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HomeMy WebLinkAboutPermit D17-0003 - 4430 S 160TH ST HOUSE - DEMOLITION160T" HOUSE 4430 S 160T" ST D17-0003 Parcel No: Address: Project Name: 0 City of Tukwila a Department of Community Development 6300 Southcenter Boulevard, Suite #100 Tukwila, Washington 98188 Phone: 206-431-3670 Inspection Request Line: 206-438-9350 Web site: http://www.TukwilaWA.gov 8108600481 4430 S 160TH ST 160TH HOUSE DEVELOPMENT PERMIT Permit Number: D17-0003 Issue Date: 1/27/2017 Permit Expires On: 7/26/2017 Owner: Name: Address: Contact Person: Name: Address: Contractor: Name: Address: License No: Lender: Name: Address: NOMADS NORTHWEST LLC 17713 15TH AVE NE #203 , SHORELINE, WA, 98155 MARK SEGALE Phone: (206) 575-2000 PO BOX 88028 , TUKWILA, WA, 98138 SEGALE PROPERTIES LLC PO BOX 88028 , TUKWILA, WA, 98138 SEGALPL902CQ SEGALE PROPERTIES PO BOX 88028 , TUKWILA, WA, 98138 Phone: (206) 575-2000 Expiration Date: 4/3/2018 DESCRIPTION OF WORK: DEMO HOUSE - REMOVE STRUCTURE AND FOUNDATION OF 2730 SF SINGLE FAMILY RESIDENCE. TERMINATE AND CAP ALL UTILITIES. PUMP AND REMOVE SEPTIC TANK. REGRADE TO MATCH ADJACENT EXISTING CONTOUR ELEVATIONS Project Valuation: $10,000.00 Type of Fire Protection: Sprinklers: Fire Alarm: Type of Construction: VB Electrical Service Provided by: TUKWILA Fees Collected: $750.92 Occupancy per IBC: R-3 Water District: HIGHLINE Sewer District: NONE Current Codes adopted by the City of Tukwila: International Building Code Edition: International Residential Code Edition: International Mechanical Code Edition: Uniform Plumbing Code Edition: International Fuel Gas Code: 2015 2015 2015 2015 2015 National Electrical Code: WA Cities Electrical Code: WAC 296-46B: WA State Energy Code: 2014 2014 2014 2015 Public Works Activities: Channelization/Striping: Curb Cut/Access/Sidewalk: Fire Loop Hydrant: Flood Control Zone: Hauling/Oversize Load: Land Altering: Landscape Irrigation: Sanitary Side Sewer: Sewer Main Extension: Storm Drainage: Street Use: Water Main Extension: Water Meter: Volumes: Cut: 0 Fill: 0 Number: 0 No Permit Center Authorized Signature: Date: 1—) 7-1 / I hearby 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 construction or the performance of work. I am authorized to sign and obtain this development per it and agree to the conditions attached to this permit. Signature: Print Name: /e Date: / /17 This permit shall become null and void if the work is not commenced within 180 days for the date of issuance, or if the work is suspended or abandoned for a period of 180 days from the last inspection. PERMIT CONDITIONS: 1: ***BUILDING PERMIT CONDITIONS*** 2: Work shall be installed in accordance with the approved construction documents, and any changes made during construction that are not in accordance with the approved construction documents shall be resubmitted for approval. 3: All permits, inspection record card and approved construction documents shall be kept at the site of work and shall be open to inspection by the Building Inspector until final inspection approval is granted. 4: Remove all demolition rubble and loose miscellaneous material from lot or parcel of ground, properly cap the sanitary sewer connections, and properly fill or otherwise protect all basements, cellars, septic tanks, wells, and other excavations. Final inspection approval will be determined by the building inspector based on satisfactory completion of this requirement. 5: 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). 6: All electrical work shall be inspected and approved under a separate permit issued by the City of Tukwila Permit Center. 7: 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. 8: ***PUBLIC WORKS PERMIT CONDITIONS*** 9: The applicant or contractor must notify the Public Works 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. 10: Permit is valid between the weekday hours of 7:00 a.m. and 10:00 p.m. only. Coordinate with the Public Works Inspector for any work after 5:00 p.m. and weekends. 11: Temporary erosion control measures shall be implemented as the first order of business to prevent sedimentation off-site or into existing drainage facilities. 12: The site shall have permanent erosion control measures in place as soon as possible after final grading has been completed and prior to the Final Inspection. 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 of Tukwila Public Works Inspector. 14: The applicant shall contact the Highline Water District at (206) 824-0375 for capping the water service to the house. 15: The applicant shall contact Valley View Sewer District at (206) 242-3236 for sanitary sewer service to the house. PERMIT INSPECTIONS REQUIRED Permit Inspection Line: (206) 438-9350 1700 BUILDING FINAL** 5200 EROSION MEASURES 5210 EROSION MEASURES FNL 0101 PRE -CONSTRUCTION 1600 PUBLIC WORKS FINAL CITY OF TUKWILA Community Development Department Public Works Department Permit Center 6300 Southcenter Blvd., Suite 100 Tukwila, WA 98188 http://www.TukwilaWA.gov Building Permit No. Project No. Date Application Accepted: ! 1 1 Date Application Expires: (For office zlse ozlly) CONSTRUCTION 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: 4430 S 160th St., Tukwila, WA 98188 i(IOn4 r, VVVQ Tenant Name: PROPERTY OWNER Name: Mark Segale Name: Mark & Keri Segale Address: P.O. Box 88028 Address: 4421 S 158th St. City: Tukwila State: WA City: Tukwila State: WA Zip: 98188 CONTACT PERSON — person receiving all project communication Name: Mark Segale Address: P.O. Box 88028 Address: P.O. Box 88028 Phone: (206) 575-2000 Fax: City: Tukwila State: WA Zip: 98138 Phone: (206) 575-2000 Fax: Email: msegale@segaleproperties.com GENERAL CONTRACTOR INFORMATION Company Name: Segale Properties LLC Address: P.O. Box 88028 City: Tukwila State: WA Zip: 98138 Phone: (206) 575-2000 Fax: Contr Reg No.: CC SEGALPL9020 Exp Date: 04/03/2018 Tukwila Business License No.: BUS -0101320 H:\d pplications\Forms-Applications On Line\201 I Applications\Permit Application Revised - 8-9-1 I.docx Revised: August 2011 bh King Co Assessor's Tax No.: 8108600481 Suite Number: Floor: New Tenant: ❑ Yes m ..No ARCHITECT OF RECORD Name: Segale Properties LLC Address: P.O. Box 88028 Company Name: Architect Name: Address: City: State: Zip: Phone: Fax: Email: ENGINEER OF RECORD Name: Segale Properties LLC Address: P.O. Box 88028 Company Name: Engineer Name: Address: City: State: Zip: Phone: Fax: Email: LENDER/BOND ISSUED (required for projects $5,000 or greater per RCW 19.27.095) Name: Segale Properties LLC Address: P.O. Box 88028 Cit': Tukwila State: WA Zip: 98138 Page 1 of 4 BUILDING PERMIT INFORMATION — 206-431-3670 Valuation of Project (contractor's bid price): $ 10,000 Existing Building Valuation: $ 147,000 Describe the scope of work (please provide detailed information): Demolish House Remove structure and foundation of 2,730 sf single family residence Terminate and cap all utilities. Pump and remove septic tank. Regrade to match adjacent existing contour elevations. Will there be new rack storage? ❑ Yes .. No If yes, a separate permit and plan submittal will be required. Provide All Building Areas in Square Footage Below PLANNING DIVISION: Single family building footprint (area of the foundation of all structures, plus any decks over 18 inches and overhangs greater than 18 inches) *For an Accessory dwelling, provide the following: Lot Area (sq ft): Floor area of principal dwelling: Floor area of accessory dwelling: *Provide documentation that shows that the principal owner lives in one of the dwellings as his or her primary residence. Number of Parking Stalls Provided: Standard: Compact: Handicap: Will there be a change in use? ❑ Yes ❑ No If"yes", explain: FIRE PROTECTION/HAZARDOUS MATERIALS: ❑ Sprinklers 0 Automatic Fire Alarm ❑ None 0 Other (specify) Will there be storage or use of flammable, combustible or hazardous materials in the building? 0 Yes ❑ No If `yes', attach list of materials and storage locations on a separate 8-1/2" x 11 " paper including quantities and Material Safety Data Sheets. SEPTIC SYSTEM ❑ On-site Septic System — For on-site septic system, provide 2 copies of a current septic design approved by King County Health Department. H:\Applications\Fotms-Applications On Line \2011 Applications\Pennit Application Revised - 8-9-11.docx Revised: August 2011 bh Page 2 of 4 Existing Interior Remodel Addition to Existing Structure New Type of Construction per IBC Type of Occupancy per IBC In Floor 2,730 0 2'"' Floor 3'1 Floor Floors thru Basement Accessory Structure* Attached Garage Detached Garage Attached Carport Detached Carport Covered Deck Uncovered Deck PLANNING DIVISION: Single family building footprint (area of the foundation of all structures, plus any decks over 18 inches and overhangs greater than 18 inches) *For an Accessory dwelling, provide the following: Lot Area (sq ft): Floor area of principal dwelling: Floor area of accessory dwelling: *Provide documentation that shows that the principal owner lives in one of the dwellings as his or her primary residence. Number of Parking Stalls Provided: Standard: Compact: Handicap: Will there be a change in use? ❑ Yes ❑ No If"yes", explain: FIRE PROTECTION/HAZARDOUS MATERIALS: ❑ Sprinklers 0 Automatic Fire Alarm ❑ None 0 Other (specify) Will there be storage or use of flammable, combustible or hazardous materials in the building? 0 Yes ❑ No If `yes', attach list of materials and storage locations on a separate 8-1/2" x 11 " paper including quantities and Material Safety Data Sheets. SEPTIC SYSTEM ❑ On-site Septic System — For on-site septic system, provide 2 copies of a current septic design approved by King County Health Department. H:\Applications\Fotms-Applications On Line \2011 Applications\Pennit Application Revised - 8-9-11.docx Revised: August 2011 bh Page 2 of 4 t` �! PUBLIC WORKS PERMIT INFORMATION — 206-433-0179 Scope of Work (please provide detailed information): Demolish House Remove structure and foundation of 2,730 sf single family residence Terminate and cap all utilities. Pump and remove septic tank. Regrade to match adjacent existing contour elevations. Call before you Dig: 811 Please refer to Public Works Bulletin #1 for fees and estimate sheet. Water District ❑ ...Tukwila ❑...Water District #125 ❑ ...Water Availability Provided Sewer District ❑ ...Tukwila 0 ...Sewer Use Certificate ❑ .. Highline ❑ ...Valley View ❑ .. Renton ❑ ...Sewer Availability Provided ❑ .. Renton ❑ .. Seattle Septic System: 0 On-site Septic System — For on-site septic system, provide 2 copies of a current septic design approved by King County Health Department. Submitted with Application (mark boxes which apply): ❑ ...Civil Plans (Maximum Paper Size — 22" x 34") ❑ ...Technical Information Report (Storm Drainage) 0 ...Bond 0 .. Insurance 0 .. Easement(s) Proposed Activities (mark boxes that apply): ❑ ...Right-of-way Use - Nonprofit for less than 72 hours ❑ ...Right-of-way Use - No Disturbance ❑ ...Construction/Excavation/Fill - Right-of-way 0 Non Right-of-way 0 ❑ ...Total Cut ❑ ...Total Fill cubic yards cubic yards ❑ ...Sanitary Side Sewer ..▪ .Cap or Remove Utilities 0 ...Frontage Improvements ❑ ...Traffic Control ❑ ...Backflow Prevention - Fire Protection Irrigation Domestic Water ❑ .. Geotechnical Report ❑ .. Maintenance Agreement(s) ❑ ...Traffic Impact Analysis ❑ ...Hold Harmless — (SAO) ❑ ... Hold Harmless — (ROW) ❑ .. Right-of-way Use - Profit for less than 72 hours ❑ .. Right-of-way Use — Potential Disturbance ❑ .. Work in Flood Zone ❑ .. Storm Drainage .. Abandon Septic Tank ❑ .. Curb Cut ❑ .. Pavement Cut ❑ .. Looped Fire Line f) ❑ ...Permanent Water Meter Size... WO # ❑ .. Grease Interceptor ❑ .. Channelization ❑ .. Trench Excavation ❑ .. Utility Undergrounding ❑ ...Temporary Water Meter Size.. WO # ❑ ...Water Only Meter Size WO # ❑...Deduct Water Meter Size ❑ ...Sewer Main Extension Public 0 Private 0 ❑ ...Water Main Extension Public 0 Private 0 FINANCE INFORMATION Fire Line Size at Property Line Number of Public Fire Hydrant(s) ❑ ...Water 0 ...Sewer Monthly Service Billing to: Name: ❑ ...Sewage Treatment Day Telephone: Mailing Address: Water Meter Refund/Billing: Name: Mailing Address: City State Zip Day Telephone: City State Zip H:\Applications\Forms-Applications On Line \2011 Applications\Permit Application Revised - 8-9-1 I.docx Revised: August 2011 bh Page 3 of 4 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 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 International Building Code (current edition). I HEREBY CERTIFY THAT I H ' E READ AND EXAMINED THIS APPLICATION AND KNOW THE SAME TO BE TRUE UNDER PENALTY OF PERJURY BY ATAWSt; THE STATE OF WASHINGTON, AND I AM AUTHORIZED TO APPLY FOR THIS PERMIT. BUILDING OWNE r TIH I� ice* ,t NT: Signature: Date: 01/04/2017 Print Name: Mark A. Segal Day Telephone: (206) 575-2000 Mailing Address: P.O. Box 881 8 Tukwila WA 98138 City State Zip H: \Applications\Forms-Applications On Line \2011 Applications\Pennit Application Revised - 8-9-1 I.docx Revised: August 2011 bh Page 4 of 4 OBULLETIN A2 TYPE C PERMIT FEE ESTIMATE PLAN REVIEW AND APPROVAL FEES DUE WITH APPLICATION PW may adjust estimated fees PROJECT NAME /(a c "1-11 (-lou; . PERMIT # 4130 s . /60 11 If you do not provide contractor bids or an engineer's estimate with your permit application, Public Works will review the cost estimates for reasonableness and may adjust estimates. 1. APPLICATION BASE FEE 2. Enter total construction cost for each improvement category: Mobilization Erosion prevention Water/Sewer/Surface Water Road/Parking/Access A. Total Improvements 3. Calculate improvement -based fees: B. 2.5% of first $100,000 of A. C. 2.0% of amount over $100,000, but less than $200,000 of A. D. 1.5% of amount over $200,000 of A. 4. TOTAL PLAN REVIEW FEE (B+C+D) $250 (1) 5. Enter total excavation volume cubic yards Enter total fill volume cubic yards Use the following table to estimate the grading plan review and permit fee. Use the greater of the excavation and fill volumes. QUANTITY IN CUBIC YARDS RATE Up to 50 CY Free 51 — 100 $23.50 101 — 1,000 $37.00 1,001— 10,000 $49.25 10,001 — 100,000 $49.25 for 1ST 10,000, PLUS $24.50 for each additional 10,000 or fraction thereof. 100,001 — 200,000 $269.75 for 1ST 100,000, PLUS $13.25 for each additional 10,000 or fraction thereof. 200,001 or more $402.25 for 1ST 200,000, PLUS $7.25 for each additional 10,000 or fraction thereof. GRADING Plan Review and Permit Fees (4) $ (5) TOTAL PLAN REVIEW AND APPROVAL FEE DUE WITH PERMIT APPLICATION (1+4+5) $ 2 So The Plan Review and Approval fees cover TWO reviews: 1) the first review associated with the submission of the application/plan and 2) a follow-up review associated with a correction letter. Each additional review, which is attributable to the Applicant's action or inaction shall be charged 25% of the Total Plan Review Fee. Approved 09.25.02 Last Revised 01.01.14 1 BULLETIN A2 TYPE C PERMIT FEE ESTIMATE PLAN REVIEW AND APPROVAL FEES DUE WITH APPLICATION PW may adjust estimated fees 6. Permit Issuance/Inspection Fee (B+C+D) 7. Pavement Mitigation Fee $ (6) $ (7) The pavement mitigation fee compensates the City for the reduced life span due to removal of roadway surfaces. The fee is based on the total square feet of impacted pavement per lane and on the condition of the existing pavement. Use the following table and Bulletin 1B to estimate the p Approx. Remaining Years Pavement Overlay and Repair Rate (per SF of lane width) 20-15 (100%) $10.00 15-10 (75%) $7.50 10-7 (50%) $5.00 7-5 (33%) $3.30 5-2 (25%) $2.50 2-1 (10%) $1.00 0-1 $0.00 8. GRADING Permit Review Fee Grading Permit Fees are calculated using the following table. Use the greater of the excavation and fill volumes from Item 5. QUANTITY IN CUBIC YARDS RATE 50 or less $23.50 51 —100 $37.00 101 — 1,000 $37.00 for 1st 100 CY plus $17.50 for each additional 100 or fraction thereof. 1,001 — 10,000 $194.50 for lst 1000 CY plus $14.50 for each additional 1,000 or fraction thereof. 10,001— 100,000 $325.00 for the 1' 10,000 CY plus $66.00 for each additional 10,000 or fraction thereof 100,001 or more $919.00 for lst 100,000 CY plus $36.50 for each additional 10,000 or fraction thereof. Approved 09.25.02 Last Revised 01.01.14 2 (8) n 0 BULLETIN A2 TYPE C PERMIT FEE ESTIMATE PLAN REVIEW AND APPROVAL FEES DUE WITH APPLICATION PW may adjust estimated fees 9. TOTAL OTHER PERMITS A. Water Meter — Deduct ($25) B. Flood Control Zone ($50) C. Water Meter — Permanent* D. Water Meter — Water only* E. Water Meter — Temporary* * Refer to the Water Meter Fees in Bulletin Al Total A through E $ (9) 10. ADDITIONAL FEES A. Allentown Water (Ordinance 1777) $ B. Allentown Sewer (Ordinance 1777) $ C. Ryan Hill Water (Ordinance 1777) $ D. Allentown/Foster Point 2 Water (Ordinance 2177) $ E. Allentown/Foster Point 2 Sewer (Ordinance 2177) $ F. Special Connection (TMC Title 14) $ G. Duwamish $ H. Transportation Mitigation $ I. Other Fees $ Total A through G $ (10) DUE WHEN PERMIT IS ISSUED (6+7+8+9+10) $ ESTIMATED TOTAL PERMIT ISSUANCE AND INSPECTION FEE This fee includes two inspection visits per required inspection. Additional inspections (visits) attributable to the Permittee's action or inaction shall be charged $60.00 per inspection. WATER METER FEE Permanent and Water Only Meters Size (inches) installation Cascade Water Alliance RCFC 01.01.2009 -12.31.2009 s ,,,,,,,,,,,„Total Fee 0.75 $600 �� $6,005 7 $6,605 1 $1100 \$15,012.59" $16,112.50 1.5 $2400 11005 $32,425 2 $2800 $48,040-----..., $50,840 3 $4400 / $96,080 ---\ $100,480 4 $7800 // $150,125 $157,925 6 $12500 iz $300,250 $312,750 Approved 09.25.02 Last Revised 01.01.14 Temporary Meter 70.75" $300 2.5" $1,000 3 Oktin 1/22_4,7 Cash Register Receipt City of Tukwila DESCRIPTIONS I ACCOUNT 1 QUANTITY PAID PermitTRAK $250.00 D17-0003 Address: 4430 S 160TH ST Apn: 8108600481 $250.00 PUBLIC WORKS $250.00 BASE APPLICATION FEE TOTAL FEES PAID BY RECEIPT: R10619 R000.322.100.00.00 0.00 $250.00 $250.00 Date Paid: Friday, January 27, 2017 Paid By: MARK SEGALE Pay Method: CHECK 1255 Printed: Friday, January 27, 2017 11:41 AM 1 of 1 CRSYSTEMS Cash Register Receipt City of Tukwila DESCRIPTIONS PermitTRAK ACCOUNT I QUANTITY PAID $500.92 D17-0003 Address: 4430 S 160TH ST Apn: 8108600481 $500.92 DEVELOPMENT $486.32 PERMIT FEE R000.322.100.00.00 0.00 $292.01 PLAN CHECK FEE R000.345.830.00.00 0.00 $189.81 WASHINGTON STATE SURCHARGE B640.237.114 0.00 $4.50 TECHNOLOGY FEE $14.60 TECHNOLOGY FEE TOTAL FEES PAID BY RECEIPT: R10310 R000.322.900.04.00 0.00 $14.60 $500.92 Date Paid: Thursday, January 05, 2017 Paid By: MARK SEGALE Pay Method: CHECK 1150 Printed: Thursday, January 05, 2017 2:44 PM 1 of 1 CR INSPECTION NO. INSPECTION RECORD Retain a copy with permit D17- 003 PERMIT NO. CITY OF TUKWILA BUILDING DIVISION 6300 Southcenter Blvd., #100, Tukwila. WA 98188 (206) 431-3670 Permit Inspection Request Line (206) 438-9350 Project: m �' Type of Inspection: .