Loading...
The URL can be used to link to this page
Your browser does not support the video tag.
Home
My WebLink
About
Permit PG09-127 - DR VIRK
LgT 'Ig )ERINVHLLS 905 ){}TJA 1111 Parcel No.: 0223200061 Address: Suite No: Value of Plumbing /Gas Piping: Fees Collected: doc: UPC -7/07 505 STRANDER BL TUKW Citylkf Tukwila Tenant: Name: DR. VIRK Address: 505 STRANDER BL , TUKWILA WA Owner: Name: WOLVERINE PROPERTIES L L C Address: 415 BAKER BLVD , TUKWILA WA Contact Person: Name: JEFFERY HEAD Address: 16653 160 PL SE , RENTON WA Contractor: Name: HEAD MECHANICAL INC Address: 16653 160TH PL SE , RENTON WA Contractor License No: HEADMMI91203 Plumbing Bathtub or combination bath/shower 0 Bidet 0 Clothes washer, domestic 0 Dental unit, cuspidor 0 Dishwasher, domestic, with independent drain 0 Drinking fountain or water cooler (per head) 0 Food -waste grinder, commercial 0 Floor drain 0 Shower, single head trap 0 Lavatory 0 Wash fountain Receptor, indirect waste 0 Sinks 2 Urinals 0 Water Closet 0 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 DESCRIPTION OF WORK: MODIFY EXISTING PLUMBING TO ACCOMODATE NEW FLOOR PLAN INCLUDING MEDICAL GAS PIPING (4 OUTLETS), DENTAL AIR AND VACUUM, N20 & 02, AND INSTALL (2) NEW SINKS.INSTALL REDUCED PRESSURE PRINCIPLE ASSEMBLY (RPPA) FOR IN- PREMISE ISOLATION. FIXTURE TYPE AND QUANTITY 0 * *continued on next page ** Permit Number: Issue Date: Permit Expires On: Phone: Phone: 206 730 -5178 Phone: 206 -730 -5178 Expiration Date: 09/23/2011 $0.00 Uniform Plumbing Code Edition: $258.75 International Fuel Gas Code Edition: PG09 -127 01/07/2010 07/06/2010 2006 2006 Plumbing (cont.) Building sewer and each trailer park sewer 0 Rain water system - per drain (inside bldg) 0 Water heater and /or vent 0 Industrial waste treatment interceptor, including its trap and vent, except for kitchen type grease interceptors - 0 Repair or alteration of water piping and/or water treatment equipment 0 Repair or alteration of drainage or vent piping 0 Medical gas piping system serving (1 -5) inlets /outlets for a specific gas 1 Medical gas piping (6 +) inlets /outlets 1 Gas Piping Gas piping outlets (0 -5) 0 Gas piping outlets (6 +) 0 PG09 -127 Printed: 01 -07 -2010 Permit Center Authorized Signature: Signature: Print N doc: UPC -7/07 City "Tukwila 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 Permit Number: PG09 -127 Issue Date: 01/07/2010 Permit Expires On: 07/06/2010 Date: 1-- i 11 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 perfo f w.rk. I am authorized to sign and obtain this plumbing /gas piping permit. Date: /// / a 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 -127 Printed: 01 -07 -2010 Parcel No.: 0223200061 Address: Suite No: Tenant: DR. VIRK • S 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 505 STRANDER BL TURIN 1: ** *PLUMBING AND GAS PIPING * ** PERMIT CONDITIONS Permit Number: Status: Applied Date: Issue Date: PG09 -127 ISSUED 10/29/2009 01/07/2010 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: The RPPA for in- premise isolation shall be installed per manufacturers specifications. 15: The Dental Office shall discharge Dental Wastewater into the sewer system per King County regulations, see attached King County fact sheet. doc: Cond -10/06 PG09 -127 Printed: 01 -07 -2010 doc: Cond -10/06 II 0 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 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. Date: PG09 -127 Printed: 01 -07 -2010 Site Address: Tenant Name: Mailing Address: CITY OF TUKWILA Community Development Department Permit Center 6300 Southcenter Blvd., Suite 100 Tukwila, WA 98188 http://www.ci.tukwila.wa.us Company Name: Mailing Address: Plumbing /Gas Permit No. 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 So .5-Tyti_JOLN P 4 Property Owners Name: pr - U Mailing Address: j3 Lap -4 Name: S . µ er ,,a 1(4 E -Mail Address:30SX . ��� ®C't�nn�rS� . H P c' c /v &'' ., -. re, / J 4 Contact Person: t - 1A_Q r» N P cs, A — E - Mail Address: e ® of c), AZ' \AO; ,.,'�C Contractor Registration Number: -VIE 't 2.t33 Contact Person: E -Mail Address: Contact Person: E -Mail Address: H:Wpplications \Forms - Applications On Line \2009 Applications \1.2009. Plumbing -Gas Piping Permit Application. doe Revised 1.2009 bh King Co Assessor's Tax No.: Suite Number: Floor: New Tenant: VI Yes ' • City State CONTACT PERSON - Who do we contact when your permit is ready to be issued Day Telephone: Z )., 730—g75 �A..?Drt.) (Al 9E058 City State Zip Fax Number:Lti ). S5 - 5 PLUMBING. / GAS PIPING CONTRACTOR INFORMATION City State Zip Day Telephone: (.t .) 73o -L.511 P� Fax Number: .2-5s Expiration Date q /a3l,1f7 I 1 ARCHITECT OF RECORD - All plans must be wet stamped by Architect. of Record Company Name: ._ Mailing Address: State ❑ ..No Zip 6 8 Zip City Day Telephone: Fax Number: ENGINEER OF RECORD - All plans must be wet stamped by Engineer of Record Company Name: Mailing Address: State Zip City Day Telephone: Fax Number: Page 1 of 2 D ate Application Accepted: VI ^ n V Date Application Expires: ( � ( r� D I l l li to Staff Initials: 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 J 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 N � Repair or alteration of drainage or vent piping y€ Medical gas piping system serving 1 -5 inlets /outlets for a specific gas TCS 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 f Gas piping outlets , -PERMIT NOTES : .. • Valuation of Project (contractor's bid price): $ . 3 OOb Scope of Work (please provide detailed information): Mnc c_C 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: 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 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 OWNER ORAUTHORIZED AGENT: Signature: Print Name: Mailing Address: c `t- c A- `P `7"--(= 1(,( 4� ) off--` H:1ApplicationsWorms- Applications On Line12009 Applicatians11-2009 - Plumbing -Gas Piping Permit Application.doc Revised: 1 -2009 bh Date: /Q" /2Q07 Day Telephone�i�e 73? 6/ 'j8 A, 9e City State Zip e2of2 Parcel No.: 0223200061 Address: Suite No: Applicant: DR VIRK Receipt No.: R10 -00506 Initials: WER User ID: 1655 Payee: HEAD MECHANICAL TRANSACTION LIST: Type Method ACCOUNT ITEM LIST: Description doc: Receiot -06 Payment Check Authorization No. GAS - 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 505 STRANDER BL TUKW Descriptio Amount 1235 60.00 Account Code RECEIPT 000.322.103.00.00 Total: $60.00 Permit Number: Status: Applied Date: Issue Date: Payment Amount: $60.00 Payment Date: 03/23/2010 10:39 AM Balance: $0.00 Current Pmts 60.00 YMENT RECEV PG09 -127 ISSUED 10/29/2009 01/07 /2010 Printed: 03 -23 -2010 Parcel No.: 0223200061 Address: 505 STRANDER BL TUKW Suite No: Applicant: DR. VIRK Receipt No.: R10 -00021 Initials: WER User ID: 1655 Payee: HEAD MECHANICAL • 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 TRANSACTION LIST: Type Method Descriptio Amount Payment Check 1073 207.00 Authorization No. ACCOUNT ITEM LIST: Description PLUMBING - NONRES RECEIPT Total: $207.00 Permit Number: PG09 -127 Status: PENDING Applied Date: 10/29/2009 Issue Date: Payment Amount: $207.00 Account Code Current Pmts 000.322.103.00.00 207.00 Payment Date: 01/07/2010 01:21 PM Balance: $0.00 PAYMENT RECEIVED doc: Receipt-06 Printed: 01 -07 -2010 Parcel No.: 0223200061 Address: 505 STRANDER BL TUKW Suite No: Applicant: DR. VINK Receipt No.: R09 -01703 Initials: User ID: Payee: doc: Receiot - 06 JEM 1165 ACCOUNT ITEM LIST: Description • • 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://wwwci.tukwila.wa.us HEAD MECHANICAL INC. TRANSACTION LIST: Type Method Descriptio Amount Payment Check 1099 51.75 Authorization No PLAN CHECK - NONRES RECEIPT Payment Amount: $51.75 Account Code Current Pmts 000.345.830 51.75 Total: $51.75 Permit Number: PG09 -127 Status: PENDING Applied Date: 10/29/2009 Issue Date: Payment Date: 10/29/2009 01:07 PM Balance: $207.00 PAYMENT RECEIVED Printed: 10 -29 -2009 Project: , / Type o f Inspectio \ Address: �[ Date Called: Special Instructions: Date Wanted — 2 4 - /L a.m. r Requester: Phone No: d - - 3 . ( q I� INSPECTION NO. rc- INSPECTION RECORD Retain a copy with permit CITY OF TUKWILA BUILDING DIVISION 6300 Southcenter Blvd., #100, Tukwila, WA 98188 PERMIT NO. (206)431 -360 Approved per applicable codes. Corrections required prior to approval. COMMENTS: ef p(e>f Insp for: Date: 3 0 $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: Pro ect: p p r T Type of nspec on: I Address: mark. /, kr Of J � D Date Called: / Special Instructions: _ _ ! D Date Wanted _ _ �� C R equester: Phone No 2 & -V0 -c1-78- PG oq - 1 2 7 INSPECTION RECORD Retain a copy with permit INSPECTION NO. PERMIT NO. CITY OF TUKWILA BUILDING DIVISION r. 6300 Southcenter Blvd., #100, Tukwila, WA 98188 (206)431 -3670 El Approved per applicable codes. Corrections required prior to approval. COMMENTS: w Ae ( C 1 i)r iKS -r!' InsESector: Date:3,, (3 0 $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: I 1 ` S Pro j ect: o eezej d a.. 1 , Type gnspec ion: r P,P(Al Address: �I /j Date Called: Special Instructions: Date Wanted: , t o �a.m,, p.m Requester: Phon 70( 0 -93 O — 5 1 IU -*3 INSPECTION NO. INSPECTION RECORD Retain a copy with permit PGoci -1 2 `1 PERMIT NO. CITY OF TUKWILA BUILDING DIVISION 'R.. 6300 Southcenter Blvd., #100, Tukwila, WA 98188 (206)431 -3670 Approved per applicable codes. Corrections required prior to approval. ❑ $60.00 REINSPECTION FEE REQUIRED. Prior to inspection, fee must be paid at 6300 Southcenter Blvd., Suite 100. Call to schedule reinspection. ___ �. ,,._. G COMMENTS: if\ 0 Insp¢ctor: Date: 3— 2. �✓ t Receipt No.: Date: Project: /409X O A Ty pe f Inspection: Y / /f/ /A/— 64S Address: _ (vgs ,i42i✓Df/Q Date Called: /7?Pl/ /,t9/ Special Instructions: /62 ci -.0 / Date Wanted: a.m,�. `_ - / C �''J. ` Requester: Phone No a 06" - 7g0- 57 78 INSPECTION RECORD Retain a copy with permit INSPECTION NO. CITY OF TUKWILA BUILDING DIVISION 6300 Southcenter Blvd., #100, Tukwila, WA 98188 PERMIT NO. (206)431 -367 Approved per applicable codes. Corrections required prior to approval. COMMENTS: IAA f-- Ai Cr , /sue A 0 $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: COMMENTS: Type of Inspection: J^ ,,.J�,i f t.,. Address: / - /S ) S. P Date Wanted: — 2 lc! a.m. p.m. Requester: Phone No: U k 7� p a i, r -<J`_ ( Q , r / Project: c i , , It c, e,s fit'` /t Type of Inspection: J^ ,,.J�,i f t.,. Address: / Date Called: Special Instructions: / • Date Wanted: — 2 lc! a.m. p.m. Requester: Phone No: INSPECTION NO. INSPECTION RECORD Retain a copy with permit p &oy_rz1 PERMIT NO. CITY OF TUKWILA BUILDING DIVISION 6�- 6300 Southcenter Blvd., #100, Tukwila, WA 98188 (206)431 -3670 Approved per applicable codes. Corrections required prior to approval. L Inspectol .. c). Date: I _ 'II) • / 0 ri $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: 1 Project: Of Vi✓ K Type of InspAction: 6 Ern-A..e, Address: 505 .it((trWW.fe( ''L Date Called: O f ,7I/ o Special Instructions: Date Wanted: 0 3 /a /r) am. p.m. Request f Phone a O(D -- 1,0-,::5/7 INSPECTION NO. INSPECTION RECORD Retain a copy with permit PERMIT NO. CITY OF TUKWILA BUILDING DIVISION 6300 Southcenter Blvd., #100, Tukwila, WA 98188 (206)431 -3670 O Approved per applicable codes. Corrections required prior to approval. COMMENTS: ` "DC Ili - 11 , 5 4att Cl Pi405 5 ptc . "T 3 re fla( S (tc e i ve1. Inspector: Date: 3 ` / f0 r7 $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: 07/28/2010 09:16 FAX 4257412500 NITROX INC ttlitrc I ii C ' Medical Gases • Medical Gas Line Verifications 'Analgesia equipment' 2706 164`" Street SW— Lynnwood, WA 98087 (425) 741 -8807 Fax (425) 741 -2500 Fax Cover Sheet Company: To: Phone: Fax: Regarding: ❑ Urgent ❑ Please Reply ❑ For Your Records Medical gas verification for Dr's Virk and Polsky Permit #PG09 -127 Janis at Nitrox Inc „0.9 O's 0 Privilege and Confidentiality Notice The information contained in this fax and it's attachments is intended for the named recipients only. It may contain privileged and confidential material. If you have received this transmission in error, please notify the sender and discard this from your files. 