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Home My WebLink AboutPermit EL12-0463 - US DENTAL LABSThis 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. EL12 -0463 US Dental Labs 645 Strander Boulevard RECORDS DIGITAL D- ) EXEMPTION LOG THE ABOVE MENTIONED PERMIT FILE INCLUDES THE FOLLOWING REDACTED INFORMATION F,age # Code Exemption � � �� Brief Explsnatoty Description, Statute /Rule The Privacy Act of 1974 evinces Congress' intent that Personal Information — social security numbers are a private concern. As such, individuals' social security numbers are Social Security Numbers redacted to protect those individuals' privacy pursuant 5 U.S.C. sec. DR1 Generally — 5 U.S.C. sec. to 5 U.S.C. sec. 552(a), and are also exempt from 552(a); RCW 552(a); RCW disclosure under section 42.56.070(1) of the 42.56.070(1) 42.56.070(1) Washington 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 Personal Information — numbers, electronic check numbers, credit expiration 10 DR2 Financial Information — dates, or bank or other financial account numbers, RCW RCW 42.56.230(4 5) which are exempt from disclosure pursuant to RCW 42.56.230(5) 42.56.230(5), except when disclosure is expressly required by or governed by other law. US DENTAL LABS 645 STRANDER BL EL1 2-0463 City (*Tukwila Department of Community Development 6300 Southcenter Boulevard, Suite #100 Tukwila, Washington 98188 Phone: 206 -43 1 -3670 Fax: 206-431-3665 Web site: http: / /www.TukwilaWA.gov Parcel No.: 0223300020 Address: 645 STRANDER BL TUKW Project Name: US DENTAL LABS ELECTRICAL PERMIT Permit Number: EL12 -0463 Issue Date: 05/18/2012 Permit Expires On: 11/14/2012 Owner: Name: WALTON CWWA TUKWILA 1 LLC Address: C/O CTMT - WALTON RE TAX , 4678 WORLD PARKWAY CIR Contact Person: Name: JEFF COY Phone: 206 - 393 -7545 Address: 2187 88 PL S , KENT WA Contractor: Name: CJ ELECTRICAL SUPPLY & SVCS LL Address: 24317 NE 27 PL , SAMMAMISH WA Contractor License No: CJELEES966M7 Phone: 425 766 -7677 Expiration Date: 10/23/2012 DESCRIPTION OF WORK: INSTALL (4) 20 AMP 120 VOLT CIRCUITS TO (4) NEW DUPLEX RECEPTACLES Value of Electrical: NRES: $1,600.00 RES: $0.00 Type of Fire Protection: UNKNOWN Electrical service provided by: PUGET SOUND ENERGY Permit Center Authorized Signature: Fees Collected: National Electrical Code Edition: $115.50 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 •ermit does not presume to give authority to violate or cancel the provisions of any other state or local laws regulating construction or pe or : n• of vy6 k. I am authorized to sign and obtain this electrical permit. Signature: Print Name: Date: 5 2- 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 EL12 -0463 Printed: 05 -18 -2012 • PERMIT CONDITIONS Permit No. EL 12 -0463 * *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 EL12 -0463 Printed: 05 -18 -2012 CITY OF TUKWI/4 Community Developmi )epartment Permit Center 6300 Southcenter Blvd., Suite 100 Tukwila, WA 98188 http: / /www.TukwilaWA.gov 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 ** King Co Assessor's Tax No.: Site Address: jP y'S S yp�� 341/0 -744014 Suite Number: 645' Floor: Tenant Name: (f tJ �%i (_ G--3 New Tenant: ; Yes Name: sF C Address: 3.,1 G/'7 gT pL� S. City: tz...yytt �-- State: Zip: 9 t o 3 Phone 393- Fax: Fax: Email: Valuation of Project (contractor's bid price): ❑.. No Company Name: G -LLZ ( C Address: .2_ 3 17 (4C -2 771 -, T ) L City: st( StateWi r Zip: Vc774 Phone:. 25^ "2 ,7 oQeax: Name: o e Tukwila Business License No.; —zL Address: 1.1)-44-Nt. t-_-.A. l..0'b ( IA State: wA Zip: City: :` 014 Name: sF C Address: 3.,1 G/'7 gT pL� S. City: tz...yytt �-- State: Zip: 9 t o 3 Phone 393- Fax: Fax: Email: Valuation of Project (contractor's bid price): ❑.. No Company Name: G -LLZ ( C Address: .2_ 3 17 (4C -2 771 -, T ) L City: st( StateWi r Zip: Vc774 Phone:. 25^ "2 ,7 oQeax: Contr Reg Not saces is fM,lExp Date: Tukwila Business License No.; Scope of Work (please provide detailed information): .—'�Ct �,T'74 (,.