH OLYMPIC LIBRARY $19.68 $19.68 $0.00 $0.00 $39.36
2010 46794 HOSP #2 HOSPITAL #2 $27.78 $27.78 $0.00 $0.00 $55.56
2010 46794 WSMET PK DIST WILLIAM SHORE MET PARK DIST $8.84 $8.84 $0.00 $0.00 $17.68
12010 46794 CITY STORMWATER CITY STORMWATER $36.00 $36.00 $0.00 $0.00 $72.00
1 2010 46794 WEED_CONTROL WEED CONTROL $0.82 $0.81 $0.00 $0.00 $1.63
2010 46794 TOTAL: $619.25 $619.23 $0.00 $0.00 $1238.48
2009 644812008 ST SCH STATE SCHOOL $145.36 $145.35 $0.00 $0.00 $290.71
i 2009 644812008 CC -GEN COUNTY $73.56 $73.56 $0.00 $0.00 $147.12
2009 644812008 PORT PORT $10.42 $10.42 $0.00 $0.00 $20.84
12009 644812008 PORT ANG PORT ANGELES $161.35 $161.36 $0.00 $0.00 $322.71
1
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WNER
DATE. PERMIT
5] ill 11?-1 11?-1
ISYLt c. `J V-, 1� 1
CONTRACTOR
ADDRESS
13b Po c_F nc
ELECTRICAL INSPECTION
WIRING REPORT
417 -4735
APPROVED NOT APPROVED
DITCH
ROUGH IN /COVER
SERVICE
FINAL
CORRECTIONS NEEDED: a c_'J LAS l 1 -e
Vz iac.. i} 6 r ti
INSPECTOR
(o u 11.l ►N'n 1
NOTIFY INSPECTOR WHEN CORRECTIONS
ARE COMPLETED WITHIN 15 DAYS
DO NOT REMOVE
Fiao 1
IL0 a J C.-L.0 S _I-- .5 J L N 'K
'Z a CA b Ax Po" t,J L, Y i J
ev a rt_ cra f2 V fL& Fj2 VTL Y
+0 PORT 44,,
9 MGM �7
l 'tRKS t.-
APPROVED
0
0
0
ELECTRICAL INSPECTION
WIRING REPORT
417 -4735
DATE PERMIT a
1 1%10 rg 1 7
OWNER/CONTRACT(
r Lzl. c_ _L& Y 6N. 7fr
ADDRESS
1307 120 (...k4 nt
DITCH
ROUGH IN /COVER
SERVICE
FINAL
CORRECTIONS f�EEDED:
6/0-00/4 I /KL� yi19- i 13014.-<,
INSPECTOR
OR
NOT APPROVED
ti.
L >Iwvr:Lt> t s awl) u c b T c] i
NOTIFY INSPECTOR WHEN CORRECTIONS
ARE COMPLETED WITHIN 15 DAYS
DO NOT REMOVE
Application Number
Application pin number
Property Address
ASSESSOR PARCEL NUMBER
Application type description
Subdivision Name
Property Use
ELECTRICAL PERMIT
CITY OF PORT ANGELES
360- 417 -4735
10 00001317
801302
130 DOLAN AVE
06 30 09 5 2 1730 0000
ELECTRICAL ONLY
Property Zoning RS7 RESDNTL SINGLE FAMILY
Application valuation 0
Application desc
13 circuit remodel
Owner
ERIC KELLEY SMART
2022 S CHERRY ST
PORT ANGELES
(805) 550 8256
Permit
Additional desc
Permit pin number
Permit Fee
Issue Date
Expiration Date
Fee summary
WA 98362
Signature of owner or Electrical Contractor X
Contractor
OWNER
ELECTRICAL ALTER RESIDENTIAL
177162
104 70 Plan Check Fee
11/12/10 Valuation
5/11/11
Qty Unit Charge Per Extension
1 00 73 5000 EIH EL BRANCH CIRCUIT WO /FEEDER 73 50
12 00 2 6000 EQH EL ECH ADDNT BRANCH CIRCUIT 31 20
Charged Paid Credited Due
Permit Fee Total 70 104 70 00 00
Plan Check Total 1.04
00 00 00 00
Grand Total :04 70 104 70 00 00
INSPECTION TYPE DATE.
