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406 S Laurel St - Building
Application Number Application pin number Property Address ASSESSOR PARCEL NUMBER Application type description Subdivision Name Property Use Property Zoning Application valuation Application desc New exit sign replacment Owner US WEST COMMUNICATIONS INC KC COX MGR PROP TAX ENGLEWOOD CO 80111 Permit Additional desc Permit pin number Permit Fee Issue Date Expiration Date Qty Unit Charge Per 1 00 57 5000 ECH Fee summary Charged Permit Fee Total Plan Check Total Grand Total INSPECTION TYPE DITCH SERVICE ROUGH IN FINAL COMMENTS 154245 57 50 9/28/09 3/27/10 57 50 00 57 50 ELECTRICAL PERMIT CITY OF PORT ANGELES 360- 417 -4735 09 00000993 138974 406 S LAUREL ST 06 30 00 0 0 8800 0000 ELECTRICAL ONLY RESIDENTIAL HIGH DENSITY 0 Contractor ELECTRICAL ALTER COMMERCIAL JOHNSON ELECTRIC LLC 11816 NE 116TH STREET KIRKLAND WA 98034 (425) 821 8226 EL BRANCH CIRCUIT WO /FEEDER Paid Credited Due 57 50 00 57 50 Plan Check Fee Valuation 00 00 00 Date 9/28/09 DATE RESULTS 00 0 Extension 57 50 00 00 00 AD/7,419 L Signature of owner or Electrical Contractor X Date INSPECTOR. SEP -24 -2009 11 45AM FROM-JOHNSON ELECTRIC City of Port Angeles Permit Application Building Division /Electrical Inspections 321 East Fifth Street P.O. Box 1150 Port Angeles Washington, 98362 Ph: (360) 4174735 Fax: (360) 417.4711 41 Date: t `Z 1 2 Single Family Dwelling Multi- Family or Commercial" X Commercial Addition I Alteration 1 Remodel I Repair Plan Review May Be Required, Please Complete Electrical Plan Review Information Sheet Job Address: t(Q{d 5. Ll9Sr Building Square Footage: SADD W 7'�t LO Ewt c it `r ftY Description of above Owner Information Contractor Information Name: at GS 7 Name: 7bl4t..L j eLE TV-k C-, Tit Mailing Address: Ae. S. t-A4t1E-` Mailing ddress: t4 QE.- (1(r City State: A- zip: `i3 City R fl State: WA-- Zip: 3r Phone: j3 Zi-Se Fax: Phone: ita _Fax: `tx f .4z1r 1614 License 1 Fxp. License #1 Exp. _T l i t 3P,'( R-4. 1L3,' In Unit Charoe 93.75 $113.75 $160.00 $205.00 5291.25 2.00 57.50 2.00 72.50 8625 $116.25 $131.25 75.00 69.00 75.00 50:00 50.00 93.75 80.00 85.25 27.50 57.50 86.25 43.75 Owner as defined try R614419,28.Z67. (1) Owner will occupy the structure for two year$ 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. 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 296.46$, The City of Port Angeles Municipal Code, and Utility Specifications. Signature of owner, electrical contractor or electrical administrator Total (Qtv Mult °plied by Unit Charnel Service/Feeder 200 Amp. Service /Feeder 201 -400 Amp. Service/Feeder 401 -600 Amp. ServlcelFeeder 601 1000 Amp. Service/Feeder over 1000 Amp. 5 Branch Circuit W1 Service Feeder .SJ.5v Branch Circuit NO Service Feeder Each Additional Branch Circuit Temp, Service/ Feeder 200 Amp. Temp. ServicelFeeder 201400 Amp. Temp, Service/Feeder 401.600 Amp, Temp. ServicelFeeder 601 -1000 Amp. Portal to Portal Hourly 5 SignlOutline Lighting Signal Circuit! Limited Energy Commercial Signal Circuit/ Limited Energy I 2 Family Dwelling Signal Circuit/ Limited Energy Multi- Famlly Dwelling 5 Manufactured Home Connection Renewable Electrical Energy 5KVA System or Less First 1300 Square Ft. Each Additional 500 Square Ft. or Portion of Each Outbuilding or Detached Garage 5 Each Swimming Pool or Hot Tub Thermostat $...5/1 Total Date: RECE 4836 SEP 2 5 2009 ELECTRICAL INSPECTIONS Cash Check Credit Card T 258 P 002 F -96 6 p t ibORT 0 W ~f'ORT~ <-~O~~v, Or..a~ -- -=-- ~ . ~'" w;itP CITY OF PORT ANGELES DEPARTMENT OF COMMUNITY DEVELOPMENT - BUILDiNG DIVISION 321 EAST 5TH STREET, PORT ANGELES, W A 98362 Application Number Application ,pin number Property Address ASSESSOR PARCEL NUMBER: Tenant nbr, name Application type description Subdivision Name Property Use Property Zoning . . . Application valuation 06-00000500 Date 5/16/06 924000 406 S LAUREL ST 06-30-00-0-0-8800-0000- QWEST BUSINESS RESOURCES RE-ROOF RESIDENTIAL HIGH DENSITY 168768 Owner Contractor US WEST COMMUNICATIONS INC KC COX MGR-PROP TAX ENGLEWOOD CO 80111 HAIGHT ROOFING COMPANY, INC. 4910 15TH AVE. N.W. SEATTLE, WA SEATTLE WA 981070409 (206) 784-8414 Permit . . . . . Additional desc . Permit pin number Permit Fee Issue Date Expiration Date BUILDING PERMIT - NO PR FEE 77651 1406.65' Plan Check Fee Valuation .00 168768 11/12/06 I Qty Unit Charge Per Extension 1020.25 386.40 BASE FEE 69.00 5.6000 THOU BL-100,001-500K (5.60 PER K) Other Fees STATE SURCHARGE 4.50 Fee summary Charged Paid Credited Due ----------------- ---------- ---------- ---------- ---------- Permit Fee Total 1406.65 1406.65 .00 .00 Plan Check Total .00 .00 .00 .00 Other Fee Total 4.50 4.50 .00 .00 Grand Total 1411.15 1411.15 .00 .00 ~ 0. O~ %/ "0. q ~ .......... So 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 reqllested 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 Signature of Owner (if owner is builder) Date T:\Policies\1102_15 b!lildiI]g permit inspection record05.wpd (1/4/2005] BUILDING PERMIT INSPECTION RECORD CALL 417-4815 FOR BUILDING INSPECTIONS. CALL 417-4735 FOR ELECTRICAL INSPECTIONS. CALL 417-4807 FOR PUBLIC WORKS UTILITIES 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 I YES NO FOUNDATION: FOOTINGS SHEAR WALLS 1 WALLS FOUNDATION DRAINAGE 1 DOWN SPOUTS PIERS POST HOLES (POLE BLDGS.) PLUMBING UNDER FLOOR 1 SLAB ROUGH-IN WATER LINE (METER TO BLDG) GAS LINE FINAL DATE ACCEPTED BY: BACK FLOW 1 WATER AIR SEAL WALLS CEILING FRAMING JOISTS 1 GIRDERS SHEAR WALL/HOLD DOWNS WALLS 1 ROOF 1 CEILING DRYWALL (INTERIOR BRACED PANEL ONLY) T-BAR INSULATION SLAB WALL 1 FLOOR 1 CEILING I MECHANICAL HEAT PUMP 1 FURNACE 1 DUCTS GAS LINE WOOD STOVE 1 PELLET 1 CHIMNEY FINAL DATE ACCEPTED BY: COMMERCIAL HOOD 1 DUCTS MANUFACTURED HOMES FOOTING 1 SLAB BLOCKING & HOLD DOWNS SKJRTING PLANNING DEPT. SEPARATE PERMlT #'s SEPA. P ARKING/LlGHTING ESA: LANDSCAPING SHORELINE: FINAL INSPECTIONS REQUIRED PRIOR TO OCCUPANCY/uSE RESIDENTIAL DATE YES NO COMMERCIAL DATE ACCEPTED YES NO ELECTRICAL - LIGHT DEPT. 417-4735 ELECTRICAL LIGHT DEPT CONSTRUCTION R.W. 1 PWI CONSTRUCTION c R.W. ENGINEERING 417-4807 PW 1 ENGINEERING FIRE 417-4653 FIRE DEPT. ( A PLANNING DEPT. 417-4750 PLANNING DEPT. I ( '111 BUILDING 417-4815 BUILDING ;J.1"ltA 1/1 T:IPoliciesll 102_15 building permit inspection record05.wpd [1/4/2005] r I 'J ~ 1 <sI ~ ~ ~ ~ ~ t ~ ~ '. ." . ~, - .. R()RTANG~LES W A, S'HI N'G-T 0 N;. U. S. A. (', . ( , PublicWbrks & Utilities Depar1rTIE:mt' . I: May 16, 2006 ,0' ::- - " Haight Roofing Company,,'Inc. 4910 15th Ave Northwest ,Seattly, ,W A 98107 ii, " .~ . . -. . 0' . . , . .' , \ . W ~ have receiyed your applicatio~ for disppsal of building ~emolitiori debris' from the referenced , site, and reviewed .the testing, results. Bas~d' on the testing results the debris appears 'to be 'acceptable for u~e in the landfill; , A copy o(your approved app;lication :is 'attachesI: 'This, 'approved application must be shown to the landfill S,dlle attend~nt at the time or disposal. " . , '. '. . , " . . . , '., " . y' - . . . ,Plea~e be advised that this disposal app,lication'is only for the m:atenals and qu~ri.tities listed in theapplicatiori.. Materials not listed or in excess of the'quantitie~ noted. may require separate . applications. and approval. ' , , Please call if'youhave'q~esti6ns: ,Ve/~~IY~OU~L ~'." '0 .," " 'v~~ .' " Garyw,. Xenworthy, P.E. ' , ' ." City Engineer, ' 'J. . " . DeputYDirector o'fEngjneering Services . ~ " GWK:tf Ene!.: ' WDA06-J? , , "cofY: . , Ken Loghry " " . , . . .. N:\PWKS\ENGI~JEER\WDAPPLIC\06-'J 7WPO' '.'FILE: Landfill SolidWast~ J?isposaJ APpJi~ation~,' , . Phone: 360"417.::4805' /, Fax:' 360~4,17 -4542. ' . " Website: www,cityofpa.us / ~ri1ail:'publicworks@cityofpa.us I' '- . !. , 321 ~ast'~ifth Stre,et -"~",b.,..~~x 1,150/ Port 1ngel~S', ~A98362-02_17" ;ent By: HAIGHT ROOFING CO INCj 2067841058j May-12-06 12:59PMj Page 2 ~ 'ViI BUILDING PERMIT. APPLICATION Fill out COMPLETELY .nd in INK. Your application and site pllln MUST BE COMPLETE to be accepted for f(:vlew. If you have any qlle.tioh8. call PERMITS (360) 417-4815 FAX(360)417-471l Applicant or Agent: Ha i ght Roofi ng COmpany ~ I nc . Owner: Qwest Buisness Resources Address: 1600 Seventh Avenue RM 230C City; Sea tt 1 e. WA Phone: 206-784-8414 f'honc; 206-345-4416 Zip: 98191 ArchitectlEngineer: Nt A Conl.r8ctor Ha i qht Roofinq Co. Address: 4910 15th Ave. N.W. PROJECT ADDRESS: 406 S. laurel LEGAL DESCRIPTION: Lot: Phone: N/ A InCStl:lte Licen~ #HAIGHRC269Q~xp; 5/2008 Phone~206-784-8414 City: Seattle.. WA Zip: 98107 St. ZONING: Block: Subdivision: CLALLAM COUNTY PARCEL NUMBER: Credit Card Holder Name: Billing AddR:l!Is: Credit Card Type VTSA _ MC _ # TYPE OF WORK: SIZE/VALUATION: IJ Residential 0 NewConstr. II( Re~roor [J Stuve 5700 SF,@s29.608 /sF.=$168.768.0Q o Muhj-family 0 Addition fJ Move 0 Garagl!l SF. @ $ ISF. - $ o Commerdal 0 Remodel 0 Demolition u DeCk. SF. @ $ /SF. = $ o Repair 0 Sign 0 Orher TOTAL VALUATION $ BRIEFDESCRIPTIONOJr'THEPROJECT: Tear-off of existint:l roof systmm, re-roof consistinQ of 1/211 oer ft. slope, .511 - 911 insulation. modified ply's set in modified asphalt. Construction Type: ~ TOTAL Sq. Ft. No. ofSl.ories: _ Lot Size: Torallot cDllcrage OC(:r.lpanT Load; &. Pruposed Sq. PI. COMMERClALJRESIDENTJAL: Ocwpancy Group: L~istin8 Sq, 1'1'. % PLA.NNING USE ONLY; APPRO V A liS: PLAN: BJ.PG: DPWU: RSAtWelland(s): 0 Yo~ 0 ND SEPA Checklist required? 0 Yes l;J Nu Orher; FIRE: onl ER: ~ v ALU A TJON 011' CONSTRUCTION; Ip all case&, . valuation amount must be en~red by the !lppli~aDt. Thi!l. figure will be reviewed 8Dd may be revised by the Building Division to comply wirh CUJTelll fee s~hedu.leli. Contact tbe Permit Coordinatnr a1417-4815 for aSlliSIllDl;6. PLAN CHECK FEE; IF a plan cbeck fce is due it mUlll be submitted sr The timc the building pennlt applicalion and eODlJlrllcLioo plans llR: 9ubmined. All (lther permit fecs are due at thc time of pl:rmil issuance. EXPIRATION 0'" PLAN REV lEW: If no permit is i!.islled within 180 days of the d811l ofapplicllrion, the appUudon will c:s.plre. Tile Building Omelia! can c)l;lIlnd me timc fnr aCDon by \lie applicant up 10 lll0 day~ upon wri~n request by the applicant (I'l(:C Section R I 05.3.2 ofthe Inlllrn8tionalllr.lilding/Rc:~idellti81 Code. ~003). No application can be elClllndcd more thsn OIlI;:C. I hereby c;,,,fify that t hl!JVfJ rIIsd and e1ClJmined this application and know the same to be truB and co~ct. J 8m eutflorizBcJ to spply for thfs permit and undartJtsnd thel it is my rasponsibll;ty to dt!lt"rmine whet permits are ~quirtld .not ff/8 CitY'I1. tmd that I must obtein such permits prior to wol1f. A.pplicant: Dale: May 12, 2006 ;ent By: HAIGHT ROOFING CO INC; 2067841058; May-12-06 12:58PM; Page 1 HAIGHT ROOFING COMPANl': INC. Mailing Address: P.O. Box 70150, Seattle, ViA 98107 Area Code: (206) 784-8414 INDUSTRIAL - COMMERCIAL - ROOFING and SHEET METAL WORK Fax: (206) 784-10$8 INSULATING CONCRI:TE ROOFS DECKS REROOFING SPECIALISTS "SINCE 19191> flACSIMILI1 TRANSMITTAL SHERT TO: Building Department-Permit Ccnf~ FROM: 'fun Rash (360) 417-47"9 D/lTE: May 12,2006 PAX NI lMn ER: COMP^NY, Gry of Po IT. AngdL"S PHONE NI)1ItBtlJ'l.; (3(10) 417-4S15 TOTAl. NO. 01' PAGES INCLUDING cOVER: -a..o FAll NUMF.ll.: 206-784-1058 Port Allgelcs- Re-Roofing Proposal ?HONH NUM1H\R: 206-784-8414 R.E: 0" lJRGtlNT ~ FoR REvrRW o PLRASll COMMENT 0 PLEASE RF.l"LY o T"T .EASE RECYCLE NOTf',s/coMMENTS: Atbched to this fax is our Building Permit Applic.-ation, Waste Disposal Application, and a good Faith Asbest.os Report for a poojC\.l' we will be starting on May 16, 2006. T also would like to know if any special requirements arc applicabJe to our use of asphalt kettles. Thank you for your help ;~nt By: HAIGHT ROOFING CO INC; 't ~ ~ 2067841058; May-12-06 12:59PM; Page 3 LODA- - 06-11 PORT ANGELES LANDFILL WASTE DISPOSAL APPLICATION Phone: (360) 417-4803 FAX: (360) 417-4709 City of Port Angeles. City Engineer 321 E Fifth Street P.O. Box 1150 Port Angeles, Wastllngton 98362 To: NOTE: All questions must be answered for waste to be approved. 1. Generator Information: Company Name: Mailing Address: Phone: Project Name: Projed location: Haight Roofing Company. Inc. 4910 - 15th Avenue Northwest Seattle, Washinqton 98107 206-784-8414 Qwest Central Office 406 S. laurel St._ Port Angeles_ WA9R36? 