HomeMy WebLinkAbout1116 E LAURIDSEN BLVD - Building (2) EL � AL PERMIT
C ANGELES 1
-Application Number . . . . 19-00000793 Date 5/29/19
Application pin number 659769 REPORT STATE SALES TAX
Property Address . . . . . . 111,6.E>LMWIDSEN BLVD OU/"excise tax form
PARCEL NUMBER: 06-30-11-5-1-0200"-0000— Q/]y
Application type description ELECTRICAL ONLY to the City of Port Angeles
Subdivision Name . .
Property Use . . . . . . (Loc ftn Code 0502)
Property Zoning . . . . .
Application valuation . . . . 0
---- -----------
Application desc
Load bank
-----------------------------------------------------------------------------
Owner Contractor
---------------------- - ------------ .
FIR LANE TERRACE CONVL CTR#259 PACIFIC POWER GROTJP
ATTN: TAX DEPT 85" SR"DWAY STREET #700
WILWAUXEE WI 53203 VANCOUVER, WA 9$660
(253) 395-9077
Permit . . . . . ELECTRICALALTER-COMMERCIAL
Additional desc .
Permit Fee . . 102.00' Pian Check. Fee .00
Issue Date . . . . 5/29/19 Valuation 0
Expiration Date 11/25/19
Qty Unit Charge Per Extension
1.00 102.0000 ECH EL- COMM 0-200 TEMP-SRV" /.FDR 102.00
Fee summary Charged Paid Credited Due
Permit PeeTotal102.00 102.00 .00 .00.
Plan Check Total. .00 .00 00 .00
Grand To` 102.00 102.00 .00 .00
•
INSPECTION TYPE DATE: RESULTS: INSPECTOR:
DITCH
SERVICE
ROUGH-IN
FINAL 4-71
COMMENT'S:
PERMfr WILL.EXPIRE SIX(6)MONTHS.FROM LASTMSPBC`t•ION
Signature of owner or Electrical Contractor X Date:
i
{
i
i
MULTI-FAMILY / COMMERCIAL
ELECTRICAL PERMIT APPLICATION,:_
Public Nkbrks and Utilities Department
321 F. 5th Street, Port Angeles. %V',A 98362
360.417.4735 1 wNvw.citvofpa.LIS I electricalpermitsL�.citvofpa.us �
Project Address: 1116 E. LAURIDSEN BLVD, Port Angeles, wa 98362
Project Description: Performing 4 hour load bank test of emergency standby Generators. - 1904033
❑ Multi-Family Residential 0 Commercial/Industrial/Public Building Square footage:
OWNER INFORMATION
Name: CRESTWOOD HEALTH AND REHAB Email:
Mailing Address: 1116 E. LAURIDSEN BLVD, Port Angeles,WA 98362 Phone: 253-395-9077
ELECTRICAL CONTRACTOR INFORMATION
Name: Pacific Power Group License: PACIFPG867D7
Mailing Address: 805 Broadway St,#700 Expiration Date: 03/28/20
Email: Service-Admin-Kent-Pgen@PacificPowerGroup.com Phone: 253-395-9077
PROJECT DETAILS
112M Unit Charge Quantity Isla(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 $
Temp. Service/Feeder 200 Amp. $102.00 �_ , $ 102
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 sl)
Renewable Elec. Energy: 5KVA System or less $113.00 $
Thermostat(Note: $5 for each additional) $56.00 $
$ 102 TOTAL
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-
466,The City of Port Angeles Municipal Code, and Utility Specifications and PAMC 14.05.050 regarding Electrical Permit Applications.
05/23/2019 Darrell Vardeman
Date Print Name Signature(❑ Owner V Electrical Contractor/Administrator)
[Electrical Permit Applications may be submitted to City Hall or electricalpermits@cityofpa.us or faxed to 360.417.4711]