HomeMy WebLinkAboutPermit File 513 34th Street r ' Engineering and Development Services �O .q
11 Y get, PO Box 547 Anacortes-WA 98221 r A ��TN 360.293.1920 FAX 360.293.1938 � 'EMAIL engineering@cityofanacortes orgRIGHT-OF-WAY PERMIT APPLICATION A -
"�r , RCW 19.122 Underground Utilities
4COVL CALL BEFORE YOU DIG -(800)424-5555 •p•W•P
Applicant shall submit application 5 days prior to start of work and application shall include:
❑ (1) Payment of assessed fee
0 (2) Drawing illustrating proposed work and its location. See checklist on
Page 2 of 2.
❑ (3) Liability insurance CG 2026 or similar. City named as additional insured. Minimum$1,000,000 each
occurrence,$2,000,000 general aggregate and$2,000,000 products-completed operations aggregate limit.
❑ (4) Proof of both state and city business licenses
❑ (5) Performance Bond—Construction cost x 150% before work begins
❑ (6) Encroachment Agreement Required To be completed by City: n Yes I No
Site Address: City Approved Exemption i Yes C No
t3 e39t EDEN ASSIGNED PERMIT NUMBER:
Parcel No.
Owner Information (Required) Contractor Information (Required)
Name ), ts Name
Address p0.° •. p Address
City City
I Phone Phone
Email f r -i�1 1 Email
Address C)I•f P-�° T3 � � '►
, eC yrt Address
Work Includes (check all that apply)
❑ Curb Cut ❑ Water ❑ Sewer Storm ❑ Street Cut ❑ Sidewall ❑ Phone L Other
Describe Work to p. be Performed: (Notification of Utility Companies is Required)
City Approval Signature Date PriN,.b‘s-tst- (n
By signature below Applicant concurs that the Applicant shall defend, indemnify and hold the City, its officials, em-
ployees and volunteers harmless from any and all claims, injuries,damages, losses or suits including attorney fees,
arising out of or in connection with activities or operations performed by the Applicant or on the Applicant's behalf
out of issuance of this Permit,except for injuries and damages caused by the sole negligence of the City.
tA) � � 1—k-1t
Applicant Signa e Date
Final Inspection Approval Signature Date
t3c6L-c-me
NON-REFUNDABLE PERMIT FEE: (To Be Completed by City)
❑ Curb Cut $50.00
'Street Cut $50.00
0 Inside Travel Way $50.00
❑ Outside Travel Way $20.00
❑ Sewer Inspection Fee $50.00
❑ Sewer Re-Inspection Fee $25.00 •
TOTAL FEE ASSESSMENT $
A Site Plan (to scale) must be attached that include all of the following:
This checklist will aid the applicant in preparing a site plan. Permits that require installation of substantial improve-
ments may require plans drawn and designed by a licensed engineer. Please check with City staff prior to submit-
ting your application.
• Draw the plan to a standard Engineering Scale[1"=10', 1"=20"etc.]on a minimum size sheet of 8'h x 11
and a maximum size of 11x17.
• Include the owners name, the parcel ID number, site address, north arrow, drawing scale and date.
• Include the contractor's name,address and phone number.
• Existing Right-of-Way lines, property lines. edge of pavement, curb/gutter, sidewalks,driveways and plant-
ing strips with dimensions between each.
• Adjoining street name(s)to the reference property.
• All existing public and private utilities in the area of the proposed project(Water, Sewer, Storm, Phone,TV,
Gas and Power), dimensioned to the edge of pavement, curb/gutter, sidewalk,driveways, planting strips.
• If applicable show easements,critical areas such as streams,wetlands and steep slopes.
• Proposed new construction.The proposed improvements shall be shown in heavier line type than the ex-
isting information
• Dimension the proposed new construction to the edge of pavement,curb/gutter,sidewalks,driveways,
planting strips, or another identifiable site feature that will help identify the proposed improvements in the
field.
• Erosion Control Plan.
• Traffic Control Plan per current MUTCD(See standard drawings at http://mutcdffhwa.dot.gov). If the work
requires any lane or street closures,the City of Anacortes Public Works Inspector must be notified a mini-
mum of 48-hours prior to scheduled work for proper public notification by the City of Anacortes.
