HomeMy WebLinkAbout708 S Race St - Building ROUTING SLIP /~.,%
Certificate of Occupancy /~.~_~/
"~alllll~C e rtificate/I ns pectic n Fee
DATE .~'- ,3- 3 ~ ~) ~
New Business ............................
Address of Proposed Business Transfer of Business Location ................ '~'
7¢'~"A ~'~, ~a.¢,~ ,f~ Change of Ownership ......................
Applicant / ~ ~ $~ (~,~7~- j ,~ C New Building .............................
Address ,";r ~ y £ [~-~,~/, ,~ Remodel .................................
Temporary Business .......................
Phone: business Y'J' ~r ~ ~'~o home_F£'~-g4/~ Change of Use ............................
Brief descriDtion of proposed business: ¢~'~, s. e //.~, ~ f'; ¢
Legal Description: Lot .,..2. Block ~ ~, ~ . Subdivision
Current Use of Property: ,~,~,, ~"/'/~/'-¢
Zoning Classification of Property:
WILL THERE BE ANY OF THE FOLLOWING? YES NO THE FOLLOWING WILL BE REQUIRED:
Construction changes ........................... PERMITS BUSINESS LICENSE
Electrical changes ............................... 1) Building 1) Taxi
MechAnical (heating, cooling, stoves) 2) Plumbing 2) Peddlers
Plumbing changes ............................. X 3) Electrical 3) 2nd Hand Dealer
New or relocated signs .......................... ~'~ 4) Mechanical 4) Pawn Broker
New septic tanks ................................ 5} Sewer 5) Dance
New sewer service .............................. 6) Sidewalk installation 6) Hotel - Motel
charged patrons .................... 7) Driveway 7)
Admission
to
installation
Fireworks
Is this a home occupation? ....................... 8) Curb installation 8) Ambulance
Excavation of filling of lots ....................... 9) Sidewalk obstruction 9) Tattoo shop
Work done in City right-of-way .................... _ 10) Water meter installation 10) Other
Is there sufficient off-street parking? ............... ~1~ 11) Fire
New driveway openings ...... 12) Occupancy
A grading plan for site drainage.. 13) Sign
(parking lots, downspouts, etc.) ... 14) Shoreline
Are the existing streets paved? ................... ~' 15) Home occupation
Are there existing sidewalks?.. 16) Conditional use
Is there curb and gutter? ......................... 17) Other
I hereby apply for a Certificate of Occupancy and acknowl-
edge that I have read this application and state that the Date: ~'" ~ ~'~ ~
information I have supplied is correct to the best of my .,~
knowledge. Signed:
REJECTED / Conditions
. Building Section
Public Works Department
Planning Department
Fire Department
City Clerk
RB.I.A.
CERTIFICATE :CUPANCY
This Certification is~ued pursuant to the requirements of Section 109 of the
Uniform Building Code certt.,~ing that at the time, Of i,~.*~ance this xtructure was
in compliance with the various ordi~ances of thc ,ON regulating Building
Use Classification: Officc Clinic
o,oup: B CO
Owne~ofBusiness/eesidenc¢: ~acobson, DC ~ 93~E: Front; ~9~:~ngeles, WA 98363
nuildin~~ ~ An eles WA 98362
~ ~' . -~'~ .... '-~Au-ust I 2002
Post on the ~lcUous place.
Shall not be removed except by Building Official.
CITY OF PORT ANGELES
DEPARTMENT OF COMMUNITY DEVELOPMENT - BUILDiNG DIVISION
321 EAST 5TH STREET, PORT ANGELES, WA 98362
I;:3kllLgll~l[,~ P't"P(MI I ISSUED: 4/22/2002 PERMIT NO: 13373
OWNER/APPLICANT PROPERTY LOCATION
708 RACE S
LYNDA WlLLIAMSON
708 S. RACE STREET, SUITE #C Lot: SPACE #C
Pod Angeles, WA 98362 Block: [] Long Legal
360/000-0000 Subdivision: RACE OLYMPIC VIEW OFFICES
T: S: Parcel No: 063001720000320
CONTRACTOR ARCHITECT
ADVERTISING SALES 8, MORE N/A
1327 E. 1ST ST
Port Angeles, WA 98362 , 98360-0000
360/452-7785 360/000-0000
PROJECT INFO
Project Value: $600.00 SFD Units: 0 Commercial: 0
Project Type: SIGN/WALL SFD SQ FT: 0 Industrial: 0
Occupancy Type: Garage: 0
Occupancy Group: MFD Units: 0
Construction Type: MFD SQ FT: 0 V
Zoning Use:
PROJECT NOTES
INSTALL 21.75 SQ. FT WALL MOUNTED SIGN
REC EIPT;~S976
FEES ASSESSMENT
Building Permit: $0.00 Misc Fee 1: $0.00 (~,
Plan Check: $0.00 Misc Fee 2: $0.00 ?
