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Home My WebLink About1005 Georgiana St - Building Owner of Business/Residence: ___J. _..--,,~._.,'.J"'" Use Classification: B --~ ~:~~'" :~t: ,Post' On t . ShaH..riot be re . ".. ous place. "",.. -,\!!!. :.. ... . lMg~J;;:ept,l',by'BLilldi ~g' Official. ,.~. W A 98362 '."':'.' CITY OF PORT ANGELES PUBLIC WORKS - ELECTRICAL DIVISION t21 EAST STH STREET, PORT AN(iEI,ES. WA 99362 ELECTRICAL PERMIT ISSUED: 7/25/2001 PERMIT NO 7347 OWNER/APPLICANT PROPERTY LOCATION OLYMPIC MEDICAL CENTER 1005 GEORGIANA E 939 CAROLINE STREET Lot: 49-51 Port Angeles, WA 98362 Block: [] Long Legal 360/417-7000 Subdivision: PERKINS T: S: Parcel No: 063000580220000 CONTRACTOR ARCHITECT ANGELES ELECTRIC N/A 524 E. 1ST ST. PORT ANGELES, WA 98362-0000 , 98360-0000 360/452-9264 360/000-0000 PROJECT INFO Project Type: COML.REMODEL Project Value: $0.00 Occupancy Type: Construction Type: ALTER SERVICE ~:~ Occupancy Group: Zoning Use: CO O, Electrical Heat: ~ [] Baseboard 0 KW [] Riser [] Underground Service [] Furnace 0 KW [] Overhead Service Voltage: 120,240 ['~ [] Heat Pump 0 KW [] TempService Phase: [] 1 [] 3 [] Fan Wall 0 KW Service Size: 200 ~, Feeder Size: 0 ~ PROJECT NOTES -~ change ucc. to doctor office. 200 a. panel, alter circuits and feeder C~' FEES ASSESSMENT Service: $74.30 Additional Feeders: $0.00 Circuit Wiring: $0.00 Temp Service: $0.00 · Misc Fee: $0.00 TOTAL FEE: $74.30 AMOUNT PAID: $74.30 BALANCE DUE $0.00 COMMt:N] S/ACTION NEEDED ELECTRICAL PERMIT INSPECTION RECORD CALL 417-4735 FOR ELECTRICAL I~SPECTIONS. PLF~,SE PROVIDE A MINIMUM 24 HOUR NOTICE. ITIS UNLA W'FUL TO COI~R, INSULATE OR CONCEAL ANY WORK BEFORE IT IS INSPECTED AND ACCEPTED. KEEP PERMIT CARD AND APPROVED PLANS AT JOB SITE DITCH ROU .-rN / COVER SERVICE FINAL GENERAL COMMENTS: CITY OF PORT ANGELES PUBLIC WORKS - BUILDING DIVISION 321 EAST 5TH STREET, PORT ANGELES, WA 98362 BUILDING PERMIT ISSUED: 12/14/2001 PERMIT NO: 13142 OWNER/APPLICANT PROPERTY LOCATION OLYMPIC MEDICAL CENTER 1005 GEORGIANA E 939 CAROLINE STREET Lot: 49 - 51 Port Angeles, WA 98362 Block: [] Long Legal 360/417-7000 Subdivision: PERKINS T: S: Parcel No: 063000580220000 CONTRACTOR ARCHITECT OWNER N/A VARIOUS Port Angeles, WA 99360 , 98360-0000 206/000-0000 360/000-0000 PROJECT INFO Project Value: $250.00 SFD Units: 0 Commercial: 0 Project Type: BACKFLOW VALVE SFD SQ FT: 0 Industrial: 0 Occupancy Type: COMMERCIAL Garage: 0 Occupancy Group: MFD Units: 0 Construction Type: MFD SQ FT: 0 Zoning Use: CO PROJECT NOTES ADDED (2) DOUBLE CHECK VALVES TO LAWN SPRINKLER SYSTEM RECEIPT # 8660 FEES ASSESSMENT Building Permit: $0.00 Misc Fee 1: BACKFLOW $27.00 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 Sign: $0.00 TOTAL FEE: $27.00 Plumbing: $0.00 AMOUNT PAID: $27.00 Mechanical: $0.00 BALANCE DUE: $0.00 Radon: $0.00 Separate Permits are required for electrical work, SEPA, Shoreline, ESA, utilities, pdvate and public improvements. This permit becomes null and void if work or construction authorized is not commenced within 180 days, if construction or work ia suspended or abandoned for a pedod 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 tree 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. / Si~'~ture o,..