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HomeMy WebLinkAboutBLD2014-00304 - MECHANICAL BLD14-00304 BUILDING PERMIT APPLICATIde Review Type: Jefferson County Department of Community Development 621 Sheridan Street Port Townsend, WA 98368 PERMIT#: BLD14-00304 Received Date: 8/27/2014 SITE ADDRESS: 430 MEADE RD NORDLAND, 98358 OWNER: KATHLEEN A DES LAURIERS PHONE: 707-217-0316 430 MEADE RD NORDLAND WA 98358-9618 9777 SUBDIVISION: Block: Lot: 47+ PARCEL NUMBER: 977700077 Section: 4 Township: 29 N Range: 1 E 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 Ductless Heat Pump TYPE OF WORK NON SQUARE FOOTAGE: TYPE OF IMP MEC MAIN: VALUATION ADD'L: HEAT TYPE: HTP CODE EDITION: 2012 HEAT BASE: HEAT TYPE: OCCUPANCY: UNHEATED: #OF STORIES: OCCUPANCY: OTHER: CONST TYPE: 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 SRE 08/25/14 151439 APPROVED Total: $152.00 �- AUG 272014 Jefferson County DC II \\tidemark\data\forms\F_BLD_App_Bld.rpt 8/27/2014 ��� ¢SON c���G .1E: :RSON COUNTY . . .1.0t_l DEPARTMENT OF COMMUNITY DEVELOPMENT 621 Sheridan Street Port Townsend,WA 98368 Web:www.co.iefferson.wa.us/communitydevelopment ESN1 N -' Tel:360.379.4450 I Fax:360.379.4451 I Email:dcd(@,co.iefferson.wa.us Building Permits&Inspections I Development Consistency Review I Long Range Planning I Watershed Stewardship Resource Center Master Permit Application MLA: Project Description(i lude separate sheets as neces a : '1-Sfcc,- J ,fi t� ss /-La I l ,� 1'02 Tax Parcel Number. 9 3?-•,eC©) ?" Property Size: (acres/square feet) Site Address and/or Directions to Property: 130 Pak/heci/ id 4- Property Owner(s)of Record: ti&G/1 DS Leaf r c.TS Telephone:36 O S—95-.2/ Fax: email: Mailing Address: 1713.9 / Q4 cie Jena Applicant/Agent(if different from owner):_fl4/'U 4I -4 14/1 eC Telephone: 36a—0'$/—333 3 Fax: 3,0 6,/ -074 b email: Ist.ai-y6i964,ia c.c freoir Mailing Address: f'©,Ai\/ a3i r /(SI y.. What kind of Permit?(Check each box that applies ❑ Lot or Road Segregation G 74Building 1 k&A.o„, __- ❑ Critical Areas Stewardship Plan ❑ Demolition Permit ❑Variance(Minor, Major or Reasonable Economic Use) ❑Single Family ❑ Garage Attached/Detached ❑ Conditional Use[C(a , K• • .' --1\❑ Manufactured Home ❑ Modular ❑ Discretionary"D"or f . : : l ❑ Commercial* A ❑ Special Use(Essenti:t • • . ❑ Change of Use ❑ Boundary Line Adjus - I ❑ Address ❑ Road Approach ❑ Short Plat** I n I /l y,' 71 � ❑ Home Business ❑ Cottage Industry ❑ Binding Site Plan** I ; -' ' '` 1 ❑ Propane ❑ Long Plat** Li j! i i__J)❑Sign ❑ Planned Rural Resid-ntial dmen ** U ❑Allowed"Yes"Use Consistency Analysis ❑ Plat Vacation/Alteration** 1 FERSOiv CNN ❑Stormwater Management ❑Shoreline Master Program i^°T i. a ** ❑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: /Q /� ,, DESIGNATION OF AGENT I hereby designate A T- to act as my agent in matters relating to this application for permit(s). OWNER SIGNATURE iI. / f9' Date: ilf/ratIli II By signing this application form,the owner/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 and right of entry to Jefferson County and its employees,representatives or agents for the sole purpose of application review and any re,uired later• spections. Staffs