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HomeMy WebLinkAboutWHEATON WAY, 2625CITY OF BREMERTON PERMIT NUMBER: BB13 00075 DEPARTMENT OF COMMUNITY DEVELOPMENT DATE ISSUED: 02/11/2013 345 - 6th Street, Bremerton, WA 98337 (360)473-5275 Fax: (360) 473-5278 ASSESSOR NUMBER: 3966-004-001-0007 ZONING: INST SITE ADDRESS: 2625 WHEATON WAY, STE D APPLICANT NAME: HICKMAN DOUG PHONE: (360) 871-6529 ADDRESS: 2081 VICTORIA AVE. PORT TOWNSEND, WA 98368 OWNER NAME: HICKMAN DOUG PHONE: (360) 871-6529 ADDRESS: 2081 VICTORIA AVE. PORT TOWNSEND, WA 98368 CONTRACTOR: RAINY DAY EXTERIORS PHONE: (360) 536-0786 ADDRESS: 4611 AIKEN RD SE, PORT ORCHARD, WA 98366 LENDER NAME: PHONE: ADDRESS: SUBMITTED: 02!11;2013 APPROVED: 02/11/2013 (RATION: 08/1012013 STATUS: ISSUED VALUATION: 52,844.00 Sign Permit Building Permit 580.00 2211 CURRENT DENTAL - N INTERNAL ILLUMINATED WALL SIGN Plan Review Fee $52.00 16-4580 Building Code Edition: State Surcharge $4.50 0236 Occupancy Group: TOTAL FEES: 5136.50 Type of Construction: � tJ Flood Zone: ., Setbacks: ; Sanitation Method: Number of Bedrooms: �1 R \ yr Square Footage: Bid Price from Applicant TOTAL Inspection Requests FIRE: Fire Inspections (360) 473-5386 DCD: Building Inspections (360) 473-5870 HEALTH: Kitsap County Health District (360) 337.5285 L&I: Department of Labor and Industries (360) 415.4000 PW&U: Public Works - Engineering (360) 473-5270 This permit shall become null and void if the described work authorized by this permit has not commenced within 180 days from the date of issuance, or if the work is suspended or abandoned at any time after the work is commenced for a period of 180 days. It is the responsibility of the permit holder to see that the required inspections are made. Failure to obtain required inspections may result in stoppage of the work until such time that the permit holder Can susbstantiale to the City of Bremerton that the concealed work meets or exceeds code requirements. Any demolition, testing. or financial burden shall be borne directly by the permit holder. Failure to substantiate code requirements will indemnify the City against any and all responsibility or liability connected with the construction. I hereby certify that I have read and examined this permit and know the same to be true and correct. All provisions of laws and ordinances governing this type of work will be complied with whether specified herein or not. The granting of a permit does not presume to give authority to violate or cancel provisions of any Stale or local law regulating construction or the performance of the construction. If listing the owner as general contractor. I certify that I am exempt from the requirements of the State Contractor's Registration Law under Section 3, Chapter 126, Laws of 1967. All revisions to an approved plan require DCD review and approval prior to performing work. All building and tenant occupancy permits are requiredo pass final inspection prior to permit expiration and obtain a certificate of occupancy prior to use or occupancy. I 'Apr I have read, and agree to ab e y ions of thi permit including conditions of zoning, building codes, and State and Federal laws. SIGNATURE OF OWNER O AGENT: 2 PRINTED NAME: DAT 1* _l r I J CONDITIONS City of Bremerton's appr vat of this application pertains only to the City's regulatory jurisdiction, and thus compliance with City regulations does not necessarily ensure compliance with federal or state laws. 10. (DCD-47) DCD: Reinspection Fee: All approved plans, the printed building permit, and the permit inspection placard. are required to be on-site for inspection purposes, and work to be inspected shall be complete and ready for inspection. If an inspection is called for and plans are not available on site, or the work is not ready for inspection, approval will not be granted. In addition, a re -inspection fee will be charged and must be collected by the Department of Community Development prior to any further inspections being performed or approvals granted. 11. (DCD-50) Final Inspection Required: All building permits shall have a final inspection performed and approved by the City of Bremerton Department of Community Development prior to permit expiration. The failure to request a final inspection or failure to obtain final approval prior to expiration may require a reactivation fee, or a new permit application if more than a year has passed with no activity. 12. (LU12) Signs must comply with BMC 20.52. A separate permit is required for any additional signs. 14. (LU25) Signs may be illuminated directly, indirectly, or internally, provided the lighting is directed away from other land uses, and away from on -coming traffic. Page 1 of 2 CITY OF BREMERTON DEPARTMENT OF COMMUNITY DEVELOPMENT 345 - 6th Street, Bremerton, WA 98337 (360)473-5275 Fax: (360) 473-5278 PERMIT NUMBER: BB13 00075 DATE ISSUED: 02/11/2013 ASSESSOR NUMBER: 3966-004-001-0007 ZONING: INST SITE ADDRESS: 2625 WHEATON WAY, STE D APPLICANT NAME: HICKMAN DOUG PHONE: (360) 871-6529 ADDRESS: 2081 VICTORIA AVE. PORT TOWNSEND, WA 98368 OWNER NAME: HICKMAN DOUG PHONE: (360) 871-6529 ADDRESS: 2081 VICTORIA AVE. PORT TOWNSEND, WA 98368 CONTRACTOR: RAINY DAY EXTERIORS PHONE: (360) 536-0786 ADDRESS: 4611 AIKEN RD SE, PORT ORCHARD. WA 98366 LENDER NAME: PHONE: ADDRESS: SUBMITTED: 02111;2013 APPROVED: 02111!2013 EXPIRATION: 08110,12013 STATUS: ISSUED 15. (LU26) All operating businesses within the City of Bremerton must obtain a City of Bremerton I ` business license prior to operation of the business. Please contact Jeanette Wischhoefer, (360) 473-5298 for more information or find the business license application at the City of Bremerton website. MINIMUM INSPECTIONS REQUIRED To request an inspection, please call (360) 473-5870 and be sure to provide your permit number, name on permit, site address, contact phone number, and inspection type. To register for on-line inspection access, visit the City's website at www.ci.bremerton.wa.us. L&I - Electrical Final Inspection Final Inspection - Building Page 2 of 2 BUILDING PERMIT 2625 WHEATON WAY, STE D INSPECTION CARD PROTECT THIS C.,1 RD I,R0A1 771E f LA THER Building 1:1 Plumbing ❑ CURRENT DENTAL - NEW INTERNAL ILLUMINATED WALL SIGN Mechanical 11 Alarm/Sprinkler 11 This Placard must be posted on or near building and the Permit & "Approved" plans must be at the site. Permit # BB13 00075 Call the followina Aaencv Telephone Numbers for inspections: Building Department Inspections Call: (360) 473-5870 WATER - Public Works - Water: (360) 473-5927 PW - Public Works - Engineering: (360) 473-5270 HEALTH - Kitsap Co. Health District: (360) 337-5285 Fire - Fire Department: (360) 473-5386 L&I - Dept. of Labor and Industry: (360) 415-4000 Inspection L&I - Electrical Final Inspection Final Inspection - Building - Property lines shall be properly identified and marked before foundation footing inspection. Setbacks are measured to the finished wall structure. - Reinspection fee may be assessed if inspection has been requested when not ready or corrections are not completed. - Permit, approved plans, engineering, and inspection card shall be on site during construction or Reinspection Fee may be assessed. Approved Date Notes FINAL BLILDLYG (360) 473-5870 ,111 of the ahmv nurs7 he cipprorcd. Occu aneli, (ipproval f )r Sl - 'R only - C O7r mert hil Stru(ture~ require a sel)cn•ate Certificate of occupc117cy. DO NOT OCCUPY BUILDING WITHOUT BUILDING DEPARTMENTAPPROVAL PROTECT THIS CARD FROM THE WEATHER RCIV +City of $temertari rto PERMIT CENTER ' (� FEB 11 2013 COMMERCIAL • Dopartmentof Building Permit Application Community Developmcnt Department of Conununity Development * 345 - 6th Street, Suite 600 * Bremerton, WA 98337-1873 (360) 473-5275 * Fax (360) 473-5278 * www.ci.bremerton.wa.us lAffacam; OwnerL Contractor Authorized Agent Business Name: C (Jr/-t?"t L)Co fti I Site Address: 2 b Z S i,� Lt e�, f-v� L�x)m _,; te. 4Ei-�,.v,,�� �i,�• I,J i} 9 �3 i C� To apply for a property address, contact Public Works at (380) 473-5270 CONTRACTOR: OWNER: Hicj,� v-44,.,,` Address: 1-101 l , v` A SE Address: Zv�el Ave City, State, Zip: �c�f} ('rc (nc , 'WA Cf$ 3 City, State, Zip: Q, - ✓4 9 36 F License # & Exp. Date: RA I k 4' DF $d 3Pq Phone #: 's 6 6 $ ? 1 - 6 Zcl Contact Name: Jc, w►c.,7 (,J; t l�� v� 6 Authorized Agent Name: JcL 3c -l. T l >- Contact Phone #: (3&,D S36- v"1 96, Address: -7 3i-1-7 E Email address: >v IR City, State, Zip: D•-ckA.-,A LJA W36 11 Tax ID/Parcel #: 3a66 -coo L4-ov i -000-1 Phone #: (ZC6 ) -76G - c�5 o `j ❑Sewer ❑ Septic Email address: tis �c ftp Ivr 8 I• car What is the application for? Please check New Construction Alteration Addition ❑ NEW COMMERCIAL ❑ TENANT IMPROVEMENT WITH WORK ❑ COMMERCIAL REMODEL ❑ TENANT IMPROVEMENT WITHOUT WORK ❑ COMMERCIAL ADDITION FeNEW SIGN ❑ COMMERCIAL REPAIR ❑ GRADING (Cubic Yards: ) ❑ NEW MULTI -FAMILY ❑ REROOF ❑ DEMOLITION ❑ Interior ❑ Exterior** ❑ Foundation Wall** ❑ Roof 1 Section-- ** Separate demolition permit and fees required. Contact Public Works for sewer cap permit (473-5270). Sewer must be capped prior to demolition permit issuance. ❑OTHER: IS THIS PROPERTY WITHIN 200 FEET OF A SHORELINE? ❑ YES N NO Scope of work proposed: 1VL5'1'4j(yke ywfit-vu+ II (�1✓✓►t t/lcfec� (.� L"� v Su v1 Square Footage: Building: Construction Type: '7)0-_72- Valuation U.'?2 Valuation I Plan Review Fee I Permit Fee I Surcharae I Total Fees I I o z,sL1,-A Ic:5 o 0 1 �o 00 1 o I/ )�, g Application for which no permit is issued within 180 days following the date of application shall expire by limitation, and plans and other Ofita submitted for review may thereafter be returned to the applicant or destroyed by the building official. The building official may extendye time for action by the applicant for a period not exceeding 180 days on request by the applicant, showing the circumstances beyond the control of the applicant ,hav p vented action from being taken. No applicant shall be extended more than once. In order to renew action on an application after expiration, th applicant shall resubmit plans and pay anew plan review fee. 7 Applicant's Sigoature Date Rev. July 2008 ,rpm w U) Ir oy Fr rr 0-0 -ja Cl) LLI U cr) I-- LLJ -C Lu > -5 >UQ 1OL'O E '6 T 0 z cr- azo T o w E m tmb2�bp ":t a- Ir a_0 0 �7) Lu - w cr CD w ) -J U) 0) E -6 c) Z < (DOLE: O' -C a) 0 cu C' cu =3 U) 03 0 0 — w ED -r - E o OL a) O 0 B c - cr, Zj c — = '5 c: 4' E �70 'n "E3 c) Ll- o ,rpm w U) 0 \ � Q A � L # q § / ----- � � §�� - a k� £ �� All � � � k\ ¥■ 2 }/ ■ k±�\\ ipa [ 7 w Z3 t� -j Q) ±owe E§ « LL k?2 ■$J U) U 0-G ! m a■ 4 4 0 � Q A � L # q § / tri r ce�fCate Of Occupancy Department of Community Development This cert ficate issued pursuant to the requirements of Section 110 of the International Building Code, as adopted 6y the Bremerton Municipal Code, certifies that at the time Of issuance this structure complied with the requirements of the code for the occupancy and division of occupancy and the use for which the occupancy is class fled. Issuance of a Certificate of Occupancy shall not 6e construed as an approval of a violation of the provisions of any building code or of other ordinances of the City of Bremerton. ISSUED TO: Timothy C. Verharen, DDS, PLLC SITE ADDRESS: 2625 Wheaton Way Suite D OWNER: Doug Hickman, The Hickman Group 2081 Victoria Ave Port Townsend, WA 98310 Type of Occupancy Occupant Code Sprinklers Construction Classification Load Common Use Edition Reg,d? VB B 30 Dental Office 2006 No Permit Number: BL -24247 Date: December 14, 2007 BB07 00833 �2 Z� / /�01- Andre L. Spencer, Dire for Special Conditions: THIS CERTIFICATE MUST BE POSTED AND PERMANENTLY MAINTAINED IN A CONSPICUOUS PLACE ,. 410/29/007 10:08 FAX 3604735200 f CITY—BREMERTON Zoos Start Dale of 6kefinesa In Demertut: WA SW Ta*IJBl Number, Properly Owner's Noma T I i % Tar Peroel V Number Type of Bus- (01ecic DHE) E3SoiePmP4*w 0 erahip �Caporatbn LLC Dlher LEGAL NAME OF BUSINESS: (n a sale pmprivbmhj k yaw*# n best arta Wude my rNadrr 1001, TRADE N" OR DBA: C °t " f PHYSICAL BUSINESS LOCATION' l ADDRESS CITY STATI 2F Mad" Address for LICENSE 6 RENEWAL KJSWE AS ABOVE ADWESS errY STATE ZJP Manny Addrea for TAX FORMS: AS ABOVE BUSMIESS PHONE A00RESS CITY c Ci e . CEII PHpNE STAT£ ZIP A • Pleaco vote shat Business T3K Forms E-MAIL ROSS (if AppKwble): are avaI eon our website et htbritwww.ci.bremeeton.wa.us ^= V t'%' } tri D / Business SQ.Foote9e Offlr.A:._S 000 Retail: r. Number of Employees 1 `z aOthe 1 c, ' ed Previous Tenantl8usiness Name: Win there be mrnodekl of an existing building W your business? Yes No Wil You operate this buskmss out of your horn? If yes. Nurrdw of employe other#han rayldant: if Home Occupancy, I have read and agree to $Nde by the Home Doc upotion Regulations in the grem®rton Munidipat Gvo2 20.48;030 attere NATURE OP BUSINESS' Check at Ihat appy and pn** as much deem as possible below. R" MGMbliv Pa idno Whalen* Admissions Oltult SsNce Udity Arm3emeni Describe in DON` ins priflidpai prsdlrct{sj or sae>"G8(s)rtwtderad: dote; Additiord licenses qr aAdOftRHNnta mabr tall rarliu�Ntad n9 � the (ItKireawt activtgr see irtetn+Ctioraf regs►dirng rcgviatyury 1{artsee. TAX REPOR'nNG STATUS • Based On Els gree Retail; ice, or Servix paasitoce5on as dela loci, or as op6onai choke, QMt1NTiit.Y -Round for UW4 and Parking Twfayam ffj",RTERi Y - Essmated Grass Reodpta over $40:000 annually or Opt`&WjGarnill % ediviraec must report @raftly) QANNLIAL - EAWMed Grass Ra*F" $+10;000 of under arnvaltyor 00031. COMPLETE INFORMATION ON REVERSE SIDE 542:le- A- H � LN tSSUCy 5 t-�r'�-�s� N ��E.►e Appl # [BB04 01177 Date Issued 07!30!2004 Applicant JIUCKMAN DOUG Type `BLDG -C Expiration Date 04!09!2005 Parcel # 3966-004-001-0007 Parent # Re -issue Date i ✓�/M Site Address 2625 wHEATON WAY, r IEDIC.+i Date Submittedj07/02/2004 Date Closed F Project Name DOCTOR'S OFFICE TENANT IDI Technically Complete F__ Last Action 10!11!2004 Zoning Date Approved 07/29/2004 Fstt- as Date 07!30/2004 Status ISSUED Override Expire? F_ Govermnent? Ne-wPerm Query Print Fortn Letters Copy Site Address Notes? Details Pazvels Structures Contactsp H «, s Approval Conditions Inspections Applications Qad � Inspec wn T�Pe ', ___ _ ', � � _. � x� R V IN ,n 11„1t�s i% " ector Name Len Reason ..... mCROSS CONNECT DA 1011112004'JVarner,Earl 0 QUESTED F F F. 30 ATCHANICAL AP 10!11!2004 Craze, Larry F 0 REQUESTED . 50 PLUMBING -ROUGH jl�i 09!1412004 Craze, Larry 0FEQUESTED �.: 60 FFRAMIIJG PA 09!16!2004 Craze, Larry 0 REQUESTED _ 70 INSULATION y - AP 10/11/2004 Craze, Lang F 0 Fi QUESTED 'r_,F, '; 110 (FINAL - FIRE TI ( 0 0 FINAL - CROSS I- Appl #;&B04 01177 Date IssuedFo7l36/2004 Applicantllh K6 "IT DOUG Type jEZDG-G Expiration Date '04/09/2005 Parcel #13966-004-001-0007 ......_. .._n Parent # ( � e �. _.... Re -issue DateSite Address j2625 %A=_ATi.1�T ,VAY, NIEDICK_ Date Submitted 107/02/2004 ... .. .._........_.. Date Closed Project Name DOCTOR'S OFFICE -TENANT IM Tecluucally Complete { Last Action'] 0/11/2004 Zoning Date Approved07129/2004 FStatusDate 07(30/2004" Status ISSUED Override Expire? � Goverzunent? � Ne-wPermitQuery Prirrt Form Letters ' Copy Site Address Notes? Details Parcels Structures Contacts Contractors Valuation 'Fia-tures Fees Approval Conditions Inspections �JJAppllcatioms' Oud Lispec bolt `Cype ", Date Inspector Name Len Re-s!a i A,rj7 50 "PLUNMING - ROUGH 14!2004 iCraze, Larry 0 iREQUESTED T' .r r" JAP x091 60 FRAMII�IG PA 09f1612004 Craze, Larry 0 r QUESTED r r- r' . 70 INSULATION _ �AP 1 011 112 004 Craze, Larry 0 REQUESTED r r'F . 110 FINAL -FIRE TI _ 0 F QUESTED F f- F_ . 120 FINAL - CROSS ,,,,,.,, w.._�.. �a 0 REQUESTED.... (AP 10/11/2004 Inspection Details y 0 Robert 0 CY/V� 1� . _30 D B UILDIIVG PERMIT INSPECT/ON P Ell F CARD DA!R.WrIPA.ate 1TPRtkC'r THIS CARD FROM THE WEATHER --- -- Building Plumbing Mechanical Fire Alarm/Sprinkler ❑ 1lTTT?TNC l�7CP7 Tl(�N� THE BUILDING PER]�ZIT APPROtTED PLANS SHALL, lel ON SITE Permit # BB04 — For Inspections Call (360) 473- 5870 Approved Date �- I Nous 1 st FO UNDA TION DO NOT POUR CONCRETE PRIOR TO APPROVAL Erosion Control In Place Foundation Footing Foundation walls Plumbing Ground Work In Slab Mechanical Footing Insulation n d PLUMBING 2 MECHANICAL GAS PIPE Rough In Duct / Vent Support / Test /Meter set - I,% " ,� 3 rd FRAMING If 1st & 2rid are approved Hold down connections Shear Panel nailing L&I Electrical Approi,ed Ventilation requirements Framing til 4 INS ULA TION Under floor walls ceiling `8th SHEETROCK z f th All of the 6 above FINAL Must be approved Prior to final BUILDING 473-5570 �¢(' C � lyq� CC (, NATER MAINTENANCE473-5927 Grease Trap, Back flow, Meters PUBLIC N'ORKS Driveway 473-5270 Sewer 473-5270 FIRE 473-5384 15385 T F'TYAT. TIVUECTIONS COMPLETED DO NOT OCCUPY BUILDING WITHOUT BUILDING DEPARTMENT APPROVAL PROTECT THIS CARD FROM THE LEATHER DEPARTMENT OF COMMUNITY DEVELOPMENT BUILDING DIVISION Bremerton, Washington (360) 473-5275 INSPECTION REPORT PERMIT #' 17 Z` ADDRESS: 261�if/�- ;L a e -7--t7 Date: az/Q�phone: CITY OF BREMERTON PERMIT NUMBER DEPARTMENT OF COMMUNITY DEVELOPMENT DATE ISSUED: 286 Fourth St. Bremerton, WA 98337 (360)478-5275 Fax: (360) 478-5278 ASSESSOR NUMBER: 3966-004-001-0007 ZONING: HC SITE ADDRESS: 2625 WHEATON WAY, MEDICAL ARTS B APPLICANT NAME: HICKMAN DOUG PHONE: ADDRESS: 2081 VICTORIA AVE OWNER NAME: HICKMAN DOUG PHONE: ADDRESS: 2081 VICTORIA AVE CONTRACTOR: KELLEY HOME SERVICES LLC PHONE: (253)224-3367 ADDRESS: 4701 88TH AVE CT NW LENDER NAME: PHONE: 0_ ADDRESS: r i t SUBMITTED: 07/02/2004 APPROVED: 07/29/2004EXPIRATION: 01/26/2005 VALUATION: $38,000.00 Commercial Building Permit w/' hanical/Plumbing Mechanical Fixture Fee $45.25 2215 INTERIOR REMODEL FOR DOCTOR CLINIC Building Permit $522.55 2211 Building Code Edition: UBC: 1997 Plan Review Fee $339.66 4580 Occupancy Group: Plumbing Fixture Fee $90.00 2213 Type of Construction: State Surcharge $4.50 0236 Flood Zone: TOTAL FEES: $1,001.96Setbacks: (Front) (Side) (Rear) (Other) Sanitation Method: Number of Bedrooms: Square Footage: Bid Price from Applicant 1 TOTAL Inspection Requests Fire Inspections (360) 473-5380 DCD: Building Inspections (360) 473-5870 H/D: Bremerton, Kitsap County Health District (360) 337-5285 L&I: Department of Labor and Industries (360) 415-4000 PW: Department of Public Works (360) 473-5270 This permit shall become null and void if the building or work described and authorized by this permit has not commenced within 180 days from the date of issuance, or if this building or work is suspended or abandoned at any time after the work is commenced for a period of 180 days. Obtaining inspections at intervals not exceeding 180 days identifies that work has not been suspended. I hereby certify that I have read and examined this permit and know the same to be true and correct. All provisions of laws and ordinances governing this type of work will be complied with whether specified herein or not. The granting of a permit does not presume to give authority to violate or cancel provisions of any State or local loaw regulating construction or the performance of the construction. If listing the owner as general contractor, I certify that I am exempt from the requirements of the State Contractor's Registration Law under Section 3, Chapter 126, Laws of 1967. All revisions to an approved plan require DCD review and approval prior to performing work. All building and tenant occupancy permits are required to pass final inspection prior to permit expiration and obtain a certificate of occupancy prior to use or occupancy. I have read, and agree to abiAe by e o itions of thi rmit i uding all conditions of zoning, building codes, and State and Federal laws. SIGNATURE OF OWNER OR AGENT: V If PRINTED NAME: ® e— DA / CONDITIONS City of Bremerton's approval of this application pertains only to the City's regulatory jurisdiction, and thus compliance with City regulations does not necessarily ensure compliance with federal or state laws. i' 1. DCD: Prior to performing any renovation or demolition work, Puget Sound Clean Air Agency (Clean Air Agency) and Washington Department of Labor and Industries (L&I) regulations require an asbestos survey be performed to determine whether there are asbestos -containing materials in the work area or structure. The asbestos survey must be conducted by and EPA -certified (AHERA) building inspector (except renovation or owner -occupied single family residences). 2. DCD: For more information, please contact Clean Air Agency through their web site at www.cleanair.org or by �L phone at 800-552-3565 or 206-689-4058. The L&I web site can be found at www.lni.wa.gov/p- ts/asbestos/asbestos.htm. 3. Cross Connection: Upgrade existing fireline by installing an approved double detector backflow assembly. Detector meter shall be Invensys brand in cubic feet X100 with 505 mxu radio read. All approved assemblies must be tested by a certified Washington State backflow assembly tester at the time of installation, whenever serviced or moved, and annually thereafter. For more information or to schedule an inspection, please call Bremerton Cross Connection Control, 473-5927. No meters will be set without prior installation, inspection, and approval by Bremerton Cross Connection Control. Page 1 of 3 CITY OF BREMERTON DEPARTMENT OF COMMUNITY DEVELOPMENT 286 Fourth St. Bremerton, WA 98337 (360) 478-5275 Fax: (360) 478-5278 PERMIT NUMBER BS -04 01177 ; DATE ISSUED: 0713412004 ASSESSOR NUMBER: 3966-004-001-0007 ZONING: HC SITE ADDRESS: 2625 WHEATON WAY, MEDICAL ARTS B APPLICANT NAME: HICKMAN DOUG PHONE: ADDRESS: 2081 VICTORIA AVE OWNER NAME: HICKMAN DOUG PHONE: ADDRESS: 2081 VICTORIA AVE CONTRACTOR: KELLEY HOME SERVICES LLC PHONE: (253)224-3367 ADDRESS: 4701 88TH AVE CT NW LENDER NAME: PHONE: () ADDRESS: SUBMITTED: 07/02/2004 APPROVED: 07/29/2004 EXPIRATION: 01/26/2005 4. Fire: Fire protection systems must comply with UFC, NFPA, UBC and BMC standards. 5. Fire: Premise identification required to UFC and BMC standards, 6" minimum and in contrasting color to building. 6. Fire: Provide fire extinguishers per Article 10-1 of the Uniform Fire Code. 7. Extend fire protection systems into all new areas. 8. Fire: Knox Box/Key Lock Box required to UFC and BMC standards. k 9. Fire: Exits shall comply with Chapter 10 of the 1997 Uniform Building Code. 10. Fire: Copies of fire ordinances and Bremerton Municipal Codes are available at the City's website, www.ci.bremerton.wa.us. To reach Scott Rappleye, cal 360-478-5384 or e-mail at srappleye@ci.bremerton.wa.us. To reach Jim Hardy, call 360-478-5385 or e-mail at jhardy@ci.bremerton.wa.us. 11. DCD: Approved Plans, Engineering, Site Plan, Permit, and Conditions, Shall remain on site and be available for inspection. 12. Building Plan Review: Code Compliance -All work in the City of Bremerton shall adhere to the following codes: 1997 Uniform Building Code 1997 Uniform Fire Code 2000 Uniform Plumbing Code 1997 Uniform Mechanical Code 2001 WA State Energy Code 2000 WA State Ventilation Code 1998 WA State Barrier Free Code As of July 1, 2004 the codes will be as follows: 2003 International Codes: International Building Code International Residential Code International Existing Building Code International Fire Code International Mechanical Code Uniform Plumbing Code International Fuel Gas Code 1998 WA State Barrier Free Code 2001 WA State Energy Code 2000 WA State Ventilation Code Check For All Washington State Amendments MINIMUM INSPECTIONS REQUIRED Inspection requests must be received by 8:00am in order to be scheduled for same day. To request an inspection, please call (360) 478-5275 and be sure to provide your permit number, name on permit, site address, contact phone number, and inspection type. Mechanical Plumbing Rough -In Framing Insulation Sheetrock Nailing Final Inspection - Fire Final Inspection - Cross Connection Final Inspection - Building Page 2 of 3 CITY OF BREMERTON PERMIT NUMBER BB04 01;177 DEPARTMENT OF COMMUNITY DEVELOPMENT DATE ISSUED: 07/30/2004 286 Fourth St. Bremerton, WA 98337 (360) 478-5275 Fax: (360) 478-5278 4SSESSOR NUMBER: 3966-004-001-0007 ZONING: HC SITE ADDRESS: 2625 WHEATON WAY, MEDICAL ARTS B APPLICANT NAME: HICKMAN DOUG PHONE: ADDRESS: 2081 VICTORIA AVE OWNER NAME: HICKMAN DOUG PHONE: ADDRESS: 2081 VICTORIA AVE CONTRACTOR: KELLEY HOME SERVICES LLC PHONE: (253)224-3367 ADDRESS: 4701 88TH AVE CT NW LENDER NAME: PHONE: 0- ADDRESS: SUBMITTED: 07/02/2004 APPROVED: 07/29/2004 EXPIRATION: 01/26/2005 FIXTURE LIST Qty Description Qty Descriptior 3 C -Sink (Lavatory, Kitchen, Mop, or Bar Sink) 3 C -Bath Fan and/or Exhaust Fan 1 C -Drainage Pipe or Vent Pipe Repair or Alteration 6 C -Grease Interceptor Page 3 of 3 CITY OF BREMERTON DEPARTMENT OF COMMUNITY DEVELOPMENT 286 Fourth St. Bremerton, WA 98337 (360) 473-5275 Fax: (360) 473-5278 Receipt Number: BDD0001877 07/02/2004 Plan Review Fee metnaa Numoer Amore CHECK 12005 $ 662.30 Total: $ 662.30 $339.66 BB04 01177 Page 1 of 1 3 ren Qriginal Fee ArBit��r�t Few Perm # Fee ['Description Code Amount ��Pa�d Bala BB04 01177 Mechanical Fixture Fee 1/2215 $ 45.25 $ 45.25 $0.00 BB04 01177 Building Permit 1/2211 $ 522.55 $ 522.55 $0.00 BB04 01177 Plumbing Fixture Fee 1/2213 $ 90.00 $ 90.00 $0.00 BB04 01177 State Surcharge 1/0236 $ 4.50 $ 4.50 $0.00 Total: $ 662.30 Previous Pajr'iYtent His A.Y�....�L t-V—J OwnmCM 40 BDD0001877 07/02/2004 Plan Review Fee metnaa Numoer Amore CHECK 12005 $ 662.30 Total: $ 662.30 $339.66 BB04 01177 Page 1 of 1 &LCOVERSON FAX NO. : 3605687501 06/87/1004 —05:30 36G1a '�F77� Orr Jun. 07 2004 09:53PM P3 MERTON VD PACE 03 APPLICANT - .»�!'yxCleMcX]c 296 441 StTret- TiMm (360) 479.5275 Pas (36o) Ors-�^yfi Building Permit Applicati Dx, CEjN7'?' �+ R AUTHOR=D AGENT 'F� L ---,E mita riaores OCU? u--04 u -•kc r. t VojA I Tay. Account Number LSO -Ooh - j ic�c o r zie.k• of CONTRACTOR: y� euro Ov►+ntEla Address N ► - �a t� r.., �-Lc; -.c� Address: 9 70/ 08 Acyc- Cr rv-,-) CV, State Z' i>,rk — • g -;ti, -state,' 6, 4P t Phone V., icense * &:Expir. Date: Authorizad Agent Adores*: t Qac+ Contact Name: Cit D y. state, 21 +'vRg itY� . . i�. �"ct Phone a>t 2�3. 1Z2q/ 356 7 Phone 0: t EG, a i �� C� z C; hook the tVD9 of aonl)Fstign for btbw• f r t 7Lt 71 PR L-.; NEW SINGLE-FAWLY P,ESIDENCE NEW DUPLEX NEW MANUFACTUPZO HOME P.ESIDENTiAL REM00=--L ESIDEN'rIAL ADDITION RESIDENTIAL REPA'R I t � NEW OOMMZRCIAL COMMERCIAL REMODI_l. COMMERCIAL A=TiON COMMERCIAL F'=nAIR NEW KJLTi-FAM!LY NANT IMFRovEMENT � L `—i :1] '7 N:W GAfIAr-E=R POP,T -NEW ACCEIRSORYBLD G NDN SIGN gTRUG7 VKE DEiv1CLET10N G RADING, (C.L;bic yarn,;: _ ) OTHER 'S THIS PROPERTY WITHIN 200 FEET DFA SRORELINZ? YES 7 NO %' Scope Of Work Proposed: q�' d ,, . �- j�,y�yL�,y _P�♦ _.YUMA �tJrlu,.. ��-Rs>�t r j. . 3--`{1a.,tA-' S�l�E- i -J i -AAA..,.) Sc.lare FDotage: Dwelfing:.2-Soo Garaga: De --k$; vBIGB:ior, 1,4FISM Review Frere Permit Fee Surcher a Tata Fees c V r- > 5 +5 . G � � v,�PI1I AppGCatipn for vtii:h no�fllzl- � ln 180 days fokwlnp :hc, dsf8 0` appli=bon sna13 mirebyItmil ,011, pians entr other deb sl DQy tt:er?aPx. de retu-,ed = MQ BppliCaat or dotavyed by the bui)con l� 'rhe lx:fidl•g offidar may t�en0 tr9 time for action by the apaliGBnf for a period not exceedir, 1 the aapricrent ahaw)n; the cercumatec►ces twyond the Comm; of thea l� g days on to ! pPi ..ant peva prevcntgtj aCctOn from being to .1e � *POGc*M 1rh811 be *Kf"Ced mgrs than once. !n Order t0 renew action on an appfisatlon after excinnion, frit 61610 resubm't Dlans snd pay a nen pi � J � VAC ���. �•.. 4Pai!CAN3"S SIGNATUAZ: DATE OD -t— RECEIVED JUL n 9 2004 ENGINEERING DIVISION T JLCOVERSON 06/87l2E1d4_ FAX NO. : 3605697501 Jun. 07 2004 09:53PM P3 MERTON DCD PACE 03 _ �c J t3Fsf�ll�l,� � OWL0 NG DFp�i,T.+t,11F, MIT C FjN7E Z. Ea`ri- UUM o>r "n;?n.un- T�`-Ti7cmc-t= :'t Q76=S�347 (360) 47795275 * Fxt (360) Ors-52rt, ]Building Permit Appiicatioio. APP! iCA1JT �] pWNEFt rnNTR,pCTORAUTHORIZED AGENT She Addres oZ&a - Tay, Account Number: –CiC�J CONTR,4CTOR:01lVIJEiR 4ddress it L 1M a ,n rz `fin Yrt, 4tfdt�ess: / vp %ivC r rA'J _CV, State: z u-� /! ? ) o i,.5tate for WC ( ge Phone c. � � C .iCf tSt ` &=Fxpir. Date: AUthorizad Agent Addrw* �7Jr![�\�ao 2q -33b 7 Et -p( L— Ccs vin 4/ -e' -e -at P��u -I tPmrs, uY,. ---137c L S Check the type of annllgation for bpjRSw. f7NEW SINGLE-FAUILV P2StDENCE � NEW CaMMZ;tCIAL El NEW GR1gAGc/OAR PQp,T LJ IgEW DUPLEX i COMMERCIAL REMODF-L L NaN AQCER5IRDRYBLDG NEW MANUFACTUFMO HOME COMMMIAL ADDITION `�—} v' N SIGN P981DENTiAL REMODnL COMMtRCIAL R:DAIR STRUC?URE DE -Mc nON PRESIDENTIAL ADDITION NEW ML/LT-FAM!LY GRADING (CL;bic RESIDENTIAL REPA'R ; ENANT IMFitovFmIrNT Z OTHER lS THIS PROPFRT'1r WITHIN 200 FEET DFA SHORELINE? YES [7 NO S2600 Of Work Proposed: a np,� q[j 1�,,, ;� Vw�� Ode Pys♦ � ;f�4.w• to !B0u.. - hm-adm!�– ,1p�3 – AXAA.> ,�.�.t-. res c,y �A r_&4& —�— Sc.iare Footage: DwelGnQ.- 2-900 Gara;a: r— VR)U2Sar, ,8n Review se -:, Permit Fee F SurCher � Tota Fres 7-4 Apptiesti0n for no g ,Min 180 days following :he psw o` appiicubon anati expire by iimiYBtian, entl plans arzr other deta submitted for nsvie may tt:er4p.&rw t -e rstuned 1D inQ appiirant or destroy4tl by the builcong offlmaJ. The tMIC11: p offiasr may emend Vs tirnta for action by the APalic2M1 for t period not b=eading t DO days on regUECT by the aPPficQnt ahOMn; the beyond the control of the appilyant have Prevcrtted aL-Uon IMM being tai en. era 5 r�e�ubm iiD a eRd pay a nevi pan once. In ord¢r to renew aa8nn on an applicailon. after excirltion, the epAii,aM APPLICANrS SIGNATUPZ: ,��EINERl U,� JLCOVERSON FAX NO. : 3605687501 Jun. 07 2004 09:53PM P3 A06107i200a 08:30 3604735278 BREMERTON UCD'O n PAGE 03 6, KtIVU4W uri��rvCgib.. 'IIT CEN7- ni-m—un , ijf'� evclnnment 1.286 -VI, -5=ct " T'reme-cm Z' My 4 OFr�3-Z (360) 4795275 Part (360) 479-��'fi —` Building Permit Application APPLICAN71: ❑ OWNER CDNTR LCTOR AUTHORIZED, AGENT Sita Addres o &A5 L0'V4,b-Ncn jdtLm I Toy Account Number.�i 1 l6le-��Oa r ewe ii1� C� 3eNL"LP" C -)I CONTRACTOR: p [� p� OWNER Address' Address: I arc C i' h.� Ci 5talte Zi ice' ,f ! n_ ) W tate 6 lizi ane #: jc;ense #.' &..E-xplr. Li&te: r thorizad Agent Addrese: :`�ex.i < 0c)(-0 r ti-t_c, r l --- {`37c 2. S F ji 17 NEW SINGLE-FAUILV RSSIDE4J Y' CD NEW CDMARCIAL NEW Mr.AR PDRIT NEW DUPLEX f 00l MER AL REMO r N-=Vd . CcGSORI' BLDG NEW MANUFACTUFMO HOME COPME I ADDrr, N N IGN PE6IDl:hlTiALREMpDEt C44 C Fi UG7lJitiECEtvICL. fOtJ f�E6lf�ENTIgL AODiTION N L F I !Lr (� GRADINC, (CubtC yarcl;.: _ ) LJ RESIDENTIAL RPPAA ly ROVF.MF.NT QTtiER JS THIS PROPERTY WITHIN 200 FEET D,�A SHORELINE? YES [7 NO Sccps of Work Proposed: q.Q--a- - rte' �Ac�,.. SYu�.1-a.� .�•-- b 3 -yt� � ��.w qrb •4 �C.