HomeMy WebLinkAbout939 Caroline St (17)Application Nuiber
Applicatiofl pin number
Propertsy Address
ASSESSOR PARCEL NUMEER :
Application t],?e description
Subdivision Name
Property Use
Property Zoning
Application valuat j.olr
ELECTRICAL PERMIT
CITY OF PORT ANGELES
360-417473s
PUBLIC BUII,D]NGS & PARKS
0
19- 00001655 DaLe 70 /25 /1-9
2411,7 5
939 CAROLINE ST
06- 3 0 - 00 - 1- 0 -3 3 25,0000-
ELECTRICAL ONIJY
REPORT STATE SALES TAX
on your excise tax form
to the City of Port Angeles
(Location Code 0502)
.\0
*\}rs-
Application desc
Triage Room
PUBLIC HOSPITAL DISTRIC" #2
939 CAROLINE ST
PORT ANGEIES WA 9A362
/.360) 417 -7t'7A
SIMPSON E],ECTRIC
243036 !t IIWY 101
PORT ANGE],ES
(360) 4s7 -9270
wA 983 63
Permits
Additional desc
Permit Fee
fssue Date
Expiration Date
EI.ECTRICAL AITER COMMERCIAT
1.4 CIRCIIITS
91.00 PIan Check Fee
lj/25/r9 Va1uaEion
4 /22 /20
Oty units Charge
1.00 5.0000
.00
0
Exiension
85.00
5 .00
Per
ECH
BASE FEE
EL ECH A.DDNT BRANCH C]RCUIT
Charged Paid Crediied Due
PermiE Fee Totsa1
PIan Check Total
Grard Total
91. 00
- 00
91. 00
91.00
.00
91, O0
00
oo
o0
00
00
00
PERMIT WILL E)(PIRE SIX (6) MONTHS FROM LAST INSPECTION
INSPECTION TYPE DATE:INSPECTOR:
DITCH
SERVICE
rl /o.t/11 ,N WY
FINAL ,i|"z.ln {v =#
COMMENTS
Signature ofowner or Electrical Contractor X Date
RESULTS:
ROUGH.IN
MULTI-FAMILY / COMTM ERCIAL
ELECTRICAL PER MIT APPLICATION
Public \Vorks and t..ltilities Departmcnt
331 I. 5th Sueet. Port Angeles. \\A 98.162
-160.4 I 7.4735 | wrvw.citvofpa.us I elcctricalpermits@cityolira.us
-o
o
3
+
939 Caroline St Port Anqeles , wA 98362
Project Description Circuits for Treage Room # 2 Alterations
n MultiFamily Residential 0 Commercial / lndustrial / Public Building Square footage:
Name Olympic l\4edcial Center
Maaling 4661sss. 939 Caroline St Port Anqeles, WA 98362
Email
Phone 360-417-7163
Simpson Eleclric LLC License:SIMPSEL9T3RO
Expiration Date 12t11t2021
Phone: 360457-9270
Mailing Address: P.O. Box 1086 Port Angeles WA 98362
Email dlsimpson 51 @omail.com
Item
Service/Feeder 200 Amp.
Service/Feeder 20'1-400 Amp.
Service/Feeder 40'1-600 Amp
Service/Feeder 601 -1 000 Amp.
Service/Feeder over 1000 Amp
Branch Circuit W Service Feeder
Branch Circuit W/O Service Feeder
Each Additional Branch Circuit
Branch Circuits 1-4
Temp Service/Feeder 200 Amp
Temp. Service/Feeder 20'1-400 Amp.
Temp. Service/Feeder 401-600 Amp.
Temp. Service/Feeder 60'l -'1 000 Amp
Podal to Portal Houriy
Sign / Outline Lighting
Signal CircuiVLimited 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)
unit Charoe
$132.00
$160 00
$225.00
$288 00
$410.00
$s.00
$74.00
$5.00
$86.00
$102.00
$121 00
$164.00
$185.00
$96.00
$88.00
$88.00
$96.00
Ouantitv fdal(Quantity x Unit Charge)
$
$
$
$
$
$
$
$
$
$
U
$
$
$
$
0086
1
14
5.00
$_
91.00 TOTAL
$113.00
$56.00
$
Owner as defined by RCW.19.28.261: (1) Owner wall occupy the structure for two years after this electricat permit is tinalized. (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.
11t23t2019 Andrew P Simpson 4"4/r*P S,]./tr4Do,
Date Print Name Signature (E Owner ! Electrical Contractor / Administrator)
IElectrical Permit Applications may be submitted to City Hall or electricalpermits@cityofpa. us or faxed to 360.417.47 j1]
Project Address:
OWNER INFORMATION
ELECTRICAL CONTRACTOR INFORMATION
Name:
PROJECT DETAILS