� C ) 2_e �t--� L t R c ut i 5 '-i (.41 1 7tel)) L- c Will service be altered? ❑ Yes No Type of Use: C -!ti"'& C ((/� Type of work: ❑ New ❑ Addition ❑ Service Change ❑ Low Voltage ❑ Generator ❑ Fire Alarm Pro . e erved b : Puget Sound Energy ❑ Seattle City Light Adding more than 50 amps? ❑ Yes /so H' pplications \Forms - Applications On Line \2011 Applications\Electrical Permit Application Revised 8- 9- 11.docx evised: August 2011 ❑ Remodel '- --tenant Improvement ❑ Telecommunication ❑ Temporary Service Page 1 of 2 RESIDENTIAL NEW RESIDENTIAL SERVICE ❑ New single family dwellings (including an attached garage) ❑ Garages, pools, spas and outbuildings ❑ Low voltage systems (alarm, furnace thermostat) $152.85 $81.90 ea $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 ELE T ' ICAL CONTRACTOR: Signature: <.._ Print Name: T 6F � " ' � % Day Telephone: o ,'-393 --7515 Mailing Address: City State Zip Date: 5 / 6 I 2—` IilApplications\Forms- Applications On Line \2011 Applications\Electrical Permit Application Revised 8- 9- 11.docx Revised August 2011 bh Page 2 of 2 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 Parcel No.: 0223300020 Address: 645 STRANDER BL TUKW Suite No: Applicant: US DENTAL LABS RECEIPT Permit Number: EL12 -0463 Status: PENDING Applied Date: 05/18/2012 Issue Date: Receipt No.: R12 -01623 Initials: WER User ID: 1655 Payment Amount: $115.50 Payment Date: 05/18/2012 11:12 AM Balance: $0.00 Payee: CJ ELECTRICAL SUPPLY & SERVICES LLC TRANSACTION LIST: Type Method Descriptio Amount Payment Check 4584 115.50 Authorization No. ACCOUNT ITEM LIST: Description Account Code Current Pmts ELECTRICAL PERMIT - NONR 000.322.101.00.00 115.50 Total: $115.50 doc: Receiot -06 Printed: 05 -18 -2012 INSPECTION RECORD Retain a copy with permit INSPECTION NO. PERMIT NO. . CITY OF TUKWILA BUILDING DIVISION x;6300 Southcenter_ Blvd., #100, Tukwila. WA 98188 V (206) 431 -367 Permit Inspection Request Line (206) 431 -2451 Project: US b Aa Type of Inspection: 2_�0� c Address: Date Called: Special Instructions: Date Wanted:. P Requester: Phone No: Approved per applicable codes. E Corrections required prior to approval. // COMMENTS:- (ax(0-161\is n4-1)c Date: s'Y REINSPECTION 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 `,g. (206) 431 -36 Permit Inspection Request Line (206) 431 -2451 Project: l5 �,( L 5 Type of Inspection: imo Address: {, - _IDLAR Date Called: Special Instructions: : Date Wanted:. . .my Requester: Phone No: Approved per applicable codes. p Corrections required prior to approval. /- COMMENTS: Inspector: n REINSPECTION FEE REQUIRED. Prior to next inspection. fee must be paid at 6300 Southcenter Blvd.. Suite 100. Call to schedule reinspection. Date: Contractors or Tradespeople P�ter Friendly Page • Electrical Contractor A business licensed by Lai 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 CJ ELECTRICAL SUPPLY 8 SVCS LL UBI No. 602327997 Phone 4254527000 Status Active Address 24317 Ne 27Th Pl License No. CJELEES966M7 Suite /Apt. License Type Electrical Contractor City Sammamish Effective Date 7/27/2004 State WA Expiration Date 10/23/2012 Zip 98074 Suspend Date County King Specialty 1 General Business Type Limited Liability Company Specialty 2 Unused Parent Company Electrical Administrator INFORMATION License MORRIG *932KS Name MORRIS, CHRIS G Status Active Business Owner Information Name Role Effective Date Expiration Date HUMENNY, DWAYNE M Partner /Member 07/27/2004 Received Date Bond Information No records found for the previous 6 year period Assignment of Savings Information Page 1 of 2 Savings Assignment of Savings Account Number Effective Date Release Date Assignment Type Impaired Date Amount Received Date 1 5/26/2004 Until Released Bond 9/25/2008 $4,000.00 7/27/2004 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 EJURT00255 9/25/2008 19.28.101 RCW ELECTRICAL CITATION Satisfied $250.00 EJURT00256 9/25/2008 19.28.101 RCW ELECTRICAL CITATION Satisfied $250.00 ESWAT00257 6/15/2010 19.28.101 RCW ELECTRICAL CITATION Satisfied $500.00 EJORP03773 5/5/2010 19.28.101 RCW ELECTRICAL CITATION Satisfied $250.00 EJORP03772 5/5/2010 19.28.101 RCW ELECTRICAL CITATION Satisfied $2,000.00 EBRIC01531 4/2/2009 19.28.161 RCW ELECTRICAL CITATION Satisfied $250.00 EBRIC01459 1/23/2009 19.28.061 RCW ELECTRICAL CITATION Satisfied $1,000.00 EBRIC01462 1/23/2009 19.28.061 RCW ELECTRICAL CITATION Satisfied $1,000.00 EBRIC01460 1/23/2009 19.28.061 RCW ELECTRICAL CITATION Satisfied $1,000.00 EBRIC01457 1/23/2009 19.28.061 RCW ELECTRICAL CITATION Satisfied $1,000.00 https: // fortress .wa.gov /lni /bbip /Print.aspx 05/18/2012