HomeMy WebLinkAboutPermit D99-0032 - Axis Chropractic - Exam Rooms and Reception AreaThis 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.
D99 -0032
Axis Chiropractic
3459 South 152nd Street
RECORDS DIGITAL D- ) EXEMPTION LOG
THE ABOVE MENTIONED PERMIT FILE INCLUDES THE FOLLOWING REDACTED INFORMATION
Page # tode Exemption = Brief Explanatory DeSctiptiop �t�tutel ule
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
32
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.
Axis
hiropractic
CONTACT
City of Tukwila
Community Development / Public Works • 6300 Southcenter Boulevard, Suite 100 • Tukwila, Washington 98188
Parcel No:
Address:
Suite No:
Location:
Category:
Type:
Zoning:
Const Type:
Gas /Elec.:
Units:
Setbacks:
Water:
Wetlands
Contractor
OCCUPANT
OWNER:'
WARNING:
AOFF
DEVPERM
RC
V -N
001
North:
125
License
004300 -0095
3459 S 152 ST
Print Name : /Wv
IF CONSTRUCTION BEGINS BEFORE APPEAL PERIOD EXPIRES,
APPLICANT IS PROCEEDING AT THEIR OWN RISK.
DEVELOPMENT PERMIT
Fire
South: East:
Sewer: '; VAL ,VU
S :. N
AXIS ; I ROPRACTIC
3459 S 152 ' TUKWILA 'WA 98'T88
KACZMARSKI NERNON
44' S 152 ST, "TUKWILA WA 98188
,VERNON KACZMARSKI
3459_'S 152'ST, TUKWILA WA 98188
r.
Permit No:
Status:
Issued:
Expires:
Occupancy:
UBC:
Protection:
.0 West:
Streams:
Phone: 206 241 -2225
Phone:
. r
* * * * * * * * * * * * * * *************"****** * * * * * * * * * *•k. * * * * * *•k•k * * * * *•k *k *•A ** c t
Permit DaScri
INTERIOR TENANT IMPROVEMENT CONSTRUCTION OF
NEW DEMISING TO CREATE EXAMINING; ROOMS AND
A RECEPTION AREA
*****• k*****.******• k k*'***********• k******** A********** kk** A*** * * *•k * * * * **k *•k *•k * * * * *k *k * `f
Construction "'Val uat ion : $ 20 00
PUBLIC WORKS,. PERMITS:`;' *(Water Meter Permits Listed
Curb CutiAcc ess /Sidewal k /CSS N
Fire Loop Hydrant:" : N No:, Si`ze(in) :. .00
loodControl Zone: N
Hauling: N Start Time: End >Time:
Land Altering: N Cut: Fill:
Landscape Irrigation: N
Movi Oversized Load N Start Time : End Time
Sani'tary Side Sewer: N No
Sewer = Main Extension: N Private: N Public: N
- ,Storm' Drainage: N
Street Use: N
Water Main N Private: N Public: N
******************.k *4( *** * * * * *•k * ** ****** * * * * * * * * * * * *•k *•A* * * * * * * *k * ** k A k k k* k * * * * * * * *k * * ;
TOTAL DEVELOPMENT PERMIT. FEES: $ 534.56
************************************************** * * * * * * * * * ** * *•k * * * *•k * * ** *** * *'k**
1�AC . \ AR.
Separate)`
(206) 431 -3670
D99 -0032
ISSUED
03/09/,1999
09/05/1999
MEDICAL OFFICE
1997
NONE
.0
206 241 -2225
Eng. Appr:
Permit Center Authorized Signature:. O Date:3
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 provision of any other state or local laws regulating construction
or the performance of work. I am arized to sign for and obtain this
development permit. Z (�
Signature: \' �, W Q-'1/� - T Date:_ - ) I 6 (19
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.
03/.091
DEVELOPMENT
900 •
a changes wi 11 .be made to the plans 'unless approved by the
ehitect or Engineer and the 'Tukwila Building Division.
.El e �t i cal. perm its sh l�l, kie ab:t i n d trrrc r ,
1t e Q.v4s•
� ian ,i of:taktvria'nd Indtt trie. and all ele u • w r i11�„b ' t`t� i by agency '(248 - 6630) r *"
.. t��': F�•iFl. +.. R+' �
5," F i t
'A1'1 mecha i wprc shall be u
mechani°cai work "'shall bpt,u.gi`d r .�ttipar permit
rats 1 ui,w -i:l a ' r' 4 `• kr ti s
JJt y 5 � ( .. h
900 l r 3'.; 4 All , ts`t, :iospec-tion „record
• . h •
t,., p,eronr.i insp'''4ctian recendsi a -d ap)ara�ved p1 a-n3 . sha;11
a,t a } i 1f ile ate., the 'fob site pri}i t�o the sta`rn..it of :any ',poi-V.- f ig
sbrG �on iti, `These documents are tu ;;be : n.
mai.ta inesi and avai
ab, ' , unt!`1; fin.al inspection approval pis- r g anted.
j t 4
90 1 '� s '� Any new ce i l r g yr�i d end .l,
Any new�;be i 11�tg, grid`.:,a,nd light fixture .,in.�ta1�12�tion 1 is,
r.equiredkto m'eet lateral by'acing,, r�egu'�i`rements fo r.ei
Zone 3.
t'.ched to c
,El
ace' iC.al mjts' shat' be d
:whirl be ,obtan } Aid tt ough ?std e.- sea - Kin
'Wi,t o ' i F i ib Heailt P1i111r i ngl 11. 1 be
h at' ]age'l y i1nc� di all '' k�y piril,g� \ .
: ,.. ,F ty 1 i � + ;
, O
INEFFECT' '
INEFFECT.
