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Home My WebLink AboutPermit EL12-0880 - JS DENTAL CLINICJS DENTAL CLINIC 327.TIJKWILA PY EL1 2-0880 City oiatukwila 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.: 0223000010 Address: 327 TUKWILA PY TUKW Project Name: JS DENTAL CLINIC LLC ELECTRICAL PERMIT Permit Number: EL12 -0880 Issue Date: 09/18/2012 Permit Expires On: 03/17/2013 Owner: Name: BETA HOLDINGS LTD Address: 18827 BOTHELL WAY NE , BOTHELL WA 98011 Contact Person: Name: JENNIFER BURGESS /NW PERMIT AGENT Phone: (206)774 -9499 Address: 1345 GULF RD , PT ROBERTS WA, 98281 Contractor: Name: ADT LLC Phone: 561 - 988 -3600 Address: 11824 N CREEK PARKWAY N, SUITE 105 , BOTHELL WA 98011 Contractor License No: ADTLLL *881DO Expiration Date: 03/20/2014 DESCRIPTION OF WORK: INSTALL LOW VOLTAGE SECURITY SYSTEM Value of Electrical: NRES: $714.00 RES: $0.00 Fees Collected: Type of Fire Protection: UNKNOWN National Electrical Code Edition: Electrical service provided by: PUGET SOUND ENERGY Permit Center Authorized Signature: $84.00 2008 Date: CV/ F //a 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 it his permit • oes not presume to give authority to violate or cancel the provisions of any other state or local laws regulating constructio e ' • • - of . • rk I am authorized to sign and obtain this electrical permit. Signature: 41I 0 A'liH/ Date:Q -/C-. �� Z w, 07 Print Name: This permit shall become null and void if the work is not comme d 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 -0880 Printed: 09 -18 -2012 1110 PERMIT CONDITIONS Permit No. EL 12 -0880 * *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 -0880 Printed: 09 -18 -2012 CITY OF TUKWA Community Development Department Permit Center 6300 Southcenter Blvd., Suite 100 Tukwila, WA 98188 http://www.TukwilaWA.gov i Electrical Permit No. Project No. Date Application Accepted: Date Application Expires: o //0 %01, v3/41(3 (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: 327 Tukwila Parkway Suite Number: Floor: Tenant Name: Js Dental Clinic LLC New Tenant: ❑ Yes ❑..No PROPERTY OWNER Name: JENNIFER BURGESS/NWPERMIT -AGENT Name: Js Dental Clinic LLC City: PT. ROBERTS State: WA Zip: 98281 Address: 327 Tukwila Parkway Email: jennifer @nwpermit.com City: TUKWILA State: WA Zip: 98188 CONTACT PERSON — person receiving all project communication Name: JENNIFER BURGESS/NWPERMIT -AGENT Address: 1345 GULF RD City: PT. ROBERTS State: WA Zip: 98281 Phone: (206) 774 -9499 Fax:, Email: jennifer @nwpermit.com ELECTRICAL CONTRACTOR INFORMATION Company Name: ADT LLC Address: 11824 NORTH CREEK PKWY N # 105 City: BOTHELL State: WA Zip: 98011 Phone: Fax: Contr Reg No.: ADLLL*81D0 Exp Date: 03/20/2014 Tukwila Business License No.: Valuation of Project (contractor's bid price): $ 714 Scope of Work (please provide detailed information): install low voltage security system Will service be altered? ❑ Yes No Adding more than 50 amps? ❑ Yes Z No Type of Use: COMMERCIAL Type of work: ❑ New ❑ Addition - ❑ Service Change ❑ Remodel ❑ Tenant Improvement ® Low Voltage ❑ Generator ❑ Fire Alarm ® Telecommunication ❑ Temporary Service 0 Property Served by: ❑ Puget Sound Energy ❑ Seattle City Light H:\ Applications \Forms- Applications On Line \2011 Applications \Electrical Permit Application Revised R -9-1 I.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 I AM AUTHORIZED TO APPLY FOR THIS PERMIT. BUILDING 0 ER OR EC RICAL CONTRACTOR: Signature: Print Name: 111/111M1- , .�1 v1/4 .VVv.- ‘.11P" ► I U;4 athleen Genge Date: 09/18/2012 Day Telephone: (206) 774 -9499 Mailing Address: 1345 GULF RD, PT ROBERTS, WA 98281 City H: \Applicalions\Forms- Applications On Line \2011 Applications \Electrical Permit Application Revised 0 -9 -1 I.docx Revised: August 2011 bh State Zip Page 2 of 2 • OP 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.: 0223000010 Address: 327 TUKWILA PY TUKW Suite No: Applicant: JS DENTAL CLINIC LLC RECEIPT Permit Number: EL12 -0880 Status: PENDING Applied Date: 09/18/2012 Issue Date: Receipt No.: R12 -02637 Payment Amount: $84.00 Initials: LAW Payment Date: 09/18/2012 02:14 PM User ID: 1632 Balance: $0.00 Payee: NORTHWEST PERMIT INC TRANSACTION LIST: Type Method Descriptio Amount Payment Check 2172 84.00 Authorization No. ACCOUNT ITEM LIST: Description Account Code Current Pmts ELECTRICAL PERMIT - NONR 000.322.101.00.00 84.00 Total: $84.00 doc: Receipt -06 Printed: 09 -18 -2012 • INSPECTION RECORD Retain a copy with permit INSPECTION NO. CITYOF TUKWILA BUILDING :360-soutbc.e-nter [Ilya., #100, Tukwila. WA 98188 Permit InspectiOn•ReqUest Line (206) 431-2451 bl-ono PERMIT NO. DIVISION r— (206) 431-3670 Project:. '..',--/ N , Type of Inspection: .e) ‘.100 Address: .',.. - : . 3 . 71/K. - Date Called: ...... Spetial Instruchoni:- 5 - : - Date Wanted: /0 ol Requester: Phone No: Approved per applicable codes. EiCorrections required prior to approval. COMMENTS: cio ficp( (641 Inspector: - :1.. 6,/' II Date: i 111 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 FR. (206) 431 -3670 Permit Inspection Request Line (206) 431 -2451 Project: js Type of Inspection: Address: 3 Z7 ,,� f� f� Date Called: Special Instructions: �Jj� 6 ! }n' 1 Date Wanted: . �/�b Q p.i Requester: ti Phone No: ElApproved per applicable codes. Corrections required prior to approval. COMMENTS: 6/164g ACADoti6i) Inspector: Date: 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 Pr. 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 ADT LLC 2067190347 11824 N Creek Parkway, N, Ste 105 Bothell WA 98011 King Limited Liability Company UBI No. Status License No. License Type Effective Date Expiration Date Suspend Date Specialty 1 Specialty 2 603190246 Active ADTLLL *881 DO Electrical Contractor 3/20/2012 3/20/2014 Limited Energy Unused Electrical Administrator INFORMATION License NICKOT'902DA Name NICKOLS, TIM Status Active Business Owner Information Name Role Effective Date Expiration Date GURSAHANEY, NAREN K Partner /Member 03/20/2012 BELEISCH, NELSON D Partner /Member 03/20/2012 TULSYAN, RAVI Partner /Member 03/20/2012 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 Federal Ins Co 82295435 03/01/2012 Until Cancelled $4,000.00 03/20/2012 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 No records found for the previous 6 year period https: // fortress .wa.gov /lni/bbip/Print.aspx 09/18/2012