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Home My WebLink AboutBLD2014-00166 BUILDING PERMIT APPLIAION BLD14-00166 Review Type: Jefferson County Department of Community Development 621 Sheridan Street Port Townsend, WA 98368 PERMIT#: BLD14-00166 Received Date: 5/8/2014 SITE ADDRESS: 75 OUTLOOK LN PORT LUDLOW, 98365 OWNER: GARTH S LINDSEY TRUSTEE PHONE: 360-437-4177 MARY H LINDSEY TRUSTEE 28368 RIVER TRAIL LN VALENCIA CA 91354-1893 TEAL LAKE VILLAGE SUBDIVISION: Block: Lot: PARCEL NUMBER: 998700096 Section: 21 Township: 28 N Range: 01 E CONTRACTOR: AIR FLO HEATING COMPANY INC PHONE: 360-683-3901 221 W CEDAR SEQUIM WA 98382 Contractor's License AIRFLI*206DG Expires 4/25/2016 REPRESENTATIVE: PHONE: PROJECT DESCRIPTION replace existing heat pump TYPE OF WORK NON SQUARE FOOTAGE: TYPE OF IMP MEC VALUATION MAIN: CODE EDITION: 2012 ADD'L: HEAT TYPE: OCCUPANCY: HEAT BASE: HEAT TYPE: OCCUPANCY: UNHEATED: #OF STORIES: CONST TYPE: OTHER: SHORELINE: CONST TYPE: GARAGE: SETBACK: DECK. BANK HEIGHT: SEWAGE DISPOSAL: WATER SYSTEM: BEDROOMS: BATHROOMS: Exist: Exist: Prop: Prop: Total: Total: Routing Date: Type Amount Paid By: Date: Receipt: Approved/Date Permit $152.00 MEB 05/07/14 148657 Total: $152.00 APPROVED MAY 072 014 Jefferson County DCD 1\hir4cmor4\rle4o\fnrmc\F RI fl Ann ft lei rnt F/RI9fiiA * .. • III / 111 --■G(6. RECFEOVIE0 �ggON pp6, JEFFERSON COUNTY �,,.4 MAY 6 2014 DEPARTMENT OF COMMUNITY DEVELOPMENT "d 621 Sheridan Street• Port Townsend •Washington 98368 4, 360/379-4450 • 360/379-4451 Fax JEFFERSON COUNTY C# www.co.jefferson.wa.us/commdevelopment DEFT.OF COMMUNITY DEVELOPMENT Master Permit Application . MLA: , Project Description(include separate sheets as necessary): reap t s-e e.xts t-i n 5 he wf- pki..M•p sysAI-M Tax Parcel Number: C61000 qb Property Size: (acres/•tuare feet) Site Address and/or Directions to Property: 5 00-E-tcx>u- L.wc x.. Pcx-t lA>..cl • L.,)A- Property Owner(s)of Record: Gi2r kv -I~ Mar.-) 1.1 o.aa Telephone: X31- 4 fl 1 Fax: 1 J email: Mailing Address: Applicant/Agent(if different from owner): Air cu) }-kea-}'n Telephone: 3te0-%Deb-60101 Fax to 85- Wri r email:t tt r aw--tto eet itT4.core ' Mailing Address: 221 W. Cedar Sit• SeXiku►s,M ,WQ a►e38 - What kind of Permit?(Check each box that applies OBuilding ❑Critical Areas Stewardship Plan ❑ Demolition Permit ❑Variance(Minor,Major or Reasonable Economic Use) O Single Family ❑Garage Attached/Detached 0 Conditional Use[C(a),C(d),or C]" ❑ Manufactured Home 0 Modular ❑Discretionary"D"or Unnamed Use Classification ❑ Commercial" 0 Special Use(Essential Public Facilities)'" ❑ Change of Use ❑Boundary Line Adjustment ❑ Address ❑Road Approach ❑Short Plat•" O Home Business ❑Cottage Industry 0 Binding Site Plan-- ❑ Propane 0 Long Plat'"' O Sign ❑Planned Rural Residential Development(PRRD)/Amendments" ❑Allowed'Yes"Use Consistency Analysis ❑Plat Vacation/Alteration•• ❑Stormwater Management 0 Shoreline Master Program Exemption/Permit Revisions.. ❑ Site Plan Approval Advance Determination(SPAAD)* ❑Shoreline Management Substantial Development-- O Temporary Use 0 Shoreline Management Variance 0 Wireless Telecommunication• 0 Comprehensive Plan/UDC/Land Use District Map Amendment O Forest Practices Ad/Release of Six-Year Moratorium 0 Jefferson County Shoreline Master Program Amendment 'May require a