20050696 Permit Pkg 090106City of Yelm
Community Development Department
Building Division
Phone: (360) 458-8407
Fax: (360) 458-3144
Name: Cameron, Doug
Address: P.O. Box 698
Property Information:
Site Address: 107 Nisqually Plaza
Assessor Parcel No. 22730110202
Contractor Information:
Name: The Roof Doctor
Address: P.O. Box 2257
Contractor License No: ROOFDI.168N8
Project Information:
Project: Mr. Dougs
Description of Work: Re-Roof of flat roof
City: Yelm
Subdivision:
Contact:
City: Olympia
Expires: 05/30108151
Permit No: BLD-05-0696-YL
Issue Date: 09/01/2006
(Work must be started within 180 days)
Receipt No: 43607
Phone: 458-3535
State: WA Zip 98597
Lot:
Phone: 352-1294
State: WA Zip: 98507
Business License:
Sq. Ft. per floor: (1st) 0 (2nd) 0 (3rd) 0 Garage 0 Basement 0
Heat Type (Electric, Gas, Other):
Fees:
Item Item Fee Base Amt Unit Fee Unit Rate No. Units Unit Desc
Building Permit -Other 271.48 0.00 0.00 0.0000 0.0000 $1,000
TOTAL FEES: E271.48
Applicant's Affadavit:
I certify that I have read and examined the information contained within the application and know the same
to be true and correct. I also certify that the proposed structure is in conformity with all applicable City of
Yelm regulations including those governing zoning and land subdivision, and in addition, all covenants,
easements and restrictions of record. If applying as a contractor, I futher certify that I am currently
registered in the State of Washington. ,y~
Signatur { Date q / ~ ~`~~
Firm 1 {'~ ~L ~T ~IJC~fv~ 1 n~ _
# Sets of Prints:
Final Inspection:
Date:
ey:
~pF THpp`'~ City of Yelm
a ~ Community Development Department PA~~
4 M
Building Dlvlsion ;EP ,~ 1 7(l~F~
Phone: (380)458-8407
L Fax: (360) 458-3144 C1-r( QF YELM
Applicant:
Name: Cameron, Doug
Address: P.O. Box 698 City: Yelm
Project Information:
Project: Mr. Dougs
Description of Work: Re-Roof of flat roof
Site Address: 107 Nisqually Plaza
Fees:
Item Acct Code
Buikling Permit -Other 032 001-322-10-00
TOTAL FEES:
CITY OF
YELM
P.O. Box 479
Yelm, WA 98597
360-458-8403
RECEIVED
RECEIPT No. 4 3 6 0 7
****TWO HUNDRED SEVENTY ONE DOLLARS & 48 CENTS
RECEIVED FROM DATE REC. NO. AMOUNT REF. NO.
ROOF DOCTOR 09/01/06 43607 271.48 CHECK 61354
P.O. BO% 2257
OLYMPIA. FiA 98507 BUDGETARY
360-352-1294
Permit Fees Schedule
Permit No: BLD-05-0696-YL
Phone: 458-3535
State: WA Zip 98597
Assessor Parcel No. 22730110202
Item Fee Base Amt Unit Fee Unit Rate No. Units Unit Desc
271.48 0.00 0.00 0.0000 0.0000 51,000
5271.48
BUILDING PERMIT SITE RE ROOF 107 NISQUALLY PLAZA
08/3+/?O~i6 10:00 FAX
1Q 001/002
AUO-29-2006 21:01 Ye lm CDD 360 46A 3164 P,03
CITY OF YELM
COMMERCIAL BUILDING P612MR APPLICATION FORM
Project Address.l0`1 N ~~QuGI ~ 1 i ~ Q7 G Parcel #:,,,,~, ~7 ~ 1 1 i~ r~7 _ ~;, ~~
.t/
c ~' L
Zoning; C.~- Current Use:~~n ~.~ -'Z-,1~1 _ Proposed Use: ~
U New Conawctlon ~ Ra-Model 1 R~Roo~f /Tenant Improvement
U Plumbing U Mechanical U Fire Prevent/Supprsss/Alorrn U Other
Project DsscrlplloNscope cf Work:~r:A~ Q~r_ ~ ~i=~-(~ L~rc~Y~~~~~t ~~ c~ `"~'>~C~~ d~GW~'~
Building Area (sq. R) Perklnp Garoga 1 a Floor u~ ~~2n0 Floor 3'd Floor
Building Height
Are there any envlronmentslly sensitive areas Itxsted on the parcel'! n__ D_~, It yes, a
completed environmental ohedcllat must accompany permit application.
