02-104741 a
City of Federal Way
Community Development Services Electrical Permit #:02 - 104741 - 00 - EL
33530 1st Way S
Federal Way,WA 98003-6210
Ph:253.661.4000 Fax:253.661.4129 Inspection request line: 253.835.3050
Project Name: ROSHOLM
Project Address: 29641 23RD SW Parcel Number: 012103 9088
Project Description: ELE-New 200 amp service and wiring for new house;includes central vacuum system. Includes alarm
system.
Owner Applicant Contractor
John&Anthonette M Rosholm John&Anthonette M Rosholm John&Anthonette M Rosholm
29641 23RD AVE SW 29641 23RD AVE SW 29641 23RD AVE SW
FEDERAL WAY WA 98023 FEDERAL WAY WA 98023 FEDERAL WAY WA 98023
(253)815-9155
Electrical Fixtures
;t, l escription = ;Q0,010 trip _iri; � G2it';tjtity ..: `.�` Description;. Quantitj
Low Voltage Burgler Alarm-Residen 1440 Service: -Residential 1440
PERMIT EXPIRES April 23,2003,IF NO WORK IS STARTED.
Permit issued on October 25,2002
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 . cordance with the laws,rules and regulations of the State of Washington and
the City of Federal ay. 1 ,, )
Owner or age . ." / i7 Date: /r 7 c1)
1 -22--93 1Sig4it g ,v
3 ' O # a_ 134-7# F , H CI (/Ny ,f,/bo, '
(cir- ---- of"27 x,144 VA/pt.,-
01)
&CD`
� RECEIVED CONSTRUCTION PERMIT APPLICATION
L
AY
APPLICATION NUMBER: () � �� I_ - L.
OCT 2 5 2002 APPLICATION NUMBER: . - -
APPLICATION NUMBER: - -
.4 ED RAL A`
IT* I t NVYre information—Please print(in ink)or type**
Please note: Electrical,Fire Prevention Systems and Engineering permits may require a separate application.
• •• • • PROPERTY INFORMATION
SITE ADDRESS: e.fel iY '// Z37z/" ASSESSOR'S TAX/PARCEL#: O t Z ! o5 - 47e9('
LEGAL DESCRIPTION OF SUBJECT PROPERTY(ATTACH SEPARATE DESCRIPTION IF LENGTHY):
!-7-7.-:-_.--":::- '-.--..-:----7---- :.-_ .. __.- • - .■ PROTECT INFORMATION-. - . - .
TYPE OF PROJECT(This application): ❑ BUILDING ❑ PLUMBING ❑ MECHANICAL ❑ DEMOLITION
otCLELECTRICAL ❑ ENGINEERING❑ FIRE PREVENTION SYSTEM
PROJECT DESCRIPTION(Provide detailed description): >'i ZiZ Z=K:.G'G' 41 / /''
r
PROJECT NAME: f �5/1)/fn /re,"!_ ri ' r�
- ■ PEOPLE INFORMATION • -
PROPERTY OWNER: NAME: DAYTIME PHONE:
V GPi21' GX.�l✓� !l �' ( ) -
_MAILI, v(EETz ,STA IIP): zie 5` _� ��L _ fa, _
CONTRACTOR: NAMC!--, ,' :/��Li///J //'V1//rD ME PHONE:
`ie-fin -
MAILIN D ET ADDRESS;CITY,STATE,ZIP): J EVENING PHONE:
ib / 3 7T 4,,/,./e,
U y� ( ) -
CITY OF FEDERAL AY BUSINESS LICENSE NUMBER: FAX NUMBER:
)
CONTRACTOR'S REGISTRATION NUMBER: EXPIRATION DATE:
(copy of card required) I /
APPLICANT: NAM •�
/DAYTIME PHONE:
MAILING ADD •CITY, ATE,ZIP): / Air EVENING PHONE:
eTIONg:TO JECT: FAX NUMBER
❑ ARCHITECT ❑ TENANT ❑ OTHER(DESCRIBE): ( ) -
E-MAIL ADDRESS:
CONTACT PERSON FOR THIS PROJECT; PROPERTY OWNER ❑ APPLICANT ❑ CONTRACTOR •
■ DETAILED BUILDING INFORMATION -
EXISTING USE: EXISTING BUILDING ASSESSED/APPRAISED VALUATION $
PROPOSED USE: PROPOSED VALUATION FOR IMPROVEMENTS: $
SPRINKLERED BUILDING? ❑ YES ❑ NO FIRE SUPPRESSION SYSTEM PROPOSED/REQUIRED:❑ YES ❑ NO
WATER SERVICE PROVIDER: ❑ LAKEHAVEN El HIGHLINE ❑ TACOMA Cl PRIVATE(WELL)
SEWER SERVICE PROVIDER: ❑ LAKEHAVEN ❑ HIGHLINE ❑ PRIVATE(SEPTIC)
**NEW RESIDENTIAL CONSTRUCTION ONLY**
NUMBER OF BEDROOMS: ESTIMATED SELLING PRICE: $
■ PROSECT FLOOR AREAS -
FLOOR EXISTING SQ.FT. PROPOSED SQ.FT. TOTAL
BASEMENT
FIRST
SECOND
•
• THIRD
• FOURTH
OTHER FLOORS(DESCRIBE)
DECK
GARAGE
HOW MANY FLOORS?
