10-101293 Electrical
City of Federal Way
Community Development Services Permit #: 1 0-101293-00—EL
P.O.Box 9718
Federal Way,WA 98063-9718 Inspection Request Line: (253)835-3050
Ph:(253)835-2607 Fax:(253)835-2609 44ar
Project Name: VIRGINIA MA N-Ctrs"' THERAPY
Project Address: 33501 1ST WAY S Parcel Number: 926504 0010
Project Description: Add/alter(2)circuits for additional receptacles in Physical Therapy office.
Owner Applicant Contractor
VIRGINIA MASON CLINIC H&M ELECTRIC INC H&M ELECTRIC INC
1100 9TH AVE PO BOX 799 HMELEI*077KR(5/19/11)
SEATTLE,WA 98101-2756 MARYSVILLE WA 98270 PO BOX 799
MARYSVILLE WA 98270
Is Use Educational or Institutional? No Service greater than 1000 Amps? No
1$1444•• .. . . mm\ .4 i.3 Lfi .; 4C,a -.. sa iii�4,i.',£v',#w,.o „y,,:, ,.•\'��5,r„ / ..?�.d':. K 9rs.S.w"A� ..
Circuits Commercial 2
PERMIT EXPIRES Wednesday, March 30, 2011
Permit Issued on Tuesday, March 30, 2010
I hereby certify that the above information is correct and that the construction on the above described property and
the occupancy and the use will be in accordance with the laws, rules and regulations of the State of Washington
nd the City of Federal Way.
Owner or agent: Z(} Date: 3 . 30. /67
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'' • THIS CARD IS T MAIN ON-SITE -
CITY OF ,: Construction Inspection Record
Federal Way INSPECTION REQUESTS: (253) 835-3050
PERMIT#: 10-101293-00-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.
O UFER Ground (4295) ❑ Ditch cover(4030) 0 Slab/Concrete Floor(4255)
Approved Approved Approved to place concrete
By Date By Date By Date
o Pool Bonding(4195) ❑ Temporary Power(4275) 0 Service(4235)
Approved Approved Approved
By Date By Date By Date
O Feeders/Sub-panels(4045) ❑ Rough Electrical(4225) 0 Ceiling Cover(4020)
Approved Approved Approved
By Date By Date By 0 �� Date q
O Final-Electrical(4055)
Approved
By
PJ01-<...).-) Date _a—k`D
Lj Rough ElectricalEl Final Electrical El Right of Way
Approved Approved Approved
By Date By Date By Date
r A - 1a _L _, _ 3_
2
' are� ERM IT SF MF CO ME( EL PL D EN .aFP
Federal
COMMUMIYDEVELOPMENT
CEI'
253-835-2607.PAX 253435-2609 1 LI PATI O N
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SUITE/UNIT I •NINO ASSESSOR'S TAX/PARCEL tf
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NAME OF PROJECT ' , 1
(Tenant or Homeowner Name) ✓:V' t w A i a L&kO
0 BUILDIAG 0 PLUMBING 0 MECHANICAL
TYPE OF PERMIT
0 DEMOLITION XELECTRICAL 0 ENGINEERING 0 FIRE PREVENTION
.biz ? mak-- -C-.e ' GS n e x 1 5-t , •l e.'
PROJECT DESCRIPTION - 1 U r e L C--e '
Detailed description of work to
be included on this permit only
d
NAME PRIMARY PHONE
PROPERTY OWNER `/i p, , rsq ek ' ( ) -
MAILING AD�,CITY,STATE,ZIP E-MAIL
OWNER IS ALSO: p CONTRACTOR 0 APPLICANT 0 PROJECT CONTACT
NAME PRIMARY PHONE
H c M l e e--tr� c J:.1-c:. ( ta)6s 8- v5 0
CONTRALTO MAD.IIfa ADDRESS,CITY.STATE.ZIP /r Ree�,/`e 2 FAX_
toil (
WA STATE CONTRACTOR'S LICENSE I EXPIRATION DATE FEDERAL WAY BUSINESS LICENSE tl
1—I PSI c 1,6It(n 71 I�Z. / l /�l`�3 /t>3/97 -,� .