State Surcharge: $0.00 Misc Fee 3: $0.00 ._.
House Moving: $0.00
Manufactured Home: $0.00 {/3
Sign: $30.00 TOTAL FEE: $30.00
Plumbing: $0.00 AMOUNT PAID: $30.00
Mechanical:
$o.o0
BALANCE DUE: $0.00
Radon: $0.00
Separate Permits are required for electricalwork, SEPA, Shoreline, ESA, utilities, private and public improvements. This permit becomes
null and void if work or construction authorized is not commenced within 180 days, if construction or work is suspended or abandoned
for a period of 180 days after the work as commenced, or if required inspections have not been requested within 180 days from the last
inspection. I hereby certi~ that I have read and examined this application and know the same to be true and correct. All provisions of
laws and ordinances governing this type of work will be complied with whether specified herein or not. The granting of a permit does not
presume to~q~,ze.-~t~,~,or',:y-te-~:~e or cancel the provisions of any state or local law regulating construction or the performance of
Ic°nstru~:~h'
Signature of Contractor or Authorized Agent Date Signature of Owner (if owner is builder) Date
T:\PLANNING\FORMS~ 1102.15 [4/2002 ]
BUILDING PERMIT INSPECTION RECORD "
CALL 417-4815 FOR BUILD1NG INSPECTIONS. PLEASE PROVIDE A MINIMUM 24 HOUR NOTICE. ITIS UNLAWFUL TO COVER,
INSULATE OR CONCEAL ANY WORK BEFORE INSPECTED AND ACCEPTED. POST PERMIT IN A CONSPICUOUS LOCATION.
KEEP PERMIT CARD AND APPROVED PLANS AT .lOB SITE
INSPECTION TYPE DATE ACCEPTED COMMENTS
YES I NO
FOUNDATION:
FOOTINGS
WALLS
FOUNDATION DRAINAGE
ELECTRICAL (LIGHT DEPT) SEPARATE PERMIT: #
PLUMBING
UNDER FLOOR / SLAB
ROUGH-IN
WATER LINE
GAS LINE
BACK FLOW / WATER
AIR SEAL
WALLS
CEILING
FRAMING
JOISTS / GIRDERS
SHEAR WALL
WALLS / ROOF / CEILING
DRYWALL
T-BAR
INSULATION
SLAB
WALL / FLOOR / CEILING
MECHANICAL
HEAT PUMP
WOOD STOVE / PELLET / CHIMNEY
HOOD/ DUCTS
PWUTILITIES/ SITEWORK (EngineeringDivis~on) SEPARATE PERMIT #'s:
WATERLINE / METER
SEWER CONNECTION
SANITARY
STOKM
PLANNING DEPT. SEPARATE PERIvlIT #'$ SEPA:
PARKING/LIGHTING ESA:
LANDSCAPING SHORELINE:
FINAL INSPECTIONS REQUIRED PRIOR TO OCCUPANCY/USE
RESIDENTIAL DATE YES NO COMMERCIAL DATE ACCEPTED
YES NO
ELECTRICAL - LIGHT DEPT. 417-4735 ELECTRICAL
LIGHT DEPT
CONSTRUCTION R..W. / PW/ CONSTRUCTION - R.W.
ENGINEERING 417-4807 PW / ENGINEERING
FIRE 417-4653 FIRE DEPT.
PLANNING DEPT. 417-4750 PLANNING DEPT.
BUILDING 417-4815. ~' ~//t3g~l~ ~--t~ BUILDING
T:~P L ANN ING\FORJViS\ 1102.15 [4/2002]
I FOR OFFICIAL USE ONLY:
BUILDING PERMIT - APPLICATION P~it~:~
Dam Approved:
Date Issued:
The Building Permit Application must be filled out completely.
