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Home My WebLink About1215 W Hwy 101 - BuildingOwner UN CHIN INC 8817 WELLER RD SW LAKEWOOD (253) 426 8293 Permit Additional desc Permit pin number Permit Fee Issue Date Expiration Date T.FormsBuilding Division/Building Pennit ff ^;U:i' s'�'.r�a,'" `r., r '.4 u`'x °il „�S""r °�`�'ri�.: 'CO” IT F�=PORT ANGEL DEPARTMENT :OF COMMUNITY ECONO DEVELOPMENT BUILDING.DTVISION 321 EAST:5TWSTREET PQRTANGELES; WA 98362 .Application ,Number .08. 00001444 Application pin number 631972 Property Address 1215 W HWY 101 ASSESSOR PARCEL NUMBER 06 30 08 5 1 0200 0000 Application type description PLUMBING REPAIR Subdivision Name Property Use Property Zoning RESIDENTIAL TRAILER PARK Application valuation 0 Application desc Install 2 double check valve on water service Qty Unit Charge Per Fee summary Charged Permit Fee Total 57 00 Plan Check Total 00 Grand Total 57 00 Co tractor GEORGE E DICKINSON 116 BARNES RD WA 98498 SEQUIM (360) 683 8332 PLUMBING PERMIT WATER SERVICE DOUBLE CHECK 137927 57 00 11/26/08 5/25/09 BASE FEE 1 00 7 0000 EA PL- BACKFLOW PROTECTION FOR =2 Paid Credited 57 00 00 00 00 57 00 00 .Date CONST INC WA 98382 Plan Check Fee 00 Valuation 0 Due Extension 50 00 7 00 00 00 00 12401/0 ;u€ 9 A/EX few Ai rfr w 7 P 65 p Det\e- 4\sNecle-A Acorova Reivt-n 1-0 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) J J 'oRks ANA NAME OF PREMISES W 6 L- C /A /A/ /f/ Lie A G e /7..,i /t` SERVICE ADDRESS I G€r'' A v LOCATION OF DEVICE. 7. C 7/14 g T /V/ ASSEMBLY W /1 7 f 76 cI 3 Manufacturer Model Size Serial No IS THIS AN APPROVED ASSEMBLY" YES NO IS ASSEMBLY INSTALLED CORRECTLY; YES P. -NO DATE OF INSTALLATION -G UNKNOWN❑ Initial Test Repairs Details i Final Test ORT COMMENTS Initial Test Repairs Final Test A /(/ek/ UG C A -1/7-1(/ REDUCED PRESSURE PRINCIPLE ASSEMBLY DOUBLE CHECK VALVE ASSEMBLY CHECK VALVE #I CHECK VALVE #2 Leaked Held at 5 psi Cleaned Replaced Closed Tight Held at 9 psi Held at 9 Opened at psi AIR GAP INSPECTION REQUIRED MINIMUM SEPARATION YES NO 11/ >le< 7 g s7 /952 Date 'Time Tester 61 if /It t`/ c, Backflow Assembly Test Report City of Port Angeles Public Works and Utilities Department Water/Wastewater Collection Division Leaked Closed Tight Held at 2 "'psi Cleaned Cleaned Replaced Replaced Signature 3- l 7 L k L 'G. RELIEF VALVE 1 PVB /SVB Did Not Open Opened at psi 3 psi Butler YES NO Cert. Test Kit Replaced TYPE OF HAZARD r CY Line Pressure �i psi Held Backpressure YES C�]''NO #2 Shutoff Held YES Br Relief Valve Exercised YES NO WHITE CUSTOMER COPY YELLOW PURVEYOR COPY PINK TESTER COPY Official Use Only Assern.# Received RP RPDA DC Er DCDA PVB Air Gap SVB AVB AIR INLET Did Not Open Opened at psi CHECK VALVE Leaked Held at psi REPAIRS Cleaned AIR INLET Opened at psi CHECK VALVE Held at psi BACK PRESSURE NO YES Passed Failed O r CITY OF PORT ANGELES DEPARTMENT OF COMMUNITY ECONOMIC DEVELOPMENT BUILDING DIVISION 321 EAST 5TH STREET PORT ANGELES WA 98362 Application Number 08 00001444 Application pin number 631972 Property Address 1215 W HWY 101 ASSESSOR PARCEL NUMBER 06 30 08 5 1 0200 0000 Application type description PLUMBING REPAIR Subdivision Name Property Use Property Zoning RESIDENTIAL TRAILER PARK Application valuation 0 Application desc Install 2 double check valve on water service Owner Contractor UN CHIN INC 8817 WELLER RD SW LAKEWOOD (253) 426 8293 WA 98498 GEORGE E DICKINSON CONST INC 116 BARNES RD SEQUIM WA 98382 (360) 683 8332 Permit PLUMBING PERMIT Additional desc WATER SERVICE DOUBLE CHECK Permit pin number 137927 Permit Fee 57 00 Plan Check Fee 00 Issue Date 11/26/08 Valuation 0 Expiration Date 5/25/09 Qty Unit Charge Per Extension BASE FEE 50 00 1 00 7 0000 EA PL- BACKFLOW PROTECTION <OR =2 7 00 Fee summary Charged Paid Credited Due Permit Fee Total 57 00 57 00 00 00 Plan Check Total 00 00 00 00 Grand Total 57 00 57 00 00 00 T:FormsBuilding Division/Building Permit ue_eA Date 1 2-to I O S re�Yt /9- Ve ci i oy� 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) BUILDING PERMIT INSPECTION RECORD PLEASE AROVIDE 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 IN CONSPICUOUS LOCATION. KEEP PERMIT AND APPROVED PLANS AT JOB SITE. Inspection Type Date 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 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 PLANNING DEPT Separate Perrnit #s SEPA. Parking Lighting 1 ESA. Landscaping 1 SHORELINE. T.Forms /Building Division /Building Permit FINAL INSPECTIONS REQUIRED PRIOR TO OCCUPANCY/ USE Inspection Type Electrical 417 -4735 Construction R.W PW Engineering 417 -4831 Fire 417 -4653 Planning 417 -4750 Building 417 -4815 FINAL Date 1 G- A ccepted by FINAL Date Accepted by RQ Date Accepted By Q cQ r V I 0 CITY OF PORT ANGELES PUBLIC WORKS UTILITIES 321 EAST 5TH STREET PORT ANGELES WA 98362 Application Number 08 00001444 Application pin number 631972 Property Address 1215 W HWY 101 ASSESSOR PARCEL NUMBER 06 30 08 5 1 0200 0000 Application type description PLUMBING REPAIR Subdivision Name Property Use Property Zoning RESIDENTIAL TRAILER PARK Application valuation 0 Application desc Install 2 double check valve on water service Owner Contractor UN CHIN INC 8817 WELLER RD SW LAKEWOOD (253) 426 8293 WA 98498 Date 11/26/08 GEORGE E DICKINSON CONST INC 116 BARNES RD SEQUIM WA 98382 (360) 683 8332 Permit PLUMBING PERMIT Additional desc WATER SERVICE DOUBLE CHECK Permit pin number 137927 Permit Fee 57 00 Plan Check Fee 00 Issue Date 11/26/08 Valuation 0 Expiration Date 5/25/09 Qty Unit Charge Per Extension BASE FEE 50 00 1 00 7 0000 ECH PL -OTHER BACKFLOW 2 OR LESS 7 00 Fee summary Charged Paid Credited Due Permit Fee Total 57 00 57 00 00 00 Plan Check Total 00 00 00 00 Grand Total 57 00 57 00 00 00 T' \Policies \1102 15 [10/08] 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 constructio Signatur of Contractor or Authorized Agent Date Signature of Owner (if owner is builder) Date CALL 417 -4831 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 COMMENTS 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 R.W PW/ CONSTRUCTION R.W PW ENGINEERING ENGINEERING 417 -4831 FIRE 417 -4653 PLANNING DEPT 417 -4750 BUILDING 417 -4815 T Policies 1102 15 [10/08] tserxer PERMIT INSPECTION RECORD YES NO FINAL INSPECTIONS REQUIRED PRIOR TO OCCUPANCY/USE DATE YES NO COMMERCIAL DATE ACCEPTED YES 1 NO I I I I I I I I I I I I FIRE DEPT PLANNING DEPT BUILDING OM ER/CON1TRACTOR t\ t*- 1 ADDRESS APPROVED 0 0 0 0 OLYMPIC PRINTERS,4DJC. (360) 452 -1381 ELECTRICAL INSPECTION WIRING REPORT 417 -4735 PERMIT -0606 IZ1S 1,J 146JY 1b DITCH ROUGH IN /COVER SERVICE FINAL INSPECTOR CORRECTIONS NEEDED 0'101. 1 —a u t 2 W 1.12,1 MSC— I 1 5510'75 62.-ouLaT) Rto R n( )11ZF iJy 250.52 FR R A L am' `L? /■1 k Y 2 ,=61) PAD iczo ?t1z pczo 1 14 4, L L) 0_c& 116) �+1 L l�L� f U r r'ork3— T LX6 -1 G74L_ 1/411.T .E)4 1\ dlD. arct Peo C-(7- HEc, zee grof.4Ar 1 Q )3eQR RUC- r- 352_ 3C� NOTIFY INSPECTOR WHEN CORRE ONS ARE COMPLETED WITHI(15 DAYS DO NOT REMOVE NOT APPROVED 0 0 Application Number Application pin number Property Address ASSESSOR PARCEL NUMBER Application type description Subdivision Name Property Use Property Zoning Application valuation Application desc Repair Moble Service Owner WELCOME INN TRAILER PARK 1215 W HWY 101 PORT ANGELES 36) 457 1553 Permit Additional desc Permit pin number Permit Fee Issue Date Expiration Date Fee summary ELECTRICAL _PE IT AND INSPECTION RECORD CITY OF PORT ANGELES 360-417-4735 Permit Fee Total Plan Check Total Grand Total WA 98363 08 00000506 716734 1215 W HWY 101 06 30 08 5 1 0200 0000 ELECTRICAL ONLY RESIDENTIAL TRAILER PARK 0 Contractor EL RM SERVICE OR FEEDER 125633 46 00 4/30/08 10/27/08 Charged Paid Credited NORTH PENINSULA ELECTRIC 761 FRESHWATER PARK RD PORT ANGELES WA 98363 (360) 477 1764 Qty Unit Charge Per 1 00 46 0000 ECH EL MOBILE HOME PARK 1ST UNIT 46 00 46 00 00 00 00 00 46 00 46 00 00 Date 4/30/08 Plan Check Fee 00 Valuation 0 Due Extension 46 00 00 00 00 ru N CIA z ter [NSPECTION ELF,CTRICAL TYPE DATE. RESULTS INSPECTOR DITCH SERVICE ROUGH -L\ FINAL COMMENTS: -7/zokc (PA 90p. Job wired by ,,.C] —E1 cal Contractor Owner Electrical contractor name License number Date Expires y, V't 1^ YN S t v"t ri L IV --),AN .Nee-Ex %3 11= New Purchaser's mailin address `oQ h- �C '�l< Cit y� i p State ZIP A CI V I C? to A Telephone number X11 Premises owner's name l C h'1 -t-_ Date Inspection Date Date FINAL FAX number 1 1/4S Address of ins on City �P� v 1 P*IN tie k es Phone number to schedule inspection Lk1\ V\ i .7-k Appr ed By Appr ed B} 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. 