05-102313 City of ity Development
Federal Way Electrical Permit #: 05 - 102313 - 00 - EL
Community DServices
P.O.Box 9718
Federal Way,WA 98063-9718
Ph.(253)835-7000 Fax:(253)835-2609 Inspection request line: (253) 835-305C
Project Name: ST FRANCIS HOSPITAL
Project Address: 34509 9THt Pot S Parcel Number: 750451 0010
Project Description: Install low-voltage access control to lab
Owner Applicant Contractor
FRANCISCAN HEALTH SYSTEM- RFI ELECTRONICS-OREGON RFI ELECTRONICS-OREGON
1717 S J ST 636 INDUSTRY DR 636 INDUSTRY DR
TACOMA WA TUKWILA WA 98188 - TUKWILA WA 98188
98405-4933 (206)575-2020
Electrical Fixtures
Description - Quantity -Description 1Quantity Description Quantity
Low Voltage-Other Commercial 2500
CONDITIONS:
This parcel is located within a Wellhead Protection Area(Capture Zone 1)and must comply with FWCC,Chapter 22,
Article XIV"Critical Areas" and fill out a Hazardous Materials Inventory Statement,if applicable.
PERMIT EXPIRES November 13,2005.
Permit issued on May 17,2005
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: t/VI Date: 51> 7/ d
THIS CARD IS TO REMAIN ON-SITE
CITY OF ' Community Development Inspection Record
Federal Way IVR INSPECTION REQUEST PHONE # (253) 835-3050
PERMIT #: 05-102313-00-EL
Owner:
Address: 34509 9TH AVE S
FEDERAL WAY, WA 98003-6700
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.
❑ Slab/Concrete Floor(4255) 0 Ditch cover(4030) 0 Pool Bonding(4195)
Approved to place concrete Approved Approved
By - - - - -Date- - - - - - - - - By- - - - - - - mate - - - - - By Date
❑ Temporary Power(4275) 0 Service(4235) 0 Feeders/Sub-panels(4045)
Approved Approved Approved
By Date By Date By Date
O Rough Electrical(4225) ❑ Ceiling Cover(4020) Final-Electrical(4055)
Approved Approved Approved
By Date By Date By 'l`` Date
)\
❑ Under-slab groundwork(4295)
Approved
By Date
'� RECEIVED
4 art O.,'r
_ Federal Way MAY 1 7 "l_C i'
PERMIT — i 42'�'��`�
COMMUVITY DEVELOPMENT SERI-ICE}s•
� SF MF CO M�L DE EN FP
33325 3"'A A'L IA/
SOUTH•Y3 BOX 9�/ITYQ fO' F FD ,� L I C A T I O NFEDER4TD
53-835-2 W'.9 3',1i:9 98063-97183-8 -260 Y V)L�(N / /
253-835-2607•F9.Y 253-835-2609 'Y
wan,.rltgolledsrnimul cow.
The ollowin• is re,uired in ormation-an incom•lete a••lication will not be acce•ted. Please •rint le•ibl in ink or J
• PROPERTY INFORMATION
SITE ADDRESS .m 509 -1 ki^x s • SUITE/UNIT#
ASSESSOR'S TAX/PARCEL# - LOT SIZE(sf)
LEGAL DESCRIPTION (e g Acme Estates,Lot 1) .
