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HomeMy WebLinkAbout121 S Olympic Ave_BLD1583_2026 �•�Y o� COMMERCIAL MECHANICAL • PERMIT APPLICATION ING Department of Community&Economic Development City of Arlington • 18204 59th Ave NE•Arlington,WA 98223 • Phone(360)403-3551 THIS APPLICATION MUST BE ACCOMPANIED BY TWO (2) SETS OF CONSTRUCTION DRAWINGS AND ALL OTHER INFORMATION OUTLINED IN THE MECHANICAL PERMIT SUBMITTAL REQUIREMENTS,IF APPLICABLE. Type of Permit: ❑ New Installation I�❑ Replacement ❑ Alteration Project Address: 121 9 . ollT►C, Ayc Parcel Project Description: _R W*t f\n, Proaoune TatlY-, Valuation: Owner:-�i�SL.Qj2kS4 �'('X�ccA_ a c>�1Ylc�llcu Phone#: 4Z5•1(DO• FNMA Address: City: I(1 Nl State: U)A Zip: CtSZ_'L-_ Email Address: 0 A-,e-i 1,f &7 '%Ac lcm ' i Contact Person: CLI�L\ 2u�� Phone#: ( 17_s'—TLO• 5,57--1 Address: ���� c� \U►mPIC� P�V•c City: AA State: WIT Zip: 6N22:� Email Address: 0_G--sCtT l`(3-r)25LQQ��1�_r o. Contractor Name: 5Y-V AAA 'C6,Qfk(•5 3t.k�2LCA Phone#: Contractor Address: l6'3"5 La+nc PGfK City: m-vl e3Ant-�State: LOR Zip-VTLZ.-S Email: Contact Person: Tc YC_ Contractor License Number: Expiration: Please indicate type of number of appliances: FURNACE CONDENSING UNIT GAS PIPING OUTLET BOILER HEAT PUMP(multi-split) UNIT HEATER CHILLER HEAT PUMP(mini-split) PAINT BOOTH COOLER HEAT PUMP(other) TYPE I HOOD AC(air cooled) HEAT REJECTION EQUIP TYPE II HOOD AC(water cooled) VENTILATION SYSTEM AST AC(evaporator) PACKAGED UNIT UST AC(VRF) DRYER OTHER hereby certify that the above information is correct and that the construction on, and the occupancy and the use of the above- described property will in accordance with the laws, rules and regulation of the State of Washington. Applicants Signature: Date Applicants Printed Name: FOR STAFF USE ONLY Received AiiM 04 2017 Permit# Accepted By Amount Received Receipt# Dafe R6beived 6/16LP Page 1 of 1 OPERATING PERMIT APPLICATION Department of Community& Economic Development 9SY' ' t City of Arlington•18204 59th Ave NE•Arlington,WA 98223•Phone(360)403-3551 Part I Applicant/Building Information n Applicant's Name: Applicant's Address: Contact Person: EA--YS.\ Telephone: S• U IE-5,L'A Address of Premises for which Operating Permit is requested: [] Same as above ❑ Other(specify):_ Tax Parcel ID#: Current Occupancy Class: Part II Type of Operating Permit An Operating Permit is required to conduct any activity or to use any class of building listed below. Please indicate the type(s) of Operating Permit(s)requested by checking each applicable box. (If you require assistance, or would like more information, contact the City of Arlington Building Department at 360-403- 3551.) ❑ Manufacturing, storing or handling hazardous materials in quantities exceeding those listed in the Fire Code (see Appendix A.)Identify the materials and quantities and describe the manner in which the materials will be manufactured, stored or handled(attach additional sheets if necessary): Revised 4/1/08 Page 1 of 4 Part H(cont'd) ❑ Conducting a hazardous process or activity, including, but not limited to, any commercial or industrial operation which produces combustible dust as a byproduct, fruit and crop ripening, waste handling, spray operations, and high-piled storage(see Appendix B.)Describe the process(es) or activity(ies)to be conducted (attach additional sheets if necessary): ❑ Use of pyrotechnic devices in assembly occupancies (see Appendix C.)Describe the devices to be used and type of event(attach additional sheets if necessary): ❑Aboveground Storage Tank(AST)(see Appendix D) ❑ Removal ❑ Decommissioning ❑ Temporary tank closure ❑ Changes in service ❑ Permanent tank closure Brief description: ❑ Underground Storage Tank(UST)(see Appendix D) ❑ Removal ❑ Decommissioning ❑ Temporary tank closure ❑ Changes in service ❑ Permanent tank closure Brief description: ❑ Temporary Membrane Structures, including tents and canopies(see Appendix E.) Brief description of structure and use: Cc: Fire Department Page 2 of 4 Part II(cont'd) ❑ Special Event Operating Permit-An Operating Permit is required for any special event that takes place within an occupied building, or an outdoor mass gathering,which is outside the scope of the permitted use(see Appendix F.)Brief description of type of gathering proposed: Part III Premises/Building Information l. Date of last inspection of Premises: 2. Has a Certificate of Occupancy been issued for the premises?