HomeMy WebLinkAbout611 Milwaukee Dr - BuildingPREPARED 9/27/06 10 54 07 INSPECTION TICKET PAGE 4
CITY OF PORT ANGELES INSPECTOR JAMES L LIERLY DATE 9/27/06
ADDRESS 611 MILWAUKEE DR SUBDIV
TENANT NBA BOB PASCO
CONTRACTOR PHONE
OWNER HUTCHINS GRAHAM /DOROTHY PHONE
PARCEL 06 30 00 4 8 0030 0000
APPL NUMBER 06 00000918 RES REMODEL
PERMIT BPR 00 BUILDING PERMIT RESIDENTIAL
REQUESTED INSP DESCRIPTION
TYP /SQ COMPLETED RESULT RESULTS /COMMENTS
BL3 01 9/27/06
14-.
BUILDING FRAMING TIME 13 00
CHRIS 460 3490
09/26/2006 11 24 AM DYASUMUR
COMMENTS AND NOTES
fir
CITY OF PORT ANGELES
DEPARTMENT OF COMMUNITY DEVELOPMENT BUILDING DIVISION
321 EAST 5TH STREET PORT ANGELES, WA 98362
Application Number 06 00000918
Application pin number 403904
Property Address 611 MILWAUKEE DR
ASSESSOR PARCEL NUMBER 06 30 00 4 8 0030 0000
Tenant nbr name BOB PASCO
Application type description RES REMODEL
Subdivision Name
Property Use
Property Zoning RS9 RESDNTL SINGLE FAMILY
Application valuation 6000
Owner Contractor
HUTCHINS GRAHAM /DOROTHY
611 MILWAUKEE DR
PORT ANGELES WA 983631418
OWNER
Permit BUILDING PERMIT RESIDENTIAL
Additional desc
Permit pin number 85241
Permit Fee 151 75 Plan Check Fee 60 70
Issue Date 8/29/06 Valuation 6000
Expiration Date 2/25/07
Qty Unit Charge Per
BASE FEE
4 00 14 0000 THOU BL -2001 25K (14 PER K)
Special Notes and Comments
Building address sign shall not be less than 6 not more
than 12 in height Numbers colors must contrast with wall
color they are mounted on (Ord 14 36 050 E)
Building Division has no requirements
Other Fees
Fee summary
ac,i4
Signature of Contractor or Authorized Agent
STATE SURCHARGE 4 50
Charged Paid Credited
Permit Fee Total 151 75 151 75 00 00
Plan Check Total 60 70 60 70 00 00
Other Fee Total 4 50 4 50 00 00
Grand Total 216 95 216 95 00 00
T \Policies \1102_15 building permit inspection record05.wpd [1/4/2005)
Date 8/29/06
Due
Extension
95 75
56 00
I
'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
fora 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 thatl have -read -and examined this application and know the same to be true and correct. All provisions of
laws and ordinances goveming 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.
ob9/0
Date Signature of Owner (if owner is builder) Date
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
YES 1 NO
FOUNDATION:
FOOTINGS
SHEAR WALLS WALLS
FOUNDATION DRAINAGE DOWN SPOUTS
PIERS
POST HOLES (POLE BLDGS.)
PLUMBING
UNDER FLOOR SLAB
ROUGH -IN
WATER LINE (METER TO BLDG)
GAS LINE
BACK FLOW WATER
AIR SEAL
WALLS
CEILING
FRAMING
JOISTS GIRDERS
SHEAR WALL/HOLD DOWNS
WALLS ROOF CEILING
DRYWALL (INTERIOR BRACED PANEL ONLY)
T -BAR
INSULATION
SLAB
WALL FLOOR CEILING
MECHANICAL
HEAT PUMP FURNACE DUCTS
GAS LINE
WOOD STOVE PELLET CHIMNEY
COMMERCIAL HOOD DUCTS
MANUFACTURED HOMES
FOOTING SLAB
BLOCKING HOLD DOWNS
SKIRTING
PLANNING DEPT SEPARATE PERMIT #'s
PARKING /LIGHTING
LANDSCAPING
RESIDENTIAL
ELECTRICAL LIGHT DEPT 417 -4735
CONSTRUCTION R.W PW/
ENGINEERING 417 -4807
FIRE 417 -4653
PLANNING DEPT 417 -4750
BUILDING 417 -4815
BUILDING PERMIT INSPECTION RECORD
T Policies \1102_15 building permit inspection record05.wpd [1/4/2005]
I 1 v
1 1 I
1 1
1
1 FINAL DATE ACCEPTED BY.
4v
1
1 1
1 1
1 I
1 1
1 1
1 1
1 1
I 1
1 1
FINAL INSPECTIONS REQUIRED PRIOR TO OCCUPANCY/USE
DATE YES NO COMMERCIAL DATE ACCEPTED
YES 1 NO
7i9 I4 I I I -Z
FINAL
SEPA.
ESA.
SHORELINE.
ELECTRICAL
LIGHT DEPT
CONSTRUCTION R.W
PW ENGINEERING
1 FIRE DEPT
1 PLANNING DEPT
1 BUILDING
DATE ACCEPTED BY.
Applicant or Agent: orb J4 3( P
Owner
Address. 6 /7 h9 w emu. /('e e
Architect/Engineer
Contractor
State License
Address: City
PROJECT ADDRESS (9 /4, w,¢ °c ke e D h
LEGAL DESCRIPTION Lot: Block:
CLALLAM COUNTY PARCEL NUMBER.
TYPE OF WORK.
Residential New Constr
Multi- family Addition
Commercial Remodel
XRepair Sign
BRIEF DESCRIPTION OF TAT,
COMMERCIAL/RESIDENTIAL. Occupancy Group
No. of Stories: Lot Size. Existing Sq. Ft.
Total lot coverage
PLANNING USE ONLY
TAFORMS\B1dgPennitform.wpd Applicant: lid 0
BUILDING PERMIT APPLICATION
Fill out COMPLETELY 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
Or City I
Re roof Stove
Mo 5e Garage
Demohtion 1X Deck
Other
PROJECT K
ifi
e
Yes No SEPA Checklist required? Yes No Other
Phone: 60 -68 3 8 9 7?
Phone.
Subdivision.
Phone:
Exp
SIZE/VALUATION
SF /SF
SF /SF
SF /SF
TOTAL VALUATION K
e/714e Pe
`Date. l Z //D4
Date Rec.
Permit
at.. Approved:
Date Issue
Zip 983 b
Phone:
Zip
ZONING
Occupant Load. Construction Type:
Proposed Sq Ft. TOTAL Sq Ft.
APPROVALS
PLAN
BLDG
DPWU
FIRE.
OTHER.
VALUATION OF CONSTRUCTION In all cases, a valuation amount must be entered by the apphcant.
This figure will be reviewed and may be revised by the Building Division to comply with current fee schedules. Contact the Permit
Coordinator at 417 -4815 for assistance.
PLAN CHECK FEE IF a plan check fee is due it must be submitted at the time the building permit application and construction plans are
submitted. All other permit fees are due at the time of permit issuance.
EXPIRATION OF PLAN REVIEW If no permit is issued witlun 180 days of the date of application, the application will expire. The
Building Official can extend the time for action by the apphcant up to 180 days upon written request by the apphcant (see Section
R105.3.2 of the International Building/Residential Code, 2003). No application can be extended more than once.
I hereby certify that l have read and examined this application and know the same to be true and correct. I am authorized to
apply for this permit and understand that it is my responsibility to determine what permits are required not the City's, and that 1
must obtain such permits prior to work.
71
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706
Mi waukee Dr.
609
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.
CITY OF PORT ANGELES LIGHT DEPARTMENT
321 E. Fifth Street
Port Angeles, WA 98362
(206) 457-0411
Site Address:
ELECTRICAL PERMIT
1M ;/W Ik.<.f/E
};/teC! ? keA~-<-r )
L ~;e.
PERMIT NO. 5/s 7/
DATE r //3 /it(
Installed By:
o READY FOR
INSPECTION
License Number:
o WILL CALL FOR
INSPECTION
Phone:
0/1
Owner/Business:
Owner/Business Address:
ELECTRIC HEAT
o BASEBOARD KW _
~ FURNACE KW /S-
o HEAT PUMP KW_
o FAN/WALL KW
')l!l RESIDENTIAL
o COMMERCIAL
;li:!' NEW CONSTRUCTION
o REMODEL
o ADD/ALTER CIRCUITS
o SERVICE UPGRADE/REPAIR
o TEMPORARY SERVICE
DetailslDescription:
Phone:
Sq. Ft.
o RISER
o OVERHEAD SERVICE
';:g UNDERGROUND ERVICE
VOLTAGE: 0 (.:) yO
~ 1 III 03 III
SERVICE SIZE d-c9O AMPS
FEEDER SIZE AMPS
Alia!- ~t<:J) ,
I -
.
w.s. No. SERVICE SIZE
CAPACITY:
o O.K. 0 NOT O.K.
ACTION REQUIRED: 0 CHANGE TRANSFORMER
o INSTALL SERVICE POLE
DATE
ENGR.
o OVERHEAD SERVICE APPROVED
o CHANGE SERVICE WIRE
o OTHER
o Ditch Inspection O.K.
!lrIJr. rA Rough-in/cover O.K.
~\l!J O.K. to connect service
b Final O.K.
S.te Address:
New Meters
--
Notify Port Angeles ity Light by Street Address and Permit Number when ready for inspection. Work must not b covered
before inspection and O.K. for covering has been given by the electrical inspector in writing on either the Wiring Report
or on the BuildjM-Permit. PHONE 457-0411, EXT. 224. ..//
'//I}IlI'I NO OCCUPANCY OR USE ESTABLISHED UNDER THIS PERMIT $ "(J'> 5'0
Electrical Inspector Permit Fee
.
WHITE - File by address
PINK - Top: Eng, Bottom, Customer
\..
OLYJ,lPICPRINTEASINC.
GREEN - Top: Meter Dept., Bottom: City Hall
,
I
.
CITY OF PORT ANGELES LIGHT DEPARTMENT
321 E. Fifth Street
Port Angeles, WA 98362
(206) 457-0411
ELECTRICAL PERMIT
PERMIT NO. 7/:> .3S-
.J /Y/fY'
,
DATE
Installed By:
0.-1-
I
o READY FOR
INSPECTION
License Number:
o WILL CALL FOR
INSPECTION
Phone:
Site Address:
,OwnerfBusiness:
Phone:
OwnerfBusiness Address:
Sq. Ft.
ELECTRIC HEAT
o BASEBOARD KW _
[] FURNACE KW _
o HEAT PUMP KW_
o FAN/WALL KW _
o RESIDENTIAL
o COMMERCIAL
o NEW CONSTRUCTION
o REMODEL
o ADD/ALTER CIRCUITS
o SERVICE UPGRADE/REPAIR
)(TEMPORARY SERVICE
o RISER
'0 OVERHEAD SERVICE
)<r UNDERGROUND SERVICE
VOLTAGE:
019\ 03~
SERVICE SIZE
FEEDER SIZE
AMPS
AMPS
Details/Description:
.
W.S. No. SERVICE SIZE
CAPACITY:
o O.K. 0 NOT O.K.
ACTION REQUIRED: 0 CHANGE TRANSFORMER
o INSTALL SERVICE POLE
DATE
ENGR.
o OVERHEAD SERVICE APPROVED
o CHANGE SERVICE WIRE
o OTHER
o Ditch Inspection O.K.
o Rough-in/cover O.K.
d1lf111l- O.K. to connect service
o Fiinal O.K.
Installer:
11ft A{/,~-t,ir c
"" c/ 0; dG
Permit/Receipt No. . ~
4s-J s:
New Meters
.
Notify Port Angeles City Light by Street Address and Permit Numberwhen ready for inspection. Work must not be covered
before inspection and O.K. for covering has been given by the electrical inspector in writing on either the Wiring Report
or on the~uildin Permit. PHONE 457-0411, EXT. 224. do &0
I. -:;..z: NO OCCUPANCY OR USE ESTABLISHED UNDER THIS PERMlT T '?,/7 n~
~ $ ~l/
Electricallnspeclor Permit Fee
WH ITE - File by address
PINK - Top: Eng, Bottom, Customer
GREEN - Top: Meter Dept.. Bottom: City Hall
OLYMPIC Pi'lINTERS INC
CITY OF PORT ANGELES
DEPARTMENT OF PUBLIC WORKS,
'j
. . . . . . . . . . . INSPECTION REPORT. . . . .v: . . , . .
REQUEST:
Date 9- ,,- q I TimE' Received by (phone, person)
Location of Work to be inspected f, 1/ ctr, II S- - '7;1// iw <1. G' /~ -e -"--
- 'I
Name of person requesting inspection . I" tu I C c', '1"
Address of person requesting inspection I 7+,A '6- II Phone No.
Type of Inspection (circle appropriate one): Permit No.
Sewer Foundation Framing Chimney Plumbing Final Sewer Excav. Other
Dr,
if/I L/
L -<....A f--,- r-
INSPECTION NOTE~
Inspected: Date ~ I q
Remarks:
/:hI -<' t- ~Y: ') v-- I t-h.
/ ^J1o .?-.-
ql
!V-<W
"
I
?~l(
Time
flit )(" )~
f,,{f? ^Vl:-;
,
S-PVv'. ~':>
By 'T~VJ ,'/ (oy
i,-,r{"y' "_Q....I~U,L~ fy/'fA
>fVu,c-<c /-"jL/-<- 5/'//1--
YES
RESTORATION REQUIRED,
NO
U {I 4. k/tA7?03
C '74'-15
I--- 36J8fo8g-G
~)(
~
~ ~c...
