HomeMy WebLinkAbout939 CAROLINE ST - Building (5) i
ELECM.CAL PERMIT
CITY DF PORT ANGELES �
360417=4735
lot
Application Number 18-00001916 Date 12/20/18
Application pin number 184748 REPORT STATE SALES TAX
Property Address . . . 939 CAROLINE ST onour excise tax form
ASSESSOR PARCEL NUMBER: 06-30-00-1-0-3325-0000- y
Application type description ELECTRICAL ONLY t0 the City of Pout Angeles
Subdivision Name .. . . . . .
Property Use . . . (Location Code 0502)
Property Zoning . . . . . . . PUBLIC BUILDINGS & PARRS
Application valuation . . . . 0
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Application desc
Door openers
Owner Contractor
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PUBLIC HOSPITAL DISTRICT,#2 SIMPSON ELECTRIC
939 CAROLINE ST 243036 W HWY 101
PORT ANGELES WA 98362 PORT ANGELES WA 98363
(360) 417-7170 (360) 457-9270
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Permit . . ELECTRICAL ALTER COMMERCIAL
Additional desc 1-4 CIRCUITS
Permit Fee 86.00 Plan Check Fee .00
Issue Date . . . . 12/20/18 Valuation 0
Expiration Date 6/16/19
Qty Unit Charge Per Extension
BASE FEE 86.00
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Fee summary Charged Paid Credited Due
-------- --- ----------
Permit Fee Total 86.00. 86.00 .00 .00
Plan Check Total .00 ..00 .00 .00
Grand Total 86.00 86.00 .,00 .00
PE TION TYPE DATE: RESULTS: INSPECTOR:
DITCH
SERVICE
ROUGH-IN j
FINAL
COh04ENTS:
PERMIT WILL EXPIRE SIX(6)MONTHS PROM LAST 1NSPECfION
Signature of owner or Electrical'Contractor X Date:
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MULTI-FAMILY / COMMERCIAL
ELECTRICAL PERMIT APPLICATION
I Ublic Works and Utilities Department
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321 F. 5th Street, PortAngeles, WA,98362.
360.417.4735 1 ,vww.cityofpa.us i electricalpermits('�cit}ofpa.us F�7i �
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Project Address: 939 Caroline St Port Angeles, WA 98362 OMC
Project Description: Power to Door Openers 1 st Floor Men & Womens Restrooms
❑ Multi-Family Residential 0 Commercial/Industrial/Public Building Square footage:
• INFORMATION
Name: Olympic Medical Center Email:
Mailing Address: 939 Caroline St Port Angeles, WA 98362 Phone: 360-452-5228
ELECTRICAL CONTRACTOR INFORMATION
Name: Simpson Electric LLC License: SIMPSEL973RQ
Mailing Address: 243036 Highway 101 W Expiration Date: 12/11/2019
Email: dlsimpson5l@gmaii.com Phone: 360-457-9270
1tsiID Unit Charge Quantity Tota1(Quantity x Unit Charge)
Service/Feeder 200 Amp. $132.00 $
Service/Feeder 201-400 Amp. $160.00 $
Service/Feeder 401-600 Amp. $225.00 $
Service/Feeder 601-1000Amp. $288.00 $
Service/Feeder over 1000 Amp. $410.00 $
Branch Circuit W/Service Feeder $5.00 $
Branch Circuit W/O Service Feeder $74.00 $
Each Additional Branch Circuit $5.00 $
Branch Circuits 1-4 $86.00. x $ 86.00
Temp. Service/Feeder 200 Amp. $102.00 $
Temp. Service/Feeder 201-400 Amp. $121.00 $
Temp. Service/Feeder 401-600 Amp. $164.00 $
Temp. Service/Feeder 601-1000 Amp. $185.00 $
Portal to Portal Hourly $96.00 $
Sign/Outline Lighting $88.00 $
Signal Circuit/Limited Energy-Multi-Family $88.00 $
Signal Circuit/Limited Energy/First 1500 sf-Commercial $96.00 $
(Note: $5.00 for each additional 1500 so
Renewable Elec. Energy: 5KVA System or less $113.00 $
Thermostat(Note: $5 for each additional) $56.00 $
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$ 86.00 TOTAL
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Owner as defined by RCW.19.28.261:(1)Owner will occupy the structure for two years after this electrical permit 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 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.
Simpson
P Andrew 12-18-2018 i
0 e S
Date Print Name Signature(E] Owner;? Electrical Contractor/Administrator)
[Electrical Permit Applications maybe submitted to City Hall or electricalpermits@cityofpa.us or faxed to 360.417.4711]