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HomeMy WebLinkAboutBLD2014-00450 - MECHANICAL 411 UILDING PERMIT APPLICA Ti It BLDI4-00450 Review Type: Jefferson County Department of Community Development 621 Sheridan Street Port Townsend, WA 98368 PERMIT#: BLD14-00450 Received Date: 12/1/2014 SITE ADDRESS: 13 WHITE ROCK LN PORT LUDLOW, 98365 OWNER: DENNIS WILD PHONE: 909-322-3688 13 WHITE ROCK LANE PORT LUDLOW WA 98365 SUBDIVISION: Block: Lot: PARCEL NUMBER: 821265006 Section: 26 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 DESCRIPTIOP NEW MECHANICAL PERMIT INSTALL DUCTLESS HEAT PUMP TYPE OF WORK RES 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: IRouting Date: Type Amount Paid By: Date: Receipt: Approved/Date c Permit $152.00 SRE 12/01/14 153885 APPROVED Total: $152.00 ~ DEC 15 2014 Jefferson County DCG \\tidemark\data\forms\F_BLD_App_Bld.rpt 12/15/2014 flONco o� JE SON COUNTY • DEPARTMENT OF COMMUNITY DEVELOPMENT 4 i . 621 Sheridan Street I Port Townsend,WA 98368 I Web:www.co.iefferson.wa.us/communitvdevelopment 9Sx �C _NG Tel:360.379.4450 I Fax:360.379.4451 I Email:dcd a1co.jefferson.wa.us Building Permits&Inspections I Development Consistency Review I Long Range Planning( Watershed Stewardship Resource Center Master Permit Application MLA: Project Description(include separate sheets as necessary): ' -Y\.S{r-&-( co___n t?r■ 4,1 9C1-c -( SS 4-+ Pohl,' Tax Parcel Number: So. IA.0 500 cci Property Size: (acres/square feet) Site Address and/or Directions to Property: 13 W 4-Fre !Rock- LAf Property Owner(s)of Record: •1. 1),r.■S W I i c-1 S Telephone: 901 - 3A9.- - 3(o' Fax: email: Mailing Address: 13 IAD h l fc- Kock- La.IA.1Q-, Po r^+ LL.Lei till 1,..', Lo A • q3.3 6 5' Applicant/Agent(if different from owner): PC-I'Ll9'SCA.la_ Ee' +- C1 • Telephone: (QC'- °8 f- 3 3 3 3 Fax: email: riA •-v e,pcvkrm.ss u.-lo.. Mailing Address: P•e'• gaX 11-3 , (�,••lsbor , 1.A._ 14c 'Y3Zc�.. t . ter-. . What kind of Permit?(Check each bo,x that applies ❑Lot or Road Segregation Building pi 14-'e-c- A-. ❑Critical Areas Stewardship Plan ❑ Demolition Permit ❑Variance(Minor,Major or Reason-• - «•• ❑Single Family ❑Garage Attached/Detached ❑Conditional Use[C(a),CO , q i r \- ,7 in-' , ❑ Manufactured Home ❑ Modular ❑Discretionary"D"or Unn- Ies i .. v `-� ❑ Commercial* ❑Special Use(Essential P •l cl roes)** ❑ Change of Use ❑Boundary Line Adjustme ' ❑ Address ❑Road Approach ❑Short Plat** ,(l; I n rp _ j °;_1 i ❑Home Business ❑Cottage Industry ❑Binding Site Plan** J ❑Propane ❑ Long Plat** a b ❑Sign ❑Planned Rural Residentia Develbpment(f RRD)/Ameid l is** ❑Allowed"Yes"Use Consistency Analysis ❑Plat Vacation/Alteration** n ,, n; ❑Stormwater Management ❑Shoreline Master Prograrr�.Exemptioa/P fir. T ❑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: // DESIGNATION OF AGENT I hereby designate h.0 to act as my agent in matters relating to this application for permit(s). OWNER SIGNATURE Date: / / - 49'0/ 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 I er inspections. Staff's access and right of entry will be assumed unless the applicant informs the County in writing at the time of the application t L!/y,p or she wa r notice. / Signature: � / Date: I(�� / 6/ 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/ tFme Jefferson County development code.The Applicant acknowledges that he,she or it holds individua and non-transferable --,:is sibility yfffor a nn wand complying with the ESA. The Applicant has read this disdaimpr,6;ru�ilsj�gns, nd,stat7 i w. Signature: �a� s V Date: it ° (/ !/ /�/ 07/24/2013 4111 1111 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: G�NERAL CONTRACTOR OR'MANUFACTURED HOME INSTALLER: PHONE: FAX: 1 e—Iti YISfl& 1�C4 *- CO (36/ (o W— 3.333 ( ) / MAILING ADDRESS: P.O. I3 x /7-3 EMAIL: &t cU c/ pelt,/1 a Q(a..JC4.+• toys., CONTRACTOR'S LICENSE WAINS 1 NUMBER: P M J/1)/ • O (4. 