� - Sc.care FDotage: Dwelling: 2-SC07 Garage: Decks; varuaUpr. ;an rcevrew Fee':, Permit Fee I Surchar -Total APPGeation for v^i:h 110 wIthin 180 days f0llowlnp :he date a` appiic8tipfl sha l expire by ItM42timl, Ord plans and othw dab swbm t d for rsvis may tt:ereallm be retumed to the 8pptioar7t or dartroyed by the huHcf^+D officiai. The buhdlrp Officiar may r-und trip tirt* fOr action by" 2=40ani for a Pieriod not mbcceeding 160 day6 ori reQl:t3L1 a]' ttr® applerant ahowin; ho crraamstences twyond the earttroi ai the aPPitdant have prevcrsted action lrnm Going taken. irte APPJ;CsM #s *11 t* e) tRnCed more than once. In ardor to renew se tnr, on an 3pPlicatlon after excirstion, the appiic3nt S hail resvbm.t Diens and pay a now pi // APPLICANT'S SIGNATL'RS: - - DATE U K j��SU/�i �% FROM : JLCOUERSON FAX NO. : 3605687501 Jun. 07 2004 09:53PM P3 06/07/10;34 08::10 '352 BREMERTON DCD �., PAGE 03 wpm n UQ=Crit"28r 4A St (3 60) 4,79.5275 x Fwr ...,\ 1t �s ZIT CENTER l'i'!L_'T11FKMi * XWA 6 4;'8-52)% Building Permit A.pplicatiol, APPLICANT- D OWNER tr. Da+.e: phone A ALITHORIZED, AGENT On Waw 1 Tar. Account Nu 7 OWNER Address: /� I cay. $tate, Z ,APhone #: Authorrzad Agent City, stats, ZID 2-q-3367 1 Phone tt- I Gh92k the tuna of aonllPatign for cslow NEW S1N(3LE-FANNLY RESiDENr_E NEW COMMERCIAL IVSW DUPUN 1 COMMERCIAL REMODEL NEW MANUFACTURED HOME OOMMMIAL ADDITION P.ESlDENTiAL REMODa-L COMMERCIAL 1knA1R RESIbENTIAL ADDITION NEW MULTI; FAM!LY RESIDENTIAL RPPA'R Tt;NANT IMFROVr&MgNT IS THIS PROPERTY WITwAr 20o DFA SHORELINE? 'F� L--- E ooy- oo(-0Ic"C' -7 ss .� i4 `�- �ck- tA3>Da � f3 `'� c�1 �► ,.,,. 3"lc ` S K- Z NEW GAr4AGZ=R POPT j NcitJR^CcSRYBLDG NZ�W SIGN STRL V' -URE DEMCUTlON GRADING (Cubic yawl,;: _ ) OTHER YES 7- NO ,+ S:Epp Of Work Proposed: �1ryW ' 4&A4 ttiAAA-) Sc"re Footage: Dwelfing: ;-900 Garage: Appkcetiort for v^i:b n0 )E- It}tift 180 day* Wlowing :he dW o; appk=tDor+ sAaH expire -- alarp and other data Sub"aw for rlvls may th6r?ari: be roWned 1C x7C OPPlielnt or doCro ed b trm �. ora The bubd1q; of6ciar -py e=ano tN tiff* for action it1A A Y by thr- huildihp of8c;ai. the appiicsot 3hv*0; tho wwrr:star+ces beyond the t ontroi at for period not exceeding 180 days on regUaat by appkcant ad+att eYtRnCpd mon than once. d e cc to r PP''"ant t� prevontBd 8t:ttort f M being tat:en. Ira shag rmubm%t alms and pay 8 neer pl e»aw aattnn on an eDD►icatlon e`er expiration, the ePPl rri APPLICANT'S SIGNATLIArz: FROM : JLCOVERSON FAX NO. : 3605687501 06/071200.: oq!3@ 36a.'7:352 i8 B$;EMER-,ON 7+;D - Jun. 07 2004 09:54PM P4 .z PAGE a CENTER Gal 478-S275 478-5278 Type of Fuel: 15Z clwvfr, El GICs Occupancy: Residentiel ;DC;Qmmerci5j F—I oil 31% Mdress:6 w TRACTOF OWNER: A!!93s. LL H lc-v-vy, city. 5bftl 16 1�bn tqt qSS3-5--cqy, sts*e. zjp: Umn" Aa am. Do Ohone;v rangm, U 2— VZ50 -z- 0,-A- Ej Propane JLCOVERSON FAX NO. 3605687501 Jun. 07 2004 09:53PM P3 96/87/10 9 �571'B BREMERTON DCD PACS 03 M .#•www. 'F� C�iLDIiVG,,, fi�IIT CEN''?'IZ 'B t_ Dcnnttatent of gmyn,11',- Tie a =: a*�, Sty ` Ti7cmf. W__56 L (360) 479,5275'° Pas (360) 479-_�,-%fi Building Permit Application ' APPLiCAN "" JWNER CONTR CTOR 1w AUTHORIZED, AGENT �— - 7 5it� AddressIP' A iJJ -tc� ! Tar, ACCOUnt Number. 3'__11.t'(r r�U` 1 CONTRACTOR: Ip o ao OWNER Address' i Address: it �23 nr� city Rtmo 7n, P' L --r_. ice:lse # &.- xpir, Bate: Authorared Agent Addrose: .}Ei��.`ao� vin % r��112 Qa�u CcnLact Name: Cit,, stats, Zi tpmr, r'`r, 37c2 -S Fits -L Lontet# Phonrs # 2 3 112,q- 336 7 P'10ne #: G, ) -0 cr) i - ChBck #ha tie of aD! 9tiQn for celow f j C ( j /-) 6 17 NEW SINGLE-FAMILY PESIDENCE [D NEW r-OMfv ERCIAL NEIN GA1,AGarAFt POPi 7 lgEw DUPE f COMMERCIAL. REMODEL. L N BVW ACCESSORY BLD G ( NEW MANUFACTURED HOME � COMMERCIAL ADDrr10N 77 NZ N SIGN RES1UEIdTiALREMODe-L COMMERCIAL REEnAIR 1STR'Ljc' URE DEtvcunoN j� RESIDENTIAL AZ?DTION rL� NEW ML)LTI.FAM!LY GRADING (Cs;bic RESIDENTIAL R3=pA'R i ENANT IMFROVEMI:NT 17 OTHER 15 THIS PROPFRTy WITHIN 200 PEET DFA SHORELINE? YES NO Sccps Or Work Proposed: L q ' lj*.,t.� L L.%W4&A4 OLA�4n+ & Rem Sc.iare FDotage: Dwelfing:.2-900 Garage: beaks: 1jA)U2.ior, 6 ,an Review L Fae kc, Permit Fee 5urchar E Tota Fees Appheation MiP 180 dap following :he pets o; :tppiiCat;'on 911211 expire by ltrniWiDn, find Ple and other deb suDrnittscJ for r. moy tt:erf&r Os rstumecl to inn Sp>aliCant or da trc,yeb by the buil�np offlc a1. 'rhe tx fidJ: p ofKa3r may r enQ tr o time, for action by ti►e aApliCant #or a pu►ripd rot t'acCeeding t8Q days Dn ri ff): b} to®appfieent ahowin he Ctrwrn tances twyond the control dF the appliCani have prevEntgd et tTort 1rllRi being tiYBri. ire spPl;QW #hall t* of htndvd mon than once. IP DrC!@r to renew senor, on an 9palicatl 5on cf±er sxL;+2ti0n, the applirarri ..e:1 reSutsm t Diens snd pay a nen• pi -APPL!CANrS SIGNATLIAZ UA T E DECIE AIS D l� 4 BREivKOlti BUILDING DEPART'ME'NT CITY OF BREMERTON DEPARTMENT OF COMMUNITY DEVELOPMENT 286 Fourth St. Bremerton, WA 98337 (360)473-5275 Fax: (360) 473-5278 Paye Receipt Number: 8 D9 1877 $0.00 1 Page 1 of 1 Tran Original Fee Amount Permit # Fee Description Code Amount Paid BB04 01177 Plan Review Fee 1/4580 $ 339.66 $ 339.66 Total: $ 339.66 Previous Payment History Recelpty 4 ill; Receipt Date F04tescript cn Amount�atd Pe 11 Payment Payment Checkz Method Number Amount' CHECK 2003 $ 339.66 Total: $ 339.66 $0.00 1 Page 1 of 1 0 1 I � , _- . � w � � �� .. f;� �� R _� � + � � � � ,, �, -' � �� � � �''�'.�.-� c�- I � � � '�-C�'" � L �. n t Y �� � � � ��� l 1 f ! �• L ( �� r'i �� } July 1"t, 2004 City of Bremerton Department of Community Development 286 4t' Street Bremerton, WA 98337 (South (80tind Permit Contractor: Randy Alcott 1 f/' Kelley Home Services D � V� �, L 470188"' Ave Ct. NW} s Gig Harbor, WA 98335 L 2[091+ �z ?r;, Authorized Agent: Kelle Powell 0UlLUINGDEPPR- ,aY PMB 205—Suite K-2 3702 South Fife Street Tacoma, WA 98409 Regarding.- Submittal Cover Letter Kelle Jeanne Powell Director 253-219-6593 www.southsoundpermit.com PMB 205, Suite K-2 3702 South Fife Street Tacoma, WA 98409 email: sspermitkp@comcast.net Site Address: Medical Arts Clinic "A", 2625 Wheaton Way, Bremerton WA 98310 Parcel: 3966-004-001-0106 or 3966-004-001-0007 Attention: Pat Conroy This letter is meant to serve as the required cover letter to our proposed project. The scope of work includes a Commercial Tenant Improvement and interior remodel. Structurally, we intend to change approximately 90 feet of wall space and add several posts and beams. The project has been initially valued at 38 thousand. A new framing plan at a scale of 1/4inch =1 foot is included in this package. Additionally, the mechanical forms list what's being added to the area from that perspective, and the existing sinks already have interct.ptors. The project will have an F-5 occupancy as a Doctor's office with four to six employees. The construction type will be wood frame. Lastly, we have a permit facilitation firm submitting our project as the authorized anent The cnmmnv k called Rnnthcnnnd Permit and the. rnntart ne.rcnn is Kelle. Powell She can be reached at 253-219-6593 or kellepowell �r,,southsoundpermt com should you have questions and are unable to reach me. On behalf of The Hickman Group, we are looking forward to working with the City of Bremerton and getting started on the aforementioned project. Thank you for the opportunity to move forward with this development. Regards, Randy Alcott Contractor FROM JLCOVERSON FAX NO. : 3605687501 Jun. 07 2004 09:54PM P5 garr «1 4 3504735+;9 W EMERTON DCD VICINITY MAP 05 1 Tuesday, June 08, 2004 Revised Floor and Lighting Flans For Medical Arts Building 2625 Wheaton Way Bremerton, Wash Beam and Col /Designed From TV Beam Sizing Disc ( Trus Joist) Detail By Design 4120 29th NW Gig Harbor, Wash 98335 253-851-1632 l0. '1660'-01177 i ��? Roof Beam (alternate) T.6Bmm(TM)8.10SerialNumber �i003o 93 6 3/4" X 10 1/2" Classic GlulamTm (24F - V4 DF) User. 2 8/3/0411:18:35 AM Pape 1 Engine Version: 1.10.3 THIS PRODUCT MEETS OR EXCEEDS THE SET DESIGN CONTROLS FOR THE APPLICATION AND LOADS LISTED Member Slope: 0M2 Roof Slope0M2 Overall Dimension: 161 i" I s. 4"All dimensions are horizontal. LOADS: Length 1 Stud wall 3.50" 3.50" 2 Wood column 3.50" Analysis is for a Drop Beam Member. Tributary Load Width: V Primary Load Group - Snow (psf): 25.0 Live at 115 % duration,15.0 Deai Vertical Loads: -Deflection Criteria: STANDARD(LL:U360,TL:L/240). -Bracing(Lu): All compression edges (top and bottom) must be braced at 2'8" o/c unless detailed otherwise. Proper attachment and positioning of lateral bracing is required to achieve member stability. -The Joad conditions considered in this design analysis include alternate -member Type Class Live Dead Location Application Point(lbs) Snow(1.15) 2150 1290 4" - Point(lbs) Snow(1.15) 2150 1290 4' 4" - Point(lbs) Snow(1.15) 2150 1290 8' 47 - Point(lbs) Snow(1.15) 1612 967 12'4" Uniform(plf) Snow(1.15) _ 595.0 410.0 0 To 16'4". Adds To Point(Ibs) Snow(1.15) 1612 967 14'4" - SUPPORTS: Input Bearing Width Length 1 Stud wall 3.50" 3.50" 2 Wood column 3.50" 4.69" 3 Stud wall 3.50" 3,50" Vertical Reactions (Ibs) Detail Live/Dead/UpiiftlTotal Location 3677 / 1851 / 0 / 5528 By Others 12378 / 8180 / 0 / 20558; By Others 4643 / 300710 / 7650 By Others gram is I 4,Y Other I None None' None -Bearing length requirement exceeds input at supports) 2. Supplemental hardware is required to satisfy bearing requirements. DESIGN CONTROLS: Maximum Design Control Control Location Shear (Ibs) 11693 10608 13041 Passed (81 %) Lt. end Span 2 under Snow loading Moment (Ft -Lbs) -19568 -19568 21990 Passed (89%) MID Span 2 under Snow loading Live Load Dell (in) 0.146 . 0.339 Passed (U834) MID Span 2 under Snow ALTERNATE span loading Total Load Defl (in) 0.236 0.508 Passed (U516) MID Span 2 under Snow ALTERNATE span loading -Deflection Criteria: STANDARD(LL:U360,TL:L/240). -Bracing(Lu): All compression edges (top and bottom) must be braced at 2'8" o/c unless detailed otherwise. Proper attachment and positioning of lateral bracing is required to achieve member stability. -The Joad conditions considered in this design analysis include alternate -member pattern loading. f PROJECT SES �• RO �� INFORMATION• OPERATOR INFORMATI Medical.Arts Building N Bremerton, Wash. Charles Robinson y Detail By Design 4120 29th Ave MW. . Gig Harbor, Wash. Phone : 253-851-1632 7 1 2 Fax :253-851-1632 crobi52526@aol ALES Copyright C 2003 by Trus Joist, a Weyerhaeuser Business TJ-Beameu is a registered trademark of Trus Joist. ams: 0.1101/ Or Classic Glulam- is a trademark of Weyerhaeuser. J ff TJM Roof Joists T. .mcrkp em smai WubWb.r 7 « a W 44" TJM Open Web eb Truss @ 48 o/c User. 2 MIN 1:47:39 PM Peps1 EngWoVemion:1.10.3 THIS PRODUCT MEETS OR EXCEEDS THE SET DESIGN CONTROLS FOR THE APPLICATION AND LOADS LISTED /j Member Slope: .25M2 Roof Slope.25M2 1, A3. All dimensions are horizontal. Product Diagram is Conceptual. LOADS: Analysis is for a Joist Member. Primary Load Group - Snow (psf): 25.0 Live at 115 % duration, 15.0 Dead SUPPORTS: / V Input Vertical Reactions (Ibs) Detail Other Width Live/Dead/UpliiftlTotal 1 Stud wall 3.50" 2150 /1290 / 0 / 3440 Bottom Chord Clip Steel X -Bracing 2 Stud wall 3.50" 2150 /1290 / 0 / 3440 Bottom Chord Clip Steel X -Bracing -WARNING: Assumed bearing length of 51 /4" exceeds the 'WIDTH' input at support 1 -WARNING: Assumed bearing length of 51 /4" exceeds the 'WIDTH' input at support 2 -Left Support: Bottom -All, Approx. clip height: 1/2", Approx. clip width: 6 7/8", Allowed choice(s): BOTTOM (ANGLE-CLIP),BOTTOM (T-CLIP),BOTTOM (Z -CLIP) -Right Support: Bottom -All, Approx. clip height: 1/2", Approx. clip width: 6 7/8", Allowed choice(s): BOTTOM (ANGLE-CLIP),BOTTOM (T- CLIP),BOTTOM (Z -CLIP) DESIGN CONTROLS: -Deflection Criteria: STANDARD(LL:U240,TL:U180). -Bracing(Lu): All compression edges (top and bottom) must be braced at 2' 8" o% unless detailed otherwise. Proper attachment and positioning of lateral bracing is required to achieve member stability. ADDITIONAL NOTES: -IMPORTANT! The analysis presented is output from software developed by Trus Joist (TJ). TJ warrants the sizing of its products by this software will be accomplished in accordance with TJ product design criteria and code accepted design values. The specific product application, input design loads, and stated dimensions have been provided by the software user. This output has not been reviewed by a TJ Associate. -Not all products are readily available. Check with your supplier or TJ technical representative for product availability. -THIS ANALYSIS FOR TRUS JOIST PRODUCTS ONLY! PRODUCT SUBSTITUTION VOIDS THIS ANALYSIS. -Allowable Stress Design methodology was used for Building Code UBC analyzing the TJ Custom product listed above. -The open web truss analysis presented is approximate. All open web trusses are custom designed to carry the specific design loads for each project. Actual truss capacity when fabricated is limited to that required to resist the specified loads. Do not use this analysis to verify the capacity of existing trusses. -Pricing Load (plf) = 160 (#) PROJECT INFORMATION: OPERATOR INFORMA ��I: .v •� Medical Arts Building Charles Robinson Bremerton Wash. Detail By Design 'Z 4120 29th Ave N. Gig Harbor, Wa Phone: 253-85 - 3 212 CS Fax :253-851-1632 crobi52526@aol Copyright ® 2003 by Trus Joist, a Weyerhaeuser Business TJi1TM, TJL^, TJLM"', TJLX", TJffi" and TJW"' are trademarks of Trus Joist.Psa: Maximum Design Control Control Location Shear (lbs) 3414 3413 3413 Passed (100%) Lt. end Span 1 under Snow loading Moment (Ft -Lbs) 36878 36150 64440 Passed (56%) MID Span 1 under Snow loading Live Load Defl (in) 0.500 2.134 Passed (U999+) MID Span 1 under Snow loading Total Load Defl (in) 0.800 2.845 Passed (U640) MID Span 1 under Snow loading -Deflection Criteria: STANDARD(LL:U240,TL:U180). -Bracing(Lu): All compression edges (top and bottom) must be braced at 2' 8" o% unless detailed otherwise. Proper attachment and positioning of lateral bracing is required to achieve member stability. ADDITIONAL NOTES: -IMPORTANT! The analysis presented is output from software developed by Trus Joist (TJ). TJ warrants the sizing of its products by this software will be accomplished in accordance with TJ product design criteria and code accepted design values. The specific product application, input design loads, and stated dimensions have been provided by the software user. This output has not been reviewed by a TJ Associate. -Not all products are readily available. Check with your supplier or TJ technical representative for product availability. -THIS ANALYSIS FOR TRUS JOIST PRODUCTS ONLY! PRODUCT SUBSTITUTION VOIDS THIS ANALYSIS. -Allowable Stress Design methodology was used for Building Code UBC analyzing the TJ Custom product listed above. -The open web truss analysis presented is approximate. All open web trusses are custom designed to carry the specific design loads for each project. Actual truss capacity when fabricated is limited to that required to resist the specified loads. Do not use this analysis to verify the capacity of existing trusses. -Pricing Load (plf) = 160 (#) PROJECT INFORMATION: OPERATOR INFORMA ��I: .v •� Medical Arts Building Charles Robinson Bremerton Wash. Detail By Design 'Z 4120 29th Ave N. Gig Harbor, Wa Phone: 253-85 - 3 212 CS Fax :253-851-1632 crobi52526@aol Copyright ® 2003 by Trus Joist, a Weyerhaeuser Business TJi1TM, TJL^, TJLM"', TJLX", TJffi" and TJW"' are trademarks of Trus Joist.Psa: Roof Joists ( Given 20" TJls ) Ti-Seem(7M) 6.10 Serial N„m6er''700 `30182s3 20" T �� JI®/L90 a@ 24 O/C User. 2 527M4 2:08:35 PM Peet EnyineVersion: 1.10.3 THIS PRODUCT MEETS OR EXCEEDS THE SET DESIGN CONTROLS FOR THE APPLICATION AND LOADS LISTED Member Slope: OM2 Roof Slope0M2 Overall Dimension: 23' JL_ UG��C/S il°l/ ©�.Tr 7, dam— 4. z 21 All dimensions are horizontal. LOADS: Analysis is for a Joist Member. Primary Load Group - Snow (psf): 25.0 Live at 115 % duration, 15.0 Dead SUPPORTS: Product Diagram is Input Bearing Vertical Reactions (Ibs) Detail Other Width Length Live/Dead/Uplift/Total 1 Stud wall 3.50" 3.50" 744 /447 /0 /1191 Overhang 1 Ply 20" JAV/L90 2 Stud wall 3.50" 3.50" 516 /303 /01820, End, TJI Blocking - 1 P+y-2V!- - -- -- --____ -Web stiffeners are required at support(s): 1, 2. See TJI JOIST INSTALLATION INFORMATION for nailing requirements. DESIGN CONTROLS: A/6ui A _C-7�x � -Deflection Criteria: STANDARD(LL:U360,TL:L240). -Bracing(Lu): All compression edges (top and bottom) must be braced at 2'8" o/c unless detailed otherwise. Proper attachment and positioning of lateral bracing is required to achieve member stability. -The load conditions considered in this design analysis include alternate member pattern loading. ADDITIONAL NOTES: -IMPORTANT! The analysis presented is output from software developed by Trus Joist (TJ). TJ warrants the sizing of its products by this software will be accomplished in accordance with TJ product design criteria and code accepted design values. The specific product application, input design loads, and stated dimensions have been provided by the software user. This output has not been reviewed by a TJ Associate. -Not all products are readily available. Check with your supplier or TJ technical representative for product availability. -THIS ANALYSIS FOR TRUS JOIST PRODUCTS ONLY! PRODUCT SUBSTITUTION VOIDS THIS ANALYSIS. -Allowable Stress Design methodology was used for Building Code UBC analyzing the TJ Custom product listed above. PROJECT INFORMATION: Medical Arts Building Bremerton ,Wash. Copyright ® 2003 by Trus Joist, a Weyerhaeuser Business TJI® and TJ -Beam® are registered trademarks of Trus Joist. e -I Joist -,Pro" and TJ -Pro'" are trademarks of Trus Joist. J. Charles Robinson Detail By Design 4120 29th Ave N. Gig Harbor, Was . 98335 7,2 Phone: 253-851-1632 Fax :253-851-1632 OArgI crobi52526@aol B=0: u0 v Maximum Design Control Control Location Shear (Ibs) 859 812 3151 Passed (26%) Lt. end Span 1 under Snow loading Vertical Reaction (Ibs) 803 803 3076 Passed (26%) Bearing 2 under Snow ALTERNATE span loading Moment (Ft -Lbs) 4029 4029 18900 Passed (21 %) MID Span 1 under Snow ALTERNATE span loading Live Load Defl (in) 0.117 0.688 Passed (U999+) MID Span 1 under Snow ALTERNATE span loading Total Load Defl (in) 0.183 1.032 Passed (0999+) MID Span 1 under Snow ALTERNATE span loading A/6ui A _C-7�x � -Deflection Criteria: STANDARD(LL:U360,TL:L240). -Bracing(Lu): All compression edges (top and bottom) must be braced at 2'8" o/c unless detailed otherwise. Proper attachment and positioning of lateral bracing is required to achieve member stability. -The load conditions considered in this design analysis include alternate member pattern loading. ADDITIONAL NOTES: -IMPORTANT! The analysis presented is output from software developed by Trus Joist (TJ). TJ warrants the sizing of its products by this software will be accomplished in accordance with TJ product design criteria and code accepted design values. The specific product application, input design loads, and stated dimensions have been provided by the software user. This output has not been reviewed by a TJ Associate. -Not all products are readily available. Check with your supplier or TJ technical representative for product availability. -THIS ANALYSIS FOR TRUS JOIST PRODUCTS ONLY! PRODUCT SUBSTITUTION VOIDS THIS ANALYSIS. -Allowable Stress Design methodology was used for Building Code UBC analyzing the TJ Custom product listed above. PROJECT INFORMATION: Medical Arts Building Bremerton ,Wash. Copyright ® 2003 by Trus Joist, a Weyerhaeuser Business TJI® and TJ -Beam® are registered trademarks of Trus Joist. e -I Joist -,Pro" and TJ -Pro'" are trademarks of Trus Joist. J. Charles Robinson Detail By Design 4120 29th Ave N. Gig Harbor, Was . 98335 7,2 Phone: 253-851-1632 Fax :253-851-1632 OArgI crobi52526@aol B=0: u0 v c4r e Col. Design TJ-Beam(T"6.10seriai 7003019253 5 1/4" x 5 1/4" 1.8E Parallam® PSL G User: 2 613/0411:30:46 AM Pagel Engine Venion: 1.10.3 THIS PRODUCT MEETS OR EXCEEDS THE SET DESIGN CONTROLS FOR THE APPLICATION AND LOADS LISTED BOTTOM OF MEMBER LOADS: Analysis is for a Column Member. Vertical Loads: Class Live Dead Snow(1.15) 12450lbs 8858 DESIGN CONTROLS: A Eccentricity T EccentricityW Comment 0 0 TOP OF MEMBER Product Diagram is Conceptual. Design Control Control Location Combined Bending and Compression 0.59 1 Passed (58.8%) Load Combination: 1.0 Dead + 1.0 Floor + 1.0 Snow L/d ratio 18.3 50 Passed (36.6%) ADDITIONAL NOTES: -IMPORTANT! The analysis presented is output from software developed by Trus Joist (Ti). TJ warrants the sizing of its products by this software will be accomplished in accordance with TJ product design criteria and code accepted design values. The specific product application, input design loads, and stated dimensions have been provided by the software user. This output has not been reviewed by a TJ Associate. -Not all products are readily available. Check with your supplier or TJ technical representative for product availability. -THIS ANALYSIS FOR TRUS JOIST PRODUCTS ONLY! PRODUCT SUBSTITUTION VOIDS THIS ANALYSIS. -Allowable Stress Design methodology was used for Building Code UBC analyzing the TJ Custom product listed above. -Required bearing length for supported member was not analyzed. -Capacity shown has been reduced to allow for some limited eccentricity. Capacity is based on the worst case of the following eccentric conditions: 8.33% of column thickness (1 st dimension) or 16.66% of column width -Columns shown must be one solid piece, i.e, no nail laminating. -Calculations are based on NDS'97 using material with a low (<I I %) coefficient of variation in MOE. Analysis is suitable for use in the United States. PROJECT INFORMATION: OPERATOR INFORMATIO : W Medical Arts Building Charles Robinson Bremerton,Wash. Detail By Design 4120 29th Ave N.W. Gig Harbor, Wash. 5 Phone: 253-851-1632 Fax :253-851-1632 crobi52526@aol ON/� --. Copyright 0200J by Trus Joist, a WeyerhAeuser Business UPM D.7IiJ++ ParallamlC is a regis110^1 tered trademark of Trus Joist, _ 1 ASSESSOR NUMBER: 3966-004-001-0007 ZONING: HC SITE ADDRESS: APPLICANT NAME: HICKMAN DOUG PHONE: ADDRESS: OWNER NAME: HICKMAN DOUG PHONE: ADDRESS: CONTRACTOR: TRI-TEK SYSTEMS PHONE: (360) 731-9859 ADDRESS: LENDER NAME: PHONE: 0- ADDRESS: SUBMITTED: 09/27/2004 APPROVED: 1111114 EXPIRATION: VALUATION: Building Permit Plan Review Fee State Surcharge $3,500.00 $97.25 2211 $63.21 4580 $4.50 0236 TOTAL FEES: $164.96' PERMIT NUMBER DATE ISSUED: 2635 WHEATON WAY 2081 VICTORIA AVE, PORT TOWNSEND, WA 98368 (tet 2081 VICTORIA AVE, PORT TOWNSEND, WA 98368 [ 1421 SUNSET VISTA, BREMERTON, WA 98310 p { d A 04/26/2005 STATUS: ISSUFI F(re'Af;arm lsorm)t FIRE ALARM INSTALLATION IN THE MEDICAL ARTS BLDG (NW PROSTHETIC & ORTHOTIC CLINIC Building Code Edition: UBC: 1997 Occupancy Group: Type of Construction: Flood Zone: Setbacks: (Front) (Side) (Rear) (Other) Sanitation Method: Number of Bedrooms: Square Footage: Bid Price from Applicant 1 TOTAL Inspection Requests Fire Inspections (360) 473-5380 DCD: Building Inspections (360) 473-5870 HID: Bremerton, Kitsap County Health District (360) 337-5285 L&I: Department of Labor and Industries (360) 415-4000 PW: Department of Public Works (360) 473-5270 This permit shall become null and void if the building or work described and authorized by this permit has not commenced within 180 days from the date of issuance, or if this building or work is suspended or abandoned at any time after the work is commenced for a period of 180 days. Obtaining inspections at intervals not exceeding 180 days identifies that work has not been suspended. I hereby certify that I have read and examined this permit and know the same to be true and correct. All provisions of laws and ordinances governing this type of work will be complied with whether specked herein or not. The granting of a permit does not presume to give authority to violate or cancel provisions of any State or local loaw regulating construction or the performance of the construction. If listing the owner as general contractor, I certify that I am exempt from the requirements of the State Contractor's Registration Law under Section 3, Chapter 126, Laws of 1967. All r94sions to an approved plan require DCD review and approval prior to performing work. All building and tenant occupancy permits are required to pass final inspection prior to permit qqration and obtain a certificate of occupancy prior to use or occupancy. I have read, and agree to abi SIGNATURE OF OWNER OR AGENT: PRINTED NAME: al/l conditions of zoning, building codes, and State and Federal laws. CONDITIONS City of Bremerton's approval of this application pertains only to the City's regulato regulations does not necessarily ensure compliance with federal or state laws. I. (DCD-01) 2. (DCD-02) 3. (FIRE -01) 4. (FIRE -09) jurisdiction, and thus compliance with City J DCD: Prior to performing any renovation or demolition work, Puget Sound Clean Air Agency (Clean Air Agency) and Washington Department of Labor and Industries (L&I) regulations require an asbestos survey be performed to determine whether there are asbestos - containing materials in the work area or structure. The asbestos survey must be conducted by and EPA -certified (AHERA) building inspector (except renovation or owner -occupied single family residences). DCD: For more information, please contact Clean Air Agency through their web site at www.cleanair.org or by phone at 800-552-3565 or 206-689-4058. The L&I web site can be found at www.Ini.wa.gov/p-ts/asbestos/asbestos.htm. FIRE: Fire Protection systems shall comply with: International Fire Code -IFC International Building Code -IBC National Fire Protection Assoc.-NFPA Bremerton Municipal Code -BMC FIRE: Provide fire alarm system to NFPA 72 and sprinklers to NFPA 13 standards. Fire Page 1 of 2 PERMIT NUMBER M04, al- DATE ISSUED: 10128/2604 ASSESSOR NUMBER: 3966-004-001-0007 ZONING: HC SITE ADDRESS: 2635 WHEATON WAY APPLICANT NAME: HICKMAN DOUG PHONE: ADDRESS: 2081 VICTORIA AVE, PORT TOWNSEND, WA 98368 OWNER NAME: HICKMAN DOUG PHONE: ADDRESS: 2081 VICTORIA AVE, PORT TOWNSEND, WA 98368 CONTRACTOR: TRI-TEK SYSTEMS PHONE: (360) 731-9859 ADDRESS: 1421 SUNSET VISTA, BREMERTON, WA 98310 LENDER NAME: PHONE: 0- ADDRESS: SUBMITTED: 09/27/2004 APPROVED: 10/21/2004 EXPIRATION: 04/26/2005 STATUS: ISSUED alarm shall have an annunciator inside the entrance, horn strobe shall be provided on the outside of the building, above the Knox Box. All sprinkler systems shall be monitored by UL listed central station. 5. (FIRE -21) FIRE: All Fire Alarm systems shall be pretested prior to scheduling an inspection with the Fire Marshals office. All Pretest record shall be made available to Fire Marshal at the time of inspection. 6. (FIRE -27) FIRE: Fire Alarm System shall be designed, installed, tested and maintained in accordance to NFPA 72. IFC Section 907 MINIMUM INSPECTIONS REQUIRED Inspection requests must be received by 8:00am in order to be scheduled for same day. To request an inspection, please call (360) 478-5275 and be sure to provide your permit number, name on permit, site address, contact phone number, and inspection type. Final Inspection - Fire Page 2 of 2 0 1 APPLICANT: ❑OWNER CONTRACTOR ❑OTHER Site Address: Tax Account Number: a 61,S W tAsaj-o4 WAVI Contractor: 11,44 ` I66L _'. 5;KW Contractor License #: tion Date: Check the tvwe of avvlication anvlied for below: ❑ SFR ❑ DUPLEX ❑ MULTI -FAMILY ❑ MOBILE ❑ ACCESSORY BLDG ❑ RES ADDN ❑ RES REM ❑ COMM ADDN ❑ COMM REM ❑ REPAIR ❑ SIGN ❑ DEMOLITION ❑ NEW COMM. ❑ TENANT IMPRO NT ❑ GRADING (cubic yards: OT IER: (tfo Square Footage: Dwelling Garage: Decks --P aluan Fla Review Foieenn�t<)ee. ....:.::.:rha es`c#ale..:.::< �3 r °L State: $ 4. SO o CJ 0___7 66o4- � Ota Applications for which no permit is issued within 180 days following the date of application shall expire by limitation, and plans and other data submitted for review may thereafter be returned to the applicant or destroyed by the building offici2applicain official may extend the time for action by the applicant for a period not exceeding 180 days application showing that circumstances beyond the control of the applicant have preventeng taken. No application shall be extended more than once. In order to renew action on aneVr the applicant shall resubmit plans and pay a new plan review fee. APPLICANT'S SIGNATUR DATE: CITY OF BREMERTON DEPARTMENT OF COMMUNITY DEVELOPMENT Receipt Number: 286 Fourth St. Bremerton, WA 98337 (360)473-5275 Fax: (360) 473-5278 Page 1 of 1 CITY OF BREMERTON DEPARTMENT OF COMMUNITY DEVELOPMENT Receipt Number: Bb©Q002323' 286 Fourth St. Bremerton, WA 98337 (360)473-5275 Fax: (360) 473-5278 Page 1 of 1 DEPARTMENT OF COMMUNITY DEVELOPMENT 345 SIXTH STREET, Suite 600 BREMERTON, WA 98337-1873 COMPLAINT FORM Date Received: -1 � �_1 0 tl Complaint Number: -] Location of Violation: (no�e !�: W :''L2 40 .7 Tax Acct. #: Owner's Name: Owner's Address: NATURE OF VIOLATION ❑ Violation can be seen from: ❑ Complainant's property (must give written City Street or Alley permission to enter property to inspect; sign below) Complainant's Signature Complaints may remain anonymous if we do not need to enter their property to see the violation. However, for the purpose of aiding the investigation of this complaint, the complaint's name and phone number will be most helpful. Complainant's Name: Street Address: Notes: Phone #: ACTION TAKEN To Be Completed By City J 00 0 0 N N N r - N N z 0 � N � O O U CC Q � z a Q � W �U a ��vOw O O Qz MO`. H� �AIC a O� OW0 Q AUa a 00 0 0 N N N r - N N DEPARTMENT OF COMMUNITY DEVELOPMENT CITY OF BREMERTON PHONE#78 S&M A/73.. � - z N/I STOP WORK AT ONCE Job Location A This structure has been inspected and the following VIOLATIONS of the City Laws and Ordinances have been found: The violation of this Stop Work Order shall constitute a misdemeanor, punishable by imprisonment in jail for a maximum term fixed by the court of not more than ninety (90) days, or by a fine in an amount fixed by the court of not more than one thousand dollars ($1,000.00), or by both such imprisonment and fine. (BMC 1.04.050) Inspector0 4U��"f Date7'Z/' I he property owner may submit a written request fo reconsideration of this notice, including the basis fo reconsideration, to the Director of Community Development. DO NOT REMOVE THIS TAG �- -- wftl� jii r - 20 ce�ifuate Of Occupancy Department of Community oeveCopment his certificate issued pursuant to the requirements of Section 110 of the International Building Code, as adopted by the Bremerton WunicipafCode, certifies that at the time Of issuance this structure complied with the requirements of the code for the occupancy and division of occupancy and the use for which the occupancy is classfied Issuance of a Certificate of Occupancy shall not be construed as an approvaf of a violation of the provisions of any 6uifdizzg code or of other ordinances of the City of Bremerton. ISSUED TO: Timothy C. Verharen, DDS, PLLC SITE ADDRESS: 2625 Wheaton Way Suite D OWNER: Doug Hickman, The Hickman Group 2081 Victoria Ave Port Townsend, WA 98310 Type of Occupancy Occupant Code Sprinklers Construction Classification Load Common Use Edition Rect,d? VB B 30 Dental Office 2006 No Permit Number: BL -24247 Date: December 14, 2007 BB07 00833 , A /� / 1'5�1- Andre L. Spencer, Dire for Special Conditions: THIS CERTIFICATE MUST BE POSTED AND PERMANENTLY MAINTAINED IN A CONSPICUOUS PLACE 10/29/2007 10:08 FAX 3604735200 CITY—BREHERTON X1005 I 1 14 10 CZA' 00 4— CITY OF BREMERTON BUSINESS LICENSE APPLICATION Tax & License Division * 345 Sixth Street, Suite 600 * wernerton, WA' 98337-1873 - 360-473-5311 Fee % F 9:,. NA ICS Orxw. Please complete all sections in order to avoi delays in processing your application. SM Date of BUSIAM In B(MeftDft: o WA 519W TpWUSI NwrAw, Property Owner's Name : Tax Parcel W N11 -13w. Type of ousinm (Chwk ONE) LJCIIPDrWW KILLC DO(her Owe, Proprietor LEGAL NAME OF BUSINESS: (it 2 Wa pmoprisobwNp. pet your IeQai nam, feet naay heft 8nn k dude any nwfdN ripen} TRADE N" OR DBA PHYSICAL BUSINESS LOCATION: ADOR09 tic CITY STATS VIP Mailing Address for LICENSE & RENEWAL CrTy VATE ZIP KISAME AS ABOVE ADDRESS Mailing Address for TAX FORMS: AMe AS ABOVE ADDRESS CITY STATE ;np BUSINESS PHONE.