� c%7 u IiLbi 6- /I' MAL Address: 412 id° Sr" Date Called: Special Instructions: Date Wante . 5- 23 /7 a ri. m. Requester. E►LSn4 Phone No: 2O6- . S 7S-- 7,Q 00 Approved per applicable codes. LJ Corrections required prior to approval. COMMENTS: Inspector: A Date:, z ,,7 REINSPECTION FEE REQUIRED. Prior to next inspection, fee must be paid at 6300 Southcenter Blvd., Suite 100. Call to schedule reinspection. INSPECTION NO. INSPECTION RECORD Retain a copy with permit -00o- PERMIT NO. NO. CITY OF TUKWILA BUILDING DIVISION 6300 Southcenter Blvd., #100, Tukwila. WA 98188 (206) 431-3670 Permit Inspection Request Line (206) 438-9350 Project: 160- / %�{JU� "' Ty `��of lnsp�ction: ry - t..0/4 - eoc"'i 1G Address: 4430 S %d,' '' ST— TSpecial Date Called: Special Instructions: CALL {bcie Date Wante 4 Z J17 Requester. s ( BLOC Phone No: 2&--2,7&-2012. Approved per applicable codes. Corrections required prior to approval. COMMENTS: Inspector: Date4/ 17 REINSPECTION FEE REQUIRED. Prior to next inspection, fee must be paid at 6300 Southcenter Blvd., Suite 100. Call to schedule reinspection. Drain Field Septic Tank Water c Car Port Power Gas capped at ROW S 160th St House Demolition: Address: 4430 S 160th St., Tukwila, WA 98188 Tax Parcel: 8108600481 Square Feet: 2730 SF bR' 30 5 160th SI t �Y-'1,1='-- L. APPROVED JAN 12 2017 city of Tukwila PUBLIC Works 1 OW { 810860050.4 .8 10860050 810860050 1 8108600481 S 160th --S 0 co 2223049065 8308600440 g O 22230490882222T47.' N 810860 -TR .1 c - 22230491Q0 o c a. 0 0 COI -t 00 8108600462 2 0 2223049039 co CO o 0379800141 0 5379800085 5379800090 5379800090 0 0 w 01 ^ in a 0 0 cn 211 5379800119 private 1922600010 5379800142 1922600020 0 co 0 0 c rn!u j 379800143 1922600030 Op�t1 1`922600041, 53 79800144 o c7 ®on Cr+mstviel5,37980012:1 3922600050. 5379800140 5379800122 1922600060 1 i.p. t S'•'74;;01314ti 1912600070 2223049087 RECEIVED JAN 12 2017 TUKWILA PUBLIC WORKS FCEIVED CFITY OF TUKWILA r rn L JAN 0 5 2017 P�IIT CENTER 192250001; 192250002; 192250003; 1922500041 1 TE PERMIT .Jc _ED FOR: mechanical f iectrical lj t mbing Gas Piping City of Tukwila B ILDING DIVISION REVISIONS No changes shall be made to the scope of work without prior approval of - Tukwila Building Division. f!OTE: ► :Cvisons will require a new plan submittal and may include additional plan review fees. PLANNING APPROVED • No changes can be madeto these plans without approval from the Planning Division of DCD FILE COPY Permit No. b1-7- 0003 Plan review approval is subject to errors and omissions. Approval of construction documents does not authorize the violation of any adopted code or ordinance. Receipt of approved Fi id Copy and conditiof s is acknowledged: 1idtj' By: Date: 1 oZ J City of Tukwila BUILDING DIVISION REVIEWED FOR CODE COMPLIANCE APPROVED JAN 2 3 2017 i4� ti City of Tukwila BUILDING DIVISION RECEIVED CITY OF TUKWILA JAN 052011 PERMIT CENTER r1--000 3 0 W ENVIRONMENTAL SERVICES, INC. Environmental Consulting & Compliance April 8, 2016 Barry Bennett Segale Properties 5811 Segale Park Drive C Tukwila, WA 98188 FiL -M RE: Asbestos consulting at the residence located at 4430 S 160th St in Tukwila, WA Dear Mr. Bennett, NOW Environmental Services is pleased to present this survey report for suspect asbestos -containing building materials analysis conducted at the residence located at 4430 S 160th St in Tukwila, Washington. We appreciate the opportunity to have been of service to you. If you have any questions regarding this report, please feel free to contact me at (253) 927-5233. Sincerely, Todd Rickert Project Manager AHERA Building Inspector/Management Planner Accreditation No. BIR/MPR/NES-052915-01 (Exp. 5-27-15) NOW Environmental Services Enclosure: Asbestos Survey Report REVIEWED FOR CODE COMPLIANCE APPROVED JAN 23 HU City of Tukwila BUILDING DIVISION RECEIVED JAN 12 2017 TUKWILA PUBLIC WORKS RECEIVED CITY OF TUKWILA JAN 0-5 2017 PERMIT CENTER 34004 9th Avenue South, Suite 12, Federal Way, Washington 98003 Phone: (253) 927-5233 Fax: (253) 924-0323 www.nowenvironmental.com 01'l' 000 (KO W ENVIRONMENTAL SERVICES, INC. Environmental Consulting. & Compliance Limited Asbestos Survey Prepared For: Segale Properties 5811 Segale Park Drive C Tukwila, WA 98188 April 8, 2016 Subject Property: Residence 4430 S 160th St Tukwila, Washington 98188 Prepared BY: Now Environmental Services 34004 9th Avenue South, Suite 12 Federal Way, Washington 98003 Contents Section Introduction 1.0 Executive Summary 2.0 Regulatory Compliance 3.0 s' Sampling Plan and Laboratory Analysis 4.0 Survey Results 5.0 Conclusions and Recommendations 6.0 Limits of Survey 7.0 Appendices Laboratory Results A )1t Field Notes 'Certification(s) 34004 9th Avenue South, Suite 12, Federal Way, Washington 98003 Phone: (253) 927-5233 Fax: (253) 924-0323 www.nowenvironmental.com /fr, Section 1.0 - Introduction On March 31St, 2016, AHERA Building Inspector Todd Rickert of NOW Environmental' Services conducted a limited inspection for suspected asbestos -containing building materials at the residence located at 4430 S 160th St in Tukwila, WA. Mr. Rickert is an Environmental Protection Agency (EPA) Accredited Building Inspector Accreditation No. BIR/MPR/NES-052915-01 (Exp. 5-27-16). Accessible areas were visited and samples were taken of building materials suspected to contain asbestos (vinyl floor tile, gypsum wallboard, ceramic tile etc.). These samples were analyzed for the presence of asbestos. In addition, the quantities of asbestos -containing materials were estimated.