05-105489 City of Federal Way Electrical Permit #: 05 - 105489 - 00 - EL
Community Development Services
P.O.Box 9718
• Federal Way,WA 98063-9718
Ph:(253)835-7000 Fax:(253)835-2609 Inspection request line: (253) 835-3050
Project Name: 7-11
Project Address: 32935 1ST S Parcel Number: 182104 9037
Project Description: Alteration to extend 120v circuit in backroom
Owner Applicant Contractor
KORNBLAU LOUIS&SON INC MADSEN ELECTRIC MADSEN ELECTRIC
376 EL ENCANTO DR 3939 S ORCHARD ST 3939 S ORCHARD ST
PASADENA CA TACOMA WA 98466 TACOMA WA 98466
91107-5308 (253)383-4546
Electrical Fixtures
Description Quantity Description Quantity Description !Quantity
Circuits- Commercial 1
PERMIT EXPIRES April 24,2006.
Permit issued on October 26,2005
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 ord• with the laws,rules and regulations of the State of Washington and
the City of Federal Way. /
Owner or agent: Date: l J` `o,S
THIS CARD IS TO REMAIN ON-SITE
CITY OF A Community Development Inspection Record
Federal Way IVR INSPECTION REQUEST PHONE # (253) 835-3050
PERMIT#: 05-105489-00-EL
Owner: ,
Address: 32935 1ST AVE S
FEDERAL WAY, WA 98003-6304
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) '❑ Pool Bonding(4195)
Approved to place concrete Approved Approved
By Date , By Date By Date
❑ Temporary Power(4275) 0 Service(4235) 0 Feeders/Sub-panels(4045)
Approved Approved Approved
By Date By Date By Date
.1❑ Rough Electrical(4225) '❑ Ceiling Cover(4020) C6 Final-Electrical(4055)
Approved Approvedaa Approved
By Date By Date By* & Date tel:) -)V:;<1
❑ Under-slab groundwork(4295)
Approved
By Date
j 14
I art Of A
_ . RECEIVED
FederalW .2
ay n PERMIT
COMMUNITY DEVELOPMENTSERVICEDCT 2 6 20A, SF MF CO MEDL DE EN FP
3994583^�AVENLBSWA 9•POBOX97183PPLICATION
FEDERAL WAY,WA 983069 / /
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olwau.conE BUILDI ERAL WAY
i NG DEPT
The ollowi • is re• {red in ormation-an Inco •tete • ••iication will not be acce•ted. Please •tint 1.e.1131 n or p .
MIPROPERTY INFORMATION
SITE ADDRESS .3e2.93.5" / Rue .5 SUITE/UNIT#
ASSESSOR'S TAX/PARCEL# - _ _ _ LOT SIZE(s)
LEGAL DESCRIPTION(e.g.Acme Estates,Lot I)
Atwell.eparaaPmfir 4 legal d aoiaoon,
■ PROJECT INFORMATION
TYPE OF PERMIT 0 BUILDING 0 PLUMBING 0 MECHANICAL
• 0 DEMOLITION At ELECTRICAL 0 ENGINEERING 0 FIRE PREVENTION SYSTEM
PROJECT DESCRIPTION(Pro ' e detailed description of work iincluded on this it onl
J :11.7146V (L-j -
4 ./'. . t...4---
�OL
PROJECT NAME(Name of Business or Owner Last Name) 7
al PEOPLE INFORMATION
PROPERTY NAME PRIMARY PHONE
OWNER 7-1/ rove, ( ) - .
MAILING ADDRESS A CITY,STATE,ZIP
-341 9 3s" / RPE. S. f=e roof L UPa y 9(de)3 -
CONTRACTOR COMPANY NAME APPL�ICAIIT NAME OFFICE PHONE
kv#D se/0 El ee-r e<d--- I Dirt (A.s:3) 38'3 -4'.cv
MAILING ADDRESS CITY STATE,ZIP CELL PHONE
3/a3 4•c neelt i) ,4e,lc.Z.¢ `t.ZYt Lb-3 ) ADZ' z3Ss
CITY OFFEDERAL WAY BUSINESS LICENSE NUMBER EXPIRATION DATE - FAX NUMBER
1 -.' 4-.L a 41 1P 3 3-B' L / / ( ) -
.0CONTRACTORS REGISTRATION NUMBER(copy of card requital with each application( EXPIRATION DATE
144 4 -a 6. Ee * 1di. Q L' 8 / /
APPLICANT COMPANY NAME APPLICANT NAME OFFICE PHONE
.3 iq'wt <c ( ) -
MAILING ADDRESS CITY,STATE,ZIP - CELL PHONE
( )
RELATIONSHIP TO PROJECT FAX NUMBER
❑ Architect a Tenant a Agent ❑ Other(Describe) ( ) _
CONTACT5 ZIE. PRIMARY PHONE E-MAIL ADDRESS
/ &WV (XS3) 3.3'3 -Ism 4
LENDER
MAILING ADDRESS CITY,STATE,ZIP
,1.
