HomeMy WebLinkAboutPermit PG11-124 - STARBUCKSSTARBUCKS COFFEE
COMPANY
3301 S NORFOLK ST
PG1 1 -124
City aftukwila
•
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
Parcel No.: 0323049024
Address: 3301 S NORFOLK ST TUKW
Project Name: STARBUCKS COFFEE COMPANY
Permit Number: PG11 -124
Issue Date: 10/24/2011
Permit Expires On: 04/21/2012
Owner:
Name: ASSOCIATED GROCERS
Address: P.O. BOX 3763 , SEATTLE, WA 98124
Contact Pgrson: --
- 13 -ame: ERIC HOPP
Address: 2401 UTAH AV S, SUITE 800 , SEATTLE WA 98134
Email: EHOPP @STARBUCKS.COM
Contractor:
Name: DB GENERAL CONTRACTORS INC
Address: 3320 WEST VALLEY HY D -106 , AUBURN WA 98001
Contractor License No: DBGENGC943O9
Phone: 206 - 318 -9309
Phone: 253 - 736 -2980
Expiration Date: 09/29/2012
DESCRIPTION OF WORK:
ROUGH IN AND INSTALL PLUMBING FIXTURES PER PLAN.
Value of Plumbing /Gas Piping:
Fees Collected:
Electrical Service Provided by:
$15,000.00
$464.63
Permit Center Authorized Signature:
Uniform Plumbing Code Edition:
International Fuel Gas Code Edition: 2009
2009
Date:
I hereby certify that I have read and e ed this permit and know the same to be true and correct. All provisions of law and ordinances
governing this work will be complied 'th, hether specified herein or not.
The granting of this permit does not pres
construction or the pe • rmance of work.
on the backofthi • - • t.
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
Signature: i / �/
Date: /0 ' Z —(/
Print N. e: `Ph 'i2 /A.) G}j4
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 -124 Printed: 10 -24 -2011
PERMIT CONDITIONS
Permit No. PG11 -124
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.
13: ** *PUBLIC WORKS DEPARTMENT CONDPI'IONS * **
14: Contractor shall coordinate with the Public Works Project Inspector Mr. Dave Stuckle at (206)433 -0179; to ensure proper
connection of grease waste line, to the new grease interceptor.
doc: UPC -4/10
PG11 -124 Printed: 10 -24 -2011
•
CITY OF TUKWILA
Community Development Department
Public Works Department
Permit Center
6300 Southcenter Blvd., Suite 100
Tukwila, WA 98188
htto://www.TukwilaWA.aov
•
Building Permit No. o t t -- 2_
Mechanical Permit No. 1'1.1( --1 l `f`
Plumbing/Gas Permit No. �‘ C I— (
Public Works Permit No.
Project No.
(For office use only)
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: 3301 S. Norfolk Street
Tenant Name: Starbucks Coffee Company
Property Owners Name: Sabey Corporation
Mailing Address: 12201 Tukwila International Blvd.
King Co Assessor's Tax No.:
Suite Number: NA Floor: NA
New Tenant: m Yes ❑ .. No
Seattle
City
State
98168
Zip
CONTACT PERSON — who do we contact when your permit is ready to be issued
Name: Eric A. Hopp
Mailing Address: 2401 Utah Avenue S. Suite 800
E -Mail Address: ehopp @starbucks.com
Day Telephone: (206) 318 -9309
Seattle
City
Fax Number:
wa
State
98134
Zip
GENERAL CONTRACTOR INFORMATION —
(Contractor Information for Mechanical (pg 4) for Plumbing and Gas Piping (pg 5))
Company Name: DB Contractors Cjevk.eyo,'
Mailing Address: 3320 W. Valley Hwy. D -106
Contact Person: Jake Hatfield
E -Mail Address: Jake @db- gc.com
Contractor Registration Number: DBGENGC94309
Au bum
City State
Day Telephone: (206) 251 -5489
Fax Number:
Expiration Date: 09/29/2012
98001
Zip
ARCHITECT OF RECORD — All plans must be stamped by Architect of Record
Company Name: Tony Gale III
Mailing Address: 2401 Utah Avenue S. Suite 800
Contact Person: Eric Hopp
E -Mail Address: ehopp @starbucks.com
Seattle
City State
Day Telephone: (206) 447 -1575
Fax Number:
98134
Zip
ENGINEER OF RECORD — AU plans must be stamped by Engineer of Record
Company Name: Rensch Engineering
Mailing Address: 111 AVE. C, Suite 104
Contact Person: Chris Rensch
E -Mail Address: chris.r @renschengineering.com
H:lApplieations\Forn s.Applieattons On Linc\2010 Applications \7.2010. Permit Applicationdoc
Revised: 7 -2010
bh
Snohomish
City
Day Telephone:
Fax Number:
98290
State Zip
(360) 863 -6677
04'723
Page 1 of 6
PLUMBING AND GAS PIPING PERMIT INFORMATION — 206 - 431 -3670
PLUMBING AND GAS PIPING CONTRACTOR INFORMATION
Company Name: F ,v err ? it/0412 /rig
Mailing Address: AO S--- Canyon %2.A .
