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Home My WebLink AboutReel_0066C . '. '. ,,' '.' '. '.,i: .' .' ".. " ',...., '. ..' ..."'. .' ....... " : " ". . ": ,,'..... '::'. " . '. '. . ..... : .. " "... ;>: . .:' ;'" '. :.' .:> '.' ..... """7' ,.....:... " .. , . , . . .: . . '.. .' . :c ,',:,'. '::' ,.',"" ."c "'", , , .',' ",' :, ,,' ", . I ..... , . ".' ':.,: c .' , "'.',",' . " ,," . '.' ,,' "'c " , GI,NEHAL I'HOVISJONS Al'l'l.ICAIILE TO ALL I'EHMITS This pcrmit is subject to all applicable provbionsof tile Revised ewes of Washington. except that any provhioll ill this ~greeUlcllt not cOllshh:nt .....ith such resolution shall ~ controlling. A bond in the amount of $ is rctjuircd for the protection of the county as sel forth in the terms of the bond. During the progress of the work such barriers shall be erected amJ llIailltaincd as JUay be neceS!illrr or as lIlay be direl:{cu for the protection of die traveling public; the barriers shall be properly lighted at night. In acceptillg this permit the petitioner, his successors and assigns, agree); to protect Jefferson CoulllY and save it harmless from all claims, act.ion~ and damages of every kind and description which may accrue to or be suffered by any person or persuns, corporation or property by reason of the perfor- mance of any such work. character of materials used or manner of installation, maintenance and operation or by the improper occupancy of right of way or public place or public structure, and ill case allY suit or action is hrought agtli/llil said Jeffersun County for damagcs arising out of or b)' rea~n of any of the above causes, the pctitioner, his successors or assigns. will UIX>I1 notice to him or thcm of COllllllefllxment of such action. dcfcnd the .'tame at his or their own sole cost and expense and will satisfy any judgment after the said suit or action shall have finally bct:n detcrrnined if adverse to the Jd- ferson County. Except as hcrcin authorized. 110 cxcavation shall be made or ohstacle placed within the limils of a COUllty road in such a mal1l1t:r as to interfere with the travel over said road, Except as hcrdn authori/.cd, IlU excavaiioll shall he made or ohslacle plal:ed withill four 141 feet of the edge of the pa\'ernclll. If the work done under this permit interferes in any way with the drairlilge of the county road. the gralllee shall Wholly und at his own expcll~ lTla~e such provision as die engineer may direcl to wke care of said nraillage. On completion of said work herein contemplated all rubbish and debris shall be immediately rCllloved and the Hladwar and roadside shalll:>t: left neat and presentable and satisfactory to the engineer. 'r; I,'"~ All of the work herein contemplated shall be done under the supervision and (() the satisfaction of the County Engineer and the entire expemc of said supcrvision shall be borne by the party or parties to whom this pcrmit is issued. I,J' f~ l f i (. The Department of Public Works hereby reserves the right to order the change of location or thl: removal of any structure or structures authorized by this permit at any time, said change or removal to be made at the sole expense of the [l<!rty or parties to whom this pcrmit is issued, or their successors and assigns. All such changes, rcconstruction or relocation by the grantees shall be done in such manner as will cause the least illlerference with any of the Coun. ty work and the County of Jeffcrson shall in no wise be held liable fur aflY damage to the grantee by reason of any such work br the County of Jeffer' son. it agents or repre!iCntatives. or by the cxercise of any rights by the County upon roads. strects. public places or structurcs in question. This permit or privilcge shall not be deemed or held to be an exclusive one and shall not prohibit the County from granting other permits or franchise rights of like or othcr nature to other public or private utilities. nor shall it prewnt the CourllY from using any of its roods. streets. or public places, or af. fect its right to full supervision and control over all or any part of them. none of which is herchr surrendered, ~,...' { ~Y" . The Department of Public Works may revoke. amend or canccllhis permit or allY of the provisions thereofat any time by giving written notice to the permittee. The permittee shall immediately remove all facilities from the right of way. Any facilities remaining upon the right of way 30 days after writ. ten notice of cancellation shall be removed by the County at the expense of the permittee, '1"'" The party or parties to whom this permit is issued shall maintain at his or their sole e,\i.peme Ihe structure or object for which this pcrmit is granted in a condition satisfaclory to the Department of Public Works, SPECIAL PROVISIONS, c' , }, ~. k L A culvert is required. Culvert shall be a minimum of 20' x 12". 'I :;. 2:., 'Applicant. shall, be responsible for all damages to county road right-of-way. ..,;, , ~ l J' ~j In accepting this permitlhe grantee, his successors and assigns, agree that allY damuge or inju~\I done to the property of the gruntee or any expenr.e incurred by him through the operation of a contractor. working for the County or nny County employee shall he at the sole expense of the grantee, his successors and nssigns. .)lO. '.A,ltr,{ -;::ro~'m,) and conditiohs as herein liel forth. Dated this'-}f &l.~ day of* . the undersigned. hcreby accepts this pcrmit subject to the terms _" 11;/ -Y. ,19 '?'j ,~r'> ~' (' 1 .<\> ~{(- ~~lll:lllll ' I "V{;'" ......-. " c.: ".:'" ,., . ,,: .. '........ ','.' ." , . "... ','. .' ". . . : :..". :': " ,'" " ' . ., . , . . ,c. :.... ,'. '. '....... ,. ...' .'.... '; '.........,:, ., ......... . .' '.c .' .' - ;..'.' "," ,.' ; .' ..'.';""" '.. ;."c, ."'" :'" ,,: "", ; '".. . " . .:....';. . ' :'> ..... .,:..,... , . ) ~. i r ; I' I, t, 'I ~ .... '.' '" . ~ . I I ",. . .. \ , .:. . . . . . " '-" ",: .... . '>" '.', ': '.' .,' ...- '..",.,' ,. tN~ .,:::;:..' ; . :". .. :'.1 x '. ;. ,-':-:",-,:,,;-~~,~.~ JEFFERSON COUNTY DEPARTMENT OF PUBLIC WORKS Fee I'aid~~ _ No ......:1'-89 ~ ll.a;ciI'INu. ArJdre.!.SRequc~t ~es_No Mile Post 1820 Jeflarson Strael P,O, Box. 1220 PorI Townsend, WA 98368 (206) 365.9160 AI'I'L1CATION .'OH I'ERMIT .';,717 J.t, . To Department of Public Works, Jefferson County, Washington. The undersigned 1,.,,11.,,'1 ~ul..,~j hereby appl-r-- for permissioll to 1"J':o1.A\.-i..- 'A 1l"'O A~r~MC~ TO w., I o\, ARQ,"'\J) Irlpl'li.UIIf "JII,/"I"d,,' JlllI.~' ..hul II.. ..ill,... II) Ju J \'T ",,,P. SKETCH: "5IT An ATC,111>D t'V\A P C I,.OT \) 011 County Road: CA pt .Gro..., RD, between MI'-C'. ~ro;l-l 0': C"~vy CHMt' Gec..;; (ioun,;E":'. t.'ilal,."I'Il'....,rmll,~I'I'l'I/lflllll..l'm.tJ/J and agree_ to do the work in accordance with your rules and regulations and subject to your inspection and approval. Date 16 19~ reo Al'l'li':lIull j\,~c.. \3A~con;II~~. (If applicant is a copartnership. set forth names of copartners) ..".?() ^lldr~!\Io ^ddrc\~ 'Vo"" QY1(,1' ~,', ' ':.....: ',', ,.,' ~ " " ",: " ":" " " ..-----------_.. Jefferson Co. DEPARTMENT OF I'UULIC WOnKS District No. (" Permit No. t7 965 SUIJervisor's neport No. Supen'isor will make detailed report with his recommendation on this appliea/ioll. Whenever possible show sketch of proposed work. Supervisor will also make additiollal repOrlS alld final report giving date of completioll of work all Otis form. Preliminary I{eport: c~ e.. 6~<fe. ..<.:D. ;1'< -p- 6-'-'2.. ~:r. f5rfrAJj) trR-D l> .' ~,-t. /H..JC> 5*';>. Date: 2-17-89 { ..I)~4- K~ Signed: Final Report: PER~7SPECTION REPORT Work covered by permit has been completed satisfnctorily. Work is not completed. Recommend permit be cnncelled, Traffic control - adequate - lnadequnte REMARKS Dnte: '-/- IL....- ~ cr"'7 ( Signed: ~ ~ (' ...",". """"'.:. ' ."., .' 11 ......, .~ ,,' '.,'.., r-::::c .' :' .....,.... . ',' ., , . '.' ':.' 1~,:I:~~;', " ;'. . . , '. '. .,:: '., ;:' " I ", : :" :, . "',. , , I :-' , }. ": .: .'.' .,. .'. >'. , , '.'... , ,:' '. ~ ' ':.':" j' 'I: j - GENERAL PROVISIONS 1. THIS PERHIT IS SUBJECT TO RCW 36.75.130, .IQO ANO .150 ANO AMENOMENTS THERETO, 2. THE GRANTEEI lTS SUCCESSORS AND ASSIGNS.. AGREES TO PROTECT JEFFERSON COUNTY AND SAVE IT HARMLESS fROM ALL CLAIMS, ACTIONS OR DAMAGES OF EVERY KIND AND DESCRIPTION WHICH HAY ACCRUE lO OR BE SUFFERED BY ANY PER50~1.. PERSONS, OR PROPERTY BY REASON OF THE PERFORMANCE OF ANY SUCH WORK, CHARACTER OF MATERIALS USED OR MANNER OF INSTALLATION; IN CASE ANY SUIT OR ACTION IS 8ROUGHT AGAINST THE CCUNn FOR DAMAGES ARISING OUT OF OR BY REASON OF ANY OF THE ABOVE CAUSES, THE PETITIONER, ITS SUCCESSORS OR ASSIGNS ~ILL, UPON NOTICE OF CO/'\MENCE- HENT OF SUCH ACTION, DEFEND THE SAME AT ITS SOLE EXPENSE AND SAlISFY ~y JUDGEMENT ARISING THEREFROM IF DETERMINED ADVERSE TO JEFFERSON COUNTY, 3. IF THE GRANTEE ENTERS INTO A CONTRACT OR AGREEMENT WITH A THIRD PARTY TO PERFORM THE WORK AUTHORIZED ~~o~~~f F~~R~b[D ~~~Hm~O A~~R~~FE~~ ~H~AnU~~V T~~ ~~~~~g~~~~I~~T~O~H~T~R~em~~~ ~~T~A~~~~~~~'2~G~~~~E ~O Q. ~~'rmA~~R~~ln ~~NT~~ ~g~m~~no~N~O~~O~m~~m ~ml~ ~a05;'y~RS~mU~~B~~C~HiH~~R~E~~I~HioG~~~~~~- LATlON AS HEREIN PROVIDED, 5. DUR1NG THE CONSTRUCTION OF THE FACILITY1 THE GRANTEE SHALL COMPLY WITH THE MAHu,A1 ON UNIFORM. TRAFFI~ DEVICF!; FOR STREETS AND HIG~ PUBLISHED BY THE U,S, DEPARTMENT OF TRANSPORTATION, 6, ON COMPLETION OF SAID WORK HEREIN CONTEMPLATED, ALL RUBBISH AND DEBRIS SHALL BE IMMEDIATELY r<EMOVED AND THE ROADWAY AND ROADSIDE SHALL BE LEFT HEAT AND PRESENTAHlE AND SATISFACTORY TO THE COUNTY. 7. THE COUNTY RESERVES THE RIGHT TO ORDER THE CHANGE OF LOCATION OR THE REMOVAL OF ANY STRUCTURE OR STRUCTURES AUTHORIZED BY THIS PE~MIT .II,T ANY T1MEI SAID CHANGE OR REMOVAL TO hE ,;ADE At SOLE EXPENSE OF 1t1E PARTY OR PARTIES TO WHOM THIS PERMIT IS ISSUED1 OR THEIR SUCCESSORS AtID A:;SIGr~s. 8. ALL SUCH CHANGES I RECONSTRUCTION OR RElOCATlON BY THE GRANTEE SHALL BE DONE IN SUCH A MANNER AS Will CAUSE THE LEAST INTERFERANCE WITH ANY OF THE COUNTY'S WORK AND JEFFERSON COUNTY SHALL IN NO WISE BE HELD lfABlf FOR ANY DAMAGE TO THE GRANTEE BY JlEASON OF ANY SUCH WORK BY JEFFERSON COUNTY1 ITS AGENTS OR REPRESENTATIVES I OR BY THE EXERCISE OF ANY RIGHTS BY THE COUNTY UPON ROADS, STREETS1 PUBLIC PLACES OR STRUCTURES IN QUESTION, 9. THE GRANTEE SHALL NOTIFY THE COUNTY'S REPRESENTATIVE UPON COMPLETION OF THE WORK UNDER THIS PERMIT SO THAT A FINAL INSPECTION CAN By MADE. ._, ,,'...... SPECIAL PROVISIONS ;~pr~!\\:n; /:.;\~~;\::!ir~ APPLICABLE PROVISIONS ARE DENOTED BY AN (X) o l,",~ :,A..co~Y,' bF.~~iHEt PERMlt/S'HAlL BE ON THE JOB SITE1 AND PROTESTED FROM THE ELEMENTS1 AT ALL TIMES DURING THE cONST"RUCTl6N'AUTHOR '~Etf BY SAID PERMIT wITHIN THE COUNTY S R~GHT-OF.WAY. B'" 2. THE APPROACH SHAl.l. BE CONSTRUCTED IN ACCORDANCE WITH THE ATTACHED DESIGN PLATE TYPE ....E!...::..i. APPROACH, A .....t'I FT.LENGTH OF 1"2- INCH DIAMETER CULVERT PIPE SHALLBE PLACE~ DITCH AND lAID TO A TRUE liNE AND GRADE, THE APPROACH SHALL BE SURFACED TO THE liMITS AS SHO'tlN ON ~~~E~~~~GA~~ W~F~~:D~A~~R T~~O~p~~~e~~E S~~~~E:iy I~N~gC~~~~~~E R~~~~_~~:W:~O~: t~ ~g~T:~l P~:M 1~~E~~AN, ~ 3, THE APPROACH SHAL.L BE SUFFICIENTLY SURFACED BACK AN ADEQUATE DISTANCE FROM THE EDGE OF THE PAVEMENT TO PREVENT ANY HUD TRACKING ONTO THE COUNTY ROAD, ANY HUD TRACKED ONTO THE COUNTY ROAD SHALL BE IMMEDIATEL.Y CLEANED UP BY THE GRANTEE OR HIS AGENT, IF NECESSARY TO INCREASE SIGHT DISTANCE1 STUMPS AND BRUSH SHALL BE REMOVED FROM BOTH SIDES OF THE e:rn~A~~At.L T~~T J:~I ~~~~~+~~~E O~U~~~~~y O~0~5R~~~~~~~:W~~~BER OR DISF IGURING OF ANY FEATURE OF SCENIC 5. ~~~~N~~~~L. BE RESTR1CTED TO THE HOURS BETWEEN 9:00A,M. AND Li:OOP.H, UNLESS OTHERWISE AUTHORIZED By THE Gr'q. o 06. A SI~P'f.T\' fONt! IN nte AMCU::r OF $. I WRITTEN BY A SURETY COHPANY AUTHORIZED TO DO nUSINESS IN THE STATE OF WASHINGTON1 SHALL BE FURNISHED TO INSURE COMPLIANCE WITH ANY AND ALL OF THE TERMS AND CONDITIONS OF THIS PERMn AND SHALL REMAIN IN FORCE UNTIL ALL WORK UNDER THIS PERMIT HAS BEEN COMPLETED AND APPROVED By THE COUNTY, BEFORE ANY LOG HAULING OPERATIONS BEGIN1 A SURETY BOND IN THE AMOUNT OF $_ . SHALL BE FURNISHED BY THE GRANTEE TO PROTECT THE COUNTY AGAINST ANY DAMAGE TO THE COUNTY ~OAD AND TO INSURE COMPLETE REMOVAL OF THE APPROACH AND CLEANING UP OF THE RIGHT~OF-WAY TO THE SATlSFACT10N OF THE COUNTY. APPROVAL OF All CLEAN UP WORK SHALL BE SECURED BEFORE THE BOND WILL BE RELEASED. SPECIAL CONSIDERATIONS 07. o 8. Forml13b ...--...... . -:---1' .,.; .' I .,'. ." .... . '. . " ;. " , '." ... 'i .... > . . . , ,:". ..:, : '."}'. ,.... . .': , i: :. , ,'" 'i '. , , . , ..' . . .... ,. : ~,' .:.... .'. .... ',. '. ',' , : . ,.'.' -.' :. ::,' "', .' ',:'. '. " /':.'.' , , " ,,,' . ". , ,'.:' ,:" .',' . '.' .. :'. '; '.:. ........ . '; '. , ,.' ;"'. , :.,;..', ' ':,:......,.. Ii, ,..... , ,: !, ;,::" . I' I:, . .......... . I':! .... :.'.' ........'... I," '.' , .' :.:....... ::' , . Ii, ' '. ...... . :....,; :,', ',:' :' , II' I,. '. L-- ;':.... '. j:L' .. .', '.,' , :. " ,'. '. ......:. '...... .....<. ,. . .....< .', ':.'. ...... I' .'. . . ...:.... ': .,' '.' ':' " ":":.'v " '., ,," '" ,", ': , '.', ", ,.:':' ",.', , ' , --'" . .....,' ......: " '.' " .,: . .... .' > . ,'. ',.:.'. ': :', _I; . ,'....':. " JI:" i' -., .' " i I : ' >:.": ' : ''''j,,;::i::' , -, , THE KINETIC CO. :' I. Ii, ( ,. ,'.~'~ ~~ ~/ ./ ,\..S ".\1"" ~J31 l.foRte- U,f 0 pO 'I),; (' -\HI \ '.< 'a ~., '.\I~ '.\'/" Ill!:'".',',',;! OL{J PISe- IloAP (j) Ga OvT OW /)/$C- RI). Q) TAI<C A RI6/tT ()JJ CI/P;; frcOR~ flP. Q) (fa 6./ 1n;!".J .1'1'011" -I/fe. s/~l'f @ )/ei/~bcr- t)J>. le/f ()JtJ6 rec:errfly f"'.e,..: 0/3 ( CafX!- lfCoe&-~ /ZP.. (f) 60 30 Fr. rVf1111P/l 0/'1 v~ /tI- ~ 4Nf s,de.. for ovt:{~,!R.- I'(~f, KINETIC'" 1",.\ ~ ~, I;, ,t ~j t I. , r ! t ~ ~ ~t . '~ ~ ~ I .. i f' i I j' \ \ i ,i\'4>'lilil'.'l"i";'~l"'~1.~" - .',: ...,'.' :."..','; .'.' :'. ,.' '. '.':, <.... ", c" C' :':., ,..,:,.." ':"';',' .'" " "",.,:..,',,': ",' ,', '. ."'" , ';""", "." ":,' ". " . ':<,'<' '. ". "'. ; :,' . . ,', .. ...... . ," :.' ,'., ,.,,', , .', . ','. .,,: ' '" .'. " ' ,'.'" ,'" ,"; , :'" ,.:, ,,', " ," '.., .":. . c',',;' : "'<-- ,." " ',,: .,',' ,.',',' "".,." " ".'.,' . :'. , '. ',,':, ' :, ,," '. ,:' , c ,', ' , , " ,: 'C'" '., ,:', , " ' ',,, ',':.' ." '" .' " "." ,," :' " "'.,", "'., :.' " " " .' , .,' .:., "'.,:' . ' ,.,,'. "."','.., '.. , , ",; " ", ';:: '. . ':,'. .,' ':",:/'" , .' ":,;' ... .', ,:, .::..; , .. "'.'.:.:,. " ," ..' :'.,., '.. " , . :. , " .,c, . .. , ...,.,' ." ,: " ,'",..~ "'. \ ---!,-:_ 'Y~~'1 "'''V~~.t;, ';~~fi' r~~>~,~f--.. """~\l~' N~ 0967 JEFFERSON COUNTY DEPARTMENT OF PUBLIC WORKS 1820 Jellerson Slreel P.O, BOll 1220 PorI Townsend, WA 98368 (206)385.9160 District No. 6 PERMIT In accordance with all applicable Revised Codes of Washington and amendments thereto, and subject Lo alJ the terms, condi- tions and provisions written or printed below or on any part of this form PERMISSION IS HEREIlY GRANTED TO U.S. West Communications 2720 Oakridge Dr., Port Angeles, WA 98362 ~ Install buried cable, including road push, along Cape George Rd. from mile post 6.13 to mile post 6.15. Job II 89-51 County Road No. 62 2 808 Franchise No. Milepost 6 . 1 3 - 6. 1 5 No work shall be done under this permit until the party or parties to whom it is granted shall have communicated with and received instructions from This permit shall be void unless the work herein contemplated shall have been completed before Mar ch 1 Dated at March 1 ,19 89 .19 90 ~~~~@wm ~fP J~. CALL 48 HOURS BEFORE YOU DIG By ~~ A~ . 1.800.424.5555 '( ,,',' :, ,,,' ;': > I..,' .. ...;, , ::;. ..'" '.. ........ '" ""', ','. '. :' . , ,: ." ' " '..' . ,,' , . , \ ,", ,', " . ".., :. ........ ..".. " ' '. '. ,,'.. " '. " '" ~ , . :. .;i '\ ..... , .: i Ii . ....:.. GENEIlAL I'ROVISIONS AI'I'L1CAIILE TO ALL I'EIIMITS This pcrmit is subject to all applicable provisions of the Reviscd Codes of Washington, CJti.CCjltthllt all)' provision in this agrcclllt:nt notl.:orl"i..tcnt with such rc~olution shall be COlli rolling, A bond ill the amount of $ is relJuired for tile prutection of the COUIll)' as set forth ill the terms of the bond. During the progress of the work such barrkrs shall he erected and muilltuincd as m,IY be Ilel:cssary Of as lIluy he directed for the protection of the traveling public: the barriers shall be properly lighted at night. In accepting this pcllnit the petitioner, his succc,>sors and assi~plS. agrr.:es to protect Jdferson County and save it harmless from all clai/ll~. actions and damagcs of every kind and description which may accrue to or be suffered by anr pcrson or persons. corporation or properly by reason of the pcrfur. mallCC of any such work. character of materials used or manner of installation. maintenance and operation or by the 111lpropt:r oa:upanc)' of right of way or public place or public structure, and in case any suit or action is brought against said Jefferson Coullty fur dalllages arising out of or by rea~m of any of thc above causes, the petitioner, his successors or assigns. will UPUlIIIOtict: to him or them of commencement of such uctiOIl, defend the same at his or their own sole cost and expense and will satisfy any judglllt:nt aftcr thc said suit or actioJl !lhall have finally bcell determined if adverse to the Jef. ferson County. Except as herein authorized. nu excavation shall bc mudc or obstaclc placed within the limits \If a coullt}' rood in such a manner as to interfere with the travel over !>aid road. Except as hercin authorized, no t:xcavation shall be made or obstacle placcu within four 141 fcet of the edge uf the pavement. Uthe work done under this permit interferes in any way with the drainage of thc cUUlllY road. the grantee shall wholly and at hi!> own expense llIa~c such provision as the cngineer may direct to take carc of said drainage. On completion of said work herein contemplated all rubbish and debris shall bc irnmt:diatcJy removed and the roadway and roodside shall be left neat and prcsentable and satisfacLOry to the engineer. All of the work herein contemplated shall be donc under the supervision and to the satisfaction of the County Engineer and the entire expense of said supervision shall be borne by the party or partics to whom this pcrmit is issucd. The Departmcnt of Public Works hereby rescrves the right to order thc change of location or the removal of any structure or SlrUCtUres authorizcd by this permit at any time. said change or removal to be mude at the sole expcnsc uf the pany or parties to whom this pcrmit IS issucd. or their succe~ors and assigns. All such changcs, reconstruction or relocation by the grantees shall he done in such manner as will cause the Icast interference with any of the Coun- ty work and the County of Jefferson shall in no wise be held liablc for any damagc to the grantee by rea!'>on of any such work by the County of Jefft:r- son, it agents or reprcsentatives, or by the cxercise of any rights by thc County U(lOn roalls, streets. puhlic places or structures in question. This permit or privilegc shall not be deemcd or held to be an exclusive one and shnll not prohibit the County from granting other pcrmits or franchise rights of like or other naturc to other public or private utilities, nor shall it prcvent the County from using nllY of its roads. streets. or public places. or af. feet its right to full supcrvision and control over all or any part of them, nOlle of which is hereby surrendered. The Department of Public Works may revoke, amend or cancel this permit or any of the provisions thereof at any time br giving written notice to the permittcc. The permittee shall immcdiatcly rcmove all facilities from the right of way, Any facilities remaining upoJlthe right of way 30 da)'s after writ, ten notice of cancellation shall he rcmoved by the County at the expense of the permittec. The party or parties to whom this permit is issucd shall mailllain at his ur their sole expcnse the structure or object for which this pcrmit is grantcd in a condition satisfactory 10 the Department of Public Works. SPECIAL PROVISIONS: 1. Cable shall be a minimum of 30" below existing ditch grade. 2. Applicant shall be responsible for all damages to county roaai]f Aht'~'j'f"'",,,,y.., Hltl \V%)ilI1F~;;~I:I;::t ...;;.,". V\:: l.HI U t ,,~ In accepting this pcrmit the grantee. his Sllccessors and assigm. agree that any damage or injury done to the property of the grantee or any expense incurred by him through the operation of a contrllctor. working for the County or .my County employec shall be at thc sole cxpcnse of thc granlee. his successors and assigns. "* If.;; to/.: ,.;- and conditions as hcrcin sct forth, Outed Ihi; 6 da, o~ . the undersigned. hereby accepts this pcrmit subject to the terms /av</' +: ,19 ?'? '~lPli(lmt Jefferson Co. DEPARTMENT OF I'UBLlC WORKS District No. Permit No. t') 9 h 7 SUIJCrvisor's HCltorl No. Supervisor will make de/ailed report with his recommendation Oil this ofJplicalio/l. ~Vhenever possible show sketch of proposed work. Supervisor will also make additional reports alld final repon giving date of completion of work on this form. IJreliminury Ilcporl: CA-pe. C~Rge R.D. /h.p. 6.13 1-0 6. /5 S ;-->'1-ND f>-KD \) i feN /J./Vi:) sl!otll.DelC.. Dale: ~, /- R'l Signed: --d-f~~ NSPECTlON REPORT \Vork covered by permit, has been compleled satisfaclorily. ;.' : ' , Work is nol compleled. Recommend permil be cancelled. Traffic conlrol - adequate - inadequale REMARKS I)ale: -4- / ~- 1'9 I SIAned: r o-~ ClI.\'l\lI'l('I'llI~lntS.I~C~. -........."...""._-,-..'<'--" -'~--'- :',.' . .., '. . .'.': : . " :,'_.: 1 ~. .... - . . '. .' ::'..! .t. .,:.' :....; . '. "':; . : ',c' o. '.... ...... . ':.:':.. " .' '., '. :~:: '. .:.' .. i?.2.___Q.} : !?!;L.EM__t.L9J.J_IQ,wn::. efl (1.. G? rag e PO 1 PERM IT 2-/t j,>' lll-WESr' COMMUNICATIONS @OUT IN P899017-881 No, .:ff2.=.~ Complete oy ___ Burled Service Wire. Work Order CONTRACTOR'S ACCEPT ANCE Firm Signature Title Dllte Unil Prlee D Co.t Piu. 0 Flat Sum 0 S '/YORK LOCATION ',-, Address ~ I '3 I L:A,.!;: (;". ~~ ~. City t!.A~F: GliO. County J~~F: Stal.~ Nurne S-rev <41 Hfl B r:Y<31rr' 2ER. ORIGINATED BI( c'AN1'> ee: Date 2.::L~ New .!8J'S/ONo,__._DueDete_ Repair .pi Tel. No. 3i5..:1I3S Temporized1lia Rearrange 0 SID No. Due Dale _ Typo 01 S9rvito I FR __~'='- ~!.~~ _~ofIB.P, __ T.,rn, Address PI1II g61l :J.. ~l:l.~~ ~~,.,.~!'l .,. ; : Sill to U S WEST Communications Attention Address City Zip . APPROVAL For FI.t Sum/Co" Plu. $ Recommended Approved by ", ':": Dale ___ Date ___ ..: ~.. - R~~:~~~~ Ou.nllly O,ecrlpllcn 01 WOlk 9LJ" H ^ " ,. '{'_.apE t.:l:l'-,,>' Q'l'I. .... P/"'IHl:. T'tJUU=-S." r::'D~_ /l.~" .,,,.Ii "-- l>'lo 1-> (,.lft7"G.(t. ^" r;"'~Q> ~ I>L U.1i ',,' 'A",) o I(es 0 No Verbal 0 No._Dale_ PERMIT REOUIRED Received from Jurisdiction ""~': .' .' "/ COMPLETED BI( Call Date__ for Service Conneclion Indicate Norl"-+l ........+. . . . . . , . . . . . . . . . . .. . f" . 'IV . . . . , ~~(j:N: l: . : : : : _k&~-:"fF '8Q 07 ,~~~ .- ...-.. ...,,, .", "",,,. ' '""" Co"","'. 'W.'. .,., ",. 7m~" :~ait ~~~~ II G~'--F. c.~~s~ , l ('f.'Q II( - . .\ff: I ~~ .-, -. - . f', i3C-CI~/Yf'T . H. .~, f' ~. r .' , ~(~ .> -... ~,'" .t: t , i. C 1,' ( . HI ~~~f1' . 1 oS 0 ,^.>'I\i'i'l~ 'M(!'ili\t C. Ar-..: GG<'> f{b\ '- p.J..\I,~. 'b\C.l\~ Nnll:"; Thl~ ~k~tr:h ITl~V not bH..n ;'lCaaJlIlIJol '...pr"'if:lnl~lIon In ~Il tlt'lflUS. II rem"ln! t"~(:nnlr~r:lnr's '..spm"lllI!Uv t~ orOl'f!Orly IOr:l:ltf.l work In I hI:" IIHI,1 l . r : .... ORIGINAL. COpy ,".', r,;\; . .!~ : .. ';. ~'Mc',;, f'~' I j .,': ...... c. ..... '. <.... ...... .,' ." .... . :., " .... .. '," .' , .' . . . ....., ........ . ....:. ,',. . ...... .;. : .... .:'" . . . ....... ...." ':". .... :.; .... ': ":.' . ;'. .' .'. .'. :".' . . . ....., '.. .....'.....:' ..... .'. :......,,:.... .... . '.. . ., .-,:; .'. "'." . .' .' . :. : ',::. '.: --" .... :: .... r '~ : ;. ..... ...... : '. ',' . . .,.. ....:.;... ..' '.' .... '. .,:.1 : ~ ,':> :. .,'. ."'.' '. (" .'::'.: ... . ..... ! ':. . ' . ,c" '" ",.' . . ". ':':: '. !i:. . ~ ! ': i. .... i , '. .' \ ..,..J\:~;n,~ ",,:,,11\'hi[~if ~~(, 111"/"""-' J..-' ,)~ Ii. JEFFERSON COUNTY OEPARTMENT OF PUBLIC WORKS 1820 Jctlerson Street P,Q, Box 1220 Port Townsend, WA 98368 (206)385.9160 N~ 0948 District No. 6 PERMIT In accordance with all applicable Revised Codes of Washington and amendments thereto, and subject to all the terms, condi. tions and provisions written or printed below or on any part of this form PERMISSION IS HEREBY GRANTED TO Pope Resources c/o Skip Wood, 21 Shine Road, Port Ludlow, WA 98365 to Install a private road approach, (type P-1), to the North side of Cape George Road at mile post 6.02 County Road No, Franchise No. 622808 Milepost No work shall be done under this permit until the party or parties to whom it is granted shall have communicated with and received instructions from 6.02 This permit shall be void unless the work herein contemplated shall have heen completed before January. 26 .1990 Dated aLJanuary 26 . 19 89 &~~~WW~~ By /J~ I<L ~.:._--_.~.-.-,,_.":""',-,-'-,-- ---."-- --' GENEIIAL I'IIOVISIONS AI'I'L1CAIILE TO ALL l'EIlMITS This permit is subject to all applicable provisions of the Revised Codes of Wa~hil1!!ton, eAccpt that an)' provision ill this :tgreemellt not cuns.j~tt'f1I with such resolulion shall be controlling, A bond ill the amounl of $ is relluired for the prolection of the (;OUIII)' as set forth ill the terms of the bond, During the progress of the .....ork such barriers shall be erected and mainlained us may be lIeces.sar)' or as Illay he dire(;(cd for the protection of the traveling public; the barriers shall be propcrly lighted ut night. In ucceptillg this pcrmilthe petitioner, his succe~sors utld assiglls. agrees 10 l)Jotecl Jefferson County ulId save it hurllllcss flOm all daims. actions and dama!!es of every kind and descriplion which may accrue to or be suffered by allY person or persons, corporation or propert)' by reason of the perfor- mance of any such work, character of malerials used or manner uf installatioll, maintenance and operation or by the improper occupancy of right of wa)' or public place or public structure. and in case an)' suit or action is bl'Oughl agaimt said Jeffersun C'oullty fur damages atilting out of or by' re,lson of any of the above causes. the pctitioner. his successors or assigns. will upon notice to him or them of COllUllenCClllcnt of such aClion. defend the same at his or their own sole cost and expense and will satisfy any judgment after lhe said suit or actioll shall have finally been determined if adverse to the Jef. ferson County. Except as herein authorizcd. 110 excu\'ation shall be made or obstacle placed within the limilS of a clJunty road ill such a mallner as 10 interfere with the travel over said road, Exccpt as hcrcill authorizcd, no t:xcavation shall be made or obslacle placed within fuur (4) feet of the cdge of the pavelllt:/lt, If the work done under this pcrmit interferes in any way with the drainage of the county road. Ihe grulHet: shall wlwlJy and at his own expense make such provision as the engineer may direct 10 take care of said drainage. On completion of said work herein contemplated all rubbish and debris shull be immediately reflloveJ and the roadway and roadllidc ~hall be left ncat and presentable and satillfactory to thc engineer. All of the work herein contemplated shall be done undcr the supervision and 10 the satisfaction of thc Countr Engineer and the entire expense of said supervision shall be borne by the party or parties to whom this permit is issued. The Department of Public Works hereby reserves the right 10 order the Chall!!e of location or the rcmoval of any structure or structures authorized by this permit at any time, said change or removal to be made at the sole expense of the part). or panies to whom this permit is issued, or their succes!;ors and assigns, All such changes, reconstruction or relocation by the grantecs shall bc done in such manner as will cause tlte Icast interference with any of the Coun- ty work and the County of Jefferson shall in no wise be held liable for any dama!!e to the grantee hy reason of any such work by the County of Jeffer- son, it agents or representatives, or by the exercise of any righls by the County upon roads. streets, public placcs or structUres in question. This permit or privilege shall not be deemed or hcld to be an exclusive onc and shall not prohibit the County from granling othcr permits or franchise rights of like or other nature to olher public or private utilities. nor shall it preVcllt the County from using any of its roads. streets. or public places, or af- fect its right to full supcrvision and control ovcr all or any part of thcm, none of which is hereby surrendered, The Department of Public Works may revoke, amend or cancel this pcrmit or any of the provisions thercof at any time by giving written notice to the permittee. The pcrmillce shall immediately rcmove all facilities from the right of way. Any facilities remaining upon the right of way 30 da)'s after writ- ten notice of cancellation shall be removed by the County at the expcnse of thc permillcc. The party or parties to whom this pcrmit is issued shall maintain at his or their sole expcmc the structure or object for which this pcrmit is gran led in a condition satisfactory to the Department of Public Works. SPECIAL PROVISIONS: 1. A 12 inch culvert 30 feet long shall be required. 2. All disturbed areas shall be restored to original condition. In accepting this pcrmit the grantec, his successors amI assigns. agree that any damage or injury done 10 the property of the gra/llce or any expense incurred by him through the operation of a COl1lntctor, working for the County or llny County employee shall be lit the sole expense of the grantee, his sllccessors and assigns. f~~ ,and conditions as herein set forth, , the undersigned, hereby accepts this pcrmit subject to the terms Dated this 2. day of j-~ 5X..~ wJ" 157 1820 Jetlerson Streel P,O, Box 1220 Port Townsend. WA 98368 (206) 385-9160 Fee Paid ':>I. Yes _ No ~73:22. Rcu:'P1l"'o ~ Addrt:!>>Hcque~t_ YQLNo Mile Post \ --,,,~~/J,,,>~ ~Vi!.~., .:... ~K:', f',V<;?r-. JEFFERSON COUNTY OEPARTMENT OF PUBLIC WORKS APPLICATION t'OI! I'EHMIT To Department of Public Works, Jefferson County. WashingJl/n. The undersigned c.p / e hereby appl_ for permission to JO / C" {vt>"'- +-5: j\~ t;qr C... .s r" T //1 I tJ /'1 ~v..., /.v'.< r , fAl'llfinmt ,,,II J~'m""luJlr ..IIQllrt .."lIn ,,,,j.. I =3 ~ ~ ~ I . i UJr4 urrs urr" 1 t ~ ;; I District No. , 6 Jefferson Co. DEPARTMENT OF PUBLIC WOnKS Permit No.--L2J.<l8 Supervisor's Ilcport No. Supervisor will make detailed report with his recommendation on this application. Whenever possible show sketch afproposed work. Supervisor will also make additional reports and final report giving date of completion of work on this form. Preliminary Report: Cripe. Gcol2j'e \KL>. /?l'p- 6.02.- 0",,) t.eFr_ ~171-'"OI11<D \); fen- ~D S/H)vo'-"~ef?- Dale: Final Report: PERMIT INSPECTION REPORT /- 25"- 99 Signed: -./J/~/<~ Work covered by permit has been completed satisfactorily. Work is not completed. Recommend permit be cancelled. Trl1ffic control - adequate - inadequate REMARKS Dale: <:./-/2-- ,57 Signed: ~.o-- - "-, "-" .'. ,;".', _ ,-,_'_,_,_'_,_.c__~,.___,__ ___ _ _<,_,__ .::.....:..._-",..;._'..;...-..;....:..',...:._.;....;:.;..~'.....;:.~.-:.-.-' r\c- -~ \. ?;::r~!;if >~~j;l, --I1;:/(~r-", .. V\r JEFFERSON COUNTY OEPARTMENT OF PUBLIC WORKS 1820 Jetrerson Streel P,O, Box 1220 Port Townsend, WA 98368 (206) 385-9160 I/. N~ 0949 District No. PERMIT In accordance wiLh all applicable Revised Codes of Washington and amendments therelo, and subjectlo aU lhe lerms, condi- tions and provisions written or printed below or 011 any part of this form PERMISSION IS HEREIlY GRANTED TO Pope Resources c/o Skip Wood, 21 Shine Rd., Port Ludlow, WA 98365 to Install a private road approach, (Type P-1), to the North side of Cape George Road at mile post 5.93. County Road No. 622808 Franchise No. Milepost 5.93 No work shall be done under this permit until the party or parties to whom it is granted shall have communicated with and received instructions from This permit shall be void unless the work herein contemplated shall have been completed before January 26 ,1990 Dated at January 26 ,19 89 &~~~@W~~, Ily A~ <L 1.800.424.5555 - -- -..' ,.'" -,' -'--.'''---~--",~_.,--,,---_._, '-'.. ~'-~ "*--'----- .._--,,-......~ -.:....-...'::..:-.,. (;ENElIAI. I'HOVISIONS AI'I'L1CAIlI.E TO ALL l'EllMITS This permit is subject to all applicable provisions of the Revised Codes of Washington. exccptthat any provi~i(JlJ in this agreemcnt ntn consistcllt with such resolution shall be cOlltroJlillg. A bond in thc amount uf $ is required for the protectioll of the courny as ltCt forth ill thc tcr/l1.~ of the bond, During the progress of the work such barriers shall be erected l.llld lIlailllaincd as may be /leccsllUry or as lIIay be llirccted fur the protection uf the traveling public; the barriers shall be properly lighted at night. In accepting this permit the petitioner. his successors and assigns, agrces to protect Jefferson CUUflty and save it harmless from illl claims, actions and damages of every kind and description which llIil)' accrue to or be suffered by allY person or persons, corporation or properly b)' reaSO/l of the perfor- mance of any such work, charactcr of Illaterials used or manner of installation, maintenance and operation or by the improper occupanc)' of right of way or public plilce or public structure, and in case any suit or aClion is brought ilgaiuM said Jefferson COUnty for damages arising out of or b)' reason of any of the above causes. the petitioner, his successors or assigns. will uroflnoticc to him or Ihelll of COllllllcnccment of such action. defend the same at his or their own sole cost amI cxpense and will satisfy ally judgmcnl after the said suit or action shall tlilve finally been determincd if ad\'crsc to the Jcf. fcrson County. Except as hercin authorized, no excuvation shall he madc or obstaclc placed within the limits of a cour1lr mad in such a lIlanner as to interfere with the lravel over said road, Exccpt as herein authoril,cd, no excavation shall be made or obstacle placed within four (41 fect of the edge of the pa\'ClllenL If the work done under this pcrmit interfercs in any way with thc drainage of the COunt)' ruad. tht: gramec shall whull)' and at his own cxpense makc such provision as thc cnginecr may direct to take care of said drainage. On completion of said work herein contemplated all rubbish and debris shall be illlll1ediiltely removcd and the roadway and road~ide shall be left neat and presentablc and satisfactory to the engincer. All of the work hcrein contemplated shall be dOlle undcr the supervision and to the satisfaction of the COUnt)' Engineer and the cntire expense of said supervision shall be bornc by the party or parties to whom this permit is issued, The Departmcnt of Public Works hereby reserves the right to order the change of location or the rcmoval of any structure or structures lluthori/.ed by this permit at any time, said change or removal to be made at the sole expcnse of the party or partit:s to whom this permit is issucd, or their successors and assigns. All such changes, rcconstruction or rclocation by the grantecs shall be done ill such manner us will cause the least intcrfcrencc with any of the Coun. ty work and the County of Jefferson shall in no wise be hcld liable for any damage to the grantet: by reason of any such work by the COUnty of Jcffer. son, it agents or reprcsentativcs. or by the exercise of any rights by the Coumy Upon roads, streets, public places or structures in qucstion. This permit or privilege shall not be deemed or held to be an exclusive one and shall not prohibit the County from granting othcr permits or franchise rights of like or other nature to other public or private utilitics. nor shall it prevcnt thc COUnty from using any of its roads. strects. or public places, or af- fect its right to full supervision and control over all or any pout of them. none of which is hereby surrendercd. The Departmcnt of Public Works may revoke, amcnd or cancel this pcrmit or any of the provisions thereof:u any time by giving Writtcfl notice to the permittce. The permittce shall immediately remove all fucilitics from the right of way, Any facilities remaining lIPOllthe right of way 30 da)'s arter writ- ten noticc of cancellation shall be removed by the County at the expense of the pcrmillec. The party or parties to whom this pcrmil is issucd shall maintain at his or their solc expense the structure or object for which this permit is granted in a condition satisfactory to the Department of Public Works, SPECIAL PROVISIONS: 1. A 12.inch X 30 foot culvert shall be required. 2. All. areas disturbed during construction shall be restored to original condition. In accepting this pcrmit the grantcc, his Sllccessors and assigns. llgrce that any dllmage or injury donc to the property of the grantce or any expense incurred by him through the operation of a contractor. working for the County or any COUnty emplo}'cc shall he at the sole expense of the grantce, his successors nn~~D r (, , - ~ . Ihe uncler,igned. herehy accepts this ""rmil suhjec, 10 the terms nnd condilions as hercin sel forth. F -e--f- ~/z- U/~ Datedlhis ~ day of .19 ?7 \ -~~-ji ~,~( 1'fft/?--"\ JEFFERSON COUNTY DEPARTMENT OF PUBLIC WORKS Fee paldL Yes _ No :, -n, -2. 2-- 1820 Jellerson Street P,Q, 80. 1220 Port Townsend. WA 98368 (206) 385.9160 R~'PINQ Addre'>SRc:que~t_ Ycsb Mile PQ1>t AI'I'L1CATION .'OIII'EIIMIT To Department of Public Works, Jefferson County, WashingJl/n, The undersigned r e? / e hereby appl_ for permission /0 JOI C" {v..,r +5 J{<t'>t7rCC->5 f., T 1/1 I tJ" -v -<: w.... r t9 1A1'(lII<lm/ ..,IIJ<,\(."t.c<ful/,' ..ha/ hl'..,'/".... /fJJuj Jefferson Co. DEPARTMENT OF PUBLIC WORKS District No. b Permit No. 09 'I 9 Supen1isor's Report No, Supervisor will make detailed report with his recommendation on this application ~Yheneve' possible show ske/ch of proposed work. Supervisor will also make additional reports and final report giving date of completion of work on this form. Preliminary Report: c."l1''L Ge.C)R..<je-\ I-<D. JovI- ? ' ~93 04/ ?e.Pr-. -:5T7'1-N{?~D ':$;,<o'1'-I><""-'~.D D,-I-c/ye:; Oale: 1 - 2....~ - &9 JJ r .Y;;I- 1< r/L./J Signed: Final Report: PERMIT Ij>1SPECTlON REPORT L/ Work covered by permit has been completed satisfactorily. Work is not completed. Recommend permit be cancelled. Traffic control.. adequate .. inadequate REMARKS Dale: --=1- \ 1. - )I ( '.:p<- c::r--- ' Signed: 4. JEFFERSON COUNTY DEPARTMENT OF PUBLIC WORKS 1820 Jelterson Street P.O. Box 1220 Port Townsend. WA 98368 (206) 385.9160 N~ 0950 District No. 6 PERMIT In accordance wilh all applicable Revised Codes of Washington and amendments therelo, and subject 10 all the lerms, condi- tions and provisions written or printed below or on any part of this form PERMISSION IS HEREIlY GRANTED TO Fope Resources c/o Skip Wood, 21 Shine Road, Port Ludlow, WA 98365 to Install a private road approach, (Type P-1), to the North side of Cape George Road at mile post 5.88 County Road No. 622808 Franchise No. Milepost 5.88 No work shall be done under this permit until the party or parties to whom it is granted shall have communicated Wilh and received instructions from This permit shall be void unless lhe work herein contemplated shall have been completed before January 26 Dated at January 26 , 19. 89 ,1990 &~~~@wram By /J~ J<L 1.800.424.5555 GENERAL I'ROVISIONS Al'l'L1CAIlLE TO ALL 1'lmMITS This permit is subjt:ct to all aplllicable provisions of the Revised Codes of Washingtoll, except that an)' plU....i~ion illlhis agreement not comistcllt with such res.olution shall be controlling. A bond in the amount of $ is rC4uired fur the prulei:tioll of the l.:OUIHy us set fonh in the terms of the bond. During the progress of the work :!ouch barriers shall be erected ;JnJ Ul;,lintaincu us ma)' be necessary or as may be direcled for the protection of the Iravcling public; the barriers shall be propcrly lighted at night. In accepting this permit the petitioner, his succ.:C'ssors and assigns. agrees to prutect Jeffersun COUllt)' am.! save it harlllh:!ts horn all claims, actiom and damages of every kind and description which Illay accrue to or be suffered by :.IllY persoll ur !JClsullS. cur potation or propert)' by rea~on of the perfor' mancc of any such work, character of mutcrials used or marlller of instullatiull. mailllt:nar\ct: and ol'lCralioll or by the improper OCl:upanC)' of right of way or public place or public structure, and in case any suit or action is broughl against said Jefferson County fOl damages arh.ing out of or b)' reaM,lJl of any of the above causes, the petitioner, his successors or assigns, wjll upon notice to him or them of cOllllllencement of such lIctioll, defend the sallie at his or their own sole cost and expense and will satisfy allY judgment aftcr the said suit or action shall have finall)' bet:n determincd if ad\'crlte ttJ the Jef- ferson County. Except as herein authorilcd, 110 excavation shall be lIlade ur oh~taclc placcd within the limits of a county road in such a manner as ttJ interfere wilh the travel over said road. Except as herein authorized. no cxcavation ~hall be lIlade or ohstacle plact:d wilhin four '41 feet of the edge of the pavemcnt. If thc work done undcr this permit interfcres in any war with the drainage of the county road. the grantct: shall wholly and at his own cxpense llIakc such provision as the engineer may direct to wke can: of said drainage. On completion of said work herein contemplated all rubbish and debris ~hal1 be immediatcl)' removed and the road war amI roadside shall be left neat and presentable and satisfactory to the cngineer. All of the work herein contemplatcd shall be done under thc supervision and to the suthfactioll of the County Engineer and the entire expense of said supervision shall be borne by the party or partics to whom this permit is issued, The Dcpartment of Public Works herebr rcserves the right to ordcr the change of location or the removal of any structure ur structures authorized by this pcrmit at any time, said change or removal to be made at the sole cxpenloe of the party or partics tu whOlllthis pcrmit i~ issued, or their succe~50rs and assigns. All such changes, reconstruction or rclocation by the gruntees shall be done in such manner as will causc lhe least interfcrcl1ce with an)' of the Coun- ty work and the County of Jcffcrson shall in no wise be held liable for an)' damage to the grantee by reason of allY such work by the COUlllY of Jeffer- son. it agents or representatives, or br the exercise of any rights by thc County upon roads. streets, public places or structures in question. This permit or privilege shall not be deemed or hcld to be an exc1usivc one and shall not prohibit the County from granting other permits or franchise rights of likc or othcr nature to other public or privatc utilities, nor shall it prcvelltthe Count)' from using any of its roads. strcets, or public placcs, or af. fect its right to full supervision and control ovcr all or any part of them. none of which is hercbr surrendered. The Department of Public Works may revoke. amcnd or cancel this permit or allr of the provisions thcreof at any timc by giving writlcn notice to the permittee. Thc pcrmittce shall immediatcly remove all facilities from thc right of way. Any facilities remaining upon thc right of way 30 da)'s after writ. ten noticc of canccllation shall be removed by the County ill thc expense of the permittce. The party or parties III whom this permit is issucd shall maintain at his or their sole cxpensc the structurc or objcct fur which this permit is granted in a condition satisfactory to the Department of Public Works, SPECIAL PROVISIONS: 1. A 12" X 30' culvert shall be required. 2. ,All areas disturbed during construction shall be restored to original lc~;~~_~ion. .~. In accepting this permit the grantee, his successors :'nd assigns, agree thin any damage or injury done to the prOllCrlY of the grantee or any expense incurred by him through the operation of a contrnctor, working for the Coullt)' or any County employee shall be allhe sole expense of thc gramce. his successors and assigns. ff'~ ~ and conditions as hcrcin set forth. Datcd this 'Z- day of , thc undersigned, hereby accepts this permit subjcct to the tcrms F~ ~/z-W~J '?'T . 19 JEFFERSON COUNTY DEPARTMENT OF PUBLIC WORKS fee: paid~ Yes _ No _3.:l3J2- !tco;c,pll'o 1820 JellelSon Streel P.O. Boll. 1220 Port Townsena. WA 98368 (206)385-9160 Addrc:~ Request _ y~ _ No Mile P~t AI'I'L1CATION t'OH PERMIT To Department of Public Works, Jefferson County, Washing~n. The undersigned 1:::_-", / e hereby appl_ for permission /0 )()/ C",(v<<,y+;; J\".t;r7rC('" ;;; r., T In .., tJ /'. ~v.., 1-</," I I' ,APf,IIl~'" ,,,/I Jo">(flht-/",I/)' ..lIa/ h, ",,110'\ It I do j . I WT4 UlT5 ~ . > . UJf'" ~ t ~ ~ ~ i I Jerferson Co. DEPARTMENT OF PUBLIC WORKS District No. b Permit No. t) 9 ~-c Supervisor's lteport No. Supervisor will make detailed report with his recommendation on this application. Whenever possible show sketch of proposed work. Supervisor will also make additional reports and final report giving date of completion of work on this form. Preliminary Report: CA-p ~ (;.eoR..'l ~\ +<-1::> _ In .(. 5'.98 <or- 5;-.-1"">/ti>S> :sHt.D. 4fV!O> i">.. f"'-I-'< Date: 1-2:>--89 Signed: .,,(),c~ K-- ~J11 Final Report: PER~SPECTlON REPORT Work covered by permit has been completed satisfactorily. Work is not completed, Recommend permit be cancelled. Traffic conlrol - adequale - inadequale REMARKS Dale: I..{.-/?.-'/ Pi Signed: ~~ ~ ("'\,~~, ...,....:::\ """'V"7;;;; I "'::',r/J;!\<: ~, :;#.l~,,,, ff'3;<;;;i'r'='. JtA'J~ ' JEFFERSON COUNTY OEPARTMENT OF PUBLIC WORKS 1820 Jelfersoll Slreel P,O, Box 1220 Pori Townsend. WA 98368 (206) 385-9160 .4. N~ 0951 DiStriel No. 6 PERMIT In accordance wjth all appHcabJe Revjsed Codes of Washington and amcndmt:nts thereto. and subject to all the terms, condi. tions and provisions written or printed below or on any part of this form PERMISSION IS HEREIlY GRANTED TO Pope Resources c/o Skip Wood, 21 Shine Road, Port Ludlow, WA 98365 to Install a private road approach, (Type 1'-1), to the North side of Gape George Road at mile post 5.79 County Road No. 622808 Franchise No. Milepost 5.79 No work shall be done under this permit until the party or parties to whom it is granted shall have communicated with and received instructions from This permit shaJl be void unless the work herein contemplated shaJl have been completed before January 26 . 1990 Dated at January 26 . 19 89 &~~~@WfEID) Ily ~~K~ 1.800.424.5555 GENEIlAL 1'1l0VISJONS AI'I'L1CAIII,E TO ALL I'EI(MITS This permit is subject to all applicable provisions of the Revised Codes of WU!o!lingloll, elicept tiLat tin)' provj~i()1I i/l this agrccmcm /lot cum.i!>tcnt wjth such resolution shall be contrulling. A bond in the amount of $ is required for the protection of the COUIll)' as M:t [oull in the lerlll~ of Ihe hond, Durillg the progress of the work such barriers .silall he erecteu and uwilltaincd as may he nel;cssary fll' as may he directed for the protection of the traveling public; the barriers shall be properly lighted at nigh!. In accepting this permit the petitioner, his successurs alld as,o,igns, agrees 10 protect Jefferson COU/lty and SU\'C it harmless from all cJuims, actions and damages of every kind and description wtJkh may accrue to or be suffered by <.lIJY person or persons. corporatiull or property by reason of the perfor- mance of any such work. character of lIlaterials used or manner of installation, maintenance and operation or b)' the improper OCCUp,IIlC}' of right of way or public place or public structure, and jll case an}' suit or actiOll is brought against said Jefferson Count~. fur damagcs arising out uf or by rea~on of any of the above causes, thc petitioner, his successors or .lssigns, will uponllotice to him or lhem of commencement of such action. defend the SUIllC at his or their own sole cost and expensc und will satisfy any judgment after the s.tid suit ur action shall have finally been dctermined if adverse to the Jef. fcrson COUllt).. Except as herein authori7.cd, no excavation shall be lIlade or obstaclc placcd within the limits of a counly road in such a manncr us to intcrfcre with the travel ovcr said road. Except as herein authorizcd, no excavation shull he made or obstacle placed within four l41 ft:et of thc cdge of the pavcmcnt. If the work done undcr this permit illlerferes in an)' wuy with the draina!\e or the Counly road, the grantee shall wholly and at hi.~ own cxpc:nse male Iluch provision as (he engineer may direct to tnke care of said druinuge. On completion of said work herein contempluted all rubbish and debris shall be illlllledialelr removed and lhe roadway und roadsidc shall be lcftneal and presentable and satisractory 10 the engineer. All of the work herein cOlllcmplated shall be done undcr the supt:rvision and to the satisfaction of the Coullty Enginecr and the entire expem.c of said supervision shall be borne by the pany or parties to whom this permit is issued. The Dcpartment of Public Works hercby rcserves the right to order the change of location or the removal of uny structure or structures authorized by this pcrmit at any time, said change or removal to be made at the sole expense of the party or parties to whom this pcrmit is issued, or their successors and assigns. All such changes, reconstruction or relocation by the grantees shall be done in such manner as will cause the least interference with any of the Coun. ty work and the County of Jefferson shall in no wise be held liable for any damage to the granlee by rcason of any such work by the COUnty of Jcffer' son, it agents or representatives, or by the exercise of any rights by the Couruy upon roads, streelS, public places or structures ill question. This pcrmit or privilege shall not be deemed or held to be all cxclusive one and shall nol prohibit the County from granting other permits or franchise rights of like or othcr nature to other public or privatc utilities, nor shall it pre\'cnl the County from using any of its roads, streets. or puhlic places, or af. fect its right to full supcrvision and control over all or on)' part of them, none of which is hcreb~' surrendercd. The Department of Public Works may revoke, amend or cancel this permil or any of lhe provisiolls thcreof at allY time by gh'ing wriucn notice to the permittec. The permittee shall immediately remove all facilities from the right of way. Any racilities rCllluining llpon the right of way 30 days after writ. ten notic~ of cancellation shall be rcmoved by the COUfHY ot thc expense of the permittee. The party or parties to whom this pcrmit is issucd shall maintain tit his or thcir sole cxpense thc structureor objccl for which this pcrmit isgramed in a condition sotisractory to the Department of Public Worl>.s, SPECIAL PROVISIONS: 1. A 12" X 30' culvert shall be required. 2. All areas disturbed during construction shall be restored to original condition. In accepting this pcrmit the grantee, his successors and ussigns. agree that any domagc or injury done to the property of the grantee or any expense incurred by him through thc operntion of a contractor, working for the County or any COUnty cmployee shall be 8tthe sole expense of the grantee, his succcssors and assigns. ~--~- and conditions as hcrein sel forth. ~~.::?- , the undersigned, herehyaccepts this pcrmit subjcct to the terms Dated this '2-- day or j~ ,]9 '?7 -~ Wc-~/ \ ~~--~ ~,~J'( .. JEFFERSON COUNTY DEPARTMENT OF PUBLIC WORKS 1820 Jellerson Street P.O. Box 1220 Port Townsend, WA 98368 (206) 385.9160 FIX paidL y~ _ No ~-- Rn:c,pl l'Oo Addrc:ssRequest_ Yes_No Mile P~I AI'I'L1CATION .'OIII'EIlM1T To Department of Public Works, Jefferson County. Washingl The. undersigned t? hereby appl_ for permission ro JOt' C,,(vt>""-!-S; <:,t;I?/C~S (" TIn ;:J /'1 -v -<: t.v.', r ~ tAp/,IIum! ....1/ .t""-,,bc' full)' "/1<11 IJ.. ",,"t'\ /U dll J l f LN3 ~ ~ , ~ I . I WT4 u:rr 5 . ! I } . ~ UJr" ~y;.:r ~ . I ~ = ~ I Jefferson Co. DEPARTMENT OF PUBLIC WORKS District No. b Permit No. 0 9::> I Supervisor's Report No. Supervisor will make detailed report with his recommendation on ,his application. JYhenever possible show sketch of proposed work. Supervisor will aiso make additional reports alld filial report givillg date of completion of work on this form. Preliminary Report: . CAj e.. Ges>>1!:fJ e... ,p..O flP fl? _ P . '5".7'7 0"'/ /.ePr _ -$ '17Th P 1ff<.D> 6 rs '-0- /rN i> i) :feN . Date: /... ?-5-- r::s9 Signed: J1~ )(~ Final Reporl: PERJ'NSPECTlON REPORT . ' Work covered by permit has been com pie led satisfactorily. Work Is not completed. Recommend permit be cancelled. Traffic conlrol . adequate . inadequate REMARKS I)ale: <-{- L l../ ? 7 / SiAn.d: ~-..s-. ~\ \ r, ._;;;;,f1!'J. ~'~~.tF r#!~,}, fP/'i;'.~;.., ,?"')}" 11/ JEFFERSON COUNTY DEPARTMENT OF PUBLIC WORKS 1820 Jefferson Slreet P,O, Box 1220 Port Townsend, WA 98368 (206) 385.9160 N~ 0952 District No. 6 I)ERMIT In accordance with all applicable Revised Codes of Washington and amendments thereto, ami subject to all the terms, comjj. lions and provisions written or printed below or on any part of this form PERMISSION IS HEREBY GRANTED TO Pope Resources c/o Skip Wood, 21 Shine Road, Port Ludlow, WA 98365 Install a private road approach, (Type P-l), to the North side of Cape George Road at mile post 5.71 to County Road No. Franchise No. 5.71 622808 Milepost No work shall be done under this permit until the party Of parties to whom it is granted shall have communicated with and received instructions from This permit shall be void unless the work herein contemplated shall have been completed before January 26 Dated at January 26 . 19 .89 .1990 &~~~@wm By ,/J~ ;<h 1.800.424.5555 GENEIlAL I'HOVISIONS AI'I'L1CAIILE TO ALL l'EIlMlTS This permit issubject to all applicable pruvbions of the Rcvi!>t:d Codes of Washingtoll, eACcpt that any provi...ion in this ugrccrm:1ll not coll..iM~1lt with such resolution shall be controlling, A bond in the amount of $ is rCl.juired for the protection of the I;OUIlI)':.iS set forth ill the terms of the buill.!, During the progrcS!> of the war.: such barriers shall be erected und lIIuinlainco as lIlay bt: necessary or as 1Il<l)' be dirt:cled fur the prolection of the traveling public; the barriers shall be properly lighted at night. In accepting this permit the pctitiollcr, his successors und as.,igns. agrees to prutCl,;t Jdfcrsoll CoulIt)' and save it harlllJc~s (mm all claims. actions and damages of every kind and description which may accrue to or be suffered by uny person or I>t:rsons, corporation or property b)' reason of the pcefar. mancc of any such work, character of materials used or mallller of installation. lllaillt~'llaIlCe and operation or by the improper OCCUP<itlcy of right of way or public place or public structure, and in case any suit or action is brought against SOlid Jeffcrsoll County for damagt:s arising OUt of or by reason of any of the ubovc causes. the petitioner, his successors or .Is~igns, will upon notice to him or them of cOlllmenccment of such action, defend the !oUllle at his or their own sole cost and expense and will satisfy allY judgmcnt aftcr the said suit or action !>hall ha\'c finally bcen detcnnincd ifadwrse to the Jef. ferson COUlllY. Except as herein authorized, 110 e~cavation shall be lIlade or obstaclc placcu within thc limits of a CUUllty road in such a mallner as to ilHerfcre with the lravel over said road. Except as herein authorized, no excavation shall be made or obstacle placcd within fuur (41 fect of the edge of tile pavement. If the work done under this pcrmit interferes in any way with tht: drainage of the cuunty road, the gralltee ~hall wholly alld at his own cxpense make such provision as the cnginecr may dirccl to take carc of said drainage. On completion of said work herein cotllclllplated all rubbish and debris shall bc illlfllediatcly rcmoved and the roadway <lnd road5ide shall be leftneal and presentable and satisfactory to the engineer. All of the work herein contemplated shall be done undcr the supervision and to the sath,faction of the County Engineer and the entire expense of said supervision shall be borne by the pany or panies to whom this pl.:rmit is issued. The [)cpartmcnt of Public Works hcreby reserves the right to order the change of location or the rernm'al of any structure or structures authorized by this pcrmit at any timc, said change or removal to be made at I lie sole cxpense of the party or parties to whom this pcrmit is issued. or their successors and assigns. All such changes, rcconstructiun or relocation by tht: grantees shall he done in such manllcr as will cause the least interfercnce with any of the Coun. ty work and the County of Jefferson shall in no wisc be held liablc for any damagc to the grantee by reason of any such work by the County of Jeffer- son, it agellls or rcprcselllatives, or by the excrcise of any rights by the County upon roads, strcelS. public places or structurcs in question. This permit or privilege shall nOl be deemed or held to be an exclusive one and shull /lot prohibit the County from granting other permits or franchise rights of likc or other nature to other public or private utili tics, nor shall it prcventthc Cmlrlty from usillgany of it~ roads, streets. or public placcs, or af. feet its right to full supcrvision and control over all or any part of them. nOlle of which is hereby surrendered. The Departmcnt of Public Works may rcvoke, amend or cancel this permit or any of the provisions thereof lit any time by giving written notice to the pcrmiuec. Thc pcrmillce shall inllnediately rcmove all facilitics from the right of WilY. Any facilities rcmaining upon the right of way 30 days aftcr wril- ten notice of canccllation shall be removed by lhc Coulltr ilt lhe expense of the permittee, The party or parlics to whom this pcrmit is i~sued shall maintain at his or their sole cxpense the structure or object for which this pcrmit is grantcd in a condition satisfactory to the Department of I)ublic Works. SPECIAL PROVISIONS: 1. A 12: X 30' culvert shall be required. 2. All areas disturbed during construction shall be restored to original condi tion. . " -0~~:::.U tf i,1;h ,:; ~ '~( 1~ t. ~), In accepting this permit the grantce, his successors and assigns, agree that any damage or injury done to the properly of the grantee or any expense incurred by him through the operation of a contractor, working for the County or any County employee shall be ntlhe sole expense of the grantee. his sllccessor~~::;..: ",IG- -=- (j' V " - ~ .the undersigned. hereby ncccplS this pcrmit subjcct to the tcrllls and conditions as hcrein set forth. Dated lh;, '2- day 01 F ~ . 19 fSr ~ U--~/ \ ...."l."'~- v;;(;}. ~,;'&"1.~;o..~ .~i' f'~~/'-'. JEFFERSON COUNTY DEPARTMENT OF PUBLIC WORKS F<< paidL Yell _' No "l73Z'Z Ra.Clpll'OQ 1820 JeHurson Street P.O. Box 1220 Por1 Townsend. WA 98368 (206l365.9160 Addu~!>> ReQul:!.t _ Yes __ No Mile P~I AI'I'LlCATlON FOR l'EIlMIT To Department of Public Works, Jefferson County, WashingJl\n. The undersigned f't? / e herebyappl_ far permission to JCJ/ C",(vt>v-+;; J<..<:-SQrCC>$ (,,1- LDr3 1 ~ i ~ I ; I lOT. wr5 WTIo . I un"., , toT6 Jefferson Co. DEPARTMENT OF l'UBLlC WORKS District No. b Permit No. t') 9:> L. Supervisor's Report No. Supervisor will make detailed report with his recommendation 011 t!lis application. Whenever possible show sketch of proposed work. Supervisor will also make additiollal reports alldjinal report giving date of completioll of work 011 this form. Preliminary Report: C"'1':>e.. 0-eJZ>fC-'} e.. \KO A-D _ f)1. p. 5".7/ OrJ L<<-P:r.- S~~OI'l-j2..D ::5t1t..[;) /,l--vC> /:): fell C'.J Dale: Final Report: ! -2~-- B9 ~~K~ Signed: PERMIT INSPECTION REPORT ,7 Work covered by permit has been completed satiSfactorily. Work is not completed. Recommend permit be cancelled. Traffic control. adequate . inadequate REMARKS Dale: . '-1--- f 7- -8 '- ~~ Signed: \ --'''>~' .~ "~'f@:~4hif 11~~~;'L' , -,."i" . " "-"~; ~ JEFFERSON COUNTY DEPARTMENT OF PUBLIC WORKS 1620 JeUerson Slreel P,O, Box 1220 Port Townsend, WA 98368 (206) 385-9t60 N~ 09 1 8 District No. 6 PERMIT In accordance with all applicable Revised Codes of Washington and amendments thereto. and subject to allthc terms, condi. tions and provisions written or printed below Of on any part of this fOfm PERMISSION IS HEREBY GRANTED TO Puget Sound Power and LLght 310 Four Corners Rd., Port Townsend, 1l\lA 98368 10 Install underground prLmary cable along the South sLde of Cape George Rd. Job # 8809706-Harwood County Road No. 622808 Franchise No. S . 66 to S. 68 Milepost No work shall be done under this permit until the party or parties to whom it is granted shall have communicated with and received instructions from This permit shall be void unless the work herein contemplated shall have been completed before November 21 19 89 Dated at November 21 , 1988. ~~~~@wm By h1~' ~ 1.800.424.5555 GENERAL I'ROVISIONS AI'I'L1CAIILE TO ALL I'EHMITS This pcrmit is subject toaU applicable provishms of the I{e~'iscd Codes of Wllshingtoll, C1\Ccpl that any pro\'ision in this agreell1CIll not consistent with such resolution shall be controlling. A bOlld in the amount of $ is rt:quired for the protel.'tioll of Ihe count)' as set forth ill the terms of the bonJ. During the progre~ of the work such barriers shall be erected and lIlaintuincu as may be Ileccs~ry or as lll<iY be dirt:cter.\ fur the protection of the traveling public; the barriers shall be properly lighted at night. In accepting this permit lhe petitioner, his successors and assigns, agrees to protect Jefferson COUIlI)' and save it IJ.mnkss from all claims, i1CtiOIlS and damages of every kind and description which llIay accruc to or be suffered br allY person or persons. corporation Of property by reason of the perfor- mance of any such work, character of materials IIsed or IIIUlIllt:r of imtallatioll. maintenance and operation or by the improper occupanC)' of right of way or public place or public structure, and in case allY suit or action is brought against said Jefferson COUnty for damages arising out of l)t b)' rca~(Jn of ~lJlY of the above caUSC!i, the fll:titioner, his sUcce~~ors or as~ign!i, will upon notice to him or them of COfll1llCIlCemellt of such action. defend the samC.H his or their own !iolc cost and expense and will !iati~fr allY judgment after the ~aid suit or aclion shull have fillully been dCll:rmincd if adverse to the Jef, ferso,n Count}'. Except as hcrein authoril.cd. 110 excavation !ihaU be made or obstacle placed willtinthc limits of a cuunt}' road in such a manner as to interfere with thc travel over said road. Except as hcrein authoriwd. 110 excavation shall be nWue or obstacle pluced within four 14) feet of the edge of the pavement. If the work done undcr this pcrmit interferes ill any way with the drainage of the Ct)Uflly road, the grantee shall wholly and at his own expense make such provision as the engineer may direct to take care of said drainage. On completion of said work herein contemplated all rubbish and debris shall be immediatcly rCll10ved and the roadway and roadside shall be left Ileat and presentable and satisfactory to thc cngineer. All of the work herein contemplated shall be done under the supervision and to the satisfaction of the COUnty Engincer and the entire cxpcnse of said supcrvision shall be bornc by the party or parties to whom this permit is i~sueJ. The Dcpartment of Public Works hereby reserves the right to order the change of location or the removal of any structure or structures authorized by this pcrmit at any time. said change or removal to be made ulthe sole expcnsc of the puny or panics to whom this permit is is~ucd, or their SUcces.'oOrs and assigns, All such changes. reconstruction or relocation by the grantees s.hall be donc in such manner as will cause the least interference with any of the Coun- ty work and the County of Jefferson shall in no wise he held liable for any damage to the grantec by reason of any such work by the Countr of Jeffer- son. it agents or representatives, or by the exercise of any rights by the County upon roads, streets, public places or structures in question. This permit or privilegc shall not be deemed or held to be an exclusive one and shall not prohibit the Count~' from granting other permits or franchise rights of like or other nature to other public or private utilities, nor shall it prevent the Count)' from using any of its roads, streets, or public placcs. or af- fect its right to full supervision and control over all or any pan of them, none of which is herebr surrendered. Thc Department of Public Works may revoke, amend or cancel this permit or un}' of the provisiolls thereof at any lime by giving written notice to the permittee. The permittec shall immcdiatcly remove all facilities from the right of way, Any facilities remaining "ron the right of way 30 days aftcr writ- ten notice of cancellation shall be removed by the County at the expense of the permittee. The pany or parties to whom this pcrmit is issued shaHmailltain at his or their sole expcn~e the structure or object for which this pcrmit is granted in a condition satisfactory to the f)cpanment of Public Works. SPECIAL PROVISIONS, 1. CabLe shaLL be instaLLed a minimum of 30" beLow existing shouLder. 2. :>";'{\~~,l::?,:-ea'~?t?;drst'-;J:bed durtng construct ton shal l be res'tored to : '~r:,l:gi~~:;::~" c,~n;d,L ~Lon. \! ',~,1; ",1 "-^. In accepting this pcrmit the grantee, his successors and ussigns, llgree that any damage or injury donc to the propeny of the grantee or any expense incurred by him through the operation of a contractor, working for the County or any County employee shall he at the sole expense of the grantee. his successors and assigns. nml conditions as herein sel forth. Dilted this 2. '2.. dny or , the undersigned, hcrchy accepts this permit subject to the terms ~ No V, .196~ ~// d~ "." - Jefferson Co. District No. h DEI'AlnMENT OF J>UULlC WOnKS Supervisor's Rellorl No. SupeflJisor will make derailed report willi his recommendation all/his application Whellel1er possible show skelCh of proposed work. Supervisor will also make addilional reports and /inal report giving dOle of completion of work all Ihis form. Permit No. 0 '71 8 Preliminary Repor.: n,'f' s: 66 1-0 5".68 C4f>e G' eo""~<a- "'~.Q. ~ ,NO j) rkrr Date: //- 2/ -$5 q" Signed: -4. c. -?;7'- J.( -kZ. .;:;, Final Report: PE~PECTION REPORT . Work covered by permit has been completed salisfactorily. " .- '.' . ' Work is nol completed. Recommend permit be cancelled. Traffic control.. adequate .. inadeQu8lc REMARKS Date: -5:i -/ ,..- 7/' Signed: ))~ .:, " ,,' ,', , ,'" " , :" "",';, j?:ill ' , , t; T- ,.'.?:;-(I'"I ?! " '.'., --~""" "", ,.,!1:t."~,, "'" . .' ""'-t eu " ".",,::::::: - - _ -. , ". " - "_ I ,. 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U:5E:.L::> :',;:r\,'o:'\:l,(2, DIe, &'Ti-; Th-::"J i~ .LOC Al};-D "T't:> u/ bc 0"" rlt>\.\CoE" I . '~'::'\1.'>\-:;'OL)T To Be Ll'5:l::I::', 'FbiC eLi'(/\, cNI'.- TD hU>-::.t:, Tz::. HC\w3C:,[; PUOET POItI'IER JOB TITLE/LOCATION \-lAP''' VYii''j W 0 NO. 'Y.,?,ocn ()G::> co ,CO NAME WO NO JOINT FACILITY CONSTRUCTION RECORD PRINCIPAL COMPANY: a PUGET "Do', lr.;.. II(;;' Pr:-1. EXT. 0 PNB 0 CUSTOMER , RA I\J.J BC 4-4 ENGlNEER'b, KcP"---.e. OUANTITIES OUTSIOE OEVELOPMENT o PUGET )3, PNB o TEL OTV IE ENGINEERED ;),5S ~~~~~~EO. .AS.BUILT. . ENGINEERED <Q35 ~~%~MEO AS,BUILT ENGINEERED ~~'WRMEO. AS-BUILT CITY COUNTY ,) 1::'-1""1; (' ,'- o USE ACTUAL COSTS (DETAIL ATTACHED) '" I'" t;j~ Ii~ I~ ~~ "'''' "-::I . L ... 113 t;j~ Iii!: ~ :J: !:: ... ... !:: V> ::> Ig I ~ liS it ~ t;jz 88 88 . 8 Ii~ m'l "-M ... ' . DATE COMPLETE .... ou.. I . ,', , , .:. <'" ' ; ~..', ... ... ..' . ". ........ .. .:' . ,: ~ ............. .' ..' '. "', ,; ." :, . ~...'. ...' . . .... . .' " '''':, ',,',' , ',',', ", .:; " . .." ,~> . ..... ,.. ,'." ,', "',' " '.........."'........ . :.' , :. ': " ,: " " ,". , " ......... ... '. . , ' , .. .. .. . ..... .... ... ., , , " , ." . .. , "'. ..!....: ..:. , .,',.' .,,' " . .....:.....:: " ,,':': """ . , ". .' , . ..': .' ': :,' , " '.: \: ~ ,. ~ {\ I . // .. ':, " :.' ',,, ".' , ", '. -:":,, ... ,....., .... . ", ,,' . .... ." . .... . . '''',',::,. , .' .. ~, : ....... . , , . ...... ~...... .~ .. -1 .'. . ' . ........... :1 ., ',:". . . . ~r '-.: ' '. ,'. ,'. . '. .' ": .' . :, '. "':." . " ':',:' " .:,' . , : ,,:.. " ....,..'.,: ....... , "f'" " .. ,.... .''': i ,'.'., ," · I PUC2.r==:C_R / \N-:, " '.' I :,.,', ::. ":" ., '. I , :', :'. :. ~I . JEtL.J~Q~ PfJ~M II \.'''\j(:d~T ......'~:.l -r":+ \.::'J/ ;.:. ~';lI,L:T II.)~', I'-l'i-YO,- '. '1 '. . ',.......;.; c,~ .". .., . '. , '. . .','" '. '.'" '. '.'. : "" ... ..' " \ -(') ::,...~):.:\J ~._ : j ~-~. ~ ~~, ~~:.~'{ ::i ~ 2i;";;::.C: 7: ?LtA.:':.c.. 06TI'd '0 ().i'~ d c:.,:\"\1' ;" F<:)I::: u6 FAC.Il.11 12'_5 l.(~)\...,)(::l t--\I-~,k"i.I__~)(',:r.":',_,) ,.1-\,-:) [~~),'-->X, \"\.4:':' - ~T. .'C:l'-l,jStj , . {'AI',,: (:.(';) CU. l,\L_!",):~.')(--,""'" \_,::')('\1 )"1'1"\ <..')11)C_ (....\ F (:::r"'--~.:;l Ol~' KlLD..:5c_ 0i. - 1 ~..~'; / 'leo' i: " ,:: . . . , ..' ". , " ". . ::, : "........ ;. ,,".r'~ rr>;:1tV ~~~R~f!n' ....~'.....:)'...J ~ .;. ~, ; " " .' / ," , Pi\:1 I \.1'"\kY " CALL, 48 HOURS BEFORE YOU DIG 1-800-424-5555 CALL ONE NUMBER FOR UNDERGROUND LOCATION ASSISTANCE, PHONE:" ,.',',' , .'. THiS SKETCH IS NOT TO BE RELIED UPON FOR EXACT LOCATION OF POWER FACILITIES *' Pu6 cT T(\ ..na:..A....e !.1 ~, c'/f' I()C')<>/a '* ('L).S1". -ID ,-~'O :..',ve. TIC.C':.J0C::t-l. '* FtA66i:-.(':':' i';.:c.D. '.' ...' " ": ,",' * L_C(~~A.rL..:,") E:(::(~ 50,6511.85 PUCET POWER WORK SKETCH WORK ORDER NO. 'IS'60 "nD &J . ..' ...... :,. .... , ',,', OF .3 I'! ,::e~~ SHEET OF ., LABOR CHARGES ACTIVITY SCALE !~ JOINT FACILITIES ARRANGEMENTS - OTHER UTiLITIES JFC NO, ?,? (y'" 16 10 _ JFC NO. OTHER UTILITY p \) R OTHER UTILITY ENGINEER T, (,r,1',\-<. TOC.K: ENGINEER CHECK Y- .' CODE 'COOl 10B07 58304 584Q5 59335 CONSTRUCTION REMOVAL OVERHEAO TRANSFORMERS REMOVEIINSTAll V.G. TRANSFORMERS REMOVE/INSTAU REARRANGE & TRANSFER 0151. CONDUCTOR v . . .,' "" >1~i~t .. .' DIVISION ~CliNTY -~._- d~Mift.P NO , " I CIRCUIT MAl', NO iDe<;;IC!;:l) ...J':::1-'":~,'::::::::::~U 3D:.'i 'UJ '0/k1 <~H', a =.,--- ._-- TITlE Il:liC'u:",..xl , 0()...,:,t-:, -- U(i i)i(':1 cx..-;', I CIRCUI!,NQ, I ,(c:.o 'II DATE ! i I /1/55 POLE CARD RESP. AREA i\.),J ~~T 703 " . lOOOiONCi.-" PC:. (1 U). T~-C)-=-ITr ..' ''''''',,"m'bK J:"'WNHvi~- ,[:H;?~.\ -lrO~'- -----ro;."CO", :.i . '..'--- --- _~u---"'-n'-_.-- ------.-+00", : "',' ."..' ."" ...~~~"lil\1l~ " '. ....'.: , . .: ,,..,.:':: ....: .'.' .:->'" .. .... . " '", II: ....... .... .., .' I. .... ,.....: ....., [\. . ..,.. , '.:' . ........... : :,'.: . , '. "":,, . . .. .' ....i ',.':.."','L' :. ..' '; ." IL PERMIT AND FRAN ,...k:.f{-'. (:.n FOREMAN'S SlGNATUR( MAPf'{O '. fCJR(MAN'SSIGNA1URl: ". .' " ", " .'. '.; ,.: . ..' ....... ',' ..' ':," :.', . ',"" ,.., ',,/. i :',' ", '.:' ..' ..' ':' '.'; ". ::. ~ :" ." ' ':,'. . '":'.''' " . ',:,. . ':.', " .' . ., ,. " ,', :'" :.: .".'.',': '.,' ". .", ........].' .:. i",' -- >. " j: L . . - .' "" ':...'.,. : ..-- I: .' :: ..' . !; . '.' '. .. ." :':. ..' . ': '.'. "." . .' , ' ".. .- .... '. ...... ',' . .' ...... ",....;.,'. .. . ,'.."..,....... " .'. . :.'. . '., ':'. c.' " . '. ..".':..,,: I; ....:..,.:'.. :.' "".', .'. " ,'. . . ' . .":,, '. .... ,'.' :. . I. If '. Ii.' fl..':'.. ,.', " .'. '..' . , " .;' ". 'I' I .'. ~ '.: i. t,........ :,...'...." '.' .' , :, . , . ;, : : '., , '.': .- , : ", . '., '. . . , " ,'." , '.'; ': . . ' . .'. .....c,.... l. '. ,,'. ..<,':' ~. '. .-, . .'. .' '., I '. .' ,', .' " '. '.,.::' ',.' ......:. ", '. . '., ." . ':" :.,...',.....' ".' :. " ."'. ",'" I.' '.. ..' .' , , , " L : I. , '. .L U.G.GENERAL NOTES :~<;'~L~~fsA~E'i~ ASCERTAIN AND OBTAIN ALL NECESSARY OPERATING RIGHTS AND fiNAL GRADE fOR ALL TRENCHES AND HANDHOLES TO BE ESTABLISHED BYDEVElDPER, If ESTABLISHED WHILE IN CONSTRUCTION PERSON & COMPANY WILL BE NOTED ON ~~~~~~~ ~~:~~HO IS ESTABLISHING G'RADE. ,DEVELOPER SHAU BE LIABLE fOR DEVELOPER TOPROVIDERI.GHT Of WAY OR CENTERLINE STAKES AND LOT CORNERS. ~~gf.;~;:'RIMARY PER STD. 2221.1321 AND UG SERVICE CONDUCTORS PER STD. NORMAL TRENCH TO BE IN RIGHT Of WAY, 2' fROM PROPERTY LINE BELOW ROAD OR SIDEWALK GRADE IN DEPTH. MINIMUM Of 36" BELOW fiNAL GRADE. All VAULTS TO BE PlACED ON CORNER OF PROPERTY LINE BORDERING EDGE Of RIGHT OF WAY OR AS NOTED ON WORK SKETCH. INSTALL MINI.PAD TRANSfORMERS PER STD. 4109.1135. INSTALL CABLE TERMINATIONS PER STD'S 2254.3217. 2254.3218. 2254.3219. 2254.3220. 