HomeMy WebLinkAboutPermit PG12-138 - HILL-ROMHILL-ROM
12610 INTERURBAN AV S
PG12 -138
Parcel No.:
Address:
City o4kukwila
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
0004800003
12610 INTERURBAN AV S TUKW
Project Name: HILL -ROM
Permit Number:
Issue Date:
Permit Expires On:
PG12 -138
06/25/2012
12/22/2012
Owner:
Name: GATEWAY OLYMPIA INC
Address: PO BOX 4900 #207 , SCOTTSDALE AZ 85261
Contact Person:
Name:
Address:
Email:
DANA THOMAS
19815 62 CT NE , KENMORE WA 98155
DANATHOMASO 1 @GMAIL.COM
Contractor:
Name: R &D PLUMBING LLC
Address: 216 NE 174 ST , SEATTLE WA 98155
Contractor License No: RDPLUPL889KB
Phone: 425 346 -4065
Phone: 206 372 -1657
Expiration Date: 05/02/2014
DESCRIPTION OF WORK:
GROUND WORK AND ROUGH IN OF WATER CLOSET, MOP SINK, AND SINK. ROUGH IN OF
EXISTING SINK AND ADDITION OF ELECTRICAL WATER HEATER.
Value of Plumbing /Gas Piping:
Fees Collected:
Electrical Service Provided by:
$3,600.00
$164.85
Permit Center Authorized Signature:
I hereby certify that I have read and
governing this work will be complie
Uniform Plumbing Code Edition: 2009
International Fuel Gas Code Edition: 2009
Date: �—
ned 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 pre
construction or the performance of work
on the back of this permit.
Signature:
Print Name:
me 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
Date: 6- 25 ' Z G ( Z
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
PG12 -138 Printed: 06 -25 -2012
PERMIT CONDITIONS
Permit No. PG12 -138
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 art 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 12 -138 Printed: 06 -25 -2012
CITY OF TUKWILA
Community Developme apartment
Permit Center
6300 Southcenter Blvd., Suite 100
Tukwila, WA 98188
http: /i'www.TukwilaWA.gov
Date Application Accepted
Date Application Expires ,
or ojfice,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 **
King Co Assessor's Tax No.: JOO !IL OGO
Site Address: i Z k 3 i �k�V Suite Number: Floor:
New Tenant: ❑ Yes X. No
Tenant Name:
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PROPERTY,OWNER
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Name:
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Address:
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Phone: yZ5 3 y6' Y6
City: /'
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State: Al,
Zip: Fitt
CONTACT,PERSON person receiving 0.pro*t.
communication, + ' .
Name: °:7
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City: 3h of I :,44.. State: i, / . Zip: / 0/55
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City: ,/`
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Zip: ����.
Phone: yZ5 3 y6' Y6
, Fax:
Email:
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PLUMBING CONTRACTORINF.ORMATION ��� ,
Company Name: \ S D 'ph, j .
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Address: i
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City: 3h of I :,44.. State: i, / . Zip: / 0/55
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Phone: Fax:
�°�' 57Z 1657
Contr Reg No.: 119 p1 1, p mil 1645 Exp Date: S- f 2_II L1
Tukwila Business License No.: outcr w ci 1 D 2)
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Valuation of Project (contractor's bid price): $ 5 600 ' Q
Scope of Work (please provide detailed information): 6�o,,,,) d f.�/ o i" %% -t 12 0....11% -'f.✓ AI c c�,��
«-7 0? 5' h.- V c.. -c( S,/..r, %+', d u c. 7z/ = car Zx .k ht.7 S..-4i
44 Q.t<<.I. /(4/T I
Building Use (per Int'I Building Code):
Occupancy (per Int'l Building Code):
Utility Purveyor: Water: Sewer:
H:\Applications\Forms- Applications On Line \2011 Applications\Plumbing Permit Application Revised 8- 9- 11.docx
Revised: August 2011
bh
Page 1 of 2
Indicate type of plumbing fixtures and/o as piping outlets being installed and the quantity below:
i
..:::. Fixture Type ;-5,
Qty.
Bathtub or combination
bath/shower
Dishwasher, domestic with
independent drain
Shower, single head trap
1
Sinks
0
Rain water system — per
drain (inside building)
Grease interceptor for
commercial kitchen (>750
gallon capacity)
I
Each additional medical
gas inlets/outlets greater
than 5
Atmospheric-type vacuum
breakers not included in .
lawn sprinkler backflow
protections (1-5)
..
Fixture Type . • ,,, .
,
Qty
Bidet
Drinking fountain or water
cooler (per head)
Lavatory
1
Urinal
I
Water heater and/or vent
Repair or alteration of
drainage or vent piping
I
Repair or alteration of
water piping and/or water
treatment equipment
Backflow protective device
other than atmospheric-
type vacuum breakers 2
inch (51 mm) diameter or
smaller
Atmospheric-type vacuum
breakers not included in
lawn sprinkler backflow
protections over 5
.• -.., fixtdre Type;,:v./
:. 4ty.