Pre—Application Conference ❑Tree Vegetation Request "Requires a Pre-Application Conference, Please identify any other local,state or federal permits required for this proposal,if known: ^^ DESIGNATION OF AGENT I hereby designate T7■r to #eat■n- to act as my agent in matters relating to this application for permit(s). OWNER SIGNATURE Date: 44r;J 30, Zv )Y By signing this application form,the owner/agent attests that information provided herein,and in any attachments,is true and correct to the best of on his,her or its knowledge. Any material falsehood or any o ,-7,n of a material fact made by the owner/agent with respect to this application packet may result in this permit being null and void. I further agree to save,indemnify and hold harmless Jefferson County against all liabilities,judgments,court costs,reasonable attorney's fees and expenses which may in any way accrue against Jefferson County as a result of or in consequence of the granting of this permit. I further agree to provide access and right of entry to Jefferson County and its employees,representatives or agents for the sole purpose of application review and any required later inspections. Staffs access and right of entry will be assumed unless the applicant informs the County in writing at the time of the app n he or she wants prior notice. Signature: Date: y' 3v Y The action or actions Applicant will undertake as a result of the issuance of this permit may negatively impact upon one or more threatened or endangered species and could lead to a potential"take"of an endangered species as those terms are defined in the federal law known as the "Endangered Species Act'or`ESA."Jefferson County makes no assurances to the applicant that the actions that will be undertaken because this permit has been issued will not violate the ESA. Any individual,group or agency can file a lawsuit on behalf of an endangered species regarding your action(s)even if y•u are in compliance with the Jefferson County development code.The Applicant acknowledges that he,she or it holds individual and non-transfea sibdity for adhering to and complying with the EM. The Applicant has read this discla' r and signs and dates it below. Signature: Date: 7' 30-(Y G:\PermitCenter\###FORMS###\DRD FORMS\Master Pemut.Application 5-29-08.doc v 1 III n BUILDER STATEMENT The signer of this statement does hereby certify that they are the Owners of the parcel referenced herein,that they are not licensed contactors aria they will be assuming the responsibility of the General Contractor for the proposed project. Signature: Date: GENERAL CONTRACTOR OR MANUFACTURED HOME INSTALLER: PHONE: FAX: ( ) ( ) MAILING ADDRESS: ' EMAIL: CONTRACTOR'S LICENSE WAINS NUMBER: NUMBER ARCHITECT/ENGINEER: PHONE ( ) FAX:( ) MAILING ADDRESS: EMAIL Project Type: Frame Type: Bathrooms: Shoreline: Type of Sewage Disposal: ❑ New 0 Wood Existing: ❑ Sewer ❑ Addition ❑ Steel Proposed: Bank ❑ Community System ❑ Alteration/Remodel ❑ Concrete Total: Height: ❑ Individual System ❑ Repair ❑ Masonry SEP Permit# ❑ Demolition ❑ Other: Bedrooms: Water Supply: Existing: Setback: ❑ Private well 0 Two Party Typ f :- Proposed: ❑ Public Total: Name of System: If this is a Commercial Prolect.:xou must answer the following: Number of Parking Spaces: Currant Proposed: Number of 6D Parking Spaces: Number of occupants(includes owners,tenants,employees,etc) Current Proposed IBC Occupancy: IBC Type of construction: Will you have Food Service? Yes / No. If this is a Propane Tank and/or Appliance Installation permit,mark all items below that apply: i Underground Tank i Above ground Tank Size of Propane Tank: i Heat Stove I Cook Stove T Woodstove 1 Fireplace Insert 1 Hot Water Tank I Pellet Stove i Other is this appliance being installed in a Manufactured/Mobile Home? Yes / No When applying fora permit to install a propane tank you must also submit a site plan showing all of the buildings,all property lines,tank location and size,distances from the propane tank to all property lines,buildings and septic system components, including the reserve area. S•uare Foo• :e Current d ?; . Main Floor Heated n EH Bid App Review: - 2 °Floor Heated Consistency Review: Other Heated Base fee: • . Mezzanine Additional Section: Heated Basement Plan Check fee: Unheated Basement State Surcharge fee: Other Unheated Pot Water Review fee: Garage/Carport SUBTOTAL Decks 911/Rd Approach fee: Other n, . TOTAL: $ /'„ OD Ogitc v iki) Receipt Number° /4 1t,5 7 Cash/Check Number. +Z 30 ,/ 5�5� .A tlil�- -7 (a ESTIMATED COST(REQUIRED) Date: 05/0 �/ .Fair market value of all labor and sited( foundation to finish,Ui1� tt $ le Initiale: �,O E i fE • G: FORMS\Master Permit Application 5-29-08.docD 0 I MAY 2014 �I JEFFERSON COUNTY ......�.....•,.,MIT/nnm noeeCpR • • • gE 1111 " ' W L) 0 Q E- 1 J rF';"F--a: L6j 1 I 1 S LA q E .-._...........-- [ i-43 \ 1 (2 CO 1 AIR FLO HEATING COMPANY 14 Page 1 of 2 • 0 Washington State Department of Labor & Industries AIR FLO HEATING COMPANY INC Owner or tradesperson 221 W CEDAR BEQUETTE, MARK A SEQUIM, WA98382 360-683-3901 Principals CLALLAM County BEQUETTE, MARK A, PRESIDENT BEQUETTE, SANDRA A, VICE PRESIDENT BERSON, JOEL R, SECRETARY FULLAWAY, MICHAEL (End: 04/01/2010) Doing business as AIR FLO HEATING COMPANY INC WA UBI No. Business type 600 347 761 Corporation License Verify the contractor's active registration/license/certification (depending on trade)and any past violations. Construction Contractor Active. Meets current requirements. License specialties HeatingNent/Air-Conditioning and Refrig (HVAC/R) License no. AIRFLI*206DG . Effective—expiration 03/07/1980—04/25/2016 Bond CBIC $6,000.00 Bond account no. SI5215 Received by L&I Effective date 02/05/2010 02/01/2010 Bond history Insurance American Hallmark Ins Co of Te $1,000,000.00 Policy no. 44CL483619 Received by L&I Effective date 04/18/2014 04/25/2014 https://secure.lni.wa.gov/verify/Detail.aspx?UBI=600347761&LIC=AIRFLI*206DG&SAW= 5/8/2014 Screen: 01 REAL PROPERTY MASTER Mode: INQUIRY Parcel# 000998700096 411eo Cd 282121107231 Auto Roll : OFF TEAL LAKE VILLAGE Nbhd Cd 3351 LOT 96 Loc ID * Taxpayer Cd LIND 3670 LINDSEY TRUSTEE, GARTH S T/P Chg Dt 6/26/2001 * Title Owner T/P Chg Usr JODI Tax Code 0231 Status TX TAXABLE Land Use 1100 RES-SINGLE Affidavit 92417 Vol/Page / C/U Code COMPLETE ADDRESS WINDOW Taxpayer LIND3670 GARTH S LINDSEY TRUSTEE MARY H LINDSEY TRUSTEE LINDSEY FAMILY TRUST 28368 RIVER TRAIL LN VALENCIA CA 91354-1893 Search Key CMD 6 : End Window CMD 7: End of Job • .. • MECHANICAL AND DEMOLITION PERMIT Jefferson County Department of Community Development 621 Sheridan Street, Port