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Home My WebLink AboutPermit PG11-022 - SIGHTLINE HEALTHSIGHTLINE HEALTH 200 ANDOVER PK E PG1 1 -022 City oWukwila • Department of Community Development 6300 Southcenter Boulevard, Suite #100 Tukwila, Washington 98188 Phone: 206 - 431 -3670 Inspection Request Line: 206 - 431 -2451 Web site: http: / /www.ci.tukwila.wa.us PLUMBING /GAS PIPING PERMIT Parcel No.: 0223100099 Address: 200 ANDOVER PK E TUKW Project Name: SIGHTLINE HEALTH Permit Number: PG11 -022 Issue Date: 04/27/2011 Permit Expires On: 10/24/2011 Owner: Name: ANDOVER PLAZA LLC Address: 1501 N 200TH ST , SHORELINE WA 98133 Contact Person: Name: TED BRANDVOLD Address: 616 14 ST , MODESTO CA 95354 Email: TBRANDVOLD@COMMERCIALARCH.COM Contractor: Name: WELLER CONSTRUCTION INC Address: PO BOX 1134 , COLUMBIA CA 95310 Contractor License No: WELLECI916CE Phone: 209 - 571 -8158 Phone: Expiration Date: 02/18/2013 DESCRIPTION OF WORK: PLUMBING TENANT IMPROVEMENTS WITHIN EXISTING SPACE FOR CANCER TREATMENT MEDICAL OFFICE /FACILITY AS WELL AS AN ADDITIONAL 11 GAS PIPING OUTLETS. INCLUDES NSTALLATION OF IN- PREMISE ISOLATON 1.5" REDUCED PRESSURE PRINCIPLE ASSEMBLY (RPPA) WILKINS Model 375. Value of Plumbing /Gas Piping: $75,000.00 Uniform Plumbing Code Edition: 2009 Fees Collected: $787.51 International Fuel Gas Code Edition: 2009 Electrical Service Provided by: PUGET SOUND ENERGY Permit Center Authorized Signature: LoW, Date: LA" L' 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 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 plumbing /gas piping permit and agree to the conditions on the back of this permit. Signature: Print Name: 71"53'C Date: 4/ —c2 7— // 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: doc: UPC -4/10 PG 11 -022 Printed: 04 -27 -2011 PERMIT CONDITIONS Permit No. PG11 -022 1: ** *PLUMBING AND GAS PIPING * ** 2: No changes shall be made to applicable plans and specifications unless prior approval is obtained from the Tukwila Building Division. 3: All permits, inspection records and applicable plans shall be maintained at the job and available to the plumbing inspector. 4: All plumbing and gas piping systems shall be installed in compliance with the Uniform Plumbing Code and the Fuel Gas Code. 5: No portion of any plumbing system or gas piping shall be concealed until inspected and approved. 6: All plumbing and gas piping systems shall be tested and approved as required by the Plumbing Code and Fuel Gas Code. Tests shall be conducted in the presence of the Plumbing Inspector. It shall be the duty of the holder of the permit to make sure that the work will stand the test prescribed before giving notification that the work is ready for inspection. 7: No water, soil, or waste pipe shall be installed or permitted outside of a building or in an exterior wall unless, adequate provision is made to protect such pipe from freezing. All hot and cold water pipes installed outside the conditioned space shall be insulated to minimum R -3. 8: Plastic and copper piping running through framing members to within one (1) inch of the exposed framing shall be protected by steel nail plates not less than 18 guage. 9: Piping through concrete or masonry walls shall not be subject to any load from building construction. No plumbing piping shall be directly embedded in concrete or masonry. 10: All pipes penetrating floor /ceiling assemblies and fire- resistance rated walls or partitions shall be protected in accordance with the requirements of the building code. 11: Piping in the ground shall be laid on a firm bed for its entire length. Trenches shall be backfilled in thin layers to twelve inches above the top of the piping with clean earth, which shall not contain stones, boulders, cinderfill, frozen earth, or construction debris. 12: The issuance of a permit or approval of plans and specifications shall not be construed to be a permit for, or an approval of, any violation of any of the provisions of the Plumbing Code or Fuel Gas Code or any other ordinance of the jurisdiction. 13: ** *PUBLIC WORKS DEPARTMENT CONDITIONS * ** 14: 1.5" Reduced Pressure Principle Assembly (RPPA) for in- premise isolation (medical facility) shall be installed per manufacturer's specifications. 15: Upon RPPA installation the backflow shall be tested by a certified tester and passing test report submitted to Public Works Project Inspector. Thereafter, annual tests shall be performed at owner's expense, and copies of test results shall be forwarded toTukwila Water Department, Minkler Shops, phone (206) 433 -1860. doc: UPC -4/10 PG11 -022 Printed: 04 -27 -2011 CITY OF TUKWILA Community Develqiikent Department Public Works DepalliThent Permit Center 6300 Southcenter Blvd., Suite 100 Tukwila, WA 98188 httix //www.ci.tkwila.wa.us Building Paid No. Di ! Oc9 -' Mechanical Prrmit No. Isork it 1 Plumbing/Gas Permit No. G [ `�-0 12, Public Works Permit No. Project No. (For office use only) 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.:'0*-f'p Site Address: Suite Number: /� 2 f# Z Floor: Tenant Name: New Tenant: Yes ❑.. No Property Owners Name: /fee-is, %i✓r. Mailing Address: .i C " i" �f l; City State CONTACT PERSON — who do we contact when your permit is ready to be issued Day Telephone: ---z,;03, Mailing Address:/' �7,�•,qs ✓1� /oC. -E7 mod/ E -Mail Address s- `� � ,� Qr �o�.