HomeMy WebLinkAbout1129 Fountain St - Building1'
V. MGM
Application Number 08 00001052
Application pin number 018612
Property Address 1129 FOUNTAIN.ST
ASSESSOR PARCEL NUMBER 06 30 08 5 8 1750 0000
Tenant nbr name QWEST
Application type description PUBLIC WORKS UTILITES
Subdivision Name
Property Use
Property Zoning UNKNOWN
Application valuation 0
Application desc
Plow 160 phone cable along Fountain St
Owner Contractor
HANSON KEVIN
819 G ST
PORT ANGELES WA
PORT ANGELES
T\Policies \1102.15R [1/05]
WA 98363
CITY OF PORT ANGELES
PUBLIC WORKS UTILITIES DIVISION
321 EAST 5TH STREET PORT ANGELES, WA 98362
Fee summary Charged Paid Credited Due
Date 8/25/08
EXCEL UTILITIES CONSTRUCTION
54 MISTY LN
PORT ANGELES WA 98362
(360) 452 1110
Permit RIGHT OF WAY
Additional desc PLOW 160 PHONE CABLE
Permit pin number 132977
Permit Fee 00 Plan Check Fee 00
Issue Date 8/25/08 Valuation 0
Expiration Date 2/21/09
Permit Fee Total 00 00 00 00
Plan Check Total 00 00 00 00
Grand Total 00 00 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
SITE EROSIONCONTROL
PARKING.
SIDEWALK
CALL 417-4807 FOR UTILITY INSPECTIONS. PLEASE PROVIDE ANINIMUM 24 HOUR NOTICE. IT IS UNLAWFUL TO cow,
INSULATE OR CONCEAL ANY WORK BEFORE INSPECTED' AO ACCEPTED. POST PERMIT IN A CONSPICUOUS LOCATION
KEEP PERMIT CARD AND APPROVED PLANS AT JOB .SITE
PM/ UTILITIES (Engineering Division)
WATERLINE [METER
swp.eci**TioN
SANITARY
STORM
:SITE.DRAINAGE
ctithikeutrER
T i102.1'5k[itO5j
INSPECTION TYPE DATE ACCEPTED
YES 1 NO
RESIDENTIAL'
LNJi 417-4807
FIRF 417-4653 I
PLANNING DEPT 417-4750 I
BUILDING' 417-4815 I
PERMIT INSPECTION RECORD
I I
Ij
DRIVEWAY APPROACH 1 F I
BACK-FLOW DEVICE 1 1
I
I,
FINAL .INSPECTIONS REQUIRED PRIOR.TO OCCUpANCWIISE
DATE YES;
YES INO
CONSTRUCTION N' AO T CON RW
PW /ENGINEERING
FIRE DEPT:
I PLANNING DEPT
BUILDING
COMMENTS
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ASSESSOR PARCEL NUMBER:
Application type description
Subdivision Name
Property Use
Property Zoning . . .
Application valuation
07-00001543 Date
230105
1129 FOUNTAIN ST
06-30-08-5-8-1750-0000-
ELECTRICAL ONLY
1/02/08
UNKNOWN
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Owner
Contractor
HANSON KEVIN
819 G ST
PORT ANGELES, WA
PORT ANGELES
WA 98363
APS ELECTRIC
546 BENSON RD.
PORT ANGELES
PORT ANGELES
(360) 452-6753
WA 98363
Permit . . . . .
Additional desc .
Permit pin number
Sub Contractor
Permit Fee
Issue Date
Expiration Date
ELECTRICAL NEW RESIDENTIAL
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118315
APS ELECTRIC
91.00
1/02/08
6/30/08
plan Check Fee
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------------~---- ---------- ---------- ---------- ----------
Permit Fee Total 91.00 91.00 .00 .00
Plan Check Total .00 .00 .00 .00
Grand Total 91.00 91.00 .00 .00
---
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Application Number
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Property Address
ASSESSOR PARCEL NUMBER:
Application type description
Subdivision Name
Property Use
Property Zoning .
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. 07-00001126 Date 10/16/07
507320
1129 FOUNTAIN ST
06-30-08-5-8-1750-0000-
ELECTRICAL ONLY
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HANSON KEVIN
819 G ST
PORT ANGELES, WA
PORT ANGELES
WA 98363
APS ELECTRIC
546 BENSON RD.
PORT ANGELES
PORT ANGELES
(360) 452-6753
WA 98363
Permit
Additional desc .
Permit pin number
Sub Contractor
Permit Fee
Issue Date
Expiration Date
ELECTRICAL TEMPORARY
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112060
APS ELECTRIC
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10/16/07
4/13/08
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CITY OF PORT ANGELES
* *
Correction Notice
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These corrections must ..be .made and are not to be
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for inspect'on.
Date
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CITY OF PORT ANGELES
PUBLIC WORKS - UTILITIES DNISION
321 EAST 5TH STREET, PORT ANGELES, WA 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
Owner
HANSON KEVIN
819 G ST
PORT ANGELES, WA
PORT ANGELES
8/10/07
07-00000843 Date
823888
1129 FOUNTAIN ST
06-30-08-5-8-1750-0000-
KEVIN L. HANSON
RES NEW SFR
UNKNOWN
66894
Contractor
OWNER
WA 98363
Structure Information 000
Other struct info . .
Permit . . . . .
Additional desc .
Permit pin number
Permit Fee
Issue Date
Expiration Date
000 1008 SF SFR & 300 SF
TOTAL % LOT COVERAGE
CONSTRUCTION TYPE
NUMBER OF STORIES
LOT SIZE
PROPOSED LOT COVERAGE
TOTAL LOT COVERAGE
NUMBER OF UNITS
ATTACHED GARAGE
22.70
V-N
1. 00
5750.00
1308.00
1308.00
1. 00
PUBLIC WORKS RES WATER SERV
108373
770.00
8/10/07
2/06/08
Plan Check. Fee
Valuation
.00'
66894
Qty Unit Charge Per
1.00 770.0000 EA PW W/M 1" SERV 5/8" METER
Permit . . . . .
Additional desc .
