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17-104407 ; r1\ �' Plumbing City of Federal Way Permit #:17-104407-00-PL Community Development Dept 33325 8th Ave S Federal way,WA 98003 Inspection Request Line: (253)835-3050 Ph:(253)835-2607 Fax(253)835-2609 Project Name: W D G DENTAL CLINIC Project Address: 31515 PETE VON REICHBAUER WAY S Parcel Number:092104 9302 Project Description: Installation of oxygen,nitrous,vacuum&dental air distribution systems. Owner Applicant Contractor YONG K PARK JACOB RITTERRITTER PLUMBING AND RITTER PLUMBING AND MECH LLC 2016 S 320TH ST SUITE F MECH LLC RITTEPM843DT(3/30/18) FEDERAL WAY WA 98003 5906 39TH AVE SW SEATTLE WA 98136 5906 39TH AVE SW SEATTLE WA 98136 Other Plumbing Fixtures 1 CONDITIONS: Subject to field inspection without plans. PERMIT EXPIRES Monday, 12 March,2018 Permit Issued on Wednesday,September 13,2017 I hereby certify that the above information is correct and that the construction on the above described property and the occup cy nd 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: d 9` / 3-2-0 /7 ,005 THIS CARD IS TO REMAIN ON-SITE ' emr Or 1/Mn�1i ' Construction Inspection Record • • Federal Way INSPECTION REQUESTS:(253)835-3050 PERMIT#: 17 104407 00 Address: 31515 PETE VON REICHBAUER WAY SI Project: YONG K PARK 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 (read left to right,top to bottom). PIease schedule inspections as appropriate. Work must not be covered until it is approved. Check withyour inspector possible you are unsure about any of the inspections or the inspection sequence. On-going inspections are loggedP��if g mg on the back of this card. 0 Plumbing Groundwork(4190) El Rough Plumbing(4230) 1=1 Final-Plumbing(4075) Approved to cover Approved Approved By Date 1l/6 i By ia Date 11 1 By .i, Date 112.1 Lc.Vc.15 riok ' 11td• (-20 Go u 0,...1- kitc)S Ix 1 1- •vS?. alb ' )1Z • , 0 Rough Electrical 0 Final Electrical D Right of Way Approved Approved Approved By Date By Date By Date • W 4 3 . `r L,4 C H 5` - Medical Gas Services, LLC Medical Gas Services,LLC 6355 NE 151st Street Kenmore,WA 98028 425-877-9623 Dental Gas Line Verification Report Date: December 25, 2019 Job Number: 2174 Contractor: WA Dental Group Date(s) and Time(s) of Testing: December 6, 2019/ 1200 hrs. Facility: WA Dental 31515 Pete Von Reichbauer Way S 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. I. 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. Most medical Gas and Dental system components in area tested are in compliance with NFPA 99 (2012ed). Level 3, Dental. H. Purge Gas: Lot#T1214601(Central) I. Initial Line Pressure Test: PASS City of Federal Way: Permit# 16-10592-=0000 J. Attachments: Work sheet 2175-VR-Dental Gas Line(2012ed) Pg. 1 of 4 Medical Gas Services, LLC Medical Gas Services,LLC 6355 NE 151st Street Kenmore,WA 98028 425-877-9623 II. Medical Gases A. Oxygen: 1. Static line pressure: 51 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: 50psig. 