4/1-
6' ~/l s +--
\ .
,r{: ~ ~
"
~v -, . i'l Pf
b~~f-I~ ~Y1-
Le IS q/c...-OQ7g0lj
C- 745D
.'38'1 {f(p'/fq I
f-lS
q4\tY ~o oJ-lv!r;f
__~...\- (0'
SURFACE RESTORATION:
SURFACE TYPE: 0 Unimproved DGravel
o Repaired by City
o Repaired by Permittee
o No Damage Found
o Asphalt 0 PCC 0 Other
Work Order # -Cf} 9 I ~ q 7 ? 2-
[lYCOMPLETE
o INCOMPLETE
fContinuA on rp'v~rc:p girl A if "''''''''A~~arv'
, "
r
CITY OF PORT ANGELES!
DEPARTMENT OF PUBLIC WORKS'
. . . . . . . . . . . INSPECTION REPORT. . . .. . . . . . .
, '
REQUEST:
Date 9- ,~ - q '} Time Received by , (phone, person)
Location of Work to be inspected 6 /7 "- {, I r - 'TI1t"( OJ a... (/ If ~.JL
.-c/--: I. . ,'/ C 0'-./
Name of person requesting inspection _ r !:id. _ ,. -J:::-
, Address of person requesting inspection .I ,+1r. '6- 0 Phone No.
Type of Inspection (circle appropriate one): Permit No.
Sewer Foundation Framing Chimney Plumbing Final Sewer Excav. Other
Dr,
'III 'f
U--A-~y
INSPECTION NOTES:
Inspected: Date rt - I}! ~ t{ ?
Remarks: IV-< W
r:bl <+~ ~ LJo--" 't-h. ",
FA} 1-0 :;... ~~\(
Time
iff( y :;;A
-h.J:;:J AYlId
1 .
C,-PjrVI c- .~
By T VJ ,oj c 0 -y
l.-t 1- ,.. r- !. ~c.// e.~ 6--' I 'fA
!:.-e VV/ c~ 1-1 h.J-<.. 5//~
YES
RESTORATION REQUIRED
NO
l{J17 h
C- (f'lLI q'l- OD
j-:::- ?7S~Ui77 0
"J'X
~
5'1i~
6' ~h ~ +---
\
,~ ,6~
'\.
. I ,11/ff $
hI/V: ,~Y1- Ly ~o+~ vti
~ I 1 __ ~qt1~ rof..(
SURFACE RESTORATION:
SURFACE TYPE: 0 Unimproved OGravel 0 Asphalt
o Repaired by City
, 0 Repaired by Permittee
o No Damage Found
U I '1 qjl
c-- If I ~ 'It- tJO'lZzj
1~~IS-?&7ro1
OPCC
o Other
179r;-Cf7ft)
Work Order #
[lYtOMPLETE
o INCOMPLETE
./
(Continue on rev,:,r.R;~ sirt~ if l1~cessary)
~~"}1~:~: - '1;:'T\~~1'1'""",: d';' . %;
r:.r....'~:
,
N~ 04674
..
APPLICATION FOR PERMIT
"
~
OWNER M '/UJdO te.c J.-I.e'{ t1 h+S JOB ADDRESS foOl, iPrP.; MTl) In~ &11
LOT 1- B BLOCK 51- 3t:'f SUBDIVISION ~16: iL>{I, 10 1&1 M,lIAJAok:'-e-e
(Print Name) 1'; I'>-l 6e rma n hereby makes application lor the 1~"Irl9-<!-
1, Work to be completed by (date)
2, Location of work: Outside Inside traveled roadway (if within traveled roadway, complete items 3, 4 & 5)
Value of work to be performed (If over $2,000, complete item 6)
3, Contractor name OR
4, Performance Bond Amount
5. Proof of insurance
Work $2,000, and less: $50,000 personal injury, $100,000 per incident, $20,000 property
Work $2,000 and more: $200,000 personal injury, $500,000 per incident, $100,000 property
6, Permittee understands that no street may be closed to traffic unless approved by the City Engineer and Chief 01 Police and
notilications given to the Chief of Fire Department
may be closed to traffic from to
(SlIeer)
City Engineer
Chief of Police
Fire Chief
PERMIT
COMMENTS/CONDITIONS
2:
o
;::
~~a:
>~<
a:","-
~~::g
W-A-'T~ Svc..
L--r l-~
For
RiW
Sidewalk
Curb/Gutter ....
Driveway
Dwy/Culvert ..
Sanitary Sewer
1. Residential...
2. Commercial.
~. ~~~,.~.pai'%~Z{diI);~~gg
5. Cap.. ... 225.00
(includes W/M removal)
6. Secondary Sewer Treatment
Storm DrainAssessment........... ~;"";L" ~ CO rrl'>>A.
_Lc~.)::~C':~::::'~::: if ~ I~
" 5I~",...7JO....7::c'-'OQ.~ ~~ -./,., J ,
2. 314. .........500.00 __ __ J2d.f'i~'i3
3. Commercial deposit
(Based on estimate 1"",,$1,000.00 deposit) .....
4. Hot tap.. .........." ......... 250.00
5. Fire Hydrant install (depoSit)
........ $40.00
..60.00
................60.00
. ........"...... ....60.00
................... ........40.00
....80.00
.-'/(rX )-r-: o/iJt,/
if3
WATER MAIN
SANITARY SEWER
STORM DRAIN
TELECABLE
TELEPHONE UG
UTI L1TY POLE
In conaiderlll:lon of the granting of thia permit, it ia further IiIgreed by the applica.nt thlilt
the City of Port Angeles and any of ita office... or employees shall be..\Ied harmleaa
to the apt)licant from any liability or responsibility for any accident, Iou or damage to
peraone or property, happening Or occurring as the proJ:imate result of any work
undertaken under the termaof thi. application and the permit or pennitawhi<::h ITIIIY be
granted in nMlponee thereto, and that all of uid liabilitiea are hereby aaeumed by the
applicant.
Signed ---;:(p t; e. r vY\a...h
Telephone No.
Mailing Address
Zf'5fJ I"''r~
Permanent .... .................. ........ ........ ..
Gravel...................... ..
Non-traveled " ..................
Curb removal.................
RESTORA nON DEPOSIT
...................325.00
....................160.00
..............160.00
................160.00
Thia certifiM thalthlll allow named applicant is granled thlll permil$ to do tha work desaibed in and tor the
p.rposesh"""" i"lthe appIicatia'l. Eachpenn~is granted subjecl to the ttNms of tle egrNlflent contained in
\tie said appIiC8~on t1I1d .wbject 10 1M provi$ons of 1M code d 1M City of Pcxl An~N. snd nothing
permittedhereuncler shall be deemed 10 override theprDYisions ot alY applicablllllaw of the City, Slallll or
FlilderalGovenvnlllnl
Permit total
Restoration total
TOTAL
Receipt No.
Issued by
...$
8' J ;.f Jq ~
24 HOUR MINIMUM NOTICE REQUIRED PRIOR TO SERVICE OR INSPECTION
Call 48 Hours Before You Dig: 1-800-424-5555
Rnance - Amount deposited ."",,,,,.,,.,,,,...........,,,..... $
Cost of repair CWIO #) ",,,...........,,,,,,,........ $
Refund amount due '........,........".""......,... $
Additional amount due City ...................".. $
INSPECTOR'S COPY - while APPLICANTS COPY - pink
Pen Print, Inc. 5/92
Work Order No.
P,O.No.
Warrant No.
Receipt No.
PUBLIC WORKS
WORK ORDER #
PERMIT
~
OFFICE COpy. canary
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APPLICATION FOR WATER
City Wdter Department
Port Angeles, Wash.
;~'
. . ,
'.
,
:;?I~
I hereby apply for water t.o be furnish~d in accordance with rates and rules of the City
for the following premi ses.: ..
Name of APpli~ont-111.dLlJ/.l()r-PP-1+eUih\.-c; ( IIvv/:ierrv.:;,,"
Address---Loo$""AA \ \ I1JA1Jl:::e €- h\ \)~
,"."_,0 "_'".k.[}- ",_ L.. I" ,.. 'S'@ N'/
-"=fL-y Y y 0
Size of Service 7/4 'I::; <g" Meter NumbG~ I g t 9f .
Service Left On 0 Service Left'Off ~Signedlf
Installed bY' /(-€'A 'j"-r.'} n,,(){") (') ()
Remarks: tt:f"rY\\T. il:- L/-0it rf 6Du+,50-
1/-,=, 4:1:.-50766>' qlt:. CHI7r-of
l' '-"'-- If'-~o ~
APPLICATION FOR WATER
City Wate., Department
Port Angeles, Wash.
,~~
?J4
I I hereby apply for water to be Furnished in accordance with rates and rules af the City
~ for the Following premises:
Name of Applicant --.Ll1.i1 UJa,(Jt::ee ~+.s
Address I.oO::S /lIL.L1 Lf..)~j k-eoQ_ Dy\ V~
Renewal 0
L /I vi-, 6ern-,aJ7:
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APPLICATION FOR WATER
City Water Department
Port Angeles, Wosh,
J(
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, " I hereby ,apply for water to be Furnished in accordance with rates onc~ rules of the City
~' for the following premises: " .
NomeofAPplicant--LU-0-W-1LUk'i'p ~i(.:\,~ (,/;y-y-.,b€~I))
Address~a..~r\ V<" _ Q ~ IX' S, p~O b/ll~)
RenewolD New Service [g-- Blk_ Lot_L Add S1--.31 fI;G
'" Size of Service 7/4 X qt Meter Number 31 S ~h 7 ~ 1
?J
Service Left On 0 Service Left Off ~igned -Ie::: ~
12 Instolled by II f( f1'066e&O
q 5 O() - ;/;;:l7f3:;
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,19ft
APPLICATION FOR WATER
City Water Department
Port Angeles, Wosh,
~)4
;. I hereby apply for water to be Furnished in accordance with rates and rules of the City
. ~ for the following premises:
VI Nome of APPlicontL14+lwiZ.JJ '€. (j; YY\h8r~I-\)!
Address-Ce-4-A4-i-IJl..h1 cJlc~~ Jx, ILL__LJ!'\<?< SI~d0
Renewol D New Service Q--- Blk_ Lot 'Z..- Add 'S L-, ~1' 1 Y
~ Size of Service "5/4 i ~ Meter Number '375" 3 ~ 77 (!)
Q Service Left On 0 Service Left Off cg.----Signed iF
--i. e.v!:1vJ (; 0 oM 0
'*' ~O{)- +,50-
q /(aG 8".;L';>O-
'1- ;;.!93.U
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APPLICATION FOR WATER
City Wat., Department J il
Port Aogeles, Wash .__~._.+ ",;;J-y __, 14!:L
I hereby apply for water 10 be furnished in accordance
for the following premise:.: ~ / 1/ 1/
Name of Applicant __..,_~_~/--_ ;(!
L13Je ~7oi'lQ?/7 Mm<,S'
Add,es s ___=-____ _______
with roles and rules of the City
c0/? J; ~Jl.6~,
-------- -_. /
'Renewal 0 New ServiceD
Blk___ Lat_ Add___
Size of Service__
_ Meter Number
Service Left On 0
Service Left Off 0
Signed
Installed by_r5.j5. G-;'5-?C(
1/ (?71.- ~ ');j 1/ -
Remorks:f'(7T I~ .
. ';:>.-::0 r:;lcL ?f'r-rn/T--z:L N';-::;Cl7
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CITY OF PORT ANGELES
DEPARTMENT OF PUBLIC WORKS
. . . . . . . INSPECTION REPORT. . . . . .
"
REQUEST:
Date
Time
Received by
(phone. person)
Location of Work to be inspected
Name of person requesting inspection
Address of person requesting inspection
~spection (circle appropriate one):
~oundation Framing Chimney Plumbing
If 1/
N
/ 0 D f.>-ll'L <:;..0 'IN II
1
B,es--r-
Phone No.
Permit No.
Final Sewer Excav. Other
INSPECTION NOTES:
Inspected: Date S- ;;J- -"1f
Remarks:
Time
4YY\
By CA4
..... .
l rL
~v' "'^. f1 7 0--
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RESTORATION REQUIRED
YES
NO
SURFACE RESTORATION:
SURFACE TYPE: 0 Unimproved OGravel o Asphalt OPCC
o Other
o Repaired by City
o Repaired by Permittee
o No Damage Found
Work Order #
o COMPLETE
o INCOMPLETE
(Continue on reverse side if necessary)
STREET SUPERINTENDENT
(DATE)
SUbdivision/Projects construction meeting held August 19, 1993,
Employees in attendance: Trenia, Jimmy, Jack, Ron, Annette, Wayne,
Gary, and Ralph.
PROJECTS DISCUSSED
1. 6th/Milwaukee Drive
(Developer)
R/W Permit paid 7/27/93
Gary Priest (Contractor) Tim German
Inspection fees deposited amount $1500.00
Water meters for Lots 1-8
paid) + $750. (paid SYSTEM USER
installed 8/ /93 ($500.00
FEE) =$6000.00 floL '3/1117 d
f2. e c-=#-507C:> 0
Items Not Paid
WATER
pi 1/~ul~$4000.00 8 Meters @ $500.00 installed on Milwaukee Dr.
..,.. $3000.00 #003<1 6 Meters on "N" to be installed
~$4500. 00 ?Z";;/J"f (system User Fee)
~/~9Vlq? $250.00~; 1 F~re hydrant hot tap @ Milwaukee Dr.
rr - $250.00 tI _J, 1 Fl.re l!ydrant hot tap @ "N" st.
