HomeMy WebLinkAboutPermit D03-320 - CHURCHILL RESIDENCE - REPAIR DAMAGECHURCHILL
RESIDENCE
5118 SOUTH 164x"
STREET
D03 -320
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Fire Loop Hydrant:
Flood Control Zone:
Hauling:
Land Altering:
Landscape Irrigation:
Moving Oversize Load:
Sanitary Side Sewer:
Sewer Main Extension:
Storm Drainage:
Street Use:
Water Main Extension:
Water Meter:
doc: Devperm
City of Tukwila
Department of Community Development / 6300 Southcenter BL, Suite 100 / Tukwila, WA 98188 / (206) 431 -3670
Value of Construction: $ $10,925.00
Type of Fire Protection: N/A
Type of Construction:
Public Works Activities:
Channelization / Striping: N
Curb Cut / Access / Sidewalk / CSS: N
N
N
DEVELOPMENT PERMIT
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Parcel No.: 6818400010 Permit Number: D03-320 z
Address: 5118 S 164 ST TUKW Issue Date: 10/17/2003 ' W
Suite No: Permit Expires On: 04/14/2004 QQ D
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Tenant: o
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Name: LYNN CHURCHILL � "
Address: 5118 S 164 ST, TUKWILA WA co w
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Owner: g
Name: LYNN CHURCHILL Phone: a. Q co
Address: 5118 S 164TH ST, TUKWIA WA - �c tO
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Contact Person:
Name: LYNN CHURCHILL �� , Phone: 206 856 -5966 i- 0
Address: 5118 S 164 ST, TUKWILA WA w ~ ui
Contractor: v 0
Name: SELLEN CONSTR CO INC Phone: 206 - 682 -7770 0 D
Address: PO BOX 9970 SEATTLE WA o 1- ' Ill w
Contractor License No: SELLEC *372ND Expiration Date:06 /01/2005 H v
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DESCRIPTION OF WORK: z
REPLACE INSULATED WALL; STEEL INSULATED GARAGE DOOR; CABINETS AND YARD LIGHT. (REPAIR AND REPLACE v co
DAMAGE DONE BY HIGH SPEED POLICE CHASE) o H:
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Private:
Profit:
Private:
D03 -320
Fees Collected: $326.66
Uniform Building Code Edition: 1997
Occupancy per UBC: 0007
Number: 0 Size (Inches): 0
Start Time: End Time:
Volumes: Cut 0 c.y. Fill 0 c.y.
Start Time: End Time:
Public:
Non - Profit:
Public:
Printed: 10 -17 -2003
Permit Center Authorized Signature:
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 development permit. LY AIN A- etr,-,Ltemtu,
Signature:
Print Name:
doc: Devperm
City of Tukwila
Department of Community Development / 6300 Southcenter BL, Suite 100 / Tukwila, WA 98188 / (206) 431 -3670
Date: /C 1. 7 3
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.
D03 -320
Printed: 10 -17 -2003
Date: W O
2
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Department of Community Development / 6300 Southcenter BL, Suite 100 / Tukwila N�A,96188 / (206) 431 -3670
City of Tukwila
Parcel No.: 6818400010
Address: 5118 S 164 ST TUKW
Suite No:
Tenant: LYNN CHURCHILL
Signature:
Print Name: t/AI A C tLaci -I `L
doc: Conditions
PERMIT CONDITIONS
Permit Number: D03 -320
Status: ISSUED
Applied Date: 10/17/2003
Issue Date: 10/17/2003
1: ** *BUILDING DEPARTMENT CONDITIONS * **
2: No changes will be made to the plans unless approved by the Engineer and the Tukwila Building Division.
3: All permits, inspection records, and approved plans shall be available at the job site prior to the start of any
construction. These documents are to be maintained and available until final inspection approval is granted.
4: All construction to be done in conformance with approved plans and requirements of the Uniform Building Code (1997
Edition) as amended, Uniform Mechanical Code (1997 Edition), and Washington State Energy Code (1997 Edition).
5: Validity of Permit. The issuance of a permit or approval of plans, specifications, and computations 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 ordinance of the jurisdiction. No permit presuming to give authority to violate or cancel the provisions of this
code shall be valid.
I hereby certify that I have read these conditions and will comply with them as outlined. 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 provision of any other work or local laws
regulating construction or the performance of work.
