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36+0-417-4735 N
Application Number . . . 20-00000275 bate 2/26/20
Application pin number . 649050 REPORT STATE SAS TAX
Prc�eXty AddYess 939 CAROLINE ST
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ASSSS60R PARCEL NUMBER: 06-30.00-1-0-3325-0000-
Application type description ELECTRICAL ONLY to the Citylof Port Angeles
Subdivision Name (Location Cade tt302) i
Property Use . . : . . i
Property Zoning . PUBLIC BUILDINGS & PARKS
Application valuation 0
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Application deco - i
Extend circuits rooms 3 and 4
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Owner Contractor
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PUBLIC MSPITAL DISTRICT #2 SIMPSON ELECTRIC
939 CAROLINE` ST 243036sW HWY 101
PORT ANGELES WA 98362 PORT ANGELES WA 98363
(360) 417-7170 (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 21/26/20 valuation . 0
Expiration Date 4/24/20
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Qty Unit Charge Per. Extension
BASE FEE $6.00
Fee summary Charged Paid Credited Due
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Permit Fee Total 86.00 $6.00 .00 .00-
Plan Check Total .00 .00 .00 .00
Grand Total 86.00 86.00 .06 .00
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INSPECTION TYPE DATE RESULTS: - INSPECTOR
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DITCH
SERVICE I
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FINAL
;COMMENTS: ;
PERMIT WILL EXPIRE SIX(6)MONTHS FROM LAS'TINSPECTION
Signature of owner or Electrical Contractor X Date:
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MULTI-FAMILY / COMMERCIAL R
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ELECTRICAL PERMIT APPLICATION 2, --
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Project Address: 939 Caroline St. Port An eles. WA 98362
Project Description: 2- Outlets grf,-m 3 ° eX Qlr—o
❑ Multi-Famity Residential R) Commercial/Industrial/Public Building Square footage:
,777
OWN
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Name: OMC Email:
Mailing Address: 939 Caroline St Phone: 360-460-1284 (Rob)
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Name: Simpson Electric LLC License: SIMPSEL973RQ
Mailing Address: P.O. Box 1086 Port Angeles,WA 98362 Expiration Date: 12/11/21
Email: dlsimpson51@gmad.00m Phone: 360-457-9270
j� Unit Chase Quantity Tots#(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 $
ServicefFeeder 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— $ 85,00
Temp. Service/Feeder 200 Amp. $102.00 $
Temp. Service/Feeder 201-400Amp, $121.00 $
Temp,Service/Feeder 401-600Amp, $164.00 $
Temp. Service/Feeder 601-1000 Amp. $185.00 $
Portal to Portal Hourly $96.00 $
Sign/Outline Lighting $88.00 $
Signal CircuiVl-imited Energy-Multi-Family $88.00 $
Signal Circuit/Limited Energy/First 1500 sf-Commercial $9600 $
(Note:$5.00 for each additional 1500 sf)
Renewable Elec. Energy:5KVA System or less $113.00 $
Thermostat(Note:$5 for each additional) $56.00 $
$ W.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,WAG,Chapter 296-
46B,The City of Port Angeles Municipal Code,and Utility Specifications and PAMC 14.05.050 regarding Electrical Permit Applications.
2/25/202o Andrew P Simpson '4 to
Date Print Name Signature(❑ Owner;? electrical Contractor/Administrator)
[Electrical Permit Applications may be submitted to City Nall or electrinalpern-ute a@cityofpa.cis or faxed to 360.417.47111