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HomeMy WebLinkAbout20210 77TH AVE NE_BLD2837_2026 (3) CITY OF ARLINGTON 238 N. OLYMPIC AVE - ARLINGTON, WA. 98223 PHONE; (360) 403-3551 BUILDING PERMIT Address:20210 77th Ave NE Permit#:2837 Parcel#:00929100000500 Valuation:.00 OWNER APPLICANT CONTRACTOR Name:HULEATT INVESTMENTS LLC Name:Zuiderweg Construction,LLC Name:Zuiderweg Construction,LLC Address: 17102 JIM CREEK RD Address:20606 101st Ave NE Address:20606 101st Ave NE City,State Zip:ARLINGTON,WA 98223 City,State Zip:Arlington,WA 98223 City,State Zip:Arlington,WA 98223 Phone: Phone:360-435-5929 Phone:360-435-5929 LIC:ZUIDECL961BI EXP:02/25/2020 MECHANICAL CONTRACTOR PLUMBING CONTRACTOR Name: Name: Address: Address: City,State,Zip: City,State,Zip: Phone: Phone: LIC#: EXP: LIC#: EXP: JOB DESCRIPTION PERMIT TYPE: Commercial Plumbing CODE YEAR: 2015 STORIES: CONST.TYPE: DWELLING UNITS: OCC GROUP: BUILDINGS: 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. IBC110/IRC110. SALES TAX N TIC&SalcAl tax relating to construction and construction materials in theCity of Arlington must be reported on your sales tax return form and led City 'lrli t # � . � ig _ re Print Name Date Released By I D to CONDITIONS Adhere to approved plans. Call for final inspection. THIS PERMIT AUTHORIZES ONLY THE WORK NOTED.THIS PERMIT COVERS WORK TO BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC DOMAIN(CURBS,SIDEWALKS,DRIVEWAYS,MARQUEES,ETC.)WILL REQUIRE SEPARATE PERMISSION. PERMIT FEES Date Description Fee Amount 10/21/2019 Medical Gas System $100.00 10/21/2019 Plumbing Permit Base Fee $25.00 10/21/2019 Processing/Technology Fee $25.00 Total Due: $150.00 Total Payment: $0.00 Balance Due: $150.00 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 � �M� !. v Permit#: 2837 Permit Date: 10/08/19 Project Name: Eagle Family Dental Site Address: 20210 77th Ave NE Company Name: Zuiderweg Construction, LLC Company Address: 20606 101st Ave NE City, State,Zip: Arlington, WA 98223 Contact: Phone: 360-435-5929 Email: zuiderwegconstructionllc@hotmail.com Permit Type: Commercial Plumbing Valuation: 0.00 Square Feet: 0 Number of Stories: 0 , Type of Construction: Occupancy Type: ��,�; Proposed Use: Addition of dental hygiene chair MIC/Opportunity Zone: Permit Issued: 51 Permit Expires: Type of Construction-DNU: Status-DNU: Status: IN PROCESS Property Parcel# Address Legal Description Owner Name Owner Phone Zoning Fees Fee Description Notes Amount Medical Gas System 322.10.00.00 $100.00 Plumbing Permit Base Fee 322.10.00.00 $25.00 Processing/Technology Fee 341.43.00.02 $25.00 Total $150.00 Uploaded Files Date File Name 10/08/2019 5722568-2837 Application.pdf �� h .% i Y COMMERCIAL PLUMBING PERMIT APPLICATION 7�l f'YC'�O 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 TWO (2) SETS OF FIXTURE SPECIFICATIONS (CUT SHEETS). CALCULATIONS ARE REQUIRED FOR GREASE INTERCEPTOR IF APPLICABLE. Type of Permit: ❑ New Installation ® Addition/Alteration ❑ Industrial Project Address: ,fib i �7Jq&.n(AF'- Parcel ID#: Lot#: Subdivision: Project Description: r�l t FAN OF 1 � ,9L �f N '. A i12- Valuation:, c Owner: —Phone Number: Address: R Q AC— City-&QL N(trnw State:QJTZip Code: 3=2 3 Contact Person: ('AdMEA,� Phone Number:! Cell Phone: E-mail: Address: City: State: Zip Code: Contractor: .Z u.1 -kLt)E d' (nL Si72LA2. 1� L( t' Phone Number: Cell Phone y19r­7; St b'j OR tlak-Y mail: _fd L[[r r✓f Cc1F �1� ?ra IJn(�r�©. P�a C�^'^^ Address:`��'� Lt✓l1bl -/�(�� City: tr State:ldlC:Z� Zip Code: 9 ' � Contractor License Number: Z 1.;� i>y Expiration Date: oc Please indicate number of fixtures: Water Closet Floor Sink Sump Hose Bibb Miscellaneous Lavatory Laundry Tub Washer Water Heater Grease Trap Urinal Interceptor Sink Med Gas Drinking Fountain Floor Drain Dishwasher Backflow Shower Other 6/16LP Page 2 of 3 COMMERCIAL PLUMBING PERMIT APPLICATION ING' Department of Community&Economic Development City of Arlington • 18204 59th Ave NE •Arlington,WA 98223 • Phone (360)403-3551 WHEN is a PLUMBING PERMIT REQUIRED? The City of Arlington requires a plumbing permit before a plumbing system or fixture is installed, altered, or remodeled. This also includes replacement of a Hot Water Tank. The City of Arlington does not require a permit to stop leaks or clear stoppages, unless the piping being repaired is altered or replaced. PLUMBING PLAN REVIEW IS REQUIRED FOR THE FOLLOWING PROJECTS 1. New Commercial Buildings 2. New Multi-Family Buildings 3. Roof Drains and Overflow Systems 4. Tenant Improvements e Installation of Medical Gas Systems 6. Installation of Commercial Kitchen's and Deli's 7. Installation of Grease Traps 8. Installation of Grease Interceptors 9. Installation of Sumps lo. Installation of Cross Connection Backflow Devices SUBMIT TWO (2) COPIES OF THE FOLLOWING FOR PLUMBING PLAN REVIEW: ❑ Plumbing plans or drawings. (Minimum plan size is 18" X 24" scale, %" scale for details.) ❑ Provide one set of plumbing drawings maximum size 11" X 17" ❑ Size of sanitary and potable water systems. ❑ Location, type and specifications (cut sheets) of proposed fixtures and equipment. ❑ Riser diagram of waste and vent, potable water and rain water systems, including sizes. C4 Medical gas piping riser diagram indicating type of gas, storage room and size of piping. ❑ Location and type of all backflow assemblies for each fixture. I hereby certify that I have read and examined this application and know the same to be true and correct and I am authorized to apply for this permit. 