HomeMy WebLinkAboutPermit PG10-145 - UHSUHS
3225 S 116 ST
PG1O-145
City ofrukwila
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
Parcel No.: 0923049066
Address: 3225 S 116 ST TUKW
Project Name: UHS
PLUMBING /GAS PIPING PERMIT
Permit Number: PG10 -145
Issue Date: 11/04/2010
Permit Expires On: 05/03/2011
Owner:
Name: RRTEEF AMERICA REIT II
Address: PO BOX 4900 #207 , SCOTTSDALE AZ 85261
Contact Person:
Name: VERNON HUBER
Address: 3702 WEST VALLEY HY N #200 , AUBURN WA 98001
Email: VRHUBER @COMCAST.NET
Contractor:
Name: HUBER'S PLUMBING CO
Address: 3702 WEST VALLEY HWY #2 , AUBURN WA 98001
Contractor License No: HUBERP *042M2
Phone: 206 - 510 -3069
Phone: 253 839 -7876
Expiration Date: 07/17/2012
DESCRIPTION OF WORK:
ADD (1) MOP SINK, (1) FLOOR SINK, (1) CLOTHES WASHER SITE. MOVE RESTROOM HOT
WATER TANK AND MOVE BREAKROOM SINK
Value of Plumbing /Gas Piping: $13,000.00 Uniform Plumbing Code Edition: 2009
Fees Collected: $244.13 International Fuel Gas Code Edition: 2009
Permit Center Authorized Signature:
Date: ` LA -10
I hereby certify that I have read and examined'this permit and know the same to be true and correct. All provisions of law and ordinances
governing this work will be complied with, whether specified herein or not.
The granting of this permit does not presume to give authority to violate or cancel the provisions of any other state or local laws regulating
construction or the performance of woj1 7I thorized to sign and obtain this plumbing /gas piping permit.
Signature: ' - Date:
Print Name: /X/ ZZ:Z/X'
This permit shall become null and void if the work is not commenced within 180 days from the date of issuance, or if the work is suspended
or abandoned for a period of 180 days from the last inspection.
doc: UPC -4/10
PG 10 -145 Printed: 11 -04 -2010
Parcel No.:
Address:
Suite No:
Tenant:
•
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
0923049066
3225 S 116 ST TUKW
UHS
PERMIT CONDITIONS
Permit Number:
Status:
Applied Date:
Issue Date:
PG 10 -145
ISSUED
10/18/2010
11/04/2010
1: ** *PLUMBING AND GAS PIPING * **
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: All new plumbing fixtures installed in new construction and all remodeling involving replacement of plumbing fixtures
and fittings in all residential, hotel, motel, school, industrial, commercial use or other occupancies that use
significant quantities of water shall comply with Washington States Water Efficiency and Conservation Standards in
accordance with RCW 19.27.170 and the 2006 Uniform Plumbing Code Section 402 of Washington State Amendments.
13: 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.
* *continued on next page **
doc: Cond -10/06
PG 10 -145 Printed: 11 -04 -2010
City of Tukwila
Department of Community Development
6300 Southcenter Boulevard, Suite #100
Tukwila, Washington 98188
Phone: 206 - 431 -3670
Fax: 206 - 431 -3665
Web site: http: / /www.ci.tukwila.wa.us
I hereby certify that I have read these conditions and will comply with them as outlined. All provisions of law and 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.
Signature:
Print Name:
Z/;
doc: Cond -10/06
PG 10 -145 Printed: 11 -04 -2010
CITY OF TUKWILA
Community Development Department
Permit Center
6300 SouthcenterBlvd., Suite 100
Tukwila, WA 98188
htto://www.ci.tukwila.wa.us
Plumbing/Gas Permit No 7& 1,
Project No.
(For office use only)
PLUMBING / GAS PIPING PERMIT APPLICATION
Applications and plans must be complete in order to be accepted for plan review.
Applications will not be accepted through the mail or by fax.