Contact Person: 14i crw L—i rtcd g ay
E -Mail Address:
Contractor Registration Number:
lctL ePl "2---3 2-14
AVallut, Loa o/�37 /
City state Zip
Day Telephone:
Fax Number:
Expiration Date: 5127 / 2.0/3
Valuation of Plumbing work (contractor's bid price): $ ISM oeD
Valuation of Gas Piping work (contractor's bid price): $
Scope of Work (please provide detailed information):
2ot,714- In Qvtd ►rt S+4.11 pluvubiy
�y{aire3 Per Plan .
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
I
Drinking fountain or
water cooler (per head)
Food -waste grinder,
commercial
Floor Drain
Shower, single head trap
Lavatory
Wash fountain
Receptor, indirect waste
Sinks
5—
Urinals
Water Closet
Building sewer and each
trailer park sewer
l
Rain water system — per
drain (inside building)
Water heater and/or vent
t
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 min)
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
H:'AppiicationsiFotms- Application, On Line12010 Applications \7.2010 - Permit Applicationdoc
Revised: 7.2010
bh
Page 5 of 6
u/41
PERMIT APPLICATION NOTES — Applicable to all permits in this application
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.
Building and Mechanical Permit
The Building Official may grant one or more extensions of time for additional periods not exceeding 90 days each. The extension shall be
requested in writing and justifiable cause demonstrated. Section 105.3.2 Intentational Building Code (current edition).
Plumbing Permit
The Building Of
in writing
grant one extension of time for an additional period not exceeding 180 days. The extension shall be requested
use demonstrated. Section 103.4.3 Unifonn Plumbing Code (current edition).
1 HEREBY C ' TIFY ' T I r V A XAMINED THIS APPLICATION AND KNOW THE SAME TO BE TRUE UNDER
PENALTY OF PERK ti BY E t .TATE OF WASHINGTON, AND I AM AUTHORIZED TO APPLY FOR THIS PERMIT.
BUILDING
Signature:
Print Name:
Mailing Address:
Date: °I 1 Z J 1
Da Telephone:
6- loos -I((
ily
State
p
! Date Application Accepted: Q 1 / L _ f 1. I
rill'` !�
Date Application Expires:
Staff Initials:
H iolppliwtionsiFmms•Applieations On Line12010 Applicotiosq -2010 • Permit Applieation.doe
Revised: 7 -2010
bh
Page 6 of 6
COk 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
SET RECEIPT
RECEIPT NO: R11 -02326
Initials: WER
Payment Date: 10/24/2011
User ID: 1655 Total Payment: 721.38
Payee: DB GENERAL CONTRACTORS, JEREMY HABERMAN
SET ID: 1024 SET NAME: STARBUCKS
SET TRANSACTIONS:
Set Member
M11 -116
PG11 -124
TOTAL:
Amount
342.85
378.53
342.85
TRANSACTION LIST:
Type Method Description Amount
Payment Credit C VISA 721.38
TOTAL: 721.38
ACCOUNT ITEM LIST:
Description
Account Code Current Pmts
MECHANICAL - NONRES
PLAN CHECK - NONRES
PLUMBING - NONRES
000.322.102.00.0
000.345.830
000.322.103.00.0
342.85
6.83
371.70
TOTAL: 721.38
SET RECEIPT
RECEIPT NO: R11 -01774
Initials: WER Payment Date: 08/16/2011
User ID: 1655 Total Payment: 958.23
Payee: DALE SPENCER
SET ID:
08 -16 -11 SET NAME: STARBUCKS
SET TRANSACTIONS:
Set Member Amount
D11 -282 655.79
EL11 -0763 130.63
M11 -116 85.71
PG11 -124 86.10
TOTAL: 655.79
TRANSACTION LIST:
Type Method Description Amount
Payment Credit C MC 958.23
TOTAL: 958.23
ACCOUNT ITEM LIST:
Description
Account Code Current Pmts
ELECTRICAL PLAN - NONRES 000.345.832.00.0
PLAN CHECK - NONRES 000.345.830
130.63
827.60
TOTAL: 958.23
INSPECTION RECORD
Retain a copy with permit Pii. (2
INSPECTION N0. PERMIT N0.
