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HomeMy WebLinkAboutBLD2015-00020 - MECHANICAL ItUILDING PERMIT APPLICA1N BLD15-00020 Review Type: Jefferson County Department of Community Development 621 Sheridan Street Port Townsend, WA 98368 PERMIT#: BLD15-00020 Received Date: 1/22/2015 SITE ADDRESS: 8234 FLAGLER RD NORDLAND, 98358 OWNER: DALE TANGEMAN PHONE: 8234 FLAGLER RD NORDLAND WA 98358-9524 9537 SUBDIVISION: Block: Lot: PARCEL NUMBER: 953700423 Section: 29 Township: 30 N Range: 1E CONTRACTOR: SETTJE LARRY PHONE: 360-301-9537 P.O. BOX 892 PORT HADLOCK WA 98339 Contractor's License SETTJC*867JJ Expires 4/11/2016 REPRESENTATIVE: PHONE: PROJECT DESCRIPTIOt New Mechanical Permit Install a Woodstove TYPE OF WORK NON SQUARE FOOTAGE: TYPE OF IMP MEC MAIN: VALUATION ADD'L: HEAT TYPE: CODE EDITION: 2012 HEAT BASE: HEAT TYPE: OCCUPANCY: UNHEATED: #OF STORIES: OCCUPANCY: 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: Approved/Date Permit $0.00 SRE 01/22/15 APPROVED Total: $0.00 JAN 232015 Jefferson County DOD \\tidemark\data\forms\F_BLD_App_Bld.rpt 1/23/2015 gON C,p 6, DEPARTMENT OF COMMUNITY 4P/VELOPMENT W4 621 Sheridan Street,Poit Townsend,WA 93363 ti .< Tel:360.379.4450 ; Fax:366.379.4451 Web:tTrIt w.co.jefferson.wa.tu/coinmunitydeve1opment E-mail:dcdCa;co.jeffeison.wa.us -1/INov MECHANICAL PERMIT APPLICATION Steps in the Permit Process: -Review required submittal items to ensure all information is completed prior to submitting application. -Make an appointment to meet with the Permit Technician by calling 360-379-4450. -Fees will be collected at intake. Additional fees may apply after review and payment is required before permit is issued. For Department Use Only Receipt#: Date: Related Application#s: ; Payment#:, Is this application for use in a Mobile/ Manufactured Home? * If Yes: A permit from Washington State Department of Labor and Industries, not Jefferson County, is required for appliances installed within a mobile/manufactured home. L&I - 360-417-2702 * If No: Complete this form and make an appointment to submit to Jefferson County Permit Tech 360-379-4450 Required Submittal items for propane tank only Complete Site plan - Please refer to the site plan checklist to ensure all items are on the site plan. Required Submittal Items—for Solar Panel installation only Complete first page and signature block only of Mechanical Permit Application. A complete solar panel supplemental application. Site Information Assessor Tax Parcel Number: Site Address and/or Directions to Property: $023' F--44444,6-g- , RDG4/(i131 rv',}r 5-" / Access (name of street(s) from which access will be gained: Description of Work: /,j7L1.— t.r/ooD grot) - Property Owner Name: A/z24-6.6 - -r OA TA/0a6-14.e)4 � su Address: $ 3 - R-A (,,,E R tea. n1©$2Dt•AAJD, u/fi 95(3SV Phone#: 2r1/5":-671 - l 'Z E-mail Address: DTAaJ6E,rtpAl 6/W/44.-. Please contact Authorized Agent/Representative with project info. COAL. Property Owner Signature: C4 Date: /2. /1(?-d/e-f Applicant j Gpntractor. It'o $zedAgent/Re resentative Name: ..5"Se. Phone#: azgl— ? E-mail Address:/(__'_fce c, G.ynr License#: � / �✓S�}_,/" Expiration Date: Y-,�J� Mechanical Application 1 • • Heat Source Electric Heating Oil Propane* Wood v" Indicate Quantity and Fixture Types Below *Propane is prohibited in Quantity Fixture Type Description hazardous locations such as Fan Bath Fan and/or Exhaust Fan basements or pits or Clothes Dryer Clothes Dryer with Exhaust Vent anywhere "heavier-than-air" Cook Stove Cook Stove, Range Hood Exhaust gas can unsafely collect. Fireplace-Gas Fireplace-Gas or Gas Log Insert *Propane tanks over 126 Fireplace-Wood Fireplace-wood, Wood Stove,or gallons require a minimum Pellet Stove setback of 10 ft.from Electric Furnace Electric Furnace or HP+/-Ducting property line and buildings, Propane (LP)Gas Furnace Propane Furnace+/-Ducting and a site plan must be submitted with the Water Heater-Gas Gas WH Vent and Combustion Air application showing the Gas Pipe System Gas Pipe System LPG/Oil setbacks. If propane tank is Propane Tank LP Fuel Tank(#gallons: ) over 500 gallons,a site plan is Heat Pump required to accompany this Generator application, and a separate Air Conditioner Fire Code approval is also required. Installation manual must be on site at time of inspection or a re-inspection fee will be charged. 