07-103156 •
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CItyoFederalWay Electrical Permit #: 07-10315,6-00-EL
Community Development Services
P.O.Box 9718
Federal Way,WA 98063-9718
Ph:(253)'835-2607 Fax (253)835-2609, Inspection Request Line: (253)835-3050
Project Name: ST FRANCIS HOSPITAL LOADING DOCK
Project Address: 34515 9TH AVE S Parcel Number: 750451 0020
Project Description: Install upto(3)circuits for electrical connection to loading dock,sump pump and controller
Owner Applicant Contractor
FRANCISCAN HEALTH SYSTEM MADSEN ELECTRIC MADSEN ELECTRIC
FRANCISCAN HEALTH SYSTEM 3939 S ORCHARD ST MADSEE*140P8 4/30/08
1717 S J ST TACOMA WA 98466 3939 S ORCHARD ST
TACOMA WA 98405-4933 TACOMA WA 98466
Additional Permit Information
Electrical Fixtures
Circuits- Commercial 3
PERMIT EXPIRES Wednesday, December 5,2007
Permit Issued oa Friday, June 8, 2007
I hereby certify that the above information is correct and that the construction on the above described property and
the occupancy and the use ill be in accordance with the laws,'rules and regulations of the State of Washington
and the City of Federal Way.
/
Owner or agent: ', Date:
_al,g/e 7
FINAL _.
�D
THIS CARD IS TO REMAIN ON-SITE
. . -.. AIL
CITY OF Community Development Inspection Record
Federal Way IVR INSPECTION REQUEST PHONE # (253) 835-3050
PERMIT#: 07-103156-00-EL
Owner: FRANCISCAN HEALTH SYSTEM
Address: 34515 9TH AVE S
FEDERAL WAY, WA 98003-6761
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.
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0 Slab/Concrete Floor(4255) ❑ Ditch cover(4030) 0 Pool Bonding (4195)
Approved to place concrete Approved Approved
By Date By Date By Date
ElTemporary Power(4275) %, El Service(4235) 0 Feeders/Sub-panels(4045)
Approved Approved Approved
By Date By Date By Date
❑ Rough Electrical(4225) ❑ Ceiling Cover(4020) ❑ Final- ctrical(4055)
Approved Approved Approved
By Date By Date B cc Date 7— (p ,. '
❑ Under-slab groundwork(4295) .
Approved
By Date
• I
For inspector reference only _
O Rough Electrical D FINAL-Electrical
Approved Approved
- By Date By Date
406/%144
CITY OF
Federal Way r I ' -
• y RC/�'` PERMIT SF MF CO ME GPL DE EN FP
COMMUNITY DEVELOPMENT SERVICES
33325 8*"AVENUE SOUTH•PO BOX 9718IVP P L I CATION TD
, 0 - 7]8 304
,1u 1*I $ ) /
253-835-2607FEDERALWAY•FAXWA 25398-86335-2609 '�
unnw.dtrlolfederahnau.com AL
^ WA1
FF fOeftC
The following is requ ji � till-an incomplete application will not be accepted. Please print legibly(in ink)or type.
0 PROPERTY INFORMATION
SITE ADDRESS 3415 15 1TM 1444, 5 SUITE/UNIT#
ASSESSOR'S TAX/PARCEL# 75 .0 4 S - 00 20 LOT SIZE(sj)
LEGAL DESCRIPTION (e.g.Acme Estates,Lot 1)
(Attach separate page for lengthy legal description)
• PROJECT INFORMATION
TYPE OF PERMIT 0 BUILDING 0 PLUMBING 0 MECHANICAL
0 DEMOLITION Ci(ELECTRICAL 0 ENGINEERING 0 FIRE PREVENTION SYSTEM
PROJECT DESCRIPTION(Provide detailed description of work included on this permit onlu)
Elec roti•-1 Cnv etec.4-.>n,,. Laacl�vt� cock S�w.P Puny p a,vlct Cot4nrlkr
PROJECT NAME(Name of Business or Owner Last Name) 1 _ 1 • d A ar
MI PEOPLE INFORMATION
PROPERTY NAME PRIMARY PHONE ,
OWNER 4e&LfL
MAILING ADDRESS CITY,STATE,ZIP E-MAIL ADDRESS
1-71-1 5. S sr T Cow.a , WA_ /egos- 4953 clawielybis
CONTRACTOR COMPANY NAME APPLICANT NAME OFFICE PHONE
itlf ser. Elec.lr;c ( 253 ) 383 - 4Yr4/4.