CITY OF TUKWILA BUILDING DIVISION It. •
6300 Southcenter Blvd., #100, Tukwila. WA 98188 (206) 431 -3670
Permit Inspection Request Line (206) 431 -2451
Project:
Type o Ins ection:
Address: �i� -Date
330/ Ala N
Called:
Special Instructions:
Date Wanted:.
/2."' 7- / (
0.
p.m.
Requester:
Phone No:
® Approved per applicable codes.
Corrections required prior to approval.
COMMENTS:
?fir) 1.1
1
ION FEE REQUIR D. Prior t next inspection. fee must be
00 Southcenter Blv Suite 100. Call to schedule reinspection.
c
INSPECTION RECORD
Retain a copy with permit
INSPECTION NO. PERMIT NO.
CITY OF TUKWILA BUILDING DIVISION
6300 5outhcenter Blvd., #100, Tukwila. WA 98188 (206) 431 -3670
Permit Inspection Request Line (206) 431 -2451
N4D
P61 v
Project:
ST A2 �3L��L
Type o Inspection:
Ai #4 0 J M b ,
A2 3s6 r I 'O o -o (/� S6r
v
Date Called:
Special Instructions:
Date Wanted:. _ _ ((
IZ
[� 1 fi
I l''rt s t''.Ltatre. t ,NL cs
Requester:
Phone No:
?AO 0 - '4( -oSS7
❑ Approved per applicable codes.
aCorrections required prior to approval. 3
'COMMENTS: fa A.
)
P tv"iw
0 {
[� 1 fi
I l''rt s t''.Ltatre. t ,NL cs
\----"i NA I.
aim,
floti.9 0m-is 5k 06'J »''
n REINSPECTION FEE REQO(RED. Prior o next inspection. fee must be
paid at 6300 Southcenter Blvd., Suite 100. Call to schedule reinspection.
INSPE
ION NO.
INSPECTION RECORD
Retain a copy with permit
P6/1" -12
PERMIT N
CITY OF- TUKWILA BUILDING DIVISION
6300 Southcenter Blvd., #100, Tukwila. WA 98188 z (206) 431 -3670
Permit Inspection Request Line (206) 431 -2451
Project:
.5-7/v1v /C'A'S
Type of Inspection:
A),016,1 -.1 "V )' /Xi1i1,4.
Address:
330 / s it/4ercc1k $
Date Called:
Special Instructions:
Date Wanted: ./i�
// � / // /
`p rte•
Requester:
Phone No:
-,76G - CAI -6 CS —7
Approved per applicable codes. IlCorrections required prior to approval.
COM NTS:
EJNSPECTION FEE REQUU ED. Prior o next inspection, fee must be
p id at 6300 Southcenter 131 d.. Suite 100. Call to schedule reinspection.
Ara
_
INSPECTION RECORD
Retain a copy with permit
CTION'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 trfta
P61 /-1211
Project:
.57" pligA2 exs
Type of Inspection:
R4lr4f,l -Xis
Address:
336 I S 14bar=614' ST
Date Called:
Special Instructions:
.0
Date Wanted:.
//— /7— //
.m.
p•-
Requester:
Phone No:
.206- 5/ / -C s5 7
Approved per applicable codes. E Corrections required prior to approval.
COMMENTS:
&
r)isr.,•it �� G�./fs a a✓ /, X7017 1--4
In ector•
d
Date:
SPECTION FEE REQUIRED. {prior to y ext inspection, fee must be
id at 6300 Southcenter Blvd.. "Site 100. Call to schedule reinspection.
