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HomeMy WebLinkAbout330 S Stillaguamish Ave_056722_2026 C I TY Ql= A HL- I hIGT[71%4 COIVSTRUGT I OIV PERM I T PE F;tM I T MC3_ _ goS-6 722 Owner: CASCADE VALLEY HOSPITAL 330 S. STILLAGUAMISH ARLINGTON 98223 Value of Work: $500. 00 Tax ID: Phone: 435-2133 Describe Work: INSTALL INJECTOR IN CT ROOM Proposed Use: HOSPITAL Legal Description: Job Address: 330 S STILLAGUAMISH AVE Contractor's Name Type Address License# CONSTRUCTION & DESIGN GEN 2755 AIRPORT WAYS CONSTDAO15LB TOTALS Fee Permit Fee $50. 00 ? SIGNATURE: C'� TOTAL FEE. . . . . . . . . . . . . . . . . $50. 00 I HEREBY CCIATFY THA I-jl V READ AND EXAMINED THIS APPLICATION AND PAYMENTS. . . . . . . . . . . . . . . . . . $0. 00 KNOW THE SAME TO BE TRUE AND COR- REC ALL PROVISIONS OF LAWS AND TOTAL DUE. . . . . . . . . . . . . . . . . $50. 00 ORD N ANC 'OVERN NG HIS TYPE OF WOR ILL COMI IED WITH WHETHER DATE RECEIPT # (/ B l G O ICIA YA Nr GOO ■ 1 ■ 1 ■ ■ 1 1 ■ 1 ■ ■ IN ■ ■ ■ ME ■ g■ ■ . NO I 1 1 NO ON ■ ■ ■ ■ 1 '■ 1 0 ■ ■J ■ J11 1 _ NO • •ol ■ ■ ■ ■ _ ■ ■ ■ ■ ON 1 1 ■ ■ 1 ■ 1 NONE ■ . ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ _. 1 . _� INNn,m 0 .000. or - ■EI ■ ■ ■ 1 ' . Ir 1'�■ M w ti im m r ol m moor Emmons NO ■ ■ ■1 7 ■ i1 ■ ■ 171 ■ M INN NO ` 1 Al — moor � 1 NJ 11, r ' ■ - L w ti' ■ �1 00 � ■ ■ . � ■ _ ■ 00 No h, I 0 0 0 minomm f6m d ib Elf IN 10 . . 0- 0 ■s '. i.' ; •.' • �3 � i 0 °r COMMERCIAL ME HANICAL ,k o 4PERMIT APPLICATION I f iV G1 Department of Community Development City of Arlington • 238 N Olympic Ave. •Arlington, WA 98223 • Phone (360)403 3431 • FAX (360)403 3447 THIS APPLICATION MUST BE ACCOMPANIED BY EIGHT(8) SETS OF CONSTRUCTION DRAWINGS, AND THREE (3) SETS OF WASHINGTON STATE ENERGY CODE APPLICATIONS. Type of Permit: ( ) Residential Apartment Zcommercial Project Address: !:�Ti LA— �� Parcel ID#: Lot#: Subdivision: Project Description: f.Q (z) Owner: [�a� �+�� AL%1 JS`r �%G i�-7A c Phone Number' Address: City: State: Zip Code Contact Person: C_��L R -A-* � �, Phone Number:,�co -i-o+ Cell Phone: Fax: E-mail: Address: City: State: Zip Code Please List Quantity of Fixtures Below: CLOTHES DRYER FURNACE UP TO 100K BTU GAS OUTLETS FURNACE OVER 100K FLR FURN INSTALL/RELOCATE SUSPENDED HTR/UNIT HTR\ APPL VENT/OTHER APPLIANCE REPAIR BOILER UP TO 3 HP BOILER UP TO 4-15 HP BOLIER UP TO 16-30 HP BOILER UP TO 31-50 HP BOILER 51 HP AND UP AIR AHNDLING UP TO 1 OK CFM AIRHANDLING OVER 1 OK CFM EVAL COOLER VENTILATION FANS OTHER VENTILATION SYSTEM VENT HOOD DOMESTIC INCINERATOR COM/IND INCINERATOR ALL OTHER UNITS FREESTANDING STOVE FIREPLACE INSERT Contractor: Phone Phone Number: Zvi--'4rdtt-40 tra Address: ZICA City: State: Zip Code: Contractor's License Number: r �rl 57�t]/�� ��l . LA Expiration: hereby certify that the above information is correct and that the construction on, and the occupancy and the use of the above- described roperty will b n-accgdance with the laws, rules and regulation of the State of Washington. J— e:nl2f Za2E2 �-r ignature Date Print Applicants Name Forms/MECH-1 • r � � . ... ,. _ � • �- � 9 • • _ \_ � j` ' �/ � �� r.a .i t� �'� �~ � i ` � � ' � �.�� ,,' � �� Look Up a Contractor, Electricap or Plumber License Detail Page 1 of 3 i Topic Index Contact Info Search Labor and In ustries Home Safety Claims&Insurance Workplace Rights Trades$Licensing Find a Law or Rule Get a Form or Publication Look Up a Contractor, Electrician or Plumber Printer Friendly.Version, General/Specialty Contractor A business registered as a construction contractor with LEtI to perform construction work within the scope of its specialty. A General or Specialty construction Contractor must maintain a surety bond or assignment of account and carry general liability insurance. License Information