04-102528City of Federal Way
Community Development Services
33530 1st Way S
Federal Way, WA 98003-6210
Ph: 253.661.4000 Fax: 253.661.4129
Project Name: BENSON
o
Mechanical Permit #:04 -102528 - 00 - ME
Inspection request line: 253.835.3050
Project Address: 1324 SW 353RD Sj- Parcel Number: 502860 0960
Project Description: Install new gas furnace and air-conditioning unit including minor alteration to gas piping..
Owner
Applicant
Contractor
David H Benson Sr. & Surang M Benson
DAVID BENSON
David H Benson Sr.
1324 SW 353RD ST
1324 SW 353RD ST
1324 SW 353RD ST
FEDERAL WAY WA
FEDERAL WAY WA
98023-6948
FEDERAL WAY WA 98023
Mechanical Valuation..........................................3500 Over the Counter Permit ...................................... Yes
Mechanical Fixtures
_ Description Quantity Description Quan-ti DescriptionQuantitti
Furnaces
PERMIT EXPIRES December 21, 2004.
Permit issued on June 24, 2004
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 and
the City of Federal Way.
Owner or agent: -b4"'. yi, 9 &,,_ —_ Date: y <14Ne , ?0,) </
P — 16, 0 " �Af � op
r-INALED
THIS CARD IS TO REMAIN ON-SITE
CITY OF + Community Development Inspecti®n �tecord
Federal Way IVR INSPECTION REQUEST PHONE # (253) 835-3050
PERMIT #: 04 -102528 -00 -ME
Owner: DAVID BENSON
Address: 1324 SW 353RD ST
FEDERAL WAY, WA 98023-6948
This card is part of your required inspection documents. 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.
❑
Mechanical Rough -in (4165)
❑
Gas Piping (4125)
❑
Final - Mechanical (4065)
Approved
Approved to release test
Approved
By
Date
By
Date
By
� Date l — Zp — d sr
Federal Allay PERMIT
COMMUNnY DEVELOPMENT SERVICES 1 2 2004 SF MF CO E L PL DE EN FP
33530 FIRST WAY SOUTH • PO BOX 9718 A p p L I C AT I O
FEDERAL WAY, WA 98063-9718 253-6614115• FAX 253-6614129d(uolleder&l q.mm CITY OF FEDERALf�y
BUILDING DEPT.
The following is required information - an incomplete application will not be accepted. Please print iegibiy (in ink) or type.
PROPERTY INFORMATION
SITE ADDRESS /3.2V S'. I �� r� ,S �r _ p��p'cJ l �y/` 9BLPJ SUITE/UNIT #
ASSESSOR'S TAX/PARCEL # — - LOT SIZE (sj)
LEGAL DESCRIPTION (e.g. Acme Estates, Lot 1)
(Acta h separate page for lengthy fegd d—ipti—)
TYPE OF PERMIT ❑ BUILDING ❑ PLUMBING Q�VCHANICAL
❑ DEMOLITION W'ELECTRICAL ❑ ENGINEERING ❑ FIRE PREVENTION SYSTEM
PROJECT DESCRIPTION (Provide detailed description of work included on this permit only)
7N1 r, !� 16�+ r iN N` Y�t Jit .
4,--5 y t Oise, 4-
PROJECT NAME (Name of Business or Owner Last Name) IS CNS 0 pj
PEOPLE1 • •
PROPERTY NAME
PRIMARY PHONE
OWNER 7) 1V.% t./ !i -f lie._
CONTRACTOR
APPLICANT
CONTACT
COMPANY NAME
APPLICANT NAME
OFFICE PHONE
MAILING ADDRESS
CITY, STATE, ZIP
CELLPHONE
CITY OF FEDERAL WAY BUSINESS LICENSE NUMBER EXPIRATION DATE
FAX NUMBER
/
)
— — — — --B L
E-MAILADDRESS Aiew'AIJ
CONTRACTORS REGISTRATION NUMBER (copy of card required with each application) EXPIRATION DATE
COMPANY NAME
APPLICANT NAME
Pe- rl� d IQ�AQJ41
OFFICE PHONE
W06 ) 4 rr -51 10—
MAILING ADDRESS
W, rd
CITY, STATE, ZIP
CELLPHONE
12CK- ) 2Q
RELATIONSHIPTO PROJECT
❑ Architect Crfenant ❑ Agent ❑ Other (Describe)
FAX NUMBER
{,�13 ) 0 %el' - 277z -
NAME
PRIMARY PHONE
E-MAILADDRESS Aiew'AIJ
LENDER Per RCW 19.27.095: Lender information is
required if project value exceeds $5,000
EXISTING USE PROPOSER USE Ci- Ltd /utrtf/ R.A•7
EXISTING ASSESSED/APPRAISED VALUE $ 2 /(jI C) n (I VALUE OF PROPOSED WORK $ , 5 D6
SPRINKLERED BUILDING? ❑ YES A O FIRE SUPPRESSION SYSTEM PROPOSED/ REQUIRED? ❑ YES ❑ NO
WATER SERVICE PROVIDER WtAKEHAVEN ❑ HIGHLINE ❑ TACOMA ❑ PRIVATE (WELL)
SEWER SERVICE PROVIDER p'LAKEHAVEN 11 HIGHLINE 0 PRIVATE (SEPTIC)
PROJECT FLOOR AREAS
AREA DESCRIPTION
EXISTING SQ. FT.
