HomeMy WebLinkAboutPermit PG11-013 - GENOA HEALTHCAREGENOA HEALTHCARE
18300 CASCADE AV
PG1 1 -013
Parcel No.:
Address:
City oKukwila
•
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
7888900175
18300 CASCADE AV TUKW
Project Name: GENOA HEALTHCARE
Permit Number:
Issue Date:
Permit Expires On:
PG11 -013
02/15/2011
08/14/2011
Owner:
Name:
Address:
Contact Person:
Name:
Address:
Email:
Contractor:
Name:
Address:
Contractor
RIVERPOINT TWO LLC
1100 OLIVE WAY #1005 , SEATTLE WA 98101
ADI SMAJIC
12219 SE 65 ST , BELLEVUE WA 98188
SMAJICCONSTRUCTION @GMAIL. COM
PETE THE PLUMBER INC
826 S 200 ST , DES MOINES WA 98198
License No: PETEPPI91409
Phone: 206 419 -8090
Phone: 206 -715 -5908
Expiration Date: 09/29/2011
DESCRIPTION OF WORK:
INSTALL KITCHEN SINK - BRING HOT AND COLD AS WELL AS WATER AND DRAIN.
Value of Plumbing /Gas Piping:
Fees Collected:
Electricity Provider:
$700.00
$120.75
Permit Center Authorized Signature
I hereby certify that I have read anct
governing this work will be complic
v
Uniform Plumbing Code Edition: 2009
International Fuel Gas Code Edition: 2009
Date: r l L i
exan \ined this permit and know the same to be true and correct. All provisions of law and ordinances
El wit , 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 ance of work. I am authorized to sign and obtain this plumbing /gas piping permit and agree to the conditions
on the back of this pe
Signature:
Date:
Print Name: ( C
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
PG11 -013
Printed: 02 -15 -2011
• •
PERMIT CONDITIONS
Permit No. PG11-013
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: 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.
doc: UPC -4/10
PG11-013 Printed: 02 -15 -2011
CITY OF TUKWIdli
Community Developm7fit Department
. Permit Center
6300 Southcenter Blvd., Suite 100
Tukwila, WA 98188
http://www.ci.tukwila.wa.us
Plumbing/Gas 1rermit No. CJ
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
y King Co Assessor's Tax No.:1 s$ p1D`�' Ot T C
Site Address: iG( o0 C45c 41, 5 - TAWiyj Vief Suite Number: Floor:
Tenant Name: G- oo T- P- 4LTCA -
Property Owners Name: Col
Mailing Address: 4 77 Oo kV`+.. 5
New Tenant:
Yes
la. No
City
State
gAider
Zip
CONTACT PERSON — Who do we contact when your permit is ready to be issued
Name: ,Q,- (
Mailing Address: /22. 19 SF \st..<4— ' (/ 'F
f c- Day Telephone:
2 496 4(q log 0
City
E -Mail Address: S +4 � I CC of% 51p (%C to L L Fax Number:
State Zip
PLUMBING / GAS PIPING CONTRACTOR INFORMATION
Company Name: r14 tr. 4-L plumb - i ino° -
Mailing Address: , .(4, So dOO SI-
Contact Person: !'� I E e� vow eiS +�-�
E -Mail Address: t:1- ~ � .rot nLA vi b er 0 e p10 a s 4, et t...1.-
Contractor Registration Number: O� iaP i 914109
'Des 111 o ;n aLs
City
�J 8-►9
State Zip
Day Telephone: i' 1 S' A
Fax Number: vz07 P-1 . 10512--
Expiration Date: Jot„ 2
ARCHITECT OF RECORD – All plans must be stamped by Architect of Record
Company Name:
� C H UELL -ER
4Ss- oc/A -r -6S
Mailing Address: fl' '
Contact Person: P41- v L
25-0 S -ail
E -Mail Address:
City
Day Telephone:
Fax Number:
State Zip
2553
ENGINEER OF RECORD – All plans must be stamped by Engineer of Record
Company Name:
Mailing Address:
A„ City
Contact Person: Day Telephone:
E -Mail Address: Fax Number:
State
Zip
H:\Applications\Forms- Applications On Line \2010 Applications \7 -2010 - Plumbing -Gas Piping Permit Application doc
Revised: 7 -2010
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Page 1 of 2
Valuation of Project (contractor's bid pritai$ loo
•
Scope of Work (please provide detailed informatio. ):
tiJS")-ALL Slj� (K i-rc �� 3.1ziR.9cr trcoT , CO L0 `d`'`4 c5' 41,4 t1ly