License CONSTDA015LB Licensee Name CONSTRUCTION Et DSGN ASSOC LLC Licensee Type CONSTRUCTION CONTRACTOR UBI 601955877 Verify Workers Comp Premium Status Ind. Ins. Account Id Business Type LIMITED LIABILITY COMPANY Address 1 2755 AIRPORT WAY S Address 2 City SEATTLE County KING State WA Zip 98134 Phone 2534649015 Status ACTIVE Specialty 1 GENERAL Specialty 2 UNUSED Effective Date 6/2/1999 Expiration Date 9/21/2007 Suspend Date Separation Date Parent Company Previous License HIGHRCI1010A Next License Associated License https://fortress.wa.gov/lni/bbip/Detail.aspx?License=CONSTDA015LB 10/25/2005 Look Up a Contractor, Electrician or Plumber License Detail Page 2 of 3 Business Owner Information Effective Expiration Name Role Date Date THORNTON, THOMAS E PARTNER/MEMBER 01/01/1980 ALSKOG, RALPH E PARTNER/MEMBER 01/01/1980 GREFTHEN, DEAN J PARTNER/MEMBER 01/01/1980 Bond Information Bond Bond Company Account EqDate Expiration Cancel Impaired Bond Received Bond Name Number Date Date Date Amount Date DEVELOPERS SURETY Et Until #3 INDEM CO 850246C 09/01/2001 Cancelled $12,000.00 08/28/2001 DEVELOPERS SURETY Et #2 INDEM CO 850246C 12/29/2000 09/01/2001 $6,000.00 09/10/2001 DEVELOPERS #1 INS CO 850246C 06/01/1999 12/29/2000 $6,000.00 I Savings Information No Matching Information Insurance Information Company Policy Effective Expiration Cancel Impaired Received Insurance Name Number Date Date Date Date Amount Date CORNHUSKER #6 CAS CO WAC460021 09/19/2005 09/19/2006 $1,000,000.00 08/15/2005 CORNHUSKER #5 CAS CO WAA002404 1 09/19/2004 09/19/2005 $1,000,000.00 09/24/2004 UNDERWRITERS #4 AT LLOYD'S CJ0352148 �09/19/2003 09/19/2004 $1,000,000.00 09/22/2003 UNDERWRITERS AT LLOYD'S #3 LONDON AOOBF051 09/19/2000 09/19/2004 $1,000,000.00 09/10/2003 TRAVELERS PROPERTY CAS #2 INS CO 680428Y9986 09/01/2000 09/01/2001 TRAVELERS INDEMNITY CO #1 OF AMER 680428Y9986 09/01/1998 09/01/2000 Summons /Complaints Information https://fortress.wa.gov/lni/bbip/Detail.aspx?License=CONSTDA015LB 10/25/2005 Look Up a Contractor, Electrician or Plumber License Detail Page 3 of 3 No Matching Information Start_a-New Search 'Printer Friendiv Version About LIEU I Find a job at L&I I Informacion en espalflol I Site Feedback .' 1-800-547-8367 t� c0 Washington State Dept. of Labor and Industries. Use of this site is subject to the laws of the V02-m-wom state of Washington. Access Agreement I Privacy and security statement I Intended use/external content policy Visit access.wa.gov Staff only link https:Hfortress.wa.gov/lni/bbip/Detail.aspx?License=CONSTDA015LB 10/25/2005 . i�, Cascade Valley Hospital Chapter 246-320 WAC Hospitals Ceiling Mount CT Injector Plan Review Comments b Q ; o > a E 0. U ¢ z 1 Cx7 Construction and renovation may create conditions that compromise the health and safety of patients, staff, and visitors. Facility planning must include, in addition to space and operational needs,provisions for infection control and safety of the facility's occupants during any renovation or new construction. The facility's infection control practitioner(ICP) and safety and security personnel (S&SP) should be involved with facility planning, design, construction, and commissioning of any new or renovated area. The design professional should incorporate the specific construction-related requirements of the ICP and S&SP in the contract documents to require the constructor to implement these specific requirements during construction. WAC 246-320- 505(2)(a)(ii), WAC 246-320-405(1), WAC 388-97-365, WAC 388-78A-2850(3),NFPA 101 Approved 11/14/05—During installation of the frame and mounting assembly for the CT injection arm. Please assure that the corridor door to the CT room is kept closed,that supply air grills are temporarily covered to reduce the air flow and return