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Home My WebLink AboutBLD2015-00191 - MECHANICAL • • 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#: BLD15-00191 Received Date 6/5/2015 SITE ADDRESS: 25 PINEWOOD CT Issue Date 6/5/2015 PORT TOWNSEND, 98368 APPLICANT: KAY ALLEN PHONE: 360-385-3735 DONALD ALLEN 25 PINEWOOD CT PORT TOWNSEND WA 98368-9570 SUBDIVISION: 9650 - KALA POINT 3-8 Block: Lot: PARCEL NUMBER: 965000369 Section: 27 Township: 30N Range: 1W CONTRACTOR: PENINSULA HEAT INC PHONE: 360-681-3333 PO BOX 173 CARLSBORG WA 98324 Contractor's License PENINI*0440W Expires 3/2/2016 OWNER, KAY ALLEN PHONE: 360-385-3735 if different: DONALD ALLEN 25 PINEWOOD CT PORT TOWNSEND WA 98368-9570 PROJECT DESCRIPTION: NEW MECHANICAL PERMIT Directions INSTALL HEAT PUMP AND AIR HANDLER 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 6/5/2016. REQUIRED INSPECTIONS: /� Installation per Manufacturer Specifications/CO2: G2 A/ MMS W Tank/Lin 1 pliance: Final Approval: OK. Vt CJ l0////5 ,I 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 6/5/2015 BUILDING PERMIT APPLICA•N BLD15-00191 Review Type: Jefferson County Department of Community Development 621 Sheridan Street Port Townsend, WA 98368 PERMIT #: BLD15-00191 Received Date: 6/5/2015 SITE ADDRESS: 25 PINEWOOD CT PORT TOWNSEND, 98368 OWNER: KAY ALLEN PHONE: 360-385-3735 DONALD ALLEN 25 PINEWOOD CT PORT TOWNSEND WA 98368-9570 9650 - KALA POINT 3-8 SUBDIVISION: Block: Lot: PARCEL NUMBER: 965000369 Section: 27 Township: 30 N Range: 1■1 CONTRACTOR: PENINSULA HEAT INC PHONE: 360-681-3333 PO BOX 173 CARLSBORG WA 98324 Contractor's License PENINI*044OW Expires 3/2/2016 REPRESENTATIVE: PHONE: PROJECT DESCRIPTIOP NEW MECHANICAL PERMIT INSTALL HEAT PUMP AND AIR HANDLER 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: Approvedao` �C® Permit $156.00 SRE 06/05/15 156132 PP / G Total: $156.00 JUN - 5 2015 Jefferson County DCD firlemorNrla/alfnrrne RI f1 Ann Rlri rnf R/ /9Ri' • • .(�g°N c0 DEPARTMENT OF COMMUNITY DEVELOPMENT W�� -1, 621 Sheridan Street,Port Townsend,WA 98368 -< Tel 360.379.4450 I Fax:360379.451 Web:www.co.ieffexson.wa.us/communitydevelopment E-mail:dcd@cn.jefferson.wa.us 9SNJNC 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 5 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. MI-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: 96 5000 36 9 Site Address and/or Directions to Property: Lc Pinewood COu( f Access (name of street(s)from which access will be gained: Description of Work: Petg0c eit- 01 -n<r,c7-1/?p ,,01)411d &fld to/i" Property Owner Name: -`( T, 1)ONAti) fciiErtl w Address: c?,.q-- Q11JEWOOD CT , pale ToW�uSEND, 1.4)A-- �836S I m Phone#: 36o- 3es" 3x-35- E-mail Address: kty . do►, . 411en r tril-cots Please contact Authorized Agent/Representative with project info. K Property Own r Signature: Date: Applicant/Contractor: Authorized Agent/Representative Name: -Pe-J1 ltv-Sufic 4c .+ Co . Phone#: -3490- (0f31- 33 33 E-mail Address: uti(?? 4(4(,,m- License #: elk)/hi I • ot(-`foW Expiration Date: lo/ It /(, co3--: I Mechanical Application 1 • • Heat Source Electric Heating Oil 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 ( '1, ,1 Yea f Pvnt, ■ / L' equired 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 i p ctions. Applicant may request notice of the County's intent to enter upon the property for visits relate•, • this p ,' lion and subsequent permit issuance. �y Signature: . __ Print Name: ll�/ (� & tk1 /1 Date: g / 6 / (o3laal S� OFFICE USE ONLY l (p Building Permit Fees Mechanical Permit fee(tank swap,woodstove,fumace,etc) $156.00 Propane—Lines,tank, and appliance (add'I $78.00) Project Scanning Fee $19.50 Total Fees* 41 S c a *Additional fees may apply. Mechanical Application 2 • • Mary Lofstrom From: Don Allen <kay.don.allen @gmail.com> Sent: Wednesday,June 3, 2015 11:39 AM To: Mary Lofstrom Subject: Re: Emailing:Allen Permit Mary, you have my permission to act as my representative. Appreciate your assistance. Don Allen On Jun 3, 2015,at 10:25 AM, Mary Lofstrom wrote: >Good morning Mr. Allen. > Please find enclosed the pdf containing a scan of the Jefferson County > Permit. You will see there is a spot for the home owner signature, > but if you will allow me, I can act as your representative. Is this okay for you? >Secondly,our installers will be presenting your rebate paperwork for > signage when they come on Monday. Please have ready your Jefferson > PUD account for them at that time. >Thanks so much. > Mary Lofstrom > Peninsula Heat Co ><Allen Permit.pdf> 1 Parcel Details Page 1 of 2 , --, . Jefferson County - Yt S _ .- rs7 tlf " =. Nt ,4l afier - - - : Pp -` '* 1' 1iIG,l�,,', , name County Info Departments Search Parcel Number: 965000369 SEARCH Parcel Number: 965000369 Printer Friendly Owner Mailing Address: KAY ALLEN DONALD ALLEN 25 PINEWOOD CT PORT TOWNSEND WA98368-9570 Site Address: 25 PINEWOOD CT PORT TOWNSEND 98368 Section: 27 School District: Port Townsend (50) Qtr Section: NW1/4 Fire Dist: Chimacum (1) Township: 30N Tax Status: Taxable Range: 1W Tax Code: 0111 Planning area:Tri-Area (4) Sewer: Drainage: Bank: View 1: View 2: Zoning 1: RR-5 - Rural Residential Zoning 2: Zoning 3: Sub Division: 9650 - KALA POINT 3-8 Assessor's Land Use Code_ 1100 - Residential - Single Unit Property Description: KALA POINT #10 LOT 322 r Tax, A/V, Sales Photos, and Permit Data Bldg Data Map Parcel lots &Survey Septic Monitoring Info ' / Jefferson County _ HOME I COUNTY INFO I DEPARTMENTS I SEARCH 1 Best viewed with Microsoft Internet Explorer 6.0 or later Windows - Mac http://www.co.jefferson.wa.us/assessors/parcel/parceldetail.asp?value=965000369 6/5/2015 PENINSULA HEAT INC Page 1 of 2 Home Inicio en Espanol Contact Search L&I St.ARRCH A-Z Index Help My Secure L&I Safety Claims&Insurance Workplace Rights Trades&Licensing 0 Washington State Department of Labor & Industries PENINSULA HEAT INC Owner or tradesperson 782 KITCHEN DICK RD Princi als SEQUIM,WA 98382 p 360-681-3333 LOFSTROM,KENNETH JOHN,PRESIDENT CLALLAM County LOFSTROM,MARY E,SECRETARY Doing business as PENINSULA HEAT INC WA UBI No, Business type 601 737 680 Corporation Governing persons KENNETH J LOFSTROM MARY E LOFSTROM; License 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. PENINI*0440W Effective—expiration 09/1611996—1 0/18/2016 Bond CHIC $12,000.00 Bond account no. SA4812 Received by L&I Effective date 07/02/2001 09/16/2001 Expiration date Until Canceled Insurance ..............._...... Ohio Security Ins Co $1,000,000.00 Policy no. BKS 55013351 Received by L&I Effective date 03/16/2015 04/26/2013 Expiration date 04/26/2016 Insurance history Savings No savings accounts during the previous 6 year period. Lawsuits against the bond or savings https://secure.lni.wa.gov/verify/Detail.aspx?UBI=601737680&LIC=PENINI*0440W&SAW= 6/5/2015 PENINSULA HEAT INC Page 2 of 2 No lawsuits against the bond or savings accounts during the previous 6 year period. 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 No license violations during the previous 6 year period. 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. 920,088-00 Doing business as PENINSULA HEAT INC Estimated workers reported Quarter 1 of Year 2015"7 to 10 Workers" L&I account representative 14/CARIE PICKETT(360)902-5592-Email:PICC235 @Ini.wa.gov Workplace safety and health No inspections during the previous 6 year period. ®Washington Stale Dept.of Labor&Industries.Use of this site is subjed to the laws of the state of Washington. https://secure.lni.wa.gov/verify/Detail.aspx?UBI=601737680&LIC=PENINI*044OW&SAW= 6/5/2015