6/16LP Page 7 of 3 "'-°� COMMERCIAL PLUMBING PERMIT APPLICATION Department of Community&Economic Development City of Arlington • 18204 59th Ave NE •Arlington,WA 98223 • Phone(360)403-3551 PROPOSED BUILDING USE ❑ New Commercial ❑ Restaurant ❑ Automotive Based ❑ Commercial Addition/Alteration ❑ Office ❑ Machine Shop ❑ Industrial ] Medical ❑ Other: CROSS CONNECTION Please check all appliances that are proposed or are permanently connected to the water supply. ❑ Ice Machine ❑ Dialysis Equip. ❑ Air washers ❑ Swimming ❑ Fire Sprinkler Pools ❑ Coffee Steam Sprinkler Urn/Espresso ❑ Hydrotherapy Equip. ❑ Generators ❑ Hot Tub/Spa ❑ w/chemicals ❑ Carbonated Bev. Q Dental Equip. ❑ Dye Vats ❑ Aquarium ❑ Lawn Irrigation ❑ Fume Hoods ❑ Laboratory Equip. ❑ Pressure ❑ Decorative ❑ Well on Washers Fountain property ❑ Degreasers ❑ Autoclave/Sterilizers ❑ Cooling Towers ❑ Other: WASTEWATER DISCHARGE 1. Does the plumbing system currently have a grease interceptor? ❑ Yes ❑ No ❑ Don't Know Date grease trap/interceptor was last cleaned(provide service record): _ 2. Does the plumbing system currently have an oil/water separator? ❑ Yes ❑ No ❑ Don't Know 3. Date oil/water separator was last cleaned (provide service record): 4. Is water used in the business process(washing, rinsing,cooling)? ❑ Yes ❑ No ❑ Don't Know 5. Does your business require a NPDES permit? ❑ Yes ❑ No ❑ Don't Know hereby certify that the above information is correct and that the construction on, and the occupancy and the use of the above-described pr petty will Mia rIan with the laws rules and regulation of the State of Wash' gton. /l pplic nts Signature Date JI9M 2,1gc. Print Applicants Name FOR STAFF USE ONLY Permit# Accepted By Amount Received Receipt# Date Received 6/16LP Page 3 of 3 :: n Raelynn Jones From: Raelynn Jones Sent: Tuesday, October 8, 2019 10:31 AM To: zuiderwegconstructionllc@hotmaii.com Cc: Kristin Foster Subject: Eagle Family Dental Good Morning, We will require the following to be submitted in addition to the Plumbing Application that was turned in on 10/7 for the addition of a dental hygiene chair at Eagle Family Dental : • Gas piping drawings indicating start point/end point sizing • Operating pressure Please feel free to reach out should you have any questions.Thank you! Sincerely, Raelynn Jones Permit Technician City of Arlington Community& Economic Development 18204 59th Ave NE Arlington, WA 98223 Office: 360-403-3436 www.arlingtotiwa.gov i ti OS i)$t'ARTML,T,1"f Of LABOR 84.LTiDUSTR Certified as provided by Law as' plumber (PL01)-JOURNEY LEVEL ANDREGJ110BE Eft Date- �! 138� Exp Date 811712M ANDREWS,GLEN J ARLINGTON,WA 58223 I P',ki \-,I,N! ()I L.AHOR & INDI,:S1KIFS Certified as provided by Law asp Medical Gas piping lnstaper (MG01)-GENERAL ANDREGJ921C9 Eff Date,212gr2OOS Exp Date: 81171202D ANDREWS, GLEN J ARLINGTON,WA 88223 • 1 f_ t PARi'MI=.TV'I l?F 1 A130K&INm `I R11 s r'4, i Certified as provided by Law es' Plumber (PL01)-JOURNEY LEVEL ANDREGJ110BE Eff Date. 1/5AM Exp Date 811712020 ANDREWS, GLEN J ARLINGTON,WA 98223 Certified as provided by Law as: Medical Gas Piping Installer (MG01)-GENERAL ANDREGA21C9 Eft Date 2r29/20Q8 EV Date: V1712020 ANDREWS, GLEN J ARLINGTON,WA 98223 CITY OF ARLINGTON BUILDING DEPARTMENT APPROVED DATE 116 1/ BY oL NO CHANGES AUTHORIZED UNLESS APPROVED BY THE BUILDING INSPECTOR 4 �,•�....._...., ...�,,._._�,.. �.,.. �� � I , �. , ,-�-T �, � i fi. ; �, r 2 - 4 a Cl 7 0 3„ 3' - g „ Dr. Office 10 - 11 " Received OCT 112019 BLZ) 2.83'7 k-4 � o v g� WOOD an ro `— Nfa V O .° N A6 KID) oto �Yv ° oc 89 + 90 �CL a �p� rU�ou u 0, i um EcW + Q E oEE oucE, Z E E E Ln wC u N- 11 ,D N t7 - r � V O E c E a/ _ _ E - ELn �-y C 0 LLJ -j Llj s E o � E E >r � M J own Clr �— C Li J W LU Z 4 d 33 �73 } } un W m < O E El Z w , �. . . , E - � .0 p U r N - o� E _'mommV0 - Received OCT 1 1 tots -11r Pre-Installation Guide aydec, reliablecre �vesolutions" A-dec 411 Dental Chair and Related Systems ■ r5.. A-dec 411 Chair with 333 RadiusO-Style System, 551 Assistant's,461 Cuspidor,and 482 Monitor Mount This document contains technical specifications for installing the A-dec 411 chair and related systems. Contents Structural Requirements . . . .. .. . ... ..... ..... . . . . . .. . . ..... ....... . . . . . . . . . .. .. . . . . . . . . . . . . . . . 2 UtilityRequirements ..... . .. . ..... .... . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . 2 ShippingWeights ..... . .. ... . .... .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . .. . . . . . . . . . . . . . . . 3 Documentation References . . . . . . . . . . . . . . . . . . . . . .... . . .... ...... ....... . . .. . . .. . . . . . . . . . . . . . . . 3 Views and Dimensions .. .... .. . . . . . . .. . . ..... .. .. ........... .... . .... . . . . . . . .. . . . . . . . . . . . . . . . 4 UtilityPlacement . ................................ .......... ..... . ...... . . . . . . . . .. . . . . . . . . . . . . . . . . 4 A-dec 411 Chair Plan View with Elevation .. . . ......... .. ...... .. .... . ........... . . . . . . . . . . . . . . . . . . . . . . 5 A-dec 332/333 Radius-Style Delivery System Plan View with Elevation ... ...... ........... .............. . . 6 A-dec 551 Assistant's Instrumentation Plan View ...... ...................................... ....... . . . 