INEFFECT
900.. .1
Part i t.i on
braced if
art itian wa1;1;
wa 1.1 'a''1:t' :ched.: to ce i 1 i
over eight''::[`. ), { ''fe *t; i n'
Any exposed insulations
'Ost be laterally,
back in'
Any exposed insulations backing material shall have a Flame
Spread Rating of. 25 .or less, and material shall bear identi
fication showing the fire performance rating thereof.
INEFFECT
INEFFECT
03/0.9/
11 44
Ai.l construction to h done ;in INEFFE+ T
11 �an�trur•t art ta' be' dart;e in �.onformanO:e with appt oved
ians, and,, regir'irements of the .Uniform Building Code' (1997..
dit :on) a:. amended Uniform Mechanical Cade (1997 Edition)
rtd Washington State'..Ener'+g,Y Code (1997 _Edit ion) .
''I[NEFFCCT
e.r <i t Thy i sguand�e of a per`nt e 7o .approval,,.
pprova 1 o :
'ans, sp,e i i or K t4 ans i am �rir t t an , l lw�n ;r { . be co
rued t 4o.� #�, �1 p �prit fapt',` - an appr~o � t. o , an.yit �ioiation
'
any h 154:0•! is =i vns af t> ul 1dttig *co,(te or t7 Any
� x, r � c t r,+ 'may �t � w� +
her,d dirt# e t the, t No p rn'1 pre rtgri t
It
. ;viiro'l a t,a '6,11, cla.rtce.l • the pr'o vt,,'ion is
de �la1 l tie va1 4 d
Project Name/Tenant:
AXls C /z� ' �� c�
Value of Construction r
20, axe
Site Address: -- 3 /6 -- d Er 4 it S ate /Zi
Tax Pt) e 4lu
Property Owner:
Will there be rack storage? ❑ yes P no
P
Street Address: .s/'ri ► r G
City State /Zip:
Fax #:
Contractor:
Phone:
Street Address:
City State /Zip:
Fax #:
Architect:
Phone:
Street Address:
City State /Zip:
Fax #:
Engineer:
Phone:
Street Address:
City State /Zip:
Fax #:
Contact Per§on::
U ( non
v aC airs i
P hone:
(. xy1/4.0) - 0 -i t ' l —,
Street Addro§s C i St / '
*yS r .D I � - i uJl � � '
Fax 1f:
Description of work to be done: Cer5 or ct /?), / 17r7 rVf76 to
G m0vc: L creak, recQp frdil CCf ?C f - 60fiiiiiiixLia0 4 15
Existing use: ❑ Retail ❑ Restaurant ❑ Multi- family ❑ Warehouse Hospital
❑ Church ❑ Manufacturing ❑ Motel /Ho el ❑ Office
❑ School /College /University - 7) Other r CajevJ
Proposed use: ❑ Retail ❑ Restaurant ❑ Multi- family ❑ Warehouse ['Hospital
❑ Church in Manufacturing ❑ Motel /Hotel ❑ Office
❑ School /College /University 'Other G _('v C.
Will there be a change of use? ❑ yes 71 no
hangge: (AAt additional sheet if necessary)
If yes, extent of change: Z.)
ggirS//4.)/1 64/4/(4.....
Will there be rack storage? ❑ yes P no
Existing fire protection features: ❑ sprinklers ❑ automatic fire alarm gnone ❑ other (specify)
Building Square Feet: f/ existing
Area of Construction: (sq. ft.) Y 1 i yk,—" •
Will there be storage of flammable /combustible hazardous material in the building? ❑ yes 74 no
Attach list of materials and storage location on separate 8 1/2 X 11 paper indicating quantities & Material Safety Data Sheets
Commercial / Multi - Family Tenant Improvement / Alteration Permit Application
CITY OF TU(VILA
Permit Center
6300 Southcenter Blvd., Suite 100, Tukwila, WA 98188
(206) 431 -3670
Application and plans must be complete in order to be accepted for plan review.
Applications will not be accepted through the mall or facsimile.
APPLICANT REQUEST FOR PUBLIC WORKS SITE/CIVIL PLAN REVIEW OF THE FOLLOWING:
(Additional reviews may be determined by the Public Works Department)
Curb cut/Access /Sidewalk ❑ Flood Control Zone
Size(s):
cubic yds. 0 Fill cubic yds.
❑ Sewer Main Extension
❑ Water Main Extension
0 Deduct
❑ Channelization /Striping ❑
❑ Fire Loop /Hydrant (main to vault) #:
❑ Land Altering 0 Cut
❑ Sanitary Side Sewer #:
❑ Storm Drainage ❑ Street Use
❑ Water Meter /Exempt #: Size(s):
❑ Water Meter /Permanent # Size(s):
❑ Water Meter Temp # Size(s): Est. quantity:
❑ Hauling
❑ Landscape Irrigation
O Private 0 Public
O Private 0 Public
0 Water Only
gal Schedule:
❑ Miscellaneous
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 period not exceeding 180 days upon written request by
the applicant as defined in Section 107.4 of the Uniform Building Code (current edition). No application shall be extended more than once.
Date application accepted.;
Date application expires:
Appllcatlort taken bp
PLEASE SIGN BACK OF APPLICATION FORM
CTPERMIT.DOC 1/29/97
BUILDING OWNER OR AUTHORIZ AGENT:
Signature: �.
�t `,
.
�
Date: 1
.7
Pr int name:
(
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'
MI
a jc; Jo-
one;,�
Mont?:
), / / 1 1 -
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#: Fax
(_6362
Address -�?