� Fax Number: City State Zip GENERAL CONTRACTOR INFORMATION — (Contractor Information for Mechanical (pg 4) for Plumbing and Gas Piping (pg 5)) Company Name: Mailing Address: / , X // Contact Person: E,/ / -- E -Mail Address! Contractor Registration Number: G� City State Zip Day Telephone: �'• • te...Jor Fax Number: o • t11 Expiration Date: ARCHITECT OF RECORD — All plans must be stamped by Architect of Record Company Name: N/4 Mailing Address: City Day Telephone: Fax Number: Contact Person: E -Mail Address: State Zip ENGINEER OF RECORD — All plans must be stamped by Engineer of Record Company Name: N �� Mailing Address: Ac:7`•a Contact Person: graZ-04, E -Mail Address: H:\Applications\Fonns- Application On Line\2010 Applications \7 -2010 - Permit Application dos Revised: 7 -2010 bh City State Zip Day Telephone: �_�l • 29 Fax Number: /-/;/.4 Page 1 of 6 { DU 1L1l11 J r r,RtV111 111 r l/i11V1i 11V11 — LVV— YJI —JV /V Valuation of Project (contractor's bid pr. $ E-,61? fix° 7 e)t7 Existin ilding Valuation: $ Scope of Work (please provide detailed information): Will there be new rack storage? ❑ ....Yes .No If yes, a separate permit and plan submittal will be required. Provide All Building Areas in Square Footage Below PLANNING DIVISION: Single family building footprint (area of the foundation of all structures, plus any decks over 18 inches and overhangs greater than 18 inches) For an Accessory dwelling, provide the following: Lot Area (sq ft): Floor area of principal dwelling: Floor area of accessory dwelling: *Provide documentation that shows that the principal owner lives in one of the dwellings as his or her primary residence. Number of Parking Stalls Provided: Standard: Compact: Handicap: Will there be a change in use? ❑ Yes ❑ No If "yes ", explain: FIRE PROTECTION/HAZARDOUS MATERIALS: X Sprinklers Xi Automatic Fire Alarm ❑ None ❑ Other (specify) Will there be storage or use of flammable, combustible or hazardous materials in the building? ❑ Yes No If "yes', attach list of materials and storage locations on a separate 8 -1/2 "x II" paper including quantities and Material Safety ata Sheets. SEPTIC SYSTEM ❑ On -site Septic System — For on -site septic system, provide 2 copies of a current septic design approved by King County Health Department. H: \Applications\Forms•Applications On Line\2010 ApplicationsO -2010 - Permit Application.doc Revised: 7 -2010 bh Page 2 of 6 Existing Interior Remodel Addition-to Existing Structure New Type of Construction per IBC Type of Occupancy per IBC 1° Floor 21, I"' %e1/ g34 e' /1/ S 2nd Floor 3rd Floor Floors thru Basement Accessory Structure* Attached Garage Detached Garage Attached Carport Detached Carport Covered Deck Uncovered Deck PLANNING DIVISION: Single family building footprint (area of the foundation of all structures, plus any decks over 18 inches and overhangs greater than 18 inches) For an Accessory dwelling, provide the following: Lot Area (sq ft): Floor area of principal dwelling: Floor area of accessory dwelling: *Provide documentation that shows that the principal owner lives in one of the dwellings as his or her primary residence. Number of Parking Stalls Provided: Standard: Compact: Handicap: Will there be a change in use? ❑ Yes ❑ No If "yes ", explain: FIRE PROTECTION/HAZARDOUS MATERIALS: X Sprinklers Xi Automatic Fire Alarm ❑ None ❑ Other (specify) Will there be storage or use of flammable, combustible or hazardous materials in the building? ❑ Yes No If "yes', attach list of materials and storage locations on a separate 8 -1/2 "x II" paper including quantities and Material Safety ata Sheets. SEPTIC SYSTEM ❑ On -site Septic System — For on -site septic system, provide 2 copies of a current septic design approved by King County Health Department. H: \Applications\Forms•Applications On Line\2010 ApplicationsO -2010 - Permit Application.doc Revised: 7 -2010 bh Page 2 of 6 PLUlI✓IBING AND GAS PIPING PERK INFORMATION — 206 - 431 -3670 • PLUMBING AND GAS PIPING CONTRACTOR INFORMATION Company Name: Mailing Address: Contact Person: E -Mail Address: Contractor Registration Number: City State Zip Day Telephone: Fax Number: Expiration Date: Valuation of Plumbing work (contractor's bid price): $ eoop/ p Valuation of Gas Piping work (contractor's bid price): $ / Scope of Work (please provide detailed information): Building Use (per Int'1 Building Code): Occupancy (per Intl Building Code): Utility Purveyor: Water: Sewer: tAft7Pcmp ocuwtc Indicate type of plumbing fixtures and/or gas piping outlets being installed and the quantity below: Fixture: Type: Qty .Fixture Type: Qty Fixture Type: Qty Future Type: Qty Bathtub or combination bath/shower. Bidet Clothes washer, domestic Dental unit, cuspidor Dishwasher, domestic, with independent drain / Drinking fountain or water cooler (per head) 2 Food -waste grinder, commercial Floor Drain Shower, single head trap Lavatory GP Wash fountain -Receptor, indirect waste 4 Sinks Urinals Water Closet `� Building sewer and each trailer park sewer Rain water system — per drain (inside building) Water heater and/or vent i Industrial waste treatment interceptor, including trap and vent, except for kitchen type grease interceptors Each grease trap (connected to not more than 4 fixtures - <750 •gallon capacity) Grease interceptor for commercial kitchen ( >750 gallon capacity) Repair or alteration of water piping and/or water treatment equipment Repair or alteration of drainage or vent piping Medical gas piping system serving 1 -5 inlets/outlets for a specific gas Each additional medical gas inlets/outlets greater than 5 Backflow protective device other than