7 A-dec 461 Cuspidor with Support Center Plan View with Elevation ............. ............. ..... . . . . . . . . . 8 A-dec 572,572L,and 372 Dental Light Plan View with Elevation ... .................................... . . 9 A-dec 482 Monitor Mount with Dental Light Plan View with Elevation ..... ................................ 10 A-dec 382 Radius-Style Monitor Mount Plan View with Elevation ............... .... .......... 11 Regulatory Information .. . . .. . ... . .. .... . .... .... . . .. . .. .. ........... 'CITY-0FARLT&GT0N BUILDING DEPARTMENT APPROVED DATE E3Y Go NO CHANGES AUTHORIZED UNLESS APPROVED BY THE BUILDING INSPECTOR OFFICE-COPY 86.0375.00 Rev A Received 'OCT 112019 t LA> 2g 7 ����� -r-,cyor:mom��J OIL ���.� f;;.��i�Nl �fr���1J1L1� 9 I' � 1 1 , +_ i �. U7 'v A-dec 411 Chair and Related Systems Pre-Installation Guide Structural Requirements Water 9 NOTE Job site construction should be com- Y Y NOTE The deliver system comes with a self- pleted before the dental equipment installa- contained water bottle.Municipal water is lionA(including finished floors,ceiling, only required if the equipment configuration plumbing,lighting,paint,etc.). includes a cuspidor or if the facility has special requirements. Dental Patient Chair Interface Requirement . 1/2" (13 mm)nominal pipe compression fitting The dental chair requires a solid,level mounting protruding 2" (51 mm)from the finished floor or surface that meets these minimum specifications: wall,supplied by the contractor. • Right angle manual shut-off valve supplied by the • Weight of 1000 lb(4448 N)for the chair,dental dental dealer and installed by the contractor. light,delivery system,and patient. Capability to anchor the chair to the floor,with a Water pressure and flow of 60±20 psi(410±140 KPa), • 1.5 gpm(5.7 L/min),not to exceed 104 F(40 C). minimum pullout load of 100 lb (445 N)for one anchor-bolt. Water plumbing to be flushed clean before the final connection to the dental equipment. Utility Requirements Electrical • 1/2" (13 mm)conduit and box with a hospital- ACAUTION Local regulation may require grade duplex receptacle supplied by the contractor. licensed plumbers and electricians to install the utilities.All plumbing and utilities must Wire box to conform to local codes. conform to prevailing local codes. • Top of duplex should not be higher than 4.25"(108 mm) above the finished floor to fit within the floor box. CAUTION The manner and method for • Voltage:120 volts,3 wire. A\ accessing the utilities within the wall is the . 110-120 VAC,50-60 Hz,15 Amp mains breaker min. responsibility of the design team working on the project(dental dealer,architectural NOTE The A-dec 411 chair is rated at services,and contractors).Utilities must be A 10 Amps max. accessible without the use of tools. Air The 10 Amp rating breaks down as follows for • 1/2" (13 mm)nominal pipe compression fitting 120 VAC @ 60 Hz: protruding 2" (51 mm)from the finished floor or o 3.5 Amps for the chair pump motor to move the wall,supplied by the contractor. chair base up. • Right angle manual shut-off valve supplied by the o 1.0 Amps for the chair back motor to move the dental dealer and installed by the contractor. chair back up or down. • Air pressure and flow of 80-100 psi(550-860 KPa), o 2.5 Amps for the 300-watt power supply 2.5 scfm. (71 sl/min) during normal use;7.5 scfm (located in the utility area)to power the chair- (210 sl/min)peak intermittent flow. mounted dental light and other ancillaries. • Air plumbing to be flushed clean before the final o 3 Amps of additional current for mains voltage connection to the dental equipment. ancillary products,such as video monitors. 2 86.0375.00 Rev A A-dec 411 Chair and Related Systems Pre-Installation Guide Central Vacuum Documentation References • Plumbing up to the floor box utility center and its Document Title p/n termination point is to be specified by the central vacuum supplier(terminates in the utility center). Installation Guides • Wet systems: A-dec 411 Dental Chair with Radius-Style Delivery 86.0378.00 o Plumbing to terminate with 5/8" (16 mm) O.D. System and Dental Light tube protruding 1"perpendicular to the floor. A-dec 461 Support Center 86.0387.00 0 10±2 in Hg,9 scfm minimum. A-dec 551 Assistant's Instrumentation 86.0388.00 A-dec 482 Monitor Mount 86.0410.00 Gravity Drain A-dec 382 Monitor Mount 86.0413.00 A-dec 572L Dental Light on an A-dec 411 or A-dec 86.0333.00 ANOTE Gravity drains are needed only on 511 Dental Chair systems with a cuspidor. Instructions for use A-dec 411 Dental Chair 86.0374.00 A-dec 461 Cuspidor with Support Center 86.0375.00 • 1-1/2" (38 mm)nominal pipe protruding 1" (25 mm) from finished floor.Trap to be placed in line, A-dec 551 Assistant's Instrumentation 86.0603.00 conforming to local codes,contractor-supplied. A-dec Self-Contained Water System 86.0609.00 • Floor mount only.Not recommended for wall A-dec Monitor Mounts 86.0309.00 mount utilities. Service Information A-dec Dental Chairs Service Guide 86.0380.00 Shipping Weights A-dec Dental Chairs Service Reference 86.0381.00 A-dec Delivery Systems Service Guide 86.0382.00 Product/Box Est.Shipping A-dec Delivery Systems Service Reference 86.0383.00 Weight A-dec Dental Lights and Monitor Mounts 86.0326.00 A-dec 411 Chair 410 lb(186 kg) Service Guide A-dec 332/333 Delivery System 88 lb(40 kg) A-dec Dental Lights and Monitor Mounts 86.0328.00 A-dec 461 Cuspidor with Support Center 66 lb(30 kg) Service Reference A-dec 551 Assistant's Instrumentation 20 lb(9.1 kg) Templates (assistant's arm only) A-dec 411 Chair Template 86.0386.00 A-dec 572/572L Dental Light 47 lb(21 kg) Adec 411 Related Modules Template 86.0385.00 A-dec 372 Dental Light 47 lb(21 kg) A-dec 411 Chair Mini Template 86.0386.01 A-dec 482 Radius-Style Monitor Mount 10 Ib(4.5 kg) A-dec Floor Boxes 85.0472.00 (mount hardware only;without monitor) Back Mount and Support Link 15 lb(6.8 kg) (required with 551 module) NOTE Use only full-scale templates for ® locating the plumbing and electrical. ANOTE The floor box mounting hole placements appear on the floor box base that is being installed. 