09-102670 11111 III City of Federal Way Electrical
Q
Community Development Services PF ILEermit #: 09-102670-00-EL
PO.Box 9718
Federal Way, Fax
(253 9718
835- Inspection Request Line: (253) 835-3050
Ph:(253)835-2607 Fax:(253)835-2609 p a
Project Name: VIRGINIA MASON-AMBULATORY SURGERY CENTER
Project Address: 33501 1ST WAY S Parcel Number: 926504 0010
Project Description: Addition of panels and circuit relocations for the separation of critical care and life safety
systems.
Owner Applicant Contractor
VIRGINIA MASON CLINIC H&M ELECTRIC INC H&M ELECTRIC INC
1 100 9TH AVE PO BOX 799 HMELEI*077KR(5/19/11)
SEATTLE WA 98101-2756 MARYSVILLE WA 98270 PO BOX 799
MARYSVILLE WA 98270
•
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Additionalnformation g
Is Ilse Educational or Institutionah Yes Service greater than 1000 Amps' No
f Electrical Fixtute4 f
Alt.Srvc 1 Feeder 201-600 amps(( 2 Alt. Srvc/Feeder 0 to 200 amps(C 10
PERMIT EXPIRES Thursday, September 16, 2010
Permit Issued en Wednesday, September 16, 2009
I hereby certify that the above information is correct and that the construction on the above described property end
the occupancy and the use will be in accordance with the laws, rules and regulations of the State of Washington
any,'e City of Federal Way.
_____.,
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Owner or agent: .7 !/ / Date:
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THIS CARD IS TO MAIN ON-SITE
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CITY OF
struction I ection Record
Federal Way INSPECTION REQUE TS: (253) 835-3050
PERMIT #: 09-102670-00-EL Address: 33501 1ST WAY S
Owner: VIRGINIA MASON CLINIC FEDERAL WAY, WA 98003-6208
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
possible(read left to right.top to bottom). Please schedule inspections as appropriate. Work must not be covered until it is approved. Check with your
inspector if you are unsure about any of the inspections or the inspection sequence. On-going inspections are logged on the back of this card.
0 UFER Ground (4295) CI Ditch cover(4030) 0 Slab/Concrete Floor(4255)
Approved Approved Approved to place concrete
By Date By Date By Date
0 Pool Bonding(4195) 1J Temporary Power(4275) GI Service(4235)
Approved Approved Approved
By Date By Date By Date
El Feeders/Sub-panels(4045) 0 Rough Electrical(4225) 0 Ceiling Cover(4020)
Approved Approved Approved
By Date By Date By Date
0 Final-Electrical(4055)
Approved
Bat Date (?- 9.--�f—'
0 Rough Electrical Final Electrical Right of Way
Approved Approved Approved
By Date By Date By Date
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Federal way PERMIT
COMMUNITYDEVELOPMHENTNOSERV 1 4 2009 SF MF CO M EL PL DE EN FP
3332FEDERAL WAY, A 98063 BO LIC ATI O N _
FEDERAL WAY,WA 98063-9718 7D . _ O / , ,�
253 835 2607�•FAX - 35- .Q2
anuu.nttle r i 1. IF4++ ���l�I�/'1 , ,
The following is requirteoration-an incomplete application will not be accepted. Please print legibly(in ink)or type.
• PROPERTY INFORMATION
SITE ADDRESS 33501 1St Way S Ou t h SUITE/UNIT#
ASSESSOR'S TAX/PARCEL# - LOT SIZE(si
LEGAL DESCRIPTION(e.g.Acme Estates,Lot 1)
(Attach separate page for lengthy legal deserlptioN
• PROJECT INFORMATION
TYPE OF PERMIT ❑ BUILDING ❑ PLUMBING ❑ MECHANICAL
❑ DEMOLITION Ili ELECTRICAL ❑ ENGINEERING ❑ FIRE PREVENTION SYSTEM
PROJECT DESCRIPTION(Provide detailed description of work included on this permit only)
Add panels and misc. circuit relocations to separate life safety and critical
care circuits that support the existing ambulatory surgical center.
