20040540.pdfI
3
DATE RECEIVED
[PERMIT EXPIRES
USE
ZONI/ PERMIT
CITY OF EDMONDS NUMBER
CONSTRUCTION PERMIT APPLICATION JOB PT#
ADDRESS SUIT11A
OWNER NAME/NAME OF BUSINESS �)I
PLAT NAME/SUBDIVISION NO LOT N LID NO,
LCUC MAILING ADDRESS I V
z LID FEE $
3. TESCP Approved 0
0 PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP HW Poinot Finquilod 0
ITY Stiord Use Permit Rert'd 0
ZIP I El EPHONE EXISTING - PROPOSED Inspection litiquired 0
Sidewalk Roquirrid 0
S REQUIRED DEDICATION- Fr UndLigiound
NAME Wrong roquirod 0
METER SIZE LINE SIZE NO. OF FIXTURES PAV REQUIRED
ED
YES 0 NO z
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3: REMARKS z
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OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROL/DRAINAGE 3
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CITY ZIP TELEPHONE
NAME CBL#
ENGINEERING REVIEWED BY
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CITY ZIP TELEPHONE
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STATE LICENSE NUMBER EX !ATION DATE CH Y VARIANCE OR CU SHORELINE OR ADB# INSPECTION BOND
REIjkD POSTED
C' OYES 0 S
PROPERTY TAX ACCOUNT PARCEL NO. SEPA REVIEW SIGN AREA HEIGHT
COMPLETE , E)�Eh T ALLOWED I PROPOSED ALLOWED PROPOSED
W '2� -7 Q'-�) L+ o C) 2— t 2- 4
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NEW RESIDENTIAL =UMBIN MECIj LOT COVER.AGE EQUIRED SETBACKS (Fr.) PROPOSED SETBACKS (Fr.)
14 (9� ALLOWED. PR POSED RFRON1, SIDE. REAR FRONT UR.51DE PEAR
COMPLIANCE OR 0 a
ADDITION COMMERCIAL CHANGE OF USE 435'0 1 ;" 5 z
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REMODEL MULTIFAMILY PARKING LOT AREA i JNING REVIEWUD BY DATE
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REPAIR GRADING FENCE
CYDS 1:1 ( X FT) REMARKS
DEMOLISH TANK 0 OTHER
GARAGE RETAINING WALL FIRE SPRINKLER
z CARPORT ROCKERY 1:1 FIRE ALARM
(TYPE OF USE, BUSINESS ACTIVITY) EXPLAIN'
KED BY TYPH OF C RUCTION
CHEC OCCUP
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UJI NUMBER NUMBER OF CRITIC L Pz
OF -2� DWELLING
AREAS SPECIAL IN ION AREA OCCUPANT
to STORIES UNITS NUMB R REQUIRED i LOAD
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DESCRIBE WORK TO BE DONE YES
REMARKS 0
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U PROGRESS - - PER I IBC 1 08/FINAL INSPECTION RECI'D
I -A U
VALUATION
/ a�2 $ '/�. I
Description FEE Description FEE
HEAT SC Plan Check State Surcharge L11
CNGLAZING % LOT SLOPE %
PCs Building Permit City Surcharge
PLAN CHECK RD:_ VESTED DATE Plumbing Base Fee
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO Mechanical
13E DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS. MARQUEES, ETC.) WILL REQUIRE
:3 Grading
i- SEPARATE PERMISSION.
cc PERMIT APPLICATION: 180DAYS Engr. Review
LU
CL PERMIT LIMIT: I YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS
SEE BACK OF PINK PERMIT FOR MORE INFORMATION Engr. Inspection
'APPLICANr. ON BEHALF OF HIS Oil HER SPOUSE, HEIRS, ASSIGNS AND SUCCESORS Fire Review Plan Chk. Deposit
IN INTEREST, AGREES TO INDEMNIFY, DEFEND AND HOLD HARMIEss THE CITY OF
2 EDMONDS, WASHINGTON, ITS OFFICIALS. EMPtOYEFS, AND AGENTS FROM ANY AND
Ir Fire Inspection Receipt #
< ALL. CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTlY
FROM *THE ISSUANCE OF THIS PERMIT, ISSUANCE OF THIS PERMI I SHALL NOT 13E
DEEMED TOMODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE Landscapelnsp. Total Amt. Due
0 NOR LIMIT IN ANY WAY IHi: CITY's ABILITY10 ENFORCE ANY ORDINANCE PROVISION
xf Recording Fee PF eceipt #
I HEREBY ACKNOWLEDGE THAT I HAVE READ 'THIS APPLICATION, THAT THE INFORMATION
GIVEN IS CORRECT, AND T14AT I AM THE OWNER. OR THE DULY AUTHORIZED AGENT OF APPLICATION APPROVAL
THE OWNER. I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC- I hisapplication is not a pennit until signed by the
TION AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED CALL Building Official or his/her Deputy: and Fees are paid, and
IN VI'6LATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO FOR INSPECTION receipt is acknowledged in space provided.
