HomeMy WebLinkAbout2619 S Race StELECTRICAL PERMIT
CITY OF PORT ANGELES
360-417-473s
RS7 RESDNTL SINGLE FAUITY
0
REPORT STATE SALES TAX
on your excise tax form
to the City of Port Angeles
(Location Code 0502)
5
\
F.)(,{
-,I
AppLication Nunicer .
Applicatsion pin nudcer
Propertsy Address
ASSESSOR PARCEI, NI]I{BER:
Application type description
Su-bdivision Name -
Property Use
Pr:operEy Zoning
Application valuation
19- 00001237 Date A/ts/1-g
517014
2519 S RjACE ST
06- 30- 10 -5 -1- 0745 -0000-
EI,ECTRICAN ONLY
Application desc
DEP x2
KaEie Roszatsycki
2619 S RACE ST
PORT ANGELES
BLACK DIAMOND ELECTRfCAI CONTR
502 BI,ACK DIAMOND RD
PORT ANGELES WA 983 53
(360) 555 - 103 5
wA 983625783
Permits
AddiLionaf desc
Issue Date
Expiration DaEe
68 .00
B/15/1-e
2/t!/20
ELECIRICAL ALTER RESIDEINTAT,
Plan Check Fee
Valuation
00
0
Qty Units Charge Per
1 .00 s. 0000 EcH EL1.00 53 .0000 ECH EL
ECH ADDNT BFANCI] CIRCUIT
R- BRANCH CIR WO/ SER EEED
Extension
5 .00
63 .00
Charged Paid Credited Due
Perrnit Fee Totaf
Plan Check Total
Grand Totsal
68 .00
.00
58 .00
58 .00
.00
58 .00
00
00
00
00
00
00
PERMTT WILL EXPIRE StX (6) MONTHS FROM [.AST TNSPECTION
INSPECTION TYPE DATE:RESULTS:INSPECTOR:
DITCH
SERVICE
ROUGH-IN s )ziltt *r??6D
FINAL x,')i/n -F %&tr
COMMENTS:
v
Signature of owner or Electrical Contractor X Date
EL1-2 sF
ELECTRICAL PERM IT APPLICATION
Public Works and Utilities Department
321 E. 5th Street. Pofi An-seles, WA 98362
3 60.4 | 7 .47 3 5 www.cityofpa.us i electricalpermrts(grcityofpa. us
f,'f,;fff
1lo
=I
]}I
l--0\
NV
--.1Project Address 2619 S Race
Project Description:Add circ for ductless x2
OWNER INFORMATION
Name: Roszatycki Email:
Mailing 466rc5s. 2619 S Race p66ng.36H61€463
ELECTRICAL CONTRACTOR INFORMATION
1r1erp6; Black Diamond Electrical License: BLACKEC894D2
Expiration Date
Phone:
Mailing Address:
Email:
PROJECT DETAILS
Item
Service/Feeder 200 Amp.
Service/Feeder 20'l-400 Amp.
Service/Feeder 40'l -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 14
Temp. Service/Feeder 200 Amp.
Temp. Service/Feeder 201-400 Amp.
Temp. Service/Feeder 401-600 Amp-
Temp. Service/Feeder 601 -1 000 Amp.
Portal to Portal Hourly
Signal Circuivlimited Energy - '1&2 DU.
Manufactured Home Connection
Renewable Elec- Energy: sKVA System or less
Thermostat (Note: $5 for each additional)
First 13@ Square Feet
Each Additional 500 square feet"
Each Outbuilding / Detached Garage
Each Swimming Pool / Hot Tub
TOTAL 68
Owner as defined by RCW.'1S.28.261: (1) Owner will occupy the structure for two years after this electrical pemit 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 monlhs 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 electric€l 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 .egarding Electrical Permit Applications.
B-2-201e BenjaminShamp
Date Print Name Signature (gl Owner ! Electrical Contractor / Administrator)
[Electrical Permit Applications may be submitted to City Hall or electricalpermits@cityofpa.us or faxed lo 360.417.47111
Unlt Chame
$120.00
$146.00
$205.00
$262.00
$373.00
$5.m
$63.00
$5.00
$75.00
$93.00
$110.00
$149.00
$168.00
$96.00
$e.oo
$120.00
$102.00
$56.00
$120.00
$,'tO.00
$74.@
$110.fi)
Ouanlitv IgEl (Quantity x Unit Charge)
5
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
u
$
$
$
$
63
.-l-!"\
L f
1 - 2 SINGLE-FAMILY
trSingle.FamilyResidentialElDuplex/ARUBuildingSquarefootage:-
1
1