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112 S Lincoln St Ste A - Building
�M1}s � 4� This certificate is issuedpuryliant to the reduirements''of Section 111 of the 2 .09 International Building Code certifying that atthe'time ofyissuance this structure was in compliance with the various ordinances of the City regulatingybziilding eoiW iction or use for the following ` A Business name: Yong Jin Asan Bakery f `' Business address 112 S LincoInStreet a b s Property owner:=Matflew & Kari Property owner's address •-,,' 512 W 101' ';" t Port -Angeles` .1NA 9'8`362:) - ., , Automatic fire sprinkder system: Not"Required Use & occupancy classification: Business- : , Building permit number. :. . -12-715 p Occupant load: r Per 2'009 IBC Table 1004 1 1 a Type of construction: V B fI 8-23-12 Date Post on the premises in a conspicuous place.;. is certificaf`s"shall not be removed except by the Building Official. i CERTIFICATE OF OCCUPANCY APPLICATION Permit # FEES-'° CITY OF PORT ANGELES w�? Certificate / Inspection���� Attn: Permit Technician ✓ — �� t 321 E. Fifth St., Port Angeles, WA 98362 $100 Parking Business Improvement Area (PBIA) (360) 417-4815 fax (360) 417-4711 fee charged for Downtown locations Wa1V(&1r + fe e 0(o,;5000rJl3/o0 PLEASE PRINT IN INK Check one: New business in P.A.? �C-hange of ownership only? El Moving location from within P.A.? ❑ Zoning Y0 (Jt�� BUSINESS NAME 0 k �eJ l [A ��—� 1 G{ In �GC, � ►� �'_ „ Business address 2 S L} ��(oj S Mailing addresls ` 5�� Phone number3&0 4S2— 3-40 7 Opening date Days & hours of operation mar Business owner's name (1 (,i z( -.e in L cl 0 G/ Contact phone 510 4�Z- 34-67 Business owner's address'1'70'7 G(' rUa% c�� F'c>K-� A -oe* • L_j rr' f _5�, 2— Brief Brief description of business /",'j4'1 InOSG 3a4,rV Tao, —ou4— (bt m c t, S' BGG S Property owner's name M a *� 04� Ce V Contact phone Zi o 4-17 26-76, Property owner's address/contact it 7-- 6'-L¢'G),-Dvim/+ S36 Z 1.1: Vel I O'In r')1 BUILDING DEPARTMENT phone 417-4815 I Bldg approval by 0° �2' 1�- on 131 t, Is the business a restaurant or bar that will seat 50 or more people? Yes ❑ No Construction changes planned (moving walls, adding/enlarging windows or doors, roofing, siding, foundation work, adding/altering stairways ram s, b throoms, electrical, heating/cooling/ventilation systems, etc). Work tanned: 77f i,k)9a Dirt vjU l v+Sf QQ i�'�� �Q tti� U �DI AtiC o, ' 5z� r -�;ysokdA _ FIRE DEPARTMENT phone 417-4653 Fire approval byl' 2I ' 12 -on V-00 Changes to a fire sprinkler system or fire alarm system? Yes ❑ No14 Work planned: Si.�-pyre �5,`�� S � �'�M•. PBIA (Parking Business Improvement Area - gowntown) phone 417-4623 Square footage of business? PBIA notified (P'(O IOon LCI, W�s Is business moving within the PBIA? Yes A No ❑ CITY CLERK phone 417-4634 City Clerk approval by Second-hand dealer/pawnbroker business? Yes ❑ No 'F" Will there be dancing at this business? Yes ❑ No V A City of Port Angeles Business License is required for: Taxi, Peddlers, Second -Hand Dealer, Pawnbroker, Dance, Hotel -Motel, Fireworks, Ambulance, and Tattoo Businesses. Page 1 of 2 on JUN -- 6 2012 �lTv T ANGELES FUJI -011-IG DIVISION COMMUNITY & ECONOMIC DEVELOPMENT phone 417-4750 Number of off-street parking spaces available for employees and customers? (A parking plan may be required.) Signs? (wall -mounted, freestanding, projecting, awning, A -frame, etc?) Signs planned: CED approval by �_ on (0_ PLEASE NOTE: NO flashing, intermittent, or chasing signs are permitted in the City of Port Angeles. PUBLIC WORKS DEPARTMENT- ENGINEERING phone 417-4812 Is site work planned (new or re -located sewer or water service, excavation, grading or filling, work in City right-of-way, P c"V!y�, new driveway openings, site drainage, parking lots, downspouts, irrigation system backflow devices, etc.). Yes ❑ No Work planned: mut -;4,0 , C qtr LA j6�__ PUBLIC WORKS WASTEWATER phone 417-4845 PWE approval by on PWW approval by on Will waste, other than domestic household waste, be discharged into the sewer system? Yes ❑ No K If yes, what will be discharged: Call for Certificate of Occupancv inspections BEFORE opening business. Building Department Inspection 417-4815 Fire Department Inspection 417-4653 Please sign up for utility services at the cashiers' counter. I hereby apply for a Certificate of Occupancy. I acknowledge that I have read this application and state that the information 1 have supplied is correct to the best of my knowledge. Incorrect information may result in revocation of permit. Date io Print Name 1fJVD 'i V1 iJl C-^" Signature 11LA., Cl T TormslBuilding DivisionlCertificale of Occupancy Application (2010).doc -�% Page 2 of 2 _' •'"1��='G�'�__ l���i- ^_.Q._,•y�.. + --'y"`f�---, ,_`s -'J'-: r"�J'--y l__�_.e �,.� � 11 % / i•-� . COMMUNITY & ECONOMIC DEVELOPMENT phone 417-4750 CED approval byc ' W+. _ — ` to- I l �� Number of off-street parking spaces available for employees and customers? (A parking plan may be required.) Signs? (wall -mounted, freestanding, projecting, awning, A -frame, etc?) Signs planned: PLEASE NOTE: NO flashing, intermittent, or chasing signs are permitted in the City of Port Angeles. PUBLIC WORKS DEPARTMENT- ENGINEERING phone 417-4812 Is site work planned (new or re -located sewer or water service, excavation, grading or filling, work in City right-of-way, oa,y` new driveway openings, site drainage, parking lots, downspouts, irrigation system backflow devices, etc.). Yes ❑ No ❑ Work planned: a�A s-(-,-_� PUBLIC WORKS WASTEWATER phone 417-4845 PWE approval by on PWW approval by on 11 Will waste, other than domestic household waste, be discharged into the sewer system? Yes ❑ No If yes, what will be discharged: Rc� afi2 A -((p (� 1reGt.S� -t'v'a 1'-P QUI rP . Pet �ixo c1Yl_,ti . Call for Certificate of Occupancv inspections BEFORE opening business. Building Department Inspection 417-4815 Fire Department Inspection 417-4653 Please sign up for utility services at the cashiers' counter. I hereby apply for a Certificate of Occupancy. ' I acknowledge that I have read this application and state that the information I have supplied is correct to the best of my knowledge. Incorrect information may result in revocation of permit. —41 Date b— 4 iol Print Name A Ul �'� IJ1 ��^" Signature '_qC4- vL- Ak� ! . T.Torms\Budding Diwsion\Certifcate of Occupancy Application (2010).doc � Page 2 of 2 1 , Heather Catuzo From: Janessa Hurd Sent: Wednesday, June 06, 2012 1:47 PM To: Heather Catuzo Subject: RE: Certificate of Occpuancy Yong Jin Asian Bakery No comment From: Heather Catuzo Sent: Wednesday, June 06, 2012 11:54 AM To: Janessa Hurd; Ken Dubuc; Roger Vess; Sue Roberds Cc: Edith Parker; Rick Hostetler Subject: Certificate of Occpuancy Yong Jin Asian Bakery Please send comments to me no later than June 15, 2012. File can be viewed at: G:\EXCHANGE\Building Routings File Name: CO Yong An Asian Bakery Thank you, Heather Catuzo Building Permit Technician City of Port Angeles --Building Division 321 East 5th Street Port Angeles, WA 98362 (360) 417-4817 hcatuzo(@citvofpa.us 1 J _+ �;wt'; r� �`'c�-�, � «moi ^ :,`.'