- CELLPHONEo FA�-Li �7. pla.va note that Business Tax Forms are avail eon ourwebsb ath9p-JAww.ci.bremvrW.*wus E -MAK. ADDRESS (if Applk;We)� -Tclk- VA4r-&'(2) Business Sq.Footega Retail:Other,„_.__.,Number of Employees Previous Tenant/Business Name:_ (K) -/'l e.c a ()0(7 - Will Owe be rernode" of an existing building for' your business? DYes FINIO Will You operate this business out of your home? if yes. Number of employees other than resident: tf Home Occupancy, I have read and agree to abide by the Home 0ocupotiom Regulations in the Eireenenon Municipal Code 20.48.030, — Signature NATURE OF BUSINESS: Check all that apply eno provide as much deW as possible below, R" Menufactu" Gambling wholes* ft"W41ming Adrnkxions BP&*kvfter Sw%ke fl wity Amu3eff*nl Describe in Debit Via P*41* PT"(s) Of W*0(6) (011601fid: '4/ -iioic- Additional licenses or wWwamits my be roilulred depeatfrig on the W010631 24:11vity- set InOUVOW" reprdhv regulatory 'Mmses' or Service CA835ifCODW gG desekod, or as optional choice, REPO!R41NG STATUS - Dried on Pte gross mcel�ls of Retail, Wholosar., M MONTHLY . Reserved la' WOW and Parking TpMam BWARTERLY - 150mated Gross Receipts um $40,000 annually or Optiorwil.(Gwitillng giclivilm must report QAk*) DANNUAL - EsilmaW Gross RempW $40,000 or under iimivally or Optional. Ion' COMPLETE INFORMATION ON REVERSE SIDE Department of Community Development 345 Sixth Street, Suite 600 Bremerton, WA 98337 (360) 473-5275; Fax: (360) 473-5278 website: www.ci.bremerton.wa.us TI-NO-WORK/CERTIFICATE OF OCCUPANCY CHECKLIST STORE NAME: Vex have n � I ► rn c 24j �' , z)()S P t'LL SITE ADDRESS: Do as W KQa+v r� W" Su i I PERMIT: W�)0 4 Qp'R 3a TYPE OF CONSTRUCTION: OCCUPANCY CLASSIFICATION: SPRINKLERS? YES OR ED SQUARE FOOTAGE OF EACH USE AREA: ADDITIONAL INFORMATION: 1 of] ME 5W7 boE�33 RECEIVED NOV 0 9 2007 Bremerton Department of -C D A A IT CENTER Community Development JE_ �'nrs Building Permit Application Dept. of Communi Develop ment * 345 - 6th Street uite 600 * Bremerton * WA * 98337-1873 (360) 473-5275 * Fax (360) 473-5278 Ilicant: Owner Contractor DAuthorized Agent Site Address: TOR: City, State's License # & Contact Nar i6ne #: \_ rcel #: :Z ell f1©cf What is the application for? (Please check One NEW SINGLE-FAMILY RESIDENCE Q NEW DUPLEX 0 NEW MANUFACTURED HOME Q RESIDENTIAL REMODEL Q RESIDENTIAL ADDITION Q RESIDENTIAL REPAIR 0 NEW COMMERCIAL Q COMMERCIAL REMODEL Q COMMERCIAL ADDITION OWNER: 1— Address: �-6 Z City, State, Zip: Phone #: (36� Authorized Ag Address: SQ r City, State, Zip: Phone #: t_j _ LjA ) 373-- 2S'3 i nt Name: f2 i [__� COMMERCIAL REPAIR 0 NEW MULTI -FAMILY `5j4JENANT IMPROVEMENT'S WON �V tc.O+rJl� Q NEW GARAGE/CAR PORT Q NEW ACCESSORY BUILDING Q NEW SIGN Q STRUCTURE DEMOLITION Q GRADING (Cubic Yards: 1 Q OTHER: Scope of work proposed: 4-0 a i 011;7F)c0 Square Footage: Dwelling: Garage: Decks: Valuation Plan Review Fee Permit Fee Surcharge Total Fees Application for which no permit is issued within 180 days following the date of application shall expire by limitation. and plans and other data submitted for review may thereafter be returned to the applicant or destroyed by the building official. The building official may extend the time for action by the applicant for a period not exceeding 180 days on request by the applicant. showing the circumstances beyond the control of the applicant have prevented action from being taken Ne apolicant shall be extended more than once in order to renew action on an apphcar!on after expiration. the applicant shall resubmit pians and pay a new plan review fee uat2 Applicant's Signature • Parcel Locators KITSA f.E bi 7 M GEOGRAPHIC INFORMATION SYSTEM Applications Parcel Search Hazard Locators Voter Information Maps & Data Map Library Download Data Section Downloads Data Change Request Resources What is GIS? Quick Facts Site Map Related Links GIS Home Contact Us Location Directions Parking Comments Last Updated: September 05, 2007 u HICKMtA DOUG ,3 3966 -aa 01-000 Copyrigh @ Kitsap Count Tax assessment, property, and valuation questions: Tax payment questions: Permit and zoning questions: Parcel Search support: Page 1 of 1 Information Service: 614, Division Street; Port Orchard, WA 91 KITSAP COUNTY PARCEL SEARCH Zoom to an area: -- Select Ai F55 s' 360.337.7160 360.337.7135 3.6.....0..3.3.7.71.81. 360.337.4435 Search by Tax Account A full or partial tax account number may t Search by Address Do NOT enter Street Direction (E,W,N,S) Blvd., etc.). A list of potential matches wil: Search by Taxpayer Enter last name first or a partial name. Show 2005 Shop Shc Copyright ©1995-2007 Kitsap County GIS. All rights reserved. Privacy Policy Disclaimer Comments/email :T '-- b t s' , http://kcwppub3.co.kitsap.wa.us/ParcelSearch/map.asp?Cmd=ZOOMOUT&APAN=&PID... 11/9/2007 Kitsap County Assessor's Property Report Property Report Tax Account No. Process No. Situs Address 966-004-001-0007 1490424 625 WHEATON WAY Property Class: 651- Medical/dental offices Parcel Information Page 1 of 1 Tax Code Area: 10010 # of Buildings: 13 Jurisdiction: 1BREMERTON Acres: 1.78 Sec-Twp-Rng: 112 24N 1E I Zoning: Icity Neighb_ orhood; 18100506 Account Status: JA - Active Taxpayer Information Name: HICKMAN DOUG Mailing Address: http://kcwppub2.co.kitsap.wa.us/pls/ilisw/lis.online_lis_info pkg.acct_info?p_in_rp_acct_... 11/9/2007 Department of Community Development City Planner, Allison Daniels Allison.Daniels@ci.bremerton.wa.us November 5, 2007 Timothy C. Verharen, DDS, PLLC 2625 Wheaton Way Suite D Bremerton, WA 98310 Oebi78 3#'S 6th �1re'@t, �uitd tRt1n ' $�m�rhmi MYNA 8g�3;7.' Thank you for submitting your Business License application to the City of Bremerton. The Department of Community Development requires that a Business License applicant apply for a Tenant Improvement Permit to determine an Occupant Load and the suitability of the premises for your intended use. To facilitate our inspector's visit, we require you to provide the items listed below before inspection. A Business License will not be granted until the inspection is completed and the Tenant Improvement Permit is approved. To avoid official code enforcement actions, please provide the following: Tenant Improvement — No ChangeMork to Occupancy Space 1) Floor Plan (2 copies): -Exits -Doors (including the direction it swings) -Walls -Bathroom(s) -Kitchen -Existing appliances -Sink(s), hood(s), cabinet(s), shelve(s), desk(s), display area(s), counter top(s), etc. - Floor Plan must be to scale and with the correct dimensions -can be on graph paper (example: 1 square = 1 foot) 2) Building Permit Application -Complete application -$47 inspection fee At the point of receiving the Tenant Improvement Permit, it is the applicant's responsibility to call for inspections: Building Inspection, (360) 473-5870 AND Fire Inspection, (360) 473-5394. Inspections are required prior to Business License issuance. AT NO TIME IS THE BUSINESS ALLOWED TO BE OPERATING WITHOUT AN APPROVED BUSINESS LICENSE AND A CERTIFICATE OF OCCUPANCY. Please contact us if you have any questions: Building Inspector Curtis Hogenson, (360) 473-5286 or Land Use Planner Allison Daniels, (360) 473-5289. Sincerely, ��� Allison Daniels CITY OF BREMERTON DEPARTMENT OF COMMUNITY DEVELOPMENT F 345 - 6th Street, Bremerton, WA 98337 (360) 473-5275 Fax: (360) 473-5278 ASSESSOR NUMBER: 3966-004-001-0007 ZONING: INST APPLICANT NAME: VERHAREN TIM PHONE: (360) 373-2539 OWNER NAME: HICKMAN DOUG PHONE: CONTRACTOR: PHONE: I LENDER NAME: PHONE PERMIT NUMBER: BB07 00833 DATE ISSUED: SITE ADDRESS: 2625 WHEATON WAY #D ADDRESS: 2625 WHEATON WAY #D, BREMERTON, WA 98310 ADDRESS: 2081 VICTORIA AVE, PORT TOWNSEND, WA 98368 ADDRESS: ADDRESS: SUBMITTED: 11/09/2007 APPROVED: EXPIRATION: 05/07/2008 STATUS: PENDING VALUATION: Tenant Improvement, No Work (Business License) TI No Work (Business License) $47.00 2211 TI -NO WORK NEW DENTAL PRACTICE TOTAL FEES: $47.00 Building Code Edition: f�j LJi 61 Occupancy Group: , Type of Construction: C L\ C_- Flood Zone: V` S Setbacks: Sanitation Method: Number of Bedrooms: 11MV7 Inspection Requests Fire Inspections (360) 473-5380 DCD: Building Inspections (360) 473-5870 H/D: Bremerton, Kitsap County Health District (360) 337-5285 L&I: Department of Labor and Industries (360) 415-4000 PW: Department of Public Works (360) 473-5270 This permit shall become null and void if the described and authorized by this permit has not commenced within 180 days from the date of issuance, or if the work is suspended or abandoned at anytime after the work is commenced for a period of 180 days. It is the responsibility of the permit holder to see that the required inspections are made. Failure to obtain required inspections may result in stoppage of the work until such time that the permit holder can susbstantiate to the City of Bremerton that the concealed work meets or exceeds code requirements. Any demolition, testing, or financial burden shall be borne directly by the permit holder. Failure to substantiate code requirements will indemnify the City against any and all responsibility or liability connected with the construction. I hereby certify that I have read and examined this permit and know the same to be true and correct. All provisions of laws and ordinances governing this type of work will be complied with whether specified herein or not. The granting of a permit does not presume to give authority to violate or cancel provisions of any State or local law regulating construction or the performance of the construction. If listing the owner as general contractor, I certify that I am exempt from the requirements of the State Contractor's Registration Law under Section 3, Chapter 126, Laws of 1967. All revisions to an approved plan require DCD review and approval prior to performing work. All building and tenant occupancy permits are required to pass final inspection prior to permit expiration and obtain a certificate of occupancy prior to use or occupancy. I have read, and agree to abide by the conditions of this permit including all conditions of zoning, building codes, and State and Federal laws. SIGNATURE OF OWNER OR AGENT: PRINTED NAME: DATE: CONDITIONS City of Bremerton's approval of this application pertains only to the City's regulatory jurisdiction, and thus compliance with City regulations does not necessarily ensure compliance with federal or state laws. 10. (DCD-01) DCD: Prior to performing any renovation or demolition work, Puget Sound Clean Air Agency (Clean Air Agency) and Washington Department of Labor and Industries (L&I) regulations require an asbestos survey be performed to determine whether there are asbestos - containing materials in the work area or structure. The asbestos survey must be conducted by and EPA -certified (AHERA) building inspector (except renovation or owner - occupied single family residences). DC D: For more information, please contact Clean Air Agency through their web site at www.cleanair.org or by phone at 800-552-3565 or 206- 689-4058. The L&I web site can be found at www.Ini.wa.gov/p-ts/asbestos/asbestos.htm. 10. (DCD-02) DCD: Validity of permit. The issuance or granting of a permit shall not be construed to be a j permit for, or an approval of, any violation of any of the provisions of the Washington State Building code or of any other ordinance of the City of Bremerton. Permits presuming to give authority to violate or cancel the provisions of the Washington State Building code or other ordinances of the City of Bremerton shall not be valid. The issuance of a permit based on construction documents and other data shall not prevent the building official from requiring Page 1 of 2 13'BU1 WS3 RECEIVED NOV 0 9 2007 Bremerton Department of PERMIT CENTER Community Development Building Pei -mit Application 7j f5 7-5 Dept of Community Development * 345 6th Street Suite 600 *.-Bremerton * WA * 95337-1873 (360) 473-5275 * Fax (360) 473-5278 Applicant ED Owner Contractor Authorized Agent Site Address: '% %"7 NTRACTOR: OWNER: ��. (L• -rt r2 r Addr Address: City, State Cit , State, Zi Lj A IT Y 3 /4 License # & Ex e' Phone #: 36o 37 3-- 1-1�3 7 Contact Name: Authorized Agent Name: , Contact ne #: Address: /Parcel #: 9L�/ _f?oN - -DCV City, State, Zip: What is the application for? (Please check one) NEW SINGLE-FAMILY RESIDENCE Q NEW DUPLEX f1 NEW MANUFACTURED HOME Q RESIDENTIAL REMODEL Q RESIDENTIAL ADDITION Q RESIDENTIAL REPAIR Q NEW COMMERCIAL Q COMMERCIAL REMODEL Q COMMERCIAL ADDITION Phone #: Q COMMERCIAL REPAIR Q NEW MULTI -FAMILY '•TENANT IMPROVEMENT— MON 0 NEW GARAGE/CAR PORT Q NEW ACCESSORY BUILDING a NEW SIGN Q STRUCTURE DEMOLITION GRADING (Cubic Yards: ) Q OTHER: Scope of work proposed: hk �, j � I`° e,4, 11 ►�rn�4 �"� ry ���cn - Square Footage: Dwelling: Garage: Decks: Valuation Plan Review Fee Permit Fee Surcharge Total Fees -- L4�-. oo Application for which no permit is issued within 180 days following the date of application shall expire by limitation. and plans and other data submitted for review may thereafter be returned to the applicant or destroyed by the building official. The building official may extend the time for action by the applicant for a period not exceeding 180 days on request by the applicant. showing the circumstances beyond the control of the applicant have pre/ented action from being takan Ne 3policant scall be extended more than once in order to renew action on an applic3r'or- after expiration, the applicant scall resubmit plans and pay a new plan review fee / �j 7 Applicant's Signature �a,a Parcel Locators All Applications Parcel Search Hazard Locators Voter Information Maps & Data Map Library Download Data Section Downloads Data Change Request Resources What is GIS? Quick Facts Site Map Related Links GIS Home Contact Us Location Directions Parking Comments Last Updated: September 05, 2007 Page 1 of 1 Information Service 614, Division Street; Port Orchard, WA 91 KITSAP COUNTY PARCEL SEARCH Zoom to an area: -- Select Ai M W4 Tax assessment, property, and valuation questions: Tax payment questions: Permit and zoning questions: Parcel Search support: 360.337.7160 360.337.7135 360.337.71.81 360.337.4435 Search by Tax Account A full or partial tax account number may t Search by Address Do NOT enter Street Direction (E,W,N,S) Blvd., etc.). A list of potential matches wil' Search by Taxpayer Enter last name first or a partial name. Show 2005 ShoN Shl Copyright ©1995-2007 Kitsap County GIS. All rights reserved. Privacy Policy Disclaimer Comments/email :F N&-T' btsi http://kcwppub3.co.kitsap.wa.us/ParcelSearch/map.asp?Cmd=ZOOMOUT&APAN=&PID... 11/9/2007 Kitsap County Assessor's Property Report Property Report Tax Account No. Process No. Situs Address 966-004-001-0007 1490424 fi625 WHEATON WAY Property Class: 651- Medical/dental offices Parcel Information Page 1 of 1 Tax Code Area: 10010 # of Buildings: 3 Jurisdiction: IBREMERTON Acres: .78 Sec-Twp-Rng: 112 24N 1E Zoning: City Neighborhood: 18100506 Account Status: JA - Active Taxpayer Information Name: HICKMAN DOUG Mailing Address: 12081 VICTORIA AVE IF- IPORT TOWNSEND IWA 98368 http://kcwppub2.co.kitsap.wa.us/pls/ilisw/lis.online_lis_info pkg.acct_info?p_in_rp_acct_... 11/9/2007 .- .. _ F_—-- -Payment C k Method Number,; CHECK 8703 $ 47.00 Total $47.00 :.. .. ..:: 771717 . '. Previous Payment History „ceipt # Receipt Date Fe escription Amount Paid Permit # Parcel genpmtrreceipts Page 1 of 1 CITY OF BREMERTON DEPARTMENT OF COMMUNITY DEVELOPMENT 345 - 6th Street, Bremerton, WA 98337 (360) 473-5275 Fax: (360) 473-5278 PERMIT NUMBER: BB07 00833 DATE ISSUED: ASSESSOR NUMBER: 3966-004-001-0007 ZONING: INST SITE ADDRESS: 2625 WHEATON WAY #D APPLICANT NAME: VERHAREN TIM PHONE: (360) 373-2539 ADDRESS: 2625 WHEATON WAY #D, BREMERTON, WA 98310 OWNER NAME: HICKMAN DOUG PHONE: ADDRESS: 2081 VICTORIA AVE, PORT TOWNSEND, WA 98368 CONTRACTOR: PHONE: ADDRESS: LENDER NAME: PHONE: ADDRESS: SUBMITTED: 11/09/2007 APPROVED: EXPIRATION: 05/07/2008 STATUS: PENDING VALUATION: Tenant Improvement, No Work (Business License) TI No Work (Business License) $47.00 2211 TI -NO WORK NEW DENTAL PRACTICE ,,//�� �} TOTAL FEES: $47.00 Building Code Edition: J r � i �! E L1� Occupancy Group: Type of Construction: 'y Ll �j L—\ c,,Flood Zone: 1�(� RECE'` V� D Setbacks: F Sanitation Method: 19 ?�07 Number of Bedrooms: g paPartmentaf nyogve►o li (.0 Inspection Requests Fire Inspections (360) 473-5380 DCD: Building Inspections (360) 473-5870 H/D: Bremerton, Kitsap County Health District (360) 337-5285 L&I: Department of Labor and Industries (360) 415-4000 PW: Department of Public Works (360) 473-5270 This permit shall become null and void if the described and authorized by this permit has not commenced within 180 days from the date of issuance, or if the work is suspended or abandoned at any time after the work is commenced for a period of 180 days. It is the responsibility of the permit holder to see that the required inspections are made. Failure to obtain required inspections may result in stoppage of the work until such time that the permit holder can susbstantiate to the City of Bremerton that the concealed work meets or exceeds code requirements. Any demolition, testing, or financial burden shall be borne directly by the permit holder. Failure to substantiate code requirements will indemnify the City against any and all responsibility or liability connected with the construction. I hereby certify that I have read and examined this permit and know the same to be true and correct. All provisions of laws and ordinances governing this type of work will be complied with whether specified herein or not. The granting of a permit does not presume to give authority to violate or cancel provisions of any State or local law regulating construction or the performance of the construction. If listing the owner as general contractor, I certify that I am exempt from the requirements of the State Contractor's Registration Law under Section 3, Chapter 126, Laws of 1967. All revisions to an approved plan require DCD review and approval prior to performing work. All building and tenant occupancy permits are required to pass final inspection prior to permit expiration and obtain a certificate of occupancy prior to use or occupancy. I have read, and agree to abide by the conditions of this permit including all conditions of zoning, building codes, and State and Federal laws. SIGNATURE OF OWNER OR AGENT: PRINTED NAME: DATE: CONDITIONS City of Bremerton's approval of this application pertains only to the City's regulatory jurisdiction, and thus compliance with City regulations does not necessarily ensure compliance with federal or state laws. 10. (DCD-01) DCD: Prior to performing any renovation or demolition work, Puget Sound Clean Air Agency (Clean Air Agency) and Washington Department of Labor and Industries (L&I) regulations require an asbestos survey be performed to determine whether there are asbestos - containing materials in the work area or structure. The asbestos survey must be conducted by and EPA -certified (AHERA) building inspector (except renovation or owner - occupied single family residences). DCD: For more information, please contact Clean Air Agency through their web site at www.cleanair.org or by phone at 800-552-3565 or 206- 689-4058. The L&I web site can be found at www.Ini.wa.gov/p-ts/asbestos/asbestos.htm. 10. (DCD-02) DCD: 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 Washington State Building code or of any other ordinance of the City of Bremerton. Permits presuming to give authority to violate or cancel the provisions of the Washington State Building code or other ordinances of the City of Bremerton shall not be valid. The issuance of a permit based on construction documents and other data shall not prevent the building official from requiring Page 1 of 2 CITY OF BREMERTON PERMIT NUMBER: BB07 00833 DEPARTMENT OF COMMUNITY DEVELOPMENT DATE ISSUED: 345 - 6th Street, Bremerton, WA 98337 (360) 473-5275 Fax: (360) 473-5278 ASSESSOR NUMBER: 3966-004-001-0007 ZONING: INST SITE ADDRESS: 2625 WHEATON WAY #D APPLICANT NAME: VERHAREN TIM PHONE: (360) 373-2539 ADDRESS: 2625 WHEATON WAY #D, BREMERTON, WA 98310 OWNER NAME: HICKMAN DOUG PHONE: ADDRESS: 2081 VICTORIA AVE, PORT TOWNSEND, WA 98368 CONTRACTOR: PHONE: ADDRESS: LENDER NAME: PHONE: ADDRESS: SUBMITTED: 11/09/2007 APPROVED: EXPIRATION: 05/07/2008 STATUS: PENDING VALUATION: Tenant Improvement, No Work (Business License) TI No Work (Business License) $47.00 2211 TI -NO WORK NEW DENTAL PRACTICE TOTAL FEES: $47.00 Building Code Edition: Occupancy Group: Type of Construction: L—1 C�, Flood Zone: ci "y Setbacks: Sanitation Method: G �` Number of Bedrooms: 1igV Inspection Requests Fire Inspections (360) 473-5380 DCD: Building Inspections (360) 473-5870 H/D: Bremerton, Kitsap County Health District (360) 337-5285 L&I: Department of Labor and Industries (360) 415-4000 PW: Department of Public Works (360) 473-5270 This permit shall become null and void if the described and authorized by this permit has not commenced within 180 days from the date of issuance, or if the work is suspended or abandoned at any time after the work is commenced for a period of 180 days. It is the responsibility of the permit holder to see that the required inspections are made. Failure to obtain required inspections may result in stoppage of the work until such time that the permit holder can susbstantiate to the City of Bremerton that the concealed work meets or exceeds code requirements. Any demolition, testing, or financial burden shall be borne directly by the permit holder. Failure to substantiate code requirements will indemnify the City against any and all responsibility or liability connected with the construction. I hereby certify that I have read and examined this permit and know the same to be true and correct. All provisions of laws and ordinances governing this type of work will be complied with whether specified herein or not. The granting of a permit does not presume to give authority to violate or cancel provisions of any State or local law regulating construction or the performance of the construction. If listing the owner as general contractor, I certify that I am exempt from the requirements of the State Contractor's Registration Law under Section 3, Chapter 126, Laws of 1967. All revisions to an approved plan require DCD review and approval prior to performing work. All building and tenant occupancy permits are required to pass final inspection prior to permit expiration and obtain a certificate of occupancy prior to use or occupancy. I have read, and agree to abide by the conditions of this permit including all conditions of zoning, building codes, and State and Federal laws. SIGNATURE OF OWNER OR AGENT: PRINTED NAME: DATE: CONDITIONS City of Bremerton's approval of this application pertains only to the City's regulatory jurisdiction, and thus compliance with City regulations does not necessarily ensure compliance with federal or state laws. 10. (DCD-01) DCD: Prior to performing any renovation or demolition work, Puget Sound Clean Air Agency (Clean Air Agency) and Washington Department of Labor and Industries (L&I) regulations require an asbestos survey be performed to determine whether there are asbestos - containing materials in the work area or structure. The asbestos survey must be conducted by and EPA -certified (AHERA) building inspector (except renovation or owner - occupied single family residences). DCD: For more information, please contact Clean Air Agency through their web site at www.cleanair.org or by phone at 800-552-3565 or 206- 689-4058. The L&I web site can be found at www.ini.wa.gov/p-ts/asbestos/asbestos.htm. 10. (DCD-02) DCD: 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 Washington State Building code or of any other ordinance of the City of Bremerton. Permits presuming to give D authority to violate or cancel the provisions of the Washington State Building code or other O�(� ordinances of the City of Bremerton shall not be valid. The issuance of a permit based on v construction documents and other data shall not prevent the building official from g Nab Page 14. 20f �'+ j 1B��+M���QD p� opME r � 0A NCS`( u U 00MMv Temporary Certificate Of Occupancy Department of Community Development this certificate issued pursuant to the requirements of Section 109 of the Uniform Building Code, as adopted by the Bremerton Municipal Code, certifies that at the time of issuance this structure was in limited comph ance with City regulations for construction or use. ISSUED TO: NORTHWEST PROSTHETICS & ORTHOLIC CLINIC SITEADDRESS: 2625 WHEATON WAY Type of Occupancy Occupant Construction Classification Load Common Use VB B 30 CLINIC Permit Numb,& B804jR1177 Date: 10/13/2004 Hugo, Special Conditions: CERTIFICATE OF OCCUPANCY EXPIRES 30 DAYS FROM DATE OF ISSUE. ALL CONDITIONS SET FORTH BY CROSS CONNECTION MUST BE COMPLETED & INSPECTED PRIOR TO ISSUE OF A PERMANENT CERTIFICATE OF OCCUPANCY. THIS CERTIFICATE MUST BE POSTED AND PERMANENTLY MAINTAINED IN A CONSPICUOUS PLACE Permit #''BB04 01177 Permit Type BLDG -C Parent App # _ Date Submitted 07102!2004 Technically Complete F_ Date Approved 07129!2004 G overmnent? r New Permit Query j Details Parcels Structu.. Date Issued 07/30/2004 Applicant HICiM DOUG Expiration Date 04/09/2005 Tax Account #'3966-004-001-0007 Re -issue DateI Site Address 2625 WHEATON WAY, Ml Date Closed F_ Project Name jDOCTOR'S OFFICE-TENA Last Action10111!2004 Zoning. Status Date 07/30/2004 Status IISSUED Print Form Letters Copy Notes? Contacts Contra... Valuation Fixtures Fees Approval Conditi... Inspecti... Project Description INTERIOR REMODEL FOR DOCTOR CLINIC Other Zoning HC Council District IDISTRICT 5 Census Class 437/Add or Alter Other Buildings & Structures Development Code 120/Commercial, Remode]IAddn View All Details Tax & License Division • 239 4' St Office Use Only Receipt # Initial Fee Due: ($65.00/yr) Initial Business Name: Business Addrressss:mo b i� City/State: 1,{C.1Y�Q 0. Zip Code: Tax Returns Mailed To: S_LICEN_S_E APPLICATI WA • 98337 • AUG 0 2 2004 CLv%. Issued: Home Address: i-1211 N E q I J City/State: �v� 1 9 0 lyak- Iq C Si ac v` (� 12,,L Date Business Started in City: -Sez`I � 1,4 (;OI.,� Business Phone: ��((++�� `� Home Phone:�j�,( Nature of Business: Gel C �,�' G 0 f '1 a ) L ,S 4 f (�1r (I 4Lt�1'1,t!,,5 (Des tev ther Retail, Wholesale, u cturing, Service, etc and specify Product or Service provided) � Type of Ownership: Sole Owner El// Partnership ❑ Corporation \ WA State Tax / UBI Number: �V1 Name / Address / P one Numbers of Partners or Owners of the Corpora n. Corporate Phone Number: C3, Previous tenant/business name: AA rU. Date Last Occupied: Y� �IJhfi1�I�� Will there be remodeling or altering of an existing building for your business?s P No ❑ Num be of Employees: If you are tenant, give property owner's name: tom -' 1,Jr4 41C V bow Business Square Footage: Is this tenant space currently vacant? Yes I No ❑ If No, Explain: Office: Will you be sharing this tenant space with another business? Yes ❑ No If Yes, Who? Retail: Will you operate this business out of your home? Yes ❑ No'q/ / If yes, will any person be employed at the home other than resident? Yes ❑ No ❑ Other: If Home Occupation, I have read and agree to abide by the Home Occupation Regulations found in the Bremerton Zoning Ordinance: Yes ❑ No ❑ PERSONAL DATA REQUIRED OF ALL APPLICANTS (If Corporation, an Officer must complete this portion) Birthdate: — Soc Sec Number: DL Number: State: UA - The undersigned hereby certifies that the information provided on this application is true and correct, to the best of his / her knowledge under penalty of perjury under the laws of the State of Washington: � 1 Print Fn II Nam e: 1(6 =" G� �u 4c Title: VV�i��l/��1 � Signature: _ DO NOT OPERATE UNTIL YOUR LICENSE IS ISSUED ............................................................................................................................................................................................. OFFICE USE ONLY Remarks: . INFORMATION _ DCD TYPE OF OCCUPANCY OCCUPANT - CONST CLASSIFICATION LOAD ALL ACCOUNTS: 05-B/O MI DRUM � J k"< 06- W tF �L -B/O PEN 08-BUSLIC PENALTY AC T SPECIFIC: 10 0 - T BUS ID # - SLE 03 -SERVICE PROP ID# �l Uertificate of Occupancy ........... Department of Community Development ghis certificate issued pursuant to the requirements of Section 109 of the Uniform ... Building Codz, as adopted by the Bremerton Municipal Code, cert that at the time _- of issuance this structure was in comphance with City regulations for construction or use. ISSUED TO: Northwest Prosthetic & Orthotic Clinic SITE ADDRESS: 2625 Wheaton Way Bldg A Type of Occupancy Occupant Construction Classification Load Common Use VB B 31 Manufacture & Supply of Orthotics & Prosthetics Permit Number: B 24332 Date: August 10, 2004 ristopher Hugo, Director Special Conditions: CITY OF BREMERTON BUSINESS LICENSE APDL Tae & License Division & 239 -t"' Street_0 Brenterton. NVA. 0 98337_ s 360 Office Use Only Receipt # Initial Fee Due: ($65.00/yr) Initial Nn,( � � Business Name: i�rl('���,yo� � ���^`=���� � COW Business Address:_ be w t��tq��-'l "i � �A6 IN- City/State; 7M.AVC - FITC Zip Code: �l 9, _:0, Tax Returns Mailed To: AUG 0 2 '61004 Issued: Name: tAt �q Home Address: 1-7 2-11 lv E 0 1 City/State: tc- 2 2 - Date Business Started in City: t' '1 S _T 11 Business Phone: %lf Home phone: Nature of Business: C CCS 1 "CAk..r�. e' , Ce A% -z FLi_5 4 (Desi o teavh ther Retail, Wholesale, Manu eturing, Service, etc and specify Product or Service provided) q Type of Ownership: Sole Owner ElPartnership ElCorporation WA State Tax / UBI Number: 1 �— Name / Address / Phone Numbers of Partners or Owners of the Corpora�f Pn: Corporate Phone Number: C- 4U 2 _v' �r Previous tenant/business name: � 1 (\r D.{ate Last }Occupied: t7" y�tC•.-STI �' V L''�i tai / .! I__A..7` A Will there be remodeling or altering of an existing building for your business? 