2. Other Contacts (if applicable): Consulting Firm: Contact: Phone: Contractor Name: Contact: Phone: Laboratory: Contact: Phone: City of Port Angeles - Landfill Waste Disposal Application Page - 1 ;ent By: HAIGHT ROOFING CO INC; 2067841058; May~12-06 12:59PM; Page 4 ~ 6. Estimated Quantity of Waste for Disposal: Cubic yards I Drums / 28 Tons (estimate both) Tons (estimate both) Other NOTE: Estimated quantity for disposal must be within 20% of the quantity actually disposed. (10% for projeas o'Jer 7,500 tons or 5,000 cubic yards.) 7. Frequency of Disposal: One time _ Monthly Through _ Annual----.!... Other Compl et ion of Job 8. Waste Sampling: Proper characterization of the waste for disposal requires the collection of representative samples. The methods ana 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 Bnd 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 NOTE 1; UnlesS prior approval has been granted by Port Angeles. the following sampling frequency will be used: . 0-25 cubic yards ;;:. 25 - 100 cubic yards = 101 ~ 500 cubic yards = 501 . 1000 cubic yards = 1001 - 2000 cubic yards = >2000 cubic yards - NOTE 2: One composite sample stlall discrete samples. 1 compo'?i'le sample 3 composite samples 5 composite samples 7 composite samples 1 0 composite samples 1 0 plus one sample for each additional 500 cubic yards comaln a minimum of three/maximum of five City of Port Angeles - Landfill Waste Disposal Application Page - 3 ;ent By: HAIGHT ROOFING CO INC; 2067841058; May-12-06 12:59PM; Page 5 9. Waste Analysis: The "DangeroU5 Waste Regulations" r-NAC 173>-303) shan be utilized \0 determine the appropriate analytical requirements for waste charactenzation. Ecology Publication #91-30 (Revised April 1994) ~Guidance for Remediation of Petroleum Contaminated $oils" shall also be used (0 characterize petroleum contaminated soils from UST releases. Submit all laboratol)' analytical results, QAlCC data, and Chain of Custody sheets along with this application. (NOTE: The laboratory mut.t be accredited by the Wat.hington State Department of Ecology.) . a) List all analytical test methods used: MIA MIA b) Provide a narrative as to why the above analytical methods were selected: MfA NOTE: . Additional sheets attached: .....J!L! YES JYA... NO 110. Soil ClassLflcation: {"FOR PETROLEUM CONTAMLNATED SOILS ONLY"-) Based on the analytical data and Ecology Publication #91-30, the soil classification is: (c.heck one) MIA Class 1 ~ Class 2 Calculated Hazard Index ~ Class 3 -1UA- Class 4 11. Dangerous Waste Affidavit: Based on a review of the analytical test results, site histol"i I and the applicable regulations. this waste is classified as: (check one) x Neither Dangerous Waste (DW) nor Extremely Hazardous Waste (EH\N) Dangerous Waste (DW) and Waste Code: Extremely Hazardous Waste (EHW) and Waste Code: City of Port Angeles - Landfill Waste Disposal Application Page - 4 f II 12. Certification: Wf;, THE UNDERSIGNED, certify that this application is true to the best of our knowledge. All information provided is correct and the enclosed analytical results represent the proposed , waste material to the best of our abilities. ~~~ Waste Gene or Signature' c::::-\ ~\\ \ \~-\,,~ b Printed Name _.u.A''-~'" -\ ~~t~ (2.0 ""'"~~ 1 ~ . Company ~/'I(J 16~ Date City of Port Angeles Approval: CitY~~ r~~cm~ ~../ Ifi,. tJ~ Date It)-/~ -Ob Approval Expiration Date C:\DA T A\WP\FORMS\WDAapp.wpd City of Port Angeles - Landfill Waste Disposal Application Page - 5 ,ant By: HAIGHT ROOFING CO INCj 2067841058j May-12-06 1:00PMj Page 6 ~~(~.~:....J-.~'\; ~-- .e.eu..... .... ':.i:",,:rt; r. PBS 'U;'~~C~':r~::y~ l~ E i~t.~GI'.ol p; 31:,":) ";~':.~~; ~.::: ~ November 22, 2005 Mr. Dan Smith Project Manager Owest Communications 1600 7th Avenue Seattle, WA 98191 RE: QwestPon Angeles . Limited Good Faith Asbestos Survey Report - Roof Replacement & HVAC Upgrades 406 South laurel Street, Port Angeles, Washington 98362 PBS Project #40591.015 Dear Mr. Smith: PBS Engineering and Environmental (PBS) performed an inspec:tion of the Owest Port Angeles site to determine the presence of asbestos-containing lTIaterials (ACM) limited to the scheduled roOfing replacement and the 2nd floor mechanical upgrades project. . The Owest Port Angeles project site is a two-story concrete structure. The date of the building construction was not provided. Upon discussion with Qwest, PBS surveyed the 2nd floor mechanical room, adjacent corridor, equipment room, and the roof for suspect asbestos- containing materials. Project Infoimation The intent of this lettor is to ensure that Owest is in complianC'..e with the Washington State Department of Labor and Industries' requirement that a "good faith" inspection for ACM be performed prior to renovation or demolition activities. All accessible areas at the locations identified above were inspected as part of this investigation. Inaccessible areas are defined as those requiring selective demolition, fall protection or confined-space entry protocols to gain access. A total of 20 suspect building materials were sampled on November 8, 2005, by AHERA~ accredited Inspector Willem Mager (AHERA Building Inspector certification number 1015477, expires April 6, 2006). Samples were assigned unique identification numbers and delivered to NVL Laboratories in Seattle, Y\QstJington for analysis. All samples were analyzed including all layers by polarized light microscopy (PLM), which has a reliable limit of quantification of one percent (1 %) asbestos by volume. 1 ::.;: '~!l ~ ~.:.il_:.;~, ~;:~~.: ~>..l~l.':l ~~ i' ~..."',~~ t;:.~. \."'5~'" .:Jf.'~ :.~ :...x. ;'>:l~;.!~!*i~ ;;,;;.; ;:"t'i't) iB2,~.I:EK~ :'/0..1( . ......_u.....nn..... , .................. .....,..................,...~......................_..,',............ ~NGIN1Hlill"":". A__IO. .t:~VI~Of.n.,.i!N'\A~ ; . .........pibu"......... ;ent By: HAIGHT ROOFING CO INC; 2067841058; May-12-06 1:00PM; Page 7 awes. Pnrt Angeles - 406 S. T .aurel St. - Limited Asbestos SIll"','ey Novemblilr 22, 2005 Page 2 of 3 )'(oN<f4~,,,,"'''~-N'{',,''''-'''''''-<fI,,,,,.~~,,,''''~~''''':~I.'''''~~'''~'T"...._-I...~..,...~..:...~.....~-I.o,:.o,:".....-I~t.... .....',~.~,'..~.....Il..................-""i....,. Suspect materials may exist in inaccessible areas such as under roofing, in ceiling or wall cavities, or other interstitial spaces. PBS endeavors to determine the presence and estimate the quantities and conditions of suspect materials in all accessible areas included in the scope .of work. Materials Sampled Building materials encountered In the proposed work area that were suspected to contain asbestos were sampled and the fallowing were analyzed to contain asbestas abave 1 %: . 12",.:12" n.oar tile (beige with small brown specks) and associated black mastic - found on the 2nd floor Equipment Roam and maybe present in other parts .of the facility .. 12"x12" loor tile (beige with brown streaks) and associated black mastic - found on the 2nn floor Equipment Room and maybe present in other parts of the facility . Window glazing compound - found on the 2nd floor Equipment Roam windows and maybe present in other parts of the facility Refer to the attachments for sample location plan (field sketch), sample inventary and laboratory analysis report. The following materials were sampled as part of this project and contained no detectlble concentratian .of asbestas: . Roofing membrane (2 layers) and rigid roof insulati.on .. 8rick mortar on roof-top chimney .. Capstone grout .. Capstane caulking . Roof flashing membrane . Vinyl sheeting (tan marbled pattern) in corridors and in Mechanical Room under flaor coating .. Paured cementitious floor coating in Mechanical Room .. Brawn baseboard and assoc.iated mastic .. Plaster c.ompasite (skim coat and plaster) walls .. Ductwork wrap and seam tape (fiberglass and foil) Materials Not Sampled (Assumed ACMs) The following materials were observed in the building (first floor) and based on the scope of work will not be impacted and were not sampled. These materials shall be presumed to be ACM unless testing proves attaerwise: . 9"x9" floor tile (brown, green. and tan) and their associated mastic . Baseboard and mastic (obselVed in select break rooms. rest rooms and perimeter office areas) . Wallboard and jaint compound ;ent By: HAIGHT ROOFING CO INC; 2067841058; May-12-06 1 :OOPM; Page 8 QW8st Port ^n!,!,eles - 406 S. I,aUIel St. - Limited Asbestl>s Survey No_mber 22. 2005 Page 3 of 3 .......,.,......"'...'......~~oI.....~..__~"l..n~...:~v.......~.c<<o(~.,.._....+......,....~~_......._."'<~..... ."._......~.~.....n__~..'.....,..._+..:".._..-."l...:,'...~""-:"No(...<l..rl.. Survey Findings The asbestos floor tile and window glazing (observed to be generally in good condition) will be impacted by the renovation project. Since the project is in the design stages, the quantities of impacted ACM is not known, The ACMs identified including cont~minated material, debris, and other presumed materials if impacted, should be removed by properly trained and asbestos certified pernonnElI using appropriate protection, work practices and engineering controls. prior to impact by demolition or renovation. A qualified asbestos abatement contractor licensed in the State of Washington should be employed to remove all such ACM accor~jjnQ to applicable local. state and federal regulations. Caution should be exercised during demolition, as concealed ACM may exist. Any material not previously identified in this survey that the contractor encounters should be sampled to determine its asbestos content prior to impact. other work that may impact asbestos should only be performed b:t personnel having proper training and utiliZing proper worker protection methods according to W1SHA standards. Work impacting asbestos is subject to the requirements of various regulations, including but not limited to: 40 CFR Part 61. NESHAPS; 40 CFR Part 763, AHERA; WAC 296-62 and 296-65; and Puget Sound Clean Air Agency Regulation III, Artide 4, Asbestos Control Standard. Respectfully. "'.;~~l~f:-(~f':::"'::':':::'~'" " . I Willem A. Mager Project Manager AHERA Bujlding Inspector Certification No.1 015477. Expires April 6, 2006 Attachments: Sample Location Plan (Sketch) PLM Sample Inventory & Laboratory Sample Results PBS' Project Personnel Certification ;ent By: HAIGHT ROOFING CO INC; 2067841058; / ~ Centr..1 Corridor ~D17 ~ l' ~012 ~1)1' -.... ~u,~ . E30H 009 wind"... gl... ",,"'pound (ACM) May-12-06 1 :OOPM; Equlpm.nt Room . 010 lIonr 1,Ie & n'.81I< (A!;M) \ Page 9 A( ACM -1n17' beige IIoor tiki & masTic L Moch."i....' Room 2nd Floor. Eastern Seotor 01 Suilcllnll ~ cnlf,,,,ey \ on~ BUildInG Roof Plan 10aaltSS ~n03 005 ~Ul. ~OD2 ~nOl ~OOH Sample Location on Roof of Building ASBESTOS (BULK) SAMPlE SYMBOLS DRAWING REFERENCE OF BULIC.SAMPLE FIELD CODE ~ (1)7- (SAMPL.E IIIUMBER). SEE INVENTORY OF SAMPLES v ______ MATERIAL TYPE SYMBOL NEGATIVE I'OSrTlH SAMPLE 6AMPLE @ . MFCHANICAl INSULATION 13 . SURfACING MATERIAL ~ . MI.aCf.l.1 A"'''OUS "A fER \J\L ~ CWEST Port Angeles. PBS Field Sketch - November, 2005 406 South lauf81 Street, Port Angeles, Washington 98362 PBS Sample Location - Not To Scale - PBS# 40591.015 Proj.c~ Sl~.. Key ;ent By: HAIGHT ROOFING CO INC; ca~ c~ $~ Ecn can ~i ct:; W II) ~ 'f ~Q. men em '&: ll. Z c ca t:: uJ U) m D.. In OJ ~ l! Cl) Q.. :) o ~ 5 o o ~ ID .!! lP D) e <C '1: o D.. iii $ a ~ ~ z w :> iE w .J a.. :liE ~ en :s r::L.. 5 -I .-J ~~ ~ ::J en Ii! 5 00 ~c;( :z :z :z o Ii: ~ Co> Ill. 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N c;; 10 q ~ .-J > :z o ~ z ~ ~ Z. IIJ :8 2 ~ ~ .,.. ... ell 5 E g a:: 1: ~ Q "5 g- w ~ z- ~~ 'E~ 1"1(1) ~ to .8 l!l ~ ~ ID r? 9 10 q ~ .... > z ~ z u 'j E i ~. (tl .... ~ !J .!,l u; '" :l: J Page 10 01 '0 ~ Q) '5 o :g 1i ,g ~ o "Z II ~ Z LO o .~ ~ ... .... ;ent By: HAIGHT ROOFING CO INCj 2067841058j May-12-06 1 :01PMj Page 11/18 ('I - In - ns~ 0 c;~ N cu_ ! .J -' ....J ....J ~ ....J ....J ~ :; .J -' -' Ea'J > > ~ ~ > > ~ > > c::1I':I Z Z Z Z. Z Z z eO -z ~t; I w cu ~ n 0 0 ~ ~ 0 0 !i 0 c ~ oge < ~ ~ ~ ~ q: c:( ~g. z z Z z :z z z z Qltn em 1:0.. "ill I ~ s:: 's. E c ~ W e CI) @ CD e a.. OJ 1! 1: ~ 'a .;;; ~ g. E 1: 1! ~ .r "" 3: '", l 'j! 3: "E ~ Q. i ld 'ii ~ ..: 'ii .r:: ~ :ll '" .... 'C:: 'i 'C:: I G; 3: ~ ~ ~ ~ ~ i 'ii "iij g ~ "iii ~ ~ ~ ii j! S 4J ~ ~ 01 cu "ii ,s ~ ~ g ~ ~ € E ti "t E '0::; ~ 'r .~ j ~ .0 .Q ,Q .0 ~ ~ U ". ~ >, GI >- -<<;- .j; !. lI; ~ '2 ~ E "2 It:! a. {l -.:: ~ I:: I!. lIS 14': F= ,Q II ..0 :II .Q III 1lI 18 loll g. j ll.. .. :$ ~ Cl ii: "" >- .21 :... ~ :;., >- >- >- ~ E ~ ~ ~ l! l:! l! S i ~ III 0 (!J Cl Cl Cl Cl ~ 0 III ~ N N .. - N i<j ~ ~ N ~ ~ ~ ~ ~ :l; ... in ~ ~ ~ i. ... ~ ~ ~ g, m >- ~. 5 ~ .5 ~ ~ ~ ~ ..'