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HomeMy WebLinkAboutPermit EL11-0416 - SIGHTLINE HEALTHSIGHTLINE 200 ANDOVER PK E EL1 1 -0416 Parcel No.: 0223100099 CityIlkf Tukwila 1 Department of Community Development 6300 Southcenter Boulevard, Suite #100 Tukwila, Washington 98188 Phone: 206 -431 -3670 Inspection Request Li ne: 206 - 431 -2451 Web site: http: / /www.ci.tukwila.wa.us Address: 200 ANDOVER PK E TUKW Tenant Name: SIGHTLINE ELECTRICAL PERMIT Permit Number: EL11 -0416 Issue Date: 05/12/2011 Permit Expires On: 11/08/2011 Owner: Name: ANDOVER PLAZA LLC Address: 1501 N 200TH ST , SHORELINE WA 98133 Contact Person: Name: JEREMY MOELLER Address: PO BOX 3205 , KIRKLAND WA 98083 Contractor: Name: C F M HEATING & COOLING INC Address: P 0 BOX 3205 , KIRKLAND WA 98083 Contractor License No: CFMHEFM953QT Phone: 425 821 -1293) Phone: 425 821 -1293 Expiration Date: 11/30/2011 DESCRIPTION OF WORK: INSTALL (9) THERMOSTATS Value of Electrical Work: NRES: $1,000.00 RES: $0.00 Type of Fire Protection: SPRINKLERS /AFA Electrical Service Provided by: PUGET SOUND ENERGY Permit Center Authorized Signature: I hereby certify that I have read an, governing this work will be compli exa d wit The granting of this permit does not p construction or the performance of work. of this permit, s Signature: Fees Collected: $96.60 National Electrical Code Edition: 2008 Date: ned this permit and know the same to be true and correct. All provisions of law and ordinances , whether specified herein or not. e to give authority to violate or cancel the provisions of any other state or local laws regulating I am authorized to sign and obtain this electrical permit and agree to the conditions on the back Print Name: 6feML1 /LIceJler 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 EL 11 -0416 Printed: 05 -12 -2011 • • PERMIT CONDITIONS Permit No. EL 11 -0416 * *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 -0416 Printed: 05 -12 -2011 CITY OF TUKWILA Community Development Department Permit Center 6300 Southcenter Blvd., Suite 100 Tukwila, WA 98188 http://www.ci.tukwila.wa. us Electrical Permit No. Project No. (loci o() (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: 200 Andover- 90,(k E Tenant Name: 6dili t; nP Property Owners Name: Mailing Address: King Co Assessor's Tax No.: 022,21D -0711 Suite Number: New Tenant: Floor: Yes ❑..No City State Zip CONTACT PERSON - Who do 1 contact when your permit is ready to be issued Name: 3-efe,(Y\9 !v `oe l ey Mailing Address: f1' O- ° '60)1 3205. E -Mail Address: LM C-ern- c wacc -cv✓rN Day Telephone: X;rwcocl City Fax Number: -/26- 82/- /2/3 1,`)\ 98693 State Zip 4125 ' 2-1-13`/3 ECTRICAL CONTRACTOR INFORMATION Company Name: CFM N ea r anct Cool; n5 zn c . Mailing Address: vv. 13„,, 3225 K6r.ElaykGi Contact Person: Jere M, �oe l \e( Se E -Mail Address: (eMLj(l of m - hvccr, ic,v Contractor Registration Number: CFM HE 1 M5 3 (rT City Day Telephone: Fax Number: Expiration Date: Wtatie51 c18083 1425 - 82.1 -12 93 y25-82i -13c13 0/30A Valuation of Project (contractor's bid price): $ ' 1 000 Scope of Work (please provide detailed information): 746+41F -I *term 06- "a' f "3' Will service be altered? ❑ Yes Type of Use: Type of work: ❑ New gLow Voltage It No Adding more than 50 amps? ❑ Yes Nr No ❑ Addition ❑ Service Change ❑ Generator ❑ Fire Alarm Property Served by: 1) Puget Sound Energy ❑ Seattle City Light 11 \Applications \Forms - Applications On Line \2010 Applications \7 -2010 - Electrical Permit Applicanon.doc bh Page 1 of 2 ❑ Remodel ❑ Tenant 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 $10.50 ea APP TCATiliVi QTES Value of Construction — In all cases, a value of construction amount should be entered by the applicant. This figure will be reviewed and is subject to possible revision by the Permit Center to comply with current fee schedules. Expiration of Plan Review — Applications for which no permit is issued within 180 days following the date of application shall expire by limitation. The Building Official may grant one extension of time