* *Please Print **
SITE LOCATION
King Co Assessor's Tax No.: 0923049066
Site Address: 3225 S 116th st.
Tenant Name:
UHS
Suite Number: 109
Property Owners Name: RREEF America
Mailing Address: P.O. Box 4900 #207
New Tenant:
Scottsdale
City
Floor:
m Yes ❑ .. No
AZ 85261
State Zip
CONTACT PERSON - Who do we contact when your permit is ready to be issued
Name: Vernon R Huber
Day Telephone: (206) 510 -3069
Mailing Address:
City
State
Zip
E -Mail Address: Fax Number:
PLUMBING / GAS PIPING CONTRACTOR INFORMATION
Company Name: Huber's Plumbing Co.
Mailing Address: 3702 West Valley Hwy.N #200
Contact Person: Vemon Huber
E -Mail Address: vrhuber @comcast.net
Contractor Registration Number: HuberP*042M2
Aubum
City
Day Telephone:
WA
State
(206) 510 -3069
98001
Zip
Fax Number: (253) 833 -5148
Expiration Date:
ARCI{ITECT OF RECORD - All plans must be stamped by Architect of Record
Company Name:
Mailing Address:
Contact Person:
E -Mail Address:
City
Day Telephone:
Fax Number:
State
Zip
ENGINEER OF RECORD - All plans must be stamped by Engineer of Record
Company Name:
Mailing Address:
Contact Person:
E -Mail Address:
City
Day Telephone:
Fax Number:
State
Zip
HA Applications On Line \2010 Applications \7 -2010 - Plumbing -Gas Piping Permit Application.doc
Revised: 7 -2010
bh
Page 1 of 2
Valuation of Project (contractor's bid pr. $ 13,000.00
Scope of Work (please provide detailed information): Add 1 mop sink 1 floor sink 1 clothes washer site. Move restroom hid
move breakroom sink
Building Use (per Int'l Building Code):
Occupancy (per Int'l Building Code):
Utility Purveyor: Water: Sewer:
Indicate type of plumbing fixtures and/or gas piping outlets being installed and the quantity below:
Fixture Type:
Qty
Fixture Type:
Qty
Fixture Type:
Qty
Fixture Type:
Qty
Bathtub or combination
bath/shower
Bidet
Clothes washer, domestic
1
Dental unit, cuspidor
Dishwasher, domestic,
with independent drain
Drinking fountain or
water cooler (per head)
Food -waste grinder,
commercial
Floor Drain
Shower, single head trap
Lavatory
Wash fountain
Receptor, indirect waste
Sinks
2
Urinals
Water Closet
Building sewer and each
trailer park sewer
Rain water system — per
drain (inside building)
Water heater and/or vent
2
Industrial waste treatment
interceptor, including trap
and vent, except for kitchen
type grease interceptors
Each grease trap
(connected to not more
than 4 fixtures - <750
gallon capacity)
Grease interceptor for
commercial kitchen ( >750
gallon capacity)
Repair or alteration of
water piping and/or water
treatment equipment
Repair or alteration of
drainage or vent piping
Medical gas piping
system serving 1 -5
inlets/outlets for a
specific gas
Each additional medical
gas inlets /outlets greater
than 5
Backflow protective
device other than
atmospheric -type vacuum
breakers 2 inch (51 mm)
diameter or smaller
Backflow protective device
other than atmospheric -type
vacuum breakers over 2
inch (51 mm) diameter
1.11
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)
1.0
Atmospheric-type
vacuum breakers not
included in lawn
sprinkler backflow
protections over 5
Gas piping outlets
PERMIT APPLICATION NOTES -
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 TH STATE OF WASHINGTON, AND I AM AUTHORIZED TO APPLY FOR THIS PERMIT.