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 instal- lation 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 Card Utility Specifications. /Signature of owner, electrical contractor or electrical administrator Expiration Date X Date Electrical Load Add and or subtractions NO LOAD CHANGES Baseboard KW Furnace KW Overhead Service Heat Pump Ton LAR Temp Service Fan -Wall KW Underground Service SAME DAY INSPECTION. CALL BEFORE 7.00 AM 360 -417 -4735 ROUGH -IN THERMOSTAT Date Appr ed By DITCH Date Appr ed By Area, Building or Equipment Inspected w ELECTRICAL WORK PERMIT APPLICATION \(Installation description Commercial Residential Cash Check Altered /Addition NC\C° 1 iJ c j 810k RECEIVED APR 3 0 2008 LIGWFDEPT Card Visa Mastercard 1'y Voltage Phase 1 3 Service Size: Feeder Size SERVICE Date Appr ed By FEEDER Date Appr ed By Action Taken Discover (Inspection fee Service Information Electrical Inspector VW-/~~ 2006/0r 1'1~/~ED 02:17 PM C~~Y_~~.,~~,_~~_~~~~~~__"...._~X No, 360..4~_~ ~.!~L,.~,~,::~~." .._..~:.~_0200,-I~2-~ .I .____..__..._..__.._., ,. __ __.,_ ...__. .... _......u.__.._ '_'_'. __.__... ___.___.____ "_ ._..._ ....... ._._._._......__.._...__..... .00 _____.._ __._ '_'0 _ _.,.__....... ~ ..0 ROUTING SLIP Certificate of Occupancy $50.00 Certificate/Inspection Fee 6,'C1AT~ ,t~' ~"~ '~ ':~,::'~~:~_' ."~" ~'~~:~.~ ~~~w'Blisr~e-S:~.:...~ ':'.:.~_:-:; .':'~. .-'. : .. ::,': : :'. ''',':': :':,'.'). .:......: )_ '-Transfer of Business' Looation':', . . , ...', :. . " , : :'.' '( " ') " - , b.aogl'WJf--O_\I)Iller.sbip__ . (*):.. New Building ,......,.,'................. ( ) Remodel . . . . . , , . ' . . . , . . . . . _ ' , , , . , , , . , _ .. ( ) Te!TIporary Business. , . , . . . . , , , . . . . . . , . . . ~. ( ) '. .. 'ChangefcifUse':' :', " .. ..,' ,", :' . . , ',', , '.. , '" _ .. .'. ( ). I' 1 Brief description of proposed business: Legal D,escription: Lot Current Use of Property: Zoning Classification of Property: Mo!:,;/ H. fro.. e. ~ I? V i?- a~r Ie Block /\.1", 6 f / ;-/....I"'-E:. ~ IV! ... b F / f- / .. fro--(., ;fV 't Subdivision p", 1""1<- /R.V po....r-~ WJLLTHERE BE ANY OF THE FOL.l.OWING? Construction changes . . , . . , , . . , , , , , . , , . . . , . . . . . Electrical changes ,_" . ' , . . . . . . . . . . , . . , , . . , . . . . Mechanical (heating, cooling, stoves) ,..'.".'"" Plumbing changes. .. . . , , , , , , , , .. . .. . .. ' . . . . . . . NllW or rlllocated signs , , , . . . . . . . . . . . . . , . . . . . , _ . New septic tanks ., . . . . . , , , , , , , , : , , . . . , . . . _ . _ : . New sewer servica , . ' , , . . ' . . . , . . . . , . . . , . , . . . , . . Admission charged to patrons ...... _ _ , , , , , , , , , , , 15 this a home occupation? __ . , .. . , . . .. , , . . . . . . . . Excavation oHllllng of lots, .. . .. . .. . .. . .. . ',' . . _ . . Wor~ done in City right-of-way ....".. __ .. , , , . ' . ' Is there sufficient off-street parking? . . . . . . , . . . , . . . , New driveway openings ..................,..'.' A grading plan for site drainage , , , . " , , , , , , , , . . . , (parldng lots, downspouts, etc.) . . . . . . . , , . , . . . . , . . Are the existing streets paved? , , .,.,." .. , , . .', , , . Are there existing sidewalks? , ",". , .', , .' . . - , . .. Is there curb and gutter? . , . .. . .. . .. . .. . .. . , .. ..". " Other. . . , . , , , . , . . . . . , , . , ., , . ' , , _ , , , , , , , , . , ' - - YES NO V"" ----'- ~ ~ --vr ---- - --;;;r -- ./ 0.../ "./ -"/ ;/ v THE FOLLOWING WILL BE REQUIRED: PERMITS 1) Bu/ld)ng 2) Plumbing 3) Beclrioal 4) Machanical 5) Sewer 6) Sidewalk Installation 7) Driveway installation B) Curb installation 9) Sidewalk obstruction .. 10) Water meter installation 11) Fire 12) Occupancy 13) Sign 14) ShoreJlne 15) Home occupation 16) Conditional use 17) Other BUSINESS UCENSE 1} Taxi 2) Peddlers 3) 2nd Hand Dealer 4) Pawn Broker " 5) Danes 6) Hotel - Motel 7) Fireworks 8) Ambulance 9) Tattoo shop 10) Other I hereby apply for a Certificate of Occupancy and acknowl- edge that I have.read this application and state that the Date: information I have supplied is correct to' the best of my knowledge. Signed: Comments / CondItions ,~ BuilejingSeolion _15~~~ I~FO Pub.~c~~~~S.D~p~~ent",.:-- ~"~ ---- Planning Department Rre..i.Dep~~ent I , City Clerk APPROVED REJECTED ~, P.B.I.A. / /~ z. /'0 7 I I CJI?-/~/24 CITY OF PA BLDC DEPT FAX No. 360 417 4711 P.002 . ..'.. .... .-- .... ....-... ... .. .....n....- PtL~ ... ._._.n........ ......-..--.----.--f- --..-.. ..--.-~-.._.,.,......_~-. . 1 \ >1 ~ex= 1.\)\I .. ---... - ...... ... ........ ---..----.... .6-t. e.-..-. JtJ\e;.- ...q-.......R.Vu....--.... .~q g D_ .-@ (!.,tc~.;i~. ~e-\C/ome Xnn 2006/0CT/25/WED 02: 17 PM . , _-R1.P._...--. ROUTING SLIP Certificate of Occupancy $50.00 Certificate/Inspection Fee un e-h\v\ Le-rvy . ft o 6' I Brief description of proposed business: Lega! D.escription: Lot Current Use of Property: Zoning Classification of Property: . _..~ ,. .; j' ~ '( . r . ~ (*)~ ~ ( ) ( ) ( )'. ( ) . Neifti'BI.i'siriess : '.':. ~ :':;' . ';-. :', : .' .:.: : :'. '.':': >: '-.' :( .Transfer of Business' Location-:. . . . .... ':. '. . .- :'.' ~bi!Q~l'l=..Oj..o.w.oer.sbjp__~__ __ New Building ......... _ . . . . . . . . . .. . . . . . . . . Remodel. . . . . . _ . . . . . . . . . .. .. .. . . . . . . . . . . . .. . Te.~porary Business. . .. . . .. . . . . . . . . . . . . . . . . . . .Change'cifUse::....... ::.. :',. ..... ...........'. H.""f<.. ~ ;<1/ ~(Arlc Block /'-1 '" 6 ( I I-I ~ IV\. <Z- :5 IV! ... 6 II /-/"'''^''<- ;ev .; Subdivision p", r 1<... ~V Pcv~~ . WILL THI;RI; BI; 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 .,..,. _ _ . . _ . . . . . . . . 15 this a home occupation? _ _ . . _ _ . . . . . _ . . . . . . . . . . Excavation oHlIllng of lots. , . . . , . . . . . .. , . , '.' , . _ , _ Wor~ done in City right-of.way . . . . . . . . _ _ _ . . . _ . . . . Is there suflicieRt off-street parking? . . . , . . . . . . . . . . . New drlveway openings .................,....... A grading plan for site drainage . . . . . . . . . . . . . . . , . . (parking lots, downspouts. etc.) . . .. . . . . . . , . . . . . . . . Are the existing streets paved? . , . . .. . . . , . . . _ .'. . . . Are there existing sidewalks? ....... . .'. , . . . . _ . . . . Is there curb and gutter? . . . . . . . . . . . . . . . . . . . . . . . . Other. . . . . . . . . . . . . . , . _ . . . . . . . . . _ . . . . _ . . . _ . . _ . YI;S NO Y'" -~ -./ - ----v;;r ---- - --;;;T -- ,,/ -- ....".- V" -,.,-/ <./ v THE FOLLOWING WILL BE REQUIRED: PERMITS 1) Building 2) Plumbing 3) Electrical 4) Meohanical 5) Sewer 6) Sidewalk Installation 7) Driveway installation 8) Curb installation 9) Sidewalk obstruction .' 10) Water meter installation 11) Fire 12) Occupancy 13) Sign 14) Shoreline 1 5) Home occupation 16) Conditional use 17) Other N - \S\ BUSINESS UCENSE 1} Taxi 2) Peddlers 3) 2nd Hand Dealer 4) Pawn Broker 5) Dance 6) Hotel. Motel 7} Fireworks 8) Ambulance 9} Tattoo shop 1 0) Other ~ ::c E '< o I hereby apply for a Certificate of Occupancy and acknowl- edge that I have .read this application and state that the Date~ information I have supplied is correct to the best of my knowledge. Signed: ~'~~Of~D ~7' "'~5~ ~8U REJECTED Building Section PUbljc Wor~s . D~p~rtment.. Planning Department Fire. Department . City Clerk RBJA ~ "3 ??-{ 8- Comments / Conditions .'" C> ~ o - o t - \'..I \ 5" \../ . ,..~- CERTIFICAT~ O~F OCCUPANCY City of Port Angele~ Building Division This Certification issued pursuant to the requirements of Section 109 of the Uniform Building Code certifying that at the time of issuance this structure was in compliance with the various ordinances of the City regulating Building .. construction or use. For the following: Use Classification: -R:.L Building Permit No.: \ \usiiiess Name: Welcome Inn . Group: ~ 'VN Type of Construction: Use Zone: CO Owner of Business/Residence: Keith Park Address: 1215 W. Hwy 101. Port Angeles. W A 98363 Building Address: 1215_W.Hwy.lOlr ~ _ ~PortAngeles. WA 98362 \~ .- ~ -, ~~.~ / .. .... _ -' __ - - :.-.. - R'_ ~... _ -....-...../ - - .'" P. .. --- -~ ~---- 7 August 1.2002 Building Official , /. Date Post on thepre~s in a g.onspicuous place. Shall not be removed except by Building Official. ROUTING SLIP Certificate of Occupancy . Certificate/Inspection Fee DATE Lf ..... 2- f.7 ..... 2.0 c) 2- Address of Proposed Business 12./;- W6S, HJ6l-jfAI4Y 101_ Applicant I< &- / (H P A /<. ~ Address Phone: New Business ............................ Transfer of Business location. . . . . . . . . . . . . . . . Change of Ownership . . . . . . . . . . . . . . . . . . . . . . New Building .......... . . . . . . . . . . . . . . . . . . . Remodel. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Temporary Business ....................... hange of Use . . . . . . . . . . . . . . . . . . . . . . . . . . . . Brief description of proposed business: HHp ~ (< legal Description: lot Current Use of Property: Zoning Classification of Property: Block 1\TP 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 ............................ f I- Admission charged to patrons. . . . . . . . . . . . . . . . . . ..'V Is this a home occupation? .................. (J'- Excavation ~t til~ing. ot lots ................. ,_:-,::. . . Work done In City nght-ot-way . . . . . . . . . . . . . ~~. . Is there sufficient off-street parking? . . . . . .~ \ '. . . . New driveway openings.............. .G... ... A grading plan tor site drainage. . . . . . . . . . . .. ..... (parking lots, downspouts, etc.) .................. Are the existing streets paved? ... :\\J .. ........ Are there existing sidewalks? . . . . . ~ . . . . . . . . . . . . Is there curb and gutter? ............ ........... Other........................................ . YES NO Subdivision 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 I hereby apply for a Certificate of Occupancy and acknowl- edge that I have read this application and state that the Date: information I have supplied is correct to the best of my knowledge. Signed: 1)f1! REJECTED Building Section Public Works Department Planning Department Fire Department City Clerk P.B.I.A. 4~?.. q -0'2 .r 2R. ~DD 'I-2v;-02.~u 4r2(r200L ~ A--L- ~ Comments / Conditions x ~. ,'ORT .ANGELES ....... ...~,... -', -.. .. ,"," '.'~.' WAS H I N G TON, U. S. A. PUBLIC WORKS & UTILITIES DEPARTMENT July 28, 2004 Welcome Inn Trailer Park Ron Ingwersen 1215 W Hwy 101 Port Angeles, W A 98363 RE: Port Angeles Landfill Waste Disposal Application, WDA 04-15 Mobile home fire damage / furniture debris Dear Ron: We have received your application for disposal ofbuilding demolition debris from the referenced site and reviewed the testing results for asbestos content. Based on the testing results the debris appears to be acceptable for use in the landfill. A copy of your approved application is attached. This approved application must be shown to the landfill scale attendant at the time of disposal. Please be advised that this disposal application is only for the materials and quantities listed in the application. Materials not listed or in excess of the quantities noted may require separate applications and approval. Please call if you have questions. Very truly yours, J~~1r-' GaryW. Kenworthy, P.E. City Engineer Deputy Director of Engineering Services GWK:tf Encl.: WDA 04-15 Copy: Gagnon Busheling Pro West Development LLC ..) N:\PWKSIENGINEER\WDAPPLIC\04-15.WPD FILE: Landfill Solid Waste Disposal Applications 321 EAST FIFTH STREET · P. O. BOX 1150 · PORT ANGELES, WA 98362-0217 PHONE: 360-417-4805 · FAX: 360-417-4542 · TTY: 360-417-4645 E-MAIL: publicworks@cityofpa.us JUL-28-2004 02:02 PM RonLawson To: 136045'9'9532 P.02 WDfY 04-/6 PORTANGELESLAND~L WASTE DISPOSAL APPLICATION CIty of Port Angeles, City Engineer 321 E Fifth Street P.O. Box 1150 Port Angeles, Washington 98362 NOTE: Phone: (380) 417-4803 FAX: (380) 417-4709 All questions must be answered for waste to be approved. 1. Generetor Inform_tlon: Company Name: Mailing Address: Contact: Phone: Project Name: Project Location: tJ,_L CD JIlt ~ I n 1\ (;.tuL6Ji'" ~.rK 1:;"/5 Lc,) Uu.>:y /01 16v-1 A"J~/..s;>s. t.()A- Cf'i3c.r:,3 R",,, 11\!i wer'"5'en J Ce,O '-is"7 I 5 S~ ~L ~~ t- III\. 'I 5ptlt"& /~ / SA I". ~{'5~ , '" 1,;),1"5 W lI~y IPI P~r-rAT1ft'lp~ LLJI} J 2. Other Cont.cta (If applicable): Consulting Firm: 'B--, aJe'ST 1) ~u~lt7f~t!f1I. T" L La. Contact: reo", /-0.. W S'o " Phone: 3 '0 t../ylJ 3"33 'I Contrector Name: t';dsnDn 81L~hpLltl Contact: .::r;,.FF ~~h Dh Phone: .3 '0 9 J.. 'f 3' ~ 0 Laboratory: .No,.T1tbJ~sl A s b~'70$ (' D?1 S'ul..-r;;:" Ii. Contact: 13~ {., W ; n EO'~ I cJ~ ~ Phone: J l.n ..'? 5.? '5 n 5 3 tI ---.----, I i I City of Port Angeles - Landfill Waste Disposal Application Page - 1 ~~~-~~-~v~~ ~L=~L ~M RonLawson 13611145'9'9532 P.03 3. Source of Waste: Check the appropriate box below and briefly describe the project, process, and/or cleanup that will or has produced the waste requiring disposal. Include the gasoline service station number (if applicable). CERCLAlMTCA Remediation Agency Contact: ~ Independent Remedial Action UST Removal - Unused Chemical Product Spill "'" Other Source: r; Y II!" d~'1!!!L 7h Jt1 t'J , , L.e /lI:r/fl'\. e- lL H. ,,75 o.c,J. ~u r/IU Tiir- Ji!. "Tr_ t - d e./ ,.. t So 6Ad. . re~ f J..1.4&. ~Y"~ F/~ , 4. Waste Materi.1 Composition: (check all that apply and include percent of total) 5011 % Foundry Slag _% Concrete/Asphalt % Dredge Sediments _% Preserved Wood % Debris - % Coal Ash % ~ Other (list) ~ Wood Ash 10 % d.". I:, r , $. ,r:,..""., F:.~ ~% , - % NOTE: Total must ecuaI100%. 5. Waste Material Contaminants: (check all that apply) Gasoline Solvents Unused Motor Oil Other. Diesel PCBs Unknown NOTE: Supply any MSDS Information with application, If available. City of Port Angeles - Landfill Waste Disposal Application Page - 2 JUL-28-2004 02:03 PM RonLawson 1360459'9532 P.04 6. Estimated Quantity of Waste for Disposal: .JO- JO Cubie yards I S '). 5 () +!- Dru ms I Tons (estimate both) Tons (estimate both) other NOTE: Estimated quantity for disposal must be within 20% of the quantity actually disposed. (10% for projects over 7,500 tons or 5,000 cubic yards.) 7. Frequency of Disposal: ~ One time Monthly Annual Other a. Waste Sampling: Proper characterization of the waste for disposal requires the collection of representative samples. The methods and equipment necessary for obtaining representative samples of a waste, and the frequency of sampling, will vary with the type and form of the waste. Check the appropriate box and briefly describe how and where the waste was sampled. Include site maps with sampling locations if possible. Number of COMPOSITE samples & number of discrete samples per composite _ Number of DISCRETE samples /; y ~~7J.4J~S 7 1)'$ ~Ti5s. ;-,.a. C7/"~ 1!9 I; "7~ 'tti.'/ :5 ~ ,I(IL.~s , , (1-.. 'C~ Lor; .......1 s NOTE 1: Unless prior approvel has been granted by Port Angeles, the following sampling frequency will be used: 0-25 25 - 100 101 - 500 501 - 1000 1001 - 2000 >2000 cubic yards cubic yards cubic yards cubic yards cubic yards cubic yards = = 1 composite sample 3 composite samples 5 composite samples 7 composite samples 10 composite samples 10 plus one sample for each additional 500 cubic yards =. = = = NOTE 2: One composite sample shall contain a minimum of three/meximum of five discrete samples. City of Port Angeles - Landfill Waste Disposal Application Page ~ 3 - -- -- ____"""T ~""'-. ~~ r .-. ~onL-D.Wson 1361345'99532 P.05 9. Waste Analysis: The IIDangerous Waste Regulations" CNAC 173-303) shall be utilized to determine the appropriate analytical requirements for waste characterization. Ecology Publication #91-30 (Revised April 1994) uGuidance for Remediation of Petroleum Contaminated Soils" shall also be used to characterize petroleum contaminated soils from UST releases. Submit all laboratory analytical results, OAtOe data, and Chain of Custody sheets along with this application. (NOTE: The laboratory must be accredited by the Washington State Department of Ecology.) a) List ell analytical test methods used: b) Provide a narrative as to why the above analytical methods were selected: s~ c.. Lt!JI.,h r~ ~u L 1$ Ir:::' r ,...., , I'L IL"T~ C~ s;,,1-U1~ ~ , NOTE: Additional sheets attached: ~ NO 10. Soil Classification: (""FOR PETRO LEU M CONTAMINATED SOILS ONL Y**) ! Based on the analytical data and Ecology Publication #91-30, the soil classification is: (check one) Class 1 ClaSB 2 Class 3 Class 4 Calculated Hazard Index 11. Dengerous Waste Affidavit: Based on a review of the analytical test results, site history, and the applicable regulations, this waste is classified as: (check one) .~ Neither Dangerous Waste (DW) nor Extremely Hazardous Waste (EHW) Dangerous Waste (DW) and Waste Code: Extremely Hazardous Waste (EHW) and Waste Code: . CIty of Port Angeles - Landfill Waste Disposal Application Page - 4 --- ~~-L~~~ ~~;~~ ~M RonLawson 136045'99532 P.06 12. Certification: We, THE UNDERSIGNED, certIfy that this application Is tNe to the best of our knowledge. All information provided is correct and the enclosed analytical results represent the proposed waste material to the best of our abilities. 12fZ)d:~ Waste Generator Signature ~ /I a.t.d i, . L o.u-> S en- Printed Name IZo tUc:> 'S-,- Oe.(..)