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. Dental Vacuum: 1. Static line vacuum: 7 "HgV. IV. Particulate Line Test: PASS V. Odor: PASS VI. Outlet: Amico A. Outlet Style: Ohio VII. Zone Valve: None— not required. VIII. Manifold /Alarm: A. Manifold: 1. Brand: Belmed 2. Model Number: 4024A 3. Serial Number: 466 B. Alarm: 1. Brand: Belmed 2. Model Number: NA 3. Serial Number: NA 2175-VR-Dental Gas Line(2012ed) Pg. 2 of 4 Medical Gas Services, LLC Medical Gas Services,LLC 6355 NE 151st Street Kenmore,WA 98028 425-877-9623 IX. Dental Equipment: A. Dental Air: New 1. System air components in compliance with NFPA 99(2012ed) 2. Brand: Dansereau Health Products, Inc. 3. Model Number: DHP/303-C-230VTS 4. Serial Number: 1495-1019-COMP 5. Configuration: Triplex 6. Horse Power: 1 7. Intake: Outside 8. Pump: Oil less B. Dental Vacuum: New 1. System vacuum components in compliance with NFPA 99(2012ed) 2. Brand: Dansereau Health Products, Inc. 3. Model Number: 3 HP HYBRID 4. Serial Number: 14958-1019-HYBRID 5. Configuration: Simplex 6. Horse Power: 3 7. Vented to outside. C. Amalgam Separator: New 1. Brand: Solmetex 2. Model Number: NXTHG5 3. Serial Number: NXTHG5-A-019196 X. Cylinder Storage: A. Location: Inside B. Ventilation: Mechanical C. Cooling Sprinkler: Yes D. Door labeled: No E. 1 Hour Rated: No F. Cylinders Secured: Yes XI. Brazier: Chris Fitzgerald A. Brazier Number: FITZGCM988PZ B. Plumbing Contractor: Ritter Plumbing and Mechanical, LLC 2175-VR-Dental Gas Line(2012ed) Pg. 3 of 4 Medical Gas Services, LLC Medical Gas Services,LLC 6355 NE 151st Street Kenmore,WA 98028 425-877-9623 XII. Witness: Angela—WA Dental XIII. Comments: A. None XIV. Recommended Corrections: A. None Tested By: Harry Pomeranz—ASSE 6030 Verifier 147 imeeisti 2175-VR-Dental Gas Line(2012ed) Pg. 4 of 4 Medical Gas Services, LLC Level 3 Verification Check List Reference NFPA 99(2012ed) Job#:2174 Facility:WA Dental Tested By: HP Test Date: 12/6/19 Facility: Z New ❑ Existing Type of Facility: ®Dental ❑Medical ❑Veterinary ❑Lab ❑Other: Medical Gases ❑ NONE Oxygen Line: ®New ❑ Existing Nitrous Oxide Line: Z New ❑Existing ❑NONE Line Pressure: 51 psi Concentration: >99% Line Pressure:50 psi Concentration:>99% Flow Test:(z3.5 scfm)® Pass ❑ Fail Flow Test: (>_3.5 scfm)® Pass ❑ Fail Particulate Test: ®Pass ❑ Fail Particulate Test: ® Pass Cl Fail Odor: ® Pass(None) ❑ Fail, Odor: ® Pass(None) ❑ Fail, Crossed Lines: ❑Yes ®No Outlet Brand:Amico Quick Connect Style:Ohio Location of Outlets:Wall Cylinder Storage ❑NONE Tank Room: Z New ❑ Existing Location:® Inside ❑ Remote Door Labeled: ®Yes 0 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 2 x N2O 2 Ventilation:❑ Natural ® N/A Ventilation:® Mechanical ❑N/A 2 Openings 1'of Floor&Ceiling: ❑Yes ❑No ❑N/A Exhaust Fan Runs Continuously: Z Yes ❑ No ❑N/A Minimum 72 in2 Free Area: ❑Yes ❑ No ❑ N/A Draws Air from within 