HomeMy WebLinkAboutBLD2013-00047 • BUILDING PERMIT APPLIARION BRLD13-000047
Jefferson County Department of Community Development
621 Sheridan Street Port Townsend, WA 98368
PERMIT#: BLD13-00047 Received Date: 2/6/2013
SITE ADDRESS: 216 GREENVIEW LN
PORT LUDLOW, 98365
OWNER: CHARLES S HYNDEN TRUSTEE PHONE: 360-301-3063
VENITA M HYNDEN TRUSTEE
216 GREENVIEW LN
PORT LUDLOW WA 98365-8750 GREENVIEW VILLAGE
SUBDIVISION: Block: Lot: 6
PARCEL NUMBER: 955600006 Section: 21 Township: 28 N Range: 01 E
CONTRACTOR: BRENNAN HTG &NC LLC PHONE: 206-248-7900
4601 S 134TH PL
SEATTLE WA 98168
Contractor's License BRENNHA971 R9 Expires 12/29/2013
REPRESENTATIVE: PHONE:
PROJECT DESCRIPTION HEAT PUMP REPLACEMENT
TYPE OF WORK RES SQUARE FOOTAGE:
TYPE OF IMP MEC MAIN:
VALUATION 2,400.00 ADD'L: HEAT TYPE:
CODE EDITION: 2009 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: Approved/Date
Permit $228.00 LYK 02/06/13 139979 APPROVED
Total: $228.00 I� G
FEB -62013
Jefferson County DCD
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CERTIFICATE OF OCCUPANCY
Jefferson County Department of Community Development
621 Sheridan Street Port Townsend, WA 98368
(360)379-4450 FAX(360)379-4451
Carl Smith, Director/Building Official
PERMIT#: BLD13-00047
SITE ADDRESS: 216 GREENVIEW LN Issue Date: 02/6/2013
PORT LUDLOW, 98365 Final Date: 3/14/2013
APPLICANT: CHARLES S HYNDEN TRUSTEE PHONE: 360-301-3063
VENITA M HYNDEN TRUSTEE
216 GREENVIEW LN
PORT LUDLOW WA 98365-8750
SUBDIVISION: GREENVIEW VILLAGE Block: Lot: 6
PARCEL NUMBER: 955600006 Section: 21 Township: 28 N Range: 01 E
PROJECT DESCRIPTION: HEAT PUMP REPLACEMENT
THE PROJECT LISTED ABOVE COMPLIES WITH THE REQUIREMENT OF THE BUILDING CODE 2009
EDITION.
OCCUPANCY GROUP:
TYPE OF CONSTRUCTION:
SPRINKLER SYSTEM yes no
THE PROJECT PASSED ITS FINAL INSPECTION AND RECEIVED FINAL SIGN OFF ON 3/14/2013
\\tidemark\data\forms\F_BLD_Occupancy.rpt 3/20/2013
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I iki6,,„,, 1 QN A JEFFERSON COUNTY
ART COME
621 DEPSheridan TMEN StreetOF O. Port MUNITY Townsend DEV•WashingLOPMENT ton 98368
360/379-4450 • 360/379-4451 Fax
"f" ^i0 www.co.jefferson.wa.us/commdevelopment
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Master Permit Application MLA: 1'______M___ _____
P I D■eicription(include separate - eets as n- -ssary):
. i L/, L'1 It t L‘ , LU L,
Tax Parcel Number.4...ff 5(o III Property Size: (acres/square feet)
Site Address and/or Directions to Property: '
11.0 Cct-Cnv.l L c Lua Li) ,LD
Property Owner(s)of Record: ' 1 r� —
2
Telephone:`:.DP0 . 'j 0\ , , Me Fax: email:
Mailing Address: A.-
Applicant/Aaen (if different
lb —from o__wner): o, A&.4�_ � s ---__ i
Telephone: . ° .. t)* x: . ,��.'I i j email•_ II y�.1 44�t -f1 l'
Mailing Address: 140 ' V L C1 i 1. �g-q__ a t � °
What kind of Permit?(Check each box that applies
❑Building ❑Critical Areas Stewardship Plan
❑ Demolition Permit ❑Variance(Minor,Major or Reasonable Economic Use)
.....Iiii=8ingle Family ❑Garage Attached/Detached ❑Conditional Use C a C • • **
❑ Manufactured Home ❑ Modular O Discretion ." U r -%
❑ Commercial* ❑Special Use a, e -11 ,._1.1,' - id )
O Change of Use ❑Boundary Line Adjustt ent l
O Address ❑Road Approach ❑Short Plat*E d
O Home Business 0 Cottage Industry 0 Binding Site Plan** i
❑Propane ❑Long Plat'**`' -
F E -'- I
O Sign ❑Planned Rural Residential Development(PRRD)/ ' d ents**
O Allowed"Yes"Use Consistency Analysis ❑Plat Vacatioii/Alterauioa'* i
O Stormwater Management ❑Shoreline-Master Program Iiieni06iiiiiiThaifnit Revisions *
O Site Plan Approval Advance Determination(SPAAD)* ❑Shoreline Management S` 'betatitldQlDetle16,a, P*
O Temporary Use ❑Shoreline Management Variance
O Wireless Telecommunication* 0 Comprehensive Plan/UDC/Land Use District Map Amendment
❑Forest Practices Act/Release of Six-Year Moratorium 0 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 A to act as my agent in matters relating to this application for permit(s).