Building Use (per Int'1 Building Code):
Occupancy (per Int'1 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
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 I S 1 ,-✓(
"y
/ `
Urinals
Water Closet
Building sewer and each
trailer park sewer
Rain water system — per
drain (inside building)
Water heater and /or vent
Industrial waste treatment
interceptor, including trap
and vent, except for kitchen
type grease interceptors
Each grease trap
(connected to not more
than 4 fixtures - <750
gallon capacity)
Grease interceptor for
commercial kitchen ( >750
gallon capacity)
Repair or alteration of
water piping and/or water
treatment equipment
Repair or alteration of
drainage or vent piping
Medical gas piping
system serving 1 -5
inlets/outlets for a
specific gas
Each additional medical
gas inlets /outlets greater
than 5
Backflow protective
device other than
atmospheric -type vacuum
breakers 2 inch (51 mm)
diameter or smaller
Backflow protective device
other than atmospheric -type
vacuum breakers over 2
inch (51 mm) diameter
Each lawn sprinkler
system on any one meter
including backflow
protection devices
Atmospheric -type vacuum
breakers not included in
lawn sprinkler backflow
protections (1 -5)
Atmospheric -type
vacuum breakers not
included in lawn
sprinkler backflow
protections over 5
Gas piping outlets
PERMIT APPLICATION NOTES -
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 0 ' AU HOOD AGENT:
Signature:
Print Name:
Mailing Address:
Date Application Accepted:
Day Telephone:
L vu
City
Date: 1i/ 77/1
C20) i19 .cfe97-0
Ntfilv WOO
Zip
State
Date Application Expires:
Staff Initials:
H: ApplicationssTorms- Applications On Line12010 Applications17 -2010 - Plumbing -Gas Piping Permit Application.doc
Revised, 7 -2010
bh
0 •
C 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.: 7888900175
Address: 18300 CASCADE AV TUKW
Suite No:
Applicant: GENOA HEALTHCARE
RECEIPT
Permit Number: PG11 -013
Status: PENDING
Applied Date: 01/19/2011
Issue Date:
Receipt No.: R11 -00103
Initials:
User ID:
Payee:
JEM
1165
Payment Amount: $120.75
Payment Date: 01/19/2011 10:32 AM
Balance: $0.00
ADNAN SMAJIC, SMAJIC CONSTRUCTION
TRANSACTION LIST:
Type Method Descriptio Amount
Payment Credit Crd VISA
Authorization No. 04639G
ACCOUNT ITEM LIST:
Description
120.75
Account Code Current Pmts
PLAN CHECK - NONRES
PLUMBING - NONRES
000.345.830 24.15
000.322.103.00.00 96.60
Total: $120.75
doc: Receiot -06 Printed: 01 -19 -2011
AA
INSPECTION RECORD
Retain a copy with permit
pp/
INSPECTIO.N NO. PERMIT NO.
CITY OF TUKWILA BUILDING DIVISION
6300 Southcenter Blvd., #100, Tukwila. WA 98188 x.(206) 431 -3670
Permit Inspection Request Line (206) 431-2451'
Proje A
b. ('..N 11 A
} r
i-LA f i
-- I4r ('
Type of Inspe ti n:
!y �id6 •e
•�
, r,
r6/�/+ •
Address: •
p
Date Called:
Speciaflnsiructions:
•
.
Date Wanted.
'
,`>
_�' ��
4�:m
p.m•
Requester:
Phone No:
Approved per applicable codes.
Corrections required prior•to approval. ••- zr
COMMENTS:
perAfr 6,411w
r.
i
•
Dat 7 r
REINS EC ION REQ IRED. Prior to next.inspection, fee must be::
paid at 6300 Southcenter Blvd.. Suite 100. Call to schedule reinspection..
•
•
'
.
INSPECTION NO.
INSPECTION RECORD
.Retain a copy with permit
Ga`-‘
P611- 013
PERMIT NO.
CITY OF TUKWILA BUILDING DIVISION 112.—
'• 6300 Southcenter Blvd., #100, Tukwila. WA 98188 (206) 431-3670
Permit Inspection Request Line (206) 431-2451
project:
A/0,1- hit,A ictA 6-44-L,..
Type .of Inspection:
.figoo‘
..,\ Pia.ht
Address:
1 VOD 644LAIAL,
Date Called:
Special Instructions:
Date Want,
—
. 1/ p.m.
Requester: .
24) (2 •—.1
Phone No:
Approved per applicable codes.
