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HomeMy WebLinkAboutBLD2015-00289 - MECHANICAL IJILDING PERMIT APPLICAT 11PN BLD15-00289 Review Type: Jefferson County Department of Community Development 621 Sheridan Street Port Townsend, WA 98368 PERMIT #: BLD15-00289 Received Date: 8/14/2015 SITE ADDRESS: 63 FOSTER LN PORT LUDLOW, 98365 OWNER: JOHN DALLEN PHONE: JOHN D ALLEN TRUSTEE 63 FOSTER LANE PORT LUDLOW WA 98365-9611 9906- PORT LUDLOW NO. 2 SUBDIVISION: Block: Lot: PARCEL NUMBER: 990600363 Section: 9 Township: 28 N Range: 1E CONTRACTOR: AIR FLO PHONE: REPRESENTATIVE: PHONE: PROJECT DESCRIPTIOI\ ELECTRIC FURNACE AND 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: OCCUPANCY: UNHEATED: # OF STORIES: CONST TYPE: OTHER: SHORELINE: CONST TYPE: GARAGE: SETBACK: DECK: BANK HEIGHT: SEWAGE DISPOSAL: WATER SYSTEM: BEDROOMS: BATHROOMS: Exist: Exist: Prop: Prop: Total: Total: Routing Date: Type Amount Paid Bv: Date: Receipt: Approved/Date Permit $156.00 SRE 08/14/15 156391 Total: $156.00 APPROVED AUG 14 211t5 Jefferson County PC \\tiriomnrIr\rint \fnrrnc\r RI fl Ann RIri rnt A/9n/9MS CL 50• r DEPARTMENT OF COMMUNITY DEVELOPMENT rj Lti?l Sheridan SUCcr, C°1rt T( n,ea1d,Vt%A 98368 1", I'AA: 360 3 79.4450 . I ax:360 179.4$.)1 -� -< .co.ic ffersrn?.w,L,L iruminu1111 develrlpmcilt li-mail:cicd(iicoj,ctfu.ctn 1a!s MECHANICAL PERMIT APPLICATION Steps in the Permit Process: -Review required submittal items to ensure all information is completed prior to submitting application. -Mechanical Permits can be mailed into our office-and do not require an appointment. -Fees are due at time of submittal, Mechanical permits are generally issued within S business days. For Department Use Only Receipt#: Date: Related Application#s: ; Payment#: Is this application for use in a Mobile/ Manufactured Home? * If Yes: A permit from Washington State Department of Labor and Industries, not Jefferson County, is required for appliances installed within a mobile/manufactured home. L&I - 360-417-2702 * If No: Complete this form and make an appointment to submit to Jefferson County Permit Tech 360-379-4450 Required Submittal Items-for propane tank only General Site plan -showing propane tank, lines, and distance from tank to all existing structures. Required Submittal Items-for Solar Panel installation only Complete first page and signature block only of Mechanical Permit Application. A complete solar panel supplemental application. Site Information Assessor Tax Parcel Number: 1€11 L J GL)-6 Site Address and/or Directions to Property: ,- • '* 4 access (name of street(s) from which access will be gained: Description of Work: u tOtt Pump c Air ,}-I vid (-ti ( iJ J„0) Property Own r Name: r!j I �.(, �1 1 btu 1 �y Address: tp17 5TH l��-,LttP Phone #: '�j ,cnc- E-mail Address: , Applicant/ Contractor: Authorized Agent/Representative yam. Name: /IYK- rIA 1.1&,, Phone #: /A / A �ii7 E-mail Address: � &�i 3 AA License #: ;" • It Expiration Date: !t !Il v Mechanical Application 1 . Heat Source Electric M Heating Oil Cj Propane* Wood Indicate Quantity and Fixture Types Below *Propane is prohibited in Quantity Fixture Type Description hazardous locations such as Fan Bath Fan and/or Exhaust Fan basements or pits or Clothes Dryer Clothes Dryer with Exhaust Vent anywhere "heavier-than-air" Cook Stove Cook Stove, Range Hood Exhaust gas can unsafely collect. Fireplace-Gas Fireplace-Gas or Gas Log Insert *Propane tanks over 125 Fireplace-Wood Fireplace-wood,Wood Stove,or gallons require a minimum Pellet Stove setback of 10 ft.from Electric Furnace Electric Furnace or HP+/-Ducting property line and buildings, Propane (LP) Gas Furnace Propane Furnace+/-Ducting and a site plan must be submitted with the Water Heater-Gas Gas WH Vent and Combustion Air application showing the Gas Pipe System Gas Pipe System LPG/Oil setbacks. If propane tank is Propane Tank LP Fuel Tank(#gallons: ) over 500 gallons, a site plan is Heat Pump required to accompany this Generator application, and a separate Air Conditioner Fire Code approval is also required. Installation manual must be on site at time of inspection or a re-inspection fee will be charged. 