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CERTIFICA TE OF OCCUPANCY APPLICA TION Permit # 08-522..
CITY OF PORT ANGELES
Attn: Building Permit Technician
321 E. Fifth St., Port Angeles, WA 98362
(360) 417-4815 fax (360) 417-4711
Print in ink
~ FEES
~Certificate / Inspection
$100.00 Parking Business Improvement Area (PBIA)
fee charged for downtown locations
(Y\ e.A l' c.-o...l
. i+h $+.
Wit- 483hz.. Zoning
Phone # 4\1- '71 70
eration
PLEASE NOTE:
A Business License is also required for the following businesses: Taxi, Peddlers, Second-hand dealer, Pawn broker, Dance, Hotel-
Motel, Fireworks, Ambulance, Tattoo shop. Contact the City Clerk at 417-4634 for additional information.
ACTION ../
New business
Transfer of business
iocation from a
PBIA location
Transfer of business
location from a
non-PBIA location
Change of ownership /
Remodel
Temporary business
Change of use
WIll THERE BE ANY OF THE FOllOWING? NO/ YES/ IF YES, CONTACT
Electrical chances V Electrical Dept. at 417-4735
New or relocated sicns ./ Buildinc Division at 417-4815
Construction chanqes ;/ "
Mechanical chances (heatinc, coolinc, stoves) ./ "
Plumbing chances V "
Fire sprinkler system chanqes ./ "
Fire alarm system chances 17 "
Is this a home occupation? V Plannina Division at 417-4750
Second-hand dealer or pawn broker? .......... City Clerk at 417-4634
New or relocated sewer or water service -:7 Public Works at 417-4807
Excavation or fillinc of lots ./ "
Work done in the City riaht-of-way ;/ "
New driveway openinqs ./ "
Gradinc site drainace (parkinQ lots, downspouts, etc.) -;? "
Landscape irrication system (backflow devices) v Water Dept. at 417-4886
Off-street parkinq ./'
Existina streets paved -7_
Existing sidewalks ./ ./
Curb and qulter if
Call for Certificate of Occupancv inspections before openinq business:
Building Department Inspection 417-4815 & Fire Department Inspection 417-4653
Please provide a minimum 24-hour notice for inspections
Please sign up for utility
services at the cashier counter.
I hereby apply for a Certificate of Occupancy. I acknowledge that I have read this application and state that the information I have
suppUed ;s :,o,",ct to the best of my knowtedge. ~.&_
Date ~ ~fS' Print Name 5eokt- VV1 ~O~ Signature I. ~
/ .
For City use onlv:
Department Approved Rejected Comments / Conditions
Initials & date Initials & date
Building 5-1~~o~ : ~ Type of construction Occupant Load
Fire ~-L,--o8 kDr Automatic fire sprinkler system required no yes
PBIA
Planning .sR S-Iq- DB
City Clerk
Public Works
T"Forms/Bullding Oivision/Cerllficate of Occupancy Application
'O"~
$~
~
CITY OF PORT ANGELES
PUBLIC WORKS - ELECTRICAL DIVISION
nl EAST 5TH STREET. PORT ANGELES. WA 9R](,2
ELECTRICAL PERMIT
Issued: 2/12/99
Permit No:
6564
OWNER/APPLICANT------------------------PROPERTY LOCATION------------------------
VIRGINIA MASON CLINIC 434 7TH ST E
433 E. 8TH Lot: 2
Port Angeles, WA 98362 Block: 228 Long Legal:
360/000-0000 Sub: TPA
T: S: Parc No: 063000022810
CONTRACTOR-----------------------------DESIGNER---------------------------------
SHAMP ELECTRICAL CONTRACTING INC.
