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Home My WebLink About321 N Chambers St - Building �caarA,o, W CITY OF PORT ANGELES PERMIT APPLICATION ` P 2013 ��^ e— Building Division/Electrical Inspections WarRICAL . 321 East Fifth Street—P.O.Box 11501 Port Angeles Washington, 98362 6�ISd'd C�d� Ph: (360) 417-14735 Fax: (360) 417-4711 Date; _Z �I,` l -? —Multi-Family or Commercial* *Plan Review May Be Required, Please Complete Electrical Plan Review Information Sheet Job Address: 32-1, .G Building Square Footage: Descriptfon of above -Tc / �rl (�v9 � r fLO GP n� ors Owner Information Contractor In ormation Name: M C_ Name: F Mailing Address' 3'2-1 N' C HA"F_ S Mailing Address: ' r3r r� 7G ti f per' City: State; zip: City: stater Zip: Phone: Fax: Phone: Fax: License#!Exp License# [,02— Item Unit Charge � Total(Qty Multiplied by Unit Charge) Service/Feeder 200 Amp. $132.00 $ Service/Feeder 201-400 Amp. $160.00 $ Sorvice/Feeder 401-600 Amp $225.00 $ Service/Feeder 601-1000 Amp. $288.00 $ Service/Feeder over 1000 Amp. $410.00 $ Branch Circuit WI Service Feeder $ 5.00 $ Branch Circuit W/O Service Feeder $ 74.00 $ Each Additional Branch Circuit $ 5.00 Branch Circuits 1-4 $ 86.00 $ Service/Feeder 200 Amp. $102.00 $ Temp.ServicolFoedor 201-400 Amp. $121.00 $ Temp.Service/Fooder401-600 Amp. $164.00 $ Temp.Service/Feeder 601-1000 Amp. $185.00 $ Portal to Portal Hourly $ 9600 $ SignlOutline Lighting $ 88.00 $ Signal Circuit!Limited Energy—Multi-Family $ 64,00 $ Signal Circuid Limited Energy i First 1500 sf—Corrmercial $ 96.00 $ Note: $5.00 for each additional 1500 sf Renewable Electrical Energy-SKVA System or Less $113.00 $ Thermostat $ 56.00 $ Note:$5.00 for each additional T-Stat $ Total Owner as defined by RCW.19.28,261:(1)Owner will occupy the structure for two years after this electrical permit is finalized.(2)Owner is required to hire an eleotrical contractor if above said property is for sale,rent or lease. Permit expires after six months of last inspection. After reading the above statement, I hereby certify that I am the owner of the above named property or a licensed electrical contractor.I am making the electrical installation or alteration in compliance with the electrical laws,N.E,C„ RCW.Chapter 19,28,WAC,Chapter 296-4613,The City of Port Angeles Municipal Code, and Utility Specifications and PAMC 14.05.050 regarding Electrical Permit Applications, Signature of owner, ec cal contractor or electrical administrator: C cash h0 Gk 1:1 Cretlit Card# X Dated; v 0110112012 r a ELECTRICAL PERMIT t CITY OF PORT ANGELES 360-417-4735 Application Number 13-00001112 Date 9/26/13 Application pin number 471696 Pr'opert'y Address . , , , , .. 321 N CHAMBERS ST ASSESSOR PARCEL NUMBER; 06-30-00-8-1-0125-0000- REPORT SALES TAX Application type description ELECTRICAL ONLY on your excise tax form Subdivision Name Property Use to the City of Port Angeles , Property zoning . . , . . , UNKNOWN (Location Code 0502) Application valuation . , . . 