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Home My WebLink AboutPermit EL10-0091 - RIVERTON FAMILY MEDICALRIVERTON FAMILY MEDICAL 13030 MILITARY RD S STE 208 EL1 0-0091 Parcel No.: Address: Suite No: City-Of Tukwila • Department of Community Development 6300 Southcenter Boulevard, Suite # 100 Tukwila, Washington 98188 Phone: 206 - 431 -3670 Inspection Request Line: 206 - 431 -2451 Web site: http: / /www.ci.tukwila.wa.us 1623049171 13030 MILITARY RD S TUKW ELECTRICAL PERMIT Permit Number: Issue Date: Permit Expires On: EL10 -0091 02/09/2010 08/08/2010 Tenant: Name: Address: Owner: Name: Address: Contact Person: Name: Address: RIVERTON FAMILY MEDICAL 13030 MILITARY RD S, STE 208 , TUKWILA WA RIVERTON PROPERTIES PO BOX 2039 , IHRKLAND WA BRAD FORSTIE PO BOX 1044 , SNOHOMISH WA Contractor: Name: BRADLEY ELECTRIC LLC Address: PO BOX 1044 , SNOHOMISH WA Contractor License No: BRADLEL968JE Phone: Phone: 425 330 -5667 Phone: 425 330 -5667 Expiration Date: 04/05/2010 DESCRIPTION OF WORK: INSTALL NEW 100 AMP DISCONNECT FOR X -RAY MACHINE. RUN NEW FEEDER FROM EXISTING SERVICE, IN EXISTING CONDUIT. USE SPARE SPOT IN METER BANK. WIRING FROM DISCONNECT INSTALLED BY X -RAY INSTALLER. Value of Electrical: NRES: $2,000.00 RES: $0.00 Type of Fire Protection: UNKNOWN Electrical Service provided by: SEATTLE CITY LIGHT Permit Center Authorized Signature: I hereby certify that I have read and governing this work will be complie Fees Collected: National Electrical Code Edition: 2008 $115.50 Date: 02- 1V°AVD ed this permit and know the same to be true and correct. All provisions of law and ordinances whether specified herein or not. The granting of this permit does not pre e to give authority to violate or cancel the provisions of any other state or local laws regulating construction • . - • erformance of work. I am authorized to sign and obtain this electrical permit. Signature: Print Name: lit Foe STl Date: 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 EL1 0-0091 Printed: 02 -09 -2010 Parcel No.: 1623049171 Address: Suite No: Tenant: • 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 13030 MILITARY RD S TUKW RIVERTON FAMILY MEDICAL PERMIT CONDITIONS Permit Number: Status: Applied Date: Issue Date: EL10 -0091 ISSUED 02/09/2010 02/09/2010 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: Print Name: 46 FOR )T /!(. Date: Z /rl4o /V doc: Cond -Elec ELI 0-0091 Printed: 02 -09 -2010 CITY OF TUKWILA Community Development Department Permit Center 6300 Southcenter Blvd., Suite 100 Tukwila, WA 98188 htto://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 ** SITIE•LOCATION,': Site Address: ! 30 30 1 / / / 1,Q ,e1-' 1ZD. S, Tenant Name: 72 1 ✓ ?7D/J F4*4»i,' /u ',A/- Property Owners Name: 441/11 /,UC Mailing Address: ? 13e K 2 o 3 9 King Co Assessor's Tax No.: Ui'2 G-k - - l t k ,..o Suite Number: Z Floor: Z New Tenant: ❑ Yes ®o K( 42 IC/_A^' D City State 98053 Zip > CONTACT =PERSON': Who do; we contact when your; permit s ready'to be issued Name: fge 4L Mailing Address: A. [5 0x /6 V7 Day Telephone: 4/0..S..— 33d t SN0 4/14 /srf w4 9s'Z9/ City E -Mail Address: At'W iI) ji.ScrEIG C° 4-4ST..vr,r State Zip Fax Number: 36 E -3-6g - 26-6 0 LE CTRICAL CONTRACTOR INFORMATI Company Name: Mailing Address: Contact Person: E -Mail Address: Contractor Registration Number: Pip Z. z.96 .S 6_ pt4LL-FtN SL-1- 4-711,IL L-C_L �0 Box /ay y g F ,esr/,i 5/U0.s4A4 /s // City Day Telephone: 9Z5 -3 ? 0 -5"6 6 7 u>A 9gz9 State Zip Fax Number: 3620 's-6 f' ZS(c 6 Expiration Date: V16120/ 0 Valuation of Project (contractor's bid price): $ ZOO, °� Scope of Work (please provide detailed information): 4 1V /00 A. D /SGO►�nll�� -T /A/57i4 L I. /0466/ /iv , 12'v Ai A cc) f ?EOM I-KiiTMier` ,,r142. 04-k— / l,J ff,xiS7/A/Gt Comes /T -15L 5A41z6._ $Por i, /1A6.775Z SANK . ltiI 1 A*, fRoA-t gr X -P4) /NSTALLFX-- Will service be altered? 