WORKMEN'S COMPENSATION INSURANCE AND RCW 111,27.
0 F F I Q'I An d(37/NA IT I I I F,
SIGNATURE (OWNER +O�RG,�'NTV, DATE SIGNED i I a DATE
(425)
771-0220
ATTENTION RF1 EASID BY 'DATE
E)ff 1333 (4.'
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL I&
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI-
ORIGINAL - FILE
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109 , YELLOW INS CTOR
PINK - OWNER GOLD -ASS SSOR
09/03 PRESS HARD -YOU ARE MAKING 4 COPIES KS S(
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NOTICE: IF THE DOCUMENT IN THIS FRAME IS LESS CLEAR THAN THIS NOTICE
IT IS DUE TO THE QUALITY OF THE DOCUMENT.
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JUN-;24-2004 16:15
P. 02/04
CITY OF EDMONDS
SPECIAL INSPECTION AND TESTING AGREEMENT
The project at ad - —issued under buildin
, " ` - c, r)e- I ires special ;ting peT UBC Chapter i
p e ad i t n u m b e F: � il. �Cl- C, I �Al - ���eoq lu� Air �, V inspection and/or t I I
and WAC Amendments 1702. The compilete ]Jst of special inspections is attached to this document.
BEFORE A PERMT CAN BE ISSUED: The owner and contracto� and special inspector shall
complete this agreement and the attached structural test(s) and inspections schedule including the
required acknowledgments.
APPROVAL OF SPECIAL INSPECTORS: Each special inspector shall be approved by the
Building Official prior to pefformi juangduties or inspections. Each special inspector sball submit
� Oualifications to g g
Statement ol , the . Official for review. Special inspectors shall display
identification. when performing special inspections on site. Special impection and testing shall meet
the mi-nimum. requirements of tSC Chapter 17 and the following:
A, ndeS gnd-Rg6gonsibilifies of JhLfteel Lbnpg=
1. Observe Work
The special inspector shall observe the site work for conformance. with the approved
(sta�nped) plans and specifications and applicable worlananship provisions of the TJBC.
Architect or Engineer reviewed shop drawings may be used only as an aid to inspection.
§pecial inspections are to be performed on a continuous basis —meaning that the special
!nspector is on site at all times observing the -work requiring special inspection. Miqdic
inspections ' if any, must have prior approval by the City.based on a separate written plan
reviewed and approved by the B4ilding Official and the engineer or architect of record.
2. Report Non -conforming Items
The special i
rispector shall bring nonconforming items to the immediate attention of the
contractor and note all such items in the daily field report. Any item not resolved in a timely
manner sball be immediate cause of the special inspector to nofify the Building Official of the
plan deviation erro ch ge or omission. It shall. also be the duty of the special inspector to
promptly noi!Yy there'ngmianeer or architect.
3. Complete Daffy Reports
Each special inspector shall complete and sign both the special inspection record and the daily
report form for each day's #Wection. These records �ball remain at the Jobsite with the
contractor for review by the Cit� Building Inspector.
4. Furnish Weekly Reports
The special inspector or inspection agency shall furnish the City with weekly reports of tests
and inspections. The project engineer or architect and others as designated -shall also be
copied on reports. Weeldy reports must include the following:
Description of daily inspections, and tests made with applicable locations
List of all nonconformifig items
Report on status of nonconforming itms (resolved or unresolvpd)
Iteinized changes authorized by the Architect, Engineer and City if not included in
nonconformance items
5. Furnish Final Construction Report
The spe�ial inspect.o.r or inspection agency shall submit a final s" d ort to the City stating
IgTle
I inspection and testing were fatlfWed anTireported. Arid, to the
that all items requiring ecia
best of his/her -.7-ge the project is in contormance with the approved plans and
,ifications, approved change orders and the applicable workmanship provisions of the
Spec
TIBC. Items not in conformance or unresolved items or any discrepancies *in
coverage, (i.e., raissed inspections, periodic tim4pection when continuous inspections were
requir4 etc.) shall be specifically itefni7.ed in this report.
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06/29/2004 09:08 3606686045 KFOUR CONSTRUCTION PAGE 01/01
JUN-25-2004 11:08 MAYES TP-STING ENUTWERS 425 ?45 1737 P.02/02
JUN-E4-2204 WIG P.03/04
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It is the d* afft ox*acW to nalif� *0 qmc�W Umpsaar Whm wmk ip rWdY fim IPC621
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2wu ne&A absU be
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pxcryided by the ccmuvcw so tW ft Xpeciul izL"ar bw t�ac to bow= foadliar Wi0k to
7
provide Aam to ApprovedAlml a== to oppmed PUMS at.
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3. pada Spedal lwpa4m Mcrib
MW jespoodble to tatda st ihe jabdtm 4R Wodd in =oft SubmitW
by tba Bped%l jftppgdqr_ 7baw nwxdc = ta be pmVideff tO the CifY txMft IV -VC= UP=
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The Xwol psy is= a ceclificm 6f owy
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TOTAL P-02
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JUN-24-2004 16:16
LELA �21 C Y, 120
OWNWIN"d
Pnad -- ��&rncr�dS MA q-4 C S
?2Q=ADC%= TESrWANSISCrION AGENCY or SMICIAL INSPECIM
RMNFORCED CONCRETE, GUNITE, GROUT AND MORTAR!