..• • .
• .
INSPECTION RECORD
Retain a copy with permit
r.azi:SZ:rrr
P61(
• - INSPMION NC); PERMIT NO. I
CITY OF TUKWILA BUILDING DIVISION
6300 Southcenter Blvd., #100, Tukwila. WA 98188 tran. (206) 431-3670
Permit Inspection Request Line (206) 431-2451
Prciject. ' " ".- • -(jr.s
Stitt 8.4 L
Type of Inspection:
-I-0 PbkAli
Addressi' .
..3 3i1 f - 'Jo r 6)1 K
Date Called:
SPecialthstruCtiOns: '--
•
.•..
. .
. . ... • .
Date Wanted:.
1 ( — go --(j
a.m.
./ltn
Requester:
Phone No:
Approved per applicable codes.
COMMENT
•
•
•
.•
Corrections required prior to approval.
(Advil(' 464- Areted
&01/— ithiron7
R
P
INSPECTION FEE REQUIR D. Prior tojfiext inspection. fee must be
d at.6300Southcenter BLvd. Suite 10 . Call to schedule reinspection.
•
4INSPECTION RECORD
'Retain a copy with permit
INSPECTION NO. .. PERMIT NO.
'.CITWOF*TU KWI LA BUILDING DIVISION
• 6300 Southteritb?. Eilvd #100, Tukwila. WA 98188 (206) 431-3670
'•••
•••
Permit InspectiokRecjuest Line (206) 431-2451
▪ •
• :•
•.
:•.• •
•
.;,. ▪ -•
• • •
PG if - 121
&: •
•
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ft.
r • --",4s._. --
b 0. .er,g
Tyge, of Inspection:
1 Cati 6 tr 1-11J PLIA-4g .
•
AddrIsdi •• /66/(1) I lc
Date Called:
—...—.....
... :...
Special Instructions: ......
•
fl- 01ft
5
1 ,
• . -
Date Wanted:,
P.m.
Requester:
Pho
1-1756- 7 ci 14 —6 SS-7
Approved per applicable codes. Corrections required prior to approval.
COMMENTS* -
•
,•
.; •
0 A 7 -----
&eV wilta k„er-: D ,447
4-114
Inspecto
•
.REINS ECT1:0N:FEE REQUIRED. Prior to next inspection. fee must be
paid at 6300toUihcenter Blvd.. Suite 100. Call to schedule reinspection.
IDate:, I 4 _ (
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:
"i P► I, Cawie eS C`scff
Type of Inspection:
Ce,Qbi t
WO*.lc
Address:
Da tCalled:
Special Instructions:
Date Wanted:
1 !- 1- 1
1
Requester:
Phone No:
N2S— L/f"
13.4 1
Approved per applicable codes. Corrections required prior to approval.
COM M1±NTS:
nspect
iDate:0— 7_1/
NSPECTION FEE REQ RED. Prior o next inspection. fee must be
id at 6300 Southcenter Blvd.. Suite 100. Call to schedule reinspection.
•
Proiect: _
Type of Inspection:
60 J Aio wev(k
5.--r*FgOCIICS 60
dges3b IP.'
Date Called:
pecial Instructions:
) S4 1
C
ell-4'k igkS 0 er".Y33_13 Le
Date Wanted: .
/
— ( I
a.m.
P.m.
Requester:
Phone No:
••q is - 4<,
_ /
3
3
/
Apiiroved per applicable codes.
IZICorrections required prior to approval.
COMMENTS:
V>4c.A e —41
Date:
1 1 — k
SPECTION FEE REQUIRED. Prior to n t inspection. fee must be
at 6300 Southcenter BLv4. Suite 100. Call to schedule reinspection.
•
•
INSPECTION RECORD
Retain a copy with permit
INSPECTION NO. PERMIT N0.
P&1I -124
CITY OF.TUKWI'LA BUILDING DIVISION
6300 SoUthcenter Blvd., #100, Tukwila. WA 98188 (206) 431 -3670
Permit Inspection Request Line (206) 431 -2451
Project:
.5trb -S
Type of Inspection:
Pt) fi
Address:
3301 5 Vorf Mt
Date Called: •
i' s1 i t
Special Instructions:
.
