HomeMy WebLinkAbout1137 HWY 101 - BuildingSignature of owner or Elechimt Contractor X Date:
ELECTRICAL PERMIT
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.
CITY OF PORT ANGELES
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SERVICE
360417-4735
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Application Number . . . . . 18-00000802 Date 5/29/18
Application pin number . . . 784602
Property Address . . . . . . 1137 W HWY 101
REPORT STATE SALES TAX
ASSESSOR PARCEL NUMBER: 06 -30 -08 -5 -8 -2010 -0000 -
on tax fom
Application type description ELECTRICAL ONLY
your excise
Subdivision Name . . . . . .
to. the City of Port Angeles
Property Use . . . . . . . .
(Location Code 0502)
Property Zoning . . . . . . . COMMUNITY SHOPPING DISTR
Application valuation . . . . 0
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Application desc
Ice machine circuit
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Owner Contractor
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1137 W HIGHWAY 101 LLC SIMPSON ELECTRIC
1137 W HWY 101 243036 W HWY 101
PORT ANGELES WA 98362 PORT ANGELES WA 98363
(360)1457-9270
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Permit . . . . . . ELECTRICAL ALTER COMMERCIAL
Additional desc 1-4 CIRCUITS
Permit Fee, 86.00 Plan Check Fee .00
Issue Date-., .. 5/29/18 Valuation . . . . 0
Expiration Date 11/25/18
Qty " Unit Charge Per Extension
BASE FEE 86.00
Fee summary Charged Paid Credited Due
----`------------ --- ------- ----------------------
p'
Permit Fee Total 86.00 86.00 .00 .00
Plan Check Total; .00 .00 .00 .00
Grand total 86.00 86,00 .00 .00
Signature of owner or Elechimt Contractor X Date:
INSPECTION TYPE
DATE: RESULTS:
INSPECTOR;-
NSPECTORDITCH
DITCH
SERVICE
ROUGH-IN�
FINAL
COMMENTS:
PERMIT WILL EXPIRE SIX (6) MONTHS FROM LAST INSPECTION "
Signature of owner or Elechimt Contractor X Date:
MULTI -FAMILY / COMMERCIAL
ELECTRICAL PERMIT APPLICATJQ
Public Works and Utilities Department
321 P. 5th Street, Port Angeles. WA 98362
360.417.4735 ; www.cityofpa.us electricalpermits(a.cityofpa.us
Project Address: 1137 W Highway 101 Port Angeles, WA 98363
Project Description: Add Circuit for ICE Machine
❑ Multi -Family Residential LI Commercial / Industrial / Public Building Square footage:
OWNER INFORMATION
Name: Fairmount Grocery Email:
Mailing Address: 1137 W Highway 101 Phone: 360-452-1627
Name: Simpson Electric
Mailing Address: PO Box 1086
Email: dlsimpson51 ogmail.com
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 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)
License: SIMPSEL973RQ
Expiration Date: 12/11/2019
Phone: 360-457-9270
Unit Charge Quantity
Total (Quantity x Un'
$132.00
$
$160.00
$
$225.00
$
$288.00
$
$410.00
$
$5.00
$
$74.00
$
$5.00
$
$86.00 �_
$ 86.00
$102.00
$
$121.00
$
$164.00
$
$185.00
$
$96.00
$
$88.00
$
$88.00
$
$96.00
$
$113.00 $
$56.00 $
$ 86.00 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-
466, The City of Port Angeles Municipal Code, and Utility Specifications and PAMC 14.05.050 regarding Electrical Permit Applications.
5/24/18 Andrew Simpsony�
Date Print Name Signature (E] Owner V Electric I Contractor / Administrator)
[Electrical Permit Applications may be submitted to City Hall or electricalpermits@cityofpa.us or faxed to 360.417.4711]
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