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Home My WebLink AboutPermit EL17-0918 - WASHINGTON STATE NURSES ASSOCIATION - FIRE ALARM MODIFICATION AND WIRING OUTLETS AND LIGHTSWASHINGTON STATE NURSES ASSOCIATION 575 ANDOVER PARK W 210 ELI7-0918 Parcel No: Address: Project Name: c 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.TukwilaWA.gov ELECTRICAL OTC PERMIT 2623049144 575 ANDOVER PARK W 210 Permit Number: Issue Date: Permit Expires On: WASHINGTON STATE NURSES ASSOCIATION EL17-0918 11/15/2017 5/14/2018 Owner: Name: Address: Contact Person: Name: Address: Contractor: Name: Address: License No: Lender: Name: Address: SOUTHCENTER CORPORATE SQUAR 635 ANDOVER PARK W #107 , TUKWILA, WA, 98188 JOE GISEBURT 1900 W NICKERSON ST STE 116-9 , SEATTLE, WA, 98119 EVERGREEN ELECTRICAL SYSTEMS LLC 1900 W NICKERSON ST #116-9, SEATTLE, WA, 98119 EVERGES904CH I1I Phone: (425) 773-0148 Phone: (206) 922-5591 Expiration Date: 2/13/2018 DESCRIPTION OF WORK: WIRE (4) OUTLETS AND (4) LIGHTS AND MODIFY FIRE ALARM AS NEEDED Valuation of single family: $0.00 Valuation of mf/comm: $4,275.00 Type of Work: TENANT IMP Fees Collected: $202.30 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: International Residential Code Edition: International Mechanical Code Edition: Uniform Plumbing Code Edition: International Fuel Gas Code: Permit Center Authorized Signature: 2015 2015 2015 2015 2015 National Electrical Code: WA Cities Electrical Code: WAC 296-46B: WA State Energy Code: 2014 2014 2014 2015 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: Print Name: Jae_ tsphwi Date: //—/ 5717 7 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 TUKWIL'A Community Development Department Permit Center 6300 Southcenter Blvd., Suite 100 Tukwila, WA 98188 http://www.TukwilaWA.gov Electrical Permit No. E -L4 1 09 ( CJ 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 Site Address: 575 Andover Park W Tenant Name: WA Nurses Association King Co Assessor's Tax No.: Suite Number: 200 .oL l O Floor: 2 PROPERTY OWNER Name: Joe Giseburt Name: Southcenter Corp Square LLC City: Seattle State: WA Zip: 98119 Address: 635 Andover Park W #107 Email: joe@evergreenelectricalsystems.com City: Tukwila State: WA Zip: 98199 CONTACT PERSON — person receiving all project communication Name: Joe Giseburt Address: 1900 W Nickerson St Ste 116-9 City: Seattle State: WA Zip: 98119 Phone: (425) 773-0148 Fax: Email: joe@evergreenelectricalsystems.com New Tenant: ® Yes ..No ELECTRICAL CONTRACTOR INFORMATION Company Name: Evergreen Electrical Systems Address: 1900 W Nickerson St City: Seattle State: WA zip: 98119 Phone: (425) 773-0148 Fax: Contr Reg No.: EVERGES904CffExp Date: 11/06/2018 Tukwila Business License No.; 0 05 _D 7 if( l , V Valuation of Project (contractor's bid price): $ 4,275 Scope of Work (please provide detailed information): Wire (4) outlets and (4) lights and Modify Fire Alarm as needed Will service be altered? ❑ Yes m No Adding more than 50 amps? ❑ Yes m No Type of Use: Commercial Type of work: ❑ New ❑ Addition ❑ Service Change ® Remodel 0 Tenant Improvement ❑ Low Voltage ❑ Generator 0 Fire Alarm ❑ Telecommunication ❑ Temporary Service Property Served by: 2 Puget Sound Energy ❑ Seattle City Light W:\Permit CentcrMApplications-Handouts\Petmit Applications\PDFs\Electrical Permit Application Revised 1-1-17.docx Revised: January 2017 bh Page 1 of 2 RESIDENTIAL NEW RESIDENTIAL SERVICE ❑ New single family dwellings $155.91 (including an attached garage) ❑ Garages, pools, spas and outbuildings $83.54 ea ❑ Low voltage systems (alarm, furnace thermostat) $61.05 ea RESIDENTIAL REMODEL AND SERVICE CHANGES ❑ Service change or alteration $83.54 (no added/altered circuits) ❑ Service change with added/altered circuits $83.54 number of added circuits $12.00 ea ❑ Circuits added/altered