PROPOSED Sq. FT.
TOTAL
BASEMENT
❑ ALTERATION
❑ REPAIR ❑ TENANT IMPROVEMENT
FIRST
T
o NO
ZONING DESIGNATION
SECOND
CHANGE OF USE? o YES
❑ NO
NEW ADDRESS REQUIRED? o
THIRD
UP/SEPA/SU? a YES
o NO
PLATTED LOT? ❑ YES o NO
FOURTH
❑ NO
ADDITIONAL FLOORS (DESCRIBE)
DECK (COVERED?)
GARAGE/CARPORT
quo
HOW MANY FLOORS?
TOTAL. EXIST KG
TOTAL. PROPOSED
TOTAL EXISTING AND PROPOSED
•`NEWHOMES ONLY" NUMBER OF BEDROOMS ESTIMATED SELLING PRICE $
Indicate number of each type of fLxture to be installed or relocated as part of this project. Do not include existing fixtures to remain.
Value of Mechanical Work
IAO-*' AIR HANDLING UNITS
BBQS
BOILERS
COMPRESSORS
DUCTS
BATHTUBS for Tub/Sha«combo(
DISHWASHERS
GAS PIPE OUTLETS
WASHING MACHINES
1
EVAPORATIVE COOLERS
FANS
FIREPLACE INSERTS
FURNACES
GAS PIPE OUTLETS
SHOWERS
SINKS
SUMPS
URINALS
VACUUM BREAKERS
GAS LOGS
HOODS (commerd�l(
RANGES
GAS WATER HEATERS
WATER CLOSETS (roaeq
DRINKING FOUNTAINS
RAINWATER SYST
HOSE BIBBS
ELECTRIC WATER HEATERS
REFRIG. SYSTEMS
WOODSTOVES
MISC (Describe)
MISC (Describe)
1. certify under penalty of perjury that the information furnished by me is true and correct to the best of my knowledge, and further, that I
am authorized by the owner of the above premises to perform the work for which the permit application is made. 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 of Federal Way, 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.
NAME/TITLE 1lC/ i f � c ��y DATE / V �4i1l.Q z of ll`
(Signature( (Title)
RELATIONSHIP TO PROJECT "caner ❑ Agent ❑ Contractor ❑ Architect ❑ Other
FOR OFFICE USE ONLY
o NEW o ADDITION
❑ ALTERATION
❑ REPAIR ❑ TENANT IMPROVEMENT
BUELDING SHELL ONLY? ❑ YES o NO
BASIC PLAN? ❑ YES
o NO
ZONING DESIGNATION
CHANGE OF USE? o YES
❑ NO
NEW ADDRESS REQUIRED? o
YES o NO
UP/SEPA/SU? a YES
o NO
PLATTED LOT? ❑ YES o NO
DEMO PERMIT REQUIRED? a YES
❑ NO
Bulletin # 100 — March 30, 2004 Page 2 of 4 k\Handouts — Reviscd\Pernlit Application
ELECTRICAL PERMIT INFORMATION
RESIDENTIAL
COMMERCIAL
NEW RESIDENTIAL SERVICE
NEW COMMERCIAL/INDUSTRIAL SERVICE
❑ Single Family Square Feet
Service or Feeder Each Add'n
(First 1300 ft2- $87.00; Each add'n 500 ft2 - $28.00)
❑ 0 to 100 amp $ 94.50 $ 58.00
❑ Detached outbuilding or garage
❑ 101 - 200 amp 117.50 74.00
(Inspected with service) $ 36.50
❑ 201 - 400 amp 220.50 87.00
❑ Detached outbuilding or garage
❑ 401 - 600 amp 256.50 103.00
(Inspected separately) $ 58.00
❑ 601 - 800 amp 332.00 140.50
NEW MULTI -FAMILY (three units or more)
❑ 801 - 1000 amp 405.50 169.50
Service Feeder
❑ Over 1000 amp 442.00 236.00
❑ Up to 200 amp $ 94.50 $ 28.00
❑ 201 - 400 amp 117.50 58.00
❑ Over 600 volts surcharge $ 74.00
❑ 401 - 600 amp 161.00 80.00
Ll or meter repair $ 80.00
❑ 601 - 800 amp 206.00 110.00
ALTERED COMMERCIAL/INDUSTRIAL
❑ Over 800 amp 294.50 220.50
Service or Feeders
ALTERED SINGLE/MULTI FAMILY
❑ 0 to 200 amp $ 94.50
❑ 201 - 600 amp 220.50
Service or Feeder
Ll 601 - 1000 amp 332.00
/
6d 0 to 200 amp $ 72.50
❑ over 1000 amp 369.50
❑ 201 - 600 amp 117.50
❑ over 600 amp 177.00
❑ # of circuits to be added/ altered