MAILING ADDRESS CITY,STATE,ZIP CELL PHONE
3'39 5. Orr.kArd s-r Th (4.k►. 98446 ( ) -
CITY OF FEDERAL WAY BUSINESS LICENSE NUMBER • EXPIRATION DATE FAX NUMBER
19"91 /0(0.(,33 -00- L I2I3II2oo-i (zss ) S9( - 7079
COPY o[ca:d required CONTRACTOR'S REGISTRATION NUMBER EXPIRATION DATE E-MAIL ADDRESS
with each appltcatlon _ /►1 x 1)5 E-E. * Iyo P8 W 3o1 Lai
APPLICANT COMPANY NAME APPLICANT NAME OFFICE PHONE
h1RDstEu .El•ec.LrvC- (zc ) 393 - 'i{'SYL
MAILING ADDRESS CITY,STATE,ZIP CELL PHONE
3139 5, OrchArdc-- Twtoww l.Ja• ?Robb ( ) -
RELATIONSHIP TO PROJECT FAX.NUMBER
❑ Architect 0 Tenant 0 Agent . Other ( z53 ) 5 ( - 7079
PROJECT NAME PRIMARY PHONE E-MAIL ADDRESS
CONTACT OI}%) REbD? (z.s-s ) 3 IS - 2..'I5, reckli imacse„e led6-•COw..
LENDER NAME Per RCW 19.27.095:
Lender information is required if project value exceeds$5,000
MAILING ADDRESS CITY,STATE,ZIP PHONE
( )
• DETAILED BUILDING INFORMATION
EXISTING USE PROPOSED USE
EXISTING ASSESSED/APPRAISED VALUE$ VALUE OF PROPOSED WORK $
SPRINKLERED BUILDING? ❑ YES ❑ NO FIRE SUPPRESSION SYSTEM PROPOSED/REQUIRED? ❑ YES 0 NO
WATER SERVICE PROVIDER ❑ LAKEHAVEN ❑ HIGHLINE 0 TACOMA 0 PRIVATE(WELL)
SEWER SERVICE PROVIDER ❑ LAKEHAVEN ❑ HIGHLINE ❑ PRIVATE(SEPTIC)
AREA DESCRIPTION EXISTING PROPOSED TOTAL
SQ.FT. SQ. FT. SQ.FT.
BASEMENT •
•
FIRST
•
SECOND
THIRD •
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ADDITIONAL FLOORS(DESCRIBE) •
DECK(O COVERED OR 0 UNCOVERED?) '
GARAGE 0 CARPORT 0
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NUMBER OF FLOORS Faun= PROPOSED TOTAL TOTAL Ed187RNOSr TOTAL PROPOSED Al TOTALS?
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"NEW HOMES ONLY" NUMBER OF BEDROOMS ESTIMATED SELLING PRICE $
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• FIXTURES
Indicate number of each type of facture to be installed or relocated as part of this project. Do not include existing fixtures to remain.