without service change $55.69 (up to 5 circuits) ❑ Circuits added/altered without service change $55.69 (6 or more circuits) $7.65 ea ❑ Meter/mast repair $69.62 ❑ Low voltage systems $61.05 (alarm, furnace thermostat) MULTI -FAMILY AND COMMERCIAL Fees are based on the valuation of the electrical contract. MISCELLANEOUS FEES ❑ Temporary service (residential) $66.30 ❑ Temporary service (generator) $82.52 ❑ Manufactured/mobile home service $87.98 (excluding garage or outbuilding) ❑ Carnivals $82.21 Number of concessions $11.02 ea Each ride and generator truck $11.02 ea ***EFFECTIVE JANUARY 1, 2014 EACH PERMIT WILL BE ASSESSED A 5% TECHNOLOGY FEE*** 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: Date: cr itl r rJ (/y'f Day Telephon - 1{0 5: (( 3-t (7 U ( 1/" 1 V ,d,eyor,sr- seerie _ ?ff-/(9 City ' State Zip W:\Permit CcnterMApplcations-Handouts\Permit Applications\PDFs\Electrical Permit Application Revised I-1-17.docx Revised: January 2017 bh Page 2 of 2 - UNCONDITIONAL WAIVER AND RELEASE NOTICE TO CLAIMANT: THIS DOCUMENT WAIVES AND RELEASES NOTICE, AND PAYMENT BOND RIGHTS UNCONDITIONALL PAID FOR GIVING UP THOSE RIGHTS. THIS DOCUMENT ISENFORCEABLE SIGN IT, EVEN IF YOU HAVE NOT BEEN PAID. IF YOU HAV CONDITIONAL WAIVER AND RELEASE FORM. ON FINAL PAYMENT LIEN, STOP PAYMENT . AND STATES THAT YOU HAVE BEEN AGAINST YOU IF YOU NOT BEEN PAID, USE A Identifying Information - Name of Claimant Evergreen Electrical Name of Customer R. Miller Inc. Job Location 112 N 36th Street, Seattle, WA 98103 . Owner Sucafina NA Customer's Job # 174023 Trade / Service: Unconditional Waiver and R4iease This document waives and releases lien, stop payment notice, and payment bond rights the and material delivered, to the customer on this job through the Through Date of this docume equipment or material delivered, pursuant to a written change order that has been fully exe signed by the claimant, are waived and released by this document, unless listed as an Exception laimant has for labor and services provided, and equipment t. Rights based upon labor or service provided, or ted by the parties prior to the date that this document is below. The claimant has been paid in full. Exceptions - This document does not affect any of the following: Disputed claims forexti-as in the amount of: Signature Company Name Evergr n Eledr,Lcal Claimant's Signature li �,T[1c/ /►t /' C/1 Claimant's Representative Name (- / St 0-7 Claimant's Representative Title ®C� ��j�% • Date of Signature l / / ` / / State of County of Subscribed and sworn to before me this day of , (year). Notary public My commission expires Cash Register Receipt City of Tukwila DESCRIPTIONS ACCOUNT QUANTITY PAID PermitTRAK $202.30 EL17-0918 Address: 575 ANDOVER PARK W 210 Apn: 2623049144 $202.30 Credit Card Fee $5.89 Credit Card Fee 1 R000.369.908.00.00 0.00 $5.89 ELECTRICAL $187.06 PERMIT FEE MULTI-FAM/COMM R000.322.101.00.00 0.00 $187.06 TECHNOLOGY FEE $9.35 TECHNOLOGY FEE TOTAL FEES PAID BY RECEIPT: R12805 R000.322.900.04.00 0.00 $9.35 $202.30 Date Paid: Wednesday, November 15, 2017 Paid By: JOE GISEBURT Pay Method: CREDIT CARD 992361 Printed: Wednesday, November 15, 2017 1:23 PM 1 of 1 SYSTEMS INSPECTION RECORD Retain a copy with permit INSPECTION NO. P;RMIT N CITY OF TUKWILA BUILDING DIVISION 6300 Southcenter Blvd., #100, Tukwila. WA 98188 (206) 431-3670 Permit Inspection Request Line (206) 438-9350 Project: A, t.106,5 Type offIrn4pection: > tf� '- t4 d-7di t - Address: .(5 AlU�'240 Date Caned: Special Instructions:_ Date Wanted: Requesier:AIL- Phone No: �� 'o'�' j o 3 7 / Approved per applicable codes. Corrections required prior to approval. COMMENTS: -F) vii f 1`1161,; './ I '\ ..--- /44- r AI z:at--1PL, J"- 4:1? 