HomeMy WebLinkAboutPermit MI02-018 - LEE RESIDENCE - DEMOLITIONJAMES LEE
DEMO
M102-01 8
City ofTukwila
Department of Community Development / 6300 Southcenter BL, Suite 100 / Tukwila, WA 98188 / (206) 431 -3670
Parcel No.: 3347401425
Address:
Suite No:
4622 S 122 ST TUKW
MISCELLANEOUS PERMIT
Permit Number: MI02 -018
Issue Date: 02/11/2002
Permit Expires On: 08/10/2002
Tenant:
Name: LEE RESIDENCE
Address: 4622 5 122 ST, TUKWILA, WA
Owner:
Name: KAUFMAN HENRY
Address: PO BOX 4428, KENT WA
Contact Person:
Name: JAMES LEE
Address: 2222 76TH AVENUE SE, MERCER ISLAND, WA
Contractor:
Name: 66(4-Ay / et,,�+% c�c..:,.r" r..
Address: ,
Contractor License No:
Ck-c0J.'„i\
Phone:
Phone: 206 235-2526
Phone:
Expiration Date:
DESCRIPTION OF WORK:
DEMOLISHING 1,000 S.F. SINGLE FAMILY RESIDENCE.
PUBLIC WORKS ACTIVITIES INCLUDE SEPTIC ABANDONMENT (SEWER WAS NEVER CONNECTED TO THIS RESIDENCE)
AND WATER SERVICE CAPPING; EXISTING WATER METER STAYS FOR FUTURE SFR CONSTRUCTION AT A LATER DATE.
Value of Construction: $2,000.00
Type of Fire Protection: N/A
Type of Construction:
Fees Collected:
Uniform Building Code Editions
Occupancy per UBC:
$71.50
1997
0007
Public Works Activities:
Curb Cut/Access/Sldewalk/CSS: N
Fire Loop Hydrant: N
Flood Control Zone: N
Hauling: N
Land Altering: N
Landscape Irrigation: N
Moving Oversize Load: N
Sanitary Side Sewer: Y
Sewer Main Extension: N
Storm Drainage: N
Street Use: N
Water Main Extension: N
Water Meter:
Channelization / Striping:
Number: 0
Size (Inches): 0
Start Time: End Time:
Volumes: Cut 0 c.y. Fill 0 c,y.
Start Time: End Time:
Private: Public:
Private: Public:
** Continued Net Page **
doc: Miscperm
M102 -018
Printed: 02-11-2002
City of
Department of Community Development / 6300 Southcenter BL, Suite 100 / Tukwila, WA 98188 / (206) 431 -3670
Permit Center Authorized Signature: Date:
l-'
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 constru • . or the performance of work. I am authorized to sign and obtain this mechanical permit.
Signature:
Print Name:
Date: // "' d
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: Miscperm
MI02.018
Printed: 02.11.2002
City ofTukwila
Department of Community Development / 6300 Southcenter BL, Suite 100 / Tukwila, WA 98188 / (206) 431 -3670
Parcel No.: 3347401425
Address: 4622 S 122 ST TUKW
Suite No:
Tenant:
LEE RESIDENCE
PERMIT CONDITIONS
Permit Number:
Status:
Applied Date:
Issue Date:
M102 -018
ISSUED
02/01/2002
02/11/2002
1: ** *BUILDING DEPARTMENT * **
2: No changes will be made to the plans unless approved by the Engineer and the Tukwila Building Division.
3: All permits, inspection records, and approved plans shall be available at the Job site prior to the start of any construction. These
documents are to be
maintained and available until final inspection approval is granted.
4: All construction to be done in conformance with approved plans and requirements of the Uniform Building Code (1997 Edition) as
amended, Uniform Mechanical Code
(1997 Edition), and Washington State Energy Code (1997 Edition).
5: Validity of Permit. The issuance of a permit or approval of plans, specifications, and computations shall not be con- strued to be a
permit for, or an approval
of, any violation of any of the provisions of the building code or of any other ordinance of the jurisdiction. No permit presuming to
give authority to violate
or cancel the provisions of this code shall be valid.
6: ** *PUBLIC WORKS DEPARTMENT * **
7: The applicant must notify the City Utility Inspector at (206)433.0179 upon commencement and completion of work at least 24
hours In advance. All inspection
requests for utility work must also be made 24 hours In advance.
8: Any material spilled onto any street shall be cleaned up Immediately.
9: Hauling over 50 cubic yards shall require application for a Hauling Permit prior to any associated activity.
10: Temporary erosion control measures shall be Implemented as the first order of business to prevent sedimentation off -site or into
existing drainage facilities.
11: From October 1 through April 30, cover any slopes and stockpiles that are 3H:1 V or steeper and have a vertical rise of 10 feet or
more and will be unworked for
greater than 12 hours, During this time period, cover or mulch other disturbed areas, if they will beunworked more than 2 days.
Covered material must be
stockpiled on site at the beginning of this period. Inspect and maintain this stabilization weekly and Immediately before, during and
following storms.
12: From May 1 through September 30, inspect and maintain temporary erosion prevention and sediment at least monthly. All
disturbed areas of the site shall be
permanently stabilized prior to final construction approval.
13: Any septic tanks in the area shall be pumped empty and removed or filled with sand. A copy of the documentation from the
business that performed the pumping
shall be provided to the City Utilities Inspector.
