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Home My WebLink About16815 SMOKEY POINT BLVD_BLD20110241_2026 0641 Lb BUILDING INSPECTION REPORT G1TY p� Permit No. 'l— 0a4 Address: I LP $15 Sr *&A P�- 61VA 74 o Contractor:�7��( �(1S'�1nLlC�-�i b>1 4SIN G'� Owner: T6L- �GLS PifV1�2S Date: - APPROVAL ® PARTIAL APPROVAL tj VIOLATION CORRECTION REQUEST Corrections listed below MUST BE MADE before work can be approved Please contact inspector Was not able to perform inspection Call 360-435-0674 FOR RE-INSPECTION by 5:00 pm the day before Inspector: a Date: / 5 ® Under-floor ® Framing ® Gas Piping ® Footing ® Drywall, nailing ® Consultation ® Foundation ®Shear Nailing ® Groundwork ® Mechanical AGrid ®Struct. Stab ® Wood Stove ® Rough-in Final '014rKlinj ® Masonry ® Drainage ® Insulation ® Other: BUILDING INSPECTION REPORT tSY Permit No. I —OD `-t G � Address: ((,gS� I e: 1- YI s D f! P" B14 7��tvGio Contractor:y De' i-f& t Cod's ywh'7 a'1 Owner: J/ 17& 6aS Date: _/g _ q— 1/ PPROVA ARTIALAPPROVAL VIOLATION Ep CORRECTION REQUEST Corrections listed below MUST BE MADE before work can be approved Please contact inspector Was not able to perform inspection Call 360-435-0674 FOR RE-INSPECTION by 5:00 pm the day before Inspector: Date: !YA !( ® 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 0 Other: ne BUILDING INSPECTION REPORT p Y �� Permit No. Address: S G • y-�'� sir Contractor: L�NG� Owner: 6A'-0 .gv-z - Date: f - 7 ® APPROVAL �kOARTIAL APPROVAL ® VIOLATION ® CORRECTION REQUEST Corrections listed below MUST BE MADE before work can be approved Please contact inspector __Was not able to perform inspection Call 360-435-0674 FOR RE-INSPECTION by 5:00 pm the day before 67 Inspector: &-k- Date: / _-�hh( ® 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: \N_ 1 � BUILDING INSPECTION REPORT Y o� Permit No. �` Lbo1i�1 (��- Address: � LOS Is r 7�'L f 1p Contractor: NG , Owner: `T jL OLS S-e�✓t Ge-S Date: - APPROVAL ® PARTIAL APPROVAL EP VIOLATION ® CORRECTION REQUEST Corrections listed below MUST BE MADE before work can be approved Please contact inspector Was not able to perform inspection Call 360-435-0674 FOR RE-INSPECTION by 5:00 pm the day before Inspector: a-�^ Date: 1 a IIIl ® Under-floor ® Framing ® Gas Piping ® Footing ® Drywall, nailing ® Consultation ® Foundation ®Shear Nailing ® Groundwork ® Mechanical ®Grid ® Struct. Slab ® Wood Stove Xkough-in ® Final ® Masonry ® Drainage ® Insulation 0 Other: l� 8 15 Smokei Pf . Blvd Lb a.ol 1 oaq I � N M N En 4-i E-1 LO Cd ro � � w O a�i a rn rd I aj > W 0 r(j 0 0 0 P4 0 w Cc$ Cd $24 ro 0 rd rn cd �� t I� 1 I I Q SNOHOMISH HEALTH DISTRICT � WWW.SNOHD.ORG Environmental Health Division December 14, 2011 Alan Roberts 9991 SE Cottonwood Dr. Port Orchard, WA 98366 Subject: Proposed JBS Gas Services, 16815 Smokey Point Blvd, Arlington Dear Mr. Roberts: Your revised plans submitted December 8, 2011 have been received; however the plans cannot be approved as submitted. The following information is still needed prior to further plan review. 1. As noted in the plan disapproval letter of November 7, 2011, no proposed menu has been submitted. A complete and accurate menu for all food items including desserts and beverages must be submitted. If menu for breakfast, lunch, and dinner are different, then a copy of each menu must be submitted. 