air grills covered with filter fabric to change the room to a negative air condition to control any dust from the installation escaping into adjacent areas. Upon completion of the work, provide terminal cleaning of the room and surfaces by the housekeeping staff before patients are seen. Compliance with the comments above provided by the Department of Health, Construction Review Services,are necessary for this facility to meet the requirements of the applicable licensing regulations found in the Washington State Administrative Code and associated references. These comments do not relieve the facility from the responsibility to meet the requirements of any other applicable federal,state or local regulations. In the event of conflicts between other jurisdictions and these written comments, the most stringent shall apply. Page 4 of 4 Plan Review Comments for Project# 8387 Cascade Valley Hospital CRS187 Page 1 of 2 Scott Black From: Dave Anderson [danderson@ci.arlington.wa.us] Sent: Wednesday, November 23, 2005 7:18 AM To: Scott A Black Subject: FW: Cascade Valley Hospital CRS#8387 this needs to go in the file for this project. David W. Anderson Building Official 360.403.3432 danderson@ci.arlington.wa.us -----Original Message----- From: Johnson, Debbie L. (DOH) [mailto:Debbie.Johnson@DOH.WA.GOV] Sent: Tuesday, November 22, 2005 2:57 PM To: Jones, Clark; curtisl@cascadevalley.org; ttcda@aol.com; danderson@ci.arlington.wa.us Cc: Eckroth, William M (LNI); Lance Talley; Plan, Byron (DOH) Subject: Cascade Valley Hospital CRS#8387 Cascade Valley Hospital CRS#8387 has been authorized to begin construction. Please contact Construction Review Services at 360.236.2944 if you have any questions regarding this letter. Thank you. «8387.pdf>> Debbie Johnson Secretary Senior Construction Review Services Phone: 360-236-2944 Fax: 360-236-2901 Email: Debb c.Jghpsc q@doh w .gov Website: w-,vw.doh.wa.gov/crs Mailing Address_ Physical Address Construction Review Services 310 Israel Road, SE P.O. Box 47852 MS: 47852 Olympia,WA 98504-7852 Tumwater,WA 98501 Public Health -Always Working for a Safer and Healthier Washington 12/1/2005 Cascade Valley Hospital CRS"'387 1 Page 2 of 2 1,,NS apt SSI'M ria}:be tw,lid'enlial,,If yore received it by miviake,lalaa.re)wrj'y Ibe.reader uud delele the xi,?,VAW AIlllless(gos to maid f-om The.Deput/menl q/'f.:Ceallh mq)!he dis.-ved to/be xrrb&i 12/1/2005 Letter of Transmittal Washington State Ilepartmentc f November 22, 2005 11rHealth Construction Review Services 310 Israel Road SE Tumwater,WA 98501 PO Box 47852 Olympia,Washington 98504-7852 www.doh.wa.gov/crs tel.360-236-2944 fax.360-236-2901 Project Info: CRS# 8387 Project 330 S. Stilliguamish Cascade Valley Hospital location: Arlington, WA 98223 Chapter 246-320 WAC Hospitals Ceiling Mount CT Injector Key People: Assigned DOH Steve Pennington Reviewer: steve.pennington@doh.wa.gov Facility Cascade Valley Hospital Facility Contact: Cascade Valley Hospital Administrator: Clark Jones Curt Leland 330 S. Stilliguamish 330 S.Stilliguamish Arlington,WA 98223 Arlington,WA 98223 (360)435-2133 (360)435-1404 clarkj@cascadevalley.org curtisl@cascadevalley.org Architect/ Construction and Design Associates Building City of Arlington Engineer: Thom Thorton Official: David Anderson 2755 Airport Way S. 238 N.Olympic Avenue Seattle,WA 98134 Arlington,WA 98223-1337 (206)464-9015 (360)403-3431 ttcda@aol.com dnderson@ci.arlington.wa.us Sprinkler / N/A Fire Alarm N/A Contractor: Contractor: Other: N/A Other: N/A Copies To: ® Local Building Official:City of Arlington ❑ DOH Child Birth Center Licensing Washington State Patrol,Fire Protection Bureau ❑ DOH Office of Accommodations&Res.Care Survey ® Architect/Engineer:Construction and Design Associates 0 DOH Office of Health Care Survey ❑ Sub-Contractor:N/A ❑ DSHS, Aging&Adult Services Administration ❑ Sub-Contractor:N/A ❑ DSHS, Div.Of Alcohol and Substance Abuse ® Dept.of Labor and Industries,Electrical Section ❑ Other: ® CRS File Page 1 of 4 Plan Review Comments for Project#8387 i Cascade Valley Hospital Chapter 246-320 WAC Hospitals Ceiling Mount CT Injector Memo: -Authorized to Begin Construction - The construction documents have been reviewed per Chapter 246-320 WAC Hospitals and found acceptable. The stamped approved copy of the documents shall be kept and available for the licensing staff on site. Please note the following: • Any changes/deviations (incl. change orders or addenda) from the approved documents must be submitted to the Department for review and approval. Please include your CRS number on all communications to Construction Review Services. • You must notify the department when construction is complete,either by the included "pink" card or by completing the form on the CRS website. Additional instructions may be printed on the pink card. When we receive notification,we will notify DOH Office of Health Care Survey that you have completed the review process and are ready for licensing. • Hospital licensing regulations do not allow use of the completed project area until the Office of Health Care Survey has been notified by CRS that the project has been completed. • The local building official is responsible for building construction permitting and occupancy. • Final licensing approval may be subject to a site inspection by DOH Office of Health Care Survey to verify compliance with Hospital licensing regulations. If you have any questions please feel free to contact Construction Review Services. You can monitor project status and fill out our online survey at www.doh.wa.goy/crs. Page 2 of 4 Plan Review Comments for Project# 8387 4 Facility Name: Cascade Valley Hospital Facility ID: 000006 Site Address: 330 S. Stilliguamish Arlington,WA 98223 Facility Data: Occupancy Group: I-2 Construction Type: 1 Applicable Code: 2003 IBC Number of Licensed Beds: Current: Added: Removed: Total: Number of Apartment units: Private occupancy: Two person occupancy: Automatic Fire Sprinkler System: 013 ❑13R ❑13D ❑Not Applicable Automatic Fire Alarm System: ❑Yes ❑Not Applicable Compartmentation on all floors required: ❑Yes ❑Not Applicable Special Egress Control Devices: N/A Approved Smoke Control System: ❑Yes ❑No Maximum allowable licensable Beds: N/A Based on size of rooms used for sleeping N/A Residents Based on size of common rooms N/A Residents Certificate of Need Approval Required: Yes ❑ No ® Granted: Yes ❑ No ❑ The data above is based on the information presented to the Department of Health Construction Review Services. Any change in the facility or facility program that causes the above information to be incorrect is subject to review by DOH Construction Review Services.Approval for construction is not approval for licensure.A copy of this certificate will be sent to the licensing agency. Page 3 of 4 Plan Review Comments for Project# 8387 '); q/ I" INSPECTION REPORT Permit No.: OS-G2d-� Lot #: Address: 3 30 Contractor: 4 Owner: 9s10I N G� Date: U.29 fil�APPROVAL ❑ PARTIAL APPROVAL ❑ VIOLATION 0 CORRECTION REQUESTED ❑ Corrections listed below MUST BE MADE before work can be approved. ❑ Please contact inspector. ❑ Was not able to perform inspection. ❑ CALL 435-0674 FOR RE-INSPECTICIN - 24 hour notice required. GorM�,b 34 - Inspector: / Date: TYPE OF INSPECTION REQUESTED ❑ Under-floor ❑ Framing ❑ Gas Piping ❑ Footing ❑ Drywall, Nailing ❑ Consultation ❑ Foundation ❑ Shear Nailing ❑ Groundwork ❑ Mechanical ❑ Grid ❑ Struct. Slab ❑ Wood Stove ❑ Rough-in ❑ Final ❑ Masonry ❑ Drainage ❑ Insulation ❑ Other: Sn,d�'y4--� � F •t � � ~ • � C I TY OF ARl_ I hIGTQt4 CQhJSTRIJGT I Oh! PERM I T PE RM I T h!O_ _ KZ1S-6 -722 Owner: CASCADE VALLEY HOSPITAL 330 S. STILLAGUAMISH ARLINGTON 98223 Value of Work: $500. 