HomeMy WebLinkAboutPermit EL09-0299 - WASHINGTON STATE SCHOOL OF RISK MANAGEMENTW • STATE SCHO L OF
RISK MANA.LGE
320 ANDOVE
PK E,
ELO9-0299
280
Parcel No.:
Address:
Suite No:
Cityllif Tukwila
Department of Community Development
6300 Southcenter Boulevard, Suite # 100
Tukwila, Washington 98188
Phone: 206 - 431 -3670
Fax: 206 - 431 -3665
Web site: http: / /www.ci.tukwila.wa.us
0223200060
320 ANDOVER PK E TUKW
ELECTRICAL PERMIT
Permit Number: EL09 -0299
Issue Dale: 05/12/2009
Permit Expires On: 11/08/2009
Tenant:
Name:
Address:
Owner:
Name:
Address:
Contact Person:
Name:
Address:
WA ST SCHOOL OF RISK MANAGEMENT
320 ANDOVER PK E SUITE 280 , TUKWILA WA
WA CITIES INSURANCE AUTHORI
14900 INTERURBAN AVE S #210 , SEATTLE WA
]BRENDA BROUSSARD
4826 NW B ST SUITE 101 , AUBURN WA
Contractor:
Name: ]KIRBY ELECTRIC INC
Address: 4826 B ST NW, STE 101 , AUBURN WA
Contractor License No: KIRBYEI077BN
Phone:
:Phone: 253 - 859 -2000
Phone: 253 859 -2000
Expiration Date: 01/13/2011
DESCRIPTION OF WORK:
RELOCATE LIGHTS, ADD 2 SWITCHES AND 2 RECEPTACLES
Value of Electrical: NRES: $1,000.00
RES: $0.00
Type of Fire Protection: UNKNOWN
Electrical Service provided by: PUGET SOUND ENERGY
Permit Center Authorized Signature:
Fees Collected: $92.00
National Electrical Code Edition: 2005
,„(LL'Zf
Date: ■S- 0 --0
I hereby certify that I have read and examined this permit and know the same to be true and correct. All provisions of law and ordinances
governing this work will be complied with, whether specified herein or not.
The granting of this permit does not presume to give authority to violate or cancel the provisions of any other state or local laws regulating
construction or the peg. rman ork. I am authorized to sign and obtain this electrical permit.
Signature. Date:
S° g ar
Print Name:
This permit shall become null and void if the work is not commenced within 180 days from the date of issuance, or if the work is suspended
or abandoned for a period of 180 days from the last inspection.
doc: EL -4/07
EL09 -0299 Printed: 05 -12 -2009
City of Tukwila
Department of Community Development
6300 Southcenter Boulevard, Suite #100
Tukwila, Washington 98188
Phone: 206- 431 -3670
Fax: 206 - 431 -3665
Web site: hitp: / /www.ci.tukwila.wa.us
PERMIT CONDITIONS
Parcel No.: 0223200060
Address:
Suite No:
Tenant:
320 ANDOVER PK E TUKW
WA ST SCHOOL OF RISK MANAGEMENT
Permit Number:
Status:
Applied Date:
Issue Date:
EL09 -0299
ISSUED
05/12/2009
05/12/2009
1: ** *ELECTRICAL * **
2: A copy of the electrical work permit shall be posted or otherwise made readily accessible to the Electrical Inspector
at each work site.
3: Approved plans shall be maintained at the construction site and shall be readily available to the Electrical Inspector.
4: All electrical work shall be in accordance with NFPA 70 - NEC, and requirements for electrical installations, Chapter
296 -46B WAC.
5: When any portion of the electrical installation is to be hidden from view by permanent placement of parts of the
building, such equipment shall not be concealed until it has been inspected and approved by the Electrical Inspector.
6: The issuance of an electrical work permit shall not be construed to be a permit for, or an approval of, any violation
of the provisions of the electrical code or other ordinances of the jurisdiction. Permits or related documentation that
presumes to grant this authority are therefore not valid.