00 -Fax Cover Sheet -0110 Permit Dept From: Janis Tukwila Bldg Dept Q 7 206 Date: 07/28/10 206- 431 -3665 Email Janis@nitroxinc.net ❑ For Your Review 10001 07/28/2010 09:16 FAX 4257412500 NITROX INC • • • • Medical Cases • Medical Gas Line Verifications • Analgesia Equipment rox RECSA 2 g 2010 D oP NF � y } -14 Date 23 July 2010 Contractor: Head Mechanical Date(s) and Time(s) of Testing: 26 October 2009 / 1605hrs 06 November 2009 / 0800hrs 24 February 2010 / 0930hrs 02 March 2010 / 1315hrs 29 March 2010 / 1330hrs 31 March 2010 / 1100hrs Facility: Drs. Virk and Polsky 505 Strander Blvd. Tukwila, WA 98188 Scope of Work: New Medical Gases, Dental Air and Dental Vacuum systems. VIRK- 10.26.09 I. General Findings: A. Medical Gases are in compliance with NFPA 99 (2005ed) Level 3, Dental "NOT FOR ANESTHESIA" B. No crossed lines were found in Medical Gases, Dental Air or Vacuum in tested areas on the day of testing. C. Medical Gases meet minimum concentrations. D. Medical Gases and Dental air are at normal pressure. E. Dental Vacuum is at normal level. F. MOST Medical Gas and Dental system components in area tested are in compliance with NFPA 99 (2005ed). Level 3, Dental See `(Comments) and *(Corrections) G_ Medical Gas Line Purity: PASS # UN, (AG) H. Initial Line Pressure Test: Pass 1) 150 psig for pressurized gas pipelines (24hrs Local Authority). 2) 60 psig for copper vacuum pipelines (24hrs Local Authority). 3) 15 psig for plastic vacuum pipelines (24hrs Local Authority). City of Tukwila: Permit # PG09 -127 I. Attachments: Purities Dental Gas Line Verification 2706 164th Street S.W., Lynnwood, WA 98087 (425) 741.8807 • 1 -800- 736-7047 • Fax: (425) 741.2500 Pg 1 of 4 lQ 002 07/28/2010 09:17 FAX 4257412500 NITROX INC 0 • Inc Note: Existing Equipment and Systems. NFPA 99 (2005 ed) #5.3.1.4 - An existing Level 3 system that is not in strict compliance with the provisions of this standard shall be permitted to be continued in use as long as the authority having jurisdiction has determined that such use does not constitute a distinct hazard to life. II. Medical Gases: A. Oxygen: 1. Static line pressure: 50 psig. 2. Oxygen concentration at outlet: >99.0% 3. Dynamic outlet free flow at outlet: >3.5 scfm B. Nitrous Oxide: 1. Static line pressure: 51 psig. 2. Nitrous Oxide concentration at outlet: >99.0% 3. Dynamic outlet free flow at outlet: >3.5. scfm II. Dental Air and Vacuum: A. Dental Air: 1. Static line pressure: 95 psig. 2. Oxygen concentration at outlet: 20.8% B. Dental Vacuum: 1. Static line vacuum: 7 "HgV. III. Particulate Line Test: PASS IV. Odor: PASS V. Outlet: Matrix A. Outlet Style: 'Ohio' VI. Zone Valve: None - Not Required VIRK- 10.26.09 (aL61 JUL 2 8 2010 COMMUNITY DEVELOPMENT • Medical Gases • Medical Gas Line Verifications • Analgesia Equipment 2706 164th Street S.W.. Lynnwood. WA 98087 (425) 741.8807 • 1- 800.736 -7047 • Fax: (42 S) 741-2500 RECEIVED Pg 2 of 4 1,0 003 07/28/2010 09:17 FAX 4257412500 NITROX INC • I �®� Inc. VII. Manifold / Alarm: A. Manifold: New 1. Brand: 'Porter' 2. Model Number: 4222NOHF 3. Serial Number: 803 B. Alarm: New 1. Brand: 'Porter' 2. Model Number: KD76326 3. Serial Number: KB22067 -008 RECEIVED V pK- 10.26.09 Pg 3 of 4 2706 164th Street S.W., Lynnwood, WA 98087 (425) 741 -8807 • 1- 800 - 736 -7047 • Fax: (425) 741 VIII. Dental Equipment: A. Dental Air: New 1. System air components in compliance with NFPA 99. 2. Brand: Dental EZ 3. Model Number: 1025D 4. Serial Number: CC0912171 5. Configuration: Duplex 6. Horse Power: 3/4 7. Intake: Inside but other space 8. Pump: Oil Less JUL 2 8 2010 COMMUNITY DEVELOPMENT • Medical Gases • Medical Gas Line Verifications • Analgesia Equipment B. Dental Vacuum: New 1. System air components in compliance with NFPA 99. 2. Brand: 'Ramvac' 3. Model Number: Bull Dog QT1 4. Serial Number: QT1001114 5. Configuration: Simplex 6. Horse Power: 1 7. Vented to outside. C. Amalgam Separator: None - See Comments and Corrections 1. Brand: none IX. Cylinder Storage: A. Location: Inside B. Ventilation: Passive C. Cooling Sprinkler: Yes - PASS per IFC D. Door labeled per NFPA: No (See Comments and Corrections) E. 1 Hour Rated: PASS per NFPA F. Cylinders Secured: PASS per NFPA 4004 07/28/2010 09:17 FAX 4257412500 :• ®�o � • ' Inc X. Brazier: Jeff Head A. Brazier Number: MGO1 HEAD*J* 016RP B. Plumbing Contractor: Head Mechanical XI. Witness: Don Koehn - CBI XI1. Comments: A. No amalgam separator found. Local authority may require separator be installed. XIII. Recommended Corrections: A. None XIV. Corrections: A. Add amalgam seperator B. Label Door per IFC Tested By: B. Evan Mc Allister, CRTT, CMGV #V -0024 Harry I. Pomeranz, CMGV #V -1033 Reviewed By: B. Evan Mc Allister, CRTT, CMGV #V -0024 B. E . n Mc Allister CRTT, CMGV #V -0024 President VIRK - 10.26.09 NITROX INC r4M+• CS V ICU 1Q 005 JUL 2 8 2010 COMMUNITY DEVELOPMENT • Medical Cases • Medical Gas Line Verifications • Analgesia Equipment Q M 2706 164th Street S.W., Lynnwood, WA 98087 (425) 741 - 8807 • 1- 800.736 -7047 • Fax: (425) 741 -2500 Pg 4 of 4 07728/2010 09:17 FAX 4257412500 Facility: Dr Polsky rox NITROX INC 1gi 006 RECEIVED JUL. 2 8 2010 t'. x[147' • Medical Gases • MedicarGas Line Verifications • Analgesia Equipment Piping Purity Test (NFPA 99, 2006 ed. #5.1.12.3,8) 5.1.12.3.8.1 These test were performed using oil -free, Nitrogen NE. 5.1.12.3.8.2 The tests shall be for total non - methane hydrocarbons (as methane), and halogenated hydrocarbons, and compared with the source gas. 5.1.12.3.8.3 This test shall be performed at the outlet most remote from the source. 5.1.12.3.8.4 The difference between the two test shall in no case exceed the following: (1) Total hydrocarbons (excluding methane), 5 ppm (2) Halogenated hydrocarbons, 5 ppm 5.1.12.3.8.5 A test for dew point shall be at the outlet most remote from the source and the dew point shall not exceed 500 ppm or -12 °C (10 °F) at 345 kPa (50 psig). Sample testing conducted by third party analytical laboratory. (GC Analysis report results on file at Nitrox, Inc office) ❑ Sample testing conducted on -site using appropriate analysis equipment. (Analysis report results on file at Nitrox, Inc office) Gas Pass /Fail Location 'Oxygen" PASS OUTLET 'Nitrous Oxide' PASS OUTLET Remarks: Pass per NFPA 99 (2005ed) VIRK- 10.29.09pur 2706 164th Street S.W., Lynnwood, WA 98087 (425) 741.880' • 1- 800.736-7047 • Fax: (425) 741 -2500 Pg 1 of 1 07/28/2010 09:17 FAX 4257412500 .• • ® Inc. NITROX INC RECEIVED lQ 007 JUL 2 8 2010 GQMMUNITif DEVELOPMENT • • • Medical Gases • Medical Gas Line Verifications • Analgesia Equipment Dear Doctor, Please read each statement in full to determine your practice requirements per NFPA 99 2005ed. for Medical Piped Gas Systems. Mark your selection (one only). Please sign and date, and return original to Nitrox Inc. Thank you for your cooperation. 3.3.90 Level 1: Medical Piped Gas and Vacuum Systems. Systems serving occupancies where interruptions of the piped Medical Gas and Vacuum Systems would place patients in imminent danger of Morbidity or Mortality. (PIP) 3.3.92 Level 2: Medical Piped Gas and Vacuum Systems. Systems serving occupancies where interruptions of the piped Medical Gas and Vacuum Systems would place patients at manageable risk of Morbidity or Mortality. (PIP) 3.3.94 Level 3: Piped Gas Systems. Systems serving occupancies where interruption of the piped Medical Gas would terminate procedures, but would not place patients at risk of. Morbidity or Mortality. (PIP) Level 3: 3.3.94 Level 1: 3.3.90 Level 2: 3.3,92 Clinic Name: ed,,, -77'' t A."-4 Dr. Name printed: M A Dr. Signature: Date a;AVIA Title 19 S 7 B itrox Irpc. . Evan Mc Allister, Pres. 2706 164th Street S.W., Lynnwood, WA 98087 (425) 741 - 8807 • 1. 800 - 7367047 • Fax: (425) 741-2500 07728/2010 09:17 FAX 4257412500 Level 1: 3.3.90 Clinic Name: Dr. Name printed: Dr. Signature: NITROX INC RECEIVED JUL 2 8 2010 itirOX COM MUNITY .. , O I,OPME1NT Inc. • Medical Gases • Medical Cas Line Verifications • Analgesia Equipment Dear Doctor, Please read each statement in full to determine your practice requirements per NFPA 99 2005ed. for Medical Piped Gas Systems. Mark your selection (one only). Please sign and date, and return original to Ni'trox Inc. Thank you for your cooperation. 3.3.90 Level 1: Medical Piped Gas and Vacuum Systems. Systems serving occupancies where interruptions of the piped Medical Gas and Vacuum Systems would place patients in imminent danger of Morbidity or Mortality. (PIP) 33.92 Level 2: Medical Piped Gas and Vacuum Systems. Systems serving occupancies where interruptions of the piped Medical Gas and Vacuum Systems would place patients at manageable risk of Morbidity or Mortality. (PIP) 3.3.94 Level 3: Piped Gas Systems. Systems serving occupancies where interruption of the tt Medical of al Gas would terminate procedures, but would not place patients Morbidity or Mortality. (PIP) Level 2: 3.3.92 Level 3: 3.3.94 •/. ..emu Pb r arerc. Db- itle Date 2706 1 64th Street S.W., Lynnwood, WA 98087 (425) 741 -8807 • 1-800-736-7047 • Fax: (425) 741.2500 Allister, Pres. 10008 INITIAL TEST DCVA / RPBA CHECK VALVE LEAKED CLOSED TIGHT 7.8 #1 ❑ DCVA / RPBA CHECK VALVE LEAKED CLOSED TIGHT #2 RPBA RELIEF VALVE OPENED: 3.8 PSID PVBA /SVBA AIR INLET OPENED: PSID PASSED x II FAILED TO OPEN: AIR GAP: OK? ❑ FAILED ❑ I ., MI FAILED TO OPEN: 0 PSID PSID X NEW PARTS AND REPAIRS CLEAN / REPLACE PART CLEAN / REPLACE PART CLEAN / REPLACE PART PVBA /SVBA CHECK HELD AT: PSID ❑ ❑ ❑ ❑ ❑ ❑ LEAKED ❑ ❑ ❑ ❑ ❑ ❑ ❑ CLEANED ❑ REPAIRED ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ TEST AFTER REPAIRS PASSED ❑ FAILED ❑ LEAKED CLOSED TIGHT ❑ ❑ PSID LEAKED CLOSED TIGHT ❑ ❑ PSID OPENED AT: PSID AIR INLET: PSID CHK VALVE: PSID BACKFLOW PREVENTION ASSEMBLY TEST REPORT CERTIFIED BACKFLOW ASSEMBLY TESTING, LLC wA. ST. CONT. LIC. # CERTBAT951BR 253 - 565 -2728 OFC 888 -718 -0500 TOLL FREE SPEC. PLMB. LIC. # FREDEPE980P1 ACCT / FILE# PG -09 -127 METER # PERMIT# PREMISE: SOUTHSOUND PEDIATRIC DENTISTRY COMMERCIAL ® RESIDENTIAL ❑ SERVICE ADDDRESS: STE 505 505 STRANDER BLVD CITY: TUKWILA ZIP 98188 CONTACT PERSON: PHONE: ASSY. LOCATION: NrE CLOSET— HAZARD TYPE: kPREMISE- ISOLATION'" ❑ DCVA © RPBA ❑ PVBA ❑ OTHER NEW INSTALL: © EXISTING: ❑ REPLACED: ❑ OLD SN #: PROPER INSTALL: YES ® NO ❑ MAKE ASSY: WATTS MODEL: OO9M2QT SER. NO: A41 759 SIZE: 1 .0 AIR GAP INSPECTION: SUPPLY PIPE DIAMETER " SEPARATION: WATER FOUND: O ® OFF 1 cert that this re 28 JULY 9 MAKE /MODEL: OF ❑ LINE PRESSURE: 120 ave u ed W C 248-290 -490 approved methods and test equipment. TESTER SIGNATURE: PRINTED NAME: AUL E. FREDERICK TEL. 253 - 565 -2728 REPAIRED BY: PAUL E. FREDERICK C' - T NO.: CERTIBAT951 BR DATE: FINAL TEST BY: CERT. NO.: B -3415 DATE: METER CAL DATE: BARTON 247 FAX: DETECTOR METER READING: PASS ❑ FAIL ❑ CERT. NO.: B -3415 DATE: 23 MAR 10 METER SERIAL NO: 216398 INITIAL TEST PASSED ❑ DCVA / RPBA CHECK VALVE #1 DCVA / RPBA CHECK VALVE #2 LEAKED ❑ RPBA RELIEF VALVE OPENED: 3.8 PSID PVBA / SVBA AIR INLET OPENED: PSID LEAKED I•A CLOSED TIGHT CLOSED TIGHT K1 FAILED TO OPEN: FAILED TO OPEN: ❑ FAILED X PSID 2.5 PSID AIR GAP: OK? X NEW PARTS AND REPAIRS CLEAN / REPLACE PART CLEAN / REPLACE PART ❑ ❑ CLEAN / REPLACE PART ❑ ❑ PVBAISVBA CHECK HELD AT: PSID 0 ❑ CHK ASSY. ❑ ❑ ❑ ❑ ❑ ❑ LEAKED ❑ ❑ ❑ ❑ ❑ ❑ ❑ CLEANED ❑ REPAIRED ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ TEST AFTER REPAIRS REPAIRS LEAKED ❑ OPENED AT: PSID AIR INLET: PSID LEAKED PASSED Ri CLOSED TIGHT I.4 CLOSED TIGHT R CHK VALVE: PSID FAILED ❑ 2.7 PSID 2.7 PSID BACKFLOW PREVENTION ASSEMBLY TEST REPORT CERTIFIED BACKFLOW ASSEMBLY TESTING, LLC WA. ST. CONT. LIC. # CERTBAr95IBR 253 - 565 -2728 OFC 888 -718 -0500 TOLL FREE SPEC. PLMB. LIC. # FREDEPE980P1 ACCT / FILE# PG -09 -1 27 METER # PERMIT #: PREMISE: SOUTHSOUND PEDIATRIC DENTISTRY COMMERCIAL RESIDENTIAL ❑ SERVICE ADDDRESS: STE 505 505 STRANDER BLVD CITY: TUKWILA ZIP 98188 CONTACT PERSON: PHONE: ASSY. LOCATION: 'N,-E. ROOM CLOSET HAZARD TYPE:__ r.7FIRE7SYSIE M © DCVA ❑ RPBA ❑ PVBA ❑ OTHER NEW INSTALL: © EXISTING: ❑ REPLACED: ❑ OLD SN #: PROPER INSTALL: YES ® NO ❑ MAKE ASSY: WATTS MODEL: 007M1QT SER. NO: 385774 SIZE: 1.0 AIR GAP INSPECTIO IJ 1 I I WI SI TG"" d l FF ve us DETECTOR METER READING: LINE PRESSURE: 120 WAC 248-290490 approved methods and test equipment. CERT. NO.: CERT NO.: CERTIBAT951 BR CERT. NO.: B -3415 BA ON 247 METER SERIAL • B -3415 DATE: 23 MAR 10 TEL. 253 - 565 -2728 DATE WATER FOUND: TESTER SIG 'Al PRINTED N REPAIRED BY: FINAL TEST BY: PE DIAMETER METER CAL DAT 28 JULY 9 MA E /MODEL: " SEPARATION: FAX: PASS ❑ FAIL ❑ 23 MAR 10 �.� DATE: 23 MAR 10 IAL NO: 216398 03/15/2010 15:26 FAX 4257412500 NITROX INC RECEIVED i tI"O MAR 15 2010 I n C ' Med( L ,;, .' al Gas Line Verifications 'Analgesia Equipment* 2706 164 Street SW — Lynnwood, WA 98087 (425) 741 -8807 Fax (425) 741 -2500 Fax Cover Sheet Company: From: Evan Mc Allister To: Dave Larson Pages: 3 Phone: Date: / March 2010 Fax: 206.431.3665 Regarding: ❑ Urgent ® Please Reply ® For Your Records ® For Your Review Comments: Dave, Amended 'LETTER OF ACCEPTANCE' #3: for Dr Virk AMD: #3 raj 001 1 VIRK.ADM #3- 03.01.10 Pg 1 of 1 Privilege and Confidentiality Notice The information contained in this fax and is attachments is intended for the named recipients only. It may contain privileged and confidential material. If you have received this transmission in error, please notify the sender and discard this from your files. 