HomeMy WebLinkAboutPermit File BLD-2020-0572 607 R Avenue (3)STATE OF WASHING I ON - Department of Labor and Industries
FACTORY ASSEMBLED STRUCTURES
P.O. Box 44430, Olympia, Washington 985044430
Web Site wwwolni,wa.gov/tradeslicensing/factory assembled structures/
08-Oct-20
Tn� City of Anacortes
PO Box 547
Anacortes, WA 98221
Don Measamer
�1LE COPY
e: Modular Building d Al
Site locations R Ave - Depot Plaza
Anacortes, WA 98221
This letter is to inform your department of a modular building being shipped to the
address above. Enclosed is a copy of the Department of Labor and Industries, Factory
Assembled Structures Section approved plans for your use. Attached is a list of items
that will require review, inspection and approval by City of Anacortes. CXT INC is
the manufacturer, they may be contacted at 208-807-3506. The Department of Labor
and Industries, Factory Assembled Structures Section has informed the manufacturer
that permits, review and inspection of on site construction, conditions and completion
of the building will be required by the City of Anacortes. If you have any questions or
concerns please feel free to contact me.
Michael Luke
Plans Examiner
WA State Dept of Labor & Industries
(360) 902-5297
lukm235@Ini.wa.gov
'• BuA 44430
1I
Pia WA 9850444M
N011rIFI1"ATIO11 '1'O LOCAL ENFORCEMENT AGENCY
The Factory-Bullt unit identified below requires 09/21 /20 M 418-1
°°mpledOu work at the site as Vedfied. Mfg CXT I N C
Owneei name City of Anacortes Wsr's BMW no.
Inwllation •ddieas
S-299 Dq% seriAll no.
Depot Plaza - 611 R Ave v-B ETA at site
B 12/31 /20
Anacortes, WA 98221 `O°°�' Phonenumsber
Skagit
360-299-1948
InsraWtion site i• in: x ity Lj County
......,.._ - - DESCRIBE ITEMS REQUIRING COMPLETION WORK AT THE SITE
City of Anacortes
Bldg Official
PO Box 547
Anacortes, WA 98221
ROOF DRAINAGE, UNDERGROUND
PLUMBING, VENT PIPING, PLUMBING
CONNECTIONS
CUSTOMER WILL CONNECT WATER
SUPPLY & WASTE LINES
Floor drains/Trap Primers/grease trap/floor sink.. 2" water "
and slab plumbing, permitting, review and approval. piping,. ,S5
Foundation permitting, review and approval. fit*'
Building connection to foundation.
NOTE: This building is only approved by LNI as
Occ = B (restrooms with associated utility rooms - unconditioned)
Mount Vernon L&I
525 E College Way, Suite H
Mount Vernon, WA 98273
ELECTRICAL
Customer Provided Utilities to Building
and Final Connection by Installer
Ali Cairns
For Postal Deli very
L)epartment of La. r and Industries FB
T attory Aa:;embled , 'suctures CC CH 11
PO Box 44430 CC CST
Glyn Apia WA 98504-4430 WA Only
For Non Postal Delivery (e.g., Fe4W. UPS) WA Rev/OR Courtesy
Department of Labor and Industries OR Rev/WA Courtesy
Factory Assembled Structures Other sty
CXT Inc
FiU out
M418-1
6071 E Flamingo Ave. Bldg 300
City/StatefL� Nampa, ID 83687
FOR DEPARTMENT USE ONLY
rcGllGWal AY NO. WAC Resubmittal Appl ID
Addendum AP No. for fees Plans reviewed by L&I listed professional
Note: Identify addendum Items on plant
Code cycles (month/year):
2015 VIA : 2015 NECO 2017 2015 2015
Size of builds 20' No of 2 Occupancy
Width: L.en 26' Area (So F : 520 modules: group: B
Type construction: Use: Sub yr SEC yr seismic Zone
V-B RESTROOM 2015 2017 D
Roof live load PSF: Wind load MPH - EXP. 'SF for CC) Floor load PSF:
220 � 150 C 400
Plot plan submitted? ❑ Yes I X No If"No", provide distance from farthest proiectioa to newest buildbWproperty line:
Front: 10' Rear 10, Left side: 1U Rieht side: 10
MEN
Type heat C3for�oed air LaHydronics red Baseboard �o�om- h� Other
Type of fuel: ❑ Electric Natural gas ❑ Propane ❑ Oil ❑ Other.