7: Any change in the scope of work described by the electrical work permit shall require additional work permits. Where
approved plans have been issued, revisions to the plans and additional review may be required.
I hereby certify that I have read these conditions and will comply with them as outlined. All provisions of law and
ordinances governing this work will be complied with, whether specified herein or not.
The granting of this permit does not presume to give authority to violate or cancel the provision of any other work or local
laws regulating construction or the performance of work.
Signature: Date: f--(v -d9
Print Name:
7?th
doc: Cond -Elec
EL09 -0299 Printed: 05 -12 -2009
•
CITY OF TUKWILA
Community Development Department
Permit Center
6300 Southcenter Blvd., Suite 100
Tukwila, WA 98188
http ://www. ci. tukwila. wa. us
•
ELECTRICAL PERMIT APPLICATION
Applications and plans must be complete in order to be accepted for plan review.
Applications will not be accepted through the mail or by fax.
* *Please Print **
SITE LOCATION
? !!,,,, ,�/ J King Co Assessor's Tax No.: 0./..)-&)-d— W �DV
Site Address: V /9N da ✓pt— %it E ke4� /f II Suite Number :P /0 Floor: 42
Tenant Name: l/u SS I ZPZIP �Gl Si- ��l o� it At4101- New Tenant: gl Yes ❑ ..No
Property Owners Name: IS /f fiegif? °..I
Mailing Address:
city scam Zip
CONTACT PERSON — Who do we contact when your permit is`ready:to:be.isstied
Name:
W12&, �CPC�� c Day Telephone: T3' fez, 2,9 od
Mailing Address: f(M 1 Loa g tsfi Si- Ao I gtv ti, lef '7/ocy
city state Zip
E -Mail Address: Jl /l f d e ) /Z371. e6 e( • C a h^ Fax Number:
ELECTRICAL CONTRACTOR INFORMATION
Company Name:14(1C �/ /Z.F L'PL _ ry C
Mailing Address: t(? /alit/ 3 Yr "6 / Ctic
QQ City State Zip
Contact Person: 17/2 046¢ Day Telephone:
E -Mail Address:1>AP* c10, 111/1(j>) e( et j Cd Fax Number:
l/
Contractor Registration Number: f�-((lg c°.To77 O It) Expiration Date: 1-13 -1 1
Valuation of Project (contractor's bid price): $ /eve, , d c)
Scope of Work (please provide detailed information): I2eLo C 1 P Ll Dal o? _S'(44-4,�
Ree a ,` e C "7-1"
Will service be altered? ❑ Yes (j No Adding more than 50 amps? ❑ Yes ❑ No
Type of Use:
Type of work:
❑ New ❑ Addition ❑ Service Change g Remodel ❑ Tenant Improvement
❑ Low Voltage ❑ Generator ❑ Fire Alarm ❑ Telecommunication ❑ Temporary Service
Property Served by:
Puget Sound Energy
❑ Seattle City Light
H: Applications\Forms- Appbcalions On Line \I-2009 - Electrical Permit Application.doc
bh
Page 1 of 2
RESIDENTIAL
NEW RESIDENTIAL SERVICE
❑ New single family dwellings $145.60
(including an attached garage)
❑ Garages, pools, spas and outbuildings. . $78.00 ea
❑ Low voltage systems
(alarm, fumace thermostat) $57.00 ea
RESIDENTIAL REMODEL AND SERVICE CHANGES
❑ Service change or alteration $78.00
(no added/altered circuits)
❑ Service change with added/altered circuits $78.00
number of added circuits $11.00 ea
[ Circuits added/altered without service change $52.00
(up to 5 circuits)
❑ Circuits added/altered without service change $52.00
(6 or more circuits) $7.30 ea
❑ Meter /mast repair $65.00
❑ Low voltage systems $57.00
(alarm, furnace thermostat)
MULTI - FAMILY AND COMMERCIAL
Fees are based on the valuation of the electrical contract.
