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360-417-4736
Application Number ' . . 19-00001211 Date 8/14/19
Application pin number697768 j REPORT STATE SALESTAX'
Property Address our excise tax form
AC
ASSESSOR PARED NUMBER: R6-3 PST
6-30-00-Or0-0000-0000- On y
Application t p ONLY to the City Of Port Angeles
pp type description ELECTRICAL
Subdivision Name . . . . , .
Property use . . (Location Code 0302)
Property Zoning . . UNKNOWN
Application valuation O
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Application desc
GENERATOR LOAD BANK
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Owner Contractor
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CITY
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CITY OF PORT ANGELES LEGACY TELECOMMUNICATIONS INC
PO BOX 1150 PO BOX 360
PORT ANGELES WA 983626217 BU�LSY WA 98322
(243) 858-0214
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Permit
- - - -------
Permit . . . . . ELECTRICAL ALTER COMMERCIAL
Additional desc GENERATOR LOAD BANK
Permit Fee . . . . 102.00lan Check -Fee 00
}
Issue Date 8/14/19 Valuation 0
2/10/20
iration
Exp Date
Qty Unit Charge Per E9ctension
1.00 102.0000 BCH' EL- COMM 0-2�0 TEMP SRV / FDR 102.00
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Fee
------------- ---------Fee summary. Charged Paid
--� Credited - _Due_--
----------------- ----- --- -- r ---
Permit Fee Total 102:00' 102'.01 '.00 .00
Plan Check Total .00 .00 00 :DO ,
Grand Total 102.00,' 102.01 :00 .00
INSPEC HON TYPE TE: RESULTS: INSPECTOR
DITCH
SERVICE
ROUGH-IN
FINALTF
j
COMIUIE'NTS'
PERMIT wm L tmm 51X(6)MONTHS FROM LAST INSPECTION
Signature of owner or Electrical Contractor X Date:
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MULTI-FAMILY / COMMERCIAL M
ELECTRICALPERMIT AP'LICATIOI
Public Warks and Utilities:Department RECF/V FG
321 E. 5th Street,PortAngeles,WA 98362 7 t
360.417.4735 www.cityofpa,us(electricalpermits@cityofpa.u. �01 f
Project Address: PS#14 1100 P St Port Angeles, WA 98363 �1
Project Description: Load bank 1 generator for Annual Maintenance
0 Multi-Family Residential El Commercial/Industrial/Public Building Square footage:
Name: City of.Port Angeles Email bcobum vofaa.us
Mailing Address: PO'Box 1150 Port Angeles,WA 98362-02#7 Phone: 360-565-3860
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Name: Legacy Telecommunications License: LEGACTL821 LL
Mailing Address: PO Box 360 Burley,WA 98322 Expiration Date:
Email: rhenry@legacypower.com Phone: 253-858-0214
Item Unit Ehacae QUentlity TgW(Quantity x Unit Charge) j
Service/Feeder 200 Amp. $132.00 $
Service/Feeder 201-400 Amp. $160.00 $
Service/Feeder 401-600 Amp. $225.00 $
ServicelFeeder 601-1000 Amp. $288.00 $
Service/Feeder over 1000 Amp. $410.00 $
Branch Circuit W1 Service Feeder $5.00 $
Branch Circuit W/O Service Feeder $74.00 $
Each Additional Branch Circuit $5.00 $
Branch Circuits 1-4 $8.6.00 $
Temp.Service/Feeder 200 Amp. $102.00 1— $ 102.OQ
Temp,Service/Feeder 201-400 Amp. $121.00 $
Temp.Service/Feeder 401-600 Amp. $164.00 $
Temp.Service/Feeder 601-1000 Amp. $165.00 $
Portal to Portal Hourly $96.00 $
Sign/Outline Lighting $88.00 $
Signal Circuit/Limited Energy-Multi-Family MAO $:
Signal CircuittUrnited Energy/first 1500 sf-Commercial . $96.00, $
(Note:$5.00 for each additional 1500 so
Renewable Elec.Energy:SKVA System or less $113.00 $
Thermostat(Note:$5 for each additional) $56.00 $
$ 102.00 TOTAL_
Owner as defined by RCW.19.28261:(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.l
am making the electrical installation or alteration in compliance with the electrical laws,N.E.C.,RCW.Chapter 19.28,WAC.Chapter 296- `I
46B,The City of Port Angeles Municipal Code,and Utility Specifications and PAMC 14.05.050 regarding Electrical Permit Applications.
8/8/19 Rich Henn
Date Print Nat'e Signature(0 Owner Electrical Contractor/Administrator)
(Electrical Permit Applications may be submitted to City Hall or epermits@cityofpa.us or faxed to 360.417.4711]
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