00 -Fax Cover Sheet -0110 03/15/2010 15:26 FAX 4257412500 ..•• , • • •• • Date: 15 March 2010 Contractor: Head mechanical Address: City & State: Phone: Fax: Contact: Subject: Medical Gas Line Verification, Dental Air and Vacuum. Nitrox Inc. has accepted to perform the third party verification for the facility named below in accordance with NFPA 99 (2005 ed.) and any local requirements for this Level 3 facility. AMD: #1: ** Because of "Recovery Room"- Recommend Level 2. AMD: #2: ** Change of Recovery room to `STORAGE room AMD: #3 ** Change storage room to future `Dental Ops' Facility: Dr. VIRK Address: 505 Strander Blvd. City & State: Tuckwilla, Wa. Medical Gas Systems: Equipment Systems: Oxygen ® Dental Air & Source Equipment ❑ Nitrogen ® Dental Vacuum & Source Equipment ® Nitrous Oxide E Medical Gas Source Equipment VIRK - LTRACC- 12.22.09ADM- 03.01.10 #3 Pg 1 of 2 Ca-PY itrox .. NITROX INC [0 002 RECEIVED MAR 15 2010 • Medical Gases • Medical Gab ndons • Analgesia Equipment Letter of Acceptance * Amendment #2 * 1. Drawing for Level 3: Pass 2. Medical Gas Manifold and Alarm: Pass / LEVEL 3 A. Source Equipment supplied by 'Patterson Dental' and are per NFPA 99 — 2005ed. 3. Medical and Dental piping installation will be per NFPA 99 2005ed. 2706 164th Street S.W., Lynnwood, WA 98087 (425) 741 -8807 • 1- 800-736 -7047 • Fax: (425) 741 -2500 03/15/2010 15:26 FAX 4257412500 NITROX INC • . • .• • • • itro RECEIVED MAR 15 2010 COMMUNI1 it DEVELOPWIEti1 Inc • Medical Gases • Medical Gas Line Verifications • Analgesia Equipment AMEND: #3 For: 1. (Dental Vacuum line to) 'Recovery Room' Now changed to 'Storage room' 2. Medical Oxygen and Vacuum in Future 'Dental OP's' NOTE: A. NFPA 99 2005ed. #5.1.13.1: Special Precautions — Piped Gas and Vacuum Systems. * Level 3 Piping System are installed to Level 1 Piping requirements. 1. Sub reference #5.1.13.1.5: The Medical - Surgical Vacuum shall not be Used for Vacuum ... or other non Medical or non Surgical applications. B. Dr's have signed to use 'System as Level 3' 1. Drawings and Medical Gas system is in compliance with NFPA 99 (2005ed). C. Final Apyroval is per 'Local jurisdiction' /;:trEc Mc Allister CR , CMGV #V -0024 President VIRK - LTRACC- 12.22.09ADM- 03.01.10 #3 2706 164th Street S.W.. Lynnwood, WA 98087 (425) 741-8807 • 1- 800 - 736 -7047 • Fax: (425) 741 -2500 Pg 2 of 2 4 003 V3 /U.i /LU IU ZL.L6 r 4LJ Z00 0413 TO: Dave Larson COMPANY: City of Tukwila PA]L NUMBER: (206) 431-3665 PHONE NUMBER: (206) 431 -3678 Dr. Virk I IS Best Regards, Jeffery A. Head I1CAU MCGIIc Iu.LL01 1111. HEAD MECHANICAL, INC 16653 160 PL SE RENTON, WA, 98058 OFFICE (425) 228.007 FAX (425) 255.5413 FACSIMILE TRANSMITTAL SHEET CC: Don Koehn CBI COMMENTS - PLEASE RLPLY FROM Jeff Head D A'L'E: 3/3/2010 TOTAL NO. OF PAGES N(iUnMC COVER: 5 SENDER'S REPTLRENCE NUMBER: YOUR RArERuNC it NUMBER: Dave, Here is a copy of the revised plan indicating the alterations to be made to the new medical gas system, a letter of acceptance from Nitrox, Inc. as well as a leer from Nitrox Inc. stating this will be a level three medical gas system signed by Dr. Polsky, the doctor who 4. actually be practicing at this facility. Can you give me a call and let me know if you need anything else, or when the permit will be ready for pick up. I can be reached at (206) 730-5178 Also, I need to add a 1" double check valve assembly as required by the fire sprinkler plan, to be installed directly above the RPI3A. I would like this to be added to this • �•�• , • well wjvv 1/ Vv.) MAR 0 42010 COMMUNITY DEVELOPMENT 8-a. k o 164 oln /21.e 2 o C 2- v ucl (4.1 (4.1 »-� /`r) $ A -e yearn y/0 A rleornm y 1c,/pea 6 used f kid? ✓Li d-lirrf • d d P7 5 � )9b fo-t. ve- .1"/A-u_ 01, Li U LL.L10 NM) 0410 U. . • • • ••, N tz„ MedU MUUM4H1U41 Date:4 2-4-11.0 0 1 Br 3 WJ VU/ VV ! Jeffery A. Head Residential & Commerci Owner Plumbing & Heating 16653 160 PL SE Renton, WA. 98058 Office (425) 228-0071 Fax (425) 255-5413 Cell (208) 730-5178 RECEIVED MAR 04 2010 COMMUNITY OEVELOPMENT us /u /LU�u LZ:Zf FAA 4L3 LOO 041i neaa Mecnanicj. Inc 03/03/202U 17:01 FAX 4257412500 NITRO% INC • • •• • • • 6 41 1111 1170X kW. Date: 01 March 2010 Contractor: Head mechanical Address: City 8. State: Phone: Fax: Contact: Subject: Medical Gas Line Verification, Dental Air and Vacuum_ Nitrox Inc. has accepted to perform the third party verification for the facility named below in accordance with NFPA 99 (2005 ed.) and any local requirements for this Level 3 facility. AMD: #1: Because of "Recovery Room" — Recommend Level 2_ AMD: 02: Change of Recovery room to 'STORAGE room Facility: Dr. VIRK Address: 505 Strander Blvd. City & State: Tuckwilla, Wa. Medical Gas Systems: Equipment Systems: Oxygen ❑ Nitrogen El Nitrous Oxide AMEND: *2 For: 1. (Dental Vacuum line to) 'Recovery Room' Now changed to 'Storage room' 2. Medical Oxygen and Vacuum in `Storage room' VIRK - LTRACC- 12.22.09ADM -03.01.10#2 Letter of Acceptance * Amendment #2 • ® Dental Air & Source Equipment E Dental Vacuum & Source Equipment ® Medical Gas Source Equipment 1, Drawing for Level 3: Pass 2. Medical Gas Manifold and Alarm: Pass / LEVEL 3 A. Source Equipment supplied by 'Patterson Dental' and are per NFPA 99 — 2005ed. 3. Medical and Dental piping Installation will be per NFPA 99 2005ed. 2906 164th Street S.W., Lynnwood. WA 98087 (425) 741.8807 • 1- 800.736.7047 • Fax: (425) 741.2500 Pg 1 of 2 IJuu;3 /uuo 41 003 • Medical Cases • Medical Gas Line Verifications • Analgesia Equipment RECEIVED MAR 0 4 2010 COMMUNITY DEVELOPMENT u;j /U,i /ZU lu ZZ: Z( r'1( 4Z3 COO o4 13 r+eaa mechanical Inc 03/03/2010 17:06 FAX 4267412600 NITROX INC • tJuu4 /uu3 004 : ilar r ibrOx /1110 • Medical Gases • Medkal Gas Line Verifications • Analgesia Equipment RECEIVED NOTE: MAR 0 4 2010 A. NFPA 99 2005ed. #5.1.13.1: Special Precautions.— Piped Gas and COMMUNITY Vacuum Syateme. " Level 3 PlpIng System are installed to Level 1 DEVELOPMENT Piping requirements. 1. Sub reference #5.1.13.1.5: The Medical - Surgical Vacuum shall not be Used for Vacuum ... or other non Medical or non Surgical applications. B. Based on NFPA 99 # 5.1.13.1.5, I CAN NOT RECOMMEND THAT MEDICAL GASES OR VACUUM BE PLACED IN A 'STORAGE ROOM #1' AREA. B. Evan Mc Allister CRTT, CMGV #V -0024 President VIRK- LTRACC- 12.22.09ADM- 03.01.10#2 Pg 2 of 2 2706 164th Street 5.W., Lynnwood, WA 98087 (425) 741.8807 • 1- 800.736 -7047 8 Fax: (425) 741 -2500 Nifi • or IP INIG • *Alegi Doses • Medical Dos Line VerJ/ltocfons • Analgesia Equipment RECEIVED MAR 0 4 2010 Dear Doctor COMMUNITY Please read each statement in full to determine your practice requirements per NFPA LOPMENT 2005ed. for medical piped gas systems. Mark your selection one onN at the bottom. Please sign and date, and return original to us. Thank you for your cooperation. 3.3.90 Level 1, Medical Piped Gas and Vacuum Systems. Systems serving occupancies where interruptions of the piped medical gas and vacuum systems would place patients In imminent danger of morbidity or mortality. (PIP) 3.3.92 Level 2, Medical Piped Gas and Vacuum Systems. Systems serving occupancies where interruptions of the piped medical gas and vacuum systems would place patients at manageable risk of morbidity or mortality. (PIP) 3.3.94 Level 3 Piped Gas Systems. Systems serving occupancies where interruption of the piped medical gas would terminate procedures, but would not place patients at risk of morbidity or mortality. (PIP) Clinic Name • Level 1 3.3.90 Level 2 3.3.92 Name printed f ' S Titie/9 signatur Da a Nit= Inc. 8. Evan McAllister Pres. 2706164" Street SW., Lynnwood, WA 98087 (426) 741.8807. 800.738.7047 • Fax (425) 741 -2500 909-4 100/100'd 1014 918/911902 0111 30-14014 92 :II 010243-E0 03 /01/2010 18:51 FAX 4257412500 NITROX INC itro - Medical Gases • Medical Gas Line Verifications • Analgesia Equipment* 2706 164 Street SW— Lynnwood, WA 98087 (425) 741 -8807 Fax (425) 741 -2500 Fax Cover Sheet Company: From: Evan Mc Allister To: Dave Larson Pages: 3 Phone: Date: 01 March 2010 Fax: 206 - 431.3665 Regarding: [_J Urgent ® Please Reply ® For Your Records ® For Your Review Comments: Dave, Amended 'LETTER OF ACCEPTANCE' #2 for Dr Virk It 001 RECEIVED MAR 022010 PERMIT CENTER VIRKADM #2- 03.01.10 Pg 1 of 1 Privilege and Confidentiality Notice The information contained in this fax and irs attachments is intended for the named recipients only. It may contain privileged and confidential material. If you have received this transmission in error, please notify the sender and discard this from your files. 00 -Fax Cover Sheet -0110 03/01/2010 18:52 FAX 4257412500 1 G' Date: 01 March 2010 NITROX INC tQ 002 Inc. • Medical Cases • Medical Gas Line Verifications • Analgesia Equipment Letter of Acceptance * Amendment #2 * Contractor: Head mechanical Address: City & State: Phone: Fax: Contact: Subject: Medical Gas Line Verification, Dental Air and Vacuum. Nitrox Inc. has accepted to perform the third party verification for the facility named below in accordance with NFPA 99 (2005 ed.) and any local requirements for this Level 3 facility. AMD: #1: ** Because of "Recovery Room" - Recommend Level 2. AMD: #2: ** Change of Recovery room to 'STORAGE room Facility: Dr. VIRK Address: 505 Strander Blvd_ City & State: Tuckwilla, Wa. Medical Gas Systems: Equipment Systems: ® Oxygen ❑ Nitrogen ® Nitrous Oxide Dental Air & Source Equipment ® Dental Vacuum & Source Equipment ® Medical Gas Source Equipment 1. Drawing for Level 3: Pass 2. Medical Gas Manifold and Alarm: Pass / LEVEL 3 A. Source Equipment supplied by 'Patterson Dental' and are per NFPA 99 — 2005ed. 3. Medical and Dental piping installation will be per NFPA 99 2005ed. AMEND: #2 For: 1. (Dental Vacuum line to) 'Recovery Room' Now changed to 'Storage room' 2. Medical Oxygen and Vacuum in 'Storage room' VIRK - LTRACC- 12.22.09ADM- 03.01.10#2 Pg 1 of 2 2706 164th Street S.W., Lynnwood, WA 98087 (425) 741.8807 • 1 =800- 736 -7047 • Fax: (425) 741 -2500 Pcog-/2 RECEIVED MAR 0 2 2010 PERMIT CENTER 03/01/2010 18:52 FAX 4257412500 NITRO% INC B. Evan Mc Allister CRTT, CMGV #V -0024 President 16 003 Inc • Medical Gases • Medical Gas Line Verifications • Analgesia Equipment NOTE: A. NFPA 99 2005ed. #5.1.13.1: Special Precautions — Piped Gas and Vacuum Systems. Level 3 Piping System are installed to Level 1 Piping requirements. 1. Sub reference #5.1.13.1.5: The Medical - Surgical Vacuum shall not be Used for Vacuum ... or other non Medical or non Surgical applications. B. Based on NFPA 99 # 5.1.13.1.5, I CAN NOT RECOMMEND THAT MEDICAL GASES OR VACUUM BE PLACED IN A 'STORAGE ROOM #1' AREA. VIRK - LTRACC- 12.22.09ADM- 03.01.10 #2 Pg 2 of 2 2706 164th Street S.W., Lynnwood, WA 98087 (425) 741.8807 • 1- 800 - 736.7047 • Fax: (425) 741 - 2500 RECEWED MAR 02 2010 PERMIT CENTER UZ /Z4 /ZU1U 11:0b rAA 4Z0f41ZODU X07--/i7 itro c • Medical Gases • Medical Gas Line Verifications ' Analgesia Equipment' 2706 164 Street SW— Lynnwood, WA 98087 (425) 741 -8807 Fax (425) 741 -2500 Fax Cover Sheet Company: From: Evan Mc Allister To: Dave Larson Pages: 3 Phone: Date: 23 February 2010 Fax: 206.431.3665 Regarding: ❑ Urgent ® Please Reply ® For Your Records ® For Your Review Comments: Dave, Amended 'LETTER OF ACCEPTANCE' for Dr Virk B. Evan Mc Allister Presendent !N1'1HUA 1Nc LJUUI RECEIVED FEB 242010 PERMIT CENTER VIRKADM- 02.23.10 Pg 1 of 1 Privilege and Confidentiality Notice The information contained in this fax and it's attachments is intended for the named recipients only. It may contain privileged and confidential material. If you have received this transmission in error, please notify the sender and discard this from your files. 00 -Fax Cover Sheet -0110 UZ /Z4 /ZU1U 11:511 FAA 4Z5Y41Z5UU s • l ` st o Date: 23 February 2010 Contractor: Head mechanical Address: City & State: Phone: Fax: Contact: Subject: Medical Gas Line Verification, Dental Air and Vacuum. Nitrox Inc. has accepted to perform the third party verification for the facility named below in accordance with NFPA 99 (2005 ed.) and any local requirements for this Level 3 facility. ** because of "Recovery Room" — Recommend Level 2. Facility: Dr. VIRK Address: 505 Strander Blvd. City & State: Tuckwilla, Wa. Medical Gas Systems: Equipment Systems: ® Oxygen ® Dental Air & Source Equipment ❑ Nitrogen ® Dental Vacuum & Source Equipment ® Nitrous Oxide Medical Gas Source Equipment 1. Drawing for Level 3: Pass 2. Medical Gas Manifold and Alarm: Pass / LEVEL 3 A. Source Equipment supplied by 'Patterson Dental' and are per NFPA 99 — 2005ed. 3. Medical and Dental piping installation will be per NFPA 99 2005ed. AMEND: 1. For: 1" 2. A c Allister TT, CMGV #V -0024 President 1VlIIUA t�J/. UUZ Inc. • Medical Gases • Medical Gas Line Verifications • Analgesia Equipment Letter of Acceptance ental Vacuum line to `Recovery Room'. ugh E (* See Attache NO `NFPA 99 ISSUES'. VIRK.LTROFACC- 12.22.09ADM- 2.23.10 PG 1 OF 1 2706 164th Street S.W., Lynnwood, WA 98087 (425) 741.8807 • 1 -800- 736.7047 • Fax: (425) 741 - 2500 UZ /Z4 /ZU1U 11:01 FAA 4Z0i41ZbUU v /Ld/'ZU IU ua :1y t 425 255 5413 T0: Harty McAQisbrx COMPANY: Nitrox PAX' NUMBER (425) 741 -2500 P (NONE NUMBER: (425) 741- 7047 . Rb: Dr. Virk Plan. Changes N0TUfCOMNP.NTS: Harty, HEAD MECHANICAL, INC 16653 160 PL SE RENTON, WA, 98058 OFFICE (425) 228 -0071 FAX (425) 255 -5413 FACSIMILR TRANSMITTAL SHEET Thank you for all of your help with this matter. 