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HomeMy WebLinkAboutBLD2014-00293 - MECHANICAL °BUILDING PERMIT APPLIC•ON BLDI4-00293 Review Type: Jefferson County Department of Community Development 621 Sheridan Street Port Townsend, WA 98368 PERMIT #: BLD14-00293 Received Date: 8/13/2014 SITE ADDRESS: 495 JUPITER LOOP RD BRINNON, 98320 OWNER: DALE W WEBBER PHONE: 360-796-4202 WENDY A WEBBER PO BOX 402 BRINNON WA 98320-0402 SUBDIVISION: Block: Lot: PARCEL NUMBER: 502103012 Section: 10 Township: 25 N Range: 2V1 CONTRACTOR: BRENNAN HEATING &A/C LLC PHONE: 206-248-7900 4601 S 134TH PL SEATTLE WA 98168 Contractor's License BRENNHA971 R9 Expires 7/13/2015 REPRESENTATIVE: PHONE: PROJECT DESCRIPTION Heat Pump Install 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 Bv: Date: Receipt: 11. Permit $152.00 SRE 08/12/14 151408 AUG 13 2014 Total: $152.00 .Jefferson County DCD \\tidemark\data\forms\F_BLD_App_Bld.rpt 8/13/2014 • _ 'Q • • 1,101111111. JEFFERSON COUNTY DEPARTMENT OF COMMUNITY DEVELOPMENT 621 Sheridan Street• Port Townsend •Washington 98368 > �y . 360/379-4450 • 360/379-4451 Fax www.co.jefferson.wa.us/commdevelopment Master Permit Application MLA: Project D scription indude arate sheets^as necessary): � C�VL.� CSS 11 C � Y-Y\-4) Tax Parcel Number.5Da I () /5-.)0 a Property Size: (acres/square feet) Site Address and/or Directions to Property: qq5 Svp► at.r L oop, 2 d far; r r bi-, G t33a o Property Owner(s)of Record: t 11 W-C.b► Telephone:' 9 (� a d Fax: V)0— email: Mailing Address: �D>C')C Loa .9% h nor, 1 C-:1 Na 3w 0 Applicant/Agent(If different from owner): '3l v.�V.r k A--seN J 1[A�1 1 Telephone: „, 11\o or 8 . •O F= ,. Dto , $ r • email: al Y111 L • • Mailing Address: . 0 _. � e. = • : • • % C-oYYI What kind of Permit?(Check each box that applies ❑Building ❑Critical Areas Stewardship Plan ❑ Demolition Permit El Variance(Minor,Major or Reasonable Economic Use) Single Family ❑ Garage Attached I 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 El Cottage Industry ❑Binding Site Plan`• ❑Propane ❑Long Plat" ❑Sign ❑Planned Rural Residential Development(PRRD)IAmendments" ❑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 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 "Requires a Pre-Application Conference Please identify any other local,state or federal permits required for this proposal, if known: •ES�IGQNATION OF AGENT I hereby designate .117 t IAA to act as my agent in matters relating to this application for permit(s). OWNER SIGNATURE 0 I A• . Date: e la I I L( By signing this appll.reform,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 o provide access and right of entry to Jefferson County and its employees,representatives or agents for the sole purpose of application review and any quired later inspections. Staff's access and right of entry will be assumed unless the applicant inform the County in writing at the time of the appl' don that he or she wa ror not' P Signatu l a__/.1_./1/1/1,—.1 Date: J/ (The actio 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 b=en 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' you are in compliance wi the Jefferson County development code-The Applicant acknowledges that he,she or it holds individual and non-tran cable responsibility for ash:ring to and complying with the ESA. The Applicant has read this dtsscllurtCr d si s and dates it below. Signatu ;: /. A Al A•� Date: rt (,� G:\PernicCenter\##f#FORMS###\DRD FOAMS\Master Permit Application 5-29-08.doc CO JEFFERSON • trirmOd7 �} DEPARTMENT OF COMMUNITY DEVELOPMENT ',_ "1 621 Sheridan Street• Port Townsend•Washington 98368 4 360/379- 450. 