01-101378 City of Federal Way Mechanical Permit #:01 - 101378 - 00 - ME
Cormnunity Development Services
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: ROLINSKI
Project Address: 1812 SW 317TH P( Parcel Number: 179010 0080
Project Description: MECH-Gas furnace changeout in existing single family residence
Owner Applicant Contractor
Stephen M&Stacey Rolinski NOR PAC HEATING&A/C INC NOR PAC HEATING&A/C INC
1812 SW 317TH PL 3414 A ST SE UNIT 102 3414 A ST SE UNIT 102
FEDERAL WAY WA AUBURN WA 98002 AUBURN WA 98002
98023-5102 (253)931-0608
Mechanical Valuation 1500 Over the Counter Permit Yes
Mechanical Fixtures
Dectpdo �Quart�t� Description ,VD
escription IQuantitld
Furnaces 1
PERMIT EXPIRES October 6,2001,IF NO WORK IS STARTED.
Permit issued on April 9,2001
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. ( J�
Owner or a:' . (.L� (/' J Date: c-GVo /(S
4 111 .4141c/#11
4.nyo, G CONSTRUCTION PERMIT APPLICATION
—
-1‘..0. 0 APPLICATION NUMBER: (9( - j 7 Q Pc.--
APPLICATION NUMBER: d/ -/ 3 1 3'v -o6_-t _
APPLICATION NUMBER:
**The f. .wing is rec teaiAormation-Please print(in ink)or type**
t-ic+J EpT.
Please note: Electrical, Fire,Prgj(pt Ef systems and Engineering permits may require a separate application.
iN ,
SITE ADDRESS: IsI2 c3\ -ci I P I . ASSESSOR'S TAX/PARCEL#: -
LEGAL DESCRIPTION OF SUBJECT PROPERTY(ATTACH SEPARATE DESCRIPTION IF LENGTHY):
TYPE OF PROJECT(This application): ❑ BUILDING ❑ PLUMBING KMECHANICAL ❑ DEMOLITION
❑ ELECTRICAL ❑ ENGINEERING❑ FIRE PREVENTION SYSTEM
PROJECT DESCRIPTION(Provide detailed description):
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PROJECT NAME: '--(. (,',ASK/
PROPERTY OWNER: NAME: DAYTIME PHONE:
i KOltv\s1: 1 j S.LaCe \_/, (Z53)(9(n1 -51-l1Z
MAILING ADDRESS(STREET ADDRESS;CITY,STATE,ZIP):
1C to (51&..) 3 L-1 'Pl , X11. In36_V ._ k.)A c O23
CONTRACTOR: NAME: DAYTIME PHONE:
K c ' AVC. H-i- -i 4- Al c , 1 (Z53 )43 I - (O'E
MAILING ADDRESS(STREET ADDRESS;CITY,STATE,ZIP• c3 411 A o t.�5 E p4S+t 1 COZ EVENING PHONE:
CITY OF FEDERAL WAY BUSINESS UCENSE NUMBER: FAX NUMBER:
- - (2-t3 )93 I -0(06-17
CONTRACTOR'S REGISTRATION NUMBER: /� EXPIRATION DATE:
(copy of card required) t3Q E. P A El A 1 2 H 5 / /
APPLICANT: NAME: DAYTIME PHONE:
5t4-pvt.e /1? 'ti/71-74-r--Cr A ( ) -
MAILING ADDRESS(STREET ADDRESS;CITY,STATE,ZIP): EVENING PHONE:
( )
RELATIONSHIP TO PROJECT: FAX NUMBER:
❑ ARCHITECT ❑ TENANT ❑ OTHER(DESCRIBE): ( ) -
E-MAIL ADDRESS: •
CONTACT PERSON FOR THIS PROJECT: ❑ PROPERTY OWNER D 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 ❑ HIGHLINE ❑ TACOMA ❑ PRIVATE(WELL)
SEWER SERVICE PROVIDER: 0 LAKEHAVEN ❑ HIGHLINE ❑ PRIVATE(SEPTIC)
+fir►
**NEW RESIDENTIAL CONSTRUCTION ONLY**
NUMBER OF BEDROOMS: ESTIMATED SELLING PRICE: $
■ PROTECT FLOOR AREAS
FLOOR EXISTING SQ.FT. PROPOSED SQ.FT. TOTAL
BASEMENT
FIRST
SECOND
-THIRD
FOURTH
OTHER FLOORS(DESCRIBE)
DECK
GARAGE
HOW MANY FLOORS?