access and right of entry will be assumed unless the applicant informs the County in writing at the time of the appli d that r e wants prior notice. © / P-.)h. Signature: Date: cl 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 you are in compliance with the Jefferson County development code.The Applicant acknowledges that he,she or it holds individual and non-transfe respon i ill for adhering to and complying with the ESA. The Applicant has read this disclai r and igns and dates it below. Signature: Date: o67 e /51 07/24/201 0 5f_I_O__tigALIL__ AJi-- /a il f 6 11, 1., ' ) t c 1 izi , ! i ' 1 7 ^ I i lie f , 7.t:,... , - o ft-,ce Law WA'i ,., I ,, i. 7., : eP a, ,..........„ f .,„,, wi P ill■",, , i. i ,, it( 1 S. 4 / i - ' .', 14 fj it 444f Ali t JEFFERSON COUNTY .CCD NO. 151 9 )) s DATE �OI 1 • RECEIVED FROM 1 fl I. lAera. The. DESCRIPTION BARS# AMOUNT ����ppp CURRENCY 3 R a , I`� *� COIN , l � � 19 s *1373 - c � n y x I 1 cn idy. d M q . # a7 '7 Ait RECEIVED BY ��! / A .i�,Aik4 TOTAL I �� Parcel Details Page 1 of 2 ,40, 0 ----1 :::4-1,), -*'* f f c nty '/I'' .#' A. e erson ou 4 ‘‘‘---�a - ke E N Home . County Info -Departments ears Parcel Number: 977700077 SEARCH Parcel Number: 977700077 Printer Friendly Owner Mailing Address: KATHLEEN A DES LAURIERS 430 MEADE RD NORDLAND WA98358-9618 Site Address: 430 MEADE RD NORDLAND 98358 Section: 4 School District: Chimacum (49) Qtr Section: NW1/4 Fire Dist: Chimacum (1) Township: 29N Tax Status: Taxable Range: 1E Tax Code: 0211 Planning area: Marrowstone (3) Sub Division: 9777 - OLSONS & HAMBLETONS Assessor's Land Use Code: 1100 - Residential Single Unit Property Description: OLSON & HAMBLETON'S LOTS 47 &48(TAX 117) Tax,A/V, Sales, Photos, and Permit Data Bido Data Map Parcel Plats&Surveys Septic Monitoring Info '" Jefferson County '„ H OME i COUNTY INFO I DEPARTMENTS I SEARCH Best viewed with Microsoft Internet Explorer 6.0 or later Windows- Mac 8/27/2014 http://www.co.jefferson.wa.us/assessors/parcel/parceldetail.asp?Parcel_NO=977700077 PENINSULA HEAT INC Page 1 of 2 ehWashington State Department of Labor & industries I PENINSULA HEAT INC 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&1 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= 8/27/2014 PENINSULA HEAT INC Page 2 of 2 Insurance history • Savings N.o.savi. gs accounts during the previous 6 year period. Lawsuits against the bond or savings No lawsuits against the bond or savings accounts during the previous 6 year period. L&I Tax debts No L&I tax debts are recorded for this contractor license during the previous 6 year period, but some debts may be recorded by other agencies. License Violations No license violations during the previous 6 year period. Workers' comp Do you know if the business has employees? If so, verify the business is up-to-date on workers' comp premiums. L&I Account ID Account is current. 