HomeMy WebLinkAbout939 Caroline St (7)Application Numbe. .
Application pin number
Property Address
ASSBSSOR PARCEL NUMBER:
Applicatior} ts)?e deacription
Subdiviaion Name . .
Prope!ty Use
Prope!ty Zoaing
ApplicaEioi! vafuaEion
ELECTRICAL PERMTT
CITY OF PORT ANGELES
360-417-473s
PTJBLIC BUILDINGS & PARKS
0
19 - 00000502 Date 4/os/19
4175 90
93 9 CAROLINE ST
06- 3 0- 00- 1-0-3325- 0000-
ELECTRICAIJ ONLY
REPORT STATE SATES TAX
on your excis€ tax forn
to the City of Port Angeles
(Locatlon Code0$2)
t.\
0
$
AppIi.cati.on desc
outle! Bio-Med shop
Contractor
PUBLIC I{OSPITAL DISTRICT #2
939 cAioLrNE sr
PORT ANGELES I{A 983 62(350) 417-7170
SIMPSON ELECTRIC
243 03 5 W HWY 101
PORT ANGEIESi360\ 4s'1-9270
wA 98363
Perml t
Additional desc
Permi! Fee
Issue Date .
Expiration Date
ELECTRICAIJ AITER COMMERCIAII
1-4 CIRCUITS
86.00 Plan Check Fee
4 /O5/t9 Va1ua! ion
to/02/t9
00
0
Qty UniE Charge Per
BASE PEE
Extension
86.00
Eee summary
Permil Fee ToLal
P1a.l Check TotaI
Grand Total
85.00
.00
86.00
86. O0
.00
86 .00
00
o0
00
00
00
00
INSPECTIONTYPE DATE RESI'LTS:INSPECTOR:
DITCH
SERYICE
] ROUGH.IN sl'z ID ,f :fP
FINAL <td4 w
CDMMENTS:
IIt
T
Tt
PERMIT WIIL EXPR.E SD( (6) IIO{IIS FROI{ IIST I,ISIECIIOT{
Sigmtue of owaer q Elccti:el Ge*u X Date:
:T:Y:i ..-::ti .::::t::: .---i:
TVIULTI-FAIU ILY / COMMERCIAL
ELECTRI CAL PERMIT APPLICATION
Public Works and tltilities Department
3l I U. -s(h Stleet. Port Angeles. \\'A 98-r62
-160.417..17.1-clu*rr,,.cit1-ofpa.usielecrricalpermitsi-Zycityofpa.us
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l"Project Address 939 Caroline St Port Angeles, WA 98362
Project Description Add a circuit for new outlets Bio-Med Shop
n Multi-Family Residential 0 Commercial / lndustrial / Public Building Square footage
OWNER INFORMATION
Name : Clallam Co Hospital Dist.#2 Email
I\,4 ailing 466rsss 939 Caroline St Phone:
Name Simpson Electric LLC License SIMPSEL9T3RO
Mailing Address P.O. Box 1086 Port Anqeles. WA 98362 Expiration Date 12t11t2019
Email dlsimpsonSl @qmail.com P hone 360-457-9270
Item
Service/Feeder 200 Amp.
Service/Feeder 201 -400 Amp.
Service/Feeder 401-600 Amp.
Service/Feeder 601 -1 000 Amp.
Service/Feeder oveLI 000 Amp.
Branch Circuit W Service Feeder
Branch Circuit WO 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.
lernp. Serv,ce/Feeder 601- 1000 Amp
Portal to Portal Hourly
Sign / Outline Lighhng
Signal CircuiULimited Energy - MuttFFamily
Signal CjrcuiULimited Energy/First 1500 st - Commercial
(Noter $5 00 for each additionat 1500 s0
Renewable Elec Energy sKVA System or less
Thermostat (Notet $5 for each additional)
Quantitv IOhl (Quantity x UnitCharge)unit Charoe
$132.00
$160.00
$225 00
$288.00
$410.00
$5.00
$74 00
$5.00
$86.00
$102.00
$121 00
$164.00
$'185.00
$96.00
$88.00
$88.00
$96.00
008614
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$113.00
$56.00
Owner as defined by RCW19.28.261 ('l) ownerwilloccupy the structure fortwo years after this etectrical permit is finatized. (2)owneris
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 slatement, I hereby certity that I am the owner of the above named property or a licensed electricat contractor Iam making the electrical installation or alteration in compliance with the electrical laws, N.E.C., RCW Chapter '19.28, WAC. Chapter 296-468, The city of Pod Angeles Municipal code, and Utility Specifications and PAMc '14.05.050 regarding itectricat permit Apptications.
86.TOTA L
412119 Andrew P Sim son 4"4/r*- p
Date Print Name Signature 1! Owner p Electrical Co / Administrator)
[Electrical Permit Applications may be submitted to City Hall or electricalpermits@cityofpa. us or faxed to 360.417.47111
360-417 -7 621
ELECTRICAL CONTRACTOR INFORMATION
PROJECT DETAILS