HomeMy WebLinkAboutPermit M97-0143 - LEAHY DONALDQr1
City of Tukwila
Community Development / Public Works • 6300 Southcenter Boulevard, Suite 100 • Tukwila, Washington 98188
MECHANICAL PERMIT
Permit No: M97 -0143
Type: B -MECH
Category: RES
Address: 14117 57 AV S
Location:
Parcel #: 336590 -0345
Contractor License No: SOUNDOC168NA
TENANT LEAHY DONALD P
14117 57TH S, TUKWILA WA 98168
OWNER LEAHY DONALD P
14117 57TH S, TUKWILA WA 98168
CONTACT DON LEAHY Phone: 206- 242 -0894
14117 57TH AVENUE SOUTH, TUKWILA, ;WA
CONTRACTOR SOUND OIL COMPANY Phone: 206 - 725 -6300
6346 RAINIER AVENUE SOUTH, SEATTLE, WA 98118
****** **************** ** 4** *** �t*** ** * ** * ** * * tlr * •ktl4* *** ** *�Ir k*** *** *9 *** * ***
Permit Description:
CHANGE/OUT SAME FOR SAME OIL FURNACE
UMC Edition:. 1994
* * * ** ** . * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** * * * * * * * * * * * * * * * * * * * * * * * * **
/
Permit Center/ thorized Signature Date
•
Print Name:
Valuation:
Total Permit Fee:
Status: APPROVED
Issued:
Expires:
- o-G ---- 7
(206) 431 -3670
800.00
42.81
I hereby certify that I have read and examined this permit and know the
same tobe 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 for and
obtain this building Permit.
Date: 214 d / 7
Title: _,QL►?._.61,0.A? e.,..__
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 t he. last 'inspection.
Projes Name/Tenant: �^
) c.til�I-..A 4 (— ep(7 8n // V
Value of Co struction:
rod c)-c)
Will there be storage of flammable /combustible hazardous material in the building? in yes El no
Attach list of materials and storage location on separate 8 1/2 X 11 paper indicating quantities & Material Safety Data Sheets
Site Address: , City Statte /Zi �y
a/I / ' ,. _ `7 t 4 /9 j a Cam. l��7 t3
Tax Parcel Number:
si k Number:
Property Owner:
A- �?. ?_.
P hone:
/7/ A..
Q Y y
Address:
Street Addre s:
City State /Zip:
Fax #:
0 Water
Contact.P..eeon:
L_) 6 it)
k_c'. I - 7 ci
Phone:
. n;
Street Address:
City State /Zip:
Fax #:
Contractor:
-moo, t.- 13
0 l L. ( r t p 41 4 /
Phone:
7
5 lc d o
.
Street Address:
� 4/6
City � State/Z .i :
%i�i)eivieli/1 - u i=_ `j0 • 9ycif/� 7gx//
Fax #:
_�
Architect:
Phone:
Street Address:
City State /Zip:
Fax #:
Engineer:
Phone:
Street Address:
City State /Zip:
Fax #:
MISCELLANEOUS PERMIT REVIEW AND APPROVAL RSQUESTED:' FILLED OUT BYAP,PIJCANT) .;
Descriptip.i of work to be done:
-< P ' 0 A. a. e C) t' 1- --'G 0;0 1 C 6_ GO r 7/ G i c_ /= C(/ /,,,J f C
Will there be storage of flammable /combustible hazardous material in the building? in yes El no
Attach list of materials and storage location on separate 8 1/2 X 11 paper indicating quantities & Material Safety Data Sheets
■ Above Ground Tanks ' Antennas /Satellite Dishes Bulkhead/Docks El Commercial Reroof
❑ Demolition El Fence Mechanical El Manufactured Housing - Replacement only
El Parking Lots El Retaining Walls El Temporary Pedestrian Protection /Exit Systems
❑ Temporary Facilities ❑ Tree Cutting
MONTHLY SERVICE BILLINGS TO:
Name:
Phone:
Address:
City /State /Zip:
0 Water
0 Sewer
0 Metro
0 Standby
CITY OF TI "(WILA
Permit Center
6300 Southcenter Boulevard, Suite 100
Tukwila, WA 98188
(206) 431 -3670
Miscellaneous Permit Application
Address:
Date application
Application and plans must be complete in order to be accepted for plan review.
