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Home My WebLink AboutPermit EL11-0698 - GROUP HEALTH COOPERATIVEGROUP HEALTH COOPERATIVE 12401 EAST MARGINAL WY S EL1 1 -0698 City ofkukwila • Department of Community Development 6300 Southcenter Boulevard, Suite #100 Tukwila, Washington 98188 Phone: 206 - 431 -3670 Fax: 206-431-3665 Web site: http: / /www.TukwilaWA.gov ELECTRICAL PERMIT Parcel No.: 7345600490 Address: 12401 EAST MARGINAL WY S TUKW Project Name: GROUP HEALTH COOPERATIVE Permit Number: EL11 -0698 Issue Date: 07/28/2011 Permit Expires On: 01/24/2012 Owner: Name: GROUP HEALTH COOPERATIVE Address: JIM DOUMA PROPERTY MGMT , 521 WALL ST Contact Person: Name: LARRY SALZBRUN Address: 3623 EAST MARGINAL WY S , SEATTLE WA Contractor: Name: EVERGREEN TECHNOLOGIES INC Address: 3623 EAST MARGINAL WAY S , SEATTLE WA Contractor License No: EVERGTI929K9 Phone: 206 - 774 -13333 Phone: Expiration Date: 05/22/2012 DESCRIPTION OF WORK: REMOVE TELE & DATA CABLING FROM OLD OFFICE CUBICLES AND REINSTALL IN NEW CUBICLES Value of Electrical: NRES: $32,854.00 RES: $0.00 Type of Fire Protection: UNKNOWN Electrical service provided by: SEATTLE CITY LIGHT Fees Collected: $660.10 National Electrical Code Edition: 2008 Permit Center Authorized Signature: vv /N �. 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 ormanceigrork. I am authorized to sign and obtain this electrical permit. Signature: Print Name: 4 !2/1 / Date: "/ x61( 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 -4/10 EL11 -0698 Printed: 07 -28 -2011 • • PERMIT CONDITIONS Permit No. EL11 -0698 * *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 -4/10 EL11 -0698 Printed: 07 -28 -2011 CITY OF TUKWI A Community Development Department Permit Center 6300 Southcenter Blvd., Suite 100 Tukwila, WA 98188 http://www.TukwilaWA.gov • Electrical Permit No. gL 11- 0 (p Q g 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 / S Co Assessor's Tax No.: Site Address: r r g t F %7A i /t/A L A S Suite Number: Floor: Tenant Name: l3'(�AU /IeA \`I &D /L� 1 r �J New Tenant: ❑ Yes Property Owners Name: ( L,QP F ) CB QChA2Q £I/o`s Mailing Address: P,S--'D/ C /1/4;A/./4 ( /at - %/4i111A (,(JA, (U% City State ❑..No TV/GS' Zip CONTACT PERSON - Who do we contact when your permit is ready to be issued Name: LAp P ( SA jr li /ui Al Day Telephone: Mailing Address: 36,2.3 0 ti aiyiniA 1 (4)40e, g Se lif—d LL)/4 • ?AIL/ /I (/ City State Zip E -Mail Address: LSA %Z.II2uA Q4e/2-9RaeN /e G- I C`DP1 _ Fax Number: .914 -V) 4/- (4t)( ELECTRICAL CONTRACTOR INFORMATION Company Name: 6exyRee.n /.eG AD (d Q)t e S Mailing Address: 23 g til}viAtial (,tJAt/ S Contact Person: `A02 y _cif[ •b(.J4A,t1 E -Mail Address: I — Contractor Registration Number: Fag/W-T /7 a q 1 C' A1f1e_. bt.JJ , 5W3L( City State Zip Day Telephone: dl?l - 1'54-1333 Fax Number: 266- 74i/- /44j( Expiration Date: 'a� - .20/ 2 Valuation of Project (contractor's bid price): $ 34, '.6 "(, DD Scope of Work (please provide detailed information): RP -11D U e. 1'- / r d,.f CA6I J"c% -f2o#1. / d, C'uL-c, igs 2p- ;Ais7' t/ , ii /ie,.,i rt, tAx 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: ❑ Puget Sound Energy ❑ Seattle City Light H:\Applications\Pomis- Applications On Line\2010 Applications \7 -2010 - Electrical Permit Application.doc bh Page 1 of 2 u(P°/'' 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: . � • / - 4 1..4_ Date: Print Name: 41, / ,c1 7 i4il Ai Day Telephone: o'6 4- 1711 33 3 E' /1.7 J,r tvay spp t/1 td4 . 7,r/.2 4 City State Zip Mailing Address: 36 Date Application Accepted: Date Application Expires: Staff Initials: H:\Applicalions \Forms - Applications On Line\20I0 Applications \7 -2010 - Electrical Permit Application.doc bh Page 2 of 2 1 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.TukwilaWA.gov RECEIPT Parcel No.: 7345600490 Permit Number: EL1 1-0698 Address: 12401 EAST MARGINAL WY S TUKW Status: PENDING Suite No: Applied Date: 07/28/2011 Applicant: GROUP HEALTH COOPERATIVE Issue Date: Receipt No.: R11 -01601 Initials: User ID: WER 1655 Payment Amount: $660.10 Payment Date: 07/28/2011 11:25 AM Balance: $0.00 Payee: LARRY SALZBRUN TRANSACTION LIST: Type Method Descriptio Amount Payment Credit Crd VISA Authorization No. 02542C ACCOUNT ITEM LIST: Description 660.10 Account Code Current Pmts ELECTRICAL PERMIT - NONR 000.322.101.00.00 660.10 Total: $660.10 doc: Receiot -06 Printed: 07 -28 -2011 INSPECTION NO. INSPECTION RECORD Retain a copy with permit PERMIT NO. CITY OF TUKWILA BUILDING DIVISION 6300 Southcenter Blvd., #100, Tukwila: WA 98188 Q (206) 431 -36 Permit Inspection Request Line (206) 431 -2451 Project: owe 1-1s 'i Type of Inspection: Gov Address: 119°1 C. flikek. Date Called: Special Instructions: Date Wanted:. �l, 0.0n. Requester: Phone No: priApproved per applicable codes. COMMENTS: Corrections required prior to approval. X Inspector: Date: Oe hi /ti ri REINSPECTION FEE REQUIRED. Prior to next inspection. fee must be paid at 6300 Southcenter Blvd., Suite 100. Call to schedule reinspection. Contractors or Tradespeople Prr, Friendly Page • 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 EVERGREEN TECHNOLOGIES INC 2067741400 3623 E Marginal Way S Seattle WA 98134 King Corporation UBI No. Status License No. License Type Effective Date Expiration Date Suspend Date Specialty 1 Specialty 2 602821961 Active EVERGTI929K9 Electrical Contractor 5/22/2008 5/22/2012 Limited Energy Unused Master Electrician INFORMATION License SALZBLG972CK Name SALZBRUN, LARRY Status Active Business Owner Information Name Role Effective Date Expiration Date SCHRIFFRIN, DAVID W Agent 05/22/2008 MACKEY, JAMES E President 05/22/2008 MACKEY, QUINN C Secretary 05/22/2008 MACKEY, JAMES E Treasurer 05/22/2008 MACKEY, DREW W Vice President 05/22/2008 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 1 HARTFORD FIRE INS CO 52BSBFA6318 05/16/2008 Until Cancelled $4,000.00 05/29/2008 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 https: // fortress .wa.gov /lni/bbip/Print.aspx 07/28/2011