Insulation Floor Walls Roof (Flat) Roof (Vault) Heating zone: Zone I Zone 2
values: N/A N/A
MEN
W SEC compliance chapter: eak ons: Electrical service:
Attached On file - AP# Amps 200 3a% �
Component Systems Prescriptive N/A Heat Pump Yes FANo
Performance Analysis Air conditions Yes No Phase X 1 3
N/A Attached Attached/Design On
L&I Review Professional Review file
Structural calculations or test proposals ❑ CD ❑ ❑ AP# ���
Truss or rafter drawing(s) C3 ❑ ❑ AP#
Truss plan if over 3 different trusses ❑ AP#NEW
t j
Girder truss or ridge beam drawing C3 ❑ r,
AP# �,, ;
HVAC drawing ❑ C3 ❑ ❑ AP#
Cross section and elevation ❑ Iza FZ3 =3 Ap##
Foundation plan ❑ ca ❑ ❑ AP#
Electrical load demand calculation ❑ C3 ❑ ❑ AP#
Panel box schedule/Electric load calc's ❑ La FM3 C3 AP#
Chassis drawing (CC units only) a ❑ ❑ ❑ AP#
Plumbing systems: ❑ ❑ ❑ ❑ APi#
OPCIAting pressure to ssNo of fttinys. Total developed length
RETURN PLANS X iar mail ❑ Overnight Q customer's expense ❑
VIA:
Other
Carrier
Fop Piwal D ekvery
DeF?Irtment of Labor and Industries
Factor;, Assemlted Structures
PO Box 44430
01yinpia WA 985044430
For Non -Postal Delivery (e.g., FedX, UPS)
Department of Labor and Industries
Factory Assembled Structures
7273 Linderson Way SW
Turnwater WA 98501
WvvW. W a.gov/1ni/FAS/
(case sensitive)
Permanent MANUFACTURER MM NO.
Alteration
Replacement P� CXT Inc. Precast MFG# M418
Multi -Tagged crrrn 3808 N. Sullivan Rd. Bldg. #7
❑ WA ❑ ID Spokane, WA 99216
❑ OR ❑ Other Tom' 509-921-8766/F-509-928-8270
APPLICATION FOR INSIGNIA
FOR FACTORY BUILT STRUCTURES
SUBMIT ONE COPY - NOTE: A separate form is to be used for each building unless multiple buildings have the
same plan approval number.
ontact person's printed name: Ail CairnsDato 09�21 �20 Fee enclosed 1
325.40
signature
Phone No
FAX No
( ) 509-892-3238 ( ) 509-928-8270
A FEE FOR EACH INSIGNIA IS DUE wrm APPLICATION — NOT SUBJECT TO REFUND
PLEASE MAKE CHECKS PAYABLE TO DEPT. OF LABOR & INDUSTRIES
Depl insignia No. Mfg Serial No. Approved Plan No.
1 0 1S-299 A I zc
OG TC is SUB YR SEC YR ESL RF �y
Dept Insignia No. Mfg Serial No.
2.
S-299 B
Dept Insignia No. Mfg Serial No.
3.
Dept Insignia No. Mfg Serial No. fteep
4.
Dept insignia No. Mfg Serial No.
s. FAS
Dept Insignia No. Mfg Serial No.
6,
Dept Insignia No. I Mfg Serial No.
7.
Dept Insignia No. I Mfg Serial No.
0
Dept insignia No. I Mfg Serial No.
E
Manufacturer to complet
Number of tags: j
FCT23.014-[x>o (PDF)
Regular mail
Via Carrier
X Overnight at customer expense— fir►
Other Acct #
Iw trulpnie - laaory bola t t-UO
nF L• _.
OF2
HTG No AC
Fee 298.70
POD _ 2 Fee
OF _ 2 $ 26,70
Fee
POD Fee
or• _ _ $
POD Fee
of �
POD Fee
OF $
POD Fee
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POD Fee
OF $
POD Fee
OF $
UPS nanued on reverse
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