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Home My WebLink AboutBLD2014-00260 - MECHANICAL •UILDING PERMIT APPLICA�N BLDI4-00260 Review Type: Jefferson County Department of Community Development 621 Sheridan Street Port Townsend, WA 98368 PERMIT#: BLD14-00260 Received Date: 7/24/2014 SITE ADDRESS: 940 MARTIN RD PORT TOWNSEND, 98368 OWNER: ROBERT AMBROSE PHONE: 907-315-4477 940 MARTIN ROAD PORT TOWNSEND WA 98368 SUBDIVISION: Block: Lot: T 10+ PARCEL NUMBER: 001291012 Section: 29 Township: 30 N Range: 1V1 CONTRACTOR: PENINSULA HEAT INC PHONE: 360-681-3333 PO BOX 173 CARLSBORG WA 98324 Contractor's License PENINI*0440W Expires 10/18/2014 REPRESENTATIVE: PHONE: PROJECT DESCRIPTION Install New Heat Pump TYPE OF WORK NON SQUARE FOOTAGE: TYPE OF IMP MEC VALUATION MAIN: CODE EDITION: 2012 ADD'L: HEAT TYPE: HTP 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: IRouting Date: Type Amount Paid By: Date: Receipt: �4p�y �teC Permit $152.00 SRE 07/21/14 151270 i�1Ai'' e� CC Total: $152.00 JUL 2 4 2014 Jefferson County DCD 1 \\tidemark\data\forms\F_BLD_App_Bld.rpt 7/24/2014 ■ (,urj 1 IG ‘4, �OOZ J.- -FERSON COUNTY LI Q4 I PARTMENT OF COMMUNITY DEVELOPMENT BSI NG�o 621 Sheridan Street Port Townsend,WA 98368 Web:www.co.iefferson.wa.us/communitydevelopment Tel:360.379.4450 I Fax:360.379.4451 I Email:dcd(a.co.jefferson.wa.us Building Permits&Inspections I Development Consistency Review I Long Range Planning I Watershed Stewardship Resource Center Master Permit Application MLA: Project Description(include separate sheets as necessary): TA (A J?____Puc_Hess Ik&t Pump u)/ 2 ,poifc Tax Parcel Number. 00 10111012- Property Size: (acres/square feet) Site Address and/or Directions to Property: 940 /ii4-f PN i.oAP Property Owner(s of Record: Ro ��T J Y. IBIza �I"_ l 11• Telephone: 90'- 3 1r tt} 1 Fax: email: n 12�i�tly f h�eDrI te-c,jf^('gm, / d Mailing Address: _ 01 Applicant/Agent(if different from owner): Pe — (( CO . Telephone: 3 p0 - t;i f--3 333 Fax: �� ,af email: $14.1 epti'li/nscf-(,r ; Mailing Address: .7•0.L I . C-i t- - �1 W/�• • ✓ co*, What kind of Permit?(Check each box that applies ❑ Lot or Road Segregation ❑Building ❑ Critical Areas Stewardship Plan ❑ Demolition Permit ❑Variance(Minor,Major or Reasonable Economic Use) ❑Single Family ❑ Garage Attached/Detached ❑ Conditional Use[C(a),C(d),or C]** ❑ Manufactured Home ❑ Modular ❑ Discretionary"D"or Unnamed Use Classification ❑ Commercial* ❑ Special Use(Essential Public Facilities)** ❑ Change of Use ❑ Boundary Line Adjustment ❑ Address ❑ Road Approach ❑Short Plat"'"' ❑Home Business ❑Cottage Industry ❑ Binding Site Plan** ❑Propane ❑Long Plat** ❑ Sign ❑ Planned Rural Residential Development(PRRD)/Amendments** ❑Allowed"Yes"Use Consistency Analysis ❑Plat Vacation/Alteration** ❑Stormwater Management ❑ Shoreline Master Program Exemption/Permit Revisions** ❑Site Plan Approval Advance Determination(SPAAD)* ❑Shoreline Management Substantial Development** ❑Temporary Use ❑Shoreline Management Variance ❑Wireless Telecommunication* ❑Comprehensive Plan/UDC/Land Use District Map Amendment ❑ Forest Practices Act/Release of Six-Year Moratorium ❑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: r DESIGNATION OF AGENT I hereby designate �.%� _ UL .., to act as my agent in matters relating to this application for permit(s). • 6v-/i1/' V OWNER SIGNATURE ��i/ � L Date: By signing this application form,the .. =r/agent attests that the information provided herein,and in any attachments,is true and correct to the best of his,her or its knowledge. Any material falsehood or any omission 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 a • right of entry to Jefferson County and its employees,representatives or agents for the sole purpose of application review and any require• later ins•-ctio . Staffs access and right of entry will be assumed unless the applicant informs the County in writing at the time of the applicat' ',1 he or s = , :nts prior notice. // // Signature: �L✓ Date: / The action or actions Appli .nt 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 youare in compli with the Jefferson County development code.The Applicant acknowledges that he,she or it holds individual and non-transfera• - =-.