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1502 PCC West E Lauridsen Blvd - Cl & grading
+04 PORTF( CITY OF PORT ANGELES T FN PUBLIC WORKS & UTILITIES 321 EAST 5TH STREET PORT ANGELES,WA 98362 Application Number 10 00000721 Date 7/16/10 Application pin number 836230 Property Address 1502 PCC WEST E LAURIDSEN BLVD REPORT SALES TAX ASSESSOR PARCEL NUMBER 06 30 14 2 1 0000 0000 on our state excise tax form Application type description PUBLIC WORKS UTILITES Y Subdivision Name to the City of Port Angeles Property Use Property Zoning (Location Code 0502) Application valuation 0 Application desc RCP #10 21 Owner Contractor STATE OF WASHINGTON HOWARD S WRIGHT CONSTRUCTRS LP GEN ADMIN PO BOX 34449 OLYMPIA WA 985041000 SEATTLE WA 98124 (206) 447 7654 Permit RIGHT OF WAY Additional desc RCP # 10 721 Permit pin number 169474 Permit Fee 150 00 Plan Check Fee 00 Issue Date 7/16/10 Valuation 0 Expiration Date 1/12/11 Q Qty Unit Charge Per Extension �] 1 00 150 0000 ECH RIGHT OF WAY PERMIT 150 00 1_ Special Notes and Comments Traffic control per attached revised plans Notify City Inspector prior to start of work by calling 360 417 4831 Minimum 24 hour advance notice of work requiring traffic revision(s) provided to entities listed on attached PSA contact list All work in the ROW be according to the plans approved under the applicable C&G Permit Fee summary Charged Paid Credited Due Permit Fee Total 150 00 150 00 00 00 Plan Check Total 00 00 00 00 R-1Grand Total 150 00 150 00 00 00 �r Separate Permits are required for electrical work,SEPA,Shoreline ESA,utilities private and public improvements This permit becomes Q— 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 presumeive authority to violate or cancel the provisions of any state or local law regulating construction or the performance of cons uction. L'h /b L /o Signature of Contractor or Authorized Agent Date Signature of Owner(if owner is builder) Date T\Policies\1102.15[10/08] PERMIT INSPECTION RECORD 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 INA CONSPICUOUS LOCATION KEEP PERMIT CARD AND APPROVED PLANS AT JOB SITE INSPECTION TYPE -7DATE ACCEPTED COMMENTS YES NO PW UTILITIES (Engineering Division) WATERLINE/METER SEWER CONNECTION SANITARY STORM SITE DRAINAGE SITE EROSION CONTROL PARKING SIDEWALK CURB&GUTTER DRIVEWAY APPROACH BACK-FLOW DEVICE FINAL,INSPECTIONS REQUIRED PRIOR TO OCCUPANCYJUSE RESIDENTIAL DATE YES NO COMMERCIAL DATE ACCEPTED YES NO CONSTRUCTION RW /PW/ CONSTRUCTION R.W ENGINEERING 417-4831 PW/ENGINEERING FIRE 417-4653 FIRE DEPT PLANNING DEPT 417-4750 PLANNING DEPT BUILDING 417-4815 BUILDING T\Policies\1102 15[10/08] COPY ID Y' 'Fg K- f LION L lu City of Port' Ani;efes NAME Of' f7 i_' i '-0 1 R i C. t tW- Psn li 4Nnrks an ,ties De CONTR,e,CTC ID i,40 (it worksis ove, -3500) MAILING ADDRESS 601 -6A Ate 15, 5., Ino A Sea4l'e W—A 9 IZd (44!Z PHONE NUMBER STREET ADDRESS OF PROPOSED WORK 1 C _C�►urr,'d 5►ei. g),tc1 ,r� (�� DESCRIPTION OF WORK(include drawings required for clarity):(If street closure is requested, please state the name of the street and limits of closure,together with the duration of closure.] r a 'c- Vb ►�. L�(.�:1, css • -i'�r �'1� l.r-�-t ar C d{' �r►n,u• �� WHAT IS THE ESTIMATED COST OF THE PROJECT? -45 000 WHAT IS THE ESTIMATED DURATION OF THE PROJECT? WHAT ARE THE HOURS OF WORK? I et w% — 4 30 pvv% LIST THE CONTRACTOR(S)THAT WILL BE DOPING THE W RK. f G F�st Gaya N+-� 1-a�145, d� T ay,vw . 4-6,-s- 5 (, 1 ,y (✓,o r s d roc�a�s HOLD HARMLESS and INDEMNIFICATION AGREEMENT In compliance with the Port Angeles Municipal Code,and in consideration of the issuance by the City of Port Angeles of a Right Of Way Con #01719 rmit to the undersigned allowing the construction of the above described work,the undersigned permittee shall(tdjr IS�Jess from,and defend the City against,any claims for personal injury or property damage arising out oi*�r' �dVn d with,the performance by the permittee of any work within the rights-of-way of the City pursuant to NAyee—Frrl�i ,�•9 �,{#. �? 0 T A g i t DATED this `1 - day of LLL ,20 t rO -- _ --. -03T01742 - �1 Cso��tn t„ V B 0L } 2 ` Applicant 'A, //z���/�r/ A ``\` NOTARY residing at t �I .�cr WgE L �� ' My commission expires: :g_ t_ 1 -2 (This permit,if approved,may be terminated by the City of PortAngeles without cause and at any time) (OFFICE USE Oft Y7 Date application received to Fee paid$ 1 S Q Receipt# Date Certificate of Insurance er PAMC 11 08.110 re eived Ie t-, i a Temporary Traffic Control Plan Approved on -1 14 N/ Performance Bond Received on N/ Application reviewed and recommendation by City EngineerD a z g f 0 is to den �r nd i the following conditions: _ i a ¢f rc ire , t�j't.