.II ~ .!l 3 ~ ~ <{ E ~ 0 I z g 0 1\ 1: ii: lr cu "Iii E E . ~ 0 1;; E IV 0 0 0 <( ~ a. m 0 0 Ii '5 € Q; Q; ~ z Q, 0"""- 0 ~ ~ ] '5 ILl 0 z S" .r::8 .g .~ 'c 1! i ~- CIII ~ .c o GI "ti -50. t: Z IV 1: Q ~ ~i ~ ~- >.1! <3 ~ :I ,Qt: o~ ... 0 g g ~ I 8~ ~ 8:2 lI'I 1f;S i:i;" E u: II: u:i CU 0 1? 5 "28 ~ "0 g ~ 9 I;: ~o " N<') NIT. N '" ..... '" e E E E OJ :2 :.2 :.2 Q. ~. e !!l ~ ::l .. .. .s 0 1. .=: .~ j j :;; ~ iii ~ ~ Q. > D.. ~ 1! ,_ ~ a: ; E E ~ e ::>- 8~ 8 .~ 0- l ~~ ;;:: ~ =~ o Q; .., ~ ~.... -u ...,. ~ 0 ~~ ~~ ~~ '"" !~~ I- III 0 Z IV ... ~ c:: .%i 0 8 ~::I a: W (j~ Oi~ "-.c u -~g j~ lit > ; I;; 1'lii i~ 8 8 ~8~ CU i!: zr8 [(8 ii: iI 'iG OJ W ro- en ell ~ C ..J .... II) co <C 9 ..- ~ q 9 9 ~ ~ '7 "I:: :: 10 I() .,., 10 'f) on In 0 ~ ... e; ~ ..- C! c; 11. c( ~ C! In en I - m I ~ 91 ~ ~ - ~ (It ~ ~ ~ ~ ~ .... ...- a a.. ~ ;ent By: HAIGHT ROOFING CO INC; OO~~~) l~b CQlI~' 102083 .- AIH" ....,,~ W1~ --- AOOREDITED I.ABORATORY AIH.4 -III Lab Code: 10186, .tL 1II1011ATIl~ln.I.( 470e AUI'IfIRA A'f. N ~ATTl(. WA.9&ll.'Gti!il-'; 1'f.L toC.S47.0HID "AX le6 fi~-I.4 ; Il:,j, nvlld~>~.II...IIJtl~ C'nnl 2067841058; May-12-06 1 :01PM; Page 12/18 "Ala.eauJ MaTERIALS lIII"",....rr.t.A("Nl . HCI.:rolf'lr, .. LAC. o;r.nvu".~, November 14, 2005 IN ":~'::';IL .'.:;" h." Willem Mager PBS Environmental (Seattle) 130 Nickerson 5t Suite 107 Seattle, WA 96109 .l A B S HAZARDOUS MAT...IAL5 !; ~ R V I ( f 5 RE: BUlk ASbetst08 Fiber AnalysIs: NVL Batch # 2516446.00 Dear Mr. Mager, Enclosel:1 plel:l~1:! find test results for the bulk samples submiUed \0 our laborCltory for analysis. Examination of these sample:. was conducted For the presence of identifiable asbestos fibers using polarized light microscopy (r>LM) with dispersion staining in accordance with U.$_ EPA/600JR-93/116 1'est Method. For samples corltaining more than one separable layer of malerials, the report will include findings for each layer (labeled Layer 1 and Layer 2, etc. for each individual la~r). The asbestos concentration in Ihe sample i:o determined by visual estimation. For those samples wilt! asbestos concentrations between 1 and 10 percent based on visual estimation, the EPA recommends 3 procedure known illS point counting (NFSHAPS, 40 CFR Part 61). Polnl counting is a statistically mere accurate means of qu;;ntification for samples with low concentrations of asbestos. If you would like us to further retinethe concentration estimates of asbestos in these samples using point counting, please let me know. This report is considered hig,hly confidential and will not be released wIthout your approval. Samples me archived for two weeks following analysis. Samples thai are nut relneved by the client am discarded after Iw() weeks. . Thank you for using our laboratory services. Please do not hesitate to call if Ihere is anything furtf1er we can assist you with. Sincerely, ~ --- - ..----- Nicfti.y, Tochnical Director Enc.: Sample Re$ults wvr....ntl'll.b'.(om t.8118.NVI_l495 ",~~ ,22.... ;enL sy: HAIGHT ROOFING CO INCj 2067841058j May-12-06 1 :01PMj Page 13/18 N\A..1 ;tncftu~ Ire. 4706 Aurora Avl:t. N., Seattle, WA 98103 reI: 206.547.01UU, Fax; 206.63-4.1936 _.nllllabs.com !F.l,V/~-iJ #102063 8Li<A<b9 ~ FbersAralysis By Polarized light Microscopy Client: PBS Environmental (Seattle) Address' 130 Nickerson SI Sult.e 107 Seattle. WA 98109 Attention: Mr. Willem Mager Project Location: Owest PorI Angeles - RCXlflHVAC Batch #: 2516446.00 Client Project #:40591.015 Samples Received: 20 Samples Analyzed: 20 Method: EPAl600R-93/116 lab 10 : 25098601 Client Sample #: 40591.015-001 Location: Owest Pori Angeles - Roof/HVAC layer 1 of 2. DescnpUon: Btack asphatUc material Non-Fibrous Materials: AsphaftlblndGr Layer 2 of 2 De15cription: Gray fibrous material Non~Fibrous Materials: Binder/Filler ub 10 : 25098608 Client Sample II: 40591.015-002 Location: Owe:!t Port Angeles - Roof/HVAC Layer 1 of 2 De8criptlon: Black asphellic material Non-Fibrous Materials: Asphaltlbinder Layer 2 of 2 Description: Gray fibrous material Non-Fibrous Materials: Binder/Fifter Lab 10 : 25098609 Client S..mple #; 40591.015-003 Location: Owest Port Angeles - Roof/HVAC laye' 1 of 2 Oes.c.rlptlon: Bleck asphaltic material Non~Fibrous Materials: Mphall1binder layer 2 of 2 D9Scriptton: Gray fibrous material Non-Fibrous Materials: BindeaFlller lab 10: 25098610 Client Sample #; 40591.015--004 Location; Owesl Port Angeles - Roof/HVAC Layor , of 1 Description: Gray sandy brittle malerial Non-Fibrous Materials: BiJ'ldl'Jrtriller. Send Lab ID : 25098611 Cl1ent Sample #: 40591.015-005 Location: Owesl Port Angeles - RooflHVAC Other Fibrous Materia/S:% Glass fibers 20"10 Asbestos Type: % None DelCCled NO Other Fibrous Materials;% Cenulose 70% Asbestos Type: % None Detected NO Other Fibrous Materials:%1 Glass fibers 20% Asbestos Type: % None Detec1ed NO Other Fibrous Materials:% Cellulose 70% Asbestos Type: ./0 None DetGCted NO Other Fibrous Materials:% GI~Jl;S fibers 20% Asbestos Type: % None Datected NO Other Fibrous Matenals:% Cellulose 70% Asbestos Type: % None Detected NO Other Fibrous Materials:% CelluloSB 2% Asbestos Type: % Nonl!l Detected NO .~~ .. /~.~. ~~~) Nick Ly _f1~L[)j~ Sampled by: Client Analyzed by: Wei Long Tai Date Analyzed: 11/14/2005 \. Reviewed by: Nick Ly O~ Issued: 11/1412005 Note; If sa"1'les are nOt hCrTIOQ8neou5l, Insn sUbs.;m-pe$ 011719 ~BnlS \&ICre analyZed separalllly. All bulk 5B1Tlf-S 3tti analyUol<J u~lng EPA 600/R.931116 Melh(ld IOIith the following measurvmenl unc:er13in6as for the repotlOO % Astlesbo (1%"0-3%, :i"""=1-9%, 10%=~'5%, 20%-10-30%. 50%;40-6O'Y.'. This repCll'l relates only b;)!he ilems Iesled. If sample was not collected by NVl. per:lOOr'lef, then the :lCll::.m.cyolltlo results j.s limited b~ the metnooology and acuity of the sample ooIlR<:luo. This feport shall 001 be reproduced elO;cept in full. without \I'tI'Ilten approval c;rl NVL. Laboratories, Inc.. It shall nol b9 u"..d to claim prexllrl endon>emen1 by NVlAP or alW oll'ler agency (If lI'Ie US (;Q\lemmeMf. Page 1 of 5 ;enT ~y: HAIGHT ROOFING CO INC; 2067841058; May-12-06 1 :02PM; Page 14/18 NVL~, Ire. 4708 Aurora Ave. N.. Sealtlfl, WA 014103 Tel: 206.547.0100, Fax: 206.6~4.1936 www.nlrllabs.com 8uk~ ResAratySs [~,":,..../-C!,~ #102063 By Polarized Light Microscopy . Client: PBS Environmental (Seatlle) Address: 130 Nickerson St Suite 107 Seattle. WA 98109 Attention: Mr. Willem Mager Project Location: Qwes! Port Ange1e$ - Roof/HVAC Batch #: 2516446.00 Client Projecl #:40591.015 Samples Received: 20 Samples Analyzed: 20 Method: EPAJ600R-93/11G Layer 1 of 1 Description: Gray sandy brittle material Non-Fibrous Materials: Binc:ler/FUIer, Sand Lab 10 : 25098612 CUent Sample #: 40591.015-006 Location: awes! Port AngftlR!': - RooflHVAC layer 1 of 2 De5cripUon: Yellow sandy brittlo material Non-Fibrous Materials: Binder/Filler, Sand la~er 2 of 2 Descriptic>>n: White soft material Non-Fibrous Materials: Binder/Filler Lab ID : 25098613 Client Sample #: 40591.015-007 location: Qwest Port Angeles - Roof/HVAC layer 1 of 1 Description: White soft material Non-Fibrous Materials: Bindet/FlIler Lab 10: 25098814 Client Sample'll: 40591.015-008 Location: Owesl PorI Angeles - Ruof/HVAC Layor 1 of 1 . Description: Black asphaltic malerial Non-Fibrous Materials: Asphalt/binder Lab 10 : 25098615 Client Sample"': 40591.015-008 Location: Owesl Port Angeles - RoofJHVAC . Layer 1 of 1 Des~riplion: Gray brittle m~tcri~1 with paint Non-Fibrous Materials: Binder/Filler, Paint Lab ID : 25098616 Client Sample #: 40591.015-010 Location: Owesl Port Angeles - Roof/HV AC layer 1 of 2 D"criplion: ~eige 1ilo Non-fIbrous Materials: Vinytlbinder Other Fibrous Materials:% Cellulose 2% Asbestos Type: % None Detected NO Other Fibrous Materials:% Cellulose 2% Asbestos Type: % None Detected ND Other Fibrous Materials:% CellulOse 3% Asbestos Type: % None Detectod ND Other Fibrous Matenals:% ~lIulose 3% k5bestos Type: % None Detected NO Other Fibrous Materials:% Glass fibel'5 4% Asbesto$ Type: % None Detected NO Other Fibrous Materials:% Cellulose 1 % Asbestos Type: % Chrysotile 2". Other Fibrous Materials:% CeUuloso 1 % Asbestos Type: % Chrysotile 2% Sampled by: Client Analyzed by: Wei long Tai Reviewed by: Nick Ly Date Analyzed: 11/14/2005 Date Issu9d: '1 "\ J-14/2005 ~ Nl~.1c L ; e~h. -..:::. ~ ~-= --- -'--- Nob;!: Ir samples are not l'IolTlOl:leneous, then sub9ampl$!; of the COf'Tl'O"9ntl; _re analyzed separlilllly. All bulk lSample~ are analyzed USing EPA OOOiR-93/116 Melhod with I/~ rOllowlng rTlI;lasur.",.,,1l uncerlailllies tor the repOl'18d % Asbe5lios (1%=0-3%, 5%"'..g'l(.. 10%~5 150"'-.20%-"'10-30%. 50%=40-60%). This report relD~ only to the Items b3~. If $:;ImptE! was nol colJedP.d by NVl oerson!llill, men lhe ilcClJra::y or me relIults is tlrn/lea b)' the methodOlogy :mcl :lr:\Jity 01 me sample OOIIeCll:lr. This report snail not be reproduced exooplln full. u,oi\tl(}u! written appro)/;l' or NVL Laboralorie~. Inc. II shall no' bE! u~ed Ie clElim oroduct endornement b~ NVLAP or any other 3Qeney of tho US GQY9l'nrnent. f"age 2 of:; ;ent By: HAIGHT ROOFING CO INC; 2067841058; May-12-06 1:02PM; Page 15/18 NVL Lchrdkres, Ire. <1'08 AUrOtEl Avo. N.. Seat1le, WA 98103 Tp.I: 206.547.0100. Fax: 206.63<'l.1a36 _.nvll:Jbs.com BukA$~6Fbers~ Li~J'~'C!.b~ll . \J #'\02063 By Polarized Light Microscopy. Client: PSS Environmental (Seattle) Address' 130 Ni(:kerson 5t Suite 107 Seattle, WA 98109 Attontlon:Mr. Willem Mager PrQject Location: Qwest Port Angeles - Roof/HVAC Batch #: 2516446.00 Clienl pruject #:40591.015 Saf11ple~ Received: 20 Samplos Analyzed: 20 Method: EPAl600R.93/116 LaY9r 2 of 2 Descriplion: 81Glck. maslic; Non-Fibrous Materials: Masticlblnder Lab 10: 25098617 Client Sample II: 40591.015-011 Location; Owest Port Angeles - Roof/HVAC Layer 1 of 2 DlIscriptlon: Beige tile Non-Fibrous Materials: Vinyllblnder Other Fibrous Materials:% CelluloSR 10% Other Fibrous Materials:% Cellulose 1% l;tyer 2 of 2 Description: Black mastic Non-Fibrous Materials: Other Fibrous Materials:% MasticIDlrlOer Cellulose 10% Lab'ID : 25098618 Client Sample": 40591.015-012 I.ocalion: Qwest Pon Angeles - Roof/HVAC uyer 1 of 2 Description: Gray yinyl Non-Fibrous Materials: Other Fibrous Materials:% Cellulose 10% Vlnyllbinder layer 2 of 2. Description: Tan woven fibrous material with mastic Non-Fibrous Materials: Other Fibrous Materials:% BinderlFiller, Mastic/binder Cellulose G5% Lab 10 : 25098619 Client Sample #: 40591.015-013 Location: awest Port Angeles - ROQf/HVAC Layer 1 of 2 DescriptIon: Brown rubbery material . Non-Fibrous Materials: Rubber/binder Layer :2 of 2 Deac.r1ption: Brown ma$lic Non-Fibrous Materials: Masticlbinder lab ID : 25098620 Client Sample #: 40591.015-014 Location: Owes! Pan Angeles - Roof/HVAC l.ayer '1 ot '2 Oescriptlon: White brittle ma'eria~ with paint Non-Fibrous Materials: Binder/Fillor, Paint Sampted by: Client Analyz@d by: Wei long Tai Revie"lllted by: Nick Ly Other Fibrous Materials:% None Detected NO Other Fibrous Materials:% Cellulose 3% Other Fibrous MaterialS:% Cellulose 2% Asbe5tos Type: % Chrysolile S% Asbestos Type: % Chrytiatile 2% Asbestos Type: % Cl'lrysotile. 5-Jo AsbestO$ Type: % None Detected NO Asbestos Type: 0/.. NOlle Qetltcted NO Asbestos Type: % None Detected NO Asbestos Type: % None Detected NO Asbestos Type: % None Detected NO Date Analy%ed: 11/14/2005 Date Issued: 11/1412005 Nick -I .' Note; II IiCllltpll!o8 are nol horrogeneouS. tnan su:bsan-ples of the COI'IlC)OI'Iems ...em analvzed separilll:ly. An bulk samplee are an;llyzed using EPA 6001R-fl3/116 Metrlnd...;1I't lt1e fOflOlll'ing n-.:lul<l!lnE!nl unccr1akltle.:l for lhc teP<J!'1lJd % ~e51l:l\l (1%=0-3%, 5%=1-9%. 10%-5-15%.20%=10-30%, 50%=40-60%), nllg report relal9s only In the IIAms wsl9d. II SCllTllllP. _s no! CXIII~ by NVL personne.l. Ihelllne a[;UI'ilIG)' of lhe msul15 ;5 limted by the mttlnf)tlnlngy and acuiw I)f the sample CA;llle<::tor. This rapert 5tlall not bG I'Elprocluc;:.,.d El"CSP\ In full. 