~ontr;;~tor of Authorized Agent / / Date Signature of Owner (if owner is builder) Date BUILDING PERMIT - APPLICATION Pmmit #: P~ ~ or p~t in ~ ~u hve ~y qu=~n~ pl~ ~g 417-~15 ~ ~/~/~ ~ A~li~tm~or ~em: ~ , ~,~ ~// Pho~: ~/~' 7~'0 A~ss: /~O.ff ~,,,.:,c~ Ci~: ~ t,~c,, Zip: ~; ~ Goner Li~ ~: E~:. ~o~: Ad~ss: . Ci~: ~p: LEG~ D~ON~ ~ Blo~: ~i~: ~ ~ P~L ~: ,, ~ Ca~ Holder N~me: , ~ OF WO~ S~UA~ON: o ~fi~ o N~ ~. o ~f ~ W~ SF. ~ S~F. ~ $ , ': No, of~ .~ S~: , ~ % ~ ~e:, ~ .c,:. _% No~: ' ~ · - .... ~.= =, ~~s):Oy~oNo S~A~~?o Y~o No ~m ' ~ ~ ~ ~ ~u ~ m~ ~1~ h~on ~ ~ ~pfi~on ~ p~ ~ ~m. ~G [~ ~P~CA~ON ~'l-F~: Yo~ ~mpl~ ~fi~, s~ ph (f~ ~M~) nd ~ ~ p~ ~ M be ~ ~ ~c B~I~ ~i~. my ~ ~ by ~ Buil~g Div. m c~ply ~ ~t ~ ~h~. ~n~t ~ P~ ~k~r at 417~815 ~ ms~. E~TION OF PL~ ~W: If no ~ ~ i~ ~ 1~ da~ of ~e ~ of ~fi~, ~is app~flan w~ exp~ ~ S~ 107.4 of ~ U~o~ B~I~ C~e, ~t e~on). ~o a~lica~on ~ ~ ~ded mom ~ on~. I ~ ~ t~ I ~e ~ ~ ~ t~ ~plic~on ~ ~ t~ ~ to be ~ ~ ~ ~ I ~ ~th~ed to ~p~ thi~ ~it. I u~ it ~ not t~ Ci~ le~ ~pomibili~ to ~t~i~ ~ ~mit~ ~ r~u~' it ~atm t~ ~plic~ r~po~ib~i~ to d~i~ ~t p~l~ ~ mqu~d a~ to obta~ PW-II02_I3[mvf'0', Applic.t:~ .~~ Dat.: /~// '/ CITY OF PORT ANGELES PUBLIC WORKS DEPARTMENT ACCOUNT PERMIT ACCOUNT DOLLAR NAME NUMBER NUMBER AMOUNT Surcharge ($4.50) 001.2291000 D.R.A. Fees Plus Interest 001.2392000 Burning Permit Fee 600.32290014 Fire Inspect/Permit Fee 600.34220015 Fire Sprinkler Plan Review Fee 600.34220016 Construction 420.32210017 Plumbing Mechanical 420.32210019 Sign 711.32210020 Clear/Grade Permit 711.32210021 House Moving 711.32210033 Sidewalk/Driveway/Curb Permit/Right of Way Permit 711.32240011 Publications 711.34150000 Blueprints-Aerial 711.34320000 Administration Cost (5%) 711.34320010 Plan Check Fee 420.34583000 Engineering Service Fees 711.34895000 T~AL GENERAL FU~ Street/Alley Restoration 752.32210032 Storm Drain/Tap 752.34490010 S/W Co-Op 752.36990000 ~AL S~EET FUND ~L Electrical Permits/Inspections 91 ~ .32210028 T~AL LIG~ DIVI~ ~ ~AL ~1~1111~ P.B.IA. 650.2319200 TOTAL PBIA ~ ~AL ~1t11~ TOTAL CAP'AL ~PR~EME~ ~N~ Property Sales 715.39510010 TOTAL P.W. IMP~E~ ~ Hot Tap (watermain) 753.34340023 F.H. Install/Meter 753.34340024 W/M Installation 753.34340025 Water System Development Charge 753.34480010 T~AL WATER FUND Sanitary Sewer Permit 754.32210029 Sanitary Sewer Tap/Cap or MH Tap 754.34350018 Sewer System Development Charge 754.34350024 ULID 215/Equivalent Service Connection Fee 782.34350025 TOTAL WA=I~.