BUILDING OWNER ORj O '
Signature:
Date: 10/18/10
Print Name: emon Huber Day Telephone: 206/510/3069
Mailing Address:
3702 west valley hwy n #200
City
aubum wa 98001
State Zip
Date Application Accepted: / i 1 ,- l � (Q Date Application Expires:
H:\Applications\Forms- Applications On Line\2010 Applications \7 -2010 - Plumbing -Gas Piping Permit Application.doc
Revised: 7 -2010
bh
Staff Initials:
Page 2 of 2
•
City of Tukwila
Department of Community Development
6300 Southcenter Boulevard, Suite #100
Tukwila, Washington 98188
Phone: 206-431-3670
Fax: 206 - 431 -3665
Web site: http: / /www.ci.tukwila.wa.us
Parcel No.: 0923049066
Address: 3225 S 116 ST TUKW
Suite No:
Applicant: UHS
RECEIPT
Permit Number: PG10 -145
Status: APPROVED
Applied Date: 10/18/2010
Issue Date:
Receipt No.: R10 -02235
Payment Amount: $195.30
Initials: WER Payment Date: 11/04/2010 11:23 AM
User ID: 1655 Balance: $0.00
Payee: HUBER'S PLUMBING CO
TRANSACTION LIST:
Type Method Descriptio Amount
Payment Check 30955 195.30
Authorization No.
ACCOUNT ITEM LIST:
Description
Account Code Current Pmts
PLUMBING - NONRES
000.322.103.00.00 195.30
Total: $195.30
doc: Receiot -06 Printed: 11 -04 -2010
City of Tukwila
�Z Department of Community Development
6300 Southcenter Boulevard, Suite #100
Tukwila, Washington 98188
Phone: 206 - 431 -3670
Fax: 206 - 431 -3665
Web site: http://www.ci.tukwila.wa.us
RECEIPT
•
Parcel No.: 0923049066 Permit Number: PG10 -145
Address: 3225 S 116 ST TUKW Status: PENDING
Suite No: Applied Date: 10/18/2010
Applicant: UHS Issue Date:
Receipt No.: R10 -02097
Initials: TLS
User ID: 1670
Payment Amount: $48.83
Payment Date: 10/18/2010 01:16 PM
Balance: $195.30
Payee: VERNON HUBER / HUBERS PLUMBING HEATING
TRANSACTION LIST:
Type Method Descriptio Amount
Payment Credit Crd VISA
Authorization No. 037934
ACCOUNT ITEM LIST:
Description
48.83
Account Code Current Pmts
PLAN CHECK - NONRES
000.345.830 48.83
Total: $48.83
doc: Receipt -06 Printed: 10 -18 -2010
INSPECT ON N0.
INSPECTION RECORD
Retain a copy with permit
PERMIT NO.
CITY OF TUKWILA BUILDING DIVISION
6300 Southcenter Blvd., #100, Tukwila. WA 98188 (206) 431 -3670
Permit Inspection Request Line (206) 431 -2451
DiA
Project:
2-; •/5
Type of Inspection:
/ - /A/44
Address:
,3.2 2- 5 S //
6 5-r
Date Called:
Special Instructions:
Date Wanted: ...
/ /
m,
\P,W
Requester:
Phone No:
.2.66 -55/0
-36
6
9
I J Approved per applicable codes. Corrections required prior to approval.
COMMENTS:
661a /,rie
ctor:
Date:
/-- .? ' ✓�
. Tlhe m
aid INSPEC at 6300 Southcenter ION FEE R�QUIRED. Blvd.. Suite rior 100. to next Call to schedule inspection. reinspectiofe ust be n.
INSPECTION NO.
INSPECTION RECORD
Retain a copy with permit
p6tO -/45
PERMIT NO.
CITY OF TUKWILA BUILDING DIVISION I -, \1
6300 Southcenter Blvd., #100, Tukwila. WA 98188 (206) 431 -367b
Permit Inspection Request Line (206) 431 -2451
Project: t.t.
Type,of Inspection: ____
Address:
3 2.25
Tl∎
---
• 11 .----Sr---
Date Called:
Special Instructions:
j
Date Wanted: ,. a.m.:
1 (-- (C--('° p.m.
Requester:
Phone 6 _C Co 9
(fO o
Approved per applicable codes. ❑ Corrections required prior to approval. Y.