Date Wanted:
IT-kin
Requester:
Ste,
Phone No:
?1-etill rOS3j
• El Approved per applicable codes. Corrections required prior to approval.. ••
tr
COMMENTS:
=
- REJNSPECTION FEE REQUIRED. Prior to next inspection. fee must be
paid at 00 Southcenter Blvd.. Suite 100. Call to schedule reinspection. -
'•
T•
Certified Backflow Testing, Inc.
(425) 427 -8889 • (206) 601 -5550 • (888) 484 -FLOW • (425) 427 -9242 fax
WWW.CBTINC.COM
BACKFLOW PREVENTION ASSEMBLY TEST REPORT
NAME e . t 4 "O n5-► r � I G ' P e o I b ( b o
SERVICE ADDRESS 010e) E 111-,);n4,11 Way 5/ .5•2,14U,
CONTACT PERSON 56114 PHONE Z O O. 9/ Y. 0 5T7
LOCATION OF ASSEMBLY Un J
co,^A S1Y1�l
DOWNSTREAM PROCESS ai iS L ASSEMBLY TYP
INSTALLATION 1\11"4
MAKE J 0141
MODEL 001 013 cm
- Residential
P gtos
FAX
DCVA - PTV /BA - SVBA
7�-f
PROPER INSTALLATION?
SERIAL NO. 3 -1 S a g o SIZE
.'
INITIAL
TEST
PASSED
DCVA / RPBA
DCVA / RPBA
RPBA
PVBA/SVBA
CHECK VALVE NO.1
CHECK VALVE NO.2
OPENED AT 2 • S PSID
AIR INLET
OPENED AT PSID
LEAKED •
CLOSED TIGHT
PSID
LEAKED •
CLOSED TIGHT
pH)
#1 CHECK 7- 2. PSID
AIR GAP OK?
OR
DID NOT OPEN •
FAILS ■
NEW
PARTS
AND
REPAIRS
CLEAN REPLACE PART
CLEAN REPLACE PART
CLEAN REPLACE PART
CHECK VALVE
HELD AT PSID
• •
• •
• •
LEAKED •
•
• •
• •
• •
• •
• •
• •
• •
CLEANED •
❑ •
REPAIRED •
TEST AFTER
REPAIRS
LEAKED •
LEAKED •
OPENED AT PSID
AIR INLET PSID
CLOSED TIGHT • ■
PSID
CLOSED TIGHT • ■
pH)
#1 CHECK PSID
CHK VALVE PSID
PASSED •
FAILED •
r
AIR GAP INSPECTION: Required minimum air gap separation provided? `(9
REMARKS: -50U Z
Detector Meter Reading
LINE PRESSURE 2c PSI
TESTERS SIGNATURE:
CERT. NO. B -5206
CONFINED SPACE?
DATE 12 / . / 11
TESTERS NAME PRINTED: TOBY SWANSON TESTERS PHONE # please see top of test report
REPAIRED BY:
FINAL TEST BY: CERT. NO. DATE
DATE
CALIBRATION DATE: 12/27/10 KIT #: 12090296 MODEL: MIDWEST 845 -5 SERVICE RESTORED? YES ❑ NO
•
I certify that this report is accurate, and I have used WAC 246- 290 -490 approved test methods and test equipment.
Certified BackfIow Testing, Inc. Po' ^' 2 y
(425) 427 -8889 • (206) 601 -5550 • (888) 484 -FLOW • (425) 427 -9242 fax
WWW.CBTINC.COM
BACKFLOW PREVENTION ASSEMBLY TEST REPORT
NAME V COA5. t C-k !O i Oct
SERVICE ADDRESS 10 1 0 0 E. VI ott, >A4 w, y 3 t Seel We- t4 4 19102
CONTACT PERSON Se4i1 PHONE 2-04 • 1/y. 0557 FAX
- Residential
LOCATION OF ASSEMBLY 04..4%
DOWNSTREAM PROCESS S frtJ l
INSTALLATION
MAKE W
e ne4/ �1114.. - 4-11,
MODEL
Ob1 13 ar
ASSEMBLY TYPE.( DCVA - PTV /BA - SVBA
PROPER INSTALLATION? 1 �' 5
SERIAL NO. 3 Lis- 2 g SIZE 371
INITIAL
TEST
PASSED
FAILED
r
DCVA / RPBA
DCVA / RPBA
RPBA
PVBA/SVBA
CHECK VALVE NO.1
CHECK VALVE NO.2
-2
OPENED AT J- 9 PSID
AIR INLET
OPENED AT PSID
LEAKED •
CLOSED TIGHT Y..
