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1204 O St - Building
PREPARED 4/30/08 10 01 18 INSPECTION TICKET PAGE 2 CITY OF PORT ANGELES INSPECTOR JAMES LIERLY DATE 4/30/08 ADDRESS 1204 0 ST SUBDIV TENANT NBR GLENN TERRA CONTRACTOR GLENN TERRA, INC PHONE (253) 853 3535 OWNER ROLLING HILL HOMES LLC PHONE (360) 582 1899 PARCEL 06 30 01 7 9 0090 0000 APPL NUMBER 06 00000939 RES NEW SFR REQUESTED INSP DESCRIPTION TYP /SQ COMPLETED RESULT RESULTS /COMMENTS BL99 02 12/04/07 JLL BLDG FINAL 12/05/07 DA December 3 2007 4 53 52 PM 1pangrle JOSH 808 1077 BLDG FINAL BL99 03 4/30/08 J L BLDG FINAL April 30 2008 9 11 19 AM 1pangrle JOSH 808 1077 BLDG FINAL COMMENTS AND NOTES PREPARED 12/04/07 8 36 38 INSPECTION TICKET PAGE 5 CITY OF PORT ANGELES INSPECTOR JAMES LIERLY DATE 12/04/07 ADDRESS 1204 0 ST SUBDIV TENANT NBA GLENN TERRA CONTRACTOR GLENN TERRA INC PHONE (253) 853 3535 OWNER ROLLING HILL HOMES LLC PHONE (360) 582 1899 PARCEL 06 30 01 7 9 0090 0000 APPL NUMBER 06 00000939 RES NEW SFR REQUESTED INSP DESCRIPTION TYP /SQ COMPLETED RESULT RESULTS /COMMENTS JOSH 808 1077 BLDG FINAL PERMIT ME 00 MECHANICAL PERMIT REQUESTED INSP DESCRIPTION TYP /SQ COMPLETED RESULT RESULTS /COMMENTS ME6 01 3/23/07 JLL MECHANICAL GAS LINE 3/23/07 AP OVERRIDE TAKEN BY PERMITS DATE 03/22/07 TIME 16 15 58 03/22/2007 04 15 PM PERMITS PAUL 460 8890 03/23/2007 03 30 PM JLIERLY ME1 01 4/02/07 PB MECHANICAL ROUGH IN TIME 13 00 4/02/07 AP 03/30/2007 03 13 PM PERMITS SHAWN 360 621 9786 04/02/2007 04 45 PM PBARTHOL ME99 01 11/27/07 JLL MECHANICAL FINAL 11/28/07 DA November 26 2007 3 56 07 PM 1pangrle JOSH 808 1077 MECHANICAL FINAL ME99 02 12/04/07 '1L MECHANICAL FINAL December 3 2007 4 54 26 PM 1pangrle JOSH 808 1077 MECHANICAL FINAL PL6 01 2/23/07 PB 2/23/07 AP PL2 01 3/13/07 JLL 3/13/07 AP PL99 01 11/27/07 JLL 11/28/07 DA PL99 02 12/04/07 J PERMIT PL 00 PLUMBING PERMIT REQUESTED INSP DESCRIPTION TYP /SQ COMPLETED RESULT RESULTS /COMMENTS PLUMBING WATER SUPPLY 02/23/2007 09 16 AM PERMITS 477 1862 GREG 02/23/2007 04 50 PM PBARTHOL NO PERMIT TO SIGN PLUMBING ROUGH IN OVERRIDE TAKEN BY PERMITS DATE 03/13/07 TIME 09 17 59 03/13/2007 09 17 AM PERMITS PAUL 460 8896 03/13/2007 04 44 PM JLIERLY PLUMBING FINAL November 26 2007 3 56 37 PM 1pangrle JOSH 808 1077 PLUMBING FINAL PLUMBING FINAL December 3 2007 4 54 56 PM 1pangrle JOSH 808 1077 PLUMBING FINAL COMMENTS AND NOTES PREPARED 12/04/07 8 36 38 INSPECTION TICKET PAGE 4 CITY OF PORT ANGELES INSPECTOR JAMES LIERLY DATE 12/04/07 ADDRESS 1204 0 ST SUBDIV TENANT NBR GLENN TERRA CONTRACTOR GLENN TERRA INC PHONE (253) 853 3535 OWNER ROLLING HILL HOMES LLC PHONE (360) 582 1899 PARCEL 06 30 01 7 9 0090 0000 APPL NUMBER 06 00000939 RES NEW SFR PERMIT BPR 00 BUILDING PERMIT RESIDENTIAL REQUESTED INSP DESCRIPTION TYP /SQ COMPLETED RESULT RESULTS /COMMENTS DRW 01 9/05/06 JLL BLDG DRYWELL TIME 13 00 9/05/06 AP OVERRIDE TAKEN BY DYASUMUR DATE 09/01/06 TIME 16 35 02 GREG 477 1862 09/01/2006 04 34 PM DYASUMUR 09/05/2006 04 34 PM JLIERLY BL1 01 9/22/06 JLL BLDG FOUNDATION FOOTING TIME 08 00 9/22/06 AP ROD 908 5510 09/21/2006 11 15 AM DYASUMUR 09/22/2006 03 12 PM JLIERLY BL2 01 9/27/06 JLL BLDG FOUNDATION STEM WALL TIME 13 00 9/27/06 AP ROD 908 5510 09/26/2006 11 25 AM DYASUMUR 09/27/2006 03 13 PM JLIERLY DSD 01 10/13/06 JLL BLDG DOWN SPOUT DRAINS TIME 13 00 10/13/06 AP GREG 477 1862 10/13/2006 07 58 AM DYASUMUR 10/13/2006 04 27 PM JLIERLY BL9 01 1/11/07 JLL BLDG SHEARWALL 1/11/07 DA 01/10/2007 03 09 PM PBARTHOL JOSH 360 912 0254 01/11/2007 03 18 PM JLIERLY over bent straps/ 1st /2nd floor connections (verify)j11 BAIR 01 4/02/07 PB BLDG AIR SEAL TIME 13 00 4/02/07 AP 03/30/2007 03 12 PM PERMITS SHAWN 360 621 9786 04/02/2007 04 45 PM PBARTHOL BL3 01 4/02/07 PB BLDG FRAMING TIME 13 00 4/02/07 AP 03/30/2007 03 12 PM PERMITS SHAWN 360 621 9786 04/02/2007 04 45 PM PBARTHOL BLI 01 4/11/07 JLL BLDG INSULATION 4/11/07 AP 04/10/2007 01 07 PM PERMITS Shawn 621 9786 04/11/2007 03 39 PM JLIERLY PW6 01 6/22/07 RV PUBLIC WORKS DRIVEWAY 6/22/07 AP 06/22/2007 03 41 PM RVESS 06/22/2007 03 41 PM RVESS PW99 01 11/05/07 RV PUBLIC WORKS FINAL 11/05/07 AP November 8 2007 10 29 24 AM rvess November 8 2007 10 30 42 AM rvess FFNL 01 11/09/07 KDD FIRE FINAL 11/28/07 AP November 28 2007 9 53 29 AM kdubuc November 28 2007 9 53 55 AM kdubuc Fire final BL99 01 11/27/07 JLL BLDG FINAL 11/28/07 DA November 26 2007 3 55 28 PM 1pangrle JOSH 808 1077 BLDG FINAL BL99 02 12/04/07 JLL BLDG FINAL Ll(F )-114 December 3 2007 4 53 52 PM 1pangrle CONTINUED ONTO NEXT PAGE e,o (11/28/2007) Linda Pangrle Re final fire inspections Page From Ken Dubuc To: Linda Pangrle Date: 11/28/2007 10 AM Subject: Re final fire inspections Good morning Linda Sorry for the delay 06 -940, 06 -1059 and 06 -939 were all finaled on 11.09.2007 I have entered them in HTE. I'm still working on the others you sent me. Thanks, Ken PREPARED 11/27/07 9 20 55 INSPECTION TICKET PAGE 4 CITY OF PORT ANGELES INSPECTOR JAMES LIERLY DATE 11/27/07 ADDRESS 1204 0 ST SUBDIV TENANT NBR GLENN TERRA CONTRACTOR GLENN TERRA INC PHONE (253) 853 3535 OWNER ROLLING HILL HOMES LLC PHONE (360) 582 1899 PARCEL 06 30 01 7 9 0090 0000 APPL NUMBER 06 00000939 RES NEW SFR PERMIT BPR 00 BUILDING PERMIT RESIDENTIAL REQUESTED INSP DESCRIPTION TYP /SQ COMPLETED RESULT RESULTS /COMMENTS DRW 01 9/05/06 JLL BLDG DRYWELL TIME 13 00 9/05/06 AP OVERRIDE TAKEN BY DYASUMUR DATE 09/01/06 TIME 16 35 02 GREG 477 1862 09/01/2006 04 34 PM DYASUMUR 09/05/2006 04 34 PM JLIERLY BL1 01 9/22/06 JLL BLDG FOUNDATION FOOTING TIME 08 00 9/22/06 AP ROD 908 5510 09/21/2006 11 15 AM DYASUMUR 09/22/2006 03 12 PM JLIERLY BL2 01 9/27/06 JLL BLDG FOUNDATION STEM WALL TIME 13 00 9/27/06 AP ROD 908 5510 09/26/2006 11 25 AM DYASUMUR 09/27/2006 03 13 PM JLIERLY DSD 01 10/13/06 JLL BLDG DOWN SPOUT DRAINS TIME 13 00 10/13/06 AP GREG 477 1862 10/13/2006 07 58 AM DYASUMUR 10/13/2006 04 27 PM JLIERLY BL9 01 1/11/07 JLL BLDG SHEARWALL 1/11/07 DA 01/10/2007 03 09 PM PBARTHOL JOSH 360 912 0254 01/11/2007 03 18 PM JLIERLY over bent straps/ 1st /2nd floor connections (verify)j11 BAIR 01 4/02/07 PB BLDG AIR SEAL TIME 13 00 4/02/07 AP 03/30/2007 03 12 PM PERMITS SHAWN 360 621 9786 04/02/2007 04 45 PM PBARTHOL BL3 01 4/02/07 PB BLDG FRAMING TIME 13 00 4/02/07 AP 03/30/2007 03 12 PM PERMITS SHAWN 360 621 9786 04/02/2007 04 45 PM PBARTHOL BLI 01 4/11/07 JLL BLDG INSULATION 4/11/07 AP 04/10/2007 01 07 PM PERMITS Shawn 621 9786 04/11/2007 03 39 PM JLIERLY PW6 01 6/22/07 RV PUBLIC WORKS DRIVEWAY 6/22/07 AP 06/22/2007 03 41 PM RVESS 06/22/2007 03 41 PM RVESS PW99 01 11/05/07 RV PUBLIC WORKS FINAL 11/05/07 AP November 8 2007 10 29 24 AM rvess November 8 2007 10 30 42 AM rvess BL99 01 11/27/07 JLL Nov FINAL November mber 26 2007 3 55 28 PM 1pangrle c.V JOSH 808 1077 BLDG FINAL PERMIT ME 00 MECHANICAL PERMIT REQUESTED INSP DESCRIPTION TYP /SQ COMPLETED RESULT RESULTS /COMMENTS ME6 01 3/23/07 JLL MECHANICAL GAS LINE CONTINUED ONTO NEXT PAGE BUILDING DIVISION CITY OF PORT ANGELES Correction Notice Job Located at /2-0 CD Inspection. of of your work revealed that the following is not in accordance with the codes governing the work in this jurisdiction Lf EXI-F5e2- c--A- ul 6_5 1± 'Y ek 1 01/6- rY\ is...5J Se DLA 1-( c4 H vC These corrections must be made and are not to be covered until reinspection is mafli Whent7rections e have been made, please call for inspecti n 7/07 bate Insp dtor for Building Division nr, NAT 12CRAAVC TWI TA( PREPARED 11/27/07 9 20 55 INSPECTION TICKET PAGE 5 CITY OF PORT ANGELES INSPECTOR JAMES LIERLY DATE 11/27/07 ADDRESS 1204 0 ST SUBDIV TENANT NBR GLENN TERRA CONTRACTOR GLENN TERRA INC PHONE (253) 853 3535 OWNER ROLLING HILL HOMES LLC PHONE (360) 582 1899 PARCEL 06 30 01 7 9 0090 0000 APPL NUMBER 06 00000939 RES NEW SFR REQUESTED INSP DESCRIPTION TYP /SQ COMPLETED RESULT RESULTS /COMMENTS 3/23/07 AP OVERRIDE TAKEN BY PERMITS DATE 03/22/07 TIME 16 15 58 03/22/2007 04 15 PM PERMITS PAUL 460 8890 03/23/2007 03 30 PM JLIERLY ME1 01 4/02/07 PB MECHANICAL ROUGH IN TIME 13 00 4/02/07 AP 03/30/2007 03 13 PM PERMITS SHAWN 360 621 9786 04/02/2007 04 45 PM PBARTHOL ME99 01 11/27/07 JLI„ MECHANICAL FINAL 1: 1 L November 26 2007 3 56 07 PM 1pangrle JOSH 808 1077 MECHANICAL FINAL PERMIT PL 00 PLUMBING PERMIT REQUESTED INSP DESCRIPTION TYP /SQ COMPLETED RESULT RESULTS /COMMENTS PL6 01 2/23/07 PB PLUMBING WATER SUPPLY 2/23/07 AP 02/23/2007 09 16 AM PERMITS 477 1862 GREG 02/23/2007 04 50 PM PBARTHOL NO PERMIT TO SIGN PL2 01 3/13/07 JLL PLUMBING ROUGH IN 3/13/07 AP OVERRIDE TAKEN BY PERMITS DATE 03/13/07 