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 making any issued permit null and void. I further agree to that all activities I intend to undertake or complete associated with this permit will be performed in compliance with all applicable federal, state and county laws and regulations and I 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. Applicant may request notice of the County's intent to enter upon the property for visits related to this application and subsequent permit issuance. Signature:• / Print Name: D,41-6" r/14)6 /14f"' Date: i)-(Pt3///it OFFICE USE ONLY Building Permit Fees Mechanical Permit fee(tank swap,woodstove,furnace,etc) $152.00 Propane—Lines, tank, and appliance (add'I $76.00) Project Scanning Fee $19.00. Total Fees* i?l *Additional fees may apply. Mechanical Application 2 Parcel Details Page 1 of 2 • iefiferson' C ount Home County Info apartments Search Parcel Number: 953700423 SEARCH Parcel Number: 953700423 Printer Friendly Owner Mailing Address: DALE TANGEMAN 8234 FLAGLER RD NORDLAND WA98358-9524 Site Address: 8234 FLAGLER RD NORDLAND 98358 Section: 29 School District: Chimacum (49) Qtr Section: SE1/4 Fire Dist:Chimacum (1) Township: 30N Tax Status: Taxable Range: 1E Tax Code: 0211 Planning area: Marrowstone (3) Sub Division: 9537 - GLENNAN SUB. ACRES Assessor's Land Use Code: 9800 - Garages, Outbuildings, Other Imps Property Description: GLENNAN SUBURBAN ACRE BLK 4 LOT 11 E/RD(LS N100') SUBJ/JLT CONSERV EASE AF#448705 Tax,A/V, Sales, Photos,and Permit Data Bldg Data Map Parcel Plats&Surveys Septic Monitoring Info Jefferson County HOME l COUNTY INFO I DEPARTMENTS l 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=953700423 1/22/2015 Settje Construction Page 1 of 2 CiWashington State Department of Labor & Industries Settje Construction Owner or tradesperson P O Box 892 Settje, Larry G PORT HADLOCK,WA 98339 360-437-5101 Principals JEFFERSON County Settje, Larry G, OWNER WA UBI No. Business type 601 160 173 Individual 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. SETTJC*867JJ Effective—expiration 04/11/2014—04/11/2016 Bond Developers Surety&Indem Co $12,000.00 Bond account no. 664454C Received by L&I Effective date 04/11/2014 04/08/2014 Expiration date Until Canceled Insurance ............................ Developers Surety&Indem Co $1,000,000.00 Policy no. BIS0001863201 Received by L&I Effective date 04/11/2014 04/08/2014 Expiration date 04/08/2015 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&I Tax debts https://secure.lni.wa.gov/verify/Detail.aspx?UBI=601160173&LIC=SETTJC*867JJ&SAW= 1/22/2015 Settje Construction Page 2 of 2 No L&l tax debts are recorded for thiSntractor license during the previous 6 y eriod, but some debts may be recorded by other agencies. License Violations No license violations during the previous 6 year period. IWorkers' comp No active workers'comp accounts during the previous 6 year period. IWorkplace safety and health I No inspections during the previous 6 year period. O Washington State Dept.of Labor&Industries.Use of this site is subject to the laws of the state of Washington. AeCtIs i� .Shin https://secure.lni.wa.gov/verify/Detail.aspx?UBI=601160173&LIC=SETTJC*867JJ&SAW= 1/22/2015 Jefferson County Building Division Permit Number: BLD15-00020 Applicant: TANGEMAN 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 Heat/Chimney Clearance 6, Wood/Pellet Stove / if yl� Smoke&CO 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 /—t 1 r- FINAL INSPECTION MUST BE APPROVED PRIOR TO BUILDING BEING OCCUPIED THIS PERMIT 1S 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#: BLD15-00020 Received Date: 1/22/2015 SITE ADDRESS: 8234 FLAGLER RD Issue Date 1/23/2015 NORDLAND, 98358 Expiration Date 1/23/2016 OWNER: DALE TANGEMAN PHONE: 8234 FLAGLER RD NORDLAND WA 98358-9524 9537 SUBDIVISION: Block: Lot: PARCEL NUMBER: 953700423 Section: 29 Township: 30 N Range: 1E CONTRACTOR: SETTJE LARRY PHONE: 360-301-9537 P.O. BOX 892 PORT HADLOCK WA 98339 Contractor's License SETTJC*867JJ Expires 4/11/2016 PROJECT DESCRIPTION: New Mechanical Permit Install a Woodstove TYPE OF WORK NON SQUARE FOOTAGE: TYPE OF IMP MEC MAIN: VALUATION ADD'L: HEAT TYPE: 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 01/23/15 154041 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