~=. ~D Milkwaukee Dr Assessment 755.34370030 TOTAL SOL~ WASTE ~ ..... ~,,~, /OO~ ~,~ ~ I ~t~ ~ FILL IN COMPLETELY - TOTAL EACH FUND AND GRAND TOTAL AR204#Z1 Open Item Inquiry Customer** OLYME OLYMPIC MEDICAL CENTER Item Reference No. 0000001 Status 2 Invoice Number I010005460 Invoice/Payment Amount 27.00 Payment Number Outstanding Balance 27.00 Original Invoice Invoice/Payment Date 12/19/01 Recurring Rec No. Due/Effective Date 01/18/02 Transaction Ref. AR 10777/ 3/ 0 GL Consolidate Rent Type Rent ID Item Type S Invoice Sundry GEN General A/R Description Sprinkler Permit for 1005 Georgiana Control GL Code 1 1221000 Accounts Receivable Prepay GL Code Disputed N Dispute Description Produce Invoice Y Invoice Generated Y Last Stmt Date 12/28/01 2002 Press first PFkey for Direct display; second PFkey for display Next: (1)/ (17) item reference (4)/ (20) invoice (5)/ (21) payment (6)/ (22) dispute (13) customer** aging (9) GL Distribution (16) exit (32) return to menu ARYY Holds all accounts receivable reports a(batch#) * CIrY OF PORT ANGELES LIGHT DEPARTMENT ELECTRICAL PERMIT N~ 17647 /0 -/~ F/ Port Angeles. Washlngton.m.....m...m...............m._uu..m........m..u. 1900_...__ 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 "6~ioo:~~~~n.oonn-.m Occupancy.n;-4;_e.e_~oooooo.____.._____oo___ ~::~~~:~:~:O-~-::::(b;ii&;;.::~~(%~~;:.......-:......:....-...'~~~~~:::::::::=::::::::::::::::::::::::::::::::::::::: /' V /..:<-O/.::,~o Light Outlets.....................--......-............ Service, volts .--.--...--.--....----....----.....--. .3' No. wIres .............--...........~;......... Size wireBJ1!..~~...._.. Main fuse ....'&.-(!f!..-.................... S Enclosure ....__......_........__.......... Receptacle Outlets...........................--.. Dryer, KW _................-....--............--.... Range, KW...._...h.........................._ "'Tater Heater: KW._n__....nn.................n.........n.. H.a', KW._..c?!.c? ....................... Motors: size, volts and phase: ...--...----........--.......--.....----....---.......--... .......--....--.---...----.......--.....----......--....... ....----...----.-...--......------......--................. ..............-............................................ ..-..........................--..............--......--.- Type of wiring: Entrance Cable ..-.............---........-- Rigid Conduit ...................... Metallic Tubing ................. Current transformers: No. & Size............---...----....... Ser. No............--......---......--.....--......... Ser. No............--.........................--..... Ser. N 0.............__................................ Type 01 Wiring: Armored Cable ............................-. Non.Metalltc ............--....--............- Knob & Tube.......................--.......- Rigid Conduit ....---......................,. Metallic Tubing .........................-. Raceway __.....___....._......._.............._ Circuits, Light..................................._.. Utility..................n..............._......... Heat .......................................-..-.. Range .....--...................--......--.......-- Water Heater ..---.....--................... Motor .........................