00 Tax ID: Phone: 435-2133 Describe Work: INSTALL INJECTOR IN CT ROOM Proposed Use: HOSPITAL Legal Description: Job Address: 330 S STILLAGUAMISH AVE Contractor's Name Type Address License# CONSTRUCTION & DESIGN GEM 2755 AIRPORT WAYS CONSTDA015LB TOTALS Fee Permit Fee $50. 00 y SIGNATURE: �Cb TOTAL FEE. . . . . . . . . . . . . . . . . $50.00 I HEREBY CERT FY THA HAVE READ AND EXAMINED THIS APPLICATION AND PAYMENTS. . . . . . . . . . . . . . . . . . $0. 00 KNOW THE SAME TO BE TRUE AND COR- REC' ALL PROVISIONS OF LAWS AND TOTAL DUE. . . . . . . . . . . . . . . . . $50. 00 ORD N NCES MORNG HIS TYPE OF WOR ILL IED WITH WHETHER SP I I El R V DATE RECEIPT # 8 G O ICIA C (� 111 ■ ■ r1 ■ 1 11 1 IN .01 LAL ■ I ■ ■ ■ ■ 1 . 1 ■ ■ 7.1 1 ■ � ■ •r�M MOM 11:9 ■ ME 0 1 ■ ■1 ■1 7 ■ 1mommommi ■ Norm ■ ■ 11 i W .ebr 0101116 a ' MLLMLNAAM ■ ■ T ■ ■ I rl 001000,1101 rr• I i r r• I T 1 rl ■ 7mmmr! mmm1 ■ ftM 1 J � r— 1 • • . r• r' ■ ■ ■ ■ ■ ■ mm ■ ■ 1 � . ! ■ ■ ■ 1 1 . . . . . 1 1 . � in" V Y ° COMMERCIAL MECHANICAL PERMIT APPLICATION � o Department of Community Development City of Arlington • 238 N Olympic Ave. • Arlington, WA 98223 • Phone (360)403 3431 • FAX (360)403 3447 THIS APPLICATION MUST BE ACCOMPANIED BY EIGHT(8) SETS OF CONSTRUCTION DRAWINGS, AND THREE (3) SETS OF WASHINGTON STATE ENERGY CODE APPLICATIONS. Type of Permit: ( ) Residential Apartment Zcommercial Project Address: '�1� �—' �'� Parcel ID#: Lot# Subdivision: Project Description:Sna NO ��y60��—Zn�� Owner: �Q,$ II j4f Y ��?Fi�� Phone Number'. 36,Q �4 Address: City: State: Zip Code: Contact Person: C ftl j,..�►-�7 _,Os_� e� Phone Number:,:�;Gn Cell Phone: Fax: E-mail: Address: City: State: Zip Code: Please List Quantity of Fixtures Below: CLOTHES DRYER FURNACE UP TO 100K BTU GAS OUTLETS FURNACE OVER 100K FLR FURN INSTALURELOCATE SUSPENDED HTR/UNIT HTR\ APPL VENT/OTHER APPLIANCE REPAIR BOILER UP TO 3 HP BOILER UP TO 4-15 HP BOLIER UP TO 16-30 HP BOILER UP TO 31-50 HP BOILER 51 HP AND UP AIR AHNDLING UP TO 1 OK CFM AIRHANDLING OVER 1 OK CFM EVAL COOLER VENTILATION FANS OTHER VENTILATION SYSTEM VENT HOOD DOMESTIC INCINERATOR COM/IND INCINERATOR ALL OTHER UNITS FREESTANDING STOVE FIREPLACE INSERT Contractor: O Phone Number: "-''4(d('-40 Address: 7? �^� ? G'�' City:-- State: Zip Code:�al � r Orl 51L6i9 � � Expiration: Contractor's License Number: P I hereby certify that the above information is correct and that the construction on, and the occupancy and the use of the above- described roperty will b n-accgrdance with the laws, rules and regulation of the State of Washington. —t /" '" 1 er- ignature Date Print Applicants Name Forms/MECH-1 � . ._ � _ 2' � �. - � ,� • .'. • t � } � t of •► ... • `�., J � ) . . ►� � •• - . �' '� "�L♦• ��•.i S `1� fit.'... I � I \, \� � 1 1 , ' 1 � I � � ' ' ♦.y �1 � � 1 Look Up a Contractor, Electrician or Plumber License Detail Page 1 of 3 Topic Index I Contact Info Search Horne Safety Claims 8 Insurance Workplace Rights Trades$ Licensing Find a Law or Rule Get a Form or Publication Look Up a Contractor, Electrician or Plumber Printer Friendly.Version General/Specialty Contractor A business registered as a construction contractor with LEd to perform construction work within the scope of its specialty. A General or Specialty construction Contractor must maintain a surety bond or assignment of account and carry general liability insurance. License Information License CONSTDA015LB Licensee Name CONSTRUCTION It DSGN ASSOC LLC Licensee Type CONSTRUCTION CONTRACTOR 601955877 V�Workers Comp Premium UBI Status Ind. Ins. Account Id Business Type LIMITED LIABILITY COMPANY Address 1 2755 AIRPORT WAY S