Cepr.f Ciar Mtetgstlon doeumsntatloe (T't'C-.
1 herebl- certly that the slew In/eratstta~f N evr*tot and t!~ tFw eoestruceee sn, end ilia occupanc~r and tM use er tl~s
above dcsuttied propergr will (r• In accordance whh tM taws, n11ea and reouLatJons otthe 6tsts e1 WNltlnotat std the
City of Ysim.
t ~G
Appitcan s Signature Data
Owner / ontractor /Owner's Agent / Confnctors Ayen! / TensM (Please circle one.)
Ail permits an non-transfQrable and will explro tf work authorized sy such permit Is not begun
wKhtn 180 daps of issuance, or M work i~ euspanded or abandonod (or a pwrlod of 18o days
.?/2006 10:00 FRX
IQ.J 002/002
~~ I~ "We. make house calls"
~~ THE ROOF DOCTOR, IIVC
Fax Transmittal Form
To: ~~~ ~Gt Frorn; ~C~Y
Comp~my: ' ~ ~ 0~' YYl Date: ~ 3c ~(~
Fax # ~5~ -- 31 ~- RE: ~ ~r~:
Number of pages including fax cover page
.~
(If you do not receive all pe9ee, pbese all number below)
~l~lJl- -1 i Ll_ -
1 ~ I
~- ~ ~ ~
C " vl
~.
'J.J'J
COY,
8120 Old Highway 99
Olympia, WA 98501
(360) 352-1294 -Fax (360) 352-9164
Look Up a Contractor, Electrician or Plumber License Detail Page I of 3
,~~ r' ;: Topic Index ~ Contact Info
"` ` 'r ' ~ i~ Search
Home Safety r Claims & Insurance ~ Workplace Rights Trades $ Licensing
Find a Law or Rule Get a Form or Publication
Look Up a Contractor, Electrician or Plumber
Printer Friendly Version
General/Specialty Contractor
A business registered as a construction contractor with L81 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 ROOFDI'168N8
Licensee Name ROOF DOCTOR INC, THE
Licensee Type CONSTRUCTION CONTRACTOR
UBI 600215549 Verify Workers Comp Premium
Status
Ind. Ins. Accou d 25210900
Business Type CORPORATION
Address 1 PO BOX 2257
Address 2
City OLYMPIA
County THURSTON
State WA
Zip 98507
Phone 3603521294
Status ACTIVE
Specialty 1 GENERAL
Specialty 2 UNUSED
Effective Date 8/28/1984
Expiration Date 5/1/2008
Suspend Date
Separation Date
Parent Company
Previous License KENSLRI194RS
Next License LACEYRC14006
Associated
License
https://fortress.wa.gov/Ini/bbip/Detail.aspx?License=ROOFDI* 168N8 8/30/2006
Look Up a Contractor, Electrician or Plumber License Detail Page 2 of 3
Business Owner Information
Effective Expiration
Name Role Date Date
SLATER, KENNETH
W PRESIDENT 01/01/1980
SLATER, KENNETH VICE
M JR PRESIDENT 01/01/1980
HONC, KEVIN N SECRETARY 08/01 /2001 04/24/2002
BALZER, THOMAS A
" SECRETARY 01/01/1980 08/01/2000
Bond Information
Bond Bond
Company Account Effective Expiration Cancel Impaired Bond Received
