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HomeMy WebLinkAboutBLD2014-00406 - MECHANICAL • BUILDING PERMIT APPLISION BLDI4-00406 Review Type: Jefferson County Department of Community Development 621 Sheridan Street Port Townsend, WA 98368 PERMIT#: BLD14-00406 Received Date: 10/30/2014 SITE ADDRESS: 610 TALA SHORE DR PORT LUDLOW, 98365 OWNER: MARY EKMAN PHONE: 206-390-9284 4508 33RD AVE W SEATTLE WA 98199-1129 9982 SUBDIVISION: Block: Lot: PARCEL NUMBER: 998200321 Section: 15 Township: 28 N Range: 1E CONTRACTOR: PENINSULA HEAT INC PHONE: 360-681-3333 PO BOX 173 CARLSBORG WA 98324 Contractor's License PENINI*0440W Expires 3/2/2016 REPRESENTATIVE: PHONE: PROJECT DESCRIPTION INSTALL NEW HEAT PUMP AND AIR HANDLER 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: BEDROOMS: BATHROOMS: Exist: Exist: Prop: Prop: Total: Total: Routing Date: Type Amount Paid By: Date: Receipt: es,,NED Permit $152.00 SRE 10/30/14 151675 " s' Total: $152.00 F ; iefferson County DOD \\tidemark\data\forms\F_BLD_App_Bld.rpt 10/30/2014 IsoN �4`' `°ea J•ERSON COUNTY III 4 DEPARTMENT OF COMMUNITY DEVELOPMENT ts" 621 Sheridan Street Port Townsend,WA 98368 i Web:www.co.iefferson.wa.us/communitvdeveloament Tel:360.379.4450 I Fax:360.379.4451 I Email:dcd@co.jefferson.wa.us Building Permits&Inspections I Development Consistency Review!Long Range Planning I Watershed Stewardship Resource Center Master Permit Application MLA: Project Description(include separate sheets as necessary): 2&n o vt- C r,c re-1(�.c,¢__ i- -f Poi . 1 ct'r �-�v��-_ h L,k_ k.,- L�v�'' Tax Parcel Number: 9 9(' 0 3?` Property Size: (acres/square feet) Site Address and/or Directions to Property: to 10 iatct., Sh.or(° Dr, Property Owner(s)of Record: M A t-`{ I-- l_ V-,-I-Ai--1 Telephone: din(o -3¶fo - q 02.8 if Fax: email: Mailing Address: 4-So 8 3 3 I23. Av L W . c ex-Hie- W A ' $l/( q- I 109c( Applicant/Agent(if different from owner): I"(44 Pcn.i n s Lk._(4- 1+r .f Co' Telephone: 3G0 - 81 -- ? 3 3 3 Fax: 36o- t-8( - 2_08Ic email: Y)ka4r j P.,pe,`r stA l 1-• Mailing Address: P o' (3474- 133 C4-r-t5l rr) W&.- /83' 1-- coo- 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 -«• o ' Use) ❑Single Family ❑Garage Attached/Detached ❑Conditional Use[C(a),C(d),or C]** ❑ Manufactured Home ❑ Modular ❑Discretionary"D"or Unnamed Use i ,,,•- . ❑ Commercial* ❑Special Use(Essential Public Facil i �8 n ,, ❑ Change of Use ❑Boundary Line Adjustment / l/,'�� ❑ Address ❑Road Approach ❑Short Plat*" ,- ❑Home Business ❑Cottage Industry ❑Binding Site Plan** �C/ , /.2 ❑Propane ❑Long Plat** " ❑Sign ❑Planned Rural Residential De -opr nt(P , Amendment** ❑Allowed"Yes"Use Consistency Analysis ❑Plat Vacation/Alteration** cPT OF ,fr, ., ❑Stormwater Management ❑Shoreline Master Program Exemption/Pe .1 �'GISrviy ❑Site Plan Approval Advance Determination(SPAAD)* ❑Shoreline Management Substantial Developme Dick, ❑Temporary Use 0 Shoreline Management Variance COPMtn/T ❑Wireless Telecommunication* ❑Comprehensive Plan/UDC/Land Use District Map Amendme P P ❑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: �5 � DESIGNATION OF AGENT I hereby designate to act as my agent in matters relating to this application for permit(s)./ OWNER SIGNATURE Date: /0!/ 7-(02-0/ cz 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 required later ins.icti•ns. Staff's access and right of entry will be assumed unless the applicant informs the County in writing at the time of the applicatioi t at he or sf / .nts prior notice. /D/� (671 Signature: �,.. .� Date: l 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 I le esponsi i'r�for adhering to and complying with the ESA. The Applicant has read this disclaimer and sign and dates it below. Signature: Date: /C/? 7-/a20l 07/24/2013 ke-eC f- # 15R c 5 Ch* 13�3iCj • 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 contractors and that they will be assuming the responsibility of the General Contractor for the proposed project. Signature: Date: GENERAL CONTRACTOR OR MANUFACTURED HOME INSTALLER: PHONE: FAX: Pey v's co (3k Cog I - 3333 (3 ( 1-gOO MAILING ADDRESS: �•(), GU x I 1-3 ca-r-1 j,IAAP, EMAIL: � e ohs t-c.J,J . c c- CONTRACTOR'S LICENSE WAINS NUMBER: PEN IN t-(4-0\A> NUMBER ARCHITECT/ENGINEER: PHONE (340)(og(- 3 333FAx:( ) MAILING ADDRESS: EMAIL Project Type: Frame Type: Bathrooms: Shoreline: Type of Sewage Disposal: ❑ New ❑ 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 ❑ Two Party Type of Heat: , Proposed: ❑ Public PUtly; A4 Total: Name of System: If this is a Commercial Project you must answer the following: Number of Parking Spaces: Current: Proposed: Number of ADA 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: Underground Tank Above ground tank Size of Propane Tank: Heat Stove Cook Stove Woodstove Fireplace.nsert rehtO evotS telleP I knaT retaW toH Is this appliance beinu installed in a Manufactured/Mobile Home? Yes /6_-) When applying for a 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. Square Footage Current Proposed For Office Use Only Amount Revision Main Floor Heated / EH Bid App Review: 2"0 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 TOTAL: $ ( '-p° Receipt Number: Cash/Check Number: a ESTIMATED COST(REQUIRED) Date: i r '� ; •Fair rket value of all Tabor d materials foundation to finish ! ( L S Initials: 1 �1' I J itrr�:ii.