HomeMy WebLinkAboutPermit M10-182 - GRIBBON RESIDENCEThis record contains information which is exempt from public disclosure
pursuant to the Washington State Public Records Act, Chapter 42.56 RCW
as identified on the Digital Records Exemption Log shown below.
M10 -182
Gribbon Residence
1602248 th Avenue South
RECORDS DIGITAL D- ) EXEMPTION LOG
THE ABOVE MENTIONED PERMIT FILE INCLUDES THE FOLLOWING REDACTED INFORMATION
F,age # Code
Exemption � � �� Brief Explsnatoty Description, Statute /Rule
The Privacy Act of 1974 evinces Congress'
intent that social security numbers are a private
concern. As such, individuals' social security
Personal Information —
numbers are redacted to protect those
Social Security Numbers
individuals' privacy pursuant to 5 U.S.C. sec.
5 U.S.C. sec.
DR1
Generally — 5 U.S.C. sec.
552(a), and are also exempt from disclosure
552(a); RCW
552(a); RCW
under section 42.56.070(1) of the Washington
42.56.070(1)
42.56.070(1)
State Public Records Act, which exempts under
the PRA records or information exempt or
prohibited from disclosure under any other
statute.
Redactions contain Credit card numbers, debit
card numbers, electronic check numbers, credit
Personal Information —
expiration dates, or bank or other financial
RCW
9
DR2
Financial Information —
account numbers, which are exempt from
42.56.230(5)
RCW 42.56.230(4 5)
disclosure pursuant to RCW 42.56.230(5),
except when disclosure is expressly required by
or governed by other law.
GRIBBON RESIDENCE
16022 48 AV S
M10 -182
City oftukwila
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
MECHANICAL PERMIT
Parcel No.: 9198600050
Address: 16022 48 AV S TUKW
Project Name: GRIBBON RESIDENCE
Permit Number: M10 -182
Issue Date: 12/28/2010
Permit Expires On: 06/26/2011
Owner::
Name: GRIBBON RICHARD J
Address: 16022 48TH AVE S , TUKWILA WA 98188
Contact Person:
Name: DEBRA COONS
Address: 12462 DES MOINES MEMORIAL DR , SEATTLE WA 98168
Email: EMAIL @GLENDALEHEATING.COM
Contractor:
Name: GLENDALE HEATING & A/C
Address: 12462 DES MOINES WY S , SEATTLE, WA 98168
Contractor License No: GLENDHA053Q2
Phone: 206 243 -7700
Phone: 206 - 243 -7700
Expiration Date: 11/02/2011
DESCRIPTION OF WORK:
INSTALLATION OF NEW GAS FURNACE 90% EFFICIENCY
Value of Mechanical: $5,298.10
Type of Fire Protection: SMOKE DETECTORS
Permit Center Authorized Signature: 7
I hereby certify that I have read and
governing this work will be complie
Fees Collected: $205.65
International Mechanical Code Edition: 2009
Date: 12125 l0
x. ed this permit and know the same to be true and correct. All provisions of law and ordinances
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 mechanical permit and agree to the conditions on the
back of this permit.
Signature:
Print Name:
( "1
Date: 28 ) Ec • Zo 16
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: IMC -4/10
M10 -182 Printed: 12 -28 -2010
PERMIT CONDITIONS
Permit No. M10 -182
1: ** *BUILDING DEPARTMENT CONDITIONS * **
2: No changes shall be made to the approved plans unless approved by the design professional in responsible charge and the
Building Official.
3: AU permits, inspection records, and approved plans shall be at the job site and available to the inspectors prior to
start of any construction. These documents shall be maintained and made available until final inspection approval is
granted.
4: Manufacturers installation instructions shall be available on the job site at the time of inspection.
5: Except for direct -vent appliances that obtain all combustion air directly from the outdoors; fuel -fired appliances
shall not be located in, or obtain combustion air from, any of the following rooms or spaces: Sleeping rooms,
bathrooms, toilet rooms, storage closets, surgical rooms.
6: Equipment and appliances having an ignition source and located in hazardous locations and public garages, PRIVATE
GARAGES, repair garages, automotive motor -fuel dispensing facilities and parking garages shall be elevated such that
the source of ignition is not less than 18 inches above the floor surface on which the equipment or appliance rests.
7: Water heaters shall be anchored or strapped to resist horizontal displacement due to earthquake motion. Strapping shall
be at points within the upper one -third and lower one -third of the water heater's vertical dimension. A minimum
distance of 4- inches shall be maintained above the controls with the strapping.