%+•[ t. ���1�=t:::.�+` p� ,,7�; i ; ..,t p `' J s=, iii-:-'�-'i?`:w>;�^�•e - .- ` «Y rft ,i/if � 'ijil V�L3�'•+;C:,�rI �k� , x, '_ip�' �• - i Eb' "a' �V /r F.t ,s�y:.y��"ts .s.{�. #y.{yp •R g'R"�'- •.. �;z-k ..• ""�w�;,_ tt. - `� - �,_ 0 � *`mow i-�" J. �•. � - N n":k r� ., fry �; i . r.. .. CO rf - All co 4 OF PORTA PORT ANGELES INDUSTRIAL WASTEWATER PRETREATMENT QUESTIONNAIRE and DISCLOSURE FORM Z* AKS ANS ✓,[.� ✓l 4j% � Z� Complete all applicable sections. Information must be typewritten or clearly printed. Attach requested information as needled. Signing official must have the authorization to provide such information on behalf of the company, corporation, or partnership. Company Name: "0601 �r lZL'- GqMailing Address: V - 47f!01 SF 1/0 a, AU �r�,en, I A/ pr X71%3 ` Address of facility in Port Ancleles (if different than above): -530'q'f^ 54:- �P Ll "_cc iµ 5F -F Contact Person: .Ski rLl �` �" Phone: Z 7--,40 7 4-15�9 36"o goecp3i: 1. Type of Industry. F -7,-t ar C, Standard Industrial Classification number (4 digit SIC code) 2. Type of Product(s) or Service(s) produced; rate of production; process used: roduct Rate of production Process (� I tM 7 GK ' (D3` i" r d4c,,-1 4- �- C� li\ ( I e.��/�� /uta w: • rj i M r- G°� t ger { �eA 3. Product Volume. 10 d o z -e ( 4-ifPlf4. Number of Employees: 5. Operation Pattern: (hr/day) (days/yr) 3� (mo/yr) 1 % 6. Water Usage (gpd): Average �St" Maximum 7. WASTEWATER DISCHARGE TO SEWERS: [List the principal materials (cleaning agents, solvents, plating solutJs, catalysts, process chemical, etc) by their generic name and principal chemicals that are regularly used in your facility and that will or might be discharged to the City sewer system] AVERAGE DISCHARGE MAXIMUM DISCHARGE TYPE OF MATERIAL OR CHEMICAL GAL. TIME & CONC. GAL. DURATION CONC. PER DAY DURATION (MG/L) PER DAY (MG/L) a) Process 4 fptt� b) Cooling c) Sanitary d) Others listed below: --`,`�_,.:''a�-,.a,t-w exa pl Deg er aser (Try filo�roethylene) 3 3PM 30emin/iiay� 0_ 3 1d AM 10 miNcla�v O W Total Discharge 9. Are there seasonal variation to the above discharges? K 0 PW -804_02 page 1 :G:a ;;: 4 PORT ANGELES INDUSTRIAL WASTEWATER PRETREATMENT QUESTIONNAIRE and DISCLOSURE FORM (continued) 10. Does your company sample and analyze your wastewater? ❑ Yes ❑ No If yes, what is the nature of that sampling program? 11. Discharge to sewerage system: Attach as "Exhibit 1" a plan of your property showing accurately the site plan, floor plan, mechanical and plumbing plans and details showing all sewers, connections to the City systems, inspection manholes, sampling manholes, and appurtenances by size, location and elevation. a) How many wastewater discharge points does your company have that are connected to the City's sewer collection system? b) Where are your discharge points located? 12. Does your company have any plans for expansion? ❑ Yes `F] No If yes, when and how would expansion alter your industrial wastes? 13. Do you provide any pretreatment of wastewater streams that occurs prior to discharge to a sanitary sewer? ❑ Yes 1Y No 14. Do you have a spill prevention, containment and control plan (SPCC) for your company? Yes ❑ No 15. Does your company have or plan to provide a parking lot, with a drain system to collect run off? ❑ Yes O' No 16. Do you dispose of any chemicals, solvents or hazardous materials to other than the sewer? ❑ Yes )dNo 17. If yes, provide a description of each material, giving the composition, solids content, annual quantity, means of disposal, and ultimate disposal location: 18. Does your company have the necessary Material Safety Data Sheets (MSDS) on file? VYes ❑ No 19. List any prohibited pollutants being discharged as regulated by the City's Industrial Pretreatment Ordinance: Pollutant Daily Max. Conc. (mg/1) . Daily Avg. Conc. (mg/1) 20. List any environmental control permits that are held by or for your facility. 21. If additional pretreatment and/or operation and maintenance activities are required in order to comply with the City's Industrial Pretreatment Ordinance, then the discharger shall provide a compliance schedule attached to this form which describes how the facility will conform to the requirements. The information contained in this questionnaire and disclosure statement is familiar to me and to the best of my knowledge and belief, such information is ue, complete and accurate. DATE: Signature: < (/ /j( �, Title: ©W� NOTE: Attach additional pages, if ne ded �� } C< ✓i RETURN TO: City of Port Angeles Wastewater Treatment Plant Attn: Superintendent 321 E. 5` Street P. O. Box 1150 Port Angeles, WA 98362 PW -804_02 page 2 [Revised 7/05] 1p1=�iY;y. CITY OF PORT ANGELES i��1 DEPARTMENT OF COMMUNITY & ECONOMIC DEVELOPMENT - BUILDING DIVISION —� 321 EAST 5TH STREET, PORT ANGELES, WA 98362 Application Number . . . . . 12-00000838 Date 7/11/12 Application pin number . . . 275360 Property Address . . . 112 S LINCOLN ST STE A ASSESSOR PARCEL NUMBER: 06 -30 -00 -5 -1 -3100 -0000 - Tenant nbr, name . . . . . . YONG JIN ASIAN BAKERY Application type description COMM REMODEL Subdivision Name . . . . . . Property Use . . . . . . . . Property Zoning . . . . . . . CENTRAL BUSINESS DISTRICT Application valuation . . . . 15225 ---------------------------------------------------------------------------- Application desc TENANT IMPROVEMENT TO BAKERY ---------------------------------------------------------------------------- Owner Contractor MATTHEW AND KARI BAILEY SOLOMON'S KEY CONSTRUCTION INC 512 W 10TH ST 214 S. LAUREL ST. PORT ANGELES WA 98362 PORT ANGELES WA 98362 (360) 565-1280 (360) 452-4480 --------------------- Structure Information 000 000 ------ Construction Type . . . . . UNKNOWN Occupancy Type . . . . . . BUSINESS:OFF/PRO/MED/REST ---------------------------------------------------------------------------- Permit . . . . . . BUILDING.PERMIT - COMMERCIAL Additional desc TENANT IMPROVEMENT Permit Fee . . . . 291.75 Plan Check Fee 189.64 Issue Date . . . . 7/11/12 Valuation . . . . 15225 Expiration Date . . 1/07/13 Qty Unit Charge Per Extension BASE FEE 95.75 14.00 14.0000 THOU BL -2001-25K (14 PER K) ---------------------------------------------------------------------------- 196.00 Permit . . . . . . MECHANICAL PERMIT Additional desc . . Permit Fee . . . . 131.95 Plan Check Fee .00 Issue Date . . . . 7/11/12 Valuation . . . . 0 Expiration Date 1/07/13 Qty Unit Charge Per Extension BASE FEE 50.00 1.00 10.6500 EA ME-HOOD/DUCT-MECH. EXHAUST 10.65 1.00 10.6500 EA ME-STOVE/FIREPLACE/MISC. APP. 10.65 1.00 10.6500 EA ME -FUEL GAS PIPING,1-5 OUTLETS 10.65 1.00 50.0000 HR ME -REINSPECTION FEE ---------------------------------------------------------------------------- 50.00 Permit . . . . . . PLUMBING PERMIT Additional desc . . Permit Fee . . . . 