86.0375.00 Rev A 3 A-dec 411 Chair and Related Systems Pre-Installation Guide Views and Dimensions ANOTE The dimensional drawings in this section are not to scale and are for reference only.For complete accuracy,use the appropriate full-sized templates. Utility Placement CAUTION Due to specific plumbing elevation restrictions,the height and placement of utilities in the floor box can affect the ability to use the floor box cover.Failure to provide adequate space will prevent installation and removal of the cover (see Figure 1).Please reference the appropriate full-size template which includes all of the necessary space constraints. Figure 1. Plumbing Elevations 51W(16 mm)O.D.tubing for Wet systems,or 40 mm O.D.tubing for Dry/Semi-dry systems Central Vacuum Only(see general notes) 1-112"(38 mm)nominal pipe for Gravity Drain (when required) O O O O a 2me%oe mm) T Ylsrti mml T height 1'(25.4 mm) 1'lr r�mml frvN rW01w0^[ FLOOR SURFACE FLOOR SURFACE 1/2"(13 mm)f nin:J plpo compression Ming vMh right"a manual shutoff valves for Air&Water 1/2"(13 mm)conduit for electrical.Supplied by contractor. (check amperage requirements) Figure 2. Floor Box Utility Connections 0 o .625 O.D.(I6rrvn)Tubing For Cmt,ol Vea only (sea q�naq notes) ELECTRICAL V�CWu 2 7/8"[73mm] 1 1/4"N33mm] 2 7/8"[73mm] IMNNHH IA' Jemin)Nemhwl pipe Fs,Gravity DWI (rh-Mwuse) O � 41/8"[105mm] r"`r'"�` 7" [179mm] 9 1/2"[243mm] ..a...m,.r a 16 7/8" [429mm] 4 86.0375.00 Rev A-dec 411 Chair and Related Systems Pre-Installation Guide A-dec 411 Chair Plan View with Elevation 25" (635 mm) Width of Backrest 9"-17.25" ( I (229-438 mm) \ i Range of Headrest 9"-18"(229-457 mm) ` r( 70.5" Ior L—Ralnis.Hnadre,t I ) 1791 mm) I I I I I 140' 13.75" Wmm) (349 mm)Tseatpocket 21.5" (546 mm) Space Between Arms 4.25" 63" (1o8mm)wa_ Farrtl 9" (1600mm) r Heatlres[Moemens 1\\ (229 mm) `I 1 aange oFHeadres[ il♦ `\I 1 J 58.5" 0486 mm) I I I I I \ 31.5" (800 mm) � 24" — — (610 mm) 26" chair ira els 11 s•frnm fusty down to fully up 11.5" (660 mm) (292 mm) Width of Baseplate Forward ChalrTrawl (from base down to base up) 34' (864 mm) 86.0375.00 Rev A 5 A-dec 411 Chair and Related Systems Pre-Installation Guide A-dec 332/333 RadiusStyle Delivery System Plan View with Elevation (shown with 333 system) O �p 19.5" 1 (495 mm) I 13"radius (330,mm) 14.5" 29"radius (368 171fT1 (737 mm) 32-34" (813-864 mm �j I I I I I I I 1 I 1 I I I I I ... I I I 1 ) 49.5" E 30" 9"-17.25" (1258 mm) (762 mm) (229-438 mm) Full Base Down to Full Base Up Range of Headrest (forward chair travel=11.5"[292 mml) 9"-18"(229-457 m m) for Lever Release Headrest 6 86.0375.00 Rev A-dec 411 Chair and Related Systems Pre-Installation Guide A-dec 551 Assistant's Instrumentation Plan View Long Arm 10"radius 10"radius (254 mm) (254 mm) r 6.75" t?j w- (171 mm) 1 13.5" (343 mm) 1 611 1 (152 mm) 36"radius (914 mm) 1 1 1 1 Short Arm 10"radius 10"radius (254 mm) (254 mm) 6" (152 mm) -- :; . j; 1. 22.75"radius t (578 mm) I / ' 1 1 , 1 1 1 1 1 1 1 1 11 1 1 1 86.0375.00 Rev A 7 A-dec 411 Chair and Related Systems Pre-Installation Guide A-dec 461 Cuspidor with Support Center Plan View with Elevation 18.25" (464 mm) � s A 4 45' 1 28.5" 14.5" (724 mm) (3688mm)m Cuspidor Only i t 18.5" (470 mm) Full Support Center i 14.5" it (368 mm) Full Support Center 14.5" (368 mm) Cuspidor Only 5.5" 140 mm) v 30" (762 mm) 21.5" (546 mm) Y- - r 8 86.0375.00 Rev A I A-dec 411 Chair and Related Systems Pre-installation Guide A-dec 572, 572L, and 372 Dental Light Plan View with Elevation (shown with A-dec 572L LED Dental Light) i 29"radius� (737 mm) 29" (737 mm) 01 0 od (508 mm) 27" - (686 mm) s�4 572 Light I t ;a`ta�•"�� i I 1 63.75° �}Q i(1619 mm) A-dec 372 Light / I 2 / 9"-17.25" 49.5" 26" 11.5° (229-438 mm) (1258 mm) (660 mm) (292 mm) Fuli base IkrMn Rangc of Headwst W Full&ix•Up 7-1B'(229.W mm) IM Lever M•Ieaw Headrest 86.0375.00 Rev A 9 r A-dec 411 Chair and Related Systems Pre-Installation Guide A-dec 482 Monitor Mount with Dental Light Plan View with Elevation s 30"radiu (762 mm) =<'- 18.5"radius (470 mm) 29" (737 mm) (559 mm) 27` (686 mm) r ( i 63.75" (1619 mm) i 49.5" 26" 30. 