0 Application desc Replace exhaust fan Owner Contractor CLALLAM CO PUB HOSPITAL CIST 2 BLACK DIAMOND ELECTRICAL CONTR ABA OLYMPTC MEDICAL CNTR 502 BLACK DIAMOND RD PORT ANGELES WA 983623909 PORT ANGELES WA 98363 (360) 565-1035 [tt w Permit . . . ELECTRICAL ALTER COMMERCIAL (�1 Additional dese 1-4 CIRCUITS t `' Permit Fee . , , . 86.00 Plan Check Fee .00 r-- � Iaeue Date 9/26/13 valuation . . , . 0 Expiration Date 3/25/14 Qty Unit Charge Per Extension BASE FEE 86.00 ------------------------ ----------------------------- t^ Fee summary Charged Paid Credited Due Permit Fee Total 86.00 86.00 .00 .00 Plan Check Total 00 00 00 00 Grand Total 86100 86.00 .00 .00 INSPECTION TYPE DATE: RESULTS: INSPECTOR: DITCH SERVICE ROUGH-IN FINAL COMMENTS: PERMIT WILL EXPIRE SIX(6)MONTHS FROM LAST INSPECTION Signature of owner or Electrical Contractor X Date: G:IEXCHANGECEUILDING Application Number Application pin number Property Address ASSESSOR PARCEL NUMBER Application type description Subdivision Name Property Use Property Zoning Application valuation Application desc 2 circuits changing room lights Owner CLALLAM CO PUB HOSPITAL DIST 2 DBA OLYMPIC MEDICAL CNTR PORT ANGELES WA 983623909 Permit Additional desc Permit pin number Permit Fee Issue Date Expiration Date Fee summary Permit Fee Total Plan Check Total Grand Total INSPECTION TYPE DITCH SERVICE ROUGH IN FINAL COMMENTS 173138 76 10 9/10/10 3/09/11 Charged 76 10 00 76 10 Signature of owner or Electrical Contractor X ELECTRICAL PERMIT CITY OF PORT ANGELES 360 417 -4735 10 00000999 060866 321 N CHAMBERS ST 06 30 00 8 1 0125 0000 ELECTRICAL ONLY UNKNOWN 0 Paid Contractor SIMPSON ELECTRIC 243036 W HWY 101 PORT ANGELES (360) 457 9270 ELECTRICAL ALTER COMMERCIAL Plan Check Fee 00 Valuation 0 Extension 73 50 2 60 Due 76 10 00 00 00 76 10 00 Qty Unit Charge Per 1 00 73 5000 ECH EL BRANCH CIRCUIT WO /FEEDER 1 00 2 6000 ECH EL ECH ADDNT BRANCH CIRCUIT DATE. q1/3 fin ¶113 /to PERMIT WILL EXPIRE SIX (6) MONTHS FROM LAST INSPECTION Credited 00 00 00 Date 9/10/10 RESULTS WA 98363 REPORT STATE SALES TAX on your excise tax form to the City of Port Angeles (Location Code 0502) INSPECTOR. Date J CITY OF PORT ANGELES PERMIT AJ,FUCATWON Building Division/Metrical b*s ectiioiast 321 East Pleb Street PM. Box 1150 Fort Angeles Washlugl?nn, 98362 Ph; (360) 4 -4735 Es, (360) 417 -4711 Date: ��./.7 17 1 2 Single Family Dwelling °emir Inform on Name Melting City: State Fax: t enee Fbrp, DeLLE3o 11 rY► 74 'tam ServlcefFeeder200 Amp. 119.00 SeMce/Feeder 201.400 Amp. 145,50 Senars/Feeder401- 800 Amp 2.04.80 Service/Feeder 601-1000 Amp, 262.20 San/ice/Feeder aver 1000 Amp, 372.59 S3renoh Ditn*{t W/ Service Feeder 2.80 Branch Ciicuit W/O Service Feeder 73,50 Each Additional Branch Clrrxdt 2.80 Temp. Service/ Feeder 200 Amp. 92,70 Temp. $ervicelFeerter 201.400 Amp. 110.30 Temp. Service/Feeder 401.600 Amp. 146,70 Temp. ServicelFeeder 601 1000 Amp 167.90 Paul to Portal liourry 95,90 Slgn/Oulllnn lighting 89,20 Signal Circuit/ limited Energy First 1500 sf- Commercial 95.90 Note: $5.00 for each additional 1500 of Signal Circuit/ Limited Energy 1 2 Family