14: Sewer and water utilities shall be plugged at the mains if they are to be abandoned. If they will be used again in the near future for
a new building, they
shall be capped at the property line and at the water meter respectively.
I hereby certify that I have read these conditions and will comply with them as outlined. 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 provision of any other work or local laws
doc: Conditions
MI02.018
Printed: 02-11-2002
i;
City of iktikwila
Department of Community Development / 6300 Southcenter BL, Suite 100 / Tukwila, WA 98188 / (206) 431 -3670
regulating construction or the performance of work,
Signature:
Print Name:
( doc: Conditions
Date:
MI02.018
Printed: 02. 11.2002
CITY OF T ``KWILA
Permit Center
6300 Southcenter Boulevard, Suite 100
Tukwila, WA 98188
(206) 431 -3670
SIAMI USE ONIY
Project Number:
Permit Number:
Miscellaneous Permit Application
Application and plans must be complete in order to be accepted for plan review.
Applications will not be accepted through the mail or facsimile.
Project Name/Tenant: 3
e_,
_
• bove Ground Tanks Antennas/Satellite Dishes Bulkhead/Docks Commercial Karoo(
srA Demolition ❑ Fence ❑ Manufactured Housinetepiacetnent only
Parkin Lots ❑ Retttlnin, Walls ❑ Tem oral Facilities NU 'free Westin,
Name:
Value of Con r t ii0O 0
Site Address :
Vb. 2/ �0 .
/2. z
-- --ii,,
City City State/Zip:
la /wit vas
Tax Parcel Number:
33 t-ovo - / v zs -- 63
City /Stale /Zip:
Property Owner:
,�
��(
76 -
G`C
- 1
Ci y State/Zip:
7ieul /tO1 "f
Phone: (2v6) 235,_ 03-260
,
Street Address:
vzZ '
Fax II: (2�) 2-7.$ - Z (� / 6
rz..
Phone: ( )
Contractor:
�%QQ
/ 4!
Street Address:
City State/Zip:
Fax 11: ( )
Architect:
Phone: ( )
r
Street Address:
City State/Zip:
Fax #: (
Engineer:
Phone: ( )
Street Address:
City State/Zip:
Fax ii: ( )
Contact Person:
Phone: ( 406)
Street Address:
22Z-
�%t�
,,,,/
Ci tate/Zip: Fax N: ( )
9,y ... .. �..,. 7�t 2T5_ z�r
MISCELLANEOUS PERMIT REVIEW AND APPROVAL REQUESTED: (TO OE FILLED OUT RYAPPLICANT)
Description of work to be done (please be specific):
.
��aCe Z4'�/V '� /I'l � � 7.0 t! r •e)e.-'*• 'tea/ -
Will there be storage of flammable/combustible hazardous material in the building? ❑ yes no
Attach /1st 0/materials and story a location on se orate O 1/2 X 11 in ur Indicatin c uarttltles & Material Stet Data Sheets
• bove Ground Tanks Antennas/Satellite Dishes Bulkhead/Docks Commercial Karoo(
srA Demolition ❑ Fence ❑ Manufactured Housinetepiacetnent only
Parkin Lots ❑ Retttlnin, Walls ❑ Tem oral Facilities NU 'free Westin,
APPLICANT RE a UEST FOR MISCEL NEOUS PUBLIC WORKS PERMITS
I Gl;nnolizetion/Striping
❑ Flood Control Zone
❑ Landscape Irrigation
❑ Storm Drainage
❑ Water Motor /Exempt iq
A Water Meter /Permanent II
Water Meter Temp it_
❑ Miscellaneous
Lr Gurb cut/Accoss /SidewalIlooi►/t°lydrant (main to v;tult)N: Size(s):
❑ Land Altering: 0 Cut cubic yir I 0 Fill. cubic: yards 0. fl,gratling/cloaring
EM Sanitary Side Sewer IS. ,!�u�• ❑ Sewer Main Extension • 0 Private 0 Public
Street Uso ❑ Water Main Extension 0 Private 0 Public
t
_, Size(s): „_,,,_ 0 Deduct 0 Water Only
Sizo(s):
Size(s): !._. .. Est, quantity: gal Schedule:
❑ Moving Oversized Load /Mauling
N6
MONTHLY SERVICE BILLINGS TO:
Name:
Phone:
Address:
City /Stale /Zip:
0 Water
0 Sewer
0 Metro
0 Standby
WATER METER DEPOSIT/REFUND BILLING:
Name:
Phone:
Address:
City /Sta e/Zip:
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 extend the time for action by the applicant for a periort not exceeding 180 days upon written request by the applicant as defined
in Section 107.4 of the Uniform fuilding Code (current edition). No application shall be extended mote than once.
Date application accepted: �1
( /� -C/
9/9/99
miscpurr.doc
Date application expires:
Application taken by: (initials)
s
ALL MISCELLANEOUS PER. APPLICATIONS MUST BE SUBMITT
ITH THE FOLLOWING:
)• AU. DRAWINGS SHALL I3E AT A LEGIBLE SCALE AND NEATLY DRAWN
> BUILDING SITE PLANS AND UTILITY PLANS ARE TO BE COMBINED
)• ARCHITECTURAL DRAWINGS REQUIRE STAMP BY WASHINGTON LICENSED ARCHITECT
• STRUCTURAL CALCULATIONS AND DRAWINGS REQUIRE STAMP BY WASHINGTON LICENSED
STRUCTURAL ENGINEER
Y
CIVIL/SITE PLAN DRAWINGS REQUIRE STAMP BY WASHINGTON LICENSED CIVIL ENGINEER (P.E.)