2.-c6 4 N1 11(uA 11NL Head Mechanical Inc PROM: Jeff Head OATm 1/28/2010 TOTAL NO. AF P1161;' INCLUDING COVER: 2 SENDER'S k1iF.N.H NCEf N UMBER.: YOUR RBPERENCB NUMBER: URGENT ❑ FOR REVIEW 0 k'LI1ASE COMMENT' ❑ PLEASE REPLY ❑ FT.EASP: AMCKCI.E The original scope of work is complete and inspected at this time. Now they wish to make the following changes. I revised the drawing and clouded the areas they are mQki„ g the changes. r`e A) Delete the N20 and the 02 in the Recovery Room 13) Add New 02 and Vacuum wall outlets in West wall Q Install new 1" Vacuum. line in ceiling to Mechani R oom — D) Install new 02 and N20 wall outlets in West wall of OP #2 E) Install new 02 and N20 wall outlets : iu : ,East wall of OP, #1 I am still working with Dave Larson Senior Plans Examinet, for the city of Tukwila. His phonc number is (206) 431-3678 and fax is (206) 431 -3665. I spoke with him yesterday regarding these changes. If you have any questions fox me you can contact me on my ell. (206) 730 -5178. We will be ready for verification late ne=t w<ek at the fist part of the week after. I will have Con. nine contact your office to schedule. d� ?f 36 7d 1p� 1001/002 12/23/2009 12:09 FAX 4257412500 } Date: 23 December 2009 NITROX INC W002 Letter of Acceptance Contractor: Head mechanical Address: City & State: Phone: Fax: Contact: Subject: Medical Gas Line Verification, Dental Air and Vacuum. Nitrox Inc. has accepted to perform the third party verification for the facility named below in accordance with NFPA 99 (2005 ed.) and any local requirements for this Level 3 facility. Facility: Dr. VIRK Address: 505 Strander blvd. City & State: Tuckwilla, Wa. Phone: Contact: Medical Gas Systems: Equipment Systems: ® Oxygen ® Dental Air & Source Equipment ❑ Nitrogen ® Dental Vacuum & Source Equipment ® Nitrous Oxide ® Medical Gas Source Equipment 1. Drawing for Level 3: Pass 2. Medical Gas Manifold and Alarm: Pass A. Source Equipment supplied by 'Patterson Dental' and are per NFPA 99 — 2005ed. 3. Medical and Dental piping installation will be per NFPA 99 2005ed. B. Evan Mc Allister CRTT, CMGV #V -0024 President VIRK.LTROFACC- 12.22.09 PG 1 OF 1 CD o N ce, 4 W it U u Q Cit CM r ink - ; f C) • rf i � J C (2 1 : W C S �1 l vu� ■■ :4 •, No eha ges 'shall be made tttie `scop of work without prior approval of Tukwila Building Division. NOTE: Rev;sions will require a new plan submittal H rrzy ."!!de additional plan rvrew fees. (.. _o t -,B /l :31VOS r; ,.. .� .,, 03/15/2010 15:28 FAX 4257412500 NITRO% INC • • • :•• • • • N tro Date: 15 March 2010 Facility: Dr. VIRK Address: 505 Strander Blvd. City & State: Tuckwilla, Wa. Medical Gas Systems: ® Oxygen ❑ Nitrogen ® Nitrous Oxide VIRK - LTRACC- 12.22.09ADM- 03.01.10 #3 • Medical Gases • Medical Gas Line Verifications • Analgesia Equipment Letter of Acceptance *Amendment #2 * Contractor: Head mechanical Address: City & State: Phone: Fax: Contact: Subject: Medical Gas Line Verification, Dental Air and Vacuum. Nitrox Inc. has accepted to perform the third party verification for the facility named below in accordance with NFPA 99 (2005 ed.) and any local requirements for this Level 3 facility. AMD: #1: ** Because of "Recovery Room " - Recommend Level 2. AMD: #2: ** Change of Recovery room to `STORAGE room AMD: #3 ** Change storage room to future `Dental Ops' Equipment Systems: ® Dental Air & Source Equipment • Dental Vacuum & Source Equipment . ® Medical Gas Source Equipment CODE REVIEWED �� APPROVED pOVED MAR 2 2 2010 Cliyof Tukwila BUILDING DIVISIfN 1. Drawing for Level 3: Pass 2. Medical Gas Manifold and Alarm: Pass / LEVEL 3 A. Source Equipment supplied by 'Patterson Dental' and are per NFPA 99 — 2005ed. 3. Medical and Dental piping installation will be per NFPA 99 2005ed. �� it � 1 z� IU 2706 164th Street S.W., Lynnwood, WA 98087 (425) 741.8807 • 1- 800 - 736 -7047 • Fax: (425) 741 -2500 Pg1of2 10002 RECEIVED MAR 17 2010 PERMIT CENTER UO/ 10/ LVJU 10: LO rIA 4L0141LOUV 1N11I(UA 11VV C� • AMEND: #3 For: 1. (Dental Vacuum line to) 'Recovery Room' Now changed to 'Storage room' 2. Medical Oxygen and Vacuum in Future 'Dental OP's' NOTE: A. NFPA 99 2005ed. #5.1.13.1: Special Precautions — Piped Gas and Vacuum Systems. * Level 3 Piping System are installed to Level 1 Piping requirements. 1. Sub reference #5.1.13 -1.5: The Medical - Surgical Vacuum shall not be Used for Vacuum ... or other non Medical or non Surgical applications. B. Dr's have signed to use 'System as Level 3' 1. Drawings and Medical Gas system is in compliance with NFPA 99 (2005ed). C. Final Approval is per 'Local jurisdiction' ) Mc Allister CR�'I' CMGV #V -0024 President VI RK- LTRACC- 12.22.09ADM- 03.01.10 #3 • Medical Gases • Medical Gas Line Verifications • Analgesia Equipment CODE SEWED FOR COMPLIANCE APPROVED MAR 2 2 2010 City of Tukwila BUILDING rn iRinN 2706 164th Street S.W., Lynnwood, WA 98087 (425) 741 - 8807 • 1- 800.736 -7047 • Fax: (425) 741 -2500 Pg 2 of 2 RECEIVED MAR 17 2010 PERMIT CENTER TO: Dave Larson COMPANY: City of Tukwila FAX NUMBER: (206) 431 -3665 PHONE NUMBER: (206) 431 -3678 RE: Dr. Virk Dave, Best Regards, HEAD MECHANICAL, INC 16653 160" PL SE RENTON, WA, 98058 OFFICE (425) 228 -0071 FAX (425) 255 -5413 CC: Don Koehn CB FACSIMILE TRANSMITTAL SHEET COMMENTS - PLEASE REPLY MAR 2 2 2010 FROM: Jeff Head DATE: 3/3/2010 Here is a copy of the revised plan indicating the alterations to be made to the new medical gas system, a letter of acceptance from Nitrox, Inc. as well as a letter from Nitrox Inc. stating this will be a level three medical gas system signed by Dr. Polsky, the doctor who will actually be practicing at this facility. Can you give me a call and let me know if you need anything else, or when the permit will be ready for pick up. I can be reached at (206) 730 -5178 Also, I need to add a 1" double check valve assembly as required by the fire sprinkler plan, to be installed directly above the RPBA. I would like this to be added to this permit revision as well. REVIEWED FOR Jeffery A. Head CODE COMPLIANCE APPROVED City of Tukwila BUILDING DiviRinki TOTAL NO. OF PAGES INCLUDING COVER: 5 SENDER'S REFERENCE NUMBER: YOUR REFERENCE NUMBER: IVED MAR 17 2010 PERMIT CENTEF fCCE rn,.o....M M ' FILE COPY For *il- Health Ha arci Applicatiians Job Name hr. V a r K. Contractor Job Location {n ___.1_LL1.LLid a ✓' Q1 t' J Apprao o Engineer Cont acoor'e P.O. No. APprovel - Representative Series 007 Double Check Valve Assemblies Sizes: W - 3° (16 - 8Omm) Series 007 Double Child( Valve Aaeembliee shall be Installed at referenced cross - connections to prevent the be cfelow of pollut -' ed water Into the potable wetter supply..Ony those cross-con- motions identified by local Inspection suttto !lee as non - health trezard shall be allowed the use of en eppvved double check valve assembly. Check with local authority having Jurisdiction meaning vertical orientation, frequency of testing or other ikon regUrernents. The valve shall meet the requirements of ASSE Std. 1015 and AWWA Std. 0610. Approved by the Foundation for Cross- Connection Control and HydraJlc Research at the University of Southern Csfdomia. Fulls • Ease of m8lntalance — only one cover • Top entry • Replaceable seats and seat discs • Moduttir construction • Compact design • Cast baonze body oonatructian -- >,4' — 2' (15 — SOmm) • Fused epoxy coated cast iron body — 21/2' — 3' (65 — Eternrn) • Top mounted bail valve test cocks • Low pressure drop • No °pedal tools required for servtdng • 1,4 —1' (15 — 25mm) have tee ha Specifications - A Double Check Valve Assembly shat be lnetaned et each noted location. The assembly shall consist of two positive seat- ing check modtiee with captured springs and rubber seat discs. The check module create and seat discs shall be replaceable. Service of all internal components shall be through • shgle accese cover secured whin stainless steel bone. The assembly still also Include two resilient seated Isolation valves; four top mounted, reagent seated test codas. The assent* shall meet the requirements of ASSE Std, 1016 and AWWA Std. 0510. Approved by the Foundation for Cross - Connection Control and t-lydratlic Research at the University of Southern California. Assembly shall be a Watts Series 007. REVISIO INCOMPLETE LTR# sot /zoo�l OUI TeoTueu3aw peaH ( 0oo71/311T r t ooftrliQT tic Test cocks Ms boldgedlbess d U6 anew vas at mart as coca= at as wake rar abeea * Ai mks sea sermeta OMNI Mist MlrMlEdniW Surma. Mb MIME MO ride to ChM Of mo6N pew two, arse tbl epelktates co meaenme wmf. • cot pie Naga ed d u1 'MAIM orb m sd) dime are monist ra mesh mete woke* sautes umb toff REVIEWED FOR COMPLIANCE MAR-z 2010 E$-007 cirvPAN.n MAR 1.91010 RMIT CENTER F1rst Check _ .......... . _....._ ... ..... Second check • • rMiodule Assembly Module Assembly The 007 Selleil textures a modular deelen concept which feoilhates complete rrUlntenw%ce and assembly by retaining the spring load. Nei Available ..W2ttts8ox.Insulated Enclosures: .For more Information; send for literature IMP II►I INII AVOURE WITH llMla8tt6 AIM /VIES FM LOCAL AipDuatioN rEQUIfeallS �am�n-rs' p6 09 - 127 21.Vg saZ aZb XV_d ss:Zl OLOZ /6L /EO • Goo /Roo Pi Pressure — Temperature 1b° • r (1 5 - 60rvtm) Temperature Range: 33 - 180°F (0.5'C - 62 Medmum Working Pressure: 176pei (12.1 bar). 2W - 3° (65 -13 mm) Temperature Range: 33'F -110 (0.6C - 43 °C) oontinucue, 140 (80°C) Inter ittent. Msodmum Waking Prissuie: 176pai (12.1 bar). Standards ASSE Std. 1015, AWWA Std. 0510 IAPMO PS31. CSA 884.5 Approvals ® (2e t ASSE AWWA, IAPMO, CSA. UPC A Approved by the Found:ton for 0088- 001nectlOn Cont and Hydradio Reeoerth et the University of Southern CaOforNs. • Models LF and S ere not listed. • UL Classified (LF models or 54' - 2' (20 - 5C nm) (except 007M34.F) • UL Ctasstfied with OSY gate valves (21/2' and 3' horl ontal only:) • Horizontal end verttoal 'flow up° approval on el suss Dimensions - Weights Models sigma vs° - r (16 - 60mm) lh Slat IC — Rf Manse Fittings dhnualm'A" . 23W (6941ml) A Surf : S • bronze strainer LF - without ef vies LH - locking handle bell valves (open position) SH - stainless steel bell valve handles HC - 2W k1Iet/outtet fire hydrant ftttlnge (2' valve) Prefix: U - UNon connections 2W - 3° 016 - OOmm) Suffix: MRS - non-rising stern resilient seated gate valves OSY - UUFM olAside stem and yoke fesllent seared gate Valves LF - without shutoff valves CT-FDA - FDA epoxy coated quarter-turn bell valves OUT Te3TUeU3 t 028H f:LUG cc?, G7,b Xv-1 GG:Z.L OL07. /RL /20 n. mm A h on it 6 no h C no 0 h mm R P me . 6 R mm A h ma t h mm ere. 1h tA00707 14 15 10 264 4% 117 21/2e 62 — — 5 127 915 85 24S• 69 214a 62 4,5 2 tA00714307 , 14 20 1116 282 4 102 315 79 — -- 8110 157 3'M 87 216 64 1941 39 6 2.3 1A007M10T 1 25 1314 337 5 130 4 102 — — 714 191 8% 85 1 43 1% 43 12 5.4 tA.0071120T 144 32 1846 416 5 127 34in 64 — — 915 241 5 127 3 78 2 50 15 8.4 1 116 40 1896 426 4 124 344 89 — — 814 248 5% 148 346• 79 2'I4 68 15.9 7.2 tL007611QT 2 50 1914 485 644 1 r, 4 102 — — WA 840 616 166 31/24. 87 2'Via 68 25.7 11.7 • 0070T•8 14 16 13 330 6 152 241 82 9 78 6 127 • 315 85 231. 59 2111 52 5.5 2.5 • 0071630T-5 h 20 1411 358 614 156 31 79 3 • 78 6941 157 9 87 2 54 154. 33 8.7 3.1 • 007h1107-3 1 25 17 157 714 197 4 102 344 69 714 191 345 85 1 43 P44. 43 14 6.4 • 007M20T-S 1'& 92 211 546 Tile 179 VAG 84 314 83 914 241 5 127 3 76 2 50 19 6.8 • 0071420S 1 40 25411 637 TA 179 311 89 31/2 95 814 248 5'341 148 314 79 2 68 19.6 8.9 • 00711110T -6 2 50 2714 692 844 222 4 102 4 102 1394 340 616 156 31/2e 87 2'141 68 33.5 15.2 • Goo /Roo Pi Pressure — Temperature 1b° • r (1 5 - 60rvtm) Temperature Range: 33 - 180°F (0.5'C - 62 Medmum Working Pressure: 176pei (12.1 bar). 2W - 3° (65 -13 mm) Temperature Range: 33'F -110 (0.6C - 43 °C) oontinucue, 140 (80°C) Inter ittent. Msodmum Waking Prissuie: 176pai (12.1 bar). Standards ASSE Std. 1015, AWWA Std. 0510 IAPMO PS31. CSA 884.5 Approvals ® (2e t ASSE AWWA, IAPMO, CSA. UPC A Approved by the Found:ton for 0088- 001nectlOn Cont and Hydradio Reeoerth et the University of Southern CaOforNs. • Models LF and S ere not listed. • UL Classified (LF models or 54' - 2' (20 - 5C nm) (except 007M34.F) • UL Ctasstfied with OSY gate valves (21/2' and 3' horl ontal only:) • Horizontal end verttoal 'flow up° approval on el suss Dimensions - Weights Models sigma vs° - r (16 - 60mm) lh Slat IC — Rf Manse Fittings dhnualm'A" . 