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 making any issued permit null and void. I further agree to that all activities I intend to undertake or complete associated with this permit will be performed in compliance with all applicable federal, state and county laws and regulations and I 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. Applicant may request notice of the County's intent to enter upon the property for visits rela to this applicati•n and subsequent permit' suance. Property O Signatur-• r�/. . . _ A ':iI/l/ 'rintName: Vt fl Ql`Qp) Date: t I I3 OFFICE USE ONLY Building Permit Fees Mechanical Permit fee (tankswp woadstove,furnace,etc) $156.00 Propane— Lines, tank, and appliance (add'I $78.00) Project Scanning Fee $19.50 Total Fees* J 1 ("Ps---7 *Additional fees may apply. Mechanical.Application 2 eN coy, JEFFERSON COUNTY DEPARTMENT OF COMMUNITY DEVELOPMENT \) ''SHINGS''. Date: 3l Time Received: /D:z1 69pm Mon. Tue. Wed. Thur. Fri. Date: Q 2/15 BLD: /$- CaoZB 9 Contact Name: Owner: AWU Contact Number: 360 f37©q£37 Address: G3 F.;irEe. LA) 206 Notes: Foundation Plumbing Framing Propane Tank Mechanic 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 T,_ Ceiling `t.�''"' `'? JEFFERSON COUNTY -pr 0,4{ 11`" I-,/-6t° DEPARTMENT OF COMMUNITY DEVELOPMENT Date: /lv Time Received: g. �pm Mon. Tue. Wed. Thur. Fri. Date: 8/77 BLD: IS - OOZ.87 Contact Name: Owner: Contact Number: 360 437-69f7 Address: LS �oSTa, I.4j 206 926, -2676 Notes: L-1, -e._ >f,e�,va f // P Iwr Foundation Plumbing Framing Propane Tank cM\echanical 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 aV Underfloor Gas/Wood stove Man-Homes Insulation Final Inspection Setbacks Floor Foundation Wall Address Posted Block &Tile Ceiling _,� Ivor • • 0 .ICE AND NOTICE OF RIGHT TO CAN* 8 0 4 0 7 0 INVOICE Merchant ID# 10 p 0 0 2 N 0 7 21 0 CREDITTERM PLAN NO. Lilo q I ( AUTHORIZATION# At -7 d ra O 0 0 name wirmar MERCHANT TICKET/ DESCRIPTION TOTAL AMOUNT INVOICE# FINANCED Buyer Name rfa-uz. �� JlU 18 �� P�•y(� 13'115.7 Y Buyer Address b 3 �O St's (irVwQ. TERMS OF PURCHASE:Regular Rate with Regular Payments unless Special Terms Buyer City/State/ZIP '70 (i(Ad Lo r� W A 9$38 2 are indicated below.If Special Terms,complete only one box below: ' No Interest if Paid in Full* Special Rate(Equal Pay): Special Rate(Reduced APR): Seller Business Name ,4,1r F(O /--12af�Jc within Months ISk %APR %APR Seller Address ZZ( W with Regular Payments 36 Equal Payments Custom Payment sellerary/state/ZW *Special Terms and APR Information c.: ws (✓i4 `� 3 PZ If your special terms promotion is No Interest if Paid In Full,you will be charged Seller Phone# 3 be b83 39e i Salesperson s(� no interest if paid in full by the end of the special terms period. If the balance is not paid In full by the end of the period,interest will be imposed from the date of Seller License# License Classification Co^-trra ..4t r purchase at the applicable rate disclosed below.Applicable Rates: TERMS.This transaction is under your Credit Card Agreement with Wells Fargo Financial If your account was opened: your APR will be: National Bank('the Bank"). on or after September 28,2010 27.99%This APR will vary with the market based SECURITY INTEREST.Where applicable,you give the Bank a purchase-money security on the U.S.Prime Rate. interest on goods purchased in this transaction.The Bank will not claim a security between February 22,2010 25.99%This APR will vary with the market based interest or other lien (except judgment liens) in your principal dwelling.You agree -September 27,2010 on the U.S.Prime Rate. that any property described in this invoice will remain personal property and will not between March 1,2009 23.90% become a fixture even if attached to real property. -February 21,2010 NOTICE TO BUYER between December 27,2007 21.90% 1.Do not sign this invoice if any of the spaces intended for the agreed -February 28,2009 terms to the extent of then available information are left blank. prior to December 27,2007 17.90% 2.You are entitled to a copy of this invoice at the time you sign it. If you are not sure when your account was opened, you may call Wells Fargo 3.You may at any time pay off the full unpaid balance due under this Financial National Bank at 1-800-459-8451.Representatives are available Monday invoice. through Friday,8 a.m.to 6 p.m.Central time. 4.The Seller has no right to enter unlawfully your premises or commit any breach of the peace to repossess goods purchased under this invoice. 5.You may cancel this transaction if it has not been signed at the main office or branch office of the Seller,provided you notify the Seller not later than midnight of third business day(fifth business day in Alaska,fifteenth business day in North Dakota if you are 65 or older)after the day of the transaction(or,in Utah,after the day of the transaction or receipt of the product,whichever is later).See the below Notice of Right to Cancel for an ex lanation of buyer's rights. /{ Buyer Signature Buyer Signature Date Z'2'_'sue BUYER'S RIGHT TO CANCEL YOU,THE BUYER,MAY CANCEL THIS TRANSACTION AT ANY TIME PRIOR TO MIDNIGHT OF THE THIRD BUSINESS DAY (FIFTH BUSINESS DAY IN ALASKA,FIFTEENTH BUSINESS DAY IN NORTH DAKOTA IF YOU ARE 65 OR OLDER)AFTER THE DATE OF THIS TRANSACTION(OR,IN UTAH,AFTER THE DATE OF THE TRANSACTION OR RECEIPT OF THE PRODUCT,WHICHEVER IS LATER).SEE THE BELOW NOTICE OF RIGHT TO CANCEL FORM FOR AN EXPLANATION OF THIS RIGHT.FAILURE TO EXERCISE THIS OPTION,HOWEVER,WILL NOT INTERFERE WITH ANY OTHER REMEDIES YOU MAY POSSESS.IF YOU CANCEL,THE SELLER MAY NOT KEEP ANY OF YOUR DOWN PAYMENT.ADDITIONALLY,IN MICHIGAN, THE SELLER IS PROHIBITED FROM HAVING AN INDEPENDENT COURIER SERVICE OR OTHER THIRD PARTY PICK UP YOUR PAYMENT AT YOUR RESIDENCE BEFORE THE END OF THE 3-BUSINESS-DAY PERIOD IN WHICH YOU CAN CANCEL THE TRANSACTION. NOTICE OF RIGHT TO CANCEL Enter date of transaction: 7—2 2— 15 Date(1) YOU MAY CANCEL THIS TRANSACTION,WITHOUT ANY PENALTY OR OBLIGATION,WITHIN THREE BUSINESS DAYS(FIVE BUSINESS DAYS IN ALASKA,FIFTEEN BUSINESS DAYS IN NORTH DAKOTA IF YOU ARE 65 OR OLDER)FROM THE ABOVE DATE(OR,IN UTAH,AFTER THE DATE OF THE TRANSACTION OR RECEIPT OF THE PRODUCT,WHICHEVER IS LATER). IF YOU CANCEL, ANY PROPERTY TRADED IN, ANY PAYMENTS MADE BY YOU UNDER THE CONTRACT OR SALE, AND ANY NEGOTIABLE INSTRUMENT EXECUTED BY YOU WILL BE RETURNED WITHIN TEN BUSINESS DAYS FOLLOWING RECEIPT BY THE SELLER OF YOUR CANCELLATION NOTICE,AND ANY SECURITY INTEREST ARISING OUT OF THE TRANSACTION WILL BE CANCELLED. IF YOU CANCEL,YOU MUST MAKE AVAILABLE TO THE SELLER AT YOUR RESIDENCE, IN SUBSTANTIALLY AS GOOD CONDITION AS WHEN RECEIVED,ANY GOODS DELIVERED TO YOU UNDER THIS CONTRACT OR SALE;OR YOU MAY IF YOU WISH,COMPLY WITH