•
.. . •
0 Current copy of Washington State Department of labor and Industries Valid Contractor's License. If not
available at the time of application, a copy of this license will be required before the permit is issued, unless the
homeowner will be the builder OR submit Flinn 114, "Affidavit in Lieu of Contractor Registration ".
BUllding,Owner /Authorized Agent If the applicant Is other U, the owner, registered architect/engineer, or contractor
licensed by the State of Washington, a notarized letter from the property owner authorizing the agent to submit this
mitt . 'notion and obtain the emit will be re ulrcd as art of this submittal.
I HEREBY CERTIFY THAT I IIAVE READ AND EXAMINE:) THIS APPLICATION AND KNOW THE SAME TO BE TRUE UNDER
PENALTY OF PENURY BY THE LAWS OF THE STATE OF WASHINGTON, AND I AM AUTIIORIZED TO APPLY FOR THIS PERMIT.
BUILDING OW ER OR AUTHORIZED AGENT:
Submit checklist No: M -9
Above Ground Tanks/Water Tanks - Supported directly upon grade
exceeding 5,000.gallons and a ratio of height to diameter or width which
exceeds 2:1
0
"Antennas /Satellite Dishes
Submit checklist No: M -1
0
; Bulkhead /Dock
u
Submit checklist No: M -10 ,
0
Commercial Reroof
Submit checklist No: M -6 .
0
Demolition ,
Submit checklist No: M -3
0
Fences - Over 6 feet in Height
Submit checklist No: M -9
0
Land Altering/Grading/Preloads
Submit checklist No: M -2
Miscellaneous Public Works Permits
Submit checklist No: H -9
0
Manufactured,Housing (RED INSIGNIA ONLY)
Submit checklist No: M -5
0
Moving Oversized Load/Hauling ': I °
Submit checklist No: M -5
0
Parking Lots . •
Submit checklist No M-4
in
. Retaining Walls • Over 4 feet in height
Submit checklist No: M -1
0
Tetnporary Facilities
Submit checklist No: M -7
0
Tree Cutting
Submit checklist No: M -2
0 Current copy of Washington State Department of labor and Industries Valid Contractor's License. If not
available at the time of application, a copy of this license will be required before the permit is issued, unless the
homeowner will be the builder OR submit Flinn 114, "Affidavit in Lieu of Contractor Registration ".
BUllding,Owner /Authorized Agent If the applicant Is other U, the owner, registered architect/engineer, or contractor
licensed by the State of Washington, a notarized letter from the property owner authorizing the agent to submit this
mitt . 'notion and obtain the emit will be re ulrcd as art of this submittal.
I HEREBY CERTIFY THAT I IIAVE READ AND EXAMINE:) THIS APPLICATION AND KNOW THE SAME TO BE TRUE UNDER
PENALTY OF PENURY BY THE LAWS OF THE STATE OF WASHINGTON, AND I AM AUTIIORIZED TO APPLY FOR THIS PERMIT.
BUILDING OW ER OR AUTHORIZED AGENT:
Signature:
Date:
Print name: lie
.a.,
Phano: ( No l j j'= 75-7(0
Fax II: l Z 06 l 27C-7 6/
Address: rtp
_7 /7, 2•2- 6 -= l~t.. oar .
City /Stntr�7ip: r� 4j.f'�'�jb
lidariaLT l M v"rr
9/9/99
tnlscpnu.d is
City of '1 ukwila
At,
6300 Southcenter BL, Suite 100 / Tukwila, WA 98188 / (206) 431 -3670
Parcel No.:
Address:
Suite No:
Applicant:
Receipt No,:
Initials:
User ID:
Payee:
3347401425
4622 S 122 ST TUKW
LEE RESIDENCE
R020000203
SKS
1165
JAMES KOWK LEUNG LEE
TRANSACTION LIST:
Amount
Type
RECEIPT
Permit Number:
Status:
Applied Date:
issue Date:
M102 -018
APPROVED
02/01/2002
Payment Amount: 71.50
Payment Date: 02/11/2002 11:09 AM
Balance: $0.00
Method Description
Payment
ACCOUNT ITEM LIST:
Check 1371
Description
Current Amts
71.50
Account Code
BUILDING - NONRES
INSP FEE - SME /SSS
STATE BUILDING SURCHARGE
000/322.100
402/342.400
000/386.904
47,00
20.00
4.50
Total: 71.50
3 729 02/12 47710 TOTAL 71.50
doa: Receipt
Printed: 02 -11 -2002
}
INSPECTION NO,
CITY OF TUKWILA BUILDING DIVISION
6300 Southcenter Blvd, #100, Tukwila, WA 98188
INSPECTION RECORD
Retain a copy with permit
PERMIT NO,
a 11
(206)431-3.70
P oject: , /
e .` % fC2
Type + f lnspectio :
/"IA
Aid ess: _ S % S �
Date . .....: 7
ty
Specie instructions: .jy 40// vie.
Date ante
a.
Rog o
Approved por applicable codes.
COMMENTSs
Corrections required prior to approval.
Inspector:
Date: L
$47.. REINSPECTION E EQUIRED. Prior to inspection, fee must be paid
at 6300 Southcenter Blvd. cite 100. CaII to schedule reins.ection.