92.00 Plan Check Fee .00 Issue Date . . . . 7/11/12 Valuation . . . . 0 Expiration Date . . 1/07/13 Qty Unit Charge Per Extension REPORT SALES TAX on your state excise tax form to the City of Port Angeles (Location Code 0502) �1ynt 7,214 (-1- Separate Z Separate Permits are required for electrical work, SEPA, Shoreline, ESA, utilities, private and public improvements. This permit becomes null and void if work or construction authorized is not commenced within 180 days, if construction or work is suspended or abandoned for a period of 180 days after the work has commenced, or if required inspections have not been requested within 180 days from the last inspection. I hereby certify that I have read and examined this application and know the same to be true and correct. All provisions of laws and ordinances governing this type of work will be complied with whether specified herein or not. The granting of a permit does not presume to give authority to violate or cancel the provisions of any state or local law regulating construction or the performance of construction. Date Print Name Signature of Contractor or Authorized Agent Signature of Owner (if owner is builder) T:Forms/Building Division/Building Permit f 4 BUILDING PERMIT INSPECTION RECORD — PLEASE PROVIDE A MINIMUM 24-HOUR NOTICE FOR INSPECTIONS — Building Inspections 417-4815 Electrical Inspections 417-4735 Public Works Utilities 417-4831 Backflow Prevention Inspections 417-4886 IT IS UNLAWFUL TO COVER, INSULATE OR CONCEAL ANY WORK BEFORE INSPECTED AND ACCEPTED. POST PERMIT INCONSPICUOUS LOCATION. KEEP PERMIT AND APPROVED PLANS AT JOB SITE. Inspection Type I Date I Accepted By Comments FOUNDATION: Footings Stemwall Foundation Drainage / Downspouts Piers Post Holes (Pole Bldgs.) PLUMBING: Under Floor / Slab Rough -In Water Line (Meter to Bldg) Gas Line Back Flow / Water I I FINAL Date Accepted by AIR SEAL: Walls Ceiling I I 1 FRAMING: Joists / Girders / Under Floor I Shear Wall / Hold Downs Walls / Roof / Ceiling Drywall (Interior Braced Panel Only) T -Bar INSULATION: Slab Wall / Floor / Ceiling MECHANICAL: Heat Pump / Furnace / FAU / Ducts Rough -In Gas Line Wood Stove / Pellet / Chimney Commercial Hood / Ducts FINAL Date Accepted by MANUFACTURED HOMES: Footing / Slab I Blocking & Hold Downs I I Skirting PLANNING DEPT. Separate Permit #s SEPA: Parking I Lighting I I ESA: Landscaping SHORELINE: FINAL INSPECTIONS REQUIRED PRIOR TO OCCUPANCY/ USE Inspection Type I Date . I Accepted By Electrical 417-4735 I I Construction - R.W. PW / Engineering 417-4831 Fire 417-4653 Planning 417-4750 Building 417-4815 T•Fnrmc/Rnilriinn nivisinn/Riiildinn Permit CITY OF PORT ANGELES DEPARTMENT OF COMMUNITY & ECONOMIC DEVELOPMENT - BUILDING DIVISION 321 EAST 5TH STREET, PORT ANGELES, WA 98362 a �^ Page 2 c ! Application Number . . . . . 12-00000838 Date 7/11/12 Application pin number . . . 275360 Qty Unit Charge Per Extension j BASE FEE 50.00 3.00 7.0000 EA PL -PLUMBING TRAP 21.00 1.00 7.0000 EA PL -WATER LINE 7.00 2.00 7.0000 EA PL -DRAIN VENT PIPING 14.00 ---------------------------------------------------------------------------- Special Notes and Comments July 9, 2012 9:05:50 AM tamiot. Electrical permit will be required for any and all electrical work and required to meet all city and state requirements. July 9, 2012 2:41:34 PM rbecker. Does the mop sink have a atmospheric vacuum breaker on the sink faucet? If it does not, you will need to get one �- installed. Are you installing a carbinated soda dispenser? If you are, you will need to install a reduced pressure backflow assembly. If you have any questions call Ron Becker at 457-8917, Fax:360-417-4886, or E-mail:rbecker@cityofpa.us A "K" CLASS FIRE EXTINGUISHER MUST BE PROVIDED AND MOUNTED WITHIN 20' OF THE COOKING AREA. A FULL ACCEPTANCE TEST WILL BE REQUIRED FOR THIS HOOD AND DUCT FIRE SUPPRESSION SYSTEM. THE TEST WILL INCLUDE A BALLOON TEST, AS WELL AS A TEST OF THE FUSIBLE LINK, MANUAL PULL STATION AND UTILITIES SHUT-OFF. This project will require a seperate permit and hood and duct suppression system plans for review. A full suppression system test will be required. July 10, 2012 3:46:26 PM sroberds. The proposal will result in conversion of retail space to a take out bakery. The site is located in the CBD where parking is provided through the PBIA. No land use issues anticipated. A separate Right of Way Use permit is required prior to placement of propane tank in City Right of Way. ---------------------------------------------------------------------------- Fee summary Charged Paid Credited Due ----------------------------------------------- ---------- Permit Fee Total 515.70 515.70 .00 .00 Plan Check Total 189.64 189.64 .00 .00 Grand Total 705.34 705.34 .00 .00 REPORT SALES TAX on your state excise tax form to the City of Port Angeles (Location Code 0502) Separate Permits are required for electrical work, SEPA, Shoreline, ESA, utilities, private and public improvements. This permit becomes null and void if work or construction authorized is not commenced within 180 days, if construction or work is suspended or abandoned for a period of 180 days after the work has commenced, or if required inspections have not been requested within 180 days from the last inspection. I hereby certify that I have read and examined this application and know the same to be true and correct. All provisions of laws and ordinances governing this type of work will be complied with whether specified herein or not. The granting of a permit does not presume to give authority to violate or cancel the provisions of any state or local law regulating construction or the performance of / f construction. r' Date Print Name Signature of Contractor or Authorized Agent Signature of Owner (if owner is builder) T:Forms/Building Division/Building Permit A BUILDING PERMIT INSPECTION RECORD — PLEASE PROVIDE A MINIMUM 24-HOUR NOTICE FOR INSPECTIONS — Building Inspections 417-4815 Electrical Inspections 417-4735 Public Works Utilities 417-4831 Backflow Prevention Inspections 417-4886 IT IS UNLAWFUL TO COVER, INSULATE OR CONCEAL ANY WORK BEFORE INSPECTED AND ACCEPTED. POST PERMIT INCONSPICUOUS LOCATION. KEEP PERMIT AND APPROVED PLANS AT JOB SITE. Inspection Type FOUNDATION: Footings Stemwall Foundation Drainage / Downspouts Piers Post Holes (Pole Bldgs.) PLUMBING: Under Floor / Slab Rough -In Water Line (Meter to Bldg) Gas Line Back Flow / Water AIR SEAL: Walls Ceiling FRAMING: Joists / Girders / Under Floor Shear Wall / Hold Downs Walls / Roof / Ceiling Drywall (Interior Braced Panel Only) T -Bar INSULATION: Slab Wall / Floor / Ceiling MECHANICAL: Heat Pump / Furnace / FAU / Ducts Rough -In Gas Line Wood Stove / Pellet / Chimney Commercial Hood / Ducts MANUFACTURED HOMES: Footing / Slab Blocking & Hold Downs Skirting Date I Accepted By Comments I � I I 5l�I- "Til I FINAL Date • )a' I--ZAccepted byA_,T I I PLANNING DEPT. Separate Permit #s Parking I Lighting Landscaping _ I FINAL Date a2' (I LAccepted by J I I I SEPA: ESA: SHORELINE: FINAL INSPECTIONS REQUIRED PRIOR TO OCCUPANCY/ USE Inspection Type Date I Accepted By Electrical 417-4735 Construction - R.W. PW / Engineering 417-4831 Fire 417-4653 Planning 417-4750 Building 417-4815 • Z2 • i a I LL T-Fnrmc/Riiilriinn nivieinn/Ri lrlina Permit PREPARED 8/22/12, 9:01:55 INSPECTION TICKET PAGE 7 CITY OF PORT ANGELES INSPECTOR: JAMES LIERLY DATE 8/22/12 -------------------- — ---------------------------------------------------------------- — ------ ADDRESS . : 112 S LINCOLN ST STE A SUBDIV: TENANT, NBR: YONG JIN ASIAN BAKERY CONTRACTOR SOLOMON'S KEY CONSTRUCTION INC PHONE (360) 452-4480 OWNER MATTHEW AND KARI BAILEY PHONE (360) 565-1280 PARCEL 06-30-00-5-1-3100-0000- APPL NUMBER: 12-00000838 COMM REMODEL ----------------------------------------------------------------------------- PERMIT: BPC 00 BUILDING PERMIT - COMMERCIAL REQUESTED INSP DESCRIPTION TYP/SQ COMPLETED RESULT RESULTS/COMMENTS ------------------------------------------------------------------------------------------------ BL3 01 8/01/12 JLL BLDG FRAMING 8/01/12 4APAugust 1, 20123:37:11 PM jlierly.BL99 01 8/22/12 BLDG FINAL -----------------------------------------------------------------------'PERMIT: ME 0 MECHAMIT REQUESTED INSP DESCRIPTION TYP/SQ COMPLETED RESULT RESULTS/COMMENTS ------------------------------------------------------------------------------------------------ ME1 01 7/27/12 JLL MECHANICAL ROUGH-IN 7/27/12 AP July 27, 2012 8:58:39 AM hcatuzo. KEITH. 206-683-1414. CALL TO MEET. July 27, 2012 3:58:11 PM jlierly. July 27, 2012 3:58:33 PM jlierly. ME6 01 8/01/12 JLL MECHANICAL GAS LINE 8/01/12 August 1, 2012 3:37:11 PM jlierly. ME99 01 8/22/12 MECHANICAL FINAL -- ----- - ---------------------------------------------------------------------- PERMIT: PL 00 PLUMB G ERMIT REQUESTED INSP DESCRIPTION TYP/SQ COMPLETED RESULT RESULTS/COMMENTS ------------------------------------------------------------------------------------------------ PL2 01 8/01/12 JLL PLUMBING ROUGH-IN 8/01/12 AP August 1, 2012 8:40:08 AM hcatuzo. JIM 460-7908 August 1, 2012 3:37:11 PM jlierly. PL99 01 8/22/12 PLUMBING FINAL --------------------- --------- COMMENTS AND NOTES -------------------------------------- PREPARED 8/01/12, 13:28:34 INSPECTION TICKET PAGE 1 CITY OF PORT ANGELES INSPECTOR: JAMES LIERLY DATE 8/01/12 ----------------------------- — --- — ---- — -------------------------- — -------------------------- ADDRESS . : 112 S LINCOLN ST STE A SUBDIV: TENANT, NBR: YONG JIN ASIAN BAKERY CONTRACTOR SOLOMON'S KEY CONSTRUCTION INC PHONE (360) 452-4480 OWNER MATTHEW AND KARI BAILEY PHONE (360) 565-1280 PARCEL 06-30-00-5-1-3100-0000- APPL NUMBER: 12-00000838 COMM REMODEL ------------------------------------------------------------------------------------------------ PERMIT: ME 00 MECHANICAL PERMIT REQUESTED INSP DESCRIPTION TYP/SQ COMPLETED RESULT RESULTS/COMMENTS -------------------------- - _ _-- — ME1 01 7/27/12 JLL MECHANICAL ROUGH -IN 7/27/12 AP July 27, 2012 8:58:39 AM hcatuzo. KEITH. 206-683-1414. CALL TO MEET. July 27, 2012 3:58:11 PM jlierly. July 27, 2012 3:58:33 PM jlierly. ME6 01 8/01/12 JLL MECHANICAL GAS LINE -------------------- - -- COMMENTS AND NOTES -------------------------- — PREPARED 8/01/12, 8-39:56 INSPECTION TICKET PAGE 2 CITY OF PORT ANGELES INSPECTOR: JAMES LIERLY DATE 8/01/12 ------ --------------------------------- -- — -------------------------- — --- -- ------ ADDRESS . : 112 S LINCOLN ST STE A SUBDIV: TENANT, NBR: YONG JIN ASIAN BAKERY CONTRACTOR SOLOMON'S KEY CONSTRUCTION INC PHONE (360) 452-4480 OWNER MATTHEW AND KARI BAILEY PHONE (360) 565-1280 PARCEL 06-30-00-5-1-3100-0000- APPL NUMBER: 12-00000838 COMM REMODEL ------------------------------------------------------------------------------------------------ PERMIT_ BPC 00 BUILDING PERMIT - COMMERCIAL REQUESTED INSP DESCRIPTION TYP/SQ COMPLETED RESULT RESULTS/COMMENTS ------------------------------------------------------------------------------------------ BL3 01 8/01/12 ---- BLDG FRAMING PfiRMIT: PL 00 PLUMB GRMIT REQUESTED IN DESCRIPTION TYP/SQ COMPLETED RESULT RESULTS/COMMENTS -- -------------- — -- ------------------ PL2 01 8/01/12 L PLUMBING ROUGH -IN August 1, 2012 8:40:08 AM hcatuzo. �I JIM 460-7908 ----------- COMMENTS AND NOTES �a-sL XW- e PREPARED 7/27/12, 9:15:37 INSPECTION TICKET PAGE 10 CITY OF PORT ANGELES INSPECTOR: JAMES LIERLY DATE 7/27/12 ------------------------------------------------------------------------------------------------ ADDRESS . : 112 S LINCOLN ST STE A SUBDIV: TENANT, NBR: YONG JIN ASIAN BAKERY CONTRACTOR SOLOMON'S KEY CONSTRUCTION INC PHONE (360) 452-4480 OWNER MATTHEW AND KARI BAILEY PHONE (360) 565-1280 PARCEL 06-30-00-5-1-3100-0000- APPL NUMBER: 12-00000838 COMM REMODEL ---------- ---- PERMIT: ME 00 MECHANICAL PERMIT REQUESTED INSP DESCRIPTION TYP/SQ COMPLETED RESULT RESULTS/COMMENTS ME1 01 7/27/12 MECHANICAL ROUGH -IN ~/ July 27, 2012 8:58:39 AM hcatuzo. KEITH. 206-683-1414. CALL TO MEET. COMMENTS AND NOTES +��� 60Cy JU -�30RT THE A NGELES co CITY OF City Use 7 W UJ ZtJ _JZ LUO Permit # 0 N z CO WASH I N G T O N, U.S.LU , c+� Q� i Date Received: 1 o z 321 East 5"' Street (� U_ o Port Angeles, WA 98362 Date Approved: IJ,B _ m P: 360-417-4817 F: 360-417-4711 cc hcatuzo@cityofpa.us 1 Building Permit Application Project Address: l2 4 S C c v/A-7 S �" Main Contact: J a M es A ryl o r 0 SO Phone # Property Nam Phone ff1 101L 1-_ Owner Mailing Address I Email ! l am FF • C ^ L-f(vW City I State�- PorzT AA)%,�� S 1 ,v A qg;ln Contractor Name ) Phong OR Mailing Address Email 9/ .S L City_ - State Zip' P�kT � �� S 9 LA) ,36 Contractor License #1 Q � f Ex*apion:/-Zo 50 rO f l f /Q N rz-- Project Value: Zoning: Tax Parcel # Lot # $ 15, 2-2-5 Ci8D 0(psc 00 513 /00 Type of Residential ❑ Commercial .Z Industrial ❑ Public ❑ Permit Demolition ❑ Fire ❑ Repair ❑ Reroof (tear off/lay over) ❑ For the following, fill out both pages of permit application: New Construction ❑ Remodel ❑ Addition ❑ Tenant Improvement Er Mechanical, ❑ Plumbing ❑ Other ❑ Existing Fire Sprinkler System? Maximum height of structure Proposed Bedrooms Proposed Bathrooms Yes 11 No r.3— (Ah exlS-hYA Project Description 6 (1 � L 1:, 3/c} �i ! t A 3 �1'f ` A/ F -L ! . A \J �t�CT-P-r— c,+c a ?LLJ111T2sL�� � M 16-0fA IA -(+L F(2r" SC4. I have read and completed the application and know it to be true and correct. I am authorized to apply for this permit and understand that it is my responsibility to determine what permits are required, and to obtain permits prior to working on projects. I understand the plan review fee is not refundable after review has occurred. I understand that I will forfeit 20% of the review fee if I cancel or withdraw the application before plan review has occurred. I understand that if