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2 ,,, d sr
City /State /Zip. , �� Qtj /e J
ALL COMMERCIAL /MULTI -FAI ILY TENANT IMPROVEMENT /ALT RATION PERMIT APPLICATIONS
MU BE SUBMITTED WITH THE FOL WING:
ALL DRAWINGS TO BE STAMPED BY WASHINGTON STATE LICENSED ARCHITECT,. �� -
STRUCTURAL ENGINEER OR CIVIL ENGINEER
➢ ALL DRAWINGS SHALL BE AT A LEGIBLE SCALE AND NEATLY DRAWN
➢ BUILDING SITE PLANS AND UTILITY PLANS ARE TO BE COMBINED
N/A SUBM ED
Complete Legal Description
❑ ❑ Metro: Non - Residential Sewer Use Certification if there is a change in the amount of plumbing fixtures
(Form H -13). Business Declaration required (Form H -10).
Four (4) sets of working drawings (five(5) sets for structural work), which include :
❑ Site Plan (including existing fire hydrant location(s)
1. North arrow and scale
2. Property lines, dimensions, setbacks, names of adjacent roads, any proposed or existing easements
3. Parking Analysis of existing and proposed capacity; proposed stalls with dimensions
4. Location of driveways, parking, loading & service areas
5. Recycle collection location and area calculations (change of use only)
6. Location and screening of outdoor storage (change of use only)
7. Limits of clearing /grading with existing and proposed topography at 2' intervals extending 5' beyond property's
boundaries
8. Identify location of sensitive area slopes 20% or greater, wetlands, watercourses and their buffers (change of
use only)
9. Identify location and size of existing trees that are located in sensitive areas and buffer (TMC 18.45.040), of
those, identify by size and species which are to be removed and saved
10. Landscape plan with irrigation and existing trees to be saved by size and species (exterior changes or change
of use only)
11. Location and gross floor area of existing structure with dimensions and setback
12. Lowest finished floor elevation (if in flood control zone)
13. See Public Works Checklist for detailed civil /site plan information required for Public Works Review (Form H-
9).
❑ V Floor plan: show location of tenant space with proposed use of each room labeled
❑ ❑ Overall building floor plan with adjacent tenant use; identify tenant space use and location of storage of
any hazardous materials; dimensions of proposed tenant space.
❑ Vicinity Map showing location of site
❑ ❑ Rack Storage: If adding new racks or altering existing rack storage, provide a floor plan identifying rack
layout and all exit doors. Show dimensions of aisles, include dimensions of height, length, and width of
rack. Structural calculations are required for rack storage eight feet and over.
❑ ❑ Indicate proposed construction of tenant space or addition and walls being demolished
❑ Construction details
❑ ❑ Sprinkler details - details of sprinkler hangers, specifically penetrations in structure, i.e., roof; size of
water supply to sprinkler vault with documentation from contractor stating supply line will meet or
exceed sprinkler system design criteria as identified by the Fire Department.
❑ ❑ Washington State Non - Residential Energy Code Data shall be noted on the construction drawings.
❑ ❑ SEPA Checklist - if intensification of use (check with Planning Department for thresholds).
❑ ❑ Attach plans, reports or other documentation required to comply with Sensitive Area Ordinance or other
land use or SEPA decisions.
❑ ❑ Food service establishments require two (2) sets of stamped approved plans by the Seattle -King County
Department of Public Health prior to submitting for building permit application. The Department of
Public Health is located at 201 Smith Tower, Seattle, WA or call (206) 296 -4787. (Form H -5)
❑ Copy of Washington State Department of Labor and Industries Valid Contractor's License. If no
contractor has been selected at time of application a copy of this license will be required before the
permit is issued OR submit Form H -4, "Affidavit in Lieu of Contractor Registration ".
Building Owner /Authorized Agent If the applicant is other than 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 permit application and
obtain the permit will be required as part of this submittal
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.
CTPERMIT.DOC 1 /29/97
' • •
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1RPSMTT Number. R9E100033. maunt 32 7i Q3/O/4 ?
;CHIROpROCTI Iryitr, Lil .:
•
.', .• • :1 'Nor. D9.9--XY032 . Type: DEVPIT.itt4 - DEVELOPMLNI 1 ' .:, •
• . ' par eel No 004300;-0095 ' . ' • ' '
Site,'Addi4esa: s 152 sr
Tota•I Fees: 534.56
TPli,s Pa`yment.' . 325.75 Total 'ALL Pmts,: 5'341.56
- —,-, '‘ ..'". ''' . '.. • ' . :' ' Balancer, .00
. ,
. ,
floc:cent Code Dr1ptit3n , ' , Amount
000/322,;100 ', BU1143:NG --•NONKES ' 321.25
000'/3B6.90/C • ' STATE. BUILDING SUteliABGE 4,.50
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• . i3 a 1 ar�ce ; 321.23 •
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000'1345. "t�30 :' ::. PLAf.CHECI< NOi'NRE$ . 208.£11.:
Project .. f -,1
Otis l ��OP OC4 rL
Type of Inspection `t
' "�^
Ad I s 14 5 152. S t
Date called: '1— t O O -'
l _ o
Special instructions:
q6kciO 0
Y =
3 0
Date wanted: a.m
M
Requester:
ilAcws
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P ne
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INSPECTION RECORD
Retain a copy with permit
INSPECTION NO.
CITY OF TUKWILA BUILDING DIVISION
6300 Southcenter Blvd, #100, Tukwila, WA 98188
Approved per applicable codes.
PERMIT NO.
(206)431 -3670
COMMENTS :j
biS TO F r,L(AL7
94(0
A,Ap
g iati
Corrections required prior to approval.
Date zo /
$47.00 REINSPECTION FEE REQUIRED. Prior to inspection, fee must be paid
at 6300 Southcenter Blvd., Suite 100. Call to schedule reinspection.
Receipt No:
Date:
INSPECTION RECORD
-te Retain a copy with permit
INSPECTION NO.
CITY OF. TUKWILA BUILDING DIVISION
6300 Southcenter Blvd., #100, Tukwila, WA 98188
Project(
'• 1 C;h, 2iiT1G/
Address c j / Date called.'
Type of inspection:
Date wanted: ' 1/-71 G a.