Permit pin number
Permit Fee
Issue Date
Expiration Date
Extension
770.00
RIGHT OF WAY
108381
50.00
8/10/07
2/06/08
Plan Check Fee
Valuation
.00
66894
Qty Unit Charge Per
1.00 50.0000 ECH RIGHT OF WAY PERMIT
Permit . . . . .
Additional desc .
Permit pin number
Permit Fee
Issue Date
Expiration Date
Extension
50.00
SANITARY SEWER HOOK UP
108399
120.00
8/10/07
2/06/08
Plan Check Fee
Valuation
.00
66894
Qty Unit Charge Per
1.00 120.0000 EA SAN SEWER HOOKUP
Extension
120.00
Special Notes and Comments
Address numbers shall be plainly visible from the street.
Separate Permits are required for electrical work, SEP A, Shoreline, ESA, utilities, private and public improvements. This permit becomes
null and void if work pr construction authorized is not commenced within 180 days, if construction or work is suspended or abandoned
for a period of f80-Clays after the work as commenced, or if required inspections have not been requested within.t80 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.
~@L-
(2) I.
O/(o(v7
Signature of Contractor or Authorized Agent
Date
Date
Signature of Owner (if owner is builder)
~
T:\Policies\1102.15R [1105]
PERMIT INSPECTION RECORD
CALL 417-4807 FOR UTILITY 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 LOCATION.
t
KEEP PERMIT CARD AND APPROVED PLANS AT JOB SITE
INSPECTION TYPE DATE ACCEPTED COMMENTS
I YES NO
PW UTILITIES (Engineering Division)
WATERLINE I METER
SEWER CONNECTION
SANITARY
STORM
SITE DRAINAGE
SITE EROSION CONTROL
PARKING
SIDEWALK
.CURB & GUTTER
DRlVEW A Y APPROACH
BACK-FLOW DEVICE I
FINAL INSPECTIONS REQUIRED PRIOR TO OCCUPANCY/uSE
RESIDENTIAL DATE YES NO COMMERCIAL DATE ACCEPTED
YES NO
CONSTRUCTION R.W. I PWI CONSTRUCTION - R.W.
ENGINEERING 417-4807 PW I ENGINEERING
FIRE 417-4653 FIRE DEPT.
PLANNING DEPT. 417-4750 PLANNING DEPT.
BUILDING 417-4815 BUILDING
. T:\Policies\I 102.15R [1/05]
~ VORT """
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CITY OF PORT ANGELES
PUBLIC WORKS - UTILITIES DIVISION
321 EAST 5TH STREET, PORT ANGELES, WA 98362
Application Number . . . . . 07-00000843
Application pin number 823888
Page
Date
2
8/10/07
Special Notes and Comments
Address numbers shall be a minimum of six inches high and be
of contrasting color from the background.
07/25/2007 04:17 PM SROBERDS --the proposal will result
in a new sfr w/attached garage in the RS-7 zone for total
lot coverage of 23%. No land use issues anticipated.
Electrical load calculations and elctrical permits are
required. .
Construct 20' wide gravel road to City standards, see
public works engineering for requirements.
Sanitary sewer connection inspection is required by
Public Works prior to back fill of ditch. 24 hour advance
notice is required.
Other Fees
SEWER SYSTEM DELV CHARGE
STATE SURCHARGE
PW WATER SYSTEM USE FEE
1000.00
4.50
1230.00
Fee summary Charged Paid Credited Due
----------------- ---------- ---------- ---------- ----------
Permit Fee Total 940.00 940.00 .00 .00
Plan Check Total .00 .00 .00 .00
Other Fee Total 2234.50 2234.50 .00 .00
Grand Total 3174.50 3174.50 .00 .00
Separate Permits are required for electrical work, SEPA, Shoreline, ESA, utilities, private and public improvements. This permitbecomes
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 riot 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:\Policies\1102.15R [1105]
PERMIT INSPECTION RECORD
~
CALL 417-4807 FOR UTILITY 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 LOCATION.
~
KEEP PERMIT CARD AND APPROVED PLANS AT JOB SITE
INSPECTION TYPE DATE ACCEPTED COMMENTS
YES NO
PW UTILITIES (Engineering Division)
WATERLINE / METER
SEWER CONNECTION
SANITARY
STORM
SITE DRAINAGE
SITE EROSION CONTROL
PARKING
SIDEWALK
CURB & GUTTER
DRIVEWAY APPROACH
BACK-FLOW DEVICE I
.
I
FINAL INSPECTIONS REQUIRED PRIOR TO OCCUPANCYIUSE
RESIDENTIAL DATE YES NO COMMERCIAL DATE ACCEPTED
YES NO
CONSTRUCTION R.W./ PW/ CONSTRUCTION - R.W.
ENGINEERING 417-4807 PW / ENGINEERING
FIRE 417-4653 FIRE DEPT.
PLANNING DEPT. 417-4750 PLANNING DEPT.
BUILDING 417-4815 BUILDING
T;\PoliciesllI02.15R [1105]
1fPORT~
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CITY OF PORT ANGELES
DEPARTMENT OF COMMUNITY DEVELOPMENT - BUILDING DIVISION
32 I 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
Owner
HANSON KEVIN
819 G ST
PORT ANGELES, WA
PORT ANGELES
8/10/07
07-00000843 Date
823888
1129 FOUNTAIN ST
06-30-08-5-8-1750-0000-
KEVIN L. HANSON
RES NEW SFR
UNKNOWN
66894
Contractor
OWNER
WA 98363
Structure Information 000
Other struct info . .
permi t . . . . .
Additional desc .
Permit pin number
Permit Fee
Issue Date
Expiration Date
000 1008 SF SFR & 300 SF
TOTAL % LOT COVERAGE
CONSTRUCTION TYPE
NUMBER OF STORIES
.LOT SIZE
PROPOSED LOT COVERAGE
TOTAL LOT COVERAGE
NUMBER OF UNITS
ATTACHED GARAGE
22.70
V-N
1. 00
5750..00
1308.00
1308.00
1. 00
BUILDING PERMIT -RESIDENTIAL
1008 SF SFR, 300 GARAGE
107342
789.25 Plan Check Fee
8/10/07 Valuation
2/06/08
315.70
66894
Qty Unit Charge Per
Extension
670.25
119.00
BASE FEE
17.00 7.0000 THOU BL-50,001-'100K (7.00 PER K)
Permit . . . . .
