HomeMy WebLinkAbout939 Caroline St (14)Application Nudber
Application pin nuiber
Property Address
ASSESSOR PARCEL NUMBER:
ApplicaEion .Eype descripEion
Subdivision Name
Propert.y Use
Propert.y Zoning
ApplicaEion valuaEion
ELECTRICAL PERMIT
CITY OF PORT ANGELES
360-417-473s
PUBLIC BUII,DINGS & PARKS
0
18 - 00001916 Date t2/2o/la
184 74I
939 CAROTINE ST
05-30 - 00- 1- 0 -3325- 0000 -
EI,ECTRfCAI, ONLY
REPORT STATE SALES TAX
on your excise tax form
to the City of Port Angeles
(Location Code 0502)
a
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ApplicaEion desc
Door openers
Contsrac,tsor
PUBLIC HOSPITA! DISTRICT *2
939 CAROLINE ST
PORT ANGEI,ES WA 983 52
(350) 417-7170
SIMPSON ET]ECTRTC
243036 W HWY 101
PORT ANGEI,ES
1360) 457 -92'7A
wA 983 53
Permit
Additlonal
Permit Fee
Issue Date
EI,ECTRICAL ALTER COMMERCIAI
1-4 CIRCUITS
86.00 Plan Check Fee
72/20/!8 vafuaEion
5/tB/i-9
desc
00
Expirat.ion Date
oty Units charge
BASE FEE
Extension
86.00
Fee summary Charged Paid Credi!ed LfuE
Permit Fee Tolal
Pfan Check ToEaI
Graod TotaI
85.00
.00
86_00
86 .00
.00
85.00
o0
00
00
00
00
00
INSPECTION TYPE DATE:RESULTS:INSPECTOR:
DITCH
SERVICE
ROUGH-IN tln ln *s
FINAL e,)r4 ln tr w
COMMENTS:
Signa ture of owner or Electrical Contactor X Date:
0
PERMTT WILL EXPIRE SIX (6) MONTHS FROM LAST INSPECTION
MULTI-FAMILY / COMMER CIAL
ECTRI A tMIT APPLI ATI
Public \lbrks and Lltilitics Department
321 l'.. -sth Street. Po* Angeles. \f ,A. 98.162
160..+ 1 7.47-r S I wrvu,.citvolpa.us I elccrricalpennitslDcityofpa.us W N
A
-$v
Project Address 939 Caroline St Port An geles, WA 98362 OMC
Project Descripti on. Power to Door Openers 1st Floor Men & Womens Restrooms
! Multi-Family Residential E Commercial / lndustrial / public Buitding Square footage
Name: Olympic Medical Center
Mailing Address 939 Caroline St Port Anqeles , wA 98362
Email:
p666s 360-452-5228
Name Simpson Electric LLC li6s6ss SlMPSEL9T3RQ
Expi ration Date: 1211 1 12019
phone 360-457-9270
l\4ailing Address 243036 Hi 10'1 W
Ema it. dlsimpson5l @qmail.com
Item
Service/Feeder 200 Amp.
Service/Feeder 201 -400 Amp.
Service/Feeder 401 -600 Amp.
Service/Feeder 601-1000 Amp
Service/Feeder ove. 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. Servrce/Feeder 201-400 Amp.
Temp. Servrce/Feeder 401-600 Amp.
Temp Service/Feeder 601-1000 Amp
Portalto Portal Hourly
Sign / Outllne Lighting
Signal CircuiULimited Energy - Multi-Family
Signal CircuiVLimited Energy/First 1500 sf - Commercial
(Note: $5.00 for each additionat 1500 s0
Renewable Elec Energy: 5KVA System or less
Thermostat (Note: $5 for each additional)
12-18-2018 Andrew P Simpson
Quantitv IqBl (Quantity x Unit Charge)LJnit 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
$18s.00
$96.00
$88.00
$88.00
$96.00
86.00
$
$
$
$
$
$
$
$
s
$
$
$
$
$
$
$
$
$113.00
$56.00
86.00 TOTAL
Owner as defined by RCW.19.28.261: (1) Owner will occupy the structure for two years after this electricat permit is finatized. (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 certiiy that I am the owner of the above named property or a licensed electrical contractor I
am making the electrical installatjon or alteration 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 Utility Specifications and PAMC 14.05.050 regarding Etectricat permit Applications.
4"Zrr,* p S)WDE,
Date Print Name Signature (! Owner F Electrical Contractor /Administrator)
[Electrical Permit Applications may be submitted to City Hall or electricalpermits@cityofpa. us or faxed to 360.417.47 jj]
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O1l|/NER INFORMATION
ELECTRICAL CONTRACTOR I NFORMATION
PROJECT DETAILS