Requester:
.Phone No.: 2_4
COMMENTS:
(,v i / iii i?
4.1,44, G 4/d) ,4/,, f 'e
�*- efAe4.4
c -r! e'-'/ /41 6 e
Inspector:
:Approved per applicable codes.
PERMIT NO.
(206) 431 -3670
Corrections required prior to approval.
$42.00 REINSPECTION FEE REQUIRED. Prior to inspection, fee must
be paid at 6300 Southcenter Blvd., Suite 100. Call to schedule reinspection.
Receipt No.:
Date:
Sprinklers:
Fire Alarm: X
Hood & Duct:
Halon:
Monitor:
Pre -Fire:
Permits:
FINALAPP.FRM
City of Tukwila
Fire Department
.1TURWILA DEPARTMENT.
FINAL APPROVAL FORM
Retain current inspection schedule
Needs shift inspection
Approved without correction notice
Approved with correction notice issued
-Z : 5/0
Authorized Signa ure
Permit No.
Date
T.F.D. Form F.P. 85
John W. Rant; Mayor
Thomas P Keefe, Ftre:Chlef
Suit #
bo
Headquarters Station: 444 Andover Park East • Tukwila, Washington 98188 • Phone: (206) 575.4404 • Fax (206) 5754439
City of Tukwila
Steven M. Mullet, Mayor
April 14, 2000
Vernon Kaczmarski
3459 S 152 St
Tukwila Wa 98188
RE: Permit Status D99-0032
3459 S 152 St
Dear Mr Kaczmarski:
In reviewing our current permit files, it appears that your permit for tenant improvements, issued
on March 9, 1999, has not received a final inspection as of the date of this letter by the City of
Tukwila Building Division.
Per the Uniform Building Code and/or Uniform Mechanical Code, every permit issued by the
building official under the provision of this code shall expire by limitation and become null and
void if the building or work authorized by,such permit is not commenced within 180 days from
the date of such permit, or if the building or work authorized by such permit is suspended or
abandoned at any time after the work is commenced for a period of 180 days.
• Based on the above, if a final inspection is not called for within ten (10) business days from the
date of this letter, the Permit Center will close your file and the work completed to date will be
• considered non-complying and not in conformance with the Uniform Building Code and/or
Mechanical Code.
• Please contact the Permit Center at (206)431-3670 if you wish to schedule a final inspection.
Thank you for your cooperation in this matter.
Sincerely,
•
Department of CommuniV Development
LLQ C?,1(1-
Bill Rambo
Permit Technician
Xc: Permit File No. D99-0032
Duane Griffin, Building Official
Steve Lancaster, Director
6300 Southcenter Boulevard, Suite #100 • Tukwila, Washington 98188 • Phone: 206•431-3670 • Fax: 206-431•3665
AXIS CHIROPRACTIC .3459 S. 152nd Street Seatac, WA 98188 -2176 '
= • - Vernon H. - kaczmarski, D.C.
-(206) 241 -2225 Far•# (206) 241 -5562
January 29, 1999
BUILDrNG PERMIT SPECIFICATIONS
General Contractor: Water & Woods
Electrical Contractor: Kel Electric
General Plan: 1430 Square feet. Existing reception area; rear storage room/x -ra
developing area; existing bathroom. Remaining space, Southwest motif; arched, s oor ess
doorways, textured painted walls; carpeted hardwood floors and existing marble entryway.
Upgraded thermal -paned vaulted ceiling windows. Installed pre - fabricated storage cabinets
in back storage room; cusfom -built curvilinear reception desk. -
Addition of seven partitioned rooms; walls are 7'8" in height with fiberglass insulation for
sound deadening. Studs are spaced 16 inches apart on center - double 2x4 top plate with
bottom 2x4 plate nailed with two 16 penny sinkers every 16 inches. (See Wall Diagram.)
X -ray room is lead lined in accordance with State Radiation Shielding requirements.
Installed a high frequency Bennett x -ray machine with 100 Amp electrical requirement.
This is an existing structure and I am initiating the process of applying for a building permit
with the city of Tukwila, post construction. Please contact me regardin
requirements for building permit approval.
Your assistance is greatly appreciated. ,....- - , 2co
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kM ` .. �,1 �' r� ENTER
incerely,
Vernon H . Itaczi narski, D.C.
enclosures
CO ter 100
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SEPPTE. PERM1'T
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BUi1..DiNG .. ;t � J � t � t1
City of Tukwila •
• 6300 Southcenter Blvd.; Suite #100..
•- ••.. • ...Tukwila, WA -.98,188 ':'.• •
• " ,
RE: Revision to Development Permit Application #D99-0032 - Axis Chiropractic
• . • • • „. .
• ;""..-, •.• Dr. Ken Nelson., Tlans :Examiner:. • • • • • • •••• , • •' •.,• • . ‘• • ... • •• • •
. • • —
This is a revision response to your regarding my building permit application:
'`
•
1.) Provide door sizes: Shown on
• -
• - - Entrance/Exit
••`. • "" • . • Roorn" #3
•
• •
Room #4
End of Hallway
Room #1
ROOT #1 - Dr.'s Entryway
Massage Room
X-Ray Room
Dark Room/Kitchen Area
Rest Room
• • :
,• ••,
AXIS CHIROPRACTIC 3459 S. 152nd Street Seatac, WA '98188-2176
Vernon II; Kaczinarski, D.C.
(206) 241-2225 Fax (206) 241-5562
February '19, 1999
diagram
Doorless Archway
17" . x847 • Doorless Archway
35" x80" - Existing Doorway
547 x 84" - Doorless Archway
37' x 84" - Doorless Archway
37' x 84" - Doorless Archway
35' x 80" - Solid Wood 'Core Construction Door
35" x 80" - Steel Door and Frame
31 x 79" - Existing Doorway and Door
28" x 80" - Existing .Doorway and Door
•
•
Indicate, existing ceiling: Please see Building Diagram - North Face
16' open beam "A" frame structure - No alterations to ceiling structure.
