HomeMy WebLinkAbout939 CAROLINE ST - Building (12) ELEMWAL PERMIT
CITY OF PORT ANGELES �' q
36,13-4�fi-4'135 �,
Application Number . . 19-00001656 Date 10/25/19
Application pin number 241.176 REPORT STATE SALES TAX
Property Address . . . . . 939 CAROLINE ST OR your @XC/S@ tax form
PARCEL NUMBER: ' 06-30-00-1-0-3325-0000-
Application type description ELECTRICAL ONLY t0 the City-Of Port AngeleS
Subdivision Name . . �LOCat%O►1 Code 0502)
Property Use . . . . . . .
Property Zoning . . . . . PUBLIC BUILDINGS & PARKS
Application valuation . . . . 0 _
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" Application desc
Triage Room
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Owner Contractor
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
Permit . . ELECTRICAL ALTER COMMERCIAL _-
Additional desc 1-4 CIRCUITS
Permit Fee 91.00 Plan Check Fee 00
Issue Date . . . . 10/25/19 Valuation . . . 0
Expiration Date 4/22/20
Qty Unit Charge Per Extension
BASE FEE 86.00
1.00 5.0000 ECH EL-ECH ADDNT BRANCH CIRCUIT 5.00
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Fee summary Charged Paid Credited Due
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Permit Fee`Total 91.00 91.00 .00 .00
Plan'Check Total '.00 .00 .00 .00
Grand Total 91.00 91.00 .00 .00
i
INSPECTION TYPE DATE: RESULTS: INSPECTOR:
DITCH
SERVICE
ROUGH-IN
FINAL ..
COMMENTS:
PERMIT WILL EXPIRE SIX(6)MONTHS FROM LAST INSPE0,10N
Signature of owner,tK Electrical Contractor X Date:
r
r` �a
.
MULTI-FAMILY / COMMERCIAL
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ELECTRICAL PERMIT APPLICATION
Public Works and Utilities Departnient
vet, Port Ang-eles, \k,"A 9U162
Project Address: 939 Caroline St Port Angeles, WA 98362
Project Description: Circuits for T Room # 2Alterations
[] Multi-Family Residential @] Commercial/Industrial/Public Building Square footage:
P.O. OWNER INFORMATION
Name: Olympic Medicial Center Email:
Mailing Address: 939 Caroline St Port Angeles,WA 98362 Phone: 360-417-7163
Name: Simpson Electric LLC License: SIMPSEL973RQ
Mailing Address:
Email: d1simpson 51@gmaii.com Phone: 360457-9270
italln Unit Charae Quantity IQ.W(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 601-1000 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 a
Each Addii Branch Circuit $5.00 * 5.00
Branch Circuits 14 �$86.00 1-4 $ 86.00
Temp. Service/Feeder 2UOAmp. $102.00 $
Temp. Service/Feeder 2O140OAmp. $121.00 ^�' $______�__
Temp. Service/Feeder 401-60OAmp. ~�^ 'r� $184.00 '� __�_ '�.� �
Temp. Service/Feeder Oo1-1000 Amp. $185.00
Portal toPortal Hour|y ~'00 ��^��� ��
�
Sign/Outline Lighting `� ' a= ~$8800 �= __��__
Signal Circuit/LEnergy-Multi-Family $88.00 $
SignalEnergy/First
'p���` ` �=
(Note: *5.O0 ~' ---'------ �
Renewable Elec. Energy: 5K}ASystem *113.00 *____--____
Thermostat(Note: $5 for each additional) �� . - � *____
. $56.00
- $ 91.00 TOTAL
Owner aodefined byRCVK19.28.281:(1)Owner will occupy the structure for two years after this electrical permit iofinalized.(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,TheCdyofPortAnge|eoMunicipo|Coge. andUU|itySpooifioadonoondRAIVIC14.O5.O5OregandingBocthoo|PnnndAppUcotiona.
11/23/2019 Andrew P Simpson
Doda Print Name Signotuno([] Owner F] Electrical Contractor/Administrator)
[Electrical Permit Applications may be submitted to City Hall or electricalpermits@cityofpa.us or faxed to 360.417.4711]