Dwelling S3 of Circuit/ limited Energy Multi-Firmly Dwelling Manufactured Home Canne:tlon Renewable Bechtel Enor+9y SKVA System or less Thermostat gar CONSTRUCTION ONLY: First 1300 Square FL Each Additional 600 Square R. or Portion of Each Outbuilding or Detached Garage Each Swimming Pool or Hot Tub 83.90 83,90 119.90 102.30 86.00 Sys 9 2009 EtECTRiCAI INSPECTIONS Multi- Family or Commemlar Commie! Addition I Aiterril t t 1 Remodel I .Repair` Job Ad Review May I Require Complete 4 1; ai elan Review Info ton S ob Addmss: s t �`i �a3L S J Budding Square Footage; Descdpflan of above �E G 1 7i1_ C iflfamtatton idanit SB t r Ur. Malgn9 pdd�a .mot_ ).te tally: p H g License /1 E Xp= _;T� ac1. ,PS&L_ q.. 3`:5 Olt 110.30 35.20 73,60 5110.30 .55, 0 0,2.0 P otet Owner a defined by RCW,19.28.261' (1) Owner will occupy the structure for two years after this eelectikel permit is finalized. (21 serer is required to hire an electrical contractor if above said property is for sale, rent or lease, Permit expires after siX months of last inape n After reading the above statement, hereby certify that I am the owner of the above named property or a licensed electrical 000 n or. i ran making the electrical installation or alteration in compliance withh the electrical laws, N.E.C., RCW. Chapter 19.28, WAC. Chapter 2964E 118 City of Pert Angeles Municipal Code, and Utility SpeciticaHans and PAMC 14.05.060 regarding ElecirIcat permit Applications. Sign ewer, electrical "II r electrical adreirdstrator CI Ceti .l ciii f Va) atmtr:om v:> \'.l - 'Z 1 'if e. ,-------.-- I .J State of Washington DEPARTMENT OF HEALTH Facilities & Services Licensing Construction Review Services P. O. Box 47852 Olympia, Washington 98504-7852 Mike Glenn Olympic Memorial Hospital 939 Caroline Street Port Angeles, W A 98362 LETTER OF TRANSMITTAL [R1 [E(Gre~~[E~ I MAR 1 7 2003 I CITY OF PORT ANGELES Dept. of Community Development Submission Information Date: March 14, 2003 Project: Rehabilitative Services Building Site Address: 321 Chambers, Port Angeles Submission: Plan Review Response eRS Project Number: 5730-005 Submission Status o Approved [8J Not Approved [8J Resubmit 2 revised copies of the plans o Accepted as noted below o Submit written responses to review [8J Enclosures: Review Comments [8J Applicable Code: Chapter 246-320 WAC Hospitals. Plan Reviewer's Action: [8J Architectural: No Action I2J Mechanical & Electrical: No Action [8J Fire and Life Safety: [8J Public Health: See Comments See Comments Copies To: [8J Local Building Official: City of Port Angeles o DOH Acute Care Licensing o DOH Residential Rehab Services o DOH Child Birth Center Licensing I2J Architect / Engineer: Lindberg & Smith Architects o Contractor: o Washington State Patrol, Fire Protection Bureau o DSHS, Patricia Lashaway, Director o DSHS, Residential Care Services, o DSHS, Boarding Home Licensing Program o Other: [8J CRSFile Notes: Please see attached plan review comments. (Rev. 4/18/00) \J6ter~\a1 ThanR you, Debra Peterman (360)236,..2944 Wi ~ -- () ~ ~ s W- ~ 4f ,--- Fire Protection Systems Review Rob Bradley Tel (360) 705-6784 FAX - (360) 705-6654 Facility: Olympic Medical Center Project: Rehabilitative Services Building CRS#: 5730-005 Date: March 3,2003 1. Not Approved 03/03/03 - Please provide a clearly legible plan for review of the fire alarm system. Rb Construction Review Service Washington State Department of Health HEALTH SERVICES CONSULTANT (DBA: SANITARIAN) REVIEW JohnR. Templar, R.S. (360) 236-2944 FAX: (360) 236-2901 e-Mail: john.templar@doh.wa.gov FACILITY: PROJECT: CRS# DATE Olympic Memorial Hospital Rehabilitative Services Building 5730-005 February 28, 2003 1. Approved 02/28/03 - Architect states there is no x-ray room in this facility. jrt 2. Approved 02/28/03 - Armstring-fine fissured ACT is used. jrt 3. Approved 02/28/03 - Faucet meets intent of rule WAC 246-320-525(4)(c). jrt 4. Not Approved 02128/03 - Provide revised drawings showing nurse call locations. jrt 5. Approved 02/28/03 - Revised pool manual accepted. jrt / Apr-26-02 e os: 25A 360-457-0212 P.Ol POI.OfftQAL~ONl.Y: I ELECTRICAL PERMIT APPLICA nON :;:."';. ""1 ,,;; l-: , o.~_.,1 Dooo 1M Ehctrll;III """"" """""""" --/lMM- M.,IIlf-Iy. Plase .".. _ pn.t .... 1f,.....1IIQ'. . . .... CII "'" .17-4735 ru - L r. eM) 417-4711 A.ppUemt lIlIdIor Aaml: A.,J J,s (',lIUItClU;Ct4~ Propony o...a-: () \ YY"\~{r ~ ~(ca..1 (ell. fr-f Addlcss: q ~ 4.. Co. r(j hY\€ City:-LA- Fu' '/..f"., -oz/Z, Pboae: Zip: Up: PboM: Zip: Contractor Adcln:ss: I...K:aiH 1#: City: Cndj, CoN HoWerN...: A.,~s ~""lJ.l/irA/I(JNs. I.vc.. BiIlitrJlAM~ IOL ~ Lil. . CJty~J< Z{p: ~tf1H CIYt6J OW N..,., _ t'lSA_ Me 2L. Permit Fee :1rf ~ rROJaCT ADD"', LEGAL DeSCIUP'J1OH: Lal: 32-t c.m~~fS '51: - ZOQNG ...;....t: .........~- n.ALL...,M COUNTY rAllCEl. NUM8ER: TV".&: 05' WORK; C RaidcDli-' 0 MulU-luiiIy g c WI C NIIbiIe HIDe II.......... ra.&l1..... ""..... _ WAC 196-t6-910 fk- BRID DESC1UPT10N or T1R rBOJECT: ~. cJA~~,.. Ji]......... H~ I -... .... - -.-- ......~ o A . --Ii C Fta'DKC o Hal Planp o Fa-Wall KW KW JeW KW 0'" c o.n.I ScnicG C T..... s.niao O~s.na VoIIIp: f'ImIr 01 0] Scnica SUr.__ PIIlIIIr IDe: Caa.-call; ; It.rrr6.Y ,""r:n;s-.. / -.. 1YWII...J~_nnI d,,,, ~ .111II........... ...... 10" ',.....wI nanTrI. tntrIl-. .,IttNVr.d.. ~ fo, ..... ~.""'. , ~n.n'~.. if ;, "".,'" Ciq's Irp''''paaJHlUy .. ....4- .... prrWv _ ,.,~. II......,.. dIo ~J rupufUd;l/il'; 10 .left"..."" o.AuI ,..,_.. ......1'CI/IIitY...." /III .....Iw.l rwllolPI,""l1fII CcuJiIC~iJl"'J4.I'J~__...f-H ~ _ <.0.: '1-24-fl- (i i:~7:) \",,---..--._~.,..-.... ,...../ ~V/V~/~VV~ ~~;~o rnA JOV~O/~O~~ :::iTKAIT::-> J::;L1::,'CTKIC l4J 01 tjj.o!_T~ ....... ~.d ~ '"'~ ~.... ELECTRICAL PERMIT APPLICATION FOil ~1("A.ll.'SE: (JSL~. DlI"~J~. ~rTTlI". Dlle.l.pp"'''C1J: D:..e h~lOl',J Th4I Electrical Permit ApptieatlOl1 must be filled out comDlllltfllv. PI-- type or I"IIprlnt In Ink. tf ygu have .ny questions, please call (360.417....,;735 Fax number: (3150) 417~711 Own.r or EI~_ Contraclor Ag.nt Strai ts Electric Pr_ny Ov.neo rJf ~m:piC MecU@J CerrtY City: Pnon.: REQUEST INSPECTION 0 452-9104 Fax: 457-4698 Phone; Address: Credit Card Holder Nllme~ Straits Cily; ~ ELECTRICAL CONTRACTOR Electric Ue.......; STRA IJ:; * 0 !