Please type or print in ink. If you have any questions, please call 417-4815
-~ ~ Phone: ~ ~-
Applicant or Agent: ~ % ~ c ....
Owner: ~ ~ ~ ~ ~ ~. ~x~:~ Phone:
Address: ~O ~ ~., ~e City: ~.>o~ ~ c ~, Zip:
~chitecffEngineer: ~ %~ ~' kG:o ~ Phone:
Contractor ~ License g: O~ ~,~ Exp: Phone:
Address: City: Zip:
PROJECT~D~SS: ~O~ ~k ~ ~c,~ Q ZONING:
LEGAL DESC~PTION: Lot: Block: Subdivision:
CL~L~ CO~TY P~CEL NUMBER: Credit Card Holder Name:
Billing Address: City:.
Credit Card ~: Exp. Date: ~SA MC
TYPE OF WO~: SIZEW~UATION:
D Residential ~ NewCom~. ~ Re-roof ~ Wood-stove ~ i .~ SF. ~ $ /SF. =$
~ Multi-fa~ly ~ Addition ~ Move ~ Garage SF. ~ $ /SF. = $
~ Co~ercial ~ Remodel ~ Demolition ~ Deck SF. ~ $ /SF. = g
~ Repair ~ Sign ~ TOTAL VALUATION $ ~
B~EF DESC~PTION OF THE PROJECT: o~ ~ ~ ~ ~ ~ ~ ~ c~' o
~,~ C>.~,~ ~"~ X%.~~
COMMERCI~SIDENTIAL: Occupancy Group: Occupant Load: ~ Cons~ction T~e:
No. of Stories: ~ Lot S~e: % Lot Coverage: %
Existing Lot Coverage: /sq. ff. + Proposed Lot Coverage: /sq. ff. = TOTAL LOT COVE~GE:
PL~NINGUSE ONLY~ · ,A~ APPROVES:
ESMW~tland(s): ~ Y~s ~ No SEPA Checklist required? ~ Y~s ~ No Other: OTHER
BUILDING PE~IT ~PLICATIO~ S~MITT~: EourappHcationandsiteplanmustbe~lledoutcompletelytobeaecepted~or
re~ie~. ~e Building Division can provid~ you ~vith mom d~tailed inFo~ation on the application and plan sub~ttal requirements. Your
completed application, sit~ plan (tot additions) and building cons~ction plans ar~ to b~ subdued to th~ Building Division.
V~UATION OF CONSTRUCTION: In all c~ses, ~ wluation amount must be entered by the applicant. ~is figure will be revi~v~d
and ~y b~ r~vised by th~ Building Division to comply with cu~ent t~ schedules. Contact th~ P~t Coordinator at 417-4815 for assistance.
PL~ CHECK FEE: Yo~ plan check t~e is du~ at &~ time ~e building p~t application and cons~ction plans ar~ sub~d. All other
'p~t t~es am due at ~ t~e otp~t issuance.
EXPIATION OF PL~ ~V1EW: If no p~t is issued within 180 days ot~ date o~application, this application will expire.
Bulldog Official can ~xt~nd ~e tim~ for action by ~ applicant up to 180 d~ys upon ~i~en mqu~st by ~e applicant (s~e S~ction 107.4 ot
~ Unifo~ Building Cod~, cu~nt ~dition). No application can b~ ~xtended mor~ than once.
I hereby cert~ that I have read and examined this application and know the same to be true and correct, and [ am authorized to applyfor
this permit. I understand it is not the Ci~'s legal responsibility to determine what permits are required; it remains the applicant's
responsibili~ to determine whatpermits are required and to obtain such. ~
Applicant:~~~ Dat~: ~. k~,
T:~O ~ S~PPS~B~ildin~e~it
CITY OF PORT ANGELES
DEPARTMENT OF PUBLIC WORKS
........... INSPECTION REPORT ...........
RE T: · ~"~, ~. ~
Date ~ ~ '~ Time Received by ' .(phone, person)
Location of Work to be inspected ~ ~-~ ~, /
Name of person requesting inspection
Address of person requesting inspection Phone No.
Type of Inspection (circle appropriate one): ~- ~ Permit No.