S
OWNER SIGNATURE ' L. J q VLLe 01-1) _ Date:
-By signing this application form,the owner/agent attests tha 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 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 that he or she wants prior notice.
Signature: Date:
The action or actions Applicant will undertake as a result of the issuance of this permit may legatively 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-transferable responsibility for adhering to and complying with the ESA. The Appicant has read this disclaimer and signs and dates it below.
Signature: Date:
G:\Pem itCenter\###FORMS###\DRD FORMS\Master Permit Application 5-29-08.doc
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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:
ENERAL CONTRACTOR OR ANUFACTURED HOME INSTALLER: PHONE: PM:
" (c)* d 4 —A MI ( a� `�1 3 q„.31,5„._
MAILING ADDRESS:`, 3 �i,
�1 b 1 J 1 T bta..`H`'(.. EMa.IL �t i rt -e.Vb rt.n.t'■A.Aida/.9,-41 y‘
CONTRACTOR'S LICENSE b"(,t�y\ (c"a,A \ q iNS
NUMBER: "-���, NUMBER rn
ARCHITECT/ENGINEER: PHONE ( ) FAX:( )
MAILING ADDRESS: EMAIL
Project Type: Frame Type: Bathrooms: Shoreline: Type of Sewage Disposal:
0 New ❑ Wood Existing: ❑ Sewer
0 Addition ❑ Steel Proposed: Bank 0 Community System
Alteration/Remodel ❑ Concrete Total: Height: 0 Individual System
❑ Repair ❑ Masonry SEP Permit#
0 Demolition 0 Other:ry Bedrooms: Water Supply:
Existing: Setback: ❑ Private well 0 Two Party
Type of Heat: Proposed: 0 Public
El CC, Total: Name of System:
If this is a Commercial Protect 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:
I Underground Tank 1 Above ground Tank Size of Propane Tank: n
1 Heat Stove 1 Cook Stove 1 Woodstove 1 Fireplace Insert 1 Hot Water Tank 1 pit; t^ e v I
Is this appliance being installed in a Manufactured/Mobile Home? Yes / No ? 1 j■ 1
When applying for a permit to install a propane tank you must also submit a site pet hawing all of the bui • gs, ri •perty
lines,tank location and size,distances from the propane tank to all property lines,buildings fif eptiejsy;�co •• -nts,
including the reserve area.