920,088-00 Doing business as PENINSULA HEAT INC Estimated workers reported Quarter 2 of Year 2014"7 to 10 Workers" L&I account representative T4/CARIE PICKETT(360)902-5592-Email: PICC235 @Ini.wa.gov Workplace safety and health No inspections during the previous 6 year period. ©Washington State Dept.of Labor&Industries.Use of this site is subject to the laws of the state of Washington. .: Access AllikWashingto0 c r.th! I&Ye trWOrnW3tlik W $ite https://secure.lni.wa.gov/verify/Detail.aspx?UBI=601737680&LIC=PENINI*0440W&SAW= 8/27/2014 �,SGN ca ^� °�, JEFFERSON COLIK { gSxr�G,G? DEPARTME OF COMMUNITY DEVELOP.NT / Date: ,— Time Received: //9/7 3/pm Mon. Tue. at, Thur. Fri. Date: 7--/Q BLD: /1 Contact Name: _3ny Owner: Contact Number: 360 5 1,S;2J Address: q'30 yd 0, /0 206 7,97#2 1793/6 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 • • Jefferson County Building Division Permit Number: BLD14-00304 Applicant: DES LAURIERS BUILDING PERMIT INSPECTION APPROVALS Applicable Code: 2012 International Building Codes To schedule inspections, call (360)379-4455 no later than 3:00PM the day before the inspection is needed. Requests received after 3:00 PM will not be scheduled for the next day's inspections. ELECTRICAL PERMITS are issued by the Washington State Department of Labor& Industries. The electrical permit must be signed off by the State Inspector prior to the County's Framing Inspection Inspection Item Date Approval Signature Notes Mechanical Systems -I -i(;.- 1(l Ductless Heat Pump x2 A final inspection will not be scheduled until all of the following are completed and signed off by the applicable Department: • Building Permit Conditions are met • Septic Permit Final/Complete for any building containing plumbing • Land Use Conditions met and signed off • Public Works Permit Final(where applicable) FINAL INSPECTION q,_10 -i 4 FINAL INSPECTION MUS1BE APPROVED PRIOR TO BUILDING BEING OCCUPIED THIS PERMIT IS VALID FOR ONE YEAR • BUILDING PERMIT Jefferson County Department of Community Development 621 Sheridan Street, Port Townsend, WA 98368 (360)379-4450 FAX (360)379-4451 PERMIT#: BLD14-00304 Received Date: 8/27/2014 SITE ADDRESS: 430 MEADE RD Issue Date 8/27/2014 NORDLAND, 98358 Expiration Date 8/27/2015 OWNER: KATHLEEN A DES LAURIERS PHONE: 707-217-0316 430 MEADE RD NORDLAND WA 98358-9618 9777 SUBDIVISION: Block: Lot: 47+ PARCEL NUMBER: 977700077 Section: 4 Township: 29 N Range: 1 E CONTRACTOR: PENINSULA HEAT INC PHONE: 360-681-3333 PO BOX 173 CARLSBORG WA 98324 Contractor's License PENINI*0440W Expires 10/18/2014 PROJECT DESCRIPTION: Install New Ductless Heat Pump x2-„ TYPE OF WORK NON SQUARE FOOTAGE: TYPE OF IMP MEC MAIN: VALUATION ADD'L: HEAT TYPE: HTP CODE EDITION: 2012 HEAT BASE: HEAT TYPE: OCCUPANCY: UNHEATED: #OF STORIES: OCCUPANCY: OTHER: CONST TYPE: GARAGE: SHORELINE: CONST TYPE: DECK: SETBACK: BANK HEIGHT: SEWAGE DISPOSAL: WATER SYSTEM: Type Amount Paid By: Date: Receipt: BEDROOMS: BATHROOMS: Permit $152.00 SRE 08/25/14 151439 Exist: Exist: Total: $152.00 Prop: Prop: Total: Total: Directions to Site: HEALTH DEPARTMENT AND PUBLIC WORKS APPROVAL REQUIRED PRIOR TO FINAL INSPECTION THIS PERMIT IS VALID FOR ONE YEAR OR IT MUST BE PROPERLY RENEWED BUILDING INSPECTION HOT-LINE 379-4455. Request must be received by 3pm the day before the inspection is needed. • Office Hours 9:00 am -4:30 pm MONDAY- THURSDAY HOT LINE AVAILABLE 24 HOURS A DAY CONDITIONS for Building Permit# : \\tidemark\data\forms\F BLD Permit Bldq.rpt 8/27/2014