TIME 09 17 59 03/13/2007 09 17 AM PERMITS PAUL 460 8896 03/13/2007 04 44 PM JLIERLY PL99 01 11/27/07 pL PLUMBING FINAL November 26 2007 3 56 37 PM 1pangrle JOSH 808 1077 PLUMBING FINAL COMMENTS AND NOTES PREPARED 4/11/07 10 11 54 INSPECTION TICKET PAGE 2 CITY OF PORT ANGELES INSPECTOR JAMES L LIERLY DATE 4/11/07 ADDRESS 1204 0 ST SUBDIV TENANT NBR GLENN TERRA CONTRACTOR GLENN TERRA INC PHONE (253) 853 3535 OWNER ROLLING HILL HOMES LLC PHONE (360) 582 1899 PARCEL 06 30 01 7 9 0090 0000 APPL NUMBER 06 00000939 RES NEW SFR PERMIT BPR 00 BUILDING PERMIT RESIDENTIAL REQUESTED INSP DESCRIPTION TYP /SQ COMPLETED RESULT RESULTS /COMMENTS DRW 01 9/05/06 JLL BUILDING DRYWELL TIME 13 00 9/05/06 AP OVERRIDE TAKEN BY DYASUMUR DATE 09/01/06 TIME 16 35 02 GREG 477 1862 09/01/2006 04 34 PM DYASUMUR 09/05/2006 04 34 PM JLIERLY BL1 01 9/22/06 JLL BUILDING FOUNDATION FOOTING TIME 08 00 9/22/06 AP ROD 908 5510 09/21/2006 11 15 AM DYASUMUR 09/22/2006 03 12 PM JLIERLY BL2 01 9/27/06 JLL BUILDING FOUNDATION WALL TIME 13 00 9/27/06 AP ROD 908 5510 09/26/2006 11 25 AM DYASUMUR 09/27/2006 03 13 PM JLIERLY DSD 01 10/13/06 JLL BUILDING DOWN SPOUT DRAINS TIME 13 00 10/13/06 AP GREG 477 1862 10/13/2006 07 58 AM DYASUMUR 10/13/2006 04 27 PM JLIERLY BL9 01 1/11/07 JLL BUILDING SHEARWALL 1/11/07 DA 01/10/2007 03 09 PM PBARTHOL JOSH 360 912 0254 01/11/2007 03 18 PM JLIERLY over bent straps/ 1st /2nd floor connections (verify)j11 BAIR 01 4/02/07 PB BUILDING AIR SEAL TIME 13 00 4/02/07 AP 03/30/2007 03 12 PM PERMITS SHAWN 360 621 9786 04/02/2007 04 45 PM PBARTHOL BL3 01 4/02/07 PB BUILDING FRAMING TIME 13 00 4/02/07 AP 03/30/2007 03 12 PM PERMITS SHAWN 360 621 9786 04/02/2007 04 45 PM PBARTHOL BLI 01 4/11/07 JLL BUILDING INSULATION v 1 /.J 1 04/10/2007 01 07 PM PERMITS Shawn 621 9786 COMMENTS AND NOTES PREPARED 4/02/07 11 50 03 INSPECTION TICKET PAGE 3 CITY OF PORT ANGELES INSPECTOR JAMES L LIERLY DATE 4/02/07 ADDRESS 1204 0 ST SUBDIV TENANT NBA GLENN TERRA CONTRACTOR GLENN TERRA INC PHONE (253) 853 3535 OWNER ROLLING HILL HOMES LLC PHONE (360) 582 1899 PARCEL 06 30 01 7 9 0090 0000 APPL NUMBER 06 00000939 RES NEW SFR PERMIT BPR 00 B UILDI NG PERMIT RESIDENTIAL REQUESTED INSP DESCRIPTION TYP /SQ COMPLETED RESULT RESULTS /COMMENTS DRW 01 9/05/06 JLL BUILDING DRYWELL TIME 13 00 9/05/06 AP OVERRIDE TAKEN BY DYASUMUR DATE 09/01/06 TIME 16 35 02 GREG 477 1862 09/01/2006 04 34 PM DYASUMUR 09/05/2006 04 34 PM JLIERLY BL1 01 9/22/06 JLL BUILDING FOUNDATION FOOTING TIME 08 00 9/22/06 AP ROD 908 5510 09/21/2006 11 15 AM DYASUMUR 09/22/2006 03 12 PM JLIERLY BL2 01 9/27/06 JLL BUILDING FOUNDATION WALL TIME 13 00 9/27/06 AP ROD 908 5510 09/26/2006 11 25 AM DYASUMUR 09/27/2006 03 13 PM JLIERLY DSD 01 10/13/06 JLL BUILDING DOWN SPOUT DRAINS TIME 13 00 10/13/06 AP GREG 477 1862 10/13/2006 07 58 AM DYASUMUR 10/13/2006 04 27 PM JLIERLY BL9 01 1/11/07 JLL BUILDING SHEARWALL 1/11/07 DA 01/10/2007 03 09 PM PBARTHOL JOSH 360 912 0254 01/11/2007 03 18 PM JLIERLY over bent straps/ 1st /2nd floor connections (verify)j11 BAIR 01 4j02/, 7 JLL /7 BUILDING AIR SEAL TIME 13 00 03/30/2007 03 12 PM PERMITS SHAWN 360 621 9786 BL3 01 §/a 2p 07 JLIII BUILDING FRAMING TIME 13 00 PERMIT ME r 00 MECHAN ICAL PERMIT REQUESTED INSP DESCRIPTION TYP /SQ COMPLETED RESULT RESULTS /COMMENTS ME6 01 3/23/07 JLL MECHANICAL GAS LINE 3/23/07 AP OVERRIDE TAKEN BY PERMITS DATE 03/22/07 TIME 16 15 58 03/22/2007 04 15 PM PERMITS PAUL 460 8890 03/23/2007 03 30 PM JLIERLY 2/07 F�t2 P MECHANICAL ROUGH IN TIME 13 00 ME1 01 4 03/30/2007 03 13 PM PERMITS SHAWN 360 621 9786 03/30/2007 03 12 PM PERMITS SHAWN 360 621 9786 COMMENTS AND NOTES PREPARED 3/23/07 10 15 45 INSPECTION TICKET PAGE 2 CITY OF PORT ANGELES INSPECTOR JAMES L LIERLY DATE 3/23/07 ADDRESS 1204 0 ST SUBDIV TENANT NBR GLENN TERRA CONTRACTOR GLENN TERRA, INC PHONE (253) 853 3535 OWNER ROLLING HILL HOMES LLC PHONE (360) 582 1899 PARCEL 06 30 01 7 9 0090 0000 APPL NUMBER 06 00000939 RES NEW SFR PERMIT ME 00 MECHANICAL PERMIT REQUESTED INSP DESCRIPTION TYP /SQ COMPLETED RESULT RESULTS /COMMENTS ME6 01 3/23/07 MECHANICAL GAS LINE OVERRIDE TAKEN BY PERMITS DATE 03/22/07 TIME 16 15 58 03/22/2007 04 15 PM PERMITS PAUL 460 8890 COMMENTS AND NOTES PREPARED 3/13/07 9 35 46 INSPECTION TICKET PAGE 8 CITY OF PORT ANGELES INSPECTOR JAMES L LIERLY DATE 3/13/07 ADDRESS 1204 0 ST SUBDIV TENANT NBR GLENN TERRA CONTRACTOR GLENN TERRA INC PHONE (253) 853 3535 OWNER ROLLING HILL HOMES LLC PHONE (360) 582 1899 PARCEL 06 30 01 7 9 0090 0000 APPL NUMBER 06 00000939 RES NEW SFR PERMIT PL 00 PLUMBING PERMIT REQUESTED INSP DESCRIPTION TYP /SQ COMPLETED RESULT RESULTS /COMMENTS PL6 01 2/23/07 PB 2/23/07 AP PL2 01 3/13 PLUMBING WATER SUPPLY 02/23/2007 09 16 AM PERMITS 477 1862 GREG 02/23/2007 04 50 PM PBARTHOL NO PERMIT TO SIGN PLUMBING ROUGH IN OVERRIDE TAKEN BY PERMITS DATE 03/13/07 TIME 09 17 59 03/13/2007 09 17 AM PERMITS PAUL 460 8896 COMMENTS AND NOTES 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 ROLLING HILL HOMES LLC 1312 MAIN ST VANCOUVER (360) 582 1899 Other struct info Permit Additional desc Permit pin number Sub Contractor Permit Fee Issue Date Expiration Date Other Fees WA 98660 COMMENTS /ACTION NEEDED CITY OF PORT ANGELES PUBLIC WORKS ELECTRICAL DIVISION 121 EAST 5TH STREET PORT ANGELES. WA 98362 06 00000939 029092 1204 0 ST 06 30 01 7 9 0090 0000 GLENN TERRA RES NEW SFR RS9 RESDNTL SINGLE FAMILY 148078 Contractor GLENN TERRA INC 9689 7TH AVE NE 124 POULSBO WA 983707531 (253) 853 3535 TOTAL LOT COVERAGE 25 00 NUMBER OF STORIES .2 00 LOT SIZE 9300' '00 TOTAL LOT COVERAGE 2301 00 NUMBER OF UNITS 1 00 ELECTRICAL NEW RESIDENTIAL EL SVC 2221 SQ FT 95950 ELECTRIC. SERVICE 113 00 Plan Check Fee 3/13/07 Valuation 9/09/07 Qty Unit Charge Per 1 00 69 0000 ECH EL R SQFT FIRST 1300 2 00 22 0000 5C EL R SQFT'ADDITIONAL 500 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 All homes in. new subdivisions that are outside of the Fire Department four minute response area shall be equipped with residential fire sprinkler systems that comply with the International Fire Code (IFC) and National Fire Protection Association (NFPA) 08/31/2006 12 49 PM SROBERDS The proposal will result in a new sfr w /attached garage for total lot coverage of 25% in the RS 9 zone No land use issues are noted Electrical load calculations and elctrical permits are required Electrical connection fee of $713 00 required 08/28/2006 03 57 PM GMCLAIN Sanitary sewer connection inspection is required by Public Works prior to back fill of ditch 24 hour advance notice is required Construct driveway to City Standards No concrete with exposed aggregate allowed in the City road right of way An inspection by Public Works Engineering is required prior to prouring concrete Date 3/13/07 Extension 69 00 44 00 SEWER SYSTEM DELV CHARGE 870 00 00 0 CALL 417 -4735 FOR ELECTRICAL INSPECTIONS. PLEASE PROVIDE A MINIMUM 24 HOUR NOTICE. IT IS UNLAWFUL TO COVER, INSULATE OR CONCEAL ANY WORK BEFORE IT IS INSPECTED AND ACCEPTED. KEEP PERMIT CARD AND APPROVED PLANS AT JOB SITE INSPECTION TYPE DATE ACCEPTED COMMENTS DITCH ROUGH IN COVE SERVICE FINAL GENERAL COMMENTS: ELECTRICAL PERMIT INSPECTION RECORD YES. I NO PW -I 102.1514/96) Application Number 06 00000939 Application pin number 029092 Other Fees Fee summary Permit Fee Total Plan Check Total Other Fee Total Grand Total COMMENTS /ACTION NEEDED CITY OF PORT ANGELES PUBLIC WORKS ELECTRICAL DIVISION 121 EAST 5TH STREET PORT ANGELES, WA 98362 Page 2 Date 3/13/07 STATE SURCHARGE 4 50 PW WATER SYSTEM USE FEE 1200 00 Charged Paid Credited Due 113 00 113 00 00 00 00 00 00 00 2074 50 2074 50 00 00 2187 50 2187 50 00 00 FINAL INSPECTION TYPE GENERAL COMMENTS: ELECTRICAL PERMIT INSPECTION RECORD CALL 417 -4735 FOR ELECTRICAL INSPECTIONS. PLEASE PROVIDE A MINIMUM 24 HOUR NOTICE. IT IS UNLAWFUL TO COVER, INSULATE OR CONCEAL ANY WORK BEFORE IT IS INSPECTED AND ACCEPTED. KEEP PERMIT CARD AND APPROVED PLANS AT JOB SITE DATE DITCH 12. ROUGH-IN/COVER I SERVIC$ ACCEPTED YES I NO 9 !Ain) I l I I l I I I I I I COMMENTS PW -1 102.15 (4'961 1 '•4 4 ,A■ !■11111\_!/I geigk Pt r ,VariMar 4 fiDtb 11.0t4 7:4 fr VI n'74Nunib 0600000939 Date 44/ '04j7,09)7:0090 0.00 :eStEggqiEl2kA litiV1 :13 d RES ttF 61; RS 4 FAM alt4iFi WA 986.0 nflo lfr, Addartkohaqkt d Permi. t e5, :Iiiii\ ),Penti; ..?„,1! p.,... SP ,RIZS,.,,,,,W2:2 .t;:f; 1, ob ,Pil ,Che,Ck Fee 17 00, 7Perm la iYBs iie 31Q5 0 7 1/ 4l'UOt ioh --0' 947-14,5TO 9 p, At f /'011Q7 :'1•• dir. .....4.; F ,er, I :4 b 11a011 be plainly yi6-kb•IC from the stree„,T ahal I z ,be. .a.