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Home My WebLink AboutPermit EL16-0983 - INDIGO URGENT CARE - WALL SIGNThis 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. EL16-0983 INDIGO URGENT CARE 17275 SOUTHCENTER PKWY RECORDSDIGITAL D-) EXEMPTION LOG THE ABOVE MENTIONED PERMIT FILE INCLUDES THE FOLLOWING REDACTED INFORMATION Page # Coda Exemption, � � � I3ri6f Explanatory 6escrlofion, Sfatutte/Ruilo The Privacy Act of 1974 evinces Congress' intent that social security numbers are a private concern. As such, individuals' social security Personal Information — numbers are redacted to protect those Social Security Numbers individuals' privacy pursuant to 5 U.S.C. sec. 5 U.S.C. sec. DR1 Generally — 5 U.S.C. sec. 552(a), and are also exempt from disclosure 552(a); RCW 552(a); RCW under section 42.56.070(1) of the Washington 42.56.070(1) 42.56.070(1) 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 numbers, electronic check numbers, credit Personal Information — expiration dates, or bank or other financial RCW 11 DR2 Financial Information — account numbers, which are exempt from 42.56.230(5) RCW 42.56.230(4 5) disclosure pursuant to RCW 42.56.230(5), except when disclosure is expressly required by or governed by other law. Personal Information — Redactions contain information used to prove RCW DR3 Driver's License. — RCW identity, age, residential address, social security 42.56.230 (7a 42.56.230 number or other personal information required to & c) (7a & c) apply for a driver's license or identicard. Redacted content contains a communication between client and attorney for the purpose of obtaining or providing legal advice exempt from RCW Attorney -Client Privilege — disclosure pursuant to RCW 5.60.060(2)(a), 5.60.060(2)(a); DR4 RCW 5.60.060(2)(a); RCW which protects attorney-client privileged RCW 42.56.070(1) communications, and RCW 42.56.070(1), which 42.56.070(1) protects, under the PRA, information exempt or prohibited from disclosure under another statute. INDIGO URGENT CARE 17275 SOUTHCENTER PKWY ELl 6=0983 City of Tukwila Department of Community Development • 6300 Southcenter Boulevard, Suite #100 Tukwila, Washington 98188 " Phone: 206-431-3670 Inspection Request Line: 206-438-9350 Web site: http://www.Tukwi[aWA.gov ELECTRICAL OTC PERMIT Parcel No: 2623049063 Permit Number: EL16-0983 Address: 17275 SOUTHCENTER PKWY 160 Issue Date: 10/26/2016 Permit Expires On: 4/24/2017 Project Name: INDIGO URGENT CARE Owner: 2015 National Electrical Code: Name: MASAO 2015 Address: 117 E LOUISA #230 C/O SCR LLC, International Mechanical Code Edition: 2015 SEATTLE, WA, 98102 2014 Contact Person: 2015 WA State Energy Code: Name: HANS VISSER Phone: (253) 538-0752 Address: 5209 122ND ST E , TACOMA, WA, 98446 (( Contractor: r/ Name: CULBERTSON SIGN SERVICE LLC Phone: (800) 925-6011 Address: 5209 122ND ST E, TACOMA, WA, 98446 f License No: CULBESS984MU Expiration Date: Lender: Name: Address: DESCRIPTION OF WORK: INSTALL (1) WALL SIGN S16-0057 Valuation of single family: $0.00 Valuation of mf/comm: $300.00 Type of Work: LOW VOLTAGE Fees Collected: $72.77 Electrical Service Provided by: PUGEST SOUND ENERGY Water District: TUKWILA Sewer District: TUKWILA Current Codes adopted by the City of Tukwila: International Building Code Edition: 2015 National Electrical Code: 2014 International Residential Code Edition: 2015 WA Cities Electrical Code: 2014 International Mechanical Code Edition: 2015 WAC 296-466: 2014 Uniform Plumbing Code Edition: 2015 WA State Energy Code: 2015 International Fuel Gas Code: 2015 (( r/ / '1 {` Permit Center Authorized Signature: rte} Date: � `. / C �✓ �. f I hearby 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 development permit and agree to the conditions attached to this permit. Signature: ;4� L� Date:l Print Name: AJS ! / Sr2 This permit shall become null and void if the work is not commenced within 180 days for the date of issuance, or if the work is suspended or abandoned for a period of 180 days from the last inspection. PERMIT CONDITIONS: 1: 'ELECTRICAL PERMIT CONDITIONS' 2: A,copy of the electrical work permit shall be posted or otherwise made readily accessible to the Electrical Inspector at each work site. 3: Approved plans shall be maintained at the construction site and shall be readily available to the Electrical Inspector. 4: All electrical work shall be in accordance with NFPA 70 - NEC, and requirements for electrical installations, Chapter 296-46B WAC. 5: 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. 6: 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. 