11.5" 9'-17.25" (1258 mm) (660 mm) (292 mm) (229-438 mm) rur En909wm Range of HPadlpfl W Full WW Up 9'-Ur(229-4S2—1 la Uevcr Rele4ae Neadleu 10 86.0375.00 RevA A-dec 411 Chair and Related Systems Pre-Installation Guide A-dec 382 Radius�Style Monitor Mount Plan View with Elevation 30"rad 762 mm < >: 9 (229 mm) t ) ) t ) ) I 2 r 44.75" (1137 mm) < 49.5" >< - 26" 11.5" 9"-17.25" (1258 mm) (660 mm) (292 mm) (229-438 mm) FAR ease od.." 144"9r of ltnadml to Full Base Up 9''18*{229.a57 mm) for Lew,Release HnMtle,t 86.0375.00 Rev A 11 5 A-dec 411 Chair and Related Systems Pre-Installation Guide Regulatory Information Regulatory information is provided with A-dec equipment as mandated by agency requirements. This information is delivered in the equipment's Instructions for Use or the separate Regulatory Information and Specifications document.If you need this information,please go to the Document Library at www.a-dec.com. „I aydec- A-dec Inc.makes no warrant/of any kind with regard to the content in this document including, A-dec Headquarters but not limited to,the implied warranties of 2601 Crestview Drive merchantability and fitness for a particular purpose. Newberg,OR 97132 USA Tel:1.800.547.1883 Within USA/Canada Tel:1.503.538.7478 Outside USA/Canada 86.0375.00 Rev A Fax:1.503.538.0276 Copyright 2013 A-dec Inc. www.a-dec.com/www.a-dec.biz All rights reserved. r_• C Medical Gas Services, LLC Dental Air and Vacuum Verification Report Date: October 13, 2019 Job Number: 2089 Contractor: Zuiderweg Construction, LLC Date(s) /Time(s) of Testing: October 11, 2019/ 0800 hrs. Facility: Eagle Family Dental 20210 77t" Avenue NE Arlington, WA 98223 Scope of Work: Added dental air and dental vacuum (1) chair. Our firm certifies that the verifier(s) named in this report are properly trained and certified to perform the activities required. All test and measurement equipment is properly calibrated and maintained. As representatives of Medical Gas Services, LLC the verifier(s) named in this report have conducted testing and verification of medical gas piping systems and related equipment to certify the following on the above date. I. General Findings: A. Dental air and vacuum are in compliance with NFPA 99(2012ed): Level 3 Dental B. No crossed lines were found in dental air and vacuum in the area tested on the day of testing. C. Dental air meets oxygen concentration. D. Dental air meets pressure requirements. E. Dental vacuum meets vacuum level requirements. F. Dental air and vacuum system components in area tested are in compliance with NFPA 99(2012ed): Level 3 Dental. G. Initial Line Pressure Test: PASS H. Permit#: 2837/City of Arlington EagleFamilyDental-10.11.19-VR-Dental Air&Vac(2012ed) Pg. 1 of 3 Received OCTI 12019 pjtj�) U31 1 1 Medical Gas Services, LLC II. Dental Air: A. Static Line Pressure: 115 psig B. Concentration of Oxygen: 20.8% III. Dental Vacuum: A. Static Line Vacuum: 7" HgV IV. Particulate Line Testing: PASS V. Odor: None—PASS VI. Dental Equipment: A. Dental Air: (Existing) 1. System air components are in compliance with NFPA 99(2005ed) 2. Brand Name: Air Techniques 3. Model Number: Air Star 50 4. Serial Number: NA 5. Configuration: Duplex 6. Horsepower: 1.5 7. Air Intake: Same space 8. Pump: Oil Less B. Dental Vacuum: (Existing) 1. System vacuum components are in compliance with NFPA 99(2005ed) 2. Brand Name: Ramvac 3. Model Number: 809E.1050.1 4. Serial Number: NA 5. Configuration: Simplex 6. Horsepower: 1 hp 7. Exhaust Vented Outside: Roof C. Amalgam Separator: (Existing) 1. Brand Name: Rebec 2. Model Number: 200 3. Serial Number: J401553 VII. Brazier: Glenn Andrews A. Brazier Number: ANDREGJ110BE B. Plumbing Contractor: Zuiderweg Construction, LLC Vill. Witness: Kim Keefe— Eagle Family Dental EagleFamilyDental-10.11.19-VR-Dental Air&Vac(2012ed) Pg. 2 of 3 Medical Gas Services, LLC IX. Comments: A. None X. Recommendations: A. None Tested By: Harry Pomeranz—ASSE 6030 Verifier EagleFamilyDental-10.11.19-VR-Dental Air&Vac(2012ed) Pg. 3 of 3 Medical Gas services, LLC Level 3 Verification Check List Reference NFPA 99(2012ed) Job#: 2089 Facility: Eagle Family Dental Tested By: HP Test Date: '0/11119 Facility: ❑ New ® Existing Type of Facility: ® Dental ❑ Medical ❑ Veterinary ❑ Lab ❑ Other: Medical Gases ® NONE Oxygen Line:❑New ❑ Existing Nitrous Oxide Line: ❑ New ❑ Existing ❑ NONE Line Pressure: psi Concentration: % Line Pressure: psi Concentration: % Flow Test: SCFH (>_3.5 scfm)❑ Pass ❑ Fail Flow Test: SCFH (>_3.5 scfm)❑ Pass ❑ Fail Particulate Test: ❑ Pass ❑ Fail Particulate Test: ❑Pass ❑ Fail Odor: ❑ Pass(None) ❑ Fail, Odor:❑ Pass(None) ❑ Fail, Crossed Lines:❑Yes ❑No Outlet Brand: Quick Connect Style: Location of Outlets: Cylinder Storage Z NONE Tank Room: ❑ New ❑ Existing Location:❑ Inside ❑ Remote Door Labeled: ❑Yes ❑ No Individually Secured:❑Yes ❑ No Cooling Sprinkler: ❑Yes ❑ No 1 Hour Rated:❑Yes ❑ No Separate from Mechanical Equipment:❑Yes ❑ No Electrical Switches/Outlets 5'above floor:❑Yes ❑ No Volume Connected or Stored: ❑ <3000 ft3 ❑ >3000 ft3 Number of Cylinders Connected:OX x N20 Ventilation:❑ Natural ❑ N/A Ventilation:❑ Mechanical ❑ N/A 2 Openings V of Floor&Ceiling:❑Yes ❑ No ❑ N/A Exhaust Fan Runs Continuously: ❑Yes ❑ No ❑ N/A Minimum 72 in'Free Area: ❑Yes ❑ No ❑ N/A Draws Air from within V of Floor:❑Yes ❑ No ❑ N/A Vented directly to outside:❑Yes ❑No ❑ N/A Fan Connected to Essential Power: ❑Yes ❑ No ❑ N/A Manifold Z NONE Manifold:❑ New ❑ Existing Piping Labeled: ❑Yes ❑ No Brand: Flex Hoses<5%❑Yes❑ No/Rigid Copper❑Yes❑ N/A Model#: Check Valve DL of Regulator: ❑Yes ❑ No Serial#: Relief Valve 50%Above Norman Line Pres: ❑Yes ❑ No Alarm/Warning System ® NONE Alarm: ❑ New ❑Existing ❑ None—Not Required Non-Cancellable Visual Alarm: ❑Yes ❑ No Brand: Cancellable Audible Alarm: ❑Yes ❑ No Model#: HI/LO Line Pressure Alarm: ❑Yes ❑ No Serial#: Reserve In