Provide wall brace detail:
Bottom plate secured to sub floor using 16-penny nails, 16" apart. Double top plate
interlocks at each wall junction with overlapping top plates and anchoring using 5:16-
penny nails at each crossmember.
4.) Provide information regarding room ventilation:
Existing forced air heating and cooling system with electric heat pump. Each room
has existing floor registers that line the inside of the outer walls. Three overhead
ceiling fans are attached to existing ceiling crossbeams: spaced on every other crossbeam.
I hope this revision sheet provides the appropriate information for resubmittal.
I Sineerely,
)
Vernon H. Kaezmarski, D.C.
enclosures
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RECEIVED
CITY OF TUKWILA
JAN 2 9 1999
PERMIT CENTER
Parcel -ID:
Owner
CoOwner
Site Addr:
Mail Adds:
Sale Date:
SalePrice:
Loan Amt :
- Use Code :
Zoning .
Prop Desc:
Legal .
Bedrooms :
Bath Full:
Bath 3/4 : -
Bath 1/2 :
Other Rms:
Dining Rm:
Fireplace:
Appliance: -
Deck
Laundry .
Porch •
Pool
Spa
. Sauna
Stories
Units
S.
1700 • d
004300 0095 - _ Bldg:1
Kac=snnraki Vernon H
3459 5.152nd it Tukwila 98188
15240 40th -Ave - S Tukwila Wa 98188
06/03/98 Doc* :2111
$320,000 FALL Deed :Warranty
$256.000 Type:Sell Seller
251 COM,RETAIL STORE,LESS THAN 10K SQFT
Bc -
Mr Franks -
ELK 2 LOT 5 ADAMS HOME TRS 3RD ADD
LOT B OF KC SHORT PLAT NO 377015
RECORDING NO 7707180912 SD PLAT
:1
LAND INFORMATION
St Access:Std
Beach Acc:
WtrFront :
WtrFntLoo:
WtrFrntFT:
Grouridevr :
VIEWS: Mountain:
OWNERS " _
:Sall. Frank L
P CUARACTZRt S TICS
1st Floor. SF
2nd Floor SF
Half Floor SF
AboveGrnd SF
Bsmnt Finished
Bsmnt Total SF
Building SqFt
Lease SgFt-
DeckSqFt
Carport SqFt
Garage Type
Attached GrgSF
Detached GrgSF
Bsmnt ParkingSF:
Basement Type t
Basement Grade
Lot SqFt :8,470
Lot Acres:.19
Lot Shape:Regular
Tde /Upind:
Topogrphy:Level
TopoPnobd :Level
Lake /Rvr:
METROSCAN -
PROPERTY PROFILE
Puget_: • - City:
TRANSFER HISTORY
DATE / DOC $ PRICE
.s
:1,440
:1,440
•
St Surface
Tennis
Elevator
Sprinklers
Security
Golf Adi
Total :5132,800
Land ,:$97,400
Struct :635,400
%Imprvd :27 _-
Levy Cd :2413 -
1998 Tax :$1,889.33
'Phone t
Vo1:15 Pg:17
MapGrid :655 D4
Nbrhdcd :430000
-- CENSUS -
Tract :282.00
Block :3
QSTR :SW 22 23N04�
Year Built
Eff Year
Bldg marl
Bldg Cond
Bldg Grade
Interior
Wall Matl
Insulation
HeatSource
Heat Type
Air Method
EletricSvo
Wtr Source
Sewer Type
Purpose
Nuisance
OTHER INFORMATION
:No
:No
DEED - LOAN ...
:1978
:Frame
:Avg
:Basebrd
Soundproof t
Storage .
Curb /Gutter :
Sidewalk
St Light :
-,Lk Wa /Sam :
TYPE
. RECEIVED
qv) OF TUKWIIA : _ .
JAN 29:
PERMIT CENTER
the Zafeiuelon Provided it Deemed Reliable, aut Is Mot Guaraftted.
E9SSTPe Ol N3Iafd 140!.L NSNUNi WONId 9T:£T 8661 -91 -100
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_RECEIVED ' ;
CITY,OF TUKWILA •
JAN 2 9 1999
PERPArr CENTER
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STATE OF WASHINGTON
DEPARTMENT OF HEALTH
DIVISION OF RADIATION PROTECTION
Airdusts jai Center, Bldg. 5 • P.O. Box 47827 • Olympia, Washington 98504 -7827
HIS IS A BILL
April 10, 1998
Dear Registrant:
WAC 246 - 254 =053 and WAC 246- 224 -050 require mandatory registration and payment of a fee .
for radiation producing (x -ray) devices used in the state of Washington.
Your current x -ray registration will soon expire. WAC 246 -224 -050 requires renewal be received
by Mav 31, 1998. Renewal forms submitted after this date will be assessed a late fee of $90.00.
Please carefully review the enclosed "X -Ray Registration Application" for accuracy and make
changes if necessary by writing on the form. If the actual number of x -ray tubes at your facility is
different from that indicated, make an appropriate correction. Any tube count changes made will
affect the registration fee due. Please call us at 1- 800 - 299 -XRAY or (360) 236 -3236 to get A
corrected fee amount. Then return your check, plus a copy of the Registration
Application/Invoice, and the x -ray compliance slip in the envelope provided.
In order to further reduce our administrative cost to you we are encouraging everyone to make a
copy of your Renewal Registration/Application Invoice form and keep it for your own records.
You will need this form to prove registration of your facility to insurance companies or Health
Maintenance Organizations that accredit your facility, As in the private sector. your canceled
check will serve to prove that you paid your registration fee. Should you have any farther
questions please feel free to call me at 1- 800 - 299 -XRAY or (360) 236 -3236.
