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HomeMy WebLinkAboutBLD2015-00198 - MECHANICAL •UILDING PERMIT APPLICATIN BRDI5-00198 Jefferson County Department of Community Development 621 Sheridan Street Port Townsend, WA 98368 PERMIT #: BLD15-00198 Received Date: 6/12/2015 SITE ADDRESS: 260 HILDA ST CHIMACUM, 98325 OWNER: SHERYL COYOTE PHONE: 360-385-5784 260 HILDAST CHIMACUM WA 98325-9727 SUBDIVISION: Block: Lot: PARCEL NUMBER: 901112017 Section: 11 Township: 29 N Range: 11/1 CONTRACTOR: FAST WATER HEATER COMPANY PHONE: 425-636-7055 12601 132ND AVE NE KIRKLAND WA 98034 Contractor's License FASTWWH948BC Expires 1/4/2016 REPRESENTATIVE: PHONE: PROJECT DESCRIPTION NEW MECHANICAL PERMIT- INSTALL WATER HEATER 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: BEDROOMS: BATHROOMS: Exist: Exist: Prop: Prop: Total: Total: Routing Date: Type Amount Paid By: Date: Receipt: Approved/Date Permit $156.00 SRE 06/11/15 156186 g p p ROVED Total: $156.00 eFi R' JUN 1 2 2015 Jefferson County DCD 11fiiiomnr4\ri�fs\fnrmc'F RI fl Ann Rid rnf n/19191 11c O • • 2 76 l fgi c,,-(–ZS JEFFERSON COUNTY cj DEPARTMENT OF COMMUNITY DEVELOPMENT r i 141 621 Sheridan Street• Port Townsend -Washington 98368 360/379-4450 • 3601379-4451 Fax �I5,� ,Sp$ www.co.jefferson.wa.us/commdevelopment Master Permit Application MLA: Project Description(include s parate sheets as necessary): 6o Yu LCta f&v Tax Parcel Number: a bill 2(J Property Size: (acres/square feet) Site Address and/or Directions to Property: p Property Owner(s)of Record: _a r • S V142, Telephone: S6 C1-- St�'� . Fax: email: Mailing Address: .26 C) i ( ow( Ave_ Applicant/Agent(if different from owner): i t/,) r I '9 j L • Telephone:‘--4VS— ---- b5j Fax: t-l .4. .--105?) email: A w Wailer Mailing Address: What 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 ❑ Modular ❑ Discretionary"D"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 Cl 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)* El Shoreline Management Substantial Development** ❑Temporary Use El 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 ** _ R=•wires a Pre-A••lication Conference Please identify any other local,state or federal permits required for this proposal, if known: DESIGNATION OF AGENT I hereby designate to act as my agent in matters relating to this application for permit(s). OWNER SIGNATURE 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: 06 PR /( , 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 d'Complying with the ESA. The Applicant has read this disclajmer and signs and dates it below. Signature. _� Date: CUJt6/ Q /I G.\PemutCenter\###FORMS###\DAD FORMS\Master Permit Application 5-29-08.doc 0 • 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: F-A-St- IA)il-fpER. �1QCt(7e ►,a (4IxT 636 `708`1 (4al 63 ( 10S�,� MAILING ADDRESS: i s 6 b I 1 b 2 o y� � a�t" EMAIL: t'Je_nylit��0 rs 7f �-e; CONTRACTOR'S LICENSE u '�V Ci L WAINS 1 `J NUMBER: it;S��(�'k GI Q C1 g ( NUMBER ARCHITECT/ENGINEER: PHONE ( ) FAX:( ) MAILING ADDRESS: - EMAIL Project Type: Frame Type: Bathrooms: Shoreline: Type of Sewage Disposal: LI New f] Wood Existing: r1 Sewer Addition ❑ Steel Proposed: Bank ❑ Community System X Alteration/Remodel ❑ Concrete Total: Height: El Individual System Cl Repair ❑ Masonry SEP Permit# ❑ Demolition C Other: Bedrooms: Water Supply: Existing: Setback: ❑ Private well ❑ Two Party Type of Heat: Proposed: ❑ Public 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: I Underground Tank I Above ground Tank Size of Propane Tank: i Heat Stove 1 Cook Stove 1 Woodstove 1 Fireplace Insert 1 Hot Water Tank 1 Pellet Stove I 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, including the reserve area. ) F Square Footage Current Proposed FQ ly E ,;.,t �,t � Amount . ' fsicn - Main Floor Heated , ' - EH Bld App Review: 2n°Floor Heated A44, a `' Consistency Review: x , Is' Other Heated ri: Base fee: Mezzanine Additional Section: Heated Basement , '' Plan Check fee: Unheated Basement ' rt' State Surcharge fee: Other Unheated Pot Water Review fee: Garage/Carport j x s SUBTOTAL Decks =ea i ,- 911/Rd Approach fee: i3t :. Other k ,,,(t -1 ce % TOTAL $ vnJ r vCLt�• Receipt Number: . : Cash/Check Number: ESTIMATED COST(REQUIRED) Date: •Fair market value of all labor and materials foundation to finish Initials: G:\PcrmitCenter\###FORMS###\DRD FORMS\Master Permit Application 5-29-08.doc • • ]gg Farm#38 7I2013Capy Port#15-40.38 ,� MAY PJt yob 76 � '� CO HEATER t Customer Satisfaction Form Your Installation Technician Today Was J� 10 Point Installation Quality Checklist ✓ • ■ . 