(i l. Pf'" ~., Lf. C. Company ? -d-9 - t) q Date N:\PCLICY _P\ 1000_8W\ 1 009_01.WPD CIty of Port Angeles - Landfill Waste Disposal Application Page - 5 JUL-28-2004 02:05 PM RonLawson 136045'99532 P.07 Notification of Demolition Permit It .. unJawflal r.... allY peI'SOn to eaple or .Do.. die delDDIIdoa (or m"or renovation) of I.Y ItnKltIIn u.... all ....... eODIaIJlIn, mor.rtlll hive bee. relllOved hili 'be an. to be demoU.b.... Work.....u IIOt COlll....ace .a ID .....011 prDJect ., dena'-'- un'" the o".er DI' ~r .... ........ "'...... approval from ORCAA. A ....tcea application for a ....OIltlOll ,baD laclude . ~. dult tbere It DO lcaowa "be.tof.aIbt.a1abl1 roatnial naaaI.... Ia t. ana of tile .tru&mln. Project Site Addresl: I~ (5' IA./ 1114)" It.' J County: ~ l aLl. a Nt City: Pr,.,.., ~~ pL p~ State: (..U ~ Zip:q'f3~.J Stl!1ina Date: ~5r. r'f\1&1e / -/" - ocr Completion Date: !!:rr; --,.1.. 1~~o'l .( It.,.. is a 10 warltins day advance notification period hm J'IICeipt of pennlt application) Property Owner. K Ie ,7)1 4,. it Telephone: J 0' do '/I/~ /1 J MaUinaAddreI.: ~/O() ~",rn:..(.wT#'". DI..."J 5'1&,7'; .31$ City: -r: r WI t.~ State: 4P It: Fax:~" dill! "'~.u Zip: '1J? 11>;' D.~1itI01l con~.lor:fY.': ;;::;;; ~"li ~ ~l i 'l3 Ma11ma Addreu: ,J. f. I . City: g.;:.~~-';.ps Contact Penon: ~ c:~ n ~ ~ YES NO V Telephone; State License #: '-0 I State: ftJII ~'() 9~F~' YD <<./ 10 q 1 ~ Zir: 933'5 ~fI Fax: -L' Demolition by Wrockina or Dismmtling? ($25.00 foe) ohec:k # Training Fire Damolition7 (lfya, aUach fire department request for traininS fire) Renovation. Altcnltiol1. Remodelixl&. Maintenance, or other COIlI1rl.lCtiOD.? ~ Albelto. found or nalpected* · All ORCAA MN.... err ....... III :a.mow ... E..,nl- AIh",.." fom\ 1nd ~ t';Ic lnU.t be IUlmda.:l prior 10 any MbcItDI l1Imoval ~I\. Aaba&al l1IIDCMl prq!ec:t. IDvoIvilaa dcInIoUtion ...... be prd'b.mcd by . Ccnif\ccl Aaba&o. Coll~ aDd all ftiablci or paalIlItillly friable ,*,1aI mllll be removed bofOft any demolition beJlM. R.efor Ie OllCAA R.e~~itm I Miele 1" for additicmal requiremellD tn.t may apply. A.betIG. SUJ"'ey Completed by AHERA CertlfJeclln'pedor 12, b I? I- ...,- J ~ i -rIi ..,..., c(~ CertlOc.tioJl Ii W A-O't Q ~ t:;J" '-/j., - 0 ~ hi. approved pmhit muat be available at the job .ite EDelOR 52! ProcesllDI Fee Ccrtlfioatian of the AlbeItDs Survey muat *,=company this form 2940 B Limited Lane NW, Olympia, WNhinp)Q 98502 360-.586.1 G44 · 1100-422-5623 · fix 360"91-6308 hOJ1Ulpap: -.~Ora · ornail: info(fptm:lYI..oJ'1l Il*v,Ollll102 'iI_.~.....___""."....","-.-,.",,~.~ >-~'"'~""""""'''''"''''''''''-''''''-_._;'''''"''''"'~-''-''''''''''"'."''''--''-"'-~''''''~_.'",,- 136045.9.9532 TO:12~q4&633 P.0S JUL-2S-2004 02:05 PM RonLawson JUL:?7-20B4 20:B9 ~RDM~N W R5BESTOS 36e-385-~58q ~ lob l.nratlnn~ Confat"t= P.2 Northwest Asbestos Consultants 406 Reed St. Port Townsend, W A 98368 , 360-385~0584 northweswbestos~onsuhants@cablespeed.com 7/27/04 Welcome Inn Trailer Court and RV Court 1215 w. Highway 101 Port Angeles. WA 98363 Ron Lawson Pro West Development General Man.er: Ron Ingwersen 1215 W. Highway 101 Port Angeles, WA 98362 Subtect: Reiards to: Inspec'o~ Survey, inspection and testing. DemolitiOn of mobile units #14, #1S, #lSA and #45. Bob Withertdge EPA-AHERA-Bulldtng Inspector Management Planner ID# WAMOA..0042..03 Expires.. 10/28/04 --~-~~-~v~~ ~L;~~ ~~ ~onLawson JUL-27-200Q 2e:B9 PROM:N W RSBESTOS 36B-385-e58~ SC'o~ of work 136045'99532 TO:12e62~q6633 P.0'9 P.3 1) BuUdlng survey and Inspection to lnspect for asbestos containing bulldlng materials (ACBM). 2) Survey, sample and record suspect material. 3) Report to Ron Lawson of Pro West Development results of testing. In~pertJon The Inspection staned with a visual survey looldng for Asbestos Containing Building Material (ACBM) requested by Ron Lawson of Pro West Development Four fire damaged mobile unlts.1I!IIit #15, #15A, #4SA The only suspect materials were from unit #4S~ Samplp #1: Sample 'fl: Samplp M3; Samqlp #4~ Samplp #5: East entry. Vinyl With mastic. Red. Bathroom floor vinyl with mastic. Top layer. Cream/gold. Bathroom floor vinyl with mastic. Bottom layer. Tan. Living room, south and west bedrooms. Floor vinyl with mastic. Cream with brown. Celling tUe, 9"x9n. Homogeneous to mobUe unit. JUL-28-2004 02:06 PM RonLawson J UL -.it.( - i::!~16Lt clt:llllt:l H<LJ'): N W ~~!::i I ~ .j~- ~~::,-~ 136045'9'9532 IU:lclObc:!~~bb":)":) ASBESTOS BULK SAMPLE DATA Northwest Asbestos Consultants 406 Reed St. Pan Townsen~ W A 98368 360-385-0584 nonhwestasbestoBcDnsu1tants@cablespeed.com To Clayton Services 4636 E. Marginal Way South. Suite 215 Seattle, WA 98134 ~ 7/14/04 JOh Lnr1itinn~ Welcome Inn Trailer Court and RV Court 1215 W. Highway 101 Port Angeles, WA 98363 Contac~ Ron Lawson Pro West Development C~npral Manai~ Ron Ingwersen 1215 W. Highway 101 Port Angeles, WA 98362 Sub'ecr.: Survey, inspection and testlng. Sample #1~ East entry. Vinyl with mastic. Red. Sample #2: Bathroom floor vinyl with mastic. Top layer. Cream/gold. Sample #3: Bathroom floor vinyl with mastic. Bottom layer. Tan. Sa mplp *4~ LIving room, SOu th and west bedrooms. Floor vinyl with mastic. Cream with brown. Sampl~ *S~ Celllng tile, 9"x9t'. Homogeneous to mobile unit. In$~tn1"! Bob Withe ridge EPA-AHERA...Building Inspector I Management Planner WAMOA - 0042-03 EXI'Jres - 10/28/04 Please call with test results when completed. Thank you, e.,e,(.,)Jl~ Bob Wltnerldge: E.F.M. P. 10 ~." - - - - - - -. ....... -- . ...... - . "' ............ r 1'- .......... :::::;. tJ n J. 36045'395:3 2 JU~-c'-~~~ c~:l~ r~UM:N ~ Hb~~IUb ~b~-~~-~~~ IU:lc~bc~~bb~~ ~.~ Q,-- ~c' ~~la~ ;~nnAS;~~~~~-;~~~;MPLEDATA --'-;';-~lDr3~~~ " . . ~ IA.J' NVLA' LAI CODIIIGu... Lag #~ ~' . ~. d u, 5 I " Y I C I . ........... 'La~......, PrioJtl!.r- .....,. · ell.. -..... __ k ...au ......Nt -.:, ... " . 1-= tt: . P1U1Dtr '" hID". . Client Name:tNordawut AlI__ CoaRI.... COIIaetBu" W'th.rid. J~ Locauond'Welcome IDa TPlIJer .ad BV Cour" Ul' W. RJIb".Y 101 · Pore Antclcl, WA '1363 ~MDt R j. (I ; . LAI.Jt )tlII5,1 . n ~CB: vaiyllMMIk r ~~'fW' ~ &at17 . ' OnmR. FIB'Il.:IIJI Cllllulll.ll S",Iho~ ) La~., HornDJa1jlMld far An II"'. N" A'''''' DIJIHlft AS,EI~ -nopE RaCEin' 0'THEJl 'MATliJUALS Pill" . 81n.. Vin~1 ,u_ .11 ...... , "'.a."e.1~~ ~'''DYDT1ON' LAYU&D ~..,,:.. ~JljHw .....,...,.,,- .......... ... It... E/JIld6I...........,.,., 1It~.... , ~LII..~; WJ[a :I~.1 : I~~ Y1..,I/MaftI, ~1JON: llew.am..Tott LQer . 0'TK!Il .I8RS C.lhI_ ,,...,.. ) lqtn HamopnlBd tor AII.I~. N" A''''' D~ ASBEfl'D8 TYR nR~ ~ W"""~ Pillet . ..". IIGlI1rI V111J1 Plnlll'..... 8tIIdIr ~~"L nli~nm9N' LAYUr.u ~ ..;.a.~..........,.., ,.,..,.:..... "1fIIIn ~ ~ ! Nel- UMMt.....,........,. Wr-lIIlM....... . , i . Q . UrUM 1:11 .: s.aia.tI MMU ~ Rn1.~~1 VJ~III. I LlIa([AT1OH: ............ La,.. r . . OTHBR.PmUS Call....... Olul ,n- ) TI: L.QIn HomoJC!li8cl far Ana'" No A",.... D~ AlIrRATO. TYPE PERCENT 0T'MB1l MAT'A1ITaJ..B "tI.. oil ...... Po.", VI~1 FW.-.. ....... W.ltM11Mi. . I " . ~".rJtL na~lP!'IftIlL LAn.... ..........~ .. "".,.. .... ..~ .,..",.. ~ ~.....,."".....,.,... ..1 ... :- . ~ tJnIiU __...... ....,.IlIttIIWJ.n .-0t8. P. 1. 1. .J ,. . I :IS , " XI 'i .0 ,.i .: , I I " I ~ ". : . \ 20 ,~ 5 ' " . '30 . :1 a; , ,I , 'J6 " .: I 10 'i' . 10 I ~ ~ 2Q as I '. ~'ED BY. Bull wftht:rtllae DA nil 7/24/200& : COMP AJIiY} Nanb.e.. A.IbeItaI 01_.... ~ BY. 0fImIe '-. DATE: 7133nOO4 ANAL YZOD BY: Rawl M..... llRAET .. .. DA t'B: 712712ClCM . , .. =........- . ""'...- .--- -..,...~-- ........... -.......... .......II~~).~ .. r-- _............. _ _......., ......-........ "-~. on. ~......... __.......- .......... ----. -__ "fw.I~"-'" ,..===..........~.-.I__...-..~ ....._.IlI'~.....-:t:_ ..,fUll...... .....____ ___-.. _..Ioo-..._"-...._,.......I__~__ -......... . ........~I ......llt..~..... ~_. JUL-2S-2004 02:07 PM RonLawson JUL:~!:~~~ ~.:.~B _~R..a!1:N III F1S8E2?=!_. __ ~:~~.:;~~~ .A rL..~~ ASB1I:ITOS BULK SAMPLE DATA ~ 'f4.ttJ~3'~.u. JlWlMLA8Q1Q -llnow ca ~U, .1. v I ell h... ............" . _a-:.....". 136045'9'9532 IU:12~qq6633 P.6 "'I~.~~ r.~ .... hI I LoI': 3ft" ft...' ......... ......... ." ...... fit ..,r~ J AIIMI... eou8ft1al. ... 'Wlllallt.... ,.1 ~........ 'W.......1u Tnlhr .ad RY en.... 1215 W. Blab.., SOl. .... AII~. WA tUG " ~: ~.:.. ..&.aa J"'''' , ~~ 'f M.1l"!'tftlr.~::-.... ....... I ) ....... 1I-.--1Ir ~ MIA" r r 11 ~ -~I .._~,..,.. ".". ..rr n'I"II9 nII-" C1t....... aI.- .... ~ ...... .....a., 1IU'- .. ..... --- v..... 1'InIr'" ....... ........ ............ -~_ LA""'" .... "'e~ ........... =-~ ..."". J r..... .. .... ---~JI>>' ~ if ........ ~.:(il w.aa -...t : lI~n.,.., r"," ~ 'l1li o , ux:AnrDf, _-_--......... UlIII , ~ ......... c:.r....... ) &..:r- H......... ~ Ne A.t---., Drt' ~ ..ywa....M rYn ~ . . tntmIl ~ ""1'&'" .1.... ..... .... I ..,a..~'1..~ UYaD ....,.._~~_...