MISCELLANEOUS FEES
❑ Temporary service (residential) .. $60.00
❑ Temporary service (generator) $75.00
❑ Manufactured/mobile home service.. $80.00
(excluding garage or outbuilding)
❑ Carnivals $75.00
Number of concessions $10.00 ea
PERMIT APPLICATION NOTES -
Value of Construction — In all cases, a value of construction amount should be entered by the applicant. This figure will be reviewed and is subject
to possible revision by the Permit Center to comply with current fee schedules.
Expiration of Plan Review — Applications for which no permit is issued within 180 days following the date of application shall expire by limitation.
The Building Official may grant one extension of time for an additional period not to exceed 90 days. The extension shall be requested in writing
and justifiable cause demonstrated.
1 HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION AND KNOW THE SAME TO BE TRUE UNDER
PENALTY OF PERJURY BY THE LAWS OF THE STATE OF WASHINGTON, AND I AM AUTHORIZED TO APPLY FOR THIS PERMIT.
BUILDING OWNER OR ELECTRICAL CONTRACTOR:
Signature / Date: .rid -a cf
Print Name: 7/,7Scy �e1�" /.O/
Mailing Address: ?IA /t/fiv £
Day Telephone:f F5-9 — Ocwo
City
State
d"5 U
/
Zip
Date Application Accepted:
Date Application Expires:
Staff Initials:
H :'lAppltcuions\Forms- Appbwtions On lined -2009 - Electrical Permit Application doe
bh
Page 2 of 2
City of Tukwila
Department of Community Development
6300 Southcenter Boulevard, Suite #100
Tukwila, Washington 98188
Phone: 206 - 431 -3670
Fax: 206 -431 -3665
Web site: http: / /www.ci.tukwila.wa.us
RECEIPT
Parcel No.: 0223200060 Permit Number: EL09 -0299
Address: 320 ANDOVER PK E TUKW Status: PENDING
Suite No: Applied Date: 05/12/2009
Applicant: WA ST SCHOOL OF RISK MANAGEMENT Issue Date:
Receipt No.: R09 -00701
Initials: WER
User ID: 1655
Payment .Amount: $92.00
Payment Date: 05/12/2009 10:33 AM
Balance: $0.00
Payee: KIRI {Y ELECTRIC
TRANSACTION LIST:
Type Method Descriptio Amount
Payment Check 509492 92.00
Authorizat_.on No.
ACCOUNT ITEM LIST:
Description_
Account Code Current Pmts
ELECTRICAL PERMIT - NONR
000.322.101.00.0 92.00
Total: $92.00
¥\1EN
EGEVED
doc: Receiot -06 Printed: 05 -12 -2009
INSPECTION RECORD (LD?111T
Retain a copy with permit
INSPE{.I ION NO. PERMIT NO.
CITY OF TUKWILA BUILDING DIVISION K.
6300 Southcenter Blvd., #100, Tukwila, WA 98188 (206)431 -36
Project:- It
Wa. ST. qtr.
Type of Inspection:
2104
Address: 32.-o A"'1)QJ(A(DateCalled:
Special Instructions:
Date Wanted:
a.„
p.m.
Requester:
._......,
Phone No:
181 Approved per applicable codes. El Corrections required prior to approval. 7
COMMENTS:
04,01
El $60.00 REINSPECTION FEE REQUIRED. Prior to inspection, fee m st be
paid at 6300 Southcenter Blvd., Suite 100. Call to schedule reinspection.
Receipt No.:
Date:
3
INSPECTION NO.
CITY OF TUKWILA BUILDING DIVISION
6300 Southcenter Blvd., #100, Tukwila, WA 98188
INSPECTION RECORD
Retain a copy with permit
61-7Z?7
PERMIT N0.
(206)431 -3670
Project: I
Type of Inspection:
Address:
32-o AA DOS
6.
Date Called:
^.
Special Instructions:
CEIL I /` t•U" I j }� ^
C
Date Wanted:
04 d
a.m:
P•
Requester:
Phone No:
Approved per applicable codes. Corrections required prior to approval.