the permit is not issued within 180 days of receipt, the application will be considered abandoned, and the fees forfeit. Date Print Name Signature v - Residential Structures '-Area Description (SQ FT) Existing Proposed Minimum $ For Office Use value Basement - First Floor Second Floor Covered Deck/Porch/Entry Deck / Garage / Carport Other (descri A�-T'otals Area Description (SQ FT) Structure (s) Addition Tenant Improvement Other (describe) Area Totals Footprint (SQ FT) of all Structures: SQ FT Site coverage (all impervious + structures) Commercial Structures Existing Proposed Minimum $ For Office Use value //000 Lot/Site Coverage Calculations Lot Size:% Lot Coverage N/A V, a N lA n4 -e- 1/ %Site Coverage Mechanical Fixtures Indicate how many of each type of fixture to be installed or relocated as part of this project. Air Handler Size: # Haz/Non-Haz Piping Appliance Vent # I Heater (Suspended, Floor, Recessed wall) Boiler/Compressor Size: # Heating/Cooling appliance repair/alteration Evaporative Cooler (attached, not # Pellet Stove/Wood-burning/Gas portable) Fireplace/Gas Stov Gas Cook StovaMisc. Fuel Gas Piping #o f Outlets: Ventilation Fan, single duct 15 r Furnace/Heat Pump/ Size: # Ventilation System Forced Air Unit 4 F �-o r -'a n G �-a r i K_ 6,&1" # of Outlets: # I Plumbing Fixtures Indicate how many of each type of fixture to be installed or relocated Plumbing Traps # Fuel gas piping # of Outlets: Water Heater # Medical gas piping # of Outlets: Water Line # ' Vent piping # Sewer Line # Industrial waste pretreatment # / interceptor Other (describe): /00 0O ---.Remove Existing Ceiling Light and Replace Tracking Lightings I i rt- I I Ceiling suspended wood grid :-Wc�wer add direction lights Delvvaen grds verify quantity an i local on }" r---� r�-f--1 ------Coffee service table one is 0 T' 6" Keil lhl I \ J one is @ 8'6* hsry �ht 15 J' - — -- ---jC'Self serve drink cooler jIII ounter Warmer) Display Pendant Lightings or Tracking Lightings ash Register loor Electrical Box under front counter for Counter Warmer and Register New Wal inging door Height l YY l t W O O Bake Oven 414 Hand Wash Three Compartment Sink C Sink w/ Grease Interceptor and Floor Drain ;offee Maker Table Add plumbing dd Electrical & Plumbing Class I Hood— I 13"t` r3•r• E -f Double Gas Wok Stove— I Add gas lines Add plumbing Add drainage line O &electrical to rooftop exhaust fan - J T Doors refri erator CITY OF POR' The Issuance of ti cations and other from thereafter r Plans, specificatic building operatior violation of all c1 Approval Date J311 �.o --Seal Kitchen Wood Floor I`�a�-•1'' "Mop Sink IL JI Add Plumbing Foe 1 n0s' - -Existing Bathroom 1 � Free stanidnl 1 Tv o Doors refrig : for yr r ing Tab e 11) ANGELES — Construction p Icing s permit baste upon these plans, spe :ifi- ata shalt not pre"Fit the building o ti -ial Wng the correction of errors in --W s and other data, or from preven`ng being carried on thereunder whvrl ;,. es and ordinances of this jurisdiction. By J.rk L M `Gough Mixers scale: 1/4"=1' 71 J --i N_ t�- xisting wall xisting wall pillar "KITCHEN" Wok Stove Iew wall stainless steel panel per city and manufacturer's requirement. isting wall pillar anging wooden structure attached to ceiling framing with steel wires or chains. E-1 Scale: 3/8 E=1 I -- I "DINER" Oven F:Z� �rap Kitchen walls with FRP Cut Out Window Compartment Sink Scale: 1/2" = 1' swinging door 2012-1278404 Page 1 of 2 Agreement Port Angeles City Of Clallam County Washington 04/30/2012 01:10-33 PM 1111 !4'i% YG,?,HL°dA L41h). W UUM I0it W04 11{I1 lR c C E t: Vt-,6,. C I T Y O r P 0 R T 4'pl,'6tL::5. PUBLIC 2012 APR 24 Pry 2: 57 RETURN ADDRESS City of Port Angeles Department of Public Works and Utilities PO Box 1150 Port Angeles, WA 98362 OF ?ORT,gNC AGREEMENT TO REMOVE ENCROACHMENT within L r � PUBLIC RIGHT-OF-WAY WHEREAS: We. /��� -,--;� �—''' ��WI- rte' and 4/ � Gtr , Husband and Wife, the undersigned owners in fee simple of the following described property: Lot 1, Block 31, Except the north 75 feet thereof, Norman R. Smith's Subdivision of the Townsite of Port Angeles Parcel Number: 0630005131000000 do hereby acknowledge that private improvements, including a propane tank and appurtenances, have been or will be constructed by us within the adjoining public street or roadway described as the First Street/Seconnd Street Allev adioinin2 the above described DrODerty. NOW, THEREFORE: We do hereby agree that said encroaching private improvements including, but not limited to, a propane tank and associated appurtenances, shall be expeditiously demolished, removed, modified, rebuilt or restored at the undersigned owner's expense within sixty (60) days of receipt of written notice from the City Engineer with work to be done in accordance with the requirements and conditions deemed necessary by the City Engineer or his designee at such time as the City finds that it is necessary to modify the use thereof. If the required work is not done in a timely fashion and/or if the work does not meet the requirements and conditions set forth, the City is authorized to have the work done and the cost thereof including reasonable overhead and attorneys fees shall become a civil debt of the property owners and shall be a lien against the property. We do also hereby agree that the City Engineer may, without notice, remove the private improvements as necessary to repair utilities or other public facilities and that the City has no obligation to reconstruct or replace such private improvements. The property owners agree to indemnify, hold harmless and defend the City, its employees, agents and assigns from and against all claims or lawsuits as alleging injury or damage to persons or property as a result of the construction and location of the private improvements as provided herein. It is agreed that this agreement shall run with the land and shall be binding on the undersigned owners, their heirs, devisees, successors and assigns and all owners now or hereafter of the land described above. PropeAy O, STATE OF ON COUNTY OF CLALLAM Date ' Date ss. On this date, before me the undersigned Notary Public in and for the State of Washington, personally appeared to me known to be the individuals who ex6uted the foregoing Agreement to Remove Encroachment within Public Right -of -Way and acknowledged to me that they signed the same for the uses and contents therein mentioned. DATED this -2 y day of PND 1 MAti N0 •:'li U) &/2014 05/21/2014 C� StH�NG.�`��` , 20V?- NOTARY 0 2 NOTARY PUBLIC for Washington, residing at My commission expires: N:\PWKS\ENGINEER\ROW Use Permits\2012 ROW Permits\Agreement to remove encroachment. wpd k_i i s ur runt yw4unt_,r3 FIRE DEPARTMENT PERMIT 321 East 5`h Street, Port Angeles, WA 98362 Application Number . . . . . 12-00000978 Date 8/21/12 Application pin number . . . 737902 Property Address . . . . . 