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ELECTRICAL PERMIT
CTI'Y OF PORT ANGELES
360-417-4735 W
cl
Application Number . . . . . 20-00001130 DaRE&OR)26TATE SALES TAX
Application pin number . . . 235650 on your eXClSe tax form
Address . . . . . 939 CAROLINE ST ASSESSOR PARCEL NUMBER: 06-30-00-1-0-3325-0000- to the City of Port Angeles
Application type description ELECTRICAL ONLY (Location Code 0502)
Subdivision Name
Property Use . . . . . . . .
Property Zoning . . . . . . . PUBLIC BUILDINGS & PARKS
Application valuation . . . . 0
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Application desc
Access Control
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Owner Contractor
PUBLIC HOSPITAL DISTRICT #2 SAFARI ELECTRIC LLC
939 CAROLINE ST 6536 KITSAP WAY
PORT ANGELES WA 98362 BREMERTON WA 98312
(360) 417-7170 (360) 813-3505
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Permit: . . . . ELECTRICAL ALTER COMMERCIAL
Additional desc . . 1-4 CIRCUITS
Permit Fee . . . . 182.00 Plan Check Fee .00
Issue Date . . . . 10/02/20 valuation . . . 0
Expiration Date 3/31/21
Qty Unit Charge Per Extension
BASE FEE 86.00
1.00 96.0000 ECH EL-LIMITED 1ST 1500 SQ FT 96.00
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Fee summary Charged Paid Credited Due
-Permit Fee Total 182.00 182.00 .00 _ .00
Plan Check Total .00 .00 .00 .00
Grand Total 182.00 182.00 .00 .00
INSPECTION TYPE DATE: RESULTS: INSPECTOR:
DITCH
SERVICE
ROUGH-IN
FINAL 0,
COMMENTS:
PERMIT WILL EXPIRE SIX(6)MONTHS FROM LAST INSPECTION
Signature of Owner or Electrical Contractor X Date:
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MULTI-FAMILY / COMMERCIAL
ELECTRICAL PERMIT APPLICATION
Public Works and Utilities Department
321 E. 5th Street, Port Angeles, NA'A 98362
360.417.4735 1 wNvw.cityofpa.us ; electricalperinits�i).citvofpa.us
Project Address: Annex Building, Olympic Medical Center, 939 Caroline St, Port Angeles,WA 98362
Project Description: Access Control Installation and Wiring
❑ Multi-Family Residential R) Commercial/Industrial/Public Building Square footage: 1500
OWNER INFORMATION
Name: Olympic Medical Center Email:
Mailing Address: 939 Caroline St,Port Angeles,WA 98362 Phone: 360417-7000
ELECTRICAL CONTRACTOR INFORMATION
Name: Safari Electric LLC License: EC SAFAREL882MC
Mailing Address: 6536►bap way, Bremerton,WA 98312 Expiration Date: 7/10/2022
Email: lay.maltry@safarielectdc.com Phone: 360-813-3505
PROJECT DETAILS
1kin Unit Charge Quantity Total(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' $8600 1 $ 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/Feeder601-1000Amp. $185.00 $
Portal to Portal Hourly $96.00 $
Sign/Outline Lighting $88.00 $
Signal Circuit/Limited Energy-Mufti-Family $88.00 $
Signal Circuit/Limited Energy/First 1500 sf-Commercial $96.00 1 $ 96.00
(Note: $5.00 for each additional 1500 so
Renewable Elec. Energy: 5KVA System or less $113.00 $
Thermostat(Note: $5 for each additional) $56,00 $
$ 182.00 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-
46B,The City of Port Angeles Municipal Code, and Utility Specifications and PAMC 14.05.050 regarding Electrical Permit Applications.
'01g.1, Mom,EMaltry Jr
9/30/2020 Jay E Maltry Jr Jay E Maltry Jr D&WTo NN=-oE�M ,kctrk om OSea Een 1
Date Print Name Signature(❑ Owner V Electrical Contractor/Administrator)
[Electrical Permit Applications may be submitted to City Hall or electrical permits@cityofpa.us or faxed to 360.417.4711]