Bond Name Number Date Date Date Date Amount Date
Until
#3 CBIC 615006 05/01/2002 Cancelled $12,000.00 04/30/2002
#2 CBIC 615006 01/11/1984 05/01/2002 $6,000.00
OREGON
AUTOMOBILE
#1 INS CO 720310 11/06/1981 11/06/1983 10/08/1983 $4,000.00
Information
No Matching Information
Insurance Information
Insurance Company
Name
Policy Number Effective
Date Expiration
Date Cancel
Date Impaired
Date
Amount Rece
Da
#17 LEXINGTON
INS CO
LX009443261
05/01/2006
05/01/2007
$1,000,000.00
04/27
#16 BURLINGTON
INS CO
HGL0006120
05/01/2005
05/01/2006
$1,000,000.00
04/28
#15 BURLINGTON
INS CO
HGL0006845
05/01/2004
05/01/2005
$1,000,000.00
04/29
#14 CLARENDON
AMERICAN INS
CO
CNT006929
05/01/2003
05/01/2004
$1,000,000.00
04/30
#13 RED SHIELD
INS CO
CNT006929
05/01/2002
05/01/2003
$1,000,000.00
04/30
#12 RED SHIELD
INS CO
TBD
05/01/2001
05/01/2002
04/27
#11 VALLEY INS CO 4103CP00228001 05/01/1999 05/01/2001
#10 VALLEY INS CO 41030000228002 05/01/1997 05/01/1999
#9 VALLEY INS CO 4103CP00228001 05/01/1996 05/01/1997
#8 CNA A129645333 09/01/1994 05/01/1996
#7 CNA TBD 09/01/1994 09/01/1995
#6 CIG NA D20038986 09/01/1991 09/01/1994
https://fortress.wa.gov/lni/bbip/Detail.aspx?License=ROOFDI* 168N8 8/30/2006
Look Up a Contractor, Electrician or Plumber License Detail Page 3 of 3
BANKERS
STANDARD INS
#5 CO D20038986 09/01/1988 09/01/1991
Until
#4 CIGNA D1326059A 09/01/1986 Cancelled
Until
#3 SAFECO INS CO CP 2059788 08/27/1984 Cancelled
TRANSAMERICA Until
#2 INS CO 18481959 10/04/1983 Cancelled 08/27/1984
NORTH Until
#1 PACIFIC INS CO CP 24862 11/06/1981 Cancelled
Summons /Complaints Information
Tax
Summons / Cause Warrant Complaint Complaint Judgement Judgement Payr
Complaint Number Id Plaintiff County Date Amount Date Amount D~
NATIONWIDE
MUTUAL FIRE
#5 042005105 INS CO THURSTON 03/29/2004 $2,375.34 $0.00
#4 MARY MANN KITSAP 09/16/1988 $0.00 $0.00
FARRELL
#3 ARNOLD THURSTON 08/17/1988 $6,000.00 $0.00
NW ROOFERS
li EMPLOYERS
#2 TRUST KING 01/22/1985 $6,000.00 $0.00
BERKHDIMER'S
#1 INC THURSTON 07/25/1983 $22,481.16 $0.00
Start a New Search Printer Friendly Version
'~ About L&I ~ Find a job at LZ*I ~ Information en espanol ~ Site Feedback ~
1-800-547-8367 -r~
1 ~ ~- Washington State Deft. of Labor and Industnes. l};e of tMs site is sub~ec.t to the law, of the ~ "~SMngton
state of Washington.
Access Agreement ~ Privacy and security statement ~ Intended use/external ronterrt policy ~ Visi; ar,cess.wa.gov
Staff only link
https://fortress.wa.gov/lni/bbip/Detail.aspx'?License=ROOFDI* 168N8 8/30/2006