23W (6941ml) A Surf : S • bronze strainer LF - without ef vies LH - locking handle bell valves (open position) SH - stainless steel bell valve handles HC - 2W k1Iet/outtet fire hydrant ftttlnge (2' valve) Prefix: U - UNon connections 2W - 3° 016 - OOmm) Suffix: MRS - non-rising stern resilient seated gate valves OSY - UUFM olAside stem and yoke fesllent seared gate Valves LF - without shutoff valves CT-FDA - FDA epoxy coated quarter-turn bell valves OUT Te3TUeU3 t 028H f:LUG cc?, G7,b Xv-1 GG:Z.L OL07. /RL /20 Dimensions - Weights 1i LJJ7Rf/0T Shim W — (15 -5 )um) Strainer 2% 65 10 254 61/2 165 26 19 3 60 10% 287 7 176 34 15 Models only 3U1 TOOTue1I381 peaH Eltg SSZ SZV XV. SS ZL 010Z/61/E0 IA. (I6j I I a as a A am h C am E. El 11 nee t n am td ea 13% 00719T-FDS 2% 85 3314 841 6% 162 81b 230 896 222 155 70 • 00741RS 214 65 391 841 936 298 Wm 230 8% 222 166 70. A• 007 -OSY 2% 65 3311 841 1614 416 9145 230 8'14 272 158 72 007- OT4Q4 3 80 34% 867 631 162 9 290 814 222 155 70 •• 0074 3 80 3414 687 1014 280 9'M 290 8% 222 186 84 • 007.08Y 9 60 34 867 18% 479 914. 230 8% 222 186 84 Dimensions - Weights 1i LJJ7Rf/0T Shim W — (15 -5 )um) Strainer 2% 65 10 254 61/2 165 26 19 3 60 10% 287 7 176 34 15 Models only 3U1 TOOTue1I381 peaH Eltg SSZ SZV XV. SS ZL 010Z/61/E0 IA. am a A fres 00070T 14 15 12Wi 326 DO07M2QT . 34 20 13% 350 0007M2QT 1 26 1634 422 0007M20T PA 32 2014 627 u007■20T 1 40 2114 546 =MOT 2 50 2414 622 Dimensions - Weights 1i LJJ7Rf/0T Shim W — (15 -5 )um) Strainer 2% 65 10 254 61/2 165 26 19 3 60 10% 287 7 176 34 15 Models only 3U1 TOOTue1I381 peaH Eltg SSZ SZV XV. SS ZL 010Z/61/E0 O O as CC ga rags ga cAIa ,;s .s Premark Qmp ; L. g b► a L d 7 art 51 00 8181 0L. 0 a 4 I o Y i t 1 0 0 ma Cs" is is caga gn is is Is 1 Plumes Cup ....s:. mi Praasie Del/ 81 2 i as MO SO i casu 2e Pleease Dreg k 6 !t C G g . a r a al 4 1 s . 00 8181 b 0 l a E N fCC ba g6 E a Insure aor i 1 I ma ea 1 0 0 ma JO Gm CCgm 681 181 SA Ve SE CA lg Ba Ma 9 Pnesu. gaip 0 p0..SrB I P1essvoe Drop TO: Joanna C OMP.AN Y; yAX NUMBER: (206) 431 -3665 puQNE NUMBER: RL Dr. Virk N /C Thank you, Terri HEAD MECHANICAL, INC 16653 160 PL SE RENTON, WA, 98058 OFFICE (425) 228 -0071 FAX (425) 255 -5413 FACSIMILE TRANSMITTAL SHEET PROM; Teri Head DATE: 3/19/10 TOTAL NO. OP PACES INCLUDING; COVER: 5 SENDER'S RRT'P.RENC:Jr NUMBER: YOUR R.'r'rRt NCE NUMBER; URGENT 0 FOR RRVTEW ❑ PLEASE COMMENT ❑ PLEASE REPLY ❑ PLEASE RECYCLE Joanna, Here are the specs for the Watts 007QT you requested for Dr. Virk's plan review. If you have any questions you can reach Jeff on his cell at (206) 730 -5178. CODECQ APP please contact DEC °P n {.; I , .For'He`a1th, Hazard Applications : Il 3 l I 1 Job Name Job Location Engineer Approval Series 009 Reduced Pressure Zone Assemblies Sizes: 1/4" - 3" (8 - 80mm) Series 009 Reduced Pressure Zone Assemblies are designed to protect potable water supplies in accordance with national plumbing codes and water authority requirements. This series can be used in a variety of installations, including the preven- tion of health hazard cross connections in piping systems or for containment at the service line entrance. This series features two in -line, independent check valves, captured springs and replaceable check seats with an inter- mediate relief valve. Its compact modular design facilitates easy maintenance and assembly access. Sizes 1 /4' -.1' (8 - 25mm) shutoffs have tee handles. Features • Single access cover and modular check construction for ease of maintenance • Top entry - all internals immediately accessible • Captured springs for safe maintenance • Internal relief valve for reduced installation clearances • Replaceable seats for economical repair • Bronze body construction for durability 1/4' - 2' (8 - 50mm) • Fused epoxy coated cast iron body 21/2" and 3° (65 and 80mm) • Ball valve test cocks — screwdriver slotted 1 /4' - 2' (8 - 50mm) • Large body passages provides low pressure drop • Compact, space saving design • No special tools required for servicing Specifications A Reduced Pressure Zone Assembly shall be installed at each potential health hazard location to prevent backflow due to backsiphonage and /or backpressure. The assembly shall consist of an internal pressure differential relief valve located in a zone between two positive seating check modules with captured springs and silicone seat discs. Seats and seat discs shall be replaceable In both check modules and the relief valve. There shall be no threads or screws in the water- way exposed to line fluids. Service of all internal components shall be through a single access cover secured with stainless steel bolts. The assembly shall also include two resilient seat- ed isolation valves, four resilient seated test cocks and an air gap drain fitting. The assembly shall meet the requirements of: USC Maaaa1..8 b.Editiont; ASSE Std. 1013; AWWA Std. REVIE®R. Shall be a Watts Regulator Co. Series 009. City of Tukwila BUILDING DIvISION FILE COPY royal status. Refer to Page 2 for approved GO' 127 Contractor Approval Contractor's P.O. No Representative ' /z" (15mm) 009QT Test Cock No 3 Ball Type Test Cocks Test Cock No 2 Flrst Check Module Assembly R.P. Zone 2" (50mm) 009M2QTHC Relief Valve Assembly Test Cock No. 4 Now Available WattsBox Insulated Enclosures. For more information, send for literature ES -WB. CORRECTION LTR #_L.- P609 ES -009 Second Check Module Assembly Water Outlet IMPORTANT INQUIRE WITH GOVERNING AUTHORITIES FOR LOCAL INSTALLATION REQUIREMENTS RECEIVED DEC 11009 PERMIT CENTER in U.S. customary reserves and metric are approximate change ei r m an y p e provided d e i for reference orals. For ca ion or measurements, sw ® Technical Service. Watts reserves the right to change a modify product design, construction, specifications, or materials with• v thout incurring any obligation to make such changes and modifications on Watts products previously or subsequently sold. TTS MODEL ' for 909, 009 end 993 sties DRAIN OUTLET M. mm In. , DIMENSIONS A mm In. B mm WEIGHT • lbs. Kgs. 909AG -A 1/4' -1/2" 009, 1/4 13 2% 60 34 79 .625 .28 W 009M2/M3 909AG -C W-1' 009/909, 1 . 25 3 83 4 7 ,A) 124 1.50 .68 1"-11/2" 009M2 909AG -F 1 " -2" 009M1, 2 51 4% 111 6 171 3.25 1.47 13/4" -3" 009/909, 2" 009M2, 4"-6" 993 '909AG;K } .- 4 " -6" 909, 3 76 6% 162 9% 243 6.25 2.83 8 " - 10" 909M1 909AG -M :- ' 8 " - 10" 909 4 102 7 3 % 187 113/4 394 15.50 7.03 909EL -A 3/4" -'W 009, 009M2/1413 - - - - - - - - 909EL -C i k:, : . 3/4"-1" 009/909. - - 2% 60 2% 60 .38 .17 " 909EL -F 11/4' -2" 009M1, t - 3% ' 92 3% 92 2 .91 1 " -2" 009/909, 2" 0f19M7. 4 "6" 993 • 909EL -H 2W -3" 009/909 - - - - - - - - Vertical Available Models: 1/4" - 2" (8 - 50mm) Suffix: QT - quarter -turn ball valves S - bronze strainer LF - without shutoff valves AQT - elbow fittings for 360° rotation 3/4° - 2' (20 - 50mm) only PC - internal Polymer Coating LH - locking handle ball valves (open position) SH - stainless steel ball valve handles HC - 21' Inlet /outlet fire hydrant fitting (2' valve) Prefix: C - clean and check strainer 3 /4' - 1' (20 - 25mm) only U - union connections (see ES-U009) Available Models: 2 - 3" (65 - 80mm) Suffix: NRS - non - rising stem resilient seated gate valves OSY - UL/FM outside stem and yoke resilient seated gate valves S -FDA - FDA epoxy coated strainer QT-FDA - FDA epoxy coated quarter -turn ball valve shutoffs LF - without shutoff valves S - cast iron strainer Note: The Installation of a drain line Is recommended. When Installing a drain line, an air gap is necessary (see ES -AG). Materials: 1 /4" - 2" (8 - 50mm) Bronze body construction, silicone rubber disc material in the first and second check plus the relief valve. Replaceable polymer check seats for first and second checks. Removable stainless steel relief valve seat. Stainless steel cover bolts. Standardly furnished with NPT body connections. For option- al bronze union inlet and outlet connections, specify prefix U (1/2" - 2 "(15 - 50mm)). Series 009QT furnished with quarter turn, full port, resilient seated, bronze ball valve shutoffs. Air Gaps and Elbows A . SIZE (DN) ' I in. mm In. , • • 'I III A mm 1 I fn. B mm , , ii In, ;DIMENSIONS C mm (APPROX.) ; I. D In mm I ln. L mm I II• : STRAINER DIMENSIONS M la mm N In. mm WEIGHT, lbs. kg.s 1 /4 8 10 250 4% 117 3% 86 11/4 32 51 140 2% 60 21/2 64 5 2 3 10 10 250 4% 117 3% 86 1'A 32 51/2 140 2% 60 21/2 64 5 2 1/2 15 10 250 4% 117 3% 86 11/4 32 51/2 •140 2 70 2'A 57 5 2 3 20 10% 273 5 127 31/2 89 11/2 38 6% 171 31/26 81 2% 70 6 3 1 25 16 425 51/2 140 3 76 21/2 64 91/2 241 3% 95 3 76 12 5 1' 32 17% 441 6 150 31 89 21/2 64 11% 289 41/26 113 31/2 89 15 6 11/2 40 17 454 6 150 31 89 21/2 64 111/2 283 41/2 124 4 102 16 7 2 50 21% 543 7% 197 41/2 114 31/4 83 13 343 5 151 5 127 30 13 MDDEL ; :SIZE DPI , - 1 A In. mm M FI C In. mm . ? , I ' . ` in. 1 1DIMENSIONS(APPRDXI) D mm E in. mm 1 • I .II In. R mm WEIGHT Ibs, kgs. I ! : I Y . 3'/2 845 1 7 / 403 4'r 114 16%2 1. 4 IFA2 � 1 2• I . 1 I • • r • BW M 'Ei' � 'c 460 IM B ! 1 1 0090T 21/2 65 33'/4 845 41 114 16% 416 18 460 7% 197 10% 270 150 68.0 009LF 3 60 — — ® 4'1 114 — — 18'6 460 — — 10% 270 76 34.5 1• 1I •1 KIIIVIMPAIMISTMITEll � 1 1 t _YifL ■ r 1 ''r r 11 1 5 22 r�r ''2. l 460 ' ' 3 e 222 11 5 L 1 27! I 98 :9.: ... '1'LR 009QT 3 80 341/4 870 7 178 41/2 114 16%2 422 181/2 460 8 222 10% 270 158 71.7 Dimensions and Weight: 1/4" - 2" (8 - 50mm) 009 T N Suffix HC – Fire Hydrant Fittings dimension 'A' = 25' (637mm) 009 '14" – 2" Dimensions and Weight: 2 and 3" (65 and 80mm) 009 DIMENSIONS (approx.) 3 80 10 257 7 178 10 254 34 15.4 tClearance for servicing Watts G -4000 Series QT – Ball Valves Capacity Performance as established by an Independent testing laboratory. *Typical maximum system flow rate (7.5 feet/sec., 2.3 meters /sec.) kPa psi 138 20 117 17 96 14 76 1 55 8 35 5 AP O kPa psl 138 20 117 17 96 14 76 11 55 8 35 5 AP kPa psi 172 25 138 20 103 15 69 10 35 5 AP kPa psi 207 30 165 24 124 18 83 12 41 6 0 0 02 AP 07.6 kPa psl 207 30 172 25 138 20 103 15 69 10 35 5 0 0 0 0 ES- 009 0830 '/" (8mm) 009QT .25 .60 .75 .95 1.9 2.9 3 8 4.5 Ipm 3/4" (10mm) 009QT .75 1.25 1.50 2.5 3. gpm .95 1.9 2.9 3 8 4.8 5.7 9.4 11.8 Ipm .25 .50 W' ( *5mm) 009QT 1 2.5 5 7.5 10 3.8 9 5 19 28.5 38 5 7.5 1.5 2.3 ,s/4" (20mm) 009M3QT 12.5 15 gpm 47.5 57 Ipm 15 4.8 mps 1111 ■ ■1• ■11 ■■11 ■ ■ ■■ 1111111■ ■■ ■ •■ ■ ••11 ■■■ •■ ■■■■■■ ■■■ ■, •11■ ■ ■ ■11 ••■ ■ ■ ■ ■ ••■ ■•/i■ ■ •■ ■ •■11 ■ ■■ ■■■■■■■!J'i /■■ ■ ■ ■11 ■ ■I 1■■■■11f■!i■■■■■■■ ■ ' -.�Z. ■ ■••■ ■ ■ ■ ■ •• r1■ ■ ■■ ■111 ■1111 ■■1111 ■■ ■1111■■ ■11 ■■ ■■■ ■I 1 ■w■ ■ ■ ■ ■■ ■ ■11■ ■ ■ ■■ ■■■ •■ •11■■■ ■ ■ ■ ■ •■ ■ ■ ■ ■ ■ ■■ 1111 ■ ■ ■ ■1 ■ ■ ■■■11■■ ■■ •1111■ •1111 6 10 14 18 22 26 30 34 38 42 46 gpm 23 38 53 68 84 99 114 129 144 160 175 Ipm 7.5 15 fps 2.3 4.6 mps 1 "„(25mm) 009M2QT 60 70 80 5 10 20 30 40 50 19 38 76 114 152 190 228 268 304 7.5 15 2.3 4.6 WWATIS® A Watts Water Technologies Company 1.17 gpm . gpm fp mps kPa psl 172 25 138 20 103 15 69 10 35 5 0 0 AP0 kPa psl 207 30 172 25 138 20 103 15 69 10 35 5 0 0 AP kPa psi 207 30 172 25 138 20 103 15 69 10 35 5 0 0 kPa psi 172 25 138 20 103 15 69 10 35 5 0 0 AP O kPa psl 172 25 138 20 103 15 69 10 35 5 0 0 10 20 30 40 50 60 38 76 1 4 152 190 228 5 7.5 10 1.5 2.3 3.0 11/2" (4Omm) 009M2QT 10 20 30 40 50 60 70 80 90 100 110 120 gpm 38 76 114 152 190 228 266 304 342 380 418 456 Ipm 5 7.5 10 15 fps 1.5 2.3 3.0 4.6 mps 20 40 60 80 100 120 140 160 180 200 gpm AP 0 76 152 228 304 380 458 532 608 684 760 Ipm 5 7.5 10 , 15 fps 1.5 2.3 3.0 4.6 mps 21/2" (65mm) 009 25 50 75 05 10- 295 5 1.5 1W (32mm) 009M2QT 2" (50mm) 009M2QT 100 , 125 150 380 475 570 7.5 10 2.3 3.0 3" (80mm) 009 70 80 gpm 266 304 Ipm 15 fps 4.6 mps 175 200 225 250 •gpm 665 760 885 950 Ipm 15 Ips 4,6 ' mps 0 25 50 75 100 125 150 175 200 225 250 275 300 325 gpm AP 0 95 190 285 380 475 570 665 760 855 950 104511401235 Ipm 5 7.5 10 tps 1.5 2.3 3.0 mps •79001 -2000 CERTIFIED USA: 815 Chestnut St., No. Andover, MA 01845 -6098; www.watts.com Canada: 5435 North Service Rd., Burlington, ONT. L7L 5147; www.wattscanada.ca © 2009 Watts Waiting 1: Demo all flooring 2. 