Receipt No: Date:
INSPECTION NO,
CITY OF TUKWILA BUILDING DIVISION
6300 Southcenter Blvd, #100, Tukwila, WA 98188
INSPECTION RECORD
Retain a copy with permit
PERMIT N
(206)431 -3670
Project:
,/f 7 ,
:,` "tie, >!eC°
Type of Inspection:
:'e - L `'rl/Ci
:
A ress.
.
Date cal e .
Special Instructions:
f
Date wanted:
1..y
a,m. .
ti. v
Requester:
Phonq;
Approved per applicable codes,
Corrections required prior to approval,
COMMENTS:
111.1_Tii e-
wit r.4:L'
iiiimuummisimisomm
�C1.1.1T10211
//1 dill •
i111.101 r
Inspector Date:
$47. � • INSPE 10 ;1 E REQUIRED. Prior to inspection, fee must be paid
at 6300 Southcenter Blvd., Suite 100. CaII to schedule reins ' ection,
Receipt No:
Date:
INSPECTION RECORD
Retain a ropy with permit
INSPECTION NO,
CITY OF TUKWILA BUILDING DIVISION
6300 Southcenter Blvd, #100, Tukwila, WA 98188
02-018
PERMIT NO,
(206)431 -3670
Project: Lee, Residence,
Type of Inspection: l )74 ii
Ad ress: , 622 s /22nd s►
Date called: 449, .. 02
Specie Instructions:
/ft► w/Vam'f aid
1/d9 ,141spee,
Date wants : �� Z"Q 2 �a,m.
p,m.
Requester:
/IVY) e.5
Phone;
2a4- 235 -25z 4
Approved per applicable codes,
Corrections required prior to approval,
tr�rrra►�n�:T
/ IRE
Inspector:
Date:
$47,00 RUNSPECTION tlE REQUIRED, Prior to Inspection, fee must be paid
at 6300 Southcenter Blvd., Suite 100. CaII to schedule reins ' ection.
Date:
:t
ti
PERMIT COORD COPY
PLAN REVIEW /ROUTING SLIP
ACTIVITY NUMBER: MI02 -018
PROJECT NAME: JAMES LEE - DEMOLITION
SITE ADDRESS: 4622 SOUTH 122 " STREET
Original Plan Submittal
Response to Correction Letter #
Response to incomplete Letter #
Revision # Permit Is Issued
'DEPARTMENTS:
BulldinlJivision C%
tJ 2 4CZ
Public Works
zuL 2
Fire Prevention E
to. 2 •(, -O "
Structural
Planningb ision L
4- 24 '4)
Permit Coordinator
DETERMINATION OE COMPLE ENESS: (Tues., Thurs.)
Complete [21
Comments:
Incomplete
DUE DATE: 02 -05 -02
Not Applicable El
TUES /THURS ROUTING:
Please Route Structural Review Required ❑ No further Review Required
DATE:
REVIEWER'S INITIALS:
APIIIQYALIDIUMBRELIONS: (ten days)
Approved E Approved with Conditions
REVIEWER'S INITIALS:
DUE DATE 03 -05 -02
Not Approved (attach comments) El
DATE:
CORRECTION DETERMINATION:
Approved ❑ Approved with Conditions L___.
REVIEWER'S INITIALS:
WRROUTE.DOC
5/99
DUE DATE
Not Approved (attach comments) Lil
DATE:
PERMIT COORD COPY
PLAN REVIEW /ROUTING SLIP
ACTIVITY NUMBER: MI02 -018 DATE: 02 -01 -02
PROJECT NAME: JAMES LEE is DEMOLITION
SITE ADDRESS: 4622 SOUTH 122ND STREET
.Original Plan Submittal ___.Response to Incomplete Letter #
Response to Correction Letter # — „Revision # Permit Is Issued
PEPARIMENI S:
Building Division
Public Works
Fire Prevention
Structural
Planning Division
❑ Permit Coordinator
DETERMINATION O S OMPLETENES : (Tues., Thurs.)
Complete 153:(
Comments:
Incomplete
DUE DATE 02 -05 -02
Not Applicable ❑
TUES /THURS ROUTING:
Please Route El Structural Review Required
REVIEWER'S INITIALS:
No further Review Required
DATE:
APPROVALS OR C.OKR CIMS: ((en days) DUE DATE 03 -05 -02
Approved Ej Approved with Conditions Not Approved (attar cam ► ents) E
REVIEWER'S INITIALS:
DATE:
CORRECTION DETERMINATION:
Approved ❑ Approved with Conditions E
REVIEWER'S INITIALS:
1PRROUTR.00C
5/99
DUE DATE
Not Approved (attach comments) ❑
DATE:
ti
:!)
m.si
ig
}
PLAN REVIEW /ROUTING SLIP
ACTIVITY NUMBER:
PROJECT NAME: LAMES LEE - DEMOLITION
SITE ADDRESS: 4622 SOUTH 122 "d STREET
M102 -018
,,.Original Plan Submittal
DATE: 02 -01 -02
Response to Incomplete Letter #
Response to Correction Letter # Revision # After Permit Is Issued
Die A T� MENTS:
Building Division
Public Works
Fire Prevention
Structural
Planning Division
Permit Coordinator ❑
DETERMINATION OF COMEL(IENESS: (Tues., Thurs.) DUE DATE: 02 -05 -02
Complete
Comments:
Incomplete
Not Applicable ❑
TUES/THURS ROUTING:
Please Route ❑ Structural Review Required
REVIEWER'S INITIALS:
No further Review Required
DATE: " Q?
