HomeMy WebLinkAbout1116 E Lauridsen BlvdELECTRICAL PERMIT
CITY OF PORT ANGELES
360-41'7-4735
-\
{\D
\,1Application Nuniber
ApplicaEion pin number
Property Address
ASSESSOR PARCEL NUMBER :
ApplicaEion t),pe descripEion
Subdivision Name
Property Use
Property Zoning
Application valuaEion -
19- 00000793 Date 5 /29 /1-9
659',169
1115 E I.AURIDSEN BLID
06- 3 0- 11- 5- 1- 0200 - 0000 -
ELECTRICAI ONLY
Qty Units Charge Per
1.00 102.0000 EcH EI- coMM 0-200 TEMP sRv / FDR
Extension
102. 00
REPORT STATE SAIES TAX
on your excise tax form
to the City of Port Angeles
(Location Code 0502)
0
ApplicaEion desc
Load bank
EIR LANE TERRACE CO}IVL CTR*259
ATTN: ?AX DEPT
!,ILWAUKEE WI 53203
PACIFIC POI4ER GROUP
85 BROADWAY STREET #7OO
VANCOIJI'ER WA 98550
1253) 395 -9O'7't
Permit
Additional deac
Permit Eee
lssue Date
Expiration Datse
102.00
s /29 / 1-9
aT/25 / t9
Plan Check Fee
Valuation
00
0
Fee summary Charged Paid Credited Due
PermiE Fee Totaf
Plan Check Total
102
L02
00
00
00
702
102
.00
. o0
.00
00
00
00
00
00
00
PERMIT WILL EX?IRE SIX (6) MONTHS FROM LAST INSPECTTON
DATE:RESULTS:INSPECTOR:
DITCH
ROUGH-IN rbln sR rsP
FINAL rldn g :MD
Signature ofowner or Electrical Contractor X Date
EIECTRICAL ALTER COMI4ERCIAL
INSPECTION TYPE
SER\TCE
COMMENTS:
tU U LTI-FAM I LY / COIM M ERCIAL
E LECTRICAL PERM IT APPLICATION
Pr"rbtic &'hrks and tltilities Departmeat
311 E. 5tli Sh'eet, Port Angeles. WA 98i52
360.41 7.4715 | wrvw.citvofpa.us j electricalpemits@cityofpa.us
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Project Address 1'116 E. LAURIDSEN BLVD, Port Anseles, wa 98362
Project Description Performing 4 hour load bank test of eme rgency standby Generators. - 1904033
E Multi-Family Residential m Commercial / lndustriat / Pubtic Buitding Square footage
Name: CRESTWOOD HEALTH AND REHAB
Mailing Address 1 1 16 E. LAURIDSEN BLVD, Port Anoeles, WA 98362
Email
phone. 253-395-9077
Name Pacific Power Group License:PACIFPG867D7
Item
Service/Feeder 200Amp.
Service/Feeder 2014OO Amp.
Service/Feeder 401-600 Amp.
Service/Feeder 601 -1 000 Amp.
Service/Feeder over 1000 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. Servicei Feeder 401-600 Amp.
Temp. Service/Feeder 601-1000 Amp
llnilQbalse
$132.00
Quantity
1
(Quantity x Unit Charge)
$160.00
$225.00
$288.00
$4'10.00
$5.00
$74 00
$s.00
$86.00
$102.00
$121.00
$164.00
$185.00
$96.00
$88.00
$88.00
$96.00
$113.00
10)
$
$
$
$
$
$
$
$
$
$
$
Pota ro Ponal -lo.r y
Sign / Outl ne Lighting
Signal CircuiULimited 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)
102 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 contracto. I
am 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 PortAngeles Municipal Code, and Utility Specifications and PAMC 14.05.050 regarding Electrical permit Apptications.
0512312019 Darrell Vardeman
Date Print Name Signature (! Owner p Electrical Contractor / Administrator)
IElectrical Permit Applications may be submitted to City Hall or electricalpermits@cityofpa. us or faxed lo 360.417 .4711]
$
$
$
€LECTAreA1, CONTRACTOR
Mailang Address: 805 Broadwav.St, #700 Expiration esls; O3128120
Email Service-Admin-Kent-Pgen@PacificPowercroup.com phone: 253-395-9077
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