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Home My WebLink AboutBLD2019-00539 - MECHANICALo e JEFFERSON COUNry 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/com mdevelopment MECHANICAL AND DEMOLITION PERMIT PERMIT #: SITEADDRESS: APPLICANT SUBDIVISION: PARCEL NUMBER CONTRACTOR: BLD19-00539 4930 CENTER RD cHTMACUM,98325 FLORAC MACE JOANN KI RKPATRICK JTWROS PO BOX 24 cHtMACUM WA 98325-0024 Received Date lssue Date 121412019 12t4t2019 801 03301 2 ADVANCED HEATING & COOLING 1211 IVY RD BREMERTON WA9831O Contractor'sLicense ADVANHC022NF Expires 812112021 PHONE: 206-499-7103 Block: Lot: Section: 3 Township: 28N Ranoe: 1W PHONE: (360)415-9335 PROJECTDESCRIPTION: PROPANEFURNAC INTERIOR GAS LlNES ONLY. OWNER WILL APPLY FOR PROPANE TANK PERMIT SEPARATELY THIS PERMIT IS VALID FOR ONE YEARAND IS NOT RENEWABLE. THE FINAL INSPECTION MUST BE SCHEDULED AND PASSED WITHIN THAT YEAR. THE EXPIRATION DATE IS 121412020. REQUIRED INSPECTIONS: lnstallation per Manufacturer Specifications/CO FinalApproval I BUILDING INSPECTION HOT-LINE 379.4455. REQUESTS MUSr t="fif8'"",=,".'fr"rt t# -T5r'lI"rT,"r:;f+f,l}o:?EcrroN rs NEEDED \\tidemark\data\forms\F_BLD_Permit_Propane. rpt HOT LINEAVAILABLE 24 HOURSA DAY 1214t2019 iltr,*c PERMTT APPLrcanO Jefferson County Department of Community Development 621 Sheridan Street Port Townsend, WA 98368 BLD19-00539 Review Type: PERMIT #: SITEADDRESS: OWNER: SUBDIVISION: PARCEL NUMBER: BLD19-00539 4930 CENTER RD cHtMACUM,98325 FLORA C MACE JOANN KIRKPATRICK JTWROS PO BOX 24 CHIMACUM WA 98325-0024 801 03301 2 Received Date: 121412019 Lot: PHONE: 206-499-7103 Block: Section: 3 Township: 28 N Range: 1\i1 CONTRACTOR REPRESENTATIVE: ADVANCED HEATING & COOLING 1211 IVY RD BREMERTON WA9831O Contractor's License ADVANHC022NF PHONE: (360)415-9335 Expires 812112021 PHONE: PROJECT DESCRIPTION: PROPANE FURNAGE AND INTERIOR GAS LINES ONLY. OWNER WILL APPLY FOR PROPANE TANK PERMIT SEPARATELY 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 SHORELINE: SETBACK: BANK HEIGHT: Amount Paid Bv: Date: Receipt Permit Scanning Fee Tech Fee $188.00 SRE $24.00 sRE $10.60 sRE 12t04t19 12t04t19 12t04t19 1 8891 0 1 8891 0 1 8891 0 Approved/Date APPROVED oEc u ll 20lg Jefferson County DCD Total:$222.60 ooDEPARTMENT OF COMMUNITY DEVELOPMENT 621 Sheridan Street, Port Tou'nsend, WA 98368 TeL 360.379.4450 | Fax: 360.379.4451 W'eb: u'ww.co.iefferson.wa.us /communi ndevelooment E-mail: dcd@co.iefferson.rva.us ng ap Bpt?{,s3? MECHANICAL PERMIT Steps in the Permit Process: -Review required submittal items to ensure all information is completed -Mechanical Permits can be mailed into our office-and do not require an -Fees are due at time of submittal, Mechanical permits are generally tn ls this application for use in a Mobile / Manufactured Home? * 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 - 360-417-2702* lf No: Complete this form and make an appointment to submit to Jefferson County Permit Tech 350-379-4450 Required Submittal ltems - for propane tank only..-t+ General Site plan - showing propane tank, lines, and distance from tank to all existing structures. Required Submittal ltems - for roof mount Solar Panel installation only (ground mount complete CAM) re& Date: DCD Receipt #: Related ication #s: For Department Use Only Site lnformation Assessor Tax Parcel Number:t/ Site Address and/or Directions to Property: Access name of from which access will be ined: D on of Work: A1lil ll MA arul lrn4,L Nmlihx ht ll5( htl* lulzy /h, zd r*zo - Property Owner Name: Address: Phone #:E-mailAddress9oa -r'aa- TIOZ Applicant/Contractor: Authorized Agent/Representative E-mailAddress Expiration Date: / D Name: Phone #: License # Ft-oo -tr m7 ; 1r Mechanical Application 1 Complete first page and signature block only of Mechanical Permit Application. A complete solar panel supplemental application. Heat Source r'Propane*WoodHeating