1. Was the new unit checked for water leaks? 6. Wafer lines purged? 2. Gas line soap tested for gas leaks? 7. Thermostat adjusted to 120 degrees? D3. Audible electric test? 8. Owr �rs manual,warranty info, service stickers 4. Washing machine drain hose replaced if used? on tank? ❑ 5. If gas was shut off,were other appliances relit •9. Installation area left clean? and tested? 10. Technician answered all of your questions? We Strive to Provide You With "Perfect 10" Service Thank you for Your Business!• ,I I'm the Regional Field Supervisor for Western Washington. During your service visit, p � if you feel my technician did not earn a "10" and you are not 100% satisfied, I want --...t':/ t to know about it Please call or email me today. . Steve B. '::3 i . (425) 636-7076 -;,y .. steveb@fastwaterheater.com r1, •, You may also receive a survey about our service. Please let us know how we did so r • s, 4 . ;t' that we can continue to provide you with the best customer service possible! Do You Participate in Online Review Forums? ww: We track reviews down to each technician and use your feedback to help motivate and train customer service excellence. Please visit www.ReviewBuzz.com, type in "Fast Water Heater" and leave us your feedback. From there, you will be able to leave a review on most major review sites.And going through ReviewBuzz.com will help us track your feedback back to the people who helped you today. It's important for us in making sure we continue to improve and for rewarding tearn members that provide outstanding customer service. You may also receive a survey from us or from one of our partners,,We strive to provide"Perfect 10" service. If you don't feel we've earned a "10", we want to know! Your input helps us as a company and our technicians provide our valued customers with the "Perfect 10" service they deserve. Thanks for your business and thanks for taking the time to leave us your feedback! Customer Sign. "re / Customer Print d Name Top-Fest Botlom-Customer FAST WATER HEATER COMPANY. • Page 1 of 5 Home Inicio en Espanol Contact Search L&I 1 A-Z Index Help My Secure L&I Safety Claims&Insurance . Workplace Rights Trades&Licensing 0 Washington State Department of Labor & Industries FAST WATER HEATER COMPANY Owner or tradesperson 11715 NORTH CREEK PARKWAY S#C106 Principals BOTHELL,WA 98011 425-814-8381 JORDAN,JEFFERY KING County DAVID,PARTNER/MEMBER HANLEYBROWN, JASON,PARTNER/MEMBER Doing business as FAST WATER HEATER COMPANY WA UBI No. Business type 602 564 544 Limited Liability Company Parent company Governing persons FWH ACQUISITION COMPANY LLC JASON HANLEYBROWN JEFFREY DAVID JORDAN; License I 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. FASTW WH948BC Effective—expiration 01103/2006—01/04/2016 Bond DEVELOPERS SURETY&INDEM CO $12,000.00 Bond account no. 549792C Received by L&I Effective date 01/03/2006 01/01/2005 Expiration date Until Canceled Insurance American States Insurance Co $1,000,000.00 Policy no. 01C155607620 Received by L&I Effective date 01108/2015 02/17/2014 Expiration date 02/17/2016 Insurance history Savings https://secure.lni.wa.gov/verify/Detail.aspx?UBI=602564544&LIC=FASTWWH948BC&SAW= 6/12/2015 FAST WATER HEATER COMMY • Page 2 of 5 No savings accounts during the previo ar period. Lawsuits against the bond or savings Cause no. 13-2-17632-7KNT Open Complaint filed by Complaint against bond(s)or savings AMERICAN FAMILY MUTUAL INS CO 549792C Complaint date Complaint amount 05/29/2013 $10,825.45 LAI Tax debts No L8:1 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 Infraction no. Satisfied PSACE00226 Issue date RCWNVAC 01/05/2015 18.106.020 Violation city Violation amount BOTHELL $1,000.00 Type of violation PLUMBER INFRACTION Description Contractor employed a person to engage in the trade of plumbing without a current journeyman,specialty or trainee certificate, temporary permit or medical gas endorsement as required.