---........--...--.. Dryer....____...__.......__.....__......__............. Furnace --........................-......---......... Remar:.o:ta:__:a_~..~_._;;..::i!;p.-~,:;~:r..-::...::-.~::.::.~:.~:__..::.__..:___._.oo.___._____oooo:~:~:...:::.:::~:::~.:~.::':::~:.':::~..: ........u.n__n__n.u___...unu___.___nn__un_.u____nu..._un...u...n____..nn_.nn.._un__.n_n...___.._n__._n__n.uudu.n....__n...u___.._n_..nn_ ......m..n________.______________..oon..____________..m_..oo___..___._..oooo.oo___.___oo_m......m....m...__m..oooooo:oo:oo.....____.;:oooo..___..____;joo..oooo Permit Fee Treas. Receipt y Y;:;;l!;; d k- . $..___...000:....000.000000__.000.___.. NO.m.............oo.......... By _.;..m:mJ.L_.._oo!./.~L~..:.:!'!:Lf:.'_d.: I" ," NOTICE-Current must not be turned on until Certificate of Inspection has been issued. .If work Is to be con. cealed due notice must be given the Inspector so that work may be inspected before concealI~ient. 1...., NOTIFY THE INSPECTOR BY PERMIT NUMBER WHEN READY FOR INSPECTION ELECTRICAL PERMIT N~ 1 7 6 4 7 Address < ..............--...-.............................................................................--.................................... Date...__.....____......_.......__.......___........._____... Owner ....__..............___.....__.un_......_u_n..___......_.._........----....----.....-.................--.............. Tenant......_____.....____u......___.....___.....___.................__.. ""^'lringContractor..................................._n...._.............._............................._._....._......._...............By.............................n............................... J NOTICE-Current must not. be turned on ~UI Ce.rtlflcate of Inspection has been issued. If work Is to be con- cealed due notice must be given the Inspector so that WO?k..may be inspected Jj~fore concealment. ". 1M Olympic Printers, Inc. CITY OF .FORT ANGELES P.l! RiV1IT APPLICATiON Building Diviision /Electrrica! Inspections 321 East Fifth Street -• P.O. Box 1,150 / Port Angeles WaShingtoirr, 95362 Ph: (360) 417 -4735 Fay.- (360) 417 -4711 Cate: 91 �_- & Plan Review May 8e Job Address: __�& G Building Square Footage; Descriptian of above i ,Q Multi-Family or Commlerciap Please Complete Electrical Pon Review I Owner Ink rrnation r .. . Name: Mailln d City.Zip: Phone: W.. Fax: License #!Exp, Zf Item Sorvice/Feeder 200 Amp, Service /Feeder 201 -400 Amp, $ervlcelFaeder 401.600 Amp ServtceiFeeder 60 1 -1000 Amp, Sorvlce /Feeder over 1000 Amp, Branch Circuit VVl Service Feeder Branch Circuit W/O S6nrrce Feeder Each Additional Branch Circuit Branch Circuits 1-4 Tamp, SerVicel f=eeder 200 Amp, Temp, Service /Feeder 201.400 Amp. Temp, Service /Feeder 401 -600 Amp. Temp. ServlcelFeeder 6011000 Amp , Portal to Portal Hourly Sign /Outllne Lighting $ignal Circuit/ Limited Energy — Multi- Family Signal Circuit/ Limited Energy / First 1500 sf Commercial NOW $5,00 for each additional 1500 sf Renewable Electrical Energy - SKVA System or Loss Thermostat Note: $5.00 for each additional T-Stat Urt t Char e $ 132.00 $160.00 $ 22$,00 $ 288,00 $ 410,00 $ 5,00 $ 74.00 $ 5,00 $ 86.00 $102,00 $121,00 $164,00 $185,00 $ 96.00 '$ 88,00 $ 64.00 $ 56,00 � 113.00 $ 56,Q0 RECEIVE AG - 6 2014 CTRIr -4 INSPECrioNs Contractor information Name; , Mailing dd sr City: �%�p _ , State: Phone: — rax:_ .. License! Exp,_. S21r� d is C Tofial 141UIti Led Unit Cho e $ $.,FF070 Total Owner as defined by RCW,19,28,261: (1) Owner wlll occupy the structure for two years after this electrical permit is finalized, (2) :owner is requlred 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 l 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,, ROW, Chapter 19.28, WAC. Chapter 296-46E„ The City of Fort Angeles Municipal Code, and Utility Specifications and PAMC 14.05,050 regarding Electrical Permit Applications, Sign of owner, electrical cont r or electrical administrator: CI Cash ❑ Chock Credit Card #._&1-j .-- ...�..� Dated; _,,... „ ��^ 01!0112992 .A ELECTRICAL PERMIT CITY OF PORT ANGELES 360-417-4735 Application Number 14- 00000938 pate 6/07/14 Application pin number . . . 136228 Property Address 1005 GEORGIANA ST ASSESSOR PARCEL NUMBER: 06-30-00-5-8- 0220 -0000- Applicati0n type description ELECTRICAL ONLY Subdivision Name Property Use . , . . , . .Property 70ning , . . . , . , COMMERCIAL OFFICE Application Valuation r . 0 -------------------------------------------------------------------------- Application desc Microwave circuits Owner Contractor CLALLAM CO PUB HOSPITAL DIST 2 SIMPSON ELECTRIC DBA OLYMPIC MEDICAL CNTR 243036 W HWY 101 PORT ANGELES W7A 983623909 PORT ANGELES WA 98363 (360) 457 -9270 Permit . . . . . . ELECTRICAL ALTER. COMMERCIAL Additional desc 1 -4 CIRCUITS Permit Fee 86.00 Plan Check Fee 00 Issue Date . , . . 8/07/14 Valuation . . . . 0 Expiration. Date . , 2/03/15 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 Grand Total 86,00 86.00 .00 00 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 -IN FINAL COMMENTS: PERMIT WILL HXPM SIX (6) MONTHS FROM LAST INSPECTION Signature of owner or Electrical Contractor X Date: G,IEXCHANGEIBUILDING s fi� Aug 07 2014 1126AM Olympic Electric Co,, Inc 3604523498 page 1 � J i AUG 7 291 CITY OF PORT ANGELES PERMIT APPLICATION ELEC`.TRICAL Building Division/I<;lectirical Inspections INSPECTION! 321 East Fifth Street -- P.O. Boar 1150 I Port Angeles Washington, 98362 Ph: (360) 417 -4735 Fax: (360) 417 -4711 Date: %—'7 - - -- Z Multi-Family or Commercial* * Plan Revie_w�I Be Required, Please Cornpl to lectrical Plan Review Information Sheet _May Job Address: �/ A L rV I C, S°6— Building Square Footage; Descrioionofabove 1 u51r,4 ► t_ Lckv t_arCg !y t29112D Owner Information Contractor Information Name: C7 HI7 L- Name: OLYMFiGELECTRIC Melling AWress. °1 <<__4 R 0-L Mailing Address; 42W TUMWATER oty ( {:�a State;.NL)azip; S2 fi:3 ,-_ City: PQRTANGELEA Stater; WA �,ip; 88363 Phone: -Lj r —t 77 e �cFax: Phone; 9694573385 Fax: 36"62-3493 License # ! Exp, License # 1 Exp, 01.