HomeMy WebLinkAbout931 W 12th Street - BuildingE -E CAL PERMIT
CITY OE' PORT ANGELES
360»417-4735
Application Number . . . . . 16-00001447 Date 9/28/16
Application pin number 505711
Property Address 931 W 12TH ST
ASSESSOR PARCEL NUMBER; 06 -30 -00 -6 -3 -5258 -0000 -
Application type description ELECTRICAL ONLY
Subdivision Name . . . . .
Property Use . . . . . . . .
Property Zoning .
Application valuation . - . 0
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Application desc
Ductless heat pump
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Owner
Contractor
------------------------
JEANETTE M AND SCOTT R GOSSARD
------------------------
BLACK DIAMOND ELECTRICAL CONTR
931 w 12TH sT
502 BLACK DIAMOND RD
PORT ANGELES
WA 98363
PORT ANGELES
WA 98363
(360) 452-3042
(360) 565-1035
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Permit . . . . .
. ELECTRICAL ALTER RESIDENTIAL
Additional desc
Permit Fee . . .
63.00
Plan Check Fee .
.00
Issue Date
9/28/16
Valuation . . . .
0
Expiration Date .
3/27/17
Qty Unit Charge
Per
Extension
1.00 63.0000
PCH —EL -R-
BRANCH CIR WO/ SER FEED
63.00
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Fee summary
-----------------
Charged
---------- ----------
^-----------------------
Paid Credited
---------- ----------
Due
Permit Fee Total
63.00
63.00 .00
.00
Pian Check Total
.00
.00 oA
.00
Grand Total
63,00
63.00 .00
.00
INSPF,CTION TYPE
DITCH
SERVICE
ROUGIJ-IN
FINAL
COMMENTS:
DATE: RESULTS:
PERMir WILL EXPIRE, SIX (6) MONTHS FROM LAST INSPECTION
Signature of owner or Electrical Contractor X
WEXCHANMBUILDING
REPORT SALES TAX
on your excise tax form
to the City of Port Angeles
(Location Code 0542)
INSPECTOR.-
Date:
NSPECTOR:
Date:
CITY OF PORT ANGELES PERMIT APPLICATION ; � 'I x'
Building Division/Electrical Inspections
321 East Fifth Street — Port Angeles Washington, 98362
Ph: (360) 417-4735 Fax: (360) 417-4711
r.17
Date: -- rZ 1 & 2 Single Family Dwelling
* Plan Review May Be Required, Please Complete Electrical Plan Revie i format'iign S l t
A.,1Job Address: 9 ;1 12-17V 7 r
Building Square Footage: s I
Description of above
�r
Owner Information
Name: S. S
Mailing Address:
City: State: Zip:
Phone: '�%S`2-a2 Fax:
License # / Exp.
Item
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 Feed
Branch Circuit W/O Service Feeder
Each Additional Branch Circuit
Branch Circuits 1-4 Only
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
Signal Circuit/ Limited Energy -1 & 2 Family Dwelling
Manufactured Home Connection
Renewable Electrical Energy - 5KVA System or Less
Thermostat
Note: $5.00 for each additional T-Stat
NEW CONSTRUCTION ONLY:
First 1300 Square Ft.
Each Additional 500 Square Ft. or Portion of
Each Outbuilding or detached Garage
Each Swimming Pool or Hot Tub
si
Owner as defined by RCW.19.28161: (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, WAG. Chapter 296-46B, The City of Port
Angeles Municipal Code, and Utility Specifications and PAMC 14.05.050 regarding Electrical Permit Applications.
Signature of owl ej(jlectrical contractor or electrical administrator:
Dated:— 7 _/
❑ Cash ❑ Check
❑ Credik Card #
02106/2012
?&k Z
Contractor Irmat' n
Name:
an
Mailing Address.
City:
State: Zip:
Phone:
- , Fa
License # 1 Exp.
Unit Charae
Qtv
Total (Qty Multiplied by Unit Charpel
$120.00
$
$146.00
$
$ 205.00
$
$ 262.00
$
$ 373.00
$
$ 5.00
$ 63.00
$ X
$'
$ 5.00
$
$ 75.00
$
$ 93.00
$
$110.00
$
$149.00
$
$168.00
$
$ 96.00
$
$ 64.00
$
$120.00
$
$102.00
$
$ 56.00
$
$120.00
$
$ 40.00
$
$ 74.00
$
$110.00
$ > �'
6 5 Total
Owner as defined by RCW.19.28161: (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, WAG. Chapter 296-46B, The City of Port
Angeles Municipal Code, and Utility Specifications and PAMC 14.05.050 regarding Electrical Permit Applications.
Signature of owl ej(jlectrical contractor or electrical administrator:
Dated:— 7 _/
❑ Cash ❑ Check
❑ Credik Card #
02106/2012
?&k Z