+.. ..r. tZ� - �e/.!r `r zr✓r a r�.e i � /1 e SIV- CO-i7' t A It oyJ4 Yh '-#k, d2aW µ, dl^ be a C-Zar f e rr lar`d a. pnli "4,r fl r -pioltcabie C i (, 10,ir tt Approved copies to: Applcant Fire O Police O Street O Other—O Address file O RCP# 1 �� MPMSIENGINEERIROW Construction/June 2010 ROW Construction PermitApplicatlon Public Service Announcement Contact List Notify minimum 24 hours in advance of planned work requiring traffic revision(s) Peninsula Daily News news@peninsuladailynews.com Newsradio 1450 KONP news@konp.com office@konp.com Clallam Transit System Terry Weed / General Manager & Public Information Officer tweed0clallamtransit.com City of Port Angeles Teresa Pierce/ Executive Communications Coordinator tpierce@cityofpa.us CERTIFICATE OF LIABILITY INSURANCE 06/17/DI_ PRODUCER LIC #0726293 1 415 391 1500 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Gallagher Construction Services/ ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE Arthur J Gallagher & Co Insurance Brokers of CA Inc HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 1 Market St Spear Tower #200 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW San Francisco CA 94105 INSURERS AFFORDING COVERAGE NAIC# INSURED INSURERA:ZURICH AMERICAN INS CO 16535 [WA] Howard S Wright Constructors LP INSURERS: 501 Eastlake Ave E Ste 100 A INSURER C: Seattle WA 98109 INSURER D: INSURER E: COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED.NOTWITHSTANDING ANY REQUIREMENT TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSRD0'L POLICY EFFECTIVE POLICY EXPIRATION LTR NSRTYPE OF INSURANCE POLICY NUMBER / LIMITS A X GENERAL LIABILITY GL04277092 05 (WA) 11/01/09 11/01/10 EACH OCCURRENCE $ 2,000,000 DAMAGE TO RENTED X COMMERCIAL GENERAL LIABILITY PREMISES Ea occurrence $ 1,000,000 CLAIMS MADE 7 OCCUR MED EXP(Any one person) $ 10,000 X STOP GAP-WA PERSONAL&ADV INJURY $ 2 000,000 X $IMM E L Limits GENERAL AGGREGATE $4,000,000 GENT AGGREGATE LIMIT APPLIES PER: PRODUCTS COMP/OPAGG Is 4,000,000 POLICY X PRO-jrCTLOC A AUTOMOBILE LIABILITY BAP4277093 05 11/01/09 11/01/10 COMBINED SINGLE LIMIT $ 1 000 000 X ANY AUTO (Ea accident) ALL OWNED AUTOS BODILY INJURY $ SCHEDULED AUTOS (Per person) X HIRED AUTOS BODILY INJURY $ X NON-OWNED AUTOS (Per accident) PROPERTY DAMAGE $ (Per ccident) GARAGE LIABILITY AUTO ONLY EA ACCIDENT $ ANY AUTO OTHER THAN EA ACC $ AUTO ONLY, AGG $ EXCESS/UMBRELLA LIABILITY EACH OCCURRENCE $ OCCUR F—I CLAIMS MADE AGGREGATE $ DEDUCTIBLE $ RETENTION $ $ WORKERS COMPENSATIONWC STATU- OTH- AND EMPLOYERS'LIABILITY y/N TRYLI, I ER ANY PROPRIETORIPARTNER/EXECUTIVE E.L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? ❑ (Mandatory in NH) E.L.DISEASE EA EMPLOYE $ If yes.descnbe under SPECIAL PROVISIONS below E.L.DISEASE POLICY LIMIT I$ OTHER DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS HSW Job #64135 RE Maier Hall & West Campus Improvements ADDITIONAL INSURED The City of Port Angeles CERTIFICATE HOLDER CANCELLATION 10 Day Notice for Non Payment of Premium HSW Job #64135 SHOULD ANY OFTHE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION The City Of Port Angeles DATE THEREOF THE ISSUING INSURER WILL 0QR9Q =MAIL 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT 8CXXXXX14EX3Z1DX%XXZXKX WAgXXY40LT2907*XgIXXZXXTKY40UM= 3=70=xx 321 East Sth Street P O Box 1150 OiQ97F7FJSKM=X CXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX Port Angeles WA 98362 AUTHORIZED REPRESENTATIVE jJ USA /`/ ACORD 25(2009/01)lingar ©1988-2009 ACORD CORPORATION. All rights reserved 16243630 The ACORD name and logo are registered marks of ACORD IMPORTANT If the certificate holder is an ADDITIONAL INSURED the policy(ies) must be endorsed. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). If SUBROGATION IS WAIVED subject to the terms and conditions of the policy certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). DISCLAIMER This Certificate of Insurance does not constitute a contract between the issuing insurer(s),authorized representative or producer and the certificate holder nor does it affirmatively or negatively amend, extend or alter the coverage afforded by the policies listed thereon. ACORD 25(2009/01) POLICY NUMBER. GL04277092-05 COMMERCIAL GENERAL LIABILITY CG 20 12 05 09 THIS ENDORSEMENT CHANGES THE POLICY PLEASE READ IT CAREFULLY ADDITIONAL INSURED - STATE OR GOVERNMENTAL AGENCY OR SUBDIVISION OR POLITICAL SUBDIVISION - PERMITS OR AUTHORIZATIONS This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE State Or Governmental Agency Or Subdivision Or Political Subdivision AS REQUIRED BY WRITTEN PERMIT information required to complete this Schedule, if not shown above, will be shown in the Declarations. Section II — Who Is An Insured is amended to in- 2. This insurance does not apply to: clude as an insured any state or governmental a. 