6'x8' tile walk off at entry 3. Carpet (J &J Commercial 6217 Concrete Jungle) at balance of floor 4. Paint Reception 1. Demo all flooring 2. Carpet (J&J) on floor 3. Wall covering on #2 walls and at center consul 4. New wall between reception and staff lounge with new door 5. Paint Kids Area 1. Demo all flooring 2. Carpet 3. Paint Checkout 1. Demo all flooring 2. Carpet 3. Wall covering on #2 walls 4: Paint HYG 1 & 2 1. Demo all flooring, and cabinets 2. Relocate plumbing and electrical from to 12:00 to foot of chair 3. Cap all plumbing not used 4. Add Tile at ops to extent of wall at left 5. Add carpet between HYG 1 & 2 and HYG 3 & 4 6. Paint HYG 3 & 4 N20 1. Update plumbing 2. No farther work DR. VIRK SOUTH CENTEIFe ml$ NO. Scope of work 1. Demo all flooring, and cabinets 2. Relocate plumbing and electrical from 12:00 to foot of chairs 3. Add Tile at ops to extent of wall at left 4. Add carpet between HYG 1 & 2 and HYG 3 & 4 5. Paint 6. Install new brushing station including plumbing FILE COPY Jeffery A. Head Owner 16653 160 PL SE Renton, WA. 98058 Office (425) 228 -0071 Fax (425) 255 -5413 a� Cell (206) 730 -5178 REVIEWED FOR CODE COMPLIANCE APPROVED DEC 2 9 2009 City of Tukwila BUILDING DIVI4IfN RECEIVED NOV 0 3 2009 TUKWILA PUBLIC WORKS RECEIVED CITY OF TUKWILA ? 9 /I ii ly PERM IT CENTER I('.\I,., (.'.r.' Residential & Commercial Plumbing & Heating Staff Entrance Closet 1. Paint Stair HYG5 &6 1. Demo flooring and cabinets 2. Relocate plumbing and electrical from 12:00 to foot of chairs Hallwayl Sterile 1. Demo flooring 2. Repair cutout of cabinet at right 3. Install tile 4. Paint 5. Alternate price for new p -lam counter tops 6. Alternate price to remove Leedal automatic water panel OP 1 Pano 1. DO NOT DEMO VINYL 2. Demo rest of flooring 1 Carpet 4. Paint 1. Demo flooring 2. Carpet on stairway to 2 floor 3. Paint 3. Add Tile at ops to extent of wall at Right 4. Paint 1. Demo Flooring 2. Repair cutout of cabinet at right 3. Install Carpet 4. Paint 1. Demo flooring, existing wall, X -ray roughin, and cabinets 2. Repair wall at opening 2 locations 3. New door at hallway 1 in existing frame 4. Add tile flooring 5. Alternate price to install new cabinet 6. Add nitrous in wall at head and foot of chair (2 locations) 7. Revise Plumbing and electrical to foot of chair 8. Revise Lighting 9. Paint 1. Demo flooring 2. Carpet 3. Paint 4. Power for new x -ray in addition to existing x -ray 1 1 H.\ 1 ) (' (E. \:\ (('. \l , ! .�( Jeffery A. Head Residential & Commercial Owner Plumbing & Heating 16653 160 PL SE Renton, WA. 98058 Office (425) 228 -0071 Fax (425) 255 -5413 Cell (206) 730 -5178 Mech Room OP2 1. No Work 1. Demo flooring, door, and wall at door 2. Install new wall between OP 1 and Storage 3. lnfill openings in upper hall wall 4. Install tile 5. Install new door & hardware 6. Alternate price to install new cabinet 7. Install nitrous at in wall at head and foot of chairs (2 locations) 8. Paint 1. New walls between OP2 and Storage 1 and Storage 2 2. DO NOT infill openings in upper hall wall it 3. Nitrous on left and right wall 4. Demo floor 5. Alternate price to Install carpet 6. Alternate price to Paint Storage 1 Storage 2 1. Demo flooring and wall at new door 2. New wall between Storage 2 and Storage 1 3. Alternate price for Oxygen in new wall 4. New door 5. Alternate price to install carpet 6. Alternate price to paint Hallway 2 RR1(E) 1. Demo flooring 2. Carpet 3. Paint 1. Paint 2. Restroom is not ADA Office 1. Demo flooring 2. Carpet 3. Paint Staff Lounge 1. Demo Flooring and cabinets 2. New wall between Staff Lounge and Reception 3. Outlet at TV screen between Staff Lounge and Office 4. Carpet 5. Paint t 11{;,\ I) h I lh;,( "i i \,\: I (', \:I „ 1 ', (' Jeffery A. Head Residential & Commercial Owner Plumbing & Heating 16653 160 PL SE Renton, WA. 98058 Office (425) 228 -0071 Fax (425) 255 -5413 Cell (206) 730 -5178 RR2 General 1. Remove and store fixtures 2. Demo flooring 3. Tile Flooring 4. Patch flooring 5. Install 32 "x36" mirror 6. Paint 7. Restroom is not ADA 1. Alternate price to install 2 look tile in existing grid 2. Allowance for balancing HVAC 111.,.\1) ;I.,4 ':I I.' \' ( (' I „ ( ( Jeffery A. Head Residential & Commercial Owner Plumbing & Heating 16653 160 PL SE Renton, WA. 98058 Office (425) 228 -0071 Fax (425) 255 -5413 Cell (206) 730 -5178 18' -10' 11'1'8-0' 0 1 0; 10 43'-0' a. 19' 1' 1st FLOOR PLAN —EXISTING RECEIVED NOV 0 3 'LUU9 TUKWILA PUBLIC WORKS FILE COPY Permit No 19'-0' w .II 9' 1' 17 -10' RECEIVED CITY OF TUKWILA OCT 2 9 2009 PERMIT CENTER 19' -3' { Jeffery A. Head Owner 16653 160 PL SE Renton, WA. 98058 Office (425) 228 -0071 Fax (425) 255 -5413 F&D Cell (206) 730 -5178 R CO i VIEWED FOR COMPLIANCE PROVED EEC 29 2009 'ICity of Tukwila II BUILDING DIVISION . GQ n 1 ) \ I(. \i,, Residential & Commercial Plumbing & Heating 1 - t L X W Jeffery A. Head Residential & Commercial Owner Plumbing & Heating 16653 160"' PL SE Renton, WA. 98058 Office (425) 228 -0071 Fax (425) 255 -5413 Cell (206) 730 -5178 LEGEND I = 1 EXISTING WALL X NEW PARTITION ALL PARTITIONS TO BE PARTITION TYPE 6, U.N.O. SEE PLAN AND DETAILS ��� //./ j/ / 1 NEW MILLWORK WALL WITH BLOCKING g PROVIDE BLOCKING FOR EQUIPMENT (E) EXISTING ELEMENT TO REMAIN 1 _ _ _ _ i EXISTING ELEMENT TO DEMOLISH KEY NOTES O PROVIDE ALTERNATE PRICING FOR NEW FACADE AT FRONT DESK O REFINISH WITH NEW SURFACE MATERIALS ON PARTITION WALLS O EXISTING RESTROOM TO REMAIN. VERIFY CODE REQUIREMENT IF NECESSARY O EXISTING MEDICAL GAS CLOSET TO REMAIN. VERIFY CODE REQUIREMENT IF NECESSARY 5 O REPAIR EXISTING CABINETS AS NECESSARY. PROVIDE AND INSTALL NEW COUNTER TOPS O NEW FLOOR MATERIALS AND PAINT /� TYPICAL THROUGHOUT (I ST 4 2ND FLOOR) L. / 1 DEMOLISH AS SHOWN C - . ) SITE VERIFY RELOCATED PLUMBING5 AND WIRINGS FOR DENTAL EQUIPMENTS LIGHT FIXTURES TO RELOCATE AS NECESSARY, TYP. O 9 PROVIDE ALTERNATE PRICING FOR THE CEIUNG REPAIR A5 NECESSARY, OR NEW CEILING THROUGHOUT. CD EXACT LOCATION OF EXISTING ELEMENTS TO BE VERIFIED ON SITE, TYP. re 5 I v I d & Pt (,po r T ?err 7 1 ofcewrap9, inc. interior d swv 570 Kttland Way Suva 101 IOtkland, W0. 98033 P: 425952-5393 F: 425-889.2725 SPACE Ni6ECT 6,TE MO/ SCALE NuibinIU 9N10'1108 emu 10 /4!3 6onz e ? 10 ClaAUtiddV 3ONVIld01OO 3000 }IO.03M31A3a i Er V.\ ,) ' [ H('1L \.\ \!. f.x(' Zd0- 13NIe1i0 N001o.0 Z 1 Jeffery A. Head Residential & Commercial Owner Plumbing & Heating 16653 160 PL SE Renton, WA. 98058 Office (425) 228 -0071 Fax (425) 255 -5413 Cell (206) 730 -5178 .11 .9 Z r _J 31106N0 H19INI4 13661060 919VM VIO.9 391136 3Sf136 606 NOI1VOO1 604 NOI1V001 ON19Wfnd ONt9NOld ONLL9IX3 DNU9IX3 AII63A A4I A - 13011Vd 9 XNI9 130f1Vd 9 XNI 639N3d810 63dVd 'dAl du '83A1349 TOY '93A13H9 TOV 3WOLINO 'N91NIi '131NOHO 318VM VI0.9 H3SN3d9lO 63dYd 93A13H9 'POY N340 319VM VIO.9 ONV N39636910 63dVd WYld 1M H8INI4 . Nrimoo 1V6nion619 ONIlSIX3 mg. z 1d0 13N18V3 N0010,0 Zl ava A-dvR ano NOLLV.S ONIHSf 88 tAl 2/1 11-.1 Fact Sheet: Discharging Dental Wastewater into the King County Sewer System FILE COPY King County Department of Natural Resources and Parks Industrial Waste Program How to meet King County regulations for dental wastewater discharged to county sewers King County Industrial Waste Mission Statement The mission of the Industrial Waste Program is to protect the environment, public health, biosolids quality, and King County's regional sewerage system. We work cooperatively with our customers as we regulate industrial dis- charges, provide technical assistance, and monitor the regional sewerage system. Introduction: In 1995, King County and the Seattle -King County Dental Society began working with dentists to achieve voluntary, proper disposal of wastes. In 2000, King County's Local Hazard- ous Waste Management Program in King County and the King County Industrial Waste Program (KCIW) began working with the Se- attle -King County Dental Society and others to identify a user - friendly process for all dental practices in the King County sewer service area to follow to ensure that they were in com- pliance with wastewater discharge limits. By the end of 2003, 97 percent of the dental practices in the county's sewer service area were in compliance with these regulations. The resulting significant reduction in silver and mercury concentrations in the county's biosolids serves as an ultimate measure of the effectiveness of these efforts. (See "King County Biosolids Recycling.") 130 Nickerson Street, Suite 200, Seattle, WA 98109 -1658 206 - 263 -3000 http: / /dnr.metrokc.gov /wlr /indwaste/ Topics overview: Introduction How to meet local dental wastewater discharge limits The routes to compliance King County Biosolids Recycling Regulatory information Best Management Practices What can dental practices expect during an inspection? A sample equipment and waste management log Additional resources Contact information PGO9- 127 Clean Water - A Sound Investment 1 How to meet local dental wastewater discharge limits m the routes to co pliance: Route 1: Use an approved amalgam separator and follow Best Management Practices (BMPs) To meet local wastewater discharge limits, the majority of King County general dentistry prac- tices that place or remove dental amalgam will need to install a King County approved amal- gam separator to remove metals including mercury and silver from their wastewater. Selecting amalgam separators: • Separators must be approved by King County, which publishes a list of approved amalgam separators. • Practices wishing to install amalgam separators that are not approved by King County must apply for dental wastewater discharge permits. Installing amalgam separators: • Separators should either be installed at each chair or in a central location that receives wastewater from all chairs (usually closer to the vacuum pump) where amalgam is removed or placed. • Separators must be maintained and wastes disposed of according to manufacturer's recommendations. • Dental practices must keep installation, maintenance, and disposal records on site for three years. (See pages 7 -8.) Estimated costs for approved amalgam separators: Costs include those of purchasing, installing, maintain- ing and removing amalgam wastes. Approved amalgam separators may range from $150 - 2000 purchase price; $200 - 500 for installation, and $200 - 700 annual maintenance including waste disposal. Disclaimer: Costs cited here are only estimates, with information subject to change. 2 Route 2: Dental practices in compliance with local dental wastewater discharge limits may apply for dental wastewater discharge permits and follow BMPs. A smaller number of practices may be able to demonstrate compliance without installing an approved amalgam separator and can choose to apply for a King County Dental Wastewater Discharge Permit in lieu of installing an approved amalgam separator. A discharge permit is needed to ensure that a dental practice meets local dental wastewater discharge limits on a consistent basis. KCIW may require a practice with a dental wastewater discharge permit to regularly collect and analyze wastewater samples. KCIW may also require annual reporting. The permitting route to compliance may apply to dental practices that do not regularly place or remove amalgams but may be able to meet the limits using BMPs only (e.g. pediatric dentists). Practices that have installed an amalgam separator that is not on the approved amalgam separator list maintained by King County, or that are utilizing another method of metals pretreatment must also obtain a permit. Costs for a dental wastewater discharge permit: The King County Dental Wastewater Discharge Authorization ranges from $705 - $1545, renewable every five years. (Per 2005 fee schedule.) Route 3: Follow BMPs and be inspection ready: Certain specialties and practices will not be required to install an amalgam separator or apply for a permit if they place or remove amalgam no more than three days each year or they limit their practice to one of the following specialties: • orthodontics • periodontics • oral and maxillofacial surgery • radiology • oral pathology or oral medicine • endodontic and prosthodontic practices that do not remove or place amalgam fillings as a service to their clients more than three days each year A small number of King County dental practices that place or remove little or no dental amalgam will not need to install a separator or apply for a permit to demonstrate compliance with the local dental wastewater discharge limits. In addition to following BMPs for amalgam wastes and used silver fixer, each practice that determines that it places or removes amalgam three days or less each year should be able to demonstrate this during an inspection. Practices should keep a record, including dates, of each procedure performed that involves placing or removing dental amalgam. ✓ 7 King County Biosolids Recycling For more than 30 years, King County has been turning wastewater solids into a product called biosolids. All of King County's biosolids are used beneficially in agriculture and for- estry or as an ingredient in compost for landscaping and gardening. Biosolids contain organic matter, as well as nitrogen, phospho- rus, potassium and other nutrients necessary for plant growth. This valuable soil amend- ment can be used to build soils, revegetate barren areas and fertilize crops. In order to be safely recycled, biosolids must meet stringent quality standards set by the U. S. Environmental Protection Agency. King County's Industrial Waste Program (KCIW) and the Local Hazardous Waste Manage- ment Program in King County work with industries, businesses and citizens to limit the amount of metals and organic contaminants entering the sewer system. Thanks to contin- ued efforts by local industries and businesses to meet source control requirements set by the county, biosolids contain only small amounts of metals and organic pollutants. For contact information see page 8. 