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Home My WebLink AboutPermit EL12-0595 - HILL-ROMHILIrROM 12610 INTERURBAN AV S EL1 2-0595 City ok ukwila 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.: 0004800003 Address: 12610 INTERURBAN AV S TUKW Project Name: HILL -ROM ELECTRICAL PERMIT Permit Number: EL12 -0595 Issue Date: 06/26/2012 Permit Expires On: 12/23/2012 Owner: Name: GATEWAY OLYMPIA INC Address: PO BOX 4900 #207 , SCOTTSDALE AZ 85261 Contact Person: Name: ALEX BURKHART Address: 727 S KENYON ST , SEATTLE WA, 98108 Contractor: Name: EVERGREEN REFRIGERATION LLC Address: 727 S KENYON ST , SEATTLE WA 98108 Contractor License No: EVERGRL954R2 Phone: 206 763 -1744 X 247 Phone: 206 763 -1744 Expiration Date: 01/06/2014 DESCRIPTION OF WORK: INSTALL (1) THERMOSTAT Value of Electrical: NRES: $180.00 RES: $0.00 Type of Fire Protection: UNKNOWN Electrical service provided by: SEATTLE CITY LIGHT Permit Center Authorized Signature: I hereby certify that I have read and governing this work will be complie' Fees Collected: National Electrical Code Edition: Date: $63.00 2008 ned this permit and know the same to be true and correct. All provisions of law and ordinances , whether specified herein or not. The granting of this permit does not pr construction or the performance of work. Signature: Print Name: 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. 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 -4/10 EL12 -0595 Printed: 06 -26 -2012 PERMIT CONDITIONS Permit No. EL12 -0595 * *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 -0595 Printed: 06 -26 -2012 CITY OF TUKWI Community Development Department Permit Center 6300 Southcenter Blvd., Suite 100 Tukwila, WA 98188 http://www.TulcwilaWA.gov Electrical Permit No. Project No. Date Application Accepted: Date Application Expires: (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 King Co Assessor's Tax No.: Ob 0 K ODD O .� Site Address: 12-C, 0 - 7-n4crv(6,-, S "''F+, Tenant Name: HA 1-110,, 1 - 110,, Suite Number: Floor: New Tenant: Q Yes ❑ ..No PROPERTY OWNER Name: Atos, bw Name: 6.7.A.y.A..its1 ply b. r,z --r,,,,,,, . City: C ' _ ,. State: A. Zip: q ci 1, Address: pp, /212x 41 oO Email: 1,6 Q2v"„,., -,I.►, c, .4,6,�,. City: S � W df/(c, State: A Z Zip: 5616 CONTACT PERSON — person receiving all project communication Name: Atos, bw Address: -Tv? 5 1, , s+. , City: C ' _ ,. State: A. Zip: q ci 1, Phone: 746 -�63_ 174j . Fax: 206, -"1.6 � L3$,i Email: 1,6 Q2v"„,., -,I.►, c, .4,6,�,. ELECTRICAL CONTRACTOR INFORMATION Company Name: F Address:..?27 s l.Ce.,,..t, s - City: S , State: VA Zip: kg Cog Phone: ifx,.� ?63- li(l,i Fax: .6_-7,G) _ 2 get Contr Reg No.: i 0.,,,L$ $ 2-3 13 Exp Date: W 1 7_,/ 1,1. Tukwila Business License No.: aus _ met" 71 Valuation of Project (contractor's bid price): $ t 8 0- °D Scope of Work (please provide detailed information): 3.1,/54 -7,/ t > , + 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: Eli Puget Sound Energy ❑ Seattle City Light H:\Applications\Forms- Applications On Line12011 Applications\Electrical Permit Application Revised 8- 9- 11.docx Revised: August 2011 bh 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 1 AM AUTHORIZED TO APPLY FOR THIS PERMIT. BUILDING OWNER OR ELECTRICAL CONTRACTOR: Signature: Print Name: Mailing Address: 727 5. 