HomeMy WebLinkAboutPermit M10-121 - GOMEZ RESIDENCEGOMEZ RESIDENCE
4504 S 124 ST
M10 -121
City otkukwila
Department of Community Development
6300 Southcenter Boulevard, Suite #100
Tukwila, Washington 98188
Phone: 206 -431 -3670
Inspectio n Request Line: 206- 431 -2451
Web site: http: //www.ci.tukwila.wa.us
MECHANICAL PERMIT
Parcel No.:
Address:
0179000782
4504 S 124 ST TUKW
Project Name: GOMEZ RESIDENCE
Permit Number: M10 -121
Issue Date: 09/03/2010
Permit Expires On: 03/02/2011
Owner:
Name:
Address:
Contact Person:
Name:
Address:
Email:
Contractor:
Name:
Address:
Contractor
GOMEZ GEORGE G
4504 S 124TH , SEATTLE WA 98178
NAIDA KHAN
1345 GULF RD , POINT ROBERTS WA 98281
NAIDA@NWPERMIT.COM
WASHINGTON ENERGY SERVICES CO
2800 THORNDYKE AVE W , SEATTLE, WA 98199
License No: WASHIES9710B
Phone: 360 - 945 -2787
Phone: 206 282 -4200
Expiration Date: 09/02/2011
DESCRIPTION OF WORK:
REPLACE 80,000 BTU GAS FURNACE
Value of Mechanical: $3,535.77
Type of Fire Protection: UNKNOWN
Permit Center Authorized Signature:
Fees Collected:
$186.50
International Mechanical Code Edition: 2009
Date: ( V
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 mechanical permit.
Signature:
Print Name:
QY 9---
'CV
Date:
53- lb
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: IMC -4/10
M10 -121 Printed: 09 -03 -2010
•
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
Parcel No.: 0179000782
Address: 4504 S 124 ST TUKW
Suite No:
Tenant: GOMEZ RESIDENCE
PERMIT CONDITIONS
Permit Number: M10 -121
Status: ISSUED
Applied Date: 09/03/2010
Issue Date: 09/03/2010
1: ** *BUILDING DEPARTMENT CONDITIONS * **
2: No changes shall be made to the approved plans unless approved by the design professional m responsible charge and the
Building Official.
3: All permits, inspection records, and approved plans shall be at the job site and available to the inspectors prior to
start of any construction. These documents shall be maintained and made available until final inspection approval is
granted.
4: Manufacturers installation instructions shall be available on the job site at the time of inspection.
5: Except for direct -vent appliances that obtain all combustion air directly from the outdoors; fuel -fired appliances
shall not be located in, or obtain combustion air from, any of the following rooms or spaces: Sleeping rooms,
bathrooms, toilet rooms, storage closets, surgical rooms.
6: Equipment and appliances having an ignition source and located in hazardous locations and public garages, PRIVATE
GARAGES, repair garages, automotive motor -fuel dispensing facilities and parking garages shall be elevated such that
the source of ignition is not less than 18 inches above the floor surface on which the equipment or appliance rests.
7: Water heaters shall be anchored or strapped to resist horizontal displacement due to earthquake motion. Strapping shall
be at points within the upper one -third and lower one -third of the water heater's vertical dimension. A minimum
distance of 4- inches shall be maintained above the controls with the strapping.
8: All plumbing and gas piping work shall be inspected and approved under a separate permit issued by the City of Tukwila
Building Department (206- 431 - 3670).
9: All electrical work shall be inspected and approved under a separate permit issued by the City of Tukwila Building
Department (206- 431 - 3670).
10: VALIDITY OF PERMIT: The issuance or granting of a permit shall not be construed to be a permit for, or an approval of,
any violation of any of the provisions of the building code or of any other ordinances of the City of Tukwila. Permits
presuming to give authority to violate or cancel the provisions of the code or other ordinances of the City of Tukwila
shall not be valid. The issuance of a permit based on construction documents and other data shall not prevent the
Building Official from requiring the correction of errors in the construction documents and other data.
* *continued on next page **
doc: Cond -10/06
M10 -121 Printed: 09 -03 -2010
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
I hereby certify that I have read these conditions and will comply with them as outlined. All provisions of law and
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 provision of any other work
construction or the performance of work.