THE INSTRUCTIONS OF THE SELLER REGARDING THE RETURN SHIPMENT OF THE GOODS AT THE SELLER'S EXPENSE AND RISK. IF THE SELLER DOES NOT PROVIDE INSTRUCTIONS FOR THE RETURN OF THE GOODS TO THE SELLER OR IF YOU DO MAKE THE GOODS AVAILABLE TO THE SELLER AND THE SELLER DOES NOT PICK THEM UP WITHIN 20 DAYS OF THE DATE OF YOUR NOTICE OF RIGHT TO CANCEL (OR, IN INDIANA,WITHIN 20 DAYS OF THE DATE OF RECEIPT OF YOUR NOTICE OF RIGHT TO CANCEL OR 10 DAYS OF RETURNING PAYMENT OR OTHER CONSIDERATION TO YOU, WHICHEVER IS EARLIER), YOU MAY RETAIN OR DISPOSE OF THE GOODS WITHOUT ANY FURTHER OBLIGATION.IF YOU FAIL TO MAKE THE GOODS AVAILABLE TO THE SELLER,OR IF YOU AGREE TO RETURN THE GOODS TO THE SELLER AND FAIL TO DO SO,THEN YOU MAY REMAIN LIABLE FOR PERFORMANCE OF ALL OBLIGATIONS UNDER THIS CONTRACT. TO CANCEL THIS TRANSACTION,MAIL OR DELIVER A SIGNED AND DATED COPY OF THIS CANCELLATION NOTICE OR ANY OTHER WRITTEN NOTICE,(WHICH,IN CALIFORNIA,MAY INCLUDE EMAIL OR FAX NOTICE)OR SEND A TELEGRAM,TO At/ F(o ge„,4 ir�S AT Z 2 I (#J2•-f• C. (ai �'t Set t+ ws W 9i38L Sell eName Seller Address(no PO Boxes)/Cl$/State/lp NOT LATER THAN MIDNIGHT OF 7-2'S --• IS . Date(2) I HEREBY CANCEL THIS TRANSACTION. Date Buyer Signature 2964STPSA(a114) CONSUMER NOTE!NON-NEGOTIABLE CONSUMER NOTE/CONSUMER PAPER/THIS IS A CONSUMER CREDIT DOCUMENT IN ARIZONA:This instrument is based upon a home solicitation sale,which is subject to the provisions of Title 44,Chapter 15.This instrument is not negotiable. IN CONNECTICUT:This instrument is based upon a home solicitation sale,which sale is subject to the provisions of the Home Solicitation Sales Act This instrument is not negotiable. IN NORTH DAKOTA:This instrument Is based upon a personal solicitation sale,which is subject to the provisions of the North Dakota Century Code.This instrument is not negotiable. IN WISCONSIN:This is a home improvement instrument and is non-negotiable.Every holder takes subject to all other claims and defenses of the maker of obligor. ORIGINAL-WELLS FARGO FINANCIAL NATIONAL BANK Parcel Print • Page 1 of 1 Parcel Number. 990600363 05/12/2015 Owner Mailing Address: JOHN DALIEN JOHN DAIIFN TRW ILE GRACE A ALLEN TRUSTEE 63 FOSTER LANE PORT LUDLOW WA 98365-9611 Site Address: 63 FOSTER LN PORT LUDLOW 98365-9611 Section: 9 School District: Chimacum(49) Qtr Section: NW1/4 Fire Dist: Port Ludlow(3) Township: 28N Tax Status: Taxable Range: 1E Tax Code: 0231 Planning area: 98365-9611 Sewer: PLSEWER- Drainage: PLDD-YES Connected(No CWF) Bank: View 1: View 2: Zoning 1: MPR-SF-4- Master Planned Resort- Single Family Zoning 2: Zoning 3: Sub Division: 9906 - PORT LUDLOW NO. 2 Land Use Code: 1100 98365-9611 Property Description: PORT LUDLOW NO 2 AREA 3 LOT 63 SUBJ TO BLA #83952 http://www.co.jefferson.wa.us/assessors/parcel/parcelprint.asp?value=990600363 8/14/2015 • • 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#: BLD15-00289 Received Date 8/14/2015 SITE ADDRESS: 63 FOSTER LN Issue Date 8/14/2015 PORT LUDLOW, 98365 APPLICANT: JOHN DALLEN PHONE: JOHN D ALLEN TRUSTEE 63 FOSTER LANE PORT LUDLOW WA 98365-9611 SUBDIVISION: 9906 - PORT LUDLOW NO. 2 Block: Lot: PARCEL NUMBER: 990600363 Section: 9 Township: 28N Range: 1 E CONTRACTOR: AIR FLO PHONE: OWNER, JOHN DALLEN PHONE: if different: JOHN D ALLEN TRUSTEE 63 FOSTER LANE PORT LUDLOW WA 98365-9611 PROJECT DESCRIPTION: ELECTRIC FURNACE AND 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 8/14/2016. REQUIRED INSPECTIONS: Installation per Manufacturer Specifications/CO2: .44 .ey /5 Tank/Lin pplianc . Ik 9/05 W Final Approval: 0/ . AL. t"l, 0/5 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 8/14/2015