TOTAL:
��...p�'.t•FIXTURESK� .rw. �,F
Indicate number of each type of fixture
MECHANICAL
AIR HANDLING UNITS) EVAPORATIVE COOLER(S) GAS LOG(S) REFRIG.SYSTEM(S)
BBQ(S) FAN(S) HOOD(S) WOODSTOVE(S)
BOILER(S) FIREPLACE INSERT(S) RANGE(S) MISC.( )
COMPRESSOR(S) FURNACE(S)
_ DUCT(S) GAS PIPE OUTLET(S) HEAT SOURCE: ❑ ELECTRIC Cl GAS
PLUMBING
BATHTUB(S) LAVATORY(S) URINAL(S) WATER HEATER(S)
DISHWASHER(S) RAIN WATER SYS. VACUUM BREAKER(S) ❑ ELECTRIC ❑ GAS
DRINKING FOUNTAIN(S) SHOWER(S) WASH MACHINE OUTLET
GAS PIPE OUTLET(S) SINK(S) WATER CLOSET(S) MISC.( )
INTERCEPTOR(S) SUMP(S)
•■ 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 daim(including costs,expenses,and attorneys'fees incurred in the
investigation and defe se of such daim),which may be made by any person,induding the undersigned,and filed against the City of
Federal Way,but o. er• -uch daim =ri-- out of th. -•fiance o the city,induding its officers and employees,upon the accuracy
of the informati• s •pr-: • the ci .s a •:rt of thi .p' icati.
NAME/ E: .r. / DATE: 7(2
❑ PROPER OWNER ❑ APPLICANT ❑ CONTRACTOR
"iFOR°OFFICE USE ONLY:_-
NEW ❑LADDIiION� :fa El;ALTERATION :. _£,REPAIR :,❑iTENANT'IMPROVEMENT,:t'4_:.
O 3
-� �.��� _ w�x�•r_�r� =LOT;SIZE:•;�:�<�,�•�_°,���_.€:x�.F�=�=_▪�4�.
aSz
Bl'IILDINGHELLO 1(l O:�`=_.---
COWP �CAN_1$ESIGNATION e`; ss = BASIC PLAM?,'' D E$f'=_ Nc .. "'
SECTION __ 'TOWNSHIP;r?'; ' RANGE-.=-__,__� <NEW:ADDRESS REQUIRED?- _":• ❑'YES• fl'NO
❑.YES -CHANGE OF USE?':`="f= .`.❑,YES -
COMMUNITY DEVELOPMENT SERVICES.33530 FIRST WAY SOUTH•PO BOX 9718•FEDERAL WAY,WA 98063-9718•253-661-4000•FAX:253-661-4129
www.cltvoffederalway.com
Construction Permit Fee Calculation Sheet
*******PLEASE NOTE: ALL FEES MUST BE VERIFIED BY CITY STAFF PRIOR TO ACCEPTANCE OF PAYMENT.
CHECKS FOR INCORRECT AMOUNTS WILL NOT BE ACCEPTED!*******
Building,mechanical,and fire prevention system fees are based on the following schedule.
• • TABLE A
TOTAL VALUATION FEE FACTOR
• (1)$1.00 to$500.00 (1)$26.00
•
(2).$501.00 to$2,000.00 (2)$26.00 for the first$500.00 plus$3.50 for each additioriaft100.00or fraction thereof,to and including
$2,000.00
(3)$2,001.00 to$25,000.00
(3)$78.50 for the first$2,000.00 plus$15.50 for each additional S1,000.00°4'fraction thereof,to and
including$25,000.00
(4)$25,001.00 to$50,000.00
(4)$435.00 for the first$25,000.00 plus$11.00 for each additional$1,0170.00 or fraction thereof,to-and
including$50,000.00.
(5)$50,001.00 to$100,000.00
{ (5)$710.00 for the first$50,000.00 plus$8.00 for each additional$1,00000 or fraction thereof,to and
including$100,000.00.
(6)$100,001.00 to$500,000.00
(6)$1,110.00 for the first$100,000.00 plus$6.00 for each additional$1,000.00 or fraction thereof,to and
including$500,000.00
(7)$500,001.00 to$1,000,000.00
(7)$3,510.00 for the fist$500,000.00 plus$5.50 for each additional$1,000.00 or fraction thereof,to and
including$1,000,000.00.
(8)$1,000,001.00 and up
(8)$6,260.00 for the first$1,000,000.00 plus$4.00 for each additional$1,000.00 or fraction thereof.
Bold number is the base fee for the specified Increment
italicized,underlined number is the fee per additional specified increment
PLUS: Add 65 percent of the base building permit fee for plan review fee.
Add 25 percent of the base mechanical permit fee for mechanical plan review fee.
Add 15 percent of the base building permit fee for Fire District*39 surcharge,commercial only.