2. As noted in the plan disapproval letter of November 7, 2011, no description of the food preparation process (HACCP) has been submitted. A HACCP for the three most popular food items from each proposed menu must be submitted. Any proposed advanced preparation of foods that include cooling of foods must be included as HACCP items. Any proposed cooling of leftover foods must be included as HACCP items. An example HACCP is enclosed. Please note that prior to operating permit issuance and approval to open the new facility, after the Health District plan review process is completed and construction is finished, the Health District permit application process must be completed and a preoperational inspection must be conducted. Please contact me if you have any questions. My office number is 425.339.5250 and my email address is rhoppaashd.snohomish wa.aov. Sincerely, ti "�J 1 Ro rt Hoppa, R.S. Environmental Health Specialist RH/sm Enclosure: Example HACCP Cc: City of Arlington Building Department Washington State Liquor Control Board Sukh Sunner, Owner Michael Shumway, Environmental Health Specialist 3020 Rucker Avenue, Suite 104 ■ Everett, WA 98201-3900 0 tel: 425.339.5250 ■ fax: 425.339.5254 u :fEL• • � •� . �. :.1 �� I 1 CITY OF ARLINGTON 238 N.OLYMPIC AVE.-ARLINGTON,WA.98223 PHONE:(360)403-3421 Address: 16815 SMOKEY POINT BLVD,ARLINGTON Permit#:BLD20110241 Parcel#:31052800202700 Valuation:$0.00 JBL GAS SERVICES,LLC JOE HALL CONSTRUCTION,INC JOE HALL CONSTRUCTION,INC SUKH SUNNER ROBERT WALKER ROBERT WALKER 22729 9TH AVE SE 1317 54TH AVE E 1317 54TH AVE E BOTHEL,WA 98021 FIFE,WA 98424-1226 FIFE,WA 99424-1226 Lic#:JOERACO259RT Exp:3/12012 DAVID BUCK 8317 33RD ST W UNIVERSITY PLACE,WA 99466 Lic#:BUCKDL•171 KC Exp:7/92013 Lic#: Exp: Plumbing PERMITTYPE: Commercial PERMIT GROUP: Plumbing STORIES: 0 CONST TYPE: DWELLING UNITS: 0 OCC GROUP: CODE: OCC LOAD: 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 1S 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/IRCI 10. SALES TAX NOTICE:Saks tax relating to construction and construction materials in the City of Arlington must be rrportod your sales tax return foam and coded Crtylo(A lingfon 0310E SignaGre Pant Name Date BY ate ARCHIVE F--�] APPLICANT ASSESSOR F7 OTHER _ _ i BLD20110241 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. • None 12/6/2011 Building Plan Check Fee(QTY: 1) $120.00 $0.00 $120.00 12/6/2011 Plumbing Permit Fee $99.00 $0.00 $99.00 Total Due: $219.00 SO.00 $219.00 BUILDING/ENGINEERING/PARKS/UTILITIES/FINAL(360)435-0674 FIRE(360)403-3607 When calling for an inspection please leave the following information: Permit Number,Job Site Address,Type of Inspection being requested,Contact Name and Phone Number,Date Prefereed,And whether you prefer morning or afternoon. • None I. II 1 CITY OF ARLINGTON 238 N. OLYMPIC AVE.-ARLINGTON,WA. 98223 PHONE: (360)403-3421 BUILDING PERMIT Address: 16815 SMOKEY POINT BLVD,ARLINGTON Permit#:BLD20110241 Parcel#:31052800202700 Valuation:$0.00 OWNER APPLICANT CONTRACTO JBL(SAS S1-1Z4'IC1--S,LLC JOE HALL CONSTRUCTION,INC JOE HALL CONSTRUCTION,INC SUKH SUNNER ROBERT WALKER ROBERT WALKER 22729 9TH AVE SE 1317 54TH AVE E 1317 54TH AVE E BOTHEL,WA 98021 FIFE,WA 98424-1226 FIFE,WA 98424-1226 Lie#:JOEHAC*259RT Exp:3/1/2012 PLUMBING CONTRACTOR MECHANICAL CONTRACTOR — DAVID BUCK 8317 33RD ST W UNIVERSITY PLACE,WA 98466 Lie#:BUCKDL*171 KC Exp:7/9/2013 Lie#: Exp: Plumbing PERMIT TYPE: Commercial PERMIT GROUP: Plumbing STORIES: 0 CONST