Townsend, WA 98368 (360)379-4450 FAX (360)379-4451 PERMIT#: BLD14-00166 Received Date 5/8/2014 SITE ADDRESS: 75 OUTLOOK LN Issue Date 5/8/2014 PORT LUDLOW,98365 APPLICANT: GARTH S LINDSEY TRUSTEE PHONE: 360-437-4177 MARY H LINDSEY TRUSTEE 28368 RIVER TRAIL LN VALENCIA CA 91354-1893 SUBDIVISION: TEAL LAKE VILLAGE Block: Lot: PARCEL NUMBER: 998700096 Section:21 Township:28N Range:01E CONTRACTOR: AIR FLO HEATING COMPANY INC PHONE: 360-683-3901 221 W CEDAR SEQUIM WA 98382 __ Contractor's License AIRFLI"206DG Expires 4/25/2016 OWNER, GARTH S LINDSEY TRUSTEE PHONE: 360-437-4177 if different: MARY H LINDSEY TRUSTEE 28368 RIVER TRAIL LN VALENCIA CA 91354-1893 PROJECT DESCRIPTION: replace existing heat pump Directions To Site: THIS PERMIT IS VALID FOR ONE YEAR AND IS NOT RENEWABLE. THE FINAL INSPECTION MUST BE SCHEDULED AND PASSED WITHIN THAT YEAR. THE EXPIRATION DATE IS 5/8/2015. REQUIRED INSPECTIONS: Installation per Manufacturer Specifications/CO2: Tank/Line/Appliance: Final Approval: 4)....q/14 BUILDING INSPECTION HOT-LINE 379-4455. REQUESTS MUST BE RECEIVED BY 3 PM THE DAY BEFORE THE INSPECTION IS NEEDED. Office Hours 9:00 a.m.-4:30 p.m. Monday-Thursday HOT LINE AVAILABLE 24 HOURS A DAY \\tidemark\data\forms\F_BLD_Permit_P ropane.rpt 5/8/2014 �QQ45°N `'°o JEFFERSON COUNTY , DEPARTMENT OF COMMUNITY DEVELOPMENT Date: 5/r9,--4- Time Received: 14;(o a pm Mon. Tue. Wei Fri. Date. 5 41jAubl-g BLD: Pi — /C'6' Contact Name: Owner: Contact Number: 360 ' ?>"q 41 4 " Address: `7 � 206 Notes: Foundation Plumbing Framing Propane Tank Mechanical J Oecx{-Puy X Setbacks Under-ground Framing Under ground Furance Footing Rough In Air Seal Above ground Gas Stemwall Hydronic Exterior shear Exterior lines Oil Straps Hot Water Htr Interior shear Interior lines Ducts Post Hole Ventilation Appliance Underfloor Gas/Wood stove Man-Homes Insulation Final Inspection Setbacks Floor Foundation Wall Address Posted Block&Tile Ceiling • Inspections are required to be called in by 3:00 pm to receive an inspection the next day. Do to staffing issues, at this time,we cannot guarantee that you will receive an inspection the next day. day. Unless you receive a call from us,assume we will arrive on your requested inspection day. • You may leave an inspection request 24 hours a day, and Inspections are available from Monday through Friday. - We cannot determine the time we will arrive in advance. However, if you call our office the morning of your inspection,around 9:00 a.m.,we can give an estimate of when the inspector will arrive. Our general office phone number is 360 379-4450. • An approved set of plans are to be on site with building permit for all inspections. If permit and plans are not on site at time of inspection,a re-inspection fee must be paid prior to re-scheduling another inspection. • If no access, no inspections will be performed, and a re-inspection fee must be paid prior to re-scheduling another inspection. Inspectors will not access a home that has personal affects inside when the owner is not present. • Commercial projects require 24 hour notice for inspection. JEFFERSON COUNTY •D CD NO. 1 � 57 DATE �/O7//4 RECEIVED FROM 124/1 ,,671/ //, th i DESCRIPTION / BARS# AMOUNT CURRENCY _4;2 ii 1e/i COIN . 1C # / . 00 cif ECKs co irk 1/ ,T,.,,,,,,,,,,.f.via m xi X000 i RECEIVED BY _ I TOTALS/ 7 1. CO