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Home My WebLink AboutBLD2015-00309 - MECHANICAL ØUILDING PERMIT APPLICA•N BRD1e 00309 Jefferson County Department of Community Development 621 Sheridan Street Port Townsend, WA 98368 PERMIT#: BLD15-00309 Received Date: 9/8/2015 SITE ADDRESS: 9182 RHODY DR CHIMACUM, 98325 OWNER: SUSAN RANDOLPH PHONE: 805-305-1810 PO BOX 373 CHIMACUM WA 98325 SUBDIVISION: Block: Lot: PARCEL NUMBER: 901142017 Section: 14 Township: 29 N Range: 1VV 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: PROJECT DESCRIPTIO NEW MECHANICAL PERMIT INSTALL NEW 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 By: Date: Receipt: Approved/Date Permit $156.00 SRE 09/08/15 159722 Total: $156.00 APPROVED SEP / 82015 Jefferson County DCD 1\firlc Tark1rlafa1fnrrnclF RI f1 Ann Rlrl rnf 0/1:2/9!114 • • ��¢ Sheridan $ON C,. DEPARTME(NT OF COMMUNITY DEVELOPMENT rt Townsend,WA 98368 a Tel:360.379.4450 I Fax:360.379.4451 co '-C Web:www.cooiefferson.wa.us/communitydevelopment 1 D E c E o �/]E E-mail:dcd@ro.jefferson.wa.us VV ISfirN0ec0 SEP - 8 2015 MECHANICAL PERMIT APPLI I 'I•N Steps in the Permit Process: JEFFER3 N C LINTY -Review required submittal items to ensure all information is completed prior I. sulmitippgO ��f$R1[OPmNf -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#: '5611-22r Date: 9/e/�� Related Application#s: Payment#: i j• 3 o v 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 J1_ 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: o042.-oo- Site Address and/or Directions to Property: 9f/ Aoly Pr- clumacvM , NA✓A Access (name of street(s) from which access will be gained: ,6174/ f fWt// /�J X Ci/t/f4aci/sy Description of Work: .7 ,j 4((4/i?`1 d� sn� /r . pa/f d ss- " f . '. Property Owner D Name: 5'14,Sail J�ndo ; 1azi - Address: /'.p. 130)( 3 -3 1 CA-4/4.cum , t4- . 0 Phone #: gO5 - 205- - /2/O E-mail Address: Ol0ft '7Slt 6Q/mf/I.Goir, m z K Applicant/Contractor: Authorized Agent/Representative =+ Iv Name: Pe-Mf(/.BEd fIr en. Phone #: 360 - d2$f- 3.333 E-mail Address:pe,H,tsti44,a&,if/od(•ea". License#: paJ/^)/• O / /,4I Expiration Date: /0//r/a0/4 Mechanical Application 1 • • Heat Source Electric Heating Oil 17 Propane* n 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 unsafety 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 IElectric Furnace Electric Furnac 4r 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 relate to this ap lic tion and subsequent permit issuance. Property Ow :r/ Miry`'i9 Signature: � Print Name: f/ib/J- Date:0/034.6,S34. 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 Total Fees* # 11'57. S° *Additional fees may apply. Mechanical Application 2 Mail - Mary Lofstrom-Outlook •s://outlook.live. : •j i. :i inbox/tp • 0� ■ Outlook Mail (Preview) • % Search Mail and People • New I Reply I Delete Archive Junk I Sweep M. S`�Q � �\ ^f�00� O \ X00 Folders Randolph qc ° e. Inbox 2 y Junk Email 1 • S G Randolph <mommysnail@msn.com> Repl MITo:peninsulaheat@outlook.com; Thu 9/3/2075 5:45 PM Drafts 2 Sent Items Attachments,pictures,and links in this message have been blocked because the sender isn't in your Safe Deleted Items senders list.I trust content from mommysnail@msn.com.l Show blocked content Archive To whom it may concern, Bell and Futch I give my permission