112 S LINCOLN ST STE A ASSESSOR PARCEL NUMBER: 06 -30 -00 -5 -1 -3100 -0000 - Application type description HOOD/DUCT SUPPRESSION SYSTEM Subdivision Name . . . . . . Property Use . . . . . . . . Property Zoning . . . . . CENTRAL BUSINESS DISTRICT Application valuation . . . . 1800 ---------------------------------------------------------------------------- Application desc HOOD/DUCT SUPRESSION SYSTEM ---------------------------------------------------------------------------- Owner Contractor MATTHEW AND KARI BAILEY' FRANK FIRE PROTECTION 512 W 10TH ST 15405 SE 310TH ST PORT ANGELES WA 98362 KENT WA 98042 (360) 565-1280 (206) 229-5245 ---------------------------------------------------------------------------- Permit . . . . . . HOOD & DUCT SUPP SYSTEM Additional desc . . HOOD/DUCT SUPRESSION SYSTEM Permit Fee . . . . 40.00 Plan Check Fee .00 Issue Date . . . . 8/21/12 Valuation . . . . 0 Expiration Date 2/17/13 Qty Unit Charge Per Extension 1.00 25.0000 ECH HOOD/DUCT INSPECTION/TESTING 25.00 1.00 15.0000 ECH HOOD/DUCT PLAN REVIEW 15.00 ---------------------------------------------------------------------------- Special Notes and Comments A "K" CLASS FIRE EXTINGUISHER MUST BE PROVIDED AND MOUNTED WITHIN 20' OF THE COOKING AREA. A FULL ACCEPTANCE TEST WILL BE REQUIRED FOR THIS HOOD AND DUCT FIRE SUPPRESSION SYSTEM. THE TEST WILL INCLUDE A BALLOON TEST, AS WELL AS A TEST OF THE FUSIBLE LINK, MANUAL PULL STATION AND UTILITIES SHUT-OFF. -------------------------------------------------------- ------------------- Fee summary Charged Paid Credited Due ----------------- ---------- ---------- ---------- ---------- Permit Fee Total 40.00 40.00 .00 .00 Plan Check Total .00 .00 .00 .00 Grand Total 40.00 40.00 .00 .00 REPORT SALES TAX on your state excise tax form to the City of Port Angeles (Location Code 0502) �nalgh-��i� This permit becomes null and void if work authorized is not commenced within 180 days, if work is suspended or abandoned for a period of 180 days afer the work has commenced, or if required inspections have not been requested with 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 recognized standards, laws and ordinances governing this type of work will be compied with whether specified herein or not. The granting of this permit does not presume to give authority to violate or cancel the pro/visions of any state or local law regulating the work specified in the permit. Si,,re of Contractor or Authorized Agent Date Signature of Owner (if Owner is builder) Date FIRE PERMIT INSPECTION RECORD Call 360-417-4655 for fire" 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 I Date Passed I Comments FIRE SPRINKLER Underground piping hydrostatically tested Underground piping flushed Interior piping hydrostatically tested Interior piping inspection Dry system air tested at 40 psi (24 hours) ' Sprinkler final FIRE ALARM I a Rough -in inspection Alarm final ILP -GAS I Completed by Contractor: Underground piping inspection/pressure test Test #I Above ground piping inspection/pressure test Piping pressure test Tank (container) inspection � �I Time initiated Test #2 Appliance inspection �f Piping pressure test LP -gas final j Time initiated j UNDERGROUND STORAGE TANK (UST) ABANDONMENT Removal of flammable/combustible liquids Tank appropriately abandoned UST abandonment final PERMIT OTHER (specify) permit final PboqlAbocz �;uPnts&t at) 345-T64 `$ -21- t? I (may GENERAL COMMENTS: 2/15/00 psi psi FIRE -RELATED PERMIT A PPLI CA TION CITY OF PORT ANGELES Attn: Building Permit Technician 321 E. Fifth St., Port Angeles, WA 98362 (360) 417-4815 fax (360) 417-4711 For City Use Only: Date Receiv d I.50 - -2I' Permit # Applicant VL? Y? 01 ;_ ; n Phone Property Oifvner / mac. ez,Phone Property Owner's Ad ress ContractorPhone �T4 k �r� ����,- ,.>~ �,� a,,,Z7 X29 Contractor's Address, License #_ , r ,� �„ e, Expires E-mail oi� PROJECT ADDRESS Project Business Name //lp Fire Alarm System ❑ Residential ❑ Multi -family ❑ Commercial ❑ Industrial Check all that apply Briefly describe the project: ❑ One addressable loop ❑ One zone ❑ Additional zones List quantity of additional zones PROJECT VALUATION (labor & materials) $ Fire Sprinkler System Check all that apply ❑ Residential ❑ Multi -family Commercial ❑ Industrial Briefly describe the project: Installing backflow protection device(s)? ❑ yes ❑ no :52 inch water line (list quantity of devices) >2 inch water line (list quantity of devices) PROJECT VALUATION (labor & materials) $ 11 11 3 1 "17 CITY OF PORT ANGELES BUILDING DIVISION Hood / Duct Fire Suppression Svstem %] Residential ❑ Multi -family commercial ❑Industrial Check all that apply Briefly describe the project: Will only the fire suppression system be installed or altered? Oyes ❑ no Will a hood and/or ductwork be installed or altered? ❑ yes* ❑ no * If yes, a mechanical permit will also be needed PROJECT VALUATION (labor & materials) $ I have read and completed this application and know it to be true and correct. I am authorized to apply for this permit and understand that it is my responsibility to determine what permits are required, and to obtain permits prior to working on pr .ects. Date7? a Print Nam,7k -5QfrY- Signature,✓ T:FormsBuilding Division/Fire-related permit application Contractors or Tradespeople Printer Friendly Page Page 1 of 1 General/Specialty Contractor A business registered as a construction contractor with L81 to perform construction work within the scope of its specialty. A General or Specialty construction Contractor must maintain a surety bond or assignment of account and carry general liability insurance. Business and Licensing Information Name Phone Address Suite/Apt. City State Zip County. Business Type Parent Company FRANK FIRE PROTECTION LLC UBI No. 602796546 2536383245 Status Active 15405 Se 310Th St License No. FRANKFP928CO Expiration License Type Construction Contractor Kent Effective Date 2/20/2008 WA Expiration Date 2/22/2014 98042 Suspend Date 02/21/2012 King Specialty 1 Fire Protect System Limited Liability Company Specialty 2 Unused Business Owner Information Name Role Effective Date Expiration Date SOURISH, FARHANG A Partner/Member 02/20/2008 Bond Information Bond Bond Account Effective Expiration Cancel Impaired Bond Received Bond Company Number Date Date Date Date Amount Date Name 1 WESTERN 70452500 02/01/2008 Until $6,000.00 02/20/2008 SURETY CO Cancelled Assignment of Savings Information No records found for the previous 6 year period Insurance Information Insurance Company Policy Effective Expiration Cancel Impaired Amount Received Name Number Date Date Date Date Date I4 Atlantic Cas L065009303 02/21/2012 02/21/2013 $1,000,000.0002/22/2012 Ins Co I3 Atlantic Cas L0650073363 02/12/2011 02/12/2013 $1,000,000.00 02/09/2012 Ins Co 2 ATLANTIC L065007336 02/12/2010 02/12/2011 $1,000,000.0002/18/2010 CAS INS CO 1 ATLANTIC L0650073361 02/12/2008 02/12/2010 $1,000,000.0001/22/2009 CAS INS CO Summons/Complaint Information No unsatisfied complaints on file within prior 6 year period Warrant Information No unsatisfied warrants on file within prior 6 year period https://fortress.wa.gov/lni/bbip/Print.aspx 7/31/2012 ELECTRICAL PERMIT CITY OF PORT ANGELES 360-417-4735 Application Number . . . . . 