Sewer Foundation Framing Chimney Plumbing' Final -Sewer Excav. Other
INSPECTIONNO~E~:, .~'~ . , .,
Inspected: Date '~ .Time By
Remarks:
RESTORATION REQUIRED ...... YES. NO
SURFACE RESTORATION:
SURFACE TYPE: [] Unimproved []Gravel []Asphalt [~PCC [~Other
[] Repaired by City Work Order #
~.~---~ {--] Repaired by Permittee [] COMPLETE
[]No Damage Found [] INCOMPLETE
(Continue on reverse side if necessary) STREET SUPERINTENDENT (DATE)
......
Instnlled By:
CITY OF PORT ANGELES
LIGHT DEPARTMENT
PERMIT NO.
~
.;2{.O ?
y~oAO
,
.
ELECTRICAL PERMIT
DATE
Site Address:
o READY FOR
INSPECTION
License Number:
o L CALL FOR
INSPECTION
Phone:
Owner/Business:
Phone:
Owner/Business Address:
Sq. Ft.
C Residential
Heat KW
C Baseboard 0 Furnace/Boiler
o Heatpump 0 Other
o Commercial/Industrial load
Total Connected load
(attach breakdown)
Total Motor load
(attach breakdown)
o New Construction
o Remodel
o Service update/alter/repair
o Overhead
o Underground
Voltage
01121 03.0
Service size
o Temporary
o Add/alter circuits
o Auxiliary power
(list below)
f(Special equipment
(list below)
Amps
Details/Description:
turd
K-~
~~I
.
W.S. No. Service
Capacity: 0 O.K. 0 Not O.K.
o Ditch inspection O.K.
o Rough-in/cover O.K.
o O.K. to connect service
,/t)P\ 1fJ Final O.K.
Size
Comments
Date
Hold for: 0 Easement 0 Letter
o Signed up for service/meter
o Meter Department notified for installation
o Fire Department notified of inspection
o Plan Review approved/pending
Site Address:
Installer:
~
Permit/Receipt No.
cQ,bIJf
()
,
New Meters
.
Notify the Department 01 City Light by Street Address and Permit Number when ready 1 r inspection. Work
must not be covered or electrically energized before inspection and O.K. for covering or service has been given
by the Inspector in Writing on the Wiring Report or the Building Permit. PHONE 457.0411, EXT. 158 or EXT. 224.
~~ NO OCCUPANCY OR USE ESTABLISHED UNDER THIS PERMIT ~o ~
.# Inspector Amount paid
WHITE - file by address YELLOW - file by number PINK - Top: Eng, Bottom: Customer GREEN - Top: Inspector, Bottom: City Hall
OLY~I"IC PRINTERS. INC.
....
CITY OF PORT ANGELES
LIGHT DEPARTMENT
N~
17754
ELECTRICAL PERMIT
/" - ,) E""\
Port Angeles, Washlngton..__..m..mmm_.._.......mmm..mm__.mm.... 19..!..~
In accordance with the City Ordinance to regulate the installation, extension. or repair of elec-
trical equipment in, on. or about any building or other structure in the City of Port Angeles. per-
::: "JJ:,:~:~~if;:;::'~_~:'=:::::::_~:~_:=
Owner 000- 000.000 . "-''''j;~ ~ r.1A <:v c:-.
Wiring Contractor ~LC..~.~.m.m:t:--..-------m By..________m.m__m...........____.__.__.....n..m............m
LIght Outlet....................:..........._.._..... ServIce, VOlts/.p.-;jL?..t:.~......._. Typ. of WIring:
Receptacle Outlets............................... NS'IO. Wlrles .---;./d~..~-y.-..- ::_:::al~~bl.~..~~~~::::~:::::::::~~::::::::~
Dryer, KW nnuu.___.........__......___h__.._._. ze W resu_...Z.._~....._..._:........._..
MaIn fu.e ?;-f.:.."..t.'.A..........
S-
Enclosure ..._...00.._....__.....................
Knob & Tube.mm___.....m___..........._
Range, KW _.......____....._______._..___.._...__...
VVater Ileater~
c9;A- KW .n.c?.-~krz--... -
dJA'" Heat' KW."/.'~T"'-:0..........
Motors: ~ze'/fJlts~nd phase:
dlA'" ..-d.g~r''-VJ.....
