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Home My WebLink AboutBLD2014-00250 - MECHANICAL GILDING PERMIT APPLICAN BLD14-00250 Review Type: Jefferson County Department of Community Development 621 Sheridan Street Port Townsend, WA 98368 PERMIT#: BLD14-00250 Received Date: 7/18/2014 SITE ADDRESS: 1410 IRONDALE RD PORT HADLOCK, 98339 OWNER: LAVERNE HICKS PHONE: 1410 IRONDALE RD PORT HADLOCK WA 98339-9580 SUBDIVISION: Block: Lot: PARCEL NUMBER: 901021010 Section: 2 Township: 29 N Range: 1Vl 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 DESCRIPTIOI INSTALL 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 148897 Total: $152.00 APPROVED JUL 18 2014 Jefferson County DCD lltidemarkldata\forms\F_BLD_App_Bld.rpt 7/18/2014 1 gar oo • P)L4104_. -2S-6 ,,w 6, JEFFERSON COUNTY I ,�, DEPARTMENT OF COMMUNITY DEVELOPMENT F'a ` ''d 621 Sheridan Street• Port Townsend •Washington 98368 - ' 360/379-4450 • 360/379-4451 Fax• 1%-kl-N G 6 wow.co.jefferson.wa.us/commdevelopment Master Permit Application r C A V E 1 MLA: • Project Description(include separate sheets as necessary): l, li l /,l 1 3 2014Prol� I I Tax Parcel Number: )+ V L�,' perty ,e: (acres/square feet) Site Address and/or Directions to Property: J u�_��. - 1 1 /! r • rlit N1Y i ! LN D oP . :..�:�:. • , Property Owner(s)of Record: r �i li��/_( Telephone: it'Z' r?S.Z7.7-,A7 Fax: email: Mailing Address: Applicant/Agent(if different from owner): �1r Flo Hei}i(Kk Telephone: Bla.O^IpOb-6001 Fax: l.B3- 3crle email:etleneair-kloheatiN"coM ' Mailing Address: 22.1 1n1. Cedar Si• SekhAien ,WE1 `l►e53el Wjaat kind of Permit?(Check each box that applies Building ❑Critical Areas Stewardship Plan ❑ Demolition Permit ❑Variance(Minor,Major or Reasonable Economic Use) ❑Single Family ❑ Garage Attached/Detached ❑Conditional Use[C(a), C(d),or C]" ❑ Manufactured Home 0 Modular ❑Discretionary"Cr or Unnamed Use Classification ❑ Commercial" ❑Special Use(Essential Public Facilities)" ❑ Change of Use ❑Boundary Line Adjustment ❑ Address ❑Road Approach ❑Short Plat" ❑ Home Business ❑Cottage Industry ❑Binding Site Plan" ❑ Propane ❑Long Plat" ❑ Sign ❑Planned Rural Residential Development(PRRD)/Amendments"• ❑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 ❑Shoreline Management Variance ❑Wireless Telecommunication" ❑Comprehensive PlanAJDC/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: ix . _,..• DESIGNATION OF AGENT T ' I hereby designate i i f 1 r 10 eo (fl / to act as my agent in matters relating to this application for permit(s). OWNER SIGNATURE ct.;-U� — /4.rt-,L 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. 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 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:\PerrnitCenter\###FORMS###\DRD FORMS\Master Permit Application 5-29-O8.doc • • 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: Ai re- c - - v1C-� ( ;/ ) (✓ c� ( 'E )) -11- MAILING ADDRESS: ZZi w. 6/y, i� /t 9�J EMAIL: •`j-t—A y)r J� c A( ? FLO O H 'lc l 'CiCd�-��— 1 1 CONTRACTORS LICENSE _ ///�� ``` WAINS Cciv?1 NUMBER: 4-I .� I` L..t^ 'l' 2UL f yV NUMBER ARCHITECT/ENGINEER: '` PHONE ( ) FAX:( ) MAILING ADDRESS: EMAIL Project Type: Frame Type: Bathrooms: Shoreline: Type of Sewage Disposal: ❑ New ❑ Wood Existing: ❑ Sewer ❑ Addition El Steel Proposed: Bank ❑ Community System [2"Alteration/Remodel ❑ Concrete Total: Height: ❑ Individual System ❑ Repair ❑ Masonry SEP Permit# ❑ Demolition ❑ Other: Bedrooms: Water Supply: Existing: Setback: ❑ Private well ❑ Two Party T pe of Heat: . ❑ Public let. p I 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 Concludes 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: 1 Underground Tank I 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 / 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 r the reserve