PROJECT NAME(Name of Business or Owner Last Name) Virginia Mason DOH upgrades
• PEOPLE INFORMATION
PROPERTY NAME PRIMARY PHONE
OWNER Virginia Mason _ ( 206) 341 - 0435
MAILING ADDRESS CITY,STATE,ZIP E-MAIL ADDRESS
1100Ninth Avenue Seattle, WA 98101
CONTRACTOR COMPANY NAME APPLICANT NAME OFFICE PHONE
HEN Electric Tnc Wayne RrPwstPr ( 360) 658 0501
MAILING ADDRESS CITY,STATE, IP CELL PHONE
PO Rox 799 MarySvi11P WA 96270 (260 )779 - 2"100
,. CITY OF FEDERAL WAY BUSINESS LICENSE NUMBER EXPIRATION DATE FAX NUMBER
�f! 19-93-103797-00-BL 12-31-2008 ( 36d 658-0502
CONTRACTOR'S REGISTRATION NUMBER EXPIRATION DATE E-MAIL ADDRESS
HMELEI*077KR 5 . 19 . 11. wayneb@hmelec .com
APPLICANT COMPANY NAME APPLICANT NAME OFFICE PHONE
Same AS Contractor ( ) —
MAILING ADDRESS CITY,STATE,ZIP CELL PHONE
( ) —
RELATIONSHIP TO PROJECT FAX NUMBER
0 Architect 0 Tenant o Agent 0 Other ( ) -
PROJECT NAME PRIMARY PHONE E-MAIL ADDRESS
CONTACT Wayne Brewster (3601658-0-501 wayneb@hmelec .com
LENDER NAME Per RCW 19.27.095:
Lender information is required if project value exceeds$5,000
MAILING ADDRESS CITY,STATE,ZIP PHONE
( ) —
• DETAILED BUILDING INFORMATION
EXISTING USE PROPOSED USE
EXISTING ASSESSED/APPRAISED VALUE$ VALUE OF PROPOSED WORK $
SPRINKLERED BUILDING? ❑ YES ❑ NO FIRE SUPPRESSION SYSTEM PROPOSED/REQUIRED? 0 YES 0 NO
WATER SERVICE PROVIDER ❑ LAKEHAVEN ❑ HIGHLINE 0 TACOMA ❑ PRIVATE(WELL)
SEWER SERVICE PROVIDER ❑ LAKEHAVEN ❑ HIGHLINE o PRIVATE(SEPTIC)
II
1
1
a III IP .
• PROJECT FLOOR AREAS
AREA DESCRIPTION EXISTING PROPOSED TOTAL
SQ.FT. SQ.FT. SQ.FT.
BASEMENT
FIRST
SECOND
THIRD
ADDITIONAL FLOORS(DESCRIBE)
DECK(❑COVERED OR ❑UNCOVERED?)
GARAGE ❑ CARPORT C
EXISTING PROPOSED TOTAL TOTAL EXISTING SF TOTAL PROPOSED SF TOTAL SF
NUMBER OF FLOORS
**NEW HOMES ONLY** NUMBER OF BEDROOMS ESTIMATED SELLING PRICE $
• FIXTURES
Indicate number of each type of fixture to be installed or relocated as part of this project. Do not include existing fixtures to remain.
MECHANICAL
Value of Mechanical Work$ (A COPY OF BID OR ESTIMATE MUST BE INCLUDED WITH APPLICATION)
AIR HANDLING UNITS EVAPORATIVE COOLERS GAS PIPE OUTLETS WOODSTOVES
BBQS FANS GAS WATER HEATERS MISC(Describe)
BOILERS FIREPLACE INSERTS HOODS(Commercial)
COMPRESSORS FURNACES RANGES
DUCTS GAS LOG SETS REFRIG.SYSTEMS
PLUMBING
BATHTUBS(or Tub/Shower Combo) LAVS(Bathroom Sinks) URINALS MISC(Describe)
DISHWASHERS RAINWATER SYST VACUUM BREAKERS
DRINKING FOUNTAINS SHOWERS WATER CLOSETS(Toilet)
ELECTRIC WATER HEATERS SINKS WASHING MACHINES
HOSE BIBBS SUMPS
SIGNATURE
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 supplied to
the city as a part offpthis application. 1 G�
SIGNATURE: l ib,,/�D DATE 7 . ' -1 ' 1
Property 6�, er and/or Authorized Age
FOR OFFICE USE ONLY
n NEW n ADDITION n ALTERATION C REPAIR n TENANT IMPROVEMENT
BUILDING SHELL ONLY? n YES n NO BASIC PLAN? n YES o NO
ZONING DESIGNATION CHANGE OF USE? n YES n NO
NEW ADDRESS REQUIRED? o YES C NO UP/SEPA/SU? C YES n NO
PLATTED LOT? n YES n NO DEMO PERMIT REQUIRED? n YES C NO
Bulletin#100—January 1,2009 Page 2 of 4 k\Handouts\Permit Application
III II
•
ELECTRICAL PERMIT INFORMATION
*NOTE: an automation fee of$6.00 will be charged for all permits.
