BLD-05-0644City of Yelm
Applicant
Community Development Department
Builtling Division
Phone: (360)458-840]
Fax: (360)458-7144
Permit No: BLD-OS-0644-YL
Issue Date: 07/22120Dfi
(Work must be stanetl within 180 days)
Receipt No: 42878
Name: DGR Capital Phone: 458.1502
Address: P.O. BOx V97 Gty: Yelm State: WA Zip gg597
Property Information:
Site Atltlress: 80] Mt. Aire Lane
Assessor Parcel No. Subtlivisicn'. Mountain Aire Lol' 3
Contractor Information:
Name: American Dream Concepts Contact: Phone' 253-735-2222
Atltlress: 399 4lh Ave. $E City: Pacific State: WA Zip: 98067
Contractor License No: AMERIDD951BM Expires: 01/1410]14 Business License:
Project Information;
Protect: Mt. Aire Short Plal
Oescripti¢n of Work: 3002 st SFR
Sq. Ft per OOOC (1st) 1489 (2ntl) 1513 (3rtl) 0 Garage 621 Basement 0
Heat Type (Electric, Gas, Otherj'. GAS
Fees:
Item Item Fee Base Amt Unit Fee Unit Rate No. Units Unit Desc
Builtling Permit 100-500k 2,121 .03 993.]5 1,12].28 5.6000 201.3000 $1,000
Builtling Plan Review 1,3]8 .66 0.00 0.00 0.0000 0.0000
Mechanical Permit 91 .25 0.00 0.00 0.0000 0.0000
Plumbing Permit 146 .00 20.00 126.00 ].0000 18.0000 Figure
Sewer ERU 5,569 .00 0.00 5,569.00 5,569.0000 1.0000 ERU
Sewer Inspection 145 .00 OAO 145.00 145.0000 1.0000 ERU
Water ERU 1,500. 00 0.00 1,500.00 1,500.0000 1.0000 ERU
Water Meter (SFD) 300. 00 300.00 0,00 0.0000 0.0000
Water Deposit a0. 00 x0.00 0.00 0.0000 OD000
Traffm Facilities Charg¢ 75]. 50 0.00 75250 750.0000 1D100 Peak PM Trip
Sewer Deposit 50. 00 50.00 0.00 O.D000 0.0000
Fire District Impact Fea ]82. 5] 0.00 ]82.5] 0.2160 3,623.0000 square foot
State Builtling Fee 4. 50 4.50 0.00 0.0000 0.0000
TOTAL FEES: E12,885. 51
Applicant's Affatlavit
I certify that I have reatl antl examinetl the information containetl within the application antl know the same
to be true and correct. I also cedify that the proposed structure is in conformity with all applicable City of
Yelm regulations intlutling those governing zonin antl lantl subtlivisicn, antl in atltlition, all covenants,
easements and reslric~ions of recoN. If agpfyi as a conlrador, I futher certify that I am currently
registeretl in the Stag of Washington.
Signature
Firm
Dale
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® RECEIPT NO 4287
8
3ae-05a-BdQ3
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RECEIVED ~ > ~ ;?
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~
"'"TWELVB THOUSAND EIGHT HUNDRED EIGHTY FIVE DOLLARS & 51 CEATS
.RECEIVED FROM DATE ~ REC NO
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` 07/21/06 42878 ;.12, 885. 51. CHECR ,,.- 3068
PO BOI 1791
'~'
't: YELM WA98597 •~; BUDGETARY • ':
'. BLD-05-0644-YL' -
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. _
PER2121.03,PL1378.66,MECH91.25, PLUH146.,SERU5569. ,SINSP145. WERU1500. WHET300.
WDEP4@. TRAP 757.50 SDBP50. FIRE782. 57,ST 4.50
City of Yelm
Community Development Department
Building Division
Phone: (3fi01458-8407
Fax: (3601458-3144
AppllwntY
Permit Fees Schedule
Permit No: BLD-05-0644-YL
Name: DGR Capital Phone: 458-1502
Atltlress: P.O. Box 1791 City: Yelm State: WA Zip 98597
Project lnfonnatlon: ~ - `
Project: ML Alre Short Pla[
Oescdption a(Wprk: 3002 sf SFR
Site Atltlress: 807 ML Aire Lane Assessor Parcel No.