: (ten days)
DUE DATE 03 -05 -02
Approved LJ Approved with Conditions 0 Not Approved (attach comments) El
REVIEWER'S INITIALS:
DATE:
CQKKECTION PFJERMINATION:
Approved ❑ Approved with Conditions
REVIEWER'S INITIALS:
WRROUTE.DOC
5/99
DUE DATE
Not Approved (attach comments) E
DATE:
1
PLAN REVIEW /ROUTING SLIP
ACTIVITY NUMBER: MI02 -018
PROJECT NAME: JAMES LEE - DEMOLITION
SITE ADDRESS: 4622 SOUTH 122' STREET
jiapriginal Plan Submittal
DATE: 02 -01 -02
Response to Incomplete Letter #„_
Response to Correction Letter # # Permit Is Issued
DEPARTMENTS:
Building Division ❑
Public Works ❑
Fire Prevention
Structural
Planning Division
Permit Coordinator ❑
DETERMINATION OF COMPLETENESS: (Tugs., Thurs.)
Complete El
Comments:
Incomplete
DUE DATE: 02 -05 -02
Not Applicable ❑
TUES/THURS ROUTING:
Please Route ❑ tr ct raI Review Required ❑ No further Review Required
.n
REVIEWER'S INITIALS: ,_ _v.1..... � DATE: i1•
(ten days)
DUE DATE 03 -05 -Q2
Approved ED Approved with Conditions ❑ Not Approved (attach comments) LJ
REVIEWER'S INITIALS: DATE:
cORRECTION DETERMINATION: DUE DATE
Approved E. Approved with Conditions E Not Approved (attach comments) E
REVIEWER'S INITIALS: DATE:
WRROUTE.DOC
5/99
PLAN REVIEW /ROUTING SLIP
ACTIVITY NUMBER:. MI02 -018
PROJECT NAME: DAMES LEE - DEMOLITION
SITE ADDRESS: 4622 SOUTH 122 " STREET
.21.OrIginai Plan Submittal
DATE: 02 -01 -02
Response to Incomplete Letter #
Response to Correction Letter # # Permit Is Issued
jJ
QJPARIMENIS:
Building Division
Public Works
Fire Prevention
Structural
Planning Division
❑ Permit Coordinator
DETE MINATION OF COMPLETENESS: (Tues., Thurs.)
Complete ❑
Comments:
Incomplete
DUE DATE: 02 -05 -02
Not Applicable El
TUES/THURS ROUTING:
Please Route g Structural Review Required
REVIEWER'S INITIAL
No further Review Required
DATE: pi. a
(ten days)
Approved Ej Approved with Conditions g
REVIEWER'S INITIALS: 5 9C4, c�
CORRECTION DETERMINATION:
Approved E Approved with Conditions ri
REVIEWER'S INITIALS:
WRROUTE.DOC •
5/99
DUE DATE 03 -05 -02
Not Approved (attach comments) L_.!
DATE: Z 02
DUE DATE
Not Approved (attach comments)
DATE:
1
it
ti
PERMIT NO.: D Q( S
BUILDING PERMITS
INSPECTIONS
0
❑
• 1 Progress Inspection Status
2 Pre - construction
3 investigation
• 4 OK to Occupy
• 5 Remove Stop Work Order
6 Follow -up
• 7 Pre -Move Inspection
50 WSEC Residential
0
60 WA Ventilation/Indoor AQC
70 NLEA inspection/Modular Struct
71 Mobile home Tie Down Insp
72 Marriage Lines
90 Rested
95 pouting Drains
❑ 100 Foundation Footings
❑ 200 Foundation Walls
250 Foundation Insulation
300 Concrete Slab /Slab Insulation
350 Crawl Space
400 Shear Wall Nailing
450 Plywood Wall Sheathing
500 Roof Sheathing Nailing
525 Plywood Deck Nulling
550 Exterior Wall Sheathing
600 Masonry Chimney
610 Chimney InstullutluNAll Types
700 Framing
750 Roof/Ceiling Insulation
800 Flour Insulation
801 Wall Insulation
802 Exterior Root' Insulation
803 Glazing Inspection
815 Lighting and Controls
900 Suspended Ceiling
000 Interior Wallboard Fastening
001 Exterior Wallboard Fastening
110 Pre -Move Inspection
115 Motor Inspection
120 Pre -Derno
140 Pre- reroot'
400 Final-Fire
700 Phial-Building
900 Final•Reroof
3100 Site Visit
4000 Special- Concrete
4001 Special -Bolts in Concrete
4001 Special- Mon/Resist Cone Frame
4003 Spccial•Reinf Steel Prestress
❑ 4004 Special - Welding
4005 Special•tiigh•Strength Bolting
4006 Special- Structural Masonry
4007 Special -Reinf Gypsum Concrete
4008 Special - insulating Cone Fill
❑ 4009 Special -Spray Fireproofing
❑ 4010 Special-Piling, Piers, Caissons
❑ 4011 Special•Shotcrete
❑ 4012 Special-Grading, Excav /Fill
❑ 4013 Speciul•Retaining Wall
❑ 4014 Special - Panels
❑ 4015 Special -Smoke Control System
TENANT NAME: -S4Vb
CONDITIONS
0001 No changes will be made to the plans unless approved
by the Engineer and the Tukwila Building Division
O 0002 Plumbing permits shall be obtained through King Co
❑ 0003 Electrical permits obtained through L & 1
❑� 0004 All mechanical work shall be under separate permit
0003 All permits, insp records & approved plans available
❑ 0006 All structural concrete shall be special inspected