'Bodily injury' 'property damage' or 'personal agency or subdivision or political subdivision shown in and advertising injury' arising out of operations the Schedule subject to the following provisions. performed for the federal government, state or 1 This insurance applies only with respect to opera- municipality, or tions performed by you or on your behalf for which b. 'Bodily injury' or 'property damage' included the state or governmental agency or subdivision or within the 'products-completed operations political subdivision has issued a permit or au- hazard' thorization. CG 20 12 05 09 0 Insurance Services Office, Inc. 2008 Page 1 of 1 ❑ SUPPLEMENT TO CERTIFICATE OF INSURANCE DATE 06/17/10 NAME OF INSURED: [WA) Howard S Wright Constructors LP Additional Description of Operations/Remarks from Page 1 Additional Information: GENERAL LIABILITY *Additional Insured as required by permit Form CG 20 12 05 09 SUPP(05/04) 1 '1:. 4 XPi'���,r�r�.-ti'C'^�'c:iS, �' �.='Ssv:� d• - .^s. ��"„�`'"'^ i S -L CA ,OL. -IV s.r+oS "Of moll. ov ,�i. ,.I:�•�� >. "�' .{ .�' rN '-}!' s�° :}' is tai-.., i `• .S Gsi iC' . N r':Y ' .. .. .. ..... . ..t' ty -, �' _ .�f.4. �.ChY•'+.,.,,"�2='p�-^. ..._ ... i�� _.:>.. P .3. ,_. �i-.� - .. .- _. _: .�. ta�'ti � ..j; `, �s�y�.4 -SSY•`c s�,.{-..._."��:- £:S.^n$- fuer ,nt;' _ �.# fir•r �"`:;i-�i,''`'f�',i �'ti1'1�� v:e.".H�.::s%a' ..:.i_:_�...._. _ ..�_ .�.____ .__._�_ ____ ._. ..__ .__ _ .'.?^r s 414 4-: _ ��•�.= yF . s�l 't 0��41A'M Mq 0-1.Maw,k- IT, slyl. all NO 42 Pig', P R i�T If 207111:- 4, nw I'll, PAM, Rm "W r iyfi V4.— 4c 1. Ai- "FIT <4 41 —;1'; I'Vl ni", z ,V- 7 WQ� 41AW,--W OF it tO 'W A N1,.- -.t•.N ��.,`�;i:�; ,cCr,*„c:.y,+.^y--:. y �;.r,'�'.7`:;kdL`...._ .._ r.,:��. •.i+ •.'y��^; k �'.ha�s" �� Wi W ..w- 0-�%., 4- 6 4 YN xi IA .tile- d. 3 A: 71 'A X 7�,,�-X J, pfv 7;M, 44eg? -7 -F9 P PCe AVi t-U 0 I.P Ek. :.Olt -Ikll� L Rl 4 A6, CA 6ZoJ�P-z -tit C70 LAUIZIDSSYl.Z-. IVD 21- MA-2110 S�7 "4 dA i: ........... i. 4N, 0.;i, -Piz. pc-4 LAI -A c t• 3 {, ��. . �•. LAS R: qkJI •� >:;,�r T:��. 4.4F F;f'^«.Sj9 rYr,"`• :r$+ r :ti":`•. ;?:.y,,,.",a`:`• rA; '"';t ev '-�a'�N.^v.ry'„A.:yu �'4s•�r'M� h 'r#>�ilfra(. k�• y � iF v��. '3•� �_:�`,:P4., -fi:t`; ,� yg ,,r:pct •N•�-�'-t�• ,3-.:?f 'q. .:-.ix: Fv' ,G�:"; �.= •_ , ra_ n ;i.,_ µ;, ;Jr �. f. t _ 71'.,",�t�:7i711 .- :o�.r :Yt:3;"?:' �,,r.>. _��H'f,V-``J• ,;�a>r. .q a�+'u''�rf�' + k � '� .-.' ., .,L+' •.y�>�r'?ji i3r'r-`+. ".�P%. '���,uv '13 .I, ,{t r,� CA' ;ir �. �,�•t 'r.J: ;fitJi w{ `� :li% .j J �,{• Vis: re:' :i Woe .�»^ -v.. ,•k. eh :M',' '.iY, ,"'Y. `,r'+"'.tom ,�. s• ':,• �=� Com.: �?': `'' �t=' 1 ! .�'� lA. ,�4� :1 S�•�,J{w-44yy,,,--.`+{r•e•'1�`�r J�. ,fir S •.�u: t "t rxf; FLAGGER'S CERTIFICATION HANDBOOK Suggested Advance Warning Sign Spacing Road Type 'Speed Distance between Signs 30 A B C 25 Urban(low speed) 100 ft. 100 ft. 100 ft. 350 ft. 350 ft. 40 Urban(hi-h speed) 150 ft. W3. Rural 500 ft. s00 ft. 500 ft. "M A 'Al - Expressxav/Freewav 1 �5 1 000 ft. 1 500 ft 2,640 ft. + Reference:MUTCD 6.2.1 Highways 0 W, A serves of three or four advance warninc, N hF scans are usually used ahead of a work area. CB A TRANSITION On hiahways, the first warnina sign should AREA be placed at least 1,500 or 2,000 feet before 4> the transition area,point of restriction, or flaq,,er station. Additional warninc, signs are placed at 500-foot intervals approaching I ya the work area. The distance of the flagger station from the work space is determined by the speed limit(see table on page 3-1 6E I Graphic) i A 6.2.2 Freeways t DR- A Specifications in V MMS— he MUTCD require the 5 II' RES-, first warning sign to be placed approxi MM TRAN 11 1 mately one mile ahead of the transition 2640 FF 1500 FT 1000 FT A area and, if needed, a second sign 2,640 feet(or about one-half mile) ahead of the transition area.A third advance warning sign would be placed 1000 feet ahead of the transition area. Y . 6.2.3 Cities < City work zones are more restrictive. M —M 'W because of narrow streets and short IT distances between intersections Signs WUKY,AREA should be placed near the edge of the roadway to be visible but should not 90 obstruct traffic ll�N 1z ;:4 As a general rule signs should be placed Wi approximately 100 feet apart in cities 6-7 v 'V Kors%vy.. a rg N Op pORT,,,ti,CE CITY OF PORT ANGELES PUBLIC WORKS & UTILITIES 321 EAST 5TH STREET PORT ANGELES,WA 98362 Application Number 10 00000425 Date 7/14/10 Application pin number 171525 Property Address 1502 PCC WEST E LAURIDSEN BLVD REPORT SALES TAX ASSESSOR PARCEL NUMBER 06 30 14 2 1 0000 0000 Tenant nbr name PENINSULA COLLEGE on your state excise tax form Application type description CLEARING & GRADING to the City of Port Angeles Subdivision Name Property Use (Location Code 0502) Property Zoning Application valuation 0 Application desc Peninsula College Soccer Field C&G #10 04 Owner Contractor STATE OF WASHINGTON HOWARD S WRIGHT CONSTRUCTRS LP GEN ADMIN PO BOX 34449 OLYMPIA WA 985041000 