•nsibili fib adhering to and complying with the ESA. The Applicant has read this disclai er nd sionr and ates it below. Signature: I / Date: 49 7 I I TI I _ 07/24/201: 1 PENINSULA HEAT INC Page 1 of 2 0 • ehWashington State Department of Labor & industries PENINSULA HEAT INC i Owner or tradesperson PO BOX 173 LOFSTROM, KENNETH JOHN CARLSBORG,WA 98324 360-681-3333 Principals CLALLAM County LOFSTROM, KENNETH JOHN, PRESIDENT LOFSTROM, MARY E, SECRETARY Doing business as PENINSULA HEAT INC WA UBI No. Business type 601 737 680 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 GENERAL License no. PENINI*0440W Effective—expiration 09/16/1996-10/18/2014 Bond CBIC $12,000.00 Bond account no. SA4812 Received by L&I Effective date 07/02/2001 09/16/2001 Expiration date Until Canceled Insurance Ohio Security Ins Co $1,000,000.00 Policy no. BKS 55013351 Received by L&I Effective date 04/04/2014 04/26/2013 Expiration date 04/26/2015 https://secure.lni.wa.gov/verify/Detail.aspx?UBI=601737680&LIC=PENINI*0440W&SAW= 7/24/2014 Parcel Details Page 1 of 2 • Jetterson C unt 0 y Home County Info Departments Search Parcel Number: 001291012 SEARCH Parcel Number: 001291012 Printer Friendly Owner Mailing Address: ROBERT AMBROSE 940 MARTIN ROAD PORT TOWNSEND WA98368 Site Address: 940 MARTIN RD PORT TOWNSEND 98368 Section: 29 School District: Port Townsend (50) Qtr Section: NE1/4 Are Dist:Chimacum (1) Township: 30N Tax Status: Taxable Range: 1W Tax Code: 0111 Planning area: Quimper (2) Sub Division: Assessor's Land Use Code: 1100 - Residential - Single Unit Property Description: S29 T30 R1W TAX 10 (LESS TAX 44)W/EASEMENT Tax,A/V, Sales, Photos,and Permit Data Bide Data Map Parcel Plats&Surveys Septic Monitoring Info '� Jefferson County HOME I COUNTY INFO I DEPARTMENTS I SEARCH Best viewed with Microsoft Internet Explorer 6.0 or later Windows- Mac http://www.co.jefferson.wa.us/assessors/parcel/parceldetail.asp?Parcel_NO=001291012 7/24/2014 • • Mary Lofstrom From: Robert Ambrose <robert@rhythmconnection.org> Sent Friday,July 18, 2014 9:02 AM To: Mary Lofstrom Subject Re:Jeff PUD Permit Great. I love being able to do business via email. Yes,please act as my representative to get the permit. Thanks! Robert On Jul 18,2014,at 9:00 AM,Mary Lofstrom<mary @peninsulaheat.com>wrote: From: Mary Lofstrom Finailto:marv@peninsulaheat.coml Sent:Thursday,July 17,2014 1:16 PM To: 'biz@)rhythymconnection.com' Subject:Jeff PUD Permit Good afternoon Bob, I left a message on your cell phone and then proceeded to find your email address on some paperwork! I am in need of your approval for Peninsula Heat to act as your representative to pull the required permit from Jefferson County. Your approval only need be a positive response to this email. We appreciate your attention. Thanks, Mary Lofstrom 1 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#: BLD14-00260 Received Date 7/24/2014 SITE ADDRESS: 940 MARTIN RD Issue Date 7/24/2014 PORT TOWNSEND, 98368 APPLICANT: ROBERT AMBROSE PHONE: 907-315-4477 940 MARTIN ROAD PORT TOWNSEND WA 98368 T 10+ SUBDIVISION: Block: Lot: PARCEL NUMBER: 001291012 Section: 29 Township: 30N Range: 1W CONTRACTOR: PENINSULA HEAT INC PHONE: 360-681-3333 PO BOX 173 CARLSBORG WA 98324 Contractor's License PENINI*0440W Expires 10/18/2014 OWNER, ROBERT AMBROSE PHONE: 907-315-4477 if different: 940 MARTIN ROAD PORT TOWNSEND WA 98368 PROJECT DESCRIPTION: Install New Heat Pump Directions (Ductless system with 2 ports) 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 7/24/2015. REQUIRED INSPECTIONS: Installation per Manufacturer Specifications/CO2: OK 9/5/4 Tank/Line/Appliance: Final Approval: 2K gi-07 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_Propane.rpt 7/24/2014 f x cbo JEFFERSON COUNTY 5 7 0 73-7L DEPARTMENT OF COMMUNITY DEVELOPMENT WrNG.C° Date: �f� l Time Received: '/ 7 3pm Mon. Wed. Thur. Fri. Date: 7-5— BLD: MI— 26° Contact Name: Owner: Contact Number: 360 ,997 3/c W7a Address: gLA, ^,y 11.7-kt,,t 206 Notes: Foundation Plumbing Framing Propane Tank Mechanical 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 i-SOT t JEFFERSON CCIIINTY DCO *NO. 151270 DATE ��21 / 1 Li RECEIVED FROM earn ` �€( )r) c DESCRIPTION n BARS# AMOUNT 4eCti*V(kW"'\C ) f ri C y W-CURRENCY 6L E 15 2.00 A t 'N ��Suuuut I t �" ti CHECKS/ i PCB " X001 -7 1 -012— 11c311 .14 , 0 --; ',4,,, , o . ,„ ,,,,,;, ,, �� C) 0 RECEIVED BY S ` . R R i S TOTAL )7 I - °°