❑ 0007 All structural welding shall be done by WABO certified
inspector
❑ 0008 All high- strength bolting shall be special inspected
O 000') ...,130115 installed in concrete shall be special inspected
❑ 0010 When special inspection is required...notO Tukwila
Building Division
❑ 001 t The special inspector 311011 submit a final signed report
❑ 0012 Any new ceiling grid and light fixture installation
❑ 0013 Partition walls attached to ceiling grid
O 0014 i eadily accessible ncccss ftl rool'tntlunied equipment
❑ 0015 Engineered truss drawings & rules shall be on site
❑ 0016 Any exposed insulation backing material shall have
❑ 01117 Subgrndc preparation including drainage, excavation
O 01)18 A statement froth thhe roofing contractor veril�'Ing lire
retardant class or roof'
0019 All construction to be done in conformance w /approved
plans
0020
0 0021 Structural observation shall be provided for this protect
All food preparation establishments must have King Co
❑ 1)1)22 <...„,• Fire retardant treated wood shall have Ilance spread of
❑ 0023 ...,.•, Notify Building Division prior to placing any concrete
0024 All spray applied Ilrcprooiing shall be special inspected
0025 All wood to remain in placed concrete shall be treated
0026 All structural masonry shall be special inspected
4 . 0027 Validity of Permit
❑ 0028 Rack storage requires separate permit
0030 No occupancy of building until final htsp by Bldg Div
0031 Comply with requirements o1" i'NIC 16,04
0032 Remove all weeds, concrete, stone foundations, flat
concrete
❑ 0034 Removal of septic tanks require approval and
compliance with King Cu !IMO) Dept.
0035 ,,,,.,Contact PW Div to obtain Insp for water /sower connect
0036 .,.,.,, Manufacturers installation instructions required on site
0038 .....,,, A C ot'O will be required for this permit
0039 Final approval for all TI w /in the !links of too SC Mull
O 00401 ..,...,All construction noise to be in compliance with 8.2 TMC
❑ 0041 Veniilutiun is required for ull new rooms & spaces
0047
0043
0044
0045
Fuel burning appliances
Appliances, which generate
Water heater shall be anchored
Reroof
"Anchoring — All new construct and substantial
improvement shall be anchored to prevent flotation"
Permit Tech:
Date: 2 05/b.
Date:
I§
lg
Agency Case No.
200200219
PUGET SOUND CLEAN A
110 Union Street, Suite 500
Seattle, WA 98101 -2038
www.pscleanair.org
NOTICE OF INTENT
kGENCY
A. Project Type: L. ❑ Asbestos Removal
2. Er Asbestos Removal & Demolition
Date Received
RECEIVED
JAN 2 2 2002
Agency Use Only .
‘ t -Ide r IAN
ARA
3. ❑ Demoiittoon, No Asbestos Removal
B.
Property Owner: J/4 /'1C • 1 C�
Phone: 2 oc) 2 3 -
Mailin Address: 2.2 274- ?t' -;t-6 Ate.
r
City: /C'A
State G4lii `
zin: Ve> 0
C. Asbestos
Contractor:
PLEASE PRINTCLEARLT THIS WILL BE TOUR RETURNM.4lLIlG LABEL
. 1 /�''• . � .
Owner /CEO:
✓/t4/.?/
Mailin: Address:
L
/,
76. ffi(/`e `
Phone: ZG7L'
2�' y °_Z
Z�
Contractor
Job No.:
SE:
Other;
$300
State:
zi :
Fax: '2.47(..)-
2-75. " 2'
/6'
D. Site
Address: �6J,2- �� • � ; �' � City: /r�,�ety� < «. zip: ��:�/ 7
Site
Manager:
1-ew. ?t ra Phone:
c.2&
Ei , 2 Asbestos Survey or No, of
0 Mat'i Presumed Structures:
n
Date Asbestos Survey
was Conducted: /- 17 - CAL
urvey t rcnu rc
Ore a t Clap Itlon pro COI
A1IEK.A Duilding Inspector: /(44
Was Friable Asbestos Identified? -YesNo —
Was Nonfrinble Asbestos Identified? CI Yes ONo
Attach a copy of the survey, ifnonfriable asbestos is
identified or if no asbestos is identified on survey.
Certification No,: �� S/ t;xp, Date: 41. 27 '4)2- State: G✓A
Demolition Start No, of 1. `!'raining Fire (List Fire Dept.)
Information: Date: .3 0 Structures; ?. GrOrdered Demolition (attach co ) of Oidrt )
/Hier! drinphlfon r-nlrnrl r ,r mailing on back, demo'? " Yes
No
Demolition ur Will nontriable asbestos be left in place during
Contractor: 1 To B e, D -fe if yes, list tyke and qty. ,
G. Asbestos Project
Information:
Start Date; / `.' / "` to �'•
Corn lotion Date; /' 2/" e'er
Work Days:0 I W Th F Sa Su —___
Hours: / 7t e+1 4.
Total • t , to be Removed: Linear Ft.
S. uare Ft,
Will all friable asbestos
t ateria s be emoved?