atmospheric -type vacuum breakers 2 inch (51 mm) . diameter or smaller Backflow protective device other than atmospheric-type vacuum breakers over 2 inch (51 mm) diameter Each lawn sprinlder system on any one meter •including backflow protection devices • • Atmospheric -type vacuum breakers not included in lawn sprinkler backflow protections (1 -5) Atmospheric -type vacuum breakers not included in lawn sprinlder backflow protections over 5 Gas piping outlets / C O. CORRECTION LTR# 1 H' Appliatioas\Fonns- Application On Line120I0 Applications W-2010 - Permit Application.doc Revised: 7 -2010 bd z011 PERMIT cEA t 17(A1--otz PERMIT APPLICATION NOTES - plicable to all permits in this application 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. Building and Mechanical Permit The Building Official may grant one or more extensions of time for additional periods not exceeding 90 days each. The extension shall be requested in writing and justifiable cause demonstrated. Section 105.3.2 International Building Code (current edition). Plumbing,Permit The Building Official may grant one extension of time for an additional period not exceeding 180 days. The extension shall be requested in writing.and.justifiable cause demonstrated. Section 103.4.3 Uniform Plumbing Code (current edition). 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 R OR AUTHORIZED AGE Signature: Date: /• 21 '•% Print Name Day Telephone:] • j/ •/ Mailing Address: - / ,� / ✓� hi r.r4 -.1 Date Application Accepted: ' City J State Zip Date Application Expires: Staff Initials: HAApplications\Fonns- Applications On Line'i010 Applications17 -71 0 - Permit Application.doc Revised 1 -2010 t bh •dr nw- • Page 6 of 6 • City of Tukwila ti Department of Community Development 6300 Southcenter Boulevard, Suite #100 Tukwila, Washington 98188 Phone: 206-431-3670 Fax: 206 - 431 -3665 Web site: hto://www.ci. tukwi la. wa. us Parcel No.: 0223100099 Address: 200 ANDOVER PK E TUKW Suite No: Applicant: SIGHTLINE HEALTH RECEIPT Permit Number: PG11 -022 Status: APPROVED Applied Date: 02/01/2011 Issue Date: Receipt No.: R11 -00830 Initials: User ID: Payee: WER 1655 Payment Amount: $674.63 Payment Date: 04/27/2011 02:36 PM Balance: $0.00 JOSEPH DOBBS TRANSACTION LIST: Type Method Descriptio Amount Payment Credit Crd VISA Authorization No. 082265 ACCOUNT ITEM LIST: Description 674.63 Account Code Current Pmts GAS - NONRES PLAN CHECK - NONRES PLUMBING - NONRES 000.322.103.00.00 000.345.830 000.322.103.00.00 Total: $674.63 178.50 44.63 451.50 doc: Receipt -06 Printed: 04 -27 -2011 C* 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://wwwci.tukwila.wa.us SET RECEIPT RECEIPT NO: R11 -00191 Initials: WER Payment Date: 02/01/2011 User ID: 1670 Total Payment: 6,118.39 Payee: WELLER CONSTRUCTION INC SET ID: 020111 SET NAME: SIGHTLINE SET TRANSACTIONS: Set Member Amount D11 -024 5,347.75 EL11 -0077 395.85 M11 -016 261.91 PG11 -022 112.88 TOTAL: 5,347.75 TRANSACTION LIST: Type Method Description Amount Payment Check 709 6,118.39 TOTAL: 6,118.39 ACCOUNT ITEM LIST: Description Account Code Current Pmts ELECTRICAL PLAN - NONRES 000.345.832.00.0 PLAN CHECK - NONRES 000.345.830 TOTAL: 395.85 5,722.54 6,118.39 . l . INSPECTION RECORD rl i� - - L Retain a copy with permit J • . IN PECTION NO. • PERMIT NO. . .:..: CITY. OF' TUKWILA BUILDING DIVISION 6360 Sotithcenter•Blvd., #100, Tukwila: WA 98188 (206) 431-367 i . • Perinit.lnspection Request Line (206) 431 -2451 s • •. s• Proje :. t. . i.�. L.AJ -1t. Type of Inspection: ! V f; NAc.__ 14,J ..-t g. Address: Date C Ilt:d:64 • GII&J Special; Instructions: • • Date Wanted: r a.m. Requester: P >F one No: t -2, 0q--3s i• -- 047 Approved per'applicable codes. E Corrections required prior to approval. IC COMMENTS: rj,(417--e...n)(6), ec-P—/\64\i Inspe tor: I 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 co with ermit P6 { 1" : INSPECTION NO. " py p PERMIT NO. CITY OF TUKWILA BUILDING DIVISION 6300 Southcenter Blvd., #100, Tukwila. WA 98188 «,. (206) 431 -367,( • Permit Inspection Request Line (206) 431 -2451 Pro' t: tleT ��. a r: , J , .` As "t•J ! 4 -e\ ,A A • Type r: Inspection: ) v Address: • 2,9 V''t!Q O tI f f Date Called: Special Instructions: pr U.Je . • R A pie JJ7e g; (4,b---.r ( J --er Date Wanted: . .O.s ;V (a I") LA/A a4 G-.)1 1'0•S 56 4 ..'V J � , _ :P -i" Requester: Phone No ` 3.5 �.,zr Approved per applicable codes. Corrections required prior to approval. COMMENTS: ��. a r: , J , .` As "t•J ! 4 -e\ ,A A • //q) kecel u,kirtf- \-(40ef-se:_si-,:c (id e -k"1- 'fir . . 4 _._! su ie .LAWS 44ertie SL`-(N ter( A pie JJ7e g; (4,b---.r ( J --er (:_._ At( G.k.s P. :1) itle JA . /-all- 'Tap .O.s ;V (a I") LA/A a4 G-.)1 1'0•S 56 4 ..'V J � Inspect r: Date: Er i( a REINSPECTION FEE REQUIRED. Prior to next inspection. fee must be paid at 6300 Southcenter Blvd.. Suite 100. Call to schedule reinspection. • •-• " • • • • • '• • • • INSPECTION P NPECTION RECORD ' • 6 i (9'2- Retain a copy with permit INSPECTION NO. PERMIT NO. CITY OF TUKWILA BUILDING DIVISION 6300 Southcenter Blvd., #100, Tukwila. WA 98188 4.4.. (206) 431-3670 Permit Inspection Request Line (206) 431-2451 k 5 Propst: \ Tyileio; ljnspg.tion: Add ess: 7,0 0 AtjDo tru e, Date Called: .....o.: Special Instructions: Date Wanted: i ./-.„., a.m... Requester: .--e-165 .....8.80g I ['Approved per applicable codes. ElCorrections required prior to approval:. COMMENTS: Ar-i-i-A-( A-19 proJ14 ..ti- A.‹_ A--gi A (2 pro Jejte,,Likv cr \I 1 . ... : S-r-si tl akieek 4 „f . .. , .. . . , . , ., _...