** Please see Table 1 for an inventory of sampled suspect building materials. Sample locations are indicated on the attached site drawings. '"` QUANTITIES ARE APPROXIMATE AND ARE NOT TO BE USED FOR BIDDING PURPOSES. PROSPECTIVE BIDDERS MUST SITE VERIFY QUANTITIES AND SITE CONDITIONS. RESIDENCE - 4430 S 160''$T IN TUKWILA, WA PROJECT #.N16-0162 Section 2.0 - Executive Summary Building Description The structure is a one story residential building with basement with approximately 2,000 square feet. The structure was built in approximately the 1960's and is a wood framed structure on a concrete foundation and slab on grade. Interior wall systems are gypsum wallboard with joint compound over wood framing. Other interior finishes include bare concrete, hardwood, ceramic tile and plywood. The exterior was painted wood siding. The roof was metal. Materials sampled were collected with the intent that this structure will be demolished. Please see attached drawings for locations. Asbestos No asbestos containing building materials were found in any samples taken. Please see Table 2 for an inventory of sampled suspect building materials found at the residence located at 4430 S 160th St' in Tukwila, WA during this survey. Table I Summary of Asbestos Containing Building Materials sampled at the residence located at 4430 S 160th St in Tukwila, WA Materiaf'D:escription , , , ,. �,. . Sample Number, ; " Material Sample Location .. ;. Analytical (Laboratory); Results No Regulated Asbestos. Building Materials Identified RESIDENCE - 4430 S 160"' ST IN TUKWIIA. WA PROJECT 4 Nf6-0162 Section 3.0 - Regulatory Compliance Asbestos The intent of the asbestos survey is to comply with governing asbestos regulations required by the State of Washington and Puget Sound Clean Air Agency (PSCAA). Currently, the State of Washington requires a written "good faith inspection" for identification of asbestos -containing materials prior to any remodeling or demolition work. During demolition and construction work it is the responsibility of the owner and the contractors to make this survey document available to all concerned parties who may be handling the building materials. In addition, PSCAA requires that a copy of the written asbestos survey be made available on-site for inspection by a PSCAA Control Officer during construction and demolition work. The survey is required to be performed in accordance with 40 CFR 763.86. These federal standards require inspections to be conducted by an EPA Accredited Building Inspector with analysis to be provided by an asbestos laboratory certified by the National Bureau of Standards. The requirements are described in Article 1 and Article 4, of PSCAA's Asbestos Control Standards. All survey work was conducted in compliance with the above mentioned standards. Asbestos -containing materials are required to be removed and disposed of in accordance with Washington State Regulation 296-155 WAC, Part S prior to any demolition, renovation, or remodeling that would disturb these materials. Washington State Department of Labor and Industries and PSCAA require that the abatement be performed using Certified Asbestos Workers under the direct on-site supervision of a Certified Asbestos Supervisor in accordance with 296-65 WAC. Also see 296-62 WAC, Part I-1—General requirements for handling asbestos. RESIDENCE -4430 S 160Th ST IN TUKWILA, WA PROJECT # N16-0162 Section 4.0 - Sampling Plan and Laboratory Analysis Asbestos Objectives The objective of the survey was to determine the quantity and location of building materials (vinyl floor tile, roofing, gypsum wallboard, etc.) that contain asbestos within areas to be impacted by planned renovation work. Asbestos Sampling Plan Protocol This survey was conducted using a protocol adapted from the Asbestos Hazard Emergency Response Act (AHERA). The protocol is as follows: 1. Group materials into homogeneous sampling areas. 2. Quantify each homogeneous sampling area and collect samples from each area using the "3-5-7" criteria for surfacing material to determine the number of samples needed. Quantify and collect a minimum of three samples of each thermal system insulation (the number of samples collected of miscellaneous materials was determined by the inspector). 3. Samples of each material were taken to the substrate, ensuring that all components of the material were included. 4. Sampling was performed by a Certified Building Inspector, and the use of proper protective equipment and procedures was followed. Asbestos Sampling Procedure 1. Spread the plastic drop cloth (if needed) and set up other equipment, e.g., ladder. 2. Put on protective equipment (respirator and protective clothing if needed). 3. Label sample container with its identification number and record number. Record sample location, and type of material sampled on a sampling data form. 4. Moisten area where sample is to be extracted (spray the immediate area with water). 5. Extract sample using a clean knife, drill capsule, or cork boring tool to cut out or scrape off approximately one tablespoon of the material. Penetrate all layers of material. 6. Place sample in a container and tightly seal it. 7. Wipe the exterior of the container with a wet wipe to remove any material that may have adhered to it during sampling. 8. Clean tools with wet wipes and wet mop or vacuum area with HEPA vacuum to clean all debris. 