COMMENTS:
A-f?"`"-A
g s' o J t1- -AW %o
Inspector:
AA_ -Nr p
Date: 1 r
n REINSPECTION FEE REQUIRED. rior to next inspection, fee must be
paid at 6300 Southcenter Blvd., Suite 100. Call to schedule reinspection.
F( /0 -(1
I ► S.PECTION RECORD
Retain a copy with permit
INS t N NO. PERMIT NO.
CITY OF TUKWILA BUILDING DIVISION
6300 Southcenter Blvd., #100, Tukwila. WA 98188
Permit Inspection Request Line (206) 431 -2451
(206) 431 -3670
Project:
Type of Inspection: , r %/
Address:
VS 5, I(‘
ST
Date Called:
Special Instructions:
Date Wanted: m
—Ec — /C7 P.m.
Requester:
Phone No:
�UG, '.g(o —3v65-
proved per applicable codes.
Corrections required prior to approval.
COMMENTS:
Inspect
EINS
pai
CTION FEE REQUIRED. P for tgfnext inspection, fee must be
at 6300 Southcenter Blvd., Sue 104. Call to schedule reinspection.
INSPECTION RECORD
Retain a copy with permit
INSPECTION NO. PERMIT NO.,
CITY OF TUKWILA BUILDING DIVISION (
6300 Southcenter Blvd., #100, Tukwila. WA 98188 (206) 431 -3670
Permit Inspection Request Line (206) 431 -2451
Project 14 s
Type of Inspection: R
C,re..)(J4.6 WOC
Date Called:
ZA ess:
25 S ((6-7-,
Special Instructions: 3 �� �'
(/"ca• t U `
Z` 5 , Bet _---m-76 6
.l
Date Wanted: I_ p
Requester:
Phone No:
EjApproved per applicable codes. El Corrections required prior to approval. /6
COMMENTS:
-
/}
e.
s.,', c4 Al p{
)P
a
r An 1'1 1/4,1-el)
Date: 0 s- _to
n REINSPECTION FEE REQUIRED. Prior to next inspection. fee must be
paid at 6300 Southcenter Blvd.. Suite 100. Call to schedule reinspection.
A
City of Tu ;', ''lla
•
Jim Haggerton, Mayor
Department of Community Developme Jack Pace, Director
October 20, 2010
Vernon Huber
Huber's Plumbing Co
3702 West Valley Hy N #200
Auburn, WA 98001 -
RE: Letter of Incomplete Application # 1
Plumbing /Gas Piping Permit Application PG10 -145
UHS — 3225 S 116 St
Dear Mr. Huber,
This letter is to inform you that your permit application received at the City of Tukwila Permit Center on
October 18, 2010 is determined to be incomplete. Before your application can continue the plan review
process the attached /following items from the following department(s) need(s) to be addressed:
Public Works Department: Dave McPherson at 206 431 -2448 if you have any questions
concerning the following comment.
1) Please complete the enclosed Non - Residential Sewer Use form.