Applications will not be accepted through the mail or facsimile.
WATER METER DEPOSIT /REFUND BILLING:
Name:
APPLICANT REQUEST. FOR MISCELLANEOUS PUBLIC WORKS PERMITS
El Curb cut/Access /Sidewalk El Fire Loop /Hydrant (main to vault) #: Size(s):
❑ Land Altering: 0 Cut cubic yards 0 Fill cubic yards 0 sq. ft.grading /clearing
in Sanitary Side Sewer #: El Sewer Main Extension 0 Private 0 Public
El Street Use El Water Main Extension 0 Private 0 Public
0 Deduct 0 Water Only
❑ Channelization /Striping
El Flood Control Zone
El Landscape Irrigation
in Storm Drainage
El Water Meter /Exempt It Size(s):
El Water Meter /Permanent # Size(s):
❑ Water Meter Temp ft Size(s): Est. quantity: gal Schedule:
El Miscellaneous ❑ Moving Oversized Load/Hauling
Phone:
City /State /Zip:
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.
MISCPMT.DOC 7/11/96
: (Initials)
BUILDING OWNER OR AUTHORIZED G EN r
Signature: ,J, »
/- �
Above Ground Tanks/Water Tanks - Supported directly upon grade
exceeding 5,000 gallons and a ratio of height to diameter or width
which exceeds 2:1
I Date: � � / .- 7
Print name: E 0
A_,-... Al
!.�
Pho ek v
Fax #:
Address:
j // /% 7 - -6 2
�, /9 6'
e..._� f )
City /State /Zip: i
`l a i-t�r; i << // a �l X/
ALL MISCELLANEOUS PE' T APPLICATIONS MUST BE SUBM D WITH THE FOLLOWING:
> ALL it RA WINGS $U A , AT A LEGIBLE SCALE AND NEATLY DRAWN
> BUILDING SI E" PLAN AND UTILITY PLANS ARE TO BE COMBINED
D ARCHITECTURAL DRAWINGS REQUIRE STAMP BY WASHINGTON LICENSED ARCHITECT
D STRUCTURAL CALCULATIONS AND DRAWINGS REQUIRE STAMP BY WASHINGTON
LICENSED STRUCTURAL ENGINEER
> CIVIL/SITE PLAN DRAWINGS REQUIRE STAMP BY WASHINGTON LICENSED CIVIL ENGINEER
(P. E.)
❑ Copy of Washington State Department of Labor and Industries Valid Contractor's License. If
not available at the time of application, a copy of this license will be required before the
permit is issued, unless the homeowner will be the builder OR submit Form H -4, "Affidavit
in Lieu of Contractor Registration ".
Building.Owner /Authorized Agent If the applicant is other than the owner, registered architect/engineer, or contractor licensed
by the State of Washington, a notarized letter from the property owner authorizing the agent to submit this permit application and
obtain the permit will be required as part of this submittal.
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.
MISCPMT.DOC 7/11/96
w:.
SUBMIT APPLICATION AND REQUIRED CHECKLISTS FOR PERMIT REVIEW
Above Ground Tanks/Water Tanks - Supported directly upon grade
exceeding 5,000 gallons and a ratio of height to diameter or width
which exceeds 2:1
Submit checklist No: M -9
❑
Antennas /Satellite` Dishes
Submit checklist No: M - 1
❑
Awnings /Canopies - No signage
Commercial Tenant Improvement
Permit
❑
Bulkhead/Dock
Submit checklist No: M -10
❑
Commercial Reroof.