S•uare Foota!e Current Pro posed I' r 1 r , x4!-"xk I9f.E 11 p y3 r
Main Floor Heated Y s 1 EH Bid App Review: '
a DrnT OF COMMUNITY)E�IELOPMEM
.nil Floor Heated Consistency Review:
Other Heated Base fee:
Mezzanine �" `
v Additional Section:
r , 1
Heated Basement �'
,� E �� Plan Check fee:
Unheated Basement •., ,, .' State Surcharge fee:
Other Unheated ,,�?t x Pot Water Review fee:
Garage/Carport SUBTOTAL
l' ``
Decks : u 911/Rd Approach fee:
Other TOTAL: $ `J([)
Receipt Number: 1' 6
�� Cash/Check Number:
ESTIMATED COST(REQUIRED)' 4 m . Date:
.Fair mantel value of all labor and materi�undation to finish -
Initials:
•
G:\PennitCenter\###FORMS###\DRD FORMS\Master Permit Application 5-29-08.doc
•
BRENNAN PROPOSAL
HEATING & AIR CONDITIONING
4601 South 134th Place
Seattle,WA 98168
(206)248-7900
1-877 BRENNAN•FAX(206)248-7905
Lic BRENNHAS171119
Date:
Project: L'hartestlynden
Address: 216 Lirecn View
City.State&tip Port Ludlow 98365
Phone: 360.301,3003
(,`oste.o Store tl 13
WE It EREDY SUBMI'I SPECIFICATIONS AND ESTIMATES FOR:
PROPOSED SYSTEM IS AS FOLLOWS:
Deliver and install Lennox R22 3.510N heat Pump.Brennan licensed electrician to supply all necessary electrical circuits to equipment lie
into existing ductwork:,air handler.and thermostat:Ductwork to he pressure tested for leakage.Supply and install equipment pad.Supply and
install refrigerant lines between heat pump and air handler.All labor and material included to complete to code.All necessary permits palled.
CPAicu Cash Card 5506 Coyterr Eveieutire Fornings 'ontribuibm 5164
EQUIPMENT: i,entaar IP5131U%-64:7 3 570/C Hear Pump
WARRANTY: I Year Labor Warranty 5 Year Part Warranty
SUBTOTAL 5300:00
TAX 4773)0
IOTA L S5.777,00
(Costos Cash Card -500.00)
(lixecutis e Earnings -106.011)
Bid valid for 30 days.
e Propose hereby to furnish material and labor-complete in accordance with above specifications
Ah,Wea ez.e Tax nnipd le be a%ape,he,: 4 ,‘ he,selapLne p p asholarwal AS10, 10`3-.. miae pa un ,'an wi Is pip hp a,surhed Jorn the paaasast scopa
somma,at P amanal.14-101j34 ft'lbs$1}V.1.-,h1.illa4s.sobs 100,1 oar pork he the,rho 1,powal,tht,SI(Ner 105510151 Ii0Cl4i10r 0f tYKTIrard1,04
• 55,"44710,00 504-,,,t0;i11157 4,:04 04 mozoAt wad At I ASIIP‘7 05 is propS so 0.411, *4 parrots'
4(45)0 men aaJa's Sri)0511,1 ChocoP'CI 0114 3.1X-i, 0.,441,44,
4*., PO/Pe III
Acceptance of Proposal
hereby authorise he above work,and agree to pay the amount set forth in this proposal.I agree to the terms and conditions of this trammel.I reserve the rplfl
:o cancel this agreement .,1thin(3)three ysurk days of the below tit*,unless W■or k has commenced,Customer will be responsible for any collection and`iir
attorvey fees is payment is not made,
Authorized Signature • '4giVir
Date of Acceptance I-2f-Zoo
_
11-)) TO - DNIOE
FEB - 62013
t
JEFFERSON COUNTY
OF COMMUNITY DEVELOPMENT
Contractors or Tradespeoplointer Friendly Page Page 1 of 2
General/Specialty Contractor
A business registered as a construction contractor with LW to perform construction work within the scope of
its specialty.A General or Specialty construction Contractor must maintain a surety bond or assignment of
account and carry general liability insurance.