(Attach separate page for lengthy legal descrrphon)
• PROJECT INFORMATION
TYPE OF PERMIT 0 BUILDING ❑ PLUMBING 0 MECHANICAL
❑ DEMOLITION 7KELECTRICAL 0 ENGINEERING EY FIRE PREVENTION SYSTEM
PROECS T DESCRIPTIO�O. ,de detailed descnp��wo�rk�included-on this ermit onl
v t c -J
•
PROJECT NAME(Name of Business or Owner Last Name) -(O__ ( JC 4Q &I s -- -
• PEOPLE�I{NFFORMAATION } - _
PROPE
1d-J
OWNERR a,nCair-)SC I "�r l `���`TA�'Ir'Y, PRIMARY G
3 Liao•`-I U
1 yt MAILING ARESS S , r, S CITY STA Z P Tat 9"8 O I
CONTRACTOR CO A NAME AAPPI LICANT NAME OFFICE PHONE
MAILING ADDRESS CITY,STATE,ZIP SS 1 C2O1 7 S � O
CITY OF FEDE L WAY BUSINES'S]LICEN E NUMBER EXPIRATION DATE FAX NUMBER _,�s�Q
A01 -i- Q F 1_ST-B L i� / 1 / �( ° )S7S vl 1S '
CONTRACTOR'S REGISTRATION NUMBER)copy of card required with each application) EXPIRATION DATE
fC- e,oS4q°L0MC "Z / �, / OS
APPLICANT COMPA NAME APPLICANT AME OFFICE PHONE
VV✓
) -
MAILIN DRESS CITY,STATE,ZIP CELL PHONE
RELATIONSHIP TO PROJECT FAX NUMBER
0 Architect 0 Tenant 0 Agent ❑ Other(Describe) ( ) -
CONTACT NAME PRIMARY PHONE E-MAIL ADDRESS
(
LENDER Per RCW 19.27.095: Lender information is NAME
required if project value exceeds$5,000
MAILING ADDRESS CITY,STATE,ZIP
• DETAILED BUILDING INFORMATION
EXISTING USE ik 9 k • , PROPOSED USE
EXISTING ASSESSED/APPRAISED VALUE $ VALUE OF PROPOSED WORK $ 1 Q
' °C)
SPRINKLERED BUILDING? 0 YES 0 NO FIRE SUPPRESSION SYSTEM PROPOSED/REQUIRED? 0 YES ❑ NO
WATER SERVICE PROVIDER 0 LAKEHAVEN 0 HIGHLINE 0 TACOMA 0 PRIVATE(WELL)
SEWER SERVICE PROVIDER 0 LAKEHAVEN 0 HIGHLINE 0 PRIVATE(SEPTIC)
z — 9S - soda S4 -f es
J r
Y �
PROJECT FLOOR AREAS
AREA DESCRIPTION EXISTING PROPOSED TOTAL
SQ.FT. SQ.FT. SQ.FT.
BASEMENT
FIRST
SECOND
THIRD
FOURTH
ADDITIONAL FLOORS(DESCRIBE)
DECK(COVERED?)
GARAGE ❑ CARPORT❑
NUMBER OF FLOORS EXISTING PROPOSED TOTAL TOTAL EXISTIIGIF TOTAL PROPOS DST _TOTALS,- -
**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 $ -
AIR HANDLING UNITS EVAPORATIVE COOLERS GAS LOGS REFRIG SYSTEMS
BB QS FANS HOODS(Commerenl) W OODSTOV ES
BOILERS FIREPLACE INSERTS RANGES MISC(Describe)
COMPRESSORS FURNACES GAS WATER HEATERS
DUCTS GAS PIPE OUTLETS
PLUMBING
BATHTUBS io,Tub/Show,Combo) SHOWERS WATER CLOSETS(Toaery MISC(Describe)
DISHWASHERS SINKS DRINKING FOUNTAINS
GAS PIPE OUTLETS SUMPS RAINWATER SYST
WASHING MACHINES URINALS HOSE BIBBS
LAVS(B.•a,room smi<a VACUUM BREAKERS ELECTRIC WATER HEATERS
DISCLAIMER/SIGNATURE BLOCK
I 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 ma -by any person,including the undersigned,and filed against the City of Federal Way,but only where such claim
arises out of the reli• • e of e city,inclu ing its officers and employees,upon the accuracy of the information supplied to the city as a part of
this application.
