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BLD20110694.pdfCITY OF EDMONDS 121 5TH AVENUE NORTH - EDMONDS, WA 98020 PHONE: (425) 771-0220 - FAX: (425) 771-0221 STATUS: ISSUED 9/6/2011 `; _ Permit #: BLD20110694 BUILDING PERMIT Expiration Date: 3/6/2012 { :. Project'.Address' 9843, EDMONDS WAY; EDMONDS Parcel No: 27033600107700 PCC PLUMBING PROS LLC PLUMBING PROS LLC CORP ACCT / STORE #454 VIRGINIA BRANCH PO BOX 188 250 PARKCENTER BLVD PO BOX 188 BUCKLEY, WA 98321 BOISE, ID 83726 BUCKLEY, WA 98321 ( ) - EXT: (360) 829-5334 EXT: (360) 829-5334 EXT: LleENSE #: PLUMBPL947PL EXP: JOB DESCRIPTION PLUMBING FOR BAKERY TI VALUATION: $0.00 Avv" 2 fzFt3A`5 PERMIT TYPE: Commercial PERMIT GROUP: 47 - Plumbing GRADING: N CYDS: 0 TYPE OF CONSTRUCTION: RETAINING WALL ROCKERY: N OCCUPANT GROUP: OCCUPANT LOAD: FENCE: N 0 X 0 FT.) CODE: 09 OTHER: N ----- OTHER DESC: ZONE: NUMBER OF STORIES: 0 VESTED DATE: NUMBER OF DWELLING UNITS: 0 LOT #: BASEMENT: 0 1ST FLOOR: 0 2ND FLOOR: 0 BASEMENT: 0 1ST FLOOR: 0 2ND FLOOR: 0 3RD FLOOR: 0 GARAGE: 0 DECK: 0 OTHER: 0 3RD FLOOR: 0 GARAGE: 0 DECK: 0 OTHER: 0 FRONTSETBACK SIDE SETBACK REAR SETBACK REQUIRED: PROPOSED: REQUIRED: PROPOSED: RE UIRED: PROPOSED: HEIGHT ALLOWED:O PROPOSED:O I REQUIRED: PROPOSED: SETBACK NOTES: I ACRE O 0 LY WITH CITY AND STATE LAWS REGULATING CONSTRUCTION AND IN DOING THE WORK AUTHORIZED THEREBY, NO RS N L BE EMPLOYED IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO WORKMEN'S COMPENSATION INSURANCE AND RCW 18:27, THIS A PLIC I IS NOT A PERMIT UNTIL SIGNED BY THE BUILDING OFFICIAL OR HIS/HER DEPUTY AND ALL FEES RE PAID. I? 5) L'L4 /RA-% q -(o - // N —// Si nature Print Name Date Released By Date ATTENTION IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFICATE OF OCCUPANCY HAS BEEN GRANTED. UBC 109/ IBCI 10/ IRC I 10. = ONLINE = APPLICANT = ASSESSOR OTHER STATUS: ISSUED BLD20110694 • Final approval on a project or final occupancy approval must be granted by the Building Official prior to use or occupancy of the building or structure. Check the job card for all required City inspections including final project approval and final occupancy inspections. • Any request for alternate design, modification, variance or other administrative deviation (hereinafter "variance") from adopted codes, ordinances or policies must be specifically requested in writing and be called out and identified. Processing fees for such request shall be established by Council and shall be paid upon submittal and are non-refundable. • Approval of any plat or plan containing provisions which do not comply with city code and for which a variance has not been specifically identified, requested and considered by the appropriate city official in accordance with the appropriate provision of city code or state law does not approve any items not to code specification. • Sound/Noise originating from temporary construction sites as a result of construction activity are exempt from the noise limits of ECC Chapter 5.30 only during the hours of 7:00am to 6:00pm on