HomeMy WebLinkAboutBLD2019-00099 - MECHANICALoa
JEFFERSON COUNTY
DEPARTMENT OF COMMUNITY DEVELOPMENT
621 Sheridan Street I Port Townsend, WA 98368
360-379-4450 | email: dcd@co.jefferson.wa. us
www. co.jeffe rson.wa. us/co m mdevelo p ment
MEGHANIGAL AND DEMOLITION PERMIT
PERIr/lT #:
SITEADDRESS
APPLICANT:
SUBDIVISION:
PARCEL NUMBER:
CONTRACTOR:
BLD19-00099
372 MOEN RD
NORDLAND,98358
GREGORY T KISSLER TRSTEE
G&SKISSLERTRUST
372 MOEN RD
NORDLAND WA 98358-9700
Received Date
lssue Date
3t18t2019
3t18t2019
921094014
FREDERICKSON ELECTRIC, INC
PO BOX 2108
PORT TOWNSEND WA 98368
Contractor'sLicense FREDEE.892RH Expires 1211912019
PHONE:
Block: Lot:
Section: 9 Township: 29N Ranqe: 1E
PHONE: 360-385-1395
PROJECT DESCRIPTION:NEW MECHANICAL. EXTEND PROPANE LINE FROM HOUSE TO
STANDBY GENERATOR.
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 3/18/2020.
REQUIRED INSPECTIONS:
I nstallation per Man ufacturer Specifications/CO
Tank/Line/Applian ce: t rL -t *tk4Lrto.- o *L* vl ,rl n ca,re.&.). thl ,Ev
FinalApproval
BUILDING INSPECTION HOT-LINE 3794455.
REQUESTS MUSr t="fif
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rs NEEDED
\\tidemark\data\forms\F_BLD_Perm it_Propane. rpt
HOT LINE AVAILABLE 24 HOURS A DAY
3t18t2019
Qr, t, NG PERMTT APPt,"ot,u
Jefferson County Department of Community Development
621 Sheridan Street Port Townsend, WA 98368
BLDl9-00099
Review Type: NA
PERMIT #:
SITE ADDRESS
OWNER:
SUBDIVISION:
PARCEL NUMBER:
BLD19-00099
372 MOEN RD
NORDLAND,98358
GREGORY T KISSLER TRSTEE
G&SKISSLERTRUST
372 MOEN RD
NORDLAND WA98358.9700
921094014
Received Date: 311812019
PHONE:
Block:
Section: 9 Township: 29 N Range: 1E
Lot:
CONTRACTOR:
REPRESENTATIVE
FREDERICKSON ELECTRIC, INC
PO BOX 2108
PORT TOWNSEND WA 98368
Contractor's License FREDEE.892RH Expires
pHONE: 360-385-1395
12t19t2019
PHONE:
PROJECT DESCRIPTION: NEW MECHANICAL. EXTEND PROPANE LINE FROM HOUSE TO
STANDBY GENERATOR.
TYPE OF WORK
TYPE OF IMP
VALUATION
CODE EDITION:
OCCUPANCY:
OCCUPANCY:
CONST TYPE:
CONST TYPE:
SEWAGE DISPOSAL
WATER SYSTEM:
BEDROOMS:
Exist:
Prop:
Total:
NON
MEC
2015
BATHROOMS:
Exist:
Prop:
Total:
SQUARE FOOTAGE:
MAIN:
ADD'L:
HEAT BASE:
UNHEATED:
OTHER:
GARAGE:
DECK:
Type
HEAT TYPE:
HEAT TYPE:
# OF STORIES:
PRO
SHORELINE:
SETBACK:
BANK HEIGHT:
Amount Paid Bv: Date: Receipt
Approved/Date
APP$IOVED
l,lAR I I 20tg
Jefferson County DCD
\\{irlamari;\dara\farmc\tr Ell 11 Ann Ellrl rnt 'r.la at1n.40
Total:
o tL3fi-I$frq
DEPARTMENT OF COMMUNITY D
621 Shcriden Strcct, l)ort'lir*.nscnd, \\',\ 98368
'lcl: 360.379.4450 | lrax: 360.379.1451
\\'r'b: urvs.co. jett'rson.u a.us/commtrnit) dcvck rnmcnt
I r-meil: dccl(4)co.ieffcrson.rva.us
MECHANICAL PERMIT APPLICATI
-Fees are due at time of submittal, Mechanical rmits are issued within 5 business
ls this application for use in a Mobile / Manufactured Home?* lf Yes: A permit from Washington State Department of Labor and lndustries, q! Jefferson County, is
required for appliances installed within a mobile/manufactured home. L&l - 360-477-2702* lf No: Complete this form and make an appointment to submit to Jefferson County Permit Tech 360-379-M5O
l{AR , I 2019
Receipt #:Date:
#:
For Department Use Only
Related #s:
Submittal ltems - for ne tank
General Site plan - showing propane tank, lines, and distance from tank to all existing structures.
Submittal ltems - for roof mount Solar Panel installation nd mount
Complete first page and signature block only of Mechanical Permit Application.
A complete solar panel supplemental application.
Site lnformation
AssessorTax Parcel Number: 22 /O>4O/
Site Address and/or Directions to P 3-72 tvloc.,t lzd rVr./lo,J, wA gBtO
Access (name of street(s)from which access will be gained: Mo.n ?oA
Description of Work: f=lz -e--I I
-.1-^)L,I L,r"*r*{o"-a,
/J
Property Owner
Name:
Address:
Phone #:
Gr oYt K,sslen3z
3OO'^ 30/ - d-t 6'3 E-mail Address:@
Eroo
!mn
=rrContractor: Authorized
Name:
Phone #:
License #
I L.
E-mailAddress:
Expiration Date:
3 o-f. *l-a
.C-C)*
N{echanicalApplication 1
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.
o
lnstallation 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 ariy 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 w-ith 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
qnd gly 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.
o
Property Owner
Signature:_Print Name
*Additional fees may apply
d 'T L',EsL- Dateo
I\fechanical Application 2
Heating Oil Propane*Electric Wood
tt
Below
Quantity
i
Fixture Type Description
Fan Bath Fan andlor Exhaust Fan
Clothes Dryer Clothes Dryer with Exhaust Vent
Cook Stove Cook Stove, Range Hood Exhaust
Fireplace - Gas Fireplace-Gas or Gas Log lnsert
Fireplace - Wood Fireplace-wood, Wood Stove, or
Pellet Stove
Electric Furnace Electric Furnace or HP +/- Ducting
Propane (LP) Gas Furnace Propane Furnace +/- Ducting
Water Heater - Gas Gas WH Vent and Combustion AirxGas Pipe System Gas Pipe System LPG/Oil
Propane Tank LP Fuel Tank (f gallons
Heat Pump
Generator
Air Conditioner
*Propane is prohibited in
hazardous locations such as
basements or pits or
anywhere "heavier-than-air"
gas can unsafely collect.
*Propane tanks over 125
gallons require a minimum
setback of 10 ft. from
property line and buildings,
and a site plan must be
submitted with the
application showing the
setbacks. lf propane tank is
over 500 gallons, a site plan is
required to accompany this
application, and a separate
Fire Code approval is also
uired
OFFICE USE ONLY
Building Permit Fees
MechaniCal Permit f€€ ltank swap, woodstove, furnace, roof -sotar panet. etc )S188.oo
Propane - Lines, tank, and appliance (add'l 594.00)
Project Scanning Fee S24.oo
Technology Fee - 5%l0 .t/O
Total Fees*222.\oa
Heet.
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