DITCH
SERVICE
ROUGH IN
FINAL
COMMENTS
PERMIT WILL EXPIRE SIX (6) MONTHS FROM LAST INSPECTION
L Y
Date 11/12/10
RESULTS
0 0
0
leFID
Date
REPORT STATE SALES TAX
on your excise tax form
to the City of Port Angeles
(Location Code 0502)
INSPECTOR.
i
v
t
0
CITY OF PORT ANGELE 3 PERMIT APPLICATION
Building Division/Electrical Inspections
321 East Fifth Street P 0 Box 1150 Port Angeles Washington, 98362
Ph (360) 417 -4735 Fax. (366 417 -4711
Date. U-4 gale.
1/1 2 Single Family Dwelling
Plan Review May Be Required
Job Address: 130 DO LAO
Building Square Footage: 1 011
Description of above
CotJYE.2 ?i la& 11.40
Item
Service /Feeder 200 Amp.
Service /Feeder 201 -400 Amp.
Service /Feeder 401 -600 Amp
Service /Feeder 601 1000 Amp.
Service /Feeder over 1000 Amp.
Branch Circuit W/ Service Feeder
Branch Circuit W/O Service Feeder
ach Additional Branch Circuit
emp 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 First 1500 SH- Commercial
Note. $5.00'for each additional 1500 s
Signal Circuit/ Limited Energy 1 2 Famil Dwelling
Signal Circuit/ Limited Energy Multi-Famil Dwelling
Manufactured Home Connection
Renewable Electrical Energy 5KVA Systei i or Less
Thermostat
NEW CONSTRUCTION ONLY.
First 1300 Square Ft
Each Additional 500 Square Ft. or Portion o
Each Outbuilding or Detached Garage
Each Swimming Pool or Hot Tub
63.90
63.90
$119.90
102.30
56.00
1 i 10 609
Owner Information Contractor Informatio
Name: _E21G L SM Al2.1 Name: OWAE.12. 6u1LDE�
Mailing Address: 130 J. DO LiS4.1 Mailing Address: Sb f A
City Ph WA Zip: C1 City State: Zip:
Phone $105 550. fe Phone: Fax:
License Exp. ¶,M AZIE L. 215 Mz, C4942414 License Exp.
ELECTRICAL
INSPECTIONS
Multi- Family or Commercial* Commercial Addition Alteration Remodel Repair*
A lease Compplete Electrical Plan Review Information Sheet
VE.., P0121 Ark El.eS
39 To 3 aED (tE.m o o LE. CfAce.( kITC.t
Unit Charge Qty Total (Qtv Multiplied by Unit Charge)
119.90
$145.50
204.60
262.20
372.50
2.60
73.50 4- 1 73
2.60d tg. 12
92.70
110.30
$148.70
167.90
95.90
88.20
95.90
$110.30
35.20
73.50
$110.30
r
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 1-aid property is for sale, rent or lease- Permit expires after six months of last inspection.
After reading the above statement, I her aby certify that I am the owner of the above named property or a licensed electrical contractor f am making
the electrical installation or alteration in ;ompliance with the electrical laws, N.E.0 RCW Chapter 19.28 WAC Chapter 296 -468 The City of Port
Angeles Municipal Code, and Utility Specifications and PAMC 14 05.050 regarding Electrical Permit Applications.
Signature of owner electrical contractor or electrical administrator' Cash Check
Credit Card
X Dated: 01/01/2010
CITY OF PORT ANGELES
LIGHT DEPARTMENT
ELECTRICAL PERMIT
N?
14989
Port Angeles, WaSb1ngton__..__...:-?...=~.?..?:.nooo______ooo_ooooooooon__ooo, 19?t!
In aooordance 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.
~::;s..:~::~:=~;::::~:~~~:=:::::::::::::::::"";~:~:~::...~::::~_~:~:::~~~~::::::::::::::::::~:::::::::::::
-::J/ ;;
~./ ./;,
Wiring Contractor ....__...';:'P'n,,~~:::l~!!~_ooo........n._ooo By..........._.............oooooo...nooo_.........__...__n............
Light Outlets_._._______________._.........__..._.....
. /bO/:;J'''G
SerVIce, volts h_____..u__................._....__
."
No. wires ____.:>._.__....__............_____.__..
l:/ . ri
Size wiresh_:~.;:.!.:~m.~~m~_____...._..
. /~(fA
MaID fuse .....:_.........________....____..._.._
.c
Enclosure h__h......m___mmm___m.n_..
Receptacle Outlets.m__mmm_.._...._.......
Dryer, K\V] ___.h_.____________..___h__._______..___
Range, KW __..____.