Additional desc .
Permit pin number
Permit Fee
Issue Date
Expiration Date
MECHANICAL PERMIT
107912
150.35 Plan Check Fee
8/10/07 Valuation
2/06/08
.00
o
'$?
?
o 9
~~
o
~
'0
oQ
Qty Unit Charge Per
BASE FEE
1.00 14.7000 ECH ME- INSTALL 100- FAU
3.00 7.2500 ECH ME-VENT FAN
6.00 10.6500 ECH ME-OTHER APPL. N/R
Permit . . . . .
Additional desc .
Permit pin number
Permit Fee
Issue Date
Expiration Date
Extension
50.00
14.70
21.75
63.90
PLUMBING PERMIT
107904
121.00
8/10/07
2/06/08
Plan Check Fee
Valuation
.00
o
Qty Unit Charge Per
Extension
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 1'80 days, if construction or work is suspended or abandoned
for a period of 180 days after the work as commen'ced, 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 Cl ~en:nit 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
~//) J... &110/0"7
Signature of Owner (if owner is builder) Date
Signature of Contractor or Authorized Agent
T:\Policies\ll02_l5 building pennit inspection record05.wpd [1/4/2005]
BUILDING PERMIT INSPECTION RECORD
r
.
CALL 417-4815 FOR BUILDING INSPECTIONS CALL 4]7-4735 FOR ELECTRICALINSPECTJONS.
CALL 417-4807 FOR PUBLlC WORKS UTILlTIES
PLEASE PROVIDE A IvlINIlvlUM 24 HOUR NOT1CE. IT IS UNLA WFUL TO COVER, INSULATE OR CONCEAL ANY WORK BEFOIi"E
J.NSPECTED AND ACCEPTED. POST PERMIT IN A CONSPICUOUS LOCA TJON.
KEEP PERMIT CARD AND APPROVED PLANS AT JOB SITE.
INSPECTION TYPE DATE ACCEPTED COMMENTS
YES NO
FOUNDA TlON:
FOOTINGS
SHEAR WALLS / WALLS
FOUNDA TION DRAII~AGE / DOWN Sl'OlJTS
PIERS I I
POST HOLES (POLE BLDGS.)
PLUMBING
UNDER FLOOR / SLAB
ROUGH.IN
WATER LINE (METER TO BLDG)
GAS LINE FINAL DATE ACCEPTED BY:
BACK FLOW / W A TEll. .
AIR SEAL
WALLS
CEILING I
FRAMING
JOISTS / GIRDERS
SHEAR Vi ALL/HOLD DOWNS
WALLS / ROOF / CEILING
DRYWALL (fNTERJOR BRACED PANEL ONLY)
T-BAR
INSULATION
SLAB
Vi ALL / FLOOR / CEILING I
MECHANICAL
ROUGH-IN
HEATPU~/FURNACE/DUCTS
GAS LINE FINAL DATE ACCEPTED BY:
WOOD STOVE / PELLET / CffiMNEY
MANUFACTURED HOMES
FOOTING / SLAB
BLOCKING & HOLD DOWNS
SK.lRTING
PLANNING DEPT. SEP ARA TE PERMlT #'s SEPA:
PARKING/LIGHTING ESA:
LANDSCAPING SHORELINE:
FINAL INSPECTIONS REQurRED PRIOR TO OCCUPANCY/USE
RESIDENTIAL DATE .YES NO COMMERCIAL . DATE ACCEPTED
YES NO
ELECTRJCAL - LIGHT DEPT. 417-4735 ELECTRICAL
LIGHT DEPT
CONSTRUCTION R.W. / PW/ CONSTRUCTION - RW.
ENGINEERING 417-4807 PW / ENGINEERING
FIRE 417-4653 FIRE DEPT.
PLANNING DEPT. 417-47'50 PLANNING DEPT.
BUTLDING 417-4815 BUTLDING
T:\Policies\1102 15 building penni! inspection record05.wpd [1/4/2005]
~ ~ORT "'-+.
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CITY OF PORT ANGELES
DEPARTMENT OF COMMUNITY DEVELOPMENT - BUILDING DIVISION
32\ EAST 5TH STREET, PORT ANGELES, W A 98362
Page 2
Application Number 07-00000843 Date 8/10/07
Application pin number 823888
Qty Unit Charge Per Extension
BASE FEE 50.00
6.00 7.0000 ECH PL- EA.FIXTURE ON ONE TRAP 42.00
1. 00 7.0000 ECH PL- EA. INSTALL WATER PIPE 7.00
1. 00 15.0000 ECH PL- EA. BLDG SEWER 15.00
1. 00 7.0000 ECH PL- EA.WATER HEATER 7.00
Special Notes and Comments
Address numbers shall be plainly visible from the street.
Address numbers shall be a minimum of six inches high and be
of contrasting color from the background.
07/25/2007 04:17 PM SROBERDS --the proposal will result
in a new sfr w/attached garage in the RS-7 zone for total
lot coverage of 23%. No land use issues anticipated.
Electrical load calculations and elctrical permits are
required.
Construct 20' wide gravel road to City standards, see
public works engineering for requirements.
Sanitary sewer connection inspection is required by
Public Works prior to back fill of ditch. 24 hour advance
notice is required.
Other Fees
SEWER SYSTEM DELV CHARGE
STATE SURCHARGE
PW WATER SYSTEM USE FEE
10,00.00
4.50
1230.00
Fee summary Charged Paid Credited Due
----------------- ---------- ---------- ---------- ----------
Permit Fee Total 1060.60 1060.60 .00 .00
Plan Check Total 315.70 315.70 .00 .00
Other Fee Total 2234.50 2234.50 .00 .00
Grand Total 3610.80 3610.80 .00 .00
Separate Permits are required for electrical work, SEPA, Shoreline, ESA, utilities, private and public improvements. This permit becomes
null and void if work or construction authorized is not commenced within 180 days, if construction or work is suspended or abandoned
for a period of 180 days after the work as commenced, or if required inspections have not been requested within 180 days from the last
inspection. I hereby certify that I have read and examined this application and know the same to be true and correct. All provisions of
laws and ordinances governing this type of work will be complied with whether specified herein or not. The granting of a per:.r:nit 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:\Policies\1102_15 building pennit inspection record05.wpd [1/4/2005]
BUILDING PERMIT INSPECTION RECORD
CALL 417-48]5 FOR BUILDING INSPECTIONS CALL 417-4735 FOR ELECTRICAL INSPECTIONS.
