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HomeMy WebLinkAbout525 W 4th St - BuildingApplication Number Application pin number Property Address ASSESSOR PARCEL NUMBER Application type description Subdivision Name Property Use Property Zoning Application valuation Owner ERIN SHIELD /BRIAN PHILLIPS 731 W 8th St PORT ANGELES Permit Additional desc Permit pin number 71860 Permit Fee 50 00 Issue Date 3/03/06 Expiration Date 8/30/06 Permit Additional desc Permit pin number Permit Fee Issue Date Expiration Date T• \Policies\ 1102.15R 1/05] WA 98363 RIGHT OF WAY 71878 40 00 3/03/06 8/30/06 Qty Unit Charge Per 1 00 40 0000 EA SAN SEW REPAIR Fee summary CITY OF PORT ANGELES PUBLIC WORKS UTILITIES DIVISION 321 EAST 5TH STREET PORT ANGELES, WA 98362 06 00000204 502856 525 W 4TH ST 06 -30 00 0 0 7460 0000 PUBLIC WORKS UTILITES RS7 RESDNTL SINGLE FAMILY 0 Qty Unit Charge Per 1 00 50 0000 ECH RIGHT OF WAY PERMIT SANITARY SEWER HOOK UP Contractor C &J EXCAVATING PO BOX 430 CARLSBORG (360) 683 7741 Plan Check Fee Valuation Plan Check Fee Valuation Charged Paid Credited Permit Fee Total 90 00 90 00 00 Plan Check Total 00 00 00 Grand Total 90 00 90 00 00 Date 3/03/06 WA 98324 0 0 0 Extension 50 00 00 0 Extension 40 00 Due 00 00 00 Separate Permits are required for electrical work, 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 certify 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 give authority to violate or cancel the provisions of any state or local law regulating construction or the performance of construction. Signature of Contractor or Authorized Agent Date Signature of Owner (if owner is builder) Date i CALL 417 -4807 FOR UTILITY INSPECTIONS. PLEASE PROVIDE A MINIMUM 24 HOUR NOTICE. IT IS 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 JOB SITE INSPECTION TYPE DATE ACCEPTED COMMENTS PW UTILITIES (Engineering Division) WATERLINE METER SEWER CONNECTION SANITARY STORM SITE DRAINAGE SITE EROSION CONTROL PARKING SIDEWALK CURB GUTTER DRIVEWAY APPROACH BACK -FLOW DEVICE T•\Policies \1102.15R [1 /05] RESIDENTIAL CONSTRUCTION R.W PW/ ENGINEERING 417 -4807 FIRE 417 -4653 PLANNING DEPT 417 -4750 I BUILDING 417 -4815 PERMIT INSPECTION RECORD YES 1 NO FINAL INSPECTIONS REQUIRED PRIOR TO OCCUPANCY /USE DATE YES NO COMMERCIAL DATE ACCEPTED YES 1 NO I I I I I I I I CONSTRUCTION R.W PW ENGINEERING I FIRE DEPT I PLANNING DEPT BUILDING I I I I I I I I I PREPARED 9/29/05 13 14 03 INSPECTION TICKET PAGE 1 CITY OF PORT ANGELES INSPECTOR JAMES L LIERLY DATE 9/29/05 ADDRESS 525 W 4TH ST SUBDIV CONTRACTOR FERRELLGAS LP PHONE (360) 683 9029 OWNER CARDINAL BRANDON PHONE (360) 670 1552 PARCEL 06 30 00 0 0 7460 0000 APPL NUMBER 04 00000025 MECHANICAL APPL PERMIT PERMIT ME 00 MECHANICAL PERMIT REQUESTED INSP DESCRIPTION TYP /SQ COMPLETED RESULT RESULTS /COMMENTS ME6 01 1/14/04 JLL MECHANICAL GAS LINE 1/14/04 DA BRANDON CALL AHEAD FOR HIM TO MEET YOU THERE 670 1552 301bs reqd test /jim ME6 02 2/25/04 RV MECHANICAL GAS LINE 2/25/04 AP BRANDON 670 1552 30 psi ME99 01 9/29/05 MECHANICAL FINAL 09/29/2005 09 22 AM DYASUMUR 09/29/2005 09 36 AM PBARTHOL COMMENTS AND NOTES Application Number Application pin number Property Address