2264.3221 AND 2254:3222. MAKE SECONDARY LUG CDNNECTlDNS IN TRANSfORMERS PER STD. 2247.8051 OR SECONDARY CONNECTORS PER STD. 2217.6391. . CAP ENOS Of SECONDARY CABLES PER STD. 2291.1115. INSTALL PRIMARY CABLE NUMBERS AT EACH END OF' PRIMARY CABLE PER CABLE NOTES. ALL CONDUIT RUNS WILL BE MARKED fOR fUTURE lOCATION. CONDUIT AND ELECTRICAL MARKERS. INSTALL PRIMARY YELLOW CABLE MARKERS PER STD. 2211.1l47 AND SIGNS PER STD. 2211.1013. INSTALL LINE GUARDS fOR EACH CABLE RUN IN ALL VAULTS. MEGGER ALL PRIMARY CABLES PRIOR TO ENERGIZING. SYSTEM SHALL BE ENERGIZED UPON COMPLETION OF INSTALLATION. INSTALL OUST CAPS ON ALL UNUSEO POSITIONS Of PRIMARY BUSHING. INSTALL GRID NUMBERS ON ALL PSP&LFACIUTlES AS NOTED ON WORK SKETCH. COMPLETETRANSFORMER RECORD FORMS fOR EACH TRANSFORMER INSTALLED AND NOTE GRID NUMBERS. JOB fOREMAN WILL BE RESPONSIBLE fOR EXISTING UTILITY LOCATIONS. CALL 1.800.424.5555. JOB fOREMAN TO. BE RESPONSIBLE FOR ALL ISSUE ANORETURN MATERIALS. JOB fOREMAN WILL BE RESPONSIBLE fOR ARRANGING ANY OUTAGES WITH CUSTOMERS. JOB fOREMAN TO. COMPLETE THE J.F.C. LINE CREWWILLBE RESPONSIBLE FOR RESTORATION. THERE SHALL BE NO INfiELD JOB CHANGE'WITHOUT PRIOR APPROVAL OF THE ENGiNEER IN CHARGE OF PROJECT AND OR SERVICE AREA. \ '.' .,. , ;. , '. ...... " . '". :- :> . .,' ". ..' . '.., .' , '. ,.. ,..:' .:. ..' :: '. ...:..... ::, :., .' '" '."'.' ~ '..' ",'. .'..'.,.,-:.... . ..'. .' :.' ". ;'. ":,' .-' ..--"""_.~.':...,'.,.:..". . ,':: .', , " " . .,"." .".... ...'- . :.,--: :.' ". .: .. " '. . " " " , '" --. . . '.: -'. ..- , :' " '.. ;.' , . " , '. ". ,'...... .,' .' ".' '" ':";',> .' ,:,,; ~ I . " ..,'.' ; ~ ,'.' . ': ''-'.: . .:.....,.. '.', .- .: .: ':. .' "., ,:.' ',.' , .',' ',,"',' ..', .... , '. ,'- . . '. :. '. . . '. " .', .,'...... '. '... . " '. ":'''' ':, "" , " .'.' ,', .",' , :', " ::.' :' J, -1 . , ,'., '.' ", , . ': ..' .:. '. :.:',:' '.: , , ..J .... r::EF:'C'F([" NUfiL<EI< '. 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'BY'b k:: ; DI::,','ni)~ : ':'1 II: CI<I,') i.' (....:.':i1i2!.~..[I~...: F ILL.Erl~::':......... : I<I:CII ,'E)) Oy-:""::(:)I:,:~:'I:,::~r~,r::Hm:;;:::;I..(:;II:II' : 1/"1(111(,1! .:;! ,::: DOl' NU .'. i I::: ,y T:1: 1'1 AT 1::: NO. Dlll( l:li:!Wi'''/(')(' 1 ()(,TE CDI."r', 1"Ur':'::rlr.ij','TC THIS 1'(1 T'OFn !.Jr.'!S FI':CIUUC[)) FIWII '::I''''TI:':OL.I.E,() r:'I:wc I I DIV, 6 ICOUNTY' J[FF TITI..E: H(',RW:JUD, DUUe; I...UCATION CAFE e;EU RO 1::'T'1' O,[,';T" r~ son, I ::~r,j I: I.J~';' I 1,11'-1 L IN' I'dl (,.;I:::H.. F: '1'11-1 curnu), S'l',::,'. DI"'I~; r::~II,:.:,P F:/t,,1 ('IS,::'T, SI...I::" {d)'v', C.., S'T!' i '(I I 1, I REPORT NUMBER~ ES~230-Cl DATe '1/09/88 TIME 17:11 T(;~!) cusr CSf'1htl'fC .\',(Si'J:,fl "'1 ()'f' I::i:: It <i.. ISSIJI.:. (1.61) 1,,1/1:.\ j";i...l1 Q~\Oq 1'.')(\'')1.1 1'-,",(.[: .33 ur:o..::s INvr~II"OC~ t,~,;"f(JC!(!;:rl"1 nCI!:~,(U:I~ 1:;'/(;1 (1I';T., !!'1C,II::tt: 1.,J/U ru"l" it,:,j!lLI:I.::,I,l rl/' fltl'(!. S'TOI'i:E:: I,~.;'()TST I I I X I I; I ._11 ;~H,}',;i)"J('.'("''')! / / Ui Jtll')ll '1"( 1::1::01..1 T 1::1:,:0 f,)1...Itd-1 r:l '( 'l IIt"1 1'1., lO J5',~;'l.J[)) (,:1';'1'" L"i'L'I'~; t"l.:','':':'j' 1'11';'Tl.'I"ll~d, Dr::.'cr;~i'!;J .:'~:nr EQUIPMENT EXPI::~SED G !GIU ::it: (o~FI '6'63 -160"1-0"1- Co'3CT '6/-1-4- (50401 I r",C'Y-, i 1'1C I !,:.'~'r rl..! t '/J/U ~:!P(j~?';"o/,':'!~j Cs i)5~' I 0 - Z;: "3 Z DIV: 6 ICOUNTY: JEFF 1 cln li(ll' .::. C> l--\ - 10 I ex!'.::. \ 120- Ii I I,t,: N...! TITL.I::: : HARWOOD, DOUG - UG PRI EXT 11:::(,SE:1ENT"j.....T - "JD3 II"'OL.E C"11'':D LUCATION CAPI:: GEO RD PT'( II"'EI:::ilu:'rU"'LJef'(: eO) lini:'PED -------------- -----------.--.---- -.-.-----------------1 DATE ORDERED IDATE FILLED IENGRD BY. IDRAWN BY. ICHECKED BY IAPPROVED BY I 1 I 1 ' 1 I Dt:: I -D i..::: 1 I I ....................... .......... ....... .......... ............ ...... ........... ..... I FII...I..ED BY 1I',I:::CI:::I\/I:::1) ErY 1.\'TClI',E.,' "d "I'"1':: DV t".. 1 f) ,IT I::: curll".. I F()I;:':::;liool~ SIC 1 NIC NO. 1 I I / " I I 1 ..................... ....... ........... ...............................1 I E'STH'Io~TI':: NO. lH11< DU('9'i06 I D(.\n:: CDi'll"., II"I.'IO'::II(,I.! SICI THIS I'::I:':I"'DI',T VI")" !"'r\oDue!:::',) 1:'IWi1 CClifrr::ULL.ED I"'I'WC I I I 1;], S'P ! n srF:: t F,:n FCI!:~ I i'-lt,1 I", I j"\11 r:::H G ':::;',,1 i':' I ~'li',1 CUDF:,:O" S' ': S' '" ('IF';::; !"'j'!G r;: i/.I ::l.:'::.~)' r. SUF r~'IDV,', t: ",:;:Tl:;' .~': ~ ~~J!} >~~';:" r'f/v,~' -. t-''\'-Jl ;.:,' lU /lIT;!... ~ JEFFERSON COUNTY DEPARTMENT OF PUBLIC WORKS 1820 Jeflel'son Streel P,O. Box 1220 PorI Townsend, WA 98368 (206) 385-9160 N~ 0882 District No. 6 PERMIT In accordance with all applicable Revised Codes of Washington and amcndments thereto, and subject to all U1C tcrms, condi. tions and provisions written or printcd below or on any part of this form PERMISSION IS HEREBY GRANTED TO puget Sound Power and Light 310 Four Corners Rd., Port Townsend, WA 98368 Install a 30' service pole on the East side of Airport Cut Off to at mile post 0.09 Job # 88-07681 County Road No. 951707 Franchise No. Milepost .0.09 No work shall be done under this permit until the party or parties to whom it is granted shall have communicated with and received instructions from n,;s permit shall be void unless the work herein contemplated shall have been completed before Sept. 28 Dated at September 28 . 19 88 .19 89 &~~~WJWlEIDJ By ..-!J~ K:..~ 1.800.424.5555 day of OiJ70B&1L ~~ " . .' . ." .... .... .' .... ........... .' " .," . '.' '. ','..'.' '. . '" "'> ". :,>., ." " .,'. ,,"<,,' " '," .. .,' ,.: . ,,' .: I; ..' ..' hlfi{'~;(~~ "(:" , .' . ." .', I "-::. ..: .' , . ""',,:,,,:," "',' "':, ..' ..' I' ~'.' :. '':''. . . ,'. . . " :.,' . ',:' '."" : " I. ..' '.:." "" '; i . " . :, , ..' ; ',... / i ~I , ,~,," I ! f ) ~'," i , t: r '. l: f ,:;,. ~~.~> te ! r,. I ,. l- I' :" /.':'..:. ",' :,'/.':>,:': "" "', , 'I ", ." , , "." ",' ',": >.', ',':'. ." ,.', . ,'" :' : '.... , '.' . ',' , , " ,: .'. , ,.' "'.. " :..' "".'\:1: '.' . -:- ", '..,., '. . ,,'.' - ~- -~--~ , GENlmAL I'nOVISIONS AI'I'L1CAJlLE TO ALL I'Enl\llTS This permit is subject to all applicable provisions of the Heviscd Codc!-. of Washington, exccptlhat an)' provi\io/l inlhis agreement nut oomi~It:1lt with such resolution shall be controlling. A bond in the amount of $ is required for the protection of the county as ~l't forth in the terms of Ihe bond. During the progress of the work such barriers !>hall be erected ami maintained as may be necessary or as ma)' be directed fur the protectioll of the traveling public: the barriers shall be propcrly lighted at night. In acccpling this pcrmit the petitioner, his successors and assigns. ugrces 10 protect Jefferson Coullty and save it harmless from all claims. actions and damages of every kind and description which may accrue to or be suffered by allY person or perSolls, corporation or property by rc'-i!ion of the perfor. mance of any such work, character of materials used or manner of in~taJJati()n.lllail1telwnce and operation or by the improper occupancy of right of way or public place or public Slructurc, and in casc allY suit or action i~ brought agaimt said Jefferson County fur damages arising oUI of or by reason of any of the above causes, the pctilioner, his successors or assigns, will upon notice 10 him or them of conUlIellCClllent of such action, defend the !"oUme at his or their own sole cost alld expense and will satisfy any judgment after the said suit or action shall have finally hccn determined if adverse to the Jef. ferson Counl)'. Excepl as herein authorized. 110 excav:.uion shall be made or obstacle placed within the limits of a county road in such a manlier as to interferc with the travel over sajd road, Except as herein aUlhorized. no excavation shall be lIlade or obstacle placeu wilhin four (41 feet of tht: edge of the [XlvcnWllt. If the work done under this permit interferes in allY way with the drainage of the county road. the grantce shall wholl)' and at his own expense make such prOlds;on as the engineer may direct 10 lUke care of SOlid drOlinOlge. On completion of said work herein contemplated all rubbish and debris shall be immediately remo\'ed amI the roo.dwa)' and roadside shall be left neat and presentable and salisfactory to Ihe engineer. All of the work herein contcmplated shall be done under the supervision alld 10 the satisfaction of the Coullty Enginccr and the clllire expense of said supervision shall be borne by the pany or panics 10 whom this permit is issued. The Depanment of Public Works hereby rescrveS the right 10 order lhe change of location or the removal ofarlY structure or strucllJres aUlhorizcd by this permit at an)' time, said change or rcmovalto be made at the solc eXpt:l1sc or the pany or panies to whom this permit is issuc<.l, or their successors and assigns. All such changcs, reconstruction or relocation by the granteeS shall be u(lnc in such manner as will cause the least interference with any of the Coun. Iy work and the CoullIY of Jefferson shall in no wise be helu liable for any damage 10 the grantee by reason of any such work by the Counlr of Jeffer. son, it agenlS or represcllIative!;, or by the exercise of any rights by the COUnty upon roads, streets, public places or structures in question. This pcrmit or privilege shall not be deemed or held to be an exclusive one tlnd ~hallllot prohihit the County from granting Olhcr permits or franchise rights of like or other nature to other public or private utilities, nor shall it prevent the COUnty from using l.lny of its roads, strects. or public places, or af. fect its right to full supcrvision and control ovcr all or any pari of thcm, none of which is hcreby surrendercd. The Department of Public Works may revoke, amend or cancclthis permit or any of the provisions thercof at any time by giving written notice to thc permittee. The permittee shall immediately remove a.1I facililies from the right of Wa}'. AllY facilities renmining UJlOn the right of way 30 days aftcr writ. ten notice of cancellation slla.11 be'remo\'ed by the County at the expense of the permiltee. The party or parties to whom this pcrmit is issued shallmainwin al his or their solc c.-.:rcnsc the structure or object for which this pcrmit is granted in a condition satisfactory to the Depunmcnt of Public Works. SPECIAL PROVISIONS: im~il~mJ6J(TItl]I~~ In accepting this pcrmit the gralllee, his sllcccssors and assigns. agrec that any damayc or injury done to the propeny of the granlce or any expense incurred by him through the operation of a contnlctor, working for thc Courlty or any COUIlIY employee shall be at the sole exrense of the granlce. his successors Dnd assigns. and conditions as herein set forth. , Ihe undersigned, hereby accepts this permil subject 10 tlte terms Dated Ihis "3 , 19 "'P'~" .... .'. .'. . . " ........ ': .' ..... .... .... , \ \ ..' ..- --': ...., ,'c". ': . ; '..: ' I . ..' .. I . .....' I. '.., < l., ;.' ~ '. .... " ::' , I.' . I" .' ~ , ,; : ~" ..... '. ','.', ( :i .... ,.'. ',: .: .,'. :,'., " ,,' '.,' ,,!. ..... liliiii JEFFERSON COUNTY DEPARTMENT OF PUBLIC WORKS Fee Paid_ Yes __ No 1820 Jellerson Streel P,O, Box 1220 Port Townsend. WA 98368 (206) 385.9160 f(c:<,;(iPINo, ^ddrc:~Rt:l.juest_ Y~_No Mile POSt AI'I'UCATION FOIlI'EHMIT To Department of Public Works, Jefferson County. Washington. The undersigned .""'P\J G:,I'::" -r- hereby appl_ for permission 10 -"':::o-OLJ~..JI::::> YC>uw ~e-- .~f- I_I (--,I-!-i 1 /0-<?i"'-I-L ~ ""::><'.6 C;;J. H. (Il,'l/Ii,'am ..'iJld,'''nl/~'Jjlll>' ..lIallit' "1,lw" '"U,,) <::..= . ,-,,-...JE- A~1Z<'~ ~I ~Fbj":-1 G-UIO F'F l2.. T::;> SKETCH: "'= ~rz:::. A TT A:::.-H Fe:. T7 kJoi2-~ .?-::;o \:::- ~ i.c:..q l .:' 122'~ '" , , ,..... '''I.' "_ " '~.... ,.I _ _ '"", ~ :::'~'l2C:::~ .L;:=':::,::-'::~ t....J~-:::.~~ C':~ On Counry Road: OI....J AI~o~T c..L.JTOFF C:> F I-l ~J '----( "Z-c::>. I~ K:-P A 1'" rz..c:. 'Y. ~' (Slu/I'IlI'arl'.l/ ('((I"'\[1l'l'/ Of mill' fl<JlmJ and agree_ 10 do the work jn accordance with your rules and regula/iolls and subject to your inspection and approval, :;;~ \~~;Y' I (Si,lIliIlUre of Applkantl (If D.pp1icant is D copartnership. sct forth names of copartners) ICOmtaclorl ~ 1(::;, FC u iZ. Go r~/-..J E., e... l?3:> Al.l..he..... Alldle~s 70 ~ 'ow N....-h'"-NP IN f>... '7Ff"$(08 3R ~ - d-'?"? 7.. JeHcrson Co. DEPARfMENT OF l'UIlLlC WOI{KS DiSlrict No. 6 Permit No. &88 ';? Supl'rvisor's Hcport No. Supervisor will make detailed report wi/It his recommendation on this application. Whenever possible show sketch of proposed work. Supervisor will al'w make additional reports and fillal report giving date of cumpletioll of lVork all this form. Preliminary Report: /7L"/~loR-' c", oFr rY/~/" Pc ,,.,. o.C)'; (:..>t;:; "',''"'J ?'""eli!. f'cJ<:. eN ,;e.RLI,'ce... '':>01",- ON LT. FoR. R+. e.u:L.L ~AJ5;-/ILt.... ,-vevv Cavi2'f"1:.~Y PO~D. ::J(,B.L &8- 07691 Date: 9 - 27-BR Signed: ...IL~ K..:J2~ Final Repor': PE~ INSPECTION REPORT Work covered by permit has been completed satisfactorily. Work is not completed. Recommend permit be cancelled. Traffic control.. adequa'e .. inadequate REMARKS Dale: 1-,J j- .?,? Signed: ~~ "--- ') \ IL t1\J ~\ zi'\ "J\r'...~ -~ ~ .f -\ ~ f JJ o w- r9 ~ \~l- , ,I[l ~~_ ~ r' ~ 4~i' ~--""=L. --i HNY z.c o r K' '-_. ~ ! ~~ ~ G~~7?~ (~).'~ j~;j.'t " -, (// '. -\ j -~7.: _() ,,\ ; V ~ --""'ii- " , -'.<//~'.~ r"~(-~. ~~ ? ~/0"')'~'rf' '" <\J) :~I",l " \J~ ,-,xx \ ::l- -- ^" 1::: ~ t~ if!Z. 1'1 ~ -.J 'I fj - J.t )-\ ~ - -, ()--~f\=::""~J' ~1 1lJ;;1 L .. - - ~ 1\ '" 1'1<1\. -'\ ~ <: g JI (\ J- lfl t-. ~ ,U 'l~ " 1\'.1 c l, 0 "'rOI\ l _. I(~~J_ ~ 'T- J' 1)_ '. r If' C. U) 1'- .... 0 , ' ~\ . , J' 15 " R \J 'J f ~,~ ':- '\J ~i ) '~ ~ ~ f-r i~ ~ Jr p Il~ ~ t ~ " L" i'J ~ S", ~ 8 O{lll~'~~\l~!l!~St L t;: -'- \I ,) ~ fJ 4 --\ cl l\- :.j \1'\ < lJrd a is "'''' s; n J\ \\ r (i' 1\ I \ 11 .4 \J ~ := \)1 <: ,,!J c '^ \/ r/'i " !), "o-5.J" ~ ", ;, -1 ~~. I" 0 };; . Ii 1 & ~~ ~ F E~ ff ~~: ~ t ~. ~m!, -1"-\ I. 1:1.",' a~ ~ I" J ::lfll'l ~. ~ V~ :~ ~ ~ ~ J\ ~ (j}l \1\ II . .~ (\ " "~-1ji1i1 let ~ J (\ y! ~ _ 0 II ~ '-~ i ~ I~ d ~ I"~ -H ~~ _ Jl c'\ ~:i ~ ~_ t ~~ h ::;I~ il~_~ !j~ 'i ~~" \" _ vrJ J 0 -\ ~ ~ '--'1 ~ I~ ~ ~ J1r ~ J'I" ~ ~,I -1\ ' ~ J ~ "J 11 ~ :;; L 'I' Q ~~S~ hO '1 II' )>:1 ~ -I -\~ 'i' . 0 -l]'l ~,' ~ ~~ ~n "m . tl. fj 0 lI' 1;"]I\~::\ ~\I( -A f\J 1111 :1 (\ ~""Q ')>' ~ iI-t. l" J' -,- C I>, n ~ ~ ,g 0 ~,. Z. L .~ G 1 I" S-'( 1:. h L ~ r S@ fr ~~cli' llJ~]\ ~0 al ~!2 ~ ~ ;'rl N Of ~ [:\ 1\ ~ ;LI~' i'~ ~ t:, Sll, ?~~ ~ l::J!Ii! ~ ~j ':.-::-.v." I I (\ IJ: 'I ' .. , V'':'l J, v (' "" 0 " ,. '-";( co,. '--1 (II ..1 21[ l! -Hi-- .. S · p ~ [" U 01 L. , J' " , 0 UJ 1- z \P -{ l}>\ .. 1\ ,Ill] "- \l '0- \I . II.~ N ~ '(1. p " ~- Of ~, ~ ffi " II z. " ",- ~ II! ~ vA ~ ~ ~ ~ ~ ~I ~," ~ ," ~ ~ (1 \ ~ .0 -l~, ~ ~ a ~ \J -\ SJ ,J-f "2/'.LI::::.:::::- -"" -. ... -'''. .. .. '-,. ,,', . '. ~...- .'. .-- " ,... - ---~' .. '''."''~.":'I;!' ,'''' 1-~~_~------ 1~I::Por(f" HUM1:<EF:: ES"f'2:30."() 1 DATE 09/13/88 TIME 15:04 T&D COST ESTIMATE SYSTEM MATERIAL ISSUE (T-61) W/O HUM1:<ER: 880768100 PAGE: Z. 01""2.. J:NVT./LOC. ISTOC/<rm.1 DOC.NO. IS/CI ACT. 1I1C.IIMI ~J/O HO. II::NTl::fil:::1) BY STOfiEISATSTI I , S , I /N..!lonO"iMIIOOI OUANTITY fiEOUIF:ED OUANTITY MATL.ID I~rUED GRP. ITEM ASSY MATERIAL DESCRIPTION I>IST/~I1:<UTIDN'_ POLES, TDI,JEr::s AND FIXTUfiES I ACT. I MC. I fiA. H..! I ~J/D B00768100 1 0';> 74~'i()O POLE 45 FOOT :< Bl ~!::!I O() 02 A'~M BP 9FT 1 1/1 (, HDL.E 2 85 135200 40 WIRE 3/0" UTILITY GUY DN ~O' 2 Ol 17700 21'1 ANCHOR SCREW SQUARE jO" ~il ~3~5000 :n 1:<RACICET 'TRANS :;'.'5 () 0,:, C/M DISTRI1:<UTION_ 01-1 CONDUCTORS loO 6 ~:! 6 I :3 :3 45' ANI> I>EVICES IACT. IMC. IRA.NJIW/O 1'1130760100 03 101300 WIRE 2 ACSR SPARROW 93 09000 INS FI1:<ER ROI> 34.5 DE 92 57200 66 CLEVIS 4-I/O"RIGID INSUL 22 20100 67 SLEEVE DE AUjo 12 ARM MT 09 69401 no ASSY GRD PLATE 2nBSQ" 21 53100 CLAMP TAP OFF 11:< FITS In-I/o 22 59400 STIRRUP 12/14 COMp YC1:<2R 04 lllOO WIRE 2/0 STR CU POLY I>ISn~IBUTION_ SERVICES 4 I I ACT. IMc. II~A.HJ'W/O (;)00760100 16 30100 SCREW 1/2X4 L.AG u, :<'1"iO() BELI..END 4M:;s pL.ASTIC 76 21300 BRACKET STANDOFF COND DB 76 35000 CONDUIT 4 r~ PL.ASTIC (STORES CODE-C ITEMS) IACT. IMC. 'RA.NJ/W/O 0(;)0768100 62 09100 XI" OH 15 12-120/200 lB ~;~ :,0 DISTRIBUTION_ TRANSFORMERS 3 EQUIPMENT - EXPENSED :3 48' 9S'OO() 6~rp ~=S'7Z.lo - ISISZ-'7_ IACT. II1G. IIM.NJIW/O 800760100 GUTOUT IOOA L/B 7.n1CV 1>A'fE / / ~ ",-r 2-\7 DATE ~ '36 "', , "0",,,,, oEFc. ,"-M'" '3<> '" 9. c"' "'''0," ''- 'c"", 'I<<> '" I R', No' "7' , - ,..-- - ---.... '-'-'- - .-- ".-.. -. - -.... ... -..- ...--.. -.... -. -- '.'-.. -..- -'" -'-.-.. -'''. - --'''. -. '''' .."...""".,,-. """"". - ."". - -. --- .----"" I pOLE CAR . TITLE: . GOUr(f"ESY FOIW'-:;PHASE OH EXl'. II::ASEMENl'FT, Qt<=J 'POLE CAI~D I -------------------------------------------------------------------------------1 LOGAT:rOH AII~POI'n CUTDF/" I'm. ~F'r~AM~CJ liM:'PED I - - - - - - - - "" - - -- -.- -. "" - - - - ".. ".'- - -"- ". -. - ". ... "'"'' -.-.." "",-." - -.. - ""." - - - -"- "" - -.- - -... .". - "!.!.J.: "........ "..- _ -..- ". _. _ _ _. "" _ I DATI:: ORI>I::liE:I> I DATE FILl.ED 'ENGI'W BY. / DI\Al>JN 1:<Y. I CHCC'(I::D BY I AP("I~(,WED BY , / / , / / I bcwtz:..i?. , GOIN-E-i?:. I , J...J~ ,: -------------------------------------------------------------------------------1 F! ""''' : "'" VEO" : n~~ ""eo '" : "'~ '"~"': PO,,,,,, S,": DOC NO. : , I ESTIMATC No. JMG (;)8076BI 'DATE CDMP. I FOI\EMAN SIG, , THIS REPORT WAS PRODUGED FROM CONTI~OLLED pROC I I I I DISP'R Sl'R'I\M FOI\'MH LIN'RM GEN,F'MN COORD. SYS.DPR ENGR R/W ASST,SUp ADV.C-STR \ (\.~ 19.~~.:1' >~~;~, [, <~?,t~- 10 JEFFERSON COUNTY DEPARTMENT OF PUBLIC WORKS 1820 Jellcf50n Slreer P.O. Box 1220 PorI Townsend, WA 98368 (206) 385-9160 tC'A N~ 0991 DiSlriCl No. 6 PERMIT In accordance with all applicable Revised Codes of Washing lOll and amendments thereto, and subject to all the terms, condi. tions and provisions written or printed below or on any part of this form PERMISSION IS HEREIlY GRANTED TO Alain OeChantal P.O. Box 988, Port Townsend, WA 98368 Install two (2) road approaches, each 40' wide, onto Airport Cut-Off Rd. at mile post 1.98 Lt. (East) and mile post 1.99 Rt. (l,est). to County Road No. 951707 Franchise No. Milepost 1. 98 + 1. 99 No work shall be done under this permit until the party or parties 10 whom it is granted shall have communicated with and received instructions from This permit shall be void unless the work herein contemplated shall have been completed before March 23 Dated at t1a rch 23 , 19 89 ,1990 ~~~~~WlEIDJ BY~'~ C_'_" ..... ,.' ,_'~_"~_...I,~"^'_'~" _ ':....: .:....:.--'_...:....'.~ GENERAL I'ROVISIONS AI'I'L1CAIILE TO ALL 1'lmMITS This permit is subjt:ct to all app!it::ablc provisions of the H.evhcd ewes of Wa~hjflglUn. c~ceJltthat any provi~ion ill thi~ agn:cmcntnot con~i~u:rll with such resolution shall be controlling, A bond in the amount of $ i~ rt:(juirt:d for tile protec.:tilJn of the county as set forth in tbe Icrrns of the bond, During the progress of the work such barriers shall be erected and lllailllained as lllay I}I.: necessary or a~ ilia)' be dirccted for the protection of the traveling public; the barriers shall be properly lighted at night. III accepting this permit the petitiOller, his succt:ssors .Im! assigns, agrces to prult:ct Jefferson County and ~a\'e it harmless from all claims. actions and damages of every kind and description which may accrue to or be suffered by any pcrSOl1 or pcrsofls. corporation or properly by reason of the pcrfor. mance of any such work, character of materials used or manner of inslaJ/alion, mailllenance and operation or by tht.: illlprupcr occupancy of right of way or public place or public structure. and in case any suit or action is brought agaimt said Jefferson COUllt)' for damages arising out of or by rca~J/l of any of the above causes, the petitioner. his successors or assigns, will Upollllotice to him ur them of eommenr.:cmelll of sUt~h action. defend the ~me at his or their own sole COM and expense and will satisfy any judgment after the said suit ur action shall have finally beell determined ifad\'er~e LO the jef- ferson County. Except as herein authorized. no excavation shall be Illade or obstacle placed within the limits of a count) fOad in such U lIlallflt:r as to interfere with Ihe travel over said rood. Except as herein authorized. no excavation shall be made or ohstacle placcd within four (4) fect of the t:dgc of the pavement. If thc work dOlle under this permit interferes in allY way with thedraillagc uf the 1..-01JlJly road. thc gralltee ~halJ whully and at his OWfl cxpense make such provjsion 115 the engineer m<JY /.Jjrccl 10 lake care of said drainage. On completion of said work hcrein cOlllcmplated all rubbish and debris shaIJ be immediately removed and the roadway and roadside shall be left neal and presentable and satisfactory to the engineer. All of the work herein contemplated shall be done under the supervision amI to thc satisfaction of the County Engineer and the clltire expense of said supervision shall be borne by the pany or p.lfIies to whom this pcrmit is issued. The Depanment of Public Works hereby rescrvcs the right to order the change of location or the remO\'al of any S1ructurt: or structurcs authorized by this permit at any time. said change or rClI\ovalto be made at the sole expense of the parly or panics to whom this permit is issued. or their SUcccssors and assigns. All such changes, reconstruction or relocation by the grantees shall be done in such manner as will cause the least interference with any of the Coun- ty work and the County of Jefferson shall in no wise be held liable for any damagc ({) the grantee by reason of any such work by the CoulllY of Jcffcr- son, it agents or rcrresenlatives, or by the exercise of any riglus by the COUIUY upon roads, streets, public places or strUCtures in question, This permit or privilege shall not be deemed or held to be an exclusive one and 1>l1all not prohibit the County from granting othcr permits or franchise rights of like or other nature to othcr public or private utilities, nor shall it prevent the County from using any of ils roads. streets, or public places, or af- fect its right to full supcrvision and control over all or any pan of them, nOlle of which is hcreby surrendercd, The Department of Public Works ma)' revoke. amend or cancel this permit or any of thc provisions thereof at any timc b)' giving wrinen notice to the permittee. The pcrmittee shall immediatcly remove all facilities from the right of way. Any facilities remaining upon the right of way 30 days after writ- ten notice of cancellation shall bc removed by the County at the expense of the permittee. The pany or parties to whom this pcrmit is issued slmlllllaintain at hisor their sole expense the structure or object for which this permit is granted in a condition satisfactory to lhc Department of Public Works. SPECIAL PROVISIONS: 1. The approach to the East side of Airport Cut-Off shall require a 40' culvert. i~;2.,;;>"il{l1e;-.r~17r.>Op,y,hrfO the West side does not require a cul vert. jlI1c:!fhIP M::lglW!J.1 ,!dlJ \A'pJ:n;'iP~:i ~1}f~1 be responsible for all damages to county road right of way. In accepting this permit the granlee, his successors and assigns. agrcc thm any dnmage or injury done to the property of lhe grantee or any e,xpc:nse incurred by him through the operation of a contractor. working for thc County or any COUnty cmployee shall be al the sole expcnse of lhe grantee, his .:'ecs~1~~gnsV7_ ~a ~Ji,/"'P-zr:// ~ (.J!l!tt"f" V" -L . aL L:/~I:.;K.. ~~G . the undersigned, herchy accepts this permit subject to the terms and conditions us h~n set fonh, Dated lhis* dT I day of* '7fl~/",-/ . I~ 07 ~ &ic<<dzt/ JEFFERSON COUNTY DEPARTMENT OF PUBLIC WORKS Fee Paid_ Yes _ Nu 1820 Jellerson Street P,O, Box 1220 PorI Townsend, WA 98368 12061385.9160 KuciplNu. Addre~ Rcqucsl_ Yes _ No AI'I'L1CATION FOn I'EHMIT [\Ail.. u...... ~;.;;:{}:.~~/ 7" To Department of Public Works, Jefferson County, Washington. The undersigned 1111-1/ /J L, ,,(l,;:- e 114// Iff!- hereby app/~ for permission to /)/:.">-h;.c.t.-/l--f/O/l-I Or e'v/t/a:;-;- 70 I It/jO,E {I Eo P '.' 8,UVlf-"t;/. ~ -=#- {d-- tUc~;;';:Z;;~~:"";:~~{ (Jaz- ~~ . ~-U! />:;--. OW/./bYJ ;Sf (JOt/,,//ir- / ;-1- 4/'%/-J7 !f/I::ff!- ~ /{)EJDF/!O//('J # (d- Hllr /Uf?'- ;1/e"b-f::, 0;(/5' SKETCH: On CoullIy Road: #" /d.- /lilif!-0f M-ole- between A //1 ;d/-iiL. r/;NJ....,h915';t"9iS . /-( ~~,;~ (Stalf'lIl'l1'..I/CfrJl"-\"..../"f",lI..pll;ml and agree <; 10 do Ihe work in accordance with your rules and regula/iolls and subject 10 your inspection and approval. Date ::s -;+- rl- 19~ a/~(./Jle(;tI-l-4;"lti7, ,"]35-/96 3 ~N &4f..u6 3J1S-{,;:>1,It./ lSlllnUlurcnr^PIlI"anll (/' ~PCIOfl /J ;LJ C (If upplicant is a cOpilnllcrship. sel forth names of copannersl /-; 0, /.~, x:: 197 ^lldrl.'!>~ -1-1)117 --!r:-~?(/tf(! :'J {>.7VCQ W 11- 18'36r Allllrl.'!>\ Jefferson Co. District No.~ DEI'AIHMENT (~))<' I'UULlC WOnKS Permit No. oct'll Supervisor's IlellOrt No. Supervisor will make detailed report with his recommendation 011 this application Whenever possible show sketch of proposed work. Supervisor will also make additional reports and final report giving datI! 0/ complelion of work all this form. I)rcliminury neport: /h'j<,rat<T c \'q--~FF - /n.p. cV'\\Jet'<..-\- h"f' 1.9} t<r G""9 :l1''''llk y.-,~, Mce. iN .'t>e 6"'(:),,,-_ 1.98 J.. r- C?/I$r) .vl,,- R<?,,: ic<i? ( ....~.T ) DO<:5 ,-.J or- A!"'l'" 1 1:?1l.. A C".../ve~. 17~""--r> ,:,II-\.'(:) . / Sn'll;;> O:r<-r1 "'" t:/l-S7 Date: '1;, - 1.:~ -'6~ Signed: .h...~(;,~~ FinaIIJL~::L:' PERV.~SPECTION HEPORT Work covered by permit has been completed satisfactorily, Work is not completed. Recommend permit be cancelled. Traffic control - adequate - inadequate REMARKS 1).1.: tl_~/- J>7 Si~n.d: D-- ~ \ l\ , , ~ ." ' . u+1 ", '. ';'j' ~v ~ I . }--tB.~'---'-1 __J. '!., , , \t 0-\1-='--- I' !I 1<.0 --~_. 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".', - "" "':. .....:.', i:\ ..JEFFERSa'4 c:::ot..aiTY DEPARTJr-lENT OF PUBL I C WORI<S FlU: 5"<.(0901 ACTION REQUEST flEQlESTED BY- :5rArJt.eI KI"tOESl4- '-1-1 :H>S"18l- LAN""" PHONE NO. - ---:?OQ::\ G.>DL.Cx.>.l) uJrJ ALT. PH. NO.- NAT'-"E OF REQl.EST- J2l'N PERSON 0 BY PHONE 0 BY LETTER T~ BY- ASJ.. PEFrrAINING TO.. o OFFICE: DENG/sURVEY o ROAD MAINT. t21EOUIP. MAINT. o SOL.I 0 WASTE REQLEST F"CR- 'i2E9A1~ HeLES - ASI'~A-t..:r 1ZoA-l:::. LOCATION- RJAD NJU,E ~T-El2. (.AtJ6 ROAD N.......ER DATE- 5\5\8'1 <+'31 - 2-5'15 ADCRESS - ....P. PRO..JECT.. Pno.JECT TITLE RAOJECT NlNBER- f-\.Pr0\;:. N e-J 5 v a..1=N..e. DESCH I PT I O'i.. \CeQ vesTS 'R.oA-D DC:: .A-s.P~. 120 Ga.-EJ.;J '":pOl H-oIES -p A'\"C1..\el) I l-I-ouJe.lEIL BACK... . f-\-A-S Ao-e A"n'AQi MAP aI SKETOi ~ REFER TO- ::PJC>1'~ ~J@i"i'-rn::- S,,~ RESP'a"W BY- RESPONSE. Fr:;~TeR- LA! oP 24 .5~} wH: <<If hrt-s 1'1 R/I-'n'""q IN rlvo/L PI~iOR.;-I-i rt1?1~/1r ,.. 'S 1-13 b oloJ (..-.,u 12- /"';-<;-r- A-l>....-; €.!.-r-;..o ?Jl.l1. l_eVeL "" :Hf /_A-Y"",y is c).. _"rfoV<LO Be:> A--1>~9""A.I-~ REVIEWED BY- DATE- c:x:l"ITACTED REQUESTER 0 IN PE~ 0 BY PHONE 0 BY' LETTER c:::cNTAcTED BV- RElXlHoEHDAT ION- PREPARE EST I NAn. Fa>- noun: TO- O DIRECTOR o ASSISTANI" DIR. o RJAD su>E:RV1 SClR INITIAL o CCNSTRLlCTION ENG. _ 0 ACcou-rrANT o PLANiING ENGINEER _ 0 o ADMIN. ASSISTANT _ 0 .' ,'.: --: :. '. , , , , '. "'" , . . ..... ;.','.: '. .:.. : ..,:, , .' .... . .'. . . ..' .. "1 I . ,.... ...... . .... . /:....: ".,' C,", ..... :. .: . :: :" ..:..' " .' .' . , . '.:. \, ".. , II .' .', ':. :..'. ..... '. : I I':',..!, . Jljj:~:f~ .... ..... "':" . "c' .. .' .. . ::!:.., . ./ , .'. .' " .' ". '. ". '. ;. ..... I ....) li~ . ".,'. . . . ',.,:." ' .:. '. :'. . . ' :' " ". :> ' : " :',:,::: " ,J: . ;, ", 'i ", ' ':,': .. '.' > ".: : '" "" ..' ' .: '.:, , '" . : ,":: ,,' . , .',;;. : : .. ,'. ':. ' '. ". ." . . . .. '.," . . .....: ...." .... ......::.:. ;'-":."" , :. ";'::'" '.: . ".;, ". ", . . :' . '., .JEFFERSC::t'lI ~TY CEP~ OF PUBL.I C WORKS FlU: ,NZ60'j ACTI ON REQUEST IlEQ<ESTED BY. A/2.r ){V.~7N.) ADORESS. /6/ W. Frre:.J.IB-#IZ-6-. $'T. DATE. ~ -//- 89 .5135- o?32-- PHONE NO.' ALT. PH. NO. NATln=: OF REQl..EST- ~ IN PERSa'lI 0 BY PHC::HE 0 BY LETrER TN<EN BY. m~ PERTAINING TO- DOFFleX DENG/sURVEY o ROAD MAINT. o EQUIP, IoIAINT. DsoLID WASTE REQlEST FOR. ?/J.Ci'I/~"'r CAPS FtZ-C7"1 ,B1fC/N? AB APD"Pc/) f!r> L..OCATIa"t.. ROAD NAME 61:#ot7/)lANO A~J!-t5s ROAD NlJotBER M.P. PRO..IECT- PRO.JEcT TITLE AROJEcT Nu.tBER- DESCRIPT'a<. ?tAT .t:!,tE/?J" i9At:.J: ,lJ7' "':,vIJ o"t:: Q,of)JI1p. 4. l),<::'AD f.~D S/?/I t.4l5" Daw.J / H6' pur !3AC}:; up 7GfYlP"nJ'rt2-/t:..7 ATTACH NAP CR SKETOI REFER TO. :5c.d7r RESPOND BY. RESPONSE.I.ItJ".c.,~N :','1" A,ee.I>'" \1.~RfJ\ R.C'>,\,llI-c.Rl'l. 2. c...." 1\-1>-.. "'T. A-fY",,,,,,-<, -h-, i>.<- \!?, \ ,,/"- e to> ,,,,,,,,n eN6tA~rI 3.....'pet> ~ D/I'lr:.e AJ"''''-' j;:;E!~,,^ A-f>",(.>/lx. /60 PAS.,. LAST ~e",;1>e'Nce I '--F, I ON w. f=~+oi-g,^e.J' z. 1lf'I.t--k,Q'S A-~O,..l"I'l"W_~ ;,J A-Retl. I L.e.;d.. w:rR. -660 wl'1 REVIEWED BY. ~ DATE. CCN'TACTED REQl.ESTER 0 IN PE~ 0 BY P't-ICW'IIE 0 BY' LETTER CXJNTACTED BV. RE~TION- ,,'. .. ,., PREPARE EST'MATIE. FQl- ROUTE TO- INITIAL 0 D I REc:rcn - 0 CONSTRUCT ID"II ENG. - 0 ACCX)l.NT ANT 0 ASS I sTAHr DrR. - 0 PLAr*lING ENGINEER _ 0 0 A:lAD fM.F'ERV I SCR - 0 ADMIN, ASSIST~T - 0 ..... . ....... ,', ..~........ , , ~', . .... . ,...';: I c.: t . .'. i: .'. . I .' : ! , !' r, '.' ,.,' i '. ...... ". , ~, . . .... . ... f i ~. " .' I .... ....... .... '. . . .'. . . .'~:' , .', '.. . .,'. , :'. . ',.... ." ..... '. .' . .' , ':,: :". : .....' .,',. .... , . ',., ',< . .. , .. ',': ,'., .: :;" ." :. .... .' .' . ." . ....: :, ': "1: ~....'/./ , '.' ." J" . Jofferson Counly Public Work!: [).)pt ,OCT 4 MP' JEFFERSON COUNTY DEPARTMENT OF PUBLIC WORKS 1820 Jetlcrson Street P,O, Box t220 p~, 't Townsend, WA 98368 (206) 385.9160 N~ 0886 District No. 5 PERMIT In accordance with all applicable Revised Codes of Washington and amendments thereto, and subject to all the terms, condi- tions and provisions written or printed below or on any part of this form PERMISSION IS HEREBY GRANTED TO Tom Beavers/Olympic Real Estate 2219 W. Sims Way, Port Townsend, WA 98368 to Install minimum of 30 feet of 12" culvert for a temporary commercial access off Paradise Bay Rd. at mile post 5.96 on the West. County Road No. 503609 Franchise No. 5.96 Milepost No work shall be done under this permit umilthe parly or purties to whom it is granted shall have communicated with and received instructions from This permit shall be void unless the work herein cOnLemplated shall have been completed before Sept. 30 DatedatSeptember 30 ,1988 ,1989 .B~~~@wm By ---<.) ~ ~ 1.800.424.5555 GENEIlAL I'I{OVISJONS AI'I'I.lCAIII.E TO ALl. l'EnMITS This permit is subject to all applil.:ilble provisions of the Revised Codes of Washingtoll, cxccpllhat an)' provi~jun in Ihi~ a~rccrncllt not t.:(Jn~h.tcllt with such resolution shall be controlling. A bond ill the amount ~lf $ ---- is rCLluired for the prmccliull of the count>' us ~et forth in the terms of the bond. During the progress of the work such barriers shall bl: erected and maintained us Illay he Ilccessar)' or as may be directed 1'01 the protection of the traveling public; the barriers shall be properly lighted nt night. In accepting this permit the petitioner, his successors alld assiglls, agrees to protect Jcffcr!ton Count)' and suve it harmless from all claims. actjon~ and damages of every kind and description which may accrue to or be suffered by an)' persoll or pcrMJllS, corporation or property by rca!tml of the perfor- mancc of UII)' such work, character of materials used or manner of installath)ll, maintellul1ce and operation or by the improper occupancy of right of way or public place or public structure, and in casc any suit or action is brought against said Jefferson Count)' for damages arising OUI of or by reason of an)' of the above causes, the petitioner. his succc!tsors or assigns. will upon notice to him or them of COllltllenCcment of 1iuch action. defend the !>ame at his or their own sole cost and expcnse and will slllisfy any judgment after the said suit or actiOll1ihall have finally been detcrmincd if advcrse 10 lhe Jef. ferson County. Except as hercin authorized. no excavation shall bc made or ubstacle placed within the limits of a cuunty road in sudl a manner as to interfere with the tra vcl ovcr said road. Except as herein authoril.ed, I1U excavatiun shall be lIIade or obstacle pla,ed within four (41 feet of the edge of the pavement. If the work done under this pcrmit interfcres in any way with lhe drainagc of the c,;ounty road.lhe grantee shall wholly and at his own cxpensc make such provision as the engineer may direct to take carc of said drainage. On completion of said work herein contcmplated all ruhbish and debris shall be immediately rernovet.! and the roadway and roadside ~hall be lcft neat and presentable and satisfactory to the engineer. All of the work hcrein contemplated shall be done under the supcn'ision and to the satisfaction of the County Engineer and thc entire expcnsc of said supcrvision shall be borne by thc party or parties to whom this permit is issued, The Department of Public Works hcreby reserves the right to order the change of location or the removal of any structure or structures authorized by this permit at anr time. said change or removal to be madc at the sole cxpensc of the party or parties to whom this pcrmit is issucd, or their succes.'iors and assigns. All such changes, rcconmuctioll or relocation by the grantecs shall he dOlle in such manner as will cause the Icast intcrfercnce with any of the Coun. ty work and the Count). of Jefferson shall in no wise be hcld liable for any dumage to the grantee b)' rcason of anr such work by thc County of Jeffcr' son, it agents or reprcscllIatives, or by thc exercise of any rights by the County upon roads, streets, public placcs or structures in qucstion. This pcrmit or privilege shall not be deemed or hcld to be an cxclusive aile and !>hall not prohibit the Courllr from granting othcr permits or franchise rights of like or othcr nature to othcr public or private utilities, nor shall it prevent the County from using any of its roads. strcets. or public places. or af. feet its right to full supervision and control over all or any part of tht:m, nonc of whkh is hercby surrendered. The Dcpartment of Public Works may revoke, amend or cancel this permit or any of the provisions thereof at any time by giving written notice to thc permiltce. Thc pcrmiltce shall immcdiatelr removc all facilities from the right of way. Any facilities remaining upon the right of way 30 days after writ- ten notice of cancellation shall be rcmovcd by the CoulllY at the expense of the permit Ice. The party or parties to whom this permit is issued shalllllaintain :It his or their sole cxpensc the structure or object for which thi$ permit is grantcd in a condition satisfactory to the Departmcnt of Public Works. SPECIAL PROVISIONS: 1. Property line rig.ht-of-way. right-of-way. should be established to identify state highway This will guarantee no enchroachrnent onto state In acccpting this pcrmit the grantee, his successors and assigns. agree thai any damage or injury donc to the properlY of the grantee or any expense incurrcd by him through the operation of a contr<lctor, working for the County or any County employce shall be atlhe sole expensc of the grantee, his successo~s uJssigns. ~ Ii t--?11 }::> ~ /1 tJ~ S- , the undcrsigned. hcreby accepts this permit subject to the tcrmli and CO(J'ion os herein '" forth. - . 'J' ___ Dated this I day of O~ / '7 J Y ,19 ^""~ )tJ-t11 r5-ec0"- .-.........,.......,.........." \ r.;-'~1~ ~~~~1 ~<, f[, <'tVh JEFFERSON COUNTY DEPARTMENT OF PUBLIC WORKS Paid ~es No ?, '3 9 If kk~ Il?'96 Itco::elptN,y Fcc 1820 Jellllfson Street P.O, BDX 1220 PorI Townsend. WA 98368 (206) 385.9160 Addres.sRequest_ Yes_No Mile POSt 9- 2$- & 5 Sf(... AI'I'L1CATION FOJ{ 1'~:J{M1T To Department of Public Works. Jefferson County, Washington. The undersigned ~m'D <? f1 I/-lArS ~;{fJ OI'JJ:n~/ ~ .rtJ1e herebyappl.;e2- for permission to .=r:",,:s 7"7'T'- L -;:?"",,,",,, "f,f.?,;.t~,. ",,,/:;;:E!?/::J,~A c;l {oiZ- -;ernfa~~ ct1f/Afl1eFZc il1L ~ S;?LeS ~ r=F .- Co ~ SKETCH: -see /J-rrrrC ,lIe D - On CoullIyRoad: /~:se ~eiJeN:G;sr-ejaS RD. Pt. i<.t>. 13"'11 P. t:> . be/ween 5.i? 10'-1 /1".,;D /Ice /';!oSS ,QorM:> f=Rol"'1 Te/2.m,' t>J1'h-;6rJ (SfOIt'III'QIt'\/I'ff"Hm't'IClrmil"(H';1II1 and agree-S- to do the work ill accordance with your rules alld reg'lIlations and subject to your inspection and approval. Date ~ :;.r 19~ ~~.e~ Sl. ISlgnulLlrCllf ^llplicuuU lConlratlorl ) c- (If applicant is a copartnership, set forth names of CopDrtners) '2 ?- } 1- r A _ . ,;:, : n::1.$.v..1.fZj J-L T ClAA/Y1 ~ Wf'r / A,"'"'' I'holle No.--2 'i")-~ Jefferson Co. DEPARTMENT 01' PUBLIC WORKS District No. .c;- Permit No. C) 8 8 6 Supervisor's RC,UJrl No. Supervisor will make derailed report with his recommendatiofl oflthis applicatioll. ~Yheflever possible show sketch Df proposed wDrk. Supervisor will also make additional reports and final report giving date of completioll of work onthis/Drm. ,Ireliminary 'lepurt: P~trD i se .!SAy? i~D. ""; /~ Posr- S. 96 R1". 'Z. is '" renopoR-A-1<.Y F-'f'pi2o/lc,I/ 30 ' . /IIeeo "i?,,--/'/-; -V 30' CO V'\W7er.<!c.lAL. W;D;-tt .Ne.e. D :s '1-0 i3~ /z" <<.,,/veRr 1-0"J (3.r.JQ~9tf t-o ""1 Df frJ>/~;'>o rfc.# rr<-"es~ I, c."'\\JeRl"" g~",;~e.D Date: 9- 29 - fjf3 Signed: .-IJ /~ K':/L lA Final Report: PER~7INSPECTION REPOHT \Vork covered by permit has been completed satisfactorily. Work is not completed. Recommend permit be cancelled. Traffic control - adequate - inadequate REMARKS nole: " -- P,.b; Slgncd:~' LJ-- nUMl'lC l'IU~'IU(~.I~('. ,:;-..,. ':') " < ~; 0 -( <v "" 4! "'-.J .':' .:! 'Z: " < ~ rCl '" .... < -~ W '" ::r ~ <!;" ::: "- ;; '" So .. '" " '0 >-...:; > <0:. ~ ~ ~') ~. , - '" ~ <Xl "- '- >< " ~ f '", .. ~ !'( .... .. o o in U1 + o o '~ \ ; I, "'. \ {1\' ~oo..d nIne. "t'-\') (Co,", :; ~ ~i::-;" Go"'~' Lot 4. ""..c..::'5 0 . ::;.:: b . 5~". ~_1 ~g.~~4 ~ oJ , :::: ~n~ <2..-r- - I.'~".!: -7---__ } ()!":,'y . ---- I '~ . 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'-. --- ---- ------ - - --- CoR 104') i-1ECONDAIlY STATE IIImnVA Y NO. !I-E SHrNE TO TERl\HNATfON POINT ,Jf~l'l'lmSON COUNTY '-<;~~~~':~~:~~~'" ; ~~..,:~ "L~~l:+"I:'\ ~,'" f~.r; 11'} ";'1*! \';',\. /Q..j " ~ .':"'lIt~'~,.' .;:.? ",r;~~:~~~i':!~~~:.. \VASIIINCO'1'ON RT^n: !lUlUW",. CO:'lll\flS510,,\ Ul:I','IlT~lI:NT.II-' IIlr:IIW.\\'S 01.1'1""'1,\. 1\'.\:oilll,'''I;'IU~ . \ 1::. J. "'1C'''~,. 1:I"lI~'''nll /I, f:, MnrllO'IN, ^'~.IIl"C'r II. ^, Muralfl, ^,r:I",.~, . " t:, ['hut'II:, M"mIH'r t:...\. c'uwu,.. .~"'''''','r sc,\u:: lIonrz. I Isrll:r:.: 100 Ff:r.l' lH:.\I.l:: \'1.11'1', I Isell ,. 10 'Lt;'I' ',U"'II11\lt:fI' Oc.toher 70,"J!;f\, / l'<<':lC;;il.~ &;! :i1,,~,~,: 1'01/ n. 01' II', fllll':E'" 5 01' G I ' "::'" "".."'.. .;.: '/:' ,,' .": , , , ..:;'... .' ' ", . ,. {"? , , ' : " "',' " " """ , ,,' ,.",,'" ". : " .! 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JEFFERSON COUNTY DEPARTMENT OF PUBLIC WORKS 1820 Jt:llerson Street P.O, Box t220 Port Townsend, WA 98368 {2061385.9160 N~ 0969 District No, 5" PERMIT In accordance with all applicable Revised Codes of Washington and amendments thereto, and subject to all the terms, condi- tions and provisions written or printed below or on any part of this form PERMISSION IS HEREIlY GRANTED TO puget Sound power and Light 310 Four Corners Rd., port Townsend, WA 98368 W Install underground cable along the East side of Paradise Bay Road from mile post 4.30. -* /5'1 0\ 2>::,'f County Road No. 503609 Franchise No, Milepost 4. 07 - 4. 3 0 No work shall be done under this permit until the party or parties to whom it is granted shall have communicated with and received instructions from This permit shall be void unless the work herein contemplated shall have been completed before Mar ch 2 Dated at March 2 ,19 89 , 19} 0 &W~~@~m ~~~ J~~, CALL 46 HOURS BEFORE YOU DIG . IlY...L)~ ~ 1-800.424.5555 'W' ,,',' ".: .:.',' ".. :",,,' , ","''''.' ". '" ". ,', , :.' " ",:, .' " " ,'" ' . ..' , /,:' .', .: "", c. ,',:, c,' ,"",.' '. . :......,..,... .' " " " , '!,.' ",' .' .,' . "";!,,,"",!' , ',' , ,,: ' '. ". :'. . ,.... :. . ',', , " y. '. . ;,c",", ". , , .' .: " ,,' :,: >, ',:" :. . GENEI1AL l'I10VISIONS AI'I'UCAIlI.E TO ALL l'EIlMITS This permit is subject to aU applicable provisions of the Revised Codes of Wa~hi"g[Ull. cxccptlhat any prm'isioll jlllhi~ ~~reC/llCllt nul consi~It'1lt with such resolution shall be controlling. A bond in lhc amounI of $ is reljuirt:J for tile protectiun of the CHUIll)' as ~ct furtll in the terms of the oond, During the progress of the work such barriers ~hall be t:reclcd amJ Illuilltailled us lIlay be Ilcce1>sar)' or as lI1a)' be dircctt:d for the pwtt:ction of tlie traveling public: the barriers shall be properly lighted at night. In accepting this pcnnillhc petitioner, his successors U/H.J assigns, agrees 10 protect Jefferson County and save itll:.J.rlllle.'>S from all claims. actions and damages of every kind and description which llIay accrue to or he suffered by all)' person or persons. corporation or property by rcusolI of the perfor. mancc of any such work. character of Illaterials used or manner of installation, rnaimcnance and Opt:tatioll or by the improper occupancy of right of way or public place or public structure, and i/l case any suit or action is brought aguimt saki Jcffer!ooll County for damages ari!oing out of or by rea!toll of any of the above causes, the petitioner, his successors Of assigns, will upon llotic.:e to him or them of commencemcnt of such action, defend the S<lfllc at his or their OWlI sole cost and cxpcnseand will satbfy any judgment after the said suit or uctioll shall have fjnalJ)' been determined if ad\'er!oC to the Jef. ferson County. Except as herein authorized. no cxcavulion shall he made or obstacle placeJ wit/lin thc limits of a cOUllty rood in such u marlller as to interfere with the travel over said rood. Except us herein aUlhori/eJ. 110 excavatinn shall be made or ohsl:.ldc plact:d within four 141 feet of lhe edge of the puvelllelll. If the work done undcr this pcrmit interferes ill allY Way with lhe druinuge of the coullty road. the gr:.lIHee !ohall wholly and at his own cxpcnSt: mal.:e such provision as the engineer may direct to take care of said drainage. 011 completion of said work hcrein contemplated all rubbh.h and debris shall he illllllCdiJtely relllO\'ed aut! the fOJdway and roadside shJII be left Ileat and presentable and satisfactory to the engineer. All of the work herein contemplated shall be done under the supervision and to the satisfuctioll of the COUnty Engineer alld the entire eApcm.e of said supervision shall be borne by the party or parties to whom this permit is issued, The Department of Public Works hereby rcservcs the right to order the change of location or the rcmoval of Iln)' structure or MrUctures authorizcd by this pcrmit at allY time, 5.1id change or rcrnovalto he made at the sule expense oflhe p,arty or parlies to wholllll1is permit is issued. or their suc:ccssors and assigns. All such chungcs, reconstruction or rclocation by the gru/ltees shall he done in such marmcr as will cause the least interfcrcnce with any of the Coun. ty work and the County of Jefferson shall in no wise be held liable for any damage to the grantee by reason of any such worl.: by the COUnt)' of Jeffer. son, it agents or represelltatives, or by the exercise of allY rights by the CoullIY IIpon roads, streets. public places or structures in question. This permit or privilege shall not be deemed or held to be an exclusive one alltl shall flut prohibit the County from graming other permits or franchise rights of like or olher nature to other public or privale utilities. nor slmll it prevcnt the COUlHY from using any of its roads. streets, or put'tlic places. or af. feet its right 10 full supervision and control over all or any part of them. none of whieh is hereby surrcndercd. The Department of Public Works may revoke, amend or cancel this pcrmit or UIlY of the pro\'hions thereof ut any time by giving written notice 10 Ihe pcrmillee. The permittee shall immediately re/llove all facilities frollllhe right of way. Any facilities remaining Upon the right of way 30 days after writ- tcn notice of cancellation shall be removcd by thc COUnty lit the eApcn.~e of the pcrmiltec. The party or parties to whom this pcrmit is issued Sill. II maintain at his or their sole expense the SlrUctllreor object for which this permit is grunted in a condition satisfactory to the Department of Public Works. SPECIAL PHOYISIONS: 1. Cable shall be installed a minimum of 30" belot< existing shoulder grade.... ;,i:1 'ii~'J/"i'!';,/.:.l~J:;;{'~-~ n 2. AP'PJ;i.c5n.t',(snk\killJoe responsible for all damages to county road right:-:'61;''i.k~}!WI'11 W;1J In accepting this permit the grantee, his successors and assigns, agree that any damage or injury done 10 the properly of the grantee or any expense incurred by him through the operation of il contraclOr. working for the COUnty or allY CoulllY employee shall be at the sole expcnse of thc grantee, his :cccssor:.and ~~g: ~ 7\' -.00~ --/- ;7 0, ,th, undersigned, herehy acccp" this permit subject to the terms and com~olls"~s ~ct forth. Dated thi?' 3 day or'i'- M~ , 19--'*3"~ * ~tU; ~. ^rrlic;llll ,," ' ; , ,','",.' ,'. . .,,' i-' , , ""'. I"~ : , District No. S- , " '''''., , .,. .>;' -:' "i, " ,.:, " . '. " .. .', '. , ' .:: ,:" " ,,:,', .,'.' ',','; " "" " " " :..:" ::"" "" ,', , .' 'c "':':,:' ': ",: ',; 'i " ,'" ,;' .:<. " ',":', , ;"',, " ",:..',' c,',' ' , I:':::>:", ".", ,'", "', . "" ,:'.'" , : ~; v' t ~j, ~o Ii'- l', Z f r \ " \ I -"';' " " " ,'I \ ~ ' , I' I l (; \ ~i:~, r' '" ',I :),"-',' Jefferson Co. DEPARTMENT OF l'UIlLlC WORKS Permit No,O'lt,9 Supenisor's n.CIJOrt No. Supervisor will make detailed report willi his recommendation 0/1 ,his application. Whellel1er possible show ~ikelch of proposed work. Supervisor will also make additional reports olldfl/lal report giving date of completion of work 011 this form. I Preliminary Report: ?~~-;se ~>'T-'t' K'I:>. .M.p' t.f-o? -10 '-1.30 S 1'1\--N 0 A'lL. '0 SH-o~Lc>e~ I ~;lL se.c.-r-.--.::;,J I, Date: .,3 -2.. - 8'1' --!1 .. ,4- t(.A 0 1 Signed: Final Report: PERI\!JT INSI'ECTlON REPORT 1/ Work covered by permit has been completed satisfactorily. Work Is nol completed, Recommend permit be cancelled, Traffic control - adequate - inadequate REMARKS Date: ,'l- 8- 197 J)<- ~ Sl~ned: Ill,' "11'1(: I'HI~ll':H"i, I~('. . ,,' .'," . .. . ',', " , ",.' , ..,.,.-- , ' ',.', , .. ....> , ',. 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() lOTS 0.:<::, _,=L~fL._,_,l~Q,_.EEBMJT.. i-'\ Y.:'.,E..T TO ; ..: Z; Po F~t: R::r:....!') k'OiJ t< YD::s f.v. r, I'W,,,. ,I ShE.:::;, illO """ AvE .:') IJ ill: -/15 .::}t...:,l-TLE !'J_\,\ r!,/, IG I F'f-r.'H e'-,__ .OS'.l :.J(1 CAC,0~ A,l_~J/\j(:;'J E~~\T :::~fl1.~~ OF r:"';,:: i. {:"~:{\~~':t\L;.!C'::?'::._ t=::r':::'\.'y '<..D, .,',: . ',',' COUNTY PERIII'f ".: *" .l):::~v;c_:LC:y,.J,~f(-: -1-C~.. I~)'I,,~~~\; 1~' LOCA"l-c::> ic:.c..(Q.., i,).-fJ:) : :~J.: "\.,::. '.}~ .~,:. CALL 48 HOURS : BEFORE YOU' DIG : 1.800.424.5555 '901011,8J ~?ir F'-i A:"'~{:1 e.fC"_ ~ ;::''::::.~ CALL PUGH PO"""EA FOR UNDERGROUND LOCATION ASSIST ANCE, P~fONE: THIS SKETCI~ IS NOT TO BE RELIED UPON FOR EXACT LOCATION OF PQWEA FACILITIES SCALE: 1":.=o.;S:CO' PQ$ET POJI'ER WORK SKETCH DATE 2:. ;' W / t?s..('~l JOINT fACILITIES AROANGEMENTS _ OTHER UTlL lABOR HEPORT1NO DATA JFCNO, OTHER UTILITY ENGINEEl1 POLES, aUYS & fDr.TUFlES CONQUCTORS, OROUNOS /I. RODS TRA.t'lS.... TRANSM U G CONDUIT U G CONDlJCTORS, GROUNDS & ~ODS JFCI"Q, OTH~A UTILITY SERVICES 1flANSFORMERS ENGINEER 'tt::r~., (,UVI$ION I COUN, Y I! SlOA(3 REf, NO 1.0c:2JTC1c.U 1__.:t..fi'O'?":':WV I .1 AET IkEM~NT ..IOU NO PLA.NT rCIRCI.E-ONE) 015T (^": olsi-"'l ; Ol:)t.' ("'0151) DrST ( ?l.~ JOBNO 8'1<,)/334 RESP. AREA N -.J SHEET \ OF, e::. TYPE or WO~I( OPERA TlON MAIf\jTEN"NCE IlETIHEMEIlIT C{lNSTRUCflOfl >< :x- X 'X nTLE ~;;;Pt. -il~..s, _. 1.\6 pel. c:x..T. PHf.'>5t:..I :j:.,.,i1;.. 1-:,) '.l LOCATION PA.l(~;-...r.:) I :::)C. ~:,A'y \ct::. - PTL "NG'N'.Dr~~ I APiRj]'~'. I~~~~:,;~:-_~ "''J I,QA."A,mSIGNATUAE JOSq 0 \ ~.3.:.1~ ~\() " rq"i-n> ...ji"-rr, Co, H::K:1n i:t ()H -if,;!::' -~I.f~:\ .<~ OA TF. COM? I U-MAP NO . j C.IRCUIT NO '2 '3 j E'INi 1"'lL.. - I (., ~J:iI.":t,1li:~~~~Jlltll1'l IIIl~AA__':~~;: L .. I, ", . .' .' " ; . ..' ..',' : . ..,. '.' ......., ' . ..,,,: ..: . '.:. '. . . '. '. .... .... , . '..:.,;. . . .. :-'.,: :' '.:' : .'. . .... ....... .... '.' . ....,' ..:' . 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Xf;: ~ .q" I~ :i-n t...... --'., :u ~.)~" ""Q ,;ij ::r gJ. >J ~ ~ -D .:J . ,-, :...~.._.-...;..----_..,~~~._,'-........~.."':'- .. . "'" 'j .' '. '. ". '. .; ..' ,. ''',,:' . ~' ..... .. : .... . ............ ....., ... .: ". . . " . c c. ;,' ...... ., .... :. i.. . '.. '.' ;........ ....... I" .., '. ".' ': .:' .. . '. .... . '. . i<r '. I' . .'.. :" ,: ..: I . .' . . I ~ '.: . .... . '': . 'i:';:}:i c': '..;:.\,;1:.. " ".:i>:::.\:i<. !X>p~ . .;. 1\ . II"~." '. i: I{ ... , > .. ....:. ':: r \. 1\ \. ': i '.' .. : I. ';. .' .:. .....: ..' .. '. :,,: " .'" ..': : , . '. " ..'.'. '." ..... " , " . , . , . ": .'., '. .... ',' . .: ' " ,::: . " " :, p ..' . '.. ;": " :, " :: '.:,.;.'.: .. " ,:, :'., .':,,' , I ,', , ' " .:.. ':.' ,:,'''' .'..' . ..:'':,' , ... :' : , " " . ':" ..JEFFERSCH a;)U-4:TY CEPAR'l1roE:NT OF PUBLIC WORKS FILE ~'i \ 3 b 9 ~"" , "',.'",J'.' >. . : I ,'" . 'I ..., ';; .,."........y~~~: . : :. ' " : ' ".: ' .',,:: ' '. '.,' , : ,. " , :'" '. : .' ."." : DATE- <-I- /'i-g9 79'1- 6's-~z.. ~ ", t ~' I t f I ACTI ON REQUEST """'-"STED BY. ~CK GI!..e.eNWflL..-r ADIlRESS. P.O. Box 26(, PHONE NO. - /1/InAJf<-o<f:. vv/1 9&<.-'z... ALT, PH. NO.- NATUE: OF REQUEST. 0---;;' PERSC::Wi 0 BY PHa'IE 0 BY LElTER TAKEN BY. "5 !<-. PERrA.HING "10- o OFFICE DENG/sURVEY ~ MAINT. o EQUIP. MAINT. o SOLID WASTE REQUEST FOR. \)R-.,'hlA9c? .w"'~K.... / ~O7' / /i3'vS.4L..L.. S"f/ORr- pI4r , / LOCATICfi. ROAD NAIoE TeFFt:"e.~ON A-tlE ROAD NL.MBER M.P. PRCUECT.. PRO.JECT TITLE FJROJECT NLMBER. DESCRIPTICW- /9 FeN Ve~ rIJ b MJ~_ c./2e~,A./ 1LJ,q...."J- wrr..5 ?V~ 0 7'r> .90 ~./'h> ANt:> Blo~/< <:"G4Lv€R.... r'Jl<l4-tN,....A/O ~N"i""n ht..s j)R(t,r~eJ?:ry' ON :JerP"R"'^..J A-//E. t' k'fJ.s",c'-- :S/lom- D/4r 4:'" - ""'-so 0/.....: ", '1>~;"Cli rJiZ;!c'r /=) H"-_ ,!)e..:r'-'lR-IV~I::> * s,"q;rr R~c:eNrL..e.., ANn 1")7".sCGlv~~eDAN02LV C4/vc:1?r " I h~ Be.eN ';N..s~L..~el~ 6'O~ /IJ,'.-v<j PRri-;^,;"'jq~ CJ,,/7rj hj~ L..o'l" -/?-Q,c;;;"J , (/ # P,q..'WJ;!:....HL.. ;?,,2A-o',A/A-Je ~.ID€.rl-""/~_~ ~ li'e..... -.9..J ~~ vve...sr- .:S,"-De.... ~ TI2 I=Fe12.5 4~ ,4.;.J 6. H2-;4-r.,~".-}f' ~ -r-J...e /VA R'r?-I- ",..' ':::, : '.' ':, , ;"'. , ", ,,' ",,,, ' ,;,: ...~ '''. ATTAOf NAP eft SKETa-t REF'ER TO. ~ &. ---- / RESI""CWD BY. RESPQtlSE . ;7 i/// /<'i/ II 11/)7//".'/" 1<; A',' I ~t:-,,'(I 1"",1 ," /1<) .- (;;.#;0_;7 ,.,' REVIEWED BY. k-::f; 1/ pt-:/;{('7"/ -;B;;~/tt~,,/t___< DATE- ;/-.;:2'/ ac:HrACTED REQl.ESTER O~ IN PERSON ? BY PHONE 0 BY' LETTER CXJNTACTED BY, RECCMoENDATlON- f/0; &/....l~ A-I { wt'/.,N'--;' <,/1 . I .. ,. . ,'''",,''.' ~ -- , - d - ',: , ",' . . ," PREPARE EST I NAn:. FaO. ROUTE TO- INITIAL 0 D I RECTCIR - 0 CONSTRUCTION ENG. - 0 ACQ)l.I'tITANT 0 ASSIBTNn' D'R. - 0 PI.NIINING ENGINEER _ 0 0 ROAD SlF'ERV I SOR - 0 ADMIN. ASSISTANT - 0 . C" ''', " , :,~";, .'. ,i .,';. " ,.., ,: ' " ...... ,,'.. " ""." ,. ..' ';,'":,,,.,,",,' '.,'. ", ,". " .' , ''';.'' .,.... ", ..,' '::'" "'" " . ,.."" ..'.: , '.....', '. :. ..".."... I,. .....,' ',' '~"" "'," , : ".. 'J\~i':j, ...." " '/'>;:;.;., .. ...,.,.... . " ':'. . -1:: , :..' , L >. .... ..... .,.,.... ." i.. ..' .'. . ...... . :". .... ..,) , .." , C(:;~TY- ROAD NO.~ . ..... .-S1ATE LOG NO. MILE POST ~ LT. OFFICE USE ONLY Ii' ..... .. .....'. '.' . ". '., .... .:. ,". . ;....:' :< t i; rr l' ~t: I '/ '.( .:.', j"-' ,..:::/ C ;. L ~~ 1 t, .,: ',. t ( - .~:; . . c,' . ...... . .': f .' : ',".," [ '.." . ... .. . " .', ',~.. I .. . '.' I.".... ....,:.;',.... .... "'. .."..' "'. '. ',',,' .. ;:,,',." " " . .... " '.: . I: PERMIT NO. '8''O-'t-I'='~.:l.... FEE PAID ~s ___No OFFICE USE ONLY JEFFERSON COUNTY DEPARTMENT OF PUBLIC WORKS Jefferson County Courthouse Port Townsend, WA 98368 .i' .e>', CHgCK ONE: C2J RESIDENTIAL APPLICATION FOR ROAD APPROACH o COMMERCIAL Application is he~by made for a pe~it to construct, operate and maintain a road approach. Please describe loaction (attach map or drawing) .3~;> /1- 'P /J-/? /I JJ l:'i ~-- ,Is /f "1 P,:, A 11 74tip//c<u,;f- '-'/:/1 {:"LrJ <-Ie S'e;;/- (,_ O.M},11,~'-h"<f.,j- .Iv mu_-t- '-""0,-<-1. ~ V << Applicant agrees to perform the work in strict complia~ce with the terms and conditions set out herein, and any special provisions attached hereto. Applicant Name >-7 lV'h J)rDE.lf'r-p Contractor Name $,",,- r . Address L( / /) 1>./ If ~/I-<: fo/. .1JR I ~<: Address '}J;:;I?T /. 1.11") L M,) I.(j /I- 9 J'..J'0.j .>'./l,pplic!"l't pignature()A,,;A J ~J0r Pl_/ Date '</fll {% f? ,~HbNE Z!.:;'7-,.Jl/rG,Y 4 I _ - -/ - Note: Indemni ty provisions of paragraph. 2 and 3 on reverse side. Contractor Signature Date I! PHONE PER M I T &~~lUJ- .. :: , , subject to the terms and conditions on the reverse side, PERMISSION IS HEREBY GRANTED to Applicant to construct, operate and malntain a road approach as requested above, and any special provisions attached hereto. No work shall be done under this permit until the applicant or contrac~orhas notified , telephone ..y APPROVED BY: --<J./ ~ K.:12.-.-:Lt Date ?f -12. -Bt5 " ., PERMIT INSPECTION REPORT ~Work covered by permit has been completed ------- satisfactorily. _______work is not completed. . ______Recommend permit be cancelled. ______Traffic control - adequate inadequate________ I:' I I CALL 48 HOURS BEFORE YOU DIG 1-800-562-6478 REMARKS INSPECTED BY';:~ '.:, " ,,' DATE 5'- OOr I Form 113-0 (RevA 2'Jl2>' 'I :' . .,':. ", .....:. . " " .'. '.....:. . ....... .... .: :.. .......'... :::' .;.' .......... .,: " .' " .'<: :. :. . < .".....,'..'" ,:,<1 . 1\:.'," . I". . ". . .', j ". '.:.' .' '" . ": . !:.' :". ........' ': :' .,.....' [, .... I: .: ': ">, :....... .. :,.' . ':'" ," ',' <'.' '., .'. ". > ,". '. .... ,.':'.,':.: ' ...:...., . "" ":.' """'" ':". .. I .'" '.', ,.., """, .,,: . ....... ...'. . '. : '. ..,' '. '" ", .., . .':' ',' '.' '. '; : ."':.. :.' '" I, ' - '. . . , '.:: ......., " :' ..." /' GENERAL PROVISIONS 1. THIS PERMIT IS SUBJECT TO ROI 36,75,}30, .140 AND .150 AND AMENDMENTS THERETO. 2. ~~~I ~~~Nl~~io~~S a~ugi~~~~s o~~y~~;1 ~7~D ~~E~~S~~ I ~~~~~C~Ht~~f~~O:C~~:JT;OA~~ :~V~U:~E=:~M~~S~N~R~~R;~~, ~~R~~~~AL~:T ~~~~E~~Y C:~E R~~O~u ~~ ~~E A~~~~~R~N~~O~~H~HXGi~~~T w~~~, cg~~~c~~: g~~~R l~~~ I ~~Egu~R O~:E:y REASON OF ANY OF THE ABOVE CAUSES, THE PETITIONER, ITS SUCCESSORS OR ASSIGNS WilL, UPON NOTICE OF COI'\HENCE- ME NT Of SUCH ACTION, DEFEND THE SAME AT ITS SOLE EXPENSE AND SATISfY MY JUDGEMENT ARISING THEREFROM IF DETERMINED ADYERSE TO JEffERSON COUNTY. 3. IF THE GRANTEE ENTERS INTO A CONTRACT OR AGREEMENT WIlH A THIRD PARTY TO PERfORM THE WORK AUTHORIZED ~~D~~~ ~ f~~R~~lD ~~Ml~~:D ~~R~~FE:~ ~H~A~~U~~Y T~~ ~g~~Ag~~~ I ~7 T~O~H~T~Rge7~~~~ ~:T~A~:~1~~'2~G:~~~E ~O 4. ~Y T~~~A~~R~~ T";~ ~~N1~~ ~:~{~~g~~~N~o~~Q~~:~n~~~~ ~~;~:= OOD~Ay~R s~ttU:5B~C~H~H~~R~E~~I~H~O G~:U~_ LATlON AS HEREIN PROYIDED. 5. DURING THE CONSTRUCTION Of THE FACILITY, THE GRANTEE SHALL COMPLY WI-TH THE &lilJAI ON UNIFORM TRAFFIC CONTROL DEVICES FOR STRFFTS AND HIGHWAYS PUBLISHED BY THE U.S. DEPARTKENT OF TRANSPORTATION. 6. ON COMPLETION OF SAID WORK HEREIN CONTEKPLATED, ALL RUBBISH AND DEBRIS SHALL BE IHMEDIATElY REMOVED AND THE ROADWAY AND ROADSIDE SHALL BE LEFT HEAT AND PRESENTABLE AND SATISfACTORY TO THE COUNTY. 7. THE COUNTY RESERVES THE RIGHT TO ORDER THE CHANGE OF LOCATION OR THe ROtOVAL OF AHY STRUCTURE OR STRUCTURES AUTHORIZED BY THIS PERMIT AT ANY TIME, SAID CHANGE OR REMOVAL TO BE KADE AT SOI.E EXPENSE Of THE PARTY OR PARTIES TO WHOI1 THIS PERI1IT IS ISSUED, OR THEIR SUCCESSORS AND ASSIGNS. 8. ~~~ ~~~~T C~~~~~~ER~~r;I~:fr~~N O~RT~~Lgg~~{~'i S B~O~~E A~~A~~~~E~~~LC~~N~~~Hl~L S~H N~ ~~~E:EA~E~~Ltl~~~~E FOR ANY DAMAGE TO THE GRANTEE BY REASON OF ANY SUCH WORK BY JEFFERSON COUNTY" ITS AGENTS OR REPRESENTATIVES, OR BY THE EXERCISE OF ANY RIGHTS BY THE COUNTY UPON ROADS" STREETS, PUBLIC PLACES OR STRUCTURES IN QUESTION. 9. THE GRANTEE SHALL NOTIFY THE COUNTY'S REPRESENTATIVE UPON COMPLETION OF THE WORK UHDER THIS PERMIT SO THAT A fiNAL INSPECTJOH CAN BY I'VJIE. 01. [;]2. .'.,::::J", Ii SPECIAL PROVISIONS : " : .;.,:,~p.~~I\!~I:\\, APPLICABLE PROVISIONS ARE DENOTED BY AN (Xl A COPY OF ~THE' ,P.iJERMIT IIAI..L BE OH THE JOB SITE, AND PROTE~TED FRO" THE ELEMENTS, AT ALL TI"ES DURING THE CONS'TRUCTlOH 'A THdRI ED' BY SAID PERMIT WITHiN THE COUNTY S RiGHT-Of-WAY. THE APPROACH SHALL BE CONSTRUCTED IN ACCORDANCE NITH THE ATTACHED DESIGN PLATE TYPE P - J APPROACH., 'So FT.lENGTH OF J 7__ INCH DIAMETER CULYERT PIPE SHALL BE PLACED IN DITCH AND LAID TO A TRUE LINE AND GRADE. THE APPROACH SHALL BE SURFACED TO THE LIMITS AS SHOWN ON ~~~E~~~G ~~ ~~~f~~~D:A~~R T~~o~p;:~e~~E S~~~~E=~Y I~N~gC~~~~~~E R~~~~_~~~W:~O:: t~ ~g;T:~L P~I1I~~E~~AH. THE APPROACH SHALL BE SUFFICIENTLY SURFACED BACK AN ADEQUATE DISTANCE FROM THE EDGE OF THE PAVEMENT TO PREVENT MY I1UD TRACKING ONTO THE COUNTY ROAD. AAY MUD TRACKED ONTO THE COUNTY ROAD SHALL BE IMMEDIATELY CLEANED UP BY THE GRANTEE OR HIS AGENT. (3"'3. ~. IF NECESSARY TO INCREASE SiGHT DISTANCE, STUMPS AND BRUSH SHAll BE REMOVED FROM BOTH SIDES OF THE APPROACH. TttE INDISCRIMINATE CUTTING Of MERCHANTABLE TIMBER OR DISFIGURING OF ANY FEATURE OF SCENIC YALUE SHALL NOT BE PERMITTED ON COUNTY ROAD RIGHT-Of-WAY. 5. WORK SHALL, BE RESTRICTED TO THE HOURS BETWEEN 9:ooA,M. AND ~:OOP.H; UNLESS OTHERWISE AUTHORIZED BY THE ENGINEER. 6. A SURETY BOND IN THE AMOUNT OF $ , WRITTEN BY A SURETY COMPANY AUTHORIZED TO 00 BUSINESS IN THE STATE OF WASHINGTON, SHALL BE FURNISHED TO INSURE COHPLlANCE WITH ANY AND ALL OF THE TERMS AND CONDITIONS OF THIS PERMIT AND SHALL REMAIN IN fORCE tJHIL ALL WORK ~DER THIS PERMIT HAS BEEN COMPLETED AND APPROVED BY THE COUNTy, BEFORE AIiY LOG HAULING OPERATIONS BEGIN, A SURETY BOND IN THE AMOUNT OF '_ . SHALL BE fURNISHED BY THE GRANTEE TO PROTECT THE COUNTY AGAINST ANY DAMAGE TO THE COUNTY ROAD AND TO INSURE COMPLETE REHCVAL OF THE APPROACH AND CLEAIiING UP OF THE RIGHT-OF-WAY TO THE SATISFACTION Of THE COUNTY. APPROVAL Of ALL CLEAN UP WORK SHALL BE SECURED BEFORE THE BOND WILL BE RELEASED. SPECIAL CaNSIDERATlONS AfP\il'......,~ ~H-I4-t...L ~/~~ At...QP~ ,R.'E:'les 1--b ~-e 'Sb""'''r14 (".)C DROft\~C-\"" .A.f"1::>i<i1AC.''''' ~ ,."e~'r- .....-J.~.'^"''''''-\M <';-~J.J.'" D"\~-r-J..,Nc.e... K.~2..V.iQ~MPN't-c.... o o 07. ~. Form 113 b r" .'~ .. Ed". ., ~hould., . ., .,-. J '" . . -.-.. - - ... ... - .~.'~~~':t: t:.:~ ~.~~_~.~ . T~:3_~~-::~ :. .~, -. ~"-'--'1-";--;~-. ..' ... .-..- n' "_'" . ... . _ . ,~,~",:.-.~~::,:,., ~. ':.: .'~:.r.f.:. T~-:::~-;~:::,:~:~:::';:;~i.. --. r;"~ :~~':':: ':" --'r~..;~ ~ :,-.7~~-: i::"~~:T~:~~~~'+ ~-.~:.,~.: ':,:~l ~.;:j.: .=~:-=l.~: -~. ~-;~.~ ': l:~,~-::" :..':- -:~: :..'~ . j : /~.: j: ___r_,d" . i . . to'nun. -- . lO'm...Rr.~'I'lI.g "'1I.h-:..~ ~ i .. , I . , .- ~. ; '-'.-.-- ..'... . .-..- .....'. Var... .. .:: ' 1" .".- ....-,-.. .. --'t. . - ...-.--.-.-. . .... . {. . . I -- - -'. ... - ! : :':. : f'~. , ~.;,_ 'j.I-._.'~'.:,r"~..,"..:..~.~~..'[,_;.,:'_.f_-.i-..~...t.~_.;. '.n.__ ~._: ~.: .~. -:~~:.,:r.~_7.~.:r-.:. ~~:.:t.~:: -...~~_::.~_:, ~~ ~ .~:.:~ c~:t~;:~~f l;l~~l-. .~ -, ,',' - =- d t.~';,.:-l - :..:-:-:-i:,:,::-:-:':~~_:::'::,:'::.'::5~-=;~::l.:. -ji~#1~Jfl~fi~#~~ ~!t~~;;"";:i/ _:~;::,~~::~:~;,-,;:: t . POSTED SIGHT DISTANCE r SPEED LIMIT. MINIMUM DESIREABLE >-'- .1_~ f~.; 'fiOTES: 1.) Culvert shall .eet ainillum specifications 'Eor HS-20 loading. Approved types include: 1) concrete 2) corrugated .etal 3) corrugated polyethylene tubi.ng-AASHTO f.J~)', County road shoulder shall be left at existing profile. 25 50 55 40 45 SO 160 Fr. 200 Fr. 240 Fr. 275 Fr. . 515 Fr. 550 Fr. 200 Fr. 240 Fr. 275 Fr. 550 FT. 410 FT. 475 FT. 2.) APPROVALS: t Director, Department A /J g of Public Works ..If/ ~ Eo<. -CD<...<- a9k~ Chairman, Board of County Commissioner" , <. . AI. ../ Date 9A.k.? Date9~f3 "FO';;'1i3':c'~. ;.1 .. ~.. ". it li 1 ,. , l t. ~;, : .. {...,. ,t. ~ . l. l: ' 1;: r \., , 1 , I, !' , :; ,\'",' I.' ' ,'. ,'. ",', '," , ': Fat/liP ceNGReTE I'fONPM~NT IN CASE ',.. v /' , Il , :~ SCALE IN FUT r=/oo' I o SO 100 .'. " '"' ,,,,.'\ \' ~..~t'11' , _ . 'I, \ r~~ j..(I, \'l\~:~ 1":"'\"'\ \\ \", "~\.<k\~,r}.'\i~ ~'~~~~~~~l~~~"~ .~tJ~ru AS' 'IS OF THIS PERMIT. 7#E , FeR A MA)(IMlIM OF 'fW0 '. FaR .sEI.</A&,e PIS~SAL NEI? .seWAt:E PIS,lJo~,A./", . .5BBo+8"36--t: 335.96 .22.'2.3.,.j'J I ~0'1 305, 'J6 ;;A.~ t:::..FOI/HD COPGRETl nOIlPHEIIT I 1 , ';.i;;'{' I N 7+0 3S'W, 0.30 10- ,.". ,.J~" \", .~ 0 I Fllon 1981 POSIT '- '" ,., ;''':r\ \" "J'l Po' o~. I .....v 10: '..J.. 'f r " ,.. q) ...:!';~( , ~ '8 I.... N6,~;\::":z.6"E N8S'O;z.".,,"W ~ ~ I o 1/7'0.95 I.n. I ,....,. i:i:; ~ y~ 5 S80 -9-8' 53" E ..............' J'TJ1+ 310.13 g ~ X 0" It. \ f.." "0 ... ~ ~ : c.~ i.". ..", r'" ,..--:~ [\ ~~ I:> III ,. )> I~ III \:) ~ ~ . 00 ~ I'{ _ III . 0 . C>;; ~~ ,\-0 c) ~ 30 30 ~ ~ 0 \n _ ,~ ~ "''\-.... ~ ~ /60.2..... " I~ N88"+8"S3"'E -' 00' 1-- I \ _ 6S & 0';, 01 ~(,'P- ,1 \ ~ ... \.. q ,1 ')","J Db O. "I ~... 'l-~' .,~ ..J '4 ~. \') ?o\ tl fJ')' !:)) ~. ):> , '<' '" .... I 200 ("\ o ~~ o 0 .... 0- o ~ "" 1);1 v-f-'J oj- 01 ~c.. ~ bJt.\ \. oz." 0, .~ :r" ,\0. -.i \S' <:SIp ~ "''''. ''''.t CS"'o " 1'l. .c ... ~ ~. "';,.. ~<l. <'"..t;. ~~"" . _ fJ!:c"D- 0....'1 fitp- LJ.:; 2f ~ peRloo OP F"lVE (r>) Ye"AR$ I ,) AREAS HAY C ~ 5>,.srEI'fS AM '~~ o$'.r'fl,. ~ ~ i-.... o">'/.s~ I .......:-!:! <!? -........ ~ -........ ... ........./ '/'" '. ..' ,... '.' '. . ..' .' ": ". .' ....., ."'.....: ....,:..'.'.. .' . ;', . . " ~ . " :'. " ,,' ','. .., ":'.: .. '.' .' ....,:' . ...'....., '. . ".": C:' . ': .. " '. '.,-'. . '. . .,.~, , '. .:. ,c,' '. c,. , .. .'." . ..: .... I . '--.J<':.:' " '.,:".': .:., .-':' re . . . 'i,?! ':. ". ,". """"'..,.., ""';" ,,:......, " .'., ,,' . .': ,. '. .' ......... . , ':. ',,: '..' ' :,: '.. ,,' . "'.' . '. ,-"',.' . :..>" ..,'. ': " ',",,',.'- . . ,:.., . .: I.' .>.' ..' .:'L- " '. .,' ',. ... .' :':.,,: .".' . l"n '. ,.~.' :'L.... .. , '.., -;:- . .' " . ,.' <-""'> . .' '".:'" :,'.' ",.' '. I..' . :..' ',>: ''-'''.':'' " '. . '......,..:. . ,".:', ~ ~ ~ lr- () I.l" 0'1 ;t ~ ~ ~ .; I:> N . Q Q ~ , . 0- ... o "" N l1li . CO'I~fY ROAD NO.,~.;'&~9:,'l ~E LOG NO.___ MILE POST "'00 TO "..3 _t!k.9A- -A~~__ OFFICE USE ONLY. JEFFERSON COUNTY DEPARTMENT OF PUULI C \~ORKS PERHlT NO $.g-S-G- I FHANCIIISE tio-.------- FEE PAID __Yes _ riC OFFICE USE ONLY Jefferson County Courthouse Port lov/llsenu, HA 9836B APPLI CA TI ON FOR /IiSTALLAEQ!L.9i-Yll!J.Il ES Name and Address of Applicant: Pacific Northwest Bell 611 6th S'treet, Ba~.n!~Di:.__ ' ___~~mi!.l:.t..()D,I...J-IE_~L___,________,_______,_ _" AplJlication is hereby made for a permit to construct, operate and maintain_burie~_,!!>~___ along East and West Haple. ( Please see attached sketch) The utility installation is located (attach map or drawing)__..E!~.:;:t~we~t~.a2]_IO___,__ AIJp1icant agrees to perform the work in strict comp1iilnce with the terms and conditions set out herein, and states that Applicant has read and will adhere to the general provi- s ions set out 011 the l"everse side of Lllis form and any special provisions attached hereto. Appl i cant Signa ture: ~eJ:J:uU;om.sj;,o.ck.....l2.0_6J_4ZB=-5.6B8__ Date :--ApJ:.LL3~..J.9~ Port Ludlow R.O. 88-7-9180 / / / / / / / / / / / / / / / / / / / / / / / / / / / I 1// P E R....!'L.L:J:. 1//&- Subject to the following"terms and conditions, PERHISSION IS HEREBY GRANTED to Applicant to construct, operate and maintain utility facilities as requested above. Thi s permit is condi tioned upon Appl icant' 5 compl iance wi th Jefferson County Ordi nance 2-81 and WAC 136-40, including amendments thereto, the general provisions set out on the reverse side of this form and any special provisions attached hereto. No work shall be done under this permit until the Appl icant has l"eceived instl"uctions to proceed from , telephone APPROVED BY:_.L.Lud:t----.:~ Date: 5--5-88 -4=: See spec.'fiL j:>ROV: s. ONS 0,..1 Reueese I / 1// / I I / / L/ / / / / / / / I I / / / / / I / / I / I PERHIT INSPECTION REPORT UTILITY DAMAGE IS COSTLY. IWork CAll 48 HOURS BEFORE YOU DIG 1-800-562 ~478 covered by pennit has been completed satisfactorily. Hork is not completed. Recommend pel"mit be cancelled. _ Traffic control_adequate; _inadequate. R[HARKS: INSPECTED BY:~{~ Date: ,-e-1$7 Gener.l Prowl"lon" ;:ocr Jd'fa:(loOIl County Oruh.. ..0: 2.ijl "nd 'MAC 1J1".4U. 1. All ..ork dOllt: under uld tr41lctlllol! ~lhlll lIo: l.lon~ III d tll1J'-OU'J11 "lid "O/'~In"lill~~ m4nhl'r, In till' l"ylnlJ of ufl(ll'''9/'ouru~ 11l1J00I\lll'~ .,!ld '4111o:~ U\.: com,tructtoll uf otlicr roloctlttll'~ lULU HIt: Ollclltntj of lrcn(he~, tIll' tUllm:lirhl UrIlle" county ro.uh. "llJ!jl~'of...ot or ollll't' ~u""tt \!(I,)I!l'lllc~. tl,,," ~hdll le.wl' such tn..tlCI'It~. dlt(llt:s 4nd lun.u:h in ~uCh 4 Io<lY 4~ lu IlltC"'C"c .l~ llltlt:"~ PO~';tillll' ..lth !'ulJllc l""..:1 J'''' :.1l"ll l4kt" 411 0"0: ~~~~~,:: r~/~~~~~ ~ ~ 0~~1! t~ l' i~. ~~l',~rl: t,~~I:\~11 ~~ ~::~ llJ ~.::'~~~ ~~o; \IJ~;' ~c~II~~ :'nr:~~ ~~~J::~~ O:I\~ I' ~~:-r ~~.~~~ :.~'; ~~'~IU~ II I':~~~; o~n~ ~ ,,~~' ~,:~~ 1 . ~:4~~~~ :::::~ ::~ ';t ~ j !ouCh ..ork. The lJrolontt"l: !olldll I.ll' 1141.l1t: 1'01 <lilY IrI~lJ"t tu po:r~l.i" or pcr~(,),,~ or ddnl<l')C to 1!/'oj.ll'I'lt ~u':tt41"t:U lhrOul)" 'u c41\.IIt~!.lLc~'> or /l..(;le(~. or through 411)' f41lurt: or I1cg It:ct to proPltrly ':IudI'd 0" '.l I...t: "'''fnl11lj 01 dllj trl'lIchl'~. (]1 tclil'~ or tunnl' I '> du'.l or mol Int. 1/'t:,,) /)1 till" '.I"Olltet:, 2. rh~ ljr4ntee, its !.UCtcs,>ors 01' U,>I'JlllO, ,>11<111 CQlllhl,"ncC (;on~tructlol1 OIl(tCf' ~uch \,l"lldt ~Ir~r'tcd lIy U\I.' County llllJIIlt'Cr '"Illll" lI'c tl~lI,' tll'rlod \lotl''' in ,>uch ptlrm;t .mJ sh411 114...1' COIlllJlctt:d 4nd Ii"'...c III ul't:rdthlll ,>uell purtlon of lIn: '>l~tl'm of IIl'l'!lJ"'elllcllt~ cl~ nl<lllJ... ~l>o:C'l'lo:lJ In ~I,/(Ij j..'c""lt or the rllJhtS thllre1tl conferrcd upon the !}r4ntllll '>h411 CtHe f,n(] tcrl1dnoloL~ ill':toI4r,,~ ulloccuph:d :.trcl't\, rOdiJ~, etc" drc tt"'ll!("'e<J. J. The grtntt:e )h4111c4Vl' ,,11 '>lrCllt'>, 4...t:IlUC'>, <llll'Y~, r(,)"d,> , /il'lll"dj':t, rH)ht).o(."<lY dn.:l Otlll'/' coullLj IlfUl.'l'ltll''>, 4fl..r 14yI1I9 Ilnd ln~t.ll1l1lJ main,> .nLl Lloll19 Construction wllrk, 1114kln9 rl:poir':t to cqull_llellt, ctc" In 4~ 1]0u.:I "n.! :.dflt conllltlOJl In oil rl'~lJl'ct\ ,:. thl'l Wl,"I'C lIlttOft: 0'0: c;UllI,jCncl" "lent of hlell work by thc <)rdlltCt', It'> <l<)t:nt,> or ('O!ltf'<IctOrlO, ,nd 411 rceordl:d 1I10flUlnellt~ ..tllC;h II'HIt 1.l1:t:lllJl~tu"lJI'O or lJi~IlI<lcl:d bj tt,l' wor.. snolll toe rnct to the SPl:c1flcolotloIlS 4nd 4Ppro...41 of till' County [n<)llll'cr. 4. In Colse of 4n)' do1l114gC to s..td :.t,.cet,>, 4...t:IlIJCIO, dl1eys, I'odd~, h\lIIl..<lY!., r!9ht:..of''''dt 01' (.th~r ClIuuty prolll'l'tllt:'. or to 1'4~o:d or \urldCt:" I'(,)od- ~4y,>, turl1.outs. l,luttt:r\, djtcht:~, ljl)od or conc;i'CU~ wdll;!., drill" 1J1\.11'~, hdnu or t:'lllldrl~mo:nt r411~, lJrjdgl'~, lre~tlc:', ..tI4r~t.':', l.fHlln9'> or '11O'''..Il\t:ntlO III the lJrolontee. tht! Silld '.1rdntce 09ru'.. tu I'cp41,. :.uch d4111d<)1' H tht! c4r1ic~tl!Plc llo'>:'llJlc <It lt~ own (oH 0.1".:1 c.\.It'!l~e, 5, \.lh~n the: County [nglnct:r dlltcmlntls thdt i1n clllcrl)t:ncy sllUdt10n dOt:~ C.l.l!ol, ht: moll order d'lll h....!;! done <lily .l1d ,ill ..url; cun'l.ldltrcd I1I.'CI'\.~.rJ to reuore to d s.fc cundit;on <In)' :.uch ,>tret:t, ilyt:nUt:, olo\lCY, rOdd. 10I<)11"4Y. d<)!lt.ul.,j4Y or oth~,. COUllty !iropcl'tj 1e1l toy tile '.lr.nte~ ur <Jl)l'nt~ '11 d condition ddngerous to Itflt or propc"L)'. fll' nldY C<luSt: to lJc fe!ildCcd or fC!ot:t rcciJrdl'll monumo:nt'> If . Ij,'dtllee I.il~ tv rt:plolCe or rt'~ct ...lu.... ,"Ithln ol rl.'.sondblt: tilOt: 4ftt!r clllllplt:tton of construction, The ljrdnlt)c, UlJun llel1ldnd, ~1l<,\ll 1'41 tu tful county ,Ill co~t!. of such conH,'uCllUf' iJr ro:..",lr "nO of doing such work. 6" All constructton or instdll.tton 01 m411\'> , vil1\1eS, pipes. poll.:~, ccllJlc~. ltnc~ filthll) 4nd fddlllic!., so:rvlce, r.ep.dr, or (t'IOCdtlOIl ,,' lhe ume, p~rfonru:d .lon,::, ov!.'r dnd/ur undcr' thc CUUllty r04dS, r1ljtlt\.Of.WilY Or otller county propt:"lie~ ~lJlljcet t(,) ':t41d ffdllC.hhc SI'olll bt: dOllc In :.",CII 1 molotlner.s not to inte,'fcrc with the con,>tructlulI, U!ll'rotlon dJld mointcn<lncc (,)( other' utlljllc~, IJul.dh: or pr'l'Jdtc, Ilr.llin~, Or<llnd!lc dltCht:\. d"d structures 10Colotcd thCI'eln, nor ..il.h till' 9"ildll\':I 0" In'pro"'clI\t~lIt of :'1.1(11 count)' rlJ",d~, '"l!lht\..of~".y (,)l' utlll!r county IH'ol't:rtl~,>. 1. The ownt:n (,)f 411 othl'r utllit!t:~, publIc 0'" 11f'l"'dte, 111,>tdllcd In :.uch eOl.llLty rOdd,>, rl(jht!o.ut'....oly or utllcr coullly prol'l.'rtic,> prior 111 tln.c to HII' l1ne5 4f1d f4Cllltlt:5 of till: fJrdntei!' S114]J tldV1-' prcfl.'rl:ll(tl d!. tu thc J!o~1t1on dllLlluc/ltloll uf ,>uelll/tilHI!!,> !.Il lll:.t<lllt:d ..1th re:.peet lO tI,e grdntec" Such prt!ft:rcncc sh411 continue 111 thc cvent. of thc nccc:.stt)' of rcl(,)ect.llI<) Or Clhlll(jln<) lht: 'JI'.dc ut' dnl SuCh COulltl 1'041$ ur rI<Jh(.at.,,<t.f" 8. Tilt: guntee. 4S hI' 's j.lr.ctlC4I.lIt:, !./Jd11 cOMt"uet IIC" ut11;ty fdCl1\tll'~ ul"ICfllfllund, [.o;tt:nlOlon of o~trht:.d fd..:llltll':' fo110..109 stret:t~, 4Wllnucs, WdYS. tloult:v/ll'lh or thoroulJhfllrcs ,>h,)l1 bt: undl.',.t.~clI uldy ..lth tilt: .PIH>o~41 of the Count)' [nl)lnecr~ 1'110'110[0, Ioowltvcr, tliot Solid dljP,'u~.l shllll not bt! unreolsondbly ..lthht:ld, (jrdlltt:C sh.ll convert l'...!~ti"q o~crhl!dd 14CilltlClO 1.0 UlH.lc"lrOulld hct1nlc,> .s dlld whllll equ;poucnt reIl1"C"Il,enl Is undt!rUkcn, or ..hen othl'l' cAlstlng o...t:rllt:4d utl1itilt!. dre p1dCt:d ullLlt:rl)(('Ulld, Willes:. '>uch rClllolCltlllCnt IS un~olofll, !nvr.CtlCdl, or ceonuflllccl'y unrI'4100n4t.ltl. Line e...ttn:'10n poli(lcs 4nd procedurelO cstdllllsllcd uy thc Cjr'oI11lI!C, "fld unllonn11 4pplll'd throu<)h ItlO !.t:l'vlclt dre., !.h.11 be tt..: sundolrd In detcnnlnlng wh4t Is "pr/lcticdl, Impr4ctlcdl or ccol1ollllcally Ur\r"e4so".ull''' under tlrlS ordjnolllct:; prClvidt!d th<lt no Ill'''' Owt!fllt:old util1ty hcll1tlt:s sIl.1I be constructed 01' t!sub1lshed 1n <lilY dreil ,>ct Hide for public p.rk, sctlOol. p!6yl,JrOund or IIthl11ttC field purpo\t!s. 9. Specl41 PrO\l1"ioflS: 'J. /CI"Nvv.-;fs -roi<. eRe :;':;;;N9:;, '5tiI"1LL i3 e ?'rrc€ t::> J~1hJ,~;krXl~k&:;n",,-n bF 30" BeLew. e'><;ST";N~ Rot'l-Dw/lV t>;+cH A^,b E'l<-,eND aeVo^-'D The. ~,q:NT....INel> t);tcH ,riRer:J 2 . err B L.e p Jt<t c & D B €. /I m;-v:;nvtfV! A L-()/v'J o~ 30" l<.o /lPVJr:} V :5 t+ rf L.L- BeLOW e.x::;.r ,'N? :SHOlALDeR. 3Rf}DE. 'P (DV'e~ \:...{) II ?S' ( T/!t:71/c./-(-- Pl./-{ S 4 - Zc, , /li..!.5.hJ../ cl -r\ ~I i (.oJ I '" I -I ,=>, ~: '2: ~. <;:;;;:. T 28 Ii l,-Ic ~ 2."2.- I_I 1"7~ \~.O - r- r 1\.t -:: 5; I T 1~ Ii '.....:.. 11:=-. /'..ll'fL~ I"Z., I. ~/.) .. // rv:; f\AMucJ '* u- .e l'- o iJ o I; i'i {) "" (0 -.0) 0::: t<'> ..() '" :r :!: Cl ~' J u' () N () " .J ~l ".-'--' (7,.., O~;: ~ - ,-'e-f'/,7 I/Ii/<:.)""""' IT L. VI_' If: :J ~ ~_~} .f,--'./. 7,.. '-! .:(-':J j....c:. ,;.y ~ ~ r) li\.~ JEFFERSON COUNTY DEPARTMENT OF PUBLIC WORKS 1820 Jellerson Street P,Q, Box 1220 Pori Townsend. WA 98368 (206)385-9160 N~ 0980 ~.c., .....-:::::..~,_. -< Dislricr No. PERMIT - In accordance with all applicable Revised Codes of Washington and amendments thereto, and subject to all the terms. condi. tions and provisions written or printed below or on any part of this fOfm PERMISSION IS HEREBY GRANTED TO U.S. West Communications 611 6th St., Bremerton, WA 98310 to Install buried cable along Paradise Bay Road from mile post 2.58 to mile post 2.60 on left. (From Tala Point Rd. to closure 1172) Jobll 96-9160 County Road No. 503609 Franchise No. Milepost 2.58 to 2.60 No work shall be done under this permit until the party or parties to whom it is granted shall have communicated with and received instructions from This permit shall be void unless the work herein contemplated shall have been completed before March 17 Dated at. March 17 . 19 89 .1990 &~~~@WlBID By ~~ I(~ 1.800.424.5555 GENEHAI. I'HOVISIONS AI'I'L1CAIlLE TO AI.L I'EHMITS This permit is subject to all applicable provisions of the Revised Codes of Wa~hil1glOlI, except that uny provision in thi!> agrccmcnl not consistent with such resolution shall be controlling, A bond ill the amoullt of $ is required for the protectioll of the cuunty as set forth in the terms of the bond, During the progress of the work such harriers shall be erected and maint:.lilled as lIla)' be lIcce1>!'kJry or as lIlay be: directed for the protct:tioll of the traveling public; the barriers shall be propcrly lighted al night. In accepting this permit the petitioner. his succes~ors and assigns, :Jgrces to protect Jcffcr~(J1l Coullty allu save it harmless from all claims, action.. and damages of every kind and description which Illa)' accrue to or he suffered by allY person or persons, corporation or Ilrupcrt)' by reasO/l of the pcrfor. mance of any such work. character of materials used or manner of installulioll, rnailllenance and opcr;J.tion or by the improper f)CCupallCY of right of way or public place or public structure. alld in cast.' any suit or action is brought uguimt said Jefferson County for damages arising out of or by ll:aSOll of any of the above causes, the (X'titioncr, his successors or assiglls. will upon nutice to him or them of commenccment of ~uch action. defend the !