NAME u �t PRIMARY PHONE
APPLICANT ` ` t I ` 6(.ethr; L .y's� (36D )i.5 2- b b t
MAILING ADDRESS,CITY,STATE,ZIP FAX
fib. D 7' '3fr14 /%sv;/ie.,,&4 g 74) (34o)L5-8-g's---o-2,
PROJECT CONTACT NAME PRIMARY PHONE
(The individual to receive and AYf1 F:• rev ' (36o )i.5-.S.- 05-0 I
respond to all correspondence MAILING DREss,CITY,STATE,ZIP 'ra FAX
concerning this application) ,0. B e)14 �' i - 11 14),Q 7O (3t ) 6 �7' -a.sv
ALTERNATE CONTACT NAME: PRIMARY PHONE E-MAIL
( ) - Lt>ev rebe)h n?ele4 COM
PROJECT FINANCING NAME
OWNER-FINANCED
Required for projects with
value of$5,000 or more MAILING ADDRESS,CITY,STATE,ZIP PRIMARY PHONE
(RCW 19.27.095)
( ) -
I certify under penalty of perjury that I am the property owner or authorised agent of the property owner.I certify that to the
best of my knowledge,the information submitted in support of this permit application is true and correct.I certify that I will comply
with all applicable City of Federal Way regulations pertaining to the work authorised by the issuance of a permit.I understand that
the issuance of this permit does not remove the owner's responsibility for compliance with local, state, or federal laws regulating
construction or environmental laws.
I further agree to hold harmless the City of Federal Way as to any claim(including costs,expenses,and attorneys'fees incurred
in the investigation and defense of such claim), which may be made by any person,including the undersigned, and filed against the
city,but only where such claim arises out of the reliance of the city, including its officers and employees,upon the accuracy of the
information supplied to the city as a part of this application. zz /�
SIGNATURE: t t B-e.— DATE �y ✓o, l(,/
PRINT NAME: \.,,/,a),/n e_ -8 re.w� e,....,"1`
Bulletin#100—4/17/2009 / Page 1 of 4 k:\Handouts\Pernrit Application
1,44,
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Value of Mechanical Work$ (A COPY OF BID OR ESTIMATE MUST BE PROVIDED)
Indicate number of each type of f xture 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 CONDITIONER FIREPLACE INSERTS HOODS(commercial)
BOILERS FURNACES HOT WATER TANKS(cas)
COMPRESSORS GAS LOG SETS REFRIGERATION SYST
DUCTING GAS PIPING WOODSTOVES
Indicate number o -ach type of fixture to be installed or relocated as part of this project Do not include existing fixtures to remain.
BATHTUBS)or Tub/-•...Combo) LAVS(Hand Sinks) TOILETS " WATER PIPING
DISHWASHERS RAINWATER SYSTEMS URIN' OTHER(Describe)
DRAINS SHOWERS VAC M BREAKERS
DRINKING FOUNTAINS SINKS(ititchen/utrlity) W' 'ER HEATERS(Electric)
HOSE BIBBS •
[S�UMM{ T T j[SUMPS W WING MACHINES TOTAL •RE
PROJECT VALUATION WA ,,- PURVEYOR SEWER PUR --''OR VALUE OF EXISTING IMPROVEMENTS
$ $
EXISTING/PREVIOUS USE LOT SIZE . Square Feet) ERIE a FIRE SPRINKLER SYSTEM? PROPOSED FIRE SUPPRESSION SYSTEM?
❑Yes❑ No ❑Yes ❑ No
OtlieiiiiiiiikallinVA?NiAakin**MPOOMAIIIIIANUANE:L -:4,aZA-AZZANTakA,1491WIT :ledatigt1M.:::12PAIWOODA::erliga*WW:,: f•iGiliblit MAW
AREA DESCRIPTION(in square feet) : I STING - ••POSED TOTAL
FOR OFFICE USE
54'iVAB 100 r Y 3
3 7 Y
73 " ..,f .a� .. f ��'' 3
3
FIRST FLOOR(or Mobile Home)
ggh.3llt.., _ .r ,x _, N. r,i .. .,,, .,. •,>.: SJ..14 ,ws, £- , kR.r.e. L
COVERED ENTRY
- 1 'g I "5
GARAGE 0 CARPORT 0
( s )p 3 "R 3
Area Totals STING
ESTIMATED SELLING PRICE$ i I #OF BEDROOM
TA : s iF pt , t o a
� s s, O
AREA DESCRIPTION Are Occupancy Group(s) onstruction #of Additional Information
in Sq a FeetType Stories
I3c �,'�,��M3, 13 3 d nIf eiiiiiiiiggilel gRtirggilittalifillirjr1"701
ADDITION
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AREA DESCRIPTION Area Construct •n #of
_.. �... ..... .,,Additional�Infor
mationOccupancy Group(s)in Square Feet Type Stories 3 9 ..,,
� y C Si z 13 'I3lO3 a f I
itill
, (n. � :�3 ` I 11pf ' lIWt € I x9Il � 3
TENANT AREA ONLY
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Bulletin#100—4/17/2009 Page 2 of 4 k:\I-Iandouts\Permit Application
I.