�/��-� /�0 ,cam/
NAME/TIT Owet l�V tF I DATE
(•1gna urc) (11tle)
RELATIONSHIP TO PROJECT 0 Owner 0 Agent ..contractor ❑ Architect 0 Other
FOR OFFICE USE ONLY
o NEW o ADDITION ❑ALTERATION o REPAIR a TENANT IMPROVEMENT
BUILDING SHELL ONLY? ❑YES o NO BASIC PLAN? ❑YES o NO
ZONING DESIGNATION CHANGE OF USE? a YES ❑NO
NEW ADDRESS REQUIRED? o YES o NO UP/SEPA/SU? o YES o NO
PLATTED LOT? o YES ❑NO DEMO PERMIT REQUIRED? o YES n NO
Bulletin#1 00—January 7,2005 Page 2 of 4 k\Handouts\Permit Application
ELECTRICAL PERMIT INFORMATION
RESIDENTIAL COMMERCIAL
NEW RESIDENTIAL SERVICE NEW COMMERCIAL/INDUSTRIAL SERVICE
Service or Feeder Each Add'n
U Single Faintly Square Feet
(First 1300 ft'--$104.50,Each add'n 500 ft2-$33 50) ❑ 0 to 100 amp $113.50 $69.50
U Detached outbuilding or garage ❑ 101-200 amp 141.00 89.00
(Inspected with service) $44.00 ❑ 201-400 amp 264.50 104.00
❑ Detached outbuilding or garage ❑ 401-600 amp 308.00 123.50
(Inspected separately) $69.50 ❑ 601-800 amp 398.50 168.50
❑ 801 - 1000 amp 486.50 203.50
NEW MULTI-FAMILY(three units or more) ❑ Over 1000 amp 530.50 283.00
Service Feeder
U Up to 200 amp $113.50 $33.50 ❑ Over 600 volts surcharge $89.00
U 201 -400 amp 141.00 69.50 ❑ Mast or meter repair $96.00
U 401 600 amp 193.00 96.00 ALTERED COMMERCIAL/INDUSTRIAL
❑ 601 -800 amp 247.00 132.00
U Over 800 amp 353.50 264.50 Service or Feeders
❑ 0 to 200 amp $113.50
ALTERED SINGLE/MULTI FAMILY ❑ 201 -600 amp 264.50
❑ 601 - 1000 amp 398.50
Service or Feeder ❑ over 1000 amp 443.50
❑ Oto 200 amp $87.00
U 201 -600 amp 141.00 ❑ #of circuits to be added/altered
U over 600 amp 212.50 (1-5 circuits-$89.00;Add'n circuits,$7.00/ea)
❑ #✓of circuits to be added/altered COMMERCIAL/INDUSTRIAL PLAN REVIEW
(1-4 circuits-$69 50;Add'n circuits$7.00/ea) $89.00 plus 35%of Permit Fee
❑ Service- 1,000 amps or greater
U Mast or meter repair $52.00 ❑ Medical/Educational/Institutional Facility
MOBILE HOMES
❑ Service or feeder only $69.50
U Service and feeder $113.50
TEMPORARY SERVICE
MOBILE HOME/RV PARK Residential/Multi-Family $61.00
❑ #f of service or feeders
(First service/feeder-$69 50;each add'n-$45 00) Commercial/Industrial Service or Feeder Ampacity
❑ 0-100 amps $69.50
❑ 101-200 amps 89.00
❑ 201-400 amps 104.50
❑ 401-600 amps 141.00
❑ over 600 amps 152.50
MISCELLANEOUS SERVICE/EQUIPMENT
❑
41 of Thermostats ❑ #1 of Signs
,First-$52.00,add'n-$16.00/ea) (First sign-$52.00;add'n sign$24.50/ea)
-XLow 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 $104.50
ecurity Alarm System ❑ Additional Plan Review $104.50/hour
❑ Voice Cabling (for modified submittals)
❑ Data Cabhnb ❑ Automation Fee on all Permits .. $5.00
(Per• tm(s) 1,,2250(% 1.00;
Each add'n 2500 ft'--16 00) -Per WAC 296-46-910(5)(10&u)
Bulletin#100-January 7,2005 Page 3 of 4 k\Handouts\Permit Application