;;4~ u: (' ~~'!f, ~ 1717' ctUt/*
SANITARY SEWEr"y
J CL.J4?U250 .00
;fII/P/?'" $300.00
(J $125.00
125.00
~ $375.00
2 lateral taps installed 8/10/93 .2@$125.00
1 MH tap installed 8/05/93
1 lateral tap installed 8/12/93
1 lateral tap installed 8/16/93
3 taps on "N" @ $125.00 each
STORM DRAIN
~$125'00
$125.00
P(lnW $ 4.0..00
~I'r $ 40.00
1 lateral tap
1 MH set
installed 8/20/93
installed 8/18/93-
installed 8/18/93
installed 8/20/93
1 CB/INLET
1 CB/INLET
$100.00 SHORING SUPPLIED to Contractor 4 hrs 8/12/93
~\
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N~
04703
APPLICATION FOR PERMIT
OWNER
LOT
II /Y> 6'e 12m AM
BLOCK
JOB ADDRESS
...(PtintJlialtlill
Work to be completed by
Location of work: Outside
Value of work to be pertormed
Contractor name
Pertormance Bond Amount
Proof of insurance
Work $2,000, and less: $50,000 personal injury, $100.000 per incident, $20,000 property
Work $2,000 and more: $200,000 personal injury, $500,000 per incident, $100,000 property
Permittee understands that no street may be closed to traffic unless approved by the City Engineer and Chief of Police and
notifications given to the Chief of Fire Department.
may be closed to traffic from to
1.
2.
Inside
3.
4.
5.
6.
(street)
City Engineer
Chief of Police
(date)
traveled roadway (if within traveled roadway, complete items 3, 4 & 5)
(If over $2,000, complete item 6)
OR
Fire Chief
PERMIT
4 ~'"
0-
COMMENTS/CONDITIONS
./;'/500 ~ I#'5'P6CT/CJN
DEPos/T
z
o
;::
~~ll:
>~<
ll:",a.
WzW
"'_ll:
WATER MAIN
SANITARY SEWER
STORM DRAIN
TELECABLE
TELEPHONE UG
UTI L1TY POLE
In conaideration of the grenting of this permit, it is further agreed by the applicant that
tho City of Port AngelM and any of its officers or employeetlahan be saved harm Ie..
to the applicant from any Ii_bill r responsibility for any accident, loss or damage to
peraona or property. happen" or occurring.. the proximate result of any work
UndelUMn underttMt ler ia apt:llication!nd the permit or pennitawhich may be
grantecl in responee the ,and that all of -abilities are hereby a..umed by the
applicant
/ -~
, Signed
(Telephone No. V0.).,.- /"l, CI <,-"
Mailing Address h /t?' s; _ /ll&.6orlr . [;7:.
-r I'l/") (th/If I 9 - t::>-
Thilceni5nthatlhe.bow nllllltKI. 'cantii ~anled the permils 10 do lIlework desaibedin and for the
pwpos.e &hQlM1 i1lhe applicalion. Each permit is !,an~ I5Ubject to the I<<ml of fle agreement contained in
Ihell&idapplicatioo and subject 10 theprovisiool of Ihe code oIlh. Cityo' Port Angel05, and nothing
perrnittedhereunder shaJlbe deernedtoov.mdelheprovi&ionsol8f\Yapplicable law of the City,Stateor
FederalGovllmmenl
. ... ......... .............. $40.00
.....................................60.00
....~
................................ ...-
.... .......................40.00
R1W
Sidewalk ..................................
Curb/Gutter ..
Driveway
Dwy/Culvert ..
Sanitary Sewer
1. Residential .. ........................................80.00
2. Commercial h...................... .................
3. Alter, Repair.. .... ..................... ...... 30.00
4. Tap .. .................... ..... 125.00
5. Cap.. ..................................... ...................... 225.00
(includes W/M removal)
6. Secondary Sewer Treatment
Assessment.... .. ......... ..................
Storm Drain
1. Tap .......................... ..............125.00
2. C.B. . . ..... .......................................40.00
Water Meter
1. 5IB~ ..
2. 3/4~ ..
3. Commercial deposit
(Based on estimate 1~=$1 ,000.00 deposit) .....
4. Hot tap.. ..................... .................250.00
5. Fire Hydrant install (deposit) .......... .
.......................m
....................~
Permanent .. .....................~.~~~.~~.~~8.?~1~~.__
Gravel ................................................... .................. 160.00
Non-traveled.. .................160.00
Curb removal ................... .............................................. 160.00
Permit total .. ....................
Restoration total.................
TOTAL
Receipt No.
Issued by
o~
.$
24 HOUR MINIMUM NOTICE REQUIRED PRIOR TO SERVICE OR INSPECTION
Call 48 Hours Before You Dig: 1-800-424-5555
Rnance - Amount deposited ..................................... $
Cost of repair (W/O #) ............................... $
Refund amount due ................................... $
Additional amount due City ....................... $
INSPECTOR'S COPY. white APPLICANT'S COPY - pink
Pen Print, Inc. 5/92
Work Order No.
P.O. No.
Warrant No.
Receipt No.
PUBLIC WORKS
WORK ORDER #
PERMIT
N~
04703
OFFICE COPY - canary
N~ 04570
APPLICATION FOR PERMIT
C-"'~ 0+ ?-A- /I 1/
OWNER AV-cLJ5.htc... WIIIIlt-rn<;; JOB ADDRESS 1::1 W COY' I-J cu.cL
LOT BLOCK 'S '- 3> ~ SUBDIVISION M \ \ WCUJ K:e..a- ""I::> V \ Ve-
(Print Name) -ri YY'\ G e.." I"1CLh hereby makes application for the following
1.
2.
Work to be completed by
Location of work: Outside
Vaiue of work to be performed
Contractor name
Performance Bond Amount
Proof of insurance
(date)
traveled roadway (if within traveled roadway, complete items 3, 4 & 5)
(If over $2,000, complete item 6)
OR v.."b" I "i<
c::le..d. i1icle~ t.r.e.e~
"d;",..,,~ -r:> "w
'rb ...e "'" c..-"",e 77iJ u
..(",-~.....'\. c..~ s..t-~ R/w
c..:.i" tIN 'i f! JIII.(I.N'l:ft..~...~ i'r-.
~ 5-3-'13
Inside
3.
4.
5.
6.
Work $2,000, and less: $50,000 personai injury, $t 00.000 per incident. $20,000 property
Work $2,000 and more: $200.000 personal injury, $500,000 per incident. $100,000 property
Permittee understands that no street may be closed to traffic unless approved by the City Engineer and Chief of Police and .
notifications given to the Chief of Fire Department. '711e,.~. m"" T b'" u <.. .Ty
. repre:.i.e:f1 ""," o~., s:rp- w.Jhe..-(
may be closed to traffic from to yP............,' .....1:1 ~.. l'Wo ".:..T....._p~
.,....1'1a"t t:"1,lIy _ QO'-"3.~le -rrt!e~
0#'\ ~.-ry R/w, ~
Fire Chief ~ --LJ:
(street)
City Engineer
Chief of Police
COMMENTS/CONDITIONS e
z Au..owc::::. FO - r cl ~~r~~~~ter
S~e""'a\,Jll....l 0+ UI\ Q..r Onvaway....
UJ :s I Dwy/Culvert
se -' 'E 1::, Y"v""" h -c n ILl 0. 0 h q .~ Sanitary Sewar
>~~ . M' L..\UQ.vk..t- -'~\v'Q... ~ 1. ReSidential
ffi en w 'kj C;J . -- '-= ......t..-... 2. CommerCial.
'" ~ <r _ Ov-vS I.." ~"1 0'0 1D "'--:::'T' 3. Altar, Rapair ............ .................. ...30.00
WATER MAIN "RW 4. Tap.. .................. .125.00
- 5. Cap .............. ................................................. 225.00
SANITARY SEWER (iocl"das W/M ramoval)
STORM DRAIN '\. \ r.... - to ~ 6. Secondary Sewer Treatment
TELECABLE ~~;" ;~ Storm OraioAssassmaol ...........................
TELEPHONE UG I"""""'" ,. Tap ........ ................... ................... ...............125.00
UTILITY POLE ~ .LO \).J=U 2. C.B. ...................... 40.00
--n . u . Water Meter
-t'e"....,..hlS~er~\T 1. 518......................
In conaiderldion of the granting of thia; permit, it ia; further agreed bY the applicant thal 2. 314"
the City of Port Angeles and any of ita officers or employeea shall be saved harmless 3. Commercial deposit
to the applicant from any liability or reaponalbility for any accident, 1068 or damage to (BaS9d on estimate 1 "=$1 ,000.00 deposit) .....
persona or property, hspt:lltning or occurring.. the proximate result of IiIny work 4. Hot tap ............................. ... 250.00
undertllken under the termaof this application and the permit or permitawhich may be ...
gnlnted in response thereto, and that 811 of uld liabilities are hereby assumed by the 5. Fire Hydrant Install (depoSit) . ..........................
appIlcanL
RIW
PERMIT
...............................................~~)
.. ................................................60.00
......................... ....60.00
..................... ..........40.00
4D-
........80.00
. .............. 475.00
..............500.00
j
Signed
Telephone No.
Maiiing Address
...2 - 12..0S
2...-7'52..)
RESTORATION DEPOSIT
Permanent ... ................. 325.00
Gravel ..................................................160.00
Non-traveled ..... ...................... ..... 160.00
Curb removal .......................... ................................m....160.oo
Permit total .........
Restoration total......
TOTAL
Receipt N .
...::;-......................$
~0-
Thia<*1ifiHlhallheabovenamadapplicantia9"anledlhepermilslodolhworkdellCl"ibadinandfoflhe
pI.rpo&llsh~l'llheapplicabc:r1.Eachperm~is9"l\l1tedGUbjectlolheterm.oIf1allllraamanlcontainadin
lIlaaaidappl;cabon and aubjec:1 10 IIlIl provisiona olllle coded lIleCity 01 Port Angales, and nolllinll
permitted hereunder shall be deemed 10 override Ih, proviaiona ol..y applicable law of the City. State Of
FederalGovemrnenl
Issued by
Date 5 -4--<; 3
24 HOUR MINIMUM NOTICE REQUIRED PRIOR TO SERVICE OR INSPE
Call 48 Hours Before You Dig: 1-800-424-5555
Rnance. Amount depcsited ..................................... $
Work Order No.
P.O. No.
Warrant No.
Receipt No.
PUBLIC WORKS
WORK ORDER #
PERMIT
Cost of repair CWIO #) ............................... $
Refund amount due ................................... $
Additional amount due City ....................... $
INSPECTOR'S COPY - white APPLICANT'S COPY - pink
PenPrint. Inc. 5/92
N~
04570
J
OFFICE COPY - canary
", CITY OF PORT
N' --r-
rerson Calling . ~
Address ~ ~ (jp r~
REQUEST FOR SERVICE
ANGELES * PUBLIC WORKS DEPARTMENT
Date:
'-f{;;;>-~fq3
person
o
o
o
?-r;L(~~/z. 75'2--/
I ^ CI ~
PRIORITY: Urgent L....:. Schedule ASAP t::.. Time :-, ~
W~re.-{Ro"'--L _
REQUEST "Sc)-\ e-d u I ~
;.:-" e _~ I ~ ,d__ uJ<k' "e P< ;,~ \ to -- S-'
I l VV'\ ~.p '(' V\f\1l- h l c:. t> ... 0 pOS'; '" c.. ---to C2 \ e a..-h V 12 a.--n c:L-
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Y'^ee*- wit-h Tt n" on "SIT€--"'5o ~WA~lhTDOJ:?! A~'!f-l'( t{);,,~J. We. ~.t///I p//t;J<J .
'0''' ""'"'b'..O< "" 'P ''0' '"0' '5' "0' "'''0''''
Contact person making request (before action) Yes 6No 6 (after action) Yes 6 No 6
Received by:
phone
mail
Phone
ACTION TAKEN "I-c:.7-V ~05'O 77~::::::'( /"1t.3":-~ cn/ ,J/n= 7'-/A-'-~
';: /"~;; Q9' _ 7?~ A.,t ~ d":a -"'~
! _' 72f&P ph?Vl /Vb--r 7i!l G-.J/ /P~ l~
~
" " " RETURN TO SECRETARY FOR FILING " " "
,
April 29, 1993
Mr. Ridout
P. O. Box 1150
Port Angeles, WA 98362
Dear Mr. Ridout,
RECEIVED ~"
--,
1
j
APR 3 0 1993 .J
CITY OF PORT ANGELES
PUBUC WORKS
CITY OF PORT ANGELES
L PUBUC WORKS "
I have asked Mr. Tim German to help me clear and plant my .56 acre lot on the northwest
comer of "N" and Milwaukee Street. This work will beautify my lot and help to sell it.
Please treat Mr. German's request as if it were me requesting this. If you have any questions,
please contact me.
Thank you,
I
~'7/t~.
Ardis McWilliams
" f/! -' (1 /'
F'ov pO( ,
1/2 (7 . hl01
5rJr;;~ pf J5
~
-.\ e.-
it- '\)\ ,u '
)-; D ~e1o-
p(vfuJiU I vJ
d 0t@ fill e
V ~J ~ tt Sf.
tJ J'I h
CITY OF PORT ANGELES
DEPARTMENT OF PUBLIC WORKS
. . . . INSPECTION REPORT. . .
REQUEST:
Date 4/_ I C)- '1.s-
Time
Received by
fr-
(phone, person)
Location of Work to be inspected
Name of person requesting inspection
Address of person requesting inspection
Type of Inspection (circle appropriate one):
Sewer Foundation Framing Chimney Plumbing
/Y1: I....d L<Lke.e trI e"'fkt<,
-r;... Q.e r... OJ 1'1
Phone No.