9. Seal the sampling location with caulking compound, spackle or duct tape. 10. Discard protective clothing, wet wipes and rags, cartridge filters, and drop cloth in a labeled plastic waste bag. Asbestos Laboratory Analysis The bulk samples were analyzed in our laboratory using polarized light microscopy (PLM) with dispersion staining in accordance with US EPA method 600/R-93/116 as specified in 40 CFR Chapter I (7-1-93 edition) Part 763, Subpart F, Appendix A, pages 499-504. Polarizing light microscopy quantifies asbestos concentrations at between 100% and 1% detection levels. Levels below 1% can only be stated as "trace." For samples containing more than one separable layer of materials, the report will include findings for each layer (labeled L-1 for layer one and L-2 for layer two, etc.) and a total percentage for the entire sample. The asbestos concentration in the sample is determined by visual estimation. For those samples with asbestos concentrations between 1 and 10 percent based on visual estimation, the EPA recommends a procedure known as point counting (NESHAPS, 40 CFR Part 61). Point counting is a statistically more accurate means of quantification for samples with low concentrations of asbestos. RESIDENCE - 4430 S 160TM ST IN TUKW IIA. WA PROJECT „ N16-0162 Section 5.0 - Survey Results Asbestos Table H Summary of suspect Asbestos Containing Building Materials sampled at the residence located at 4430 S 160th St in Tukwila, WA Material Description Sample. Number '' Material' Sample Location, Analytical (Laboratory,). Results Vapor Barrier, Siding N16-0162-001 Exterior Non -Detect Joint Compound and Gypsum Wallboard N16-0162-002 Kitchen . Non -Detect Joint Compound N16-0162-003 Bedroom #3 Non -Detect Joint Compound N16-0162-004 Bedroom #2 Non -Detect Vapor Barrier, Roof N16-0162-005 Roof Non -Detect Attic Insulation N16-0162-006 Attic Non -Detect Hardwood Squeak Sheet N16-0162-007 Living Room Non -Detect 9"x9" Vinyl Floor Tile, Gray w/colored Spots and Dark Mastic N16-0162-008 Fumace Room Non -Detect 12"x12" Ceramic Tile, Tan N16-0162-009 Bathroom Non -Detect Mastic, Gray N16-0162-010 Bathroom Non -Detect Grout, Tan N16-0162-011 Bathroom Non -Detect 12"x24" Ceramic Tile, Brown and Mastic, White N16-0162-012 Bathroom Non -Detect Green Tile N16-0162-013 Rear Entry Non -Detect Mastic, Gray N16-0162-014 Rear Entry Non -Detect Grout, Gray N16-0162-015 Rear Entry Non -Detect RESIDENCE 4430 S 160TN ST IN TUKWILA, WA PROJECT 4 N16-0162 Section 6.0 - Conclusions and Recommendations NOW Environmental Services is not responsible for materials which require destructive means to access, or materials which are hidden from sight, those materials hidden behind walls, or materials which cannot be found with reasonable diligence. Extreme caution should be used during renovation or demolition to ensure that additional unidentified materials are not disturbed. In the event that additional materials are discovered, the material should be sampled by an EPA Accredited AHERA Building Inspector and analyzed to determine if it contains asbestos prior to disturbance. Asbestos According to Washington Administrative Code (WAC) 296-62-07721, prior to the start of work, a building owner must identify the presence, location, and quantity of ACM and/or presumed ACM (PACM) prior to renovation and demolition. This information must be communicated to contractors bidding on work, contractors performing other work, employees and tenants in or adjacent to the work area. The Puget Sound Clean Air Agency Regulation III, Article 4 requires that an asbestos survey be conducted prior to any renovation or demolition of existing buildings. This survey was intended to meet these regulatory requirements. Asbestos -containing materials are required to be removed and disposed of in accordance with Washington State Regulations prior to any demolition, renovation, or remodeling that would disturb these materials, Washington State Department of Labor and Industries and PSCAA require that the abatement be performed using Certified Asbestos Workers under the direct on-site supervision of a Certified Asbestos Supervisor. The only exemption is for resident owners performing removal of asbestos -containing materials other than furnace interiors and direct applied mudded asbestos insulation. ACM is identified as those building materials containing greater than one percent (>1.0%) of asbestos as verified by laboratory analysis. All building materials fabricated prior to 1980 are assumed to contain asbestos unless proven otherwise by a licensed building inspector. Materials that contain 1.0% or Tess asbestos are not regulated for disposal purposes. However, removal of materials containing 1.0% or less asbestos is considered an unclassified asbestos operation by OSHA and WISHA. Unclassified asbestos operations cover employees likely to be exposed in excess of the permissible exposure limit (PEL), and who are performing operations not covered by Class I through IV. For construction work involving unclassified asbestos the applicable requirements will include: an exposure assessment, use of vacuum cleaners equipped with HEPA filters, use of wet methods and prompt cleanup of debris, use of respirators and protective clothing, training, and record keeping. Asbestos -containing joint compound associated with non -asbestos gypsum wallboard (GWB) assemblies is sometimes found in specific locations of a building. The presence of asbestos in this material requires personnel impacting the material to adhere to regulatory requirement outlined in WAC 296-62-17712(2) and training as outlined in WAC 296-62-07722(5) and WAC 296-62-07728. Personal protect equipment and proper work practices are required pending completion of a negative exposure assessment. Such an assessment may include air monitoring of workers' breathing zones. Refer to WISHA Regional Directive 23.30 for additional information. The possibility exists that additional ACMs may be present in wall and ceiling cavities. Any previously unidentified material encountered during construction activities should be sampled prior to impact. Work that may be impact asbestos should be performed by personnel having proper training and utilizing proper worker protection according WISHA standards. NOW Environmental Services recommends that a Certified Asbestos Project Designer design any asbestos abatement project