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18-102416City of Federal Wry Community Development Dept. 33325 8th Ave S Federal Way, WA 98003 Ph: (253) 835-2607 Fax (253) 835-2609 Building - Commercial Permit #:18 -102416 -00 -CO Inspection Request Line: (253) 835-3050 Project Name: CLEAR CHOICE DENTAL IMPLANT CENTER Project Address: 2505 S 320TH ST Parcel Number: 797820 0535 Project Description: TI - Interior modifications including demolition of partition walls and finishes, construction of partition walls and acoustical ceiling. Includes plumbing and mechanical. Owner Applicant Contractor Lender MJR DEVELOPMENT SEAN MUZARCLEAR CHOICE CONSTANTINE BUILDERS INC OWNER IS LENDER 6725 116TH AVE NE SUITE 100 MANAGEMENT SERVICES LLC 18486 BALLINGER WAY NE Type I - B KIRKLAND WA 98033 8350 E CRESCENT PKWY LAKE FOREST PARK WA 98155 0 Mechanical to be Included? ..................................... GREENWOOD VILLAGE WA 80111 Plumbing Work Valuation?..................................... 150000 Census Category: 437 - Commercial alt / add / conversion Includes: #1 #2 #3 #4 Occupancy Class: B Construction T Type I - B Occupancy Load: 93.00 Floor Areas . ft. 6,925.00 Additional Permit Information New / Additional Sq. Feet -1st Floor ..................... 0 New / Additional Sq. Feet - 2nd Floor.................... 0 New / Additional Sq. Feet - 3rd Floor ..................... 0 Occupancy #1 - Area (Sq. Feet).............................. 6925 New / Additional Sq. Feet - Basement .................... 0 Occupancy #1 - Construction Type...........,............. Type I - B New / Additional Sq. Feet - Deck .......................... 0 New / Additional Sq. Feet - Garage........................ 0 Mechanical to be Included? ..................................... Yes Plumbing Work Valuation?..................................... 150000 Mechanical Work Valuation? .................................. 90000 Number of Stories................................................... 6 New / Additional Sq. Feet - Other ........................... 0 Is this an Online or O.T.C. application?.................. No Permit for Building Shell Only? .............................. No Plumbing to be Included? ........................................ Yes New / Additional Sq. Feet - Total ........................... 0 Will Certificate of Occupancy be Issued?............... Yes Occupancy #1 -Use ................................................ Clinic - Outpatient Comprehensive Plan Designation........................... City Center Core Zoning Designation ................................................. CC -C Total Valuation: 344,518.75 Air Handling Units 3 Compressors / Heat Pumps 1 Ducting 1 Dishwashers Vacuum Breakers Hose Bibbs 2 Lavatories 2 Water Closets 1 1 Sinks 15 I Water Heaters 1 PERMIT EXPIRES Sunday, 27 January, 2019 Permit Issued on Tuesdav, July 31, 2018 1 ��I I hereby certAthathe above information is correct and that the construction on the above described property and the occupancy and the use will be in accordance with the laws, rules and regulations of the State of Washington and the City of Federal Way. Owner or agent: Date: 7 30� WIT I" +t --J, V City of Federal Way Certificate of Occupancy This Certificate issued pursuant to the requirements of Section 111 of the International Building Code or Section R110 of the International Residential Code is certifying that at the time of issuance, this structure was in compliance with the various ordinances of the City regulating building construction or use. This certificate is valid ONLY when endorsed by City staff. Tenant Name: CLEAR CHOICE DENTAL EMPLANT CENTER Address: 2505 S 320TH ST Unit 110 Permit # 18 -102416 -00 -CO Includes: #1 #2 #3 #4 Occupancy Class: B Construction Type: Type I - B Occupancy Load: 93.00 Floor Area (sq. ft.) 6,925.00 Owner Name: MJR DEVELOPMENT Owner Address: 6725 116TH AVE NE SUITE 100 KIRKLAND WA 98033 Building Official ae The priority focus in the review and inspection