0---c'es ❑ No Adding more than 50 amps? Type of Use: "..v• Type of work: [] New ❑ Addition ❑ Service Change [] Low Voltage ❑ Generator ❑ Fire Alarm Property Served by: [] pis get Sound Energy 2 Seattle City Light H:\Applications\Forms- Applications On Line\2010 Applications \1 -2010 - Electrical Permit Application.doc bh Page 1 of 2 dySc 9N•-14 -Cr .54c1016 Yes ❑ No ❑ Remodel lnant Improvement ❑ Telecommunication ❑ Temporary Service RESIDENTIAL NEW RESIDENTIAL SERVICE ❑ New single family dwellings $152.85 (including an attached garage) ❑ Garages, pools, spas and outbuildings $81.90 ea ❑ Low voltage systems (alarm, furnace thermostat) $59.85 ea RESIDENTIAL REMODEL AND SERVICE CHANGES ❑ Service change or alteration $81.90 (no added /altered circuits) ❑ Service change with added/altered circuits $81.90 number of added circuits $11.55 ea ❑ Circuits added/altered without service change $54.60 (up to 5 circuits) ❑ Circuits added /altered without service change $54.60 (6 or more circuits) $7.65 ea ❑ Meter /mast repair $68.25 ❑ Low voltage systems $59.85 (alarm, furnace thermostat) MULTI - FAMILY AND COMMERCIAL Fees are based on the valuation of the electrical contract. MISCELLANEOUS FEES ❑ Temporary service (residential) $63.00 ❑ Temporary service (generator) $78.75 ❑ Manufactured /mobile home service $84.00 (excluding garage or outbuilding) ❑ Carnivals $78.75 Number of concessions $10.50 ea 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. I 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: Signatur Print Name: 131& MRSTi. Mailing Address: T X3oic /04y Date Application Accepted: Day Telephone: o./e t*,S/,/ City Date: 2 �— Zo /4 yzS- 33a —S6 C7 d v4- 9K29/ State Zip Date Application Expires: H:\Applications\Forms- Applications On Line\2010 Applications \1 -2010 - Electrical Permit Application.doc bh Page 2 of 2 Staff Initials: • 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 Parcel No.: 1623049171 Address: 13030 MILITARY RD S TUICW Suite No: Applicant: RIVERTON FAMILY MEDICAL RECEIPT Permit Number: EL10 -0091 Status: PENDING Applied Date: 02/09/2010 Issue Date: Receipt No.: R10 -00215 Initials: JEM User ID: 1165 Payment Amount: $115.50 Payment Date: 02/09/2010 10:46 AM Balance: $0.00 Payee: BRADLEY A FORSTIE, BRADLEY ELECTRIC TRANSACTION LIST: Type Method Descriptio Amount Payment Credit Crd VISA - Authorization No. 067211 ACCOUNT ITEM LIST: Description 115.50 Account Code Current Pmts ELECTRICAL PERMIT - NONR 000.322.101.00.00 115.50 Total: $115.50 PAYM' ENT RFCFIVED doc: Receiot -06 Printed: 02 -09 -2010 INSPECTION RECORD Retain a copy with permit INSPECTION NO. PERMIT N0. CITY OF TUKWILA BUILDING DIVISION ; ►�- 6300 Southcenter Blvd., #100, Tukwila, WA 98188 Euo.00�� (206)431-3 70 Pr (VTo Al`` mrM Type of Inspection: Address /363o 1irtlrv--1 Date Called: Special Instructions: r 2:30 p,01- Date Wanted: Z /(V a.m p.m. Requester: 111 Phone No: Approved per applicable codes. Corrections required prior to approval. COMMENTS: rtv- Inspector: r Date: 0210/ 0 ri $60.00 REIN PECTION FEE REQUIRED. Prior to inspection, fee must be paid at 6300 Southcenter Blvd., Suite 100. Call to schedule reinspection. Receipt No.: Date: -- ..,,�., �.,.,.,.�*.- ,.......mac �- .�•��.. 7 Untitled Page • Page 1 of 2 Electrical Contractor I A business licensed by LW 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 Phone Address Suite /Apt. City State Zip County Business Type Parent Company BRADLEY ELECTRIC LLC 4253305667 PO BOX 1044 SNOHOMISH WA 982911044 SNOHOMISH Limited Liability Company UBI No. 602383276 Status ACTIVE License No. BRADLEL968JE License Type ELECTRICAL CONTRACTOR Effective Date 4/5/2004 Expiration Date 4/5/2010 Suspend Date Specialty 1 GENERAL Specialty 2 UNUSED ADMINISTRATOR INFORMATION License FORSTB*970J2 Name FORSTIE, BRAD A Status ACTIVE Business Owner Information Name Role Effective Date Expiration Date FORSTIE, BRADLEY A PARTNER /MEMBER 04/05/2004 Bond Amount Bond Information Bond Bond Company Name Bond Account Number Effective Date Expiration Date Cancel Date Impaired Date Bond Amount Received Date 1 COLONIAL AM CAS SURETY OF MARYLAND 04/05/2004 Until Cancelled Can $4,000.00 04/05/2004 https://fortress.wa.gov/lni/bbip/Detail.aspx 02/09/2010