HomeMy WebLinkAboutPermit File 4804 Harbor View Place s
CO q CITY OF ANACORTES
WASHINGTON
co
gOoP4W BUILDING DEPARTMENT
CERTIFICATE OF OCCUPANCY
This is to certify that the(Description of Building or Structure):
Single Family Residence
Located At: 4804 Harbor View Place
STREET&NUMBER
Owner: Jim Zevely
Constructed By: Owner
OWNER OR CONTRACTOR
Bldg.Permit#C0M98-0012 Date Of Issue: 3-6-98
Occ.Group: R3 Use Zone: R2
Has Been Inspected And Occupancy Is Hereby Authorized,
This 28th Day Of October 19 99 .
irffre AUTHORIZING FILIAL
SEE REVERSE SIDE FOR SPECIAL QUIREMENTS.
COMBINATION PERMIT
CITY OF ANACORTES PERMIT NO. : COM98-0012
P.O. BOX 547 APPLIED: 01/20/98
ANACORTES, WA 98221 ISSUED: 03/06/98
(206) 293-1901 EXPIRES: 03/06/99
SITE ADDRESS: 4804 HARBOR VIEW PL
ASSESSOR' S PARCEL NO. : 4613-000-013-0002
PROJECT DESCRIPTION: New single family
r OWNER — CONTRACTOR — LENDER
ROBERTSON SMITH ZEVELY
4807 HARBOR VIEW PLACE 4807 HARBOR VIEW PLACE
ANACORTES WA 98221 ANACORTES WA 98221
293-4458 293-4458
ZEVELJC110DN
— FEES
TYPE OF WORK -NEW AREA (sf) VALU...5: 240000 Code Amount---- By- Date---- Receipt
TYPE OF USE •SF LOT • 66222 REQUIRED SETBACKS---- ESPL $ -100.00 MD 03/06/98 8085
CENSUS CATEGORY •101 1ST FLR • 1965 FRONT • 20 ft PLCK $ 508.95 MD 03/06/98 8085
ZONING 2ND FLR • 1498 SIDE(1)..: 5 ft PRMT $ 783.00 MD 03/06/98 8085
:R2 - •
BASEMENT 0 SIDE(2)..: 10 ft PMEC 8 88.50 MD 03/06/98 8085
OCCUPANCY GROUP GAR/CARPORT...: 820 REAR • 20 ft PPLM $ 174.00 MD 03/06/98 8085
:R3 •? •? •? OTHER • 729 REQUIRED PARKING-- STBC $ 4.50 MD 03/06/98 8085
TYPE OF CONSTRUCTION TOTAL • 0 SEWR $ 3483.00 MD 03/06/98 8085
:5N •? •? :? : NUMBER OF UNITS • 1 ACCESSIBLE.: 0 IMPT $ 400.00 MD 03/06/98 8085
OCCUPANT LOAD STORIES • 2 COMPACT • 0 STRM $ 1126.00 MD 03/06/98 8085
0: 0: 0:66222: BUILDING HEIGHT.: 0 ft IMPRV SURF.: 0 sf INSP $ 50.00 MD 03/06/98 8085
FUEL TYPES BOILERS/COMPRESSORS- DOMES. INCIN •0
:/GAS/ / /: 0-3 HP • 0 COMML. INCIN •0
FURN < 100K BTU: 1 3-15 HP • 0 RELOC/REPAIR...: 0 TOTAL $ 6517.95
FURN >=100K BTU: 0 15-30 HP • 0 CLOTHES DRYERS.: 1
FURN - FLOOR...: 0 30-50 HP • 0 GAS WTR HEATERS: 1 — NOTES -UNIT HEATERS...: 0 50+ HP • 0 STOVE, APPLI...: 1
VENT FANS • 5 AIR HANDLING UNITS-- FIRE LOG/LITE..: 2
VENT SYSTEMS...: 0 <= 10000 cfm.: 0 W00DSTOVES • 0
VENT W/0 APPLI.: 0 > 10000 cfm.: 0 OTHER UNITS • 0
EVAP COOLERS...: 0 GAS OUTLETS • 1
HOODS • 1
WATER CLOSETS...: 4 WASHING MACHINES: 1 FLOOR DRAINS • 0
BATH TUBS • 3 ELEC WTR HEATERS: 0 WTR PIPING/TREAT: 1
SHOWERS • 1 LAUNDRY TRAYS...: 0 HOSE BIBBS • 4
DISHWASHERS • 1 URINALS • 0 GREASE TRAPS • 0
LAVATORIES • 5 WASTE INTERCEPT.: 0 ADD'L FIXTURES..: 1
KIT SINKS W/DISP: 1 DRINKING FOUNT..: 0
I hereby acknowledge that I have read this permit and state that the above information is correct, and agree to comply with all
ordinances and laws regulating activities covered by this permit.
Issued by Ap licant or Ow 's Signature
24 Hour Notice equired For All Inspections
camprmt, Rev: 11/04/93
I
CITY OF ANACORTES
1 V WATER DEPARTMENT RETURN TO:
p` �,o City of Anacortes
BACKFLOW PREVENTION ASSEMBLY Water Department
Pe 2201 "A"37th Street
S
TEST REPORT Anacortes, WA 98221
CoR �4
�• RETURN NO LATER THAN
NAME OF PREMISES WO 13 e r'T M- `� Itt ,/ FILE NO.
SERVICE ADDRESS t4 d�. t-c AA:-�o re, ( L�fJ' 40,14
LOCATION OF ASSEMBLY( E ®k B .A 1-1 20 Y�•`Pr°'�E'.-t�•—` C�
ASSEMBLY: 4.--104 —l-S V CD C0-�L ct 4� t" t3�{ a. y a,
MANUFACTURER MODEL SIZE SERIAL NO,
LINE PRESSURE AT TIME OF TEST 4:34 LBS. TYPE OF ASSEMBLY ti C 0A-
Reduced Pressure Assemblies Pressure Vacuum Breaker
Double Check Assemblies Relief Air Inlet Check Valve
1st Check 2nd Check Valve Opened at
psid psid
Initial DC-closed tight ._._. Closed tight....... a---15pened at Did not
Test RP- psid Leaked... . ._... ...❑ psid open ... ❑ Leaked ._ . ... ❑
Leaked. ..... .. ....._ ..❑
Repairs
and
Materials
Used
Test After DC-closed tight ❑ Closed tight ❑ Opened at Opened at psid
Repair RP- psid psid psid
AIR GAP INSPECTION: Required minimum air gap separation provided . . . . Yes ❑ No ❑
nn I
REMARKS: P A,c5 a +U / a °a •
THE ABOVE REPORT IS CERTIFIED TO BEAO E:
INITIAL TEST PERFORMED BY ' A 9 •' " CERT. NO. t� i Sala DATE 10 l a& l9 9.
I
REPAIRED BY DATE
FINAL TEST PERFORMED BY CERT. NO. DATE