7: 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. PERMIT INSPECTIONS REQUIRED Permit Inspection Line: (206) 438-9350 2100 ELECTRICAL FINAL 7003 ROUGH -IN ELECTRICAL 7002 SERVICE 7001 UNDERGROUND/SLAB CITY OF TUKWILA Community Development Department Permit Center • 6300 Southcenter Blvd., Suite 100 Tukwila, WA 98188 littp://www.Tuk-wilaWA.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.: 2623049063 Site Address: 17275 Southcenter Pkwy Suite Number: 160 Floor: Tenant Name: Indigo New Tenant: ❑ .....Yes ®..No PROPERTY OWNER Name: MASAO 652705 Address: C/O SCR LLC 117 E LOUISA #230 City: Seattle State: WA Zip: 98102 CONTACT PERSON — person receiving all project communication Name: Hans Visser Address: 5209 22nd St E City: Tacoma State: WA Zip: 98446 Phone: (253) 538-0752 Fax: (253) 538-0778 Email: csspermits@gmail.com ELECTRICAL CONTRACTOR INFORMATION Company Name: Culbertson Sign Service Address: 5209 122nd ST E City: Tacoma State: WA Zip: 98446 Phone: (253) 538-0752 Fax: (253) 538-0778 Contr Reg No.: CULBESS984Mtfxp Date: 08/30/2018 Tukwila Business License No.; BUS -0993893 Valuation of Project (contractor's bid price): $ 300 Scope of Work (please provide detailed information): Install one internally -illuminated wall sign on the tenant's main (east) exterior facade Will service be altered? ❑ Yes m No Type of Use: Tvoe of work: ❑ New ❑ Addition ❑ Service Change ❑ Low Voltage ❑ Generator ❑ Fire Alarm Property Served by: ❑ Puget Sound Energy ❑ Seattle City Light H:\Applications\Forms-Applications On Line\2014 ApplicationsTlectrical Permit Application Revised 1-1-14.docs Revised: ]anuaiT 2014 bh Adding more than 50 amps? ❑ Remodel ❑ Telecommunication ❑ Yes m No ❑ Tenant Improvement ❑ Temporary Service 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) $80.90 ❑ Service change with added/altered circuits.................$81.90 $86.25 number of added circuits .......................$11.55 ea ❑ Circuits added/altered without service change ........... $54.60 (up to 5 circuits) $10.80 ea ❑ Circuits added/altered without service change ...........$54.60 ............... $10.80 ea (6 or more circuits) ............................................... $7.65 ea ❑ Meter/mast repair ....................................................... $68.25 ❑ Low voltage systems ................................................. $59.85 (alarm, furnace thermostat) PERMIT APPLICATION NOTES - MULTI -FAMILY AND COMMERCIAL Fees are based on the valuation of the electrical contract. MISCELLANEOUS FEES ❑ Temporary service (residential) ................................. $65.00 ❑ Temporary service (generator) ................................... $80.90 ❑ Manufactured/mobile home service ........................... $86.25 (excluding garage or outbuilding) ❑ Carnivals.................................................................... $80.60 Number of concessions ......................... $10.80 ea Each ride and generator truck ............... $10.80 ea ***EFFECTIVE JANUARY 1, 2014 EACH PERMIT WILL BE ASSESSED A 5% TECHNOLOGY FEE*** 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 1 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: Date: 10/24/2016 Print Name: Hans Visser Day Telephone: (253) 538-0752 Mailing Address: 5209 122nd St E Tacoma WA 98446 City State Zip H:\Applications\Forms-Applications On Line\2014 ApplicationsElectrical Permit Application Revised 1-1-14.docx Revised: January 2014 bh Page 2 of 2 DESCRIPTIONS PermitTRAK ACCOUNT QUANTITY PAID $333.17 EL16-0983 Address: 17275 SOUTHCENTER PKWY 160 Apn: 2623049063 $72.77 ELECTRICAL $69.30 PERMIT FEE MULTI-FAM/COMM R000.322.101.00.00 0.00 $69.30 TECHNOLOGY FEE $3.47 TECHNOLOGY FEE R000.322.900.04.00 0.00 $3.47 S16-0057 Address: 17275 SOUTHCENTER PKWY Apn: 2623049063 $260.40 SIGN $248.00 PERMANENT SIGN PERMIT FEE R000.322.100.00.00 0.00 $248.00 TECHNOLOGY FEE $12.40 TECHNOLOGY FEE TOTAL PAID BY RECEIPT:R9736 R000.322.900.04.00 0.00 $12.40 $333.17 Date Paid: Wednesday, October 26, 2016 Paid By: CULBERTSON SIGN SERVICE LLC Pay Method: CHECK 13008 Printed: Wednesday, October 26, 2016 10:32 AM 1 of 1 (r�197 SY57EM5 INSPECTION RECORD Retain a copy with permit -0 o INSPECTION NO. PERMIT 10. CITY OF TUKWILA BUILDING 6300 Southcenter Blvd., #100, Tukwila. WA 98188 Permit Inspection Request Line (206) 438-9350 DIVISION (206) 431-3670 /f Project: ci ID Type of Inspection: 6,A/ Address: Date Called: Special Instructions: j !