Use Alarm/Change Over: ❑Yes ❑ No Eagle Family Dental-1 0.11.1 9-Chklst-Level 3 Verification (2012ed) Pg. 1 of 2 Medical Gas Services, LLC Emer enc ShutofflZone Valve (X] NONE Valve:❑ New ❑ Existing ❑ None—Not Required Brand: 3 Part Valve: ❑Yes ❑ No With Down Line Gauges: ❑Yes ❑ No Sensor Location:❑ UL ❑ DL Labeled: Dental Equipment ❑ Not Tested Dental Air System: ❑ New ® Existing ❑ NONE Dental Vacuum System: ❑ New ® Existing ❑ NONE Brand:Air Techniques Brand: Ramvac Model#:Air Star 50 Model#: 809E.1050.1 Serial#: NA Serial#: NA Conf:❑ Simplex ® Duplex ❑Triplex ❑ Quad Conf: ® Simplex ❑ Duplex ❑Triplex ❑Quad Compressor Type: Oil less Pump Type: Oil lubricated Compressor On:85 psi Compressor Off: 115 psi Vac Level:7"HgV Horse Power: 1 hp. Line Pressure: 115 psi Particulate: ® Pass❑ Fail Drain:® Sealed ❑Open ❑ Floor ®Wall Concentration: 20.8% Horse Power: 1.5 hp. Flexible Connectors: ®Yes ❑ No Receiver:®Yes ❑ No Drain:® Manual ❑Auto Air 1 Water Separator:®Yes ❑ No Moisture Indicator: ®Yes ❑ No Exhausted to Outside:®Yes ❑ No Dryer:®Yes ❑ No Location of Discharge: Roof Intake:❑ Outside ❑ Inside(other) ® Inside(same) Piping: ❑ Hard Copper ®Schedule 40 PVC Amal am Separator ` ❑ New ® Existing ❑ Not Required ❑ None Brand: Rebec Model#:200 Serial#:J401553 Comments: Arlington 2837 Kim Keefe Eagle Family Dental-1 0.11.1 9-Chklst-Level 3 Verification (2012ed) Pg. 2 of 2 > A u W , z 00 co O � z OG F o irr"--i t,y q O 99 Z U �✓ ¢ 1 z �✓ pC A F x Z V A a O AW gz Ln G ❑ Q as zzg o 04in o z , 0.z ,4 A 'n 04 0 O aa... LO m o Q O GC >C C4 A F Z �' o V W F. OFOA 0wOF Ln CQ Oda A OO m F W CIOO a '� z 3 -a 91. OZ A � Z per., U F OF z0a. Z z v�iaw. o a F O a z a v H p �r w 0 Q a z z zaa 0. O�Ca � � z z ❑ ❑ 0. F ❑ ❑ ❑ ❑ ❑ ❑ z ��� �Ny °�' COMMERCIAL PLUMBING PERMIT APPLICATION IN 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 TWO (2) SETS OF FIXTURE SPECIFICATIONS (CUT SHEETS). CALCULATIONS ARE REQUIRED FOR GREASE INTERCEPTOR/F APPLICABLE. Type of Permit: ❑ New Installation ❑ Addition�/Alteration ❑ Industrial Project Address: 26A 10 :77 .�' ( AP_ /�.� Parcel ID#: Lot#: Subdivision: Project Description: NT W C'f-hc_i flL f-kLy( NL (r./-�/-1 i/�Valuation: Owner: —Phone Number: Address: R Ap� 99 CityAR I>y'/yam N State: U J6 Zip Code: Contact Person: 04,d (Fs1?,_, Phone Number: V,8- Cell Phone: E-mail: Address: City: State: Zip Code: Contractor: .ZUIURIL)El, ( _n L_A(S—FRL ,MN4 Ll , Phone Number: Cell Phonel2r1:2AV -SIPt ORt/X-3X7-Email: ZU-04E(`LL)r. �Sfp�ZBIJI ' ,' C Address: ��I l�'t1G1F_lu,�w. City: - State:1d IQ - Zip Code: 9&Qi25N.S Contractor License Number: 2a inE.�i 4!L5,ds I Expiration Date: con Please indicate number of fixtures: Water Closet Floor Sink Sump Hose Bibb Miscellaneous Lavatory Laundry Tub Washer Water Heater Grease Trap Urinal Interceptor Sink Med Gas _� Drinking Fountain Floor Drain Dishwasher Backflow� Shower Other 6/16LP Page 2 of 3 COMMERCIAL PLUMBING PERMIT APPLICATION y�l rNC',9 Department of Community&Economic Development City of Arlington • 18204 59th Ave NE •Arlington,WA 98223 • Phone (360)403-3551 WHEN is a PLUMBING PERMIT REQUIRED? The City of Arlington requires a plumbing permit before a plumbing system or fixture is installed, altered, or remodeled. This also includes replacement of a Hot Water Tank. The City of Arlington does not require a permit to stop leaks or clear stoppages, unless the piping being repaired is altered or replaced. PLUMBING PLAN REVIEW IS REQUIRED FOR THE FOLLOWING PROJECTS 1. New Commercial Buildings 2. New Multi-Family Buildings 3. Roof Drains and Overflow Systems 4. Tenant Improvements b.? Installation of-Medical Gas Systems 6. Installation of Commercial Kitchen's and Deli's 7. Installation of Grease Traps 8. Installation of Grease Interceptors 9. Installation of Sumps lo. Installation of Cross Connection Backflow Devices SUBMIT TWO (2) COPIES OF THE FOLLOWING FOR PLUMBING PLAN REVIEW: ❑ Plumbing plans or drawings. (Minimum plan size is 18" X 24" scale, %" scale for details.) ❑ Provide one set of plumbing drawings maximum size 11" X 17" ❑ Size of sanitary and potable water systems. ❑ Location, type and specifications (cut sheets) of proposed fixtures and equipment. ❑ Riser diagram of waste and vent, potable water and rain water systems, including sizes. Q Medical gas piping riser diagram indicating type of gas, storage room and size of piping. ❑ Location and type of all backflow assemblies for each fixture. I hereby certify that I have read and examined this application and know the same to be true and correct and I am authorized to apply for this permit. 