TYPE: DWELLING UNITS: 0 OCC GROUP: CODE: OCC LOAD: 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. rr 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 NOTICE: Sales tax relating to construction and construction materials in the City of Arlington must be reported n your sales tax return form and coded City of Arlington#3101 Signature Print Name Date 44eie4ecTBy Date ARCHIVE = APPLICANT ASSESSOR OTHER ,« r" I BLD20110241 CONDITIONS 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. • None PERMIT FEES Date Descriptiom Fee Amount Paid Balance Due 12/6/2011 Building Plan Check Fee(QTY: 1) $120.00 $0.00 $120.00 12/6/2011 Plumbing Permit Fee $99.00 $0.00 $99.00 Total Due: $219.00 $0.00 $219.00 CALL FOR INSPECTIONS BUILDING/ENGINEERING/PARKS/UTILITIES/FINAL(360)435-0674 FIRE(360)403-3607 When calling for an inspection please leave the following information: Permit Number,Job Site Address,Type of Inspection being requested,Contact Name and Phone Number,Date Prefereed,and whether you prefer morning or afternoon. • None 1� I ` :i �� INTERCEPTORS 800 Series TAG Grease Interceptors, Series 800 - 801 Product Description: Recommended for removing,then retaining fat,oil,and grease from wastewater in kitchen and restaurant areas where food Is prepared. The 800 series grease interceptor Is constructed of coated corrosion-resistant fabricated steel with no-hub connections and separate no-hub flow control;a one-piece removablA-baffle;diamond plate, non-skid cover;and a unique,combination cover locking/lifting device. Features and Benefits: •Slip-resistant diamond plate cover •Designed to be installed in above-the-floor installations or recessed where space is limited •One piece removable baffle assembly •Combination cover locking/lifting device • Constructed of fabricated steel,corrosion-resistant coated • Regularly furnished with no-hub inlet and outlet,threaded available •Low type grease interceptor is designed to be installed under the sink or in an area where space is limited •Conforms to PDI Grease Interceptor Standard PDI-G101 • IAPMO Listed,File No.2697 and C-3878 _ L °` �Jl Flow Control for Series 800-801 Series 800-801 GPM GREASE FIG. FLOW CAP G NO. RATE LBS A B C D(LENGTH) E(HEIG F(WIDTH) Plu Size 800-Y02-04 4 a 02" 6718, 23/4' 14" 9 5/8" 14' 1 12" 800-Y02-0/ 7 14 02" 7 314' 3 114" 15 114" 11" 16 1/4' 1 12" 600-Y02-10 10 20 02" 8 3/4' 3 6/8' 16 3/4" 12 3/8" 16 314' lip, 800-Y02-15 15 30 02" 111/4" 312" 19, 14 3/4" 19' 112" 600-Y03-20 20 1 40 1 03' 1 12314" 4' 21" 16314' 2.1° I Ir-" 600-YO3-25 25 50 03" 14 114" 4 1/8' 2L-3/4" 18 3/8' 22 314" 1 12" 800-Y03-35 36 70 03" 1412" 412" 24" 19" 24" 112" 800-Y03-50 50 100 03" 1412" 51/4" 331/4" 19 314" 24" 112" LOW TYPE M-Y -201 0 1 40 1 03" 1 T 1 312` 41" 1012' 213/4" 112' —411 801-Y03-35 35 70 03" T 4 3/4" 63 3/4° 1 11 3/4" 2712" 1 1 12" 001-Y03-S0 50 1 100 1 3" 1 10" 1 515/16" 1 51314" 1 1515/16" 1 2712" 1 112" 600402-04 4 8 02" 6 7/8" 2 314" 14" 9 Wal t 4' 1 12" 800-T02.01 7 14 02" 7314" 31/4" 15 114" 11" 151/4" 112' 800•T02-10 10 20 02" 8 3/4" 3 518" 16 3/4' 12318, 16 3/4' 1 1/2" 800402-15 15 30 02" 11114" 312" 19" 14 3/4" 19" 112" 800-TM-20 20 40 03" 12 314" 4' 21" 16 314" 21, 1 12" W0403-25 25 50 03, 14 1/4" 4 1/8' 22 3/4' 18 3/8' 22 3/4' 1 12" 800-T03.35 35 70 03" 14 112' 412" 24" 19, 24' 1 12" 600-T03-50 50 lo0 63;_1 1412" 1 51/4" 1 331/4" 1 19 314" 1 24' 112 LOW TYPE AOI-T03-20 20 40 1 03" 1 T 1 3 1! 