8: All plumbing and gas piping work shall be inspected and approved under a separate permit issued by the City of Tukwila
Building Department (206- 431 - 3670).
9: All electrical work shall be inspected and approved under a separate permit issued by the City of Tukwila Building
Department (206- 431 - 3670).
10: VALIDITY OF PERMIT: The issuance or granting of a permit shall not be construed to be a permit for, or an approval of,
any violation of any of the provisions of the building code or of any other ordinances of the City of Tukwila. Permits
presuming to give authority to violate or cancel the provisions of the code or other ordinances of the City of Tukwila
shall not be valid. The issuance of a permit based on construction documents and other data shall not prevent the
Building Official from requiring the correction of errors in the construction documents and other data.
doc: IMC -4/10
M10 -182 Printed: 12 -28 -2010
CITY OF TUKrvILA
Community Development Department
Permit Center
6300 Southcenter Blvd., Suite 100
Tukwila, WA 98188
htto://www.ci.tukwila.wa.us
MECHANICAL 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 Address: ( low() 2-1 Ls- A Uc S .
Tenant Name: ' le 1 & gitskl, `/ (C„
Property Owners Name: D L 6_ (. g
Mailing Address: ((d CD 2,2 Li Sk'` 18-v3 5 -
Mailing Address:
King Co Assessor's Tax No.:
Suite Number:
Ic( cov(.3 sd
Floor:
New Tenant: ❑ Yes
❑ ..No
City
ki■1` "s3—( gg
Zip
State
G f A lifay Telephone: ( 6% 2 L( ° -i 'T p C�
2-Ut 9v--S M n rf.J S AlelvtabAL oe_ sue- wpr 5A' 16$
City
T State Zip
E -Mail Address: A ) L ►0A-L- f-4---)4\1-11^-1 0 C- {s\ Fax Number: (?tea %) 2 t,{ 5 -- -3 t-(t4
Company Name:
Mailing Address:
Contact Person:
E -Mail Address: €014-1 t L GL JD �} 197 NG - car”) Fax Number: e Kn -I v�
C ` l I I V`2-I 2-00
I
&LE NA) 4 L i Z lV (s- ? A t 2 & J OI .trt a✓.r + ,1Ar
r �{ 2 P t- c (Vl a t 114-,dm d1LI , L D- S Yd W.li c 8? b&
D State Zip
Day Telephone:(2...A.1s ) Z „cf 3 - 7% Ot)
Contractor Registration Number: L- i'i P + A- OS 3 Q 2_ Expiration Date:
Company Name:
Mailing Address:
Contact Person:
E -Mail Address:
City
Day Telephone:
Fax Number:
State
Zip
Company Name:
Mailing Address:
Contact Person:
E -Mail Address:
H:\ApplicationsTorms- Applications On Line\2010 Applications \7 -2010 - Mechanical Permit Application.doc
Revised: 7 -2010
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City
Day Telephone:
Fax Number:
State
Zip
Page 1 of 2
• •
Valuation of project (contractor's bid price): $
Scope of work (please provide detailed information): 1 •(.s 4rAtir-'i1 to or N e-A-S
,24,1 ft---PC 9 o 7 cxr,
Use: Residential: New '0 Replacement
Commercial: New ❑ Replacement ❑
Fuel Type: Electric ❑ Gas ...
Other:
Indicate type of mechanical work being installed and the quant'ty below:
a.:x.� z c,� t
YP ��._ i t.,
� r
Qty..;
S ��; .
Umt -Type �;:�ti r. „
„Qty•,
h<<u:;� H
KUoit3Type:t�
kg
Qty ..Bioler
_ , :
/Compressor a, 1
Qty
furnace <100k btu
!
I
air handling unit
>10,000 cfm
fire damper
0 -3 hp /100,000 btu
furnace >100k btu
evaporator cooler
diffuser
3 -15 hp /500,000 btu
floor furnace
ventilation fan connected
to single duct
thermostat
15 -30 hp /1,000,000
btu
suspended/wall/floor
mounted heater
ventilation system
wood/gas stove
30 -50 hp /1,750,000
btu
appliance vent
hood and duct
emergency
generator
50+ hp /1,750,000 btu
repair or addition to
heat/refrig/cooling system
Incinerator - domestic
other mechanical
equipment
air handling unit <10,000
cfm
incinerator - comm/ind
PERMITAPPLICATION 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 additional periods not to exceed 90 days each. The extension shall be requested in writing
and justifiable cause demonstrated. Section 105.3.2 international building code (current edition).