-----..,„ A i 1 - • 11 . ••• '. ■ . REINSPECTION FEE REQUIRED. Prior to next inspection"; fee must lie ••:. paid at 6300 Southcenter Blvd., Suite 100. Call to schedule reinspectiorC ... — ? , �..�.. ��..:. INSPECTION RECORD -.: Retain a copy with permit INSPECTION NO. PERMIT NO. CITY OF TUKWILA BUILDING DIVISION 6300 Southcenter Blvd., #100, Tukwila. WA 98188 (206) 431,3670. Permit Inspection Request Line (206) 431 -2451 Project i s• 6 , , ) • A e, Typ�,pf Ins ion: _,_, P J r` Address: 0(> l/DI,kif t Date Called: Special Instructions: Date Wanted: / _.3 _ a� ,uf (> (l p.m. Requester: Phonln 6-i, __ ss-q .......2,s—ept Approved per applicable codes. El Corrections required prior to approval. 3,1..7 4 A epiode COMMENTS: Inspector: 1 Date: / (0 .J n REINSPECTION FEE REQUIRED. Prior to next inspection, fee must be paid at 6300 Southcenter Blvd., Suite 100. Call to schedule reinspection. VP — .! -. ". ep i. : 0224. -... 4mil INSPECTION RECORD - Retain a copy with permit INSPECTION NO. PERMIT NO. CITY OF TUKWILA BUILDING DIVISION 6300 Southcenter Blvd., #100, Tukwila. WA 98188 (206) 431-3670 Permit Inspection Request Line (206) 431-2451 4-3 PrScts, 41t.-7--L: A e tfrAitti Tykcc); ulnspec47;__ crvie1/43.. Ant: 0 ArtAtI 0 kft. 1 Date Callel 11.,.__ _---E--Lil Special Instructions: Date Wanted: 5" -3 i it ..mm. — i Requester: ---_---- Ph4 Nlii.•:5,......4 /7 ( 60 10 ElApproved per applicable codes. ElCorrections required prior to approval. COMMENTS: 'kir) 4 k?prn a ikp ..„ (e. J, i ) A J irpp6 /-7- 11.,.__ _---E--Lil 4- s.: ._E._ Of -' p tc“ i --ST- A i pru 0 de-A c'... isps.' 11 /-\ Jrr-- t, 0. J e___ c.44-0 :/‘ (t= r:b i ---_---- e- J A-A •• 1 P__ all 0 .r/ ,e c;?•--, 1) " .e. Alt) M 6 fLe 7-1j ?o' d - -----. 1 . InKctor: Date: c 1 ri REINSPECTION FEE REQUIRED. Prior to next inspection, fee must be paid at 6300 Southcenter Blvd., Suite 100. Call to schedule reinspection. iM1 INSPECTION RECORb p, 1(_ J2• Retain a copy with permits -j L_� INSP.ECTION NO. PERMIT NO. / CITY OF TUKWILA BUILDING DIVISION G " 71 6300 Southcenter Blvd., #100, Tukwila: WA 98188 Permit Inspection Request Line (206) 431 -2451 (2o6) 431-3670 • Project:` 4([( }n0 Type o nsption ` kJ n tr..il Address: � 1�.i &4n JJ k Date Called: ;� Special Instructions: Date Wanted: ,s.— "�)— p.m. Requester: Phone No: 1.1 r` u 1 r A ❑ Approved per applicable codes. ECorrections required prior to approval. COMMENTS: n tr..il p r b J p-Q V i 1.1 r` u 1 r A -, - Di\ 6,0 P- k) ps: _ 3 V-- a tom-- 1 ,) ` 1 V---.∎ 0 ) c . A 1 _. Ins ector: Date z 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 r61(_dA INSPECTION NO. PERMIT NO.. CITY OF TUKWILA BUILDING DIVISION C 6300 Southcenter Blvd., #100, Tukwila. WA 98188 . (206) 431 -3670 Permit Inspection Request Line (206) 431 -2451 Projec ype of Inspection: �v C IC �r u� .n ��" �1 k,i L,1..V �.A* Address: / 7�v , AM dt/U . -,— Date Called: Eil) c-cNA r re.i P J •` 0' � I Special Instructions: ��'v4(0 d r Date Wante� �� a.m. Requester: Phone No: 20 Co' -7r -93017 jApproved per applipable codes. aCorrections required prior to approval. COMMENTS: , ri 4..1 typro v A 1 t L? f 14. .i+ //Ord ,I - GOILLIOCeA e_ elAASro'l/e.-6/.1-r.oti Eil) c-cNA r re.i P J •` 0' � I el) .C,»Jarf N) Liafi 2I) cic_S I j A.N-L p 8 D--Q Air i1 4 oi Dated ❑ REINSPECTION FEE REQUIRED. Prior to next inspection, fee must be paid at 6300 Southcenter Blvd., Suite 100. Call to schedule reinspection. �'1 INSPECTION RECORD Retain a copy with permit PERMIT NO. INSPECTION NO. CITlr`::O.F TUKWILA BUILDING DIVISION, 630 that center Blvd., #100, Tukwila, WA 98188 (206)431 -3670 P-F1' _ o Type of Inspec ' n: r C.t..r Adi11ess no 24Adaer ge‘. Date Called: c) s-/of-hi Sp cial Instructions: Date Wanted: Q #109 /// p.m. Requester:\ . Phone No: Approved per applicable codes. ElCorrections required prior to approval. COMMENTS: baG%f(Ow 4e5+ re reCeWec/. Inspector: VS loate h /II ❑ $60.00 REINSPECTION FEE REQUIRED. Prior to inspection, fee must be paid at 6300 Southcenter Blvd., Suite 100. Call to schedule reinspection. Receipt No.: 'Date: FILE COPY a 2160 company RECEIVED MAR 25MIL. TUKWIIA PUBLIC WORK . r r ►, • Model 375 Reduced Pressure Principle Assembly AT1ONl SUBMITTAL SHEET FEATURES Sizes: ❑ 1/2" ❑ 3/4" ❑ 1" ❑ 1 -1/4" ❑ 1 -1/2" ❑ 2" Maximum working water pressure 175 PSI Maximum working water temperature 180 °F Hydrostatic test pressure 350 PSI End connections Threaded FNPT ANSI B1.20.1 OPTIONS (Suffixes can be combined) ❑ XL - ❑ S - ❑ SE - ❑ FT - ❑ AG - ❑ SAG - ❑ BOF - with full port QT ball valves (standard) with low lead ball valves (See 375XL) with bronze "Y" type strainer with street elbows with integral male 45° flare SAE test fitting with air gap with bronze "Y" strainer and air gap with Blow out/Flush fitting ACCESSORIES ❑ Repair kits ❑ Thermal expansion tank (Mdl. XT) ❑ Soft seated check valve (Mdl. 40XL) ❑ Shock arrester (Model 1250) ❑ QT -SET Quick Test Fitting Set ❑ Test Cock Lock (Model TCL24) ❑ Blow out / Flush fitting (RK34- 375BOF (1/2" or 3/4 "), RK1- 375BOF or RK114- 350- 375B0F) APPLICATION Designed for installation on potable water lines to protect against both backsiphonage and backpressure of contami- nated water into the potable water supply. Assembly shall provide protection where a potential health hazard exists. STANDARDS COMPLIANCE (3/4" - 2 ") • ASSE® Listed 1013 �.fl • IAPMO® Listed MAR 2 3 2011 • CSA B64.4 • AWWA compliant C511 P[ER C 'y • Approved by the Foundation for Cross Connection Control and Hydraulic Research at the University of Southern California • Contact Factory for 1/2" Approvals MATERIALS Housing Fasteners Elastomers Internals Springs Ball Valves Struts Reinforced Nylon, F.