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. I 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,
Bill Rambo
Permit Technician
Enclosures
File: PG10 -145
W:\Permit Center \Incomplete Letters\2010\PG10 -145 Incomplete Ltr # 1.DOC
6300 Southcenter Boulevard, Suite #100 • Tukwila, Washington 98188 • Phone: 206 - 431 -3670 • Fax: 206 - 431 -3665
NOW t;
PLAN REVIEW /ROUTING SLIP
ACTIVITY NUMBER: PG10 -145 DATE: 10 -25 -10
PROJECT NAME: UHS
SITE ADDRESS: 3225 S 116 ST
Original Plan Submittal X Response to Incomplete Letter # 1
Response to Correction Letter # Revision # After Permit Issued
DEPARTM NTS:
uildin
(vision
ublic orks
ID
VD.M
Fire Prevention
Structural
n
n
Planning Division
Permit Coordinator
1
DETERMINATION OF COMPLETENESS: (Tues., Thurs.) DUE DATE: 1 0-26-10
Complete 14 Incomplete ❑
Comments:
Not Applicable
Permit Center Use Only
INCOMPLETE LETTER MAILED:
Departments determined incomplete: Bldg ❑ Fire ❑ Ping ❑ PW ❑ Staff Initials:
LETTER OF COMPLETENESS MAILED:
TUES/THURS ROUTING:
Please Route Structural Review Required No further Review Required n
REVIEWER'S INITIALS: DATE:
APPROVALS OR CORRECTIONS:
Approved ❑ Approved with Conditions
Notation:
REVIEWER'S INITIALS:
DUE DATE: 11 -23 -10
Not Approved (attach comments) n
DATE:
Permit Center Use Only
CORRECTION LETTER MAILED:
Departments issued corrections: Bldg ❑ Fire ❑ Ping ❑ PW ❑ Staff Initials:
Documents/routing slip.doc
2 -28-02
• ?F IT WORD COPIA
PLAN REVIEW /ROUTING SLIP
ACTIVITY NUMBER: PG10 -145 DATE: 10/18/10
PROJECT NAME: UHS
SITE ADDRESS: 3225 S 116 ST
X Original Plan Submittal
Response to Correction Letter #
Response to Incomplete Letter #
Revision # after Permit Issued
DEPARTMENTS:
Building pivisiori ■
lic o ks!" ` 4`O
Fire Prevention
Structural
Planning Division
nPermit Coordinator ❑
DETERMINATION OF COMPLETENESS: (Tues., Thurs.) DUE DATE: 10/19/10
Complete n
Comments:
Incomplete k
Not Applicable
Permit Center Use Only
INCOMPLETE LETTER MAILED: 6 () )-0 1t
, 0
Departments determined incomplete: Bldg ❑
LETTER OF COMPLETENESS MAILED:
Fire ❑ Ping ❑ PW Staff Initials:
TUES/THURS ROUTING:
Building
Please Route ❑ Structural Review Required n No further Review Required n
REVIEWER'S INITIALS:
DATE:
APPROVALS OR CORRECTIONS:
Approved n Approved with Conditions ❑ Not Approved (attach comments) ❑
Notation:
REVIEWER'S INITIALS:
DUE DATE: 11/16/10
DATE:
Permit Center Use Only
CORRECTION LETTER MAILED:
Departments issued corrections: Bldg ❑ Fire ❑ Ping ❑ PW ❑ Staff Initials:
Documents/routing slip.doc
2 -28 -02
•
City of Tukwila
Steven M. Mullet, Mayor
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
REVISION SUBMITTAL
Steve Lancaster, Director
Revision submittals must be submitted in person at the Permit Center. Revisions will not be accepted through
the mail, fax, etc.
Date: /03/ o
Plan Check/Permit Number: PG 10 -145
• Response to Incomplete Letter # 1
❑ Response to Correction Letter #
❑ Revision # after Permit is Issued
❑ Revision requested by a City Building Inspector or Plans Examiner
Project Name: UHS
Project Address: 3225 S 116 St
Contact Person: de/0/74 1J R
Summary of Revision:
Phone Number: .2/71‘-‘/ -30
/%74F5/,4
74 air/4,744 477'
3
S 74, •G'Z,e9h4j . %o/ %5 .2 %'/ /�,(s G /s✓j. s 741e
/f4tai9 14,4"0-4/A
RECEIVED
CITV OF TUKWILA
OCT 2 5 201
PERMIT CENTER
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 0'1 -5"1i 0
\applications \forms - applications on line \revision submittal
Created: 8 -13 -2004
Revised:
La King county
Department of Natural Resources and Parks
Wastewater Treatment Division
N ®n- Residential
Sewer Use Certification
• To be completed for all new sewer connections, reconnections or
change of use of existing connections.
• This form does not apply to repairs or replacements of existing
sewer connections within five years of disconnect.