~DS Port Angles, WA 9/03 Zip: Phone- 452-9104 Zip; 98362 Electrical ~!ractor: Straits Electric Addr...; P.O. Box 291 4 INSTALLATION WIRED BV; DOWNER Si//ingAddress' P.O_ "ox 2914 City: Port Angeles, WA Credit Card Number: Exp. Dare: Zip: 983 62 V/SA..--2-MC;_ PROJECT ADDRESS: 321 ChGtm~ TYPE OF WORK: Check all that apply: 0 New o Alteralion/Addltion 'J Residental 0 Multi-family ~ Commercial 0 Mobile Home Sq.Ft. o Remote Mete, 0 Detached garage 0 Hot Tub 0 Swim Pool 0 Septic Pump 0 Low Voltage 0 Telecom. 0 Sign Number of Circujts added or altered: DESCRIPTION OF THE ELECTRICAL PROJECT: ,~ 9:N;'LL Electrical Heat Load Additions Service Information o Baseboard o Furnace o Heat Pump o Fan-Wall _KW _KW _KW _KW o Ovemead Service o Temp Service o Unde'ground Service Vollage: Phaoe: 0 1 0 3 Service Size: Feeder Size: PAMe 14.05.060(6): Fo, industrial, commercial, & residential p,ojects la'g.., than.. duplex, a one -line d,awing of the Electrical Service & Feeders. building size (sq. fl.). load caleulalions, and the type & of conductors andlor raceway is required and shall aeeompan~ the Eler.;:trical Permit application. I hereby certify that I have read and examined this application and know that same to be trve and correct, and I am authorized to apply for this permit. I understand it is not the City's legal responsibility to determine what permits are required; it remains the applicants responsibility to de mine what permits are required and to obtain such_ Credit Card Holder's Slgnatu Tucker IChristie Tucker Date: Date: \'0/<;;(b I PW-9019 Owner or Elee. Cont. Slgnatu 'fi- 01/11/2002 10:5J FAX J604574698 STRAITS ELECTRIC I4i 01 ti~ iI ~. ~~~ ~.... ELECTRICAL PERMIT APPLICATION FOR OF'FICIA.L un O;\.1.Y 0."""', ~ Ptrmil.: ~ 7c;'"~ 'S Dillt,ypl"~d: QillelMOltd: The ELectrieaJ Permit Application mus( be filled out comoletetv. Pi.... tvpe 01' ..prlnlln Ink. II you hove ony question.. pIoooo coli (360. 417~735 Fu numbor: (360) 417-4711 Own.'orEI"".Con""clD'Agsn~ Straits Electric PropenyQwner. Ol~e HeA1aV Cener REQUEST INSPECTION 0 Phone' 452-9104 Far: 457-4696 PRone: Address: CIty: Address: P. 0 _ Box 2914 Oily: :l9 ELECTRICAL CONTRACTOR Electric: Ucen..': STR.AIE*O~DS Port Angles, WA 9/03 Zip: Phon..452-91 ( Zip: 98362 EI9Ctrical Contraetor: Straits Electric INSTALlATION WIRED BY: 0 OWNER Credlr Card Holdl1r Nsme~ S tra! ts Billing AddTe$s: P.O. 'lox 291 4 CredirCardNumber: Zip: 983 62 VISA:~MC:. PROJECT ADDRESS: 32-~lgets s-t-tecf- - 1>1\- TYPE OF WOAK: Check all thaI apply: ~ New 0-AlleratiOnfAddition o Residenlal 0 Multi-family ~mmercial 0 Mobile Home Sq. Ft. .0 Remote Meter 0 Detached garage 0 Hot Tub 0 Swim Pool 0 Septic Pump 0 Low Voltage 0 Telecom. 0 ~ Number of Circuits added or ellsred: DESCRIPTION OF THE ELECTRICAL PROJECT: ~0a.1 ~ll ~h{)A. Electrical Heat Load Additions fR;!:.