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HomeMy WebLinkAboutBLD2017-00229 - MECHANICAL • i 'ON(-..-----,s,3 L ��� JEFFERSON COUNTY kt,L.Q , DEPARTMENT OF COMMUNITY DEVELOPMENT ti 621 Sheridan Street I Port Townsend, WA 98368 360-379-4450 I email: dcd@co.jefferson.wa.us �sf�I ��� www.co.jefferson.wa.us/commdevelopment MECHANICAL AND DEMOLITION PERMIT PERMIT #: BLD17-00229 Received Date 5/30/2017 SITE ADDRESS: 5683 CAPE GEORGE RD Issue Date 5/30/2017 PORT TOWNSEND, 98368 APPLICANT: CONSTANCE ATWOOD PHONE: 360-385-6081 5683 CAPE GEORGE RD PORT TOWNSEND WA 98368-9042 SUBDIVISION: Block: Lot: PARCEL NUMBER: 001195004 Section: 19 Township: 30N Range: 1W CONTRACTOR: PENINSULA HEAT INC PHONE: 360-681-3333 PO BOX 173 CARLSBORG WA 98324 Contractor's License PENINI*0440W Expires 10/18/2018 PROJECT DESCRIPTION: NEW MECHANICAL PERMIT- INSTALL DUCTLESS HEAT PUMP SINGLE PORT. 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 5/30/2018. REQUIRED INSPECTIONS: Installation per Manufacturer Specifications/CO: Tank/Line/Appliance: /, if) 6/9/17 C/1//2 , Final Approval: (� ��f 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 5/30/2017 BLD17-00229UILDING PERMIT APPLICA N Review Type: Jefferson County Department of Community Development 621 Sheridan Street Port Townsend, WA 98368 PERMIT #: BLD17-00229 Received Date: 5/30/2017 SITE ADDRESS: 5683 CAPE GEORGE RD PORT TOWNSEND, 98368 OWNER: CONSTANCE ATWOOD PHONE: 360-385-6081 5683 CAPE GEORGE RD PORT TOWNSEND WA 98368-9042 SUBDIVISION: Block: Lot: PARCEL NUMBER: 001195004 Section: 19 Township: 30 N Range: 1V\ CONTRACTOR: PENINSULA HEAT INC PHONE: 360-681-3333 PO BOX 173 CARLSBORG WA 98324 Contractor's License PENINI*044OW Expires 10/18/2018 REPRESENTATIVE: PHONE: PROJECT DESCRIPTION: NEW MECHANICAL PERMIT- INSTALL DUCTLESS HEAT PUMP SINGLE PORT. TYPE OF WORK NON SQUARE FOOTAGE: TYPE OF IMP MEC VALUATION MAIN: CODE EDITION: 2015 ADD'L: HEAT TYPE: OCCUPANCY: HEAT BASE: HEAT TYPE: OCCUPANCY: UNHEATED: #OF STORIES: CONST TYPE: OTHER: SHORELINE: CONST TYPE: GARAGE: SETBACK: DECK: BANK HEIGHT: SEWAGE DISPOSAL: WATER SYSTEM: BEDROOMS: BATHROOMS: Type Amount Paid By: Date: Receipt Exist: Exist: Permit $180.00 SRE 05/30/17 169826 Prop: Prop: Scanning Fee $23.00 SRE 05/30/17 169826 Total: Total: Total: $203.00 Approved/Date 11.91 AY � �i17 je erson County pCR firiomorL\rlfa\fnrmclF RI fl Ann Rlrl rnf FM/01117 • 0 SON �, DEPARTMENT OF COMMUNITY DEVELOPMENT t„, �6 621 Sheridan Street,Port Townsend,\1'.k93368 w �,a Tel:360.3%9.-1-170 I Fax:360.3%9.-1-15 i `' -C \\'ch:www.co.ieffermin.wa.usicommunitvderelipment r �r-� E-mail:0 Berl n co.iefferson.n-a_us ,31 — Cr y/ MECHANICAL PERMIT APPLICATION Steps in the Permit Process: -Review required submittal items to ensure all information is completed prior to submitting application. -Mechanical Permits can be mailed into our office-and do not require an appointment. -Fees are due at time of submittal, Mechanical permits are generally issued within 5 business days. For Department Use Only Receipt#: ` , ,c n C). Date: 5430}- Related Application#s: Payment#: i l,f023{•(,.> C(; Is this application for use in a Mobile/Manufactured Home? * If Yes: A permit from Washington State Department of Labor and Industries, not Jefferson County,is required for appliances installed within a mobile/manufactured home. L&I-360-417-2702 * If No: Complete this form and make an appointment to submit to Jefferson County Permit Tech 360-379-4450 Re fired Submittal Items—for propane tank only / General Site plan—showing propane tank,lines,and distance from tank to all existing structures. T.1 ._. Required Submittal items—for roof mount Solar Panel installation only(gro ff J;!ii(( ,l!katT Air; T Complete first page and signature block only of Mechanical Permit Applicat i&' ' ' :us • A complete solar panel supplemental application. ALMAY 2017 EFFESite Information �NNTY prrQ Assessor Tax Parcel Number: 00 J V\ Site Address and/or Directions to Property: 5(0 S3 Ca G, - Access(name of street(s)from which access will be gained: ci c ct.,.).-, - Description of Work: i iN_ N-ta.0._\-ic .-. c ex_ FL,A;IF.S L,,� .b,,k.c:-}-t S 1 _A--r,,,,,jo Property Owner Name: CS-.a,yt(-0-- A—F-c- csrA Q3 Address: J5.