1' s No ❑ Numbe of Employees: If you are tenant, give property owner's name: _1 �� Business Square Footage: Is this tenant space currently vacant? Yes No ❑ If No, Explain: Office: Will you be sharing this tenant space with another business? Yes ❑ No If Yes, Who? Retail: Will you operate this business out of your home? Yes ❑ No'w Other: If yes, will any person be employed at the home other than resident? Yes ❑ No ❑ If Home Occupation, I have read and agree to abide by the Home Occupation Regulations found in the Bremerton Zoning Ordinance: Yes ❑ No ❑ PERSONAL DATA REQUIRED OF ALL APPLICANTS (If Corporation, an Officer must complete this portion) Birthdate: Soc Sec Number: DL Number: State: L� 4 The undersigned hereby certifies that the information provided on this application is true and correct, to the best of has /her knowledge under penalty of perjury under the laws of the State of li ushington: Print Full Name: � A1�____- Title: du riN�)V � i'`'/ kr Signature: DO NOT OPERATE UNTIL YOUR LICENSE IS ISSUED ............................................................................................................................................................................................. OFFICE USE ONLY Remarks: _ DCD TYPE OF INFORMATION OCCUPANT OCCUPANCY - CONST CLASSIFICATION LOAD ALL ACCOUNTS: ACCDLINT SPECIFIC: 05-13/0 XflNIMUM 0 - T BUS ID # r! Ic t 06-U - SLE yF- y LA;, ti t1 -B/O PEN 03 -SERVICE PROP ID# 08-BUSLIC PENALTY ITT OF BREMERTON B 'SI?`NESS EI Tax & License Division e 239 4": Street • Bremerton Office Use Only Receipt # Initial Fee Due: ($65.00/yr) Initial Business Name: Nlff.'j Business Address:�Vl,�q�_ City/State: 7Ct.AY t " "�� V Zip Code: fl -� Tax Returns Mailed To: Date Business Started in City: Nature of Business: r 7ENSE APPLIC.4T Off,- WA a 98337 s 360/73- _ i AA AUG 0 2 200 Name: Issued: Home Address: Iy City/State: 2 2 - Home Phone:S�" Type of Ownership: Sole Owner ❑ Partnership ❑ Corporation WA State Tax/ UBI Number: W1 -1b-1 '`J-1 I 1— Name / Address I Phone Nuttmbers of Partners or Owners of tthe Corpora n: f Corporate Phone Number:VV Previous tenant/business name: U' 'll��t���Yvt�r ^,,(L.r Date Last Occupied: p(` �'1i,lY`Li WCJ� C� <' �,iE vvL= ALF Will there be remodeling or altering of an existing building for your business?sNo ❑ Numbe of Employees: If you are tenant, give property owner's name: Gi1� 1L_,l �/�.�1 �l�y _ Business Square Footage: Is this tenant space currently vacant? Yes Int No ❑ If No, Explain: Office:l Will you be sharing this tenant space with another business? Yes ❑ No If Yes, Who? Retail: Will you operate this business out of your home? Yes ❑ No'W Other: If yes, will any person be employed at the home other than resident? Yes ❑ No ❑ If Home Occupation, I have read and agree to abide by the Home Occupation Regulations found in the Bremerton Zoning Ordinance: Yes ❑ No ❑ PERSONAL DATA REQUIRED OF ALL APPLICANTS (If Corporation, an Officer must complete this portion) Birthdate Soc Sec Number: DL Number: State: Ulyk The undersigned hereby certifies that the information provided on this application is true and correct, to the best of his /her knoovledge under penalty of perjury under the laws of the State of li ashington: Print Full Name: �Cf'AA;_�LFi\��� Title: ���i1�vl'"/� Signature: DO NOT OPERATE UNTIL YOUR LICENSE IS ISSUED ............................................................................................................................................................................................. OFFICE USE ONLY Remarks: _ _ nCD TYPE OF INFORMATION OCCUPANT OCCUPANCY - CONST CLASSIFICATION LOAD ALL ACCOUNTS: ACCOLINT SPECIFIC: 05-B/O MINIMUM 0 - T BUS ID # 06- U - SLE -B/O PEN 03 -SERVICE PROP ID# C/ 08-BUSLIC PENALTY FAX TRANSMITTAL COVER SHEET CITY OF BREMERTON DEPARTMENT OF COMMUNITY DEVELOPMENT 286th 4th Street*Bremerton*WA*98337 (360).478-5275 *** Fax (360) 478-5278 DATE: T O : A %-A*� 0- «n 1!4, A- -6-' ) (1-0 v."\ i CONII'ANY/DEP_ARTIVIENT: TELEPHONE NUNMER: F_AX NUMBER: 5 3 9�, (-- 15 cf FROM: Number of pages including cover page (�) r CONINIENTS: I �-; s z t r r�/ -L 1J �1q, 10,K� 4- W -�u tti1.22 03/19/2003 Y. tD Arldr Lcri"A an: N 18:20 253-926-1996 AUTOMATED COMMUNICAT GN',1T EE St 266 4th Ste -.-t, Brome�rton� WA 9&-- Pt►o n6: (J647) 4,78 -5 7-5 FAX-, ( :445a) 478-5278 BUILD PERMIT 2! 2-S WKATON WAY HARR -SON I10�PITAL PEHAS CENT�E'P 1, v Appli.64nt, AUTI)MATFOi COMMUNICATT.QNS CORP'.. 2.)t-.;4zf7:6736 $007 PACIFIC: 14WY E. STE' 2 F CI C >i1Ft, 9F3it�� Owner r tf�R�tTSf�N HO KTA 3typ=f 79- bl. i? 7_5ZU CHERRY AVE 13REMERTflN: WV. P..a1:0 C:tintrintot': AUTOMAVED COMMUNICATTPHS' COV - ..25,340.031.10 PpIrm.zt 140� S -t Al 1.ts PAGE 02 .03-0104 03/pA%2t1U3 Q3/19/2nO3 OR.115/�'t103 c AOTt1M C161N EXP` 01/31/2004 5007 PAC:TM HWY 'E STE AI•.ARM S.YSTF'M FOR RENOVA110 t 0 9FOAP..0<,NTO. lv't,a7. C JNtia.a'Z��3'tare= i8k,U6' .Va7mmiian Permit .tunes:. 7XZ.Z:5 Fr;�tl:=: Acidi.tionai Fs�"� .OU �° 4,50t]_t7n w . Plan Check 7':31.. . T Uth t Fie^;, 4.5.0 Tm.a-1 pi-rmi.i t"Nje- � ,TSN••!••1•SMT.�i.4TT,X, M,.Y..R •.•T Rri. R.•FAX. TT TMT•F!••F Tni R. I•wi MA. A.•F TT• i+1•W. AX,+�.T •{• /h T1. ?T }riT M*wi .11 ••F. rR TMR4 liT•iCvx.FXwxx**I, t* IKX �y, M .y y. W L Y•Yr YI W W W 1'hiti nernit, s,hRll becc-K' ritrll 'And V^id if cjuw wildi.riq nr'wnr:c iuthnrarwi W this? ppyIti+. ).a r,n4. xtnmr!Tu @r1 wS.t}i9t9 i,i My.) iely)? firs] the rlat.p Orf such nemit. 01' if thi,% kxt11tirxa nv work diAl y -wired tyr :.eech parmif, is Wit!pendari nr ttFu�tYiOii�d Ht. ariv ti. -W rafter Che work is eofflpmp—ri fbr R net'ind in 1.90. FlDTIGF - 1f:, i ti i.hp rorjcnrai bi l i t)• of : •t.ttsa pe mit tol de•r'.: nrnt the c9, ty , of': V-reroerton ,,r Mui ltii.rxa off ieiat res to it lFrdi rew.t3r�xj 9,rt�+er..tlons arti` `m de, The Penti.t holder fs t nntii� the f'�-fildi.t� C�tfirist] wlaerl ready far' •�� tywaf,t;iarv". Fa; b.kre of Uw pormi# hU1�e-r' tt7 rlot:ifr it* Wildirh,fit�ftG•i�l of rt�qlirerf i.i,�?ctiarWZ mav rV^;u1t: in. 0* sienl,,n r of i1*je work until svc:h 1;xAw it�oi +he P�ymic 1vosie'r can a�..b-*0ritiatto to the rg-lildtm official tl'e9t_ +;tte csc. l.ad wC7Yk' meets (]Y tt* m C'C7�C rAgl]iTfMltslT{''.Ns� /fin}' r�#WJ1it.1Cn, tLratlrl5, 4r, f`irtar>G�,sl Calydetn 5ris3iX bo rxrnrr c1 roctl% tv the permit hrlGrr_ fsa5].ure to ftula*Yt.;rlt.7aite rx+c* i-v4:AiY4>n12i�i% w;71 S.rx*FI1 Ifv'1-he C.itV M as iri> 'si �xricf a� r� 'iaibiJ.ttx or llahiXtt> rnrni�cteax3 witri t Trin ti7aF_E t>tf :`.. . �. x hr*�tf ca ifV t,a+ 7 have o*J ex�ai,rw! thin Parm'it'><tt o k1kkl the >;a�M to ttt� ir'up �nrJ C��trerf� AiX am 1 u di. niM •0.0-tl i:Yoe of %w)rk twill to Cow]iOd i4tli wlrei ixr; �pf� iFze�1 hek�is�. el a�ii�, . �t'B.rrt q mj . lhr}„ 11(+i vrelquw- tD C,i vn AlAk or ty .brp vi nlaite ro• r -Incas•] wt,e FreNjsi m. t s of gry Qtr9 to or j1, j7V� rOrOt.V JCti0i 0;Y. flV-- Perfri1-I irOff of M_mtrilct-ion- �,.,�..��.«• � � a] �ti'lil'F11 a. — — ......... I.rxl:ia - .«.. cosi-f:i,ff.ti, .1. mo ekv(pt frim i:l-,ra rrr.-•t:he rbt.at, conprartor'0A r9gicstra4:ian law. urs:r 9•iyrt;tt-ut'�:,„-...«....•..«.4.--•.,..-..«......r,.,..,.._..... ..... --.. _ ,.....,,,...,..�., 1,:?te�� __--.r.�, 03/19/2003 18:20 253-926-1996 AUTOMATED COMMUNICAT PAGE 03 - 173/ J-7/ LOua aa.�a .0 i.rw•rr.,:,...,.. -• --- - 8REM1>='Ir Qt*d1Mz'k E� F� 286 017 Pfa�nec � 60) 4Ft�rt527�5'::,. X. 317 4.78-'5;278. FIL[.lt1:r��]1 piE.,,•my.i. No= 03-t? C�✓� St;ai.us z ISSVED 2FSZ� Wfif_'ATON WAY t; - • j e:: rt�r{: G3/1r3��UC3 �OSTTA., FA'' CENTER Hf?fT rP C:XPJi'GLi': (•1Gr..i'_ NQ: F-' C T Z' 0 N 'S' .02700 r- TNAL--SLOG Dop't: � 8LC)G D i,v j eyfo i : ''�• �::� w k;:Y �:�.� �'#:'�' *' x:� k �� � �' � � Y'�'-t•� �:�::�• � �' �'Y � ��r%;'� �:'x• �i::l'ix::�''f:,�: W x� �, x: •h: •#� *-x'�%tx: x: � a"#� � ��� �F:x• � �:�x•:x'x: * �W * # `► .; TESTStVG: Nl�ta�. be rCsC-ntriSQd by t.h,:. W�hi Eisai-ari .¢yS�r{"],r.�Cr11 a ttt a-�in�a Off Pt` '61NSP Mt���i E>�> r� 9.�i r c.1 wit: 17 f.l'i+ W xi 'W '= .:•St_�[,t �' of. WA'D0--0't : of L�,bor`''and 'f r[ iJ �:Y �,c'�` �i.7�3-art 416-_c,2235 ;1;,T1:4T'OMWti:tTl/t±it..!;0P f'iesal��l't t"etc., I'ic. t, .'! .... . Al_l. ,'TNSf'F_' T71 �. RF*l�h� 0THC i'PY ri;�, .C3s CM1f,p'Tot4 MAST BE SCHEDUI-1- TF�C�C1!tGH THE:, P r mi l' CF TFR 7?f1 -57 7NN 03/19/2003 18:20 253-926-1996 AUTOMATED COMMUNICAT 8 R5 M I-- RTO N PEJ' M]'T CF -NTL --F: PERM], CON(- I ge permit. N61 i*74i ,Jnb oddrass, ;m,.25 WHEATON WAY Apt r Quad A S 'Sl- Aoc.-t NO; F" .5, ! I e, cl HARRISON i-i.osriTAL. ALITOMATFD -COMMUN. ATIONS,t.-. IJOSPTTAL .. c• ntrraGtor Akjl OHAI ED FIRE ALARM. SY�-;TFM FOR RENOVATTON F-1011pr_H(IB—CENI 'ER PAGE 04 01: 1P612. 03/19/2 coviditions. apd 72'""" )A 7 , 0 t-1 frorlt door.- S)A, bo n(aRY. �4T'fd Visi.hl,:� from n t,,ast-,.J.nu as feciLilre,-d by NF Audip and visible shall sYnc..ri Q)Outdoor ho-rn/o-Lrobe tr !F,,ec-.t. sid c b il d 5: H)Sc(:)rA!-- Of work is pQorly de,fj nec)*, thereMnY he, 0 nS i t- P: h land ng appoi rit-ment 3 )Ai I, u�st.in.q F)T., T,eqvjred per PRIOR TO PERFORIMIN6 ANY RE*10V 1-1 'M F,U(if--T Sok)ND Cl -LAN AT -F! AGEN.c,-.Y. CLEAN, e,-j.j p. A( -,ENC -Y) ANO wT or ND TN Dt)SVRXE�'-* WAsHTN(-,TTnN cepAizrmr-, - LAGOR A p �- R r-, cjR H � L) -1 Q, REGULA-UnNS REQL!I�r.- 01 SUr�VEY HE "A, ATERTALS 3(3C -S pic- ING M DUERmiNE WjjEj'jjER THERE'ARC 'I. B T n URkj.F..y. MkiST. RE Tt - 'A 3-N 1-4 'WORK ARE.A Cg7 S,.l lUCTUR 4: r-oNr)VCT EQQY AN -UPA CERTIr, I r;.,D AHURA (Excr.'PT RENaVATION OF OWNERFAM)LY., Rlr.'-',TDF-.'NCES .T r- AN ATR,..AGrEN(:Y TNFODMATTON, PLEA5r..caN7AC FOR MORE Op ay [�ItION5 AT TjJR0 T Ea SJ TE AT', wk,�lw '. P80:1 �3a hia I r :'Oy'q 1206 5-40511.- THE -L--& -8 STTE B CA or I WF. 800- FOUN A J ww 11 wa L5c-ym3,1- HOICIeT P 1! RECEIPT RECEIPT Number: 03000221 Amount: 115,75 03/19/03 16=48 Payment Method: CHECK Notation= AUTOMATED COM ____._-__.___-._w_._--___________._-__-__.__._______.___W..__-._________.__._--_.._.___________._ Init: PC Permit No: 03-0104 Type: FIREALMS FIRE ALARM PERMIT Site Address= 2625 WHEATON WAY Location: HARRISON HOSPITAL REHAB CENTER Total Fees: 188.06 This Payment 115.75 Total ALL Pmts= 188,06 Balance: .00 Account Code Description Amount. 16-322.1001 (2211) BUILDING PERMIT FEES 111.25 643-237.13 ( 0236) STATE: OF WA SURCHARGE ---------------------------------------------------------------- 4.50 1! Bank Of America-Checkin ]MATED COMMUNICATIONS CORPORATION 5007 Pacific Highway East, Suite 7 S A�A S6i -'_ -i-i&1 71 11,1,111 fill fill ,,11111141111„1 1,,11,11,,1,1,111„111,,11,111,1„111Il,i,illA 03/04/2003 15:45 253-926-1996 03/04/2003 14:11 3604785278 AUTOMATED COMMUNICAT PAGE 02 COMMUNITY AEVELOPMEN PAGE 02 ;ro PERMIT CENTER u g6 4m tt+4R'� °� Bremerton " WA'' 5175 * Fax (560) 478.3278 Building Permit ,Application APPLICANT: [71 OWNER CONTRACTOR ❑ AUTHORIZED AGENT Clio �drlreeit i r' L IA/�� 1A6I �.�.�. f Tax Account Number: Chqck the tvgl of acohoatign for below: NEW SINGLE-FAMILY RESIDENCE j�j NEW COMMERCIAL. NEW DUPLEX p��J COMMEVRCiAI REMODEL a NEW MANUFACTURED NOME COMME.ROiAL ADDITION REsioeNTL& RSMODEL a COMMERCIAL REPAIR RESIDENTIAL ADDITION NEW MULTI -FAMILY Q RESIDENTIAL REPAIR TENANT IMPROVEMENT IS THIS PROPERTY W/TNIN 200 FEET OF A SHORELINE? NEW GARAGE/CAR PORT � NEW ACCESSORY BLDG NEW SIGN STRUCTURE DEMOLITION F] GRADING Cublo yarde; (5 OTHER YES 7 NO Scope of Work Proposed: S J� Square Footage: pwelling:� —_ If �a�9eDecks: - valuation Plan Review Fee Permit Fee _LO-101 rllw Applioiitlon for whloh no Permit Ia Issued within 180 days following the datia of application shall axplre by limitation, and plans and other data duhmlited for review may thereoftor be returned to the applicant Or destroyed by the building official. The building o!fldal may extend the time for 96on by the ilpplioant for a period not exceeding 18D days on request by the applicant snowing the circumatsrcaa beyond the control of the applicant h0lve prevented action from being taker,. No appicant shall be extended more than once. In order to renew sotivn or an application after exp relion, the applicant shat resubmit pans and pay a new plan review fee. APPLICANT'S SIGNATURE: --- DATE. j — 02 r -,,-b F 1 TZ 6- E3F:Z EE: MI=—R TC]1%! IPe�RM = T GEE: "TI—E F:Z t Pie/ 286 4th Street, Bremerton, WA 98337 Phone: ( 360 ) 478-5275 ,FAX: ( 360 ) 478-5278 1 BUILDING PERMIT Job 2625 WHEATON WAY ���/� Permit : 03-0104 Location: ��� C�5 Status: PENDING Parcel No: Applied: 03/06/2003 Issued: Applicant: AUTOMATED COMMUNICATIONS CORP 253-843-6736 Expires: 5007 PACIFIC HW'Y E STE 7 FIFE WA 93424 Owner: HARRISON HOSPITAL 360-877--6188 2520 CHERRY AVE BREMERTON WA 93310 Contractor: AUTOMATED COMMUNICATIONS CORP 253-£34£3-673Lic #: AUTOMCC161M4 Exp: 01/31/2004 5007 PACIFIC HWY E STE 7 FIFE WA 98424 Subcontr= Desc: FIRE ALARM SYSTEMS Valuation Permit Fees: 111.25 Total Calculated Fee: 188.06 4,500.00 Plan Check Fees= 72.31 Additional Fees: .00 * Other Fees: 4.50 Total. Permit Fee: 188.06 This permit shall become null and void if the building or work authorized by this permit is riot commenced within 180 days from the date of such permit, or if this 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. NOTICE - It is the responsibility of the permit holder, not the City of Bremerton or Building official to see to it that required inspections are made. The permit holder must notify the Building Official when ready for inspections. Failure of the permit holder to notify the Building Official of required inspections may result in the stoppage of the work until such time that the permit holder can substantiate to the building official that the concealed work meets or exceeds code requirements. Any demolition, testing, or financial burden shall be borne directly by the permit holder. Failure to substantiate code requirements will indemnify the City against any and all responsibility or liability connected with the construction. I hereby certify that I have read and examined this permit and know the same to be true and correct. All provisions of laws and ordinances governing this type of work will be complied with whether specified herein or not. The granting of a permit does not presume to give authority to violate or cancel the provisions of any other state or local law regulating construction or the performance of construction. Signature: Date: I certify that I am exempt from the requirements of the State contractor's registration law, under Section 3, Chapter 126, laws of 1967. Signature: Permit Center -,-Approved By r -,Lt':_ �3 Date= Date: Lo P, c --.S 2 S A- "ACID RLCETPI RECEIPT Nufutser® 000000` Anf cru n t : &31 03/06/03 10:44 If Paymenc Method: CHECK K Notat. ion AUT011ATt O" J ff:E.t = )L. --------------- ------_ Pei fl: i t f �i Y / EJ\ T: &,(-A ` J Total Fees: 188.06 This Payment MY Tot4s.,P ALL Pmts 72.31. Balance: 1.1.5,?5 Account Code Description i'iFI oust 16 4S 11300 (080) BUILDING PLAN CHECK FEES 12.31 �M �y PERMIT CENTER n4y Development -1286 4d, Street * Bremitnon " W.A " 98337 (360) 478-5275 u Fax (360) 478-5278 iiding Permit Application "t3-J�- )112 Iq CONTRACTOR ❑ AUTHORIZED AGENT Site Address 2-6 ZS L✓ w bj Tax Account Number: CONTRACTOR: low , OWNER Name: Address:.S-o o c,` "� E ; > Address: 2 NEW GARAGE/CAR PORT C4, Zi c 1� - ,p' -It City, State, Zip Z.- "a, 9 -Pilo Phone #: Z s"J 9L 6 - / y7 Phone 0 NEW SIGN License #/��� c c /6//,, Ex ir. Date: 1 -_V -0y Authorized Agent Address -,1-.26, 6,))c 4/y L Contact Narne: Ti A-1 City, State, Zi Contact Phone #: zrd yL l -/ 9 Y> Phone #: 6 > 7 -. /,Poo Check the type of appiicatiol� ti'lrTJ low , NEW SINGLE-FAMILY RESIDENCE ❑ NEW COMMERCIAL NEW GARAGE/CAR PORT NEW DUPLEX COMMERCIAL REMODEL ❑ NEW ACCESSORY BLDG ❑ NEW MANUFACTURED HOME ❑ COMMERCIAL ADDITION ❑ NEW SIGN ❑ RESIDENTIAL REMODEL ❑ COMMERCIAL REPAIR STRUCTURE DEMOLITION ❑ RESIDENTIAL ADDITION ❑ NEW MULTI -FAMILY ❑ GRADING (Cubic yards: ) ❑ RESIDENTIAL REPAIR ❑ TENANT IMPROVEMENT OTHER !� IS THIS PROPERTY WITHIN 200 FEET OF A SHORELINE? YES ❑ NO Scope of Work Proposed: Square Footage: Dwelling: IS -0-0 Garage: Decks: Valuation Plan Review Fee Permit Fee Surcharge I Total Fees 'i,3I l'i1I.2.� /gw.ak Application for which no permit is issued within 160 days following the date of application shall expire by limitation, and plans and other data submitted for review may thereafter be returned to the applicant or destroyed by the building official. The building official may extend the time for action by the applicant for a period not exceeding 18D days on request by the applicant showing the circumstances beyond the control of the applicant have prevented action from being taken. No applicant shall be extended more than once. In order to renew action on an application after expiration, the applicant shall resubmit plans and pay a new plan review fee. APPLICANT'S SIGNATURE r DATE: — �-� • 03/04/2003 15:45 253-926-1996 AUTOMATED COM14JNICAT PAGE el Phone- (253) 926-1947 5007 Pacific Hwy. East SW.# 7, Fifc, Wa. 98424 Fax: (253) 926-1996 FAX MEMO DATE: 3-4-03 ...................... ................... TO: CITY OF BREMERTON ............... I .............. ............ ATTN: Pat Conroy PHONE TOi: - 478-5275 1 .............. ........... ........... .... .......... ... I . . ...... ...... ....... ... FAX TO: 360-478-5278 NO. OF PAGES: 3 (;NCLUDING-THIS PAGE) ................... ... FROM: Jim Markwith ........ . ... . ...... PROD. NAME: HARRISON MEMORIAL HOSP. REF: FIRE ALARM SYSTEM .. ....... ............... 11 .. ... ..... ....... ....................... SUBJECT: PLEASE SEE ATTACHED APPLICATION FOR PROCESSING, THANK YOU Sincerely yours, Jim Markwith Project Engineer Automated Communications Corp. 5007 Pacific Hwy, E. Suite 7 Fife, WA. 98424 Phone: (253) 926-1947 Fax: (253) 926-1996 iimmarkwith(Mautocomcorn.com www.autocomccE2.com LET US KNOW IF YOU DO NOT RECEWE ALL PAGES NUMBER OF PAGES SFINT Fire Detection & Alarm + Nurse Call * Intrusion Detection * Security CCTV * intercom *.Public Address &.Nfusic * Access Control 24 Hour Fmergency Service Alarm Moulto;llig Job Adds Locat i�:::. Parcel. Pin: Ez-1F;ZCM E--- F:Z -T C3 P4 F=°t—=F--ZM IE T CI=—"IFCFJ 286 4th Street., Bre-ey-t.on, WA 98337 Phone: (360) 478-5275 FAX: ( 360) 478--52.78 B(JIl_DING PERMIT Permit. No: 03-010<�r f oC{fj/L(S6YI%��-s�(�G� We"67 � Status: PENDING Applied: 03/06/200:3 Issued: ..� Ap,T)l:icant. AUTOMATED COMMUNICATIONS CORP 25.3_848--6736 Expires, ��� � 500? PACIFIC HWY F STE ? f":IF'E WA 9£3426 kC"'C1.46JHJ ' 2 Owner. SON HOSPITAL. :360-87/-61882520 Ct ERRY AVE BREMERTON WA 9f3310 01)ntrac,tor• AUTOMATED COMMUNICATION.`.;CORP 253--£�48--673Lir. #' )11TOa xn" 01 1311200e 500? PACIFIC K14Y [ `ATE ? FIFE Wo 9£342 SUbcontr - pD Valuation Permit. Fres". 1.11.25 Total Calculated Fee: 188.06 4.,500-00 Plan Ch€cK, Fees= :x2.31 Additional Fees: .C10 Other Fee! 4.50 Total. Permit F"ee% 188.06 i> hermit shall become, rxill arra :yid if tl-K> buildir" or wick authorized by thi-s permit is riot commenced wit.hira 180 diex frc* the date of sluch permit, or if this Wi.l.dinq or work Fuathorizr--c? by such Permit is <suspended or abaivJovwd at any time after the work is commenced for a period of 180 days. yNOTICE, - It is the resporriibility of the permit holder, not thw: City of Brenrrrton or- Bui.ldir19 Official to see to it that regi:red irrx)eectiorts are made.' N'te Permit holder must noti.f; the Building Tiff inial when ready for, inspection,.,. F4ikilure of the permit holder to D'K)tif:/ the Njildirn;a Official of required inapeCtions may result. in the stoppage of the work until such time: i-Irt the permit 1'oldei (van substantiate to tNk building official thraL the concealed work meets or e°xr-:eedix code requirements. Any demolition, test.irw.,a, or finoncial burden shall be borne directly by the ,permit hr)lder. Failure to substantiate corms renuirements will indemnify the, Cit.y ~<-iainzt ;err;• arra all rp:aponsibility or liability connect&d with the coma tructicri. h reby certify that I have read anti examined this permit and know the s4rcw- to be true arri correct. All prr i5yic,rt+ of laws and ordinance-�3 governing this L> -pe of work will L* complied with whether specified herein r not. The yraratire,::a of a permit does rKat presume to given aait.hority to violate or cancel theprov.isiom of �.' other state or local law requlatirc4 construction or the performance of construction. 'igraature. Date = I I certif>' thcat'S1 am exempt prom the rvcn,irr wnt.s of the state cont.ractor"s registration law, under aecti�.�n 3,<rh;7kPterr 1.26, law, -3 of 1967. ga7-�tu r cr ;. ermit Center —Approved By, 161 t)ate+' ��-kAn�13 eR Q ,� 4 r, -A � � tww=fC C3 Pt > P p, FR R T 1 M, N 5007 Pacific Hwy. East Ste.# 7, Fife, Wa. 98424 Phone: (253) 926-1947 Fax: (253) 926-1996 Submittals For Harrison Memorial Hospital Rehab Renovation 2625 Wheaton Way Bremerton, Wa. 98310 January 30, 2K3 Fire Alarm System Section 16721 .Z/ � /�4,,<i�APPROVED y FIRE M/,RISHAL s 0 twotection systems mvsl COMPIr with 'JFC, NFPA, URC, and 'WC �i�na mrlsFlan ire�riew ragWFe('�' R [Pn [E mE FEB 2 8 2003 D BREMERTON MUING DEPARTMENT _.a�tc�1 '^ � h ' Model 5204 Fire Alarm Control Im Panel and Optional Digital Communicator Silent Knight's 5204 is compact and easy to install and service, delivering features you'd expect to find in systems costing much more. The Silent Knight Model 5204 Fire Alarm Control Panel is a local fire evacuation control panel designed for applications requiring manual and automatic fire alarm as well as water flow and sprinkler supervisory service. Description 3 amp current output available for external devices. The basic 5204 unit offers local fire Compatible with 2- and 4 -wire alarm control for up to four zones smoke detectors as well as water NSILENT and central station communications flow and sounding devices. with the optional UL Listed Model Two 1.5 amp supervised notification 5205 Digital Communicator. The circuits programmable for steady, 5204 has 3 Amp power supply, 2- pulsing, or supervisory 1.5 Amp supervised notification • Auxiliary outputs of 1.5 amp at 12 or circuits and supports both 2- and 24 VDC and 175 mA at 12VDC =_ 4 -wire smoke detectors. (only) • Smoke verification, pre -alarm delay The 5204 includes an annunciator and cross -zoning minimize false inside the cabinet for annunciation alarms. and operation. LEDs are visible • Two general purpose relays (2.5A 5204 without opening the cabinet. dry contact, Form C) Operation keys include SILENCE, • Optional plug-in UL Listed digital Auxiliary Outputs: DIALER RESET, and DISPLAY communicator (Model 5205) 1.5A @ 175 mA @ or 24 VDC @ 12VDC TROUBLES. • Up/downloading (reduces Mechanical Specifications: Remote annunciation is available installation time) Dimensions: through the optional Model 5230. • Programmable from on -board touchpad or optional remote 14-7/8"W x 15 5/8"H x 4-114"D This four -wire annunciator can annunciator (Model 5230) (37.8 x 49.8 x 10.6 cm) perform the same operation as the . Accu-ZoneTM' diagnostics for on-site Color: Red main system annunciator and troubleshooting. Telephone Requirements: T f J k• RJ31X 2 d features English-language LCD display and programming capability. Specifications Features • The 4 Class B can be converted to Class A using the Model 7181 Zone Converter. • Fuseless design reduces service calls. • Field selectable 24 or 12 VDC power supply. Electrical Specifications: Primary AC: 120 VRMS @ 60 hz, 2.5A Total Accessory Load: 3A @ 12 or 24 VDC Standby: 120 mA Alarm: 400 mA Notification Circuits: Two Class B 1.5A @ 12 or 24 VDC. Programmable for steady, pulsing, temporal and supervisory for sprinkler system supervision. ype o ac . ( require ) Approvals: UL 864 NFPA 72 -Central Station Reporting -Local Protective Signaling System -Auxiliary Signaling System -Remote Signaling FCC Part 68 and Part 15 CSFM: 7165-0559:117 New York City: MEA 429-92-E SILENT KNIGHT Model 5204 Fire Alarm Control Panel and Optional Digital Communicator Engineering Specifications The contractor shall provide a completely electrically supervised fire alarm control system. The system shall contain a fire alarm control panel to supervise and operate heat and smoke detection devices, alarm notification devices and visual annunciators. An optional digital communicator shall transmit fire alarm, trouble and supervisory signals to a central station. The controller shall be UL Listed for use under NFPA 72 standards. It shall provide power and control for four supervised detection zones, 2 supervised notification circuits, and, optionally, an approved plug-in digital communicator. The controller shall be Silent Knight 5204 or equivalent. There shall be four Class B detection zones. Products of combustion detection may be either 2- or 4 -wire and shall be cross - listed by UL for use on the system. The detection zones shall be programmable to (1) be cross zones so that two adjacent detectors must sense products of combustion, (2) automatically reset a detector to verify that smoke exists, and (3) see a single detector in alarmflbefore an alarm is sounded, and, optionally, transmit a signal to the central station. There shall be two 1.5 amp supervised alarm notification circuits. They shall cause the bells/horns to ring steady/pulsing/ temporal through the premises until reset or silenced. The control shall be equipped with two auxiliary relays that shall be programmable to operate on (1) alarm, (2) trouble, (3) supervisory, (4) supervisory trouble and (5) system trouble. The relays shall maintain contact until cleared. The control shall have one on -board touchpad and shall support 3 remote annunciators. LEDs shall augment the display to clarify the system status to an operator. An integral touchpad shall be provided to operate, set up and interrogate the system. The optional plug-in digital communicator shall be UL Listed for use under NFPA 72 standards. It shall have the capability to supervise two telephone lines, seize the phone line and send the alarm signal on one or both lines without additional equipment. It shall be able to communicate to a central station in SIA, SK FSK (4/2), SK4/2 tone burst, SK 3/1, SESCOA 3/1, Radionics BFSK. The communicator shall sound a local trouble signal if the telephone service is interrupted for longer than 45 seconds and it shall transmit a signal indicating restoral of phone service. The optional digital communicator shall have the ability to send a test signal to the central station every 24 hours. The test signal shall be able to be transmitted at a specific time of day or night by setting a program within the communicator. The alarm signals transmitted to the central station shall indicate which zones are in alarm and which zones are in trouble. Restoral from an alarm shall also be transmitted by zone. cessories 5230 Remote Annunciator Performs all the same functions as the on -board annunciator and features an LCD English-language **isplay and backlighting. 205 Digital Communicator Performs all the same functions as the on -board annunciator and features LCD English-language display and backlighting. 5211 Auxiliary Relay Enables ground start phone lines. 4180 Status Display Module Provides 16 outputs to give alarm and trouble conditions by zone. Can be used to drive LED or graphic annunciators. Non - supervised. 7181 Fire Zone Converter Converts Class A zones to Class B and vice versa. SILENT KNIGHT 7550 Meridian Circle, Maple Grove, MN 55369-4927 800-446-6444 or in Minnesota 612-493-6435 FAX: 612-493-6475 World Wide Web: http://www.silentknight.com 5220 Direct Connect Module Used for city box and polarity reversing direct wire applications. 