Sincerely,
Alton Je
X -Ray Facility Registrar
NOTE:. ADDITIONAL INFORMATION ON BACK SIDE OF THIS PAGE
Enclosure: Registration Application, Return Envelope, X -Ray Compliance Slip
0
a. COMPANY NAME '
b. STREET ADDRESS
c. CITY
Id. STATE
e. ZIP CODE
1, TELEPHONE NUMBER
a. NAME OF HOSPITAL, DOCTOR OR OFFICE �WHERE INSTALLED
?C/ ' C..4. ro�ra �7�, .
b. STREET ADDRESS
3y.5 /. 7 - '� —° ,..5.74----
C. CITY C /'
, - -
c CONTROL MODEL NUMBER
!r /P n 3o
Id.S c T ., 5
e. ZIP CODE
S /
f. SELECTED COMPONENTS
It. TELEPHONE NUMBER 1
zo6 . 84c14 J
a. THE MASTER CONTROL IS
� A NEW INSTALLATION
❑ EXISTING (Certified)
❑ EXISTING (Non -certified)
b. CONTROL MANUFACTURER /
�GN/C.r✓# x �6! _"
��"1
d CONTRO TRIAL NUMBER '7
1 . '� / !� 2_ SI
c CONTROL MODEL NUMBER
!r /P n 3o
e. SYSTEM MODEL NAME (CT Systems Only)
Complete the following Information for the certified components listed below which you installed. For beam limiting devices . tables and CT gantries enter the manufacturer and Model number in the
indicated spaces For other certified components, enter in the appropriate blocks how many of each you Installed In this system.
f. SELECTED COMPONENTS
OTHER CERTIFIED COMPONENTS
g . (Enter number of each installed in appropriate blocks)
81AM
LIMITING
DEVICE
MANUFACTURER
,�1C
.,.
MODEL NUMBIE�Rn.�/
— .7 U�_!
DATE MANUFACTURED
i ti '5
f %•RAY CONTROL CRADLE
11 HIGH VOLTAGE GENERATOR ❑ FILM CHANGER
MANUFACTURER
H/
MODEL NUMBER
DATE M•• ACTURED
S318V1
MANUFACTURER
MODEL NUMBER
DATE MANUFAC1UR:::
1 VERTICAL CASSETTE HOLDER ❑ IMAGE INTENSIFIER
MANUf ACT Uh
NI9
MODEL NUMBER
LATE MANUFACTURED
U TUBE HOuSING ASSEMBLY ❑ SPOT FILM DEVICE
(Medical)
DENTAL TUBE HEAD OTHER (Specify)
¢
V Z
Z
1
MANUf ACT ultLR
MODEL NUMBER
EFAIE MANUFACTURED
5. ASSEMBLER CERTIFICATION
I affirm that all certified components assembled or Installed by me for which this report is being made, were adjusted and tested by me according to the Instructions provided by the
manufacturer(s), were of the type required by the diagnostic ■•ray performance standard (21 CFR Pan 10I0). were not modified to adversely affect performance, and were installed in accordance
with provisions of 21 CFR Part 1020. I also affirm that all instruction manuals and other Information required by 21 CFR Part 1020 for this assembly have been lurnnhed to the purchaser and within
15 days Irom the date of assembly, each copy of this report will be distributed as Indicated at the bottom of each copy
a PR TED NAME b SIGNATUR Ic.
DATE
72L) 5 1 1
0/ . ■ , ea I. . Ail G.." r Ai t it L s 4+
6 COMMENTS
FOR FDA USE ONLY
1. EQUIPMENT LOCATION
3. GENERAL INFORMATION
FORM FDA 2579 (5/90) PREVIOUS EDITION MAY BE USED.
DEPARTItNT OF HEALTH AND HUMAN SERVICES
PUBLIC HEALTH SERVICE
FOOD AND DRUG ADMINISTRATION
REPORT OF ASSEMBLY
OF A DIAGNOSTIC X -RAY SYSTEM
2. ASSEMBLER INFORMATION
Form Approved; OMB No. 0910 -0213.
Expiration Date: December 31. 1991.
See reverse for OMB statement.
821921
a. 'THIS REPORT IS FOR ASSEMBLY OF CERTIFIED COMPONENTS WHICH ARE (Check appropriate box(es))
❑ NEW ASSEMBLY • FULLY CERTIFIED SYSTEM
REASSEMBLY • FULLY CERTIFIED SYSTEM
❑ REASSEMBLY • MIXED SYSTEM (Both certified and uncertified components)
❑ REPLACEMENT COMPONENTS I:: AN EXISTING SYSTEM
❑ AN ADDITION TO AN EXISTING SYSTEM
b. INTENDED USE(S) (Check Applicable box(es))
❑ GENERAL PURPOSE RADIOGRAPHY
❑ GENERAL PURPOSE FLUOROSCOPY
❑ TOMOGRAPHY (Other than CT)
❑ ANGIOGRAPHY
❑ PODIATRY
❑ UROLOGY
❑ MAMMOGRAPHY
❑ CHEST
CHIROPRACTIC
❑ CT HEAD SCANNER
❑ CT WHOLE BODY SCANNER
❑ HEAD • NECK (Medical)
DENTAL • INTRAORAL
❑ DENTAL • CEPHALOMETRIC
❑ DENTAL PANORAMIC
❑ RADIATION THERAPY SIMULATOR
❑ C • ARM FLUOROSCOPIC
❑ DIGITAL
❑ OTHER (Specify in comments)
c. THE X•RAY SYSTEM IS (Check one)
S STATIONARY
❑ MOBILE
d. THE MASTER CONTROL IS IN ROOM
e. DATE OF ASSEMBLY
1 7 I, /
(mo (day)
4. COMPONENT INFORMATION (If additional space is needed for this section use another form, replacing the preprinted number with this Form
Number and complete Items 1, 4, ands only)
White Copy - FDA, HFZ -353, 5600 Fishers Lane, Rockville, MD 20857
redacted
AXIS
PHONE CHI ROPRACTIC
15243 PACIFIC HIGHWAY 241-2225
SEA TAC, WASHINGTON SUITE B
9 8188
DATE
DOLLARS F]
VERNON H. KAOZMARSIO, o6'
`v-J
STATMENT DATE:
05 -15 -1998
- RAD SHIELDING
PAUL • SNYDER, HEALTH PHYSICIST
-15420 SE 20th PLACE
BELLEVUE, WA 98007 - 6333
206 - 746 -6488 FAX 644 -4097 •
PLEASE RETURN THIS PORTION WITH PAYMENT.