Permit No.
sewerExcav.(Ot~ rres"",...e. 'Ie:;,-
Final
INSPECTION NOTES:
Inspected: Date 4- I I - 9 S Time A ft1 By <---1 ~
Remarks: 13,1/ If.bnds .{! E'><-c.e.I} p.-....HUy-{> "t".,t-,.w:.l:<z... /.'..-e.. 6l
;;lIe::. 11.5 {'",or IS_,'Y1. -no d..-or> - -- -.? ,"wc/" /,'''<'.$ P '-I1f,...s -110 J.....P
, ,
-r.;.s 1::50 C-D ..... ole.1eJ - 0 I<
J
RESTORATION REQUIRED. . . . .. YES NO
SURFACE RESTORATION:
SURFACE TYPE: 0 Unimproved 0 Gravel 0 Asphalt 0 pec
o Other
o Repaired by City
o Repaired by Permittee
o No Damage Found
Work Order #
o COMPLETE
o INCOMPLETE
(Continue on reverse side if necessary)
STREET SUPERINTENDENT
(DATE)
. . . . .
CITY OF PORT ANGELES
DEPARTMENT OF PUBLIC WORKS
. INSPECTION REPORT. . . . . .
. . .
REQUEST:
Date (0 -/9 - q.s--
Time
6":'-
r
Received by
~r
Location of Work to be inspected
Name of person requesting inspection
Address of person requesting inspection
Type of Inspection (circle appropriate one):
N/c- uA4u..e::c--c: ~~
77' M . ~fr1I4-7-1
Phone No. z-/Z3Z--
Permit No.
Sewer Foundation Framing Chimney Plumbing Final Sewer Excav. Other
P r/ /I---L..-
INSPECTION NOTES:
Inspected: Date. t, -;L 1-<1..s-- Time By ---c.... 4-
Remarks: zJ~n.x- v>1~~Yl<:;' c;;-,p..w-...., .,.......""....'" "'j-;;-;:....... """'''''/''''0;: l"7r:11JP l..v~,.v'I --t:@...-IPd .,:;J>'t.d. ;:;,oor1l,ffd
, ,
Paul,,) . CLL......h {/ a,-H-.p ,p J,_t:' C>?r('>~Dt(",V\
, "
~~ weP...J. l<~II,n..' ;v'\ -H:..-f>_ C'u{-rL.,-"'..Rr d'r"".~.
RESTORATION REQUIRED . . . . .. YES NO
SURFACE RESTORATION:
SURFACE TYPE:. 0 Unimproved o Gravel o Asphalt OPCC
o Repaired by City Work Order #
o Repaired by Permittee 0 COMPLETE
t:J No Damage Found 0 INCOMPLETE
o Other
(Continue on reverse side if necessary)
STREET SUPERINTENDENT
(DATE)
-,
.'
,.
,.
,
,
N~
04580
APPLICATION FOR PERMIT
".
OWNER
LOT ~
(Print Name)
L~R
JOB ADDRESS (p 11 M 1\ (lH~-tJ Ke'Q_
SUBDIVISION.4?'I.hUd.ll6' un -' ~
hereby makes application for the following
BLOCK
1. Work to be completed by (date)
2. Location of work: Outside Inside traveled roadway (if within traveled roadway, complete items 3, 4 & 5)
Value of work to be performed (If over $2,000, complete item 6)
3. Contractor name OR
4. Performance Bond Amount
5. Proof of insurance
Work $2,000, and less: $50,000 personal injury, $100.000 per incident, $20,000 property
Work $2,000 and more: $200,000 personal Injury, $500,000 per incident, $100,000 property
6. Permittee understands that no street may be closed to traffic unless approved by the City Engineer and Chief of Police and
notifications given to the Chief of Fire Department.
may be closed to traffic from to
(street)
City Engineer
Chief of Police
Fire Chief
PERMIT
In conaider.ion of the gl"8nting of this permit, it is further agreed by the applicant that
lne City of Port Angelo. and any of ita officers or employee. shall be..wed harmle_
to the applicant from any liability or responsibility for any accident, Iou or damage to
pe~'" or property. happening or GUurring .. the prol.irNIte ....ult 01 any work
undertaken undorthe .rme of thie applicetion and the permit or permitawhic:h may be
~...o,,:,: "'PO~~"'o,aodlh~.toll of "r!!#'" II.bllit...... he..by ....mod by the
Slgned~ ~
Telephone No. ~'Z.- z..oS-
'MaHingAddress (PIe 5, ?~ob'l j>,,4,
COMMENTS/CONDITIONS See ~W"k .................... ......~.~
w ~ K I LV () Se.. Cf ~ 3 ~~~;~~::lm .. ............_...................-..... ~gg
~ ~ ~ 75fm d- Ya / nOn 'So \J~ Sanita? S~:~id9ntial .. .......................... ... 80.00
ffi !;f! fu -s I'D€- 0 P 1.0' s, be. iDA--f Ie- 2. Comme,,'..' . ---------------
U) - 0: ~:~~:R~A~~WE~ I 40 ;-~~r~I ~. ~~L::::~'emov.,i ...............................~~.~
STORM DRAIN - 6. Secondary Sewer Treatment
TELECABLE La -, -::.. . Assessmeol..
--/ Storm Drain
TELEPHONE UG 1. c:I:iiiL::l.--.------
UTILITY POLE 2. C.B.
Water Meter
1. SIaN ...................
2. 314N
3. Commercial deposit
(Based on estimate 1N=$1 ,000.00 deposit) .....
4. Hot tap.. .... . ................... ......250.00
5. Fire Hydrant install (deposit) ........ ...................
....125.00
..........40.00
/2...-5-
....... ........... .....475.00
______.__.____ 500.00
'I
Permanent ..
Gravel
Non-traveled ...
Curb removal.........
RESTORATION DEPOSIT
.......325.00
..................................................160.00
................... ........ ......... ......... 160.00
.................................. .............160.00
---
The CI<'Ii'" lIlat Ill. &bow nemed applicant ie granted lh. permits 10 do ",...00. dnaibed in and for Ill.
pI.I'poH tIlown r. 1Il.lIppIicatioo. e,ch perm~ ie granllld IU~ to lhe tenne 01.,. 'g,..,..,.t COl'llllned In
lhe Aid application andlUbjecllothe p<ovilione 01 the coded lheCity of PootAngel... and nothing
perm~1lId Illnundef ehall be deemed 10 ov.mde lhe p<ovisiOfl5 ollrlY applicable law of lhe City. S,",,,, Of
FederalGovem'nent
Permit total .
Restorationtotal.......
TOTAL
Receipt N
___________________.$
1/"--~
I =2::
Issued by
Data Z - /4fitlf-/
24 HOUR MINIMUM NOTICE REQUIRED PRIOR TO SERVICE OR INSPECTION
Call 48 Hours Before You Dig: 1-800-424-5555
Finance - Amount deposited ..................................... $
Cost of repair 01"10 #) ............................... $
Refund amount due _.................................. $
Additional amount due City ....................... $
INSPECTOR'S COPY. white APPLICANT'S COPY -- pink
Pen Print, Inc. 5/92
Work Order No.
P.O. No.
Warrant No.
Receipt No.
PUBLIC WORKS
WORK ORDER #
PERMIT
N~
04580
OFFICE COpy. canary
"\. ..'
.' - ,
CITY OF PORT ANGELES
DEPARTMENT OF PUBLIC WORKS
. . . . . . INSPECTION REPORT. . . . . .
. . . I .
<.
REQUEST: '/ A .
Date 7___ /16 11</
Time
<(-
,
L7l\~rx!.
~
Received by
(phone, person)
Location of Work to be inspected
Name of person requesting inspection
Address of person requesting inspection
Type of Inspection (circle appropriate one):
L I:S R-
Phone No.
4ShO
Sewer Foundation Framing
Chimney Plumbing
Final
Permit No.
Sewer Excav. Other ~'+^1P-
INSPECTION NOTES:
. I'
( IJ
Time
+.~ 0,'"\
+= c>,,~"v \ '
By
i:: "I
hr+-t- ~~ I ( ~--' t)r
. \ c -t-oc.t.Jee:,
Inspected: Date
Remarks:
Q...ros>s '
i \ Y\'2..-
U:r S
, 'e.. - ,
-r
I ,
, J,-#C'''' ,.,. u.
, I...
,..
. J ,
v 1
<t II
- , t
1l'>
.3 <'l 111
"-
;r1 J W"I.t!<. ~'C ~~.
... "l ........ /j.'j,I.N "t'O <cf'
"ve. Tt41'
,f\
RESTORATION REQUiRED...... YES NO
11\
~
SURFACE RESTORATION:
SURFACE TYPE: D Unimproved D Gravel D Asphalt D pce
D Other
o Repaired by City
o Repaired by Permittee
o No Damage Found
Work Order #
D COMPLETE
D INCOMPLETE
(Continue on reverse side if necessary)
STREET SUPERINTENDENT
IDATEl
hI
CITY OF PORT ANGELES
DEPARTMENT OF PUBLIC WORKS
. . . . . . . . INSPECTION REPORT. . . . . .
REQUEST: ! .J/ '.'
Date uPa / 1C/
Time
Received by -V (phone. person)
(tJ-&-//71/~ .rj/!~
r;;cuw.r ~~J
,\
Location of Work to be inspected
Name of person requesting inspection
Address of person requesting inspection
Type of Inspection (circle appropriate one):
Sewer Foundation Framing Chimney Plumbing
~&.
INSPECTION NOTES: /; Jt, ~ nJ
Inspected: Date ~3;,z't/ Tim. e / t~. By
Remarks: ..- . ... ~ tb -t?- / /?2_/L.r~ J
.=? -11- ~L r"'.........f [eft;_
- d
Permit No. L/-6J1..J
Final Sewer Excav. Other S+A~~
Phone No.
RESTORATION REQUIRED . . . . .. YES
)
/NO
IX
-
,
<(J
"
-1-' (2.." I/hI<<.e.f
~x'sl''''1
~
'-->-- (.. ",,,,1' by C:I:(
<:.
;.
L.:....... 1"_/",,.1. 1-/ I ~ b..,j,:~.l. ~...)
bl-se.
SURFACE RESTORATION:
SURFACE TYPE: 0 Unimproved OGravel OAsphalt OPCC
o Other
o Repaired by City
o Repaired by Permittee
o No Damage Found
Work Order #
o COMPLETE
o INCOMPLETE
fContinuA on rF!verse side if necessary)
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APPLICATION FOR WATER
City Water Department
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Name 01 ApplkonLM..UwtlOtee. *r~~ (,1;"", 6('v~Y\) (;V}rl, D1 C
Address~l\.\lMJLb2e.-~i\J'€J (y\g::;-, P'eA.bbd (( {j
,.".~, 0 ,.....".0 "k__~ ,,,~ Md 5~'17'.b I
. Size 01 service----!fttP4 - Meter Numb~ i'6.___ 11P
Service Left On 0 Service Left Off GJ-'" Signed 1r~
Installed by /i-e .c}/Y1j- (;"() ~ 60
'<emarks: PfVWl'T~ ~&l~ 4 7j()O +7~p~
--y -<:> ~ JL -Sn/(/;( d ~~i", "" ~
Port Angeles, Wash.
I hereby apply lor water to be lurni shed in accordance with rates and rules 01 the City
for the lollowing premise.:
,
APPLICATION FOR PERMIT
~ (, I j Md lVGU I::ee-. llii~i-S
OWNER..:R I c.J:::.. f:\..n d i? ,SOY") JOB ADDRESS
LOT BLOCK SUBDIVISION
"\
\
..
(Print Name)
N~ 04825
b~\v
hereby make. application for the following
1. Work to be completed by
2. Location of work: Outside
Value of work to be performed
3. Contractor name
4. Performance Bond Amount
5. Proof of insurance
Work $2,000, and less: $50,000 personal injury, $100.000 per incident, $20,000 property
Work $2,000 and more: $200,000 personal injury, $500,000 per incident, $100.000 property
6. Permittee understands that no street may be closed to traffic unle.s approved by the City Engineer and Chief of Police and
notifications given to the Chief of Fire Department.
may be closed to traffic from to
(date)
traveled roadway (if within traveled roadway, complete items 3, 4 & 5)
(If over $2,000, complete item 6)
OR
Inside
(street)
City Engineer
Chief of Police
Fire Chief
COMMENTS/CONDITIONS
z
o
i=
~ja:
>~<
a:(J)""
wzw
(J)_a:
WATER MAIN
SANITARY SEWER
STORM DRAIN
TELECABLE
TELEPHONE UG
UTILITY POLE
Signed
Telephone N
Mailing Address
f
Thiseet1ili..lhat lh.~ named appIieantisS"anlldlhe ~jlStodolh.WOfkdH.aibed;n and for 111.
purpor;esh~inlh'Wieatia'l.E.chp"""'iti''7anllKlsubjltettolhtenn.ofto'89t~lH'Ilcontainedin
lh.s.aid lIpJllieation and....bjeclla the provisions oftha eoct.CIf!h. City 01 Port Angej.., and nothing
permitt8dhtlf.....ndershallbedeemedtoovenidelhepl'OI/isionsofa"lyapplieabl.lawollt1.C<ty. Stahl or
Fec:IlnlGoverrmenL
PERMIT .........$40.00 3")-
......... ..................60.00
. ......... ............... ...60.00
............. ......-r-
................... ....40.00
RJW
Sidewalk
Curb/Guller ...........................
Driveway....
Dwy/Culvert ..
Sanitary Saw"er
1. Residential...................
2. Commercial.
3. Alter, Repair .........
4. Tap... ...........................
5. Cap..
(includes W/M removal)
6. Secondary Sewer Treatment
Assessment...... .................. .......................