5541 Downloading Software and 5530 Modem For remote programming of 5204 and other Silent Knight products using an IBM PC or compatible computer. MADE IN AMERICA FORM# 350778, Rev. 6/99 Copyright © 1998 Silent Knight IONIZATION AND DETECTOR PHOTOELECTRIC t ■ Low Profile Appear- ance ■ Plug -In 2 -Wire Base, 4" and 6" Size ■ Tamper Resistant Locking Head Remote LED Output ■ Non -Polarized Wire Connections ■ Dual Chamber Design ■ 2000 FPM Airflow Rating ■ Interchangeable Bases ■ Fine Mesh Insect Screen ■ RFI/EMI Immunity ■ Removable Cover for Field Cleaning ■ UL Listed (268) 6" Base General Information The THORN Automated Systems' Models ISC-3501 and ISC-350P are part of THORN's complete range of series 350 smoke and thermal detectors, all of which plug into a common set of interchangeable bases. Surface -mounted electronic circuitry allows for a compact, low -profile design. Detector bases are available in 4' and 6' sizes. A separate terminal on the detector provides a voltage output for connection to a remote LED. Wiring connections are non - polarized for ease of installation, unless the remote LED output is used. Detector Design The ISC-3501 and ISC350P detectors have a molded white polycarbonate case, UL 94 V- O grade. Nickel -plated stainless steel wiper contacts connect the detector to the terminals in the mounting base. ISC-3251 THORN Automated Systems' ISC-3501 is a dual chamber ionization -type smoke detector which will sense the presence of particles of combustion, particularly those produced by fast, flaming fires. Inside the detector case is a printed circuit board which has the ioniza- tion chamber system mounted on one side and the signal processing electronics on the other. The detector utilizes a dual ionization Please note that UL Listings and other regulatory chamber design, which consists of an inner affairs information may be found under THORN or reference chamber and an outer smoke source ionizes the air within both chambers. The ionization causes a small electrical current to flow. If smoke is introduced into the chamber, current flow through the chamber decreases. This effect is greater in the smoke chamber than in the reference chamber. Once the current imbalance between the two chambers reaches a preset threshold, an alarm signal is generated. The twin chamber design provides good compensation for atmospheric pressure and temperature and is insensitive to the effect of dirt and dust that may be deposited on the radioactive source. This design also allows operation of this detector in air flows of up to 2000 feet per minute without detrimental effect on its performance. ISC-350P •44EWOO The chamber of the ISC-350P photoelectric detector is an optical arrangement consisting of two main parts: an infra -red LED and a photo diode light receiver. The LED emits a burst of collimated light every 10 seconds. In clear air conditions, the photo diode will not receive light from the LED due to its arrange- ment within the chamber. When smoke enters the chamber, it scatters light onto the photo diode, which is detected in the detector's electronic circuitry. Once light has been detected by the photo diode, the LED emits two further bursts of light at two-second intervals. If light is scattered onto the photo diode on both of these pulses - due to the presence of smoke - the detector will change to the alarm state. To ensure maximum reliability, the LED emits light modulated at about 3KHz, and the photo diode will react only on receiving light at this frequency. Autocall, Inc. which are now doing business as a single entity - THORN Automated Systems, Inc. All approvals are subject to re-examinalion. re visions and possible cancellat" ®' 835 Sharon Drive, Westlake, 44145 I I O Automated Systems Phone: (216)) 87 871-9900 s FAX (216) 871-8320 183/0693 IONIZATION AND PHOTOELECTRIC; DFTFCTOR Installation and Wiring The detector base mounts directly to a 3" octagonal electrical box using two (2) 8-32 screws. Refer to NFPA 72 for spacing, location and other guidelines. Wiring connections to the terminals in the detector base are non -polarized and are such that a miss-ing detector head will interrupt the control panel's initiating circuit, causing a trouble condition at the control panel. Specifications Testing Annual functional tests may be performed using the THORN Model TA- MED Smoke Detector Test Pole and Aerosol Test Gas. Maintenance It is recommended that at least once per year, the detector head should be cleaned by using the suction from a vacuum cleaner. Cleaning may be required more frequently if the detector's environment contains sources of dust and dirt. The detector's cover is easily removed in order to apply vacuum cleaning around the detection chamber screen. Refer to THORN publication number 850502 for complete instructions regarding installation, wiring, testing and maintenance. ,4 f Ordering Infonnation Model Part No. Description ISC-3501 ISC3501 ISC350P Operating Voltage: 16'to 34 VDC (2 volt p -p maximum ripple) 16 to 34 VDC (2 volt p -p maximum ripple) Standby Current: 30 to 45 microamps at 24 volts 30 to 45 microamps at 24 volts Alarm Current: 52 milliamps at 24 volts 52 milliamps at 24 volts Operating Temperature: UL listed for environments from 32OF to 120°F Actual performance from 32°F to 140°F UL listed for environments from 32OF to 120°F Actual performance from -5°F to 140°F Humidity: 0% to 95% relative humidity 0% to 95% relative humidity Altitude: Up to 6500 feet Insensitive to altitude Air Velocity: Up to 2000 ft/min Insensitive to air movement Radioactive Source: Americium 241, 0.9 microcuries None RFI Immunity: 90 volts per meter, 27 MHz to 1 GHz 65 volts per meter, 27 MHz to 1.0 GHz Dimensions: 4' diameter x 2" height, including base 4" diameter x 2' height, including base Ordering Infonnation Model Part No. Description ISC-3501 920067 Ionization smoke detector head ISC-350P 92006B Photoelectric smoke detector head IBC -350 920083 4" base, 2 -wire w/remote LED output IBC -351 920085 6' base, 2 -wire w/remote LED output IAC -350 920084 6" adapter ring and base plate for 4' base (Converts 4' base to 6" base) IA-MLH 920105 Link head IA -MET 920106 Extract tool IA -MER 920107 Dust cover remover IA -MEP 920108 Extension pole IA -MED 920109 Smoke detector test pole IA-MEH 920111 Aerosol test gas Please reference both the model and part numbers when ordering. These instructions do not purport to cover all the details or variations in the equipment described, nor do they provide for every possible contingency to be met in connection with installation, operation and maintenance. All specifications subject to change without notice. Should further information be desired or should particular problems arise which are not covered sufficiently for the purchaser's purposes, the matter should be referred to THORN AUTOMATED SYSTEMS, INC., Westlake, Ohio 44145. THORP Automated Systems 835 Sharon Drive, Westlake, Ohio 4145 Phone: (216) 871-9900-9900 FAX (216) 871-8320 183/0693 HE/\T DETECTORS ■ Rate-of-Rise/Fixed Temperature Operation or Fixed Temperature Operation ■ Choice of Operating Temperatures Features - 500 Series ■ One Circuit, Normally Open ■ Rugged Design Unaffected by Vibration ■ Silver Clad Electrical Contacts ■ Large Terminals ■ Weather/Moisture Proof (WPB-MPB) ■ Explosion/Moisture Proof (EPB-MPB) Features - 600 Series ■ One or Two Circuit, Normally Open ■ Easy Installation ■ Low Profile ■ Visual Indication 600 Series The 500, WPB-MPB, EPB-MPB, and 600 series heat detectors are avail- able in a wide range of operating tem- peratures and styles to fit most any application. Heat detectors are de- signed for property protection, where it is not practical to use smoke detectors. Rate -of -rise units detect fires that rapidly grow in intensity. This method quickly responds to abnormally fast temperature increases. Fixed -temperature units detect fires that build temperatures to a high level at a slow rate. This method responds to a specific tem- perature setting. The 500 series heat detectors are an ultra - sensitive, electric fire detection thermostat. Two dual action models offer the rate -of -rise element and different fixed temperature ele- ment settings. Two other models are avail- able with different fixed temperature settings, but without the rate -of -rise element. WPB-MPB and EPB-MPB series heat detectors include the features of the 500 series detectors. They are designed for use in applications requir- ing protection against weather, moisture (inter- nal condensation), and explosive atmospheres. The 600 series heat detector is attractive and durable, and features combination rate - of -rise and fixed temperature detectors, as well as fixed temperature only. 500 Series The 500 series is an 'open circuit" device designed to close an electrical circuit upon activation. The compact, simply designed unit is rugged and unaffected by vibration. All metal parts are brass or aluminum, mounted on a durable, mineral -filled, phenolic base. No exposed metal parts carry current. Elec- trical contacts are all silver clad and of ample size. Large line terminals and wire ways are pro- vided in the base for easy installation in either open wiring or concealed wiring systems. WPB-MPB Series Weather/moisture proof WPB-MPB series detectors include a cast metal box, gasket, and special steel cover plate with attached standard mechanism. A crossed wire guard is also included. Four wire entrances threaded for 1/2" rigid conduit are furnished. Emerging wire points are sealed with epoxy. EPB-MPB Series EPB-MPB Series Explosion/moisture proof EPB-MPB series include a cast metal backbox, cover plate, and modified mechanism. The backbox has two opposing wire entrances, threaded for 1/ 2" rigid conduit. Box, cover, and base are pre- cision machined for extremely close tolerance fit. Explosion/moisture proof models are UL and FM listed for the following classifications: - Class I, Group C - Atmospheres containing ethyl -ether vapors ethylene, or cyclopropane. - Class I, Group D - Atmospheres containing gasoline, hexane, naphtha, benzine, butane, propane, alcohols, acetone, benzol, lacquer solvent vapors, natural gas. - Class 11, Group E - Atmospheres contain- ing metal dust of aluminum, magnesium, or their commercial alloys. - Class ll, Group F - Atmospheres contain- ing carbon black, coal or coke dust. - Class 11, Group G - Atmospheres contain- ing flour, starch, or grain dust. Listings & Approvals • UL Listed; File No. E14885 (EPB series) S1758 (all others) • ULC Listed; File No. CS757, Vol.1 (600 series) • CSFM No. 7270-0061:005 (600 series) 7270-0061:002 (all others) • MEA No. 188-94-E • FM ID No. . QF4A3.AE (EPB series) ORORAY/ONM&AY (all others) UL UL C LISTED LISTED M"P1"°"'" Grinnell A5562 ISO 9001 FIRE PROTECTION SYSTEMS COMPANY IV -175/0 199 Page 1 of 2 HEAT DETECTORS 600 Series The 600 series heat detectors offer a choice of rate-of-rise/fixed temperature operation or fixed temperature operation. A low profile and an all white finish allow the units to be used in applications where aesthetics are a major consideration. The units protrude only 13/8' from the ceiling surface with a junction box mounting. The pneumatic rate -of -rise element re- sponds to a rapid rise in temperature ap- proximately 15°F (8°C) per minute. This rise in temperature causes expansion of air within the sealed chamber faster than it can escape through a calibrated vent. The resultant increase in pressure de- presses the diaphragm, causing the elec- trical contact to close the circuit. The fixed temperature element uses a fusible alloy. When activated, the external heat collector drops away to provide quick visual confirmation that the element has operated. Each detector includes a patented revers- ible mounting plate. In one position, it easily attaches to 4e junction box, 3 1/4" octagon box or plaster ring. In reverse, the plate can be used for open wiring without a junction box. A 1/4' space between detector and mounting surface allows for wire connec- tions. All mounting screws are concealed. The detector simply attaches to the mounting plate with a push and twist Mo- tion. No tools are required. The mounting plate is molded of white self -extinguishing thermoplastic rated at 105°C. The plate is extremely strong yet adapts to uneven mounting surfaces. 2-114' or 4' cut for wAace Reversible outlet Box or mounting Mounting 4' Square Box Plate O Marking 1-1 Reverslble 515433 Mounting O Plate interior 1--N/0 Rate -of -rise and fixed 50x50 - UL r � r weather/moisture proof 1.-N/0 temperature, 136°F (58°C) &92' Round Flirt Mead explosion/moisture proof 1-N/0 Woodscmims yg to 1 • Scrawe Junction Box Ceiling Surface Mounting Mounting (600 series) (600 series) 500 series 4 -VT � r— —7---r 2_�, uB i —�- + O� I -tea va 47ra 2.114' 5_117 5V Weathet7moisture proof 5_117 ExplosiorVmoisture proof N/PB-MPB series EPB-MPB series Ordering Part No. Information Model No. Environment Contacts Operation Marking Spacing eft.)* 515433 501 interior 1--N/0 Rate -of -rise and fixed 50x50 - UL 515437 WPB-MPB-501 weather/moisture proof 1.-N/0 temperature, 136°F (58°C) none 30x30 - FM 515441 EPB-MPB-501 explosion/moisture proof 1-N/0 515434 502 interior 1-N/0 Rate -of -rise and fixed white dot 50x50 - UL 515438 WPB-MPB-502 weather/moisture proof 1-N/0 temperature, 190°F (88°C) 30x30 - FM 515442 EPB-MPB-502 explosion/moisture proof 1-N/0 515435 503 interior 1-N/0 Fixed temperature, black dot 15x15 - UL 515439 WPB-MPB-503 weather/moisture proof 1-N/0 136°F, (58°C) 15x15 - FM 515443 EPB-MPB-503 explosion/moisture proof 1-N/0 515436 504 interior 1-N/0 Fixed temperature, black dot 15x15 - UL 515440 WPB-MPB-504 weather/moisture proof 1-N/0 190°F (88-C) on white 15x15 - FM 515444 EPB-MPB-504 explosion/moisture proof 1-N/0 515445 601 Interior 1-N/0 Rate -of -rise and fixed none 50x50 - UL 515449 621 interior 2-N/0 temperature, 135°F (57°C) 30x30 - FM 515446 602 interior 1-N/0 Rate -of -rise and fixed gray ring 50x50 - UL 30x30 - FM 515450 622 interior 2-N/0 temperature, erature, 200°F (940C) 515447 603 interior 1-N/0 Fixed temperature, gray dot 25x25 - UL 515451 623 interior 2-N/0 135°F, (57-C) 20x20 - FM 515448 604 interior 1-N/O Fixed temperature, gray ring 15x15 - ul_ 515452 624 Interior ?_-N/O 200°F (94°C) and dot 15x15 - FM Please reference both the model and part numbers when ordering. 'Maximum spacing allowance: Refer to National Fire Alarm Code standard NFPA 72 for application requirements. This literature does not cover all the variations in the equipment described, nor does it provide for every possible contingency to be met in connection with installation, operation and maintenance. Al specifications and listings are subject to change without notice. ff you need more infomlation on this product, or have a question, contact Grinnell Fire Protection Systerns Com - parry, Westlake, Ohio 44145. ® 19% Grinnell Fre Protection Systems company, a Division of the Grinnell Corporation. AUTOCALLO is a registered trademark of the Grinnell Corporation. 835 Sharon Drive, Westlake, Ohio 44145 aGrinnell" Phone: (440) 899-5445; FAX (4 871-2301 http://www.grininn nelIfire.conn A tgCC INTERNATIONAL LTD. COMPANY FIRE PROTEG11ON SYS'T'EMS COMPANY IV -175!0199 Page 2 of 2 MANUAL STATIONS ■ Die-cast Metal Construction is Low Profile, Functional Design ■ Dual Action Option i -Institutional (Key - Operated) Option ■ Explosion -Proof Option ■ Break Glass Option ■ Weather-proof Option ■ Hex Screw or Key Lock Reset Options ■ UL Listed Key -lock Lift and Pull General Information THORN Automated Systems' RMS series manual pull stations are of high quality non- toxic die-cast construction. Low profile and smooth edges offer an attractive yet functional design. All compo- nents are pre -painted or have plated sur- faces to inhibit corrosion. The RMS series manual pull stations have a 10 amp snap action switch. They can be used with or without a break glass rod for positive indication that the unit has been operated.: Automated Communications Corporation 5007 Pacific Hwy E., Suite 7 Fife, WA 98424 Ph (253) 926-1947 Fax (253) 926-1996 Institutional Hazardous Locations THORN's RMS series explosion -proof, weather-proof pull stations are constructed of high strength metal die-cast alloy. The UL rating of class I group'B (hydro- gen) C & D, class II groups E,F,G, class III and outdoor rating of type 4X, allows these stations to offer unmatched placement flexibility. The terminal block connections, D.P.D.T. contacts ®10 amps meet most electrical requirements indoors or out. Having a 'conventional" pull station design the RMS series stations offer easy identification. MANUAL STATION10 Specifications Contact Single -pole, single throw (double -pole, single throw optional) Contact Rating 10 amps @ 125/250VAC Wire AWG 12 to 22 AWG Wiring Terminal block connections (6-32 mi/sem plate) Switch 10 amp ® 120VAC Key Switch (pre -signal) 0.5 amp O 30VDC Dimensions Standard Station 3.325"W x 4.750' L x 0.875" D 15.5 oz/420 grams (weight) single gang mount RMS -IT -DAH 3.325' W x 4.750' L x 1.625' D (break glass) 1lb. 9oz/756 grams (weight) RMS -IT -LP 3.325' W x 4.750' L x 1.500' D 11b. 4oz/560 grams (weight) RMS -IT -WP -LP 3.25' W x 4.750' L x 1.75' D RMS -2T -WP -LP 2lbs./909 grams (weight) Ordering Information Model Part No. Description RMS -1P 960672 Single -pole, single -throw w/pigtails Explosion -Proof Break Glass RMS -2T 960674 Double -pole, single-Virow wlterminal connecuuns RMS -IT -LP 960675 Dual action (lift/pull), single -pole, single -throw, terminals RMS -1T -WP -LP 960678 Weather-proof, single: pole, single throw, terminals, dual action RMS -2T -WP -LP 960679 Weather-proof, double: -pole, single throw, terminals, dual action RMS -EX -WP -LP 960680 Explosion -proof, double -pole, double -throw, terminals, dual action RMS -IT -KL 960677 Keylock reset, single -pole, single -throw, terminals RMS -IT -KL -LP 960681 Keylock reset, single -pole, single -throw, terminals, dual action RMS -IT -KO 960682 Key -operated, single -pole, single -throw, terminals, institutional 00 rICZAP07 Inrinnr hackhnY (ci one -P rnni int) (3.325W x 4.750'H x 1.75'D) GR 960684 Glass rod (used in all pull stations above) KY -15 960685 Keys, set of 2, for keylock reset and institutional pull stations RMS -IT -PS 960676 Pre -signal station, single -pole, single -throw w/extra key operated contact terminals KY -PR 960686 Keys, set of2, for pre -signal keyswitch RMS -IT -DAH 960683 Pull station, single -pole, single -throw with break glass adapter, terminals NOTE: Key -reset units are keyed the same as THORN Autocall control panels (reset key only). It does not apply to the pre -signal key -lock or the institutional station american a�CO security equipment jcompany SH24C-3075110 Select-A-Horn/Strobe® Ceiling and Wall Mount Combination Description: AMSECO's Ceiling and Wall mount Select-A-Hom/Strobe is designed to comply with the Americans with Disability Act (ADA) and meet UL Standard 1971 requirements for emergency signaling devices for the hearing impaired. The SH24C-3075110 Select-A-Hom/Strobe features a unique candela intensity field selector switch for changing the candela output. It provides three different settings, 30cd, 75cd and 110cd. The Horn provides two different field selectable tones, and a High / Low output setting that can be achieved with the use of mini jumpers located on back of the unit. The round housing design offers a low profile appearance and is clearly labeled with "FIRE" lettering to be view from all angles. These appliances are polarized for connecting to supervised fire alarm circuits. The strobe is designed with a xenon flashtube and provides a candela intensity field selector switch for maximum performance. The Ceiling mount Select-A-Horn/Strobe series is available in red and white housing 24V DC models. The SH24C-3075110 can be synchronized by using the SMD10-3A (daisy chain) Sync Module to comply with NFPA recommendations concerning photosensitive epilepsy when installing 2 or more visual appliances within the field of view. The strobe signals are listed for indoor use, ceiling and wall mount, under UL 1971 Standard. Strobe Selectable Candela Output: war—mmol-No-oh, �iR .. .300 roof ca Ordering Information: CORPORATE OFFICE & WAREHOUSE 228 East Star of India Lane, Carson, CA 90746 Phone (310) 5384670 * Fax (310) 538-9932 * (800) 421-1096 EAST COAST OFFICE & WAREHOUSE 30 Chapin Road 1207, Pine Brook, New Jersey 07058 Phone (973) 575-4433 * Fax (973) 575-5504 * (800) 526-1060 http://www.amseco-kai.com / e-mail: info@amseco-kai.com MEA, Pending Features: " Strobe field selectable settings 30cd 75cd or 110cd. • ADA/NFPA/ANSI compliant. " UL listed for Ceiling and Wall mounting under UL1971. * Screw terminal capacity up to 12 AWG. * Polarized strobes with wide listed voltage ranges using filtered DC or unfiltered FWR input voltage. • Horn field selectable tones: 3000 Hz interrupted or Electro -mechanical Temporal or Non -temporal High or Low dBA output * Meets ADA guidelines for minimum one flash per/sec (1 Hz). * All models mount to 4" square, back box. ' 24 volt strobe models 30, 75 or 110 candela intensity. • Tamper -proof candela selector switch. • Synchronization requires an AMSECO SMS1-3A or SMD10-3A (daisy chain) Sync Module. * Available in red or white housing. Horn Selectable Sound Output: cc Iwo Sm 13 Temporal Non -Temporal Electro Mech - 3000 Hz High Low Model Input Selectable Sync Mounting Horn Flash Housing Number Voltage Strobe Output Module Type Sound Rate Color (VDC) (Candela) Output (Times/min.) SH24C-307511 OR 24 30, 75, 110 SMD10-3A Ceiling/Wall Selectable 60 Red SH24C-3075110W 24 30 75 110 SMD10-3A Ceiling/Wall Selectable 60 White Engineering Specifications: The audible and visual alarm indicating appliance shall be AMSECO model SH24C-3075110 or equivalent device. The Strobe shall be listed under UL 1971 Standard for signaling devices for the hearing impaired and shall be approved for fire protective service. The candela output shall be field selectable, having a minimum of three (3) field selectable strobe intensity setting, 30cd, 75cd and 110cd output. All settings shall be UL1971 listed for both ceiling and wall mount applications. The Horn shall provide two different field selectable tones, and a High and Low field selectable sound output setting. The signaling Horn/Strobe shall operate on 24VDC from a non -coded regulated DC supply or full -wave rectified, unfiltered supply. The signaling strobe shall be designed to produce a signal flash of one flash per second with continuously applied minimum voltage. When strobe synchronization is required, the horn/strobe shall be compatible with the AMSECO SMS1-3A or SMD10-3A or other source of AMSECO sync protocol. The Horn/Strobe shall be capable of CEILING and WALL mounting to a universal back box. Signaling devices shall be installed as per plans and specifications. Light Output Dispersion: Qo qo LN 0 01 90° wl(j o Compound Compound a0 ° 90° � 450 / \ 450 �d qo p \ 0 00 900 ° 90° o ° 0 - Compound Compound Horn/Strobe Combination Wiring: Wired Without Audible Silence Feature: Sync Module F.A.C.P.To Next Device F.A.C.P. SMD10-3A `E P Signal +` To Next Device or Signal �. p. or End -Of Line- Circwt IN OUT • End -Of Line - Circuit Resistor + H+A­�+ + _ Resistor + + +fl 'The Sync module is rated for 3.0 amperes at 24 VDC. Signals Wired for Independent Operation: To Next Device or End -Of Line -Resistor Strobe Horn + F.A.C.P. + — + — T Focloly seWV wrnpels HORN / STROBE � -_� Il H II ) Wired for Audible Silence Feature: Strobe + 00 an Signal — Circuit Sync Module To Next Device or FAC.P. SMD1a3A sE F' To Next Device Strobe Signal Flom Signal t or End -Of Line - End -Of Line -Resistor circus Circuit INPUT OUTPUT Resistor Horn — Signal + + Circuit I LLt— WARNING: ` The Horn/Strobe must be used only on circuits with continuously operating voltage. DO NOT use strobe on coded or interrupted circuits in which the applied voltage is interrupted ON and OFF as the strobe may fail to flash. ' The applied voltage must be within its rated input voltage range. * Fuse ratings on signaling circuits must handle peak currents from all devices connected to those circuits. Horn/Strobe Current Draw Table: i=l0 =0 Horn Strobe 30cd Horn Strobe 75cd Horn Strobe 110cd PC -3 I PC2 Pattern Tone ELECTRO MECHANICAL NON -TEMP. 3000 Hz ELECTRO MECHANICAL TEMPORAL 3000 Hz ELECTRO MECHANICAL NON TEMP. 3000 Hz ELECTRO MECHANICAL TEMPORAL 3000 Hz ELECTRO MECHANICAL NON TEMP. 3000 Hz ELECTRO MECHANICAL TEMPORAL 3000 Hz PC1 VOlume CCC 3 2 1 16 V HIGH 1 1 1 160 LOW 1 1 0 138 HIGH 1 0 1 160 LOW 1 0 0 138 HIGH 0 1 1 160 LOW 0 1 0 138 HIGH 0 0 1 160 LOW 0 0 0 138 HIGH 1 1 1 218 LOW 1 1 0 201 HIGH 1 0 1 218 LOW 1 0 0 201 HIGH 0 1 1 218 LOW 0 1 0 201 HIGH 0 0 1 218 LOW 0 0 0 201 HIGH 1 1 1 273 LOW 1 1 0 256 HIGH 1 0 1 273 LOW 1 0 0 256 HIGH 0 1 1 273 LOW/ 10 1 0 256 HIGH 10 0 1 273 LOW 10 0 01 256 Average Current DC (mA) FWR HIGH Low Sound output (dBA(Z_DDC) 24V 33V 16V 24V 33V 16V 24V 33V 129 116 203 171 153 86 88 88 110 101 189 158 142 76 80 83 129 116 203 171 153 87 88 88 110 101 189 158 142 77 81 83 129 116 203 171 153 1 80 84 84 110 101 189 158 142 '73 76 79 129 116 203 171 153 82 84 84 110 101 189 158 142 74 77 79 170 148 276 221 195 86 88 88 151 133 262 208 184 76 80 83 170 148 276 221 195 87 88 88 151 1337 262 208 184 77 81 83 170 148 276 221 195 80 84 84 151 133 262 208 184 '73 76 79 170 148 276 221 195 82 84 84 151 133 262 208 184 *274 77 79 207 173 348 270 232 86 88 88 188 158 334 257 221 76 80 83 207 173 348 270 232 87 88 88 188 158 334 257 221 77 81 83 207 173 348 270 232 80 84 84 188 158 334 257 221 '73 76 79 207 173 348 270 232 82 84 84 188 158 1 334 257 221 274 77 79 Note: The low volume Temporal setting of *1 8 *2 at 16V FWR/DC are not suitable to use for Fire Alarm Public Mode (Suitable for General and Private Modes only). Strobe Only Current Draw Table: Current (n -A) DC FWR 16V 24V 33V 16V 24V 33V Average 126 90 72 175 136 113 @ 30cd Peak 225 218 167 421 355 341 In -Rush 254 298 338 402 418 458 Average 189 131 104 248 186 155 9 75cd Peak 304 222 212 562 464 454 In -Rush 306 342 374 540 478 498 Average 244 168 129 320 235 192 @ 1 10c Peak 418 2g8 208 680 572 532 In -Rush 386 398 430 644 580 548 Application: The SH24C-3075110 Ceiling Horn/Strobe Series is recommended for use in areas such as: meeting rooms, schools, corridors, apartments, office buildings, restaurants, hotels, and any other application where effective audible and visual waming are required by Federal, State, or local authority having jurisdiction. FkTstr Rate ELECTRO MECHANICAL HIGH Low 1 1 1 1 1 0 34 17 44 25 49 34 33 19 40 27 45 34 86 76 88 80 88 83 NON TEMP HIGH 1 0 1 34 44 49 33 40 45 87 88 88 3000 Hz Horn LOW 1 0 0 17 25 34 19 27 34 77 81 83 «nN ELECTRO HIGH 0 1 1 34 44 49 33 40 45 80 84 84 MECHANICAL LOW 0 1 0 17 25 34 19 27 34 "' 73 76 79 TEMPORAL HIGH 0 0 1 34 44 49 33 40 45 82 84 84 3000 Hz LOW 0 0 0 17 25 34 19 27 34 2 74 77 79 Note: The low volume Temporal setting of *1 8 *2 at 16V FWR/DC are not suitable to use for Fire Alarm Public Mode (Suitable for General and Private Modes only). Strobe Only Current Draw Table: Current (n -A) DC FWR 16V 24V 33V 16V 24V 33V Average 126 90 72 175 136 113 @ 30cd Peak 225 218 167 421 355 341 In -Rush 254 298 338 402 418 458 Average 189 131 104 248 186 155 9 75cd Peak 304 222 212 562 464 454 In -Rush 306 342 374 540 478 498 Average 244 168 129 320 235 192 @ 1 10c Peak 418 2g8 208 680 572 532 In -Rush 386 398 430 644 580 548 Application: The SH24C-3075110 Ceiling Horn/Strobe Series is recommended for use in areas such as: meeting rooms, schools, corridors, apartments, office buildings, restaurants, hotels, and any other application where effective audible and visual waming are required by Federal, State, or local authority having jurisdiction. FkTstr Rate 60 tN'ries / min Application: The SH24C-3075110 Ceiling Horn/Strobe Series is recommended for use in areas such as: meeting rooms, schools, corridors, apartments, office buildings, restaurants, hotels, and any other application where effective audible and visual waming are required by Federal, State, or local authority having jurisdiction. FkTstr Rate 60 tN'ries / min Dimensions: Inches (mm) 67/8 Room Spacing for Ceiling -Mounted Visible Appliances Minimum Light Output by Room Size (Non -Sleeping) m EO o M Mounting: 3-3/8 (85.7) g Room Spacing for Wall -Mounted Visible Appliances Minimum Light Output by room Size (Non -Sleeping) um Maximurrr Cellih Helght , 15 cd. � NA 30'X 30' 20'X 20' 15 cd. 30 cd. 55 cd. 30'X 30' 30 cd. 45 cd. 75 cd. 40'X 40' 60 cd. 8o cd. 115 cd. 50'X 50' 95 cd. 115 cd. 150 cd. Using the Sync Modules: The Sync modules are designed to provide a synchronized temporal pattern (code 3) tone, and synchronize the strobe flashes when used with AMSECO's line of Select -A -Strobe, Select -A -Horn, and Select-A-Horn/Strobe as well as the ability to silence the horn while maintaining the strobe flashes. The SMD10-3A has the capability of connecting two style Y (class B) circuits or one style Z (class A) circuit, and is rated for 3 amperes per circuit. The SMD 10-3A can be interconnected so that more than two alarm zones can be synchronized when connected using the SYNC terminals. (Daisy chain connection). The Max number of interconnected SMD10-3A modules is twenty (20). All input are polarized for compatibility with standard reverse polarity supervision of circuit wiring, when used with a Fire Alarm Control Panel (F.A.C.P.). Ordering Information: standard 4" square back box. � ;Maximum 4_ Dne strobe' Two Strobes Four' S �bt�s 20'X 20' 15 cd. NA NA 30'X 30' 30 cd. 15 cd. NA 40'X 40' 60 cd. 30 cd. 15 cd. 50'X 50' 95 cd. 60 cd. 30 cd. 60'X 60' 135 cd. 95 cd. 30 cd. 70'X 70' 185 cd. 95 cd. 60 cd. 80'X 80' 240 cd. 135 cd. 60 cd. 90' X 90' 305 cd. 185 cd. 95 cd. 100' X 100' 375 cd. 240 cd. 95 cd. 110' X 110' 455 cd. 240 cd. 135 cd. 120'X 120' 540 cd. 305 cd. 135 cd. 130'X 130' 635 cd. 375 cd. 185 cd. NA: Not allowable Model Input Maximum Average Mounting Color Number Voltage Load.r, Current Back.Box (VDC)' (Amps) ` (MA) .. SMS1-3A 24 3 9 4"x4"x1-1/7 Red SMD10-3A 24 3 9 4"AN1-1/2" Red The total current draw from all devices connected to the sync module should not exceed 3.OA, and should only be connected to circuits that provide continuously applied voltage. SMS1-3A or SMD10-3A: For a synchronization system, the maximum number of strobe lights that can be connected to a listed Fire Alarm Control Panel 3Amp Loop circuit is as follows: 14 (30cd, 16-33VDC) or 10 (30cd, 16-33V FWR) 13 (75cd, 16--33VDC) or 8 (75cd, 16-33V FWR) 11 (110cd, 16-33VDC) or 7 (110od, 16-33V FWR) The maximum wire impedance between any adjacent strobe light is 5.6 ohms. Due to continuous development of our product line, specifications are subject to change without notice. MAX. WIRE DISTANCE _ (IN FEET) PANEL 1 APPLIANCE J X WIRE CONDUCTIVITY TOTAL CURRENT DRAW WIRE CONDUCTIVITY 18AWG 60 16AWG 95 14AWG 153 12AWG 244 Includes wire to and from appliance. american security alm equipment fcompany SL24C-3075110 Select -A -Strobe Ceiling and Wall Mount Description: AMSECO's Ceiling and Wall mount Select -A -Strobe is designed to comply with the Americans with Disability Act (ADA) and meet UL Standard 1971 requirements for emergency signaling devices for the hearing impaired. The SL24C-3075110 Select -A -Strobe features a unique candela intensity field selector switch for changing the candela output. It provides three different settings, 30cd, 75cd and 110cd. The design provides tamper -proof caps for each candela setting with the rating engraved for easy identification located on front of the unit. The round housing design offers a low profile appearance and is clearly labeled with "FIRE" lettering to be view from all angles. These appliances are polarized for connecting to supervised fire alarm circuits. The strobe is designed with a xenon flashtube and provides a candela intensity field selector switch for maximum performance. The Ceiling mount Select -A -Strobe series is available in red and white housing 24V DC models. The SL24C-3075110 can be synchronized by using the SMD10-3A Sync Module to comply with NFPA recommendations concerning photosensitive epilepsy when installing 2 or more visual appliances within the field of view. The strobe signals are listed for indoor use, Ceiling and wall mount, under UL 1971 Standard. Strobe Selectable Candela Output: d OCd Tamper 3 proof cap Ordering Information: CORPORATE OFFICE & WAREHOUSE 228 East Star of India Lane, Carson, CA 90746 Phone (310) 538-4670 * Fax (310) 538-9932 * (800) 421-1096 EAST COAST OFFICE & WAREHOUSE 30 Chapin Road 1207, Pine Brook, New Jersey 07058 Phone (973) 575-4433 * Fax (973) 575-5504 * (800) 526-1060 http://www.amseco-kai.com / e-mail: info@amseco-kai.com u� u MEA & Pending Features: ' ADA/NFPA/ANSI Compliant. ' UL listed for Ceiling and Wall mounting under UL1971. • Screw terminal capacity up to 12 AWG. • 24V DC strobe with field selectable settings 30cd, 75cd, 110cd. • Polarized strobes with wide listed voltage ranges using filtered DC or unfiltered FWR input voltage. " Meets ADA guidelines for minimum one flash per/sec (1 Hz). * All models mount to 4" square, back box. * 24 volt strobe models 30, 75 or 110 candela intensity. * Tamper -proof candela selector switch. Synchronization requires an AMSECO SMS1-3A or SMD10-3A (daisy chain) Sync Module. Available in red or white housing. Strobe Wiring: Control Q� FiD To Next Device Panel t` �a or End -Of Line - Resistor + — Application: The SL24C-3075110 Ceiling Strobe Series is recommended for use in areas such as: meeting rooms, schools, corridors, apartments, office buildings, restaurants, hotels, and any other application where effective audible and visual warning are required by Federal, State, or local authority having jurisdiction. Model Input Selectable Sync Mounting Flash Operating Housing Number Voltage Strobe Output Module Type Rate Voltage Range Color (VDC) (Candela) (Times/min.) (VDC) SL24C-3075110R 24 30, 75, 110 SMD10-3A Ceiling & Wall 60 16 -- 33 Red SL24C-3075110W 24 30 75 110 SMD10-3A Ceiling & Wall 60 16-33 White The strobe is listed for indoor use with a temperature operating range of 32°F – 120°F (0°C – 49°C ) Engineering Specifications: The visual alarm indicating appliance shall be AMSECO model SL24C-3075110 or equivalent device. The Strobe shall be listed under UL 1971 Standard for signaling devices for the hearing impaired and shall be approved for fire protective service. The candela output shall be field selectable, having a minimum of three (3) field selectable strobe intensity setting, 30cd, 75cd and 110cd output. The signaling Strobe shall operate on 24VDC from a non -coded regulated DC supply or full -wave rectified, unfiltered supply. The signaling strobe shall be designed to produce a signal flash of one flash per second with continuously applied minimum voltage. When strobe synchronization is required, the strobe shall be compatible with the AMSECO SMD10-3A or other source of AMSECO sync protocol. The Strobe shall be capable of CEILING and WALL mounting to a universal back box. Signaling devices shall be installed as per plans and specifications. Light Output Dispersion: R IN 0 0 o, Compound ` j Compound V0 a _7_ 45° �' 4 5o o 0 �O 0 0 Compound Compound Current (mA) 16V DC 24V 33V 16V FWR 24V 33V @ 30cd Average 121 87 70 168 131 110 Peak 221 215 165 414 350 338 In -Rush 254 298 338 402 418 458 @ 75cd Average 183 127 101 240 180 151 Peak 298 218 209 554 458 450 In -Rush 306 342 374 540 478 498 @ 110cd Average 236 162 125 310 227 186 Peak 410 282 204 670 564 526 In -Rush 386 398 430 644 580 548 Using the Sync Module: 900 w'1(( Room Spacing for Ceiling -Mounted Visible Appliances Minimum Light Output by Room Size (Non -Sleeping) ?0° Wiring Terminals: Sync Module FA.c.P. SMD10-3A , SfRoeE HORN Si nal rt �• To Next Device or - o C r.. IN OUT i • End -Of Line- 0 0 Resistor + — H+H- t — + — o 0 + — 'The Sync module is rated for 3.0 amperes at 24 VDC. Dimensions: Inches (mm) o 9 WARNING: The Strobe must be used only on circuits with continuously operating voltage. DO NOT use strobe on o coded or interrupted circuits in which the applied voltage is interrupted ON and OFF as the strobe may fail to flash. ' The applied voltage must be within its rated input voltage range. ' Fuse ratings on signaling circuits must handle peak 1-13/32 (35) currents from all devices connected to those circuits. 