Business and Licensing Information
Name BRENNAN HEATING&A/C LLC UBI No. 602346866
Phone 2062487900 Status Active
Address 4601 S 134Th Pl License No. BRENNHA971R9
Suite/Apt. License Type Construction Contractor
City Seattle Effective Date 12/29/2003
State WA Expiration Date 12/29/2013
Zip 98168 Suspend Date
County King Specialty 1 General
Business Type Limited Liability Company Specialty 2 Unused
Parent Company
Other Associated Licenses
License Name Type Specialty Specialty Effective Expiration Status
1 2 Date Date
MIKE'S Construction
MIKESMS922L6 MECHANICAL Contractor General Unused 6/26/2008 6/26/2014 Active
SERVICES LLC
FLO0RSL012JL FLOORING Construction General Unused 4/13/1999 4/6/2003 Archived
SOLUTIONS LLC Contractor
GUTTER HELMET Construction Out Of
GUTTEHW995PH OF WESTERN WA Contractor General Unused 10/8/2001 10/8/2007 Business
LL
EMPIRE Construction
EMPIRPS891PS PROTECTION& Contractor General Unused 10/10/2011 10/10/2013 Suspended
SAFETY
Business Owner Information
Name Role Effective Date Expiration Date
ERDAHL, DARRIN PAUL Partner/Member 12/29/2003
Bond Information
Bond Bond Company Name Bond Account Number Effective Date Expiration Date Cancel Date Impaired Date Bond Amount Received Date
2 FEDERATED MUTUAL 9127230 12/22/2004 Until Cancelled
INS CO $12,000.00 11/04/2004
Assignment of Savings Information No records found for the previous 6 year period
Insurance Information
Insurance Company Name Policy Number Effective Date Expiration Date Cancel Date Impaired Date Amount Received Date
4 Federated 9820726 07/13/2007 07/13/2013 $1,000,000.0006/12/2012
Mutual Ins Co
3 FEDERATED 9820726 07/13/2005 07/13/2007 $1,000,000.0006/09/2006
MUTUAL INS CO
Summons/Complaint Information
Cause County Complaint Judgment Status Payment Paid By
07-2-13582-1 Date:05/09/2007 Date: Date:
KING Open
GRONVOLD DEVELOPMENT CO LLC Amount: $10,000.00 Amount: $0.00 Amount:
https://fortress.wa.gov/lni/bbip/Print.aspx 2/6/2013
Contractors or Tradespeople inter Friendly Page Page 2 of 2
III
InterPlead: No
Warrant Information No unsatisfied warrants on file within prior 6 year period
Infractions/Citations Information
Infraction/Citation Date RCW Code Type Status Violation Amount
PPEJP00330 9/14/2012 18.106.020 PLUMBER INFRACTION Satisfied $250.00
https://fortress.wa.gov/lni/bbip/Print.aspx 2/6/2013
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OWNER: 4 tkA-.APA"...., - Contact Name:.
ADDRESS: " .:2-k 6 . .
&I ri A/v-OeLo. C-vv.- 1 _ De-,1 7
Contact Number 360 ,0 I DU/0
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• _ 206 .‘
Notes: tjed. (-)1A,--•T -..-e.- .
.
• .
Foundation Plumbing - Framing . Propane Tank Mechanical , .
Setbacks _ Under-ground Framing Under.ground Furnace
Footing _ Rough in Air seal Above ground - Gas
Stemwall _ Hydronic Exterior shear Exterior lines Oil
Straps interior shear Interior lines . Ducts -
_-.... .
--
Post Hole _ Ventilation Appliance ,
Underfloor _ Gas/wood stove
Man-Homes .
Setbacks V Insulation. Final Inspection
Foundation
Block&lie floor _wall ceiling. Address Posted V A
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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#: BLD13-00047 Received Date 2/6/2013
SITE ADDRESS: 216 GREENVIEW LN Issue Date 2/6/2013
PORT LUDLOW, 98365
APPLICANT: CHARLES S HYNDEN TRUSTEE PHONE: 360-301-3063
VENITA M HYNDEN TRUSTEE
216 GREENVIEW LN
PORT LUDLOW WA 98365-8750 6
SUBDIVISION: GREENVIEW VILLAGE Block: Lot:
PARCEL NUMBER: 955600006 Section: 21 Township: 28N Range: 01E
CONTRACTOR: BRENNAN HTG &NC LLC PHONE: 206-248-7900
4601 S 134TH PL
SEATTLE WA 98168
Contractor's License BRENNHA971 R9 Expires 12/29/2013
OWNER, CHARLES S HYNDEN TRUSTEE PHONE: 360-301-3063
if different: VENITA M HYNDEN TRUSTEE
216 GREENVIEW LN
PORT LUDLOW WA 98365-8750
PROJECT DESCRIPTION: HEAT PUMP REPLACEMENT
Directions
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 2/6/2014.
REQUIRED INSPECTIONS:
Tank/Line/Appliance:
FinalApproval. 14***--- l
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 2/6/2013