HomeMy WebLinkAboutBLD2019-00143 - MECHANICALo o
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.jefferson.wa. us/commdevelopment
MEGHANIGAL AND DEMOLITION PERMIT
PERMIT #:
SITE ADDRESS:
APPLICANT
SUBDIVISION:
PARCEL NUMBER:
CONTRACTOR:
BLD19-00143
20 KEEFE LN
PORT LUDLOW, 98365
ALICE COOPER
20 KEEFE LANE
PORT LUDLOW WA98365
9906 - PORT LUDLOW NO. 2
Received Date
lssue Date
4t15t2019
4t15t2019
990600369
CUSTOM HEARTH FIREPLACES & STOVES
3301 WA-16
PORT ORCHARD WA 98367
Contractor'sLicense CUSTOH*9S2OK Expires 911212019
PHONE:
Block: Lot:
Section: 9 Township:28N Ranqe: 1E
PHONE: 360-373-1332
PROJECT DESCRIPTION: NEW MECHANICAL - INSTALLATION OF PELLET STOVE
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 411512020.
REQUIRED INSPECTIONS:
lnstallation per Manufacturer Specifications/CO
TanULine/Applia t{2
tD
FinalApproval
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
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HOT LINE AVAILABLE 24 HOURS A DAY
4t15t2019
o o
BUILDING PERMIT APPLICATION
Jefferson County Department of Community Development
621 Sheridan Street Port Townsend, WA 98368
BLDl9-00143
Review Type: NA
PERMIT #:
SITEADDRESS:
OVUNER:
SUBDIVISION:
PARCEL NUMBER:
BLD19-00143
20 KEEFE LN
PORT LUDLOW 98365
ALICE COOPER
20 KEEFE LANE
PORT LUDLOWWA98365
990600369 Section: I
Received Date: 411512019
PHONE:
9906. PORT LUDLOW NO. 2
Block:
Township: 28 N Range: 1E
Lot:
CONTRACTOR:
REPRESENTATIVE:
CUSTOM HEARTH FIREPLACES & STOVES
3301WA-16
PORT ORCHARD WA98367
Contractor'sLicense CUSTOH-952OK Expires 911212019
PHONE: 360-373-1332
PHONE:
PROJECT DESCRIPTION: NEW MECHANICAL - INSTALLATION OF PELLET STOVE
ryPE OF WORK
ryPE OF IMP
VALUATION
CODE EDITION:
OCCUPANCY:
OCCUPANCY:
CONSTTYPE:
CONSTTYPE:
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
HEATTYPE:
HEATTYPE:
# OF STORIES:
SHORELINE:
SETBACK:
BANK HEIGHT:
WOD
Amount Paid By: Date: Receipt:
Permit
Scanning Fee
Tech Fee
$188.00 NVA
$24.00 NVA
$10.60 NVA
04t10t19
04t10t19
04t10t19
183746
183746
183746
Approved/Date
APPROVED
Apr 15 2019
Jefferson County DCD
Total:$222.60
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a 6,pn - ao t43
DEPARTMENT OF COMMUNITY
621 Shcriden Strect, l)ort'lirwnsend, \\',\ 98368
'l cl: 360.379.4450 | lrax: 360.379.4151
\\'cb: u'u u.co.icftcrsorr.wa.us/comrnrrnit) dcvck rpmcnt
I'l-mail: dcd(Tico.icffcrson.rva.us
o
APR I 0 201.n
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 rmits are issued within 5 business
Required Submittal ltems - for propane tank only
Required Submittal ltems - for roof mount Solar Panel installation only (sround mount complete cAM)
Complete first page and signature block only of Mechanical Permit Application.
A complete solar panel supplemental application.
Receipt #: \ PrTl +t" Date: it l1o1ti
#:
For Department Use Only
Related #s:
ls this application for use in a Mobile / Manufactured Home? fl* lf Yes: A permit from Washington State Department of Labor and lndustries, no! Jefferson County, is
required for appliances installed within a mobile/manufactured home. L&l - 350-417-2702* !f No:this form and make an a ntment to submit to Jefferson Cou Permit Tech 360-379-4450
Site lnformation
Assessor Tax Parcel Number:
Site Address a or Directions to o
from which access will bestAccessname
n of Work:
Owner
Name:
Address:
Phone #:E-mailAdd ress:
icant / Contractor: Authorized
Name:
Phone #:
License #:
Uaty4y\ lleurtNt 4
L
a-O4- tz-fl
Expiration Date:
E-mailAddress
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Mechanical Application 1 /
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MECHANICAL PERMIT APPLICATION .-.
General Site plan - showing propane tank, lines, and distance from tank to all existing structures.
Heat Source
Electric Heating Oil Propane*Wood
o 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 pack'et may result in making ariy issued permit null and void.
Property Own 0t7SignaturePrint Na
lndicate'Quantity of NEW Fixture Types Below *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
required.
Quantity Jjrture'rvPe Description
Fan Bath Fan and/or Exhaust Fan
Clothes Dryer Clothes Dryer with Exhaust Vent
Cook Stove Cook Stove, Range Hood Exhaust
Fireplace - Gas Fireplace-Gas or Gas Log lnsert
lr/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 Air
Gas Pipe System Gas Pipe System LPG/Oil
Propane Tank LP Fuel Tank (# gallons: )
Heat Pump
Generator
Air Conditioner
OFFICE USE ONLY
Building Permit Fees
Mecha n ical Pgrm it fee (tant r*.p, woodstove, furnace, roof -sotar panet, etc )Srsg.oo
Propane - Lines, tank, and appliance (add'l 594.00)
Project Scanning Fee Sz+.oo
Technology Fee - 5%lo k_o
Total Fees*$za?.uo
*Additional fees may apply
Nlechanical Application 2
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