❑ Yes ❑No Type: ❑ Permanent ❑ Temporary Date of Issuance:_ 3. Are there currently any open Building Permits associated with the premises? ❑ Yes Z No If yes, please describe (attach additional sheets if necessary): 4. Additional Comments: ',fl-;�A or Y, 1 u� SIGNATURE OF APPLICANT I herby certify that the foregoing information (and all information in attached sheets, if any) is true and c lete.o . Signature of Ahplicant or Authorized Re esentatives Signature Date Q �� Dq 3kAPPkkj Inc-, Name and Title (if applicable)of person signing Application (Please print) Cc: Fire Department Page 3 of 4 Part IV To be completed by the City of Arlington Building Department Inspection Required: ❑ Yes ❑No Inspections Performed: ❑ Yes ❑No Date of Inspection: Tests or Reports required verifying compliance? ❑ Yes ❑No If YES, have Tests or Reports been received? ❑ Yes❑No Application(s) Approved: ❑ Yes ❑ No Operating Permit Issued by: Date Operating Permit Issued: Date Operating Permit Expires: Type/Description of Operating Permit: Conditions of Operating Permit(list conditions here AND in the space provided in the Operating Permit): Additional Comments: (Attach additional pages if needed) Cc: Fire Department Page 4 of 4 ~' OPERATING PERMIT APPLICATION Appendix A Hazardous Materials Storage Department of Community&Economic Development City of Arlington• 18204 59th Ave NE•Arlington,WA 98223•Phone(360)403-3551 • An Operating Permit is required when a hazardous material listed in any of the categories in tables 5003.1.1 (1), 5003.1.1 (2), 5003.1.1 (3), or 5003.1.1 (4) of the Fire Code is manufactured,stored, or handled; and the quantity of such hazardous material exceeds the quantity listed in the applicable table. o This includes any building that is,whole or in part, a "Group W occupancy; is a pre-existing and non-conforming hazardous occupancy; or has outdoor use of, manufactures,and/or stores materials that exceed the tables for physical and/or health hazard. • An Operating Permit will not be issued until an inspection has been performed and establishes,to the satisfaction of the Fire Marshal,that the requirements of the Fire Code are satisfied; including provisions and requirements regarding manufacture, use,and storage, listed in Chapter 50 of the Fire Code. o A previous fire safety inspection will not wave this requirement. • Tests necessary to verify compliance with the Fire Code must be performed by the applicant, and the reports of such tests must be provided to the Fire Marshal. These tests and reports vary from product to product; however,they must include the following requirements: ❑Verification of inspection of the fire protection systems ❑Verification of inspection of storage cylinders,tanks, or containers ❑ Presentation of Material Safety Data Sheets (MSDS) ❑Verification of compliance with any other applicable State Agency Revised 9/2016 CITY OF ARLINGTON INSPECTION CARD No building construction shall be commenced until permit holder INSPECTION RECORD SHALL or his agent has posted this Inspection Record Card in a REMAIN AT JOB SITE conspicuous place on the premises. OWNER: Grange Supply Inc CONTRACTOR: Skagit Farmers Supply JOB ADDRESS: 121 S. Olympic Avenue LOT NUMBER TYPE GROUP NATURE of WORK: Propane tank relocation USE of BUILDING: PERMIT No: 1583 DATE ISSUED: 8.16.2017 INSPECTOR MUST SIGN ALL SPACES PERTAINING TO THIS JOB DEPARTMENT INSPECTION DATE(S) PASS FAIL INITIALS FOOTING BUILDING FOUNDATION (360)403-3417 UNDERFLOOR SHEARWALL PLUMBING(groundwork) ROUGH PLUMBING GAS PIPING ROUGH HEATING&VENTILATION FRAMING INSULATION WALLBOARD(SHEAR/RATED WALLS) CEILING GRID STRUCTURALSLAB CROSS CONNECTION CONTROL IN PREMISE PUBLIC WORKS GRADING (360)403-3457 TEMPORARY TECSP ASBUILTS APPROVED MAINTENANCE BOND STORM DRAINAGE SYSTEM PAVING,SIGNAGE&MARKINGS LANDSCAPING PLANNING CONDITIONS ONSITE UTILITIES WATER ONSITE UTILITIES