1 2' 213/4" 112" 801-T03 35 35 70 03" T 4 3l4" 53 3/4" 11 3/4" 27 1 l2 1 12" 601-T03-60 60 1 100 03" 1 10" 1 5 16/16" 1 61 314" 1 15 16/10" 1 27 12" 1 12" NOTE:Dimensional data Is subject to manufacturing tolerances and change without notice. (q,fl�+ A Product of: Series 800-801 S JAY R.SMITH MFG.CO: "°'"°'°' S1w,2•-wov+4 suns,-sawx SPM 1013 CT$ 10/08 uzo0'ii-eu90f-MOA n 9189-ZZ6 (C9Z) 9189-LLL (008) gaH3 'I'IO.L 9ZZI-VZV86 uoIJIuius-PAk `aJl3 8Z89-ZZ6 (£9Z) :XHA }s'e2l anugAV MV9 L I£I tivi iN3waint;i wn t .LH69Z*DVH20P T I3d aNI NOlsarlxssNO3 rlrlVH :4Or FIAT MOLDED STONE SERVICE BASINS Lm MSB 2424 MSB 3624 INSTALLATION INSTRUCTIONS 1. REMOVE CRATE AT INSTALLATION POINT. DO NOT ROCK MOP BASIN EDGES.(THIS PRECAUTION WILL PREVENT DAMAGE TO CORNERS OF THE BASIN). METHOD FOR CHECKING FACE OF MOP BASIN FLOOR FOR 0 TRANSPORTATION DAMAGE: O A. WIPE FACE OF BASIN FLOOR WITH A WET CLOTH. (WATER) B. WHEN THE WATER EVAPORATES,ANY SLIGHT CRACK IN THE MOP BASIN FLOOR WILL BE NOTICEABLE. REMOVE CRATE NTH CARE DO NOT STAND ON END 2.NOTE BASIN DIMENSIONS IN THE DIAGRAM.BASIN TYPICALLY IS PLACED NEXT TO A FINISHED BLOCK, CERAMIC TILE OR I A CONCRETE WALL, A SMALL GAP(APPROXIMATELY 1/8`)SHOULD BE PRESENT BETWEEN THE BASIN AND THE FINISHED WALLS. B E 3.PROVIDE FOR DRAIN CONNECTION.THE STAINLESS STEEL DRAIN --- I BODY IS DESIGNED TO PROVIDE FOR A CAULK CONNECTION —I OR QDC-3 JOINT TO A 3"DRAIN PIPE.3"DRAIN PIPE PROVIDED D BY OTHERS. (ALTERNATE STRAINER 1453-BB FOR RESIDENTIAL MODEL NO. A B C D E USE EFS-2424 AND EFS-3624 USE 2"PIPE PROVIDED BY OTHERS) MSB-2424 24 3/16 24 3/16 12 12 10 4.PLAN THE INSTALLATION BY CONSIDERING THE LOCATION OF A C MSB-3624 136 3/16 124 3/1fi 18 12 10 WATER SUPPLY FAUCET.MOP AND HOSE HANGER BRACKETS MAY ALSO BE INSTALLED. NOTE ON THE DIAGRAMS THE SUGGESTED LOCATION OF THESE ITEMS. SEVICE FAUCET (2)CLEARANCE HOLES NTH VACUUM FOR 1121.P.S. MOP BASIN INSTALLATION BREAKER MOP HANGER SUPPLIES.NOT LESS 5.A LAYER OF MORTAR SHOULD BE PLACED IN THE AREA WHERE THAN 1-1/4 DIA. THE MOP BASIN IS TO BE INSTALLED. THIS PROCEDURE IS RECOMMENDED BY FIAT IN ORDER TO SUPPORT THE BASIN IN 8 CASE THE SUB FLOOR IS UNEVEN.MORTAR SHOULD COVER THE 4 ENTIRE AREA BETWEEN BASIN AND BUILDING FLOOR. WARNING! DO NOT DROP THE MOP BASIN OVER AN EXPOSED HOSE ' DRAIN PIPE.LIFT AND PLACE THE BASIN CAREFULLY TO AVOID DAMAGE. LEVEL RECEPTOR CAREFULLY 12 FF E 6.USE A SPIRIT LEVEL ON TOP OF THE BASIN TO ASSURE LEVEL. 6 36 REMOVE ANY EXCESS MORTAR THAT MAY HAVE SQUEEZED OUT AFTER BASIN INSTALLATION IS COMPLETE. 18 1 E 7.CAULK GAP BETWEEN FINISHED WALL AND MOP BASIN USING ON(—] SILICONE CAULKING. HOSE HOLDER MSB 2424 DETAIL MSB 3624 DETAIL CONCRETE REMOVABLE STAINLESS —CONCRETE REMOVABLE STAINLESS STEEL COMBINATION ! STEEL COMBINATION SILICONE DOME STRAINER AND SILICONE DOME STRAINER AND SEALANT LINT BASKET SEALANT LINT BASKET 12 2416 ►I 12 3616 FI t 6RING / 10 0 LMORTAR MORTAR MORTAR �— MORTAR STAINLESS STEEL LOCK 7NEOPRENE GASKET STAINLESS STEEL LOCK RING NEOPRENE GASKET AINLESS STEEL DRAIN BODY STAINLESS STEEL DRAIN BODY 3"PIPE BY OTHERS -3OR CAULK AND LEAD JOINT 3"PIPE BY OTHERS (2"PIPE FOR EFS-2424) BY OTHERS (2°PIPE FOR EFS-2424) QDC-3OR CAULK AND LEAD JOINT BY OTHERS DO NOT STACK OR STORE MOP BASINS FLAT Spec:2039 11/3/03. 255 Hutchings St. Winnipeg, MB. R2X 2R4 PRINTED IN U.S.A. .