-.. iftifiiiiiiimr,.Ot 1- izi, J high., ,and' ey ci'l from th.' e :hare leg .-.*.t r;r40,,P*t::., new 511,0tivggdorrs ‘'r,lat. ''4 of the I SI; `..F.. ..:VVJAV b e fortli,mpa r,espori k se areaoSshAL.D. equipped wi'irtli.7' NARY.:.;' C-WiIt" r4.'-fr.L .0 s`ptirix].01. .8.,,9 eTri ,thpcompLy with the 5i- n,.. v, 4 i' k .09cle! !ci F0 and i re Prot ec.t sgo err, 2 .4:,4, ay.. p3.1, ,s E:044po I will ret.".. Z i,,i,/4tf.ahed 40,4 for t,._,, coverage of! -?4,4ZO:11 V Mo land use utiat`g not-ed. tr. 1 0 g. tdigUlatiori and 'elret kkpelqi are 'EAlec `0'ohnect.icin fee of 4^7 -go rued fflay2oS12a 0...; y,,D.1:, GIACliAtN rfaeyeir cpnriectioh ihapectrolAt_ ...,,Riti haat fill of dqq, equated 4 uqp. qr347 to City Standards.- No ,allotki• in. 6he' :"C Oa Y'rVia..kaVii'd7,--.'-'-'4d-,,e-. 4:`, e !a X; a 'Public Works 'EnTfheer-ih oprourrin4 ,c,ohciet e !Et!.4111Z-RI" .04#0;t',es! n :.1, .:-V. Charged 4T's, 4 tr* CITY OF PORT lAd6 FIRE DEPARMOTT Vta:Mf 5! Stiee.t,,t tor; Anigilrest INA‘A I t teLFENN7 "tTERRA WC:7 7 1 4- r- .NEr Al g2.4' T '''x., 4 i ri -r .5 1:13 3 707 (2:53),- 8.:3 3535 TbT4 LOT -ZE, t -9OO ToTkr„, �VEAE 401 NUMBER co: '111314133E11,4270T.R1,,,OP 4 '2 0 0 roiii!Wo .by hQur !E‘ advance c rete with iga of way Ail qui(red 'Prior td r‘,'M sgriElt.,SINZWELV HAWGZ MAtE0S FEE PaVidited 4- .4nd ,o ff WOE, ,,x§; ilidtbirtiMerlee 1113.0661!ayks aliailcioned a oeriodiofi It lc;80 Clays -afer the or has cogrere r ot trattrisi)eettd4 A lasvinspemon. -bere,I* hiliat dverrekt Aftel TOCOrglillZeti tan tarcr$,tv5 OfaiOne,, s goVatiitik,tgis hi 2 eafe Signatarg pfs0Wgetbf Ya' VAlth peeitiOIIIMroftvor n. theigpan glasiottt-cto I.0:, au @Di oA eyp F F fiAysidie, speelfw c1 it J.pewn a pr r,• e be: !Date 0) u:rio ergr 17*. I tit:el/Or Iriteribr, groan pin rt FIRE PERMIT INSPECTION RECORD Call 1 inspections Please provide a minimum 24-hour notice It is unlawful to .cOvertfitOlate or cjeal .,"any.-Vpitk before in and accepted. Post permit in a conspicuous location 4 Dryit at 40, psi (24 hours) Spriitaing Rouglmktits Alati Undervi inspection/pressure test Above-grarimpiping inspection/pressure test 4 Tarik4ciontahrier).Jospection 4 Type PAP410#14tostatically tested; iifiusbed rp,nagkkdfOStatically tested irispection r5; GENE NTS EP PERMIT' CARD AND APPROVED PLANS AT .40.13 SITE Date Passed TN 44$STORAGE TANK (UST) ABANDONMENT artitridbletorrtlitisfible .fibi;94iSlilatately.:2ribandoned. U.% ban ondent final mign-01. (spe totritifetgd by :Coiltraettit- Comments Test #1 Pipinapresstre tegl Tithe-Initiated Test Piping.preSstifetegt Tithe, initiated- 2/1 V00- 7 A■ ieat i 4 101411ithe oflp4JiDri.umber T ©theft Ae „G 49 YCItY OF PORT ANG:AE DEPARTMENT JET, 1 treet, Port Atiestig,/, 44,i9,4P6 I. Page '•4•,71.,:2 Date 00 00 '''k,:y 4 00 00 !oo o 0- ;;0 74. 5 20 ,.5.0: 00 my 50' 2'074 to 00 .66 L.* 4. r :P4 4 r 4 Y Mif,,k0 e..011 OS null and Void if Work.vaii.tliOit not corrimeneeltWitn.„180: -1y, pettod O f 180 days afOr th e wo '.,k.,_144,,-2,:a5;:iL... ,abantlohed/Ot. t a has nced or if re_ti 1 1 4 n s,pecti t Ons:/ha l• k8# 0 days frortehe:Jasonspeetion. there by certify/ tii,a,r4y and 'exarrtinottikt.4 troPatrd'Ootilig.ot A11,:ptOVisigns of recognized standartailband ordinances rci: _.4k.), etieeriNI5eolfiedg,h'eretri or not The -granting does, not'15:ifelorrie to give. a% 44 I ---,--J 0 At .1 .1, 1;l ',i•tif-'-' P POS Aany-st- 'Or local law regulating ink:)).york, specified fled nv.thepqrhit •,.v •,,e. t,,, 44 ,.f.. (it, =4' tf fv1r-,k.•,.k:- '--4 i i ...1 ....4,- ....,..4-..,. .e "!`1-‘ ignatuteoligo4tAadtOror Auttionzett Agolkt ,,IDAte Si of Owner iciPOWnerAsAilifittleik_ t• ,..01 ,-..,-Tvr.:;-, .14-1. 3' •N- 4 15.- k. !if,- f r; L..1." ‘;"ki4i's, -4"tf, :...F. 't?.; 4• p.,1 .v.r.;- 1 ',..-c, :0..', ii, 14k. .-i, 4I: Artki`ii TT k. efla .4 V 9. r., Call 36O-4174655 for fire inspections Please provide a minimum 24-hour notice. It is unlawful to coyakliiStflate i'' or .cd;Reeali work before mspectetl'And accepted. Post permit in a conspicuous location. Inspection Type KEEP PERMIT CARD AND APPROVED PLANS AT JOB SITE Irrangping hydrostatically tested yinyaNitrilt flushed Intef hydrostatically tested Interiprhpaping inspection DrY;Aystiktair tested at 40 psi (24 hours) S P,O l ig a Sii i1 F FP s 461 Ti,Spee,,tion 11§14 ',Ong-inspection/pressure test inspection/presSUre test Tylk. eCliata4119 On nspeetiori 1 4 1 4 ®t Nii) TANK (UST) ABANDONMENT I _,ble/corribUstlbleliquids I l'altitagpmp ratOleali an doned bata oriTrferit final p.E O HEIR (specify) perini FIRE PERMIT INSPECTION RECORD K 'Completed by Test #1 Piping pressure test Time jiiitiatka Test #2 Piping pressure test Time initiated, Project Name: Private Residence Address 1204 "0" Street Installer• Innovated Fire Sprinkler Installer Telephone: 452 -7583 Type of System. Open PORT ANGELES FIRE DEPARTMENT 102 East Fifth Street, Port Angeles, Washington 98362 (360) 417 -4650 FAX (360) 417 -4659 Fire Sprinkler System Plan Review 13❑ Date: 3.2.2007 PAFD Permit 07 -07 We have checked this plan and find that it conforms to the requirements of the code. Additional Comments. 131R 13 D All systems, including underground mains, shall be installed by a state licensed and certified company Systems shall be installed per the applicable NFPA Standard. All electrical components shall be compatible with the fire alarm system. All underground piping must be inspected and hydrostatically tested by the Port Angeles Fire Department PRIOR to being covered. A witnessed flush of the.underground piping is required. A design sprinkler flow test and alarm test are required for all 13D systems. Before final acceptance of the system, an inspection will be conducted to ensure that the installation complies with the applicable NFPA Standard. This 13D system will require a measured flow test. Contractor Reviewed by n Building Department Date: Fire Department 3zcr7 RKS M FIRE DEPARTMENT PLANNING DEPARTMENT PUBLIC WORKS/ENGINEERING DIVISION LIGHT DIVISION ENERGY Li ENGINEERING POLICE DEPARTMENT ADMINISTRATION CITY CLERK RISK MANAGEMENT FROM. PUBLIC WORKS/BUILDING DIVISION RE ADDRESS 0--r) (1) NAME /CONTACT 11)14 e-p 1 1-- PHONE hhS a PERMIT NUMBER. (13K 9' 9 PROJECT DESCRIPTION ,o, Q C c ja NEW CONSTRUCTION ADDITION /ALTERNATION COMMENTS /CONDITIONS DATE.3 7 X i REVIEW/RETURN FILE O -07 Fill out C OMPLETELI and in INK. Your application and site plan MUST BE COMPLETE to be accepted for review If you have an3 questions, call PERMITS (360) 417-4815 FAX(360)417 -4711 t Applicant or Agent. v.CQ,. /.e�� 7 �^V Owner Architect/En iineer PROJECT ADDRESS 2 0 L i CD LEGAL DESCRIPTION Lot: p, Block. Subdivision. CLALLAM COUNTY PARCEL NUMBER. COMMERCIAL/RESIDENTIAL. Occupancy Group: No. of Stones: Lot Size: Existing Sq Ft. Total lot coverage PLANNING USE ONLY ESA/Wetland(s) Yes No SEPA Checklist required? Yes No Other BUILDING PERMIT APPLICATION Phone: C 45 2 ?S Phone. Zip ZONING Occupant Load. Construction Type: Proposed Sq Ft. TOTAL Sq Ft. T•\FORMS\B1dgPermitform.wpd Applicant: v+ -C.li A,11 Date: 1. FOR OFFICIAL USE ONLY Date Rec. If 7 Permit i~ ..pal q Date Approved- -may Date Issued. Address: 1 c E •4z3 City P-uNf CJ- c e O. P Zip Zc;7 C, Phone: Contractor,NA/f V,4T 0 JY State License y JGL/4O 1e Address: a r �v G. ti L City e S' Phone: S..2 —2 V.3 TYPE OF WORK. SIZF/VALUATION R esidential New Constr Re -roof Stove SF /SF Multi- family Addition Move Garage SF /SF Commercial Remodel Demolition Deck SF /SF Repair Sign Other TOTAL VALUATION 2 7,5'6 BRIEF DESCRIPTION OF THE PROJECT Ili S'7`/ r- •2 'et '4 .'1 k ilea s* i j ,,Le APPROVALS PLAN BLDG. DPWU FIRE. OTHER. VALUATION OF CONSTRUCTION In all cases, a valuation amount must be entered by the applicant. This figure will be reviewed and may be revised by the Building Division to comply with current fee schedules. Contact the Permit Coordinator at 417 -4815 for assistance. PLAN CHECK FEE. IF a plan check fee is due it must be submitted at the time the building permit application and construction plans are submitted. All other permit fees are due at the time of permit issuance. EXPIRATION OF PLAN REVIEW If no permit is issued within 180 days of the date of application, the application will expire. The Building Official can extend the time for action by the applicant up to 180 days upon written request by the applicant (see Section R105.3.2 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 prior to wc-k. PREPARED 2/23/07 9 54 53 INSPECTION TICKET PAGE 1 CITY OF PORT ANGELES INSPECTOR JAMES L LIERLY DATE 2/23/07 