(1-5 circuits - $74.00; Add'n circuits, $6.00/ea)
.a<L# of circuits to be added/ altered
(1-4 circuits -$58.00; Add'n circuits $6.00/ea)
COMMERCIAL/INDUSTRIAL PLAN REVIEW
$ 74.00 plus 35% of Permit Fee
❑ Mast or meter repair $ 43.50
❑ Service over 200 amps
❑ Medical/Educational/Institutional Facility
SINGLE/MULTI FAMILY PLAN REVIEW
❑ Service Over 400 amps
$ 74.00 plus 35% of Permit Fee
MOBILE HOMES
❑ Service or feeder only $ 58.00
TEMPORARY SERVICE
❑ Service and feeder $ 94.50
Commercial Residential
MOBILE HOME/RV PARK
❑ 0 - 100 $ 58.00 $ 51.00
❑ # of service or feeders
❑ 101 - 200 74.00 51.00
(First service/feeder-$58.00; each add'n -$37.50)
❑ 201 - 400 87.00 n/a
❑ 401 - 600 117.50 n/a
❑ over 600 127.00 n/a
MISCELLANEOUS SERVICE/ EQUIPMENT
❑ # of Thermostats
❑ # of Signs
(First -$43.50; add'n-$13.50/ea)
(First sign -$43.50; add'n sign $20.50/ea)
❑ Low Voltage
❑ Swimming pool/hot tub ................ $87.00
Square Feet to be served by system(s)
(Includes additional circuit, if required)
❑ Fire Alarm System
❑ Yard Pole meter loops ..................... $58.00
❑ Security Alarm System
❑ Additional Plan Review $87.00/hour
❑ voice Cabling
(for modified submittals)
❑ Data Cabling
11
(Per System(s) 1st 2500 ft2-$51.00;
Each add'n 2500 ft2-13.50) • Per wnc 296-46-910(5)(b)fi & 6)
Bulletin #100 -March 30, 2004 Page 3 of 4 k\I landouts - Revised\Permit Application
CITY OF 4A
Federal Wayscew
111 % 410
DEPARTMENT OF COMMUNITY DEVELOPMENT SERVICES
33530 First Way South
PO Box 9718
Federal Way WA 98063-9718
253-661-4000; Fax 253-661-4129
www.citvoffcderalway.com
ERA\_\NAY
Affidavit in LieV eneral Contractor Registration
State of Washington
County of King
I, D Gy d N. a -CMS 0A1 , state as follows:
(Print name as signed)
I have made application for a building permit from the City of Federal Way, Washington.
2. I understand that state law requires that all building construction contractors be registered with the
State of Washington. The exceptions to this requirement are stated under Section 18.27.090 of the
Revised Code of Washington (RCW), a copy of which is printed on the reverse side of this affidavit.
I understand that prior to issuance of a building permit for work that is to be done by any contractor,
the City of Federal Way must verify either that the contractor is registered by the State of
Washington, or that one of the exemptions stated under RCW 18.27.090 applies.
4. In order to provide verification to the City of Federal Way of my compliance with this requirement, I
hereby attest that after reading the exemptions from the registration requirement of RCW 18.27.090, I
consider the work authorized under this building permit to be exempt under No. ��, and will
therefore, not be performed by a registered contractor.
I understand that I may be waiving certain rights that I might otherwise have under state law in any
decision to engage an unregistered contractor to perform construction work.
APPLICANT'S SIGNATURE S10N,,
`.�� pj,� � �T �ignpyl and sworn to before me this
V Z �� ' � �`D►` ay of 20011.