weekdays and 10:00am and 6:00pm on Saturdays, excluding Sundays and Federal Holidays. At all other times the noise originating from construction sites/activities must comply with the noise limits of Chapter 5.30, unless a variance has been granted pursuant to ECC 5.30.120. • Applicant, on behalf of his or her spouse, heirs, assigns, and successors in interests, agrees to indemnify defend and hold harmless the City of Edmonds, Washington, its officials, employees, and agents from any and all claims for damages of whatever nature, arising directly or indirectly from the issuance for this permit. Issuance of this permit shall not be deemed to modify, waive or reduce any requirements of any City ordinance nor limit in any way the City """"s ability to enforce any ordinance provision. THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE SEPARATE PERMISSION. PERMIT TIME LIMIT: SEE ECDC 19.00.005(A)(6) BUILDING (425) 771-0220 EXT. 1333 1 ENGINEERING (425) 771-0220 EXT. 1326 1 FIRE (425) 775-7720 1 PUBLIC WORKS 425) 771-0235 1 PRE-TREATMENT 425) 672-5755 1 RECYCLING 425) 275-4801 When calling for an inspection please leave the following information: Permit Number, Job Site Address, Type of Inspection beiniz requested, Contact Name and Phone Number, Date Prefereed, and whether you prefer morning or afternoon. • B -Plumb Ground Work • B -Plumb Rough In • B -Plumbing Final BACKFLOW ASSEMBLY TEST REPORT 13ATman Testing - BACKFLOW ASSEMBLY TESTING AND REPAIR CUSTOMER / FACILITY NAME - CONTACT / OWNER NAME WATER PURVEYOR PCC Natural Markets _ TYPE EDMONDS PUBLIC WORKS NEW CONSTRUCTION ASSEMBLY/CUSTOMERID# PHONE NUMBER FAXNUMBER PURVEYOR CONTACT NAME [:]Y NN RPBA - - Linda McMur h SERVICE ADDRESS / METER NUMBER CUSTOMER / OWNER / CONTACT MAILING ADDRESS PURVEYOR FAX NUMBER 9803 Edmonds Way CONFINED SPACE (425) 744-6057 CITY / STATE ZIP CODE CITY / STATE ZIP CODE PURVEYOR EMAIL ADDRESS Edmonds WA 98020-5901 228-1618 - mcmur h c ci.edmonds.wa.us ASSEMBLY MANUFACTURER MODEL TEST GAUGE MAKEMODEL SERIAL NUMBER TYPE SIZE DOWNSTREAM PROCESS LE'AKE'D ❑ WATTS 009QT RELIEF VALVE OPENED AT 2.9 PSID 354113 RPBA 1/2" DISHWASHER CHECK VALVE #2 CLOSED TIG14T ❑ LOCATION OF ASSEMBLY RPBA LEAKED ® LEAKED ❑ CONFINED SPACE SE corner of bakery to right of dishwasher under hand wash sink PHONE NUMBER ACROSS CHECK VALVE #I ❑YES NNO INSTALLATION TYPE PREVIOUS MAKE / MODEL / SERIAL NUMBER PASSED TEST NYES 0 N 228-1618 DETECTOR READ [:]New N Existing [:]Replacement Relocation of same assembly I APPROVED AIR GAP NYES ONO APPROVED AIR GAP NYES [—]NO N/A DOH APPROVED ASSEMBLY (NOV 2008 LIST) ORIENTATION PROPER INSTALLATION WATER LINE PRESSURE VALVE POSITIONS PRIOR TO TESTING DCVA N YES ❑ NO H N YES []NO 50 PSIG SOV#I NON ❑OFF SOV#2 NON ❑OFF INITIAL TEST RESULTS TEST AFTER REPAIRS/CLEANING TEST GAUGE MAKEMODEL CHECK VALVE # I CLOSED TIGHT N CHECK VALVE # I CLOSED TIGHT N CALIBRATION DATE LEAKED ❑ LE'AKE'D ❑ Mid -West RELIEF VALVE OPENED AT 2.8 PSID RELIEF VALVE OPENED AT 2.9 PSID 01/07/1 1 FAILED TO OPEN ❑ FAILED TO OPEN ❑ PHONE