ASSESSOR PARCEL NUMBER Application type description Subdivision Name Property Use Property Zoning Application valuation Owner CARDINAL BRANDON 525 W 4TH ST PORT ANGELES (360) 670 1552 Permit Additional desc Permit pin number Permit Fee Issue Date Expiration Date Qty Unit Charge Per Fee summary Permit Fee Total Plan Check Total Grand Total CITY OF PORT ANGELES DEPARTMENT OF COMMUNITY DEVELOPMENT BUILDING DIVISION 321 EAST 5TH STREET PORT ANGELES, WA 98362 WA 983622221 MECHANICAL PERMIT RENEW PERMIT 1/2 FEE 61374 28 83 9/29/05 3/28/06 Charged 28 83 00 28 83 04 00000025 800100 525 W 4TH ST 06 30 00 -0 0 7460 0000 MECHANICAL APPL PERMIT RS7 RESDNTL SINGLE FAMILY 340 BASE FEE T \Policies \1102_15 building permit inspection record05.wpd [1/412005) Contractor FERRELLGAS LP ONE LIBERTY PLAZA LIBERTY (360) 683 9029 Plan Check Fee Valuation Paid Credited 28 83 00 00 00 28 83 00 Date 9/29/05 MO 64068 Due 00 0 Extension 28 83 00 00 00 Separate Permits are required for electrical work, 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 certify 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 give authority to violate or cancel the provisions of any state or local law regulating construction or the performance of construction. Signature of Contractor or Authorized Agent Date Signature of Owner (if owner is builder) Date CALL 417 -4815 FOR BUILDING INSPECTIONS CALL 417 -4735 FOR ELECTRICAL INSPECTIONS. 0 CALL 417 -4807 FOR PUBLIC WORKS UTILITIES PLEASE PROVIDE A MINIMUM 24 HOUR NOTICE. IT IS UNLAWFUL TO COVER, INSULATE OR CONCEAL ANY WORK BEFORE INSPECTED AND ACCEPTED. POST PERMIT IN A CONSPICUOUS LOCATION f KEEP PERMIT CARD AND APPROVED PLANS AT JOB SITE. 1 INSPECTION TYPE DATE ACCEPTED COMMENTS C YES I NO FOUNDATION: FOOTINGS WALLS FOUNDATION DRAINAGE DOWN SPOUTS PIERS POST HOLES (POLE BLDGS.) PLUMBING UNDER FLOOR SLAB ROUGH -IN WATER LINE (METER TO BLDG) GAS LINE BACK FLOW WATER AIR SEAL WALLS CEILING FRAMING JOISTS GIRDERS SHEAR WALL/HOLD DOWNS WALLS ROOF CEILING DRYWALL (INTERIOR BRACED PANEL ONLY) T -BAR INSULATION SLAB WALL FLOOR CEILING MECHANICAL HEAT PUMP FURNACE DUCTS GAS LINE WOOD STOVE PELLET CHIMNEY COMMERCIAL HOOD DUCTS MANUFACTURED HOMES FOOTING SLAB BLOCKING HOLD DOWNS SKIRTING PLANNING DEPT SEPARATE PERMIT #'s PARKING/LIGHTING LANDSCAPING RESIDENTIAL ELECTRICAL LIGHT DEPT 417 -4735 CONSTRUCTION R.W PW/ ENGINEERING 417 -4807 FIRE 417 -4653 PLANNING DEPT 417 -4750 I BUILDING PERMIT INSPECTION RECORD BUILDING 417 -4815 I q— g.cf:,2,5'I V T- \Policies \1102_15 building permit inspection record05.wpd [1/4/2005] SEPA. ESA. SHORELINE. FINAL INSPECTIONS REQUIRED PRIOR TO OCCUPANCY/USE DATE YES NO COMMERCIAL DATE ACCEPTED YES I NO ELECTRICAL LIGHT DEPT CONSTRUCTION R.W PW ENGINEERING I FIRE DEPT I PLANNING DEPT 1 BUILDING 41/4 S 7 PREPARED 2/25/04 12 24 56 INSPECTION TICKET PAGE 3 CITY OF PORT ANGELES INSPECTOR ROGER VESS DATE 2/25/04 ADDRESS 525 W 4TH ST SUBDIV CONTRACTOR FERRELLGAS LP PHONE (360) 683 9029 OWNER CARDINAL BRANDON PHONE (360) 670 1552 PARCEL 06 30 00 0 0 7460 0000 APPL NUMBER 04 00000025 MECHANICAL APPL PERMIT PERMIT ME 00 MECHANICAL PERMIT REQUESTED INSP DESCRIPTION TYP /SO COMPLETED