'fIIiltJout -men approv;:)l of NVl liworatnnes. Inc:. It 5hell not be u5ed 10 claim product endorllement by NVLAP Of allY olher ~nt;y "'lhe uS GQltemment. Page 30/5 :enL ~y: HAIGHT ROOFING CO INC; 2067841058; May-12-06 1 :02PM; Page 16/18 NV1... LcIDabies, re <1108 Aurora Ave. N.. Seattle, WA 98103 Tql: 2.06.547.0100. Fa)!;: 206.834.1936 www.rwllabs.cnm 8ukA~Fles~ By Polarized light MicrOSGDpy Cllen!: PBSEnvircinmenlaJ (Seeltle) Address: 130 Nickerson 51 Suite 107 Seattle. WA 98109 Attention: Mr. Wlllem Mager Project Location: Owesl Port Angeles ~ RooflHVAC Batch '#: 2516446.00 Client Project #:40591.015 Samples Received', ~o Samples Analyzed: 20 Metl1od: EPA/600R-931116 Layer 2 of;2 Desc;:rlptlon: Gray sandy britUe material Non-Fibrous Materials: B1noerlFiller, Sana Lab /D : 25098621 Client Sample II: 40591.015-015 Location: Owesl Port Angeles - Roof/HVAC Layer 1 of 2 ~5erlptlon: White briUle material with paint Non-Fibrous Materials: Binder/Filler. Painl Layer 2 of l! Ousc::ription: Gray sandy brittle malerial Non-Rbrous Materials: BlnderlFillBr, Sand Lab 10: 25098622 Client Sample #: 40591.015-016 t()r::~til)n: QWRl'>1 Pori Angeles - Roof/HVAC Layer 1 of 2. Description; White brittle material wiLh paint Non-Fibrous Materials: Binder/Filler, Paint Layer 2 of 2 Description: Gray sandy briltlEl malerial Non-Fibrous Materials: BindcrlFiller. Sand Lab 10; 25098623 Client Sample II: 40591.015..()17 Location: Qwest Port Angeles. Roof/HVAC LaYllr 10f 1 Descrtptlon: Gray sandy brittle material with paint Non-Fibrous Materials: Binder/Filler, Pi!llnl Lab 10: 25098624 Client Sample #; 4O~1.015-o18 Location: Owest Port Angeles - Roof/HVAC Layer 1 of 1 DescriptioJ\: Gray sandy britUe material with paint Non-FibrOlls Materials: Blotter/Filler, Painl Lab \0 : 25098625 Client Sample #: 40591.015-019 Location: Qwesl Port An9cle$ - RooffHVAC Other Fibrous Materiats:% Collulose 3% Asbestos Type: % None Detected NO Other Fibrous Materials:% Cellulose 2% Asbestos Type: % None Detected ND Other Fibrous Materials:% Cellulose 3% Asbestos Type: "/0 None Dotectl:ld ND Other Fibrous Malerials:% Cellulose 2% Asbestos Type: %.. None Detected NO Other Fibrous Materials:% Cellulose 3% Asbe,.tos Type: % None Detected NO Other Fibrous Materlals:% Cellulose 3% Asbestos Type: ./0 None Detected NO Other Fibrous Mnterials:% Cellulose 3% Asbestos Type: % None Detected NO Sampled by: Client Analyzed by: Wei Long Tai Reviewed by: Nick Ly Date Analyzed: 11/14/2005 Date Issued: 11/14/2005 ~:----- ~........-._.. --..,. ... ~ .'~ NiCK L . ~~~""") Note: If samples are not homogl!neous. therI subsafTl,lies of the carnponen15 W'le11:l analyZed separately. All bulk samples are analyzed using b.PA tiUU/R-93/116 Mett\OCI Wlthlhe rollO.vlng IllIl'asurement unCXlrlaln~e5 for the I1ilporled % Astrei;1oE; (1%=0-3%,5%"'1-9%.10%-5.15%,20%:10.30%, 50%=40.60%). This repor1 relams only Ie llle ile.fJS 19s~. If 9Smple was nor r:nIl~ by NVl D8rsonnp.l. Ihen lhe accur<lcy tlf tilt! t"SlJlts is Iirnil$l1 by the mclhodologyand acuity of the samplE! coIleclDr. This report shall nol be I1'lptoduCIld e'Cl'1.pl in fuU, wilhout written approval f)f NVL Lebor<tlorip.s, Inc. It 5hal~ IYlI tip. IIS1ld \0 daim prodlJcl ur'ldorsemenl by NVLAP or any olher agency of Ihe US GOllefnment, Pane 4 of 5 ;ent ~y: HAIGHT ROOFING CO INC; 2067841058; May-12-06 1 :03PM; Page 17/18 N\IL l.atnatOOes, Inc. 4708 AUrO~a Ave, N., Seattle, WA 98103 Tel; 206.547.0100, Fal(: 206.631.1936 _.nvllab5.c;orn BuIk~.Fbers~ ay Polarized Light Microscopy o-:nw)'l1LA'tfJ 11102003 Client: PBS Environmental (Seattle) Address: 130 Nickerson St Suite 107 Seattle. WA 98109 Attention: Mr. WlIJem Mager Project Location: Qwest Port Angeles. Roof/HVAC Batch #: 2516446.00 Chent Project #:40591.0'15 Samples Received. 20 Samples Analyzed: 20 Method; EPAl600R.93/11S ~ Layer 1 of 1 Description: Gray soft matar:;!1 with sand Non~Fibrous Materials: BInder/Filler. Sand Other Fibrous Materials:% Cellulose 3% Synthetic filJell'i 20% Asba5tos Type: % None Detected NO !;.... . lab 10 = 25098626 Client Sample #: 40591.015~20 LOcation: Qwest Pori Angeles - Roof/HVAC layer 1 of 3 D&scrlptJon: White paper Non-FlbroljS Materials: Ottler Fibrous Ma1erials:% Bindor/Filler. Cellulo6e 70% L:lI~o' 2 of 3 Doscription: Silver paper with maSlic and white woven fibrous material Non-Fibrous Materials: Other Fibrous Materials:% Binder/Filler, M~stic/binder Glass tibers 20% Layor 3 of 3 Description: 'fellow fibrous material Non-Fibrous Materials: Binder/Fillet' Asbestos Type: % None Detected ND Asbestos Type: % None Detected ND . Other Fibrous Materials:% Glas5 fibers 8O'Y.. Asbestos Type: % None Detectod ND Sampled by: Clienl An8ty~ed by: Woi Long Tei Reviowod by: Nick Ly ~ Note: If SdrJ'lll9S dire nat I10m0gBfl9OU1l. Ihon $1.ltlsan'ul9$ of Ihe components W0ffl 3IMly.red separately. All Culk s..mpJes :lre analyzed UIW'Ig LI-'A 6OOIR-931116 Method with !he following meBsurement u/lo:malr11ie5 for the reported 'I(, ASbeSIDS (1%-:()..3%. 5%=1-9%. 10%=5.15%.20%='0-30%, 5O%=4()-{l0'Jl,I, Th~ repon relates only 10 the i1ems bleCl. " 5alT1ClJe was not ~lIeclDd by H\II.. pel'5onnel, lhen th.. a=ulClcy 0' It'Ie l'e~l.Il1B is limited by the methodology ..nd acuity of the sampfe ('..nI'"dor. Thi,; rllpult shall not be reproduGtld a.cepl in rulf. without wri,tlen ap;n()val aT NY!. l.abor"'1orie:s. ,nc. It "h>'lU nnt be used to daim prOClUCI enrxv-~",ment by NVLAP or any oll'1P.' :1t!)F:ncy at the US Govemmenr. Date Analyzed: 11/14/2005 Date tssued: 11/1412005 ~ - -- . ........ '" . ---. Nick Ly.<'--' '.~ Page 5 or 5 ,enl ~y: HA1GHr ROOFING CO INC; . 2067841058; May-12-06 1 :03PM; Page 18/18 l7 r . d '-" '-'" SS01p8L 01 SBLl 288 9B2 2082 W~ ~2~1d 113B ~~ 20:81 9082 21 ^~W Look Up a Contractor, Electrician or Plumber License Detail Page I of3 Topic Index Contact Info r.... Safety ClaIms & Insurance _"ry,__m .__, Workplace Rights.Trades & Ucen3ing Find a Law or Rule Get a Form or Publication Look Up a Contractor, Electrician or Plumber Printer FrieDdlY_Y~Lsion ,General/Specialty Contractor A business registered as a construction contractor with LEi I to perform construction work within the scope of its specialty. A General or Specialty construction Contractor must maintain a surety bond or assignment of account and carry general liability insurance. License Information License HAIGHRC269QK Licensee Name HAIGHT ROOFING COMPANY INC Licensee Type CONSTRUCTION CONTRACTOR UBI 600142367 _\'erjN WOLlseLs_CoJOPYremium 51aJus Ind. Ins. Account Id Business Type CORPORATION Address 1 4910 15TH AVE N.W. Address 2 City SEATTLE County KING State WA Zip 98107 Phone 2067848414 Status ACTIVE Specialty 1 GENERAL Specialty 2 UNUSED Effective Date 11/12/1974 Expiration Date 5/11/2008 Suspend Date Separation Date Parent Company Previous License Next License Associated License https://fortress.wa.gov/lni/bbip/Detail.aspx?Li cense= HAl GHR C269Q K 5/12/2006 g \!l! CITY OF PORT ANGELES PUBLIC WORKS - ELECTRICAL DIVISION l21 EAST 5TH STREET. PORT ANGELES. WA 98362 Appl~cat~on Number Application pin number, Property Address ASSESSOR PARCEL NUMBER' Appl~cation type description Subdivision Name Property Use Property Zoning Application valuation 06-00000426 Date 191256 406 S LAUREL ST 06-30-00-0-0-8800-0000- ELECTRICAL ONLY 5/09/06 RESIDENTIAL HIGH DENSITY o Owner Contractor US WEST COMMUNICATIONS INC KC COX MGR-PROP TAX ENGLEWOOD CO 80111 JOHNSON ELECTRIC 11816 NE 116TH ST KIRKLAND KIRKLAND WA 98034 (425) 821-8226 Permit Add~tlonal desc Permit p~n number Sub Contractor Permit Fee Issue Date Exp~ration Date ELECTRICAL ALTER COMMERCIAL JOHNSON/ 1-5 CIRCUITS 76547 JOHNSON ELECTRIC 61 30 Plan Check Fee 5/08/06 Valuation 11/04/06 00 o Qty Unit Charge Per 1 00 61 3000 ECH EL-COMM ALT <5 CIRCUITS Extension 61 30 ~ ~ Fee summary Charged Paid Credited Due ----------------- ---------- ---------- ---------- ---------- Permit Fee Total 61 30 61.30 00 .00 Plan Check Total .00 00 .00 00 Grand Total 61 30 61 30 00 00 lJ\ t ~ COMMENTS! ACTION NEEDED ELECTRICAL PERMIT INSPECTION RECORD CALL 417-4735 FOR ELECTRICAL INSPECTIONS. PLEASE PROVIDE A MINIMUM 24 HOUR NOTICE. IT IS UNLA WFUL TO COVER, INSULA TE OR CONCEAL ANY WORK BEFORE IT IS INSPECTED AND ACCEPTED. KEEP PERMIT CARD AND APPROVED PLANS AT JOB SITE INSPECTION TYPE DATE ACCEPTED COMMENTS YES NO UITCH 11I1I1(~I-I_lN !l,;UV.hK SERVICE - 14TNAl ~~5"'()6 ~ GENERAL COMMENTS: PW-II02.1S (4196) g Yl CITY OF PORT ANGELES PUBLIC WORKS - ELECTRICAL DIVISION 121 EAST 5TH STREET. PORT ANGELES. WA 983()2 Appllcation Number Application pin number Property Address _ ASSESSOR PARCEL NUMBER. Application type description Subdivision Name Property Use Property Zoning Application valuation 07-00000080 Date 048240 406 S LAUREL ST 06-30-00-0-0-8800-0000- ELECTRICAL ONLY 2/05/07 RESIDENTIAL HIGH DENSITY o Owner Contractor US WEST COMMUNICATIONS INC KC COX MGR-PROP ~AX ENGLEWOOD CO 80111 JOHNSON ELECTRIC 11816 NE 116TH ST KIRKLAND KIRKLAND WA 98034 (425) 821-8226 Permit Addltional desc . Permlt pln number Sub Contractor Permit Fee Issue Date Expiration Date ELECTRICAL ALTER COMMERCIAL JOHNSON EL/ 1 CIR 94003 JOHNSON ELECTRIC 58 00 Plan Check Fee 2/05/07 Valuatlon 8/04/07 .00 o ~, ~ Qty Unlt Charge Per 1 00 58 0000 ECH EL-COMM ALT <5 CIRCUITS Extension 58 00 CA -----;~~-~~~~~~;-------};~~~~~~--------~~~~------;~~~~~~~-------;~~--------- ----------------- ---------- ---------- ---------- ---------- Permit Fee Total 58 00 58 00 00 00 Plan Check Total 00 00 00 .00 Grand Total 58.00 58 00 00 .00 ~ COMMENTS/ACTION NEEDED ELECTRICAL PERMIT INSPECTION RECORD CALL 417-4735 FOR ELECTRICAL INSPECTIONS. PLEASE PROVIDE A MINIMUM 24 HOUR NOTICE. IT IS UNLA WFUL TO COVER, INSULATE OR CONCEAL ANY WORK BEFORE IT IS INSPECTED AND ACCEPTED. KEEP PERMIT CARD AND APPROVED PLANS AT JOB SITE INSPEC'J10N TYPE DATE ACCEPTED COMMENTS , YES NO UIH":l1 lUll TGH.IN / '1 IV.... K - ........... .....&, SERVICE FINAL '5'-/S' "07 MrfJ GENERAL COMMENTS: PW-I 1112.1' 14196) PREPARED 7/21/06, 8:15 52 CITY OF PORT ANGELES INSPECTION TICKET INSPECTOR. JAMES L LIERLY PAGE DATE 9 7/21/06 ADDRESS TENANT, NBR CONTRACTOR OWNER PARCEL APPL NUMBER: 406 S LAUREL ST QUEST COMMUNICATIONS JOHANSEN MECHANICAL INC US WEST COMMUNICATIONS INC 06-30-00-0-0-8800-0000- 06-00000282 COMM REMODEL SUEDIV: PHONE PHONE (425) 481-2266 PERMIT: BPC 00 BUILDING PERMIT - COMMERCIAL REQUESTED INSP DESCRIPTION TYP/SQ COMPLETED RESULT RESULTS/COMMENTS ~~~~-~~----;/;~/~~---ti-;---------~~~~~~~~~~~~~:::;~~~--~;~~~------------------------------------ 07/20/2006 10 21 AM DYASUMUR --------------------------- ---------------------- --- --------------------------------------------------------------------- PERMIT: ME 00 MECHANICAL PERMIT REQUESTED INSP DESCRIPTION TYP/SQ COMPLETED RESULT RESULTS/COMMENTS MERP 01 6/21/06 JLL MECHANICAL REFRIGERANT PRESS. 6/21/06 AP PRESSURE CHECK OK 325 PSI EACH SIDE M"'_"'____'I"I"___~---~~:::::.::::::., ::::::~_:::::::::::::::::::::::::::_____ PREPARED 6/21/06. 12:46 10 CITY OF PORT ANGELES INSPECTION TICKET INSPECTOR JAMES L LIERLY PAGE DATE 3 6/21/06 ADDRESS TENANT, NBR: CONTRACTOR OWNER PARCEL APPL NUMBER: 406 S LAUREL ST QUEST COMMUNICATIONS JOHANSEN MECHANICAL INC US WEST COMMUNICATIONS INC 06-30-00-0-0-8800-0000- 06-00000282 COMM REMODEL SUBDIV PHONE PHONE (425) 481-2266 PERMIT: ME 00 MECHANICAL PERMIT REQUESTED INSP DESCRIPTION TYP/SQ COMPLETED RESULT RESULTS/COMMENTS ~--~/;~/~~----;~~-------~~~~~~~~~-~;~~~=~~---;~~~~-~;~~~------------------------------- _________~~----~---::~::~~~~~10~~~:~ R~~G ~~~~~~O~-~~~~~-~~~~~~~~-~~-~~~~~~. gT~'~6':~~=mm 73e>l1f ~Es ~4~~z: d ~ORT ~ S ~,.~ L~ ~ ~~ CITY OF PORT ANGELES DEPARTMENT OF COMMUNITY DEVELOPMENT - BUILDlNG DIVISION 321 EAST 5TH STREET, PORT ANGELES, WA 98362 Application Number Application pln number Property Address ASSESSOR PARCEL NUMBER: Tenant nbr, name . . Application type descrlptlon Subdlvlslon Name Property Use Property Zoning . . . Application valuatlon 06-00000282 124056 406 S LAUREL ST 06-30-00-0-0-8800-0000- QUEST COMMUNICATIONS COMM REMODEL Date 4/14/06 WA 98072 hN~- 7 al /c:J(p ~. /1 ---S" ~'C90 RESIDENTIAL HIGH DENSITY 130000 Owner Contractor US WEST COMMUNICATIONS INC KC COX MGR-PROP TAX ENGLEWOOD CO 80111 JOHANSEN MECHANICAL P. 0 BOX 1768 WOODINVILLE (425) 481-2266 INC Permit Additional desc . Permit pin number Permit Fee Issue Date Explratlon Date BUILDING PERMIT - COMMERCIAL 73940 1188.25 Plan Check Fee Valuation 772.36 130000 10/11/06 Qty Unit Charge Per Extension 1020.25 168.00 BASE FEE 30.00 5.6000 THOU BL-100,001-500K (5.60 PER K) Permit . . . . . Addltlonal desc . Permlt pln number Permlt Fee Issue Date Expiration Date . MECHANICAL PERMIT 73957 107.70 Plan Check Fee Valuation .00 o 10/11/06 Qty Unlt Charge Per Extension 50.00 36.40 21. 