SEWER Sewer OFFSITE UTILITIES WATER (360)403-3508 OFFSITE UTILITIES SEWER SEWER PRETREATMENT Water CROSS CONNECTION CONTROL PREMISE (360)403-3526 SIDE SEWER/CLEANOUT/FINAL WATER SERVICE INSTALLATION WATER SERVICE FINAL FIRE DEPARTMENT (360)403-3526 HYDRO/FLUSH (360)403-3607 UNDERGROUND""INCL FDC (360)403-3607 FIRE ALARM /AUTOMATIC SPRINKLER (360)403-3417 HOOD SUPPRESSION SYSTEM (360)403-3607 FINAL FIRE WALK-THROUGH (360)403-3417 FINAL INSPECTION ALL SIGNATURE BLOCKS MUST BE COMPLETE CITY OF ARLINGTON 238 N. OLYMPIC AVE- ARLINGTON, WA. 98223 PHONE; (360)403-3551 BUILDING PERMIT Address:121 S.Olympic Ave Permit#:1583 Parcel#:00378800700501 Valuation:0.00 OWNER APPLICANT CONTRACTOR Name:GRANGE SUPPLY INC Name:Co-op Supply,Inc. Name:Skagit Fanners Supply Address:PO BOX 233 Address:121 S.Olympic Ave Address: 1833 Lane Park City,State Zip:MARYSVILLE,WA 98270 City,State Zip:Arlington,WA 98223 City,State Zip:Burlington,WA 98233 Phone: Phone:425-760-5524 Phone:360-757-6053 MECHANICAL CONTRACTOR PLUMBING CONTRACTOR Name:Skagit Fanners Supply Name: Address: 1833 Lane Park Address: City,Slate,Zip:Burlington,WA 98233 City,State,Zip: Phone:360-757-6053 Phone: LIC M EXP: LIC#: EXP: JOB DESCRIPTION PERMIT TYPE: Commercial Mechanical CODE YEAR: 2015 STORIES: 0 CONST.TYPE: DWELLING UNITS: 0 OCC GROUP: BUILDINGS: 0 OCC LOAD: PERMIT APPROVAL 1 AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUCTION AND IN DOING THE WORK AUTHORIZED THEREBY;NO PERSON WILL BE EMPLOYED IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO WORKMEN'S COMPENSATION INSURANCE AND RCW 18.27. THIS APPLICATION IS NOT A PERMIT UNTIL SIGNED BY THE BUILDING OFFICIAL OR HIS/HER DEPUTY AND ALL FEES ARE PAID. IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFICATE OF OCCUPANCY HAS BEEN GRANTED. IBC1 l0/IRCl10. A ES TAX--TICE:Sales tax relating to construction and construction materials in the City of A'N' gZ7rr ust be reported on your sales tax return form and ded City of rli t ton#3101. Vature Print Narhe Date weascd By Date CONDITIONS Approved as submitted. Adhere to approved plan. TI IIS PERMIT AU'1HORIZS ONLY THE WORK NOTED.THIS PERMIT COVERS WORK TO BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE.PUBLIC DOMAIN(CURBS,SIDEWALKS,DRIVEWAYS,MARQUEES,ETC.)WILL REQUIRE SEPARATE PERMISSION- PERMIT FEES Date Description Fee Amount 8/16/2017 Building Permit-Other mount 8/16/2017 Mechanical Permit Base Fee $50.00 .00 8/16/2017 Processing/Technology Fee $25.00 Total Due: $100.00 Total Payment: E0.00 Balance Due: S100.00 CALL FOR INSPECTIONS BUILDING(360)403-3417 When calling for an inspection please leave the following information: Permit Number,'rype of Inspection being requested,and whether you prefer morning or afternoon 00378800700100 : A ©8 bollards on '' 04 `n ' 2 4' center I / Tank end 25' from building i "' j> Y � " 4 1 ' Electrical Shut J 1 PP off at building p T Filling station IFI pump inside bollards. Bollards:Set 2' in concrete. J Tank is under j 11' long. :�:T880R�QR5Q i '� I , '" Carr• o!�1vltncm z y ti is>• Filling sta- tion inside posts West corner. in - �� ` CITY OF ARLIN BUILDING DEPARTMENT, L _ C � APPROVED By NO CHANGES AUTHORIZED UNLESS APPROV'- FY THE • ' BUILDING IN '�OR 1 . ecelve AUG 0 4 2017 7 CITY OF ARLINGTON e 238 N. OLYMPIC AVE -ARLINGTON, WA. 98223 PHONE; (360)403-3551 BUILDING PERMIT Address:121 S.Olympic Ave Permit#:1583 Parcel#:00378800700501 Valuation:0.00 OWNER APPLICANT CONTRACTOR Name:GRANGE SUPPLY INC Name:Co-op Supply,Inc. Name:Skagit Farmers Supply Address:PO BOX 233 Address:121 S.Olympic Ave Address: 1833 Lane Park City,State Zip:MARYSVILLE,WA 98270 City,State Zip:Arlington,WA 98223 City,State Zip:Burlington,WA 98233 Phone: Phone:425-760-5524 Phone:360-757-6053 MECHANICAL CONTRACTOR PLUMBING CONTRACTOR Name:Skagit Farmers Supply Name: Address: 1833 Lane Park Address: City,State,Zip:Burlington,WA 98233 City,State,Zip: Phone:360-757-6053 Phone: LIC#: EXP: LIC#: EXP: JOB DESCRIPTION PERMIT TYPE: Commercial Mechanical CODE YEAR: 2015 STORIES: 0 CONST.TYPE: DWELLING UNITS: 0 OCC GROUP: BUILDINGS: 0 OCC LOAD: PERMIT APPROVAL I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUCTION AND IN DOING THE WORK AUTHORIZED THEREBY;NO PERSON WILL BE EMPLOYED IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO WORKMEN'S COMPENSATION INSURANCE AND RCW 18.27. THIS APPLICATION IS NOT A PERMIT UNTIL SIGNED BY THE BUILDING OFFICIAL OR HIS/HER DEPUTY AND ALL FEES ARE PAID. IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFICATE OF OCCUPANCY HAS BEEN GRANTED. IBC 110/IRC 110. SALES TAX NOTICE:Sales tax relating to construction and construction materials in the Cit=-/C_;Aa rted on your sales tax return form and coded City of Arlington#3101. 