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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