6/16LP Page 1 of 3 COMMERCIAL PLUMBING � o PERMIT APPLICATION C.f,NG Department of Community&Economic Development City of Arlington • 18204 59th Ave NE•Arlington, WA 98223 •Phone (360)403-3551 PROPOSED BUILDING USE ❑ New Commercial ❑ Restaurant ❑ Automotive Based ❑ Commercial Addition/Alteration ❑ Office ❑ Machine Shop ❑ Industrial El Medical ❑ Other: CROSS CONNECTION Please check all appliances that are proposed or are permanently connected to the water supply. ❑ Ice Machine ❑ Dialysis Equip. ❑ Air washers ❑ Swimming ❑ Fire Sprinkler Pools ❑ Coffee Steam Sprinkler ❑ Hydrotherapy Equip. ❑ ❑ Hot Tub/Spa ❑ Urn/Espresso Generators w/chemicals ❑ Carbonated Bev. El Dental Equip. ❑ Dye Vats ❑ Aquarium ❑ Lawn Irrigation ❑ Fume Hoods ❑ Laboratory Equip. ❑ Pressure ❑ Decorative ❑ Well on Washers Fountain property ❑ Degreasers ❑ Autoclave/Sterilizers ❑ Cooling Towers 0 Other: WASTEWATER DISCHARGE 1. Does the plumbing system currently have a grease interceptor? ❑ Yes ❑ No ❑ Don't Know Date grease trap/interceptor was last cleaned (provide service record): 2. Does the plumbing system currently have an oil/water separator? ❑ Yes ❑ No ❑ Don't Know 3. Date oil/water separator was last cleaned (provide service record): 4. Is water used in the business process (washing, rinsing, cooling)? ❑ Yes ❑ No ❑ Don't Know 5. Does your business require a NPDES permit? ❑ Yes ❑ No ❑ Don't Know I hereby certify that the above information is correct and that the construction on, and the occupancy and the use of the above-described pr pert y will b ac ordan ' with the laws, rules and regulation of the State of Washington. Alpllillch6ts Signature Dafe JILAZ Print Applicants Name FOR STAFF USE ONLY Permit# Accepted By Amount Received Receipt# Date Received 6/16LP Page 3 of 3 Medical Gas Services, LLC Dental Air and Vacuum Verification Report Date: October 13, 2019 Job Number: 2089 Contractor: Zuiderweg Construction, LLC Date(s) /Time(s) of Testing: October 11, 2019/ 0800 hrs. Facility: Eagle Family Dental 20210 771h Avenue NE Arlington, WA 98223 Scope of Work: Added dental air and dental vacuum (1) chair. Our firm certifies that the verifier(s) named in this report are properly trained and certified to perform the activities required. All test and measurement equipment is properly calibrated and maintained. As representatives of Medical Gas Services, LLC the verifier(s) named in this report have conducted testing and verification of medical gas piping systems and related equipment to certify the following on the above date. I. General Findings: A. Dental air and vacuum are in compliance with NFPA 99(2012ed): Level 3 Dental B. No crossed lines were found in dental air and vacuum in the area tested on the day of testing. C. Dental air meets oxygen concentration. D. Dental air meets pressure requirements. E. Dental vacuum meets vacuum level requirements. F. Dental air and vacuum system components in area tested are in compliance with NFPA 99(2012ed): Level 3 Dental. G. Initial Line Pressure Test: PASS H. Permit#: 2837/City of Arlington EagleFamilyDental-10.11.19-VR-Dental Air&Vac(2012ed) Pg. 1 of 3 Received OCT 112019 Medical Gas Services, LLC II. Dental Air: A. Static Line Pressure: 115 psig B. Concentration of Oxygen: 20.8% III. Dental Vacuum: A. Static Line Vacuum: 7" HgV IV. Particulate Line Testing: PASS V. Odor: None—PASS VI. Dental Equipment: A. Dental Air: (Existing) 1. System air components are in compliance with NFPA 99(2005ed) 2. Brand Name: Air Techniques 3. Model Number: Air Star 50 4. Serial Number: NA 5. Configuration: Duplex 6. Horsepower: 1.5 7. Air Intake: Same space 8. Pump: Oil Less B. Dental Vacuum: (Existing) 1. System vacuum components are in compliance with NFPA 99(2005ed) 2. Brand Name: Ramvac 3. Model Number: 809E.1050.1 4. Serial Number: NA 5. Configuration: Simplex 6. Horsepower: 1 hp 7. Exhaust Vented Outside: Roof C. Amalgam Separator: (Existing) 1. Brand Name: Rebec 2. Model Number: 200 3. Serial Number: J401553 VII. Brazier: Glenn Andrews A. Brazier Number: ANDREGJ110BE B. Plumbing Contractor: Zuiderweg Construction, LLC Vill. Witness: Kim Keefe— Eagle Family Dental EagleFamilyDental-10.11.19-VR-Dental Air&Vac(2012ed) Pg. 2 of 3 Medical Gas Services, LLC IX. Comments: A. None X. Recommendations: A. None Tested By: Harry Pomeranz—ASSE 6030 Verifier f EagleFamilyDental-10,11.19-VR-Dental Air&Vac(2012ed) Pg. 3 of 3 Medical Gas Services, LLC Level 3 Verification Check List Reference NFPA 99(2012ed) Job#: 2089 Facility: Eagle Family Dental Tested By: HP Test Date: 10/11/19 Facility: ❑ New ® Existing Type of Facility: ® Dental ❑ Medical ❑ Veterinary ❑ Lab ❑ Other: Medical Gases M NONE Oxygen Line:❑New ❑Existing Nitrous Oxide Line: ❑New ❑ Existing ❑ NONE Line Pressure: psi Concentration: % Line Pressure: psi Concentration: % Flow Test: SCFH(>:3.5 scfm)❑ Pass ❑ Fail Flow Test: SCFH (>-3.5 scfm)❑ Pass ❑ Fail Particulate Test: ❑ Pass ❑ Fail Particulate Test: ❑Pass ❑ Fail Odor: ❑ Pass(None) ❑ Fail, Odor: ❑ Pass(None) ❑Fail, Crossed Lines:❑Yes ❑ No Outlet Brand: Quick Connect Style: Location of Outlets: Cylinder Storage Z NONE Tank Room:❑ New ❑ Existing Location:❑ Inside ❑ Remote Door Labeled:❑Yes ❑ No Individually Secured: ❑Yes ❑ No Cooling Sprinkler: ❑Yes ❑ No 1 Hour Rated:❑Yes ❑ No Separate from Mechanical Equipment: ❑Yes ❑ No Electrical Switches/Outlets 5'above floor: ❑Yes ❑ No Volume Connected or Stored:❑ <3000 ft3 ❑ >3000 ft3 Number of Cylinders Connected:OX x N20 Ventilation:❑ Natural ❑ N/A Ventilation:❑ Mechanical ❑ N/A 2 Openings l'of Floor&Ceiling: ❑Yes ❑ No ❑ N/A Exhaust Fan Runs Continuously: ❑Yes ❑ No ❑ N/A Minimum 72 in Free Area:❑Yes ❑ No ❑ N/A Draws Air from within 1'of Floor: ❑Yes ❑ No ❑ N/A Vented directly to outside:❑Yes ❑ No ❑ N/A Fan Connected to Essential Power: ❑Yes ❑ No ❑ N/A Manifold Z NONE Manifold: ❑ New ❑ Existing Piping Labeled: ❑Yes ❑ No Brand: Flex Hoses<5':❑Yes❑ No 1 Rigid Copper❑Yes❑N/A Model#: Check Valve DL of Regulator: ❑Yes ❑ No Serial#: Relief Valve 50%Above Norman Line Pres: ❑Yes ❑ No Alarm/Warnin System ® NONE Alarm:❑ New ❑ Existing ❑ None—Not Required Non-Cancellable Visual Alarm: ❑Yes ❑ No Brand: Cancellable Audible Alarm: ❑Yes ❑ No Model#: HI 1 LO Line