RESULT RESULTS /COMMENTS ME6 01 1/14/04 JLL MECHANICAL GAS LINE 1/14/04 DA BRANDON CALL AHEAD FOR HIM TO MEET YOU THERE 670 1552 301bs reqd test /jim ME6 02 2/25/04 MECHANICAL GAS LINE „c BRANDON 670 1552 COMMENTS AND NOTES PREPARED 1/14/04 12 26 54 INSPECTION TICKET PAGE 5 CITY OF PORT ANGELES INSPECTOR JAMES L LIERLY DATE 1/14/04 ADDRESS 525 W 4TH ST SUBDIV CONTRACTOR FERRELLGAS LP PHONE (360) 683 9029 OWNER CARDINAL BRANDON PHONE (360) 670 1552 PARCEL 06 30 00 0 0 7460 0000 APPL NUMBER 04 00000025 MECHANICAL APPL PERMIT PERMIT ME 00 MECHANICAL PERMIT REQUESTED INSP DESCRIPTION TYP /SQ COMPLETED RESULT RESULTS /COMMENTS ME6 01 1/14/04 JLL MECHANICAL GAS LINE BRANDON CALL AHEAD FOR HIM TO MEET YOU THERE 670 1552 COMMENTS AND NOTES go l“ is 0 Application Number Property Address ASSESSOR PARCEL NUMBER Application description Subdivision Name Property Use Property Zoning Application valuation CITY OF PORT ANGELES DEPARTMENT OF COMMUNITY DEVELOPMENT BUILDING DIVISION 321 EAST 5T1-1 STREET PORT ANGELES, WA 98362 04 00000025 525 W 4TH ST 06 30 00 0 0 -7460 0000 MECHANICAL APPL PERMIT RS7 RESDNTL SINGLE FAMILY 340 Date 1/13/04 Owner Contractor CARDINAL BRANDON FERRELLGAS LP 525 W 4TH ST ONE LIBERTY PLAZA PORT ANGELES WA 983622221 LIBERTY MO 64068 (360) 670 1552 (360) 683 9029 Permit MECHANICAL PERMIT Additional desc COOK STOVE LINES TANK Permit Fee 57 65 Plan Check Fee 00 Issue Date 1/13/04 Valuation 0 Expiration Date 7/11/04 Qty Unit Charge Per BASE FEE 1 00 10 6500 ECH ME -GAS PIPE 1 TO 5 Fee summary Charged Paid Credited Due Permit Fee Total 57 65 57 65 00 00 Plan Check Total 00 00 00 00 Grand Total 57 65 57 65 00 00 6 Extension 47 00 10 65 Separate Permits are required for electrical work, 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 certify 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 give authority to violate or cancel the provisions of any state or local law regulating construction or the performance of construc n. /1 /v /0g Signature of Contractor or Author Agent Date Signature of Owner (if owner is builder) Date T\PLANNING\FORMS \1102.15 11/14/2003] FOUNDATION: FOOTINGS I I I WALLS I 1 I FOUNDATION DRAINAGE /DOWN SPOUTS I I I ELECTRICAL (LIGHT DEPT) SEPARATE PERMIT ROUGH -IN I I I PLUMBING UNDERFLOOR /SLAB I I I ROUGH -IN I I WATER LINE (METER TO BLDG) I I I I GAS LINE 1 I BACK FLOW WATER I I I AIR SEAL WALLS I I I CEILING I I I FRAMING JOISTS GIRDERS I I SHEAR WALL/HOLD DOWNS I I WALLS ROOF CEILING I I DRYWALL (INTERIOR BRACED PANEL ONLY) 1 I T -BAR I I INSULATION SLAB I 1 I WALL FLOOR CEILING I 1 1 MECHANICAL HEAT PUMP I I I GAS LINE I I /N 04 1 RV I WOOD STOVE PELLET CHIMNEY I I I HOOD/ DUCTS I I I PW UTILITIES SITE WORK (Engineering Division) SEPARATE PERMIT #'s: WATERLINE METER SEWER CONNECTION SANITARY STORM PLANNING DEPT SEPARATE PERMIT #'s PARKING/LIGHTING LANDSCAPING RESIDENTIAL ELECTRICAL LIGHT DEPT T \PLANNING\FORMS \1102.15 11/14/20031 BUILDING PERMIT INSPECTION RECORD 1 I 1 1 I 1 1 I I I 1 1 1 1 I SEPA. ESA. SHORELINE. CALL 417 -4815 FOR BUILDING INSPECTIONS. CALL 417 -4735 FOR ELECTRICAL INSPECTIONS. PLEASE PROVIDE A MINIMUM 24 HOUR NOTICE. IT IS 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 