Address 2 City SEATTLE County KING State WA Zip 98134 Phone 2534649015 Status ACTIVE Specialty 1 GENERAL Specialty 2 UNUSED Effective Date 6/2/1999 Expiration Date 9/21/2007 Suspend Date Separation Date Parent Company Previous License HIGHRC11010A Next License Associated License https://fortress.wa.gov/lni/bbip/Detail.aspx?License=CONSTDA015LB 10/25/2005 �.r. Look Up a Contractor, Electrician or Plumber License Detail Page 2 of 3 Business Owner Information Effective Expiration Name Role Date Date THORNTON, THOMASE PARTNER/MEMBER 01/01/1980 ALSKOG, RALPH E PARTNER/MEMBER 01/01/1980 GREFTHEN, DEAN J PARTNER/MEMBER 01/01/1980 Bond Information Bond Bond Company Account Effective Expiration Cancel Impaired Bond Received Bond Name Number Date Date Date Date Amount Date DEVELOPERS SURETY Et Until #3 INDEM CO 850246C 09/01/2001 Cancelled $12,000.00 08/28/2001 DEVELOPERS SURETY Et #2 INDEM CO 850246C 12/29/2000 09/01/2001 $6,000.00 09/10/2001 DEVELOPERS #1 INS CO 850246C 06/01/1999 12/29/2000 $6,000.00 Savings Information No Matching Information Insurance Information Company Policy Effective Expiration Cancel Impaired Received Insurance Name Number Date Date Date Date Amount Date CORNHUSKER 46 CAS CO WAC460021 09/19/2005 09/19/2006 $1,000,000.00 08/15/2005 CORNHUSKER #5 CAS CO WAA002404 09/19/2004 09/19/2005 $1,000,000.00 09/24/2004 UNDERWRITERS #4 AT LLOYD'S CJ0352148 �09/19/2003 09/19/2004 $1,000,000.00 09/22/2003 UNDERWRITERS AT LLOYD'S #3 LONDON AOOBF051 09/19/2000 09/19/2004 $1,000,000.00 09/10/2003 TRAVELERS PROPERTY CAS #2 INS CO 680428Y9986 09/01/2000 09/01/2001 TRAVELERS INDEMNITY CO #1 OF AMER 680428Y9986 09/01/1998 09/01/2000 Summons/Complaints Information https:Hfortress.wa.gov/lni/bbip/Detail.aspx?License=CONSTDA015LB 10/25/2005 Look Up a Contractor, Electrician or Plumber License Detail Page 3 of 3 i No Matching Information Start,a•N, Sear h 'Printer Friendty Version �r About L&I I Find a job at L&I I Informacion en espaPiol I Site Feedback ro I! ,4� 1.800-547-8367 Q Washington State Dept.of Labor and Industries. Use of this site is subject to the laws of the state of Washington. Access Agreement I Privacy and security statement I Intended use/external content policy Visit access.wa.gov Staff only link https:Hfortress.wa.gov/lni/bbip/Detail.aspx?License=CONSTDA015LB 10/25/2005 �.l Cascade Valley Hospital Chapter 246-320 WAC Hospitals Ceiling Mount CT Injector Plan Review Comments b ca ; 0 > a E; o U CL Q z 1 © Construction and renovation may create conditions that compromise the health and safety of patients, staff, and visitors. Facility planning must include, in addition to space and operational needs,provisions for infection control and safety of the facility's occupants during any renovation or new construction. The facility's infection control practitioner(ICP) and safety and security personnel (S&SP) should be involved with facility planning, design, construction, and commissioning of any new or renovated area. The design professional should incorporate the specific construction-related requirements of the ICP and S&SP in the contract documents to require the constructor to implement these specific requirements during construction. WAC 246-320- 505(2)(a)(ii), WAC 246-320-405(1), WAC 388-97-365, WAC 388-78A-2850(3),NFPA 101 Approved 11/14/05—During installation of the frame and mounting assembly for the CT injection arm. Please assure that the corridor door to the CT room is kept closed, that supply air grills are temporarily covered to reduce the air flow and return air grills covered with filter fabric to change the room to a negative air condition to control any dust from the installation escaping into adjacent areas. Upon completion of the work, provide terminal cleaning of the room and surfaces by the