30 BASE FEE 2.00 18.2000 ECH ME-INSTALL 100+ FAU 2.00 10.6500 ECH ME-OTHER APPL. N/R Fee summary Charged Paid Credlted Due ----------------- ---------- ---------- ---------- ---------- Permit Fee Total 1295.95 1295.95 .00 .00 Plan Check Total 772.36 772.36 .00 .00 Grand Total 2068.31 2068.31 .00 .00 ~ ~ ~ C/\) " }'---- ~ ~ ~ Separate Permits are required for electrical work, SEPA, Shoreline, ESA, utilities, private and public improvements. This permit becomes null and void if work or construction authorized is not commenced within 180 days, if construction or work is suspended or abandoned for a period of 180 days after the work as commenced, or if required inspections have not been requested within 180 days from the last inspection. I hereby certify that I have read and examined thiS application and know the same to be true and correct. All provisions of laws and ordinances govemlng 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 constru tion. I( - I Y -0 0 Date Signature of Owner (If owner is builder) T IPohclesll102_15 bUlldmg penmt mspectIOn record05 wpd [1/4/2005] BUaDING PERMIT INSPECTION RECORD CALL 417-4815 FOR BUILDING INSPECTIONS. CALL 417-4735 FOR ELECTRICAL INSPECTIONS. CALL 417-4807 FOR PUBLIC WORKS UTILITIES 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 I YES I NO FOUNDATION: FOOTINGS SHEAR WALLS 1 WALLS FOUNDATION DRAINAGE 1 DOWN SPOUTS PIERS POST HOLES (POLE BLDGS ) PLUMBING UNDER FLOOR 1 SLAB ROUGH-IN WATER LINE (METER TO BLDG) GAS LINE FINAL DATE ACCEPTED BY BACK FLOW 1 WATER AIR SEAL WALLS CEILING I I FRAMING JOISTS 1 GIRDERS SHEAR W ALL/HOLD DOWNS WALLS 1 ROOF 1 CEILING DRYWALL (INTERIOR BRACED PANEL ONLY) T-BAR INSULATION SLAB I WALL 1 FLOOR 1 CEILING I MECHANICAL ;<.T hIUlo?-~ HEAT PUMP 1 FURNACE 1 DUCTS GAS LINE U/~ DATE ~ WOOD STOVE 1 PELLET 1 CHIMNEY FINAL ACCEPTED BY , COMMERCIAL HOOD 1 DUCTS MANUFACTURED HOMES FOOTING 1 SLAB BLOCKING & HOLD DOWNS SKIRTING PLANNING DEPT SEPARATE PERMIT #'s SEPA PARKlNGILIGHTING ESA- LANDSCAPING SHORELINE: FINAL INSPECTIONS REQUIRED PRIOR TO OCCUPANCY/uSE RESIDENTIAL DATE YES NO COMMERCIAL DATE ACCEPTED YES NO ELECTRICAL - LIGHT DEPT 417-4735 ELECTRICAL LIGHT DEPT CONSTRUCTIONR W IPWI CONSTRUCTION - R W ENGINEERING 417-4807 PW 1 ENGINEERING FIRE 417-4653 FIRE DEPT PLANNING DEPT. 417-4750 PLANNING DEPT. , I BUILDING 417-4815 BUILDING "1/ .",/ tJ"1. I~ T \Pohcles\ 1102 15 butldm nnItms lIOn record05 w 1/4/2005 I ~ \ ~ ~~ t~ '';: ~ V 1 gpe pee pd[ BUILDING PERMIT - APPLICATION Fill out COMPLETEL Y and in INK. Your application and site plan MUST B COMPLETE to be accepted for review. If you have any questions, call PERMITS (360) 417-4815 FAX(360)417-4711 Applicant or Agent: Johansen Mechanical, Inc. Phone: 425-481-2266 Owner Qwest Communications Phone: 206-345-4416 Address: 1600 7th Ave., Room #2302 City: Seattle Zip' 98191 Architect - KDW Architects 206-547-1940 ArchItect/Engmeer:Enqineer - Tres West Enqineers Phone' 253-472-3300 Contractor Johansen Mechanical, InC3bte LIcense #JOHANMI173PKExp:2/1 /07 Phone: 425-481-2266 Address 20109 144th Ave. N.E. CitY" Woodinville Zip' 98072 PROJECT ADDRESS. 406 S. Laurel Street, Port Angeles ZONING: Res/High Densitv LEGAL DESCRIPTION' Lot: 1,2&3 CLALLAM COUNTY PARCEL NUMBER: Block' 86 063000008800 SubdIVIsIOn: Credit Card Holder Name. BIlllOg Address. CredIt Card Type VISA _ MC _ # TYPE OF WORK: o ReSIdentIal 0 New Constr. 0 Re-roof 0 Stove o MultI-family 0 AdditIOn 0 Move 0 Garage K CommercIal eX Remodel 0 DemolitIOn 0 Deck o Repair 0 Sign 0 Other BRIEF DESCRIPTION OF THE PROJECT A/C equipment per drawings. piping, per drawings. COMMERCIALIRESIDENTIAL: Occupancy Group. B SIZEIV ALUATION: SF @ $ ISF = $ SF. @ $ ISF = $ SF @ $ ISF = $ TOTAL VALUATION $ 130,000 Remove existing A/C equipment and install new Set new rooftop condensing units and install refer. No of Stones L Lot Size. Total lot coverage EXIStlOg Sq. Ft. Occupant Load & Proposed Sq. Ft. ConstructIOn Type: I-A % = TOTAL Sq. Ft. PLANNING USE ONLY: APPRO V ALS: PLAN: BLDG: DPWU: FIRE: OTHER: ESA/Wetland(s): 0 Yes 0 No SEPA Checklist reqUIred? 0 Yes 0 No Other' V ALUATION 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 BUIldlOg DIVISion to comply WIth current fee schedules. Contact the PermIt Coordmator at 417 -4815 for aSSIstance. PLAN CHECK FEE. IF a plan check fee IS due It must be submItted at the tIme the bUIldmg permit applicatIOn and constructIOn plans are submitted. All other permIt fees are due at the tIme of permit Issuance. EXPIRATION OF PLAN REVIEW: If no permIt IS Issued wIthm 180 days of the date ofapphcatlOn, the application will expire. The BUIldmg OfficJal can extend the tIme for actIOn by the applicant up to 180 days upon WrItten request by the applIcant (see SectIOn R105 3.2 of the InternatIOnal BUlldmg/ResIdentJaI Code, 2003). No application can be extended more than once. I hereby c.ertJfy that I have read and examined thiS application and know the same to be true and correct. I am authonzed to apply for thiS permit and understand that It IS my responSibility to determine what permits are reqUired ,not the City's, and that I must obtain such permits pnor to work. APP~~~ Date3 /;; ~ / h(; ",' .. J ' \::;1 ,/ / " 105 ~0 &1. / t\ v~ ?"s ~ I ~,: '0 Q;- ~ .Sf 110 6i~ &1. I/'~ Feet VertIcal Dalum ~ NA VD 88 HOrizontal Datum = NAD 83/91 Area Map ThIS map IS not mtended to be llsed as a legal descnption Thfs map/drawmg IS produced by the OfV of Port Angeles for 1/s own use and purposes Anv other use of this map/draWing shall not be the responslbllttv of/he elfy ~~\ (~ ~ LETTER OF TRANSMITTAL ~C'i~M.' 1-'~'\ F 0 Sex : 768 · Wood'nn! e. V;;' 98072 425-481-2266 Bus . 425-486-6933 FAX From: Denise Reese Date 3/22/2006 Project: Qwest Port Angeles Job # P11173 Reference: Permit Application {.lMI) Johansen Mechanic~ TO: City of Port Angeles 321 East Fifth Street Port Angeles, WA 98362 ATTN: Dave RECEIVED MAR 2 4 2006 CITY OF PORT ANGELES BUILDING DIVISION WE ARE SENDING YOU: ATTACHED SHOP DRAWINGS COpy OF LETTER UNDER SEPARATE COVER VIA PRINTS PLANS O&M'S SPECS THE FOLLOWING ITEMS' CHANGE ORDER SUBMITTALS OPIE DATE NO DESCRIPTION 1 Permit Application 3 Plans 3 Structural Calculations 3 Equipment Specifications THESE ARE TRANSMITTED as checked below: For Approval For Your Use Resubmit As Requested For RevIew and Comment For BId (5) Due _ Approved as SubmItted Approved as Noted Returned for correctIOn Per you Request For SIgnature ResubmIttal SubmIttal Please Return (1 copy) Immediate Action FYI REMARKS: Dave - attached you will find our application for a commercial mechanical building permit. Please process the attached and notify me of the fees due and I will forward a check to you. If you have any questions, please feel free to call me. Thank-you. COPY TO File SIGNED, QJF~ P/(~ RECEIVED BY: DATE: i ~ORT ~ ....-l..O~~ &'t'i:a~ 'IL -=.so ~ "l.tii:~ CITY OF PORT ANGELES DEPARTMENT OF COMMUNITY DEVELOPMENT - BUILDING DIVISION 321 EAST 5TH STREET, PORT ANGELES, WA 98362 Application Number Pin number Property Address ASSESSOR PARCEL NUMBER: Application description Subdivision Name Property Use Property Zoning . . . Application valuation 04-00000476 Date .944716 406 S LAUREL ST 06-30-00-0-0-8800-0000- MECHANICAL PERMIT 6/08/04 RESIDENTIAL HIGH DENSITY 80000 nl'l4L.e-o el?&/~ Owner Contractor US WEST COMMUNICATIONS INC KC COX MGR-PROP TAX ENGLEWOOD CO 80111 JOHANSEN MECHANICAL INC P. O. BOX 1768 WOODINVILLE WA 98072 (425) 481-2266 Permit MECHANICAL PERMIT Additional desc HP & DUCT MOD Permit Fee 61.70 Plan Check Fee .00 Issue Date 6/08/04 Valuativn 0 Expiration Date 12/05/04 Qty Unit Charge Per Extension BASE FEE 47.00 1. 00 14.7000 ECH ME- INSTALL 100- FAU 14.70 Fee summary Charged Paid Credited Due - --------------- ---------- ---------- ---------- ---------- Permit Fee Total 61.70 61.70 .00 .00 Plan Check Total .00 .00 .00 .00 Grand Total 61.70 61.70 .00 .00 ~ ~ \j\ k r" ~ (\) - Separate Permits are required for electrical work, SEPA, Shoreline, ESA, utilities, private and public improvements. This permit becomes null and void if work or construction authorized is not commenced within 180 days, if construction or work is suspended or abandoned for a period of 180 days after the work as commenced, or if required inspections have not been requested within 180 days from the last inspection. I hereby certify that I have read and examined this application and know the same to be true and correct. All provisions of laws and ordinances governing this type of work will be complied with whether specified herein or not. The granting of a permit does not presume to give authority to violate or cancel the provisions of any state or local law regulating construction or the performance of construction. ON FiLe Signature of Contractor or Authorized Agent Date Signature of Owner (if owner is builder) Date T:\PLANNING\FORMS\II02.15 [11/14/2003] BUILDING PERMIT INSPECTION RECORD CALL 417-4815 FOR BUILDING INSPECTIONS. CALL 417-4735 FOR ELECTRICAL INSPECTIONS. PLEASE PROVIDE A MINIMUM 24 HOUR NOTICE. IT IS UNLA WFUL TO COVER, INSULATE OR CONCEAL ANY WORK BEFORE INSPECTED AND ACCEPTED. POST PERMIT IN A CONSPICUOUS LOCA nON. KEEP PERMIT CARD AND APPROVED PLANS AT JOB SITE. INSPECTIpN, T':PE DATE ACCEPTED COMMENTS YES I NO FOUNDATION: FOOTINGS " WALLS FOUNDATION DRAINAGE/DOWN SPOUTS ELECTRICAL (LIGHT DEPT) SEP ARA TE PERMIT: # ROUGH-IN I PLUMBING UNDER FLOOR / SLAB ROUGH-IN WATER LINE (METER TO BLDG) GAS LINE BACK FLOW / WATER AIR SEAL WALLS CEILING I FRAMING JOISTS / GIRDERS SHEAR W A\:WJ\Q,l,.!;1.~WNS WALLS / ROOF / CEIL~ DRYW ALL "~RJOR 81"::0 PANEL ONLY) T-BAR ... , INSULATION SLAB , WALL / FLOOR / CEILING I I MECHANICAL rrleC~(;<'rllcC{J ~ll1cvf g.. 30 -01 Ju. ./ HEAT PUMP GAS LINE WOOD STOVE / PELLET / CHIMNEY HOOD / DUCTS PW UTILITIES / SITE WORK (Engineering 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 OCCUPANCY/USE RESIDENTIAL DATE YES NO COMMERCIAL DATE ACCEPTED YES NO ELECTRJCAL - LIGHT DEPT. 417-4735 ELECTRJCAL LIGHT DEPT CONSTRUCTION R.W. / PW/ CONSTRUCTION - R.W. \ ENGINEERJNG 417-4807 PW / ENGINEERJNG FIRE 417-4653 FIRE DEPT. PLANNING DEPT. 417-4750 PLANNING DEPT. BUILDING 417-4815 BUILDING T:\PLANNING\FORMS\ II 02.15 [11/14/2003] 3: >-l "0 , ;l>"Oon;l> n"O OJ 0< ~ , "O;l>=-:otJ H", '" "0 , "O",ZZtJ >-lOJ '" '- , t"intIjl-3::t1 0<"0 [fJ H , tT.l::tl::tltT.l ;l> 0 0 ..; , Zr-' ;l>[fJ 0"' H .. , ~. n[fJ ...,OJ >-l tJ ~ to 0 "0 OJ. ",. 0 t n. "' ",00 00 OOJ >-l'- '- 3:0 w w '1:lC:O OOC:~,t::. ~.::. r-'OJO 01::>00'1(1)00 '- OJ[fJ , , ~'" QO o ~~~ ~6~~{J) OJ'" r-'- -- 'tJtJ~ 0 [fJ[fJ OJ +- ool-3tI:lt"i [fJH 00 Z;l> w is. ... n e:: "' H -...]o03:::tI tv OJH~ '" 3:OJt'l '" [fJZ o3:()t"i e::[fJ 3: ' 2 ~ H r-'''O OJoo ~[fJ -.J >-l "0 nQ)H 1-3 ~ ::r::OnH ~o;l>n , '>-l;l> , H HOHt-t tdC/)Q3: , ",tJ..; noo tr:ltT.l):::ltT.l OJ OJ ;t:-OZH n",n , [fJ[fJ t"'O{J)Z H~O<~ e::n n r-'", "0 Z BiOJ ~ >-lH OJ H H [fJ'tJ "' n n tJto n '->-l 3: 0 OJe:: ;l> nH H H 3: H r< 00 >-l HZ 3: [fJr-' 3:Z Z[fJ OJ Ot:::ltvl-1j 3: [fJ"O Z HOH OJ "0 OJ >-l ::tIZO'lZ Z OJn [fJ HQ' ;l> >-l n>-l Z lJ>r-' [fJ >-lH ~ Q~6 00 "'z tJ totJ , OJ '" '-<>-l Z r-'=-:lJ> ~8 0 r-'OOO "O"O[fJ >-l "'''' 55~ OJ?, OJ O?' , [fJOJ [fJ ",OJ ZZtJ >-l "' OJOJH r-' n[fJ < , :>> r-' r-'O H r-'8 OJ ... "' O>-l tv r< Z lJ> >< ;l> n>-l OJ ... r-'tv 00 r-'''O H , "03: tv ~. tv 0 '" Zn '" OJO Z >-l "' ;l> n >-l tJ"O 0 ;l>;l> "' >-lQ [fJ OJ OJ =-: H r-' r-' 00 '- W 0 '- 0 ...tv 2004/APR/12/MON 02:59 PM CITY OF PA BLDG DEPT FAX No, 360417 4711 p, 00 liDO I BUILDING PERMIT - APPLICATION FOR OFfIClAL USE ONLY: ate Rcc.:~ -4 - (:) '-I ,.,,,,<#04 $ Dale Approved: . () .. Date Issued: - Fill out COMPLETELY and in INK.. Your application and site plan MUST B COM:PLETE to be a.ccepted for re'vie'l'\', If you ha"e any questions, call PERMITS (360) 417-4815 FAX(360)417-4711 Applicant or Agent: \j'ol--)C-<.-J.1 ~(~ "-kt:,..).,tdd ',u<.--I Phone: 4-2C ~F81- ~~ Owner: ()Wefrl' C.r;rY"t rn Uh "Gt:lt-llf\t.S Phone:-#K .;lD~ .316-45"9+ Address:Ji?OO '11'''''- Ave City: "5ec~. . tAlA Zip: Cj'X /q I Architect/Engineer: Tre.6 ltJe~~8H1L'"'~t-s _ Phone: -=- d.5"5 4 72.-3~ Contractor ~aJ.\~t'M ^'\~ State License #:.1..bHM>M,l1l"F..xp: ~~ / -'O~ Phone:-1:81-:';"~(.o J) a...... _..1' "11 111 q . ---- '-A.lidres-s: ....y.:l~.\.. f;7f)j<-Flfz,8-- ..-....- --.- -.- -......-.... .-Gity~ WDoa IhV--I. .Ue.. __LLn.. .~.. ..-.........--. . ....Zip.: RO 7 d-.- , PROJECT ADDRESS'~~ Sou.t~ L.a.U.V"'e,\ . ZONING: LEGAL DESCRIPTION: Lot: 'i 2. .,...3 Block: 8' 'iJ Subdivision: CLALLAM COUNTY PARCEL NUMBER: J? (,0"'300000 g 80 See. Pi o...(II~ Credit CardHolder Name: Billing Address: City: Credit CardType VISA Me # Exp. Date: TYPE OF WORK: SIZE!V ALUATION: .0 Residential 0 New Constr. 0 Re-roof 0 Stove SF_ @$ ISF. = $ o Multi-family )IIq Addition 0 Move. 0 Garage . SF- @ $ /SF. = $ ~ Commercial Cl Remodel 0 Demolition 0 Deck SF. @ $ ISF. = $ . . . 