made by the City prior to issuance of this Certificate was on those matters which experience has shown most severely affect the health and safety of the general public. Although the City has made as complete a review and inspection as is reasonably possible (within budgetary time and personnel limitations), the City neither guarantees nor warrants to the owner) occupant or to any other person that this Certificate evidences strict compliance with each and every ordinance or regulation of the City or the State of Washington affecting the construction or use of said structure or the land upon which itis situated. Such compliance is the responsibility of the owner and / or occupant of the premises. w crrr o. THIS CARD IS TO REMAIN ON-SITE �%w , Federal �A/a Construction Inspection Record y INSPECTION REQUESTS: (253) 835-3050 PERNM #: 1810241600 Address: 2505 S 320Th ST Unit 110 Project: MJR DEVELOPMENT FEDERAL WAY WA 98003 Scheduled inspections may be failed if this card is not on-site. DO NOT LOSE THIS CARD. Inspections are listed as close to sequential order as possible (read left to right, top to bottom). Please schedule inspections as appropriate. Work must not be covered until it is approved. Check with your inspector if you are unsure about any of the inspections or the inspection sequence. On-going inspections are logged on the back of this card. El Initial Erosion Control (4365) ® Slab/Concrete Floor (4255) Footings/Setback (4110) El Re -steel (4215) To be done PRIOR to breaking grand Approved to place concrete Approved to place concrete Approved to place concrete or grout By Date By Date By Date ® Plumbing Groundwork (4190) ® Slab/Concrete Floor (4255) Plumbing (4230) © Underfloor Framing (4285) Approved to cover Approved to place concrete Approved Approved to sbeath floor By Date ,�S Date 9 —,S Date it By Date 0 Floor Sheathing (4105) ® Plumbing (4230) ® Mechanical Rough -in (4165) Approved to install flooring L[!]:Rongb Approved Approved i By Date By Date it By Date _ I q_% a,. By Date By Date 10 Gas Piping (4125) Q Fire/Draft Stops (4095) Interim Erosion Control (4370) pproved to release test Approved Approved By Date _ By Date By Date Prior to se6edaling a Framing hapection;03 Framing (4120) ® Insulation (4150) Electrical, Plumbing & Meeba desi Roves -in sad FhwDratt Stop brspnctioas mast be signed- Approved to insulate :a] Approved to install wallboard ofaad approved. IBC 109.3.4 By Date Ck — By Date is Gypsum Wallboard Nailing (4130) ® Suspended Ceiling Grid (4265) � Final - S K F & R (4060) Approved to install mud tape Approved to drop file Approved By 44 Date � Z � � � By Date By Date 1781 Final - Planning Q Final Erosion Control (4375) 99 Final - Mechanical (4065) Approved Approved Approved By Date By Date By Aykj Date l / 0 Final - Plumbing (4075) Final - Building (4050) Approved Approved By Date 11 f tit, By dAJ Date l� / Rough Electrical Final Electrical Right of Way Approved Approved Approved By Date By Date By Date DATY INSPECTOR AREA -AND �� 5 (CIA _etKII0,0elfowl Medical Gas Services, LLC • Medical Gas Services, LLC 6355 NE 151st Street Kenmore, WA 98028 425.877.9623 Dental Gas Line Verification Report Date: November 9, 2018 Job Number: 1714 Contractor: Head Mechanical Date(s) and Time(s) of Testing: November 6, 2018 Facility: Clear Choice Dental Implant Center 2505 S 3201' ST Federal Way, WA 98003 Scope of Work: New Medical Gases, Dental Air and Vacuum Our firm certifies that the verifier(s) named in the report are properly trained and certified to perform the activities required. All test and measurement equipment is properly calibrated and maintained. As a representative 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. General Findings: A. Medical Gases are in compliance with NFPA 99(2012ed): Level 3, Dental "NOT FOR ANESTHESIA" B. No crossed lines were found in Medical Gases in the tested areas on the day of testing. C. Medical Gases meet minimum concentrations. D. Medical Gases