HomeMy WebLinkAbout1021 Caroline St (3)ELECTRICAL PERMIT
CITY OF PORT ANGELES
360-4t7-4735
COMMERCIAL OFFICE
0
D ARErcRJP 6T AT E S ALES TAX
on your excise tax form
to the City of Port Angeles
(Location Code 0502)
u
ts
061
Applicatiod Number - - -
Appti.cation pin number
Property Address
ASSESSOR PARCEL NUMBER:
Application t,,pe descripEion
subdivision Name
Ploperty Use
ProperEy ZorIing
Applicatsion valuation
20-00000798
17a392
IO21 CAROI]INE ST
06-l0 - 00 -s-3 -0440-0000-
ELECTRICAL ONLY
Application desc
Lighting and circuit update
Oii,ner Contrac!.or
olympic Medj.cal cenEer
9]9 CAROLINE ST
PORT ANGELES I{A 983523901
SIMPSOII ELECTRIC
241036 r{ HitY 101
PORT ANGE]-ES
l360\ 457-9210
wa 98353
PenniE
Additional desc
Permit Fee
Issue Date , -
ExpiraEion Date
ELECTRICAL ALTER COMMERCIAL
1-4 CIRCUITS
155.00 PIan Check Fee
7 /2L/29 valuar ion
t/L7 /2L
.00
0
Extens ion
86.00
90,00
Qty Unit Charge Per
15.00 s - 0000 EcF
BASE FEE
EI,-ECH ADDN? BRANC'II CIRCUI"
Charged
PERMII WILL EXPIRE SIX (6) MONTHS FROM LAST INSPECTION
Permit Fee Total
Plan check Total
Srand Total
165
L65
00
00
00
166 .00
.00
166 .00
.oo
.00
.00
- 00
- 00
.00
Paid CrediEed Due
.
INSPECTION T1?E DATE:RESULTS:INSPECTOR:
DITCH
SERVICE
ROUGH-IN *t ho)zo F VD
FINAL r lplzn d\
COMMENTS:
Signature ofowner or Electrical Contractor X Date
w
ELECTRICAL INSPECTION
WIRING REFORT
4'.17-47#
NOT APPROVED
.....DITCH
@ PY
SERVICE
,hL
.....FINAL
APPROVED
tr
tr
tr
trD
-2@
CONTFACIOF
,!\
ADOFESS
o
CORRECTIONS NEEDED:
NOTIFY INSPECTOR WHEN CORRECTIONS
ARE COMPLETED WITHIN 15 DAYS
- DO NOT REMOVE-
tt t -*-C
l-.-tA4- Zeztrtr- -
ELECTRICAL INSPECTION
WIRING REPORT
417-4735
DATE
I )1 7L\20 -'fla INSPECT
CONTBACTON
4,*^*6oN Zrrzz-
ADDNESSIOZJ c'*r>(--' u r*{lE-
NOT APPROVED
COBRECTIONS NEEDED
D
o
tr
tr
NOTIFY INSPECTOR WHEN CORFECTIONS
AFE COMPLETED wlTHIN 15 DAYS
_DO NOT REMOVE-
I h? ., ) A) .-','-z-.e a courv.
ELECTRICAL INSPECTION
WIRING RERORT
417-4735
'"i l.t l"o zo-fi8 INSPECTOA-57
CONTAACTOBg>nProg tZLzrL
ADOFESS
lO21 CD,rz,,D L) A e_
APPROVED NOT APPROVED
....._DtrcH.......
. ROUGH IN/COVER . ,
.....SERV|CE......
......F|NAL......,
CORRECTIONS NEEDED czst-t l/c- C-er..b
U
tr
tr
CI
tr
D
tr
tr
tr
NOTIFY INSPECTOR WHEN CORRECTIONS
ARE COMPLETED WITHIN 15 DAYS
_ DO NOT REMOVE-
MULTI-FAMILY / COMMERCIAL
ELECTRI CAL PERMITAPP ICATION
Public Works and [Jtilities Department
321 Fl. 5th Street. Pon Angeles. \\A 98361
360.417 .4735 I wwrl.cityotpa.us I electricalperm irstr?ic itl otpa.us
Project Address 1021 Caroline St Port Angeles, WA 98362
Project Description Circuite update lighting, updating wiring to hosp ital grade, and Alteration for Wound Care Building
E Multi-Family Residential U commercial / lndustrial / Public Building Square footage:
O!\NER INFORMATION
Name o[,4c Email
ELECTRICAL CONTRACTOR INFORMATION
Name Si n Electric LLC License SIMPSEL9T3RQ
PROJECT DETAILS
Item
Service/Feeder 200 Amp.
Service/Feeder 201-400 Amp.
Service/Feeder 40 1 S00 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 Brancfi Circuit
Branch Circuits 1-4
Temp. Service/Feeder 200 Amp.
Temp. Service/Feeder 201400 Amp.
Temp. Service/Feeder 401€00 Amp.
Temp. Service/Feeder 601 -1000 Amp.
Portal to Portal Hourly
Sign / Outline Lighting
Signal Circuivlimited Energy - Multi-Family
Signal Circuiulimited Energy/First 1500 sf - Commercial
(Note: $5.00 for each additionat 1500 s0
Renewable Elec. Energy: sKVA System or less
Thermostat (Note: 55 for each additional)
Ouantitv Iglal (Quantity x Unit Charge)Llnit 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
86
16
14
$________-$EAO-
$
$
$
$
$
$
i
s
$
t
00
$113.00
$56.00 t6rdTOTAL
Owner as defined by RCW19.28.26'1 : (1) Owner will occupy the struclure for two years after this electrical permit is finalized. (2) Owner is
required to hire an electrical contrac{or 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 c€rtify 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 PortAngeles Municipal Code, and Utility Specifications and PAMC 14.05.050 regarding Electrical Permit Applications.
712012020 Andrew P Simpson ,4"4"r*P 54./o-*
ELcoM !o
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Mailing Addrcss: 939 Caroline St Port Angeles, WA 98362 Phone: !9!:19!l?9119!-
Mailing AddrGss: ExpiralionDale: J!4@-
Email: Phone: !991!Z!?29-
$_
$_
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OD
Date Print Name Signature (E Owner ! Electrical'Contractor /Administrator)
[Electrical Permit Applications may be submitted to City Hall or electricalpermits@cityofpa.us or faxed to 360.417.47111