ADDRESS 1204 0 ST SUBDIV TENANT NBR GLENN TERRA CONTRACTOR GLENN TERRA INC PHONE (253) 853 3535 OWNER ROLLING HILL HOMES LLC PHONE (360) 582 1899 PARCEL 06 30 01 7 9 0090 0000 APPL NUMBER 06 00000939 RES NEW SFR PERMIT PL 00 PLUMBING PERMIT REQUESTED INSP DESCRIPTION TYP /SQ COMPLETED RESULT RESULTS /COMMENTS PL6 01 2/23/07 PLUMBING WATER SUPPLY 02/23/2007 09 16 AM PERMITS 477 1862 GREG COMMENTS AND NOTES I /o PREPARED 1/11/07 10 42 23 CITY OF PORT ANGELES ADDRESS TENANT NBR CONTRACTOR OWNER PARCEL APPL NUMBER PERMIT TYP /SQ DRW 01 BPR 00 BUILDING PERMIT RESIDENTIAL REQUESTED INSP DESCRIPTION COMPLETED RESULT RESULTS /COMMENTS BL1 01 9/22/06 JLL 9/22/06 AP BL2 01 9/27/06 JLL 9/27/06 AP DSD 01 10/13/06 JLL 10/13/06 AP BL9 01 1/11/07 VL 1204 0 ST GLENN TERRA GLENN TERRA INC ROLLING HILL HOMES LLC 06 30 01 7 9 0090 0000 06 00000939 RES NEW SFR 9/05/06 JLL 9/05/06 AP INSPECTION TICKET INSPECTOR JAMES L LIERLY BUILDING DRYWELL TIME 13 00 OVERRIDE TAKEN BY DYASUMUR DATE GREG 477 1862 09/01/2006 04 34 PM DYASUMUR 09/05/2006 04 34 PM JLIERLY BUILDING FOUNDATION FOOTING TIME ROD 908 5510 09/21/2006 11 15 AM DYASUMUR 09/22/2006 03 12 PM JLIERLY BUILDING FOUNDATION WALL TIME ROD 908 5510 09/26/2006 11 25 09/27/2006 03 13 BUILDING DOWN SPOUT GREG 477 1862 10/13/2006 07 58 10/13/2006 04 27 BUILDING SHEARWALL 01/10/2007 03 09 PM JOSH 360 912 0254 AM PM AM PM SUBDIV COMMENTS AND NOTES PHONE (253) 853 3535 PHONE (360) 582 1899 DYASUMUR JLIERLY DRAINS TIME DYASUMUR JLIERLY PBARTHOL 13 PAGE 3 DATE 1/11/07 09/01/06 TIME 16 35 02 08 00 00 13 00 s+tvge rte- 68„} 'te -10 0 '(9 Jt PREPARED 10/13/06 10 22 13 INSPECTION TICKET PAGE 16 CITY OF PORT ANGELES INSPECTOR JAMES L LIERLY DATE 10/13/06 ADDRESS 1204 0 ST SUBDIV TENANT NBA GLENN TERRA CONTRACTOR GLENN TERRA INC PHONE (253) 853 3535 OWNER ROLLING HILL HOMES LLC PHONE (360) 582 1899 PARCEL 06 30 01 7 9 0090 0000 APPL NUMBER 06 00000939 RES NEW SFR PERMIT BPR 00 BUILDING PERMIT RESIDENTIAL REQUESTED INSP DESCRIPTION TYP /SQ COMPLETED RESULT RESULTS /COMMENTS DRW 01 9/05/06 JLL BUILDING DRYWELL TIME 13 00 9/05/06 AP OVERRIDE TAKEN BY DYASUMUR DATE 09/01/06 TIME 16 35 02 GREG 477 1862 09/01/2006 04 34 PM DYASUMUR 09/05/2006 04 34 PM JLIERLY BL1 01 9/22/06 JLL BUILDING FOUNDATION FOOTING TIME 08 00 9/22/06 AP ROD 908 5510 09/21/2006 11 15 AM DYASUMUR 09/22/2006 03 12 PM JLIERLY BUILDING FOUNDATION WALL TIME 13 00 ROD 908 5510 09/26/2006 11 25 AM DYASUMUR 09/27/2006 03 13 PM JLIERLY DSD 01 10/13/06 JL BUILDING DOWN SPOUT DRAINS TIME 13 00 GREG 477 1862 10/13/2006 07 58 AM DYASUMUR BL2 01 9/27/06 JLL 9/27/06 AP COMMENTS AND NOTES PREPARED 9/27/06 10 54 07 INSPECTION TICKET PAGE 6 CITY OF PORT ANGELES INSPECTOR JAMES L LIERLY DATE 9/27/06 ADDRESS 1204 0 ST SUBDIV TENANT NBR GLENN TERRA CONTRACTOR GLENN TERRA INC PHONE (253) 853 3535 OWNER ROLLING HILL HOMES LLC PHONE (360) 582 1899 PARCEL 06 30 01 7 9 0090 0000 APPL NUMBER 06 00000939 RES NEW SFR PERMIT BPR 00 BUILDING PERMIT RESIDENTIAL REQUESTED INSP DESCRIPTION TYP /SQ COMPLETED RESULT RESULTS /COMMENTS DRW 01 9/05/06 JLL 9/05/06 AP BL1 01 9/22/06 JLL 9/22/06 AP BL2 01 9/27/06 LL BUILDING DRYWELL TIME 13 00 OVERRIDE TAKEN BY DYASUMUR DATE 09/01/06 TIME 16 35 02 GREG 477 1862 09/01/2006 04 34 PM DYASUMUR 09/05/2006 04 34 PM JLIERLY BUILDING FOUNDATION FOOTING TIME 08 00 ROD 908 5510 09/21/2006 11 15 AM DYASUMUR 09/22/2006 03 12 PM JLIERLY BUILDING FOUNDATION WALL TIME 13 00 ROD 908 5510 09/26/2006 11 25 AM DYASUMUR COMMENTS AND NOTES PREPARED 9/22/06 9 26 25 INSPECTION TICKET PAGE 19 CITY OF PORT ANGELES INSPECTOR JAMES L LIERLY DATE 9/22/06 ADDRESS 1204 0 ST SUBDIV TENANT NBR GLENN TERRA CONTRACTOR GLENN TERRA INC PHONE (253) 853 3535 OWNER ROLLING HILL HOMES LLC PHONE (360) 582 1899 PARCEL 06 30 01 7 9 0090 0000 APPL NUMBER 06 00000939 RES NEW SFR PERMIT BPR 00 BUILDING PERMIT RESIDENTIAL REQUESTED INSP DESCRIPTION TYP /SQ COMPLETED RESULT RESULTS /COMMENTS DRW 01 9/05/06 JLL 9/05/06 AP BL1 01 9/22/06 BUILDING DRYWELL TIME 13 00 OVERRIDE TAKEN BY DYASUMUR DATE 09/01/06 TIME 16 35 02 GREG 477 1862 09/01/2006 04 34 PM DYASUMUR 09/05/2006 04 34 PM JLIERLY BUILDING FOUNDATION FOOTING TIME 08 00 ROD 908 5510 09/21/2006 11 15 AM DYASUMUR COMMENTS AND NOTES Application Number 06 00000939 Application pin number 029092 Property Address 1204 0 ST ASSESSOR PARCEL NUMBER 06 30 01 7 9 0090 0000 Tenant nbr name GLENN TERRA Application type description RES NEW SFR Subdivision Name Property Use Property Zoning RS9 RESDNTL SINGLE FAMILY Application valuation 148078 Owner Contractor CITY OF PORT ANGELES PUBLIC WORKS UTILITIES DIVISION 321 EAST STH STREET PORT ANGELES, WA 98362 Date 9/11/06 ROLLING HILL HOMES LLC GLENN TERRA, INC 1312 MAIN ST 9689 7TH AVE NE 124 VANCOUVER WA 98660 POULSBO WA 983707531 (360) 582 1899 (253) 853 3535 Other struct info TOTAL LOT COVERAGE 25 00 NUMBER OF STORIES 2 00 LOT SIZE 9300 00 TOTAL LOT COVERAGE 2301 00 NUMBER OF UNITS 1 00 Permit PUBLIC WORKS RES WATER SERV Additional desc 3/4 DROP IN WATER METER Permit pin number 86058 Permit Fee 195 00 Plan Check Fee 00 Issue Date 9/11/06 Valuation 148078 Expiration Date 3/10/07 Qty Unit Charge Per BASE FEE Qty Unit Charge Per 1 00 110 0000 EA SAN SEWER HOOKUP 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 All homes in new subdivisions that are outside of the Fire Department four minute response area shall be equipped with residential fire sprinkler systems that comply with the International Fire Code (IFC) and National Fire Protection Association (NFPA) 08/31/2006 12 49 PM SROBERDS The proposal will result in a new sfr w /attached garage for total lot coverage of 25% in the RS 9 zone No land use issues are noted Electrical load calculations and elctrical permits are required Electrical connection fee of $713 00 required 08/28/2006 03 57 PM GMCLAIN Extension 195 00 Permit SANITARY SEWER HOOK UP Additional desc Permit pin number 86041 Permit Fee 110 00 Plan Check Fee 00 Issue Date 9/11/06 Valuation 148078 Expiration Date 3/10/07 Extension 110 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 s and ordinances governing this type of work will be complied with whether specified herein or not. The granting of a permit does not 1 pre ume to give authority to violate or cancel the provisions of any state or local law regulating construction or the performance of con Signature of Contractor or Authorized Agent Date Signature of Owner (if owner is builder) Date T•\Policies \1102.15R [1/05] PW UTILITIES (Engineering Division) WATERLINE METER SEWER CONNECTION SANITARY STORM SITE DRAINAGE SITE EROSION CONTROL PARKING SIDEWALK CURB GUTTER DRIVEWAY APPROACH BACK -FLOW DEVICE RESIDENTIAL CONSTRUCTION LW PW/ ENGINEERING 417-4807 FIRE 417 -4653 PLANNING DEPT 417 -4750 BUILDING 417-4815 T•\Policies \1102.15R (1/05) PERMIT INSPECTION RECORD CALL 417 -4807 FOR UTILITY INSPECTIONS. PLEASE PROVIDE A MINIMUM 24 HOUR NOTICE. IT IS UNLAWFUL TO COVER, INSULATE OR CONCEAL ANY WORK BEFORE INSPECTED AND ACCEPTED. POST PERMIT IN A CONSPICUOUS LOCATION. KEEP PERMIT CARD AND APPROVED PLANS AT JOB SITE INSPECTION TYPE DATE ACCEPTED YES I NO I I I I I 1 1 I I 1 I I I .1 1 I I I I I I I 1 I 1 I 1 I 1 I I 1 I I I 1 I 1 I I 1 I I I 1 I I I I I FINAL INSPECTIONS REQUIRED PRIOR TO OCCUPANCY/USE DATE YES NO COMMERCIAL DATE ACCEPTED YES I NO CONSTRUCTION LW PW ENGINEERING I FIRE DEPT I PLANNING DEPT. BUILDING COMMENTS Application Number Application pin number Special Notes and Comments Sanitary sewer connection inspection is required by Public Works prior to back fill of ditch 24 hour advance notice is required Construct driveway to City Standards No concrete with exposed aggregate allowed in the City road right of way An inspection by Public Works Engineering is required prior to prouring concrete Other Fees Fee summary Permit Fee Total 305 00 305 00 00 00 Plan Check Total 00 00 00 00 Other Fee Total 2074 50 2074 50 00 00 Grand Total 2379 50 2379 50 00 00 Separate Permits are required for electrical work, SEPA, Shoreline, ESA, utilities, private and public improvements. This permit becomes null and void if work or construction authorized is not commenced within 180 days, if construction or work is suspended or abandoned for a period of 180 days after the work as commenced, or if required inspections have not been requested within 180 days from the last inspection. I hereby certify that I have read and examined this application and know the same to be true and correct. All provisions of laws and ordinances governing this type of work will be