67/8 (174) 2-25132 (70) 1 Mounting: standard de0.. ��Q 4" square oQ Coo back box. elgh�� X10 ellen 20, Celhng, erSfze 20'X 20' 15 cd. 30 cd. 55 cd. 30'X 30' 30 cd. 45 cd. 75 cd. 40' X 40' 60 cd. 80 cd. 115 cd. 50'X 50' 95 cd. 115 cd. 150 cd. Wiring Terminals: Sync Module FA.c.P. SMD10-3A , SfRoeE HORN Si nal rt �• To Next Device or - o C r.. IN OUT i • End -Of Line- 0 0 Resistor + — H+H- t — + — o 0 + — 'The Sync module is rated for 3.0 amperes at 24 VDC. Dimensions: Inches (mm) o 9 WARNING: The Strobe must be used only on circuits with continuously operating voltage. DO NOT use strobe on o coded or interrupted circuits in which the applied voltage is interrupted ON and OFF as the strobe may fail to flash. ' The applied voltage must be within its rated input voltage range. ' Fuse ratings on signaling circuits must handle peak 1-13/32 (35) currents from all devices connected to those circuits. 67/8 (174) 2-25132 (70) 1 Mounting: standard de0.. ��Q 4" square oQ Coo back box. Scope of w Address: Owner: �— Contractor: BREMERTON BUILDING DEPARTMENT I Inspection Report • �C�iYI/1. �OIr t�' a% Permit Number: 62 FOUNDATION Phone: Phone: 1;7 COMMENTS: FOOTINGS APPROVED: '13 —�'� WALLS APPROVED: CoANAi f% Electrical approved Plumbing & mechanical approved Crawl space access (min. 18 x 24) Floor joists and beams/proper clearance to earth Positive connections posts & beams Foundation vents Posts properly supported Anchor bolts; nuts & washers in place Mudsill: treated material Floor joists: size & span Beams/girders: size & span Notching & drilling: joists & beams, studs Smoke detectors: all required locations Exhaust fans: where required Exhaust fans insulated: unconditioned space Whole house fan, outside air intakes each bedroom Fans terminating directly outside Range hood Dryer exhaust vent All vent terminations: windows & property line Fireplace combustion air Windows: meets egress requirements Windows: proper U valve Windows: safety glazed where required Ceiling heights Stairs: headroom clearance Stairs: rise & run; proper width Fire blocking: stairs, soffits, lowered ceilings Fire blocking wall to ceiling, furred walls every 10' Fire blocking: tubs/showers Fire blocking: lids in void spaces, shafts Fire blocking: stuff holes top & bottom plates Sheet rock backing Wall bracing Rafters size/notching Trusses: specs, bracing Attic access Attic ventilation Wall & roof sheathing Shear nailing Building dried in COMMENTS: APPROVED: ENERGY CODE COMPLIANCE Insulation: proper R valve Insulation: proper fastening Insulation: vapor barrier Bottom plates caulked to floors Penetrations caulked as required Electrical boxes Basketed or caulked 6 mil black poly in crawl space COMMENTS: i. UNDER FLOOR/FOUNDATION INSULATI APPROVED: WALL INSULATION APPROVED: 2 -6-6CEILING INSULATION APPROVED: MECHANI[:AI Appliance location and access, proper support Appliance clearance to combustibles Venting: clearance to combustibles Venting: size & support Vent termination Combustion air Ducts: size & support Gas pipe under test Gas pipe size & support Gas pipe: underground min. 12" below grade Gas pipe: within 6" or underground -coated Gas shutoff within T of appliance Gas logs: safety shut-off Gas logs: damper permanently open Wood stoves EPA certified Wood stoves & fireplaces: Tight -fitting doors Wood stoves & fireplaces: proper health Manufacturer's specs on site Chimney liner: when required Chimney: separate flues when required COMMENTS: GAS PIPING APPROVED: OTHER APPLIANCES APPROVED: PLUMBIN(2 FURNACE APPROVED: DWV & water piping under test DWV: proper grade DWV: proper sizing DWV: proper drainage fittings where required DWV & water piping proper support DWV: required cleanouts Vent termination All fixtures vented properly Water supply: proper sizing Shut-off valves on all fixtures Water heater: gate valve on cold water supply Vacuum breakers: where required Water heater relief valve drain to outside Water heater: seismic strap R-10 pad under water heater when required Water -piping insulated as required Grease traps/interceptors: where required Proper indirect wastes: where required COMMENTS: PLUMBING GROUNDWORK APPROVED: PLUMBING ROUGH -IN APPROVED: SHEETROCK Proper fastening nails - 7" o.c. horiz. Plane Nails 8" o.c. vertical plane Proper fastening screws 12" o.c. horiz. Plane (1/2") Screws - 12" o.c. horiz. plane (1/2') 24" o.c. framing Proper fastening: screws - 16" o.c. vert. Plane (1/2") Screws - 12" o.c. vert. plane (1/2") 24" o.c. framing Proper fastening screws - 12" o.c, horiz. plan (5/8") Screws - 12" o.c. horiz. plane (5/8') 24" o.c. framing Proper fastening screws - 16" o.c. vent. Plane (5/8") Screws - 12" o.c. vert. Plane (5/8") 24" o.c. framing Area & occupancy separation walls Draftstops where required Usable space under stairs (5/8" required) Waterboard where required (not on ceiling) Corridors COMMENTS: SHEETROCK APPROVED: FINAL Energy code requirements met, exhaust fans Plumbing & mechanical Garage/dwelling door self closing solid core Smoke detectors where required Handrails & guardrails, as required Fire ratings maintained Exit signs when required Emergency lighting when required Occupant load posted when applicable Building weatherlight Wood siding to earth separation (6") Building address posted Randon monitor when required • os-cxWWy }G' DING DRART�;^i ;�v Pro Deskin P.O. Box 699 Tracyton, Washington 98393-0699 Phone & FAX (360) 377-1026 Memo January 24, 2003 �'�� To: Mike Miller ; Company: Rice Fergus Miller Architects 360-792-1385 2672 From: Jay Bartram, SE., PE.��r'' SfONAL Subiect: New Beams & Columns,--y�--- Harrision Rehab Renovation EXPIRES have enclosed 3 sketches showing the new beams and columns to replace the bearing walls scheduled for demolition in this building. The existing long span roof framing consists of open web wood chord / metal tube web joists with fir double 2x4 chords that are on the order of 45" deep (not verified if tapered) and spaced 48" maximum on center. The lower roof consists of TJI framing at 24" oc. The indicated framing is only shown in a schematic nature. Based on a roof live load of 30 PSF and a dead load of 15 PSF the bearing wall may be replaced with a line of 6X6 posts and a GLB beam. The GLB is to be installed in a 2 span condition located so both the open web and TJI rafters bear on the beam, the open web joists should have a minimum 2.5" bearing onto the beam. Locate the end posts centered under the girder truss, the other posts may be aligned with the existing walls, however no span may exceed 10'-3" between posts. The 6x6 posts may be toe nailed with (8) 16d nails to the beam and subfloor. In the crawl space provide a built up multiple stud post of at least the same area as the 6x6. Verify that the existing footing is at least 8"x16". Notify our office if there are any discrepancies from the above. Where new footings are indicated, it is recommended to cut a small access hole nearby to place the concrete. Provide 2 #4 each way in footings larger than 20" square. Square footings may be an equivalent round by area and may be bagged concrete with no inspection. Provide a post from the footing to the floor sheathing the same size as the post above. Two girder trusses may need web blocking if the post does not align with the web member work points, see the sketch. Please call if there are any questions. Encl: 3 sketch CC: Ron Hutch Con Construction 871-2929 oa, i' r EB 2003 D BREMERTON BUILDING DEPARTMENT I I I I I FTG 8"x181" SO I I I I I 0R 200 1 BLOCK TRUSS PER DTL r ---I I I FTG 8"x18 I I OR 200 I I L— COMM. THERAPIST o CLOSET OFFICE 105 ELL E — — — — �nnrr ID ���sd V E D 2003 BREMERTON BUILDING DEPART(AENT Ll - RECEPTION E Im2 F. 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Cl) O O (0 M N� M l0 N O R 7 Cl) Cl) M Q~ a C 0 0 0 (O O 00 O O N N N N _ m W N m N m m m m Q~ C N (o0 r N O o (00 N W � ' m� M M N (O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O J W O O O O O O O O O O O 0 0 0 0 0 0 0 0 0 0 0 0 0 Q oc (o ro ro 0( oc co 00 (o (o (o ro 3 d . j0' N N N 0 N N 0 N N N N J lL 0- (0 W O O o O (D O O (O a O LL C 0) O N rn rn rn N J Q O a 'H O 0 0 0 0 0 0 0 (0A 0 0 J LL a 7 7 V Vi V_ N R N O t+l V J N N N N N a N N 0 J 0 ao 2 J S Nm O m - O U S Ux x N x N X X Q O Q M e- X V N W'T N N (O H N N N N J # * J N -=3 N m m> CO m LL LL LL N H N U' U' J 0 U C, 0 O J O F N m m m w J co X w aQ mixoof F- F U w N it a M _ w 0 c7 V) o>jzwaLLz-' L p 2_ O Z @ D m LL 2' O i O OU m U m D 7 r 4 2003 D gUfL� NG MERTON U PARTtIEW 01/20/2003 12:08 FAX. 3607926552 G0*4 cx-c ( n AJ -5 cPR SERVICE AI» FACILITIES DESIGNL� i11 44- c BACKF-LOW ASSENT-BLY TEST REPOR-• D-EVICE A/(r',NUFACTUREF, f! titODE 4 S ,T S -c u - ti Y.. M PRESS= AT TWE OF T3-=l&o . LBS_ TYPE OF DEtiZ(--= PRESSURE DROP ACROSS FZ�.SI" CRECK VALVE ' 3 LBS_ Ecc;EIv� jAN BREMERT N BUILDING DEPA T CHECK VALVE � i Ch�CK VALVE s 3 DE-r"c. TLaL PRESSiJRE IIy.�L�E L.LD...----•---, D -------•---•- a opti-En AT.LS REDUCED CLCISED TICHT-- CLOTIGUT..- PR£SSL`RE PSID psm DID NOT REPAIRS FFPAMU-s RF -'-AIRS CIF-A'�D........ CL_E_ IN-ED--..-----•--Gi CLF-A-'�eI7__--•--- - C RES LACED- REPLACED- R-?L4CEt1. - D15C--•---------••---.= DISC. ---.-..--••-_.T DLSC �RL�1G..-•---------�-r `-�'�"`'G----------•----= LOWER....---�-•---- GLIDE.- CI..ME........ -••------C S2R1tiCr.._.._..__ ..-..-------�.�.------_ PIN RSI; -L. P24 R-CT.4L`1 - -- G DL�PL�L GLV LAa---- -- __.- - - FINGE PIN ............ LLm% C'm PN ------------ LPD` ------------------------- ------ _- SFr�T_...._.......�._r LOW? -- -- -= DL4_ofMAGiM - ------------------ -------_- - DEs=F 07ZE , DFSCRJBc= L•PPM-•------------------- •-----•----- LOWS.: ------------• ._.._ -- Sc.- 0T='E"ZL OE;-= E: FLKA TEST FINAL IES - FOAL- TEST CLOSED TIGHT-_ Cl CLOSED -nrai- T.-- a OPE,ti-ID AT LBS R -DUCED PRESSURE A-%EITNMLY PASSF-D....... .8--ASSEl�E$LY FACED........_- CALMRAMN OF TF -ST EQUMNEE: T DATE -S N tkn QF EQUiPMF_ iT 1M I,Vr1 t , SPrT � Sr-RI.d.I-'.3 TI A-80VE REPORT ZS CER7MED TO BE TRUE DS 1MTIAL TEST` PERFORMED BY� Z4jj ���,► CERT.OE 3A 0 �A-I-E ` r REPAIRS BY DATE FIrIAL Tk-= PERFOR-NEED BY cERT. 4 DATE__ ADVANCED SPECIALTY SERVICES P4. Box 342 10ogsWn, WA 9EQ4$ MM Qui-AGlIR Certificate of occupanc'? pepartment of Commun2ip,Ibebefoprrceni 746a WS416mrc a&wd����.��7os� zuow,� ga&may Bode, a.a 4 tie Sgwg� ( we' wTrz w t1at at tie tume 4 a a u= tw atzuezzw a," cN d&aA&"w a'.a &�w9a&�" cowtwe'�Ig="e. ISSUED TO: HARRISON MEMORIAL HOSPITAL REHAB SITE ADDRESS: 2,625 WHEATON WAY MEDICAL ARTS BUILDING Type of Occupancy Occupant Construction Classification Load Common Use VN B 72 REHAB Permit Number: Date: 02-0664i' _� ` , 7-31-03 1 r kr r CHRISTOPHER HUGO, DIRECTOR Special Conditions: 5"N' Iit.1 'iiS Owner= HARRISON HOSPITAL_ (LEASEE) 792-6550 2520 CHERRY AVE BREMERTON WA 98310 Contractor. HUTCH CON CONSTRUCTION INC 871-6188 Lic 0 HUTCHCC075LP Exp: 06-26--2004 PO BOX 432 MANCHESTER WA 98353 Subcontr: Desc= INTERIOR RENOVATIONS TO AN EXISTING MEDICAL OFFICE FOR A NEW REHAB CENTER FOR HARRISON HOSPITAL ! HCM(�C*M1:K�KJR�C%KHCyC:.�?K�(MC*�:����K'�YFHC�C��:�CHC�KW�CAC*71•aK'KHt�C71C�fW.*�C�C�C%C?KXC�:.ik�C�:�C*AKN*:�C�(JICS:XCYfXt7K�(W.*�7K:KN:BCW..k::K7K%:�CJK*�l;(iW�C:K:K�C*MC Valuation * Permit Fees: 11511.05 Total Calculated Fee: 2,416.29 170,000.00 Plan Check Fees: 900.74 Additional Fees= .00 * Other Fees: 4.50 Total Permit Fee. 2,416.29 MECHANICAL/PLUMBING FIXTURES— MECH-Range..................... I MECH--Exhaust Fans ............ . 2 MECH-•Range Hood (ies)......... I PLBG-Lavatory................• 2 PLBG-Kitchen Sink............. 3 PLBG-D! shwasher.....,_......... 1 F'LB6--Water Heater ............. 1 PLBG-{7rinkine Fountain........ 1 This permit shalt r;crr:xrwx ro_11 :arid void if kha buildirr� or work authorized by this permit is not commenced within 180 days from the date of such permit, or if this building or work authorized by such permit is suspended or abandoned at any time after the work is commenced for a period of 184 days. NOTICE - It is th responsibility of the permit holder, not the City of Bremerton or Buildiro Official to see to it that required inspections are made. The permit holder must notify the Building Official when ready for inspections. Failure of the permit holder to notify the Building Official of required inspections may result in the stoppage of the work until such time that the permit holder can substantiate to the building official that the concealed work meets or exceeds code requirements. Any demolition, testing, or financial burden shall be borne directly by the permit holder. Failure to substantiate code requirements will indemnify the City against any and all responsibility or liability connected with the construction. I hereby certify that I have read and examined this permit and know the same to to true and correct. All provisions of laws and orTper es governing this type of work will be complied with whether specified herein or not. The granting of it,does-n9t presume to give authority to violate or cancel the provisions of any other state gf-Wa,1_w, egulatIA6 construction or the performance of construction. Signatu pate:% Z'A e t I certify tha- I am exempt from the requirements of the state contractor's registration law, under Section 3, Chapter 126, laws of 1967. SignatUYet....__._.._..._.......,._.._.._.._...�.....___.�......._...__.._......_._._......�....._..._...,....._.._.__....._.._...._............._. �Jat.f?=..,_._.._._.r.....�,..._..�_..�__.__..._.....__._,..._..�........._..,......�._ �:X(*7K��YMC?R**1K�C�+KJK*1KMC1Kk:1K*�K*�I:�k1K Permit Center --Approved B _ __. Date 0 E3REMFEE FRT[JPERM=T GF-L"-TFF_ tZ 286 4th Street, Bremerton, WA 98337 Phone: ( 360) 478-5275 FAX: ( 360 ) 478-5278 BUILDING PERMIT Job Addr= 2625 WHEATON WAY Permit No: 02-•0664 Location= HARRISON HOSPITAL REHAB CENTER Status. ISSUED Parcel Not Applied: 10/21/2002 Issued: 12/06/2002 Applicant, HARRISON HOSPITAL (RAM PRASAO) 792-6550 Expires: 06/04/2003 2520 CHERRY AVE BREMERTON WA 98310 Owner= HARRISON HOSPITAL_ (LEASEE) 792-6550 2520 CHERRY AVE BREMERTON WA 98310 Contractor. HUTCH CON CONSTRUCTION INC 871-6188 Lic 0 HUTCHCC075LP Exp: 06-26--2004 PO BOX 432 MANCHESTER WA 98353 Subcontr: Desc= INTERIOR RENOVATIONS TO AN EXISTING MEDICAL OFFICE FOR A NEW REHAB CENTER FOR HARRISON HOSPITAL ! HCM(�C*M1:K�KJR�C%KHCyC:.�?K�(MC*�:����K'�YFHC�C��:�CHC�KW�CAC*71•aK'KHt�C71C�fW.*�C�C�C%C?KXC�:.ik�C�:�C*AKN*:�C�(JICS:XCYfXt7K�(W.*�7K:KN:BCW..k::K7K%:�CJK*�l;(iW�C:K:K�C*MC Valuation * Permit Fees: 11511.05 Total Calculated Fee: 2,416.29 170,000.00 Plan Check Fees: 900.74 Additional Fees= .00 * Other Fees: 4.50 Total Permit Fee. 2,416.29 MECHANICAL/PLUMBING FIXTURES— MECH-Range..................... I MECH--Exhaust Fans ............ . 2 MECH-•Range Hood (ies)......... I PLBG-Lavatory................• 2 PLBG-Kitchen Sink............. 3 PLBG-D! shwasher.....,_......... 1 F'LB6--Water Heater ............. 1 PLBG-{7rinkine Fountain........ 1 This permit shalt r;crr:xrwx ro_11 :arid void if kha buildirr� or work authorized by this permit is not commenced within 180 days from the date of such permit, or if this building or work authorized by such permit is suspended or abandoned at any time after the work is commenced for a period of 184 days. NOTICE - It is th responsibility of the permit holder, not the City of Bremerton or Buildiro Official to see to it that required inspections are made. The permit holder must notify the Building Official when ready for inspections. Failure of the permit holder to notify the Building Official of required inspections may result in the stoppage of the work until such time that the permit holder can substantiate to the building official that the concealed work meets or exceeds code requirements. Any demolition, testing, or financial burden shall be borne directly by the permit holder. Failure to substantiate code requirements will indemnify the City against any and all responsibility or liability connected with the construction. I hereby certify that I have read and examined this permit and know the same to to true and correct. All provisions of laws and orTper es governing this type of work will be complied with whether specified herein or not. The granting of it,does-n9t presume to give authority to violate or cancel the provisions of any other state gf-Wa,1_w, egulatIA6 construction or the performance of construction. Signatu pate:% Z'A e t I certify tha- I am exempt from the requirements of the state contractor's registration law, under Section 3, Chapter 126, laws of 1967. SignatUYet....__._.._..._.......,._.._.._.._...�.....___.�......._...__.._......_._._......�....._..._...,....._.._.__....._.._...._............._. �Jat.f?=..,_._.._._.r.....�,..._..�_..�__.__..._.....__._,..._..�........._..,......�._ �:X(*7K��YMC?R**1K�C�+KJK*1KMC1Kk:1K*�K*�I:�k1K Permit Center --Approved B _ __. Date 0 a,r BLDG Division: Dept: BLDG E3REP4ETX Tf3N P'ERtyl = T CENTER BLDG Division: 286 4th Street, Bremerton, WA 98337 Division: Dept: Phone: ( 360) 478-5275 FAX: ( 360) 478-5278 Dept: BLDG Division: Dept: r Division: Dept: Building Permit No: 02--0664 .lob Address: 2625 WHEATON WAY Status: ISSU Location: HARRISON HOSPITAL REHAB CENTER Issued: 12/06/'2002 Assr Acct No: Expires: 06/04/2003 R E Q U I R E D I N S P E C T I O N S Item: 01400 MECHANICAL Item: 01600 PLUMBING ROUGH -IN ,Item: 01700 FRAMING Item= 01800 INSULATION Item: 02150 CROSS CONNECTION CONTROL_ Item: 01900 SHEETROCK NAILING Item: 02701 F=INAL_. -FIRE. Item: 02700 FINAL --BLDG Dept: BLDG Division: Dept: BLDG Division: Dept: BLDG Division: Dept: BLDG Division: Dept: CROSSCC Division: Dept: BLDG Division: Dept: FIRE Division: Dept: BLDG Division: TENTING: Must be recognized by the Washington Association of Building Officials SPECINSP: Must be registered with the State of WA ST OF WA: State of WA Dept. of Labor and Industries 478-4921 HEALTH: Bremerton/Kitsap Health District 478--5235 'xY ALL INSPECTIONS PERFORMED BY THE CITY OF BRE.MERTON MUST BE: SCHEDULED THROUGHAN& PERMIT CENTER, ( 360) 478--5 -q:)5. Permit Holder's Signature: Date:_.. .a 1 - �0.0 BREMERTON�PERMIT �CENTER V PERMIT CONDITIONS Permit No: 02-•0664 Page". 2 DETERMINE WHETHER THERE ARE ASBESTOS -CONTAINING MATERIALS IN THE WORK AREA OR STRUCTURE. THE ASBESTOS SURVEY MUST BE CONDUCTEDBY AN EPA CERTIFIED (AHERA) BUILDING INSPECTOR (EXCEPT RENOVATION OF OWNER -OCCUPIED SINGLE FAMILY RESIDENCES). FOR MORE INFORMATION, PLEASE. CONTACT CLEAN AIR AGENCY THROUGH THEIR WEB SITE AT www.pseleanair.orrg OR BY PHONE. AT 800-552---3565 OR 206--689-4058. THE L&I WEB SITE CAN BE FOUND AT www.lrii.wa.gore/wisha/p-t.s/asbestos/asbestos.htm. 4. LAND USE CONDITION OF APPROVAL: (A) APPROVED AS jak�G AS BUILDING FOOTPRINT IS NOT' ALTERED. is ... Permit Holder's r �� Da to Permit No: 02--0664 BREMERTON PERMIT CENTER F PERMIT CONDITIONS Page; 1 Job Address: 2625 WHEATON WAY Applied: 10/21/200 Assr Acct No: Approved: 12/06/200 Location: HARRISON HOSPITAL REHAB CENTER Issued: 12/06/200 Applicant: HARRISON HOSPITAL (RAM PRA`.:AD) Owner: HARRISON HOSPITAL (LEASEE) Contractor: HUTCH CON CONSTRUCTION INC Description: INTERIOR RENOVATIONS TO AN EXISTING MEDICAL OFFICE FOR A NEW REHAB CENTER FOR HARRISON HOSPITAL Conditions: 1. A)Alter fire alarm system to maintain NFPA 72 requirements B)Double key deadbolts not allowed, use deadbolt. with interior thumb release. C)Meet or exceed UBC Chapter 10, "Egress" requirements D)Submit fire alarm plans for fire department approval E )Knox box required for after hours access F)Fire alarm system shall be functional during and after construction phase G)Fi.re extinguishers required per UFC 10--1 H)Address numbers required on street side of the structure in a contrasting color 1.)Contact 478--5385 or 478-5384 with questions CROSS2. CONNECT I ON CONTROL A)Upgrade fire line to incluce an approved double detector check valve assemlby. Bypass meter shall be Invensys brand 3/4" XS/8" in cubic feet X IOU. Meter must be equipted with radio read system 505MXU. B)A cross -connection inspection is required at final inspection. please contact Earl Varner @ 360-478-5927 for questions and inspections. NOTE: ALL APPROVED BACKFLOW ASSEMBLIES MUST BE ON THE CURRENT" WASHINGTON STATE DEPARTMENT OF HEALTH APPROVED ASSEMBLY LIST AND MUST" BE TESTED AT THE TIME OF INSTALL- ATION, WHENEVER MOVED OR SERVICED, AND ANNUALLY. TESTS MUST BE PERFORMED BY A CERTIFIED WASHINGTON STATE BACKFLOW ASSEMBLY TESTER. TEST REPORTS MUST BE SENT' TO BREMERTON PUBLIC WORKS AND UTILITIES, ATTN: CROSS CONNECTION CONTROL, 100 OYSTER BAY AVENUE, BREMERTON, WA 98312. PRIOR TO PERFORMING ANY RENOVATION OR DEMOLITION WORK, PUGET SOUND CLEAN AIR AGENCY (CLEAN AIR AGENCY) AND WASHINGTON DEPARTMENT OF LABOR AND INDUSTRIES (L&f) REGULATIONS REQUIRE AN ASBESTOS SURVEY BE PERFORMED TO t RECEIPT 11 RE CE; :IPP Number, 02f)C 1081. Amount., 1.51.5.55 12/06/02 15: ,42 P,,yment hethod� CHECK Notation" HARRISON HOSP Irrit.", Pi.. Pe fni.t No. 02-06(..,4 TYE's: BLOC BLDG EarERMIE' W%MEC'H/P Site Address- 2625 WHE:A1ON WAY Location. HARRISON HOSPITAL REHA3 CENTER Total Fees: 2,416.29 This Payment 1,515.55 Total ALL Pints= 2,416.29 Balance= ..00 A,cc=t ttftt 'Coyle Description Amount (2211) BUILDING PERMIT FEES 488'..01 I64,345.8300 (4580) SUILDING PLAN CHF'CK FEES 900-4 16-322.1005 (2.2151 MECHANICAL PERMIT FEES 59.3O 1.6-322.1003 (?213) PLUMBING PE4RMI E FEES 66.00 643•-237.13 (0236). 4TATE OF WA SURCHARGE. 4.50 r 11 � t 4 1 4 E3 R E M E R T O N P E R M= T CC FEE" T E R 286 4th Street, Bremerton, WA 98337 Phone: ( 360 ) 478-5275 FAX: ( 360 ) 478-5278 BUILDING PERMIT Job Addr: 2625 WHEATON WAY Permit No: 02--0664 Location: HARRISON HOSPITAL REHAB CENTER Status: PENDING Parcel No: Applied: 10/21/2002 Issued: Applicant: HARRISON HOSPITAL (RAM PRASAD) 792-6550 Expires: 2520 CHERRY AVE BREMERTON WA 98310 Owner: HARRISON HOSPITAL (LEASEE) 792-6550 2520 CHERRY AVE BREMERTON WA 98310 Contractor: HUTCH CON CONSTRUCTION INC 871-6188 Lic #: HUTCHCCO75LP Exp: 06-26-2004 PO BOX 482 MANCHESTER WA 98353 Subcontr: Desc: INTERIOR RENOVATIONS TO AN EXISTING MEDICAL OFFICE FOR A NEW REHAB CENTER FOR HARRISON HOSPITAL Valuation Permit Fees: 1,511.05 Total Calculated Fee: 2,416.29 170,000.00 * Plan Check Fees: 900.74 Additional Fees: .00 * Other Fees: 4.50 Total Permit Fee: 2,416.29 MECHANICAL/PLUMBING FIXTURES-- MECH-Range.................... 1 MECH-Exhaust Fans............. 2 MECH-Range Hood (res)......... 1 PLBG-Lavatory................. 2 PLBG-Kitchen Sink............. 3 PLBG--Uishwasher..........� 1 PLBG-water Heater ............. 1 KEG-Dri ing Fountain 1 � a This permit shall become null and void if the building or wo k authorized by this permit is not commenced within 180 days from the date of such permit, or if this 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. NOTICE - It is the responsibility of the permit holder, not the Qi ty of Bremerton or Building Official to see to it that required inspections are made. The permit holder must not 'fy t gilding Official when ready for inspections. Failure of the permit holder to ratify the Build' ic'a of quired inspections may result in the stoppage of the work until such time that the permi r c bst fate to the building official that the concealed work meets or exceeds code re ir�ients. A Jemo�i ib , testing, or financial burden shall be borne directly by the permit holder.jiiabil��y io(bsta k�tee requirements will indemnify the City against any and all responsibility or n. ed wilt construction. I hereby certify that I have read and ened this p�r it and k' Q to be true and correct. All provisions of laws and ordinances governing this type of work will kiec lied with whether specified herein or not. The granting of a permit does not presume to give authorit to violate or cancel the provisions of any other state or local law regulating construction or the performance of construction. Signature: I certify that I am exempt from the r Section 3, Chapter 126, laws of 1967. Signature. Permit Center --Approved �K�e Date" the,State contractor's registration law, under Gate' to �✓ / ��-� F2EMEF2-IF OR! PERM I T 4--ENTEF2 286 4th Street, Bremerton, WA 98331 0-, Phone: ( 360 ) 478-5275 FAX: ( 360 ) 478-5278 l C) ' BUILDING PERMIT 25 WHEATON WAY Permit No: 02--0664 ,ARRISON HOSPITAL REHAB CENTER Status: PENDING Applied: 10/21/20( Issued: HARRISON HOSPITAL (RAM PRASAD) 792-6550 Expires: 2520 CHERRY AVE BREMERTON WA 98310 weer: HARRISON HOSPITAL (LEASEE) 792-6550 2520 CHERRY AVE BREMERTON WA 98310 ,tractor: HUTCH CON CONSTRUCTION INC 871-6188 Lic #: HUTCHCC075LP Exp: 06-26-2004 PO BOX 482 MANCHESTER WA 98353 Subcontr: Desc: INTERIOR RENOVATIONS TO AN EXISTING MEDICAL OFFICE FOR A NEW REHAB CENTER FOR HARRISON HOSPITAL Valuation * Permit Fees: 1,511.05 Total Calculated Fee: 2,416.29 170,000.00 Plan Check Fees: 900.74 Additional Fees: .00 Other Fees: 4.50 Total Permit Fee: 2,416.29 MECHANICAL/PLUMBING FIXTURES-- MECH-Range.................... 1 MECH-Exhaust Fans....... ---� MECH-Range Hood (res)......... 1 PLED -Lavatory ................. 2 PLBG-Kitchen Sink....... . 3 yPLBG-Dishwasher............... 1 PLBG-Water Heater............. 1 PLBG-Drinking Fountain.,...... 1 R This permit shall become null and void if the building or work authorized by this permit is not nced within 180 days from the date of such permit, or if this building or work authorized by such permit is su ded or abandoned at any time after the work is commenced for a period of 180 days. NOTICE - It is the responsibility of the permit holder, not the City of Bremerton or Building Official to see to it that required inspections are made. The permit holder must notify the Building Official when ready for inspections. Failure of the permit holder to notify the Building Official of required inspections may result in the stoppage of the work until such time that the permit holder can substantiate to the building official that the concealed work meets or exceeds code requirements. Any demolition, testing, or financial burden shall be borne directly by the permit holder. Failure to substantiate code requirements will indemnify the City against any and all responsibility or liability connected with the construction. I hereby certify that I have read and examined this permit and know the same to be true and correct. All provisions of laws and ordinances governing this type of work will be complied with whether specified herein or not. The granting of a permit does not presume to give authority to violate or cancel the provisions of any other state or local law regulating construction or the performance of construction. Signature: Date: I certify that I am exempt from the requirements of the state contractor's registration law, unde D v Section 3, Chapter 126, laws of 1967. OCT 2 5 2002 UUU Signature' Date- Permit Center --Approved By: ctr-,_ Date: OREMERiON BUILDING DEPARTMENT EtRaMERTC3" 1=11ERM I T CENTER 286 4th Street, Bremerton, 4WA 98337 Phone: ( 360) 478--5275 FAX: ( 360) 478-5278 BUILDING PERMIT ,a Addr: 2625 WHEATON WAY Permit No: ocation: HARRISON HOSPITAL REHAB CENTER Status: r'arcel No: Applied: issued: Applicant: HARRISON HOSPITAL (RAM PRASAD) 792-6550 Expires: 2520 CHERRY AVE BREMERTON WA 98310 Owner: HARRISON HOSPITAL (!EASES) 792-6550 2520 CHERRY AVE BREMERTON WA 98310 02-0664 PENDING 1.0/21/2002 Contractor: HUTCH CON CONSTRUCTION INC 871-6188 Lie #: HUTCHC:C075LP Exp: 06-26-2004 PO BOX 482 MANCHESTER WA 98353 Subcontr: Desc: INTERIOR RENOVATIONS TO AN EXISTING MEDICAL OFFICE FOR A NEW REHAB CENTER FOR HARRISON HOSPITAL Valuation * Permit Fees: 1,511.05 Total Calculated Fee: 2,116.29 170-000.00 * Plan Check Fees: 900.74 Additional Fees: .00 Other Fees: 4..50 Total Permit Fee., 2,41.6.29 MECHANICALiPLUh1fTW FIXTLAM'S--- t -C , nye.. ........ I HECH-Exhaust Fans...........,., 2 !1ECH-r?anye "kxad (res) ..... 1 Pi- -Lavatory.... . ........ 2 PLaG-Kitchen Sink. ........... 3 PLM -Dishwasher........... I 66—Water Heater... ......... 