Submit checklist No: M -6
®
Demolition-
Submit checklist No M -3, M -3a
❑
Fences - Over 6 feet in Height
Submit checklist No: M -9
❑
Land Altering/Grading /Preloads
Submit checklist No: M - 2
❑
Loading Docks
Commercial Tenant. Improvement
Permit. Submit checklist No: H -17
❑
Mechanical (Residential & Commercial)
Submit checklist No M -8,
Residential only - H -6, H -16
❑
Miscellaneous Public Works Permits
Submit checklist No H -9
❑
Manufactured Housing (RED INSIGNIA ONLY)
Submit checklist No: M -5
❑
Moving Oversized Load /Hauling
Submit checklist , No: M
❑
Parking Lots
Submit checklist No: M -4
❑
Residential Reroof - Exempt with following exception: If roof structure
to be repaired or replaced
Residential Building Permit
Submit checklist No: M -6
❑
Retaining Walls - Oyer 4 feet in height
Submit checklist No: M -1
❑
Temporary Facilities
Submit checklist No: M -7
❑
Temporary Pedestrian Protection/Exit Systems
Submit checklist No: M - 4
❑
Tree Cutting
Submit checklist No: M -2
ALL MISCELLANEOUS PE' T APPLICATIONS MUST BE SUBM D WITH THE FOLLOWING:
> ALL it RA WINGS $U A , AT A LEGIBLE SCALE AND NEATLY DRAWN
> BUILDING SI E" PLAN AND UTILITY PLANS ARE TO BE COMBINED
D ARCHITECTURAL DRAWINGS REQUIRE STAMP BY WASHINGTON LICENSED ARCHITECT
D STRUCTURAL CALCULATIONS AND DRAWINGS REQUIRE STAMP BY WASHINGTON
LICENSED STRUCTURAL ENGINEER
> CIVIL/SITE PLAN DRAWINGS REQUIRE STAMP BY WASHINGTON LICENSED CIVIL ENGINEER
(P. E.)
❑ Copy of Washington State Department of Labor and Industries Valid Contractor's License. If
not available at the time of application, a copy of this license will be required before the
permit is issued, unless the homeowner will be the builder OR submit Form H -4, "Affidavit
in Lieu of Contractor Registration ".
Building.Owner /Authorized Agent If the applicant is other than the owner, registered architect/engineer, or contractor licensed
by the State of Washington, a notarized letter from the property owner authorizing the agent to submit this permit application and
obtain the permit will be required as part of this submittal.
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.
MISCPMT.DOC 7/11/96
w:.
14117 57 AV 5
CITY. OF TUI:.WILA
`Addr=ess,..
6
remnant LEAHY DONALD 1' Status APPROVED
T�titpe B -MECH Applied 09/24/1997
Parcel # 336590 -0345 Issued:
k 'k k •4 4 'H •k k'* ik •k:-k ;k •k •k ; k •k ' k * •k •k •X k t4' :4 k •E * •k .k .k k 'k 'k •k •k 4 * 4 •k 'k •k 'k :k * •k 'k :k 'k •4 •k'k •k :k * •k •k1F :4 k •k 'k k * 4 k * •4 •k y4 k 'k •k *
Permit Conditions:
1 <. No .;changes wi.l l be .made: to the Plans un 1 ass approved by the
Ar.'chitect or Engineer. and the Tukwila Bu r lding. Division.
All perm ►its', ns,pectiAn:'.,rtieco t1 ':ah,a. plans shall be
a l oble at ' the joh . si.te -- prior to the s'tart i t any con-
eruction. These ' are to 'lie ma intained and avai 1,-
able .un t i 1 final fin*PilisRa6XfO07, 4,p0roval 'u
Al ; 1 . construct i:on to; be done.. fn conformance with .appr lived
p 1`ans and ; ,r egu 1 rementS 5 ,=of' the Uniform Bu t - 1 d i ng .Code 1'994
Ed ,i t i on) •Wamended, ' Un i forr'" Mechan i ca'1';:Code ''t• 1994: Ed t'.i an)
and Wash)ngton 'Stat'e En'ergv,.Chde (1994 Edition).':.;:
Va 1'i d i t',y': of Per�iiri t The issuance of,, a per n► l t'.or-'approva 1 ;of
pTars&specification , and computa�t`ions shall not
str�ue .��t'o ,be a pet :mi t . t ark an approval of, any,,, v i l at i city`
ot. anY0ot 1'to pr,.ovIsion" of the: building code or of ariv
otheri`.or din4nces }of the ; 1,urisdiction No permit presuming
gI v " a lf thor;i�ty,,'to violat "or /(C.ancely the provi ,ions Of this
cod �shal 1 be `vat id: !