1'e,
0 No
Thermal S stem Insulation: • DoilerU'umace Ins. ■ Duct In ■ Pipe Ins,
Other:
$150
Surfacin ' Mat'l: • Fire•rooiing • Paints • Plaster • Textured Coatings
Other;
$300
Misc, Mat'l • Cement Bd. • Cement Pi ■ Friable Flooring or Roofing Matti
Other:
$750
H. Asbestos/Demolition Protect Categories:
1. Single•Family Residence: (Check box A & 8 for asbestos removal & demolition)
A. ❑ Asbestos Removal Project
8. 2- Demolition Pro'ect r
otilleation P_ end
Project Fe, Schedule
A. Prior Notice
B. 10 Days
$ 25 Non - Refundable
Fee Covers Asbestos
Removal & Demolition
2. • All Other Demolitions With No Asbestos Removal Pro'ect -
' G 10 Da s
$150
3. 2 10. 259 linear feet or 7 48 - l59 s. uare feet of asbestos (see back ...-
Da s
$150
A. ■ 260.999 linear feet or 160.4.999 square feet of asbestos '
, rile t
$300
5. 1,000.9,999 linear feet or 5,000 - a9 999 s•uare feet of asbest. ''. ' . '•
$ '
$750
6. • > 10,000 linear feet or > 50,000 s s uare feet of asbestos r r ' `. • "Ps".
_ 10 Da s
$2.000
7. • Emergency Asbestos Project or • Emergency Demolition Proiect
Prior Nonce
Twice Project Fee
do hereby certify that the information contained in this notification & supplemental data described herein is, to the best drily
knowledge, accurate & complete.
Signature
Representing
Date
Puget Sound Clean Air Agency Form No. 66 -160 (Revised 9/7/00) AM
Agency Use Only
Reviewed By
/ /.1;?/ /:L
The Puget Sound Clean Air Agency 'Mires advance notification before any per commences a friable asbestos project
• involving materials equal to or greater in size than 10 linear feet or 48 square feet and for all demolition projects
(regardless of asbestos content) involving structures with a projected roof area greater than 1.20 square feet (Regulation
III, Article 4). All asbestos removal and demolition notifications must be submitted to the Agency on current Agency
forms, Asbestos removal and demolition projects involving materials and structures below the notification threshold are
still subject to all other requirements of Regulation III, Article 4.
The Agency notification form must be used to submit a notification for an asbestos project, a combined asbestos and demolition
project and a demolition project where no asbestos removal is required prior to demolition. After receiving a complete
notification with the appropriate project fee, the Agency will review the form and return a copy to the asbestos and demolition
contractor by mail. The returned copy will be your validated notification.
J. demolition -
Contractor:
A r. 1 WILL ,%v R ,v.IMILInb ue L.
Owner /CEO:
._._ Mailing Address: -
Phone:
Contractor's
Job #,
Cit .
State:
Zi':
Fax;
GUIDELINES FOR SUBMITTING AN ASBESTOSIDEMOLITION NOTIFICATION
Step 1. Check the appropriate project type in Box A.
Step 2. Enter property owner information in Box B.
Step 3. Enter the asbestos contractor or property owner information, if the property owner is conducting a single - family residential
project, in Box C. Print clearly this is your return mailing label.
Step 4. Enter the site address for all notifications in Box U. For multi-structure projects, attach supplemental sheet with a site map
(include on address for each site) and a list of the type and amount of friable asbestos to be removed from each structure.
Step 5. Check either osbestoa survey or material presumed in Box E. All demolitions require that an Asbestos Hazard Emergency
Response Act (AHERA) asbestos survey be conducted by a certified AHERA building inspector. Attach a ceBy of the aurv�v_reguLts
10., 0tlli01110 mittal Pnr { jeLts where nenfriable asbestos_) _kletnifie Lanstproicetsithm_noiskteltsLuwas ide nificdl pan the
SIIIYt~.L'.
Step 6. Enter the project information in Box F. and check the training fire or ordered demolition (a copy of the official order must be
attached) if appropriate. All asbestos must be removed prior to conducting a training lire. Additional training fire requirements are
contained in Regulation 1, Section 8.08. Unity nonfriable asbestos materials will be left in place during demolition, check yes and list
the type and quantity of material.
Step 7. Enter asbestos project information in Box G.
Stop 8. For Single- Family Residential projects; check BOX 1-11A for renovation projects, BOX 1:111I for demolition projects with no
asbestos removal and BOX HIA and H1A for asbestos removal and demolition projects. The total project fee for single-family
residential projects is S25 regardless of category or categories chosen, Asbestos removal may be conducted after a complete
notification is received, but demolition activities can only begin on the 10th day after the notification is received,
For Commercial asbestos projects; check the project category 112 • 6 that matches the amount of friable asbestos that will be
removed. The project category fee includes both asbestos removal and demolition. To file for an emergency asbestos or demolition
project, check the appropriate box 1 - 6 and the applicable emergency box in H7. Altertt<ejegpcy regye,sls q t ss l+e,g.cco, pJpaujekk
too i ► o ►e ti o , ► tt o t s . ', e : e - ► o co, ► t e ► o' - t u_tt a Leff in accordance with the requirements in
gualationlijjafigiLtQL(s),,
Step 9, Please certify the accuracy and completeness of the information provided by signing the notification in Box 1.
Mandatory amendments to the notification are required for changes that increase the project category, change the types of asbestos
materials to be removed and work schedule changes. No fee is required for work schedule changes if the contractor is participating in
the Agency work schedule fax program. A fifty- dollar processing fee is required for all other amendments.
Puget Sound Clean Air Agency asbestos regulations and forms can downloaded from the Agency web page at www.pscleanair.org.