6-A , /,) Signature Print Name Date Released By Date CONDITIONS Approved as submitted. Adhere to approved plan. THIS PERMIT AUTHORIZS ONLY THE WORK NOTED.THIS PERMIT COVERS WORK TO BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC DOMAIN(CURBS,SIDEWALKS,DRIVEWAYS,MARQUEES,ETC.)WILL REQUIRE SEPARATE PERMISSION. PERMIT FEES Date Description Fee Amount 8/16/2017 Building Permit-Other $50.00 8/16/2017 Mechanical Permit Base Fee $25.00 8/16/2017 Processing/Technology Fee $25.00 Total Due: $100.00 Total Payment: $0.00 Balance Due: $100.00 CALL FOR INSPECTIONS BUILDING(360)403-3417 When calling for an inspection please leave the following information: Permit Number,Type of Inspection being requested,and whether you prefer morning or afternoon r �asTaaa700100 ,+ 8 bollards on x� , 4' center _ Tank end 25' K Y from building i bl ;; ;, • r _ � Electrical Shut r off at building F� G Filling station �' •,�, i @ `d - pump inside `'� h = «L �+ ,e N FIUI J . bollards. ' Bollards:Set 2' a � in concrete. i Tank is • under 11' long. 1 ►r , f"`„ Filling sta- tion inside posts at South I y , West corner. e RWA 0 _ r l K 6 CITY OF ARLINGTON 238 N.OLYMPIC AVE-APUNGTON, WA. 98223 PHONE;(360)403-3551 BUILDING PERMIT Address:121 S.Olympic Ave Permit#:1583 Parcel#:00378800700501 Valuation:0.00 OWNER APPLICANT CONTRACTOR Name:ORANOF.SI-iPPLY INC Name:Co-op Supply,Inc. Name:Skagit Farmers Supply Address:PO BOX 233 Address:121 S.Olympic Ave Address:1833 Lane Park City,State'Lip:MARYSVILLE,WA 98270 City,State Zip:Arlington,WA 98223 City,State Zip:Burlington,WA 98233 Phone: Phone:425-760-5524 Phone:360-757-6053 MECHANICAL CONTRACTOR PLUMBING CONTRACTOR Name:Skagit Farmers Supply Name: Address:1833 Lane Park Address: City,State,Zip:Burlington,WA 98233 City,State,Zip; Phone:360-757-6053 Phone: LIC#: EXP: LIC#: EXP: JOB DESCRIPTION PERMIT TYPE: Commercial Mechanical CODE YEAR: 2015 STORIES: 0 CONST.TYPE:: DWELLING UNITS: 0 OCC GROUP: BUILDINGS: 0 OCC LOAD: PERMIT APPROVAL 1 AGREE TO COMPI.Y WITH CITY AND STATE LAWS REGULATING CONSTRUCTION AND IN DOING THE WORK AUTHORI710 THEREBY;NO PERSON WILL BE EMPLOYED IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO WORKMEN'S COMPENSATION INSURANCE AND RCW 18 27 THIS APPLICATION IS NOT A PERMIT UNTIL SIGNED BY THE BUILDING OFFICIAL OR HIS/HER DEPUTY AND ALL FEES ARE PAID, IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFICATE OF OCCUPANCY HAS BEEN GRANTED. 1BC110/1RC 110. SALES"TAX NOTt E•Sales tax relating to construction and construction materials in the City urA'H on n u$1 be reported on your sales tax return form and tied City of rli ton#3I01. )Z,1,S O �1 6-1� 'I ignature Print Vrn a Date Raleascd BY Date CONDITIONS Approved as submitted.Adhere to approved plan. TH S PERMIT AUTHORIZS ONLY THE WORK NOTED.Tl[1S PERMIT COVERS WORK TO BE DONE ON PRIVATE PROPLRTY ONLY. ANY CONSTRUCTION ON THE PUBLIC DOMAIN(CURBS,SIDEWALKS,DRIVEWAYS,MARQUEES,ETC.)WILL REQUIRE SEPARATE PERMISSION PERMIT FEES Date Description t un Fee Amount 8/16/2017 Building Permit-Other mo 8/16/2017 Mechanical Permit Base Fee $25.00 8/16/2017 Processing/Technology Fee $25 00 Total Due: S100,00 Total Payment: S0.00 Balance Due: $100.00 CALL FOR INSPECTIONS BUILDING(360)403-34I7 When calling for an In,Pectlon Please levee the following information; Permit Number,Type of Inspection living requested,and%%hether you prefer morning or afternoon CITY OF ARLINGTON 238 N. OLYMPIC AVE-ARLINGTON, WA. 98223 PHONE; (360)403-3551 BUILDING PERMIT Address:121 S.Olympic Ave Permit#:1583 Parcel#:00378800700501 Valuation:0.00 OWNER APPLICANT CONTRACTOR Name:GRANGE SUPPLY INC Name:Co-op