HomeMy WebLinkAboutPermit PG11-039 - ANGOLKAR 4 SMILESANGOLKAR 4 SMILES
13530 53 AV S
PG1 1 -039
City Mt Tukwila
Department of Community Development
6300 Southcenter Boulevard, Suite #100
Tukwila, Washington 98188
Phone: 206 - 431 -3670
Inspectio n Request Line: 206 - 431 -2451
Web site: http: //www.ci.tukwila.wa.us
Parcel No.: 0003000038
Address: 13530 53 AV S TUKW
Project Name: ANGOLKAR 4 SMILES
PLUMBING /GAS PIPING PERMIT
Permit Number: PG11 -039
Issue Date: 03/24/2011
Permit Expires On: 09/20/2011
Owner:
Name: PRATEJ LLC
Address: 17000 SE 65TH PL , BELLEVUE WA 98006
Contact Person:
Name: GARY VOGLER
Address: PO BOX 174 , PACIFIC WA 98047
Email: GVPLUMBING @HOTMAIL.COM
Contractor:
Name: G V PLUMBING & CONSTRUCTION
Address: 141 VALENTINE CT , PACIFIC 98047
Contractor License No: GVPLUC *021R3
Phone: 206 - 423 -3359
Phone: (206)233 -2621
Expiration Date: 01/22/2012
DESCRIPTION OF WORK:
INSTALLATION OF DENTAL AIR & VACUUM LINES.
Value of Plumbing /Gas Piping: $5,700.00 Uniform Plumbing Code Edition: 2009
Fees Collected: $437.06 International Fuel Gas Code Edition: 2009
Electrical Service Provided by: SEATTLE CITY LIGHT
Permit Center Authorized Signature:
Date: v l I
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 work. I am authorized to sign and obtain this plumbing /gas piping permit and agree to the conditions
on the back of this permit.
Signature:
ImA) Date: 31 Z4A \ l l
Print Name: /-t 9 -y L \)66. u S" 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 11 -039 Printed: 03 -24 -2011
PERMIT CONDITIONS
Permit No. PG11 -039
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
PG 11 -039 Printed: 03 -24 -2011
CITY OF TUKWI
Community Developm epartment
Permit Center
6300 Southcenter Blvd., Suite 100
Tukwila, WA 98188
htto://www.ci.tukwila.wa.us
Plumbing/Gas rmit No. `VG ( \-r0 3/
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
Site Address: 3S ZO 53 2O Y4UE S
Tenant Name: A N (,61_144
King Co Assessor's Tax No.: 00 300— OC/ 3
Suite Number: Floor: J Sr
New Tenant: Bt Yes ❑..No
Property Owners Name:
Mailing Address:
City
State
Zip
CONTACT PERSON — Who do we contact when your permit is ready to be issued
Name:
(\Q.-t L va. `t.
Mailing Address: 0 (111, \') 4
•
E -Mail Address: G, V " hIT yru4At.... , t,.p
Day Telephone: 2.06 -'1 23 -33s1
City
Fax Number:
State
Zip
PLUMBING / GAS PIPING CONTRACTOR INFORMATION
Company Name:
Mailing Address:
c, V PL36
P 0R3ay,NI)
PAc.1 ct C_ W q q8o'))
`' City State Zip
Contact Person: �`�l I.,. V 0b Li 1Z. Day Telephone: ). s- 423-3351
E -Mail Address: Fax Number:
Expiration Date: 1 `Z2 112-.
Contractor Registration Number: 6V PLU C-* 621 2.3
ARCHITECT OF RECORD — All plans must be stamped by Architect of Record
Company Name:
Mailing Address:
City
Contact Person: Day Telephone:
E -Mail Address: Fax Number:
State
Zip
ENGINEER OF RECORD — All plans must be stamped by Engineer of Record
Company Name:
Mailing`Address:
. t , City State Zip
Contact Person: Day Telephone:
E -Mail Address: Fax Number:
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 pip: $ 61 od vvr
•
Scope of Work (please provide detailed information): .T'/VStiluATI On) OF 1DE/A'TOt` Ale
E_
VAw a v Lis
Building Use (per Int'1 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
Dental unit, cuspidor
Dishwasher, domestic,
with independent drain .