Work within the City Right-of-Way is permitted by approval of the City Engineer. All work in the right-of-way must be
bonded. The applicant and owner must use warning signs,traffic control, and barricades as necessary to ensure
public safety in the work area. The applicant and owner must restore the right-of-way to previous condition. Perma-
nent restoration may include overlays of portions of the right-of-way and restoration of landscaping which have been
disrupted by excavation work. The applicant and owner are liable for damage to public and private property.
Page 2 of 2
u. y j
Z LONGITUDINAL BUFFER SPACE B NOTES
'w SIGN SPACING = X
r
i POSTED SPEED(MPH) 25 30 35 140 145 RURAL ROADS 45/55 MPH 500'4 1. This plan is intended for use on roadways when traffic volumes create
m LENGTH B(FEET) II 55 85 120 170 270 RURAL ROADS&URBAN ARTERIALS 35/40 MPH 350'* sufficient gaps for motor vehicles to yield.
a RURAL ROADS,URBAN ARTERIALS, 25/30 MPH 20D't 2. Steady BurningWarning
'Li;
RESIDENTIAL&BUSINESS DISTRICTS mark Channelizing De sat night C per MUTCD)shall be used to
URBAN STREETS 25 MPH OR LESS 100't
m ALL SIGNS ARE BLACK ON ORANGE UNLESS DESIGNATED OTHERWISE 3. Adequate sight distance shall be provided for drivers to see opposing
CHANNELIZING DEVICE SPACING traffic,otherwise use flaggers and/or Temporary Signal.
POSTED SPEED IN TAPER IN TANGENT ALL- RAD PACING MT BE ADJUSTEDDTO ACCOMMODATE 4. Extend Channelizing Device taper across shoulder-recommended.
(MPH) (FEET) (FEET) AT-GRADE INTERSECTIONS AND DRIVEWAYS.
cm
35/ 30 5D 5. Post mount signs when in place for 3 days or longer.
25/30 20 40
6. For speed limit 35 mph or higher replace W1-3R with W1-4R.
7, For signs size refer to Manual on Uniform Traffic Control Devices
•
(MUTCD)and WSDOT Sign Fabrication Manual M55-05.
R1-2
RIW '20-4 8. Consider using a PCMS for additional advance warning.
`Q W3-2 ONE LANE
• •
lir ..,
ROAD
AHEAD ' 1
ROAD
WORK
(((((( TO
V
AHEAD
I ROAD WORK) G20-2A RBM f
ONCOG
END
JI
TRAFFIC J)
B 100'MAX. 15' X X X
m '/.'Y'/,.�i/
® ,WORK AREA
FOR LOCAL AGENCY USE ONLY
7 ® ® ® NOT FOR USE ON STATE ROUTES
Z
iV ter.
a x la x a ������kwwasyl4'�o2�� n
wzal
0
ROAD W1-3R I END l� ? / �� 5S
WORK W20.1 IIROADWORKJ G20-2A ®F.s d�CI STBR��G,��`v g
AHEAD ONE LANE WO
sl®DAL l�
4 E
ROAD IEXPIRES AUGUST 9.2009I R442
AHEAD LANE CLOSURE
WITHOUT FLAGGERS
LEGEND LOW VOLUME ROAD
STANDARD PLAN K-20.20-01 N SIGN LOCATION
SHEET 1 OF 1 SHEET
® ® ® CHANNELIZING DEVICES
APPROVED FOR PUBLICATION
IT.�� BARRICADE-TYPE 3 L
Pasco Bakotich Ill 10-12-07
8 FLASHING WARNING LIGHT STATE DESIGN ENox+eER DATE
Woohinylq,MIA C.Wrlment of 18018 0r81/
r -"
k
NOTES
z LONGITUDINAL BUFFER SPACE = B SIGN SPACING = X
I- 1. This plan is intended for use on roadways when traffic volumes create
2 POSTED SPEED(MPH) 25 30 35 40 45 RURAL ROADS 45/55 MPH 500'± sufficient gaps for motor vehicles to yield.
ix LENGTH B(FEET) 55 85 120 170 270 RURAL ROADS 8 URBAN ARTERIALS 35/40 MPH 350't
RURAL ROADS,URBAN ARTERIALS, 2. Steady Burning Warning Lights(Type C per MUTCD)shall be used to
wRESIDENTIAL&BUSINESS DISTRICTS 25/30 MPH 200't mark Channelizing Devices at night.
w URBAN STREETS 25 MPH OR LESS 100't
ALL SIGNS ARE BLACK ON ORANGE UNLESS DESIGNATED OTHERWISE 3. Adequate sight distance shall be provided for drivers to see opposing
m traffic,otherwise use flaggers and/or Temporary Signal.