P.O. BOX 383
Port Angeles, WA 98362
360/452-1689
,
000/000-0000
PROJECT INFO----------------------------------------------,---------------------
prj Type: COML. MISC. prj Value: $0.00
Occ Type: Cnstr Type: ADD CIRCUITS
Occ Grp: Occ Load: Land Use:
Electrical Heat
Baseboard KW:
Furnace KW:
Heat Pump KW:
Fan/Wall KW:
o
o
o
o
Service Type
Riser
X Overhead Service
Underground Service
Temp Service
Voltage:
Diameter:
Service Size:
Feeder Size:
120,240
X-I -3
200 AMPS
DAMPS
PROJECT NOTES-------------------------------------------------------------------
HOUSE USED TO STORE RECORDS BY VIRGINIA MASON
ADD CIRCUITS
PROJECT FEES ASSESSMENT---------------------------------------------------------
Service: $0.00
Additional Feeders: $0.00
Circuit Wiring: $54.00
Temp Service: $0.00
$0.00
Misc
TOTAL FEE:
Amount Paid:
$54.00
$54.00
-------------~-------------------
---------------------------------
TOTAL FEE:
$54.00
Balance Due:
$0.00
COMMENTS/ACTION NEEDED
ELECTRICAL PERMIT INSPECTION RECORD
CALL 417-4735 FOR ELECTRICAL INSPECTIONS. PLEASE PROVIDE A MlNJMUM 24 HOUR NOTICE. IT IS UNLA WFUL TO COVER,
INSULA TE OR CONCEAL ANY WORK BEFORE IT IS INSPECTED AND ACCEPTED.
KEEP PERMIT CARD AND APPROVED PLANS AT JOB SITE
INSPECTION TYPE DATE ACCEPTIID COMMENTS
YES I NO
UBI..:!1
~{jH-1N I LUYtlK
.Vier;
; ,
I ZJf"'Y91 I
GENERAL COMMENTS:
YW-II02.1'14I9C5J
1" - .'.
CITY OF PORT ANGELES LIGHT DEPARTMENT
321 E. Fifth Street
Port Angeles, WA 98362
(206) 457-0411
ELECTRICAL PERMIT
PERMIT NO. ~t,o I
DATE '/ 2'1/9r
, .
.
Installed By:
~, ')~
b'S q~
p. A-. cft"fJ,'e-
o READY FOR
INSPECTION
License Number:
o WILL CALL FOR
INSPECTION
Phone:
Site Address:
Owner/Business:
RCM.'!-.+L h.()u.~(. ,
Phone:
Owner/Business Address:
Sq, Ft
ELECTRIC HEAT
o BASEBOARD KW ~
o FURNACE KW ~
o HEAT PUMP KW
o FAN/WALL KW
o RESIDENTIAL
o COMMERCIAL
o NEW CONSTRUCTION
o REMODEL
'& ADD/ALTER CIRCUITS
10 SERVICE UPGRADE/REPAIR
o TEMPORARY SERVICE
o RISER
~ OVERHEAD SERVICE
o UNDERGROUI)ID SERVICE
VOLTAGE: /2fJ@.c!O
,
~1~ 03~
SERVICE SIZE ~O AMPS
FEEDER SIZE AMPS
DetailslDescription:
~e~~
cl.e/l4-v1 r -e1 ur
r
("
(
, .
Wtlud
~t
.
W.S. No. SERVICE SIZE
CAPACITY:
o O.K. 0 NOT O.K.
ACTION REQUIRED: 0 CHANGE TRANSFORMER
o INSTALL SERVICE POLE
DATE
ENGR.
o OVERHEAD SERVICE APPROVED
o CHANGE SERVICE WIRE
o OTHER
o Ditch Inspection O.K.
o Rough-in/cover O.K.
o O. K. to connect service
~Final O.K.
Site Address:
1.3
L,
~b~
New Meters
--
Installer:
.