Drinking fountain or
water cooler (per head)
Food -waste grinder,
commercial .
Floor Drain .
Shower, single head trap
Lavatory
Wash fountain
Receptor, indirect waste
Sinks
Urinals
Water Closet
Building sewer and each
trailer park sewer
Rain water system – per
drain (inside building)
Water heater and/or vent
Industrial waste treatment
interceptor, including trap
and vent, except for kitchen
type grease interceptors
Each grease trap
(connected to not more
than 4 fixtures - <750
gallon capacity)
Grease interceptor for
commercial kitchen ( >750
gallon capacity)
Repair or alteration of
water piping and/or water
treatment equipment
Repair or alteration of
drainage or vent piping
Medical gas piping
system serving 1 -5
inlets/outlets for a
specific gas
1270
8 ,Z-
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
protectionsr(1 -5)
Atmospheric-type , , _,
vacuum breakers no
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 RQAUUTHORIZED AGENT: I
Signature: '` � Date: 3 q
Print Name: 644M L V Q6t,,,,E 2
Mailing Address: 9' 0 C c- c \"V
Day Telephone: 2,6 - 403-3351
WA
City State Zip
9809')
Date Application Accepted: 3-, g — I/
Date Application Expires:
ct--&-(/
Staff Initials:
H:1ApplicationslForms- Applications On Line12010 Applications17 -2010 - Plumbing -Gas Piping Permit Application.doc
Revised: 7 -2010
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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.tukwi la. wa. us
Parcel No.: 0003000038
Address: 13530 53 AV S TUKW
Suite No:
Applicant: ANGOLKAR 4 SMILES
RECEIPT
Permit Number: PG11 -039
Status: PENDING
Applied Date: 03/08/2011
Issue Date:
Receipt No.: R11 -00442
Initials: WER
User ID: 1655
Payment Amount: $437.06
Payment Date: 03/08/2011 02:15 PM
Balance: $0.00
Payee: G V PLUMBING AND CONSTRUCTION
TRANSACTION LIST:
Type Method Descriptio Amount
Payment Check 2666 437.06
Authorization No.
ACCOUNT ITEM LIST:
Description
Account Code Current Pmts
PLAN CHECK - NONRES
PLUMBING - NONRES
000.345.830 87.41
000.322.103.00.00 349.65
Total: $437.06
doc: Receiot -06 Printed: 03 -08 -2011
INSPECTION RECORD
etain a copy with permit
dZi
P611-ON
NS ECTION NO. PERMIT NO.
CITY OF TUKWILA BUILDING DIVISION
• 6300 Southcenter Blvd., #100, Tukwila. WA 98188 1t► (206) 431 -3670
Permit Inspection Request Line (206) 431 -2451
Project:
AAI6OLAR LI S>mIi±SS
Type of Inspectio
IAA t� A-1.
,
Address: _
� ^' r
Date Called:
47 r,M. �t Cps
Special Instructions:
7
Date Wanted:.
e, _ (p •— (1
' p.mm. .
Requester:
Phone No:
proved per applicable codes. D Corrections required prior to approval. e
COMMENTS:
47 r,M. �t Cps
7
kj
,.
V
\
t
NSPECTION FEE REQUIR . Prior next inspection. fee must be
at 6300 Southcenter Blvd., Suite }1'00. Call to schedule reinspection.
R•
INSPECTION RECORD
to Retain a copy with permit
INSPECTION NO.
p61 r -O39
PERMIT NO.
CITY OF TUKWILA BUILDING DIVISION
6300 Southcenter Blvd.., #100, Tukwila. WA 98188 oz. (206) 431 -3670
Permit Inspection Request Line (206) 431 -2451
Project: / � � A, 1'e
r -A./ba ^'l, i
Type f�lnspection:
, NAt._. PL -& r
Address: _ r�
13530 53`--,4i
Date Called:
Special Instructions:
D S 4 O CY% ` O(
Date Wanted:.
i (B -
/aa.m.
r i
INSPECTION NO.