360/379-4451 Fax $� $ www.co.jefferson.wa.us/commdeveiopment v��'� Master Permit Application MLA: Project • 'ption include arate s >-is as necessary): k u�.Vk-css . `,0 Tax Parcel Number.,51,)a I 0 ri--)0 1 a Property Size: (acres/square feet) Site Address and/or Directions to Property: \ O5 S■) s-,1 r Loop 2A r ►-) r1al l G 83a o Property Owner(s)of Record: gnt\ LU-C. �D -t'' Telephone:'? ,c lr 4 a D Fax: `y7 a- email: Mailing Address: 4)C) 0 y GO. cf I h y b r\ Cfl so'3 Q 0 ApplicantlAgent(if different from owner): 'rinnitn A-neN 0/41.4) y._et Telephone: .. •to o a . •0 Fax... Ole, - 6 .. • email: Aim 1.c a7 • •,. , Ir Mailing Address: . O e �- � e. = • , . • < C.-OPY1 What kind of Permit?(Check each box that applies ❑Building ❑Critical Areas Stewardship Plan ❑ Demolition Permit ❑Variance(Minor,Major or Reasonable Economic Use) Ingle Family ❑Garage Attached/Detached El Conditional Use[C(a),C(d),or C]" Discretionary°D"or Unnamed Use Classification ❑ Manufactured Home ❑ Modular ❑ Iscrefronary o ❑ Commercial* ❑Special Use(Essential Public Facilities)" ❑ Change of Use ❑Boundary Line Adjustment ❑ Address ❑Road Approach El Short Plat" ❑ Home Business ❑Cottage Industry El 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 El Wireless Telecommunication* ❑ Comprehensive Plan/UDC/Land Use District Map Amendment ❑Forest Practices Act/Release of Six-Year Moratorium El 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: •ESIGNATION OF AGENT I hereby designate .�" i .4 Vl9`to act as my agent in matters relating to this application for permit(s). OWNER SIGNATURE I0 ■ d. A , • Date: e l a J j`( By signing this appll -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 quired later inspections. Staffs access and right of entry will be assumed unless the applicant i mi the County in writing at the time t th appl' lion that t he o.she wa prior noti k /� I Li Signatu ) l" iv v�v�y �'�`� Date: "r The actin 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 b en 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' you are in compliance wi the Jefferson County development code.The Applicant acknowledges that he,she or it holds Individual and non-tran rable responsibility for h ring to and complying with the ESA. The Applicant has read this l r 1rkk�lsig/ns and dates it below. Signaturlp: Th Date: ((( /I // `I G:\PeimitCentet\#1/#FORMS###\DRD FORMS\Master Penmt Application 5-29-08.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: pENERAL CONTRACTOR OR 'ANUFACTURED HOME INSTALLER: PHONE: FAX: .I► , o.- .. iO4 ( C' . ' a'. 3\C... (alOk.P (I(350 MAILING ADDRESS:y 4,C) 3 V . ] t✓W t! l.. r_.- t� CONTRACTOR'S LICENSE \`{.0 r�o'� �._ "\ k • ;� C 4 uvgi NS c.m NUMBER: i NUMBER ARCHITECT/ENGINEER: PHONE ( ) FAX( ) MAILING ADDRESS: • EMAIL Project Type: Frame Type: Bathrooms: Shoreline: Type of Sewage Disposal: ❑ New ❑ Wood Existing: ❑ Sewer ❑ ;Addition ❑ Steel Proposed: Bank o Community System W-Atteration/Remodel ❑ Concrete Total: Height: ❑ Individual System ❑ Repair ❑ Masonry SEP Permit# ❑ Demolition ❑ Other: Bedrooms: Water Supply: Existing: Setback: i1 Private well ❑ Two Party Typ Heat Proposed: 0 Public 61-I L 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 andlor Appliance Installation permit,mark all items below that apply: I Underground Tank I Above ground Tank Size of Propane Tank: I Heat Stove I Cook Stove I Woodstove I Fireplace Insert I Hot Water Tank I Pellet Stove I Other Is this appliance being installed in a Manufactured I 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• the reserve area. i . ,r. :Square Footage Current Proposed :4 'i t w li T Ittr = -. - , ..., <r .:', Main Floor Heated t t '7.-14 EH Bid App Review: 4 0°Floor Heated Consistency Review: Other Heated Base fee: /1) v.L4il '4. �('//�J.9 V Mezzanine VP- rP"° Additional Section: Heated Basement " -` Plan Check fee: Unheated Basement ' � State Surcharge fee: ' - ,'Irk Other Unheated r .w'{ • > Pot Water Review fee: Garage/Carport SUBTOTAL AMU Decks _ .. 911/Rd Approach ==: { 1 Other `'rz,.�s:�.