04-103678 City of
Development Services eveway
CommunityElectrical Permit #:04 — 103678 — 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: HOLDSWORTH
Project Address: 1020 SW 305TH 4. Parcel Number: 178850 0055
Project Description: Remove/replace existing overhead service mast and installing new meter on post with grounding.
Replacing existing 100 amp panel with new 125 amp panel.
Owner Applicant Contractor
Daniel S Holdsworth Daniel S Holdsworth Daniel S Holdsworth
1020 SW 305TH ST 1020 SW 305TH ST 1020 SW 305TH ST
FEDERAL WAY WA FEDERAL WAY WA FEDERAL WAY WA
98023-8235 98023-8235
Electrical Fixtures
Description Quantity;Iu Description Quantity _ Description Quantity
Alt.Serv./Feeder:0 to 200 amps-Res. 1 Mast or Meter Repair-Residential/Mt 1
PERMIT EXPIRES March 12,2005.
Permit issued on September 13,2004
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,.��p I ,,�p�
Owner or agent: ( 1+Wf t1 �" n Date: 9/i? °11
p‘VSS)
•
THIS CARD IS TO REMAIN ON-SITE
am OF Community Development Inspection Record
Federal Way IVR INSPECTION REQUEST PHONE # (253) 835-3050
PERMIT #: 04-103678-00-EL
Owner: DANIEL S HOLDSWORTH
Address: 1020 SW 305TH ST
FEDERAL WAY, WA 98023-8235
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 Date By Date
❑ Temporary Power(4275) ❑i Service(4235) ❑ Feeders/Sub-panels(4045)
Approved Approved Approved
By Date B - S Date 5_ zo v By Date
El Rough Electrical(4225) .
❑ Ceiling Cover(4020) <0
Final-Electrical(4055)
Approved Approved / Approved
By Date By Date eA.+:�� Date ? ,..- (
♦ 7s
❑ Under-slab groundwork(4295)
Approved
By Date
cnwi-,—;:m-Lint 0 - / o 3 _Ca 3--_,E3
Federal Way - PER
SF MF CO M:,- DE EN FP
COMMUNITY DEVELOPMENT SERVICES �). nn^ a T
333258TMAVENUESOU77f•Po c 7-tl!:J .APPLICATION
I FEDERAL WAY,WA 98063.941 _TD /
1
253-8352607•FAX 253-835-2609 /
unuw.dtVofederdmau.cont ".i-.,.a sq I;'r:' b v
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The following is refiiiiihittinfmiinai4on-an incomplete a..lication will not be acce•ted. Please print legibly(in ink)or type.
N PROPERTY INFORMATION
SITE ADDRESS )C' uCi 5 11/ D 55'1 5-r - SUITE/UNIT# (
ASSESSOR'S TAX/PARCEL# l 4r�i n✓ � O 5- Q c JCLOT SIZE(s� y,G^C)
LEGAL DESCRIPTION(e.g.Acme Estates,Lot 1) IC 5-7 -.3
/Moth separate page for lengthy legal description)
■ PROJECT INFORMATION
TYPE OF PERMIT 0 BUILDING 0 PLUMBING 0 MECHANICAL
0 DEMOLITION frELECTRICAL 0 ENGINEERING 0 FIRE PREVENTION SYSTEM
PROJECT DESCRIPTION(Provide detailed description of work included on this permit only)
R4 vn vv_e a R_pp iAc-4 ea4ORtit 0vet t-W i2 S-'Rlc(r.� hoc't G FL-(et'c C '''iv .,-L 4i;fl< 1141, I,aSaA,o
fiO ih D S Cotsn-tcf kki-p L • /3P iAci cirkiu►Te,iy) 1.4 S-PR I/1(4 uP-ic f H-( C&,', .017 /) 411 ii C
I 6(i-e 0-4,mc. Co-0.0-1 {tP v 1 A-P rh avf5.
