HomeMy WebLinkAboutBLD2019-00151 - MECHANICALo
JEFFERSON COUNTY
DEPARTMENT OF COMMUNITY DEVELOPMENT
621 Sheridan Street I Port Townsend, WA 98368
360-3794450 | email: dcd@co.jefferson.wa. us
www. co.jefferson.wa. us/com mdevelopment
MEGHANIGAL AND DEMOLITION PERMIT
o
PERMIT #:
SITEADDRESS:
APPLICANT
SUBDIVISION:
PARCEL NUMBER
CONTRACTOR:
BLD19-00151
40 STEVENS ST
PORT HADLOCK, 98339
RICHARD W LISKE
PO BOX 267
PORT HADLOCK WA 98339-0267
9567 - HARRISBURG
Received Date
lssue Date
4t16t2019
4t16t2019
956700904
FREDERICKSON ELECTRIC, INC
PO BOX 2108
PORT TOWNSEND WA 98368
Contractor'sLicense FREDEEIS21NT Expires 813012020
Block: Lot:
Section:2 Township: 29N Ranqe: 1W
PHONE: 360-385-1395
PROJECT DESCRIPTION: NEW MECHANICAL - INSTALL DUCTLESS HEAT PUMP
THIS PERMIT IS VALID FOR ONE YEARAND IS NOT RENEWABLE.
THE FINAL INSPECTION II'IUST BE SCHEDULED AND PASSED WITHIN THAT YEAR.
THE EXPIRATION DATE IS 411612020.
REQUIRED INSPECTIONS:
lnstallation per Manufacturer
TanULine/Appliance
FinalApproval ,l
BUILDING INSPECTION HOT-LINE 379455,
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
\\tidemark\data\forms\F_BLD_Permit_Propane. rpt
HOT LINE AVAILABLE 24 HOURS A DAY
4t16t2019
PHONE:
a BUTLDTNG PERMTT orrr,"ot*BLDl9-00151
ReviewType: NA
Jefferson County Department of Community Development
621 Sheridan Street Port Townsend, WA 98368
PERMIT#:
SITE ADDRESS
O\^/NER
SUBDIVISION:
PARCEL NUMBER:
BLD19-00151
40 STEVENS ST
PORT HADLOCK, 98339
RICHARD W LISKE
PO BOX 267
PORT HADLOCK WA 98339-0267
956700904 Section: 2
Received Date: 411612019
PHONE:
9567 - HARRISBURG
Block:
Township: 29 N Range:
Lot:
1\\
CONTRACTOR:
REPRESENTATIVE:
FREDERICKSON ELECTRIC, INC
PO BOX 2108
PORT TO\^/NSEND WA 98368
Contractor's License FREDEEI82l NT Expires 813012020
PHONE: 360-385-1395
PHONE:
PROJECT DESCRIPTION: NEW MECHANICAL.INSTALL DUCTLESS HEAT PUMP
TYPE OF WORK
TYPE OF IMP
VALUATION
CODE EDITION:
OCCUPANCY:
OCCUPANCY:
CONST TYPE:
CONST TYPE:
BEDROOMS:
Exist:
Prop:
Total:
NON
MEC
SQUARE FOOTAGE:
MAIN:
ADD'L:
HEAT BASE:
UNHEATED:
OTHER:
GARAGE:
DECK:
Type
HEAT TYPE:
HEAT TYPE:
# OF STORIES:
SHORELINE:
SETBACK:
BANK HEIGHT:
EEE2015
SEWAGE DISPOSAL:
WATER SYSTEM:
BATHROOMS:
Exist:
Prop:
Total:
Approved/Date
APPROVED
Apr 16 2019
Jefferson County DCD
Amount Paid By: Date: Receipt:
Permit
Scanning Fee
Tech Fee
$188.00 NVA
$24.00 NVA
$10.60 NVA
04t16t19
04t16t19
04t16t19
183816
183816
1 83816
Total:$222.60
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DEPARTMENT OF COMMUNITY DEVELOPMENT
(r21 Slrcridan Strect, Port'l'orvnscnc|, !?A 98368
'l'cl: 360.379.4450 | Fax: 360.379.4451
Wcb: wwrv.co.icffc rsnn.wn.us /cornrtutti rI*tlcvclopur!:rr.t
l,l-rnail: tlcd@co.is:t'tctsorr.wa.us
MECHANICAI. PERMIT APPLICATIO
Steps in the Permit Process:
-Review required submittal items to ensure all information is completed prior to submitti
-Mechanical Permits can be mailed into our office-and do not require an appointment.
-Fees are due at time of submitta Mechanical rmits are nera issued within 5 business
ls this application for use in a Mobile / Manufactured Home? 4/ o* lf Yes: A permit from Washington State Department of Labor and lndustries, not Jefferson County, is
required for appliances installed within a mobile/manufactured home. L&l - 36O-4L7-27A2* lf No: Complete this form and make an appointment to submit to Jefferson County Permit Tech 360-379-4450
Required Submittal ltems - for propane tank only
Required Submittal ltems - for roof mount Solar Panel installation only (ground mount
Complete first page and signature block only of Mechanical Permit Application.
A complete solar panel supplemental application,
APH i 2 2019
tr trtr0V
Receipt #;For Department Use Only
Related #s:
Site lnformatlon
Assessor Tax Parcel Number: q5b7 0O q oq
Site Address and/or Directions to Property: tlD i7euap5 r,tt rY:f ?,,ro-r t-/ a ht oc/2,
Access (name of street(s)from which access will be gained: il1o,^i6omt RY to CiOAP 'ro S
Description of Work:Do clt€72 //c-'rr f P"a!> jtqt
Property Owner
Name:
Address
Phone #
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3Ca Za5 lVttZ E-mailAddress:7opWt4:/kisJ0n&)Lta
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-{Authorlzed
Name:
Phone #:
License #:
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,3bO, 53l ?f8t E-mail Address: .fo O f,ou'o tzo'rr,ric. r,
Expiration Date: q/to lzopI-Fa d-r: F {r qzt N1'
Mechanical ;\pplicatior: 1
General Site plan - showing propane tank, lines, and distance from tank to all existing structures.
Date:
#:
Heat Source
Electric 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 attac.hments,
is'tru6 and correci 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 aqree to that all activities I intend to undertake or complete associated with this permit will be performed in
complianc-e with all applicable federal, state and county laws and regulations and I agree to provide access and right
of entrv to Jefferson Cbunty and its employees, repres'entatives or agents for the sole purpose of application review
and any required later insp-ections. Applicant may request notice of the County's intent to enter upon the property
for visit-s relbted to this application and subsequent permit issuance.
Property
Signature rint Name:,(, J, no Li s ke Date: ?-t1'l ?
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 1.0 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.
Quantlty Fixture Type Description
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
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 (fl gallons
rWt Heat Pump
Generator
Air Conditioner
OFFICE USE ONLY
Building Permit Fees
|M.oo I oB .o"M€Choflical P€f filit f€€ (tant< swap, woodstove, furnace, roof -sotar panet, etc )
tance add'l- Line taP and a
Proiect Scanning Fee
519/35 lo. t oTechnology Fee-5%
LZZ.l. oTotal Fees*
#
*Additional fees may apply.
Mechanical Applicauon 2
Fl Heatins oil l-l
Fan
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