Item Acct Code Item Fee Base Amt UnH Fea Unit Rate Nc. Units Unit Desc
Building Permit tOQ500k 032007-322-10.00 2,121.03 993.75 7,127.28 5.6000 201.3000 51,000
Building Plan Review 700001J45-8&00 1,376.66 0.00 0.00 0.0000 0.0000
Mechanical Permh 032007-322-10-00 91.25 0.00 0.00 0.0000 0.0000
Plumoing Permit 032001-322-10-00 14600 20.00 726.00 7.0000 18.0000 Fixture
hewer ERU 802412-343-50-01 5,569.00 0.00 5,56900 5,569.0000 1.0000 ERU
Sewer lnspedion 805412-343-80.00 145.00 0.00 145.00 145.0000 1.0000 ERU
Water ERU 715601-343-80.02 1,500.00 0.00 7,500.00 1,500.0000 1.0000 ERU
Water Meter (SFD) 712401-343-80.01 300.00 300.00 0.00 0.0000 0.0000
Water DeposR 740402-389-00-00 40.00 40.00 0.00 0.0000 0.0000
Trafic Fadlfties Charge 420 120.345-85-00 757.50 0.00 757.50 750.0000 1.0100 Peak PM Tdp
Sewer DeposB 742402-380.01-00 50-00 50.00 0.00 0.0000 0.0000
Fire District Impact Fee 105001-345-85-00 782.57 0.00 782.57 021fi03.623.0000 spuara loot
State Building Fee 180 001-386-00.00 4.50 4.50 0.00 0.0000 0.0000
TOTAL FEES: 512,885.57
CITY OF YELM
f 'DENTIAL BUILDING PERMIT APPLIC! 'N FORM
,- Projec[Address: S~,O'~ n1}~. ~/y'M ~GU1L'. Parcel#:
Subdivision: f/lf. fl r%~L ~yf/ ~~ Lo[ #: .5 Zoning;
New Construction a Rc Model I Re-Roof /Addition a Home Occupation Sign
u Plumbing a Mechanical a Mobile / Manuf/actured Home Placement u Other
Projec[DescriplioNScrope of Work: /(/'1> ~,CY7S~/clron~ y h~r~2Y.wt l1v Sr~~ez~~
Project Value: ~ 3CCJttbp eo
Building Area (sq. ft) 1"Floor ~y~~ 2ne Floor 5I ~3 Garage ~ Deck_,~
Basemen[ ~~// Carport Patio
# 8edrooms~ # Bathrooms1 Heatin :'GASI THER or ELECTRIC (Circle One)
Are there any environmentally sensitive areas located on the parcel? ~~ If yes, a
completed environmental checklist must accompany permit application.
9~
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~~06
BUILDING OWNER NAME: jj[, e c~.yl,T'c~.l /AJ(_
ADDRESS I~.n. yak 1~9/ EMAIL
CITY YPIfYI STATE GtIR ZIP R.`:{fj- TELEPHONE 2G,r> 4S6 /5~~-
ARCHITECT/ENGINEER PLIE INC. LICENSE#
ADDRESS ~f9a~I 1U`rt~ .Sf.. SU Su~4L C EMAIL
CITY L~~euonOl STATE~H.4 _ZIP 9E3't9 TELEPHONE z~i3-(~&2- oy SG
Copy of mitigation agreement with Yelm Community Schools, if applicable.
1 hereby certify that the above information is correct and that the constmction on, and the occupancy and the use o(the
above tlescdbetl preperty will ba in accordance whh the laws, rules antl regulations of the State of Washington and the
City oT Yelm.
`~~P~ C9 ~3o~oc.,
A icant's Signature Date
Owne I Contractor I Owner's Agent I Contractor's Agent (Please circle one.)
All permits ara non-transferable and will expire if work authorized by such permit is not begun
within 180 days of issuance, or if work is suspended or abandoned for a period of 180 days
105 Yelm Avenue Weaf (J60J 45&J8d5
PO 13os 499 (360) 458-3]44 FAX
Yerm, WA 98599 www.ci.velm.ma.ua
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YELN COMMUNITY SCHOOLS
PO fi0% 47fi
VELM, MA 98597
Clerk: Gerber
Terminal: 1
Receipt: 23789
Manual Receipt:
NDGR
NDGR
DGR INC, V Kempinski
7/20/2006 9:58 AM
D~ Item ____ Price
1 CPF2900 2675.00
MITIGATION
Mountain Aire Ofi-015 Lot 3
Subtotal: 2675.00
Tax: 0.00
Total: 2675.00
Check 2fi75.00
3067
Change Due: 0.00
THANK YUU
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General/Specialty Contra[tor
A business registered as a construction contractor with L&I to perform construction work within the scope
of its specialty. A General or Specialty construction Contractor must maintain a surety bond or assignment
of account and carry general liability insurance.