3 egula o inf rm t� 1 What are the requirements for dental practices in King County? Dental practices that remove and or place amalgam must use approved amalgam man- agement practices and must install an amal- gam separator. (A small number of practices may choose to apply for a King County Dental Wastewater Discharge Permit.) Why do dental practices need to meet the dental wastewater discharge limits? Protecting water quality is a sound business investment. The region is committed to improv- ing its natural resources, including water. This means that businesses and regulators must work together to find better ways to manage waste. Regulations are designed to prevent busi- nesses from discharging substances that can degrade the wastewater treatment process, harm workers or facilities, or impact surface - water quality. All wastewater discharged by any business, located in the King County sewer service area, including dental practices, must adhere to regulations as described in King County Code —Title 28 (KCC) and Public Rule PUT 8 -13 (PR). Most commonly, dental practices need to address the amounts of mercury and silver they discharge to the sewer system. While this is only a portion of the mercury and other pollutants going into the environment, dental amalgam nonetheless is identifiable and con- trollable in the waste stream. What are the rules defining the wastewater discharge limits? King County limits for metals and their applica- bility to businesses in the sewer service area are cited in King County Code —Title 28 (http: // www.metrokc.gov /mkcc /CODE /index.htm #28) 4 and in King County Industrial Waste Local Dis- charge Limits at http: / /www.metrokc.gov /recelec /archives/ policies /put813pr.htm on the internet. If an industrial user discharges less than 5,000 gallons of wastewater per day, the industrial user must comply with local discharge limits for mer- cury of 0.2 parts per million (ppm) and for silver 3.0 ppm. For more details about our rules and regulations go to http:// dnr .metrokc.gov /wlr /indwaste.htm or call KCIW at 206 - 263 -3000 to have a copy of the regulations mailed. (See end of document for additional contact information.) County Code provides that businesses or indi- viduals who illegally discharge substances to the sewer system must pay for damages and may be fined. Names of businesses that are fined are published in a Seattle Times display ad titled "Companies Violate Pretreatment Standards." King County dentist and KICW inspector view the practice's amalgam separator. ✓ 1 Best mcina ement practices(BMPs) for dental practices in King County sewer service area. Whichever route to compliance is applicable to a particular dental practice, it is crucial that all practices follow BMPs for amalgam wastes and spent fixer used in X -ray processing. KCIW requires that all dental practices use BMPs as a means of limiting metal discharges into the sewerage system. 1. BMPs for amalgam wastes: • Keep amalgam out of sinks and never rinse amalgam waste down the drain. • Clean or replace chair -side traps on a regular schedule and properly dispose of amalgam waste. • Clean vacuum pump filters regularly, according to the manufacturer's recom- mendations, and properly dispose of amalgam waste. • Send amalgam wastes to a licensed TSDR (treatment, storage, disposal, or recycling facility. • Maintain all disposal records on site for three years. • King County expects all dental practices to apply BMPs for amalgam wastes on an ongoing basis. 2. BMPs for properly handling spent fixer used in X -ray processing: o Collect spent fixer and have it disposed of by a vendor who will recover the silver in it. (OR) • If practices prefer to treat the fixer on site and dispose of it down the drain, they must remove the silver by installing two chemical recovery cartridges (CRCs) in a series. Cartridges must be sized and maintained according to the manufacturer's recommendations. o Maintain all disposal or maintenance records on site for three years. o King.Countji expects all dental practices to apply. BMPs• to spent fixer on an on going basis. 3. BMPs for use of cuspidors: O Practices may discharge wastewater from cuspidors directly to the sanitary sewer without having to route then through the amalgam separator provided that: During placement or removal of amalgam, use suction device to evacuate waste and use cuspidor primarily as receptacle for patients when they rinse their mouths for refreshment. Maintain in -line filters in cuspidor and handle all dental wastes, including waste amalgam particles, according to current BMPs for Dental Office Wastewater. 5 What can .lental practices expect during an inspection? The compliance inspection process: Compliance inspections of all dental practices that discharge mercury into the King County sewerage system occur on an ongoing basis. Each year the county inspects a portion of dental practices in the sewer service area for compliance with its regulations and general compliance with federal, state and local haz- ardous waste regulations. Inspectors from KCIW, the Local Hazardous Waste Management Program in King County (LHWMP) and Public Health — Seattle & King County may inspect dental practices. Inspec- tors may schedule inspections with dental practices or may visit without prior notice. While KCIW and LHWMP each have their own criteria, the two agencies are combining their inspections into one session for ease of the dental practices. Since dental practices that are certified by the EnviroStars program have already demon- strated compliance with these regulations, they will not receive additional inspections. (See page 8 for additional EnviroStars information.) What can dental practices expect during an inspection? During inspections, which will normally last less than one half hour, the inspector: • Will look to see if the dental practice has ONE of the following: • an approved amalgam separator unit (ASU) properly installed (see Compliance Route 1, page 2), or • a valid wastewater discharge permit, (see Compliance Route 2, page 2), or • an exemption from the above require- ments (see Compliance Route 3, page 3). • Will check to see that X -ray fixer is properly managed. • Will check to see that other hazardous wastes such as scrap amalgam, lead foils, and certain disinfectants are being disposed of properly. 6 • Will check records such as: • receipts or other documentation for equipment maintenance, and, • solid and liquid hazardous waste removal records. • Will also answer any questions practices may have about maintaining compliance. Inspection follow -up: A typical follow -up to an inspection would include the inspector completing an inspection report and evaluating the dental practice for compli- ance. If the practice is in compliance there will be no further action. Minor Problems: If minor problems are noted during the inspec- tion, King County will follow -up to see if they have been corrected promptly. If so, there will be no further action. Major Problems: If the inspector noted major problems (e.g. no separator or permit in place when required) he or she will set up a compliance schedule for that dental practice. If the practice does not correct the problem within 30 days, King County will proceed using its Enforcement Response Plan. The goals of this plan are to: • Correct violations as soon as possible. • Treat all industrial dischargers equitably. • Eliminate any economic advantage to a business for not complying. • Recover costs caused by violations. More information about the Enforcement Re- sponse Plan is contained on the KCIW Web pages. See "Enforcement" or "Dental Office Waste." For additional information regarding compliance inspections, see contact information page eight. ' Suggested equipment and waste management log See example provided by the King County Industrial Waste program as a resource for dental practices on next page. Records should be kept three years, including receipts and manifests. Date Event or waste type Number or amount and units Vendor name Signature and title of dental practice employee Date Event or waste type Number or amount and units Vendor name Signature and title of dental practice employee Example 3/8/95 silver fixer 5 Gallons Safety Kleen Helen Delecroix/ Dental Assistant 3/8/95 Harvey's 2 Gallons Safety Kleen Helen Delee roix/ Dental Assistant 1/1/04 replace filter on ASU filter 1 ABC Dental Supply Helen Delecroix/ Dental Assistant 5/5/05 scrap amalgam/ lead foils 5 gallon bucket Enviroclean Dr. Young /Dentist Sample equipment and waste management log Example provided by the King County Industrial Waste program as a resource for dental practices. Records should be kept three years, including receipts and manifests. Additional resources for meeting the local dental practice wastewater discharge limits: KCIW's Dental Office Waste Web pages, http: / /dnr.metrokc.gov /wlr /indwaste /dentists.htm include: o a downloadable version of this fact sheet; o a downloadable Dental Practice Wastewater Discharge Permit Application and Guidelines and Instructions; ® the list "Amalgam Separators Approved by King County "; a comparison chart for King County approved amalgam separators, and links to information about companies that transport dental office waste to licensed TSDRs (treatment, storage, disposal, or recycling facilities); and, 3 information about the EnviroStars program, a service of the Local Hazardous Waste Management Program of King County that certifies businesses for their efforts in preventing pollution and reducing hazardous waste. To request mailed copies of this information. see contact information below. King County Biosolids Recycling: For more information see the program's Web pages at http:/ /dnr.metrokc.gov/WTD /biosolids/ or contact Technology Assessment and Resource Recovery by calling 206 - 684 -1255 or emailing roberta.king@metrokc.gov. March 2005 Printed on recycled paper 8 King County Department of Natural Resources and Parks Industrial Waste Program 130 Nickerson Street, Suite 200 Seattle, Washington 98109 -1658 206 - 263 -3000 206 - 263 -3001 FAX 5053dh.p65 King County's Wastewater Treatment Division protects public health and water quality by serving 18 cities, 16 sewer districts and more than 1.4 million residents in King, Snohomish and Pierce counties. Formerly called Metro, the regional utility now operated by King County has been preventing water pollution for nearly 40 years. This information is available in accessible formats for persons with disabilities upon request. Please call 206 - 263 -3000 or TTY relay service at 1- 800 - 833 -6388. March 18, 2010 Jeff Head 16653 160 PI SE Renton, WA 98058 RE: Letter of Incomplete Application # 1 to Revision #1 Plumbing/Gas Piping Permit Application PG09 -127 Dr. Virk — 505 Strander Bl Dear Mr. Head, • City of T 1 epartment of Community %Development Jack Pace, Director This letter is to inform you that your permit application received at the City of Tukwila Permit Center on March 17, 2009 is determined to be incomplete. Before your application can continue the plan review process the attached items from the following departments need to be addressed: Public Works Department: Joanna Spencer at 206 431 -2440 if you have any questions concerning the attached comments. Please address the comment above 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. 1 have enclosed one for your convenience. 