Notify Port Angeles City Light by Street Address and Permit Numberwhen ready for inspection. Work must not be covered
before inspection and O.K. for covering has been given by the electrical inspector in writing on either the Wiring Report
or on the Building Permit. PHONE 457-0411, EXT. 224. ri
~1 NO OCCUPANCY OR USE ESTABLISHED UNDER THIS PERMIT $ ;;J 0
Electrical Inspector Permit Fee
WH ITE - File by address
PINK - Top; Eng, Bottom, Customer
GREEN - Top: Meter Dept., Bottom: City Hall
OLYMPIC PRINTERS INC
~,., "J
CITY OF PORT ANGELES
LIGHT DEPARTMENT
ELECTRICAL PERMIT
N? 16439
c'P -;- p>
Port Angeles. Washlngton___....._______.___.............______.......__...__...___.___. 19_____:__
In accordance with the City Ordinance to regulate the installation, extension. or repair of elec-
trical equipment in, on. or about any building or other structure in the City of Port Angeles, per-
mission is hereby granted to dO electrical work as listed below.
Address __m___.___f!...Y.._____~;.___/?i::.~..,____.____________________.m___' Occupancy_______~!.L,2~:________._______________
Owner ___mJL-t.':!7j~_:..!Z/1..__'!:l~~~.____________. Tenant.___.______.__________..___...~.________________m__._m________._____.
Q , )" " li/ (X (ii
Wiring Contractor ___Y:h,:t:::?___?:-_~_~.~:._~____~!'!::.:_______________ By________________...______.________...____________________.____________
/ :J'J/ :::{/C-
Service, volts .................u.........~..........
3
No. wires ...m..m........m....C:...m....
C/, ~'r~ f
SIze wlres....:0m.m....:..............._..
~j::?d -4
Main fuse ..............................
,.--
Enclosure ..m..::?....m....................
Light Outlet"---____________________________________..
Receptacle Outletsm............................
Dryer, KW ___.nn..................................
Range, KW..............................
Water Heater:
KW------------,--.~:-.~"ij'/.--------'---i'j--
_ /3, ) ;/Ct.Y" Ifb
Heat. K W...........................................;.......
Motors: sIze, volts and phase:
Total Load.....m.....................
Type of wIring:
Entrance Cable ............
Rigid Conduit _________________
MetalUc Tubing ...........................
Current transformers:
No. & Size.......................................
Ser. No..............................................
Ser. No..............................................
Ser. No..............................................
Ser. No. .............................................
~
Type of Wiring:
Armored Cable ..............................
Non-Metallic .................._............._
Knob & Tube.....mm.m................._
Rigid Conduit _______________________________
MetalUc TubIng m..m...................
Raceway ......................._......_.__._
Circuits, Llght_______________________._______________
Utility _____________________________________________
I-J eat ......u..............................._......
Range .............................u..............
Water Heater ...............................
Motor ........................................__...
Dryer ........;.....................................__
Furnace .........................'_._.................
Total ...........__..........................
Remarks: __.uu__.u.______....._~'1..~..e__t:..._:.ood.;.:~.::'~_h..oo_..n_u_..oo_____.n.__n..noon.noo__n_u._oo_nn.....___..........unn._u.......
/' .~- -
-;~;::;~u;~~---------------.---.---------;~~~~.n;~~~;~~---n--n------mu.n-------nu---'jnn~~~;r.-0uu.nm.--:/7------------
$:...___.............mm__oou_____. NO......mm_.mn__.mm_ By __l;~~~:~...!.:il.-~:_:_'!~.:~..~::i:.:~::..~_d...
#' ~
NOTICE-Current must not be turned on until Certificate of Inspection has been issued. If work is to be con.
cealed due'~ot1ce must be given the Inspector so that work may be inspected before concealment.
NOTIFY THE INSPECTOR BY PERMIT NUMBER WHEN READY FOR INSPECTION
"
ELECTRICAL PERMIT
N?
16439
Address.................................................__.....................................................................................Date..._.........._.._.._.........,._...:'.._......_..._.....
Owner ......h..........................._......_.._......_......_.._........................................................... Tenant......n_....;:............h_.....h...h.....n...n..........n..
WiringContractor...........h......._._................._._.............__.........................................._..................By...................:.......................n....__..._._.....
'. NOTIC~urrent must not be turned on until Certificate of Inspection has been issued. If work Is to be con-
cealed due notice must be given the Inspector so that work may be Inspected before concealment.
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