INSPECTION RECORD
Retain a copy with permit
•
"W/--03Y
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: pc...ae. i.� / /,�
07 f7 /J�s�Y6�.►
�Typeof lnnspection: /f '
l'7tW /J6lA' TriderhAif
Address:
/35 - x'35
Date Called:
`-
Special 'nstructions:
Date Wanted a:
[!- 3,--/ / p.m
Requeste
Phone No
2-'f2- - -S9'
JApproved per applicable codes. Corrections required prior to approval.
COMMENTS:
Z= 4./0 61/b .¢rze,
Bi-, //di )7.1
A-601").6
Inspector:
I
n REIN PECTION FEE REQUIRED. Prior to next inspection. fee must be
paid at 6300 Southcenter Blvd., Suite 100. Call to schedule reinspection.
•r �
•
•
INSPECTION NO.
•
. CITY OF TUKWILA BUILDING DIVISION •
6300=Southcenter Blvd., #100, Tukwila. WA 98188 (206) 431 -3670
Permit Inspection Request Line (206) 431 -2451
Retain a copy with permit .51 o` '
PERMIT NO.
Project:
V /MO a & P t - T G s 7 a oa 0
Type o spection:
\j Z0 1 h - . v 4,0,-0,...e., ��
Address:
/3 53 0
5`3 rn) -S
Date Called:
' .
Special Instructions:
74-- .�
Date Wanted:
11-- 11/ —L / /
- rt'"i.
per.—
Requester:
Phone No:
23 -35
55
15kApproved per applicable codes.
Dtorrections required prior to approval. •
COMMENTS:
V /MO a & P t - T G s 7 a oa 0
•
jJ 4,4 L.lw6 (es 7-- Grua 4D
\j Z0 1 h - . v 4,0,-0,...e., ��
ti
Date:
RE PECTION FEEREQUI D. Prior to; ext inspection, fee must be
pa rt 6300 Southcenter'Blvd Suite 100 „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
P4.
Project:
goe.1'.✓4. $` qg
Type of Inspection:
zrAmer R6 ? dz1f
r
Address:
7755 c /01A4G/a/�9G-
Date Called:
kt-1-41
Special Instructions:
e-70// .2 o miov "4"0.
Date Wanted:
3 .-.2 T – l/
P.m.
Requester:
.110.1/A /$ ®?' '47
2 Z--
Phone No:
2c' 4'J S -74' #92
2----
Approved per applicable codes. Corrections required prior to approval.
COMMENTS:
Q
kt-1-41
"
C,V 1 ft4t6e441
-,2,..., ,.....-e:44111
2----
.0"-N)
e1,4' Ili
A. .. .
. ..
1
r.
.
A
/ .
nspector:
rf
Date:
l ' REINSPECTION FEE REQUIRED. Prior to next inspection, fee must be
paid at 6300 Southcenter Blvd., Suite 100. Call to schedule reinspection.
Airgas
Airgas Medical Services, Inc.
Everett, WA 98201
(425)741 -8807 fax (425)968 -4620
http: //www.airgas.com
Dental Air and Vacuum Verification
Report
Date: August 17, 2011
Job Number: 201316
Contractor: HMS Construction
Date(s) / Time(s) of Testing: August 8, 2011 / 1000hrs
August 16, 2011 / 1314hrs
Facility: DRA Professional Center
13530 53`d Ave. S
Tukwila, WA 98168
Scope of Work: Installation of New Dental Air and Vacuum Source Equipment
Our firm certifies that the verifier(s) named in this report are properly trained and certified to
perform the activities required. All test and measurement equipment is properly calibrated and
maintained. As representatives of Airgas Medical Services the verifier(s) named in this report
have conducted testing and verification of Medical Gas Piping Systems and related equipment
to certify the following on the above date.
I. General Findings:
A. Dental Air and Vacuum are in compliance with NFPA 99(2005ed):
Level 3 Dental
B. No crossed line were found in Dental Air and Vacuum in the area tested on the day of
testing.