� I .: BLD20110241 (PT-LIVE) - Per- �Trax by Bitco Software Page 1 of 1 BUILDING PERMIT PERMIT#: BLD20110241 OWNER: JBL GAS SERVICES, LLC-SUNNER,... STATUS: APPLIED ADDRESS: 16815 SMOKEY POINT BLVD, ARL... BALANCE: $0.00 ISSUED: CREATED: 12/5/2011 .,I SCREENS: Select Screen... 1 FUNCTIONS: Select Permit Function... [] PLUMBING REVIEWS PRINT ADD NEW SUMMARY REVIE... DESCRIPTION 1ASSIGNE...IDUEDATE1LAST I (##) EQ. DO...I ASSIGN REMOVE 2000 C-Building I CYOUNG 12/9/2011 0 Y N Assign Remove 2008 C-Community Development I ARUSKO 12/9/2011 0 Y N Assign Remove http://coaweb2.arlington.local/PertnitTrax/Module_ Permits/Permits Permit/Permit_Revie... 12/5/2011 COMMERCIAL PLUMBING 10 PERMIT APPLICATION Department of Community Development City of Arlington• 238 N Olympic Ave. •Arlington,WA 98223 • Phone (360)403 3551 • FAX(360)403 3418 THIS APPLICATION MUST BE ACCOMPANIED BY THREE(3)SETS OF CONSTRUCTION DRAWINGS,AND THREE (3)SETS OF FIXTURE SPECIFICATIONS(CUT SHEETS). CALCULATIONS ARE REQUIRED FOR GREASE INTERCEPTOR/F APPLICABLE. Type of Permit: ® Commercial a Commercial Addition/Alteration (❑) Industrial Project Address: 15815 smokey Point Blvd. Parcel I D#: 31052800202700 Lot#: Subdivision: Project Description: Remodel Exiting convenience Store Valuation: $12,000.00 Owner: Sukh Sunner-JBL Gas Services LLC Phone Number: 42S894.1ee7 Address: 22729 9th Ave SE City: Bothel State: wA Zip Code: 90021 Contact Person:Robert walker Phone Number: 253922.6815 E%t4 Cell Phone: 253-505-7725 Fax: 253.922-5829 E-mail: robertw@ioehall•com Address: 1317 54th Ave East City. Fife State: WA Zip Code: 98424-1226 Please List quantity of fixtures Below: -Y_ &-r-tki'ti WATER CLOSET BATH TUB SHOWERS 1 L �� l` LAVATORIES CLOTHES WASHER LAUNDRY TUBS FLOOR DRAINS - FLOOR SINKS 2 SINKS -- URINALS SUMPS DISHWASHERS i WATER HEATERS ROOF DRAINS WATER PIPING DWV ALTER/REPAIR LAWN SPRINKLERS DRINKING FOUNTAINS MISC PLUMB FIXTURE 1-3570 GREASE INTERCEPTOR GREASE TRAP Contractor: Joe Hall Construction,Inc Phone Number: 253.922.6e15 Ext.4 Address: 1317 54th Ave East City. Fife State: WA Zip Code: 9e424-1226 Contractor's License Number: JOEHAC"259 RT Expiration: March 2o12 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 be in accordance with the laws, rules and regulation of the State of Washington. ",A-- �- 41 ?-Dec -Wt,1 Dec Applicants Signature Date Print Applicants Name RECEIVED FOR STAFF USE ONLY D)Lq I 4,�41 DEC 0 2 2011 Permit# Accepted By Amount Received Receipt# —COAMRmfftam I I COMMERCIAL PLUMBING PERMIT APPLICATION Department of Community Development City of Arlington• 238 N Olympic Ave. •Arlington,WA 98223 • Phone (360)403 3551 • FAX(360)403 3418 CROSS-CONNECTION SURVEY FORM (Please complete form and submit to Permit Center) NOTE: The Rules and Regulations of the State of Washington Department of Health require that certain premises install backflow prevention assemblies(WAC 246.290.490). Backflow prevention assemblies shall be installed at any premise where, in the judgment of the City of Arlington Cross Connection Control Specialist, the nature of activities on the premise may present a hazard to the public water system. Type of Permit: ® Commercial (E) Commercial Addition/Alteration (❑) Industrial Proposed Building Use: ® Restaurant ® Medical ® Industrial ® Residential ® Commercial v_r Other: convenience store&Gas station Contact Person: Robert Walker Phone Number: 253.922.6815 Ext 4 Cell Phone: 253 606.7726 Fax: 253.922.6828 E-mail: robertw@joehall.com