CREDIT TO THE ACCOUNT OF:
DR. VERN KACZMARKI D.C.
15243 PACIFIC HIGHWY SOUTH SUITE B
SEATAC WA 98188
THANK YOU
AMOUNT ENCLOSED $
PROPER IDENTIFICATION ASSURES CREDITING TO CORRECT ACCOUNT
Payment due the first of the month following delivery of the report.
Interest rate for late payment after 30 days is 1.5% per month.
City of Tukwila John W Rants, Mayor
Department of Community Development Steve Lancaster, Director
February 18, .1999
Vernon Kaczmarski
3459 S 152nd Street
Tukwila, WA 98188
Dear Mr. Kaczmarski:
SUBJECT: LETTER OF INCOMPLETE APPLICATION #2
Development Permit Application Number D99 -0032
Axis Chiropractic
3459 S 152 St
This letter is to inform you that your permit application received at the City of Tukwila Permit Center on
January 29, 1999, is determined to be incomplete. Before your permit application can begin the plan review
process the following items need to be addressed.
Buildin&Division; Contact Ken Nelsen, Plans Examiner, at (206)431 -3677, if you have any questions
regarding the following:
Sincerely,
Brenda Holt
Permit Technician
encl
File: D99 -0032
1. Provide door sizes.
2. Indicate existing ceiling.
3. Provide wall brace detail.
4. Provide information regarding room ventilation.
The City requires that four (4) complete sets of revised plans be resubmitted with the appropriate revision
block. If your revision does not require revised plans but requires additional reports or other
documentation please submit four (4) copies of each document.
In order to better expedite your resubmittal a Revision Sheet must accompany every resubmittal. I have
enclosed one for your convenience. Revisions must be made in person and will not be accepted through the
mail or by a messenger service.
If you have any questions please contact me at the City of Tukwila Permit Center at (206) 431 -3671.
1.111111 nnf nn - /nALI ••I . &7/ _ r...._ M114.1 All OAAC
February 4, 1999
Vernon Kaczmarski
3459 S 152nd Street
Tukwila, WA 98188
Dear Mr. Kaczmarski:
SUBIECT:
This letter is to inform you that your permit application received at the City of Tukwila Permit Center on
January 29, 1999, was determined to be incomplete. Before your permit application can begin the plan
review process the following items need to be addressed.
Building Division; Contact Ken Nelsen, Plans Examiner, at (206)431 -3677, if you
regarding the following:
1. Plans must define new from existing (walls, ceiling, lighting).
The City requires that two (2) complete sets of revised plans be resubmitted with the appropriate revision
block. If your revision does not require revised plans but requires additional reports or other
documentation please submit two (2) copies of each document.
In order to better expedite your resubmittal a Revision Sheet must accompany every resubmittal. I have
enclosed one for your convenience. Revisions must be made in person and will not be accepted through the
mail or by a messenger service.
If you have any questions please contact me at the City of Tukwila Permit Center at (206) 431 -3671.
Sincerely,
Brenda Holt
Permit Technician
encl
File: 099 -0032
City of Tukwila
Department of Community Development
John W. Rants, Mayor
Steve Lancaster, Director
LETTER OF INCOMPLETE APPLICATION #1
Development Permit Application Number D99 -0032
Axis Chiropractic
3459 S 152nd Street
have any questions
6300 Southcenter Boulevard, Suite #100 • Tukwila, Washington 98188 • (206) 4313670 • Fax (206) 4313665
JAN-21- ' 99 THIJ 12: 49 ID: KEL ELECT 2538502347 TEL NO: 206 850 2347 1426 P02
3610 Academy Dr SE Auburn WA 98092
253-833-5368 253-852-7470 Fax 253-850-2347
1-19-99
Dear Doctor Kaczmarski;
KEL Electric is owned and operated by Kim E. Luettgen. Kim has more than twenty
years experience In the electrical trade and has been an Electrical contractor for
more than 11 years. He is supported by a knowledgeable staff both in the field and
in the office.
Ket Electric is a full service electrical contractor. We do electrical installations for
Manufacturing equipment, industrial repair and maintenance, custom homes, tenant
improvement, remodels, and service calls. We do this with an eye on quality and
value to our customer. We offer free estimates and a one-year warranty on all labor
and material.
In addition, KEL is an environmentally friendly company. We recycle or reuse all the
electrical material and office paper and supplies that we can. We work hard to
minimize the waste we produce. We have gone from a one cubic yard dumpster to a
90 gallon tote; and that is generally only half-full when it's picked up.