Water Heater:
KW..m..............mm..mm.....mm..
. /6 /3,8
Heat. R\V....h_.h____U...________.__...___....______.....
Type of wiring:
Entrance Cable __....h.....__.hmmm__
Motors: size, volts and phase:
Rigid Conduit m.m_____mm__m._____._
Metallic TUbing _..........................
Current transformers:
No. & Slze...._...__...m.....__m____h.....__
Ser. NO....h...h.._..........___...................
Ser. No.-_.____._._...___..___..._...________________.
Ser. No.__.____.............._..._.....__.___._____._.
Type of Wiring:
Armored Cable .......__h_.............m..
Non-Metallic __mmn...mn..__..h_......
Knob & Tube.......d_...._....__..____._m_
RIgid Conduit ...............................
Metallic Tubing m____..mhm..........
Race\vay .__.._.._.00........_.._...._....__.____..
Circuits, Light......__........____........________h_
Utility ____d._____......._............._...._....__
Heat
Range 00_________..____......_.................._..
Water Heater m._m.m..h...............
Motor _____._______________..._..h__..__.._....._
Dryer.u.__.._________________._________._h__.hn.__
Furnace .......h................._..............m
Total Load......hh.h__..___________ Ser. NO.____________.h__.___.__________.__..___..... Total ._____________..____..._.____..___..___
Remarks: ....--.........--1-!-!!:.""'.,n,,=....._.,~.!.?~...y._...:/i~_::yooo____....m....n......___....ooo.....__.__n.m.n..n.__.__..___
Permit Fee
$ooo_.._ooo____oooooonooooooooo___.
Treas. Receipt
NO.ooo.n....__nn_nn_______
By .tic!..._i~~.:~~..~=.'!=~:.'''Ln....
NOTICE--Current must not be turned on until Certificate ot Inspection has been issued. It work is to be con-
cealed due notice must be given the Inspector so that work may be inspected betore concealment.
NOTIFY THE INSPECTOR BY PERMIT NUMBER WHEN READY FOR INSPECTION
/0
r/
(i(<J
8/1
:J-cXi ;f--
ELECTRICAL PERMIT
N?
14989
f) C! /0f-c.--..->-c..--o
:::~::::r:;;;z~:~:L??~~:~:;;~;:::::::::::::::::.::::=::.::::::...::::::::::::::'::.::::.:::::::.:::::::::::::::::::::::::::::::::::::::::::::~:~:::::::~::::::~:
Total 1,.oad ......_........_...._....__..._...__........._..................._....._..._____h____.._ ...__......__________..............
lnspectloncompleted..._.........._.n..._.............._...............................~.............__.____..__..........._..__..._...........___................___._.........._.........._.........
i
\
1M 3-72 Olympic Printers, Inc.
CITY OF PORT ANGELES
DEPARTMENT OF PUBLIC WORKS
. INSPECTION REPORT. . . . . .
REQUEST:
Date / Z - z...o ~o c,
Time
Z : 3~ PJ.A.. Received by f)-e,^-vu's E. (phone, person)
Location of Work to be inspected i 5D 00 (a..tA. A v e .
Name of person requesting inspection ~. ~ Deuu/"3> E '
Address of person requesting inspection Le r,t? 'Ia..,rj) ('1 'f-B Phone No.
V
Type of Inspection (circle appropriate one):
Sewer Foundation Framing Chimney Plumbing Final
Permit No.
Sewer Excav. Ot~A....-fe.0
INSPECTION NOTES:
Inspected: Date / Z~ z.o,-of., Time :5 ~ 50 (/M-
Remarks: -"?t"P'",-,',..-el L" C.L. M~'V1 b,e",I<
(I
By i2erc v1,"5 E.
w';tL ""- r<.JtA,', b....V<...J.
I
RESTORATION REQUiRED...... YES
NOX
rfJ ~
Do Ie.. VI.. Ave.. \f)
i-
'---,
V) ~
.::J.. ::l
( 3~ 100el) ~
\S ! t07 ~ 2" e-L. .~
~ I 0
.
~ ~
SURFACE RESTORATION:
SURFACE TYPE: 0 Unimproved DGravel
o Repaired by City
[] Repaired by Permittee
o No Damage Found
o Asphalt 0 PCC 0 Other
Work Order # StJ3L(Z.-/11
o COMPLETE
o INCOMPLETE
(Continue on reverse side if necessary)
STREET SUPERINTENDENT
(DATE)