Please check all appliances and/or applications that are permanently to the water supply and apply to your proposed USE and OPERATION. Ice Maker O Dialysis Equip. ® Air washers ® Swimming Pools ® Fire Sprinkler 4ZO Hydrotherapy Espresso Mach. ® Equip. ® Steam Generators ® Hot Tub/Spa ® Sprinkler w/chemicals er Carbonated Bev. ® Dental Equip. O Dye Vats Q Ice Machine ® Lawn Irrigation ® Fume Hoods 0 Laboratory Equip. ® Pressure Washers 0 Coffee Urn/Espress. ® Well on property ® Degreasers O Autoclave/Sterilizers ® Cooling Towers O Aquarium O Decorative Fountain Other: 1 existing restroom and mop sink Authorized Signature: Date: 1 November 2011 Office Use Only Comments: Date Received: Survey Received By: Assembly Required: ❑ DCVA ❑ RPBA ❑ AVB ❑ Other Inspection Required: ❑ YES ❑ NO I COMMERCIAL PLUMBING I PERMIT APPLICATION Department of Community Development City of Arlington• 238 N Olympic Ave. •Arlington,WA 98223 • Phone(360)403 3551 • FAX(360)403 3418 WASTEWATER DISCHARGE SURVEY FORM (Please complete form and submit to Permit Center) NOTE: Arlington Municipal Code 13.08.590 requires that any and all commercial or industrial dischargers will not discharge to the City of Arlington Sanitary Sewer System without a negotiated discharge agreement. This survey will help us determine whether your business will require an agreement. 1. Type of Permit: ® Commercial (❑) Industrial 0 Commercial Addition/Alteration 2. Proposed Building Use: ® Restaurant ® Medical ® Industrial ® Residential ® Commercial (ED Automotive Based Machine Shop Other: Convenience Store&Gas Station 3. Does the plumbing system currently have a grease interceptor? ® Yes No ® Don't Know 4. Date grease trap/interceptor was last cleaned (provide service record): ® Don't Know 5. Does the plumbing system currently have a oil/water separator? ® Yes ® No (9 Don't Know 6. Date oil/water separator was last cleaned (provide service record): Don't Know 7. Is water used in the business process(washing,rinsing, cooling)? ® Yes No ® Don't Know 8. Does your business require a NPDES permit? ® Yes ® No Don't Know Contact Person: Robert Walker j� �� Phone Number: 425.894.1867 Cell Phone: 253.606.7726 Fax: 253.922.6828 E-mail: robertw@joehall.com The above information is complete and accurate to the best of my knowledge. I understand that any changes in the sewage discharge from the site must be reported to the City of Arlington Public Works Utilities Division / Wastewater Department immediately by contacting 36040 -3526. 'Z,DeL 21 -- 1-_Novernbar-2011 Authorized Signature: Date: Office Use Only Comments: Date Received: Survey Received By: Assembly Required: ❑ DCVA ❑ RPBA ❑ AVB ❑ Other Inspection Required: ❑ YES ❑ NO i f .g."7' C 1n wr .4 �+f� 1.. p l �� ft y..,.- �kc i ?i •� I`iT �� r}�.,r vi <��1,AY P. �•1� E R ti/E PTO■ i r .- 1OF, % yy IQ800 Series ; , . t �.a {llC{fTAt , Grease Interceptors, Series 800 - 801 Product Description:Recommended for removing,then retaining fat,oil,and grease from " wastewater In kitchen and restaurant areas where food Is prepared. The 800 series grease Interceptor Is constructed of coated corroslon-resistant fabricated steel with no-hub connections and separate no-hub flow control;a one-piece removabl9-baffle;diamond plate,non-skid cover;and a unique,combination cover locking/Ilfting device. Features and Benefits: • Slip-resistant diamond plate cover •Designed