___ J --. Mer P.12 . . . " II '. . . I " II .. II .. " .. ~ II .7 ., . "', . '. . .. :l ."' . . , '. .. ANAl. YDD BYI JI:acbd W"'_ D.RA.ET l' 'f' .. ~ DA 'I1t 7f't'112OO4 . . 'AWI'LED BYf .. ~ DA'J'B: 1I1~/JCI04 'CONPAlfYf ~~...4I~~ 1lB(;:L....1n1 ........ 0.\111: 71J.1J2Ia ~ ... - .... ----- ..-- a. ......- ... s.:--..-.............. ==........ ............. -..... ......~-..-.. ..-_ .~._ ._...._............ .....~ __4 _,............___ .......-....... 'IWI......._~............=....__ ......~ -..........-..0.-.._1 - -& . _~'...........__ '*"'-_1 "".... . - JUL-2S-2004 02:07 PM RonLawson .Ju.,.-e:r -&::t:llO... C::li:J: J.l!:I ~I'(Ln'IiN III H:;'~:::lIU~ .jblCJ-~::>-~l:l'i 136045'99532 IU:J,c:t:lt:lc:.....tlt::l..:l..:l P.13 1"". r .. Surn~QI Samples were taken and sent to Clayton Services. Mobile units #1~ #15 and #15A were extremely damaged by flre and I was unable to pul1 any samples. Most areas that were stllllntact were unsafe to enter. I did sample areas of unit #45. That had fire damage to the rear of the mobile. I was able to Identify 5 suspects of ACBM and samples were taken. Test results confirm that samples from unit #45 were nan asbestos containing buUding materlal (see lab results). Sincerely, g~~ Bob Wltherldge, E.F.M. JUL-2S-2004 02:08 PM RonLawson JUL:~?-2e04 20:11 FROM:N W RSBESTOS 360-3e5-e5B~ 136045'9'9532 TO:12062~~6633 P.14 P.B RECEIVED :.-"~ ..J_ ....;/1: O. ...'UO.C...A.... .,Jif': ..... . .....D!..... .,.....-... ..L';I..... ........ iiw/, I .?J~..~;$.".".../ . ".', ~'~~-j..m:RJi(j..... iI~..~.~li\~ ...~ I BV: '1\1> . ~~>--' L,. . .. .. . .H.,. "<'::':"F.:;;"..;,.:;;~ t . . . . ~_..,",._~ _:...~~:..' :~~~':'::~::::~~::'~;".""'""':'~tu1da 11 on 0 f Demo 11 11 on P erm11 It is unlawful for any person to cause or allow the demolition (or major renovation) of any structure unless all asbestos- containing materials have been removed from the area to be demolished. Work shall not commence on an asbestos project or demolition unless the owner or operator has obtained written approval from ORCAA. A written application for a demolition shall include a certification that there is no known asbestos-containing material remaining in the area of the structure. JUL 2 8 2004 ORCAA Project Site Address: /d. L<) fA.) !I LV'; / {J / County: t L aLL a h1 City: ~"j-I !~j pI ps , State: ,.-1-/.,4 zip:Q':93/r,;;L Starting Date: C-s /qtl.&.le 8>> -/(; - ocr Completion Date: h-r;Jy\/Jife 8.-#~Oll *( here is a JO working day advance notification period from receipt of permit application) Property Owner: K. e I Th 4 r J< Mailing Address: ,,-toO 5(?u~ Ce'tT~V" ~ City: 7 if /(rv r L Q.... Telephone: ..J Dt: d- '/ if t, III alvd 'S....rle 315 State: aJ ~ Fax: ,;let- d.l/t/ t?33 Zip: Cf'x:- / Pi> Demolition Contractor: G it Mailing Address: r 15 // City: ~~:T ~eLe~. . Contact Person: . -e F ~ G tLj' n Co f1 YES NO ~ State License #: reO' L( 70 C("7 3, State: tul) Telephone: 3C,D 9';;;"[';J.&. 1[) Fax: Zip: 9:?3'3 ;J /'11- Demolition by Wrecking or Dismantling? ($25.00 fee) check # ~ Training Fire Demolition? (If yes, attach fIre department request for training fIre) L' Renovation, Alteration, Remodeling, Maintenance, or other Construction? - V Asbestos found or suspected*(....e..e ~ J 6)..--tJ r~I;:,R..+-- * An ORCAA "Notice of Intent to Remove or Encapsulate Asbestos" form and appropriate fee must be sub'rrutted prior to any asbestos removal work. Asbestos removal projects involving demolition must be preformed by a Certified Asbestos Contractor and all friable or potentially friable asbestos must be removed before any demolition begins. Refer to ORCAA Regulation I Article 14 for additional requirements that may apply. Asbestos Survey Completed by AHERA Certified Inspector f?g b p y.r ,4 uJ; 711 e v-t d.ye. Certification # LlJ 1t-n1 0 A- CJ 0 <{;)... - 0 ~ his approved permit must be available at the job site Enclose $25 Processing Fee Certification of the Asbestos Survey must accompany this form Rev. 07/11/02 2940 B Limited Lane NW, Olympia, Washington 98502 360-586-1044 * 800-422-5623 * fax 360-491-6308 homepage: www.orcaa.org * email: infoia.!OTcaa.org P 4,1 D :~jj~~~~~':Jn:}~~W :~ 1;: r-'\ ENTRAN~~:.\. ~"'i~8i1l ..... ~ I} ill,,' '. II ~1;;:!!1 4\0 ~SIl ill. . Vl ....to. ~} Iii ~ ,; ~... (x:'. ~ ~.. "-../"V Z '"f . .... . .. (").m \ m -" '1'\)\ - '. ~ \. . 'I'\) I\) .... I' I\) ~ ~ ::.1;;1 'ai" · ~ 1\ ~ \' '\ "' I ,,--I\) · 01 ~\ ~ .0:-''''' \, 0", ,~ ~ >t\ 1\ I I'..' I ~~' ~ . , ~I..', , 1',.;.. () ,'..... (" ...,;, t~,J '\:j n ,<' "ql , (\"')>' ~}> l~~ \~C"l (\:~ ~---l~_\ \0 \.~) .''\, I ,;.:' ~ f'1 ... Cfl (\:') ~-,/ ',~: \.. 1"~';'" l,l',.".l \"1'\ " '~>, ,.,) 'I ,:1 Q\"rl \'..f> Y } '.';"., .':" .'. . " /;'\ (1,~":f' .., 1.1 >~ . .... "U1 >U1 .... 1- ..... . 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CITY OF PORT ANGELES PUBLIC WORKS - ELECTRICAL DIVISION 321 EAST 5TH STREET, PORT ANGELES, WA 98362 ELECTRICAL PERMIT ISSUED: 9/10/2002 PERMIT NO 7816 OWNER/APPLICANT PROPERTY LOCATION JIM HOPPER 1215 HWY 101 W 1215 W HWY 101 Lot: 1-2-3-4 Port Angeles, WA 98363 Block: Long Legal 360/457-1553 Subdivision: UNION ADD T: S: Parcel No: CONTRACTOR ARCHITECT SHAMP ELECTRICAL CONTRACTING IN N/A P.O. BOX 383 Port Angeles, WA 98362-0000 , 98360-0000 360/452-1689 360/000-0000 PROJECT INFO Project Type: COML. MISC. Project Value: $0.00 Occupancy Type: Construction Type: SERVICE REPAIR Occupancy Group: Zoning Use: RTP Electrical Heat: · i !Baseboard 0 KW ,I Riser I ! Underground Service ~ Furnace 0 KW ~'~, Overhead Service Voltage: 240,120 ~ Heat Pump 0 KW L Temp Service Phase: ~:~ 1 I Fan Wall 0 KW Service Size: 200 Feeder Size: 0 PROJECT NOTES WELCOME INN TRAILER PARK SPACE 14A. REPLACE 200 AMP MOBILE HOME SERVICE. REC # 9649 FEES ASSESSMENT Service: $64.90 Additional Feeders: $0.00 Circuit Wiring: $0.00 Temp Service: $0.00 Misc Fee: $0.00 TOTAL FEE: $64.90 AMOUNT PAID: $64.90 BALANCE DUE $0.00 COMMENTS/ACTION NEEDED ELECTRICAL PERMIT INSPECTION RECORD CALL 417-4735 FOR ELECTRICAL INSPECTIONS. PLEASE PROVIDE A MINIMUM 24 HOUR NOTICE. ITIS UNLA t4/FUL TO COVER, INSULATE OR CONCEAL ANY WORK BEFORE IT IS INSPECTED AND ACCEPTED. KEEP PERMIT CARD AND APPROVED PLANS AT JOB SITE DITCH ROUGH-IN / COVER SERVICE FINAL I GENERAL COMMENTS: ROUTING SLIP °' ...... '- Certificate of Occupancy ~J Certificate/Inspection Fee DATE ~ ~ 2- ~'- ,-~ ?~O C~ ~-- Business ............................ Address of Proposed Business Transfer of Business Location ................ 12. l_5- W£5-r I-/ l~ ft. l,~/t~ ? 14) J Change of Ownership ...................... ,/~ Applicant K. ITH New Building ............................. Address Remodel ................................. Temporary Business ....................... Phone: business ('.~O/3 home (:z'o~] 2~'~1~'- ~)Change of Use ............................ Brief description of proposed business', H H p ~ r~ V Legal Description: Lot Block Subdivision Current Use of Property: Zoning Classification of Property: WILL THERE BE ANY OF THE FOLLOWING? YES NO THE FOLLOWING WILL BE REQUIRED: Construction changes ............................ PERMITS BUSINESS MCENSE Electrical changes ............................... 1) Building 1) Taxi Mechanical (heating, cooling, stoves) ....... ~ 2) Plumbing 2) Peddlers Plumbing changes ............................. ~ 3) Electrical 3) 2nd Hand Dealer New or relocated signs ........................... ~ 4) Mechanical 4) Pawn Broker New septic tanks ............................... (7~1~//- 5) Sewer 5) Danc~ Newsewerservice ._ .......................... ~/ ~LT/-- -- 6)Sidewalkinstallation 6)Hotel-Motel iAsdt~:; °hno Cmhea ~cecdu ~ t patrons .................... ~./~7~- 7) Driveway installation 7) Fireworks (.~ 8) Curb installation Ambulance Excavation' of fllhng' ' of lots ...................:~'~ · 9) Sidewalk obstruction 9) Tattoo shop Work done in City right-of-way ............. ~'~'.~ ·/ _ 10) Water meter installation 10) Other Is there sufficient off-street parking? ...... ~:X/k'k. '. /. _ -- 11) Fire New driveway openings ............... -...'('~"<'/?/. .... 12) Occupancy A grading plan for site drainage ............. / ...... 13) Sign {parking lots, downspouts, etc.} ........... / ...... 14) Shoreline Are there existing sidewalks? ..... ~ ./ .......... 16) Conditional use Is there curb and gutter? ........... '~ ........... 17) Other Other .......................................... / I hereby apply for a Certificate of Occupancy and acknowl- edge that I have read this application and state that the Date: information I have supplied is correct to the best of my knowledge. Si9ned: APPROVED REJECTED Comments / Conditions Building Section Public Works Department Planning Department Fire Department City Clerk RB.I.A. CERTIFICATE OCCUPANCY This Certification isaUqd pursuant to the requirements of Section 109 of the Uniform Building Code c~rtif~p~g that ~t the time of iSSuance this structure was in compliance with the var~o~ *f the City regulating Building Use Classification: R-i Buildig~it No.: aTo,,p: R ~ co,~st,~¢tio.: CO o,~.