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Home My WebLink AboutBLD2014-00253 - MECHANICAL •UILDING O PERMIT APPLICATION B Review 0253 Type: Jefferson County Department of Community Development 621 Sheridan Street Port Townsend, WA 98368 PERMIT #: BLD14-00253 Received Date: 7/18/2014 SITE ADDRESS: 2110 EAST QUILCENE RD QUILCENE, 98376 OWNER: ANNA MARIE NYLUND TRUSTEE PHONE: 360-765-3562 A M NYLUND LIVING TRUST PO BOX 538 QUILCENE WA 98376-0538 SUBDIVISION: Block: Lot: TX 7 PARCEL NUMBER: 701194005 Section: 19 Township: 27 N Range: 1V1 CONTRACTOR: AIR FLO HEATING COMPANY INC PHONE: 360-683-3901 221 W CEDAR SEQUIM WA 98382 Contractor's License AIRFLI*206DG Expires 4/25/2016 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: 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 $152.00 SRE 07/18/14 148891 Total: $152.00 JUL 18 2014 Jefferson County DCD \\tidemark\data\forms\F_BLD_App_Bld.rpt 7/18/2014 14 0-5(Z ' c% JEFFEROPN COUNTY 19T-----E I y DEPARTMENT OF COMMUNITY DEVELOPMENT 621 Sheridan Street• Port Townsend •Wash'ington 98368 i JUL 1 8 2014 3601379-4450 • 360/379-4451 Fax l I j vvvvw.c9.jefferson.wa.us/commdevelopment L+� --J t� JEFFERSON COUNTY Master Permit Application MLA.- DFf?f.OF COMMIINI?Y DFVFLOPMFNT _ ; Project Description(induce separate sheets as necessary): . Tax Parcel Number: q(') ( I q L.1 DC)c Property Size: (acres/square feet) Site Address and/or Directions to Property: id Property Owners)of Record: a..M1i '12 .. nmf01 Telephone` Ai— w� — daligir^ Fax: email: Mailing Address: r Applicant/Agent(if different from owner): A .8 ■e V_Ai . Telephone: A.1.,.,.,: • F: SS . •...+ email: ..r/.111�rera1! _1 itevini. ' Mailing Address: ANIIIIIIMIERFRII A. i1W_` II / `•____ • w"� What kind of Permit?(Check each box that applies 0 {E D n/7 I� - \ ��• ❑Building ❑Critical Areas St- A V I� ❑ Demolition Permit ❑Variance(Minor, , �1 easonable Economic Use) G7 Single Family ❑Garage Attached/Detached ❑Conditional Use[C(=i • or C]** ❑ Manufactured Home CI Modular ❑Discretionary'D'or Cla t4 ❑ Commercial" ❑Special Use(Ess, ., • is F�lities)*" J ❑ Change of Use ❑Boundary Line Ad 1:,- ❑ Address ❑Road Approach ❑Short Plat" El Home Business ❑ Cottage Industry ❑Binding Site Plan" JEFFERSON COUNTY EVEL ❑Propane 0 Long Plat DEPT.OF COMMUMITY DEVELOPMENT O Sign ❑Planned Rural Residential Development(PRRD)iAmendments** O Allowed'Yes'Use Consistency Analysis ❑Plat Vacation/Alteration*" ❑ Stormwater Management ❑Shoreline Master Program Exemption/Permit Revisions`* ❑Site Plan Approval Advance Determination(SPAAD)' ❑Shoreline Management Substantial Development" ❑Temporary Use O Shoreline Management Variance ❑Wireless Telecommunication* ❑Comprehensive Plan/UDC/Land Use District Map Amendment ❑Forest Practices Act/Release of Sbc-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: I ESIGNATION OF AGENT I hereby designate , ' ,es!ii e • 4. to act as my agent in matters relating to this application for permit(s). OWNER SIGNATURE d.��,� bWW,A __ Date: 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 inspections. Staffs 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: /C� Date: + L ` 9 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-transferable responsibility for adhering to and complying with the ESA. The Applicant has read this disclaimer and signs and dates it below. Signature: Date: G:1PermiiCentes\###FORMS###\DRD FORMS\Master Pennit.Application 5-29.O8.dc 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 contactors and that they will be assuming the responsibility of the General Contractor for the proposed project. Signature: Date: ----- �0 d lI GENERAL CONTRACTOR OR MANUFACTURED HOME INSTALLER: PHONE: �, ( ) ( ) �c�i�jj ' �i MAILING ADDRESS: EMAIL: I I , I I I I I. JUL I . t CONTRACTOR'S LICENSE WAINS � NUMBER: NUMBER ARCHITECT/ENGINEER: PHONE ( ) 1 FAX , ,7,7---� MAILING ADDRESS: EMAIL ._ ' ' Project Type: Frame Type: Bathrooms: Shoreline: Type of Sewage Dis' • U New ❑ Wood Existing: U Sewer to' Addition 0 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: f t f t4'SS Proposed: ❑ Public �kt1 "�I) Total: Name of System: If this is a C ommercial 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 i No If this is a Propane Tank and/or Appliance Installation permit,mark all items below that apply: 1 Underground Tank 1 Above ground Tank Size of Propane Tank: 1 Heat Stove 1 Cook Stove 1 Woodstove 1 Fireplace Insert 1 Hot Water Tank 1 Pellet Stove 1 Other Is this appliance being installed in a Manufactured/Mobile Home? Yes I No 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, includin• the reserve area. X� :. J-4.7" _ { i .,� 1 =..L:Z—if m Y ...