1'of Floor: ❑Yes Z No ❑N/A Vented directly to outside: ❑Yes ❑ No ❑ N/A Fan Connected to Essential Power: ❑Yes ❑No ®N/A Manifold ❑NONE Manifold:® New ❑Existing Piping Labeled: ®Yes ❑No Brand: Belmed Flex Hoses<5': Z Yes❑No I Rigid Copper El Yes❑N/A Model#:4024A Check Valve DL of Regulator:®Yes ❑ No Serial#:466 Relief Valve 50%Above Norman Line Pres: ®Yes ❑No Alarm/Warning System 0 NONE Alarm: ®New ❑ Existing ❑ None—Not Required Non-Cancellable Visual Alarm: Z Yes ❑No Brand: Belmed Cancellable Audible Alarm: ®Yes ❑ No Model#: N/A HI I LO Line Pressure Alarm: ®Yes ❑No Serial#: N/A Reserve In Use Alarm/Change Over: ®Yes ❑No WADental-12.6.19-Chklst-Level 3 Verification (2012ed) Pg. 1 of 2 Medical Gas Services, LLC Emergency Shutoff/Zone Valve ®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: Dansereau Health Products, Inc. Brand: Dansereau Health Products, Inc. Model#: DHP/303-c-230-vts Model#:3 HP HYBRID Serial#: 14958-1019-COMP Serial#: 14958-1019-HYBRID Conf: ❑Simplex ❑ Duplex ®Triplex ❑Quad Conf: ®Simplex 0 Duplex ❑Triplex ❑Quad Compressor Type:Oiless Pump Type: Regen Compressor On:60 psi Compressor Off: 100 psi Vac Level:7"HgV Horse Power: 3 hp. Line Pressure: 100 psi Particulate:® Pass❑ Fail Drain: ❑Sealed ® Open ® Floor ❑Wall Concentration:20.8% Horse Power: 1 hp. Flexible Connectors: ®Yes ❑No Receiver:®Yes 0 No Drain: ®Manual ❑Auto Air I Water Separator:®Yes ❑No Moisture Indicator: ®Yes ❑ No Exhausted to Outside: ®Yes 0 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: Solmetex Model#: NXTHG5 Serial#: NXTHG5-A-019196 Comments: Not labeled. Ritter Mech Permit 16-105920-00-CO Federal Way WADental-12.6.19-Chklst-Level 3 Verification(2012ed) Pg.2 of 2 A RECEIVED CITY OF PERMIT APPLICATION SEP 13 2017 PERMIT CENTER+ 33325 8th Avenue South + Federal Way,WA 98003-6325 Federal Way 253-835-2607 + FAX 253-835-2609 +permitcenter@cityoffederalway.com CITY OF FEDERAL WAY COMMUNITY DEVELOPMENT PERMIT NUMBER I 1 _ 1 014 4 O -7 _ ? L„ TARGET DATE 41.1/ / /' 7 SITE ADDRESS SUITE/UNIT# 31515 PETE VoN R>~scti.mu . wkii s PROJECT VALUATION ZONING ASSESSOR'S TAX/PARCEL# $ 2 8, 000 . 00 O 9 2- 1 o tt - R 3_ 2- TYPE TYPE OF PERMIT ❑ BUILDING rig PLUMBING 0 MECHANICAL 0 DEMOLITION 0 ENGINEERING 0 FIRE PREVENTION NAME OF PROJECT W D G D E.i%)f fr I_ C N�--L DetailedPROJECT DESCRIPTION "rxd 'f}LL TL.DN C c D�cYGE N NZ r-z.0 / description of work to / V�Lv U M -D EN rq,[ be included on this permit only A.tQ ,DI S rAr SU 717..f)x1 5 ciSTE.H S . NAME - PRIMARY PHONE .. . YOUN K Ph_R{C PROPERTY OWNER MAILING ADDRESS #, F E-MAIL 2-C,i(0 5 32oTO ST, CITY STATE ZIP Fr to i-L 1,04 Loa A, 1 8 o o 3 NAME ,., PHONE r•17T-"R PLoM�„[N AND /`�t�C4A,v. C$L. 2o . 