HomeMy WebLinkAboutPermit M12-034 - HILSEN 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.
M12-034
Hilsen Residence
1522540th 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
Personal Information —
social security numbers are a private concern. As
such, individuals' social security numbers are
Social Security Numbers
redacted to protect those individuals' privacy pursuant
5 U.S.C. sec.
DR1
Generally — 5 U.S.C. sec.
to 5 U.S.C. sec. 552(a), and are also exempt from
552(a); RCW
552(a); RCW
disclosure under section 42.56.070(1) of the
42.56.070(1)
42.56.070(1)
Washington 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
Personal Information —
numbers, electronic check numbers, credit expiration
9
DR2
Financial Information —
dates, or bank or other financial account numbers,
RCW
RCW 42.56.230(4 5)
which are exempt from disclosure pursuant to RCW
42.56.230(5)
42.56.230(5), except when disclosure is expressly
required by or governed by other law.
HILSEN RESIDENCE
15225 40 AV S
M12 -034
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
MECHANICAL PERMIT
Parcel No.: 0043000168
Address: 15225 40 AV S TUKW
Project Name: HILSON RESIDENCE
Permit Number: M12 -034
Issue Date: 03/07/2012
Permit Expires On: 09/03/2012
Owner:
Name: HILSEN MARILYN J +KENNETH E
Address: 15225 40TH AVE S , SEATTLE WA 98188
Contact Person:
Name: MIKE KREIGER
Address: 13324 BINGHAM AV E , TACOMA WA 98446
Email: MOOSEKREIGER @YAHOO.COM
Contractor:
Name: PUGET SOUND GAS PIPING INC
Address: 13324 BINGHAM AVE E , TACOMA WA 98446
Contractor License No: PUGETSG956MA
Phone: 253 - 678 -6163
Phone: 253 - 539 -4488
Expiration Date: 07/27/2013
DESCRIPTION OF WORK:
INSTALL A DIRECT VENT GAS INSERT. RUN (2) 3" LINERS TO A CAP
Value of Mechanical: $1,800.00
Type of Fire Protection: UNKNOWN
Electrical Service Provided by:
Permit Center Authorized Signature:
Fees Collected: $167.70
International Mechanical Code Edition: 2009
i?„4
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 arty 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: Mt.
Date: ✓ '2'
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
M12-034 Printed: 03 -07 -2012
PERMIT CONDITIONS
Permit No. M12-034
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: All 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
M12 -034 Printed: 03 -07 -2012
CITY OF TUKWILA
Community Development Department
Permit Center
6300 Southcenter Blvd., Suite 100
Tukwila, WA 98188
http://www.TukwilaWA.gov
•
Mechanical Permit No. 11 1 — 031-1
Project No.
Date Application Accepted:
Date Application Expires:
(For office use only)
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 LOCATION
Site Address:
King Co Assessor's Tax No.: Q0/3°00 000 /6 O
\ S ilo S. I ux�
Tenant Name:
Suite Number: Floor:
PROPERTY OWNER
Name: 14 �- r.
Address:u 11 44 Atvll�r`t4 4,..__
F
Address:
Name: /1/1/142V4.-Lk)
CSE"-
Zip: 7r373
Phone: _4 7 r G/g 3 Fax: Ai /4
Address: I7_70 3
zr" I4t/
e •
Cityr
State: boo.
Zip/5
CONTACT PERSON — person receiving all project
communication
Name: 14 �- r.
Address:u 11 44 Atvll�r`t4 4,..__
F
Address:
Phone:2�_2 _.Z -3 Fax: A/%
City (C) -ZZ.✓ 3 State: l/�,4
Zip: 7r373
Phone: _4 7 r G/g 3 Fax: Ai /4
Email:MDosrize,-SGi=g_ ?Yr*fkx.Cc
New Tenant: ❑ Yes ,g..No
MECHANICAL CONTRACTOR INFORMATION
T—
Company Name: ,aD - . c
Address:u 11 44 Atvll�r`t4 4,..__
F
Cityr ivo. State: (.4J1 Zipcj8-(.) %/ C7
I
Phone:2�_2 _.Z -3 Fax: A/%
Contr Reg No.: Fot.i isc %S' om Exp Date: 7/4o i 3
Tukwila Business License No.: �L.3S _0�y / -ZLf 7 ce
Valuation of project (contractor's bid price): $ / 8 QD
Describe the scope of work in detail: so674,1L bV &- - -s scw-i --' Z' 3" S
`ry 4 (Y► ?.
Use: Residential: New
Commercial: New
Fuel Type: Electric ❑
Gas
Replacement
Replacement
Other:
H: Wpplications\Forms- Appli®tions On Line\2011 Applications\ Mechanical Permit Application Revised 8- 9- 11.docx
Revised: August 2011
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Page 1 of 2
•
•
Indicate type of mechanical work being installed and the quantity below:
Unit Type
Qty
Furnace <100k btu
Furnace >100k btu
Floor furnace
Suspended/wall/floor
mounted heater
v
X
Appliance vent
Repair or addition to
heat/refrig/cooling
system
Air handling unit
<10,000 cfm
Unit Type
Qty
Air handling unit
>10,000 cfm
Evaporator cooler
Ventilation fan
connected to single duct
v
X
Ventilation system
Hood and duct
Incinerator – domestic
Incinerator –
comm/industrial
•
Unit Type
Qty
Fire damper
Diffuser
Thermostat
Wood/gas stove
v
X
Emergency generator
Other mechanical
equipment
Boiler /Compressor
Qty
0 -3 hp /100,000 btu
3 -15 hp /500,000 btu
15 -30 hp /1,000,000 btu
30 -50 hp /1,750,000 btu
50+ hp /1,750,000 btu
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 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).
