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Home My WebLink AboutBLD2015-00322 - MECHANICAL WB UILDING PERMIT APPLICASN BRLD1e 0033222 Jefferson County Department of Community Development 621 Sheridan Street Port Townsend, WA 98368 PERMIT#: BLD15-00322 Received Date: 9/23/2015 SITE ADDRESS: 134 SCHWARTZ RD NORDLAND, 98358 OWNER: MIKE P KOWALSKI PHONE: BETTE KOWALSKI PO BOX 237 NORDLAND WA 98358-0237 SUBDIVISION: Block: Lot: PARCEL NUMBER: 021283027 Section: 28 Township: 30 N Range: 1E CONTRACTOR: PENINSULA HEAT INC PHONE: 360-681-3333 PO BOX 173 CARLSBORG WA 98324 Contractor's License PENINI*0440W Expires 10/16/2016 REPRESENTATIVE: PHONE: Heat PROJECT DESCRIPTIOP Install Ductless H ea 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 $156.00 HAC 09/23/15 159205 APPROVED Total: $156.00 SEP 2 3 2015 Jefferson County DCC 11+irinmarLlrlafa\fnrrne\G RI fl Ann RW rM O/7R/7ll1A • • �c ON eo DEPARTMENT OF COMMUNITY DEVELOPMENT 6 621 Sheridan Street,Port Townsend,WA 98368 'La Tel:360.379A450 I Fax:360.379.4451 ti Web:www.co.iefferson.wa.us/communitydevelopmenl E-mail:dcdCtuco.iefferson.wa.us 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#: 667Z0,6 Date: 9/ ' k6 Related Application#5: Payment#:/ 1467 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&1-360-417-2702 * 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: Qa/a2r3--ea2 7 `' Site Address and/or Directions to Property: /,3I Se. ,efretz Rd-, /lva/1�t( _ Access (name of street(s)from which access will be gained: Orr /74 v S�lti,d,-fZ , '"� 1 Description of Work: ,j l' j cc. ass Ao, - vMP Property Owner Name: 13 ak, AWAISA 1 o Address: p•Q•840/ 23; N ( Phone#: 3&41 - 57/-2303 E-mail Address: heikk914441Cht,e•J m Applicant/Contractor: Authorized Agent/Representative H Name: Phone#: 360 - 6 t- >333 E-mail Address:p i/p{ �p0/ .404, License#: f(7J/i/J• ag46:7147 Expiration Date: /01/t/ 6 Mechanical Application 1 • • Heat Source Electric Heating Oil n Propane* Wood Li 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(ft gallons: ) over 500 gallons, a site plan is Heat Pump / weir /k itAld/Wile ile , 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 related to this application and subsequent permit issuance. Property Owner Signature: Print Name: Date: OFFICE USE ONLY Building Permit Fees Mechanical Permit fee (tank swap,woodstove,furnace,etc) $156.00 Propane—Lines, tank, and appliance (add'I $78.00) Project Scanning Fee $19.50 i Total Fees* 1 5 . ✓-O *Additional fees may apply. Mechanical Application 2 9/21/2015 Re:PUD Rebate-Mary Lofstrom Re: PUD Rebate Bette Kowalski Sat 9/19/2015 2:00 AM To Mary Lofstrom <peninsulaheat @outlook.com>; Hi Mary, here's my authorization: I allow Peninsula Heat to act as my representative in order to obtain a mechanical permit. Bette Kowalski On Sep 18, 2015, at 4:45 PM, Mary Lofstrom <peninsulaheat @outlook.com> wrote: Bette, I forgot to ask if you would respond to this email by stating that you allow Peninsula Heat to act as your representative in order to obtain a mechanical permit.... I need to include your authorization with the