are at normal pressure. E. Dental Air is at normal pressure. F. Dental Vacuum is at normal level. G. Medical Gas and Dental system components in area tested are in compliance with NFPA 99 (2012ed). Level 3, Dental. H. City of Federal Way: Permit # 18 -102527 -00 -FP I. Attachments: Worksheet Note. Existing Equipment and Systems. NFPA 99(2012ed) #5.3.1.4 - An existing Level 3 system that is not in strict compliance with the provisions of this standard shall be permitted to be continued in use as long as the authority having jurisdiction has determined that such use does not constitute a distinct hazard to life. 1714 -11.9.18 -VR -Dental Gas Line Pg. 1 of 4 ..0 Medical Gas Services, LLC • Medical Gas Services, LLC 6355 NE 1515t Street Kenmore, WA 98028 425.877.9623 11. Medical Gases A. Oxygen: 1. Static line pressure: 50 psig. 2. Oxygen concentration at outlet: >99.0% 3. Dynamic outlet free flow at outlet: >3.5 scfm B. Nitrous Oxide: 1. Static line pressure: 50 psig. 2. Nitrous Oxide concentration at outlet: >99.0% 3. Dynamic outlet free flow at outlet: >3.5 scfm III. Dental Air and Vacuum: A. Dental Air: 1. Static line pressure: 100 psig. 2. Oxygen concentration at outlet: 20.8% B. Dry Dental Vacuum: is 1. Static line vacuum: 12 "HgV C. Dental Vacuum: 1. Static line vacuum: 7 "HgV • IV. Particulate Line Test: PASS V. Odor: PASS VI. Outlet: A. Outlet Style: DISS VII. Manifold /Alarm: A. Manifold: New 1. Brand: Accutron 2. Model Number: 27497 3. Serial Number: 27497-00-001746 B. Alarm: New 1. Brand: Accutron 2. Model Number: 27535-5 3. Serial Number: 27535-01-000300 1714 -11.9.18 -VR -Dental Gas Line Pg. 2 of 4 Medical Gas Services, LLC • Medical Gas Services, LLC 6355 NE 151st Street Kenmore, WA 98028 425.877.9623 VIII. Dental Equipment: A. Dental Air: New 1. System air components in compliance with NFPA 99(2O12ed) 2. Brand: MidMark 3. Model Number: P72 4. Serial Number: V2O3O324 5. Configuration: Triplex 6. Horse Power: 1.5 7. Intake: Another space 8. Pump: Reciprocating B. Dry Dental Vacuum: New 1. System air components in compliance with NFPA 99(2O12ed) 2. Brand: MidMark • 3. 4. Model Number: 029-511-00 Serial Number: V2O2O581 5. Configuration: Simplex 6. Horse Power: 3 7. Vented to outside. Yes • C. Dental Vacuum: New 1. System air components in compliance with NFPA 99(2O12ed) 2. Brand: MidMark 3. Model Number: 029-511-00 4. Serial Number: V2O2O833 5. Configuration: Simplex 6. Horse Power: 3 7. Vented to outside. Yes D. Amalgam Separator: New 1. Brand: Solmetex 2. Model Number: NXT HG5 3. Serial Number: NXT-HG5-A-012778 IX. Cylinder Storage: A. Location: Inside B. Ventilation: Mechanical C. Cooling Sprinkler: Yes D. Door labeled: Yes 1714 -11.9.18 -VR -Dental Gas Line Pg. 3 of 4 Medical Gas Services, LLC • Medical Gas Services, LLC 6355 NE 151st Street Kenmore, WA 98028 425.877.9623 E. 1 Hour Rated: Yes F. Cylinders Secured: Yes X. Brazier: Jeff Head A. Brazier Number: HEAD*J*016RP B. Plumbing Contractor: Head Mechanical XI. Witness: Tom Malen — Constantine Builders XII. Comments: A. None • XIII. Recommended Corrections: A. None Tested By: David Pomeranz — ASSE 6030 Verifier t�.i t ;��L�.►�.e~',�.t�_� irk. 1714 -11.9.18 -VR -Dental Gas Line Pg. 4 of 4 0 • Medical Gas Services, LLC Level 3 Verification Check List Reference NFPA 99(2005ed) Job #:1714 Facility: Clear Choice Dental Implant Center Tested By: DP Test Date: 11.6.18 Facility: ® New ❑ Existing I Type of Facility: ® Dental ❑ Medical ❑ Veterinary ❑ Lab ❑ Other. Madinat Gaspc I-1 NONE Oxygen Line: ® New ❑ Existing Nitrous Oxide Line: ® New ❑ Existing ❑ NONE Line Pressure: 50 psi Concentration: >99 % Line Pressure: 50 psi Concentration: >99 % Flow Test: SCFH ( 2:3.5 scfm ) ® Pass ❑ Fail Flow Test: SCFH (a3.5 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: NA Quick Connect Style: DISS Location of Outlets: 12 Oclock CWinder Stnranp M 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/Oudets 5' above floor: ® Yes ❑ No Volume Connected or Stored: ® <3000 