Storm Drain
1. Tap .......
2. C.B. .....
Water Meter
1. !YB~ ..............................
2. 314~ .....
3. Commercial deposit
(Based on estimate 1N=$1,OOO.OO deposit) .....
4. Hot tap ..................... .... 250.00
5. Fire Hydrant install (deposit) .....
.........80.00
(Z ,,>
5?()-:+ .32-4V
..........30.00
...........125.00
...... 225.00
~ID-
................... .......................... 125.00
................. ....................40.00
.................~
.................... 500.00
~
Permanent
Gravel
Non-traveled
Curb removal
RESTORA nON DEPOSIT
............................. ........ ..................325.00
.............................................160.00
..............160.00
................... ........................160.00
Perrnittotal ....... ........................................... ....................
Restoration total.................................................................
1:~:~.~:iP$r11~~~~~$ 2 _~?~ ;-
24 HOUR MINIMUM NOTICE REQUIRED PRIOR TO SERVICE OR INSPECTION
Call 48 Hours Before You Dig: 1-800-424-5555
Rnance - Amount deposited ..................................... $
Cost of repair rNlO #) ............................... $
Refund amount due ................................... $
Additional amount due City ....................... $
INSPECTOR'S COPY - white APPLICANT'S COPY - pink
PenPrint, Inc. 5/92
Work Order No.
P.O. No.
Warrant No.
Receipt No.
PUBLIC WORKS
WORK ORDER #
PERMIT
N~
04825
OFFICE COPY - canary
.
CITY OF PORT ANGELES
DEPARTMENT OF PUBLIC WORKS
. . . . . INSPECTION REPORT. . . . . . . . . . .
Time I '2..', $ 0 f~ Received by o(i:/j (3, person)
"
REQUEST:
Date y- '2.. 7-1\...(
Location of Work to be inspect~/l 1-1/ LW 11/</!"l;-
Name of person requesting inspection
Address of person requesting inspection
~nspection (circle appropriate one):
~oundation Framing Chimney Plumbing Final Sewer Excav, Other
Phone No.
Permit No.
INSPECTION NOTES:
Inspected: Date 1- ~ 7 - 'r <-I
Remarks: CD """P '-P~
Time
P,AI}
By:-----r ^- r1
'-"
RESTORATION REQUiRED...... YES
NO IX
-
_~r38't..~);L. _ _.
n1,lw3,,-ke e...-
6}(~sthl (,."?oJc.. '-l'de.€-f
!:. )( '-\ r,,-d""CE'1-
\ v
r~
J
";r
.-
1
ell '
- - - - -)
I
,~' I
-.y..!:..
,
SURFACE RESTORATION:
SURFACE TYPE: 0 Unimproved 0 Gravel 0 Asphalt 0 PCC
o Other
o Repaired by City
o Repaired by Permittee
o No Damage Found
Work Order #
o COMPLETE
o INCOMPLETE
(Continue on reverse side if necessary)
STREET SUPERINTENDENT
(DATE)
.> ~ \,ORT "l-V
. ~ 0 . . Q~
" ~ ~~(~
CJ ' ~ IS'
r~~
CITY OF PORT ANGELES
.o~...""
81./C wo~
June 28, 1995
3,1 E FIFTH. P.o. BOX 1150
PHONE 13601 457-0411
PORT ANGELES. WASHINGTON 98362-3206
FAK (3601 452-0353
Mr. Tim German
618 S~ Peabody St.
Port Angeles Wa. 98362
RE: Milwaukee Heights Phase II, Public Improvements Completion.
Dear Mr. German:
The public improvements required for the referenced subdivision have been tested and
completed to the satisfaction of the City of Port Angeles. These improvements include the
City Standard paved streets, curbs and gutters, and sewer, water, and storm facilities
required for the subdivision. The required as-built mylars for these improvements have
been provided by your engineer which completes the requirements for acceptance. The
public improvements for Milwaukee Heights Phase II have been accepted and will be
maintained by the City of Port Angeles.
Very Truly Yours, J
i\. _~.)~
G~K\;;worthY, P.E. -
City Engineer
GWK:gk
Copies: J. Pittis, Dir.
Building Div.
Planning Dept.
Disk: Dlwplprojecls\mwkhtlla.gwk
File: 93-17.02
Jack Pittis, Director (ext. , 20]
Gary Kenworthy, City Engineer [ex! 129)
Tim Smith, Contracts Administrator text. 226J
Ken Ridout. Deputy Director text. 122]
Bob Jones, Solid Waste Superintendent [e)(l._ 228]
Pele Burrelt Equip Srvcs 5uperintendent!ext 155}
Phyllis Rasler, Administrati've ASSistant [etl 120]
Dale Warner, Street Superintendent [el<'t 164)
Ralph Ellsworth, Water Supermlendent text 247]
Mike Robertson, Wastewater Superintendent [el<'l,1631
,~\
,,\,ORT .01..
'0' . "Q
,,-I. r~'-.:~
~ """'l:;~~
. "~:.
CITY OF PORT ANGELES
.o~<":)
Vel. Ie WO~~
June 28, 1995
321 E FIFTH' P.O. BOX 1150
PHONE (360) 457.0411
PORT ANGELES, WASHINGTON 98362.3206
FAX: 13601 452.0353
Mr. Tim German
618 S. Peabody St.
Port Angeles Wa. 98362
RE: Milwaukee Heights Phase I & II, Public Works Conditions.
Dear Mr. German:
Please be reminded that the storm outfall improvements not to exceed $15,000 for Phase
I are required to be competed by September 14, 1995 and that a sewer study is still
required for Phase I I.
Very Truly Yours,
l\ _l .L~
G'a~K)l;'orthY, P.E.
City Engineer
GWK:gk
Copies: J. Piltis, D~.
Building Oiv.
Planning Dept.
Disk: D\wp~roject5\mwkhlllb.gwk
File: 93-17.02
Jack Pittis, Director [ex!.. 120J
Gary Kenworthy, City Engineer text 129]
Tim Smith, Contracts AQministrator text 226J
Ken Ridout, DeputyDirector[ext 122]
Bob Jones, Solid Waste Superintendent text. 228]
Pete Burrett, Equip, SNCS, Superintendent lext. 155]
Phyllis Rasler, Administrative Assistanl[ext, 120]
Dale Warner, Street Superintendent (ext 164/
Ralph Ellsworth, Water 5uperinlerlderlt [ext247)
Mike Robertson, Wastewater Superintendent (ext 163]
CITY OF PORT ANGELES
DEPARTMENT OF PUBLIC WORKS
. . . . . . . . . . . INSPECTION REPORT. . . . . . . . . .
REQUEST: c-'l } u ___
Date J / / / c1,~ Time
I
Location of Work to be inspected
Name of person requesting inspection
Address of person requesting inspection
Type of Inspection (circle appropriate one):
E5T6S
--
/ /;?YA<-.<
Received by (phone, person)
/7:k.-~~
{/OWZ/ /H/?~ 5, :iL
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Phone No.
Permit No.
Sewer Foundation Framing Chimney Plumbing Final Sewer Excav. Other
INSPECTION NOTES:
Inspected: -/-'9S--
Remarks:
By ,R'.:r:
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20'
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RESTORATION REQUIRED . . . . .. YES
NO
SURFACE RESTORATION:
SURFACE TYPE: 0 Unimproved 0 Gravel 0 Asphalt 0 PCC
o Other
o Repaired by City
o Repaired by Permittee
o No Damage Found
Work Order #
o COMPLETE
o INCOMPLETE
(Continue on reverse side if necessary)
STREET SUPERINTENDENT
(DATE)
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STATE OF WASHINGTON
OEPARTMENT OF HEALTH
WATER BACTERIOLOGICAL ANALYSIS
SAMPLE COLLECTION: R.EAD INSTRUCTIONS ON BACK OF GOLDENROD COpy
If In.tructlon....,. not followed, .ample will be rejected.
DATE COUECTED TIME COLLECTED COUNTY NAME
MOHll1 DAY YEAR ~: ~
I.( / (J! 9__ AM DPM 1(,
,.
TYPE OF SYSTEM IF PUBLIC SYSTEM, COMPLETE:
(iqPUBLlC ~
I D INDIVlDUAL 11.0. No.1 (( ~ ."; (' ;t'i
("N.' only 1 rNldenot) ." ~~,
NAME OF SYSTEM
CIRCLE GROUP
~.J B
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.... ,./ ,r'" ,.' ., r.,
, A.,J...- (.> 1'- ._'
SPECIFIC LOCATION WHERE SAMPLE COlLEOTED TELEPHONE NO.
tl'i,!wc.,,/(e. d( ~;I"+''':;,
DAY (
,.. i-I' ril.l
EVENING ( ) ,
SAMPLE COLLECTED BY: (Name) SYSTEM OWNEAiMGR,: (Name)
c;t.? -: ,/ ftrIJ
SOURCE TYPE." GROUND WATER UNDE SURFACE INFLUENCE
D SURFACE QWELL or D SPRING D PURCHASED or D COMBINATION
\&J WELL FIELD INTERTIE or OTHER
SEND REPORT TO: (Print
TYPE OF SAMPLE (check only one In thig column)
o ~2~~~~ WATER 0 Chlorinated (Residual: _ Total~ Free)
check treatment r 0 Flnered
o Untreated or Other
D REPEAT SAMPLE
Prevlout coliform presence Lab'
Dele
o RAW SOURCE WATER Source · ~ [I]
o NEW CONSTRUCTION or REPAIRS
o OTHER (Spedly)
REMARKS:
o Total Coliform
o Fecal Coliform
(LAB USE ONLY) DRINKING WATER RESULTS
D UNSATISFACTORY, Colijorms pr.sent ~~TISFACTORY.
Coliform. absent
REPEAT D E. CoIl present o E. Coli absent
SAMPLES
REOUIRED o Fecal present D Fecel absent
OTHER LABORATORY RESULTS
TOTAL COLIFORM ~ /100 ml E. COLl_ /lOOml
FECAL COLIFORM _ /100 ml PLATE COUNT Iml
ANOTHER SAMPLE REQURED
SAMPLE NOT TESTED BECAUSE: TEST UNSUITABLE BECAUSE:
D Sample too o~ o Confluent grow1h
D Wrong container D TNTC
D Incomplele torm o Turbkl culture
D o Excess debris
SEE REVERSE SIDE OF GREEN COpy FOR EXPLANATION OF RESULTS
LAB NO, (7 DIGITS) DATE, TIME RECEIVED
RECEIVED BY
qdD-g)~ if/;)
DATE REPORTED lABORATORY:
-/3-rstf
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FlEw.RK1
DOH ~2 (REV, 4It2)
WATER SUPPLIER Copy
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N~ 04513
I
APPLICATION FOR PERMIT
OWNE~... Q/"..,,,,>#e- t Il~b /-,010B ADDRESS Sbt! (Po off 1/ WdJ1 ,lc 11 L
LOT BLOCK SUBDIVISION 7; II E:J I
(Print Name) hereby makes ;,{,PIiCatiOn for the following
1.
2.
Work to be completed by
Location of work: Outside Inside
Vatue of work to be performed
Contractor name r-;><?~.". #, t' r-f
,-
Performance Bond Amount
Proof of insurance
3 (date)
traveled roadway (if within traveled roadway, complete items 3, 4 & 5)
(If over $2,000, complete item 6)
OR
3.
4.
5.
Work $2,000, and less: $50,000 personal injury, $100.000 per incident, $20,000 property
Work $2,000 and more: $200,000 personal injury, $500,000 per incident, $100,000 property
6. Permittee understands that no street may be closed to traffic unless approved by the City Engineer and Chief of Police and
notifications given to the Chief of Fire Department.
~ ./. " 1...t. I
./- V .... -.... .or.... L-/~ may be closed to traffic from to
(street)
City Engineer
Chief of Police
Fire Chief
COMMEi5_NTS/CONDITION~ll ~-t1' ~walk ..................
. J.- V' - Curb/Gutter
l'! ~ c: nbJVI ~rtJ . ;rjj5~~~~~, ...................
~ ~ ~ t' e- U J 1. Residenti':1I.............
LLJ (/) W ,2. Commercial...........
(/)~a:: q (to. ~ ^~. Alter. Repair.......... .......................30.00
::~~:R~AS~WE. (1 ~ ~ VI ~~. ~:L;~/~;~mOV~) .... ....~~~
~~~:~A~~:IN V :.b.o;, 6. . ~:~:~Zn~erTr~~~~~............................
1: ~ Storm Drain
~~~L~~~~~~G f~ I f\J ~. ~a~ ........ ................'~~
.J Waler Meter
1. 518~ .......................... .................. ....475.00
In conaideratlon of the gfllntlng of thiS permIt, it IS furt r agreed by the applicant that 2. 314w.. . ............ SOO.oo
the City of Port Angeles and any of Ita officers or employeee ahall be saved harmle.. 3. Commercial deposit
to the applicant from any liability or responsibility for any accident, loss or damage to (Based on estimate 1 ~=$1.000.oo deposit) .
persons or property. happenln r occurring.. the prolfimate result of any work 4. Hot tap 250 00
undertaken under the termll 0 . appriClltionandthepermitorpennitawhichmaybe . ... . ...........
granted in response them d that all of uld UabilltiH are hereby ...umed by the 5. Fire Hydrant Install (depoSit) ............................
,.....,"'n1. ~_
Signed ~~
Telepho No.
"Mailing Address
PERMIT
40
.............. $40.00
. ............................ ...........60.00
.......60.00
......60.00
....... 40.00
....80.00
Permanent .......