C. Dental Air meets oxygen concentration,
D. Dental Air meets pressure requirements.
E. Dental Vacuum meets vacuum level requirements.
F. Dental Air and Vacuum system components in area tested are in compliance with
NFPA 99(2005ed): Level 3 Dental — See (Note), (Comments), (Recommended
Corrections) and (Corrections)
G. Initial Line Pressure Test: PASS
City of Tukwila, Permit #: PG10 -122 & 175
Note: Existing Equipment and Systems
NFPA 99(2005ed) #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.
DARPRO -08- 05.11- 201316 Pg 1 of 3
Airgas
Airgas Medical Services, Inc.
Everett, WA 98201
(425)741 -8807 fax (425)968 -4620
http: //www.airgas.com
II. Dental Air:
A. Static Line Pressure: 110 psig
B. Concentration of Oxygen: 20.8%
III. Dental Vacuum:
A. Static Line Vacuum: 9" HgV
IV. Particulate Line Testing: PASS
V. Odor: None — PASS
VI. Dental Equipment:
A. Dental Air:
1. System air components are in compliance with NFPA 99(2005ed)
2. Brand Name: Air Techniques
3. Model Number: All Star 70
4. Serial Number: 706685
5. Configuration: Triplex
6. Horse Power: 1.5
7. Air Intake: Outside
8. Pump: Oil Less
B. Dental Vacuum:
1. System vacuum components are in compliance with NFPA 99(2005ed)
2. Brand Name: Air Techniques
3. Model Number: All Star 80
4. Serial Number: SD3745
5. Configuration: Duplex
6. Horse Power: 2 hp
7. Exhaust Vented Outside: Wall
C. Amalgam Separator:
1. Brand Name: Solmetex
2. Model Number: HG5
3. Serial Number: K -31697
VII. Brazier: Gary Vogler
A. Brazier Number: VOGLEGL972QE
B. Plumbing Contractor: GV Plumbing
VIII. Witness: Rick Peterson — HMS Construction
DARPRO -08- 05.11- 201316 Pg 2 of 3
iroas
Airgas Medical Services, Inc.
Everett, WA 98201
(425)741-8807 fax (425)968 -4620
http: /Iwww.airgas.com
IX. Comments:
A. None
X. Recommended Corrections:
A. None
XI. Corrections:
A. None
Tested By:
Harry Pomeranz — ASSE 6030 Verifier
DARPRO -08- 05.11- 201316 Pg 3 of 3
Airgas
Airgas Medical Services, Inc
Everett, WA 98201
(425)741 -8807 fax (425)968 -4620
http: /Iwww.airgas.com
Level 3 Verification Check List
Reference NFPA 99(20O5ed)
Name of Facility: DRA Professional Center
Test Date: 08/08&16/11
Job Number: 201316
Verifier 1 Inspector: HP
Facility: ® New ❑ Existing 1 Type of Facility: ® Dental ❑ Medical ❑ Veterinary
Medical Gases 6a NONE
Oxygen Line ❑ New ❑ Existing
Nitrous Oxide Line ❑ New ❑ Existing ❑ NONE
Line Pressure: psi
Concentration: %
Line Pressure: psi
Concentration: %
Flow Test: SCFH (z3.5 scfm ) ❑ PASS ❑ FAIL
Flow Test: SCFH (z3.5 scfm ) ❑ PASS ❑ FAIL
Particulate Test: ❑ PASS ❑ FAIL
Particulate Test: ❑ PASS ❑ FAIL
Odor: ❑ PASS (None) ❑ FAIL,
Odor: ❑ PASS (None) ❑ FAIL,
Crossed Lines: ❑ YES ❑ NO
Outlet Brand:
Quick Connect Style:
Location of Outlets:
Cylinder Storage
❑ New ❑ Existing ❑ NONE
1 Hour Rated: ❑ YES ❑ NO
Cylinders Secured: ❑ YES ❑ NO
Door Labeled: ❑ YES ❑ NO
Cooling Sprinkler: ❑ YES ❑ NO
Location: ❑ Inside ❑ Remote