12-00000912 Date 7/20/12 Application pin number . . . 061648 Property Address . . . . . . 112 S LINCOLN ST STE A ASSESSOR PARCEL NUMBER: 06 -30 -00 -5 -1 -3100 -0000 - Application type description ELECTRICAL ONLY Subdivision -Name . . . . . . Property Use . . . . . . . . Property Zoning . . . . . . . CENTRAL BUSINESS DISTRICT Application valuation . . . . 0 ---------------------------------------------------------------------------- Application desc 6 circuits bakery equipment ---------------------------------------------------------------------------- Owner Contractor ------------------------ ------------------------ MATTHEW AND KARI BAILEY BOTERO & SON ELECTRICAL 512 W 10TH ST 940 TAMARACK WAY PORT ANGELES WA 98362 PORT ANGELES WA 98362 (360) 565-1280 (360) 452-4766 ---------------------------------------------------------------------------- Permit . . . . . . ELECTRICAL ALTER COMMERCIAL Additional desc . . Permit Fee . . . . 99.00 Plan Check Fee 00 Issue Date . . . . 7/20/12 Valuation . . . . 0 Expiration Date 1/16/13 Qty Unit Charge Per Extension 1.00 74.0000 ECH EL -COMM BRANCH CIR WO/ SIF 74.00 5.00 5.0000 ECH EL-ECH ADDNT BRANCH CIRCUIT 25.00 ---------------------------------------------------------------------------- Fee summary Charged Paid Credited Due --------------------------------------------------------- Permit Fee Total 99.00 99.00 .00 .00 Plan Check Total .00 .00 .00 .00 Grand Total 99.00 99.00 .00 .00 a Z REPORT SALES TAX on your excise tax form to the City of Port Angeles (Location Code 0502) INSPECTION TYPE DATE: RESULTS: INSPECTOR: DITCH SERVICE ROUGH-INg ) j Z T-4 FINAL 11 � z_ COMMENTS: v PERMIT WILL EXPIRE SIX (6) MONTHS FROM LAST INSPECTION r Signature of owner or Electrical Contractor X Date: G:\EXCHANGE\BUILDING IA o,tp°RTq, ELECTRICAL INSPECTION 4-�N _ y WIRING REPORT RKS h 417-4735 V' DAFT I PERI / I (NSP A OWNER -7//jvv) 106-1 *12,0 (CONTRACTOR ADDRESS It 2 U, a\f G C7 LUQ,( APPROVED NOT APPROVED ❑ .................DITCH.................... ❑ t.l,l..... ROUGH IN/COVER ............... ❑ ❑ ....................SERVICE................... ❑ ❑ .....................FINAL.................... ❑ CORRECTIONS NEEDED: S NOTIFY INSPECTOR WHEN CORRECTIONS ARE COMPLETED WITHIN 15 DAYS - DO NOT REMOVE - CITY OF PORT ANGELES PERMIT APPLICATION R E E U Building Division/Electrical Inspections i t$1K 321 East Fifth Street — P.O. Box 1150 / Port Angeles ashington 98362 JUL 1 Ph: (360) 417-4735 Fax: (360) 417-4711 ELECTRICAL b'"� I'ECTlo�ia Date: 'i % 1 2 S welling INSPECTION"') * Plan Review May Be Required, Please Complete Electrical Plan Review Information Sheet Job Address: p -7 Z.' Building Square Footage: Description of above 2 !_ /'.✓Lam:. �C x Ifr,v ./ .r'i._ r� ✓l�74� y a Owner Information Name:, Mailing Address: City: State: Zip: Phone: Fax: License # / Exp. Item Service/Feeder 200 Amp. Service/Feeder 201-400 Amp. Service/Feeder 401-600 Amp Service/Feeder 601-1000 Amp. Service/Feeder over 1000 Amp. Branch Circuit W/ Service Feeder Branch Circuit W/O Service Feeder Each Additional Branch Circuit Branch Circuits 1-4 Temp. Service/ Feeder 200 Amp. Temp. Service/Feeder 201-400 Amp. Temp, Service/Feeder 401-600 Amp. Temp. Service/Feeder 601-1000 Amp . Portal to Portal Hourly Signal Circuit/ Limited Energy -1 & 2 Family Dwelling Manufactured Home Connection Renewable Electrical Energy - 5KVA System or Less Thermostat Note: $5.00 for each additional T-Stat NEW CONSTRUCTION ONLY: First 1300 Square Ft. Each Additional 500 Square Ft. or Portion of Each Outbuilding or Detached Garage Unit Charqe $120.00 $146.00 $ 205.00 $ 262.00 $ 373.00 $ 5.00 $ 6 5.00 ,---,$,'75.00 $ 93.00 $110.00 $149.00 $168.00 $ 96.00 $ 64.00 $120.00 $102.00 $ 56.00 $120.00 $ 40.00 $ 74.00 L� rie,. a —ay t P J Contractor Information // ` Name: X 1�art) Mailing Address: 9 Yo i k "I'l ,o .2_.. -., (:�'/ City: P.."Statej�g_Zip: c7K5 Phone: 'i / Ri i Fax:�i 2 License # I Exp. ✓ � � � �+� Qty Total (Qtv Multiplied by Unit Charge). uv 74 - - $ ,�x;'cx' Each Swimming Pool or Hot Tub $ 110.00 $ Total G9 CID Owner as defined by RCW.19.28.261: (1) Owner will occupy the structure for two years after this electrical permit is finalized. (2) Owner is required to hire an electrical contractor if above said property is for sale, rent or lease. Permit expires after six months of last inspection. After reading the above statement, I hereby certify that I am the owner of the above named property or a licensed electrical contractor. I am making the electrical installation or alteration in compliance with the electrical laws, N.E.C., RCW. Chapter 19.28, WAC, Chapter 296-46B, The City of Port Angeles Municipal Code, and Utility Specifications and PAMC 14.05.050 regarding Electrical Permit Applications. Signature of owner, electrical contractor or electrical administrator, ❑ cash ❑ Check Credit Card # C7-'K/171—e _� Dated: --12 �J 7 011[12012 CERTI FICATE� OF OCCU PAN CY City of:Port Angeles-- }Building "Division This certificate is issuedpursuant suant to the requirements of Section 110 of the j006 International Building Code certifving that at,the,time ofissuance this structure was in compliance with the various ordinances of the City regulating' building;construction or usefor the following 1�, Business name Pa'cific..Northwest:t.Games. ('Owner Matt*Wolff & Nathan Heustis) Business address 1 T2 IS, Lincoln St. .'Suite A. Property owner Matthew &. Kari.Baile.y Property owner s.address 512 W 1 Qt''St.,; Porfi Angeles INA,,'98362.x, Automatic fire sprinkler system Per4BC Use & occupancy classification Mercantile Occupant load. Per 2006=1BG Table,1'004.1 '1; ,-. tt Buildingpermit number, 1:0=63'' x' Type of construction VBA u,,... 03/08/10 Sue R_ob:erd ; yPl _ ;ng Manager Date Post on the premises in a conspicuous place. This,certif cate shall riot be removed except by the Building Official. 