-� � Vii S•uare Foota•e Current Pro• •Sect • �e 6�- ai` �r, - `'�' I its n'-- t { Main Floor Heated 4ve q•--7,PA_t- 1 EH Bld App Review: 2"°Floor Heated m t � Consistency Review: 4 Other Heated Base fee: '��. �) Mezzanine _ may= Additional Section: ,;..ate--- Heated Basement Plan Check fee: Unheated Basement ' ■' fi State Surcharge fee: Other Unheated •-+r Pot Water Review fee: Garage/Carport z .. SUBTOTAL Decks ., 911/Rd Approach fee: Other / TOTAL $ t 1 I ' �- , Receipt Number. `+till x Cash/Check Number. 1� ll.245 5 x n : ESTIMATED COST(REQUIRED) Date: ��' /1` .Fair market value of all labor and materials foundation to finish Initials: SCr: GAP emritCenter\###FORMS###\DRD FORMS\Master Permit Application 5-29-I)8.doc Parcel Details Page 1 of 2 • • - ,F Jefferson ount p,. s atior: �-, -..„.,, °V.'bca. _. Home County Info Departments Search Parcel Number: 701194005 i SEARCH Parcel Number: 701194005 Printer Friendly Owner Mailing Address: ANNA MARIE NYLUND TRUSTEE A M NYLUND LIVING TRUST PO BOX 538 QUILCENE WA98376-0538 Site Address: 2110 EAST QUILCENE RD QUILCENE 98376 Section: 19 School District: Quilcene (48) Qtr Section: SE1/4 Fire Dist: Quilcene (2) Township: 27N Tax Status: Taxable Range: 1W Tax Code: 0321 Planning area: Quilcene (10) Sub Division: Assessor's Land Use Code: 1100 - Residential - Single Unit Property Description: S19 T27 R1W TAX 7 (LESS E OF CO RD & LESS R/W Tax,A/V, Sales, Photos, and Permit Data Bida Data Map Parcel plats&Surveys Septic Monitoring Info •,, � "°g+ Jefferson County HOME I COUNTY INFO I DEPARTMENTS I SEARCH Best viewed with Microsoft Internet Explorer 6.0 or later s Windows - Mac http://www.co.jefferson.wa.us/assessors/parcel/parceldetail.asp?Parcel NO=701194005 7/18/2014 Parcel Details Page 2 of 2 • • http://www.co.jefferson.wa.us/assessors/parcel/parceldetail.asp?Parcel_NO=701194005 7/18/2014 AIR FLO HEATING COMPANY INC Page 1 of 2 • • Washington State Department of CO Labor & Industries AIR FLO HEATING COMPANY INC Owner or tradesperson 221 W CEDAR BEQUETTE, MARK A SEQUIM, WA98382 360-683-3901 Principals CLALLAM County BEQUETTE, MARK A, PRESIDENT BEQUETTE, SANDRA A, VICE PRESIDENT BERSON, JOEL R, SECRETARY FULLAWAY, MICHAEL (End: 04/01/2010) Doing business as AIR FLO HEATING COMPANY INC WA UBI No. Business type 600 347 761 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 HeatingNent/Air-Conditioning and Refrig (HVAC/R) License no. AIRFLI*206DG Effective—expiration 03/07/1980—04/25/2016 Bond CBIC $6,000.00 Bond account no. SI5215 Received by L&I Effective date 02/05/2010 02/01/2010 Bond history Insurance American Hallmark Ins Co of Te $1,000,000.00 Policy no 44CL483619 Received by L&I Effective date 04/18/2014 04/25/2014 https://secure.lni.wa.gov/verify/Detail.aspx?UBI=600347761&LIC=AIRFLI*206DG&SAW= 5/8/2014 AIR FLO HEATING COMPANY 4 2 6 3 3 Check Number: 42633 Jefferson County Dept of Comm Dev. Date Description Amount 07/16/2014 Nylund Mech Permit 171.00 45012 c.06 JEFFERSON COUNTY DEPARTMENT OF COMMUNITY DEVELOPMENT Date: g-�/ Time Received: h r) 2-, s/pm Mon. Tue. Wed. 4i Fri. Date: -- .J BLD: )9-^,t5'3 Contact Name: Owner: Contact Number: 360 765 35 (9Z Address: 1-1 !C QL, ( 206 Notes: U PULAI 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 OW NO. 148891 . / DATE 1---48"-"Ii RECEIVED FROM y DESC9IPTION � BARS# AMOUNT CURRENCY r�F�, S2,ADD COIN TT`-'Vl �' EC:(5) `FZ do3 3 c OC) co O O RECEIVED BY TOTAL 1)\- • • 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 #: BLD14-00253 Received Date 7/18/2014 SITE ADDRESS: 2110 EAST QUILCENE RD Issue Date 7/18/2014 QUILCENE, 98376 APPLICANT: ANNA MARIE NYLUND TRUSTEE PHONE: 360-765-3562 A M NYLUND LIVING TRUST PO BOX 538 QUILCENE WA 98376-0538 TX 7 SUBDIVISION: Block: Lot: PARCEL NUMBER: 701194005 Section: 19 Township: 27N Range: 1W CONTRACTOR: AIR FLO HEATING COMPANY INC PHONE: 360-683-3901 221 W CEDAR SEQUIM WA 98382 Contractor's License AIRFLI*206DG Expires 4/25/2016 OWNER, ANNA MARIE NYLUND TRUSTEE PHONE: 360-765-3562 if different: A M NYLUND LIVING TRUST PO BOX 538 QUILCENE WA 98376-0538 PROJECT DESCRIPTION: Install NEW DUCTLESS HEAT PUMP 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 7/18/2015. REQUIRED INSPECTIONS: Installation per Manufacturer Specifications/CO2: Tank/Line/Appliance: Final Approval: 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 11 tidemark\data\forms\F_BLD_Permit_Propane.rpt 7/18/2014