SEATTLE WA 98124 (206) 447 7.654 Structure Information 000 000 SOCCER FIELD Permit CLEAR & GRADE Additional desc GRADING & FILLING Permit pin number 164509 Permit Fee 110 00 Plan Check Fee 00 Issue Date 7/14/10 Valuation 0 Expiration Date 7/14/11 Qty Unit Charge Per Extension BASE FEE_ 110 00 O Permit CLEAR & GRADE Additional desc CLEARING & DRAINAGE Permit pin number 164525 —Q Permit Fee 75 00 Plan Check Fee 00 Issue Date 7/14/10 Valuation 0 Expiration Date 7/14/11 Qty Unit Charge Per Extension BASE FEE 75 00 �o Permit CLEAR & GRADE Additional desc ENG REVIEW STORM WATER Permit pin number 164533 Permit Fee 400 00 Plan Check Fee 00 Issue Date 7/14/10 Valuation 0 Expiration Date 7/14/11 Qty Unit Charge Per Extension BASE FEE 300 00 4 00 25 0000 ECH PW ENG REVIEW STORM WATER 100 00 Permit CLEAR & GRADE 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 presum ive authority to violate or cancel the provisions of any state or local law regulating construction or the performance of const r cti n. Sign ure o Contractor or Authorized Agent Date Signature of Owner(if owner is builder) Date T-\Po1icies\1102.15[10/08] PERMIT INSPECTION RECORD CALL 417-4831 FOR UTILITY INSPECTIONS PLEASE PROVIDE A MINIMUM 24 HOUR NOTICE ITIS UNLAWFUL TO COVER, INSULATE OR CONCEAL ANY WORK BEFORE INSPECTED AND ACCEPTED. POST PERMIT INA CONSPICUOUS LOCATION KEEP PERMIT CARD AND APPROVED PLANS AT JOB SITE INSPECTION TYPE' DATE ACCEPTED COMMENTS YES NO PW UTILITIES (Engineering Division) i WATERLINE/METER SEWER CONNECTION SANITARY STORM SITE DRAINAGE SITE EROSION CONTROL PARKING SIDEWALK CURB&GUTTER DRIVEWAY APPROACH BACK-FLOW DEVICE FINAL INSPECTIONS REQUIRED PRIOR TO OCCUPANCY/USE RESIDENTIAL DATE YES NO COMMERCIAL DATE ACCEPTED YES NO CONSTRUCTION RW /PW/ CONSTRUCTION R.W ENGINEERING 417-4831 PW/ENGINEERING FIRE 417-4653 FIRE DEPT PLANNING DEPT 417-4750 PLANNING DEPT BUILDING 417-4815 BUILDING T\Policies\1102.15[10/08] CITY OF PORT ANGELES PUBLIC WORKS & UTILITIES 321 EAST 5TH STREET PORT ANGELES, WA 98362 Page 2 Application Number 10 00000425 Date 7/14/10 Application pin number 171525 REPORT SALES TAX Additional desc onour state excise tax form Permit pin number 168500 y Permit Fee 770 00 Plan Check Fee 00 to the City of Port Angeles Issue Date 7/14/10 Valuation 0 (Location Code 0502) Expiration Date 7/14/11 Qty Unit Charge Per Extension 10 00 55 0000 HR PW INSPECTION 550 00 4 00 55 0000 ECH PW ENG ADDITIONAL REVIEW 220 00 Special Notes and Comments July 14 2010 8 31 30 AM permits No comments or conditions All work must be done according to the Bruce Dees and Associates 18 sheet plan set dated 6/10/10 as well as the stormwater site plan sealed by John Knowles 3/25/10 Fee summary Charged Paid Credited Due Permit Fee Total 1355 00 1355 00 00 00 Plan Check Total 00 00 00 00 Grand Total 1355 00 1355 00 00 00 Separate Permits are required for electrical work,SEPA,Shoreline ESA,utilities private and public improvements This permit becomes null and void if work or construction authorized is not commenced within 180 days if construction or work is suspended or abandoned for a period of 180 days after the work as-commenced,or if required inspections have not been requested within 180 days from the last inspection. I hereby certify that I have read and examined this application and know the same to be true and correct. All provisions of laws and ordinances governing this type of work will be complied with whether specified herein or not. The granting of a permit does not presume to give authority to violate or cancel the provisions of any state or local law regulating construction or the performance of construction. Signature of Contractor or Authorized Agent Date Signature of Owner(if owner is builder) Date T\Policies\1102 15[10/08] PERMIT INSPECTION RECORD 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 INA CONSPICUOUS LOCATION KEEP PERMIT CARD AND APPROVED PLANS AT JOB SITE INSPECTION TYPE DATE ACCEPTED COMMENTS YES NO PW UTILITIES (Engineering Division) WATERLINE/METER SEWER CONNECTION SANITARY STORM SITE DRAINAGE SITE EROSION CONTROL PARKING SIDEWALK CURB&GUTTER DRIVEWAY APPROACH BACK-FLOW DEVICE FINAL INSPECTIONS REQUIRED PRIOR TO OCCUPANCY/USE RESIDENTIAL DATE YES NO COMMERCIAL DATE ACCEPTED YES NO CONSTRUCTION R.W /PW/ CONSTRUCTION R.W ENGINEERING 417-4831 PW/ENGINEERING FIRE 417-4653 FIRE DEPT PLANNING DEPT 417-4750 PLANNING DEPT BUILDING 417-4815 BUILDING T\Policies\1102 15[10/081 OF POR�NQ J FF PERMIT NO I 0 — C) CLEARING AND GRADING PEII IT I. PERMIT FEE CALCULATIONS 1 Grading and filling plan review and permit fee (per PAMC 3 70 11 OD) 0-250 cubic yards (CY) and <4 of cut/fill ($40 00) $ 251 1 000 CY($75 00) $ • 1 001 10 000 CY ($110 00) $ 110 • 10 000+ CY ($35 00 + $15 00 per 10 000 CY) $ 2. Clearing and drainage plan review and permit fee (per PAMC 3 70 