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HomeMy WebLinkAboutPermit EL12-0842 - IMPACT INCThis 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 -0842 Impact Inc 354 Upland Drive 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 9 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. IMPACT INC 354 UPLAND DR EL1 2-0842 City ofrukwila Department of Community Development 6300 Southcenter Boulevard, Suite #100 Tukwila, Washington 98188 Phone: 206 - 431 -3670 Fax: 206 - 431 -3665 Web site: http: / /www.Tukwila WA .gov Parcel No.: 8835100090 Address: 354 UPLAND DR TUKW Project Name: IMPACT INC ELECTRICAL PERMIT Permit Number: EL12 -0842 Issue Date: 09/10/2012 Permit Expires On: 03/09/2013 Owner: Name: ENTERPRISE RRW Address: PO BOX 1201 , MAPLE VALLEY WA 98038 Contact Person: Name: DANNY KEITHLY Address: 827 S DIRECTOR ST , SEATTLE WA, 98108 Contractor: Name: KEITHLY ELECTRIC CO Address: 827 S DIRECTOR ST , SEATTLE WA 98108 Contractor License No: KEITHEC 101BJ Phone: 206 -763 -6875 Phone: 26 723 -3418 Expiration Date: 01/11/2014 DESCRIPTION OF WORK: LIGHTING RETROFIT Value of Electrical: NRES: $10,000.00 RES: $0.00 Type of Fire Protection: UNKNOWN Electrical service provided by: Permit Center Authorized Signature: Fees Collected: National Electrical Code Edition: $264.50 2008 Date: 9- ( 0 - )2._ 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 performance of work. I am authorized to sign and obtain this electrical permit. Signature: Print Name: Am/7 ilk4714 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. Date: ( %V° -7c doc: EL -4/10 EL12 -0842 Printed: 09 -10 -2012 PERMIT CONDITIONS • Permit No. EL 12 -0842 * *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 -0842 Printed: 09 -10 -2012 CITY OF TUKWILA Community Development Department Permit Center 6300 Southeenter Blvd., Suite 100 Tukwila, W4 98188 http: / /www.TukwilaWA.eov Electrical Permit No. L; L \ O V P-- 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.: Site Address: 354 Upland Drive Tukwila, WA 98188 Suite Number: Floor: Tenant Name: Impact, Inc New Tenant: ❑ Yes m ..No PROPERTY OWNER Name: Danny Keithly Name: RRW Enterprises LLC Address: 827 S Director St Address: PO Box 1201 City: Seattle State: WA City: Maple Valley State: WA Zip: 98038 CONTACT PERSON .— person receiving all project communication Name: Danny Keithly Address: 827 S Director St Address: 827 S Director St Phone: (206) 763 -6875 Fax: (206) 764 -8880 City: Seattle State: WA Zip: 98108 Phone: (206) 763 -6875 Fax: (206) 764 -8880 Email: danny@keithlyelectric.com ELECTRICAL CONTRACTOR INFORMATION Company Name: Keithly Electric Company Address: 827 S Director St City: Seattle State: WA Zip: 98108 Phone: (206) 763 -6875 Fax: (206) 764 -8880 Contr Reg No.: KEITHEC101BJ Exp Date: 12/31/2012 Tukwila Business License No.: BUS- 0993206 Valuation of Project (contractor's bid price): $ 10,000 Scope of Work (please provide detailed information): Lighting retrofit Will service be altered? ❑ Yes El 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: 121 Puget Sound Energy ❑ Seattle City Light H:'Applications \Forms - Applications On Line \2011 Applications\Electrical Permit Application Revised 8 -9 -1 I.docx Revised: August 2011 bh )J.P 4-'1) 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. 1 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 0 \t ER i R LECTRICAL CONTRACTOR: Signature: ' Date: 09/06/2012 Print Name: D K ithly Day Telephone: (206) 763 -6875 Mailing Address: 827 S Director St Seattle WA 98108 City State Zip H:\Applications \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.: 8835100090 Address: 354 UPLAND DR TUKW Suite No: Applicant: IMPACT INC RECEIPT Permit Number: EL12 -0842 Status: PENDING Applied Date: 09/10/2012 Issue Date: Receipt No.: R12 -02561 Payment Amount: $264.50 Initials: WER Payment Date: 09/10/2012 09:34 AM User ID: 1655 Balance: $0.00 Payee: AMY HUNTER TRANSACTION LIST: Type Method Descriptio Amount Payment Credit Crd VISA Authorization No. 02291G ACCOUNT ITEM LIST: Description 264.50 Account Code Current Pmts ELECTRICAL PERMIT - NONR 000.322.101.00.00 264.50 Total: $264.50 doc: Receiot -06 Printed: 09 -10 -2012 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 -3670 Permit Inspection Request Line (206) 431 -2451 6/11-01g2 Project: Na l jt- Type of Inspection: ry (CV Address: 3C -f 3N`1-Ao Date Called: Special Instruction's: O A- k(1-10 fr14 4.— (kc , 9Q .o Date Wanted:. 9 /` �5 (i.r.,,,,n Requester: Phone No: 10 Approved per applicable codes. El Corrections required prior to approval. COMMENTS: Inspector: Date: 1 • n REINSPECTIO FEE REQUIRED. Prior to next inspection. fee must be paid at 6300 Southcenter Blvd., Suite 100. Call to schedule reinspection. Contractors or Tradespeople Peter 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 Phone Address Suite /Apt. City State Zip County Business Type Parent Company KEITHLY ELECTRIC CO 2067233418 827 5 Director St Seattle WA 98108 King Corporation UBI No. Status License No. License Type Effective Date Expiration Date Suspend Date Specialty 1 Specialty 2 601218771 Active KEITHEC101BJ Electrical Contractor 1/11/1990 1/11/2014 General Unused Other Associated Licenses License Name Type Specialty 1 Specialty 2 Effective Date Expiration Date Status KEITHEC339R9KEITHLY ELECTRIC CO Electrical Contractor General Unused 12/29/1967 12/31/1990 Archived Master Electrician INFORMATION License KEITHDM963DZ Name KEITHLY, DANIEL M Status Active Business Owner Information Name Role Effective Date Expiration Date KEITHLY, DANIEL M Agent 12/20/1989 1/8/2007 KEITHLY, DANIEL President 01/01/1980 $1,000.00 KEITHLY, ROBERT 10/27/2010 01/01/1980 01/09/2012 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 1/10/1990 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 EJONV00497 1/8/2007 19.28.101 RCW ELECTRICAL CITATION Satisfied $1,000.00 EOXFJ00688 10/27/2010 19.28.101 RCW ELECTRICAL CITATION Satisfied $206.25 EOXFJ00685 10/27/2010 19.28.101 RCW ELECTRICAL CITATION Satisfied $206.25 https://fortress.wa.gov/lni/bbip/Print.aspx 09/10/2012