Supply,Inc. Name:Skagit Farmers Supply Address:PO BOX 233 Address:121 S.Olympic Ave Address: 1833 Lane Park City,State Zip:MARYSVILLE,WA 98270 City,State Zip:Arlington,WA 98223 City,State Zip:Burlington,WA 98233 Phone: Phone:425-760-5524 Phone:360-757-6053 MECHANICAL CONTRACTOR PLUMBING CONTRACTOR Name:Skagit Farmers Supply Name: Address: 1833 Lane Park Address: City,State,Zip:Burlington,WA 98233 City,State,Zip: Phone:360-757-6053 Phone: LIC#: EXP: LIC#: EXP: JOB DESCRIPTION PERMIT TYPE: Commercial Mechanical CODE YEAR: 2015 STORIES: 0 CONST.TYPE: DWELLING UNITS: 0 OCC GROUP: BUILDINGS: 0 OCC LOAD: PERMIT APPROVAL I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUCTION AND IN DOING THE WORK AUTHORIZED THEREBY;NO PERSON WILL BE EMPLOYED IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO WORKMEN'S COMPENSATION INSURANCE AND RCW 18.27. THIS APPLICATION IS NOT A PERMIT UNTIL SIGNED BY THE BUILDING OFFICIAL OR HIS/HER DEPUTY AND ALL FEES ARE PAID. IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFICATE OF OCCUPANCY HAS BEEN GRANTED. IBCI10/IRCI10. SALES TAX NOTICE:Sales tax relating to construction and construction materials in the City of g ust be reported on your sales tax return form and coded City of Arlington 43101. ' Signature Print Name Date Released By Date CONDITIONS Approved as submitted. Adhere to approved plan. THIS PERMIT AUTHORIZS ONLY THE WORK NOTED-THIS PERMIT COVERS WORK TO BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC DOMAIN(CURBS,SIDEWALKS,DRIVEWAYS,MARQUEES,ETC-)WILL REQUIRE SEPARATE PERMISSION. PERMIT FEES Date Description Fee Amount 8/16/2017 Building Permit-Other $50.00 8/16/2017 Mechanical Permit Base Fee $25.00 8/16/2017 Processing/Technology Fee $25.00 Total Due: $100.00 Total Payment: $0.00 Balance Due: $100.00 CALL FOR INSPECTIONS BUILDING(360)403-3417 When calling for an inspection please leave the following information: Permit Number,Type of Inspection being requested,and whether you prefer morning or afternoon :f� ��.•� ..� .,� } � c . T :�. � - ;i L ,/ ��,'S rafT • Permit Information Date 8/7/2017 Permit Number 1583 Project Name Co-op Supply,Inc. Applicant Name Co-op Supply, Inc. Applicant Address 121 S.Olympic Ave City, State,Zip Arlington,WA 98223 Contact Casey Russo Phone 425-760-5524 Email caseyr@co-opsupplyinc.com Permit Type Commercial Mechanical Site Address 121 S.Olympic Ave Valuation 0.00 Status Applied Permit Issued Permit Expires Square Feet 0 Type of Construction/Occupancy Load Number of Stories 0 Proposed Use Relocate 1000 gallon propane tank Assigned To Kristin Foster Property Information Owner Information Parcel#:00378800700501 GRANGE SUPPLY INC GRANGE SUPPLY INC PO BOX 233 121 S OLYMPIC AVE MARYSVILLE,WA 98270 Contractors Contractor Name Primary Contact Phone Email Contractor Type License License# Skagit Farmers Supply 360-757-6053 CONTRACTOR IlLabor and Industries JSKAGIFS120QH Review Date Type Description Target Date Completed Date I Assigned To I Status 8/10/2017 rommercial Mechanical 3/17/2017 IRick Karns 111n Review Uploaded Files Upload File 1 Date File Uploaded B 8/7/2017 1:24:51 PM 1583 Site.pdf Foster,Kristin x 8/7/2017 1:24:51 PM 1583 Application.pdf Foster,Kristin x r.., , :. �.AY COMMERCIAL MECHANICAL • PERMIT APPLICATION Department of Community&Economic Development City of Arlington • 18204 59th Ave NE•Arlington,WA 98223 • Phone(360)403-3551 THIS APPLICATION MUST BE ACCOMPANIED BY TWO (2) SETS OF CONSTRUCTION DRAWINGS AND ALL OTHER INFORMATION OUTLINED IN THE MECHANICAL PERMIT SUBMITTAL REQUIREMENTS, IF APPLICABLE. Type of Permit: ❑ New Installation n� Replacement Alteration Project Address: �2� `) . ( ��; t?►C , dL Parcel Project Description: Roo►nc), 90yam Ttmy,- Valuation: Owner:C>-b-A) 5 to j2plSA m Yrl'a Phone#: 4zs. 7(op• 5, mA Address: \2_\ �j, a�tirvv�nc. Rf City: f\\Y\I0 1 State: \ l' /1 Zip: Ct&= -1 Email Address: P A to f .