CHANNELIZING DEVICE SPACING
ALL SIGN SPACING MAY BE ADJUSTED TO ACCOMMODATE 4. Extend Channelizing Device taper across shoulder-recommended.
g POSTED SPEED IN TAPER IN TANGENT AT-GRADE INTERSECTIONS AND DRIVEWAYS.
(MPH) (FEET) (FEET)
5. Post mount signs when in place for 3 days or longer.
35/45 30 80
25/30 20 40 6. For speed limit 35 mph or higher replace W1-3R with W1-4R.
7. For signs size refer to Manual on Uniform Traffic Control Devices
(MUTCD)and WSDOT Sign Fabrication Manual M55.05.
•
RR,W W20.4 8. Consider using a PCMS for additional advance warning.
A w3-2 ONE LANE
NV ..
ROAD
AHEAD W20-1
ROAD
WORK
TOl AHEAD
R1-2a ONCOMING J
(ROAD WORK G20-2A BAN TRAFFIC
B 100'MAX. 15' X X _ X
N N N N N
. .
® ® /i/RK AREA%�� - ® ® ®�----
D ,)/0i /'%-, ® ® FOR LOCAL AGENCY USE ONLY
® "'' l " p NOT FOR USE ON STATE ROUTES
i ® ® ® ® � ® ® ® — — /
Iiill
w �®'S®;OF WASy,�c'01,
H X p X q 5'' Q °� 9
_ ff§
71
y �4��
W20-1 03R
END Po "`'igiPl'-'s y gS
ROAD (ROAD WORK G20-2A �tlA,4-01 ST CR 25335�o ��� 3 i R�g
WORK W20-4 ®NAL ° la Eg
06
AHEAD ONE LANE I EXPIRES AUGUST 9, 2009 I $ e
ROAD LANE CLOSURE
AHEAD WITHOUT FLAGGERS
LOW VOLUME ROAD
LEGEND STANDARD PLAN K-20.20-01
N SIGN LOCATION SHEET 1 OF 1 SHEET
a ® a CHANNELIZING DEVICES APPROVED FOR PUBLICATION
0!:f23 BARRICADE-TYPE 3 L Pasco Bakotich III 10-12-07
41 FLASHING WARNING LIGHT Ilk STATE DESIGN ENGINEER DATE
IV Washington Stato Department of Transportation
1
Y
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...;..tii:. i.. 1:.....» 006868 -F'20.t-...
• '• Engineering and Development Services
PO Box 547,Anacortes,WA 98221
Telephone 360.293.1920
Fax 360.293.1938
:x" z . E-mail enoineeringc citvofanacortes.orq
RIGHT-OF-WAY PERMIT FRANCHISE APPLICATION
Submit this application at least five days before the work starts. Please complete
both sides of this form. (City completes shaded sections.)
SITE
LOCATION:FRANCHISE INFORMATION CONTRACTOR INFORMATION
Company Name Zj? 1 d `-�,�� c r _ Name
Mailing Address 0• go Address
City . _ f City
State L3 y2 Zip State Zip
Telephone 3 t ( ,-L 3 9 (,) Telephone
Contact Name r'\I 1 l_. License Number
PROJECT INFORMATION
Work Includes (check all that apply)
❑ Curb Cut ❑ Water SSewgr. El Storm ❑ Gas ❑ Sidewalk
❑ Street Cut ❑ Phone ❑ Power ❑ Cable ❑ Culvert ❑ Outside the Traveled Way
qq
Describe Work: ,' C"� SQ`� " trd s E �� m
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Work within the City Right-of-Way is permitted by approval of the City Engineer. All work in the right-of-
way must be bonded. The applicant and owner must use warning signs, traffic control, and barricades as
necessary to ensure public safety in the work area. The applicant and owner must restore the right-of-
way to previous condition. The applicant and owner are liable for damage to public and private property.