MANUFACTURERS ( INSTALLATIOWINSTFtiC,`T'II NS , REQUIRED ON ,,SITE
FO r t-THEpAilitILDIN4 INS.PEC-TORS +,REVIEW.
fr
Permit No M97.014'3
READY FOR ISSUANCE
$ Si BALANCE DUE
NO STATE CONTRACTORS LICENSE REQUIRED?
IS THIS CONTRACTOR IN THE SYSTEM? YES ( g
APPLICANT CONTACTED DATE CALLED CALLED BY
PLAN REVIEW / ROUTING SLIP
ACTIVITY NUMBER M97 --0143 DATE 9/24/97
PROJECT NAME LEAHY DONALD & FREDA
DEPARTMENT:
BUILDING DIVISION FIRE PREVENTION PLANNING DIVISION
PUBLIC WORKS [J STRUCTURAL PERMIT COORDINATOR 0
NINI■111111M1■IPIMINIIIMP 11=11114111•1•1, AM=
DETERMINATION OF COMPLETENESS: (T,Th) DUE DATE
COMPLE �� NOT COMPLETE E NOT APPLICABLE Ei
COMMENTS
TUES /THURS ROUTING: PLEASE ROUTE fl NO FURTHER REVIEW REQUIRE
ROUTED BY STAFF [i (If routed by staff, make copy to master file & enter Sierra.)
REVIEWERS INITIAL
APPROVALS OR CORRECTIONS: (ten days)
CORRECTION DETERMINATION:
REVIEWERS INITIAL
C:ROUTE-F
DATE
DATE
DUE DATE 10/08/97
•
APPROVED fl APPROVED WI CONDITION 1 NO APPROVED (attach comments) 0
REVIEWERS INITIAL I DATE 11
DUE DATE
APPROVED I 1 APPROVED W/ CONDITIONS [I] NOT APPROVED (attach comments) 0
(Cenificadon of occupancy required. )
L roj ct:
.- ? s ue 1 A c n
Type f inspection:
('�(-
Special instructions:
D an .t : t, .1 — � 1
.m.
c)ck...
pg.- ..N , a.......c)sqL\
l INSPECTION RECORD
Retain a copy with permit
INSPECTION NO.
CITY OF TUKWILA BUILDING DIVISION
6300 Southcenter Blvd., #100, Tukwila, WA 98188
Approved per applicable codes.
Inspector:
cDate:
0
(206) 431 -3670
Corrections required prior to approval.
.r / .li /i
$42.00 REINSPECTION S EE REQUIRED. Prior to inspection, fee must
be paid at 6300 Southcenter Blvd., Suite 100. Call to schedule reinspection.
Receipt No,:
Date:
:F k* **•*k'.. **•k*.
CITY CIF' TUKWI
* * *,A.,k * ***
TRANSM.I Num
Pa vment: Met
Permit Parc�e1
S'i .`Hddr
T h i s Payment
A count Code
000(345 . x.30
000/322.100
*:t *.*A **,k• *** ** Pt **.%**k `` A* A**k* k *******•d +F•kkk.A.A,F•t **.*•h•/
LA WH 1
Ak * A F * *�A * k ke r •**A* L4
FRAI' SMIT
'
b.er 89700643 'Amount:.
ho CHECK No;tat ion: )OUALI; LLAMY'. I.rt i t: Wi 3
— . •.r r . �. 4. • • .« r. r .•. .. w. n r. .•. r. ..• . ... r w. r. r . r... •. .. •.. r r. u. w. r. • .. w. r. rr r. r. r
Nor": , M97-- 014: Type': U• -MECH . MECHANICAL HERMIT
Na :.,33.!35 r0 -0345
ess: 14'117. 57 Alt $
Total reesz 42.01
42.81 Tot«1 ALL Pmts: 42.81 '
Balance:'
.00
** ..* *k * * *A ***fi**A***A*a *k *!:* *A.A *** *1 **RA*A* *•.A*•* *•
Description Amount
PLAN CHECK - RES 8.56
.. -: _ MCCH(ai�(IGHir . RCS 34 .25
_
42.81 09/26/97 1.3:03
MODELS
LOWBOY • .