fN ❑ >3000 fP Number of Cylinders Connected: OX 2 x N20 2 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 to Exit Access Corridor: ❑ Yes ❑ No ® N/A Fan Connected to Essential Power: ❑ Yes ❑ No ® N/A Manifn►d M NOW Manifold: ® New ❑ Existing Piping Labeled: ® Yes ❑ No Brand: Accutron Flex Hoses < 5': ® Yes ❑ No I Rigid Copper ❑ Yes ❑ N/A Model #: 27497 Check Valve OL of Regulator: ® Yes ❑ No Serial #: 27497-00-001746 Relief Valve 50% Above Norman Line Pres: ® Yes ❑ No Alarm / Wamina Svstem n NONE Alarm: ® New ❑ Existing ❑ None — Not Required Non -Cancellable Visual Alarm: ® Yes ❑ No Brand: Accutron Cancellable Audible Alarm: ® Yes ❑ No Model #: 27535-5 HI I LO Line Pressure Alarm: ® Yes ❑ No Serial #: 27535-01-000300 Reserve In Use Alarm 1 Change Over: ® Yes ❑ No 1714-11.6.18-Chklst-Level 3 Verification Pg 1 of 2 • • Medical Gas Services, LLC Dental Equipment ❑ Not Tested Dental Air System: ® New ❑ Existing ❑ NONE Dental Vacuum System: ® New ❑ Existing ❑ NONE Brand: MIDMARK Brand: Midmark Model M P72 Model #: 029-5111-00 Serial M V2030324 Serial M V2020833 Conf: ❑ Simplex ❑ Duplex ® Triplex ❑ Quad Conf: ® Simplex ❑ Duplex ❑ Triplex ❑ Quad Compressor Type: Reciprocating Pump Type: Oil -less Compressor On: 80 psi Compressor Off: 100 psi Vac Level: 7 °HgVHorse Power. 3 hp. Line Pressure: 100 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 Type: Dessicant Location of Discharge: Roof Intake: ❑ Outside ® Inside (other) ❑ Inside (same) Piping: ❑ Hard Copper ® Schedule 40 PVC Amalgam Separator ® New ❑ Existing ❑ Not Required ❑ None Brand: Solmetex Model #: NXT-HG5-A-012778 Serial M NXTHG5-A-012778 Comments: 2505 South 320TH ST SUITE 110 Federal Way 98003 Dry Vac Midmark 029-5111-00 V2020581 17 Installer Jeff Head 18 -102527 -00 -FP City of Federal Way 1714-11.6.18-Chklst-Level 3 Verification Pg2of2 RECEIVED CITY OF i. Ju1404 2018 PERMIT APPLICATION Federal Way �� OF FEDERAL WAY PERMIT CENTER + 33325 81h Avenue South + Federal Way, WA 98003-6325 CON, .JN. lY DEVELOPMENT WAY 253-835-2607 + FAX 253-835-2609 + permitcenter(ic,cityoffederalway.com PERMIT NUMBER 1 Jj _ © A —'Z / k _ C O �_ 9 TARGET DATE SITE ADDRESS ')605 5. 3 004 CC4 SUITE/UNIT # ►�10 PROJECT VAUATI '4(00yeeo ZONING ASSESSTARL # I' 3 — TYPE OF PERMIT BUILDING id PLUMBING 0 MECHANICAL ❑ DEMOLITION ❑ ENGINEERING ❑ FIRE PREVENTION NAME OF PROJECT PROJECT DESCRIPTION Detailed description of work to WT be included on this permit only NAME PRIMARY PHONE WI R. l.bP �E rrl-r 20,p - a456 '05 W, PROPERTY OWNER MAILING ADDRESS "O a- %\%;"" Avg. "V E-MAIL CITY �r `,Stu A If A. � Vv wJ3 NAME , (,�, rt PHONE - s7- GD MAILIN/99R2 G ES DRS' I �%E-MAIL wao � E -MA CONTRACTOR CITYS ke ATE ZIP FAX t w qk /,5_57 WA STATE CONTRACTO 'S LICENSE # r3 toh)STT 9 z EXPIRATION DATE `1 za �Zo FEDERAL WAY SUSHIM LICENSE # NAM Awl rA- PRIMARY PHONE MAILING ADDRESSE-MAIL 63W F. cm4mw- —aaK ' GNazwQAex�c APPLICANT CITY STATE ZIP FAX PROJECT CONTACT NAME 51,94VA PRIMARY PHONE MAILING ADDRESS i�. E-MAIL (The individual to receive and respond to all correspondence 350 T CITY 6-Qt4\wcr> 1.1 STATE CD ZIP tba\ FAX concerning this application) PROJECT FINANCING NAME OWNER -FINANCED When value is $5,000 or more MAILING ADDRESS, CITY, STATE, ZIP PHONE (RCW 19.27.095) I certify under penalty of perjury that I am the property owner or authorized agent of the property owner. I certify that to the best of my knowledge, the information submitted in support of this permit application is true and correct. I certify that I will comply with all applicable City of Federal Way regulations pertaining to the work authorized by the issuance of a permit. 