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 the Permit Center at (206) 431 -3670. Sincerely, C Bill Rambo Permit Technician Enclosures File: PG09 -127 W:\Permit Center \Incomplete Letters\2009 \PG09 -127 Inc Ltr #1 to Rev # 1.DOC Jim Haggerton, Mayor 6300 Southcenter Boulevard, Suite #100 • Tukwila, Washington 98188 . Phone: 206 - 431 -3670 • Fax: 206 - 431 -3665 DATE: March 17, 2010 PROJECT: DR VIRK 505 Strander Blvd PERMIT NO: PG09 -127 (Revision #1 After Permit Issued) PLAN REVIEWER: Contact Joanna Spencer (206) 431 -2440 if you have any questions regarding the following comments. On your plan please specify manufacturer name and model number of the proposed backflow and submit backflow cut sheet. Please make sure the backflow is from the WA State Department of Health approved bacflow list. H: Joanna/PG09 -127c • • PUBLIC WORKS DEPARTMENT COMMENTS Terri, Dr. Virk Permit Revision REVISION NOIL ?GO9 127 This is what I understand we need to do to begin the revision process for Dr. Virk: • Take these two submittal packages to the permit desk at the City of Tukwila • Speak to a permit technician and see if there is a form they want you to complete and turn in with the two submittal packages. • I would have the existing permit file with you for reference • If there are questions that cannot be answered I have been working with Dave Larson in that department. He is very helpful • Call me if you still have questions. To clarify the changes we are requesting to make: • We are changing the storage room into a future OP • We are deleting the N20 on the south wall • We are relocating the 02 from the south wall to the west wall • We are adding a vacuum to the west wall • We are also adding a 1" double check valve into the main water supply in the staff lounge. RECEIVED MAR 17 2010 PERMIT CENTER December 1, 2009 Jeffery Head 16653 160 P1 SE Renton WA 98058 RE: CORRECTION LETTER #1 Plumbing /Gas Piping Permit Application Number PG09 -127 Dr. Virk — 505 Strander Bl Dear Mr. Head, This letter is to inform you of corrections that must be addressed before your plumbing/gas piping permit(s) 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. The Public Works Department has no comments at this time. Building Department: Dave Larson at 206 431 -3678 if you have 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) complete 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, ifer Marshall it Technician e File: PG09 -127 a City (I f •,2} S`�L.s ,, i��lY�. Tu 0 v o E Jim Haggerton, Mayor Department of Community Development W:\Permit Center\Correction Letters \2009\PG09 -127 Correction Letter #1.DOC Jack Pace, Director 6300 Southcenter Boulevard, Suite #100 m Tukwila, Washington 98188 ® Phone: 206 - 431 -3670 c Fax: 206 - 431 -3665 Building Division Review Memo Date: November 30, 2009 Project Name: Dr. Virk Permit #: PG09 -127 Plan Review: Dave Larson, Senior Plans Examiner Tukwila Building Division Dave Larson, Senior Plan 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 show on the plans all existing, new and relocated backflow prevention devices for both the tenant isolation and isolation for individual pieces of equipment. Existing devices, not altered, will need current certification. Should there be questions concerning the above requirements, contact the Building Division at 206 -431- 3670. No further comments at this time. DEPARTMENTS: Building D'vi ion s Public Works Complete Comments: TUES /THURS ROUTING: Building Please Route REVIEWER'S INITIALS: APPROVALS OR CORRECTIONS: Documents/routing slip.doc 2 -28 -02 PER ` 1TCt CgIa�y .i PLAN REVIEW /ROUTING SLIP ACTIVITY NUMBER: PG09 -127 PROJECT NAME: DR VIRK SITE ADDRESS: 505 STRANDER BL Original Plan Submittal Response to Correction Letter # DATE: 03/19/10 X Response to Incomplete Letter # 1 X Revision # 1 after Permit Issued Fire Prevention Structural DETERMINATION OF COMPLETENESS: (Tues., Thurs.) Incomplete ❑ n Planning Division n U Permit Coordinator U DUE DATE: 03/23/10 Not Applicable u Permit Center Use Only INCOMPLETE LETTER MAILED: LETTER OF COMPLETENESS MAILED: Departments determined incomplete: Bldg ❑ Fire ❑ Ping ❑ PW ❑ Staff Initials: Structural Review Required n No further Review Required ❑ DATE: DUE DATE: 04/20/10 Approved r Approved with Conditions n Not Approved (attach comments) u Notation: REVIEWER'S INITIALS: DATE: Permit Center Use Only CORRECTION LETTER MAILED: Departments issued corrections: Bldg ❑ Fire ❑ Ping ❑ PW ❑ Staff Initials: DATE: 03 -17 -10 ACTIVITY NUMBER: PG09 -127 PROJECT NAME: DR VIRK SITE ADDRESS: 505 STRANDER BL Original Plan Submittal Response to Incomplete Letter # Response to Correction Letter # _ X Revision # 1 After Permit Issued DEPARTMENTS: i din Div s' n P 1 `t i P>jblic orks DETERMINATION OF COMPLETENESS: (Tues., Thurs.) Complete TUES/THURS ROUTING: Please Route APPROVALS OR CORRECTIONS: Notation: Documents /routing slip.doc 2 -28 -02 • PE T PY PLAN REVIEW /ROUTING SLIP n Fire Prevention Structural Incomplete Structural Review Required tx1 u n Planning Division Permit Coordinator DUE DATE: 03-18 -10 Not Applicable Comments: Permit Center Use Only INCOMPLETE LETTER MAILED: 3 t 0 LETTER OF COMPLETENESS_ MAI,4.ED: PW Departments determined incomplete: Bldg El Fire ❑ Ping ❑ PW St Initials: n No further Review Required u REVIEWER'S INITIALS: DATE: DUE DATE: 04 -15 -10 1 n Approved 1 1 Approved with Conditions n Not Approved (attach comments) ❑ REVIEWER'S INITIALS: DATE: Permit Center Use Only CORRECTION LETTER MAILED: Departments issued corrections: Bldg ❑ Fire ❑ Ping ❑ PW ❑ Staff Initials: ACTIVITY NUMBER: PG09 -127 PROJECT NAME: DR VIRK SITE ADDRESS: 505 STRANDER BL Original Plan Submittal X Response to Correction Letter # 1 DATE: 12 -10 -09 Response to Incomplete Letter # Revision # After Permit Issued DEPARTMENTS: 1)1_ Atjc tik Building Division Public Works tE PLAN REVIEW /ROUTING SLIP Fire Prevention Structural DETERMINATION OF COMPLETENESS: (Tues., Thurs.) Complete 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 gl Structural Review Required ❑ No further Review Required REVIEWER'S INITIALS: DATE: APPROVALS OR CORRECTIONS: Documents /routing slip.doc 2 -28 -02 Incomplete Y Planning Division ❑ Permit Coordinator DUE DATE: 12-15 -09 Not Applicable n DUE DATE: 01 -12 -10 Approved n Approved with Conditions ❑ Not Approved (attach comments) n Notation: REVIEWER'S INITIALS: DATE: Permit Center Use Only CORRECTION LETTER MAILED: Departments issued corrections: Bldg ❑ Fire ❑ Ping ❑ PW ❑ Staff Initials: o PE 0 Y T PLAN REVIEW /ROUTING SLIP ACTIVITY NUMBER: PG09 -127 PROJECT NAME: DR VIRK SITE ADDRESS: 505 STRANDER BL X Original Plan Submittal Response to Correction Letter # DATE: 10 -29 -09 Response to Incomplete Letter # Revision # After Permit Issued DE • ARTMENTS: _ g +I 6 is7on Pu blic c W r s Fire Prevention Structural Planning Division Permit Coordinator DETERMINATION OF COMPLETENESS: (Tues., Thurs.) DUE DATE: 11-03-09 Complete Incomplete 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 Structural Review Required ❑ No further Review Required REVIEWER'S INITIALS: DATE: Documents /routing slip.doc 2 -28 -02 u DUE DATE: 12 -01 -09 APPROVALS OR CORRECTIONS: Approved 1 1 Approved with Conditions Notation: REVIEWER'S INITIALS: DATE: Not Approved (attach comments) lk Permit Center Use Only CORRECTION LETTER MAILED: ii Departments issued corrections: (BI g Fire ❑ Ping ❑ PW ❑ Staff Initials: X210 � t 01 REVISION NO. DATE RECEIVED STAFF INITIALS STAFF INIT , • S ISSUED DATE STAFF INIT S l 3 —% —10 m * F' , 3`( , '. Summ. of Revision: ► �. i . ,� . �, � b, , . 7 ;, r2 op ; D z r r kvgi• , . � ; 1 Ake (. t uAlie , Received by: y REVISION NO. DATE RECEIVED STAFF INITIALS ISSUED DATE STAFF INITIALS Summary of Revision: Received by: REVISION NO. DATE RECEIVED STAFF INITIALS ISSUED DATE STAFF INITIALS Summary of Revision: Received by: REVISION NO. DATE RECEIVED STAFF INITIALS ISSUED DATE STAFF INITIALS Summary of Revision: Received by: REVISION NO. DATE RECEIVED STAFF INITIALS ISSUED DATE STAFF INITIALS Summary of Revision: Received by: REVISION NO. DATE RECEIVED STAFF INITIALS ISSUED DATE STAFF INITIALS Summary of Revision: Received b : PROJECT NAME: 1)( _ SITE ADDRESS: • REVISION LOG PERMIT NO: V G Qq- ORIGINAL ISSUE DATE: k -140 (please print) (please print) (please print) (please print) • City of Tukwila \applications \fonns - applications on Iine\revision submittal Created: 8 -13 -2004 Revised: 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.tulcwila.wa.us Revision submittals must be submitted in person at the Permit Center. Revisions will not be accepted through the mail, fax, etc. Date: .5I 1,9 1 ZO i 0 [r Response to Incomplete Letter # ;� El Response to Correction Letter # CITY C � ❑ Revision # after Permit is Issued MAR 1 9 2010 ❑ Revision requested by a City Building Inspector or Plans Examiner PERMIT CENTER Project Name: IN V 1 R Project Address: _505 I!J I Contact Person: ))24frl Phone Number: � 4ZS- 77E-0o - 71 Summary of Revision: P- 'i 1 (;t�wt, I C.44-6 Plan Check/Permit Number: 0 PG 09 - 127 Sheet Number(s): "Cloud" or highlight all areas of revision including date of revision Received at the City of Tukwila Permit Center by: AV' Entered in Permits Plus on o9Atei 1 6� Revision submittals must be submitted in person at the Permit Center. Revisions will not be accepted through the mail, fax, etc. Plan Check/Permit Number: P6 l ! ' / 2- Date: 3 // 7//0 • 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 ❑ Response to Incomplete Letter # ❑ Response to Correction Letter # Revision # 1 after Permit is Issued ❑ Revision requested by a City Building Inspector or Plans Examiner Project Name: b(. ,11 r K 1 Project Address: SQ C ;Sfra 'f - K 1/0 Contact Person: T'e F r r /- .- r Phone Number: 2-0 Co • 7 36 - cl Summary of Revision: S .eJ2 Kite d Sheet Number(s): "Cloud" or highlight all areas of revision including date of revision Received at the City of Tukwila Permit Center by: K - Entered in Permits Plus on 7-1, 0 \applications \forms- applications on Iine\revision submittal Created: 8 -13 -2004 Revised: REr CmOFTV MAR ,1.7 2010 P ERMIT C , Revision submittals must be submitted in person at the Permit Center. Revisions will not be accepted through the mail, fax, etc. Date: 1 j q ❑ 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: �r �i l'l( �»5 Project Address: ,SOS ST r kr Ill „� Contact Person: ec Phone Number: (7oC�72D -SL) 8 Summary of Revision: I — 2057 l /00c.) /a/ r � �i�� / l ij �s�la r1 ,t Sheet Number(s): "Cloud" or highlight all areas of revision including date of revision Received at the City of Tukwila Permit Center by: Entered in Permits Plus on • City of Tukwila \applications \forms- applications on line\revision submittal Created: 8 -13 -2004 Revised: Department of Community Development 6300 Southcenter Boulevard, Suite #100 Tukwila, Washington 98188 Phone: 206 - 431 -3670 Fax: 206 - 431 -3665 Web site: http://www.citukwila.wa.us Plan ChecWPermit Number: /a // %7 RECEIVED CITY IDEC X1:0 2009 PERmir TEA Bond Company Policy Effective Expiration Cancel Impaired Bond Amount Received Insurance Name Number Date Date Date Date Amount Date UNITED 1 SPECIALTY INSURANCE FE1S5100047008 /12/200908/12/2010 $1,000,000.0009 /23/2009 CO Bond Bond Company Name Bond Account Number Effective Date Expiration Date Cancel Date Impaired Date Bond Amount Received Date 1 ULLICO CASUALTY COMPANY SB009000837 09/23/2009 Until Cancelled 2/6/2009 EXPIRED $6,000.00 09/23/2009 License Name Type Specialty 1 Specialty 2 Effective Date Expiration Date Status APTMEMI952CB APT MECHANICAL INC CONSTRUCTION CONTRACTOR GENERAL UNUSED 2/2/2005 2/6/2009 EXPIRED Name Role Effective Date Expiration Date HEAD, JEFFREY ALLAN PRESIDENT 09/23/2009 Untitled Page General /Specialty Contractor A business registered as a construction contractor with Lai 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 HEAD MECHANICAL INC 2067305178 16653 160TH PL SE RENTON WA 98058 KING Corporation UBI No. Status License No. 602944908 ACTIVE HEADMMI912O3 License Type CONSTRUCTION CONTRACTOR Effective Date 9/23/2009 Expiration Date 9/23/2011 Suspend Date Specialty 1 PLUMBING Specialty 2 UNUSED Other Associated Licenses Business Owner Information Bond Information Insurance Information • https://fortres.wa.gov/lni/bbip/Detail.aspx • Page 1 of 1 01/07/2010 STERILE(E) PANO E) MECH. RM E AFF NTRAN 111 ' l 11 11i- -'--11 La,€o 0 1:4 40 4 1e .2: +s� • � 12�A Vawu ' t.34 u aa?�..r s - --- = a� �o� n ,p r vN Neal o i s rctita = 02- ' to (...ert :asp'\ t &Q 12_.? $a'i t A 5: 44/1 ∎ ►a Maser fv✓` `` L 3 - m MAIN ENTRANCE City Of Tukwila BUILDING DIVISION REVISIONS No changes shall be made to the scope of work without prior approval of Tukwila Building Division. SOTE Revisions will require a new plan submit &I ancj ma +y inc'ude additional plan review fe . REVIEWED FOR CODE COMPLIANCE APPROV ED DEC 2 9 2(09 'h L 144 , F, City of Tulwlla BUILDING DIVISION ILE COP ft ?‘0 12 7 Per Flan review : pp s is subject to errors and omission Approval of ' *n t' on documents does not authorize 'he violation •f a : adopted code or ordinance. Receipt ..,. ". p 1 ' F E acknowledged;