Gravel
Non-traveled
Curb removal
RESTORA nON DEPOSIT
.......................325.00
...........................................160.00
.............................160.00
.......................... .. ............160.00
-
Thi.cer1ifi_ lhtlhe above n&m..:! applie<<nt i. grant..:!lhe permits to do Ihe.......k dHaibed in and for Ihe
pI#pOM mown in lh lIIpplic;t~gn. Each permit i. grllll~ subject to the term. 01 fle e9tMm8l'lt contained in
the Mid appIi~~on lltldsubjec:lto thep'ovioion& 01 the eodeol the City 01 Pori "ngeles. and nothing
pennitted hereundet lIhaIl be deem..:! 10 OYenide the p'ovisiona of.,y applicablelew of the City. State or
FederalGoYerrmllll
Permit total ....
Restoration total
TOTAL
Receipt No.
4-2)
Issued by
u3Z)uuuuu.$
Dale
24 HOUR MINIMUM NOTICE REQUIRED PRIOR TO SERVICE OR INSPECTION
Call 48 Hours Before You Dig: 1-800-424-5555
Rnance - Amount deposited u.u.u..................... ..... $
Cost of repair (yV1O #) ............................... $
Refund amount due ................................... $
Additional amount due City ....................... $
INSPECTOR'S COPY - white APPLICANT'S COPY. pink
PenPrint, Inc. 5/92
Work Order No.
P.O. No.
Warrant No.
Receipt No.
PUBLIC WORKS
WORK ORDER #
PERMIT
N~
04513
OFFICE COPY - canary
------
-------
CITY OF PORT ANGELES, WASHINGTON
TREASURER'S OFFICE
321 E. FIFTH
457.0411 P.O. BOX 1150
DATE OF RECEIPT: ~17"L?\q3
RECEIVED OF: \y.,..... G Q. V YY\ CLV"'\
L NO. Credit 10 Aeel. of IN PAYMENT OF AMOUNT
1
Cemetery
Police -
2 Convention
Center
3
4
5
8
7 SewerfWater
8 Solid Weste
9 Equipment
Rentsl
Off Stroet
10 PSrkln
Flremena
11 Pension
12 Cemetery
Endowment
13 L.I.
Quarant
14 Sell Ins.
15 1978 G.O.
Bds.
18 Investment
Portlollo
17 L.I.D.S.
18 Utilities
De sit
50823 REC'DB~
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PUBLIC WORKS CONSTRUCTION
and RIGHT-OF- WAY PERMITS
City Phone: 206-457-0411, ext. 124 ,
/~
.....<,UCANT/OWNER: II J?1 &f'Yh7t::J-i--. ADDRESS OF JOB: .111/ I U /Ii+! )'y-.o Q
APPUCANT ADDRESS: PHONE LEGAL OF JOB:
WORK IS 0 OIITSIDE or 0 INSIDE OF TRAVELED ROAD VALUE OF WORK IS:S (If work is outside roadway
and is equal to or less tban S2,OOO, then permit may be issued to other than licensed and bonded contractor.)
PERMIT 00 24 8
'f-Ir::
PLANS REQUIRED 0 YES 0 NO CONTRACTOR: DATES FOR START & FINISH
PERFORMANCE BOND REQUIRED 0 YES 0 NO AMOUNT: S
PROOF OF INSURANCE: 0 Worl< 52,000 or leSs: S50,000 personal injury, SlOO.OOO per incident, S20,000 property
o Work over S2.000: S200,000 personal injury, S500.000 per incident. SI00,OOO property
o Right of Way Use: S300,000 personal injury, S300,000 per incident, S 100,000 property
Permittee undentaod8 that no s~ may be closed to traffic unless approved by the City Engineer and Cbief of Police in advance of the
closure: that there is a 24 hour minimum notice prior to inspection. and to call 48 hours before diggmg to: 1-800-424-5555.
.........."'.. ~fIIlWI...... II........... by IbI ~ _... Clyol PaIt-.... -'..,. 0/. om-. <<....,.. au 1.-..... ___ WI u. ~ 1l"OIII.., lWlOIIJor ~
fotlll)'......_fl~la...-ar~. .........GlOIaInq.u.~-waollol:lY woR\nllmlIaI.....u:.ttnmoithit.ppllCSuaalml ti'e pemul Dl'pemu~...nidlMIY t:. ~ ID__
''''--. _.?~ Mid. u.bi1I&iIII_...,. ---1Ir u......
SigDed:-;;-~ ~~ DATE: /I/~/o/~
c:c ~. ',on'D REO'O I
moE FEE 'AID IT1'E FEE ,Alll
RJOKT OF WAY EXCAV. tJn- I-
....... ~ SAN. SEWER (Sfl) (6" 10 PI1- 6'1." ....00
-.
.-.... SAN. SEW'ER IU"'. 1.1 \mil ....00
....""..,.. SI~.(I) SAN SEWER IUFR'. ADD. UNIT ".00
DlNEWAY 1123.00 SAN 5EWEIt 0THEJt.S . Mia-US.CD: $O.lXlS hL
M..-S13O 1(X),~fISO.lll)Ua_
DWYCUL~.~ ....... SEWD. TAP. BY CTTY ~O SI25.lXlJSXlO.(X)
WYEiM~HOLE TAP
mEErCLT. ~ .lllO... ~ PLY!) - SEWER. C~IWATD. METa SZlli.CIJ
REJ,(OVAL
OTlIEIlJOHT OF WAY WORX ....... ALTDATlONI SJO.CIJ
REPAIJl TO SEWD
FIlU! HYD<AI<T DEPOSIT STORM DRA[N TAP Sl1J.OO
J.D. WATEJI. ttKVlCE 10 X !II" U>>.OO CATCH SA.SI/'lS IN LOTS PEIl EACH S<<I.OO
W. WATEJI. SDV!CE 10 X )1.0 U15.00 SECONDARY SEWER ASSESS. s.&IO.OOinSOIHKla.a.oo:lC I i
,
lD.WATEJl.S~~'.~" -.00 S~SYS. DEV.CHARGE l)2HXJ /EWM I
.
COMM. WATDl SDVICE 10 . $1,0:0 MQ.WAlIKEE DR. SEWER ASSESS. SlXl.OO/EWM
~~:-J~
WATEJl SERVICE. 0T1IER EmMA,", RIGHT OF WAY USE PERMITS VARIES S3. SIOO
WATER. sn. DEV. CHAlGE "50.00 IEW"Iro4 YOT AU , I '~U/l) - I
ThiI..wo- UlIIIIII...",..... ~ iI....... U. JIamN 10 00 l1li__ --..e-s 111_ (....l1li ~_ lQ Iia ~ Eadr. ~IIN' if....-........ 10 \he..,.... of \he .,_ _1nDll ill lDl: ~CIIIIOn
ad"';""'IIII~tttlm.Cil)'tttlPort ~ M\Bc:ipUCGda. "'<Xl'IintJl&mul.., .......at.II. .........1O_rnlaW: -uiaNoiilfr'l' IppI,,-,,1o il'" OllN Ci,.. C.,....... SlOW: Of ;:....1 eo..._.
COMMENTS/CONDITIONS:
[J O~~ Repair lO--Cn.J<-.-- ~ ~ ~ /Y\ \ ~U--i,-,-ju-~ t4Us
o Saslitary Sewer ~t/,--, I \I f-..\ 1\ :s -\ . .~
o Storm Drain
OU~~~~~w j /
"lOOT TOTALS 5 1. !If) ---- RECEIPT #' ISSUED B~': )-~ 'VI - DATE!! ~hf
INSPECTION FEES $
PW.m09.03 1121931
INSPECTOR'S COPY. WIlITE APPUCANT'S COPY - PINK
WORK ORDER No.
00248
OFFICE COPY - CANARY PERMIT
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CITY OF PORT ANGELES
DEPARTMENT OF PUBLIC WORKS
. . . . . . INSPECTION REPORT. . . . . .
.
REQUEST: / /.
Date 7 I /7/, 4Lf
Time
Received by
(phone. person)
Location of Work to be inspected
Name of person requesting inspection
Address of person requesting inspection
Type of Inspection (circle appropriate one):
UJ 11----M-!-l uJ t1.J.J? " 0 _
Phone No.
Permit No.
Sewer Foundation Framing Chimney Plumbing Final Sewer Excav. Other
RESTORATION REQUiRED...... YES
NO X
-----------
V. <U IV
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SURFACE RESTORATION:
SURFACE TYPE: D Unimproved D Gravel D Asphalt 0 PCC
D Other
o Repaired by City
D Repaired by Permittee
o No Damage Found
Work Order #
o COMPLETE
o INCOMPLETE
(Continue on reverse side if necessary)
STREET SUPERINTENDENT
lDAIEI~
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CITY OF PORT ANGELES
IO~'"
U81.IC WO~~
J21 E. FIFTH' POBOX 1150
PORT AKGELES. WASHINGTON %3bL
PHONE 12061 457.0411
November 8, 1991
Brian Hardin
Land Title Company
402 s. Lincoln street
Port Anqeles, WA 98362
RE: Milwaukee Drive Sewer Latecomer's Fee
Land Title File No. CL 27065
Dear Brian:
The latecomer's fee established by Ordinance No. 2618 will affect
only those properties that connect to the sewer line placed in
Milwaukee Drive from loth Street to 18th Street.
If a property has, or will have, a working septic system and does
not intend to connect to said sewer system, there will be no monies
due the City. The latecomer's fee will only be due if and when a
property is connected to the sewer system. (See Section 1,
Ordinance 2618.) This ordinance will be out by time in ten (10)
years from November 16, 1990 (see Section 6, Ordinance 2618).
The City of Port Angeles, Washington, hereby acknowledges that
Lot 4, Ocean view Estates, is released from the Milwaukee Drive
trunk sewer connection charge until the owner of said lot requests
connection to the City's sanitary sewer. Upon said request, the
latecomer fee will be assessed along with interest and any other
normal connection fees related to the type of construction.
If you have any additional questions or comments, please call
Trenia Funston at 457-0411, ext. 124, or myself.
Very
yours,
Ja N~ Pittis, P.E.
Director of Public Works
ce: Trenia Funston
llndTltl..ICDR
EA..l (pZ-D
,/ "spec-TlOn
o
Pr'Z)e.L-T ct ~-/l
04662
N~
APPLICATION FOR PERMIT
OWNER)A I III M \) t'~ ~~e(~_-k JOB ADDRESS
LOT BLOCK SUBDIVISION
(Print Name)
lo-tJ-'/Aif I/W{LrJCee,
/~el[)L
hereby makes application for the following
1. Work to be completed by (date)
2. Location of work: Outside Inside traveled roadway (if within traveled roadway, complete items 3, 4 & 5)
Value of work to be performed (If over $2,000, complete item 6)
3. Contractor name OR
4. Performance Bond Amount
5. Proof of insurance
Work $2,000, and less: $50,000 personal injury, $100.000 per incident, $20,000 property
Work $2,000 and more: $200,000 personal injury, $500,000 per incident, $100.000 property
6. Permittee understands that no street may be closed to traffic unless approved by the City Engineer and Chief of Police and
notifications given to the Chief of Fire Department.
may be closed to traffic from to
(street)
City Engineer
Chief of Police
PERMIT
COMMENTS/CONDITIONS
'S~ ':3ewe.r- T~p {M4)
(J) <g 1-Slq3
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WZW
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WATER MAIN
SANITARY SEWER
STORM DRAIN
TELECABLE
TELEPHONE UG
UTI L1TY POLE
In conalderatian of the Qfllnting of this permit, it is further agreed by the applicant that
the City of Port Angeles and any of Ita officefll or employees shall be aeved harmlen
to the applicant from any liability or responsibility for any accident, Iou or damage to
pereoM or property, happening or occurring a. the proxilTlllte result of any work
undertaken under the terlN of this application and the permit or permlte which I'MY be
granted in reaponee thereto, and that all of &aid Iiabilhlea are nereby assumed by the
apt)IiCllnt.
Signed
Telephone No.
Mailing Address
Thi.0W1i5eslhatthe .oov.named appIicant;1 ganted the permits to do lheWOfk~~ in and lor the
pI.IpQH 1h<Mn in the appIiee~an. Elm permit il ganted subject to the tlInnl 01 tle 19.e&ment contained in
the Mid sppIiea~on and subject to the provillianl of the eode of the City of Pm Angeles, and nothing
permitted hereunder shall be deemed to override the provisiOll6 or lWly applicable law of the City. Stale 0(
FederalGoverrvnenl
Fire Chief
.. ...................... ..... $40.00
. ...,........... ..60.00
...60.00
.................. ....................60.00
...40.00
RJW
Sidewalk
Curb/Gutter ..
Driveway
DwylCulvert .....
Sanitary Sewer
1. Residential........ . . ..............
2. Commercial.
3. Alter, Repair.. ............................... 30.00
4. Tap... ..................125.00
5. Cap.. .. ............................. .................... 225.00
(includes W/M removal)
6. Secondary Sewer Treatment
Assessment..
Storm Drain
1. Tap..
2. C.B.
Waler Meter
1. 51BM .................,
2. 314M .......................
3. Commercial deposit
(Based on estimate l~=$l,OOO.OO deposit)
4. Hot tap.. . .. . ........... 250.00
5. Fire Hydrant install (deposit) .... ...................
.........80.00
.. .................125.00
.................. ..........40.00
..................475.00
...............500.00
RESTORA TlON DEPOSIT
Permanent ................ .................... .................325.00
Gravel............................. ..............................160.00
Non-traveled.. ......................... ................. 160.00
Curb removal ..................160.00
Permit total. ....................................... ..............................
Restoration total................. ..............................