��%, TOTAL: $ ot s Receipt Number: I Q 4 0g - -. z.T:,Frt 4, Cash/Check Number. , 4 ESTIMATED COST(REQUIRE r r :0• Date: • i 4- .Fair market value of all labor and maten.s foundation to finish Initials: r•J. t l�,C 1 I Z ./ G:\PemvtCenter\##itFORMS#41ADRD FORMS\Master Permit Application 5-29-08.dox BRENNAN HEATING & A/C LLC Page 1 of 2 • Cili Washington State Department of ) Labor & industries BRENNAN HEATING & A/C LLC Owner or tradesperson 4601 S 134TH PL ERDAHL, DARRIN PAUL SEATTLE, WA 98168 206-248-7900 Principals KING County ERDAHL, DARRIN PAUL, PARTNER/MEMBER Doing business as BRENNAN HEATING &A/C LLC WA UBI No. Business type 602 346 866 Limited Liability Company License Verify the contractor's active registration I license/certification (depending on trade) and any past violations. Construction Contractor Active. Meets current requirements. License specialties GENERAL License no. BRENNHA971 R9 Effective—expiration 12/29/2003-12/29/2015 Bond ................. FEDERATED MUTUAL INS CO $12,000.00 Bond account no. 9127230 Received by L&I Effective date 11/04/2004 12/22/2004 Expiration date Until Canceled Insurance Federated Mutual Ins Co $1,000,000.00 Policy no. 9820726 Received by L&l Effective date 06/13/2014 07/13/2007 Expiration date 07/13/2015 Savings No savings accounts during the previous 6 year period. Lawsuits against the bond or savings https://secure.lni.wa.gov/verify/Detait.aspx?UBI=602346866&LIC=BRENNHA971R9&SAW= 8/13/2014 BRENNAN HEATING & A/C LLC Page 2 of 2 No lawsuits against the bond or sass accounts during the previous 6 year p;d. L&I Tax debts No L&I 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. PPEJP00330 Satisfied Violation date RCW/WAC 09/14/2012 18.106.020 Violation city Violation amount Seattle $250.00 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. On 9/11112, Brennan Heating & A/C LLC employed Levy Malcom Steere to perform plumbing related duties without proper plumbing certification. 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. 803,761-08 Doing business as BRENNAN HEATING &AIR CONDIT Estimated workers reported Quarter 2 of Year 2014"76 to 100 Workers" L&i account representative T1 /FEARAED FEROZE (360)902-4797 - Email: FERH235 @Ini.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. ACcess Wasttingt to https://secure.lni.wa.gov/verify/Detail.aspx?UBI=602346866&LIC=BRENNHA971R9&SAW= 8/13/2014 � COG ti JEFFERSON COUNTY DEPARTMENT OF COMMUNITY DEVELOPMENT D1 ^ p� y� 9`rHfNG C)I C'11'L �,!J *lv Date: 'l 0 Time Received: L(O'3 Mon. ue.; Wed. Thur. Fri. Date: BLD: alt_2CIS Contact Name: Owner: It Contact Number: 360 71f 92.0z. Address: LIgs Juett-u- leap .24E6 Notes: bk-6-A-cr pu1 1 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 COUNTS Da) No.5140 : DATE • r 0.0 I+ / Q RECEI VED FROM1 � DESCRIPTION BARS qy� AMOUNT CURRENCY Oct Pita I S 2 COIN 5 _ /1 fj�.lAi4,/X 1 9, CHECKS �! 1-brat S ea Cm 49.5 T � I.�- r I einni4 1 n5� l ptivnT RECEIVED BY : .�, L < -/IL► TOTAL I , 0 0 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#: BLD14-00293 Received Date 8/13/2014 SITE ADDRESS: 495 JUPITER LOOP RD Issue Date 8/13/2014 BRINNON, 98320 APPLICANT: DALE W WEBBER PHONE: 360-796-4202 WENDY A WEBBER PO BOX 402 BRINNON WA 98320-0402 SUBDIVISION: Block: Lot: PARCEL NUMBER: 502103012 Section: 10 Township: 25N Range: 2W CONTRACTOR: BRENNAN HEATING &A/C LLC PHONE: 206-248-7900 4601 S 134TH PL SEATTLE WA 98168 iaimie(ftreenan heating.com Contractor's License BRENNHA971 R9 Expires 7/13/2015 OWNER, DALE W WEBBER PHONE: 360-796-4202 if different: WENDY A WEBBER PO BOX 402 BRINNON WA 98320-0402 PROJECT DESCRIPTION: Heat Pump Directions Install ductless heat pump 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 8/13/2015. REQUIRED INSPECTIONS: Installation per Manufacturer Specifications/CO2: Tank/Line/Appliance: Final Approval: 7/P)15- - 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 8/13/2014