0 Repair 0 Sign CI Other. ~~ TOT{.L VALUATION $ ~C,OOO . BRIEFDESCRIPTlON OF'THE PROJECT: Ductw~v-~m d.i+l.C;~nO\'\~ 1 h~~o.cce~ pr-Ie~, t-fVAC ...Q..9WPW\pAJ\.1 ~tQ.fIP~tl +e.,W\P c.oO~4lnd Q\tba.,1a.nce , --1/' COMJv.IERCIAL/RESWEl\'TIAL: Occupancy Gi'oup: Occupant Load: Construction Type: No. of Stories: ~ Lot Size: Existing Sq. Ft. & Proposed Sq. Ft. = TOTAL Sq. Ft. Total lot coverage % ESAlWetland(s): 0 Yes D No SEPA Checlclistrequired? 0 Yes 0 No Other: APPRO V ALS: PLAN: BLDG: DPWU: FIRE: OTHER: PLANNINGVSE ONLY: BUILDING PERMIT Arl'LlCATIDN SUB:MlTTAL: The Building Division can provide you with IDfounation on the application and plan submittal requirements if you have questions. . VALUATION OF CONSTRUCTION: In all cases, 3 valuation amount must be entered by the applicant. Tbis flgUI"1: will be reviewed and maybe revised by thl: Building Pivision to comply with current fee schedules. Contact the Pemut Coordina.tor 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 C011Etruction plans are i:;ubroi.tt-l':d..-A.J1...QtheX-flelmit..fees...are..du~Jluhp.-..1im.tif.P-ermit issuance. .. ". . . EXPIRATION OF rlJAN REVIEW: If no permit is issued within 180 days of the date of application, the application will expir-.e. 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 A of the Unifo;r:m Building Code, cum~:nt editiou) No application can be extended more than Ollce. . I hereby certify that I have rBad and examined this application and know the same to be true and correct. I am authorized to apply for this permit and understand that it is my responsibility to determine what permits are required ,not the City' and that I must obtain such permits prior to work. \.. Pate: ".,. / ,- ~1 T:\FORMSWP S\BuiJoingpcrmit.wpo Applicant: Received Time Apr,12, 4:05PM CITY OF PORT ANGELES DEPARTMENT OF COMMUNITY DEVELOPMENT - BUILDING DNISION 321 EAST 5TH STREET, PORT ANGELES, WA 98362 Application Number Pin number Property Address ASSESSOR PARCEL NUMBER: Application description Subdivision Name Property Use Property Zoning . . . Application valuation 04-00000724 Date .942516 406 S LAUREL ST 06-30-00-0-0-8800-0000- ELECTRICAL ONLY 8/13/04 RESIDENTIAL HIGH DENSITY o Owner Contractor US WEST COMMUNICATIONS INC KC COX MGR-PROP TAX ENGLEWOOD CO 80111 JOHNSON ELECTRIC 11816 NE 116TH ST KIRKLAND KIRKLAND WA 98034 (425) 821-8226 permi t . . . . Additional desc Sub Contractor Permit Fee Issue Date Expiration Date ELECTRICAL NEW COMMERICAL 200A 1 5 BRANCH CIR 1 JOHNSON JOHNSON ELECTRIC 157.10 Plan Check Fee 8/13/04 Valuation 2/10/05 .00 o ~ 6'- Qty 1. 00 1. 00 Unit Charge Per 95.8000 ECH EL-COM 101-200 NEW SRV FEEDER 61.3000 ECH EL-COMM ALT <5 CIRCUITS Extension 95.80 61.30 C}\ Fee summary Charged Paid Credited Due ----------------- ---------- ---------- ---------- ---------- Permit Fee Total 157.10 157.10 .00 .00 Plan Check Total .00 .00 .00 .00 Grand Total 157.10 157.10 .00 .00 ~ ~ ~ ~ ~ li ~ '" \ "' ~ ~ ~ .....- r/Jt/f'fL- 8) t}1' kC 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 orwork is suspended or abandoned for a period of 180 days after the work as commenced, or if required inspections have not been requested within 180 days from the last inspection. I hereby certify that I have read and examined this application and know the same to be true and correct. All provisions of laws and ordinances governing this type of work will be complied with whether specified herein or not. The granting of a permit does not presume to give authority to violate or cancel the provisions of any state or local law regulating construction or the performance of construction. Signature of Contractor or Authorized Agent Date Date Signature of Owner (if owner is builder) T:\PLANNING\FORMS\1102.15 [11/14/2003J BillLDING PERMIT INSPECTION RECORD CALL 417-4815 FOR BUILDING INSPECTIONS. CALL 417-4735 FOR ELECTRICAL 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. INSPECTIOI'< TYPE DATE ACCEPTED COMMENTS YES NO FOUNDATION: FOOTINGS WALLS FOUNDA TION DRAINAGE/DOWN SPOUTS ELECTRICAL (LIGHT DEPT) SEPARATE PERMIT: # ROUGH-IN PLUMBING UNDER FLOOR 1 SLAB ROUGH-IN WATER LINE (METER TO BLDG) GAS LINE BACK FLOW 1 WATER AIR SEAL WALLS CEILING FRAMING JOISTS 1 GIRDERS SHEAR WALL/HOLD DOWNS WALLS 1 ROOF 1 CEILING DRYW ALL (lNTERJOR BRACED PANEL ONLY) T-BAR INSULATION SLAB WALL 1 FLOOR 1 CEILING I I MECHANICAL HEAT PUMP GAS LINE WOOD STOVE 1 PELLET 1 CHIMNEY HOOD 1 DUCTS PW UTILITIES 1 SITE WORK (Engineering Division) SEP ARA TE PERMIT #'s: WATERLINE 1 METER SEWER CONNECTION SANITARY STORM PLANNING DEPT. SEPARATE PERMIT #'s SEPA: P ARKING/LIGHTING ESA: LANDSCAPING SHORELINE: FINAL INSPECTIONS REQUIRED PRIOR TO OCCUPANCY/USE RESIDENTIAL DATE YES NO COMMERCIAL DATE ACCEPTED YES NO ELECTRICAL - LIGHT DEPT. 417-4735 ELECTRJCAL Mb/IYI .Ittn LIGHT DEPT r J "U' I' CONSTRUCTION R.W.I PWI CONSTRUCTION - R.W. ENGINEERJNG 417-4807 PW 1 ENGINEERING FIRE 417-4653 FIRE DEPT. PLANNING DEPT. 417-4750 PLANNING DEPT. BUILDING 4J7-48J5 BUILDING T:\PLANNINGIFORMS\J J02.15 [J J/1412003] CITY OF PORT ANGELES DEPARTMENT OF COMMUNITY DEVELOPMENT - BUILDING DIVISION 321 EAST 5TH STREET, PORT ANGELES, WA 98362 "O.......A-YI '~Tlf/1 Application Number pin number Property Address ASSESSOR PARCEL NUMBER: Application description Subdivision Name Property Use Property Zoning . . . Application valuation 04-00000724 Date .942516 406 S LAUREL ST 06-30-00-0-0-8800-0000- ELECTRICAL ONLY 8/13/04 RESIDENTIAL HIGH DENSITY o Owner Contractor US WEST COMMUNICATIONS INC KC COX MGR-PROP TAX ENGLEWOOD CO 80111 JOHNSON ELECTRIC 11816 NE 116TH ST KIRKLAND KIRKLAND WA 98034 (425) 821-8226 Permit Additional desc Sub Contractor Permit Fee Issue Date Expiration Date ELECTRICAL NEW COMMERICAL 200A 1 5 BRANCH CIR 1 JOHNSON JOHNSON ELECTRIC 157.10 Plan Check Fee 8/13/04 Valuation 2/10/05 .00 o Qty Unit Charge Per 1.00 95.8000 ECH EL-COM 101-200 NEW SRV FEEDER 1.00 61.3000 ECH EL-COMM ALT <5 CIRCUITS Extension 95.80 61. 30 ~~ ~~ Fee summary Charged Paid Credited Due ----------------- ---------- ---------- ---------- ---------- Permit Fee Total 157.10 157.10 .00 .00 Plan Check Total .00 .00 .00 .00 Grand Total 157.10 157.10 .00 .00 ~~ ~~ Separate Permits are required for electrical work, SEPA, Shoreline, ESA, utilities, private and public improvements. This permit becomes null and void if work or construction authorized is not commenced within 180 days, if construction or work is suspended or abandoned for a period of 180 days after the work as commenced, or if required inspections have not been requested within 180 days from the last inspection. I hereby certify that I have read and examined this application and know the same to be true and correct. All provisions of laws and ordinances governing this type of work will be complied with whether specified herein or not. The granting of a permit does not presume to give authority to violate or cancel the provisions of any state or local law regulating construction or the performance of construction. Signature of Contractor or Authorized Agent Date Signature of Owner (if owner is builder) Date T:\PLANNING\FORMS\1102.15 [11/]4/2003] BillLDL"NG PERMIT INSPECTION RECORD CALL 417-4815 FOR BUILDING INSPECTIONS. CALL 417-4735 FOR ELECTRICALINSPECTIONS. 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 S]TE. INSPECTION TYPE DATE ACCEPTED COMMENTS YES I NO FOUNDATION: FOOTINGS WALLS FOUNDATION DRAINAGE/DOWN SPOUTS ELECTRICAL (LIGHT DEPT) SEPARATE PERMIT: # ROUGH-IN PLUMBING UNDER FLOOR 1 SLAB ROUGH-IN WATER LINE (METER TO BLDG) GAS LINE BACK FLOW 1 WATER AIR SEAL WALLS CEILING FRAMING JOISTS 1 GIRDERS SHEAR WALL/HOLD DOWNS WALLS 1 ROOF 1 CEILING DRYW ALL (INTERJOR BRACED PANEL ONLY) T-BAR INSULATION SLAB WALL 1 FLOOR 1 CEILING I I MECHANICAL HEAT PUMP GAS LINE WOOD STOVE 1 PELLET 1 CHIMNEY HOOD 1 DUCTS PW UTILITIES 1 SITE WORK (Engineering Division) SEP ARA TE PERMIT #'5: WATERLINE 1 METER SEWER CONNECTION SANIT AR Y STORM PLANNING DEPT. SEPARATE PERMIT #'s SEPA: PARKING/LlGHTING ESA: LANDSCAPING SHORELINE: FINAL INSPECTIONS REQUIRED PRIOR TO OCCUPANCY/USE RESIDENTIAL DATE YES NO COMMERCIAL DATE ACCEPTED YES NO ELECTRJCAL - LIGHT DEPT. 417-4735 ELECTRJCAL e /it; /'4 /!r!{) LIGHT DEPT CONSTRUCTION R.W.I PWI CONSTRUCTION - R.W. , I ENGINEERJNG 417-4807 PW 1 ENGINEERJNG FIRE 417-4653 FIRE DEPT. PLANNING DEPT. 417-4750 PLANNING DEPT. BUILDING 417-4815 BUILDING T:\PLANNING\FORMS\1102.15 [111l4/2003] CITY OF PORT ANGELES LIGHT DEPARTMENT .~ ELECTRICAL PERMIT PERMIT NO. / s- 9'0 .;<. / //' /I'J> I , DATE Site Ac;idress: Installed By: . WILL CALL FOR INSPECTION Phone: Owner/Business: Phone: Sq. Ft. o Residential Heat KW o Baseboard 0 Furnace/Boiler o Heatpump 0 Other 1st Commercial/Industrial load (' Total Connected load (allach breakdown) Total Motor load (allach breakdown) o New Construction o Remodel o Service update/alter/repair o Overhead o Underground Voltage o 10 030 Service size o Temporary o Add/alter circuits o Auxiliary power (list below) ~ Special equipment (list below) Amps DetallslDescription: ~twl ~S~J 4~ /If/( ~//~ ~;;{ hUg .Lz~7 . W.S. No. Service Capacity: 0 O.K. 0 Not O.K. o Ditch inspection O.K. o Rough-in/cover O.K. o O.K. to connect service r Final O.K. Size Comments Date Hold for: 0 Easement 0 Leiter o Signed up for service/meter o Meter Department notified for instaliation o Fire Department notified of inspection o Plan Review approved/pending Installer: - .' . Permit/Receipt No. /$"1(0 Meteo D:,z:/;,/fp Notify the Department of City Light y Street Address and Permit Number when ready for inspection. Work must not be covered or electrically energized before inspection and O.K. for covering or service has been given by the Inspector in Writing on the Wiring Report or the Building Permit. PHONE 457.0411, EXT. 158 or EXT. 224. -; ~ NO OCCUPANCY OR USE ESTABLISHED UNDER THIS PERMIT / b !!!2- Inspector Amount paid WHITE - file by address YELLOW - file by number PINK - Top: Eng, Bottom: Customer GREEN - Top: Inspector, Bottom: City Hall Site Address: ~ofo S<J. ~e I OLVU,PIC PRINTERS, INC. CITY OF PORT ANGELES LIGHT DEPARTMENT :.- LECTRICAL PERMIT o Residential Heat KW o Baseboard 0 Furnace/Boiler o Heatpump 0 Other Jill Commercial/Industrial load Total Connected load (attach breakdown) Total Motor load (attach breakdown) o New Construction o Remodel ~Service update/alter/repair i1Add/alter circuits o Auxiliary power (list below) o Special equipment (list below) Details/Description: PERMIT NO. jq/r / /;z$t' , , DATE o READY FOR ,WwILL CALL FOR INSPECTION INSPECTION Phone: Phone: Sq. Ft. o Overhead ~ Underground 'TO 5l..A.v/C.E. Voitage /U,I 2.0'1 o 10 ]g:30 Service size /000 Amps o Temporary POL~ .. ~$.eV/rL ~~& /' MEv.) SYttJ/(J /000 A- e /J.oI2OK 316 / / 2. 6€N f-/L rvrn fl.... /2.5 I< pJ fi) /2.0/LiJl 3~ )< t ' I " I, ''!s'' '~-I'I 'C" P" ,\ -J f, "1_-;,.." .25 . 1/ 2.-) hEct/ '3. "/(2.. ,. /5 'JDrAL X /1\ o~ = I ~O ~ / A-dcl "h&fV Ii '12. ~ ,$ 3'~ ~ -1'/ .1'1 ~o ~ 1~55 ~ ",?/;p' 'TorA L Size Comments Date Hold for: D Easement D Letter o Signed up for service/meter o Meter Department notified for instailation o Fire Department notified of inspection o Plan Review approved/pending , IC-- Notify the De ment of City Light by Street Address and Permit Number when ready for inspection. Work must not be covered or electrically energized before inspection and O.K. for covering or service has been given by the Inspector in Writing on the Wiring Report or the Building Permit. PHONE 457.0411, EXT.158 or EXT. 224. Ai#-- NO OCCUPANCY OR USE ESTABLISHED UNDER THIS PERMIT 3S~ ~ , Inspector Amount paid WHITE - file by address YELLOW - file by number PINK - Top: Eng, Bottom: Customer GREEN - Top: Inspector, Bottom: City Hall Site Address: J -14 / ,(.~ Installer: CE . OLYM!lC PRINTERS, INC. New Meters o (" CITY OF PORT ANGELES DEPARTMENT OF PUBLIC WORKS . . . . . . . . . . . INSPECTION REPORT. . . . . . . . . . . REQUEST: Date 10 - 'Z u - D (. Time '7 I/lvt. Received by Pc...", (5 E.. (phone. personj . (;L/ c: Location of Work to be inspected t/ 0 f.. :5:0. L",- vre ( -:5 -( , Name of person requesting inspection iJ..CVl...;., L. Address of person requesting inspectio,@iZ,v" VA I2tJ If'l-lJ Phone No. '11-' -1.ftf''Icr Type of Inspection (circle appropriate one): Permit No. Sewer Foundation Framing Chimney Plumbing Final Sewer Excav. Other INSPECTION NOTES: Inspected: Qate / D .- Z 0 .~, 0 ~ _ Remarks: kejJa..re.d 2.. C..!... f Time 9'I/M w,'rl... By t2enh ,5" E . .:::;:. rC:,<Jc-..lr bo..o'lcl. , Me,- t V\ RESTORATION REQUIRED . . . . .. YES X' NO 1 rn ,/ /\ /I ~ -~ \J - .v L/ Vv '=/ <-,J ~/ ~ -i'^ ~ \.. j.t. J ;5~\elA.JL iN, i..-/ - ~II' .