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HomeMy WebLinkAboutPermit PG09-116 - 7-ELEVEN7- ELEVEN 14057 INTERURBAN AV S PGO9-1 16 Parcel No.: 3365900865 Address: Suite No: 14057 INTERURBAN AV S TUKW Tenant: Name: 7- ELEVEN Address: 14057 INTERURBAN AV S , TUKWILA WA Owner: Name: Address: THE SOUTHLAND CORPORATION C/O TAX DEPT, PO BOX 711 Contact Person: Name: ROCK BORCHARDT Address: PO BOX 870 , SULTAN WA Contractor: Name: ROCK OF AGES PLUMBING INC Address: PO BOX 870 , SULTAN WA Contractor License No: ROCKAPI983BJ DESCRIPTION OF WORK: INSTALL BACKFLOW DEVICE ON POP MACHINE AND SLURPEE Value of Plumbing /Gas Piping: $500.00 Fees Collected: $45.00 Plumbing 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 doc: UPC -7/07 Cit341bf 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 PLUMBING /GAS PIPING PERMIT FIXTURE TYPE AND OUANTITY * * continued on next page ** Permit Number: Issue Date: Permit Expires On: Phone: Phone: 425 780 -1312 Phone: (360)793 -3722 Expiration Date: 01/11/2010 PG09 -116 10/05/2009 04/03/2010 Uniform Plumbing Code Edition: 2006 International Fuel Gas Code Edition: 2006 Plumbing (cont.) 0 Building sewer and each trailer park sewer 0 0 Rain water system - per drain (inside bldg) 0 0 Water heater and /or vent 0 0 Industrial waste treatment interceptor, including 0 its trap and vent, except for kitchen type 0 grease interceptors 0 0 Repair or alteration of water piping and /or water 0 treatment equipment 0 0 Repair or alteration of drainage or vent piping 0 0 Medical gas piping system serving (1 -5) 0 inlets /outlets for a specific gas 1 0 Medical gas piping (6 +) inlets /outlets 0 0 Gas Piping 0 Gas piping outlets (0 -5) 0 0 Gas piping outlets (6 +) 0 PG09 -116 Printed: 10 -05 -2009 Permit Center Authorized Signature: I hereby certify that I have read and governing this work will be compile doc: UPC -7/07 City ofTukwila 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 xa with Permit Number: PG09 -116 Issue Date: 10/05/2009 Permit Expires On: 04/03/2010 Date: 'Q 10S I O 1 ed this permit and know the same to be true and correct. All provisions of law and ordinances 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 rformance of work. I am authorized to sign and obtain this plumbing /gas piping permit. Signature: 1 e (, OJ Date: /cyq.57.00g Print Name: �' l v�-t` 0 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. PG09 -116 Printed: 10 -05 -2009 Parcel No.: 3365900865 Address: Suite No: Tenant: 7- ELEVEN doc: Cond -10/06 • 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 14057 INTERURBAN AV S TUKW 1: ** *PLUMBING AND GAS PIPING * ** PERMIT CONDITIONS * *continued on next page ** Permit Number: Status: Applied Date: Issue Date: PG09 -116 ISSUED 10/05/2009 10/05/2009 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. PG09 -116 Printed: 10 -05 -2009 Signature: Print Name: 11 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 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 construction or the performance of work. Date: /D/0.5JY doc: Cond -10/06 PG09 -116 of law and ordinances governing other work or local laws regulating Printed: 10 -05 -2009 Site Address: Tenant Name: _ t/eue -t Property Owners Name: S 6 t.•; -t L-4 4d Cv/t Pr, A Mailing Address: Name: Mailing Address: E -Mail Address: Company Name: Mailing Address: CITY OF TUKWILA Community Development Department Permit Center 6300 Southcenter Blvd., Suite 100 Tukwila, WA 98188 htto://Www.cLtukwila.wa.us L./ X114 a0 4S C/b 7i9,( t' Po y i H: \Applicaions\FOrias- Applications On Line \2009 Apphcaiions4 - ?009 = Plumbing -Gas Piping Permit Apphcanon.doc Re, ised: I -2(e) bh geld ,( 7// City P etc ® 4- A2-9 t ?,s /`ct /At A:n ...,7h c - i f? o r (QX cf 2() i 4-4 City Contact Person: E -Mail Address: Fax Number: Plumbing /Gas Permit No. 1 01 . a( Project No. (For office use only) PLUMBING / GAS PIPING PERMIT APPLICATION Applications and plans must be complete in order to be accepted for plan review. Applications will not be accepted through the mail or by fax. * *Please Print ** SITE LOCATION King Co Assessor's Tax No.: 33‘s 4 Suite Number: New Tenant: ❑ Yes El „No State CONTACT PERSON - Who do we contact when your permit is ready to be issued Day Telephone: n �z City A ftiAy.t.