>Utile at his or their OWII sole cost ami expense and will satisfy :m)' judglllelll after till: said suit or uctioll shall have finully been determined if ad\'er~e to the Jef. ferson County. Except as hcrein authori/,ed, no excavation shall be Illude or obstacle plact:u within the limits of U c(Junty road ill !ouch a manner us to interfcrc with lhc travel over said road. Except U!o hcrdn authoril.eu. /10 excavation shall he mude or ubstacle placed within four (4) feel of the cugc of the p:n'clllcnt. If thc work done undcr this pcrmit interferes in any way wilh the drainage of the coullly road. the gralltet: shall wholly and Ul his own expensc lIlal..e such provision as the ellgincer Illay direcl to take care of said drainage. On completion of said work herein contemplated all rubbish and debris shall be immediately removed and the roadway and roadside shall be lc:(t flea! and presentable and satisfactory to the engineer. All of the work hcrein contemplated shall be donc under the supcrvision and to the satbfaction of the County Engineer and the cfllire expense of said supervision shall be borne by the party or parties to whom this permit is issued, The Department of Public Works hereby reserves the right to order the change of location or the rel11O\'al of anr structure or structures authoriled by this pcrmit at any time, said change or removal to be made at the sole expense of the party or panics to whom this permit is issued. or their successors and assigns. All such changes, reconstruction or relocation by the grantees shall be donc in such manner as will cause the least interference with any of the Coun. ty work and lhe County of Jefferson shall in no wise be held liable for any damage to the gruntee by reason of any such wor~ by the Count)' of Jeffer' son, it agents or representativcs, or by the excrcise of uny rights by the County upon roads. streets, public places or structures in question. This permit or privilege shall not be deemed or held to bc an exclusive onc and ~hall not prohibitthc Cuunty from granting other permits or franchise rights of li~e or other naturc to other public or private utilities, nor shall it prcvcntthc County from using any of its roads, Weets, or public places, or af. fect its right to full supcrvision and control over all or any part of them, none of which is hcreby surrendered, The Departmenl of Public Wor~s may revoke, amend or cancel this pcrmit or any of the provisions thereof at any time by giving written notice to the permittee. The permittee shall immediatcly rcmove all facilitics from the right of way. Any facilities renwining upon the right of way 30 days after wril' ten notice of cancellation shall he removed by the County at the cxpense of the permittee. Thc party or parties to whom this permit is issued shallmuintain at his or their sole expense the structure or ohject for which this pcrmit is granted in a condition satisfactory to the Department of Public Wor~s, SPECIAL PROVISIONS: 1. Calble shall be a minimum of 30" below existing shoulder grade. 2.;;)t.f>.PI'.l.j,ca. I..'1:~Shalhbe responsible for all 1111 l! '1"'l"mIO~1 'II 1.!Jl.'~I\\;!I: "':'1 l.l! " '1 \1" .r.. 11;1.\1 .....::::J \.:':"1111 u ~)I"J damages to county road right of way. In acccpling this permit the grantee, his successors and assigns. ngrce that any damage or injury donc to the property of the grantce or any expense incurred by him through the operation of a contr:lctor, working for the County or any County cmployce shull be at the sole expense of the grantee, his successors and assigns. If) ~ _ iJ< ~ e ftJwlJ~ JA l/J wJ- CllHt flK.- . the undcrs;gned. herehy acceplS thi, perm;' ,ubject '0 the te"", and conditions as hcrein set forth. If .. Dated 'h;'..... ~ I day of'Y J'I1.aAcV\ ' 1/6t( ^r."",,~ e.. ~ r U0uJuJ-~. ~c.- JEFFERSON COUNTY DEPARTMENT OF PUBLIC WORKS KctC.p1 No Fee Paid_ Yr."!!i _ No 1820 Jellerson Street P.O, Box 1220 Pori Townsend. WA 98368 (206) 385-9160 AddressReque~l_ Yes_No Mile }>(1.)t AI'PI.ICATION 1'Q1{ l'E1{MIT To Department of Public Warks, Jefferson County, Washington. The ul/dersigned U 5 WE5T Communications (PNB) herebyappl_ for permissiol/ to pl ace buri ed cabl e from exi sti ng closure #72 to Tal a Poi nt IAtlflli. <1111 ,\'/I! d,-Inil,,' lull)' ~'1i1J1 hI' ~iIIll'.\ /u dl! J Road and then to the north onto Private Property. (Please see attached sketch) 5-15 T-28N R-l E Telephone Company Engineer, Jim Williams, 478-4404 Terri Comstock, 478-5688 SKETCH: Project, 969160 Port Ludlow RECEIVED MAR 1 6 1989 JEFFERSON COUNTY PUBLIC WORKS DEPT. On eaumy Road: beHveen (Sla''''I<'O,.../cm,\\'I/rl't'l",mllt'""i/l1/ and agree_ (a do rhe work iI/ accordal/ce with YOllr rules al/d regulatiol/s al/d sub jeer to your il/specl/on al/d approval. Date March 14. 19.-lliL- tCnntractu'1 ALldlc't.\ Ad.lrc\\ Phone No, .' i J 1 f " ;~ ,~ , " " I f; ~, '1 L I ~. r I r ~l~' I 1 j .I l j 1 1 I I I I I I r I I 1 'I I 1 'j .1 j .1 :.' . . .j m' :\ \; ~. t 'I , lli . '" i'~ Z~ ;Jt;~ "\ ~. ~. ..." . . .' < ~ ~ ~ ~ ;J () ] : ~ :;;.., :)"3" (J- <... - (;) . <:" 'J~..s 'j l- ~ , (}- J,;; ~ I) ~ ~ Ie I~':J:S ~ ~!~ 3:: .);.9 IJ <I)-:::"!oc? ::: I, -!J tCI oJ n. ; t t [ I t I ~ .... .,( '.' ... / / >- I I~ I~ ~ \- ., ~ :l "- VI 'd 'j I.!J c::... 0._ I;: ~ p) '€ .'~ '2 ~,~ \)C 0- I~I~ lI. .., ~>--. " ~f!l. '. ::: : .' "., .' ':,.':,:',. '.' '.. "', " .'.' ...... ...... ..........., , '. . .... .... .: .... : ", '. '. ......, .... :::', '.' '. 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" '.' .... .',. .' ,.," ..:.... .'. : .;....., . : :: ".':"';., '. I,' '" ..... ,i" L , . '. ...... "., .:.... "'.' ...'.... :... .' ". . } ":'., ' ................ : . '.. ," : . ....' .... ,.' . .,....'..L.......,. -; '..... , , " t ~: . : i. ", L I ~. t: :.; . . L I . .'. :L .,CAU fOR BIDS . . . . .. r-ici;;c~ i'; h~;~~Zj~;h.~t;i.~.B~ard ,of County Commfssionen of Jefferson ;County,. State 'of ~,Wa$hington, w~11 'receive sealed bids up until the hour of, 10:.45, a,m.) Monday,;'June, 27, 1988, "at the 'office, of I the County Commissioners, Courthouse, ;1' Port Townsend, Washington, 98368,' to be opene'd, and read ~fte~, that date 'a'nd tirri~ for .stripir:'9 '.~ariou~ co.unly 'rodds'cnd otlier work as'set forth in' th'e'contraCt plon~' a~d specifi~~(i~n~. Major its.ms of ~ork'will bet, ',' :.',' 1313,52 Mi..' Painted Strip.....',..':.. 1957.0 Sq.:Ft;.llj":P~i~t.d Barri.r' ',' Stripe,.'" ' ~. ':', ':', '., "':' ;^( .. ',', 'a.5 Hun. Type II Lane ~arkers";'''l',, 634.0 Ln. ft,'Th.rmaplastic . Paveme~t M~rking~', "", ;, '.:, ~"_," 3832,0 In, FI:. Painted Gor. Strip..., 8 Inch Width' --...... .". ". . Bids shall be 5ubm!tted in 'accordance with the plori.tC!n~ 'sp'edflcat},ons.~on: file at the office of the;, Director of ,Public Works, P ,0. Box 1220 J.ff.r- so!:,' Street,: Court.ho~se~,Port .To~~- : send; ,'-, Washington,',:, 98368l'f:where copies may, be obtained-:/:/':.., '. ,:;.':":" : Each bid shall b. accampani'."a bY' a ! surety ,> bo'nd/~.po.$tal,' ~oney<order, 'ca'sh~ cashie'rs check' or certified check 'p~yable to, 'the'.Trei"~u'~er 'o~, Jeffe~son lCO,unty in~:'the'~suf!1 of, 5D(o,'~of. 'the:,bid "aT~uni~L,,~o,' be, fo:rfei~ed fo:'J~ffe'rson :Cauntr' b'YJh.:succ.,,!ul bjdd.r:;f h. .fails to'enter.into a contrad'arid,.file : an'~ 'acceptcible';' surety ~, bont(; in :.,th~ anlo'un.f,:'of >; l 00% ", 'of ;)h'e'~:'~olit~a'ct P\ic.i.~ithi~; t.,,; (10): day.~i"W tli. ,award~c' Th,e.'bC?ord o~';ICounty'.Com- :.missio~eis, rese~~~:.the r!gn(t~: rejeCt 'o'ny"ciru;fall bid~,: ~nd ,to:accep),'~e bid" ae:ef!'lea .'m,os,t: adva~tcige,~us~,t.o ~ !Jeffe"rso'n Coilnty, clnd to'w_aiy~,-ci.I.1 in- ,fnr'~Dlities' in' t.hej),~ddinQ.'!;:,\?,,>;t>~ '. . Daied'thi, 6th'day of June;'1~B8;" . 'BOARD'OFJEFFERSON.COUNTY, .~.~.~,~,.~.~n,I~~~~~~.".~/'~>::!;;:{;,'t ! .. '.2796~ ~22 . , "..:. . ~;; ." . . .... .'. ." ..... .' ..... ,:,' '. .. '. ." ".' ;': ". ...., .'. l ". .' . ." '" ........ ./ . . . ........ .' .' . :..'....., .... .'.:: .. .: :."', .. .,.... .' :.'" .' '. I~ Affilidvit of Publication STATE OF WASHINGTON) COUNTY OF JEFfERSON) fRANK W. GARRED, being IWQrn, ~ay~ hll i~ Iho publhhor of thu Pori Town~tJnd/JoHorson Count)' leader, 0 woel..,)' nl,tWlpopOr which ha~ bUlln lIuobli~hlld, publi~htid in tho Engli~h longuog!;> ond circula.ed continl.loull)' 0' 0 wlle~Jy ne....'pcper in tho rown of Port Tawn~!;>nd, in ,aid County and 5tatc, and far genoral circulation in ~aid count)' for morltt than si... (6) monrh~ prior 10 the dCle of Iho first publication of tho Notice horltttc aT. tached, and that Ihe soid Port Town~end/Jef/er~on County ~::~;~;:: byn l~: ;:~~r1:: CO~~r~:f ~:j~ lje~fe~:~~Cdo~~t~;"agn~ Ihot onno...ed is true cop)' allhe Call for Bids MTO 766 os it oppeared in Ihe regular ond entire issue of ~oid poper itself and nOI in a ~upplomenttheruof for a period of t.wo consecutive weeks, boginning on the 15th dayof_o.I!!~, 19~. ondendingonthe22nd dayof June lct3~, ond that said newlpaper was regularly distributed to its subscribers during all of Ihis period. Thot the full amount cf 5..8...8___0_0_ha$ been paid in full. Aat Ih:e rote of 55.50 per column inch fo~ ln~ertion_. ~W. .. .V Subscribed and sworn to bef~\rot me this 2 2nd day of Jllll~. 19_81L ~~_~_u:, ,.,/1 - ---O-----Not~~PubliCi~ Wnshin{Jlol'. nlSlrling ot Hadlock . .. . '.. : .. ~ .j i :1 .. : ,1 . . ..... .." . . . 71...... :. I. . i . ..... .' I. '. ',., '. . '..' .:', . .~....'::..... ..... ...." .... ,,;,,' ...... .': ! .':' i..... .: I. '.' ':.' . . r ~ "1 I J :.. < ,., :: .:.:. . . .' . '.. ..... :'. . ",: :.: . . '" . ....' " ".. . '. ..... .. :'. ". '..:' '.... ',., .... '.' 'I ~ . . . . ,'... ... .' .... :. ".. ..:' , '. . :.....,:. .... .. .' . : '..' ".:: . .' I'>:' ~"."'. . "." ~, " ,,' .. ;-11 ~~".. ( \ JEFFERSON COUNTY DEPARTMENT OF PUBLIC WORKS PROJECT/WORK AUTHORIZATION AREA AREA CODE: PROJECT NAME s-rei'P(,v(,. 198'8 PROJECT No:IMT I ~g=;66 TYPE OF WORK S"l"eiP'N(~ 7 ~€7Vr I?I912K/^/6c:, LeQ,;(fl"Y ~i~ S t/-c, ?:t.J2 BREAKDOWN OF WORK ITEMS: G;?/(;.hC/~;NC:r COST EST!t-1ATE: i 6,000. 00 oe;;rrzipi/J(. -!- 'K:l."~e'?JT ~PK://J& i <;0, 0(')0.00 /~ $5S.000 .00 TOTAL: SUBMITTED ~~~ BY: ~~tr'><. II 198'8 ~OQr- APPROVED: ,<' . / Z BY: 4t2u?Q.,p~ DIRECT~ PUBLIC WORKS ROUTE TO: INITIAL f1)2 0 ASSISTANT DIRECTOR [2] ACCOUNT! NG 0 ROAD SUPERINTENDENT 0 BOARD OF COUNTY COMl~ I SS lONERS [J CONSTRUCTION ENGINEER [3' ~(!hVTY C'A-6/A/Ee-e ~ 19805- " , '" '-:." ~, , ,,<!, ,-7 i #, 'I "i(t-lee> ',',' l/ " '7: I) ,\' ',t., ~' Ii' " r ? ~, i~. l\; I ~ t .',,' ~' ~ L r. >.'" ",c 6 ::, 1," 1 ' \ , :.< . , i ',' ':', ",'>' ' :', "', ' ,',.' , ", , ':;', ,,',,":' '" ,,, .': ".' ," " " """ 'C'.,'" ','" " ", ,.,'; , : ". ".", " '::' L: ';' , . ,,:",' " ",.,".',"', "",', ',", ' ,~, l ': ,," , ' ' - 1 TG't'- tAt<:e 7Cf) 2 J../-tMHA-NO DIZ,flG 3 f/A"2I='- POl'''' l2/) 4 ;2c;, A-no fI- t::t- rc.o 5 W </ Ll3 rv.::> ;Jg nQ 7 -. D " / 10 No 11 PI/UN$,' ~ 12 r-_ /.. ,~ TZD (300' 13 14 15 '7), / ~ - 16 ,ez," b1Jt2E _' 17 16 19 lZePi-~ 20 - 21 -/~ _/ 24 I 25 -; Lh:>1MO 1'1A-~T7~ - 26 22 23 <; 27 26 29 30 31 32 33 . "'." ", :'" , '.. ,:'." . ,",;:: ,'", ",.' ,:,'-, " '.', "". " " . ' ~PrOS / t. ,uf, r-, TV FiNISH- ~ -n-I-1 wr.-{ I ;:.~ 'iU:> '?O. ~ d51- , ofF <;tip) /' ...,"-PO/l. "......" 'i' I FiP6LCl j ~ ~ ~LO <- Co '''''''L j 0",", r>"..N..2 ( N2">>" CD... ./ I~ Sel:? i-- .' , ("1 6 IN"'" ~=ov , '. ' . , , '" ',;.'.' . " '..' , :' , , ,'"',',, , ,"~ , ..", ". , : "'.'::.' '. ","" :' ",,:,: ,': ~ 6 :.' . " .", : , , ": " ". "":".",." ,': " "",'. " ;.,',,' '", ":'.' . ': '", ','" .", '."','i- c' ',,":' "':'" , ':.. ':"" , ", ":', ,',",,' "', :' I '. " ' '::' I.,: , .....;-J, ;'" " ," , ' '.' " , " . ", " " " : '-"', " " '" ' ", , ,',' " " k, " ' " .,. I ' ','1: " :' ":", 'i i '" ',' .., """..,',. ". ":'" - . ,'. . '" ' , "" :-.", '., !', '. " I' " ',:: ROAD ~ ~ ~-~~.~_. 123< 567 !i +~ 1 ~S J LI;./~ 2 MGr..1 ""E'S / GrJS7 r<J<:71 L. 3 e.CJ0/L. ir.t:;7J'Tli7L < W. Vrl<-Le'1' 2D / 1?rk1r Y T.)i2 IVC 5 w. \If't1..L1d!T' k!.,(, J,.. u= i2 v ':'1. 6 "'~""G ,.. ~'"D u'" ,-1',..... 7 7 <.1)"", ~ . ';2.". 1 c.,::vc 8 <. n,,, r-.. -pn-:/j /'~ /'. 9 S. f'\.~, ~. i>'n. 7'''''''r-> - ~ 10 ("A:;:>E:' ;" / r""'" /" 11 r~ ~ -~ ~-r "e;.<; 12 ~.'\":k,.-~ / 1'"-,,~,'~ 13 / /u~~' ~ .. / /. ~ - OS...&? ~ 3 & i:-~.....bs I Ii 'i>j"). . ,,u. '" uP -- c: . "" AID 12.D. - 'y" >,', ,(. . I.l.""" Ie.. 2- S1bP i~ , ".C';.:. ':, c: I~ 15 ':?~ J .. 16 1/"""",1.7 ~...rr 17 u=.l, em"". r;z:>v 18 1-1'<:<;<;'1 .6 19 1<<. ,~., to J 20 /-/I~,</ c<!. / ( 21 / .-r.D~""" 'I cH7 221/.0 rj 1""'- J ""'L~ ..~ 23 &vi;> I ~F ,T1+ -;>....( ~" / r= .,.,., =:J2- 2< ~ /,.,., ,,~h._ 25 ~,r ~ . , . 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'>-:l 0 ~ ~ ~ :P .. ~ ZO ~. V't "'" ~ "'"-l..\ ~ 0<.\ f' - ~ \::,. . ~ ~ ~ ~~ "'- , ~ ~ '" ~ J 11\\', ~ e <::: c,.' ~ <:::. ." K L\ S'\ ~ , ~\ ~ ~ , ~ <;:-O~, ~ -i ~- f;' ~ I 0 ~~~ ~ ~ ~ ~ ~ . , , .' -::..... """ ' () 7> ~ ~"""" ~ '-I ~' '" \r.\ \)" ~ Z ~ .. -... ~;ll ~ _2 ~ <m' I _n I ~~ -1-...... - ~ .'S ~ ~ ~ ~ "'::::- r- .- ,-,..,.._~- ~ ~, c ~ g~ -_..~ 'J ~ m\:,"_ \.LI_ _ ~ ~ .~ :..,:iJ .._- -- - ."- ". \ \'~ \"" ,~ ~ ~ IN "':c ~ ~ \"\ ::!J- ~ ~ ~ :..,~ " ..... ..... "- ....... .. ~ ..-. 0 ;:: ~ ." m ~ ~ II> ~~ .,,'" m- ~ \.u ~ ~ \::\ ~ ~i~ ~ - q ~ ~ ~ =< !:l ~ ---.. 'R ~ " :..,~~ '?\....... ~ '~. ~ ~ ~ ~ ~ ~ ~ c '2 ~ ~ ~ r , .... ( .. l'- ('\ ;00: ~ ~ " .. b ~I ... ... ." ~, ., r \; , ~ ~. ;:: ~ t m " , ~ II> ~ !' t ~ , ." :P ..., m '0 I" ffi 2 . III ..... ..... II> n :< :< o '" Nt;,"", '" ..... C'> co n ~ ~ ,= 21 ~ 1=2-"" ~ ~ ~ N y; 2 -< -:.:- co 0 ~ ~ ..... ..... III n ;c :c -< m ." 0 :P '" .. '" 0 ... ~~ ~ ~ ~:i: ~ ~ ~ ... m S ~ 2 ~ ill ~ ~ ~ ~ '" f> $ -"" o ... :P ~ ... ... ~ ~ ~ VI ... ~ ~ -< ~ :; .... '" n "'.... G; .... rn..... ~ 2 ~~ ...... VI -I V'I ...... ZQ -<," n '" = :< '" o '" ~ is '" ... ... :P :p r- 5 ~ U\ VI ;J; ~ =< - .... .... '" .... n '" ct'lIl r- -i ~~ ffi 2 m: '" 01 .......... - c.n n VI...... :< :< ~:4:: - .... '" '" 0 :i: :P -i m '" - :P r- :i: n , ' ,., III o n :i: '" I ,., n '" c::_ "'..... :r'" m = 0' - "'..... not:' '" : Q ~$ el ,= .. Ul_ no 'f' .. " A:\ uev\ ~ January 27, 1989 Rockey's Road Striping Co. 916 Garden Hill Road Elma, WA 98541 Re: Project Number MT0766, Pavement Marking 1988 Dear Harold: Attached is the lien detail for liquidated damages in the form of direct engineering costs and penalties for paint application out of tolerance. Your contract with Jefferson County was terminated on November 30, 1988 as per Section 1-08.10 of the Washington State Department of Transportation 1988 Standard Specification for Road, Bridge, and t~unicipal Construction. Wi thin this section it is stated "The Contractor shall bear any extra expenses incurred by the State in completing the work, including all increased costs for completing the work, and all damages sustained, or which may be sustained, by the State by reason of such refusal, neglect, failure, or discontinuance of work hy the Contractor". If you have any questions or concerns please contact me. Sincerely, Tom Morello Project Engineer . ...._J ~\a.... sc.k<"",,,le ~: 't)I~ ""~~.... ~Tol""'~ xc: MT0766, corres. PWA02 ~ ipf)1f\J1 -# 00,117 ! S; ;3, 0 cf J31 I~ @.i JEFFERSON COUNTY DEPARTMENT OF PUBLIC WORKS \ ~~-~w:v " '" ,.r)'''i.il i' ;~~~~-'- ~'t;..~.J" '.? )F;J.....:.to 1820 Jellerson Street P.O. 80x 1220 Port Townsend. WA 98368 (206) 385.9160 Gary A. Rowe, P.E., Director Robert G. Nesbitt, P.E., County Engineer November 21, 1988 Rockey's Road Striping Company 916 Garden Hill Road Elma, WA 98541 Attn. Harold Rockey Dear Mr. Rockey, Be advised that as of November 30, 1988, your contract for pavement marking, MT0766, is terminated as per Section 1-08.10 of the Washington State Department of Transportation 1988 Standard Specification for Road, Bridge, and Municipal Construction. All work not completed prior to the date of termination wi 11 be deleted. Sincerely, ~~E. County Engineer cc: MT0766 l' 02- 100% Recycled Paper '''i Rockey's Road Striping Co. ' (I __~___-_---_--_-____-__--__--___-__-----____---__----_--------------,i,l ~. ..,::: .',', , <>' t..:, ',' " ," ':':', ','",' ' . ":.: .:,' !, ",", ':)."V;.,.'H'. ,';>>. " ". "...:,'..... ,., '. : :, " 'I, ' , .: : " ,: ,:: ";: i " " " :, h .', " ',' .'..',' , , , ',' " . ,:,: .. , .... ":" '" ' ,.,' ',':' :. :, '" I, , ", : " ' ," '...:, ..,.., " Ii .'. " " , , ' t ! ( ;': 1 ? ,'. ':],':" ,,:,- , :" ,: ..".: .. ,.; , ..':".; , ....' :' " ;":' '," ,',:,", ' , , ' ':, ',.'. . .,..:, ' ,.,,' , , ' q \ ' ,:, .'.. . , ,,/,".' I' :,.", ,,:., I,:. ' ..." ,: > , ' L..", " ' I: "',' . ;>:' . I:' .' ..,'..,', I;' ",;', '" ,:',:, ' 1":;,1 ' I. '.,', ,---:- , ' l:L . I~ , :.~ October 31, 1988 Jefferson County Dept. of Public Works 1820 Jefferson street P.O. BoX 1220 port Townsend, Washington Attn: Robert Nesbitt, P.E. Re: project Number MT0766, Gentlemen; ;-::i;; {:-? .,:1 ',' " . ..: JII ',',. ',' III , ',' '.', : " ",' , " , "',' ", ," .'..'..'..,....', ' , . II : '. ..' "',~2'. II : :,'...' , :..'.. )"",' ',' ",'" :' ',,' ,:\ ': ','. ',' i .. ! ... ~, " , i , I~ I :, 98368 PAVEMENT MARKING 1988 Rockey's Road Striping Company transported to Jefferson county, Hadlock Shop on or about 8/23/88 six (6) barrels yellow traffic paint and one (1) barrel of White traffic paint. , Yours Truly, :~::::!Zner ROCKEY'S ROAD STRIPING CO. .'. " .. .' , ' " ',: '..: ,,',' , ,--- 916 Garden HIli Rd . Elma, Washington 98541 . (206) 482.3327 "" '" '-~;i~<" " .',:,' ",' :': " ,,: :" , '" .. , ': , ",,' , ".' " ',), ',' " ":.... .".,.:..,:'....' " ',."',." .'.'.'/ ..' '" 'i.,' ,'';,..' C ' " ',':', ',,', , ~:"".'.". '," " ::, . , ,,',,'c," " '.. ',i" ,,' ,:", , C: , ",' "'1 :"""" -.J'.....".,.."., . " :, ,'," "~~ic-y_~~- ," , ~. .,.,.,>~~~ ",\,.-'~" t .l',~ ;~~ ~; t .,) l 4,; '.g", I t., f' l (, .. ,,' ..,' " ,;, ' ' TO :,.Hr /...-'C- ~/ ..:"'- ,., h, ..'.'!""';','; "; '.;' ," , , ;,":r-,g , $(~HlTf & YUlOWcomSINU,Cf, WHnf (onWlU u 'UUltl~.I.):;t,:,:,mH IlDTi. ,,', : ;"\':~;':.">"~,;,~,'~ f""...:,:;_:.,' '9 COWLIT~COUNTY. WASHINGTON",'::: ,,:> " ,,' J ., ' ''''i'''\~'';'i[; ':, x I').''')'') ....,..' 7 .."~ 1/ / .IV (, , . _ >"""''':. ' :',.",','.-:,.', ADDRess ' , : :',':', ~~')'::::li ,:',-'''.' KE lSO, WAS~', 9~~t. - :i Telephone ' ;:':J ,;:',(' r'" /cJ - .3 / - f?t? "csr "'tiEPl, Ive::'.' _ / ."/ (!1 a c.: C;~~Jlvr.,.- ('.1....-11 t~)c ....-..:. 7-/..Jj 1'.) 1/~./6 /'//47'c,,-'V.]( /v,>)(.)u/./-;-,,: J'?,u :.' ('),; T MESSAGE: /.1 PO/I-' ....4/dA/IV/.j't. 7/16 .......-/. )(":::.-~':) "',.,),,,: 'l('''';'_) ~, I . /. ~-_,'''r./A......'T /F~.J~A')C- .rV'=-.J/~~'D;:~'; / '...J 1\ .') .c:- ,~/.I L... / /'-/(~. 7';'-1~" (_,~.~'C(/L-I -rz '--L/U/v,-'/ I 1f't:..I/1. i,f . ~ I: ~~~) i~_~/~_,:~ ~:?;~ .,1, <,-,0 c.::'..,.,_ J-77'~T-~'ic-'V-" ! ,::i,/r) r-:;:A~ REPLY TO ____ .lfolOlD ~~/~'./>~~.... ~5';t~~"-i:=Z_ I ' .,..-i...; /,,~) (./ /L/ Y" L ~,.."- / - // / 'Oc"',) ,/ ..<../_~ /-11'/ C::. ;;. /-) /! /,-; Vc:'<) (1,.) 7' - . "'~~--,l..)7-~:'?p(') // /rJ/A..;" /_) ~ ...r-.....,~----- ~ (.J(- -r/2'-. (-.J()7' REPL.Y Dftlfol..ATO...DO NOT ",,,'T-I eII;OW-THI."L:IMC-___ <;:"-J , ,..- J "-- ~ (.j/ ~_;'" '" :'~,.'.-;,,;.',:k.J......'.""'".,.;;'~,~'..u; '........"_~w._..~.. ~ENDP.ITS 1 AND 1INU.C'.~.1T I Will IE 'flU'NED WlfH ."IV ~1' - 'i: ,t - :' a '" ,~ :j' ;~ I :~.. I I' :.;. ~ J .' .- .. ,-'.- ".., " ,,": ,'-, " ": ;\' ',', ,', , , " \,:,~,." " 1:: ;'.;:" ',' ,:~';'" , , ,';":' " "'," :, :"..... " .. '" f :r ~.; , k;' ~'"' It' , .~ '. 1, f " }; '~, r ;!~ } ~ ~ ~ r X., f I" 'I', t t!t t." k .' '.. ..,',....'>' .', '.. ..'. . ,: . ," ",' "".',:, " '.',' .': ' '/' "',' ," "',,,, ';.. "",' '" ""',, ,,;, ,", , ',,' ",' """ " ",:.', ',.',,' ': '", .',:' ,", "." ,:: ", ' ,:' ';-.' .'" ""."':':,, :," '" :",',: ",', ,,' ':", ',',," "'."" " ,"",', .'"ji' :,':, ': ,,'" "',," ,'.... , , ,:'. ,':' , ' ,.' '. ' ',.' "," ,,:" , " '" . .' '" , " ':, ' ," '. .' .' ." ' ..,'.' " '..., . ,'. ;.:" , ",,' : , " ,', ' , "', .:, .. ,"... .." '. ,'..., '.' , . '.' .',' . " , .',".. ". .'...,. . : '. 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'f}{O oi>.'.. ,,~,_. r"_~il':~.B~~~-& >(~ Hq~",~- _ .;..'~=~= -- -,,----, ,- ." 7 - ---'7 -. / / -.----- I I I ____.__'______.___._______ i .__ ..____._.____._____ I , ,---, "".-----,----------, i -- " ",--,------._______ Ii, ~f;i~f ,,,~ t~, '..."'.:ol",;')'l ~... t.....' ;"~;K' _~jll.I~~t.~',.,",:;:;"...:.l~,.,~"f:~:;..;~~~ i :< " , ,: ",,: .' ,,' , ::: Y" :',') :', i~~f:g' "",'" : "', '," ,; .;: " . ,"c, ':, ,,' ,'.': "'" ,'; . ," , , " .: ,\ , ::,' ,', , , "" i ',. ':, '.. "" "'-' .;".... " "C '.,.~ :' ""'. r ./.. '.' r ." '., !. ',: '. , , ',' '." ,; " . ',' i", ,.', , ',' . .' ..,.'.'.., .' ., . ' ,"'.' , ' : '.' ,:, ! .' .,., ,'. '.' .,.,',..., , ',';,,' "': , : ' .': ',' ",. ", , ,.', " ,,"'" ,," Ii' :;' '.";,,,_........,:---:::.., '..;' ".,' ..,:' , " ,-'; ,,,,,....'..,' , ' ,:. " " ' , :' ;; '.'.'. .'..', ...',.,. , ," ": " . ,- " ,': '.. " ,,' ,,''', " .' , ",', .,..,... '. "'.,'," . '.'..,'.,.'. ," ,", ',',' ',', , , " " " ". ,,' ',,', " , , , ,',.',"", , ,", ,,'" , .. ..,' , ,',.", ,.; . ,', " : '",', , ','; : i ,..".. ", J " ",.',' ,,", "" : I',', ' ('.' .' 11/,. ," :: "< ". ii' ..,' I ," , i" , .';, , .,',',' . ,', ,..."..' ',' , i " ",:,',,', j .' ' ',',.'..'.., , '" ,'''. : r: ..' '," .'...., . , : ", ~ ' ", ,,' ',:',' ", ""', " , " " .> " "'."- " .,', ,,'. .', ..,.. " ' "'" ,:' '.', :" ", ," '..,' .',: .' ,..',; " , ,:, ",:,.", ":.-, , ", "", " :,,',""", !: .',:' '. " d , t' ; . , I --------------------------------------------------------------------, , " ;' , " ... ", , , I . .' '. " " : ,',:,." h '.' , ,'" !I ,~~ .: I~" f" ':, I~~ ., .: :'i '~:~ 'g":c:. "', J ' if ., .,' ' . .. " '",".. .' , ':'.',' ',', ,',,"',' ;' ,', .'". ' " .; .', , ' I, ,; , I;",':,,""!: I,:, ',' "', ,", ' ",,' \.: ", '. ,.,'., .:' '. , ,: :,; ; ': ,''' '} , :" ' : .""", "" " ',.' 'j ',',': '" , " ! , ,,.: ,:" :".',' , , , "', " " , " " " " . , " .' ': ,',' " (. ' I , , " " 1, "i ! L I L I'L .," g SEP 2 ~ I.':,;j lH 2 8 Ital o ~ Rockey's Road Striping Co. Sep.tembelL 27, 1988 Je66eILhon Coun.ty Vep.t. 06 Pub~~c WOIL~~ 1820 Je66elL~on S.tlLee.t P.O. BOl< 1220 POIL.t Town~end, Wa~h~ng.ton 98368 Gen.tlemen: Th~~ le.t.telL ~~ ~n lLeply .to .the ~e.t.te4 .tha.t wa~ ~en.t .to me on Sep.tembelL 23, 1988 concelLn~ng P40jec.t No: MT0766, Pavemen.t Ma4~- ~ng 1988: Unaccep.tab~e; Y~e~d ou.t~~de o~ .the 10% .to~e4ance: I wa~ no.t awa4e .tha.t my y~e~d wa~ ou.t beyond .the 10% accep.ted ~~m~.t un.t~l I ~po~e w~.th Al by phone on 04 a40und 9/8188. Be60ILe we ~ta4.ted youlL ~.t4~p~ng plLojec.t I .to~d A~ .tha.t my .two va.t~ hold a.t lea~.t 300 ga~~on~ 06 pa~n.t each, and .they do. A6.te4 ~pea~~ng w~.th A~ on .the phone on 918188 I wen.t ou.t and a~~ed Cha4~~e, l.the S~ag~.t Coun.ty T4a66~c Eng~ne(4) 'how many oa44el~ 06 pa~n.t welle loaded, becau~e I ~new I wa~ ou.t 06 ye~~ow. We coun.ted emp.ty ye~~ow ba4lLel~ and came up w~.th 5. 1 .to~d ChalL~~e .tha.t .the4e mu~.t be a m~~.ta~e, .tha.t my va.t~ ho~d a.t lea~.t 6 balLlLel~ each. 1.t Wa~ no.t un.t~~ I emp.t~ed .the va.t~ .the nel<t .t~me .tha.t I 60und .that I had ~e.t.tlemen.t ~n .the bo.t.tom 06 my va.t~. S~nce .then I've cleaned my va.t~ and I can once aga~n hold 300 ga~~on~ ~n each va.t. I phoned A~ aga~n on applLox~ma.tely 9/9/88 and el<p~a~ned .the p40blem .to h~m, and .toLd h~m .tha.t .the plLob~em had been cOlL4ec.ted and .tha.t wha.t wou~d have .to be done now ~~ .to compu.te ac.tua~ quan.t~.t~e~ on hand and ac.tual q uan.t~.t~e~ u~ ed. We had aglLeed upon a mee.t~ng w~.th you peop~e be60ILe I com- mence WOIL~ on .the 2nd pha~e .to C044ec.t any leg~.t~ma.te ~1L4egu~a4- ~.t~e~ .tha.t you m~gh.t have. ' S.talL.t~ and ~.top~ ou.t o~ ~pec~~~ca.t~on: A~ 601L .the ~.ta4.t~ and ~.top~, I've ~en.t my on-boa4d compu.telL bac~ .to .the 6ac.tolLY 601L adju~.t~ng, bu.t a6.telL 4e-pa~n.t~ng ~ome 06 YOU4 1L0ad~ ~.t ~oo~~ .to me .tha.t .the con.t4ac.t01L be60ILe me ha~ al~o had ~ome p40b~em w~.th the~4 ~.ta4.th and ~.top~. L~ne w~d.th ou.t o~ ~pec~~~ca.t~on: Th~~ ~~ .the 6~4e~.t .t~me I've healLd any.th~ng abou.t my ~~ne w~d.th be~ng ou.t 06 ~pec~6~ca.t~on. I .t4Y .to ~eep all my pa~n.t gun~ adju~.ted .to a ~.tanda4d 4" l~ne eQua~Ly. The ~~ne w~d.th w~LLDva4q ~40m 40ad .to 40ad depend~ng o~ ~ow much clLown OIL now ~~zz~e clLo~n. 916 Garden HIli Rd . Elma, Washington 98541 . (206) 482.3327 .', flii ';'. .. ~ ~ .~ () .. Rockey's Road Striping Co. -~--------------------------~--------------------------------------, OVelthYJltau: 1 Wahl-t't awalte 06 al1Y ovelthpltay pltobl.em. 1 uhe BA.l1kh 33 tltuck 9unh, wLth new tA.Ph. POhhA.bl.y you coul.d be l.ookA.ng at the l.A.l1e at IntelthectA.Onh 011 AC mat whelte machA.ne woul.d be mov- Ln9 hl.oWelt thal1 noltmal., thA.h coul.d account 601t home hpl.atteltA.119 e66ect. " '1 J 1 TheltmoYJl.ahtLCh out o. hYJecL~LcatA.ol1-EquLYJm'l1t ul1a~r'Y:JrahR.; ThLh A.h tltue, We tltA.ed to l.ay home theltmopl.ahtLc down, and had home pltObl.emh wLth oult equA.pmel1t. We mal1u6actulte theltmopl.ahtA.C equA.pment and what I'm tltYA.l1g to do Lh l.ay yoult 16" theltmo- htop balth A.n ol1e pahh. It makeh 601t much I1Lcelt l.00kL119 l.A.l1e, Itathelt thal1 havA.ng a jOA.l1t olt a heam. RockeY'h Road StltLpA.l1g Company Iteglteth any A.l1col1vLenA.el1ce that hah been cauhed by Uh. We 6ul.l.y Lntel1d to WOItI? wLth you al1d get thehe pltobl.emh coltltected. Je66elth0l1 County mUht ul1delthtand the A.ncol1vel1A.ence that they behtowed upon uh by 110t havA.119 al1 InhpectOIt Iteady to htaltt the job a6telt we had a9lteed UpOI1 a htaltt date. ThA.h hah thltowl1 oult hchedul.A.l1g 601t the woltk total.l.y 066 tltack. Yo ulth T Itul.y , 1-J.::~//2~~ Haltotd Roc.k-e:;j:" OWl1elt ROCKEY'S ROAV STRIPING CO. 916 Garden HIli Rd . Elma, Washington 98541 . (206) 482-3327 .. . ", . . \' ~ , J.dI3:l3IiNllnJ.311:iI~S3~O" ',' c'" m.L~ Ell6L'inr'tUIE0s.t~ -----..-,--,-..--..,--, ----....i ' ,: x!"X!" O;!! 'OElIi!I',"m'..!l i\l'" ~ "'~l~g[U!l;. 1,'" "!,..-!!! ~i! mt''''<' '_ - Q !i ,,0 2!I:,=g ...i!il;!i,m; " . 1 ~i m~ ~ ~i i ~ 0' f"~' "uo ;, - .. - c Z , ----------------L, ,".' ( ..'. N ~f.~~!'~ <u$i I I !PH~i~ \ , 'I' m_,,",, ~'r "-I &f~-~-ocl!o l' ~ 1: :lIl..', ~" Co')> ;\1' 0 ~ 'l;; g:;I<. ;', a j , ' 51 l1Jil "OD " ,. ,. ~ ' 0 . g _ - " ,:,q '~I . 5 ~; Sj"'-: '::~':' z.-,'.70~ '~l ::::i:,~-:'..,': ~!!;t i ~ ,..~ j 0 oil. . 1. 0,.'., !Ig--mi ~ :1- '. ""O;I::k' &:~i~H~ ~ :r -: '"0 ~ ,,011,. rll l!. ", '-ail' =z .. "" . ~!i IA -,~' .' ~'I;; Il. illl d c.. ,-' 10 ",'-,,?I, -I'...c..-,.: 'g,;" ~!.a"! ,'. >> ":! ',' ul,:~i':..::',~,'-', . ,." , 0" \,:,a.~ CIl :'~';;"!. ---------------; : .' " ~ ~,~: 7\r9;, " ~ H & I ~~...-' r:"," ,',":':.: :'."::,,,,.:;:" ;:;: -''',0,:( ";,,_~"t,~ ';:.<c:,:.,lIrlfi~ng:::'-: ; ,,' ~I<ii;, & .',... "CO "~'" g!in- ' ------, : 1>-'111: ,,':~, T':[$[i~ ---------- ,,' , " --,------_.---,-----------,..,-!" ',,' ',,', , ---~--_._---~ j ,', :':::'- ~. . , '.' , c -, ,,' , __'~:~~ I; .' ", ..',,'.....," __ ,_on , ' , " ',", '" ' ", '..'.. '.,'..'. " '" " -.. '--.- '.. ,',',' .', " " :: , " ;III , ;, September 23, 1988 , "- __,..___, 'd _ ____ ,,;, ,;" ',:: __ ....,_..,.. ,___ _____ ,__ _ ____m____________ ,,_____, ",-:'" .: "' , -- --_..,.._--,,-,-,----, ----..-----..--..- - -:. Project Number MT0766, Pavement Marking 1988~. __________m _____m______u" '------...----------------,--.--- ,0,. .,: Rockey's Road Striping CD. 916 Garden Hill Road --:-:--El-/Tla,_WA_9B51l.1,_______..__" __ Reo Rockey: Ii! I. ~Ou~r-e.c:or::d5--shOLo'J__that---.you-have---compl eted__appr:.ox imateLy_-50J'---ef___.. Project #MT0766, Striping 1988. A~ter review o~ the project and, project rec'ords., to date, it ~"'as determined that the work that you_ha:v.e-ac:c:omp.1..i.shed._i.s____ unaccep tab 1 e.. _.__._Thi_s_._~_ dE:!ter::mi na.ti on_ was________.___. based on the following: F r f' i vi..eLd-Ou.t.si..de~o_f._the-1.0::l."_tol_er:ance.._____._.__________________ Starts and stops out of specification Line width out of specification ---~Over::.-spr=.a~' .____._.._.____."._. ""'_'___'___'.'_._.. ...._______.,___~.__._________ Thermoplastics out of specification Equipment unacceptable ~:' . , p f Jefferson County requests that you submit a plan to rectify these problems,., within 10 days of receipt of this letter., Dr Jefferson ------Coun-~wi-J.~,pur::.sue.:....a-cour= ss-,of-ac.ti on-_ 6f-_ our:.._ own_rlesi gn...__~_ Sincerely., ~l r ~~ t " ------------..-.--....-.,. - ....,....-. ~--- ....-.... " Robert G. N~.bitt. P.E. ~Count~-Eng~nee~ .~. --'~...-.-.---_.._-~-~.------___;.-.----. I xc: MT0766'., corres. PWA02 ).. \, , , , ~~ ..', ':,' ,", ,..:"" "''- "',' ",', ' " " ", ,: ..,...". "... ,":'",':" ' .'.. .' ,,'..., " ,,' "" ,'..,:' ,,' ",' " . ,'", ',' ,,,, ,', ....., ,. .,,:' "'", .': I":'" l- e. ..,:~ , " :, : , " : ,',' , .", ',' ". -I '. ,.. .'.' ,'. · , ',' --, ' ,':': .- ". .... " .. , ..'''- , 1 .. , ' :' ... .'. ."" .," , ,: ,.', ' " ,,', , ,::;' , ',. " ., ',:':' " , " ,'" . '...', ' : """, ',', .. '." ,,' ',",;':, ,: J .,. , '" ", ." " '" :," .. ...'.. . , '" <,,'" .........'1" . J '" , , ' ",,", :': , ;, . :: ::, l I' .. ~ 0) TO: Robert Nesbitt Jefferson County Engineer HE: Striping Contract, MTO,G6, Rocky's Road Striping Co. FROt1: Al Scalf Inspector DAT~: 9/21/B8 The Contractor has worked in Jefferson County eight days 8/23 _ 8/26 and 8/30 - 9/2. The Contractor was paid "Materials on Hand" in the amount of $25,,20.12 on 8/1/BB. The invoice indicated 45 barrels of yellow (2250 gallons), 25 barrels of white (1250 gallons), and 31,200 pounds of Beads. The Contractor delivered to the Hadlock Shop 3 Barrels of Yellow and 1 Barrel of Vlhite on 8/29/88. Therefore, the total gallons available were 2400 gallons of yellow, 1300 gallons of white and 31,200 pounds of beads. As of 9/2188 the Contractor had striped 35.38 miles of SNP/SKIP, 60.61 miles of DNP, 24.86 miles of SKIP, 95.6 miles of EDGE and 633.6 feet of 8" GORE. During this period the Contrac tor used 2200 gallons of Yellow, 1100 gallons of ~lh i te, and 18,200 pounds of Beads. The Yield based upon the Engineers Specification of 16 gallO~' f paint and 4 pounds~eads per mile of 4" solid line wa 25 light on the yellow, ,39% light on the white and 4% heavy the beads. Subse tly, the Contractor was deficient 546.6 gallons of yellow and 429.6 gallons of white. The Contractor is allowed 10% tolerance although these quantities don't reflect this tolerance. Upon review of the Inspector's Daily Reports the Contractor was cautioned on 8/24/8B by Al Scalf "If yield is out of tolerance repaint or we would dock the Contractor." On 8/25/88 Karen Bailey, Jefferson County Inspector, "light on white, light on yellow, and not to go any lighter" and 8/30/88 Karen Bailey "I informed contractor that with the numbers he gave me that he was ,% light on white and 5% light on yellow this morning, and not to go any 1 i gh ter" . On 9 11 3/B8, Al Scalf discussed the Yield situation with the Contractor and requested Harold Rocky to make an appointment with Tom Morello, Jefferson County Project Engineer to resolve the yield discrepancies. On 9/15/88 Harold Rocky called Al Scalf and said "Paint sludge had accumulated on the bottom and sides of his vats and this would account for the yield contradictions. He told me that at first his tanks held 300 _ 325 gallons, but due to the paint sludge the tanks actually held 250 gallons". The Contractor is due back in Jefferson County the week of September 26 _ 30. Currently, approximately 1/2 of the striping is complete, and I estimate the Contractor will require 1 week to complete t e striping and 1 week to complete the placing of Ther op sics. Inspector ~_ F,Le,; /,^-ro 7c"(,, ~,' r CC"_<.,~''',''',_''',tr, ":,: ',':"", " .. ,',' ' ',' , ",,;:' Rockey, .....'. I, ~. I " ....'. -:-],' , ".' I _____________________________~I, ~Uii='~ I . ~ il ~~=~ ~ ',T[., 1 "...' " 1 .; i~jli ii ~ f ~:g" iI:, ~ ,"" '. ' ...., ,', ,'.' \1 i~11F~ i-I' '~~ ~\r1-~ ~ ~ i,',', '.;< ", :.", : i :::. ~ ~ J] ~ co -E'" I F ~ ' "~i " \ ,.: a: '. a ~ g ""0 co~ .i, 0.. i, ,r ' .' .., ", . ,- :: l l! ~,~ ~ Ii' 1:0: I-: 0'. !! :! ' ,', I "~, . , f ;! a: ~ ~ , e >." I ' 0::: U 0 0 tJ "'"" " , , w 0 iI . ,i s~~c( ~8 ~, e, . @ '.' , II iH HI i 2i Igsc;z liDO; ~lil ~ i i'll,' ,'/1 ','., c3 i ~ .. H ~ ~ ill::::.n ~ ~ ~ i~ ~ 1 ~._ 1 . I ., . ~]H~~~~ ~ 'i ~~~~ ~ h~ .gg t~~ ~ I 'I' .>' , ! ;...~__'~ '" a: -"<tNW "Iil't:o.!:-w ~!!> ,~: "',"", ' 1 ~ ~e~~~~= 0 D' .a~r-4V1 ~ D:~~ .!~ ~ ~ ~.J." ~ :"/ Iy::,~".;:: :;':::'').<'',''!_';:,>'" , . ~ i: ~~;2 ..: N ";' .; ol<lo <:0 '" x '" X" :' .. , , ";",, ;,: !" ,', I = , DOMESTIC RETURN f1~CeIPT ::, ; , , ;:' " , JEFFERSON COUNTY jPSForm3Bl1.Julyl983447-845, ' ",', .-- ", . '''', '.- 1820 Je.66e.lthOn S.tlte.e.t' ' " ,',," , .,; '.":;:i7::;:~\'." P.O. Ba lG 1 72 ' ., " :. ' " . POIt.t TawMe.nd, Wa.hh.i.ng.ton 98368 ' ",:' ':, A.t.tn: Tom Malte.LLa ' ',: ' EncLohe.d a.lte. zeltOlG COpLe.h 06 0~1t ma..teItLa.Lh an :'. ":', hL.te. a..t .the. Q~LLce.ne Shop. ' ,:.' "::"', V~e. .to .the. de.La.y Ln h.ta.It.t.i.ng .the. co n.tlt a. c.t , a.n ' , . a.dva.l'Lce. ma..te.It.i.a.L pa.ymen.t wa~Ld be. a.pplte.cLa..te.d. . : ..,',. , .,,',. , ,':.'" ,:~/ .:, ..,..,'.., (;1 " .1 "" i. ) , " , , : " ',', ''';'', , I '.'.' '..".",.'..'.....',. ..; , " '.: '-'" " " " '.',' ,<, ":,:''-:" ,'. , :"" '.' " : \'. ' '.' . ~< " '" ,',' :' 1,'::::'/ I: ,; ,', . ,', , . ,,' , ':- . " ':,', " ," , '., .::~ 'it~/T~ ' > ; ,"" .' ;.: .,.",... . '. '.' :' '. : .: .',' ..,', ,,'.'. '.., , "" "" : , ':' ,.' .,.,,', ", "'. ' , I~' "". . . ...' .'.......' . .'. ';, ' '''', Ii '.' ' ,". ..:.'., .', ; , , ,: "'," " . " , " "', : " . ,~ ," '... :.' " " ' ,. .", f, " -' , : ".; r :.'.'."'. ,\ ., :""." , '",', ... ". '.,i "....' i, .., t '. ,'" . " .:: , ,', ;, :' :,: ...;,'." ' ., ' 'i" , ' , ',',,' It I, i " L ,,', ", .'" " I .- ", .. ", '.. , , ", } L :.'L / "'-... : J ~Ly 25, 1 988 :II Yo Ulth T It~Ly , ~~~ne.lt-ope.Ita..tolt ROCKEY'S ROAV STRIPING CO. '. !' , ~ - . i.,'. '.:. .., ..; RECIEr\fED JUL 2'1 1988 :, ". : . :. '., \ " \ " :, \,.' ". :Jt::r-r~Emr;:!")N COUNTY ENGIN~:E".5 OF;::ICE ',' "'G"d"HIIIRd.Elm'~'.(2061":'~27/~:", ,', .' ',. ..,...'.... .',', "': ',) ',,' ',,, ' " -.J , ','-. ''', ,:"", .'.'.' , , .. p "''',.' , , ,: '" , ,. ,...,.."..i..".. " ,: , ",":: ' :',', ',','" .,' . ;" . . " ,.........' ....... '). '. " . .... " . ", ~ ~ fc :t \,~ , '~\; 1 1 ~, t ,~\, '~, t" I, ~ t: h, , '~ f 1 '~"'. ; fl.; i". (' I. f' I, I !, '..,' ,. '.; .' - .. c SEP 2 c 1.','1 ',~J 2 . llaa .... C Rockey's Road Striping Co. --~--- -- ----- --------------------------------- -- LcIT'b--R.. of Se'VI. z:~ Sut-;."",,,-\T I'< "1'v..J Se.p.te.mbe.1t. 27, 1988 Je.66eJL60n County Ve.pt. 06 Pubt~c WOIt.~~ 1820 Je.66e.It.~On Stlt.e.e.t P.O. Box. 1220 POIt..t Town~e.nd, Wa~h~ng.ton 98368 Ge.ntte.me.n: Th~~ te.t.te.1t. ~~ ~n It.e.pty .to the. ~e..t.te.1t. .that Wa~ ~e.nt .to me. on Se.pte.mbe.1t. 23, 1988 conce.lt.n~ng Plt.oje.c.t No: MT0766, Pave.me.nt Malt.~- ~ng 1988: Unacce.p.tabte.; Y~e.~d ou.t~~de. o~ the. 10% tote.lt.ance.: I wa~ not awalt.e. tha.t my y~e.~d wa~ ou.t be.yond the. 10% acce.p.te.d ~~m~.t unt~t I ~po~e. w~th At by phone. on Olt. alt.ound 9/8/88. Be.601t.e. we. ~talt..te.d yoult. ~tlt.~p~ng plt.oje.c.t I .totd At .that my two va.t~ hotd at te.a~t 300 gatton~ 06 pa~nt e.ach, and .the.y do. A6.te.1t. ~pe.a~~ng w~th At on the. phone. on 9/8/88 I we.nt out and a~~e.d Chalt.t~e., (the. S~ag~t County Tlt.a66~e Eng~ne.e.lt.l how many balt.lt.e.~~ 06 pa~n.t We.lt.e. toade.d, be.cau~e. I ~ne.w I wa~ ou.t 06 ye.~tow. We. eoun.te.d e.mp.ty ye.ttow balt.lt.e.t~ and came. up w~th 5. I totd Chalt.t~e. tha.t the.lt.e. mu~t be. a m~~ta~e., .that my vat~ ho~d at te.a~.t 6 balt.lt.e.t~ e.ach. I.t wa~ not unt~t I e.mpt~e.d .the. va.t~ .the. ne.x.t .t~me. that I 60und .that I had ~e..t.tte.me.nt ~n .the. bot.tom 06 my va.t~. S~nce. .the.n I've. cte.ane.d my va.t~ and I can once. aga~n hotd 300 gatton~ ~n e.aeh va.t. I phone.d A~ aga~n on applt.ox.~mate.ty 9/9/88 and e.x.p~a~ne.d .the. plt.obte.m .to h~m, and to~d h~m that .the. plt.ob~e.m had be.e.n colt.lt.e.e.te.d and .that wha.t wou~d have. .to b~ done. now ~~ .to compute. ac.tuat quant~t~e.~ an hand and ac.tua~ q uant~.t~e.~ u~ e.d. We. had aglt.e.e.d upon a me.e..t~ng w~.th you pe.opte. be.601t.e. I eom- me.nee. WOIt.~ on .the. 2nd pha~e. .to eolt.lt.e.c.t any te.g~t~ma.te. ~lt.lt.e.gutalt.- ~t~e.~ .that you m~gh.t have.. Stalt.t~ and ~top~ out o~ ~Pe.c~~~cat~on: A~ 601t. .the. ~.talt..t~ and ~.top~, I've. ~e.n.t my on-boalt.d compu.te.1t. bac~ to .the. 6aetolt.y 601t. adju~.t~ng, but a6.te.1t. It.e.-pa~n.t~ng ~ome. 06 yoult. It.oad~ ~.t too~~ .to me. .tha.t .the. eon.tlt.ac.tolt. be.601t.e. me. ha~ at~o had ~ome. plt.obte.m w~.th the.~1t. ~talt..t~ and ~top~. l~ne. w~d.th aut o~ ~pe.c~~~ca.t~on: Th~~ ~~ the. 6~1t.e.~t .t~me. I've. he.alt.d anyth~ng abou.t my t~ne. w~d.th be.~ng ou.t 06 ~pe.c~6~ca.t~on. I .tlt.y .to ~e.e.p att my pa~n.t gun~ adju~.te.d .to a ~tandalt.d 4" t~ne. e.Quatty. The. t~ne. w~d.th w~t~Dvalt." ~lt.om It.oll.d to It.oad de.pe.nd~ng 00'1. /laW mueLelt.own Olt. noW ,(..(.;t:z""e. eJ!.Q~ clo..l1.i.fl1 916 Garden HIli Rd . Elma, Washington 98541 . (206) 482-3327 ,:". ,.' ; .., ,'.....,..,.,..--:>" , ":'''. . i' " , ,.-',:- " " ......, '..:, ", , ','" "',' '" :,'!,' ';"'" " ' """'" ."'.".",,, '., ,'.. ,,' '. ",:, ,:' " ,';;,',.. ........: ,.... '" . .. ,...,.... ... ..' ,> :,"'" , ".:"'''' :';' "",,,' ..' " .: ".,.' ':; " :.,' .' " '... '., ,. ." ..',',. .: ... ......, .'...' . ..' " '", . :", , , . " " '. ," , , ".. "'.,. ' " :", ' ,', , " , , .' '. ,:. ".,. ." : ., .'. :/:.:' .,.., '..' ,'... ...,. .,' ..,. ..' ';:' ".,: ..,. . " :...:' ::,':.'~, . :.-; ...::. ", ',,"',' ,. : , " ",' ,.,:' .-, ,,', :, ..: ":' ,",',:'" }! ;' :,-':-" ' " ,', ,:', ":' '. , ','," ,. ; ',: .... " ,,",' ' ",'",,' , ,',: .', ", ,:, ' , , , ' ,,," " .- '.:.:,.' , '., '..,' , ",,' ... , \ ; i, :"" "" ,:,' ':'",' '.' ,: ---" , , ,:::" , :"""', ":,' ) : i. ,I II , '," . .,,' ,:,:: '", . ".:" '.' "',' '" ',: :"', " .<;", .; ~,. i~;'__: f > ~'. , i' t t ~-; t t' ~, ", I ~ l 'i'i 1 " " " ': ," ,,' , '.',:,. " , . IIIIl. />>..... .' Rockey's Road Striping Co. , ,,'.,. ~ .:::---- ------ ----------------------- ------------ -- -- -------- -----L('. - ,," " .r " " , ,'" , , :: " : , , , . , ,,, '; , , ,.. ':': " ',' , ", ',,' ' :''',,'::'.... :." :,', :", '," ' ',' ',;: .: ", ':, ',,:', " ", ',:, ' ,', ' , .' ,'".. : ".,', ,.: '. .': . ..' " '.." ' ,,:" ,', '. '., ". ", .'.' .,' " < '., ..... :'" "',, , ,', '," ...' , " ::';, "',: ..,' ",',!, '''', ' ' ,', '.", :,,' ,,,'.," . ,.....'.. ',',,' , , ' ,", ',' ': ",' ,::' ,,' " :,,' i :. " ,,"", " '", , ',', :, ", ',.'" , ,,':', ';",: .. ',' , ': '," :' ' ';', '" " ", : ,',' ",,' ,'.-" ,.' ': ',' " , " ",' , ," ,:' ,:' " "''''" , "...',.. " ',' ,;',,', '," "", ": ","" ' :.' "" :' ", /':":' ,'," ,,' , ':,:,':', "'. "'.',: ," ' :,' ,'. . . .... ' :' ','.'.,, , '" .. "",,' ,'" ,; '" ,," :-,';">,,,':, :', ' ,...... .', '.." , .', i, ','. ,:. .:,'.', " '" '"...,'.:, ",'" , .. ".... , " , . ,', ';,-,'", '-';',' "'," ' :::, " ""'''' " ;,:, '" ", , ' ',,' "'" , "'.::: , " ":, , " .- " , OV~4~P4au: 1 wa4n'~ aWa4~ 06 anv OV~44p4aV p40b~~m. r U4~ B~n~4 33 ~4~C~ gun4, w~~h n~w ~~P4. P046~b~v vou cou~d b~ ~oo~~ng a~ ~h~ ~~n~ a~ Inz~4~~c~~on~ on AC ma~ Wh~4~ mach~n~ wou~d b~ mov- ~ng ~~OW~4 ~han n04ma~, ~h~6 cou~d accoun~ 604 60m~ 4p~a~z~4~ng ~66~cz. The~mooLa~~LC6 OU~" o~ ho~el~leaLlon-Eoul~mpnL u"ar~p~rnhlp; Th~4 ~4 Z4U~, w~ ~4~~d ~o ~av 60m~ ~h~4mop~a6~~c. dow", al'td had 40m~ p40b~~m~ w~~h OU4 ~qu~pm~n~. w~ manu6ac~u4~ ~h~4mop~a4~~c. ~qu~pm~nz and wha~ I'm ~4v~ng ~o do ~-I> ~av IfOU4 16/1 ~h~4mo- 4Z0P ba46 ~n on~ pa64. I~ ma~~6 604 much n~C~4 ~oo~~ng ~~n~, 4azh~4 ~han hav~ng a jo~nz 04 a 4~am. Roc~~V'4 Road S~4~p~ng Companv 4~g4~~6 anv ~nconv~~n~~nc~ ~haz ha6 b~~n cau-l>~d by U4. w~ 6u~~v ~n~~nd ~o W04~ w~zh vou and ~~ zh~~ ~ p40 b~~m-l> C044~C~~d. J~66~440n Coun~v mU4~ und~44~and ~h~ inconv~n~~nc~ ~ha~ ~h~1f b~6zow~d upon u-l> bV noz hav~ng an In6p~c~04 4~adlf ZO 4~a4~ ~h~ job a6~~~ W~ had ag4~~d upon a 6~a4~ da~~. Th~4 ha4 ~h40wn ou~ 4ch~du~~ng 604 ~h~ W04~ ~o~a~~1f 066 ~~ac~. YOU46 T~u~V, - 1~ 'fb Q.Oo:>1 . rJ ::J1AL.'/ t. I ANr:; I-I~--// /?!.~''''' Ha40~d Roc~iy. oWn~~.._ _, -ROCKEY'S ROAV STRIP.I.l./c; cO. '~ r \ \)J G U,}8tf ( fiYR I 11~ \HM. /.<vM~ ~tITJh/l2.. oJeeV ;..- ~ -j4l M p.(JO A1.-- .J"L>-l "z"$- 2.9 ovll,.. ca.eex - ( - ,JOoW ) CD. RPi-i,,^oPO Co"'" N\ . ~~ 'W lID) rw ~ ' ~ SllorJe0 :J1JL,/ 1'3 II -- \ ' 916 Garden Hili Rd . Elma, Washington 98541 . (206) 482.3327 ", : "',, ""," " ,:",' ::' , "" ; .~<:':;:;';-;:'-,_:,:,~. "'<<"~I;-"'-:-: -; .' -/~~_;-;~f'12':" :-.:.'-'>< ")-.';"'." " '~ I ( i. ~, , ~~ I ,'I, ,I t, " ,\' \'. J{ ~ ]', t. I", ~, , '" " ,',., f'". t' ~,". ", ",,', , ' " ' . , ,.: ", ' -;", , " ' J' ", .',..... ." , ,: . ,...'. ,': ....., :,' .';',>' . ,.' .,'....', .." ...,.";. , ..',' ,'. ',: '",' " , '" ,'.:' ," ,,': .,' ,... '...,' ... .' . ,,,' ""'"'"., , ,::"" ,," : ,.' ' ,'" ,', , :, ,....,' . ,'. .'.. . '.', ',' ,:-'.,,' ,',' ... ',"'" ::,'; ." . ' .,'., . '., ",..":,, " ,."'.. " """,' ',''', " ".' ' " "" ',' '.," ,',-,: " ;;:"".,," ';' "', "". :",: ',::' ',',,' " '''",',,:.,'' ",' ,',,' .", '" ..,..., ...... '," ':, ':',' "'.'.; ".',' ,", " ' :,-:' ','" ,., .. , ' " " . " ;i'.: "" ", , ,',:, ," ' ,,', " ': ,,' " ',,:, .' ,,', ,'. ' ' .. .,' ,..' , ..", '..' '. , ' .'.' ',< " " '~-:- '." ,.,..' H,< ~, .., ,..-,.: " ' .'~,_ ,> ',. ,""'~ "\ q , .. . ' September 23, 1988 Rockey's Road Striping Co. 916 Garden Hill Road i=lma~--9B5Q.1 Re: Project Number MT0766, Pavement Marking 1988 Rockey: Dur~-Qcor-d~ow--that--y~u-have-completsd-appr~imateLY-50~f Project #MT0766, Striping 1988. After review of the project and project records, to date, it was determined that the wo~k that )~ou-ba.v.e~p.Li..sben ; c:. II"laccept.ab.le--Tbi.s---de.t...er...minat.LcD-Hac:::. based on the following: v;eLd-OUtsLde-ef-Lhe-10Z-toler-ance Starts and stops out of specification Line width 'cut of specification OVQr...-pr__y _.- Thermoplastics out of specification Equipment unacceptable Jefferson County requests that you submit a plan to rectify these problems, within 10 days of receipt of this l~tter, or Jefferson ~cunty-w~~ur~Q~-cQur~e-Of-a~tion-Of-our~wn-desi~n Sin~erely, Robert G. Nesbitt, P.E. ~unty-Engi~eer- xc: MT0766, corres. PWA02 '" ""', 'I" (' " ' , ' ,",,' ,." ,,',; "" ,,' ,':: '" ',;'," '" ' " "':,-', :': , ,,:,' '" "~I, " ::;:,:: , " :~j " '. ' .; "1liO"". 6' \ \ f'"\ TO: Robert Nesbitt Jefferson County Engineer RE: Striping Contract, MT0766, Rocky's Road Striping Co. FROM: Al Scalf Inspector DATr:: 9/21/lJ8 The Contractor has worked in Jefferson County eight days 8/23 - 8/26 and 8/30 - 9/2. The Contractor was paid "Materials on Hand" in the amount of $25,720.12 on 8/1/lJ8. The invoice indicated 45 barrels of yellow (2250 gallons), 25 barrels of white (1250 gallons), and 31,200 pounds of Beads. The Cqntractor delivered to the Hadlock Shop 3 Barrels of Yellow and 1 Barrel of White on 8/29/88. Therefore, the total gallons available were 2400 gallons of yellow, 1300 gallons of whi te and 31,200 pounds of beads. As of 9/2/8d the Contractor had striped 35.38 miles of SNP/SKIP, 60.61 miles of DNP, 24.86 miles of SKIP, 95.6 miles of EDGE and 633.6 feet of lJ" GORE. During this period the Contractor used 2200 gallons of Yellow, 1100 gallons of White, and 18,200 pounds of Beads. The Yield based upon the Engineers Specification of 16 gallons of paint and 4 pounds of beads per mile of 4" solid line was 25' light on the yellow, 39% light on the white and 4% heavy on the beads. Subsequently, the Contractor was deficient 546.6 gallons of yellow and 429,6 gallons of white. The Contractor is allowed 10% tolerance although these quantities don't reflect this tolerance. Upon review of the Inspector's Daily Reports the Contractor was cautioned on 8/24/88 by Al Scalf "If yield is out of tolerance repaint or we would dock the Contractor." On 8/25/88 Karen Bailey, Jefferson County Inspector, "light on white, light on yellow, and not to go any lighter" and 8/30/&8 Karen Bailey "1 informed contractor that with the numbers he gave me that he was 7% light on white and 5% light on yellow this morning, and not to go any lighter". On 9/13/lJ8, Al Scalf discussed the Yield situation with the Contractor and requested Harold Rocky to make an appointment with Tom Morello, Jefferson County Project Engineer to resolve the yield discrepancies. On 9/15/88 Harold Rocky called Al Scalf and said "Paint sludge had accumulated on the bottom and sides of his vats and this would account for the yield contradictions. He told me that at first his tanks held 300 - 325 gallons, but due to the paint sludge the tanks actually held 250 gallons". The Contractor is due back in Jefferson County the week of September 26 - 30. Currently, approximately 1/2 of the striping is complete, and I estimate the Contractor will require 1 week to complete t e striping and 1 week to complete the placing of Ther op sics. Inspector () ~ c P A-f<t"r'P -, :::,e ~vty Ro~D. \ .J- Als TJ'Tt-L- GDJE L;~e.s . -:::-1~ t: _:>0 C-;? -l ep.; "'\ ' V \~., V& ~O''V ~ ye~ ~+- ~~ +OK ) Ke A L . I PBONE F3ALOGU.E' ~. 1 - ,\ I (Narne) _I-~------ - -- --" -- - ,------ ---- ,1\ Talked w;~re.lCf:Lt:.~-..- of ~'/ik;lyD_f:5l?eE-rs,- I )-N.called LJ Pa,'Y cJlled Too"e _S};,_'T,'(),I"1-._- O"IC _.l7..!5_!'E/o I Subject j6'T07U,(o__-::::_~GJ2e:;:a;L.-/?:Jm/c./d~_19B3 \ What I so;do .5__IJl6::J1?kzG1J.-2_J~.iJJ.,.~-~_--~,-H-fYD- I .SeE'._tlc__=SW/d'O"""-_4--7R - ~s----- 1 108D__<D"lX/:-2.a--e-rag:.7] ke:'"__,_.-</~-l50-.J: 1-0,88. A"t-~O- --rHt'lT ~ ~ j;;-€" fi5S€SSJ.</b. Z>/lZer;."- O-/ry'Ue'E:"e/,I(/(",- \! C0:r..s__~fl$-L-~---7?61B1}LJ1-tUf..,----..----,---___m------- What party sa;d: ,_t'.__~L~_-g,~~_I9-_c..O?'r.:'_OE--~--- ' !-=.~_\S)--~C,~-'---'------'----_"_'-----"-----------------'--------- --"-~~ ------ ---,-_.~-------------,._--------------_.,_.- ..------------.- L ~ ~. ~. , r ~ c [ L 1 I =-___L___~lCo:-6!D,- - tci77J'J-ffi-:7i2fC& C[Tc-i:l:'e?:/ f!7F 7"lf-ci' i --~j)______~7S,____l"9U.O_j4r=:-~GVT~~q ~- --- I _,t8C___~"':::J___S,6f./5C,.,___ cL__~c-?..-:-'V rr77OJ:...r_LelJeT4-." 7l2__________ I .- ~d'._ E7?E.=V1,,"L..A/./'JV.3Q, .1'1.8.3. . ."'-= ~- I. --~-~___/3.€___ /:T$5G7>':S/U.c. ,--~_'S__J), i2e0::, i '. - --@({..b::, }.C.~uU;~___C&5T5 -~.IJ(j.___TO__71:+G___~___ , -1)"l-:Il;;;:L__~__,~d6Z__,nll!!l,e:_,_u'::IflS,,_, d-?~----u.:te:___ --0.9~___~~____JJr____,.ee07_Y) __ ~__ _ -e~, JJ~,____ I,",.,' -----,-~----~L?85,lB'"'j__A=J -,-~--~-~__~,_-SO__.J...,_ --,-~e:----,~,E)_~_tIDD~-e:.s~"j._A:_~_~_ (,'9--a~---.-- ,. -- -__,,,,,,,,'l~.~ ~ IGNED ' rW" ~ . ~flw '-c)'- -. D -..J((}s:::J~ .5:::! JS f'l ~ ...0 JEFFERSON COUNTY DEPARTMENT OF PUBLIC WORKS Courthouse PORT TOWNSEND, WA 98368 > ,",~:;,J(~.t'w#..~~..:~~;,;~ii~t;;;{~;i/i:Sj,;':J"'~;'!':, .._\(t~;r~;~~~<;:l6':fS~,,}$l't7},~,\~"'f!:t'~'~~.~\.C\~\~ ~:;\~';\:"":lt; ~;!SF!EED!*f.;, )0'" ~ ! ....=f';\~~~>i:\'!: j! (206) 385.3505 DATE, ,/;/5/89 SU8JECL~e--Yj' ~, 'S'lZr'?G2- - TE'i2/'-74iI17JO)/ Lb / f -el?--: TohJ.,,~ , />"/T07 b 0: I~ .~ ORIGINAL Shecl-L of.--l.- Do.. 11/2/88 WASIIINGTON STATE DEPART~IENT OF TRANSPOI{'l'ATJON Change Ord~r CHANGE ORDER Number ? fZl o Ordered by Engineer under lerms of Section 01 lhe Standard Spocifications 1- 04. .:I j1\\TO ,Cor.::, Change propo~ed by Contraclor Rockey's Road Striping 916 Garden Hill Rd. Elma, WA 98541 Endo".d by,lZ..ci<r<-/s f2.4j)-.S:t.i?1i~1/L.6..-G:,.: V . / ~ "t?'C<'Q"'i""N""'" _ _ 'e '6.-4~/~'-d'_ _ tL:=LfL_ Sjgnll~ /)ul" Pavement Marking 1988 By: AlIurtwy-i,,-/Il(' /Juh' ..... .. ........."..............."...........,.............'. DESCRIPTION OF WORK .......".... You ore ordered 10 perform lhe lollowing de:s.cribed work upon receipt of on appro...ed copy of th-iS. change order: Add the following items: Quantity Price Total Item if14 Skip Center stripe with no pass 2 . 00 mi. $210.20 $420.40 20 gallon per mile specification Item if15 Double no pass 6.00 mi. $326.52 $1959.12 20 gallon per mile specification Item if16 Skip center stripe 2,00 mi. $68.94 $137.88 20 gallon per mile specification Total add $2517.40 Deduct the quantities stated from the following items: Item ifl Skip center stripe 2.00 mi. $62.50 $125.00 Item if2 Skip center stripe with no pass 2.00 mi. $178.00 $356.00 Item 1ft4 Double no pass 6.00 mi. $275.00 $1650.00 Total Deduct ($2131. 00) . ~nv.;~:~I~dl.eriols and measurement 10 be in occordance with the prO\lisions of the Standard SpeCIfications and Special Provisions for rhe type 01 construe. CURRENT CONTRACT AMOUNT ESTIMATED NET CHANGE THIS ORDER ESTIMATED CONTRACT TOTAL AFTER CHANGE s6l988.50 $ 386.40 $ 61,602.10 HEADQUARTER'S USE APPROVED: _ ~~'Y:iit4/ /, '#/ ~1i1)1l~c;;,~-;;;Cr ~J{,,~ ~ ~ ORIGINAL Sheel~ of..J!.!.- 0010 f12/88 WASllINGTON STATE DEI'AHTMENT OF "J'HANSPOH"J'A"J'ION CHANGE ORDER Chung" Order 01 Number [J Orderod by Engineer under terrns of Seclion of the Slondord Specifi(:olions 1 - 04.4 MTO 766 D Chango proposed b'~ Contractor Rocky's Road Striper 916 Garden Hill Road Elma, WA 98541 Endorsed by: ---Ro.ck~Road_Str...iper_ ,/:!, ;;?:;2""= '/-- t5:-e13 ~.seo.lturo: 1)dh' , ,;" Pavement Markings 1988 By: AtI"rnl')'-;n-j"Cl /Jutl! 'Y~~'~;~'~;d'~;~'d' ;~. '~~;f'~~;';"~h~' f~il~:':"j~'~' d~~~;;b~d' :':"'~~k' '~~o~E~;~i:~'~INo~::~~~d copy of lhis change order: 1. The specifications and contract documents "Time For Completionll page 6, paragraph l~ sentence 1, September 15, 1988 is changed to October 15,1988. \" Item 12 is a new item to include placement of Type II Lane Markers supplied by Jefferson County. The contractor will install the lane makers supplied by the county. The cost will be $205.00 per hundred not to exceed 7.0 hundred. $1,435.00 0. Item 8, 8.5 hundred Type II Lane Markers is reduced by 7.0 hundred as indicated by item 12. (2,170.00) 4. Item 13 is a new item to remove 4.4 hundred Type "y" temporary reflectors at a cost of $50.00 per hundred. 220.00 ($515.00) All work, malerials ond measuremenllo be in accordance with lhe provisions af rhe Standard Specificorions and Special Provisions for lhe type of construe- lion involved. DISTRICT o ::~~~~~L HEADQUARTERS o ::~~~~~L ORIGINAL CONTRACT AMOUNT CURRENT CONTRACT AMOUNT ESTIMATED NET CHANGE THIS ORDER ESTIMATED CONTRACT TOTAL AFTER CHANGE 62,503.50 62,503.50 (515.00) 61,988.50 DISTRICT USE APPROVAL RECOMM~N~ED nn ~1. ~ _2/-./t./86 /',."jl".tH",IlIf"'I'" /Jut(> G3"" APPROVAL RECOMMEND HEADQUARTER'S USE :~~ I I~r.:bu',,)' Con.{/ructmn Ung;net'r %/~ ~8:.. '7--'-%:;:: DISTRICT ADMINISTRATO By: DOT , , . .: .. :'~ ' <: ".. '. :":""", , ':",.' ~T;:}r- ' ":",,, ..J: ',' '.':, "",' ',";' , , ,-:, ' " " -':"" ',' ': :," ' ". , 1'- " . , .". : " ", :.'". .,,;'1";" '. ." I :.;- .' ~ : ." ! . , "''',: , ',' .'.,'., , "; .... : "', ' , " ,:':,:.. " ";"" : i '. ., i '. '.; I,. i.;, t I .' ' ',' ',' .,.".'. ',,:, . .'..','.' "'I ::;..,:' "', ' '< ,:~;~:: ".:, ..' " ',', i .- ".! , >, ':'i, . " " ': :'..-: L '.' " " :;' ': '<, ','. ":," ' , :;": " '.. : ': ;, ,:" "" ,'" , '," " '\ i .', "," ',-', ':':" ,':," ,:' ":', ,', " ' ',' :, ,',', ",.,' , '.' " . , "~. " I ~" .' :': :.' :. }, ..',:' .- '; '. ' , . ,; ,>' . " '.." :' :'" ' I;.;" : ":',,, : , ' <, . ',;' ,"."..".' :,,' , '''. . ! L ", L L ..... .~ ,G4 \...- . " Shoo~ of 41--1 Dole -942/88-- W ASIIINGTON STATE DEPAR'nll,NT OF TRANSPORTATION CHANGE ORDER xC] o Ordered by Engineer under torms 01 Section of the Standard Spccificoliom I .. 04. 4 Chango proposed by Conlraclor Rocky's Road,Str1per, 916, Garden R111 Road 1l1ma, }fA 98541 Endor5~d by.;: : ,~'~=~",~-;,3~,!1P~r /./< -;"/;:?-.L..;.' '7- IS"/:?U ~ ~i'.~~ ---0;;;;:-- Title {c]v/",-,J; it ;r.. Cmu-;}.,-~;".:,. b.y Surt!ly: ~'/Jf!n n'quin.JJ \i,-,' ;',-..'" ,'! A""' PROJECT ENGINEER I Chongo O,der 01 Number MTO 766 By: - i ~"""... ...".... Pavement,::M4rldngs '1988 AtllJrne:y..in-joJl." J)olt,. ..,............................................... ..... ...... ...... ...... ......OESCRIPTION OF WORK. ............ .... ........ ,.:.: ..... You ore ordered 10 perform Ihe following described work upon receipl of on approved copy of ,his change order: . " .' I I' . t I. :.',,', ~ , (, j , 1. The specifications and contract docun:ents "Time For Completion" page 6, paragraph I, sentence I, September 15, 1988 is changed to October 15,1988. 2. Item 12 is a new item to 1nc1ude placement of Type II Lane Markera aupp11ed by, Jefferson ,County. The contractor will instll11 the lane makers supplied by the county. The cost w111 be $205.00 per hundred not'to exceed 7.0 htmdred. Itemil~;-8~5 h';ndr~d Type' ULane Markers is reduced by 7.0 'hundred as1nc1cated,by:itemI2. .'.. " . , 4; ,Item 13'1s anew item ,to rOlllOve 4.4 hundred Type ''Y'', temporary ref1ectors at a cost of $50.00 per htmdred. I,' $1,435.00 220.00 ($515.00) .. , ~ ~ ,,,I..,,, .;"....'. :1 ~.,' ....,',1. . · . :', ".. , .,;, it : ,...,.. ...; .:, ", .i',:;;".1 . . '." . ,.'.....'.,, .,......'\" ; ..",' , .."':.,.. . ..,.,. .,' , ,", - ',',', ..., ,.', , , '," ';;:" "''','' , , , '.', -',':, <, ' ,:'" ,'" '."'. ;'...'.""...' ',:' " I.' "", i i," ::' i,,'" " J ", All work. mOle:fols and me~sur;m;~i 10 b: tn acco'rdonco ~irh~lhe~pro'vi~ions of 'h~ Sla~d~~rd Sp~cilfi~otio'~S o~d Special P;ovision~ ror Ih~'type o~ conslruc- lion involved. . DISTRICT D ::~~~~~L HEADQUARTERS D ::~~~~~L I ORIGINAL CONTRACT AMOUNT $62,503.50 I $ CURRENT CONTRACT I AMOUNT 62,503.50 $ ESTIMATED NET CHANGE I THIS ORDER (515.00) $ DISTRICT USE APPROVAL RECOMMENDED HEADQUARTER'S USE APPROVED: --:~...., ,-' ,,' 'I.. , ' ),." ;' /r' /' lJ<Jtr o APPROVED ~I/ 1,-' lI~qbwtl:V Construction UnR;necr ., , .- 1"fljl.a !':"Nj,,,~,'r o APPROVAL RECOMMENDED .,,/ DISTRICT ADMINISTRATOR .I .,. " By. DOT Dalo: rO~M .21.003 JlfVISf09/79 ESTIMATED CONTRACT TOTAL AFTER CHANGE 61 988.50 , ' .,:/r' ~,. ..' IJ.,tr , ':.J ,:,"',. ,-:," ... -:" /,c. /"; ~',,~ '",'" ',' , ..', ,>' , -,' ,',: ,: ' ."7".' . ,.'.'..',.. " '. i'.: ,." " " . . '.. ," ,,' :::: , '...:,', ,::':, :' ;.. ':' ,:', : " ',,'''' ':.. ......... .'. .'.: .: ,',. ,,' ,"'"',.', " "',' ," '. ., , "" " ' ,.:"',.': ,;",'. , ' ",', " ", " ,.' . " ".., ',,' ",' .. ' " .,.......:. " , ':.".., ~ " ~'> .. ~I?;'}:' {;if:f ~ CHANGE ORDER 5~ EL-I'<'-A- q\I~\'B6 Chango Order Nvmber ORIGINAL o (() Sheel~ of~ Dale ~2/88 WASHINGTON STATE DEI'AIlTMENT OF TIlANSPORTATlON 01 KJ Ordere~fbl~:n~:nede~'dnS~e:c:fi~r;;~Oo~s Section 1 - 04.4 (,,"l;I"! I.", MIO 766 o Change proposed by Conlroclor Endof5ed by; ~,.kJr I Q 'Rn~d-.S-tU.pGr_ e,mtr.....t.,r firm N~",., Rocky's Road Striper 916 Garden Hill Road Elma, WA 98541 SiA"iJll4"" 0",1.' ~ '!:'_ 1.1 ,." i/..' r. Tille emu",,' /f;l'e,. by SUfl'I)'! (<<'b.'n f"l'"uirl'J) , . "....~, 1 " i. .Pavement Markings 1988 By: AIIIJmeY';Pl-jfKI v,,"" .................... ............... ................... ...... ... ........ ..... "" DESCRIPTION Of WORK ......,.... ...... .... ,.... ........... . You ore ordered 10 perform the following described work upon receipt of on approved copy of this change order: 1. The specifications and contract documents "Time For Completion" page 6, paragraph 1. sentence 1, September 15. 1988 is changed to October 15.1988. 2. Item 12 is a new item to include placement of Type II Lane Markers supplied by Jefferson County. The contractor will install the lane makers supplied by the county. The cost will be $205.00 per hundred not to exceed 7.0 hundred. $1.435.00 3. Item 8, 8.5 hundred Type II Lane Markers is reduced by 7.0 hundred as indicated by item 12. (2.170.00) 4. Item 13 is a new item to remove 4.4 hundred Type "Y" temporary reflectors at a cost of $50.00 per hundred. 220.00 ($515.00) All work, moteriols ond measurement to be in accordance wilh the provisions of the Standard Specifications and Special Provisions for Ihe type of construc- tion involved. DISTRICT o ::~~~~~L HEADQUARTERS o ::~~~~~L ORIGINAL CONTRACT AMOUNT CURRENT CONTRACT AMOUNT ESTIMATED NET CHANGE THIS ORDER ESTIMATED CONTRACT TOTAL AFTER CHANGE 62.503.50 62,503.50 (515.00) 61,988.50 DISTRICT USE APPROVAL RECOMMENDED HEADQUARTER'S USE APPROVED: Prujf','IJi".-:io/I'rf o APPROVAL RECOMMENDED !JaU o APPROVED 1-I;~hwa.v Construct;'", EnR;n('C'r 1)",., DISTRICT ADMINISTRATOR By: DOT Dote: PHONE DIALOGUE' ~ I (Name) -,8'-ett..t;~~-'<4ttL._...___..._..____._. Talked wi'" IJIrM.tdl4 .J::;-,-ce',;f:10 of -.JH,e ,,8...!Y"cJ_..C;,I1~/tTS._ 1~lIed rJ Party called Time __f"~:I:!J_/!~._ Date _.L6L?-y"if'%:._ SUbjec, .~~,y:>:-k~..::{;-,<!JR/'<&.~.._.B.Zl17'd, ~7L'flr,;';:"!:~r--__.YA~/d.G.. What I ,aid:..ThJ-J() f..h~_Krr0.~ 7UAr bV H~o O~Jlpt..(~-...~---"~~<.c;> OLPA/J"lLC?J;~;L~~'--)._b",:!:"__ h"'l>_..J\J.~"!:"._1D:{?'1_fi'tKJ__ ...4.,,<-:!._r-<CJ(?,.c..._ !!O~ ~,__~.E Ct1?~~Q-'lU-9.A"L..1'~.~~l'LH'<::_~~<l~. CJJJ t+ 15 WA"'-._!Q_f&!<!E,.x"J'?I:O.~.IJ..F:~ JE. (+-fLOO~t!)~L.?!:!:WJ_t)_e....,_~L~~~.I,tAJ~~CW~_g:>._ What narty ,aid: --?IJJ.!L_J"1,e._r.2A!.Q~ $ r(jo-~':L~L_4JkJJJ_0t:!Cf;~_ _~I',LU.A"-""-)_'[:1{,)---.!,)Q'O.EY_'1:J:f:~~ON.Q.}N.l>__t':.<)___l~_____ _"t.Uf~ T IIU CD . -----_.__..._._------,--_._.~.__...,---~------~-- Action Needed _(.J_~H:::g L-1Lh-/?_R..-.. 1r-::.JJ!.e~e:S.2~1Z'i._____________ PIlm1E DIALOGUE' r: , I (Name) &UC:-L!: //-ll/.t2,,!:.______.__ Talked with ~'7'I1JCII<1 7: J:::,.,-cJ.l $tI ol~~X/!Jt:EI?.--,,----, I~alled 0 Party called Time k;.L~I?~--- Date ~t2..::..~:l-8.E?_._",______ Subject .PO<:Ley''s~~;l!I&~{blVp:lA' -r _~ )fI;t]~~/_!ft~~~~- #"'~KINt; 178&. What I said, .f--,,"L/.E.~<fA /iJ-r,(!JC"''' jJr"~GI,I ,L!rrlJel.$Y IIV .pAc-r .pcl~ //VTe-,l?/v'AT"lONA (. F II:; LU-_ -r>" 1N:Se/~ A^,c4 <!-o t;<"",,,,,,,,- ,.,...",,--S'iJK'-;'r7' -""o',e'-rife At!1ove ,et:P"4Ile~o C-<JAJr/Lp"T" 7'-"KJ~ "G~,,"Ete";Oi<J c.O. J~ ",aVJJVG. P/t09z;-"s"".~W7rM--r#JC-=N~Jt;Ac:rO~/~~y''--.Ro''''''-:5'n<J/''J''''''-;.-X- ExPl-"'J;J&O 1"H-A7 r;l-,E; co,.;rJ(.Acrol!. I<!. Ii!t/NNINr. OUr tJ,c 'Tl/'lt: ~H-I4""_"'He--4!U"'''''7.....-t),c--WdJtc~-774''''r-IJJd5-8e6.v-CO''''I''",aet)-- C)d"'I',iUIf.. 6'0,,") /" O$J""/C/f!:.AJ..... -z: 'Tbl.-,c)/JdT.tIJdr' t/NO",;,< 'THe: ,c,c){/JS4 CJr-:--7J-IE-Jo&FF-.Ea-" llN_C.c.:l._p,eO:$,e.c.U7"IW('--J"=ItAJ &~_r_ WA:;'-- M.<Ii!-t/'Jv 77I.€' D::>,vOJAJ!;. ,cG,"'^,W ,a""A~C ",0 ~uu~ r",JcrS J J",.>>:J 'T'+4r What party said' . _4Jff ,d1l..1E. .2'V..c~~J"r/JV(., ?O i<.J(y!t.~ WI7Y. C~"'- ~ c.-~tiff'''fff~p Wi=;6 .wJlf8~ A;JKJ ;;:p.tD-C-7P"'DV ifJO-';ee>>t.Mi4L- __ '-.Z:~""_lfb~"'I'..!.!;"_A-c.~v-I t.UU-."==- =N<r7"c"C-~cKif::I.:1.~^"O "",er /hl'1 ~/l/oCAJ ..,-uJ<l r ;+€ ,4H40 8,e~ t"$.<!,-;O/lM. Action Needed _K'4;~ p 'TH-1= ~>?IIVG "'''f~!'!C '1_I./fJ.E.~t!...":!...",-t:J_J"!.2_ '7l+e: /,~GI2.1E:7S 77+-1!Z C6f'J"-I2.,o. <.:, -- w~ ,_....,--"".. ""_.....................~~ M n / PROPOSAL NT0766 TO: The Board of Jefferson County Commissioners Jefferson County Courthouse port Townsend. Wa. 98365 THE UNDERSIGNED AS BIDDER DECLARES; That he/she has personally examined the site and premises of the proposed improvement and determined the amount and character of the work and material necessary to complete same in compliance with the accompanying contract plans. and specifications; that he/she has been regularly engaged in contract work for /c/ years. The undersigned proposes and agrees if this proposal is accepted. to provide all necessary machinery. tools and equipment. and all other means of construction to do all the work and in the manner therein prescribed and according to the requirements of the Engineer as therein set forth at and for the total sum set forth below, which sum shall be adjusted in final settlement according to the amount the actual quantities in construction are increased or decreased from the amounts given in the list of quantities at and for the following unit :. :QUA.~ITY:UNIT DESCRIPTION AMOU3T: TOTAL :\~--------:-----:---------------------------------:---------:----------: 1r;z...:'1i: 47.6: MI. : SKIP CENTER STRIPE : : : :--:--------:-----:---------------------------------:~~_~e_:~~~~~~~ :2: 57.5: MI. : SKIP CENTER STRIPE WITH NO PASS: ~--:--------:-----:---------------------------------:l~l2~qf2:~~~~}~~s? :3: 3832: L.F.: PAINTED a" GORE STRIPE :--:--------:-----:---------------------------------:-___~~J2_:----3~}~ :4: 90.6: MI. : DOUBLE YELLOW CENTER STRIPE :__:________~-----:---------------------------------:~_~~~~_~3~-Z~~-~~: :5: 1305: L.F : PAINTED BARRIER STRIPE :--:--------:-----:---------------------------------:-___~~~:---3-9J~~~ :6: 117.8: MI. : PAINTED EDGE STRIPE :--:-------~:-----:-------~-~-----------------------:L~J?_~_:L2T?~l~~ :7: 634: L.F.: PLASTIC STOP BARS :__:________:_____:---------------------------------:-__~~~_:--~L~~~~~ : 8: ~: HUN : TYPE II LANE MARKERS '-fIe,':; .00: :__:_---~:~_:_-~-_:_-------------------------------_:-~~q~~~_:_~~~~-~~. ; 9 ; . 3; EA. ; PLASTIC TRAFFIC ARROW . . . 5'0. eJO: I SO. 00 : .__.________._____._________________________________._--______0______----- .. .. ... : 10: 3 :SQ.YD: REMOVE PLASTIC TRAFFIC MARKINGS St?C:>O. : , 5'0.00: 13 .. ,., -----:---------------------------------:--------- ---------- 28 L.F. REMOVE TEMPORARY STRIPE /.OV '2 e. 00 -----:---------------------------------:--------- 12.. TOTAL BID c;;,z, SO:s..5'O A proposal guarantee in the ~m o~f the total bid is attached hereto in the amount of q. I ;;;-v.c> 'l:/ . NAME OF BIDDER Roe-KeV'.s !?",.o(> S,f;2/PIN& 00_ ADDRESS (1/ t, G.4e\')~"f n,t.L ReL CG-nA 1.,v.4<;H. 585>-'1'/ Dated this ~~ day of Off icial H~/ Title 0CA'VK",'L) _-r;:.1..../~ ('? Signature of Authorized . 1988. 14 I I I I I I I I I I I I I I I. I I I I .~ ~. ("j PROPOSAL MT0'16G TO: The Board of Jefferson County Commissioners Jefferson County Courthouse Port Townsend, Wa. 98365 THE UNDERSIGNED AS BIDDER DECLARES; That he/she has personally examined the site and premises of the proposed improvement and determined the amount and character of the work and material necessary to complete same in compliance with the accompanying contract plans, and specifications; that he/she has been regularly engaged in contract work for /G/ years. The undersigned proposes and agrees if this proposal is accepted, to provide all necessary machinery, tools and equipment, and all other means of construction to do all the work and in the manner therein prescribed and according to the requirements of the Engineer as therein set forth at and for the total sum set forth below, which sum shall be adjusted in final settlement according to the amount the actual quantities in construction are increased or decreased from the amounts given in the list of quantities at and for the following unit prices: : PLA." :. :QUA3TITY:UHIT ITEM DESCRIPTION AMomrr TOTAL :--:--------:-----:---------------------------------:---------:----------: :1: 47.6: MI. : SKIP CENTER STRIPE :--:--------:-----:---------------------------------:~-~~~q-:~~~~~~ :2: 57.5: MI. : SKIP CENTER STRIPE WITH NO PASS: ~--~--------~-----~----------------------------_____~J~L2~qf2~~~~~2~:9_q :3: 3832: L.F.: PAINTED an GORE S'rRI?E :--:--------:-----:--------------------_____________:-___~~q_:----3~~~ :4: 90.6: MI. : DOUBLE YELLOW CENTER STRIPE :--:--------:-----:--------------------------_______:~_~~::~_:3~-Z~~-~~ :5: 1305: L.F : PAINTED BARRIER STRIPE :--:--------:-----:---------------------------______:-___~~~:---~-7~~~ :6: 117.8: MI. : PAINTED EDGE STRIPE :--:-------~:-----:---------------------------------:L~-~-q_~L2~2~l-~fJ, :7: 634: L.F.: PLASTIC STOP BARS :--:--------:-----:---------------------------------:---~-~q-:--~~?~~~~~ :8: 8.5: HUN: TYPE II LANE MARKERS :__:_------_:_---_:_-------------------------------_:-~~q~~~_:_~~~~~~~~~ ;9 ; , 3; EA. ; PLASTIC TRAFE'tC ARROW . . . SO. c)O: I So. <)0 : :--:--------:-----:---------------------------------:-------~-:----------: : 10: 3 :SQ.YD: REMOVE PLASTIC TRAFFIC MARKINGS ->"".00.: , 5"0. oD : 13 . ::.'.' ;,.".. :. ,. "'t ,. r , } , , .~ F ~. ,. ~ >, l ." i , ~. +" \. ~'" i' ! ,~, l ,\ : L.~"". ..... ;\ .:. .... .: ,.. '.. . . .....:. ......:" ,.' ... ...., ::'..... :;:, . :' .:. :':." I \ I I I .\ I I 1 I I I .1 J I I J I I '.' ..... ;... , . ,~ .~ .. . . : .> .' ...<~ ..... . :. -----:---------------------------------:---------:----------: : 11: 28 L. 'f!. REMOVR TE:1J?ORARY STRI?E -ze.oo~ ...; ..f: '..'.' '. . '. ': .....: ..' .. .:., ;..... . .:, . .' '.. ...,.:.. . ',: .".' ... :'j... .. '., . .; ..".' ..... .'. .,.... ....\ ....: ',<,< ...:... ..... .'. '.,'. .':..,'.;. .:.. ... .:.. ......... .. .> .,'. :.:. .. ....'. ., . .:. .. ,'.. ... ., ':., ...'.... '.' .:: '..' ...... . . . '......... . ... ' ...... . . .. .... ....:. .:' ,.'. .." ...... ' .' .. : .:.... . ..... ... ...,'.... . .. .... . '. . :,' .. ...; . .. .. ......' '..: ::, .... : '.. .. ... ,.'.' .. . '.". :" :. ....':. .:i.'. .; .: .. . .. .".. ...... ..' .... ., .......'.... i.. ...'. .. .. '.. . ".. .... .:.. ." . ;'.. " " ...' ' ',,' ;. . .'. ...:.. .'. ..,.. '..:'. :.', .: . .,',:,.:'.. . .. ' . '.' ..:.,..... ....:. ,. .. . ......, .. .', ." . . .'. .... " ...::.'. .. . :. .:,:. ,)'i' '. .' . .'.:' , . . " , . .:.:. .... ....:... . ,'.. . :' ..: .... .. . . .', .'.'.:.' ':. ... ...' . '..'. ,.,,:, '. " ,'.':'.,:;-' ''''.,'''1 ",' ~ /.ou : : :--:~------- -----:---------------------------------:---------:----------: TOTAL BID c;,z, S03.S"O A proposal guarantee in the ~m o~f in the amount of ~. I.:;c:;.o C/ NAMR OF .BIDDER Roc-k€Y'5 Ko41'> the total bid is attached hereto S.-r(2IPIN& c,o_ ADDRESS 9/~ G,4r:!oE"r Ec..4'7A . 1/,,/,4<;H. 11"_'- Rd- <J8S-Y/ Signature of Authorized Official He.-.<.'/ ,kC.../!.. , Title 0rAJAJK.'z] ~ Dated this -ZG. day of -1-;"..<..n~ , 1988. 14 . . ..,_.,.._"""U._U..,. I :.'''.. i", . \ I -I I I I I I I I I I I j I I ] j ) :- TABLE OF CONTENTS INTRODUCT ION. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . AMENDMENTS TO THE STANDARD SPECIFICATIO~S SECTION 1-01, SECTIO:<' 1-02, SECTION 1-05, SECTION 1-09, SECTION 8-09, SECTION 8-22 DEFINITIONS AND TERMS...... ........................ BID PROCEDURES AND CONDITIONS................. ..... CONTROL OF WORK......... . . . . . . . . . . . . . . . . . . . . . . . . . . . MEASUREMENT AND PAyMENT................ ...... ....... LANE MARKERS............. . . . . . . . . . . . . . . . . . . . . . . . . . . . PAVEMENT MARKING................. . . . .. . . . . . . . . . . . . . SPECIAL PROVISIONS INTRODUCTION. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . PREQUALIFICATION OF BIDDERS.................... ........... ....... DATE OF OPENING BIDS............................................. DESCRIPTION OF WORK. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . CONSIDERATION OF BIDS.... . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . PREVENTION OF ENVIRONMENTAL POLLUTION AND PRESERVATION OF PUBLIC NATURAL RESOURCES........... . . . . . . . . . . . . . . . . . . . . . . . . . . . STATE SALES TAlC.......... . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . GAME AND FISHERIES REGULATION......... ......... ..... ............. OBLITERATION OF PAVEMENT MARKINGS......................... ....... PAINT DAMAGE. . . . . . . . . . . . . . . . . . . . . : . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . WAGES....................................... ...................... WAGE RATE FOR~IS. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . FUNDS. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . TRAFFIC CONTROL.......... . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . TIME FOR COMPLETION............................................. SOURCE OF MATERIALS................... . . . . . . . . . . . . . . . . . . . . . . . . . . . PAVEMENT MARKINGS........ ....................................... . OTHER PROJECTS........................ . . . . . . . . . . . . . . . . . . . . . . . . . . . 3ID PROCEDURES AND CONDITIONS........... ....... .................. STANDARD PLANS................................................... PROPOSAL. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . CONTRACTOR'S DECLARATION OF OPTION FOR MANAGEMENT OF STATUTORY RETAINED PERCENTAGE......... .................... .... .. . NON-COLLUSION AFFIDAVIT.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . CONTRACT (SAMPLE I . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . CONTRACT BOND {SAMPLE)........................................... PAGE 1 1-2 2 2 2 2 2 3 3 3 3 3 4 4 4 4-5 5 5 6 6 6 6 6-7 7-8 8 8 9-12 13-14 :5 16 17 18 "'" ,.... \ I I I 1 I I 1 1 I I I \ I I J J I ] IlITRODUCTION The following amendments and special provisions shall conjunction with the 1988 Standard specifications for Road, Municipal Construction adopted in January 1988. be used in Bridge, and Where the term "Commission" or "Washington State Transportation Commission" appears in the Standard Specifications or Special ?rovisions, it shall be interpreted to mean the Board of County Commissioners of Jefferson County. Where"the term IIDepartment'l or II Department of Transportation" appears in the Standard specifications or Special ?rovisions, it shall be interpreted to mean the Director of ?ublic Works of Jefferson County and such agents as are authorized to act in his behalf. Where the term "Engineer" appears in the Standard soecifications or Soecial ?rovisions, it shall be interpreted to mean the County Engineer of Jefferson County, acting directly or through his duly authorized representatives. Where the term "State" appears in the Standard Soecifications or Special ?rovisions, it shall be interpreted to mean jefferson County acting through its authorized representatives. Where the term "State Treasurer-Department of Transportation" appears in the Standard Specifications, it shall be interpreted to mean Jefferson County Treasurer, acting through its authorized representatives. AMENDMENTS TO THE STANDARD SPECIFICATIONS The following Amendments to the Standard Specifications are made a part of this contract and supersede any conflicting provisions of the Standard Spec if ica t ions. For informational purposes, the da te following each Amendment title indicates the implementation date of the Amendment or the latest date of revision. Each Amendment contains all current revisions to the aoolicable sections of the Standard specifications and may include references which do not apply to this particular project. SECTION 1-02, BID PROCEDURES ~~ CONDITIONS (Januarv 25, 1988) 1-02.13 Irregular proposals Item (bl under No.2 is deleted 1 I I I I I I I I I I I I I I I I .J I I I . ..... I!: j- .' SECTION 1-05. COYTROL OF WORK (March 14. 1988) 1-05.12 Final Acceptance The first sentence of the first paragraph is revised to read: The Contractor must perform all the obligations under the contract before final acceptance can occur except as provided in Section 1-09.9 for unilateral acceptance. SECTIOl!f 1-09. MEASUREMENT AM) PAYMENT (3anuary 4. 1988) 1-09.6 Force Account Item No.6, Contractor Markup on SUbcontractors, is revised to read: When work is performed on a force account basis by approved subcontractors, the Contractor will be allowed an additional markup equal to 5 percent of the total cost computed for 1, 2, 3. 4, and 5 for all administrative costs. SECTIOlf 8-09, LANE MARKERS (April 11. 1988) 8-09.3(4) Application Procedure The first sentence of the first paragraph is revised to read: The marker shall be affixed to the oreoared oavement area with sufficient adhesive so as to squeeze out a small -bead ~f adhesive around the entire periphery of the marker. SECTIOlf 8-22. PAVEMENT MARKING (3anuary 4. 19881 8-22.2 Materials The second sentence of the second paragraph is revised to read: Glass beads shall comply with specifications for adherence coated glass spheres. 2 I I I I I I ] I I I I I J J I I :1 I j 1<- ~. ,F .- j . SPECIAL PROVISIONS The following special provisions supersede any conflicting provisions of the 1988 Standard Specifications for Road, Bridge, and Municipal Construction adopted in January, 1988, and the foregoing amendments to the standard specifications and are made a part of this contract. It shall be understood that all references to state officers in the above mentioned standards shall mean the corresponding county offices for the purpose of this contract. For eKample, all references to Highway Commission shall mean the Board of County Commissioners, and all references to the Director of Highways shall mean the County Engineer. The term "Engineer" as used in these specifications or in the standard specifications, whenever they apply, refers to the County ~ngineer, County of Jefferson, who is in charge of this work or in his absence, the County Engineer's representative. The ~ngineer may be contacted at the Courthouse, Port Townsend, Wa, 98368, Telephone Number 206-385-9160. PREOUALIFICATIOlf 011' BIDDERS (October 22. 