HomeMy WebLinkAbout939 Caroline Street - Building (2) 3 _ _
ELECTRICAL PERMIT
CITY OF PORT`:ANGELES 0
360-41 T-4735 �
Application Number . . . 21-00000840 Date 7/13/21
Application pin number 389040
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
T -Application desc
Load bank Re-test
Owner Contractor
PUBLIC HOSPITAL DISTRICT #2 LEGACY TELECOMMUNICATIONS INC
939 CAROLINE ST PO BOX 360
PORT ANGELES WA 98362 BURLEY WA 98322
(360) 417-7170 (253) 858-0214
-----.-.----------------------------------------------------------
.Permit ELECTRICAL AL�ZR COMMERCIAL
Additional desc
Permit Fee . . 185.00 Plan Check Fee .00
Issue Date . . . . 7/13/21 Valuation 0
Expiration Date 1/09/22
Qty Unit Charge Per Extension
1.00 185.0000 BCH EL- COMM 601-UP TEMP SRV/FDR 185.00
---- - ------- -- ----- _-- -- ---------------------------
Fee summary Charged Paid Credited Due
•Permit Fee Total 185.00 185;OQ 00 .00
Plan Check Total .00 .00 .00 .00
Grand Total 185.00 185.00 .00 .00
I
REPORT SALES TAX
on your excise tax form
to the City of Port Angeles
(Locadion Code 0502)
INSPECTION TYPE DATE: RESULTS: INSPECTOR:
DITCH
SERVICE
ROUGH-IN.
FINAL J
COMMENTS:
PERMIT WILL EXPME SIX(6)MONTHS FROM LAST INSPECTION
Sign afore of owner or Electrical-Contractor X Date:
G:IEXCHANG&BUILDING -`—
•
MULTI-FAMILY / COMMERCIAL
ELECTRICAL PERMIT APPLICATION 3
Public Works and Utilities Department
321 E. 5th Street, Port Angeles, WA 98362 �
360.417.4735 1 www.cityofpa.us I eIectricalperm its(a7,,cityofpa.us
Project Address: 939 Caroline St. Port Angeles, WA 98362
Project Description: OMC Generator#3 Load Bank
❑ Multi-Family Residential 0 Commercial/Industrial/Public Building Square footage:
OWNER INFORMATION
Name: Olympic Medical Center Email: ifrancis@olympicmedical.org
Mailing Address: 939 Caroline St.Port Angeles,WA 98362 Phone:;360-417-7621
ELECTRICAL CONTRACTOR • ' !
Name: Legacy Power Systems License`. LEGACTL821 LJ
Mailing Address: 8102 Skansie Ave Gig Harbor,WA 98332 Expiration Date: 06/14/22
Email: rlundin@legacypower.com Phone: 253-858-0214
llgm Unit Charge Quantity Total(Quantity x Unit Charge)
Service/Feeder 200Amp. $132.00 $
Service/Feeder 201-400 Amp. $160.00 $
Service/Feeder 40-1-600 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/O Service Feeder $74.00 $
Each Additional Branch Circuit $5.00 $
Branch Circuits 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 1 $ 18500
Portal to Portal Hourly $96.06 $
Sign/Outline Lighting $8800 $
Signal Circuit/Limited Energy-Multi-Family $88.00 $
Signal Circuit/Limited Energy/First 1500 sf-Commercial $96.00 $
(Note: $5.00 for each additional 156616
Renewable Elec. Energy: 5KVA System or less $113.00 $
Thermostat(Note: $5 for each additional) $56.00 $
$ 185.00 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.
7/12/2021 Ryan Lundin
Date Print Name Signature(❑ Owner V Electrical Contractor/Administrator)
[Electrical Permit Applications maybe submitted to City Hall or electricalpermits@cityofpa.us or faxed to 360.417.4711]