OL 66)11 / / Date: 10
D03 -320
Printed: 10 -17 -2003
xSI
Site Address:
Tenant Name:
Property Owners Name:
Mailing Address:
Name:
Mailing Address:
City State Zip
E -Mail Address: Fax Number: ° 70 3
Company Name: 'EZ L E7V CZ 1 /11
Mailing Address: 2
Contact Person: #11 cH,4? Aci.efi
E -Mail Address:
Contractor Registration Number: 3 "
gton State Contractor License must be presented at the time of permit issuance **
* *An original or notarized copy of current Washi
RCH R
ITECT OF E CORD All plans must be wet stamped by Architect of Recor
Company Name: 1\1
Mailing Address:
Contact Person:
E -Mail Address:
ENGINEER OF RECORD = All plans must be wet stamped by Engineer of Record
Company Name:
Mailing Address:
Contact Person:
E -Mail Address:
\applications \permit application (3.2003)
3/2003
CITY OF TUKWILA
Community Development uepartment
Public Works Department
Permit Center
6300 Southcenter Blvd., Suite 100
Tukwila, WA 98188
5 l S Sa l lo 11— (Sy —
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 **
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tAiF
City State Zip
7cs 1 g DDay Telephone:ZQfr3 b 76 -(59
T (2(LA � l 5i'a Number
f 5 67, 1 . 9 .37 0 Expiration Date:
Page 1
King Co Assessor's Tax No.: parcel ..14- (oa (8' 4) 00 l
Suite Number:
New Tenant: ❑ .... Yes
'71t1!..c,Ot
City
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State
Day Telephone: S gp . (o 0
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City
Day Telephone:
Fax Number:
State
City
Day Telephone:
Fax Number:
State
Floor:
❑ ..No
cl �l e
Zip
to
Zip
Zip
I;DING :PERMIT INFORMA
1..5.2. i
Valuation of Project (contractor's bid price): $ I D l q9: 5 J Existing Building Valuation: $ ��'(� (liv1
Scope of Work (please provide detailed information): f1° 1Gt.C.k.- t. 146 cc ( Gt.'FC \
Will there be new rack storage? ❑ ..Yes
PLANNING DIVISION:
Number of Parking Stalls Provided: Standard:
Will there be a change in use? 0 ....Yes
\applications \permit application (3.2003)
3/2003
o if "yes ", see Handout No.
Page 2
for requirements.
Provide: All Building Areas in; Square :Footage Below
Addition to
Existing
Structure
• 3f Floor
Basement
Accessory : Structure * .;.:
ttached; Garay
Detached Garage
Attached Carport
Detached Caipo
Covered,Deck: ;
UncoveredDeck :>
by h (.
;Type of
Construction
per :UBC
:':,Type. of ;.
Occupancy per
''UBC
+r
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: i/CQ..e k L(SQ
Lot Area (sq ft): I t `1 kte Floor area of principal dwelling:-{'' S Floor area for accessory dwelling:
*Provide documentation that shows that the principal owner lives in one of the dwellings as his or her primary residence.
Compact: Handicap:
o If "yes ", explain:
FIRE PROTECTION/HAZARDOUS MATERIALS:
0.. Sprinklers ❑..Automatic Fire Alarm ❑..None p . 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 indicating quantities and Material Safety Data Sheets.
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Scope of Work (please provide detailed information):
ater District
...Tukwila 0... Water District #125 ❑ .. Highline ❑ ...Renton
❑ ... Water Availability Provided
Se er District
iV ...Tukwila ❑... ValVue ❑ .. Renton ❑ ...Seattle
❑ ...Sewer Use Certificate 0... Sewer Availability Provided 0 .. Approved Septic Plans Provided
0 ...Septic System - For onsite septic system, provide 2 copies of a current septic design approval by King County Health Department.
Submitted with Application (mark boxes which apply):
❑ ...Civil Plans (Maximum Paper Size — 22" x 34 ")
0 ...Technical Information Report (Storm Drainage)
❑ ...Bond .. Insurance ❑ .. Easement(s)
Proposed Activities (mark boxes that apply):
0 ...Right - of - way Use - Nonprofit for less than 72 hours
.. .Right -of -way Use - No Disturbance
0 ...Construction /Excavation/Fill - Right -of -way
Non Right -of -way
0 ...Total Cut
0 ...Total Fill
0...Sanitary Side Sewer
.. .Cap or Remove Utilities
0 ...Frontage Improvements
0 ...Traffic Control
.. .Backflow Prevention - Fire Protection
Irrigation
Domestic Water
0 ...Permanent Water Meter Size...
0 ...Temporary Water Meter Size..