housekeeping staff before patients are seen. Compliance with the comments above provided by the Department of Health, Construction Review Services,are necessary for this facility to meet the requirements of the applicable licensing regulations found in the Washington State Administrative Code and associated references. These comments do not relieve the facility from the responsibility to meet the requirements of any other applicable federal,state or local regulations. In the event of conflicts between other jurisdictions and these written comments, the most stringent shall apply. Page 4 of 4 Plan Review Comments for Project# 8387 �-. I I I Cascade Valley Hospital CRS187 Page 1 of 2 Scott Black From: Dave Anderson [danderson@ci.arlington.wa.us] Sent: Wednesday, November 23, 2005 7:18 AM To: Scott A Black Subject: FW: Cascade Valley Hospital CRS#8387 this needs to go in the file for this project. David W. Anderson Building Official 360.403.3432 danderson@ci.arlington.wa.us -----Original Message----- From: Johnson, Debbie L. (DOH) [mailto:Debbie.Johnson@DOH.WA.GOV] Sent: Tuesday, November 22, 2005 2:57 PM To: Jones, Clark; curtisl@cascadevalley.org; ttcda@aol.com; danderson@ci.arlington.wa.us Cc: Eckroth, William M (LNI); Lance Talley; Plan, Byron (DOH) Subject: Cascade Valley Hospital CRS#8387 Cascade Valley Hospital CRS#8387 has been authorized to begin construction. Please contact Construction Review Services at 360.236.2944 if you have any questions regarding this letter. Thank you. «8387.pdf>> Debbie Johnson Secretary Senior Construction Review Services Phone: 360-236-2944 Fax: 360-236-2901 Email: Oebbie.j ohi-ison@doh.wa.ggN, Website: www.doh.wa.gov/crs Mailing Address Phvsieal Address_ Construction Review Services 310 Israel Road, SE P.O. Box 47852 MS: 47852 Olympia,WA 98504-7852 Tumwater,WA 98501 Public Health -Always Working for a Safer and Healthier Washington 12/1/2005 S Cascade Valley Hospital CRS"'387 Page 2 of 2 Tbi,r::tr:r.,,r:r;;ic1;;he iu,!/idr relia/. 1 f ynu tecrir e::(rl by r:i lcr,E, /srr,m uotrf y ll e.rerarlar uud do lelr:l{a t:rerrr�ge. Al/a e: (ges!o of d f om!ha.[.)ef r l%:eret 0l•,Ffeallh mqy be dis loped to tbe�,nblec: 12/1/2005 Letter of Transmittal Washington State Departnientof November 22, 2005 (Ij� Health Construction Review Services 310 Israel Road SE Tumwater,WA 98501 — PO Box 47852 Olympia,Washington 98504-7852 I www.doh.wa.gov/ers tel.360-236-2944 fax.360-236-2901 Project Info: CRS#8387 Project 330 S. Stilliguamish Cascade Valley Hospital location: Arlington, WA 98223 Chapter 246-320 WAC Hospitals Ceiling Mount CT Injector Key People: Assigned DOH Steve Pennington Reviewer: steve.pennington@doh.wa.gov Facility Cascade Valley Hospital Facility Contact: Cascade Valley Hospital Administrator: Clark Jones Curt Leland 330 S.Stilliguamish 330 S. Stilliguamish Arlington,WA 98223 Arlington,WA 98223 (360)435-2133 (360)435-1404 clarkj@cascadevalley.org curtisl@cascadevalley.org Architect/ Construction and Design Associates Building City of Arlington Engineer: Thom Thorton Official: David Anderson 2755 Airport Way S. 238 N.Olympic Avenue Seattle,WA 98134 Arlington,WA 98223-1337 (206)464-9015 (360)403-3431 ttcda@aol.com dnderson@ci.arlington.wa.us Sprinkler / N/A Fire Alarm N/A Contractor: Contractor: Other: N/A Other: N/A Copies To: ® Local Building Official:City of Arlington ❑ DOH Child Birth Center Licensing ® Washington State Patrol,Fire Protection Bureau ❑ DOH Office of Accommodations&Res.Care Survey ® Architect/Engineer:Construction and Design Associates ® DOH Office of Health Care Survey ❑ Sub-Contractor:N/A ❑ DSHS, Aging&Adult Services Administration ❑ Sub-Contractor:N/A ❑ DSHS, Div.Of Alcohol and Substance Abuse Dept.of Labor and Industries,Electrical Section ❑ Other: ® CRS File Page 