�!?L. Q Q,LA'lnC`.,Corn J Contact Person: -(",-sCC k Phone#: `IDS ,too- 55z`A Address: 1 L\ , ' �� ��\���Y�?0 tl� ��' r City: State: U�)n_ZipA V Z? Email Address: NEPaA f P $ceo. -15-1- (a0S3 Contractor Name: Yiaalk SiA LIA Phone#: 'S(J?O'�o�Ol Oy5 S ( ;A IT J Contractor Address: 1�-33 Lar,c PG�K City: �j�►r`'rf1G�inn L State: b0 R ZiplYUL� Email: Contact Person: '5 �CYL Contractor License Number: Expiration: Please indicate type of number of appliances: FURNACE CONDENSING UNIT GAS PIPING OUTLET BOILER HEAT PUMP(multi-split) UNIT HEATER CHILLER HEAT PUMP(mini-split) PAINT BOOTH COOLER HEAT PUMP(other) TYPE I HOOD AC(air cooled) HEAT REJECTION EQUIP TYPE II HOOD AC(water cooled) VENTILATION SYSTEM AST AC(evaporator) PACKAGED UNIT UST AC(VRF) DRYER OTHER \/1 I hereby certify that the above information is correct and that the construction on, and the occupancy and the use of the above- described property will in accordance with the laws, rules and regulation of the State of Washington Applicants Signature: N'lxwi �—' Date l Applicants Printed Name: ` � V �— J�-�) FOR STAFF USE ONLY Received Aim 0 4 2017 c Permit# kptVVBJL716 Amount Received Receipt# Dafe 1eceived 6/16LP Page 1 of 1 1 I ' OPERATING PERMIT APPLICATION Department of Community& Economic Development City of Arlington•18204 59th Ave NE•Arlington,WA 98223•Phone(360)403-3551 Part I Applicant/Building Information (� Applicant's Name: --C.�-W sik--in c I ,(�L. l (\- �f Applicant's Address:12�• J. ���►r1r�1L y-� Contact Person: La>--&AL�5 Telephone: U o' G52-1 Address of Premises for which Operating Permit is requested: Same as above ❑ Other(specify): Tax Parcel ID#: Current Occupancy Class: Part II Type of Operating Permit An Operating Permit is required to conduct any activity or to use any class of building listed below. Please indicate the type(s)of Operating Permit(s)requested by checking each applicable box. (If you require assistance, or would like more information, contact the City of Arlington Building Department at 360-403- 3551.) ❑ Manufacturing, storing or handling hazardous materials in quantities exceeding those listed in the Fire Code (see Appendix A.)Identify the materials and quantities and describe the manner in which the materials will be manufactured, stored or handled (attach additional sheets if necessary): Revised 4/l/08 Page 1 of 4 i ' _1 - �� r• f i Part II(cont'd) ❑ Conducting a hazardous process or activity, including, but not limited to, any commercial or industrial operation which produces combustible dust as a byproduct, fruit and crop ripening,waste handling, spray operations, and high-piled storage (see Appendix B.) Describe the process(es)or activity(ies)to be conducted (attach additional sheets if necessary): ❑ Use of pyrotechnic devices in assembly occupancies(see Appendix C.)Describe the devices to be used and type of event(attach additional sheets if necessary): ❑Aboveground Storage Tank(AST) (see Appendix D) ❑ Removal ❑ Decommissioning ❑ Temporary tank closure ❑ Changes in service ❑ Permanent tank closure Brief description: ❑ Underground Storage Tank(UST)(see Appendix D) ❑ Removal ❑ Decommissioning ❑ Temporary tank closure ❑ Changes in service ❑ Permanent tank closure Brief description: ❑ Temporary Membrane Structures, including tents and canopies(see Appendix E.)Brief description of structure and use: Cc: Fire Department Page 2 of 4 i i : : M Part II(cont'd) ❑ Special Event Operating Permit-An Operating Permit is required for any special event that takes place within an occupied building, or an outdoor mass gathering,which is outside the scope of the permitted use(see Appendix F.)Brief description of type of gathering proposed: Part III Premises/Building Information 1. Date of last inspection of Premises: 2. Has a Certificate of Occupancy been issued for the premises?❑ Yes ❑No Type: ❑ Permanent ❑ Temporary Date of Issuance: 3. Are there currently any open Building Permits associated with the premises? ❑ Yes No If yes, please describe(attach additional sheets if necessary): 4. Additional Comments: Ndk 0 c7� SIGNATURE OF APPLICANT I herby certify that the foregoing information(and all information in attached sheets, if any) is true and co fete. Signature of 4pliant or Authorized Reg�resentatives Signature Date G l -Dp 1r`c, A �t�j-} ► �hteZ� �e!)f AAQ r Name and Title (if applicable)of person signing Application (Please print) Cc: Fire Department Page 3 of 4 �, -. � �.; I S ,1 I 1 OPERATING