HomeMy WebLinkAbout907 GEORGTANA ST - Building ELE&RWAL PERMIT
CPTY OP PORT ANGELES �.
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Appi cation Number . . . 19-00000453 Date 4/02/19
Appli*;ion pin number . 216837 REPORT STATE SALES TAX
l�roj�er*y Address 907 GEORGXANA ST
ASSESSOR PARCEL NUMBER: 06-30-00-5-8-0145-0000 on your excise,tax form
Application type description ELECTRICAL ONLY to the City of Port Angeles
Property Use . . . . . (LoCati'On Code 0502
Property Use 1 )
Property Zoning . . . COMMERCIAL OFFICE.
Application valuation 0
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Application desc`
Office space improvement:
Owner ContraCtor
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CLALLAM CO HOSPITAL DIST #2 SIMPSON ELECTRIC
939 CAROLINE ST 243036 W HWY 101
PORT ANGELES WA 983623909 PORT ANGELES WA 98363
(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 . . . 4/02/19 Valuation . . . 0
Expiration Date -9/29/19
Qty Unit Charge Per Extension
BASE
yy�� 86.00
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Fee summary Charged Paid Credited Due
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Permi Fee Total 86.00 86.00 00 00
Plan Check Total .00 ,00 00 .00
Grand Total 86.00 86.00 00 .00
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INSPECnON'i E DATE: RESULTS INSPECTOR
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FINAL
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COMMENTS:
PERMIT WILL EXPIRE SIX(6)MONMTHS FROM LAST 1HEPECII'ION
Signature of owner or Electrical.Cbmwtor X Date:
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ELECTRICAL PERMIT APPLICATIOWIR 17201y
I'LlbliC Nk"orks and Utilities ]department
- 321 E. 5th Street, Port Angeles, WA 98362 �
360.417.4735 1 v<- w.cityofpa.us I clectricalpermits(4)cityofpa.us
Project Address: 907 Georgiana St (Basement )
Project Description: Office Space improvements 4 Circuits
❑ Multi-Family Residential ❑ Commercial/Industrial/Public Building Square footage:
OWNER • r " •
Name: Olympic Medical Center Email:
Mailing Address: 939 Caroline St Phone: 360-460-1284
ELECTRICAL CONTRACTOR:INFORMATION
Name: Simpson Electric LLC License: SIMPSEL973RQ
Mailing Address: P.O.BOX 1086 PORT ANGELES,WA 98362 Expiration Date: 12/11/2019
Email: dlsimpson5l@gmaii.com Phone: 360-457-9270
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"PROJECT
re DETAILS
bm Unit Charge Quantity Totai(Quantity x Unit Charge)
Service/Feeder 200 Amp. $132.00 $
Service/Feeder 201400 Amp. $160.00 $
Service/Feeder 401-600 Amp. $225.00 $
Service/Feeder 601-1000 Amp. $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 1-4 $ 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 sfl
Renewable Elec. Energy: 5KVA System or less $113.00 $
Thermostat(Note: $5 for each additional) $56.00 $
$ 86.00 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.
3/25/2019 ANDREW P SIMPSON /0
Date Print Name Signature(❑ Owner ❑ Electrical Contractor/Administrator)
[Electrical Permit Applications may be submitted to City Hall or electricalpermits@cityofpa.us or faxed to 360.417.4711]
��,;�" ELECTRICAL INSPECTION
�� WIRING REPORT
�& 417-4735
DATE: PERMIT# INSPECTOR
X51
OWNER
CONTRACTOR
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ADDRESS
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APPROVED NOT APPROVED
❑ . . . . . . . . . . . . . . . . DITCH . . . . . . . . . . . . . . . . . . . . ❑
� aTJ)A-ROUGH IWCOVER . . . . . . . . . . . . . . . ❑
❑. . . . . . . . . . . . . . . . . . . . SERVICE . . . . . . . . . . . . . . . . . . . ❑
❑. . . . . . . . . . . . . . . . . . . . . FINAL . . . . . . . . . . . . . . . . . . . . ❑
CORRECTIONS NEEDED:
NOTIFY INSPECTOR WHEN CORRECTIONS
ARE COMPLETED WITHIN 15 DAYS
- DO NOT REMOVE--