1 • H:\Applications \Forms - Applications On Lme\2011 Applications\Electncal Permit Application Revised 8- 9- 11.docx Revised: August 2011 bh Day Telephone: City Date: 6/ (( - .2/0h - -7b) - (7LN -'l 2L1-2 State Zip Page 2 of 2 GP 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. tukwila. wa. us SET RECEIPT RECEIPT NO: R12 -01990 Initials: JEM Payment Date: 06/26/2012 User ID: 1165 Total Payment: 332.31 Payee: EVERGREEN REFRIGERATION, LLC SET ID: S000001766 SET NAME: EVERGREEN REFRIGERATION SET TRANSACTIONS: Set Member EL12 -0595 M12 -104 TOTAL: Amount 63.00 269.31 63.00 TRANSACTION LIST: Type Method Description Amount Payment Check 005451 332.31 TOTAL: 332.31 ACCOUNT ITEM LIST: Description Account Code Current Pmts ELECTRICAL PERMIT - NONR MECHANICAL - NONRES PLAN CHECK - NONRES 000.322.101.00.0 000.322.102.00.0 000.345.830 63.00 215.45 53.86 TOTAL: 332.31 t l INSPECTION RECORD Retain a copy with permit �L(Z��} INSPECTION NO. PERMIT NO: - CITY OF TUKWILA BUILDING DIVISION 6300 Southcenter Blvd., #100, Tukwila. WA 98188 (206) 431=367 Permit Inspection Request Line (206) 431 -2451 Project: t Type of Inspection: - - Address: /rUn `0 h �! ,�� Date Called: • ._ - Special Instructions: 71" ST4rr Date Wanted:. 7 2:3f aa.m.- -.0- Requester: 1 Phone No IJApproved per applicable codes. COMMENTS: ElCorrections required prior to approval. - Inspector: _.11/0-vbffiecq Date: o7 /z3 (�Z n REINSPECTION FEE REQUIRED. Prior to next inspection; fee•must:be paid at 6300 Southcenter Blvd.. Suite 100. Call to schedule.reinspection:• Contractors or Tradespeople P ter Friendly Page Electrical Contractor A business licensed by Lli1 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 REFRIGERATION LLC 2067631744 727 S Kenyon St Seattle WA 98108 King Limited Liability Company UBI No. Status License No. License Type Effective Date Expiration Date Suspend Date Specialty 1 Specialty 2 602512953 Active EVERGRL882JB Electrical Contractor 4/2/2012 4/2/2014 General Unused Other Associated Licenses Specialty Specialty2 Effective Expiration Dat Status EVERGRL915LR EVERGREEN Electrical Residential Hvac /Rfrg 6/12/2009 6/12/2013 Re- REFRIGERATION LLC Contractor Ltd Energy Licensed Electrical Administrator INFORMATION License DUCHAGC910CR Name DUCHARME, GEOFFREY C Status Active Business Owner Information Name R Role E Effective Date E Expiration Date PATTON, DOUGLAS P Partner /Member 0 04/02/2012 PATTON, ROGER P Partner /Member 0 04/02/2012 PATTON, MATTHEW P Partner /Member 0 04/02/2012 Electrical Administrator INFORMATION License DUCHAGC910CR Name DUCHARME, GEOFFREY C Status Active Business Owner Information Name R Role E Effective Date E Expiration Date PATTON, DOUGLAS P Partner /Member 0 04/02/2012 PATTON, ROGER P Partner /Member 0 04/02/2012 PATTON, MATTHEW P Partner /Member 0 04/02/2012 PATTON, ADAM P Partner /Member 0 04/02/2012 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 Travelers Cas Et Surety Co 105264448 08/22/2009 Until Cancelled $4,000.00 04/02/2012 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 ESHA000627 5/4/2012 19.28.101 RCW ELECTRICAL CITATION Not satisfied $250.00 https: // fortress .wa.gov /lni /bbip /Print.aspx 06/26/2012 https: // fortress .wa.gov /lni /bbip /Print.aspx 06/26/2012