HomeMy WebLinkAboutPermit PG11-114 - DR THOMPSONDR THOMPSON
6840 FORT DENT WY
PG11-114
Parcel No.:
Address:
City ATukwila
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.TukwilaWA.gov
PLUMBING /GAS PIPING PERMIT
2954900425
6840 FORT DENT WY TUICW
Project Name: DR THOMPSON
Permit Number:
Issue Date:
Permit Expires On:
PG11 -114
07/29/2011
01/25/2012
Owner:
Name: PEPPERWOOD HOLDINGS LLC
Address: 2835 82ND AVE SE #300 , MERCER ISLAND WA 98040
Contact Person:
Name:
Address:
Email:
GREG SMALLING
PO BOX 1917 , RENTON WA 98057
greg@gsmechanicalshop.com
Contractor:
Name: GS MECHANICAL LLC
Address: PO BOX 1917 , RENTON WA 98057
Contractor License No: GSMECML928RK
Phone: 206 372 -0332
Phone: 206 -372 -0332
Expiration Date: 12/12/2012
DESCRIPTION OF WORK:
RELOCATE EXISTING MEDICAL VACUUM VENT. DISCONNECT VENT FROM BUILDING WASTE AND
VENT SYSTEM AND RUN INDEPENDENTLY TO OUTSIDE EXHAUST. NO WORK IS TO BE DONE TO
VACUUM SYSTEM OR RELATED EQUIPMENT.
Value of Plumbing /Gas Piping:
Fees Collected:
Electrical Service Provided by:
Permit Center Authorized Signature:
I hereby certify that I have read and
governing this work will be complie
$500.00
$113.40
Uniform Plumbing Code Edition:
International Fuel Gas Code Edition: 2009
2009
Date:
ed this permit and know the same to be true and correct. All provisions of law and ordinances
whether specified herein or not.
The granting of this permit does not p
construction or the performance of work.
on the back of this permit.
Signature:
e to give authority to violate or cancel the provisions of any other state or local laws regulating
I am authorized to sign and obtain this plumbing /gas piping permit and agree to the conditions
Print Name:
Date: i /le1//1
This permit shall become null and void if 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 -114 Printed: 07 -29 -2011
•
PERMIT CONDITIONS
Permit No. PG11 -114
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 -114 Printed: 07 -29 -2011
CITY OF TUKW
Community Development Department
Permit Center
6300 Southcenter Blvd., Suite 100
Tukwila, WA 98188
http://www.TukwilaWA.gov
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
Site Address: G 8 yO For-T �✓/* /
Tenant Name: I -IA � So-,
Property Owners Name: 0- C- ---e -60 C o
Mailing Address: 2 95 3‹ R Z h)- 4!J c. 5 C
King Co Assessor's Tax No.: �1 410 ---04 l
�5 f
[a"No
Suite Number:
Floor:
New Tenant: ❑ Yes
City
State Zip
CONTACT PERSON — Who do we contact when your permit is ready to be issued
Name: 4r/zc-5 3;01
Mailing Address: Pb 60, - /y/ 7
E -Mail Address: jf e3 t� SS .It / Sizy Co
2
Day Telephone: Zo co Y'7 Z. U 3 3 Z
5- 7
City State Zip
Fax Number: `' Z S Z 2 Co Z b Z
PLUMBING / GAS PIPING CONTRACTOR INFORMATION
Company Name: & S N% 4
Mailing Address:
Contact Person:
.s
5a .1
T
E -Mail Address:
Contractor Registration Number: G S C_ r'I q 2 eb /Z‹
City
Day Telephone:
Fax Number:
/L/ /Z`jL
State
Zip
Expiration Date:
ARCHITECT 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:
H:\Applications\Porms- Applications On Line\2010 Applications \7 -2010 - Plumbing -Gas Piping Permit Application.doc
Revised: May 2011
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City
Day Telephone:
Fax Number:
State
Zip
Page 1 of 2
Valuation of Project (contractor's bid prig. $ So 0 M /
Scope of Work (please provide detailed information): nQe. OGct. 4C e Xr s T i/1-( (�a L c>U w, t/ - ✓J I
015 c o h •vim I r r " T J ✓ � - `l- ro _ ✓ t L e e ( � / L.✓ 4 s .4- tie � � 5 / 51 _>,✓! �t J ✓ -) r7
Irde /fie .-cue (, o��s,d e,ril r 1-0 2 do-,
Ito Ua_C- lJ y r S Y s �^-1 o r r e. e Me..