1984) Section 1-02.1 of the standard specifications is deleted for this project. DATE OF OPENING BIDS (September 17, 1984) Sealed bids will be received at the following location before the specified time: Jefferson County Commissioners Office, Courthouse, Port Townsend, Wa. 98368. The bid opening date for this project shall be Mondav, June 27, 1988. The bids will be publicly opened and read after 10:45 A.M. on this date. DESCRIPTION OF WORK (Januarv 25, 1982) This contract provides for the pavement marking of various Jefferson County roads, all in accordance with the contract plans, these special provisions, and the standard specifications. CO~SIDERATIOlf OF BIDS (November 2, 1981) Bidders are notified that all bids are likely to be rejected if the lowest responsive bid received eKceeds the Engineer's estimate by an unreasonable amount. In the event all bids are rejected for this reason, this project may be deferred for readvertising for bids until a more competitive situation exists. 3 .,~ r~'. i~ r", \ 1 I 1 \ \ 1 \ I 1 I I \ .\ \ I J I I PREVENTION OP ENVIRONMENTAL POLLUTION AND PRESERVATIO~ OF PUBLIC NATURAL RESOURCES (June 11, 1984.) In addition to the requirements of section 1-07.1 of the standard specifications, the Contractor shall comply with the follo'..,ing environmental provisions which are made a part of the contract documents. A copy of the environmental provisions is available to the Contractor at the project Engineer's office. If the contractor's operations involve work outside the areas covered by the following environmental provisions he shall advise the Engineer and request a.list of any additional environmental provisions covering the area involved. A copy of any additional environmental provisions is also available to the Contractor at the Project Engineer's office. Regulation 1 Olympic Air Pollution Control Authority STATE SALES TAX (November 2. 1981) The work on this contract is to be performed upon lands whose ownership obligates the contractor to pay State sales tax. The provisions of section 1-07.2(1) of the standard specifications applY. ~~ AND PISHERIES REGULATIONS (November 2. 1981) No hydraulic permits are required for this project unless the contractor's operations use, divert, obstruct, or change the natural flow or bed of any river or stream. or utilize any of the waters of the state or materials from gravel or sand bars. or from stream beds. OBLITERATIO~ OF PAVEMENT MARKI~GS (Mav 2. 1983) construction Requirements Where shown on the plans or where designated by the Engineer the Contractor shall remove pavement markings. The pavement markings shall be obliterated until blemishes caused by the pavement marking removal conform to the coloration of the .adjacent pavement. If, in the opinion of the Engineer, the pavement is.materially damaged by pavement marking removal, such damage shall be repaired by the Contractor at the contractor's expense and to the satisfaction of the Engineer. Sand or other material deposited on the pavement as a result of removing stripes and markings shall be removed as the work progresses to avoid hazardous conditions. Accumulation of sand or other material which might interfere with drainage will not be permitted. 4 I 1 I I I I I I I I I I I I I I J I I ,:It '. ,,:,. ~ Measuremen t Removal of strioes 4 inches or less in width will be measured by the actual linear {ootage removed with no deduction being made for the unmarked area caused by the skip pattern in center stripes and lane stripes, Removal of stripes in excess of 4 inches in width and of irregular areas such as traffic islands, etc., will be measured by the square yard. Removal of traffic arrows and traffic letters will be measured by the unit. PaY1llent Payment will be made for such of the following bid items as are included in the proposal: "Removing Paint Stripe", per linear foot "Removing Plastic Stripe", per linear foot "Removing Painted Traffic Marking", per square yard "Removing Plastic Traffic Marking", per square yard "Removing Painted Traffic Arrow", per each "Removing Plastic Traffic Arrow", oer each "Removing Painted Traffic Letter",-per each "Removing Plastic Traffic Letter", per each The unit contract price(s) for the above listed'item(s) shall be full pay for all work specified. PAINT DA.~GE The Contractor is responsible for all damage from spills, spatters and over spray that occurs on this contract. All costs for furnishing labor, equipment, materials, and tools necessary in repairing paint damage shall be incidental to and included in the contract price. WAGES No workman, laborer, or mechanic employed in the performance of any part of this contract shall be paid less than the .Prevailing Rate of Wage" as determined by the Industrial Statistician of the Department of Labor and Industries. The schedule of prevailing wage rates for the locality or localities where this contract will be performed is by reference made a part of this contract as though fully set forth herein. Current wage rate data will be furnished by the Industrial Statistician upon request to: Department of Labor and Industries Industrial Insurance Division General Administration Building Olympia, WA 98504 Telephone (206) 753-4019 5 . ',.. .... . .. : .'.' '.:" :. f ?::{ ". t 1>" 1" t'" ,f r~ r' ~ r,. \,'i IV \ .'. . I \ t . 1 I l r" \ i (i:.' .. ;. f !"./ Ii '\ .i. ,.' , . - :.. ' .::,: :1' :.: "" .. '. --". .,' '. j,,;:, ...... .., .,.. ,.' -c;-:', ... ';'" ' . .'.'... :' i:, . "":",.:'.'.. L"- \ '.".: .,' < ':, , ',...".. ". :. ..;..'; ",.' .....'.,. .,.: .....' :: . . '.':.'.... ...':i. .. -. :,.., . ",: ....... . :"; , " ".'. ".... . '., "'.:. '. .- -..... - .'..,' ;.,... '.: .",' .;.; ;:i, ':" .' . .'..,' :":', '.' -' .. .'." ...'.. 1 I ,. . ... ,.. I I I I I I j r I I I I j J I J J I I ~t. .~ ~. -, ~AGE RATE FORMS Section 1-09.9 of the standard specifications is revised by replacing the sub-section titled Required Do~ents with the following: Before payment is made by the Local Agency of any sums due under this contract, the Local Agency must receive from the contractor and each subcontractor a copy of .Statement of Intent to Pay Prevailing Wages. (form L & I Number 700-29) approved by the Washington State Department of- Labor and Industries. Upon completion of this contract, the Local Agency must receive from the Contractor and each subcontractor a copy of .Affidavit of Wages Paid" (form L & I Number 700-7) approved by the State Department of Labor and Industries. In addition the Local Agency must receive from the Prime Contractor a copy of .Release for the Protection of Property OWners and General Contractor" (form L & I Number 263-83) approved by the State Department of Labor and Industries. These affidavits will be required before any sums retained, according to the provisions of RCW 60.28.010, are released to the contractor. Forms may be obtained from the Department of Labor and Industries. A fee of $12.50 per each "Statement of Intent to Pay Prevailing Wages" and "Affidavit of Wages Paid" is required to accompany each form submitted to the Department of Labor and Industries. The Contractor is responsible for payment of these fees and shall make all applications directly to the Department of Labor and Industries. These fees shall be incidental to all the bid items of this contract. If using the occupational codes for wage affidavits and payroll, and if the project involves more than one jurisdictional area, the Contractor shall reference the area just after the occupation code number. For example: 10-0010Yak.e. FUNDS Jefferson County road funds are involved in this contract. TRAFFIC CONTROL Section 1-07.23(5) of the standard specifications shall apply. TIME FOR COMPLETION This project shall be completed in accordance with the orovisions of Section 1-08 of the Standard Specifications on or before September 15, 1988. SOURCE OF MATERIALS No Source has been provided for any materials necessary for the construction of this improvement. 6 . . . , .'.- ... , I', . "..".. ..'". , ..... .", . .'., : '< ' :.: , ...y'"... '..',,'.'.'" ,. . :.. '.; ::" :.. ',' ;: .' , . .... '. ' ... .," '.': - ~I .".. ,.1:' , '. ,. ..;.,' ~ ~ ' : ..:,' .. :. '..,' t, : : r.,' .. " '.'. i j j l 1 < I j ',.' .'."':1 ,.. I I I I I ) I I I I , I J I j J ./ I j The Contractor shall make his own arrangements to obtain the necessary materials at his own expense, and all costs of acquiring, producing and placing this material in the finished work shall be included in the unit contract prices for the various items involved. PAVEMENT MARKINGS Auqust 17 , 1987 Materials In accordance with Section 8-22.2, the plastic material used to form pavement markings shall be one of the following: * * 1. ** 2. ** 3. ** 4. ** 5. 3M STAMARK brand pliant polymer pavement marking film, 60-mil thickness, coated with pressure-sensitive adhesive, manufactured by 3M company, 3M Center, St. Paul, Minnesota 55101. prismo brand thermoplastic pavement marking material, 60 mil thickness (HT60), coated with pressure-sensitive adhesive, manufactured by Prismo Universal Corporation, 300 Lanidex Plaza, Parsippany, N.J. 07054. Prismo brand thermoplastic pavement marking material, 90-mil thickness CHT90), coated with pressure-sensitive adhesive, manufactured by Prismo Universal Corporation, 300 Lanidex Plaza, Parsippany, N.J. 07054. Seibulite MM pliant polymer pavement marking material, 60 mil thickness, coated with pressure sensitive adhesive, manufactured by Seibulite of America, Inc., 3136 East Victoria Street, Rancho Dominguez, California, 90221. Cata-lite pliant polymer pavement marking material, 60 mil thickness, coated with pressure sensitive adhesive, manufactured by Ferro Corporation, Cataphote Division, P.O. Sox 2369, Jackson, Mississippi 39205. 6. Pave-Mark Hydrocarbon formulation, 125 mil thickness, hot extruded thermoplastic, manufactured by Pave-Mark Corporation, 1855 Plymouth road N.W., P.O. Box 94108, Atlanta, Georgia, 30318. 7. Pave-Mark Alkyd formulation, 125 mil thickness, hot extruded thermoplastic, man.ufactured by Pave-Mark Corporation, 1855 Plymouth Road N.W., P.O. Box 94180, Atlanta, Georgia, 30318. 8. Lafrentz brand, 125 mil thickness, hot extruded thermoplastic manufactured by Lafrentz Road Services Ltd., Edmonton, Alberta, Canada, T6E4N7 7 l\ ~ 1,; , t L f, i~ ) , ~ ~ :1,. i " i: , i ; ,. if , t, \, ~ ..i' l~ 7. ,)", '".:.:.,.... \ 1 I , I I .- I -, ,'" I I I J I .. , J I ! ] J ] I ,.,.,. . ."', .--,. i ) Ii? nM ~. :,-_J ,.. . ~. . .,., " .:' r,.,J : i I; > i I Ij j 1 , J , ,',. .: ., ,:". .:'.,,' .'.. ,..' :' .'. '.'..:".' :.:... .,.' ,. ..;. :.: '.:. . '.... .', ,. ,,:. , ,.' .. :" .. ::,,:;:',' .,. .... ,.... '.:....,.,:..'." ,<'.. , . .... ,. ... . : .,'.".' <, ". ".. .'.,",. '., .. . , . ..,. .:., ., ,',' . ':., , '"',,,::., ", . .... ,. ,.:..,''' .'. .' :.:,. ',if:, .,. '{'., .'.. , f. ' , ',' ., '. ",,':', ',' ':.:':. ,..':'.<' , ,'. " ,. .'.,.. . .:', . ,.:. '., ... .... ,~,' , , ",. f> ,', ,. ..i ..: ,. , :" f, .,. ' , ,. ";"." " . ..'", :'f, ,': '.. . ..::. .', ' . '-- ,:,f: ',;... "'. 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I 1 I I I STATE OF WASHINGTON: COUNT V OF JEFFERSON) 1 I I I I I I I I I I J :1 I v---, ro .;.0.." \OJ NON-COLLUSION AFFIDAVIT ss The undersigned. being duly sworn. deposes and says that the person. ~ir~. association. co-partnership or corporation herein named. has not. either directly or indirectly. entered into any agreement. participated in any collusion. or otherwise taken any action in restraint o~ free competitive bidding in the preparation and submission of this proposal to Jefferson County for consideration in the award of tho contract. J..t:: ch ., ,->-_;{2._"JL __~""1.!f?l~~_G- JbLL_-tL~ r=~.$.V-HL!.2 \---- -/1Cc~ctor) :7 Subscribed and sworn to before me thi~_~~~y of _~___. 19J[1. ~~.2i?~~=s.... at":~f?_~_~~~~l.~-----~::iding ------------------------------------ i~"""..,..,.,..""", I NINA M. GEORG = NOTlII'iV I-'UBLIC :. . IT"Tl OF WAS",NGTON : : M~ Commll.:lon Ell.plrnAus.20, 1991 : ,.,...........--.,...--., 16 ";"" ,fI) ill \ \ 1 ] \ \ 1 B. I 1 \ I I I I \ I J I ~" , \ CONTRACTOR"S DECLARATION OF OPTION FOR MANAGEMENT OF STATUTORY RETAINED PERCENTAGE A. I hereby elect to have the retained percentage of this contract held in a fund by the Owner until (30) ddYs following final acceptance of the work. Data__~~~~-~~~-------------Signed~~~-~~----- I hereby elect to have the Owner deposit the retaine~ercentaga of this contract in an interest bearing account. not subject to withdrawal until after final acceptance of the work. c. 1 hereby elect to have the Owner invest the retained percentage of this contract from time to tim. a5 5uch retained percentag. accrues. Date______________________________Signed------------------------ I hereby designate____________________________________________________--- as the repository fo~ the escro~ of said funds. I hereby further agree to be fully responsible for payment of all costs or fees incurred as a result of placing said retained percentage in escro~ and investing it as authorized by statute. The Owner shall not be liable in any way for any costs or fees in connection therewith. Date______________________________Signed--------------------------------- .. 15 !,_..~' (~ Intern~nal Fidelity' Insuran<eCompany 24 COMMERCE STREET NEWARK, N. J. 01102 ~ BOND NO. 808143-87-3 Thac we, the undersigned, KNOW ALL MEN BY THESE PRESENTS: ROCKEY'S ROAD STRIPING COMPANY as principal, and THE INTERNATIONAL FIDELITY INSURANCE COMPANY, a corporation of che SCaCe of New Jersey, as SureCy, are held and firmly bound unto JEFFERSON COUNTY in Che :l~Jl Pi&bCJ1TT~~~~ ~~O~~~~~ ~~~ ~gg~~6 ~~~T~OA~~C~~~100 ($3,150,00) for che payment of which, well and Cruly to be made, we hereby jointly and severally bind ourselves, our heirs, executors, a~in1strators. successors and assigns. Signed, chis 22 day of JUNE 19 88 The condition of che above obligaCion is such that whereas che Principal has submitCed to JEFFERSON COUNTY a certain bid, aCtached here Co and hereby made a part hereof, Co enter into a concract in writing for JEFFERSON COUNTY PAVEMENT MARKING 1988 MT 0766 NOW. T&EREFORE, (a) If said bid shall be rejecCed, or in the alCernate (b) If said bid shall be accepCed and the Principal shall execuCe and deliver a conCract in che Form of Contracc atcached hereco, properly compleCed in accordance wiCh said bid, and shall furnish a bond for Che faithful performance of said ConCract, and for the payment of all persons performing labor or furnishing maCerials in conneccion Cherewith, and shall in all ocher respects perform the agreement created by che accepcance of said bid; THEN, THIS OBLIGATION SHALL BE VOID. ocherwise the same shall remain in force and effect; it being expressly understood and agreed chaC Che liabil- ity of Che Surety for any and all claims hereunder shall, in no evenc, exceed Che penal amounC of chis obligacion as herein stated. The SureCy, for value received, hereby stipulaCes and agrees thac the obligations of said Surety and iCs bond shall be in no way impaired or affecCed by any extension of time wi Chin which Che said bid may be accepted; and said Surety does hereby waive notice of any such extension. IN WITNESS WHEREOF, che principal and che Surecy have here Co set Cheir hands and seals, and such of Chem as are corporaCions have caused their corporaCe seals, Co be hereCo affixed and these presencs Co be signed by cheir proper officers, the day and year first seC forth above. Signed, sealed and delivered in che presence of: ROCKEY'S ROAD STRIPING COMPANY /./c--.4/ ~ ' Principal f / ATTEST: ATTEST:r/r;J1d a /{. (1.-/ a" Ie ) Bid Bond '.... . ., . ' ........, ". ,.,.'" ,.\: ':..". '.... ,>:,. .'," . .,.',', .. ... , .,'. ';.. . ,'.. ',I .-..'.. .. . , I <jfi,t ' I L " .... '\ ,'.. . .'. ,,'... .... , . . ,'... '. ... '1 .. ,~ . ., r' .,,) :.,' .. ... . '. .. '.:. .'-.. ',; .. '.,... , ........'. ... .. ,'..; :',:... ;. , ' \ :., : .. :. . :. .'.. i...,' . " ,.. I. .. ,:: '. f : L :.,:; ;..' ... ... .. ... : . ~;, .' i: Ii r , (c. , i{ E, D li, ...' . \ ,.. ~ , ' .:.'.... : II.?:! ,: ... i~~' ... . ; .::.,: .;, . '. . ,.,',. :':>' '~\ ' ' 1 ..,.:,: ,. , "~I .: ': ,'... " ... .' ..:' '.;. .. '.... .':....:.. ..,. . L L L' ':. " <' I. .' ...., '.. ...,.. ,: . .,W: '. . .,:. .'. .,,', . . . .: '. -;.. . :.,. .." ...., .... .. ':.,.. .,' >, : ' ...- .,...: . ,. . 'C. :. .., ...,. :., ',:.' .. ....'...', " "."',.' .:" ',,:..; ",.. .', ., .... .,..'::.. . ..".:. ...' ,.. ',,' .. .' .. :.,'.;. " '.', i,' " ,....... .,.', .' .':,: , ., , '.;".'- . 'I.,:::.' -.-J, '. .,. . .' ..., (":. .'! .,. . '~ ~,..''''~ / ' :~; ~:'<I ~' ~ .,...r '.:7 Internq,onal Fidelity' Insuranc8Company . 24 COMMERCE STREET NEWARK, N. J. 07102 ~- BOND- NO. 808143-B7-3 KNOW ALL MEN BY TIIESE PRESENTS: That we, the undersigned, ROCKEY'S ROAD STRIPING COMPANY as principal, and TIlE INTERNATIONAL FIDELITlt' INSURANCE CGlPANY, a corporation of the State of New Jeraey, as Surety, are held and firmly bound unto JEFFERSON COUNTY in the ~Jrifi P.f& cgrT Tlmk ~~o~~m ~~~ iru~g~~b ~~i'r~O A~~C~~~lOO ($3,150.00) for the payment of which, well and truly to be made, we hereby jointly and severally bind ourselves, our heirs, executors, administrators, successors and assigns. Signed, this 22 day of JUNE 19 88 the condition of the above obligation is such that whereas the principal has submitted to JEFFERSON COUNTY a certain bid, attached hereto and hereby made a part hereof, to enter into a contract in writing for JEFFERSON COUNTY PAVEMENT MARKING 19B8 MT 0766 NOW, THEREFORE, (a) If said bid shall be rejected, or in the alternate (b) If said bid shall be accepted and the principal shall execute and deliver a contract in the Form of Contract attached hereto, properly completed in accordance with said bid, and shall furnish a bond for the faithful performance of said Contract, and for the payment of all persons performing labor or furnishing materials in connection therewith, and shall in all other respects perform the agreement created by the acceptance of said bid; TIIEN, THIS OBLIGATION SIIAl.L BE VOID. otherwise the same shall remain in force and effect; it being expressly understood and agreed that the liabil- ity of the Surety for any and all claims hereunder shall. in no event, exceed the penal amount of this obligation as herein stated. The Surety, for value received, hereby stipulates and agrees that the obligations of said Surety and its bond shall be in no way Unpaired or affected by any extension of time within which the said bid may be accepted; and said Surety does hereby waive notice of any such extension. IN WITNESS WHEREOF. the principal and the Surety have hereto set their hands and seals, and such of them as are corporations have caused their corporate seals. to be hereto affixed and these presents to be signed by their proper officers, the day and year first set forth above. Signed, sealed and delivered in the presence of: ROCKEY'S ROAD STRIPING COMPANY /.1,~4/ ~ , Principal I ~ INTE~~ONAL FlDEL:~ )N~~CE BY( l.fI-:-' )f.J:~~ PATRICIA T. KITCH~J ATTORNEY-IN-FACT / ATTEST: ATTEST:c1/~1do. f{ (lJo.) !p) Bid Bond , ... ~ ~: I,; "I j t ij ,.~.... . .. . .. . i'.' : ;..,.. ." ,. '.' ... . . ,; .... I ~.. ...' . I ' ... . ',.,'. . "... :1iI '......, , .. I . '. ...'. ':. '. ii .. ..<, .... " . . . .'.:. .. .' .,.'. " . ..".. ...;: ... ...... . . .. "...., ,. . '., ..... i.' : .; I .;. ;.,: , '. , . . ... , " ....,'.;,.,., .' . ' ... '.; 1.. .. :: ..'. CO. .'. .,-..., P5)WER OFATTOR:NIS} INTERNATIONAL FIDELITY INSURANCE COMPANY. JlO:\.1E OFHCE: 24 C(ntl\lEltCE STltEET NE\\'AltK. NEW JlmSEY 07102 . U():\,"ri :'\0. 806143";'87-3 ~ ~ KNO\VA'LL MEN BY THESH PRESENTS: That I!'\TEIU'':ATIONAI. FIDI<:L1T\' Il'iSL'ltA"";CE CO:\IP,\:\'Y. a~-urpf)r:Jtinn Or~al1i/l:J and 'e""~ling. u~IJcr the laws' ufthe Slale of Ncw Jcrsey. and having ib prilll-ipal ulfil'c in the Cil)' lIf Ne......ilJk. NC'w 1er:o\.'y. dll\.':O hereby eimMilute and ilppl,int ~ KRISTINE T. NIEDER. D. KEVIN REINMILLER,PATRICIA T. KITCHEN PORTLAND, OREGON itstruc and la.....ful attufllcy(s).in.facl to CXCl.utC. seill uud deliver l~lr and on its hdl:tlf as .surel)'. .1Il)' alld lill hlinds lInd uridcn>lkjn~.s,. contrt'l'ts of indi!'lIlnnj' .>llld uthcr . writings obligatory ill thcnalurc thcreof. ....'lIjch an~ or IlUl)' b~' allll......ed. rC(luin'd Ill' pcrllli\lcJ by law. :olillUte. rule. n:gula'litJll. Cllntr.u:t or Illhcf"\\.'bc. all~ thc, CJl.cl'Ulk'l1 of such instl'Umenl{s) ill pursuilllce of these presellls, .shall be ilS bimJinj; upon the said ISTEHNATJONAL I:JUELlTY ISSURA-,,"Cg CO:\IP,\~Y, a<; fUIJ)'llOd amply, to nil intcnts and purposcs, us, if lhc same had been July ,-,x"t'uted and llckllowkdgcd by it.. rl'~u!:uly l'Iccled .(llliccrs ill itsprincip.ill nll.k~:. ' This Power of Attorney is cxecuted, alid Illay be certified to and ilia)' be remked, pursuant to and byaulhority of Art ide 2. - SeL'liull 3:'01' 111L.' By' Law!> adoplcd by Ihe DourJ of Directors. of INTERl'\ATIO!\'AL FIUEI..JTY ISSURASCE COMI'ANY ul il lIleeting ~'.llkJ and Imld on the 23rdduy oj" 1J~'l'efl1bcr.~I96l:l, any Vice President, Exccutivc Vice President. Secretary or Assistalll Secrctilry. slwll hilve puwcr and ilulhnrilY (I) To appoint AUornc)'s.in-faet. and to authorize them to execute nn hehalf uflhe Coillpany, and ;lltadlthe Sl'al Ill' till' Comp.lIl)' thl."retu, 1Il1nd.~ and undertakings, coiltructs of indemnity _and mher writings obligator)' in Hie naturc thaeof :md. (2)To rClIlove, at nny tinte.uny' SUcll Attorney-ill-lace and re\'uk..: (he l.lUawrity given. Further. this Power of Auhollcy is signed and scaled by facsimile pursuanl It) rcslIluliollUf the Board of Directors uf said Clllllp.:my adopted lItallleetillg duty cillled und held on the 4th dny of Fl.lbruary, 11)75 of whit-h the followirig is trucexeerpl: I:'\TEKN{\TIO~AI,'FJUELIT\' ISSl1RA:'\CE CO~II'AN\' ~ Now therefore,lhe sign;lturc';' oflOueh oflicersand the,seal of the.! Compim}' Illuy be aflixeJ 10 ari)' ~1I.::h pow('r of ;llIurncy or any Lcnincale rcliltin~ theretll hy facsimile. and any ~ueh powl.lr, of attorncy or ccrtilicate bCo:lrlng such fucsimile signatures or fw.:simllc seal .shall bc ,,"lid illlJ binding upon the Company ;lnJ. iln)'su..h power so executed .lOd certilied b)' facllimile signatures and fucsimilc s('ul shall hl.l valid and binding upon thc COlllpany in the future ,wilh respell to llnybllOd Ill' undefl<lking to which it is lIttadll:d. . . IN TESTIMONY WHEREOF.' INTERNATIONI\L FII>EI.IT\' I:,,<SUItASCECo.I\WAl'iY has caused this inslrumcntlu be !l,igncd; and its corporiltescaltohe anixcd by its uuthnril.ed oflkcr, this Ist. day Ill' May. A.D. 1986. ~'WP- ,-"",,",,~~ ? On this 1st. day of May 1986;-befme me came thcindividual ......ho executed the preceding instrumcnt, tn /lie PcNlnllny' kr.O\\'Il. and, being h)' me duly sworn;' said Ihal he is the thcrein described und authorized onicer of the ISTEH.:'<i'ATIOSAt nUELI')'\' ISSUHA:\"CE CO!\JPASY; Ihilt Ihe seal affil;,ed In said instrument is'th,: CO/"fl?i"'dleSeul nf,said Cmnpany;thal Ihesaid CorpnraleSeal and his signature were duly unixed by ~lrdl'r oCthe Boardof Direclnrs,nfsaid.Cnmpany; /,~~~~'~:~:2:~;;.\ i~"'~OTARI\~\ l~! ':_":''P'~~,~''_;,OJ \~\~U II L\~"''''j ....",i.......:./-t- .,' ~..~,,~~.~_::~~...'~'~. IN TESTIMONY WHEREOF, I have hereuntll sct lTl)' h.md uno aflheJ my Offici.l! Seal. lit tht: Cit)' of Nl.lw;lrk. New Jersey the day mld yt:ar lirst lIhove .....riuen. ))(LLltf,;LU. ,)((1-. ~j.(;) A NOTARY PUBLIC OF NEW JERSEY J\ly Commissiun Expirt:s No\'cmber :!3. 1992 CERTIFICATION I, the unde'rsigned oflicer of INTERNATIONAL FIIlEI..I'I'Y INSURANCE COMI'ANY do herehy certify Ihat I haw ellmpared Ihe 'fnrcgiling copy of the' Power ,of Attorney and lIffidavit. and lhe .;opy of the Section of thl.l By-Laws of suid COlllpany liS set forth in sllid Power of Allnrncy. with Ihe ORIGINALS ON FILE IN ~~~n~i~u: ~~~I~~~~(I~~l~n~~~~~'~~'f:l~df~~~I~ ~h:d s~~:c~.re correct trnnseripts thereof. and of Ihe whnl~ (If Ihe said originals. and Ihal the slliJ Power of IN TESTiMONY WHEREOF, I h:lv~ hereunto sclmy hund Ihis 22 dllY of JUNE If) 88 ~A,,~:7~~ .( - '__-"_.IlI<..Jl,,,,,,,,..,,,,,,;~<,,i;;).iiJ>,~(,tij;'\k;S;;;.t:~~;i.~x.;c%~;;~Z1r:1J~!i)!}'\ii'iii\li~~_~~~~-' ~ L L ~ L --1 (I " ....0WEROF ATTORNCi INTERNATIONAL FIDELITY INSURANCE COMPANY' ~ I IIOME OI<"....CE: 24 COJ\lMERCE STREET NEWAIU';:, NEWJEKSE\' 07102 1l()~1> NO. 818039-88 ~ KNOW ALL MEN BY THESH PRESENTS: Thai INTERNATJONAl..:mEJ.IT\' I~SUJt^!\CE COl\IIJAN\', a ,"urpuration orgulli/cd uud cxi!>ling under the' laws ~f the Stale nfNcwJcrscy. and having its principal uflkc in the City of Newark, Ni:W krscy. ducs hcn:by con~titulc and ap[luinl KRISTINE T. NIEDER. D. KEVIN REINMILLER. PATRICIA T. KITCHEN PORTLAND. OREGON its true ami lawful allorncY(li)-in-lllcl to execute. seal and deliver for and un its behalf as surcly. allY and all numh unJ unJcnilJdngs. contracts of indcmnilyarid uther writings obligatory in the lIalUrc Ihereof. which arc or Illuy he allowed. required or permilled by law. staluh.:. rult:. regulation. contract or ulhcrwbc. and Ihe cxe\.'utiun of such instrUlIIent(s) in pursuance of these present!>, !>hall be as binding upon the suid INTERNA'J'JONAL I-'JI)EI.ITl' ISSURANCE CO:\II'ANY. us fully and amply, to all intents and purposes, as if the same had b<:en duly cxecuted and acknowledged by its regularly elected ofliCl.'rs al its principill uffice, This Power of Attorney is executcd, and may be certified to und lIIay be revoked, pursuant tn and bYilulhurity of Article 2, " Section 3, uf the By'Laws udoptcd by the Bourd of Directors of INn:RNAl'IONAI~ FIUELITY INSURANCE C()~II'ANY at a lIlectingculled und hald.ollthe 23rJ day of Dcccmbc:r.IIJ6H. IN TESTIMONY WHEREOF, I have herellnto set my hand this 13tbilY of. July 19 88 ~^,::2::7'~~-.. ...... Presidl.'nt or any Vice President; ExeeutivcVicc: Prc~idellt, S..:cretllry or Assistunt Sccrct:lr)', shall huvc pnwcr and authority (I) To appoint Attorncys~in-fact; and to authori/.c thcm to exeeuteoll behalf of the Cumpany. and attach the Seal of the Company therein, bonds and undertakings. comractliof indcmnl'y und miler writings obli.l.:atory in the nature therenf and. (2) To relllove, ~t any. timc. any' such Attorney-in-fact and re\'llke the authority given, . Further. .this ')ower of Atthoneyis signeJund scaled by facsiriLilc pursuant II> resolution of the BOlln.l of Din:ctors uf said COlllpan}' aduptedata meeting dul~,caIICd and beld on the 4th day of February, 1975 of which the fullowing is true excerpt: Now therefore the signaturcli of such officers and the seal of tht! Company may be llrfix.ed to any sut'h pnwerllfaunrm'y or any certificate relating Iherctoby facllimilc. andany such power ofnuorney or ccrlificute bClIring such facsimile signatures or facsimile seal shall be valid and binding upon the COll1puny and any su.::h power so ex.ecuted and certified by fac~illli1e signatures and facsimile lOcal shall be valid and binding upun the CUlllpOlny in the future with respcc:l to any hOlid or undertaking to. which il is attached. IN TEST.lMONY WHEREOF, INTERNAl'IO~AI. FIUEUl'Y INSURA~CE CO~II"AN\' has caused this instrumenttobesi~ncd llnd its corporate seal to be aft1x.ed by its uutlmril-ed oflker, this 1st. day of May, A.D, 19H6. STATE OF NEW JERSEY CoulIIY of Essex <7Aif9P ",",. .,. ,-~. ~.. On Ihis 1st. day of May 1986; before mecamc the individual who cx.ecUlcd the preceding inSlrulllent. to mc rcrsonally known, lmd. thathe'is the therein described and authorized officer of the INTERNATIONAL I-'IJ)EI.ITY INSURANCE COI\fI'ASY; that the is the,Corpornte, Seal of said Compuny;that Ihe~aid Corporate Seal and his signllturc werc duly anixed by order ufthe Uoard ">S~~';:~::~~;'" f~/~OTA.li ~\~\ !lDL".- ,<:.>i \4r\{'U B L..\C/......j .,<~i...;.......~:t- .f ~"'-,~~.~.~~,.,'~.~. IN TESTIMONY WHEREOF, I have hereunto set my hand aodaffixed my Official Selll. lllthe City of Newark. New Jersey the day and )'ear tirsl above written. /:)(Llj~tU ) A NOTARY PUBLIC O~ NEW JERSEY My CUl11mission E"-pires Nuvember 23. .1991 CERTIFICATION I, the undersigned ofrycer of INTERNATIONAl. FJI)ELlT\' INSURANCE COMPANY do hcreby certify thai I have cnmpOlred .thc foregoing 'COP)' of the Po".er of Atturney Ilnd aflidllVlt, und the copy of the Scction of the ny~Laws uf sllld COll1puny us set furlh in said Pllwcrof Atwrney, with the ORIG1N^I.S ON FILE IN THE HOME OFFICE OF SAID COMPANY. und that the sumeurc carreL't transcripls thereof. lllld nf the whole of the said origlnah, ami thalllle said Power of Anorney has not been revllked Ilnd is now in full force and effect. L ~ L ~ L ~ IN~rERNATIOJL FIDELITY INS'URANCE OMPANY 24 COMMERCE ST., NEWARK, NEW JERSEY 07io2 STATEMENT OF ASSETS, LIABILITIES, SURPLUS AND OTHER FUNDS AT DECEMBER 31, 1987 ~ Bonds (Amortized Value)....... . ........... ... .., ........ . . . Common Stocks (Market Value).............................. Mortage Loans on Real Estate............................... Real Estate........................................... ,.... Cash & Bank Deposits...................................... Short Term In....estments...... . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Unpaid Premiums & Assumed Balances........................ Reinsurance Recoverable on Loss Payments................. . . . Electronic Data Processing Equipment......................... Interest & Dividends Due and Accrued.. . . . . . . . . . . . . . . . . . . . . . . Equity in Pools and Associations... . . . . . . . . . . . . . . . . . . . . . . . . . . Funds Held in Escrow Accounts. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Collateral Funds Held Under Contract. . . . . . . . . . . . . . . . . . . . . . . . : Contract Balances Due and Unpaid. . . . . . . . . . . . . . . . . . . . . . . . . . . . TOTAL ASSETS................................ LIABILITIES. SURPLUS & OTHER FUNDS Losses (Reported losses net as to reinsurance ceded and incurred but not reponed losses). . . . . . . . . . . . . . . . . . . . . . . . . . . . Loss Adjustments Expenses.................................. Contingent Commissions & Other Similar Charges. . . . . . . . . . . . . . . Other Expenses (Excluding I:lxes. licenses and fees).. . . . . . . . . . . . Taxes, Licenses & Fees (Excluding Federal Income Tax).. .... . .. Federal & Foreign Income Taxes (Excluding Deferred Taxes)..... Unearned Premiums.... .................................... Funds Held by Company Under Reinsurance Treaties............ AccounlS Withheld by Company for Account of Others. . . . . . . . . . . Liability for Un:luthorized Reinsurance. ................... .. .. Liability for Uncashed Checks............................... TOTAL LIABILITIES..... .... .................. Common Capital Stock........... ......... ....... .. ...... . .. Preferred Cilpital Stock..........:.......................... Gross Paid-in & Contributed Surplus.......................... Unassigned Funds (Surplus).................................. Surplus as Regards Policyholders.................. TOTAL LIABILITIES. SURPLUS & OTHER FUNDS S32.380.170 1,827,nS 128.527 64,330 4,333,439 473.445 961,653 948,070 214.523 769,792 279 5.597,520 (5.597.520) 482.357 542.584.513 SI3,472,178 4.041.659 90.606 96,792 518,472 1.047.000 14.201.930 50.000 38.991 384.539 57 S33.942.224 1,330.000 1.200.000 544.600 5.567.689 8.642.289 542.584.513 I, PHILIP KONVITZ, Presidem of INTERNATIONAL FIDELITY INSURANCE COMPANY, certify that the foregoing is a fair statement of Assets, Liabilities, Surplus and Other Funds of this Company, at the close of business. December 31. 1987. as reflected by its books and records and as reported in its statement on file with the Insuro.nce Department of the State of New Jersey. IN TESTIMONY WHEREOF, I have set my hand and affixed the seal of the Company, this February 29, 1988. INTERNATIONAL FIDELITY INSURANCE COMPANY \, ,.... . CONTRACT (-, C ..... JEffERSON COUNTY, WASHINGTON THIS AGREf.MENT, made and entered into this day of. C i' 19 between the COUNTY OF JEFFERSON, acting through the Jefferson County ~mm s- slDnerS and the Director of Public Works under..and by virtue of Title 36, RCW, as amended and Rockey's Road Stripino Co, of flrna, Washinoton hereinafter called the Contractor. WITNESSETH: That in consideration of the tenns and conditions contained herein and attached and. made a part of this agreement, the parties hereto covenant and .agree as follows: I. The Contractor agrees to furnish all materials and do certain,work, to:wit: That the said Contractor herein will undertake and complete the (ollowlng descrIbed work: Pavement markings, Type 2 lane markers and removal of varlOUS pavement markings, county wide, in accordance with and as described in the attached plans and specifications and the Standard Specifications of the WaShington Department of Transportation, which are by this reference incorporated herein and made a part hereof, and shall perform any al- terations in or additions to the ~ork provided under this contract and every part thereof. The Contractor.shall provide and be at the expense of all equipment, work and labor of any sort whatsoever that may be required for the transfer of materia15 and for constructing and completing the work provided for in this contact and every part thereof, except such as are mentioned in the specifications to be furnished by the County of.Jefferson. II. The County of Jefferson hereby promises and agrees with the Contractor to eloploy, and does employ the Contractor to provide the materials and to do and cause to be done the above described work and to complete and finish the same according to the attached plans and specifications apd the terms and conditions herein contained, and hereby contracts to pay for the s~ according to the attached specifications and the schedule of unit or itemized prices hereto attached, at the time and in the manner and upon the conditions provided for in this contract. The County further agrees to employ the Contractor to perform any alterations in or additions to the work provided for in this contract that may be orde.red and to pay for the same under the tenns of this c~ntract and the attache9 plans an~ specifications, III. The Contractor for himself, and for his heirs, executors, administrators, successors, and assigns, does hereby agree to the full perfonnance of all the c~e- nants herein contained upon the part of the Contractor. IV. It is further provided that no liability shall attach to the County by reason of entering into this contract, except as expreSSly provided herein. IN WITNESS WHEREOF, the Contractor has executed this instrument on the day and year first below written, and the Board of County Commissioners has caused this in- strument to be executed by and in the nawe of said County of Jefferson the day and year first above writtlln. . Executed by the Contractor '>. /$- Rockey"s Road Striping Co. Contractor ...?--:-7 /...~ ./~ I~_L 6y .~ :if.Al. - CONTRACT BONO JEFFERSON COUNTY. WASHINGTON KNOW ALL MEN BY THESE PRESENTS; That Rockey'.s Road Strininp fn . of Elma, Washinqton , as Principal, ilnd International Fidelity Insurance Company , AS Surety, ilre jointlY and severillly held ilnd ~re bound unto the COUNTY OF JEFFERSON, the penill sum of Sixty-Two Thousand, Five Hundred Three50/W811ilrs ($ 6::>.501 50 ), for the payment of which we jointly ilnd severillly bind outselves, our heirs, executors, ildministriltors, ilnd ilssi~ns, ilnd successors ilnd ilssigns, firmly by these presents. The condition of this bond is such thilt WHEREAS. on the dilY of .A.'D., 19_, the said Rockev's Roen Strining f" Principill herein, executed a certain contract with the County of Jefferson, by the terms. conditlons Gnd provisions of which contract the said Rockey's Road Striping Co. . Principal herein, agrees to Install various pavement markings county wide. install t e various oavempnt nl~~kingc in selected areas. BOND NO. 818039-88 as per specifications made a partJf said contract. which contract as so executed, is hereunto attached, and is now referred to and by this reference is incorporated herein and made a part hereof as fully for all purposes as if here set forth at length. NOW, THEREFORE, if the Principal herein shall faithfully and truly observe and complY with the terms, conditions and provisions of said contract in all res- pects and shilll well and truly and fully do. and perform illl matters and things by the said Principal undertilken to be performed under silid contract, upon the terms proposed therein, and within the time prescribed therein, ilnd shilll pay all subcon- tractors and materiillmen, ilnd all persons who shall supply such contractor or sub- contractor with provisions and supplies, and Shilll in all respects faithfully per- form silid contrilct according to law, then this obligiltion to be void, otherwise to remain in full force and effect. WITNESS our hilnds this 13th day of July .19~. Rockey'.s Road Striping CO. PRINCIPAL Sf' JJ----"""',/ -~ thls..LJ::.:::,day ,.19~ INTERNATIONAL FIDELITY INSURANCE COMPANY SUR~ COMPANY ByLJ 1fr/I'~n r5Jf-d.? A- By: PATRICIA T. KITCHEN, A t to rney-i n -Fact Address of locill office and agent of Sur~ty Company: TRE nOND EXPERTS P.O. HOX 127Z9, PORTLAND, OR 97212 F.'II 158-. (50:3) 2.-[;'1.2.0'" 1- ~<N - 4S(P - ~ 4 <I<> emove r, n Cl' CALL FOR BIDS MTO 766 Notice is hereby given that the Board of County Commissioners of Jefferson County, State of Washington, will receive sealed bids up until the hour 0= ___~~~j~____~~_M. Mondav, June 27.~ at the office of the County Commissioners, Courthouse, Port Townsend, Washington, 98368, to be opened and read after that date and time for stri9ing various county roads and other work as set forth in the contract plans and specifications. Major items of work will be: 313.52 Mi. Painted Stripe 1957.0 Sq. Ft. 18'1 ?ainted Barr~er Stripe 8.5 Hun. Type II Lane Markers 634.0 Ln. Ft. Thermoplastic Pavement Markings 3832.0 Ln. Ft. Painted Gore Stripe 8 Inch Width 3ids shall be submitted in accordance with the plans and specifications on file at the office of the Director of ?ublic Works, ?O. 30K 1220 Jeffe~son Street, Courthouse, Port ~ownsend, Washington, 98368 where copies ~ay be obtained. Each bid shall be accompanied by a surety bond, postal ~oney order, cash, cashiers check or certified check payable to t~e Treasurer of Jefferson County in the sum of 5% of the bid amount, to be forfeited to Jefferson County by the successful bidder if he fails to enter into a contract and file an accentable suretv bond in the amount of 100% of the contract urice within ten (10) days of the award. The board of County Commissione=s reserves the right to reject any and all bids, and to accept the bid deemed most advantageous to Jefferson County and to waive all informalities in the bidding. Dated this ~day of 2'-~~-- , 1988. 30ARD OF JEFFERSON COUN~Y COMMISSIONERS ~~~/ 3.G. 3rown, Chairman . . I ~ ~ ~ 1;; ~~ ~ g ~ 2 rl ., 0 't? "l-~~~' nz ~~~€- ~~~ :ii a ~gg S " -? [. lj ~~~ - -"'(r.lm -is (,./:. ....c:. ":>:'s ml~ ~o ~ ~ g i 0 (p NO. OF /J~ WITHHOLDING.... !-~ ,.., D(CMPTlONS 0 " "'"' " n ~ 0 'b t, ~ :!I 0 "12:'" ~ g~ ....[m j:: 15 ,~ , 2 ~; 3 ~ '" n '" 0 '" 0 ~ "' 0 "' 0 "' "' "' 0 OT. OR ST. '" 0 .0 0 "t:[ F- " ~~ ~ - ~' ~ <: il~ ~ ..l::. ~~ ., ~ ,. 2 0 ~ 0 " ~ 0 1( ..l::. ".. ~ ,. 00 g 0 ~~ ~ ;?~ Q ,. .... '" I:E ~i'l 2 0 ~ ~~ $ ~g ~ r- :!; ~ !:l1<~ '1 ~,~ ~ ~ ~ ~~~ ~ 0.. r., :r::. J::.. ~ ~ r, ~ ~ ~ ~ " ~ ~ S6~ ~ 2; ~ g ~ [\, 0 f qe! - 15 be ~ ~~ <:>Q :--- ~ 10 ~ ~ ~8 ill ",i!i 0 i'l ~ ~ 8.. Q ~~ " ~ P i:l ~ .t;. i'l ~ i~~~ ;g J'Q ::;; ... g ;C ~ ~ 5 I a " ;C !;l !:( '" o .... f .. $ ~ '" :;! C;; <:l '" 3: " :0 ~ ;a o 3: :;! '" U> c: ;!l ~ " o <> c: 3: ~ c ~in ~~ ~~ ,,;: ~~ ~~ li!!; 0", 20 " - ." 5l n o 3- ~ ;r ",- a '5!. a' ~ c: '" .!'! U> .. 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Ql '0 ;. ~ ~ g. ~a~~g ~~~~~ 0...._0..... 3~g'@Q1 P. ~ ~:~ I'D RI::) t.l miai S n' 3 UI g~"*"s: ~. i ~~. tnlr.:l ::rUl ::::'l'll~l'll [~~~ SS~~ ~ ~~~. :::l :::I Ql 0 Q~:r~ ~~Q~ :::r~ Q) ~ w:eg-g ~~ ffi ~ -. c. 0_ o I'll ... 0 3~~g ~!~~ ~. g'~' ~ n _. n f1) 0:::1 0 c.. " n " Q'.ai!f 3g~_ :e~c.~ :~~i t1l 0:::1 al ~.~;~~ ~e:~ a~ [3g:~~ ~ ~~. ~ m ~~~ ~ co~C'~ saw=Q. ~N~~ "''' *q:~ fJ ~ 31l ~~~~ . is'''< ~~~[ ;:j~'3 ~ ~!.g 5 ;!~~ ~~~a ~ a g,~ S" ~'O :r ~~ ~ ~ ~2.iii'O' :r:.(; ~g oC"~ ~~a~ p~a;. ~~~~ ~~e:2: II) 0 0. ii: ~~~.~ cp a 3.5: o g~fr :i -g ~ il,- 3Q. lig ..~ !!. ~, S:Q. ~~ c..2, .... ~'a~'" ". ~ir ;0 Q ~ . ~!![ ~' m ~ nl :T n "C ~ ~ ~~~ I ~ ~~~ "C ~ - ~ go i" S' ".~ C. ~~~ ~ ~~fg, ~ ;; ~. ~ ~ g C. ". . ~ i~ ~ a 3 ". ~ ~ ~ " '" ::: 6 z '() '" " 3 ~ ." ~ ~ o z o o " ". .. e 1&1 I 85':i' ~ ~~g~ ~~g,g ~ ~ g ~ :~~s: ~"E.~ ~ H~~ ag3~ 0' g g -. ::lr1'::l:J .,I:loo-'" :e:sif ".-w g'l'lIm8" i ~ ~ ri . ~.~ ~ Co_ii: -".~ ::I. C8 n ~~:!. .,.3i ~:l S!:r- 1IlC8&, ~ N ~ ~.., ,=,,~g ~ Q ~ ~~'E =g-p: g:11l.1'lI ~ n '" ~ '" "l 6 z <n ~ [ ~ o ~ c " :1 ~' ". ~ " W '< ! ::;; ili '" '" ." '" ;; '" '" '" '" z t:l ~ " '" '" ;'l 6 ;; " /;; :J: ~ " 30 ~~ ~~ ~3: ~ ..< ~ .. .gg- ;;;" '" 0 " ~ H <n3 ~~ ,,~ "'w "",.., ~" C"o ~u o _ ?= ;. ~ " ~ ~ .~ " ',..:..)<., :)f I ~, r" , I: I I I : ..' . I ... ":.. .:.: . . .:' ~, I ..> . , .,:.. ....,. . ..... .. i~ :,. ..., . . '. = . , .., . '... ie: ----------------- - ':" . . ',......,.... . ... . , 'I , .1 .. ,r., .\ .... .,., .. ,:.. '.' . .' " .. : .. .... ...,. ------------------------------------------------! I ,--. I=",(.,f' , r,,\ TO -7 (/e: ^ "1" ?P'il7.0(-,--" Rockey's Road Striping Co. Aug Ul.>.t 1 7, 1 988 J~66~~l.>on Coun.ty V~p.t. 06 Pub~~c Wo~~1.> 1820 J~66~~l.>on S.t~~~.t P.O. Box. 1220 Po~.t Townl.>~nd, Wal.>h~ng.ton A.t.tn: Tom Mo~~~~o 98368 .... ., . .. Subi~c.t: Pav~m~n.t Ma~~~ng 1988 P~oi~c.t No: MT0766 Enc~ol.>~d ~I.> you~ copy 06 .th~ In.t~n.t .to Pay P~~va~~ng Wag~ ~a.t~I.>. Th~y hav~ b~~n I.>~gn~d and ~x.~cu.ted by .th~ S.ta.te and a~e 60~ you~ 6~~e. ". :...., '.' ': ,.. , '. .: Ii ..,." ... .'., " ;.:\:':,;:?' ; ..'..'.' '.'.. .'. .. . , : , ".:.'. '.'..,..,.: , .' ',. .. .. :' YOU~-6 T~u~y, ~~~owne~. Roc~ey'l.> Road S.t~~p~ng Co. RECE~VED IWG 18 1988 JEFFERSON COUNTY ENGINEERS OFF~CE " .; .:"..:.. 916 Garden HIli Rd . Elma, Washington 98541 . (206) 482-3327 \.:):>,---".'I---Ki~cST %1~rgEd~T1i.W~~e.8~~'iu~iN~~uHRIAI~ 'S1~ATIS:hciAN OFT-liE - nkPARTMENT'OF---' . y,..'''; '.. .. LABOR AND INDUSTRIES BEFORE IT IS SUBMITTED TO SAID OFFICER. /, .:;,,: PROGRESS PAYMENTS: Each voucher claim submitted to an owner by a contractor for payment I;'" ',', .. ..' .. on a project estimate shall state that prevailing wages have been paid in accordance with the pre. I:),: ,r,i :iD:;.:':" :'.. filed statement or statements of intent to pay prevailing wages on file with the public agency. :::/..;'/i ...,. .....':...: COMPLETE AND MAIL ENTIRE SET FOR APPROVAL TO: f ....:'..;::... Employment Standards Division, Department of Labor and Industries, :: .,.. General Administration Building, Olympia, Washington 98504 i' ..........< .. ..... [:ON'I'IlACTons, D1STIlJIIUTg A1'1'1l0VI.;Jl STATg~n:N1'S AS I'OI,I,OWS: ] .. c'...i'<' ""NK COPY) OIllC1lNAI,-AWAnIllNO AC1I,NCY ';":.,:., . ,',>': ':,_':".:,;. mum COPY) ntlP'.IC^TI':-l'HlMI~ CON'I'f{AC'l'On '""",:<":,,::,:<::,::,,},,, : ::',.,' (YI~I.1.0W copl{) THIPI.ICATE-S\IBC()N'I'ltAt:'I'on ',' "." :<,_ (GHEEN COPY) (~lJ/\IlH' JPl.lc,\'n~-IN1JlJH'I'mC^1. H'I'A'I'IH'I'ICIAN (Hl.winucl h;.' ])I'plIl'lnwnll ..;iF, 1.1.71111." 10"""'101',,, (/1.'") ,.""."". , ..,' ~ : .....,<ii '0 ~\A \'I'.c,I'\~" ~ ';) \,,~~ ~~\. \,!.' '" v.~,\,~oO , L L / ~....'... '.. .. ~ ..'" . '.. .... .' , ., :. ,. . . .... .. .' ............... .: , , ,. .... .'. . '. .' .. .' '...' . . .. '. ..:" '.. , ,. ... . "'" :.: .... ... . '... : . .. .. ' .' I .. ... .. , . .. .. . ,:.: .. : . .' ' , I:' .. I,: " ..'., I' '0'. I' .., .. I.'; . I . '.,: :. I, ...... :i' . .. .;.: '.,: ... '. ...:. ..: .:.... . ..... ' '.' '.. ..":, . ,. . '. ".'.,.' .:". ..., :.0 ",.::;:'., '. . ,':,/',; . ::'...., ; " ...' .. . .,.> ..'.... .' : :. ... ,. .' .,: .... ..... . , ", . .:..'.. ':;: :.' . , , ". ~"..... I 1 I. , ... /1 -=r '. .' ~ . : .:,.' ..'.. . i' '... ... ".. .. .' r'~,J\":':::::f::<: ..:;,':::. ,,' . ' ' ,,-"'.N",.," . I ";, "~I' ,., '.,' ':;, .:[i~~~::~~ ~:A~~:it.,'!~~.:lg:rnm' ... ., '. . '.. ,..>:/' Olympia; WA 98504 I. '., ....'...' """, : . ,.. ..:, ..... , .".,'.,' "". ,... I '...: ..' .: : .' :', . " .',. ..' <'. . '''., .. , ... .,., . ,., , ,. . .'... ':, . .., '. . ." .,:'.. . " I ,..' , . ',.. .... . . .., ... ... . ,.. . . .: ~. . , ., '.. .' .'. . , ...' ..,'..:,...' , ... .'.'..."'..'.' , ., . .,,: "..,. ! ."',; , . ',' ,;.. .'.. I.L. ,." ,\~~: . '" .. . ....... ' .. . . ,< '.'. : .. ',,: .. ?,~~/E;;.: .. '... I j ..:.,.. .. . .' .. .\ :... ':' ..... .:. ..., ,..... .:: ' ",/.. .'.' . ...: i . .' '." ... I l" .: U , :,,', .:. . .".... " ,: ",:"... i:' ::', .', .,.: : .... , . ..: ..:.. ':. " .' .'. I:: .,..,.. :",. , '.,::..: ..:.:. ,.: .':.. :.. '. "., : .:.: ), ,. : ' ., I,: , . L : IL G"'" ~... { or "\ -..,,,..-,,: ('"'\ Stutcmcnt of INTENT '}'O PAY PREVAILING WAGES (Public Work~ Contract) Awarding Agency ,.,:V;:.F.'.f..!';.B.$.9N. ..c.OJ)/'!.TX....... .... ............... Contract Namber ...J:J:rO.7..RJL.u ..........u..,... ......... .....u.....,., ....................,.u. Dat. Contract Awarded ..,J..\1.1.y.....8.,.....19.8.8......... .............. ......,. .......... ::::~J'O~ ~~'~~::~~:~"""'h.....l County in Which Work Performed .J.e.f.fer.s.on....cOlln.ty................. Locution Within County ...C.o.unty.~.Wid.e..m ...................-. ......... .......... Prim. Contraetor ....ROCKEY..'..S...ROAD...S.T.RIP.ING...CO... ....... . Do You Intend To Use Subcontraclors" Yes 0 No 1ZI In compliance with RCW 39.12.040 I, the undersigned, being a duly authorized representative of ..., ROCKEY.'..S.... RO~d~~l~~~r~~ ~~l~~,;~Sg(,...916. Gardenllill.. Rd'.i..E 1 maiiAI;l,ilJilting ton. ..98541 do hereby certify that the following rates of hourly wage and hourly fringe benefits will be paid to all laborers, workmen and mechanics employed by me upon the public works project described above and that no laborer, workman or mechanic will be paid less than the "prevailing rate of wage" as determined by the Industrial Statistician of the Department of Labor and Industries. PLEASE NOTE: If apprentices are to be used they must be registered with the State Apprentice. ship Council or they must be paid prevailing journeyman wages. CIlAIi"r HATE 01'-' HOVlUS PAY HATE OF 1I0UltLY FIUNGE BENEFITS FLAGGER 10.78 ,/' ./ 3.43 ~ IIlIWMER*IIlII!ERX%IIlIR FOREMAN OWNER-OPERATOR (PAVEMENT MARKING) DRIVER OWNER-OPERATOR (PAVEMENT MARKING) ./ NOTE: Attach Additional Sheets as Needed. ....ROCKEY.'.5.... ROAD ...ST.Rl.P ING .. COMP ANy.... Bykl~L~O"(J:;;.CO'1TI';f~~) Subscribed and sworn to before me this ..c;:;u.~... day of humu......u , 1~.~ ~ji{~".. rilOtary Public ;11 and lor the State of WaHhillRfrm, r(Jj/idiflN ill Washifljllotl. Pur I~ & I UHO Only-'-,,': APPROVED ........ .i>;?-- Department of l..nbor & Industries' . Ind~strinl Statistician.: By...."di, ..,.... ..91w''...'u....'',...''''. J)a~UGulF88 "~'. "Y............... . v BEFORE FINAL SETTLEMENT can be made on any public works project, the prime contractor and each and every subcontractor must submit form LI-700.7 "Affidavit of Wages Paid" to the officer charged with the disbursement of public funds. EACH AFFIDAVIT OI? WAGES PAID MUST BE CERTIFIED BY THE INDUSTRIAL STATISTICIAN OF THE DEPARTMEN'\, OF LABOR AND INDUSTRIES BEFORE IT IS SUBMITTED TO SAID OFFICl~R. PROGRESS PAYMENTS: Each voucher claim submitted to an owner by a contractor for payment on a project estimate shall state that prevailing wages have been paid in accordance with the pre- filed statement or statements of intent to pay prevailing wages on file with the public agency. COMPLETE AND MAIL ENTIRE SET FOR APPROVAL TO: Employment Standards Division, Department of Labor and Industries, General Administration Building, Olympia, Washington 98504 [CONTIlAC')'OIlS, IlISTIlJIIUTI~ AI'I'1l0Vlm S'rATlmgNTS AS I'OJ.I.OWS: ] (PINK COPY)' OltrmNAI.-AWAIlIHNfl A(lJo:NCY (Bl.UI~ COPY) nIJPI.'CA'I'I~-pnIMg CON'I'UACTOIl IYEI.l.nW COP") 'I'H1PI.ICA'n:-Rt!IICON'I'IlAC'I'on I<1Hl':Jo:N C()J'n (~tlAlln'IPI,ICATE-INll[JR'I'IUCAI, H')'A'I'IS'I'IC1AN (HI.tull1l'rl hy 1ll'I'I1l'llTwnl1 1.1'7011-211 11111'111 $l I'll)' (11'11111 ~.:.r.:''', :i ~eO !\A \'.,,-c,f.\ \ ']., ';) \Cj'O'O .\$\. \.~ \ tI> ",,~\\.\<oO I 'i"'~-' L .. ---,...,-/OO.~~r ~ '---""tr8l<t~'i!'li~:!~,"~:,::?;:'H:::;~.1:,!'.r.'~ :: ::;",':~,': ~.: ,t{^:'r;':"';',I~I.(,:-;;~....,';-"'" '.' \1::',"'i',::.~ i:'iJJ..1St,;~.,jt~'''.n~,~;'I~'..,,, '~jJ:.;':,'!;':.'" K~ t':'VV/;"^ ,.' l.t~\:::;:' J~ ,"~:~'*,'I1)1'tI'.~~----- "I .. ., .'. .. . .:; ........... " :. ... ,., .. ,.: ,... ' :i. . ,..: '. '.'. , , ,: . . :. " . . :.'.... .. .,:', "..:'. ...., . . . '., '.' ". .. ..." ...' ..," :., I. ..-... ...,: :,..' .;:. ..,:: .... .' :.;', .:;: .. '.. I... ..; ;. '.. '. ....... - : ." .......: , . .:,: '.': . .;......... . .' ,... .....:,:... ,... ,.'> ... ..'.'. <. : ....: '. .." ,'... '.:' '.,. .." . . . ....' .' " , :,: :~:}2!~ . ......... : . .::":.'..:.' .. ..... :: . ......' ... ....... .'.': : ..... . . ,.'. '. :...' .: .........., :,:. .".: .:,. . ..':. ,'. ..':':. /1 .--1,"'1':;,0 I 'r..f" .. .IJ Yo ! .~....... ... > . ). : . c. .,. , .;... : ::.; , .::J' -.J :. ..:....: " .; ... ~ r-, ("'j' ~ COUNTY OF JEFFERSON, STATE OF WASHINSTON CONTRACT VOUCHER OETAIL NORt: SHEET Project: Pa"...t ~arki.g - 198B - ~T07bb Date: 1212B/8B Ti..' 11:5b:22 Input bY~ Chk'd bY:_~ Work Done To 11/30/8B Estilate No.5 and Final Rook'y's Ro.d Striping 91b Sard,. Hill Rd. Ell', NA 9B541 iiiEi;iioTAl-iuNii-i--------------iiEii--------m----------------i--PREViiius--i--PRESENT---i---iiiTAl----i--PREViiius--i--PRESENi-------iiiiAl----- :NO. :OUANTlI : UNIT 810 : QUANTITY : QUANTITY : QUANTITY: A~OUNT A!OUNT MOUNT : .___: ..___.: _____: ________________________________: ------------: ------------: .----------- t------------: ------------: ------------: ------------: : I: 45. b : !I. :SK1P CENTER STRIPE Ib2.S0 : !I. 39.93 : !I. 1.73 : !I. 41.bb: 12,495.b3: ~I. 1108.13: 12,b03.75: : ____: ______: _____: ________________________________: ____________: ____________: .-----------: ------------: ------------ J ------------: ------------: : 2 155.5: !I. :SKIP CENTER STRIPE NITH NO PASS I 1178.00: 53.5B : 0.25 : 53.83: 19,537.24: 144.50: 19,5BI.74: !I. !I. !I. ~1. : ____ ______: _____ ________________________________ ____________ ____________ ------------ :------------: ------------1------------: ------------: 10.10: IbOB.OO: 435.00: 2043.00: mO.BO: l.F. L.F. L.F. L.F. $43.50 : 1204.30 : : 3: 3832 :l.F. JPAINTEO 8' GORE STRIPE : ____: ______: _____: ________________________________: ------------ I ------------: ------------1------------: ------------: ------------: ------------: : 4: B4.b : "I. :DOUBLE YELlDW CENTER LINE 1275.00 : Bb.B7 : 0.33 : 87.20 : m,BB9.25 : 190.75 : 123,9BO.00 : : : : !I. : !J. : M. : !I.: : : : : ----: ------: -----1--------------------------------: ------------ 1------------: ------------ :------------1------------: ------------: ------------: : 5: 1305 IL.F. :PAINTEO 8ARRIER STRIPE 10.30: 0.00 : 0.00 : 0.00: 10.00 : 10.00 : 10.00 I : : I : L.F. : L.F. : L,F. : L.F.: : : : : ____: ______: -----: --------------------------------: ------------1------------: ------------: ------------: ------------: ------------: ------------: : b ;117.B ; !I. ;PAINTED EOGE STRIPE ,::~I.OO; ~::B.35; "1.0.00; ~;:B.35; 119,3BO.85 ; 10.00; 119,3BO.B5 ; J ----: ------: -----: --------------------------------: ------------: ------------: ------------1------------: ------------: ------------: ------------: I 7: 6,4 :L.F. :PLASTlC STOP BARS 14.50 : l.F. 54.00 : L.F. 0.00 : L.F. 54.00: 1243.00: SO. 00: 1243.0D I 1..F. : :: --------: ------------: ------------: ------------: : ----: ------: -----: ------------------------- -------: ------------: ------- -- -_.: ------------: : B: 1.5 lHUN. :TYPE II LANE ~ARKERS 1310.00: 0.80 : 1.16 : 1.96: I24B.OO: 1359.bO: Ib07.bO: l' :: : HUN. I HUN. : HUN. : HlIN. : : : : ____: ______: _____: ________________________________: ______ ______: ____________: ------------: ----- -------: ------------: ------------1------------: 3 lEA. :PLASTlC TRAFFIC ARROW 150.00 : EA. 0.00 J EA, 0.00 I EA. 0.00 : EA. 10.00 : SO.OO I 10.00 : : ----: ------: -----: --------------------------------: ------------: ------------: ------------ : ------------: ------------: ------------: ------------ : 3 : SO. YO: RE"OVING PLASTIC PAVE!ENT 150.00 : 0.00 : 0.00 : 0.00 : 10.00 : 10.00 : 10.00 : I :~ARKIN6 : SO. YO. : SQ. YD. : SO. YO. : SQ. YD. : : I : : ____: ______: _____: _____________________ ___________: ____________: ------------: ------------: ------------: ------------: ------------1------------: 29 JL.F. :RE~OVIN6 TE!PORARY STRIPE ' 11.00 : 28.00 : 0.00 : 2B.00 I 12B.00 : SO. 00 I 12B.00 : : : : : : L.F. : L.F. L.F.: L.F. : : : : ----: ------: -----: --------------------------------: ------------: ------------: ------------ :------------: ------------: ------------: ------------: : 12: 7.0 JHUN. :TYPE 1I LANE ~ARKERS 1205.00 I 4.14 : 2.B6: 7.00: IB4B.70: 15Bb.30: 11,435.00 J J': : : (SUPPLIED BY JEFFERSON COUNTY) I HUN. I HUN. : HUN. : HUN. : :: : ____: ______: _____: ________________________________1 ------------: ------------: ------------1------------: ------------: ------------: ------------1 : 13: 4.4 lHUN. :RE~OVE TYPE Y REFlECTORS 150.00 : HUN. 0.52 : HUN. 0.73 l HUN. 1.25 : HUN, m.oo : I>b.50 : 162.50 : : ____: ______: _____: ________________________________: ------------: ------------: ------------1------------: ------------: ------------: ------------: I II: 2.0: !I. :SKIP CENTER STRIPE WITH NO PASS: : (20 GALLON SPECIFICATION) 1210.20 : !l. 1.94 : "I. 0.00 I !J. 1.94 : ~I. 1407.79 : 10.00 : 1407.79 : , , , , : ____: ______ : _____: ________________________________: ------------: ------------: ------------: ------------1-------- ----: ------------: -- ----------1 : 15: b.O: !I. IDOUBLE YElLDW CENTER LINE : (20 GALLON SPECIFICATlONI 132b.52 : !I. 5.77 : ~I. 0.00 : !I. : 5.77: 11,984.02: 1'0. : 10.00: I1,BB4.02: , : -..--: ------: -----1--------------------------------: ------------1------------: ------------1------------: ------------: ------------: ------------1 o ~ ~ COUNTY OF JEFFERSON, STATE OF NASHINGTON CONTRACT VOUCHER OETAIL NORY. SHEET Oat" 12/2B/BB Ti..: 11:5b:22 Input bs&?f. Ch~'d bY:~ Nork 00'" To 11130/B8 Esti..t. No.5 and Final Rock.y's Road Stri pi ng 91b Gard.n Hill Rd. Eha, NA 9G541 iiiEiiiiiiiAl-iuNii-i-mn--m---iiEii-------mn--mm-m---i--PREyiiiUS--inpREsENi--m--iiiiAl----i --PREyiiius --i--PRESENi m--niiiiAlnn. :ND. :QUANTI: : : UNIT BID : QUANTITY : QUANTITY I QUANTITY : MOUNT : AI10UNT AMOUNT: : ----: ------1-----: --------------------------------: --------.---: ------------: ------------: ------------: ------------: ------------: ------------: I 1b: 2.0: MI. ISKIP CENTER STRIPE $b2.50 I 1.59 I 0.00: 1.59 I 199.3B I 10.00 I 1(20 GALLON SPECIFICATION I I MI. MI.: MI. 1 MI. 1 I 1 1----: ------1-----1--------------------------------: ------------1------------ i --------.---: ------------: ------------: ------------: -.----------: IN/A IN/A : NIA IPAVmn FOR MATERIALS 011 HAND : SEE ESllnATE NO. 1 IAS PER INVOICES $13m 1lb0493: OATEO 08-05-88 AMOUNT BILLEO AMOUln PAlO I 127,073.81 I I (127,073.811 I 10.00 I 127,073.81 I $0.00 11127,073.8111 : ____: _____.: _____: _______.___________.______._____: __________..: ...._..R____: ____________: ____________: ____________: ___________.: .___________: SUB-TOTAL $591248.65 1 1l,2b9.28 I IbO,517.92 : Warrant No. Tota! Alt. II ,205. BI 1-5X RETAINED PER CONTRACT: (12,9b2.431: I her~by certify nn honor that thE above estimate is based upon actual .~asurellent~ and that the same is true and correc~~---.--.----.~~~~::-------~-~:~~:~~~::-;--~~~:~~~~~.;_~:~:~::~~:_; - c~~niy E~gi~;;~-m 'S.. Chang. Order 11 II the undersigned, having first been duly slIIorn, do hereby depose and say that uSee Change Order 12 no laborer, Illork.lan or .echanic so employed in connection Illith perforunce of this Mork has been paid less than the prevailing rate of lIIage as specified in the princ:ipal contract, and .that the above bill is true and correct;and that there is due Ie thi 5 date, il:c:ording to c:ontrac:t I the sum of $1 t 205. 81 and that the same or any part thereof has not been paid. (Sign Her.)_j:,I~__!Z-~_n for Rock.y's Road Striping Co. Subscrib.d and s.om to b'f~ oat'_I-_-::LI=o/_, 19GB ______day of ____n__n______, 1988. Order.d Paid County Audi tor By n________________n________________ Chairun, Board of County COf'llissioners ..__._~ n f) (""-) Project: Pav...nt ~arking - 1988 - ~10766 Oat.: 12/28/88 Ti..: 11:56,22 Inputbv:~ Chk'd bv:~ Work Don. 10 11/30/88 Esli..le No.5 and Final COUNIV OF JEFFERSON, SIAIE OF WASHINGTON CONTRACT VOUCHER DEIAIL WORI: SHEET Roo,ey's Road Striping 916 6arden Hill Rd. Eloa, WA 98541 iiTE"i TO IAi:- iUNI 1- i- __nm_ - -- - - i IE H - _m -- - --- - ui m_ mm -- i - -PREVI ousui-- PR ESENI on -- - - I 0 IALw - i -- PREV Ioiis -- inp RE SE N T _n___ - TOTAL ----- IND. lGUANTl i I UNIT 810 i aUANTlTY I QUANTITY I aUANTlTY I AMOUNT A~OUNT AIOUNI I I I 45.6 : ~I. lSKIP CENTER STRIPE : ----: ------ :-----: --------------------------------: ------------: ------------: ------------: ------------: ------------: ------------: ------------: $62.50 I ~I. 39.93 I ~I. 1.73 I ~I. 41.66 I 12,495.63 I ~1. 1108.13 I $2,603.75 I J ----: ------: -----1--------------------------------: ------------: ------------ J ____________: ____________: ____________: ____________: ____________: I 2 I 55.5 I ~I. ISKIP CENTER STRIPE NlTH NO PASS I 1178.00 I 53.58 i 0.25 I 53.83 I 19,537.24 I ~I. ~J. ~1. ~J. $44.50 i 19,561.74 I : ----: ------: -----: --------------------------------: ------------: ------------: ------------: ------------: ------------ ~ ------------: ------------: I 3 I 3832 lL.F. IPAINTED 8' 60RE STRIPE $0.10 I 1608.00 I 435.00 I 2043.00 I 1160.80 I $43.50: 1204.30 I loF. loF. loF. loF. : ---- I ------: -----, -------------------------------_: ____________, ____________, ____________ ____________ ____________ ____________ ____________: : 4 I 84.6 I ~I. IDOUBLE YELLOW CENTER LINE $275.00 I 86.87 i 0.33 I 87.20 I $23,889.25 I ~. ~. ~. ~. 190.75 : 123,980.00 I I 7 I 634 iloF. IPLASTlC STOP BARS : 6 1117.8 I ~I. IPAINTEO EDGE STRIPE 1151.00 I 128.35 I 0.00 I 128.35 I $19,380.85 i 10.00 I 119,380.85 I : : : J , tH. : tH. : tll."1. ::: : ----: ------: -----: --------------------------------: ------------: ------------: ------------: ------------: ------------: ------------: ------------: : 5 I 1305 IL.F. IPAINTEO 8ARRIER STRIPE 10.30 I 0.00 I 0.00 I 0.00 I $0.00 i $0.00 : I I I I loF. loF. I L.F. I loF. I I I : : ----: ------: -----: --------------------------------: ------------: ------------ J ------------: ------------ J ------------: ------------: ------______: : ----: ------: -----: --------------------------------: ------------ J ------------ J ------------: ------------: ------------: ------------: ---_________: $4.50 i L.F. 54.00 I L.F. 0.00 : loF. 54.00 I loF. $243.00 I 10.00 I I 8 I 1.5 IHUN. lTYPE 11 LAfIE ~ARKERS $310.00 I 0.80 I 1.16 I 1.96 I 1248.00 I 1359.60 I : HUN. I HUN. HUN. I HUN. I I : ----: ------ I -----: --------------------------------: ------------1------------: ------------: ------------: ------------: ____________1 ____________: : ----: ------: -----: --------------------------------1 ------------1------------] ------------: --------____: ____________: ____________: ____________: I 9: 3 lEA. IPLASTlC TRAFFIC ARROW 150.00 : 0.00 : 0.00 I 0.00 : 10.00 I $0.00 I $0.00 I : : J : : EA. : EA. : EA. EA.: : : : 1----: ------: -----: --------------------------------: ------------ J ------------ :------------: ------------ J ____________: ____________: ____________: 3 ISQ.YO:RE~OVING PLASTIC PAVEIENT $50.00 I 0.00 i 0.00 I 0.00 I $0.00 : $0.00 I $0.00 I I lMRKING I SO. YD. I sa. YD. SUO. I SO. YD. I I I I 1 ----: ------: -----: --------------------------------: ------------: ------------: ----~_______ 1------------: ____________: ____________: ____________: 28 iL.F. IRE~DVING TE~PORARY STRIPE I $1.00 : 28.00 I 0.00 I 2B.00 I $28.00 I $0.00 I 128.00 I : I I I I loF. I L.F. loF. I loF. I I i I : ----: ------: -----: --------------------------------1------------1------------: ------------: ------______: ____________: ____________: ______~_____: I 13 I 4.4 IHUN. IRE~OVE TYPE Y REFLECTORS $50.00 I 0.52 : 0.73 I 1.25 I $26.00 I 136.50 i I I I HUN. I HUN. : HUN. I HUN.: I I I : ----: ------: -----: --------------------------------: ------------: ------------: ------------1------------: ------------ J ------------: -----~------I i 12: 7.0 iHUN. :TYPE II LANE ~ARKERS $205.00 I 4.14: 2.86 I 7.00 I $848.70 I 1586.30: $1,435.00 I I': I : ISUPPLIEO BY JEFFERSON CDUNTY) I HUN. I HUN. I HUN. I HUN. I I I : ----: ------ : -----: --------------------------------l------------: ------------1------------ : ------------1------------: ____________: ____________: I 14 I 2.0 I ~I. ISKIP CENTER STRIPE ilTH NO PASS I 1210.20 I 1.94 I 0.00 I 1.94 I 1407.79 I $0.00 I I 1120 GALLOtl SPECIFICATION) I ~I. I ~I. : II. I ~1. I I I I : ----: ------: -----: --------------------------------: ------------l------------: ------------: ------------: ------------: ------------1------------: 115 I 6.0 I ~I. IDOUBLE YELLOW CENTER LINE . 1326.52 I 5.77 i 0.00 I 5.77 I 11,884.02 I $0.00 I 11,884.02 I WO GALLON SPECIFICATlDN) ~I. "1. II. ~I. : ---- : ------: ----- : --------------------------------1------------: ------------: ------------1------------: --------____ : ____________: ____________: ~ COUNTY OF JEFFERSON, SIAIE OF NASHINGION CONIRACI VOUCHER OETAIL NORK SHEET Rockey's Road Striping 916 Garden Hill Rd. Eloa, NA 9B541 D.te: 12/2B/BB Ii.e: 11:56:22 Inputby1:!X\ Chl:'d by:_~ Proiect: Pave.ent !arking - 19BB - MI0766 Nork Done 10 11/30/BB EsHute No.5 and Final jIyEMiyiiyAL-iuNIy-j----------u--IyEii- ------m------mm-----i--PREvIiius--i--PREsENy----miiiyAL----i--PREVIOUS -TPRESENy-------yOy AL----- IND. IOUANTlI I : UNII BID I QUANIlTY I DUANIlTY I QUANTITY I AMOUNT : AMOUNT I A!OUNT I : ----I ------ 1-----: --------------------------------: ------------: ------------: ------------: -------_____: ------------1------------: ____________1 : ----: ------: -----: --------------------------------: ------------: -----.------: ------------: ------------: ------------ 1------------: ------------: I 16: 2.0 I MI. ISKIP CENTER STRIPE 1120 GALLON SPECIFICATlOIII 162.50 : MI. 1.59 I MI. 0.00 I MI. J .59 : 199.3B I 10.00 : MI. IN/A I N/A IN/A IPAVMENT FOR MATERIALS ON HAND I SEE ESTIMTE NO.1 AMOUNT BILLED I 127,973.81 I 10.00 I 127,073.BI I IAS PER INVOICES 113652 1160493: DATED OB-05-BB AMOUNI PAID I 1127,073.Bll I 10.00 : 1127,073.BI) I : ----: ------: ----.: --------------------------------: -----------.: ------------: ------------ J---...---.--: ------------: --____._____: ____________: Warrant No. SUB-TOTAL $59,248.65 : 11,269.2B I Total A,,!. 11,205. Bl 1 hereby certify on honor that the above estimate is based upon actual ""sur...nts and that the me is true and comc!.~~--u----u-:~:~::-------:-~~~::~~:::-;--~:::~::~:_;_~:~:~~::~:_: County Engineer 'Se. Chang. Order 11 1, the undersigned, having first been duly sworn, do hereby depose and say that uSee Change Order .2 no laborer. Nodun or lechanic so employed in connection Nith perfor.ance of this work has been paid less than the prevailing rate of wage as specified in the principal contract, and that the above bill is true and correct;and that there is dUE me this date, according to contract, the sum of $11205.81 and that the salllr:: or any part thr::reof has not been paid. (Sign Herel.l.~~?'5______ for Rockey's Road Striping CD. Subscribed and SNOrn to beloJ' .e this Date_I--=-.LL-:~u' 19BB ____uday of _____u_____u__, 19BB. Ord"ed Paid :-5% RETAINED PER CONTRACT: (12,962.431: County Audi tor By -____u____u___________u__u______ Chair.an, Board of County COlSlissioners (SEAll , .' " .: i',.;': . ',.. ~: ...,.,..... ....' . , . '., .. i..,..,. ' . ., .'. '.""...,.',.. ',.. ,',: .. . ." .. ,'..,. ,:, ,,'. , .',' ,':..' ' . ...... ,'.' ..., '.' ....,.. . '... .'~'..."'."" ...,'.'. '. ,..,:: , " .',.. ., .,' .. ." .. '." ,'.., , .... .' I': , . ... 'cO': ,:':" '., . .'; .., .. , ,,:'" .,. .':.. . ., (":1 .. ,.1 .". ... . ,0 ,. I, i. r--- DATE gilD, '88 SU8~ECT 7f.)(/6;;~;VT /-7rJRL'/QC- Ihf-f?c::vr ICc7Z- /~~J?//j'C5 e/-l drJU.b /-7TO 7~b : .....';, . .. TO -/1'j;Pci..z:> /?cc~e'~ l"uu y:S l?6ff7) "$ni?/NG CD. JllbG;:JRD5V IJ/LL :?D. .' c;::2/-?/4 -1 l-<-rJ . 985''-1/ .' '..... ;., :;:. '.."",. '. 7{ G-;;'rs~ S)C!..AJ ~s77/:;~ n-A/D --;::eOC 6-=5'5/""</(; rh- C- 3 Pe7V'R/C/ c.~ ~-~ /lto--:; &~ TI-f€ TO /'l'€ ~JJ CL C!5el:J k;2.. ; 1f!J7:x/ y .. SIGNED~' {~~ /.:: ".,....."~'.O'II"IU'rDIlD"'llrO~PD":Il"~.mDI.~cHI~I..I"'"1.lll'"DrS&DD., -"--~--""-"""-~-''''''''''''----~-' ! r i S,ll-TOTAL $0.00 m.C1J.8! 12l.C1J.81 "" ,'" Wdrr<Y1C No. Tot.l Iwt. $25.T20.12 I rrEaSUraT9'lts .rod tret eM S~ is ;: ~ ;:.. ~ i'olvi"l, first this....k Ns """.." 'lot .,. ." .~ .., this ..... ;:.;.:; is ds do CaIlty 8v.Ii-; "" I in tr. TOTAlS 125.120.12 (SIiJ' Here) fCJ'lb::key's~Stripif'9. SJbscriOOd a"d 5'/C1I'Tl to beforel!S this _<>>Vol ,1588. ill.. , 1588 ():deredP,id , ,:' :: --- '.'.. ' . .",'. .. - ,,,. ,..,. ,: ..:,. ..'. ,.,. .".'. '.' ..,..., ,'.,. ,J .," ".,;: '" ...'.., . ,." ..:., ' ':.:' , ,. , . .:: " :' ..: . .".., i. .. ," '.' " .,. . .,' . ,,:' '>i. ....: , ,'.,. ..'---- . .:'.,..:. , I' ., I,: .' " , , ,..... ~ . , '. ' I'.. .:1' I I: ' .; -, LL By CMfl'm.Vl RtoJIM flf rnl'!.tv-Cam~a- r . .' .,.. " L." .. - ' :' . ,;. I .' . .. .,. .: .:. ' ---:-:- :. I .., . .. .'..; ,I\~;J>: .:..... .. . :". .....:: .' .'. .; . ... '. i .. ... ....:....,\:" . .., .. ... .., . i. .... [. .... : ' . ',...;,.'. . ".. .('.. ,., '. .... ... :.;,.' ... :., ., :' .. .. ,/ ... ;.' .. . .>..' . ,I, ..', '..', .. ,. :~. >.. .. . I..'. .."..' '" ".,.".,...'.. :..i:' :. . ,. ...,:,: '.,. .......,', ' "', :. ,,','. .,.". . .', '.<:.' , .. ,..:,.",.,',.. ." I! ' .: '.' ... I'", .", ,I ,. ..,' 't,'. . ,.,'. ,,:,. '-- ".,' ,... .... .. :.. i' '.. , . .', .',. ., ' "" .," ':,,' :,',.. ',., ..,. ," ,'......, ... " ).....,.- I ....,.. I : L....- ~ ;'~),\ ';,":;'~! p" . <~Y.;>: .',i';)i};: I'" ;.l~'i;,:':~ .,';. ~ ;<<", ',:', ''.i-~:;' (, ~', , ,. i'y-:.'_',: \;' "~'~ " , :~ ,f<-;~: j~' .>'; I"~ i<_!';;<.:;_<:,~":'":'" .. , i '. .i .. :.' , I 'j ".,.. \; : . '.,.., . :, ",. Ii, {, ~~. '!i' i( '.. : :, f.' "~, l'~ ... y. '.,.~, .._'.""'__":':'___'__"'_'<="~'W"~~~~'_~''''__W-''''";''''~'''.' "",_c,..ww"t_~..",,~,...WJ..",:,"'..' "'-".t ,. l,./ . .. .' ,., : " .. :~ ~(;~'\;;':>;" ('~,~.::~i; :.'::i:;,;,t-.~::, j"," ,';::'.';..;-,. e,,\''-.''r~:, , '" .,/ >;;::~<" <':~':;~J,fj':;J;" ..._."__n__ " Project: PaY9T81t 1'\3rkfr.; ~ 1988 - MT0166 ,. I~' catHY Cf ;EFFO'W<. STm Cf iilSill>3TOO o:t<TPACT 'N.ll<ER WAIL <001 SiEET tnl'Jt~/:,~.""""" CH<.'d'~/?Jl- ",k_To,8/01/a8 ~I>~l : -:----:- .'.: i . ..... .' i ..', : .., I .. I " :. n':.' .. I ." I .. .":, .. , '.:. . .. " : 0.,,, 8/05/i8 fir.e: 11:30 A.;,!. _.Ca1<r,,'crJ _1<x:""'.I'oolSWpirq Ide,..., 915 Go"., Hill Rd. El..,WA Si541 .... .... IITEMITOTAL I\.NIT I ITEM I I PRr/la.5 I =-T I TOTAL I PRr/la.5 I =-T I rom. I [~. [QJIIiTlI I 1 1mT BIO I <w<rrITY I QJUflITY I Cl!A'IllTY I ~mr I IIUIiT I ''IJJfl' I I I [ I I I I I I 1 I I I I I 47,B 1 ,1. 1Sl<IP CENTER STRII'€ I 162,50 I 0.00' O.CO 1 0.00 I 10.OC I 10.00 I 10.00 I I [ I I I '1. [ ,1. I '1. I 'I. I I I I 1 I I I 1 I I I I I I 1 , 2 I 57.5 I '1. 1Sl<IP CENTER STRII'€ HITl! 00 PASS I 1118,00 I 0.00 I 0,00 1 C.OO I 10.00 I IUD' ID.CO I I I I 1 .1 '1. I '1. I 'I, I Mr. I I I I I 1 I I I I I 1 I I I I I 11 3B32 p. [PAlIlTED B' OORE STRII'€ I 10.10 I O.OC I 0.00 I C.OO I 10.00 I 10,00 I 10.00 I I I 1 1 I u, I L.F, I U, 1 loF. I I 1 I ---1=1 I I 'I I 1 I I I I I 4 I 90,B I MI. [OOJlLE YEL~ CENTER LINE I 1215.00 I 0.00 I o.eo I o,eo I 10.00 I 10,00 I 10.00 I I 1 I I I MI. I MI. , '1. I MI. I I I I I 1 I I I I 1 I I I I 1 I 5 I 1305 IL.F. IPAINTED 8AliR1ER STRIPE. '10.30 I O.CO I O.CO , 0.00 I 10.OC I 10.00 I 10.00 I I I I I I U. I LF. I U. I L,F. I I I I I r I I I' I , I I I , , 5 1f17.8 I 'I. 'PAINTED EIX:E 5TRlPf I 1151.00 I O.CO I O.CO I 0.00 I 10,OC I 10,001 ID.CO I 1 , I I I MI, I 'I. I .1. , MI. I I , 1 I I I 1 I I I 1 I , I I I 7 I 534 p. II'lA5I1C 5Ta> BAAS I IUD I 0.00 , 0.00 I 0.00 I 10.00 I 10.CO I 10.00 I I I I I I L.F. 1 L.F. , U. [ L.F. I I I I I I 1 1 I I , -I I , 1 I 1 B 1 8.5 11Ul. ITYPf llLA~E XlRKE15 I 1110.00 I 0.00 I 0.00 I C.OO I 10.00 I \0.00 I 10.OC I 1 1 I I I 1Ul, I 1Ul. I 1Ul. 1 1Ul. I I I , 1 I I 1 'I I I I I I I I 9 I 1 lEA. IPLASTIC TRAFFIC ARl!)j I 150,00 I O,OC I 0.00 I 0.00 I 10.00 I 10,00 I 10.00 I 1 [ I I I EA. I EA. I EA. I EA. I I , I I 1 I 1 1 I I I I I I I 1'0 I 3 lill.YOIROOIING I'lA5TlC PAVOOT I 150.00 I O,OC I 0.00 I C,OC I \0.00 I 10.00 I 10,00 I I I I IMARKING I ill.YO. I ill.YO, I ill.YO. I ill.YO. I I I I 1 1 I I 1 I I [ I I I I , 11' 28 'L.F. IROOIING TE'rolARY 5TRIPf I \1.00 I O,CC I 0.00 1 C.CO I 10.00 1 10,00 I 10.OC I I I I 1 I L.F. I LF. I U. I L.F. I I , I 1 1 1 I 1 I 1 I I I I I 112 I N/A I NlA IPA\1oOO Fal MATERIAlS (N Hll<0 I N/A I I I I IUD 1\27,073.811121.073,81 1 1 I I IAS PER flMllC!S :13552 & 11604931 I I I I , I I 1 1 1 1 1 I 1 1 I I I 1 I 3.l!-TCTAL I 10.00 1127.073.B1 112T,073.81 1 Wo""" No. Tot.l Att. \25,720.12 I 'I 1 I 1-5% RElAII!EQJ>fIl~IQ.0U!lW5l.691WU.35U'11 I t..reI>; cartlfyall=r tko' ,Is ''''''''''1.... I, basal "pal "",,1 I I I I I "","l'aI'Blts and ,Nt 'Is ,.... i, tM and correct. I TOTAlS I 10.001125.120.121125,720,12 I , I I , 1 .e ;-. :.' , . ':. ( ,. .: .: ...: ! ... .. :>" . . :>., Co.r1ty frgineer I. tlslt"d<rslil'al. koviOJ first ban 6Jly ,.om. do I-ereby depose and "" tko' no la!xJreto. \IO"~ or rrec~;c so erolOVEd in carEct;cn with oerfOl"!1'M;8 of this \IO"k res hem P!lid less tkrl t/"e prevailing: rate of wage as s~iffe:l1n tM princip"l aJ\tr~. .vd trat tl-e <!Ibave bill is trw and corre:t; ~ tree tl-ere 1s ciJe lte this ~te. accordina to CCI'ltr~. thB sun of S25 120 12 Yld that tresarreorN'!'/ p,5rt tl'ere:lf t'asnot!:an paid. , (519\lIere) f..1lx""", Rold St,l,iOJ. SJbscribed W 5'IO'T\ to before rre this Date . 1988 day 01 . 19BB. 0rder0J P.id ,..'., -CMt\'JoJdir.. (SEAL) IIy r.!o..oIil'lMn RNIrt1l"1f rn.,~aw- \/ :, ,'> . . C'~ ~ .: .... ." ....>" " :. . '.". ',.. ": . ,::. ., .,.. .",.. ... '.',' ... , .':,.>.. .: . .". ,. . .. ,.'. . <. ., ... '.. ',. .,. '.: :c" .., ,. ,:',.. .'. . :.,.. . ....>.. '.. . . ~... '.I.,'..... : .. .......:> c ,. .. ' ": .':' ;:. .' '.,'.. ... " . ......., . .... . .:.,,'. . .,'.. . ,'. .::. ',e. "'. ,: . . , . . . ,": ., :..':. P.......,...nt. "......king - 19S8 - "T0766 (~ COUtiT'r' OF JEFFERSON. SlATE Of WASIUHGTOtI ~,' COHTRRCT YOUCHER DETAIl.. ~ SliEET ., , Daw: 11.107....00 liM': 11::)1:24 Input b<J: t!2----- Chk'd b~ Work Oone To 10;31/88 Est.i.aotu No. 4 iIiEHlfornc-mmTI-- -- -ifErr---------I-------r-pRfUiiiis:-PRESENT-I-fCj fAC----r-iiREV 1(1)5- i-PRESEHT--r--ioT Ai: -- :NO. :~TJI 1 : l..tiIT BID 1 QlAfllTY I QU~rITY 1 Ql.AIHITY 1 AMOLllT : AMOUlH : ArIOUHT 1---: ---1--- 1----------------1-----1------1------1------- 1 -----------1--------1---------- , 1 1 4'S.6 1 ,n. ISKIP CEHTER STRJPE 1 .62.50 1 24.86 1 15.07 1 39.93 1 $1,553.75 I '941.68 I 12,495.63 1 .. : I I' 1 "I. 1 "I. 1 HI. 1 "I.' : : 1---1 ---1---1----------------------1------1------1------1-------: -------- I --------1------ I 2 I ~,.:s I "1. ISKIP CENTER 6TRIPE WITH NO PflSS I t17E1.00 I 35.38 1 18.20 1 ei3.~: $6,297.64 I $3,239.60: $9,537.24 1 H : : 1 1 tu. 1 "I. 1 "I. 1 "I. 1 1 : 1---: ---1---1----------------1------1-------: -------1-------1-----.--- :-------: ------ 1 3 I 3932 IL.F. IPAIHTED B" GORE STRIPE 1 10.10 1 633.00 1 975.00 1 1608.00 1 $63.30 1 $97.50: $IW.80 1 I 1 : : I...F. I L.F. : L.F. 1 loF. 1 1 : 1---: ---1---1------------------1-------1-------1 -------1-------1-------1--------: ------ --. 1 4: 94.61 I"IJ. lOOUBLE Y'B-LCMoI CEHTER LlHE 1 1"275.00 1 60.63 1 26.24 1 86.87 : 116,673.25 1 S7,216.oo 1 123,889.25 1 .. I 1 1 : "I. I HI. 1 "I. 1 HI.: : : 1--: ----1--- :-------------------: --------1-------1------1-------: ------: -------: ------ I 5: 130S ILF. IPAINTEO EnRRIER STRIPE : SO.30 I 0.00 : 0.00 1 0.00 : SO.OO t 10.00 : $0.00 I I 1 1 1 L.F. 1 L.F. I L.F. 1 L.F. 1 : : 1---: ---1--- :------------------1------1-------1------1-------1--------1------- 1 -------- 1 61117.8 I "J. IPAIHTED EDGE STRIPE 1 1151.00 1 95.60 1 32.7S 1 128.~ I "4,435.60 1 14,945.~ I 119,380.8:5 1 1 1 1 I "I. 1 "I. I "I. I HI. I : : 1---1---1---1-------------------1------1-------1 ------1-------: -------1----------: ----- --- I 7: 634 IL.F. IPLASTlC STOP BARS I $4.50 1 5".00 1 0.00 1 5".00 I 5243.00 1 10.00: $243.00 1 I 1 I 1 L.F. : L.F. 1 L.F. 1 L.F.: : : 1---1---1---1-----------------:------1-------1------1--------1------1-------1------- 1 8 1 1.:5 IHW. ITYPE 11 LifiE WlRKERS 1 1310.00 1 0.80 : 0.00 1 0.80 1 1'249.00 1 $0.00 I $248.00 ,. I I I t t<<JN. I HI..H. I HJN. , Ha(. I : : 1---1---1---1-------------------1------1-------1------1-------1-------- 1 -------: ------- 1 9 1 3 lEA. IPL..RSTIC TRAFFIC ARROW 1 sso.oo 1 0.00 I 0.00 1 0.00 1 10.00 I 30.00 I $0.00 : 1 1 IlEA. I EA. 1 ER. 1 EA.: I : 1---1 ----1---: -----------------1------1-------1------1-------1-------1----------: ------ 1 10 1 3 ISQ.YDIRENOVHG PLASTIC PAYEI"IEHT 1 $SO.OO 1 0.00 1 0.00 1 0.00 I 10.00 I 10.00 I SO.OO I 1 I It'lAAKIH6 1 SQ.YD. 1 SQ.YO. : SQ. YD. I sa.YD. 1 1 I 1---1---1---1---------------1------1-------1------1-------1--------1-------1------ 1 11 1 28 IL.F. IREt1OVItf3 TEI'PORMY STRIPE I $1.00 1 28.00 1 0.00 1 28.00 1 $28.00 1 $0.00 I $28.00 1 I 1 I 1 L.F. I L.F. I L.F. 1 L.F. I 1 1 1---1----1---1----------------1-------1-------1------1--------1------- :-------1----- -- 1 12 1 7.0 IHI..tl. ITYPE II lH-lE f1ARKERS I $205.00 1 4.14 1 0.00 1 4.14: $848.70 1 10.00: $848.70 I. I 1 I ($lFPLlED BY JEFFERSON COl.tITY) I tl.JN. 1 ~. 