- State . -'zip 'Fax Number: PLUMBING / GAS PIPING CONTRACTOR INFORMATION City State Contact Person: L pCk .Q F Lt 1.4q Or Day Telephone: J State Floor: Zip Zip E -Mail Address: ACC( aPactCc''r 16�:E;j PAcZ4auf ,e0 C4 Fax Number: 3 Ca - c Contractor Registration Number: q/°/ , g v� ©cam ryf� �,1 Expiration Date: j�/i�x � /r? ' ARCHITECT OF RECORD - All plans must be wet stamped by Architect of Record Company Name: Mailing Address: Zip Contact Person: E -Mail Address: cit Day Telephone: Fax Number: ENGINEER OF RECORD - All plans must be wet stamped by Engineer of Record Company Name: Mailing Address: State Zip Day Telephone: Page 1 of 2 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 PERMIT APPLICATION NOTES - • Valuation of Project (contractor's bid price): $__ 0 c Scope of Work (please provide detailed information): Qyt ,1o,' acht'tf , Building Use (per Intl Building Code): Occupancy (per Int'I Building Code): Utility Purveyor: Water: Indicate type of plumbing fixtures and /or gas piping outlets being installed and the quantity below: Value of Construction — In all cases, a value of construction amount should be entered by the applicant. This figure will be reviewed and is subject to possible revision by the Permit Center to comply with current fee schedules. Expiration of Plan Review — Applications for which no permit is issued within 180 days following the date of application shall expire by limitation. The Building Official may grant one extension of time for an additional period not to exceed 180 days. The extension shall be requested in writing and justifiable cause demonstrated. Section 103.4.3 International Plumbing Code (current edition). I HEREBY CERTIFY THAT 1 HAVE READ AND EXAMINED THIS APPLICATION AND KNOW THE SAME TO BE TRUE UNDER PENAL'T'Y OF PERJURY BY THE LAWS OF THE STATE OF WASHINGTON, AND I AM AUTHORIZED TO APPLY FOR THIS PERMIT. BUILDING OWNER OR AUTHORIZED AGENT: Signature: V)■ rA- gJJ Print Name: ID E/t< 8 i2..ti1 c Mailing Address: IP, p 'Q k; a c Date Application Accepted: 101 ocl ot) ill S4-4 -e( t'4-ek / 'Pe ✓ c.v... Date Application Expires: H: \Applications \Forms- Apphcauons On Line \2009 Applications \I - 200'). Plumbing -Gas Piping Permit Application.doc Ref used: 1 -20119 bh Sewer: S �. \► "L vu t4-- City State Date: ) &1/2 Day Telephone: ?so -13/ Z Staff Initials: Zip ge 2 of 2 Parcel No.: 3365900865 Permit Number: PG09 -116 Address: 14057 INTERURBAN AV S TUKW Status: PENDING Suite No: Applied Date: 10/05/2009 Applicant: 7- ELEVEN Issue Date: Receipt No.: R09 -01557 Initials: JEM Payment Date: 10/05/2009 01:22 PM User ID: 1165 Balance: $0.00 Payee: ROCK OF AGES PLUMBING INC TRANSACTION LIST: Type Method Descriptio Amount Payment Credit Crd MC - Authorization No. 021816 ACCOUNT ITEM LIST: Description PLUMBING - NONRES 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 RECEIPT 45.00 Account Code Current Pmts 000.322.103.00.00 45.00 Total: $45.00 0 Payment Amount: $45.00 PAYMENT RECEIVED doc: Receiot -06 Printed: 10 -05 -2009 Project Type f Inspect'on: Address: dci o �� J ' 1 Date Called: (,.. ,k-,,, Spe Instructions: Date Wanted: j (� �� gi 1 Requester: Phone N s —_ )7r0 — / 3 ! 2_ P 1(149 INSPECTION RECORD Retain a copy with permit -�- L INSPECTION NO. Pi?RMIT NO. CITY OF TUKWILA BUILDING DIVISION 6300 Southcenter Blvd., #100, Tukwila, WA 98188 (206)431 -3670 Approved per applicable codes. 0 Corrections required prior to approval. COMMENTS: J ,n [ ,l-^ .1 , e In hector: Date: ❑ $60.00 REINSPECTION FEE REQUIRED. Prior to inspection, fee must be paid at 6300 Southcenter Blvd., Suite 100. Call to schedule reinspection. 