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CITY OF ANACORTES "AS-BUILT" )ewer
` r stone
CONTRACTOR: I r S`q 1 '_V_4(vdw-- n c,, v1/4:er
PLAT/DIVISION: BLOCK
LOT ADDRESS: 513 3 LiTh S4 ° grew f ,
DATE: I\t ' dS.0
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GS?i Y Off, City of Anacortes Permit#: BLD-2004-0018
904 6th Street Issue date: 09/28/2004
Anacortes,x 547 Expire date: 09/28/2005 ti); WA 98221-0547
re (360) 293-1901
Job Address: 513 34TH ST Permit Type: Single Family Alteration/Repair Permit
ANACORTES WA 98221 Project:
APN: P56737
Remarks: Reframe walls and roof of south bedroom per plans as approved and noted.
Owner: BILL MENDUM Contractor OWNER
Address: PO BOX 1656 Address:
ANACORTES WA 98221
Phone: (360)293-8575 Phone:
License#:
General Information: Fees:
Use Zone R3 Building Permit Fee 32.50
Building Valuation 2000 Plan Review Fee 21.13
Occupancy Group it-1 State Building Code Fee 4.50
Construction Type v-b Total Calculated: 58.13
Deposits/Receipts: 0.00
Total Due: 58.13
THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION AUTHORIZED IS NOT COMMENCED WITHIN 180 DAYS, OR IF
CONSTRUCTION OR WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 180 DAYS AT ANY TIME AFTER WORK IS COMMENCED. 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 OTHER
STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE PERFORMANCE OF CONSTRUCTION,
r't-k C J�Q 6^-41pS
SIGNATURE OF OWNER OR AUTHORIZED AGENT ISSUED BY
£1'8S$ 620900 saa3 r4!WJ1d
b ZOO bOOZ/2Z/6O T000 T-1,17.LZt'O
, : %'t X 4 City of Anacortes Permit#: BLD-2004-9809
'CI .rA 904 6th Street Issue date: 07/09/2004
'4 P.O.Box 547 Expire date: 07/09/2005
`,'Y' tl1.' Anacortes, WA 98221-0547
:,�t�,al `'ly`'
Job Address: 513 34TH ST Permit Type: Reroof Single Family Residence
ANACORTES WA 98221 Project:
APN: P56737
Remarks: Reroof with 15#felt and 30 year comp roofing.
Owner: BILL MENDUM Contractor:
Address: PO BOX 1656 Address:
ANACORTES WA 98221
Phone: (360) 293-8575 Phone:
License#:
General Information: Fees:
Building Valuation 1000 Building Permit Fee 17.50
State Building Code Fee 4.50
Total Calculated: 22.00 I
Deposits/Receipts: 0.00
c 4 * O 0
c
* 0 4 4 0 o Total Due:
a 4 N N - o .F -F N N 22.00
f N .(. 4 y .E -fit- -%
iE * -14
-% 3 4 - *
u cn 4 Oc_ "K- -%- if-
F to . -% i4 *
ti.
m 00 4 to * 4 ec,L 44
4 ^-IF is 4 R X- = -*
t 01 LL * II O T *
-X- V) -X- II II
't V i4 iE c = II 4 4-• 4
4 0 N W j4 c ZCL
-X-
4 .. A ti 4 W i4 a W iE N -%
• SL CC
i4 V) 34 CO -4 N 4 -O I
* a m W * W V) R] 4 ...jr 4.* # N C
iF U i(- LL S 0 44-i4 H -2 -F * O 4-'
' C E * ' -e 4 @ U 44 34 a f- --
34 -X- H CJ 4� s i4 4+ 61
14 # O H 44 d i4 u O i4 44 F- 4-+
4: r Q ++ iS- 2 iSJ U * 2 ni Cr. -%- 44 I N -
-- 4 O 44--- _ t 0
OC C
THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION AUTHORIZED IS NOT COMMENCED WITHIN 180 DAYS, OR IF
CONSTRUCTION OR WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 180 DAYS AT ANY TIME AFTER WORK IS COMMENCED. 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 OTHER
STATE OR LOCAL LAW RE ULATING CONSTRUCTION OR THE PERFORMANCE OF CONSTRUCTION.