.. • Water Only Meter Size
.. .Sewer Main Extension Public _
❑ ...Water Main Extension Public _
\applications \permit application (3.2003)
3/2003
Please refer to.:Public:Works Bul!etin #1 fqr:fees and estimate Sheet
cubic yards
cubic yards
. Abandon Septic Tank
. Curb Cut
. Pavement Cut
. Looped Fire Line
IP
Call before you Dig: 1- 800 - 424 -5555
a
WO#
WO#
WO#
Private
Private
0 .. Geotechnical Report 0...Traffic Impact Analysis
0 .. Maintenance Agreement(s) ❑...Hold Harmless
❑ .. Right -of -way Use - Profit for less than 72 hours
0 .. Right -of -way Use — Potential Disturbance
❑ .. Work in Flood Zone
0 .. Storm Drainage
❑ .. Grease Interceptor
❑ .. Channelization
❑ .. Trench Excavation
❑ .. Utility Undergrounding
0 ...Deduct Water Meter Size
FINANCE INFORMATION
Fire Line Size at Property Line
0 ...Water ❑ ...Sewer
Monthly Service Billing to:
Name:
Mailing Address:
Water Meter Refund/Billing:
Name:
Mailing Address:
Number of Public Fire Hydrant(s)
0 ...Sewage Treatment
Day Telephone:
City
State
Zip
Day Telephone:
City
State
Zip
Page 3
1
Unitt e:`` r.. :.:Qty
,
UnitT e.
Type: ;.:
Qty
Unit:T a
Type: i
•..
- Qty
Boiler /Com ressor•
P '
Qty
Q Y
Furnace <100K BTU
Air Handling Unit
>= 10,000 CFM
Other Mechanical
Equipment
0 -3 HP /100,000 BTU
Furnace>100K BTU
Evaporator Cooler
3 -15 11P /500,000 BTU
Floor Furnace
Ventilation Fan
15 -30 HP /1,000,000 BTU
Suspended/Wall/Floor
Mounted Heater.
Ventilation System
30 -50 EIP /1,750,000 BTU
Appliance Vent
Hood
50+ I-IP /1,750,000 BTU
Heat/Refrig /Cooling
System
Incinerator - Domestic
Air Handling Unit
<= 10,000 CFM
Incinerator — Comm /Ind
ECHANI.
Company Name:
Mailing Address:
Contact Person:
E -Mail Address:
T.INFQ' 6 - 431-36'
MECHANICAL CONTRACTOR INFORMATION
Contractor Registration Number: Expiration Date:
* *An original or notarized copy of current Washington State Contractor License must be presented at the time
Valuation of Project (contractor's bid price): $
Scope of Work (please provide detailed information):
Use: Residential: New ....0 Replacement ....
Commercial: New .... ❑ Replacement .... []
Fuel Type: Electric Gas ....D Other:
Indicate type of mechanical work being installed and the quantity below:
NPc
City
Day Telephone:
Fax Number:
State
Zip
Of permit issuance**
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 extend the time for action by the applicant for a period not exceeding 180 days upon written request by the applicant as
defined in Section 107.4 of the Uniform Building Code (current edition). No application shall be extended more than once.
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 O ER OR AUTHORIZED GENT:
Signature: Cf iL,LI.1
Print Name: , r p�
� �4��� �l�J Day Telephone: 'X (0 ) p �(n
Mailing Address: 571 9) c ' . 1 6,10 S ME ►G co LC(
Date Application Accepted:
7 - /7 -o 3
\applications \permit application (3.2003)
3/2003
ate Application Expires:
Page 4
Date: r d / - 7 . V 3
A� /�' �, i /�► �/ I � '1 r ' 1 ► r State •
1:J �. • 1� //_fil ievrf idtp a 1 "(� f► t� eoreoz� S ���►r,�f7�� / • �.�� �rari vil. .70 ?: ' :.r i a• .
i\C.l� ti�iU' , � � /4/� � 1� � ..�i�. - -•� � �:Y /j- `�'�•A
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Staff Initials:
RECEIPT = i~
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Parcel No.: 6818400010 Permit Number: D03 -320 t 6 v
Address: 5118 S 164 ST TUKW Status: PENDING o 0
Suite No: Applied Date: 10/17/2003 N o
Applicant: LYNN CHURCHILL Issue Date: w H
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Receipt No.: R03 -01258 Payment Amount: 326.66 ga 5
u_¢
Initials: SKS Payment Date: 10/17/2003 10:55 AM = d
User ID: 1165 Balance: $0.00 t--' _
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Type Method Description Amount U
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Payment Check 3238 326.66 0
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Payee:
TRANSACTION LIST:
ACCOUNT ITEM LIST:
Description
doc: Receipt
City of Tukwila
6300 Southcenter BL, Suite 100 / Tukwila, WA 98188 / (206) 431 -3670
LYNN CHURCHILL
BUILDING - RES
PLAN CHECK - RES
STATE BUILDING SURCHARGE
Account Code Current Pmts
000/322.100
000/345.830
000/386.904
195.25
126.91
4.50
Total: 326.66
- 37S7 1C1/17 9716 TOTAL 326.66
Printed: 10 -17 -2003
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Pr ject:
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Type of i evion:
A y
X71 SO
1,‘..) .(AVM(
Date Call d:
#Rj 17 6 1 03
Spe ial Instructions: fy t�
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Requester:
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INSPECTION NO.