TOTAL .............................................. ........................$
Receipt No
Issued by
Date
dd1'3
24 HOUR MINIMUM NOTICE REQUIRED PRIOR TO SERVICE OR INSPECTION
Call 48 Hours Before You Dig: 1-800-424-5555
1ce - Amount deposited ..................................... $
Cost of repair IY"IO #) ............................... $
Refund amount due ................................... $
\dditional amount due City ....................... $
'opy - white APPLICANT'S COPY - pink
/.;:5192
Work Order No.
P.O. No.
Warrant No..Receipt No.
PUBLIC WORKS
WORK ORDER #
PERMIT
N~
04662
OFFICE COpy. canary
.
CITY OF PORT ANGELES
DEPARTMENT OF PUBLIC WORKS
. . . . . . . . . . . INSPECTION REPORT. . . . . . . . . . .
REQUEST:
Date 8-\I-Clt3
Time ;;: 00
Received by
~, person)
I
.
Location of Work to be inspected
Name of person requesting inspection N."" "..::,
Address of person requesting inspection ~"Jor T Cl{J
~Inspection (circle appropriate one):
( 0 Foundation Framing Chimney Plumbing Final
INSPECTION NOTES:
Inspected: ~ ~ (I - <1 .3
Remarks:
q I If
~, , 1.:n4 all. ~
Phone No. uJt<J'frV?
Permit No. 'fh'fiQ
Sewer Excav. Other
\
1YI rltUc:ud d jJtfiV'f'
q''-j lJp.
f
RESTORATION REQUIRED. . . . .. YES .><:- NO
,
..?3!9
;>
l'
o
SURFACE RESTORATION:
SURFACE TYPE: D Unimproved DGravel
D Repaired by City
D Repaired by Permittee
D No Damage Found
'~sPhalt D PCC D ~ther
Work Order # tr~ ~ 0);)
[tr'COMPLETE Jw fJY CO;t/U/lc'TO.-t
D INCOMPLETE 'I -IJ -o/J
---1D >f.yp ~ i-
'i!!III~~
~/.lR/ "",..~____ 9~~ /7~
/
~TAI=I=T ~IIPJ:AINTI=Nnr:NT InATE}
(Continue on reverse side if necessarv)
CITY OF PORT ANGELES
DEPARTMENT OF PUBLIC WORKS
. . . . . . . . . . . INSPECTION REPORT. . . . . . . . . . .
REQUEST:
Date OR -;;)0 - 93
.
Received by ---r-;;-f111 W @. person)
@ IAl~
Time
10,'$ 0
Location of Work to be inspected m ('!tA) rA uLQ e I>>t.
Name of person requesting inspection :::r: ;foe/a dur
Address of person requesting inspection ,YTDrc~ .t-@ Phone No.
Type of Inspection (circle appropriate one): Permit No. <!0g:;;
Sewer Foundation Framing Chimney Plumbing Final Sewer Excav. Other ~ 'ST71 ,0vt
INSPECTION NOTES:
Inspected:
Remarks:
,W-fJrm.
Time /1,'30 By
<.. ( ., NlH T ~
tJ.RST ()t- /Uft oN JJ
RESTORATION REQUiRED...... YES
NO~
4;' ()p
r'/
;/tJO-tLW 2~.
4yfi
SURFACE RESTORATION:
SURFACE TYPE: 0 Unimproved OGravel ~phalt
o Repaired by City
o Repaired by Permittee
o No Damage Found
OPCC
I
o Other
L{ to 3;2
Work Order #
o COMPLETE
o INCOMPLETE
(Continue on reverse side if necessary)
'nAT.~'
STREET SUPERINTF'NnI'NT
.,~-"~-- ~ ..
CITY OF PORT ANGELES
DEPARTMENT OF PUBLIC WORKS
. . . . . . . . . . . INSPECTION REPORT. . . . . . . . . . .
REQUEST:
Date '6 = \ to " q 3
f~-~
._ i""
/
.
Time \ 1. 00
........-; -
Received by } t..Lhc f<./
(phone. person)
, ~"
Location of Work to be inspected 1'Y\ l \ W (J Lek Q r? ~ I \ Q.1 Sh-t---S
Name of person requesting inspection ~()clofu[
.--
Address of person requesting inspection ~v0e, I ccp Phone No. l,0v.:)LlD I 'L
Type of Inspection (circle appropriate one): Permit No. L\ 10'6 'L.
Sewer Foundation Framing Chimney Plumbing Final Sewer Excav. Other
INSPECTION NOTES:
Inspected: Date 1)- \ lo - q ::, Time_lQ.. ~ ()O By Tj(,cw\be.b(
Remarks: ~p 1tJ" 7;;p 011. //J' 177(u",-z- 3'3 Dp 97 r tU 6) -mir
'./ ' 1/ r ,~ --i U
671 IV . U3.Jc IPX? &tc)orfr//.{l -1,.9 ?()O -Ss f!,OA1C!S
>~
RESTORATION REQUIRED. . . . .. YES ).( NO
-
111rJ.w~ I ~
7
1~
!
SURFACE RESTORATION:
SURFACE TYPE: 0 Unimproved OGravel ~sphalt
o Repaired by City
o Repaired by Permittee
o No Damage Found
OPCC
o Other
l\OI'2-
Work Order #
o COMPLETE
o INCOMPLETE
(Continue on reverse side if necessary)
STREET SUPERINTENDENT
(DATE)
, .
"
CITY OF PORT ANGELES
DEPARTMENT OF PUBLIC WORKS
. . . . INSPECTION REPORT. . . . . . . .
v"
. ,-,-
REQUEST:
Date
Time
Received by
(phone, person)
Location of Work to be inspected
Name of person requesting inspection
Address of person requesting inspection
Type of Inspection (circle appropriate one):
Sewer Foundation Framing Chimney Plumbing Final
I..~
/'~ "
~ ;V
.
G-a~'-I
/
Pr-,,,-sT
Phone No.
Permit No.
~~. Other
INSPECTION NOTES:
Inspected: Date g - If.. - 9 ~
Remarks:
Time ,~
By c..--r ~
;/
/
RESTORATION REQUiRED...... YES X. NO
. //
2Z- -r77':/ / '. /~..\
// 2;;- 0
/ / /~ ,Z . ~~_;;:;r~
ll~~~ ---.J
L~
~~
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<b
,
,
~~
<
SURFACE RESTORATION: ($"X ID
SURFACE TYPE: 0 Unimproved 0 Grave1 &I Asphalt 0 PCC
o Other
o Repaired by City
o Repaired by Permittee
o No Damage Found
Work Order #
o COMPLETE
o INCOMPLETE
If:nntimlA nn rAVArse side if necessary)
CTDa::::a::::T CIIDE:DII\ITl:l\lnE:I\IT
InATt:\
CITY OF PORT ANGELES EN 0zo
DEPARTMENT OF PUBLIC WORKS J//.p"4- =; j
. . . . . . . . . . . INSPECTION REPORT. . . . . . . . . . .
REQUEST:
Date
Time
Received by
(phone. person)
Location of Work to be inspected (Of!J1 f!f/!Wf..l4:x;
Name of person requesting inspection G/ f!Jt?'t'Yi
Address of person requesting inspection Phone No.
Type of Inspection (circle appropriate one): Permit No.
Sewer Foundation Framing Chimney Plumbing Final Sewer Excav. Other
RESTORATION REQUIRED . . . . .. YES
Pf!Jth 0 j 0'1 to F1M 1/iz6
NO
t1//V{JriKo 1Jr/~
.P
[3(:, I
'f
~
i:. ~
1111 /IT JE.
. cOil. Gi'7'
/'1/{flI/Ymt3E
SURFACE RESTORATION:
SURFACE TYPE: 0 Unimproved 0 Gravel 0 Asphalt 0 PCC
o Other
o Repaired by City
[] Repaired by Permittee
o No Damage Found
Work Order #
o COMPLETE
o INCOMPLETE
(Continue on reverse side if necessary)
STREET SUPERINTENDENT
(DATE)
"
.-
CITY OF PORT ANGELES
DEPARTMENT OF PUBLIC WORKS
. . . . . . . . . . . INSPECTION REPORT. . . . . . . . . . .
REQUEST: J I ./ J Y3 _____
Date '6 (ilq3 Time / 1::::----- Received by /,v CT~ person)
Location of Work to be inspected (y tr ! MJ.lu.)ti.A~ ~.M~
Name of person requesting inspection ,-~/lI)1Y~ - .
Address of person requesting inspection Phone No,
Type of Inspection (circle appropriate one): Permit No,
~undation Framing Chimney Plumbing Final Sewer Excav, Other
~hl~ ~
INSPECttl~ OTES: L?;:::
Inspected: I By k
Remarks: - co/. . t/ " /{}}.
ti? do ~ w/II ~~ ~
~~S;19J - <-Ilo -tq)/ f/t/r:U<:'PeYJ ('mid ,0'~r 96'1- d'tfr7d 70 :/o#J/+:- U////
~ yCair J(2;n?TI/J0 mM~~ /1ft1 mlllllml1m' b mil 1- C:g~ ~
-f/?J1 !/let(} IW7 frlJKrJ1O?,
, .
RESTORATION REQUiRED...... YES NO
/'1/CJClIJ(..UlJE /J1f/t/E
-
-
/
~
IJ!< Ep
\...~ .
7(Jp n;b /1/11- Fe ; 8.tJ '.fhn erIJJ:,a;ve/h&?!
<----' 8"Rt/c,
'\.;
'~
SURFACE RESTORATION:
SURFACE TYPE: 0 Unimproved OGravel 0 Asphalt 0 PCC
o Other
o Repaired by City
o Repaired by Permittee
o No Damage Found
Work Order #
o COMPLETE
o INCOMPLETE
IContinue on reverse side if necessaryl
._~TR_EET SUPERINJENOENT . _ _lOA TEl___
;'.i
.... , ~4'"
----------
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-----
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---
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CITY OF PORT ANGELES
DEPARTMENT OF PUBLIC WORKS
. . . . . . . . . . . INSPECTION REPORT . . . . . . . . . . .
REQUEST:
Date D'O- 0-:)- C{ '3 Time g: 60 11 Received by~1 ~i'1061<- (phone. person)
Location of Work to be inspected 171 ; /0a u l eG DiP; V e
Name of person requesting inspection ()tU-e1l ~
Address of person requesting inspection 111 d. ~p
Type of Inspection (circle appropriate one):
("3 Foundation Framing Chimney Plumbing Final Sewer Excav. Other
,"~J
"
. .
Phone No.~ xT. /103
Permit No. LIb '8 ~
INSPECTION NOTES:
Inspected.:J!ate 0 ~. ():;: 9::3
Remarks:' {,,_o(l.pd <:. <)0117 ('I'Ci.. rtj
tt5Pd I kr' OJdo :iff h rI
Time 1/ ;Of) .!!.
rn tI oj)
. t;
~fd ma.
By ()" )..Q1l S;
X'" m (1 f7 h6 '.(J Or/a /J1f r:
77()7JS A. . q y.:/ f
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(Y\ \ 1l0o. \).1.e -€- 'VR..
> ii 1:/ .. . r .::">
,~-
-" ....
'.
nc , t'J'
5
'T
RESTORATION REQUIRED . . . . .. YES NO
SURFACE RESTORATION:
SURFACE TYPE: 0 Unimproved 0 Gravel 0 Asphalt 0 PCC
o Other
o Repaired by City
o Repaired by Permittee
o No Damage Found
Work Order #
o COMPLETE
o INCOMPLETE
(Continue on reverse side if necessary)
STREET SUPERINTENDENT
-----. ---
(!>A 1]:)
."
CITY OF PORT ANGELES
DEPARTMENT OF PUBLIC WORKS
. . . . INSPECTION REPORT. . . . . .
E1J. &2-0
IrlSre07'()J-J (!i)
~
. .
~"
REQUEST: 1 I
Date 'tJ r 0 't'?
Time
Received by
(phone, persont
Location of Work to be inspected
Name of person requesting inspection ~P/ T
Address of person requesting inspection
Type of Inspection (circle appropriate one):
~ Foundation Framing Chimney Plumbing Final Sewer Excav. Other
~ .
INSPECTION NOTES: II
Inspected: Date 1/ ID 1 q3
Remarks:
- 1701 rtJdt/ WdI1tl //l1JlCcTln (It- u m 1'1xht
;:[00 f?JI1 {,,,- S'~
(p i:f. / /VLl.l u.) A,;'t:~ bn u '€...
q~-/7
Phone No.
Permit No.
.
l/fa~
Time
///0
By ?<;J /
/
j
c. ""f if'! T~
RESTORA TION REQUIRED. . . . .. YES ;)/ NO
?:f-"7:. "Tap -, $.~-e.ll..'P
,~ ~/'i6~
:;( ~ <J
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\
\
----
o
51 d"".e-\
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Ill-I ..\ I.e-R--~
~ 'l..Ycl.
L\ \'-) .
----
------
~
,
=<
/
SURFACE RESTORATION:
SURFACE TYPE: 0 Unimproved
5~'x t ( --- )
o Gravel 0 Asphalt 0 PCC
o Other
o Repaired by City
o Repaired by Permittee
o No Damage Found
Work Order #
o COMPLETE
o INCOMPLETE
(Continue on reverse side if necessary)
STREET SUPERINTENDENT
(DATE)
.~
CITY OF PORT ANGELES
DEPARTMENT OF PUBLIC WORKS
. . . . . . . . . . INSPECTION REPORT. . . . . . . . . .
REQUEST:
Date <g -It) - 9'3
Time
/ : :3 0 j).1'? Received by
I
~erson)
Location of Work to be inspected /f1,/ wc<uf~-e 01"','1/-'::
Name of person requesting inspection 0 lA.J C'" .s
Address of person requesting inspection S-ec..u-e<e- l""P Phone No.