complied with whether 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 [1 /05] CITY OF PORT ANGELES PUBLIC WORKS UTILIII S DIVISION 321 EAST 5TH STREET PORT ANGELES, WA 98362 06 00000939 029092 SEWER SYSTEM DELV CHARGE 870 00 STATE SURCHARGE 4 50 PW WATER SYSTEM USE FEE 1200 00 Charged Paid Credited Due Page 2 Date 9/11/06 PW UTILITIES (Engineering Division) WATERLINE METER SEWER CONNECTION SANITARY STORM SITE DRAINAGE SITE EROSION CONTROL PARKING SIDEWALK CURB GUTTER DRIVEWAY APPROACH BACK -FLOW DEVICE CONSTRUCTION N RW PW/ 417 -4807 FIRE 417 -4653 PLANNING DEPT 417-4750 1 1 BUILDING 417 -4815 TAPolicies\1 102.15R 1/05) RESIDENTIAL PERMIT INSPECTION RECORD CALL 417 -4807 FOR UTILITY INSPECTIONS. PLEASE PROVIDE A MINIMUM 24 HOUR NOTICE. IT IS UNLAWFUL TO COVER, INSULATE OR CONCEAL ANY WORK BEFORE INSPECTED AND ACCEPTED. POST PERMIT IN A CONSPICUOUS LOCATION. KEEP PERMIT CARD AND APPROVED PLANS AT JOB SITE INSPECTION TYPE DATE ACCEPTED YES I NO 1 I 1 I 1 I 1 I I I I 1 1 I I I M I I I I I I I I I I I I I I I I I I 1 I I I I 1 1 I I I I I I I I I 1 .1 I I I I I I I COMMENTS FINAL INSPECTIONS REQUIRED PRIOR TO OCCUPANCY/USE DATE YES NO COMMERCIAL DATE ACCEPTED YES I NO CONSTRUCTION RW PW ENGINEERING I FIRE DEPT I PLANNING DEPT BUILDING I 1 I I I I I I CITY OF PORT ANGELES DEPARTMENT OF COMMUNITY DEVELOPMENT BUILDING DIVISION 321 EAST 5TH STREET PORT ANGELES, WA 98362 Application Number 06 00000939 Application pin number 029092 Property Address 1204 0 ST ASSESSOR PARCEL NUMBER 06 30 01 7 9 0090 0000 Tenant nbr name GLENN TERRA Application type description RES NEW SFR Subdivision Name Property Use Property Zoning RS9 RESDNTL SINGLE FAMILY Application valuation 148078 Owner Contractor ROLLING HILL HOMES LLC GLENN TERRA, INC 1312 MAIN ST 9689 7TH AVE NE 124 VANCOUVER WA 98660 POULSBO WA 983707531 (360) 582 1899 (253) 853 3535 Other struct info TOTAL e LOT COVERAGE 25 00 NUMBER OF STORIES 2 00 LOT SIZE 9300 00 TOTAL LOT COVERAGE 2301 00 NUMBER OF UNITS 1 00 Permit BUILDING PERMIT RESIDENTIAL Additional desc Permit pin number 85647 Permit Fee 1294 65 Plan Check Fee 517 86 Issue Date 9/11/06 Valuation 148078 Expiration Date 3/10/07 Qty Unit Charge Per Extension BASE FEE 1020 25 49 00 5 6000 THOU BL -100 001 500K (5 60 PER K) 274 40 Permit MECHANICAL PERMIT Additional desc Permit pin number 86280 Permit Fee 122 25 Plan Check Fee 00 Issue Date 9/11/06 Valuation 0 Expiration Date 3/10/07 Qty Unit Charge Per Extension BASE FEE 50 00 1 00 14 7000 ECH ME INSTALL 100- FAU 14 70 5 00 7 2500 ECH ME VENT FAN 36 25 1 00 10 6500 ECH ME VENT SYSTEM OTHER 10 65 1 00 10 6500 ECH ME -GAS PIPE 1 TO 5 10 65 Permit PLUMBING PERMIT Additional desc Permit pin number 86298 Permit Fee 170 00 Plan Check Fee 00 Issue Date 9/11/06 Valuation 0 Expiration Date 3/10/07 Qty Unit Charge Per Extension BASE FEE 50 00 13 00 7 0000 ECH PL- EA FIXTURE ON ONE TRAP 91 00 1 00 7 0000 ECH PL- EA INSTALL WATER PIPE 7 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 -a -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 ume to give authority to violate or cancel the provisions of any state or local law regulating construction or the performance of onstructi T•\Policies \l102_15 building permit inspection record05.wpd [1/4/2005] Signature of Contractor or Authorized Agent Da e Date 9/11/06 Signature of Owner (if owner is builder) Date 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 CONSTRUCTION R.W PW/ ENGINEERING 417 -4807 FIRE 417 -4653 I PLANNING DEPT 417 -4750 I BUILDING 417 -4815 I BUILDING PERMIT INSPECTION RECORD CALL 417 -4815 FOR BUILDING INSPECTIONS. CALL 417 -4735 FOR ELECTRICAL INSPECTIONS. CALL 417 -4807 FOR PUBLIC WORKS UTILITIES PLEASE PROVIDE A MINIMUM 24 HOUR NOTICE. IT IS UNLAWFUL TO COVER, INSULATE OR CONCEAL ANY WORK BEFORE INSPECTED AND ACCEPTED. POST PERMIT IN A CONSPICUOUS LOCATION. KEEP PERMIT CARD AND APPROVED PLANS AT JOB SITE. INSPECTION TYPE DATE ACCEPTED COMMENTS YES I NO T• \Policies \I 102_15 building permit inspection record05.wpd [1/4/2005] I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I FINAL FINAL SEPA. ESA. SHORELINE. FINAL INSPECTIONS REQUIRED PRIOR TO OCCUPANCY/USE DATE YES NO COMMERCIAL DATE ACCEPTED YES I NO 417 -4735 ELECTRICAL LIGHT DEPT CONSTRUCTION R.W PW ENGINEERING I FIRE DEPT I PLANNING DEPT I BUILDING DATE ACCEPTED BY. DATE ACCEPTED BY. I I I I I I I I I CITY OF PORT ANGELES DEPARTMENT OF COMMUNITY DEVELOPMENT BUILDING DIVISION 321 EAST 5TH STREET PORT ANGELES, WA 98362 Page 2 Application Number 06 00000939 Date 9/11/06 Application pin number 029092 Qty Unit Charge Per Extension 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 All homes in new subdivisions that are outside of the Fire Department four minute response area shall be equipped with residential fire sprinkler systems that comply with the International Fire Code (IFC) and National Fire Protection Association (NFPA) 08/31/2006 12 49 PM SROBERDS The proposal will result in a new sfr w /attached garage for total lot coverage of 25% in the RS 9 zone No land use issues are noted Electrical load calculations and elctrical permits are required Electrical connection fee of $713 00 required 08/28/2006 03 57 PM GMCLAIN Sanitary sewer connection inspection is required by Public Works prior to back fill of ditch 24 hour advance notice is required Construct driveway to City Standards No concrete with exposed aggregate allowed in the City road right of way An inspection by Public Works Engineering is required prior to prouring concrete Other Fees Fee summary SEWER SYSTEM DELV CHARGE 870 00 STATE SURCHARGE 4 50 PW WATER SYSTEM USE FEE 1200 00 Charged Paid Credited Due Permit Fee Total 1586 90 1586 90 00 00 Plan Check Total 517 86 517 86 00 00 Other Fee Total 2074 50 2074 50 00 00 Grand Total 4179 26 4179 26 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 -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_15 building permit inspection record05.wpd [1/4/2005] 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 I 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 BUILDING PERMIT INSPECTION RECORD I' i I I 1 -7 /aGI17 I I I I I 1 I I I IHIii(o 1 I 1 I I I I I I I I I I I I CONSTRUCTION R.W PW/ ENGINEERING 417-4807 FIRE 417 -4653 I I I PLANNING DEPT 417 -4750 I �7 I I Li BUILDING 417 -4815 I b- 7O -Og I GI-- I T \Policies \l 102_15 building permit inspection record05.wpd [1/4/2005] NO 417 -4735 ELECTRICAL LIGHT DEPT payweu PC, privix 0346 D97„/ FINAL DATE ZV1 1 ACCEPTED BY. SEPA. ESA. SHORELINE. FINAL INSPECTIONS REQUIRED PRIOR TO OCCUPANCY/USE DATE YES NO COMMERCIAL DATE ACCEPTED YES I NO CONSTRUCTION R.W PW ENGINEERING I FIRE DEPT I PLANNING DEPT I BUILDING I I I I /Zl fRDuSI n 7u I 3' /23 10/ I 1 lam-- I I 1 I I FINAL 11—°4-67 DATE 0-" ACCEPTED BY. I I PREPARED 9/05/06 10 44 36 INSPECTION TICKET PAGE 5 CITY OF PORT ANGELES INSPECTOR JAMES L LIERLY DATE 9/05/06 ADDRESS 1204 0 ST SUBDIV TENANT NBA GLENN TERRA CONTRACTOR GLENN TERRA INC PHONE (253) 853 3535 OWNER ROLLING HILL HOMES LLC PHONE (360) 582 1899 PARCEL 06 30 01 7 9 0090 0000 APPL NUMBER 06 00000939 RES NEW SFR PERMIT BPR 00 BUILDING PERMIT RESIDENTIAL REQUESTED INSP DESCRIPTION TYP /SQ COMPLETED RESULT RESULTS /COMMENTS DRW 01 9/05/06 ALL BUILDING DRYWELL TIME 13 00 OVERRIDE TAKEN BY DYASUMUR DATE 09/01/06 TIME 16 35 02 GREG 477 1862 09/01/2006 04 34 PM DYASUMUR COMMENTS AND NOTES 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)417-4711 BUILDING PERMIT APPLICATION FOR OFFICIAL TE ONLY O at Rec. 2c Permit# te Approved. ate Issued. 3(20 (21—gy.33 DELI. Phone (0 O- Sc0S t p Applicantt n or Agent: W Owner l 7 L VA/ Th IZ R� L 1 iU C- Address I S (Q g T "S T, t 22_3 Cit PP )1.›...T -t it)( ES Zip 'U..? Arclntect /Ei bgineer C A r s r,.4 e, P L.4.v S IZ V ZG E Phone. 2 S3 ZS L1- 317 OEJv�rr 36, 0 Contractor t, e-. J4/ 7 .1/VC-State License /862 /UHF Exp J toy, Phone CO 2-1 yIs Address J See 1! r T. Z.2-3 City Po fe --r A-.19 E4ES Zip Co Z. PROJECT ADDRESS I 2.. D I-/ ZONING LEGAL DESCRIPTION Lot: 9 Block: Subdivision. nt_ L T/v CLALLAM COUNTY PARCEL NUMBER. 06 ,2 COI 7900 0 Credit Card Holder Name: Billing Address: Credit Card Type VISA MC TYPE OF WORK. 1 4 Residential g New Constr Re roof Multi- family Addition Move Commercial Remodel Demolition Repair Sign BRIEF DESCRIPTION OF THE PROJECT COMMERCIAL/RESIDENTIAL. Occupancy Group 3 Occupant Load. Construction Type: U 7 V No. of Stories: Lot Size: 300 Existing Sq Ft. Proposed Sq Ft. Z3 41 TOTAL Sq Ft. Z 3 0 18' 1 tioo S O Total lot coverage Z S PLANNING USE ONLY TAPolicies\BL 1102_13 wpd App City Phone. 