(Employed Christopher William Best to engage in the trade of plumbing while in possession of an expired trainee certificate at above SFR) Infraction no. PSACE00227 Satisfied Issue date RCWNVAC 01/0512015 18.106.020 Violation city Violation amount BOTHELL $1,000.00 Type of violation PLUMBER INFRACTION Description Contractor failed to provide proper supervision as required.(Employed plumber trainee Friedrich Laurence Timmons to engage in the trade of plumbing at above SFR without providing him with supervision required by statute) Infraction no. PESPR00717 Satisfied Issue date RCW/WAC 09/26/2014 18.106.020 Violation city Violation amount BOTHELL $1,000.00 Type of violation PLUMBER INFRACTION Description Contractor failed to provide proper supervision as required.Contractor failed to provide proper supervision as required.Chris L Lowrie/plumber trainee installed a hot water tank without supervision. Infraction no. PPEJPD0468 Satisfied RCW/VVAC https://secure.lni.wa.gov/verify/Detail.aspx?UBI=602564544&LIC=FASTWWH948BC&SAW= 6/12/2015 FAST WATER HEATER COMPANY• Page 3 of 5 Issue date 18.106.020 • 10/04/2013 Violation amount Violation city $1,000.00 BOTHELL Type of violation PLUMBER INFRACTION Description Contractor employed a person to engage in the trade of plumbing without a current journeyman,specialty or trainee certificate, temporary permit or medical gas endorsement as required.On 10/03/2013,FAST WATER HEATER COMPANY employed Mr.Richard E. Egge an expired plumbing trainee to perform plumbing related duties. Infraction no. PPEJP00230 Satisfied ................ Issue date RCW/WAC 12/09/2011 18.106.020 Violation city Violation amount Kirkland $1,000.00 Type of violation PLUMBER INFRACTION Description Contractor employed a person to engage in the trade of plumbing without a current journeyman,specialty or trainee certificate, temporary permit or medical gas endorsement as required.Fast Hot Water Company employed Christopher W Best,an expired plumber trainee to remove an old hot water heater and replace it with a new one. Infraction no. PJAJC01333 Satisfied Issue date ROW//VAC 11/30/2011 18.106.020 Violation city Violation amount Kirkland $1,000.00 Type of violation PLUMBER INFRACTION Description Contractor employed a person to engage in the trade of plumbing without a current journeyman,specialty or trainee certificate, temporary permit or medical gas endorsement as required.(Fast hot water company employed Patrick James Folkes,an uncertified Individual,who removed the water supply lines and was in the process of removing the electrical branch circuit connection to the HWT). Infraction no PZETD00570 Satisfied Issue date RCWNVAC 11114/2011 18.106.020 Violation city Violation amount Kirkland $1,000.00 Type of violation PLUMBER INFRACTION Description Contractor failed to provide proper supervision as required.(Chris Lowrie/plumber trainee installed hot water tank without supervision) https://securc.lni.wa.gov/verify/Detail.aspx?UBI=602564544&L1C=FASTWWH948BC&SAW= 6/12/2015 FAST WATER HEATER COY • Page 4 of 5 Infraction no. PJAJC01324 Satisfied Issue date RCWNVAC 11/09/2011 18.106.020 Violation city Violation amount Kirkland $1,000.00 Type of violation PLUMBER INFRACTION Description Contractor failed to provide proper supervision as required.