- D wiEWED FOR Stainless Steel, 300, Silicone (FDAApp COMPLIANC Buna Nitrite (FDAAppro0e ; _: OVED Delrin, Nylon, NSF Listed' Stainless steel, 310 seriesAP, 2 Lu i I Cast Bronze, AST B 584 Forged Brass, AS M B 124 MODELS 375SE H OPTIONAL STRAINER (MODEL S) of Tukwila INn niViRlf1 C B DIMENSIONS & WEIGHTS (do not include pkg ) v[! �YI[I F (1/2' -1 °) F (1 -1/4' - 2' ) MODEL 375 SIZE in. mm DIMENSIONS (approximate) WEIGHT A in. mm B in. mm C in. mm D in. mm E in. mm F• in. mm G in. mm H in. mm J in. mm LESS BALL VALVES lbs. kg WITH BALL VALVES lbs. kg 1/2 20 8 7/8 225 115/16 49 1 5/8 41 215/16 75 3 7/8 98 121/4 311 3 76 10 7/8 276 121/4 311 4.7 2.1 5.7 2.6 3/4 20 8 7/8 225 115116 49 1 5/8 41 215/16 75 3 7/8 98 12 5/8 321 3 76 11 279 12 1/4 311 4.7 2.1 5.7 2.6 1 25 113/16 284 21/4 57 21/4 57 37/16 87 4 102 149/16 370 4 102 133/4 349 151/4 387 8.2 3.7 9.7 4.4 1 -1/4 32 14 7/8 378 3 3/8 86 3 3/8 86 3 3/4 95 5 3/4 146 201/2 521 3 3/4 95 18 457 18 1/2 470 18.7 8.5 20.5 9.3 1 -1/2 40 151/4 387 3 3/8 86 3 3/8 86 3 3/4 95 5 3/4 146 22 559 41/2 114 18 3/4 476 201/4 514 18.3 8.0 21.5 9.8 2 50 16 406 3 3/8 86 3 3/8 86 3 3/4 95 5 3/4 146 24 _610.4 3/4_120.720 3/4 527 20 3/4 527 19.4 8.8 23.5 10.7 'atent No. 6,513,543 & 7,784,483) DOCUMENT #: REVISION: BF -375 SM 1111 a e1of2 CORRPECTION LTR# I WILKINS a Zurn company, 1747 Commerce Way, Paso Robles, CA 93446 Phone:805/238 -7100 Fax:805/238 -5766 In Canada: ZURN INDUSTRIES LIMITED, 3544 Nashua Dr., Mississauga, Ontario L4V 1L2 Phone:905 /405 -8272 Fax:905/405 -1292 Product Support Help Line: 1- 877 - BACKFLOW (1-877 -222 -5 56) • Website: http: //www. 1iL1-' oiiL 0.0 30 0 N - a FLOW CHARACTERISTICS MODEL 375, 375XL 1/2 ", 3/4" & 1" (STANDARD & METRIC) FLOW RATES (I /s) 1.3 2.5 3.8 y 20 — N UJ - 10 W • � a 0 0.0 a 20 - --3/4" (20mm) 1/2" (15mm) - - 1.7■1._- 1" (25mm) 5.0 207 , 138co cc 69 W n a 20 40 60 80 FLOW RATES (GPM) MODEL 375, 375XL 1 -1/4" - 2" (STANDARD & METRIC) 3.2 6.3 FLOW RATES (I /s) 9.5 12.6 15.8 N 015 J W cc • 10 y 0) a ▪ 5 0 1 -1/4" (32mm) 1-- 1-1/2" (40mm) TYPICAL INSTALLATION 50 100 150 FLOW RATES (GPM) p Rated Flow (Established by approval agencies) Local codes shall govern installation requirements. To be installed in accordance with the manufacturers' instructions and the latest edition of the Uniform Plumbing Code. Unless otherwise specified, the assembly shall be mounted at a minimum of 12" (305mm) and a maximum of 30" (762mm) above adequate drains with sufficient side clearance for testing and maintenance. The installation shall be made so that no part of the unit can be submerged. (1 -1/4" - 2") 81/8 (1/2" -1') 51/2 (1 -1/4" - 7) 3' PIPE (1/2' - 1') 2" PIPE (DRAIN LINE CAN BE ANY STANDARD PIPING MATERIAL) 12" MIN. 30" MAX. DIRECTION OF FLOW INDOOR INSTALLATION FLOOR DRAIN 200 138 2" (50mm)- 103 2 O J W 69 0) N W 34 kr a 250 Capacity thru Schedule 40 Pipe Pipe size 5 ft/sec 7.5 ft/sec 10 ft/sec 15 ft/sec 3/8" 3 4 6 9 1/2" 5 7 9 14 3/4" 8 12 17 25 1" 13 20 27 40 1 1/4" 23 35 47 70 1 1/2" 32 48 63 95 2" 52 78 105 167 MODEL 375SAG (SHOWN) OPTIONAL PROTECTIVE ENCLOSURE OPTIONAL STRAINER (MODEL S) WATER METER ..0;,6.1 6- INLET SHUT OFF FLOOR DRAIN DIRECTION OF FLOW c OUTDOOR INSTALLATION SPECIFICATIONS The Reduced Pressure Principle Backflow Preventer shall be ASSE® Listed 1013, rated to 180 °F and supplied with full port ball valves. The main body shall be Nylon and the seat disc elastomers shall be silicone. If installed indoors, the installation shall be supplied with an air gap adapter. The Reduced Pressure Principle Backflow Preventer shall be a WILKINS Model 375. WILKINS a Zurn company, 1747 Commerce Way, Paso Robles, CA 93446 Phone:805 /238 -7100 Fax:805/238 -5766 IN CANADA: ZURN INDUSTRIES LIMITED, 3544 Nashua Dr., Mississauga, Ontario L4V 1L2 Phone:905 /405 -8272 Fax:905/405 -1292 Product Support Help Line: 1- 877 - BACKFLOW (1 -877- 222 -5356) • Website: http: / /www.zum.com Page 2 of 2 April 20, 2011 • city of Tukwila Jim Haggerton, Mayor Department of Community Development Jack Pace, Director Ted Brandvold 616 14 Street Modesto, CA 95310 RE: Correction Letter #2 Plumbing /Gas Piping Permit Application Number PG11 -022 Sightline Health — 200 Andover Pk E Dear Mr. Brandvold, This letter is to inform you of corrections that must be addressed before your plumbing/gas piping permit can be approved. All correction requests from each department must be addressed at the same time and reflected on your drawings. I have enclosed comments from the Building Department. At this time the Public Works Department has no comments. Building Department: Dave Larson at 206 431 -3678 if you have any questions regarding the attached memo. Please address the attached comments in an itemized format with applicable revised plans, specifications, and /or other documentation. The City requires that two (2) sets of revised plans, specifications and /or other documentation be resubmitted with the appropriate revision block. In order to better expedite your resubmittal, a `Revision Submittal Sheet' must accompany every resubmittal. I have enclosed one for your convenience. Corrections /revisions must be made in person and will not be accepted through the mail or by a messenger service. If you have any questions, please contact me at (206) 431 -3670. Sincerely, Bill