-CD( '3 C G i. n Phone#: 3( --'3$S-(o©F3I E-mail Address: C ho},., E Applicant/Contractor: Authorized Agent/Representative Name: ?E/\JalV Su C\- d-(E4 "1— Phone#: 3(00-(0, B I- 33 3 3 E-mail Address: Pay peei,isu(aJJeA.as. License#: '(�EN•\j$„' C� Expiration Date: `� Mechanical Application 1 • • Heat Source 1 Electric / Heating Oil Propane* Wood 1 Indicate Quantity and Fixture Types Below QuantityFixture Type *Propane is prohibited in yP Description hazardous locations such as Fan Bath Fan and/or Exhaust Fan basements or pits or IClothes 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 Electric Furnace Electric Furnace or HP+/-Ducting property line and buildings, - Propane (LP)Gas Furnace Propane Furnace+/-Ducting and a site plan must be Water Heater-Gas Gas WH Vent and Combustion Air submitted with the Gas Pipe System Gas Pipe System LPG/Oil application showing the Propane Tank setbacks. If propane tank is p LP Fuel Tank(#gallons: ) over 500 gallons,a site plan is ( Heat Pump/ 12 5 ' required to accompany this application,and a separate Air Conditioner I Fire Code approval is also required. Installation manual must be on site at time rrf inspecti•n tr 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 Own k � Print Name: �f_C " Signature: ��t ,�� Date: �) 74: 1 OFFICE USE ONLY Building Permit Fees I Mechanical Permit fee (tank swap,woodstove,furnace,etc) Sa-W00 )'D Propane—Lines,tank, and appliance (add'l $85.00) Project Scanning Fee moo' A.3 Total Fees* ,201 c *Additional fees may apply. Mechanical Application 2 • I1NINSUtA Thank you for choosing Peninsula Heat for our services. Due to your property being located in Jefferson County, we are required to receive approval from you to apply for a mechanical permit from the County. Please sign and date below indicating your acceptance. Thank you very much! Print Name: Cre Address: -17K-63 Date: 7) 771 Sign: c __c4cc144 -_ 'arcel Details Page 1 of ''I'*''''''''''''<'' ,„ i .,., ',,,, , fere h �. � � r a#hcr�#��n [ata,- ba5e T... Maps 3 ,,, ,',..„ am Home cLfo �,De ar ren ea eh Parcel Number: ;001195004 , SEARCH Parcel Number: 001195004 Printer Friendly Owner Mailing Address: CONSTANCE ATWOOD 5683 CAPE GEORGE RD PORT TOWNSEND WA98368-9042 Site Address: 5683 CAPE GEORGE RD PORT TOWNSEND 98368 Section: 19 School District: Port Townsend (50) Qtr Section: SW1/4 Fre Dist: EJFR (1) Township: 30N Tax Status: Taxable Range: 1W Tax Code: 0111 Planning area: Quimper (2) 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: DISCOVERY RIDGE DIV II PARCEL 4 Tax, A/V, Sales, Photos, and Permit Data Bldg Data Map Parcel Plats &Survey Septic Monitoring Info Jefferson ty HOME I COUNTY INFO I DEPARTMENTS I SEARCH Best viewed with Microsoft Internet Explorer 6.0 or later Windows - Mac Ittp://www.co.j efferson.wa.us/assessors/parcel/parceldetail.asp?value=001195004 5/30/201', PENINSULA HEAT INC Page 1 of 2 • S p� Search L&I Home lis enol Contact 3 s�� A-Z Index Help My L&I Safety&Health Claims& Insurance Workplace Rights Trades&Licensing A h6 Washington State Department of Labor & industries PENINSULA HEAT INC Owner or tradesperson PO BOX 173 CARLSBORG,WA 98324 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 09/16/1996-10/18/2018 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 03/17/2017 04/26/2013 Expiration date 04/26/2018 Insurance history Savings .............. No savings accounts during the previous 6 year period. Lawsuits against the bond or savings Help us improve https://secure.lni.wa.gov/verify/Detail.aspx?UBI=601737680&LIC=PENINI*0440W&SAW= 5/30/2017 PENINSULA HEAT INC Page 2 of 2 No lawsuits against the bond or savings jnts 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 2017"7 to 10 Workers" L&I account representative T1/TYRONE COLEMAN(360)902-4807-Email:COTI235@Ini.wa.gov Workplace safety and health Check for any past safety and health violations found on jobsites this business was responsible for. ©Washington State Dept.of Labor&Industries.Use of this site is subject to the laws of the state of Washington. Help us improve https://secure.lni.wa.gov/verify/Detail.aspx?UBI=601737680&LIC=PENINI*0440W&SAW= 5/30/2017