~ " v -.....j ~i " ( . 2 c.r. Zz t2eo!~ .-7i ik- Q, . '- -: ~4 \{\, I ~ II tl o..! es-l- B(eis I SURFACE RESTORATION: SURFACE TYPE: 0 Unimproved OGravel o Repaired by City D Repaired by Permittee o No Damage Found o Asphalt OPCC ~Other~Cov;.Cre t . ~ kg Hil..4'C< Work Order # 303cft-.- iOG f?.AM/l IO(!, COMPLETE 3/1. tS./aJ ~ o INCOMPLETE Jr.. 1/16/0, /;;JJred I//~~ 1F (Continue on reverse side if necessary) STREET SUPERINTENDENT (DATE) MAY-OS-ZOOS 03:Z3PM FROM-JOHNSON ELECTRIC +4/5 8/1 4836 T-S19 P OOZ H9/ ~ ~; ELECTRICAL WORK PERMIT APPLICATION Job wired by }ll Electrical Contractor DOwner Install:\IiOn descriplion ;i' Commercial a Residential D New )tAlteredJAddition E.lectrical COl1tl.lClOT name License Dumber D:ue Expires: :JoHf../;5t:W &tfLIR:~ :r:;.iC. .:Jc>I.hJ:3fI3~,"\(Z.l..\ Purchsser's mailing addrc=ss 1l/1l:>J ,: JiliJ& i<le II ,,11 >T' 10'(' Cily ~Ul) /.t),.q.- TclcpllOne number - Bz{- 8,ZZr;, p~W ~~r~ name Address of i~ectioD '-IoIP :::). lrn.l ~~ L $T/l.U.-, C">J?iLT AUGriL-5 Phone Dumber to sChedule in'Jpect'on:l(Z5"'~'_ Owner as defined by RCW.J9.28.26/:(I) OWnCr wm occupy tile. SIr-uClure!orlwo years ufitr rl,is electrical permit is finaljzed. (2) Ow/le,. is required fu hire an eleclrlctJ{ Ct11t1"actOr if abovl' said properly Is for so/e. renJ or lease. Aflcr reading lhc above statement, I hereby ccnify that I am th~ owner of tlle above named prope=rty or a. Iict:'nsed eleclrlcul contractor_ I am making the: dectriC31 insul- laDon or "IteratiOn in compliance with lne electrical laws, N.E.C.. RCW_ Chapter 19.28, WAC. Chapter 296-46B. The Cily of Pan Angeles Municipal Code, and Utility Spc:cificntions. Slguatu 7i1DJ,ot: Al.lO /UHtllI (6) l-/Gtfr) ( 'I) 'le4: frl/C4Lf ltcVik (Z) '304777/ FaDea..-) JV~ UaJ '/:1Hti ". "f~iGdlJ ~iUE- F1)?t AlAi'LU\ T6 J.le~ ltLlJ.-(fl41;uT- /-::;- C{~d '" .. Stale Zlb . /&"31 FAX number o Cash 0 Check # I2l' Credit Card VIsa .- C~#________________ Mastercard Discover x eCrriCDI eOntnctor or I!leccrlcal ndministrIltor Date: tS. slo~ Expiration Date of card inspection fee $ (./,.3 C) Service Information ectrlcal Lo A t- s and or subtraction o NO LOAD CHANGES o BaSaboard IQN CJ f*urnace KW o tieat Pump _ Ton _ LAA o 'an-Wall IQN o Overhead Service o Tamp Service lJ Underground ServJce Voltage Phase 0 1 0 3 Service Size: _ Feeder Size: SAME DAY INSPECTION. CALL BEFORE 7:00 AM 360-417-4735 ROUGH-IN THERMOSTAT /' SERVICE (lllle AtlPn.vnl D)' DlI1l1 ^1"1'(ov,lI Dy 0"11:: Applllve~ ~y 5/< ~hFINAL JD , DlTCH FEEDER D:Jte DaL~ AfIJ1roYe~ Ely V Ie ^pprDyed&y AJ1lKVvooDy./ "- Inspection Arca, Building or Equipment Inspected Action Tllken Electrical Date Iospl::ctor I/CP 5ig /0' FEB-22-2006 11 :23AM FROM-JOHNSON ELECTRIC +425 821 4836 T-019 P 002 H65 , FOR OFJ1C1AL LISE QNI~Y ~tdRn-: Pemir r. . Due "PpnllQi; o..cllamt; ELECTRICAL PERMIT APPLICATION The EleCll1cal pennit Application mllsl be Oiled aut eomDle\elY. Pie""" type or reprln! In Inle. 1/ you have any questions, pleasll call (36U. 417-4735 Fax number: (36U) 417-4711 Owner 01' Elec. ConlrSCtOr Agent' JeJl1F#/ ttfCrfe/~ :rile.. ,,"one: I(tf g~/.$~Fax: ifz$- Bzt. 'I8~ ~- Properly Owner. CIty: Phone:. AddresS: i{f)(, ~lA"'lI LAukL' Ele<:lTical Contractor. Jc>It~!btl ~~ I 'Oic.. Address: Ilt'{l.~ ,wI/- I IIIISTAUATION WIRED BY: Zip: Clly: "ELECTRICAL CONTRACTOR Credit Canl Holder Name: ::Jr::JIuw Et<<-tP/c-, :rUe. SA;ne- Phone: Z1p:~1Y . DOWNER Billing AdC/ffi!$s: City: Zip: Credit Card Number: Exp. Date. VISA: Me PROJECT ADDRESS, tfc;(; Souifl ~L- TYPE OFWOFlK, Check an that apply: 0 New Jli'Altera~onlAdd~ion o Residenlal 0 Mulll-famiiy -,- Ii Commercial 0 Mabile Home, Sq. FI. .:J Remote Meter 0 Detached garage 0 Hot Tub 0 Swim Pool 0 $epli<::,P,ump" '0 Low Vollage o Telecom. 0 NumberofCircuils added orallerect-,i.,..,. I . __ ",,"-"'J/'-'-' ' DESCRIPTION OF THEaEciR,~~1. PR~JEGT' [;I1!W,"S/I APP :7Ujr;M:,.:(/} 1~)11J4/> ~ . ., . .. 1O~ J/~W CSU'iffw-J&lT" .. -.'.. ~ . . -.; .'. LIlJA #- yzi,"- C::l>3::; - Z/ ?rc;~-3~'2 L Electrical Heat Load Additions : c. __ L,' / _ Service Infonnation . E:-f6 OU;, ", o Baseboard _ KW (3 1 c\ . {J 7 Vollage: o Fumace _KW b b{.erhead Service Phase: 0 1 o Heal Pump _ KW 0 Temp Service Service Size: o Fen.Wall _ KW :0 Underground Service Feeder Size: MS7'h"G- 03 PAMC 14.05.060(81: Far industrial, commerdal, & residential projects larger than a duplex, a one . line drawing ollhe Electrical Servic< Feeders, building size (sq. IL). load calculations, and the type & of conductors andlor raceway;is required and shall accompany the Electrical Permit application. ., I hereby-Certify that I have read and examined this application and icnow that same to be tnie and correct, and I authorized to apply for this permit. I understand it is not the City's legal responsibility to determine what permit: are required; it remains the applicants responsibility to determine what permits are required and to obtain Such. I / ~ 10 N,IL, 1/ (p +i, 51 'h~().J. tVA-, 080' C~rd Holder's SIgnature: /. Owner or Elec. Cant,. SIgnature: Date: zo/ ~ Date; PW -9019 / $' 18, 70 AUG-12-2004 02:37PM FROM-JOHNSON ELECTRIC +425 821 4836 T-271 PO02 H70 - S I/I/~ "<iiiii.... .b ELECTRICAL PERMIT APPLICATION. , FOItOA'lOM.UUONLY """""" . PtmoiIr. ---- -- The EleclriClll Pennil Appllcallon ","""be filled 011"'0"'111-"'. PI......1Jpe or reprint In Ink.. If you have aftY questlo..... please call (3&0. 417-4735 09'- 7;2 d f';1x num-. (360) 417-\711 ..-f 1j:z-5- fPl-OSS(' awn.rarEI.c.Con\nlClllrAge.... Jet:""t:" Jc\44Stl.tJ" Phon.: 'fzS-gz/'&~ax: J{~.d(;; 't8J~ &LJ.e.S r 4.0(." ~l LAu..~EL 'Sr-. . ClIy:Jog- r4tiCie.f.l-S" EI.ctrtcal ConttllClDr. ;JO ~)Od GClS::1f4?:...., ~. u.:..nse"aol+n,eI~8'/I1.Elcp: (/- X;-fJt{ Addlllos: -. I~$I~' j..{~ Jj6.'f1'Sr- ClIy:---K.!R.I(lA-t..t.O 11)J. INSTAl.lATION WIRED BY: D OWNER Jl(~ICALCONlllACTOR ::JeFF ..JblJil:oq Bflltng Address' to ~ T1. CIIy:~~rAt.4) ,l.JA. CredifCardNumber: Date. :(, Phllne: Prapelt\l Own.r. Zip: PhOne: '/l)i~ ' ZIp: 9-~o3( Address: Credit Card Holder Name; Zip: JfJoJ'I ~ PRO.JECT ADDRESS: Lfo(P 'S. L~L $:1'. TYPE OFWOAK: Check all that apply: 0 New JiQ AlleralionlAddltion o Residenlal 0 Multi-family " %. Commercial 0 Mob~e Home. .' Sq, Ft " LI Remote MeIer ODetachedgarage 0 Hot Tub 0 Swim Pool 0 ~pIIl:.P~p-. '0 Low Voltage 0 Telecom. C Number of Circuits added orallenKt.i',r". S . ., ",,"'l ,,~ '.( c'.;.. . :' . DESCRIPT10NOFTHE.aEciRl~PR~JEGT; 'irzov;pe.Aup ~j.t5r./.I(I;QJ).fa,) '{teAm! ~€,-," bfF ~F EY.;s.,...~' 1/v1dfG.eAR.,. r/.L'jiAII (l.) ~f1. -C;rli:Pr'tf r;~ iNk. GWrr~pT: ?I2oJ{D.<. (2)" 'In.. Ib. ~.ucl1- C(~uJ7J. ..-' ~ " . Electrical Heat Load Addltlq~s / ,', ~( 0)( 0 : SerVi~'lnfol'lllation '1 ""6<"srlLt 6-- Ia:{Zo€N':SIP sF.:tvdZ. Voltage: Phase: 0 1 0 3 S.rvice Siza: Feeder Size: o l3aseboanl o Fumace o Heat Pump o Fan-Wall _KW _KW ~KW _KW o OVerh.ed Service DTemp Service o Undetllround Service P AMC 14_05.060(8): For industrial, commen:ial, & residential projecl$ IllI1ler than a duplex, a one - line drawing 01 the ElecIlicaJ Servi< Feeder.;. building size ( d the e & of conductor.; and/or raceway is required anti shall accompany the Electrical Pennit 9l'pllcation. J hereby'certify that I have 'read and examined this application and know that same to be true and correct. and authorized to apply for this permit. I understand it is not the City's legal responsibility to determine what permil ~i~\i,:~t remains the applicants responsibility to determine what permits are required and to obtain sucli Credit Card Holder's Signature: ~ Date: \) \- Owner or Elec. Com. Signature: rp f Date: g -rt-oY PW-9019 A". ~...." A.<I: \ '--^I \ \ 'OlJ ,''I' 95. [30 p; 5 C/ /Zt:U-t 75 -:/ ~ /-30 /PLJ 8>>~/M .. ..r /L'-. /~ Sep/10/2014 12:23:58 PM ESC Automation 425 -487 -8769 111 CITY OF PORT ANGELES PERMIT APPLICATION Building Division/Electrical inspections 321 East Fifth Street -- P.O. Box 1150 / Port Angeles Washington, 98362 Ph: (360) 417 -4735 Fax: (360) 417 -4711 Date: Multi - Family or Commercial* * Plan Rev Jab Address: Building Sque Description of Ow=e, Maili License # I Exp• Contractor Information Name: Mailing Addr ss• City: State; Zip:97'bZl Phon • Fax: License # l Exp�U1 �_ aQT `rj Item Unit Charge (,qty Tota! 0Y Multiplied by Unit Charge 1 4 es ServicelFeeder 201 -400 Amp. $160,00 $ ServicelFeeder 401 -600 Amp $ 226.00 $ ServicelFeeder 601 -1000 Amp. $ 28a.00 $ ServicelFeeder over 1000 Amp. $ 410.00 $ Branch Circuit WI Service Feeder $ 5.00 $ Branch Circuit WIO Service Feeder $ 74.00 $ Each Additional Branch Circuit $ 5.00 $ Branch Circuits 1.4 $ 86.00 $ Temp. Service! Feeder 200 Amp. $102.40 $ Temp. ServicelFeeder 201.400 Amp. $ 121.00 $ Temp. ServicelFeeder 401 -600 Amp $164.00 $ Temp. ServicelFeeder 601.1000 Amp , $185.00 $ Portal to Portal Hourly $ 96.00 $ Slgn10utline Lighting $ 88.00 $ Signal Circuit! Llmiled Energy — Multi - Family Signal Circuit! Limiled Energy! First 1500 sf - Commercial $ 64.00 $ 96.00 $ $ Note: $5.00 for each additional 1500 sf Renewable Electrical Energy - 5KVA System or Less $ 113.00 $ Thermostat $ 56.00 _�_ $ Mote; $5A0 for each additional T -Stat 1.10 $152, 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 requfred 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 properly 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 296.4613, The City of Port Angeles Municipal Code, and Utility Specifications and PAMC 114.05.050 regarding Electrical Permit Applications. Signature of owner, electrical contractor or electrical administrator: ❑ cash D check (� .,Credl1 Card #W fhlil 42 �Y)Y) - x Dated: J `lo`Zay 0116112012 ji 11l Q5 Ad3 XzZ Application Number Application pin number Property Address , ASSESSOR PARCEL NUMBER: Application type description Subdivision Name . . . , , Property Use . , . . . , . . Property Zoning , . . . , , . Application valuation . . , Owner CENTURY LINK COMM, INC KC COX MGR -PROP TAX ENGLEWOOD CO 80111 ELECTRICAL PERMIT CITY OF PORT ANGELES 360 -417 -4735 14- 00001087 Date 9/11/14 036937 406 S .LAUREL ST 06-30-00-0-0- 8800 -0000- ELECTRICAL ONLY RESIDENTIAL HIGH DENSITY 0 Contractor ESC AUTOMATION INC 22121 17TH AVE SE STE 116 SOTHELL WA 98021 Permit . . . , ELECTRICAL ALTER COMMERCIAL DATE: 1 Additional. desc , . DITCH REPORT SALES TAX Permit Fee 152.00 Plan Check Fee 00 Issue Date 9/11/14 Valuation , . . . 0 Expiration Date 3/10/15 Ll Qty Unit Charge Per COMMENTS: Extension 1.00 95.0000 ECH RL- LIMITED 1ST 1500 SQ FT 96,.00 1.00 56,0000 ECH EL -LVT- THERMOSTAT 66,00 --°------------------------------------------------ Fee summary Charged Paid Credited Due Permit Fe4 Total 152.00 152.00 .00 00 Plan Check Total 00 .00 00 .00 Grand Total 152.00 152,00 .00 .00 INSPECTION TYPE DATE: 1 INSPECTOR: i DITCH REPORT SALES TAX on your excise tax form to the City of Port Angeles (Location Code 0502) ROUGH -IN INSPECTION TYPE DATE: RESULTS: INSPECTOR: i DITCH SERVICE ROUGH -IN FINAL Ll COMMENTS: PERMrr WILL EXPIRE SIX (6) MONTHS FROM LAST INSPECTION Signature of owner or Electrical Contractor X Date: G:IEXCHANGEIBUILDING JUL -OB -2014 Oa;51AM FROM-JOHNSON ELECTRIC +425 821 4636 T-310 P.002/002 P-695 CITY OF PORT ANGELES PERMIT ApPI.,IcAmN Building Division/Elect lical Inspections 321 East Fifth Street = P.O. Box 1150 / fort Angeles Washington, 923362 Ph: (360) 417 4735 Fag: (364) 4174711 RECEIV Date; 7. 7 - ZD!V * Plan Review May Job Address: Building Square Footage; Description of above Owner Information Multi - Family o ommert:ial� JUL 9 2014 ELECTRtl red, Fuse Complete Electrical Plan Review Informatio Sheet PAISPE TIONS v 7" LAV 019 eZ.. 5 T-Llelfr Fr" 6Ct. Name: Mailing Address: ZL _ � vim" la Marling Address; 1 City: Egtr:v State: IWA Zlp: _ qN 7 Phone;06 - X!(S VV7� Fax, Phone: y,? - 2L- Fax; License #! Exp._ _ License #! 6xp. g�y1,A j Stem Unit Charge Service/Feeder 200 Amp. $132.00 Service/Feeder 201.400 Amp. $160.00 Servicefteder 401.600 Amp $ 225.00 Service/Feeder601 -7000 Amp. $ 268.00 Service /Feeder aver 1000 Amp. $ 410.00 Branch Circuit W/ Service Feeder $ 5.00 Branch Circuit W/O Service Feeder $ 74,00 Each Additional Branch Circuit $ 5.00 Branch Cirouits 1-4 $ 86.00 Temp, Service/ Feeder 200 Amp. $102.00 Temp. Servlce/Feeder 201100 Amp. $121.00 Ternp. ServlceJFeeder401.600 Amp. $164.00 Temp. Service /Feeder 601 -1000 Amp _ $165.00 Ponal to Portal hourly $ 96.00 SlgnlOutline Lighting $ 98.00 Signal Circuit! Limited Energy - Multi - Family $ 64.00 Signal Circuit/ Limited Energy ! First 1500 sf - Commercial $ 96.00 Note; $5,00 for each additional 1500 aF Renewable Electrical Energy - 51NA System or Less $113.00 Thermostat $ 56.00 Note: $5.00 for each additional T -Stat Contractor Information Name: V'D /4 Iv Information Marling Address; 1 Nie- I Gty CJArI,.. State: W zip: Phone: y,? - 2L- Fax; - 9x1 - License #! 