CALL 41 7-4807 FOR PUBLIC WORKS UTILITIES
PLEASE PROVIDE A ivlINlMUIv1 24 HOUR NOTICE. IT IS UNLA WFUL TO COVER, INSULATE OR CONCEAL AN}' WOIU. BEFORE ,
I1\'SPECTED AND ACCEPTED. POST PERMIT IN A CONSPICUOUS LOCATJON.
KEEP PERMIT CARD AND APPROVED PLANS AT JOB SITE.
o
,-'
INSf'ECTlON TYPE DATE ACCEPTED COMMENTS
I YES NO
FOUNDATION:
FOOTINGS 2>/Solol J'LL S~ \,0-tt \l tt J 4/07 "'J"LL..
I .
SHEAR WALLS 1 WALLS 't>Y-j We., \ , ,I'IOg "JLL
FOUNDATION DI(AII~AGE 1 DOWN SPOUTS
PIERS I I
POST HOLES (POLE BLDGS.)
PLUMBING
UNDER FLOOR 1 SLAB I
ROUGH-m " -1-'-07 :TLL
W A TEll. LINE (METER TO BLDG) ;-"7-0& :ILL.
GAS LINE FJNALg-b....Og DAT;JiL- ACCEPTED BY:
BACK FLOW 1 WATER
AIR SEAL c> 1- ()Q-oz, """SL-L-
WALLS
CEILING
FRAMING cd-Ib-Og, -:SU
JOISTS / GIRDERS
SHEAR W ALL/HOLD DOWNS
WALLS / ROOF 1 CEILING
DRYW ALL (fNTERJOR BRACED PANEL ONLY)
T-BAR . I
INSULATION n l-Ib-O~ '"Ju.",
SLAB
WALL / FLOOR / CEILING
MECHANICAL
ROUGH-IN
HEATPU~/FURNACE/DUCTS
GAS LINE FINAL 8" - ~ ~r;g DATE .JLL ACCEPTED BY:
WOOD STOVE 1 PELLET / CHIMNEY
MANUFACTURED HOMES
FOOTING / SLAB
BLOCKING & HOLD DOWNS
SKJRTfNG
PLANNING DEPT. SEPARATE PERMJT #'s SEPA:
I' ARKING/LIGHTING ESA:
LANDSCAPING SHORELINE:
FINAL INSPECTIONS REQUIRED PRlOR TO OCCUPANCY/USE
RESIDENTIAL DATE .YES NO COMMERCIAL DATE ACCEPTED
YES NO
ELECTIUCAL - UGHT DEPT. 4 \ 7-4735 ELECTRICAL
LIGHT DEPT
CONSTRUCTION RW. /PW/ CONSTRUCTION - R.W.
ENGINEERfNG 4 I 7-4807 PW / ENGINEERING
FIRE 4] 7-4653 FIRE DEPT
PLANNING DEPT 417-4750 PLANNING DEPT
BUILDrNG 417-4815 '6-h-()J'( "':\ L L- BUILDJNG
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T:\PoJiciCS\ 1 ] 02 15 bUlldmg pennI1 JJJspectJon record05.wpd [1/4/2005J
~
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Applicant or Agent: Kr i/ I' l-
Owner: >0. ~ ~
tI~ ~ j \J "'"'
Phone:
/1 OR OFF1ClAL USE ONLY:
DmeRec,D17 '1 ~O].
I pennil#:::a b
E " i Dme J'.pprDved: 0
are issued:' #\.
- -V
BUILDING PERMIT - APPLICATION
Fill out COMPLETELY and in INK, Your application and site plan MUST
COMPLETE to be accepted for review. If you have any questions, call
PERMITS (360) 417-4815 FAX(360)417-471l
Phone:
Address:
f11 ,
6- s r City: jJo / f .A ......, t-l~~
t b V\. ;~ SCi/ v I' (L.~ phone:
Zip:
't93' :$
ArchitectlEngineer:
Contractor
Address:
,.,....O,A. .l-
Phone:
Zip:
'ZONING:
Ic......s/,
.;es -;
LEGAL DESCRIPTION: Lot: I 5 Block:
CLALLAM COUNTY PARCEL NUMBER: U~
I 7 Subdivision:
008-)'$ i?)"O
house \,00 ~ S'ift. gel. ~e 360 sfff-
TITEOFWORK: ' ~oo$e SIZE/VALUATION:
~Residential l)!(. New Constr. 0 Re-roof 0 ,~tove\)OO%SF. @$ (00. DO /SF. = $
o Multi-family 0 Addition 0 Move)( Garage 300 SF. @ $ 21.38 /SF. = $ ) 1..\ ll.\
o Commercial 0 Remodel 0 Demolition 0 Deck SF. @ $ " /SF. = $
o Repair 0 Sign 0 Other TOTAL VALUATION $"~ 84~
BRIEF DESCRIPTION OF THE PROJECT, f v uJ ~ I 5 1<- "f "2- il..) NU ~) I I'S ~ ~'-
,A.H'^-vW. J' 0-.. .r c.-- j <-
COMMERClALIRESIDENTlAL: Occupancj' Group:
, ~ t;;".~c)
No, of Stories: L Lot Size: :;['0 1< /1) Existing Sq. Ft.
Total lot coverage 2. 2..'7 %
) SF~
Occupant Load: Construction Type: tV (. vr-
& Proposed Sq. Ft. 13 CbB = TOTAL Sq. FtJ '30 g
)
LJ .. }-L
0-.. .....
c)
PLANNING USE ONLY: APPROVALS:
PLAN:
BLDG:
DP\VU: -
ESAlWetland(s): 0 Yes 0 No SEP A Checklist required? 0 Yes 0 No Other: FIRE:
OTHER:
-
V ALUATlON OF CONSTRUCTION: In all cases, a valuation amount must be entered by the applicant.