PROJECT NAME(Name of Business or Owner Last Name) a(r S VP
• PEOPLE INFORMATION -
PROPERTY NAME PRIMARY PHONE
OWNER Q c,r • 1,0 (fi0I/}14 QS 3' ) nI GI E, cid 3
MAILING ADDRESS CITY,STATE,ZIP
ID 420, •i Iv 30St'icr F----0,9ivoty 4.4 q WQ) 3
CONTRACTOR COMPAM NAME APPLICANT NAME OFFICE PHONE
Y'Y,6Z071fl-,e- ( )
MAILING ADDRESS CITY,STATE,ZIP CELL PHONE
( ) -
CITY OF FEDERAL WAY BUSINESS LICENSE NUMBER EXPIRATION DATE FAX NUMBER
- - - / / ( )
B L
CONTRACTOR'S REGISTRATION NUMBER(copy of card required with each application) EXPIRATION DATE
APPLICANT COMPANY NAME APPLICANT NAME OFFICE PHONE
00 el Memos(,,( t/) ( S3 ) ,II a- -rad I _
MAILING ADDRESS CITY,STATE,ZIP CELL PHONE
(a ac c w 5-5--r0 5/4"----49-- F---4,2 L.A.( c 'i 3 ( ) -
RELATIONSHIP TO PROJECT FAX NUMBER
0 Architect perenant 0 Agent 0 Other(Describe) -- ( ) -
CONTACT NAME PRIMARY PHONE E-MAIL ADDRESS
10g0 1OtIs 17fij (asf ) Pill -0(2 ;
;
LENDER Per RCW 19 27 095e Lender informatwn is
.. ;required if project value es,ceeds$5,000
MAILING ADDRESS CITY,STATE,ZIP
■ DETAILED BUILDING INFORMATION
EXISTING USE PROPOSED USE
EXISTING ASSESSED/APPRAISED VALUE $ VALUE OF PROPOSED WORK $
SPRINKLERED BUILDING? 0 YES j'NO FIRE SUPPRESSION SYSTEM PROPOSED/REQUIRED? 0 YES /c NO
' WATER SERVICE PROVIDER Jir LAKEHAVEN o HIGHLINE 0 TACOMA 0 PRIVATE(WELL)
SEWER SERVICE PROVIDER 0 LAKEHAVEN 0 UIGHLINE X'PRIVATE(SEPTIC)
• PROJECT FLOOR AREAS
��—7._________________--
-
AREA DESCRIPTION EXISTING SO.FT. PROPOSED S•.FT. TOTAL
FMST 415 aric, rr
SECOND
THIRD
FOURTH
ADDITIONAL FLOORS(DESCRIBE)
DECK(COVERED?)
GARAGE/CARPORT
TOTAL EXISTING
TOTAL PROPOSED TOTAL EXISTING AND PROPOSED
HOW MANY FLOORS? 1
"NEW HOMES ONLY" NUMBER OF BEDROOMS
ESTIMATED SELLING PRICE $
PD TURES _
Indicate number of each type offixture to be installed or relocated as part of this project. Do not include existing fixtures to remain.
MECHANICAL
Value of Mechanical Work $
GAS LOGS REFRIG.SYSTEMS
AIR HANDLING UNITS EVAPORATIVE COOLERS W FRIG.SYSTEMS
FANS HOODS(comm<rdall MISC(Describe)
ES
BOAS FIREPLACE INSERTS RANGES
BOILERSMGAS WATER HEATERS
COMPRESSORS FURNACES
DUCTS GAS PIPE OUTLETS
PLUMBING WATER CLOSETS(rode) MISC(Describe)
BATHTUBS(or Tub/shouercombo) SHOWERS
SINKS DRINKING FOUNTAINS
GAS PIPE
HERS OUTLETS SUMPS
DISHWASHERS
RAINWATER SYST
URINALS HOSE BIBBS
WASHING MACHINES VACUUM BREAKERS ELECTRIC WATER HEATERS
LAVS(Bathroom Sulks) _ _
DISCLAIMER/SIGNATURE BLOCH ': _-_- -
dge, and
her,that I
3 Icertify d yr penalty perjury e theinformation form the work for which the permit application shed by me is true and correct to the best of ymade.leI further gree to hold
harmless
authorized by theowner of the above premises to perform
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. q
�/�n� f,ee —( 37---°4-/---°4-/NAME/TITLE ,Jr"�'9'/'lty t_ DATE I
/ (Signature) (Title)
RELATIONSHIP TO PROJECT `Owner 0 Agent ❑ Contractor ❑ Architect ❑ Other
FOR OFFICE USE ONLY
LALTERATION
IMPROVEMENT
o NEW ❑ADDITION o REPAIR o TENANT o YES ❑NO
BUILDING SHELL ONLY? ❑YES o NO BASIC PLAN?