~ft,"."'-7;f;:;""'"
,r,~:::::::::::::::::f..~:::::
RIgid Conduit ............m._._.___........
Metalllc TubIng m_._.___._m._....._.._.
Type of wIrIng:
Entrance Cable ..............mm....u...
Raceway ..............................._......_
RigId ConduIt m_mm_._._.
MetalUc TubIng .........
CIrcuIts. Llght.._.__..._......____....._.............
Utillty .._......._..............._...m_....._m._
Heat ..._..........._.._........._._........_.._.
Current transformers:
Ser. No....._...__..._................................
Range ._____.___...................................
Water Heater m.m......___...............
Motor ..._........h......................_...~...
No. & Size..........._...........................
Ser. No. ..............................._...._...._...
Dryer...._.____.......____......._________.............
Furnace _.._.....................'___......_.___..._..
Ser. No.........._......................_
Total ~~_._:..._......... Ser. NO.................._..........___m__.....__ Total ...m___m...........................
~:=~.~~~~--~::Z!::=:~:=:::~::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::
.~~~;~n;~~....n..mmnmm.nm.;~~~~.__~~~~;~~n.m___._____.m.m__m..m'Jf;P~1~2:--
$______..mm..___.m.._____m____. NO.__m______.....m..m.... By ..___:_______...__.000___000......000__000.____.._000.000.__.....000__
NOTICE-Current must not be turned on until CertifIcate of Inspection has been issued. It work Is to be con.
cealed due notice mU8t be gIven the Inspector so that work may be Inspected before concealment.
NOTIFY THE INSPECTOR BY PERMIT NUMBER WHEN READY FOR INSPECTION
N~ 1 77 5 4
ELECTRICAL PERMIT
Address........_________.................____._._..._....._.........___.._..__.............._._.___._.................-.----...................Date..._......_.._.__.._.................._......____......
Owner ....-.............................._.........._.....____...._.._...........__.........._................._...........00.... Tenantu................._..uu_........._..............._..__..uuu...
r
\
,
\"
V.rIring Contractor...._......_............._._._..........._..._____................................_...____......__...._......_.._......___ By ....._____....................._..._................._...___..
NOTICE-Current must not be turned on until Cert1flcate of Inspection has been Issued. It work 18 to be con.
cealed due notice must be given the Inspector so that work may be inspected before concealment.
1M Olympic Printers, Inc.
JPE, LLC 360- 975 -3314 p.1
RElCITY OF PORT ANGELES PERMIT APPLICATION t V
Building Division/Electrical Inspections
321 East Fifth Street — P.O. ]Box 11501 Port Angeles Washington, 98362 MAR 2 ® 2011
Ph: (360) 497 -4735 Fax: (360) 417 -4711 ELECTRICAL �
Date: ��g �� Z Multi-Family or Commercial* INSPECTIONS
* Plan Review May Be Required, Please Complete Electrical Plan Review Information Sheet
Job Address: i 0, is . 2 �: la,
Building Square Footage;
Description of above _ _lam r 14 eL - (' rr I-
'
Owner Information Contractor information
Name: Zy�da ,4 (11 Name: JP45)LL-i.
u
Mailing Address: G,P`C S'. e:-o 6 4- Mailing Address;
3 . ._ _ . ,,. �l wciZ 9 _
City: ;Or,f— State. ji Zip: 31. "L city: Se : `
StatB Zip:
Phone: 'fta-P�Fax; `t.12 -Z �-W` Phone:. L,: -7 31 i5i � Fax: Sf - 5175 3� /
Licensa�IExp. License #!> xp.