Type of Inspection (circle appropriate one): Permit No. '1(98:2..
~wJ Foundation Framing Chimney Plumbing Final Sewer Excav. Other
----
INSPECTION NOTES:
Inspected: r -10 -7 ~
Remarks: b /'
Time
~w~r2.. /2:i
RESTORATION REQUiRED...... YES p( NO
;11,'1 we;" VI ~-e-c Orlf/~
/.~~
,/\
1Y\~
p1.~'
...
'"
~
~
'-
'"
'^
~
SURFACE RESTORATION:
SURFACE TYPE: 0 Unimproved OGravel o Asphalt OPCC
o Other
o Repaired by City
o Repaired by Permittee
o No Damage Found
Work Order #
o COMPLETE
o INCOMPLETE
(Continue on reverse side if necessary)
STREET SUPERINTENDENT
(DATE)
CITY OF PORT ANGELES
DEPARTMENT OF PUBLIC WORKS
. . . . . . . . . . . INSPECTION REPORT. . . . . . . . . . .
REQUEST:
Date S-lI-Oi.3 Time ;1:00 Received by
Location of Work to be inspected Y'/\,' 1~4,~ ~
Name of person requesting inspection N..\.t ~~
Address of person requesting inspection ~"Jor T n.r
~Inspection (circle appropriate one):. .
( 0 Foundlltion Framing Chimney Plumbing Final Sewer Excav. Other
INSPECTION NOTES:
~-(1-<13
Q, person)
(
Phone No. wi0*V?
Permit No. 'Ih,(;~
\
Inspected:
Remarks:
q I II
trlr /tUcuufef Ptf(i"f
q1ti J)p.
f
RESTORATION REQUIRED. . . . .. YES ~ NO
,
~.319
>
6
SURFACE RESTORATION:
SURFACE TYPE: 0 Unimproved 0 Gravel
o Repaired by City
o Repaired by Permittee
o No Damage Found
~sPhalt 0 PCC 0 ~ther
Work Order # tt'l~ 401;<
o COMPLETE
o INCOMPLETE
----1D s+ n" :e t-
'I! l:J..J ~ ~
(Continue on reverse side if necessary)
STREET SUPERINTENDENT
(DATE)
CITY OF PORT ANGELES
DEPARTMENT OF PUBLIC WORKS
. . . . . . . . . . . INSPECTION REPORT. . . . . . . . . . .
REQUEST:
,I
/
"
Date
Time
Received by
(phone, person)
Location of Work to be inspected
Name of person requesting inspection
Address of person requesting inspection Phone No.
Type of Inspection (circle appropriate one): Permit No.
Sewer Foundation Framing Chimney Plumbing Final Sewer Excav. Other
INSPECTION NOT~~:
Inspected: Date B/Z'oJqJ Time //"/A S-
Remarks: rJ7/Jj;/?J T??/J '/7</ j/7(1Ibf)
By !4l
i- auld f!llt ,/:MII/rP" /f?"Jr:llle#~d /?7 /;'r5Jfi:JrJ /1/ /JaA/ (;11 - C3r'/Jr
oa/Je/" ///:0 ,~~,~~d C/{}(/('fl!dc:?;! ~ f3 "',t:'VC e/~/..(-Jhb7
/ ...... v
RESTORATION REQUiRED...... YES NO
J.-.-- 83'
gttJUffd lap * &:rr ;Cl'X".
ErlJt E /? Fa
~
l
--@
bf2
!7 {'iI/ rfY/t. C IJ.
I~
07' I~~
. ,~
r
L
OJ-
3,5
" :~ \
/'1/IU{]tket3 I:Y,
---------
SURFACE RESTORATION:
SURFACE TYPE: 0 Unimproved OGravel o Asphalt OPCC
o Other
o Repaired by City
D Repaired by Permittee
D No Damage Found
Work Order #
D COMPLETE
o INCOMPLETE
(Continue on reverse side if necessary)
STREET SUPERINTENDENT
(DATE)
CITY OF PORT ANGELES
DEPARTMENT OF PUBLIC WORKS
. . . . . . . . . . . INSPECTION REPORT. . . . . . . . . . .
REQUEST: \ ._1 r.
Date 3 ~3 Time Received by (phone. personl
.
Location of Work to be inspected
Name of person requesting inspection
Address of person requesting inspection
Type of Inspection (circle appropriate one):
e Foundation Framing Chimney Plumbing Final Sewer Excav. Other
SIJv\ .
INSPECTION NOTES: \ 1 .
Inspected: Date . ?f! 1l1t13 Time (I/(5 < By kr/
Remarks: JC'Chrn_ O~ ,[;tv&? //~(/?&_~J /f fiJ7/7/P?j' (!/,,h/~ (o///d /f{/J
i7J /r;otz Of: - /1;?j; /1 hm/ ~G. of" /Z;..{, ~(/ rtf/$- ~c;:w ~ 0/ff if? ,fat/%?
rrfi!; of /lI//tiLl~ ;tJ #?d )>~~ ~h' Otc/ 7frP/ &for {[7(p/p? #:74~ IJf #'tJr~
J7$ ()/ Mh/1~,
tf-i)r7./I()r; hod i!f./J/!?v:rJ r5!4ce -/17~ J('?/7~ UO(" m~'3i ~h" 'j (J&JI/v:;/7h/
RESTORATION REQUIRED. . . . .. YES NO
(e/cu. (t">JG1ul;- (YV UO/CV/nt0)
((J ~ / /Yt'r I /)}A-Ure<.4U
/
~ 1\-tL'1 -plUesr
hone No.
40%2-
Permit No.
SURFACE RESTORATION:
SURFACE TYPE: 0 Unimproved 0 Gravel 0 Asphalt 0 PCC
o Other
o Repaired by City
o Repaired by Permittee
o No Damage Found
Work Order #
o COMPLETE
o INCOMPLETE
(Continue on reverse side if necessary)
STREET SUPERINTENDENT
(DATE)
CITY OF PORT ANGELES
DEPARTMENT OF PUBLIC WORKS
. . . . . . . . . . . INSPECTION REPORT. . . . . . . . . . .
REQUEST:
#
Date
Time
Received by
(phone, person)
/'- t!J , /(4/1// /?/ / /Y' ,
Location of Work to be inspected '0 (_:Ll/UAJ~L/
Name of person requesting inspection
Address of person requesting inspection
Type of Inspection (circle appropriate one):
Phone No.
Permit No.
Sewer Foundation Framing Chimney Plumbing Final Sewer Excav. Other
INSPECTION NOTES:
Inspected: Date e/;9/9:7 Time ".;;;) By ~
Remarks: - ((}ff/?}::i:r p()!- ~~ (7;7 k//o//$'d u&7$! /';7,& 0'7 Uf.Jb
M~ /h ~4/h.(l~ ,pate, / '
IO,''7f) - ~~/7711O'~" /Jp-;/ rJ! ((/?)rmijhC/7 J/Jt$1 (rJd--; rJ/' #//..b: ,
,r, ~~ v' /
~o/g(3j1cd ,/''8 ,JJa:~ (J'A"YJI t7/1'?:;7;/ ,/Jj!6 k,;.ft:;;/ (lJ'j h/C'/;I #(}r 0'7 ;1/;1",
i' 27 - J %((77 VA Itf; y , vi r 4 /,/' ((:..(2cUc /?, /!/ w a. v
RESTO..A TION REQUIRED . . . . .. YES NO
f)t'l!;J dcm fJt 6:i/{ friO tv - O/7tJ/IleY dlorff? 111/ MIl d>e -'o/U'k h
!1I!/1/0Uf-cC t7/I~ ~1tO{//, Ih&t 10 Cd!! OJ (D//7a:z:tJt{/ 8,{1)-&'pt
to (j lue {)J (ffJ !gO/. /7~ v
SURFACE RESTORATION:
SURFACE TYPE: 0 Unimproved 0 Gravel 0 Asphalt 0 pcc
o Other
o Repaired by City
o Repaired by Permittee
o No Damage Found
Work Order #
o COMPLETE
o INCOMPLETE
(Continue on reverse side if necessary)
STREET SUPERINTENDENT
(DATE)
CITY OF PORT ANGELES
DEPARTMENT OF PUBLIC WORKS
. . . . . . . . . . . INSPECTION REPORT. . . . . . . . . . .
REQUEST:
Date 0/ !8j1J
.
.
Time 2:CO
(Phone.~
Received by
?4J-
Location of Work to be inspected r2 t!7 I ~/Jl.M7dtCC JJ~
Name of person requesting inspection 0:.P1 j:Jr/t'r!f
Address of person requesting inspection Phone No.
Type of Inspection (circle appropriate one): Permit No.
Sewer Foundation Framing Chimney Plumbing Final Sewer Excav. Other
INSPECTION NOTES: cJ3
Inspected: Date .~/f}/1J I Tim-: t:t'fo By t<J,/ . .
Remarks: - selt~ ~lr;tOh?J 10/1.6 01 l?orffi'rf(}O/17 r(/iJ"r::/ ~
10/11 Mike /J/r'/i(C r - 11m' fi)6'J t (')f /II if f:- (fJm,IJ/C'11?J C?rcr7J/' bjJ
(011(; nl1Y" 10 111.[111/ iff #/J,,-1I1 /-'1}J
RESTORATION REQUIRED . . . . .. YES NO
SURFACE RESTORATION:
SURFACE TYPE: 0 Unimproved o Gravel o Asphalt OPCC
o Other
o Repaired by City
o Repaired by Permittee
o No Damage Found
Work Order #
o COMPLETE
o INCOMPLETE
(Continue on reverse side if necessary)
CTD~t:T CIIDJ:DII\ITl:l\lnCI\IT
InAT~'
CITY OF PORT ANGELES
DEPARTMENT OF PUBLIC WORKS
. . . . . . INSPECTION REPORT. . . . . .
CD
REQUEST:
Date
Time
Received by
(phone, person-)
Location of Work to be inspected
Name of person requesting inspection
Address of person requesting inspection
TpeoHrspection (circle appropriate one):
Sewer oundation Framing Chimney Plumbing
fY?a-\ V\ ex ie-VI S ;-0 VI
fill : I ~. ".k.u> iJP~ Co L.i<:;
I
~ W"\ ~-'-p_V-1.o'Vl '" V\
Phone No.
Permit No.
Final Sewer Excav. Other
INSPECTION NOTES:
Inspected: Date / I - / S - '1 '-I
,
Remarks:
Time 3 I 3 0
By c- ~
RESTORATION REQUiRED...... YES NO
.y{1 ~ I v><' v. \( "-
[..~~ee.f
,IIW
OOd
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"
,
-~\"
..
-/
5''/;-r-r
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yYlA
z
=:
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SURFACE RESTORATION:
SURFACE TYPE: 0 Unimproved 0 Gravel 0 Asphalt 0 PCC
o Other
o Repaired by City
o Repaired by Permittee
o No Damage Found
Work Order #
o COMPLETE
o INCOMPLETE
(Continue on reverse side if necessary)
STREET SUPERINTENDENT
(DATE)
CITY OF PORT ANGELES
DEPARTMENT OF PUBLIC WORKS
. . . . . . INSPECTION REPORT. . . . . .
.@
REQUEST:
Date
Time
Received by
(phone. person)
Location of Work to be inspected
Name of person requesting inspection
Address of person requesting inspection
Type of Inspection (circle appropriate one):
/11, Jwa"-k !-k1<;!,15
J
Phone No.
Permit No.
Sewer Foundation Framing Chimney Plumbing Final Sewer Excav. Other
INSPECTION NOTES:
Inspected: Date 1 / - 17 -"I '-/
Remarks:
Time
BY~
RESTORATION REQUiRED...... YES
*'
~
/'0 Gl."..
.~
S~e-'!-e.. c9~
'i,'I/'fUe I :J$"' ,"'Plle..... ~ <3/Ic....D,
''''~ 0.-
.....V'(I -c...- c","c...,O,
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NO
111 ak~ ."*-1
QI
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~~,-/,,/ .
'-~ ~ "", Fv<l.. \
,c.p,
.~
SURFACE RESTORATION:
SURFACE TYPE: 0 Unimproved OGravel o Asphalt OPCC
o Other
o Repaired by City
o Repaired by Permittee
o No Damage Found
Work Order #
o COMPLETE
o INCOMPLETE
, .
fContinue on reve'tse side if necessary)
. -, J.. f\
STREET SUPERINTENDENT
(DATE)
'/
CITY OF PORT ANGELES
DEPARTMENT OF PUBLIC WORKS
. . . . . . INSPECTION REPORT. . . . . .
(])
. . . . .
REQUEST:
,
Date
Time
Received by
(phone, person)
Location of Work to be inspected /11, /,"" '" lu-<"
Name of person requesting inspection
Address of person requesting inspection
Type of Inspection (circle appropriate one):
I
.J",,'} Id<-,
Phone No.
Permit No.
Sewer Foundation Framing Chimney Plumbing Final Sewer Excav. Other
INSPECTION NOTES:
Inspected: Date / I - I f? - '7 ~
(
Remarks:
Time
BY~
RESTORATION REQUiRED.... . YES
ty1-4
NO
/
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(l\) .
I 00
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SURFACE RESTORATION:
SURFACE TYPE: 0 Unimproved 0 Gravel 0 Asphalt 0 PCC
o Other
o Repaired by City
o Repaired by Permittee
o No Damage Found
Work Order #
/
o COMPLETE i
j 6
o INCOMPLETE
(Continue on reverse side if necessary)
STREET SUPERINTENDENT
(DATE)
d