for Peninsula Heat to act as my agent in the matter of permitting of my heat pump. Callis Insurance CC PUD Forms Location 9182 Rhody Drive,Chimacum Wa 98325 CC Rebates 09/03/2015 City of PA Rebates Susan Ranolph City of PT Sent from Mail for Windows 10 Correspondence SVC Financing -'� \ , SA42- ff-444 "I `P16z. ki-cit 0t- C lu 1i r 7 tDu, r C r-i) FF f i r�-1-4Aht .., ,Ain c '•j'� yrs. f . . --` mil 41 C `^v p' tAr/ J 9 Al ‘sp1 f 0 V' -ct.' , ill \I ' ( ' LLi V A---- 04-0(1v P. SEP 8 %015 JEFFERSON COUNTY DEPT.OF COMMUNITY DEVFLOPMFNT Parcel Details • • Page 1 of 2 f\: Jefferson County WASHINGTON ` Weather Station ` Database Tools at Maps �2 Webcam _.n. Home County Info Departments Search Parcel Number: 901142017 SEARCH Parcel Number: 901142017 Printer Friendly Owner Mailing Address: SUSAN RANDOLPH PO BOX 373 CHIMACUM WA98325 Site Address: 9182 RHODY DR CHIMACUM 98325 Section: 14 School District: Chimacum (49) Qtr Section: NW 1/4 Rre 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: S14 T29 R1W TAX NO. 22 Tax, A/V, Sales, Photos, and Permit Data Blda Data Map Parcel Plats&Surveys Septic Monitoring Info Jefferson County HOME I COUNTY INFO I DEPARTMENTS I SEARCH Best viewed with Microsoft Internet Explorer 6.0 or later is Windows - Mac http://www.co.jefferson.wa.us/assessors/parcel/parceldetail.asp?value-901142017 9/8/2015 PENINSULA HEAT INC Page 1 of 2 lo InicioenFspanol Contact 'SearchL&I SEARCH A-Z Index Help My Secure L&I Safety Claims&Insurance Workplace Rights Trades&Licensing Alt Washington State Department of " Labor & Industries PENINSULA HEAT INC Owner or tradesperson A CBOX 173 RLSBORG,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 09116/1996—10/18/2016 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 03/16/2015 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?lJBI=601737680&LIC=PENINI*0440W&SAW= 9/8/2015 PENINSULA HEAT INC Page 2 of 2 No lawsuits against the bond or savings accW during the previous 6 year period. • L&I Tax debts No LSI 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 2 of Year 2015"7 to 10 Workers" L&I account representative T4!CARIE PICKETT(360)902-5592-Email:PICC235@lni.wa.gov Workplace safety and health Check for any past safety and health violations found on jobsites this business was responsible for. C 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=601737680&LIC=PENINI*044OW&SAW= 9/8/2015 • 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 #: BLD15-00309 Received Date 9/8/2015 SITE ADDRESS: 9182 RHODY DR Issue Date 9/8/2015 CHIMACUM, 98325 APPLICANT: SUSAN RANDOLPH PHONE: 805-305-1810 PO BOX 373 CHIMACUM WA 98325 SUBDIVISION: Block: Lot: PARCEL NUMBER: 901142017 Section: 14 Township: 29N Range: 1W CONTRACTOR: PENINSULA HEAT INC PHONE: 360-681-3333 PO BOX 173 CARLSBORG WA 98324 Contractor's License PENINI*0440W Expires 10/16/2016 OWNER, SUSAN RANDOLPH PHONE: 805-305-1810 if different: PO BOX 373 CHIMACUM WA 98325 PROJECT DESCRIPTION: NEW MECHANICAL PERMIT Directions INSTALL NEW 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 9/8/2016. REQUIRED INSPECTIONS: Installation per Manufacturer Specifications/CO2: (D( Vi(,c Tank/Line/Appliance: ?0(746—' l 74 Final Approval: 144( ri `v 61 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_Perm it_Propane.rpt 9/8/2015