- J k i S
Item Unit Charge Qty
Total (Oty Multiplied by Unit Charge)
ServicelFeeder 200 Amp. $132.00
$
ServicelFeeder 201400 Amp. $ 160A0
$
SerricelFeeder 401.600 Amp $ 225,00
$
ServicelFeeder 601-1ODD Amp. $ 288.00
$
ServicelFeeder over 1000 Amp, $ 410.00
$
Branch Circuit WI Service Feeder $ 5.00
$
Branch Circuit 00 Service Feeder $ 74,00
$
Each Additional Branch Circuit $ 5,00
$
Branch Circuits 1.4 $ 86.00 r
$_
Temp. Serkal Feeder 200 Amp, $102.00
$
Temp. SerAcelFeeder 201400 Amp. $121.00
$
Temp. ServicelFeeder 401500 Amp. $164.00
$
Temp. Ser AcelFeeder 601 -1000 Amp . $185.00
$
Portal to Portal Hourly $ 96.00
$
5lgnl0u%ne Lighting $ 88.00
$
Signal Circuit! Limited Energy- MuNkFamily $ 64.00
$
Signal Circuit! Limited Energy/ First 1500 sf- Cemmercial $ 96.00
$
Note: $5.00 for each additional 1500 sf
Renewable Electrical (Energy - 5KVA System or Less $113.00
$
Thermostat $ 56.00
$
Note: $5.00 for each additional T -Stat
$ (C•�f) Total
Owner as defined by RCW.1 8.28.261: (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 thal I am the owner of the above named property or
a licensed electrical contractor. I am making
It1e electrical installation or alteration in compliance wifh the electrical laws, N.E.C., RCW. Chapter 19.28, WAC. Chapter 296 -468, The City of Port
Angeles Municipal Code, and utility Specifications and PAMC 14.05.050 regarding Electrical Permit Applications.
Signature of owner, electrical contractor or electrical administrator: ❑ Cash IJ
cheek
<CrealtCard#
45"V"- �—'IG _
f
Dated: J I �f l _ _
01N114a92
r
ELECTRICAL PERMIT
CITY OF PORT ANGELES
360- 417 -4735
Application Number . . . . 14- 00000347 Date 3/21/14
Application pin number 688063
Property Address 708 S RACE ST A
ASSESSOR PARCEL NUMBER; Q6-30-01-7-2-0000-3100-
Application type description ELECTRICAL ONLY
Subdivision Name . , . , . .
Property Use
Property Zoning . , . , , , . UNKNOWN
Application valuation , . , , D
Application dose
Hot water tank
Owner
Contractor
RESULTS:
STRAIT EXERCISE AND
WELLNESS C
JPE ( JERRY PETERSON 7
708 S RACE ST A -S
73 EAST LOMA VISTA RD
PORT ANGELES
WA 98362
SEQUIM WA
98382
------- -------
(360) 731 -8994 y
------- --- - - - - -- -° -
"✓
--------------------------
Permit , , . . . .
ELECTRICAL ALTER
COMMERCIAL
Additional desc
1 -4 CIRCUITS
COMMENTS:
Permit Pee
66,00
Plan Check Fee
00
Issue Date
3/21/14
valuation
0
Expiration Date
9/17/14
Qty Unit Charge
Per
Extension
BASE
VRE
86.00
- --- ---- --- -- -------- ---
Fee oummary
-- --- - -- -
Charged
-
Paid ,Credited Due
--
Permit Fee Total
86,00
86,.00 .00
.00
Plan Check Total
.00
.00 'Co
,00
Grand Total
86,00
86.00 'Co
.0o
REPORT SALES TAX
on your excise tax form
to the City of Port Angeles
(Location Code 0502)
INSPECTION TYPE
DATE:
RESULTS:
INSPECTOR:
DITCH
SERVICE
ROUGH -TN
l
FINAL
COMMENTS:
PERMIT WILL EXPIRE SIX (6) MONTHS FROM LAST INSPECTION
Signature of owner or Electrical Contractor X Date:
G:TXCHANGEISUILDING
C7'
JPE, LLC 360 -975 -3314 p.1
REcEIVE4
CITY OF PORT ANGELES PERMIT APPLICATION S 2 2014 ��`•
Building IDiVnion/Electrical InWetions ELECTRICAL �
INSPECTIONS
321 East Fifth 5tre�et — P.O. Boa 1150 /Fort ales Was oa, 93 ELECTRICAL
Ph: (364) 417 -4735 Fax: (3611) 4174711
Date: — i � _ f & 2 Single Family Dwelling
" Plan Review M Be Required, Please Complete Electrical Plan Review Information Sheet
dob Address;
Budding Square Footage:
DeacipWn of above
Owner Irh ma 'on Contractor Information
N me: l Name: J99. LL4-
Maiirrg,Address: 7r �A-^ eC_2 ._V'-.U4- Ma1bVAddn�s_ '7 e'xrF+�
City: Yu, Srate t.JA Zip. %�" — State: U
cry: ��
Phmw ` - ,7r,' Fax Pltate �'; 7` Fax
License 9 f F.vp License #! &rp. ir�eYa* !!j
era Uri# Chm Total M Multi fied by Unit Cha as
Semice&eder 200 Amp. $120.00 $
ServicelF'eedar 2014OO Amp. $146.00 $
ServiceiFeeder 4014M Amp $ 205,00 $
Servio Feeder 601-IOM Amp. $ 2&200 $
ServiceFeeder over 1000 Amp. $ 373.00 S
Branch Cirmrit W1 Service Feeder $ 5.00 $
Branch Circuit WIG Service Feeder $ 63.00 $
Each Additional Branch Ucuh $ 5.00 $
Branch Circuits 14 S 75.00 5—C —U
Temp. Senticel Feeder 200 Amp. S 93,00 $
Temp. ServicdFeedar 201400 Ante. $110.00 $
Temp. ServioelFeeder 401 -600 Amp, $149.00 S
Temp, ServicafFeeder BD1 -1000 Amp. $168.00 $
Portal to Portal Hourly $ 96.00 $
Signal ClrcuiV Limited Energy -1 & 2 Family Dwelling $ 64.00 $
ManufaAred ttome Connection $120.00 $.