362 O p d p Exp S17E/VALUATION Stove I8 I SF 767 O /SF I Garage 4 4 0 SF I,/ 3 P/SF t$ 4 4 e c l t P o t c t t re) $F 1 Z O S' /SF Other TOTAL v ALUATION /l l s-ft.Lx_c .zp S ESA/Wetland(s). Yes No SEPA Checklist required? Yes No Other VALUATION OF CONSTRUCTION In all cases, a valuation amount must be entered by the applicant. This figure will be reviewed and maybe 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 he 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 within 180 days of the date of application, the application will expire. The Building Official can extend the time for action by the applicant up to 180 days upon wntten request by the applicant (see Section R105.3.2 of the International Building/Residential Code, 2003) No application can be extended more than once. 1 hereby certify that 1 have re d and .xamined 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 respo .ibility o det a mine wh •e mits are required ,not the City's, and that 1 must obtain such permits prior to work. Date: ,Z+� Date. $i38 Ss9, 8R r sA Z.,v a 636 0 7? L9 APPROVALS. PLAN BLDG DPWU FIRE OTHER Option Ill TY P E Site Information Lot: Permit I a 11 Address. Notes: City' _PO itzu C., L ES State. t A Zip. 1 FS 622 Contact: M 1 7112122,5 Phone. S S 1 D r9 Phone2: �6r') rQ 2_1 L-133 Fax: 34_0 S`a -s' O I O L Glazing Area l() of Floor Unlimited Group R 3 Occupancy Only Prescriptive Approach Simple Form For the Washington State Energy Code (2003 Edition) Climate Zone 1 Building:Department Use Only Table 6 -1 PRESCRIPTIVE REQUIREMENTS FOR GROUP R OCCUPANCY CLIMATE ZONE 1 (Unlimited Glazing Option Only) I Glazing U- Factor I Door Wall Wall Wall Slab U- Ceiling' Vaulted Above Int Ext Floor' On Vertical Overhead' factor Ceiling' Grade Below Below Grade Grade Grade 0 40 0.58 0.20 R 38 R 30 c R 21 R 10 R 10 This oject complies with the following The project is a single family residence le 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 VIAQ. Location of the door(s) taking this exception F 1-1GA c.0 See the code text for footnote references The project will take advantage of the following exceptions to the prescriptive option 602.6 Exception 1 One door that is 24 ft. or less that does not meet the standards is allowed Location of the door taking this exception 602.6 Exception 2. Doors with a U- factor of 0 40 allowed without calculations Option Ill only Copyright 2002, WSUCEEP02 -056 Copied by permission from the Washington State university Extension Energy Program F r (ZLE i) 4 t( ta. E. L er TJ2 1 PA-Ai e F L ICE PL.'S c, E Prescriptive Simple Form Climate Zone 1 7/26/2004 Sincerely CASCADE RESIDENTIAL DESIGN INC 102 S 26 Street Tacoma, WA 98402 253 284 3170 Fax 253 284 3183 August 17 2006 Attn Port Angeles Building Department Building Location 1204 0' St. Port Angeles WA Glenn Terra Homes is authorized to construct our plan 1821/2A for a single use on the site address referenced above based on the criteria in the accompanying construction documents and calculations Any revisions or alterations must be authorized by Cascade Residential Design Inc prior to commencing work Mark Myers P E 1 EXPIRES. 6 -S -o1 I Project Engineer ,..o(MAY /03 /WED 03 20 PM CITY OF PA BLDG DEPT FAX No 360 417'"11 P 001/001 NW CORNER S58 45$11 5u9UR&AN LOT 68 IJU7E R,aS, 'V. 53. P. 12 HAS 1N7EFPR£7ID THE I CURVE TABLE OEM D1MEN$ON ALONG THE NOR1H9 SIERLY CURVE 1 LENGTH 1 RADIUS DELTA Ta a0UN0ARY (240 AM) 70 8E A NoRE; -0R -LESS 157#1 0.o 1o1 yn C t b" CA{A,.A£SOLTINC IN A POSITION FORME 8.4T 10.011 4 84.78 00.01 70.901 0000 99901 0000 2.07 10.00 7'7 11.34 1000' 41 I GO 19.711 10.00 1C9 I.Z.31 10.00 0i f:ti1 �'3Pfl 0 cit i2.iI'' 30.40 74 '1 C14 1 00.491 50,001 1.5 l'053 I .11.491 00.00 J 1014 I 24.93! 5000 27'1 7.' q 11C10 C10 1 15.71 10.00 q�10oly trz,1C10 I 10711 10.00 tch I S5 4;' i 2 F rn SaFr 27 I 11.Z.1 I 1 2 REB AR/GAP LS 22 9' I w 1 1 12 1 533+07'49'W r 14.47 FROM cAL !D I 1 I 1 CORNER POSITION 8 'al E 8 6e5 Air f` y 7O L w g .,�,10•QO 1 1 w al 5. a7t e n 191 102 !ICs G C6 CS Q 6 25' .I�ILOQ__'1 s'r 2.4 A. ----t tos a� safr i i n 1' I .13t�► 125 V� H. 4 END. (8/05) 1/2' RE9AR /CAP LS 28329' S69'09'25"W, 0.35' FROM CALCULATED CORNER POSTION 1 11 '26 .1 k3 25' 1 9427 SOST I fa 0 1 1 L.... .•A Zr I 4 25 25 F I �l 23I I�L1 I go I v 4 11 53,4 1 1 iNS6k54 '�1 Cl.. N. t r .-.w. 9• I o I 23 1p1 20 t I 19 I18 r 11531 SOFT. L gl 9224 SOFT. 1 8 9002 saFr.1 00/ I -1 1 I1 -j0. A- ...,.1 s L I b 04 N H 80.7Y 356'49'47'E 7a.00 0- 98.00' 77.77' '1� IB PR1)GEOUREL: THIS RECORD OF SURVEY 1$ BASED ON A GROUND SURVEY UTILIZING CONVENTIONAL TRAVERSE METHODS THIS SURVEY MEETS OR EXCEE THE STANDARDS CONTAINED IN WAC 332- 130 -000• EQUIPMENT r TOPCON MODELL GT$ 60 5'�MTOTALSTA7/DN DATE -OF SURVEY' Q 30' I SO' W. 1477-I STREET 34. 597' I 4. w I 974 SO.P7 I 6 r I 9000 Safi T. 125' L "Ie't5 t 5$40'47 E1 0' WIDE POWV1 ESM7 447'W 150 00' ROLISlQ MILS G oUflr 41• S OUTHWEST CORNER OF THE SURVEYED PARCEL .r- i ..0 1 4 4 b IN POS ITION OETER►ONfD BY 1}65 OFFlI� 3331104 r y 2 4 I I HOLDS THE O£ED•CALl OF 240 FEET FROM 1HE y]5+ 9300 son I 7 i NORTHWEST CORNER OF 5UBUR9AN LOT 68. 0...:.1:„, h I A COMPREHENSIVE RENEW OF THE CHAIN OF s •+'7'."" L. v 1 "0 l F ry 9 Tax OR AL 68 SHOWS c6NSISTENCY OF 1 .L THE 240 FOOT CALL G6"g s¢ r J_ I' 1-li r 1 J7116�f1 FI 10 I I 1 1.0. 4 c7' cy S. I 9000 SQFT 114 N 1 ~0 I 1 2s' .17407 t. s fl O o .•••'Y p,S 5 I 11 1 z s' j "1 I; >n 1 10059 SQF4 o o a 8 j l eo0o ,arr. 1 I$ a l 1� t zs' h 1 1 12-!!p 1 1, L -.4_,-,....4,4.4.___,... 01. I ;1 8' 71(L�fiODD• '1 2s II I t1,7--• I 1 111 g .I 6. I N( P I 9000 50 FL I ,4 t I J 42:45'47F 9 I Q I 1 I t. b ^SI I I I moo i3 SQ.FT 1 n 1 1 9000 SQFE I n 25' I I 556 A 1 1 loj i o I 13 1 25 o 1� ti x 01 I I 9000 SOFT 1 11 I 9000 =Pr. 1 1 I 25 I t 4s F 59 1 L. ,43 4 9 L 506 4 4irra' I •'I 7' v;,,J'erN__ 1 -Ism I 1 I I 131 i 25' I 13 /g I I, I1" no I I. 3 I 3• I In, a I 1 9000 scut 1 n 1 0 3 OFT 1 h vi I I as' I I 'iz 2 8 S 1 to' I_ rit.- 12 Q- 0 Q -1 c .0. ..120.ntr_ ts 1 1g I zs y I h I r 66 17.0 :al I i3 I 8-I 2 I A M1 l 1 9400 50.FT 1 n 1 9000 soy?: I In 1 v• 5 I 1 25' I 1 51 14 4 T L.-M L i�54, 1 1 1 1 1§ I 1$ 1 o f x mo o' "1 2 7' A` _OAT- 1 81 22 9 049 5 0500 7'. 9020 saFT. al 9tao snFT. g I I I f 15 7 I 1 Id. 7' l I N `I 751 ,1 1 1 1 ,174 1 41 I I soD3 SO.FT. i R 1 9003 saFT_ 1 e 20. _"llv »0. 60 0' ���1tt 76 ire Go: 'Ro d w .tl 0 .ey 410 1 220 557'4 E 7 22'1.41' 1 b z5645 1 SEE 555454rE b n t0' NOE POWER E57,47 534•91' o :n FOR N58•45'47 "W 310.00 PER 1 I, BRADLEY R. LYMANGROVER, REGISTERED AS A LAND SURVEYOR BY THE STATE OF WASHINGTON, CERTIFY THAT THIS LAND SUBDIVISION IS BASED ON AN ACTUAL SURVEY -OF THE LAND DESCRIBED HEREIN CONDUCTED BY ME. OR UNDER MY SUPERVISION; AND DECLARE THAT THE DISTANCES, COURSES AND ANGLES ARE SHOWN HEREON CORRECTLY. AND THAT MONUMENTS OTHER THAN THOSE MONUMENTS APPROVED FOR�E171NG 71��4 L�4i�R i� 14 fii H>ai�E flEfid SEf A.T..CQT.:C,CRNERS "STAKED ON. T21E _GROUND A DEP.iCTED QN THE' PLAT 8 5,24, Loi 9 Zok' h ‘k t©z 4 r vu�GS FEB-21-2004 0B:43A FROM:ELECTRIC SERUICE 4526424 TO: 4174711 P.l/1 V ') .}: i^~ .,-" \ 0':," v;...,~ , ELECTRICAL WORK PERMIT APPLlCATI6N Job wired by W "l.. ,..,..,..,,! ~t- ~.. ...... ~ Cuntractor Q Owner Installation descriplion o Commercial tI RII;:lIIocnllBI Electrical \;::;~e purCh~~ni]ing Odress license number Date Expires L.eCl.., 132.- o New o Altered! Addition LJ '. City ~ ^ Slate IP ~ W..... C, r~6 '- Telcphone.nY"!~2_ FAX number '-f~.{,,'hLI ..p",. ~ 2.:l6u '5., f2-r- I , Premlse.v1J'rner's ~ \J, \AA-. \""'--""-~ /8.? I L.Jo () -;4~ rj /rlL Addre;:t~nqecllon $ '6 City r .4 Phone number to schedule Inspection: OW1Ier (f.( defined hy RCW 19 28.261 :(1) Owner will nccupJI the ,~Iruclltre for two ycar.\' after ,1Ii,~ electrical pemlit is finalized. (2) OWller ;,~ required fa hire on eleclrical contractor if above said properl)' is for sole, refit or lease-, After fc_ading the above statement, I hereby certify thai I am the owner or the above named property or Il licensed electrical contractof. , am making the electrical instal- lation or al1erllliun ill compliance wilh the electricol laws, N.E,C., RCW. Chapter 19.28, WAC. Chapter 296-46B, The City of Port Angcles Municipal Code, ond Utility Specifications. ~gnatncr;:r. e Cl CllSh Cl Check # D Credit Card Card # Visa Mast"f'llr<}. _ 0-- "\:--'4... Discover ---------------- 1 contractuI'" Of clcc:tricul administrator Date: ~ 2'-( Expiration Date of card Inspection rec $ /3.DO Service 1nformatlon Voltage I ~ Phase 0 , Service Size: ~ Feeder Size: ~ Electrical Load Additions and or subtractions o NO LOAO CHANGES o Ba~ard KW ~ace U?KW CJ Heat Pump _ Ton _ LAR o Fan-Wall KW Q Overhead Service [J Te~ice ~rground Service SAME DAY INSPECTION. CALL BEFORE 7:00 AM 360-417-4735 Dale ApprovedlJ)' SERVICE 2.