~of~i~/~ia~: ~ Park WA 98363 Bui{ding Address: k 98362 ~, 2002 Date Post on the place. Shall not be removed except by Building Official. CITY OF PORT ANGELES DEPARTMENT OF COMMUNITY DEVELOPMENT - BUILDING DiVISION 321 EAST 5TH STREET, PORT ANGELES, WA 98362 ~pplication Nu~er ..... 03-00000227 Date 3/06/03 Property Address ...... 1215 ~07 W HWY 101 ASSESSOR PARCEL NUMBER: 0363008871805000 Tenant nbr, name ...... SPACE ~100 Application description . . . RES ACCESSORY BUILDING Property zoning ....... Application valuation .... 1200 Owner Contractor ................... ...... Structure Information CANOPY OVER EXISTING MOBILE HOME Const~ction Type ..... TYPE V NON-RATED Occupancy Type ...... GARAGES, CARPORTS, SHEDS ...........................................................................Permit ...... BUILDING PERMIT - NO PR FEE Additional desc . . Permit Fee .... 68.35 Plan Check Fee . . ,00 Issue Date .... 3/06/03 Valuation .... 1200 Expiration Date . . 9/02/03 Qty Unit Charge Per Extension BASE FEE 47,00 7.00 3.0500 ~ BL-501-2K (3.05 PER C) 21.35 Other Fees ......... STATE SURCHARGE 4.50 Fee stutana ry Charged Paid Credited Due Permit Fee Total 68,35 68.35 .00 .00 Plan Check Total .00 .00 .00 .00 Other Fee Total 4.50 4,50 .00 .00 Grand Total 72.85 72,85 .00 .00 o 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 saroe'1~ be true and correct. All provisions of laws and ordinances governing this type of work will be complied with whether spe~'~ ~ not. The granting of a permit does not presume to give authority to violate or cancel the provisions of any state or Iodal law rfll]ui~ting construction or the performance of construction. Signature of Oontractor or Authorized Agent Date 8ig~ture of-~ (if owner is builder) Date T:\PLANNING\FORMS\ I 102.15 [4/2002] BUILDING PERMIT INSPECTION RECORD CALL 417-4815 FOR BUILDING INSPECTIONS. PLEASE PROVIDE A MINIMUM 24 HOUR NOTICE. ITIS 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 YESINO FOUNDATION: FOOTINGS WALLS FOUNDATION DRAINAGE ELECTRICAL (LIGHT DEPT) SEPARATE PERMIT: # PLUMBING UNDER FLOOR / SLAB ' ROUGH-IN WATER LINE GAS LINE BACK FLOW / WATER AIR SEAL WALLS CEILING FRAMING JOISTS / GIRDERS SHEAR WALL WALLS / ROOF / CEILING DRYWALL T-BAR INSULATION SLAB ' WALL/FLOOR/CEILING MECHANICAL HEAT PUMP WOOD STOVE / PELLET / CHIMNEY HOOD / DUCTS PW UTILITIES / SITE WORK IEnglneedng Division) SEPARATE PERM/T #'s: WATERLINE / METER SEWER CONNECTION SANITARY STORM PLANNING DEPT. SEPARATE PERMITit'S SEPA: PARKING/LIGHTING ESA: LANDSCAPING SHORELINE: FINAL INSPECTIONS REQUIRED PRIOR TO OCCUPANCY/USE RESIDENTIAL DATE YES NO COMMERCIAL DATE ACCEPTED YES NO ELECTRICAL - LIGHT DEPT. 417-4735 ELECTRICAL LIGHT DEPT CONSTRUCTION R.W. / PW/ CONSTRUCTION - R.W. ENGINEERING 417-4807 PW / ENGINEERING FIRE 417-4653 FIP,~ DEPT. PLANNING DEPT. 417-4750 PLANNING DEPT. BUILDING 4174815 BUILDING T:\PLANNING\FORMS\1102.15 [4/2002] eOnT~v FOROFFICIALUS O~N~LY: a,°~' ~ Date Rec.: ~' ~ BUILDING PERMIT - APPLICATION Date Approved: Date issued: The Building Permit Application must be filled out completely. Please type or print in ink. If you have any questions, please call 417-4815 Applicant or Agent: 1,6~&/'aV¢~- / .Zg,6~ Phone: ~,5-~- Owner: ~/ta77/ ~.~/21~_/~ /dyq,~ ~:r.~. Phone: ~,5-7-/~-~-2:'~ Address: /.a/6~ /~;z//-- x../~ City: ~T- . ~,~ ~-'t~ ] ~/./A~ Zip: Architect/Engineer: Phone: Contractor License #: Exp: Phone: Address: City: Zip:. PROJ CTA Dm SS: ZONING: LEGAL DESCRIPTION: Lot:._~_~ 7 Block: Subdivision: CLALLAM COUNTY PARCEL NUMBER: Credit Card Holder Name: Billing Address: City:. Credit Card #: Exp. Date: VISA MC TYPE OF WORK: SIZE/VALUATION: [] Residential [] New Constr. [] Re-roof [] Wood-stove SF. ~ $ /SF. =-$ [] Multi-family [3 Addition [] Move [] Garage SF. ~ $ /SF. = $ [] Commercial [] Remodel [] Demolition 51/~ ,De. ck ~g:n~ SF. ~ $ /SF. = [] Repair f3 Sign TQTAL VALUATION $ / BRIEF DESCRIPTION OF THE PROJECT: t~htJtar,tt ~I,~':/Z t/,/,g:'lg/t-Z'-J~gJ~ / CtI~MMERCIAL/RESIDENTIAL:~ Occupancy Group:. Occupant Load: / Construction Type:. No. of Stories: ~ Lot Size: % Lot Coverage: % Existing Lot Coverage: /sq. ft. + Proposed Lot Coverage: /sq. ft.: TOTAL LOT COVERAGE: /sq. PLANNING USE ONLY: APPROVALS: PLAN Notes: BLDG. DPW FIRE ESA/Wetland(s): [] Yes [] No SEPA Checklist required? [] Yes [] No Other: OTHER BUILDING PERMIT APPLICATION SUBMITTAL: Your application and site plan must be filled out completely to be accepted for review. The Building Division can provide you with more detailed information on the application and plan submittal requirements. Your completed application, site plan (for additions) and building construction plans are to be submitted to the Building Division. VALUATION OF CONSTRUCTION: In all cases, a valuation amount must he 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 4174815 for assistance. PLAN CHECK FEE: Your plan check fee is due 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, this 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 107.4 of the Uniform Building Code, current edition). No application can be extended more than once. 1 hereby certify that ! have read and examined this application and know the same to be true and correct, and I am authorized to apply for this permit. I understand it is not the City's legal responsibility to~d~rm~ what permits are required; it remains the applicant's resp°nsibilityt°determinewhatpermitsarerequiredandt°°btainf~u/~F'//~ ~ d'~'~ ~ .~ CITY OF PORT ANGELES PUBLIC WORKS - ELECTRICAL DIVISION .12\ EAST 5TH STREET. PORT ANGELES. WA 98362 ELECTRICAL PERMIT Issued: 3/29/99 Permit No: 6590 oWNER/AppLICANT-----------~------------PROPERTY LOCATION-----------~------------ JIM HOPPER 1215 HWY 101 W 1215 W HWY 101 Lot: 1-2-3-4 Port Angeles, WA 98363 Block: Long Legal: 360/457-1553 Sub: UNION ADD T: sp #12 S: Pare No: CONTRACTOR-----------------------------DESIGNER--------------------------------- BOB'S ELECTRIC 1227 DEER PARK RD. PORT ANGELES, WA 98362 360/457-6887 , 000/000-0000 PROJECT INFO---------------~---------------------------------------------------- prj Type: MOBILE HOME prj Value: $0.00 Occ Type: Cnstr Type: FEEDER Occ Grp: Occ Load: Land Use: RTP Electrical Heat Baseboard KW: Furnace KW: Heat Pump KW: Fan/Wall KW: o o o o Service Type X Riser Overhead Service X Underground Service Temp Service Voltage: Diameter: Service Size: Feeder Size: 120,240 X-I -3 o AMPS 200 AMPS PROJECT NOTES------------------------------------------------------------------- PROJECT FEES ASSESSMENT--------------------------------------------_____________ Service: $0.00 Additional Feeders: $0.00 Circuit Wiring: $0.00 Temp Service: $0.00 Misc MOBILE FEEDER $42.50 TOTAL FEE: Amount Paid: $42.50 $42.50 ================================= -------------------------- TOTAL FEE: $42.50 Balance Due: $0.00 COMMENTS/ACTION NEEDED ELECfRICAL PERMIT INSPECfION RECORD CALL 417-4735 FOR ELECTRICAL INSPECTIONS. PLEASE PROVIDE A MINIMUM 24 HOUR NOTICE. IT IS UNLA WFUL TO COVER, INSULA TE OR CONCEAL ANY WORK BEFORE IT IS INSPECTED AND ACCEPTED. KEEP PERMIT CARD AND APPROVED PLANS AT JOB SITE INSPECTION TYPE DATE ACCItM'Ell COMMENTS YES I NO UITCH J){"\r -IN I CUVER ~(,F. r 1<" ,,...,..., ..J. GENERAL COMMENTS: PW-II02.UI061 ~ ~o::~ CITY OF PORT ANGELES PUBLIC WORKS - ELECTRICAL DIVISION 32\ EAST STH STREET, PORT ANGELES, WA 98362 ELECTRICAL PERMIT Issued: 5/21/98 Permit No: 6312 OWNER/APPLICANT------------------------PROPERTY LOCATION------------------------ JIM HOPPER 1215 HWY 101 W 1215 W HWY 101 Lot: 1-2-3-4 Port Angeles, WA 98363 Block: Long Legal: 360/457-1553 Sub: UNION ADD T: S: Pare No: CONTRACTOR-----------------------------DESIGNER--------------------------------- SHAMP ELECTRICAL CONTRACTING INC. P.O. BOX 383 Port Angeles, vIA 98362 360/452-1689 , 000/000-0000 PROJECT INFO-------------------------------------------------------------------- prj Type: COML. MISC. prj Value: $0.00 Occ Type: Cnstr Type: FEEDER Occ Grp: Occ Load: Land Use: RTP -Electrical Heat Service Type Baseboard KvJ: 0 Riser Voltage: 0 Furnace Kv~: 0 Overhead Service Diameter: -1 -3 Heat Pump KW: 0 Underground Service Service Size: 0 AMPS Fan/Wall KW: 0 Temp Service Feeder Size: 0 AMPS PROJECT NOTES------------------------------------------------------------------- WIRE UNDERGROUND FEEDERS TO NEW RV STALLS. 