PERMIT APPLICATION 1 Appendix A Hazardous Materials Storage Department of Community& Economic Development City of Arlington•18204 59th Ave NE•Arlington,WA 98223•Phone(360)403-3551 • An Operating Permit is required when a hazardous material listed in any of the categories in tables 5003.1.1 (1), 5003.1.1 (2), 5003.1.1 (3), or 5003.1.1 (4) of the Fire Code is manufactured, stored, or handled; and the quantity of such hazardous material exceeds the quantity listed in the applicable table. o This includes any building that is,whole or in part,a"Group W occupancy; is a pre-existing and non-conforming hazardous occupancy; or has outdoor use of, manufactures, and/or stores materials that exceed the tables for physical and/or health hazard. • An Operating Permit will not be issued until an inspection has been performed and establishes,to the satisfaction of the Fire Marshal,that the requirements of the Fire Code are satisfied; including provisions and requirements regarding manufacture, use, and storage, listed in Chapter 50 of the Fire Code. o A previous fire safety inspection will not wave this requirement. ■ Tests necessary to verify compliance with the Fire Code must be performed by the applicant,and the reports of such tests must be provided to the Fire Marshal. These tests and reports vary from product to product; however, they must include the following requirements: ❑Verification of inspection of the fire protection systems ❑Verification of inspection of storage cylinders,tanks, or containers ❑ Presentation of Material Safety Data Sheets (MSDS) ❑Verification of compliance with any other applicable State Agency Revised 9/2016 i i i 8/7/2017 SKAGIT FARMERS SUPPLY Search L&I Washington State Department of Labor & Industries SKAGIT FARMERS SUPPLY Owner or tradesperson PO BOX 266 BURLINGTON,WA 98233 Principals 360-757-6053 MUZZALL,RONALD EDWIN,PRESIDENT SKAGIT County BOLAND,THOMAS EDWARD,PRESIDENT WILLIAMS, RICHARD IVER,VICE PRESIDENT SAKUMA,STEVEN MARK,SECRETARY SMITH,JENNIFER JOYCE,SECRETARY SAKUMA,STEVEN MARK,TREASURER LAGERLUND,NELS OSCAR,DIRECTOR MUZZALL,BOB (End: 10/12/2012) WALLACE,GEORGE (End: 10/12/2012) JOHNSON, HUBERT (End:10/12/2012) JOHNSON,GREGORY DEAN,DIRECTOR (End: 10/14/2016) DUQUAINE,BRIAN C,AGENT (End: 10/14/2016) Doing business as SKAGIT FARMERS SUPPLY WA UBI No. Business type 292 000 096 Corporation Governing persons DANNE ANDERSON KENNETH KADLEC; DANNEANDERSON; THOMAS BOLAND; GREGORY D JOHNSON; HUBERTJOHNSON; NELS LAGERLUND; RON MUZZALL; RONALD EDWIN MUZZALL; STEVEN MARK SAKUMA; JENNIFER SMITH; GEORGE WALLACE; RICHARD I WILLIAMS; License Verify the contractor's active registration/license/certification(depending on trade)and any past violations. Construction Contractor Active. Meets current requirements. License specialties https://secure.ini.wa.gov/verify/Detail.aspx?UBI=292000096&LIC=SKAGI FS 120QH&SAW= 1/3 i 8/7/2017 SKAGIT FARMERS SUPPLY GENERAL License no. SKAGIFS120QH Effective—expiration 11/08/1988-10/15/2018 Bond Merchants Bonding Co(Mutual) $12,000.00 Bond account no. WA30502 Received by L&I Effective date 10/07/2011 10/08/2011 Expiration date Until Canceled Bond history Insurance BERKLEY NATIONAL INSURANCE CO $1,000,000.00 Policy no. XCP9000991 Received by L&I Effective date 09/26/2016 09/30/2015 Expiration date 09/30/2017 Insurance history Savings No savings accounts during the previous 6 year period. Lawsuits against the bond or savings No lawsuits against the bond or savings accounts during the previous 6 year period. L&I Tax debts No L&I tax debts are recorded for this contractor license during the previous 6 year period,but some debts may be recorded by other agencies. License Violations No license violations during the previous 6 year period. Workers' comp Do you know if the business has employees?If so,verify the business is up-to-date on workers'comp premiums. L&I Account ID Account is current. 