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 6147 -c?t'S' INSPE TION NO. PERMIT NO. CITY OF TUKWILA BUILDING DIVISION 6300 Southcenter Blvd., #100, Tukwila. WA 98188 (206) 431-3670 Permit Inspection Request Line (206) 438-9350 Project: f ut55,5 Type of Inspection: ^ � ' j ,, Address: 5 -7c -o , Date Called: Special Instructions: !� ?OPAL'S - FIA Date Wanted:a.m i 1 (7 p.m. Requester: Phone No: Approved per applicable codes. Corrections required prior to approval. COMMENTS: f/( A'fgO thJ& Inspector: Date: REINSPECTION FEE REQUIRED. rior to next inspection, fee must be paid at 6300 Southcenter Blvd., Suite 100. Call to schedule reinspection. EVERGREEN ELECTRICAL SYS6C Home Espanol Contact Safety & Health Claims & Insurance Washington State Department of Labor & Industries Page 1 of 3 Search L&I A -Z Index Help My L&I Workplace Rights Trades & Licensing EVERGREEN ELECTRICAL SYS LLC Owner or tradesperson Principals GISEBURT, JOE R, PARTNER/MEMBER Giseburt, Joe, AGENT Doing business as EVERGREEN ELECTRICAL SYS LLC WA UBI No. 602 863 827 1900 W NICKERSON ST STE 116-9 SEATTLE, WA 98119 425-773-0148 KING County Business type Limited Liability Company License Verify the contractor's active registration / license / certification (depending on trade) and any past violations. Electrical Contractor Active. ............................................................. Meets current requirements. License specialties GENERAL License no. EVERGES904CH Effective — expiration 02/08/2010— 02/13/2018 Designated administrator GISEBURT, JOE R License type Master Electrician Bond TRAVELERS CAS & SURETY CO Bond account no. 105543287 Active. Meets current requirements. License no. GISEBJR975RJ $4,000.00 Received by L&I Effective date 01/21/2011 01/22/2011 Expiration date Until Canceled Savings No savings accounts during the previous 6 year period. License Violations Infraction no. EROJE01059 Issue date 05/05/2017 Violation city SEATTLE Type of violation Satisfied ......................... RCW/WAC 19.28.101 RCW Violation amount $1,000.00 14 Help us improve https://secure.lni.wa.gov/verify/Detail.aspx?UBI=602863827&LIC=EVERGES904CH&SAW= 11/15/2017 EVERGREEN ELECTRICAL SYS LLC ELECTRICAL CITATION Description Failing to get an inspection or obtain a valid electrical/telecommunications work permit or post a provisional electrical work permit prior to beginning the electrical/telecommunication installation or alteration as referenced in WAC 296-46B-901. Infraction no. EHICQ00246 Issue date 07/16/2015 Violation city Seattle 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. Infraction no. EJOCJ00255 Issue date 12/04/2014 Violation city Seattle Type of violation ELECTRICAL CITATION Description Employing an individual for the purposes of chapter 19.28 RCW who does not possess a valid certificate of competency or training certificate to do.electrical work. Infraction no. EMABQ04130 Issue date 06/11/2013 Violation city SEATTLE Type of violation ELECTRICAL CITATION Description Employing an individual for the purposes of chapter 19.28 RCW who does not possess a valid certificate of competency or training certificate to do electrical work. Infraction no. EMABQ04129 Issue date 06/11/2013 Violation city SEATTLE Type of violation ELECTRICAL CITATION Description Failing to get an inspection or obtain an electrical/telecommunications work permit or post a provisional electrical work permit prior to beginning the electrical/telecommunication Satisfied ..............._....... RCW/WAC 19.28.101 RCW Violation amount $1,000.00 Satisfied ..... .................. RCW/WAC 19.28.271 RCW Violation amount $500.00 Satisfied RCW/WAC 19.28.271 RCW Violation amount $250.00 Satisfied ........................... RCW/WAC 19.28.101 RCW Violation amount $250.00 0 Page 2 of 3 Help us improve https://secure.Ini.wa.gov/verify/Detail.aspx?UBI=602863 827&LIC=EVERGES904CH&SAW= 11/15/2017