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Home My WebLink About4109 Old Mill Rd - BuildingNAME OF PREMISES r,‘„, SERVICE ADDRESS t t e /7 C C, f 4 LOCATION OF DEVICE. ASSEMBLY l C J C C j l/ Manufacturer Model Size Serial No IS THIS AN APPROVED ASSEMBLY? YES NO IS ASSEMBLY INSTALLED CORRECTLY' YES NO DATE OF INSTALLATION UNKNOWN 0 Initial Test Repairs Details COMMENTS DOUBLE CHECK VALVE ASSEMBLY CHECK VALVE #1 Leaked Held at ?psi Cleaned Replaced Backflow Assembly Test Report City of Port Angeles Public Works and Utilities Department Water/Wastewater Collection Division r f REDUCED PRESSURE PRINCIPLE ASSEMBLY CHECK VALVE #2 Leaked Closed Tight Held at 7 psi Cleaned Cleaned Replaced Replaced i 1 fl/ T J C Final -7 I J Test /1 a t~ f �i t Y T" t i v RELIEF VALVE PVB /SVB Did Not Open Opened at psi 3 psi Buffer YES NO Final Closed Tight Test Held at psi Held at F psi Opened at psi AIR GAP INSPECTION REQUIRED MINIMUM SEPARATION YES NO WHITE CUSTOMER COPY YELLOW PURVEYOR COPY PINK TESTER COPY Replaced Official Use Only Assem.# Received RP RPDA DC DC DA PVB Air Gap SVB AVB AIR INLET Did Not Open Opened at psi CHECK VALVE Leaked Held at REPAIRS Cleaned psi AIR INLET Opened at psi CHECK VALVE Held at psi BACK PRESSURE NO YES TYPE OF HAZARD Line Pressure f) psi Held Backpressure YES NO #2 Shutoff Held YES NO Relief Valve Exercised YES NO Date/Time Tester Signature Cert. Test Kit Passed Failed Initial Test 5 is v tf t-• `l ll• ',71 .7 f Repairs .fro' 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 HOCH ERVIN 4109 OLD MILL RD PORT ANGELES Permit Additional desc Permit pin number 77743 Permit Fee 57 00 Issue Date Expiration Date 11/13/06 Qty Unit Charge 1 00 Fee summary Permit Fee Total Plan Check Total Grand Total CITY OF PORT ANGELES DEPARTMENT OF COMMUNITY DEVELOPMENT BUILDING DIVISION 321 EAST 5TH STREET PORT ANGELES, WA 98362 7 0000 ECH WA 983621906 PLUMBING PERMIT Per Charged 57 00 00 57 00 06 00000519 665190 4109 OLD MILL RD 06 30 15 3 4 0250 2001 JOHN CHIASSON PLUMBING REPAIR 3800 BASE FEE PL- EA LAWN BACKFLOW 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. Contractor DOWN TO EARTH LANDSCAPING 306 S VALLEY PORT ANGELES (360) 452 0824 Plan Check Fee Valuation Paid Credited 57 00 00 00 00 57 00 00 Date 5/17/06 WA 98362 Due -7//q/tz 00 0 Extension 50 00 7 00 00 00 00 p4 E S 17 7 N Signature M 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] 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 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 NO FINAL FINAL DATE ACCEPTED BY. DATE ACCEPTED BY. PLANNING DEPT SEPARATE PERMIT #'s SEPA. PARKING /LIGHTING ESA. LANDSCAPING SHORELINE. FINAL INSPECTIONS REQUIRED PRIOR TO OCCUPANCY/USE RESIDENTIAL DATE YES NO COMMERCIAL DATE ACCEPTED YES I NO ELECTRICAL LIGHT DEPT 417 -4735 ELECTRICAL LIGHT DEPT CONSTRUCTION R.W PW/ CONSTRUCTION R.W ENGINEERING 417 -4807 PW ENGINEERING FIRE 417 -4653 I I I I FIRE DEPT PLANNING DEPT 417 -4750 I 4 I PLANNING DEPT BUILDING 417 4815 0 1 I BUILDING T' \Policies \1102_15 building permit inspection record05 wpd [1/4/2005] I I I I I I I I I Fill out COMPLETELY and in INK. Y our application and site plan MUST BE COMPLETE to be accepted for review If you have an questions. call PERMITS (360) 417 -4815 FAIi(360)417 -4711 Applicant or Agent: A (Al v, 77, 1 L1 tJ Owner LAS S T G teV M Address: Ur S �Ja P City 49 (2■ de Architect/Engineer F4 v Contractor 00 u Tv e„ State License Address: 'trt) 5 t )'a.LI r w A 4- City T 0 des PROJECT ADDRESS 1 l o°i S 01f-I a4 t i I 6Q t-) T ,FOAL DESCRIPTION Lot: Block: CLALLAM COUNTY PARCEL NUMBER. TYPE OF WORK. Residential New Constr Multi- family Addition Commercial Remodel Repair Sign BRIEF DESCRIPTION OF THE PROJECT Re -roof Stove Move Garage Demolition Deck Other COMMERCIAL/RESIDENTIAL. Occupancy Group BUILDING PERMIT APPLICATION 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 Phone: C fl R S 5 Phone. `i (o Q o 7,3,5 Subdivision. Phone: Exp FOR OFFICIAL USE ONLY Date Rec.:(/ -5 7 /a6 Permit #:1V- Date Approved: t 47 Date Issued: 061i7/40 Zip K3 7_ Phone- q57- $SS Zip (5-, ZONING STZF/VALUATION SF /SF SF /SF SF /SF TOTAL VALUATION Occupant Load. Construction Type. Proposed Sq Ft. TOTAL Sq Ft. APPROVALS PLAN BLDG DPWU FIRE. OTHER VALUATION OF CONSTRUCTION In all cases, a valuation amount must be entered by the 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 work. nn y T•\FORMS\BIdgPermitform.wpd Applicant: 1,_ l 1/�C..�„,d�_ Date: I