HomeMy WebLinkAbout939 Caroline ST - Building (4) ELEC n AL PERMIT N
CITY-OF PORT ANGELES t
360-417-4735
Application Number . . . . . 21-00000074 Date 1/25/21
Application pin number . . 439368
Property Address . . 939 CAROLINE ST
ASSESSOR PARCEL NUMBER: 06-30-00-1-0-3325-0000-
Application type description ELECTRICAL ONLY
Subdivision Name . . . .
Property Use . . . . . . .
Property Zoning . . . . . . PUBLIC BUILDINGS & PARKS
Application valuation . . . . 0
Application desc
Med Compressor basement mech.
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Owner Contractor
PUBLIC HOSPITAL DISTRICT #2 SIMPSON ELECTRIC
939 CAROLINE ST 243036 W HWY 101
PORT ANGELES WA 98362 PORT ANGELES WA 98363
(360) 417-7170 (360) 457-9270
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Permit . . . . . . ELECTRICAL ALTER COMMERCIAL
Additional desc . . 1-4 CIRCUITS
Permit Fee . . 86.00 Plan Check Fee .00
Issue Date . . 1/25/21 valuation . . . . 0
Expiration Date . . 7/24/21
Oty Unit Charge Per Extension
BASE FEE $6.00
~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
REPORT SALES TAX
on your excise tax form
to the City of Pout Angeles
(Locedon Code 0502)
INSPECTION TYPE DATE: RESULTS: INSPECTOR:
DITCH
SERVICE
ROUGH-IN n- )
FINAL
COMMENTS:
PERMIT WILL EXPIRE SIX(6)MONTHS FROM LAST INSPECTION
Signature of owner or Electrical Contractor X Date:
GAEXCHANG&BUILDING
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MULTI-FAMILY / COMMERCIAL
ELECTRICAL PERMIT APPLICATION 3
Public Works and Utilities Department tv
321 E. 5th Street, Dort Angeles, 'A%A 98362
360.417.4735 1 w ww.cityofpams ! electricalpennits(q�cityofpa.us O
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Project Address: OLYMPIC MEDICAL CENTER 939 Caroline St Port Angeles, WA 98362
Project Description: Circuit for Med Air Compressor > Basement Mechanical Rm
❑ Multi-Family Residential 0 Commercial/Industrial/Public Building Square footage:
OWNER INFORMATION
Name: OMC Email:
Mailing Address: 939 Caroline St Port Angeles,WA>98362 Phone:
ELECTRICAL CONTRACTOR INFORMATION
Name: Simpson Electric LLC License:'SIMPSEL973RQ
Mailing Address: P.O. Box 1086 Port Angeles, WA 98362 Expiration Date: 12/11/2021
Email: dlsimpson51@gmail.com''' Phone: 360-457-9270
PROJECT DETAILS
&M Unit Charge Quantity Tata1(Quantity;x Unit Charge)
Service/Feeder 200 Amp. $132.00 $
Service/Feeder 201400 Amp. $160.00 $
Service/Feeder 401-600 Amp. $225.00 $
Service/Feeder 601-1000 Amp. $288.00 $
Service/Feeder over 1000 Amp. $410.00 $
Branch Circuit W/Service Feeder $5.00 $
Branch Circuit W/0 Service Feeder $74.00 $
Each Additional Branch Circuit $5.00 $
Branch Circuits 1-4 $8600 1-4 $ 86.00
Temp. Service/Feeder 200 Amp. $102.00 $
Temp. Service/Feeder 201-400 Amp: $121.00 $
Temp. Service/Feeder 401-600 Amp: $164.00 $
Temp. Service/Feeder 601-1000 Amp. $185.00 $
Portal to Portal Hourly $9600 $
Sign/Outline Lighting $88.00 $
Signal Circuit/Limited Energy-Mul#-Family $88.00
Signal Circuit/Limited Energy/First 1500 sf-Commercial $96.00 $
(Note: $5.00 for each additional 1500 sf)
Renewable Elec. Energy:5KVA System or less $113.00 $
Thermostat(Note: $5 for each additional) $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-
46B,The City of Port Angeles Municipal Code, and Utility Specifications and PAMC 14.05.050 regarding Electrical Permit Applications.
1/21/2021 Andrew P Simpson xozw /o IS4i e,
Date Print Name Signature(❑ Owner V Electrical Contractor/Administrator)
[Electrical Permit Applications may be submitted to City Hall or electricalpermits@cityofpa.us or faxed to 360.417.4711]