NUMBER CHECK VALVE #2 CLOSED TIG14T ❑ CHECK VALVE #2 CLOSED TIG1IT N RPBA LEAKED ® LEAKED ❑ TEST GAUGE MAKE ACTUAL PRESSURE DROP PSID ACTUAL PRESSURE DROP 5.4 PSID PHONE NUMBER ACROSS CHECK VALVE #I ACROSS CHECK VALVE 41 PASSED TEST OYES NNO PASSED TEST NYES 0 N 228-1618 CLEAN / REPAIR: N see remarks DATE OF TEST 12/21/11 SIGNATURE,- APPROVED AIR GAP NYES ONO APPROVED AIR GAP NYES [—]NO CHECK VALVE #I CLOSED "TIGHT PSID CI -11 -CK VALVE #1 CLOSED TIGI-TT PSID LEAKED ❑ LEAKED ❑ DCVA CHECK VALVE #2 CLOSED TIGHT PSID CHECK VALVE #2 CLOSED TIGHT PSID LEAKED ❑ LEAKED ❑ PASSED TEST OYES ONO PASSED TEST ❑YES ❑NO CLEAN/ REPAIR: ❑ see remarks REMARKS damaged o-ringon CV#2. -Replaced VALVE POSTIONS AFTER TESTING SOV#I NON ❑OFF SOV#2 NON ❑OFF TESTER NAME BAT CERTIFICATION TEST GAUGE MAKEMODEL SERIAL NUMBER CALIBRATION DATE Jason A. Moe B4536 Mid -West 845-5 03051790 01/07/1 1 REPAIRED BY COMPANY NAME PHONE NUMBER Same ( ) - FINAL TEST BY BAT CERTIFICATION TEST GAUGE MAKE MODEL COMPANY NAME PHONE NUMBER Same BATman Testing(206 228-1618 DATE OF TEST 12/21/11 SIGNATURE,- (I HEREBY CERTIFY THAT I USED WAC 246-290-490 APPROVED TEST METHODS AND DIFFERENTIAL PRESSURE TEST EQUIPMENT FOR THE ABOVE TEST RESULTS) MICROFILM BACKFLOW ASSEMBLY TEST REPORT 13ATman Testink- BACKFLOW ASSEM13LY TESTING AND REPAIR CUSTOMER/ FACILITY NAME -. - CONTACT/ OWNER NAME WATER PURVEYOR PCC Natural Markets SIZE EDMONDS PUBLIC WORKS NEW CONSTRUCTION ASSEMBLY/CUSTOMERID#PHONE NUMBER FAX NUMBER PURVEYOR CONTACT NAME [:]Y NN LOCATION OF ASSEMBLYCONFINED - - Linda MCMur h SERVICE ADDRESS / METER NUMBER CUSTOMER / OWNER / CONTACT MAILING ADDRESS PURVEYOR FAX NUMBER 9803 Edmonds Wa DOH APPROVED ASSEMBLY (NOV 2008 LIST) 425 744-6057 CITY / STATE ZIP CODE CRY / STATE ZIP CODE PURVEYOR EMAIL ADDRESS L.Edmonds WA I 98020-5901 1 1 rncrnurphy@ci.edrnonds.wa.us ASSEMBLY MANUFACTURER MODELS ERIAL NUMBER TYPE SIZE DOWNSTREAM PROCESS WATTS 10091V13QT 1 338646 RPBA 3/4" 1 DISHWASHER LOCATION OF ASSEMBLYCONFINED SPACE SE corner of bake under counter between dishwasher and triple sinks ❑YES ONO INSTALLATION TYPE PREVIOUS MAKE / MODEL / SERIAL NUMBER DETECTOR READ N New ❑ Existing ❑ Replacement I N/A DOH APPROVED ASSEMBLY (NOV 2008 LIST) ORIENTATION PROPER INSTALLATION WATER LINE PRESSURE VALVE POSITIONS PRIOR TO TESTING ® YES ❑ NO H N YES ❑ NO 50 PSIG SOV#1 ®ON ❑OFF SOV#2 NON ❑OFF INITIAL TEST RESULTS TEST AFTER REPAIRS/CLEANING TESTGAUGE MAKE CHECK VALVE #I CLOSED TIGHT ® CHECK VALVE. #1 CLOSED TIGHT ❑ CALIBRATION DATE LEAKED ❑ LEAKED ❑ Mid -West RELIEF VALVE OPENED AT 2.9 PSID RELIEF VALVE OPENED AT PSID 01/07/11 FAILED TO OPEN ❑ FA LED -1'0 OPEN ❑ PHONE NUMBER CHECK VALVE 42 CLOSED TIGHT N CI IECK VALVE #2 CLOSED TIGI IT ❑ RPBA LEAKED ❑ LEAKED ❑ TEST GAUGE MAKE ACTUAL PRESSURE DROP ACTUAL PRESSURE DROP PHONE NUMBER ACROSS CHECK VALVE #1 9.1 PSID ACROSS CI IECK VALvI #1 PSID PASSED TEST ®YES []NO PASSED TEST DYES ONO (206) 228-1618 CLEAN/ REPAIR: ❑ see remarks DATE OF TEST 12/21/11 SIGNATURE �'"' ��- APPROVED AIR GAP ®YES❑NO APPROVED AIR GAP