1 Receipt No.: (Date: Project: - 7 - LP.M t.l Type of Inspection: PT NJ A i J Address: _ 1 L D S7 1- NI-lei); V , i Date Called: A. ii c Special Instructions: , S Date Wanted: ( c-- 30 -o9 a.m .m. Requester: Pone No: Z 7 , 5 v - 1311 COMMENTS: ( pi r ) 3 P-1 /U6 L h {k r t,) 1, J ( LcA -e 7S A. ii c , S 4 A - A. 5( _sr- 1 )- - c , P--1 At —A, Insp ctor: P44 Date: 0 .3 .ar INSPECTION NO. INSPECTION RECORD Retain a copy with permit CITY OF TUKWILA BUILDING DIVISION LI Approved per applicable codes. Pe65 -i1 Co PERMIT NO. 6300 Southcenter Blvd., #100, Tukwila, WA 98188 (206)431 -3 Corrections required prior to approval. fl $60.00 REINSPECTION R QUIRED. Prior to inspection, fee must be paid at 6300 Southcenter Blvd., Suite 100. Call to schedule reinspection. Receipt No.: (Date: ) ' New L.1 Existing Replacement File No: CIt Zip c Location: Cross Connection Control For: crAt i.G't /le- ‘Type Assembly:158:4 Manufacturer: C.7.1 Size: 3 4.- Serial No:/0 INITIAL TEST RESULTS TEST AFTER REPAIRDR: CLEANING Service Address: . g_O__S2 Street RPBA DCVA PVB AG WaterPmvevor: Line Pressure Minimum AG Separation: Passed Test: Check Valve Pressure Drop Across No. I Check Valve (A) Relief Valve Opened (B) -.Z. Buffer (C) (A-B)._._.... _ IS THIS A PROPER INSTALLATION? Water Service Found: REMARKS certify this report is accurate, and til t Repaired By: Repair 'lest By: . T(0 q ,-- it(o Backflow Test Report No. I check: Closed Tight Li Leaked No. 2 Check: Closed Tight Leaked Yes 4.../ No Yes No Line Pressure No. 1 check: Closed Tight Leaked No. 2 Check Closed Tight.. Leaked Passed 'rest: Yes _ _ - Line Pressure Air Inlet: Opened Failed to Open f lj No _ Signature Leaked Passed 'rest: Yes . Minimum Separation: Yes . No e-k- C Jowl Typed or Prir e Name Initial rest By: iick signal tr8 Rock of Ages Plumbing P.O. Bb 1-370 Sultan. WA 98294 (42h) 483:7202 %A(ww.rockotagesplt irnbing.corn ■.■ Press( ire Drop Acrc:ss psid No. I Check Valve A) psid Relief Valve Opened (Et) psid Butter (C) = (A-8) No. 1 check: Closed Tight Leaked No. 2 Check: Closed Tight Leaked Minimum AG Sepa:ation: Yes No Passed Test: Yes_ No psid psid psid psid YES . C <_ NO On Off No. I check: Closed Tight - - IJ Leaked lJ No. 2 Check: Closed Tight Leaked Passed Test: Air Inlet: Opened Failed to Open check Valve Passed Test: Used WAC. 46H290-490 appro■i lj Yes_ . No ..._ Leaked Yes 0 F 4 o PLUMBING Water Service Left: On Ott Phone No. Geri NO. /- 3 6 cPy Date ._,,.._y_ psid .psid psid psid ..._..psid . _ _psid . ....psid Test Equipment: Make ‘.401.: Model Serial it C372,_e_Z., Accuracy Verification Date 9/_0 Assembly Tested: Satisfactorily ___LZ" Failed I CERTIFY THE ABOVE REPORT TO BE TRUE: Methods and Differential Test Date _ Gest No. Date__ Bond Bond Company Name Bond Account Number Effective Date Expiration Date Cancel Date Impaired Date Bond Amount Received Date 3 CBIC FC3936 01/08/2007 Until Cancelled $12,000.0012/05 /2006 2 GREAT AMER INS CO OF NY 790- 2865 -308 01/08/2003 Until Cancelled 01/08/2007 $12,000.0011 /18/2002 1 WESTCHESTER FIRE INS CO WACB308 01/08/2002 /08/200 Until Cancelled 02/01/2003 $12,000.00 01/02/2003 Name Role Effective Date Expiration Date BORCHAARDT, ROCK PRESIDENT 01/11/2002 Amount Insurance Company Name Policy Number Effective Date Expiration Date Cancel Date Impaired Date Amount Received Date 5 NATIONWIDE MUTUAL INS CO acp7570976585 10/17/200810/17 /2009 $1,000,000.00 10/08/2008 4 NATIONWIDE MUTUAL INS ACP7520976585 10/17/2006 10/17/2008 $1,000,000.0009 /19/2007 Untitled Page General /Specialty Contractor A business registered as a construction contractor with L£tI 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 Phone Address Suite /Apt. City State Zip County Business Type Parent Company ROCK OF AGES PLUMBING INC 3607933722 PO BOX 870 SULTAN WA 98294 SNOHOMISH Corporation UBI No. Status License No. License Type Effective Date Expiration Date Suspend Date Specialty 1 Specialty 2 602169013 ACTIVE ROCKAPI983BJ CONSTRUCTION CONTRACTOR 1/11/2002 1/11/2010 GENERAL UNUSED Business Owner Information Bond Information Insurance Information • Page 1 of 2 https://fortress.wa.gov/lni/bbip/Detail.aspx 10/05/2009