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
•
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4
3 .
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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
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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
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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
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Bulletin#100—January 29,2016 Page 2 of 2 k:\Handouts\Permit Application