Separate from Mechanical Equipment: ❑ YES ❑ NO
Electrical Switches /Outlets 5' above floor: ❑ YES ❑ NO
Volume Connected or Stored: ❑ <3000 ft3 ❑ >3000 ft3
Number of Cylinders Connected: OX N2O
Ventilation: ❑ Natural ❑ Inside ❑ Outside
Ventilation: ❑ Mechanical
2 Openings within 1' of Floor & Ceiling: ❑ YES ❑ NO
Exhaust Fan Runs Continuously: ❑ YES ❑ NO
Minimum 72 In2 Free Area: ❑ YES ❑ NO
Draws Air from within 1' of Floor: ❑ YES ❑ NO
Vented to Exit Access Corridor: ❑ YES ❑ NO
Fan Connected to Essential Power: ❑ YES ❑ NO ❑ nla
Manifold ❑ New ❑ Existing ❑ NONE
Brand:
Flexible Hoses Less Than 5': ❑ YES ❑ NO
Model #:
Check Valve DL of Regulator: ❑ YES ❑ NO
Serial #:
Relief Valve 50% Above Norman Line Pres: ❑ YES ❑ NO
Alarm / Warning System
❑ New ❑ Existing ❑ NONE ❑ Not Required
Non - Cancellable Visual Alarm: ❑ YES ❑ NO
Brand:
Cancellable Audible Alarm: ❑ YES ❑ NO
Model #:
Hi 1 Low Line Pressure Alarm: ❑ YES ❑ NO
Serial #:
Reserve In Use Alarm: ❑ YES ❑ NO
Verification #: DRA- 08.05.11- 201316
01 -AG -Level 3 Verification Check List (2005ed)- Rev2.1
Pg 1 of 2
Airgas
Airgas Medical Services, Inc
Everett, WA 98201
(425)741 -8807 fax (425)968-4620
http: //www.airgas.com
Emergency Shutoff / Zone Valve
❑ New ❑ Existing ❑ NONE ❑ Not Required
Brand:
3 Part Valve: ❑ YES ❑ NO 1 With Down Line Gauges: ❑ YES ❑ NO 1 Sensor Location: ❑ DL ❑ UL
Labeled:
Dental Equipment
Amalgam Separator
■ New ❑ Existing
❑ Existing ❑ NONE
❑ Not Required
New ❑ Existing ❑ NONE
Dental Air System /1 New
Dental Vacuum System ►5
Brand: Air Techniques
Brand: Air Techniques
Model #: All Star 70
Model #: All Star 80
Serial #: 706685
Serial #: SD3745
Triplex ❑ Quad
❑ Simplex ❑ Duplex 11
Triplex ❑ Quad
❑ Simplex L Duplex ❑
Compressor Type: Recip.
Pump Type: Regen.
Compressor On: 90 psi 1 Off: 110 psi
Vac Level: 9 "HgV
Horse Power: 2 hp.
Line Pressure: 110 psi
Gauge: 0 -300 psi
Drain: ❑ Sealed 11 Open ❑ Floor ./ Wall
Concentration: 21 %
Horse Power: 1.5 hp.
❑ NO
Flexible Connectors: 0 YES
❑ NO
Receiver: // YES ❑ NO
Drain: Manual ❑ Auto
Air 1 Water Separator: 12 YES
❑ NO
❑ NO
Moisture Indicator: 15 YES
Exhausted to Outside: 0 YES
Dryer: ►/ YES ❑ NO Type:
Membrane
Location of Discharge: wall
(other) ❑ Inside (same)
Sch 40 PVC
Intake: I Outside ❑ Inside
Piping: ❑ Hard Copper ■
Amalgam Separator
■ New ❑ Existing
❑ NONE
❑ Not Required
Brand: Solmetex
Model #: HG5
Serial #: K -31697
Comments:
Verification #: DRA- 08.05.11- 201316
01 -AG -Level 3 Verification Check List (2005ed)- Rev2.1
Pg 2 of 2
REVISIONS
1Vo changes shall be made to the scope
of work without prior approval of
Tukwila Building Division.
NOTE: Revisions writ! require a new plan submittal
and may include adcftional plan review fees.
SEPARATE PERMIT
REQUIRED FOR
hi Mec haul
rf Electrical
P(Piumbing
❑ Gas Piping
City of Tukwila
BUILDING DIVISION
FILE COPY
Permit No., PCB 112 )
Ptan review approval is subject to MOTS and om1eione.