■ DETAILED BUILDING INFORMATION
EXISTING USE PROPOSED USE
EXISTING ASSESSED/APPRAISED VALUE $ VALUE OF PROPOSED WORK $
SPRINKLERED BUILDING? a YES ❑ NO FIRE SUPPRESSION SYSTEM PROPOSED/REQUIRED? a YES ❑ NO
WATER SERVICE PROVIDER a LAKEHAVEN a HIGHLINE a TACOMA ❑PRIVATE(WELL) _
SEWER SERVICE PROVIDER a LAKEHAVEN a HIGHLINE 0 PRIVATE(SEPTIC)
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-$104.50;Each add'n 500 ft2-$33.50) ❑ 0 to 100 amp $113.50 $69.50
❑ 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
0 601-800 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 -
❑ Up to 200 amp $113.50 $33.50 ❑ Over 600 volts surcharge $89.00
❑ 201 -400 amp 141.00 69.50 ❑ Mast or meter repair $96.00
❑ 401 -600 amp 193.00 96.00 ALTERED COMMERCIAL/INDUSTRIAL
❑ 601 -800 amp 247.00 132.00
❑ Over 800 amp 353.50 264.50 Service or Feeders
❑ 0 to 200 amp $113.50
ALTERED SINGLE/MULTI FAMILY 0 201 -600 amp 264.50
❑ 601 - 1000 amp 398.50
Service or Feeder ❑ over 1000 amp 443.50
❑ 0 to 200 amp $87.00
❑ 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)
L #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
❑ Mast or meter repair $52.00 " ❑ Medical/Educational/Institutional Facility
MOBILE HOMES
❑ Service or feeder only $69.50
❑'Service and feeder $113.50
TEMPORARY SERVICE
MOBILE HOME/RV PARK Residentiai(MultiFamily $61.00
❑ #of service or feeders
(First service/feeder-$69.50;each addh-$45.00) Contntercica/1'ndustrial Service or Feeder Ampacity
❑ 0-100 amps ._ $69.50
O I01-200 amps 89.00
O 201-400 amps 104.50
❑ 401-600 amps - 141.00
❑ over 600 amps 152.50
•
MISCELLANEOUS SERVICE/EQUIPMENT
❑ #of Thermostats U M of Signs
(First-$52.00;addh-$16.00/ea) (First sign-$52.00;addh sign$24.50/ea)
❑ Low Voltage U Swimming pool/hot tub $87.00
Square Feet to be served by system(s) (Includes additional circuit,if required)
❑ Fire Alarm System U Yard Pole meter loops $104.50
❑ Security Alarm System U Additional Plan Review $104.50/hour
❑ Voice Cabling (for modified submittals)
❑ Data Cabling
❑
U Automation Fee on all Permits .. $5.00
(Per System(s). 2500 ft2-$61.00;
Each addh 2500 ft2-16.00) •Per WAC29646.9IOf5)M&o)
Bulletin#100-January 7,2005 Page 3 of 4 IdHandoutsPPermit Application
.
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 0 CARPORT 0
NUMBER OF FLOORS EXISTING PROPOSED Tom -
"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
BBQS FANS HOODS(c.mmerd.q WOODSTOVES
BOILERS • FIREPLACE INSERTS RANGES - MISC(Describe)
• COMPRESSORS FURNACES GAS WATER HEATERS
DUCTS GAS PIPE OUTLETS
PLUMBING
BATHTUBS(orhb/S.were mb.) SHOWERS WATER CLOSETS pito MISC(Describe)
DISHWASHERS SINKS DRINKING FOUNTAINS
GAS PIPE OUTLETS SUMPS RAINWATER SYST
WASHING MACHINES URINALS _ HOSE BIBBS
LAVS(eeuuoom awry 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 authorised 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, expense; 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,incl ng its o cers and employees,upon the accuracy of the information supplied to the city as a part of
this application.
NAME/TITLE ,li( DATE /d -,Z(e
(Signature) (Tide)
RELATIONSHIP TO PROJECT a Owner ❑ Agent ❑ Contractor 0 Architect ❑ Other
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