Signature:
Print Name:
Icy
Date:
ordinances governing
or local laws regulating
doc: Cond -10/06 M10 -121
Printed: 09 -03 -2010
CITY OF TUK A
Community Development Department
Public Works Department
Permit Center
6300 Southcenter Blvd., Suite 100
Tukwila, WA 98188
htto://www.ci.tukwila.wa.us
Building Pe No.
Mechanical Permit No. tit 10— 0_1
Plumtiing/Gas Permit No.
Public Works Permit No.
Project No.
For of ice use onl
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
(-1564 I 1 `l l King Co Assessor's Tax No.: V / 7 q (7n� 7< - ?
Site Address: S I Suite Number: Floor:
Tenant Name: r /y 66/27 P
Property Owners Name:
Mailing Address:
New Tenant: ❑ Yes No
ItVit“.L (6- Stagt -e 4 �� p7 (�
CONTACT PERSON — who do we contact when your permit is ready to be issued
Name:
Mailing Address:
Day Telephone: , &Q Cyj 7Q 7
Zip
City State
E -Mail Address: /'tCUc/6— ( n`{ /)OP n t - l ,*7) Fax Number:
GENERAL CONTRACTOR INFORMATION —
(Contractor Information for Mechanical (pg 4) for Plumbing and Gas Piping (pg 5))
Company Name:
Mailing Address:
City
Contact Person: Day Telephone:
E -Mail Address: Fax Number:
Contractor Registration Number: Expiration Date:
State
Zip
ARCHITECT OF RECORD — All plans must be stamped by Architect of Record
Company Name:
Mailing Address:
City
Contact Person: Day Telephone:
E -Mail Address: Fax Number:
State
Zip
ENGINEER OF RECORD — All plans must be stamped by Engineer of Record
Company Name:
Mailing Address:
City
Contact Person: Day Telephone:
E -Mail Address: Fax Number:
State
Zip
H:\Applications\Forms- Applications On Line \2010 Applications \7 -2010 - Permit Application.doc
Revised: 7 -2010
bh
Page 1 of 6
BUILDING PERMIT INFORMATIO1206 -431 -3670 •
Valuation of Project (contractor's bid price): $ Existing Building 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
•
Existing
Interior Remodel
Addition to
Existing
Structure
New
Type of
Construction per
IBC
Type of
Occupancy per
IBC
1' Floor
rd 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:
❑ Sprinklers ❑ 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 11 " paper including quantities and Material Safety Data 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:1Applications\Forms- Applications On Line\2010 Applications17.2010 - Permit Application.doc
Revised: 7 -2010
bh
Page 2 of 6
MECHANICAL PERMIT INFORMA N - 206 - 431 -3670
MECHANICAL CONTRACTOR INFORMATION
Company Name: 14 / 1()
Mailing Address:
•
Contact Person:
E -Mail Address: n a, cl-wcr ntiftginfr
Contractor Registration Number:M -p- q7/0 6
City State Zip
Day Telephone: - 9((-c27
Fax Number:
Expiration Date: 1f `/,69(%/2
Valuation of Mechanical work (contractor's bid price): $ �ff
sy-
Scope of Work (please provide detailed information):
Use: Residential: New ... Replacement .... ❑
Commercial: New .... ❑ Replacement .... ❑
Fuel Type: Electric ❑ Gas....
Other:
Indicate type of mechanical work being installed and the quantity below:
Unit Type:
Qty
Unit Type:
Qty
Unit Type:
Qty
Boiler /Compressor:
Qty
Furnace<100K BTU
I
Air Handling Unit >10,000
CFM
Fire Damper
0 -3 HP /100,000 BTU
Furnace>100K BTU
Evaporator Cooler
Diffuser
3 -15 HP /500,000 BTU
Floor Furnace
Ventilation Fan Connected
to Single Duct
Thermostat
15 -30 HP /1,000,000 BTU
Suspended/Wall/Floor
Mounted Heater
Ventilation System
Wood/Gas Stove
30 -50 HP /1,750,000 BTU
Appliance Vent
Hood and Duct
Emergency
Generator
50+ HP /1,750,000 BTU
Repair or Addition to
Heat/Refrig/Cooling
System
Incinerator - Domestic
Other Mechanical
Equipment
Air Handling Unit
<10,000 CFM
Incinerator — Comm/Ind
H:\ Applications\Forms - Applications On Line\2010 Applications \7 -2010 - Permit Application.doc
Revised: 7 -2010
bh
Page 4 of 6
r
PUBLIC WORKS PERMIT INFCOIATION - 206 -433 -0179
•
Scope of Work (please provide detailed information):
Call before you Dig: 1- 800 - 424 -5555
Please refer to Public Works Bulletin #1 for fees and estimate sheet.