6xp. g�y1,A j ;5 Gg, A�1�64 — Q_t rr Total MY Multiplied by Unit Charnel $ Ib7, 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 1 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 19.26, WAC, Chapter 296 -466, The City of Port Angeles Municipal Code, and LilaTtty Specifications and RAMC 14.05.050 regarding Electrical Permit Appliwtinns. Signature of owner, elecirical contractor or electrical administrator: 0 cash M, check n_' nmdlt Card Dated djsz=lN ELECTRICAL INSPECTION WIRING REPORT RKS 417-4735 IITI; PERMITS lNSpF(;Tp4q-, awrle CONTRACTOR off )4 ✓ 6)1�� PRESS lo'go, rp� r NOT APPROVED .................... DITCH ................. — 0 ROUGH IN/COVER ............... o 1:1 .................... SERVICE ................... 0 ❑ ............... ..... FINAL ........... ........ 11 CORRECTIONS NEEDED: y- To cl- -;A'ev NOTIFY INSPECTOR WHEN CORRECTIONS ARE COMPLETED WITHIN 15 DAYS — DO NOT REMOVE — r JUL -08 -2014 08:51AM FROM - JOHNSON ELECTRIC +425 821 4836 T -310 P. 001/002 F -695 m °�r RECEIVE91ectrical Information Form 0 r '>�� ;=� ° P00 Woft & lltiflties PeP*rUWnt 13601417.4700 m kM �°� JUL 9 "R city cleamew inspector (360) 417 -4738 Please complete and reWm 0 Public Works 8 rtrnent 7Nameaand � entservlce, Name: cB ivv7ujeY GUNK I&Aoo &5r;0i6� address of party Street: /Z375 ZG vE A/h' responsible for permanent City 1 State 1 21P: WA 5�geZ! service billing? Daytime: Phone: Z66- 3 VC- 4/4(/ to Home Phone! .) A Site contact: Excavator. [J S'ngle- family residence Commercial ❑ Overhead service ❑ Underground service other than above) Ime: a0l" �T04W'S'L*W Title: 5 vOiAr r 7W#%-, P a*- 7- fbt me Phone: `f �s -6Z1 - $ Z'Z. 6 ,rne:: EfwK.444 At4 c , Company: AUr. N ytime Phone: Z.53 - S'7Z - 5 6 6 s me: 1 06W.l'o.v &-4e7-0zo(_ Comnanv: 37e1zsw .TVN-o✓r 6JQ Phone: 'VyJ--9jZ1 822. L Phone: X) ❑ New Multi- family residence; # of units ❑Subdivision; 0 of lots ❑General service ❑ Other: • DeSeri tian of work: DCZ4V F;N 40" «' PR4+jrO0 ,001VC t I5dit N Street address I lot number .Sdvi.'I ,err'" Nom" AWD or 10,3A of Ze Nearest cross street: Desired connection date: Electrical transformer serving property is: []on a pole I-i an the around Total square.footage: /7800 . sq. ft Main disconnect size: /000 amps Voltage: 01201240 1ph - X110/208 3ph ❑2771480 3ph ❑1201240 3ph ]]480 3W 3ph ❑ Other Standard residential loads (Lighting, refrigerator, dishwasher, washer) Check all that apply: Q-A/C (/0 ton) ❑ Range /Oven ❑ Hot Tub ❑ Clothes Dryer ❑ Heating ❑ Pumps _Hp) ❑ No Load Change ❑ Water Heater ❑ Elevator {. Hp) 'MOther P94-C79 Z • 7 "14 FAN FO frora �' - Please provide a copy of the following. *Detailed plot plan (.dwg or .dxf format mandatory for subdivisions). 1*Electrical one-line drawing showing the service entrance panel and location. "Connected load data. .*Size and locked rotor amps of all motors over Soho. Date: 7- MAIL OR DELIVER COMPLETED FORM TO: 321 E 5TH STREET; PORT ANGELES, WA 98362 FAX TO: 380- 417 -4711 WS Information form.xis WF i:IPVJY. SING lT1ENGP .1mOrgii1a1311flfpffll�tianform Revised 1-15-OS k INSPECTION TYPE ELECTRICAL PERMIT DATE: RESULTS: CITY OF PORT ANGELES DITCH 360-417-4735 Application Number 14- 00000810 Date 7 /09/14 Application pin number . . , 442680 Property Address . . . . . . 406 S LAUREL ST i 7 ASSESSOR PARCEL NUMBER: 06- 30- 00 -0 -0 -8800 -0000- REPORT SALES TAX Application type,deucription ELECTRICAL ONLY 0l7 your excise tax form Subdivision Name . . . . . Property Use to the City of Port Angeles Property Zoning . . , . . . . RESIDENTIAL HIGH DENSITY (Location Code 0502) Application Valuation : , 0 Application desc NEW.AHU Owner Contractor CENTURY LANK COMM. INC JOHNSON ELECTRIC KC COX MGR -PROP TAX 11816 NE ].16TH ST KIRKLAND ENGLEWOOD CO 80111 KIRKLAND WA 98034 B� (425) 821 -8226 Ll .,- O -_-__.-__.------------------------------------------------------ Permit . . . . . . ELECTRICAL ------ - -- - -- FILTER COMMERCIAL Additional desc 1 -4 CIR. Permit Fee 182100 Plan Check Fee 00 Issue Date 7/09/14 Valuation . . . , 0 Expiration Date 1/05/15 Qty Unit Charge Per Extension BASE FEE 86.00 1.00 96.0000 ECH EL- LIMITED 1ST 1500 SQ FT 96,00 --- - - - - -_ __..__..------------------------------------- ---------------- - - - - - -- Fee summary Charged ----------------- ---- - -- - -- Paid Credited Due ---- - - - - -- ---- - - - - -- ---- - - - - -- Permit Fee Total 182.00 182.00 .00 .00 Plan Check Total .00 00 .00 .00 Grand Total 182.00 182.00 .00 .00 INSPECTION TYPE DATE: RESULTS: INSPEC'T'OR: DITCH SERVICE HOUGH -IN i 7 FINAL COMMENTS: PERMIT WILL EXPIRE SIX (6) MONTHS FROM LAST INSPECTION . Signature of owner or Electrical Contractor X Date: G:IEXCHANGEIBUILDTNG { ELECTRICAL PERMIT CITY OF PORT ANGELES 360 -417 -4735 Application Number 15-- 00001258 Date 10/07/15 Application pin number . . . 951386 Property Address . , , 406 S LAUREL ST ASSESSOR PARCEL NUM3ER: 06-30-00-0-0- 8800 -0000- Application type description ELECTRICAL ONLY Suhdivision Name . . , . . Property Use Property Zoning . , , , . . , RESIDENTIAL HIGH DENSITY Application valuation . . . . 0 Application desc Fire alarm replace Owner Contractor RESULTS: CENTURY LINK COMM, INC DITCH MCCOY ELECTRIC CO INC KC COX MGR -PROP TAX 2014 SE 9TH STREET ENCLEWCOD CO 80111 PORTLANI] OR 97214 ?� �. ! (503) 234 -7521 Permit . . . . , ELECTRICAL ALTER COMMERCIAL Additional desc 1 -4 CIRCUITS Permit Fee 257.00 Plan Check Fee 00 Issue Date 10/07/15 valuation . , . , 0 Expiration Date 4/04/16 Qty Unit Charge Per Extension -BASE FEE 86.00 1100 96,0000 ECH EL- LIMITED 1ST 1500 SQ FT 96.00 15100 5,0000 ECH EL-ADDNT LIMITED 1500 SQ FT 75.00 Fee summary Charged Paid Credited Due. Permit Fee Total 257,00 257.00 ,00 .00 Plan Check Total. 00 00 .00 ,00 Grand Total 257,00 257.00 .00 00 REPORT SALES TAX on your excise tax form to the City of Port Angeles (Location Code 0502) INSPECTION TYPE DATE: RESULTS: INSPECTOR: DITCH SERVICE ROUGH -IN ?� �. ! FINAL COMMENTS: PERMIT WILL EXPIRE STX (6) MONTHS FROM LAST INSPECTION Signature of owner or Electrical Contractor G:IEXCHANGEBUILDING Date: RECENED Off; rl.��Tl�lc��>r Crrx of PoRT ANGri Lr,,s PE, W&T APPLICATION ErLEC TiICAL � •�•s`- Building pli'viijo/r, lectrical Inspections 321 EAst FIffik Street -- P.O. Boar 1150 / Port Atxgeles Washington, 98362 Flt: (360) 417 -4735 Fax: (360) 417-4711 � Date: b • & , f 5 Mulli•Famlly or Commercial * Plan Review _ H va ta 2 RSS . LL.. d em Waal Plan Review InformakEon 5haek 6 C Job Address: Building Square Foolag6: Descdpilon W ebove� Owner information Name: Mailing Address, City: .— ,Slate zlp: phanw _ — YM, _.._._._._... i,icenso f�! 1=xp Unit harci e Seolco/Feeder 200 Amp, $132,00 san+loelFoeder 201400 Amp. $180,00 ServfoelFoeder 401.800 Amp $ 225,00 ServicQf eerier 0014000 Amp. $ 288.00 SorvicelFeeder over 1000 Amp. $ 410.00 13ranoh 01roultIN $mvice Fooder $ 6100 Branch Circuit WO Service Fender $ 74.00 EachAddltlanalBranohGlrcuit $ $00 Sranoh Mmuits 1.4 $ 86.00 Temp. Servlcel Focder200 Amp. $102,00 Temp. 8ervlce1Feadsr 201 -406 Amp, $121.00 Tamp, Service/Feeder 401.600 Amp. $164,00 Temp. SorricelFeeder 601 -1000 Amp , $188,00 Portal to portal dourly $ 98,00 Sign /Oulline Lighting $ 88.00 Slgnel Gfrculff limited Enorgy - MuIO•Family $ 64.00 819nal Circulif Limited Energy I First 1500 sf- Gornm9*l $ 90,00 Note: $5.00 for each additional 1500 sf Renewable Elecldoul�nergy- 54NA System orLess $113,00 Thermostat $ 56.00 Note: $5.00 for each addllional T.Slat Contr t r ofor rr Nome; ; Malll Ad r ss:, City le, Xlp: `i'- Phone � `7 Licersselp." 30,1 of i atal,tQty Multtplirlti by t)n11, Charpol $ $ $ Owner as dal3med by RCW.19.28,281: (1) Owner will occupy the structure for two years after this electrical permit Is finallzod, (2) Owner is rogolred to hire an electrical contractor if above said property Is for safe, rant or lease. Permit 6xplres after slx months of last inspection. After reading the above statement, f hareby cedlfy that I am the ownar of the above named property rar a loaned oloolrlcal contractor, I am making the electrioal Installation or alteration in compliance wAh the electrical laws, N.E,C., ROW. Chapter 19,28, WAC. Chapter 286-4613, The City of Part Angeles Municipal Cade, and Utility 5peollfcallo% and PAMC 14,05.050 regarding Electrical Permit Appficatlons, Signolltre of owner el Ctrfcat contractor or electrical adminfstrator: rl ORA 0 chnak © CradltCard#- DOW: 10 - lU - 01�b[5 0110112012 .l Application Number . . . . . 23-00000261 Date 3/16/23 Application pin number . . . 825230 Property Address . . . . . . 406 S LAUREL ST ASSESSOR PARCEL NUMBER: 06-30-00-0-0-8800-0000- Application type description ELECTRICAL ONLY Subdivision Name . . . . . . Property Use . . . . . . . . Property Zoning . . . . . . . COMMUNITY SHOPPING DISTR Application valuation . . . . 0 ---------------------------------------------------------------------------- Application desc Generator ---------------------------------------------------------------------------- Owner Contractor ------------------------ ------------------------ QWEST CORPORATION TITAN ELECTRIC PROPERTY TAX 12828 NORTHRUP WAY #205 PO BOX 4065 BELLEVUE WA 98005 MONROE LA 71211 (206) 633-2811 ---------------------------------------------------------------------------- Permit . . . . . . ELECTRICAL ALTER COMMERCIAL Additional desc . . 1-4 CIRCUITS Permit Fee . . . . 218.00 Plan Check Fee . . .00 Issue Date . . . . 3/16/23 Valuation . . . . 0 Expiration Date . . 9/12/23 Qty Unit Charge Per Extension BASE FEE 86.00 1.00 132.0000 ECH EL-COM 0-200 SRV FEEDER 132.00 ---------------------------------------------------------------------------- Fee summary Charged Paid Credited Due ----------------- ---------- ---------- ---------- ---------- Permit Fee Total 218.00 218.00 .00 .00 Plan Check Total .00 .00 .00 .00 Grand Total 218.00 218.00 .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 3/15/23,14:08:34 PAYMENT DUE CITY OF PORT ANGELES PROGRAM BP820L --------------------------------------------------------------------------- APPLICATION NUMBER:23-00000261 406 S LAUREL ST FEE DESCRIPTION AMOUNT DUE --------------------------------------------------------------------------- ELECTRICAL ALTER COMMERCIAL 218.00 TOTAL DUE 218.00 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 3/24/2023 23-261 TAP OWNER CONTRACTOR Titan Electric PROJECT ADDRESS 406 S Laurel St 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 4/13/2023 23-261 TAP OWNER CONTRACTOR Titan Electric PROJECT ADDRESS 4063 S Laurel St Application Number . . . . . 22-00000783 Date 6/28/22 Application pin number . . . 200281 Property Address . . . . . . 406 S LAUREL ST ASSESSOR PARCEL NUMBER: 06-30-00-0-0-8800-0000- Application type description ELECTRICAL ONLY Subdivision Name . . . . . . Property Use . . . . . . . . Property Zoning . . . . . . . COMMUNITY SHOPPING DISTR Application valuation . . . . 0 ---------------------------------------------------------------------------- Application desc Circuits ---------------------------------------------------------------------------- Owner Contractor ------------------------ ------------------------ QWEST CORPORATION MCCOY ELECTRIC CO INC PROPERTY TAX P. O. BOX 1550 PO BOX 4065 NORTH PLAINS OR 97133 MONROE LA 71211 (503) 234-7521 ---------------------------------------------------------------------------- Permit . . . . . . ELECTRICAL ALTER COMMERCIAL Additional desc . . Permit Fee . . . . 129.00 Plan Check Fee . . .00 Issue Date . . . . 6/28/22 Valuation . . . . 0 Expiration Date . . 12/25/22 Qty Unit Charge Per Extension 1.00 74.0000 ECH EL-COMM BRANCH CIR WO/ S/F 74.00 11.00 5.0000 ECH EL-ECH ADDNT BRANCH CIRCUIT 55.00 ---------------------------------------------------------------------------- Fee summary Charged Paid Credited Due ----------------- ---------- ---------- ---------- ---------- Permit Fee Total 129.00 129.00 .00 .00 Plan Check Total .00 .00 .00 .00 Grand Total 129.00 129.00 .00 .00 PREPARED 6/27/22, 8:03:02 PAYMENT DUE CITY OF PORT ANGELES PROGRAM BP820L --------------------------------------------------------------------------- APPLICATION NUMBER:22-00000783 406 S LAUREL ST FEE DESCRIPTION AMOUNT DUE --------------------------------------------------------------------------- ELECTRICAL ALTER COMMERCIAL 129.00 TOTAL DUE 129.00 Please present reciept to the cashier with full payment