Rambo Permit Technician encl File: PGI1 -022 W:\Permit Center \Correction Letters '2011\PG11 -022 Correction Letter #2.DOC 6300 Southcenter Boulevard, Suite #100 • Tukwila, Washington 98188 • Phone: 206 - 431 -3670 • Fax: 206 - 431 -3665 Tukwila Building Division Dave Larson, Senior Plan Examiner Building Division Review Memo #2 Date: April 19, 2011 Project Name: Sightline Health Permit #: PG11 -022 Plan Review: Dave Larson, Senior Plans Examiner The Building Division conducted a plan review on the subject permit application. Please address the following comments in an itemized format with revised plans, specifications and/or other applicable documentation. (GENERAL NOTE) PLAN SUBMITTALS: (Min. size 11x17 to maximum size of 24x36; all sheets shall be the same size). (If applicable) Structural Drawings and structural calculations sheets shall be original signed wet stamped, not copied.) 1. In the response to review memo #1 a RPPA was deleted from a rooftop chiller. If it was required per the manufacturer, it would still be required to protect the tenant's potable water. The addition of the tenant RPPA would not negate the need for the chiller RPPA. Please add the device again or provide reason and justification to remove it. 2. Please provide a complete gas piping plan back to the meter or meters and provide BTU ratings for both existing and new equipment. Provide size of pipe sections and lengths to show compliance with IFGC. 3. On page P2.2 keynote 4 says not used but it was used in upper left corner of this page. Please clarify. Should there be questions concerning the above requirements, contact the Building Division at 206 -431- 3670. No further comments at this time. . . ALEXANDER SCHEFLO Phone (209) 948 -9761 and ASSOCIATES, Inc. CONSULTING MECHANICAL ENGINEERS 2926 PACIFIC AVE. P. 0. BOX 4183 STOCKTON, CALIF. 95204 March 22, 2011 Commercial Architecture 616 14th Street Modesto, CA 95310 Attention: Ted Brandvold Reference: Sightline Health - 200 Andover Pk E Subject: City of Tukwila, WA - Response to Tukwila Building Division Correction Letter #1, dated 2/7/2011 Ted, The following is my firm's response to plumbing plan requirements: 1. Please add the number of gas piping outlets to the outlets to the permit application unless the gas piping is not intended to be part of the scope of this permit. Response: Complied, refer to revised permit. 2. Note 7A on sheet P2.0 states that a new 3 inch waste will be connected to an existing 2 inch waste. Please revise as necessary so that waste is not recued in the direction of flow. Response: Complied, refer to revised keynote. 3. Note 7 on sheet P2.2 mentions a RPBA for isolation of the rooftop chiller but the plumbing legend does not include a symbol for this device and the plan does not show a symbol for a RPBA. Please add. Response: Complied, refer to revised legend and floor plan. 4. An RPBA is required to isolate medical facilities. Please add an RPBA at the water point of connection to this tenant. Response: Complied, refer to revised plumbing floor plan. If you have any questions or concerns regarding the above, please feel free to call. Sincerely, thr4 ■ Mitch Scheflo, P.E. Mechanical Engineer ALEXANDER SCHEFLO AND ASSOCIATES, INC. P:IWORK111247 CORRESPONDENCE1 11247ylancheckresponse2- 7- 11.docc ALEXANDER SCHEFLO and ASSOCIATES, Inc. CONSULTING MECHANICAL ENGINEERS 2926 PACIFIC AVE. P. 0. BOX 4183 STOCKTON, CALIF. 95204 Commercial Architecture 616 14th Street Modesto, CA 95310 Attention: Ted Brandvold Phone (209) 948 -9761 March 22, 2011 Reference: Sightline Health - 200 Andover Pk E Subject: City of Tukwila, WA - Response to Public Works Department Correction Letter #1, Dated 2/17/2011 Ted, The following is my firm's response to plumbing plan requirements: 1. Due to the nature of Sightline Health business services (medical clinic), which is considered a high hazard, a Reduced Pressure Assembly (RPPA) shall be installed as a backflow device for cross - connection control for in- premise isolation to protect the other tenants in the building from water cross contamination. Please show location diagram of RPPA installation and specify size, make and model number of the backflow. Please submit RPPA cut sheet and circle the RPPA to be installed. Please install a floor drain or other means of drainage outlet since the devise spits. Make sure that the backflow is from the WA State Department of Health Backflow Prevention Assemblies Approved for Installation in Washington State list. Cloud, date and number this revision. Response: Complied, refer to revised plumbing floor plan indicating a RPPA device being installed on the water service to the tenant improvement. Refer to plumbing fixture schedule sheet P8.0 for size and specification. A cut sheet of the specified backflow is attached. Refer to keynote #11 for direction on how to drain the outlet on the RPPA. If you have any questions or concerns regarding the above, please feel free to call. Sincerely, Mitch Scheflo, P.E. Mechanical Engineer ALEXANDER SCHEFLO AND ASSOCIATES, INC. P:\ WORK\ 11247\ CORRESPONDENCE\ 11247ylancheckresponse2- 7- 11.docx i • City of O, Tukwila • Jim Haggerton, Mayor Department of Community Development Jack Pace, Director February 18, 2011 Ted Brandvold 616 14 Street Modesto, CA 95310 RE: Correction Letter #1 Plumbing /Gas Piping Permit Application Number PG11 -022 Sightline Health — 200 Andover Pk E Dear Mr. Brandvold, This letter is to inform you of corrections that