�.Cty CD ` D.Pr pF CGiVllt UNITY OFVECppMENr Parcel Details Page 1 of 2 • • _---F--'-.: ,„441 4t Jefferson,,,,..,, 4,,, .30„ ., County „„., i.,, , ,,,,,,,, ,,,,,,,,.. „,A 1.,-., „..,,,_„__„,...„......„...t ., ,z.:,,,...,„.,.-zaD:4„,•..4-ti. ,,.--,-...---------- p-a,..--,„,,,,,=- %4 ' :„, ' '''' Al ' Home County Info .Departments , search Parcel Number: 998200321 SEARCH Parcel Number: 998200321 Printer Friendly Owner Mailing Address: MARY EKMAN 4508 33RD AVE W SEATTLE WA98199-1129 Site Address: 610 TALA SHORE DR PORT LUDLOW 98365 Section: 15 School Dom: Chimacum (49) Qtr Section: SE1/4 Are Dist: Port Ludlow (3) Township: 28N Tax Status: Taxable Range: 1E Tax Code: 0231 Planning area: Paradise Bay (8) Sub Division: 9982 - TALA SHORES Assessor's Land Use Code: 1100 - Residential - Single Unit Property Description: TALA SHORES #3 21 Tax,A/V, Sales, Photos, and Permit Data Bldq 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 IS Windows- Mac http://www.co.jefferson.wa.us/assessors/parcel/parceldetail.asp?Parcel_NO=998200321 10/30/2014 PENINSULA HEAT INC Page 1 of 2 • • 0 Washington State Department of Labor & Industries 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 09/16/1996-10/18/2016 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= 10/30/2014 PENINSULA HEAT INC Page 2 of 2 Insurance history • Savings No savings 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&l Tax debts ......................................... No L&l 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 W 1tin ton ` reWO'NOV https://secure.lni.wa.gov/verify/Detail.aspx?UBI=601737680&LIC=PENINI*0440W&SAW= 10/30/2014 BUILDING PERMIT Jefferson County Department of Community Development 621 Sheridan Street, Port Townsend, WA 98368 (360)379-4450 FAX (360)379-4451 PERMIT#: BLD14-00406 Received Date: 10/30/2014 SITE ADDRESS: 610 TALA SHORE DR Issue Date 10/30/2014 PORT LUDLOW, 98365 Expiration Date 10/30/2015 OWNER: MARY EKMAN PHONE: 206-390-9284 4508 33RD AVE W SEATTLE WA 98199-1129 9982 SUBDIVISION: Block: Lot: PARCEL NUMBER: 998200321 Section: 15 Township: 28 N Range: 1E CONTRACTOR: PENINSULA HEAT INC PHONE: 360-681-3333 PO BOX 173 CARLSBORG WA 98324 Contractor's License PENINI*044OW Expires 3/2/2016 PROJECT DESCRIPTION: INSTALL NEW HEAT PUMP AND AIR HANDLER 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 10/30/14 151675 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 Jefferson County Building Division Permit Number: BLD14-00406 Applicant: EKMAN 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 Miscellaneous A final inspection will not be scheduled until 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 FINAL INSPECTION MUST BE APPROVED PRIOR TO BUILDING BEING OCCUPIED THIS PERMIT IS VALID FOR ONE YEAR _``.` G{ JEFFERSON COUNTY �9S ,,c,-co DEPARTMENT OF COMMUNITY DEVELOPMENT --' Date: t/- /� Time Received: //5 67 apm Mon. Tue. Wed. Thur. Fri. Date: I I —IG 19- BLD: /4— 6, Contact Name: Owner: Contact Number: 360 6,g/ 3333 Address: (p/O /q-uA s-i0,4 206 Notes: vw vo.aT of-boo; cry r Dttc enA r jk7 Oil Foundation Plumbing Framing Propane Tank (Mec9iY h a ni 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 0 a Jefferson County Building Division Permit Number: BLD14-00406 Applicant: EKMAN 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 ,-, 9..„ Miscellaneous (Mid Per v - 4 Q Po ` eCL (hC. - A final inspection will not be scheduled until 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 f l_-0_IL FINAL INSPECTION UST BE 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#: BLD14-00406 Received Date: 10/30/2014 SITE ADDRESS: 610 TALA SHORE DR Issue Date 10/30/2014 PORT LUDLOW, 98365 Expiration Date 10/30/2015 OWNER: MARY EKMAN PHONE: 206-390-9284 4508 33RD AVE W SEATTLE WA 98199-1129 9982 SUBDIVISION: Block: Lot: PARCEL NUMBER: 998200321 Section: 15 Township: 28 N Range: 1E CONTRACTOR: PENINSULA HEAT INC PHONE: 360-681-3333 PO BOX 173 CARLSBORG WA 98324 Contractor's License PENINI*0440W Expires 3/2/2016 PROJECT DESCRIPTION: INSTALL NEW HEAT PUMP AND AIR HANDLER 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: 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 10/30/14 151675 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