Corrections required prior to approval.
ri
COMMENTS:
P"
TPe
re Sa_ Lite
lInspeetor:
rate:,—b •
-p /(
REINSPECTION FEE REQUIRED/ Prior to next inspection, fee 'must be
4---1 paid at.6300 Southcenter Blvd.. Suite 100. Call to schedule reinspedion,
•••••
% Jim Haggerton, Mayor
epartment of Community I' evelopment Jack Pace, Director
January 26, 2011
Adi Smajic
12219 SE 65 St
Bellevue, WA 98188
RE: Correction Letter #1
Plumbing /Gas Piping Permit Application Number PG11 -013
Genoa Healthcare —18300 Cascade Av
Dear Mr. Smajic,
This letter is to inform you of corrections that must be addressed before your plumbing/gas piping permit
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 Public Works Department. At this time
the Building Department has no corrections.
Public Works Department: Joanna Spencer at 206 - 431 -2440 if you have any 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) 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 M. shall
lit Technician
c
File: PG11 -013
W:\Permit Center\Correction Letters \2011\PG11 -013 Correction Letter #1.DOC
6300 Southcenter Boulevard, Suite #100 • Tukwila, Washington 98188 • Phone: 206 - 431 -3670 • Fax: 206 - 431 -3665
• di
PUBLIC WORKS DEPARTMENT COMMENTS
DATE: January 21, 2011
PROJECT: Genoa Healthcare
18300 Cascade Ave
PERMIT NO: PG 11 -013
PLAN REVIEWER: Contact Joanna Spencer (206) 431 -2440 if you have any questions regarding the
following comments.
1) Due to the nature of the Genoa Healthcare business services (medical clinic /pharmacy), which is
considered a high hazard, a Reduced Pressure Principle Assembly (RPPA) shall be installed as a
backflow devise for cross - connection control for in- premise isolation to protect the other tenants
in the building from water cross - contamination. Please show location diagram of RPPA
installation and specify size, make and model number of the backflow. Please submit RPPA cut
sheet and circle the RPPA to be installed. Please install a floor drain or other means of drainage
outlet since the devise spits. Make sure that the backflow is from the WA State Department of
Health Backflow Prevention Assemblies Approved for Installation in Washington State list.
W:Other/Joanna /PG 11 -013
OtIERiNIT COORD COPS
PLAN REVIEW /ROUTING SLIP
ACTIVITY NUMBER: PG11 -013 DATE: 02/08/11
PROJECT NAME: GENOA HEALTHCARE
SITE ADDRESS: 18300 CASCADE AV
Original Plan Submittal
X Response to Correction Letter # 1
Response to Incomplete Letter #
Revision # after Permit Issued
DEPARTMENTS:
Building Divi ion
Public Works
Fire Prevention
Structural
Planning Division
❑ Permit Coordinator ❑
DETERMINATION OF COMPLETENESS: (Tues., Thurs.)
Complete
Comments:
Incomplete ❑
DUE DATE: 02/10/11
Not Applicable
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 ❑
REVIEWER'S INITIALS:
No further Review Required ❑
DATE:
APPROVALS OR CORRECTIONS:
Approved ❑ Approved with Conditions
Notation:
REVIEWER'S INITIALS:
DUE DATE: 03/10/11
Not Approved (attach comments) ❑
DATE:
Permit Center Use Only
CORRECTION LETTER MAILED:
Departments issued corrections: Bldg ❑ Fire ❑ Ping ❑ PW ❑ Staff Initials:
Documents/routing slip.doc
2 -28 -02
• PERMITCOgRD COPItik
PLAN REVIEW /ROUTING SLIP
ACTIVITY NUMBER: PG11 -013 DATE: 01/19/11
PROJECT NAME: GENOA HEALTHCARE
SITE ADDRESS: 18300 CASCADE AV
X Original Plan Submittal
Response to Correction Letter #
Response to Incomplete Letter #
Revision # after Permit Issued
ARTMENTS:I
�1 ing iivisio i
PLTIic or %
Fire Prevention
Structural
Planning Division
Permit Coordinator
DETERMINATION OF COMPLETENESS: (Tues., f hurs.)
Complete
Comments:
Incomplete
DUE DATE: 01/20/11
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
REVIEWER'S INITIALS:
Structural Review Required
No further Review Required
DATE:
APPROVALS OR CORRECTIONS:
Approved ❑ Approved with Conditions
Notation:
REVIEWER'S INITIALS:
DUE DATE: 02/17/11
Not Approved (attach comments)
DATE:
Permit Center Use Only
CORRECTION LETTER MAILED:
Departments issued corrections:
bAattC
Bldg ❑
Fire ❑ Ping ❑ PW Ipl
Documents/routing slip.doc
2 -28 -02
Staff Initials: AVIA-
• •
City of Tukwila
REVISION
SUBMITTAL
Department of Community Development
6300 Southcenter Boulevard, Suite #100
Tukwila, Washington 98188
Phone: 206 - 431 -3670
Web site: http: / /www.ci.tulnvila.wa. us
Revision submittals must be submitted in person at the Permit Center. Revisions will not be accepted through
the mail, fax, etc.