License Information
License AMERIDC9516M
Licensee Name AMERICAN DREAM CONCEPTS LLC
Licensee Type CONSTRUCTION CONTRACTOR
UBI 602460080 Verifv_VJorkers.COmpP_re_mium
StaWs
Ind. Ins. Account
Id
Business Type LIMITED LIABILITY COMPANY
Address 1 390 4TH AVE SE
Address 2
City PACIFIC
County KING
State WA
' Zip 98047
Phone 2537352222
Status ACTIVE
Specialty 1 GENERAL
Specialty 2 UNUSED
Effective Date 1/14/2005
Expiration Date 1/14/2007
Suspend Date
Separation Date
Parent Company
Previous License AMERIDC0048L
Next License
Associated
License
https://fortress.wa.gov/lni/bbip/Detail.aspx?License=AMERIDC951BM 7/17/2006
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Business Owner Information
Name
Role Effective
Date Expiration
Date
BURBRIDGE,
JAMES G PARTNER/MEMBER 01/14/2005
BAKER,
MANNACE EIV PARTNER/MEMBER 01/14/2005
Bontl Information
Bond Bond
Company Account Effective Expiration Cancel Impaired Bond Received
Band Name Number Date Date Date Date Amount Date
OLD
REPUBLIC
SURETY Untif
#1 CO YLI248839 01/12/2005 Cancelled ~ $12,000.00 01/14/2005
Savings Information
' No Matching Information
Insurance Information
Insurance Company
Name
Policy Number Effective
Date Expiration
Date Cancel
Date Impaired
Date
Amount Received
Date
WESTERN
PACIFIC
MUTUAL
#2 INS CO WPGL4600022606 01/13/2005 01/13/2007 $1,000,000.00 01/03/2006
WESTERN
PACIFIC
MUTUAL
#1 _ _ INS CO WPGL4600022605 01/13/2005 01/13/2006 ® $1,000,000.00 01/14/2005
Summons /Complaints Information
No Matching Information
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1-800-547-8367 Shthgtail
a Washington State Oep[. of Lebor and Industries. Use of thiz site is subJett m the laws of the
state of Washington.
Access Agleemen[ Privacy a0d security stalemen[ Intendetl use/ee[emal con[enf policy Visit aCCP55. Wd.QOV
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General/Specialty Contractor I~
A business registered as a construction contractor with Lfll [o pertorm construction work within [he scope
'~of its specialty. A General or Specialty construction Contractor must maintain a surety bond or assignment
''. of account and carry general liability insurance.
License Information
License AMERIDM940MP
Licensee Name AMERICAN DREAM MECHANICAL LLC
Licensee Type CONSTRUCTION CONTRACTOR
UBI 602631979_Veri_fy_W ocke[s_Comp_ PremiO_m
Status
Ind. ins. Account
Id
Business Type LIMITED LIABILITY COMPANY
Address 1 390 4TH AVE SE
Address 2
City PACIFIC
County KING
State WA
Zip 98047
Phone 2532616569
Status ACTIVE
Specialty 1 PLUMBING
Specialty 2 UNUSED
Effective Date 7/77/2006
Expiration Date 7/17/2008
Suspend Dale
Separation Date
Parent Company
Previous License AMERIDC957BM
Next License
Associated
License
_ _. _. _ _httos://fortress.wa.eov/lni/bbip/Detail.aspx?License=AMERIDM940MP 7/20/2006
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i
Business Owner Information
Effective Expiration
Name Role Dale Date
BAKER,
MANNACE EIV PARTNER/MEMBER 07/17/2006
(BURBRIDGE,
JAMES G
PARTNER/MEMBER
07/17/2006 --
Bond Information
Bond Band
Company Account
( Effective Expiration Cancel Impaired Band Received
Bond Name Number Date Dale Date Date Amount Date
EMPIRE
FIRE AND
MARINE Until
#1 INS CO F8802459 07/08/2006 Cancelled $6,000.00 07/17/2006
Savings Information
No Matching Information
Information
Company Policy Effective Expiration Cancel Impaired Received
Insurance Name Number Date Date Date Dale Amount Date
FARMERS
INS
#1 EXCHANGE 035138587 07/03/2006 07/03/2007 $1,000,000.00 07/17/2006
Summons /Complaints Information
' No Matching Information
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General/Specialty Contractor
A business registered as a construction contractor with L81 to perform construction work within [he scope
of its specialty. A General or Spe[ial[y construction Contractor must maintain a surety bond or assignment
of account and carry general liability insurance.