JOB SITE. INSPECTION TYPE DATE ACCEPTED COMMENTS YES 1 NO FINAL INSPECTIONS REQUIRED PRIOR TO OCCUPANCY /USE DATE YES NO COMMERCIAL DATE ACCEPTED YES 1 NO 417 -4735 ELECTRICAL LIGHT DEPT CONSTRUCTION R.W PW/ CONSTRUCTION R.W ENGINEERING 417 -4807 PW ENGINEERING FIRE 417 -4653 I I I FIRE DEPT PLANNING DEPT 417 -475 :0 11 rv_ C1--- 1 1 PLANNING DEPT BUILDING 417 -4815 (9 I\ R L 1 1 BUILDING 1 CITY OF PORT ANGELES LIGHT DEPARTMENT ELECTRICAL PERMIT N? 15458 Port Angeles, Wash1ngtonnn&::::nl.,5_.~m::::nm__._m__m_nn_...n, 19..2.J- 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- mission is hereby granted to do electrical work as listed below. Address ns:..;).,,__s.m_njAJ.:.n--'::l~.nnm_nnnn._mmmn OccupancYn__nnn.m_~mm.__. Owner mmmf:l.L.C__,__I~nn Tenant___..h_nnhn_.nm_.n.___._m_m__..nnmmnnm___m___._n Wiring Contractor -~--..-E.~.~ By_n_...._._.__n.~;~~.~;.~::~:~--nnn..m-n...nmn-- Light Outlets_______n_________________________________ Service, volts J___________________?n'::!..O . R t I 0 tl t N' I ..3 Armored Cable m.mmm................. eeep ae e u e Sm._m...........n...m.m O. w res .........m.....mnhnn_.nn._.n Size Wlresn"fY.n:nU4-n!!f Main fuse n_;;:A,cr.()___:I.1_______ Dryer, KWjn.._n_........n..nnnnnn.nnnn. Non-Metallic ......m...m.............nn. Knob & Tube......m.............n......n.. Range, KW n..nnn__n___nn Rigid Conduit nm....nm_mmn...n... Water Heater: Enclosure h.d.............n..............nn. Type of wiring: Entrance Cable 00....._......__......_...... Metallic Tubing nnnmmnnm........ Heat~:;-_::_1~:;::-_::i:~;;:__:- Race\vay .........0000...0000.00................._ Rigid Conduit ................ Circuits. Light.. Motors: size, volts and phase: Utility mm....n......................n.....:m Metallic Tubing ....m......m........... Current transformers: No. & Slze...........d.......................... Heat Range ........................nn....nnnnnn_ 'Vater Heater ...mn....................m Ser. NO._..............n.._n.n.._................. lI,Iotor ______........__............................ Ser. NO..n_nn..nn._.._nnnn.._____..nn._.... Dryer...n......nn....n.......n............n.._._ Furnace _.mm....m..m...n_.... Ser. NO..............n.......n........n.........__ Total Load..m...m..............n.. Ser. NO.....n...nnn...n..nn........_.......... Total .unn..nnnn...nn...nn._....n Remarks: __nm.~d.d..~.nn~__Y.::9.nmAnm_m_.._nn~.,nn...nn;/~.mn~=~m5=_n~.0! nn Mn'i1n'nm.m/~.,.~m.mnmnmmmm_mnn.mnmm_hmnmnnm___mmmm__m.nnmm.mnm__.nnmnm Permit Fee $m.m.__n.___mmmmnmm__ Treas. Receipt NO.nm._.m.nmm.m.m By _n._m__{dJ.~m__n_____mmn_.__m NOTICE-Current must not be turned on until Certificate of Inspection has been issued. It work is to be con. cealed due notice must be given the Inspector so that work may be inspected before concealment. NOTIFY THE INSPECTOR BY PERMIT NUMBER WHEN READY FOR INSPECTION :z tI--d ;I ~ ~. .{,f, (?J9 ELECTRICAL PERMIT NC: 15458 Date call~or ~~tlonfAi.______'fnkgnn___.....n....n_.nn_..._nn__nnn.......nnhn...._......i~LC=n7.~_~.n.. prellminar;;'ispectl&;;' dlrtes.L.~.___nn...__...n.nn..n...nnh____n...nn.nn nn. Inspection coonPleted_~i.::?::.::.._.........n..