I HEREBY CERTIFY I HAVE READ AND EXAMINED THIS APPLICATION AND KNOW THE SAME TO BE TRUE UNDER
PENALTY OF PE / :. LAWS OF THE S s; 1 = WA 1 GTON, AND I AM AUTHORIZED TO APPLY FOR THIS PERMIT.
Date: / Z ' v0 —/A)
Print Name: �z ,L - Day Telephone: C2o 4) Lq 3 -/ ? 70 O
Mailing Address: 2 / /tom ✓y%n i i✓ 1% i2U7� 57�/
City State Zip
Date Application Accepted:
Date Application Expires:
Staff Initials:
H:Upplicat ions \Forms - Applications On Line\2010 Applications \7 -2010 - Mechanical 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.tukwila.wa.us
RECEIPT
Parcel No.: 9198600050 Permit Number: M10 -182
Address: 16022 48 AV S TUKW Status: PENDING
Suite No: Applied Date: 12/28/2010
Applicant: GRIBBON RESIDENCE Issue Date:
Receipt No.:
Initials:
User ID:
R10 -02571
JEM
1165
Payment Amount: $205.65
Payment Date: 12/28/2010 12:33 PM
Balance: $0.00
Payee: GLENDALE HEATING AND AIR CONDITIONING
TRANSACTION LIST:
Type Method Descriptio Amount
Payment Check 64376 205.65
Authorization No.
ACCOUNT ITEM LIST:
Description
Account Code Current Pmts
MECHANICAL - RES
000.322.102.00.00 205.65
Total: $205.65
doc: Receiot -06 Printed: 12 -28 -2010
•
° • - •.,':,
Contractors or Tradespeople liter Friendly Page
•
General /Specialty Contractor
A business registered as a construction contractor with L8I 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
Phone
Address
Suite /Apt.
City
State
Zip
County
Business Type
Parent Company
GLENDALE HEATING a A/C INC
2062437700
12462 Des Moines Wy S
Seattle
WA
981682266
King
Corporation
UBI No.
Status
License No.
License Type
Effective Date
Expiration Date
Suspend Date
Specialty 1
Specialty 2
600003167
Active
GLENDHA053Q2
Construction Contractor
11/22/1995
11/2/2011
General
Unused
Other Associated Licenses
License
Name
Type
Specialty 1
Specialty 2
Effective
Date
Expiration
Date
Status
GLENDHO110PU
GLENDALE
HEATING
a OIL CO
INC
Construction
Contractor
General
Unused
10/31/198911/2/1995
01/01/1980
Archived
GLENDO'237DM
GLENDALE
OIL CO
INC
Construction
Contractor
Boiler /Steam
Fit /Prot
Piping
A
Air
Heat,Ventilation,Evaporat
3/14/1977
11/2/1989
Archived
Business Owner Information
Name
Role
Effective Date
Expiration Date
HOEFER, ARTHUR A
Impaired Date
01/01/1980
Received Date
HOEFER, GERALD A
3/11/1977
1/20/2009
Bond
$1,000.00
1/20/2009
Insurance Information
Insurance
Company Name
Policy Number
Effective Date
Expiration Date
Cancel Date
Impaired Date
Amount
Received Date
11
WESCO
INSURANCE
COMPANY
WPP101953800
11/02/2010
11/02/2011
$1,000,000.0010
/29/2010
10
FEDERATED
MUTUAL INS CO
0715288
11/02/2004
11/02/2011
11/23/2010
$1,000,000.00
09/27/2010
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
12/28/2010
EGIS TRALTION ER F [ _
981b8
LF625-052-000 (8/97)
DEPARTMENT OF LABOR AND I \DL`
REGISTERED AS PROVIDED BY LAW AS
CONST CONTR GENERAL
REGIST. # EXP. DATE
CCO1 GLENDHA053Q2 11/2/2011
EFFECTIVE DATE
GLENDALE HEATING & A/C INC
12462 DES MOINES WY S
SEATTLE WA 98168 -2266
DEPARTMENT OF LABOR AND INDUSTRIES
LICENSED AS PROVIDED BY LAW AS
ELEC CONTR HVAC/RFRG
SE #;
EXP. DATE
2/14/2012
/14/2000
GLENDALE\HEATING & A/C
12462 DES MOINES MEMORIAL DR
SEATTLE WA 98168 -2266
F625- 052 -000 (8/97)
L