Loading...
HomeMy WebLinkAboutPermit EL11-0040 - GENOA HEALTHCAREThis record contains information which is exempt from public disclosure pursuant to the Washington State Public Records Act, Chapter 42.56 RCW as identified on the Digital Records Exemption Log shown below. EL11 -0040 Genoa Healthcare 18300 Cascade Avenue RECORDS DIGITAL D- ) EXEMPTION LOG THE ABOVE MENTIONED PERMIT FILE INCLUDES THE FOLLOWING REDACTED INFORMATION Page # tode Exemption = 8rlef Explanatory DeSclriptiop �t�tutel ule The Privacy Act of 1974 evinces Congress' intent that social security numbers are a private concern. As such, individuals' social security Personal Information — numbers are redacted to protect those Social Security Numbers individuals' privacy pursuant to 5 U.S.C. sec. 5 U.S.C. sec. DR1 Generally — 5 U.S.C. sec. 552(a), and are also exempt from disclosure 552(a); RCW 552(a); RCW under section 42.56.070(1) of the Washington 42.56.070(1) 42.56.070(1) State Public Records Act, which exempts under the PRA records or information exempt or prohibited from disclosure under any other statute. Redactions contain Credit card numbers, debit card numbers, electronic check numbers, credit Personal Information — expiration dates, or bank or other financial RCW 12 DR2 Financial Information — account numbers, which are exempt from 42.56.230(5) RCW 42.56.230(4 5) disclosure pursuant to RCW 42.56.230(5), except when disclosure is expressly required by or governed by other law. GENOA HEALTHCARE 18300 CASCADE AV EL1 1 -0040 Parcel No.: Address: Tenant Name: 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: / /wwwciiukwila.wa.us 7888900175 18300 CASCADE AV TUKW GENOA HEALTHCARE ELECTRICAL PERMIT Permit Number: EL11 -0040 Issue Date: 01/19/2011 Permit Expires On: 07/18/2011 Owner: Name: Address: Contact Person: Name: Address: RIVERPOINT TWO LLC 1 100 OLIVE WAY #1005 , SEATTLE WA 98101 EARL HUMPHRES 855 TROSPER RD # 108 BOX 365 , TUMWATER WA 98512 Contractor: Name: S & H ELECTRIC INC Address: 855 TROSPER RD #108 , TUMWATER WA 98512 Contractor License No: SHELEI *044JZ Phone: 206 - 793 -2421 Phone: 360 352 -1621 Expiration Date: 04/10/2012 DESCRIPTION OF WORK: ADD 68 DUPLEX OUTLETS 2 DEDICATED, 4 FOURPLEX OUTLETS, 2 GFCI OUTLETS, 18 MOTION . :.VITCHES, 3 SINGLE SWITCHES, RELOCATE EXISTING LIGHTS Value of Electrical Work: NRES: $15,000.00 RES: $0.00 Type of Fire Protection: UNKNOWN Electrical Service provided by: PUGET SOUND ENERGY Permit Center Authorized Signature: Fees Collected: $350.50 National Electrical Code Edition: 2008 Date: \--1.9-- 1, 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 grar-, Ong 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 pc r•.it. Signature: Print Name: 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 -9/09 EL11 -0040 Printed: 01 -19 -2011 • • PERMIT CONDITIONS Permit No. EL 11 -0040 * *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 EL11 -0040 Printed: 01 -19 -2011 CITY OF TUKWILA Community Development Department Permit Center 6300 Southcenter Blvd., Suite 100 Tukwila, WA 98188 http://www.citukwila.wa.us Electrical Permit No. 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 ** ��ii /� /j King Co Assessor's Tax No.: 7 &kel O -00 5 Site Address: /d� dX eAse -40 e4Vg. S Suite Number: Floor: .2 G-5A0A eAc7N -,ee Tenant Name: New Tenant: IA- Yes El ..No Property Owners Name: Mailing Address: City State Zip CONTACT PERSON - Who do we contact when your permit is ready to be issued Name: l7GG/��2-� S /� Day Telephone:-9e6- 7�3- 9�J _ Mailing ddress: g. TAO- P, RD- 8t - %$ / 4- - / S7 �. g is z�r�r.