permit app... Thanks. Mary Lo fa-troiw peva,msalau}f eat C a-vvipawy 360-681 -3333 https://outlook.I i ve.com/owaJ#viewmodel=ReadMessageltem&Item ID=AQM kADAwATM 3ZmYAZS 1 kN m Y3LTIyADYwLTAwAi OW M AoARgAAA9JJOcoW 74V... 1/1 r PENINSULA HEAT INC • Page 1 of 2 Home Inicio en Espanol Contact Sear4h L&I J UZI A-Z Index Help My Secure I&I Safety Claims&Insurance Workplace Rights Trades&Licensing 0 Washington State Department of Labor & Industries PENINSULA HEAT INC Owner or tradesperson PO BOX 173 CARLSBORG.WA Principals 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 09/16/1996—10/18/2016 i Bond CBIC $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 03/1612015 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= 9/23/2015 Parcel Details Page 1 o 2 Jefferson County WASHINGTON Weather Station Database Took Maps — Irtif Webcam Home County Info Deomrtmellts Search Parcel Number: 021283027 SEARCH Parcel Number: 021283027 Printer Friendy Owner Mailing Address: MIKE P KOWALSKI BETTE KOWALSKI PO BOX 237 NORDLAND WA98358-0237 Site Address: 134 SCHWARTZ RD NORDLAND 98358 Section: 28 School District:Chimacum (49) Qtr Section: SW1/4 Fire Dist: Chimacum (1) Township: 30N Tax Status: Taxable Range: 1E Tax Code: 0211 Planning area: Marrowstone (3) 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: S28 T30 R1E TAX 37 Tax, A/V, Sales, Photos, and Permit Data Bide Data Mao Parcel Plats&Surveys Septic Monitorinuinfo Jefferson County HOME I COUNTY INFO I DEPARTMENTS I SEARCH Best viewed with Microsoft Internet Explorer 6.0 or later Windows - Mac http://www.co.jefferson.wa.us/assessors/parcel/parceldetail.asp?value°021283027 9/23/2015 • • 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 #: BLD15-00322 Received Date 9/23/2015 SITE ADDRESS: 134 SCHWARTZ RD Issue Date 9/23/2015 NORDLAND, 98358 APPLICANT: MIKE P KOWALSKI PHONE: BETTE KOWALSKI PO BOX 237 NORDLAND WA 98358-0237 SUBDIVISION: Block: Lot: PARCEL NUMBER: 021283027 Section: 28 Township: 30N Range: 1E CONTRACTOR: PENINSULA HEAT INC PHONE: 360-681-3333 PO BOX 173 CARLSBORG WA 98324 Contractor's License PENINI*0440W Expires 10/16/2016 OWNER, MIKE P KOWALSKI PHONE: if different: BETTE KOWALSKI PO BOX 237 NORDLAND WA 98358-0237 PROJECT DESCRIPTION: Install Ductless 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 9/23/2016. REQUIRED INSPECTIONS: Installation per Manufacturer Specifications/CO2: fFC „Sipe-S /c/7,/s# Tank/Li pplianc /CVO-CA/ Final Approval: 2A' -roc C044,1 14////5 1q�- 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_B LD_Perm it_P ropane.rpt 9/23/2015 go`SON °b( JEFFERSON COUNTY DEPARTMENT OF COMMUNITY DEVELOPMENT SHING G Date: 9; 3 J Time Received: [ 010 (3/pm Mon. Tue. Thur. Fri. Date: CP(T '•7 BLD: I 32 . Contact Name: Owner: Contact Number: 360 97 f L3 0 3 Address: r,4 g d" J R 0 206 Notes: 46/0— PV.-4) 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 COIAWY Q JJ • 15.92 5 DATE 7 Z.- RECEIVED FROM (72 f11 ' `S(-)IlA [ 'e_cf DESCRIPTION BARS AMOUNT A /) CURRENCY�D ^ 1647 , 66 l� Z 3 O Z7 COIN ]CAt�' L L �E CHECKS C Deaf-- ne-W 0 0 RECEIVED BY TOTAL /76,50