10
MODEL NO.
4
OL2 -56
OL5 -85
$i;�<ti'$.s;;;:1 „i
Ot;11-1O5
OL16 -125
OL20 -151
3
OL33 -200
3
OL37 -250
3
OL39 -320.
BTU PER HR. INPUT
70,000
106,250
ri; '126,000 r
156,250
185,000
250,000
312,500
400,000
BTU PER HR. OUTPUT
AT BONNET
56,000
85,000
'` Y; '0
;? ;101';000 '-
125,000
151,000
200,000
250,000
•
320,000
HEIGHT OF CASING
34 -3/4"
43 -1/4"
; 46 -;1/2" �'"
46 -1/2"
50 -1/2"
60 -3/4"
67 -3/4"
67 -3/4"
WIDTH OF CASING
19"
25"
•.:-:3 s. '25 " : ':
27"
27"
34"
38"
38"
DEPTH OF CASING
48"
50 -1/4"
;;, 54 /2 ",;'
58 -1/2"
58 -1/2 "•
72"
85 -1/2"
85 -1/2"
WARM AIR OUTLET
17" x 17"
20" x 20"
':',20 " .) 10 ",a
22" x 22"
22" x 22"
28" x 28"
32 "' x 32"
32" x 32"
RETURN AIR INLET
17" x 17"
20" x 14"
20" ?, x )6 " ?;
22" x 18"
22" x 18"
28" x 24"
32" x 28"
32" x 28"
DIA, OF FLUE OUTLET
5"
6"
' ; k' : 6" w. i ::
7"
7"
9"
9"
9"
FLOOR- CENTER OF FLUE
29-1/4"
36" ,,, =, ; 1' 2"
40"
44"
51 -3/4"
59"
59"
BLOWER TYPE
B
BELT
BELT
4 : BELT' .
z :.DIRECT v
1/0 ` 3' •
BELT
DIRECT
1a
BELT
DIRECT.
1/2
BELT
N/A
1/2
BELT
N/A
3/4
BELT
N/A
1
DD
DIRECT
DIRECT
1/3 - 5-
MOTOR HORSEPOWER
B
1/3
DO
1/2 -4SP
.2
.5
1/2 -4SP
.2
.,s1 /2=
.5 : ', 2iii, ; '
4SPs;',
t ;5i;
374-4SP
.2
.5
3/4 -4SP
.2
.5
.2
.5
.2
.5
.2
.5
CFM 0
.2 & .5 W.C.5
B
1040
750
1157
970 •1525:
,'9150 :.
1702
1410
2073
1516
2315
1920
2893
2410
3700
3350
HI -SPEED
MH -SPEED
ML -SPEED
LO -SPEED
DD
1455
1241
1726
1493 .1728i
;1506
2239
1962
2177
1885
DO
1197
1049
1320
1213 1363
::3!1249 :
1799
1606
1699
1516
DO
957
875
1066
983 1Q60,#
988#
1477
1346
1390
1269
DD
768
685
848#
764# ,845#
059#
1178
1077
1117
1019
LARGEST REC, A /C
B
2 -1/2 T
4 T '.a
c
T`.:
5 T
5 T
10 T
12 T
12 T
DD
3 T
85'
3 -1/2 T - :3- 1 /2 =:T.
85' zs:. 85?„': :
5 T
85'
5 T
70'
85'
85'
85'
TEMP RISE
. .
B
DD
70'
70' ': ;7v:.,? .
70'
70'
NOZZLE SIZE
SPRAY ANGLE
PATTERN
H= HOLLOW
S =SOLID
UL
RATED
,55
.75 F , �' ` 90 { ,
1,25
1.35
2,00
2.50
3.00
SHIPPED
WITH
.50
70' H
,75 ' l''' !,00'
80' H 6(� ' H
u ;
1.10
80' H
1.35
80' S
1.75
80' S
2.25
80' S
2,75
60' S
NO. AND SIZE OF
PERMANENT FILTERS
ONE
16" x 20"
ONE yr Qi E k
20" x 20" ' '2'0 " S 25?'.