- -023 -1 Item U It, t Charge gty Total . Qf Multiplied by unit C ref ServioelFeader 200 Amp, $132,00 $ Servloeffeader 201400 Amp, $160.00 $ Service/Feader 401-6600 Amp $ 225.00 $ Service /Feeder 601 -1000 Amp. $ 2880 $ ServiWFeeder aver 1000 Amp, $ 410.00 $ Branch Circuit 4UI Service Feeder $ 5.00 $ Branch CI muit 4+110 Service Feeder $ 74.00 $ Each Additional Branch Circuit $ 5.00 $ Branch Circuits 14 96.00 $ Temp. Service! Feeder 200 Amp. $102.00 S Temp, Service /Feeder 201400 Amp. $ 121.00 $ Temp, Service /Feeder 401- 600 Amp. $ 164.00 $ Ternp, Service /Feeder 601 -1000 Amp , $185.00 $ Portal to Portal Hourly $ 96.00 $ Sign/Outline Lighting $ 88.00 $ Signal Circuit! Limited Energy - Multi - Family $ 64.00 $ Signal Circuit/ Limited Energy I First 1500 sf -- Commercial $ 96.00 Note; $500 for each additional 1500 sf Renewable Electrcal Energy -6KVA System or Less $113.00 $ Thermostat $ 56.00 $ Note: $5,00 For each additional T -Stat $ rota! 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. Signature of owner, electrical contractor or electrical administrator; 0 cash 13 check 0 Credit Card N _O*d: -, — 1� 011a'ir2012 V ELECTRICAL PERMIT CITY OF PORT ANGELES 360- 4174735 Application Number 14-- 90000943 Date 8/08/14 Application pin number 737679 Property Address . . , . , , 1005 GEORGIANA ST ASSESSOR PARCEL NUMBER, 06-30-00-5-8- 0220 -0000- Application type description ELECTRICAL ONLY Subdivision Name Property Use Property zoning , . . . , . . COMMERCIAL OFFICE Application valuation ; . 0 ----------------------------------------------------- --- -- ------------ - - - - -- Application desc Security panel Owner Contractor --- --------------- - - - - -- ------------------------ CLALLAM CO PUB HOSPITAL DIST 2 OLYMPIC ELECTRIC CO INC `QBA OLYMPIC MEDICAL CNTR 4230 TIIMWATER PORT ANGELES WA 983623909 PORT ANGELES WA 98363 (360) 457 -5303 ------------------------------------------------- ---- - - - - -- - -._ - - --- Permit , , . . . . ELECTRICAL ALTER COMMERCIAL Additional desc , Permit Fea 96.00 Plan Check Fee .00 Issue Date 8/08/14 valuation . . . . 0 Expiration Date 2/04/15 Qty Unit Charge Per Extension 1,00 96.0000 ECH EL- LIMITED 1ST 1500 SQ FT 96.00 Fee summary Charged Paid Credited Due Permit Fee Total 96.00 96100 .00 .00 Plan Check Total ,00 .00 .00 .00 Grand Total 96.00 96,00 ,00 ,00 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 -IN 3 1� d FINAL COMMENTS: PERMIT WILL EXPIRE SIX (6) MONTHS FROM LAST INSPECTION Signature of owner or Electrical Contractor X Date: G:IEXCHANGEIBUILDING ELECTRICAL PERMIT CITY OF PORT ANGELES 360- 417 -4735 Application Number 15- 00001565 Rate 12/30/15 Application pin number 462500 Property Address 1005 GEORGIANA ST ASSESSOR PARCEL NUMBEk; 06 -30 -00 5-5- 0220 -0000- Application type description ELECTRICAL ONLY Subdivision Name . , . . . . Property Use . . . . . . . , Property Zoning , , . . . , , COMMERCIAL OFFICE Application valuation , . . . 