This figure will be reviewed and may be revised by the Building Division to comply with current fee schedules. Contact the Permit
Coordinator at 417-4815 for assistance.
PLAN ClIECK FEE: IF a plan check fee is du? it must be ~u?mitted at the time the building permit application and construction plans are
submitted. All other permit fees are due at the tlille of perIDlt lssuance. .
EXPIRATION OF PLAN REVrnW: lin? permit is issued within 180 days ofthe date of application, the application will expire. The
Building Official can extend the t1IDe for actIOn by the apphcant up to 180 days upon wntten request by the applicant (see Section
RI05.3.2 of the International Building/Residential Code, 2003). No application can be extended more than once.
I hereby certify that I have read and examined this application and know the same to be true and correct. I am authorized to
apply for this permit and understand that it is my responsibility to determine what permits are required ,not the City's and that I
must obtain such permits priorlo work. '
T:\FORMS\BldgPennitform.wpd Applicant:
(Jj/}!.--
Date:
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Lot:
Prescriptive Approach-Simple Form
For the Washington State Energy Code ( 2003 Edition)
Climate Zone 1
Site Information Building Depmiment Use Only:
13/o--J, () Ie V\ ~ ('/ ~ V'-t '..... A<' O""-J, _ () Il '3
I '- Permit # l D "1
I~
Address: Vv,' {r v V .s r
Notes:
City:
/./J.
.
State:
vV.......
Zip:
Contact:
Phone:
Phone 2:
FAX:
Table 6-1
PRESCRIPTIVE REQUIREMENTS FOR GROUP R OCCUPANCY
CLIMATE ZONE 1
Option Glazing Glazing U-Factor Door Wall Wall Wall Slab
Area % .U- Vaulted Above . Interior Exterior on
of Floor VelTIcal Overheac Factor Ceiling Ceiling Grade Below Below Floor Grade
Grade Grade
Unlimited'
III Group R-3 OAO 0.58 0:20 R-38 R-30 R21 R-21 R-10 R-30 R-10
Occupancy
Only
( Unlimited Glazing Option Only)
This Project complies with the following:
./ The Project is a single family residence or duplex.
./ The Project is wood frame OR all of the insulation is interior or exterior of the framing.
./ All building components meet the requirements listed in Table 6-1, Option Ill.
./ The Project will meet all other provisions of the WSEC and VJAQ.
The Project will take advantage of the following exceptions to the prescriptive option.
o 602.6 Exception 1. One door, that is 24ft. Or less, that does not meet the standards allowed.
Location of the door taking this exception
o 602.6 Exception 2. Doors with a V-Factor of 0.40 ,allowed without calculations, Option III only.
Location of the Door (s) taking exception
Type of Heat Source:
Elec/".\-
/ ~,,~ /1-, 'r
I
_ <..-Ie-I,
Cs":')
-
EXHIBIT A
-.--- --- ---------- -- --------- _ ------ ------. ...---- 6. FD..E NUMBER: 17. LOAN NUMBER:
SEITLEMENT STATEMENT 1911 3007061<101
, 6. MORTGAGE INS CASE NUMBER:
C;. NOTE: 1PD:l bm is fumished to g/IIe you 8 $fBlBmtmtaf aduaI SIBttfsm8nt costs. AIIIOIDIts paid to end by th9 se!t1ement 8gI1IIt BIB *-a.
IIBms marIIBd 'fPOCl' MlI8 paid ar4sItte the r:Iasing; fhI1y BIB shawn beIB for ;,,A,,,,,,Jiu,..J putpOS8S end BIB not tnduded in /he totals.
1.0 3I9lI 11911.PRln9l1l1Sl
D. NAME AND ADDRESS OF BORROWER: E. NAME AND ADDRESS OF SB.lER: F. NAME AND ADDRESS OF LENDER:
Kevin L Hanson Craig Hedlman Westsound Bank
619 S. 'G' SL Amy C. Hedlman 607Pac:l1icAw
P.0Il Angeles, Wa 9B363 221 Fogarty Bnlmerlon, WA 9B337
Port Angeles, Wa 9B362
G. PROPERYYLOCATlON: H.. SETTlEMENT AGENT: 27~26397 L SETTlEMENT DATE:
NNA Founlaln Sl 'Advanlage Esaow Company
Port Angeles, WA 9B363 June 29, 2Of11
ClaDam County, Washinglon PLACE OF SET1lEMENT
L 13 & 14 BL 17 FensyIvania B02 East FIrst Sl, SuilB 1
Pk. Add'n
PortAnge/ss, WA 9B362
J. StJMMAR'( OF BORROWERS TRANSACTlON K. SUMMARY OF SEl..lER'S TRANSACTION
100. GROSS AMOUNT DUE FROM BORROWER: 400. GROSS AMOUNT DUE TO SB.1.ER:
101. ContIad Sales PriI:e 90 000.00 401. ConlracI Sales Prit:e
102. Personal PnlDeItv 402. Personal Pnmsrtv
103. SslIIement DIames to BomMer ILin8 14m'l 1,663.90 403.
104. 404.
105. 405.
For IIBms PaId 8v Seller In adtIance For I!Bms Paid BV Seller In 8dtR1nt:8
106. CilvlTCMII T_ to 406. CilvITCIWll Taxes to
107. r.....ntvT_ 06I29IU7 to f171011f1T 1.16 4f17. r....mtvT_ to
1OB.Asssssmenls to 4OB. Assessments to
109. 409.
110. 410.
111. 411.
112. 412.
120. GROSS AMOUNT DUE FROM BORROlIIIER 91,6B5.ll6 42Cl GROSSAMOUNTDUE TOSEUER
ZOo. AMOUNTS PAID BY OR IN 8BIALF OF BORROWER: 5OIJ.. REDUCT10NS IN AMOUNT DUE TO SB.1.ER:
201. n.mn..iIor emnest monov 1 JDf.oo 501. ExI:ess IlmxmiIISee 1nslM:tions\
202. . PiIrIdmif Amount of New Loan s 40000.00 502. SelIIemsnt ~ to Seller n -. 1400\
203. taken "'-to 503. . . s\ takenSUiiiSd to
204. 504.
205. 505.
206. 506.
207. 5f17.
208. Ctedillowanls cIoslnn costs 1 000.00 508.
209. 509.