- .. Service Information v o Baseboard o Furnace o Heal Pump o Fan-Wall _KIN _KIN _KIN _KIN o Ovemead Se",;ce o Temp Servfce o Underground Servfce Voltage: Phase: 0 1 0 3 Servics Size: Feeder Siu: PAMC 14.0S.lll!O(B): For industriel, commercial. & re.iden~al project. larger than a duplex. a one -line drawing of the Electrical Servics! Feeders. building size (sq. ILl, load calculaUons, and the type & of conductors and/or raceway is requirel! and shali accompany the Electrical Psrmit application. I hereby certify that I have read and examined this application and know that same to be true and correct, and I a authorized to apply for this permit. I understand it is not the Cily's legal responsibility to determine what permits are required: it remains the applicants responsibility to de ine what permits are required and to obrain such. Credit Card Holder's Slgnatu PW-9019 Owner or Elee. Cont. Signatu RECEIVED of Ir CITY OF PORT ANGELES PERMIT APPLICATION MAY 14 2014 - Building Division/Electrical Inspections 321 East Fifth Street — P.O. Box 11501 Part Angeles Washington, 96362 ELECTRICAL Ph: (360) 417 - -4735 Fax: (360) 417 -4711 _ _ INSFECTIONS Date: P od��! d .'_2 Multi- Family Commercial.-,) 'Plan Review May l3e equired, le se Complete Plectri ai P# r eview Informati0 Sheet Job Address;_ <,1/ 91� L �,AdI77li�-6'`--�, 2 2,.,.,� t i SrCa� � 1�7i? &:A Building Square Footage: [}ascription of above Owner Information Name: _ Mailing Adc�r ss• � �l1..� ,��,,r -e� T " City: state: Zip; 46�e�,_ Phone - 'U? Fax: License U Bxp, -- Item Unit Charge ServicelFeeder 200 Amp. $132.00 Senrfce /Feeder 201 -400 Amp. $180.00 Service/Feeder 401 -600 Amp $ 225.00 ServicelFeeder 601.1000 Amp. $ 286.00 Service /Feeder over 1000 Amp. $ 410.00 Branch Circuit W/ Service Feeder $ 5.00 Branch Circuit W/O Service Feeder $ 74.00 Each Additional Branch Circuit $ 5.00 Branch Ciroulto 1-4 $ 8100 Temp, Service! Feeder 200 Amp, $102.00 Temp, Service/Feeder 201.400 Amp. $12100 Temp. Service/Feeder 401.600 Amp. $164.00 Temp, Service /Feeder 601 -1000 Amp , $185.00 Portat to Portal Hourly $ 96.00 SigntOuthne Lightfng $ 88,00 Signal Circuit! Limited Energy - Multi- Family $ 04M Signal Ciro& Limited Energy i First 1500 sf - Commercial $ 96.00 Note: $5,00 for each additional 1500 at Renewable Eiecidcal Energy - 5KVA System or less $113.00 Thermostat $ 56.00 Note: $5,00 for each additional T -Stat Contractor Information Name: Mailin g A re s: r 3r s I k> City: t -' Ca State:. -Zip:, Phone:-45:�.2j—Q Fy License #1Ex Cif Total Q Multiplied by Unit Charge $ $ !.7 Total Owner as defined by RCW.19.28261: (1) Owner will occupy the structure for two years after this electrical permit is finalized, (2) Owner is required to hire an electrical contractor if above said property is for sale, rent or lease. Permit expires after six months of last inspection, After reading the above statement, I hereby certify that I am the owner of the above named property or a licensed electrical contractor. I am making the electrical instailatlon or alteratlon In compliance with the electrical laws, N.E.C., RCW, Chapter 19.28, WAC. Chapter 296 -464, The City of Port Angeles Municipal Code, and Utility Speolfications and PAMC 14,05.050 regarding Electrical Permit Applications. Signatu f owner, electrical c Tractor or electrical administrator,. 