HomeMy WebLinkAboutPermit EL19-0435 - DEPARTMENT OF LABOR & INDUSTRIES - RELOCATE CIRCUITS AND POWERLABOR & INDUSTRIES
12806 GATEWAY DR
ELI 9-0435
Parcel No:
Address:
City of Tukwila
a
Department af 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
2716000050
12806 GATEWAY DR
Project Name: LABOR & INDUSTRIES
ELECTRICAL OTC PERMIT ,
Permit Number: EL19-0435
Issue Date: 5/23/2019
Permit Expires On: 11/19/2019
Owner:
Name:
Address:
Contact Person:
Name:
Address:
contractor:
Name:
Address:
License No:
Lender:
Name:
Address:
BOEING EMPLOYEES CREDIT UN
1Z770GATEWAY DR,TUKVV|LA,WA,
98168
RONALD SHACKELFORD
POBOX 2l5^3PANxVVAY WA, 98387
MATRIX ELECTRIC ILC
15419 24TH AVE E , TACOMA, WA,
98445
''"
Phone: (253) 797-9797
Phone: (253) 797-9797
Expiration Date: 8/19/2020
DESCRIPTION OF WORK:
RELOCATION OF EXISTING CIRCUITS AND POWER FOR MOVEABLE FURNITURE, INTERCONNECTIONS OF CUBICLES.
Valuation of single family: $O.00
Valuation of mf/comm: $35,508.00
Type of Work: REMODEL
Fees Collected: $807.37
Electrical Service Provided by: SEATTLE CITY LIGHT
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 FueI Gas Code:
2015
2015
2015
2015
2015
National Electrical Code:
WA Cities Electrical Code:
WAC 296-46B:
WA State Energy Code:
2017
2017
2017
2015
Permit Center Authorized Signature:
/
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 ./conditions attached to this permit.
Signature: r Date: /-?((Print Name: � A �I P .� .� 6�
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 NEPA 70 - NEC, and requirements for electrical installations,
Chapter 296-46B WAC and the Washington Cities Electrical Code.
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
http://www.TukwilaWA.gov
Electrical Permit No. E -41 c7— oe-M5
Project No.
Date Application Accepted: 05b3 /1?
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: 7,2 YO G4.-1-4AN) Dove_ Suite Number:
Tenant Name: 1— Ck koor InAAki e New Tenant: 0 Yes
Floor: 1
PROPERTY OWNER
Name:
OINCIA & S
Name:
City:r
VI Zip4 rn,.7
4" State
Address: 2.0 4 —
15
-121'1" AN6 S 5“ ( Zp
. 14
City: kevvi_
State: w A zip:q 3.032_
CONTACT PERSON — person receiving all project
communication
Name:
OINCIA & S
Address: tp, 0 00 y...... 2.1. 5
City:r
VI Zip4 rn,.7
4" State
City: s State: WA
ZiP9/43t 7
Phone: Fax:
Z53-711-R7q,
Email:
rnna rna.4-rilteACCAriC NA •
4004
..No
ELECTRICAL CONTRACTOR INFORMATION
Company Name: Mot 4r, )( g(4..cora4c Id_ c.
Address:
City:r
VI Zip4 rn,.7
4" State
Phone: 2 53- 7r- 979iax:
Contr Reg No.: ni 4411 el cloitix.E. xp Date:
V Si 12`
Tukwila Business License No.; 23 EA to
Valuation of Project (contractor's bid price): $ 35 6-4,49
Scope of Work (please provide detailed information):
120i1J ,Pirr mod(' 14-t7 le in Ory r
C
c.1
Will service be altered? 1:::1 Yes )::;trNo
Type of Use: CV1s one. f t, ot.,t
Type of work:
O New 0 Addition
O Low Voltage 0 Generator
Adding more than 50 amps? ED Yes
O Service Change ,/'Remodel 0 Tenant Improvement
O Fire Alarm 0 Telecommunication 0 Temporary Service
PropertyServed by:
Puget Sound Energy 0 Seattle City Light
WAPertnit CenterkApplications-HandoutsTemit Applications \PDFaltElectrical Permit Application Revised I -1 7-19.docz
Page 1 of 2
RESIDENTIAL
NEW RESIDENTIAL SERVICE
O New single family dwellings $180.00
(including an attached garage)
O Garages, pools, spas and outbuildings $120.00 ea
O Low voltage systems
(alarm) $60.00 ea
RESIDENTIAL REMODEL AND SERVICE CHANGES
O Service change or alteration $120.00
(no added/altered circuits)
O Service change with added/altered circuits $100.00
number of added circuits $10.00 ea
O Circuits added/altered without service change $60.00
(up to 5 circuits)
O Circuits added/altered without service change $60.00
(6 or more circuits) $10.00 ea
O Meter/mast repair $80.00
O Low voltage systems $60.00
(alarm, furnace thermostat)
MULTI -FAMILY AND COMMERCIAL
Fees are based on the valuation of the electrical contract.