2 FEEDERS PROJECT FEES ASSESSMENT--------------------------------------------------------- Service: $0.00 Additional Feeders: $67.00 Circuit Wiring: $0.00 Temp Service: $0.00 $0.00 Misc TOTAL FEE: Amount Paid: $67.00 $67.00 --------------------------------- --------------------------------- TOTAL FEE: $67.00 Balance Due: $0.00 COMMENTS/ACTION NEEDED ELECfRICAL PERMIT INSPECfION RECORD CALL 417-4735 FOR ELECTRICAL INSPECTIONS. PLEASE PROVIDE A MINIMUM 24 HOUR NOTICE. IT IS UNLA WFUL TO COVER, INSULA TE OR CONCEAl. ANY WORK BEFORE IT IS INSPECTED AND ACCEPTED. KEEP PERMIT CARD AND APPROVED PLANS AT JOB SITE INSPECTION TYPE DATE ACCKPTED COMMENTS I YES NO UlTCH ROUGH-iN I LUVbK / I l'lNAL 1<-f'K/q)(' I ~~ I GENERAL COMMENTS, PW-II02.IS[4I96) '~';;. ~ &QJ CITY OF PORT ANGELES PUBLIC WORKS - ELECTRICAL DIVISION J2\ EAST 5TH STREET, PORT ANGELES, WA 9HJ62 ELECTRICAL PERMIT Issued: 10/21/97 Permit No: 6092 OWNER/APPLICANT------------------------PROPERTY LOCATION------------------------ JIM HOPPER 1215 W HWY 101 Port Angeles, WA 98363 360/457-1553 ~ T: CLAUDE WILSON <- ' S: 18 1215 Lot: Block: Sub: Pare No: HWY 101 W 1-2-3-4 Long Legal:. UNION ADD CONTRACTOR-----------------------------DESIGNER--------------------------------- OWNER VARIOUS Port Angeles, WA 99360 206/000-0000 , 000/000-0000 PROJECT INFO-------------------------------------------------------------------- prj Type: MOBILE HOME prj Value: $0.00 Occ Type: Cnstr Type: Occ Grp: Occ Load: Land Use: RTP Electrical Heat Baseboard KW: Furnace KW: Heat Pump KW: Fan/Wall KW: Service Type o Riser o Overhead Service o Underground Service o Temp Service Voltage: Diameter: Service Size: Feeder Size: -1 o -3 o AMPS o AMPS PROJECT NOTES------------------------------------------------------------------- EXISTING MOBILE HOME SERVICE - /;?&&/- L.~ ~cfr.~ PROJECT FEES ASSESSMENT----------------------------------~---------------------- Service: $41.00 Additional Feeders: $0.00 Circuit wiring: $0.00 Temp Service: $0.00 $0.00 Misc TOTAL FEE: Amount Paid: $41. 00 $41. 00 --------------------------------- ---------------------------------- TOTAL FEE: $41. 00 Balance Due: $0.00 COMMENTS/ACTION NEEDED ELECTRICAL PERMIT INSPECTION RECORD CALL 417-4735 FOR ELECTRICAL INSPECTIONS. PLEASE PROVIDE A MINIMUM 24 HOUR NOTICE. IT IS UNLA WFUL TO COVER. INSULA TE OR CONCEAL ANY WORK BEFORE IT IS INSPECTED AND ACCEPTED. KEEP PERMIT CARD AND APPROVED PLANS AT JOB SITE INSPEC'IlON TYPE DATE T ACCEPTED COMMENTS r YES INO 11I111GH-1N I CUVhK . ~lCE /O/-.~TT.- -7CMA I FINAl I I I GENERAL COMMENTS, rw-II02.IS(06) o Ditch Inspection O.K. o Rough-in/cover O.K. 41\ !"iO.K. to connect service 7;/lfif{' o Final O.K. . . CITY OF PORT ANGELES LIGHT DEPARTMENT 321 E. Fifth Street Port Angeles, WA 98362 (206) 457-0411 PERMIT NO. . "It, 0 ~ ?/;S/rt . " DATE ELECTRICAL PERMIT Site Address: Sq. Ft. o READY FOR INSPECTION Lice se Number: o WILL CALL FOR INSPECTION Phone: Installed By: /0 I uJ , 2:], <~ U~L J)..:tf\.1.- Owner/Business: Phone: Owner/Business Address: ELECTRIC HEAT o BASEBOARD KW _ o FURNACE KW _ o HEAT PUMP KW_ o FAN/WALL KW U' RESIDENTIAL 0 RISER tJ COMMERCIAL V OVERHEAD SERVICE o NEW CONSTRUCTION 0 UNDERGROUN,D Si;:RVICE o REMODEL VOLTAGE: /2..t)~yO o ADD/ALTER CIRCUITS 0/ 1 rjJ '0 3 ~ }3. SERVICE UPGRADE/REPAIR SERVICE SIZE Zc90 o TEMPORARY SERVICE FEEDER SIZE 2Cl(J C~ S) tf: hi . AMPS AMPS Details/Description: 1l1J..:l ~p I W.S. No. SERVICE SIZE CAPACITY: o O.K. 0 NOT O.K. ACTION REQUIRED: 0 CHANGE TRANSFORMER o INSTALL SERVICE POLE DATE ENGR. o OVERHEAD SERVICE APPROVED o CHANGE SERVICE WIRE o OTHER Site Address: Permit/Receipt No. 0"Cv 0 & d- ~ f.,U, Installer: S ~j4-v\ Li ~ Z/.e.C/tw New Meters Date: ij~~.t Notify Port Angeles City Light by Street Address and Permit Numberwhen ready for inspection. Work must not be covered before inspection and O.K. for covering has been given by the electrical inspector in writing on either the Wiring Report or on the Building ~jt. PHONE 457-0411, EXT. 224. , - / NO OCCUPANCY OR USE ESTABLISHED UNDER THIS PERMIT 1M $ Electrical In~pector If -10 t<i . Permit Fee WHITE - File by address PINK - Top: Eng, Bottom, Customer GREEN - Top: Meter Dept., Bottom: City Hall OLYM~IC PRINTERS INC. \ ---- - , ~ \ " " " ., " , , ' \ " . " \ . , ,. , , ,- , . " , \ " " " \.' ,. \' ). '\ \ \ " .. " , t :...~.. ~ .. ..- . ...\ ,'" , " " .,.;,..".J'. \ \ .. ' . ' ~ . . , \ , (......... "--' . CITY OF PORT ANGELES LIGHT DEPARTMENT 321 E. Fifth Street Port Angeles, WA 98362 (206) 457-0411 ELECTRICAL PERMIT PERMIT NO. S-tj3/ z/zo/l(, . DATE Site Address: /:2./5' ~ W 1+ D READY FOR INSPECTION License Number: D WILL CALL FOR INSPECTION Phone: Installed By: Owner/Business: I~ Phone: OwnerfBusiness Address: I Sq. Ft. ELECTRIC HEAT D BASEBOARD KW ~ D FURNACE KW ~ D HEAT PUMP KW ~ D FAN/WALL KW ~ D RESIDENTIAL D COMMERCIAL D NEW CONSTRUCTION D REMODEL D ADD/ALTER CIRCUITS }&' SERVICE UPGRADE/REPAIR D TEMPORARY SERVICE D RISER )81 OVERHEAD SERVICE D UNDERGROUf)lD SERVICE VOLTAGE:l2c?@0D ~1 r/J D 3'r/J SERVICE SIZE c:: 0 AMPS FEEDER SIZE AMPS Details/DescriPtion:,;;:; rtf-;'Rfr/ ~ ~cL I . W.S. No. SERVICE SIZE CAPACITY: D O.K. D NOT O.K. ACTION REQUIRED: D CHANGE TRANSFORMER D INSTALL SERVICE POLE DATE ENGR. D OVERHEAD SERVICE APPROVED D CHANGE SERVICE WIRE D OTHER D Ditch Inspection O.K. D Rough-in/cover O.K. ~ % O.K. to connect service ..</2.t 19f~ D Final O.K. Site Address: Installer: I CU, Permit/Receipt No. St/.3/ New Meters -,----- . Notify Port Angeles City Light by Street Address and Permit Number when ready for inspection. Work must not be covered before inspection and O.K. for covering has been given by the electrical inspector in writing on either the Wiring Report or on the Building Permit. PHONE 457-0411, EXT. 224. ~ ~ NO OCCUPANCY OR USE ESTABLISHED UNDER THIS PERMIT $ r ..3/) Electr~allnspector Permit Fee WHITE - Fife by address PINK - Top: Eng, Bottom, Customer GREEN - Top: Meter Dept., Bottom: City Han OlYMPICPRINTEASINC ~' ~/ . o Ditch Inspection O.K. o Rough-in/cover O.K. ~.J/l 'ii O.K. to connect service ./(jf'v Y 0- Final O.K. . . --. PERMIT NO. SJ~/ / /If./Y(;, , CITY OF PORT ANGELES LIGHT DEPARTMENT 321 E. Fifth Street Port Angeles, WA 98362 (206) 457-0411 DATE ELECTRICAL PERMIT Site Address: Installed By: /,;2.;5 13 Owner/Business: Owner/Business Address: ELECTRIC HEAT o BASEBOARD KW _ o FURNACE KW _ o HEAT PUMP KW_ o FAN/WALL KW _ o RESIDENTIAL o COMMERCIAL o NEW CONSTRUCTION o REMODEL o ADD/ALTER CIRCUITS o SERVICE UPGRADE/REPAIR o RISER o OVERHEAD SERVICE o UNDERGROUNjd SERVICE VOLTAGE: / a9/.;2}pD 01(11 03~ SERVICE SIZE 262D o TEMPORARY SERVICE FE" ~ZE DetailslDescription: ~ u.r /l1~ ~ ~. l ~~ z/.edu;, ~;j a/~f J AMPS AMPS . W.S. No. SERVICE SIZE CAPACITY: o O.K. 0 NOT O.K. ACTION REQUIRED: 0 CHANGE TRANSFORMER o INSTALL SERVICE POLE DATE ENGR. o OVERHEAD SERVICE APPROVED o CHANGE SERVICE WIRE o OTHER Site Address: New Meters Permit/Receipt No. (j), Installer: /;)/s ~ ~ I Notify Port Angeles City Light by Street A d Permit Number when ready for inspection. Work must not be covered before inspection and O.K. for covering has been given by the electrical inspector in writing on either the Wiring Report or on the Building Permit. PHONE 457-0411, EXT. 224. ..# !t91A1. _ NO OCCUPANCY OR USE ESTABLISHED UNDER THIS PERMIT $ I'" ~O EI clrical Inspector Permit Fee WHITE - File by address PINK - Top: Eng, Bottom, Customer GREEN - Top: Meter Dept., Bottom: Cily Hall ~ OLYM?IC PRINTERS INC. . . ~ . / CITY OF PORT ANGELES LIGHT DEPARTMENT 321 E. Fifth Street Port Angeles. WA 98362 (206) 457-0411 PERMIT NO. S.;16 L 7" k /9"> . DATE ELECTRICAL PERMIT Site Address: Sq. Ft. o READY FOR INSPECTION License Number: o WILL CALL FOR INSPECTION Phone': Installed By: Owner/Business: ~ Phone: Owner/Business Address: ~~ ELECTRIC HEAT o BASEBOARD KW _ o FURNACE KW _ o HEAT PUMP KW_ o FAN/WALL KW _ o RESIDENTIAL o COMMERCIAL o NEW CONSTRUCTION o REMODEL o ADD/ALTER CIRCUITS o SERVICE UPGRADE/REPAIR o TEMPORARY SERVICE o RISER o OVERHEAD SERVICE o UNDERGROUND SERVICE VOLTAGE: o q\ D3111 SERVICE SIZE AMPS FEEDER SIZE c>l.t9O AMPS DetailslDescription: //MIL ~ ~ cp?~ {..1 W.S. No. SERVICE SIZE CAPACITY: o O.K. 0 NOT O.K. ACTION REQUIRED: 0 CHANGE TRANSFORMER o INSTALL SERVICE POLE DATE ENGR. o OVERHEAD SERVICE APPROVED o CHANGE SERVICE WIRE o OTHER o Ditch Inspection O.K. o Rough-in/cover O.K. tJ O. K. to connect service ~Final O.K. Permit/Receipt No. Sc2(, "Z.. New Meters Installer: Notify Port Angeles City Lig t by Street Address and Permit Number when ready for inspection. Work must not be covered before inspection and O.K. for covering has been given by the electrical inspector in writing on either the Wiring Report or on the Building Permit. PHONE 457-0411, EXT. 224. If. .