HomeMy WebLinkAboutPermit EL10-1026 - PACIFIC NORTHWEST PERIODONTICSPACIFIC NW
PERIODONTICS
411 STRANDER BL
EL1O-1026
Parcel No.:
Address:
Tenant Name:
City0f 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
0223200052
411 STRANDER BL TUKW
PACIFIC NW PERIODONTICS
ELECTRICAL PERMIT
Permit Number:
Issue Date:
Permit Expires On:
EL10 -1026
12/15/2010
06/13/2011
Owner:
Name:
Address:
Contact Person:
Name:
Address:
Contractor:
Name:
MEDICAL CENTERS CO LLC
411 STRANDER BLVD STE 107 , TUKWILA WA 98188
RON SCHINDLER Phone: 206 - 953 -7761
1416 NW 46 ST -STE 105 PMB #134 , SEATTLE WA 98107
CABLE DESIGNS Phone: 206 - 953 -7761
Address: 1416 NW 46 ST - STE 105 PMB #134 , SEATTLE WA 98107
Contractor License No: CABLED *969RA Expiration Date: 11/29/2012
DESCRIPTION OF WORK:
ADD (20) NETWORK RUNS, ADD (6) TELEPHONE RUNS
Value of Electrical Work:
NRES: $3,200.00
RES: $0.00
Type of Fire Protection: UNKNOWN
Electrical Service provided by: PUGET SOUND ENERGY
Permit Center Authorized Signature:
Fees Collected: $157.50
National Electrical Code Edition: 2008
Date:
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 performance of work. I am authorized to sign and obtain this electrical permit and agree to the conditions on the back
of this permit.
Signature:
cfrj �-L CQ_ Date: 0
Print Name: i4' L- SC- 41/ .J LE rz -
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 -9/09
ELI 0-1026 Printed: 12 -15 -2010
• •
PERMIT CONDITIONS
Permit No. EL10 -1026
* *ELECTRICAL **
1: A copy of the electrical work permit shall be posted or otherwise made readily accessible to the
Electrical Inspector at each work site.
2: Approved plans shall be maintained at the construction site and shall be readily available to the
Electrical Inspector.
3: All electrical work shall be in accordance with NFPA 70 - NEC, and requirements for electrical
installations, Chapter 296 -46B WAC.
4: 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.
5: 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.
6: 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.
doc: EL -9/09
ELI 0-1026 Printed: 12 -15 -2010
CITY OF TUKWILA
Community Development Department
Permit Center
6300 Southcenter Blvd., Suite 100
Tukwila, WA 98188
http://wwwci.tukwila.wa.us
Electrical Permit No. Ll t (49
Project No.
(For office use only)
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
Site Address:
y// Ji-.► '' 0 CIZ ,&LV
Tenant Name: ib tlie. n/1. -1 Pte-.10 aU'+71f.j
Property Owners Name: 0 i _ Q tZ �a -� •✓
Mailing Address: Lt// S/^ m.�e 0ER_ 13) U0
King Co Assessor's Tax No.: 0 2- Z 324 d 5Z
Suite Number: 30 Z Floor: 3
New Tenant: ❑ Yes g..No
' /Lt Ed) CA.) e-&-1.-1,÷4^,3 CO LLC-
Ste. /O? /LLG -1L.4 %4 98'/ $B'
City
State Zip
CONTACT;PERSON - •�Vlio'do Nve contact when yMpermit is:ready to.be slued
Name: KUN (i, (&(3& Qes )4 pts Day Telephone: 2- D(e " 953 ` 1-1(o
Mailing Address: H/4 H/4 NQ 54-/ Ste. /0 S 1 P,4ij3 *71/3,/ s-et / t'I1 q S 1 o?
State Zip
E -Mail Address: JZ ,J 0 L E2 aCO 'cRs'l i,./CI" Fax Number:
City
ELECTRICAL .CONTRACTOR INFORMATION
Company Name:
Mailing Address:
Contact Person:
C /3Ce ,0c:5 )7 i s
l 41/6 Nb•/'6 S� / ,Sty /65, P.)16 /3y J-/1
R o,( Se, /4- 0 E rL
E -Mail Address: re-v,.i 5c. N s , Q L.-et . c_mvcilt t . r/ef
City
Day Telephone: 'Zvi+ - 95-3 "7/4 t
Fax Number:
Expiration Date: ` Z q— ? ' 7Z
Contractor Registration Number: CA 45 L E10'15-6? le 9 i
State
(A/i9 98/ a'?
Zip
Valuation of Project (contractor's bid price): $ 3 4.'0
Scope of Work (please provide detailed information): 5.
A--P0 6 7-1,/_,y/daKt i
Will service be altered? ❑ Yes ❑ No Adding more than 50 amps? ❑ Yes ❑ No
Type of Use:
Type of work:
❑ New ❑ Addition ❑ Service Change ❑ Remodel ❑ Tenant Improvement
'Low Voltage ❑ Generator ❑ Fire Alarm ❑ Telecommunication ❑ Temporary Service
Property Served by:
21 Puget Sound Energy
❑ Seattle City Light
H:\Apptications \Forms - Applications On Line\2010 Applications \7.2010 - Electrical Permit Application.doc
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Page 1 of 2
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
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.