1 tfJH. I HLti. 1 I I 1---1---1---1------------------1------1-----__1______1-------1------1-------1-------. 1 13 I 4.4 II-U-I. IREI'KlVE TYPE Y REFLECTORS I 150.00 1 0.52 1 0.00 1 0.52 1 $26.00 1 10.00 I '26.00 I. 1 I 1 I HJH. 1 Hl.tl. 1 t<<JH. 1 Hl.Ii. 1 1 I 1---1----1--1----------------1------1---____1_______1_------1------1-------:------- 1 14 1 2.01 I'll. ISKIP aHTER STRIPE WITH NO PASS: 1"210.20 1 0.00 I 1.94 1 1.904 I 10.00 I $407.79 : "-07.79 1 u I 1 1<20 GfLLC1'4 SPECIFICATION) I "I. I "I. I HI. : "I. 1 I 1 1---1---1---1----------------1 ------1-------1------1-------: -------1-------: -_____ I 15 I 6.0 1 "I. IDOl..&.E YEU..OW CENTER LINE 1 '326.52 I 0.00 1 5.77 1 S.n I fO.OO I 11.684.02 I '1.884.02 : H I 1 1<20 GALLCH SPECIFICATION) 1 HI. : "1. 1 HI. 1 "I. 1 I 1 1---1---1---1------------------: ------1-------1--------1-------1 ------1-------1-------- I 16 1 2.0 1 "1. ISKIP COlTER STRIPE I '62.50 1 Q.OO 1 1.59 1 1.59 : $0.00 1 1'99.38 1 ''39.38 I .... 1 1 1<20 GALLC1'4 SPECIFICATIOH) I "1. 1 pn. 1 HI. 1 HI. 1 I 1 1---1---1---1---------------------: ------1-------1-------1--------: -------1--------: _______ ItvA I NIR 1 H.lA IPAVI1EHT FOR MATERIALS OH HflHD : SEE ESTlI1ATE HO. I 1 A/'IOUHT BILLEO : 127,073.81 : '0.00 I $27,073.81 I 1 liAS PER It-lJOlCES 113652 .160493 I OATED 08o.()5-68 1 A/'IOUHT PAID 1<127,073.81)1 $0.00 1<$27.073.81) 1---1---1---1----------------1------1---____1 -------1--------1------1-------1------- Warrant Ho.________ lot.! Rat. $17,889.84 : SUB-TOTAL i ...0,417.24 : $18,831.41 ; $5.9,248.6S . I-~;-': RETAINED PER C{)-jTRACTI ($2,020.86)1 ($941.57>1 ($2,962.43) 1 hl'rei;JW Cl'rtll'w on honor t.n.at t.h~ KlOVI' esti_t.e ~5 ~~ upon Ktud 1 : I ' .1i'.~I'.ent.s...d that t.he 5a..1' is t.ru..lnd corrKtA-~~~~~------~~RL~----;~~~~~~;-~~~!:~-:~~~~:~~. cO~~.:!" I .Set" Change Ordeor II I, tr.. lrIcM-r5igned, tNtvir.g f'lI:,st bE-e-n dul.., sloIorn, do he-NbIJ d~ose and say tho1lt HSee CIHlnge Order '2 no laborlt,., workaOWl CI" aKt.anlc so _pIOlJ~ In COf'rlK"tion with s>>rf'oraanc:. of' this WCIrk has bun pilid 11'55 Ulan ttw preo....U ing r.u of' Wo1Ige .5 specif'il'd in the- pt"inc:ipill Cont.riICt, oiI"d thcIt Ule i!b0'l.l1i' bill is true .nd corrl'ct;.ilnd thoilt ther. :is ckJ. .. this diltEo, accor"ding t.o ContrKt, t.he- s... of' S17,8a9.84 .and th.oilt thl' ~M' or .,..y par theNof' has not bHn paid. (Sign Hwe~ _ for Rocke..,'s Road Striping Co. ~~::~~dor~::~~_: ~S:~i5 Orde~d P~id ~t.eLC.2_____, 19BB ~~~~~or~~c~~"~S () r; Proje::t: Pa\'8la1t ""rking - 1988 - MT0766 o,te: 9/07/88 Ti",: 11:30 A.H. InPJt ill: A3 Ci'l<'d ilIllf :lJJN7Y Cf jEFFERSO'l. STA7E Cf AASiINGT()'j OOiTRACT I'Cl..OiER DETAlL f()f<< 91EET Ccntractor: Ro:keyls Rood Striping .odd....s: 916 Gardal Hill Rd. El..., i'lA 98541 IITfJ<IlTOTAl IU'iIT I ITEM 1 PRfVIWS 1 PRESENT 1 TOTAl 1 PRfVIWS ! PR;:seIT ! TOTA:. 100. IQJANTlI I I LljIT 810 / (l.l1IIT17Y I QJ~T17Y / (I.I~TI7Y / IK1J/T I AlUNT I IKWT ! /-1-1-1 /-1-1-1-1-/-1-1 / 1 I 47.6 I HI. ISKIP CENTER STRIPE I $62.50 I 0.00 I 17.06 I 17.06 1 10.00 I 11,066.25 I 11,066.25 / I 1 1 11M!. / HI. I Ml. 1 HI.! 1 1 1 /-1-1-1 1-/-1-1-1-1-/-/ 1 2 / 57.5 1 MI. ISKIP CENTER STRIPE WITH I/J PASS I' 1178.00 1 0.00 1 25.38 I 25.38 ! 10.00 I 14,517.64 1 14,517.64 1 1 I I / I HI. / HI. I HI. 1 ,~1. 1 i I I /-I-/-! I-/-I-I-I-!-I-I I 3 /3832 Il.F. IPAINTED 8' OORE STRIPE 1 10.10 1 0.00 I 0.00 I 0.00 1 10.00 1 10.00 1 10.00 I 1 Iii I l.F. I l.F. I l.F. I l.F. I ! 1 1 1-1-1-1 1-1-1-1-1-1-1-/ I a I 90.6 [ HI. ir0:J6lE YELl(lo/ CENTER LINE / 1275.00 1 0.00 1 41.82 ! 41.82 1 10.00 1111,500.50 1111,500.50 ! i I I I 1 HI. 1 HI. 1 HI. 1 HI. I ! I 1 1-1-1-1 1-1-1-1--1-1-/-1 / 5 11305 Il.F. !PAINTED BARRIER STRIPE I 10.30 1 0.00 1 0.00 I 0.00 I 10.00 ! 10.00 I $0.00 1 1 / I I I l.F. I U. 1 L.F. I l.F. 1 I I 1 1-1-1-1 1-1-1-1-1-1-1-1 1 5 1117.8 1 HI. IPAINTEO EOOE STRIPE / 1151.00 I 0.00 1 93.02 I 93.02 I 10.00 1114,045.02 1114,045.02 1 I 1 \ I 1 1 MI. / HI. / HI. I HI. I I I I 1-1-1-1 1-1-1-1-/-1-1-1 1 7 1 534 1l.F. IPlASTlC STOP 8ARS i 14.50 I 0.00 1 0.00 I 0.00 I 10.00 I 10.00 I 10.00 I I II! 1 l.F. / l.F. 1 l.F. 1 L.F. 1 1 1 I 1-1-1-1 !-/-I-I-I-I-/-I 1 8 I 8.5 Itw. I7YPE IllA'1E I<W<<ER5 1 1310.00 1 0.00 1 0.00 1 0.00 1 10.00 1 10.00 1 10.00 1 I I 1 / 1 rW. 1 IW. i IW. I IW. I I 1 I 1-1-/ I /-1-/-1-1-1-1-1 I 9 I 3 !EA. IPlASTlC TRAFFIC ARk\:ll 1 $50.00 I 0.00 1 0.00 I 0.00 ! 10.00 I 10.00 1 $0.00 1 1 1 1 IlEA. I EA. I EA. ! EA. II! 1 1-1-1-1 !-/-!-!-I-!-I-I 1 10 1 3 ISQ.YOIROOlING PlASTIC PAVEMENT 1 150.00 1 0.00 ! 0.00 1 0.00 1 10.00 ! 10.CO 1 10.00 I I 1 I I_1M3 I SQ. YD. 1 SQ. YO. 1 SQ. YO. I SQ. YO. I 1 1 1-1-1-1 1-1-1-1-1-1-1-1 . 111 I 28 IU. IROOIIM3 TEII'CilARY STRIPE 1 11.00 I 0.00 1 0.00 I 0.00 1 10.00 1 $0.00 1 10.00 I 1 j ! ! 1 l.F. 1 l.F. / U. ! l.F. I 1 1 1 1-1-1-1 1-1-1-1-1---1-1_1 /12 1 N/A 1 N/A IPAi1>IfNT FOR MATERIAlS ~ IWIO / N/A II! I $27,073.81 1(127,Oll.81)! 10.CO I 1 I 1 IAS PER INVOICES "13652 & mOa93/ 1 I ! I I" I I !-I-I-! 1-1-1-1-/-1-1-1 I as-TOTAl. /127,073.81 1 14,055.60 /131,130.41 1 Warrant No. Total//nt. 13,853.77 I 1 I 1 I !-5% RETAINED PER CCNTRACTI (It,353.59)1 (1202.83)1 (11,555.52)1 I i'erclr,I certify 0'1 Imor tret tre above esti...te is basa:l upen actual I 1 I 1 I neasu""""'ts <rod tret tre sane is tl'\.e <rod correct. A ~~. ~ U TOTALS 1125,720.12 I $3,853.77 1129,573.89 I ~&]ot'6i 1-1-1-1 CaIlty ttv;i,.,.,. "lESS PREVIWS PA'rIfNT FOR MATERIALS ~ IWID I, tre unoersi~, having first bea1 ",'y Mrn. do rereol cepase <rod soy tl'l3t no 1abcrer, \fr.C('iqran or rrecMnic so emp;oyed in cO'V"tectiO"l with perform31'lCe of this "",k Ius bea1 poid less t~ the prevail ing rate of 1<49" as spe::ified in tre principal C<J\tract, and tMt ti'e ,Cove bill is tl'\.e and correct: and that ti'ere is clue '" this dote, according to C<J\troct, the sun of 13,853.77, and tMt tre sane or any port thereof Ius not bea1 poid. (Sig> Here)4...V~~ for !<x:key's Rold StripilYj Co. Subsoribed and SW>'I1 to before '" this o,te ~ / , 1988 _doyof , 1988. Ordered Paid I<lrk Il:Te To: 9/01/88 Esti...te No. 2 Co.I1ty Auditor (SEAl.) Bv Chail'1l\ll1, Board of Co.I1ty ComlissiO'llll'S ,:. ." I. ." , ., :,;:;~~Y~ .. , .. '. \,.. :' I.; I.,: .r, ;, :" ;11 Ii I~ " :. , ',..',.' J.C ...:': ..,.,,: ".. . . ,.'. ,..., :,.<.i~: :,:,.:,' Project: PaYaiU'lt ~o!rki01- 1989 - KT0766 .'... . ., --"""octOCL.~tcl,!J>) '~':.',,~-:':,/'."_' ",', .ACc!ress: 916 GarCEI'l Hill Rd. , . EIOl, WA 96541 .. ; .. .., , :. :,: ...,' ..... : " '.."... .. , . ., :' '.."." i '.. .,.. ' , 'C. ; .' . '.,,: ., "..,.: . ." .,'.: , :." .. '.. .'.,:. " , ',' .'. "'..' .,. i. L . I: .. I ,~ I: C I' '." ,', . , ,'. ;.,c.': ,', ..", ; ., '. ., ..'~': '.. ' . ., .,: ...'.'. , ....'.,,'. ". '. ,>L' :',:,'.: ') -'.. I. ,. . -, . .. ..... ~ I : ) , . ...1.... ...; .' '., . .,' .'.,., , .- ... .' ,.'. ,:.... , . " .. ' ,,'..::".. , .. .' . .C...,.. . :.' . ... ,.. .:.;. .'. :..., . .. '.. C, : .. (') 01NTY CF JEfFEW4. STATE CF iiASillIJTCN crnnocT \U.OiER WAIL ;(fO( 9;EET fnp..lt"":~. Cl>:d.o"flir- ltrk_To, 6/01/86 Illt" 6/05/66 ffr.e: 11:30..;.1. 1=<,.-1""',...,..... 1 :: IITEMITOTAlILNlf I lfEM I I ~IM I FI<iSENT I TOTAl I PRflla.G I PRESalT I TOTAl I 1>0. IQJNifll I I LNIT BID I (tIHTITY I QJlllfITY I QJ~~TITY I ~1tlHT I ~'W/f I 4'O.HT I I 1 I I I' I I I I I , I 1 I 47.6 I 'I. !SKIP eESTER STRIPE I 162.50 I 0.00 1 0.00 I 0.00 I 10.00 I 10.00 I 10.00 I I 1 I I I '1. I 'I. I MI. I 'I. I I I I I I I , I I I I I 1 I I I 2 I 51.5 I ,1. 15I<IP CENTER 5TTllPE WITH 00 PIS; I I11B.OO I 0.00 1 0.00 I 0.00 I 10.00 I 10.CO I 10.CO I I I I I .1 MI. I MI. I MI. I 'I. I I I I I I I I I I I I I I I I I J 13132 IL.F. IPAlNTE1l I' (l.'1<f 5TTllPE I 10.10 I 0.00 I 0.00 I 0.00 I 10.00 I 10.00 I 10.00 I I I I I I L.F. I L.F. I L.F. I L.F. I I I I -1=' I' I I I I 1 1 I 1 I 4 I SO.5 I 'I. IIXUlLf yaLClHelTlHI>E I 1215.0: I 0.00 I O.CO I O.CO I 10.CO 1 10.00 I 10.CO I I J I J I '1. I '1. I 'I. I '1. I I I 1 I I I I I I I I I I I I I 5 1 1305 IL.F. IPAIMTED emllER 5lRlPE I IUD I 0.00 I 0.00 I 0.00 I 10.00 I 10.00 I 10.00 I I I I I I L.F. I L.F. I L.F. I L.F. I 1 I I I r I I I 1-1 I I I I , I B 1111.1 I MI. IPAINTED EOOf STRIPE I 1151.00 I O.CO I O.CO I 0.001 10.00 I 10.00 I 10.CO I I I I I I 'I. I ,'I. I '1. I '1. I I I I I I I I 1 I I 1 I I I I I 11 634 IL.F. Ipuslle 5TCI' BIJ5 I 14.50 I 0.00 I 0.00 I 0.00 I 10.00 I 10.CO I 10.00 1 I I I I I L.F. I L.F. I L.F. 1 L.F. I 1 I I I 1 I , I I 1 I 1 1 , , I 8 I 8.5 IHJj. ITYPE H u.~e :wl\E15 I 131D.CO I 0.00 I 0.00 I 0.00 1 ID.CO 1 lo.cO I 10.00 I I I I I I HJj. I flN. I flN. I flN. I I I I I 1 , I 1 I I I I , 1 I I 9 I 3 lEA. IPlASlle lRAFFIC ARlOl I 150.00 I 0.00 I 0.00 I 0.00 I 10.00 I 10.00 I 10.CO I I I I I I EA. I EA. I EA. I EA. I 1 I I I I I I 'I I I I I I I 110 I 3ISQ.YDIROOIlOO Mile PA'lEer I 150.00 I 0.00 I O.CO I 0.00 1 10.00 I 10.00 I 10.00 1 I I I 11ARKlOO I SQ.YIl. I 51.YIl. I 51.YD. 1 Sl.YD. I 1 I I I I I I I' I I I I I I 111 I 28 IL.F. IROOIlOO 100JIWlY 5lRlPE I 11.00 I O.CO I 0.00 I D.CO I 10.00 I 10.00 I 10.00 I I I I I I L.F. 1 L.F. I l.F. I L.F. I , I I I I I 1 I I I 1 , 1 I , 1121 NIA I N/A IPAMNI All "-ATERIILS al HI.~D I N/A I I I I ID.CO 1127.013.11 1121.013.11 I I I I I.IS PER lIMlICfS .13652 & .16114931 I I I I I I I I 1 I 1 I I I I I , . 1 I , SlI-IOIAl I 10.00 1121.013.11 , 121.013.11 I Total."'. 125.120.12 I I I I I I-5\OflAI,rnPER~D..IID...l-!\l.J51.5m.!IUW')1 I hrel7t COI'ttfy '" Iu'O' tNt "" ..... estt..t. is bosal 'IX" oct\lol I I I I 1 .....rmmts.-d tNt till ,in Is tn..;rd c:arer:t:. ~/ r-/ R#(7')r><./ TOIILS I 10.001125.120.121125.120.121 Co.nty8'lgineer I. "" uWsi!l"d. ""'Ing first Ixm ciJlv""". do ""'"'...... O"d S'i tNt ro labrer. \IQ"~ cr lr'I!Ct'a'lie $0 B!01cve:1 in c:a'l"I9:ticn wit" t8'fa'lM"Ot of thfs irO"k Ms b3rf1 pafd less tlwl thJ ~n 1ng rat. of wagI as S'pJ:tffld in tht lX'ircip,11 CO'ltract, ard that tilt am bill is tM R lXX'ra:t; R tNlt tnn is cLe n this &te. aceordfna to CO'Itract dw SUI of S25 72fi 12 ;rd tNt It. ,.,. '" Ol'i port ttorool ... not blm poid. X (SI'1lI'<n)~~/?:---L... . r...!O:ket.,1bod Striping. Slt.cribed .-d """' to bel... ~ Illt. . 1988 _dlrt of . mi. <rderod I'old I.... ........... I: ......... .. ., , . . -:-'. '.. ... .. ,'. . , ,'. .., ,....: ..,.' " . '. ..' . ..q...... ., .. .. .;: .':.. ........... ........; . " .. .. ,.' ,.'., ':. '.:., . .' ' ., .',. .' .'. .'.':> ...,.', . Klrr~t No. :' , .. ..'. ' .. ... ;. ... . , :. Bv N-..i_ ~MMri'lr.t:!Irf'I'Mllt'Cf~ . v ,,' '. '~"-.... .......... . .' .' '. . ., .'. ./. .' ~ ", . . :.,. >:, , . ..', . I ,,'., :.... -..J , ':....'...' .,'.:.';" , . ~ .. 1 . j .1 1 j J. i I I f 1 I j .~ i I f, I -~ "1") q-'7-'i5~ CoAJIML-fvrc (Aj t& 80 f? e. f (ecio 0 0 t 11uJIZ 0 l<J;J Hd o^-J~ tJ- {JtIL({1ioj 60 x -r USiltfl Je.'{(et'-CoAJ Cbu.v/iej-!;;/I-- most e;-f -/41l.- cfiM( !(~4 L L L . , -I 1 ~. ~ ~ q-<t-'61A. ""'" T~'PE: \1 RE-r:U::CT0125 --r;:1?O/JDALE RD - '10 '1 CoRIVeRS f?d - 07 Ne5ses Co(1JUee.s R& - 5/ Ce./'J-re(l... p..&- - ;2:;1. 'i 3'8''3 -tnlbj mve.- al/f.etJ-c4 fLCk..erf.- Uf 5:2.- L./VO f..f;f Lr",cnil...-..5 L L ~ ~ ~ 1';-73'3o-\?~ rY)ORi\Jj"f\Jj (iIZol? ,- JI<?b 6tn05 ~oo wt-tirG . " 300 ye-llo0 - ~-3~-15f; flf+u.tvrso 10 + q-/-gg , '3(.z. (3@:los :: j:i"a; , :L ye...1Io(.() (00 5" wh{te..... ;150 ;r- 2 '7 Bff-tos ;;:. I 'i 50 L{ '-I e. il.o W" / '?re \ u)hlZ C;;V1 8EA05 = ~ 'Ie lIow +- 1'1 d3tnps L{ ylZ.- [(oW q-I -'6Y L L L (.e()(} 13'50 ) 'lOD 100 I bs aGO ::: 3X-tLl.\1 -', -. "' I ~ L 'L I'- ~-.'~"':" __u~~~lS \1 r2LLOv) 3~~ k Lt(, hr- i<, ~';':' , I'('~ ;;2L(t7J.b/ 377S;c;{= 1:, I "Z.. q:s: 5' \-'" , _______."__""". r ===r=--' 1 ~.. / \~o- 2-~f' ,I' ,\,X~~_ .~~ ~7S 9ro = J - 31:)~ . ~ ~;I . rZ-ZDD__- --=- W 1~lr~ 7[' ~ ~3~.0.B~ / ' UU(l -~ I II I I I i ~ ~ ~ .,.>. :.>;.,;,: '.. ,.. >.. ,;. k,,; ~.- , \ .,~ [7 . ", . d". ..>>..<. · '>1 > ., .. ..>. ;, > >.. ..~ . .. . . .;, i '.; , Roo::'!',; S~,P, '"If A-Uc,0S r l'16\3 Pr>Y esrl M.o.n;: ..\-< RoAl;> SNP W/SKlP 1 . ImP 'ioo<,p 3 1 131..:>,1 BB 2 GHIM"=,^^ 1<.0. 0, 40 3 "P=AV= 'TAU"'" F:D. 4-. = 4 I'.,....\~.., Rr>, 2..010 6 elz.'-l\re 7 e.e.>~ =. B ~p.. RC:>. 9 W. VP.U..e:( 12J;:>. 10 LAltsooJ LK. 1<.D 11 ~ ~ ",g 12 er~<lo a::t: ~ 13 14 SI-z.dB'O 15 OAZ '8A'I ~ 16 t-JE.<Se~ 1'01>':'__ Rn 17 4-- CoR/IJ="- i<:.D 18 ~tJDAt.6 lU:> 19 20 BI~,,-I~ 21 UPPeR.. I-\o~ l2f) 22 nl L- C. ..tV l<:n 23 ,., <oAR.vJA'ml>. R..D 24 25 8/-:~o I SEl 26 ~ p,,,,-t IV). 27 Z~.'''')'''cG 28R~o'f l:>~'A1Q"""~ 29 CHIMAC.U"" Rr\ 30 Ft.A6lB1L lZQ 31 el~\ \ filB 32 I'lAK. P"A'I (2r-. 33 ~Le'1.. R.o A\!4 U 5"1' T07".Prl- , ., . . . : :. ",>..:' .., . ;. :.." , ;,.......: ., ':" '. . ,; .:, .' ",""', .., ..,'-': .,.: .. ;: ... ,. ..: ".' > .>" ,: ;. '. .... ;.. '. '." , .:.' .....;.', ' ,.'..,:L , .,....:,..:,;: ,. .' ',...' ...',.'...,..' .'. I: '...,' , .., . ..., I, . I:. ",,',' ". I ,.. " , " ,., .. :.' ':. .>.',: , .,.,; l.oZ- 2.'17 I. (.,0 0.20 l.qq 3.07-- r-' E.D<>E 3.14- 13.zo (".ft:> '1/;;./60 yj q(-z..t9a A% e" 18" (;,0'" ~~'E"- 5 6 I.Id1 2.2.;3 1.010 1/o.\S- (.70 3. '-2- O.ICo O.ot:> o.(,,? 2.'+B 0.0+<5 D.9I'l l.ob 0.06 0.72- \.22- 0.07 1."1, 2..72- 0.(,,'2. 3. 10'1 4-.SI 1.'1\ \"I.4'{- 0.'2.;2- o.'h_ 0.7(" o. 2- <t 0.:1"2- o. '1-Lj- \.5,,- 0.0(0 \.",,6 '5.17 S.ol 0...,.1 '-I.u, 0.310 oA'f 1.5<+ o."lo 0.","- 0.108 0."10 I. '1-:>' 10.11 0.0"2.- 0.",,+ "2..73 <to ~Z- '.0'5 /. 70 1. ~7 -'1 . '2.0 z..S. ?B 1.f1.132- n.O(o Cj,.02- . ... . , - .,'. , . ., .. .1. .' i ..-c- ! , ., .,', :' , , .'...'. ;. :.. . . . '.. ..... ... h ... ... II . . , ," .. ...... .,.. ... .. . .;.... , ..' i ! ... ; , :: ;. ..: '. ;, . .'.'... ..:: .., .'.: :.. .. .'> .. ~~ ... ' :, ., 5 ": '., . l:, '; , ...: "... .'.: ..,'.: .. '.,' ,;.. ':.' ... .:: .... . .... :.., : .>.,,':, .. '. . ,,:, "." ',.,..." ' ': . ,...'.:....';.....'.,.:...'...'.'...':......... .. '.', ........ ., .. I ". ....... :.. --1'.'. ' :. '.'... ;, ,.,. ,.,.' .,:'; ,.,:, " .. . ." ....' :. ":., ::: . r '. . -.:....I . .. '. :" .. ..' ..... ", :. ,---' ;. , .', '.".' .,: . Ii,: r.~'." \; .. . . :--;---;- ----,--------..-.'-.--.. - ,_.___m__" '. --. -" -.---.. --- ---- .', ,-- ---- -.-, --- -- . .,--------.. -- -----.. --' -.\ I' I ., I, 41 NORRIS PAINT COMPAN0 ('\ CUSTOMER/PACKING SLIP I . .. .,. . '. / 1675 COMMERCIAL STREET NE . ' . . --:- I SALEM, OREGON 97303 . : .",..'..... '..1.' '...i ... ...... ....,. f!.~~~o~-';~~;;':;~;~~.............,~::~,:.? ..... ...... .... :?:;~;?':..-... .415 4 ,I . /1) CIJSTOMER: 5699 2) SHIP-TO: 1 (/ ", . .,... 'r ROCKEY THE ROAD STRIF'EI': .,..', '.... ... ..'1 916 GARDEN HILL F:OM ",I . ",'.. ,:.,.: EI.Mr,. UA . . ..,'C, .,. .. C '43)) DATE RECE IVEtt: 10::::~ll !/.' ':,: ! i , EXPECTED SHIPMENT: lQ./U/.8,8, , ....1 ~,~i,~~~:~:~:,:,":"'" ~ii~,;'LC ,,",. '> ...'< , ... ,. .. ..' . I,:, ... ,. . .. , ,."... ::' '., ... . . ... :, . I,. ,: .'.~.". ' __________ _______n__n_____n __u_ _____uu_ - I' "'.: .": ... . ..' f) .:ltHCSY.:!"." :, ORE 'C/C YEL.l.OW TRAFF 1711 500H F'L f( . ..,. '..... ;..; ,.,.. ..'! ' GAl. ". .,. .. ". 2) :tHca"'l .'. '., :.. ,.. ..:'. .. '.: ... 3)' .' ., ... ,.,. .\>" , . .,'; '. . .' '., . ...,..:".,:. ., .' . i.' .. '!., ' : ',.' .'. '.', ., c', ...,:' .",. '... ",,' ..,.' ":.' "'..'... i. '. "" .' . .,'. .,. ... .. .. . '. . ,'. : ...,. . ' ,.... J' ::i,,:. .;",. '..:. I,. .,. ,. '. I:.. , .,...' ' ~. ,.' ...:' '..... . ',.. ." \ ,,'.,.:,i, ,:.::..'.. " ;'>'., '. ,,' ( .' :...' ,,', , ., .:.', . . . , ...:. ,.,', ,..'.. ' :. ". ,.. ., . ' ,. ... I, ,'.: t. '.: ~ ; i;:"::: : . L 'L .,' ....". ,.:... . . ... ' ,.. .. .:..' ... , ',: ... . .,' . ... .., .. "." .' . .. .... .'::: " .. ..' . .... ., .. .., ': ... , : :').. '..,.... .. ':~:~:~- ~~:~~:~- ., .,., ,....9.'./;..": . ':' .. .., .....~;,~:.:s,(j,/fL:. . ...... . . <L':~fJ*"'.. '. . ... j,., . . .'.. ..: " '; :,.... .....'.. ..... ...... . ". .. I ..." .,'...'. .'. :,'. , ., '. . .; . . . . .> . '.,,::,:.': I ... I...... ............ .. ... .:.... .. . " . . .". . ..: , .,.. '.;" .,,..,:.,: i . .,. ,: . ... ........ ... . '''. .,' , .. .., /1" ,.... .. '. .. ',., :.', .....:.:.. .' -:.. -1.,< ...:.' " " .' . ..> ". ,. . ..':) ........."... :......':. :.... ,," .. , .::,.. " .,.... :, ,... ',,: '. . .... . . . . ~ , :: \.. ,."." ,', .. .....:, , .- ','... ':':',"" . . . '.... ., ' '.. . ..... .... ,:,' :".' . . " . .' ., ... . ... SHIP DATE /0 _ 3/ _ ,~<>,' IB1LL OF LADING NO. ,r:'_ 1 EA. FRT. -!SALES TAX % n I I I \ ~~========~=====~==~=====~====;~~======~~==~====~~~;====:=~=~~=~====~=~====~= ORDER NO: 15458 4 ITEMS STATUS: 0 10/28/88 =;:===,===::== ====Z=:lOI=====::=::: ==~:;;'=:I::;:::;: =::::':1: :::11:1.:1 :=;= =:::;;.;::== =====s=::::;:::;; ;:===:.::1=::= =lll:;;' -=e: =o;&:~= ---------FINlSHEtt GOOD--------- ---CONTAINER---- 10 DESCRIPTION Itt DEse ~~E C/C WHITE TRAFFl 16 U 50 OH F'L R OAL (HSDS) ENCLOSED ,.. ..'..:', '.. ., : ,..: ' , '.,.. ',.." ... !Ji~!,_..(~,kl,...i,Q.!.lit..~,L ."..' .. ....,,', ..~'\.... ,,' :~ ~ ~ ~ ~;,~~~;,,;;,; ~;,;,L ~;;,= ~~;, ~~,; ~,;~~~: = ~,;~ ~ ~ ~ ~,,~'" ,..''''~...~.. __ ~D- , ,.... " , ~~.,.,., .', '. ,.' . " .' ~ ,,' ' . !.:' .,: ^ . -:.. ",:.' . , . . '\" - '," ," '. " .' ....:' .. . .....;,... ========:;: =;.,:::::= ,..',' .;,..", c;'. THE ABOVE SALE IS SUBJECT TO ALL TERMS AND CONDITIONS ON THE REVERSE SIDE!. INCLUDING THOSE LIMITING WARRANTIES, _"-==-~__'~~~"'lIiW'" -tIIP1l~ L =-.J I I . ' .... ..... : ..... ... ' : .: : ,...., ....: ... . .'. ' .. ',.:' ..: . .: . --1. ~ h ,~ . 'TERMS AND CONDITiONS OF S{.\LE 1. Buyer's Accoptonco at Turms and Conditions. All G:li~~~ ,H~! r1\;Hl... (JJlly 011 H1'.;s,' 1(,lm" <lllrj ('l)rd,lld'l:, AfI~ :HYld!(jnal or con/!Ictir:g tlJrnlti ::'t.Jbrr:lltc~l. by Buym i;\Tl1 rejected, without turlher objoctlon tJY S..:ller ,)(}I'!('~' 10 Ult'o8 t(~lrli', iJlld c()nrlltlcn~" 11 BUYI!! f"I::; {f; reject thefT1 i~lrQ,;.'<ilit::lIY upon receipt hereol, tak.es possosslon olllw 'J'Jou:; to !Jl' undur H11~_ (Jrd;>l or drll;f"..'I.,{; plOt '1(:d~ !Il ",nJ w0'11/.llh lnu Irur,~rlcl!on proposed. 2. Prices. PRICES ARE SUBJEC1 TO CHANGE WI rHOUT N01ICE. F-'I!Cp.~, wl!l b.o: lho::;r.: in I'flt)(;t en 010 (lult:: 01 ~~::~'mdlj \^ifltten or V.;;lbLd quotations of price are subject to cli':W9L' unless ottWrvJI$U aUret!d I)y Scll('r 1'1 '/mtll1<J 3. Paymont; Dofault; Tolotos. Guyer ugrees 10 pay the n6t price:. 1,.11 no(,)d~ {lflJ ,If I,! ~,hIPPllllJ ur elller fI..l;Jtt.:d ch;,.rqv;-, Irl fu!I....1ihln ~~O daV":i of HIP.' dal;,:; such goods are invoic.::cl, unl\,,~~oth(:r payment terms <:lre :;t;;tted by Suller on t!,p !(.\~".~ h'~fl~(;t If Buy'.!! 1..II~ 10 pay In 11;11, E3u',,:r "qr~1';S to P;:,Y" dt:l;::.ult c,harge of 1 'i~% plH month on the bal,mcB OlJl!>tanding and to p()y 81\ c{\~,l<; 01 ,:,:1,..:\~!101'. 1,)\.\ud,llq ,'''III,Gulllln,lalion al1mfH-Y'., Ipf'S BU'It;r will P<iY nll sales, use or SImilar taxes unposed upon the gooos ~ol(j or upon Hlt-;Ir fll,lI'U!Llctur,.', !,alf~ or dt'IIIolW/. 4, Advanco Payment; ROP05sosslon. SelllH r.~$'Jrvl;'S lllt~ rl(Jhtln d,::;conllllUt; shll,ilHipt 01 and reqUire p3ynH~nl Hi :1dv:lnr~e lor the '.}0oCS <.It ,~ny time if In Seller's opinion Buyer's actions or fllu)nl;icil conditIon mdiG<:lh; ,/lat F.lu),td~, Ii:JYITH:nt for IJ.')od:~ 01 d.:;re(llllil,; not tit:: rccf.'IVL'd, In such ~:V"!flt i Seller may cancellhe remwnder 01 the order, t\f\d Sellcr .jho r(:~~crv(!S lhe f1!Jhl, ,lIlHHI<J ,)t tu,r rlHlldlilt!". tu reIJo~st:sS;)1 8QYld" e;..pensll all gOI)US. and related m3tfHials that may be stored ...../tI1 SrdlfJr tor 8uY,H'baccrll,nl, w:thoul uT1d,~r',)0UI9 <lilY tur1hef I'Jl:;jillprr-,c,-,t(Jln(lSQr 'Jllerundef!ol<ino ~u(;h procc€'lJings as may be rHQuircd by law; Buyer ack!1owl!:dgot- thai all qoads lInd r,,'lillt'd nlak'r1dl';.:;.o repo"s,t'"ssf:d 'Nll1 be Sell~!T's prop'Jr\:; 5. Shlpmont; Risk of Loss. Se(I(~r will dell~rrnlrw 111 Its Gole tJt:o\;rell\.)l) lr.e rnulhod '.lnd rOUlf! uf of 1J00d5 Unlt!',$ ar,y ddlelenl tf'rtll$ are stated by 50110ron the fdG€ihoreof. ~ltI pric1.:is OJI>:! F.Q.B. St!lil.lf'i Dlacl~ ot bIJStr\'~Ss, il~ floh,d III 111~ b !Jr.lX on lfl\..l,).ce ;,<'!wol; d (joons are ShlPP8d , or delivered dIrectly by Seller, orby ony meansolt18r Ulan common CiHnur. BlIY\1r /Jill pay Sell8r St~paro\[;ly lor th.:co'.>tG arl'Jchary.j$ relaterlthCtclO, , Title 10 thc guodS sold hereunder passes from Seller to BU'I!.!r ill lh~~ r.O n. pC'ill! ,jC''.>19n:I1e'.t or u!.Jon BU'It..,'':;i reculpt oltne fJoods it dollerent shipment terms are stated on the tace hereot Seller ret,e:rVGS tho right to mnke dt;"llvt.~ryol till.! uoods In ,w;t"llm",:nb, Clod ail such Insti,.11fmenls when ~epar:ilely invoiceej will be paid tor when duu per lt1vOlc0. without rf!q<.m) to I he d;jh~s 01 ::;ub::..t.'t.;\Jenl rJell"'t:~lr:s ;,11 g[)'Jd~; iJCCl'ptcd Will be paid for rt"::galdless of any clalill r€:lallng 10 other dellvef.~d or undulivcre(j rJoods Bu ,/':1' will 81 all !l!nns li(!,H lhu r If.... olios':> jcH all ~Joods dUl!n~~ shipment. dnd all shipmont:. will be insured, if at 811, solely at BlJy.::r's b'JirJ<:.nse: St..dluf will In its ~(jle d!~,crellon dt'.lerr.'lIn<.' Iltl8\IH!f. under wh~t It.!rms (lnd for wtwt amounts shipments will bt': msured (With Input frol11 Buyer II so rr~quest'!d If' wfllllH)) Clnd WIt! f1'~ke accordingly 6. No Liability for Delays. Seller WIll nttUll1plto rn01~t any sl1lnr1\!~l1t or ddlv~,(): d,ite3 !.pecdl('d Ilf-!/'}If) 1):11 no eVfm: be rcsponslblt":: or hablo to Buyer or any third party for any d~HIILlges or ottler cas!s, Inc..ludln'j"l1cir:h...r,tal 01 COfl'~uqu~:f111.1: dam:.lgc5. ft!suttlflg from <:tny delays 111 thE:: shipment or delivlJry 01 goods, regardless of the callSO 01 suetl dljl<)ys. ,. Accoptance of Goods. Buyer will exal1l1no <'III noods lfl1fT1..,diately upr.)n rec(:q)! ,llld vnil be deemed 10 hn.'.'l; LJ,ccepWd sucn gOOfJS as confOrmIng unless wl1tlen notice to [he contrary IS sent 10 Seller wrthln 5 duYS 01 Buyer's rt:t:.elpt 01 goods 8. Limited Warranty; Limitation on Liability, Seller warr::lnts !hot Itle goods nre as descnbed on Ihe !nCf! of this Older, anci. except as may otherwise t,e expressly proviaed in a separate wriltHn wmr;:Jnly, SELl.ER MAt<ES NO OTHER REPI1ESENTATION 011 WAF~RMnY OF ANY KlNO, EXPRESS OR IMPLIED, ASTOTHEGOODS' MEACHANTA8!LllY, FITNESS Fon APN;TICULAH PURPOSEOR OTHEHWISE. .....ht,ther used alone or in corntlinatlon with other rnaterial~ Notwilhstandmq I~H~ fomqOlnQ, SellF:r mn, ;It lis sole op!iGI\ cy..'llllll1egoods that art;" returned In tile manner provided in p3ragraph9 hereol. and, llln itssoladiscrutlon S.;!llerdetcrmllles slIch goods tobe d..:!(-ct,...e;.sto manufacture(mcluding tailuretomeet the qualifications set faith in any Technical Bulletin rt:l<ltrng 10 tlte gcods tnat St;I!er tla$ prevIouslY pravloed to Buyer), Seller may at Its option, and solely as an ac'coltllTlodation to Buyer. repair, replace or Issue credit tm such goods; provided, however, that nolhlng In this sentence is :0 be construed as a commitment or obligation of Seller to do ,my of tt1l3 fOlegoing or us a warranty of Sell0r, und IN NO EVENT WILL SELLER BE LIABLE FOB ANY INCIDENTAL OR CONSEQUENTIAL DAMAGES OF BUYER OR OF ANY THIRD PARTY. 9. Return of Goods. Seller will have no responsibility or obligation whats()pver regarding goods returned wllhoul Seller's prIor written authori:r.ation; ~Joods returned without authorizallon WIll be refus..,d. 1 n rt~ql,esllng such auttlorlzallon, Bl.Jyer musl submit a detailEd slote-ment 01 the leason tor rcturn. Buyer must prepay all costsol returning goods S811cr WIll rf!fu$p.goods shlppud collect nnd reserves the rIght to charge back and set off terms & conditions: goods may be SUbject to red$on;:iule handling. msrJt~(;tlon and restocking charges by Seller Upon recBipt of qoc,ds for which return h~s been properly authorIzed by Seller, Seller's only obligation will be \0 Im,poct :H1U return such goodS. to Buyer at Buyer'S expense and risk. Buyer will be !esponsible for all transportation costs tor SeUer's resllipment at returned goods (whether or not !c;!pt1Ired) to Buyer and for Seller's shipment of replacement goods..if any. Buyer will at allllrnes bear ttw rts,1<, of loss lor all goods returned to Seller and lor any replacement goods shipped to Buyer All shipments of repaired or replaccmunt goods to f:!uyer Will be insured. it al aI!, in accordance with the last senhmce oj paragraph 5 hereof. : 10. Buyer's Warranties. Buyer repre~ents andw~l1rants that tilt' 5018 ;)l1d delivery of the goods to II will !101 ....Iolate any taw, regulation, ruk!, ordoror restncti0n of the United $to.tes or nny state or ollIeI' governm(:tltal aulhorlty, and S8'I\0r IS furni:;hing pood~ to Buyer only In reliance upon this representation. Buyer assumes the risk of all applIcations and usr~s of ttlE! nooe];;; ,Ind ':-1~1f(-?e~; 10 Indemnify and hold S(~l!er harfllless agoOlll1st any cl.:; irn, loss or cost incurred by Seller in connection with any armllCdtion or use 01 th~ goods by Buyer. IncludIng vllthout lirnitallcn claims 01 injurit?s to any persons or damuges to any prore'rty(whetherconnectedwIU, Buyer orthHd p3rticsl diroctlyor Indirectly arising. In whole or in part, out ofanyoefect or hazard presented by products or processes into which the goods are incorporated. Buyer acknowled<;Jes that It has recC:'lved and is familiar wIth Seiler's safety and haw,rd labels and other information concerning the goods sold hl?reunder, and Buyer represents and warrants thaI it will disseminate such information so as to warn persons Buyer C8n reasonably foresee tn:'lY be o^nosed to suclll1azards. including it!; employees, agents. contrac;tors and customers. . .' 11. Patents. As to any goods manufactured or sold bit SellE:r to meet Ruyt::r'" particular SI1f:Cific3110ns or requirements, BU,/Pf agreos to do/end, indemnify ar:d hold Seller harmless ag!3instany SUIt or act.on ;)nd from all cJi1I1Wql~S. (;1,,11\15 ;)nd demands !;lased upon. and to relc.:Ise and not bnng any suit or acllon a9ainst Seller on account 01, actual or i;jlleyed ir,/! ingtllnenl of'any Untlod SInk", or tomign nntent relating to the ml:lnulacture or sale of the goods covered by such patent. . 12. Custom Orders. If Buyer places ,an order with Sellm lor ~Nods that are custom-mad8 for Buyer and ~ul)Seqllently cancBIG that oreer, 8uyer agreeS to pay Seller its publiShed prIce for such goodS;;lS <Ire cOl\l,-:Jlet.:d and ~ln eQlIJt"blc; pncp. based upon the completion ot such goods as are ill proco:';s at the time of cnnc(!!Ia~ion. ' 13. Applicable Law; Attorneys' Foes. This instrument and performance Iwrounder will be goverened by the laws 01 the ~,13te of Or.;90n appllcnble 10 conlmcts made and performed entirely in that state. Guyer tl\jlce::, thdlll may tmng suit OIq;>Il1St SelIN only In Oregon, and Buyer submit:> H~.elf 10 the jurisdiction of that state lor purposes of SUit against It l,y St~l!er Buyer ag.efJs 10 pOly Seller lor any CO:its or exp(ms(~s, includmg r\~a~on3ble atlornoys' fees nnd court costs, lncurrod in connect ton with the enforcement of tllese terms and conditions. 14. Entire AgroomenL These terms and conditions, tonethcr with any additlcHwi torms not cont<1ined hemin IJut contam(~d in any ClHrfll"ltly offeclivesales qontri1ct between Buyer and Seller, cOfll.lItute thl! enllre aqrQ(Jlnef1t belwnen Buyor and Seller rel<'lting to ltlO goods sold hereunder and supersede '011 prior verbal or wfltten renresentatlons, anreol1wnts or (mde($tandlngs, lncludinn Without limit;lllon salas lttemture, sampler" modf..ls or ot/lOr sales information. No agent, omployee or oltH:::r (t'Il!C"~,t'nt<ltlve of SI,IIIH has ilnY authority 10 bind Seller to any nltirmdllon, reprm,entation or w::\mlflly concorning the goods sold h,I(Wllldt.'I. ~jrld no lTlo(jllicHI 1(H1 olth(jSt~ term', .lnd condlllons will he ejj('ctlve unlc'iS made in writing on i1 d;:!!'e subs(~qLJel"ll to the effDctive dale Ilf'ft'ol .:Jnd r,x"'~\lt"'d by ~\ dIlly (luthofllHd reprt~!:.f'nt;)llvt~ of Seller 15. Roturn of ContF.llntH5. Seller wUJ giv6 8uyor cn'){jlt lur Ifclulnd.l.,k' C(,HI!;llrll!r~ It rt-ltulns In good condItion Within gO daY5 01 shlpmont by SeliN. ~tl ,,,~~n,...o- \ \ '\ \ \ \ \ \ \ .~ I I , ., .".., ". 1't0 MT07~r." o -, --,;e~/c... CCT.J<..rf1z.DL- "$1(",uS Co. t Zt..:>)'7R2-) L-IFe t.-/TE ;e~VG jZCJ>'}-D /-'/I9ELeTV;; "- r--. rv '\J ~ ~ ~ ~ i ~ : : ~ /-</ ve;u?"Z7'Z Y :P~rI.~~ ~~ t.cRtT Zs (- g',yO ~ \.Q "r) ~ 8 ~1\1 a.". \.;f 00 W"l h. 00 ~ 1 \ ~ ",,,-- ~ ~v} ~vAv o~if ~ " <t ~ ~ ~<2 Tsre- ]I tH.I/~ /ME((Jt~ ---====:- --- .. ". ,.' ,.'. ,.'.', "_' ,,", -'" "".'.'-", .:""J -,.: " ",.',-,.". '. L,.:.., ,.' ," " '-".' .-';~~~~i~&~fJ.'~;f~.,xxxii~;~~W~~x~i.~.%~~~xxx1.i:) - ----- Potters Industl.es Inc.- ~ ... _ ATLANTIC DIVI:.tDN,CAIlLITADf,N_J. ~n :.rfiliatc of l11C PQ.corporntion ~:~,~f:~~~~:.~~~:~:~~~~{r~~}.~: 0"10 377 Route 17, Hasbrouck Heights, NJ 07604. U.S.A. ::~:;~:1~1~:~~~~~t~.TH~.;LtW.tLL. N.J. CAN 6 Y Tel: 201.288.4700 Telex: 219054 or 133447 -',; . i i ~:~:IE~:::~:'t~:'LBT~~:~R~I~j:~~~(c;. e""IAO'" CUSTOMER NUMDER IC~$TOMtR I'URCHA-Sf. ORDER NUMBER CUSTOMER REQUISITION NO. 1 STATfJ COUPIITV I TERRITORY I :5475 'VERBAL-ROCKY. "U' n~nnl .nn.n I.. ...:. ..... . .... . . ' . 10 ...... : . ,. SIiIPTO: ~EFFERSON COUNTY SHOP I 377 CHIMACUM ROAD, HADLOCK, WA 98339 , L --1 INVOICE TO: IROCKyrs ROAD STRIPING I 916 GRADEN HILL ROAD ELMA, WA n541 I :.:: ..... :: . '.: L TEAMS: DESCRIPTION PRODUCT NO. HIGHWAY SPHERES 0.0. WASHINGTON AC-04 0100WA PROJECT tlMT0766 NET INVOICE TAX FREIGHT TOTAL I' r . . .. ENTRY NUIoII8Efl ICAlf. OF ENTI\Y .160493 '7/20/88 THIS ORDER ACKNO.....LEOOED BY RESALE NUMBER " F.O.B. CANBY, FREIGHT PREPATn .. Ann INVOiCe NUMBER I INVOICE DATE I SHIPPING NUMBER 160482 7/22/SB ~~n~?I.O DATE SHIPPED I SHIPPED VIA ...,. .?J?nH'~ I R..E,ST WAY CUSTOMER: SUBJECT TO TERMS OF SALE ON REVERSE SlOE. r-ROCKY'S ROAD STRIPING ~ 916 GRADEN HILL ROAD ELMA, WA 98541 --1 ~ L -.n DA TYPE PACKAGE UNIT PRICE/LB. AMOUNT QUANTITY ORD SHIP ~1,200.00 ~1,2CO.00 7,020.00 .2250 7,020.00 547.56 281.25 7,34B. B1 SELLER REPRESENTS THAT WITH RESPECT TO THE PRODUCTION OF THE ARTICLES ANDIOR THE PERFORMANCE OF THE :ii:RVICES COVEREO BY THIS INVOICE, IT HAS FULLY COMPLIED WITH THE PROVISIONS OF THE FAIR LABOR STANDAROS ACT OF 193B. AS AMENDED. '" RnXY , . 1n79~. NIOWARI<." . ft~.ft' ~~.~...., .... .-.-- '" . . ".:....... . ... ....'... ... .'. ..' ....... .... ,>, .......... . .,.. :. .... . . .'. '.. . . ..... ......, ,..' .,' .. " .. .;,i: ::,:. :::' :', i'.., .' .,:., ';"::. .1 ':.'.:. ',: . '.:..:' '--- I.: .. i.... I>:, .... . I::.. ., ' Ii."" I', ; .' .'. .... ..."".-.. .,:. .... '.. . : :' ... .. ,:. ! : ( . .:, ............ , :..',.'. ... .. --l , ,::/ .. ...... " :.. ..... '.': ....,\, .., , . .:..., .. . .1 '.' '. ....1 . . .. . ..... .. ...:.... ...... ". , ,<i. ',. . .. . :'.' .'.., ....:.:. . ..:. ,......... , .., ,'.; . .'. .'.,. '..:. .. . .. .. ". . I ... . .. ... '. - .: .' ,. .. .. . . , .:. .......1 I . '. . ... i......,...........' ..' . ........:..;' 1 .. ..' . . i." ..... i . I I I " ); .:'.. c' )'. it .:.. ,:: .'. .., .", .' I .:'.: '. .' , ,~:,:' : ' " ", :;:,'/,;:">':_>::':',::,0" ~"" :~:~': rv ~~~~~~:~{.:: ....................................'..........,.... 5 f, ~ rn;T HER 0 ADS TR I PER ....', Ii 91& GARDEN HILL ROAD .'.}~6 ELMA. WA 93541 CUST. ORDER NO. I SHJP.~ENT DATE I SALESM~~ I ..... g~~~~I~ UNIT DESCRIPTION I >:. ., 2250. GAL "HW8Y2 WASH IDCS YELLOW '1' 45. C1'R- 1711 50 OHPL R., 1250. GAL "HWeWl WASH. IDCS WH I'l'E TR 25. CTR- 1&11 50 OHPL R 1. M.S.D.S. ENCLOSED 1. CEf,! IE ICAT IONS ':. h . i,',.: ,:-,'....."J.w:..,~_...:~~. .. ,.' . I . '., . ... .,j. :". . . '..... ,.,.. . ..; . . . . .,. . .. .... ... ..:.'.:... ": ... ..... :.. I, .1 BILL OF LADlflG flO..; :. .:, ;.: .',. . AMOUNT .: 12500.00 : '. I.'. .. 5&25.00 I", I .. 0.00 ! ! o. (1),::::::",>; ;. l U INVOICE ~UMBER: 13652 ORDER NuMBER: 14347 ..8a DATE S H I P T o 1. VIA TEAMS I /OUANTITYI UNIT I UNIT PRICE.' I SHIPPED I .' I 2250. GAL 5.GO 4~ CTR .J. 1250. GAL 5.30 25. CTR 1. 0.00 1. 0.00 THE ABOVE SALE IS SUBJECT TO ALL TERMS AND CONDITIONS or. THE REVERSE SIDE. INCLUDING THOSE LIMITING WARRANTIES. ,. S,Jrvicecharge at the rate of 1 Wlh PER MONTH which isan ANNUAL PERCENTAGE RATE of 18% charged on past due accounts. Illegal action becomes necessary to enforce payment 01 this instrument. reasonable attorney fees and cost will be awarded to the t"revailing party. PLEASE REMIT FROM THIS INVOICE NO STATEMENT WILL BE SENT ORIGINAL - "~- . ,. - - ..-..... .. ~\1I ~ )}. (?~ 9~ .-<V f\) ~. tb\ '\tt7 /\4;,. / 0 ~ "'"' ~ ;,)) J ~ !. r L .,. )" :' I ...... ., .....':. . ..... . .. .., . ',: .... ','. ........... .... :,' ". ..<. : ,. ...... .: ....:. '. .;...... ...... ..... " . .. I' I I, '1 :;: ".'...;. I ~;,... ..: .. . . .. , ' '.. .:.'. ... : .', .... .... ,..'..:. .', .".. .'. " . ..:' ...., 5 ..' .... . ...: .. ,. .:.... , I , .,~. ,~, JU L l,~ ..:. ... : I; : :..: .c' ; 19225..00 LAST AMOUtlT ltl THIS COLUMN IS YOUR INVOICE TOTAL !:, I.. I . , I, .:, ,,'(. l/ I.:.' . . ';,.d .....:, ..: .... ..:.. ., '.,' C'....: ., ,'. .... .' " ..... "" .... . .'! . ..' ..". ..... .'1.. , - . .. . . . . ....: .,;.' .'.:. .' '. . .'..., :... .....:. . .. .: ... . ..' ,. ----J .' ".'.':.', .....,. . .. 'I ':'.' ~':.I .' .. :... ....' ....... '1. ..... .. 'RocKe'! n f;l,'lltlt;: (I ),1,110 H1..Cr]'.II:.II: r.,;:I'I.(:"I[1I [:liJr'hFN'I: 1~I.il~J l::'~.~:.'] t.: /..' :..::.:.:.:"(' CUBl (H.a:I"'" (milL II: ~~ck;Jn~(lRO<lcL Str:f!!Y' 0/0 377 Ch ;....,CU:lAloY\ Rot . HetctJoc.k. LUa. SHIP DATE //.,i , 1 EA. FAT. )1[LIVUilll lwei:, TEAMS ?.. 1 :'!/Oll ",' / j 'L/8H I .' . SALES TA % SPECIAL INSTRUCTIONS: C hJiU (~.l ( i.H. lJf~ b,-a('('r!1.I..JIJ.J ::~::.:',,,:,:,:,;~-,-.~-:.;.,,".~' .':~:- ;~:,;., '";. .:.. .', OF' TtF:I:. IlU: t'1:','l7 6 llT,Y; ::;1',."' Uf-.; '.'. "'..'.""""""1 JiH[;liEll GOOI'..", .--.......- ,,'''''COI11;',];;[[,........ )ll IIF!;CI:H'Tllm JlI lIFSr: 1) kllJ.lIJY;' HM:11 I DCI.' \TLFOW TRI. 1.71. 1. SO Oil 1'1.. Ii 3C,,:'ll'13 ~.C, -)1'/;;; ~/D-C.i-(,-i t:[)"ct"c.S Hill. :11l~!l)l.J 1. 01,'\811 J[IC~.: olHJTL mr.r 8(..,- /0'2'7 1 t.l.1 ~(J CiH Pi f: nl'd. i.~.:.l~ j.\. f;. rl. S. El~Cl_OS[IL...-- CI In 1 r I Cft'! r UPS [:11 1 P HI 1I1~; TO FIJI LfJ ~\. ;!()t~..../1 U2'.'~;::,27 ,"t/ 0' ,,1,. ~1/)) .:'\;E ABOVE SALE IS SUBJECT TO ALL TERMS AND CONDITIONS ON THE REVERSE SIDE, INCLUDING THOSE jlTING WARRANTIES, CUSTOMER/PACKING SLIP .' ,I j :11 fit: 2811 "Se~", C!..o. 7/J:'/nr: f1J 1'1'[ 11 .;~F:10. ,;",.:~~.' ;~!.:-~~":" "'.'..~ ,._1,'-. l. ~.. . :i I /)" l , ,;, :I. . ft, " VJ,'" I !. t t t. 'I:' '~ ~, r '~., 10." r' ~, ,. ~ I. 't- " , I> ~ \ t,'6': {.",J' t. .' i. __-"':_____-'.,'..:>.; .~....:. ... ,.~;~;:it~~t~.~~'J<xxx~~~ti~~o.~~f,cx~v:~"--.""-'-.~ -".-"~'"""""""-",=~--' ... ~:.,.. ....<:1: ::,---'-. otters Industllcs Inc.- ~ (/:. I"'''''U.''. ,mo',".' ...../i/! an aFfiliate of 1he - . ~:~'~::,,~:':;'~=':~, ' 160493 . 7 /2 0 /8 8.. · ' PQ.eorporatiOf1 :=:~~c~:~t=~~~~~.D.OH'O r THIS OROER ACKNOWL.EDGEO BY'i'+':'C ." 377 Route 17. Hasbrouck Heights, NJ 07604, U.S.A. 'lI'......'II".TPtVl.'OOII....UTCAUM'fLL."'... 'CANS Y ':.""':' ":'::: ~ Tel: 201.288-4700 Telex: 219054 or 133447 . J .~~~:~:::=~~O.TlIl"" :""'.'u.". OUST...'......."..,..."........ .:. '..m"'~7.;;,:.~;-=;:;:,:~~~.,~""..~.~'.1 COUHN I "..""',\'.;' >:, :5475 VER8Al~ROCKY' -, RESALE NUMBER ' ',n~nn 'nn~n,!:';~.in I F~.B. ~ C, ? I:. .., SHIP TO: r-JEFFERSON COUNTY.SHOP 377 CHIMACUK ROAD, HADLOCK, WA 98339 L INVOICE TO: r-ROCKY'S ROAD STRIPING 916 GRADEN HILL ROAD EL MA, WA 98541 L TEAMS: DESCRIPTION PRODUCT NO. HIGHWAY SPHERES D.O. WASHINGTON AC-C4 0100WA PROJECT IIMT0766 NET INVOICE TAX FREIGHT TOTAL ..J "I CANBY, FREIGHT PREPATn & ann INVOICE NUMBER I'NVOICE DATE SHIPPING NUM8ER 160482 7/22/88 1An~'H<l DATE SHIPPED ISHIPPED VIA .7/7nIRR D".T UAV CUSTOMER: SU8JECT TO TERMS OF SAL.E ON REVERSE SlOE. r-ROCKY'S ROAD STRIPING 916 GRADEN HILL ROAD ELMA, I ii WA 98541 ~ L ~r. na'~ ~ TYPE PACKAGE UNIT PRICE/LB. AMOUNT OUANTITY ORD SHIF ~1,200.00 ~1,200.00 .2250 7,020.00 7,020.00 547.56 281.25 7,848.81 SELL.ER REPRESENTS THAT WITH RESPECT TO THE PRODUCTION OF THE ARTICL.ES AND/OR THE PERFORMANCE OF THE SERVICES COVERED BY THIS INVOICE, IT HAS FUL.LY COMPLIED WITH THE PROVISIONS OF THE FAIR L.ABOR STANDARDS ...CT OF 11138. AS AMENDED. PLEASE REMIT TO: P.O. BOX Y '.:. ,. -i. ,...:. , ., .. ,. . .. ,...., .::" ,'" :' :'.. . , . ..' :.. .,."." ... ..';.. , /' .' .' ..... :.... . . ., . '.. ..,. .', ...: ' . .. . .. . .. ....'..., ..' '. ,.: ..', :'. "',": ':::".' .:.... ......., ...::. :'" ,. .. .... . . , '; :: ..... ...: . ... .. '.. ->: ': ...' ," .. ::.''':' ".' :.:,... ..:: ~. ,.'. ... . , ,..: ..., I d - 10793, NEWARK, N,J. 07101 ORIGINAL INVOICE I I .. ... . ..... .' " ....:' .:. .:: ..' ..:,..' . ' ......, . '.'.' '., ":.. '..',.' ". '.. i.:...., , .' . ....'.. ..' . '.::..... .;. . ,. . .,.. . .. . .:' ...:'.' .. .. ',. ., . " .'. ' ,... ., :', . ... , . ,.. .. .; ..,"...'.. . "..;,. ."'. .. ' '" .' : ..:. :.'., . ...".'. .... . . ',:' ,...... .. : ..; .... : . ',.. ,.,~ . .. ,....... I ... ,c. .. .' '... '," . '. ': .. :, ... . . . .,' .i ': . ...' \ :...', . ,.,'., .;. :. ..,.. .1-:-'-------.. ~I") :.;....-.....',~..;..:.".;. ~. . '''\' ~ NORRIS PAINT COMFANY , 1675 Commercial Street H.E. P.O. Box 2023, Salem, Oregon 97308 Phone (S03) 364,2277 "Yhi~PO~o~ . INVOICE NUMBER: 13&52 ORDER NUMBER: 14347 5~ ROCKEY THE ROAD STRIPER 91& GARDEN HILL ROAD ELMA. WA ':OATE. ...., ._.. . JUL 1,\1 _ 88 TO. P1J:-E ..0l./.1'" .1. 1/1 @'JO . M~ (!.o;JT1lilc.--r 93541 S H I P T o VIA GAL i<HW6Y2 WASH HICS CTR- 1711 50 OH PL R ..,.. GAL i<HW8Wl WASH. IDCS WH lIE TR 5.30 6625.0() 25. CTR- 1611 50 OH PL R 25. 1. M.S.II.S. ENCLOSED 1. 0.00 0.00 1. CERT IF lCAT IONS 1. 0.00 0.0',) THE ABOVE SALE IS SUBJECT TO ALL TERMS AND CONDITIONS ON THE REVERSE SIDE, INCLUDING THOSE LIMITING WARRANTIES. 19225.00 ~rvice charge at the rale 011 '12% PER MONTH which isanANNUAL PERCENTAGE RATE of 1B'!b charged onpasldue accounts. Illegal action ecomes necessary 10 enlorce payment 01 this instrument, reasonable attorney lees and cost will be awarded to the prevailing party. PLEASE REMIT FROM THIS INVOICE NO STATEMENT WILL BE SENT ORIGINAL LAST AMour~T IN THIS COLUMN IS YOUR INVOICE TOTAL \11 ~~ ~ ~ ~ ~ '0, ~. fb' ,\00 /'\~. 0/ 0 ~ ."". ;.0) 0 j ~ LlJ l ~J =u ,;r:',,\ NORRI~..,n COMPANY A Subsidiary 01 ;~f-iITTAKEA CORPORATION C) ~, ..1 July 26, 1988 Rocky the Road Striper 916 Garden Hill Road Elma; WA 98541 Dear Customer: Norris Paint Company certifies that the product manufac- tured by us and designated as batch numbers Yellow 8G- 1143, 8G-1142, 80-0607, 80-0605 and White 8G-l087 were manufactured to meet State of Washington specification. '0 The material was ordered on your purchase order number Rocky and shipped on our bill of lading number F-0987 dated July 18, 1988. ~ Michael Evans Quality Assurance ME/djm (j) '675 COMMERCIAL STREET N,E./SALEM. OREGON 973031(503) 364.2277 MAILING ADDRESS: P.O. BOX 2D23/SALEM. OREGON 97308 f) z o P-I ~ U i~ ~~ ~ ~ ~ U ~ ~ ~ ~ Q) ::: l!l ~.:!l ~ S.<a en ~ J.-1 ~...-)~~ co .s~ g ~ S ePil 'E 11 .s ~ ~~~51 .5:5 ~-5(l)5:> ~li~ ~ .~ ~ ~ ..- to).s OJ .... ..... '""' e en Cd ..<::Q)Q)Q) "'"';E.... ~ Q."c::"J:;: s:: ~ 0 ::: &i~"'"' .0 Q)..c ._.- .::: SQ 1iJ...=s ~ -ail 0._ >>.~ .... Q.lS....1l1il;<;:l"'"'B5 ..<::o<s"O'-'ca ~ 'r ~ .>:5 ::I rn'S ~8~8liO-~Q) ...... :::.~ "'" <J rn <E rn Q) "0 .~ ~ l!l il gj .~::: t5 <Il 0 0 ... ~ Cl) ::s~:p ~.... 11~ ]~~ ],] ~16::g~......~ -2..s ~..<::~.sg~ ~~ ] .s ~ &i Q.l .;::; ~ rn 1l .s Q.l::is il .s ~ g;!ffL ~ il 1! 1J 13 '0 ';Jt>tJ~i! ~1:l S .:5,$ ~;;848.s]t:~ ~i ~ ?j a >>1l <Il 8 '0 ~Q.l ~]] ~ ~ii.@>~ 8 g::]~~&~~ .Sl ,~ o o N .... M .~ c co ~ o 01 " ..... ~ tJ o <>: Q; E .9 rn ~ U n co co '" .... ~ tJ o <>: J .... III .0 .., QJ > d Z d a: Q; E o 0; ~ u >. al '" .... Q; .0 E ~ z C':' C w ::; o (\ " o (j C CJ) ... Q) ~ C ~ .... C z. CJ)~~ :J ~ .2' O 8.~ Co tj U ::I -0 e CJ) a.. .c Q) l(l ~ 5x Q) '0 r-: ~~i ~::= a: "'I'- CI'- "'M QJ "''0 III Q) ..,..., UJ~~ s::u .. o . .., ... lSI. ., .~ ~ ~"'.. .c: < if.:g '" III :>: ~ Q; ca :::E >. ..,'" ,,'" "..... 00 CJE-< ;:;: ""* o "'..., .., tJ QJ QJ ........, ....0 QJ .... 0-,0.. .., o '" " ~~.. STIMSONITE Pavement Markers consist of molded acrylic retro.reflector units ~ in epoxy.filled plastic shells, . . ~ designed for lane lines and other ~ traffic control markings. The reflective -...;~ elements are located on the inner . ~ surface of the slanted face of the marker. ~TtH When cemented to the roadway they present ~ a low profile, offering minimum obstruction with ~ZH maximum reflective area. ~ "'~/A . /1~S)..",~ ~'Qi I 7lY''//'"'' <':' Typical Model 88 Marker SURFACE PREPARATION The surface must be dry and free of oil, grease, dirt, curing compound, loose particles or an~' "',ther material whicll will adversely affect the bond of the adhesive. The preferred melhod of . surface preparation is by sand blasting or grinding the road surface. APPLICATION Apply to the cleaned pavement surface a quantity of epoxy adhesive sufficient to com- pletely cover the base of Ihe marker, an,J to fill any irregularities in the pavement. Generally, a pad b~tween 1/16" and 1/8" thick is sufficient. Place the marker on the adhesive with sufficienl pressure to extrude a small amount of epoxy around the periphery of the marker, taking care 10 leave a pad of epoxy between marker and pavement. The marker should be prolected from traffic unlil the adhesive 11as properly hardened. TRIl FFI C. CiD/JW.OL si 6t-}S Co (MArJV P.O. e,OI( \'~"S - 1<>')0" 5'. ADAMS 'ST. 11'1 Cll fYlA. w/\ ~ ~ '1 L/ ADHESIVE A two-part epoxy adhesive should be used, avail- able from AMERACE or made to the recommended formula below: Specifications COMPONENT A Pari. by Weight 87.00 13.00 3.00 3.00 28.00 0.005 Malerlal Epoxy Resin ..,. Aliphatic Gtycidyl Ether Titanium Dioxide.. ... ........ ASTM Designation: 0476. . , . . . Filirillaled Polyethylene.....,... Talc."...............................,., . Silicone Anti.foam. Type DB 100. 100% Solids. COMPONENT B Material N.Aminoethyl Piperazine Nonylphenol Furnace Black...".,. Fibrillated Polyethylene. Talc..,..,.. .. Silicone Anti.Foam, Type DB 100, 100% Solids, Part. by Weight 23.16 52.00 0.10 0.30 65.00 0.005 The use QI an' incorrect adhesive (not in accor- dance with "this formula) may invalidate official ap. proval of installed markers. The contents 01_ Package A & B should be thor- oughly mixed by stirring before use; if this is not possible the material should be discarded. Equal volumes of Package A & B should then be mixed together until a uniform color is obtained, without visible streaks. No more than one quart of adhesive shall be prepared at one time. The pot life of the mix may be prolonged by cooling or by spreading it out in a thin layer on a flat surface be. fore application. Any mixed batch of adhesive which becomes too viscous to allow pressing the marker into place, with the adhesive freely extruding from Ihe edges, should be discarded. WARNING Follow Manufacturer's Cautionary Instructions lor Handling Epoxy Adhesive. Amerace Corporation, Signal Products Division 7542 North Natchez Ave.. Niles, Illinois 60648 Phone: (312) 647-7717 Printed in U.S.A. ,::. !~ INSPECTOR'S DAILY REPo1<T ~ '"'DEPARTMENT OF TRANSPORTATION Book -.QL Page _~_ Contract No. Mro 7tdo lIighway Date -ll\li.\a:> P.E. Ro~~ Ne"''l>rrr Section (Title) Mf'rt<Jc:.,~ Day fVtO;J()Ay' Weather A.M. SOD P.M. 5:UN/IJ'I 52....0 ~ i2eJc.tY - OVJNc'1f!- Location and Type of Work ~!.Jn=R. RD /2ePl.-ec7ZJ1:S M,P //.5 - 15.0 Number and Classification of Contractor's Men and Equipment Status (In use andlor deadlincd for ma;n- / - 3;", rrW fk/w.;p I - I norJ nAT'/3e!) z- OuJN,.,,7I.- OJ"'~ /-~9(;:7<... tennllce, etc.) Diary (Report of day's opcr::Itions, orders given and received, discussions with contractor, visitors from Headquarters, District or FI-IWA, unusual conditions, recommendations and statement for monthly estimate No uJlX/C "liBS /I/IO/BB ()~/mlJ /-IouoAY' 11/11/88 I , D7/S - ~ ;&601 L4U.b---O Me 77x/) fhM. Tl-fE rtWe11.e\.>I $A7D fie LV eVU) Be 4-r ,4r L<h.s 77-Ie 7JfE. Sr...n.//eI 4tll1Iex; .:r l:lR..y 77fG OJN~ 4rw toc.tz. SI-/".p ~ /0 .'DO AM . 1/'fG;' UvtJ'TYi'A<:..rnR ~A-{)(;:-o. /D30 - lUST" c..J fn.f TJ.k;: c.o~ ANI) EPoxy 77IGv PU+-c.e 72ef'i.ec:n,1(.s. PI2.0Ce:'B)tQ 7'0 c~ ~ ~A-O W '-I/G Cc:..v~te. ?CA-ceD 2S0~ DOT ~C::~~s~~a;;~~ eJ: INSPECTOR'S DAILY REP().?!' r::: EPARTM~/liT OF TRANSPORTATION Book __01- Page _~ Date 4.lfm- P.E. 7zYl< ;t.UJk-Uo fV/A?;2.K/AkjS Day IMJrtSf.)4o/ P.M. C- LauOy 55"" ~C/CV - Ot.tJNI::'1::.._ Contract No. M,7lJ 7("e,. lIighway Section (Title) ?Mt:'111ENT Weather A.M. .5Howes Contractor's Representative(s) and Title ~W )jo uJo-~ Location and Type of Work \..... ----------- ------ ------, Number and Classification of Contractor's Men and Equipment Status (In use and/or deadlincd for main- Aio '--- tenance, etc.) cJ~ ---------- -------- ------- Diary (Report of day's operations, orders given and received, discussions with contractor, visitors frol11 Headquarters, District or FHWA, unusual conditions, recommendations and statement for monthly estimate /)-ft?' Ca.JmACm'R- VAl W6le./CAi3L& dFCA<JSq ~ CofIfrr<A-~ :r C-ovc..l;lt){- ?~'.)/c.T 7ON\.Y>1..~ - ~ (J4u..eO 0';:: AT We/' 07/0 - n04>-f C()It/O/'T70r/S. IS G4u-eJ 4r /5'30 - -T 700 NtAA 7J-I.e aJt5'177k7<. c:Gv0177DN-S AI2.... rut!'- I tJ "7'7k=' It{ DaN 11' ClOT ~~~t;'.~;2~~~ 'Kr;~~':'::=-~''''''''''''''''-~''''''''''''':'''';;<'"''~\.':o::~'~:-.,"""",,,,,,,,-,,~,,,,,,-~,,,,,,,,,,",,,,,,,,,,,,,,,.,~,,,_,~"~,,,.".\~.;,.~,,:,,';"<"";';_'~..:....:.<~,,,,.~,,......,.!~_:;_'....:.?:1:.~;~, ,...,".~,~,_,.I,,;~ .I. ,i.""'h:~~':',':' ,":;::::":'''>;~...~,...~,~-..,,-..,., 1 WI \\.B'..c.€ 2 3 · '{ 8J.D,J) 5 6 \.fC;- 1?..............<- 7 8 9 10 11 i 12 13 " IS 16 17 18 W I.lr\>e. 19 ---- 20 21 22 23 24 25 26 >....,~ .~-...~". f :; ~-'. ~. lJ . ,~. , ~, pi', } ~' r *' ~, f '}. c&' l ,. .~ I' '. '. . ',~ ':'. .......... :', ".., ',.. ',' '.' " I,:' '" .,......,' : .' .' ',.,.'.... '.L-' 1< ,,:, :,...... , ,..',', ' :. :' ..' ,. .' ': .:\,' :', .' \ . . . 1,:< . "',, " .. ',",: " ',',,: ., ,'; , "., .,.,.. 'L \\'\B8 rt-~GWr -:r ") ! ..' ',' . :, ',.,i .:,.. .."'.....'. c'.. ;'. . ,.,. - '-- _ '/ \.aJ::> r /. 'f(.e, C /c"Y -n+e \2.a<'rl) S~ Pee... ^_."S - 1M, 8" ',:.: SNP 1;NP SKIP 6t46 Go.... <[ 1 vl(5t.lP 3 . 5 6 7 8 g' 2 I 'lS'.,~ foo.58 Z.<l.8'5' '1<;;.(.. o.~'2.- it .. ~ -z.....so -..1 ~Mll') :>'00 !2rl'", 'P.>""'''''''T uP I F<b.~ l<SO ,.~, L.LT"", -z."100 -\50 \?~ !> ON '-"....,0 '11(" ''='0 100 'n:> I,,-~..._, N v....... '7,~O r~........ ,.J';' 1"2Sb 5'D SI2A (SO ,. N ~ , '-I-e;,-, '= " lGo 13><=> \7'0 S~I- ~:,oo 27 ,. .",.28 ,,\[ il=)rff);ii,\r~~;;';i:;~}3J~"'i:~iiJi(eu;,'i;) f','r.:Jt. .. ~~~ti,~ . .'" "',,' "C "'." 30 31 32 33 I~ 7/,-r;;;..."'f, ~ V ()A' ,.-, I /,_ .L./ :L 1 ",.- - .....'.....,."._,_.__ ......,__. ... J' ",' ".:." ..:..' . I '., \, , ," '> ,"".' ""'," , , .. ":.,1."" :. ....."... ," . .: I' ::;' .,,'. : ': '. " ,'"" .' . ....' .. .',,, .. .'" .'," . I ',', - , .. "",',, " oe'" . ,,:'" {," ,"!'~> : " t'- -~. ", ;',i " , " , " : !.',:' .' I,;,',:" ! 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", , ,','" ,'.',:':', ::. , , " " '" ' ':, ' , ",' '" , :):,-1 '", '," , ,:; , ,- I " i ; ~ r " " , ,.: "', , , ' ,', , ' :," :" "";' , "",'" ',',"".,' :.; ',' ' " ",'" ',,, , ", , , ,', "',i' ':', , ,~' ",,' ),: ,:' , ,', ,~~~~ ", ',"', . :" " , I,":"":':::': .-J'<:, , , , ,)" ~ " , INSPECTOR'S DAILY REP()~ eEPARTMENT OF TRANSPORTATION Book ~ Page ~ Section (Title) Contract No. /iii TO tbb Highw"y ~ PrtVt:7YleVT !YH-te.JC/A)y5 J:A-.tJ w,rJb Date -4488 P.E. 70M M~uo Day -rU~ryp./ P.M. 5<0;0 Weather A.M. Contr"ctor's Represenlative(s) and Title JlI'ttWU) MCi::-Y - 0 c.Uv&~ Location and Type of Work No Wot2K.. '~ ~ ~ tenancc, etc.) Number and Classification of Contractor's Men and Equipment Status (In use and/or deadlined for main- ~ No '" ~ ~ ~ Diary (Report of day's operations, orders given and received, discussions with contractor, visitors from Headquarters, District or FHWA, unusual conditions, recommendations and statement for monthly estimate H~,-o 12-=1<\.! CALU:.""1;> .4T 07(5 AWD WE i)ISCUS5E>.> 'TI+€ WGA-n"",.-a.. CoNe ITloN.$. - i>tE 'PAJ&,M.e.oJ, I:, we:;- AtJr) 0/IJuJoRl~u;:. Wl<o A~ TO A ( 300 ,~I>.> ME'Enr0<\ TD "1)IS'-uS~ Tl-l-C. '/,8..r::, CONFucT'> c+ Au4uS'.T A'<\Jr) S e<>;-o;""P,t:~ :T 1J'Jh:iI'tI'V\.~-f"':> 1"0""" ./v\.or1-~ 'P.;1.uc.E. lAul<.LE: ANI') 13010 1Jt""'B ,,.. A-l'lo,H" Tl"-€ -^^~-nrV"'. 1300 -~I)~C\c:.--I .<\-1UL,J<="Y) ,..I 1\+1:0 Cbvl>.nlOtJ.<c; ,-...Jf) vJ~ Jo^.tr w..... >1-.....".,...." (q:)ct:.y T'D ^^ At\..() Q\E1...LO i? Il..U,-", (A..; I?. I 12 too C?, tJes0'T1'" - ~~, ( I) t::orJq$ (z.') CHAN4E 1'0. E'NC,'N8=>'<S ') ~ :5rr'L, p~ Wc= "'Sc.u $.0; '='0:::> ; rA-\ r:::a Fc~ .A-wc,uS. WOR.t:.. ORneR.... - "'["b.M. "'^ l>I1..8..<..O '\2cA-;)s. W ,'-tc\4- vU ctE ?"'tJn::'"1) .A'I 1';>, s'-us~"'~ \='I>.'(E 'Ft.,z_ Co GAu.o.J SP~c:.'l1C.MlcJ. OOT 'DAM .Z2~04 REVISED '/7' 4 ~ 0. INSPECTOR'S DAILY REP()'r ~IEPARTMENT OF TRANSPORTATION Book~ Pa~ ~ Contract No. MT{) 76b Highway Date Section (Title) MIlt3l1A.eNt MPdZ.CltJ{j~ 10(2.7/113 P.E. (~ NeSIl,rr , Day 77-ft/1UfV;.-/ P.M. -pr<J:VN-';Y 550 ~ -OCUI1.-\9L Weather A.M. &;:lot.- 35" Contractor's Representative(s) and Tille ~ Location and Type of Work Number and Classification of Contractor's Men and Equipment Status (In use and/or dcadlined for main- tenance, etc.) Diary (Report of day's operations, orders given and received, discussions with contractor, visitors from Headquarters, District or FHWA, unusual conditions, recommendations and statement for monthly estimate ~ 'I ,el.,f::> ~"'A-/:: , C:, c:qAU...o,J SPac. ~.S"l '-t. 1<. I ~.89 Q,5 :. 0.185 " 2-D '><32- ><4 >< -3L -----. ---.. 1'1.8 I "!".I>.... II.Sep 5.'11- 'f C::;'"2(OvJ : z'7G..'f6 6.'1 'L. GA-<..'-O.J5 W ~ ,,-e -::. 21 (0 HEAVY 315'''' ~ ep,o<; ~ "'" 3;/10 'Z-loo l-\i:A\J'(' tlOT t~~r;'.:~2;;~: /. ~~. (Signed) I ",peetor INSPECTOR'S DAIL Y REI)~ WEPARTMENT OF TRANSPORTATION Book ~_ Page 33- Contract No. mTo7/u(o lIighway Date Section (Title) 'Pfl'W muJI ml/!2Jcr'/lJj Weather A.M. /0 -;W-81l P.E. _"7J:2LYt--LJ2Qg.J.Jl52- Day Tl-fttll.5fJa!j--- P.M. Contractor's Representativel',) '"nd Title Ou......J;Jftv /-1 r+1?~ ( cf1 Location and Type of Work Number and Classification of Contractor's Men and Equipment Status (In use and/or deadlined for main. tenance, etc.) Diary (Report of day's operations, orders given and received, discussions with contractor, visitors from Headquarters, District or FHWA, unusual conditions, recommendations and statement for monthly estimate (fUN M~ h/. j'A<if--I=/L. afr -/1u Vn pliSS /i AlP (esfimate&. u " off- f.). C{ / Sfl1/.f -/old Jll'rn -In hi+ <f Mnm AJnt.J bAJ. S-hzip""o E. CtJ/lA.WLbi/L. -Ihe.JJ L€./a,,;d- Cu.f-o.rf ~ LV. 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INSPECTOR'S DAILY REPCQ ,'---'" .dEPARTMENT OF TRANSPORTATION Book ~ Page-'1..5- Contract No. fYrr0710 10 Highway Dale ~ P.E."LOIrL motU//<> Section (Tille) pAU~rnp/^lf rY/(j(l/(i"-J3 Day TUe5IJ/lfj Weather A.M. P.M. 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'7:5'0 Contractor's Representative(s) and Title /-flliR 01 rO f? 0 clcr _ 0 W,Jet( Location and Type of Work ~ / - / ~ / Number and Classification of Contractor's Hen and Equipment Status (In use and/or deadlined for maintenance, etc.) / /' - / ~ /' Diary (Report of day's operations, ~rders given and received, discussions with con- tractor. visitors from Headquarters, District or FHWA, unusual conditions, recommend- ations and statement for monthly estimate) ~;~]ff~~~~r.1: i:i "~~:::;~'1; ;:r!n~1:s ~..~ h,,~ ~~i;}t;;::f;~ ~~~~~~:;~;;;:~:~ $:k~::~ ~~Ji;j~L;;%z:~~ l~iR;t is, d f~;~t';:~~~/i;,~):P~..:~~J;;'~~ ~'J~~"~:f~~ ~?~~ ~E~~~~~r 1~(21~f~~ ;~'b::'f;;:O~I~': J ;~ F;?~ :.~~~~ 'i~ i~1~;;}d!1:,f~~\ - fa ~~~~~~~~ hi~'~~~~ ';ctr,/i6- ~~ fA~' (Signed) Inspector ~.~.. (1~ .!34'~''''\V~~~p:~tor DOT ~~~~S:~2;~g~ ..... ",,=,~- 0(" INSPECTOR'S DAILY REPORT Book -D-1- Page :r2:fL..1.<:'B Contract No. m,l) I (.(e Highway Date '8"- d-5 -'ii',? P. E. Ro li>Cl.II..T iVe..se;, rr Section (Title) 'Pt1VGrflff!Jf W1ilfZ~' iJg Day THl(12S0f1l( Weather A.M. OtlRRet<'i>-j- 1.00' P,M. 5oJNN'1 17.0 Contr~ctor's Representative(s) and Mtle , UiARDld- ~OCL'{ - OwiJe{l... Locat~n and Type of Work n"Wdl W. t-"~_,( :J. ,11,1"5 OAr:. &IV R(} F"'.:rrl 'R,/! ' ',h:.~~s.. Ccr<.NClLR..r.::> ::I'J2cN C)A'\..G ~ 4-Cca..N~ \2.1) .. ~ Number and Classification of Contractor's Men and Equipment Status (In use and/or dead lined for maintenance. etc.) (_ Fa"o '0'50 'Pr-i1Nf STR.; fee 1- Il/ll^'OR.. n{>e.R!1..folL 1'~-fuN fltt1<jiNj 'fRucJL l-ffl.udc... cQlI.i'lPlI 1-~J0<>oOe-~ '-"IC.AV'T"ION 5,1o.-J-w;oT ?......N-r' l- -P11l..1jlft. le<.boU/I.- z...B - c:..oNES Diary (Report of day's operation~ orders given and received. discussions with con- tractor. visitors from Headquarters. ~istrict or FHWA. unusual conditions. recommend- ations and statement for monthly estimate) tnu.madVII. OIl.Ri.Jdl o.i' ?' 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'fI'/I_ofT'-"'-"-' INSPECTOR'S OAIL Y REPORT Book ..QL Page ~ Date ?-,;2'3-<6't P.E. 1?OP/:.trr tVf:58i-rr Day IiI!f Tu. f::5fYIy P. M. ~tJlJi.JV '6s 0 Contraotor's Representative(s) and Title /:IY-!I?o { D 'liocty _ Otul..Jf:ft- Location and Type of Work / /' /' / Contract No. YVlTOilli/o Highway - Section (Title) lnVEi'YJeiJI 5rRi PIIJ(. Weather A.M. _______ Number and Classification of Contractor's Men and Equipment Status (In use and/or deadlined for maintenance. etc.) ~ ,,/ ,,/ / Diary (Report of day's operations. orders given and received. discussions with con- tractor. visitors from Headquarters. District or FHWA. unusual conditions. recommend- ations and statement for monthly estimate) Sai~ hi t:t:"", .fRo drJ a. c.I!.AJf~/E'AI~ tJ.fu& -/'heAl +u.f<.tJ aROUNd! alVei II,.., ",1.311 sh?;pd./fl~Jidl;N,j ""cad! . 'All) pf.obiV>1S -ihefRh tit 5'R !D':(.. C'.f26XJ/?&lJ12fl::. '5i1J"iEtLm. TJ:WU {Jt,JD iJlfJ.... ~U...fikrp& hiA.r.v In CAlmf)O.lm ,'AHe8iu',,-liI'JJ aN~ ..thoJ fo YlnrPJork ;mf/Jz&"dllllJ , 1ht1~1 6*fjPd a:f -:"jim, -f,IL fY)nil.t1 ptli,Jt- dAJrg hfl"rI's ""+ :J.lrn ,/ ANi"itllfL (l,himat:l.u'l1__I?Dfl,f, -j11nJ 1f^lish(1(j! ~iJI1~ IJA:II~.'1 I?cO, r ~~;fj5ir~I~;~'rir(4Jf~,~~J]j:f:;tj ;;t 5J.:~~!:~?f! ~€~~~~~~ d,,-!'/-/.!...n ~A tlntl. ThfS j~ -117- 1<+ I,JmJ.-;1IJ11 4/1;;- Tnhk./JP --I1-.d &",) U S"O/CVin n,,"/ <\(;-j) ro(~~ >oJ 7 rll"lo<l':; '3G.COI"'~ 1(,.5'-11 5.5'1,'1 u.n5fOj .., ~ _1);6 "'~;."- vti X ~ x 3~ )( 'f 2..6.10... d." 333.oU _ '/ u_... 131.<./ 1/7.;2.'" 8'1,'0'- x II. 3t.o ~~31""'5'-_13~"'QIl"''j tiel q. ~ 3 Go 0'1) WIh'7e: ,,:;q:/, ../' I 5~S -7 DOT ~~nM~27~~~ ~~ (1~;yA-' ~ Ins! ~ ,:: ' , L '. __1: ", ',.' ' :",,;' ' '. , ,,,"'," "'~~, i " , , " :' '>. ." ..... .'; , "..': .' " :;, <":",:'!'.' ','::' " " . ~ ", ','" ,:,': ,; "- " ',' ..' < > . . " " '", ,', -: c" " .' '[ , , :'i, i , " " , , It ., iI .' .dl. ," " , ' .,' , " ': ," ',' "" , ", , ", :: . '.. " ",," ",' ',:' : ' . ,', '" ,::' ~ ,,;'. ':, ',' ,,';' ':" -.J . '..X~~;, ': ,,",:',: .,' :"i:, . "" ".' , ~c. . " ,,: . "'~,~"~~~^~..;......;~";-<~~.^.,, ~..-~ f-<~~"'" .:':)I'~'.;.~_i==?:?{~""'~,,",."""..T.ll..~I~'Y~' , ,("," " .-;', ~'-~.., .:,~;: <. -,~, -.:-." Q ~ ;J/' ..... "m=t~_ INSPECTOR'S DAILY REPORT Book ~ Page ~ Contract No, fYfT])/I.& Highway, Date ff..)..:2;'6''if P.E. 'RoBERT )JES~ Section (Title) rltiU&rlelJJ- 5/RipllJj Day fYlOI.JOIIj Weather A. N. p, M. 5IA.NI'4.f 'DD' Contractor's Representative(s) and Title _JlaRDlcL ,I<ocbt- t:Jw"J.J.e...e- . Location and Type of Work I-lriDWcL ':)t!QP -f/mlvIlL of P[JjJ!5"TRtPEf2- Number and Classification of Contractor's Men and Equipment Status (In use and/or deadlined for maintenance, etc.) / _ f)t).t,J f}l?i()tL -!Puet- t / , - OIJ.JvUr n{JeRa 10 IV 1- 1 ThJ..J +001 7RfACfc.. 1- -f/{f)(k.... ('J,({'Uel2-- 1- .p/ajS~/L Diary (Report of day's operation~ orders given and receive~ discussions with con- tractor, visito~s from Headquarters, ~istrict or FHWA, unusual conditions, recommend- at'ons and statement for monthly estimate) of I1Rf".I)t,{J -Ii tL tI--f'. ~dln~ <htf ~2~Iki.(ii T~~~ '- 7J~;:xr![' J:;':f t::,j-!;:;,fi!~ w h~: -cr' ~~~f~~11~mi}!!{{:~iI:g;;~~~~ !?;~/$t;JJ;E:J6_0H7~~!fLl~;;;f!~ -!f1u YYJn III tf.5I1 d, . ~~'~ ~;o t1 :~,mORtr~~f~:i:%~~~F :;i/!irt~~ ~~~~~; . ~ ----- ------ ~ DOT m~s:~2;~~~----- ----- ______ I ~ ~ ~'"'~: ~ <J_lnsPl'Jct_or. --- - ,--'":- ;::':~~~~,~~,\r.'1,~7 '?~l. INSPECTOR'S DAILY REI;'Olh Contract No. MTe 7106 Highway Section (THle) -PAVefV\e~JO Date 11(2..'6188 I IvlA{2jC"JC~S Vi> , DEPARTMENT OF TRANSPORTATION Book _QL Page 51-- I Weather A.M. Lr 1<:",..\ I..) P.M. 72.0 c"-':i P.E. -raM ,N\.()12.a.LD Day C.LL)Uo'f IIMtJf)~y 5Do Contractor's Representative(s) and Title No 1-1 A-ROl-f) Location and Type of Work WC'RJc, -o.....}rJ\:::'"~ tenancc, etc.) Number and Classification of Contractor's Men and Equipment Status (In use anu/or dcadlined for main- fj "" Cl2-ev J II '2- 'B '2:B II \ :2."1 ( \3'6 , , COt..J""'-AGTn>'<-. CA-1..LG\-::, CoIJ<R.AC Tt)oQ. ~>) " ~ ~ "-.. '------ -------- ------ Diary (Report of day's operations, orders given and received, discussions wHh contractor, visitors from Headquarters, District or FHW A, unusual conditions, recommendutions and statement for monthly estimate L L \?;CO I-\Q S - 071S -We"" CotJD/Tl()'J$;. 0,10 uJcT CoM€>, noM; 17'.l;; ^^ och, II:- I "PA-o (;> <= '" Co iJ"f\'V>.C Ib;e.. A-r H-A-I:>LOCJ<" Sr\.op '" ~ ~ ~ ~ ~. !JOT rORM 422-004 REVISEU 1/78 ~--- ~ -.J ~ ~ .~ INSPECTOR'S DAILY REP'blh @ . - . DEPARTMENT OF TRANSPORTATION Book ~ Page '1 0 ~ Contract No. IV T/'> 7(~("'lfighway Date Id2.ZJ R'd. P.E. IOI'A I , ).;\ o(<.8-LQ Section (Tille) -P-A-1J~/.~r.=-I')1 J1^t:-C~IC\,)(\ S Day MO/JI).<-y P.M. J2PcI ^J SO'" VJ1('JC-/ - OuJdE:R...... Weather A.M. K'AI._} Contractor's Reprcsentative(s) and Title j.I.AP ",_.1) , Location and Type of Work Wn t O\T.I:"-iC "-.. ------- ------------ ~ Number and Classification of Contructor's Men and Equipment Status (In use and/or deadlined for main- tenance, etc.) '\\0 cp=d "'- ------- ------ -- Diary (Report of day's operations, orders given and received, discussions with contractor, visitors from Headquarters, District or FHWA, unusual conditions, recommendations and statement for monthly estimate v.JEI CDI J() /T\ o/JS - U I J LJ) DR.ICM~L~ 1000 GMlG.. I"^E:T 0J 1m Cot .ir1'<;. C TOR.. Co? I-IAOLoc..IC. S',-+oP - I+'M \ Oc. \1)0 ER...S. C\+edc... COI.r.-.., A C'rDR D<,A-, ,JEb TPdJIc...-:,. T TD ,-0 I+. ^^ ) I-IE 1\ 2-S' D{<- S/>n..) ('JJ)A-I "12..6 Co v u:::, I -r I-h:: vJ m-<.IC.. h'<.. \ '>P-{ ~A-\r) WA"J'B) m\ D uJ oR-Ie. - (;,)6 CUtJO Illod.5. u.)cQ.K - vJe;- C.C:>I.ll:) ,Tlo,)> -n+At~\<'S.(~\JIIJ~ ('\-UL-I))F<Y ~-I A"iJl'-S (1 \ull~lc..(' lj\-r~l..lr)A'( --n-n;-<. <.:-- \\ \"2> II \;;.'" tlOT ~'::~~S~~2?/~~ L --1 L ~ L ~ L L L INSPECTOR'S DAILY REI~T ({I DEPARTMENT OF TRANSPORTATION Book~ Page pR Contract No, MID 1bbHighway Section (Tille) AAI/erng)i /JlA1<K.IM'!'>' 724/1/ 1/ /Z')88 I I P.E. (V/M rllDtZELLO Date We"ther A.M. Day //.1 OIJfY:I,/ P.M. f'.-WUi)Y c:c.O leoe/c./ Contmctor's Representutive(s) and Tille - /-1/11200) Loc"tion and Type of Work ',,- '-...... '............. No /.JJof2.K. -~ ~ ~ Number and Classification of Contractor's Men "nd Equipment Status (In use "nd/or deadlined for nwin- . No U(pj , tenancc, etc.) I... Diary (Report of day's operations, orders given and received, discussions with contractor, visitors from Headquarters, Districtor FHWA, unusual conditions, recommendations and statement fOfmonthly estimate 07/0 77fl;' C.O~t:JCTl:ire. c4t'..L9'.) -)Vo WeRle - v.JeT: /000 7)ISc-vSSEO vJln-I RDl".82T _ ;(/e>I3ITT ~ COI.JTT(LC.c T SnV4Tlo"';, THE CcvvnG4<:.T 77/tIE '>;XPIRFf) ocr IS, NBB. UJEA?71D< LotlD/77D/V-5 m2E COOL <t (/)&T. ' "lCn'pF12r VE;81n- VFoJJt=ZJ '/?:) ~'i!mll/A-7E (" O,cm:<.A C T 1030 7DM H/I\'\ ----- IU IDAJI6'lr A/OU 30, /'788. / . //'/DI<I:-7..t..D ('A-U!?:J {O(I/77<ACTD/2. TD /IJ!Orc.N'l '(f-I1;; Co/,./m4cr- uJOUt..() exiP;(U; ,x.lorJ 3~, 1'189. -------- tJor ~'::~~s~~2;o/~~ ~ ~ ~ ~ -.J L L L I INSPECTOR'S DAILY RElfotT ,((j' DEPARTMENT OF TRANSPORTATION Book ~ Page gg I Contract No. ItfTD 1b& Highway Date Section (Title) 'PA V8I4E'1r It'1Ar?I<"loXfs Weather A.M. t'OO'-' II 118/&3 I ' ".E. fCcP....F.lo?r )./E..'B In- Contractor's Representative(s) and Title ~L6 Day nz,tA/ P.M. 72r. 5ul1lIJV 50 D 72co::y - cWNt-;c:. Location and Type of Work ST7C.1 p/'-''j K'EPt Ferner - f{f ILL 12.1), 7710tfAS leI). KEFiEC'rd!-$ OLD {;;a IQ:;Il1lSmD .eD. ;..111:;' T/If 65: AvF. /lttJOHU.-- 7eb. (fillJ,.fJ/) 'PIS LOJ/8<V j.kc/(fHTS 73BGK:f?7T . 'R-: i2D / C.-qr-'t= (j{;'{). 'ED . / Number and Classification of Contractor's Men and Equipment Status (In use andlor deadlined for main- tenance, etc.) z- ouJ!)rR.- oPGnAn)/IS I - ST72,P1A/r 77<-UCl<::.. 1- '1V TVN "'J?;CK.U,o,II1A(dP1Ar 1 - nA&;'I='7:!. I Diary (Report of day's operations, orders given and received, discllssion~'.with contractor, visitors from Headqllarte'rs:~5jstrict or FHWA, unusual conditions, recommendations and statement for monthly estimute !I/11t.OW IZocp/ (lAU&I.). fi! 07/5..:L leX{) HI/1I1 (JgJ77--I6R. 1.tJci 5. {OOf.- , gUT PAIA,ol'f1g/T 7/;:y, T A~ TZ> ,AAE€7' / N,.,..ff ;-11M ;:tr /030/IM. (eJ j./f11)Wc/C S;-IoP. 1100 111//3/ (..,0) moo{ Ilfe, Cd'~C1?JIC /7tIIO (AIO 0,-" 7th;; 7)qy5 UJoAl/G. :R-EPL€C7?.:JRS- Sm.IPIlie? I /iDi/ISEO '7?-fE C()C\I'F><iACTOK, .ON t?cACc':-Yl-1€?V;- o-F ~.nr=:CTtXs: . 12EFi.ECITxR. S!louu') J.!,'JVE 1'-1 LO/J!/.$T&IIT , UNI"U2;1/l /1PPt.lC4n,.lfJ , r=ft.<xV uHllof Cot/ENS; /HE PVTlR,E lZEn-EC77:JR-.. AtJO 77fE Dr: l:: 'fJR VOt::. s ~.0A,( At-I- SIDes. -'lIfE C at'J,PA C i?Yi2 HA5 A t'?AP (-<..) I'1H NO EPWj. tJOT. ~c:.~~s~~zi/~~ !iA{,.-o ~.If ~ ~ ~ L ~ L L ~ ~ L L L INSPECTOR'S DAILY REIfJtT Contract No. Mro 7tdo Section (Title) Weather A.M. Contractor's Representatlve(s) and Tille Location and Type of Work Highway GloEPARTMENT OF TRANSPoRTATlbN Book~ Page ~ Dute M A1<./t:./I.1;.S 500 \\\\~Iffi . I I'.E. lCo(~)('~'" JJE~..rT Itlt)f'J()Ay Day SvNf'.J..! ~2-0 /-h:t~) P.M. 720cl:-V - ov)fJc-""- t!..!3'N'lriit< reD !2EFI E'9~ 1f,j.P' /1.5 15.0 tenancc, etc.) 1- 3/-1 rvrJ P,c/CUP Number and Classification of Contractor's Men and Equipment Status (In use andlor deadlined for main- 1 - / roiJ nA-T' I3EI'> z- OU)Nb7<.. OP8l?Ar/');f'-S I - h.A.::. ,,-EZ Diary. (Report. of. day's operations.. orders given and received, discussions with contractor, visitors from Headquarters, District or FHWA, unusual conditions, recommendations and statement for monthly estimate No uJC5IC-K. I{=f/BB /1/10/88.' () en:>< kAlJ /-Inu f)/Id III II / 88 , I I 07/") ).1 flJoi'I"X /) Pro,. YV C.a-r I ,..,-?'J 1i1;.:;. 4, -r;v 0 ;.{,AA 77-fE rA1lt.=:l'11r-':11f'1 vJA.\ ,<,<"/ I f) /.IF I..J DeJtJ) t=;.= 4., 77-11" In'VJ 1111'='- (~ )'71-1 7I+E Sr V/JP/ 4.";;1/1')(' J: > ""'~y 77ff; (c),uifl'AC7n1'. ,4>'ft){fJCJ::.. Slkf" ~ /():OOA./.. ~ / ,.,AlT;e,qr 77'~ / -0"'" r C^ l'7'r?AC 'TN? 1"",./);--0. ,p.=r:==; Fr71'">i! < "',Mn fP1"IIIY ~! lCc)Prl> TI'l P/A-n=' 72FnpC7M., '2.5D J?€17H"~ OOT. ~C::~~s~~2?/~~ RPrlt'~~)f--f) TO (' p J;c:e nAf'FO) ""fH,", CO/JT>2P(7"r>:, \ {'.IIII {V' ~ I ~ .-J ~ n () /?~/i/ , ()O (>/b.?o tj;? 'f f }/J -r tJ7bb JEFFERSON COUNTY PUBLIC WORKS DEPARTMENT CONTRACT CLOSURE / RETAINED RELEASE SCHEDULE Job No. MTD (1,;."" LA. No. S.A. No. Job Title: 1/A'U~M8\I;" (\1\""'-"'-' r>J (IS aLh =----{ U/' Road/Facility Name: Contractor: R.oG<<:.'-/',> S1'R..OltV'1 Addres,s: '11<0 (;A1Z-QeN t-ku.... C2J> Road Number: City: e. WlAA State: VJI\J --rb "^ ..AA,O-r2..6t-l.D Zip: q'2>S<l I Project Coordinator: Document: Date: 1\\'-1 \86 Completion Letter To Contractor Completion Letter To State Aid, C.R.A.B., D.O.E., etc. p-\ z.& \ 88 . Final Estimate To Contractor Ilho\'b'O Final Contract Voucher Certification To Contractor ~ II II I. 59 '\ II l gq \ \ (" \ 3'1 I ~ ~ 'f,/I7/ a 9 Notice Of Completion To L & I, Contractor Compliance Unit Notice Of Completion To Dept. Of Revenue Affidavit Of Wages Paid From The Contractor And All Sub-Contractors Certified Payroll From The Contractor ~ Notice From Contract Compliance Unit, L & I Certification From The Dept. Of Revenue Retainage: -1\ Ceo ,517. q2-- 31 OLE>. '10 -e- "310'2..<;;'. '10 1.....0C{D. B\ Total Contract Amount 5~ Retained As Per Contract Documents Interest on Retained Amount Sub Total ( Retainage plus Interest) Total Liens Against The Retainage * Total Retainage Less Liens 4t Retainage Dispersed to Contractor Date S- C?- g>q ~~~ ", ,- ,-' .. ' :".'" : ' .',' ".:, .'~ ;.,. ", ,:- " "i:,,'.'" ',' ',' .." ';;" , :' : ..', "" , " ;: I ~ > ~ .; ~{ l '1', ;'" " r;~E,:~i:' , ' , " ", ::' "',.,",,',, . .' '.' , ,":, ". ,', ;' " Ii'" ", " I', " - ': "', .',",',.'i'" I" ":',,, ,": :" , "', :":'. .', ,'''' ,',' I: ". , 1\', " LL ' PINK-Headquarters Construction L:;'." ,,;:,:_: GOLDENROD-Project Engineer I.':;::';; '~,\:" " ' ,':':" ',: ',,' ',..' ':, ""',"'" ,,'., """ , , "", ,,' :\" :"";; , " . ': , , ' " .' ,> " ,"! ,,:., , .' ,.' ,.", , ' , . " ',:: . . '"."",," ".,>>" I' . "''', " ',: ,:":,:,:",,, .'.',,:, ': .: , , ',. ,:1. ,,', J' - ,':' '.', ',', "'" I' .,~" . , " ' , , - ,("') W _.....__..T.--_.'...... REPORT OF o PRIME CONTRACTOR'S PERFORMANCE CONTRACTOR I CONTRACTOR NO. (Hdqlra. ~ Only) , ~trO -r l,b ~ ~tegC.Tso r-C:::N~ (,,(0 --- SIGN RT. (Co. Rd./C'ly) , ~"S ~AD ~1lZ.1 Pee.. i'lE":1 ::T\ 88 COMPLETION DATE Dc.... 1<:;,''188 SECTION -Pp.VE'M~ M.AR.tL,N~S TYPE(S) OF CONSTRUCTION PERFORMED BY THIS FIRM .5n>-.Ploo.)~ -PLA<-,tJ~ ~5 IN/ltJ6t ~oP<..A$'f\c.> With relerence to the following 'ealutes of the Contractor's operations. state your opinion on this project. indicating whether EXCELLENT. SATISFACTORY, MARGINAL or UNSATISFACTORY, giving brief explanations. Under EQUIPMENT, give your opinion of adequacy and condition of equipment used. List major items of equipment rented, rather than owned, by the Contractor. PROGRESS OF WORK Rating ~ S A>c<l> R>I ";c. \19:>"'4 t..Jc., ~ w,JraA(...'Tt)P.. c::.ou <-0 (.OMM \IN I (.krE. ~ ON v) ~ l-+e;. c,Ul>14K.1 ~, ""<"P~ VV'ootJCf>o'l's. aUALiTY--OF-WORK '11eW::> 't)€fficsr. Rating MA-t-b. tV_/tlNSt>nISFA<:-rrnvj ,sTA-R-r ANf) ~ps 'VPF ax.e ""lJas ? SPe'c:. 0'" \>3'1:>,"" TP S....,"" ~,oJct MM'4,oJ"<\- - 6E~ \Z.!).- 5Pec. ooJ o...eo.J~ of" 5m"'" (.ctJMl~-ro"- SISU-S 1-L.H>le ON '10" =OJJIiI- '8-'2-"..,,(..,,) tolo ~,~ 00..- oP lOUT oP \?- 2.1.-."> t.-) 1><- 2..... ,.(:l>) E-aUIPMENT -1W' Raling ...:S"",,~r. ~ }/VIPrCl.4IIJ_ NO ~,o..qc. I.>P I..ll<o'..... 000.) 5~~ FltiN. -n ~s ~AL.,> S~ NO~> ot../;> eI<.. TZ>0 H<4r 'O~ ~ '"TI'\al.MOPt.AI"Tlc. ........,l.6R.. - NO ,-,c.E'lJSe: -SoaS-....... VPfr';. Fv/..J- ~ ="0::> t,)" ....10-5 CO~ATION TO Raling i"~'irec. Fa>.. 1>f!e -~ /..CO ~= ~aDI;> WO~eleR.. "'1"*"'- 'i1aJ:> Co~I(:.."'<;' ~s '10"> f'e=t- ~~ ~N~T I eJe;tJ "J1-lQv<o~ '1oJ ~o.J \tel> t..-I'IJ"I 1'D 'fou . CONTROL' OF SUBCONTRACTORS Ihfl ~~ ()1-k '7,;/ O~ K~~D ADMIN./MGMT./SUPV. Rating ~I"'A-l- DISTRICT COMMENTS AND RECOMMENDATIONS , .:J: ~'-"671<0 ~ i?<<.J'-6'T''s ~ ~ PW6-"uerr Be ~~ "!t!.!: r'?C726' ~rr Co'1..Jv-?ftc..~ c.n.In (,..<.- He C/'J7.f ~ ~ rrc:; r:fr:ts / r?'j:)Bove'D H-i s t:::>eT2~ e:J./~ I . n n _ ~'7_~ ''';.Jj 'NGIN:/J.. f)/7 _ I OIST, AOM'N, OR CONST, 'NGR, " DISTRIBUTION: WHITE-District Administrator CANARY-Headquarters Construction DOT ~~~I~E4~~'~~~ -liaR. , ", ,>.",', ' ", .:: .... :,', ',' :,:,:," :' ..... ........... " "'" . ,:'. .. ': .', , " ': ,>", " . ',.', . " . ':, , , -:-~' ':: , ~ .: \:..' , .' , ." ,."', . .,' '" ' '." " . ..... ....: ... " , " ' " , ,:,' '.' , ',',,, < .. I....., . I ,:, ," , :, , I..... I. I" I' I !~ , ~I '.: .'" '", '" ", 'T'" I 7) /\2:/~~\-'~""" "() State or Washington Department ot Revenue Audit Procedutea & Administration Olympia, Washington 98S04.()()90 600 163 155 RECEH/ED Certificate of Payment of State Excise Taxes by Public Works Contractor Contractor: APR 1 7 1989 JEFFERSON COUNTY PUBLIC WORKS DEPT 17 418 ROCKEY'S ROAD STRIPER 916 GARDEN HILL RD ELMA WA 98541 PWC We hereby certify that taxes, increases and penalties due or to become due from the above named contractor under Chapter 180, Laws of 1935, as amended, with respect to the following public works contract: JEFFERSON COUNTY PAVEMENT MARKINGS 1988 - MTO 766 together with all other taxes, increases and penalties due from such contractor, have been paid in full or that they are, in the Department's opinion, readily collectible without recourse to the state's lien on the retained percentage. This certificate is issued pursuant to the provisions of Chapter 60.28 Revised Code of Washington for the sole purpose of informing the state, county or municipal officer charged with the duty of disbursing or authorizing the payment of public funds to said contractor that the Department of Revenue hereby releases the state's lien on the retained percentage provided by this Chapter for ex- cise taxes due from said contractor. This certificate does not release said contractor from liability for additional tax which may be later determined to be due with respect to the abov! ...'mentioned contract or other activities. Date at Olympia, Washington, ,//;3/.9/ FORM REV )1 00211 (J.85) STATE OF WASIlINGTON ~ ftE.PART;:JtljT OF ~EVENUE ~i!-// .?t2A:.t<L/ SUE MORRIS Ccrti/yhlg OfflceT ROUTING: While CtlJ'ly-l}isbursing OlTicer. Cumlry Copy-Cuntractor, Pink CUfly-Filc. Goldenrod Copy-Special File. "","'3-' I) o JEFFERSON COUNTY DEPARTMENT OF PUBLIC WORKS C ""{? ( \ -\'~0--.i~/ ..< .rhy.~.I: . ~'4, ~ic- rf'~ ~.1r.)>.' /~-:;,i-~".'" 1820 Jefferson Street P.O. Box 1220 Port Townsend. Wf, 98368 (206) 385.9160 Gary A. Rowe, P,C., DIrector Robert G. Nesbitt, P.C., County Engineer January 27, 1989 Rockey's Road striping Co. 916 Garden Hill Road Elma, WA 98541 Re: Project Number MT0766, Pavement Marking 1968 Dear Harold: Jefferson County has received the Certification of Payment of state Excise Tax from the Decartment of Revenue. Attached is the lie~ detail for liquidated damages in the form of direct engineering costs and penalties for paint application out of tolerance. Your contract with Jefferson County was terminated on November 30, 1988 as per Section 1-08.10 of the Washington State Department of Transportation 1988 Standard Specification for Road, Bridge, and Municipal Construction. Wi thin this section it is stated "The Contractor shall bear any extra expenses incurred by the State in completing the work, including all increased costs for completing the work, and all damages sustained, or which may be sustained, by the State by reason of such refusal, neglect, failure, or discontinuance of work by the Contractor". Your total retainage, less liens, in the amount of $935.09, has been submitted for payment. If you have any questions please contact me. Sincerely, ~~~ Project Engineer xc: MT0766, corres. PWA02 6 0 17./7 19B /?T07(P? - fflv~GXFr /-?/J2-k:/4er-- - . Dl1?..e:Cr ~&-i/-.l~"-l.(' Cb-;,'T'5 ~ 06'- 1'5) \G8B O'J(.C. 19T 77Y1 ~ 121'J7Ci5 : ";?a:.- -n/"lC '!J'l./~ OV~i~ 77 i?€ j 13. 77 I', I" :;i [-, 1:1 t:~ '&fl7t..eY $/5./0 $20.18 I:. I1t- ~r i:. " i" l~ i'l Ii @cro'B~ ~ !,' r: I:: ~e;t/ -oo1Le:.- I" :1 ' I:i Ii Ii'! .! 11 1[1 f1l, ~ i'l Eeb rfi?5 . t!:>V6R.71nG: ~. ~,.oo 8.s0 )(.'1.18 x/3;77 $> 559. ')~ +- 11 1/7 .05 = iP iJ>17.D3 '-1.50 'Zo .I"S -1190.81 LJ-(., .00 X. 15010 $ ~9t..J ,,=,b 1- l$ 19$".'-H ,I :!NbVD'? B6li!-- ., l :irh- '5~ ; :j :1 !I 'I '[ :I i ".00 )( IS'LD _~gO.lcO Jt 'io .Coe -= T~ cft/5S3.df :, " . . '; , ". ,c ", - ',.;, : ,< , , : t. .'> " , I ;' " " p . , .- ';; " (rn-PCJrl-/l1 FNI:IE ) 1': 'RcU-ll n\-€."[W.o.o S"OC< pIS ~~ \'\'\88 I ""''' . 2 VlAe.\IQ~ 3 V 5 1 't."7 6 ~n ~ . I. -. 7 Jo>? 0 1.1,^iJa 9 10 11 12 Ar.ltGli:.~ TO 13 rur..o <.>J ~ 'l, eu:> ,. <:.or-! Ft-tc:I"" 'tl. ~. \.",.J 15 91......, \ 88 _ 16 "l\(~IBB 17 T \ 18 19 20 21 22 23 2' 25 28 27 28 29 30 31 ~ 32 33 ' I -- -'-.. - . " '. '; ~ . .' : .' '.,i . ',-c~',. . '.' , .-. , '.,' ". , . ,. ;.,' .' ." " . ". ,,' .,'. . :''-'' ,,' '-. ",,' " . ':.- , '. '.' ~,' , "'. : " 1 2 3 . 5 e 7 e ~ c:!o~ llS, '3(. '1.5',2 'ft.Z-'1\ ! It 5;:7.77 ''7: V~. \...R ~ "re..L.. // / '. " ',,' ""i," " . . ", ,", .... .,::': ' .',' '. '.' "," ,', , ,:. " "," , .",', ::", :, .', :;, .,,',','" >,c ,'. 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S$' '1<;;,c. 0.'2- '0 .".".,..',;:<.2 " .,; 2 , i, .....,..,".....,.,.;. 3 '...../,;?: · 'f 8..I-O.J) ! ]// "i" 5 I i, ,..\ 6 \-I.",,)" '",. '4 S' P.>............",.. ~ ,:>...0;;0 ~'" >: :>'co ~r-z.'2, 'l' 7 12rl'''' "P.>lU> ""'" LIP i, 6 I o:;;b 1'...... t..\T"~ Ii,',.."; " I~ " 9 2.'"700 .',:. .,......... '0 -150 l'3~n. " .,..,1""""0 '11<.. ;in) ,/ 11 7-,>..0 F '2 \00 Tt> I"-~,,,_..... ,to! 11_ . ':' , ,. . '3 ,?_q..;D (..",,-,-1,..,0;. : t 14 '5 '6 17 '8 wl.lr\~- '9 --- 20 2' 22 23 24 2S 26 27 28 \f,g f)t 29 30 3' 32 .i 33 ii, 6 ,," .(. ",. .. ..'