Approval of construction documents does not authorize
the violation of any adopted code or ordinance. Receipt
of approved Reid Copy andeonditions is acknowledged:
By, )84'0
5 3 211 II
City Of la
BUIi.DING DIVISION
CORDEVIEWED FOR
CODE
MAR 21 26i1
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PERMIT SET
ANGOLKAR4SMILES
13530 53RD AVENUE SOUTH
TUKWILA, WASHINGTON
HYPHEN
Design Concept — To Completion
W. 921 Broadway Bate 201
Spokane, Wa 99201
509.315.5129
09 -01 -2011
city of Tukwila
Jim Haggerton, Mayor
Department of Community Development Jack Pace, Director
GARY VOGLER
PO BOX 174
PACIFIC WA 98047
RE: Permit No. PG11 -039
13530 53 AV S TUKW
Dear Permit Holder:
In reviewing our current records, the above noted permit has not received a final inspection by the City of
Tukwila Building Division. Per the International Building Code, International Mechanical Code, Uniform
Plumbing Code and /or the National Electric Code, every permit issued by the Building Division under the
provisions of these codes shall expire by limitation and become null and void if the building or work authorized
by such permit has not begun within 180 days from the issuance date of such permit, or if the building or work
authorized by such permit is suspended or abandoned at any time after the work has begun for a period of 180
days. Your permit will expire on 10/01/2011.
Based on the above, you are hereby advised to:
1) Call the City of Tukwila Inspection Request Line at 206 - 431 -2451 to schedule for the next or final
inspection. Each inspection creates a new 180 day period, , provided the inspection shows progress.
-or-
2) Submit a written request for permit extension to the Permit Center at least seven (7) days before it is
due to expire. Address your extension request to the Building Official and state your reason(s) for
the need to extend your permit.
The Building Code does allow the Building Official to approve one extension of up to 180 days. If it is
determined that your extension request is granted, you will be notified by mail.
In the event you do not call for an inspection and /or receive an extension prior to 10/01/2011, your permit will
become null and void and any further work on the project will require a new permit and associated fees.
Thank you for your cooperation in this matter.
Sincerely,
Bill Rambo
Permit Technician
File: Permit File No. PG11 -039
6300 Southcenter Boulevard, Suite #100 • Tukwila, Washington 98188 • Phone: 206 - 431 -3670 • Fax: 206 -431 -3665
March 10, 2011
•
CityofTukwila
Jim Haggerton, Mayor
Department of Community Development Jack Pace, Director
Gary Vogler
PO Box 174
Pacific, WA 98047
RE: Letter of Incomplete Application # 1
Plumbing /Gas Piping Permit Application PG11 -039
Angolkar 4 Smiles —13530 53 Av S
Dear Mr. Vogler,
This letter is to inform you that your permit application received at the City of Tukwila Permit Center on
March 8, 2011 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:
Building Department: Allen Johannessen at 206 433 -7163 if you have any questions
concerning the following comment.
1) Provide drawings that are not reduced and that are readable.
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: PGII -039
W:\Permit Center\Incomplete Letters\2011\PG11 -039 Incomplete Ltr #1.DOC
6300 Southcenter Boulevard, Suite #100 • Tukwila, Washington 98188 • Phone: 206 - 431 -3670 • Fax: 206 - 431 -3665
APERMITCOORD COPY •
PLAN REVIEW /ROUTING SLIP
ACTIVITY NUMBER: PG11 -039 DATE: 03/16/11
PROJECT NAME: ANGOLKAR 4 SMILES
SITE ADDRESS: 13530 53 AV S
Original Plan Submittal X Response to Incomplete Letter # 1
Response to Correction Letter # Revision # after Permit Issued
PART 0[6i.
ui ding ivision
Public Works ❑
Fire Prevention
Structural
n
Planning Division
nPermit Coordinator ❑
DETERMINATION OF COMPLETENESS: (Tues., Thurs.)