1 understand that the issuance of this permit does not remove the owner's responsibility for compliance with local, state, or federal laws regulating construction or environmental laws. I further agree to hold harmless the City of Federal Way as to any claim (including costs, expenses, and attorneys' fees incurred in the investigation and defense of such claim/, which may be made by any person, including the undersigned, and filed against the city, but only where such claim arises out of the reliance of the city, including its officers and employees, upon the accuracy of the information supplied to t e city asf as part of this application. Aoal I It (,(f SIGNATURE: DATE ` ,F— PRINT NAME: Bulletin #100 – January 29, 2016 Page 1 of 2 k:\Handouts\Permit Application GENERAL INFORMATION CRITICAL AREAS ON PROPERTY? WATER PURVEYOR VALUE OF MECHANICAL WORK MECHANICAL PERMIT FOR OFFICE USE tXtST't wl to $ Indicate how many of each type offixture to be installed or relocated as part of this project Do not include existing fixtures, to remain. AIR HANDLING UNITS FANS GAS PIPE OUTLETS OTHER (Describe) _22— AIR CONDITIONER FIREPLACE INSERTS HOODS (commercial) OTHER (Describe) BOILERS FURNACES HOT WATER TANKS (Gas) Construction a COMPRESSORS GAS LOG SETS REFRIGERATION SYST Area Totals DUCTING GAS PIPING WOODSTOVES J TOTAL FIXTURES GENERAL INFORMATION CRITICAL AREAS ON PROPERTY? WATER PURVEYOR VALUE OF PLUMBING WORK PLUMBING PERMIT FOR OFFICE USE tXtST't wl to $ t 5 o eE'A Indicate how many of each type offixture to be installed or relocated as eart of this project. Do not include exisdr ixtures to remain. BATHTUBS (or Tub/shower Combo) �_ LAVS (Hand Sinks) TOILETS WATER PIPING _ DISHWASHERS RAINWATER SYSTEMS URINALS OTHER (Describe) DRAINS SHOWERS Z VACUUM BREAKERS Construction a DRINKING FOUNTAINS _ SINKS (Kitchen/Utility) WATER HEATERS (Etectrie) Area Totals HOSE BIBBS SUMPS WASHING MACHINES J TOTAL FIXTURES GENERAL INFORMATION CRITICAL AREAS ON PROPERTY? WATER PURVEYOR SEWER PURVEYOR VALUE OF EXISTING IMPROVEMENTS FOR OFFICE USE tXtST't wl to F)C I STI w G $ EXISTING/PREVIOUS USE LOT SIZE (In Square Feet) EXISTING FIRE SPRINKLER SYSTEM? PROPOSED FIRE SUPPRESSION SYSTEM? ADDITION Yes ❑ No .4 Yes ❑ No COMMERCIAL - REMODEL/TENANT IMPROVEMENTS ------ . .-------------------------------------------------------------------..............------. --------------------------------------------------------------------------------------------- ............. RESIDENTIAL -NEW OR ADDITION AREA DESCRIPTION (in square feet) BASEMENT FIRST FLOOR (or Mobile Home) EXISTING PROPOSED TOTAL FOR OFFICE USE SECOND FLOOR' NEw BUILDING ..................................................................... --------------...----------------------- COVERED ENTRY ADDITION DECK GARAGE ❑ CARPORT ❑ COMMERCIAL - REMODEL/TENANT IMPROVEMENTS ------ . .-------------------------------------------------------------------..............------. --------------------------------------------------------------------------------------------- ............. OTHER (describe) Construction a # of Stories Additional Information TOTAL BUILDING Area Totals EXISTING PROPOSED TOTAL --------------------------------------------------...................................................-- ------------ "NEW xoaW ONLY"ESTIMATED SELLING PRICE $ FOOF BEDROOMS COMMERCIAL - NEW/ADDITION AREA DESCRIPTION Area in Square Feet Occupancy Group(s) Construction a # of Stories Additional Information NEw BUILDING ADDITION COMMERCIAL - REMODEL/TENANT IMPROVEMENTS AREA DESCRIPTION Area in Occupancy Groups) Square Feet Construction a # of Stories Additional Information TOTAL BUILDING TENANT AREA ONLY PROJECT AREA ONLY Bulletin #100 — January 29, 2016 Page 2 of 2 kAHandouts\Permit Application CITY OF FEDERAL WAY Temporary Certificate of Occupancy This temporary certificate is issued pursuant to the requirements of International Building Code, Section 110.3. Tenant name: CLEAR CHOICE DENTAL IMPLANT CENTER Owner Name: CLEAR CHOICE Site Address: 2505 S 320`" Street, Suite 110 Permit number: 18 -102416 -00 -CO Occupancy Class: B Construction Type: I -B Floor Area: 6,925 sf Sproul, Buildiniz Official November 14, 2018 Date * _ empoary occupancy allowed for staff training only ** This TEMPORARY CERTIFICATE OF OCCUPANCY expires on December 3, 2018 ••k N' �l .� ��