.'," ..,; I "Z5t> I.; <;0 BI:zA i' l ':;0 . 'I' I 4-SO ;. 1= ., \'" 13>0 " ..-0 $KI'6.1 - l~o ; : " I ''''~~~)o I 'Ie:u.o".) 1.1(~ i',; I -, 2. ~6)0 o)!hno Ll6t\1 I ; ': Ifi'^P1tn~, A~ II VA /? , I~.J/ ~_ , /' ,',";: " :' ,:':, ,,,' , ' '.' :-- '. -,-.' . ' , ' '/, .',',. . ' ',.," "'.,' ,,' , , , . ',' ,"':', . , i'", ,,' >.''.' . "",,',,'.", ' " " ,,' ::,',,', :, ,:: " ' ", 'i.. " ,". " "" ,'. ::' H.; ",' ",' :,' ,'" , I:";, ii """",.' , " ,:;.;-- " ".'" "" --;..- " : ' " , ' -- . -- , '.--::- ,:.,,': ",' ' ;' .' ':, . ',. , ., . , ,', '.': ' ", . '. ,. ,", "'i'" i,: " ' ): , " " ".' ,i', ',' '" ,,'..'.' " "':, . , '., ;':: I.' ,,""".",,', ". .',,'.' ~':.:;"" ,:. "'.' " ',,': :, ?/t:j\ " .:,'.' :.r' , , ;'." ", " J <"" ,:: ','. '.:","~.""i"""','" , ',,' .', ,'. 1 l,} t I,' ' I' I;' Ii"", I: .,,:':' ~ . II.... ,......, 'de o JOSEPH A. DEAR Oirl!ctor STATE OF WASHINGTON DEPARTMENT OF LABOR AND INDUSTRIES January 12, 1989 Jefferson County Courthouse P.O. Box 1220 Port Townsend, WA 98368 ACCOUNT 1D: 407,664-00-2 Rockey's Road Striping Company Contract No.: MT0766 Gentlemen: (Q; Please be advised that the Department of Labor and Industries does hereby release Jefferson County Courthouse from any further liability pursuant to RCW 51.12.050 and RCW 51.12.070 as would otherwise incur in connection with a contract calling for pavement marking, county wide, 1988 in Jefferson County. @ This certificate does not release Rockey's Road Striping Company from liability for additional contributions which later may be determined to be due with respect to'the above mentioned contract or any other contracts said contractor may have performed. Very truly yours, ~ Kaye Kjorl aug Administrative Assistant Contractor Compliance Unit Phone: (206) 753-4398 CCU1:P14.jk31.1 cc to w Rockey's Road Striping Company 916 Garden Hill Rd. Elma, WA 98541 State of Washingtor:-) Department of RevenJe AX-02 Excise Tax Division . Audit Procedures & Review Olympia, Washington 98504 \~ \\\ 8'1 sCl"I NOTICE OF COMPLETION OF PUBLIC WORKS CONTRACT Reg. No. ----- Date \\\\\&1 From: ~-R.~o-J Co<JN'r"/ ~. """ -P"'?t.<c,vJCNUGS DO NOT USE Assigned To I ~<-.o Date Assigned Jb-J"-..so,J S-r. 'PORT TowNSeu<:> I WN P.W.C. Number '1S 3(,13 Date Gentlemen: Notice is hereby given relative to the completion of contract or project described below. Description of Contract: ,?Av/2/IAgr, V\IV"<'-<:"NCjS - lQ'l'2> V\O\, TO 7 G:k, Contractor's Name , lZoClc-s'i s l2m.M) ~,~ OJ I Co G, MU':>erJ /-\-\ ~l- RJ) . SL-V-A I V-' tJ "ig<;;<\- \ 71sl'3l> III"?o\ 'bB 't'2,2.- ??z-7 Phone Number: Contractor's Address Date Work Commenced Date Work Completed Date Work' Accepted: "\?o[<O'O Surety or Bonding Co. \N("6"'n.jl.JA-OOt.J~ F1l?1:,L.I,...../ \ N ~Vlt.A-^Jth Co. Agent's Address -n~ ~ GI-P~~ 'P.O. "0'" I'z:n.f\) '\'b","-""",I) I ""- $ f.,ZJSO?'?D Amount Disbursed: $ (,,0\511.9'1- q 7'2_' "2- Contract Amount Add it ions Amount Retained ?102S.90 S1.4'l~.03 Sales Tax Total Total (" 2..,5!>?S-O By Disbursing Officer The Disbursing Officer must complete and mail three copies of this notice to the Department of Revenue, Olympia, Washington 98504 immediately after acceptance of the work done under this contract. NO PAYMENTS'SHALL BE MADE FROM RETAINED FUND until ,receipt of Department's certificate, and then only in accordance with said certificate. ~UBjECT:, CA-u.h-r:::> S/~l ~c.ICCY ':.",:",J.JJ4:e" H-,o.-vetJ1r S ((.,lVeD ST.!l -p,c.-./ _..WILt- SeNl) 1VV\v>t€!)I~'i - DATE: ,\ II \3'1 ~ ... . . '<'. . :;:'.;\;I;\1~t '.. ..' . ! '" . -:-; , . "f. , .' ..'.. . .. '.,' . "; '., ".. . h.."'> I . ,I..' ":. I, '.;' '. ...... ~; f .;,.... ,...' '.,. -: '. .;.;, '.' . . Grayarc .. P.O. eQ. 2944 H,u\tord. CT 06104 CAll TOLL fRH:l.800.24J.5250 o REPLY MESSAGE o REORDER ITEM /I F72 Fold At I,) To Fit arayarc Wlndo..... Envelope II EW10P ,.J7r<.o :rec.,.- n LE: FROM 1. '. ,'\, , ;,:' .'.;' ..:' . JEFFERSON COUNTY Department of Public Wor1<s Courthouse PORT TOWNSEND, WA 98368 (206) 385-3505 TO ~>n .M",.,-e, _........ _n i'6~\Ll=:-S> ~ . }J DD-LE eE CoM P LEn oJ - ~-p-;--. I:5'F ~~~ ""D. L ~T <- =---~i v 0 uc. t.J-erc:.... \ \ \ ,\ 8"i , ... (l'~ .~ ." ... :.: ..... c. c:o~.. \.... PLEASE REPLY TO - SIGNED /" REPL Y...._.m....... ... n" ./ ~ Ii ".' I>: '- DATE: SIGNED ~ lIem 1/ F72 <!;) Wheeler Group Inc. 1978 THIS COPY FOR PERSON ADDRESSED DETACH THIS COPY-RETAIN FOR ANSWER. SEND WHITE AND PINK COPIES INTACT. .:'::.. :;,. .,' :',",;,:":'.: . , "_'n ...__-:-:--_..... '." ".', ..... :.. .', .... ..' ';". .' . .' ..... . " , ,'. ....., '.. . ... '. .',;. ...... . .. ." '. . .,,::'.", '. " '..' .'. . . .'. ..''':'.' .,":.', >; . .. ":,',,,'."::,;; , ,..,.,,: . .'.' '..:: ". .--. 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Ifi " ' ",",'" ':,,:, ,I :,.' >. ... ',' ' .: , ' r' ". ~,: ' ~, ' ".' ,','.,. .." , ',,", " " ""', ':" \"" " ,?,::"""'\\' ,.'{."\ "'laV"'"''V nUT , ,:.,: "",' :",: ',:','.:" .' .- '" , .;.~' :' '. , ' ': ,.. , ":.' i . . .'.,,' ',., , :,:':<. '". ,', <: ", ' .J;., .r' i''-''''':''''-'': '".' ;,': ",: " , :"'. '.',"'. '., ""',, "'. " ", ;:',', ",,', ". ,,: , : ,: ,', ,: . :"':" "", ' ,,, , ,',"', .,' , " ::,,':' , ',: .'," ' ,:',' ", ;Lh:;';;- ',';'r: " ". ., .' ", : ,: II ':, ", I: . ,'" " l\'" ;'::: " "",,'."':'."..'L }" '. :',::1 I I r \', '( '" " i " ). ,'.' . l: " ',"" , ,,'" :. ,: ..; ""'" ;, L /'! n roo", w-g I Request for Taxpayer I Give this form ~:~:r~~~'~~:'~;h~9:':~sury I Identification Number and Certification tONt~~ ~~~~et~~~'s~o Internal Revenue Service Name (If Jomt /lames, k.lllIst anu cltcle tile name of 11m persoll or ent,ty wllOSe nurnbt'f you enler In P.ut I bl.'low 5tll: In,ttUct!oni If your name ha, changed.) Harold Steven Rockey o Address 916 Garden Hill Road 1i: list account number(s} here (optional) ~ Iil1I1II Taxoaver Identification Number Enter your taxpayer identification number in the appropriate box. For individuals and sole proprietors, this is your social security number. For other entities, it is your employer identification number. If you do not have a number, see How To Obtain a TIN, below. Note: If the account is in more than one name, see the chart on page 2 for guidelines on whose number to enter. 98541 I ;"';~ 'i'~'747t~6 19 10 11 I OR I Emi'OY~ IdjnUflialloi nUiberl IImIJ For Payees Exempt From 8ackup Withholding (See Instructions) Requester's name and address (optional) I I Certlficatlon.-Under penalties of perjury, I certify that: (1) The number shown on this form is my correct taxpayer identification number (or I am waIting for a number to be issued to me), and (2) I am not subject to backup withholding either because I have not been notified by the Internal Revenue Service (IRS) that I am subject to backup withholding as a result of a failure to report all interest or dividends, or the IRS has notified me that I am no longer subject to backup withholding (does not apply to real estate transactions, mortgage interest paid, the acquisition or abandonment of secured property, contributions to an individual retirement arrangement (IRA), and payments other than interest and dividends). Certification Instructions.-You must cross out item (2) above if you have been notified by IRS that you are currently subject to backup withholding because of underreportlng interest or dividends on your tax return. (Also see Signing the Certification under Specific Instructions, later,) Please I ~I:r~ Signature ~ L / ././ ~ Dale ~ /, ?_ eYe Instructions (Section references are to the Internal Revenue Code.) Purpose of Form.-A pers~n who is required to file an information return WIth IRS must obtain your correct taxpayer identIfication number (TIN) to report income paid to you, real estate transactions, mortgage interest you paid, the acquisition or abandonment of secured property, or contnbutions you made to an individual retirement arrangement (IRA). Use Form W-9 to furnish your correct TIN to the requester (the person asking you to furnish your TIN), and, when applicable, (1) to certify that the TIN you are furnishing is correct, (2) to certify that you are not subject to backup withholding, and (3) to claim exemption from baCkup withholding if you are an exempt payee. Furnishing your correct TIN and making the appropriate certifications will prevent certain payments from being subject to the 20% backup withholding. Note: If a requester gives you a form other than a W.9 to request your TIN, you must use the requester's form. How To Obtain a TIN.-lfyou do not have a TIN, you should apply for one immediately. To apply for the number, obtain Form 55.5, Application for a Social Security Number Card (for individuals), or Form SS.4, Application for Employer Identification Number (for businesses and all other entIties), at your local office of the Social Security Administration or the Internal Revenue Service. Complete and file the appropriate form according to its instructions. To complete Form W.9 if you do not have a TIN, write ~Applied For" in the space lor the TIN in Part I, sign and date the form, and give it to the requester., For payments that could be subject to baCkup Withholding, ~ou .will then have 60 days to obtain a TIN and furnish It to the requester. L 'Ouj.iMg1'Fie '6c:J:day period, the payments you ~~Lv:;~~rr not be subject to the 20% backup withholding, unless you make a withdrawal. However, if the requester does not receive your TIN from you Within 60 days, backup withholding, jf applicable, will begin and continue until you furnish your TIN to the requester. Note: Writing ~Applied For~ on the form means Ulat you have already applied for a TIN OR that you intend to apply for one in the near future, As soon as you receive your TIN, complete another Form W.9. include your new TIN, sign and date the form, and gIve it to the requester. What. Is Backup Wlthholdlng?-Persons making certarn payments to you are required to withhold and pay to IRS 20% of such payments under certacn conditions. This is called ~backup withholding." Payments that could be subject to backup withholding include interest, diVidends, broker and barter exchange transactions, rents, royalties, nonemployee compensation, and certain payments from fishing boat operators, but do not include real estate transactions. If you give the requester your correct TIN, make the appropriate certifications, and report all your taxable interest and dividends on your tax return, your payments will not be subject to backup withholding. Payments you receive will be subject to backup wltilholdrng if: (I) You do not furnish your TIN to the requester, or (2) IRS notifies the requester that you furnished an incorrect TIN, or (3) You are notIfied by IRS that you are subject to backup withholding because you failed to report all your interest and dividends on your ta~ return (for interest and dividend accounts only), or (4) You fail to certify to the requester that you are not subject to backup Withholding under (3) above (for interest and dividend accounts opened after 1983 only), or - (5) You fail to certify your TIN, This applies only to interest, dividend, broker. or barter exchange accounts opened alter 1983, or broker accounts conSidered Inactive in 1983. For other payments. you are Subject to backup WIthholding only if (I) or (2) above applies. Certain payees and payments are exempt from baCkup Withholding and information reporting. See Payees and Payments Exempt From Backup Withholding, below, and Exempt Payees and Payments under SpeCific Instructions, on page 2, if you are an exempt payee. Payees and Payments E~empt From Backup Withhold In g.- The foHowing lists payees that are exempt from backup withholding and inf~rmation reporting. For interest and dividends, all listed payee~ are exempt ~xcept item (9). For broker transactIOns. payees listed in (1) through (13), and D person registered under the Investment Advisers Act of 1940 who regularly acts as a broker are exempt. Payments subject to reporting under sections 6041 and 6041A are generally exempt from backup withholding only if made to payees described in items (I) through (7). except that a corporation that provides medical and health care services or bills and collects payments for such services is not exempt from baCkup withholding or information reportmg. Only payees described in items (2) through (6) are exempt from backup withholding for barter exchange transactions, patronage dividends, and payments by certain fishing boat operators. (1) A corporation, (2) An organizatio~ exempt frof!l tax under section 501(a), or an Individual retirement plan (IRA), or a custodial account under 403(b}(7}. (3) The United States or any agency or instrumentality thereof. Form W.9 (Rev. 12.81) llllIM .....""'"'-~~-,..~!C__ . , \ \ \ \ 1 . .: I . "~ .'. '. " , " ", . -----, '.. i ." :.1 ..........< , .. :: '.....:., . .. .' " , ".', '.:,,' c"'". "'. .' " I ,......'. ".' : " , " '. '.. .... '. ,. , . , ,,",', .' '.,: " , ., f.. ' I . ,'" ",' 'i .'. , ,.:.'. ", ' I .' I I.',. " ,'.' ":, . -' " I.>... i ,':: "'. /,1 .'" , ~',:';" ,'. ,,' . ',-",' " ::> .' ' .':.:,,::: ". , ".,:;" ':"::.' '....,: ":,".., ,., " ,... ., ,,.. : '" ." ,: '.: '.' ,....'.. ,',',.' .., :". ,'.'....',.", c, ' " .,'-:" ,"" , .. '." , I:' '" >'.' :: " .", , ' ..J ,." '.- . , .' '> " " ' ".; , , . 1','. " , ---1' .' " ,> ' ~.' .' i :.,' .,,:: ...... :.,< ' (:," .....: .- '. ...., . .:.' ... ::.' : .', '~"'.,.:," ',' .'.' '.: '.'" ''', - .... " ....", -,-:- "',, " .' """', '.' " '...., " II:::. " " .: ' '., '::,".. ' .".. ". . , .:.' : .'. " : I' f t., ~. L '~ r; t >' t, r t ,r ~, ,l f ~< t, l ; " ; :" I r \ !' '" .: ,": " Form W 9 (Rev. 12.81) (4) A stale, the District of Columbia. a poss~ss.on of I.he United States. or any polItical subdivision or instrumentality thereof. (5) A foreign governrncnt or a political subdivision, agency or instrumentality thereof. (6) An international organrzatlon or any agency or Instrumentality thereof. (7) A foreign centrill bank of issue. (8) A dealer In securities or commodities required to register in the U.S. or a possession 01 , the U.S. (9) A futures commISSion merchant registered with the Commodity Futures Tradmg CommiSSion. (10) A real estate investment trust. (11) An entity regIstered at all times dunng the tax year under the Investment Company Act of 1940. (12) A common trust fund operated by a bank under section 584(03). (13) A financIal institution. (14) ~ middleman known, in the Investment community ,as ~ nominee or listed in th~ most recent publIcation C?f the Amenca,n Society of Corporate Secretanes, Inc" Nomlllee List. (15) A trust exempt from tax under section 664 or described in section 4947. Payments of dIvidends and patronage dividend,S gener~lIy not subject to backup wlthholdmg also mclude the following: . Payments to nonresident aliens subject to withholding under section 1441. . Payments to partnerships not engaged in a trade or business in the U.S. and that have at least one nonresident partner. . Payments of patronage dividends not paid in money. . Payments made by certain foreign organizations. Payments of Interest gellerally not subject to backup withholding include the following: . Payments of interest on obligations issued by in~ividuals. Note: You may be subject to backup Wlt.hlloldmg" this interest is $600 or more a~d /s paid in the course of the payer's trade or busmess and you have not provided your correct TIN to the payer. . Payments of tax.exempt interest (including exempt. interest dividends under section 852). . Payments described In section 6049(b)(5) to nonresident aliens. . Payments on tax. free covenant bonds under section 1451. . Payments made by certain foreign organizations. . Mortgage interest paid by you. Payments that are not subject to information reporting are also not subject to backup withholding. For details, see sections 6041, 6041A(a), 6042. 6044, 6045, 6049, 60S0A, and 60S0N, and the regulations under such sectIons. Penalties Failure To Furnish TIN.-If you fall to furnish your correct TIN to a requester, you are subject to a penalty 01 $50 for each such failure unless your failure is due to reasonable cause and not to willful neglect. Failure To Include Certain Items on Your Tax Return.-If you fail to properly Include on your tax return certain items reported to IRS, such failure will be treated as being due to negligence, and you will be subject to a penalty 01 5% on any part of an underpayment. of ta~ attributab.le t.o that failure unless there IS clear and convmcmg evidence to the contrary. Civil Penalty for False Information With Respect to ~lthholdlng.-If you ,make a false statement With no rerlsonable baSIS that results m no imposition of backup Withholding, you are subject to a penalty of $500. ...:" L ( "") r') What Name and Number To Give the Requester POlE!." 2 Criminal Penalty tor Falsifying InlormatJon.-WllIfully falsifYIng certltJcatlons or affirmations may subject you ~o cnmmal penalties including flnes and/a/lmprlsonment. Specific Instructions Name.-lf you are an individual. generally provide the name shown on your SOCIal security card. However, il you have changed your last name, lor JIlstancc, due to marnage. Without Informing the Social Security AdrniOlslratton 01 the name change, you may enter your first, name and both the last name shown on your SOCIal security card and your new last name. Signing the Certlflcatlon.- (1) Interest, Dividend, and Barter Exchange Accounts Opened Before 1984 and Broker Accounts That Were Considered Active During J983.-YOu are not required to sign the certification; however, you may do so. You are required to provide your correct TIN. (2) Interest, DIvidend, Broker and Barter ElIchange Accounts Opened After 1983 and Broker Accounts That Were Considered Inactive ~urlng 1983.-You ~ust sign the certification or backup wilhholdmg will apply. If you are subject to backup WithhOlding and you are merely providing your correct TIN to the requester, you must cross out item (2) in the certrfication before Signing the form. {3) Real Estate Transactlons.-Yo,u must sign the certification. You may cross out Item (2) of the cerhflcation if you WIsh. (4) Other payments.-You are required to furmsh your correct TIN, but you are not reqUired to sign the certIfication unless you have been notified of an incorrect TIN. Other payments include payments made in the course of the requester's trade or business for rents, roya1ti~s, goods (other than bIlls for merchandise), medIcal and health care services, payments to a nonemployee for services (including attorney and accounting fees), and payments to certain fishing boat crew members. (5) Mortgage Interest Paid by You, Acquisition or Abandonment of Secured Property, or IRA Contrlbutlons.-You are required to furnish your correct TIN, but you are not required to sign the certification. (6) ElIempt Payees and Payments.-If you are exempt from backup withholding, you should complete this form to avoid possible errone~us backup withholding. Enter your correct TIN In Part I, write MEXEMPTM in the block in Part II, cross out item (2) 01 the certification, sign and date the form. If you are a nonresident alien or foreign entity not subject to backup wlthholdmg, give the requester a completed Form W.8. Certificate of Foreign Status. (7) TIN "Applied For."-Follow the mstructlons under How To Obtama TIN. earher, sign and date this form. Slgnature.-For a joint account, only the person whose TIN is shown in Part I should sign the form. Privacy Act Notlce.-Section 6109 requires you to furnish your correct tall payer iden~iflcation number (TIN) to persons who must flle information returns with IRS to report interest, dividends, and certam other income paid to you, mortgage interest you paid, the acquisition or abandonment of secured property, or contributions you made to an individual retirement arrange'!1ent (IRA). IRS uses the numbers for identificatIon purposes and to help verify the accuracy of your tax return. You must provide your TIN whether or not you are required to file a tax return. Payers must generally Withhold 20% of taxable Interest, dividend, and certain other payments to a pa,yee who does not furnish a TIN to a payer. CertalO penalties may also apply. For this type of account: 1. IndIvidual 2. Two or more individuals (joint account) 3. Custodian account of a mInor (Uniform Gift to Minors Act) 4. a. The usual revocable savings trust (grantor is also trustee) b. So.called trust account that is not a legal or valid trust under state law 5. Sole proprietorship For this type of account: I Give the name and . SOCIAL SECURITY number of: The indiVidual The actual owner of the account or, if combined funds, the first indiVidual on the account! The mmor2 The grantor.trustee1 The actual owner I The owner3 Give the name and EMPLOYER IDENTIFICATION number of: Legal entity (Do not furnish the iden. tification number of the personal representative or trustee unless the legal entity itself is not designated in the account title.)4 7. Corporate The corporation 8. Association, club, The organization religious, charitable, educational, or other tax.exempt organization 9. Partnership 10. A broker or registered nominee 11. Account with the The public entity Department of Agriculture in the name of a public entity (such as a state or local government, school district, or prison) that receives agricultural pro' gram payments I list first and circle the name of the person whose number you furnish. 2 Circle the minor's name and furnish the minor's social security number. J Show the name of the owner. .. list first and circle the name of the legal trust, estate, or pension trust. Note: If no name is circled when tllere is more than one name, the nllmher will be considered to be that of the first name listed. 6. A valid trust, estate, or pension trust The partnership The broker or nominee .' ,~'.'.'. . ::', ',," . " . , ~. '. ' " .'.,' :....,' '," , . . ,"".' .,' .' . .. 1::. ..... ............ ; I' ..... . '. ','. , " '.: '. :t I .':". ....... : .'. ,........ , ,: . , !,.", ,'. '. , ..' .', . .... '.'. : . '. .. . . , . ", 'J , " ," :.' 'i: . . . '.' d ,.... ; :,-' "',;' . '.,", :":" "0 ", . " ..,.': {. ." ....>::< . . ......... .:' .....': , ., ". ' .' .' ....., , .: .-,'." " " '" .... .... ... '.' i ,"': .. ,':, :. .'. , ", .'<':"., '...' , .... ".' , '.' 'i'.:' ",: " . .:,,' .' ,J<, >.. .--1" . ','. ,'., uU. S. GOVERNMENT PRINTING OFFICE: 1987_206.416 . ;:." .i , ", .' , '.' . .'. ..-> " , ", .." ': ,'. .' '" , .' ,".'''.' " ,":,-.::' ,,' . ' '., ',;, ',,'-' , " ".', .'..., :. .' . .,......., .:' '" ,':. .... '. : . ': ;, .' . ( . :'!, '.; . , :,,' .'.":' " . ". .'. ,,:: :'. . .'. "".': .... .' '; '. '. , ' ' ;("" ',: .'.,' "'" " " ", ::",.:L :,": .. .' I. .' ..:. " " L,' ". " "",,' ." : ",,:" ''': . .' I ...'.... .I. .' ---1 " :. , :. ": .......... I' , .' . \ .--- ~ Jy; Affidavit of \fi' PREVAILING WAGES PAID ~\ Public Works Contract ($2500 & OVER) Complete & mail entire set I ~.50 WITH AI'I'ROVAL FEE OF ~ TO: Departlllent of Labor & Indusuics ESAC Division 925 Plum Street He?10 Olymp;a~\V~:985CJ:1-44.0.I . ..(20.6)75~:4019...... ~."~.'\ ~ INSTRUCTIONS ON BACK Clly ......916,.Garden..H.il L.Road. ... .. Slaic 0"" "'zfp' 'C~nt;~~tiji'i)w "No. pavement Marking-1988-MT0766 ~ Bid due date Dale conlract awarded .'.6/27I88..". 7/8/88 ! Count)' where work performed Date work compleled LJeUerson.County,' 11/30/88 ; Prime conlraclOr "W~?;r;~~~~n't ~R~t~n"i"~~!fo~~l~~).ro~~'; ..".,...,,:.c,~j,'X' No .' N:'~URAPPROVED COPIES WILL 8E MAILED TOt:r~I~~~~~,~:,:.;/ ROCKEY'S ROAD S'l'RIPING CO. ....Jl. r: 7..::z' . ...........E lma ,....Wash.ington.,................. ..........,........ w .9.8.5 41....... . . Please allow a minimum of 10 to 15 working days for processing from ths date the Department received your document with the correct approval te8. coN'rRAciAWARDiNG..'harn.....~,.......,~.,...'"w....~''" ...m.""'......,."'~.."w.. 1~~:d~:t?~.~,::.JEFli:ERSON'^COUNT.Y. ..~.__De~ftftment..of..--EUbl.}&i..w~~kSw,....piion~numbC.rw' . .1 B20. .Jef.f.er.son.. street/.P ..0. ...BQx...12 20"Pt...,Townsend, Wa. 9836B.. ( 206) 385~9160 ... 1. CRAfT ; 2, RATE uF ; 3. RATE OF HRLY ; 4. APPRENTICES: Name, regisu-ation U, .."." "N".__......"~~..,,",,...,.,. ,.,"'~."'~"'..,~~."'''~..~''''''.. : HOURLY PAY .\"'~.~.~9.~E~~f.~I~..; .~~.~,~~..~.~.. P..~.~.~~.~.~.~.~~.~..~..~.~~~..~.~..~~:.~... 3.43 V .....w....""..."""".,.,,,,,."''' 3.4:1 ,,';;r 3.43 10.7B,/' . F..1 agger.m~..."__~w."",..",,,,_"m""~~'-""-"'''''''''''w ..""...__~"..w......".... ..!;}!l?,'?...r,~"-,. .,...,.....~.w"..~..,.. ...__J,?~..!l.6::::.... .. Flagger 10.7BV' .~.":,n"cJ,X...,<::E.";W.~PFc:l.~... .........l'al1>1y.<::f.aW.. f<?!,:c:1 Clinton Rogers . RJj'!gge,J:::,"'w.....,"'..""""",,,,, ...,.....lO.7.B~..3.4}~. .Gesi..laLQcl:1.. ....v6WNER:cOPERATOR..... ..(PAVEMENT. MARKING) .~6WNER"OEERATOR........... . (PAVEMENT.. MARKING). jC,QREMAN ..DRIVER... .... i"HE'ji'EBy"C"ERTiFY 'TH'AT'THE"'A'Elo'vE 'j'r.j"rOR'M'"A:TioN'"is'c'ORREC"i''' AND THAT ALL WORI-:ERS I EMPLOYED ON THIS PUBLIC WORKS Name and address of company completing this fonn: PROJECT WERE: PAID NO LESS THAN THE PREVAILING WAGE RATE:" ...........................-.'" ....". ~~p~ER~E~r~~~Ft~~~i l~%UI~}D~~iR~l{I'I~TI~bA~~fAmETHAT ; ~ompany name ".. Tr\'&,.;r:tECC"i)~~ :'~?F Yd~~tO';.E/~gg~t ~';!'ti'oi;'.t~~ 'i.,Ao,!;hJs 7 '1 M" L., RQ~KE:i..~,S,~',ROAD,:..S,TRI.Pl NG.... .COM PAN Y PROPER PAYMENT OF PREVAILING WAGES, ETC., ARE SUBJECT ddrcss ..-::Jl V::J. 0 r~~t~I~KA~o/ci'ls Dri'.J'~'i-~'e'oj,~r.i's WILL BE REQUIRED TO PAv..G;lJ:::deI1J:I.il.l....R.o;lIl......,..,.. /.2. ,>12 NOTARY; (comptete 4 copies and have each notarized) City Slate Zip ;!~iiJscRir;.ED..A.Nii.swo~N..;:o..uEj;oR.E..ME. , ?1[1.~.,...,.w.??.J:l..~.D:.9t.9.I1..: "......" .......,"~. ~..?.4J:". ;THlS DA1'!': December 13, 1988 :Pimnc number ~Re&islration num~r : II: 0;- ^ fI.'l'p'll ii"L: ici' 'IN" ^ r:iii' FCIR 'i'i~'E'si"^'i E' :: m \. :or Washington \:"<;:'~:O~;;;%ZkF" ... : Blma, Wa. ~.M\;:.coh\t1Ui:S.hJi.t:x'~hrt:s"ON................. .,.,.....,.........................,',.... ........ . AW\l-'~tl)l.:;. ~1.'l$~ ..... ................ DEG JAJ~.~~ F70~7tJ ~ UtlliDWli' of wages 8-88 :: ...J By L" M^ILNMI~ ';d ~. . ~ INSTR,-,CTIONS TO' COMPLbfE THE AFFIDAVIT OF PREVAILING W-AGES PAID DISTRIBUTE ^I'I'ROVEI> COI'IES AS FOLLOWS: 1. Awnrding agency 2. L & I Employment Stds. 3. Prime comractor 4. Subcontractor 1. Enter each craft you employcd on Ihis projcct. If operating engincers and/or truck drivcrs were used, please describe the type and listthc size or rated capacity of the equipment. If the work was done by owncrs or partncrs plcase state so undcr # J. If the work was done by owners or panners #2, #3 and #4 need not be completed. Partners who own less than 30 percent of a partnership are considered to bc cmployees. 2. Enter the rate of hourly pay for each craft or c1assifcation. 3. Enter the rate of hourly fringe bencfits only if you are paying one or more of the following bcncfits: vacation, !,'TOUp medical insurancc (e.g., Blue Cross, County Medical, etc.), pcnsion and/or an apprentice training fund. If you arc not paying benefits into these funds, add the prcvailing fringe benefits to the rate of hourly pay and list the total under #1. a. Individual company pension plans must be approved by the IRS. b. Apprentice training progranls must be approved by the State Apprenticcship Council. 4. If apprentices have been employed on this project, provide this additional infonnation: name, registration number, stage of progression and dale hired. PLEASE NOTE: The amount listed under #3 plus the amount listed under #4 (if any) must equal or exceed the "prevailing rate of wage". OVERTIME To determine the prevailing wage for hours worked in excess of 8 hours per day, 40 hours per week, or on Saturday, Sunday & holidays, please call 753.4019. APPRENTICES Any worker not registered with the State Apprenticeship Council must be paid prevailing journeyman wages. Any apprentice not registered with the State Apprenticeship Cuuncil within 60 days of hiring must be paid prevailing journeyman wages for the time preceding the date of registration. To verify apprentices registration and status, call (206) 753.3511. RETAINAGE Contractors are re's'ponsible for Obtaining and filing affidavits of the sub,c~ntractors. This is required 'by law and ..rctainage can not lawfully be released until such affidavits arc filed. , This Affidavit is approved based on the information provided by ihe ,rc:o/ltractorlsllbConlractor."'t does not sig/lify approval of the clas,\'ijicatio/ls of labor used by the cOnlraclOrlsllbcolllractor, '" .", ,~, . . ,'JI) i/.... 'If',. " () WASHINGTON STATE DEPARTMENT OF TRANSPORTATION HEADQUARTERS n . FINAL CONTRACT VOUCHER CERTIFICATION OI~6Ol~1 CONTRACTOR ROCKEY'S RO~Q bTHIrER 916 Garden Hill Rd. ADDRESS CITY Elma DATE ~~_1.L, lqAG STATE Wn. Federal.Ald Projoct Numbor PAVEMENT MARKINGS 1988 DATE WORK COMPLETED: FINAL AMOUNT $ 60 '\17 G? l\Tn"""mh~V' "H'\. ]9a..e CONTRACTOR'S CERTIFICATION I, the undersigned, having first been duly sworn, certify that the attached bill is a proper charge for work performed and material furnished to the State of Washington; that the same or any part thereof has not been paid; and that I am authorized to sign tor the claimant; that in connection with the work performed and to the best of my knowledge no loan, gratuity or gift of money in any form whatsoever has been extended to any employee of the Department of Transportation nor have I rented or purchased any equipment or materials from any employee of the Department of Transportation; I further certify that the attach- ed final est/mate is a true and correct statement showing all the monies due me from the State of Washington under this con- tract; that I have carefully examined saId final estimate and understand the same and that I hereby release the State of Washington from any and all claims of whatsoever nature which I may have, arising out of the performance of said contract, which are not set forth in said estimate. x 19d!:z- x ~tt/$ M".&~ j.~~ f-/S'-9/ DEPARTMENT OF TRANSPORTATION CERTIFICATION he final esllmate 10 be based ea ure ents. and to be true and APPROVED I - z.., - g>1 O:TE~.(;~}J DISTRICT ADMINISTRATOR 8yx~0~ vL- HEADQUARTERS USE ONLY Date of Acceptance I - 2--7 -.87 INSTRUCTIONS This Final Contract Voucher Certification is to be prepared by the Engineer and the original and first copy forwarded to Head. quarters for acceptance and payment. The Affidavit of Wages Paid must be prepared by the prime contractor, all subcontractors and all subcontractor's agents and forwarded with the Final Contract Voucher Certification, Contractors Claims, If any, must be included and the Contractors Certification must be labeled Indicating a claim attached. DOT FOAM 134.'.6 REVISED 5.79 (") 1""'0 I, ,) JO~11'1l A. DEAf{ {)irl'((or STATE OF WASHINGTON DEPARTMENT OF LABOR AND INDUSTRIES January 12, 1989 RECE~VED Jefferson County Courthouse P.O. 80x 1220 Port Townsend, WA 98368 JAN 19 1989 JEFFERSON COUNTY PUBLIC WORKS DEPT ACCOUNT ID: 407,664-00-2 Rockey's Road Striping Company Contract No.: MT0766 Gentlemen: Please be advised that the Department of Labor and Industries does hereby release Jefferson County Courthouse from any further liability pursuant to RCW 51.12.050 and RCW 51.12.070 as would otherwise incur in connection with a contract calling for pavement marking, county wide, 1988 in Jefferson County. This certificate does not release Rockey's Road Striping Company from liability for additional contributions which later may be determined to be due with respect to the above mentioned contract or any other contracts said contractor may have performed. Very truly yours, ~CL~.~t~o Kaye i<Q)>rl:~~ - ~ Administrative Assistant Contractor Compliance Unit Phone: (206) 753-4398 CCU1:P14.jk31.1 cc to Rockey's Road Striping Company 916 Garden Hill Rd. Elma, WA 98541 ~ rj CONTRACTOR"S DECLARATION OF OPTION FOR MANAGEI1ENT OF STATUTORY RETAINED PERCENTAGE I hereby elect to have the retained percentage of this contract held in a fund by the Owner until (30) days following final acceptance of the Hork. DatD__~~~-~-~~~-----------_-Signed-L~~~~-~~----- I hereby elect to have the Owner deposit the retaine~ercentagD of this contract in an interest bearing account, not subject to withdrawal until after final acceptance of the work. Date______________________________Signed__________________------ c. I hereby elect to have the Owner invest the retained percentage of this contract ~rcm timB to tim. as such retained percentag. accrues. I hereby designate_______________________________________________________ as the repository fo~ the escrow of said funds. I hereby further agree to be fully responsible for payment of all costs or fees incurred as a result of placing said retained percentage in escrOH and investing it as authorized by statute. The Owner shall not be liable in any way for any costs or fees in connection therewith. Date______________________________Signed_______________------------------ '. 15 \ %~~f( .~1t;ri ry/5\r'~' w VlT;L-. ~ );../ DtI5 N~ 088 1 JEFFERSON COUNTY OEPARTMENT OF PUBLIC WORKS 1820 JeHerson Street P.O. Box 1220 PorI Townsend. WA 98366 (206) 385.9160 District No. 5 PERMIT In accordance wilh all applicable Revised Codes of Washington and amendments thereto, amI subject to alllhc terms, condi- tions and provisions written or printed below or on any part of this form PERMISSION IS HEREBY GRANTED TO puqet Sound power and Light 310 Four Corners Rd., port Townsend, WA 98368 to Install underground cable from mile post 1.46 to mile post 1.54 on the North side of Paradise Bay Rd. ,Job # 88-06906 County Road No. 5.03609 Franchise No. Milepost 1.46 to 1.54 No work shall be done under this permit until the pany or parties to whom it is granted shall have communicated with and received instructions from This permit shall be void ualess the work herein contemplated shall have been completed before Sent. 28 Dated at September 28 ,19 88 ,19 89 &~~~@wm By A..-ur'?:;f- I<~ 1.800.424.5555 GENEltAL 1'1l0VISIONS Al'I'L1CAIILE TO ALL I'EHMITS This permit is subjcct to all applicable provi!'.iol11> of the Rcvi~cd Codes of Wa~hinglOn. CX{;Cpllhat any pru"hioll in Ihi!o agreemcnt not con~i!otcnt with such resolution shall be contrulling. A bond in the amount of $ is required for the protection of thi.: county U1> sct forth ill the terlUS of the bond. During the progress of the work such barriers shall be erected and nmintalm:d as Illay be Ilcl.:cssar)' or as lIla~' be directed for the prolt:clion of tlie traveling public; the barrierli shall be properly lighted at night. In accepting this permit till: petitioner. his Succc!>.'iors and assigns, agrees It) protect Jefferson Coullty and !>avc it harmlc!os horn all claim!), actions and damages of every k.ind and descriptioll which lIIay accrue 10 or be sufft:re.:d by any person or persons. corporation or properlY b>' reason of the pc:rfor' manee of any such worl-;, character of lIlateriab used or lIlallnl.:r of imaallation, muintenum;e and orcration or by the improper occupallc>' of right uf way or public place or public struclUre, and in case.: any suit or actioll i!l brought against said Jefferson County for damages arising out of or by rcason of any of the above callses, thl.: petitioner, his succes!lors or assigns. will upon notice to him or thcm of cOllllllCnCcnlCllt of such action, ddclId the samc at his or their own sole cost and expense and will satisf>' any judgment arter the !laid suit or action shall have finally been dctermined if ad\'er!le to the Jd. ferson County. Except as herein authorized. no excavation shall hI.: made or obstacle placcJ within the limits of a county road in such a rnanm:r as to interfere with the travel over said road. Except as hcrein authorizcd. no excavation shall be made or obstacle placed within four (4) feet uf the cdgc uf tile paVCIllI.:Ill. If the work done under this permit interferes in any way with the drainage of the county road, the gnllltcc shall wholly and at his own expense mal\e such provision as the engineer lIIay direct tn take care of saiJ drainage. On completion of said work herein contemplated all rubbish and debris shall be immediately removed auJ the roadway and roadsiJe !lhalI be left ncat and presentable and satisfactory to the engineer. All of the work herein contemplated shall be dOlle under the supervision and to the satisfaction of the Coullty Engincer and the entire expense or !laid supervision shall be borne by the party or parties to whom this permit is issued. The Departmcnt of Public Works hereby reserves thc right to order the change of location or the rcmoval of any structure or structures authorilcd by this permit at any time, said change or removal to be made at the sok expense of the party or parties to whom this permit is issued, or their successors and assigns. All such changes, reconstruction or rclocation by the grantees shall be done in such manner as will calise the least interference with any of the Coun. ty work and the Coullty nf Jefferson shall in no wise be held liable for any damage to the grantee by reason of any such work by the Count)' or Jeffer. son, it agents or representatives, or by the exercise of any rights by the County upon roads, streets, public places or structures in question. This permit or privilege shall not be deemed or held to be an exclusive one and shall not prohibit the County from granting other permits or franchise rights of like or other nature to other public or priv:lte utilities, nor shall it prevent the County from using any of its roads. streets, or public places, or af. feet its right to full supervision and control over all or any part of them, none of which is hereby surrendered. The Department of Public Works may revoke, amend or cancel this permit or any of the provi~ions thereor lit any lime by giving written notice to the permittce. The permittce shall imlllcdiately remove all facilities frolll the right of way. Any facHities remaining upon thc right orway 30 days aftcr writ. ten noticc of cancellation shall be rcmovcd by the County at the expeme of the permittec. The party or parties to whom this permit is is!>ucd shall maintain lit his or their sole expcnse the strllC\LIre or object for which this permit is granted in a condition satisfactory to the Department of Public Works, SPECIAL PROVISIONS: 1. Cable shall be a minimum of 30" below existin<T shoulder <Trade. ~. ~T~dlt\7~:;'; ",: :.'Ul\,!ti,j,., ...~"".-* l." ........s.t In accepting this permit the grantee, his successors and assigns, agree that any dumage or injury Jone to the property of thc grantee or any expense incurred by him through the operation of a contractor, working for tile County or any County employee shall be at thc sole expense of the grantce, his successors and assigns. , the undersigned, herehy accepts this pernlit subject to the term!> and conditions as herein set fonh. .19'08 Dilled this ~ o~ To 13/Z;T'- day of ~~. 1UU"!o HEtcycled Paper JEFFERSON COUNTY DEPARTMENT OF PUBLIC WORKS RcuiPl Suo Fee Paid_ Yes _ No 1820 Jel/erson Street P.O. Box 1220 PorI Townsend, WA 98368 (206) 385,9160 Address Request _ YI:!> _ No Mile PoM Al'PLlCATJON FOIl PEltMIT To Department of Public Works, Jefferson County, Washington, The undersigned 7u '= I~ T =::-0 Ll r0b -pc; IN f::.TL. """ Ll (--.1-1."- t' _0 . hereby oppl_ for permission 10 --rl2-EN<::'-l-i ""-\.-D N <= -,\-.1 ~ No~ I i-l- ""=1 r:>~ 'rlf'flliCUII/ ,,'ill J""uilit' fllll.~' ...hllt I,,' O\'j,VlI:'.\ If! do j <:.:) F -p P iZ-b'D I"""r.: L- p. ~~ 1<--;;;>. ~Ai' l2-D ~x-rlE.N'D IN c::;, ""-5\ ~'I N <= c@.. p... [>12-0 )( , 4<:>0 ' '-~""'L W f'"-"'=T SKETCH: ~E:- fZ- p... -rr A=-l-l r;;;:.P !Aloj2.K:.. ~~I2O-I~1--1 RECEIVE'""": SEP 2 1 19(": JEFFERSON c .'IT'l ENGINESi". ""J. t>i-~ On CoulllY Road: -P"'I':-4>:Cw<;;.E<:- '"\?A"-f 12:1:7 >$ L0PLoN ~A'-f g.,D- \..... p.,\L.E, \2-D bel ween -r-iSAL- /Stult'flI'OTI.'I/rrmHIrt'f'/(Jfmll"".JIIIII and agree_ 10 do the work ill accordance with your rules and regulations and subject to your inspection and approval. Dale 9- 8 J9~ 4~ ~.~::~ (If applicant is n copartnership, set forth names of copartners) .-.r::,16 4 <"'..apl-J~A74 ''jL1':? AlIlIrr\S "T'oe...,- -row"'~a.,.JD L^J/>.-, 9'ii7(,,~ Phone No. '?'5I'?- 4~?2.. IConlrIlC\Of) AlIdreMl r<fZ-Y, ,_L'l IJ~i _~A.LJ.LT ~~ T~ r<RX (j]~f'8~> -. __H)) ~v~..,. ((';:"'0 '..7'/ ~- -- --'--.-., /1 CL&~~::~~ ;1 t..1J. '1"4 ~-j "-....~~1 I <T~ .i~ ~l Y~li:-I"?_. (U~, i~> ----/; Q1'f"?_<>..1j (( ~---l-'~/;;d..L;,r...L Q!",~~ - ~ - L~:.I,o., rl 'Fu ", E:..€t 4<:::>, 'f'iZ-1!-1 ,6:..12..-( -~-----""- .":"?~H.f:!:l 4~:;~Jf$~~ ~ ~~~-Ef'5Z~ . ' \,",,:,. , ,', ,...< ". /, II'~" ' " "" ,."",", ; "c, . ',.' ',:. ' , i:~ '" ~.l ~; ;".',",., .' " " .", .. ' ','.. ~' , I ,; '.. ".,'. " " ":,,," " . :, ,',' .' " ., ,. .:,' , ,:' , . '; /: , .- ,:' ,', .: I: . I: ,,", : 1\ ,.,- , : ," ' ,;" " ::,', I .',: ' " '. '" ,;;,: .' :":/ ',.: , " " "'.',.- , " " ' , : ,", ':'" ,:",' " ,.", . ' , ",'.," .- , ' , . L IL I - ",' \ '(,J l"-t~g.Gi (I Hi',;;:" r!~' \ ...:- __ .. . 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V7 I/"""",",?;ao '5h I i -;9'0 C,16 V 7 V 8 V:'.:::.N I'::~" I "=>1<:\, I 14-'''; r::.... <t .:., VB V'7 1/.:;""+-1 2.10' I '>!.::y I 1'300 c,<t Ve::;: VIe. v';"""',J Sc,",,,' 1"';,l<v I J "5'0 / .;:;...:;? '.. " V 10 Tz.. 1/c,,,,.N (,,00' I"'>KV II ""-5,,':);:' <::...-;1. -....-'..-.. ,'" ...., . L ~ . ~ ~ ---'i ': . . .. -- , .,' . ,..,;.... I:' " . '. . " '. , ' . ..' . . .i, ..,. , " . I, "", ":. i '.. ,: t ", '. k' f;;'"~;;t:?~f ;.- ,;:.' .... ,.. I --". . 'i',. ',.' , I .:' " : , , .'. :. " I . .... ,.' ".'. '" I;' .' : ... :.., ",. "'.,;,, ':, ,. ': : -- "'.', i I :' . ; '. ; , L L I i' CALL ONE NUMBER FOR UNDERGROUND LOCATION ASSISTANCE. PHONE:- THIS SKETCH IS NOT TO BE RELIED UPON FOR EXACT LOCATION OF poWER FACILITIES " puon POWER CALE ..blOl--\ {:'" ~ = WORK SKETCH JOINT FACILITIES ARRANGEMENTS - OTHER UTILITIES WORKOROER NO. 6B-oc?'7::b . SHEET OF .::.ib.- OF..::!:--- LABOR CHARGES ACTIVITY ~s n.es' .' : : CONSTRUCTION REMOVAL . OVERHEAD TRANSFORMERS REMOVE/INST AU. U.G. TRANSfORMERS REMOVEIINSTALL REARRANGE & TRANSFER OIST:CONOUGTOR .. ! . FC NO.~~ "X:;( -? JFC 1'10.- OTHER UTILlTY~"'-l-;;- -r::f. . OTHER UTILITY - 'ilGINEER _ - ENGINEER- \ 6\ON :.'" j_ \ COON", _ ..I-\U,~"NO. -\CIRCUIT"\,,.NO. -\~IRCUIT"O. . REsP.AR.... ~""-"" '-' .."""..,.,1 I "..e. ...';7 I"" H 4'5 Ipn.-, 1(." kU ~..y' VI~ VI L-J'="'- (P,,"?e- J:).Pl'-' ;b "xf'FT.'"es ~. --- . '.' '. _ I -p p..,l<- p.. "'P \ "-.;> fS.. '-5p.., "'1 "\2i:? . " "h. \"EtRtDBY '\D~W"BY , _ 'ICHECKEDBY . -::-_. i\QVol r.::J2.. \ '-::::\ oW CE- \ .<. \ ", .... ""'~ \ .... '. ~:' :'.' ' :' , '.-' ".,:", II:,:/. ':.' .',<. I; ..... .', ,:- ",. ,.,'.. ,.", ',' . '.'" ; ",..' ......' i . ", \AI~~ ~ - \-0JI.1[ COMPo 1DATECOMP, fOREM"N'S SIGNATuRE fOREMAN'S5tGNATURE. - . . L coeE ACOO1---' 10807 $8304 S8405 59335 -;- CAtE 1:;'_:~.e'B l'OlECARD ......PPE.D . . :'S~]V;' ~..' .' '. j,\. , '.. ....~: i . . \ I, I L . ,'.:' " . ..",. . .""::..' . '.:, ". .... ....:' ":' .' . .......< . ....'..:, " "'.::" . , .' ': .:,' ." '" ',: . :.': .' .:' :" '. : " ON' to] 01 l ; CHECK ,,>-<-:', ~~:'"'T ....., ;.. :. ... ~ . ...,.,..~t.J'MJi:l~::-:.:,:~):~'}~~~:~:;;:'J' ", '.'. ',,' '. ,:.,' " . . ,", , .... ...".....' '.' " :'., '" ", , , ,..: . ..... .'. ,':: '. .'" ., ".' ',',' . . ':..' . .'. ,'., '.' ,: ..... ..... .' ':,'., ......' ::'. '. . . ,".. . .': ..' .' '. .... ...: .-.J ., ...... .'" ~ ..J I~EJ)0rn- NUMDEF(: EST2:50."01 Tt.,D COST ESTH1ATE SYSTEi1 ~J/O NUI.mEI':: B80690600 DyrE 09/0B/Bfl TIl1E 07: 40 t1ATEIUAL ISSUE: (T-(,l) PAGE: ~ OF'4 ------------.-----------------.------------------------------.----------------------- INVT. I LDC. I SHICI(HM. I DOC. NO. I SIC I ACT. I MC. I r~A I ~J/O NO. J ENTEHED BY I DATE: STOI~E I SATST I I I S I I I N,J I 13806'/0600 I I / / --------------------------------------------------------------------------------- DUANTITY I~EQUIF~E!) DUANTITY MATL.I!) ISSUED GHP. ITEM ASSY MATEHIAL DESCHIPTION DISTHIDUTION- POLES, TOWEHS 1 1 ::! AND FIXTURESIACT. IMC. IRA.NJIW/O 880690600 B9 74500 POLE 45 FOOT 137 211300 02 ARM 81" 9FT DEADEND HD 87 21100 01 ARM EPOXIROD SIDEMNT12.5 413 29500 27 BRACKET CUTOUT MOUNTING :~ -------------------------____________.___M______________.__.."_ DISTHIDUTION- OH CONDUCTORS AND DEVICES IACT. IMC. IRA.NJIW/O 13130690600 2 413 25200 ARRESTOR S/DIST MID 27KV 93 50300 53 INS 13KV 1 PORC PIN TYPE PTP <~ 'I:.> ~)();'100 51 INS 1 :'lI<V 1 Por~c PIN TYPE 92 57200 66 CLEVIS 4-1/8"RIGI!) INSUL 89 69401 130 ASSY GR!) PLATE 288SU' 90 22300 81 RO!) CHOUN!) 3/4'X8' SINGLE 2 48 99000 CIJTOLIT 100A t./B 7A81<V 2 21 53100 CLAMP TAP OFF 1B FITS '8-1/0 2 22 59100 STIRRUP 2/0 COMP YCB26H 6 ~!1 61700 CONNECTCm YC4C4 2 21 62000 CONNECTOR YC2C4 4 B4 42000 ~JII~E 4r,WG CU FLEX INSUL --.--------------------------------------------..--------------------------------- DISTRIDUTION- UG CONDUIT, 4(1 HI 6130 ~,OO :;.~ BURIED SYSTEMSIACT. IMC. IRA.NJIW/O 1300690600 76 24500 BELLEN!) 2IN ABS PLASTIC 76 24600 BELLEND 3 ABS PLASTIC 76 34B00 CONDUIT 2 IN PLASTIC 76 34900 CONDUIT 3 IN PLASTIC 25 13000 BEND 2' 90 DEGREE STEEL 25 33200 BUSHING 2" THREADED GRND 76 63900 HH PRECAST 4'B"X4'B"X3'6 76 62000 HH 36"X42" W 21"X24' MINIPAD 76 56400 COVER HH 4'B"SD 3X3STLPL 25 03000 77 CONDUIT 2 GALV 38 45000 SIGN BURIED CADLE 10"X13 76 68300 MARKER CADLE PLASTIC ~! 1 'I 1 ~! 10 1,0 DISTRIBUTION- UG CONDUCTORS AND DEVICES IACT. .-..------------.--------------.-----.---------------- IMC. IHA.NJIW/O BB0690600 DIV: 6 I COUNTY: ,JEFF. I U""MAP~:'251 EC.~ GI<T ~IAP'::'O, 1-l45 I CI<T'::' f'TL I ~ IRA: N,J I -..--..-.---.-.--,.....,...,....... .,. ........... .........,... ................. ....'-........----.-..----.--.-1 TITI...E: IlAY VIE~J VILLAGE (PH,;SE...I) -"PI~I UC EX I EASI::MENTp-r. Co. ~':5 I POLE CAI~D I ----------- ------------1 UJCATH1N PAI'~A1HSE BAY I~D. I PEr~M~FF~At1 1 MAPPI::D I ---------------------------------------------------------------------------1 :~:_~::~~~:.~':~::~...J..~:~~:~~:::~:.~:~~~.......:.~~~;~~:;~~._ .._.._J.~;;~~.._.~::I.~::::I,:r:~..,::'~_.:.:I~-:~.. i I::'ILLE!) BY 1 ::~ECEIVED BY I STOFEf f'PPf~OVAI... I DATE COt1P. I FOf~E~IAN SIG I DOC NO. I . I I ~, I / II I 1 ------------------------------- --------------------------------------1 I ESTH1ATI:: NO. ,JMC 0El06906 IDATI:: cm1p.IFtmEt'IAN SICI I THIS REPORT WAS PRODUCED n~OM CONTHOLLED pROC I I I I DISp'R STR'RM FDR'MN LIN'RM GEN.F'MN COORD. SYS.OpR ENGR R/W ASST.SUp ADV.C-STR ----------.--------.-.-------.--.-.----- L ,; !~, 'f D." r t i i r r~. 4.: ~:~ I. 1''-:' ..'. .: ; I" .................. ,. . . .,........ '.' .........;:J;"iG~!;f;~9~.ILJ:l1lJEr~ : ,.I,S'I~~!;;~..O 1 T &Ii. CO,.'i:T .. ESTlt1ATE SYSTH1 ~J/O NUI1lJEI~: 8306'10600 ~~i:tfi~::~~~~8I.Be r lf11~ 07: 40 I1ATEIUAL. ISSUE (T"-61) PAGE: 4t- ClF4 ..', "". I LOC. 1 STOCI<Rl1. I DOC. NU. I SIC I ACT. I11C. I RA I ~J/O NU. Il:lnEI~ED lJY I DATE "".:.' STn,n I s,nST 1 I I 'i: I I I N.J IlJ306'106~)O I I I I (~UANTITY r~Er~UII~ED QUANTITY MATL.ID ISSUED GRp. ITEI1 ASSY MATERIAL DESCRIPTION ,:.:il9.00, D6 ;51500 CADI.. 4/(, 1 'tST 3[; MH'IV UG ~,'f.,OO D~'; 'n,IOO CADI.. 1/0 CN ..IACi<ET 1 ~';I<V ~!2 78 06100 ELBClW ::!OOI', 110 AL 1 ~';I<V 1 76 30600 CAP INSUL WI 3FT GRND WIR 1 76 25900 BOX TERM 4 BUSHING 15KV 1 ~'> 48 40200 CONN BLOCI< 6....;!~'>O 6 HOLE 1~! 40 40700 CONN I<LOCI<'::',)-;5~'>~) D 1I0LE 1 ~5 4D 420(,0 ADAPTOF< STUD ~5/B TF<ANSF 1~! 4D 421 00 ADAPTOI~ STUD 1" TRANSF 1 ~) D'J 6't40 1 PLATE GND 2lJ3Sb" X. 06" TII ~! 1 ~'; ~';~5~)(") SCI~E.J 1/2X 1 EVEI:WLll'~ 2 76 6't6~)O NUT 1/2" SplUNG SHORT 2 7D ~5~!~;OO TEI~I'1 CBI... liS 110 CN 1 ~';I< V ------------------ ---------------<STORES CODE-C ITEMS)----------------------- DISTRIBUTION- TRANSFORMERS IACT. IMC. IRA.NJIW/O lJ80690600 1 6':> 470~;0 XI" 1 PM ;5'1 7-,240/1 ~!O a 62 47100 XI" 1 PM 5() 7-';:!4()/120 EQUIPMENT - EXPENSED IACT. IMC. IRA.NJIW/O ea0690600 I I 1 Ii ! : II t: II'! ! /',J I !L. !)IV: 6 I COUNTY: JEFF. I U'-11AI::":J:'Z'j{IIS~ cln 11,~P~'C>, loJ 4'3 I Cln':~ p-rL. I (. IRA: IU I -------------------------------------------------------------------------------1 TITLE,: BAY VIE.J VILI..AGE(pIIASE....I),..PI:n UG EX JI"ASEI'IENTP!.G.&'5lpOLE: CAI~j) I I LOCATION PARADISE [<,;y I:~D. IpEI~~I/,Fr~At-I I t1AF'I"ED I -------------------------------------------------------------------------------1 ~~:~ I:~ ~:: ::::~ r:: ~:"..,:..~:: .::1: ~: ~~, ~-.I:-. ~ ~:". ." ,:,~~;~~~~,~_.._....._ J_~~ ~~ ~~__,:..(~I: :~~ I::: ~:_,~: ~_l: I~...:~ _ i ~~~~ I~:~~:_:~ __ "__ __ .:, :~I:~:~I~..: ~ ~:l:'.._ ~:' ~..,,__ ,:..~:.l_:~ :~I~ ~:,:~: ::,_ ,_.. J.,~::,: ~ __~:::~ ::::, ,:'.1:: ~I:~:~::::I ",:~ ,I::~ i [) 0 C N II . ! ESTIt-IATE NIL ,.IMG (W(~6'106 I DATE CllMP. I FOF~ENAN SIG I 1 TillS REPORT WAS PRODUCED FROM CONTROLLED pROC I 1 I I DISP'R STR'RM FOR'MN LIN'RM GEN.F'MN COORD. SYS.OPR ENGR R/W ASST.SUP ADV.C-STR .., ._._ .~_..__,_,..__.__._.._,,' _.,_,.._...._....__._._.__._. n.", -.- -- ----- .~"".~~~~~.:.~;r:;';~:.~;.;;~:wrAtiZ':;;;~~;;::~:~ .,' . .....-'..,'.. .'.>:. '.' ':' --." :'. ..>.' :.:' ., /, , ,.' .'. . ..... ......... '.' .. .... '. '. . ." ". ..'; . '.':,' ..' ..' . . '.. . ...,' . ". ' ..., :..... .......... .', <' .... '.. ....<" '.' : ;,';. .. . '.' ,c. . .:' "",:;, " " " ,'. .', ': .;'.:' ............ '. . ...... . '.' '., " . .,. ..; '" '. .." ," .' . : . c ";, .'.,." .'. .:: .. ,. "'.'. .: '. .: c. ',' ' "'" .', .' " '. " ,'. .'., >'., .... .:. " '",'. , " " "'. . '.,' ".':. :';'. ."";<" '. ............. "'.,"'... "', : ~ .:..- ......, '\.". . .... .........'/. .' ~ .:i > .... .........,.. "i.,:'...:. .. ','. '. , . .:.," ,~ : ... .. '. :'. '" . ,..... :.': ,,:,'. ...., "'. .... .::: ,'. . . '. '.'. :'.,: III . " . ~ I ',- ': :" . . ...'" .~ .'. . " ..' ...,'.. .... I '. < '.. ~, , ....' :"': '. .' .:. ..'." "",'., .:'. ..... . '.. '.. '"., . ,\ " ' ,'. ' ",,: :"', , '. "', , , .,: .' ,-','l,.' .. :, ',,', .:--- , , . : ','" " "'.,' '.'., ":"'-- . ".',1 ,". ; . ..' , " ,......... '. ; i , . . , , . L L JOINT FACILITY CONSTRUCTION RECORD ~ JOB TITLE/LOCATION Y~,-,' W 0 NO. sa, ,.x.").::> ,. co CO NAME W 0 \/lv~J \JIL LJ........"ri-_(P".+-t;::....~~.i:.-.-:-c.} RA .. !.J BC..::L::::L- ENGINEER..J NO QUANTITIES .,:",~c::;).....J'S::_fZ- PRINCIPAL COMPANY: B"'PUGET o PNB 0 CUSTOMER OUTSIOE DEYELOPMENT :c ~ J: 5 I U I G ~ ~ l:;j ~ l:;j ~ ":- 8 ~ ~ ~ ~ ~ 'I '. " , ! : ,.",.,\. ....'. ! ': ' ," I; ..... ". .' I ..... ",'.. . .', I I" ",'. .', 1 '....,... '." I .', ' , ' " , . ',',:,' 1\ '. '. '. ' . .,' . ',.... ...,'. . .... '. .'.", ,.," 1. . . JFCNO. p$'1,/x.f',,-,~ ........ ,'. "', .f~~ :::~:E~:'L1TY C-J~",-c 1.\ , .' ", '., ..','. . .', "".'" .' 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PHONE: I -~Cl THIS SKETCH IS NOT TO BE RELIED UPON FOR EXACT LOCATION OF POWER FACH.lTlES ,,;,~,"'4-S'?S~ .790701'-113 WORK SKETCH DATE 9.5-:::',:;:'>' JOINT FA.CIlITlES "P.l'P,',.QEMENTS - OTHER UTlL L"BOFl REPORTING DA.TA PLANT '.CIRCLE ONE) JFCNO >.I/J>... POl.ES. GUYS" FIXTURES CONDUCTORS. GROUNDS'" ROOS U G CON[)UtT U G. CONDUCTORS. GROUNDS & RODS SERVldtS TnANSM lRANSM ENGINEER DIVISION J LCOUNTY .11 STQHES REF NO l,.,J C'.5'-o>i-rfJ2-1- .J ,:;:.Fr;r=:fZ;';>>'lf TIllE l?:,A-r-' VIEW VILLl:..<.c:~E- "F-\,I;:::...c;,I:::" ~ l.OCA lION ..r'.....f.:....:r.:L t.:'-T"> , ,":...;..E-:' ENO!N~E.HEU!!..~ ~ !APPROV":O BY '~-:'l<'_"l\.^J ~=-,p?- /::::""l,fe:"., -",,;;,g-( l2.T:::> I CHECKED flY I FOREMAN'S SIGN"-TURE L .... 0UI't JOB NO, 6R_r')/_ ')(,,( RESP. AREA {..L..1 SHEET I OF' 4 TYPE OF WORK OPERATION MAINTENANCE ~")~""o? CQNSfRUC.lIOf,1 A"--'.x:> I I O'?>O"" J:;d . . 1 109'CO'"'l t::;.., -),:> I p,.(....f.":I=t1 '05""""""" JOB NO. 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It h' ~ .' ~ ' ;.... ,;'\ i.......' :,,; HJ .. ,.' ~ r..~' I'; \; I \tl\ i 1 II' i,' .\\ I'" 'l;. , .'., ,,-,:,. 11, .;"\ \_. l~' I 1'0.' ~ B .~ ~ ~. ~E ~ I f\,' ~. t t>J m c.' it . III .....' _ .. ~~ f\ ~ lH f\ ~ (' \' ~ {I \,.: '\'".i ;::1 l , " i:j I Iy I:, ",,,.1,,,,, . ! t . II H \\ \:~ \- ~ i I' I }Ji!' < < ", ..., .' \.,\" I.' ~ to) 1\/ tel N ~,J 10.! 'i -l ,- ':. I..' '''. I: ~. ..I) J::. vJ N ' N ;;:: {) ,,' ()..'l ".] t> ,. (Ii ,1 \' .1 \ .;.. ,," --~- ~-- --------~ ~:-2~1:-~t-~-'~~~ ==. ...~~ .,5'\ ,,0 ;~' ';~' '-.1.\ 0 ...1, h (, [~ ,;.J . h' t". \ ..~:" J,' Y. .' U O,'~ \.,. t" 0 () ,) f" l'tJ. I' i'. -. ;--;::~:~-;... ~ I'I.;!~I~.; ~ I .... t' .,,". - .- ,- -., - ~". - """, .... \: ~. i-::- ~'\ ;, i~" ~~ * g ~ ~ "'"16 2~ 000 g ~ ~ ~~-~ ~_:~ ,.,"~~ 21="~~.~ ~ ~'~ ~:;;;, ;~'~ d +"',~ ~S "" 8 ~ ~ ~ "'z ~ ~ ~;J) ,., ~~. ~ ~ ~ rri ~ ;:[; ili. M :g ~ ~ ~~. iii ":t z ~ z ~C)'~ ~ ~ ~ ~ ~~ ?J ~ ~ (; ~, oC) ~. g ~;. "'! ~ ?c. :;:: ~j ~ ~. ~ i ....... ~ ~ - .. "'I C> 5 c: ~j Ii ~ ~ a! ~ , ~ ~ i. -J :t ~ !.": .. 6 '" ;:: ~ ft, !~ ~ ~ ~~ ~ !! M C) ~: ,:~.?" r- ~:: <!! ~. .~.~ C' E~~~>O~r "'I:: i.... ..~~ :;; eo I r$ . ;';1 , ~ i: ~i~ : ~ ~. .,,~,~ )J s. ~ i:," ~'..~ '] ... S";1 a ~ a i'~ .:.~ i~~ ~J..~ ~ E~ ; ,_ ;"ld', ;r ".0 '::~ ~ : i ~:; ig~ ~:'~ ~ ~~. ;; ....~ o 0 ':t ~~ i : ~ !.~ "'~: ~. !:5. .i: ;:' .:. ~ ;.- ~,. ...., .... 2;' ,~ ''* .. . . ,..,' ',,' l.i .' 'I I , I' \1 \ , I : t ~ t: , \ i \ , , , II ;~ i\ l \,1 , ~.; \j~ 1j H'l I' .\ ri ;r J ;~\,i.,...\ \~ I ..... ,I' \ t.... '-',.1' _" fCo'UNT'-' 8,PAD NO.~ "'JSTA~G NO. jM:U: POST /.SS-L'r- OFFICE USE ONLY CHECK ONE: o RESIDENTIAL JEFFERSON COUNTY DEPARTMENT OF PUBLIC WORKS Jefferson County Courthouse Port Townsend, WA 9836~ _No APPLICATION FOR ROAD APPROACH IiQ;] COMMERCIAL Application is he~by made for a permit to construct, operate and maintain a road approach. Please describe loaction (attach map or drawing) 100 feet East of the intersection of Teal Lake Road and Paradise Bay Road on the North side of Paradise Bay Road Applicant agrees to perform the work in strict compliance with the terms and conditions set out herein, and any special provisions attached hereto. Applicant Name Pope Resources Contractor Name SAME Address 60M Paradise Bay Rd Suite 4 Port Ludlow, WA 98365 Address Applicant Signature Date PHONE 437-2101 Contractor Signature Date R PHONE Note: Indemnity provisions of paragraph.. :~nd 3.on reverse side. Subject to the terms and conditions Applicant to construct, operate and special provisions attached hereto. PER M I T .~MlIDWf8ID on the reverse side, PERMISSION IS HEREB~ GRANTED to malntain a road approach as requested above, and any No work shall be done under this permit until the applicant or contrac~orhas notified , telephone BY: ...Ll~.;(~ Date 9-9-ef3 APPROVED PERMIT INSPECTION REPORT ,~rk covered by permit has ------- satisfactorily. been completed CALL 48 HOURS BEFORE YOU DIG 1-800-562-6478 _Work is not completed. . ______Recommend penmit be cancelled. ______Traffic control - adequate inadequate_______ REMARKS Form 113-0 (RevA 2-Jl2) , INSPECTED BY ",,0 c> DATE' "> -R,,,.,. r' 1 t' GENERAL PROVISIONS 1. THIS PERHIT IS SUBJECT TO RC1I 36,75,130, .1~O ANO .150 AHD AHENDHENTS THERETO. 2. ~r~ 1~~~r~iioA~s o=~ill~~;5 o~~v:~~ I ~~~D ~~E~~S~~ I ~~~~~C~H~~~F~~O:C~~~T~O~~ i~V~U::E~~~M~~5~~R~~R~~~. ~~Ri~~~AL~:T~~~~E~~Y C:~ER~~O~U?~ ~~E A~~~6~R';'f~~o~HrXG~~~~Tw~~~1 cg~~c:~: g~~~Rl~i~I~~Eg~R O~:E:y_ REASON OF "NY OF THE ABOVE CAUSEs. THE PETITIONER. ITS SUCCESSORS OR ASSIGNS WILL. UPOH HOTlCE Of COt?\EHCE "ENT OF SUCH ACTION. DEFEND THE SAHE AT ITS SOtE EXPENSE AND SATISFY M't JUD6EKEHT ARISIHG THEREfROI'I IF DETERMINED ADVERSE TO JEFfERSOH COUHTY. 3. IF THE GRAHTEE EHTERS IHTO A CONTRACT OR AGREEMEHT WITH It THIRD PARTY 10 P[RfOR" THE WORK AUTHORIZED ~~D~~~~ F~~R~~[n ~~Hr~~:D ~~R~~Fe~~ ~H~A~~U~~Y T~~ ~g~~~~~~1~7T~O~.JT:Rge7~~~~ ~~T~A~~~1~~12~G:~~~E~O Lt. ~Y T~~~A~~R~~T ~~ ~~Ni~~ ~~~{~~~;f~H~O:~Q~~:~~~~~= ~~~~:: ~D~Ay~R s~t~U:~8Ja:C~H~H~~R:E~I~H~O G~z:n~_ LATlOH AS HEREIN PROVIDED. 5. DURING THE CONSTRUCTION OF THE FACILITY, THE GRANTEE SHALL COMPLY WITH THE &f11Ll1 ON UNIFORM TRAFFIC CONTROL DEVICF!';; FOR STRFFTS AND HIGHWAYS PUBLISHED BY THE U.S. DEPARTMENT OF TRAHSPORTATJOH. 6. ON COMPLETION OF SAID HORK HEREIN CONTEMPLATED, ALL RUBBISH AND DEBRIS SHALL BE IHl1EDIATELY REli0VED AHD THE ROADWA't AND ROADSIDE SHALL BE LEFT NEAT AHD PRESENTABLE AND SATISFACTORY TO THE COUHTY. 7. THE COUNTY RESERVES THE RIGHT TO ORDER THE CHANGE OF LOCATION DR THE REf'll)VAL OF ANY STRUCTURE OR STRUCTURES AUTHORIZED BY THIS PERMIT AT AliY TlI'\E... SAID CHANGE OR REfo'DVAL TO BE KA!lE AT SOLE EXPENSE OF THE PARTY OA PARTIES TO WHOI1 THIS PERMIT IS ISSUED. OR THEIR SUCCESSORS AND ASSIGNS. 8. :~~ ~~~~T C~~~~~:ER~~~N~n~Cl~~N O~A T~~L~~C~~~s B~O~~E A~~~n~E~~~\~~H~~~Hi~L S~H H~ ~~~E:E A~E~Lt,~:~iE FDA ANY DAMAGE TO THE GRANTEE BY REASON OF ANY SUCH WORK BY JEFfERSON COUNTY, ITS AGENTS OR REPRESENTATI VES... OR BY THE EXERCISE OF ANY RIGHTS BY THE COUNTY UPON ROADS... STREETS... PUBLIC PLACES OR STRUCTURES IN QUESTION.. 9. THE GRANTEE SHALL NOTlFV THE COUNTY'S REPRESENTATIvE UPON COMPLETION OF THE WORK lIHDER THIS PER"'IT SO THAT A FINAL INSPECTION CAli BY f"I.ADE. 0 1, IRl 2, I:EI 3. ~ ~. 0 5. 0 6, 0 7, 1l8l8. SPECIAL PROVISIONS (i i!'\lfJ.i:;r:"<:;'![D~f~~U'CABLE PROVISIONS ARE DENOTED BY AM ex) A COPY OF THE-.PERi"'IT'SHAL.(-SE "ON.' THE JOB SITE, AND PROTE~TED FRO'" THE ELEI"\EHTS... AT ALL TI"'ES DURJNG THE CONSTRUCTION AUTHORIZED BY 'SAID~PERHIT WITHIN THE COUNTY S RIGHT-OFwWAY. THE APPROACH SHALL BE CONSTRUCTED IN ACCORDANCE WITH THE ATTACHED DESIGN PLATE TYPE H- n APPROACH.... 60 FT.LENGTH OF /"L INCH DIAMETER CULVERT PIPE SHALL BE PLACED IN DnCH AND LAID TO A TRUE LINE AND GRADE. THE APPROACH SHALL BE SURFACED TO THE LIMITS AS SHOWft ON ~~:E~~~G~~ ~~~F~~~D~A~~R T~~o~p~=~e~~E S~:~~E:~Y I~N~gC~~~~~~E R~~~w~~~w:~O: :t~ ~~T:~L p~:Hr~~~~AN. THE APPROACH SHALL BE SUFFICIENTLY SURFACED BACK AN ADEQUATE DISTANCE FROM THE EDGE OF THE PAYU1,ENT TO PREVENT AAY HUD TRACKING ONTO THE COUNTY ROAD. ANY HUD TRACKED ONTO THE COUNTY ROAD SHALL BE IJ<V1fDIATELY CLEANED UP BY THE GRANTEE DR HIS AGENT. IF NECESSARY TO INCREASE SIGHT DISTANCE, STUMPS AND BRUSH SHALL BE REMOVED FROI1 BOTH SIDES OF THE e~r~~A;~ALL T~T I:~I ~~=~7}~:~E O~U~~~~~Y O:o~~R~~~~~~~~wl~~BER OR D1SF IGURING OF ANY FEATURE OF SCENIC WORK SHALL BE RESTRICTED TO THE HOURS BETWEEN 9;001..11. AND ~:OOP."~ UNLESS OTHERWISE AUTHORIZED BY THE ENGINEER. A SURETy BOND IN THE AMOUNT OF S , WRITTEN BY A SURETY COt1PAHY AUTHORIZED TO 00 BUSINESS IN THE STATE OF WASHINGTON, SHALL BE FURNISHED TO INSURE COt1PLIANCE WITH ANY AND ALL OF THE TERMS AND CONDITIONS OF THIS PERMIT AND SHALL REMAIN IN FORCE UHIL ALL WORK ~DER THIS PERMIT HAS BEEN COriPLETED AND APPROVED BY THE COUNTY. BEFORE ~Y LOG HAULING OPERATIONS BEGIN, A SURETY BOND IN THE AMOUNT OF $. . SHALL BE FURNISHED BY THE GRANTEE TO PROTECT THE COUNTY AGAINST NlY DAMAGE TO THE COUNTY ROAD AND TO INSURE COMPLETE REMOVAL OF THE APPROACH AND CLEANING UP OF THE RIGHTwOF-WAY TO THE SATISFACTION OF THE COUNTY. APPROVAL OF ALL CLEAH UP WORK SHALL BE SECURED BEFORE THE BOND WILL BE RELEASED. SPECIAL CONSIDERATIONS "r~;- <." ~"D,,:Ar.H -5HI"1 LL ~(# C't:J"vs"R ",<:'rpj"~ f.p, Covutj'r-V !<tJ.r+h TN'7-pp<ec"J-';o"'/ 4.;..7-A,.J,....,~bS ~N,"') ..:;v A-cCCJJ<b,.<jlrJC€ 1.A...h~"""'I-I R,qy 1/;PtN rJ:L.l-.I'H1 f:! ?IA-Nc::... Form 113 b J" ,- -" ' ,-- r" .. '.0 ....__ :':h.~._~'::':~: .,' J. ., :',T~ ' i : !~.~;i;..~:;~>':'; , ~'",o""rt:'.I'II"g 411~-'.- ':' .::.~' ... ...- . : ; _ ~ ..1[,g. .f ~",'''r . ',,'- ~: :,:") :':: . ;.-t.. ," ..-. .-..-.-.- _n.. . ._~_.:..;. 4. ~.- ...- " -- '- . '! : :-:.: '. t.- .,.-, ...- .... ._0 , ~::: T':~~~~:~:~~':~~-":'~';::~ ;:-:,:.; :~~_.:~~..~~:~~;t:~~~\(~~~~~:~:;::E:: \~~.':': . J-u" . .. ..."t.., .. "0-' . . ' . . ---'~ID'....::t . '. __ -'-," . J .-.----- T~~~IE:l~:~~f}.~I:~:i~j :;'-':r:~~;f:~';~~~~~~~2 :-~.,.~-t::::J:r ~lft,"..Mn..t - __..- _~'~I"IZ CUMr' ... ...... ...,.:I::::l~....-.'---_.'--'- ........-...' - :t8.:~-~~~~l~~~:;:T;j~ ~: ;~L~,;', ~:;;~::;r 'SIGHr IlISTANCEIi:I=E . I ,.POSTED r. SPEED LIMIT. MINIIM4 DESIREA!LE .. . -~ .... F~: -. tr.; ... ' .~~... .- ~: '.\. ',.'.:'0". 1.' Cul~eri ahan aeet alnllwII apecificaUons '<<or HS-20 loaUng. Approvee! types lnclue!e: l) concrete 2) corrugatee! ~tal ,) c:orrugued polyethylene tuhi,ng-AASBTO f!.,i~)'" 2.) 'County road ahoule!er ahan be left lit ' existing profile. 25 160 FT. 200 FT. : '.,SO 200FT . 240 FT. a5 240 FT. 275 FT. 40 275 FT., ISO FT. 45 115 FT. 410 FT. SO ISO FT. 47S FT. APPaDVALS : J)1rector. Department R /J ~ of Public Works ./f/7 <<. <~ a9Jt~ Chairman, Boare! of '\ Colmt,. Commi..lonerB ' c.. - ./ Date ,.Aft.... Date 9~ -!3 ""onn'li3-:e'~.~.I .._~..- , " - _ ;-=--~...~.'.: .-4..'.J, ~..,_. __:'. . I , " ~:":," l,'", >y: , t, \: ~., ~ 't; , ,~': , r::. i::::' l;. ; I: t f. ..~ " t' ,::i, " '" " " . " .,'.' '.' , "', \, " ,'y" '" I v. , ,", . ',,' " , . " . ", ' . .:" '" .,,: , " ,:'; , ",',' ,. . ,,1 ." " '.," /:: ":. :: ':", ' ,', ,','.' ,.' ",,:'. " '. :' ","', .:....- , ,,': ,: " . " '. ;.: . , ; , \'! I,,'I/i I" " ", ,.',' "',,' , I' ," ~ ," L...:: l' ..,'.'.:' ~~. '".,'-"'---'---.--.--:-'. . i:.)Ji:':" .1~/60~\'~\ \\I~~~*-i~~i"yh ,Dl ~ ~ \\..\ L V _ ~~-~' ":~\ii~~.........1J' ':":'.','",'.'", ~ ,,~. ~ -=- ~ ~~~..~ ~...',. <: \)J, \. ~ r- I' I""" ... :","""';"" -l /6'C' 0- ~ ~ _.:>< /'" ~ "::' ," "~f"...~ ~ ~ I)ii ':'i" ~?;: .'><....... ........----- '''''' ~~.......... ......f'-..:'-"::;:., " - 'Y , "I' ___ ,____'~....., ....... ,-, /6'<t ~~'l : "IT .,tb"'~Wf.~~81';'I' - ~'" '., :-;: ~ :\'% ..........\''\ .;:;, .-:?' _l :--t-:~: r;r::;=.~~ ' '.. ~ "..: , ~y ~ ~ ~-II,t.~ ~~'~~l"~~~\, "- \, ::/ 16'6' 18 ~ --0 I e ~~tJ;J-- \.... ' ~':~'::'~'" N ___:., Ire-: ~ ,'U ~~ '~", ,.. ~ · ',ci' Iffi' f i [t r ~ :- ~ ~ "'''~ -': '" '--....__.. ; ':.,,:.: 16'8 I~ I j i Ii (---;l? l"'~" ~::,.:;t~ t ~ ' _-----i-., " '.'~ \jl II t- . " \'--' ~~~~ '~'~~I~~ (")~, ii', n. \ ~/I( ~ ~h >....~~ NI~_~ ~-I S I?O \ I 11/ 1'- ti~~\~';'~' :~~~~;: ~-~~ ~l , I. rl/I /' ~ \\'1 "~: _~, y.......':=. ~ "'=::-:11 + /11(// /' ~~~ '~'iJ ~~~8"jf- ~ --I I?C' \;/1 {III i; ~ "I': ~,V \ ~ $Jg ~j',?/~ >: : ~~ ~ I /fIll! /-k t'-- (\ , i ,~~:j;, "F --=:- ~ --- _ 'I ';( - I ~ \ ! ':r)C-,:f::.;J. tt........ , -- \ I/I{III/III I 0'~/jJj;l Wj'lJ ~i ~ " . :< : "; , \ III I ')1 \ \ 'f1."i'J', ill ~: <-/?6'.t" VII/!! [kl( }~(t!1- '1/11L. ..{.... " /~~~ ~/~IIII \\ ~ {~~JP~,~: I A~!!ii II ~ 4 J\~.,I{ ;j.."..' r. ;<-tJ~ },,~ :~rQtII~~ \ ~~~~~~: i :Hli!iiINfl\ t\_~~\ '~ ...... <:< .......... .' , .:< . .", , ':'" <,. -,' ':.,' , ...,......'.:. '," . ,..,.':, ,: ;". , '. ":. '''''' ,", ," ':, , '! ,", ",', ".: ",,'" . ',': ..... > , "'J ",~I'.,. " :. "',"" ,," ," , '" ::. . , ' " " - " ',', . I " , ----' ""I1I#i: '~'.,'. ":~,....",,, '.:/ ',.' "', ",' ,,'... ....... /. .. .' '" ' ,'., ,,' '" ' , , " . " ":"" "'. , ',' 1.' '''' , ,,', :' ",.,~"';' , <"" , , " ' " " ",',','. ,',' , ,: ,,', "","", ,''-',' ':':" ,'. '",',, " ': '-"",: " , "",', " < I " ---' , .. ;'" ','" ," " ' :,' '.',,', . ',,'" ",.. "" ,';'".' , ,.- I~~~~: 1M' r:~ JEFFERSON COUNTY DEPARTMENT OF PUBLIC WORKS Jefferson County Courthouse Port Townsend. WA 98368 PERtm NO. rr-f-r-2. FEE PAID ~s _No ~ICE USE ))NLY Yf'l ~/.32'~f?J NO.~ NO. ~.,.- OFFICE USE ONLY APPLICATION FOR ROAD APPROACH CHECK ONE: o RESIDENTIAL [J;}t COMMERCIAL Application is he~by made for a per.mit to construct, operate and maintain a road approach. Please describe loaction (attach map or drawing) 450 feet West of the intersection of Teal Lake Road and Paradise Bay Road, on the North side of Paradise Bay Road. , '. i' ;' ." ;," . j , . ! . Applicant agrees to perform the work in strict compliance with the terms and conditions set out herein, and any special provisions attached hereto. Applicant Name Pope Resources Contractor Name Address 60M Paradise Bay Road Suite 4 Address Por:t Ludlow, WA 98365 Contractor Signature Date Applicant Signature Date PHONE 437-2101 M PHONE Note: Indemnity provisions of paragraph,,2 'and 3.on reverse side. ~\~W~~m Subject to the terms and conditions on the reverse side, PERMISSION IS HEREBY GRANTED to Applicant to construct, operate and malntain a road a~proach as requested above, and any special provisions attached hereto. PERMIT No work shall be done under this permit until the applicant or contractprhas notified , telephone APPROVED BY: /J./~ ,II J/JvLl/J Date 9- 9- gg PERMIT INSPECTION REPORT .~ork covered by permit has been completed ------ satisfactorily. .. I CAll 48 HOURS BEFORE YOU DIG 1-800-562-6478 ______work is not completed. . ______Recommend permit be cancelled. ______Traffic control - adequate inadequate________ REMARKS INSPECTED BY:~ DATE ,-~,,~ Form 113-0 (R...A 2-jl2) " I, I ", '., \, ,,'.,,",' . ,"", ,:' ',' ',',: ::"" '.-, ,'.-, ',.", .,: .' ,': '" , ' .' ',' ":,,", " ',' , ': ,,' . '. ',.- " ;'. , ':. , ", " .... , ",':':-; " ".' '. I" ",,:....- :: ", .'ii", ' ,'" ::" :.-: .,' ''',,' " . , .".' '. ',' ,'.. .' '! ,....' ',' ""'" " " ' ,.-: . ,'f, " , ' ; . .' . ',' ...:...- :' ,. 'I ......., ,-. III :: ' " ....,'" 1<'. . ,,'.,' :'. " ..,'- ". :",' , '; i :', ,: I ' ," ,: i ,." :', .. I ! .. ,:< : i , , '..'. i :'.', ,:'1"', ,', "',' I ":', ': ',." '. ',: ,'c, ," ..' ", I ,: i I ! i ! , I ! i F ., ), " , I GENEPAL PROVISIONS 1. THIS PERHIT IS SUBJECT TO ROI 36.75.130, .1~0 AND .150 AHD AHENDHENTS THERETO. 2. THE GRAHTEE. ITS SUCCESSORS AND ASSIGNS, AGREES TO PROTECT JEFFERSON C~~~T~O ~~ i~V~U:~E=~~t'\i~St.~R~~R;~~. ~~~~~~S, "'g~I~:~P~:T~A~G~~...~~ E~~R~H~I~~R~~~~~R ~=T1~~ ~~~~H W:~,A CHARACTER Of MATER IAtS USED OR AAH:E:y OF INSTALLATION; IN CASE NiY SUIT OR ACTION IS BROUGHT AGAINST THE COUNTY fOR DAKAGES ARISIHG OuT OF 0 NCE- REASON OF ANY OF THE ABOVE CAUSES, THE PETITIONER, ITS SUCCESSORS OR ASSIGNS WILL.. UP0t4 HOT ICE OF COME. MENT OF SUCH ACTION.. DEFEND THE SAME AT ITS SOLE EXPENSE AND SATISFY MY JUDGEI'lEHT ARISING THEREFROK IF DETERMINED ADVERSE TO JEFFERSON COUNTY. 3. IF THE GRANTEE ENTERS INTO A CONTRACT OR AGREEKEHT WITH A THIRD PARTY TO fERfOR" THE WORK AUTHORIZED ~~D~=~~F~~R~~U ~~Hl~~:D "':~R~~FE:~ ~H~A~~~~y T~~ ~~~~~f::~~1~7T~O~H~T:Rg~7~~~~ ~~T~A~~l~~'2~G:~~~E:O 4. ~y T~~~A~~R~~T'1~ ~~HI~~ ~:g{~~g~1~N~O:~Q~~:~~~~~~ =~~~;= ~DgA'i~R sllitU:~O:C~H~H~~R~E~,~H~O G~:~~~_ U.TlOM AS HEREIN PROV'DED. 5. DURING THE CONSTRUCTION OF THE FACILITY, THE GRANTEE SHALL COMPLY WITH THE ""ANUA' nH ...IFORM TAAF~le rONTROL DEVltFS FOR STREETS AND HI(;HWAYS PUBLISHED BY THE U.S. DEPARTHENT OF TRAHSPORTATlON. 6. ON COMPLETION OF SAID WORK HEREIN CONTEMPLATED, ALL RUBBISH AHD DEBRlS SHALL BE II"oMEDIATELY REI'K)YED MD THE ROAmolAY AND ROADSIDE SHALL 8E LEFT HEAT AHD PRESENTABLE AHD SATISFACTORY TO THE COUNT.Y. 7. THE COUNTY RESERVES THE RIGHT TO ORDER THE CHANGE OF LOCAl ION OR THE REI'K)YAL OF MY STRUCTURE OR STRUCTURES AUTHORIZED BY THIS PERMIT AT ANY TlKE, SAID CHANGE OR RE/'K)YAL TO BE I'\ADE AT SOLE EXPENSE OF THE PARTY OR PARTIES TO WHOM THIS PERMIT IS ISSUED, OR THEIR SUCCESSORS AND ASSIGNS. 8. ~~~ r~~~T c~~~~~~ER~~~N:I;~cr~~N O~R T~~Lg~C~{~ S 8~O~~E A~~A~~~~E~~~L C~~N~~~H.l.~L S~H H~ ~~~E:E A~E~ Lt I ~:~~E fOR NiY DAMAGE TO THE GR,ANTEE BY REASON OF ,ANY SUCH WORK BY JEFFERSOH COUHTY I ITS AGENTS OR REPRESENT,ATlVES, OR BY THE EXERCISE OF ANY RIGHTS BY THE COUNTY UPON ROADS, SIREfTS, pUBI..1C PLACES OR STRUCTURES IN QUESTION.. 9. THE GRANTEE SHALL NOTIFy THE COUNTY'S REPRESENTATIVE UPON COMPLETION OF THE WORK UNDER THIS PERMIT SO THAT A FIN,AL INSPECT'OH CAN By I'\ADE. 0 1, IB 2. 0 3, ~ ~, 0 5, 0 6, 07, 00- 8, r -'.' , ,\ ", SPECIAL PROVISIONS APPLICABLE PROVISIONS ARE DENOTED BY ,AN (X) ~o~g~~ug~I~EA~~~~~Iz~~A~~ ~~Ig"P~=~I~O:I~~I~'T~~DC~~f~~;E~I~n~~O~~~A~~EMfHTS, AT ALL THiES DURING THE THE APPROACH SHALL BE CONSTRUCTED IN ACCORDANCE WITH THE ATTACHED DESIGN PLATE TYPE ~ ~ ~~~~~A~D .1'D TOS. TRUEF[i~~N~~ g=,AOE. ((HE APPROA~~C~H~Lt~~E=U~~~~~~TT~I~~ESt~~~T~EA~L~~~I.~.. ~ ~~~E~~1:G~~ ~~=F~~:D~A~~R T~~O~p~:~ei~E S~~~~E=~Y I~H~gCg~~~~~E R~~~~.~~~W:~O:: t~ ~g;T:~L p~:Hr~~J~AN. THE ,APPROACH SHALL BE SUFFICIENTLY SURFACED BACK AN ADEQUATE DISTANCE FROM THE EDGE OF THE P,AVEMEHT TO PREVENT A/iV MUD TRACKING ONTO THE COUNTY ROAD. .ANY HUD TRACKED ONTO THE COUNTY ROAD SHALL BE IHI1.EDIATELY CLEANED UP BY THE GRANTEE OR HIS AGENT. IF NECESS,ARY TO INCREASE SIGHT DISTANCE, STUMPS AND BRUSH SHAll BE REMOVED FROM BOTH SIDES OF THE e:r~~A~~ALL T~T J:~I ~~:~7}~~~E O~U~~~~~Y O:O:~R~~~~~~~~wl~~BER. OR DISFIGURING OF ANY FEATURE OF SCENIC WORK SHALL BE RESTRICTED TO THE HOURS BETWEEN 9:00A.M. AHD q:QOP."; LWLESS OTHERWISE AUTHORIZED BY THE ENGINEER. A SURETy BOND IN THE AHO'UNT Of $ , WRITTEN BY A SURETY COMPANY ,AUTHORIZED TO DO BUSINESS IN THE STATE Of WASHINGTON, SHALL BE FURNISHED TO INSURE COI1PLUNCE WJTH ANY .AND All OF THE TERHS AND CONDITIONS OF THIS PERMIT AND SHALL REMAIH IN fORCE lJiTlL ALL WORI( LttDER THIS PERMIT HAS BEEN COKPLETED ,AND APPROVED BY THE COUNTY. BEFORE ANY LOG HAULING OPERATIONS BEGIN, A SURETY BOND IN THE ,AMOOOT OF S . SH,At.L BE FURNISHED BY THE GRANTEE TO PROTECT THE COUNTY AGAINST ANY DA.HA.GE TO THE COUNTY RO...o AND TO INSURE COMPLETE REMOVAL Of THE APPROACH AND CLEANING UP OF THE RIGHT-Of-WAY TO THE SATISFACTION OF THE COUNTY. APPROVAL OF ALL CLEAN UP WORK SHALL BE SECURED BEFORE THE BOND WIt.L BE RELEASED. SPECIAL CONSIDERATIONS 7-~,~c:. ~:>n~t'JA~J..I <H-I9LJ Be CDN-S'T"RUC1'""€D '*' roOIA.....n-Y' Rf.:l~ LAJi"'"@~Pc...,."r"I,..J '<""~AlDA-t~\\, A-ND ~',.J A.~L~k..i"'l~A.1Ce' w....-+-t... KA- y' <./,' PIA) rJ I' I...-l A.- J .p J?/ 4A \ " . Form 113 b '.. r. :,:".} . ". '. " "" . \,'. '.., '. . ':,..' "'::,'.., . , '. ':. . '. ,.- ..,....~"-'c .. , . .~.~ :".' ~ ::.: :"". . .) I:;{,:;;:; :. ,,!' . " Ie ' i ",.:'<;;,'.':.f,' '. :,' : : ':, : . .;. Ii I:' : ''- ;" :. . , ',.",. .), : . " t -. ",", , ", " I;,.. :''-,,,,;'. " . ::::.". " .,: . .':' :.' i.:.: .' " ',': "." . " .. "', '.c' :.:. ,:" '. " ",. :,: . 1\ .' , ( ~' , " ,/ ;, ,:, (:i.:'::': ,: ",...,: . " , ,", '" . ',' " ': ,.'..' '.:'" ' . ".' ..: ,', ',,' , I:i:, .,'., l~ "'.',"'L'. I , :L L " t. . ~'. . - ---:::--.. --.. --::-- ---:.: ::__00:, . 'TY"- P_I . --::--- .. .. _.n ---' --. '_ .. ..~-.,_~.: _ .. ::--" : - _:: PRIVATE ROAD APPROACH '. _, _ . :-. j~"A~~~~'~~.~~'lf!~~~:t,.:: - ..:': ::rlcj;-::~~~ !:':.~~~-1.!~~ ....:.-:. .-.:~ :~~. : .-I2'Dio~in.c:u~i) .:W~~.d ~ ,l f~ig:::~;;~."- ~~1~1I.; .II~~~~: .-~.: ... ... ... .-";11.1. ~..uIrWX~.. ~... "'-7--- . -----~ --t . ':.!' !~~~:...: ~.~.: :"'~-><':.:--~ :; ~ . :_r~~:::~:~ . COUNT., 41O'.D. ,.- -.... - .. , ,7"':__.,_._ :.... .' : i h . .. 1'- . .: .. .. .. ~~~~ ~~ rOUI~r .~ ~ _ ...~~ : . ._~~~7. . >:t'..' --. I.~.".. ,.- ......--'- I.. ,..-- (. - J: --::: .. 0- r;~,~i~::Fc;:~~~:::~:= :i;-:~=1~~ ~~~;:":,I.~d_(:h~~~:7;~~f:;; '~~.f:,:': .'-1-1::_.........,__.._.... . . 'oo__~1:O' . _... ___._ 00.___.'...--'_,. ..1..__.___ .}~~~;.E~it~~s.l.::~~':;j .~" u~:~~tB~'~~~~:.:)ic;; -,"-, ,..,.......,-...--..T:J~U.;.....II..' - "'--~".""'''I2.cu'''''rl-'' .~-- -z:::l-"';'t"~r-1-~--:"-;-1' '-'~'."" ji~:.~~~E~~~2:;}~/;~j~~.:~~LS.; ~:;,;~::~,~? ..- ~I:;~I:~E'~:I:::~ - . !' . POsTED Ii ICIfI' IlISTANCE r SPEED LIMIT. NINIHl./M DESIREABLE .... ~_. E. ...- ~&.....: -- f!-; .:..: f-' WOTES: 25 160 FT. 200 FT. -. , . "SO 20DPl'. 240 FT. '. IS 240 FT. 275 FT. 40 275 FT.. SSO FT. 45 lIS FT. 410 FT. 10 S50 FT. 475 FT. .- ....,'.... 1.) Culvert .hall .eet ainl_ .peclflcaUons '~or tlS-20 loadlna. Approved ~)'pes include: 1) concrete 2) corroaated _tal ,> corruaated pol)'edJylene tubi.ng-AASHTO f!~)',,, 1:oUllty road ahoulder .hall be left at . existing profile. 2.) APPJtOVALS : 4,/ /2. ~~ a9ft~ Olail'lllaD. 80ard of County Commi..loners .. , . .L ...) ~rec~or. Department of Public Vorks Date "A~... Date 9--6-!J .. .o~ ",is::c';. :".1....;.:.:.: ,". ._ "-" ......-- '-0 .__...._..._.__ . ;...::.2..~~..~~:. ~._. .. _0. :.:-:;:':'. . . .', ~ _"-;: I .- .,_...-~-- " III 1 ~.. I :' .','. . r :' ". " i , '.' f ~.....,'..'.,'..' ~ .. . .< . '" . J u u..,;f ' .r! . .'. .: I" . ..."" . ..' . . '. ,; , '.', . " ',": :" ". '. :-' -, .' .... :, .... , i - .. .... '. i ,'.' ',' '. ',-'. I .':. .,". , ....'. .... .... 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G\ \~ \ \ .to ~~c;~::::;-:--- 'x, y ,ic' -~::::::::- ~~__~-;/~; / ,j/rrfJ~\ .J....1."\ _, \ ~-..~-i .........:. i.' :::- _ _ _,.;:::- ---.--/ ~I/~'////~~: T ~ ~ i.9// :. .;ii -- /)ffi .~r~r /' I \~. ....; ic; -- ;~:~ f~'/~j I \\ ~_ii .c,_ - / ~/ /, / I \. \ I: I '//,.i',;.. ,';'" ." .~"")'" )/;'!'/",i .'. i'. ...... ."'. <;j .........,........... ......,.y.' ;) .. ii/C" . ........i)' ..J..... c, ii, ...... .: }', .i ).;; '. iii';'.: ....... ................i;i'1; (. -.-u...;,) ...i...;,..... '. 'iJ... . ,,': '.,,' /: '. .... . .. . ' ,,'-, ,- '" '". .' .: . /: " " '. ' L ..' ..... " I . '. '." . "" .'; . Ii > '. .' . ,,;i ...... , '. ," .:,' ;"'0': .:.. . ...' .' . '. '." . . .'......:.. "; . '. ,;.' I; I: ,0 . '.," . " : ~.. ; : ..; " .... I ~ . I;' Ii' !" '.' '.: " I"~ ','.' i .,," , ", . " ',' i' ,.,"" ;". ....., "". '." '. . . :': " . ",.' ..... : .' '.. '.' , , ',' ,,' . '" ,. ',,, :' ;, L --.J '. L L l ',' ,co'um ROAD IW, s'I/I. TE LOG NO. ?O'Mo9 M1LE peST ~ OFFICE USE ONLY JEFFERSON COUNTY DEPARTMENT OF PUBLIC WORKS Jefferson County Courthouse Port Townsend. WA 98368 PERMIT NO. 'O~-3-;;lr-'2- FEE PAID /yes _No OFFICE USE ONLY ...::/1' .P:'-. ~j 0 ,_.:.,/~~_ k'/'1' ;.r, ,( "'.'