CITY OF TUKWILA BUILDING DIVISION
6300 Southcenter Blvd., #100, Tukwila, WA 98188
Approved per applicable codes.
INSPECTION RECORD
Retain a copy with permit
DD33o
(206)431 -3670
El Corrections required prior to approval.
COMMENTS:
f�i titre 1 i Y\ C4
Inspector:`
— A i •CD A 4_, Po-.
Date:
$47.00 REINSPECTION FEE REQUIRED. Prior to inspection, fee must be
paid at 1300 Southcenter Blvd., Suite 100. Call to schedule reinspection.
Receipt No.:
Date:
J
CITY OF - ~UKWILA
Permit Center
6300 Southcenter Boulevard, Suite 100
Tukwila, WA 98188
(206) 431 -3670
ALTERNATE PLAN SUBMITTAL AUTHORIZATION
FOR LIMITED SCOPE OF WORK
U.B.C. Section 106.3.2 exception
Application # :1)O3" � ZO
Project name C114e1 n�� d es t
c\-etAC
J
Address lr 1 1 8 S ( (e'J-1 .
Description of work e l.peL (( door j G� QC, v c , r . ov e✓` \ \ 4A �v� e r tors
&AcA We At o v. r i c t s i trto c9 90 V"4 of e.,
Related reference number
The above project permit applicant, due to the limited scope of work is authorized to submit reduced plan
requirements describe as noted below.
1. Complete permit application required: ( Note, all application must include; 1) property assessor
number, 2) copy of contractors license or completed owner waiver form. )
Building X. Mechanical Other
2. Minimum plan and /or specification requirement:
Site plan Floor plan Elevations Foundation
Cross sections Roof plan W.S.E.C. compliance Narrative X
Structural calculations ( stamped by Washington State licensed engineer )
Specific required information t).)\ tvvi (tee fGtr Off'
Y`P��GG•2Gt atn rec, rrv‘ (Coy futOr.1x.2wvftet11-
3. Other special instructions: OTC.
Authorization by, r ( 1 "1` p�N`
TBD3 /96 -form 12
Date L0 LL -03
( Authorization void 30 days after the date issued. )
LICENSE DETAIL INFORMATION Form Page 1 of 2
Current Filter: None
Name
Address
Address
City
State
Zip
Phone Number
Effective Date
Expiration Date
Registration Status
Type
Entity
Specialty Code
Other Specialties
UBI Number
STATE OF WASHINGTON
DEPARTMENT OF LABOR AND INDUSTRIES
Specialty Compliance Services Division
P. O. Box 44000 Olympia, WA 98504 -4000
THE RESULT OF YOUR INQUIRY FOR LICENSE NUMBER SELECTED IS:
LICENSE DETAIL INFORMATION
Registration# or License SELLEC *372ND
SELLEN CONSTR CO INC
PO BOX 9970
SEATTLE
WA
98109
2066827770
8/20/1963
ACTIVE
CONSTRUCTION CONTRACTOR
CORPORATION
GENERAL
UNUSED
578006698
* *VIEW CROSS REFERENCE FILE FOR THIS LICENSE* * *
* *VIEW PRINCIPAL OWNER(S) FOR THIS LICENSE* * *
* *VIEW CONTRACTOR BOND /SAVINGS INFORMATION * * *
* *CHECK INQUIRY FOR SUMMONS AND COMPLAINTS* *
* * VIEW CONTRACTOR INSURANCE INFORMATION * * *
*
New inquiry by CITY , NAME , PRINCIPAL OWNER NAME , LICENSE , UBI
NUMBER , check the
L &I Contractor Industrial Insurance Premium Status or return to the L &I Construction
Compliance Home Page
https: / /wws2.wa.gov /lni/bbip /TF2Form.asp ?License= SELLEC *372N0
10/17/2003