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:
Signature:
/
Print Name: o N rI 7 J c- 14 -1,.1 p L t Z
Mailing Address: / / i ( U✓ 'C�1--- ,S / .54-, / °'-S
Date:
Day Telephone: Z ° ' q S 3 ` 77c /
P/0 1 /3'/ j
City State
ggla'-1
Zip
IDate Application Accepted: Date Application Expires:
Staff Initials:
H: \Applicat ons \Forms - Applications On Line \2010 Applications \7 -2010 - Electrical Permit Application.doc
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Page 2 of 2
•
City of Tukwila
�y 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.tulcwila.wa.us
Parcel No.: 0223200052
Address: 411 STRANDER BL TUKW
Suite No:
Applicant: PACIFIC NW PERIODONTICS
RECEIPT
Permit Number: EL10 -1026
Status: PENDING
Applied Date: 12/15/2010
Issue Date:
Receipt No.: R10 -02509
Initials:
User ID:
WER
1655
Payment Amount: $157.50
Payment Date: 12/15/2010 02:14 PM
Balance: $0.00
Payee: RONALD SCHINDLER
TRANSACTION LIST:
Type Method Descriptio Amount
Payment Credit Crd VISA
Authorization No. 141331
ACCOUNT ITEM LIST:
Description
157.50
Account Code Current Pmts
ELECTRICAL PERMIT - NONR
000.322.101.00.00 157.50
Total: $157.50
doc: Receiot -06 Printed: 12 -15 -2010
Z
INSPECTION RECORD
Retain a copy with permit
INSPECTION NO. PERMIT NO.
CITY OF TUKWILA BUILDING DIVISION
6300 Southcenter Blvd., #100, Tukwila. WA 98188 (206) 431 -3670.
Permit Inspection Request Line (206) 431 -2451 `(L
640-/Wo
PrcJ
4t- - 4o4.
°
&(0p0477c5
Type of Inspection:
60
Address:
r ��
' J
Date Called:
Special In tr�ictions:
Special
Date Wanted:
—y
/�m
Requester:
Phone No:
Approved per applicable codes.
COMMENTS:
Corrections required prior to approval. 7
Date: 01 '
n REINSPECTIdN FEE REQUIRED. Prior to next inspection. fee must be
paid at 6300 Southcenter Blvd.. Suite 100. Call to schedule reinspection.
INSPECTION RECORD
Retain a copy with permit
INSPECTION NO. PERMIT NO.
CITY OF TUKWILA BUILDING DIVISION
6300 Southcenter Blvd., #100, Tukwila. WA 98188 (206) 431 -3670
Permit Inspection Request Line (206) 431 -2451
at 0 - to24,
Project( 1, (2
Project() . N. . d 6\1O Do :4mA
Type of Inspection:
7o®
Address:
911 STIZA D
Date Called:
Special Instructions:
Pi
Date Wanted:
/29 24
i
p.m..
Requester:
Phone No:
Approved per applicable codes. Corrections required prior to approval.
COMMENTS:
.07/ c6- LIA) cot/0c
AIM ini)
Inspector:
1/7&46\
n REINSPECTIONFEE REQUIRED. Prior to next inspection, fee must be
paid at 6300 Southcenter Blvd., Suite 100. Call to schedule reinspection.
Date:
/0
Contractors or Tradespeople Prer Friendly Page
•
Electrical Contractor
A business licensed by LEI 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
CABLE DESIGNS
2069537761
1416 Nw 46Th Street, Suite 105
PMB #134
Seattle
WA
98107
King
Individual
UBI No.
Status
License No.
License Type
Effective Date
Expiration Date
Suspend Date
Specialty 1
Specialty 2
602299994
Active
CABLED *969RA
Electrical Contractor
11/29/2004
11/29/2012
Telecommunications
Electrical Administrator INFORMATION
License SCHINRJ967Q9
Name SCHINDLER, RONALD J
Status Active
Business Owner Information
Name
Role
Effective Date
Expiration Date
SCHINDLER, RONALD J
Owner
12/01/2004
Bond Amount
Bond Information
Page 1 of 2
Bond
Bond Company Name
Bond Account Number
Effective Date
Expiration Date
Cancel Date
Impaired Date
Bond Amount
Received Date
5
American Contractors
Indem CO
100145207
11/18/2010
Until Cancelled
$4,000.00
11/15/2010
4
Ullico Casualty
Company
SB009001061
11/18/2009
Until Cancelled
11/23/2010
$4,000.00
11/12/2009
2
PLATTE RIVER INS CO
41089863
11/18/2006
Until Cancelled
01/14/2010
$4,000.0012/18/2006
10/24/2008
1
ACCREDITED SURETY
E CAS CO
10034812
11/18/2004
Until Cancelled
12/30/2006
$4,000.0012/01/2004
10/16/2007
Assignment of Savings Information No records found for the previous 6 year period
Insurance Information
Insurance
Company Name
Policy Number
Effective Date
Expiration Date
Cancel Date
Impaired Date
Amount
Received Date
7
01-110 CAS INS
BH01053294981
11/18/2010
11/18/2011
$1,000,000.0009
/09/2010
6
OOHIO CAS INS
BH01053294981
11/18/2009
11/18/2010
$1,000,000.00
10/19/2009
5
OHIO CAS INS
BH00953294981
11/18/2008
11/18/2009
$1,000,000.00
10/24/2008
4
OHIO CAS INS
BH00853294981
11/18/2007
11/18/2008
$170,000.00
10/16/2007
3
OHIO CAS INS
BH0053294981
11/18/2006
11/18/2007
$170,000.0009/29
/2006
2
OHIO CAS INS
B1-10053294981
11/18/2005
11/18/2006
$1,000,000.0011
/17/2005
1
OOHIO CAS INS
BH0053294981
11/18/2004
11/18/2005
$1,000,000.00
12/01/2004
https://fortress.wa.gov/lni/bbip/Print.aspx
12/15/2010