Date:o2 /Q8l20ff
Plan Check/Permit Number:
❑ Response to Incomplete Letter #
to Correction Letter # / C�N�.14
❑ Revision # after Permit is Issued FEB. 0 8 2011
❑ Revision requested by a City Building Inspector or Plans Examiner PERMIT CENTER
Project Name:
Project Address:
Gen a. /
/ 09c7 0/4-sc4i
Contact Person: c0Q44a4..i Pss4l,.f_�o/
napf 6,441 /cr slpVVpfr(c;64tNe.•e-
Summary of Revision:
Phone Number: 26.4/9'8090
Pe/ Pc() 71- lcilLe." taileioej4,24.1
65enc2&- Hee214 c .t = d l !ties 14
/`r.. 0i7.4.4. -+5e isoe4swal.a-t_
Sheet Number(s):
"Cloud" or highlight all areas of revision including date of revision
Received at the City of Tukwila Permit Center by:, kV/
Entered in Permits Plus on
H:Wpplications \Forms - Applications On Line \2010 Applications \7 -2010 - Revision Submittal.doc
Created: 8 -13 -2004
Revised. 7 -2010
w
Joanna Spencer - Genoa Healthcare
• Page l of l
From: Victor Breed
To: "j spencer @ci.tukwila.wa.us"
Date: 02/03/2011 7:11 PM
Subject: Genoa Healthcare
CC: Harpur Davidson
Joanna,
I was asked by our new landlord to provide you with an overview of our business. Genoa Healthcare operates
pharmacies, usually located inside of community mental health centers, in 25 states around the country. They
are "closed door" pharmacies serving only those patients being seen at the mental health center.
The space we will be occupying in Tukwila will be only for office /administrative personnel. This will include a
portion of our human resources department, our accounting team, central purchasing function (all deliveries go
directly to pharmacy locations) and the billing and collections functions.
1 hope this is the type of information you are looking for. Please let me know if I can provide any additional
information.
Regards,
Vic
Victor Breed
Chief Financial Officer
Genoa Healthcare
9725 SE 36th Street
Suite 304
Mercer Island, WA 98040
D — 425.679.5696
Disclosure - This email, including any attachments, is for the sole use of the intended recipient(s) and may contain confidential and /or privileged
information. Any view. use, disclosure or distribution of this email or the information contained in this email or any attachment that is not expressly
authorized by the sender is strictly prohibited. If you are not the intended recipient, please contact the sender by reply email and destroy all copies of
the original message.
n / 's ease C sGe;
1/14 - f /P.r) -t 6 , e. Ps e .@ ica._c ?'
JQ/rn Q
CITYISMA
FEB 0 8 2011
PERMIT C
CORRECTION
pin -o13
file: / /C: \Documents and Settings \joanna.TUKWILA \Local Settings \Temp\XPgrpwise \4D... 02/07/2011
Contractors or Tradespeople Per 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 PETE THE PLUMBER INC UBI No. 602956500
Phone 2067155908 Status Active
Address 826 S 200Th St License No. PETEPPI91409
Suite /Apt. License Type Construction Contractor
City Des Moines Effective Date 9/29/2009
State WA Expiration Date 9/29/2011
Zip 98198 Suspend Date
County King Specialty 1 Plumbing
Business Type Corporation Specialty 2 Unused
Parent Company
Business Owner Information
Name
Role
Effective Date
Expiration Date
VOWELS, PETE DUANE
Chief Executive Officer
09/29/2009
Bond Information
Page 1 of 1
Bond
Bond Company Name
Bond Account Number
Effective Date
Expiration Date
Cancel Date
Impaired Date
Bond Amount
Received Date
1
American Contractors
Indem CO
100098816
09/29/2009
Until Cancelled
$6,000.00
09/29/2009
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
2
WESTERN
HERITAGE INS
CO
SCP0823165
09/29/2010
09/29/2011
$1,000,000.00
09/27/2010
1
WESTERN
HERITAGE INS
CO
SCP0765879
09/29/2009
09/29/2010
$1,000,000.0009
/29/2009
Summons /Complaint Information No unsatisfied complaints on file within prior 6 year period
Warrant Information No unsatisfied warrants on file within prior 6 year period
https: // fortress .wa.gov /lni/bbip /Print.aspx 02/15/2011