11 OD) Less than one acre ($40 00) _$ One acre to 5 acres ($75 00) $ -j S • Over 5 acres ($15 00 per acre) $ Inspection Fees (per PAMC 3 70 110 E)($55/hr) $ g S o 4 Engineering Plan Review(per PAMC 3 70 115) Water($0 50/LF) $ Sanitary Sewer($0 50/LF) $ • Storm Sewer($300+$25/Acre) $ .400 • Street/Alley/Parking Lot($0 50/linear feet of centerline) $ 5 Additional Plan Review of changes additions, or revisions to submitted or approved plans (per PAMC 3 70 117) ($55/hr) $ Z z.c Environmental Checklist(SEPA Review) (per PAMC 3 70 070G)($125) $ 12—,5 cx 7 TOTAL PERMIT FEE. ' 1,400 II. CONDITIONS APPLIED TO ALL PERMITS 1 Notify the City(417-4831) forty-eight(48) hours before beginning any land-disturbing activity 2. Notify the City (417-4831) within 48 hours of completion of any erosion and sediment control measures. 3 Obtain written permission from the City prior to modifying any plans. 4 Install all erosion and sediment control measures as identified in the approved plans. 5 Maintain all road drainage systems, stormwater drainage systems, control measures, and other facilities identified in the plans. 6 Repair siltation or erosion damage to adjoining surfaces and drainage ways resulting from land developing or disturbing activities 7 Inspect all erosion and sediment control measures at least once each week during construction, and after each rain of 0 5 inches or more (over a 24-hour period) and immediately make any needed repairs. 8 Allow the City to enter the site for the purpose of inspecting compliance with the plans or for performing any work necessary to bring the site into compliance with the plans. 9 Keep an up-to-date, approved copy of the plans on the site 10 Ensure that all workmanship and materials are in accordance with the City of Port Angeles Urban Services Standards and Guidelines, and the current edition of Washington State Department of Transportation s Standard Specifications for Road, Bridge and Municipal Construction 11 Contact the City Engineer(417-4803) immediately if hazardous materials or soils are encountered III. PLANNING PERMITS REQUIRED JZ'1 SEPA Checklist(Excavation or filling 100 cubic yards or more or part of exempt project) ❑ 2 Environmentally Sensitive Area (ESA)Application/Approval. Cl 3 Wetlands Permit Application/Approval ❑ 4 Other(s) IV. PLANS AND SPECIFICATIONS TO INCLUDE A. AN ACCURATE PLAN OF THE ENTIRE SITE AS IT EXISTS AT THE TIME OF APPLICATION, WHICH MUST INCLUDE. ❑ 1 All property lines. ❑ 2 Contours over the entire site (5-foot contours are standard but other intervals may be required) April 2009 c&g permit.doc(February 2010) Page 1 of 3 ❑ 3 The date, basis, and datum of the contours. ❑ 4 Graphic representations of all existing vegetation on the site, designated by their common names, the amount of bare ground and the amount and type of impervious material (rock and artificial) ❑ 5 The location of all existing drainage facilities, natural and man-made. ❑ 6 The locations of any wet areas and estimated capacity of any areas which impound surface water ❑ 7 The location and estimated discharge of all visible springs. ❑ 8 The location of all structures, utilities, and their appurtenances, including structures and utilities on adjacent properties when such information is reasonably available ❑ 9 Date north arrow and adequate scale as approved by the City Engineer on all maps and plans ❑ 10 Identification of and mitigation measures for on-site areas which are subject to severe erosion and off-site areas which are especially vulnerable to damage from erosion and/or sedimentation. B. THE PROPOSED WORK SCHEDULE, WHICH DETAILS THE FOLLOWING ❑ 1 Sequence for clearing grading filling drainage alteration, and other land disturbing activities. ❑ 2 On-site soil or earth material storage locations and source of import materials and location of the site where spoils will be disposed ❑ 3 Schedule for installation and removal of all interim erosion and sediment control measures including vegetative measures. ❑ 4 Schedule for construction of final improvements, if any ❑ 5 Schedule for the installation and maintenance of required permanent erosion and sediment control devices. ❑ 6 Outline of the methods to be used in clearing vegetation and storing and disposing of the cleared vegetation. C. AN ACCURATE FINISHED GRADE PLAN OF THE ENTIRE SITE AS IT WOULD APPEAR AFTER THE COMPLETION OF WORK COVERED BY THE PERMIT, WHICH MUST INCLUDE. ❑ 1 Finished contours achieved by grading (at the same intervals as the existing contours) ❑ 2. Boundaries of all areas to remain undisturbed with identification and the location of all other vegetation shown on the plan that will remain after the completion of all work. ❑ 3 Drainage and related facilities to be constructed with and as part of the work. ❑ 4 Boundaries of all areas where surface