PSID
LEAKED •
CLOSED TIGHT
pm
#1 CHECK S -1 PSID
AIR GAP OK?
OK
DID NOT OPEN •
NEW
PARTS
AND
REPAIRS
CLEAN REPLACE PART
CLEAN REPLACE PART
CLEAN REPLACE PART
CHECK VALVE
HELD AT PSID
• •
• •
• •
LEAKED •
•
• •
• •
• •
• •
• •
CLEANED •
• •
• •
• •
REPAIRED •
TEST AFTER
REPAIRS
LEAKED •
LEAKED •
OPENED AT PSID
AIR INLET �, • PSID
CLOSED TIGHT •
PSID
CLOSED TIGHT •
PSID
#1 CHECK PSID
CHK VALVE ' ‘ PSID
PASSED •
FAILED •
AIR GAP INSPECTION: Required minimum air gap separation provided?
ye r
Detector Meter Reading
REMARKS: LINE PRESSURE I30 PSI
CONFINED SPACE?
TESTERS SIGNATURE: fr° y
CERT. NO. B -5206 DATE /2 /S / 11
TESTERS NAME PRINTED: TOBY SWANSON TESTERS PHONE # please see top of test report
REPAIRED BY: DATE
FINAL TEST BY: CERT. NO. DATE
CALIBRATION DATE: 12/27/10 KIT #: 12090296 MODEL: MIDWEST 845 -5 SERVICE RESTORED? YES NO ❑
I certify that this report is accurate, and I have used WAC 246- 290-490 approved test methods and test equipment.
I. PE
PLAN REVIEW /ROUTING SLIP
ACTIVITY NUMBER: PG11 -124 DATE: 08 -16 -11
PROJECT NAME: STARBUCKS COFFEE COMPANY
SITE ADDRESS: 3301 S NORFOLK ST
X Original Plan Submittal
Response to Correction Letter #
Response to Incomplete Letter #
Revision # After Permit Issued
DEPARTMENTS:
VLI
uilding Division
A. C
Public orks
i
Fire Prevention
Structural
n
Planning Division
Permit Coordinator
DETERMINATION OF COMPLETENESS: (Tues., Thurs.)
Complete
Comments:
Incomplete
n
DUE DATE: 08-18 -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
❑ No further Review Required
REVIEWER'S INITIALS: DATE:
APPROVALS OR CORRECTIONS:
Approved n Approved with Conditions
DUE DATE: 09-15-11
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
Contractors or Tradespeople,nter Friendly Page
1
General /Specialty Contractor
A business registered as a construction contractor with LItI 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 DB GENERAL CONTRACTORS INC UBI No. 602650709
Phone 2537362980 Status Active
Address 3320 West Valley Hwy D -106 License No. DBGENGC94309
Suite /Apt. License Type Construction Contractor
City Auburn Effective Date 9/29/2006
State WA Expiration Date 9/29/2012
Zip 98001 Suspend Date
County King Specialty 1 General
Business Type Corporation Specialty 2 Unused
Parent Company
Business Owner Information
Name
Role
Effective Date
Expiration Date
BEDNARIK, DEWAINE
President
09/29/2006
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
DEVELOPERS SURETY
Et INDEM CO
743855C
09/28/2006
Until Cancelled
$12,000.00
09/29/2006
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
5
Nationwide
Mutual Ins Co
ACP7505276908
09/28/2011
09/28/2012
$1,000,000.0009
/27/2011
4
Continental
Western Ins Co
CWP26515525
09/28/2010
09/28/2011
$1,000,000.0009
/22/2010
3
Continental
Western Ins Co
CWP265155
09/28/2008
09/28/2010
$1,000,000.00
09/10/2009
2
CONTINENTAL
WESTERN
CWP26515521
09/28/2007
09/28/2008
$1,000,000.0009
/28/2007
1
CONTINENTAL
CAS CO
CWP265155
09/28/2006
09/28/2007
$1,000,000.00
09/29/2006
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 10/24/2011