- /," _ci/.7/1"x? CHECK ONE: o RESIDENTIAL APPLICATION FOR ROAD APPROACH o COMMERCIAL Application is he~by made for a permit to construct, operate and maintain a road approach. Please describe loaction (attach map or drawing) East side of Paradise Bay Road~ 1500 feet southwest of it's intersection with Oak Bay Road. Applicant agrees to perform the work in strict compliance with the terms and conditions set out herein, and any special provisions attached hereto. Applicant Name Pope Resources Contractor Name Same as applicant Address Address 60M Paradise Port LudlotllJ Contractor Signature Date Subject to the terms and conditions Applicant to construct, operate and special provisions attached hereto. ~ PHONE 3 .on reverse side. PERMIT _., on the reverse side, PERMISSION IS HEREBY GRANTED to ma~ntain a road aFproach as requested above, and any Note: Indemnity No work sha1l be done under this permit until the applicant or contractprhas notified , telephone APPROVED BY: --<J, n=tA-j( fl.-.-!J /] Date 3-28-88 PERMIT INSPECTION REPORT ~rk covered by permit has been completed satisfactorily. -- CAll 48 HOURS BEFORE YOU DIG 1-800-562-6478 _Work is not completed. . ______Recommend permit be cancelled. _______Traffic control - adequate inadequate_______ REMARKS INSPECTED BY: \) DATE',-~~ Form 113-a(R....A 2-,82) " , ,. {' GENERAL PROVISIONS 1. THIS PERHIT IS SUBJECT TO RC\I 36,75.130. .140 AND ,150 ARD ""ENDNERTS THERETD. 2. ~~~,~~ARmio~;s D~ug~m~~s o~~v~~~'mD ~~E~~S~~' ~~~6~C~Ht~~F~~O~C~~~T;o"~~ :~V~UI~E~~~N~~S~~R~~R~~~. PERSONS OR PROPERTY BY REASON OF THE PERFORMANCE OF ANY SUCH WORK. CHARACTER OF I1ATERIALS USED OR MHNER ~~A~~~T~~L:~~ o~~ }~E C::~vr~AmL OMCmh :~R~:~~~; ~~~~mO~~E O~O~~r':~R H ~~G~~~R ~~mE D~~ ~~~~N~~- MENT OF SUCH ACT10N~ DEFEND THE SAME AT ITS SOLE EXPENSE AND SATlSFV MY JUDGEMENT ARISING THEREFROK IF DETERJ1lNED ADVERSE TO .JEFFERSON COUNTY. 3. IF THE GRANTEE EHTERS INTO A CONTRACT OR AGREEKEHT WITH A THIRD PARTY 10 PERfORM THE WORK AUTHORIZED ~~D~~~~F~~R~~U Z~M~~gD '::~R6~FE~~ MA~6~~v T~~ ~~~~~m~'~~T~o~HnRg~m~~ ~IT~A~~~l~~'2~G:i~eE ~O 4. t.\~W~~R~~T"':~ ~~Nl~~ ~g~m~m~NeD:~Q~~:~~~~~~ ~~~~:: roD~i.V~R s~tt~~~C~H~H~;R~E~I~H~DG~~m- LATlOH AS HEREIN PROVIDED. 5. DURING THE CONSTRUCTIOH OF THE FACILITY.. THE GRANTEE SHALL COKPLY WITH THE ,.,ANtlA. nH lIu~nR" TAU~It: CONTROL DF.YICFS FOR STAFFTS AND HIr.HWAVS PUBLISHED BY THE U.S. DEPARTHENT OF TRAHSPORTATIOH. 6. ON COMPLETION OF SAID WORK HEREIN CONTEMPLATED.. ALL RUBBISH AND DEBRIS $HALL BE IMHEDIATELY REf'K)VED AND THE ROADWAY AND ROADSIDE SHALL BE LEFT NEAT AND PRESENT....BLE ,\HD SATISFACTORY TO THE COUNTY. 7. THE COUNTY RESERVES THE RIGHT TO ORDER THE CHANGE OF LOCATION OR THE REI'tOVAL OF AHY STRUCTURE DR STRUCTURES AUTHORIZED BY THIS PERMIT AT ANY TIME, SAID CHANGE OR REHOVAL TO BE I1ADE AT SOLE EXPENSE OF THE PARTY OR PARTIES TO WHOK THIS PERMIT lS ISSUED, OR THEIR SUCCESSORS AND ASSIGNS. 8. ~~~ ~~~~T c~:~~~~fR~~~N~r~~cl~~N O~R T~~L~~~~+~s B~O~~E A~~A~~~~E~~~L C~~N~~~Hl~Ls~H H~ ~~:E:E ....~E~Ltl~:~iE FOR ANY DAI1AGE TO THE GRANTEE BY REASON OF ANY SUCH WORK BY JEFFERSON COUNTY, ITS AGENTS OR RfPRfSEHIAIJVfS.. OR BY THE EXERCISE OF ANY RIGHTS BY THE COUNTY UPON ROADS, STREETS, PUBLIC PLACES OR STRUCTURES IN QUESTlOH. 9. THE GRANTEE SH....LL NOTl fY THE COUNTY' 5 REPRESENTATIVE UPON COMPLETION Of THE WORK UNDER THIS PERt'UT SO THAT A FINAL INSPECTION CAN BY f'W)E. 01. [!;;y2. ';!'~\I!i?~IF1(;'i!@ ," SPECIAL PROVISIONS "";:~'d;;ii"l;'1f'illttAPPLICABLE PROVISIONS ARE DENOTED BY AM (X) A C~:;P'Y::'C:F'LiH~~'P~~'IU1jSH.~E OH THE JOB SITE, AND PROTECj.TED FRO" THE ELEf'\EHlS, AT ALL TIMES DURING THE CONSTRUCTION AUTHORIZED BY SAID PERMIT WITHIN THE COUNTY 5 RIGHT-Of-WAY, THE APPROACH SHALL BE CONSTRUCTED IN ACCORDANCE WITH THE ATTACHED DESIGN PLATE TYPE c.-I APPROACH. A _I'v ~ Ft . LENGTH OF J >~ tNCH DIAMETER CULVERT PIPE SHALL BE PLACED IN DITCH AND LAID TO A tRUE LINE AND GRADE. THE APPROACH SHALl. BE SURFACED TO THE LIMITS AS SHOWN ON ~~~E~~~G A~~ ~~~F~~~D:A~:R T~~O~p;:~e~~E S~~~~E:~Y I~N~gcg~e~~~E R~~~_~~~.~~a::t~ ~~l:~L p~:H1~~~~1M. THE APPROACH SHALL BE SUfFICIENTLY SURFACED BACK AN ADEQUATE DISTANCE FROI1 THE EDGE OF THE PAVEMENT TO PREVENT ANY MUD TRACKING ONTO THE COUNTY ROAD. AHY HUD TRACKED ONTO THE COUNTY ROAD SHALL BE II'V'\EDIATELY cLEANED UP BY THE GRANTEE OR HIS AGENT. IF NECESSARY TO INCREASE SIGHT DISTANCE, STUMPS AND BRUSH SHALL BE REMOVED FROM BOTH SIDES OF THE e:r~~A~~;'LL T~T I:~I ~~:A7}~:~EO~U~~~:~y O:o:~R~~~~~~~~wl~~BER OR DISFIGURING OF ANY FEATURE OF SCEHIC WORK SHALL BE RESTRICTED TO THE HOURS BETWEEN 9:ooA.H. AHD LI:OQp.",; lJ'CLESS OTHERWISE AUTHORIZED BV THE ENGINEER. A SURETY BOND IN THE AMOUNT OF S , WRITTEN BY A SURETY COMPANY AUTHORIZED TO DO BUSINESS IN THE STATE Of WASHINGTON, SHALL BE FURNISHED TO INSURE COMPLI....NCE NITH /lMY AND ALL OF THE TERMS AND CONDITIONS OF THIS PERMIT AND SHALL REMAIN IN FORCE lIHIL ALL WORK l.IiDER THIS PERMIT HAS BEEN COMPLETED AHD APPROVED BY THE COUNTY. BEFORE AAY LOG HAULING OPERATIONS BEGIN, A SURETY BOND IN THE AMOUNT Of $ . SHALL BE FURNISHED BY THE GRANTEE TO PROTECT THE COUNTY AGAINST M4Y OMAGE TO THE COUNTY ROAD AND TO INSURE COMPLETE REMOVAL OF THE APPROACH AHD CLEAHING UP OF THE RIGHT-OF.WAY TO THE SATlSFAClION OF THE. COUNTY. APPROVAL OF ALL CLEAN UP WORK SHALL BE SECURED BEFORE THE BOND WILL BE RELEASED. SPECIAL CONSIDERATIONS [g" 3. ~. 05. 06, 07, 08, Form 113 b TYPE C-I COMMERCIAL ROAD APPROACH I---~'~ J ; ~~ ----"-~--=:~~~~~- 3O'R 12"010 mln,CU'ie,. Eaistino dllch EdO. of Shoulder _--=-='::' --==-..:.:.... _ _ _ _ L~S..'::'~d.::~~~m.' be r,Quired) Countr Roo,! Varin ~ ---------------------------:------------- C of County Road , EdQ' .':hOUider I r-zomln. AL!!.'.9!!ir~d___ I .tZ'f. ~ ---~:;;;::; ~ -:n~"bgllas' ~. loI,n,;t' '.p cour" 1oI10.Iz-cu,..3 PLAN POSTED SPEED LIMIT SIGHT DISTANCE REQUIREMENTS SIGIIT DISTANCE' MINIMUM DESIREABLE PROFILE 25 30 35 40 45 50 160 FT. 200 FT. 240 FT. 275 FT. 315 FT. 350 FT. 200 FT. 240 FT. 275 FT. 350 FT. 410 FT. 475 FT. NOTES: 1.) Culvert shall meet for HS-20 loading. 1) concrete 2) corrugated metal 2.) County road shoulder shall be left at existing profile. uunlmum specifications Approved types include: APPROVALS: County Engineer Date Chairman, Board of County Commissioners Date Form 113-d ~ I nCOMIT "0. c'" 3 " tlO- -;2g--2 ~----- , - - _.:. ----Nor-rD - 'SUit.If- -.----- COUN.V~fWAlJ NO.~ STA'f~ LOG NO. MILE POST ~TO..e.u.. (,l,FFI CE USE ONL.Y JEff ERSON COUNTY DEPARTMENT OF PUBLIC WORKS Jefferson County Courthouse Port Townsend, WA 98368 l'ER/'I1T NO.n-~-:l!"-1" FRANCHISE NO. FEE PAlO _Yes ~o OFFICE USE ONLY APPLlCATIOlj FOR INSTALLATION OF IlTlLlTlES Appllcal),~: /7 Contra9l'or" Name Htr/~f?, /l./I//:5-et/ Name ,M-rrrJn/i,Cl, Job No.)(tf-93 I oj Address MANAGER I & M hddress /Ogy ff r/::'e/?C e-' /c:b, 21Zu UAKRIDGE DRIVE ,t/r /l, './, j, S ~1'AN6[lES, VIA 98362 ij . /1'.171" ,o. phone: phone: .v:. <; 7 -,{, t, S;-~, Application is hereby made for a permit to construct. operate and maintain t51//?/I'O// ?:PIp ,;:JZON~ )e/Z-t//Cr> , The utility installation is located (attach map or drawing) (., / ./ ( r/ /cPfe! :Cdu Applicant agrees to perform the work in strict compliance with the terms and conditions set out herein, and states that Applicant has read and will adhere to the general provi- sions set out on the reverse side of this form and any special provisions attached heretO. Applicant Signature: d./..k? .J}.au J~L- Da te: ~.:?- 2- 7- 5'" Y 1// / / / / / / / / / I I I I I / / I / / / I / / / / / / / I / I / I / / / / / I / / = PER M I T ~ ~lO)rrnf(11\V1~rm Subject to the following terms and conditions. PERl'IlSSION IS .{&\E13ifG\ffil\:\!itI~il!JPlicant to construct. operate and maintain utility facilities as requested above. This permit is conditioned upon Applicant's compliance with Jefferson County Ordinance 2-81 and WAC 136-40. including amendments thereto. the general provisions set out on the reverse side of this form and any special provisions attached hereto. No work shall be done under this permit until the Applicant has received instructions to proceed from . telephone y~ Date:. :,-2-:>-~ APPROVED BY: NOTE SPECIAL PROVISIONS ON REV[~SE I / / I I I / ( I I I I I I / I I {:/ I I I / I I I I I I I PERMIT "INSPECTION REPORT ~WOrk covered by permit has been completed satisfactorily. Work is not completed. Recommend permit be cancelled. _ Traffic contrOl_adequate; __inadequate. REMARKS: I NSPECTED BY: )''>----------- I / I I I IT 1-800-424-5555 Date: 0"- "," 8", , , (iener.l Provillon, per Jefferson C,)\lnt)' Ord1 ) 2-81 lInd IolAC 136.40. I A" ...,. d,n. ,nde< "Id ,,,",hh. ,h." be d,n. 'n. th""" .nd .o,',..n"" m.nne<, In the ",'n, ,f ,nde<.",od .,,."n.. .n: .."" .nd '" ~~:li'~~::~n,~:::::~,::;: 1:: ;~:.:n:n~h:,~~:;:nln o:,~;.:,::;. .:h:, '~~;:;i:~. ':~.;. ~~~:':,':~~: ib;:,:::;o~;~g, ';,:::i' .~~"~;: 1 :,~~;t. il' d~;' :~~','t.. ~i~~~~:'~:;:;:~: :'::. ':.l:':~.;h:"~~h:~ :~:t,~:::::: ~;.l;j;;:,~h~:;n;~: :;~:;, o;n~'::~,:~.~::':; ~:,~,:h .~:;: io~n:, .:~';. ::' .~:o~:;; ;;~~;,;';, ,",h .".. The ,,,n'.. ,h.ll b. ".". '0' on, 'nj", " ..,,'" " ....... 0' d.m.,. '0 ....e<t, ,,,,,'nod 'h""h ." ,,,.1......, 0' ",,1m, ,r through ."y hnure or neglect to properl)' g\,lud or ghe lol.rning of any trenchU, ditchu or tunnels d\,l9 or m.dnUhll:d bl the 'Jranue. 2. Th. '..n.... It, '",,,..,,,,, '''''''. ,.." ""..".." "n"''''''" ,~de< ",h .."'" ,..n..d b, 'ho C"ntY En,'n.e< ."h'n the ,..... ....,d ,,,..d in $1,1'" penllit .nd ,holl h..,e c(JlIp1eted .nd h..,e in operation !.uch portion of the $y,ttm of improvementS U 1114'1 be spec:1fh4 In ,ul;h pemlt or the rights therein conferred upon the grantee sh.ll ceue .nd terminate iMoh.r as unoccupied streets, r06ds. lite., Ire concerned. 3. The ,'A"" ,,,,, ,.....11 ........ ....,... .11.", ,,,d'. h.,h.'", ,.,h"-Or..., ood othe< '0"'" ."..".... .ft., ..,'n, oo~ 'n...'\ln, fIIalns and doing construction work. II'I4king repatrs to equtplllent. etc., in as good Ind ufe condition In 1\1 rupecU II, the)' ~ere before the cCJlmltnce. rnent of such work by the grantee, i1.$ agents or contracton, and 611 recorded monumen1.$ ~hlch have been dhturbed or dhphced b)' the M'Or.. ShAll be reset to the specific.tlons and approval of the County Engineer. ~. In use of In)' dall\4ge to Slid streets. ,venues. l11eys, roads, h1qhlOllYSo rights.of-wa)' or other count)' properties. or to paved or surhced I"1)ld- ~a)'s. tum.ouU, gutten. ditches. wood or concreU wll..s. drl1n pipes. hand or embAnkment raits. bridgu, trutles. .harves, hndings or /I"IOnulfof:nts b)' the grantee. the uid grantee Igrees to repair such dambge at the earliest time possible at iU oom cost 4nlS upen5e. 5. When the County Engineer detef"1ftines that an emergenc)' sHuatlon does edst, he may order and hne done an)' and .11 work cOMic!ered necenarl to restore to I ufe condition Iny such street, Ivenue, al1ey, rOld. high...)', r1gM-of-"")' or other count)' propert)' left b,. the gr.ntee or 4genU in I condit10n dangerouS to life or prope,.ty. He III')' CAuse to be rephced or ,.eset recorded monl6lll!nU if . grlntee hils to ,.ephce or reut U1"1f: within I reasonable time after cD:Tlpletlon ot construction. The gr.ntee, upon eem.nd, shall PlY to the county III costs of such construction or rep,'r ,nd of dOin9 such work. 6. All construction or 1nstlllatton of lI'I4ins. vahes. pipes, poles. c.bles. lines fitting Ind facl1lttu. urvice. repair. or relocatton of the Sl/lle. performed .long, over and/or under the cOl,lntl raids. rtghU.of.IoIIY or other count)' properties subject to ule t,..nchlse sha11 be done in such . ","nner IS not to interfere with the constructlon. oper.tion ,nd IIIllntenlnce of other utl\tties, public or priv.te. d,..tns, dre1nlge dltchn .nd $tl"'\lctures 10Clted therein. nor wtth the ljIrldlng or il1lprovement ot such cOunt,. rOldS. righU.of-.....l or other countl properties. 7. The owners of .11 othtr utilities, pubHe or privlte. tnsulled In 5udJ county rQ.ds.. rl9hu-of.~a'y or other" count,. pro\>ert1e$ prtor in till1t to the linn Ind faclltties of the grentet sh.ll h.ve preference IS to the pos1tton Ind lOCAtion of such utilHtes so tnsulled with rupect to the grlntee. Such preference shall conttnue in the event of the necessity ot relo"tlng or chlnging the grede of .n)' such count)' rOld or right-at-WI)'. 8. The 9r.ntee. IS fer IS prICt1cable, shall construct ne.... util11.)' fAcilitles underground. Eatenslon of o'ierhud t.c11it1u fo11o~ing streets, I...enue$. ways. bOule"'lrds 01" thOl"Oughfares shall be undertaken 01'111 ....ith the .\>\>rov.l of the Count)' EngIneer< PRovIDED, however. thlt Sltd 'PPI"O...al sh.ll not be unruson.bll withheld. Gl"lntee s~all convert uisting o'ierhud facilities to underground ftcilitles IS Ind ....hen equ1pment repllCement is undert....en. or when other u1stin9 overhead utl1it1es are placed underground. unless such rep1ac.e~nt h unufe, trrpl".ctiC11. or econClrTltull,. unreasonlbl'. Line utenslon policies and procedures established by the grlntee. and unlforTllly .pplled through its serv1ce Iru. shill be the standlrd in determln1ng ~h.t is "practlcal. tmproctical or tcon(1nic.lly unreuon4b1e:" under this ordlnlnce; provided th.t no nil''' overhe.d utility facllitles shan be constructed or e$tlblhhed in .1'11 Irel set ...ide for public p.rk. school. pllyground or Ithletic field purpouS. 9. Special prOvisions: co"-'DV\.t- :5H-n-L-L 8e. plrl-ceo o ~ tu-f IT m/"';OOV/'-'11'V7 of 30" BeLaVoJ EX;';,T"iN/ ex,;- e"-''D Be';1 0 ~ D -riot:.. i:?,r'lc::.k. OF G fa rrD E- 141\) D Si-I"'ll..L eX-';:S7"-(N; \);i'c.I-/. .\! i I /-.. -,j ~ ~~^' WURK LOCATION J(, pJ CONTRACTOR'S ACCEPTANCE Addre~ I~L~ __2.iY 2L?::"J /)- Flrm.___. CIty 'l~7p_ VI (0 Counly~~Slate W,4.. Signatule Name INjre,^ __,C A,o, /~f,,~, TI\ie_ ,---" _ 6' Unit PrlClJ 0 Cost Plu~ 0 ORIGINATED BY Yo",,. <? Dale '3 -2 '1- 'i::l?> New , ~ SIO NO, ~D-t{;>._-:Uffjue Dale _ Bili to: PACIFIC NORTHWEST BELL Repair b Tel. No. _ Temporized 0 /vo Altention Rearrange OSlO No, Due Date __ _,_..__. Address -- ----.-'---- [~~~f~]~;'~~~~ ~~::::~:;;o~""" "'::::;g~? Oc.scrlPllrorworK ~. ~~i~~~k \. ~Il~--I ~k ~ l 'PERMITREQUIRED 0 Yes 0 NO _ t~~--..:::!:::- 11< _ ---T~f.-- Received from ,n_ -- Verbal 0 :11:.1.W/ ._ __--l-(,...S'" Jurisdiction _--.--' No, 0 Burled Service Wire - Work Order PBOOO l6.811 No,5jJi:5L'L Comple1e by _--- DOlle Fl.' Suon 0 $ .., __ L ~-__ _____________._0--. Sketch Work Required _ Include Lcngttls. depttlS, wire size and amount &AP, ).,>i? (:OY'~{7J ~/'!"Ir, ' : .e.....((eJ,' ' " lED'" '/~' ' 1 j r~:J\:. 1ft" _ill... · ) L a---- ~.__.,- ,- --'~ , L Wc1,!"I:;V "15'CJ pJ ~ ~ /.-10.1 ~ ,.- laC/) 4-f (of Nee! . I':. ;, v - ,LJ -,.' -.,,- lO;'_?'E-,~/b"LP,___,\'--.$/r,,:]-----------,---~~-~' ' -' ." - - r.ot(~ nll5 sk~tch may not be ~accuralf: r(;pu:-scotahon In all detail!;, It remalnslhe ecntraclo"slesponslbl1lty10 properly locale work In the held 5(7CO~ Dlj Sllrf S~~ ORIGINATOR'S COpy ~ \ ''''-~ ')1h<i,{J( '~~,l, Y-<r,l. . .. JEFFERSON COUNTY DEPARTMENT OF PUBLIC WORKS 1820 Jellersorl Slreet P,O. Box 1220 Port Townsend, WA 98368 (206) 385.9160 N:: . 0902 District No, 5 PERMIT In accordance with all applicable Revised Codes of Washington and amendments thcreto, aad subject to all the terms, condi. tions and provisions written or printed below or on any part of this form PERMISSION IS HEREBY GRANTED TO U. S, West Communications 611 6th St., Bremerton, W~ 9B310 to Install underground telephone cable along Paradise Bay Rd. from mile post 1.24 to mile post 1,54, and along Ludlow Bay Rd, from mile post 0,00 to mile post 0.51 .:;~, ,/1,7 f-c M~( 5),,( 7?;'~ // /7'!~ County Road No. 503609, 508209 Franchise No. Milepost See Above No work shall be done under this permit until the party or parties to whom it is granted shall have commuaicated with and received instructions from This permit shall be void unless the work herein contemplated shall have been completed before Ocotber 26 Dated at October 26 ,19 BB /iRllm Dy ~~' /<~ 1.800.424.5555 , \9 B9 GENEIlAL 1'1l0VISIONS AI'I'L1CAIILE TO ALL l'EIlMITS This pcrmit is suhj,ctto all applicable pruvisiuns 01 the Revised Codes of Washington, ",,,pt that any provisi.... in this agreem,nt oot eonsislent with such resolution shall be controlling. A bond in till: UlIIoulIl of S i~ required for the protection or the l.:Ounty as set forth ill the terms of the bond. Outing ,he progress 01 ,he wotk such harriers shall be erected and maintaioed as may I", ne""'''y or as may be directed fur the pmlection of the traveling public; the barriers shall he properly IighlcJ at night. 10 accep'ing 'his pcrmitthe I"'ti'ioner, his suecessms and assigos, agrees to prolect Jefl",,,o Couo,y aod save i, harmless from all clain", actions and damages of every kind and deserip,ion which may acerue to or be sulfered hy any pcrson or persons, corporation or property by reason of the pcrfor' mance of any soch work, character of materials used or manncr of instullation, mairHeo""ee and operation or by the improl",r ",eupaney '01 righ' of way or public place or public structure, and in ease ,ny suit or action is bro,ght ag,inst said kHcrson Cnunty for damag" arising out 01 or hy reason of any of lht: above cuuscs. the JlCtitioner. his successors or assigns, will upon !lotice 10 him or lhem of commencement of such action, ucknJ Ihe !.:.IIIlC at his or 'heir own sole cost and expcnse and will satisfy any judgment afler ,he said suit or action shall have finally be,n determined if adverse to ,he Jcf' fcrson County. Except as hereio au'hori,ed, no excavation shall be made or ohstacle placed whhin ,he limits of a eounty "",d in such a mamter as to interlere with the lra\lcl over said road. Except us herein aUlhorizcJ. no c),cu\'utiol1 shall he malic or obstacle placed within four (4) rector the cdgl: uf thl: pa\'crnclIL If the .....ork done under this flI=rmit interferes in any way .....ith the drainage of the cuulIty roml. the grantee shall wholly and <It hi!. 0.....11 cxpen~ make such proVision as the engineer lIlay direct to take care ot' said urainage. On completion of said work herein cOlltemplated all rubhish and tll:bris shall be inllJlcdia!dy rt.'murel! amJ Ihe roadway and roadside shall he!ch neat and presentable and satisfactory to the cngincer. All of the work herein contemplated shall be dOllc under the supervision allllto the sathfactioll of the County Enginecr and the entire expense of said supervision shall be borne by the party or p;lrlies to whom this permit is issued. The Departnrelll of Publie Works hereby reserv" the right to order tlte chang' of location or the rernoval of any structure 0' stroctu," autltorized by this permit at any time. said change or removal 10 be made at the sole expense of tile pany or partics to whom this permit is issued, or their successors and assigns. All such changes. reconstruction or relocation by the grantees shall be done in such maTlller as will eause the least interference with any of the Coun- ty work and ,he Coon'y of Jefferson shall in no wise b, held liahl, for uny durnage to th' grantee by "ason of any such work by the County of Jclf,,- son. it agents or repn.:sentativcs. or by the exercise of uny rights by the County upon roads. streets, public places or structures in question. This pc,mi' or privilege shall not be deemed or held to be an exclusive one and shall not p,ohihittlte County from g","ing other pcrmits or franchise rights of like or other nature to other publie or private utilities, nor shall i, p,"ventthe CountY from using any of its roads, streets, '" poblic places, or af, feet its right to full supervision and control over nil or any part of them. none of which is hereby surrendered. The Department of Public Works may revoke. amend or cancel this permit or any of the provisiolls thereof at any time by giving written notice to the pcmtillee, The pcrmillce shall immediately remove all facilities from the right of way, Any facilities remainiog 01"0 the "ght of way )0 days aftcr writ, tcn notice of call1.-ellation shall be removed by the County at the expcn!.e of the pcrmillec. The pany or parties to whom this pcrmil is i..ued shall maintain at his or ,heir sole espcose the strocture or nb;'" for which ,his pcrmit is gramed in a condition satisfactory to the Department of Public Works. SPECIAL PROVISIONS: 1. No open cutting of Ludlow Bay Rd, will be allowed. 2. Cable shall be installed a minimum of 300 below existing shoulder. 3. l~~~~~~d during construction shall be restored to original condition. In accepting this permit the grantee, his successors and assigns. agree th;:1I any damage or injury done to the property of the grantee or any expcn!;C incurred by him through the operation of a contractor. working for the County or any County employce shall be at the sole expense of the grantee. his sne.~e!lo~s a,n~ a:sig:,,~ f) /P /l~ ( _I ~-.-J """:r- '-A/ ~~ K- lQ)' '" I~ ~ . the lmuersigncd. hereby accepts this permit subject to the terms and conditions as herein set forth, Dated this 3{ vJo~ ,I9W d,lyof C)-~~'1~ ~~~'{;~f( >~~" /r~~~ /"~~ JEFFERSON COUNTY DEPARTMENT OF PUBLIC WORKS Fee Paid__ Yes _ No 1820 Jellerson Streel P.O. Box 1220 Port Townsend, WA 98368 (206) 385.9160 Rcce'PI "'u. Address ReQuesl _ Yes _ No Mik Post AI'I'UCATION FOlll'lmMIT To Department of Public Works, Jefferson County, Washington. The ulldersigned U S West Communications (PNB) herebyappl_ jorpermissiollto bury cable along Paradise Bay Road (See attached sketch) IApp/I"U"I'",f/l/t'\udlt'fllll.\'",IIIIIIW"'I.\hl'.I/IIJ", S-16 & 21 T-28N R-1E Telephone Company Engineer Jim Williams, 478-4404 SKETCH: RECEIVED (See attached sketch) OCT 18 lSS8 JEFFERSON COUNTY PUBLIC WORKS DEPT, 011 CoulIlY Road: between (SIOWIII'UIO'Io/rm'B"..../tlfmil..fI('illl) and agree_ to do the work in accordance witlI your rules and regulatlons and subject (0 your inspection and approval. Date October 13, J9~ -Y-~ :."~r:,dfz;l- ICo""",..' (If applicant is a copartnership. set forth Ililmes of copartners) Addrc!\.\ ^ddre~\ Jcffcrson Co. District No. -? DEI'AnTMENT OF I'UIJUC WOnKS Permit No. (') q 02.., Su()cnisor's Iteporl No. Supervisor will make detailed report with his recommendation on this application lVhenever possible show sketch of proposed work. Supervisor will also make additional report~. and }illal report gil'ing date of completion of work all litis form. I)re'iminary n.eporl: ?m?M>;:S E B~'1 t-"'DLO,^" 8i1Y N/. .RI>. 111-;:>. 1.2'( fo /h'j::>. 0.00 -1-0 /h.p, ,11, p, /. :;-.; 0,5/ /Yo C-oK OL-D c\<\.T I'1-cc~D.5S BoRQ... lA.NbeR R \.::>, l~oi4-D. /l-;?11/c/lNT- C L. VI D L-Ow .13 flY At>,;) S/Mt..L ? '-1$;1 Dale: /0/<:,s/88 . , A,~ K~ Signed: Final Reporl: PdT INSPECTION REPORT . Work covered by permit has been compleled satisfaclorily. Work is nol completed. Recommend permit be cancelled. Traffic control - adequate - inadequate REMARKS nnle: c;-- g-.<t',/ SI~ned: Vl-. 0- .---' ~ '~ '7. J 1- Co .-<. C'b ~ ",<>I. <>J Q · .- 3 ~ 1- -I- l- I.?: ~ ~ '_j ~ lj IJ) m\J/!j- 1"')""'- V) ~ 'l. Gl j-/.. 'G \ \ '\1 \ \ \ \ \ \. . \:fi\ '\\ .. \ ~":\ \ \' \, '\\\ '\ :l' \ \ ~ \ \,' \ . \ \ s ~ \ - \ , " '" \l . <; '-' ~ " 1- 0 C c L"lO ~ ,J ~ ~ <).. f.. J G ~ ~ .~ ~ ~ rD ~ j 'G S- t1 J Q.. ~ ~ I-~ J ~f ~ I ~ I ,0 I ~ I ~ II~ r;-IO~ i i I I I 0 Lt '" ""I I ' i I I I ! o~t oJ ! ! I ,- i I -q I ~ '~ r i I I ! .., '< ~ " " ,~ .. " ~ '" " v v ~ C 0- ~ :><:':: ,--':~ ~ ~ ;:) 'I} .0;: :; ~ - 1'- '" , .9 I- 2:. ' .:; C>.. vI/') _..9 Jr- i;;; C l "" - J l!J < J t:> 1"'-:;;1,.)' J " VJO,:J-' ".l :: <:::; ~ ':: ;) I- :> ~ 3 "'- 17 " a.. I-!I ~ ~\-b'~ ~ '" ," ;... ! \[ "'~ ~ ~ ,,~~~"'ll) \l ':::!....J . '~ -t- ~ ~ ~o i .<; j.. I \J'- M 0( ."",tu"-At:! .0'" _ " '" <l: ~ ~ ~ '" ~ -;: l> ~ ~ II <t -:> . \) I ;:-: ~ <:::L Q <t "'" _ '" cC ""<:0 <t~l1.?~ ~ Alt)uQJ~I. '%: .5. .~.j 00 , ~ t 0...:; ,~ 'J ~ ~ )-...:J . Q .<: -..J "" ~ 't: ...) ..) ~- '" l.... ';!l <Q,~ N ~ ol ;) 1~S~\l"QJ'O j I, 1: ~ i!' ~ ,~ ~ .o;jO;;:o;o;l~"~\' .J " ~ ~ .... "<l '- J.... -.J <>; < ~ .s:: ... 1_ ~" '~v -.; ;:;) J >:J. ~ ~ <J";:...::i~";'~.J ':;/ /.J :l i..:'" ... l.!J "".,.l "I \/I ~ ; .,. -. <t ,I:; ..9 ~,..'" QC!.-3 <J ~~ '1l'~ ~ '~ "2 oJ 1- bo .( <6 ~.;: oJ? '" . 3 - 1- + /- ~ ;: ..9 1-.:.. <::. - 0, - \J I.!J m~e; I.!J - 1--)- '0 <:d. 761--51 "l." j-/..;; \ \ \ \ \, \ \ \ \\ \ " \ "., \ \ ~ \ ' \~\\\, ",I \ ~ \ \ \, I '\~ \\\ Co \ " :l \ \ 'I \ ~ . \ ' \ \ \ \ I , I I 0 Lr ""'I i I S G > o,J ., '0 " <;; v (J '" I- 0 ( v oJ - j "'- J..- 3 '2 G '.!J ,~ <;! ~ ~ c{? \ \ L"lO '* < j ~ s- ~ oJ (;l.. :v ~ I-~ i I ~ \ \ \ ..., '< -=l ~ :: ~ S' ~ C ~- J ~ v- t ~ :1 tf) ~/-~r' '" '" '::: ..9 I- r:. l <>" ~ .5 ~ ~ 12 v') - <: ~ :).;3c- v., "l: ~ '" ~ ~ o ~ 'oJ .~ .J- ~ ~ ~ f.... \J '- ........ v ~ D. - ~ ~ ~ ~'" ~<t \..!.; .:) ~ I~ ~ :- :2 ""- ~ () A \i) U ~ -l- .5".. d: I, o..-'l .t j J~~ .,0 "l2 . ~ 1 ~ l ~ j ~ '" ~ '3 ~ ~ It ....J ..,J " t ':i <:;"';:L ~ <J . - 'l! :;j7-lJ \!I t!. -.! '" ..... <t ,- ..3 a <:!...3 ~ ~ , ~ ~ ~ ~ ~ :;, t ~ ~ ~ " u >- ~ ;g ~ ~ ... ":!) ."J ~ j i' .~ j .:; ,~ OJ j ~ ..., \l ~ -..J '2:: N ~ ~ ~ ll'" () ) 'Q i:; ~ .~ ~ .... ...J ~ J'" ~ ~ ~ ~ 'l to' ... .<::I ~ ~ ..J \II .~ ~ '~ () .) ,.. II 1- "() '1 '~ ~ ~ l{j '" ~,) \,[ >-~ 'l:~ ~. ~ ':T V> " _ J " :r '< , .:, Co .J r- j J J ' J ~ ,~ ;) f-- I; " a.. .' ';..;-..;.. _ '~:.~::=~~>~.:..:.:..;.:';:':..t :-'.:'......~':.;.:','''~;.:.:' ':,:'.' ';~' _ _ ______ r---"""'r JEFFERSON COUNTY DEPARTMENT OF PUBLIC WORKS Fee Paid_ Yes _ No 1820 Jellerson Street P.O. Box 1220 Port Townsend. WA 98368 (206)385.9160 R<<cipt Nu Addrc!>> Request _ Yes _ No Mile: POM q I a Al'!'L1CATION FOI{ "EllMIT To Department of Public Works, Jefferson County, Washington. The undersigned U S WEST Communications (PNB) herebyappl_ forpermi;sion to place 190' of 5x drop across RllOdy Drive. (Please see attached sketch). Anderson Lk Road is al'S't1"'1n'Vo'tve'd' "/,,",, ",,/""""'" f26 SKETCH: RECEIVED APR 1 3 1989 JEFFERSON COUNTY PUBLIC WORKS DEPT. On County Road: between IStar..1/'.ar....'f'm,\I-\",...'nrmil..poilllJ and agree_ to do the work in accordance with your rutes and regulations and subject to your inspection and approval. Date April 11, 19~ ~01~(c:.l1if "'"""""", (I r applicant is a copartnership, sel forth nnmes of coparlllcrsl 611 6th Street Bremerton, Washington 98310 No.l.l.O{o ) <:J7"5S1r:70 Alldre\lo A,lllre" Jefferson Co. DiSlriCI No, b DEI>ARTMENT 0)0' J>UULlC WORKS Pef/nilNo. 0005' Supervisor's HCIJOrt No. Supervisor will make de/ailed repon wilh his recommendation Oil/his opplicolion. JVhenever po.')Sible show sketch of proposed work. Supervisor will also make addiliollal repons and final repo" gil'ing dale of complelion of work all this form. I'rellminury Reflort: u, 5. LJ<?si fiS;:;r:..s <'~5 ./o",v.. I (I) C v5 {""n<'r,> C OW'\h--:S'.. (.-It;.,.fl:.IC /-1'-~f"A')l V~ .u~ s""olcL.~ ;"oW,J.s '-' 0 /rok /." I-- r--e Ro/--o'f . Dale: "-1_1(.) -k'1 ; Signed: :=1) .=---- Final Report: PERMIT Y;SPECTlON REPORT ~ Work covered by permit has been completed satisfactorily. Work is not completed. Recommend permit be cancelled. Traffic control - adequate - inadequate REMARKS Dule: S'/l}, ~ Signed: ~ <"_ -- ~ , 1 .' , ,~ P8990 (6.Sl J i' .. ;-:--;:, ,,':i ' ,. '. II Pacific Northwest Bell Buried Service Wire. \ ~ ,;i< 1:,./; 1 No, t ,," ',"'" ~ Work Order Complete by ~ " ' , ,','> ,':'>,'; ":',;,/ i ',:,.,",,: WORK LOCATION CONTRACTOR'S ACCEPTANCE f " . ',', ; Address .;I,4R I ANDeRsoN Lie f<o , " -'- ~ Firm " City Jl+- T OuJNseJ') County ~2$,otJ State WA- Signature , Name:::::D RIC.f+ARD Le"ONA-12.O Title Date ..,'.'. .... > @ 'F\J eY2. ~"BJ Q.a> VI. 0 12'SCAP Etf' Unit Price 0 Cost Plus 0 Flat Sum 0 S 11 ORIGINATED BY T Cornsmc.t. Date 4/1.,/'2>'1 ) ~ ~g9~z~e ~-8~ Bill to: PACIFIC NORTHWEST BELL New S/O No, A ... Due Date - '1 , , R ' 0 0 395'_ IfoO 0 epalr Tei. N'@:-O:; _ ~36 Temporized Attention Rearrange 0 S/O No, Due Date_ Address Type of Service Cily Zip I eBL Pair Color/B.P. Term. Address I,", CD 7 ~/jo y-::; J: 145 Z- APPROVAL For Flat Sum/Cost Plus $ I, @ 7 8c.Q Y-Bi<. T,145Z- Recommended Date_ Approved by Date_ Contract Description of Work Reference Quantity PERMiT REOUIRED ~ Yes 0 No 'PL /1.>00' 3 - ;;1,,-1964- flcoo ' Receivedfrom ~c;,t+ ~; Irt1er verbai!Zf " '51::12.v/c.1f: WI/1/..$ Jurisdiction No,_Date f.I/l{eA '. 'iL '[)'WI(e, fur-/1 , 1 ,;' f COMPLETED BY Dale_ ,'. Call for Service Connection f' j l,ndi~ate,NOr!h"~ Sketch Work Required - Include Lengths, depths, wire size and amount ~~j I 'E\j~IZEtkl' Cgj\iU .~~'1 '''.' ...... TIT r,-R, \9.:,' , CuSTDffitP,'~' , 5'.,. 0;.0\ IRENa-\' , , ,'"', r 'z.o" ' . . , , , , , " r-' .fL'I~~ '. . "P.i~5z.. 1L 3-(3ovJ t'I 0 {{ .6 ~ :09 ~Rt=.. , , . , t : '7J'llo~~ " , J. .' ?L'.'D' Wl1fV '/1/' . . . . I ~c.\,.- 17 r r'L I :~l , ~w.livAL ' , , , I AN Oe2.5e.1\.l l.'L (.(1.) I '- .,: 1':J Ie' Note: This sketch may not be an accurate representation in all delails, it remains the contractor's responsibility to property locale work in the Iield. ~ '. , ORIG'~)lL r.npy ,'" ,. ~ " .. ' ,,' .',,:,.; ,'. ','. ' " "..', ',': :>" ,.:". : :, ....... ..' . '.' . ......- .... 1\ ", " ",e,,',' '. ...... : ":"" \ . ':, "'.'. ,. .. .' '<> . ..... ., ,.<::\ ' :,";':.:,: "". .... , .... ". , ......... . ,," ,",,'. " :',', , ," .':. ... :' .' ;""..e , ;, '..' ':')" ',:'" ,:." , "', ,1'; " " '.,:' ", , " ',.: '. :. I ..' , ~;. ,'..; L.--,'" .---1..." > . " '. ,." " ;:.: ' ' ". . " I " ':", I. ,,: , .'.. '..' , .... . , ", " , I~' :. :.' . . , ,",":' " - ,-',', ' ':::: I. ..:. .', . " I' I:, .' I:.~:.. - JEFFER:SOi cx::>U-4TY DEPARTJoIENT OF PUBL I C WORKS F' u: 60/ ?v8 ACTI ON REQUEST REQl.E:STED BY _ /J1 R. ' BA- k' e.J2.. DATE ' ~ - 2. I - 8 '1 ADDRti:SB- ~~Ol ,;:,\:)'....c.(J<.IeiJ,y R'I::>, PHCJNENO,- '3.€S--7'-1-n P<'>k!" '7Ow",Se",,") AJ.T, PH, NO,- NATu:-=. OF REQlEST- 0 IN PE~ Rav F"Ha'tE 0 BY LElTER TAKEN BY. ~ PERTAINING TO- DOFFICE: (gtENG/SI.JRVEY o ROAD MAINT. o EQUIP. MAINT. o SOLID wASTE RE~ST FCJR- s :'1N Rt'~,^e<:.-'- fOR B..,.t-, r',^RII E LOCATION- ROAD NAME $;, \);~u"~R'1 Rt:> ROAD NUoIBER 60/508 M,P, ~,2-b PRO.Ji=:CT _ PfIO,JECT TITLE FtfK).,JEc:T Nl..MBER. DES~""rION- mR, P,~L ep r;./~; m 5> -rAt' r,MC?JJr,lL 'N ~~(YV I CJ t= j,,<:., ho,~se. ,<., .5/,-,<-'- D"'fN'}eeo",.s, He H,,'-'K'::' IN" CI'1'N .o,^---r- '^ p ,~o fl.. e .s. ~;? /<.I oS 74, c:. o,.J "r1<?OL -r-R1'l-FF="-C, /,I.- 'Sf',Ys -rk(,<{ hAUl' h"'AR~e p"'L~;,.J'l Ou'r oF- df>/IL DR ~<.J"wAY. ATTACH MAP CR SKETOi REFER TO- 7c.o;--r- RESpOND BY. RESpONSE- r~p<Je. ';;9#.5 vv; f1, 2" M DI,I- /H> <.I'-sol? 7 e)< 757' C/,.,J Ba r-# e""..12..;S 61[; cV\~"e CAf>V/?.or-IS ' eJ.Os-'- -{;;<? -rRJI-Fr='-" -rR/lve.L,'N9 8,,.,-,-,0/ D:R.P,"-'-'-G>~ s:, -r~e ?RM?leYVl A:{>PPh!?" 14.- Be -11,,, P""oi'!- ~~'Q""r ';;/~~~:~ ~"'o"" j,,'., 9i,,-,vewffS/ .,(., 'Me 5"urll- ilIt!Jf~Si9;;5 111<7#"-' c.V\R~.:2. lJiS;I3:L,f/, PRtJ/<I~fV1. !tl/lyBe. peeD k, /2f'UlC/J-'/'e Di<~velo<J"''1 Oi/.h"<.JC(, REVIEWED BY- ~ DATE, :s -z-g -89 c:x:wT'ACTED REQt.ESTER 0 IN PERSO'I 0 BY Pt<<JNE 0 BY' LETTER CONTACTED BY. RE~TION- PREPARE EsT ""An:, FCA- RDtJ1'E TO- D. DIRECTOR o ASSIST",," DIR. o ROAD""""" I SCR INITIAL o CCNSTRUCTIQ'of ENG. _ 0 ACC'C)l.l'lllTANT o PLN'INING ENGINEER _ 0 o ADMIN, ASSISTANT _ 0 :;,;'"~:.:::'~~__~,_ :-"~"',J",.'- ~':...,.-~ ~,._'~_:_.._'.u;__.':""_ --;---.-.-:::--..--..- ",,1" \ ~~~.I} ~~r;1 ff~/~4:r'-""""\ I""J' 1Jpp. JEFFERSON COUNTY DEPARTMENT OF PUBLIC WORKS 1820 Jellerson Street P.O. Box 1220 Parl Townsend, WA 98368 (206) 385-9160 N~ 0905 Dislricl No, 3 PERMIT In accordancc with all applicable Revised Codes of Washington and amendments therelo, and subject to all the terms, condi, tions and provisions written or printed below or on any part of this form PERMISSION IS HEREBY GRANTED TO Thomas M. Young BEQ 2200 P.O, Box 292 Silverdale, WA 98315 to Install 30 feet of 18" culvert for a road approach to East Quilcene Road at mile post 4.30 1'" County Road No, 327508 Franchise No. Milepost 4. 30 't No work shall be done under this permit until the party or parties to whom it is granted shall have communicated with and received iastructions from Dave Ward - 765-3699 This permit shall be void unless the work herein contemplated shall havc been completed before Nov. 1 Dated at November 2 ,19 88 ,19 89 &~~~@W[8ID By ~~ K~ 1.800.424.5555 GENEnAL I'ROVISIONS AI'I'L1CABLE TO ALL I'ERMITS This permit is subject to all applicable provhions of the Revised Codes of Wa~hjngton. excepllhal any pro~'i!>iofl in thi\, agreemcnt nol C'.:lmi!.tent with such resolution shall be cannolling. A bond ill the amount of $ is required for the protection of the cvtJnI}' as set forth in the terms of the bond. During the ptogre~ of the wor~ such barriers shall be erected and maintained as ma)' be nc:ce!oSar)' or as mB)' be directed for the ptOlCClion of the traveling public; the barriers shall be properl)' lighted al night. In accepting this permit the petitioner. Ilis sUccc~or5 and lISSiglllo, agrees 10 prolect JdfcrMln County and !>a'.e it harmlc!oS from all claims, actions and damages of every kind and description which may accrue to or be suffered by an)' person or pcrWIIS, corporation or properly b)' rea~on of the perfor. mance of an)' such work, character of materials used or manner of installation. maintenance and operation or by the improper OCCUpanc)' of right of way or public place or public structure. and in ca!iC any suit or uction is brought agaimt said Jeffer!.on Count)' for damages arising out of or b)' reason of any of the above cause!>, the petitioner. his succe!.!.ors or assigns. will upon lIotice to him or them of commencemelll of such action. ddend the !.Sme at his or their own sole crn.t and eJl.pcnst: and will f>atisf)' any judgment after the !.aid !.uit or action shall have finall)' been determined if adver!.e to the Jef. ferson Count)', EJl.cept as herein authorized. no excavation shall be made or obstacle placed within the limits of a count)' road in such a manner as to interfere .....ith the travel over said rood. Except as herein authoril.cd. no eJl.cavation shall be made or obstacle placed within four (41 fe-.:t of the edge of the pavement. If the work done under this permit interferes in any .....a)' with the drainage of the county roa\\. the granlee !iohall wholly and at his own eJl.pcn!>(: make such provision as the engineer may direct to take care of S,3id drainage. On completion of said work herein contemplated all rubbish and debris shall be immediately removed and the road.....ay and roadside shalllx: icfl m:a! and presentable and sati!iofactor)' to the engineer. All of the work herein contemplated shall be done under the !ioupervision and to the sati!.faction of the County Engineer and the entire eJl.pen!.e of said supervision shall be borne by the party or parties to whom this permit is i!iosued, The Department of Public Works hereby reserves the right to order the change of location or the removal of any Structure or structures authorized by this permit at any time, said change or remo\'alto be made at the sole expeme of the party or parties to whom this permit is issued, or their !ioucce!.Sors and assigns. All such changes, reconstruction or relocation by the grantees shall be done in !iouch manner as will cause the lea!iot interference with an)' of the Coun. ty work and the Count)' of Jefferson shall in no wise be held liable for any damage to the grantee by reason of any such work by the County of Jeffer. son, it agents or representatives, or by the exercise of any rights by the County upon roads, Streets, public place!io or structures in que!iotion. This permit or privilege shall not be deemed or held to be an exclusive one and shall not prohibit the County from granting other permit!io or franchise rights of like or other nature to other publie or private utilitie!io, nor shall it prevent the COUnty from using any of its road!io. streets, or public place!io, or af. fect its right to full supervision and control over all or any part of them. none of which is hereby surrendered, The Department of Public Works may revoke, amend or cancel this permit or any of the provisions thereof at any time by giving wrinen notice to the pcrmiuee. The permittee shall immedialely remove all facilities from the right of way. Any facilities remaining upon the right of way 30 day!io aher writ. ten notice of cancellation shall be removed by the County at the expcn!oC of the pcrmince. The parly or parties 10 whom this pcrmit is i!iosued shall maintain at his or their sole expense the structure or object for which this permit is granted in a condition satisfactory to the Department of Public Works, SPECIAL PROVISIONS: 1. All areas dis=bed during construction of approach shall be ccmpletely restored to original condition. In accepting this permit the grantee, his successors and assigns, agree that any damage or injury done to the property of the grantee or any expense incurred by him through the operation of a contractor, working for the County or any County employee shall be at the sole expense of the grantee. his successors and assigns. and conditions as herein set forth. . the undersigned, hereb)' accepts this permit subject to the terms Dated this day of , 19 and agree_ to do the work in accordance with )'our rules and regulations and subject to your inspection and approt1ol. Dare J 0- ~/n 19~ ~~~{!I( C\.'''' O'..,~~. ~"" ~r~cant is a copartnership, '}orth nantes orcopa(.~!sl le:':"",1 ;,~ ," ^""~' .,' d S,p 'Po-f' LJ. 7 '..', ~.&4-# ~5'5//f' N"'V"'n_I\C\:,~ q~ ;: Phone No. "f'o/- #'4..$1" Phone Nu,-Sf; t - ~C\ ,JT I'... " , " '_:' , ' 100% ,ReCycled Paper ___ , ~ I . , ""," ,,_:{;i.:."" .'. ',,', '.' ,',..",,'.' ". ,.' " " ,.".;rTI;;;{ " , , ' "~,I ,', '--' I', ," , ',: "," ",.' > ' ",," '"',,, : I " ,: " "'. .'.' ,', " " ::", ',', ',', " :>'" ( ", ::' ' "'d ," ,,:'.:' ." .,'" ,,' .:,' :',:. "',' "~I ". " ". '.. .'1 .:J'. ":q, , .' ", ,,',. .: \'.' I, , ' , , "'I""", :"'."" , _..1 "", I.',.'," , ,'. -;c-, ,: ' ," ,~ -: ,. ,I " . :": I :"',,,:,<.,'. ',". .'1, ~ I " . . .1 I ."', r: ': j, ",' " ' ,:'1, ;, --' ',' ': . 'i. .~ ," ,', <. : ,,' . r ), " , l' , " , " ". I: .:~ ,I' , Ii.: '" I " I ~ ,,' Ii::, ' , \,.;, ' i,/ . ,'" ',," :. " " I , " . 1,'".," - 1",>< ld__ " . , \ "'~~'_~ ;.O{ '-- t; !,~h JEFFERSON COUNTY DEPARTMENT OF PUBLIC WORKS _r':J.1~~c..'J,Jj. T~':'g.", '-/' .rr: LI1l ~n KcuI!'II'Ou 1820 Jefferson Streel P.O. Box 1220 PorI Townsend, WA 98368 (206) 365,9160 Addn=" RequcM_ Yes_No Mile PU'>l Al'I'1.1CATION FOR l'ERMIT To Departmeat of Public Works, Jeffersoa County. Washington, ~ The undersigned 7'/l/JIiA:5' 1-/, ,'/-(Ntf- herebyappl_ for permission 10 ,~~ 0" ~-v-l ~ ~WJ.t.. Jir e>. O>-~ .~ OA",,"""'.'''JO''I'~'''''''I'''''''J'I \) SKETCH: ]~30~C~~~,k-~sot~ c>y-.,rr--,))r., ~&,wYt~ Ro-ac~ ~ " '. ...., On County Road.' ~~t. no-o..& '-1.20 0 ~ 7"7'rO bell\'een .. {Slall'/1l'Uft'\/rm,\\'lfrt't'/ormill'{l/llmJ - " . : -- '., I' ...'.' '.,; ........'.... . ;" '.' , " " , J..;i , . '.. ,,:: ,,;' .. .........; i , . ,"., , : : ." I" ",' . " , ' '," District No, :5 JeHerson Co. DEl'AIUMENT OF I'UHLlC wonKS Permi/No, (')90S- Supervisor's IlcllOrl Nu. Supefl1isor will make detailed report with his recommendation all Ihis applica/ioll. Whenever possible show sketch a/proposed work. Supervisor will also make additional reports am/fillal report giving date a/completion a/work all (his/orm. Preliminary IlclJOrl: // /"6 t-al,o-<?/J / ~ ~~"Ly ~ d~oP Dale: 0(.'.--1 . ,;) "f) I I t; -r8 I Signed: J(O~ LJtJi-J/ Final Report: PERMIT INSPECTION REPORT , l7 Work covered by permit has been completed satisfactorily. Work is not completed. Recommend permit be cancelled. Trame control - adequate - inadequate REMARKS Do..: ::> - q- J'i SI~n.d: ~<-- e___ JEFFERSON COUNTY DEPARTMENT OF PUBLIC WORKS ~ Fcc Paid_ Ye!f _ No 1820 Jellerson Street P.O. Box 1220 PorI Townsend, WA 98368 (2061385'9160 Re<<ipl No. Addrt!.S RcqueM _ Yes _ No Mile P~t J AI'I'L1CATJON FOR I'EIlMIT To Department of Public Works, Jefferson County, Washington, The undersigned ~ ,j?K..1Q.l''' _ hereby appl_ for perllli,sion 10 ~.n~ V~Jk't ^ ~I\ V 'AI'I'''''\J~ '/,::;',/. j,'Jr; .,., /'" .,,,,,, '" "" / SKETCH: ~~ On Coutlly Road:~~ R ~ bell\'een /"Lff (S/Oltll<'U'l'.I/(,,,,,\\',I/rt'l'/nrmil,,p(lill!1 to do the work ill accordance with your rules alld regulations and subjecllo your inspection Gild approval. "'l - (, 19~ JeHerson Cu. Disl riel No, 2... DEPARTMENT OF punuc WORKS Permit No. ~ Supervisur's Hc,lOrl No. Supervisor will make dewiletl report with his recommendation on this applicatioll. Whenever possible show sketch a/proposed work. Supervisor will also make additional reports and fillal report gilling date of comple/ioll of work on this form. Preliminary It.eporf: Dale: Final Report: PERMIT INSPECTION REPORT V Work covered by permit has been completed satisfactorily. Work is not com pie led. Recommend permil be cancelled. Traffic control - adequate - inadequale Signed: REMARKS -- fl/oiZK- a; i41f ( <s-'(-e V 'geFoi2e. oi)J->?'-;,v ,IAlI /1- Pe/?_,.." r f __ Date: 1r\-/7-9;C'\ SiAned: ~\,) 11. n,/, CQ. ~kV\ 2A.v ~...... -;- , =- . ". . '.',', '.' ',.- . .' '.:','.' . ", '..'.' . ..' './' .' ',,:".": ,:..', . ~:, . :t' .: , . ":;".:: , . ~>: . '~. . .. '.' \ '.. , . : ';" ,': ::,' \ May 12, 1989 ~~-;;.,Gi'7 ~t~~~::;iL ~~d< r(!;~;---"\ t?~' JEFFERSON COUNTY DEPARTMENT OF PUBLIC WORKS Duane E. Phinney Department of Fisheries 115 General Administration Building Olympia, WA 98504 Dear Duane, Tarboo Creek, WRIA #17.0129 Re: 1820 Jelferson Street P,O, Box 1220 Port Townsend, WA 98368 (206) 385.9160 Gary A. Rowe, P.E., Director Robert G. Nesbitt, P.E., County Engineer This particular blockage you are referring to is a concrete culvert. The problem is being corrected by a joint effort of Trout Unlimited and the Jefferson conservation District. I understand that a Hydraulic Permit has been issued or is in the process of being issued for this work. If you have any further questions, please feel free to contact me. Sincerely, ~~ County Engineer cc: CR #931507 : I, . '." \ "., ".. ~', " I:; , " ." c.... ',' ,,' ':-:-- -. ' ':' ,'. "', \ ':"', . ':. '., ' ( . . ':" I ::' :' :,':.. ." '. , , , . , . ~, .' .' , ; " I, ) 'I ,:,: '''.' \ ,. , .: , .,: ' ," .,,' : .':' '::. . :: II ': ," -' ,:' :, ''. :'" ''', I,' . I:,':",: ..,.',' , I:,::"" . \ ::::", .' ", ,', " , ,t, '.') , .,,',' ::' ,",'. 1(."'- :' ','.' I 100% Recycled Paper " ' . ~l> ,,' "'" ., , "':' :. . "::. ',.'.' : . ,"-:'. -,- '. ':':'. '. ".' '. .: ,," "', :'" .:'; \l::" :'.' ......'., i"':.".,.,:: i. . ,',' . :. .: , :" .' . l'"". ',,: I: .- i . :, .'-. ! '" i f' t ~'.."... ,,': '.',:.' "".:: '. . ",. " '. ':) ,,'.::." :> " , :".,r ::' .,'. :', :". .', , <",'.' ".,' '',',' ,.' ':" , ,,' .:: :::: . ,."f,... , , ." .":.: .' . ,', ",; , , '.': ,:i. '., ',-. " ': , ',' , ":.' ,: . " :,,'. , .' .' , , ':: ." ",. ,:,',' :.," " ,',', "1','," , ':. ", '~' -,,-------",.. 11. \ [~ ,./~ ~'!~4~if >.if.'~:I, rf/J~X' h N~ 0988 JEFFERSON COUNTY DEPARTMENT OF PUBLIC WORKS 1a20 Jetterson Street P.O. Box 1220 PorI Townsend, WA 98368 (206)385-9160 District No, 6 PERMIT In accordance with all applicable Revised Codes of Washington and amendments thereto, and subject to all the terms, condi' tions and provisions written Of printed below Of on any parl of this fOfm PERMISSION IS HEREBY GRANTED TO G. Baker Ent" I nc, P.O. Box 778, HadLock. WA 98339 to InstaL L a type C-1 conunercLaL ,accesS to the West sLde od Rhody Dr. at mLLe post 2.59. Access wLLL be 50' Ln wLdth and serve Lot 151 of Seventh Ave. Acre TractS. -:;€NP cor'! --d= i/?;I;-cA-rui <(hV'r"'~":> ;roIL .:/ County Road No, Franchise No. 2.59 952007 This permit shall be void unless the work hereia contemplated shall have been completed before March 23 Dated at March 23 ,1989 By -<J~ /<~ 1.800.424.5555 ,19 90 GENERAL l'nOVISIONS AI'I'UCAIIl,E TO ALL I'ERMITS This permit is subjccllo ull applicable provisions of the Hcviscu Cooes of Washington. exceJlI that any provisIoll ill tllis agreement nOI ClJtL\h,ICIH .....ilh such resolution !lhalJ be controlling. A bond in the amuullt of S is rClluircJ fur the protection of the cuumy <1\ .'Cl forth ill the tcrm.\ or the bond. During the progress uf the work such bourters shall be CICC1Ctl amllllaimaillcd as Illay be IICCCSS.U)' or as llIay he dircc.:tcd for the protection of ttie traveling public; the barriers shall be properly lighted uluight. In accepting this permit the petitioner, his succc!;.....urs ami assigns. :.tgrccs to pl'OtCl.:t JcHcrsoll COUlIlY amI save it harmless from all claims. ul;(iolls UllU damages of eyery kind allLI description which Illay accrue to or he suffercd by allY person or per!\OllS, corporation or propc:rty by reason of the perfor- mance of any such work. character of materials lIsed or lIl:lIIl1er of installation, maintenance and openuiulI or by the improper oc~upatlC)' of right of way or public place or public structllre, and in ca!>C any suit or action b brOil ell! against said Jefferson Coullty fur damages arising out of or by u:a"O/l of any of the ubove causes, t/lt.: jlCtitioner, his successors or assiglls, will upon I\(llice to IJim or theln of COlnmel\(;crnent uf such action, defend the ~rne at his or their own sole cost and expense and will satisfy any judgmcnt after the saiJ suit or action shall have finally been determincd if adverse to the Jd. fersol1 County, Exccpt as herein authorized, no excavalion shalt be made or obl>lacle placed within the limits of a county road ill such a milliner as to interfcre with the travel ovcr said road. Except as herein authori/cd, 110 excuvation shall he maue or llhstach: pl.u:eJ within fOllr (4) fcet 01' the edge {If the pavemcnt. If the work done under this permit interferes in any way with the drilinage ul" tILe cuulLty ruad. the gralltec ~balJ wholly allJ at hi!. own cxpcn~c make such provision as the cngineer may llirect to lUke care of said drainage. On compleljon of SOlid work Jlerdl1 conlcmpJaled all ruhhish >JlIrJ dehris !.JwlJ be immcrJkucJy !L'l1loycd JmrJ the roadwJlY .:JmJ WJlhidc s1lall lx' JcfJ m'.al and presentable and satisfactory to the engineer. All of the work hcrein contemplated shall be done under the supervision and to the sati~factiun of the Cuunty Engineer and the entirc expense of said supervision shall be borne by the party or parties to whom this permit is issued. The Departmcnt of Public Works hereby reserves the right to order the change of location or the removal of any structure or structures authoriled by this permit at any time, said change or rernovalto be Illade at thl: sok expense of the pafty or partie!. to wholllthis permit is issued, or their succc!.MJrs and assigns. All such changes, reconstruction or relocation by the grantees shall he done in such manner as will cause the least interference with any of the Coun- ty work and the Coullty of Jefferson shall in no wise be held liuble for allY d:unuge to the grantee by reason of any such work by the County of Jeffcr- son, it agents or represcntatives, or by the exercise of any rights by the County upon roads, streets, public places or structures in question. This permit or privilege shall not be deemed or held to be: an exclusive one and shall nol prohibit the County ftom granting other permits or franchise rights of like or other nature to other public or private utilities, Ilor shall it prevent the COUnty from using any of its eo:lds, streets, or puhlic places, or af. fect its right to full supervision and comeol over all or any part of them, none of which is hereby surrenJereJ. The Department of Public Works may revoke, amend or cancclthis permit or any of the provisions thereof at uny time by giving wrillcn notice to the permittee. The permittee shall immediately remove all facilities from the right lll'way. Any facilities remaining upon tile right of way 30daysafter writ. ten notice of cancellation shall be removed by the County at the cxpeme of the permittce. The party or parties to whom this permit is issued slwll maintain at his or their sole cxpense the structure ur object for .....hich this permit is granted in a condition satisfactory to the Departmcnt of Public Works. SPECIAL PROVISIONS: 1. No cuLvert requLred at thLs LocatLon. Ln wLdth. Approach shall be 50 feet 2. ApplLcant shall be responsLble for all damages to county road rLght of way. In accepting this permit the grantee, his successors and assigns, agree thnt uny damage or injury done to the property of the grantee or any expense incurred by him through the operation of a contractor, working for the Coullty or any County employee shall be at the sole expense of the grnntee, his :cccsso;, an~ a~ig2s~,.. ~ I,., /.l~ . '1C, ,. q Po..ll:..c..1 o:ft;.. ,....)f? ,the undersigneJ, hereby llcCeptS this permit subject to the terms and conditions ns herein set forth. Dated this-X:" U> day ()r~ ~L ,1-:1'[1 A(1plICUlll tvl{f~~' Sun.1o:':{ )r;io.ob.rw-' "I ~ / \ JEFFERSON COUNTY DEPARTMENT OF PUBLIC WORKS 1620 Jelferson Street P.O. Box 1220 PorI Townsend, WA 98366 (206) 38~.9160 Fee Pajd~ Yes _ No -3Ill.1-c Reu'r>i r-;'o. Address RC4UL~t_ Yes_No Mile PU'it AI'I'UCATION FOil I'EHMIT I~ ~sP~~ ~' .x:>2-J;.. <.3~/g't To Department of Pubiic Works, Jefferson County. Washington, J The undersigned fl ,(!3 ,.d.,r-p-:.-e E;,.;I", for permission 10 . . /lOslnc<.. --~ hereby app'y- ~ c:i'<.I~e. ~(' Ap~,yJ. (C-;) ~~d /Il~. +ta<J ItA Lo+ ,Z:A/C, ,q C!JI/l' Rei ..-I4j?4.J<!l<'4 r:. ;'t""1::;:;::fJ;t ";; ()~ ~a2tr. ~ lS'f O/r .s;e-€.. SKETCH: See A-trA-c:-he.d f11Nf on.,C?1/I1IY Road: \-J-v I- M tl-r...l ~ ~"<- between Tf2.<)tJ dA-c€. J /hJd (Slalflll'f/,,""rmU'.\If<'f'ff>flllil"fIOim; and agree_ 10 do the lVork in accordance with your rules and regulations and subject to your inspection and approval. ~ /9_ ~e ISlllnutulcur ^l1pll,anll (ConlraclOrl ~'1e ~;kd!..Ji2l:;,IL-02A ~!? 339 Phone No.--38S'- 0/2..5 (If applicant is a copartnership, set fOrlh nllmes or copartners) Addrc~' .'.' '.' - .'--C .'; :; ",' '.' :.' .::. c. . ,... ., I,' '. .,'.' :... " .' f.... l- .'.. j ~ ,'. '1 I ~ i.... " .'; ....... . .' :1: ;: ".,. ........ i :, " .~ ; ..... > . J . ....~ '.' '. .... . ".: ..,: ':'"" :....: ". ..... ". . : ".'. .. ". ..',. I 1/ .; . . :.'. .' I .j .', '. '..' .... .... . . '. , rW- . '.' . .' ..1 _____ }- I"r' '. '- --:-L- ...i ~4 :: . . . - 1 --- , .. . .' . SEC. .3 ,/ . ~ :: . . ~-+~ I ',:. :"'f"'7""i''(:i '., .. ~~ - ....., I : ,/ .d ~ :',.' R~~'7'""'t~ '. .>:':' (-tee ~d-~ . . . J':~';:;' ". .~~- ~ 151 15~::~'k~:~ !1\;~B9 I; ~~i,<~'j'> . .'. 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' ;." . ,. :. , . ' I .......,.. .... ,...::.. L ~.' ". i .... '". . ..' ':. ' . ,..' i' . .... ;, '. ' .,...' '.. .,....,; . ....< ',: , '.....: '" .. . . .\ .... .......'. ' I., ...... ..' . .... ..... ! ....,..... 75 .' .' '. ,.': ". . .'. /'.,<' . . .. . ..':':..: '. ..:.;.....;.. . \':'>>,<::: ':: i:,:;~ . ., '" .... .:i',... . ',:, . , ','. '.' '.. ....... . .....0 /:~ ',"" . " '. . '. .' .... ....... ';,?"" " .....' ...... ,.... " , '.:.. . '............" ...... ~ '" ''-'.. ::..,., :. ',':.',' .\:.< . ,".': '. , . :.: .' .' ..... , :,. .,. '. ' ~ ' . ..' ,. ,. . ~; / , "..... . .. . .... "'f , .. ' '.. .' ...... " .,.'. .: . ,,: '. :,', . }"h;;J;' I, ,'\~;i~ ,.,' ., " '. '. '. ':: \' . C , ' I~. ;, . . ., <'.... : , i .. ., , ; . .'." ~ :' . ,.' . ".:" : :. ':, . : i I " " I .- ,', , f f i ,: l I" Ii I': '\. , ..,"/ ".., ,...' , .', . ',: ,,', ',,<,' ',', c' ". .' .' ,'. ..' "'.' ..' ,.... .',..: .....,/ "':':':',', .' .:,,' ',:' '..,.' ".,..' :. ," . ," ". :, ..,',.' " ,: , :. . . " .:: :1,':', ,.' ' .' ;.. ,', .!, . . . .,.,'.." I.'.... '.. , '.,1 .. ,',". ":. , . i , ::; ':'.:" ; ':i<::i i' I' , : ',,'. COUNTt ROAD NO. ,0r<>,o.) ~~ d) Co; ADDRESSING YES NO MILE POST - - OFFICE USE ONLY PERMIT NO. $6'-/-/3-( JEFFERSON COUNTY DEPARTMENT OF PUBLIC WORKS Jefferson County Courthouse Port Townsend, WA 98368 FEE PAID QFFICE III, /) _Yes --':'No .USE. ?NLY ' . II b.u (;/:::.., o I" APPLICATION FOR ROAD APPROACH CHECK ONE:" c:J RESIDENTIAL" 18J COMMERCIAL Applicaticin is he;'by made for a pe=it to construct. operate and maintain a road aPzoach. Please describe loaction (...tt...ch IllIlp or dr...wing) aCC:e.5,S de::.,.""S.s ,f"6"e/" 1&1"",,, /ltJ~u u.e. ;::"ro'M. BI o>cJ::' Z 3 7;i ';>1",,- k ~I a v..r ~ t!J' tV,.d... CAa/,III"'''S .2~'/' a.,,).!"!-'<Pk T;;'" r...".,,'/,.,/~I' Applicant agrees to perform the work in strict compliance with the terms And conditions out herein. and ~ny speci...l provisions ...tt...ched hereto. ; Applicant Name GA ry L J", H.s'en 'Contractor NlUIIe Address ,~tt W ,c;-:I.!A ~"'7 . Address ,.1/"",//". '" AI 0>0 q,R ;u R' Applicant Sign...ture ~~ ~ ~A'~ Contr...ctor Signature Date/1-/,5'- 79' PhonE!"""-"R..r#'~?/? 'J!"~K. Date Phone Note: J:ndemnity provisions of par...graph" 2 'and'3.on 'reverse side. ' .', "" ,.' .'.", ; PERM I T &~~ill; Subject ~ th~ terms ...nd conditions On the reverse side. .PERMISSION IS.IIEREBY,GRANTED to" Applic...".t to construct. operate and ma'intain a Ioad appro...ch....s. requested .above.,...nd ....r;~" special.~~~~:~6~O:~ a~~a~c~~~... h~re;t.o.'" . ". . .' . ,-.> . './" ~': ;' <.. ~.~. .,;...~':.:: . No work sh...ll'be done'~de'r ~his ~permit until 'the ...pplic...nt or-'co.ntractPrhas noHfj.ed of /':'- ~ b~~?- '~..v~/~.D;'/ - . telephone '('QJ;5:..' 'J /6'7'" ),; APPROVED Byf'71'JJd a rz;f:;J~ " Date' /'//p'/cftf: *-. :5b,:,.;.,--4:"~ '$ri!.O'-i:c. I~ '" /. " ", ,,'~. , ,,'.,,' ,":.,', . ..... PERMIT INSPECTION REPORT.'-" " f~l ~ ;;;~ fCALL ...:... t ~ iIfO BEFORE J... YOU DIG -:- f'.1 @ . I " . . work' covered by permit has been completed ------- satisfactorily. ' i -,--work is not completed. , ~ecommend permit be cancelled. _______Traffic control - adequ...te inadequate~ 1-800-424-5555 REMARKS J:NSPECTEP BY: DATE' FOfm 113-0 (RovA 2'JlZI .' 'L" . '-. ','. ~." ,." j .' '1 .,. . T . '. ..,' . .... ....... '. , . '.. .' .>. . ' ':,' .,- " .' , . :. " ", '. ......, ,: ,'-.. ': !.... . '. . '. : " ,:. .') . '." . , set .... .....'. +; . ','..";. .', , ~-: . ,'.' ," . : ..-'. '.' , , . .'. ., . ",,' :.':, . ' " , : , "". .. . . ',. ;'.' , I:' '. " ., ". 0.,' ..:..., . ,: : . .. . : ,,' , '" .... '.. . .'. , . ........ ". ,',,,..". '.-:" ".:>',', '.'....-,') ". ~(:1Y~ . . ...' ': , .,- ;' '.. .... :.. ..... . ", ... , "" ~. ..:. I11III GENERAL PROVISIONS 1. THIS PERHIT IS SUBJECT TO RC1I 36.75.130, .1qO AHD ,150 AND AMEHDHENTS THERETD, 2. THE GRANTEE" ITS SUCCESSORS AND ASSIGNS.. AGREES TO PROTECT JEFFERSON COUNTY AND SAVE IT HARHLESS FROI1 ALL CLAIMS.. ACTIONS OR DAl'1AGES OF EVERY KIND AND DESCRIPTION WHICH HAY ACCRue TO OR BE SUFFERED BY ANY PERSON. PERSONS.. OR PROPERTY BY REASON OF THE PEAFORI'tANCE OF ANY SUCH WORK.. CHARACTER OF MATERIALS USED OR HANNER OF INSTALLATION.. IN CASE AAV SUIT OR ACTION IS BROUGHT AGAINST THE COUNT., FOR DAMAGES ARISING our OF OR BY REASON OF ANY OF THE ABove CAUSES, THE PETIT,IONER.. ITS SUCCESSORS OR ASSIGNS WILL.. UPON NOTICE OF COMMENCE- MENT OF SUCH ACTION.. DEFEND THE SAME AT ITS SOLE EXPENse AND SATISFY MY JUDGEMENT ARISING THEREFROI1 IF DETERMINED ADVERSE TO JEFFERSON COUNTY. . 3. IF THE GRANTEE ENTERS INTO A CONTRACT OR AGREEMENT WITH A THIRD PARTY TO PERFORI1 THE WORK AUTHORIZED ~:D~~~:F~~R~~[D ~~~M[~~:D A~~R~~FE~~ ~H:A~~U~;Y T~~ ~~~~~g~~~ 1~1 T~O~H~ T:R~~7~'~~~~ ~: T~A~:~=1~~~2:G:~~~E ~o 4. ~Y T~~~A~~R~~T"1~ ~rNr~~ ~g~~{~~~~~OHAH~O:~Q~~=~~~~~: =~~~:= ~DgAy~R S~:ttu:~~~C~H~H~;R:E~~I~H~O G~~~~E_ LATlON AS HEREIN PROVIDED. .5. DURiNG THE CONSTRUCTION OF THE FACILITY~ THE GRANTEe SHALL COMPLY WITH THE MANUAl ON UNU'nRM TRAFllrrc CONTRnt '. DEVICE~ FOA STRFFTS AND HIr.I-lWAV!I PUBLISHED BY THE u.s. DEPARTMENT OF TRAHSPORTATlOH. .. 6. ON COMPLETION 0' SAID WORK HERerN CONTEHPLATED~ ALL RUBBISH AHe DEBRIS SHALL BI! IHI1EDIATELY REMOVED AHD THE ROADWAY AND ROADSIDE SHALL BE LEfT NEA' AHD PRESENTABLE AND SATISFACTORY TO THE COUNTY. ... ....\..:., 'i T.' THI! COUNTY RESERVES THe'RIGin'TO ORDER THE CHANGE 0" LOCATION OR ft.r!: REMOVAL O. u.y 'STRUCTURE Oil STRUCTURES AUTHORIZED BY THIS PER,UT AT MY TUiE~ SAID CHANGE OR REMOVAL TO BE /'\ADE AT SOU. EXPENSI! 0' THI!. PARTY OR .... PARTIES TO WHOft THIS PERMIT IS ISSUED~ OR THEIR SUCCESSORS AND ASSIGNS. ' :~~ ~~~:T. Cr~~::ER~i~N~r~:fr~~N 0~\~~Lg5~~:S'l s B:O~~! A~SA~::~E~~~~L Cg~N~~H~Hl~l. S~HN~ :1;~E:E A~E~lt I ~:~:. FOR ANY DAMAGE TO THE GRANTEE BY REASON OF ANY SUCH WORK BY' JEFFERSON COUNTY. ITS AGENTS OR REPRESENTATIVES.. OR BY THE EX.[RCISE OF ANY RIGHTS BY THE COUNTY UPON ROADS, STREETS, PUBLIC PLACES OR STRUCTURES IN QUESTIOff.- THI! GRANTEE SHALL NOTIFY THE COUNTY'S REPRESENTATIVE UPON COI1PLETlCN 0' THE WORK UNDER THIS PER"lT SO 'THAT Ai FINAL INSPECTlOIt CAN BY ......DE. .. ___ 8. ..,----- ~. SPECIAL PROVISIONS APPLICABLE PROVISIOHS ARI! DENOTED BY AN (X) o 1. A COpy 0' THE PERfilT SHALL BE ON THE JOB SITE~ .'AND PROTE~TED FRO" THE ELEMENTS, AT ALL TIMES DURING THE . t' '.j CONSTRUCTION AUTHORIZED BY' SAID PEIU1IT WITHIM THE COUNTY S RIGHT-Of~WAY. . .; '. I _;~:.:. 0,2. . THE APPROACH SHALL BE CONSTRUCTED 1M ACCORDANCE WITH THE ATTACHED DESIGN PLATE TYPt! . ~. :..i APPROACH. A FT.lEHGTH OF INCH DIAMETER CULVERT PIPE SHALi:"'1iE"'PmE~ onCH AND LAID TO A TRUE LINE AND GRADE. THE APPROACH SHALL BE SURFACE!) TO THE LIMITS AS SHOWN ON ~~~E~~mG A~~ ~~=F~~~D:A~~R T~~o~p~:~ei~E S~~~~E:~Y I~Nrgc~~e:;~E R1~~~-~~~w:~0:I~E ~g;T:~L p~:Mr~~E~~AN. o' 3. THE APPROACH SHALL BE SUFFICIENTLY SURFACED BACK AN ADEQUATe DISTANCE FROI1 THE EDGE 0' THE PAVEMENT TO PREVENT ANY MUD TRACkING ONTO THE COUNTY ROAD. ANY HUD TRACkED ONTO THE COUNTY ROAD SHALL BE IMMEDIATELY. CLEANED UP BY THE GRANTEE OR HIS AGENT. ': 0 q. IF NECESSARY TD INCREASE SIGHT DISTAHCE, STUMPS AHD BRUSM SHALL BE REHDVED FROI1 BOTH SIDES OF THE e:r~~A~~ALLT~~T':~I:~=~~~~:~Eo~U~~~:~yO:o~~R~~~~~~~~wl~~BER OR DISFIGURING OF ANY FEATURE OF SCENIC o 5. ~~~~N~~~~L BE RESTRICTED TO THE HOURS BETWEEN 9:ooA,I1. AHD 4:00p.M. UNLESS OTHERWise AUTHORIZED BY THE o 6. A SURETy BOND IN THE AMOUNT OF , ~ WIUTTEN BY A SURETY COMPANY AUTHORIZED TO DO BUSINESS IN THE STATE OF WASHINGTON, SHALL BE FURNISHED TO INSURE COMPLIANCE WITH ANY AND ALL OF THE TERMS AND CONDITIONS OF THIS PERMIT AND SHALL REMAIN IN FORCE UNTIL ALL WORK UNDER THIS PERl1lf HAS BEEN COMPLETED AND APPROVED BY THE COUNTY. BEFORE ANY LOG HAULING OPERATIONS BEGIN~ A SURETY BOND IN THE AMOUNT OF '_' . SHALL BE FURNISHED BY THE GRANTEE TO PROTECT THE COUNTY AGAINST ANY DAI1AGE TO THE COUNTY ROAD AND TO INSURE COMPLETE REMOVAL OF THE APPROACH AND ClEAHING UP OF THE RIGHT.OF.WAY TO THE SATISFACTION OF THE COUNTY. APPROVAL OF ALL CLEAH UP WORK SHALL BE SECURED BEFORE THE BOND WILL BE RELEASED, SPECIAL CDNSIDE,MTIONS of;C' ..<:o~~,.vc; /05 .$C' ~~N m""o~6 Y-'/C47"'/O,,) /?.-eou~"/'~?J "t?/fE c,,~phr....,), ~~;"C:.4.vr ~u';7'" 9/1"," .;rFrr.~"e:s.:...,;; G'h.Jr~ ,'5"C).z. I!?/' r#~ /J1/t-c.. Y4t-Gf'C / ~r rill' 7/M&,( 6A.J/,-- OfAd,-Y .P/9/rr- rv' ~ W~ "/ / / / 07. .z1 8. Form 113 b 'M-~_\IlI1I ~ :~..._!'"- =.,t. = t / ',""".'" ", '. ,", ',,' ':,. . i/:: '. ",.""", - -:>"'jl ~r ",: 'c,. ,:,: '.,', ::: " ", " '~"h " :",:""',:,,~.: ,:--,":. "~',. ; ", ,','- :';,:';.i: :':,':,<: ;. ," '.:', .' ::-:::"':'>"':;,:',::::'1 jo. '., "." I j~: , L': ',. '... .' . ',;, ':', " '.', " , , ,:i~:~~ , " ' .', , , . " .;,' ;,. " ! J: ( . .' , ,"', i " '. l r , \ ! 1 " , ; ,,:, ~ ,.'-'" ,; , L .':,': -~ F~:' !~~ _. '.,rt:-; ., ,;.2::: " ~. ': ., ,. : , "i I: '::." I' I.', -- :,: .m:," DISTANCE REQUlREHENTs,' !- ."OSTEn SIGHT DISTANCE !:' SPEED LIMIT, HINIHUM DESIRE.l.8LE ..':' 2S -. : ,.,30 '. '5 40 45 SO . '" - (' " , " ',,.' ',---"1.'.'.'. "",1, .' , ,'., " '".,' , " , "', ' ""'" .,: .' ,", , :, I "'" f."":' I'. '. ,< . :. ..'. . ", '.' ' :, " " " . :'" ,',,:"'," " .', ""." :' ,: " " ;, !' ,', " ;', , :< .' ---.." '''''1'-, '", ",. ,'.", ", '.. I m, ,- __ I ..,--.. -,"---.- ---....---..:,.. "'TYPE .-1 '~,~.... . .. - ,,-0-, ,.- r ,,:-' -. .::-" ..:: f'RIVATE flOAO APPROACH' .... j:~:1i~~i~~-:-~~:1f~11~~t..: - . :-"f- ~t~-:,~~J1:;' :-E~E~? .. , ;,~ :R9im'.. . ~ t J~/ ~':.i:m-;;;:;'~"'" , :' , :': :::: , 7':' ,:' : ,'...Z-Oi...in,Cu;.,.'t-" tOmln.ll.d, ':, ' zom..,flrl:~I.llng IIIUd>':- ':'-"::,~' .... ... .-:1.1. ".-~-r.~..... ..... ...-;--- --- . ;,.... :'.T-.-.j : f.' , '.... ',. 0; "~!~~l.._:',-t"';'" ,- ;:,,:i~~.'~~~:7, , , -. ... .,., - '.'.' ,_' ____,_, , :,:~ :t :', , , :', '",> ',: I', 1 . , " L:... .. ';. , ",", ",'" 47 ?I. ,p~ Date ~Aft~ r;; ., a9ft~ \ ',' Chairman, Board of jt ;" "",: '~;;;n_ti3:c,~",!~:"::,,,~:'tY~amd~8iOners . '..__"._~~,..,_~:te~_~-!!~. \ '.B"i i,i L" " .. .. !'~,.I~"..~"',... ~ -~.. COUNTY ~OAD, ..., , , VarMa ~::. '!: -.'" ~. t . . ..'--'. . "':,', "':,,: ,:' i:-, "". " ," '. "'.'. ",';;~:' . , ....".'"i, ',', ' ;', ". ':":.,:' ',:' . " i..,"" .... ." : ..,..., '. i ;'. "" ": ".' I:' '.', ;','.:, ' I;,.': '.' '.' ,c,'.',' .. I; .'. ',,' ..... '. ' I,. . ,........L 1;/, _ ~OTES: ..~.::.... 160 FT. 200 FT. 240 FT. 275 FT., !IS FT. 350 FT. 200 FT. 240 FT. 275 FT. 350 FT. 410 FT. 475 FT. 1.) Culvert shall meet mnbnm specifications " '~or HS-20 lOading. Approved t)'pes include: 1) concrete 2) corrugated metal ;J> corrugated polyethylene I:ubi,ng-AASHTO f2.J~)'. t:ounty road shoulder shall be left at existing profile. 2.) #J'PROVALS : Director. Department of Public Works . ". - .-. ~ ~ ~. --, ..:....::..-."":'...I...l..-__. i. ~l..,... ~~~. .. . I .. ... ....-.. '- ..-.----- " ' - "<t1l11ll,...Il r/':' . .' ...... .'.::;'>: i....... ...........:. ""'''.' '," ',\, .' ", ' .:.........: .:.:..."......, "':.' '.', ",:,,,,, , , . , .-' " ,: , "',:.::, .'.,,'" . ...... ":<', ~"". :',,'.,., "::""'Sd:'''~':~ . . ." ".; : . Co'., , " ,: "." " " -.J" . " . ':, ,,' , " ': ' """ ." ""'.: "':'1'."" , .! ' - " - ". . , Sketch: " , , "" :,' " On County Road between <, .: ' . . ,,:;:,':"., " ." , '. .- :',. :,:, ...-.:;. ' ,.' ',." ,.. . >", ......,..:.'...'"..,. . .... .... ' "'. :: .' : '.'. .." , , ,: . " 1 ," ".-: :.' ','. ":',':. ' ::':.,':.' ':: :" I.' ". .' .'. 'i,.. .,'. .' Ii" .' Ii ".' , , I l,' "', I .' :", . P. . '. r::,: .,.',.' ,,' ' I) .,' .',.,,' ..'. :'L ':j".',>:::, ,'.. ' ..,::' .' , ::.': :'. :. ;: '.' . .'.... I:, l' '. y.., \. 1 ' I . , : .' . , III APPLICATION FOR PERMIT - . ;, ..: ...: '. " ~.,....~'~ ;::';} .';1 , ':.': .. 1 '. , ..... '.P,': .,....,:,'. . .' " . 'c.' I: "'.' : :. .' ." I .' I " :. TO: Jefferson County Department of Public Works Courthouse Port Townsend, WA 98368 The undersigned GdJAV L ...../.e)-(.$"""'- / hereby appl ies for permission to C/PAJ' T;",,,,,~ e>.J?C R"'",d"~k ./....,'" h2v, J'..dH< I('),d 1" dJ"/tle. /;; 1.",1- ;7 t1 L?t K, 2' I c/,"'I........"'$ ".,/,,):z:;; :Z:-Y""''/./-L .......:.:.. C' , :i: ..:..... ", ',: and agrees to perform work in accordance with all rules and regulations applicable as on this document and subject to inspection and approval by JEFFERSON COUNTY DEPARTMENT OF PUBLIC WORKS. ' Jdy 7(/~~J" Appl icant 3..?&' g R#da:V dr Address C, /: fI-~'/ /~~,f' lJu. ~ g .YJ 9 3E?.5- ?,t?/~ /2 -I$?- ~9 Phone Number Date ' APPROVED BY:~~~ ~~ , : DATE: / ~G /g-t- ;- :' < Page 1 (please see reverse) :' , I',: " ". ... ,- '. :"'" ',.' ,,' : . , c.'..' .,': .,: . > ',.,' ,', "..::: ' .':,: ' .,,' ,." ...':,,'-., ". ,.',-, :.":,. .',::, . ~'....'. '."" :. ' ": ",,:: " ':, ",' . . ",' "" '.'" " " -' ,',. ':,' ~ .~. ........ , , ",". ", ',"'" ,:,; '( '," ", " , " '"..: ' .~.,"" I " . '. '."""'," ,,' . . ! , , "\ ": ",. ' ,.., , ',', .:"." c' . '," , . . ' ", ,.' " "'", ,',.:, ' '. ': ' . " " ",' . , ;" I Ii, k :i " .' ,',. i , :;, .- p, t.., '\ ,:,' :; , :,: \ ~ ',' s " 'L , ., . :' "'" " c,' "." .",: , .' PERf11T NUMBER COUNTY ROAD NUMBER PER M I T " Subject to the following terms and conditions. PERMISSION IS HEREBY GRANTED to Applicant to perform work as described on the reverse of this document. This permit is conditioned upon Applicant's compliance with the general provisions set out herein. and any special provisions attached hereto. GENERAL PROVISIONS: In case of any damage to said streets. avenues. alleys. roads. high- ways. turn-outs, gutters; ditches. wood or concrete walks. drain pepes, hand or embank- ment rails. bridges. and any and all other appurtenances by the Grantee. the said Grantee agrees to repair such damage at the earliest time possible at his own cost and expense. The Grantee. its sucessors and assigns. agrees to protect Jefferson County and save it harmless from all claims. actions or damages of every kind and description which may ac- crue to or be suffered by any person. persons. or property by reason of the performance of any such work. character of materials used or manner of installation, maintenance and operation. or by the occupancy of rights of way by the Grantee; in case any suit or action is brought against the County for damages arising out of or by reason of any of the above cause, the petitioner, its sucessors or assigns will. upon notice of commence- ment of such action. defend the same at its sole cost and expense and satisfy any judge- ment arising therefrom if determined adverse to the County. During the progress of the work such barriers shall be erected and maintained as may be necessary or as may be directed for the protection of the traveling public; the barriers shall be properly lighted at night. On completion of said work herein contemplated all rubbish and debris shall be immediately removed and the roadway and roadside shall be left neat and presentable and satisfactory to the Department. +++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++~+++++++++++++++ Permit Inspection Report: .',:,,' ",'." . .' ': Inspected By Date Page 2 V1Ul\.1lIli'!l'II$llv-" -:- , :'. ~ "- . .' :II , '.; ') ':,.'':",/ ]' , ': " i -",;<~~ 1 ", "" ';< 'I ." ",.,':., ' i ' ,,"', ",'; . ,;",",":", : ,:..', '" ':,,: ", ..,;/ :. "<:,\ '. ", "",:,'. ".,' , -:: , ",; ,.:. ':, : '. ,:.-., ,: : ~' ""'.: '< ..,',' ',: ,', , "', . . ::: , .' '. . " ,',. , ' ... " :', ': ,':, , " .' "<: , , , .' ..-' " " ': ,:.' :'" ' ','.',,; ,," , . ,,', .." ,'" ' , , ,", :,,' .'.' ',:, , " , ",',/ ,', ',"'.,,',.',::" .', , ':' ',:",:" ,,': ", " ,.'" -', . .. '" : , ",'",':", ' ';c, ',':',' " '" ~ ">"" , ':''.'' ': ' ,,;' :,; ,":', , , "': .,,: ; "c: " :. "'" "" '..'" I ,.,..., ,.,:". ~ ,,' " ,,' '" '" ,,' ,,: '.-1 ,",' , :? ',;': ". ' ........ ..... .:. .' " '.. '. . ',: . ~. . .. ....... " .'. ..."'. .:", ':"'.,.'. , .,.",' " , , .' .,.',., :,', 'i ,', ,::'. ' "":'., ":,.' .. '. . I, " ': '.', ......' , j " :" " . ','" "...., ':'," ". . " '<L .:',', :'.,', ',~' : I:. : L : :, '. ,~:~:",:!,:, " ;., . .:",:i " . i ~, ,. j, " ',. ~ ( \ , ~' . ,:}, .~. l:L ,', .' ......,.,. .,' '.'" . .....', '," : ". '.:". , ". .',.,'" > ",', ", ':, :"" ,:,i . '. ".:'. ""'C', , ',"'.: : : C':' i: . ,.' . ,. ,', .,' ,::,:" (, . ' :,.... . , ...'., ':',:. "W". .' "; ':'." ':.' . ".', . :;' .'. .. :. ". . ,: . ! ,'. . ..0'.'.' , . :;', .,,'.,, .,,' y :OUNTY ROAD NO.q?~~7 iTATE LOG NO. 11 LE POST 'J, ,u, IT' OFFICE USE ONLY JEFFERSON COUNTY DEPARTMENT OF PUBLIC WORKS Jefferson County Courthouse Port Townsend, WA 98368 PERMIT NO.'b'8'-~-3-/ FEE PAID ~es ___No OFFICE US7E ONLY '- f"AZ..i/ ~ ~.L::. CHECK ONE: 181 RESIDENTIAL APPLICATION FOR ROAD APPROACH o COMMERCIAL Application is he;'by made for a pennit to construc~operate and 'maintain a road ap,Proach. Please describe loaotion (attach map or drawing),I ad,/, /'/./7",//,- "'/"',,)/"0 r . /I' I " , " . ' Applicant agrees to perform the work in strict compliance with the terms and conditions out herein, and any special provisions attached hereto. Applicant Nam0 "" / L o,K7 /-- ~'7 n ;ow. 'contractor Name Address?,.;',,; /::";/7(.//.'';-1 ~. /(cI' Address 'AA T /, 4-~/" ~" '/.,)" '7 f3';6- 1,', -'/ /7' /-/ , App 1caI?t Sl.gnature ./ ",-~.-.?// Y~4-.. J-.,,--<,_ _' Contractor Sl.qnature Date. t':- -'/ - ,?p .. . " Date Note: Ind~ty prov:(sions of paragraph.. 2 :.-and 3 ,on reverse side. set ,5" /' > / .(:' / PERMIT &mImF Subject to the terms and conditions on the reverse side, PERMISSION IS HEREBY GRANTED to Applicant ~o construct, operate and ma1ntain a road approach as requested above, and any special provisions attached hereto. :' ...... , " co. No work shall be done under this permit until the applicant or contractprhas notified , telephone k':d~ ~--<"~ Date 6 -~ '-8e, APPROVED BY: . PERMIT INSPECTION REPORT j Work covered by permit has been completed ~ satisfactorily. CAll 48 HOURS BEFORE YOU DIG 1-800-562-6478 ______work is not completed. ~ecomme~d permit be cancelled. ______Traffic control - adequate inadequate_______ REMARKS '. INSPECTED BY ;~~ y--., DATE ',I-;;n:ry Form 113"0 (RNA 2-.82): , ~ . i f: f.' l' f , I ---:-' . .. ..... .' ...:-.., .... '. .1. .... .... . . '. . .. ) '. ..... ..... . .' '.' " " :', " ...' ' . ....', ". ".",:. '. ... . " .,.... . '. .', ." ,'.': .... , ':".. .' ,',' .. , " '. .'j ,'. ,:, ........ , f, -., ,". ,.'... i... ......... .' :. . ", ',' '", , ..::. : ,', . ".-.'" ....,.. '.' , :.. ': .: . " '.: .' .......' " , ."'... ' .' '~' .'/ :.~::;,' .~ . GENERAL PP.OVIS IONS 1. THIS PERMIT IS SUBJECT TO RC'~ 36.75.130, .140 AIlD ,150 AtlD AMENDM'~TS TH'RETO. 2. ~~~,~~~Nm'D~Is o~u~~~~~~s o~N~vml~~~D ~~~E~~s~~ I~~~~~C~H~~~F~~O~C~~~T~OA~~ ~~V~U:~E~~~M~~S~N~R~~R;~~' PERSONS.. OR PROPERTY BY REASON OF THE .PERFORMANCE OF AN'f SUCH WORK.. CHARACTER OF MTERIAI.S USE1J OR MAllUER OF INSTALLATION; IN CA.SE ~y SUIT OR ACTION IS BROUGHT AGAINSl niE CDUNT't FOR DAMAGES ARISItlG ouT OF DR: BY REASON ,OF ANY OF THE ABOVE ,"'USES.. T~E PETITIONER.. ITS SUCCESSORS OR ASSIGltS HILL.. UPON NOTICE OF tOMME-Hee- Mun Of SUCH AcnON.. DEFEND THE SAME AT ITS SOLE EXPENSE AND SATISFY ~y JUDGEMENT ARISIHG THEREFROM If DETERMINED ADVERSE TO JEFFERSON COUNlY. 3. IF THE GRANTEE ENTERS INTO A CONTRACT OR AGREEMENT HITH A TUIRD PART't 10 PERFoRtt THE WORK AUTHORIZED ~~J~~~F~~R~b~n ~~~M~~~D "::~R~~FE~~ ~H~A~~U~~/~~ ~g~~~g~~~I~~T~O~H:T~Rg~~~~~~~ ~~T~A~~~~~b~G~~~eE~O 4, ~~\~W~~R~h'1~ ~~NI~~ ~~~~mmo~N~D:~o~m~~~~~ ~m:~ roD~Ay~R s~~l1:u~~B~~cIH~H~~R~E~11H~0 G~~m_ LATlOfi AS HEREIH PROVIDED. 5. DURING THE CONsTRUCTlON OF THE FACILITY.. THE GRAnTEE SHALL coMPLY WITH THE twiUA1 ON UNIFORM. TRAFFIC r.nNTROL PEYICf~ FOR STAFfT!;; ANO HIr.HWA'fS PUBLISHED BY THE U.S. DEPARTtlEHT OF TRANSPORTATION. ,6. OK COMPLETION OF SAID WORK HEREIN CONTEHP'-'TEO" ALL RUBBISH AtlD DEBRIS SKALL liE IMMEDIATELY REttOVED AHD THE ROADWAY AND ROADSIDE SHALL BE LEfT HEAT 10HD PRESENTABLE AHD SATISfACTORY TO THE COUNTY. 7. THE COU"'fY RESERVES THE RIGHT 10 ORDER THE CHANGE OF lOCATION OR THE REr10VAL OF ANY STRUCTURE OR STRUCTURES AUTHORIZED BY THIS PERMIT AT ANY liME" S"ID CAAMGE all REt"IJVAL TO BE HADE AT SOLE EXPENSE OF THE PARTY OR PARTIES TO "'tiDl1 THIS PERMIT IS ISSUED" OR THEIR SUCCESSORS AND ASSIGNS. ~~~ ~~~T c~~~mER~~g~Nm~C~~~N O~R T~~Lggm$~ S B~D~~E A~~A~~~~~~~~L c~~N~~l~L S\':iH N~ :n;~E:e"~Etj\Lt r~mE FOR ~Y DAMAGE TO TtlE GRAHTEE BY REASON OF AMY SUCH ,",ORK BY JEFFERSON COl.ltTY" ITS AGENTS OR REPRESENTATIVES" OR BY, THE E~ERC1SE OF AHY RlGHTS BV THE CouNTY UPON ROADS" STREETS" PUBLlC PLACES OR STRUCTURES IN QUEST IOH. 9., THE GRANTEE SHALL NOTIFY THE COUNTY'S REPRESENTATIVE UPON COMPLETION OF THE WORK UNDER THIS PERl1lT so THAT !' FINAL IHSPECTlOH CAjl'BY HADE. .8. SPECIAL PROVISIONS , ,.,.:.,.., ... ' __ ..'~ ,. _ APPLICABLE PAOVISIOHS ARE DENOTED BY AN (I) -D:':i.-;rA:td~~"o'~fT~~f~EkA.1T SH.ALl BE ON THE JOB SITE.. AHD PROTE~TED FROK THE ElEtt.ENTS" AT ALL TIMES DURING THE ; :..'; "q ~Ort~,TR~fl~l~ '~~Tt10RIZED BY SAID PERHlT WITHIN THE COUNTY S RIGHT-OF-WAY. E::f"2;" THE APPRO.c~ sHlee\ BE CONSTRUCTED IN ACCORDANCE HITH THE ATTACHED DESIGN PLATE TYPE P - ( APPROACH. A. _lA' 70 . FT. LENGTH OF ''1' INCH DIAMETER CULVERT PIPE SHALL BE PLACED IN DITCH AND LAID TO. A TRUE UHE AND GRADE. THE APPROACH SHALL BE SURFACED TO THE LIMITS AS SHOWN ON m~E~~:':;~ I~~FmD~A~~R T~~c~P~:~O~~E S~~~~E~iy I:;N~~cg~Z~~~E R~~~~-:;~-w~~O~:t~ ~~~T:~L p~~"mE~~AH. THE APPROACH SHALL BE SUFFICIENTLY SURFACED BACK AN ADEQUATE DISTANCE FROM THE EDGE OF THE PAVEMENT TO PREVENT AAY' HUD' TRACKING ONTO THE COUNTY ROAD. ANY HUD TRACKED ONTO THE COUNTY ROAD SHALL BE It'V'1EDIATElY CLEANED UP BY THE GRANTEE OR ttl S AGENT. (I]/3. ~ .05. 06. IF NECESSARY.O INCREASE srGKf DISTANCE.. STUMPS AND BRUSH SHALL BE REJiDVED FROH BOTH SIDES OF THE e~m~A~~ALI: T~~T I~~I ~~:~m:~E o~U~~~~~y O:o~~R~~~~I~~~~H~~~BER OR DISFlGU~ ING DF ANV FEATURE OF SCEN IC WORK SHALL BE RESTRICTED TO THE HOURS BETWEEN 9:00A.M. AND ~:OOP.H. lJICLESS OTHERWISE AUTHORIZED BY THE ENGINEER. A SURETY BOND IN THE AHOUNT OF $ ~ WRlnEN BY A SUREr., COMPANY AUTHORIZED TO DO BUSINESS IN THE STATE OF WASHINGTON... SHALL BE FURNISHED TO INSURE COMPLIANCE WITH ANY AND ALL OF THE TERljS AND CONDITIONS OF THIS PEIlHIT AND SHALL REHA1" IN FORCE lJiTlL ALL WORK UNDER THIS PERMIT HAS 8EEN COHPLETED AND APPROVED BY THE CO\llilY. BEFORE ANY LOG HAULING OPERATIONS BEGIN... A SURETY BOND IN THE AHOUNT OF $ . SHALL BE FURNISHED BY THE GRANTEE TO PROTECT THE COUNTY AGAINST ~Y DAMAGE TO THE COUNTY ROAD AND TO INSURE COMPLETE REMOVAL OF THE APPROACH AND CLEANING UP OF THE RIGHT-OF"'WAY TO l'HE SATISFACTION OF THE COUNTY. APPROVAL OF ALL CLEAN UP WORl< SHALL BE SECURf.P BEFORE THE BOND WILL BE RELEASED. SPECIAL CONSIDERATIONS 07. 08. .... .,'. . ........... ". " i...,......'.......' .' . ;,.' , " '.. .. . . .'" .. ..:,;', : ' ,'.' ..' .'. . ....... :."" . . .. ' .: . .. ..: '.:',". '. . . :.... , ....',.. ,'.: It> . : :' " " . ',", I ;'j'.. "':: .' , . ... ,.., " ,..' " '. I'" ;:., . . ....' .. I' '.' ..... I .:....-- ~~;1 " k- '.: Ir '; ~ , t '" ';:' '. :.'