��►- 7��L�s' L A [ City tare QZ' E -Mail Address: bU- G A (jmpe- iv',�g%1 /�fi/�• C ax Number gs�_ v'2 ELECTRICAL CONTRACTOR INFORMATION Company Name: p 1 EL /G //� iG,,N G .j %EL I - o4' 7 3 Z- Mailing Mailing Address: D 6� 7-0\5 1:2&:,€' � 5 Q. / 8� �� /44T. / EGG "- / c� 2 Contact Person: 1---447,2094/7/X4e5 E -Mail Address: /45 A B©VE Contractor Registration Number:iB. (oZ 170' /V Expiration Date: /"- 7/ City State ' Zip Day Telephone: 2 - 793 '/ 2 / Fax Number:' .8,57.7- 5 986 Valuation of Project (contractor's bid price): $ /5; 460© Scope of Work (please provide detailed information): Aid t 8 de--17a44 GQ�GG� -2Z7/.47E p f 7L 4OLG_ Dom-r- TS �- �.�� D -7Z—, S - /f _,720T4.ri Sa /Z g- //v& L/, S ,ee- 4C,4 / N G L✓6.17IT-5 Will service be altered? ❑ Yes No Adding more than 50 amps? ❑ Yes No Type of Use: Type of work: ❑ New ❑ Addition ❑ Service Change - Remodel 13,1 Tenant Improvement ❑ Low Voltage ❑ Generator ❑ Fire Alarm ❑ Telecommunication ❑ Temporary Service Property Served by: NiSi Puget Sound Energy ❑ Seattle City Light H:\Applications \Forms - Applications 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, furnace 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 =;; r� 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: EA-et C • fe:/ P/ S ��+ /Day Telephone lZ ` 7,C3 c7V;7 Mailing Address: 235"7easPP�e �� e�O25 {O� %G%li�/i�%7� td4 91372 City State Date: /- a -// Zip Date Application Accepted: Date Application Expires: Staff Initials: H:Wppiications'Forms- Applications On Lined -2009 - Electrical Permil Application.doc bh Page 2 of 2 • • st4ILA4p City of Tukwila Department of Community Development 0 6300 Southcenter Boulevard, Suite #100 y Tukwila, Washington 98188 Phone: 206-431-3670 Fax: 206 - 431 -3665 Web site: http: / /www.ci.tukwila.wa.us Parcel No.: 7888900175 Address: 18300 CASCADE AV TUKW Suite No: Applicant: GENOA HEALTHCARE RECEIPT Permit Number: EL11 -0040 Status: PENDING Applied Date: 01/19/2011 Issue Date: Receipt No.: R11-00106 Payment Amount: $350.50 Initials: WER Payment Date: 01/19/2011 02:10 PM User ID: 1655 Balance: $0.00 Payee: EARL HUMPHRES TRANSACTION LIST: Type Method Descriptio Amount Payment Check 4271 350.50 Authorization No. ACCOUNT ITEM LIST: Description Account Code Current Pmts ELECTRICTAL PERMIT - NONR 000.322.101.00.00 350.50 Total: $350.50 doc: Receiot -06 Printed: 01 -19 -2011 r L, to- • • INSPECTION RECORD Retain a copy with permit INSPECtION NO. /vbtfo RMIT NO. CITY OF TUKWILA BUILDING DIVISION 6300 Southcenter Blvd., #100, Tukwila. WA 98188 p_(206) 431 -3670 Permit Inspection Request Line (206) 431 -2451 Project: C1I Type of Inspection: �L3 Address: 6° Date Called: Special Instructions: - . Date Wanted: �� / m. : m. Requester: Phone No: Approved per applicable codes. Corrections required prior to approval. COMMENTS: 4. Inspector: (Date: 020/2"5—/I ri REINSPECTION FEE REQUIRED. Prior to next inspection, fee must be paid at 6300 Southcenter Blvd.. Suite 100. Call to schedule reinspection. •- a • • • • • • • • L . ti INSPECTION RECORD Retain a copy with permit INSPECTION NO. PERMIT NO. CITY, OF TUKWILA BUILDING DIVISION 6,1/-00410 6300 Southcenter Blvd.;.