to be installed In above-the-floor installations or recessed where space is limited •One piece removable baffle assembly • Combination cover locking/lifting device • Constructed of fabricated steel,corrosion-resistant coated •Regularly furnished with no-hub inlet and outlet,threaded available •Low type grease interceptor is designed to be installed under the sink or in an area where space is limited • Conforms to PDI Grease Interceptor Standard PDI-G101 • IAPMO Listed,File No.2697 and C-3878 - � H Flow Control for Series 800-801 Series 800-801 GPM GREASE FIG. FLOW CAP G NO. RATE LOS A a C D(LENQTH) E(HEIGHT) F Plu Sim 800-Y02-04 4 8 02' 6 718" 2 3/4' 14" 9 6/8" 14' 1 im li00Y02-07 7 14 02" 73/4" 31/4' 151/4' 11" 161/4' 112" 000-Y02-10 10 20 02' 8 3/4' 3 5/8' 16 3/4' 12 3/8" 16 3/4' 1 12' 800-Y02.15 15 30 02" 11 114" 3 12' 19, 14 314• 19" 1 12' WO-YOJ-20 20 40 03' 12 3/4" .1' 21' 16 3/4' 21' 1 12" 600-Y0345 25 50 13" 14 1/4' 4 1/8' 22 3/4' 18 3/8' 22 3/4" 1 12' 800-Y03.35 36 70 03• 141/2 412' 24' 19` 24" 112' 800-Y03.50 so 100 03• 1412" 51/4' 331/4' 19 3/4" 24" 112' LOW TYPE 801-Y03.20 20 1 -to 1 03' 1 1' 1 31Z 1 41" 1 1011Y 1 21 3/4' 1 112- 801403-35 35 1 70 103' 7" 1 4314' 1 533/4' 1 11 3/4" 1 271M i 1/2" 801-Y03.50 50 100 09" 10- 516/18' 51 3/4' 1 1615AW Z Me i Me 600402.04 4 8 02' 8 7/8' 2 3/4' 14" 9 Wr 14" 1 l a, 800402-07 7 14 or 73/4' 31/4" 151/4- 11' 15114" 11R' 000-T02.10 10 20 02' 8 We 3 War 16 3/4' 12 34' 16 314" 1 12' 800402-1 16 30 02, 11114" 31& 19" 14 3/4' 19' 11/2- 800•T03 20 40 or 1239" 4' 21" 153/4" 21' 1112" W0403-26 25 60 03' 141/4' 4118' 22314" 183/8' 23:1/4 11/2" 800403-35 35 70 03' 141/2' 41/2' W 19- 24' 1112' 800-T03-50 50 100 or 14 ire 51i4° 331/4` ie3/4' 24' iirr LOW TYPE 801•T03-201 20 1 40 1 03" 1 -r I 31W 1 410 101/2' 21 3/4" 1 1 ire 801-T09-3. 36 1 70 1 03" 1 63 3/4' 11 3/4" 2711T 1 1 1&- _laDi-T0s-s0 so I 100 I Os- I 10' 1 516118- 1 513/4" 1 1615/18" 1 2712" I112" NOTE Dimensional data Is subject to manufacturing tcterances and change without notice. (�'fls A Product of. C series 800-801 R.SMrrHMFG.VV.• •MJUSII'! CTS OIW.IONOF•MITMINOU.TNI..,ING. +•�16•aGPM SlfOsl-16QPM SPM 1013 10/08 1 FIAT MOLDED STONE SERVICE BASINS „ PROUJIM LM MSB 2424 MSB 3624 INSTALLATION INSTRUCTIONS 1. REMOVE CRATE AT INSTALLATION POINT. DO NOT ROCK MOP BASIN EDGES.(THIS PRECAUTION VtWLL PREVENT DAMAGE TO CORNERS OF THE BASIN). METHOD FOR CHECKING FACE OF MOP BASIN FLOOR FOR O TRANSPORTATION DAMAGE: O A. WIPE FACE OF BASIN FLOOR WITH A WET CLOTH. (WATER) B. WHEN THE WATER EVAPORATES,ANY SLIGHT CRACK IN THE MOP BASIN FLOOR WILL BE NOTICEABLE. REMOVE CRATE WITH CARE DO NOT STAND ON END 2.NOTE BASIN DIMENSIONS IN THE DIAGRAM.BASIN TYPICALLY IS PLACED NEXT TO A FINISHED BLOCK, CERAMIC TILE OR �. A �� CONCRETE WALL. A SMALL GAP(APPROXIMATELY 1/8�SHOULD \ BE PRESENT BETWEEN THE BASIN AND THE FINISHED WALLS. B 3.PROVIDE FOR DRAIN CONNECTION.THE STAINLESS STEEL DRAIN BODY IS DESIGNED TO PROVIDE FOR A CAULK CONNECTION OR QDC-3 JOINT TO A W DRAIN PIPE.3°DRAIN PIPE PROVIDED D BY OTHERS. (ALTERNATE STRAINER 1453-BB FOR RESIDENTIAL MODEL NO.1 A I B C D E USE EFS-2424 AND EFS-3624 USE 2'PIPE PROVIDED BY OTHERS) C MSB-2424 24 3/16 24 3/16 12 12 10 4•PLAN THE INSTALLATION BY CONSIDERING THE LOCATION OF A MSB-3624 36 3/16 24 3/16 18 12 10 WATER SUPPLY FAUCET.MOP AND HOSE HANGER BRACKETS MAY ALSO BE INSTALLED. NOTE ON THE DIAGRAMS THE SUGGESTED LOCATION OF