Clothes washer,
domestic
Food-waste grinder,
commercial
Wash fountain
Water closet
I
Industrial waste
treatment interceptor,
including trap and vent,
except for kitchen type
grease interceptors
Repair or alteration of
drainage or vent piping
Backflow protective
device other than
atmospheric-type
vacuum breakers over 2
inch (51 mm) diameter
Gas piping outlets
Fixture Tyk. '. ; ,
;Qty.-
Dental unit, cuspidor
Floor drain
Receptor, indirect waste
Building sewer and each
trailer park sewer
Each grease trap
(connected to not more
than 4 fixtures - <750
gallon capacity
Medical gas piping
system serving 1-5
inlets/outlets for a specific
gas
Each lawn sprinkler
system on any one meter
including backflow
protection devices
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 AUT RI
Signature:
Print Name: 1-1A 0 NAS
Date: C Z3/2
Day Telephone:
Mailing Address:
City State Zip
H:\Apphcations\Forms-Applicattons On Line \2011 ApplicationsTlumbing Permit Application Revised 8-9-11.docx
Revised: August 2011
bh
Page 2 of 2
•
City of Tukwila
Department of Community Development
6300 Southcenter Boulevard, Suite #100
Tukwila, Washington 98188
Phone: 206 -43 1 -3670
Fax: 206 -431 -3665
Web site: http: / /www.TukwilaWA.00v
RECEIPT
Parcel No.: 0004800003 Permit Number: PG 12 -138
Address: 12610 INTERURBAN AV S TUKW Status: APPROVED
Suite No: Applied Date: 06/25/2012
Applicant: HILL -ROM Issue Date:
Receipt No.: R12 -01967
Payment Amount: $164.85
Initials: JEM Payment Date: 06/25/2012 09:00 AM
User ID: 1165 Balance: $0.00
Payee: DANA THOMAS
TRANSACTION LIST:
Type Method Descriptio Amount
Payment Credit Crd VISA
Authorization No. 185690
ACCOUNT ITEM LIST:
Description
164.85
Account Code Current Pmts
PLUMBING - NONRES
000.322.103.00.00 164.85
Total: $164.85
doc: Receiot -06 Printed: 06 -25 -2012
•
INSPECTION NO.
INSPECTION RECORD
Retain a copy with permit
PERMIT NO.
CITY OF TUKWILA BUILDING DIVISION
6300 Southcenter Blvd., #100, Tukwila. WA 98188 F- (206)431 -3670.
Permit Inspection Request Line (206) 431 -2451
Project:
/,/ /LL.. /?0,P1
Type of Inspection:
- /n/'1 %_:
Ad•d�resss:
/aC 6 /6)_1.J✓7 %'
?'/ ,11/
Date Called:
_ .'
Special Instructions:
Date Wanted:.
7_ / 7—
a.mr
p.m.
Requester: .
Phone No:
_2.10 6 - 37Z- /G
pproved per applicable codes. Corrections required prior to approval.
COMMENTS:
In, speSto /tAt.4
I
REIN! PECTION FEE REQUIRED. irior to next spection fee must be::
pt/at 6300 Southcenter Blvd., Suite 100. Call to schedule reinspection.-
•
y`t
'INSPECTION RECORD
Retain a copy with permit
INSPECTION NO.
PERMIT NO.
CITY OF TUKWILA BUILDING DIVISION
6300 Southcenter Blvd., #100, Tukwila. WA 98188 Az, (206) 431 -3670
Permit Inspection Request Line (206) 431 -2451
Project:
Type of Inspection:
Address:
1 240 1 0 D.N inup 13 r\kN
Date Called:
Special Instructions:
Date Wanted: t
4,1 -Co (12_
en.
Requester:
Phone No:
2C4 372'1657
10 Approved per applicable codes. E Corrections required prior to approval.
COMMENTS:
‘44,,Ad
4 .41/ ,f
Inspecto
Dat
PECTION FEE REQUIR -' Prior toAext inspection, fee must be
at 6300 Southcenter Blvd., uite 100. Call to schedule reinspection.
Contractors or Tradespeople Printer 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 R &D PLUMBING LLC UBI No. 603202448
Phone 2063721657 Status Active
Address 216 Ne 174Th St License No. RDPLUPL889KB
Suite /Apt. License Type Construction Contractor
City Seattle Effective Date 5/2/2012
State WA Expiration Date 5/2/2014
Zip 98155 Suspend Date
County King Specialty 1 Plumbing
Business Type Limited Liability Company Specialty 2 Unused
Parent Company
Business Owner Information
Name
Role
Effective Date
Expiration Date
TINDAL, ROBERT ANTHONY
Partner /Member
05/02/2012
THOMAS, DANA WAYNE
Partner /Member
05/02/2012
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 &
Indem Co
256550C
05/02/2012
Until Cancelled
$6,000.00
05/02/2012
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
1
Contractors
Bonding &
Insuranc
C11SJ6233
05/02/2012
05/02/2013
$500,000.00
05/02/2012
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 06/25/2012