water runoff will be retained detained or infiltrated ❑ 5 Method for discharging surface water off-site including the provisions required to control the velocity and direction of discharge to protect downstream properties ❑ 6 Location of building set-back lines, and approximate limits of cuts and fills foundations, retaining walls, driveways, etc. ❑ 7 Location and dimensions of sensitive areas and any associated buffer zones and other areas to be maintained or established ❑ 8 Location and description of proposed erosion and sedimentation control devices or structures. ❑ 9 Off-site grading shall be noted on the plans and a dated letter of permission from the property owner(s) of the land effected shall be provided and noted on the plans. V. ADDITIONAL INFORMATION REQUIRED ❑ 1 Hydrologic and hydraulic computations. ❑ 2. Engineering geology and soils reports ❑ 3 Erosion and Sediment Control Plan ❑ 4 Engineering cost estimate of drainage facilities and erosion control plan. ❑ 5 Inspection and maintenance agreement. ❑ 6 Letter(s) of permission for off-site work. ❑ 7 Copies of other required permit(s) ❑ 8 Other information. ❑ 9 Security deposit, bond or other approved method of guaranteeing performance (circle one) in the amount of $ W-1 0 Insurance required in the amounts of $ per occurrence and $ aggregate April 2009 c&g permit.doc(February 2010) Page 2 of 3 VI. ADDITIONAL CONDITIONS ❑ 1 Additional Conditions applicable to this permit listed here and/orttache ee t 1 610 �a U a fl c S u�(1nw f ► c b o 3 25 0. VII. PERMIT APPROVAL This certifies that the named applicant is granted a Clearing And Grading Permit for the work described and the purpose shown in the application This permit is granted subject to the terms of the agreement contained in the application subject to the provisions of the City of Port Angeles Municipal Code and subject to any additional conditions which are attached to this permit or as noted in sections II thr gh VI above and section VIII below Nothing permitted hereunder shall be deemed to override the provisio of any applicable law of the City County State or Federal Gqvernment. This permit expires 4yeom th a of issuance, unless otherwise specified by th fy i ee City Engine Date Dep . oom & Economic Development Date Vlll. INSPECTIONS AND SIGN-OFFS Please call 417-4831 to schedule required inspections, no later than noon of the previous business day to schedule an on-site inspection of the permitted activity(les)checked below Date Inspection Date Work Required No Description of Activity Requested Completed 1< 1 Installation of sediment control measures/BMPs prior to land disturbing activity x 2 During construction of sediment basins or stormwater management structures. 3 During rough grading, including hauling of materials. 4 Prior to removal or modification of sediment control measure. 5 Notice of completion received from permittee 6 At completion of final grading 7 Final establishment of vegetation/re-vegetation 8 Completion of final erosion control measures. 9 As-built grading plan required 10 Soils grading report required 11 Geologic grading report required April 2009 c&g permit.doc(February 2010) Page 3 of 3 0. CERTIFICATE OF LIABILITY INSURANCE 06/17/10' PRODUCER LIC #0726293 1-415-391-1500 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Gallagher Construction Services/ ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE Arthur J Gallagher & Co Insurance Brokers of CA Inc HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 1 Market St Spear Tower #200 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW San Francisco CA 94105 INSURERS AFFORDING COVERAGE NAIC# INSURED INSURER A:ZURICH AMERICAN INS CO 16535 [WA] Howard S Wright Constructors LP INSURER B: 501 Eastlake Ave E Ste 100—A INSURER C: Seattle WA 98109 INSURER D: I I INSURER E: COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED NOTWITHSTANDING ANY REQUIREMENT TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSRL DD' POLICY EFFECTIVE POLICY EXPIRATION LTR NSRTYPE OF INSURANCE POLICY NUMBER O T M DD ATE(MMIDDIYYYYI LIMITS A X GENERALLIABILITY GL04277092-05 (WA) 11/01/09 11/01/10 EACH OCCURRENCE $2,000,000 DAMAG TO RENTED X COMMERCIAL GENERAL LIABILITY PREMISES Ea occurrence $ 1,000,000 CLAIMS MADE _X1 OCCUR MED EXP(Any one person) $ 10,000 X STOP GAP—WA PERSONAL&ADV INJURY $ 2,000,000 X $1MM E L Limits GENERAL AGGREGATE $ 4,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS COMP/OP AGG $ 4,000,000 POLICYFX PRO-JECT LOC A AUTOMOBILE LIABILITY BAP4277093-05 11/01/09 11/01/10 COMBINED SINGLE LIMIT X ANY AUTO (Ea accident) $ 1 000 000 ALL OWNED AUTOS BODILY INJURY $ SCHEDULED AUTOS (Per person) X HIRED AUTOS BODILY INJURY $ X NON-OWNED AUTOS (Per accident) [PROPERTY DAMAGE $ (Per accident) GARAGE LIABILITY ANY AUTO UTO ONLY EA ACCIDENT $ A