For IIBms Seller J1diustments For Itsm3 UiiiiiiiiiBVSeIler
210. r.itvITCIWll Taxes to 510. CilvITown Taxes to
211. eowiiVTaxes to 511. CmmIvTaxes to
212. Ass8ssments to 512. Assessments to
213. 513.
214. 514.
215. 515.
216. 516.
217. 517.
218. 516.
219. 519.
220. TOTAL PAID BYJFOR BORROWER 42,000.00 520. TOTAL REDUCTION AMOUNT DUE SELLER
300. CASH AT SET11.EIIIENT FROMITO BORROWER: 600. CASH AT SETTLEMENT TOIFROM SEI..LER:
301. Gross Amount Due From Borrower Iline 120\ 91 665.06 601. GrussAmountDueToSellern~-4201
302. Less Amount Paid BvlFor 8on'ower Iline :mil ( 42,000.00) 602. Less Reduclions Due Seller IiJDf! 520) (
303. CASH ( X FROM) ( TO) BORROWER 49,665.06 603. CASH ( X TO){ FROM} SELLER
The undersigned hereby aduJowIedge tecelpt of a c:ompteted Copy of pages 1&2 of this statement & any IIlIad1menlll referrild to heRlln.
I HAVE CAREFUlLY REVIEWED THE HlJD..1 SETTlEMENT STATEMENT AND TO THE BEST OF MY KNOWLEDGE AND BEUEF, IT IS A TRUE AND
ACCURATE STATEMENT OF ALL RECEIPTS AND DISBURSEMENTS MADE ON MY ACCOUNT OR BY ME IN 1lI/S TRANSACTION. I FURTHER CERTIFY
THAT I HAVE RECEIVED A COPY OF THE HlJD..1 SETTLEMENT STATEMENT.
Bomlwer
KevlnLHanson .
TO THE BEST OF MY KNOWlEDGE, THE HUD-1 SETTlEMENT STATEMENT WHICH' HAVE PREPARED IS A TRUE AND ACCURATE ACCOUNT OF THE
FUNDS WHICH WERE RECEIVED AND HAVE BEEN OR WILL BE DISBURSED BY THE UNDERSIGNED AS PART OF THE SETTLEMENT OF THIS
TRANSACTION.
~Ji=:VCompany
WARNING: IT IS A CRIME TO KNOWINGLY MAKE FALSE STATEMENTS TO THE UNITED STATES ON THIS OR ANY SIMILAR FORM. PENAL nES UPON
CONVICTION CAN INCLUDE A ANE AND IMPRISONMENT. FOR DETAILS SEE: TITLE 16 U.S. CODE SECTION 1001 & SECTION 1010.
HUO-I f,H6) RESPA. HII4305.2
r1~ORr~G
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CITY OF PORT ANGELES
PUBLIC WORKS - UTILITIES DIVISION
321 EAST 5TH STREET, PORT ANGELES, WA 98362
tJl- ~q:5
Application Number
Application pin number
Property Address
ASSESSOR PARCEL NUMBER:
Tenant nbr, name
Application type description
Subdivision Name
Property Use
Property Zoning .
Application valuation
07-00000843 Date
823888
1129 FOUNTAIN ST
06-30-08-5-8-1750-0000-
KEVIN L. HANSON
RES NEW SFR
8/10/07
UNKNOWN
66894
1121 f1;unklln 5[
Owner
Contractor
HANSON KEVIN
819 G ST
PORT ANGELES, WA
PORT ANGELES
OWNER
WA 98363
GAAAGEK .jj ~
Structure Information 000 000 1008 SF SFR & 300 SF
Other struct info TOTAL % LOT COVERAGE
CONSTRUCTION TYPE
NUMBER OF STORIES
LOT SIZE
PROPOSED LOT COVERAGE
TOTAL LOT COVERAGE
NUMBER OF UNITS
ATTACHED
22.70
V-N
1. 00
5750.00
1308.00
1308.00
1. 00
Permit
Additional desc .
Permit pin number
Permit Fee
Issue Date
Expiration Date
PUBLIC WORKS RES WATER SERV
108373
770.00
8/10/07
2/06/08
plan Check Fee
Valuation
.00
66894
oJ
Qty
1. 00
Unit Charge Per
770.0000 EA
Exte~ .
_~~_~~~_~~_~~~~_=~~~_~~=~~________~770.~~_ =:>
Permit
Additional clesc
Permit pin number
Permit Fee
Issue Date
Expiration Date
RIGHT OF WAY
108381
50.00
8/10/07
2/06/08
Plan Check Fee
Valuation
.00
66894
________'~~~___~~~::~~~~~~_:~;~__~=~~:_~~_~~:_::~=:___----------~~~:~~.
Permit
Additional desc
Permit pin number
Permit Fee
Issue Date
Expiration Date
SANITARY SEWER HOOK UP
108399
120.00
8/10/07
2/06/08
Plan Check Fee
Valuation
.00
66894
Qty Unit Charge Per
1.00 120.0000 EA SAN SEWER HOOKUP
~.~;;~~~
Special Notes and Comments
Address numbers shall be plainly visible from the street.
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. J hereby certify that I have read and examined this application and know the same to be true and correct. All provisions of
iaws and ordinances governing this type of work will be complied wjth 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 locai law reguiating construction or the performance of
construction.
Signature of Contractor or Authorized Agent
Date
Signature of Owner (if owner is builder)
Date
T;\Policies\1102.15R [1/05)
CITY OF PORT ANGELES
PUBLIC WORKS - UTILITIES DIVISION
321 EAST 5TH STREET, PORT ANGELES, WA 98362
Application Number
Application pin number
07-00000843
823888
Page
Date
2
S/10/07
Special Notes and Comments
Address numbers shall be a minimum of six inches high and be
of contrasting color from the background.
07/25/2007 04;17 PM SROBERDS --the proposal will result
in a new sfr wfattached garage in the RS-7 zone for total
lot coverage of 23%. No land use issues anticipated.
Electrical load calculations and elctrical permits are
required.
Construct 20' wide gravel road to City standards, see
public works engineering for requirements.
sanitary sewer connection inspection is required by
Public Works prior to back fill of ditch. 24 hour advance
notice is required.