Jim Nannery
1Vlanager
Ke, Plectrio
Visit us at litLUth...sj.nwcontractors.com
Contractors # kele1"137CJ
RECEIVED
CITY OF 'TUKWILA
JAN 2 9 1999
PERMIT CENTER
ACTIVITY NUMBER: D99 -0032
PROJECT NAME: AXIS CHIROPRACTIC
DATE: 3 -1 -99
Original.Plan Submittal
Response to Correction Letter # Revision # After Permit Is Issued
XX Response to Incomplete Letter
DEPARTMENTS:
B ifdin Division
, � .3 l
Pubc Works
TUES /THURS ROUTING:
\PR•ROUTE.DOC
6/98
u 4 GDO Ra • CD �
PLAN REVIEW /ROUTING SLTP
a
Fire Prevention
Structural
Planning Division si
Permit Coordinator
DETERMINATION OF COMPLETENESS: (Tues, Thurs) DUE DATE: 3 -2 -99
Complete E Incomplete ❑
Comments:
Not Applicable ❑
Please Route f No further Review Required
Routed by Staff (if routed by staff, make copy to master file and enter into Sierra)
REVIEWERS INITIALS. DATE:
APPROVALS OR CORRECTIONS: (ten days) DUE DATE: 3 -30 -99
Approved ❑ Approved with Conditions ❑ Not Approved (attach comments) ❑
REVIEWERS INITIALS: DATE:
CORRECTION DETERMINATION: DUE DATE:
Approved ❑ Approved with Conditions ❑ Not Approved (attach comments) ❑
REVIEWERS INITIALS: DATE:
rnni} Coov C.o
LAN REVIEW /ROUTIN
ACTIVITY N UMBER: n99 -oo32
PROJECT NAME: ART CHIROPRACTIC
Original. Plan Submittal
Response Correction Letter. #
DATE: 2 -12 -99
Response to Incomplete Letter
Revision # After Permit Is Issu ed
DEPARTMENTS:
'vision
is orks ��
S
2.2..„19,
'Jo
Fire Prevent 21 PIanni n`6ivision
alit- 2 ' 2 '45
Zflq
Structural Permit Coordinator III
DETERMINATION OF COMPLETENESS: (Tues, Thurs) DUE DATE: 2 -16-99
Complete fl Incomplete
Corrients:
L Y 42 11U4 k z-160-141 1
TUES /THURS ROUTING: Please Route El No Review Required
Routed by Staff El (if routed by staff, make copy to master file and enter into Sierra)
\PR•ROUTE.DOC
6/98
I►!1
Not Applicable 0
REVIEWERS INITIALS. DATE:
APPROVALS OR CORRECTIONS: (ten days) DUE DATE: 1 -16 -99
Approved El Approved with Conditions fl Not Approved (attach comments)
REVIEWERS INITIALS' DATE:
CORRECTION DETERMINATION: DUE DATE:
Approved El Approved with Conditions E Not Approved (attach comments) 0
REVIEWERS INITIALS. DATE:
ACTIVITY NUMBER: D " 003
PROJECT NAME: 19'x1 ChirOPrQ(:tIG
Original Plan Submittal
Response to Correction. Letter #
DATE: I "Z 1
Response to Incomplete Letter.
Revision # After Permit. Is Issued
DEPARTMENTS:
Building Division (g
Public Works '` csa_
oth Ala- 7r2
rhi(d m-fi "c c,1 nic .
TUES /THURS ROUTING:
Routed by Staff
\PR•ROUTE,DOC
6/98
Nemo coon/ a
PLAN REVIEW /ROU SLIP
Fire Prevention
Structural
Please Route ❑
1iv\ 4Ai.e
APPROVALS OR CORRECTIONS: (ten days)
Approved ❑ Approved wi',h Conditions ❑
g-
o
REVIEWERS INITIALS:
REVIEWERS INITIALS.
CORRECTION DETERMINATION:
Planning Division
0 4. t -L-M
Permit Coordinator
DETERMINATION OF COMPLETENESS: (rues, Thurs) DUE DATE: a . a - 9 9
Complete ❑ ,, h/,,,, Incomplete Not Applicable ❑
Comments: /V5 i s a car) 4e Cf Glee m cchair (salon -Iv c
airef no f lire ple -r'r i - ,
❑ D --
3 ' 5 '
El (if routed by staff, make copy to master file and enter into Sierra)
No further Review Required
DATE:
DUE DATE: (Q II!0 " 9
Not Approved (attach comments)
DATE:
O
6
DUE DATE:
Approved ❑ Approved with Conditions ❑ Not Approved (attach comments) ❑
REVIEWERS INITIALS DATE.
REVISION SUBMITTAL
DATE: a \ -. Gq• PLAN CHECK/PERMIT NUMBER: pill. 002.
PROJECT NAME: yI Oi4 p e
PROJECT ADDRESS: _ 9) 4 5 I62.
4 %
CONTACT PERSON:
CITY OF TUKWILA
Department of Community Development
Building Division - Permit Center
6300 Southcenter Boulevard, Tukwila, WA 98188
Telephone: (206) 431 -3670
REVISION SUMMARY: ` t% 1 L'5,6d17• / 7c 0 /` e G�=-/ri »y� %/ ��6)5- /-�r /' f
a /uty2: ,rS? j j) 9Q--�0 ?, �2 Cei5 /
SHEET NUMBER(S)
"Cloud" or highlight all areas of revisions and date revisions.
SUBMITTED TO:
CITY USE ONLY
PHONE:
RECEIVED
CITY OF TUKWILA
MAR 0 1 1999
PERMIT CENTER
biatAxiie
3/19/96
REVISION SUBMITTAL
DATE: I - q C- 1 PLAN CHECK/PERMIT NUMBER: 041- 005'Z
PROJECT NAME: AxI L
PROJECT ADDRESS: J91 7. 112.
CONTACT PERSON:
B
CITY OF TUKWILA
Department of Community Development
Building Division - Permit Center
6300 Southcenter Boulevard, Tukwila, WA 98188
Telephone: (206) 431 -3670
REVISION SUMMARY:
Pex
Ed pla,rNs `�� v� exis
SHEET NUMBER(S)
"Cloud" or highlight all areas of revisions and date revisions.
SUBMITTED TO: )6X m nclj
Planning;
re
PHONE:
RECEIVED
CITY OF TUKWILA
I- F B 1 2 1999
genv-
: PutilioNV rks
3/19/96
WATERS & WO