0cu.Qj 3 g/IL) V) 1j C t 15> (10 C, PREPARED 2/10/10 8 03 10 INSPECTION TICKET PAGE 4 CITY OF PORT ANGELES INSPECTOR JAMES LIERLY DATE 2/10/10 ADDRESS 112 S LINCOLN ST SUBDIV TENANT NBR PACIFIC NORTHWEST GAMES CONTRACTOR PHONE OWNER MATTHEW / KARI BAILEY PHONE (360) 565 1280 PARCEL 06 30 00 5 1 3100 0000 APPL NUMBER 10 00000063 CO CHANGE OF OCCP/USE PERMIT CO 00 CHANGE OF OCCUP/USE REQUESTED INSP DESCRIPTION TYP/SQ COMPLETED RESULT RESULTS/COMMENTS C099 01 22//100///.1(00 JLL BLDG C/O FINAL OVERRIDE TAKEN BY LPANGRLE DATE 02/09/10 February 9 2010 3 40 17 PM 1pangrle MATT 797 4362 C OF O FINAL PACIFIC NORTHWEST GAMES COMMENTS AND NOTES TIME 15 41 43 (1/25/2010) Linda Pangrle Pacific Northwest Games From Pacific Northwest Games <pacificnorthwestgames@gmail com> To <Ipangrle@cityofpa us> Date 1/25/2010 1 34 PM Subject: Pacific Northwest Games Hello Linda P This is Matt Wolff with Pacific Northwest Games I was in there last week applying for our occupation permit. I had general some questions about permits and signs I was hoping you could answer for me We are looking into getting an 'OPEN' sign and we didn't see anything in the paperwork that specifically addressed them Are there any special rules regarding neon open signs that are inside the windows? Also we hadn't thought about parking for us while we are at work. Is there some sort of permit that we can get to park downtown for more than 2 3 hours without getting a ticket? We would really appreciate not getting tickets =) Thank you in advance for your time and any assistance you can provide me Matt Wolff Pacific Northwest Games Port Angeles WA 98362 360-797-4362 M°� 5 � 1Zs1�o Page 1 Print in ink' CERTIFICATE OF OCCUPANCY APPLICATION Permit# 16--63 CITY OF PORT ANGELES Attn. Building Permit Technician 321 E. Fifth St. Port Angeles, WA 98362 (360) 417-4815 fax (360) 417-4711 FEESnp/ icate /Inspeection Qom' 411/ usiness Improve Areo (i'BIA) arged ford ntow tocations - BUSINESS NAME BUSINESS ADDRESS ��2 �� 2Ge� 4 14 Z Zoning Business mailing address c.5 41,v—L. Phone # Oper> plate Febt O Days &hours of operation M4 t t- t o Washington State Tax I D # If known list the name of the previous L OL q, -4 business at this location Brief description of proposed business re, 4-, r'l. �.r��,� . k,�� a. -r t — nP.tk) Business owner's name r✓!q 1t L )o/ r F f iU "eUstl s Phone # -J--J -4 K 3 6 z Business owner's home address t'3 �/ W v�. S / P t �.+� cl Sr •J 9 fs' 3 6 PLEASE NOTE: A Business License is also required for the following businesses: Taxi, Peddlers, Second-hand dealer Pawnbroker Dance, Hotel - Motel, Fireworks, Ambulance, Tattoo shop Contact the City Clerk at 4174634 for additional information. NO✓ I WILL THERE BE ANY OF THE FOLLOWING? ACTION ✓ Electrical Dept. at 417-4735 Fire I Electrical changes New business I New -or relocated signs invite, wit,daw only V,/" I Construction changes / 1 City clerk Mechanical changes (ventilation, heating, cooling, eta) Transfer of business } Plumbing changes location from a PBIA location I Fire sprinkler system changes ✓ I. Fire alarm system changes Transfer of business I -New or relocated sewer or water service location -from a I Excavation or filling of lots non-PBIA location I Work done In the City right -of --way ✓ I New driveway openings Change of•ownership I Grading site drainage (parking lots, downspouts, eta) ✓ Landscape irrigation system (backflow devices) Remodel ` Is this a home occupation? 'Is this a second-hand dealer or pawnbroker business? Temporary business Is there off-street parking for this business? Is the street in front of this business paved? Change of use I Is there a sidewalk in front of this business? (:::: Is there a curb & gutter in front of this business? ashier counter Call for Certificate of Occupancv inspections before openincl business. Building Departm4nt inspection 4.17-4615 & Fire Department inspection 417-4653 Please provide a minimum 24-hour notice for inspections NO✓ YES✓ iF YES, CONTACT Building Electrical Dept. at 417-4735 Fire Building Div at 417-4815 I ✓ I Planning 1 City clerk Public Works ✓ I I ✓ Public Works at 417-4807 ,r I ✓ I I ✓ I i 1 Water Dept, at 417-4886 I ✓ I Planning Div at 417-4750 City Clerk at 417-46:14 I I How many spaces? I ✓ I ✓ I (:::: PleaIsigncup, for utility services ashier counter i hereby apply for a Certificate. of Occupancy f acknowledge that 1 have read this application and state that the information i have suppfied is, correct to the best of my knowledge, Date t ! 0 Print Name . fvl r' �J o (� Signature U For City use only: Department Approved Rejected Initials & date Initials & date Building Alo-ilo ,Ta, Fire Zi -10 KDb i PSIA I???b-!o RN Planning 1 City clerk Public Works T.FormWElulltling DIvisIONCerBrccete of OccWancy Application Comments i Conditions Type of construction Occupant Load Automatic fire sprinkler system required no yes V 112' 11 12., p, 127 106, 116 ° 129 r ^. 124 =136 119 JW sr, fC7108 Q r k 131 210 214 s � 114 CERTIFI CUPANCY Buildi This Cdr�;ifi ,caiion-issuedpursuant to the requirements of Secticit4109 of the din ,�ocr7fBui was a Ic_ P Use Classification Kehl -ii. j Pennit No Group. M Construction Owner of Business/Residencel Tdsw'h Gone Building Address: 112 ,Street. 11 Post on th Shall not be 5t' Sfte&o,.PortqAn2eIes, WA 98363 eles. WA 98362 ember 20, 2001 Jdtuous place. uilding Official. DATE /0./? //o / Address of Proposed Business / / Z. �__ L pi C o L h Applicant ATG S P P� i . Address 90 7 � /5 tea. 95? 36 -2- Phone: Phone: business M VAI ROUTING SLIP Certificate of Occupancy $47.00 Certificate/Inspection Fee 1 • V���of Po�oFm _ s '►.-SII �'euc woa�'e New Business ....... .................... ( ✓ ) Transfer of Business Location ................ ( ) .S% Change of Ownership ...................... ( ) 6'1'� /,-I c New Building ............................. ( ) r Remodel ................................. ( ) Temporary Business ....................... ( ) home y -S Z- 5707 Change of Use .................... ( ) Tl Z. w Brief description of proposed business: 7�, T (lo a, Ze- a 61 : 00P Legal Description: Lot BlockIle Subdivision Current Use of Property: rnN-+/1'ti7-,- -7-_ S S'TorP Zoning Classification of Property: wr P -mac �'�r Z_ CED WILL THERE BE ANY OF THE FOLLOWING? Construction changes ..... ..... Electrical changes ... ..... Mechanical (heating, cooling, stoves) Plumbing changes . ...... ..... New or relocated signs . ... New septic tanks New sewer service . Admission charged to patrons . .... Is this a home occupation? ... Excavation of filling of lots ... .... Work done in City right-of-way .... Is there sufficient off-street parking? ..... New driveway openings A grading plan for site drainage ... (parking lots, downspouts, etc) ... . Are the existing streets paved9 Are there existing sidewalks? .... Is there curb and gutter? .... ....... Other ........ ...... ...... YES NO l i l / i I hereby apply for a Certificate of Occupancy and acknowl- edge that I have read this application and state that the information I have supplied is correct to the best of my knowledge. L �k Building Section Public Works Department Planning Department Fire Department City Clerk P.B.I.A. THE FOLLOWING WILL BE REQUIRED: PERMITS BUSINESS LICENSE 1) Building 1) Taxi 2) Plumbing 2) Peddlers 3) Electrical 3) 2nd Hand Dealer 4) Mechanical 4) Pawn Broker 5) Sewer 5) Dance 6) Sidewalk installation 6) Hotel - Motel 7) Driveway installation 7) Fireworks 8) Curb installation 8) Ambulance 9) Sidewalk obstruction 9) Tattoo shop 10) Water meter installation 10) Other 11) Fire 12) Occupancy 13) Sign 14) Shoreline 15) Home occupation 16) Conditional use 17) Other Date: 4013/10 / Signed:X9__� 7- Comments / Conditions