{ ZONING DESIGNATION
CHANGE OF USE? ❑YES ❑NO
NEW ADDRESS REQUIRED? o YES o NO UP/SEPA/SU? ❑YES ❑NO
PLATTED LOT? a YES a NO DEMO PERMIT REQUIRED? o YES ❑NO
Bulletin#100—March 30,2004 • — Page 2 of 4 k\Handouts—Revised\Pcrmit Application
ELECTRICAL PERMIT INFORMATION I
RESIDENTIAL -COMMERCIAL
NEW COMMERCIAL/INDUSTRIAL SERVICE
NEW RESIDENTIAL SERVICE
Sertrice or Feeder Each Add'n
❑ Single Family Square Feet ❑ 0 to 100 amp $ 94.50 $ 58.00
(First 1300 ft2-$87.00;Each add'n 500 ft2-$28.00) ❑ 101 -200 amp 117.50 74.00
❑ Detached outbuilding or garage ❑ 201-400 amp 220.50 87.00
(Insppectedtwith service) $36.50 ❑ 401-600 amp 256.50 103.00
❑ Detached outbuilding or garage 332.00 140.50
(Inspected separately) $58.00
0 601-800 amp 405.50 169.50
❑ 801 - 1000 amp
fNEW MULTI-FAMILY(three units or more) ❑ Over 1000 amp 442.00 236.00
Service Feeder
❑ Up to 200 amp $ 94.50 $ 28.00 ❑ Over 600 volts surcharge $74.00
O 201 -400 amp 117.50 58.00 ❑ Mast or meter repair $80.00
❑ 401 600 amp 161.00 80.00
❑ 601 800 amp 206.00 110.00 ALTERED COMMERCIAL/INDUSTRIAL
❑ Over 800 amp 294.50 220.50 Service or Feeders
❑ 0 to 200 amp $ 94.50
ALTERED SINGLE MULTI FAMILY ❑ 201 600 amp 220.50
EI ❑ 601 - 1000 amp 332.00
Service or Feeder 369.50
O to 200 amp
$ 72.50 ❑ over 1000 amp
❑ 201 -600 amp 117.50 ❑ #of circuits to be added/altered
❑ over 600 amp 177.00 (1-5 circuits-$74.00;Add'n circuits,$6.00/ea)
❑ #of circuits to be added/altered COMMERCIAL/INDUSTRIAL PLAN REVIEW
(1-4 circuits-$58.00;Add'n circuits$6.00/ea) $74.00 plus 35%of Permit Fee
❑ Service over 200 amps
Mast or meter repair $43.50 ❑ Medical/Educational/Institutional Facility
SINGLE MULTI FAMILY PLAN REVIEW
❑ Service Over 400 amps
$74.00 plus 35%of Permit Fee
MOBILE HOMES
TEMPORARY SERVICE
❑ Service or feeder only $58.00
❑ Service and feeder $94.50 Commercial Residential
❑ 0- 100 $58.00 $51.00
MOBILE HOME/RV PARK 0 101 -200 74.00 51.00
❑ # of service or feeders n/.
(First service/feeder-$58.00;each add'n-$37.50) ❑ 201 -400 87.00
a
0 401 -600 117.50 n/a
❑ over 600 127.00 n/a
MISCELLANEOUS SERVICE/EQUIPMENT
❑ #of Signs
❑ # of Thermostats (First sigo $43.50;add'n sign$20.50/ea)
(First $43.50;add'n-$13.50/ea) ❑ Swimming pool/hot tub $87.00
❑ Low Voltage (Includes additional circuit,if required)
❑ Fire Alarm System
Square Feet to be served by system(s)__- $58.00
0 Yard Pole meter loops
1 o Security Alarm System ❑ Additional Plan Review
(for modified submittals)
$87.00/hour
Cl Voice Cabling
O Data Cabling
(Per❑ System(s) 1•.2500 ft2-$51.00; &,
Each add'n 2500 ft2-13.50) 'Per WAC 29646-910(5)(14 )
Page3of4
k\[landouts-Revised\Permit Application
Bulletin#100-March 30,2004 0