HomeMy WebLinkAbout939 Caroline St (2)Application Number
Application pin nunrber:
Proper!y Address
ASSESSOR PARCEL NUMBER:
Applicatsion t)?e descripEion
Subdivision Name
Proper!y Use
ProperEy Zoning
Application valuat.ion
ELECTRICAL PERMIT
CITY OF PORT ANGELES
360-417-4735
PUBIIIC BUILDINGS & PAR(S
0
18 - 000 013 80 Date 9/O5/Le
66'7420
939 CAROIJINE S?
06-30 00 1,0-3325-0000-
EIJEC?RICAIJ ONIJY
REPORT STATE SALES TAX
on your excise tax form
to the City of Port Angeles
(Location Code 0502)
SN
\:
\\
\sso
Applicatlon desc
30 amp T? rcpt
ContracEor
PUBI,IC HOSPITAI] DISTRICT
939 CAROIJINE ST
PORT ANGELES WA
(360) 417-7170
SIMPSON ELECTRIC
243035 I,t HWY 101
PORT ANGELES
136O) 4s7 92'70
#2
983 62 wA 98353
Permit
Additional
Issue Dale
EIECTR]CAL ALTER COMMERCIAI]
1-4 CIRCUITS
85.00 Plan Check Eee
9/a5/ 18 valtrar ion
3/a4/19
desc
00
0
Expiration Date
Qty units charge Per
BASE FEE 86.00
Fee summary Charged Pa id Crediled
Permit Fee Toi:a]
Plan Check Tota]
Grand Total
85. 00
.00
85. 00
86.00
.00
86.00
00
00
00
00
00
00
INSPECTION T\?E DATE:RESULTS:INSPECTOR:
DITCH
SERVICE
ROUGH-IN qlz/n F UP
FINAL z1tlra .NP\
PERMIT WILL EXPIRE SIX (6) MONTHS FROM LAST INSPECTION
Signahre ofowner or Electrical Contractor X Date:
Due
SP
COMMENTS:
ELcoM MULTI-FAM ILY / COMMERCIAL R
ELECTRICAL PERIU IT APPLICATION
Public Works and Utilities Department ttFj
321 E.5th Street, Poft Angeles, WA 98362 ll'iSPE
3 6A.4 17 .47 3 5 www.cityofpa. us electricalpermits@cityofpa. us
IH
AI
1'o
=J
=
N
].
\N
CD
C)Projeet 4661sss. Olympic Medical Center 939 Caroline St Port Angeles, WA 98362
OWNER INFORMATION
Name:
Mailing
c Medical Center
Address. 939 Caroline St Port Angeles, Wa 98362
Email
p6sns. 360-417-7000
Name Simpson Eleclric LLC l-isessg SlMPSEL9T3RQ
PROJECT DETAILS
Item
Service/Feeder 200 Amp.
Service/Feeder 201-400 Amp.
Service/Feeder 401 €00 Amp.
Service/Feeder 60'l-1 000 Amp.
Service/Feeder over 1000 Amp.
B€nch Circuit W Service Feeder
Branch Circuit WO Service Feeder
Each Additional Branch Circuit
Branch Circuits 'l-4
Temp. Service/Feeder 200 Amp.
Temp. Service/Feeder 201-400 Amp.
Temp. Service/Feeder 401600 Amp.
Temp. Service/Feeder 601 -'l 000 Amp.
Portalto Portal Hourly
Sign / Outline Lighting
Signal CircuivLimlted Energy - Multi-Family
Signal CircuivLimited Energy/First 1500 sf - Commercial
(Note: $5.00 for each additional '1500 s0
Renewable Elec. Energy: 5KVA System or less
Thermostat (Note: $5 for each additional)
Ouantitv Total (Quantitv x unit CharoelUnit Charqe
$132.00
$160.00
$22s.00
$288.00
$410.00
$5.00
$74.00
$5.00
$86.00
$102.00
$'12'1 .00
$164.00
$185.00
$96.00
$88.00
$88.00
$96.00
008614
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$113.00
$56.00
860 TOTAL
Owner as defined by RCW.19.28.261i (1) Owner will occupy the structure for two years after this electrical permit is finalized. (2) Owner is
required to hire an electrical contraclor it 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 eleclrical contractor. I
am making the electrical installation or alteralion in compliance with the electrical laws, N.E.C., RCW Chapter 19.28, WAC. Chapter 296-
468, The City of Port Angeles Municipal Code, and LJtility Specifications and PAMC 14.05.050 regarding Electrical Permit Applications.
91412018 Andrew P Sim son
Oate Signature (E Owner p ElecAical Contractor /m inistrator)
[Electrical Permit Applications may be submitted to City Hall or electricalpermits@cityofpa. us or faxed to 360.417.47111
Project Description l- 30 Amp Outlet for lT >lDF13
E lVlulti-Family Residential E Commercial / lndustrial / Public Building Square footage:
-
ELECTRICAL CONTRACTOR I NFORMATION
Mailing Address: PO Box 1086 Port Angeles, wA 98362 Expiration g61s'. 1211112019
Email: dlsimpsonsl @gmail.com Phone: 360-457-9270
Print Name