105,154-00 Doing business as SKAGIT FARMERS SUPPLY Estimated workers reported Quarter 2 of Year 2017"Greater than 100 Workers" L&I account contact T1/NICHOLE CAROW(360)902-5634-Email:CANI235@lni.wa.gov Public Works Strikes and Debarments Verify the contractor is eligible to perform work on public works projects. Contractor Strikes No strikes have been issued against this contractor. Contractors not allowed to bid No debarments have been issued against this contractor. Workplace safety and health Check for any past safety and health violations found on jobsites this business was responsible for. Inspection results date 08/05/2014 Violations Inspection no. 317366482 Location https://secure.ini.wa.gov/verify/Detail.aspx?UBI=292000096&LIC=SKAGIFS120QH&SAW= 2/3 � � U U / � , . / - / ^� \ | | | " J U 8/7/2017 SKAGIT FARMERS SUPPLY 11016 E Montgomery Dr Spokane Valley,WA 99206-6146 Inspection results date 07/05/2013 Violations Inspection no. 316828557 Location 31686 Sr#20 Oak Harbor,WA 98277 Inspection results date 05/29/2013 Violations Inspection no. 316763887 Location 12939 Avon Allen Rd Burlington,WA 98233-3556 O Washington State Dept,of Labor&Industries.Use of this site is subject to the laws of the state of Washington. Help us improve https:Hsecure.ini.wa.gov/verify/Detail.aspx?UBI=292000096&LIC=SKAGIFS120QH&SAW= 3/3 y �. ,� Kristin Foster From: Casey Russo <caseyr@co-opsupplyinc.com> Sent: Wednesday, August 09, 2017 6:50 AM To: Kristin Foster Subject: Re: Permit to Re-locate Propane Tank 1000 gallon Thank you Casey Russo Arlington Stores Manager C0-op SupplyInc D 121 South Olympic Arlington,WA 98223 36o-435-3213 On Mon, Aug 7, 2017 at 1:07 PM, Kristin Foster<kfoster arliVonwa.gov>wrote: Casey, Can you please verify the gallon size of the propane tank? Thanks Kristin Foster Permit Technician City of Arlington 18204 59 h Ave NE Arlington, WA 98223 360 403 3549 kfoster@arl ingtonwa.gov 1 z m 0- -a -n O m —I %tt CY r) TT = UQ 0- rD p (D rN-r O c- c rD N _Q v CD T_: r-r fD O c S 7 UI cn S cn• N c �cr O f� y _C Z O C C� r ZD� .� S13 OD J O j" .r- r - • �1'r `. o m O i m i a go - r JE _ ,s O 4 LM t W I if _ y M o O p .'' i r-j � `? ,�,� . �� � � '= n= C� eK n, . � O V �T t3 � J �� , � �� � �, x . � h � r; � I � ' i ;� Part IV To be completed by the City of Arlington Building Department Inspection Required: ❑ Yes ❑No Inspections Performed: ❑ Yes ❑No Date of Inspection: Tests or Reports required verifying compliance? ❑ Yes ❑No If YES, have Tests or Reports been received? ❑ Yes ❑No Application(s) Approved: ❑ Yes ❑ No Operating Permit Issued by: Date Operating Permit Issued: Date Operating Permit Expires: Type/Description of Operating Permit: Conditions of Operating Permit(list conditions here AND in the space provided in the Operating Permit): Additional Comments: (Attach additional pages if needed) Cc: Fire Department Page 4 of 4 i Permit#: 1583 Permit Date: 08/07/17 Permit Type: COMMERCIAL MECHANICAL Project Name: Co-op Supply, Inc. Applicant Name: Co-op Supply, Inc. Applicant Address: 121 S. Olympic Ave Applicant, City, State, Zip: Arlington,WA 98223 Contact: Casey Russo Phone: 425-760-5524 Email: caseyr@co-opsupplyinc.com Scope of Work: Relocate 1000 gallon propane tank Valuation: 0.00 Square Feet: 0 Number of Stories: 0 Construction Type: Occupancy Group: ID Code: Permit Issued: 08/16/2017 Permit Expires: Form Permit Type: Status: COMPLETE Assigned To: Kristin Foster Property Parcel# Address Legal Description Owner Name Owner Phone Zoning 00378800700501 121 S OLYMPIC AVE GRANGE SUPPLY 539 Other Retail INC Trade NEC Contractors Contractor Primary Contact Phone Address Contractor Type License License# Skagit Farmers Supply 360-757-6053 1833 Lane Park CONSTRUCTION Labor and SKAGIFS 120QH CONTRACTOR Industries Plan Reviews Date Review Type Description Assigned To Review Status 08/10/2017 COMMERCIAL z.Rick Karns MECHANICAL Fees Fee Description Notes Amount Building Permit-Other Inspection Fee $50.00 Mechanical Base Permit Fee $25.00 Processing/Technology $25.00 Total $100.00 Attached Letters Date Letter Description 08/16/2017 Building Permit Payments Date Paid By Description Payment Type Accepted By Amount 08/16/2017 Casey Russo 65951011 cc $100.00 Outstanding Balance $0.00 Uploaded Files Date File Name 08/16/2017 2532260-1583 Issued Permit.pdf 08/14/2017 2525363-Re Permit to Re-locate Propane Tank.msg 08/07/2017 2507608-1583 Application.pdf 08/07/2017 2507609-1583 Site.pdf