Other Fees
SEWER SYSTEM DELV CHARGE
STATE SURCHARGE
PW WATER SYSTEM USE F
1000.00
1230.0
Fee summary Charged Paid Credited ue
----------------- ---------- ---------- ---------- ----------
Permit Fee Total 940.00 940.00 .00 .00
Plan Check Total .00 .00 .00 .00
Other Fee Total 2234.50 2234.50 .00' .00
Grand Total 3174.50 3174.50 .00 .00
Separate Permits are required for eiectrical work, SEPA, Shoreiine, 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' 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:\Policies\1102.15R [liDS)
Issued date: 23 j/o /c;)
APPLICATION FOR WATER
City Water Division, Port Angeles, WA
Installed by & date:') ,€+CJI,iJ,Jh-,-of':, Permit #
.
D 7-843
I hereby apply for water to be furnished in accordance with rates and rules of the City for the
foHowing premises:
Applicant Name & Phone: J<e..V I V) !-fa .1'17>01') % 2-0 I ty::j
Site Address: 11'lI! [?jUl'\4-oiYlS1MailingAddress: ~Iq S "'q "ST
Blk: Jl Lot: I =3 Add: fe..t, I') "PK Parcel #: O~ '3002><'; 8' J 7 60
Meter#'sC F I'eZ,70ZU WIQ#: J)3'1'K 1301
Fees: ~77/'- + 11.30 - RestorationRe~uired: Uo
Svc: ON IOFF
\ "J <::7(>/ 1/
Svc: Size _ ~ "" \
Signature: -9P...z
Remarks:
N
:;y
:..;
~
<a
">
.;,....
~
Ie' ~ E
s
CITY OF PORT ANGELES
DEPARTMENT OF PUBLIC WORKS
. . . INSPECTION REPORT. . . . . .
REQUEST: ,1
Date fPr''f/oB
Location of Work to be inspected
Name of person requesting inspection
Address of person requesting inspection
Type of Inspection (circle appropriate one): Permit No.
Sewer Foundation Framing Chimney Plumbing' Final~wer EX~ Other
Time
Received by -rr:
/
117, q r;UJIl-kt h 5+
Do VL M()r?X~IS()'n -K f-I~~J;
Phone No. ~~77 &
07-'8'4-'5
(phone, person)
INSPECTION NOTES: /J
Inspected: Date 6- '{-VB Time
Remarks: NBW 5e"-'er c.6""'~C.+:=V\ se>>.dd e.. ~ ,sf,'
h l' We. ("",oN\. S""ddl-Q... +0 ?/L, ~r !>V( -10
,
By
" J
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V",~s.e.
~a.,'
'?l
~
-J
~
J
o
i
.~
~
Jl-tIH
C.
~
RESTORATION REQUIRED . . . . .. YES
?JL
NO K.
?IL
~
1~''Id
,,/I pile...
NC,';/
5
-n0'
z"""'"....v ':",SOL ,?vc..
2.7' .
~v'.~
/ \'1.
.' II'
, \
S C-~n.c:.t ~ 'f.e. """~l ~
"'J'/
SURFACE RESTORATION:
SURFACE TYPE: 0 Unimproved 0 Gravel 0 Asphalt 0 PCC
1~5
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.
..I
REQUEST:
Date <2> - /...../-oA
Time "L
Received by
(phone. person)
Location of Work to be inspected I { "Z. '1
Name of person requesting inspection
Address of person requesting inspection
Type of Inspection (circle appropriate one):
Sewer Foundation Framing Chimney Plumbing
FD\Avh-, \. V\
Phone No.
Permit No.
S Sewer Excav. Other
6,-PJtj3
INSPECTION NOTES:
Inspected: Date ~- 4- Oe. Time By 'i2.V
Remarks: h....~ v.e.. Uk.." / t?> '- L/ - o~
l2.,...,nrl L\M. f>.bve\M. e.v-1- S e.:...'1-cfA ~
.5e..\.Ue...-- t.I>- Y -66 or IGv
RESTORATION REQUiRED...... YES NO X-
.
SURFACE RESTORATION:
SURFACE TYPE: 0 Unimproved 0 Gravel 0 Asphalt 0 PCC 0 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 SLJPERINTFNDFNT
/DATEl
h'0<1
Job wired by
5
~ ~
\'l.....?'
, ~ElectricSlI Contrsctor 0 Owner
~Ic iCl56racto~arecr,..~ CL LiCCTL&~f'Q
rur<~'4' blinPi3~l16J f\ R.Jt
Cily 'IJ. A, .
Stlltl? ZIP
Cf~w
Telephone number 5 FAX number
. -Yb;;!-J:"U
p"mi"\.(~~ r'V\ 8'1:11501\
Addre~~ ~ill~ecrlon .....L. '\
) Id-J .{cu Y\.::L4. I l\
City PA
rhone number to schedule inspection:
6,0"- 42-
Owner a.I' defined by RCW.1-9.28.261:(l) Owner ..,:ill occupy the structure- fur two
yetlT.Y uf/tr this efecIrical pmnil is fiJ'l(llizetL (2) Owrter is required", "ire all elecrrical
VOlltrClclor If above ,taid prOperly Lf for .fale. rcr.t or lease.
Afttt ~ading tbe above statement, I hereby cerrify that I 3nl the owner of the above
named propeny or a licensed electrical contnlctor. I am making the electrical instal.
lation or alteration in' compliance with the e1cctricllllaw~, N.E.C., RCW. Chapter
19.28. WAC. Cha.ptCT 296-4bl3. The City of Pori Angeles Municipal Code, and
Utility Spccificurions.
SlgDa1~r f ner,' clce
x
n ot subtrac.ti.Q.mi.
a'.Rn~(hor or~Jettrie31 adminislrAtor
I<-~ Date:Gl -;)4--D7
I",clricalload Add
IJ NO LOAD CHANGES
o Baseboard KW
a Furnace _ KW
o 'Heat Pump' _ Ton _ LAR
o ~an~W:i1l KW
(
ELECTRICAL WORK PERMIT APPLICATION
Installation dcscripti~ _
a Commercial .JSl...:RcsideDtial
)(New D Altered/Addldon
.