. ; :... ," " :',,, " .: . : .,' ,,/' .' . . ".::-.,' ..' ":. ,- ...., , PLaN'" ,..' ,.. 00' __..... ., __ .,~ - -....1 Count, flood ..... . ___"_"__ ___..... : ::::j:::;~. ":_,~'---l ~.. ......._ .,---, , i j":,c-,,"~: {;+;?:~,~ f~t;:-:; ~= _" .: '.. .: :.__ ;;.... :.;:.~_,,:-.1,=-_;,'~:"":.~_::~.:l.':,~.,..~_~'.:1-.~~~I.ft-'~.~~..~.-D:~.~I-I.~D.~I.:I~..I".,~_._....~: ~:~IILI2..C~u':~."I' "t,' r.,"_',,:_,~:_~,.....-,_.',.. '::~L~__ - ~~~.~:~ ~.~>~.~. ~3._~~~, .~ ..,.. of _,. t.J :f8~~~:.:.-~'~'~i '.~~' :-.~-::-.:'l.~.:.~:-~:.: . _ ....... . . ~ . .....: "In. I: tDP CCM,JfI~ . . ;~:l~.~.~::.=:.:j,~~~;=-;'::;~~ ">"":'" ~--- ., ,. ""j' t ~~l ". ..> . .....: '''' .....:;"1.. ::: ..:. . ., . .' . :. " . ," " } " l - . :". T i I i I I I L ( lYPE ,_, "0 . f'RIVATE ROAD APPROACH . .J. -_... . ~ - , - . ,::.. " .. ::: . ...::~:~.: ''-.. i:"-:"--:--'--,'-:-::=.T~::~-::::'-- .' - . I _ .... .._ n. .....' .. ...,. ...... .. ':"'; -,'-' -.. _..~ .-...... .. . . . --.-----.. ..~i~.~.~: ..:..:..._. .,.': .....1- .'. " '''::: :..:..~..._._..-...- .. .. to'",in.Z4'1n01. .. . .. /"'F ..... .. -- .. .. .,to!:l.mmIDn..'~D'd, ~ . .az.Oia ",in. Culvert - " ..Edgl ehhovlh'.-" . Varle, t , i ::h:.. SIC'" DISTANCE REQUIREMENTS . .. POSTED SIGm' DISTANCE SPEED LIMIT, IolINI/olUM DESIRE.f.IlLi! 1i00ES: 25 30 35 40 45 50 160 FT. 200 FT. 240 FT. 275 FT. SIS FT.' SSO FT. 200 FT. 240 FT. 275 FT. SSO FT. 410 FT. 475 FT. 1.) Cu~e~' .han meet alnimum .pecifications '~or 115-20 loacUne. Approved types include: 1) concrete 2) corrugated metal 3) corrugated polyethylene tubi,ng-AASBTO r.J~)'. County.road shoulder shall be left at existing profile. 2.) --UPROVALS: .4'. ~ /2. ,(/D<.oc- Chairman. Board of a '917 ~ County Comm18s1oners ,,<. A! . ~ Director. Department of Public Works Date "'Aft.... Date9~-!J . .o;.....iS:c:. ..!....:.: .' -, .- .-- ---- ._............:.....i._:..;......... . ..~_.. ''':'''-'-- ~'Q1Il ~"~lInillIWIiII5' 4. - , I . ...... .'. -- .-:..: . . . . '" .<:.' .... . ..r : ... ..... . 1.< -- I _,.... ':. ..:'i: . .' ::. . . :-.'. ,.' . "'.. . I. '.' " ....... . '. '. " '.' ....:.... : i : . -i,: :> ," . . : r '. , ... ':. ".. '.. '" :. . '.. . ":.'. '.....,... .:" '. :'. ",.,.:,- ". "'. :. . .', .' : , .- , . . :.: i.. :" .: ;':'. ,'. . :. '. --.' ...... : .::. . ":. , ".:,.' ::: , . ". . ,: ' ,.. ..., '" ..... . " . '. ."', " . (. . .... ......... " '. ,'" : '.. . : ". <, . I.... " - " r \1 L- /1 p.0. LI~)~t;;;~CI , ;\GGI'JI';}-JSr5 i -----.-. , C-1 .: j~ ! __._ ,_ _ _ /?/ft2.fLX__ --!.5}3 ;'-~- ;9;\-------r7, 6 A r-- --~ ~~_ r~ h ~~;C~~aJ ~R"k/>- ~ VJ . . .~,~:f'.,"'".,,_...... ......I;..,........--'~..-:.:'". .'...."""'.L~.'..._".. .'- .....'-~ CAll 48 HOURS BEFORE YOU DIG 1-800-562-6478 PERMIT INSPECTION REPORT j work covered by permit has been completed . satisfactorily. --york is not completed. ~ecommend permit be cancelled. _______Traffic control - adequate inadequate_______ REMARKS INSPECTED BY~~ ~ - DATE <j -;;I,-;ry \ 1'\.~;P~' " S'~ '.~~~if >~l\I.l~l, V.I<'~..'- '" p'\r lilt" ,'L JEFFERSON COUNTY DEPARTMENT OF PUBLIC WORKS 1820 Jllflerson Street P.O. 80)( 1220 PorI Townsend, WA 98368 (206) 385.9160 N~ 0878 District No. 5 PERMIT In accordance with all applicable Revised Codes of Washington and amendments thereto, and subject to all lhe terms, condi- tions and provisions written or printed below or on any part of this form PERMISSION IS HEREBY GRANTED TO U. S. "Iest Communications 2720 Oakridge Dr. Port Angeles 98362 to Install buried service wire at mile post 3,91 on the east side of RhodY Dr. Job # 88-315 Couaty Road No, 952007 Franchise No. Milepost 3. 9 1 No work shall be done under this permit until the party or parties to whom it is granted shall have communicated with and received instructions from This permit shall be void unless the work herein contemplated shall have been completed before Se p tembe r. I? 1~9 Dated at September 19 ,1988 &~~~@WlEID1 By ,<J~~ 1.800.424.5555 f : ", ' , :-', :',. > " ',i .' "" :. . ",.'. ',:" \ ,'" , -~, . :.' , , ,., ,,' GENEHAL I'HOVISIONS AI'I'UCAIII,E TO AI,I, I'lcllMITS This permit is subject to all applicable provisions of the Revised ewes of Washington, CXCCpllh.Jt any pruvhiofl illlhi.. agreemellt IlIJI C{Jm;sh::111 ',\,'jlh such resolution shall be cOlHroJ/ing, A bond in the UIlIOUfII of $ is rl~quirl'J for the protection of the coulIty as !oct fotth i/l the (crrm of the bond. During the progress of the work such barriers shall be crcctcu :Jlld mailltilim:u as ilia)' be IJccc~\ary or as llIay be Jircl;tcd for the protection of Ihe traveling public; the barriers shall be properly Iighlcl.l al night. In accepting this pennlt the petitioller,llis succeSSors ul1d ussigns, aglCcs to protect Jefferson Cuullt}' afld save il harnllc~ fwm all claims. aellom and damages of every kind and description which may uccrue tu or be suffered by any pcr:>on or perSOIlS, corporution or prupctl}' by r~;'1.'0I1 of the perfor. muncc of uny such work, charucter of materials used or mariner of inswlJution, llluirllclIDflcC and opcrutiulI or by thc improper occupancy of right of way or public place or public structure. and ill cuse allY suit or actioll is brought against said Jeffcr!>olJ CounlY for damages urisillg oUt of or b}'lca~rlll of any of the above causes, the petitioner. his Successors or assiglls, will Upollllotice to him or thell! ofcommencemellt of such actioll, defend the S4.1lJ1e ul his or their own sole COSI and expense amI will satisfy allY judglllcJlI after Ihe suid suit or actioll shall have fill4.lIJ}' been deh:rlllilled if adverse {c) the Jef. ferson COUIllY. Except as herein authorized, 110 excavation shall be m:u.le or obstacle placed withiuthe limits of a county road in SUc/1 u manncr as to illlerfere with the travel over said rood. Excepl as Jlcrein authorizcd, 110 excavation shall be made or obstacle placed within four 14/ feet of the edge of the pavement. Iflhe work done ullder this permit interferes ill any way with the drai!l:l!;:e of the ctJulI!y rood. the gralltce !>hall Wholly 4.lml ut his own e'-pcll.\e make such provision as (he cngineer may direct to tuke care of said druinuge. On completion of said work herein cQn/cmp/uted uti rubbish u/ll1 debris shall hc immedi:.ttcly removed olrlLl the trhlLlwuy and r04.llbide shall he Icftllc<lt and presentable and satbfactory to the cngineer. All of the work herein contcmplated .shall be done under the supervision and to the sati!>factioll or Ihe C:oullIY Engineer ;lr1u the cntire expen~e of said supervision shall be borne by the party or parties to whum this permit is is!'iued. The Department of Public Works hereby rescrves the right to order the clwnge of location or thc removal of allY structure or structures authorized b)' this permit at any time, said change or removal to be made at the sole cXpcJl!>c of the party or parties to whom this permit is issued, or Iheir successors aud assigns. All such changes, reconstruction or rdocation b~' the Bram~es shall he dOl\e in such m.\nller as will cause the least interference with uny of the Coun. ty work and the COUnty of Jefferson shall in 110 wise be held liable for uny danwge to the grantee by reason of any such work by the COUnt}' of Jeffer- son, it agents or rcprcscntativcs, or by the exercise of any rights by the COUnty upon roads, sltcels, public places or structures in (juestion. This permit or privilege shull not be deemed or held to be UI1 exclusive one and shall not prohihitthe County (rulll granting othcr permits or franchilie rights of like or other nature to othcr public or privale lItililies, nor shall il prC\'em thc Coumy from using any of liS road.~. streelS, or public places, or af. fect its right to full supervision and control over all or any part of lhem, nOlle of which is herehy surrendered. The Depart/nent of Public Works may revoke. amend or canee/this permit or :lny of the Prll\'isioll!t thereof ,It any timc by giving written notice to the permittec. Thc permittee shall immcdiatcly remove all facilities from the rigl1l of way. Ail}' facilities rernuining upon the right of way 30 du}'s after writ. ten notice of canceJ!alion shall he removed by the COUnty at the expcllSC of the permillee. The panyor parties to whom this permit is issued shall maintain at his or their sole expense the structure or ohject for which this permit is grantcd in a condition satisfactory to the Department of Public Works. SPECIAL PROVISIONS: 1. Cable shall be installed at a minimum of 30" below existing grade. 2. All areas shall be restored to original condition. Wl~WW~~~Lt\ In accepting this permit the grantee, his successors and assigns, agree that any damage ur injury done to the property of the grantce or any cXpense incurrcd by him through the operation of a cOnlractor, working for the Count}' or uny County employee shall be althc sole expense of the grantee, his successors and assigns. and conditions as herein set forth. Dillcd Ihis Z~ day of ,the undcrsigncd, hercby DCCCplS this permit subject to the terms 5y/. ^I'I'"",,,,/c( .~ , 19 'lFy '-, -- ." . ," ',," '." , " " "".' '--, ., . '.:, .' ',",' :,i :., '." ". ' " " :.......... . " ,::,:',', "'''' ""," ...... .... . ,: c, "", '. ....',. .:......' ; .' " . .' '.. I I .; '", . ."', ;'" '. --:-- i.. " . ;.'.. , "., f , '., ,. ;.. "'," '!. " : ..' , : ":' "." .,' , ; I """ , ., I. I I I I '. , , ,." ; .,' <.:. :... '.' , . ,.: .,. ". .' . .....> , i,. .." '. , ,,' .' " ' " I"" .,.., , " ~ I ,. ..".' c " ..... ....... "",,' .': i " I : I'.'" I i ....' 'i. ,'. 'i " ' ,'.' " ..', .".' ..' ":, i , .' ',-- '. . . . ;':. " " ," ."',..','. , " :" ',i " . .' , ','. '" -: .,;c'" y , .' "..",. ... .,'.'.... " .' ...:' -.. ...... . ..... I'" "_l'.:". IIIIIIIIIII " " :. . ',' ,.', ..... JEFFERSON COUNTY DEPARTMENT OF PUBLIC WORKS Fee Paid_ Yt:~ _ No 1820 Jelletson Street P.O, lJox 1220 Pori Townsend. WA 98368 (206) 385.9160 Re<<il"i ""l.I Address ReqUl:,sl_ Yes _ No Mile P01>I AI'I'UCATlON FOR I'EHMIT To Department of Public Works, Jeffersoa County, Washington, The ulldersiglled tt. 5; t./""sr ~&. #,41 If",;j) hereby appl_ for permis>ioll to f'/"cc: j,w-rJ Sc.rJve 4-,.,("<, t:<(."", -f';{~4.t:J; /AII(JII"JlJI",II""'I"I~'fllll) "/1<1/11<' IUlh" flIJ,,)./ ..,/ SKETCH: ~""<=' .l-1Ia&-/..-/ P/vrk Orrl?~ "i'Y- 3/S;- 011 Caullly Rood: R/'~ j)r. between (Slall'''I'tl'''''C'm\\'\I''~''fJ'mll''"oi/lfJ and agree_ Date to do the work in accordance with your rules Gnd regulations alld subject to your inspection and approval. "7-/7' 19~ ,?,ICz::rrr tSillnlllUrCUrAflllli'lInll Hoc;{..-- .6'<<c,{/"". ICorllrllclurl /}U" ./ ~ ') 2-0 (J.jrl,~JJr ~k5-.t./-4. U,'? ~? Phone No. t{~2- ~/'7 7-'7 (If applicant is a copanncrslllp, set fOrlh names of copanners) All<lfC~\ Jcffcrson Co. Dis/rict No. s DEPAUTMENT OJo' I'UIlLIC wonKS Pertuit No, CJ 8 7 R Supcrvisor's ltc-port No. Supefl1isor will make tletailed report with his recommendation olltlus application. Ii/hellever possible show sketch oj proposed work. Supervisor will also make additional reports and }i/1al report gil'ing dale oj completion oj work all this form. Preliminury Iteport: 1\1: Ie. '?c:;,,- 3."1\ LoT, ON rl,;5 ~I\;:)~ of" R \\-0 t>-< ~\\.eb-( \)R~.J e. D~- Ro rt-t> vJ I/- '( \) ',-I-cH ex;sJ-:^,,/ Date: 9- /9-Q,'B Signed: ...1\ /~ 'IC~ Final Report: PERMIT INSPECTION REPORT { / Work covered by permit hils been completed satisfactorily. Work is not complefed. Recommend permit be cancelled. Traffic con'rol - adequate - inadequate REMARKS Do'.: </-,;;" <>9 I SIAn.d: "\.. 'f':\_ ,,' .'. .... . " ; I; " " '.:: .:., .. . , I ' . . -: .':.... ',' . . '..;<"c\: ~.' . r,' .' ;,,: . .... , I:, t ': ". " .. : j. , .. ' :. . .:', . ,,' :-,' . ::: :'...;. ':".: , ::.... " ", . '. ,.'.... ,: " '.' . .,.... .,':.' ......., . '.. ....' .... '. ',: ".' , '.'. . :", ,c. ';. ,''', '.. ":' 'I, :. ,".' " .' ,: ' ... .. .' ::. ,i, :. " , "'..', ; :-, , , ':i .,..' ,'.,.-.' '. """',~ .. " .' , '. '. . ;, ":,.",, "" ',,',., ' ':' :.. '....., '" :.' :' "..' /:. "" '. . ': ,..",'...., ,'.. ......' Ii '.',... "" I" .:.. ','. :' . , " ",', . I; l I LL L f:# @ P&cItlc NorthWGet Bell PERMIT c;1-I'I OUT IN WORK LOCATION Address :3"t II ~ I. . cJ.~ O~__._ City PT, County V :ri:r=~ State.Y~ Name _-1-u(?~""'~ CAo.-~ ORIGINATED BY ~" CC _._.._ Dale -'7'.::.!!f::fJ'fj New ~S/ONo, DueDate_ Repair 0 Tel, No, TemporiiedD #p Rearrange DS/ONo, Due Date_ TVpo of S.rvlc. ee1........... PaIr Color/B,P, Tfrm, Addro~ ~/-;.(;"' .L'::I~ -- -- R~~i~~~~ ! Quantity I -i-- IC.s; Oetlcrlp11on Of Work no' F', '.'J (?_,,:. R...~ J:J'~ ,A,J-.l., .;c, 'P..., 1._.L1-.!..-~L _ IUI..... --------...... If..",," - ~ ~ ~ I so,", ---- '---- ---- -- ,_. ---'--- Sketch Work Required. Include Lengths. depths, wlro size and arnmJnt :C~'^'~~~ f~~t ,i.6~: l 1'11.0 ~p~~ : t~fI\\\ Burled Service Wire. Work Order CONTRACTOR 'S ACCEPTANCE Firm Signature Title, Unit Price 0 Co,t Plus 0 Pll99018,a,) No, 9Jl:31~ Compiete by ____ Date Flet Sum 0 S_ Bill to: PACIFiC NORTHWEST BELl Allentlon Aadrass Clty_,____~Zip ..- APPROVAl For Fiat Sum/Cost PIUS $ R&commendad Approved by' DBta_ Date_ o Yas 0 No Verbal 0 No,_Data_ Date __ for Service Connection l,ndl~ate,North +' If. , '101 5 , , W' --,----....-.--.-.'--------...-..,-, NOh~' Tnl:!; $~C'1el"l r"l"lc.y 1"101 be on :JeCt,Hl'lte r('pr/):r.en1t'lllon 11"1 ~II d~I.!ll.s, It remains U'h' contraclOr's responsibility 10 prol)erty InCill~ wOrk In the fjeld, ........ L ORIQINAl COpy PERMIT REOUIRED Racelved from Jurisdiction COMPLETED BY Call . ... ,R'~C1.,l~ VI!.., " ',' 'c-, ".,'- AI,' .. -". , "". , I 1 ! r _ ,'.: I ,', ,,: t " , I, i", I . '. .: ,,: ..". ," ". ,': I',. .'.,. '::,:.: I " .,.. : : ',' . 1\> I ' ".. ", " "',"'; .,'.' .: i :'.',. ..",.': ...:,: ,':' .' :: ',.': .. I, "':'::',i:': , ""',' ;" ;," " ;, ,::' , ,>i : ..;, '. ".."..,." c.,.. ":':. " ....:.'..., ',".. '. ,;'}. ':' '-'". -,:' r", ,I C " ----cC '".', ,: : .' ,', . ".',' , . , ' .:' .' . ,,".. , . ;",' " , .' " .I'-C: . ,..'.'. " ' , '.': . ': :,: ~ , i , , .' ;''-,,~',: ....: ",,-,'i:{::, },. ,: '. " " .:", " 'J' ", - .. '. \ -,l"-.r"~ '>C;{~'if/.~if ,iP.~XI 1'0,.'.''''-' ;,.. \).1' V\T~II,... . - JEFFERSON COUNTY DEPARTMENT OF PUBLIC WORKS N~ 08 B 9 1620 Jetrerson Slreel P.O. Box 1220 PorI Townsend, WA 98368 (206) 385.9160 District No, 5 PERMIT In L!ccordancc with all applicable Revised Codes of Washington and <.IlTlCndrnCnls thereto, and subject to all the terms, condi. tions and provisions written or printed below or on any parl of this form PERMISSION IS HEREIlY GRANTED TO f'\.lget Sou-d Po\\er and Llght 310 Four Comers Rd., Port Tmmsend, 1\11\ 98368 10 InstaLLu-dergroLnd cabLe from mLLe post 2.50 to mLLe post 2,77 and a road push at mLLe post 2.50 on Anderson L'lke Road, fOl- Evergreo, CAlm Escapee Reb"eat, Job # 88-08535 RECEIVED OCT 11 19118 JEFFERSON COUNTY PUBLIC WORKS DEPT, County Road No, 523408 Franchise No, Milepost 2.50 to 2,77 No work shall be done under this permit until the party or panics to whom it is granted shall have communicated \vilh and received instructions from This permit shall be void ualess the work herein contemplated shall have bccn completed before October 5 Daled at October 5 . 19 88 .1989 ~~~~@Wl8ID lly~~K~ 1.800.424.5555 GENElIAL l'Il0VISIONS AI'J'L1CAIILE TO ALL l'EIlMITS Thi~ permit is subjccllo all applkab\c provisions of till; Revised Codes of Washington, except that all}' pro,,'bioll inlhis agreement nol cumi!.ll:nt with such resolution shall be controlling. A bond in the amount of $ is required for the protection of the county as set forth ill the terms of the bond. During the progress of the work such barriers shall be erected and maintained as may be necessary or as lIla}' he directed for the prulcctioTl of the traveling public: the barricn; shall be properly lighted at night. In accepting this pcrmillhc petitioner. his successors and assigns, agrees to protect Jefferson Coullty arId save it har.lllcs!> from all claims. actiuns and damages of every kind and description which lIlay accrue to or be suffered by any person or persons. corporation or property b}' rc:ason of the perfor. mancc of <lilY such work, character of materials used or manner of installation. maintenance and opcration or by the improper occupanc)' of right of way or public place or public structure, and in case allY suit or action is brought against S<lid Jcffc:rson County for damagcs arising out of or b)' rca!.oll of any of the above causes. thc petitioncr, his successors or assigns, will upon notice to him or thc:rn of commenccment of such actioll, defend Ihe same at his or their own sole cost and expense and will salisfy any jUdglllClll after the said suit or action shall havc finally bc:en determined if adwrse LO Ihe Jef. ferson County, Except ;:IS herein authorized. no excavation shall be made or ohstacle placed within the limits of a cnullly road in SUdl a Illanllc:r as to interfere with the travel over said road. Except as herein authorized. 1\0 excavation shall be m:ll..!e or ubstacle placed within four (4) feet of the edgc of thc pavcmelll. If the work done under this permit interferes in :111)' way with the drainage of the eoumy road. the grantee shall wholly and at his own expcmc make such provision as the engineer may direct to take care of saitl drainage. On completion of said work herein contemplated all rubbish and debris shall be imll1el-Hatel}' removed and Ihe roadway and road~idc shall be left neat :md presentable and satisfactory to (he engineer. All of the work herein cOlllemplated shall be done under the supervision and IU thc satisfaction of the COUllty Engineer and the entire expense of sail! supervision shall be borne by the party or panics to whom this permit is issued. The Department of Public Works hereby reserves the right lOorder the change of location or thc rcmoval of all)' structure or structures authoril.cd by this permit at any time. said change or removal to be made at the sole expense of the par Iy or parties to whom this permit is issued. or thdr SUCl,:c~\ors and.'as'sig,ns. All such changes, reconstruction or relocation by the grantees shall be done in sllch manner as will cau~e the least interference with any of the Coun- ty work and the County of Jefferson shall in no wise be held liable for any t.larnage to the grantee by reason of any such work b)' the Co~nt)' of Jeffer- son, it agents or representatives; or by the exercise of any rights by the CoulllY upon roads. streets. puhlic places or structures in qucstion. This permit or privilege shall not be deemed or held to be an exclusive one and shal1 not prohibit the County from granting other permits or franchise rights of like or.other ~~t~re to other' pu~lic or private utilities. nor shall it prevent the County from using any of its roads, streets, or public places. or af- fect its right to full supervision and' control over all or any part of them, none of which is hereby surrendered. The Department of Public Works may revoke, nmend or cancel this permit or any of the provisions thereof at any time by giving written notice 10 the permittce. The permittee shall immediately remove all facilities from the right of way. Any facilities remaining upon the right of way 30da)'s after writ, ten notice of c3ncellation shall be removed by the County nlthe expense of the pcrmillec, The party or pnrties to whom this permit is issued fthall maintain at his or their sole expense the structure or ohject for which this permit is grallled in a condition saliftfactory to tbe Department of l)lIblic Works. SPECIAL PROVISIONS: 1. Cable and cross Lng shaLL be LnstaLLed a mLnLI1LI11 of 30" below exLstLn~ roaclvay de tches. 2. ALL areas dcs-b.;j-,hL>d shall be restored to orL~Lnal condLtLon. WD'b;jti'l:il~~ . ~ In accepting this permit the grantee, his successors and assigns, agree thut any d.\m3ge or injury done to the property of the grantee or any expense incurred by him through the operation of a contractor. working for the Coullty or any County employee shall be at the sole expcme of the grantee, his successors and assigns. . the undersigned, hereby accepts this permit subject to the terms and conditions as herein sct forth. Dated this d:lyof (jG -r: 7 ,lOW C;~~ , UU"/a Hecyclea t'aper \ ,~~ ~~1&~~1( ,~~,.t, l?\p"-ir~ . JEFFERSON COUNTY DEPARTMENT OF PUBLIC WORKS .~J 3 jJertcrson County Public Works Oo~t. Fee Paid_ Yo _ No 1820 Jellerson Street P.O. Box 1220 PorI Townsend, WA 98368 (206)385'9160 1985 Rll'cipl No AllLlrc!>sRcqucSI_ Yes_No Mile P05t AI'.'L1CATION tUn .'g(lMIT To Department of Public Works, Jefferson County, Washington. The undersigned "PLI,==<IZ-I ~ J"-'P Tb,^'E-1Z- hereby app/_ for permission /0 I f\J "'=',I>I_L-- p.. It L.I (.,,1-1\ C-<,:> . '?<:6 ~I. U<':::. f..l"l'li..()fll....iIId,.\j"IJ<.jl'".1' ..il<III"'....n/wl/Ou.lJ L.I N F2- ALaN <= 'Iii ~ ~? A~ As::::..- ~?<; "=0T~ ?=P -fL ~D~r-J =IDlE- OF 1<:> ''PLJ "==='I..:} LI~_ 1Z-D, A.t-J D~r.J Lf....IC:.-lE- 1- 4" c:::::..e>rvDu II L!-O' SKETCH: ""?iE:..1S AITA?-l--JISD V\j6 e.~ <<-:::>~ E---rL-- i-j On CoufIIY Road: ~~\Z.":Z>N E-){T~"D' t..I b Af"l2-o)(, L.AI:::: IE:- 1~61 ~.,~ lA..J !z:"::5f"' '$. l2-f-4c D--r' T.:>~ {S/aI,.fIl./"..../ffD.lI.,I"..../f"",IIt'p.,imJ and agree_ to do the work ill accordance with your rules and regulatiolls and subject to your inspection and approval. Date CJ-ZR /9-SB- ~.L ~,;r~ (If applicant is a copartnership, set forth names of copartners) (ContraCIOr! Addrcn Addrcf>.\ ".:i Jefferson Co. DEPARTMENT OF PUBLIC WORKS District No, .5- Permit No, 6 ee- ;; Supervisor's I{eport No. Supervisor will make detailed report with his recommendation on this application. ~Vheneller possible ~'how sketch of proposed work. Supervisor will also make additional reports tllld final report giving date o[ completioll of work on this form. Preliminary Report: ~ /!/V/)eI?5CJrV L./H~e Ra fl-b :2- :5"0 I-c )(~ 1"''1 11-, 2,,,-0 /If' 0 D '7-c If r!! S -' AJ y-I,;s do':? e /l-_ .'------ Z,77 - J"T Date: I;) -5 - ~Pl Signed: _,/L~ k- -fA-._O / Final Report: PERMlyrNSI'ECTION REPORT V Work covered by permit has been completed sarisfactorily. Work is not completed. Recommend permit be cancelled. Traffic control... adequate ... inadequate REMARKS Dale: (I-~I- 8} Signed: )--::;" "CY--.. ( '.' , . . ',' , '. . , I ,.... :. . ',-, I: It I p:':: 1 l' I f f ,,-.,-. , . 11 'I n .. n ......r " 'r,J. u ~., I " o ~'. .1T1 (") o ;;: "tl ..' Ei ..' IT1 .' ;11111 I II ". " I; ..... S ::1 :ll . ~ I:. "" 0 ~ '11 , " ; .\ << .... e tJ 0 z if'':::: III n : ....... t! [;l~ . )< ~.'K ;:l~ .. oo!:l~ - .. . n :.- a:J ,.. '" z .0 ... '" en .... ~ ~l~ ........ =::: .'. '.' ~ Jl ,1'\ . L ~l Ii "" m I, f' (\ I'" . ..' . . .' ~.~. 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'" .z"'. ,., ",. >~'z~, 5 ~g;~t~~ ~a ZZ ,'!!j B l:IQ~'!iJ.', ~:~!E"!Egg~. ,;;'.' p.:r ~2~"~'!=; ~ t 9 '!iJ ~'" '~~.g ~ g'~~ ,~i!f",p,., ~ lJjJ!l,,!!lg ~ ill ~'~.. ~.!ll m i€1~51'm.: .,~. ~,r~f 1; Q~ ~~ ~. ~'",':i!~....''<z~/~.''.'~.:'::;,:''''' :0 ~.", "'..., ~ 0 ;g~A g Z C~5' .>. ....;: :r: 13 ~'~'!~ ';:; 0 a:;:J c)... m~.-, "'r"". [~Sl,'2; .,~. ~~:.~.~, '",;_,'~,'" '~~J<~'~~::, .~ "Yld; ",~,'" ';::",.i:ii ~ ..<5, 00- !:l'm "'~'. ~'u; " m . ",. ,'.iii. ~~ ::i!!l';ll3:a"'~"cn ll'f!il ~Illil';.i' g :;; ~ ~ ~'5 ill '~'C;';;O"z ~ illt; ~g ~ ';1:8' ....~5.!\!......C> Z ~. ~,~ '" '" .~. ~...;;:~' 5 o lD _ '" !ll ~ P '~~~p ~ i ~ l '~,'. g l". 'Z!r l" NUMBER: EST230-01 09/28/88 TIME 12:13 T&D COST ESfIMAfE SYSlEM MATERIAL ISSUE (T-61) IVU iWiIDEI::, Pt'JC[ : INVT. II..,OC. I ,:nOCI(I'~I'I. I DOC. NU, I SiC 1 (,CT. \ riC. \ R,; I cJ/O ilU. I Ell 1I:,1::ED!:iY 1),YI'[ S'TOI':!:: I SATST 1 I I S I I I N,J 1 000U:,::5:500 I I IIUt,NT I TY I~E(IUII~I":D QUANTITY MATL.ID ISSUED G \':: I'" . ITI,:M (,,';'SY il(,TEI::: I (,\1.., DI":SCI':II" rIUi! 'i' 70 06100 ELBDVJ ::.!00A j I':) (d... 1 ~)I(V 6 76 :,(,)(,00 CAP IilSUL loJ/31"'T GI::ND vJlI~ ," 76 2~,9()0 BOX TEI::tl <1 BUSIIlNG 1 :51(V ~!. B9 69401 PL(dE GND 2UB.'W" X. 06" TH 61:5 :',:',:'i()O SCI::EI.J 1 /:.:~X1 ,,:vumLm '1',) ::>0 4:50()0 SICI.I 1:<LII"::I:I',:D Cr,1:<LI::: 10" Xl :',\ 6 7(, (,';600 NUT 1/2" spln,I-/G SIICII'(1 ---________________________________(STURES CODI":=C ITEMS)--------- ----------- DISTRIBUTION- TRANSFORMERS IACT. IMC. IRA.NJIW/O B80053500 '1 6:,:.~ ~:>9'1 ~)O XF 3PN 22~:> 12 ..4UO/277 EQUIPMENT - EXPENSED bIZ/D. <O~ -n~5-1 9?j.t..J I \1 G::.::S 1 'i? 4(" - I S22CJ'J II Cc,?'7?iO IS2"2..'72. I (,CT. 1 liC. IRA.NJIW/O BOOB53500 10-7.-/0 ---------_.._-_.__.._------_.._.__.._-_...._._-~_.._---..-------------.------....--.------------. D I IJ: 6,.1, (.~ (~~ ~ ::: :.:.: ,.:! I::: I:::~: .:, .... '00 .1..1.:: i:~ 0':: '::6.'?...I.~. :t?.~ ~:: 1':.1~ ... ~:1'~ I::: '::e~..I::I...~.! _..... .~.~: '':.!: ':1' I ~,: ,~~,_ ....~ ~~,~ :..., ~ ::!. : T ITL.E::: EVE":~G:~EEN COHD ESC(oI::':~I':: 1'~ET:;:I:::,Yr I EASEMENT 'FI. II"'OL.E Ct,":D I 1 IMAPPED I ________ 00_1 IDFMv,IN BY. 1 CI..IECI(I:,O BY 1,,\ppr::DVED BY I I GalA! 1:E:-r2 I I I __________________ ----------1 IRECEIVED BY ISTORES APPRDVAL IDATE COMp.IFORI":MAN SlGI DOC ND. 1 I I I I / 1 I \ ___________._______ 00_______ --------.---1 I 1:::STU1ATE tlO. ,JrIG aooa:',315 'DATI" CDMP. I FIJF~EtIM< SIG I 1 THIS 1":I''''''Ol'n I"I,;S F':::DOUCI:::D FIHli'l CDNTI:::DL.L.ED P:WC I 1 I 1 LOCATION 2481 ANDERSON LAKE RD 11"'I"m-ll.,Fr::A11 .----------.--.----..-.---..--.-----.----'.'... DATE ORDERED IDATE FILLED IENGRD BY. .,........._~.m...,' I ........1...00....... ~....,.......<..........'..G9..~...~.~... FILLED BY DJSP'R STR'RM FDR'MN LIN'RM GEN.F'MN COURD. SYS.DPR ENGR R/W ASST. SUP ADV.C-STR """, " " < ", "'. . J ~-' , · '-, : , . , ,'.,', ";. ,': "" ., ". .'. " ',' ,', ",', ; , ; .,: , ' ,,' ",:' ii',,,. ' ,:'s " , , ,:' ': :'.; ,.:".,.', It ' ;, ,', '" I' ~~ "" Ii: ~ ~~!l~:t~, :,' "", ,,' ; ,,' ,,','.' , ' , ':: , :" ';', " ,",',,':,' '," ,....,' " .", , :, " ' , ,,:">,,':' ',', ' ;,,, ':.' ' I ':, I; '::' '.', ,", J. ", ' ; ,.", L ,. L :'. ':, ' ';': "'" ,: ", " " '" :', , ' " '., " , ", ' , ',' ''.' ' ',"," , , " '.,'.'.:".'. ", "', , ,.:' " :' , ,'" ' ' ,C,' " . , , , 0:' ,Ii"';' ,I ,~.""";:',: I , ,".".' .,"":., ,'. ,,'''. '" ,,,,, "" : ,.', ,,,',,"',, , :',' JNTY ROAD NO.~a~YD~ ;TATE LOG NO. 11 LE POST I. -Sg OFFICE USE ONLY JEFFERSON COUNTY DEPARTMENT OF PUBLIC WORKS Jefferson County Courthouse Port Townsend, WA 9B36B ~ PERMIT NO. 'ff"O- g - V7 - f t FEE PAID ~Yes _No !' ...pFFICE USE ONLy' ~gll IrPJ~fX!vr ,-r>//k/. f I / , I f . .~"" I , , CHECK ONE: ~ RESIDENTIAL APPLICATION FOR ROAD APPROACH , o COMMERCIAL 1 ) I Application is he;'by made for a permit to construct, operat" and 'Jll3:lntain a road approach. Please describe' ioaction (atta~h Jll3p or drawing) 1'1011:\'1-\ SIO!? O~ I-\tJQe'rl~ON 1.."', (1.1) MILl; \.5 A(7Pll.u>( liAe ~"IO MP!-l '>I(,N. Ml\IlKEO'lIv (lED rLCI'(',(,IN(" Applicant agrees to perform the work in strict compliance with the terms and conditions set out herein, and any special provisions attached hereto. APPlic"':'~ N~me i2rfr::r7. ii, ,)I)tf'Y . Contractor Name (UJi'/O'/ Cilflmll[,l Address \7,\ ,) '.<. (,":?:--1- Address J B? 1) ,t&, 3'; vv.tJ /J., 1" I€d. '. 'V'cll~r "1'-\N\\<;.f-t-.J{) , p-,,- -r""".u.J.. Applicant signature'l6\'X~ V, 1(':(/1,'-<< Contractor Signature ~"'-'^.L.1 (A.,eu,.., " .//1 Date. '\\1 h' '. ,I,C~~I:-, _ U V Date I')' Jlv1,; 51' g~ ' ' , Note: :Ind~ty provi,sions of paragraph. 2' '.and 3 ',on ' reverse side. :3\.1 :;,.' IN plI.vlV'f Or- , ... '. .... , ,',' , .' ",; " PERMIT &~~~ " " :' , :'. , " , :.' , . ' , , " '. . '. ". .' .....' : .. ',,', .' ..', :;, ,',' ", . :' ..... '-,"'. Subject '.to the terms and conditions on the reverse side, PERMISSION IS HEREBY GRANTED to Applicant "0 construct, operate and ma1ntain a road approach as requested above, and any special provisions attached hereto. No work shall be d~ne under this permit until the applicant or contractprhas notified , telephone APPROVEDB;' -1l~ K .-/~91 Date R-/6'-fY8 : ,: ','.', ':. , .' CAll 48 HOURS BEFORE YOU DIG 1-800-562-6478 /. PERMIT INSPECTION REPORT , Work covered by permit has been completed ~ satisfactorily. _Work is not completed. ~ecomme~d permit be cancelled. _Traffic control - adequate inadequate________ ," .' : " " REMARKS Form 113-0 IR."A 2-p2l ~ INSPECTED BY:~. ~ .: .. ..... " .~~... , " .. .......... ..... , , " ',.',",:<',;.-" . ,':'. ,:, " " ":;.' ",I:',:' ;,'}/;::n:, DATE q.,), 1- r'1 '. '''" . , ",: ,',,,;,: !", L '~ ,\ .' " , " '. " ,", "', ", ;, ,':.: :"', , .:' ,} ',',., 'I ''', ' " .',' .." ".rC::: .'i ~ ''',''. I, .' ',' .--.J ',. GENERAL PROVISIONS 1. TillS PERMIT IS SUBJECT TO RCII 36.75.130, ,1QO AIID ,150 AIID AMENDMEHTS THERETO, 2. THE GRANTEE", ITS SUCCESSORS AND ASSIGNS, AGREES TO PROTECT JEffERSON COUNTY AND S,.V[ IT HARI1L.ESS FROM ALL CLAIMS", ACTIONS OR DAMAGES OF EVERY KIND AND DESCRIPl ION WHICH MAY ACCRUE TO OR BE SUffERED 8Y AN'" PfRSOM, PERSONS", OR PROPERTY BY REASON OF THE 'PERFORMANCE OF ANY SUCH WORK, CHARACTER OF tlATERIALS USElI OR I'WlNER ~~Al~~T~~L~~}O~~ {~E C~~~Vf'~A~m, O~H~Cm~TIM:~U~~~ ~~~~~~~D~~E O~O~~r~~R 1l~~G~~~R~~:~~E O~~ ~~~:H~~- tlEHT OF SUCH ACTION.. DEfEND THE SAME AT ITS SOLE EXPENSE AND SATISFY #tY ...UDGEMENT ARISIHG THEREFROM If DETERMINED ADVERSE TO JEffERSON COUNTY. 3. IF .THE GRANTEE EHTERS INTO A CONTRACT OR AGREEHENT WITH A THIRD PARTY TO PERFORK THE HORI( AUTHORIZED ~~J~~~F~~R~~~6 ~~M~~;D A~~R~tfc~g MA~~U~~/~~ ~g~g~~~~~I~~T~O~H:T~Rgem~~~ ~~T~A~~~~~b~GmeE~O iI. ~~V T~~~A~~R~~T ~~ ~~H1~~ ~g~~{'~~~~~C:NeD:~Q~~:~n~~~~ ~~;~:= gaDgAy~R S~~U:5B~~C~HiH~~R~E~I~H~O G~~~~~_ LATlON AS HEREIH PROVIDED. 5. DURING THE CONSTRUCTION OF THE FACILITY", THE GRANTEE SHALL CaP1PL"I WITH THE t1AtilLll ON UHHnRM TRlFF"Ir. rnNTROL pF.VICF!\:, FOR STRFFTS ANO HIr.HWAVS PUBLISHED BY THE U.S. DEPARTMENT OF TRANSPORTAl ION. ON COHPLETlON OF SAID WORK HEREIN CONTEMPLATED" ALL RUBBISH AND DEBRIS SHALL BE IP1I1EDIATELY REI10VED #.NO THE ROADWA.Y AND ROADSIDE SHALL BE LEFT HEAT #.NO PRESENTABLE AND SATUFACIORY TO THE COUNTY. 7. THE COUNTY RESERVES THE RIGHT TO ORDER THE CHANGE OF LOCATlOH OR THE REI'tOYAL OF ""'Y STRUCTURE OR STRUCTURES AUTHORIZED Bt THIS PERHIT AT >>tV TlKE... SAID CHANGE OR REttOVAL TO BE KAnE AT SOLE EXPENSE OF THE PARTY OR PARTIES TO WHOI1 THIS PERI11T IS ISSUED." OR THEIR SUCCESSORS AND ASSIGNS. ~~~ ~i~T C~~~~~~ER~~~N~~~~~N O~R T~~L~~~~hDr1s a~O~~E ~"'~~~~E:~~~L c~~N~~l~L S~H R~ :-;-;~E:EA~E~ Lt r~;~~E FOR A14Y DAMAGE TO THE GRANTEE IlY REASON OF ANY SUCH WORK BY ....EFFERSON COUflTY" ITS AGENTS OR REPRESENTATIVES, OR BY. THE EXERCISE OF ANY RIGHTS BY THE COUNTY UPON ROADS, STREETS" PUBLIC PLACES OR STRUCTURES IH QUESTI~. 9., THE GRANTEE' SHALL NOTIFY THE COUNTY'S REPRESENTATIVE UPON COMPLETION Of THE WOAIC. UNDER THIS PERI1IT sO THAT ~ FI~AL 'lNSPEClIOH C,,!, 'BY IWlE. ,6. "8. .0 o SPECIAL PROVIS IONS , "," APPLlCAIlLE PROVISIONS ARE DENOTED BY AN (Xl ~O~~~~~~I~~A~~~~1i~"'i~ :~I~lHpl~~1~0:1~~1~'T~~DC~~~~~~~E~I~~~~~~A~;EKEHTS' AT ALL TUtES DURING THE THE APPROACH ISH~LJ.aEf~ONSTRUCTED IN ACCORDANCE WITH THE ATTACHED DESIGN PLATE TYPE P-I IIPPROACH. It. '2.D FT. LENGTH OF I '?:. INCH DIAMETER CULVERT PIPE SHALL BE PLACED IN DITCH AND LAID TO. A TRUE LINE AND GRADE. THE APPROACH SHALL BE SURFACED TO THE LIMITS AS SHOWN ON ~~~E~~G ~~ ~~~F:~~D~A~~R T~~O~p~:~ei~E S~~~~E=~Y I~N~gc~~~~~~E R~gi~~~-,,~~O~::i ~g~T:~L '~HI~~E~~' THE APPROACH SHALL BE SUFFICIENTLY SURFACED BACK AN ADEQUATE DISTANCE FROM THE EDGE OF THE PAVEMENT TO PREVENT MY' MUD' TRACKING ONTO THE COUNTY ROAD. ~Y f1UD TRACKED ONTO THE COUNTY ROAD SHALL BE II1l'\EDIATELY CLEANED UP BY THE GRANTEE OR HIS AGENT. IF NECESSARY 10 INCREASE SICiHT DISTANCE, .STUMPS AND ERUSH SHALL BE REMOVED FROM BOTH SIDES OF THE e:r~~A~~ALL ~~~T 1:~I~~:~7{~~~E ~U~~~:~y O:O~~R~~~~~~~~wl~~BER OR DISF IGU~ING OF ANY FEATURE OF SCENIC 5. 1I0RK SHALL BE RESTRICTED TO THE HOURS BETWEEN 9:00A.M. AND Q:OOP.". UlLESS OTHERWISE Al/fHORllED BY THE ENGINEER. 6. A SURETY BOND 'N THE lJ'K)uNT OF $ . WRITTEN BY A SURETY COl'lPAttY AUTttORIZED TO DO BUSINESS IN THE STATE OF WASHINGTON. SHALL liE FURNISHED TO INSURE COMPLIANCE WITH ANY AND ALL OF THE TERriS AND CONDITIONS OF THIS PERMIT AND SHALL REKAIN IN fORCE UHIL ALL WORI( UNDER THIS PERHIT HAS BEEN COMPLETED AND APPROVED BY THE COUNTY. 7. BEFORE ANY LOG HAULING OPERATIONS BEGIN, A SURETY BOND IN THE AMOUNT OF $ ~ SHALL BE FURNISHED BY THE GRANTEE TO PROTECT THE COUNTY AGAINST N4Y DAMAGE TO THE COUNTY ROAD AND TO INSURE COMPLETE REMOVAL OF THE APPROACH AND CLEAN1NG UP OF THE RIGHT-Of-WAY TO THE SATISFACTION OF THE COUNTY. APPROVAL OF ALL CLEAN UP WORK SHALL BE SECURE,p BEFORE THE ElOHD WILL ElE RELEASED. . SPECIAL CONSIDERATIONS ,-01. 8"2. 8'3. [$"il. o 08. 113b ----:----- " .' .., "',' :.' ;: :".: ".:,:,' ...... .' , ,":, : '." ' .......,.,' , .".;" ,/;~':' " ' .' ! ,1.- I '. ' " . , .. .. . :-:- '.' .. 'C ",' " I.: :,: i . ". .,. ':, :'. ~\\ :. :. ',' :';, :..: ., ':,..... c' .. "'; " .. " , : .'. ".' . " '" .' , .., " '.,~H ,.'. :: . .' " ',,', ,',..".'., '. ..,' ',.'. . , , '." .',' : '. I;. , , . "., "'" ,',', .-: \ ;,' .', : , > !,,, " < , ;' "," ',' I . . ,.:; " .' I, "'" ',". ":'" ": I; '.. '., ',' "',,..,.' " ,'. .:" i" ,,;,' ' i ". .' :'" . '.," " '. ,: ,,:, ,'" . : !,:: ':, , '.'.".,',,"', .....:"" . ",',,: ',.": .< .:, ':....., . ,."': .. . ".,,:'. :, ,,: '.'", , ". ' . " '" '.: ' ':":L IL . ..' '~';""';( . .... ,r ,.>; "'" :fl.- ....ii' .';." ',J''< "" ...',:'. ,:.....'..,..':' :.:' ...., :,::' , >.' ,. ......,...,.. , , . ;.; .. """'.::." !....;." i~!~~~:tj~ii~<i: ..i~~J3::~~~\E'-':::l--~-(;::c~- ;i;~~f1 " ~ :"ET;:hi'~ i-;':4:';:~;;~1 ~-,:~ . -, ':;IL12-cvjy~rl:3' ":-:-:' '~~l~~.~-~j>~ ,:';i~~~~L,,~it t.':.:: ,.:.... ,... j~12,~.iii.~:.i,~: :::~;~;~:~~ ,'~,i.':':__" ; , : ~::~~~:. SIGHT DISTANCE REQUIRFHENTS "i)/;': t "OSTED SIGHI' DISTANCE :.'......:, f. SPEED LIMIT, HINIHllM DESIREA.tlLE ....,.. " ',:. .,', ; :....,.... "'. :: : "', ". r . ","'," " ;, ,,'.': >., " '. ,":': ,.".... ,:", ':' ." " '"'' ..' ,. ",: ..:'., . ."" .' , "...:; ': '., ' ',,;:;':" :'- ?Xi.. " ',', .',:/;;.~::: '.L;!l( '. < .: . , , . ':.: . ." '. ..:: I '.: .-J ,>, c'.' :.' ~ ( ":::,,-;:. "" '" TYPE ,-, i. " f>RIVAT[ 1l0AO APPROACH i: I" 1- c.. :--:---'-=;:cc:~::-I , ... - . ... .... ...-...... '.. . ,,<L~~~~',:-~;: :,~'~:~j::,~:~,:~~~ ~.:~; ~:., ~.,.__. . -- ::':! .- to'tnin.2.4'lnClIl. ~/. -- ....~R~."'D;.. I, 'J~(;;iOo':",";.I;.'-.'Il~;r.',.t,n"~,,_~'."', H, .U.oi...in,e.....,t.. tomln,lIad, '~,.~ ~ ~ .. ." ..~':~'.hh..."tr,-,'" .__.._.,.,.'" --"J:::t"";~~ ,'~. "': v~.-~-:- t = , - 'H "... .,:': 1~~~;"I" : , " .. : COUNTY ~OAD _, _, .. ... l ! ':"'h:.. T i ; I I IlOTES: 25 ,3D S5 4D 45 SD 16D FT. 2DD FT. 24D FT. 275 FT. Sl5 FT. ' SSD FT. 2DD FT. 24D FT. 275 FT. SSD FT. 410 FT. 475 FT. 1.) eufie;; ahall meet alnbl1.111l apeclficaUons '~or HS-20 loadini. Approved types include: 1) concrete 2) corrugated metal 3) corrugated polyethylene tubi,ng-AASBTO t'2.J2) , County road ahoulder ahaIl be left at n existing profile. 2.) -~Pi1iVALS: ';", ; " t 4712. ~~ Chairman. Board of a '917 ~ County Comm1.s1oners .. Co .A!' ;; Date 9'" f3 Director. Department of I'ublic Ilorks Date ?..4ft.? . *o;;;-,ij":c :....;....:.: .- i I l - :1\ ,~:' '..... .. - -. ...0: ... '-~""'-._l"..':-_:';";-i'_" '.-r-;r'.. ''':''-'-- "," L ", "..'( '. ,....), i........ "~: ~ I, i' ~ ,,' ''- . :, ',: :'" I",'" .' ",:;: "',,',', " .' ,.' ,:. " " .';- >/ ". ",J/' , ", , ".' - ., ".'. ;, ',: ': :' . ~ :. ,':: .. :' "". ',.' . .,: :; .,' ",:' "" I,,:' 'r: '~i 11 " : " 'i . (',:: j ~,' " 1 ..' , . : :.: ,.'., i ) ,,', ,. " . " ",' ,; i., ... '. , i:',":,' '. L RoAD \ A 1"1"1<",,\0 ""\e--~ ~i--- '\ t w 6 t 9 1(, "'TI'~TC PMLI< /0 ,~ - S-V,-rc: 1 fA (lK I R\ S LE'/ ANDfl~So'" - ---- . . ' ',., ."1 ,',.,.... ,:: , I ",' t " " 't t' " " , I I - _.- I ,~ - I, ;)'h0N 1,',/ I ..,', -- --:'1 ,..,.:". "..,' , . ' , " .:"', ::" " ,: '" '';' i"." \ " [' ',:. , . .",,' " , , . ".' , '." : ".: '" v G'. ". }' ~ to' ~., f;;; i ':'''-''-':-~'''- --".. subject 'to the . terms and conditions on the reverse side, PERMISSIONIS~llEREBY-GIUU'f"''''''------ I\pplicant 1;0 construct, operate and ma'intain a road approach as requested above. and any special,provisions attached hereto. ....' ';,r" No work shall be done under this permit until the applicant or contractprhas notified . telephone , ,.pPROVEDB~: ~~ ;( ....;dAA.9'J . . . CAll 48 HOURS BEFORE YOU DIG 1-800-562-6478 .' ,:,:,., '\ . ,','. '-, ' "",' " , ..", , . ,'.'. .:"" ',' ,,', . . ' ','. .... " " '. ". ' . ',,,: ,",. :.,' , , ';,.' :" :' ' ~: " ::.'.: : ' . . .....". . " !" .' '. , : :'i . , ,-, '. ,'''' "::,."i'."":':.' ,'". '. ,.,.:...... ., . ,.' i: '. :"',','.,', I' ," .; . '...,'.......,..' " ". :.," ~ .' , L- '. :', , . I'L Form 113-0 (R...,A 2'j!2.1', B- /6' - 'B-fJ Date I PERMIT INSPECTION REPORT ~ Work covered by permit has been completed ~ satisfactorily. ~ork is not completed. . ~ecomrne~d permit be cancelled. _______Traffic control - adequate inadequate________ :' REMARl<S INSPECTED BY ::s-.- ,-.,.- DATE<!.,'J,\-li''1 ... n _ n ",;)) '" ',: ',"", '." ..... .:': ,'.<':..'" " ," . ". "":',. , :" ....... ' ',; , ,',;',..:.'.. :" ,.II . " ,. '.' , ", ',,' '., :..... ...... "," , .,' ..' ., .. .. .. .... .'. . .~. . . .':" ; : ",.'; , .' .'" .." ............: .' ',' .',' ';(' jl ....;.,j ...., . I;':. .', 2U "'" J , ;';, , " "", '" .. , , ,.-' " ,..... ...' ':'.:. .' '.. ....... ."..:'.' , -- "\r. .'. . .'.' '. ...; " : --- , , "..' : .. . ,'. "'., : "., i '\1: . '1'.., '. ',...i' ,.....~ .'\' .' . ,'.' ',:' . ,', I"..: ' ' . I; . ',', .. .', ' .'...... . " !, . '.....' !> ,.....- I'L' -::; ,. :: : , "" . ':., . :., 'o. }"-: i : 1. ;'-" ~i' I( 0: I~i ~':~ '(:c ( , ,': Ii '. ". :", .. ! ",' : .. , :.. . ::,",.'"'' . .,"~" . '.' ..,...."....,','. ,..' " .',: : , ..,'.. ; . ; .' " ,.;',' ''','''.'. '., ., ','. .... '.,' '."" .... "", ',' .' ,,'. " .," :, " "",.,'..,:, ',." '.... \ r<",,,,w ~'J~~.' '3''A.!.'"C' ro""'Wi. i-~, /!'~"'" 0962 JEFFERSON COUNTY DEPARTMENT DF PUBLIC WORKS 1820 Jellerson Slrcel P.O. Box 1220 Pori Townsend. WA9S368 (206)385-9160 N~ Dislricl No. 6 PERMIT ,'. : ;,~ ' , In accordance with all applicable Revised Codes of Washington and 3mcmJI11CIlts thereto, and subject to all the terms, com.li. lions and provisions written or printed below or on any part of this fOfm PERMISSION IS HEREBY GRANTED TO U. S. West Communications 2720 Oakridge Dr,. Port Angeles, WA 98362 to Install buried service wire along the South side of Cape George Rd. from mile post 5.61 to mile post 5.64 _ .,' .' ',.. Job II 89-39 County Road No, 622808 Franchise No, Milepost 5.61 to 5.64 No work shall be done under this permit until tile party or parties to whom it is granted shall have communicated with and received instructions from This permit shall be void uniess the work herein contemplated shall have been completed herore February 14 ,J 9 90 Dated at February 14 ,19 89 , &~~~@~\tlW ~r~ J.~ CALL 48 HOURS BEFORE YOU DIG . By ~~ K~ 1.800.424.5555 .' ..7l , ~ ~. " '" ~. , '. .", ~'> , . " .... '. ..' ',.' ":',, ,'. ; .' . . .' ,'. '" .'. ,....,' .:,r. " .'.' .. . " ,'. ,'. . '. '. '::. i, .; ", ". ,... ,., ..... ,'. i f I,: : : . , '..,. ': ,'. ,; . , .: .-::...J ., '" ,'. . 1 ~ .... ..". .,. . ":' '. . '.' . .' i .', ". '. : ... .' " . .'.: .", ..... . .' '.' . .' ,'., " '.' " '.' ':,' "." '. ,. :. '. .' '. ','.' ,.",' . ':':.':. ." , ." .... ! .",,' ...... '. ,:,'",., L :' ',.,' 'i. i.,':' , " , ::'.',' "'.."'.', , >,,-:-,,' "". , ',./.,h ,,",', : :il'; 1,/ :' ;':...\ " ;, " . ..,' .' . " ," '~~ .'. ". ," ""C.., .' i........ '; )~:*'~~;(: :1 :; .' ....' ..: , " ..'-\c,.:.n ':~' . . .,' . ::" ",' . .. "" Ii /, IJ '.. " .< '. .. ,.,: , " '-"' l . .' "," .....' '. :'-:," .. h," '.,. "" :,', ': . '''..-.' .;.' '. " i ,.':,. .,": ," \ , " .:.;' .\ \ " '" I'" ' I, I .; ':" , ;.' ; :L l -,.....:,,, ..' GENEIlAI. 1'1l0VISIONS AI'I'L1CAIII.E TO AI.I. I'EIlMITS This permit is subject 10 all upptiClblc provisions of the Rcvi\cd Codes of Wa,>hirlglun. cxccpllhul any provblu/I in thi~ agreement not ,umi~lclll with such resolution shall be controlling. A bond in Ihe amount of $ is rCljuircu fur the protcctioll of the couHt}' a~ M:l lunh ill the Icnm of the bOlld. During the progress of the work such barriers shall be erecled and muinwined ..Hi /Ilay be IICl:CSsary or it, may be dircctcu for the protection of the traveling public; the barriers shall be properly lighted ulllight. In accepting this permit the petitioncr. his successors and assign!>. agrccs to protect Jeffersolll'oullIY and saVe it harlllle~ from all c1auw>. al:lions and damages of every kind and description which llIay accrue to or he suffered by allY person or persom. corporalioll or property b)' reasun of the perfur- mance of any such .....mk. characler of materials used or manller of illStallatioll, muilltenancc and operation or by the improper oct:upancy of right of way or public place or public Slfucture. and in case any suit oractioll is brought against said Jefferson CounlY fur damages arising out of or by rcasoll uf any of the above causes, the petitioner I his succcs~ms or assigns, will UpOllllOlkc to him or them of commellcement of such aClion. defend the same at his or Iheir own sole cost und expense and will sath.fy any judgment after Ihe said suit or action shall have finally been determined if adverse to the Jef. ferson County. Except as herein authori/.ed. 110 excuvutioll shall be made or obstacle plat:ed wilhillthe limits of a coullty road in such a manller Ult to interfere with the travel over said road. Except as herein uuthorized, 110 e",cavation shall be made ur ohstacle placed within four (4) feet of the edge ()f the pa\'elllcnt. If the work dOlle under this permit interferes in any way wilh the drainage of thc coullty road. the gralllce shall wholly amI at his OW/l e.\.pen\c lI1ake such provision as the engincer may direct to take care of said drainage. On completion of said work herein conlemplated all rubbish and debris !>hall be immeiJiatcly rctllovciJ and the roadway and road\ide ~ha]] be left neat and prcsentable and satisfactory 10 the cngineer. All of the work herein contemplated shall be done under the supervision and to the satisfaction of the CounlY Engineer and the entire expense of said supervision shall be borne by the party or rmrties to who/11 this permit is issued. The Department of Public Works hereby reserves the right 10 order the change of location or the removal of any structure or !)\ructures authorized by this permit at any lime, said changc or removal to he made at the sole expensc of the party or panics 10 whom lhis permit is issued. or their successors and assigns. All such changes, reconstruction or relocalion by the gralllees shall he done in such mallner as will cause thc Icast interference with any of the Coun. ty .....ork and the County of Jefferson shall in no wise be held liable for any damage to tile grantee by reason of any such work by thc County of Jeffer- son. it agents or representatives. or by the exercise of any rights by the CounlY upon roads. streets, public places or structures in question. This permit or privilege shall not be deemed or held to be an exclusive one and shall not prohihit the County from graming other permits or franchise rights of like or other nature to 01 her public or private utilities, nor shall it prevent the County from using any of its roads. streets, or public places, or af. feet its right to full supervision and control over all or any pnrl of them, 110ne of which is hereby surrendered. The Department of Public Works may revoke, amend or cancel this permit or any of the provisions thereof at any time b)' gi\'ing wrincn nOlicc to the permillee. The perrniuee shall immediately rcmove all facilities from the right of way. Any facilities remaining upon the right of way 30da)'s after writ. tcn notice of cancellation shall be rcmoved by the County at the expense of the permittee. The party or parties to whom this permit is issued shall maintain at his or Ihcir solc cxpense the strllclUre or objCt:1 for which this permit is granted in a condition satisfactory to the Department of Public Works, SPECIAL PROVISIONS: 1. Cable shall be a minimum of 30" below existing shoulder, except where crossing ditch cable shall be 30" below existing ditch grade. 2. Applicant shall be responsible for all damages to county road right-of-way. ~ '! In accepling this permit the grantee. his successors and assigns, agree Ihat allY damage or injury done to the property of the grantee or any expense incurred by him through the operation of a contractor, working for the CounlY or any ('ounty employee shall he at the sole expense of the grantee, his successors and assigns. ' /f,s; tv:.sf- and conditions as herein set forth. , the undersigned. herehy .lccepts this permit suhject to the terms Dated this /(, /'".6 ,19.79 day of A""h"",,;/d ,a:~ '. .. III ~, . ..... I.:' ", '. . ",' ,'. .:. ',. .~..' ,'. :., . ".., ' '. ' '.'. :' .-,.-': " .....,." >. .' ,'" >/ ,'. .-,' .,'"i,,' . ',' .' " , ,: ..' , ",.., ',' "','. , , .-" r '. ,', ", i ,,'.:. " ,...,.' , " , , . ,;:: 'i:;",! . '.. . .:': " ".. ',: : ',' " .'."',. :..,......... .' , :.-; , , " ,': " , .' '.' ,'. '.: I:, ,..... . ',' " ", '.:: "..: ...' , ".... " , ,', ". " , '.' ,'..:.' :. '.. .......: .'." " ..::.." . , ,:".:. .:.,., ... " "'. ',,:....' ", " '. .:, ::'-,...." , , ,': . '. '.' ..'. ,', :' : ':., '. . .,,' ....:' '.. ,:.,,''';.':' ~'.. .' -' .-l " "', ." ',.,: ..J \ ~>-0f} ri~ < ;J;. !' , JEFFERSON COUNTY DEPARTMENT OF PUBLIC WORKS Ftc Paid_ Yes _ No '- 1820 Jellerson Street P.O. Box 1220 Port Townsend. WA 98368 (206) 385,9160 Ra;cipt No. Addu:!>S Rt:Que!.\ _ Yel>_ No Mile I'~I Al'l'UCATION nil{ 1'lCltMIT fL.4~j <:' )J~ ...&.~=%~/8)' To Department of Public Works, Jefferson County, Washingloa. The undersigned hereby app/~ for permi"ioll 10 ~rft ((~ /;."'~ "'/o"J 4,/e."f j"rl ",..t :5'Nrvfc",.. cvlr.o- ;;.".., ,Apl'b,allf "i/lII.-lml", JIIII,. .../iall,.. ,,';''''''' /u J(/ j 1~r7/""A I c ~ 73'f 25',;) , ge''''" Cet!Y-c" ,.(Je( SKETCH: S-,,"" c; It",c-h"d Mrk t7r/er 717-3'7 {/!..ps"," r"fcr f. /((5 A""'!""" &>11 rr,.,;I-) RECEn/ED FEB 8 1989 JEFFERSON COUNTY PUBLIC WORKS DEPT. all CoulllY Road: 7" ~tI'Y"'" ,fc/ between (,\'I(]I"'lt'(/It"\lrff"I-\I"~'1 ()fmUI'I",;III/ alld agree~ to do the work ill accordallce with your rules alld regulatiolls alld subject to your illspection and approval, Date 2- 7 19...1!L- rJd W"'# . /?:i~ A&r"'" /~..I"A /' ISlgnnlUfe nf Apllhcuml ClIllUIIClllTl (If uPlllicnnt is n copurtncrship, set forth names of copartners) 2720 ,~.- /1"" ~.4s. 4/4 q'g35L Phone No. lIS-1 - '7'l1l!.9 A'u.? 4",,;/ ^iJdre.., District No. h Jefferson Co. DEPARTMENT 01<' ('UHLlC WonKS Permit No. 091.7_ Supervisor's UClwrl No. Supervisor will make detoiled report with his recommendation oil/his application. JVhellel'er pas.sible show sketch of proposed work. Supervisor will also make additional reports Gndlinal report gil'illg dale of completion o[ work Oil this form. Preliminary Ucport: CA-p e.. 6-e..cA.~ e fC'J). PI'f' $.6/ ~ ""'t. 5'. 6 'f O't-rl-NP/HVi> sl-l'-p A-"'D D .-kH /l!e-<-J P.ANB~ Dale: 2-/3 -~~ Signed: --d---<~K~L'-J Final Repor.: P~NSPECTJON REPORT 'York covered by permit has been completed sutisfactorily. Work is not completed. Recommend permit be cancelled. Traffic control - adequate - inadequate REMARKS Dale: <( ) U/ 1i'j SIRn"I:~ ~ IN PERMIT ~ -- \V()I-1r( i. OCA liON MdW,~_ SGIQ. .c.[jf.E...Ge:';)R~h~__._ Glly .'TOiJl!..l;$.~ County .-=J.J:tf.E,_.u StotcWJl" ',,,me .__hofJw.._j:i^p.WC~1:>,______. Gr~IGi~IMED flY c.i:hh..1;\l5:e._ . Da18fk<<rgq "r;w ~ :';/0 No S::.e,,l})..!W Owe Dete ___.___ f.h:'palf l. i l'ul. NCI, _.. ";"empQrlzod [.J R~\!II~UhJtoi O~/O NO. .___u,__Dul) Dute____ Buried Service Wiro . Work Order o8~qO jl.o<;;) No l'l..::Y'i..- COmpieh? Dy Typ~ ~)f SlJr\'k-."._. r=t.5t:-r--r;;;--!' "c~l~~;a.p. I "-'- -T.ot....;;;A.~;-~..--1 ~-----.J-,-,.~--T~==~-T---'---===-~:1 t--'-!----~---.-.. ---=C' 1 i.;:,,_L~~<<"Ol'Or. ~! wo,;,;-"-''-T r~1~):~nCc:~!~ 'i '------;:,--.:r---.s -1" [ I I.. a 1,I~",L-..,'.~).\L~3.---,,-.---T.----1 .E...?;.lI.-"'...-Ci.:.I) 5~Rti .1 "'I--m_- ]' ! I Q ,?OV..I.J.1?:--JH.ll""-"'...'t---.-'---.r'-.-- :-e.~"', ~Rfl"'lltjt1j..~;'/l ~'I I COMPLETED BY __u.._.___.._' Datc -,- I . t>...C~:,)$(.INa'_ .1,l-LlS '.", ... - P- .r..---i Cal! ____________ tor Servlc~ Connection f-lSF~~< Ii. 1.'" ...i- '1' r-' -.-.,..-.--..,..... I-li(:>.s..........,. '__ --'.'-j--'-' Ind:~"leNor!h ~--------" '?<t~ ~~,. 1'1 ,. I 1--+~ ,j..,cr:...#r'6_,Y(;J...J.9 .~ ..=~~.-:-....___..__J ,j Pi:;'I~;.;;hY~H-;;;im;---~~_;~-;;~~.mtt.i~, v~lfe $.IZ~ f1.n~j <),m(I~:f.t : · . . .CLoV0J. .. i I I I I I ic..513'l> ' · ,(&,0 I... _----.----- 1 __...-::::....:~.=....=---=---_.----_.----..-~-------.-- ,I .260 CONTRACTOR'S ACCEPTANCE Firm_,~___".._._ ._ Slgoature . TIlle _' UOil Pr;ce [J _____,__.,.,.,_ Date ___ ,__ COST Plu)S 0 F I.n Sum [J $. Bill try U S WEST Communications Allen lion __.., Address .. City Zip ~tJPHOV AL Far Flat ~um/COH Plu:i S ____.____. ____H____ Ri~cornrr.l;.ndc:d .__________________..____ Date .---,.----- Apprcv8d oy ______., "..._. .,. _ Dole .".,...- PERlvllT REOUIREO 0 Yes [J No r~ecr.~iverj from _._______.____ Varoal 0 ';urlsd1cticm ______.__ No. _._.______ Date ___ {J PO,t.J~ ~.O' .~f\J:it, Jt ' 'pi"t..E: b' , . c.~..S.f.lrd:. l... --'---"-~'-'-'~"~---~-"- r._.tif'~_$~~e R;,t>, Nt'l~' T~i~'!.ke'~(;h lY"~Y r;cl O'il c\n :;ccurBt~ (~.p;~~~;,~.;;;I~~~_;.;_I.i~17 '~;t<lr'51r;C c:;-~l'rOClcr'~ re~p'_;'~-!;I~ii~~;~;.;C;c,;:e we.rr. In lhe) tl"" ORIGINAL Copy o I, "'-" ,-. , .' ' j ,.'. ,',': ,: \ '. ," '. .,...'" ,i :","' . ':" :" ':',' ." . , -. , ','." Ii' ':, ,:':,"'. ,". , , , ,'::. '.: ,; : .: , " : . .',:.' ') ;', i , . ", , :, , ; , , " ,; ; . , : " ' , .. ~'.\,:,,~i:\-,:,::',:: . "..f));:,~":: .' .:,' .", " ,.' .: . " '::! . :'. . It ,", " .. : .' ::: .i'..., ," , ,.", " . , , . , '.,: ' , . '<' ',' : '.:. , :,' , .' ',' , .:: :,: . ,:" '.:.. .. i' ':., , ,;.,.,,' " 'q '., I~ " :': ' " I' ~, , \ ; '::, ! '. ,I"~ , " ".' ,', ""':..', . ; ",/ ': . ','. .::",,>,: , ',' , :', ',,', . , " ' 1:'1'. .", , ,,"';,:':, .,' I L I \ L IL :,.!,". . -, ~-<"~? I{,-~ APPROVED .BY, CALL 48 HOURS BEFORE YOU DIG 1-800-562-6478 f"''''!''''''''''''!?:'''r~ tirJ=ff"\\ ~~\f rr~~ ~~:.;. f!~~~ ~ V 2~ ~ SEP ,2 8 1':?7 Fonn 113-0 (RovA 2-jl21 ..H':r-;-:=::.:~:.~~[):\= <...~(')UNT\' ri? ~ '::::~ ~\:~ L~ :~!~2 f:~: ....: ~:.:: ;.'r r;:: : , ----- . . ...AM:.! . Date 9 -: 3,a - 8;-"?, : ,":". '1:1:' .J'" ;.' .'l.,", PERMIT INSPECT~ON REPORT.." I Work' covered by permit' has been completed - satisfactori1y. '." ' i , Work j,s not cOlJ\pleted. ~ Recommend permit be cance11ed. _Traffic control - adequate inadequate~ REMARKS :-;:.. ;o~.""l t,.l f~ ..::.....,_'" \.\r>\\..... 1"...._~ <=. r e ^ ....1'.., t 1._ r ....',J(......;..,;. I.... . I'~_ J:NSPECTED BY: DATE' r: , .' " n, 1.' ..pi,,.. ~ :' ,: 'c; . .'., :.:""',.'." :' ",' , ' '::'..,"';:,;i\,. ';'<', " ".,' " , ;:, " .- " ,', .: :"", ,,' ,", ' ,". . "I',: .' -1 . ',.....' . I','" ~,", c.:.' ;1'-:1~" I. ., Ii. ..' 0 '. (. I I::. ! ..... I .. " .' : !/ ." 'i '. . f >)' ....:. ' ~ . .' '.. . ; ,:' :;.',: ,;";.:.,.:. ;", ~ '.. j i' \1 '. ',.. I I . " . .: ,.,.' .:: ",:' . .:' . . '" ....i.. . ,," ..:." ':. .' '. . . . . i ." ! .1 L.. .:' i. . ,'. .'.' ..... . . ..... ....., . ."::'. ~:\c; '. ,. ;. :1" I:. ! '. . i r ( . " .... , j{;,i:':.; ~\ \\ Ir....,:{:,.:..:.':..... 1 ". ..: ". ::"'., I: '.;-;~\' "', :. ,~" . :.' '-~ : <<:i:'" ',. . ;,. .,. ". ...... ) ... ':. .... '.. . , ....:. . '. . . . ,....... .:. ,..... '.' "">. <. ,.......". '., ,,' . ." . . .... . .....::.....,.'. . ,,' '. . ','. . ." ". I;:,.":: .... Ii'..... l'..: ,..... ,........:L I I:L .,-'~ L GENERAL PROVISIONS 1. THIS PERHIT IS SUBJECT TO RCll 36.75.130. .140 ""0 .150 AND AMENDHENTS THERETO. 2. ~r~J~;~HI~~io~~s o:~lli~~:s or~v::~ I ~~~o ~~Eg:s~~ 1~~~~~C~H~~~F~~O:C~~~~T~o ~~ g~v~U:~E=~~Ki~5~~R~~R;~,. ~~R~~~~AL~:T ~~~~E~~Y C:~ER~~O;U ~~ ~=E A~~~~~R~~~O~H~:G~~~~T w~~~.. cg~~~c~~: g~~~~R l~~~ 1~~Egu~R O~:E:y ~~~~o~F O~u~~y Ag~J ~=~ ~:~~~D C~~~Et:'H~H~TPn~ T ~g~~REx~~~S~u~~s~~~ s~~ ~~ I ~~~G~A~~f ~~~~I~gT {~~R~~Rg~~~HCE'" DETERMINED ADvERSE TO JEfFERSON COUNTY. 3. IF THE GRANTEE ENTERS INTO A CONTRACT OR AGREEMENT WITH A THIRD PARTY TO PERfORI1 THE WORK AUTHORllED ~~D~~~~F~~R~~[o ~~[~~:D "::~R~~FE~~ ~H~A~~U~~.,r~~ ~~~~Ag~~~1~7T~a~H~T:Rg~~~~~~~ ~V~J:~:1~~#2~G::~~E~0 4. ~'t T~~~A~~R~~ T~~ ~rNI~~ ~g::g{~~~~1Ott~eo:~Q~~:~C~~~~ =~;~:= ~D~Ay~R s~:LtU:~~C~H~H~:R:E~1 ~H~O G~:~~E_ LAllON AS HEREIN PROVIDED. 5. DURING THE CONSTRUCTION OF THE FACILITY# THE GRAtiTEE SHALL COKPLY MITK THE MANIJAL ON ''''FORM TRJ..FFIC ~ONTROL DEVIC~~S FOA !'iTRE'ETS AND HJ(:;HWAY~ PUIl.ISHED BY THE U.S. DEPARTt1ENT OF TRAHSPORTATlOtf. . r. 6. ON COI1PLETION 0' SAID WORK HEREIN CONTEI1PLATED# ALL RUBBISH AND DEBRIS SHALL IE IHI1EDIATELY REI'tOVEO AHO THE ROADWAY AND ROADSIDE SHALL BE LEfT NEAT AND PRESENTABLE AHD SATISFACTORY TO THE COUNTY. .. _ " ~"; '\ . - 1. l~'H~~~~~ :~s~~risp~:~I~I~~TJ.~ ~~~~ ~~~DC~~'~Eo~AL~~~~~ ~~ ~~E~~:O:~Lsg~"::p':~~~C~~R~H~.P:~~~~~RE~.. .{ ,.ARTlES TO WHOIt THIS PERI1IT IS ISSUED... OR 7MEUI SUCCESSORS AIID ASSIGNS. ;~~ ~~i~T C~~~~~~ER::~r:~~::=IA~N O~R T~~L~~e~{~~ s B~o~~E A~~~~~~E~~~L C~~N~H~Hl~L S~HN~ ~~E:EA~E~Lt I~:~:E FOR MY DAKAGE TO THE GRANTEE BY REASON OF ANY' SUCH WORK 8Y ..EffERSON COUNTY.. ITS AGENTS OR REPRESENTATIVES" .. OR 8Y THE EXERCISE OF ANY RIGHTS 8Y THE COUNTY UPON ROADS" STREETS# PUBLIC PLACES OR STRUCTURES IN QUESTION. . : 9. THE GRANTEE SHALL NOTIFY THE COUNTY'S REPRESENTATIVE UPON COl1PLETJON Of THE WORK UNDER THIS PER,.." SO THAT ~. .". A fiNAL INSPECTION CAlf IY KADE. _ __ 8. =::.~. -~:-. SPECIAL PROVISIONS APPLICABLE PROYISIONS ARE DENOTED BY AN (X) , ~O~~~~U~~Ib::EA~~~~ATz~~A~~ ~ilg"P~~liO:I~~I=#;~DC~O~~~~E~I~~~~O~~:A~~~ENTS... AT ALL ~IMES ;DUR~HO" THE.. .~._:.:. . THE APPROACH SHALL IE CONSTRUCTED IN ACCORDANCE WITH THE ATTACHED DESIGN PLATE TYPE~~" ..\ APPROACH. & h<l iN 2-rl FT. LENGTH OF '"7 INCH DIAKETER CULVERT PIPE SHALL BE PLACED ... . ~ DITCH AND LAID TO A TRUE LINE ,\ND GRADE. THE APPROACH SHALL BE SURFACED TO THE LIMITS AS SHOWN ON ~7~E~~~G ~~ ~~~F~~~D~A~~R T~~O~P~:~~~~E S~:~~E:~Y I~N~gC~~~~;E R ~ ~~~_~~~w:~O~: t~ ~g;T:~L P~:M~~~E~~"". ~ l;i D,l, ~ 2. ~E .... ". ~ 3. : lZ1t 4. 05. 06. THE APPROACH SHALL BE SUFFICIENTLY SURFACED BACK AN ADEQUATE DISTANCE FROM THE EDGE OF THE PAVEMENT TO PREVENT AllY I'tUD TRACKlNG ONTO THE COUNTY ROAD. ANY t1lJD TRACKED ONTO THE COUNTY ROAD SHALL BE; IMMEDIATELY CLEANED UP BY THE GRANTEE OR HIS AGENT. 1:p~a~~~~ARfH~OI~Sf:~:~~I~l~~Tc8~~I~C~F ~~~~~N~~L~R~~~Bi~Aai g~s:~~3~~~GF~~"J~T~E~{e~~ g~ ~~~PCIC VALUE SHALL NOT BE PERI1ITTED ON COUNTY ROAD RIGHT-Of-WAY. . WORK SHALL BE RESTRICTED TO THE HOURS BETWEEN 9:0010.11. AND ~:OOP.I1. UNLESS OTHERWISE AUTHORIZED BY THE ENGINEER. A SURETY BOND IN THE AJoIIOUNT Of S # WRITTEN BY A SURETY COt"JIANY AUTHORIZED TO DO BUSINESS IN THE STATE OF WASHlNGTOH, SHALL BE FURNISHED TO INSURE COMPLIANCE wITH ANY AND ALL OF THE TEAMS AND CONDITIONS OF THIS PERMIT .-.ND SHALL REMAIN IN FORCE lItTlL ALL WORK UNDER THIS PERI1IT HAS BEEN COKPLETED AHD APPROVED BY THE COUNTY. BEFORE MY LOG HAULING OPERATIONS BEGIN, A SURETy BOND IN THE Al'\OUHT OF $ . SHALL BE FURNISHED BY THE GRANTEE TO PROTECT THE COUNTY AGAINST AliY DArtAGE TO THE COUNTY ROAD AND TO IHSURE C01"lPLETE REMOVAL OF THE APPROACH AND CLEMING UP OF THE RIGHT-Of-WAY TO THE SATISFACTION OF THE COUNTY. APPROVAL OF ALL. CLEAN UP WORK SHALL BE SECURED BEFORE THE BOND WILL BE RELEASED. 07. 08. SPECIAL COHSIDERATJOHS Form 113 b .. .. ~~-- 1.--,-~,.,..,....,~.llI1l1!~' . ~l.. . . I '.' '. . . ..... .'.. .' ~'. '. I...... . . .... ....! . . ). . . ......, , ~ .' ......:'. .... ; ....:.. '.. ,..... :'. ..... "". .:. . ; ...,'. ", ': ',:. .. .... . '. '.' ',........ . . . ..:..:. : '.: '. .. " : ,". . ." . .' ,'.' ....... ,': , ..'.. t" .... .": i: : ..' '. '.. " .... ......... .'. . .,. '" .' .' '. .". '. . ........,:....:... .... '. . ". :. . ...::: "",'." .. . ':,::,\: . . ... '.. .'.:',:,:..< . .. .. .... ',,:,:.! . '. ... : . . .:.' . '. .. ", .'.:' .. .' :~"""'i, . ':, . '. .'. ........ .' 1 --.J '.' / ". "', .... . ". .. ...( .," . '.. .'. ...... .. :....... .' ':, '. , '~ -.1 ',' .::' :' : :, I11III ..roO ...2..'Oia min. Cui....,t -. . ! " . .~; :.: .;.-:.....'m.:.~~l~.;.:~: -, i.;.~,< :";" ;::'~:::_~:~::~: :'. -. - -------- _---.:'~:- . ':-0__- .'.-__ __:--.:... _0' _.__-.;.__~ --:"_4 _'___' ._......:.- . .., ~ . .. ":' .' ~ ~ L:.: . ! . ,.,... '.. r .. . to:~I~.';~~ i!Om.., ~.~'i'lIng .lItctl . . Edg. (lit should.r Varin' o. t . ! -. .... t ~. !. .... r;.; , PLAN .,. - ., ,t.,CoIln"Rood' ','- . J. --.....:-:::-1: .:-:-~:~.~: EdoeO:'.~i~d" ~~~ :_, -~~~~::.:~.~~.~~~~o._ :I;~':'--"~:Z.-_~,:...~ ',~,:~_-_',:::~~,'_1,',: _ [20mm I ... . _ .. ~.." .. _.' . . , ,. ~:~~_ --- . ~ ~ :':-= ~: ~.l:~~=:,~-':' ~:i~~~::".'~:~ :':',~'.~.': .,':~.!!!9E.lr.-d' i:2D/O . ..:- ': :~<. . ..0_- -.. - - - ~-- ___ .___.._. . .---.. ------.--.--..----.. ----- ib~fTIlI?:fl~~f.f:-, ",;;~~''":::."" . .:; ."~;:;:::~::;.;;.:2, . POSTED SIGHT DISTANCE SPEED LIMIT, MINIMUM OESIREABLE ~. NOTES: 1.) Culver~ shall mee~ minimum specifica~ions 'for HS-20 loading. Approved ~ypes include: 1) concre~e 2) corrugated metal 3,> corrugated polyethylene tubing-AASHTO H2.J2). {:Olmty road shoulder shall be left at \m n ' existing profile. 25 30 35 40 45 50 160 FT. 200 FT. 240 FT. 275 FT. 315 FT. 350 FT. 200 FT. 240 FT. 275 FT. 350 FT. 410 FT. 475 FT. 2.) APPROVALS: l 4~ 12. .(?~ Chairman, Board of a % ~ County Commissioners .. <.. . ..A'! ...J Date9~-!J Director, Department of Public Works Date 9A..k; ~ Foiin,i'!::c'. ..,.,- '''''. '\ '\., -'\ , "- ~ 'Y..>- \.., ..- ~ o '\. "(,. LOT ft 50 '\"'" .'\.... " '. ", " ". ......., \"'" \.lA "\. "\. ~ " , "x// .() '..0 .,\ ,. "'// " '\ ", " '....,." " '\. , " .\.~ ... ... / / ,- / ,( ~ yO ~v v~ ./ ....'" '\ ./ "''''\, Lor -# Jle ~ '''''I - I~,~?__-- ..1 /iflf'.u/". '::i. .y1;,~~'i. \:; 1:' Lo'- H' 7'? ~ \e C>~ Tfllf/AP.l'fcK 0,LI.(1I;;.1; /. " ~ '" ." .l!\'=- , ~,':~~c:~\!.', <~/., O /,'--,- - 0<'/' --- "/ \, ;; "--j I:=,=.'~,:-., ~=----.L r4.':'GII_€ rlC""'1r "s-~ ~(,.' I" ,---- :'1 v ~8'" PQV~~.~ i/ ,..,.,(';..... ~. ! f'rH'.fl. ff<t<.<.. , 0.1'0t./1[)1'I!{t: ! J 1.1. P,,' T DO,,,'!',,,!''),/ I kc.;.:!~ . Ji. . ..HI!,:,,,: :-;.. .:..~~~- bei n:.:::.I.....:~ ....':. i "" I I I I J J , I (l'_.....1.e.("' e..9 'VQ''''L~/..~,,~ .5J 7t;'J c..1:'.rl)o.z.C'e..S=-O(ClP:l~ .-..... -I' I .,/ ./ ./ i (..,D NO(3I-l: t..AIVe; <I I '-.. "\:l ~ '" j , I i i '" H.J. lIiinnihan Co~ Inr. 3059 Oak Bay hll, Hadlock, 'Nash. 'JS.'0~ # 206-437.2104 1l1lte () A- rs A (~ LQT# 1-19 ESM' . O' Zro/5 43 ,. ....N.""".' '" 0 ... CCI'\MON n II :: ARt" !J7 l . ~ - ., ~ ~ "" "'2/;' ..,'w "'.7.oi...... ~ I~D "J 'u., 8 JB W 'fa I. '" '" ,.', .-, ~.. . 'I. k1 , ~ ,: ~ ~ 'i Z9 .1 : I " Z8 ZT .' ;~! i '.., ~ > Ill". J. .,'r ;t .ltO.. " 01' ;0 Q' 8 (~! , 25 . .. 23 ;;'k ~" 24 . 31 JO IS ". ..' III." l.ANE .N "" )1'1.' r ilIJlil. 17 Q) . . ) ) . . . /8 ~.. ~ R ':x ~8 ~8 . . . /9 ' " 20 21 U ~~ ii.' ,. ~~ ~t . ~ . . !i k g . , .... ." It..II ,.'( 9,ih) ,,) ~Ai-l- He NO ~Wi?I."C7' V'F-HICUt.-A'. /\CC;::~> '.~. ,1t:UdCE/V7' /..01':;' ON7'O PA7'/~N :sr'K~'F-7: RECORD! NG CERT! F! CA TE; .'( Nit A L C R Zt;~ /.5 PJr I;' 07" :5+'? ~;,S7 ~~',. "-$9 2.~ of-;.D 02.' Sf$" 2009 /9. 5;. ;!J,:' 7~~ ~ 'I-:s" 57' 0-'- IJl/~ IB71 ~,5' 3C'! 31 II- 37- ' 2S" '18 ::0 ~3,2.!0 Zt:," 7.~" ~2. 0"- /'1' 'II" IS. 9:- I!:. 92 ;?lS' ;;~. .33 1'102:;" SI" I~ e~ /6. i'9 '-/1". , .. 1~" ;;f 2!'0 '3(.' "?" 7~,(..1 2Pf'~ :So~ :U;l! 3(,' o~ a;"(:'b" {,,73 ~,7.3 I?"!'~ Filed for record dt the request of IlAA~ (' on ..i,. ,199A.D.at ",-m past 0 c1'tcr and recordedin Volum ~ats. ! . records of Jefferson County, Washington. \ ~\:,-~f), 1 \':';:-rg:Kr. \~~ :-,-- rj(.~~?" - '. viTiI.-. - N~ 0922 JEFFERSON COUNTY DEPARTMENT OF PUBLIC WORKS 1820 Jcllerson 5lrllel P.O. 80x 1220 Pori Townsend, WA 98368 (206) 385.9160 DislriCl No. 6 PERMIT In accordance with all applicable Revised Codes of Washington and amendments thereto, and subject 10 all the terms, condi. tions and provisions written or printed below or on any part of this form PERMISSION IS HEREBY GRANTED TO Douglas Harwood P.O. Box 1443, Port Townsend, WA 98368 10 Bore ~nder Cape George Road at mile post 5.66 to install a 2" water service line. MlWM[6W County Road No. 622808 Franchise No. Milepost 5 . 66 No work shall be done under this permit until the party or parties to whom it is granted shall have communicated with and received instructions from This permit shall be void unless the work herein contemplated shall have been completed before November 3 O. 19 89 Dated at November 30 .19. 88 BY./J~ K~ 1.800.424.5555 , " ,',".' --.."~~~~, - ---,-~,-~~ GENEIIAL 1'1I0VISIONS Al'l'UCAIlLE TO ALL I'EIIMITS This permit is subject to illl applicable provisions of the Rcvised Codes of Washington. exccpt that any provision ill this agreemcnt not c(lll~blellt wilh such resolution shall be controlling. A bond in the amounl of $ is rt~4uired for the protection of the coUnly as set forth in the terms of tilt:' hondo During the progress of till: .....ork such barriers shall he erecled und lIluilltaincd as Illa>' be lIcces--\:u)' or as may be directed for the protection of ttie traveling Jlublic; the barriers shall be properh' IighteJ at night. In accepting this permit Ihe petitioner, his successors und assigns, agrees 10 protect Jdferson County and save it harmless frolll all claims, actions and damages of every kind and description which lIlay accrue to or be suffered by any l)l.:rSOll or persons. corporation or property b>' rca!o.oll of the perfor' mancc of any such work, character of materials used or manner of illstallaliull, maintenance and operation or by thc improper occupancy of right of way or public place or public structure. and in case allY suit or uClioll is brought against said Jefferson Count>' for damages arising out of or by reason of any of the above causes, thc petitioncr. his successors or assigns. will upon notice to bim or them of commcm:ement of such action, dcfcndthe saUlC at his or their own sole co.st and CXI)l.:!lSC am.! will satbfy allY judgment after the said sui I or ..ction shall have finally becn determined if adverse to the Jef. ferson County. Except as herein authorized. no cxcavution shall be made or obstacle placed within the limit.!. of a COUllly n>.:IU in su!;h a lIH1nllCr as to interfere .....ith the travel over saiu road, Except as herein authoril.ed. no excavation shall he Illade or ubswcle placed within four (4) feel of the edge of lhe pavemellt. If the work done under this permit interferes in any wa>' with the drainage of lllC courley road, lhe gTiltllee sh,]ll wholly and at hi.<. own expense make such provision as the cngineer may direct to take care of said drainage, On completion of said work herein contemplated all ruhhish and dehris shall be imllledialely rellloved <.Iud the roadway and roadside !;haIJ be ldt neat and presentable and sati!;factory to the engineer, All of the work herein contemplated shall be done under the supervision and to the sath,faction of the County Engincer and the entire expen!iC of said supervision shall be borne by the party or panics to whom this 1)l.:f1l1it is is!;ucJ, The Department of Public Works hereby reserves the right to order the c!lange or location or the removal of any structure or structures authoril.cd by this permit at any time, said change or removal to be made at the sole expense of the party or parties to whom this permit is ili!;uetl. or their succeSMlrs and assigns, All such changes, reconstruction or relocation by the grantees shull be tlone in such manner as will cuuse lhe least interference with uny of the Coun. ty work and the County of Jefferson shall in no wise be held liable fur any damage to the grantee by reason of any such worl-; by the County of Jeffer' son, it agents or representatives. or by the exercise of any rights by lhe County upon roads, streets, public places or structures in question, This permit or privilege shall not be deemed or held to he an exclusive one and shull not prohibit the County from granting other permits or franchi!;c rights of like or other naturc to other public or private utilities. nor shall it pre\'ent the County frol1l using any of its roads, streets, or public places, or af. feet its right to full supervision anti control over all or allY part of them, nOlle of which is hereby surrendered. 'voke. amend or cancel thili permit or any uf thc provision!; thereof al any time by giving written notice 10 the 'move all facilities frorn the right of way, Any facilities remaining urollthe right or way 30 days after writ. lY the County al the expense of the permittee. SPECIAL PROVISIONS: 1. A conduit shall be installed a minimum of 30" below existing road way ditch. 2. All areas disturbed during construction shall be restored to original condition. In Accepting this permit the grantee, his successors and assigns. agree thatllllY damage or injury donc 10 the property of the grnntee or uny expen~ incurred by him through the operation of a contractor. working for Ihe County or uny Coullty employee shall be at the sole expense of the gralllec, his successors tlnd ussigns, "00-.1 <q ~\ A\IL '^-.lD 01) and conditions as herein set forth, , the undersigned, hcrclly accepts this permit subject 10 the terlllS Dated this Jo day of ~. .19~ '.d.~ ""'llli,'lllll C 1820 Jellersofl Street P.O. Box 1220 Pori Townsend, WA98368 (206) 385-9160 Fee I'a~ ~ Yes _ No " 4,~ /I'.~r sr ;;;'~."va/..3r ~ '-' ;:Fo/:i:J-...-: f(a;eipl No JEFFERSON COUNTY DEPARTMENT OF PUBLIC WORKS Address f{equ~1 _ Yes _ No Mile P<>>I To Department of Public Works, Jefferson County, Washington. The undersigned 'f::/c\...o.~ \0....;. ~4--<7?/.e~~~~~~ # API'L1CATION ..on l'EnMIT ~ _6<. 07 ~ ~0,/~ Z)O/ ~V' \-\=. \ ,,,j 00 c^, "erebY,app/~. forpermissioll fO bo<"<'- '^'"^c\..Q, G,\",,,,- ~""..~...<.. ?c\, ~<.;--clo..., I (AI'/,lwUII/ hlfl "".\"'''~' /111/,1' ",'hut Iw ",'/,I/r.. IfI d,.'t \'~\~\,\ -'\. <. /I w",l.,~. r-^"<.\ ""- "-c.:> :;;'''- t-' 11-(.., I '(X6pt...-'-t'l '" ;, v~\\ CI.> ",JS"'-c,"--=" t''{"'C \""-,c\..,,.$ j i , SKETCH: I I 1) \ L.o'\-' '3, S C- \,.JIJ."\':'..p.",.,..,....,,,,\-... .~ .. --~~~~:-"\~i <:c:=~::~~~:~~:~.__~\. . '- -~-~~-~ \::x:I,~'.....~,..,., \ cC.c\\,\C-__'I;,., -.,~....."., ' r , ; --.... f. /J s: F, V\: ..r .5 c. 10 c..~i" oCr'- "c. rile)", .",-",,,,\,<:,.. ~\r'V"c...,--""/ '5e...,O C"f''1 +u ,.q-pp\;C-o'!-t-'l ~f c',' -. '.' '. .c' Co-~~Bck~!J" between \L .-...~. ~ .5\- , =-.A.. 011 COUIlIY Road: VJ" \. \"""--1,,- (Sro/I' Irt'O,..\1 ('rfl\\..\",,<,t Ilr mll"/I"ilrlJ and agree_ to do the work il1 accordance with your rules and regulatiolls and subject to your inspection and approval. Date N",,/ '2". J9~ "1",,,__ ~,-..re.......,",~ \ _~.,.iJ ISilllllllUrtllfAl1l1litllntl ....... ,.- (If applieDnl is a copartnership, set fOrlll names of copartners) ~() (1-.;0,,," \L\ '-\-1.., \='>0......"" \6""',....","~.,<\ "J <~ No, ~qS- - ,), t.,,'''; 9:' T-::><:.I'''' .I...; 'E. \".. \ ~\... ~-v--.... IConl,.clIlT) Atlllll:"" Addre!>.' Jefferson Co. District No. t DEPARTMENT OF punLlc WORKS Permit No, c;q t.-"2- Supervisor's Ilc(Jorl No. Supervisor will make de/ailed report with his recommendation on this application. ~Vhenever possible show sketch afproposed work. Supervisor will also make additional reports and final report giving date of completion of work on this form, Preliminary H.e(Jorl: /Yl. p. s: (,b ::;-r-hTVP_I> D;tr.tf. 0"'> C riJ> e... C- <'0 I'2fj e. Ro.'l-o w"1''1 )) :fcH So""r-H- :5:-0& . 1<0 "'1-P . ,-ft..QNY NO(>';-I'/ slOe.. /'Je.w P/J<.JeWl{i'N'7' ON of rf.c ~ I<.o~. /?o 4-J:> Dale: /1- "2.-9 -<J_<~ ~k p,~ Signed: Final Reporl: PERMIT INSPECTION REPORT Work covered b)' permit has been compleled satisfaclorily. Work is nol compleled. Recommend permit be cancelled. Traffic conlrol - adequale - inadequale REMARKS Dale: Slllned: Alo ,"-"-".-' .,-'.,..,.--"-,....... . --_._-~._--- JEFFERSON COUNTY DEPARTMENT OF PUBLIC WORKS Fet: I'aid_ Yes _ No 1820 Jellerson Street P.O. Box 1220 Port Townsend. WA 98368 (206) 385-9160 R<<:cipl No Addrt:!>sRt:qul:st_ Yes_No Milt: POs( AI'I'LlCATION FOn l'EnMIT To Department of Public Works, Jefferson County, Washington. The undersigned )t' hereby app/~ jor permission /0 61.f1G= tI //,{J&';1I{ c!'cJU' ~d7 ~/kCi -If= ~t) I Ii.; rl1o;7t Or +;;;""'"":6;;;:;';';;;;;' k;:: 35' ~. /l-ItI/J 35"' ~ cJF #~ "f/7"stl/z;;S ftff- SKETCH: RECEIVED DEe 13 1988 JEFFERSON COUNTY PUBLIC WORKS DEPT. On CoufllY Road: :JF q' () hetl1:eell /S/{J{..II,'f"..,I{f.ro.....,flWf>rmil,.ptliml and agree2- to do the work in accordance with your rules and regulations and subject to your inspection and approval. Dare ~-/3 19~ (I&~ -d. f/J~ ~~ fJ/Ml4y7f} IS'80U1UrCtlr~fll1l!1:anll lC(lOlra~lorl' /) I? C (If npplicant is a copartnership. set forth mimes of copartners) f-",. t!J ~ K" C} ?f cL ^,/d""r f1;fZ1J1- -bW/J~BJJJ (j) fI crif3!J;1 ^,/d,,,, Phone No 3$3 - 1963 Phone No. 100% Recycled Paper , ,.', x, ..,' ... ,( ,,: :"': ',,: '. ; .' ,: '" I!" ,r i ',. :. " :,'. ,":: " .. ;".': ,':, ,> , (' .\< '".", ';,'. " " .. ' ": ',: ':'... ,',!.: , ,',"., "., " " ", ,.' .: ..' '", ,-. ,; ,- ,,: .,,' "',.. " ',," : .." > "" District No, JcHersoll Co. UEI'ARTMENT 01<' I'VOLle WORKS Permit No. . ~" '. " ,'..", , ',' ", ':. ".." ",' , , .;. " '. I. " ", " ,..' , ,'." .' ': ", I' ',,': "': ,: ,',,",,', I ':.,', '.'.,,' ',::' :i" '.' ' ': , " .' ,', ",', "', Supervisor's Report No. Supervisor will make detailed report with his recommendation all this applicatioll. Whenever possible show sketch a/proposed work. Supervisor will also make additional reports ami final TepO'! giving dOle of completion of work all this form. I)rcllminary Itcpor': Dale: ~-/2-- ,JI1 , Signed: ~ C}-.--=:r Hnal Report: PER~~;~~ECTlON REPORT L:7~"O~k covered by permit has been completed satisfactorily. Work is not completed. Recommend permit be cancelled. Trarfic control - adequate - inadequate REMAl{KS Dale: ...,:.. '", .."..,'.', :,', ,'.., '."..'. ".' ",.::,...,.::""..' ,".",' ',.' ",:, ,', " :, .:,. . . . ,,'.'.,',,": '." '., ":." ,", ". ': ..., ,..' SI~n.d: , ", , .' ,. . , '.' "" :,::, . . ". .' . .. ",' ,.." .,.. , ,', ", ,". ",...',', .,., ,.'" . .' , " " ',. .','., ,'.',' :" .., ,',: : ,,' " .,',': , .. ,'. ',' ....:" " ' ,', ' ' "., '.',,;. . ",'..., ,..' '.' "..'..'. ". :"...., ",:::' " .,,::...... ". ,,' ,:<" '.:':" ", ,,,,.' ," 1 , I . '>, ..", : ,': '.' I: .' ~ + :; ". ',: :, -.J" : ....... - ..: .." , '..,.; ,,',,', '" ,",' .,,'\. ',' ,."C".."" ,. " ,'.' . ',. , @PIIdftc Northweat &.II ... . 'I:' 1;>1 . I: .; .. ;" " ,,' , , ,., ',.. : ,'...: . " I ~ i I: f::, " '. ;,' .;,;~ '. , II I~ " .. , " ',., : ' ".... , , " .' . :,. '.:".'.,.,,'.. , :." , " '..,' ',.. ,', ' " " " " ,:'; .,' .. .:'..:...,. "..', "'. ,,:', ,: - \" ' :': ,', " "," .. ' , j '," .. .. ..:- ,: ' ' i ..,'..;, C" ',.,.,' i: :':, I:: ',...".,.,...'.:.(.. r .'.. <":. .," , ",,, "'. '.,.., I .. ;", '. ",',... ',' . " .. ..",., I" L I. L .; O. 8 '7 04:36 PM POl / LoOT"AoO. _..._ _..*~ WORK lOCATION "ddr818 ~5 f"../lP'! (;eOR~ C<ric. CltyPrS~~~:.oun~ -.J.~F stateWA. Name l!' tlP'7'IAJ_A!:. ORIGINATED BY R \) ~, 4.')~ __. Date~7 New QlI SIO No,,", ...., (, Sq Due Dete ~,.~ Rapalr 0 Tel. No:~IlC. " !~ Temporized l(J Rearrange OS1<; No. __ Due Date_ Tvp. 01 StrVlco...J..l~ CB L. Pllr Coler/B.P. T,Mn. Addres, t. I t:JII) Y-RL H. :{71J c,-, --- OttCrlpllOl1 oIWorlt i2 -;0;:;--;0:-" ~A ~I :....;,..,. :).\.... -.--. I A'" '_ L ,_ ~:~~~~. OJ....uty - Burled Service Wire - Work Order P8990 I~ ~)), No S-~~~ Complete oy _ __ ..-- CONTRACTOR'S ACCEPTANCE Flrm__... Slgnatura Tltle.......__ Unit Price 0 CO" Plu. 0 D3Ie.___ FI.t Sum rJ $___ Bill to: PACIFIC NORTHWEST BELL AHentlon, Address __,__n.n City .... ___.o.o_ Zip _........ ..-..-,.."..- APpnOVAL For Ft.1 S'J"'/COSl PIulS...,.._,.." ,,-- Recommendea _" " .... ,... Dale -.. . .." Ap~roved by _,__ _, _ Dale. - - ..- -- PERMIT REQUIRED 0 YeA 0 No Received Irom .o"-' , "_,, ....., .. _ '1erbel 0 Jurisdiction __ No, .o..___ Dale_ -- ",.o_ Dals__ . "_u'_'~___ tor Service Conn8ctlon COMPLETED BY Call___, ._- -,,- -....... -._LJill Sketch Work Required. Includo Lengthc;, ~iapth5. wire si~e .)nd amount 'c.,q'f"l: '~./i.,:' . \ fNY6: ,}I> , ' ' " . VT .' ,. . . . ., ii :L~N~. : :: ...'.; >C ~..,.... __. ,.~1,. ' J> . . .. ...,.'" ' ' , ., '.'.i' , .0 . ..,.',," '~>./\, ... ~ .,. ._' ' . ' . , . . , ' , . ,_.,~~_~..:. . ' . , '......, , .,........i. ...... Nolo: Trlt. sk..,lct) I""d)' npl bill "'I ,",c(,;ur;jl", rl,lpHn,:..nliit1rm In 1'1" r1P.1Allo;,!1 r,..r"'ltl"5Ih~ (':l)nlrtU:-IOr'S fI!'5C10n9IbI1l1'r' lClprop(:rly IClC01C worl( In InO 11~'d ':''/',;:':::~~<;:/':~'":'<'''>:''' _ _ '_''''..' _'_' O~GIN~LC~~__: ___'___. _ _~;i:/,i{J i'i. "iT <i; i<, · ...... :.,' ...,.. .. .. i.i:..,' "'" ..i::i' ':', '.. ii,"" i.i..: ...,i fif ~~Jl~ "ii.,')'; .'I}:;: .. ",i)';..'} iJ"ii;( . ,-_.. / ,....-..._ '"...,. Allr:t> T'RENCH . C' FINS' P~O\)IDt= . O' OUSTOMER PROVIDE, SIGNATURE . e,O.lJN-ry ~~\"T.s . ',- L ,-"l -~~ .~ dj~otc. ,'" ) -"'" '. O~ J f.lo'-'\ , I or,th .-- I I f\ :\~, .lQ ~.." ," ,', ., ~,' ,> \J , "I ...'.',,' '" \ ," ", .. ,.,..: .. ',' : . . " ' ,.... :', ' > '.,.; '" , " '., ..... o ..: .,i,,'i,,; I ,;;,t>~(~ . '" "',.,' .'. ,..,".. . :', " .' , ...... ", ~ '. " ' ~ ' ,'., ,,, , ,~ ,. " : " , I , . ", ..:' .~ ~