(:~h:______n_...n.h__._n::.n...:::::::::::::::::::::::~:::::?;(:z::;;~: Total Load .........n.nunnn..u.nn.nn.._n.nnn__.nn...nnnnnn.....n.un.._.n.. ....u. ..nnunnn.....u.................n............nnn.__..n................._.........._......_ 1M 3.72 Olympic Printers, Inc. ) ( I. 1 ii a , fti '�a 1Y ,U e, s p 6, � i9 W�k- CITY OF Po T ANGELES PERMCT APPLICATION DEC Building Division /Electrical Inspections FXTRICAL 321 East Fifth Street -- P-0- BOX 1150 /Port Angeles Wnshin.gton, .98362 MPFC ON Ph: (360) 417-4735 Fax: (360) 417«4711 Date: --LA `- A -Z-,/— , & 2 Single homily Dwelling *'Plan ROVIOW Ma Be Required, Please Cora fete Electrical Dian view lnf ®rmatiQn sheet J4bAddress: .� � . aull ij Square Fcralage, O�cr�iion t7f shrove Bordner inforrrrat on a-~ Name: iitaifingAddress: Phone: Irp tJcaense�1 fax; Mat SetWMJFeeder 2WAmp. McelF r#er209.440 Amp, 8er'0kefFeeder 401 -800 Amp +I eerier 601 -100(1 Amp, SWIc+elFeederover 9000 Amp, Branch Circuit W/ Sen("ice Feeder Branch Circuit W/O Service Feeder 80 Addifionat Branch Circuit Branch Circuits 1.4 Temp Service/ Feeder 200 Amp. Temp. $MICS/Feeder201404Amp, Temp. ServicalFeeder401 -600 Amp. Temp. 8eruiralF00der 601 -9000 Amp, Po" to partal Dourly 600 CdreufU Limited Energy -1 & 2 Family Dwelling ManufaMred Home Conneclfon Rr newa9le Electrical Energy - 6KVA Systern or Less Thermostat Note; $5.00 fcreach additlorral T.Stat I�NSTRUC'i r]N wL °v, Firs# 1306 Square Ft. ch Additional 540 Square Ft, or portion of Each Outbuilding or Detached Garage Emb Slimming Pool car Hot Tub Eig $ I20.00 $146.00 $ 208.00 $ 262.00 $ 373.00 $ 6.00 $ 63,00 $ 5.00 $ 75.00 $ 93.00 $ 110,00 $ 949.00 $169.00 $ quo $ 64.00 $ 920.00 $ 102.00 $ 56.00 $1.20.00 $ 40.00 $ 74.00 $ 910.00 A P[]kl',��Fe Crs »tractor Information y Name: 45X4 'Ie Mailing Address: , / City 'r . Sataxf' e : er�5 rn 2i p i ELECTRICAL PERMIT CITY OF PORT ANGELES 360- 417 -4735 Application Number . . . , . 14- 00001462 Date 12 /05/14 Application pin number . . . 417510 RESULTS: Property Address . , . . , . 525 W 4TH ST DITCH ASSESSOR PARCEL NUMBUR; 06-30-00-0-0- 7460 -0000- Application type description ELECTRICAL ONLY Subdivision Name . , , , . . Property Use . , , . , . , . Property Zoning . . , , RS7 RESDNTL SINGLE FAMILY ROUGH -IN Application valuation . , , , 0 I Application desc Ductless heat pump Owner Contractor BRIAN PHILIPS /ERIN SHIELD EXTRA MILE TECH & ELECT,, LLC 525 W 4TH ST 418 N. RACE ST, PORT ANGELES WA 983622221 PORT ANGELES WA 98362 (360) 457 -5222 Permit . . , ELECTRICAL ALTER RkSIDENTIAL Additional desc . . Permit Fee 68.00 Plan Checic Fee 00 Issue Date . . . . 12/05/14 Valuation , , , , 0 Expiration Date . , 6/03/15 Qty Unit Charge Per Extension 1.00 5.0000 ECH 'EL -ECH ADDNT BRANCH CIRCUIT 5.00 1,00 63.0000 ECH EL -R- BRANCH CIR W01 SER FEED 63,00 Fee summary Charged. Paid Credited Due Permit Fee Total 68.00 68,00 00 .00 Plan Check Total .00 .00 .00 .00 Grand Total 68.00 68.00 .00 DO REPORT SALES TAX on your excise tax form to the City of Port Angeles (Location Come 0502) INSPECTIONTYPE DATE: RESULTS: INSPECTOR: DITCH SERVICE ROUGH -IN I FINAL ( L COMMENTS: PERMIT WILL EXPIRE SIX (6) MONTHS FROM LAST INSPECTION Signature of owner or Electrical Contractor X Date: G:IEXCHANGEIBUILDING t 11 ELECTRICAL PERMIT CITY OF PORT ANGELES - 360-417-4735 Application Number . . . . 