THESE ITEMS. SEVICE FAUCET (2)CLEARANCE HOLES WITH VACUUM FOR 1/21.P.S. MOP BASIN INSTALLATION BREAKER — MOP HANGER SUPPLIES.NOT LESS 5.A LAYER OF MORTAR SHOULD BE PLACED IN THE AREA WHERE THAN 1-1/4 DIX THE MOP BASIN IS TO BE INSTALLED. THIS PROCEDURE IS RECOMMENDED BY FIAT IN ORDER TO SUPPORT THE BASIN IN __� 8 CASE THE SUB FLOOR IS UNEVEN.MORTAR SHOULD COVER THE 4. ENTIRE AREA BETWEEN BASIN AND BUILDING FLOOR. WARNING! DO NOT DROP THE MOP BASIN OVER AN EXPOSED HOSE DRAIN PIPE.LIFT AND PLACE THE BASIN CAREFULLY TO AVOID DAMAGE. —� LEVEL RECEPTOR CAREFULLY 6.USE A SPIRIT LEVEL ON TOP OF THE BASIN TO ASSURE LEVEL. 36 3.6 REMOVE ANY EXCESS MORTAR THAT MAY HAVE SQUEEZED OUT AFTER BASIN INSTALLATION IS COMPLETE. 1B U _ 7.CAULK GAP BETWEEN FINISHED WALL AND MOP BASIN USING P4 SILICONE CAULKING. HOSE HOLDER MSB 2424 DETAIL MSB 3624 DETAIL CONCRETE REMOVABLE STAINLESS CONCRETE REMOVABLE STAINLESS STEEL COMBINATION STEEL COMBINATION SILICONE DOME STRAINER AND SILICONE DOME STRAINER AND SEALANT LINT BASKET , SEALANT LINT BASKET 1 Z 244 -� 12- +--� 36j g - -�- 3' //—3' 10 10 t' I1 +2 MORTAR MORTAR MORTAR —MORTAR STAINLESS STEEL LOCK RING NEOPRENE GASKET STAINLESS STEEL LOCK RING NEOPRENE GASKET STAINLESS STEEL DRAIN BODY STAINLESS STEEL DRAIN BODY 3'PIPE BY OTHERS_ p0C-3 OR CAULK AND LEAD JOINT 3'PIPE BY OTHERS (Y PIPE FOR EFS-2424) BY OTHERS (Y PIPE FOR EFS-2424) _ QDCJ OR CAULK AND LEAD JOINT BY OTHERS DO NOT STACK OR STORE MOP BASINS FLAT Spec:2039 11/3103. 255 Hutchings St. Winnipeg, MB. R2X 2R4 PRINTED IN U.S.A. �' ./� r r DEPARTMENT OF LAB01,-'M INDUSTRIES D.00) PO BOX 44470 FIRST-CLASS MAIL $fate Of Washington OLYMPIA WA 98504-4470 U.S.POSTAGE PAID OLYMPIAWA PERMIT#312 I BUCK,DAVID L 8317 33RD ST W UNIVERSITY PLACE WA 98466 — zoo, �— Detach And Display Certificate u DEPARTMENT OF_LABOR AND INDUSTRIES a CERTIFIED AS PROVIDED BY LAW AS PLUMBER JOURNEYMAN �+ CERT.# EXP.DATE �t1 PLOI BUCKDL•171KC 7/9=13 EFFECTIVE DATE 5/3/1983 l BUCK,DAVID L 1 8317 33RD ST W UNIVERSITY PLACE WA 9M66 t� F625-052-000(5:97) — - -- - -- -- Detach And Display Certificate CERTIFIED AS PROVIDED BY LAW AS PLUMBER JOURNEYMAN Please Remove CERT.# EXP.DATE And Sign PLOT BUCKDL*171KC 7/9/2013 EFFECTIVE DATE 5/3/1983 Identification Card Before BUCK,DAVID L Placing In 8317 33RD ST W Billfold UNIVERSITY PLACE WA 98466 Signarure -- Issued by DEPARTMENT G TRIES RECEIVED F625-052-000(8/97) DEC 0 p qt„i COA PERMIT CENTER A rn p3 rnrrnrnrn C7 � N I � 2 � rn () z p x] z ➢ tt� r Wcz W —� O C', C Z 0 C — r " - i z Z , z � m m T f- --I < o z 1 l S m m G) Z a eirl u 31d5:ata.nX u Er. � O 172K D G I e °VI z `-1 - � ro 6— U71 / 1 � O +p G� n y s71 —Q rn G P' fi IL C7 < N rn 0 q> S I adz 0 X I A rn z cn ,' I -Q O N A �rn o I n z 0] nitLi�00D A Apzrn 71 -n NU,rnoZ rn0®o ?LAMA A� nrnT z (l z r N.0\ AATER FLTL—R BAGKFLOA F i ❑ rn FOUKTAN O O O 3 2A1080 FIRE EXTI NGU I SHER rn 7 Q\ � O it II I r N VUi -U'( p3 rnr7K3 ? rnz � xc� r� A rn z � N r rn (N Cl ,a ,� I�T1 � ' T 0rnzA A z> v RC r p n ro m 0 Emuo > , - -n - - - - - - - - - -- - - - - - z ° � - - - cn rrl y G p O fr' I � _ z S a Z h1 l °ram n p`�`� — Jf HAND 51 i fv DD j I N N F- Z T > i -o I z Q N sfcp�, I d < N m3 j A rnC7zm I Q n N ❑ >zM> Q 3 f N O A >Zrn -n O ® dCI�' � ln m - NLAm Z rnO®o z°AA� �j lP A 0 >> D 0 -4Z� RAJ LD�wr BA%& xBOX (Jl41 1 rWTcR FfLTE�Z ❑ DJ BAGKFL 'A F D r FOUNTAIN rn �a J ° ZS ° 3 2AIOE30 FIRE 4'EXTI NGIJ 15HER 1 rn 0 II