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Home My WebLink AboutPermit EL12-1143 - US HEALTHWORKSUS HEALTEIWORKS 200 ANDOVER PK E EL12 -1143 City AI'ukwila 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.: 0223100099 Address: 200 ANDOVER PK E TUKW Project Name: US HEALTHWORKS ELECTRICAL PERMIT Permit Number: EL12 -1143 Issue Date: 12/07/2012 Permit Expires On: 06/05/2013 Owner: Name: ANDOVER PLAZA LLC Address: 1501 N 200TH ST , SHORELINE WA 98133 Contact Person: Name: JEANIE SOMONSKI Phone: 425 656 -7111 Address: 22026 68 AV S, BLDG A , KENT WA, 98032 Contractor: Name: PROTECTION ONE ALARM MNTRG INC Address: 1035 N 3 ST, STE 101 , LAWRENCE KS 66044 Contractor License No: PROTEOA033BP Phone: 425 656 -7153 Expiration Date: 01/24/2013 DESCRIPTION OF WORK: SUITE 8: BASIC BURGLAR ALARM/WIRELESS Value of Electrical: NRES: $2,500.00 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. Date: $136.50 2008 401[2 I hereby certify that I have read and examited this permit and know the same to be true and correct. All provisions of law and ordinances governing this work will be complielllL with, whether specified herein or not. The granting of this permit does not p to to give authority to violate or cancel the provisions of any other state or local laws regulating construction or the erform e of work. I am authorized to sign and obtain this electrical permit. Signature: ` gip/ Date: r/-2 ?//— r Print Name: EFF /14 ! 0f4f 141- 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 -1143 Printed: 12 -07 -2012 • PERMIT CONDITIONS Permit No. EL12 -1143 * *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 -1143 Printed: 12 -07 -2012 CITY OF TUKWILA Community Development Department Permit Center 6300 Southcenter Blvd., Suite 100 Tukwila, WA 98188 http://www.ci.tukwila.wa.us Electrical Permit No. EU2-II�l3 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 Site Address: 2°o AcJ l7Dc 2 PAQ-). -F Tenant Name: 4S -RF4L L 1(4S King Co Assessor's Tax No.: p Suite Number: 0 New Tenant: Property Owners Name: Floor: ❑ Yes ..No Mailing Address: SAME AS SITE City IAA State yiehr CONTACT PERSON - Who do we contact when your permit is ready to be issued Name: JEANIE SOMONSKI Day Telephone: (425) 656 -7111 Mailing Address: 22026 68th Ave S Build A KENT WA 98032 City State Zip E -Mail Address: JEANIESOMONSKI @protectionl.com Fax Number: (253) 398 -1053 ELECTRICAL CONTRACTOR INFORMATION Company Name: Mailing Address: PROTECTION ONE 22026 68th Ave S Contact Person: PROTECTION ONE E -Mail Address: same as above Contractor Registration Number: PROTEOA033BP KENT . WA 98032 City State Zip Day Telephone: (253) 398 -1053 Fax Number: (253) 872 -4419 Expiration Date: 01/24/2013 Valuation of Project (contractor's bid price): $ o c Scope of Work (please provide detailed information): �S 1C V l.ct °6 t.. 1 Q c Will service be altered? ❑ Yes Type of Use: Type of work: ❑ New ❑ Addition' ❑ Service Change 0 Low Voltage ❑ Generator ❑ Fire Alarm ❑ Telecommunication ❑ Temporary Service m No Adding more than 50 amps? ❑ Yes No ❑ Remodel ❑ Tenant Improvement Property Served by: IAPuget Sound Energy ❑ • Seattle City Light H:\Applications\Forms- Applications On Line \2010 Applications \7 -2010 - Electrical Permit Application.doc 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 OWNER OR ELECTRICAL CONTRACTOR: Signature: Print Name: Mailing Address: 7617 S 180TH ST Date: 107? /(c Day Telephone: (425) 656 -7111 KENT City State 98032 Zip Date Application Accepted: Date Application Expires: Staff initials: H:\Applications\Forms- Applications On Line\2010 Applications \7 -2010 - Electrical Permit Application.doc bh Page 2 of 2 Ill ,J,�,� ►,-.