JI
Of
I "I Z. 0 : -S
It ra
III�9� '����....0��7`�� d~ _ N s N (Print)0?
t `' Cp W X�� �6M1,�
Notary's Signature
NOTARY PUBLIC in and for the State of
Washington, residing at el 14 A County
My Commission expires: y
Bulletin # 116 —June 17, 2004 Page I of 2 k:\Handouts — Revised\Contractor's Affidavit
Revised Code of Washington
18.27.090 Exemptions. The registration provisions of this chapter do not apply to:
I ) An authorized representative of the United States
government, the state of Washington, or any
incorporated city, town, county, township, irrigation
district, reclamation district, or other municipal or
political corporation or subdivision of this state;
2) Officers of a court when they are acting within the scope
of their office;
3) Public utilities operating under the regulations of the
utilities and transportation commission in construction,
maintenance, or development work incidental to their
own business;
4) Any construction, repair, or operation incidental to the
discovering or producing of petroleum or gas, or the
drilling, testing, abandoning, or other operation of any
petroleum or gas well or any surface or underground
mine or mineral deposit when performed by an owner or
lessee;
5) The sale or installation of any finished products,
materials, or articles of merchandise that are not actually
fabricated into and do not become a permanent fixed
part of a structure;
6) Any construction, alteration, improvement, or repair of
personal property performed by the registered or legal
owner, or by a mobile/manufactured home retail dealer
or manufacturer licensed under chapter 46.70 RCW who
shall warranty service and repairs under chapter 46.70
RCW;
7) Any construction, alteration, improvement, or repair
carried on within the limits and boundaries of any site or
reservation under the legal jurisdiction of the federal
government;
8) Any person who only fumished materials, supplies, or
equipment without fabricating them into, or consuming
them in the performance of, the work of the contractor;
9) Any work or operation on one undertaking or project by
one or more contracts, the aggregate contract price of
which for labor and materials and all other items is less
than five hundred dollars, such work or operations being
considered as of a casual, minor, or inconsequential
nature. The exemption prescribed in this subsection does
not apply in any instance wherein the work or
construction is only a part of a larger or major operation,
whether undertaken by the same or a different
contractor, or in which a division of the operation is
made into contracts of amounts less than five hundred
dollars for the purpose of evasion of this chapter or
otherwise. The exemption prescribed in this subsection
does not apply to a person who advertises or puts out
any sign or card or other device which might indicate to
the public that he or she is a contractor, or that he or she
is qualified to engage in the business of contractor;
10) Any construction or operation incidental to the
construction and repair of irrigation and drainage ditches
of regularly constituted irrigation districts or reclamation
districts; or to farming, dairying, agriculture, viticulture,
horticulture, or stock or poultry raising; o'r to clearing or
other work upon land in rural districts for fire prevention
purposes; except when any of the above work is
performed by a registered contractor;
11) An owner who contracts for a project with a registered
contractor, except that this exemption shall not deprive
the owner of the protections of this chapter against
registered and unregistered contractors;
12) Any person working on his or her own property, whether
occupied by him or her or not, and any person working
on his or her personal residence, whether owned by him
or her or not but this exemption shall not apply to any
person otherwise covered by this chapter who constructs
an improvement on his or her own property with the
intention and for the purpose of selling the improved
property;
13) Owners of commercial properties who use their own
employees to do maintenance, repair, and alteration
work in or upon their own properties;
14) A licensed architect or civil or professional engineer
acting solely in his or her professional capacity, an
electrician licensed under the laws of the state of
Washington, or a plumber licensed under the laws of the
state of Washington or licensed by a political
subdivision of the state of Washington while operating
within the boundaries of such political subdivision. The
exemption provided in this subsection is applicable only
when the licensee is operating within the scope of his or
her license;
15) Any person who engages in the activities herein
regulated as an employee of a registered contractor with
wages as his or her sole compensation or as an employee
with wages as his or her sole compensation;
16) Contractors on highway projects who have been
prequalified as required by RCW 47.28.070, with the
- department of transportation to perform highway
construction, reconstruction, or maintenance work;
17) A mobile/manufactured home dealer or manufacturer
who subcontracts the installation, set-up, or repair work
to actively registered contractors. This exemption only
applies to the installation, set-up, or repair of the
mobile/manufactured homes that were manufactured or
sold by the mobile/manufactured home dealer or
manufacturer;
1.8) An entity who holds a valid electrical contractor's
license under chapter 19.28 RCW that employs a
certified journeyman electrician, a certified residential
specialty electrician, or an electrical trainee meeting the
requirements of chapter 19.28 RCW to perform
plumbing work that is incidentally, directly, and
immediately appropriate to the like -in-kind replacement
of a household appliance or other small household
utilization equipment that requires limited electric power
and limited waste and/or water connections. An
electrical trainee must be supervised by a certified
electrician while performing plumbing work.
Bulletin #116 — June 17, 2004 Page 2 of 2 k:\Handouts — Revised\Contractor's Affidavit