RESIDENTIAL COMMERCIAL
NEW RESIDENTIAL SERVICE NEW COMMERCIAL/INDUSTRIAL SERVICE
Service or Feeder Each Add'n
❑ Single Family Square Feet
(First 1300 ftz-$121.00;Each add'n 500 ftz-$39.00) 121 0 to 100 amp $131.50 $80.00
O 101-200 amp 163.00 103.00
❑ Detached outbuilding or garage(w/service) $51.00 Ili 201-400 amp 305.50 120.50
❑ Detached outbuilding or garage(inspected separately) $80.00
U 401-600 amp 356.00 142.50
❑ Swimming pool(w/service) $80.00 ❑ 601 800 amp 460.50 195.00
❑ Swimming pool(inspected separately) $120.50
0 801 - 1000 amp 562.50 235.50
❑ Hot tub/spa/sauna(w/service) $51.00
❑ Over 1000 amp 613.00 327.00
❑ Hot tub/spa/sauna(inspected separately) $80.00
❑ Septic pumping system(w/service) $51.00 ❑ Over 600 volts surcharge $103.00
❑ Septic pumping system(inspected separately) $80.00 U Mast or meter repair $111.00
NEW MULTI-FAMILY(three units or more) ALTERED COMMERCIAL/INDUSTRIAL
es
Service Feeder `t) Service or Feeders
(Dot include circuits.)
❑ Up to 200 amp $131.50 $39.00 1% 1 to 200 amp $131.50
O 201 -400 amp 163.00 80.00 :7 201 600 amp 305.50
O 401 -600 amp 223.00 111.00 ■ 601 - 1000 amp 460.50
❑ 601 -800 amp 285.50 152.50 ❑ over 1000 amp 513.00
❑ Over 800 amp 408.50 305.50
U #of circuits to be added/altered
ALTERED SINGLE/MULTI FAMILY (1-5 circuits-$103.00;Add'n circuits,$8.00/ea)
Service or Feeder COMMERCIAL/INDUSTRIAL PLAN REVIEW
❑ 0 to 200 amp $100.50 $103.00 plus 35%of Permit Fee (0 3 211.1(
❑ 201 -600 amp 163.00 ❑ Service- 1,000 amps or greater
❑ over 600 amp 245.50 la Medical/Educational/Institutional Facility
❑ Additional plan review for
❑ #of circuits to be added/altered modified submittals $115.00/per hour
(1-4 circuits-$80.00;Add'n circuits$8.00/ea)
❑ Mast or meter repair $60.50 TEMPORARY SERVICE
Service or Feeder Each Add'n
MANUFACTURED HOMES U 0 to 60 amp $ 71.00 $32.00
❑ Service or feeder only $80.00 ❑ 61- 100 amp 80.00 39.00
❑ Service and feeder $131.50 ❑ 101-200 amp 103.50 51.00
O 201-400 amp 120.00 60.50
MOBILE HOME/RV PARK U 401-600 amp 163.50 80.00
❑ #of service or feeders ❑ Over 600 amp 183.00 92.00
(First service/feeder-$80.00;each add'n-$52.50)
MISCELLANEOUS SERVICE/EQUIPMENT
❑ #of Thermostats
(First-$60.50;add'n-$18.50/ea) ❑ #of Signs
U Low Voltage (First sign-$60.50;add'n sign$28.50/ea)
Square Feet to be served by system(s) U Yard Pole/meter loops/pedestal $80.00
❑ Fire Alarm System U Portable Generator(transfer equipment) $100.50
❑ Security Alarm System U Ditch cover/inspection only $120.50
❑ Voice Cabling
❑ Data Cabling
0 1s1 2500 ft2-$71.00; For fees not listed,contact the Permit Center at
Each add'n 2500 ft2-$18.50) 253-835-2607
Bulletin#100-January 1,2009 Page 3 of 4 k\Handouts\Permit Application