OilElectric lndicate of NEW Fixture Below Fixture Bath Fan and/or Exhaust FanFan r with Exhaust VentClothes DrClothes Hood ExhaustCookRaCook Stove ace-Gas or Gas lnsertFiFirelace - Gas Fireplace-wood, Wood Stove, or Pellet Stove Fireplace - Wood Electric Furnace or HP +/- DuctElectric Furnace Pro Gas FurnaceaneLP Gas WH Vent and Combustion AirWater Heater - Gas m LPG/OilGas P llonsLP Fuel Tank #ne TankPro Heat Pump Generator *Propane is prohibited in hazardous locations such as basements or Pits or a nywhere " heavier-tha n- 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 red.Air Conditioner lnstaltation manual must be on site at time of inspection or a'- " i6-inspeiiion 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 iii rnowieoge. Any material fabehood or anv omission of a material fact made by the owner/agent with respect to thi;;pJti;JtLl-p"Cr.6t il;t a;liin .iiing ariv issued permit null and void. Property Signatur rint Name:-r'I t4//o^t"u4.U//4/4),e OFFICE USE ONLY Permit FeesBuildi sL88.ooMechanical Permit fee ltank swap,woodstove, furnace, roof -solar panel, etc ) ane - Lin tan and liance add'l s24.00ScanninFee Fee - 5%Technol Total Fees* *Additional fees may apply Mechanical Application 2 I Propane Furnace +/- Ducting s Gas Pipe System +-1 h.L lt*w DEC - { 2019 JEFFERSON COUNry[rcD ffi" \1,\r >. j'hQjo LaNrg z&D n,l*l ag l- 'gI x$ Pn 1t1', tfif' I 9 0 t- $_ \ $l 9 oo t *. t, d ,$ 4, ? I \)c5 7 bo- & \u\" t Ir c &7 I o)f d Y dfv g. rr 5l0r o Cc +, ,fl 4 ofrogo aq9 PE o cOx 3 llaro,Sir,l"a I I I I\)I t, \n#r g4r I'$tsr I I I I I I I I I I & Ero. I ' it't Iqsd L4^t)3 -r{ ),y) .,ttr o 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: BLD19-00567 430 WERNER RD PORT LUDLOW, 98365 BURTON GABRIEL CYNTHIAGABRIEL PO BOX 65372 PORT LUDLOW WA 98365-0372 Received Date lssue Date 12t18t2019 12t18t2019 821082016 PENINSULA HEAT INC PO BOX 173 CARLSBORG WA 98324 Contractor'sLicense PEN|N|.044OW Expires 1011812020 PHONE: 360.437.0795 Block: Lot: Section: 8 Township: 28N Ranqe: 1E PHONE: 360-681-3333 PROJECT DESCRIPTION: INSTALL SINGLE-ZONE DUCTLESS HEAT PUMP THIS PERMIT IS VALID FOR ONE YEARAND IS NOT RENEWABLE. THE FINAL INSPECTION MUST BE SCHEDULED AND PASSED WITHIN THAT YEAR. THE EXPIRATION DATE 'S 1211812020. REQUIRED INSPECTIONS: lnstallationperManufacturerSpecifications/Co: TanULine/Applian td Final UZo d BUILDING INSPECTION HOT-LINE 3794455. 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_Perm it_Propane. rpt HOT LINE AVAILABLE 24 HOURS A DAY 12t18t2019 ?r,.r,NG PERMTT APPr,"dl*BLD19-00567 Review Type: Jefferson County Department of Community Development 621 Sheridan Street Port Townsend, WA 98368 PERMIT #: SITEADDRESS: OWNER: SUBDIVISION: PARCEL NUMBER: BLD19-00567 430 WERNER RD PORT LUDLOW, 98365 BURTON GABRIEL CYNTHIAGABRIEL PO BOX 65372 PORT LUDLOW WA 98365-0372 821082016 Received Date: 1211812019 PHONE: 360.437.0795 Block: Section: 8 Township: 28 N Range: 1E Lot: CONTRACTOR: REPRESENTATIVE: PENINSULA HEAT INC PO BOX 173 CARLSBORG WA 98324 PHONE: 360-681-3333 Contractor's License PENlNl.044OW Expires 1011812020 PHONE: PROJEGT DESCRIPTION: INSTALL SINGLE-ZONE DUCTLESS HEAT PUMP TYPE OF WORK TYPE OF IMP VALUATION CODE EDITION: OCCUPANCY: OCCUPANCY: CONST WPE: 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: SHORELINE: SETBACK: BANK HEIGHT Amount Paid Bv: Date: Receipt Permit Scanning Fee Tech Fee $188.00 MRB $24.00 MRB $10.60 MRB 12t18t19 12t18t19 12118t19 1 89002 1 89002 189002 Approved/Date APPHCIVED oEc I E 208 Jefferson County DCD Total $222.60 \\+idam..L\.la+r\farmc\tr Al h Ann ald rn+,t)ta9t.rd,to oo DEPARTMENT OF COMMUNITY DE 621 Sheridan Street, Port Townseod, Ii'-\ 98368 'l'eL 360.379,$150 | Fax: 360.379.1-+51 !C'eb: wq,'rv.co.ieffelson.rxa.us/ communit]'developmenr E-rnail: dcd@co.iefferson.wa-us -? IIifl,EC le 20tg MECHANI CAL PERMIT APPLICATION Steps in the Permlt Process: -Review required submittal items to ensure all information is compteted priorto submitting application -Mechanical Permits can be mailed into our office-and do not require an appointment. -Fees are due at time of Mechanical are nera issued within 5 business Receipt #:Date: *: For DeparUnent Use Only Related #s: ls this application for use in a Mobile / Manufactured Home?