(contractor dispatched plumber trainee Jeff Zimnisky to install an expansion tank and replace a pressure relief valve on a HWT at the above SFR). Infraction no. Satisfied PBATI00591 Issue date RCW/WAC 01127/2010 18.106.020 Violation city Violation amount Kirkland $1,000.00 Type of violation PLUMBER INFRACTION Description Contractor employed a person to engage in the trade of plumbing without a current j ou rneymanlspecia ltyltra ineelmed-gas certification as required.Contractor employeed Richard E.Egge,a residential maintenance electrician,to install a gas water heater when not certified as required. ...... ........... Infraction no. PBAT100592 Satisfied Issue date RCW/VVAC 01/27/2010 18.106.020 Violation city Violation amount Kirkland $1,000.00 Type of violation PLUMBER INFRACTION Description Employee who authorized the plumbing work assignment of the person employed in violation of 18.106.020.Contractor/employee for Fast Water Heater,authorizrd Richard Egge,to install a gas water heater when not certified as required. Workers' 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. 053,806-01 _....................... Doing business as FAST WATER HEATER COMPANY Estimated workers reported Quarter 1 of Year 2016"51 to 75 Workers" L&I account representative T1 I NIKKI BUTLER(360)902-4918-Email:BUTQ235 @lni.wa.gov IWorkplace safety and health https://secure.lni.wa.gov/verify/Detail.aspx?UBI=602564544&LIC=FASTWWH948BC&SAW= 6/12/2015 FAST WATER HEATER COMPANY. • Page 5 of 5 No inspections during the previous 6 year period. 0 Washington State Dept.of Labor&Industries.Use of this site is subject to the laws of the state of Washington. https://secure.lni.wa.gov/verify/Detail.aspx?UBI=602564544&LIC=FASTWWH948BC&SAW= 6/12/2015 Parcel Details • • Page 1 of 2 rz Jefferson County 14rraa,,."' :71'21111i r Home County info -Departments Search Parcel Number: 901112017 SEARCH Parcel Number: 901112017 Printer Friendly Owner Mailing Address: SHERYL COYOTE 260 HILDA ST CHIMACUM WA98325-9727 Site Address: 260 HILDA ST CHIMACUM 98325 Section: 11 School District: Chimacum (49) Qtr Section: NW1/4 Fire Dist: Chimacum (1) Township: 29N Tax Status: Taxable Range: 1W Tax Code: 0211 Planning area:Tri-Area (4) Sewer: Drainage: Bank: View 1: View 2: Zoning 1: RR-5 - Rural Residential Zoning 2: Zoning 3: Sub Division: Assessor's Land Use Code: 1100 - Residential - Single Unit Property Description: S11 T29 R1W TAX 21 (LESS W 396' & S30' WEST OF DRAINAGE DITCH) Tax V Sales Photos and Permit Data Bldg Data Ma. Parcel lats &Surveys 1 i Septic Monitoring Info Jefferson County , , ,_. HOME I COUNTY INFO I DEPARTMENTS I SEARCH d Best viewed with Microsoft Internet Explorer 6.0 or later Windows - Mac http://www.co.jefferson.wa.us/assessors/parcel/parceldetail.asp?value=901112017 6/12/2015 FAST WATER HEATER COMPANY. Page 1 of 2 Home Inicio en Espanol Contact Search L&I. A-Z Index Safety Claims & Insurance Workplace Rights Washington State Department of ,, Labor & in dust ri es FAST WATER HEATER COMPANY Owner or tradesperson 12601 132ND AVE NE #17 IRS PARTNERS KIRKLAND, WA 98034 Doing business as FAST WATER HEATER COMPANY WA UBI No. Governing persons 601 933 036 #17 IRS PARTNERS DAVID GEORGE BOHANNON; JEFFREY DAVID JORDAN; JERRY IVY; TAMMY LOWRY; TODD SANDOZ; Workers' 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 closed. 053,806-00 Doing business as FAST WATER HEATER COMPANY Estimated workers reported N/A L&I account representative T1 I NIKKI BUTLER (360)902-4918-Email: BUTQ235@lni.wa.gov Workplace 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. https://secure.lni.wa.gov/verify/Detail.aspx?UBI=601933036&SAW= 6/12/2015 • 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#: BLD15-00198 Received Date 6/12/2015 SITE ADDRESS: 260 HILDA ST Issue Date 6/12/2015 CHIMACUM, 98325 APPLICANT: SHERYL COYOTE PHONE: 360-385-5784 260 HILDA ST CHIMACUM WA 98325-9727 SUBDIVISION: Block: Lot: PARCEL NUMBER: 901112017 Section: 11 Township: 29N Range: 1W CONTRACTOR: FAST WATER HEATER COMPANY PHONE: 425-636-7055 12601 132ND AVE NE KIRKLAND WA 98034 Contractor's License FASTWWH948BC Expires 1/4/2016 OWNER, SHERYL COYOTE PHONE: 360-385-5784 if different: 260 HILDA ST CHIMACUM WA 98325-9727 PROJECT DESCRIPTION: NEW MECHANICAL PERMIT- INSTALL WATER HEATER 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 6/12/2016. REQUIRED INSPECTIONS: Installation per Manufacturer Specifications/CO2: Tank/Line/Appliance: i?-- Final Approval: —1/4/5- 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 6/12/2015