OTHER THAN EA ACC $ AUTO ONLY. AGG $ EXCESS/UMBRELLA LIABILITY EACH OCCURRENCE $ OCCUR CLAIMS MADE AGGREGATE $ DEDUCTIBLE $ RETENTION $ $ WORKERS COMPENSATION WCRY STAT%- OTH- AND EMPLOYERS'LIABILITY Y/NFIR ANY PROPRIETOR/PARTNER/EXECUTIVE❑ OFFICER/MEMBER EXCLUDED? E.L.EACH ACCIDENT $ (Mandatory in NH) E.L.DISEASE EA EMPLOYE $ If yes,describe under SPECIAL PROVISIONS below E.L.DISEASE POLICY LIMIT 1 $ OTHER DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS HSW Job #64135 RE Maier Hall & West Campus Improvements ADDITIONAL INSURED The City of Port Angeles CERTIFICATE HOLDER CANCELLATION 10 Day Notice for Non-Payment of Premium HSW Job #64135 SHOULD ANY OFTHE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION The City of Port Angeles DATE THEREOF THE ISSUING INSURER WILL EXNXVXW=MAiL 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT 321 East 5th Street XWC P 0 Box 1150 Port Angeles WA 98362 AUTHORIZED REPRESENTATIVE USA ` `` ACORD 25(2009/01)lingar ©1988-2009 ACORD CORPORATION. All rights reserved 16243630 The ACORD name and logo are registered marks of ACORD Gallagher Construction Services/ Arthur J Gallagher 6 Cc Insurance Brokers of CA Inc 1 Market St Spear Tower #200 San Francisco CA 94105 USA B } X ,;' �.aPO e The City of Port Angeles In 321 East 5th Street P O Box 1150 t :J Port Angeles WA 98362 USA 14:65.79 IIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIII�IIIIIIIIIIIIII IIIIIIillll ,� ;( 'art i�niseles ;ili; Inr�; ,ir•�iJtiiitDivUon .r qi; v.0 This document was brought to you by Gallagher Construction Services in San Francisco CA via CertificatesNow The data included in this notice and in the attached document is confidential to ConfirmNet and Gallagher Construction Services in San Francisco CA If you have questions regarding the content of this document please contact Gallagher Construction Services Main Phone (415) 391-1500 Email gcssfcerts@ajg com cc The City of Port Angeles (MAIL) The data included in this notice and in the attached document is confidential to Ebix BPO and the party responsible for bringing you this informa,ion Certificate Delivery by CertificatesNow www.ConfirmNet.com 877.669.8600 1:6 IMPORTANT a If the certificate holder is an ADDITIONAL INSURED the policy(ies) must be endorsed. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). If SUBROGATION IS WAIVED subject to the terms and conditions of the policy certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). DISCLAIMER This Certificate of Insurance does not constitute a contract between the issuing insurer(s), authorized representative or producer and the certificate holder nor does it affirmatively or negatively amend, extend or alter the coverage afforded by the policies listed thereon. ACORD 25(2009/01) 3:6 POLICY NUMBER. GL04277092-05 COMMERCIAL GENERAL LIABILITY CG 20 12 05 09 THIS ENDORSEMENT CHANGES THE POLICY PLEASE READ IT CAREFULLY ADDITIONAL INSURED - SPATE OR GOVERNMENTAL AGENCY OR SUBDIVISION OR POLITICAL SUBDIVISION - PERMITS OR AUTHORIZATIONS This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL. LIABILITY COVERAGE PART SCHEDULE State Or Governmental Agency Or Subdivision Or Political Subdivision. AS REQUIRED BY WRITTEN PERMIT Information required to complete this Schedule, if not shown above,will be shown in the Declarations Section II — Who Is An Insured is amended to in- 2. This insurance does not apply to clude as an insured any state or governmental a. 'Bodily injury' 'property damage or 'personal agency or subdivision or political subdivision shown in and advertising injury' arising out of operations the Schedule subject to the following provisions performed for the federal government, state or 1 This insurance applies only with respect to opera- municipality or tions performed by you or on your behalf for which b. 'Bodily injury' or 'property damage' included the state or governmental agency or subdivision or within the 'products-completed operations political subdivision has issued a permit or au- hazard' thorization CG 20 12 05 09 © Insurance Services Office Inc 2008 Page 1 of 1 ❑ SUPPLEMENT TO CERTIFICATE OF INSURANCE DATE 06/17/10 NAME OF INSURED: [WA] Howard S Wright Constructors LP Additional Description of Operations/Remarks from Page 1 Additional Information: GENERAL LIABILITY *Additional Insured as required by permit - Form CG 20 12 05 09 SUPP(05/04) 5:6 PORT,,y � 11 i Application No. (C 111wil"PF CLEARING�A�,.A,',,D f RA ,tNG PERMIT APPLICATION (Applicant must complete,Paget'S1,ofApplicafion. Page 2 will be completed by the City) ' I Name of Applicant: Deborah Frazier Peninsula College Applicant's Mailing Address: 1502 E Lauridsen Blvd Port Angeles,WA 98362 Applicant's Phone Number; (360)452-9277 Plan Preparer(Architect/Engineer). Bruce Dees&Associates Preparer's Mailing Address. 