40 LA) NUMBER ARCHITECT/ENGINEER: PHONE ( ) FAX:( ) 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 Dux-Hess tti 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 I evotS telleP I knaT retaW toH i Is this appliance being installed in a Manufactured I Mobile Home? Yes 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 pn- it�.,_ Main Floor Heated EH BId App Review: - ,1 ' W _..� e 2 na 'Floor Heated Consistency Review: i Other Heated Base fee: 4°4" 1 t. /4;7? L. Mezzanine Additional S ctiioonl -----1' ---1 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: $ /77/3 ( .1/ Receipt Number. / 5 3 ggS' Cash/Check Number: ESTIMATED COST(REQUIRED) Date: 4 •Fair market val of all la rand mate ' s foundation to finish /2/It q ?,3 • l Initials: 07/24/2013 Parcel Details • Page 1 of 2 • a 1 , County Home County Info ;.: Departments Search Parcel Number: 821265006 SEARCH Parcel Number: 821265006 Printer Friendly Owner Mailing Address: JIMMY L THIBODEAU BETTY J THIBODEAU 13 WHITE ROCK LN PORT LUDLOW WA98365-9565 Site Address: 13 WHITE ROCK LN PORT LUDLOW 98365 Section: 26 School District:Chimacum (49) Qtr Section: NW1/4 Fire Dist: Port Ludlow (3) Township: 28N Tax Status: Taxable Range: 1E Tax Code: 0231 Planning area: Paradise Bay (8) Sub Division: Assessor's Land Use Code: 1100 - Residential - Single Unit Property Description: WHITE ROCK COVE TRACTS TRACT 6 V9/P186 Tax,A/V, Sales, Photos, and Permit Data Bldg Data Map Parcel Plats&Surveys Septic Monitoring Info , Jefferson County HOME I COUNTY INFO I DEPARTMENTS I SEARCH '+ 41 SS I Best viewed with Microsoft Internet Explorer 6.0 or later Windows- Mac http://www.co.j efferson.wa.us/assessors/parcel/parceldetail.asp?Parcel_NO=821265006 12/1/2014 PENINSULA HEAT INC . Page 1 of 2 • inWashington 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"044OW 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= 12/1/2014 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 L8d 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. lWorkers' 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 3 of Year 2014"7 to 10 Workers" L&I account representative T4/CARIE PICKETT(360)902-5592-Email: PICC235 @Ini.wa.gov IWorkplace 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 Wlttttt https://secure.lni.wa.gov/verify/Detail.aspx?UBI=601737680&LIC=PENINI*044OW&SAW= 12/1/2014 • • Jefferson County Building Division Permit Number: BLD14-00450 Applicant: WILD 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 T2-2:2,-,(4. Mechanical Systems 12'2-7"),'( 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 A-,23-/q FINAL INSPECTION MUST 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#: BLD14-00450 Received Date: 12/1/2014 SITE ADDRESS: 13 WHITE ROCK LN Issue Date 12/15/2014 PORT LUDLOW, 98365 Expiration Date 12/15/2015 OWNER: DENNIS WILD PHONE: 909-322-3688 13 WHITE ROCK LANE PORT LUDLOW WA 98365 SUBDIVISION: Block: Lot: PARCEL NUMBER: 821265006 Section: 26 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: NEW MECHANICAL PERMIT INSTALL DUCTLESS HEAT PUMP TYPE OF WORK RES SQUARE FOOTAGE: TYPE OF IMP MEC MAIN: VALUATION 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: Type Amount Paid By: Date: Receipt: BEDROOMS: BATHROOMS: Permit $152.00 SRE 12/01/14 153885 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_BIdg.rpt 12/15/2014 egoc� JEFFERSON COUNTY gCL. DEPARTMENT OF COMMUNITY DEVELOPMENT Date: (a. 1(0Time Received: )0 3 2 ("/pm Mon. rrfr. Wed. Thur. Fri. . r Date: t2- - 25 BLD: ` `�-- cf St Contact Name: Owner: Contact Number: 360 5'09 3 z 2 .Sa' Address: \ 3 w YL+ ©(,t{ l_3 206 Notes: �ti 41 f ://.fp 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 Dcip NO. 1 3 85 DATE I �O RECEIVED FROM (90 I/ / ti. /-iiJt/ //1c. DESCRIPTION BARS AMOUNT CURRENCY 1g 15-12_,,,ort [ COIN cci / I CHECKS V: VA i 44-4PL3#17O C ikfiLif inci- Q m ,„.,,,1 _ ,,,,,, - ?foil* .,,,,..„266-; Acip, 0 ' 1 fcgt ' h:- Kdeje. Z, 141L-it 0 RECEIVED BY _ 1 / . . _L//s/1 'IF TOTAL 124