� Q Date Wanted: a.m 6/0 p.m. Requester: Phone No: 10 Approved per applicable codes. —1 Corrections required prior to approval. LAI pector: —1. , V\,, 1 /,,.,, 1 Date: REINSPECTION FEE REQUIRED. Prior to next inspection, fek must be paid at 6300 Southcenter Blvd., Suite 100. Call to schedule reinspection. INSPECTION RECORD ✓ ��® Retain a copy with permit Q INSPECTION NO. PERMIT N0. CITY OF TUKWILA BUILDING DIVISION 6300 Southcenter Blvd., #100, Tukwila. WA 98188 (206) 431-3670 Permit Inspection Request Line (206) 438-9350 Project: /J� /v awl Type of Inspection: Al_ Address. . Date Called: Special Instructions: ( Date Wanted: ( a.m Requester. Phone No: �f nApproved per applicable codes. 11 Corrections required prior to approval. inspector: /uate: L REINSPECTIO FEE REQUIRED. Prior to next inspection, fee Lust be paid at 6300 Southcenter Blvd., Suite 100. Call to schedule reinspection. 5/1/2017 City of Tukwila Allan Ekberg, Mayor Department of Community Development Jack Pace, Director HANS VISSER 5209 122ND ST E TACOMA, WA 98446 RE: Permit No. EL16-0983 INDIGO URGENT CARE 17275 SOUTHCENTER PY #160 Dear Permit Holder: In reviewing our current records, the above noted permit has not received a final inspection by the City of Tukwila Building Division. Per the International Building Code, International Mechanical Code, Uniform Plumbing Code and/or the National Electric Code, every permit issued by the Building Division under the provisions of these codes shall expire by limitation and become null and void if the building or work authorized by such permit has not begun within 180 days from the issuance date of such permit, or if the building or work authorized by such permit is suspended or abandoned at any time after the work has begun for a period of 180 days. Your permit will expire on 6/25/2017. Based on the above, you are hereby advised to: 1) Call the City of Tukwila Inspection Request Line at 206-438-9350 to schedule for the next or final inspection. Each inspection creates a new 180 day period, provided the inspection shows progress. -or- 2) Submit a written request for permit extension to the Permit Center at least seven(7) days before it is due to expire. Address your extension request to the Building Official and state your reason(s) for the need to extend your permit. The Building Code does allow the Building Official to approve one extension of up to 180 days. If it is determined that your extension request is granted, you will be notified by mail. In the event you do not call for an inspection and/or receive an extension prior to 6/25/2017, your permit will become null and void and any further work on the project will require a new permit and associated fees. Thank you for your cooperation in this matter. Sincerely, 7�w�- \ ) Bill Rambo Permit Technician File No: ELI 6-0983 6300 Southcenter Boulevard Suite #100 9 Tukwila, Washington 98188 • Phone 206-431-3670 9 Fax 206-431-3665 CULBERTSON SIGN SERVICE LT r Home Espanol Contad ISearch L&I A-7 Indra Help bty Leel Safety & Health Claims & Insurance Workplace Rights Trades & Licensing Washington State Department of Labor & Industries CULBERTSON SIGN SERVICE LLC Owner or tradesperson 5209122ND ST E 602 043 276 TACOMA, WA 98446 Principals p 253-538-0752 CULBERTSON, PAUL, PARTNER/MEMBER PIERCE County CULBERTSON,PAUL E JR JR, PARTNER/MEMBER CULBERTSON Doing business as CULBERTSON SIGN SERVICE LLC WA UBI No. Business type 602 043 276 Limited Liability Company Governing persons PAUL E JR CULBERTSON PAUL E SR CULBERTSON, License Verify the contractor's active registration / license / certification (depending on trade) and any past violations. Electrical Contractor Active. Meets current requirements. License specialties SIGN License no. CULBESS984MU Effective — expiration 08/30/2002— 08/30/2018 Designated administrator CULBERT$15N, PAUL * - - License type Master Electrician Bond No bond accounts during the previous 6 year period Savings (in lieu of bond) Received by L&I 08/30/2002 Release date N/A Savings account ID License Violations Infraction no. EALEJ00261 Issue date 07/16/2012 Violation city TACOMA Type of violation ELECTRICAL CITATION Description Failing to obtain or post an electrical/telecommunications work permit prior to beginning the electrical/telecommunication installation or alteration as referenced in WAC 296-46B-900 (3)(6), effective after 12/30/2008 see WAC 296- 46B-901. No permit for 2nd sign installed at this address. Active. Meets current requirements. License no. CULBEP'979QL $4,000.00 Effective date 08/30/2002 Impaired date N/A Satisfied ............. RCW/WAC 19.28.101 RCW Violation amount $2,000.00 Infraction no. ELEIS00416 Satisfied .............. 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