Water District
❑ .. Tukwila ❑ ...Water District #125
❑ .. Water Availability Provided
Sewer District
❑ .. Tukwila
❑ .. Sewer Use Certificate
❑...Valley View
❑ ...Sewer Availability Provided
❑... Highline
❑ ... Renton
❑... Renton
.0... Seattle
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.
Submitted with Application (mark boxes which apply):
El.. Civil Plans (Maximum Paper Size — 22" x 34 ")
❑ .. Technical Information Report (Storm Drainage)
El.. Bond 0... Insurance ❑... Easement(s)
Proposed Activities (mark boxes that apply):
❑ .. Right -of -way Use - Nonprofit for less than 72 hours
El.. Right -of -way Use - No Disturbance
El.. Construction/Excavation /Fill - Right -of -way ❑
Non Right -of -way
❑ .. Total Cut cubic yards
El.. Total Fill cubic yards
El.. Sanitary Side Sewer
El.. Cap or Remove Utilities
El.. Frontage Improvements
El.. Traffic Control
El.. Backflow Prevention - Fire Protection
Irrigation
Domestic Water
❑... Geotechnical Report
El... Maintenance Agreement(s)
El.. Traffic Impact Analysis
El.. Hold Harmless — (SAO)
❑ .. Hold Harmless — (ROW)
❑... Right -of -way Use - Profit for less than 72 hours
0... Right-of-way Use — Potential Disturbance
El... Work in Flood Zone
El... Storm Drainage
. Abandon Septic Tank
. Curb Cut
. Pavement Cut
. Looped Fire Line
❑ .. Permanent Water Meter Size..
El.. Temporary Water Meter Size .
❑ .. Water Only Meter Size
El.. Sewer Main Extension Public
El.. Water Main Extension Public
WO #
WO #
WO#
Private ❑
Private ❑
0... Grease Interceptor
El... Channelization
D ... Trench Excavation
❑ ... Utility Undergrounding
❑ .. Deduct Water Meter Size
FINANCE INFORMATION
Fire Line Size at Property Line Number of Public Fire Hydrant(s)
❑ .. Water El.. Sewer ❑ .. Sewage Treatment
Monthly Service Billing to:
Name: Day Telephone:
Mailing Address:
City State Zip
Water Meter Refund/Billing:
Name:
Mailing Address:
Day Telephone:
City
State
Zip
H:\Applications\Forms- Applications On Line \20I0 Applications\7 -2010 - Permit Application.doc
Revised: 7 -2010
bh
Page 3 of 6
PERMIT APPLICATION NOTES — eicable to all permits in this application •
IDate Application Accepted:
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 OWN OR AUTHORIZED AGENT:
Signature: KY/ e
Print Name: 1�/Q'%7\/ /.Q.C�
� O// / i l Day Telephone:
Mailing Address:
City
Date: 9-ld
997-
State
Zip
Date Application Expires:
Staff Initials:
H:\Applications\Forms- Applications On Line\2010 Applications \7 -2010 - Permit Application.doc
Revised: 7 -2010
bh
Page 6 of 6
PLUMBING AND GAS PIPING PER INFORMATION — 206 - 431 -3670
PLUMBING AND GAS PIPING CONTRACTOR INFORMATION
Company Name:
Mailing Address:
City State Zip
Contact Person: Day Telephone:
E -Mail Address: Fax Number:
Contractor Registration Number: Expiration Date:
Valuation of Plumbing work (contractor's bid price): $
Valuation of Gas Piping work (contractor's bid price): $
Scope of Work (please provide detailed information):
Building Use (per Int'l Building Code):
Occupancy (per Int'l Building Code):
Utility Purveyor: Water: Sewer:
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
Fixture 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)
Food -waste grinder,
commercial
Floor Drain
Shower, single head trap
Lavatory
Wash fountain
Receptor, indirect waste
Sinks
Urinals
Water Closet
Building sewer and each
trailer park sewer
Rain water system — per
drain (inside building)
Water heater and/or vent
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 sprinkler
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
sprinkler backflow
protections over 5
Gas piping outlets
H:\Applications\Fonns- Applications On Line12010 Applications17.2010 - Permit Application.doc
Revised: 7 -2010
bh
Page 5 of 6
(J,��,��A w4� �y City of Tukwila
o/ l 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
Parcel No.: 0179000782
Address: 4504 S 124 ST TUKW
Suite No:
Applicant: GOMEZ RESIDENCE
RECEIPT
•
Permit Number: M10 -121
Status: PENDING
Applied Date: 09/03/2010
Issue Date:
Receipt No.: R10 -01752
Initials: WER
User ID: 1655
Payment Amount: $186.50
Payment Date: 09/03/2010 10:14 AM
Balance: $0.00
Payee: WASHINGTON ENERGY SERVICES
TRANSACTION LIST:
Type Method Descriptio Amount
Payment Check 6570 186.50
Authorization No.