for an additional period not to exceed 90 days. The extension shall be requested in writing and justifiable cause demonstrated. I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION AND KNOW THE SAME TO BE TRUE UNDER PENALTY OF PERJURY BY THE LAWS OF THE STATE OF WASHINGTON, AND I AM AUTHORIZED TO APPLY FOR THIS PERMIT. BUILDING OWNER OR ELECTRICAL CONTRACTOR: Signature: (J Zer-e m� Moeller Print Name: �{� Mailing Address: T o•'X 3205 Date Application Accepted: Date: 05-'11-11$ Day Telephone: 127--82-/-121,3 Kirhanl 106 16c 63 City State Zip Date Application Expires: H Applications\Forms- Applications On l.ine\2010 Applications\7 -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.tulcwila.wa.us Parcel No.: 0223100099 Address: 200 ANDOVER PK E TUKW Suite No: Applicant: SIGHTLINE RECEIPT Permit Number: EL11 -0416 Status: PENDING Applied Date: 05/12/2011 Issue Date: Receipt No.: R11 -00954 Payment Amount: $96.60 Initials: JEM Payment Date: 05/12/2011 10:23 AM User ID: 1165 Balance: $0.00 Payee: CFM HEATING AND COOLING INC. TRANSACTION LIST: Type Method Descriptio Amount Payment Check 5978 96.60 Authorization No. ACCOUNT ITEM LIST: Description Account Code Current Pmts ELECTRICAL PERMIT - NONR 000.322.101.00.00 96.60 Total: $96.60 doc: Receipt-06 Printed: 05 -12 -2011 • 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 -3 'Peririt Inspection Request Line (206) 431 -2451 etitoiftc, Project: r, , , e Type of Inspection: © O Addre4ss 6 " , ( Date Called: Special I•nst ?t ctfoiis: • Date Wanted:. (((( 0 a.m Re uester: q Phone No: Approved per applicable codes. a Corrections required prior to approval. COMMENTS: • Date: 411 1.1 RE-INSPECTION FEE REQUIRED. Prior to next inspection. fee must be paid) at 6300 Southcenter Blvd.. Suite 100. Call to schedule reinspection. -- mrr.• t':•'',".„ INSPECTION Request • Retain a copy with permit i� INSPECTION NO. PERMIT NO. CITY OF TUKWILA BUILDING DIVISION 6300 Southcenter Blvd., #100, Tukwila. WA 98188 e.. (206) 431 -36 Permit Inspection Request Line (206) 431 -2451 Project: 314,4 -rod Type of Inspection: (09 Address: zoo Aishoigtr . Date Called: Special Instructions: /; cyr,r) Date Wanted: Requester: Phone No: giApproved per applicable codes. a Corrections required prior to approval. COMMENTS: D•�• � o Jr,N Inspector: Date: 0 I I REINSPECTION FEE REQUIRED. Prior to next inspection, fee must be paid at 6300 Southcenter Blvd.. Suite 100. Call to schedule reinspection. .Y, • • • Contractors or Tradespeople titer Friendly Page 1 Electrical Contractor A business licensed by L&I 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 C F M HEATING a COOLING INC 4258211293 11447 120Th Ave Ne #200 Kirkland WA 98033 King Corporation UBI No. Status License No. License Type Effective Date Expiration Date Suspend Date Specialty 1 Specialty 2 602361244 Active CFMHEFM953QT Electrical Contractor 11/30/2005 11/30/2011 Hvac /Rfrg Ltd Energy Unused Electrical Administrator INFORMATION License SELLMMA91686 Name SELLMAN, MICHAEL A Status Active Business Owner Information Name Role Effective Date Expiration Date CLANCY, SHAUN P Agent 11/30/2005 Bond Amount CLANCY, SHAUN P President 11/30/2005 797048C Bond Information Page 1 of 1 Bond Bond Company Name Bond Account Number Effective Date Expiration Date Cancel Date Impaired Date Bond Amount Received Date 2 DEVELOPERS SURETY Et INDEM CO 797048C 11/21/2008 Until Cancelled 19.28.271 RCW ELECTRICAL CITATION $4,000.0012/19/2008 $250.00 1 RELIANCE INS CO SRS1008650 11/21/2005 Until Cancelled 01/08/2009 EBOES00512 $4,000.0011 /30/2005 Assignment of Savings Information No records found for the previous 6 year period 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 ECHAE00296 12/28/2007 19.28.101 RCW ELECTRICAL CITATION Satisfied $250.00 EMEHU03041 10/26/2009 19.28.271 RCW ELECTRICAL CITATION Satisfied $250.00 EBOES00511 12/16/2010 19.28.101 RCW ELECTRICAL CITATION Satisfied $1,000.00 EBOES00512 12/16/2010 19.28.101 RCW ELECTRICAL CITATION Satisfied $250.00 https: // fortress .wa.gov /lni/bbip /Print.aspx 05/12/2011