15-00001394 Date 11/03/15 Application pin number 955318 Property Address . . . . . . 525 W 4TH ST ASSESSOR PARCEL NUMBER: 06-30-00-0-0- 7460 -0000- Application type description ELECTRICAL ONLY Subdivision Name . . . . . Property Use . . . . . . . Property Zoning . . . . RS7 RESDNTL SINGLE FAMILY Application valuation . . . 0 Application desc 2nd floor multipurpose room Owner Contractor BRIAN PHILIPS/ERIN SHIELD OWNER 525 W 4TH ST PORT ANGELES WA 983622221 Permit . . . . . . ELECTRICAL ALTER RESIDENTIAL Additional desc Permit Fee . . . . 68.00 Plan Check Fee 100 Issue Date . I . . 11/03/15 Valuation 0 Expiration Date . . 5/01/16 Qty Unit Charge Per Extension 1100 5.0000 ECH 'EL-ECH ADDNT BRANCH CIRCUIT 5.00 1.00 63.0000 ECH EL-R- BRANCH CIR WO/ SER FEED '63.00 Fee summary Charged Paid Credited Due Permit Fee Total 68.00 68.00 100 '00 Plan Check Total ;00 .00 ;00 ,QQ Grand Total 68.00 68.00 100 100 RESULTS: k REPORT SALES TAX on your excise tax form orm to the City of Port Angeles (Location Code 0502) INSPECTOR: Signature of owner or Electrical Contractor X Date: GAEXCHANGEMILDING CITY OF PORT ANGELES PERMIT APPLICATION Building Division /Electrical Inspections 321 East Fifth Street — P.O. Box 1150 / Port Angeles Washington, 98362 Ph: (360) 417 -4735 Fax: (360) 417 -4711 Date: /I- � f & 2 Single Family Dwelling 4 * Plan Review May Be,Le uired, Please orrAete Electrical Plan Review Information Sheet Job Address: � > 22 Building Square Footage- Description of above Owner Infor Contractor Information rlon Name: Name: Mailing Address: Mailing Address: City: State, Zbp: City: _ State: Zip: Phone°, 00— 22 C'?_ Fax;, Phone:.. ..,,, ,,,,,__- —Fax:, License # / Exp., License # / Exp.. Item Unit Charge ty Total MY Muffi lied by Unit. Charge) Service /Feeder 200 Amp. $120.00 $ Service /Feeder 201 -400 Amp. $146.00 $ Service /Feeder 401 -600 Amp $ 205.00 Service /Feeder 601 -1000 Amp. $ 262.00 $ Service /Feeder over 1000 Amp. $ 373.00 ----- Branch Circuit W/ Service Feeder $ 5. $ Branch Circuit B 635 �'� $ Each Additional rra Branch Circuit d � Branch Circuits 1-4 $ 75.00 7 Temp. Service/ Feeder 200 Amp. $ 93.00 $ Temp. Service /Feeder 201400 Amp. $110.00 $ Temp. Service /Feeder 401 -600 Amp. $149.00 Temp. Service /Feeder 601 -1000 Amp . $168.00 .................. ............................... $ Portal to Portal Hourly $ 96.00 $ Signal Circuit/ Limited Energy -1 & 2 Family Dwelling $ 64.00 Manufactured Home Connection $120.00 Renewable Electrical Energy - 5KVA System or Less $102.00 $,wawa Thermostat $ 56.00 $, Note: $5.00 for each additional T -Stat NEW CONSTRUCTION ONLY: First 1300 Square Ft. $120.00 $, Each Additional 500 Square Ft. or Portion of $ 40.00 $. .... Each Outbuilding or Detached Garage $ 74.00 , $ .......,,�, Each Swimming Pool or Hot Tub $110.00 $ 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 -4613, 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 ❑ Check re it Card # mmmmIT 0110112012 X ..� .. �� ,Dated: !,� _..�„ ...