Pressure Alarm: ❑Yes ❑ No Serial#: Reserve In Use Alarm 1 Change Over: ❑Yes ❑ No Eagle Family Dental-10,11.19-Chklst-Level 3 Verification (2012ed) Pg. 1 of 2 Medical Gas Services, LLC Emergency Shutoff/Zone Valve Z NONE Valve:❑ New ❑ Existing ❑ None—Not Required Brand: 3 Part Valve: ❑Yes [] No With Down Line Gauges: ❑Yes ❑ No Sensor Location: ❑ UL ❑ DL Labeled: Dental Equipment ❑ Not Tested Dental Air System: ❑ New ® Existing ❑ NONE Dental Vacuum System: ❑ New ® Existing ❑ NONE Brand:Air Techniques Brand: Ramvac Model M Air Star 50 Model#: 809E.1050.1 Serial M NA Serial#: NA Conf:❑Simplex ® Duplex ❑Triplex ❑ Quad Conf: ® Simplex ❑ Duplex ❑Triplex ❑ Quad Compressor Type: Oil less Pump Type: Oil lubricated Compressor On:85 psi Compressor Off: 115 psi Vac Level: 7"HgV Horse Power: 1 hp. Line Pressure: 115 psi Particulate:® Pass❑ Fail Drain:® Sealed ❑ Open ❑ Floor ®Wall Concentration: 20.8% Horse Power: 1.5 hp. Flexible Connectors: ®Yes ❑ No Receiver:®Yes ❑ No Drain:® Manual ❑Auto Air I Water Separator:®Yes ❑ No Moisture Indicator: ®Yes ❑ No Exhausted to Outside:®Yes ❑ No Dryer:®Yes ❑ No Location of Discharge: Roof Intake:❑ Outside ❑ Inside(other) ® Inside(same) Piping: ❑ Hard Copper ® Schedule 40 PVC Amalgam Separator ❑ New ® Existing ❑ Not Required ❑ None Brand: Rebec Model M 200 Serial#:J401553 Comments: Arlington 2837 Kim Keefe Eagle Family Dental-10.11.19-Chklst-Level 3 Verification (2012ed) Pg. 2 of 2 CITY OF ARLINGTON 238 N. OLYMPIC AVE - ARLINGTON, WA. 98223 PHONE; (360)403-3551 BUILDING PERMIT Address:20210 77th Ave NE Permit#:2837 Parcel#:00829100000500 Valuation:.00 OWNER APPLICANT CONTRACTOR Name:HULEATT INVESTMENTS LLC Name:Zuiderweg Construction,LLC Name:Zuiderweg Construction,LLC Address: 17102 JIM CREEK RD Address:20606 101 st Ave NE Address:20606 101 st Ave NE City,State Zip:ARLINGTON,WA 98223 City,State Zip:Arlington,WA 98223 City,State Zip:Arlington,WA 98223 Phone: Phone:360-435-5929 Phone:360-435-5929 LIC:ZUIDECL961BI EXP:02/25/2020 MECHANICAL CONTRACTOR PLUMBING CONTRACTOR Name: Name: Address: Address: City,State,Zip: City,State,Zip: Phone: Phone: LIC#: EXP: LIC#: EXP: JOB DESCRIPTION PERMIT TYPE: Commercial Plumbing CODE YEAR: 2015 STORIES: CONST.TYPE: DWELLING UNITS: OCC GROUP: BUILDINGS: 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. IBC110/IRC110. SALES TAX N TICF—•Sale tax relating to construction and construction materials in the ity of Arlington must be reported on your sales tax return form and dcd City t # I I. i rc Print Name Date Released By D tc CONDITIONS Adhere to approved plans. Call for final inspection. THIS PERMIT AUTHORIZES ONLY THE WORK NOTED.THIS PERMIT COVERS WORK TO BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC DOMAIN(CURBS,SIDEWALKS,DRIVEWAYS,MARQUEES,ETC.)WILL REQUIRE SEPARATE PERMISSION. PERMIT FEES Date Description Fee Amount 10/21/2019 Medical Gas System $100.00 10/21/2019 Plumbing Permit Base Fee $25.00 10/21/2019 Processing/Technology Fee $25.00 Total Due: $150.00 Total Payment: $0.00 Balance Due: $150.00 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 Permit#: 2837 Permit Date: 10/08/19 Permit Type: COMM HZCIAL PLUMBING Project Nam e Eagle Fam iy Dental Applicant Nam a Zuiderweg Construction, LLC Applicant Address: 20606 101 st Ave NE Applicant, City, State, Zip: Arlington,WA98223 Contact: Phone: 360-435-5929 Em al: zuiderwegconstructionllc@hotm al.com Scope of Work: Addition of dental hygiene chair Valuation: 0.00 Square Feet: 0 Num ber of Stories: 0 Construction Type: O xupancy G ioup: ID Code: Permit Issued: 10/24/2019 Permit Expires: Form Permit Type: Status: LASERFICHE Assigned To: Raelynn Jones Property Parcel# Address L egal Description O wrier Nam e Caner Phone Zoning HULEATT 00829100000500 2 0210 77TH AVE NE INVESTM INTS He th Services e Other LLC Health Services Contractors Contractor P rim ay Contact P hone A ddress C ontractor Type L icense License# Zuiderweg Construction, Zuiderweg 360-435-5929 20606 101 st Ave CONSTRUCTION COA 602 355 896 LLC Contstruction,LLC NE CONTRACTOR Zuiderweg Construction, Zuiderweg 360-435-5929 20606 101 st Ave CONSTRUCTION Zuiderweg LLC Contstruction,LLC NE CONTRACTOR Contstruction,LLC ZUIDECL961B1 Inspections Date I nspection Type D escription S cheduled Date C om lieted Date I nspector S tatus 10/25/2019 C04.PLUMBING 10/25/2019 B UILDING C omlieted GROUNDWORK Fees Fee D escription N otes A m amt Medical Gas Piping f ee per inlets/outlets $100.00 Plum flng Base Perm i Fee $25.00 Processing/Technology $25.00 Total $150.00 Attached Letters Date Letter D escription 10/08/2019 Building Perm i Paym arts Date Paid By D escription P aym art Type A ccepted By A m amt 10/24/2019 Zuiderweg Construction C heck#8778 R aelynn Jones $150.00 O itstanding Balance $0.00 Uploaded Files Date File Nam e 01/06/2020 6054429-2837 10-25-19 IC.pdf 10/24/2019 5799418-2837 Issued Perm i.pdf 10/21/2019 5778577-2837 Dental Air&Vacuum Verification Report.pdf 10/11/2019 5740110-Adec 411 Chair Installation Guide(1).url 10/11/2019 5740111-AdecCabinet pyre location drawing.url 10/11/2019 5740112-DuskinEagleFamiyOpExpansion 090519(1).url 10/11/2019 5740113-eagle fam iy dental hygienist chair addition.url 10/11/2019 5740114-med gas cert.url 10/08/2019 5722568-2837 Application.pdf O x • N O O to d " O 2J r Q @ n_+ a N � � a d < iu v s @ n + =i' a O ZJ v @. 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