Complete
Comments:
Incomplete ❑
DUE DATE: 03/17/11
Not Applicable
Permit Center Use Only
INCOMPLETE LETTER MAILED: LETTER OF COMPLETENESS MAILED:
Departments determined incomplete: Bldg ❑ Fire ❑ Ping ❑ PW ❑ Staff Initials:
TOES /THURS ROUTING:
Please Route Structural Review Required ❑ No further Review Required ❑
REVIEWER'S I ITIALS: DATE:
APPROVALS OR CORRECTIONS:
Approved ❑ Approved with Conditions
Notation:
REVIEWER'S INITIALS:
DUE DATE: 04/14/11
Not Approved (attach comments) U
DATE:
Permit Center Use Only
CORRECTION LETTER MAILED:
Departments issued corrections:
Bldg ❑ Fire ❑ Ping ❑ PW ❑ Staff Initials:
Documents/routing slip.doc
2 -28 -02
*PERMIT M,`. i � COPN •
PLAN REVIEW /ROUTING SLIP
ACTIVITY NUMBER: PG11 -039
PROJECT NAME: ANGOLKAR 4 SMILES
SITE ADDRESS: 13530 53 AV S
X Original Plan Submittal
Response to Correction Letter #
DATE: 03 -08 -11
Response to Incomplete Letter #
Revision # After Permit Issued
DEPARTMENTS:
Building Division
Public Works
ot
Un iJ /A-- "S-16-1k
Fire Prevention MI
Structural ❑
Planning Division
Permit Coordinator
it
DETERMINATION OF COMPLETENESS: (Tues., Thurs.)
Complete
Incomplete
DUE DATE: 03-10-11
Not Applicable
Comments:
Permit Center Use Only � 1
INCOMPLETE LETTER MAILED: A40— U1 LETTER OF COMPLETENESS MA ED:
Departments determined incomplete: Bldg Fire ❑ Ping ❑ PW ❑ Staff Initials:
TUES/THURS ROUTING:
Please Route n Structural Review Required ❑ No further Review Required ❑
REVIEWER'S INITIALS: DATE:
APPROVALS OR CORRECTIONS:
DUE DATE: 04-07-11
Approved n Approved with Conditions n 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:
Documents /routing slip.doc
2 -28 -02
!'
•
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
Revision submittals must be submitted in person at the Permit Center. Revisions will not be accepted through
the mail, fax, etc.
Date: ,Ii%1tl
Plan ChecWPermit Number: PG 11 -039
® 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: Angolkar 4 Smiles
Project Address: 13530 53 Av S
Contact Person:
RECEIVED
CITY OF TUKWILA
MAR 16 2011
PERMIT CFRrrFF
CI Mt"( va6LEF- Phone Number: 266-423- 3351
Summary of Revision: 2. Co (u TE- SET S - S 1vnJ eD e->`Ra IT �►ER.
w 1 ser &3s1NEss C A-R-D S
Sheet Number(s):
"Cloud" or highlight all areas of revision including date of revision
Received at the City of Tukwila Permit Center by:
VEntered in Permits Plus on 6 3 //t, //i
hit)
\applications \forms - applications on line \revision submittal
Created: 8 -13 -2004
Revised:
Contractors or Tradespeopleenter 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 G V PLUMBING & CONSTRUCTION UBI No. 600142739
Phone 2537351344 Status Active
Address P 0 Box 174 License No. GVPLUC'021 R3
Suite /Apt. License Type Construction Contractor
City Pacific Effective Date 12/23/1998
State WA Expiration Date 1/22/2012
Zip 98047 Suspend Date
County King Specialty 1 General
Business Type Individual Specialty 2 Unused
Parent Company
Business Owner Information
Name
Role
Effective Date
Expiration Date
VOGLER, GARY L
Owner
12/23/1998
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
2
DEVELOPERS SURETY
Et INDEM CO
856610C
12/14/2001
Until Cancelled
$12,000.00
12/14/2001
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
6
CBIC
C11511418
01/01/2009
01/01/2012
$1,000,000.0012
/13/2010
5
OHIO CAS INS
BH053439196
01/01/2006
01/01/2009
$1,000,000.00
12/10/2007
4
HARTFORD CAS
INS CO
525BAPJ0199
01/01/2003
01/01/2006
$1,000,000.00
11/29/2004
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 03/24/2011