222 E 26th Street,suite 202 Tacoma,WA 98421 Preparer's Phone {Number- (253)627-7947 Location of Proposed Activity (Street address or lot and block number) f Owner of Property' Peninsula College (if not applicant, attach letter of authorization from property owner) Description of Proposed Activity(Also attach plans, sketches or other important information which would assist in our initial review). Strip sod from the existing soccer field. Earth work construct new synthetic turf soccer[laid. i fEstimated Amount of Material, in cubic yards,to be excavated, imported, or exported 3,154 CY Cut&Fill. 2.128 CY Impoit permeable base stone. If the answer toany of the following three questions is yes, an Environmentally.Sensitive-Area (ESA) application with a SEPA checklist and associated fees are required to be.submitted with i this application and will be processed according to the City's consolidated permitting process-. 1 Is the excavation or fill associated with the development of a parking lot for more than 20 vehicles? No (yes or no) 2. Is the total amount of excavation or fill expected to exceed 100 cubic yards? Yes (yes or no) 3. Will any portion of the grading excavating or filling occur within 200 feet of any of the following? jlf the answer is yes, please check the appropriate condition(t)3 No Shoreline No Stream/Creek No 40% or greater slope. i The applicant hereby affirms and commits that the information submitted for this permit is accurate and that the applicant will comply with the terms and conditions of this permit and the City ofd Clear' nd Gra.ding Ordinance. o 0 CP Signature of Applicant-or authorized representative Date t Sept 2009 a&g application.doc page 1 of 2 I CLEARING AND GRADING PERMIT APPLICATION ❑ 1 THE PROPOSED ACTION HAS BEEN DETERMINED TO BE EXEMPT FROM A CLEARING AND GRADING PERMIT,BASED UPON THE INFORMATION PROVIDED BY THE APPLICANT THE ; BASIS FOR THIS EXEMPTION IS AS CHECKED BELOW ❑A. Land clearing, grading filling, sandbagging, diking, ditching, or similar work during or after periods of extreme Weather or other emergency conditions which have created situations such as flooding or high fire danger that present immediate danger to life or property as authorized by the City Engineer ❑ B. Land clearing necessitated by order of the City Council related to the abatement of a public nuisance,where the work is administered by the City ❑ C Removal of dead, diseased, or damaged trees which constitute an imminent hazard to life or ` property ❑ D Clearing performed under the direction of the City Engineer within a public right-of-way or upon an easement,for the purpose of installing and maintaining water storm, sewer, power, cable or communication lines. ❑ E. Cemetery graves. ❑ F Non-destructive vegetation trimming with proper removal and disposal of debris. EXEMPTIONS"G"THROUGH"L"SHALL NOT APPLY IN SITUATIONS WHERE THE PROPERTY INCLUDES AN ENVIRONMENTALLY SENSITIVE AREA. ❑ G Land that is less than one acre, except where an adjacent area containing disturbed areas under the same ownership or chain of ownership has been similarly exempted so that the combined area is greater than one acre and final site stabilization is not complete. ❑ H. If a building permit is issued, no additional clearing, grading, or filling permit or associated fee will be required; provided that the starldards established in the City's Urban Services Standards and Guidelines shall be applied as a condition of said building permit. ❑ 1 Routine maintenance of existing stormwater drainage facilities located outside of a critical area (as defined by PAMC 15.20.030), including, but not limited to, detention/retention ponds, wetponds, sediment ponds, constructed drainage swales, water quality treatment facilities, such as filtration systems and regional storm facilities that are necessary to preserve the Water quality treatment and flow control functions of the facility This exemption does not apply to any expansion andlor modification to any existing stormwater drainage facilities. ❑J Roadway repairs and overlays within a public street right of way for the purpose of maintaining the pavement, curbing, or sidewalk on existing paved roadways. ❑ K. Forest practices regulated under RCW 76.09 Activities involving conversion of land to uses other than commercial timber producfion are subject to clearing and grading regulations ❑ L. Other reason as indicated hereon: �An exemption from a Clearing and Grading Permit does not exempt the person doing the work from meeting all applicable federal, state, and local codes, standards, guidelines, and regulations, including obtaining and meeting the conditions of all applicable permits. I 012. E PR _SED'" .CTION IS NOT EXEMPT C&G PERMIT REQUIRED Dept.of Co m.&-Economic Developmebate City Engineer Date f Sept 2009 c&g application.doc 2 of 2