MECHANICAL
Value of Mechanical Work$ (A COPY OF BID OR ESTIMATE MUST BE INCLUDED WITH APPLICATION)
AIR HANDLING UNITS EVAPORATIVE COOLERS GAS PIPE OUTLETS WOODSTOVES
BBQS. FANS GAS WATER HEATERS MISC(Describe)
_ BOILERS FIREPLACE INSERTS HOODS(commercial)
COMPRESSORS FURNACES RANGES
DUCTS ' • GAS LOG SETS REFRIG.SYSTEMS
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PLUMBING
BATHTUBS(or7ub/Shower combo) LAVS(Bathroom Sinks) URINALS MISC(Describe)
DISHWASHERS RAINWATER SYST VACUUM BREAKERS
DRINKING'FOUNTAINS' SHOWERS WATER CLOSETS(Toilet)
ELECTRIC WATER HEATERS SINKS WASHING MACHINES
HOSE BIBBS SUMPS
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SIGNATURE
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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 o the city,including its officers and employees,upon the accuracy of the information supplied to the city as a part of
this application. /
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NAE/TITLE /
M / DATE 6/B/07
(Signature) (Title)
RELATIONSHIP T PROJECT 0 Owner 0 Agent *Contractor 0 Architect 0 Other
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o NEW o ADDITION o ALTERATION o REPAIR o TENANT IMPROVEMENT
BUILDING SHELL ONLY? ❑YES o NO . BASIC PLAN? o YES n NO
ZONING DESIGNATION CHANGE OF USE? o YES o NO
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NEW ADDRESS REQUIRED? o YES o NO UP/SEPA/SU? o YES o NO
PLATTED LOT? o YES o NO DEMO PERMIT REQUIRED? o YES o NO
Bulletin#100—April 2,2007 Page 2 of 4 k\Handouts\Permit Application
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- ELECTRICAL'.PEltMIT>INFORMATION --
RESIDENTIAL COMMERCIAL
NEW RESIDENTIAL SERVICE NEW COMMERCIAL/INDUSTRIAL SERVICE
❑ Single Family.Square Feet
Service or Feeder Each Add'n
' (Fiist 1300 ft2-'$111.00;Each add'n 500 ft2-$35.50) ❑ 0 to 100 amp $120.50 $74.00
❑ Detached outbuilding or garage ❑ 101-200 amp 149.50 94.50
(Inspected with service) $47.00 ❑ 201-400 amp 280.00 111.00
❑ Detached outbuilding or garage ❑ 401-600 amp '327.00 131.00
' (Inspected'separately) $74.00 0 601-800 amp 423.00 179.00
0 801 - 1000 amp 516.50. 216.00 •
II NEW MULTI-FAMILY(three units or more) ❑ Over 1000 amp 563.00 300.00
Service Feeder
O Up to 200 amp $120.50 $35.50 ❑ Over 600 volts surcharge $94.50
O 201 -400 amp 149.50 74.00 0 Mast or meter repair $102.00
O 401 -600 amp 205.00 102.00 ALTEREDCOMMERCIAL%INDUSTRIAL
0 601 -800 amp 262.00 140.50
I ❑ Over 800 amp 375.50 280.50 Service or Feeders
❑ 0 to 200 amp $120.50
I I ALTERED SINGLE/MULTI FAMILY 0 201 -600 amp 280.50
❑ 601 - 1000 amp 423.00
Service or Feeder ❑ over 1000 amp 471.00
❑ 0 to 200 amp $92.50
❑ 201 -600 amp 149.50 A 3 41 of circuits to be added/altered
I ❑ over 600 amp 225.50 (1-5 circuits-$94.50;Add'n circuits,$7.00/ea)
1
❑ # of circuits to be added/altered COMMERCIAL/INDUSTRIAL PLAN REVIEW
(1-4 circuits-$74.00;Add'n circuits$7.00/ea) $94.50 plus 35%of Permit Fee
❑ Service- 1,000 amps or greater
I ❑ Mast or meter repair $55.00 ❑ Medical/Educational/Institutional Facility
MANUFACTURED HOMES
❑ Service or feeder only $74.00
❑ Service and feeder $120.50
TEMPORARY SERVICE
MOBILE.HOME/RV PARK Residential/Multi-Family $65.00
❑ #of service or feeders
(First service/feeder-$74.00;each add'n-$48.00) Commercial/Industrial Service or Feeder Ampacity
O 0- 100 amps $74.00
❑ 101-200 amps 94.50
0 201-400 amps 111.00
O 401-600 amps 149.50
O over 600 amps 162.00
MISCELLANEOUS SERVICE/EQUIPMENT
❑ #of Thermostats ❑ #of Signs
(First-$55.00;add'n-$17.00/ea) (First sign-$55.00;add'n sign$26.00/ea)
❑ Low Voltage ❑ Swimming pool/hot tub $111.00
Square Feet to be served by system(s) (Includes additional circuit,if required)
❑ Fire Alarm System 0 Yard Pole meter loops $74.00
❑ Security Alarm System 0 Additional Plan Review $111.00/hour
❑ Voice Cabling (for modified submittals)
❑ Data Cabling
. 0 0 Automation Fee on all Permits .. $5.00
1.12500 ft2-$65.00;
Each add'n•2500 ft2-17.00) •Per WAC 296.46-910(5)(b)(i&ii)
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Bulletin 11100-April 2,2007 Page 3 of 4 k\Handouts\Permit Application