--;;-- NO OCCUPANCY OR USE ESTABLISHED UNDER THIS PERMIT ~ /cP-z...... $ ~u . , Electrical Inspector Permit Fee WHITE - File by address PINK - Top: Eng, Bottom. Customer GREEN - Top: MeIer Dept., Boltom: City Hall OLYMPIC PRINTERS INC D Ditch Inspection O.K. D Rough-in/cover O.K. . k{t>-.O.K. to connect service ~11Iq; D Final O.K. . . CITY OF PORT ANGELES LIGHT DEPARTMENT 321 E. Fifth Street Port Angeles, WA 98362 (206) 457-0411 PERMIT NO. ~c9.;z d'N~s , DATE Site Address: D WILL CALL FOR INSPECTION Phone: Installed By: Owner/Business: Phone: Sq. Ft. ELECTRIC HEAT D BASEBOARD KW _ D FURNACE KW _ D HEAT PUMP KW_ D FAN/WALL KW _ D RESIDENTIAL D COMMERCIAL D NEW CONSTRUCTION D REMODEL D ADD/ALTER CIRCUITS D SERVICE UPGRADE/REPAIR D TEMPORARY SERVICE D RISER ~. OVERHEAD SERVICE b UNDERGROUND ERVICE VOLTAGE: '2. }61 rjJ D 3 SERVICE SIZE ~ AMPS FEEDER SIZE (c~ AMPS DetailslDescription: fr7~ ~ ~~p ~ ~ W.S. No. SERVICE SIZE CAPACITY: D O.K. D NOT O.K. ACTION REQUIRED: D CHANGE TRANSFORMER D INSTALL SERVICE POLE DATE ENGR. D OVERHEAD SERVICE APPROVED D CHANGE SERVICE WIRE D OTHER A), Permit/Receipt No. 0',;20 1- New Meters Notify Port Angeles City ight by Street Address and Permit Number when ready for inspection. Work must not be covered before inspection and O.K. for covering has been given by the electrical inspector in writing on either the Wiring Report or on the Building Permit. PHONE 457-0411, EXT. 224. .Ii .~~ NO OCCUPANCY OR USE ESTABLISHED UNDER THIS PERMIT $ fI> 10 Electrical Inspector Permit Fee WHITE - File by address PINK - Top: Eng, Bottom, Customer GREEN - Top: Meter Dept., Bottom: City Halt OLYMPIC PRINTERS INC- CITY OF PORT ANGELES LIGHT DEPARTMENT 321 E. Fifth Street Port Angeles, WA 98362 (206) 457-0411 ELECTRICAL PERMIT Site Address: #fI? o READY FOR INSPECTION License Number: o WILL CALL FOR INSPECTION Phone: ~ ~~t/f tv Installed By: Owner/Business: Owner/Business Address: ELECTRIC HEAT o BASEBOARD KW ~ o FURNACE KW ~ o HEAT PUMP KW o FAN/WALL KW o RESIDENTIAL o COMMERCIAL o NEW CONSTRUCTION o REMODEL o ADD/ALTER CIRCUITS o SERVICE UPGRADE/REPAIR o TEMPORARY SERVICE Details/Description: ~I 414v1 , {( ~ /n,aA,:J, I ~,,(/sh4~ r;-$c.t2(JrCJ~. PERMIT NO. 9"9'py ~/~/x> DATE Phone: Sq. Ft. o RISER o OVERHEAD SERVICE o UNDERGROUN9-SERVICE VOLTAGE: /dZ-O (.i21D %q\ D3~ SERVICE SIZE FEEDER SIZE .;;2CH) AMPS AMPS W.S. No. SERVICE SIZE CAPACITY: o O.K. 0 NOT O.K. ACTION REQUIRED: 0 CHANGE TRANSFORMER o INSTALL SERVICE POLE DATE ENGR. o OVERHEAD SERVICE APPROVED o CHANGE SERVICE WIRE o OTHER o Ditch Inspection O.K. o Rough-in/cover O.K. .-1~~O.K. to connect service o Final O.K. Site Address: Installer: tv, -#= fJ1 Permit/Receipt No. f/1yt"r New Meters -- Notify Port Angeles Ci y Light by Street Address and Permit Number when ready for inspection. Work must not be covered before inspection and O.K. for covering has been given by the electrical inspector in writing on either the Wiring Report or on the Buildin9--E'ermit. PHONE 457-0411, EXT. 224. ,{I.' ~ ~'1 NO OCCUPANCY OR USE ESTABLISHED UNDER THIS PERMIT $ ;r.3 0 Else ricallnspector Permit Fee WHITE - File by address PINK - Top: Eng, Bottom, Customer OLYMPIC PRINTERS INC. GREEN - Top: Meier Dept., Bottom: City Hall . CITY OF PORT ANGELES LIGHT DEPARTMENT 321 E. Fifth Street Port Angeles, WA 98362 (206) 457-0411 ELECTRICAL PERMIT Site Address: PERMIT NO. f"'? ~ r DATE ~/,8//5rr Installed By: READY FOR NSPECTION License Number: o WILL CALL FOR INSPECTION Phone: ELECTRIC HEAT D BASEBOARD KW _ D FURNACE KW _ o HEAT PUMP KW_ D FAN/WALL KW _ D RESIDENTIAL D COMMERCIAL o NEW CONSTRUCTION o REMODEL D ADD/ALTER CIRCUITS D SERVICE UPGRADE/REPAIR D TEMPORARY SERVICE Phone: Sq. Ft. D RISER (!1fOVERHEAD SERVICE D UNDERGROU~ SE5VICE VOLTAGE: JZ& 2..0 ~116 D316 SERVICE SIZE ~ AMPS FEEDER SIZE ~ AMPS DetailslDescription: c~hA-.> ~Lif SP~ ~7 - ~c!- ;Z;;iM . , W.S. No. SERVICE SIZE CAPACITY: D O.K. D NOT O.K. ACTION REQUIRED: 0 CHANGE TRANSFORMER D INSTALL SERVICE POLE DATE ENGR. D OVERHEAD SERVICE APPROVED D CHANGE SERVICE WIRE o OTHER o Ditch Inspection O.K. o Rough-in/cover O.K. ~ 1'4-. O.K. to connect service o Final O.K. Site Address: .# Installer: Permit/Receipt No. -r~ y9" New Meters . Notify Port A geles City Light by Street Address and Permit Numberwhen ready for inspection. Work must not be covered before inspection and O.K. for covering has been given by the electrical inspector in writing on eitherthe Wiring Report or on the Building Permi . PHONE 457-0411, EXT. 224. NO OCCUPANCY OR USE ESTABLISHED UNDER THIS PERMIT $ WHITE - File by address PINK - Top: Eng, Bottom. Customer OLYMPIC PRINTERS INC. ~tJl 00 Permit Fee GREEN - Top: Meter Dept., Bottom: City Hall CITY OF Powr ANGELES PERMIT APPLICATION Building Division/Electrical Inspections 321 East Fifth Street — P.0, Box 1150 1 Pont Angeles W.Ishin�torl' �8362 Ph - (360) 417-473i Fax. (360) 417-4711 DaW 9/5/2013 - I & 2 Single Family Dwelling I(ECEIVEp SEP 5 ELEC,TRJCAL "N [J' ' Plan Review Wy Be Required, P ose Complete Eleclrical Pian Review Informatiotl shwt JtbAdftsS� 1215W Highway lol SUIldmg Square Fcotaae: — ---- Owner Information HM, 0, Unch[nLeroV m Aftoss: _1z'3wt1_ghway'�1 City; _Port Angeles A ? .jp: _!8 P�*N; 2069724752 Item u9t Charge SmviceftOot 200 Afro, S QUO SerkOeadof 201.400 Amp. 3146,00 Servqcejfo,� dof 401-6M Amp $205,00 SeNlce/Fmdef (1014U Amp, 42100 uric Feeder Dyer 1000 Ate, Branch Umuk W/ Service RaMef Branch CirruR WONMcm Feader S 63,00 Each Addtional Branch Circa &M Drench Ck;�dts 1.4 75.W Temp. SeNice /Fawner 2(10 Amp, M.00 Temp, SeMcOeeoer 20140 Amp, $110.00 Temp. Serv!WFesdet 401 �KO Amp, $ 149,0D Temp, 05'ervicefFeedef 601,00 Amp IGHO Pwal to polal. Hourly; S W•00 Signal 040 Umiled Energy- i & 2 F,�rnlJy Ing $ 64.00 Manufadured I*me coanscVon $12040 Renewal* EfeWical Energy - 5KVA System or less $102,00 Nrm,oMal $ 56-00 Note: $5,00 W each adftng T-Sial NEW CQN§jRP0tqN-QN�y: Fht 1300 square Ft $ 120.W Each ftfi Tonal l"40 &Wma ft ot Porticn of $ 40.00 Each OWNA(rog % wtached GarAgo $ XW Eadt Symming Pool or Hol. Tub $110,00 Contractor InformaHon NOMW. Protect Your Home M A6efeS$: j750 Priority Way South Dr ndianapolls N �.G240 _ Gt$ _�_ 24 __ FJVHO, _ �66-502-3559 Fa%: 317-564-2547 FXp, PPOTEYH 934RS exp 12/10/2013 Total (QtV Multiplied �y,Unit Chargel 64�1111 $--_64_00 Total Chyner as defined by RCK%28.261, 11) Owner will occupy the strwtore for two years after this eledrical permit Is finalized, (2) Owner ifl mriuked to hire an el trial contactor if above saki }property is for sole, rent or Pefrnit expires after six moflihs of last inspection, After readffV the above statement, I hereby cer6fy, that I am the owner of the above named property or a Ilmosed eiectdcal coatrzd% lam mak' Ing the elaftal insliall000n or alterallon In Comphans with the elecirkM lam m, NZG., ROW. C*. ter 19,28, WAC, Chapter 296-4 M, The City of Port Angeles Municipal Code, and Utility Speciricaftis and PAMC 14,05,050 regarding FJeftal Perrdf Apoicarions, Signature of owner, electrical contractor or electrical administrator, 0 Cosh 0 Check 0 cmilit Cod L'�&Uel '-Waa& Wd� 9/5/2013 —Vt — ELECTRICAL PERMIT CITY OF PORT ANGELES 350- 4174735 Application Number . , . . . 13- 00001011 Date 9%06/13 Application pin number . . , 289030 Property Address . . . . 1215 W HWY 101 ASSESSOR PARCEL NUMBER: 06-30-08-5-1- 0200-0000- Applicaticn type. description ELECTRICAL ONLY Subdivision Name . . . . . . Property Use . , . . . , . , Property Zoning . . . , . , , RESIDENTIAL TRAILER PARK Application valuation , , . . 0 ---------------------------------------------------------------------------- Application desc Security system Owner Contractor UN CHIN INC PROTECT YOUR HOME 8817 WELLER RD $W 3750 PRIORITY WAY SOUTH DRIVE LAKEWOOD WA 9849$ #200 TNDTNAPOLTS IN 46240 (317) 810 -4720 ---------------------------------------------------------------------------- Permit . . . . . ELECTRICAL ALTER RESIDENTIAL Additional desc , . Permit Fee 64.00 Plan Check Fee .00 Issue Date . . . . 9/06/13 Valuation . . . , 0 Expiration Date . , 3/05/14 Qty Unit Charge Per 1,00 64.0000 ECH E ----------------------------- Fee summary Charged ------- ---- - - - - -- --- - - - - - -- Permit Fee Total 64.00 Plan Check. Total 00 Grand Total 64,00 Extension L- SINGLE CIR LIMITED RES 64.00 ----------------------------------------- Paid Credited Due ---- - - - - -- ---- - - - - -- --- - - -- - -- 64.00 .00 .00 .00 .00 00 64.00 .00 00 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 -IN FINAL COMMENTS: PERMIT WILL EXPIRE SIX (6) MONTHS FROM LAST INSPECTION T Signature of owner or Electrical Contractor X Date: G:IEXCHANGEIBUILDING