must be addressed before your plumbing/gas piping permit can be approved. All correction requests from each department must be addressed at the same time and reflected on your drawings. I have enclosed comments from the Building and Public Works Departments. Building Department: Public Works Department: Dave Larson at 206 431 -3678 if you have any questions regarding the attached memo. Joanna Spencer at 206 431 -2440 if you have any questions regarding the attached memo. Please address the attached comments in an itemized format with applicable revised plans, specifications, and/or other documentation. The City requires that two (2) sets of revised plans, specifications and /or other documentation be resubmitted with the appropriate revision block. In order to better expedite your resubmittal, a `Revision Submittal Sheet' must accompany every resubmittal. I have enclosed one for your convenience. Corrections /revisions must be made in person and will not be accepted through the mail or by a messenger service. If you have any questions, please contact me at (206) 431 -3670. Sincerely, • encl Fitt: ...FG 11 -022 shall it Technician W:\Permit Center \Correction Letters \2011\PG11 -022 Correction Letter #1.DOC 6300 Southcenter Boulevard, Suite #100 • Tukwila, Washington 98188 • Phone: 206 - 431 -3670 • Fax: 206 - 431 -3665 Tukwila Building Division Dave Larson, Senior Plan Examiner Building Division Review Memo Date: February 7, 2011 Project Name: Sightline Health Permit #: PG11 -022 Plan Review: Dave Larson, Senior Plans Examiner The Building Division conducted a plan review on the subject permit application. Please address the following comments in an itemized format with revised plans, specifications and/or other applicable documentation. (GENERAL NOTE) PLAN SUBMITTALS: (Min. size 11x17 to maximum size of 24x36; all sheets shall be the same size). (If applicable) Structural Drawings and structural calculations sheets shall be original signed wet stamped, not copied.) 1. Please add the number of gas piping outlets to the permit application unless the gas piping is not intended to be part of the scope of this permit. 2. Note 7A on sheet P2.0 states that a new 3 inch waste will be connected to an existing 2 inch waste. Please revise as necessary so that waste is not reduced in the direction of flow. 3. Note 7 on sheet P2.2 mentions a RPBA for isolation of the rooftop chiller but the plumbing legend does not include a symbol for this device and the plan does not show a symbol for a RPBA. Please add. 4. An RPBA is required to isolate medical facilities. Please add an RPBA at the water point of connection to this tenant. Should there be questions concerning the above requirements, contact the Building Division at 206 -431- 3670. No further comments at this time. • • PUBLIC WORKS DEPARTMENT COMMENTS DATE: February 17, 2011 PROJECT: Sightline Health 200 Andover Pk E PERMIT NO: PG11 -022 PLAN REVIEWER: Contact Joanna Spencer (206) 431 -2440 if you have any questions regarding the following comments. 1) Due to the nature of Sightline Health business services (medical clinic), which is considered a high hazard, a Reduced Pressure Principle Assembly (RPPA) shall be installed as a backflow devise for cross - connection control for in- premise isolation to protect the other tenants in the building from water cross - contamination. Please show location diagram of RPPA installation and specify size, make and model number of the backflow. Please submit RPPA cut sheet and circle the RPPA to be installed. Please install a floor drain or other means of drainage outlet since the devise spits. Make sure that the backflow is from the WA State Department of Health Backflow Prevention Assemblies Approved for Installation in Washington State list. Cloud, date and number this revision. W:Other /Joanna /PG 11 -022 • PLAN COP OUTING SLIP ACTIVITY NUMBER: PG11 -022 PROJECT NAME: SIGHTLINE HEALTH SITE ADDRESS: 200 ANDOVER PK E Original Plan Submittal X Response to Correction Letter # 2 DATE: 04 -25 -11 Response to Incomplete Letter # Revision # After Permit Issued DEPARTMENTS: )sio gu li ding D sion Public Works Fire Prevention Structural n Planning Division Permit Coordinator DETERMINATION OF COMPLETENESS: (Tues., Thurs.) Complete Incomplete DUE DATE: 04 -26 -11 Not Applicable Comments: Permit Center Use Only INCOMPLETE LETTER MAILED: LETTER OF COMPLETENESS MAILED: Departments determined incomplete: Bldg ❑ Fire ❑ Ping ❑ PW ❑ Staff Initials: TUES /THURS ROUTING: Please Route r Structural Review Required n No further Review Required REVIEWER'S INITIALS: DATE: APPROVALS OR CORRECTIONS: Approved n Approved with Conditions Notation: REVIEWER'S INITIALS: DATE: 54- DUE DATE: 05-24-11 Not Approved (attach comments) n Permit Center Use Only CORRECTION LETTER MAILED: Departments issued corrections: Bldg ❑ Fire ❑ Ping ❑ PW ❑ Staff Initials: Documents /routing slip.doc 2 -28 -02 WERMIT COORD COPY PLAN REVIEW /ROUTING SLIP ACTIVITY NUMBER: PG11 -022 DATE: 03/23/11 PROJECT NAME: SIGHTLINE HEALTH SITE ADDRESS: 220 ANDOVER PK E Original Plan Submittal X Response to Correction Letter # 1 Response to Incomplete Letter # Revision # after Permit Issued DEPA TMENTS: 11)Tdin I sl Pubfic Woks Fire Prevention Structural n Planning Division n ❑ Permit Coordinator ❑ DETERMINATION OF COMPLETENESS: (Tues., Thurs.) Complete g Comments: Incomplete ❑ DUE DATE: 03/24/11 Not Applicable n Permit Center Use Only INCOMPLETE LETTER MAILED: LETTER OF COMPLETENESS