0 _.__-_------------------ Application desc Extend 3 Qulets from existing owner Contractor ------------------ - - - - -- -------------------------- CLALLAM CO PUB HOSPITAL DIST 2 SIMPSON ELECTRIC DBA OLYMPIC MEDTCAL CNTR 243036 W HWY 101 PORT ANGELES WA 983623909 PORT ANGELES WA 98363 (360) 457 -9270 Permit . . . , . . ELECTRICAL ALTER COMMERCIAL Additional desc 1 -4 CIRCUITS Permit Fee 86.00 Plan Check Fee 00 Issue Date 12/15/15 Valuation 0 Expiration Date 6/12/16 Qty Unit Charge Per Extension SASE FEE 86100 Fee summary Charged paid Credited Iaue Permit Fee Total 86.00 86,00 .00 .04 Plan Check Total e0 .00 p0 00 Grand Total 86.00 86,00 p0 ,00 REPORT SALES TAX on your excise tax form to the City of Port Angeles (Location Code 0502) PERMIT WILL EXPIRE SIX (6) MONTHS FROM LAST INSPECTION Signature of owner or EIectrical Contractor X_ GAFACHANOMBUFLI)MG Date: l QTY OF PORT ANGELES PERMIT APPLICATION Building Divisioin/Electrical Inspections 321 East Fiftb Street — P.O. Box 1150 /Port Angeles Washington, 983 Ph: (360) 417-4735 Fax: (360) 41.7-4711 Multi•Family or Commercial* 1pi), --,`'-,`,;,,,A`-: * Plan Review May Be Required, Piease Complete #rlectrlrral Plan Review Infdrmation Sheet Job Address., Buli&nq Square Footage; Descriplion of above !9�—1 Owner Inform AO-0 Mailing Address; City; 12- A -Stale,^ ,ice4; Phone:' .:W oil 5" 1 Item Unit CbAr—qp Service/Feeder 200 Amp, $132.00 SarvicelPeeder 201400 Amp. $160.00 Servlce/Feeclar 401.600 Amp $225,00 Service /Feeder 601-1000 Amp. $288.00 Servioe/Fetcler over 1000 Amp. $410-00 Branch Circuit W1 Service Feeder $ 6,00 Omnoln Circuit W10 Service Feeder $ 74.00 Each Additional Oranch Circuit $ 5.00 Branch Circuits 1.4 $ 86,00 Temp. Service/ Feeder 200 Amp- $102,00 Temp. ServicelF&eder 201.400 Amp. $121,00 Temp, Service/Feeder 401.600 Amp. $164,00 Temp. Service /Feeder 601 -1000 Amp . $185.00 Portal to Portal Hourly $ 96.00 Signt0iAline Lighting $ 88.00 Signal Circuit/ Llmtted Energy- Muffi-Family $ 64-00 Si9ml Circuld Limited Energy I First 1500 af - Commercial $ 90,00 Notoi $S.00 for each additional 1500 af Renewable EWrical Energy- 5KVA System or Less $113.00 thermostat $ 56.00 Note: $5,00 for each additional T-Stat Contractor Information Name: C-: r -ily Phon Lit 'on Total- 1!y Multi Tied by.Unit Cha!Re) $ Total Owner as dunned by RCW,19.28,261: (1) Owner Wit occupy the structure for tiro years after this electrical permit is finalized. ( 1) 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 IN owner of the above named property or a licensed electrical cor tractor. I am making the electrical installation or alteration In compliance with the electrical laws, N.E.C,, RCVV. Chapter 19.20, WAC, Chapter 2964 510, The City of Pork Angeles Municipal Code, and Utility Specifications and PAIVIC 14.05.050 regarding Electrical Permit Applications. Signature of owner, electrical contractor or electrical administrator: I-D Cash ❑ check GrodliCa(d A. DRIe4- ZO-Z -11-/5— DlMIP012