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
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
l
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 OR AUTHORIZED AGENT:
Signature:
Print Name: 5,..n At c " ti –
Mailing Address:
P0 6v,- i9 /7
Date Application Accepted:
b`l
Date: 7- 2 //
Day Telephone: 2-06, - 3 7 Z -U 3 a Z
City
7& 05- 7
State Zip
Date Application Expires:
H:1Applications\Forms- Applications On Line12010 Applications17.2010 - Plumbing -Gas Piping Permit Application.doc
Revised: May 2011
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Staff Initials: �■
Page 2 of 2
1 •
w City of Tukwila
yy Department of Community Development
6300 Southcenter Boulevard, Suite #100
Tukwila, Washington 98188
Phone: 206 - 431 -3670
Fax: 206 - 431 -3665
Web site: http: / /www.TukwilaWA.gov
Parcel No.: 2954900425
Address: 6840 FORT DENT WY TUI{W
Suite No:
Applicant: DR THOMPSON
RECEIPT
Permit Number: PG11 -114
Status: PENDING
Applied Date: 07/29/2011
Issue Date:
Receipt No.: R11 -01615
Payment Amount: $113.40
Initials: JEM Payment Date: 07/29/2011 09:57 AM
User ID: 1165 Balance: $0.00
Payee: GREG SMALLING, GS MECHANICAL LLC
TRANSACTION LIST:
Type Method Descriptio Amount
Payment Credit Crd VISA
Authorization No. 119275
ACCOUNT ITEM LIST:
Description
113.40
Account Code Current Pmts
PLUMBING - NONRES
000.322.103.00.00 113.40
Total: $113.40
doc: Receiot -06 Printed: 07 -29 -2011
INSPECTION RECORD
Retain a copy with permit
INSPECTION NO. PERMIT NO.
P6(1-- 114
CITY OF TUKWILA BUILDING DIVISION it-
6300 Southcenter Blvd., #100, Tukwila. WA 98188 (206) 431 -3670
Permit Inspection Request Line (206) 431 -2451
ect' .—/-11_0 t'0 .5.041
Type. nsSP t�...,. PL.,"
F
I •
Address: 44 r I 1L � .....Date
4 `-i
Called:
Special Instructions:
05 2P 1.08- 'Ot
,X 01 I A t i
Date Wanted: ,..a.,py.
Requester:
Phone 0 C _ 3'7 Z -- 033 2_
'Approved per applicable codes. D Corrections required prior to approval.
COMMENTS:
rd 4',, _ 4,..,#8
DR-; i-e ,,f ievrif,,,I-
r
r
�Insp r:
ran,,_.
INSPECTION FEE EQUIRED. Prior to next " inspection. fee must be
id at 6300 Southce ter Blvd., Suite 100. Call to schedule reinspection.
Contractors or Tradespeople PPter 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 GS MECHANICAL LLC UBI No. 602564160
Phone 2063720332 Status Active
Address Po Box 1917 License No. GSMECML928RK
Suite /Apt. License Type Construction Contractor
City Renton Effective Date 12/12/2008
State WA Expiration Date 12/12/2012
Zip 98057 Suspend Date
County King Specialty 1 General
Business Type Limited Liability Company Specialty 2 Unused
Parent Company
Business Owner Information
Name
Role
Effective Date
Expiration Date
SMALLING, GREG
Partner /Member
12/12/2008
Amount Received Date
SMALLING, GARY
Partner /Member
12/12/2008
02/27/2009
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
CBIC
511307
12/09/2008
Until Cancelled
$12,000.00
12/12/2008
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
Ohio Cas Ins Co
BR053764777
02/27/2009
02/27/2012
$1,000,000.0002 /24/2011
1
CBIC
C11511307
12/09/2008
12/09/2009
03/13/2009
$1,000,000.0012 /12/2008
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 07/29/2011