* !f 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&t - 360-417-2702* lf No: Com this form and make an intment to submit to Jefferson Cou Permit Tech 360-379-4450 ired Submlttal ltems - for tank GeneralSite plan - showing propane tank, linel and distance from tank to all existing structures. Submiftal ltems - for roof mount Solar panel installation complete first page and signature block only of Mechanical permit Application. A complete solar panel supplemental application. Site !nformation Assessor Tax Parcel Number: 20429 Site Address Directions to 430 \ 'ERNER RD, PORT LUDLOW WA 98365 Access eof s from which access will be ined: Swansonville Rd of Work:lnstall a singlezone Fujitsu ductless heat Pump tn living area of home Owner Name: Address: Phone #: Cynthia BasdekiarGabriel PO Box A$72, Port Ludlow 360-437-0795 or 360437-21 36 E-ma i I Add ress: CGraham@olycap.org Authorized Name: Phone #: License #: Peninsula Heat, lnc 360-681-3333 E-mailAddress: Expiration Date:PENINI-O44OW 10t1Et2020 @rIo '(, mv =I8 Mechanical Application 1 -) mount complete CAM) oo Heat Source Heating OilElectricV WoodPropane* Fixture Description *Propane is prohibited in I hazardous locations such as basements or pits or a nywhere " 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. 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 Fireplace - Wood Fireplace-wood, Wood Stove, or Pellet Stove 1 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 FuelTarlk (# gallons Heat Pump Air Conditioner lnstallation manual mus! be-on sit-e-at t[me of inspection or are-inspection fee will be charged. Pv.-tig}lg U1lPP,ll9J^"1I9lTr 1t19 gwnerrfgent attests that the information provided herein, and in any atrachments,ls Irue ano colrect to tfie best of his, her or its knowledge. Any material falsehood or any omission of ahaterial fact ' made by the owner/agent with respect to this application pact<'et may resutt in mliingZiiy isiulo pelmit nuir-ini'iroio. Property nt Name : Kathryn Kohmetscher Datez /7 -/ I -1 OFFICE USE ONLY Permit FeesBuild Mechanical Permit fee (tanr fumace, roof -solar etc Fee-5%Techn o 27?'c oTotal Fees+ *Additional fees may apply Mechanical Application 2 T Quantitv Electric Furnace Generator s188.00 Propane - Lines, tank, and appliance (add'l Sg+.OO) Project Scanning Fee Sz+.oo a PEff{TN swrA wl^* d=rJ Lr, Jto.- , d* %3Lf o G isl!-a t ilT'I OEC. I B Z/JB HEA:r Thank you f.or choosing Peninsula Heat for our services. Due to your property being located in Jefferson- CounW, we are required to receive approval from you to apply for a mechanical permit from the County. Please sign and date beloW indicatin'g your acceptance. Thank yoq very much ! ' Print Name:Cy,..{l^,r-- (r^t p:uL Address:4Zc P-,4 Datei /) -, b -ltl Sign: .- j.' e,,ru* o o Step 3: Confirmation and Receipt Result: Payment Authorized Confirmation Number: 6845 2TTT Your paymcnt has been authorized successfirlly and paymcnt will be pmcessed. scrvioes. Pleasc savc or print r copy ofthis rcceipt for rccofid kecpirry purposcs. Bills Customer First Name: Last Name: AddrBss Line 1: Addr€ss Lino 2: Citr Stete: Zip Code: Phone Number: Email Mdress: lnformation Mary Loisbom PO Box 173 CarlsboA Washington 98324 360681€333 kathy@peninsulahcat.com Payment lnfonnation Payrnent Date: 1218x201 9 Card Type: Viss Card Numbar: .*ffin0383 of $222.60 on Parcel Number Or Mdress 20429 Subtotal: Fee:$7 Paynent: slap 1: solsct Paym€nts step 2: Review and submtt step 3: confirmatron and frecerpt escription Amount D