1
SIG ATURE OF OWNER 0 AUTHORIZED AGENT ISSUED BY
0
FOR INSPECTIONS CALL: CITY OF ANACORTES PERMIT N ! 700
293.1901 BUILDING PERMIT
24 Hrs. Notice Requested Site Address 513 34th Street 1
NAME (OR NAME OF BUSINESS) •
x Phillip Lang PLUMBING
w MAILING ADDRESS •
O 509 34th Street No. TYPE OF FIXTURE OR HEM FEE
CITY TELEPHONE NUMBER Water Closet $
Artacortes WA 98221 Bathtub
NAME Lavatory
b Shower
5 ADDRESS Kitchen Sink
u Dishwasher
• C CITY TELEPHONE NUMBER Laundry Tray
• Clothes Washer
NAME Water Heater
' ce Larson Heating, Inc r Urinal -
ADDRESS Drinking Fountain
1492 Hoxie Lane Floor Sink or Drain
CITY TELEPHONE NUMBER Slop Sink
o• Anacortes, WA 98221. 293-4967 Water Piping
STATE LICENSE NUMBER CITY LICENSE NUMBER
LARSOIII*112NE 4253
CJ,Residential 0 Non-Residential PERMIT $ '
❑ New ❑ Add ❑ Alter ❑ Repair TOTAL FEE $
O.Building 0 Plumbing .O Mechanical MECHANICAL
❑ Sign 0 Demolition 0 Other [.GAS ❑ OIL 0 ELECT. '' 0 OTHER
Legal Description of Property or Tax Account Number No. TYPE OF EQUIPMENT FEE
Lot Block of
Air Cond. Unit $
Refrigeration Unit— HP
')+ ___ Boiler— - HP _
Forced Air System— BTU/KW
Describe Work - Floor Furnace
yr,a.es p i pi rtcs 1" Wall Heater 9.00
Unit Heater -
Clothes Dryer
Occupancy Use Ventilation Fan _
R Single Family Residence 0 Multi-Family Residence Range Hood
�' 0 Office 0 Retail 0 Storage 0 Church Air Handling Unit— CFM
I 0 Restaurant 0 Other Pre-manufactured Stove or Fireplace
NOTICE 1 Gas Piping 3 nn-
This permit is issued by the Building Official and,under the provisions
of the Uniform Building Code,shall expire by limitation and become null
and void if the building or work authorized by such permit is not com- PERMIT $ 1 a nn
menced within 180 days from the date of permit issuance,or if the building TOTAL FEE $ %�9I
or work authorized by such permit is suspended or abandoned at any time
1 after the work is commenced for a period of 180 days. TOTAL FEES VALUATION FEE
By affixing my signature, I hereby certify that I am the owner of the Building $
property for which this permit is issued or am an authorized represen-
tative of the owner. Plan Check n art
All provisions of laws and ordinances governing this type of work will Plumbing
be complied with whether specified herein or not,including routine calls Mechanical - r,T - 941
for inspections. Sign-
•
C /,'� Demolition
(' e/ Energy Surcharge
Signature of Owner or Authorized Agent (Date) State Surcharge
Other
Street Setback Side Yard Setback Rear Yard Setback TOTAL $
H - - 27 ,.no.
1 Use Zone Occupancy Group Type of Const. Conditions:
Ij Lot Area Vacant Site Dwelling Units
❑Yes El No .
Fire Sprinklers Required No. of Stories Bedrooms Occupant Load
".‘ - Ill Yes ❑No ,
Size of Bldg. Plans Checked By:
WHEN SIGNED AND DATED BELOW,THIS IS YOUR PERMIT
Permission is hereby given to do the above described work,according to the conditions
hereon and according to the approved plans and specifications pertaining therto,subject to
compliance with the ordinances of the CITY OF ANACORTES.
.
Permit Issued By; - k (4 L. 06/088/90
Blilaing Official (Date)
Elks: i n Frank
PERMIT ;,14 7905
ADDRESS 5 )3 34I+
LEGAL DESCRIPTION
ASSESSORS" ACCOUNT NO. . 3 25- j --coo
c 7 —C
PERMIT NO. DATE DESCRIPTION DATE FINALED
/G9J i / —ea -75 JDx / L odcktuo-n
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