-1..8-07 ~ D~le Apptflve<! ~y , ROUGH-IN .:%. &-.:r:- 0/1 Apl""tlVctllly THERMOSTAT FINAL H!~.Itri" "ttl~ ~ ~ ;1- 1-1-07 Dale DITCH ~ ....Pproved By FEEDER Dale Approyed By ,$ o .- . Inspection Date Area, Building or EquipmenllnspeCled Action Taken . . , .1 .' ; .J"h~ ~ 7 ELECTRICAL INSPECTION ~" - WIRING REPORT 417-4735 J<:::"- O~T. APPROVED NOT APPROVED o .................... DITCH . . . . . . . . . . . . . . . . . . . . 0 D.. . . . . . . . . . . . . . . ROUGH IN/COVER. . . . ..... . . .. . . 0 D. .. . . . . . . . . . . . .... . . SERVICE. . . . . . . . .. . . . . . . . . . 0 )I2L-.-... . . . . . . . . . . . . . . . . FINAL. . . . . . . . . . . . . . . . . . . . 0 CORRECTIONS NEEDED: . ., NOTIFY INSPECTOR WHEN CORRECTIONS ARE COMPLETED WITHIN 15 DAYS - DO NOT REMOVE - . ... -- OLYMPIC PRINTERS, INC. (360) 452-1381 3604172733 ST OF WA L&I 6/8 09:14:55 a.m 04-02-2007 PORT ANGELES CITY L T PAGE 01 .. -- . 0a/30/2007 08: 55 3604174729 (i CITY OF PORT ANGELES L1G T DIVISION FAX T SMISSION COVER SHEET . Date; To: Fax: Re: Sender: 3/30/07 Labor & Industries 417-2733 Inspections Kathy Trainor Phone: 417-4724 Fax: 417-4729 YOU SHOULD RECEIVE 1 PAGE, INCLUDING THIS COVER SHEET. IF YOU DO NOT RECEIVE A L THE PAGES, PLEASE CALL (360) 417-4724. Please Inspect for: 1204 '0' Sl Rough-In Thank you, Kathy # j;L c5(/~ ~ ,.~ ~ ~..... CITY OF PORT ANGELES PUBLiC WORKS - UTILITIES DNISION 321 EAST'51HSTREET, PORT ANGELES, WA 98362 () ~-4'39 Application Number Application pin number Property Address ASSESSOR PARCEL NUMBER: Tenant nbr, name Application type description Subdivision Name Property Use Property zoning Application valuation 06-00000939 Date 029092 1204 0 ST 06-30-01-7-9-0090-0000- GLENN-TERRA RES NEW SFR 9/11/06 RS9 RESDNTL SINGLE FAMILY 148078 I; / /204 s u IJ ROLLING HILL HOMES LLC 1312 MAIN ST VANCOUVER WA 98660 (360) 582-1899 Other struct info GLENN-TERRA, INC. 9689 7TH AVE, NE"# POULSBO (253) 853-3535 TOTAL % LOT COVERAGE NUMBER OF STORIES LOT SIZE TOTAL LOT"COVERAGE NUMBER OF UNITS 124 WA 983707531 61tWl~ Owner Contractor 25.00 2.00 9300.00 2301.00 1.00 Permit PUBLIC WORKS RES WATER SERV Additional desc 3/4" DROP IN WATER METER Permit pin number 86058 Permit Fee 195.00 Plan Check Fee Issue Date 9/11/06 Valuation Expiration Date 3/10/07 ,00 148078 BASE FEE Extension 195.00 Qty Unit Charge Per 86041 110,00 9/11/06 3/10/07 Plan Check Fee Valuation ,00 148078 1~~~A)1 ( , \V.J ) }/ Permit Additional desc , Permit pin number Permi t Fee Issue Date Expiration Date SANITARY SEWER HOOK UP Qty 1. 00 Unit Charge Per 110.0000 EA SAN SEWER HOOKUP Extension 110,00 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. All homes in new subdivisions that are outside of the Fire Department four-minute response area shall be equipped with residential fire sprinkler systems that comply with the International Fire Code (IFC) and National Fire Protection Association (NFPA). 08/31/2006 12;49 PM SROBERDS -- The proposal" will result in a new sfr w/attached garage for total lot' coverage of 25% in the RS-9 zone. No land use issues are noted. Electrical load calculations and elctrical permits are required. Electrical connection fee of $713.00 required. 08/28/2006 03;57 PM GMCLAIN ---------------------------- 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 pr~sume 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\II02.15R (I/OS) e ,.~ ~ ~;;;o.> CITY OF PORT ANGELES PUBLIC WORKS - UTILITIES DNISION 321 EAST5TIISTREET, PORT ANGELES, WA 98362 Application Number Application pin number 06-00000939 029092 Page Date 2 9/11/06 Special Notes and Comments Sanitary sewer connection inspection is required by Public works prior to back fill of ditch. 24 hour advance notice is required. Construct driveway to City Standards. No concrete with exposed aggregate allowed in the City road right of way. An inspection by Public Works Engineering is required prior to prouring concrete. Other Fees SEWER SYSTEM DELV CHARGE STATE SURCHARGE PW WATER SYSTEM USE FEE 870.00 4.50 1200.00 Fee summary Charged Paid Credited Due ----------------- ---------- ---------- ---------- ---------- Permit Fee Total 305.00 305.00 .00 .00 plan Check Total .00 .00 .00 .00 Other Fee Total 2074.50 2074.50 .00 .00 Grand Total 2379.50 2379.50 .00 .00 Separate Permits are required for electrical work, SEPA, Shoreline, ESA, ulilities, private and public improvements. This permit becomes null and void if work or construction authorized is not commenced within 180 days, if constructiDn 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 wiil 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 constructio"n or the performance of construction. Signature of Contractor or Authorized Agent Date Signature of Owner (if owner is builder). Date T:\Policies\II02.ISR'{1I0S] YJ The City of Port Angeles Building inspections Dept. Upon reviewing the single family residential plans submitted for permit, the following are some of the items that will need to be taken -in to consideration. Foundation Footing The minimum size of a footing in Seismic zone D2 are as follows. (1 Story 12" W/ 6" min. thick) (2 story 15" W/ 7" min. thick) (3 story 23" W/ 8" min. thick) (Load bearing value of soil 1,500 (psf). With 2 4 bars horizontal continuous 3" off the bottom of footing. The minimum specified compressive strength of concrete in basement walls, foundation walls, exterior walls and other vertical concrete work exposed to weather in moderate weathering table R402.2 of the IRC is 3000Ibs with a min. of 5% air entrained, but not more that 7% Foundations in seismic categories D2 that exceed 50' -0" in either direction are required to have a continuous footing per section R403.1.2 including support of an interior braced wall line. Locating and marking the property boundary is required for a footing inspection. Tables in chapter 4 of the IRC. Will be applied for soils that are heavy in moisture (hydraulic) in nature or foundation wall over 5' -0" in height. Verify site conditions and unbalanced back fill at time of application. Foundations Drains are required as per section R 405.1 (see exception for soil classification) 2- Foundation walls Vertical steel in foundation walls as of July 1 2004 Vertical bar reqd to be 1 #4 bar with a hook and tied to the footing steel in place at 4 -0" 0 C. at footing inspection. One #4 bar horizontal within the top 12 "of the wall. 1 anchor bolt with a 3" x 3" x steel washer is required at 6' -0 "OC for a 1 story and 4' -0 "OC for a 2 story, along and within 12" of each end the pressure treated sill plate. Crawl space ventilation is required at (1') s.f. of vent per (150') s.f. of area per sec. R408.2. 2003 IRC. 6 mill black poly is required in crawl space as a below grade moisture barrier per section R406.3.2 2003 IRC. Finish grade shall be a 6" slope away from foundation within 10' -0" of the foundation wall measured horizontally as per sec. R406.3 2003 IRC. 3- Framing. All connections from a pier to a post and beam are required to have positive connection per code. In addition any connectors/ fasteners in contact with treaded wood are req'd to be hot dipped zinc /galv (See manufacture details.) All floor joist are required to be blocked with 2x material at the beam support. 7/16" OSB sheathing is required to be nailed to pressure treated sill plate and bottom plate or sole plate of wall. (or other approved hold down's). Attic ventilation is required at (1') s.f. of vent per (150') s.f. Of area with an allowable 50% of ventilation can be located in the upper portion of the ridge if applicable per 2003 IRC. Truss design and calculations are required upon submitting an application, lateral connections are required to end walls where truss rafters are perpendicular to end walls. A truss /rafter tie shall be required to prevent uplift per code. 4- Braced Wall Lines. In Seismic category D2 exterior and interior braced wall lines cannot exceed 25' -0" Wall bracing must start within 8' -O" of a transverse wall or a designed collector Standard wall bracing methods are required as per section R602.10.3 of the 2003 IRC. If the wall bracing methods cannot be met, then refer to "Alternate Braced wall panel" Section 602.10.6 of the 2003 IRC. If any of the aforementioned methods cannot be met, engineering design will be required for the "SHEAR WALL" design. Section R602.10.9 for interior braced wall line support for 1 and 2 story buildings require a continuous footing supporting a braced walI line, interior and exterior not to exceed 50' -0 "intervals. 