�--- J--". r. d mra-ft'.
AnuptcTmts
Rxifforcing Tests
Mix Desins
Reinfatdng Placement
Bitcb Plot Inspection
Invect Placing
Cast Samples
Nk-up Simples
Comlamsion Tests
PRECAsTIPRESTRESSED CONCRETE!
Ve" Fhd-TPm% Prv.Tent Maddine
A Tem
Reinfoicinp Tau
Tnidm Tem
Mix Designs
Reinfoming Placement
Pwamcni
Cmcrete Bitching
Installation Imsepetion
Cut Samples
Pick-up SIMPI;
:ression Tesu
MASONRY:
— SpcCial Inspectim StMUS Wed
— Preliminary Acceptance Tests fMasonryU65. Wall Prisms)
— Subwqucm Ttsts (Mow. Gfmt. Field Wall Prim&)
— Placement Inspwtioit of Units
STRUCTURALSTMLfWELDING:
Simple and Ten (list specTic memben below)
Shop Matelial Idenfification
Welding Inspedon [3 Shop [3 Field
Ultrawnic Inspocd(m [3SN9 OEM
MO'sti 11h solting
lmpccdw 13 Skv [3 Ficid
0 A325 0 N EIX Ej F
0 A490
Metal D=k Woldin'g Impection
ReWoming, Steel Vklftg laspettion
Metal Stud Welding Inspemon
conarm Ingm Welding InAp=lon
FIREPROOFING:
— Placement Inspectiou
—DmityTem
—11ilcknmUsts
— Inspect Botching
INSULATING CONCRETE:
Swple vW Tea
Pl=cn=u Iftspection
Unit Weights
FILLMATERIAL.-
Acceptance Tcsts
P4=njcnt Inspection
FwJd Denshy
STRUCTURAL WOOD:
— Shm WAII Nailing Inspection
— Inspection of Glu-1am Fab.
— Inspection of Truss 3oiza Fab.
ADDMONAL INSTRUCnONS OR OTHER TESTS Sample and TeSt ComponetitS
AND INSPECTIONS:
Fam completed by:
TCICPWM No.: Date:
TnT01 D MA
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� s
TESTING ENGINEERS, INC.
Everett Office
917-134th Street SW
MAVCC
mm
Suite A-1
Everett, WA 98204
ph 425.742.9360
E:� 13
R C
fax 425.745.1737
MTE No.: E4236
AUG, 13
Tacoma Office
10029 S. Tacoma Way
Project: BIRKBY RESIDENCE
Suite E-2
Address: 839 Cary Road, Edmonds, WA
I)EVELOPMENT SERVKA-..'�
Tacoma, WA 98499
p h 253.5B4.3720
Permit No.: 04140 (City of Edmonds) (;ITy OF EDMON10,
fax 253.584.3707
Owner: Birkby Residence
Portland Office
7911 NE 33rd Drive
Architect:
Suite 190
Portland, OR 97211
Engineer: SDA
ph 503.281.7515
Contractor: K-Four Construction
fax 503.281.7579
Page 1
Date: 813/04
Weather: Pt Cloudy
Inspection: Epoxy
Sample(s): N/A
Monitor the epoxy of threaded rod into existing foundation for HD1 OA, HD8A,
PHD6, and PHD5
hold-downs per 10/S-1. Hole diameter depth and cleanliness were verified.
Simpson SET-22
(ICBO #5279) was used per manufacturer's specifications. Stephen (SDA) verbally
approved
epoxy substitute via phone conversation.
To the best of our knowledge, items inspected this date are in accordance with approved plans
and specifications. INSPECTOR: Cheri Willett
REVIEWED BY:
Timothy G(Oeckerie, P.E.
cc:Bill Krueber-K-Four Construction; Bldg Dept -City of Edmonds
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RECORD OF INSPECTIONS
INSPECTOR DATE APPROVED
SETBACKS .....................
FOUNDATION:
Footing ......................
Wall..........................
Pier/Porch .................
Retaining Wall ...........
Slab Insulation ..........
PLUMBING:
Underground .............
Rough -In ................... <3 - �r-4
Commercial Final ......
HEATING: /J—J/eA/r X/K
GasTest ....................
Gas Piping .................
Equipment .................
Commercial Final .......
N4
EXTERIOR SHEATHING
NAILING ..........................
FRAMING ........................
FIRST FLOOR FRAMING ...
ov-A
INSULATION ...................
ct
k4 Floor Insulation .........
Wall Insulation ...........
Ceiling Insulation .......
T vis
0 SHEETR OCK NAILIN
SPECIAL INSPECTION
(42
V^
MISCELLANEOUS ..........
FINAL APPROVAL FOR
OCCUPANCY .................
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