to ensure that the job is completed according to regulatory standards. RESIDENCE -4430 S 160T" ST IN TUKWILA, WA PROJECT 4 N16-0162 Section 7.0 - Limits of Survey Asbestos surveys are non -comprehensive by nature and subject to many limitations including those presented below. Our assessment has considered risks pertaining to asbestos; however, this survey is limited to only those locations sampled. This survey was not designed to identify all potential concerns or eliminate all risk associated with asbestos. Materials sampled were limited by the scope of work as defined by the drawings provided. Lead based paint & TCLP testing, mercury Tight tubes and/or other hazardous materials were not included in the scope of work during the course of this survey. Other risks that were not evaluated with this survey; Risks such as 1) toxic and hazardous substances in (or in contact with or associated with) soil or ground water; 2) risks associated with structural, electrical, or mechanical working of the building; 3) risks associated with radon gas, slope stability, building settlement, moisture, or site drainage and flooding have not been evaluated during this survey. No warranty, expressed or implied, is made. The site visit consisted of a thorough visual walk-through of building for the purpose of viewing and sampling potential asbestos -containing material. A TCLP sample was not collected of the building to determine levels of leachable lead in building debris. Suspect PCB containing light ballasts were not estimated. Fluorescent bulbs were not quantified for recycling purposes. Mercury vapor lamps were not identified during the survey. NOW Environmental Services performed this survey in accordance with the generally accepted standards of care that exist in the industrial hygiene profession in Washington State at the time of this study. The asbestos survey was performed in preparation for removal of asbestos -containing materials in accordance with NESHAPS regulations. This survey is not intended for use as plans and specifications. These estimates are for approximating actual bid prices from contractors only, and may not reflect the actual final costs of asbestos and/or lead abatement. They do not include sales tax, or Owner costs such as abatement project oversight and monitoring for compliance to law and/or compliance to project plans and specifications. These estimates assume that adequate, professional plans and specifications are prepared and the abatement costs are minimized by professional project management, and that all asbestos containing materials are abated during one project by the same asbestos contractor. Written By: Todd Rickert Project Manager AHERA Building Inspector/Management Planner Accreditation No. BIR/MPR/NES-052915-01 (Exp. 5-27-16) Re iewed By: 0 Donna McNeal CEO/Laboratory Director RESIDENCE -4430 S 160Th ST IN TUKWILA, WA PROJECT # N16-0162 APPENDIX A Laboratory Results Emir • .. , tat Compliance & Consulting ORION Environmental Services 34004 Ninth Avenue South, Suite Al2, Federal Way, WA 98003 Phone: (253) 952-6717 • Fax: (253) 927-4714 Email: info@oriones.net • Web: www.oriones.net WBE W2F9219763 Polarized Light Microscopy Test Report EPA Method 600/R-98/116 Client: Segale Properties Address: 5811 Segale Park Drive C, Tukwila, WA 98188 Attention: Barry Bennett Project Name: Residence Demo ASBIN 7730 S 16th St, Tukwila Project Number: N16-0162 Rpt. Date: 4/1/2016 Page: 1 of 2 Invoice: 161546 Date Rcvd: 4/1/2016 Chest _'' '' j , �, M � `' 'Sample !DI:"'Sample.ID'.,3 . . Orion�4 t ,J , ,Material ,. r ^., , . 4 t .Description- ' .ter., • 1i..' , - 3= - ' Sample r, _ ~_Treatment a ... Asbestos'` . 'tontaming . ,,Materrar.',' ..7: . - Asbestos 1 Type ,1,.. „ , Other • :,Fibers 'r,' - • 4 -- 001 20160401-12 Vapor Barrier ND cellulose 002a 20160401-13 Joint Compound ND cellulose 002b Gypsum Wallboard ND cellulose 003 20160401-14 Joint Compound ND cellulose 004 20160401-15 Joint Compound ND cellulose 005 20160401-16 Vapor Barrier ND cellulose 006 20160401-17 Attic Insulation ND cellulose 007 20160401-18 Hardwood Squeak Sheet ND cellulose 008a 20160401-19 9"x9" Vinyl Floor Tile ND 008b Dark Mastic ND cellulose 009 20160401-20 12"x12" Ceramic Tile ND 010 20160401-21 Mastic ND 011 20160401-22 Grout ND 012a 20160401-23 12"x24" Ceramic Tile ND 012b Mastic ND cellulose 013 20160401-24 Tile ND 014 20160401-25 Mastic ND 015 20160401-26 Grout ND Polarized Light Microscopy Test Report (cont.) Client: Segale Properties Address: 5811 Segale Park Drive C, Tukwila, WA 98188 Attention: Barry Bennett Project Name: Residence Demo ASBIN 7730 5 16th St, Tukwila Project Number: N16-0162 Rpt. Date: 4/1/2016 Page: 2 of 2 Invoice: 161546 Date Rcvd: 4/1/2016 i:Sy3 +?,,•'Y •{ N. x Client .cr.R• Sample ID, �'` . �_ ►e- ,,D i Orion Sample ID ', • ' ''` ,`.yA';i' -Material Description % t. ,. ' •_ C t i' -` 4 "f r .. -f Sample`" ,Treatment -4 .Asbestos containing Material <, i -Yom- 'NF N- Asbestos '�,: Type -. ,x�. : �.f • ('Other.. °• 'Fibers ` Dup: Laboratory QA/QC Duplicate; M; Mastic [(a), (b), (c), etc.]: Sample layers numbered from front to back. Comments: For layered samples, each component has been analyzed separately. ND means non -detect for asbestos fibers by EPA Method 600/R-98/116.Disclaimers: PLM has been known to miss asbestos in a small percentage of samples that contain asbestos. Thus, these laboratory results represent due diligence, however negative or <1 % PLM results can not be guaranteed. Per EPA guidelines samples will be archived for 30 days then will be disposed of. This report may only be reproduced in full with written approval of ORION Environmental Services. Analyzed By (Print) Don . McNeal Date 4/7/2016 Reviewed By (Print) Dennis Rauschenberg Date 4/7/2016 alyzed :y (Signature) r _ Time • , ed ignature) ..., , / Time APPENDIX B Field Notes RP m N Of e a 1• 1 ; 0 M rF 16* 1 Iompom 1 / 1 - '1 I 1 1 , I / I , 1 ' I $ 7 V 1 .__J.1.. J..._J_ .J •.--- 1 1 l { I- I -�..- I.�'.. 