#100, Tukwila. WA 98188 1� (206) 431 -3670 Permit Inspection Request Line (206) 431 -2451 'Project: 6664 goi f ti Type of Inspection:r04) Rt./a- - Boa 4&.. P67,3 Aisfi, Address: /Boo OvocA-06 Date Called: Special Instructions: Date Wanted: Y ■ a . Requester: Phone No: Approved per applicable codes. Corrections required prior to approval. COM MENTS: Rt./a- - Boa 4&.. P67,3 Aisfi, e3- To ,i1c, oc ;s r'€_nii#t8 .. an Id 9tictit, Fog, cd6143.cis 04 4�. C :.) ❑ REINSPECTION FEE REQUIRED. Prior to next inspection. fee must be • paid at 6300 Southcenter Blvd.. Suite 1.00. Call to schedule reinspection. • INSPECTION NO. INSPECTION RECORD Retain a copy with permit PERMIT NO. CITY OF TUKWILA BUILDING DIVISION 6300 Southcenter Blvd., #100, Tukwila. WA 98188 (206) 431 -36 Permit Inspection Request Line (206) 431 -2451 Project: G a /4" ' 14 Type of Inspection: 7,,,,, Address: /ow thseA4y6 Date Called: Special Instructions: . Date Wanted: ,., / a.71 p.m. Requester: Phone No: Approved per applicable codes. COMMENTS: EJCorrections required prior to approval. • rkiuAi(li - 63440-01\ g6d4 f# //1 tee Inspector: jiti414A1 n.REINSPECTION FEE REQUIRED. Prior to next inspection. fee must be paid at 6300 Southcenter Blvd., Suite 100: Call to schedule reinspection. (Date: D2' 0411 ere • - . - ...p.y..1- • r • :•x. • •r ••••••.r.111, .'+:.a•rw ti.... .. .. s. Win••.. . --•.1' •r..p l INSPECTION NO. CITY OF TUKWILA BUILDING DIVISION 6300 Southcenter Blvd., #100, Tukwila, WA 98188 INSPECTION RECORD Retain a copy with permit t2. l/ -yO PERMIT NO. (206)431 -3670 Project: Project, OA mes- Ac�-He/Fao Type of Inspection: ?003 Address: / 0300 C,asc.t -ate Air Date Called: Special Instructions: - Date Wanted: l .2 /. // dD p.m. Requester: Phone No: 'pproved per applicable codes. LJ Corrections required prior to approval. COMMENTS: 4 J 4, Inspector: IV/2 Y 4 v-07 (Date: 0 $60.00 RENVSPECTION FEE REQUIRED. Prior to inspection, fee must be paid at 6300 Southcenter Blvd., Suite 100. Call to schedule reinspection. Receipt No.: !Date: Contractors or Tradespeople Pr1 ter Friendly Page Electrical Contractor A business licensed by LEt1 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 S lY H ELECTRIC INC 3603521621 855 Trosper Rd 1,108 BOX 365 Tumwater WA 98512 Thurston Corporation UBI No. Status License No. License Type Effective Date Expiration Date Suspend Date Specialty 1 Specialty 2 601703614 Active SHELEI'044JZ Electrical Contractor 4/9/1996 4/10/2012 General Unused Electrical Administrator INFORMATION License SCHWESR932OJ Name Status SCHWENK, SCOTT R Active Business Owner Information Name Role Effective Date Expiration Date HUMPHRES, EARL Agent 04/09/1996 4/25/2007 HUMPHRES, BRIAN President 01/18/2011 $500.00 HUMPHRES, EARL Vice President 01/18/2011 ELECTRICAL CITATION SMITH, WILLIAM H Member 04/09/1996 01/03/2011 HUMPHRES, TERRI Secretary 04/09/1996 01/03/2011 Bond Information No records found for the previous 6 year period Assignment of Savings Information Page 1 of 1 Savings Assignment of Savings Account Number Effective Date Release Date Assignment Type Impaired Date Amount Received Date 1 4/8/1996 Until Released Bond $4,000.00 Insurance Information No records found for the previous 6 year period Summons /Complaint Information Summons and Complaints are not filed with the department for this contractor type Warrant Information Warrants are not filed with the department for this contractor type Infractions /Citations Information Infraction / Citation Date RCW Code Type Status Violation Amount EBRIC00799 4/25/2007 19.28.161 RCW ELECTRICAL CITATION Satisfied $500.00 EVANC00253 3/12/2007 19.28.101 RCW ELECTRICAL CITATION Satisfied $250.00 EHATR00288 7/10/2007 19.28.101 RCW ELECTRICAL CITATION Satisfied $250.00 https: // fortress .wa.gov /lni /bbip /Print.aspx 01/19/2011