:
ro ~f>){) i-efl1~~fj-
S e.. f IJ ( c--6 . - .
o Cash
o Check #
0"-
~; Ie.
o Credit Card
Card #
Mastercard'
Discover
VlSll
Expiration Date
of card
Inspection fee ~C)
$ ifc-
$erviea Information
j'i4 Overhead Service
)JJ..iemp Service
o Underground Service
Voltage
PhaseD 1 03
ServiCE! Siza:_
Feeder Size:
SAME DAY INSPECTION, .CALL BEFORE 7:00 AM 360-417-4735
ROUGH-IN lHERMOSlAT
U.'
DITCH
DIce
.Inspection
Date
Area, Building or Equipment Inspected
1.&/ <'i -t'../!. fe6 q{ +I/:)'" t. PIZ.WET7
--&;
IO-{-t)
(..'14<2.. 6'1. TfC7,. Dr.) 0'
SEP 2 4 200
SERVICE
^~lIrcved D1
1).le
^fIrImvdDy
l'EIDER
^!!;rcndBy
O,tc
Approved By
Action Taken
Elceti-ica.l
!nspettoT
00
6-
S..
l'" . .:~..
~~ r.;
~ ~.
........;;or.>
07-/r;Y3
Job wired by
\l1.Eleclrical Contractor 0 Owner
Electrical conl?clor name _ J... \ . (License DUmb.:!J....:. Date Expires
~ "~",:) . 6,( e<-t r-, ~ ~nM..lh:ut()r
~Sb'i1in;?;~~SCl 1\ ~Dal
Ci<y"cr-T <A./\.'3 el"'.6St"c ZIPW A. '&Bb3
T(:l~h.one. nUIl\~~ '1 L7.t..:J FAX number S
ObC> ~"fO<7'o -/7 ::J/ ,( ..........1>
Pre.,i,e, owne~';)} of\. 1Att ll&:ll\...
Addre.. of iu,peCliou.g Il;2 q ..f"~'lVfq I f\.
Cily p,:A ~
Pbone number Co schedule inspecttou:
Owrl~'t (~:> defined by RCw'J9,28.261:(l) Owner will oc(.:"Upy IIle SII"udJf/'fJ-Jor
Yt~rs QJ1<>.r this elec!riml permit i<; }ll1.alued. (2) OwneJ' is required m hire an elecTrical
"ontractQr if l1bove said property iy for sale., Tent or lease.
After reading the above stalemenl. I hereby certify that I am the owner of the above
named property or 3. licensed electrical contractOr. 1 am making the ck:ctrical im:bl~
lation or alteration in compliance witb the eleClricallaws. N.E.C.. RCW. Chapter
19.28, WAC, Chapter 296-46D, The City or Porl Angeles Muni.cipal Code, antI
Utility Specifications.
Slguatll Q owner, el
x
~aC;lt cl~t:i;;:;:5~21~;~
EJectrical Load A
o NO LOAD CHANGES
Q Baseboard KW
o Furnace KW
o Heat Pump _ Ton _LAR
o F'a:n-Wall _ KW
c 'ons
n
n
.
ELECTRICAL WORKPERMlT APPLICATION
.
Installation description
Cl Commercial \(Residenti.o.l
~ew
Q Alteredl Additlop
J\ellJ t-<.i2:5 ~ Je fl~
t'3Dp, 5'0 f't.
o Cash
o Check #
aYLls-J-z
a Credit Card
Card #
Mastercard
Discover
Visa
- -
----------------
Expiration Date
of card
I~
In!l~ fee I- Oct
$ ~ c:!!f!El~--
Service Information
Voltage -::u.J ~
Phasel(! 1 0 3
Service Size:"..@,4
~eeder Size: ~
lEl{ Overhead Service
U Temp Service
o Under9(ou(ld $eNice
SAME DAY INSPECTiON. CALL BEFORE 7:00 AM 360-417-4735
ROUGH-IN TflERMOSTAT SERVICE
r-"3,--t>7 W 1-b..o7 ~BY
/);11': AIlPtOv<.:iJ By D~j~ Appm~d By Dlll'"
,.- FEEDER
FINAL DITCH
-z1~0P; ~ D~le ApprovnlBy
0.. Appro.vea By l}~T'" Apllrovell Hy.-/
Inspcction Area, Building OT' r::quiprnenl Tnspected Action Taken Electrical
Date Inspector
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1d W~[S:60 L00G 1[ "830
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ELECTRICAl:. INSPECTION
WIRING REPORT
417-4735
IN~
PERMIT #
~/- <;70
It?? 1Zt.Jz..c--T~1 c
ADDRESS
23-----1EQu tV -rA I f--.(
APPROVED NOT APPROVED
o .................... DITCH. . . . . . . . . . . . . . . . . . . . 0
D................ ROUGH IN/COVER.............. ~
D. . . . . . . . . . . . . . . . . . . . SERVICE. . . . . . . . . . . . . . . . . .~
D.. . . . . .. . . . . . . . . . . . . . FINAL. . . . . . . .. . . . .. . . . . ..0
.
CORRECTIONS NEEDED: ~YLE. uJ \ ~E..S ~C)j; f/ZOh
, I"
li.Db~~"f ~0.o J' 'I 3rD..4 n t..WOE.
~(H ~OX~~ Al\l!> l-iA....t. lZ0N>ea
-rtl\ll~ ~Ll(;'H I ~ 1s-hll-l R~Oh.
l-<IIc..HFN ClJTL~Ts ~ [l~ IN 2.'-11/ or
ktL"'-E.. of SLt:l.B 217). $2...
c,.., N La, ~ ,"IE- "Ji..NC....,.s.~ "\> J:..L.f~C::f~.!:S>€-
AC€..Pf--:~lglL.fT'i' ;?C?o. ~
h€T"ER. H,~I~ ~HALL- lSe.... Y::>r:lt.JEi!::>I
/1 I / I ~ "'^ II tl
L(IZ-'n c..rr'r' !4.U7./7D -X....l~""3b
NOTIFY INSPECTOR WHEN CORRECTIONS
ARE COMPLETED WITHIN 15 DAYS
- DO NOT REMOVE -
OLYMPIC PRINTERS, INC. (360) 452-1381