- "'qs City of Tukwila 2'o. yy Department of Community Development Gl 6300 Southcenter Boulevard, Suite #100 r Tukwila, Washington 98188 / Phone: 206-431-3670 Fax: 206 - 431 -3665 Web site: http: / /www.TukwilaWA.gov Parcel No.: 0223100099 Address: 200 ANDOVER PK E TUKW Suite No: Applicant: US HEALTHWORKS RECEIPT Permit Number: EL12 -1143 Status: APPROVED Applied Date: 12/07/2012 Issue Date: Receipt No.: R12 -03272 Initials: User ID: JEM (1165 Payment Amount: $136.50 Payment Date: 12/07/2012 08:05 AM Balance: $0.00 Payee: PROTECTION ONE ALARM MONITORING, INC TRANSACTION LIST: Type Method Descriptio Amount Payment Check 3894 136.50 Authorization No. ACCOUNT ITEM LIST: Description Account Code Current Pmts ELECTRICAL PERMIT - NONR 000.322.101.00.00 136.50 Total: $136.50 (inn. Raraint_(1R Printarl• 19_n7_9M9 INSPECTION NO. INSPECTION RECORD Retain a copy with permit PERMIT N0.'" CITY OF TUKWILA BUILDING DIVISION 6300 Southcenter Blvd., #100, Tukwila: WA 98188 (206) 431 -3670 Permit Inspection Request Line (206) 431-2451 Project: s tftt-rk>aaroCS Type of Inspection:. `¢ to :. Address: a � Zv Date Called: Special Instructions: mN Date Wanted:. nn,�__m„., t -6.: Requester: Phone No: Approved per applicable codes. COMMENTS: Corrections required prior to approval. 1/ Inspector: 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 Pfter 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 PROTECTION ONE ALARM MNTRG INC 4256567153 Attn: Justin B. Vise 1035 N 3rd St Ste 101 Lawrence KS 66044 Out Of State Corporation UBI No. Status License No. License Type Effective Date Expiration Date Suspend Date Specialty 1 Specialty 2 601354926 Active PROTEOA033BP Electrical Contractor 1/17/1997 1/24/2013 Limited Energy Unused Electrical Administrator INFORMATION License BERGEMA893BL Name BERGENER, MATTHEW A Status Active Business Owner Information Name Role Effective Date Expiration Date MACKENZIE, JAMES M JR 01/01/1980 RANKIN, THOMAS K 01/01/1980 HESSE, JOHN W 01/01/1980 CORNELL, MONTGOMERY W 01/01/1980 C T CORPORATION SYSTEM Agent 01/01/1980 BECK, ANNETTE President 10/27/2000 SOMMA,TONY Secretary 10/27/2000 KINGSLEY, RENEE T Vice President 10/27/2000 CHRETIEN, CRAIG Vice President 10/27/2000 SANCHEZ, JOSEPH Vice President 10/27/2000 WILSON, TONY Vice President 10/27/2000 SIMONETTI, RICH Vice President 10/27/2000 DEVIN, ANDY Vice President 10/27/2000 WIENGARTNER, CRAIG Vice President 10/27/2000 CORY, DENNIS (MIKE) Vice President 02/25/2002 GRIFFIN, JOHN ERIC Vice President 01/09/2003 Bond Information Page 1 of 2 Bond Bond Company Name Bond Account Number Effective Date Expiration Date Cancel Date Impaired Date Bond Amount Received Date 3 TRAVELERS CAS & SURETY CO 030S103622605BCM 06/01/2001 Until Cancelled $4,000.00 05/14/2001 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 12/07/2012