MISCELLANEOUS FEES
O Temporary service (residential) $60.00
O Temporary service (generator) $90.00
O Manufactured/mobile home service $100.00
(excluding garage or outbuilding)
O Carnivals $100.00
Number of concessions $11.00 ea
Each ride and generator truck 511.00 ea
***EFFECTIVE JANUARY 1, 2014 EACH
PERMIT WILL BE ASSESSED A 5%
lECHNOLOGY 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 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 EL, TRICAL CONTFtACTQR:
AI/4
Signature:
Print Name:
Mailing Address:
Date: 5/3/f
id Sl1c%4"-/r 1 Day Telephone: 2.13- ?97- 91 7
ocAe az 4a 1 City
leVA st1,31)7
Zip
W:Terinit Center1Applications-Handout sWermit Applications WCIFs\Electrical Permit Application Revised I-17-19.do
Page 2 of 2
Cash Register Receipt
City of Tukwila
Receipt Number
DESCRIPTIONS
PermitTRAK
ACCOUNT
1 QUANTITY
PAID
$807.37
EL19-0435 Address: 12806 GATEWAY DR
Apn: 2716000050
$807.37
Credit Card Fee
$23.52
Credit Card Fee
R000.369.908.00.00
0.00
ELECTRICAL
$746.52
PERMIT FEE MULTI-FAM/COMM
R000.322.101.00.00
0.00
$746.52
TECHNOLOGY FEE
$37.33
TECHNOLOGY FEE
TOTAL FEES PAID BY RECEIPT: R17722
R000.322.900.04.00
0.00
1111.1151M1
$807.37
Date Paid: Thursday, May 23, 2019
Paid By: RONALD P SHACKELFORD
Pay Method: CREDIT CARD H36442
Printed: Thursday, May 23, 2019 1:57 PM 1 of 1
CirirWs Y5 TE M
CO TUKWILA ETKAKIT
6200 SOUTHCENTER BLVD
TUKWILA, WA 98188
206'433'1870
CITY OF TUKWILA
Date: 05/23/2019 91:50:48 PM
CREDIT CARD SALE
MASTERCARD
CARD NUMBER: **********5792 K
TRAN AMOUNT: $807.37
APPROVAL CD: x36442
RECORD #: 800
CLERK ID: Laurie
Thank you!
Customer Copy
INSPECTION RECORD
Retain a copy with permit
INSPECTION NO. PE' SIT NO.
CITY OF TUKWILA BUILDING DIVISION
6300 5outhcenter Blvd., #100, Tukwila. WA 98188 (206) 431-367
Permit Inspection Request Line (206) 438-9350
Pro Pro_ c
Type o Inspection:
Address:
I /gay Oki -6W
Date Called:
.,....
Specia Instructions:
(-304.11Tkiit
el(14/ 03 ( 'WI &
Date it`anted:
a. .
p.m.
Requester:
A Ofd
Phone No:
7777
3 777
proved per applicable codes. El Corrections required prior to approval.
nspector:
Date:
REINSPECTION FEE REQUIRED. Prior to next inspection. fee must be
paid at 6300 Southcenter Blvd.. Suite 100. Call to schedule reinspection.
Matrix Electric LLC
Washington State Department of
Labor & industries
Ho ine pan o I Contact
Safety & Health Claims & Insurance
Inakx Help
Workplace Rights Trades & Licensing
Matrix Electric LLC
Owner or tradesperson
Principals
Shackelford, Ronald P Jr, PARTNER/MEMBER
SHACKELFORD, DORTHY
E, PARTNER/MEMBER
SHACKELFORD, RONALD JR, P, AGENT
Jones, Anthony, PARTNER/MEMBER
(End: 03/05/2012)
Doing business as
Matrix Electric LLC
WA UBI No.
603 032 786
15419 24th ave e
TACOMA, WA 98445
253-797-9797
PIERCE County
Business type
Limited Liability Company
Governing persons
DOROTHY
E
SHACKELFORD
RONALD P JR SHACKELFORD;
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.
MATRIEL901NR
Effective — expiration
08/19/2010— 08/19/2020
Designated administrator
Shackelford, Ronald P Jr
Active.
Meets current requirements.
License type License no.
Electrical Administrator SHACKRP883JW
Bond
TRAVELERS CAS & SURETY CO
Bond account no.
105465064
54,000.00
Received by L&I Effective date
08/19/2010 07/29/2010
Expiration date
Until Canceled
Savings
No savings accounts during the previous 6 year period.
License Violations
Is
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