For technical assistance contact (206) 689-4058 and for administrative inquiries contact (206) 689 -4090.
Puget Sound Clean Air Agency Form No.: 66.160 (Revised 9/7/00) AM
5/
CITY OF i UKWILA
Permit Center
6300 Southcenter Boulevard, Suite 100, Tukwila, WA 98188
Telephone: (206) 431 -3670
H -4
AFFIDAVIT IN LIEU OF CONTRACTOR REGISTRATION
STATE OF WASHINGTON
COUNTY OF KING
) ss.
)
_____t. , L , states as follows;
1. I have made application for a building permit from the City of Tukwila, Washington•
2. I understand that state law requires that all building construction contractors be registered with the
State of Washington. The exceptions to this requirement are stated under Section 18.27.090 of the
Revised Code Washington, a copy of which is printed on the reverse side of this Affidavit, I have
read or am familiar with RCW 18.27.090,
3. I understand that prior to issuance of a building permit for work which Is to be done by any
contractor, the City of Tukwila must verify either that the contractor Is registered by the State of
Washington, or that one of the exemptions stated under RCW 18,27.090 applies,
4. In order to provide verification to the City of Tukwila of my compliance with this requirement, I hereby
attest that after reading the exemptions from the registration requirement of RCW 18,27.090, I
consider the work authorized under this building permit to be exempt under No. - ,, and
will therefore not be performed by a registered contractor.
I understand that I may bp waiving certain rights that I might otherwise have under state law in any decision to
engage an unregistered contractor to perform construction work.
A,D N
ttOTAR tr
v i
l
• FL UO • 1
‘`\Ar W
AFFCONT 1/13/00
Signed and sworn to before me this
day of _ , — - - __,,, 20..,2_,:,'"•
a. Ae
NOTARY PUBLIC in and f.r the State of Washington,
residing at ki n.. County.
Name as commissioned:
My commission expires: 6 -lb -U4
18.27.090 Exemptions. This chapter • ID not apply to:
1. An authorized representative of the United States
Government, the State of Washington, or any
incorporated city, town, county, township, irrigation
district, reclamation district, or other municipal or
political corporation or subdivision of this state;
2. Officers of a court when they are acting within the
scope of their office;
3. Public utilities operating under the regulations of the
utilities and transportation commission in
construction, maintenance, or development work
incidental to their own business;
4. Any construction, repair, or operation incidental to the
discovering or producing of petroleum or gas, or the
drilling, testing, abandoning, or other operation of any
petroleum or gas well or any surface or underground
mine or mineral deposit when performed by an owner
or lessee;
5. The sale or installation of any finished products,
materials, or articles of merchandise which are not
actually fabricated Into and do not become a
permanent fixed part of a structure;
6. Any construction, alteration, improvement, or repair
of personal property, except this chapter shall apply
to all mobile /manufactured housing. A
mobile /manufactured home may be installed, set up,
or repaired by the registered or legal owner, by a
contractor licensed under this chapter, or by a
mobile /manufactured home retail dealer or
manufacturer licensed under chapter 46.70 RCW;
7, Any construction, alteration, Improvement, or repair
carried on within the limits and boundaries of any site
or reservation under the legal jurisdiction of the
federal government;
8. Any person who only furnished materials, supplies, or
equipment without fabricating them Into, or
consuming them in the performance of, the work of
the contractor;
9, Any work or operation on one undertaking or project
by one or more contracts, the aggregate contract
price of which for labor and materials and all other
Items is less than $500, such work, or operations
being considered as of a casual, minor, or
inconsequential nature. The exemption prescribed in
this subsection does not apply in any instance
wherein the work or construction is only a part of a
larger or major operation, whether undertaken by the
same or a different contractor, or in which a division
AFFCONT 1/13/00
of the operation is made into contracts of amounts
less than $500 for the purpose of evasion of this
chapter or otherwise. The exemption prescribed in
this subsection does not apply to a person who
advertises or puts out any sign or card or other
device which might indicate to the public that he is a
contractor, or that he is qualified to engage in the
business of contractor;
10. Any construction or operation incidental to the
construction and repair of irrigation and drainage
ditches of regularly constituted irrigation districts or
reclamation districts; or to farming, dairying,
agriculture, viticulture, horticulture, or stock or poultry
raising; or to clearing or other work upon land in rural
districts for fire prevention purposes; except when
any of the above work is performed by a registered
contractor;
11. An owner who contracts for a project with a
registered contractor;
12. Any person working on his own property, whether
occupied by him or not, and any person working on
his residence, whether owned by him or not but this
exemption shall not apply to any person otherwise
covered by this chapter who constructs an
Improvement on his own property with the intention
and for the purpose of selling the improved property;
13. Owners of commercial properties who use their own
employees to do maintenance, repair, and alteration
work in or upon their own properties;
14. A licensed architect or civil or professional engineer
acting solely in his professional capacity, an
electrician licensed under the laws of the state of
Washington, or a plumber licensed under the laws of
the state of Washington while operating within the
boundaries of such political subdivision, The
exemption provided In this subsection is applicable
only when the licensee is operating within the scope
of his license;
15, Any person who engages in the activities herein
regulated as an employee of a registered contractor
with wages as his sole compensation;
16. Contractors on highway projects who have been
prequalified as required by chapter 13 of the Laws of
1961, RCW 47.28.070 with the department of
transportation to perform highway construction,
reconstruction, or maintenance work.