TOTAL:
Indicate number of each type of fixture
11111101111111111
AIR HANDLING UNIT(S) 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.( T^5 e\ )
COMPRESSOR(S) I FURNACE(S)
DUCT(S) GAS PIPE OUTLET(S) HEAT SOURCE: ❑ ELECTRIC ❑ 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)
— - )CK
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 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/TIT ,�M( /(e-•\.APOJ DATE: CJI/0 /C17
CI PROPERTY OWNER 0 PLICANT CONT CTOR
FOR OFFICE USE ONLY:
❑ NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ TENANT IMPROVEMENT
CENSUS CODE: LOT SIZE:
ZONING DESIGNATION : BUILDING SHELL ONLY? ❑ YES ❑ NO
COMP PLAN DESIGNATION BASIC PLAN? ❑ YES ❑ NO
SECTION TOWNSHIP RANGE NEW ADDRESS REQUIRED? ❑ YES ❑ NO
PLATTED LOT? ❑ YES ❑ NO CHANGE OF USE? ❑ YES ❑ NO
COMMUNITY DEVELOPMENT SERVICES•33530 FIRST WAY SOUTH•P.O.BOX 9718•FEDERAL WAY,WA 98063-9718•253-661-4000•FAX:253-661-4129
C•O CONSTRUCTION PERMIT APPLICATION
APPLICATION NUMBER: Q - J 3_ 7
\)\) FlY 0°r� - APPLICATION NUMBER: Q — - 13v - )i-- --
*1\ APPLICATION NUMBER: - -
N? following,*(equired information-Please print(in ink)or type**
Y;A -{.
Please note: Electrical, ' e tion Systems and Engineering permits may require a separate application.
■ PROPERTY INFORMATION
SITE ADDRESS: 1512 sw 3111-1- P 1 . ASSESSOR'S TAX/PARCEL #: -
LEGAL DESCRIPTION OF SUBJECT PROPERTY(ATTACH SEPARATE DESCRIPTION IF LENGTHY):
:r - ■ PROTECT INFORMATION .. .• .
TYPE OF PROJECT(This application): ❑ BUILDING ❑ PLUMBING MECHANI . ❑ DEMOLITION
❑ ELECTRICAL Cl ENGINEE' 'G❑ FIRE PREVE ION SYSTEM
PROJECT DESCRIPTION(Provide detailed description):
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PROJECT NAME: 4—(,'015/X/
- .11 PrOPL 'INFORMATION
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PROPERTY OWNER: NAME . 1
itI k dItta.. . -5oZ
MAILING Ar SS - .•EET ADORES ; STATE, . ' : _
5512 , 3V1 tom. 1v • 51,7-3
•
CONT - OR: ' 'E: ME PHONE:
Z 4- Ai 4. '' (Z33 ) I - 67sCOs-
•
IU , DDRESS(SIRE .DRESS,CITY,STATE,ZIP• 3411-1-. t . 'e t•._ EVENING PHONE:
CITY OF FED WAY BUSINESS UCENSE NUMBER: FAX NUMBER:
- - - - _ _ _ (23 )931 -O(q-7
CONTRACTOR'S REGI :TION NUMBER: A . l A I 5 EXPIRATION DATE:
(copy of card required) k) fi, B_ Pa H / /
APPLICANT. - NAME: DAYTIME PHONE:
S/41.,1- - Al i. -' tom - - + ,7_,.. ( ) -
MAILING ADDRESS(STREET ADDRESS;CITY,STAT , - _ '- EVENING PHONE:
( )
RE. 'ONSHIP TO PROJECT: FAX NUMBER:
❑ A'CHITECT El 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? El YES ❑ NO FIRE SUPPRESSION SYSTEM PROPOSED/REQUIRED:❑ YES ❑ NO
WATER SERVICE PROVIDER: ❑ LAKEHAVEN ❑ HIGHLINE ❑ TACOMA ❑ 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:
Indicate number of each type of fixture
MECHANICAL
AIR HANDLING UNIT(S) EVAPORATIVE COOLER(S) GAS LOG(S) REFRIG.SYSTEM(S)
BBQ(S) FAN(S) HOOD(S) WOODSTOVE(S) },
BOILERS) FIREPLACE INSERTS)
RANGE(S) ( MISC.( T-6 2/` )
COMPRESSOR(S) FURNACE(S)
DUCT(S) GAS PIPE OUTLET(S) HEAT SOURCE: ❑ ELECTRIC ❑ 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)
- =
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)$24.25
(2)$501.00 to$2,000.00 (2)$24.25 for the first$500.00 plus$327foreach additional$100.00or fraction thereof,to and including$2,000.00
(3)$2,001.00 to$25,000.00 (3)$71.46 for the first$2,000.00 plus$15.00 for each additional$1,000.00 or fraction thereof,to and including
$25,000.00
(4)$25,001.00 to$50,000.00 (4)$403.61 for the first$25,000.00 plus$10.82 for each addition/$1,000.00 or fraction thereof,to and including
$50,000.00.