area. r3. ^ R Y4 4- ` z 4 SF«r {y. ;$ 8 ,r j '4 " �',4.11'i''':'i' 5 S•uare Foote:e Current Pro'•sod ,.r,v .1;i'l . .ry�r t i init11t. 1:1!;_�_ ;;.k,4 Ei t `k., _o_ . . Main Floor Heated r r EH Bid App Review: 2n0 Floor Heated � __"` � Consistency Review: _ ` €» Other Heated [ .i fu t Base fee: Mezzanine Additional Section: Heated Basement „fie Plan Check fee: Unheated Basement ''''-' State Surcharge fee: - Other Unheated N-+, Pot Water Review fee: Garage/Carport -„ SUBTOTAL Decks 4 � 911/Rd Approach fee: Other - . -�'-1 TOTAL: $ Receipt Number. '. k Cash/Check Number: gilt}. xa^ .4 ESTIMATED COST(REQUIRED) Date: 'Fair merket value of all labor and materials foundation to finish Initials: G:\PermitCenter\###FORMS###\DRD FORMS\Master Permit Application S-29-08.doc • 4r,c.\LS (1 L 7 1.p.4.. L 0 (.;..vs. cat"- ?a, AIR FLO HEATING COMPANY INC • Page 1 of 2 Clik Washington State Department of Labor & Industries AIR FLO HEATING COMPANY INC Owner or tradesperson 221 W CEDAR BEQUETTE, MARK A SEQUIM, WA98382 360-683-3901 Pr'inc'ipals 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—.xoiration 03/07/1980—04/25/2016 3ond CBIC $6,000.00 Bond account no. SI5215 Received by t.&I Effective date 02/05/2010 02/01/2010 and history surance American Hallmark Ins Co of Te $1,000,000.00 Policy no 44CL483619 deceived by L&I Effective date )4/18/2014 04/25/2014 ://secure.lni.wa.gov/verify/Detail.aspx?UBI=600347761&LIC=AIRFLI*206DG&SAW= 5/8/2014 Parcel Details Page 1 of 2 • • Jeffers Count ... Home County Info Departments Search Parcel Number: 901021010 SEARCH1 Parcel Number: 901021010 Printer Friendly Owner Mailing Address: LAVERNE HICKS 1410 IRONDALE RD PORT HADLOCK WA98339-9580 Site Address: 1410 IRONDALE RD PORT HADLOCK 98339 Section: 2 School District: Chimacum (49) Qtr Section: NE1/4 Fire Dist: Chimacum (1) Township: 29N Tax Status: SNR/DSBL Range: 1W Tax Code: 0211 Planning area:Tri-Area (4) Sub Division: Assessor's Land Use Code: 1100 - Residential - Single Unit Property Description: S2 T29 R1W TAX 30 & 78 LESS TAX 147,148,151 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 II Best viewed with Microsoft Internet Explorer 6.0 or later Windows - Mac http://www.co.jefferson.wa.us/assessors/parcel/parceldetail.asp?PARCEL NO=901021010 7/18/2014 Parcel Details Page 2 of 2 • • http://www.co.jefferson.wa.us/assessors/parcel/parceldetail.asp?PARCEL N0=901021010 7/18/2014 116°°N cb6 JEFFERSON COUNTY DEPARTMENT OF COMMUNITY DEVELOPMENT r c o Sfrti Date: of Time Received: I ' 2/ t am pm Mon. Tue. Wed. Thur. Fr Date: 44//5 BID: 14- - b4250 Contact Name: Owner: lis c{(g Contact Number: 360 Address: I cE(o I pen.)pfd lea 206 • - 50332— Notes: ilegi 74Mp Foundation Plumbing Framing Propane Tank Mechanical Setbacks Under-ground Framing Under ground Fora nce 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 Wail Address Posted - ., T:1_ Ceiling • C ck Number: 42619 42619 AIR FLO HEATING COMPANY Building Department Amount Jefferson County Bu Description 171.00 Date 07/10/2014 Hicks Permit (replacing check)p JEFFERSON COUNTY OW NO. 148897 DATE RECEIVED FROM Ni ' 4'- ' t A 4/i► B�ARSpDESCRIPTION y AMOUNT CURRENCY CURRENCY �-� a_ COIN I I- cn 0 33 O RECEIVED BY TOTAL ill ' • • 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 #: BLD14-00250 Received Date 7/18/2014 SITE ADDRESS: 1410 IRONDALE RD Issue Date 7/18/2014 PORT HADLOCK, 98339 APPLICANT: LAVERNE HICKS PHONE: 1410 IRONDALE RD PORT HADLOCK WA 98339-9580 SUBDIVISION: Block: Lot: PARCEL NUMBER: 901021010 Section: 2 Township: 29N 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, LAVERNE HICKS PHONE: if different: 1410 IRONDALE RD PORT HADLOCK WA 98339-9580 PROJECT DESCRIPTION: INSTALL 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: 5 (S. 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