0 cash 0 cheat � Credit Gard #, c J Dated; 01104I2012 try !.J r 0 ELECTRICAL PERMIT CITY OF PORT ANGELES 360 -417 -4735 Application Number . . . . , 14- 00000560 Date 5/15/14 Application pin number , . . 511920 Property Address . . . . 321 N CHAMBERS ST ASSESSOR PARCEL NUMHER; 06-30-00--8-1-- 0125 -0000- Application type descri.ptien ELECTRICAL ONLY Subdivision Name Property Use . . , . , . , Property Zoning , . � . , . . UNKNOWN .Application valuation . . . . 0 ---------------------------------------------------------------------------- Application desc Floor box extend ---------------------------------------------------------------------------- Owner Contractor CLALLAM CO PUB HOSPITAL, LIST 2 STMPSOK ELECTRIC DBA OLYMPIC MEDICAL CNTR 243036 W HWY 101 PORT ANGELES WA 983623909 PORT ANGELES WA 98363 (360) 457 -9270 Permit . . , . . . ELECTRICAL ALTER COMMERCIAL Additional desc . , 1 -4 CIRCUITS Permit Fee , , . . 86.00 Plan Check Fee .00 Issue Date 5/15/14 Valuation . . , . 0 Expiration Date 11/11/14 Qty Unit Charge Per Extension BASE FEE 86.00 Fee Summary Charged Paid Credited Due Permit Fee Total 86.00 86.00 00 .00 Plan Check Total .00 .00 .00 .00 Grand Total 86.00 86.00 .00 OQ REPORT SALES TAX on your excise tax form to the City of Port Angeles (Location Code 0502) INSPECTION TYPE DATE: RESULTS: INSPECTOR: DITCH SERVICE ROUGH -IN �''' VP FINAL COMMENTS: PERMIT WILL EXPIRE SIX (6) MONTIiS FROM LAST INSPECTION Signature of owner or Electrical Contra_ ctor X Date: GAEXCHANGEIBUILDING t a � V V1 { �J Z. V` Application Number . . . . . 22-00000757 Date 6/22/22 Application pin number . . . 149583 Property Address . . . . . . 321 N CHAMBERS ST ASSESSOR PARCEL NUMBER: 06-30-00-8-1-0125-0000- Application type description ELECTRICAL ONLY Subdivision Name . . . . . . Property Use . . . . . . . . Property Zoning . . . . . . . UNKNOWN Application valuation . . . . 0 ---------------------------------------------------------------------------- Application desc Fire panel circuit ---------------------------------------------------------------------------- Owner Contractor ------------------------ ------------------------ CLALLAM CO PUB HOSPITAL DIST 2 SIMPSON ELECTRIC DBA OLYMPIC MEDICAL CNTR 243036 W HWY 101 PORT ANGELES WA 983623909 PORT ANGELES WA 98363 (360) 457-9270 ---------------------------------------------------------------------------- Permit . . . . . . ELECTRICAL ALTER COMMERCIAL Additional desc . . 1-4 CIRCUITS Permit Fee . . . . 86.00 Plan Check Fee . . .00 Issue Date . . . . 6/22/22 Valuation . . . . 0 Expiration Date . . 