1 1 1 1 1 1 1 •1 m M I 1 1 , 1 - 1 1 —4- -r---1----4---- : --,- --i. ., ; • • I - ; C} 1 '1 1 • i____,-64 11 -- -_T__ -r. 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TIME: 4J'-/-/- 0,2 36 RECEIVED BY:""/".e. 1 h 13 1 W X N w H d A Q A rw 0 ADDRESS: All 3 c7 tzad" 1 it (1 t Lti 1 0 1 INSPECTOR: %7/• 1 DATE SAMPLED: 3 -73 -Ice dA 0en a 0 N a 0 x 0 wa Ud V k CELLULAR: OTHER FIBERS 4 a Q F a LOCATION OF MATERIAL MAg MATERIAL ID MATERIAL DESCRIPTION ..\ V ,) ,) \. t c!.) L c6 a c t)'\1) ...6 s_ 15 T L.Y) l > T -- x , i_ , t ENa E. RELINQUISHED DATE / TIME: A/-/ /60 a 3 1 a RECEIVED BY:�c,ole%r DATE / TIME: 4/ \ ,,1 '.2 ' Cli t , 4g._ F ADDRESS: 11340 1( -& 11 - t FZ Ct , i.'\ N U W gh � rg DATE SAMPLED: 3 -'/ -1 (ra 1 0 4 HOUR 024 -HOUR 03DAY CLIENT: 1 4 ,. a d - 1 TELEPHONE: 1 7 CELLULAR: OTHER FIRERS w a F El5F d LOCATION OF MATERIAL . ow . 01 g MATERIAL ID MATERIAL DESCRIPTION 4 V- L , cl_i it3.., , t I 6 t0 ljz co. s.c. _, C''"p ii L :b ?c, ,b -.to ‘. i as u �^ `° o.0 c 3 >2 c u u w '0 a> E P. v 0 V ORION Environmental Services M O . O CO 01 (0 4-+ 3 c wrI C N O LL 0 N 3 .Q1N 1 a 3 �� a, s x3 Y t1- • • • N O n G W N of 7 ctD a) c aJ N o <• M0 C N 0 Z C ...c E M D_ W ANALYSIS REQUESTED Other e.lpads 1HOM/1IVI ling PIoW in/ PIoW TCLP f d1D1-1a430 YHA 8 peal Hydrocarbons Z s3H aa430 t spH Ja430 9-Hd1M/M X318 X318 a IDH-Hd1M (ixa) Q-Hd1M a-Hd.LM D-Hd1M Total Metals Z slelaW aag10 1 slelaW Ja430 V1108 8 peal Asbestos solsagsy.ia ll0 0.131 i!V WJd lin9w,d XXXXXXXXXXXXXXX Client: Segale Properties Address: 5811 Segale Park Drive C, Tukwila, WA 98188 Attention: Barry Bennett Phone: (206) 575-2000 Fax: (206) 575-1837 Project Name: Residence Demo ASBIN 7730 S 16th St, Tukwila Project Number: N16-0162 Rpt. Date: 4/1/2016 P.O. Number: Page: 1 of 1 Orion Sample ID 20160401-12 11 20160401-13 120160401-14 20160401-15 20160401-16 20160401-17 20160401-18 20160401-19 20160401-20 20160401-21 20160401-22 20160401-23 20160401-24 20160401-25 20160401-26 +' Co.. c Bulk, PLM Bulk, PLM Bulk, PLM Bulk, PLM Bulk, PLM Bulk, PLM Bulk, PLM Bulk, PLM Bulk, PLM Bulk, PLM Bulk, PLM Bulk, PLM Bulk, PLM Bulk, PLM __ Bulk, PLM v 10 G 4/1/2016 4/1/2016 4/1/2016 4/1/2016 4/1/2016 4/1/2016 4/1/2016 4/1/2016 4/1/2016 4/1/2016 4/1/2016 4/1/2016 4/1/2016 4/1/2016 4/1/2016 Client Sample.ID 001 002 003 004 005 006 007 008 009 1010 011 012 013 014 015 0 e- N M 'Ch 10 (0 1- 00 C) O - N M APPENDIX C Certifications z 0 w U c) 0 a O M 4 c0 C e`S a N ACCREDITATION NO.BIR/ MPR/ -NES -052915-01 Donna McNeal — Instructor PPERMT COORD CCPY0. PLAN REVIEW/ROUTING SLIP PERMIT NUMBER: D17-0003 PROJECT NAME: 160TH HOUSE SITE ADDRESS: 4430 S 160TH ST X Original Plan Submittal Response to Correction Letter # DATE: 01/11/17 Revision # before Permit Issued Revision # after Permit Issued DEPARTMENTS: k.3 KW&'X\1 Building Division L AINU AtVri Public Works KA 10( 1*(11 111111 Fire Prevention Structural Planning Division ❑ Permit Coordinator PRELIMINARY REVIEW: Not Applicable n (no approval/review required) REVIEWER'S INITIALS: DATE: 01/12/17 Structural Review Required DATE: APPROVALS OR CORRECTIONS: Approved Corrections Required (corrections entered in Reviews) Notation: DUE DATE: Approved with Conditions Denied (ie: Zoning Issues) 02/09/17 REVIEWER'S INITIALS: DATE: Permit Center Use Only CORRECTION LETTER MAILED: Departments issued corrections: Bldg ❑ Fire ❑ Ping 0 PW ❑ Staff Initials: 12/18/2013 SEGALE PROPERITIES LLC Home Espanol Contact Safety & Health Claims & Insurance A 141 Washington State Department of kAPLabor & Industries Search L&I Page 1 of 2 A -Z Index Help MyL&1 Workplace Rights Trades & Licensing SEGALE PROPERITIES LLC Owner or tradesperson Principals SEGALE, MARIO A, PARTNER/MEMBER SEGALE, MARIO A, AGENT Doing business as SEGALE PROPERITIES LLC WA UBI No. 602 023 533 PO BOX 88028 TUKWILA, WA 98138-2028 206-575.2000 KING County Business type Limited Liability Company Governing persons DEVELOPMENT METRO LAND USA M ATKINS; NITA L SEGALE; TERESA NADEAU; TINA A COVEY; License Verify the contractor's active registration / license / certification (depending on trade) and any past violations. Construction Contractor License specialties GENERAL License no. SEGALPL902CQ Effective — expiration 02/18/2010— 04/03/2018 Bond ............... SAFECO INS CO OF AM Bond account no. 6115146 Active. Meets current requirements. $12,000.00 Received by L&I Effective date 03/28/2002 02/18/2010 Expiration date Until Canceled Insurance ............................... Alaska National Insurance Co $1,000,000.00 Policy no. 16DLS31006 Received by L&I Effective date 03/30/2016 04/01/2016 Expiration date 04/01/2017 Insurance history Help us improve https://secure.lni.wa.gov/verify/Detail.aspx?UBI=602023533&LIC=SEGALPL902CQ&SAW= 1/27/2017 SEGALE PROPERITIES LLC Savings No savings accounts during the previous 6 x period. Lawsuits against the bond or savings No lawsuits against the bond or savings accounts during the previous 6 year period. L&I Tax debts ................. No L&l tax debts are recorded for this contractor license during the previous 6 year period, but some debts may be recorded by other agencies. License Violations No license violations during the previous 6 year period. Workers' comp Do you know if the business has employees? If so, verify the business is up-to-date on workers' comp premiums. L&I Account ID 878,961-02 ................................. Doing business as SEGALE BUSINESS PARK Estimated workers reported Quarter 4 of Year 2016 "51 to 75 Workers" L&l account representative T3 / KAYLENE MONIER (360)902-6627 - Email: BRKB235@Ini.wa.gov Account is current. Workplace safety and health Check for any past safety and health violations found on jobsites this business was responsible for. Inspection results date 12/09/2014 Inspection no. 317552669 Location 196th St and Southcenter Pkwy. Tukwila, WA 98188 Violations Page 2 of 2 © Washington State Dept. of Labor & Industries. Use of this site is subject to the laws of the state of Washington. Help us improve https://secure.lni.wa.gov/verify/Detail.aspx?UBI=602023533&LIC=SEGALPL902CQ&SAW= 1/27/2017