1 HEREBY CERTIFY THAT 1 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 1 AM AUTHORIZED TO APPLY FOR THIS PERMIT.
BUILDING OWNER 0
Signature:
Print Name:
Mailing Address:
A THOR14ED AGENT:
eke— ( /2r1--1, S C % Day Telephone:
<C,,-2_( 12s
City
H:Wpplications\Forms- Applications On Line\2011 Applications\Mechanical Permit Application Revised 8- 9- 11.dooc
Revised: August 2011
bh
Date: 3 - 7- /
7,s-3 - 6 ?a-- I &3
w,q. �K373
State Zip
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.TukwilaWA.Qov
Parcel No.: 0043000168
Address: 15225 40 AV $ TUKW
Suite No:
Applicant: HILSON RESIDENCE
RECEIPT
Permit Number: M12 -034
Status: PENDING
Applied Date: 03/07/2012
Issue Date:
Receipt No.: R12 -00950
Payment Amount: $167.70
Initials: WER Payment Date: 03/07/2012 11:28 AM
User ID: 1655 Balance: $0.00
Payee:
t.L
1A4 PT KREIGER
TRANSACTION LIST:
Type Method Descriptio Amount
Payment Cash
Authorization No.
ACCOUNT ITEM LIST:
Description
167.70
Account Code Current Pmts
MECHANICAL - RES
000.322.102.00..00 167.70
Total: $167.70
City of Tukwila
6200 Southcenter Blvd, Tukwila, WA
1 Finance Department
1206701 -1 03/07/2012 BR1 T103
Wed Mar07,2012 11:36AM Trans #30 -30
30 $264.30 DCDGEN - DCD Permits Plus
- General Fund
Secondary ID: MIKE KREIGER
1 ITEM(S): TOTAL: $264.30
MasterCard PAID $264.30
www.tukwilawa.gov 206 - 433 -1835
INSPECTION NO.
INSPECTION RECORD
Retain a copy with permit
PERMIT NO.
CITY OF TUKWILA BUILDING DIVISION
6300 Southcenter Blvd., #100, Tukwila. WA 98188 iZ- (206) 431 -3670
Permit Inspection Request Line (206) 431 -2451 1Z-OZt,�
Project:
i/i4. stA/ .R. 5 .
Type of Inspection:
. F, ry l4 L-
•
Address:
i52..S 410 41/ S
Date Called:
Special Instructions:
Date Wanted:.
_7..._ / t- /- /Z
a.m.
(p.m-
Requester:
Phone No:
2 53- 67,1 -6/6
Approved per applicable codes. a Corrections required prior to approval.
COMMENTS:
.5-1)9 ml /M''
G;: -)b PIf -0)1
s ect:or:
Date:
REINSPECTION FEE REQUIRED. Prior to next inspection, fee must be
L./paid at 6300 Southcenter Blvd.. Suite 100. Call to schedule reinspection.
Contractors or Tradespeople Peter 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 PUGET SOUND GAS PIPING INC UBI No. 602435577
Phone 2535394488 Status Active
Address 13324 Bingham Ave. E License No. PUGETSG956MA
Suite /Apt. License Type Construction Contractor
City Tacoma Effective Date 7/1/2005
State WA Expiration Date 7/27/2013
Zip 98446 Suspend Date
County Pierce Specialty 1 Plumbing
Business Type Corporation Specialty 2 Unused
Parent Company
Other Associated Licenses
License
Name
Type
Specialty 1
Specialty
2
Effective
Date
Expiration
Date
Status
PUGETSG974C7
PUGET SOUND
GAS PIPING
Construction
Contractor
Other
(Specify)
Unused
2/27/2003
2/27/2005
Archived
CLASSGP986JP
CLASS A GAS
PIPING
Construction
Contractor
Other
(Specify)
Unused
4/17/2002
4/17/2004
Archived
Business Owner Information
Name
Role
Effective Date
Expiration Date
BRADLEY, ANTHONY
President
07/01/2005
Amount
BISCARRET, DOMINIC
Secretary
07/01/2005
L1790002281
ANDERSON, ANDY
Vice President
07/01/2005
Bond Information
Page 1 of 2
Bond
Bond Company Name
Bond Account Number
Effective Date
Expiration Date
Cancel Date
Impaired Date
Bond Amount
Received Date
2
CAPITOL INDEMNITY
CORPORATION
919233
03/02/2006
Until Cancelled
04/06/2010
$6,000.00
03/08/2006
Assignment of Savings Information
Savings
Assignment of Savings Account Number
Effective Date
Release Date
Assignment Type
Impaired Date
Amount
Received Date
2
4/27/2010
Until
Released
Bond
$6,000.00
4/27/2010
Insurance Information
Insurance
Company Name
Policy Number
Effective Date
Expiration Date
Cancel Date
Impaired Date
Amount
Received Date
9
Ctolantic Cas Ins
L1790002281
04/11/2011
04/11/2012
$1,000,000.00
04/11/2011
8
ATLANTIC CAS
INS CO
L17900228
04/11/2010
04/11/2011
$1,000,000.00
03/31/2010
7
ATLANTIC
CASUALTY INS
CO
L071003336
04/11/2009
04/11/2010
$1,000,000.00
04/13/2009
6
AMERICAN
STATES INS CO
25CC15518010
04/11/2008
04/11/2009
$1,000,000.0004
/15/2008
5
FIRST
NATIONAL
INSURANCE CO
OF
25CC15518010
04/11/2007
04/11/2008
$1,000,000.0004
/13/2007
4
LINCOLN
GENREAL
PUGET7
12/06/2006
12/06/2007
$1,000,000.00
12/06/2006
https://fortress.wa.gov/Ini/bbip/Print.aspx
03/07/2012