ACCOUNT ITEM LIST:
Description
Account Code Current Pmts
MECHANICAL - RES
000.322.102.00.00 186.50
Total: $186.50
PAYMENT
zginmaerFn
doc: Receiot -06 Printed: 09 -03 -2010
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
/I0 -•124
Projef f},
c1 hit
Type of inspecti n: •
: Al �-.�!
d`
Ad ress:
4.745.124:-
Date Ca
'`7
Special Instructions:
(
�) v ,� 6-1)
V —! (nk 4,
Date Wanted:
i e 'i l '! O
.
rr
p.m.
Requester:
Phone No: 7
7
Approved per applicable codes: • Corrections required prior to approval. .
COMMENTS:
.p
Insp
ctor:
Date:
/40—/
7 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
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 ' •
to -t
Pr/O.L4-2— t:
22f 'Ae. c,
Type of Inspection:
:.,vim 1(�C..
Address:
s70 .1 S. �2��
Date C ed: •
Spe ial Instructions: /, ('
�' ,00 g1 r v T.1 /'
Z • •
"Re-
Date Wa ted: •
L .._' -:j ' p.m.
nester.
Phone No: -76 2275 "7(
tue - *�,c -v. , e _f
C•MMENrS:
Corrections required prior•to approval.
�Mt J i kA-'-e _ / r f r ejAf laAef
r ,+rte, st`� 6 t P ikA J` ? fre '
.^.. refer
Ins ector: '"
ti-
1
Date �'
0 REINS EtiION FEE REQUIRED: Prior to next inspection. fee must be
paid at 6300 Southcenter Blvd.; Suite 100. Call to schedule reinspection.
Contractors or Tradespeople Peer 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 WASHINGTON ENERGY SERVICES CO UBI No. 602320560
Phone 2062824700
Address 2800 Thorndyke Ave W License No. WASHIES971OB
Suite /Apt. License Type Construction Contractor
City Seattle Effective Date 9/2/2003
State WA Expiration Date 9/2/2011
Zip 98199 Suspend Date
County King Specialty 1 General
Business Type Corporation Specialty 2 Unused
Parent Company
Status Active
Business Owner Information
Name
Role
Effective Date
Expiration Date
OLSON, CRAIG
President
09/02/2003
Amount
HEAGLE, RANDY
Secretary
09/02/2003
000259901
CHRISTIANSON, STEVE
Treasurer
09/02/2003
OLSON, VERN
Vice President
09/02/2003
Ironshore
Specialty Ins Co
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
1
DEVELOPERS SURETY
Et INDEM CO
571389C
08/29/2003
Until Cancelled
$12,000.00
09/02/2003
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
8
IRONSHORE
SPECIALTY INS
CO
000259901
05/01/2010
05/01/2011
$1,000,000.0004
/30/2010
7
Ironshore
Specialty Ins Co
00G4H0905001
05/01/2009
05/01/2010
$1,000,000.00
04/29/2009
6
UNITED
SPECIALTY INS
AGL0810381
05/01/2008
05/01/2009
$1,000,000.0004
/30/2008
5
UNDERWRITERS
AT LLOYDS
CJ0749013
05/01/2007
05/01/2008
$1,000,000.0004
/27/2007
4
UNDERWRITERS
AT LLOYDS
CJ0677036
05/01/2006
05/01/2007
$1,000,000.0004
/28/2006
3
UNDERWRITERS
AT LLOYDS
CJ0583038
05/01/2005
05/01/2006
$1,000,000.0004
/27/2005
2
LLOYDS OF
LONDON
CJ0426061
04/01/2004
05/01/2005
$1,000,000.0004
/13/2004
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
Infractions /Citations Information
Infraction / Citation I Date I RCW Code I Type I Status I Violation Amount
https://fortress.wa.gov/lni/bbip/Print.aspx
09/03/2010