TWO .
14" x 25"
TWO
14" x 25"
11 TWO
2 "x20 "x25"
11 FOUR
2 "x16 "x20"
11 FOUR
2 "x16 "x20"
APPROX. EFFECTIVE
HEATING SURFACE
3038.4
SQ. IN
4850 , '`;' 50
SQ. IN '' SQ;0.1!I i ,...
7400
SQ. IN
7525
SQ. IN
12,000
SQ. IN
16,000
SQ. IN,
16,000
SQ. IN
APPROX. SHIPPING WT,
315 LBS.
x R. •. rn
410 LBS, `'500�.LBS:
560 LBS.
600 LBS,
1025 LBS,
1120 LBS,
1150 LBS.
SEASONAL EFFICIENCY °
82.8%
82.0% .: rp1AV' '
80.0%
81.1%
N/A 9
N/A S
N/A
SEASONAL EFFICIENCY
WITH VENT DAMPER
85.6%
:...,, I '` ::
84,0% :;
83,0%
83.6%
N /A°
N /A°
N/A
S
•
2 ON ALL OUTLET AND INLET DIMENSIONS, THE FIRST DIMENSION IS MAOTH,
3 THESE MODELS SHIPPED KNOCKED DOWN - ALL OTHER UNITS ASSEMBLED.
4 THESE UNITS ARE EQUIPPED MATH A HIGH MICRON FILTER AND CANISTER
FOR OIL LINE FILTRATION,
r SPEED NOT RECOMMENDED FOR HEATING. •
OIL -FIRED FURNACE SPECIFICATIONS
5 CFM USING MOTOR SUPPUED AS STANDARD - FOR HIGHER STATIC RESISTANCE
IN DUCT SYSTEM, A LARGER MOTOR MAY BE REQUIRED.
6 SUBSI1TUUON OF A LARGER MOTOR AND /OR ALTERING THE PULLEY RATIO WILL
RESULT IN HIGHER UM AND PERMIT LARGEST RECOMMENDED AIR CONOITCNING.
7 BTU OUTPUT BASED ON BOX EFFICIENCY. RATED BY MANUFACTURER.
ALL SPECIFICATIONS SUBJECT TO CHANCE WITHOUT NOTICE.
Thermo Pride
6 SEASONAL EFFICIENCY (ALSO CALLED MIX - ANNUAL FUEL UTILIZATION
EFFICIENCY) RATINGS ARC BASED ON TESTS FOLLOWING U.S. DEPARTMENT
OF ENERGY TEST PROCEDURES.
° DEPARTMENT Cr ENERGY TEST PROCEDURES DO NOT REQUIRE TESTING ON
UNITS WITH 200,000 BTU INPUT OR HIGHER.
"'ALL MODELS IN CHART ARE U.L. LISTED.
11 0L33,37,39 HAVE DISPOSABLE FILTERS.
MOIOSA -6970
SOUND OIL COMPANY
TEL No.206 -725 -5007 Sep 26,97 11:49 No.005 P.01 /01
DEPARTMENT OF LABOR AND INDUSTRIES
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DEPARTMENT OF LABOR AND INDUSTRIES
THIS CERTIFIES THAT.THE PERSON NAMED HEREON IS REGISTERED AS PROVIDED BY LAW AS A • fi ti• b r .� :.1, r
, a s x ,• 4 t! ?'..}' . ..vr j ' . :' j
�►.
...Id:, £ i R• A Ly r
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STATE OF WASHINGTON
F62S.0b2.000(3.92)
l� > -i t't�C`S�y�".S`C�•'� ��� :i�.a •:.155 ."'.^•:.�\ \:.T :�`."L.'�.::5.^.._'�SS't.�
. DEPARTMENT OF AND INDUSTRIES
THIS CERTIFIES THAT THE PERSON NAMED HEREON IS REGISTERED AS PROVIDED BY LAW AS A
F625.052- 000(9.1