1 FILSG-Drinking F�ount�ai*n....... 1 - \ i � I This permit shall become null and vox if the tuilding or work authrrized by this Permit is rrot commenced within 180 days from the date r_�f such ,permit or if this building or work authorized by such permit is suspended or abandoned at any time after the work i carmenced for a period of 180 days. NOTICE. - It is the responsibility of th permit holder, not the City of Bremerton or Building Official to see to it that. required inspections are made. The Permit holder must notify t{ie Building official when ready for inspections. Failure of the permit hnlder to notify the Building Official of required inspections may result in the stoppage of the work until such ti. met t the! permit holder,ogn substantiate to the building official that the concealed work meets or exceeds code requ' _ demolition, testing, or, financial burden shall be borne directly by the permit holder. Failure to s+..ibstarrtiate code requirements will indemnify the City against any and all responsibility or liability connected with the construction. I hereby certify that I have read and examined this permit and know the same to be true and correct. All provisions of laws and ordinances governirLg this type of work will be come --,lied with whether specified herein or not.. The granting of a permit does not presume to give authority to violate or cancel. the provisions of any other state or local law regulating construction or the performance of construction. Signature, Date:. I certify that I am exempt from the requirements of the state contractor's registration law, under Section 3, Chapter 125, laws of 1967. �S j1 OT Permit Center --Approved By:_ Date: /(I,,, - - Date: __1Qa. E3FaEMaF2 T C3N PERM I T CENTER 286 4th Street, Bremerton, WA 9833.7' Phone: ( 360 ) 478-5275 FAX: ( 360 ) 4,78-5278 BUILDING PERMIT Job Addr: 2625 WHEATON WAY Permit No: Location: HARRISON HOSPITAL REHAB CENTER Status: Parcel No: Applied: Issued: Applicant: HARRISON HOSPITAL (RAM PRASAD) 792-6550 Expires: 2520 CHERRY AVE BREMERTON WA 98310 Owner: HARRISON HOSPITAL (LEASEE) 792-6550 2520 CHERRY AVE BR.EMERTON WA 98310 02-0664 PENDING 10/21/2002 �_oijtr-actor: HUTCH CON CONSTRUCTION INC 871-6188 Lic: #: HUTCHCCO75LP Exp: 06-26-2004 PO BOX 482 MANCHESTER WA 98353 Subcontr: Desc: INTERIOR RENOVATIONS TO AN EXISTING MEDICAL OFFICE FOR A NEW REHAB CENTER FOR HARRISON HOSPITAL Valuation m Permit Fees: 1,511.05 Total Calculated Fee: 2,416.29 1701000.00 * Plan Check Fees: 900.74 Additional Fees: .00 Other Fees: 4.50 Total Permit Fee: 2,416.29 MECHANICAL/Pt.,UHB1NG FIXTURES— MEGH-Pange Hood (rens )......... 1 PLBG-Dishwasher................ 1 MECH-Range.................... 1 MECH-Exhaust arm.. c 2 PLM -Lavatory ................ PL BCT-Kitche Sink... ..,..... 3 PLBG-A,Jater Heater.........:... i PLe.,Cn-flrink , Fountal ........ 1 This permit 9Poll become null and void if the building or work authorized by this permi is not ommenced within 180 days from the date of such permit, or if this building or work authorized by such p rmit .' �spended or abandoned at any time after the work i.s commenced for a period of 180 stays. NOTICE - It is the responsibility of the permit holder, not the City of Bremerton or Building Official to see to it that required inspections are made:; The permit holder must notify the Building Official when ready for inspections. Failure of the permit holder to notify the Building Official of required inspections may result in the stoppage of the work until such time that the permit holder can substantiate to the building official that the concealed work meets or, exceeds code requirements. Any demolition, testing, or financial burden shall be bowie directly by the permit holder. Failure to substantiate code requirements will indemnify the Cit; against any and all responsibility or liability connected with the ccmtruction. I hereby certify that I have read and examined this permit and know the _name to be true and correct. All provisions of laws and ordinances Governing this type of work will be complied with whether specified herein or not. The arae ing of a permit does not presume to give authority to violate or cancel the provisions of any other st local law regulating construction or- the performance of construction. Signature:_._ Date: I certify that I a� exempt from the requirements of the stake contractor's registration 1 uRaeC Section 3, Chapter 126„ laws of 196?. �C �` 7- ' D Date: i 6REClEtiQ�r Permit Center ---Approved BY: _.____ _ _ .. Date: ML Owner: HARRISON HOSPITAL (LEASEE) "19:x --65 k2 2520 CHERRY AVE BREMERTON WA 98310 I-witi-actor. HUTCH CON CONSTRUCTION INC 871-6188 Lic 0: HUITCHCCO75LP Exp' 06-26-2004 PO BOX 482 MANCHESTER WA 98353 Subcontr: Jesc: INTERIOR RENOVATIONS TO AN EXISTING MEDICAL OFFICE FORA NEW REHAB CENTER FOR HARRISON HOSPITAL Valuation Permit Fees: 1l511.05 Total Calculated Fee: 2.,.416.29 170,000.00 Plan Check Fees: 900.74 Additional Fees: .00 Other Fees: 4.50 Totai Permit Fee: 2,416.29 ?11En_-A*V1CPL/1:1.LW,1h* PTX'rJPZ-S,--- MECH-Rarp.qp .............. ...... 4 lreot-tE_xJoust Fara,............. 2 MECH-R-an. F+xA rvB) ..... I F.I. Ba -Lavatory 2 -Kitchen Sink ................ ? I MLBO-Water Healer.___ PL -0-rinkirrsi FCO.Intaln t _ �,f ! _7 T h, i permit sPal I beccxm null snd void if the; buildiiv or work au t r i zed te­ thiz permit i t ccmtem*-�, witf)in i.180 days, from t ',-* rjate of such permit. or ,,f this Wilding o -r w-,rk ac hn�yized by stuch mit i:s suspvmJej or atandiried at am, tim., after the work is; co�rced for 3 rJeric'd of 1*0 hmpt NOTICE - It is tt* responsibility of ttre penrit hilt the Clt;, of Bremy-ton or Building ufficial t,-,, set to it that reQUAr-ed in%�#.-CtionS- are M&,,. The permit holden must notify the Nildim, official wj-*r, ready for inspections. FaIDAY* of the Permit holder to notify U* Building official of regmired inovectiorm nw?osjtlt in tFoe stoppa* of the work until such time that the permit holder can soit*tantiate to tl,* building official that the i.:onoealtd work meets or AxceedD COde Arty cwiolltion, testing, or i 1mrn-ial tstrCW-n shall be Vx,"w directly b>- tiv permit holder. Failure to skjbst2ntiate cc.* r*qjir")e(*s will irpdemnify the Cit.,,., a,r4ainst any and ail reWoy�ibility or liability covirvacted with U -pe I hereby certify tJ e r permit andkrc4i to be true arms C*r-eC:t. All I.s t>,o provisions, of laws it1arxc t aerniryee of work will be complied with wh*Owr qpocified herein Or mt. Th* qrantinq c)f a oermit dc*. -,. not Prew_w* to give &uthorit,, to violate oy c:anc*1 the provisions of any other state t -.)-r lkxal I 13tl,­P.L� -_01ntrk1Ctj0Tj Or rt* POrfOrMaT10--0 Of tyuc ion. 1'cev-tif 'that I am exempt fr,-*n the re,4uA?­_M!1t._A of the state re!;ist�ation p,'Sw rg r� SeChaptertion 3, Chapter 1pw.-�4 of I P Permit Center --Approved BY: Date" Date Ha .- V 052002 BREMERTON BUILDING DEPARTMENT LE1FREiM[:-_.F,Z'TC)" CE:"'T'E_E-FZ 286 4th Street, Breuer tcn,44A 98337 Phone: (360) 478-5275 FAX: (360) 4.78--5278 BUILDING PERMIT Job Addr. 2625 WHEATON WAY Permit No: 02-0664 LQcatiori: HAPRISON HOSPITAL RICHAB CENTEP Status; PENDING Parcel No: Applied. 10'/21.%2002 -Issued: ,jApplicant; HARRISON HOSPITAL. (RAM PRASAD) Expires: 4 2520 CHERRY AVE BPEMERTON WA 98310 Owner: HARRISON HOSPITAL (LEASEE) "19:x --65 k2 2520 CHERRY AVE BREMERTON WA 98310 I-witi-actor. HUTCH CON CONSTRUCTION INC 871-6188 Lic 0: HUITCHCCO75LP Exp' 06-26-2004 PO BOX 482 MANCHESTER WA 98353 Subcontr: Jesc: INTERIOR RENOVATIONS TO AN EXISTING MEDICAL OFFICE FORA NEW REHAB CENTER FOR HARRISON HOSPITAL Valuation Permit Fees: 1l511.05 Total Calculated Fee: 2.,.416.29 170,000.00 Plan Check Fees: 900.74 Additional Fees: .00 Other Fees: 4.50 Totai Permit Fee: 2,416.29 ?11En_-A*V1CPL/1:1.LW,1h* PTX'rJPZ-S,--- MECH-Rarp.qp .............. ...... 4 lreot-tE_xJoust Fara,............. 2 MECH-R-an. F+xA rvB) ..... I F.I. Ba -Lavatory 2 -Kitchen Sink ................ ? I MLBO-Water Healer.___ PL -0-rinkirrsi FCO.Intaln t _ �,f ! _7 T h, i permit sPal I beccxm null snd void if the; buildiiv or work au t r i zed te­ thiz permit i t ccmtem*-�, witf)in i.180 days, from t ',-* rjate of such permit. or ,,f this Wilding o -r w-,rk ac hn�yized by stuch mit i:s suspvmJej or atandiried at am, tim., after the work is; co�rced for 3 rJeric'd of 1*0 hmpt NOTICE - It is tt* responsibility of ttre penrit hilt the Clt;, of Bremy-ton or Building ufficial t,-,, set to it that reQUAr-ed in%�#.-CtionS- are M&,,. The permit holden must notify the Nildim, official wj-*r, ready for inspections. FaIDAY* of the Permit holder to notify U* Building official of regmired inovectiorm nw?osjtlt in tFoe stoppa* of the work until such time that the permit holder can soit*tantiate to tl,* building official that the i.:onoealtd work meets or AxceedD COde Arty cwiolltion, testing, or i 1mrn-ial tstrCW-n shall be Vx,"w directly b>- tiv permit holder. Failure to skjbst2ntiate cc.* r*qjir")e(*s will irpdemnify the Cit.,,., a,r4ainst any and ail reWoy�ibility or liability covirvacted with U -pe I hereby certify tJ e r permit andkrc4i to be true arms C*r-eC:t. All I.s t>,o provisions, of laws it1arxc t aerniryee of work will be complied with wh*Owr qpocified herein Or mt. Th* qrantinq c)f a oermit dc*. -,. not Prew_w* to give &uthorit,, to violate oy c:anc*1 the provisions of any other state t -.)-r lkxal I 13tl,­P.L� -_01ntrk1Ctj0Tj Or rt* POrfOrMaT10--0 Of tyuc ion. 1'cev-tif 'that I am exempt fr,-*n the re,4uA?­_M!1t._A of the state re!;ist�ation p,'Sw rg r� SeChaptertion 3, Chapter 1pw.-�4 of I P Permit Center --Approved BY: Date" Date Ha .- V 052002 BREMERTON BUILDING DEPARTMENT Y B D� - D (0 (0 1 PERMIT CENTER Department of Community Development's 286 4th Street Bremerton WA's 98337 (360) 478-5275 Fax (360) 478-5278 Building Permit Application APPLICANT: ❑ OWNER ❑ CONTRACTOR [AUTHORIZED AGENT Site Address 2102 W hUQLM Wa fi Tax Account Number: q11 D 5(a 55`�/v CONTRACTOR: i}U" - Cbt i Valuation OWNER or Authorized Agent: Permit Fee Address: 'PO• aa '{'v2 I Total Fees Address: 2_402 r a�_ Cit , State, Zip Ww wA q�23 City, State, Zi f� 33 License # & Expir. Date: p h (� i� � V E Contact Name: 14IuTCHCb ?5L_'P OCTD 2 2102 Contact Phone #: ( 3(00 ) $1 l — W-6 BREMER TON Check the type of application for below: BUILDING DEPARTMENT ❑ NEW SINGLE-FAMILY RESIDENCE ❑ NEW COMMERCIAL ❑ NEW GARAGE/CAR PORT ❑ NEW DUPLEX 9 COMMERCIAL REMODEL ❑ NEW ACCESSORY BLDG ❑ NEW MANUFACTURED HOME ❑ COMMERCIAL ADDITION ❑ NEW SIGN ❑ RESIDENTIAL REMODEL ❑ COMMERCIAL REPAIR ❑ STRUCTURE DEMOLITION ❑ RESIDENTIAL ADDITION ❑ NEW MULTI -FAMILY ❑ GRADING (Cubic yards: __ ) ❑ RESIDENTIAL REPAIR ❑ TENANT IMPROVEMENT ❑ OTHER IS THIS PROPERTY WITHIN 200 FEET OF A SHORELINE? YES ❑ NO [� Scope of Work Proposed: IN1T" LOf� PADUN(187Qs 777 AAJ FjCty7M(-j M.Cf7(CM_ ? UV�� l l • 1*/- 17(2. COCA C o..r S'TP u c -m o..j G & S T: Square Footage: Dwelling: _4,470 SF Garage: Decks: Application for which no permit is issued Ain 8ti dV� �/ fc�llowing the date of application shall expire by limitation, and plans and other data submitted for review may thereafter be returned to the applicant or destroyed by the building official. The building official may extend the time for action by the applicant for a period not exceeding 180 days on request by the applicant showing the circumstances beyond the control of the applicant have prevented action from being taken. No applicant shall be extended more than once. In order to renew action on an application after expiration, the applicant shall resubmit plans and pay a new plan review fee. APPLICANT'S SIGNATOR DATE: O Valuation Plan Review Fiee Permit Fee Surchar a I Total Fees r a�_ 13 �5 Application for which no permit is issued Ain 8ti dV� �/ fc�llowing the date of application shall expire by limitation, and plans and other data submitted for review may thereafter be returned to the applicant or destroyed by the building official. The building official may extend the time for action by the applicant for a period not exceeding 180 days on request by the applicant showing the circumstances beyond the control of the applicant have prevented action from being taken. No applicant shall be extended more than once. In order to renew action on an application after expiration, the applicant shall resubmit plans and pay a new plan review fee. APPLICANT'S SIGNATOR DATE: O PERMIT CENTER Department of Communitv Develooment 286 4th Street',' Bremerton -1 WA 98337 (360) 478-5275' Fax (360) 478-5278 MECHANICAL F-] I PLUMBING Type of Fuel: [0,' Electric ❑ Gas ❑ Oil ❑ Propane Occupancy: F� Residential commercial Site Address: 2bZr- W kp� l,(aw . 24wj v� ww al% -5(0 CONTRACTOR: - OWNER: Address: Address: City, State, Zip: City, State, Zip: License # & Expiration Date: NO. TYPE OF EQUIPMENT NO. TYPE OF FIXTURE RANGE % WATER CLOSET WOOD/PELLET STOVE/GAS FIREPLACE BATHTUB GAS FURNACE btu (D LAVATORY (BATH SINK) CONVERSION BURNER: btu SHOWER UNIT HEATER btu 3 KITCHEN SINK . _ BOILER btu DISHWASHER GAS PIPING LAUNDRY TRAY n] OCT 2 1 2002 EVAPORATION COOLERS btu CLOTHES WASHER BREMERTON AC UNIT btuffkO WATER HEATER BUILDING DEPARTIVIENL- HEAT PUMP btu URINAL REHEAT BOX btu: I DRINKING FOUNTAIN -EXHAUST FANS ONEw FLOOR SINK OR DRAIN I RANGE HOOD (RESIDENTIAL) WATER PIPING & ALTERATION RANGE HOOD (COMMERCIAL) GREASE TRAP/INTERCEPTOR CLOTHES DRYER HOSE BIBBS INCINERATOR LAWN SPRINKLER SYSTEM DUCT ALTERATION SWIMMING POOL TANK TYPE: BLDG. SEWER: (MOBIL/MOVED HOME) REFRIGERATION UNIT ROOF DRAINS OTHER: OTHER: MECHANICAL FEES: PLUMBING FEES: TOTAL FEES: A Icant's Signature I Date ��*?�?��r�rw��a����a�**�;zc*��:*��sx�:axe*�x*�:�����:�r�rW;x���►:*��n;��m*�x;W����x�w� RECEIPT RECEIPT Number: 02000946 AmouW 900.74 10%21102 16:45 Payment Method: VISA Notation: PRASAD VISA Ini.t: VW w__ _M PermitNo: -~-µ-------M 02-0:64 Type:SLOGBLDG PERMIT WIMECHIP Site Address: 2625 WHEATON WAY Location: HARRISON HOSPITAL REHAB CENTER Total Fees: 2,416.29 This Payment 900.74 Total ALL Pmts: 900.74 Balance) 1,515.55 Account Code Description Amount 16-322.1001 t2211j BUILDING PERMIT FEES 900.74 0,�t —i 4- 2165 OFFICE USE ONLY F BREM T Nr I OFFICE Receipt ;y Initials TAX & LICENSE DI N Fee Due _ _Initials ,, �_ 239 Fourth St MAR 1 2 2002 ed: $50 Bus. Lic. Application Fee Bremerton, WA 98337 (PRORATED) (360) 478-5311 (Make Checks Payable to City Treasurer) BUSINESS LICENSE LCfi bW E (or General Regulatory License Application - Lic. Fee Due $ ) (License Type ) Firm Name: �� 1� ` �- ; 1 -- Owner Name: Address: J 0.i Home Address_ 11) J� ( City/ ZI Code: City/ State: f C' YY� uW "� n / 11J is Zip Code: y e t YLQ V% p FS3 ) Tax Returns To Be Mailed To: r\S Q.�,J Date Business Started in City: Nature of Business: DcAA- 4:0 Phone :<3�P , / 4-7 9, ( 4 S Q Home Phone: (36 U) _79- C) 4 � 79-D4�_c (Designate whether Retail, Wholesale, Manufacturing, Service, etc., and specify Product or Service provided) Type of Ownership: Sole OwnerPartnership 11Corporation El Corporate Headquarters Phone: � f G`- X Names/ Addresses/ Phone of Partners or Officers of the Corporation: I v 01 WA State Tax / UBI No. �" G 1 -7 G �' 1 Contractor License No.: N 0- Kitsap Co. Assessor's Tax Accnt. No.: (business premise) Will there be remodeling/ altering of an existing building for your business? Yes ❑ No �2/No. of Employees_ Business Square Footage: If tenant, property owner's name: Is this tenant space currently vacant? Yes ❑ No ❑ If no, explain Will you be sharing this tenant space with another business? Yes/ No ❑ If yes, who? IZ Do you operate this business out of your home? Yes ElNo 4 If yes, will any person be employed at the home other than a resident? Yes ❑ No ❑ M C_ If home occupation, I have read and agree to abide by the Home Occupation Regulations of Bremerton Zoning Ordinance Ch Office . Retail Kitchen Dining . Storage IV. Sec. 9. Yes ❑ No ❑ PERSONAL DATA: REQUIRED OF ALL APPLICANTS (If Corporation, An Officer Must Complete This Section) PERSONAL DATA: BirthdateS 3 i - la f Soc. Sec. No.: �3 3 7 V 41 Y 3 Driver',sLic1. No.:— Verified Addresses for Past 5 Years: s 3 i L c- J! P �� :�') v C-� �C I. Emergency Contact: (Name/ Phone) 1- ( YW r 3 _703 2. The undersigned hereby certifies that the information provided on this application is true and correct, to the best of his/her knowledge under penalty of perjury under the laws of the State of Washingon: Print Futl Name: Title: Signature: DO NOT OPERATE UNTIL YOUR LICENSE IS ISSUED t OFFICE USY: 3 G BL us Remark T IL MAR 1 ? 20028 1- mom TBWHLSLE BREMERTON TCSERVC@DILDING DEPARTMENT �Jf TZPENLTY PROP ID # Z OF BJ?A � r Certificate orrupaurp -Mepartment of Communitp 3kbelopment '74e-4 era ej&,4a #owaaia ro ae urzte e"a of Seettou 109 4 tle Z au &a44 f eode, as adwrd 4 ae vvwcer,&w 7& aueitral Bode, earOw drat at tk luxe 4 WaaaZee, flue. JOW&ne 41" at eoticA&VW Wa4 &-Y aegd a&410 j mw eoaJ&W-tion on uee, ISSUED TO: COSTA AND HOLDREN DDS, PLLC .SITE ADDRESS: 2625 WHEATON WA Y SUITE C Type of Occupancy Occupant Construction Classification Load Common Use VN B 14 DENTAL PRACTICE Permit Number: BLOI-01 4 Date: 01 /26 12001 CHRISTOPHER/HUGO, DIRECTOR Special Conditions: l THIS CERTIFICATE MUST BE POSTED AND PERMANENTLY MAINTAINED IN A CONSPICUOUS PLACE ;4 f ' 19 C_ ((ff 11 �b7.00014 2165 d LS u � 9 too OFFICE USE Y JAN 1 9D e' r Receipt# ninitialsEIREMERTCITY BREMERTON �U. Initials BUILDING DEPARTMENT 39LICENSE Fo Fourth Street JAN 18 Fee Due Bremerton WA 98337 V OFFICE USE ONLY Lic. # 2001 Issued: $30 Bus. Lic. Application Fee (360) 478.5311PNSE (PRORATED) 1,1 (Make Checks Payable to City Treasurer) BUSINESS LICENSE APPLICATION (or General Regulatory License Application - Lic. Fee Due $ (License Type ) Firm Name: COSTA AND HOLDREN Djj"- , Owner Name: Address: 2625 WHEATON WAY (�( Home Address: City/State: BREMERTON, WA Zip Code: '8310 City/ State: Zip Code: Tax Returns To Be Mailed To: 1890 POTTERY AVE. PORT ORCHARD, WA 9636L Date Business Started in City: March 1 . "'.001 Bus. Phone: ( 360) 479-1450 Home Phone: Nature of Business: eAMILY '•' ' "AC`i i (Designate whether Retail, Wholesale, Manufacturing, Service, etc., and specify Product or Service provided) Type of Ownership: Sole Owner ❑ Partnership ❑ Corporation ❑ Corporate Headquarters Phone: ( 360) 8 WA State Tax No.: ARpLT'Pn VOR Contractor License No.: Kitsap Co. Assessor's Tax Accnt. No.: (business premise) Names/ Addresses/ Phone of Partners or Officers of the Corporation: LOSE S. HOLDREN 6531 LAKE DR. BREMERTON, WA 98312 (360) 792-1293 MARTA R. COSTA 9542 SE VIEW PARR PORT ORCHARD, WA 98366 (360)871-6524 Will there be remodeling/altering of an existing building for your business? Yes ❑ No CX No. of Employees 3 Business Square Footage: If tenant, property owner's name: T" ,HICKMAN GROUP Office Is this tenant space currently vacant? Yes ❑ No 171If no, explain 4q 0t) i 2 t TZ% /- C !« Retail Will you be sharing this tenant space with another business? Yes ❑ No ❑ If yes, who? Kitchen 0 (� Do you operate this business out of your home? Yes ❑ No ❑ If yes, will any person be employed at the home other than a resident? Yes ❑ No ❑ If home occupation, I have read and agree to abide by the Home Occupation Regulations of Bremerton Zoning Ordinance Ch. IV, Sec. 9. Dining Storage Yes ❑ No ❑ PERSONAL DATA: REQUIRED OF ALL APPLICANTS (If Corporation, An Officer Must Complete This Section) PERSONAL DATA: Birthdate: 5/31/1961Soc. Sec. No.F33- - - Driver's Lic. No.: Verified ❑ Addresses for Past 5 Years: 6531 LAKE DR rsREMERTON, WA 983-1 Emergency Contact: (Name/ Phone) 1. RIDSE S. T;OT,DREN (360) 792-1?93 2.. _:arta Costa (3604871-f7:.. The undersigned hereby certifies that the information provided on this application is true and correct, to the best of his/her knowledge under penalty of perjury under the laws of the State of Washingon: Print Full Name: iOLDREN , DDS Title: 1-1SER Signature: DO NOT OPERATE UNTIL YOUR LICENSE IS ISSUED Date:— OFFICE ate: OFFICE USE ONLY: B06LIC Remarks: v{ is U 5�to U7 1�w'FARETAIL �Lzl� &32 112 ' C7 TBWHLSLE TCSERVCE TZPENLTY WHITE -TAX & LICENSE CANARY -PLANNING PINK -FIRE GOLDENROD -POLICE GREEN -BUILDING BUS ID # PROP ID # 01/24/2001 14:17 36047B527B COMMUNITY DEVELOPMEN PAGE 01 J�1N 19 D CO 'v `l v E FFICE USE ONLY l ! L. r ? 6yy BRETON Lic a `IHN 24 200}'�lals MERTON TAX 8 LICENSE DIVISION,JAN 18 2001 1 d Initials „BUILDING DEPARTMENT 230 Fourth SireM ISVP BREMERTDN Bremerton, WA 37 w I c D (� UILDING DEPARTMENT (360) 478-53 1 Lir t �i J L� imam `wk BUSINESS LICENSE APPLICATIONW JAN�D - L (or Generag Regulatory License Application - Lic. Fee Due $ ) 2 4 2001 BREMERTDN (License Ty ) BUILDING DEPARTMENT � f� G� ��� o1"Zy_Dl G® COSTA AND HOLDREN DDS, Pi.1.0 Owner Name Firm Name: Adder: 2625 WHEATON WAY Nome Address BREMERTON, WA 96310 City/stare: �? codq:� • �Ity/State Z;DCode. Tax Returns To Be Mailed To: 18 9 0 POTTFL_ AVfi PORT ORC . 4 8 366 March 1, 2001 13 6 0) 4 7 9 —14 5 0 Nome Phone Deme auskless Stead in City: Bus Phone. Nature of Business: FA14ILY DENTAI. P (Designate whether netaa. wholesale. Manufacturing. Service, etc-. and specify Vrpeucf or Service provid00) Type o1 Ownerahlp: Sole Owner 0 PairtnershWic Corporation F7 WA State Tax No . ARRI-TED FOR Corporate Headquarters Phone: (36 0) 876-0550 Contractor License No., Kitsap Co Assessor's Tax Accnt No (business pfsmise) Names/Addresses/Phone of Partners or otticers of the Corporation. ROSE S. HOLDREN 6531 1.AYE DR. BRE -MERTON, WA 98312 360 792-1293 M"TA R. COSTA 9542 SE VIEinT PARK PORT ORCiTARD, WA 98366 (36011671-6524 Nil them be remodeling/altering of an wdsting building for your business? Yes 0 No CX No of Employees— 3 Business Square Footage: ItWent, property owner's name: THE HICKMAN GROUP Office �. .� Retail Date Kitchen r post -It" Fax Note 7671 o g°ea� ('/�,� who? From / Dining To U Co./Dept. co No 0 ,Storage phone a Phone M aUons of Bremerton Zoning Ordinance Ch IV, Sec 9 elves G No 0 Fax a Fax M � BRED OF ALL'APPLICANTS (If Corperaw, An Officer Must Complete This 8niton) 5 / 31 / 19 61 5 3 3 -- 7 8- 414 3 Driver's Lic No Verified O PERSONAL DATA: Birthdate: Soc. Sec No.. , Addresses for Pant 5 Years: 653"'LII nu AIA 9 8 FmergsncyoDnw-(Name/Phone) 1. RMSE S. HOLDREN (360)792-1293-2Mlarta Costa (3604871-6524 The ued0nlpned hereby ouMn 11111011111111 Inlormedon provided on this application is true and correct, to the best of his/her kno7,�& dwr pynder the lawn a rn. 3W ofROSE S. HOLDREN , nDS TIUe: KY.14"ER Signature: DO NOT OPERATE UNTIL YOUR LICENSE IS ISSUED Date: ctrt,aaa� �ratraaa>raanana�r�trrra�naatraa***a¢a�'oa,cacr� BUSL IC OFFICE USE ONLY BUS ID p TARETAIL Remarks:TBWHLSLE TCSERVCE TZPENLTY PROP ID N WNITE—TAX A LICENSE CANARY—PLANNING PINK—FIRE GOLDENROD—POUCE GREEN—BUILDING ptcrict+1 �( ( q ,D Z 2165 � D OFFICE USE ONL D � � `�' Receipt# 4IreariC,1i C CI OFCENSE BREME oNON Fee Due Initials 239 Fourth Street QQ 13REMERTON Bremerton, WA 98337 (p3O Bus. Lic. Application Fee (360) 478.5311 (PRORATED) (make Checks Payable to C et" DEPARTMENT BUSINESS LICENSE APPLICATION (or General Regulatory License Application - Lic. Fee Due $ (License Type ) OFFICE USE ONLY Lic. # Issued: Firm Name: �Pni ngi11 a TntrzrZentlt' a3 Rain Cl i -4i p Owner Name: Scan F. tti 1 1 i�g-r, 4-l'. Address: 2525 Beaton Way Home Address: 07R T 11 ahga Rai City/State: ? Zip Code: S.L. 1 . City/State: r-eaw tA, WA Zip Code: Tax Returns To Be Mailed To: 2625 Wheaton Tida�r ;'r - r , j Date Business Started in City: 12/1159 Bus. Phone: A6 1,;_-41 Home Phone: Nature of Business: E=rvi : ° . (Designate whether Retail, Wholesale, Manufacturing, Service, etc., and specify Product or Service provided) Type of Ownership: Sole Owner ❑ Partnership ❑ Corporation ❑ WA State Tax No.: Corporate Headquarters Phone: Contractor License No.: Kitsap Co. Assessor's Tax Accnt. No.: _ (business premise) Names/Addresses/Phone of Partners or Officers of the Corporation: Will there be remodeling/altering of an existing building for your business? Yes ❑ No ❑ No. of Employees Business Square Footage: i If tenant, property owner's name: Office Is this tenant space currently vacant? Yes ❑ No ❑ If no, explain ��. +—d:�r�ttR� e2r;�; Retail D Will you be hanng this tenant space ith another business? Yes ❑ No ❑ If yes, who? = as ate^ Kitchen Do you opera Yeis business out of your home? Yes ❑ No ❑ Dining If yes, will any person be employed at the home other than a resident? Yes ❑ No ❑ Storage If home occupation, I have read and agree to abide by the Home Occupation Regulations of Bremerton Zoning Ordinance Ch. IV, Sec. 9. Yes ❑ No ❑ PERSONAL DATA: REQUIRED OF ALL APPLICANTS (if Corporation, An Officer Must Complete This Section) PERSONAL DATA: Birthdate: i1.4_6Soc. Sec. No.: Driver's Lic. No.: jjTJ.T V.J' 307� Verified ❑ Addresses for Past 5 Years: �;r' 1R T 7 1 a i, aQ w, Rr Emergency Contact: (Name/ Phone) 1. ti (E I �nN ■ r �i �l . o r 1 U 5 2. The undersigned hereby certifies that the information provided on this application is true and correct, to the best of his/her knowledge under penalty of perjury under the laws of the State of Washingon: �{ Print Full Name: Title: Signature: DO NOT OPERATE UNTIL YOUR LICENSE IS ISSUED Date: z2— — �r OFFICE USE ONLY: -,BUSLIC RETAIL BUS ID# WHLSLE TCSERVCE TZPEN LTY WHITE—TAX & LICENSE CANARY—PLANNING PINK—FIRE GOLDENROD—POLICE GREEN—BUILDING PROP ID #. _,j OF Apt, certificate of Orrupantp Mepartment of �tCommunitp MebetoPM]tnt %j w%&P4& 4d&u "ae eo ae wriwmew4 4 See4w 109 O de 24sd4v eowe, au adwzd 4 ae Se Nmeod eo4, tlsat at rk tune 4 caauanm, da atfutatam a," to eoyc*u" uktk 64 ux1uiat&w �n eow&oetlw mt am, ISSUED TO: KITSAP COLORECTAL SURGERY, INC. SITE ADDRESS: 2625 WHEATON WAY Type of Occupancy Occupant Construction Classification Load Common Use VN B 16 MEDICAL OFFICES Permit Number: BL99-0182 Date. 09/16/1999 N E10LAN, PLANNING MANAGER Special Conditions: THIS CERTIFICATE MUST BE POSTED AND PERMANENTLY MAINTAINED IN A CONSPICUOUS PLACE 1p 2155 t i-1 � - �=f OFFICE USE ONLY(, C /'► d FICE USE ONLY Receipt# v -bv30gs8 Initials CITY OF BREMER �e ' # TAX & LICENSE DIVISI Fee Due Initials 239 Fourth Street AUG 0 2 1999 Is $30 Bus Lic Application Fee Bremerton, WA 98337 FIE rn (PRORATED) (360) 478-5311 ��r,q_1 i C S U Make Checks Payable to City Treasurer) BUSINESS LICENSE APPLICATION AUG U 4 199n J (or General Regulatory License Application - Lic. Fee Due $ (License Type ) BUILDING DE DEPARTMENT Firm Name: le r Name: J ,�fteo Address: Home Address: Z l V G I L City/State:/' P_N� e�1'� bi 9A Z Code: 3 City/ State: 1 U) Zip Code: Tax Returns To Be Mailed To: ?-1; Z eallLn, WIXY, 111, P �P_P^ Date Business Started in City: 30 912.2 us. Phone: 3 7 7 -- (i 7 HonW Phone: - 3 Nature of Business: t CGc-P Ot�bt ell G 2� , SD,�/z/via /v1 C/J rA P" 3a__1'd119vt , d'Pricm SL whether Retail, Whdlesal4, Manufacturing. Service,Atc . and specify Type of Ownership: Sole Owner ❑ Partnershin r Corporation Corporate Headquarters Phone: _ E 7 — LI -7— / 7 Names/Addresses/Phone of Partners or Officers of the Corporation: ri WA State Tax No fuct or6ervice provided) Q/t Contractor License No.: AY/I Kitsap Co. Assessor's Tax Accnt. No.: 5fzr� J (vii`{ . ��� _ gice (business premise) r Will there be remodeling/ altering of an existing building for your business? Yes No ?�lo. of Employees 1% , r . , If tenant, property owner's name: ,I Jr9 Is this tenant space currently vacant? Yes DE`�'No If no, explain Will you be sharing this tenant space with another business? Yes 1� :1 If yes, who? d ffI S; �— Do you operate this business out of your home? Yes No WUmev1`S �jrL�111�SS Business Square Footage: Office 1.570 Retail Kitchen Dining _ If yes, will any person be employed at the home other than a resident? Yes No —_ Storage If home occupation, I have read and agree to abide by the Home Occupation Regulations of Bremerton Zoning Ordinance Ch. IV, Sec. 9. Yes E No PERSONAL DATA: REQUIRED OF ALL APPLICANTS (If Corporation, An Officer Must Complete This Section) PERSONAL DATA: Birthdate: ZziLA6 5 Soc. Sec. No.: 3 5 c7i 9 F70—Driver's Lic. No.:(24 3-9 7S -J6 3 Verified Addresses for Past 5 Years: 4.9 f ' S� 9 L Emergency Contact: (Name/ Phone) 1. J6i�n (e&_ 6t ee, _�y — / �� 2. The undersigned hereby certifies that the information provided on this application is true and correct, to the best of his/her knAwledu.enalty of perjury under the laws of the State of Washin on: Print Full Name: �� Uf 1 4S 6�ePh Title: ��S / ��i C��Df2Qc �ct,�? nature DO NOT OPERATE UNTIL YOUR LICENSE IS ISSUED / Date :r i7 �.� :. •� OFFICE USE ONLY: BUSLIC Remarks: .�+\ 1� I �T TARETAIL BUS ID # TBWHLSLE TCSERVCE TZPENLTY PROP ID # ,-A i BUILDING PERMIT 9076 City of Bremerton, Washington 98310 Phone: (206) 478-5281 Assessor's Tax Account No.: 3966-004-001-0007 Site Address: 2625 Wheaton Way Phone No.: 479-1450 Owner's Name: Medical Arts Partnership Address: -3 Applicant: ❑ Owner ❑ Architect ❑ Contractor ❑ Tenant Architect Firm: Representative: Address: Phone: Contractor: Fields Roof Service, Inc. Representative: Art Hoff Address: 25924 78th Ave. S. Kent 98032 Phone: Contractor's License No.: FIELDSRS262L1 Exp. Date: 4/4/89 Residence ElBusiness ❑❑ New Other: El Repair ❑Remodel/Addn ❑ Demolish ❑ Duplex ❑ Multi -Family (No. units ) ❑ Sign ❑ Parking Lot ❑ Grading (cu. yds ) ❑ Bldg. Move Nature of Work Proposed: Strip and reroof 90 squares 3 tab and built up Sq. Ft.: Utilities: ❑ Water ❑ Waste ❑ Sewer ❑ Septic ❑ New ❑ Existing ❑ Storm Valuation of Materials/Labor: Plan Review Fee: Permit Fee: Surcharges: [UBC Sec. 304(b)] $ $ 90.00 State $1:50 ❑ $6460.00 Receipt No.: Receipt No.: 790919 Energy $10/$15 ❑ Date: Date: 9/27/88 Zone Designation: Occupancy Classification (UBC): No. Stories: Minimum Req. Setbacks: Front: Side: Rear: Height: Heat Source: Comments/Conditions of Approval: Richard R. Mumma, Building Official INSPECTIONS REQUIRED: Foundation ❑ Framing ❑ Plumbing ❑ Mechanical ❑ Wallboard ❑ FINAL ❑ OWNER OR BUILDER SHALL CALL 478-5281 FOR ALL REQUIRED INSPECTIONS AND RECEIVE APPROVAL PRIOR TO CONTINUING WORK. SEPARATE PERMITS ARE REQUIRED (WHERE APPLICABLE) FOR PLUMBING AND MECHANICAL. All provisions of laws and ordinances governing this type of work will be complied with whether specified herein or not. The granting of a permit does not presume to give authority to violate or cancel the provisions of any othe/rstator-local law regulating r the performance of construction. SEE AND READ NOTICE ON REVERSE. �co�ns�truction Signature ��{ -�/��� Date Copies to: White -owner; Yellow -file; Pink -Assessor: Goldenrod -Building Stat. Code I 4k I' Ar, - NOTICE - This permit shall become null and void, if the building or work authorized by this permit isnot commenced within 180 days from the date of such permit, or if this building or work authorized by such permit is suspended or abandoned at any time after the work is com- menced for a period of 180 days. I hereby certify that I have read and examined this application and know the same to be true and correct. All provisions of laws and ordinances governing this type of work will be complied with whether specified herein or not. The granting of a permit does not presume to give authority to violate or cancel the provisions of any other state or local law regulating construction or the performance of construction. I certify that I am exempt from the requirements of the state contractors registration law, under Sec. 3, Chap. 126, laws of 1967. - INSPECTIONS - 1. Foundation, before placement of concrete. 2. Frame, before covering inside walls and after all plumbing, mechanical, etc., are in- . stalled and approved. 3. Wallboard or lath before finishing. 4. Final, after completion and before occupancy. NOTICE — It is the responsibility of the permit holder, not the City of Bremerton or Building Official to see to it that the required inspections are made. The permit holder must notify the Building Official when ready for the inspections. Failure of the permit holder to notify the Building Official that construction has commenced to a point that inspection is ap- propriate, will relieve the City of Bremerton of any and all responsibility for the manner in which construction is performed. .ft PERMIT APPLICATION City of Bremerton, Washington 98310 Phone: (206) 478-5281 rBUILDING sor's Tax Account No.: c)06VI ddress: at G o�.