Please Print or Type
a s ro /A(s7'
Property Street Address
Oida
City
t G
Owner's Name
lab
State
ZIP
Subdivision Name (<a'1 7/9/ AF'/!,r
Subdiv. #
Building Name / eL ,p(.2
Lot #
Block # /67
(if applicable)
Owner's Phone Number (with Area Code)
Property Contact Phone Number (with Area Code)
Owner's Mailing Address
For King County Use Only
Account #
No. of RCEs
Monthly Rate
Property Tax ID #
Party to be Billed (if different from owner)
City or Sewer District
Date of Connection
Side Sewer Permit #
Please report any demolitions of pre - existing building on this property.
Credit for a demolition may be given under some circumstances.
Demolition of pre - existing building? ❑ Yes ❑ No
Was building on Sanitary Sewer? ❑ Yes ❑ No
Was Sewer connected before 2/1/90? ❑ Yes ❑ No
Sewer disconnect date:
Type of building demolished?
Request to apply demolition credit to multiple buildings? ❑ Yes ❑ No
CORRECTION
LTR# 1
A. Fixture Units
Fixture Units x Number of Fixtures = Total Fixture Units
Kind of Fixture
Fixture Units
No. of Fixtures
Total
Fixture Units
Public
Private
Public
Private
Bathtub and Shower
4
4
Shower, per head
2
2
Dishwasher
2
2
Drinking fountain (each head)
1
.5
Hose bibb (interior)
2.5
2.5
Clotheswasher or laundry tub
4
2
a,
Sink, bar or lavatory
2
1
Sink, Clinic flushing
8
8
4
Sink, kitchen
3
2
Sink, other (service)
3
1.5
(
Sink, wash fountain, circle spray
4
3
Urinal, flush valve, 1 GPF
5
2
Urinal, flush valve, >1 GPF
6
2
Urinal, waterless
0
0
Water closet, tank or valve, 1.6 GPF
6
3
Water closet, tank or valve, >1.6 GPF
8
4
Total Fixture Units
Residential Customer Equivalent (RCE)
20 fixture units equal 1.0 RCE
Total No. of Fixture Units _
20
,9b
RCE
B. Other Wastewater Flow
(in addition to Fixture Units identified in Section A)
Type of Facility /Process:
CL tali ij ih-SP f / /Cr)/
C.
Estimated Wastewater Discharge:
/6 ' V L 3
Gallons /days
Residential Customer Equivalents (RCE):
187 gallons per day equals 1.0 RCE
Total Discharge (gal /day) =
187
Total Residential Customer Equit;
(add A & B) anf OFTUK.4).1.
T. 2.5, 2010
RCE
RCE
PERM l MITER
Pc-710 Ns-
Pursuant to King County Code 28.84, all sewer customers who establish a new service which uses metropolitan sewage facilities shall be subject to a capacity charge.
The amount of the charge is established annually by the King County Council at a rate per month per residential customer or residential customer equivalent for a
period of fifteen years. The purpose of the charge is to recover costs of providing sewage treatment capacity for new sewer customers. All future billings can be
prepaid at a discounted amount. All future billings can be prepaid at a discounted amount.
Questions regarding the capacity charge or this form should be referred to King County's Wastewater Treatment Division at 206-684-1740.
I certify that the information given is correct. I understand that the capacity charge levied will be based on this information and any
deviation will require resubmission of corrected data for dele tnation of a revised capacity charge.
/iX440/1 4
Signature of Owner /Representative
Print Name of Owner /Representative
1058 (Rev. 9/07)
Date /OS
White - Kina County Yellow - Local Sewer Aaencv Pink - Sewer Customer
Contractors or Tradespeople Pr. ter Friendly Page
General /Specialty Contractor
A business registered as a construction contractor with L &I to perform construction work within the scope of
its specialty. A General or Specialty construction Contractor must maintain a surety bond or assignment of
account and carry general liability insurance.