Add$4.50 for WA State Building Code Council,plus$2.00 per unit for duplex&above.
**Electrical,plumbing,and mechanical fees are calculated separately**
:_:- =_ = ■ BUILDING . _._..
PROPOSED VALUATION:
FEE FACTOR FROM TABLE A: Number: (a)Base Fee:
(b)Additional Increment Fee:
Estimated Permit Fee: (1)
Estimated Plan Review Fee: (2)
Estimated FW Fire Department Surcharge: (3)
(COMMERCIAL ONLY)
• • MECHANICAL
PROPOSED VALUATION:
FEE FACTOR FROM TABLE A:Number: (a)Base Fee:
(b)Additional Increment Fee:
Estimated Permit Fee: (4)
Estimated Plan Review Fee: (5)
■ FIRE PREVENTION SYSTEM
PROPOSED VALUATION:
FEE FACTOR FROM TABLE A:Number. (a)Base Fee:
(b)Additional Increment Fee:
Estimated Permit Fee: (6)
Estimated Plan Review Fee: (7)
. - •. . . . •■ PLUMBING . . • .. . -
Base Fee Number of Fochxes
$22.50+{ X$8.00/fixture}= (8)Estimated Permit Fee
Estimated Permit Fee
X .65= (9)Estimated Plan Review Fee
Miscellaneous Fixture Charge:(10)
Sub Total(Page one): Line(s)(1)+(2)+(3)+(4)+(5)+(6)+(7)+(8)+(9)+(10)= (11)
I 50
TABLE B
%TRESIDENTIAL SERVICES MOBILE HOMES MISC EQUIPMENT/TEMP SERVICES .
ingle Family Service or feeder only $50.00 #of Thermostats(First 43 I•s�add'n-S I I.50ea)
• (First 1300 ftr- 7 •Each add'n 500 ft2-$24.00) _Service and feeder $81.00 X#of Low voltage fire', ____iiiarms
Square Feet _ Fina 2500 ft=- Each ,.'. 00 ft2-S 11.50
Each outbuilmg or garage $31.00 MOBILE HOME/RV PARK Square Feet:
Q
(Inspected with service) _#of service or feeders •.Per WAC 96-46-910(5)(b)(i&ii)
_Each outbuilding or garage $50.00 (First service/feeder-S50.00;Add'n service/ _#of Signs(First sign-537.50;add'n sign
(Inspected separately) . • feeder-S32 each) $17.50 each) .
•
_Swimming pool,hot tub,spa $75.00
• . _Yard Pole meter loops $50.00
NEW MULTI-FAMILY COMMERCIAL/INDUSTRIAL COMMERCIAL/INDUSTRIAL
(Includes three units or more) Altered Service or Feeders
Service Feeder Amps Service or Add'n _0 to 200 S 81.00
_Up to 200 amp $ 81 00 ....... ...$ 24.00 Feeder _201-600 189.00
_201-400 amp 101.00 50.00 _0 to 100 $ 81.00 S 50.00 _601-1000 284.50
_401-600 amp 138.00 68.50 _101-200 101.00 63.50 _over 1000 317.00
_ (1
601-800 amp 176.50 94.50 _201-400 189.00 75.00 _#of circuits
_Over 800 amp 252.50 189.00 _401-600 220.50 88.50 -5 circuits-$63.50;Add'n circuits,$5 ea)
ALTERED SINGLE/MULTI FAMILY _601-800 284.50 120.50
(When inspected separately from the services.) _801-1000 348.00 145.50 TEMPORARY SERVICE
Service or Feeder _Over 1000 379.00 202.50 Residential/Multi-Family/Commercial/Industrial
_0 to 200 amp $ 68.50 _Over 600 volts surcharge 63.50 _0-100 5 50.00
_201-600 amp 101.00 _Mast or meter repair 68.50 _101-200 63.50
_over 600 amp 151.50 _201-400 75.00
_Mast or meter repair 37.50 _401-600 101.00
#of circuits _over 600 109.00
(1-4 circuits-550.00;Add'n circuits$5 ea)
If a new or altered commercial service is 200 amps or greater,or a new or altered residential service is greater than 400 amps,a plan review is required.Fee is 35%of
permit fee+563.50.Add'I plan review for other submissions is$75.00/hr.
FIXTURE DESCRIPTION(A) FIXTURE FEE FROM TABLE B(B) NUMBER OF UNITS(C) TOTAL(D)
TOTAL COLUMN(D):
Total Column(D)
Estimated Permit Fee: (12)
Estimated Permit Fee from line 12
Estimated Plan Review Fee: $63.50+( X.35)=(13)
• DEMOLITION
Estimated Permit Fee: (14)
Bond Amount:(15)
■ ENGINEERING
Estimated Permit Fee:(16)
Bond Amount: (17)
k ■ OTHER FEES
Mitigation Fee:(18) (20) (22)
SBCC Surcharge:(19) - (21) (23)
Total (Pages One&Two): Line(s)(11)+(12)+(13)+(14)+(15)+(16)+(17)+(18)+(19)+(20)+(21)+(22)+(23)= (24)
Bulletin #100-February 19,2002