761 69 /9 MAILING ADDRESS E-MAIL 06 3rl/ 4i 9ve Scv ,jaco6brt .9 -Nci -e ho-l4 CONTRACTOR CITY STATE ZIP FAX 50ArtLe wA 98/3,C N A- ', WA STATE CONTRACTOR'S LICENSE# EXPIRATION DATE FEDERAL WAY BUSINESS LICENSE# Vr-11-FPM 643,Vr / / - NAME PRIMARY PHONE APPLICANT- MAILING ADDRESS E-MAIL CITY STATE ZIP FAX NAME PRIMARY PHONE PROJECT CONTACT J A CO3$ KTTE A- 2-0 6 76 9 6,9 1 (The individual to receive and MAILING ADDRESS E-MAIL l /� L respond to all correspondence 590(0 g9 r,4 ,1 v£ `SW JctCObb ri' 'rel - hal-Met /, concerning this application) CITY STATE ZIP t?,9 136 FAX .5.t Arnz too p NAME PROJECT FINANCING ❑ 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. I 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 suppl' he ci a part of this application. SIGNATURE: (� DATE rb qr it-ZD 17 PRINT NAME: J qco 9 R= 2 Bulletin#100–January 29,2016 Page 1 of 2 k:\Handouts\Permit Application VALUE OF MECHANICAL WORK MECHANICAL PERMIT $ Indicate how many of each type of fcclure 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) AIR CONDI;'IONER FIREPLACE INSERTS HOODS(commercial) BOILERS FURNACES HOT WATER TANKS(Gas) COMPRESSORS GAS LOG SETS REFRIGERATION SYST DUCTING GAS PIPING WOODSTOVES Ivel w�(_OF PLUMBING CYRK PLUMBING PERMIT $ 424000, 00 Indicate how many of each type of fixture to be installed or relocated as part of this project.Do not include existing fixtures to remain. BATHTUBS(or Tub/Shower combo) LAVS(Hand Sinks) TOILETS WATER PIPING DISHWASHERS RAINWATER SYSTEMS URINALS OTHER(Describe) DRAINS SHOWERS VACUUM BREAKERS DRINKING FOUNTAINS SINKS(Kitchen/Utility) WATER HEATERS(Electric) HOSE BIBBS SUMPS WASHING MACHINES TOTAL FIXTURES GENERAL INFORMATION CRITICAL AREAS ON PROPERTY? WATER PURVEYOR - SEWER PURVEYOR VALUE OF EXISTING IMPROVEMENTS EXISTING/PREVIOUS USE LOT SIZE(In Square Feet) EXISTING FIRE SPRINKLER SYSTEM? PROPOSED FIRE SUPPRESSION SYSTEM? ❑Yes ❑ No ❑Yes ❑ No RESIDENTIAL - NEW OR ADDITION AREA DESCRIPTION(in square feet) EXISTING PROPOSED TOTAL FOR OFFICE USE FIRST FLOOR(or Mobile Home) COVERED ENTRY -'- � GARAGE 0 CARPORT 0 • ,Y �^2 'b,' s r i t ..�'' Gs •E•Ex ,�_. t r $ Y_ aw,�+f .. "F .a.x x _._._____—_--__—__..______...........___ —_�..—.___ .._..._ . •1 - '�.., ,: ,5e4 ri3'� "F.� r... 1•z1e. 7 t..e,, •'>±"•.,t tX „`,�-<: rc EXISTING PROPOSED TOTAL Area Totals ESTIMATED SELLING PRICE$ #OF BEDROOMS COMMERCIAL—NEW/ADDITION Area in Construction #of AREA DESCRIPTION Occupancy Group(s) l I I Additional Information Square Feet ;t7.+r` y1C s-J *.c Stories �,A rMe Stb x xd: K ',4. y- s 5!'-t,e...-,�.: zN.'`.^.��'�-I.� � #K€.:.-. �.'�..'°:� ���„ '+.�M.%:' ..��� "m "�`-� _, ?. ... ...•- *� r.��-�`ifr iia.ar z c� ,tom ADDITION COMMERCIAL—REMODEL/TENANT IMPROVEMENTS Area in Construction #of AREA DESCRIPTION Occupancy Group(s) Additional Information S uare Feet Type Stories d e l " Oxy r3 °: ':, 3 #Y � '�tr.'t r`k3'"' t �'xt """`tt{""t. *-' '=v'`'" ;e a e; (•...A tom.. .. ' TENANT AREA ONLY RQJLCT W _ .,-r _ KtaA°,�.s"`� .. ~;r- ��� _. x.K.,�,.-a�s-c•.:. .YY. .: t�....: u.,x^fit,�'�.�xssri, c sa'-�'i. {.?•"�f f�E ' �:.J�.. , Bulletin#100—January 29,2016 Page 2 of 2 k:\Handouts\Permit Application