Business and Licensing Information
Name HUBER'S PLUMBING CO UBI No. 601725669
Phone 2538397876 Status Active
Address 3702 West Valley Hwy. North #2 License No. HUBERP *042M2
Suite /Apt. License Type Construction Contractor
City Auburn Effective Date 7/22/1996
State WA Expiration Date 7/17/2012
Zip 98001 Suspend Date
County King Specialty 1 Plumbing
Business Type Individual Specialty 2 Unused
Parent Company
Other Associated Licenses
License
Name
Type
Specialty
1
Specialty
2
Effective
Date
Expiration
Date
Status
HUBERP*232L7
HUBERS
PLUMBING CO
Construction
Contractor
Plumbing
Unused
6/27/1977
5/27/1997
Archived
Business Owner Information
Name
Role
Effective Date
Expiration Date
HUBER, VERNON R JR
Owner
07/22/1996
Bond Information
Page 1 of 2
Bond
Bond Company Name
Bond Account Number
Effective Date
Expiration Date
Cancel Date
Impaired Date
Bond Amount
Received Date
5
PLATTE RIVER INS CO
41152474
05/06/2010
Until Cancelled
$6,000.0005/26/2010
03/19/2010
4
Great American Ins.
Co.
2875327
05/06/2009
Until Cancelled
05/08/2010
$6,000.0004/21/2009
3
FEDERATED MUTUAL
INS CO
9335611
09/13/2007
Until Cancelled
05/06/2009
$6,000.0009/10/2007
04/21/2009
2
AM STATES INS
EX948812
06/25/2002
Until Cancelled
09/13/2007
$6,000.0006/14/2002
Assignment of Savings Information No records found for the previous 6 year period
Insurance Information
Insurance
Company Name
Policy Number
Effective Date
Expiration Date
Cancel Date
Impaired Date
Amount
Received Date
13
OHIO CAS INS
CO
BRO(11)
53856312
03/30/2010
03/30/2011
$1,000,000.00
03/19/2010
LIBERTY
12
NORTHWEST
BR01053856312
03/30/2009
03/30/2010
$1,000,000.00
04/21/2009
INS CORP
11
FEDERATED
MUTUAL INS CO
9434729
06/14/2008
06/14/2009
04/23/2009
$1,000,000.00
05/12/2008
10
FEDERATED
MUTUAL INS CO
5077100
06/14/2007
06/14/2008
$1,000,000.00
06/29/2007
9
AMERICAN
SAFETY
01TSRGL0750
07/20/2006
07/20/2007
$1,000,000.0007
/20/2006
INDEMNITY
00
HARTFORD
8
CASUALTY INS
52SBALU1219
07/20/2000
07/20/2006
$1,000,000.00
06/20/2005
CO
Summons /Complaint Information
https://fortress.wa.gov/lni/bbip/Print.aspx
11/04/2010
40 /2
REVISIONS
No changes shall be made to the scope
of work without prior approval of
Tukwila Building Division.
NOTE: Revisions will require a new plan :.ubm'ttei
std malj ihc:ude adr!itional R4 = n n er ►i 4•a fens. I
SEPAR : PEZtiT
REQUIRED FOR:
Mechanical
Electrical
Pluming
pt Gas PiPing
City of Tukwila
BUILDING DIVISION
REVIEWED FOR Y.
CODE COMPLIANCE
APPRMED
Nuv 03 2uii
City of1jjcwila
BUILDING nn►lcinry
FILE COPY
pointtho, Pcito -Nc
Plan reviewepprovaf is subject to woe and onlisoions.
Approval of construdion documents does not authorize
the violation of any adopted code or off. Receipt
of append Cow end isadmowiedged
BY ''°"'
City Of AdcwIla
BUILDING DIVISION
RECEIVED_
CITY OF TUKKWILA
OCT 182010
PRMIT CENTER
3 G°
LA
\-#W1L-1.
ti
REVIEWED FOR
CODE COMPLIANCE
A PpRnVED
it..,/ 06 2011 City of Tukwila
BUILDING DIVISIQN
RECEIVED
CITY OF 111KWILA
OCT 18 2010
PERMIT CENTER