1 of 4 Plan Review Comments for Project#8387 �: t I 1 i Cascade Valley Hospital Chapter 246-320 WAC Hospitals Ceiling Mount CT Injector Memo: - Authorized to Begin Construction - The construction documents have been reviewed per Chapter 246-320 WAC Hospitals and found acceptable. The stamped approved copy of the documents shall be kept and available for the licensing staff on site. Please note the following: • Any changes/deviations (incl. change orders or addenda) from the approved documents must be submitted to the Department for review and approval. Please include your CRS number on all communications to Construction Review Services. • You must notify the department when construction is complete, either by the included "pink" card or by completing the form on the CRS website. Additional instructions may be printed on the pink card. When we receive notification,we will notify DOH Office of Health Care Survey that you have completed the review process and are ready for licensing. • Hospital licensing regulations do not allow use of the completed project area until the Office of Health Care Survey has been notified by CRS that the project has been completed. • The local building official is responsible for building construction permitting and occupancy. • Final licensing approval may be subject to a site inspection by DOH Office of Health Care Survey to verify compliance with Hospital licensing regulations. If you have any questions please feel free to contact Construction Review Services. You can monitor project status and fill out our online survey at www.duh.wa.gov/crs. Page 2 of 4 Plan Review Comments for Project# 8387 4 Facility Name: Cascade Valley Hospital Facility ID: 000006 Site Address: 330 S. Stilliguamish Arlington,WA 98223 Facility Data: Occupancy Group: I-2 Construction Type: 1 Applicable Code: 2003 IBC Number of Licensed Beds: Current: Added: Removed: Total: Number of Apartment units: Private occupancy: Two person occupancy: Automatic Fire Sprinkler System: E 13 ❑13R ❑13D ❑Not Applicable Automatic Fire Alarm System: ❑ Yes ❑Not Applicable Compartmentation on all floors required: ❑Yes ❑Not Applicable Special Egress Control Devices: N/A Approved Smoke Control System: ❑Yes ❑No Maximum allowable licensable Beds: N/A Based on size of rooms used for sleeping N/A Residents Based on size of common rooms N/A Residents Certificate of Need Approval Required: Yes ❑ No ® Granted: Yes ❑ No ❑ The data above is based on the information presented to the Department of Health Construction Review Services. Any change in the facility or facility program that causes the above information to be incorrect is subject to review by DOH Construction Review Services.Approval for construction is not approval for licensure.A copy of this certificate will be sent to the licensing agency. Page 3 of 4 Plan Review Comments for Project# 8387 C,J 00 co Ln V C co C � � p p O O O -O N L O O5 a F A m o _� X � Mg a O m ca D � O \ OOf O .p —0 s 1— m w � W W .tea O 0 N -P W S� 0 72 s X O r� W O� fTl I• p 0 O - \O c3 N m rn Ks 0 CD CN O O p N 1 O 1 C N � f O O II < 1 ® V I O z 00 i n i m ; i S i i 0 0 CD ie PRO 6 DRAWING INFORPATION TITLE : PLAN AND DETAILS ® n = O o® � o F7 N CC) DRAWING FILE: AZH-05-125,dwg FTIEMPOWER INJECTORSUPPORT o I o DRAWN BY: a CASCADE VALLEY HOSPITAL ®� CHECKED BY:: Tod, A LINGT N, A 98223 k�, DATE: 10-11-05 0 . REVISION 1 : DATE: REVISION 1 : DATE: SCALE: AS-NOTED PLOTTING SCALE: 1 :1 r J �aX ID tr cr z ��zz L-4 7 - � X, IT M 1 1+ D IT ._ jj n i ,i O �� _._ c \ 0 z ! ro , - '_...• x lJ r i ro 5 �, W 1 —I � , �f Q I _....c. _.__ 0 71 ..... �., —....a ...., �,i;� ID Py i( i IL I I� to � d r O � O Z I THIS DRAWING NOT TO BE COPIED, DUPLICATED OR V£CTORIZED WITHOUT OBTAINING SPECIFIC PRIOR WRITTEN CONSENT FROM AVAC, INC,