(5)$50,001.00 to$100,000.00 (5)$664.35 for the first$50,000.00 plus$7.50 for each additional$1,000.00 or fraction thereof,to and including
$100,000.00.
(6)$100,001.00 to$500,000.00 (6)$1,025.55 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)$3,337.23 for the fist$500,000.00 plus$5.09 for each additional$1,000.00 or fraction thereof,to and including
$1,000,000.00.
(8)$1,000,001.00 and up (8)$5,788.23 for the first$1,000,000.00 plus$3.91 for each additional$1,000.00 or fraction thereof.
Bold number is the base fee for the specified increment
Italicized,underlined number is the lee 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)
PROPOSED VALUATION: 5 CSU
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 Fixtures
$21.00+{ X$7.00/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)
1
• ELECTRICAL ,
TABLE B
NEW RESIDENTIAL SERVICES MOBILE HOMES MISC EQUIPMENT/TEMP SERVICES
_Single Family _Service or feeder only $44.25 1 #of Thermostats(First-$33.50;add'n-$I0.50ea)
(First 1300 ft2-$67.00;Each add'n 500 ft2-$21.50) _Service and feeder $72.25 _#of Low voltage fire or burglar alarms
Square Feet: First 2500 ft--$38.75;Each add'n 2500 ft2-$10.50
_Each outbuilding or garage $28.00 MOBILE HOME/RV PARK Square Feet:
(Inspected with service) _#of service or feeders ' Per WAC 296-46-9I0(5)(b)(i&ii)
_Each outbuilding or garage $44.25 (First service/feeder-$44.25;Add'n service/ _#of Signs(First sign-$33.50;add'n sign
(Inspected separately) feeder-$28 each) $16.00 each)
_Progress inspection per 1/2 hr $33.50
_Swimming pool,hot tub.spa 67.00
Yard Pole meter loops 44.25
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 $72.25
_Up to 200 amp $72.25 $21.50 Feeder _201-600 169.00
_201-400 amp 89.75 44.25 _0 to 100 $72.25 $44.25 _601-1000 254.50
_401-600 amp 123.25 61.50 _101-200 89.75 56.25 _over 1000 282.75
_601-800 amp 158.00 84.25 _201-400 169.00 67.00 _#of circuits
_Over 800 amp 225.25 169.00 _401-600 197.00 78.75 (I-5 circuits-$56.25;Add'n circuits.$5 ea)
ALTERED SINGLE/MULTI FAMILY _601-800 254.50 107.25
(When inspected separately from the services.) _801-1000 310.75 129.75 Temporary Service i
Service or Feeder _Over 1000 339.00 181.00 _0 to 60 $38.75 '
_0 to 200 amp $61.50 _Over 600 volts surcharge 56.25 _61-100 44.25
_201-600 amp 89.75 _Mast or meter repair 61.50 _101-200 56.25
_over 600 amp 135.25 _201-400 67.00
_Mast or meter repair 33.50 _401-600 89.75
_N of circuits _over 600 97.75
(1-4 circuits-$44.25;Add'n circuits$5 ea)
If service is greater than 200 amp,a plan review is req'd.Fee is 35%of permit fee+$56.25.Add'l plan review for other submissions is$67.00/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: $56.25+ X.35=(13)
• DEMOLITION
Estimated Permit Fee: (14)
Bond Amount:(15)
. . - • ENGINEERING .
Estimated Permit Fee:(16)
Bond Amount: (17)
- - • 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-January 3, 2001