• ELECTRICAL •
RESIDENTIAL COMMERCIAL
NEW SINGLE FAMILY RESIDENCE NEW COMMERCIAL
Total Square Feet 1st Service/Feeder Additional Feeders
(including attached garage): 0 100 amp: x'$1$1 50 ,,,-_;-x 80.00
FEES: First 1300 ft2-$121.00; 101- 200 amp, x$163,00! x$103.00
Each additional 500 ft2-$39.00
201- 400 amp x.$30550 x$120.50
NEW MULTIFAMILY (3 units or more) 4401- 600 amp x$356.00 _x$142.50
1st Service/Feeder Additional Feeders 601 800 amp; x$460.50 x$19.5.00
0- 200-'asnp x $1 15': .• ", x $ 39.00 801-1000 amp x$562.50 x$235.50
201 -400 amp x $163.00 x $ 80.00 Oyer 1000 amp x 13:00 x$327.00
401 -600 amp x X3'00 x $111.00
601 -800 amp x $285,50 x $152.50 Over 600 volts,surcharge x$103.00
Over 800 amp x;;$40840. .,, x $305.50
ALTERED SINGLE or MULTI FAMILY ALTERED COMMERCIAL
1stService/Feeder Additional Feeders 1st Service/Feeder Additional Feeders
0-� 200 amp $100:50 q x $ 39.00
0 20E1:amp" x$131 50' x$103.00
201 -600 amp x $163.00 x $ 80.00 201- 600 amp x$305.50 x$142.50
Over 600 ampu _ "x $245.50 -x $111.00 601=1000 amp x,$4611.50'; x$235.50
Over 1000 amp x$513.00 x$327.00
Added or Altered Circuits
1-4 circuits$80.00;each additional$8.00 Added or Altered Circuits
1-5 circuits$103.00;each additional$8.00
Mast or meter repair $60.50
Mast or meter repair $111.00
MANUFACTURED HOMES PLAN REVIEW FEES
Service or feeder only x $ 80.00 0
$103.00 plus 35%of Permit Fee;Plan Review required for:
Service and feeder." x "$131.50
❑ New,or alteration to,service of 1,000 amps or greater
❑ Medical/Educational/Institutional Facility
Plan review for modified submittals $120.50/hour
MISCELLANEOUS SERVICE/EQUIPMENT
LOW VOLTAGE TEMPORARY SERVICE
❑ Fire Alarm System 1st Service/Feeder Additional Feeders
❑ Security Alarm System
❑ Voice/Data Cabling 0 00 m'" ;:. x $ 71.00 _„„ x $ 32.00
❑ Other 61-100 amp x $ 80 00 u $ 39.00
Area to be served by system:
I.,2,500 ft2-$71.00;each additional 2,500 ft2-$18.50 101 200 •amp' " x $1 50 x $=51.00
201-400 amp x $120.00 __ x $ 60.50
#of Thermostats 4411-600 amp s x $163.50 " " x.$ 80.00
First$60.50;each additional$18.50
Over 600 amp ' x $183.00 _X $ 92.00
#of Signs **NOTE: an automation fee of$6.00 will be charged
First$60.50;each additional$28.50 on all permits**
Yard Pole/meter loops/pedestal x$ 80.00
Portable Generator(transfer equipment)_x$100.50 For fixtures or fees not listed contact the Permit Center at
Ditch cover/inspection only x$120.50 253-835-2607
Bulletin#100-4/21/2009 Page 3 of 4 k:\Handouts\Pennit Application