Inspector: '4
I.
bate: Q�
'1)
❑ $60.00 REINSPECTION FEE REQUIRED. Prior to inspection, fee must be
paid at 6300 Southcenter Blvd., Suite 100. Call to schedule reinspection.
Receipt No.:
Date:
2-
INSPECTION NO.
INSPECTION RECORD
Retain a copy with permit
CITY OF TUKWILA BUILDING DIVISION f-
6300 Southcenter Blvd., #100, Tukwila, WA 98188 (206)431 -3670
Project
f. s c.t-�ax.
Type of Inspection:
2/ 00
Address: a
Date Called:
Special Instructions:
Date Wanted:
069 0I
.m.
p.m
Requester:
Phone No:
Approved per applicable codes.
ElCorrections required prior to approval.
COMMENTS:
OngieLearitS 141 ,Si 461 Tr- 1 tt-o■
- 14t , ,, A 016-12(40100 LfGtii�-TIrJ(�
E oR
J1Llpfn1&
Inspector: / / f (Date:
or'ai'o7
LJ$60.00 REINSPECTION FEE REQUIRED. Prior to inspection, fee must be
paid at 6300 Southcenter Blvd., Suite 100. Call to schedule reinspection.
Receipt No.:
Date:
INSPELION NO.
INSPECTION RECORD
Retain a copy with permit
61)11 - 011/
PE MIT NO.
(206)431 -3670
CITY OF TUKWILA BUILDING DIVISION
6300 Southcenter Blvd., #100, Tukwila, WA 98188
Project; � � � M��� l
1
Type of Inspection:
Date Called:
700,
Address: /
31.Ebove9\ r .
Special Instructions:
Date Wanted:
QS 13
.m.
p.m.
Requester:
Phone No:
Approved per applicable codes. Corrections required prior to approval.
COMMENTS:
U1AIt/ CoJef_
Inspector:
Date: 05, 13 l 0
El $60.00 REINSPECTION FEE REmUIRED. Prior to inspection, fee must be
paid at 6300 Southcenter Blvd., Suite 100. Call to schedule reinspection.
'Receipt No.:
Date:
Untitled Page
• 0
Page 1 of 2
Electrical Contractor
A business licensed by Lai to contract electrical work within the scope of its specialty.
Electrical Contractors must maintain a surety bond or assignment of savings account.
They also must have a designated Electrical Administrator or Master Electrician who is a
member of the firm or a full -time supervisory employee.
Business and Licensing Information
Name KIRBY ELECTRIC INC UBI No. 601433048
Phone 2538592000 Status ACTIVE
Address 4826 B ST NW STE 101 License No. KIRBYEI077BN
Suite /Apt. License Type ELECTRICAL CONTRACTOR
City AUBURN Effective Date 1/15/1993
State WA Expiration Date 1/13/2011
Zip 98001 Suspend Date
County KING Specialty 1 GENERAL
Business Type Corporation Specialty 2 UNUSED
Parent Company
Other Associated Licenses
License
Name
Type
Specialty
1
Specialty
2
Effective
Date
Expiration
Date
Status
KIRBYE *101QE
KIRBY
ELECTRIC
ELECTRICAL
CONTRACTOR
GENERAL
UNUSED
11/5/1990
11/5/1994
ARCHIVED
MASTER ELECTRICIAN INFORMATION
License KIRBYDE962LZ
Name KIRBY, DOUGLAS E
Status ACTIVE
Business Owner Information
Name
Role
Effective Date
Expiration Date
KIRBY, DOUGLAS E
Cancel
Date
01/01/1980
Bond
Amount
KIRBY, SHANNON
5
01/01/1980
70607132
Bond Information
Bond
Bond
Company
Name
Bond
Account
Number
Effective
Date
Expiration
Date
Cancel
Date
Impaired
Date
Bond
Amount
Received
Date
5
WESTERN
SURETY CO
70607132
01/14/2009
Until
Cancelled
$4,000.0011/05/2008
MERCHANTS
https: // fortress .wa.gov /lni/bbip/Detail.aspx
05/12/2009