� fc9/�F.4 io,r� 6yA, Phone No.:'s Name: RkDic4,4,C7's 0"',Ije7u-,e 511 g' Address: S��F Applicant: ❑ Owner ❑ Architect Contractor ❑ Tenant Architect Firm: Representative: Address: Phone: Contractor: r/lEe-175 hoar Representative: 'Voe7 �F✓ Address: S C�4 4 vL 5 . Alu 7 Phone: OG,j'o Contractor's License No.: 1 3�� �l �- Exp. Date: -)/� ❑ Residence t5 Business ❑ Other: ❑ New ❑ Repair I Remodel/Addn ❑ Demolish ❑ Duplex ❑ Multi -Family (No. units ) ❑ Sign ❑ Parking Lot ❑ Grading (cu. yds ) ❑ Bldg. Move ��)) Nature of Work Proposed: �x r r 2oa r' L o (/Q S -M V_ Sq. Ft.: Utilities: ❑ Water ❑ Waste ❑ Sewer ❑ Septic ❑ New ❑ Existing ❑Storm Valuation of Materials/Labor: Plan Review Fee: Permit Fee: Surcharges: [UBC Sec. 304(b)] $ Receipt No.: $ ?6 Receipt No.: State $ 3.5 0 EI Energy $10/$15 ❑ Date: Date: Zone Designation: Occupancy Classification (UBC): No. Stories: Setbacks: Front: Side: Rear: Height: Heat Source: Comments/Conditions of Approval: I understand that applications for which no permit is issued within 180 days following date of application shall expire by limitation, plans and/or other data submitted may be returned to applicant or destroyed by the Building Official. (Sec. 304(d)UBC). I certify that the information on this application furnished by me is true and correct and that the applicable requirements City/ oaf, Bremerton will be met. Signature fsril�f Date ?17 Copies to: White -owner; Yellow -file; Pink -Assessor: Goldenrod -Building Stat. Code !NSPECTION RECORD CARD CITY OF BREMERTON BUILDING DEPARTMENT 9070 PERMIT NUMBER ADDRESS & DIRECTIONS 2625 Whenron Way OWNER Medical Arts Partnprghin PHONE CONTRACTOR Fields Roof Service, Inc. PHONE FOUNDATION CORR 0. K. 1. PERMIT ON SITE 2. CHECK PLANS TO PERMIT 3. CHECK SETBACKS 4. PROPERTY STAKES 5. FOOTING SIZE CORRECT 6. WALL SIZE CORRECT 7. CHECK FOR FILL 8. REQUIRED STEEL IN PLACE 9. CHECK FIREPLACE FOOTING 10. ANCHOR BOLTS 11. FOUNDATION PLATE 12. FOUNDATION VENTS 13. CRAWL SPACE ACCESS FOUNDATION INSPECTION APPROVED BY: 2 FRAMING coRCOMMENTS: 1. WIRING APPROVED 2. FOUNDATION VENTS 3. SHIELD UNDER POSTS 4. POSITIVE CONNECTIONS 5. SOIL TO WOOD CLEARANCE 6. POST CLEARANCE - 2" 7. BEAM SUPPORT 8. TR. MAT. NEXT TO CONC. 9. WASHERS ON ANCHOR BOLTS 10. BEAMS PROPER SIZE 11. FLOOR JOISTS SPAN 12. NOTCHING & DRILLING A -FLOOR JOISTS B -STUDS 13. STAIRS A -WIDTH B -RISE & RUN C -WINDERS D -LANDINGS E -HEADROOM 14. ATTIC VENTILATION 15. CHIMNEY STRAPS SECURED 16. FIREPLACE COMBUSTION AIR 17. FANS VENTED OUTSIDE _ 18. A -BATHROOMS B -LAUNDRY ROOMS C -KITCHEN 18. WATER CLOSET CLEARANCE 19. SMOKE DETECTOR FRAMING INSPECTION APPROVED BY: COMMENTS: CORR O.K. 20. FIREBLOCKING A -STAIRS B -DROP CEILINGS C TUBS OR SHOWERS D -ROOF & CEILING LINES E -FURRED OUT AREAS F -FIREPLACE AT CEILING G -ELECTRICAL HOLES PLUGGED - H -PLUMBING HOLES PLUGGED - I -LID IN VOIDS 21. WINDOWS A -SAFETY GLAZING B -VENTILATION C -REQUIRED FIRE EXITS D -WINDOW SILL HEIGHT 22. CEILING HEIGHTS A -BASEMENT B -MAIN FLOOR C -UPPER FLOOR 23. SWAY BRACING 24. TRUSSES A -PROPERLY INSTALLED B -STAMPED 25. ATTIC ACCESS 26. CEILING JOIST SPANS 27. RAFTER SPANS 28. ROOF SHEATHING 29. ROOFING APPLICATION 30. SIDING 31. CLOTHES CHUTE 32. SHEETROCK BACKING A -UNDER STAIRS B -ABOVE GARAGE DOOR HANGERS MMECHANICAL 1. FURNACE SIZING 2. FURNACE LOCATION 3. FURNACE CLEARANCE 4. 'B' VENT SIZING 5. 'B' VENT CLEARANCE 6. 'B' VENT SUPPORT 7. COMBUSTION AIR 8. DUCT SIZING 9. DUCT CLEARANCE 10. DUCT SUPPORT 11. DUCT JOINTS 12. GAS PIPING TEST 13. GAS PIPING SIZING 14. GAS PIPING SUPPORT 15. OTHER CORR 0. K. CORR 0. K. 1. WOOD STOVE CLEARANCE 2. CHIMNEY CLEARANCE _ 3. HEARTH EXTENSION 4. CHIMNEY HEIGHT FURNACE APPROVED BY: HEAT PUMP APPROVED BY: GAS PIPING APPROVED BY: WOOD STOVE APPROVED BY: OTHER: PPLUMBING CORR O.K. 1. UNDER TEST 2. GATE VALVE 3. WATER PIPE SIZING 4. DRAIN PIPE SIZING 5. VENT PIPE SIZING 6. PROPER SUPPORT 7. PROPER FITTINGS UNDERGROUND APPROVED BY: 8. VENTING 9. CLEANOUTS ROUGH -IN APPROVED BY: 10. PROPER GRADE 11. HOT WATER TANK P.R. VALVE 12. OTHER 3 WALLBOARD CORR O.K.. COMMENTS: 1. LID OVER SIDES 2. NAILING 3. W/R AT TUB OR SHOWER 4. 5/8 UNDER STAIRS 5. FURNACE ENCLOSURE 6. FIRE SEPARATION GARAGE 7. ATTIC ACCESS 8. DROP CEILING & LIGHTING 9. BACKING AS NOTED ON FRAMING_ WALLBOARD INSPECTION APPROVED BY: 4 FINAL CORR 0. K. CORR O.K. 1 . HANDRAILS 9. OUTSIDE GARAGE 2. GUARDRAILS 10. CLOTHES CHUTE A -HEIGHT 11. SEWER/HEALTH DEPT. B -INTERMEDIATE 12. COMMERCIAL BUILDING 3. EXHAUST FANS A -MECHANICAL APPROVED A -KITCHEN VENTING B -PLUMBING APPROVED B -BATHROOMS 13. SMOKE DETECTORS C-LAUNDRYROOMS 14. FIREPLACE HEARTH D -DRYER 15. SAFETY GLAZING/ 4. TILE AT TUB OR SHOWER DOUBLE GLAZED 5. DISHWASHER 16. INSULATION CERTIFICATE PROPERLY INSTALLED 17. FREE-STANDING 6. FIRE DOORS FIREPLACE APPROVED A -SELF-CLOSING 18. WINDOWS & DOORS CAULKED B -SWEEP OR THRESHOLD WEATHER-STRIPPED 7. ATTIC ACCESS 8. HOT WATER TANK FINAL INSPECTION APPROVED BY: NOTES: PLANNING: -.,, OF 8,P 1, _ M certificate of O)CCUPaurp Mepartment of Communitp Mebelopment 744 em&#nju4ge ro e4e w� 4 see� los 4 the %a0vm &ddvi (', e, as adopted 4 ae gwwm k maaaAd 6n& wzr4aj ticat at ek tuxe 4 W&Zvw, ff" a&C,rct U a" uc eotio&ww tint! &Y wq"&&z,, a �" e"dAwr w oa "U, ISSUED TO: COSTA AND HOLDREN DDS, PLLC .SITE ADDRESS: 2625 WHEA TON WAY SUITE C Type of Occupancy Occupant Construction Classification Load Common Use VN B 14 DENTAL PRACTICE Permit Number: BLOI-0014 Date: 0112612001 CHRISTOP HUGO, DIRECTOR Special Conditions: THIS CERTIFICATE MUST BE POSTED AND PERMANENTLY MAINTAINED IN A CONSPICUOUS PLACE Certflcate of Occupancy Department of Community Development This certificate issued pursuant to the requirements of Section 109 of the Uniform Building Code, as adopted by the Bremerton MunicipaC Code, cert that at the time of issuance this structure was in compliance with City regulations for construction or use. ISSUED TO: Northwest Prosthetic & Orthotic Clinic SITE ADDRESS: 2625 Wheaton Way Bldg A Type of Occupancy Occupant Construction Classification Load Common Use VB B 31 Manufacture & Supply of Orthotics & Prosthetics Permit Number:74 4332 Date: August 10, 2004 9 i�� 7 ristopher Hugo, Director Special Conditions: CITE • OE BREME TON AUSINESS LICENSE; APPLICATION Tax c6 License Iii'isiot a 23tP -1 `t' Street s Bremerton. WA e 9$337 u ;fi(1;3-XVI 1 Office Use Only Receipt # Initial Fee Due: ($65.00/yr) Initial Business Name: !1, —�N` Business Address: City/State: 1\ Zip Code: Tax Returns Mailed To: AUG 0 2 2004 ame: Issued: Home Address: 1—T 211 1\J )• (o City/State: �kh"'O Vj L/ 'A -9�^- 2- Date Business Started in City: � ) Business Phone: � uc' Homc Ph�olne: Lta-s , Nature of Business: 1 « GC: Lig l� iti. ('I Wim% 4 (Desi o tc wh ther Retail, Wholesale, Mapu eturing, Service e(c. and specify Product or Service provided) Type of Ownership: Sole Owner ❑ Partnership ❑ Corporation 50 R'A State Tax / URI Number: Name / Address / Phone Numbers of Partners or Owners of the `` Phone Number: Previous tenant/business name: l _ �1f� � . _�(\s Date Last Occupied: � An- - 't',Aj c�Will there be remodeling or altering of an existing building for your business? es / No ❑ Numbe of Employees: If you are tenant, give property owner's name: V—, . 41 Business Square Footage: Is this tenant space currently vacant? Yes l / No ❑ If No, Explain: Office: z l 4CD Will you be sharing this tenant space with another business? Yes ❑ No If Yes, Who? Retail: Will you operate this business out of your home? Yes ❑ No Other: If yes, will any person be employed at the home other than resident? Yes ❑ No ❑ If Home Occupation, I have read and agree to abide by the Home Occupation Regulations found in the Bremerton Zoning Ordinance: Yes ❑ No ❑ PERSONAL DATA REQUIRED OF ALL APPLICANTS (If Corporation, an Officer must complete this portion) Birthdate: 0-1— i t' — 5 '� Soc Sec Number: S b i�- S L 6 16- DL Number: 4141 TTI ME- 4%11'., M� State: (�,� The undersigned hereby certifies that the information provided on this application is true and correct, to the hest of his /her knowledge under penalg' of perjury under the laws of the State of if ashington: Print Full Name: OFFICE USE ONLY Title: ���1'� Signature: DO NOT OPERATE UNTIL YOUR LICENSE IS ISSUED Remarks: _ _ DCD TYPE OF INFORMATION OCCUPANT OCCUPANCY - CONST CLASSIFICATION LOAD ALL ACCOUNTS: 05-13/0 NM'4 M 06- U � )' -B/O PEN 08-BUSLIC PENALTY ACCOUNT SPECIFIC: 0 - T BUS ID # SLE 03 -SERVICE PROP ID# t�l $Gy0 0 (� N9 419 7 2 Fee $ -------------------------- ----------_---------- .................... Receipt No. ................ ..-=5------......-•----......._... BUILDING PERM IT CITY OF BREMERTON • BUILDING DEPARTMENT F. E. IRISH, Building Inspector • Essex 3-1411, Ext. 36 Owner's Value I Bldg. Dept. $ Value I DESCRIPTION: Lot Block Address on Job Building ---------------- X ---------------- and -------------- Front Yard ________________________ Rear Yard ---_------ Occupancy------------------------------------------------------- Owner-------------------------------------------------------------- Contractor------------------------=-- ----------------------- This permit is issued for: ---------------------------------------------------------------------------------------- ---------------------------------------------------------------------------------------- ---------------------------------------------------------------------------------------- ---------------------------------------------------------------------------------------- ---------------------------------------------------------------------------------------- ---------------------------------------------------------------------------------------- All work to conform to all applicable building ordinances and amendments. Please note the following special instructions and requirements. DETACH HERE AND POST THIS SECTION ON JOB ---------------------------------------------- Date ------------------------------------------ stories------------------------ basement. Lot ---------------- x ---------------- ---------- Side Yard ------------------------ Garage ------------------------------ ----------------------------------------------- Zone ------------------------------------------ ----------- Address --------------------------------------- Phone ----------------- ---------- Address ---------------------------- --------------- Phone---------------- INSPECTION — Reinforcing steel must be inspected after placing and before covering. FORMS shall be inspected and approved before pouring. All plumbing, wiring and the frame of all buildings must be inspected and approved before covering. Wood preservative to be used on all wood against masonry. Ventilate foundation and attic. Sepa- rate permits required for plumbing, wiring and heating. See City Engineer before working on streets or sidewalks. ---------------------------------------------------------------------------------------------- ------------------------ --------------------------------------------------------------------------------------------------------------------------------------------------------------------------- .; mfr= �`e�:*�� ------------------------------------------------------------------------------------- -- �: _ f =: ecf<n.r---=---------------------------------------------------------- ---------------------------------------------------------------------------------------- ---------------------------------------------------------------------------------------- ---------------------------------------------------------------------------------------- ---------------------------------------------------------------------------------------- ---------------------------------------------------------------------------------------- ---------------------------------------------------------------------------------------- ---------------------------------------------------------------------------------------- ---------------------------------------------------------------------------------------- ---------------------------------------------------------------------------------------- ---------------------------------------------------------------------------------------- ---------------------------------------------------------------------------------------- ---------------------------------------------------------------------------------------- ---------------------------------------------------------------------------------------- ---------------------------------------------------------------------------------------- ---------------------------------------------------------------------------------------- ---------------------------------------------------------------------------------------- ---------------------------------------------------------------------------------------- ---------------------------------------------------------------------------------------- ---------------------------------------------------------------------------------------- ---------------------------------------------------------------------------------------- ---------------------------------------------------------------------------------------- ---------------------------------------------------------------------------------------- ---------------------------------------------------------------------------------------- ---------------------------------------------------------------------------------------- ---------------------------------------------------------------------------------------- ---------------------------------------------------------------------------------------- ---------------------------------------------------------------------------------------- ---------------------------------------------------------------------------------------- ---------------------------------------------------------------------------------------- --------------------------------------------------------------------------------------- ---------------------------------------------------------------------------------------- ---------------------------------------------------------------------------------------- Owners Signature_____________------------------------------------ By ----------------------------------------------------------------- His Authorized Agent Building Inspector ----------- ' -------------------- ;------------------------------------------- ,s DF By________________________________________________________________________________________ BUILDING PLANS ROUTING SLIP Names Fez �a a . x �.v �`��?►� Address Phone 1; 7 to Received Type of Construction ALW < REMODEL ADDITION ALTIMATION Building Dept. Approval ? e$7'_:� Date Permit Issued TRAFFIC �,TM R -W DEPT. Initial Date Received Date Approved Comments Approved Not approved Correction Not q ENGINERII\TG DEPT. Approved. Approved Correction Permit Init. Qe aired -- Sanitary Drainage Storm Drainage Gas Tains Underground Utilities sidewalk Driveway Date !received Date A")T)roved ELECTRICAL DEPT. Comments Initial Date Received Approved Date Arrpoved _ Not A;)proved Comments Correction PLbT_31NG DEPT. Date Received Date APproved Comments Initial A. -)proved dot approved Correction 0 BUILDING' ERMIT 301" q � City of Bremerton, Washington Phone: (206) 478-5281 OWNER'S VALUE BLDG. DEPT. VALUE PLAN CHECK FEE RECEIPT NO. PEROFT FEE RECEIPT NO. SITE ADDRESS/ LOCATION 6 2 W ct- f Cx, OWNER'S NAME �,�,..� (A 67_ UUIN I MAU I Uri DATE IT.[*7.1: u riCJIUCIVLiC /L -J\ DUOIItlCAJ Li V I rich L -i IYCVv Lr4 11CYAIri LJ NtMUUtL IJ AUUJ UM I I IUN LJ I5 PLANNING/ZONING FIRE ZONE STORIES OCCUPANCY THIS PERMIT ISSUED FOR: V' All provisions of laws and ordinances governing this type of work will be complied with whether specified herein or not. The granting of a permit does not presume to give authority to violate or cancel the provisions of any other state or local law regulating construction or the performance of construction. INSPECTIONS REQUIRED: Foundation ❑ Framing ❑ Plumbing ❑ Electrical ❑ Wallboard ❑ FINAL FOR INSPECTORS USE ONLY: REINSPECTION: NOT TYPE OF INSPECTION I DATE I TIME 1APPROVEDIAPPROVED FINAL INSPECTION APPROVED BY COMMENT DATE TIME APPROVED Building Inspector ISSUANCE OF OCCUPANCY CERTIFICATE REQUIRED BEFORE OFCUPYING BUI D N !. OWNER'S SIGNATURE BY Authorized Agent Imo'" BUILDING DEPT BUILDING HERMIT City of Bremerton, Washington Phone: (206) 478-5281 &° 4304 Al OWNER'S VALUE BLDG. DEPT. VALUE PLAN CHECK FEE RECEIPT NO. PERMIT FEE RECEIPT NO. DATE S TE ADDRESS / LOCATION OWNER'S NAME&� c ,Ce,7 ADDRESS PHONE CONTRACTOR STATE CONTRACTOR'S LIC. # ADDRESS PHONE ❑ RESIDENCE BUSINESS ❑ OTHER ❑ NEW ;r REPAIR ❑ REMODEL ❑ ADDITION ❑ DEMOLISH PLANNING / ZONING FIRE ZONE STORIES OCCUPANCY THIS PERMIT ISSUED FOR: fez -e-- � I All provisions of laws and ordinances governing this type of work will be complied with whether specified herein or not. The granting of a permit does not presume to give authority to violate or cancel the provisions of any other state or local law regulating construction or the performance of construction. INSPECTIONS REQUIRED: Foundation ❑ Framing ❑ Plumbing ❑ Electrical ❑ Wallboard ❑ FINAL SEPARATE PERMITS ARE REQUIRED (WHERE APPLICABLE) FOR PLUMBING, MECHANICAL AND ELECTRICAL. C FOR INSPECTORS USE ONLY: REINSPECTION: NOT TYPE OF INSPECTION DATE TIME APPROVED APPIROVED COMMENT DATE TIME APPROVED FINAL INSPECTION APPROVED BY Building Inspector ISSUANCE OF OCCUPANCY CERTIFICATE REQUIRED BEFORE OCCUP_YIN BU OWNER'S SIGNATURE Authorized BUILDING DEPT./jJ /,/� NG c,-- 6 Mets BUILDING PERMITSite Address I NSPECT/ON Ohe*To CARD Project Description PROTECT THIS CARD FROM THE WEATHER O or F Building IV Plumbing ❑ Mechanical ❑ Alarm/Sprinkler ❑ DURING INSPECTIONS THE BUILDINQ EERMIT ROVED PLANS SHALL BE ON SITE Permit # B B o — p Q37 @H Nvl� For Insneetions Call (3601473- 5870 Approved Date Notes 1 St FOUNDATION DO NOT POUR CONCRETE PRIOR TO APPROVAL Erosion Control In Place Foundation Footing (Check Setbacks) Foundation Walls Plumbing Ground Work Mechanical Ground Work Under Floor Framing Footing Insulation - 4" 2 nd PLUMBING MECHANICAL GAS PIPE Rough In Exhaust Fans/Duct Heating, Duct, Vent Support / Test / Meter set Fire S rinkler Line 3rd (IF hT FRAMING & 2"ARE APPROVED) Shear & Hold Down Connections L&I Electrical Approved Roof/CrawUVentilation Framing 4th INSULATION Under floor Walls Ceiling th 5 ETROCK (Fire Sprinkler must be approved prior to sheetrock) FINAL FINAL ELECTRICAL 415-4000 Dept of Labor & Industry WATER MAINTENANCE 473-5927 Grease Tray, Back Flcrsw, Water Meters PUBLIC WORKS Driveway Approach 473-5270 Sewer Connection 473-5270 KITSAP CO. HEALTH DISTRICT 337-5285 Septic Systems FIRE 473-5394 NAL B UILDING A11 of the above must be approved. 473-5870 Occupancy approval,Jor SFR only - Commercial structures require a separate Certificate of Occupancy. 16A DO NOT OCCUPY BUILDING WITHOUT BUILDING DEPARTMENT APPROVAL PROTECT THIS CARD FROM THE WEATHER Rev. August 2007 4" Vt'i E g E d P IT CENTER J U L 21 2008 COMMERCIAL REMERTON-DEPT. (Cw�ilding Permit Application MUNITY DEVELOP tv1ENT Department of Community Development ' 345 - 6th Street, Suits 600 ' Bremerton, WA 98337-1873 (360) 473-5275 ' Fax (360) 473-5278 ' www.ci.bremerton.wams Business Name: /IIV2 i c w ( .)qv -f5 Q i of �k d0Ys� b %,s -f Site Address: '�116 -SS L-) I'-V'J ^ L)01 2 F31 d To apply for a property address, contact Public Works at (360) 473-5270 CONTRACTOR: 1 S z v; e OWNER:Heel. Address: -q,)Lq Address: 1 U4, C - 4v, i City, State, Zi , U3 License # & Exp. Date: , j Phone #: Contact Name: Authorized Agent Name: Contact Phone #: Address: Email address: City, State, Zip: Tax ID/Parcel #:U j _moi" Phone ❑ Sewer ❑ Septic I Email address: 0 NEW COMMERCIAL ❑ TENANT IMPROVEMENT WITH WORK ❑ COMMERCIAL REMODEL ❑ TENANT IMPROVEMENT WITHOUT WORK ❑ COMMERCIAL ADDITION ❑ NEW SIGN 0 COMMERCIAL REPAIR 0 GRADING (Cubic Yards: ) ❑ NEW MULTI -FAMILY n REROOF ❑ DEMOLITION Interior Exterior— Foundation Wall" Roof / Section— '" Separate demolition permit and fees required. Contact Public Works for sewer cap permit (473-5270). Sewer must be capped prior to demolition permit issuance. ❑ OTHER: IS THIS PROPERTY WITHIN 200 FEET OFA SHORELINE? YES 71 NO F1 Scope of work proposed: �,o� r e rko"I'I rnQrj • �-I C �, VK W- q V -C. u` I4 , V IKtV., L (CJ Square Footage: Building: .r struction Type: 4-a i c k d aw Valuation Plan Review Fee Permit Fee Surcharge Total Fees 04 0.70 Application for which no permit is issued within 180 days following the date of application shall expire by limitation, and plans and other data submitted for review may thereafter be returned to the applicant or destroyed by the building official. The building official may extend the time for action by the applicant for a period not exceeding 180 days on request by the applicant, showing the circumstances beyond the control of the applicant have prevented action from being taken. No applicant shall be extended more than once. In order to renew action on an application after a atio i, thea cant shall r ubmi plans and pay a new plan review fee. 76 / 6 Ap Icant's Signature Dat Rev. July 2008 CITY OF BREMERTON DEPARTMENT OF COMMUNITY DEVELOPMENT LIM345 - 6th Street, Bremerton, WA 98337 STOPWORK FEES $1,076.00 2211 (360) 473-5275 Fax: (360) 473-5278 Building Permit r Building Code Edition: State Surcharge $4.50 0236 ASSESSOR NUMBER: 3966-004-001-0007 ZONING: INST APPLICANT NAME: FIELDS ROOF SERVICE PHONE: (253) 852-4974 OWNER NAME: HICKMAN DOUG PHONE: CONTRACTOR: FIELDS ROOF SERVICE INC PHONE: ( ) 275-0596 LENDER NAME: PHONE: SUBMITTED: 07/21/2008 PERMIT NUMBER: BB08 00455 DATE ISSUED: 07/21/2008 SITE ADDRESS: 2625 WHEATON WAY ADDRESS: 25924 78TH AVE S, KENT, WA 98032 ADDRESS: 2081 VICTORIA AVE, PORT TOWNSEND, WA 98368 ADDIkESS: 25924 78TH AVE S. KENT„ WA 98032 APPROVED: 07/21/2008 I €XPIPATION: 01/17/2009 STATUS: ISSUED VALUATION: $106,090.00 Commercial Buildin"rmitw Mechanical/Plumbing STOPWORK FEES $1,076.00 2211 MEDICAL ARTS BLDG - REROOF Building Permit $1,076.00 2211 Building Code Edition: State Surcharge $4.50 0236 Occupancy Group: TOTAL FEES: $2,156.50 Type of Construction: Flood Zone: Setbacks: Sanitation Method: Number of Bedrooms: Square Footage: Bid Price from Applicant 1 TOTAL Inspection Requests Fire Inspections (360) 473-5394 DCD: Building Inspections (360) 473-5870 H/D: Bremerton, Kitsap County Health District (360) 337-5285 L&I: Department of Labor and Industries (360) 415-4000 PW: Department of Public Works (360) 473-5270 This permit shall become null and void if the described and authorized by this permit has not commenced within 180 days from the date of issuance, or if the work is suspended or abandoned at anytime after the work is commenced for a period of 180 days. It is the responsibility of the permit holder to see that the required inspections are made. Failure to obtain required inspections may result in stoppage of the work until such time that the permit holder can susbstantiate to the City of Bremerton that the concealed work meets or exceeds code !, requirements. Any demolition, testing, or financial burden shall be borne directly by the permit holder. Failure to substantiate code requirements will indemnify the City against any and all responsibility or liability connected with the construction. I hereby certify that I have read and examined this permit and know the same to be true and correct. All provisions of laws and ordinances governing this type of work will be complied with whether specified herein or not. The granting of a permit does not presume to give authority to violate or cancel provisions of any State or local law regulating construction or the performance of the construction. If listing the owner as general contractor, I certify that I am exempt from the requirements of the State Contractor's Registration Law under Section 3, Chapter 126, Laws of 1967. All revisions to an approved plan require DCD review and approval prior to performing work. All building and tenant occupancy permits are required to pass final inspection prior to permit expiration and obtain a certificate of occupancy prior to use or occupancy. / I have read, and agree to abide by the coD.0776i o his permit including all conditions of zoning, building co es, and State and Federal laws. SIGNATURE OF OWNER OR AGENT: 5-4-4; C PRINTED NAME: DATE 7/2-1 v "'60NDITIONS City of Bremerton's appr Val of this application pertal s only to the City's gul tory jurisdiction, and thus compliance with City regulations does not nec ssarily ensure compliance 1�th ederal qr.state laws. 10. (DCD-01) 10. (DCD-02) DCD: Prior to performing any renovation or demolition work, Puget Sound Clean Air Agency (Clean Air Agency) and Washington Department of Labor and Industries (L&I) regulations require an asbestos survey be performed to determine whether there are asbestos - containing materials in the work area or structure. The asbestos survey must be conducted by and EPA -certified (AHERA) building inspector (except renovation or owner - occupied single family residences). DC D: For more information, please contact Clean Air Agency through their web site at www.cleanair.org or by phone at 800-552-3565 or 206- 689-4058. The L&I web site can be found at www.Ini.wa.gov/p-ts/asbestos/asbestos.htm. DCD: 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 Washington State Building code or of any other ordinance of the City of Bremerton. Permits presuming to give authority to violate or cancel the provisions of the Washington State Building code or other ordinances of the City of Bremerton shall not be valid. The issuance of a permit based on construction documents and other data shall not prevent the building official from requiring 0 Page 1 of 2 Page 2 of 2 CITY OF BREMERTON PERMIT NUMBER: BB08 00455 DEPARTMENT OF COMMUNITY DEVELOPMENT DATE ISSUED: 07/21/2008 345 - 6th Street, Bremerton, WA 98337 (360) 473-5275 Fax: (360) 473-5278 ASSESSOR NUMBER: 3966-004-001-0007 ZONING: INST SITE ADDRESS: 2625 WHEATON WAY APPLICANT NAME: FIELDS ROOF SERVICE PHONE: (253) 852-4974 ADDRESS: 25924 78TH AVE S, KENT, WA 98032 QWNER NAME: HICKMAN DOUG PHONE: ADDRESS: 2081 VICTORIA AVE, PORT TOWNSEND, WA 98368 CONTRACTOR: FIELDS ROOF SERVICE INC PHONE: ( ) 275-0596 ADDRESS: 25924 78TH AVE S, KENT„ WA 98032 LENDER NAME: PHONE: ADDRESS: SUBMITTED: 07/21/2008 APPROVED: 07/21/2008 EXPIRATION: 01/17/2009 STATUS: ISSUED the correction of errors in the construction documents and other data. The building official is also authorized to prevent occupancy or use of a structure where in violation of the Washington State Building code or of any other ordinances of the City of Bremerton. in inrg 9i\ _ B6 B 11sRrnva 11. (OTHER) Fire extinguishers shall be in place on the roof during the scope of the work. A method of �s calling 9-1-1 shall be in place on the roof or the site (telephoe or cell phone or radio). A fire watch shall be in place during the work and for at least 1/2 hour after work is completed for the day. 12. (OTHER) Torch down roofing to be performed by trained personnel who follow the manufacturer's_ instructions. MINIMUM INSPECTIONS REQUIRED To request an inspection, please call (360) 473-5870 and be sure to provide your permit number, name on permit, site address, contact phone number, and inspection type. Final Inspection - Fire Final Inspection - Building Page 2 of 2 A • [�] � C J d (` 12 p _p js O E I N y .N = W F- 'Z y_ U y �ca�Ot jam` _� C' m E C. / O 0 rte-•+ .� s _ y L o o _ O O •^ O 'E i V J2 aL.. V W wz C cu O _0 _ ca W Q ooJ� �� Ul r=odZ RS �E �I-- Z LU � n � � � � r � .y °- C � ji pC o O r .a C � n WCN �2 CoO J .., O E m O O Z �0 O 0 p z �. } LL CL O N c � = >, `° y dam A E �n V •` O ZU .D s L Vit'Q O _C L�G 2 ��;•°c= n. m 300 ' aZ Nµ- O L a �- ea -W .0 O i C ON = m m E E L m eo o �. N < Q .5 75 E E ° O o ... Uo ° 'a CL ° 'a +� V1> s ._ m ca C- O O � EEa= � .cn raOiaOi ti Sep 28 06 01:19p Al Weller E OLYGLASS J ROOF COATING "sPScWKzM 4 A571DBASE SHam MECHAN ! DROOFDEp(ACCORC TO FACTORY MUTUAL MMUIREMENrS ROOF DECIU to SUBSTRATE warmw PART 1 - DESCRIPTION Provide all labor, materials. equipment, supervision and incidentals as needed to install a complete POLYGLASS,, reinforced modified bituminous roofing system over a new or approved, prepared existing roof substrate. All details of installation shall conform to "POLYG Specifications, Detalls and General Recoanmendations', DUALITY ASSURANCE 1. Products used in the work of this Section shall be manufactured by poLyGLA,Sru or approved for use in conjunction with the products manufactured by POLYGLASSTM. 2- The Roofing Contractor and his personnel shall be currently approved by POLYGLASST,r as qualified to install the materials of this section. 3. Do not apply roofing during inclement weather. Do not apply roofing membrane to damp, frozen dirty, or dusty surfaces. PART 2 - MATERIALS BASE SHEET - POLYGLA&sTM modified bituminous base sheet, reinforced with a glass Tibor mat and weighing aPProxirnalWY 80 pounds per roll. There are approximately 200 square feet of finished base sheat coverage In each roll. Tradename: ELASTOBASE ROOFING MEMBRANE - POLYGLASSTu modified bituminous roof membrane reinforced with a polyester mat Top surface of membrane has factory applied grannies (available in a variety of calors) except at selvage edges. This material is packaged In a roll providing approodmately 100 square feet of finished roof coverage and weighs approximately 105 pounds. Trade name; POLYFLEX G 5036354136 p1 200 SERIES SPECIFICATIONS P 1 OK -T EX G MGRAN VLARj, 1 LAYER $ BASE SHEET - NEW OR REROOFING POLYFLEx G 22=D- APPROVED COLD ADHMVEl APPRD ED MUTUAL & FASTENING PATTERN ASPHALT PRIMER - Meeting ASTM D 41 specification, applied in strict conformance to manufacturers recommendations. COLD PROCESS ADHESIVE (Where specified) - Follow the Instructions of the adhesive manufacturer with regard to storage and installation requirements. FASTENERS - Unless otherwise approved by POLYGLASS or specified by the architect, shall consist of fasteners aTNnd plates of the size, type and quality required for FM Approval. SURFACE COATING (Where required by specification) _ emulsion coating, asphalt latex emulsion roof surfacing material, asphaltic based aluminum roof coating (fjbrated or non-fibrated) or a colored acrylic coating, may be required to meet necessary Piro code approvals Consutt POLYGLASST„ Technical Service Department for fire rated assembly information. PRODUCT HANDLING All materials, except those that are shop fabricated shag be delivered to the job site with their original labels intact. Bulk materials shall be Identified by the manufacturer as to specification issued. All materials shalt be stored in accordance with the instructions Of the manufacturer prior to their application or installation. 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