12/19/22 Qty Unit Charge Per Extension BASE FEE 86.00 ---------------------------------------------------------------------------- Fee summary Charged Paid Credited Due ----------------- ---------- ---------- ---------- ---------- Permit Fee Total 86.00 86.00 .00 .00 Plan Check Total .00 .00 .00 .00 Grand Total 86.00 86.00 .00 .00 MULTI-FA MILY/ COMMERCIAL ELE CTRICAL PERMIT APPL ICATION Public \Yorks and Utilities Department 321 E. 5th Street, Port Angeles. WA 98362 360.417.4735 I www.cityofpa.us I electricalpermits(s/.cityofpa.us Project Address:-------------------------------------- Project Description:--------------------------------------□Multi-Family Residential D Commercial I Industrial/ Public Building Square footage: __________ _ OWNER INFORMATION Name: ________________________ Email: ______________ _ Mailing Address: ________________________ Phone: ___________ _ ELECTRICAL CONTRACTOR INFORMATION Name: License: ___________ _ Mailing Address: ________________________ Expiration Date: ________ _ Email: Phone: ___________ _ PROJECT DETAILS llim! Service/Feeder 200 Amp. Service/Feeder 201-400 Amp. Service/Feeder 401-600 Amp. Service/Feeder 601-1000 Amp. Service/Feeder over 1000 Amp. Branch Circuit W/ Service Feeder Branch Circuit W/O Service Feeder Each Additional Branch Circuit Branch Circuits 1-4 Temp. Service/Feeder 200 Amp. Temp. Service/Feeder 201-400 Amp. Temp. Service/Feeder 401-600 Amp. Temp. Service/Feeder 601-1000 Amp. Portal to Portal Hourly Sign / Outline Lighting Signal Circuit/Limited Energy -Multi-Family Signal Circuit/Limited Energy/First 1500 sf -Commercial (Note: $5.00 for each additional 1500 sf) Renewable Elec. Energy: 5KVA System or less Thermostat (Note: $5 for each additional) Unit Charge Quantity $132.00 $160.00 $225.00 $288.00 $410.00 $5.00 $74.00 $5.00 $86.00 $102.00 $121.00 $164.00 $185.00 $96.00 $88.00 $88.00 $96.00 $113.00 $56.00 Total (Quantity x Unit Charge) $ ____ _ $ ____ _$ ____ _$ ____ _ $ ____ _ $ ____ _ $ ____ _ $ ____ _ $ ____ _$ ____ _ $ ____ _ $ ____ _ $ ____ _ $ ____ _ $ ____ _ $ ____ _ $ ____ _ $ ____ _ $ ____ _ $ _____ TOTAL Owner as defined by RCW.19.28.261: (1) Owner will occupy the structure for two years after this electrical permit is finalized. (2) Owner is required to hire an electrical contractor if above said property is for sale, rent or lease. Permit expires after six months of last inspection. After reading the above statement, I hereby certify that I am the owner of the above named property or a licensed electrical contractor. I am making the electrical installation or alteration in compliance with the electrical laws, N.E.C., RCW. Chapter 19.28, WAC. Chapter 296- 46B, The City of Port Angeles Municipal Code, and Utility Specifications and PAMC 14.05.050 regarding Electrical Permit Applications. Date Print Name Signature (0 Owner D Electrical Contractor/ Administrator) [Electrical Permit Applications may be submitted to City Hall or electricalpermits@cityofpa.us] lJ CD ELECTRICAL INSPECTION WIRING REPORT APPROVED NOT APPROVED DITCH ROUGH IN/COVER SERVICE FINAL COMMENTS: Fire alarm panel circuit NOTIFY INSPECTOR at (360) 808-2613 WHEN CORRECTIONS ARE COMPLETED WITHIN 15 DAYS DATE PERMIT # INSPECTOR 7/15/2022 22-757 TAP OWNER CONTRACTOR Simpson Electric PROJECT ADDRESS 321 N Chambers St