License Information
License BESTCCH955CH
Licensee Name BEST CHOICE HEATING
Licensee Type CONSTRUCTION CONTRACTOR
UBI 602461451yerify_WOrkers_Comp.Premium
Status
Ind. Ins. Account
Id
Business Type INDIVIDUAL
Adtlress 1 12608 37TH AVE E
Address 2
City TACOMA
County PIERCE
State WA
Zip 98446
Phone 2535371329
Status ACTIVE
Specialty 1 AIR HEAT,VENTILATION,EVAPORA7
Specialty 2 SHEET METAL
Effective Date 3/15/2005
Expiration Date 3/15/2007
Suspend Date
Separation Date
Parent Company
Previous License
Next License
'. Associated
License
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Business Owner Information '~
Name Role Effective Date Expiration Dale
HURSH, RHOAN C OWNER 02/08/2005
Bond Information
Band Bond
Company Account Effective Expiration Cancel Impaired Bond Received
Bond Name Number Date Date Date Date Amount Date
Until
p1 CBIC SF9798 03/75/2005 Cancelled $6,000.00 02/15/2005
Savings Information
No Matching Information
Insurance Information
Insurance Company
Name Policy
Number Effective
Date Expiration
Date Cancel
Date Impaired
Date
Amount Received
Date
p7 CBIC C175F9798 03/15/2005 03/15/2007 _ $1,000,000.00 02/27/2006
Summons /Complaints Information
No Matching Information
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Staff only link
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CITY OF YELM INSPECTION LOG
PROJECT Lot 3 Mt. Aire 2572
PERMIT NUMBER OS-0644
ADDRESS 807 Mt. Aire Lane
SET BACKS Date:
Corrections
UNDER FLOOR^ Corrections
llRY WELL ^_ Corrections
FOOTINGREBAR_ _^Date:_
Footing ^ 12"
Wal] ^ 6"
Required vents_
Corrections
WALL REBAR ^Date:
® 16" Other_
® 8" Other_
COMBINED FRAME! EXTERIOR SHEAR WALL INSPECTION
Hold downs ^ Shear Nailing ^
Frame
^
Gas/Propane _
^
Plumbing
^
Mechanical _
^ _
Corrections:
INSULATION ^Gas ^Electric ^Other
^Foam and Seal ^Vapor barrier ^PVA
Corrections:
SHEET ROCK/SHEAR WALL NAIL
Corrections:
FINAL
^Sewer Final ^Electrical ^ Civil Final ^Landscape Final ^C of O
^Address ^ Insulation ^ Site Drainage ^ Sidewalk
Cotrrections:
CITY OF YELM -BUILDING DEPARTMENT
RESIDENTIAL CERTIFICATE OF OCCUPANCY
Building Atldress
Owner Name
Owner Address
Building Permit Number BLD-05-0644-YL Plan Number Plan
Areas
Special
Building
Date: April t6 2007
This structure is incompliance with the International Residential Code (Chapter
51-51 WAC) as adopted by the Washington State Building Code Council pursuant
to Chapters 19.27 and 70.92 RCW, effective July 1, 2004
*x******x****xx -C0IR1. JOURNAL- *zxxx xx xxx*xxxxx*xx DATE APR-16-2007 ***** TIME 02:91 **x*****
MODE = MEMORY TRANSMISSION START=APR-16 02:40 END=APR-16 02:91
FILE No.=250
STN CO[R9. KEY NAME STATION NAME/EMAIL ADDRESS/TELEPHONE N0. PAGES DURATION
No.
001 OK s 99581253 001/001 00:00:27
-Yelm CDD -
***** DP-3520 xxxxxxxxxxxxxx*x: :**xx -,yelm CDD - ***** - 360 458 3199- **x*xxxxx
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