OYES ONO CHECK VALVE #I CLOSED TIGHT PSID CHECK VALVE #I CLOSED T1GI IT PSID LEAKED ❑ LEAKED ❑ DCVA CHECK VALVE #2 CLOSED TIGHT PSID CHECK VALVE #2 CLOSED TIGHT PSID LEAKED ❑ LEAKED ❑ PASSED TEST [-]YES ONO PASSED TEST []YES ONO CLEAN/ REPAIR: ❑ see remarks REMARKS VALVE POSTIONS AFTER TESTING SOV#1 NON ❑OFF SOV#2 NON ❑OFF TESTER NAME BATCERTIFICATION TESTGAUGE MAKE MODEL SERIAL NUMBER CALIBRATION DATE Jason A. Moe 134536 Mid -West 845-5 03051790 01/07/11 REPAIRED BY COMPANY NAME PHONE NUMBER N/A ) - FINAL TEST BY BAT CERTIFICATION TEST GAUGE MAKE MODEL COMPANY NAME PHONE NUMBER N/A BATman Testing (206) 228-1618 ----a_ - DATE OF TEST 12/21/11 SIGNATURE �'"' ��- (I HEREBY CERTIFY THAT 1 USED WAC 246-290-490 APPROVED TEST METHODS AND DIFFERENTIAL PRESSURE TEST EQUIPMENT FOR THE ABOVE TEST RESULTS) MICROFILM OF EDM Inspection � OHO Comments BLD20110694 47 - Plumbing Applied: 08/25/2011 Issued: 09/06/2011 Expires: 03/06/2012 ��c. 1 R90 Address: 9803 EDMONDS WAY, EDMONDS INSPECTION DATE INSPECTOR ACTION 1120 - B -Plumb Ground Work 09/07/2011 STEINIKE CMP Comment: 1126 - B -Plumb Rough In 09/08/2011 STEINIKE PAR Comment: Trench drains ok. 1126 - B -Plumb Rough In 09/19/2011 STEINIKE CMP Comment: 1152 - B -Plumbing Final 12/16/2011 LAWLER , COR Comment: RPBA required at dishwasher. Provide test results from certified tester for both RPBAs 1152 - B -Plumbing Final 01/06/2012 LAWLER CMP Comment: 1/9/2012 8:37:46 AM 121 5th Ave, Edmonds Washington - Phone: (425) 771-0220 Page 1 of 1 12/21/2011 14:50 3608296505 PLUMBING PROS PAGE 02/02 17/21/201,1. 08:27 36082965@5 PLUMBING PROS PAGE 01/01 r,--,, •?i.411"`t v e. t QQ-partn7cnt or Labor 4% induttrics Huller Seellonr 4. BOILtR / PRESSURE VUSSEL PO Box d44 If) � INSTALLATION OR Olympia WA 98504-4419 ' UINSTALLATION PERMIT Phone:1 360-902.6400 •- FAX; 360.901.5292 1 Formit per Object C -mail; 00IIe1rl4lawa'gov ttl p:lf[3�1 44,Ulb�ce�icfr� Unk tlt¢�pV iptsdmua�l' 1A tf, fm _ �...: ii-' — „�Foi' L+�it ilgc pltl� !'Isit1�11T NUN1BGit: " The Owner/De NOTLr: Owner/Designee Is responsible fvr natiiyin� the inspector or Ltibc,r ori lndustrles whnra insp coons sr a ncotfod, All h.. ectlon costs and fees will be levolced fbllawln fns cotivn and aro rhe rcRpansiblii of a Awner. CONTRACTOR/OWNER r Brom lf'te 111 t101ds In MIA box down to the Installer's name and si Inatturo %stallp r / ContrAL-tor Owner / Millin ,[,0catlgn ()hjeet Locative Mime. 9Irc4, 6CI�J SCh, Slow, 7,ip wet W Cutttttet Nnntxlrltle 1'[Ion n a.d.. rax CO _ Street pssi) !Par kceC4, -11Tt i��V Streay �$v� �rlwlonUS p W321 t�� Canla. �,3 phone trR��Fax B-Inai l �QS',Cdrti etJY3 �t 3?,� U�� "m d.r to Or) u,r 5,� Dollor Ntl.11ot)nl BOW Number Stsrial / Utfioi' Number ' ; Stflntp 1 s WA 98b zo Tillc !_f�r� "W7w.- lum61m- i�YaS-c M11MI, ul-ka1.11 u 112- rarTI��C�1t^ _ Year Built Inpuc(18TU/IC V) ' Mnx RlowaliIF Wo •Icin.-..' .. , q un7or olSaFat���^M �.. � es:ut(� V' '��� �}��• lD0 � � I y 1 a.lves ::atety Vnlva SOf, hl'OSStH'C• Comments: .,... 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