Renew" Electrical Energy - 5KVA System or Less $102.00 $
Themmstat $ 56.00 $
Note: $5.00 for each additional TSt+at
NEW CONSTRUCTION ONLY:
Fast 1300 Square Ft $12D,OD $
Each Additional 500 Square Ft. or Portion of $ 40,0D $
Each Outbuilding or Detached Garage $ 74,M $
Each Swimming Pool or Hot Tub $110,00 $
' 75. arc) Total
Owner as defined by RCW.19.28.261: (1) Owrrer will occupy the stn ucttue for two years after this electrical permit is frrWized. (2) Owner is required
to hire an electrical contractor 4 above said property is for sale, rent or lease. Permit expires after six months of last inspection.
After reading the above siatament, l hereby Gratify that I am the owner of the above named property or a licensed electrical contractor. I am making
the electrical'rn"atkm or alteration in awnplianoe with the electrical laws, N.E.C., RCW. Chapter 19.28, WAC. Chapter 29646B, The City of Part
Angeles Muni ipal Code, and utility Specifications and PAMC 14.05.050 regarding Electrical Permit Applications_
Vgnature of owner, electrical conlracior or electrical ada dnistratnr: ❑ rasa ❑ check
cr&ranra
41161rE042
ELECTRICAL PERMIT
CITY OF PORT ANGELES
360-417-4735
Application Number . . , , , 1.4- 00000159 Date 2/12/14
Application pin number , . , 034673
Property Address , . , . . , 708 S RACE ST B
ASSESSOR PARCEL NUMBER: D6-30-D1-7-2- 0000 -3100-
Application type description ELECTRICAL ONLY
Subdivision Name
property Use
Property Zoning . , , , . . . UNKNOWN
Application valuation . , , , 0
Application desc
1 -4 circuits
Owner Contractor
JACOBSON LEE /CHRISTINE JPE ( JERRY PETERSON )
3822 CANYON EDGE DR 73 EAST LOMA VISTA RD
PORT ANGELES WA 98362 SEQUIM WA 98382
(360) 731 -8994
Permit , . , , ELECTRICAL ALTER COMMERCIAL
Additional desc 1 -4 CIRCUITS
Permit Fee 86.00 Plan Check Fee 00
Issue Date 2/12/14 Valuation . , , . 0
Expiration Date 6/11/14
Qty Unit Charge Per Extension
BASE FEE 86.00
Fee summary Charged 'Paid Credited Due
Permit Fee Total. 86.00 86,00 00 00
Plan Check Total ,00 00 ,00 00
Cxand Total 86.00 86.00 ,00 a0
REPORT SALES TAX
on your excise tax form
to the City of Port Angeles
(Location Code 0502)
INSPECTION TYPE
DATE:
RESULTS:
1NSPECTOR:
DITCH
SERVICE
ROUGH -IN
va ot
FINAL
COMMENTS:
PERMIT WILL EXPaE SIX (6) MONTHS FROM LAST INSPECTION
Signature of owner or Electrical Contractor X Date
Q%EXCHANGRBUILDING
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