0 cP 5- Egress. Rooms used for sleeping are required to have one window with 5.7'S.F of openable space and a sill height of not more the 44 above finished floor for emergency escape per 2003 IRC. 6- Energy and Air Quality Insulation, Heating, Air conditioning, Lighting, Windows and Appliances to meet 2003 WSEC VIAQ New single family structures are required to have a whole house exhaust fan with a 24hr timer per table 3 -1, 3 -2, 3 -3 of the 2003 VIAQ Mechanical fresh air intake (FAI) is required to have a 24 hr timer or windows in all bedrooms and living, dining area may have intake ports for fresh air per 2003 VIAQ if zone heat is applicable. 7- Dry Wall. (Gypsum wall board) 5/8" type "X" sheets rock is required in the accessible usable space under stairs and on ceiling of a garage only if a habitable area is located above the garage. The rating of the sheet rock nail pattern must be visible to the inspector Nail pattern for all sheet rock 1/2" and 5/8" to be 8" on center and 12" OC if drywall screws are used. Per table 702.3.5 of the 2003 IRC. Interior braced wall panels are to be inspected prior to tape, bed and texture. Moisture resistant wallboard is required around w /c. A cementuous backer board is required for tiled areas at tub and showers. Vapor barrier is required. A perm rated paint may be substituted for a poly vapor barrier on the warm in winter side. 8- Plumbing. Water heaters are required to have two approved seismic straps in the upper and lower 1 /3" of the tank per UPC. T &P valve to bet" I.D and directed to the exterior and turned 90 degree downward not less that 6 -12" above finish grade. Water heater s are required to have a 26 ga. Pan of other approved drain pan with a' /4" drain line from pan to exterior Impact protection for w/h and mechanical equip are required to resist 6,0001bs impact if located in the garage area. All DWV are req'd. to be tested under water pressure per 2003 UPC or air test (consult manufacture recommendations for air test) Min. test pressure in Residential LPG is 30 lbs. 9- Smoke detectors. shall be located in each sleeping room and in the hall leading to each sleeping area. One smoke detector is required at the top of each stairs, and at least one smoke detector is required on every floor level. Smoke detectors must be within 6" to 12 "from the ceiling if mounted on wall. Smoke detector shall not be less than 36" from any air return. Power supply for smoke detectors shall be from the main house supply that is not switched and required to be battery back up. Smoke detectors to be inter- connected so that if one smoke detector alarm will start a chain reaction to all other smoke detectors as per code. 10- Maximum building height allowable is 30' -0" based on an average grade plain per 2003 IRC. Property pins shall be located and marked for a footing inspection to verify zoning set back requirements. 11 Safety glazed tempered glass required within 24" of any doorway edge, along with other requirements as per 2003 IRC. 12- All water, sewer, gas, electrical, drywells, downspouts and footing drains are required to be inspected before cover This letter is not intended to cover all items required by the City of Port Angeles, but is to serve as a guide to help you understand frequently asked questions, "ALL WORK IS SUBJECT TO FIELD APPROVAL" 4/05. CITY OF PORT ANGELES DEPARTMENT OF PUBLIC WORKS . . . . INSPECTION REPORT. . . . . . . . . j REQUEST: Date ~ - 2.."2 - ()"7 Time Received by 7< I? (phone, person) Location of Work to be inspected / 20 L( 0 Name of person requesting inspection ~, Address of person requesting inspection Type of Inspection (circle appropriate one): Sewer Foundation Framing Chimney Plumbing Final Sf Phone No. Permit No. 6b-9.s~ Sewer Excav. Other ])"..: oI-<?. l.J..knJ / INSPECTION NOTES: Inspected: Date fr,- '2. 2 - Of Remarks: Time By kV ok RESTORATION REQUiRED.......... YES N~ SURFACE RESTORATION: SURFACE TYPE: D Unimproved D Gravel D Asphalt D PCC D Other D Repaired by City D Repaired by Permittee D No Damage Found Work Order # D COMPLETE D INCOMPLETE (Continue on reverse side if necessaryl STREET SUPERINTENDENT (DATf~ Date CITY OF PORT ANGELES DEPARTMENT OF PUBLIC WORKS . . . . . . . . .. INSPECTION REPORT. . . . . .., /2-1/01 . ~ Time / . . . . . REQUEST: 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 jZ/J-~l ~ " 'i? '/ t'!1 PYles, s/ Phone No. Permit No. Final Sewer Excav. Other tYo '-lJ sF INSPECTION NOTES: L-ZZ-CJt Inspected: Date Remarks: ,..lev-' 5"'-v0Q.,r oL + t=' v-ope-vi y II 'I' ~ " Time By RV . J. 'P e',(, Sf~....-3 ~. V~ c:..o '^' 'A ~ c.+~.o'V"'\. l<.> lQ.le~ I RESTORATION REQUIRED.. .. .. .. ... YES NO X PIt... Bad:. ,-"",,\..,~ v..lv~ C/o 12,(j'=! t>i\! tA'jQ.. I ~ 30 ".,,,(-> fJL") '1' ....4..~.......--....- 'c.(J~-t.p PIt..., Joj,' '.'; 1IwGt."?V<'- \0 1411';. I J ~ ..,../If O---S I'\S' "",...}T'o OO:;;( -<::\ /lA/Ii SURFACE RESTORATION: SURFACE TYPE: 0 Unimproved 0 Gravel 0 Asphalt 0 PCC IlL-fl'ST o Other o Repaired by City o Repaired by Permittee o No Damage Found Work Order # o COMPLETE o INCOMPLETE I (Continue on reverse side if necessary) STREET SUPERINTENDENT (DATE) "';-V- :;'O''j,'tD- "-'t'L- ~e5 ..--- APPLICATION FOR WA City Water Division 11200~2 I hereby apply for water to be furnished in accordance with following premises: Name of Applicant: Q Ie flt1 re yra.., ~ddress: IZo4 ~ 1/ (!)//S-rY~T Renewal 0 New Servi~lk. Lot Size of Service I 'I 54 Ijj r t9p "h Service Left On 0 Service Left ~ Sign Installed by SIPS-Of 00 'it /q6~ + $12CD~ Remark~: 'R:fJ1AI-pLOb-Q:;q N I 'Z- -tt.. -$1-. "E vJ, w ~ , ~ It) .1,:. \ r <;) \' ,~ ,II) "" S CITY OF PORT ANGELES DEPARTMENT OF PUBLIC WORKS . . .. . INSPECTION REPORT. . . . . . REQUEST: Date //-S-07 Time Received by (phone, person) /,'-'0 li c::::- /101/. ~ ~ - Location of Work to be inspected Ot ~ J _ ~ Name of person requesting inspection \J~ ~ - ~ ~ Address of person requesting inspection Phone No. ~tf-/077 Type of Inspection (circle appropriate onel: ~ Permit No. ~-~9 / Sewer Foundation Framing Chimney Plumbing Final ewer Excav. Other f/.if./ Inspected: Date Remarks: .5ew€..r ];>r,'ve L~ INSPECTION NOTES: //-b-07 / 2.~zz-07 \0-22___67 Time By Rv , l' 6lC.S r':J Fv'"", 0.. \ <!.) K R. V RESTORATION REQUIRED . . . . ., YES NO 7Z SURFACE RESTORATION: SURFACE TYPE: D Unimproved DGravel DAsphalt Dpcc D Other D Repaired by City [] Repaired by Permittee [] No Damage Found Work Order # o COMPLETE o INCOMPLETE (Continue on reverse side if necessary) STREET SUPERINTENDENT lDATEI j G...;.I.. , ~;;. . ."'J' R . '," .>-' .',; "", "0 " ~.. '1-::'~r """,~.+--;;j';''''' ,,'~''i,\~'h;i'J,'.n'- . '.,j.~: _,_,:,,;.,"" > .".:;_,,\>1,"'''''' ~'", ,-~. . 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'r . 11r.. ., ~~'>;",-,.r __ ..... '.OIW'.. -oQ.;;l"-_. _'. '- ....... g.' .......~. -oR .P.... ".I' . '-':(!<Y ~j! . ffi~.::-i_ ;. 'rf~ r . f. I'. . - _<VI " .r l~ 1/1 iQ ~ <D""" \ -..9 .0 ::iJt- ~ ~ CITY OF PORT ANGELES DEPARTMENT OF PUBLIC WORKS . . . . . . INSPECTION REPORT. . . . . . . . . . REQUEST: Date Time Received by (phone. person) Location of Work to be inspected ~ \ ~ Y'-,j Name of person requesting inspection L1, , yt Address of person requesting inspection Type of Inspection (circle appropriate one): Sewer Foundation Framing Chimney Plumbing L 0+ g ~} -e.r-'S, Phone No. Permit No. Fin~~wer Exca9ther INSPECTION NOTES:__ - ________ /J Inspected: D~te -I\!9;; !.R-:-:oS-J Time ,:): 20fWl By ~~ Remarks:Th,~ IV\SPFC-+'O,,", t..t.h4s rOY'"lpl..t-cd by Wf.A~1 oJ C( ON "'-,,'~c. u/s,...j.. CAMd W ;~l.+-t e I'A ~"'m<~.j...i(),,", prOch J("cl by +-L e.. ~o",-f"4-<-te- TJ.-e SU<.JfK:... S'i',t2..././.c, Lf)I4'<?, i"'s-kll~J CUtJ br'l-~l-.e.'({..d b-eC,n-\-le-t'.'ytt.-1 ;"-sfuL'c,'l Iot~t....c.-c_.'L-1 Tr1:s-lA(/~ bl-IO"PJc..wfe <Q. [;;i' sou.A/l" otfY\-tCL-1- l;).n,f-(j5I-A,Jc/ APPO'<lC:Z' o e-ep, to I' Pi/C - AS" 1 (<;; 'P",sl P,t:/(JJr-/-y (. l-td /n 5 +411_ cI Lj:;U-f ?os/ RESTORATION REQUiRED..... ~ YES NO i.. '-1$70 ~"cl ~ /IYDUP 1 (P/' Pile, 3<;' 1 o ~. r- /J ~, s~ I~//I;;J' -~ J..o+ 1+ I. :J ~lo/'fVc.. l Vl , o , 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)