MAILED: Departments determined incomplete: Bldg ❑ Fire ❑ Ping ❑ PW ❑ Staff Initials: TUES /THURS ROUTING: Please Route NI Structural Review Required n REVIEWER'S INITIALS: No further Review Required n DATE: APPROVALS OR CORRECTIONS: DUE DATE: 04/21/11 Approved ❑ Approved with Conditions n Not Approved (attach comments) Notation: REVIEWER'S INITIALS: DATE: Permit Center Use Only CORRECTION LETTER MAILED: Departments issued corrections: Bldg ' Fire ❑ Ping ❑ PW ❑ Staff Initials: u�2 Documents/routing slip.doc 2 -28 -02 � Et�IMI� M :i;" �. COPI • PLAN REVIEW /ROUTING SLIP ACTIVITY NUMBER: PG11 -022 PROJECT NAME: SIGHTLINE HEALTH SITE ADDRESS: 200 ANDOVER PK E X Original Plan Submittal Response to Correction Letter # DATE: 02 -01 -11 Response to Incomplete Letter # Revision # After Permit Issued DEPA9TMEN7S: bL doK, Building •ivOo I•r s Fire Prevention Structural n Planning Division n Permit Coordinator DETERMINATION OF COMPLETENESS: (Tues., Thurs.) Complete Incomplete n DUE DATE: 02 -03 -11 Not Applicable Comments: Permit'Center Use Only INCOMPLETE LETTER MAILED: LETTER OF COMPLETENESS MAILED: Departments determined incomplete: Bldg ❑ Fire ❑ Ping ❑ PW ❑ Staff Initials: TUES/THURS ROUTING: Please Route �1 Structural Review Required REVIEWER'S INITIALS: nNo further Review Required DATE: APPROVALS OR CORRECTIONS: DUE DATE: 03 -03 -11 Approved ❑ Approved with Conditions Not Approved (attach comments) Notation: REVIEWER'S INITIALS: DATE: Permit Center Use Only CORRECTION LETTER MAILED: _ Departments issued corrections: Bldg Fire ❑ Ping ❑ PWWJ Staff Initials: Documents /routing slip.doc 2 -28 -02 • 1 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.ci.tukwila.wa.us REVISION SUBMITTAL Revision submittals must be submitted in person at the Permit Center. Revisions will not be accepted through the mail, fax, etc. Date: April 21, 2011 Plan Check/Permit Number: PG 11 -022 ❑ Response to Incomplete Letter # ▪ Response to Correction Letter # 2 ❑ Revision # after Permit is Issued ❑ Revision requested by a City Building Inspector or Plans Examiner Project Name: Sightline Health Project Address: Contact Person: 200 Andover Park East Ted Brandvold Phone Number: (209) 571 -8158 Summary of Revision: 1. The RPPA is still required on the chiller per Keynote 8 on drawing P -2.0. 2. The attached drawings P1.1, P2.0, & P2.1 have the added gas line piping information requested. 3. The shut -off valve indicated on P2.2, Keynote 4 is an isolation valve for isolation of the tenant space from the main building / adjacent suites. Keynote 4, on the attached drawing P2.2, has been modified. AEA y OF TUKWILA APR 2.5.2011 Sheet Number(s): P1.1, P2.0, P2.1 & P2.2 PER "Cloud" "Cloud" or highlight all areas of revision including date of revi ion C Received at the City of Tukwila Permit Center by: Entered in Permits Plus on 'I1 \applications \forms- applications on line\revision submittal Created: 8 -13 -2004 Revised: 1 -2009 • • 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.ci.tukwila.wa.us Revision submittals must be submitted in person at the Permit Center. Revisions will not be accepted through the mail, fax, etc. Date: Plan Check/Permit Number: PG 11 -022 ❑ Response to Incomplete Letter # • Response to Correction Letter # 1 ❑ Revision # after Permit is Issued ❑ Revision requested by a City Building Inspector or Plans Examiner Project Name: Sightline Health Project Address: 200 Andover Pk E Contact Person: T6 D i5eA10 jVDLD Phone Number: (2.43°1) s'j 1 • 815 8 Summary of Revision: e 4S e CE1< /1'n:14 -1 Lo e--ii Sheet Number(s): "Cloud" or highlight all areas of revision including date of revision Received at the City of Tukwila Permit Center by: AA` Entered in Permits Plus on 0 \applications \forms- applications on line\revision submittal Created: 8 -13 -2004 Revised: Contractors or Tradespeople Per Friendly Page • General /Specialty Contractor A business registered as a construction contractor with L&I to perform construction work within the scope of its specialty. A General or Specialty construction Contractor must maintain a surety bond or assignment of account and carry general liability insurance. Business and Licensing Information Name WELLER CONSTRUCTION INC UBI No. 602793194 Phone 2095320686 Status Active Address Po Box 1134 License No. WELLECI916CE Suite /Apt. License Type Construction Contractor City Columbia Effective Date 2/5/2009 State CA Expiration Date 2/18/2013 Zip 95310 Suspend Date County Out Of State Specialty 1 General Business Type Corporation Specialty 2 Unused Parent Company Business Owner Information Name Role Effective Date Expiration Date WELLER, JAMES J Member 02/05/2009 Amount WELLER, DEANNA L Member 02/05/2009 G24014009004 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 DEVELOPERS SURETY Et INDEM CO (DEVS) 780941c 01/08/2009 Until Cancelled $12,000.00 02/05/2009 Assignment of Savings Information No records found for the previous 6 year period Insurance Information Insurance Company Name Policy Number Effective Date Expiration Date Cancel Date Impaired Date Amount Received Date 2 WESTCHESTER FIRE INS COMPANY G24014009004 03/08/2011 03/08/2012 $1,000,000.00 03/22/2011 1 Westchester Fire Ins Company G24014009003 03/28/2008 03/08/2011 $1,000,000.0003 /16/2010 Summons /Complaint Information No unsatisfied complaints on file within prior 6 year period Warrant Information No unsatisfied warrants on file within prior 6 year period https: // fortress .wa.gov /lni/bbip /Print.aspx 04/27/2011